To: Office for Civil Rights, Washington HQ Office

U.S. Department of Education

Office for Civil Rights
Lyndon Baines Johnson Department of Education Building
400 Maryland Avenue, SW
Washington, DC 20202-1100

TO WHOMEVER IT MAY CONCERN,

PLEASE NOTE THAT WE HEREBY FILE THIS FEDERAL

CIVIL RIGHTS COMPLAINT (TITLE IX) AGAINST
HARVARD UNIVERSITY.

YOURS TRULY,

JAMES PRESTON, ESQ. (ADMITTED DISTRICT OF

COLUMBIA #430613)
KURSAT CHRISTOFF PEKGOZ, PH.D.
JOHN DAVIS, ESQ. – PERSES INSTITUTE

CC: ASSISTANT SECRETARY FOR CIVIL RIGHTS, HONORABLE KENNETH MARCUS

CC: ASSISTANT ATTORNEY GENERAL FOR CIVIL RIGHTS, HONORABLE ERIC DREIBAND
CC: OFFICE FOR CIVIL RIGHTS, ELECTRONIC SUBMISSION PORTAL

1

 PROLOGUE
GENERAL. Men face more discrimination than women in 91 of 134 countries,
including the United States.1 The American criminal justice system is biased
against male defendants.2 Likewise, there are concerns about discrimination
against men in the American family court system.3

NO WAGE GAP. The persistent myth that men earn more than women for the
same work is fueled by flawed comparisons which “do not control for many
factors that can be significant in explaining earnings differences.”4 Men “are
significantly more likely … to work longer hours.” In addition, a woman’s
decision to take time off for marriage and childbearing is another factor that
may result in a lower salary.5 This was demonstrated in a 2005 study by the
Congressional Budget Office which found “no gender gap in wages among men
and women with similar family roles.”6 Furthermore, it is axiomatic that men
work in more dangerous jobs and thus are more likely to suffer grievous harm:
“riskier jobs get paid more.”7 Women control 60% of personal wealth and buy
85% of all customer purchases: moreover, 40% of women earn more than their
husbands.”8 In 2010, Time reported that “single women under 30 actually
earned, on average, 8% more than their male counterparts.”9 A recent study
found out that women are 36% more likely than men to receive a job offer.10

BIAS IN EDUCATION. The education system in America is especially biased

against men. 77% of all teachers in the public education system are women.11

1 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205349
2 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2144002
3 https://ir.library.illinoisstate.edu/cgi/viewcontent.cgi?article=1631&context=etd
4 U.S. Bureau of Labor Statistics, Highlights of women’s earnings in 2013, December 2014,

https://www.bls.gov/opub/reports/womens-earnings/archive/highlights-of-womens-earnings-in-
2013.pdf.
5 Ketterer, Sarah, “The ‘Wage Gap’ Myth That Won’t Die,” Wall Street Journal, September 30, 2015,

https://www.wsj.com/articles/the-wage-gap-myth-that-wont-die-1443654408.
6 O’Neill and O’Neill, What Do Wage Differentials Tell us About Labor Market Discrimination?, National

Bureau of Economic Research, March 2005, p. 33,

https://www.nber.org/papers/w11240.pdf?new_window=1&mod=article_inline
7 Worstall, Tim, “Here's Your Gender Pay Gap - Fatal Occupational Injuries,” December 21, 2016, Forbes,

https://www.forbes.com/sites/timworstall/2016/12/21/heres-your-gender-pay-gap-fatal-occupational-
injuries/#750063c26c3e.
8 “Statistics on the Purchasing Power of Marketing,” girlpowermarketing, (emphasis in original)

https://girlpowermarketing.com/statistics-purchasing-power-women/.
9 Williams and Ceci, supra, , quoting, O’Neill and O’Neill, What Do Wage Differentials Tell us About Labor

Market Discrimination?, National Bureau of Economic Research, March 2005, p. 33,

https://www.nber.org/papers/w11240.pdf?new_window=1&mod=article_inline; citing, Luscombe,
“Workplace Salaries: At Last, Women on Top,” Time, September 1, 2010,
http://content.time.com/time/business/article/0,8599,2015274,00.html?mod=article_inline.
10http://insight.movemeon.com/insight-analysis/gender/women-more-likely-to-get-hired-than-men
11https://nces.ed.gov/pubs2017/2017072.pdf

2

Girls have higher grades than boys in all categories.12 Numerous studies “have
shown that stereotyping [by female teachers] can bias teachers’ assessment and
grades” against boys.13 New civil rights data published by the Department of
Education makes it clear that concerns over the underrepresentation of women
in STEM education are outdated.14 Women are the overrepresented sex among
college students nationwide.15 They are also the majority of law students16 and
medical students.17 Almost every college offers a Women’s Studies
Department,18 but no equivalent programs exist for men.19

BIAS IN SEXUAL HARASSMENT ADJUDICATION. According to institutions that

release such data, the overwhelming majority of all persons sanctioned under
Title IX theory are male.20 However, men and women experience sexual
victimization at equal rates21 and the majority of male victims report female
perpetrators.22 The majority of Title IX administrators are women.23

CHILLING EFFECT. Male students/professors who deviate from the orthodoxy of

campus gender politics often face mobbing or termination. There are many such
examples, including cases covered by the press.24,25,26,27,28

12http://www.apa.org/news/press/releases/2014/04/girls-grades.aspx
13 Camille Terrier, Boys Lag Behind: How Teachers’ Gender Biases Affect Student Achievement, November 2016,
MIT Department of Economics and National Bureau of Economic Research, (“Research shows that
teachers’ biases generate self-fulfilling prophecies, produce stereotype threats, affect students’ interest in a
subject, and affect students’ levels of effort.” pp. 1-3 (citations omitted) https://seii.mit.edu/wp-
content/uploads/2016/11/SEII-Discussion-Paper-2016.07-Terrier-1.pdf.
14https://www.ed.gov/news/press-releases/us-department-education-releases-2015-16-civil-rights-data-

collection
15https://nces.ed.gov/programs/digest/d16/tables/dt16_322.20.asp
16https://www.nytimes.com/2016/12/16/business/dealbook/women-majority-of-us-law-students-first-

time.html
17https://www.washingtonpost.com/local/social-issues/women-are-now-a-majority-of-entering-medical-

students-nationwide/2018/01/22/b2eb00e8-f22e-11e7-b3bf-
ab90a706e175_story.html?utm_term=.3873f1eff392
18 https://datausa.io/profile/cip/050207/
19 The creation of a Men’s Studies program is not a hypothetical request. There are scholars who would like

to teach such subjects (Edward Stephens, Warren Farrell) and there is also demand for such programs. For
example, a Facebook page called “Gender Studies for Men” has 5000+ likes on Facebook, a not-so-
insignificant number since most Women’s Studies programs have small cohorts:
https://www.facebook.com/GenderStudiesForMen/
20 Stanford University’s 2018 Title IX Report:

https://news.stanford.edu/2018/02/27/provost-issues-campus-wide-report-title-ix-sexual-harassment-
cases/
Yale University’s 2018 Title IX Report:
https://provost.yale.edu/sites/default/files/files/FINAL%20February%202018%20Report(1).pdf
21 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062022/
22 https://www.sciencedirect.com/science/article/pii/S1359178916301446?via%3Dihub
23 https://www.nas.org/articles/gender_inequity_among_the_gender_equity_enforcers
24http://www.foxnews.com/us/2018/03/12/college-student-kicked-out-class-for-telling-professor-there-

are-only-two-genders.html
25https://www.andrewlawton.ca/pro-free-speech-professor-rick-mehta-fired-by-acadia-university/
26https://thehill.com/blogs/blog-briefing-room/news/409090-catholic-university-suspends-dean-over-

comment-that-degraded
27 https://pjmedia.com/trending/students-demand-professor-fired-after-he-champions-due-process-says-

accusers-sometimes-lie/
28https://www.washingtontimes.com/news/2019/jan/7/peter-boghossian-portland-state-univ-professor-fac/

3

 COMPLAINT
The American Psychology Association has recently proclaimed that
masculinity is a form of (or a driving factor for) mental illness.29 [copy
attached] We hereby file this Title IX complaint against Harvard University,
a sponsor and accomplice of APA.

