New Psychotherapy for Men / Edition 1 available in Hardcover
New Psychotherapy for Men / Edition 1
- ISBN-10:
- 0471177725
- ISBN-13:
- 9780471177722
- Pub. Date:
- 08/10/1998
- Publisher:
- Wiley
New Psychotherapy for Men / Edition 1
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Overview
"Men suffer under a code of masculinity that requires them to be:aggressive, dominant, achievement oriented, competitive, rigidlyself-sufficient, adventure seeking, willing to take risks,emotionally restricted, and constituted to avoid all thingsperceived as 'feminine.' Such a code is bound to take a toll onmen's longevity. The average life expectancy for males in theUnited States is seven years shorter than that for women.Traditional male role traits inhibit men from seeking medical helpin the early stages of disease and from being sufficiently attunedto their own internal processes to detect early warnings ofillness." —from the Introduction.
Slowly, the truth emerges. In a society in which men are expectedto be strong, independent, aggressive, and impervious to emotionalstress, boys are nine times more likely than girls to suffer fromhyperactivity, young men are five times more likely to commitsuicide than young women, and men have far higher rates ofsubstance abuse and antisocial personality disorder than women.Clearly, many men are in need of psychological treatment andpsychotherapy. Ironically, however, the very qualities that areresponsible for many of their emotional and behavioral difficultiesmake it much more difficult for men to admit they have problems,seek professional help, or have faith in the efficacy oftreatment.
In New Psychotherapy for Men, leading figures in the field of men'spsychology explore the psychological sources of men's emotionaldifficulties and offer specific techniques to help therapistsovercome men's resistance to therapy. With the help of full-lengthcase studies, they trace the sources of emotional and psychologicaldisturbances in men and present new models for assessing andtreating men's unique emotional difficulties. This book illuminatesthe unhealthy aspects of masculinity through the lens of genderrole strain, creating state-of-the-art, gender-specific treatmentsfor men.
Major issues addressed in New Psychotherapy for Men include:
* Reluctant men in couples therapy
* Group therapy for traditional men
* Gender role strain in the family system
* Recognizing and treating depression in men
* Men's shame and trauma in therapy
* Gender role strain as a factor in male impotence
* Treating male violence
* Helping men find a voice for their feelings
* Adapting psychodynamic therapy for men.
This book also takes a multicultural perspective, discussing thespecial problems of anger and stress experienced by AfricanAmerican men, psychotherapy for gay men, and the difficulties thatcan arise when a female therapist treats a male patient.
Groundbreaking, broad in scope, and infused with countlesspractical suggestions, New Psychotherapy for Men is anextraordinarily helpful guide for all mental health professionalswho deal with men. It is also an excellent graduate-level text,offering today's students a rich, fully developed body of newknowledge with which to begin their careers.
Product Details
| ISBN-13: | 9780471177722 |
|---|---|
| Publisher: | Wiley |
| Publication date: | 08/10/1998 |
| Pages: | 336 |
| Product dimensions: | 6.38(w) x 9.98(h) x 1.15(d) |
About the Author
RONALD F. LEVANT, EdD, is Dean and Professor of Psychology, NovaSoutheastern University, Ft. Lauderdale, Florida. The founder andformer director of the Boston University Fatherhood Project, Dr.Levant has played a major role in the American PsychologicalAssociation in setting up organizational structures on thereexamination of masculinity: He is founder and Chair of the APADivision of Psychotherapy's Task Force on Men's Roles andPsychotherapy and cofounder and first president of the Society forthe Psychological Study of Men and Masculinity (SPSMM). Dr. Levanthas published sixty refereed articles and book chapters and tenbooks, including Men and Sex (edited with Gary R. Brooks, and alsofrom Wiley), Between Father and Child (with John Kelly),Masculinity Reconstructed (with Gini Kopecky), and A New Psychologyof Men (edited with Dr. Pollack).
Read an Excerpt
PART ONE
TREATMENT MODALITIES
CHAPTER 1
The Trauma of Oedipus:
Toward a New Psychoanalytic Psychotherapy for Men
William S. Pollack
ALMOST A century ago, Freud (1912/1957b) described a painful dilemma in many men's lives-a neurotic conflict so universal as to be understood as a paradigm for derailment of the boy's journey toward healthy manhood: The unconscious split between an idealized image of the female (as mother substitute) and the symbol of degraded femininity (as prostitute)-The Madonna and Whore dichotomy. He summarized that for these men (and, I believe, to some extent, he meant everyman), "Where they love they do not desire and where they desire they cannot love" (p. 183, vol. XI, 1957b). Freud understood this degradation of men's lives to be a direct consequence of the burdens of the Oedipal struggles of desire and aggression in boyhood. To a large extent (whether openly or unwittingly), our psychology of men and the dynamic psychotherapies that emanate from it have accepted either this aggression and desire/conflict-based model or, alternatively, a paradigm of separation/autonomy for understanding and for attempting to treat men's pain.
This chapter attempts to forge an empathic foundation for a new psychotherapy for men, from a modern psychoanalytic (developmental/self-psychology) perspective. Listening to male patients reveals a fissure in many men's self-systems, one beginning well before the Oedipal period. This chapter is organized to support the theory that historical, cultural, and economic forces affect parenting styles so as to make it likely that as boys, men will suffer a traumatic disruption of their early holding environment, a premature psychic separation from both maternal and paternal caregivers. This is a normative male gender linked, loss, a trauma of abandonment for boys which may appear later in adult men, through symptomatic behavior and characterological defense.
Because of the unconscious sense of shame accompanying this frightening sense of deficit, many men seek treatment only reluctantly and under pressure from significant others. Often they enter the treatment setting with: empathic disruptions in their relationships (love/desire splits in romance or an inability to commit) as an attempt to unconsciously protect against further loss, limited emotionality with an intolerance of feelings of vulnerability, or to express and bear sadness; which consequently, hinders their ability to grieve-to mourn, and to change. These defenses are often incorporated into a syntonic character armor blocking a man's overt expression of all strong feelings, except anger, and may be maintained consciously, and valued, as a (false) self-sufficiency-a process I previously described as defensive autonomy (Pollack, 1990).
