Several weeks ago, the American Psychological Association (APA) released its latest in a series of practice guidelines for psychologists – this time for “Psychological Practice with Boys and Men.” Prior years had seen guidelines focused on ethnicity, older adults, girls and women, LGBT, and “transgender and gender-non-conforming” persons.
Curiously, despite claiming to be based on 40 years of research, and the product of 12 years of intensive study, the latest release attracted little attention. More, the responses that have appeared in print and other media have largely been negative (1, 2, 3, 4, 5). 
What happened?
At first blush, the development and dissemination practice guidelines for psychologists would seem a failsafe proposition. What possibly could go wrong with providing evidence-based information for improving clinical work? And yet, time and again, guidelines released by APA end up not just attracting criticism, but deep concern. Already, for example, a Title IX complaint has been filed against the new guidelines at Harvard.
Consider others released in late 2017 for the treatment of trauma. Coming in at just over 700 pages ensured few, if any, actual working professionals would read the complete document and supportive appendices. Beyond length, the way the information was presented–especially the lack of hypertext for cross referencing of the studies cited–seriously compromised any straightforward effort to review and verify evidentiary claims. Nevertheless, digging into the details revealed a serious problem: a discontinuity between the evidence reviewed and the conclusions reached. For example, despite “strongly recommending” certain approaches over others, none that topped the list had actually been shown by research to be more effective than any other.
Guidelines are far from benign. They are meant to shape practice, establishing a “standard of care” — one that will be used, as the name implies to guide training and treatment. As such, the stakes are high, potentially life altering for both practitioners and those they serve.
And so, on reading the latest release from the APA, we wonder about the consequences for men and boys. Even a superficial reading leaves little to recommend “being male.” Gone are any references to the historical or current contributions of men — to their families, communities, marginalized peoples, culture, or civilization. In their place, are a host of sweeping generalizations often wrapped in copious amounts of political, progressive jargon on a wide variety of subjects, many of which are the focus of research and debate by serious scientists (e.g., the connection between media violence and male aggression, socialization as a primary cause of gender and behavior, the existence of a singular versus multiple masculine ideal, etc.).
Cutting to the chase, when viewed in this way, is it any wonder really, that many men – as the document accurately points out – “do not seek help from mental health professionals when they need it?” (p. 1).
And lest there be any doubt, men as a group, are in need help. 
You’ve likely read the statistics, seen examples in your practice, perhaps in the life of your family or friends. It starts young, with boys accounting for 90% of discipline problems in schools, and continues to the end of life, with women living 5 to 10 years longer on average. The “in between” years are not any better, with men significantly more likely to be incarcerated, addicted to drugs, drop and fail out of school, and end their lives by suicide.
To be clear, the document is not overarchingly negative. At the same time, if our goal, as a profession, is to reduce stigma — which previous, and even the present, guidelines do for other groups and “non-traditional” males — then the latest release risks perpetuating stereotypes and prejudices of “traditional” men and the people in their orbit.
Sticking to the science of helping, instead of conforming to popular standards of public discourse, would have lead to a very different document – one containing a more nuanced and appreciative understanding of the boys and men who are reluctant to seek our care. In the fractious times in which we find ourselves, perhaps it’s time for guidelines on how to live and work together, as individuals and as a species.
As always, interested in your thoughts,
Scott & David
Scott D. Miller, Ph.D. & David Prescott, LICSW
International Center for Clinical Excellence
P.S.: Registration for our Summer Intensives on Implementing Feedback Informed Treatment and Deliberate Practice is now open — two clinical practices research shows improves retention and outcome in behavioral health care. For more information, click here.
I have to admit that I was really thrown by the APA publication about men, and I was not sure how to respond. After reading several newspaper articles and discussing these with my wife, she gave me the sage advice of actually reading the APA publication for myself. It was a slow read for me as I do not often read scholarly articles these days (graduated in 2001). On the whole, some of my concerns went away by reading the source document. What remained though were some real concerns about what seemed to be gaps in logic and biased interpretations. It was a relief to hear Scott echo the same thing because I began to doubt my perceptions after reading the article…
Maybe the misunderstanding was mine since I was not an academic? Or if I believed the article, maybe my toxic masculinity was blinding me from seeing what was obvious to others? But also, I really wanted to give the APA the benefit of the doubt… I feel a bit sick to think that my guiding organization would fall into the divisive public discourse endemic in society today.
Thanks for your blog Scott.
Thank you for this.
The newsletter is great and I look forward to reading it. The comments on the APA guidelines for working with boys and men are appreciated.
I have noticed after being in private practice for 34 years and a Psychiatric Social Worker for 50 that I am getting more calls for service now from men for both individual psychotherapy and for couple work. This is a change with the Millenials and Gen X from the Boomers and the Elders.
My experience is, of course, anecdotal, relegated to clincial experience and my type of general psychotherapy practice by a LCSW-R in Western New York. However, there is a societal shift in norms, attitudes, and behaviors. What these shifts mean for deliberate practice I am not sure, but as male in a female dominated profession, I find that I, perhaps, as a 73 year old father of 9, grandfather of 15 have something to offer clincially that is unique.
As a Narratively oriented therapist with a bit of family systems, and Bowenian ideas incorporated, I have never been very enamored with “guidelines” and “evidence based practices.” As Michael White said at a conference I attended when asked if Narrative Therapy was “evidence based, ” “I am not a researcher so I don’t know how to answer that. I am more concerned with Narrative therapy being ethically based.”
Amen!
nicely worded Scott. The APA Guidelines should lead each member to a reexamination of who has taken charge of the institution. They need to know who is speaking in their name..
Having worked with homeless males for over three decades. it puzzles me that we have to develop a science on how we interact with men who are disconnected with ordinary people and their families.
In some of my past studies come across the ‘Satir” model, which had a focus on connecting with people (young and old) and the engagement process for helping.
Males certainly find it difficult to share their inner most thoughts and feelings, and from my experience it can only happen in a ‘safe environment’ where their ‘manhood’ is not diminished by the process.
Theories and models mean nothing to the ordinary male, and what they need is just ordinary people helping them with their ordinary problems. . It can only happen when we are on the same level, ie person to person, sharing problems together.
When the environment and relationship is right, then men learn from each other , gain support , and develop hope for their future
In my opinion, it’s easy to dismiss this effort. Needless to say that it is directed towards professionals working with men rather than their clients, as you seem to suggest Scott. It is common that we as men don’t want to address and speak out against dominant forms of masculinity that can have a detrimental effect on women and children as well as on ourselves. I think the issues are more complex than a focus on psychology would be able to reveal. But in the first guideline I can already see some suggestions that sound quite reasonable to me:
– Clinician awareness of one’s stereotypes and biases against boys and men is a critical dimension of multicultural competence.
– Prescriptions and proscriptions for behaviors that either align with or contradict the dominant ideal of masculinity are not linear, uniform, or without resistance.
– Psychologists are encouraged to expand their knowledge about diverse masculinities and to help boys and men, and those who have contact with them, become aware of how masculinity is defined in the context of their life circumstances.