1. By using APA’s guidelines, Harvard University creates a set of different

standards of behavior/sanctions/treatment for men and women. This is
a violation of Title IX.30,31
2. By using APA’s guidelines, Harvard University has adopted biased
training materials which rely upon sex stereotypes.32 Title IX
specifically prohibits such biased training materials.33,34
3. By using APA’s guidelines, Harvard University creates a hostile
environment against men.35
4. By using APA’s guidelines, Harvard University discourages men from
seeking counseling services. No reasonable male person would seek
counseling at a clinic where his sexual identity is considered to be a
form of mental illness (or a driving factor for mental illness). Such
dissuasion is prohibited by Title IX.36
5. Harvard University violates Title IX by endorsing an external agency
(i.e., APA) which discriminates on the basis of sex in offering services.37

29 https://www.apa.org/monitor/2019/01/ce-corner.aspx
30 34 CFR § 106.31(b)(4) prohibits “separate or different rules of behavior, sanctions, or other treatment.”
31 APA does not maintain that femininity (traditional or otherwise) is a mental health risk factor.
32 APA’s guidelines are predicated upon the assumption that some highly subjective and capricious

characteristics such as “stoicism” or “risk-taking” are stereotypically masculine. These assumptions are
irrational, unscientific, and regressive.
33 “Decision-making techniques or approaches that apply sex stereotypes or generalizations may violate

Title IX and should be avoided so that the adjudication proceeds objectively and impartially” (September
2017, Q&A on Campus Sexual Misconduct, Question 8, p. 5). Given the proximity of counseling and sexual
harassment prevention/adjudication on college campuses, the 2017 Dear Colleague is relevant here.
https://www2.ed.gov/about/offices/list/ocr/docs/qa-title-ix-201709.pdf
34 34 CFR § 106.45(b)(1)(iii) [proposed]. “Require that any individual designated by a recipient as a

coordinator, investigator, or decision-maker … receive training on the definition of sexual harassment and
how to conduct an investigation and grievance process … and that any materials used to train
coordinators, investigators, or decision-makers not rely on sex stereotypes.”
https://www2.ed.gov/about/offices/list/ocr/docs/title-ix-nprm.pdf
35 As per DOE policy, hostile environment can occur even in the absence of intent to harm or even if the

hostility is not directed at a particular target. Nor does hostile environment require sexual intent: gender
animus or hostility based on sexual stereotypes is sufficient to trigger Title IX liability (October 2010, Dear
Colleague Letter, pp. 7-8). This includes situations in which “students are harassed for exhibiting what is
perceived as a stereotypical characteristic for their sex” (ibid).
https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201010.pdf
36 CFR § 106.36 prohibits discrimination in counseling.
37 34 CFR § 106.31(b)(6) prohibits an institution from “aid[ing] or perpetuat[ing] discrimination against any

person by providing significant assistance to any agency, organization, or person which discriminates on
the basis of sex in providing any aid, benefit or service to students or employees.”

4

 LEGAL THEORY
The Supreme Court prohibits gender discrimination against men. In Craig v.
Boren, the Supreme Court criticized the use of sex in a statute that prohibited
vendors from denying only to males the option to purchase a higher alcohol
content beer.38 The Court found the statute’s reliance on “broad sociological
propositions by statistics … a dubious business, and one that inevitably is in
tension with the normative philosophy that underlies the Equal Protection
Clause.”39 Original and appellate courts have proscribed sex discrimination
against men as well as women,40 and decisions have been based on different
laws and statutes including Title IX, Title VI, Title VII and the Fourteenth and
Fifth Amendments.41
The Supreme Court has consistently rejected “overbroad generalizations
about the different talents, capacities or preferences of males and females” as
a basis for sex classifications in other state and federal laws.42 In Mississippi
Univ. for Women v. Hogan (Hogan),43 the Supreme Court held that denying
men enrollment in a nursing program was impermissible gender
classification under the Equal Protection Clause of the Fourteenth
Amendment.44 Though the issue concerned an equal protection challenge,45
the decision is helpful in evaluating whether Yale’s sex restriction for certain

38 Craig v. Boren, at p. 204.
39 Ibid. at p. 210. “We conclude that the gender-based differential contained in Okla. Stat., Tit. 37, § 245 (1976
Supp.) constitutes a denial of the equal protection of the laws … and reverse the judgment of the District
Court.” The Court allowed the vendor to “rely upon the equal protection objections of males 18-20 years of
age to establish her claim of unconstitutionality of the age-sex differential.” Id. at pp. 192-93.
40 Craig v. Boren, 429 US 190, 202, 204 (1976) (“Indeed, prior cases have consistently rejected the use of sex

as a decision-making factor even though the statutes in question certainly rested on far more predictive
empirical relationships than this.”); Sessions v. Morales-Santana, 137 S. Ct. 1678, 582 US __,
198 L. Ed. 2d 150 (2017) (invalidating a law that treated men less favorably than women in determining
citizenship); Orr v. Orr, 440 U.S. 268 (1979) (invalidating Alabama statute that imposed alimony obligations
on husbands, but not wives); Caban v. Mohammed, 441 U.S. 380 (1979) (invalidating New York statute that
required the consent of the mother, but not the father, to permit the adoption of an illegitimate child).
41 In Glenn v. Brumby, 663 F. 3d 1312 (11th Cir. 2011) the Eleventh Circuit drew upon U.S. Supreme Court

cases interpreting Title VII to reach its conclusion in favor of the plaintiff, even though the plaintiff chose to
pursue only a remedy for the Fourteenth Amendment violation.
42 United States v. Virginia, 518 U.S. 515, 533 (1996) (denying women admission to a state military institute);

see also, Sessions v. Morales-Santana, 137 S. Ct. 1678, 582 US __ (2017) (invalidating law that effectively
treated men less favorably than women in acquiring U.S. citizenship); Weinberger v. Wiesenfeld, 420 U. S. 636,
640-41, 653 (1975) (invalidating federal law that denied benefits to male single parents, but allowed benefits
for females).
43 Mississippi Univ. for Women v. Hogan, 458 U.S. 7, 18, 724 (1982)
44 Ibid., at pp. 720-21, quoting Wengler v. Druggists Mutual Ins. Co., 446 U. S. 142, 150 (1980).
45 Ibid., at p. 730. Under the Equal Protection Clause, the discriminating entity must be a government or

state actor and must show the gender classification serves "important governmental objectives and that the
discriminatory means employed" are "substantially related to the achievement of those objectives." Ibid. at
p. 724. Claims may be brought under both Title IX and for violations of equal protection under 42 USC §
1983. Fitzgerald v. Barnstable School Committee, 555 U.S. 246, 129 S.Ct. 788, 790 (2009)

5

benefits is reasonable. In Hogan, the Supreme Court reasoned that a sex
classification must be ---

…determined through reasoned analysis rather than through the

mechanical application of traditional, often inaccurate, assumptions
about the proper roles of men and women. Care must be taken in
ascertaining whether the statutory objective itself reflects archaic and
stereotypic notions. Thus, if the statutory objective is to exclude or
"protect" members of one gender because they are presumed to suffer from an
inherent handicap or to be innately inferior, the objective itself is illegitimate
[italics added]46
Mississippi Univ. for Women v. Hogan, 458 U.S. 7, 18, 724 (1982)

