Thursday, May 27, 2010

David Wexler, Ph.D. - Men in Therapy in the 21st Century

http://www.finaletally.com/images/gallery/soprano_therapy.jpg

For any therapists out there - or maybe even life coaches - who work with men, this telecourse, from Psychotherapy Networker, with David Wexler seems essential. Dr. Wexler is the author of Men in Therapy: New Approaches for Effective Treatment and When Good Men Behave Badly: Change Your Behavior, Change Your Relationship.

In his writings, Wexler offers some crucial insights into the ways in which men manifest emotional issues differently than women do, and why female therapists need to understand how and why this is true, as well as how to talk to men in a way that will allow them to feel safe expressing themselves.

His discussion of the "Broken Mirror" (from the article Shame-O-Phobia: Why men fear therapy, see below) using a construct from Self Psychology, is immensely useful in understanding men - it definitely helped me understand why my inner critic gets triggered by my relationship partner while perceived criticism from others barely even registers much of the time.
A metaphor from self-psychology, the broken mirror, is particularly helpful in understanding the dynamics of male shame. This sensitivity to shame—to feeling incompetent, not valuable, unloved, unneeded, unimportant—is often governed by the psychological relationships with mirroring-self objects in our lives. It works like this: the response from others serves as a mirror, reflecting an image that governs our sense of well-being. Sensitivity to mirroring-self objects and broken mirrors isn't gender-specific, but men are more vulnerable to experiencing these mirrors as referenda on their performance and personal value. When the mirror image is negative (or is perceived as negative), the reflection can reactivate a man's narcissistic injury and deliver a blow to his feeling of competence. There's no more potent a mirror for a man than the one reflected by his intimate partner. If she (or he, in a gay relationship) is unhappy, he's failed. If she offers even a normal, nonabusive criticism, it's as if she's yelling at him: "You've failed at making me happy." And the shame-o-phobic man, vulnerable to broken mirrors and narcissistic injuries, will hear that message whether it's unintended or not.
I think a lot men can see themselves in this brief passage. Sometimes Jami can say something that is as free from judgment or shaming as humanly possible (and being a therapist, she knows how to do this), and I hear it as though I am the worst partner in the world. This doesn't happen all the time, of course - some days my critic is more reactive than other days - but when it does, I withdraw and she wonders what the hell just happened.

For an extended sample of his writing (and an explanation of the "narcissistic wound," see the article excerpt below.

Anyway, here is the info for the telecourse.

T915 Men in Therapy in the 21st Century

Learn about contemporary models of male psychology and how to engage men in therapy to bring out the best qualities even in “difficult” or “defensive” men.

david_wexlerDavid Wexler, Ph.D.

media-telecourse-tn Dates: Tuesdays, June 8, 15, 29; July 6
Time: 12:00 PM to 1:00 PM EST
CE Credits: 4 hours
Fee: $85; Online Member Discount: $75

ordernow

Course Description

Traditional models of psychotherapy and couples therapy have often fallen short in trying to reach and engage men because they don’t recognize the defenses and strengths that men typically bring with them into relationships. In this course, you’ll learn about creative 21st-century perspectives on male psychology, particularly how to reach men and bring out their best qualities. We’ll discuss the “broken mirror” phenomenon, ways in which men rely on women excessively for validation of the self, and the challenging and rich issues that emerge when women therapists treat men. We’ll explore how to creatively incorporate language and imagery that make sense to men and how to help them achieve authenticity and intimacy in their relationships.

Meet the Instructor

David Wexler, Ph.D, is the executive director of the Relationship Training Institute in San Diego. He's the author of "Men in Therapy: New Approaches for Effective Treatment," "When Good Men Behave Badly: Change Your Behavior, Change Your Relationship," "Is He Depressed or What?" and "STOP Domestic Violence."

Learning Objectives

1. Describe four contemporary insights about male psychology and how to integrate them into your couples work.

2. List three examples of “guy talk” that engages men and helps bring out their best qualities.

3. Explain the concept of the “broken mirror” and how it can be used to reach men more effectively.

Course Contents

Session 1: Understanding “Good Men Behaving Badly” * The shame of masculinity * Masculine gender role stress * The “broken mirror” sequence * The power of women.

Session 2: Rules of Engagement * Typical male counseling-o-phobia * Respecting “relational dread” * Guy talk for engaging men in treatment * Respecting resistance.

Session 3: When women treat men/diversity issues and treating men * Countertransference and challenges * When men “come on” to female therapists * Cultural sensitivity and cultural competence * Therapist/client matching issues * Alpha errors and beta errors.

