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Psychologists want to change how they treat men. That’s a problem.

January 18, 2019 at 4:49 PM

A therapist takes notes. (Gretchen Ertl for The Washington Post)

Sally Satel is a resident scholar at the American Enterprise Institute, a psychiatrist and a lecturer at Yale School of Medicine.

The American Psychological Association is, yet again, under fire. This time, the organization is accused of pathologizing masculinity and calling upon its membership to “re-engineer” the traits of manhood.

At issue is the APA’s first-ever “Guidelines for Psychological Practice With Boys and Men” — originally released this summer, but only recently getting attention. The document, developed over 13 years and grounded, as the APA describes in a press release, in “more than 40 years of research showing that traditional masculinity is psychologically harmful,” lists harmful aspects of everyday masculinity, including “emotional stoicism, homophobia, not showing vulnerability, self-reliance, and competitiveness.”

Many critics argue that the guidelines, as Fox News’s Laura Ingraham put it, conflate masculinity with “being a pig or a creep or a Harvey Weinstein kind of person.”

That might be a bit over the top. But there is another, deeper problem with the guidelines: They risk subverting the therapeutic enterprise altogether because they emphasize group identity over the individuality of the patient.

Psychotherapy is the ultimate personalized medicine. The meanings patients assign to events are a thoroughly unique product of their histories, anxieties, desires, frustrations, losses and traumatic experiences.

"Gender-sensitive" psychological practice, as the APA calls it, is questionable because it encourages clinicians to assume, before a patient even walks in the door, that gender is a cause or a major determinant of the patient’s troubles.

It is, of course, quite possible that the patient finds himself constrained by traditional expectations of men. For example, a man might struggle at home because he feels unable to express affection for his children. He might feel conflicted about the degree of aggression he needs to express to please his boss. He might not be able to come to terms with his son’s homosexuality.

These tensions will organically declare themselves during treatment. But therapists shouldn’t come primed to see a patient’s distress through the lens of traditional masculinity and its alleged trials. Not all problems men have will be related to their gender.

To be fair, the APA does emphasize that it does not intend to mandate changes in practice. But therapy is a delicate business not readily amenable to guidelines tailored to gender — or to any group affiliation, for that matter. So when the APA encourages practitioners to engage in vaguely defined activities — “address issues of privilege and power related to sexism” or “help boys and men, and those who have contact with them become aware of how masculinity is defined in the context of their life circumstances” — it seems more focused on a political agenda than on the patient.

Take the male trait of “emotional stoicism.” The guidelines appear to regard this disposition as a problem in need of fixing. It is not clear why this is necessarily so. And surely emotional openness is not a goal that can be foisted on a resistant patient.

But, for the sake of argument, let’s say that the patient and clinician decide that it is in the patient’s interest to be more emotionally expressive. Further questions need to be explored: Which particular emotions does he want to express more fully? Why, to whom and in what contexts should he express them?

But why is there a need to direct attention to men’s emotional lives in the first place? Indeed, when a psychotherapist needs a guideline to remind him or her that management of emotions — in any patient — is an issue that will likely arise, one wonders whether that therapist is even up to the task.

Leading with an ideological agenda presents another threat: It risks alienating the patient and thereby compromises a critically important phenomenon called the therapeutic alliance. In his classic 1961 book, “Persuasion and Healing,” psychiatrist Jerome D. Frank describes the alliance as “the therapist’s acceptance of the sufferer, if not for what he or she is, then for what he or she can become.”

Through that therapeutic relationship, the patient gains insight, a degree of mastery over himself and alternative ways of thinking about his problems. Frank believed, as do many therapists today, that the power of a clinician’s dedication to the patient is not only essential but may also be the most active ingredient in the therapy itself.

The field of psychology is overwhelmingly populated by liberals, with only about 6 percent of social and personality psychologists identifying as conservative. Psychiatrists are similarly left-leaning if a bit less so, with 75 percent registered as Democrats. The APA doesn’t make public the political affiliations of its members, but they are likely similarly liberal.

“If we can change men,” said one of the drafters of the APA guidelines, “we can change the world.” But therapy and activism should not mix.

People seeking help are in a state of suggestibility. Therapists need to be careful about imposing their “gender-sensitive” worldview on them.

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