working w/the drinking man

1. 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

2. ? of counseling… jkorcusk@usd.edu; 605.677.5840

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. positive factors • Self-esteem • Assertiveness • Independence • Confidence Source: O’Neil, 1995; Pleck, 1985 jkorcusk@usd.edu; 605.677.5840

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. ? 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

26. ? 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

27. ? 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

28. ? 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

29. 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