If you think barbershops are all about haircuts and shaves, take a closer look.

For African-American men in particular, barbershops often serve as epicenters of culture, community and camaraderie. Debra Johnson is hard at work adding counseling to that list as well. Her approach works in part because, for most of these men, the barber chair is a lot more inviting – and a lot less intimidating – than the therapist’s couch.

Johnson, a counselor and founder of Changing Generational Legacies LLC, makes monthly visits to local barbershops near her Columbia, Md., consultation practice. When she began dropping by a few years ago while working for a government agency, Johnson was keenly aware that men – especially Black men – do not generally embrace counseling. So Johnson ditched her counselor name tag, picked up a blood pressure cuff and headed off to meet the men on their “turf.”

Johnson, who is also a nutritionist, makes the trips with a nurse, offering free blood pressure checkups to the barbershops’ clients. Many men in the Black community know someone who has suffered a stroke, Johnson explains, so they view the checkup as beneficial and normal. But oftentimes, she adds, the checkup also doubles as a makeshift counseling session. “Being an African-American woman myself, I know that counseling is just taboo [for African-American men],” says Johnson, a member of the American Counseling Association. “So I’m not going to go in and say, ‘I’m going to provide you these counseling services.’ I can’t go in as a counselor.”

The blood pressure checks are performed in a room separate from the rest of the barbershop clients, giving Johnson the opportunity to talk one-on-one with the men about stress, poor diet and anything else that might affect blood pressure. As the conversations get rolling, many of the men open up. On a recent trip, Johnson and the nurse found that one man’s blood pressure reading placed him in the risk zone for a stroke. Because they keep track of previous blood pressure readings at the barbershops, Johnson knew the man hadn’t previously been in the stroke zone. She asked him what had changed, and the man revealed he was under a tremendous amount of stress, including facing eviction from his home.

After Johnson and the man chatted for about 20 minutes, the nurse suggested they recheck his blood pressure. To their surprise, it had dropped back down to normal. “Even for me, it was a ‘wow’ moment,” Johnson says. “He was just as stunned.”

The client went back into the main room of the barbershop and shared what had just happened, helping the other men begin to see the connection between releasing life’s stressors and good health, Johnson says. “Through that process, I’ve really learned that Black men are hurting, but they don’t have a safe place to share that pain. Vulnerability is not embraced, for Black men or for most men.” Johnson adds that a number of men from her barbershop trips now make the trip to visit her – as clients of her counseling practice.

Johnson might slowly be creating counseling converts among barbershop customers, but getting men engaged in the therapeutic process remains a challenge for many in the field. “There is a large body of research that shows men are less likely than women to seek many forms of support, including counseling and many forms of health services,” says Mark Kiselica, vice provost and professor of counselor education at the College of New Jersey. “This hesitance to seek assistance is a contributing factor to some of the problems that are more common in men than in women.” Men are less likely to seek mental health services when they are in distress, Kiselica says, and experts suspect that is a contributing factor in boys and men being more likely to commit suicide.

In fact, men seek counseling services at about half the rate of women, says Travis Schermer, an outpatient therapist at Mercy Behavioral Health’s East Liberty Center in Pittsburgh. Compounding the problem, he says, is that men are in a sort of crisis of meaning and identity. A lack of models of masculinity, the loss of career-based identities, emotional isolation and the use of nonrestorative behaviors such as drug and alcohol use and pornography all point to a crisis of meaning, Schermer says. “What men are supposed to be and how they’re supposed to be has become less clear,” says Schermer, an ACA member who is also an instructor at Chatham University and a doctoral candidate in counselor education at Kent State University. “It’s really a struggle of identity in a lot of ways.”

Toughing it out

Although men are less likely to seek counseling, they’re just as likely to continue treatment once they’re there, says Schermer, adding that the reasons men tend to avoid counseling aren’t crystal clear. “Some have conjectured that the process of counseling is antithetical to masculine ways of being, while others have conjectured it has more to do with the discourse occurring in the masculine community concerning counseling,” he says. “I believe it’s a mixture of the two. Counseling does not typically honor a masculine way of being, which is commonly more action oriented. In turn, there are barriers that many men perceive from other men, such as a social stigma about attending counseling that is enforced through shame and prejudice. Combined, these elements depict men as viewing counseling as uninteresting and as socially undesirable.”

