Masculinity and psychotherapy: a qualitative study of clinical psychologists' experiences working with men

Introduction: Generally, men are less likely to seek psychotherapy than women, despite suffering similar rates of mental health difficulties. Theorists often link men’s mental health difficulties and their reluctance to seek help to societal models of masculinity, which emphasise restrictive emotionality and toughness. Therapy, with its emphasis on emotional vulnerability, has been described as the antithesis of masculinity. However, if men are well engaged they can achieve similar rates of positive outcomes as women. Evidence suggests that therapists are reluctant to admit to making assumptions based on gender about their male clients, but do make use of gender stereotypes in their talk about clients anyway. This study aimed to examine how discourses of masculinity influenced and were used within therapists’ talk about their male clients, and what the implications of this might be.
Method: Semi-structured interviews were conducted with 9 UK Clinical Psychologists working in adult secondary mental health care about their experiences working with male clients in therapy. Responses were analysed using Foucauldian Discourse Analysis.
Analysis: Participants’ responses to their male clients were informed by wider discourses of masculinity, and aspects of masculinity were constructed as posing specific difficulties in therapy with men by all participants. Participants were more likely to rely on discourses of masculinity, as opposed to psychological discourses of mental health, when talking about clients who had evoked strong negative feelings, such as fear or revulsion, or with whom therapy had not been successful. It was possible to overcome this tendency; however, achieving this required deliberate, on-going effort and self-reflection on the part of the therapist.
Discussion: This study highlighted the importance of therapists reflecting on and processing their own assumptions about and responses to aspects of masculinity in their work with male clients, so that they do not become barriers to effective therapeutic engagement.