Session 4: Relationship authenticity and relationship intimacy * The authentic self and the authentic other * The four pillars of intimacy * Intimacy: action steps * Emotional honesty and behavioral honesty * True love.

ordernow

The current issue of Psychotherapy Networker has a special section on men (The Secret World of Men: What therapists need to know). One of the articles - and a very good one in my opinion - is Shame-O-Phobia by David Wexler (I think it is free to read online even for non-subscribers).

Here is a bit of the article:

Men who've experienced toxic doses of shame early in life will do anything to avoid reexperiencing it as they grow older. It can originate from family experiences, from peer experiences, or just from the culture at large. A shamed boy becomes a hypersensitive man, his radar always finely tuned to the possibility of humiliation. His reaction to slights—perceived or real—and his ever-vigilant attempts to ward them off can become a kind of phobia. Tragically, the very men who are most desperate for affection and approval are the ones who usually can't ask for it: instead, they project blame and rejection and perceive the worst in others. Sometimes the smallest signs of withdrawal of affection will trigger old wounds, and they'll suddenly lash out at those they see as slighting them, even as they're unaware of the dark feelings stirring inside them. This is a state of mind that many of us in the field call shame-o-phobia, an endemic condition throughout Guy World.

With their profound fear of appearing weak or—god forbid!—feminine, most men will do whatever it takes to prove their manhood. In one recent study, men were assigned to three different groups and given the task of keeping their hand in painfully icy water for as long as they could. Those who were told that the ability to withstand the discomfort was a measure of male sex hormones and an index of physical fitness showed greater cardiovascular reactivity, reported feeling more performance expectations, and kept their hand in the water the longest. This was in contrast to the group who were told the test was a measure of high levels of female sex hormones and the ability to bond with children, and with the third group, who received no explanation at all.

What does this tell us? The length of time a guy will tough it out with his hand submerged in freezing water depends on whether he thinks his masculinity is in question. For some men, their hand could fall off before they'd risk the shame of not seeming "man enough" to take it.

Women feel shame, too, of course, and much of the emotional experiences for men and women are more similar than not. But there are still some fundamental differences in how men are both hardwired and acculturated that can't be ignored in the therapist's office. Even as infants, boys are more overstimulated by direct eye contact and show less ability to regulate arousal through intimate connection. These infant boys then grow up in a Guy World culture that emphasizes successful performance and deemphasizes reliance on others as a way to self-realize. Furthermore, evolutionary psychology teaches us that men are wired for procuring and performing (while females are wired for tending and befriending)—a trait that may provide a biological backdrop to the modern male focus on success. Without that, he ain't much—or so he feels.

To ignore the powerful effect of shame-o-phobia is to risk not really "getting" men, even if you happen to be a man yourself. An otherwise benign or mildly embarrassing event—like carrying the purse across the plaza, or a daughter who isn't having a good time at a Halloween party—can overactivate a man's fear that he's failing at some central task of being a real man.

The Broken Mirror

A metaphor from self-psychology, the broken mirror, is particularly helpful in understanding the dynamics of male shame. This sensitivity to shame—to feeling incompetent, not valuable, unloved, unneeded, unimportant—is often governed by the psychological relationships with mirroring-self objects in our lives. It works like this: the response from others serves as a mirror, reflecting an image that governs our sense of well-being. Sensitivity to mirroring-self objects and broken mirrors isn't gender-specific, but men are more vulnerable to experiencing these mirrors as referenda on their performance and personal value. When the mirror image is negative (or is perceived as negative), the reflection can reactivate a man's narcissistic injury and deliver a blow to his feeling of competence. There's no more potent a mirror for a man than the one reflected by his intimate partner. If she (or he, in a gay relationship) is unhappy, he's failed. If she offers even a normal, nonabusive criticism, it's as if she's yelling at him: "You've failed at making me happy." And the shame-o-phobic man, vulnerable to broken mirrors and narcissistic injuries, will hear that message whether it's unintended or not.

A few years ago, I was interviewed on a radio show about the psychological concept of the broken mirror. Afterward, the (male) interviewer said to me off-air: "Damn! Now I get what happened to me yesterday! I came out of the bathroom after shaving and I'd nicked myself a little on the cheek. My girlfriend looked up at me and said ÔWhat happened to you? That's the second time you've done that this week?' And I just went off. I started yelling at her, and then I stormed off, and our plans for the day were ruined. And it was all because I had a manhood attack. I know she didn't mean anything like that, but that's what I heard. What the hell's wrong with me?"

This man experienced his girlfriend's comments as a stab at his masculinity. It was as if she'd said, "What kind of loser are you that you can't even shave properly? Any man should be able to pull that off!" To a guy whose self-esteem—particularly his masculine self-image—feels vulnerable (this includes most men), this simple interchange, silly as it sounds, can feel like as an unbearable assault. My radio interviewer, as best as I could tell, didn't suffer from a narcissistic personality disorder, nor was he particularly outside the norm. He experienced the broken mirror and reacted in ways that are typical, in one form or another, for many of us men.

