Men in Therapy: New Approaches for Effective Treatment

There is overwhelming evidence that men are resistant to seeking help for mental health problems and, compared with women, are less likely to seek and participate in psychotherapy or counseling (1). In contrast, there is substantial evidence that men are equally afflicted by psychological problems and in need of mental health services but instead stoically “man up” or turn to alcohol and drugs in an effort to self-medicate. Many have attributed this pattern to the constricting influence of hegemonic masculinity, but it might also be the case that some therapists misunderstand and fail to relate to their male patients. This too is understandable, because male psychological distress often manifests as hostility and violence, especially toward women, who constitute the majority of therapy providers.

Men in Therapy is a valuable resource for all mental health professionals. Wexler provides helpful information for developing and maintaining therapeutic relationships with men. His therapeutic insights reflect both a solid grasp of the research into masculinity-related issues and his personal knowledge as an experienced, male-oriented psychologist.

Wexler begins the book by discussing the effects of masculine socialization on men's psychological functioning. He focuses primarily on well-established, masculine-related constructs (including male gender role stress, male gender role conflict, and the “boy code”) and how they may contribute to negative mental health outcomes for men. Although others have done this before him and at least as well (2), this is a necessary foundation for the book and is very accessible and well written. He adeptly interweaves examples from his cases to illustrate how these different constructs manifest in men's lives. Particularly helpful is his discussion of the relationship between masculine socialization and alexithymia.

Drawing on psychodynamically oriented self-psychology, his “broken mirror” construct elucidates the development of fragile male self-identity and how it manifests intrapsychically and interpersonally. His writing style makes his theory-driven explanations throughout the book highly comprehensible. For example, he convincingly explains how the broken-mirror phenomenon manifests in father-child relationships and contributes to patterns of negative interactions. If you read only chapters 1 and 2, you would be a better therapist for men, but we are certainly not recommending that you stop there.

Wexler provides practical advice and suggestions for engaging men in the therapeutic process. Chapters on men in relationships, male-type depression, men who are batterers, fathering, men in groups, and male diversity issues make strong contributions to male therapeutic literature. The chapter on treating men who are in relationships is exceptionally helpful. In addition to providing usable worksheets for clients, Wexler explores important relational themes, such as empathy, intimacy, and attachment. He also discusses male “relational dread” and provides effective intervention strategies for this common therapeutic phenomenon. However, more coverage specific to male divorce issues would have been helpful.

As noted earlier, when a male seeks therapy, more likely than not his therapist will be female. As Wexler notes, this creates “especially complex transference and counter transference issues in treating men.” It also produces the myriad issues any therapist confronts when treating a client from a culture different from his or her own. The importance of competence in multicultural counseling makes the chapter “When Women Treat Men” required reading for any female therapist treating or planning to treat a male client. We agree with Wexler that viewing male behavior as a product of male socialization rather than solely as a manifestation of psychopathology will increase a female therapist's ability to understand, empathize with, and effectively treat men. This book, and especially this chapter, will help her do that.

We were impressed with his respectful tone throughout the book. Rather than being pedantic, Wexler encourages understanding and compassion for male-specific issues (such as how male socialization impedes emotional maturity). He emphasizes the importance of meeting men where they are rather than expecting them to immediately fit into a therapeutic mindset. He discusses effective ways to use masculine values in the service of better emotional and relational functioning (an example is his commentary on how to encourage male relational heroism).

We recommend this book to any mental health professional interested in improving his or her knowledge base and therapeutic skills with male patients. Although male therapy issues have received greater attention in recent years, there remains a shortage of practical, research-based books written for practicing therapists. As a competent guide for treating men, Wexler's book is a good start. If we can learn to be more effective therapists for men, perhaps it will reduce male resistance to treatment and the stoic endurance of emotional and psychological distress.