Psychotherapy with Men

As therapists, we share the common knowledge that psychotherapy with men and their masculinity is tough. Sometimes, men are wonderful clients, open and motivated; they make significant breakthroughs. But more often, they’ve been sent by their wives or the courts, and they’re distant and oppositional, or so agreeable that you know they’re simply trying to placate you.

Psychotherapy with men is daunting for many reasons, but we believe it’s particularly arduous because most male’s masculinity is itself pathological — diseased — which both exacerbates other mental health/substance disorders and undermines treatment. Here are some insights and tactics that can make your work with men easier and more successful.


Mascupathy Book CoverIn many years working with men from various walks of life with diverse presenting problems, we repeatedly saw the same patterns of distorted thinking and errant behaviors. Over time, we developed the term mascupathy to describe the pathology common to all these men. Our book, Mascupathy: Understanding and Healing the Malaise of Contemporary American Manhood, explains the origins of our terminology and presents not only a new template for understanding men, but also innovative treatment methodologies.

Mascupathy is a mental health condition that’s primarily caused by male socialization, exacerbated by unresolved trauma, and reinforced through frequent threatening and demeaning interactions with other men. The mascupathic syndrome features an exaggeration of the masculine characteristics of aggression, invulnerability, and insularity to the exclusion of feminine qualities of conciliation, openness, and intimacy. All men struggle with mascupathy to some degree; in some men it leads to violence; in others it produces emotional poverty and relational distancing.

Here are a few principles that generate more effective treatment.

Values Antithetical to Therapy

First, the values of socialized masculinity are antithetical to effective therapy. Conventional masculine socialization teaches men to secret private experiences, exert control over others, present the self as invincible, and favor action to the exclusion of introspection. The process of therapy is, of course, effective when clients self-disclose, relinquish control to the therapist, let down their armor, and engage in inner exploration.

Second, conventional DSM diagnoses such as major depression, OCD, and PTSD describe symptoms, but neglect the underlying conditions of many men: fear that stems from repeated experiences that the world is not a safe place, shame that one hasn’t lived up to the high standards of manhood, anger over unresolved losses, and loneliness from self-imposed alienation and isolation. These are the real traumas that men bring to therapy, and they call for a new tactics for treatment.

A Co-occuring Disorder

Third, for the purposes of developing treatment plans, mascupathy needs to be seen as a disorder that co-occurs with a conventional DSM disorder or substance dependence. Treatment of mascupathy should be concurrent but separate from other disorders. For example, didactic treatment of chemical dependence can parallel experiential group therapy of mascupathy.

Given men’s debilitating experiences, treatment for mascupathy needs to be grounded in the development of a safe environment, the creation of a level playing field, the modeling of openness and authenticity, and demonstration of the benefits of awareness of the inner life. In some cases, these activities require the therapist to depart from traditional therapeutic roles.

Finally, group therapy is much more efficacious for men than individual treatment. The group can harness the ancient destructive power of the pack to new constructive ends. For example, when men new to the group observe “elders” engage in self-disclosure, their desire to belong propels them to acknowledge flaws and mistakes which they previously refused to admit. This process of disclosure is extraordinarily healing.

In conclusion, we believe that treating substance abuse and other disorders in men without providing therapy for mascupathy is like removing lymph nodes without excising the primary tumor.

Take a look at our website, and our new book Mascupathy: Understanding and Healing the Malaise of Contemporary American Manhood. We are convinced that our analysis of men and mascupathy can make your work as a therapist both more effective for your clients and more fulfilling for you.