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Engaging men in family therapy: does the gender of

the therapist make a difference?


Anna Dienhart
a
The results of this exploratory Delphi study provide a beginning formula-
tion of a gender-sensitive approach to working with men in the specialized
field of couple and family therapy. The research specifically investigated
what a panel of thirty-six expert family therapists believed would be
appropriate and effective techniques to engage men in therapy and in the
process of family change. This report focuses on findings highlighting
differences between what female and male therapists preferred as tech-
niques to work with men in family therapy.
Introduction
Traditional gender roles and family structure have been shown to
adversely affect men in families (Cath et al., 1989; Hanson and
Bozett, 1985; Lewis and OBrien, 1987). A family therapist generally
expects that therapy can be instrumental in altering the cycle that
has kept men distant and women central in the family. More specif-
ically, gender-sensitive family therapists generally look for ways to
engage men more fully in the context of family therapy, and to hold
them mutually responsible, with women, for problems and change
in the family. Yet one of the most interesting findings in a North
American study by Wheeler (1985) was the simultaneous endorse-
ment of two seemingly contradictory issues. In the first instance, it
was considered very important for family therapists to avoid placing
upon women the primary responsibility for change in the family. In
the second instance, almost all of the interventions identified
focused on intervening with women, while few intervention ideas
were directed at men. The now significant literature in North Amer-
ica on women in family therapy is evidence that some family thera-
pists are treating women differently (Goodrich et al., 1988;
McGoldrick et al., 1988; Walters et al., 1988). However, while
2001 The Association for Family Therapy and Systemic Practice
The Association for Family Therapy 2001. Published by Blackwell Publishers, 108 Cowley
Road, Oxford, OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.
Journal of Family Therapy (2001) 23: 2145
01634445
a Assistant Professor, Department of Family Relations and Applied Nutrition,
University of Guelph, Guelph, Ontario, Canada N1G 2W1.
feminist family therapy has evolved towards an integrated model of
gender sensitivity, it often lacks explicit knowledge on how thera-
pists engage men more fully in family change.
Both Goldner (1985) and Hare-Mustin (1978), in their early
critiques of family therapy, pointed out that the therapist often sees
the man in the family as less competent than the woman in negoti-
ating the therapeutic relationship. The mans relative helplessness
in this situation is often compensated for by the implicit yet power-
ful message of if I am not protected here, Im not coming back
(Goldner, 1985: 40). These authors believe that, historically, it is this
implicit message, and the associated yet embedded power and
control that has kept the therapist manoeuvring carefully around
the man, treating him with kid-gloves and often framing interven-
tions to appeal to his position. Recent research suggesting that male
clients in couple or family therapy are interrupted much less
frequently than the female client offers substantiating evidence of
this phenomenon (Stratford, 1998; Werner-Wilson et al., 1997).
Some feminists label this man idealizing (Caplan and Hall-
McCorquodale, 1984; Haig and Avis, 1988), whereas other authors
hint at a particular difficulty of engaging men in the process of ther-
apy (Collison, 1981; Scher, 1981). Erickson (1998) notes her
concern about the potential, in feminist family therapy, for the ther-
apist to approach any difficulties of engaging male clients from an
implicit man-blaming perspective. Both perspectives are poten-
tially very limiting to our work with men in families.
Socialization into the masculine mystique stipulates how men
are supposed to be strong, omnicompetent and rational-logical in
their expression; all attributes which are often thought to be quite
antithetical to the typical notion of therapy. Help-seeking beha-
viour, especially for men in the pervasive masculine mystique
culture predominant in North America, Britain and Europe, is
often associated with weakness. Further, men are typically socialized
into a story of masculinity which contributes to a belief that self-
reflection and introspection will lead to humiliation and rejection
(Allen and Laird, 1991; Carlson, 1981). When men do seek help
they may be seen by the therapist as being coerced either by family,
employers or the court to attend sessions. Thus men are often seen
as unwilling participants in therapy. Those who do enter therapy on
their own volition may present as more willing, but they are still
likely to wrestle with highly constraining stories about masculinity
(Allen and Laird, 1991; Collison, 1981). Further, therapists may,
22 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
perhaps inadvertently, view men who do seek therapy in more nega-
tive terms based on cultural ideologies of masculinity (Robertson
and Fitzgerald, 1990). Some research (Robertson and Fitzgerald,
1990) has shown how these cultural ideologies can combine to
create an environment of mistreatment of the male client.
Generally, therapy literature in both Britain and North America
(the context of this research) offers fewer therapeutic strategies and
tools specifically designed for working with men than it does for
women. Much of the therapeutic literature focusing on men is
located in a psychoanalytic tradition (e.g. Erickson, 1993; Frosh,
1994). The family therapy literature which does specifically address
therapy with men (Bograd, 1991a; Dienhart and Avis, 1990; Dien-
hart and Dollahite, 1997; Erickson, 1993; Meth and Pasick, 1990)
often treats men as generic; i.e. the literature does not focus on
differing types of men (Guldner, 1985), or focuses only on a couple
of specific issues for men, such as men who have been abusive, or
are identifying as gay or bisexual.