Clinical insights derived from modern psychoanalysis, including the need to address men's harsh self-criticism, alertness to the painful affect of shame as well as guilt, awareness of the deprivation-entitlement divergent conflict, and the provision of a self-object holding environment-with uncritical acceptance (for extended periods) of men's illusion of self-sufficiency-will illustrate how psychoanalytic psychotherapy can cure. The myth of Oedipus-so central to our received wisdom about masculinity-will be deconstructed to reveal unempathic parenting, intergenerational trauma, premature separation and loss, the overarching dynamic of shame-driven aggression, and a shame-phobic character style in men. Two case studies follow.
CASE STUDY: ALAN
Alan, a successful attorney in mid-life, sought treatment under pressure from his fiancZe when he continued to put off setting a date for their wedding. Somewhat shamefully, he recounted his worry that monogamy was perhaps not "in man's nature," at least not in his. No matter how much he loved his fiancZe, the thought of "hitching" himself to one woman for the rest of his life was an anathema to him. He worried that he might be "addicted to sex," requiring an unending number of new female conquests; and he felt too disturbed to marry.
Alan had previously undergone a trial of psychotherapy after college, but broke off the treatment when the psychologist encouraged him to stay attached to his, then, girlfriend-even though he was "feeling bored"-in order to see what feelings might emerge. He remembered leaving both the therapist and his girlfriend, simultaneously.
While remaining empathic to his patient's pain as a result of his psychic split between erotic desire and sex, on the one hand, and love or intimacy on the other, the current therapist maintained an open mind as to whether this was a problem of so-called addictive sexuality or a sexual issue at all. What finally emerged, slowly and painfully over time, were a series of memories of early childhood separations from his family which Alan experienced as painful. These left him in later childhood with terrifying anxiety culminating in attacks of panic. Adding to his distress were his caretakers' unempathic injunctions to "act like a man," not "like a baby" and accept the necessary and rational reasons for what was a tremendously hurtful disruption of his holding environment. In adolescence, these anxieties were driven underground when Alan rediscovered masturbation as both a stimulating and self-soothing device. During his college years, masturbation gave way to serial sexual affairs. Later, Alan came to understand that his intermittently intense sexual drive and activities were often an attempt to create, what he called, a "sense of safety"-to self-soothe overwhelming internal tension states when separation anxiety threatened to engulf him.
During this patient's long and successful analytically oriented therapy, he reported the following fantasy:
It's like I'm an astronaut all alone in space...very exciting and not burdened by commitments. I'm connected by a cord, like an umbilicus which keeps me connected, but free to roam. When I have the desire, I can land on base, either eat or fuck, be satisfied again-refuel-and then go back out into space.
Alan was struggling to integrate intimacy and individuation without falling prey to a terrifying sense of loss.
Like Alan, many men's normative traumatic experience of premature separation, though often not consciously remembered, forever cast a pall on their relationships. Men are constantly seeking, yearning to be connected. However, they are terribly frightened of the shameful dependency such connections may bring forth. Too often the focus in the psychology of men has been the suppression of anxieties and depressive defenses these connections elicit and to replace experience-near fear with a model of sexually-based conflict. Men are not merely independent aggressive competitors, autonomously disconnected from others. They are frightened searchers, looking to connect, but wary should the bond once more be tragically broken. To help men become more empathic to themselves, as well as to others, we must provide a psychotherapy that is more empathic to men.
DECONSTRUCTING OEDIPUS: BOYS' TRAUMAS
For Freud and generations of psychoanalysts who followed, the myth of Oedipus became the central paradigm of unconscious forces at work in self and gender identity formation-especially for little boys. The story came to represent boys' unconscious sexual wishes for their mothers, fears of retributive castration by their fathers, and finally, the renunciation of this wish-leading to a more stable sense of self through the boy's identification with his father's masculine role. Freud believed the great power of this myth rests in our fearful recognition that all men harbor the same wishes that Oedipus lived out, and that such unconscious conflicts make up men's neurosis. Freud felt: "... (that) the poet, as he unravels the past, brings to light the guilt of Oedipus,...compelling us to recognize our own inner minds, in which those same impulses, though suppressed, are still to be found....Like Oedipus, we live in ignorance of these wishes,...(and) seek to close our eyes to the scenes of our childhood" (Freud, 1900/1957a).
Yet, it appears to be Freud who closed his eyes to two central components of the myth he analyzed. First, the tragedy is set in motion not by a child's fantasies, but by an adult's hurtful actions. Laius, Oedipus's father, was so frightened that his son's birth would lead to his power on the throne being usurped that he hired a herdsman to murder the child. One rendering of the myth goes even further and suggests that it was not Laius alone, but also Oedipus's mother Jocasta who attempted to sacrifice the infant to appease the gods.
Oedipus survived, was adopted into another family, and on his return to Thebes, inadvertently murdered his father. He was soon to marry the queen, whom he did not consciously know to be his mother. Oedipus was worried, however, by dark prophesies and tried to reflect upon his action of marriage, contemplating withdrawal. Again he was betrayed by one of his parents, this time Jocasta (his mother, soon to be wife) who mocked the dire predictions and urged Oedipus to marry her without any further delay.
Freud chose to ignore Oedipus's earliest trauma, blaming the fantasies of the unconscious. But, in fact, the story of Oedipus is indeed a tale of a young boy betrayed and abandoned to die by his own mother and father. It is not Oedipus' unconscious lust for his mother or jealousy of his father that sets the stage for downfall, but his parents' hurtful rejection of him. I have no argument with Freud's pivotal belief in unconscious fantasy as the nidus of neurosis. Yet, I believe that boys also deserve an empathic understanding of what may be a gender-specific trauma for males. The point is not to villainize Jocasta, or cast aspersions on Laius-to condemn mothers or fathers-but rather to highlight that men may either feel, or unconsciously experience a sense of having been prematurely and traumatically abandoned, betrayed, or hurtfully separated from their primary love objects. Like Oedipus, most men may have no conscious memory of this earlier trauma, though their vulnerabilities (especially to shame) in adult life may be the evidence of the unhealed wound. I believe that this normative traumatic abrogation of the holding environment, for boys, comes about due to a complex combination of factors.
