Journal of Family Therapy (1988) 10: 109-123

Men and fathers in therapy

Margare t O'Brien"

This paper relates social scientific research on masculinity and fatherhood to the position of men and fathers in therapeutic settings. Common male pathways used for seeking help are described. The paper ends by exploring the implications of these patterns for couple and family work. Particular attention is paid to gender differences in the perception of male engagement in therapy.

Introduction

The purpose of this paper is to offer a preliminary examination of the position of men and fathers in therapeutic environments or clinical settings. I want to explore in particular the barriers and constraints which appear to limit full male expression in clinical work, whether i t be at the early stage of help seeking (when there are emotional problems) or at the later stages in the therapeutic process, for instance, in the interactions between client and therapist in the clinic.

The background to my paper is the growing research literature on the psychology of men, masculinity and fatherhood (e.g. Lamb, 1981; Lewis and O'Brien, I 987; McKee and O'Brien, 1982; Pleck and Sawyer, 1974). Since the early I970S, American researchers of gender relations have shown a keen interest in the psychology of men. Social and behavioural scientists in the U.K. have been less explicit in their consideration of male rhles, although the issue has been visible in other arenas (e.g. in radio, television, newspapers).

For the U.K., 1984 appeared to be 'the year of the man'. Five popular books about the male condition were published-all but one written by women (Ford, I 984; Franks, 1984; Hodson, I 984; Ingham, 1984; Roberts, 1984). These and other writers suggest that the modern Western male is undergoing a crisis of identity. The traditional norms of bread-winning, protecting and being physically strong are seen as no longer totally appropriate for contemporary men. A different set of

Accepted September 1987. *Department of Sociology, North-East London Polytechnic, Livingstone Road,

London E I ~ , U.K. '09

o 163-4445/88/020 I 09 + I 5 $03.00/0 0 1988TheAssociationforFamilyTherapy

I I o M. O’Brien

prescriptions and expectations are being put forward as more suitable for, and even more characteristic of, men. Embedded in this argument is a notion of the ‘new man’ or ‘new father’. The new man is one who shares domestic and child-care duties; gives the family equal priority with work; discusses personal feelings with his partner and others; is emotionally closer to his children than his forefathers, and so on. Empirical data suggest that the prevalence of such a composite new man is actually quite low (Coverman and Sheley, I 986; Lewis, I 986).

Research and debate about male rdes have implications for therapeutic theory and practice. These will be explored in this paper. Since the therapeutic encounter is one place where social and internal worlds meet, an exploration of male experiences of therapy can generate rich data and also new research questions about masculinity and fatherhood more generally.

In this paper, I will firstly examine data which show that men are less likely than women to seek help about emotional concerns. I t seems that this gender pattern recurs regardless of whether the problem is individual-, couple- or family-based. I will then go on to consider some of the explanations for the phenomenon of the so-called disengaged man or peripheral father. The third part of the paper will concentrate on therapist-male client interactions in the consulting room or clinic. The paper will end by considering the implications of engaging men in therapy. It will be suggested that therapists need to be sensitive to the consequences of this process, especially for women, and may have to utilize imaginative therapeutic strategies in this regard.

Seeking help A starting point for many clinicians working with ‘families’ which include fathers is the realization that a majority of such men, for whatever reason, tend to be absent from consultations. Clinical opinion and experience is that when there are relationship problems in families (either conjugal or parental), it is mothers rather than fathers, wives rather than husbands, who make the initial approach to an agency for help. The man or father has been described as ‘disengaged’ in literature on individual psychotherapy (Kirshner et al., 1982; Solomon, 1982), marital counselling (Brannen and Collard, 1982) and family therapy (Atkins and Lansky, 1976; Heubeck et al., 1986)~ although we do not know whether the man himself would concur with such a description.

Empirical data do align with clinical opinion but the material is rather patchy.

Men and fathers in therapy I I I

Maritalproblems

Five recent U.K. small-scale studies of marital counselling all point to the finding that women do indeed tend to make the first agency contact; are more likely than men to come alone for the first session and are more likely to continue with counselling afterwards (Brannen and Collard, 1982; Heisler, 1984; Gaunt, I 985; Hunt, 1985; Timms and Blampied, I 985). For instance, in Brannen and Collard’s London study, two-thirds of first contacts to formal agencies were made by wives. They found that men were also less involved in informal lay referral networks such as those involving friends and kin.