More importantly, this literature specifically lacks research know-
ledge on how working with men in family therapy may be different
given the gender of the therapist and her/his own assumptions about
gender patterns in families. What literature does exist is typically
found in the individually focused counselling psychology area, not in
the specialized field of family therapy. The counselling psychology
literature in North America suggests, generally, that: female counsel-
lors pay attention to issues of challenging the restrictive, traditional
male gender roles; the recognition that the male client is often torn
between two powerful motivations avoiding anything feminine and
the desire to attach himself to a female; and recognition that male
defensiveness requires continual patience on the part of the female
therapist (Birk, 1981; Bograd, 1991b; Carlson, 1981; Ericskon, 1993;
Slive, 1986). It is believed that specific issues for male therapists locate
around issues of power, intimacy and pain (Scher, 1981). A male ther-
apist may have the unique opportunity to be a powerful role-model,
as he may exhibit behaviours, values and beliefs that are not
constrained by the typical male gender stereotype. The male thera-
pist may be an important source of support as the male client
confronts his own socialized limitations to his humanness (Ipsaro,
1986; Morgan, 1981; ONeil, 1981; Reimers and Dimmock, 1990;
Rice, 1978; Scher, 1981; Solomon, 1981; Wong et al., 1976).
Collison (1981) cites research literature which indicates that:
men tend to report greater satisfaction with female counsellors;
Engaging men in family therapy 23
2001 The Association for Family Therapy and Systemic Practice
men tend to do more self-reflecting and self-revealing with female
counsellors; and men tend to have a higher return rate when the
intake worker is a woman. However, recent research suggests the
gender of the therapist is not a statistically significant determinant
in the experience of the male client in couple or family therapy
(Werner-Wilson, 1997).
This clinical literature indicates how mens socialization raises
some difficult issues for therapists working with them in the process
of change. Most of this literature is found in the counselling
psychology and psychotherapy practices of individual oriented ther-
apists. There is limited literature in the family therapy field specifi-
cally exploring therapeutic techniques aimed at engaging men in
the process of therapy and family change. In the family therapy
field, there is a striking absence of literature exploring how the
gender of the therapist may interact with the underlying assump-
tions, conceptualizations and applications of family therapy inter-
ventions when working with male clients in family therapy.
The research reported here specifically investigated what a panel
of expert family therapists (located in North America) believed
would be appropriate and effective techniques for engaging men in
therapy and in the process of family change. This report focuses
explicitly on findings highlighting differences between what the
female and male therapists preferred as techniques to work with
male clients in family therapy.
Methodology
As part of an exploratory study designed to begin the process of
delineating specific gender-sensitive interventions and therapeutic
tools aimed at men, the Delphi Technique was used to tap expert
opinions and to generate hard data (Preble, 1983). Essentially, the
Delphi Technique is a method for structuring group communica-
tion so that the process is effective in allowing a group of individu-
als, as a whole, to deal with a complex problem (Linstone and
Turoff, 1975: 3).
As applied to this study, the Delphi Technique involved a panel
of thirty-six experts, identified from a survey of published literature
in North America, in two rounds of structured communication. In
both rounds, the panelists were asked to consider interventions
they believed would be useful and effective for any family therapist
(either female or male) who was working with men in therapy. In
24 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
addition, in both rounds, the expert panelists were asked to
consider interventions they considered appropriate and potentially
effective with the typical issues presented in family or marital ther-
apy (importantly, the study did not address specific issues, such as
family violence, woman abuse, sexual orientation or those thought
to be associated with particular cultural, racial, ethnic or class
groups). The experts on the panel were generally in positions of
educating, training and/or supervising the next generation of
family therapists in North America. They reported working with a
broad range of family therapy issues and, depending on their
geographic location, some population diversity. However, in this
exploratory research, an in-depth study of differential application
of therapeutic technique and intervention based on particular
identifiers of the clientele was outside the intended parameters. As
such, care should be taken when considering generalization.
Round I (DQI) of the structured communication presented the
panel with 129 suggested interventions for working with male
clients gathered in an earlier study (Avis, 1986), and requested the
panelists to review and submit any new ideas. In round II (DQII)
the panel used a seven-point Likert-type rating scale to indicate the
degree to which they would endorse each of the 339 items, gener-
ated in round I (DQI) as an appropriate and effective intervention
to engage men in therapy and in the process of family change.
The reliability of both DQI and DQII or the accuracy with
which the items represent the opinions the panelists submitted
was established by two independent raters. A sample of a quarter of
the submitted items was randomly selected and checked, first by the
researcher and then by the two independent raters. Inter-rater reli-
ability of 0.99 for DQI and 0.98 for DQII was established by dividing
the number of agreements by the number of agreements plus
disagreements.
Sixty-nine potential panelists were invited to contribute to this
study. Of the forty-three respondents who committed to participate
in round I (DQI), thirty-six (twenty-three women and thirteen men)
completed round II (DQII), and thus qualified for inclusion in the
present study. All thirty-six panelists met the selection criteria based
on the following four considerations for establishing expertise:
possess a degree in a mental health discipline; at least seven years
clinical experience in family therapy, with at least five years spent
integrating mens issues or gender-sensitive ideas into their therapy;
published at least one article or chapter on mens issues or gender
Engaging men in family therapy 25
2001 The Association for Family Therapy and Systemic Practice
issues and family therapy, or feminism and family therapy; and/or
made at least one national convention presentation on gender or
mens issues and family therapy, or feminism and family therapy.