THEORY
I choose to read this myth and its modern deconstruction as illustrative of the pain many boys have suffered-not due to vicious sadism or economic neglect-but normatively and repetitively as a result of unconscious societal demands for a separation model of male growth and development.
Almost 30 years ago, Ralph Greenson coined the term dis-identify, to denote what he considered to be a "special vicissitude in the normal psychological development of the boy which occurs in the pre-Oedipal years" (Greenson, 1968, p. 370). His model, based primarily on his clinical work with and research studies of transsexuals (and bolstered by his interpretation of the underlying dysfunctions that gave way to his male neurotic patient's conflicts), led him to opine "that the male child, in order to attain a healthy sense of maleness, must replace the primary object of his identification, the mother, and must identify instead with the father" (p. 370, italics mine). He went on to state categorically that the boy "must dis-identify from mother and identify with a male figure if he is to develop a male gender identity" (p. 372). Although he felt that all infants emerged into younger childhood from a "primitive symbiotic-identification with a mothering person" (p. 372), boys appeared to have a more fragile and special problem in maintaining a healthy sense of gender identity. This, Greenson believed, was because boys required an additional developmental step: They needed to dis-identify from mother and form what he called a counter identification or contra-identification as a way to counteract the early identifictory basis with a primary female figure. Girls, it seems, had it easier, theoretically, because they could remain identified with their mothers; but boys had a more rocky course for two reasons:
(1) the need to renounce their love for their mothers, and (2) the often less available alternative identificatory figure of father.
This a special problem because the boy must attempt to renounce the pleasure and security-giving closeness that identification with the mothering person affords, and he must form an identification with the less accessible father. (Greenson, 1968 p. 373)
Make no mistake about it, Greenson saw this need to dis-identify as essential to the young boy's capacity to internalize a healthy male gender identity (equally as salient as anatomical or biological differences) and saw the consequences for any disruption of such a process of separation as dire. The example of his 5-year-old patient, Lance, leaves little doubt that if this little boy's identification with mother and play with his "Barbie" doll were not interrupted by Greenson's active attempts to push for dis-identification, he would become "either a full-fledged trans-sexual or a transvestite" (Greenson, 1968 p. 371).
Much as this model of dis-identification may seem impossibly simplistic to us today, when it was combined historically with an object-relations model that conceptualized separation (Mahler, Pine, & Bergman, 1975) as the hallmark of mental health, the push for intrapsychic and intrapersonal separation from the mother became a central normative developmental focus in the early growth and development of boys-a focus still embraced in some quarters. As we move to deconstruct the essentially masculine, replacing it with a societally constructed model of gender-in which women are primarily responsible for the early caretaking of children, and fathers have historically been emotionally unavailable-we may begin to see that the need for male dis-identification is not just a clumsy and cumbersome model of normal human development. It is an unwitting justification for the normative traumatization of boys, and later adult men.
Chodorow (1978, 1989), in her thoughtful critique of Freud's theories of early development, pointed her finger at the emperor's new clothes. Girls did not come to motherhood as second-class citizens in relinquishing their hope for a penis, turning away from their mothers and toward their fathers with the wish to provide them with a baby. Since women are still largely responsible for caretaking in the early years of a child's life, identity formation for females occurred through the integration of and identification with an ongoing relational attachment to their mothers. This "sense of continuity and similarity to their mother" led to a healthy sense of mutuality in relationship, and identification with the caretaking and maternal feminine role from early childhood onward. What, then, for boys?
If one accepts Chodorow's argument, one must basically agree with her that in society, historically, "because women mother the sense of maleness in men differs from the sense of femaleness in women and masculinity (or maleness) becomes more conflictual and more problematic, than femaleness" (Chodorow, 1989, p. 109). What becomes clear from this perspective is that little boys and grown men, unconsciously, fend off an earlier sense of oneness with their mother that tends to threaten their gender identity, and/or independent sense of self. Not as a normal developmental pathway based upon a biological bedrock, but, rather, as a result of a fault in our child-rearing systems. Both because of the current child-rearing practices which create the significance of the mother, and the consequent "absence of concrete, real, available male figures of identification and love who are [equally] salient" for the boy, "learning what it is to be masculine comes to mean learning to be not womanly." As a result, separateness becomes more salient, for boys. Boys, and later men, come to eschew "feminine" identifications and experiences, such as: dependency, the expression of strong feelings (with the exception of anger), and relational bonding.
A NORMATIVE (GENDER-LINKED) DEVELOPMENTAL TRAUMA
Yet, deep in the adult male's psyche lies the formative experience of a little boy, struggling to maintain a sense of a masculine self, vis-^-vis his attachment to his mother. He is also struggling with the very real loss of
an earlier affiliative oneness, which can never be regained-within this system-without a threat to masculine identity.
While Chodorow's discussion of gender identity development is insightful, it does not adequately capture what this experience of development must feel like for a little boy. Nowhere do we get a sense of the loss associated with the boy's definition of his own masculine identity and core gender self: an experiential process that requires (according to this model) a separation from the most cherished, admired, and loved object in his life-at what would be a phase inappropriate time from the point of view of girls' development. Equally significant, this broken maternal connection or dis-identification (Greenson, 1968) occurs within a social context of child rearing: (a) in which girl siblings are allowed to remain connected; and, (b) in which the father often remains absent or emotionally unavailable to his young son, as an alternate nurturing figure for the "lost" mother.
Chodorow (1978) makes the suggestion that the intrapsychic developmental events so significant to the young boy may actually be played out reciprocally, and interpersonally between mother and son: "Though children of both sexes are originally part of her self, a mother unconsciously and often consciously experiences her son as more of an other than her daughter. By contrast, mothers experience their sons as a male opposite. Boys are more likely to have been pushed out of the pre-Oedipal relationship and to have had to curtail their primary love and sense of empathic tie with their mother" (p. 166, italics mine).
As a consequence, males may be more vulnerable to traumatic and premature actual separations-disruptions that may later be experienced by the child as loss or abandonment-than females are.