Circuit courts agree with this normative philosophy and expanded upon the
use of Title IX to eliminate discrimination against men. The Second Circuit of
Appeals has clarified that discrimination against men is unconstitutional
even in the absence of malicious intent and even for a short period of time.47
The Sixth Circuit of Appeals has clarified that unlawful anti-male bias can be
inferred when the overwhelming majority of the impacted parties are male.48

The plain language of Title IX, rooted in 34 CFR §106, prohibits any institution
from funding/sponsoring/listing discriminatory programs and initiatives.49
Title IX prohibits recipients from listing, soliciting, approving, sponsoring
discriminatory programs even if they are entirely external to the University.50
Even listing discriminatory programs is in express violation of Title IX:
nothing in the language of 34 CFR §106 suggests that an institution is even
allowed to mention a discriminatory program on its webpages.51 Title IX
prohibits discrimination in terms of counselling.52 Title IX prohibits
discrimination in terms of health benefits.53 Title IX prohibits any kind of
preference for admission in any educational entity, or its substituent chapters.54

46 Ibid., at pp. 724-725.
47 “A defendant is not excused from liability for discrimination because the discriminatory motivation does
not result from a discriminatory heart, but rather from a desire to avoid practical disadvantages that might
result from unbiased action. A covered university that adopts, even temporarily, a police of bias favoring
one sex over the other in a disciplinary dispute, doing so in order to avoid liability or bad publicity, has
practiced sex discrimination, notwithstanding that the motive for the discrimination did not come from
ingrained or permanent bias against that particular sex” (Doe v. Columbia University, No. 15-1536, 2nd
Circuit 2016, p. 26, footnote 11).
48 "The statistical evidence that ostensibly shows a pattern of gender-based decision-making and external

pressure on Miami University supports at the motion-to-dismiss stage a reasonable inference of gender
discrimination ... nearly ninety percent of students found responsible for sexual misconduct between 2011
and 2014 have male first-names" (Doe v. Miami University, No. 17-3396, 6th Circuit 2018, p. 15).
49 Such is the overall intent of CFR § 106.
50 CFR § 106.37.
51 34 CFR §106.37(a)(2) expressly prohibits even listing any outside organization’s offerings “in a manner

which discriminates on the basis of sex. In reading 106.31(b)(6) and 106.37(a)(2) together, “significant
assistance” would thus include the mere listing of a sex-discriminatory offering.
52 CFR § 106.36.
53 CFR § 106.39.
54 CFR § 106.22.

6

In determining whether discrimination occurs, Title IX requires an assessment
of the overall effect.55

As per DOE policy, a hostile environment can occur even in the absence of
intent to harm or even if the hostility is not directed at a particular target. Nor
does hostile environment require sexual intent: gender animus or hostility
based on sexual stereotypes is sufficient to trigger Title IX liability (Dear
Colleague Letter, 2010, p. 8).56 This includes situations in which “students are
harassed for exhibiting what is perceived as a stereotypical characteristic for
their sex” (id.). For example, men who are subjected to negative effects on the
basis of their stereotypically masculine characteristics (i.e. traditional
masculinity) are victims of sex discrimination, prohibited under Title IX. This
context is especially relevant in terms of understanding APA’s guidelines.

Whenever the Department of Education investigates an educational

institution for discrimination against men, the decision generates significant
public support. For example, after Yale University was placed under a similar
investigation, an article by Fox News gathered 1,500+ positive comments.57 A
video by Stephanie Hamill received 1.4 million views.58 Two articles about
similar complaints (published on Campus Reform) were shared 12,000+ times
on social media.59 An article about the University of Texas-Austin’s attempts
at classifying masculinity as a mental health problem has received 1,900+
critical comments.60 61% of male students at Yale University agree (at least in
part) with the operational logic of a complaint filed against Yale, according to
at least one poll conducted by Yale itself, and 26% of male students believe
they were specifically victims of anti-male discrimination themselves.61 Last
but not least, according to recent poll conducted by YouGov, 69% of all
Americans believe that men face discrimination to some extent. 74% of men
believe that such discrimination occurs, while 63% of women agree that men
face some degree of discrimination (p. 102).62 Given such popular support, the
Department of Education has appropriate democratic authorization to
prosecute this Complaint

The complaint seeks to eliminate gender discrimination against men without

jeopardizing the civil rights of women.

55 CFR § 106.37.
56 https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201010.pdf
57 Please refer to p. 102 in the survey.

https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/7dh1943i0z/econTabReport.pdf
58 https://www.facebook.com/Americanvoicesthedailycaller/videos/683586881973534/
59 https://www.campusreform.org/?ID=11249 && https://www.campusreform.org/?ID=10899
60 https://pjmedia.com/trending/university-of-texas-to-treat-masculinity-as-a-mental-health-issue/
61 https://yaledailynews.com/blog/2018/09/16/mens-rights-move-in-on-yale/
62https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/7dh1943i0z/econTabReport.pdf

7

 SIGNIFICANT ASSISTANCE
It should be clear to any reasonable person that Harvard University offers
significant assistance to the American Psychology Association.

• Upon information and belief, all of Harvard’s psychologists and

counselors use the APA guidelines.63 APA is the largest professional
organization of psychologists in the United States. This reliance on APA
guidelines counts as endorsement, and APA derives significant
financial benefit from this connection.
• Harvard’s Clinical Psychology program is accredited by APA and all
clinicians in the program receive APA training.64
• Two programs at Harvard are APA-approved sponsors for “continuing
professional education.” Both programs are affiliated with the Beth
Israel Deaconess Medical Center.65 The programs are:
o Continuing Education Program Inc.
o Cognitive Neurology Unit
• APA uses campus space at Harvard.66
• APA uses Harvard’s websites to list/solicit its events.67
• The current president of APA, Jessica Henderson Daniel, is a Harvard
professor and thus receives salary from the institution.68 Harvard must
compel Jessica Henderson Daniel to sever all ties with APA, or else
terminate her professorship.
• A reasonable person may impute other forms of financial, reputational,
professional ties between APA and Harvard. If need be, a compliance
review by OCR can reveal such information.69

63 APA’s guidelines are nationally binding, including all Harvard counselors accredited by APA.
64 https://psychology.fas.harvard.edu/clinical-psychology
65 http://approvedsponsors.apa.org/ [Insert keyword: Harvard].
66 For example, APA accreditation requires use of campus space. “Also listed for each program is the date

of the next regularly scheduled site visit.” Harvard is scheduled for an accreditation visit at 2020.
https://www.apa.org/ed/accreditation/programs/doctoral.pdf
67 For example, an upcoming APA conference (2019, May) scheduled to take place in Athens is currently

being advertised on Harvard’s website.

https://psychology.fas.harvard.edu/event/american-psychological-association-9th-annual-international-
conference-psychology
68 https://www.apa.org/news/press/releases/2016/11/jessica-daniel.aspx
69 “The compliance review regulations afford OCR broad discretion to determine the substantive issues for

investigation and the number and frequency of the investigations” (Case Processing Manual, p. 20).

8

 REQUEST FOR INJUNCTIVE RELIEF
Any of the following forms of injunctive relief would satisfy the allegations
raised in this complaint.

1. APA may repeal the guidelines, thus eliminating the discriminatory

practice(s) in question.

2. APA may alter the guidelines to eliminate the characterization of

“masculinity” as a form of mental illness and/or a mental illness factor,
thus eliminating the discriminatory practice(s) in question. APA should
instead adopt guidelines which are rational and non-discriminatory, i.e.
guidelines which do not rely on the kind of broad and regressive sexual
stereotypes discouraged by Supreme Court doctrine and/or which do
not seek to justify differential and invidious treatment based on sex.