The results of DQII were compiled and statistically analysed for
significance. The theoretical median, first and third quartiles and
the interquartile range were calculated for each of the 339 items.
The median, as the point below which 50% of the responses fall,
yields a measure of the relative degree to which the panelists
endorsed the item. The interquartile range indicated the dispersion
of the middle 50% of the responses as a measure of how widely the
responses differed from one another.
A median less than or equal to 2.00 and an interquartile range
less than or equal to 1.50 determined significance for inclusion of
each item. On the seven-point Likert-type rating scale, a median of
less than or equal to 2.00 indicated that 50% of the responses were
highly endorsed. An interquartile range of 1.50 indicated a rela-
tively high degree of consensus among respondents. Sub-analysis of
responses by gender of the respondent serves as the basis for this
exploration into the differences found between male and female
therapists.
Results
General results of the study indicate sufficient consensus between
the female and male therapists to endorse 131 (or 38.6%) of the
total 339 items in the second round of the Delphi Questionnaire
(DQII). (These results are published elsewhere: see Dienhart and
Avis, 1994.) Of the remaining items, a gender-based sub-analysis
revealed that male therapists endorsed an additional twenty-seven
items as appropriate and potentially effective, while female thera-
pists endorsed an additional thirteen items. This report focuses on
these intervention possibilities and the patterns of difference
between those items endorsed by the male therapists and those
endorsed by the female therapists on the panel. This sub-analysis is
presented in Tables 1 and 2 by gender of respondents. Each table is
organized around the six sub-categories of items in the original
analysis: developing the therapists own perceptual and conceptual
skills; challenging stereotypical attitudes and behaviours; encourag-
ing mutual responsibility for family change; challenging familys
balance of power; encouraging affective expression in men; and
structuring treatment.
26 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
TABLE 1 Male panelists items endorsed (by sub-category)
Developing therapists own perceptual and conceptual skills
Mdn IQR
1.200 1.150 Neutralize your own anti-male biases and stereotypical
notions about men.
1.278 1.361 Recognize the values of the masculine mystique.
1.136 0.636 See men, as well as women, as victims of our gender myths.
1.278 1.361 Develop an understanding of sexual issues for men, espe-
cially the performance emphasis linked to power and
pornography; and, how genitally based sexuality is for
many men.
1.278 0.986 Examine the multiple contexts of the man in interaction
with his world; for example, men and fathers/fathering;
men and male friendships systems; men and women rela-
tionships, both intimate and non-intimate; men and the
work system; men and sexuality; men and creativity (non-
work-oriented energy flow, etc.).
1.700 1.317 Develop and maintain a balanced interpretation of the
reciprocity of male and female role behaviour.
1.500 1.375 Become aware of and avoid patterns of competing with the
male client.
Challenging stereotypical behaviours and attitudes
Mdn IQR
1.700 1.317 Impart solid, factual data on malefemale differences
pertaining to a given presenting issue.
1.278 1.361 Point out the pros and cons of things staying the same.
1.500 1.375 Point out how men use rationality and conflict to approach
problem resolution.
2.000 1.375 Help men to recognize and reap the benefits of tradition-
ally female behaviours, rather than condemn them for
macho attitudes.
1.500 1.375 Have fathers take administrative responsibility for their
children.
1.278 1.361 Do not patronize men by telling them that their contribu-
tion is better than anyones, or that they are an expert on
raising boys, or any other contrived booster.
Encouraging mutual responsibility for family change
Mdn IQR
1.375 1.188 Have the couple assess and evaluate the fairness of the
current division of responsibilities.
1.500 1.375 Ask what the present arrangement reflects about their rela-
tionship.
Engaging men in family therapy 27
2001 The Association for Family Therapy and Systemic Practice
TABLE 1 Continued
Mdn IQR
1.200 1.150 Model an equal balance of power by spending equal time
talking to, attending to, and considering men and women.
1.278 0.986 Highlight the strong feelings of responsibility that the
husband/father has for the family by validating his unique
ways of showing it.
1.500 1.375 Ask the man whether or not his abusive behaviour is
successful in meeting his own needs. Pointing out the lack
of success of their own way is a powerful motivator to learn
new ways.
1.278 1.361 Assist the husband to identify feelings and reactions as
distinct from what he might typically say out loud.
Challenging the familys power balance
Mdn IQR
1.833 1.217 Discuss how his power can lead to a wide assortment of self-
destructive behaviours.
Encouraging affective expression in men
Mdn IQR
1.136 0.636 Assume that both the man and the woman need help in
learning to effectively communicate emotional expression.
1.375 1.396 Teach men the difference between feelings and thoughts.
1.375 1.188 Recognize and respect the shame inherent in many mens
expressions of vulnerable states.
1.375 1.396 Re-establish contact with hurt parts of himself and hurtful
experiences through exploration of his family of origin; for
example, when hurt, grazed his knee, etc., where did he
turn?
1.375 1.396 Explore male bonding patterns by pursuing discussion of
relationships that the male client has had with other men
in youth, school, military, etc.
Structuring treatment
Mdn IQR
1.375 1.396 Call the man yourself; let him know his presence is impor-
tant.
1.625 1.396 Be persistent in contacting men in systems (Stanton and
Todd found that when men are called five times or so, the
rate of their participation in therapy increases by nearly
50%).