I have argued (Pollack, 1992) that we may be seeing a developmental basis for a gender-specific vulnerability to a traumatic abrogation of the early holding environment (Winnicott, 1974), an impingement in boys' development-a normative life-cycle loss-which may later in life leave many adult men at risk for fears of intimate connection. This traumatic experience of abandonment occurs so early in the life course that the shameful memory of the loss would likely be deeply repressed.
Boys have a problematic course toward gender identity. They also have a continuing need to defend against urges toward affiliation and intimacy because of the repressed trauma of shameful and premature separation. This is a loss that may have been unassuaged by their father's inability to assume an alternative nurturant role. Having experienced a sense of hurt in the real connection to their mothers (as a result of her societally constructed role to make gender differentiation clear), and the subsequent loss of finding no equally salient alternative in their fathers, many boys, and later men, are left at risk for empathic disruptions in their affiliative connections-searching endlessly and yet fending others off in order to avoid the fear of retraumatization.
Later cross-gender relationships may revive the deeply repressed and ambivalent yearnings toward the early mother. The result may be the creation of transitional or self-object relationships with women who function unconsciously as mother substitutes meant to both repair and assuage the unspeakable hurt of premature traumatic separation; while allowing men to simultaneously deny the loss of the earlier relational bond. In their unconscious yearning for closeness, men may seek out women who meet these repressed needs, only to deny such women any mutually empathic response. This occurs not because these men are immature or bad or fear symbiotic reunion. Rather, they need to protect themselves from the danger of reexperiencing the repressed pain, sadness, or depression which the new affiliation threatens to evoke and which they feel unable to mourn or tolerate. Such men maintain that they are self-sufficient while they are in the midst of a deeply dependent or interdependent connection. Elsewhere I have called this phenomenon in men defensive autonomy (Pollack, 1990).
This paradoxical situation may lead to the misunderstanding that we see in traditional, intimate relationships between men and women, and perhaps may account for much of the pain experienced by the two genders as they attempt to listen to and interpret each other's "voice." It may also begin to explain the apparent resistance that men show in unmodified forms of dynamic psychotherapy, and the preponderance of the diagnosis of narcissistic personality disorder among males. Following Modell (1976), I believe that dynamic treatment must pay close attention to the requirement for creating a symbolic recreation of the early holding environment in the treatment of narcissistic issues. Kohut's (1971, 1977) understanding of the need for facilitating and maintaining (for long periods of time) an experience-near, nonjudgmental, stabilizing self-object transference arrangement-either of a mirroring or idealizing type-may broaden our capacity for empathic connection with patients so conflicted about relationship itself, patients who often are men.
NATURE AND NURTURE
In addition to my argument for powerful unconscious sequelae in the functioning of adult men-as a result of our gender differentiation processes in the parenting of young boys-are two additional influences on the developmental psychology of men. First, the historically insidious, psychoeducationally oriented, skill-based, gender-tracked role socialization models in schools and homes (see Levant, this volume); and second, the biological predispositions to male fragility and expressivity in infancy and its psychosocial consequences throughout the life cycle of men.
GENDER-BIFURCATED ROLE SOCIALIZATION
The very systems of gender-bifurcated role socialization that have been strongly criticized by feminist scholars as stifling girls' voice and for tracking them into doll play, sibling care, and away from assertion and mathematics skills have been equally devastating and limiting for young boys, in their developmental pathways. David and Brannon (1976) have delineated four stereotyped male ideals or admonitions through which we have historically socialized boys into manhood. The injunction to become a "Sturdy Oak" refers to men's stoicism and our teaching boys not to share pain or to openly grieve. The "Give 'em Hell" stance of our athletic coaches creates the false self of daring, bravado, and love for violence; while the ideal of being a "Big Wheel" stresses the need to achieve status and power at any cost. But perhaps the most traumatizing, straitjacketing social role training is that of "No Sissy Stuff"-the condemnation of the expression of any strong, dependent, or warm feelings or urges which are seen as feminine and therefore, totally unexceptable or taboo. The mommy track for women and its equally destructive counterpart, the daddy without feeling, work-'til-you-drop track for men, begins long before the work/career ladder is in view. It is the fruition of our early, rigid gender-bifurcated socialization systems-systems internalized into early models of boys' intrapsychic, engendered ideal selves.
Pleck (1981, 1995) has argued that men are ground down trying to live up to such inhuman standards of masculinity or what he calls gender role strain. The Fox Indians of Iowa refer to the ritualized achievement of manhood status as "The Big Impossible" (Gilmore, 1990). Levant and Kopecky (1995) have pointed cogently to the skill deficits resulting in adult men due to these gender-based training experiences in boyhood. They note a severe inability of men to identify, express, and describe their own feeling states, particularly those of warmth, caring, sadness, or pain. This Levant links to the psychological disorder of alexithymia-the inability to connect words with feelings, leaving men with a vague "buzz" feeling of undifferentiated affect, rather than a clear or articulate emotional message of caring and love to convey to their loved ones (Levant & Kopecky, 1995).
THE BIOLOGICAL IMPERATIVES
Although it is difficult to parse out the distinct contributions of nature versus nurture in gender differentiation, some infancy research data is helpful in this process. A critical review of the developmental and biological data concerning the differences between female and male babies supports the claim that girl infants are generally more calm and less irritable while male infants are more expressive and emotive (Haviland & Malatesta, 1981). As a result, some researchers (Silverman, 1987) argue:
The less stable state system of the male infant leads to decreased social interaction. Not only is it difficult to establish social interchange during fussy irritable states, but the parents' task during these states becomes one of soothing and calming rather than socializing....This then produces
diminished social interchange between mother and infant, and, as does not happen with female infants, provides increasing separation with mothers and sons. (p. 328)
Brody (1993, 1996) takes a different route to a strikingly similar conclusion: Gender dimorphic, biologically based temperamental predispositions in infants, in combination with specific caretaker interactions, lead to radically different affective socialization for boy and girl babies. Following from Cunningham and Shapiro (1984) and Weinberg (1992), Brody opines that, "Infant boys are more emotionally expressive than are infant girls, and hence their expressions are easier for...parents to read" (Brody, 1996, italics mine).