3. Harvard University may sever all ties with APA (including the use of
campus space, the use of Harvard’s websites, the use of any kind of
funding by or through Harvard, the use of APA guidelines by
Harvard’s counsellors, all ties between APA and Harvard
professoriate).

9

APA GUIDELINES
for the Psychological Practice
with Boys and Men
AUGUST 2018

APA!|!Guidelines for Psychological Practice with Boys and Men! I

Acknowledgements
Guidelines for Psychological Practice for Boys and Men was developed by several groups of individuals beginning in 2005 and continuing with updates and
revisions through 2018. The final draft was compiled and updated by Fredric Rabinowitz, Matt Englar-Carlson, Ryon McDermott, Christopher Liang, and
Matthew Kridel, with assistance from Christopher Kilmartin, Ronald Levant, Mark Kiselica, Nathan Booth, Nicholas Borgogna, and April Berry. Guidelines
recommendations and selected literature were determined with the assistance and expertise of several scholars: Michael Addis, Larry Beer, Matt Englar-
Carlson, Sam Cochran, lore m. dickey, William B. Elder, Anderson J. Franklin, Glenn Good, Michele Harway, Denise Hines, Andy Horne, Anthony Isacco,
Chris Kilmartin, Mark Kiselica, Ron Levant, Christopher Liang, William Liu, David Lisak, James Mahalik, Ryon McDermott, Michael Mobley, Roberta Nutt,
James O’Neil, Wizdom Powell, Fredric Rabinowitz, Aaron Rochlen, Jonathan Schwartz, Andrew Smiler, Warren Spielberg, Mark Stevens, Stephen Wester,
and Joel Wong. The authors gratefully acknowledge the APA staff support for several years under the leadership of Ron Palomares.

Copyright © 2018 by the American Psychological Association. This material may be reproduced and distributed without permission provided that
acknowledgment is given to the American Psychological Association. This material may not be reprinted, translated, or distributed electronically without
prior permission in writing from the publisher. For permission, contact APA, Rights and Permissions, 750 First Street, NE, Washington, DC 20002-4242.

This document was approved by the APA Council of Representatives over the course of its meeting August 2018, and is set to expire in approximately 2028.
It is available online at http://www.apa.org/about/policy/psychological-practice-boys-men-guidelines.pdf.

Suggested Citation
American Psychological Association, Boys and Men Guidelines Group. (2018). APA guidelines for psychological practice with boys and men. Retrieved from
http://www.apa.org/about/policy/psychological-practice-boys-men-guidelines.pdf

II!APA!|!Guidelines for Psychological Practice with Boys and Men

APA GUIDELINES
for Psychological Practice
with Boys and Men
AUGUST 2018
INTRODUCTION

Boys and men are diverse with respect to their race, ethnicity, culture, migration status,
age, socioeconomic status, ability status, sexual orientation, gender identity, and religious
affiliation. Each of these social identities contributes uniquely and in intersecting ways to
shape how men experience and perform their masculinities, which in turn contribute to
relational, psychological, and behavioral health outcomes in both positive and negative
ways (e.g., Arellano-Morales, Liang, Ruiz, & Rios-Oropeza, 2015; Kiselica, Benton-Wright,
& Englar-Carlson, 2016). Although boys and men, as a group, tend to hold privilege and
power based on gender, they also demonstrate disproportionate rates of receiving harsh
discipline (e.g., suspension and expulsion), academic challenges (e.g., dropping out of
high school, particularly among African American and Latino boys), mental health issues
(e.g., completed suicide), physical health problems (e.g., cardiovascular problems), public
health concerns (e.g., violence, substance abuse, incarceration, and early mortality), and
a wide variety of other quality-of-life issues (e.g., relational problems, family well-being;
for comprehensive reviews, see Levant & Richmond, 2007; Moore & Stuart, 2005; O’Neil,
2015). Additionally, many men do not seek help when they need it, and many report distinc-
tive barriers to receiving gender-sensitive psychological treatment (Mahalik, Good, Tager,
Levant, & Mackowiak, 2012).
The development of guidelines for psychological practice with boys and men may help
to attend to the barriers that lead to the aforementioned disparities. Indeed, the American
Psychological Association (APA) has developed guidelines for psychologists working with
specific populations such as gay/lesbian/bisexual clients (2012), racial and ethnic minori-
ty clients (2017a), older adults (2014), transgender and gender-non-conforming persons
(2015a), and girls and women (2007). The APA also has developed guidelines for psycho-
logical practice in health care delivery systems (2013a), forensic psychology (2013b), and
psychological evaluation in child protection matters (2013c). These guidelines serve to (a)
improve service delivery among populations, (b) stimulate public policy initiatives, and (c)
provide professional guidance based on advances in the field. Accordingly, the present doc-
ument offers guidelines for psychological practice with boys and men.

APA!|!Guidelines for Psychological Practice with Boys and Men! 1

Purpose and Scope Definitions

Professional Practice Guidelines are statements that suggest or GENDER

recommend specific professional behavior, endeavor, or conduct
Gender refers to psychological, social, and cultural experiences
for psychologists (APA, 2015b). Guidelines differ from standards
and characteristics associated with the social statuses of girls and
in that standards are mandatory and may be accompanied by an
women or boys and men, whereas sex refers to biological aspects
enforcement mechanism. Thus, guidelines are aspirational in
of being male or female. Gender includes assumptions, social
intent, and they are intended to facilitate the continued systematic
beliefs, norms, and stereotypes about the behavior, cognitions, and
development of the profession to help assure a high level of profes-
emotions of males and females (Pleck, 1981, 1995). Gender norms
sional practice by psychologists (APA, 2015b). Guidelines may be
and stereotypes also vary within and between groups associated
superseded by federal or state laws, and APA (2015b) distinguish-
with other dimensions of diversity such as ethnicity, sexual orien-
es between clinical practice guidelines and Professional Practice
tation (McDermott et al., 2017), ability (Griffith & Thorpe, 2016),
Guidelines, noting that the former provides specific recommenda-
socioeconomic class (Liu, 2017; Liu, Colbow, & Rice, 2016), and
tions about clinical interventions whereas the latter are “designed
race (Hammond, Fleming, & Villa-Torres, 2016; McDermott et al.,
to guide psychologists in practice with regards to particular roles,
2017). Although gender and sex can be seen as overlapping and
populations, or settings and provide them with the current scholar-
fluid categories with multiple meanings (Marecek, 2002), this doc-
ly literature … representing [and] reflect consensus within the field”
ument uses the term gender to refer primarily to the social expe-
(p. 823). Additionally, as noted by APA (2015b), guidelines “may
riences, expectations, and consequences associated with being a
not be applicable to every professional and clinical situation” (p.
boy or man.
824). Thus, these guidelines are not definitive and are designed to
respect the decision-making judgment of individual professional
CISGENDER
psychologists. In addition, consistent with the recommendations
and procedures outlined by APA (2015b), these guidelines will need Cisgender is used to refer to people whose sex assigned at birth
to be periodically reviewed and updated at least every 8 to 10 years, is aligned with their gender identity (Green, 2006; Serano, 2006).
from the year of acceptance by the APA Council of Representatives, These guidelines address conflict that cisgender, transgender, and
to take into account advances in research, changes in practice, and gender-nonconforming individuals may experience due to societal
the effects of changing contemporary social forces and context. expectations regarding gender roles (Butler, 1990).
Hence, readers are advised to check the current status of these
guidelines to ensure that they are still in effect and have not been GENDER BIAS
superseded by subsequent revisions. The term gender bias refers to beliefs and attitudes that involve
The present document articulates guidelines that enhance stereotypes or preconceived ideas about the roles, abilities, and
gender- and culture-sensitive psychological practice with boys and characteristics of males and females that may contain significant
men from diverse backgrounds in the United States. These guide- distortions and inaccuracies. Psychologists have an ethical obliga-
lines provide general recommendations for psychologists who seek tion to recognize and confront these biases (APA, 2010).
to increase their awareness, knowledge, and skills in psychological
practice with boys and men. The beneficiaries of these guidelines GENDER ROLE STRAIN
include all consumers of psychological practice including clients,
students, supervisees, research participants, consultees, and other Gender role strain is a psychological situation in which gender role
health professionals. Although the guidelines and supporting lit- demands have negative consequences on the individual or others
erature place substantial emphasis on psychotherapy practice, (for reviews, see Pleck, 1981, 1995). The negative effects of gender
the general guidelines are applicable to all psychological practice role strain are mental and physical health problems for the individ-
(e.g., individual, couples and family work, group work, psycho-ed- ual and within relationships (O’Neil, 2008, 2013; Pleck, 1995). Boys
ucational programming, consultation, prevention, teaching, career and men experience gender role strain when they (a) deviate from
counseling) across multiple helping professions (e.g., nursing, or violate gender role norms of masculinity, (b) try to meet or fail to
social work, counseling, school counseling, psychiatry). Rather than meet norms of masculinity, (c) experience discrepancies between
offering a comprehensive review of content relevant to all areas of real and ideal self-concepts based on gender role stereotypes, (d)
practice, this document provides examples of empirical and con- personally devalue, restrict, or violate themselves, (e) experience
ceptual literature that support the need for practice guidelines with personal devaluations, restrictions, or violations from others, and/
boys and men. We encourage institutions, agencies, departments, or (f) personally devalue, restrict, or violate others because of gen-
and/or individuals to discuss ways in which these guidelines may der role stereotypes (Pleck, 1995).
be applied to their own settings and relevant activities.
MASCULINITY IDEOLOGY
Masculinity ideology is a set of descriptive, prescriptive, and pro-
scriptive of cognitions about boys and men (Levant & Richmond,
2007; Pleck, Sonenstein, & Ku, 1994). Although there are differ-
ences in masculinity ideologies, there is a particular constellation

