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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Culturally Competent Care for Men

Duncan Shields, MA, RCC

Reprinted from the "Culture" issue of Visions Journal, 2014, 9 (4), p. 28

Mental health professionals are becoming increasingly aware that a person's culture shapes their identity, values, attitudes and beliefs in key ways. These cultural differences can also shape how people experience mental health challenges, what they believe about the meaning of the challenges they face, and what they feel would be helpful for them as treatment or healing. While mental health counsellors and clients may not share the same cultural background, it's important that counsellors respect the cultural background of the clients they work with, and be open to discussing how care can best “fit” the client. Counsellors need to be "culturally competent;" that is, speak and work with their clients in ways that make sense to the client and that don't alienate them.

Feminist theorists have suggested that—in addition to what we normally think of as cultures, such as South East Asian or White Anglo-Saxon and so on—female gender (femininity) can also be understood as a kind of culture. This culture shapes societies' expectations for females and can affect attitudes, opportunities, power in relationships and identity. For decades, university counsellor training programs have prepared mental health professionals to consider these kinds of impacts when working with female clients.

The mental health profession, however, has been slow to consider what effect male gender (masculinity) has on attitudes, opportunities and power in relationships when men experience mental health challenges.

It's important to be clear about the differences between the terms, gender and sex, two central parts of our identity that are frequently confused. Sex describes the biological makeup of the male and female body, while gender refers to a series of social roles and behaviours we begin to learn as children and are exposed to throughout our lives (e.g., masculinity or femininity).

While some functions, particularly reproductive, are determined by biology, all cultures have behaviour norms for males and females. These behaviour norms extend into every area of work, family life and social convention.1 Each culture or social group may have slightly different expectations for the masculine and feminine role, but they are usually significant parts of how individuals in that social group understand themselves and their role in the world.

Most of us learn to comply with the dominant gender expectations of our social group at an early age and, if we examine them at all, come to view these norms as natural and normal.2 However, within each male or female social group, individuals may identify very closely with gender expectations, or they may not feel the need to conform. We refer to those who conform closely to gender expectations as "traditional."

"Traditional" men

Traditional men have not been served well by our mental health system. In part, this is because we've been slow to recognize masculinity as "culture" and to consider that culture respectfully. Two decades of clinical work with men, and my recent research and work in developing the curriculum for a national program for male veterans returning from service, have given me insights into how viewing these clients through a lens of "cultural competence" can help us understand how to adapt our services to better meet the needs of male clients.

Over the years, researchers have proposed many models of ideal masculinity. In 2006, a review of the research on male gender norms noted eight prized attributes that define the ideal of masculinity in many cultures. These include: toughness, intensity, strength, competition, discipline, courage, sacrifice and aggressiveness.3 Such ideals are often emphasized and exaggerated in settings where men take on demanding work in dangerous or difficult environments such as the military, policing or other traditionally male-dominated work environments.

These masculine ideals, although useful in some situations, do not serve men well in relationships, in caring for their health, in admitting to difficulties, or in seeking assistance. The traditional man has a need to maintain the appearance of stoic competence (not showing feelings, appearing to be in control, etc.) when faced with experiences that overwhelm or bring into question their personal sense of control.

This may make it more difficult for these clients to admit they have a problem, let alone ask for help. To avoid feeling shame, traditional men may continue to comply with masculine ideals of being tough and unemotional on the surface by hiding personal struggles from their families, close friends, work colleagues and mental health professionals. These men may remain silent rather than seek help through therapy.

Research has suggested that across the globe, most cultures tend to idealize a tough, strong and unemotional image of masculinity; therefore, asking for help is often seen as an expression of weakness and frowned upon by those who seek to conform to this strong male role model.4

Despite the many advances we’ve made toward equality between men and women, the fact remains that there is a large population of traditional men who view having mental health issues as weakness, failure and a loss of control. So, the challenge for mental health professionals is to find a way to bridge the gap between men’s need for help and the cultural pressures to stay silent.

Strategies to help the traditional man seek help

Multicultural theories and approaches can be helpful to create trust and reduce a client's fear of the stigma associated with seeking help. Therefore, it's important for mental health professionals to become culturally competent. This means that, regardless of their own cultural background and gender roles, mental health professionals must strive to communicate and practise in ways that respect and take into account the language and cultural realities of the people they are working with.5

In my research and work with male military personnel and men in other traditionally male-dominated professions, I’ve found that the following changes to how I practise can make therapy more culturally appropriate:

  • Start with strengths. For example, in the veterans groups we start the program with an exercise that focuses on their "proudest moment," rather than having them reveal the details of their trauma. Starting with a strength-based conversation rather than focusing on a deficit or weakness allows the men to get comfortable in the group and build cohesive respect-based relationships. This provides a solid foundation for later discussions about their trauma.

  • Make space for male language and metaphors. For example, the men in our veterans program are often more comfortable referring to the program as a "course" rather than "group therapy." Similarly, one veteran talked about his trauma work this way: "Only the toughest belong here. We’re in a battle. That battle is not done alone. You never go to battle alone." Adopting the language that men are more comfortable with, and using examples based on challenges they face, helps to engage men and move them to action. Metaphors based in work, sports, conflict and so on can be helpful.

  • Recognize men's preference for doing rather than talking. Traditional men are often less comfortable than women when it comes to discussing their feelings or even admitting they have a problem. So, focusing on behavioural or "how-to" strategies can provide a familiar starting place to build confidence and demonstrate value in the therapy process. Self-regulation strategies (e.g., body and breath awareness) and self-coaching (cognitive therapy) exercises, which have a strong "how-to" component, can be high-value techniques in that they can be quickly mastered, so "fit" men well.

The foundation for effective work with traditional men, as with work across all cultural boundaries, is high regard and profound respect for the "other."

Mental health professionals can embrace the strengths present in the traditional male client and build on those strengths, while helping them break free of the need to project a competent, unemotional image. These men can then start to take responsibility for their lives and move toward healthier, more productive behaviour and relationships. When these clients—who are our fathers, brothers, sons or partners—are better served by culturally appropriate mental health services, we all stand to gain.

About the author

Duncan is a Counsellor in private practice, and president of the BC Association of Clinical Counsellors. He is the Canadian Wounded Warriors Doctoral Scholar and is currently conducting biopsychosocial research at the University of British Columbia in the area of war trauma and masculine socialization

  1. Kilmartin, C.T. (2010). The masculine self (4th ed.). New York: Sloan.
  2. Barrett, F.J. (1996). The organizational construction of hegemonic masculinity: The case of the US Navy. Gender, Work, and Organization, 3(3), 129-142.
  3. Englar-Carlson, M. (2006). Masculine norms and the therapy process. In M. Englar-Carlson, M.A. Stevens, & M.A. Stevens (Eds.), In the room with men: A casebook of therapeutic change (pp. 13-47). Washington, DC: American Psychological Association.
  4. Brooks, G.R. (2010). Beyond the crisis of masculinity: A transtheoretical model for male-friendly therapy. Washington, DC: American Psychological Association.
  5. Brown, L.S. (2008). Cultural competence in trauma therapy. Washington, DC: American Psychological Association.

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