Trauma Treatment And Men – Gender Specific Treatment Strategies

men in treatment cover image

Counsellor and Interventionist, David Brown, explores the area of gender responsive treatment and the specifics of working with male clients.

Over the past twenty years, the mental health and addictions fields have begun to recognise the tremendous importance of trauma on human behaviour. Our increased understanding has developed, in part, as a result of sophisticated brain research on the physical effects of trauma. The Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV-TR) of the American Psychiatric Association (2000) defines trauma as “involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. The person’s response to the event must involve intense fear, helplessness or horror (or, in children, the response must involve disorganised or agitated behaviour).There are many factors that influence how a male responds to a traumatic event, including age, family background, personal resources and resilience, the health and response of the environment (e.g., family, work, social), previous trauma, etc. Estimates are that anywhere from 42 to 95% of males coming to treatment have been exposed to trauma. In fact this large range may be a reflection of how poorly male trauma has been assessed.

I have found that many men have never been given permission to talk about their trauma as it is bounded in such deep shame. They feel uncomfortable discussing what happened in a safe and understanding environment. In our culture, a principal rule of being a man is to not admit weakness, the quintessence of which is to deny abuse or the incredible pain caused by traumatic events. Many males, as a result of how they are raised and the gender-related messages they are inundated with, may see violent/abusive events as normal and not as trauma.

Therapists and clients need to be educated in three core elements: an understanding of what trauma is, its process, and its impact on both the inner self (thoughts, feelings, beliefs, values) and the outer self (behaviour and relationships). We also need to know about coping skills, grounding exercises, and interactive exercises so that we become comfortable working with men. This being said it is also critically important that therapists do their own work if they have been exposed to their own trauma as they will be unable to help if their own trauma still gets in the way.

This brings me to the internationally known mental health and addiction specialist, Dan Griffin. Dan authored, A Man’s Way through the Twelve Steps, and co-authored, with Dr Stephanie Covington and Rick Dauer, Helping Men Recover, the first trauma-informed curriculum to specifically deal with men’s unique issues and needs.

Dr. Covington defines addiction as

“A chronic neglect of self in favor of something or someone else”.

How does an addicted man shift from chronic neglect to a healthy care of self? How does he shift from a downward spiral to the upward spiral? How does he grow and recover? These are the questions that we are beginning to answer in this very different approach to male treatment. The sad thing is that we are still in the early days of what could be breakthrough thinking and it is my hope that in reading this article you will begin to ask yourself new professional questions about how you are treating men? Is it in the manner of the ages or is it in a new and enlightened atmosphere. It is time for us to be doing something different, something which is responsive to the needs of men.

This is important work as it is a well-worn thought that men do not get the same kind of attention in treatment or with regard to their trauma as women do. This leads to men being re-traumatised as the system does not understand the connection. Let me give you an example from my own practice. I had a young man in treatment with me for a substance abuse disorder. As a young man he had been serially molested by female relatives including his mother. He used alcohol as a means of self-medicating. He was on probation and had a very tough female probation officer who just saw the client’s behaviour as defiance. It was only when we suggested to her that his reactions to her had been programmed by his trauma history. He was frightened of her and her attitude towards him reactivated his paralysis and trauma. When I saw him I saw a strong looking, masculine man who had not dealt with his history and was stuck. Here was a case where this man had taught himself to minimise his traumatic life experiences and to act “as if” using alcohol as his “fixative”. When I had the opportunity to talk to the probation officer about what was happening, she was mortified that she had caused re-traumatisation. Nowhere in her experience had she had any training to prepare her for this and so she was doing what her experience taught her to do which was to get this man’s attention and bring him down a notch or two.

I would like to say two things at this juncture. As a man in long term recovery everything I had heard in early recovery made sense. But there were still important pieces missing as I was a victim of my environment, trauma and best thinking. These were the pieces that had never been addressed and such always represented a real danger to me from a relapse potential as they were unresolved. At this point I met Dan and was introduced to his book. Once I picked it up I could not put it down as it was life changing for me. It helped me see why I thought the way I do and why there was always a tendency for me to self-sabotage as my trauma was still bubbling away under the surface and keeping me stuck. My attention was captured early in his book with this very simple thought that, being a man equals the consumption of alcohol. Believing “Real men don’t get out control” coupled with “Real men know how to party” (i.e., get drunk). Believing men are powerful. Believing men are in control. Keeping thoughts and feelings to yourself (talk trauma are you kidding?). Always keeping up a good front and being fiercely independent; relationships are not a priority.

