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working w/the drinking man james s. korcuska, ph.d., ncc ndca midwinter conference bismarck, ND february 2, 2004 ? of counseling… Disclosing Relinquishing control Nonsexual intimacy Showing weakness Seeking help Expressing feelings Experiencing shame Introspecting

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working w the drinking man

working w/the drinking man

james s. korcuska, ph.d., ncc

ndca midwinter conference

bismarck, ND

february 2, 2004; 605.677.5840

of counseling
? of counseling…; 605.677.5840

whose values

Relinquishing control

Nonsexual intimacy

Showing weakness

Seeking help

Expressing feelings

Experiencing shame


Acknowledging failure

Confronting pain

Admitting ignorance


Keeping control

Intimacy sexualized

Showing strength

Being self-reliant

Being stoic

Expressing pride

Taking action

Endless persistence

Denying pain

Feigning omniscience

whose values?; 605.677.5840

  • 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; 605.677.5840

willing men
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); 605.677.5840

drinking men
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; O’Neil, Good, & Holmes, 1995; Pleck, 1995; Wilsnack & Wilsnack, 1997; 605.677.5840

Lower Control



antisocial disorders

minimal self-awareness

Higher Activity Levels



novelty seeking

affiliation seeking


positive expectancies for use

personality; 605.677.5840

drinking in men s lives
drinking in men’s 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; 605.677.5840

messages men hear
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; 605.677.5840

positive factors
positive factors
  • Self-esteem
  • Assertiveness
  • Independence
  • Confidence

Source: O’Neil, 1995; Pleck, 1985; 605.677.5840

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

the other side; 605.677.5840

gender role conflict
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; 605.677.5840

gender role conflict13
gender role conflict
  • Restricted sexual & affectionate behavior b/w men
    • homophobia
    • fear of femininity
  • Restricted emotionality
    • inexpressiveness
    • devaluation of emotion; 605.677.5840

alternative pathways
alternative pathways
  • Shoulder-to-shoulder rather than face-to-face
  • Address issues of competition between men
  • Address issuesof intimacy & vulnerability, especially with men; 605.677.5840

Actions over direct emotional connection

doing with others

doing for others

Symbols over explicit affection

paradoxical statements


Commitment over self-disclosure of feelings

Companionship over expression of intimacy

communication; 605.677.5840

e g male groups
Talking aboutspecific 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

e.g., male groups; 605.677.5840

  • 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; 605.677.5840

  • 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; 605.677.5840

  • Grief may be the doorway to men’s 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; 605.677.5840

working w feelings
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; 605.677.5840

more work
more work
  • Respectfully push
    • what’s your anger tolerance?
  • Hold & focus
    • stay w/ the body
    • use silence
  • Teach & model
  • Use experiential learning
    • avoid escalating anger that cannot be addressed by session’s end; 605.677.5840

cross cultural
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; 605.677.5840

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

suggestions; 605.677.5840

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

gendered therapists; 605.677.5840

about stress
? 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?; 605.677.5840

about support
? 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?; 605.677.5840

about masculinity
? 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?; 605.677.5840

about feelings
? 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?; 605.677.5840

look beyond
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; 605.677.5840