The Male-Female Research Bias

I’ll grant that some of this is speculation, but I’ve often wondered if counseling has some kind of inversion of the male-skewed research bias that exists in medicine. More males were used in medical studies in the 80s and earlier, partially due to availability and partially due to increased difficulties in accounting for female hormone processes. (As discussed in Dr. Sarah Hill’s book This is your Brain on Birth Control.) They assumed similarity in regard to everything else and thus didn’t recognize potentially different effects of medication based on sex differences, most significantly pain-killers in women. This obviously led to a lack of understanding and mismanagement of female-specific health concerns.

I think a similar oversight exists in mental health therapy. More females show up to therapy, and more females provide therapy, which at least seems to suggest a good reason to ask if this may have created a decreased awareness of more effective interventions for males.

A Potential Oversight

Mental health therapy has long emphasized verbal communication and introspection — methods that naturally cater to what many consider a more traditionally female approach to processing emotions. This is also famed within a historical conceptualization of “the talking cure” as the goal of psychology generally. However, in other areas we do have a recognition of ways that action-oriented processes might be more beneficial. For example, many examples of play-therapy, typically utilized in children, can be found where the acting-out of emotional processes in play can serve as mediums for understanding the interactions of internal and external processes and gaining closure. This can be very effective in non-verbal children and even adults. But play-therapy aside, let’s consider how an enacted treatment process might apply to men.

Enacted and Forward-Focused Healing

Forward-focused trauma therapy is an approach popularized by Eric Gentry and focuses more on attending to the future a person wants to create as a resolution to past events, rather than organizing thoughts and beliefs about traumatic memories. Enacting this kind of process is a practical and action-oriented approach to therapy, which may resonate more with male clients, and obviously some females as well. This concept would prioritize activities that embody personal significance or demonstrate emotional processing through action. A gut-level illustration of this is quite intuitive: An adult male who had conflicts with his deceased father might create closure to the guilt in a grieving process by completing the restoration of a car he and his father had started working on together. This physical task, laden with emotional significance, becomes a therapeutic process in itself. He can’t communicate with his father directly, but can still feel he is cooperating with dad by completing a goal they established together. By putting his emotional energy into completing the car, this not only honors his father’s memory but also creates a representation of his father’s lasting influence and contribution to his life in a very functional way — he can now drive the car.

Integrating action in Therapy

I’ll be the first to say I don’t entirely know what this kind of therapeutic process would look like. I can think of a few examples here and there that I’ve seen, but more often anecdotal in the course of life, not in therapy. For example, camping alone in the woods as a response to anxiety, or taking cold showers as a reinforcement process for someone’s sense of self-efficacy. It would be interesting if this could be expanded. Recognizing the therapeutic value of enacted processes could revolutionize the way mental health services address those who are reluctant to talk about every little thing that’s gone wrong in their lives.

Specifically for men, by integrating activities that allow men to process emotions through action, therapists could offer more relatable and effective support. This might range from engaging in meaningful projects, to personal challenges, to trying to start a business or even art-therapy kinds of creative expression that enable someone to externalize and work through their sense of being-in-the-world (emotions) in a manner that feels natural to them.