Familyproblems

Systematic data on gender patterns of attendance to agencies who deal with family issues and take a family approach are even more sparse. I could not find any published U.K. material on this question, and although there is more American research the measures used are rather limited, usually based on therapist impression rather than actuarial session by session data (Gurman and Kniskern, 1981). One example is the work by Berg and Rosenblum ( I g77), who analysed 60 family therapists’ views about fathers in treatment. The therapists reported that about 30% of families turned up to the first interview without father, and that in general fathers were more resistant than mothers about coming back to the clinic. As mentioned above, family therapists from both Europe and the U.S.A. have commented on the relative absence of men from family sessions. Indeed, a crucial task of early sessions is how to engage the reluctant father (Gurman and Kniskern, I 98 I ) .

Individualproblems

Routine social surveys provide us with much more comprehensive data about individual consultative and help-seeking behaviour.

At an individual level, men overall utilize physical and mental health care services at a lower rate than women. Analysis of the 1980 General Household Survey shows that adult men between sixteen and fifty-five years are more likely than women of a comparable age to report good physical health, fewer days of restricted activity due to illness and fewer physician visits (Cunningham-Burley, 1986). Identical self- report gender differences have been found in other studies (Verbrugge,

I I 2 M . O’Brien

1985) despite the context of a real higher prevalence of physical disease and a higher mortality rate amongst men (Macintyre, 1985; Bayliss et al., I 986).

As far as psychiatric morbidity statistics are concerned, it seems that fewer adult men than women present with psychiatric symptoms at the primary care level (Goldberg and Huxley, 1980). However, in the U.K. a t least, when men do present, they are more likely than women to be referred on to a psychiatrist and to be admitted as an inpatient (Goldberg and Huxley, 1980; p. 133). Some of the explanations for this gendered pattern of help-seeking and referral will be explored later in the paper, but several writers have suggested that men’s easier passage from community to hospital might be because when they present to the general practitioner their problems are a t a more serious stage of development (e.g. Horwitz, 1977). Patterns of psychiatric diagnosis also vary by gender of patient. In the U.K., gender differences are most apparent for the depressive/neurotic categories which are female-dominated and the drug dependence syndromes which include more men than women (Williams, I 984).

I t seems then that the ideology of the new man or involved father, important in many clinicians’ philosophies and training, is not reflected in male help-seeking behaviour, nor, as will be seen, in the interactions between professionals and clients in the clinic. Recently, clinicians have been trying to understand why men are under- represented in help-seeking and giving settings and how fathers can be more effectively engaged in therapy. Before these areas are explored, let us consider the question, why bother to engage men and fathers in this way a t all? Possible answers include:

( I ) Adoption of a preventive approach to male emotional and physical ill-health which would emphasize the therapeutic advantages for men of earlier problem recognition and appropriate help-seeking action.

( 2 ) Conceptual assumptions underlying a particular therapeutic intervention, as is the case with the systemic approach of family therapy which necessitates male involvement, if males are in the presenting system. With this approach, a ‘problem’ is not seen to reside within one person but is instead understood in terms of how all individuals within a system interrelate.

(3) Therapists might want to respond to women’s and mothers’ requests, often voiced in the first session, for more sharing, understanding and/or less abuse from their male partners.

M e n and fathers in therapy I I 3

Why men do not present

There are many potential explanations of male patterns of help- seeking. I intend to consider some of these, beginning with those concentrating on individual psychological processing and then moving on to arguments that are centred more around social and institutional considerations.

Problem recognition

Some American and U.K. evidence suggests that men are less likely than women to interpret symptoms associated with mild depression and low general well-being as signs of emotional problems, and as a consequence they are less likely to obtain professional help voluntarily for their difficulties (Kessler et a l . , 1981; Briscoe, 1982). Briscoe points out that an identical affect state might have typically ‘masculine’ and ‘feminine’ interpretations. In her London study, she found, for example, that women tended to perceive the affect state of ‘not having recently felt particularly excited or interested in something’ as indicative of ‘things going badly’, whereas male subjects were more likely to see this situation as ‘a normal state of affairs’. So the process by which an individual begins to recognize or label an emotional problem as being such might well be influenced by gender. Symptomatic men may feel the same level of malaise or unhappiness as comparable women but may process these sensations through different sets or schemas in which the criterion for problem recognition is set at a different level. Certainly, there is psychophysiological work suggesting that men tend to be less attentive to certain bodily states and changes than women (Pennebaker, 1982). Thus, i t may well be that this difference in ‘internal attentiveness’ carries over to interactions with others so that, in a familial context, men are slower than women in perceiving indicators of relationship diffkulties.