Men and Therapy

The field of counseling and psychotherapy hasn't done a particularly good job of creating a user-friendly environment for male clients. The problem begins with a lack of awareness about the profound impact of shame-o-phobia and the vulnerability to broken mirrors. Furthermore, there's a mismatch between the relational style of many men and the touchy-feely atmosphere of most counseling and psychotherapy.

Think of what we typically ask a man to do in therapy settings: recognize that something is wrong with him, admit that he needs help, openly discuss and express his emotions, get vulnerable, and depend on someone else for guidance and support—all extremely challenging tasks in Guy World.

Too often therapists—both male and female—try to massage men into being more like women in the ways they express themselves and experience their emotions. So it isn't surprising that only one-third of psychotherapy clients are men. Either men have fewer psychological problems (not likely!), or else many are too turned off by the whole therapy enterprise to seek the help they need. In fact, men usually get therapy only because someone else has insisted on it. When I ask men in an initial therapy session, "What are you doing here?" the answer I hear is "My wife told me I needed to be here." Other times, it may be their boss or their grandmother or their doctor, or even a probation officer. They perceive the decision to use the therapeutic services and the process of using them to be not particularly helpful and not particularly masculine—often even downright threatening. It's our job, as counselors and therapists, to adapt our approach to these realities.

Part of what makes treating men challenging is that they generally don't signal their psychic pain as clearly and straightforwardly as women. In the postfeminist turmoil of shifting relationship dynamics, men have been struggling to find a way to relate intelligently, parent sensitively, and manage their emotional needs with more consciousness and depth. Many of us haven't figured out a way to do all these things and still really feel like men. Author William Pollack describes men's anger as their "way of weeping"—an expression of underlying pain that women would more likely display with tears or more direct expressions of sadness and loss. Men also "weep" by drinking, withdrawing, acting defensive, blaming others, getting irritable, being possessive, working excessively, becoming overly competitive, suffering somatic complaints and insomnia, and philandering.

As therapists, we have two choices: shoehorn men into a process that's traditionally been more user-friendly for females, or reshape what we do and how we present it to better reach male clients.

Read the whole article.

One of the concepts he mentions in this brief section of the much longer article is the narcissistic wound. The following is a good explanation of the narcissistic wound, from Linda Marks, which is a very central concept in Psychosynthesis (primal wounding), Self Psychology (see Philip Cushman's Why the self is empty: Toward a historically situated psychology), and many other therapeutic models.
The wound to heart and psyche that gets called narcissism occurs when a child's vulnerable and developing core sense of self is not seen and reflected back by the adults around him/her. Each child is born a unique individual with special gifts and personal challenges, multi-layered and both simple and complex. For any one layer to develop, that part of the child needs to be seen, heard, understood and valued. Parents have to be present to be mirrors—to bear witness and reflect back. Healthy parents help young people build a frame of reference for living.

A child needs a safe context in which to explore and express his/her core sense of self. A child needs adults who are themselves grounded in who they are so they have emotional and psychic space to be receptive to the individual child at any moment, rather than relating to the child from their own unmet needs. Any one adult may be capable of seeing and developing certain aspects of a child, and less equipped to see and develop other ones. In this sense, it does take a village to raise a child, and with the loss of this village and the committed long-term adult relationships the village offers to a child, many levels of the child's developing self will be missed entirely.

When a parent's own woundedness and unmet needs override their ability to be present to a child or a parent's undeveloped parts of self render them unable to respond to a child's vulnerable and authentic needs, the child's core sense of self can be lost, fragmented or undeveloped. The loss, fragmentation and lack of development of the core sense of self is the root of the narcissistic wound. Raw, broken, undeveloped and lost, we enter a cold cruel world ill-equipped to relate, define fulfillment from the inside out and connect with the spirit of life.

A significant part of this process, the "fragmentation and lack of development of the core sense of self," which stems from the narcissistic wound, is the source of our subpersonalities, especially the manager parts - for me it is the inner critic (and the perfectionist), while for others it might be the pleaser (seeking to please everyone to avoid shame or abandonment), or the pusher (seeking recognition to avoid shame or abandonment).

Anyway, I highly recommend this article, and Wexler's books.


1 comment:

Kevin said...

If we really feel that something is going wrong with us and that we need some extra help, we must think of the options we have to overcome the problem. I know that there are different beliefs when it comes to psychology, and one´s got to choose the one we feel more comfortable with. I think that Cognitive therapy is of great help and that has already shown good results in other people. I decided to try it and it really worked for me. I wanted to express my experience and opinion.
Thanks and nice blog!
Kevin