Supported by her interpretation of the findings by Tronick and his research laboratory (Tronick, 1989; Tronick & Cohn, 1989) that mothers and their infant sons have an easier time matching their emotional interactive states, Brody suggests that, "Both mothers and daughters may have to work harder to read each others' emotional signals than do mothers and sons" (1996). The result may be the beginning of a long journey toward affective bonding for mothers and their daughters and an increasing emotional inexpressiveness and disconnection for parents and their young sons:
Working harder may translate into talking more to daughters about feelings, as well as in displaying a wider range of feelings to daughters....For females, this may eventually result in both amplified facial expressiveness in order to communicate more clearly, as well as in better emotional recognition abilities. In contrast, in adapting to their sons' higher emotional intensity, parents may respond with more constraint and a de-emphasis on emotional expressiveness. These types of socialization patterns also represent the conformity to the cultured gender role stereotype that girls should be more emotionally expressive and that boys should be more emotionally constrained. (Brody, 1996)
The empirical findings on differential socialization of emotion language for young boys and girls do not disappoint us in this regard. Mothers appear to use more words about emotions when they speak to their young daughters than their sons (Dunn, Bretherton, & Munn, 1987); mothers tend to speak more about sadness with girls and anger with boys (Fivush, 1989). By the time they are of school age, young girls expect more positive reaction from mothers for the expression of sadness than for anger, while young boys expect negative reactions from both parents if they express sadness (Fuchs & Thelen, 1988).
Fathers have been especially active in promulgating such gender-bifurcated socialization models of the expression of emotion. They use more emotion-laden words with their daughters than with their sons and engage in more negative teasing or aggressive verbal jousting with their sons than with their daughters (Gleason & Greif, 1983; Schell & Gleason, 1989).
We are gaining a better developmental understanding of why anger has been the more accepted emotion for men. Through anger-the final common pathway for all their other strongly repressed affects-boys, and later men, express their vulnerability, powerlessness, and their pain in their search for safety. Anger is the stepchild of men's repression of their vulnerability in their search for legitimate authority. Its true parentage remains too shameful to face-the earlier trauma of abandonment-hence, the poorly defined responses of violence and rage, by which men hope to achieve what is in essence the unachievable.
Biological predisposition combines with cultural and social patterns to foster an earlier and potentially more hurtful separation paradigm between boys and their parents. Added to the thesis arguing for the unconscious trauma of loss, such an integrated biopsychosocial model becomes a powerful hermeneutic for a new psychoanalytic psychology of men.
What would a man, who as a boy sustained such gender-bifurcated socialization and early unconscious psychological hurt, look like? In all likelihood, he would be obsessionally concerned about maintaining a rigidly independent self and have a matrix of intrapsychic defenses, something like: unconscious anger or rage toward women, defensive condescension of anyone in a care-taking role, overvaluation of independence (defensive autonomy), devaluation of the need for connectedness or interdependence, stoic denial of sadness or pain with an inability to grieve loss or to mourn, a walling off of a vulnerable but hidden core self, a proclivity to externalize inner conflict, a relative incapacity to put feelings into words (alexithymia), and the need to take refuge in impulsive action to avoid anxiety. This is remarkably similar to the description of a prototypic narcissistic character structure.
In addition, you would expect that any overt sense of dependency-especially upon women-would be quite frightening for men; since this would threaten a repetition of the undependable earlier tie, which had been disrupted. Simultaneously, however, there would be the conflicted need to be mirrored and to connect with an idealizable soothing object, side-by-side with the terror of sustaining such a connection, for fear of its disruption. If this is indeed men's dilemma, from whence comes the resolution?
Healthy traditional masculine gender identity (replete with rigid differentiation from femininity) is an element of the false self construction in men and is founded in two faulty biopsychic constructs:
1.
An identification with the absent aggressor "bogey man" father (Mitscherlish, 1963) creating a self-critical and perfectionistic superego that demands never ending reaffirmation through workaholic production-oriented successes to fend off rageful states of depressed self-esteem, and
2.
A self shaming need to hide the prematurely disrupted sense of needing to be held, which manifests itself in angry defiance and pseudoindependence. Consequences of such a faulty construct is a susceptibility to a gender-specific type of disorder of the self, listed in Table 1.1 (see also Pollack, 1998, this volume, Chapter 7).
TREATMENT
To help men become more empathic, we must become more empathic to men. In psychotherapy we see many men who are frightened about some aspect of their work or love life that they cannot master. These men are most afraid of the very fact that they are afraid. They have been brought up to believe that a man must not seek help at a time when he needs it most. So they deny their dependence on the therapy or the therapist. If pushed prematurely to face the truth, they will resort to more drastic protection of their fragile self, their independence-they will flee from treatment or devalue the therapy or the therapist. If the therapist remains calm and does not criticize in return, if he or she recognizes and supports men's need to save face when receiving help, then internal changes of great consequence may occur. We must be sensitive to men's shame and not further shame them in psychotherapy.
Winnicott wrote that one should never ask "Did you conceive of this or was it presented to you from without?" If we can sustain the process of change without putting demands upon men before they can accept them, transformation can occur. This is not very different from the theory of how to get a good idea accepted by an organization. Consultants know that the best way to help others is to enable them to feel they have come to the good idea themselves. They can then own it and empower its implementation.
In Alan's case, it was necessary to modify psychoanalytic psychotherapy-not so much in its frequency (intensity), duration, or self-reflective associative model-but rather in the arena of supporting the patient's need to believe, for long periods of time and without interpretation or challenge to his denial, that both the therapy and therapist are almost unimportant to him. In this way, my approach is similar to Modell's (1976) understanding of the cocoon transference necessary for the maintenance of what he calls the illusion of self-sufficiency within the early holding environment of a psychoanalysis-a background of safety that is required for mutative change in the treatment of narcissistic personality disorder. It differs, however, in that it does not require a confrontation of the reality of separateness, and thereby falls closer to Kohut's (1977) concept of the creation of a stabilizing, idealizing self object transference.