Expressivedifferences

Where men do recognize familial or marital problems, expressive norms associated with conventional masculinity, at least in Western cultures, can inhibit articulation, especially in the public domain (Soloman and Levy, I 982).

Writers ascribing to this view argue that the existence of familial difficulties is suggestive of a degree of personal weakness and so is more

I 14 M . O’Brien appropriately communicated to outsiders by female family members. Men’s reluctance to attend hospitals, even in the face of possible heart attacks, and the instrumental r81e of wives in engineering admission gives some support to this argument (Finlayson and McEwen, 1977). As Richman (1982) reminds us, the first commandment of (‘old’) masculinity is:

Thou shalt not cry or expose feelings of emotion, fear, weakness, symptoms, empathy or involvement before thy neighbour.

Jourard’s ( I g7 I ) work on self-disclosure also highlights social constraints on male expression of affect. He found that, in general, American men had lower levels of personal self-disclosure than women.

As far as the public disclosure of child-related problems are concerned, there is some evidence that both mothers and fathers accept the normative prescription of mother as child-care expert and specialist in dealing with health professionals (Kerr and McKee, 1981; Graham, I 984).

I t seems that the mother both receives (Gluck et al., 1980) and transmits the emotional atmosphere of the family and moreover is reinforced in this position by the feedback she receives from others outside the home. In the majority of families there is, of course, a material basis to this transaction, since women take on the main responsibility for child-care, and also, some would argue, for adult care:

As the principal carer, the mother acts not only as the home nurse, home doctor and home tutor, she is also the person in contact with the professionals who perform these roles in the public domain. Typically it is mother who seeks out health professionals; she is the one, too, who is sought out by them. (Graham, 1984; p. 164)

Therefore, the mother might indeed be the more reliable informant about emotional family issues. Kerr and McKee (1981) show that fathers tend to attend child health clinics only when requested by their wives or when there is an ‘important’ developmental issue to consider, such as immunization. Social service involvement, for instance in cases of child abuse, may also result in fathers being compelled to attend a therapeutic setting. It might be that fathers are only seen as necessary, both by themselves and others, when family distress is exceptionally high.

Men and fathers in therapy I I 5 Institutional factors

Further factors which influence the involvement of fathers in clinical milieux are the nature of the therapeutic institutions and the therapists they contain. A clinic might seem, to the eyes of both potential clients of each sex and the therapists themselves, a woman’s place located in woman’s time. Just as research on the family takes place in men’s working hours and often excludes fathers, so, too, does therapy with the family. Also, therapists and other health workers might share the societal belief of some of their male clients that expressing concerns about fatherhood or husbandhood is indicative of weakness and femininity. Even if therapists do not consciously hold this belief, Atkins and Lansky (1986, p. 183) suggest that male clients might through the course of treatment project these feelings onto the therapists and so create in turn quite a debilitating institutional countertransference for fathers.

Shared social values surrounding masculinity can generate conflicts around a man’s more ‘feminized’ past, rendering a father anxious and/or hostile toward a treatment situation he sees as passive, or as inflicting passivity or powerlessness, or as dominated by women or by ‘affected, panty-waisted men’. The mental health system then becomes the inheritor, through projection, of shared inner conflicts surrounding masculinity and femininity, activity and passivity, and power and weakness.

Other researchers into gender issues in psychotherapy have noticed the ‘discomfort’ some therapists feel when treating men and indeed the ‘deficiencies’ in fledgling male therapists’ appreciation of emotional issues’ (Kirschner et al., 1982; p. 27 I ) .

In an interesting article, Brearley (1986), past England cricket captain and now a psychoanalyst, describes some of the dilemmas of being a male therapist and of working with male clients. He feels that being a male therapist is dificult, as the qualities of a good therapist, that is to be able to ‘to receive, listen, wait and to remain in the dark’ (Brearley, 1986; p. g) , do not come easily to men. Of his patients, he comments that the men ‘tend to be more cut off from their feelings’; that they ‘experience less conscious misery, or are vaguely miserable but unable to say or know why’ (Brearley, 1986; p. 3) .

