Mars vs. Venus – in Recovery
We have long known that there are significant differences in the ways that men and women think, act, and relate. To a large extent these differences are neurobiological in nature as male brains and female brains show significant structural differences. For starters, the brains (and heads) of boys and men are about 9 percent larger than those of girls and women. The extra brain matter in males is mainly white matter, the part of the brain that transmits signals between brain cells. At the same time, males have relatively less of the corpus callosum, a structure that allows the left and the right sides of the brain to communicate. (Generally speaking, the left brain controls logic, analytical thinking, and objectivity, whereas the right brain controls intuition, synthesis, and subjectivity.) It seems the male brain has more connections to nearby cells, but less connectivity between the two hemispheres; vice versa for females. These basic structural differences explain, at least in part, some of the readily observable differences in male and female behavior.
And these differences are readily apparent from birth onward. For instance, studies show that one-day-old baby boys spend more time looking at a mechanical mobile than at a live face, whereas one-day-old girls tend to focus on the face. Inherent gender traits are apparent not only in humans, but animals. For instance, young male vervet monkeys prefer to play with toy trucks, whereas young female vervet monkeys prefer dolls. Similar studies conducted with human boys and girls yield the same results. Other studies show boys tend to be more aggressive and physically active than girls, but girls often learn to talk earlier and more fluently. Studies of adults show that males routinely score higher on physics and engineering problems, while females tend to rate higher on tests of emotion, social sensitivity, and verbal fluency. In general, at all ages and life-stages men tend to be more “left brain” and women more “right brain.” Men tend to be stronger systematizers, women stronger empathizers. Men are from Mars, women are from Venus. And so it goes.
Not surprisingly, the inherent neurological and behavioral differences between men and women can be amplified in a psychotherapeutic or treatment setting. Because of this, men and women with highly similar underlying issues and diagnoses often respond very differently to certain treatment modalities. What works well for men might be counterproductive with women, while a game changing clinical move with a woman could send a man running for the exit. These issues are especially apparent when treating clients for trauma, addiction, or (very often) both.
Gender Separate Treatment: Men
Traumatized and/or addicted men typically have a hard time entering treatment, as doing so means admitting weakness and lack of control. This goes against their neurological wiring, and, perhaps more importantly, their upbringing and social conditioning. Simply put, men are both hardwired and taught to be strong, decisive, competitive, and in control at all times in all situations. Because of this, a man having to admit that something is wrong in his life and, even worse, that he doesn’t know how to fix it can be a bitter pill to swallow.
Unfortunately, when a man finally does walk through the front door of a therapist’s office or treatment center he can’t help but bring his “male baggage” with him, which can make him very hard to engage in treatment. After all, the primary qualities asked for in most psychotherapeutic treatment settings are vulnerability, emotionality, honesty, and a willingness to open up and discuss even the most troubling, embarrassing, and shameful issues at length and in detail. This is completely counterintuitive for the vast majority of men (gay and straight alike). Because of this, relying on traditional forms of talk therapy – uncovering how the past affects the present, re-experiencing it, and (hopefully) re-processing it in such a way as to reduce its power in the present – is usually not an easy or effective path in the early stages of clinical work with men. Some men simply cannot or will not fully open themselves to this process.
So how can we successfully treat traumatized and/or addicted men in therapy? To a certain extent, it actually helps to appeal to their straightforward, logical, problem-solving nature. As such, Cognitive Behavioral Therapy (CBT) and other highly directive forms of treatment are often the most effective methodologies. With these approaches therapists initially focus on three things:
- Helping the client understand the nature of his problem (for instance, fear of intimacy in the present caused by sexual abuse in childhood)
- Helping the client identify and learn to recognize the triggers that set his problem in motion (his wife getting “clingy,” for instance, causing him to become angry and dismissive of her)
- Helping the client develop and implement healthier coping mechanisms (suggesting a “family activity” that also involves the kids, for instance, which satisfies his wife’s need for togetherness while easing the emotional burden he feels)
In treatment settings, men are often distracted by external life concerns that are not really “of treatment,” like who will take care of the house and family if they spend a month at an inpatient facility. For many men these things are easier to focus on than the more important treatment issues like identifying and dealing with underlying emotional pain. In such instances it may help to remind clients that all of the obligations they’re worried about are already in jeopardy, which is often what brought them to treatment in the first place, and the solution they are seeking is to remain in recovery and address their inner demons. In other words, the best way for a male client to accomplish his greater life goals is to stay in treatment. And more often than not, if you can keep a male patient in treatment long enough, you can eventually ease him through the much needed emotional work that is anathema to his male false-self adaptation.