2!APA!|!Guidelines for Psychological Practice with Boys and Men

of standards that have held sway over large segments of the pop- Need for Professional Practice Guidelines for
ulation, including: anti-femininity, achievement, eschewal of the
Boys and Men
appearance of weakness, and adventure, risk, and violence. These
have been collectively referred to as traditional masculinity ideol-
Boys and men have historically been the focus of psychological
ogy (Levant & Richmond, 2007). Additionally, acknowledging the
research and practice as a normative referent for behavior rather
plurality of and social constructionist perspective of masculini-
than as gendered human beings (O’Neil & Renzulli, 2013; Smiler,
ty, the term masculinities is being used with increasing frequency
2004). In the past 30 years, researchers and theorists have placed
(Wong & Wester, 2016).
greater emphasis on ecological and sociological factors influenc-
ing the psychology of boys and men, culminating in what has been
GENDER ROLE CONFLICT
termed the New Psychology of Men (Levant & Pollack, 1995). For
Gender role conflict (GRC) is defined as problems resulting from instance, socialization for conforming to traditional masculinity ide-
adherence to “rigid, sexist, or restrictive gender roles, learned ology has been shown to limit males’ psychological development,
during socialization, that result in personal restriction, devalua- constrain their behavior, result in gender role strain and gender role
tion, or violation of others or self” (O’Neil, 1990, p. 25). GRC is the conflict (Pleck, 1981, 1995; O’Neil, 2008; O’Neil & Renzulli, 2013),
most widely studied aspect of masculine gender role strain, and and negatively influence mental health (e.g., O’Neil, 2008, 2013,
researchers have demonstrated that men experience conflict relat- 2015) and physical health (Courtenay, 2011; Gough & Robertson,
ed to four domains of the male gender role: success, power, and 2017). Indeed, boys and men are overrepresented in a variety of
competition (a disproportionate emphasis on personal achieve- psychological and social problems. For example, boys are dispro-
ment and control or being in positions of power); restrictive emo- portionately represented among schoolchildren with learning dif-
tionality (discomfort expressing and experiencing vulnerable emo- ficulties (e.g., lower standardized test scores) and behavior prob-
tions); restrictive affectionate behavior between men (discomfort lems (e.g., bullying, school suspensions, aggression; Biederman
expressing care and affectionate touching of other men); and con- et al., 2005; Centers for Disease Control and Prevention, 2015).
flict between work and family relations (distress due to balancing Likewise, men are overrepresented in prisons, are more likely than
school or work with the demands of raising a family; see O’Neil, women to commit violent crimes, and are at greatest risk of being a
2008, 2013, 2015 for reviews). victim of violent crime (e.g., homicide, aggravated assault; Federal
Bureau of Investigation, 2015).
OPPRESSION Despite these problems, many boys and men do not receive
the help they need (Addis & Mahalik, 2003; Hammer, Vogel, &
Oppression includes discrimination against and/or systematic
Heimerdinger-Edwards, 2013; Knopf, Park, & Maulye, 2008).
denial of resources to members of groups who are identified as
Research suggests that socialization practices that teach boys from
inferior or less deserving than others. Oppression is most frequent-
an early age to be self-reliant, strong, and to minimize and manage
ly experienced by individuals with marginalized social identities; is
their problems on their own (Pollack, 1995) yield adult men who
manifested in both blatant and subtle discrimination in areas such
are less willing to seek mental health treatment (Addis & Mahalik,
as racism, ageism, sexism, classism, and heterosexism; and results
2003; Wong, Ho, Wang, & Miller, 2017). Further complicating
in limited access to social power (Robinson, 2012; Worell & Remer,
their ability to receive help, many men report experiencing gender
2003).
bias in therapy (Mahalik et al., 2012), which may impact diagnosis
and treatment (Cochran & Rabinowitz, 2000). For instance, sev-
PRIVILEGE
eral studies have identified that men, despite being 4 times more
Privilege refers to unearned sources of social status, power, and likely than women to die of suicide worldwide (DeLeo et al., 2013),
institutionalized advantage experienced by individuals by virtue of are less likely to be diagnosed with internalizing disorders such as
their culturally valued and dominant social identities (e.g., White, depression, in part because internalizing disorders do not conform
Christian, male, and middle/upper class; McIntosh, 2008). to traditional gender role stereotypes about men’s emotionality
(for a review, see Addis, 2008). Instead, because of socialized ten-
PSYCHOLOGICAL PRACTICE dencies to externalize emotional distress, boys and men may be
Psychological practice includes activities related to all applied more likely to be diagnosed with externalizing disorders (e.g., con-
areas of psychology, such as clinical, counseling, and school psy- duct disorder and substance use disorders) (Cochran & Rabinowitz,
chological practice; supervision and training; consultation; teach- 2000). Indeed, therapists’ gender role stereotypes about boys’
ing and pedagogy; research; scholarly writing; administration; lead- externalizing behaviors may explain why boys are dispropor-
ership; and social policy (APA, 2010). tionately diagnosed with ADHD compared to girls (Bruchmüller,
Margaf, & Schneider, 2012). Other investigations have identified
GENDER-SENSITIVE systemic gender bias toward adult men in psychotherapy (Mahalik
et al., 2012) and in other helping services such as domestic abuse
A gender-sensitive treatment, prevention program, or other psy- shelters (Douglas & Hines, 2011). Broader societal factors, such as
chological intervention has been adjusted or manipulated to poten- the stigma of seeking psychological help, also negatively impact
tially be more effective or appropriate for men based on the extant men’s help-seeking behaviors and the subsequent delivery of psy-
literature.