Heinz Kohut (1971, 1977) argued that the appropriate treatment response in narcissistic development is an empathic or "experience-near" understanding of the individual's needs to take in and utilize the other, that is, the selfobject, in a manner that silently performs missing functions within the self-without necessarily acknowledging these significant external contributions. Kohut accepted that certain people may need to be highly dependent on others to fulfill deficits or tolerate conflicts and traumas in their earlier lines of self-development, while never consciously acknowledging such dependency. Consequently, he advised against disrupting such a stable transference constellation until it could be interpreted from within the patient's own perspective-rather than imposing our own external "maturity morality," due to the therapists countertransference needs for recognition and authority. I find such advice invaluable in the depth of psychological treatment of men.
Sometimes, as in Alan's case, the early phase of the treatment may be conceptualized-by patient and therapist alike-along the lines of an extended consultation in which the patient's defensive independence and fear of connection is neither interpreted nor confronted. Rather, in this case, as in many others, the associations often begin in the work arena with discussions of disappointments in competitive expectations and interpersonal conflicts with coworkers, without requiring any acknowledgement of the patient's need for support for extended periods.
The more extensive case vignette of Jim will be utilized to illustrate this new psychoanytic psychotherapy designed for men.
CASE STUDY: JIM
Jim, a single man in his late thirties, came for intensive psychoanalytic therapy because of struggles with colleagues at work and the inability to maintain an emotional commitment with a woman. In the initial sessions, Jim described his family as a 1950s American classic-somewhere between "Leave It to Beaver" and "Ozzie and Harriet." Past therapies had failed to deal with his overly rigid self-requirements for success and his painful sense of failure in heterosexual romantic relationships. His past experiences with former therapists were unhelpful, leaving him feeling "misunderstood." Later it emerged that Jim had experienced an intense sense of dread in trying to depend upon these treaters, and eventually a terrifying experience of shame or humiliation in being unable to utilize the treatment offered to him.
Over the course of our intensive psychodynamically oriented treatments, it also became clear that Jim's parents-although well-intentioned and caring-had substituted rigid rules for living for a more empathic understanding of their child's specific psychic needs. Jim's father would often pull away from his son when he was upset; and his mother would preach to Jim about what he should be doing or how silly it was for a boy to be so emotional.
Given such a childhood background, Jim had developed a classic combination of psychodynamic defenses and deficits woven into a character structure common to many men in our society. First, he unconsciously split off and/or repressed most of his deep core feelings (especially vulnerable emotions of sadness or loss)-except those of anger. Consequently, he was "angry" much of the time. Next, he eschewed any overt dependent relationship with another person out of the likelihood that they might disappoint and abandon him-leading to a dangerous sense of embarrassment or shame. He created and lived out what I have described elsewhere (Pollack, 1990) as a gender-based model of defensive autonomy or pseudo-self-sufficiency. He devalued empathic insights or language-based self-reflections ("What difference do they make?") and searched, instead, for actions he should engage in to change things. Jim engaged in perfectionistic attempts at work-based mastery, and consequently fell victim to harsh self-criticism punctuated with episodic projections onto others during rage release attacks. And, finally, he clung to this defensive character structure consciously as a type of syntonic armor to protect himself.
Kohut, the pioneer of self-psychological, experience-near psychoanalytic treatment, often commented that such an approach-from within the patient's needs, and perspective-can often put extreme strain on the therapists' narcissistic need to be valued. So, we are all likely to slip. In Jim's case, this occurred toward the end of the first year of the psychotherapy: prior to a planned interruption in our treatment due to my upcoming vacation. Although Jim was in the midst of discussing some very painful issues concerning his sense of "failure" and "shame" at work and was bitterly deriding me for not "doing enough" or "really being there" to help him, he remained steadfastly silent about the upcoming interruption-one quite ill-timed from the perspective of his needs. When finally, I could no longer avoid what appeared to be a series of associations to the important issue of abandonment, I somewhat meekly raised the concern that the upcoming interruption due to my vacation might be affecting Jim and his feelings. He remained silent for quite a while and then finally said, "You're just like all the rest of them, then! You think you're all so important, to tell the truth I really don't think at all about your going and it doesn't matter to me!"
This derailment from the empathic understanding of Jim's need to keep his sense of dependence upon the therapy and therapist out of awareness was not without potential benefit. Once I realized what Jim had experienced in my interpretation-that he would be forced to recognize his "inferiority" through his reliance upon me-I responded, "You know, I think you're right. I don't think it's so much that you'll miss me or you have to miss me. That's where others have misunderstood you. I do think though that you're working very hard and we're working very hard together, and...all things being equal...it's not completely fair to you to have to interrupt at this time...so you might have some thoughts or feelings about that."
Jim responded immediately, "You're absolutely right! I wish I could come here during those few weeks and keep working on this. But you'll be away, so what's the use of talking about all this, anyway." To which I replied, "The use is that you have a need right now to keep working on this very actively and your needs count, and my plans are getting in the way of your needs!" Jim replied, "I didn't think it would be all right to say that I wouldn't miss you very much, but I'd miss doing our work." "It's perfectly all right, because that's what you feel," I replied. "Here we should feel free to talk about whatever you think and feel."
Over time, Jim became trusting enough to share an unconscious fantasy. Reviewing his sense of failure and the feeling of being doomed to boring work, he tentatively shared the memory that when feeling scorned, incompetent, or ashamed as a child-all alone without support of parents or friends-Jim used to retreat to his room and fantasize about the future: A house would be burning down and no one would know how to save the occupants. Out of the blue Jim would arrive and without a glimmer of fear or hesitation thrust himself into the burning building, carrying out the women and children into complete safety. Then he would be hailed as a hero and the "limelight" (as he described it) would be on him. Finally, he would be "important," receive a medal, and everyone would recognize his courage. This reparative fantasy (or curative fantasy/Ornstein)-a pastiche of boyhood Superhero comics and Jim's father's wartime exploit stories-was the heroic and grandiose alternative to a real life filled with an endless sense of the shame of "never measuring up."