28 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
TABLE 2 Female panelists items endorsed (by sub-category)
Developing therapists own perceptual and conceptual skills
Mdn IQR
No additional items. See Dienhart and Avis (1994) for list
of consensus items.
Challenging stereotypical behaviours and attitudes
Mdn IQR
1.350 1.500 Analyse the mans unexamined value system with him.
1.375 1.500 Organize therapeutic interventions around what is repara-
tive not only for the child (identified client) but also the
mans missing experience in his original family.
Encouraging mutual responsibility for family change
Mdn IQR
1.233 1.008 Be sensitive to what is on the list of mutual responsibility,
especially noting whether it includes the often invisible
work of emotional tension management, kin-keeping
activities, etc.
1.346 1.277 Ask family members about why or how mum became the
designated person to take responsibility for the family.
1.643 1.379 Repunctuate sequences away from a focus on womens
enmeshment (or similar patterns) and place greater
emphasis on mens behaviour; for example, instead of
woman nags/man withdraws state woman makes request
for greater emotional contact/because of mans relative
inexperience in this he falls silent as a way of negating the
legitimacy of her request.
1.414 1.442 Use rituals specifically designed to frame responsibility for
change as belonging to both the woman and the man (e.g.
odd/even days can frequently accomplish this).
Challenging familys power balance
Mdn IQR
1.643 1.379 Minimize the tendency to stigmitize and infantilize the
men in poor families which are involved with social service
agencies.
Encouraging affective expression in men
Mdn IQR
1.500 1.417 Enable men to identify and label the different feelings of
emotional responsivity and emotional fusion.
1.643 1.379 Suggest again and again that men dont have to live in
emotional isolation, overburdened, etc., and that he can
pursue alternatives.
Engaging men in family therapy 29
2001 The Association for Family Therapy and Systemic Practice
TABLE 2 Continued
Mdn IQR
1.813 1.313 Devote entire sessions of mens groups to the exploration
and expression of certain kinds of feelings; for example,
have separate sessions of mens groups to look at tender-
ness, fears and anxieties, what produces joy, what are active
or passive feelings and behaviours.
Structuring treatment
Mdn IQR
1.500 1.417 Contact men directly regarding appointments so as not to
allow all appointment-setting to be the womans responsi-
bility.
1.286 1.441 Make it a policy that the man reschedules appointments
when his schedule conflicts and the woman reschedules
when hers conflicts.
1.455 1.423 When the male client asks for an appointment later than
your usual schedule to accommodate his business, state
clearly your unavailability at that time.
Discussion
Interpretation of the study results must be set against the backdrop
of the selection criteria. The selection criteria specifically required
some evidence that panelists have been recognized for their inter-
est in and contribution to moving the field of family therapy
towards developing a greater sensitivity of gender issues and how
they may play out in families. Given their leadership roles in devel-
oping the feminist critique of traditional family therapy, 95% of the
female panelists self-identified as either feminist or feminist-
informed. Though many of the male panelists also contributed to
the critique of gender neutrality in family therapy theory and prac-
tice, only 16% self-identified with feminist ideology. Sixty-two per
cent of the male panelists preferred a gender-sensitive ideology
(compared to only 4% of the female panelists), with another 22%
as non-specified. These self-identified ideologies most likely influ-
ence some of the subtle differences in the ideas and interventions
found between the female and male panelists. In particular, a femi-
nist ideology explicitly examines power relations and the underly-
ing assumptions that keep inequitable gender structures in place in
families and in society, whereas it is believed that a gender-sensitive
stance looks more broadly at the relations between genders and
30 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
promotes mutual understanding. It is difficult to discern, however,
whether the results in this study resonate these important differences
or some other politically situated difference, such as an implied
injunction against men referring to their ideology as feminist.
Developing the therapists own perceptual and conceptual skills
The highest level of consensus between male and female therapists
was found in the areas dealing with a therapists basic perceptual
and conceptual skills regarding gender. This area was also rated, by
both female and male panelists, as the number one priority in devel-
oping a gender-sensitive approach to working with men in family
therapy. These basic perceptual and conceptual skills have to do
with what goes on in the mind of the therapist (Tomm and Wright,
1979). Thinking skills are a prerequisite to executive skills, and are
typically so intricately and integrally intertwined that they are diffi-
cult to separate. Expanding the therapists view of how socialization
may affect both men and women, client and therapist, is essential in
conducting gender-sensitive therapy. Engaging in values clarifica-
tion, generally, and specifically with regard to the socializing influ-
ences regarding men and masculinity, was highly valued by both
female and male panelists. Such a perspective is in keeping with the
feminist critique of family therapy (Feldman, 1982; Goldner, 1988;
Hare-Mustin, 1978, 1987; Hines and Hare-Mustin, 1978; Jacobson,
1983; James, 1984; James and McIntyre, 1983, 1989; Taggart, 1985),
and is in keeping with the recommendations of Erickson (1998)
and others (McDaniel et al., 1995).