APA!|!Guidelines for Psychological Practice with Boys and Men! 3

chological services (Hammer et al., 2013; Mackenzie, Gekoski, &
Knox, 2006; Mahalik et al., 2012).
In addition to specific mental health concerns and help-seek-
ing behaviors, a combination of biological, social, and economic fac-
tors may have unique consequences for men’s physical health and
well-being. For most leading causes of death in the United States
and in every age group, boys and men have higher death rates than
girls and women (Courtenay, 2011; Gough & Robertson, 2017). For
example, despite men having greater socioeconomic advantages
than women in every ethnic group, the age-adjusted death rate has
been found to be at least 40% higher for men than women (Hoyart
& Xu, 2012). Sex differences in risk-taking are largely responsible
for this discrepancy, but all of these problems can be exacerbated
by social identity statuses such as race, ethnicity, sexual orienta-
tion, or social class (Courtenay, 2011).
In summary, contemporary studies indicate that the phys-
ical and mental health concerns of boys and men are associated
with complex and diverse economic, biological, developmental,
psychological, and sociocultural factors. Many of these factors
also intersect with men’s multiple identities (Gallardo & McNeill,
2009; Liang, Salcedo, & Miller, 2011; Schwing, Wong, & Fann, 2013;
Shields, 2008), indicating that understanding how boys and men
experience masculinity is an important cultural competency. The
psychology of men, however, is rarely taught at either undergrad-
uate or graduate levels (O’Neil & Renzulli, 2013), including multi-
cultural counseling courses (for a review, see Liu, 2005). Research
further suggests that having adequate knowledge of men’s gender
role socialization has important implications for psychological
practice with boys (Bruchmüller et al., 2012) and men (Mahalik et
al., 2012). Therefore, compelling evidence exists supporting the
need for guidelines for psychologists who provide services to boys
and men. In the sections to follow, specific guidelines and addition-
al rationale are presented.

4!APA!|!Guidelines for Psychological Practice with Boys and Men

Guidelines for
Psychological Practice
with Boys and Men

APA!|!Guidelines for Psychological Practice with Boys and Men! 5

GUIDELINE 1 heterosexual, cisgender, able-bodied, and context (Diamond & Butterworth, 2008;
Psychologists strive to recognize privileged (Liu, 2005). Moreover, the ideal, Nagoshi & Brzuzy, 2010; Vegter, 2013).
dominant masculinity is generally unat- Although the cultural and societal
that masculinities are constructed
tainable for most men (Pleck, 1995). Men pressures to endorse, conform to, and
based on social, cultural, and
who depart from this narrow masculine perform dominant masculinity are con-
contextual norms. conception by any dimension of diversi- siderable, men still have agency and can
ty (e.g., race, sexual orientation, gender part from dominant ideals (Iwamoto &
Rationale identity, and gender expression) may find Liu, 2009). Men not meeting dominant
Clinician awareness of one’s stereotypes themselves negotiating between adopt- expectations often create their own com-
and biases against boys and men is a ing dominant ideals that exclude them or munities within which they develop cultur-
critical dimension of multicultural com- being stereotyped or marginalized (Liang, al standards, norms, and values that may
petence (Liu, 2005; Mahalik et al., 2012). Rivera, Nathwani, Dang, & Douroux, 2010; depart from dominant masculinity. For
Understanding the socially constructed Liang et al., 2011; Schwing et al., 2013). instance, in racial and ethnic, youth, or gay
nature of masculinity and how it affects When trying to understand the communities, boys and men may develop
boys and men, as well as psychologists, complex role of masculinity in the lives forms of resistance in action and attitudes
also is an important cultural competency of diverse boys and men, it is critical to that challenge the expectations of domi-
(Levant & Silverstein, 2005; Liu, 2005; acknowledge that gender is a non-binary nant masculinity, such as that of the “cool
Mellinger & Liu, 2006; Sue & Sue, 2012). It construct that is distinct from, although pose” of African American men (Majors &
is common to use the term “masculinities” interrelated to, sexual orientation (APA, Billson, 1993) or the engagement of John
rather than “masculinity” to acknowledge 2015a). Heteronormative assumptions Henryism (e.g., working harder) behaviors
the various conceptions of masculine gen- often falsely conflate sexual and masculine identified among African American adult
der roles associated with an intersection identity for men (Shields, 2008), as well men (Matthews, Hammond, Nuru-Jeter,
of multiple identities (e.g., rural, work- as disregard sexual attraction and gender Cole-Lewis, & Melvin, 2013). Although
ing-class, adult, White masculinities may role adherence for those who identify as such adaptations challenge hegemonic
take a different form than urban, teenage, a sexual minority, transgender, or gender masculinity, they often carry with them
Mexican American masculinities; Kimmel nonconforming (APA, 2015a; Nagoshi, significant problems of their own. For
& Messner, 2012). Certain forms of mas- Brzuzy, & Terrell, 2012). Expression of example, despite evidence indicating that
culinities are more socially central and romantic or sexual attraction might pres- African American men engage in John
associated with authority, social power, ent gay, bisexual, transgender, and gender Henryism (Matthews et al., 2013), the
and influence (Connell & Messerschmidt, nonconforming individuals with gender long-term effects of these behaviors may
2005). In Western culture, the dominant role–related conflict that is, in part, born be detrimental to health and well-being
ideal of masculinity has moved from an from violations of heteronormative gender (McEwen, 2004). Further, despite ethnic
upper-class aristocratic image to a more role ideals (Schwartzberg & Rosenberg, minority boys and men’s engagement in
rugged and self-sufficient ideal (Kimmel, 1998), and potentially alienate sexual- and positive behaviors, they may be stereo-
2012). Thus, traditional masculinity ideolo- gender-minority men from a complete typed and subject to labeling by educa-
gy can be viewed as the dominant (referred male identity (Wester & Vogel, 2012). This tors, law enforcement, and mental health
to as “hegemonic”) form of masculinity may ostracize some gay, bisexual, trans- professionals as aggressive or hypermas-
that strongly influences what members of gender, and gender-nonconforming indi- culine. For instance, Goff, Jackson, Di
a culture take to be normative. viduals from an inherent sense of male Leone, Culotta, and DiTomasso (2014)
Prescriptions and proscriptions for identity (APA, 2015), leading to feeling demonstrated how African American boys
behaviors that either align with or contra- pressured to adopt dominant masculine are more likely to be perceived as older,
dict the dominant ideal of masculinity are roles to reduce feelings of minority stress less innocent, more responsible for their
not linear, uniform, or without resistance (Green, 2005; Skidmore, Linsenmeier, & actions, and being more appropriate tar-
(Pleck, 1995). Many men are socialized Bailey, 2006). Additionally, some sexu- gets for police violence. Thus, while most
by friends (e.g., mimicking behaviors and al and gender minority individuals do not men experience pressures to conform to
interests), family (e.g., imitating parent wish to label their gender identity and hegemonic masculinity, some men, par-
and sibling behaviors), peers (e.g., con- do not feel masculine behaviors are an ticularly those from marginalized groups,
forming to group social norms to avoid essential component of male gender iden- may be targets of gendered, racial, and
ostracism), and society (e.g., adhering to tity (Bockting, Benner, & Coleman, 2009). heterosexist stereotypes (Vaughns &
media portrayals of gender conformity) to For these individuals, masculinity may be Spielberg, 2014).
adopt traditional masculine ideals, behav- conceptualized as a set of characteristics
iors, and attitudes. Yet for some men, this that fall on a spectrum and are expressed Application
dominant ideology of masculinity has differently from one individual to anoth-
Psychologists are encouraged to expand
inherent conflicts. For instance, dominant er, vary over the course of one’s identity
their knowledge about diverse masculini-
masculinity was historically predicated on development, or may depend on external
ties and to help boys and men, and those
the exclusion of men who were not White, who have contact with them (e.g., parents,

