PHENOMENOLOGY OF MALE VETERANS

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PHENOMENOLOGY OF MALE VETERANS

• 37TH Summer Institute on
• Substance Abuse and Mental Health
• Newark, Delaware
• July 30, 2008
• Gary R. Brooks, PhD

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THE TRADITIONAL MALE ROLE

• David Brannon (1976)
• No Sissy Stuff
• The Sturdy Oak
• Give Em Hell
• The Big Wheel

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BOYS TO MEN TRAUMATIC PROCESSES IN MALE
SOCIALIZATION

• Masculinity Rites of Passage (Gilmore, 1990)
• Developmental research re male role latitude
• Loss of the relational (Real, 1997)
• Normative Alexithymia (Levant, 2005)
• Male emotional funnel system (Long, 1987)
• Male empathy deficits (Lisak, 2005)

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DIVERSITY AMONG SOLDIERS AND VETERANS

• Differences among veterans based in era and war
• Officers versus enlisted
• Rear-echelon versus grunts
• Lifers versus non-lifers
• Race and ethnicity
• Heads versus juicers
• Veteran identity and role saliency

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RACIAL AND CULTURAL IDENTITY MODELS (Cross, 1995
Helms, 1995)

• Conformity (idealize majority culture deprecate
  ones own group)
• Dissonance (inner-conflict)
• Resistance and Immersion (strong identity with
  ones group and exclusion of others)
• Introspection (re-consideration)
• Integrative Awareness (incorporation of dual
  identities)

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VETERAN IDENTITY DEVELOPMENT MAINTENANCE

• Conformity (Identify as civilian, resist veteran
  identity status)
• Dissonance (conflict between loyalty and
  rejection)
• Resistance and Immersion (only vets can
  understand vets Vet Center Model)
• Introspection (re-consideration)
• Integrative Awareness (view self as vet and
  civilian)

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WAR AND COMBAT AS UNNATURAL ACTS

• Staying to fight requires override of human
  instincts ie, flight more likely than fight
• Acquisition of soldiers has always required
  extreme measures
• Religion, patriotism, and material inducements
  most common non-gendered motivations
• Masculinity as a tool to induce men to fight

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MAKING SOLDIERS MILITARY SOCILIZATION

• Violence exalted
• Suppression of feelings and emotion
• Emotional distance and isolation
• Paranoia and distrust
• Buddyship
• Distorted sexuality and misogyny
• Homophobia
• Alcohol and substance abuse
• Frustration and bitterness
• Fighting machines

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PSYCHIC CONSEQUENCES OF WAR AND COMBAT

• Combat fatigue cumulative stress and sleep
  disruptions
• Shell Shock emotional numbing in the face of
  uncontrollable horror
• PostTraumatic Stress Disorder (a) hyperarousal
  (b) intrusion (c) constriction

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POST TRAUMATIC STRESS DISORDER

• Exposure to intense threat to self or others,
  creating intense fear, horror or sense of
  helplessness
• Reexperiencing intrusive thoughts flashbacks
  nightmares
• Increased arousal startle response,
  hypervigilance, sleep disturbance, inability
  to concentrate
• Emotional numbing and avoidance detachment,
  isolation, substance abuse, survivor guilt

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POST-MILITARY GENDER ROLE STRAIN

• Intense socialization into warrior masculinity
• Intense identification with comrades and
  paranoia/distrust of outside world
• Intense combat experience and PTSD (optional)
• Immersion in veteran culture and veteran identity
• De-programming failures
• Perpetuation of seclusion and paradoxical
  reinforcement of difference
• Stagnation and chronic disability

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THE TRADITIONAL MILITARY FAMILY

• Mission first family second
• Boundary irregularities (less insulated from
  military demands more distant from civilian
  world)
• Sharply demarcated gender roles
• Fathers control and lead their families
• Mothers care for children and run household when
  father absent
• Rapid shifts in family roles and structure
  (mothers and parentified children relinquish
  authority when father returns)

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WHY MALE VETERANS HATE PSYCHOTHERAPY