Peter Kleponis, assistant director of Comprehensive Counseling Services and the Institute for Marital Healing in West Conshohocken, Pa., says pride plays a role in keeping men away from counseling. Many men don’t want to admit they have a problem in the first place, he says, while also pointing to socialization and the male problem-solving nature as primary reasons why men avoid counseling. Women are more relational, Kleponis says, and tend to look to others for help when they have a problem. Men, on the other hand, believe they have to find the solution on their own. “We men were raised to think we have to solve our own problems and pull ourselves up by our bootstraps, so to speak.”

Kiselica agrees that socialization plays a role in distancing men from counseling. “The more traditional a man is, the less likely he is to seek help from others,” says Kiselica, a member of ACA. “He’s raised to think he should ‘tough it out’ on his own.” But while acknowledging that traditional masculinity is a viable factor, he contends research has overemphasized this aspect and believes a few other factors deserve increased attention.

“Too many clinicians assume that the reason some men don’t go for help when they are in trouble is because they don’t want help,” Kiselica says. “That assumption is often erroneous and simplistic.” Many men are simply too overwhelmed to get help, he explains, pointing out that they might come from families with multiple problems, be experiencing poverty, have low educational levels or have fragile family structures. Another factor is the fear of being judged. “There are some populations of men who are very accustomed to being judged,” Kiselica says. “They feel they’re going to be blamed for problems before their side of the story is even told.” Teenage fathers, with whom Kiselica has worked for 30 years, are prominent among this group, as are fathers of children in the welfare system, incarcerated fathers and fathers of color. “We really need to rethink the way we think about boys and men and how we try to help them,” Kiselica says. “The reason I’m accentuating this is that most of the people who write about men situate the problem within the man. Professionals need to think more complexly about boys and men – that’s my primary message.”

Research on male sexual development resonates with Mark Freeman, who runs a counseling and consulting practice in Winter Park, Fla. One model of development from researchers D. David and R. Brennan highlights four “rules” that men and boys learn through cultural and family development. Although simple, Freeman says, the model makes a lot of sense when considering the divide between men and counseling. The first rule is “no sissy stuff. You’re undermined and ostracized for any sign of femininity. Talking about your feelings one-on-one with another human being is in that realm,” says Freeman, a past president of the American College Counseling Association, a division of ACA.

The second rule is “the big wheel.” With this rule, what counts is how much a man can accumulate in terms of wealth, status, success and other related measures. The third rule – “give ‘em hell” – teaches men to be daring and aggressive and to take risks. The last rule is to “be a sturdy oak.” This rule includes a measure of toughness, Freeman says, and tells men that they should be self-reliant and shouldn’t show their feelings or emotion. “All four of these rules are completely antithetical to opening yourself up to another person in a counseling center,” says Freeman, who directed the counseling center at Rollins College for more than 20 years. He estimates that during his time at the college, there were three to four female clients for every male client who sought counseling.

A targeted approach

Masculinity, fear and cultural “rules” could all be keeping men away from counseling, but Kiselica suggests counselors themselves might inadvertently be putting up “No Men Allowed” signs. “What’s overlooked is that mental health professionals tend to not know how to do male-friendly outreach and male-friendly engagement strategies,” he says. “They don’t know how to recruit men for services or how to engage them once they get in, despite their best intentions.”

Only by designing and providing services that appeal to men will they actually be drawn in, says Kiselica, adding that his years of work with teenage fathers has taught him that lesson quite clearly. “If you say you have a counseling program for teenage fathers, they won’t come,” says Kiselica, author of When Boys Become Parents: Adolescent Fatherhood in America. On the other hand, offering help related to finances, getting a job, legal questions about paternity or questions about being a father will resonate with that population. “If you construct the services to have what young men are looking for, you can join them at those points where they want help and then bridge from there to other issues in their lives,” Kiselica advises.

That mentality is applicable to all men, not just teenage fathers. “You have to design the services to fit the males you are targeting,” says Kiselica, who also coedited Counseling Troubled Boys, published in 2008 as part of a series of books about counseling boys and men. Simply offering counseling services and expecting men to show up won’t get counselors very far, he emphasizes. “You have to gear it toward what is the salient service for them.”