Although the gender of a clinician or therapist has always been considered a potent dimension in the therapeutic relationship, systematic research into this area is only a recent development and has been especially pronounced in the U.S.A. We know very little about gender and therapeutic relationships elsewhere. Data from the U.S.A.

I I 6 M . O’Brien

indicate that male psychotherapists are more involved in marital, family and group therapy than their female counterparts. By contrast, female psychotherapists spend a larger part of their therapy time doing individual work when compared to their male colleagues (see Dryden, 1984). I am in the process of collecting comparable U.K. data, and the material I have gathered so far suggests a similar pattern.

There is growing evidence that a male therapist in the early stages of family therapy can facilitate whole family engagement (Heubeck et al., 1986). In this situation, a father might feel that he is not entering into women’s territory, that he is ‘in with a chance’ and that he might even have an ally who can understand him.

Whatever the dharacteristics associated with fathers’ lack of involvement with the helping professions, there is certainly a current concern to engage the peripheral father. This motivation might originate from the philosophical assumption underlying a particular intervention, as in the case of family therapy. Alternatively, wider political orientations, such as a belief in shared parental responsibility for child-care, may be in operation. It could be said that the persuading and cajoling of fathers to enter into the inner sanctum of the consulting room resonates with some of the strategies used by women to encourage more male involvement in the emotional life of the home.

I will now move on to the third part of this paper which considers therapist-male client interaction in the consulting room or clinic.

Men and fathers in the consulting room

Style o f therapy in couple work

Just as there are often conflicts of interest between mothers and fathers in the home, these may also occur during consultations with helping professionals. Men and women in such settings may want the same outcome, for example, help with children’s sleep problems or relief from chronic marital arguments, but their investment in the consultation and expectation of treatment may vary considerably. Brannen and Collard (1982) found that men were less satisfied than women with non-directive ‘ventilative’ style of marital counselling, expressing a preference for more structured advice giving or goal setting. One reason for this might be a transfer of work talk into the therapeutic encounter, a strategy that might be preferable to men, especially at times of threat (Weiss, I 985).

Men and fa thers in therapy I I 7 However, other research has indicated that men who persist in

counselling begin to accept the value of ‘just talking’ (Hunt, 1985). As one of Hunt’s respondents commented:

Well, unless you are actually expressing feelings regularly, the words don’t come easy to describe how you feel when you are asked ‘how do you feel about . . .?’ Normally, you don’t get down to it, so I didn’t find it easy to say how I am feeling . . . basically because I’m not practised at it (Hunt, 1985; p. 78). The propensity of more men than women to drop out after the first session disallows any further practice at ‘talk’. Moreover, the expectation of at least a degree of open talk about feelings a t this session might dissuade some men from returning. A recent study of the first interview in U.K. marriage guidance settings suggests that after this session, men ‘perceive their counsellors as slightly less warm and friendly’ and ‘feel slightly less understood’ than female clients (Gaunt, 1985; P. 25).

The silent man

At times it appears that the relative silence of male clients in the consulting room mirrors couple interaction more generally. Wives and female partners drag their men to the therapist in order for the therapist to make the man speak..

I will illustrate this process with an excerpt from the first few seconds of a couple session.* This couple had been seen once before with their two sons, nine and five years old, when the presenting problem was that their youngest son was being rude and disobedient to his mother. At that time, the therapy team had noticed how Mrs M. allowed herself to be labelled as incompetent by her husband and that she was unable to get him to support her authority. The team wanted to see the couple alone to explore marital issues. (The therapist in the consulting room was female and the rest of the team, who were behind the one-way mirror in an adjoining room, consisted of two men and one woman. The family had consented to being observed by the team.)

This selected transcript (Table I ) illuminates male disengagement and is also suggestive of how parenting dysfunction might be maintained in this family. One pattern seems to be that the husband

*This case example is taken from such work at the Marlborough Family Service.

I 18 M . O’Brien TABLE I Opening sequence

Time (seconds) Transcript Comments

005 Th. What did you want to dis- cuss today? (Husband looks away from Th. towards win- dow, wife looks at Th.)

W.

or4 H.

0 2 0 W.

