This piece is the final of a three-part series for CT Online. It is the result of the work of ACA President S. Kent Butler’s Gender Equity Task Force. The first article, “Breaking the binary: Transgender and gender expansive equality,” was published on April 4, and the second article, “Counseling girls and women in the current cultural climate,” was published on May 5.

In this article, we shine a spotlight on how boys and men are impacted by gender equity and how counselors may apply this knowledge in pragmatic, clinical ways. Because gender equity is often conceptualized through a privileged, Western lens, we weave in an intersectional perspective to underscore boys’ and men’s diverse experiences and identities.

As we learned in the second article in the series, girls and women continue to be marginalized by gender-based oppression, so it is not surprising that gender equity issues have historically been associated with them. However, what is often not discussed is how boys’ and men’s well-being may also be negatively affected by the patriarchal system that benefits them.

Readers may wonder what these issues have to do with professional counselors and the counseling profession, given that gender-based terms and conversations often have political connotations associated with them. Counselors whose clients do not present with overt conflicts around gender and gender socialization may avoid direct inquiry on this part of the client’s identity and could miss one or more ways that male clients adapt to the world around them, and thus, how gender has shaped them as people.

Consider that in 2020, an estimated 11.3% of men in the United States sought counseling, despite a greater need for it. Socialization practices for men include such things as stoicism, rugged individuality and solitary problem-solving. These can be very positive characteristics and behaviors, but they can also create isolation, sublimation of emotions and self-blame. It is imperative that we explore the influence of gender equity in the lives of boys and men and reduce the societal stigma impeding their help-seeking processes.

Broadening our perspective on masculinity

Research shows that, compared to girls and women, boys and men face disproportionate rates of harsh discipline in schools, academic difficulties, insufficient education, higher rates of completed suicides and higher rates of substance use and dependence. The counseling profession often overlooks boys and men as a specialized group, in part because of their inherited positions of male privilege and power, as if that privilege automatically erases the presence of potentially debilitating problems.

Professional counselors may be more effective in working with boys and men if they hold a flexible conceptualization of masculinity as diverse, multiple, and intersectional, to form a more inclusive view of how boys and men exist in the world.

One helpful way to understand this is to see boys and men representative of multiple and complex expressions and identities of unique personhood, rather than as a monolith or archetype — one version of masculinity. This is referred to as multiple masculinities. As we additionally layer in the cultural experiences and backgrounds our clients represent, we can take an intersectional perspective. As an illustration, we explore three of many types of masculinity and manhood: traditional masculinity, “toxic” masculinity and precarious manhood.

Traditional masculinity can be thought of as the possession and expression of prized Western characteristics, such as being white, heterosexual, and cisgender, as well as being the person who provides for and protects a family or group. This type of masculinity is commonly seen as holding a lot of power and privilege in society, and it typically rejects or excludes men who embody stereotypically “feminine” characteristics like empathy, caring and softness. Throughout the ’80s and ’90s, the men’s movement sought to connect men with their intrinsically masculine nature through retreats in the woods, rituals of manhood and initiation ceremonies. The movement appealed mostly to white, heterosexual, upper-class men to the exclusion of other cultures, classes and sexual/affectional orientations.

“Toxic” masculinity is a colloquial term that includes those traits of masculinity that are oppressive, such as interpersonal violence, shaming, bullying, gang involvement and self-entitlement. This view of masculinity is controversial because some see it as an attack on masculinity and because of the belief that there is inherent toxicity in being a man. Research indicates that toxic masculinity is the result of boys and men feeling insecure and then acting from that insecurity against those seen as weaker than them.

Related to the concept of toxic masculinity is precarious manhood, defined by psychologists Vandello and Boson as a felt sense of manhood that is “hard won and easily lost.” It is elusive, requires achieved status, and is confirmed by others through one’s demonstrations of manliness. It is so tenuous, however, that just one unmanly action or behavior can call one’s manhood into question, regardless of the attempts to prove it. Attempting (and failing) to prove oneself according to stringent societal and systemic norms creates an unstable sense of one’s manhood, which may in turn incite toxic behaviors to restore balance.

While these are just three examples within a multiple masculinities framework of many types, we recommend above all that counselors take an intersectional approach that will give space for our clients to bring all of themselves to the therapy room. This necessitates an awareness of cultural and subcultural influences of how unique relationships to manhood are formed.

Understanding the gender role characteristics of machismo as well as the influences of acculturation and socioeconomic status can be beneficial in counseling Latinx boys and men. When counseling African American boys and men, understanding the “cool pose” as resistance to indignities and inequality is helpful from a contextual perspective. Counseling Indigenous men will encourage self-examination and connection to community and needs to include decolonization practices toward healing and authenticity. Transgender, gender expansive and nonbinary people express masculinities that usually do not conform to the narrow, rigid and heteronormative nature of traditional masculinity, and they have often been damaged by the behaviors of toxic masculinity.