Gender Separate Treatment: Women
Women are usually much more willing to enter therapeutic treatment than men, and they do so with more enthusiasm and less trepidation. Often, they are genuinely relieved to surrender the illusion of control over their situation. Because of this, women tend to stay longer in treatment settings, to be more willing to address traumatic issues, and to adapt better and more quickly to the social aspects of certain treatment settings such as group therapy, inpatient treatment, and outside support groups. Mothers, however, do tend to struggle with role-loss and treatment enforced separation from their children (especially younger ones) if they opt for inpatient treatment.
Since women tend to operate more emotionally and holistically than men, they can be less adept at compartmentalizing. Thus, women’s lives are much more likely to be in near-total ruin when they arrive in treatment. Essentially, men are usually able to hide or contain their underlying issues for long periods of time, succeeding in the workplace and even developing romantic (though usually not fully intimate) relationships. With women, however, their underlying emotional struggles are much more likely to leak out and affect nearly every aspect of their day-to-day existence. Because of this, many women present with an entire universe of problems, all of which need be addressed in treatment.
When a woman whose global functioning has been seriously compromised by trauma, addiction, and the like arrives in treatment, a therapist might initially be inclined to implement CBT or some other directive methodology. However, these forms of treatment don’t always work well with female patients. In fact, many women, especially early in the process, can struggle with linear, directive forms of therapy, often questioning assignments and suggestions to the point where such an approach simply breaks down. In such cases more traditional forms of talk therapy, with a focus on relationship and empathy building, may be more useful as a primary tactic. The clinician can then build in assignments, education, and CBT as the relationship permits. In other words, the directive approach must be introduced more subtly into the process as part of a larger, “feelings oriented” therapeutic conversation.
Another issue that may arise with women, especially those whose underlying trauma is sexual in nature, is that they may act out their trauma in treatment settings by becoming more seductive with and/or distracted by men, both staff members and fellow patients. In such cases, gender separate clinical environments are highly recommended. Therapists should also be aware that females in treatment often manifest cross- and co-occurring disorders. For instance, a woman may be seeing a therapist to work on drug abuse issues, only to find herself beginning to smoke, put on weight, or engage in out-of-control spending, hoarding, sexual acting out, etc. In such cases, all of the woman’s substance/behavioral compulsions need to be treated simultaneously. If she doesn’t learn about their interconnections and what lies beneath, she may not heal from any of her issues.
Cut and Dried?
Major caveat here: almost everything written above is based on generalizations. As any good therapist knows, every client is different, and no patient ever fits neatly into any clinical package. The generalizations above are easily influenced by a client’s age, race, sexual orientation, and cultural and class issues. Not every man behaves in traditionally masculine male ways, nor does every woman consistently fit the female stereotypes. In general, however, and once again this is a matter of nature (neurobiology) as well as nurture (social conditioning), males tend to be less than willing to make themselves emotionally vulnerable, whereas females will often question the need for therapeutic assignments and direction. Of course, all clients typically need a dose of both directive and talk therapies. No matter what, regardless of the patient’s gender or the primary therapeutic approach being utilized, the therapist must always pay close attention to the client’s reactions, seeing what the individual is (and is not) tolerating from an emotional standpoint, as pushing too hard can be counterproductive. Yes, you want to get as much work done as possible, but never to the point of damaging the therapeutic relationship or causing further harm to the patient’s already fragile ego state.
He has also provided clinical multi-addiction training and behavioral health program development for the US military and treatment centers throughout the United States, Europe, and Asia.