Advertising your services in a different way can also help. As part of his practice, Freeman offers executive coaching services, which he finds to be much more appealing to men. “I can reach men much easier because they’re all interested in leadership development. But to be honest with you, the work is very similar [to counseling].” The approach proved effective on a college campus as well, says Freeman, who taught a course on leadership while working at Rollins. Because the course had the word leadership in the title, more male students signed up, Freeman says, but the content was more “feminine,” touching on human relations and interpersonal skills. “You have to present it in such a way that it fits with those four rules [mentioned earlier],” he says. “If you’re talking about leadership development with men or boys, that’s the ‘sturdy oak’ – it doesn’t look like ‘sissy stuff.’ I build their trust by not violating one of the four rules. You still get to the same place where they can be vulnerable and open up.”

For his practice, Kleponis, an ACA member who partially specializes in men’s issues, creates marketing materials that feature a masculine look, are written from a masculine perspective and refer to things that will speak to men, such as sports or fixing an engine. But marketing materials and brochures are only marginally effective, Kleponis says, so he also advocates partnering with local men’s organizations. Many of Kleponis’ clients are Catholic, so he incorporates Catholic spirituality into the therapeutic process when applicable and has also partnered with local clergy, the Knights of Columbus and an organization called the King’s Men that assists men struggling with addictions to pornography.

A plan of action

Once men make their way into therapy, counselors say the next hurdle is getting them involved in the therapeutic process. One of the biggest mistakes counselors make right off the bat, Kiselica says, is sticking with tradition. “Counselors stay in their offices and expect men and boys to open up and spill their guts,” he says. “This is inconsistent with the ways boys and men naturally form their friendships. When boys and men form friendships, they do things together. They’re often very active. They talk about personal things in the context of instrumental activities.”

For example, boys might play a video game side by side, or men might work together on a car. While engaged in those activities, Kiselica says, they are more likely to have very personal conversations. The talks might not be as deep or as lengthy as conversations shared by women, but men gradually get to know each other in this manner, Kiselica says.

What does this mean for counselors? Embrace men’s active side, Kiselica advises. For example, go to a basketball court and shoot hoops while you talk. With the permission of parents, Kiselica has taken some of his young male clients fishing. Counselors who can’t leave their facility should still explore options for doing something active with their male clients, whether it’s taking a walk or playing checkers, Kiselica says. “Boys and men often relate to each other while they’re immersed in an activity, and if counselors can do this, they’ll help boys and men to open up.”

At one of the workshops he presents, a school counselor told Kiselica she was having trouble getting boys to come to her office. He suggested she buy a Nerf basketball hoop and put it on her door. Not too long after that, he received a letter from the counselor. “The boys were now fighting to go to her office,” Kiselica says. The counselor found that she could learn all sorts of important information about what was going on in the school – not necessarily by talking with the boys, but just by listening as they shot hoops side by side.

Kleponis also encourages counselors to take note of the way men relate over activities. Even though he can’t take to the ice with a client, if Kleponis finds out the man follows the Philadelphia Flyers, he’ll talk hockey with him to build rapport. “It helps develop a sense of trust,” he says. “It’s not really therapist and patient; it’s just a couple of guys. And that’s where they will open up. From there, I can move into whatever the problem issue is.” Kleponis recommends male therapists for male clients, particularly if the client is dealing with a sexual issue. Otherwise, he might be more hesitant to open up, Kleponis says.

“While I think there are many similarities between my approach with men and women, I do make special considerations with men,” Schermer says. “Oftentimes with male clients, I will spend much more time building rapport. I will take time to honor what is often an initially positive presentation. It’s not uncommon for men to present with ‘nothing wrong.’ This is an aspect of themselves, one that they often need to present to the world in order to perform their masculinity.” Often, it’s through honoring that story that trust and rapport is built, Schermer says. “With women, I find I gravitate more toward the problem initially. With men, I will spend time in a positive space that is close to the problem. We’re almost like base jumpers standing on the edge packing our chutes. We’re talking about the jump, i.e. the process of counseling; about great jumps in the past, i.e. times that we’ve been successful before in and out of counseling; and sharing some anxiety about the jump, i.e. worry about facing these issues. When we feel strong together, we’ll take that jump. It’s never my decision to jump. I just sit on the ledge waiting for them.”

