I remember being in grade school and hearing the age-old cliché, “Big boys don’t cry,” whenever a male peer began to show he was upset about something.
At the time, I didn’t think twice about it, and I’m sure there were moments when I repeated those very words, not realizing the harm I was doing. Regardless of intention, I now see that these types of subtle messages convey a normative stance of stoicism, invulnerability, and detachment that contribute to toxic ideals of masculinity.
First, I think it’s important to define what “toxic masculinity” is and why it should be a topic of concern in a therapeutic setting.
Toxic masculinity is a framework of manhood that includes key elements such as dominance, control, the suppression of full emotional expression, and, sometimes, the perpetration of violence.
There is a common perception that expressing emotions negates men’s ability to be in control of a situation or will cause others to perceive them as “weak.” For some boys and men of that mentality, the only acceptable emotion is anger. Thus, various other emotions (such as sadness, frustration, confusion) may be masked by an angry façade, creating difficulties in the journey to self-revelation and healing in therapy.
This expression looks different for all men and boys; however, common manifestations include the aforementioned stoicism or aggressive outbursts, respectively. It may seem reductive to posit a binary for their experiences (and I do recognize that many of my clients were/are able to move beyond those two expressions), but I have witnessed this dichotomy more often than not.
Societal Messages About Gender Roles
These expressions are rooted in societal messages of traditional gender roles that begin during childhood, and are subsequently reinforced (sometimes unintentionally) by parents, teachers, peers, and media. These influential people and messages should be taken into consideration through a holistic evaluation of the client’s presenting problems and history.
For example, what messages did the client receive about masculinity from these various sources that may affect how he chooses to express or restrict himself in therapy? Cultural values should also be considered in the internalization of particular ideals of masculinity.
For the purposes of this article, I will briefly address African-American and Hispanic/Latino* cultural ideals of masculinity, as the majority of my clients have self-identified with these racial and ethnic categories.
African-American Perceptions of Masculinity
Within the African-American community, there are core factors that influence models of masculinity such as: family/community, church, and oppressive experiences with authority figures – all of which can affect therapeutic progress.
With issues of racism disproportionately impacting the lives of African-American individuals, there seems to be a growing culture of distrust for authority figures. This distrust may translate to therapy wherein the client is suspicious of the therapist’s motives, fears rejection for expressing “unmanly” emotions, or worries that the therapist will report the client for some misdeed.
As a respite from feelings of distrust and rejection, church is frequented by many African-Americans, and faith plays an integral role in their resilience. Although the church is often a place of solace, some interpretations of the church’s teachings may also contribute to men’s feelings of inadequacy as they receive messages about being “strong” and a “provider.”
When men’s experiences of emotionality and/or financial stressors arise, this may create cognitive dissonance in relation to the teachings of the church, thus fueling the internalization of harmful ideals of masculinity, albeit inadvertently.
Some African-Americans may also believe that mental health issues can all be solved through prayer, which may contribute to their reluctance to seek help from a mental health professional. Though family members and those within the African-American community may be well-intentioned in their portrayals of manhood, if they subscribe to rigid ideals of masculinity, there is little room for emotional expression.
Hispanic/Latino Perceptions of Masculinity
There are many similarities regarding rigid perceptions of masculinity within Hispanic/Latino culture, as well.
The concept of machismo is one that runs deep in Hispanic/Latino cultures. Key features of machismo, as defined by Dr. Paniagua , include: physical strength, sexual attractiveness, masculinity, aggressiveness, and the ability to consume excessive amounts of alcohol without getting drunk.
These messages seem to be implicitly passed on generationally, and are often accepted and internalized by many boys and men. As many of us know, there is stigma when it comes to seeking help for mental health issues but, in the Hispanic/Latino community, “mental illness” may be a term that further stigmatizes therapeutic help, as some consider it synonymous with the term “loco .” In such cases, it may be more conducive to use phrases like “mental health” to shift the focus to a more positive perspective.