6!APA!|!Guidelines for Psychological Practice with Boys and Men

teachers, coaches, religious leaders, and tus, spirituality, immigration status, and Juntunen, 2015) and suicidality (Clements-
other community figures), become aware ability status, and each contributes to a Nolle, Marx, & Katz, 2006). Furthermore,
of how masculinity is defined in the context boy’s basic sense of self and influences policing of masculinity expression in boys
of their life circumstances. Psychologists his behavior as he grows (David, Grace, & by their caregivers tends to be ineffective
aspire to help boys and men over their Ryan, 2006; Wilson, 2006; Vacha-Haase, and emotionally damaging to the child,
lifetimes navigate restrictive definitions of Wester, Christianson, 2010). Gender is one and creates tension in the relationship
masculinity and create their own concepts of the most fundamental of these dimen- (Hill & Menvielle, 2009). Nonetheless,
of what it means to be male, although it sions (for a review, see Banaji & Prentice, throughout childhood, boys may choose
should be emphasized that expression of 1994). Gender identity development to conform to these norms rather than face
masculine gender norms may not be seen begins before birth, shaped by the expec- disapproval. Further, Liu and Concepcion
as essential for those who hold a male tations that parents and other significant (2010) argue that some Asian American
gender identity. For others, masculinity adults have for how a boy should be treated boys and men give in to the pressure to
may function as a means to avoid further and how he should behave (Basow, 2006). conform to hegemonic masculinity stan-
marginalization (Sánchez & Vilain, 2012). Boys (and girls) begin to make distinctions dards by endorsing masculinity that does
Clinicians may explore the importance and between males and females during infancy not represent their preferred identities. In
perceptions of masculinity in minority pop- (Banaji & Prentice, 1994) and increasing- other situations, African American boys
ulations to obtain a better understanding ly assign certain meanings to being male and men who feel they cannot abide by
of gender expression across various inter- based on their gender socialization expe- hegemonic masculinity standards con-
secting identities. Toward that end, psy- riences (David et al., 2006). Over time, a struct standards of their own, which can
chologists strive to understand their own boy’s gender identity becomes crystal- take the form of gang behavior, cool pose,
assumptions of, and countertransference lized and exerts a greater influence on his and unique dress codes (Liang, Molenaar,
reactions toward, boys, men, and mascu- behavior (Banaji & Prentice, 1994). By the & Heard, 2016; Majors & Billson, 1993).
linity (Mahalik et al., 2012). Psychologists time he reaches adulthood, a man will tend Refugee and immigrant boys and men
also can explore what being a man means to demonstrate behaviors as prescribed often have different experiences from boys
with those they serve. Further, psychol- by his ethnicity, culture, and different con- and men born in the United States (Zayas,
ogists may utilize available assessment structions of masculinity. 2015) as their development is shaped by
instruments to help boys and men discover Inconsistent and contradictory mes- traumatic experiences (Brabeck, Lykes, &
the benefits and costs of their gendered sages can make the identity formation Hunter, 2014).
social learning (Mahalik, Talmadge, Locke, process complicated for some popula- Moreover, the painful experiences
& Scott, 2005), such as the Male Role tions of boys and men (Wilson, 2006). For associated with becoming the target of rac-
Attitudes Scale (Pleck et al., 1994), the Male instance, boys and men from racial or eth- ism and inequality can lead some minority
Role Norms Inventory, Short Form (Levant, nic minority backgrounds as well as those males to avoid identifying with their cultur-
Hall, & Rankin, 2013), and the Conformity who are gay, bisexual, transgender, or intel- al heritages (Liu & Concepcion, 2010) and
to Masculine Norms Inventory (Mahalik et lectually, psychiatrically, or physically dis- have been associated with poor psycholog-
al., 2003), as well as measures of gender abled may be the targets of various forms ical and physical health outcomes (Alvarez,
role conflict (O'Neil, Helms, Gable, David, of prejudice and microaggressions (Abbot, Liang, & Neville, 2016). For instance, adult
& Wrightsman, 1986), gender role stress Jepson, & Hastie, 2016; Nadal, 2008) and African American men in the United States
(Eisler & Skidmore, 1987), and normative often experience conflicts between dom- are at greater risk for higher blood pressure,
male alexithymia (Levant et al., 2006). See inant and minority views of masculinity prostate cancer, cardiovascular disease,
Smiler and Epstein (2010) for a review and (Kiselica, Mulé, & Haldeman, 2008; Liu and stroke (Hammond, 2012; Hammond et
critique of these instruments. & Concepcion, 2010). Boys with feminine al., 2016). Indeed, the relationship between
identities or expressions may face espe- racial discrimination and depressive symp-
cially negative reactions to non-normative toms was found to be best explained
gender expressions, including emotional by White, Eurocentric masculine ideals
expressions such as passivity or crying of restrictive emotionality (Hammond,
GUIDELINE 2 (Kane, 2006), and experience strong pres- 2012) and self-reliance (Matthews et al.,
sure to demonstrate and conform to mas- 2013). Among, adult Latino men, Arellano-
Psychologists strive to recognize
culine expressions. Research has demon- Morales and her colleagues (2016) found
that boys and men integrate strated the more boys violate norms of that gender role conflict and life satis-
multiple aspects to their social masculinity, the more verbal and physical faction were inversely associated among
identities across the lifespan. abuse they may face from peers (Kosciw, Latino day laborers who experienced high
Greytak, Giga, Villenas, & Danischewski, levels of racism but not those who report-
Rationale 2016). These experiences may lead to ed lower levels. Regarding Asian American
mental health problems, including depres- men, investigators have identified that
There are multiple dimensions to identi-
sive symptoms (Dank, Lachman, Zweig, & many stereotypes depict them as femi-
ty, including, age, ethnicity, gender, race,
Yahner, 2014), self-injury (dickey, Reisner, & nized, weak, or otherwise unmanly (Wong,
sexual orientation, socioeconomic sta-

