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

I read with great interest the draft guidelines for psychological practice with boys and men. I
appreciated the hard work and time (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 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 quite repetitive and tends to read a bit like a
screed against traditional masculinity rather than a thoughtful, objective piece. Also, literature
on the neurobiological origins of gender are 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 use of progressive jargon throughout: power, privilege,
intersection, “perform masculinity”, microaggressions (but see the recent exchange between
Lilienfeld and others in PPS on the limitations of this concept.) Much of this was presented
uncritically and without 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 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 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 gender as an outcome of
socialization despite a fairly wide range of literature that suggests a neurobiological origin for
gender identity, particularly in the sexually dimorphic 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’s main weakness is that much of it, instead of reading as an actual
practice guideline, tends to read as an invective against “traditional” masculinity…although at
times the authors also switch the language to “hegemonic” or “sexist” masculinity…at one point
dropping qualifiers altogether to imply just “masculinity” is associated with negative outcomes.
The language about “traditional” masculinity is often put in very stark terms, implying
significant links with negative outcomes (although we are never informed about effect sizes) that
could not be explained by third variables such as harsh family environment, genetics, etc. To
me, this did not read like a fair and objective literature review by 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, they
could actually do more harm than good as far as “traditional” men are concerned. This could
come through increasing practitioner biases toward “traditional” men, advocating therapies that
are not too different from other problematic “conversion” therapies for those who do not adhere
to a set of rigid gender norms (ironically, in this case, gender norms enforced by a progressive
movement opposed to traditional masculinity), as well as actually 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 traditional 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 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, 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 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 sweeping statements that assume effects are
absolute truths. These statements should be removed.

At times the guidelines appear to push clinicians to challenge traditional masculinity or challenge
“male privilege”. But this appears to be a 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 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 the time he reaches adulthood, a man will
tend to demonstrate behaviors as prescribed by his ethnicity, culture, and different
constructions of masculinity.” I find that a pretty bleak view of the human condition…I’d
argue we’re not merely machines programmed by 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 by emphasizing that the manuscript does have some important points
about opening up therapy to non-traditional males. But this shouldn’t come 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 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 myself 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.

Chris Ferguson

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