Diverse and multiple masculinities have persisted and evolved despite traditional masculinity’s pervasiveness in society, and it is important for counselors to recognize and affirm and help their clients to know that there is more than one way to be a man.

Masculine identity socialization

Very early in life, young boys learn patriarchal language and what it means to work and provide for the family, as well as how to operate in the world as a man. They also learn the consequences of not evidencing these lessons. Through overt and covert behaviors, implicit and explicit messages, and a system of rewards and punishments, early caregiving environments reinforce ideas about how men and boys should embody and express masculinity to avoid reproach by others.

Appearing or performing in less masculine ways than expected may trigger early and continued rejection experiences, especially when boys demonstrate what are regarded as feminine traits like sensitivity, compassion and kindness toward others. These boys may be shunned by other boys and looked down on by men they may look up to, or idealize, for the very characteristics they are expected to possess. These experiences can trouble a boy’s internal sense of self and the way he interacts with the external world, which often includes a desire for peer acceptance and connection.

Some of these learned characteristics include being logical, engaging in visible conflict and adventure, attaining wealth and status at work, being self-confident, being a quick and resolute decision-maker, striving actively for power, exacting concrete results and tangible rewards, and being invulnerable, competitive and strong. All of these and more create an image of the “ideal man” — one that is not real but ideal, an image to which boys and men should aspire but which they will never realistically attain. Because of how gender socialization is structured, this model and these characteristics are taught and reinforced by both men and women in the home, school, church, work, social and other environments. Boys and men who cannot easily develop, maintain and expand on these qualities may frequently feel an impending sense of failure to live up to their expectations.

Paradoxically, power is one of the privileges that men are automatically afforded by the patriarchal system in Western society, yet they rarely feel that they realistically have this power. They instead feel a lack of power, which is further threatened when historically marginalized groups seek power of their own. This may contribute to a sense of insecurity, insufficiency and a concomitant need to enact power-related behaviors on those around them, as reinforcement of their inherited position.

Joseph Pleck, a prominent researcher on gender role socialization for men, described three consequences for men’s seeming inability to live up to the roles prescribed for them:

1) A man’s long-term failure to perform expected behaviors and traits may lead to low self-esteem and other potential mental health consequences.

2) A man may be successful at performing and attaining desired masculinity, but only through a traumatic socialization process (e.g., hazing, bullying, sublimation, rejection, isolation), which may create negative side effects such as poorer mental health outcomes.

3) A man may be successful at performing and attaining desired masculinity, but this comes with negative side effects because of the rigid characteristics themselves (e.g., low family involvement, reinforcement of traditional gender roles at home, negative health consequences typical for men).

The pressure to perform traditional masculine behaviors can lend itself to a restricted range of adaptive or healthy coping strategies, which has clear implications for the overall health of men and their help-seeking behaviors. When men come to counseling, they rarely offer presenting concerns related to explicit problems with their level of gender role adherence, but instead they seek help for substance use issues, anger management, work conflicts or interpersonal distress, and usually at the insistence of a spouse or partner rather than of their own volition.

Gender equity and boys’ and men’s health

Gender equity has a significant influence on boys’ and men’s health and well-being. Studies show that men who recognize and affirm gender equity have better mental health, more satisfying relationships, reduced mortality, and engagement in other prosocial behaviors that bolster healthy living, such as increased physical activity and decreased substance use.

However, in general, there continue to be significant gender disparities whereby boys and men experience greater health-related repercussions. One such example is life expectancy. In 2020, the life expectancy for men was 75.1 years compared with 80.5 years for women. The disparities become more salient when intersecting factors such as race are considered. Black men have the lowest life expectancy of any group and on average live six years less than white men. These patterns are also seen in suicide rates of boys and men. A 2021 report by the Centers for Disease Control and Prevention (CDC) revealed that although suicide rates among white men and women dropped by 5%, suicide rates increased among 10- to 24-year-old Black (23%) and Latinx (20%) boys and men.

The COVID-19 pandemic further highlights a significant health issue influenced by gender equity. According to the CDC, men are 1.6 times more likely than women to die from COVID despite a similar number of confirmed cases in both sexes. Death rates from COVID for Black and Latinx men are six times higher than those for white men. These disparities are partially explained by the fact that the immune responses of men tend to be lower. This, in combination with gendered practices and behaviors typically associated with masculinity, such as smoking, drinking, not following preventative public health recommendations (i.e., mask-wearing, handwashing), avoidance of receiving health care, and higher rates of co-occurring health issues (e.g., heart disease, diabetes, hypertension), contributes to the high COVID death rates among men.