With this simple paragraph and these simple thoughts I recognised me. I recognised that is the way I had always thought and that was the source of being a legend in my own mind. The source of so much trouble and confusion, even in recovery. Then I saw the next thought which became the clarion call for my own liberation and the beginning of me being able to find other men, my wife and therapists to talk to as I realised that was the key for me. Strangely nobody laughed at me. I saw that being a man equals the absence of alcohol. Embracing powerlessness and acceptance.  Letting go of control. Admitting or confessing – allowing yourself to be known to another; unmanageability. Being part of the group and in close relationships with others.

What joy! What sweet liberation. What incredible permission to rid myself of that 800 lb. gorilla that had always lived on my shoulders. Welcome to the world David!

How does this relate? For too long gender responsive has meant for women. Somehow men were excluded. Maybe because we were not sure how to treat them. Trauma was certainly not treated as most clinicians did not understand it. Think about it from this perspective too. “70% of people working in the field are women, but 70% of those going through services are men,” (Dan Griffin).

Helping Men Recover, the first trauma-informed curriculum to specifically deal with men’s unique issues and needs is the curriculum that we use in our practice to treat men.  For over two years, we have facilitated 90 minute Men’s Groups every Monday and Wednesday in an outpatient setting. The men have responded to the curriculum very well. Men respond to it and are daring to talk about issues that historically they would never have thought of discussing. We see male socialisation being used effectively which in turn is having a positive impact on men’s recovery. We have witnessed that if men feel safe, men are willing to look at many important, although difficult, issues which were commonly overlooked in traditional treatment. In many cases, this was because the counsellor was female and she was uncomfortable talking to men about the issues that really needed to be looked at. Clearly this held these men back. The issues we routinely talk about are relationships, sexuality and sexual behaviour, power and control, privilege and entitlement, and grief. We are helping men reflect on their common experiences which improve their chances of successful long term recovery. It is exciting to see how they bond as they first take those baby steps in communicating stuff that they have never felt was worthwhile talking about or they were too traumatised or ashamed to do so. It is marvelous to be an observer in the room and see leaders emerge who demonstrate what healthy communication looks like because they have been given permission for the first time in their lives to talk about these negative experiences that have shaped them into who they became. It is exciting to witness as these men grow and cast off the trauma that has held them back as they make a conscious decision to live in the solution and not the problem. It is suspected that anger, domestic violence is reduced and general well-being is improved the more of this work that the men participate in.

We are finding that confronting men is not an effective strategy for getting them to engage in treatment. After all, remember society says real men don’t cry, tell them not to show your emotions unless it’s anger, be strong, don’t ask for help, don’t be vulnerable, be sexually aggressive, put work before relationships, put success before relationships.  Society tells men that power and having power is central to being a man. Then we put them in an environment where we say we want you to be vulnerable, we want you to ask for help, we want you to talk about your feelings, and anger is not OK. This tension is the elephant in the room. I have found that when we work with men in ways that help them verbalise and understand this tension, when we point out to them that it makes sense for the situation to feel difficult and challenging, there is an entirely new context for them in terms of treatment, their addiction, powerlessness, and any of the other challenges they have in recovery. I feel blessed to be able to do this work with men as it is sacred. It must become the norm!


 

** From the FINAL REPORT, MALES, TRAUMA, AND ADDICTIVE DISORDERS 2013 SUMMIT

This article could not have been written without the assistance and input of Dan Griffin. Dan Griffin, M.A. has worked in the mental health and addictions field for over two decades. His newest book, A Man’s Way through Relationships is the first trauma-informed book focused solely on helping men navigate the challenges of creating healthy and intimate relationships. He is author of A Man’s Way through the Twelve Steps (Hazelden), the first trauma-informed book taking a holistic look at men’s experience of recovery from addictions. He is co-author of groundbreaking curriculum Helping Men Recover, the first trauma-informed curriculum to deal with men’s unique issues and needs.

David Brown is a professional interventionist, mentor, coach, public speaker and educator.