Seventy per cent of the original items in this category were
endorsed as significant by both female and male panelists, suggest-
ing the paramount importance of the therapist uncovering the
subtleties of his or her own gender socialization in developing the
basic awareness of gender issues. Despite the general consensus, a
difference between male and female panelists was found. Male
panelists selected an additional seven items as appropriate and
potentially effective; sub-analysis by gender of panelists did not
reveal any additional items selected by female participants. Qualita-
tive interpretation of these items (Table 1) suggests the male
panelists value developing therapists awareness that specifically
uncovers the potential for the therapist to hold subtle anti-male
biases. Embedded in these items is the male panelists recognition
that socialization into being male is not a monolithic experience,
Engaging men in family therapy 31
2001 The Association for Family Therapy and Systemic Practice
nor one that is always consciously chosen. The items selected by
male panelists feature a tone of approaching gender sensitivity from
a balanced perspective, one that sees both women and men as,
perhaps unwittingly, performing gendered patterns which may limit
their abilities to have satisfying relationships, especially with their
partners and children. One item endorsed by the male panelists
explicitly recognizes the potential for competitive patterns to
develop when a male therapist is working with men in family ther-
apy. This finding is consistent with issues identified in the coun-
selling psychology literature (Scher, 1981).
Challenging stereotypical attitudes and behaviours
Male and female participants agreed on 36% of the interventions
suggested for challenging stereotypical attitudes and behaviours
(see Dienhart and Avis, 1994). In this area, the male panelists again
endorsed more additional items than the female panelists (six
compared to two). Interpreting the differences between the
endorsements of male and female panelists in the area of challeng-
ing stereotypical attitudes and beliefs, there is a difference in how
the men and women on the panel see the root of problematic atti-
tudes and behaviours.
In the selections of the male panelists there is a tendency to
favour sharing concrete information with family members about
trends in gender patterns found in our society, while implicit in the
female participants selections is a focus on the individual mans
attitudes and behaviours. The male panelists also selected items that
may require the therapist to use insider knowledge about being a
male in the world to inform and challenge the man in the family. At
the same time, there is a blend of using direct and subtle chal-
lenges. The direct approach has the therapist pointing out the
potentials and pitfalls of the current situation, while the more
subtle approach uses the mans own experiences to embed a thera-
peutic challenge. The notion of inviting men to explore alternative
benefits in behaviours typically associated with women, rather than
directly confronting and condemning traditional male behaviours,
is another subtle way of challenging existing beliefs and behaviours.
Sub-group analysis resulted in two interventions being favoured
by the female panelists alone. One intervention, suggesting that the
therapist work towards making explicit the implicit in a mans value
system, may open space for exploring, and ultimately changing
32 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
attitudes and behaviours. The second item suggests that unresolved
issues in the mans family of origin may need to be addressed when
working with an identified child client.
Encouraging mutual responsibility for family change
In the category addressing mutual responsibility for change in the
family, female and male panelists agreed on nearly 60% of the
items. An earlier study (Avis, 1986) suggested that this area was a
major issue in developing a model of gender-aware family therapy.
In accord with earlier literature (Goldner, 1985; Hare-Mustin,
1978), the items here go beyond a basic structural move of altering
the effectiveness of the parental subsystem by bringing the
husband/father in from the periphery. The items selected focus on
broadening the definition of the problem to address gendered
patterns in the division of labour over a wide spectrum of family life.
Sub-group analysis resulted in both female and male panelists
selecting several further items (see Tables 1 and 2). The four items
selected by the female participants alone focus more on pointing
out the position of the woman in the family and inviting a review of
how she came to carry primary responsibility for family life, espe-
cially the subtle activities of emotional management and kin-keep-
ing. The female participants also favoured an intervention that
specifically placed more responsibility on the man for perpetuating
problematic patterns. While highlighting the mans responsibility
in punctuating problematic gender patterns of interaction, the
suggested alternative contains some sensitivity to how a mans rela-
tive inexperience in the area of emotional contact may place him at
a disadvantage. Female participants selected an item suggesting use
of concrete ways (odd/even days) to involve men in new (for him)
family responsibilities.
The five items endorsed by the male panelists alone again suggest
an underlying expectation of looking more generally at the fair-
ness of present arrangements, as opposed to focusing on the
inequity of the womans position. The focus on modelling equality
in the session was consistent with their selections in other cate-
gories. While holding a concern for balancing between focusing on
the man and the woman, the male panelists also selected several
items that would focus directly on the mans experiences and his
potential for changing. A few of the selections made by the male
panelists reveal sensitivity to the embedded affective experiences of
Engaging men in family therapy 33
2001 The Association for Family Therapy and Systemic Practice
men in families, especially with regard to the unique ways a man
may show his deep feelings of responsibility for his family. This
perspective is quite consistent with emerging fathering literature
(Hawkins and Dollahite, 1997). The male panelists were sensitive to
the ways men in families may experience feelings that are not
expressed. Working with the man to assist him with distinguishing
his feelings and to examine what he may say or do to obscure his
feelings was another way the male panelists may work directly with
the man towards producing change in family interaction patterns.
Challenging the familys balance of power
The area of challenging the familys balance of power was one
where female and male participants agreed on only one-third of the
suggested items. Low consensus was not limited to the whole panel.
This category had low consensus between the male and female
panelists, between female panelists alone, and between male
panelists alone. Sub-group analysis resulted in the endorsement of
only two additional items, one each for the female and male sub-
groups.