One explanation for why many boys and men experience gender-based health discrepancies is due to restrictive and prescriptive socially constructed masculine gender norms. One such masculine norm is their supercilious attitudes about their health and well-being, which often lead to unhealthy behaviors.

Boys and men are socialized to be independent and autonomous, leading many of them to think they can rely solely on themselves to solve their own problems and health issues. Given that researchers have found a negative correlation between self-reliance and help-seeking behaviors, it makes sense that boys and men may often not speak up, seek therapeutic assistance or get medical care until it is too late. Because traditional masculinity rewards boys and men who disguise their health-related needs, ailments and sufferings behind an armor of self-reliance, aggression and physical toughness, their health can be negatively impacted.

Barriers toward help-seeking behaviors

Young boys are often socialized in ways that promote risk-taking and rugged independence, restrict emotional expression and prioritize demonstrations of physical prowess, reinforced by the generational attitude that “boys will be boys.” These factors may contribute to greater stigma for boys’ and men’s mental health help-seeking, and the lower rates of mental health treatment, because counseling support is seen as a weakness and not a strength.

Counselors may consider intentional efforts to engage boys and men in counseling services and to assess appropriate levels of care more effectively. Counselors often adapt their practices to meet their clients’ particular needs, so to with boys and men — activity-based work in sessions, behavior-influenced theories and adventure therapy may encourage men to participate more fully. Counselors should also consider developing strategic community partnerships to support mental health education efforts for boys and men.

Programs such as Brother, You’re on My Mind, a National Institute on Minority Health and Health Disparities initiative aimed at engaging African American men in discussions about mental health, often include counselors who can demystify the counseling process and contribute to shifts in common misperceptions about the mental health of boys and men. Similarly, there are school and community-based programs tailored for boys and men that develop positive definitions for masculinity and support healthy sexuality and relationships. Whether through community partnership or direct discussion in session, counselors can explore the role of masculinity in boys’ and men’s presenting concerns, their coping, and resources for social support.

The importance of relationships and a trauma-informed approach

Socialization of masculinity also influences how boys and men engage in relationships. People’s relationships with others, from birth through adulthood, influence how they construct ideas and behave regarding gender expression, sexuality/affectionality and healthy relationships. Research shows that rigid ideas about masculinity can influence heterosexism (homophobia) and cissexism (transphobia), unsafe sexual practices and even aggressive forms of initiating romantic and sexual encounters.

As previously described regarding precarious manhood, boys and men may feel pressured to demonstrate their manhood in unhelpful or unhealthy ways as an indicator of their masculinity or to maintain their social position. This felt pressure also relates to shame and lower rates of reporting/disclosing when a boy or man experiences abuse, trauma or relationship violence.

For instance, although gender-inclusive campaigns for relationship violence are rare, one in 10 men will experience relationship violence in their lifetime, and one out of every 10 rape victims is male. Intimate partner issues (e.g., divorce or separation, loss of child custody) and relationship violence also increase the risk of suicide, especially among men ages 35 to 64.

Therefore, counselors need to be aware of the risk as well as the protective factors associated with mental health challenges for men and the tendency for many men to underreport symptoms.

Research shows that men uniquely benefit from positive relationships with others, such as from being married or partnered and engaging in reciprocal social activities and endeavors.

Meaningful attachments in men’s relationships and friendships significantly reduce the negative influence of childhood adversity and traumatic life events and enhance their mental and physical health.

A wide body of research also supports the effects of father involvement on healthy child development. Fathers often play, communicate and parent in different ways than mothers. As a result, father involvement has significant influences on child well-being, including school readiness and behavior, cognitive development, self-confidence, secure attachment and development of empathy. Finally, men may play critical roles in family discussions about how to treat girls and women and challenge stereotypes associated with masculinity and femininity.

Intersectional counseling practice

The Multicultural and Social Justice Counseling Competencies describe an essential first step for professional counselors to engage more deeply in their self-understanding of their knowledge, beliefs, skills/abilities and responsibilities for advocacy with clients. This process centers the client-counselor relationship and encourages an authentic exploration of the client’s place in society, how systems of oppression and privilege have affected them, and how the work of counseling connects to client advocacy.

Given the strong and systemic gender socialization in society and the way boys and men are often caught in the traditional masculinity trap, counselors should take time to assess the many diverse psychological, affectional, cultural, ethnic, religious and economic contexts in which their male clients exist.

If counselors have not first engaged in their own self-awareness and reflexivity work, they may continue to view the world from their own vantage point rather than the client’s. For instance, if a male client comes to counseling presenting with anger/aggression and repetitive violent behaviors, the counselor could potentially disempower or harm the client by assuming the client “is just an angry person” or that the client embodies a toxic form of masculinity. Both assumptions may foreclose on the possibility of deeper issues, such as past traumas, repeated discrimination and oppression, or maltreatment, and could forestall the client’s potential for growth and development.