If there is a chance by coming here that, um well, what have we decided between us? (Turning to husband)

(Touches nose with hand and pauses) I’ve forgot- ten. (Pause.) You’ve got a better memory than me

(Looks at H. and then moves head upwards very quickly. Looks at Th.) You see, I’m using this as a platform to make him talk

H. creates a distance between himself and w q e and Th. by looking away. W. engaged NV* with Th.

W. speaks first. Defining her right to do so? And/or own- ing ‘the problem’? Falters- loses confidence in her posi- tion and attempts to get H.’s support/involvement. To re-

frame ‘her problem’ as ‘their problem’?

Nose touching = anxiety? Pausing is an indication once more of distancing self from situation. The H. apparently disqualzfies both his W. and the problem with the phrase ‘I’ve forgotten’. However, he immediately backtracks and asserts that his W. has a ‘better memory’ than he and so accepts that there is a problem but it is her problem, not their problem.

NV movements suggest shock/despair/anger of W. towards H. NV and V t be- haviour of W. to Th. indi- cate her plea for support in getting husband to play a part in problem and the ses- sion

*NV, non-verbal. TV, verbal. Th., therapist; W., wife; H., husband

M e n and fathers in therapy I I g distances himself from family-related discourse and only enters into the interchange in a disqualifying manner. He disconfirms his wife’s view of reality by indicating that there is not really a problem. Mr M.’s first words in the session implied that he had forgotten why he had come.

During the session, the only times that the vicious circle of disunited parenting and male patient disengagement broke down was during the involvement of a male therapist.

O n a couple of occasions, a male therapist entered the room, and it was noticeable how Mr M. engaged with him both verbally and non- verbally. The first occasion concerned bed-time. The male therapist came in and supported the female therapist’s interpretation of divided parenting. He likened the MS’ parental approach as two goal posts far apart, allowing the children to kick the balls through the middle! Mr M. nodded in agreement.

The male therapist’s second intervention came right at the end of the session while the female therapist was prescribing homework. She had set a task for the parents to put aside half an hour every week to discuss parental issues together. Mrs M. accepted the task, whereas her husband was complaining about its artificiality. The male therapist entered the consulting room and said to the female therapist (several times), ‘They won’t do it, I don’t know why, but they won’t do it.’ M r M. smiled.

The manner in which particular family therapists align with fathers has come under criticism of late, especially from feminist therapists. For instance, Hare-Mustin (1981, p. 558) argues that some thera- peutic manoeuvres reinstate stereotypical gender r8les and may in fact create an even more ‘one down’ position for women:

Minuchin (1974) sees himself as modelling the male executive function, forming alliances, most typically with the father and through competition, rule setting, and direction, demanding that the father resume control of the family and exert leadership as Minuchin leads and controls the session. . . . These illustrations reveal how the unquestioned acceptance and reinforce- ment of stereotypic sex roles takes place in much of family therapy, despite the possibilities inherent for change in the systems point of view.

However, the creative use of a male therapist, as in the case described above, might be more likely to instigate a shift in a partner’s family r81e, as Goldner (1985, p. 45) suggests:

A male therapist telling a father to shape up can be seen as a rude awakening, a female therapist with the same message can be just another nag.

1 2 0 M . O’Brien

I t seems, therefore, that the different ways in which female and male therapists operate to promote parental unity and equality is a future area of inquiry.

Style of therapy in farnib work

Some of the active techniques used in structural family therapy such as enactments of parent-child dialogue and explicit manoeuvres altering proximity have also been favoured by fathers (Russell et al., I 984). In a longitudinal study of thirty-one cases, Russell and her colleagues found that mothers favoured relatively gentle interactions such as ‘tracking’ or positive connotation. It might be that the more active therapeutic techniques help integrate fathers back into the family system and decrease their feelings of parental incompetence and helplessness. Family therapy clinics which require father presence before any therapeutic work can begin might have the same effect. But Russell et al. caution against change occurring too quickly, as family members very involved in the original structure might experience blame and frustration. This family member is most often the mother.

Over the last few years, gender issues are being more openly discussed in the family therapy literature (Hare-Mustin, 1986). In particular, there has been concern that some assumptions of systems thinking, for example, the insistence that all participants play a part in the maintenance of dysfunctional behaviour, can have negative consequences for women in families, for instance, where men are violent or abusive (McIntyre, 1985). Such an assumption, McIntyre (1985, p.253) posits, overlooks the social dominance of men in the public sphere and fallaciously assumes equal power in the home. In the consulting room, as the interaction between the couple becomes highlighted, the woman’s status is redefined from victim to ‘co- conspirator’.