The feminist critique of family therapy has clearly challenged
assumptions of neutrality and raised awareness of potential power
differences in families related to gender. However, there remains
disagreement in the field as to the meaning of power and how
gender-based power dynamics may play out in families. The items in
this category generally suggested that family therapists go beyond
addressing issues of who performs what responsibilities in the
family, to addressing issues of rule-making and control. While chal-
lenging mutual responsibility for family change (discussed above)
deals with behavioural change, challenging power patterns in the
family focuses more on who defines the familys rules, that is in the
realm of second-order change. Male and female panelists generally
agreed upon interventions that raised and explored mens blatant
abuses of power in the family, even where physical abuse was not
present. Attention to exploring the familys economic and financial
arrangements and decision-making rules about family resources
were favoured by both female and male participants. The general
panel recognized the importance of redefining power to include
the power to care for and the power to connect. Although both of
these behaviours tend to be associated more with feminine traits in
our society, they are increasingly recognized in the literature as an
34 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
important area of power in family interactions (Krainchfeld, 1987).
In efforts to challenge stereotypical attitudes and behaviours
(discussed above), the male panelists favoured using the benefits
associated with these traditional feminine abilities to help men
change. Here, recognizing these abilities in women may open up
space for both the man and the woman to talk about their subtle
experiences of having different power bases in the family. Such
exploration may lead both the man and the woman to make adjust-
ments in their specialized power bases, thus potentially opening up
space for a different power balance to emerge in the family. The
female panelists were particularly sensitive to how experiences of
poverty could erode a mans sense of place in his family.
Encouraging affective expression in men
The most striking differences between the female and male
panelists were found in the area of encouraging affective expression
in men. Generally, the male participants ranked this category as
their second priority (after attention to developing the therapists
own awareness regarding gender issues), possibly suggesting that
male therapists recognize the leverage to be gained by joining with
men at the affective level. The female panelists rank this category
fifth among the six categories, suggesting that the women prefer to
address a male clients affective experiences only after the family is
sharing responsibility for change and restructuring its balance of
power.
The low ranking of this category by the female panelists raises the
question of whether a similarly low ranking would result if the target
clientele were women, as opposed to men in families. It also raises
the question of whether the results reflect assumptions specific to
working with men springing from socialized stereotypical notions
about men and feelings. It may be that the women on the panel see
little chance of effecting change in mens affective expression. This
stance is articulated by Ellman et al. (1989). They note the pitfalls of
attempting to deal with male affective expression in therapy.
Commenting on the stereotypical unfeeling man, Ellman et al.
warn therapists to steer clear of intervening unless and until the
man himself has identified his lack of emotionality as a problem for
himself. They suggest that this usually comes quite late, if at all, in
the therapeutic process. If the relatively low ranking by female ther-
apists is not gender specific, i.e. if affective issues would enter late,
Engaging men in family therapy 35
2001 The Association for Family Therapy and Systemic Practice
if at all, in the therapeutic process regardless of the clients gender,
it raises questions about the impact and efficacy of family therapy
training in a traditional male model. Female therapists trained in
the techniques of many family therapy models, especially the tradi-
tional structural and systemic models, may learn to question their
relational capacities and connecting approaches; they may learn to
rely on a more distant and authoritative posture with clients (Caust
et al., 1981). Goodrich (1989) noticed this tendency in her work
with women therapists. She believes that female therapists should
be encouraged to claim their personal authority and to do therapy
in a way that feels most natural to them as women. Interestingly,
Goodrich does not comment on fostering these abilities in male
therapist trainees.
If the low ranking of this category by female participants is
gender specific, it raises another question: What might account for
the difference in their work with men and women? The women on
this Delphi panel primarily identify with a feminist ideology, as
opposed to a gender-sensitive ideology. As feminist family thera-
pists, they are most likely deeply concerned with challenging the
sociocultural inequities of patriarchy and male power and privilege.
Thus the feminist assumption that the personal is political may
account for the higher priority placed on addressing issues of
mutual responsibility and the power balance in the family. Within
this framework, might it be seen as letting the man off the hook or
providing an excuse for not changing if the therapist too readily
and openly identifies with his pain? The risk in readily identifying a
mans affective experiences may be seen as averting attention from
the underlying power dynamics and perhaps regenerating, in the
therapy context, sociocultural patterns of women pursuing and
nurturing male expressiveness. This potential is noted in the coun-
selling psychology literature (Collison, 1981); it might be even more
contentious when working with male clients in the context of family
therapy. None the less, Erickson (1998) believes that family thera-
pists must move beyond potentially constraining notions of
masculinity, and stereotypical gender relations, if we are to act ethi-
cally in our work with men in families.
It is not clear whether the sub-group of female panelists actually
leave affective issues until late in therapy and/or wait until the male
client self-identifies it as a problem. Other literature addressing
complex issues encountered when working with populations of
males who are involved in abusing their family members both as
36 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
spouse abusers and incest perpetrators suggests that female ther-
apists are finding ways to use affective issues to connect with the
client and then to confront him with the destructiveness of his
controlling and dominating behaviours (Pressman, 1989; Wheeler,
1989). This literature suggests that a female therapist may enhance
her personal authority with genuine empathic and caring connec-
tions to the male clients pain, thus gaining leverage to challenge
him about his behavioural choices. The nuance of such a combina-
tion requires a therapist to confront without blaming, support with-
out over-identifying, be angry without punishing, and be political
without being over-bearing (Ault-Riche, 1988: 178).