Instead, the counselor may recognize that the client’s emotions and behaviors may be justified because of the contextual circumstances and the tools and resources he possessed at the time. The client might have felt he had no choice in how he behaved because of the constraints placed on him by society. The counselor could explore the client’s relatedness to strict gender socialization patterns as well as the emotional effects this brings. The counselor could affirm the client’s characteristics of being strong, powerful and courageous, and help the client develop alternative forms of expression and problem resolution to avoid negative outcomes. And if the client should choose to, he can learn to channel these characteristics toward gender equity and advocacy for disempowered groups.

Inquiring about men’s early patterns of gender socialization and uncovering what was expected of them when they were boys, as well as discovering what the consequences were for not meeting these expectations, will give counselors important insight for the counseling process.

Counselors should listen for how tightly male clients tie their self-worth to their masculinity, as any disruption in their understanding of themselves and their manhood can cause deep internal conflict and potentially negative external behaviors, such as through sexist, homophobic or transphobic actions. Counselors can help male clients envision a broader sense of themselves and a more complex view of manhood — one that embraces self-acceptance and affirmation, interdependence and relationality, and which values positive expression of emotion.

Counselors can also contribute to reexamination of gender stereotypes, social pressures and sexual misconceptions in session through the use of gender-specific group psychoeducation programs such as Time Out! For Men (applied in tandem with substance use treatment to explore gender role stereotypes and how they influence relationship factors such as communication skills and sexuality) or the Men’s Trauma Recovery Empowerment model (applied to help with trauma healing and posttraumatic growth). Research seems to suggest that the treatment effects are comparable in terms of client outcomes regardless of whether a gender-specific approach is utilized. However, for some boys and men, representation in gender-specific mental health services may help reduce internal barriers to help-seeking.

In addition to building a strong foundation of therapeutic rapport, which will also contribute to men’s mental health outcomes, counselors should inquire about male clients’ sources of social support and how their personal ideas of masculinity influence their well-being and relationships. This may provide male clients a safe space to work through both the challenges and positive contributions of what it means to be a boy or man in society.

Conclusion

Professional counselors are in a unique position to support boys and men to achieve gender equity as it relates to their health and well-being.

First, counselors can empower boys and men to advocate for their own health and well-being by educating them on the relationship between self-reliant attitudes and poorer health outcomes.

Second, counselors acknowledge the diverse intersecting identities of boys and men and how these identities may predispose certain groups of boys and men to adverse health experiences.

Third, counselors can help young boys and adolescents examine existing gender norms and roles and how the adoption of these norms may impede healthy living. This focused conversation may allow important space for child and teen clients to identify their authentic beliefs, values and forms of gender expression as they continue their growth and development.

Fourth, counselors should recognize that boys and men are not a homogeneous group and that there are many subgroups of men with diverse and varied ways of expressing masculinities that are validated and affirmed in the counseling space. Counselors should strive to be creative and flexible in their counseling approaches with boys and men to best meet their treatment goals and objectives.

Finally, counselors are encouraged to work with boys and men to explore and debunk the negative gender stereotypes that contribute to maladaptive thoughts and behaviors that thwart their health and well-being.

 

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Find out more about ACA’s Gender Equity Task Force at acagenderequity.weebly.com.

 

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Suzy Wise is a licensed professional counselor in Illinois, a national certified counselor and an assistant professor and core faculty in the clinical mental health counseling program at Valparaiso University. Suzy’s participation on the ACA Gender Equity Task Force included chairing the Boys and Men subgroup and being a contributing member of the Transgender and Gender Expansive subgroup. Contact Suzy at Suzy.Wise@valpo.edu.

Matthew Bonner is a licensed clinical professional counselor and an assistant professor of counseling at Johns Hopkins University. He is a member of the ACA Gender Equity Task Force. His research interests include multicultural issues, assessment in counseling, and human services models of treatment. Contact him at mbonner6@jhu.edu.

Michael P. Chaney is a licensed professional counselor in Georgia and Michigan and an associate professor in the Department of Counseling at Oakland University. He is co-chair of the ACA Gender Equity Task Force, a member of the ACA Ethics Committee and editor of the Journal of LGBTQ Issues in Counseling. Contact him at chaney@oakland.edu.

Naomi J. Wheeler is a licensed professional counselor in Virginia, a licensed mental health counselor in Florida, a national certified counselor and an assistant professor in the Department of Counseling and Special Education at Virginia Commonwealth University and coordinator for the Couples and Family Counseling concentration. Contact Naomi at njwheeler@vcu.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.