Conclusions and implications

As I stated in the Introduction, the aim of this paper is to explore the position of men and fathers in the therapeutic milieu, paying special attention to constraints disallowing full male expression. By concentrating on the male actor, it is possible that I have, using Hare- Mustin’s (1986) terminology, committed an alpha error. That is, I may have exaggerated the differences between men and women. Writers committing beta errors assume no difference between the

M e n and fathers in therapy I 2 I

sexes. Instead, I hope that the ideas in this paper raise the discussion above crude dichotomies. As the material has shown, shifts in male behaviour necessarily affect women and vice versa. Moreover, there appears to be a complex gendered patterning in the way humans recognize and communicate personal and family malaise. Mild depressive symptoms and low general well-being both in the self and in others appear to activate women to ‘make good’ and to seek help. Often, individual and family stress has escalated to quite a high level before men are prepared or forced to take restorative action. As research has shown, even at this time it is wives and mothers who are initially prime movers in encouraging men to ‘talk’ about emotional concerns.

However, despite initial reluctance on behalf of men it seems possible that paternal involvement, for instance, in family therapy, creates closer father-child relationships and enhances men’s self-esteem as fathers (Heubeck et al., 1986). Also, the resolution of traumatic family quandaries associated with, for instance, physical or sexual child abuse, might be resolved more successfully and more quickly if fathers are present (Tyler, 1986). Similarly, earlier recognition of bodily changes connected to heart disease might increase male life expectancy. But what are the consequences of these shifts for contemporary wives and mothers?

It could be argued that in the current sex-gender system, as the emotional arena seems to be a female specialism male encroachment might have negative consequences for women. An incompetent father often means a more competent mother, a stronger father-child relationship might mean a less intimate mother-child bond. Given the continued patriarchal character of the work-place, which in many ways operates to discourage maternal entry, any transformation of men into competent and emotionally sensitive partners begs the question: what areas are left in which women can excel and derive meaning? Thus, it may well be that in the present climate some women will react to the ‘new man’ or ‘new father’ with a degree of circumspection and even resistance.

Acknowledgements

I would like to thank the therapists at the Marlborough Family Service, particularly Ann Miller, for providing such a stimulating introduction to family therapy.

I 2 2 M . O’Brien

References ATKINS, R. and LANSKY, M. (1986) The father in family therapy: psychoanalytic

perspectives. In: M. E. Lamb (Ed.), The Father’s Role: Apblied Perspectives. New York. Wiley.

BAYLISS, R., CLARKE, C. and WHITEFIELD, A. (1986) The female life span.Journa1 o f the Royal College ofphysicians in London, 20: 29~-293 .

BERG, B. and ROSENBLUM, N. (1977) Fathers in family therapy: a survey of family therapists. journal of Marriage and Family Counselling, 3: 85-91.

BRANNEN, J. and COLLARD, J. (1982) Marriages in Trouble. London. Tavistock. BREARLEY, M. (1986) Counsellors and clients: men or women. Marriage Guidance, 22:

BRISCOE, M. (1982) Sex Differences in Psychological Well-being. Psychological Medicine.

COVERMAN, S. and SHELEY, J. F. (1986) Change in men’s housework and child-care

CUNNINGHAM-BURLEY, S. (1986) Marital Status and Health. Paper presented to First

FINLAYSON, A. and MCEWEN, J . (1977) Coronary Heart Disease and Patterns of Living.

FORD, A. (1984) Men. London. Weidenfeld and Nicolson. FRANKS, F. (1984) Me Tarzan, You jane . London. Souvenir Press. GAUNT, S. (1985) The First Interview in Marriage Guidance. National Marriage Guidance

Council Research Paper No. 2. Rugby. NMGC. GLUCK, N., DONEFER, E. and MILEA, K. (1980) Women in families. In: E. Carter and

M. McGoldrick (Eds), The Family Lzfe Cycle. London and New York. Gardner Press.

GOLDBERG, D. and HUXLEY, P. (1980) Mental Illness in the Community. London. Tavistock Publications.