Many people of Hispanic/Latino heritage may also exhibit more physical symptoms than emotional symptoms, which may be the result of suppressed feelings (somatization). It is important for therapists to complete a comprehensive intake that also assesses for physical health issues, as these symptoms may be indicative of underlying emotional problems.
As a result of the mental health stigma, Hispanic/Latino people may choose to seek help for physical ailments from a general practitioner (more socially acceptable), resort to prayer, or consult folk healers (espiritualistas) before visiting a therapist.
Inevitably, the aforementioned issues affect all sexes/genders within the Hispanic/Latino community; however, they affect boys and men in a unique way – particularly with regard to emotional attunement and expression.
Rather than stray from the principles of machismo, I have noticed that many of my Hispanic/Latino clients will divert the conversation from themselves or sit in silence out of uncertainty or discomfort with the therapeutic setting.
Working Through Masculinity with Clients
In light of some of the expressions and internalized values of masculinity, psychoeducation is necessary, but I also like to practice White’s (1959) theory of modeling “effectance.” He posited that a feeling of competence related to the client’s ability to affect reality should, ultimately, be what guides the client’s progress. He defined effectance as “a gentle motive without compulsive pressure .”
When utilizing this intervention, the therapist is showing the client how to cope with various discomforts, situations, people, etc. by modeling an ideal reaction. I have found this particularly helpful with my male clients when I am faced with silence as resistance to therapeutic progress.
Supportive silence can be very useful in those moments because I am truly allowing space for progress to occur at the client’s pace (even if it does not immediately feel as if anything is actually happening).
I recognize that some of us may work in settings where the luxury of time spent in silence is not possible, but it may be worth considering when a client seems stuck. This intervention helps the client to tolerate the tension, begin to understand the therapist’s motives, and to consider ways of moving forward that align with the client’s comfort level and emotional needs (i.e. “How would you like to spend this time today?”).
In many of my cases, my clients have complex trauma, and their initial and/or sporadic silence is a way to ascertain whether or not I will “abandon” or demean them for not complying with what they believe are my expectations (similar to reenactments of their traumatic experiences). It also seems as if it is a way for them to feel they have a modicum of control in therapy – often an unfamiliar and uncomfortable situation.
Perhaps a reason why therapy sometimes feels uncomfortable for boys and men, aside from cultural variables, is because it seems as if they are giving up some of the control that has become an important part of their masculine identities. Making oneself vulnerable in a place such as therapy may be equated with weakness, which also goes against the masculine ideal of strength.
As therapists, I believe it is our responsibility to validate and normalize the myriad of emotions and reactions that inevitably surface during sessions. I also have found it helpful to “backtrack” with my male clients by working together to understand when and how particular messages about communication, emotions, and masculinity were conveyed.
I feel that true change cannot occur unless there is a comprehensive understanding of the problem, and sometimes the problem has deep roots in the formative years of childhood and adolescence when boys are establishing aspects of their masculine identities.
Familiarizing ourselves with cultural variations of symptoms will enable us to more readily identify the source of distress for our clients, and also inform our culturally competent treatment plans moving forward. Much of this work begins with unpacking and disproving traditional gender “norms,” something from which we all might benefit.
It should be noted that the points in this article are based on the author’s personal experiences with male clients in residential and correctional settings. This is not meant to represent factual experiences for all male clients, nor is it meant to represent experiences in their entirety for males of African-American or Hispanic descent.
* The terms Hispanic and Latino will be used to represent people from Spanish-speaking cultures, and people of Latin American origin, respectively. Please note that these two terms are not necessarily interchangeable.
 Paniagua, F. A. (2005). Assessing and treating culturally diverse clients. Third Edition. New York, NY: Sage. Dichoso, S. (2010). Stigma haunts mentally ill Latinos. Retrieved from http://www.cnn.com/2010/HEALTH/11/15/latinos.health.stigma/ White, R.W. (1963). The ego and reality in psychoanalytic theory (p. 147). New York, NY: International Universities Press.
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