• Stereotypes of Psychotherapy
• Social Construction of Masculinity
• Political Power and Triangulations
• The Way Therapists have Treated Men

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MALE SOCIALIZATION AND PSYCHOTHERAPY

• REAL MEN -
• HIDE PRIVATE EXPERIENCE
• MAINTAIN CONTROL
• EXHIBIT EMOTIONAL STOICISM
• PRESENT SELF AS INVINCIBLE
• TAKE ACTION
• AVOID RELATIONSHIP CONFLICT
• KNOW WHAT TO DO
• SEXUALIZE INTIMACY

• IDEAL THERAPY CLIENTS -
• SELF-DISCLOSE
• RELINQUISH CONTROL
• EXPRESS FEELINGS
• EXPERIENCE VULNERABILITY
• INTROSPECT
• CONFRONT RELATIONSHIP ISSUES
• ADMIT IGNORANCE AND FAILURE
• MANAGE NON-SEXUAL INTIMACY

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MALE-FRIENDLY PSYCHOTHERAPY

• INFORMED BY IN-DEPTH KNOWLEDGE OF MENS LIVES
• ATTUNED TO POWER AND POLITICAL ISSUES
• BROAD IN INTERVENTION MODALITIES
• POSITIVE AND ENHANCING
• TRANSTHEORETICAL
• SENSITIVE TO DIVERSITIES AMONG MEN
• DEMANDING OF THERAPIST SELF-AWARENESS

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VETERANS ON THE THRESHOLD OF THE THERAPY OFFICE

• MALE-SPECIFIC DIAGNOSTIC ASSESSMENT
• MASCULINITY INVENTORIES
• MANHOOD INTERVIEW
• MOTIVATIONAL ASSESSMENT
• STAGE OF CHANGE ISSUES
• SOCIAL CONTEXT ANALYSIS
• MOTIVATION MATRIX

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DEVELOPING A THERAPEUTIC ALLIANCE

• THERAPEUTIC ALLIANCE (BORDIN, 1994)
• AGREEMENT ON GOALS
• AGREEMENT ON TASKS
• THERPEUTIC BOND EMOTIONAL CONNECTION
• EMPIRICALLY-VALIDATED TREATMENTS VERSUS THE
  THERAPEUTIC ALLIANCE
• THE M.A.S.T.E.R.Y MODEL

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M.A.S.T.E.R.Y. MODEL

• M Monitor Personal Reactions to Troubled
  Men
• A - Assume Men are in Pain
• S - See Mens Problems in Gender Context
• T Transmit Empathy and Compassion
• E Empower Men to Change
• RY - Respect Mens Readiness to Change and
  Yield Somewhat to System Pressures

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WITHIN THE THERAPY OFFICEPSYCHODYNAMIC OBJECT
RELATIONS APPROACHES

• DEVELOMENTAL TRAUMA AND CUT-OFF OF EMOTIONAL
  EXPERIENCES
• TRAUMATIC ABROGATION OF THE HOLDING ENVIRONMENT
  (POLLACK)
• PROBLEMATIC MASCULINE-SPECIFIC SELF-STRUCTURES
  (Rabinowitz Cochran)
• RE-CREATION OF DISRUPTED HOLDING ENVIRONMENT
• FOCUS ON ISSUES OF LOSS AND GRIEF
• RESPECT NEED FOR DEFENSIVE AUTONOMY

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WITHIN THE THERAPY OFFICECOGNITIVE THERAPY
(Mahalik, 2005)

• SPECIAL ADVANTAGES FOR MEN
• NOT ABOUT FEELINGS
• NON-BLAMING
• RAPID EFFECTS
• CONSCIOUSNESS-RAISING RE GENDER MANDATES
• PROCESS
• ADDRESS UNREALISTIC MASCULINITY SCHEMAS
• POINT OUT DESTRUCTIVE SELF-TALK