A big part of masculinity, Schermer says, is the assumption that men are supposed to be strong, in control and have it all together. When men arrive in counseling, they’re struggling with an image of themselves as not being in control, he says. Sometimes, the counselor will initially hear a positive presentation – the client will talk about all the positive things going on in his life. The important thing, Schermer says, is for the counselor not to react in a challenging way. “We need to honor their positive presentation as being a ‘true’ aspect of themselves and not a denial of the problem.”

Once a client begins sharing some of his struggles, Schermer recommends incorporating action-oriented elements into the therapeutic process. Talk with the client about the action steps he’s going to take, Schermer says, because planning that out feels powerful and instills a sense of moving forward. “Men do feel a bit more invited into the process when you say, ‘It’s collaborative. We need to figure it out together. It’s a team approach.'”

Kleponis concurs, saying a team problem-solving approach can go a long way with male clients. He assures his male clients that, together, they’ll get to the root problem of what’s going on by brainstorming, doing some problem solving and coming up with a solution.

Freeman recommends starting with the cognitive rather than the affective realm. He might help a client look at how a negative belief is obstructing his ability to succeed in his marriage or how he can change certain behaviors to become more successful at work or at home. Men respond well to solution-focused work, Freeman says, so keeping the conversation goal-oriented and focused on what the client wants to achieve will help keep male clients engaged.

Avoid asking too many questions initially, Kiselica says. Instead, begin by talking to a male client about his interests and try to relate to those interests. Many boys and men have previously been forced into counseling when they got into trouble, so they might associate a barrage of questions with being interrogated by an authority figure such as a principal or a corrections officer, Kiselica explains.

Another good rapport builder? “Inject humor,” Kiselica says. “Guys use humor as a way to express affection and to form bonds with other men.”

More than meets the eye

One of the more common presenting problems among male clients is anger, Kiselica says. “Men and boys tend to be either forced or pushed to go into counseling for anger-related problems or some sort of disruptive behavior. So, on the surface, that’s often the presenting problem.” But the situation is typically more complicated than that, he says. “It could be that the man is experiencing extreme pressure at work, he may be feeling that he and his wife are incompatible in some way, or it could be that he has suffered some trauma in the past that he’s never had an opportunity to deal with.” Kiselica says an estimated 400,000 boys nationwide are the victims of some form of abuse or neglect each year. It’s also estimated that 15 percent of adult men in the United States experienced some sort of sexual abuse as boys. “So you always have to try to bear in mind there may be more than initially meets the eye [with the presenting problem],” he says.

Kleponis says pornography addictions are another common problem among male clients. When he began working as a counselor more than a decade ago, most of the client addictions he saw were to drugs and alcohol; now, he says, 90 percent of the addictions he encounters are to Internet pornography. Many men also struggle with selfishness, Kleponis says. “That’s one of the biggest problems in relationships and marriages.”

For clients with pornography addictions, Kleponis uses a traditional 12-step program. But for the issue of selfishness, he uses positive psychology. Positive psychology is based on research findings that people who practice virtue on a regular basis are psychologically and emotionally healthier. Kleponis helps clients set up action plans that include picking two virtues and practicing those virtues every day. In doing this, Kleponis says, clients oftentimes receive a positive reaction from their significant others, children and coworkers. “Hopefully they begin to see that practicing virtue is much more beneficial than the vice, so they’ll profit more from it.”

Issues of meaning are also common for men, Schermer says. Men labor to connect with others emotionally, he says, often wrestling with emotional awareness and to find the language to communicate effectively. Although men often are good at expressing their emotions through behavior, Schermer says he frequently works with men to connect in ways that are also meaningful to others, not just to the man personally. That might mean learning to say “I love you” instead of just showing it behaviorally, he says.

