Reaching the Man behind the Mask: Clinical Issues for Men

On March 18, 2026, I will be presenting a clinical workshop on this topic as part of the ICB Spring Conference in Itasca, IL. For those of you who are planning to attend my workshop, consider this a short preview. For those of you who cannot attend, here's what you are missing.

Our culture sets expectations for gender socialization early in one's life. Blue for boys. Pink for girls. Boys are taught to be tough, play to win, and never cry. Girls are taught to play nice, look pretty, and smile. This socialization continues throughout one's lifespan. That's not to suggest there's no gender identity fluidity these days. On the contrary, the pushback on gender fluidity may be further evidence of the rigidity often seen in this socialization. In this blog and in my workshop, I focus exclusively on boys trying to appear as strong men and their tendency to hide behind socially acceptable masks to hide their true selves. To quote Mark Twain, "When a boy reaches the age of 12, he starts acting as if he is a man, and he keeps doing that the rest of his life."

Behind the masks are many core issues common to men. For this writing, I offer you the following four:

1. Trance of unworthiness

2. Reliance on work identity

3. Toxic masculinity

4. Rigid defenses, especially denial

Trance of unworthiness

Tara Brach (Radical Acceptance, 2003) offered this term, which many of you know as shame. This term captures the experience better because it reveals the impact of the negative, self-talk patterns upon our self-identity. If we tell ourselves we are inadequate in many ways, we begin to believe it's a fact, instead of a hyper-critical self-judgment. With the high expectations of being a strong male, it's no wonder we think we fall short. But since we cannot let others see our vulnerability, we wear a mask to tell the world, "I got this."

Reliance on work identity

For most men, work is more than a means to pay the bills. It's a measuring stick of a man's value because a job represents varying degrees of status, authority, wealth, and competence. Among the many facets of a man's life, work is in the driver's seat, leaving home, health, relationships, and community in the back seat. This is particularly stressful for men who may be underemployed or unemployed during their working years. For a man retiring from a long career, losing his work identity is a major challenge.

Toxic masculinity

Please keep in mind, not all masculinity is toxic, however there are many behaviors which are destructive to others and to men themselves. These behaviors grow from the emphasis for men to be competitive even in the face of violence and other high-risk activity, such as the following:

• Excessive alcohol and other drug use

• Dangerous driving

• Bullying

• Gun violence

• High rates of suicide

Rigid defenses, especially denial

To hide one's vulnerability, men not only wear masks, but also wear suits of armor. Unfortunately, instead of serving as protection against perceived threats, this armor imprisons men, making them less able to respond to actual threats. One example is the man who has progressed so far into his alcoholism that he fails to recognize the damage done to him and those closest to him. He believes he can manage as long as he continues to act as if everything is OK.

When men enter counseling, they are often forced into it by employers, probation officers, and family members, which adds to the resistance to change. In the face of this resistance, counselors may fall into two traps. The first is to try to break through the resistance which tends to result in power struggles. The second is to lower clinical expectations in an effort to reach a short-term goal, such as maintaining abstinence while in treatment. There are many clinical approaches to better serve our male clients. For example, Motivational Interviewing reframes resistance into ambivalence to encourage the change process to begin and to develop further. Much has been written about Motivational Interviewing, so I will focus on other approaches.

Acceptance Commitment Therapy (ACT)

Using ACT, a counselor invites a client to examine his behavior, especially in areas in which he feels stuck. One of its key concepts is the acronym F.E.A.R. to highlight things that prevent change,

Fusion: being so stuck in a problem, one is blind to possible solutions

Excessive goals: when goals are set too high, a man may simply give up

Avoidance of discomfort: change is uncomfortable, reinforcing old patterns

Remoteness from values: without values, we lose our guiding compass on how to act

For more information about ACT, I recommend books by Russ Harris.

Narrative Therapy

This approach helps men to recognize new meanings in their lives. Our lives are not mere facts, but more importantly, our interpretations of these facts. For men who are stuck within a trance of unworthiness and self-destructive behaviors, we need to help them to reframe their experiences into new stories which offer a new direction for change. This is especially powerful when done in a men's group because the feedback from other men is valuable to re-shape a man's story about his life.

Self-Compassion

In her book titled Self-Compassion (2011), Kristin Neff describes the tendency for people to be their own worst critic, thinking this will help promote change. However, self-criticism tends to disempower us, making it an ineffective motivator for change. She identifies the following three components of self-compassion which better serve us:

1. Self-kindness: offering oneself supportive understanding, not hyper-criticism

2. Connection with humanity: struggles are part of the human condition

3. Mindfulness: helps to ground us in a safe space from which to better examine our situation while letting go of past regrets or future anxieties

In addition to clinical approaches, men's organizations offer nonclinical, peer support to promote personal awareness and ongoing growth. Two local organizations are Victories and the Mankind Project. Each provide weekend retreats and ongoing men's groups, giving men sacred spaces to share their experiences, connect with other men, and learn to live with open minds and open hearts.