Review of Practice Guidelines for Men and Boys

Peer-Review of Draft Guidelines for Psychological Practice with Boys and Men

I read with great interest the draft guidelines guidelines for psychological practice with with boys and men. I appreciated the hard work and time (13 (13 years) that went into this. I also appreciated some of the important points the draft guidelines bring up, such as the importance for therapists to be familiar with working with men and boys bo ys who may be non-traditional in their approach to masculinity. However, I felt that the good messages get lost in a lot of potentially anti-male rhetoric that I suspect might be offensive to many men (and women) particularly those who identify as “traditional.” Indeed, much of the manuscript is is quite repetitive and tends tends to read a bit like a screed against traditional masculinity masculinity rather than a thoughtful, thoughtful, objective piece. Also, literature on the neurobiological origins of gender are a re missing, and more tangentially, the piece tends to make sweeping generalizations about other controversial areas (such as claiming media violence viewing is a risk factor for aggression, a belief increasingly in doubt) that detract from the article’s central points. I hope my following observations will be viewed as constructive, even where critical, which is my intent. As one issue, the document uses copious c opious use of progressive jargon throughout: power, privilege, intersection, “perform masculinity”, microaggressions (but microaggressions (but see the recent exchange between Lilienfeld and others in PPS on the limitations of this this concept.) Much of this was presented presented uncritically and without addressing addressing the controversies behind some of these concepts. Much of this language would also tend to be identified mainly with the progressive movement, which tended to make it feel more ideological ideo logical than scientifically objective and neutral. That’s not necessarily a bad thing, but ultimately will limit the audience, and can appear to be appealing to certain constituencies rather than maintaining careful, neutral and objective language. Early on the manuscript makes a hard distinction between gender and sex which is not uncommon, of course. However, these authors make a hard hard differentiation between the two that, again, appeared more ideological than a careful consideration of their overlaps and differences. Further, throughout the manuscript, the authors solely consider gend er as an outcome of socialization despite a fairly wide range of literature that suggests a neu robiological origin for gender identity, particularly in the sexually dimorphic limitation limitation of the hypothalamus. This was a major oversight that makes the document appear either uninformed or purposefully neglectful of certain bodies of literature. Probably the document’ document’s main weakness is that much of it, instead of reading as an actual  practice  practice guideline, tends to read as an invective against “traditional” masculinity…although at times the authors also switch the language to “h egemonic” or “sexist” masculinity…at one point dropping qualifiers altogether to imply just “masculinity” is associated associated with negative outcomes. The language about “traditional” “trad itional” masculinity is often put in very stark terms, implying significant links with negative outcomes (although we are neve r informed about effect sizes) that could not be explained by third variables variables such as harsh family environment, genetics, etc. To me, this did not read like a fair and objective literature review by disinterested disinterested scholars. I am also concerned that, for a document that theoretically is designed to reduce stigma of men and masculinity (which it does admirably for non-traditional masculinities) the document, if

anything, runs the risk of promoting stereotypes and prejudices of “traditional” men (and  possibly also women who view themselves as more traditional.) In this sense, I am concerned that were clinicians to actually take these guidelines seriously, the y could actually do more harm than good as far as “traditional” men are concerned. concerned. This could come through increasing practitioner biases toward “traditional” men, advo cating therapies therapies that are not too different from other problematic “conversion” therapies for those who do not adhere to a set of rigid gender norms n orms (ironically, in this case, gender norms enforced by a progressive movement opposed to traditional masculinity), as well as actuall y making therapy LESS attractive to men, even as the authors rightly point out that men are less likely to seek help. In some cases, the insinuated linkages between tra ditional masculinity and some outcomes seemed little more than speculations, and were difficult to endorse (e.g. learning disorders, African American men turning to gangs because becaus e they are excluded from traditional Eurocentric masculinity, etc.) In general though, in sweeping terms, traditional men are portrayed as nearly monstrous, their cultural values associated with everything from sexism to promiscuity to their own declining health (which essentially places blame on them, something we generally try to avoid with other groups). I think a lot of men with traditional values would be shocked to learn, for instance, instance, that they were promiscuous, didn’t value women’s rights, were incapable of making deep friendships, or finding non-violent ways to solve problems. Surely, traditional masculinity also has many  positive features, none of which are recognized in this document. This puts this document in the ironic position of not following its own main guideline: to be culturally sensitive to those in need of treatment. Again, the unfortunate element is that the guidelines make excellent points about reaching out to non-traditional non-traditional men. It’s unfortunate that the guidelines do not seem intent on extending the same courtesy to traditional men. Again, also the document keeps emphasizing socialization as a causal element and neglects wide  bodies of research on the evolutionary and neurobiological origins of male gender and behavior. The authors make a few swiping statements about media effects both related to violent media and aggression, and later to body image/muscularity ideal. Both of these areas are VERY controversial, and certainly not well represented by sweepin g statements that assume effects are absolute truths. These statements should be removed. removed. At times the guidelines appear to push clinicians to challenge traditional masculinity or challenge “male privilege”. privilege”. But this appears to be a progressive progressive advocacy agenda, not a clinical goal. I doubt it is productive to push clinicians to make this a standard goal for treatment with “traditional” men. I have skepticism that a male who comes for treatment treatment for depression is going to benefit much from discussions of his privilege, for instance.

The document also uses a lot of language that appears to remove agency from men, once again, traditional men in particular. For example, “By “By the time he reaches adulthood, a man will tend to demonstrate behaviors as prescribed by his ethnicity, culture, and different constructions of masculinity.” masculinity.” I find that a pretty bleak view of the human condition…I’d ar gue gue we’re not merely machines programmed by b y our cultures (or biology either.) Other issues such as intimate partner violence are more complex than presented in this document (there is, for example, considerable evidence to suggest both men and women, heterosexual and homosexual, etc., perpetrate intimate partner violence in about equal proportions.) Many of the terms are often vague such as “sexist constructions of masculinity”…how is this defined, exactly? Isn’t this rather subjective? The document is also rather repetitive throughout. This makes it somewhat difficult to read. Guideline 10 appears to be largely an advocacy goal, not practice guideline. Why is in a document that is ostensibly a practice guideline? Text is suddenly blue, page 53. I do want to conclude b y emphasizing that the manuscript does have some important points about opening up therapy to non-traditional non-traditional males. But this shouldn’t come at at the cost to traditional males. As it currently stands, I think this document might make an interesting debate  paper (although it still is rather repetitive repetitive and has other issues). But it lacks the objectivity,  balance and breadth of literature review, and concern for all backgrounds (rather than just some) that would be necessary for an APA endorsed practice guideline. Further, I suspect that, if clinicians were to implement some of the recommendations, the potential for harm to some clients is non-trivial. I’ll note, for what it is worth, I do not consider m yself a “traditional” male (at least how the authors seem to define it) or conservative. I recommend against acceptance of this document as an APA practice guideline, but do encourage the authors to take some of my concerns to heart and see if they could improve it. Signed, Chris Ferguson