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In some areas, this can be done by developing kinship: for instance, knowing a bit about where the client grew up, having a common understanding of the client's work, or sharing an interest in a recreational pursuit. Certain male clients feel threatened by or uncomfortable with the help-seeking process, so clinicians in behavioral health settings can spend time initially developing rapport and establishing a connection before beginning screening and assessment. From their first contact with a male client, clinicians can be sensitive to the ways traditional male gender norms may be influencing the screening and assessment process. Although time restrictions are a reality, clinicians can make the most of the time they do have, even if only a few minutes. Of course, establishing rapport and trust with the client from the start is essential.
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When screening and assessing male clients for substance use disorders, behavioral health clinicians can take a number of steps to alleviate the discomfort men may experience when seeking professional assistance.
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Their need to prove themselves may extend into a number of different areas, including sexual accomplishment, physical domination (which can lead to violence), or competitive interactions with other clients (e.g., through the telling of war stories about their substance abuse). They may resent being told what to do, and so suggestions may need to be reframed as conclusions that are reached collaboratively between client and counselor. As a result, male clients may develop combative or competitive relationships with male treatment group members and staff or may appear resistant to others' suggestions. Men are also expected to be competitive and, at times, aggressive. Their need to be self-sufficient may result in a false sense of accomplishment or security in their recovery, which may manifest as unwillingness to follow through with continuing care or attend mutual-help meetings. This too is, in part, a reflection of men's stoicism. They may also have trouble analyzing their own problems, particularly feelings related to those problems. Men often have concerns about privacy and need reassurance that treatment will pose no threat to their image or standing. Consequently, they may have trouble identifying or expressing weaknesses or problems within treatment, which may be perceived as a lack of trust or an unwillingness to be open with counselors or fellow clients. Men are expected to be independent, self-sufficient, stoic, and invulnerable. The other considerations of which behavioral health service providers need to be mindful follow from an understanding of the factors that define masculinity and male roles in our society, which are discussed in Chapter 1. In treatment planning, consider approaches that have been found effective with men or with men who have particular characteristics (such as a high degree of anger)-these, too, are discussed in Chapter 5.
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Providers should also recognize the motivations that typically bring men to treatment (such as criminal justice system involvement, referrals from other behavioral health resources, and family or work-related pressures, discussed in Chapter 5) and the possible resentment of treatment staff that can result. Small adaptations can be made to improve treatment for men, such as ensuring that waiting rooms have decorations and reading material that appeal to men, and asking about client preferences regarding types of treatment (many men prefer more instrumental approaches, such as cognitive–behavioral therapy) and behavioral health service provider gender (see the discussion on therapist gender later in this chapter). As noted in Chapter 1, most clients in substance abuse treatment are male, and most research into treatment methods has used populations that reflect the composition of treatment programs. Many treatment approaches useful for men are the same that have been found useful for all clients. Treating Men for Substance Abuse: General Considerations