Jim's rich unconscious fantasy life guided our creation of the unique nature of the holding environment (Modell, 1976) required in this man's therapy. There needed to be a sense of safety, continuity, and responsiveness-that the therapist would be available, nonjudgemental, and responsive: Shining the spotlight when necessary. Yet, this had to be juxtaposed with a respect for Jim's need for distance, safety, and (for a long period of time) denial of any dependent urges or wishes vis-^-vis his therapist. Jim required the use of the therapist as-what Kohut has described as-a selfobject: A part self/part other to be manipulated by the patient into the approximately responsive and supportive stance-without the therapist's complaint, expectation of recognition, or premature interpretation of this function (Kohut, 1971, 1977).
Although Jim continued to complain that no one-including and especially, his therapist-understood or cared about him, with the aid of this experience-near, gender-sensitive, uncritical holding environment of psychotherapy, he gradually became able to meet and, then to sustain relationships with women whom he liked; and one whom he grew to love. Ambivalent all the while, he felt increasingly confident that he wished to make a permanent commitment, and married.
A crystalizing moment in the treatment emerged when Jim's father took ill and was dying. Jim debated about whether or not he should return to make one last attempt at contact with this man who, "was never there for me," and, "so I'm not really losing anyone, anyway." Together, during this period, we worked through how painful it had felt for Jim-over and over again-when his father abandoned him emotionally as he attempted to find support as a growing child. Due to his own perfectionism and isolation of affect, Jim's father, "always had to get things right"; and couldn't be bothered "with children interfering." Consequently, if Jim and his dad were building models together (one positive activity Jim remembers) and if they didn't work, his father would vociferously and angrily blame the manufacturer, and literally leave Jim holding the pieces. Perhaps, most painful, was Jim's realization that these stereotypically masculine defensive traits-the avoidance of vulnerable feelings and workaholic perfectionism-were the only male role models available to him in his predominantly female world. And that, therefore, to his horror in retrospect, he had identified with them, internalized them, and made them his own. As Jim said, almost in tears, "I've become just like my dad."
Jim journeyed home and saw his father for what turned out to be the last time. Upon his return, after his father's death, and with tears in his eyes, Jim recounted the last discussion: a warm and friendly chat, but still devoid of the deeper meaning and connection that Jim had always longed for. Yet, for the first time, Jim acknowledged the fact that they both had done the best they could-and this recognition of the limitations of the human condition was a new and relieving experience for Jim.
Now, the depth psychological work on the intrapsychic defenses against relationships, the defensive autonomy, took place. We learned together that it had become better for Jim, "not to ask for help, than to ask and not receive it" due to the devastating shame and frightening vulnerability that such a rebuff would generate. Jim revealed that all his life he had "wanted somebody by his side" (an older brother figure); yet often he felt in the treatment like telling the therapist to "Go away," so that his need for a soothing, guiding object would not show in this interpersonal context; and thereby lead to further embarrassment or an intolerable sense of loss. Jim was not really so often mad as he was sad and frightened. We unearthed an unconscious belief (that was once available to him in childhood) that shame came from feeling feelings and that, therefore, if he could achieve a state of "having no feelings," or the next best thing, not experiencing any, he could avoid all pain. The pain of depending upon a potentially helpful, later abandoning significant other (male or female) was almost annihilatory: "Needing someone like that is like being part of someone else's dream....They wake up and you disappear." It was only Jim's own childhood dream or fantasy of the invulnerable heroes that could soothe such deep anxieties and maintain connections. In fact, when the therapist commented that Jim had legitimate reasons to continue to attempt to defend against deeper connection, and consequently potential further hurt, Jim returned to the next session uncharacteristically positive in his attitude. He commented how important that clarification had been, "You said hurt, and that was...(a revelation). I never realized that it was hurt and...(not anger), I was struggling with."
Returning to this issue, Jim spoke about his struggle with trust, "It's not really that I don't trust you...I've known you for quite a while now and you have really helped me...it's that I feel too vulnerable to have needs, to really show my needs, and maybe...to show that I need you. It makes me feel weak and very scared." I then replied, "Yes it's frightening, but it's part of the human condition to depend on each other, isn't it?" Jim, said, "Is it? You know when they talk about those homeless people sleeping alone out in the cold and how can they do it...I sort of know how they can do it. It's their way of keeping themselves private, of not having to let anyone in." He went on to say, "You know it's not just letting someone in once, it's needing them, and then feeling they won't be there, or they're expecting that they can come in again...It leaves you with no private sense, no sense of your self."
Soon, Jim began to speak about how he had fantasized for several years about having children, but felt it impossible. How could he risk being like his own father and emotionally abandoning his child in his time of need? "You really have to be dedicated to them all the time," he said. And Jim wasn't sure he'd have the emotional stamina and self-esteem security to achieve this seemingly daunting task. Most of all he worried that, " I won't be able to take their hand, help them stand up for themselves, and let them know that they're important, too."
Jim was afraid that what was now becoming his wife's pressing need-to address childbearing-would bully him into just doing, "what looks like the right thing," repeating the earlier traumatic interaction with his mother and father, to his detriment. He felt certain that the therapist also would have expectations of "mature behavior" and shame him into becoming a father. When it was clarified that no normative expectations were being held by the therapist, but that perhaps Jim was selling himself short in thinking that he had to fail at parenting, as his own father had, Jim began to cry, and then said:
I see myself like in the picture of the student uprisings in Communist China, in Tiananmen Square....Standing tall with my son by my side, facing the tanks and armies of totalitarianism. I am holding my son's hand and telling him, "This is important, you're important!"
Jim began to play with his nephews when they visited and spoke of the joy it triggered. Stopping himself somewhat, he acknowledged, "Parenting won't just be fun!" The therapist agreed but suggested that it needn't be seen as an unbearable burden, either. Jim began to talk about the kind of father he'd like to be. (The work continues.)
SUMMARY
Jim's dilemma, although personally tied to his own early developmental experience is a paradigm for the pain that many men feel in all relationships-including psychotherapy. Men are constantly seeking and yearning to be connected, often with women, but also with their fellow men. However, they are terribly frightened of the shameful vulnerability of memory of past hurt and trauma that such connection will bring. Too often, the psychology of men has been only a means to suppress the anxiety and fear that such connections elicit and to replace them with a defensive withdrawal of angry frustration that tends to cloud the real issues. Men are not narcissistic, self-sufficient loners, who care for no one else. They, we, are frightened searchers looking to connect, but very unsure of what unconscious "insurance" we need, should the connection go awry.