Part of Schermer’s work with male clients involves finding models of masculinity. One surprising model who often comes up is Mr. Rogers. Clients see him not only as masculine, Schermer says, but also as a man who was very emotionally aware and present with others. Schermer helps clients identify significant men in their own lives and then delve into what it meant for those individuals to be men and how they showed their masculinity. This process helps clients recognize the qualities they picked up from others and also creates awareness that how they act will impact other people’s lives. For example, a client might come to understand why he believes that “real men” don’t talk about their feelings and how that belief is hurting his wife. “It creates this sense of agency,” Schermer says. “[Clients say], ‘If I knew that this would happen, I would never have let it happen.'”

No matter the presenting issue, Kiselica says counselors should use a positive masculinity approach. “The very first thing across all of these [issues] is searching for and affirming male strengths,” he says. For example, if Kiselica is working with a client who is a father, he’ll ask the client to share how he tries to be a good father. “I identify a really worthy strength and then help him to maximize his potential in that strength and remove barriers to it,” Kiselica says.

Kiselica adds that counselors should affirms men’s practice of “action empathy” because many men demonstrate their care for others by actively doing something for them rather than verbalizing that care. Group therapy is another good option for men, he says. “If you devise the [counseling] program to appeal to men, engage him in a male-friendly manner and affirm his strengths, he’s then more likely to trust you with a very vulnerable topic,” Kiselica says. “All of this work that I’m talking about gives you currency with men. It allows you to earn their trust and delve into topics they might not otherwise explore.”

Know thyself

Speaking generally, gay men are less hesitant than other men to get involved in counseling, says Leslie Kooyman, an assistant professor at Montclair State University in New Jersey who spent almost 10 years in private practice. “I think the difference is that it depends on where a male is with their masculine identity and their feminine identity.” On the masculine side, men tend to be more distant, rational and logical and less relational, says Kooyman, an ACA member who is a gay man. “Men in general are not conditioned to express feelings or even identify feelings,” he says.

The reason gay men might be more open to counseling, Kooyman says, is because they have already dealt with feelings that are different from the “norm.” These individuals had strong emotions growing up, often feeling isolated or different, he says, so they are more accustomed to feeling vulnerable and expressing feelings as adults.

Counselors who want to work with gay male clients should get involved in gay-friendly community organizations, whether through membership, volunteering or giving presentations on topics such as substance abuse, Kooyman says. But before these clients walk through the door, it’s important for counselors to understand their own sense of sexuality and how they feel about homosexuality, Kooyman says. “If you’re not really comfortable with gay men and gay male culture with your own values, then it’s going to hinder the process,” he says. “Even a gay counselor working with a gay client has to be comfortable with his own identity and know himself. That’s the first part – know thyself.”

The second part, he says, is being very familiar with sexual identity models, such as those developed by Vivienne Cass and Richard Troiden. Beyond that, counselors need to understand the client’s external culture – what this man’s career, family and sexual life are like in relation to being gay. The question to explore, Kooyman says, is “What does being gay mean to him?”

The coming-out process, intimacy, isolation and relationship issues are all common topics with gay male clients. Isolation is often a result of the stigma attached to being gay, Kooyman says, so an important task for counselors is getting these clients more engaged in the community and perhaps connecting them with people who might be struggling with the same issue. With intimacy issues, Kooyman says counselors should know the sexual identity models and then explore with the client where he is within the stages of identity development. Addressing intimacy might mean helping clients identify both their own feelings and those of a partner to see what needs are being presented and how to deal with those needs, Kooyman says.

Getting gay men involved in the therapeutic process depends largely on the counselor’s ability to explore the client’s culture and worldview in a positive, nonjudgmental way, Kooyman says. Don’t make assumptions, he emphasizes, and be open enough to share what knowledge you have of his culture as a counselor. Show the client you understand the context of the world in which he lives, Kooyman says.

As a counselor who works with gay men, Kooyman says it can be exciting to partner with clients who are willing to be a bit more creative. “The societal expectations have already been broken,” he says. “They’re often not as married to the societal expectation of gender. They seem much more open to explore who they are as a person rather than trying to fit a mold.”

