working wthe drinking man

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working w/the drinking man

• james s. korcuska, ph.d., ncc
• ndca midwinter conference
• bismarck, ND
• february 2, 2004

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? of counseling
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whose values?

• Disclosing
• Relinquishing control
• Nonsexual intimacy
• Showing weakness
• Seeking help
• Expressing feelings
• Experiencing shame
• Introspecting
• Acknowledging failure
• Confronting pain
• Admitting ignorance

• Nondisclosing
• Keeping control
• Intimacy sexualized
• Showing strength
• Being self-reliant
• Being stoic
• Expressing pride
• Taking action
• Endless persistence
• Denying pain
• Feigning omniscience

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assumptions

• There is no silver bullet (pun unintended)
• Miller Hester (2003)
• An array of approaches have been shown to be
  effective
• Miller, Wilbourne, Hettema (2003)
• An informed eclecticism
• Miller Hester (2003)
• Individual differences matter

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willing men?

• Masculine gender roles linked reluctance to seek
  help
• Good, Dell, Mintz, 1989 Good Wood, 1995
  Robertson Fitzgerald, 1992
• Men less likely than women to seek counseling
• Vessey Howard (1993)
• Men may not be willing clients
• Brooks (1998)

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drinking men

• DX w/ alcohol-related disorders 5x more often
  than women
• American Psychiatric Association (2000)
• Substance abuse among men linked to traditional
  masculine gender roles the socialization
  process into those roles
• Beiner, 1987 Blazina Watkins, 1996 Brooks,
  1997 Burda Vaux, 1987 Cooper et al., 1992
  Eisler, 1995 Korcuska, 2003 Levant, 1995
  ONeil, Good, Holmes, 1995 Pleck, 1995
  Wilsnack Wilsnack, 1997

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personality

• Lower Control
• impulsiveness
• aggressiveness
• antisocial disorders
• minimal self-awareness

• Higher Activity Levels
• extraversion
• outgoing
• novelty seeking
• affiliation seeking
• hyperactivity
• positive expectancies for use

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drinking in mens lives

• Facilitate entrance into male roles
• Maintain male roles
• Curvilinear relationship?
• Pathway to male friendship
• Release from role responsibility
• emotional catharsis
• facilitate positive negative affect
• loosen fear of homophobia

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messages men hear

• Be tough
• Be strong
• Be logical
• Be successful
• Be self-sacrificing
• Be daring
• Be a man, over and over again
• Be TENDER, except in when it conflicts with above

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positive factors

• Self-esteem
• Assertiveness
• Independence
• Confidence
• Source ONeil, 1995 Pleck, 1985

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the other side

• Problematic risk-taking
• Violence to self/others
• Avoidance of help-seeking
• Relational dread (Shem, 1998)
• Restricted affect, especially between men

• Problematic achievement orientation
• Inattention to personal well-being
• Sense of entitlement
• Younger men report more gender role conflict

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gender role conflict

• Success, power, competition
• risk taking,
• interpersonal control, power, dominance
• centrality of sports
• concern w/ hierarchy
• competence v. vulnerability
• competition w/other men

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gender role conflict

• Restricted sexual affectionate behavior b/w men
• homophobia
• fear of femininity
• Restricted emotionality
• inexpressiveness
• devaluation of emotion

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alternative pathways

• Shoulder-to-shoulder rather than face-to-face
• Address issues of competition between men
• Address issues of intimacy vulnerability,
  especially with men

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communication

• Actions over direct emotional connection
• doing with others
• doing for others
• Symbols over explicit affection
• paradoxical statements
• teasing

• Commitment over self-disclosure of feelings
• Companionship over expression of intimacy

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e.g., male groups

• Talking about specific topics
• avoiding negative affect
• Keeping it light
• engaging in teasing, joking, storytelling, humor
  to deflect emotion

• Maintaining boundaries
• Mutually supporting through testimonials
• Eating drinking central
• Accepting silence silence as acceptance

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anger

• Externalization of uncomfortable feelings
• Emotional funnel system
• underdevelopment of emotions may lead to
  overdevelopment of anger
• Autonomic hyperarousal
• the loss, to some degree, of the physiological
  capacity to monitor emotional states

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shame

• Shame provides interpersonal and intrapsychic
  feedback
• intimate relationships require shame management
• Masculine gender role development asks boys men
  to by pass shame
• Shame is transformed
• contempt, fury, envy, narcissism, antisocial
  behavior
• May show up as guilt

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grief

• Grief may be the doorway to mens feelings (Bly,
  p.163)
• May be tied to earlier sense of premature
  separation, abandonment
• boys may not be given a chance to grieve a loss
• Loss of entitlements
• Women in their lives may restrict grief

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working w/feelings

• Respect their intensity, insensibility, scope
• Shame, guilt, grief behind anger
• Know how men avoid or indirectly discharge
  painful feelings
• sarcasm, numbness, whatever she says
• Work carefully work confidently
• Monitor affect regulation
• Ensure follow up

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more work

• Respectfully push
• whats your anger tolerance?
• Hold focus
• stay w/ the body
• use silence
• Teach model
• Use experiential learning
• avoid escalating anger that cannot be addressed
  by sessions end

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cross cultural?

• Soft sell or Hard sell?
• Value enjoy masculine culture
• Value enjoy masculine forms of relating
  communicating
• Empathize
• Articulate the gender bind
• Raise gender issues w/care

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suggestions

• Know the code connect through action (Pollack,
  1998)
• Convey a understanding of the bind
• tough tender
• Use stories
• Use metaphor/allegory

• Know use symbolic language to convey teach
  emotion closeness
• Chill with each other, e.g., companionship
• Be there, e.g., commitment
• Use activities to normalize talking

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gendered therapists

• Female to Male
• Speak to differences
• Learn speak the culture
• Express empathy
• Avoid role traps
• Hold onto professional status

• Male to Male
• Accept kinship
• Share dilemmas
• Express empathy
• Monitor power struggles

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? about stress

• How does drinking help men to deal w/ stress?
• In what ways are men expected to handle stress?
• What do women need to know about the pressure
  faced by men?

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? about support

• If I wanted to show a man support during a
  difficult time, how would I do that?
• How does the drinking life allow support from
  others, especially men?
• How does the drinking life support friendships?
• Who do you count on?

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? about masculinity

• How did you learn what it takes to be a man?
• Who were the men in your life that influenced
  you?
• what are the positive negative voices?
• Who were the bullies in your life?
• What or who told you that you were finally a man?

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? about feelings

• How does drinking help you to handle difficult
  feelings?
• What have you lost in your life?
• what were the positive outcomes of the loss?
• what were the things that were not so easy to
  take?
• how did drinking help you to swallow things?

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look beyond

• Alternative or comorbid dx
• Relational problems
• Loneliness
• Grief
• Cognitive approaches must be tailored to clients
  level of functioning, especially as it relates to
  drinking drugging