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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

jkorcusk@usd.edu; 605.677.5840

of counseling
? of counseling…

jkorcusk@usd.edu; 605.677.5840

whose values
Disclosing

Relinquishing control

Nonsexual intimacy

Showing weakness

Seeking help

Expressing feelings

Experiencing shame

Introspecting

Acknowledging failure

Confronting pain

Admitting ignorance

Nondisclosing

Keeping control

Intimacy sexualized

Showing strength

Being self-reliant

Being stoic

Expressing pride

Taking action

Endless persistence

Denying pain

Feigning omniscience

whose values?

jkorcusk@usd.edu; 605.677.5840

assumptions
assumptions
  • 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

jkorcusk@usd.edu; 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)

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 605.677.5840

personality
Lower Control

impulsiveness

aggressiveness

antisocial disorders

minimal self-awareness

Higher Activity Levels

extraversion

outgoing

novelty seeking

affiliation seeking

hyperactivity

positive expectancies for use

personality

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 605.677.5840

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

Source: O’Neil, 1995; Pleck, 1985

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 605.677.5840

communication
Actions over direct emotional connection

doing with others

doing for others

Symbols over explicit affection

paradoxical statements

teasing

Commitment over self-disclosure of feelings

Companionship over expression of intimacy

communication

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 605.677.5840

anger
anger
  • 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

jkorcusk@usd.edu; 605.677.5840

shame
shame
  • 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

jkorcusk@usd.edu; 605.677.5840

grief
grief
  • 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

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 605.677.5840

suggestions
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

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 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?

jkorcusk@usd.edu; 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?

jkorcusk@usd.edu; 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?

jkorcusk@usd.edu; 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?

jkorcusk@usd.edu; 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

jkorcusk@usd.edu; 605.677.5840