The importance of trust

“There’s a lot of stigma associated with seeking out a counselor,” Johnson says of the African-American community’s relationship with counseling. For men, in particular, seeking professional help is seen as a sign of weakness, so the likelihood of a Black man picking up the phone and calling a therapist is very slim, she says. “It’s odd and almost rare when a man calls on his own who has not been mandated [by the courts],” says Johnson, who has been doing advocacy work specific to African-American men for six years. Most of the male clients Johnson sees have come in because their wives or significant others asked them to participate in couples counseling.

Many African-American men would much sooner seek help from a pastor at a church or an elder in the community than reach out to a counselor, she says. “When you’re dealing with African-American men, there’s this whole historic perception that exists that they’re strong and they can handle all things. For some people, help is seen as positive, but for an African-American man, the word help can be viewed as a weakness for him.”

Lack of trust is reason No. 1 that African-American men steer clear of counseling, Johnson says. “Trust is the absolute biggest issue. They don’t trust systems, period.” Although the Tuskegee syphilis experiment happened decades ago, the memory of it is still prevalent in the Black community, she says. Many African Americans don’t trust the medical community, Johnson says, and fear that any information collected will be used against them.

Heading out to the barbershops has allowed Johnson to reach more African-American men, but she admits that earning their trust has taken time and patience. Trust is built gradually and depends heavily on following through on promises. “They are very used to being misled,” she says. “When I say, ‘I’m coming to the barbershop,’ I’m there.” Johnson recommends that other counselors follow her model and go wherever the men are, whether that means traveling to barbershops, building partnerships with churches or using other creative approaches. In each case, it’s essential that the counselor bring a service the men feel they need. For Black men, Johnson stresses, that’s not going to be counseling. Instead, offer something that will resonate with them as being necessary, and then use that as a springboard to respectfully provide counseling-related services.

Upon finding the “in” and connecting with potential clients, Johnson recommends adding coaching aspects to the treatment. “I find traditional counseling is not as effective as counseling in addition to coaching. Coaching doesn’t feel as much like ‘Someone is taking care of me [and] asking me questions about my deeper feelings.'” Coaching gets clients more involved through action-oriented questions, Johnson says. Questions might include “How do you see yourself?” and “What challenges are you facing?”

But don’t assume that all clients know what to do, Johnson cautions. For example, she says, a counselor might ask a client what it means to be a father, but the client might not be clear on the meaning if his father was not present and he lacked a positive male role model in his life. A counselor’s role, Johnson says, is to help clients work through the issue and figure out what is preventing them from being what they envision.

One issue many African-American men present with is oppression, even though they rarely use that word, Johnson says. Being overlooked for a promotion at work is one example of a significant stressor. Money is another. This can involve not only the stress related to being a provider but also distrust or stress over getting a fair deal at a bank or business. Johnson says her clients also struggle with the many instances in which others are distrustful of them, such as when women clench their purses in the elevator or cross the street when an African-American man is approaching. Regardless of whether the woman crossed the street for a completely unrelated reason, perception is reality for African-American men, Johnson says.

Johnson is a firm believer in the power of the mind, so when confronting issues in session with clients, she likes to use cognitive restructuring. “I believe if we change how we think, we’ll change what we do,” she says. Once her clients realize they can change their thoughts, their stress levels often decreases. Johnson asks her clients to focus on what they are doing that is not giving them the outcome they want. “They may be in some cases the victim, but if they’re here in counseling, then we need to move beyond that,” she says. One sentiment Johnson hears from clients at times is, “The Man always has his foot on my neck.” She advocates an active approach in response. “When I hear that, I say, ‘If the Man has his foot on your neck, then you’re lying down. Get up.'”

Counselors can’t expect to sit back silently and simply listen when working with African-American male clients, Johnson says. These clients often feel as though no one understands them, so it is important for counselors to engage with them, she explains. “Allow them to talk, but when they stop talking, it’s important to paraphrase. Make sure you’re getting – or not getting – what they’re saying. They like being asked. It’s empowering.”

Counselors might have to be creative to pull in these clients initially, but once they figure out how to reach them, Johnson says, the payoff is big. She notes a higher percentage of her male clients show up for counseling sessions than her female clients. “[My male clients] realize, ‘Wow, I can use this, and this is really working for me.’ But you’ve got to get them in. You can’t wait for them to come to you.”



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