Working with Men

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland.

When men come to psychotherapy, it is not a small thing. It usually represents a victory of sorts. It is a victory over all the personal and cultural prejudices and stereotypes that keep them locked in a non-speaking, non-questioning, non-reflective place. More often than not they will have reached a crisis point in their lives and yet they will, generally speaking, do their utmost in sessions to underplay just how big that crisis has been.
Men are not supposed to show any weakness. We have had decades of change and yet that faulty axiom is still alive and well and operating in the male world. Instead they are supposed to tough it out, keep silent about things that bother them, reject any attempt to communicate their more private thoughts, remain loyal to the significant people in their lives at the expense of being truthful about their own ideas and experiences; and on and on it goes.
I was reminded of my colleague’s question about working with men while watching Gabriel Byrne’s excellent hit show ‘In Treatment’, particularly in his dealings with the male patient Alex. It takes time to cut through the male defenses. Often you’ll hear people say that it is about getting to a point where men trust you enough, and trust the process enough, to speak freely. But there is more to it than that.
It is also about bringing them to a point where they accept that life is not a compartmentalized business. We cannot consider an issue in isolation, it is connected to many, many other areas of experience. Nor can we dismiss ideas because they seem trivial.
Some men feel if we are not discussing big issues with big objectives driving them that the therapy is not doing what it should. But trivial ideas contain the key to new material that has never been uncovered before and very often these are the ideas that men defend most strongly against letting out.
Offering the kind of guidance and presence to allow these elements come together is an important part of the challenge. It is like going to the jungle and spending a very large amount of time clearing a space in which you can set up base camp. Huge energy is spent before any exploration even begins.
When I said it was like a wrestling match I was also referring to something else. Often you find with men that they want to be convinced as to why it is they are sitting in your consulting room, despite the fact that they will have elected to come. The process of cultural male stereotyping has been very effective. Some don’t believe that talking is of any value, that it can do any good, and some believe only bad things can come from it. As a therapist you find yourself almost drawn into a subtle debate as to why they should have to talk in order to ‘fix’ something. A man with an irrational fear of random violence will want to know why he should consider having to talk at all, why is it not possible to simply give him a form of words that he can say to himself when the anxiety strikes that will banish it from his mind. A young man in prison for a sexual offence that he says has brought shame upon him and his family cannot see how talking can fix any of that. And yet these men continue to come, for their different reasons. At one level they know the therapy process can offer them answers but at another level they resist it at every turn. Paradoxes abound in the psychotherapeutic world.
For this reason, the business of getting back to basics can take a considerable length of time. I was struck when reading up on the subject of modified psychoanalytic psychotherapy how that shortened form of therapy recommends that the first four sessions be set aside to establish the client’s symptom history. Four weeks, at two sessions a week, is either optimistic, or else the therapist is incredibly good. Particularly if you are dealing with someone who starts each session anew, as if previous sessions have had no effect. Some men begin not with a desire to speak but with a desire to disguise and keep hidden, or pretend there is no issue, or talk about nothing other than the narrow symptom itself, why it is there, how bad it makes them feel and why it simply cannot be made go away.
As a therapist you spend each session returning and returning and returning to the same essential point: the symptom is a result of their whole set of life experiences, not simply a small part of it. Once they arrive at that understanding, the work begins in earnest.