We must rethink our psychoanalytic and psychodynamic treatment models as they pertain to men, across the life cycle: Questioning whether our conceptualization of both healthy resolution of conflict and remediation of deficit are truly experience-near to many men's unconscious experience of father and mother hunger (Herzog, 1978)-to their early, pre-Oedipal struggles with a separation trauma, which only too often can be neither named nor mourned.
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Table of Contents
TREATMENT MODALITIES.The Trauma of Oedipus: Toward a New Psychoanalytic Psychotherapyfor Men (W. Pollack).
Desperately Seeking Language: Understanding, Assessing, andTreating Normative Male Alexithymia (R. Levant).
Cognitive Behavior Therapy for Men (T. Mooney).
Group Therapy for Traditional Men (G. Brooks).
Reluctant Men in Couples Therapy: Corralling the Marlboro Man (J.Shay & C. Maltas).
Men in the Family: A Family System's Approach to Treating Men (R.Lazur).
ENDURING PROBLEMS, NEW SOLUTIONS.
Mourning, Melancholia, and Masculinity: Recognizing and TreatingDepression in Men (W. Pollack).
Men's Shame and Trauma in Therapy (S. Krugman).
Gender Role Stress and Male Erectile Disorder (L. Morris).
Confronting AND Treating Empathic Disconnection in Violent Men (D.Lisak).
BROADENING THE SPECTRUM.
Treating Anger in African American Men (A. Franklin).
Being Gay and Being Male: Psychotherapy with Gay and Bisexual Men(S. Schwartzberg & L. Rosenberg).
When Women Treat Men: Female Therapists/Male Patients (M.Potash).
Index.
Foreword
IT IS an honor to invite readers into this wonderful collection of theoretical and clinically informed papers addressing the dilemmas and strategies involved in the conduct of psychotherapy with male clients. For the past several years, Drs. William Pollack and Ron Levant have been creating exciting new models for the psychologies of men and in this ground-breaking book they have included other innovative clinicians in this expanding dialogue.
Since its inception, psychotherapy has been widely used by women. It has been avoided by most men. As one contributor notes, "Traditional men hate psychotherapy." The typical therapy dyad has been male therapist and female client. While feminists have protested against the gender biases of traditional therapy that have been detrimental to women, little has been written about the difficulty that men have had in entering therapy or making use of it.
Until recently most clinical theories pretended that psychotherapy could or even should be gender-neutral. When gender of therapist was referred to, it was often with the caveat that all therapists can speak to or call forth a maternal or paternal transference. Gender was seen as having relatively little importance. It was felt that most traditional therapy models were equally valid for both men and women. Feminist therapy early suggested that gender as well as other contextual factors needed to be included in our theories and practices. Since the 1970s, there has been an increasing emphasis on different developmental and clinical models for women and men. Psychological theories that spoke to the human condition have increasingly been viewed as limited in their application to both men and women. Thus application of theories of human psychology, without attention to gender, may be not only subtly distorting but destructive for both men and women clients.
This volume provides the practitioner with many valuable applications of the new understanding of mens' psychology that have been emerging in the past decade. It has been suggested that men are not typically
allowed to ask for help; indeed they have not been allowed to show "weakness" or vulnerability. Men have not easily embraced traditional treatment models. The very qualities that are called for in psychotherapy (emotional vulnerability and availability, capacity to ask for help, the ability to articulate feelings states, openness to being affected by others) are discouraged in men. Few clinicians or theoreticians have undertaken the task of finding ways to address the specific needs that men have in therapy. Nor have we sought ways of rethinking the obstacles that keep men from getting help with their suffering or participating in psychotherapy.
The authors in this book have taken on the task of increasing the accessibility and usefulness of psychotherapy for men. They have demonstrated poignantly and powerfully that beneath the mask of stoicism and lonely strength that men are encouraged to present to the world, men suffer enormous psychological pain. These chapters detail the experiences of isolation of those who cannot reach out when help is needed, the shame of those seeking to meet impossible standards for masculinity, the stress of those cut off from their own resources for empathy and connection, and the ongoing, often hidden, yearnings of those who want to be close and intimate without sacrificing their sense of competence or masculinity. These authors provide both understanding of these dilemmas and practical clinical suggestions for helping men move out of their isolated pain.
This volume is rich in its appreciation of the special pathways to healing that are growth-enhancing for men. Written by practitioners from many different therapeutic and theoretical persuasions, as well as from diverse personal experiences, the book serves as a much-needed bridge to effective psychotherapeutic work with men. As a society, we cannot afford to neglect the profound psychological suffering that men encounter in their lives. As professionals, we clinicians need to seriously reconsider our approach to male clients. Old models of male development and treatment of men are at best inadequate and at worst lead to treatment failures and unremitting pain for men in therapy. This book offers a comprehensive and compassionate reworking of our understanding of men. It contains solid, exciting new theory and moving clinical case studies and examples. It also provides practical guidance and new ways to think about approaching men's psychological suffering. This comprehensive book brings us a discussion of normative alexithymia in men and ways to bring men into greater awareness of their emotions; the psychotherapy of shame; unrecognized depression in men and how to help men become more empathic with themselves; psychotherapy with gay and bisexual men; working with violent men; men in couples therapy; treating anger in African-American men; using group therapy; working with erectile disorders; adapting psychoanalytic and cognitive behavioral approaches. The chapters are thoughtful, pragmatic, and cutting edge. They offer a pathway for men from a place of hating or fearing psychotherapy to a place of healing possibility.
This is a book filled with wisdom and practical clinical advice but most importantly, it offers hope. We must assist men in their growth and realization of their full potential through acknowledgment of their need for help and the special ways that need manifests itself. We also must assist men in dealing with the ultimate human vulnerability with which we all struggle. In so doing, we offer the possibility of new developmental pathways to all men and women. I believe this book should become required reading for all those who are or will be treating men in psychotherapy. Beyond that, I hope its visions of new models of male development and personal change will impact a broader audience who will be moved to question and challenge the limiting and distorting socialization which we impose on young boys and men.
JUDITH V. JORDAN, PHD