Ninety percent of the therapists in the United States are women. The reason men shy away from becoming therapists is not the central issue of this essay. The dearth of male therapists however, plays a significant role in male resistance to couples therapy, and that is the topic of this essay.
Traditional couple’s therapy is biased towards women, as they tend to be the caretakers of relationships. Conversation, thoughts, feelings, and emotions are the stuff that women are made of – much more-so than men. Exploring emotions and feelings in a clinical setting might feel as familiar to a man as a walk on the surface of the moon. “Generally, women talk as a way to connect; men talk as a way to share information. Women are more comfortable with disclosing personal concerns and eliciting help. Men are often less likely to share and reach out and ask for help and are more likely to seek solutions and play the role of Mr. Fix-It” (Forrest and Steigerwald, 2004).
Recognizing and Assessing Resistance
Here are some common forms of resistance which men may use to avoid dealing with certain topics with their therapist: Minimal discussion with the therapist, irrelevant small talk, preoccupation with the past or the future, asking the therapist personal questions, and missing appointments.
Questions from men that demonstrate resistance may include: Our marriage is on shaky ground; I’m curious…are you even married? Our children are the biggest source of conflict in our lives, do you even have children? We’re married for twenty-six years; are you even twenty-six years old?
Dr. Steven Stosny (2009) believes that men dislike therapy, not because they may have to “talk like a woman”, but because they hate that therapy forces them to experience the most heinous emotional state for a man: feeling like a failure.
Shepard and Harway (2012) assert that, “A particular theme plays a central role in why many men struggle in couples therapy; that theme is the role of shame in men’s lives. The issue of shame manifests in both the male’s vulnerability to experience shame in sessions and in the presenting problem that brought the couple into therapy. It is critical that the therapist knows how to use interventions and choose words that avoid inadvertently shaming the male.
This author offers another theory of male resistance: the power and control model. The husband resents being outnumbered in each session by females, two to one, and doesn't believe he has a fair chance on a level playing field. He's in the minority from day one, in unfamiliar territory, and frustrated because there are so few male therapists available in general (a one-in-ten-ratio). He has lost control.
Too much openness and emphasis on emotions will likely be unsettling for a man who has been taught that his emotions are to be kept inside at all costs. Asking a man to speak intimately about his life in weekly sessions with a person who is there to help him might make him uneasy since it goes against the stereotype of the independent "Marlboro Man" who relies on himself and doesn't need others. Marlboro Man, an iconic male character depicted in cigarette advertisements in the 1950’s, was a rugged, handsome, hard-working, and very masculine man.
How often have we heard the expression "man up" as a way of saying....tough it out or "crying is for sissies". There is a commonly held view that real men do not cry and that men should take care of their personal problems by themselves. If they cry or ask for help, they are seen as wimps or wusses, as "girlie" men, men who are not to be respected or valued.
Overcoming Male Resistance - How to Engage Men in Therapy
Make the husband as comfortable as possible: The therapist should try to put the male client at ease by introducing herself, being personable, reassuring him about confidentiality, and explaining how her role works.
Acknowledge his perspective: Perhaps he does not see a need to be in therapy or is furious that he is being forced to attend. Acknowledgment for how he feels will help to ease strong negative emotions. At the very least he’ll appreciate that the therapist understands how he sees things.
Discern what he wants: Everyone wants something. Find out what the male client wants. When clients have a number of needs, the therapist’s task is to clarify which of these needs should be addressed as the top priority.
Use what he finds motivating: Most human beings are motivated by either pleasure or pain; sometimes both. Some men are only motivated to consider or explore change when the status quo becomes very uncomfortable for them. Men who are going through relationship difficulties, are often reluctant to attend counseling. But when their partner takes steps toward separation, they will move heaven and earth to do what it takes. Resistance is strongly influenced by the therapist’s approach. If resistance continues, it may be a signal that the therapist needs to stop what they are doing and change their approach. Changing the format is an option. It may be helpful to see couples separately: thirty minutes with the wife, thirty minutes with the husband, and thirty minutes everyone together.
It Takes One to Tango
And last, how do you draw in a husband who simply refuses couples therapy?
Old School: conjoint therapy means husband and wife must come to each session together weekly. New School: start working with the spouse who walks in your door because every minute counts! My colleague, Dr. Mona Fishbane, uses an approach which involves the therapist calling the husband on the phone. She explains to the husband that therapy is power and that since he has the power to author his relationship, doesn't he want a vote? Start by sharing, “Your wife came to my office for a session to work on your marriage. If I were you, I'd want ‘a say’ in how that turns out.” When you get the husband to try one session of therapy, you better be even-handed and convincing so he sees there’s something in it for him…or you may never see him again.
The takeaway: therapists should all be hope mongers, regardless of a concern of false hope. Rabbi Dr. Abraham Twerski z’tl often said, “I’d rather be accused of giving false hope, than giving false despair.”
Dr. Alan Singer has been a marriage therapist in New Jersey and New York since 1980 with an 80% success rate in saving marriages of couples on the brink of divorce. He serves as an Adjunct Professor for the Touro University Graduate School of Social Work. He coordinates reconciliation for family estrangement, is a Certified Discernment Counselor, blogs at FamilyThinking.com, and is author of the book, Creating Your Perfect Family Size (Wiley). All counseling sessions use ZOOM. His mantra: I’ll be the last person in the room to give up on your marriage. email@example.com (732) 572-2707