The sub-group of male panelists ranked encouraging affective
expression in men higher (ranked as second among the six cate-
gories) and endorsed more items than did the female sub-group. In
this category, as with the previous categories, male panelists selected
and endorsed an item suggesting an acute sensitivity to avoiding the
temptation to see a problem in the emotional area of family life as
primarily residing with the man. The item assume that both the
man and the woman need help in learning to effectively communi-
cate emotional expression clearly implies shared responsibility for
changing patterns of affective expression in their family. The
themes underlying the particular interventions may indicate that
the male therapists on this Delphi panel have a unique perspective
on the individual male experience and how, if not addressed, affec-
tive issues may serve to block change in the family. The male
panelists identify shame and socialized injunctions against
emotional expression as underpinning much that appears in the
form of power dynamics in the family. They endorsed interventions
which suggest that the therapist should recognize and respect the
socialized sense of shame inherent in a mans expression of vulner-
able states and begin to untangle the web of complex feelings which
typically get expressed as anger. These items suggest that a stroke
then challenge approach can be enhanced by identifying, validat-
ing and normalizing the affective issues which keep him trapped in
patterns of male control and dominance. The impact of having
these feelings validated and normalized, as well as being chal-
lenged, may be increased, since it is coming from a male therapist.
This insider perspective may also serve to break the socialized
injunctions against affective expression and vulnerability (Ipsaro,
1986; Morgan, 1981; ONeil, 1981; Scher, 1981; Solomon, 1981).
Further, openly addressing affective issues is an opportunity for the
Engaging men in family therapy 37
2001 The Association for Family Therapy and Systemic Practice
male therapist to model alternative modes of living, thus teaching
the power of connecting, caring and nurturing (Ipsaro, 1986;
Morgan, 1981; ONeil, 1981; Rice, 1978; Scher, 1981; Wong et al.,
1976).
Structuring treatment
The last category, interventions for structuring treatment, was
clearly considered the sixth priority by both female and male parti-
cipants. While structuring treatment may be the first order of busi-
ness when actually doing therapy with families, it is not surprising
that the panelists considered this to be the least important area of
consideration, relative to the other five categories.
The panel generally agreed that the therapist should include the
man in the family in the therapy. Both male and female participants
agreed that the therapist should challenge men to examine their
priorities around setting therapy appointments. The female sub-
group differed slightly in the manner in which they pursued these
objectives. Female participants identified the need to set definite
limits on the therapists flexibility, especially around requests to
accommodate his business schedule and cancellation and/or re-
booking appointments. Although the male and female sub-groups
both agreed with the need for the therapist to call the man to stress
the importance of his attendance, the male sub-group was more
willing to call several times to engage the man in therapy.
Only one of the twenty items suggesting varying treatment
modalities was selected by the panel: educate where relevant.
Neither the male nor female sub-group endorsed any of the five
items specifically suggesting using male groups to raise conscious-
ness about the traps of stereotypical attitudes and behaviours. (It
should be noted, however, that this type of modality is embedded in
an item endorsed by women in the area of encouraging male affec-
tive expression.) This finding was somewhat surprising in light of
research identifying mens groups as the treatment of choice when
working to change the attitudes and behaviours of abusive males
(Adams, 1986; Gondolf, 1987; Gondolf and Hanneken, 1987; Saun-
ders, 1984).
Several other items which have been used extensively with
women (e.g. keeping personal process journals, using popular
media analysis to deconstruct gender scripts, bibliotherapy, encour-
aging creative pursuits, or using intensive retreats to work through
38 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
socialization issues, etc.) were not endorsed by either the male or
female sub-panel. It is not clear whether these approaches are not
well suited for male clients, or whether the typical view of the resis-
tant male client has narrowed our point of view of what can serve
as effective treatment with men. It may be that the traditional view
of family therapy meeting with the couple or the whole family is a
bias against modalities which work with an individual member, even
if individual work could be in the service of changing family
patterns.
Conclusions
The results of a gender-based sub-group analysis of this Delphi study
exploring ways to engage men in family therapy reveal some differ-
ences in the degree of endorsement and the degree of consensus
between male and female panelists. Though the differences
between female and male panelists were generally not large, inter-
preting subtle differences in items selected and endorsed by the two
gender-based sub-groups revealed some interesting trends. The
following discussion of these minor differences is tentative and
quite specific to this highly selective panel of North American
family practitioners.
First, the female panelists endorsed more items that addressed
issues of power and privilege held by men. The male panelists
endorsed more items that validated mens vulnerabilities and the
burdens of that power and privilege, as well as items that seemed to
question mens volition in maintaining oppressive social structures.
Some of these differences may arise from the women on the panel
coming to their feminist or feminist-informed orientation via recog-
nizing and challenging the power inequities inherent in patriarchy.
The female therapists on the panel would likely remind us how men
are not aware of how much social structure yields advantages for
them (Goode, 1982: 137). In general comments noted at the end
of the Delphi study, one male panelist articulated a potential root of
some of the differences revealed in the sub-group analysis. He
commented that perhaps if men could acknowledge their position
of sociocultural privilege, women could more readily connect with
mens pain. For this group of female feminist-minded family thera-
pists, it may be a question of how to separate the individual experi-
ence without losing a sociocultural context of the collective.