GOLDNER, V. (1985) Feminism and family therapy. Family Process, 24: 31-47. GRAHAM, H. ( I 984) Women, Health and the Family. London. Wheatsheaf Books. GURMAH, A. and KNISKERN, D. (1981) Handbook of Family Therapy. New York. Brunner

HARE-MUSTIN, R. T. (1981) A feminist approach to family therapy. In: E. Howell and

HARE-MUSTIN, R. T. (1986) The problem of gender in family therapy theory. Family

HEISLER, J. (1984) TheNMGCClient . Rugby. NMGC. HEUBECK, B., WATSON, J. and RUSSELL, G . (1986) Father involvement and

responsibility in family therapy. In: M. E. Lamb (Ed.), The Father’s Role: Applied Perspectives. New York: Wiley.

3-9.

Monograph Supplement I . Cambridge. Cambridge University Press.

time 1965-1 975. journal of Marriage and the Family, 48: 4 13-422.

Congress of the European Society of Medical Sociology, Groningen, June.

London. Croom Helm.

Mazel.

M. Bayes (Eds), Women And Mental Health. New York. Basic Books.

Process, 26: I 5-27,

HODSON, P. (1984) Men: An Investigation into the Emotional Male. London. Ariel Books. HORWITZ, A. (1977) The pathways into psychiatric treatment: some differences

between men and women. Journal of Health and Social Behaviour, 18: I 6 9 1 78. HUNT, P. (1985) Clients’ Responses to Marriage Counselling. NMGC Research Report No.

3 . Rugby. NMGC. INGHAM, M. (1984) Men: The Male Myth Exposed. London. Century Publishing. JOURARD, S. (1971) The Transparent S e 6 New York. Van Nostrand. KESSLER, R., BROWN, R. and BRONNAN, C. (1981) Sex differences in psychiatric help-

seeking: evidence from four large-scale surveys. journal of Health and Social Behauiour, 22: 4964.

M e n and fathers in therapy I 23

KERR, M. and MCKEE, L. (1981) The father’s role in child health care. Health Visitor, 54: 47-5 1.

KIRSHNER, L. A., HAUSER, S. T. and GENACK, A. (1982) Research on gender and psychotherapy. In: M. T. Notman and C. C. Nadelson (Eds), The Woman Patient. New York. Plenum Press.

LAMB, M. E. (1981) The Role of the Father in Child Development, 2nd edn. New York. Wiley.

LEWIS, C. (1986) Becoming A Father. Milton Keynes. Oxford University Press. LEWIS, C. and O’BRIEN, M. (1987) Reassessing Fatherhood: N e w Observations on Fathers

MACINTYRE, S. (1985) Marriage is good for your health; or is it? Lecture to the Royal

MACINTYRE, D. (1985) Domestic violence: a case of the disappearing victim. The

MCKEE, L. and O’BRIEN, M. (Eds) (1982) The Father Figure. London. Tavistock

PENNEBAKER, J. W. (1982) The Psychology of Physical Symptoms. London. Longmans. PLECK, J. and SAWYER, J. (1974) Men and Masculinib. New Jersey: Prentice-Hall. RICHMAN, J. (1982) Men’s experiences of pregnancy and childbirth. In: L. McKee

ROBERTS, Y. (1984) M a n Enough. London. Chatto and Windus. RUSSELL, C. S., ATILANO, R., JURICH, A., and BERGER, P. (1984) Intervention

strategies: predicting family therapy outcome. Journal of Marital and Family Therapy, 10: 241-25 I .

SOLOMON, K. (1982) Individual psychotherapy and changing masculine roles: dimensions of gender-role psychotherapy. In: K. Solomon and N. Levy (Eds), Men in Transition: Theory and Therapy. New York. Plenum.

TIMMS, N. and BLAMPIED, A. (1985) Intervention in Marriage. Social Services Monograph. Sheffield University. Joint Unit for Social Services Research.

TYLER, A. (1986) The abusing father. In: M. E. Lamb (Ed.), The Father‘s Role: Applied Prospectives. New York. Wiley.

VERBRUGGE, L. (1985) Gender and health: an update on hypothesis and evidence. Journal of Health and Social Behaviour, 26: 156-182.

WILLIAMS, J. (1984) Women and mental illness. In : J. Nicholson and H. Beloff (Eds), Psychology Survey. Leicester. B. P. S.

and the Modern Family. London and New York. Sage Publications.

Philosophical Society of Glasgow, I I December.

Australian Journal of Family Therapy, 5: 249-258.

Publications.

and M. O’Brien (Eds), The Father Figure. London. Tavistock Publications.