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WITHIN THE THERAPY OFFICEBEHAVIOR THERAPY

• ADVANTAGES
• TASK-FOCUSED
• INSTRUMENTAL
• MINIMAL DEMANDS FOR EMOTIONAL INSIGHT AND
  EXPRESSION
• FACE VALIDITY
• VARIANTS
• ASSERTIVENESS TRAINING
• ANGER MANAGEMENT TRAINING
• EMOTIONAL SKILLS TRAINING
• SELF CONTROL

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WITHIN THE THERAPY OFFICE -INTERPERSONAL THERAPY

• ADVANTAGES
• SHORT-TERM
• PROBLEM-FOCUSED
• ADRESSES RELATIONAL SHORTCOMINGS
• BROADENS RELATIONAL REPERTOIRE

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WITHIN THE THERAPY OFFICE -HUMANISTIC,
EXPERIENTIAL, EXISTENTIAL PSYCHOTHERAPY

• CORRECT EXAGGERATED SENSE OF CONDITIONAL WORTH
  (KILMARTIN, 2007)
• DEEPENING PSYCHOTEHRAPY THROUGH BODY-WORK AND
  GESTALT EXPERIETIAL EXERCISES (Rabinowitz
  Cochran, 2002)
• RECOGNITION OF MORTALITY AND IMPLICATIONS OF MALE
  ROLE CHOICES

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THE ALL-MALE THERAPY GROUP

• Men's Groups as Familiar Terrain Confronting
  the male chorus (Pittman, 1995)
• Countering Men's Emotional Isolation from Other
  Men (altruism)
• Decentralizing Women in Mens Lives
• Enhancing Communication Skills
• Discovering Emotional Interconnections
  (universality)
• Instilling Hope and Initiating Mutual Empowerment

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TRADITIONAL MEN AND MARRIAGE (HISTORICAL,
DEVELOPMENTAL, POLITICAL, AND GENDER
SOCIALIZATION PERSPECTIVES ON MENS RELATIONSHIPS
WITH WOMEN)

• Male Early Development- Psychoanalytic
  Perspectives
• Restrictive Early Socialization and
  Hypermasculinity
• Adolescence and Sexuality
• Misogyny in Patriarchal Culture
• The Institution of Marriage
• Men's Traditional Expectations of Marriage
• The Civilizing Value of Marriage
• Marital Services
• Career and Symbolic Benefits
• Emotional Benefits
• Physical Benefits

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GENDER-SENSITIVE FAMILY THERAPY FOR MALES
(BROOKS, 1992, 1998)

• Concerted efforts to include a reluctant male
  family member
• Help for males to articulate their perspectives
• Overcome preoccupation with career goals and
  neglect of relational goals for males
• Encouraging males to recognize vulnerabilities
  and prioritize self-care
• Empowering male family members in nurturing and
  caretaking
• Promoting connection and emotional intimacy among
  male family members
• Encouraging role latitude for sons
• Promoting new fatherhood roles
• Conducting family of origin work to explore
  masculine family heritage.

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DIVERSITY AMONG MEN -COMMON ISSUES FOR MEN OF
COLOR

• IMPACT OF RACISM AND OPPRESSION
• UNEMPLOYMENT
• LIFE EXPECTANCY
• INCARCERATION
• SUBSTANCE ABUSE
• DISTRUST OF MENTAL HEALTH ESTABLISHMENT (HEALTHY
  PARANOIA)
• UNDERUTILIZATION OF MENTAL HEALTH SERVICES
• RACIAL AND CULTURAL IDENTITY ISSUES
• ETHNOCENTRIC MONOCULTURALISM

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MULTICULTURAL COMPETENCE(SUE SUE, 2008)

• AWARENESS
• KNOWLEDGE
• SKILLS

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THERAPEUTIC SKILL ISSUES

• LANGUAGE AND COMMUNICATION
• HUMOR TEASING
• MALE FRIENDLY ENVIRONMENT
• SELF-DISCLOSURE ADVICE GIVING
• MOTIVATIONAL ENHANCMENT
• COPING WITH DEFENSIVENESS
• USING TRIANGULATION
• UTILIZATION OF THERAPIST GENDER