Second, women panelists endorsed items suggesting a more
Engaging men in family therapy 39
2001 The Association for Family Therapy and Systemic Practice
direct confrontation of the male clients position and contribution
in the family, while male panelists endorsed more items which
stressed mutual responsibility for change, mutual participation in
therapy, and mutual participation in the presenting issues. The
female sub-group tended to be sensitive to traditional woman-blam-
ing bias, and endorsed items which challenged the familys propen-
sity to see the family and the presenting issues as the womans
responsibility. The sub-group of male panelists seemed to be sensi-
tive to any implicit blame directed at men, as well as, perhaps, being
defensive about any suggestion that men are any more responsible
than women for the development or maintenance of family
patterns.
Third, the men on the panel seemed to identify more frequently
with the pain and isolation associated with male socialization and
endorsed more items which directly addressed these issues or
implied the importance of uncovering mens affective lives. The
female therapists on the panel did not place high priority on work-
ing with mens affective expression.
These tentative results give the impression that, although they
may be coming from different vantage points, both men and
women on the panel are committed to working at breaking down
the nuances of socialized gender differences. The results may indi-
cate that the women on the panel were generally expressing the
influence of what Doherty (1991) has called the pervasive a deficit
perspective of viewing men and masculinity found in much of the
family science literature. Some of the items endorsed by the male
panelists suggest that the male therapists on the panel were express-
ing a resource-based perspective that has emerged more recently in
the fatherhood literature (Dienhart, 1998; Doherty et al., 1998;
Hawkins and Dollahite, 1997).
The results for the male and female sub-groups may reflect
perceived differences in what a male and female therapist can do in
the therapeutic session, given the traditional gender disparity in
power and authority that is part of our cultural inheritance. This
sub-group analysis, by gender of respondent, suggests that the
stereotypical dynamics of power and pursuer-distancer patterns can
make it more difficult for female therapists to pursue mens affect
and vulnerability in therapy without falling into the trap of taking
care to protect a mans feelings, or experienced as being another
woman who is pushing him to be expressive when he may feel unfa-
miliar with or feel inadequate in this area. Male therapists enter on
40 Anna Dienhart
2001 The Association for Family Therapy and Systemic Practice
a more equal footing, and can break with traditional dynamics if
they pursue mens vulnerability and connect with their pain.
The selection criteria for participants in this Delphi study specif-
ically required the prospective panelists to be highly educated lead-
ers in the field of family therapy, particularly with regard to raising
issues of gender-based dynamics in families and family therapy.
These selection criteria necessarily limit generalization. At the same
time, this study offers a unique perspective on how therapists and
educators in North America who are intentionally adopting gender-
aware approaches in their family therapy practices, and are working
to engage men in a family therapy that holds men mutually respon-
sible, along with women, for family change. This initial enquiry has
contributed to developing some understanding of the importance
of family therapists taking to the therapeutic setting an acute aware-
ness of gender issues, as well as of his or her own gender socializa-
tion.
Though the sub-group analysis results for male and female
panelists are exploratory, they suggest some broad-reaching impli-
cations for further research, training and clinical practice in family
therapy. The results of this study suggest that we must not only re-
think our stereotypical notions about women in families, but that
we must take a closer look at how our family therapy models
constrain our understanding of men and their patterns of interac-
tion, and how our own gender socialization, as a male or female
therapist, may differentially influence how we work with men in
family therapy.
Training programmes in family therapy must integrate material
on male socialization. Training should focus on both heightening
trainees awareness of their own gender socialization, and on bring-
ing a gender lens to conceptualizations of all case material. Mater-
ial related to gender should be integrated into every course, as well
as explored in depth in a separate course (Avis, 1989). Trainees will
need opportunities to examine the subtle expectations of male and
female roles embedded in their family-of-origin relationships. Inte-
grating gender awareness in clinical practice and supervision means
examining interventions, including the repertoire of joining and
executive skills, for the nuances of gender in their messages and
meta-messages.
For practitioners already offering family therapy to clients, read-
ing the growing body of literature on male socialization and mens
writings on men would be an important step in developing a gender
Engaging men in family therapy 41
2001 The Association for Family Therapy and Systemic Practice
awareness in their work with men. Attending workshops on gender
issues in therapy and using peer supervision to analyse implicit
gender content embedded in their work are other options.
Further research is needed into questions such as: What are some
of the differences in mens experiences of family therapy when (1)
a male or (2) a female therapist does and does not pay attention to
their underlying affective experience; using a general panel of
family therapists (i.e. without specific focus on an ideology sensitive
to gender issues), how do the results compare with the results from
this study, especially on the issue of encouraging affective expres-
sion in men; and what are some of the differences men in therapy
report regarding how they perceive (1) the person of the therapist,
and (2) the effectiveness of therapy in family therapy with (1) a
male, or (2) a female family therapist who is specifically focused on
facilitating a change in the familys balance of power.
The field of family therapy has certainly paid more attention to
issues of gender in family therapy over the past decade. The results
of this Delphi study, specifically the sub-group analysis based on
gender of the therapist presented here, suggest that paying atten-
tion only to the gender of the client is not sufficient; we need to be
aware of how the gender of the therapist may influence what inter-
ventions are favoured when working with men in family therapy.
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