APA!|!Guidelines for Psychological Practice with Boys and Men! 7

 Horn, & Chen, 2013; Wong, Owen, Tran, Moreover, identity changes impelled by Application
Collins, & Higgins, 2012). Such gendered aging may interact with any of the afore-
Psychologists strive to understand the
racism may have a unique effect on Asian mentioned sources of identity such as race,
important role of identity formation to the
men’s self-views. For instance, in samples ethnicity, and sexual orientation (Vacha-
psychological well-being of boys and men
of Asian American men, researchers iden- Haase et al., 2010). Other experiences
(Basow, 2006) and attempt to help them
tified that perpetual foreigner racism-re- common to many men across the lifespan,
recognize and integrate all aspects of their
lated stress and a desire to appear more such as serving in the military, can also
identities (David et al., 2006; Liang et al.,
“American” predicted unique variance in have significant impacts on men’s iden-
2010; Liu & Concepcion, 2010) throughout
maladaptive drive for muscularity atti- tities from young adulthood through old
the lifespan. For example, as men’s career
tudes beyond the internalization of an ath- age (Leppma et al., 2016). Indeed, an older
identities shift throughout their lives (Liu,
letic-muscular ideal (Cheng, McDermott, man’s military service and combat experi-
Englar-Carlson, & Minichiello, 2012), psy-
Wong, & La, 2016). In terms of immigra- ence may be relevant to his overall well-be-
chologists could benefit from understand-
tion status, the vast majority of unaccom- ing, as well as have a negative impact on
ing and applying general knowledge about
panied minors subsequently apprehended health-related changes with age (Wilmoth,
adult development and aging (APA, 2014)
by border patrol agents are male (Byne & London, & Parker, 2010). Likewise, transi-
when working with older adults negotiating
Miller, 2012). Young men are often escap- tion to retirement can be especially import-
role transitions from employed to unem-
ing unrelenting and escalating violence ant for older adults who strongly identified
ployed (whether by planned retirement
from their country of origin (Carlson & with their work and career. Indeed, retire-
or involuntary unemployment) (James,
Gallagher, 2015), and these experiences ment (and other job changes) may be
Matz-Costa, & Smyer, 2016). Working
often re-shuffle the emotional, behavioral, associated with a loss or power and/or
toward such goals may be especially chal-
and relational dynamics of these individ- privilege. For example, research demon-
lenging with aging, multiracial, multiethnic,
uals and their families (Gonzalez, 2011; strates increased morbidity and mortality
and sexual and gender minority males (i.e.,
Jimenez-Castellanos & Gonzalez, 2012; risks post-retirement, including suicide,
gay, bisexual, and transgender) who tend
Suarez-Orozco, Yoshikawa, Teramishi, & and suggests the potential benefits of
to experience more complicated identi-
Suarez-Orozco, 2011). preventative interventions for some men
ty-related conflicts (Nadal, 2008). Thus,
Boys and men who are members of facing retirement (Bamia, Trichopoulou,
psychologists are encouraged to under-
more than one minority group may have & Trichopoulos, 2008; Brockman, Müller,
stand the special developmental, educa-
an especially difficult time resolving identi- & Helmert, 2009). Sexual and gender
tional, career, mental health, and social
ty-related conflicts. For example, gay boys minority persons adhering to rigid mascu-
needs of sexual and gender minority, racial
and men of color may experience racism linity ideologies may have a more difficult
and ethnic minority, boys and men across
in the LGBT community, while also experi- time transitioning into older age, since
socioeconomic status, and multiethnic and
encing homophobia/heterosexism in their an array of factors influence socialized
multiracial boys and men. Providers may
racial/ethnic community and may choose gender roles at this developmental stage.
need to initiate a discussion about topics
to turn on and off certain aspects of their For example, as older sexual and gender
related to social and emotional support
identities as they move between different minority individuals leave the workforce,
systems given that social isolation is often
cultural contexts (Nadal, 2008). Similarly, they face significant concerns about inde-
identified as an issue for sexual minority
multiethnic and multiracial boys and men pendence and financial resources (dickey
and transgender and gender-nonconform-
may feel pressure from their families to & Bower, 2017; Witten & Eyler, 2015), and
ing individuals (Porter et al., 2016).
embrace one portion of their identities are more likely than cisgender, hetero-
Psychologists look to understand the
while experiencing demands from peers to sexual men to live alone and report lack
impact of military service over the lifespan
accentuate different ones. These types of of social support (Witten & Eyler, 2015).
of men. Military veterans represent a broad
vacillations can result in identity confusion Finally, adherence to rigid masculinity
range of intersecting identities (National
and contribute to the development of men- norms for aging gay, bisexual, transgender,
Center for Veterans Analysis and Statistics,
tal health problems (Nadal, 2008). and gender-nonconforming persons has
2014), and veterans themselves are a
As men grow into old age, they take been correlated with higher incidents of
distinct cultural group with a wide range
on different roles and challenges that often self-destructive behaviors (e.g., substance
of experiences based on military branch,
impel a re-examination of gender expec- use, unprotected sex), physical and men-
time and place of service, and occupation
tations. Given that work roles may change tal health problems (e.g., depression, sui-
(National Center for PTSD, 2014; Sherman,
through retirement, family roles may cide, neglecting medical needs), and fears
Larsen, Borden, & Brown, 2015). In addi-
change through grand parenting status of not being able to express their male
tion to understanding military culture, hier-
or loss of a spouse, and health problems identity due to dementia or being misgen-
archy, and reintegration issues, psycholo-
often arise, internal conflicts can ensue, dered after death (Courtenay, 2000; Oliffe,
gists strive to recognize the connections
especially for men who base their identi- 2007; Porter et al., 2016; Sánchez, 2016;
between military service, masculinities,
ties on being a financial provider, having Westwood & Price 2016).
and common mental health concerns such
physical strength and stamina, or function-
as post-traumatic stress disorder, traumat-
ing well sexually (Kilmartin & Smiler, 2015).
ic brain injury, substance-related disorders,

8!APA!|!Guidelines for Psychological Practice with Boys and Men

depression, anxiety, and suicidal ideation, and skills necessary to effectively work GUIDELINE 3
as well as psychological help-seeking with multicultural issues with boys and Psychologists understand the
(Leppma et al., 2016; Jakupcak, Primack, & men (Liu, 2005) and with aging men impact of power, privilege, and
Solimeo, 2017). (Vacha-Haase et al., 2010).
sexism on the development of boys
Psychologists strive to understand Psychologists strive to become aware
that some racial and ethnic minority boys of and eradicate any biases they have and men and on their relationships
and men may not have had opportunities toward boys and men from historically with others.
to learn about specific aspects of their marginalized groups (Kiselica et al., 2008;
family’s heritage. Therefore, acquiring Liu & Concepcion, 2010) and to recognize Rationale
knowledge about their previously unac- value conflicts they may have with their Although privilege has not applied to all
knowledged group(s) may offer oppor- service recipients (Nadal, 2008). These boys and men in equal measure, in the
tunities to discover additional aspects of biases may manifest in use of heterosexist aggregate, males experience a greater
their identities or dispel negative and/or assumptions (e.g., asking a male client if he degree of social and economic power than
unrealistic images that society has pro- has a wife without knowing his sexual ori- girls and women in a patriarchal society
moted about those reference groups (Liu entation) or values (e.g., encouraging a gay (Flood & Pease, 2005). However, men
& Concepcion, 2010). Psychologists also man to act less “flamboyantly”) (Nadal, who benefit from their social power are
strive to reduce and counter the damaging 2008). While attempting to understand, also confined by system-level policies and
effects of microaggressions by teaching respect, and affirm how masculinity is practices as well as individual-level psy-
boys and men from historically margin- defined in different cultures, psychologists chological resources necessary to main-
alized backgrounds skills to cope with also try to avoid within-group stereotyping tain male privilege (Mankowski & Maton,
racism, homophobia, biphobia, transpho- of individuals by helping them to distin- 2010). Thus, male privilege often comes
bia, ageism, ableism, and other forms of guish what they believe to be desirable and with a cost in the form of adherence to sex-
discrimination (Liu & Concepcion, 2010; undesirable masculine traits and to under- ist ideologies designed to maintain male
Nadal, 2008; Reel & Bucciere, 2010; stand the reasons upon which they base power that also restrict men’s ability to
Vacha-Haase et al., 2010), and by working these beliefs (Liu & Concepcion, 2010). function adaptively (Liu, 2005).
with families, schools, and communities to Psychologists also strive to work to Sexism exists as a byproduct, rein-
provide supportive environments for these address the unique relational needs of gay, forcer, and justification of male privilege.
populations. bisexual, and transgender boys within the Although the majority of young men may
Psychologists working with boys and family and peer context. Parents and care- not identify with explicit sexist beliefs
men strive to become educated about the givers of sexual and gender minority chil- (McDermott & Schwartz, 2013), for
history and cultural practices of diverse dren, particularly fathers and male care- some men, sexism may become deeply
identities; to understand how these practic- givers, may benefit from education about engrained in their construction of mascu-
es relate to racial, ethnic, and cultural iden- the psychology of masculinities, including linity (O’Neil, 2015). For instance, most
tities; to have awareness of how masculini- a range of masculine expression, intersec- boys are taught from an early age that
ty is conceptualized in these groups; and to tional identity factors, and the role of social they will suffer negative consequences for
communicate this understanding and inte- power in maintaining traditional notions of violating masculine role norms (Reigeluth
grate it into meaningful therapeutic inter- masculinity. Additionally, understanding & Addis, 2016). The impact of such sex-
actions, such as participating in cultural the likely involvement of genetic factors ism extends from boyhood into adulthood,
ceremonies and becoming integrated into in the development of gender identity has sometimes influencing critical identity-for-
their clients’ respective communities (Liu, been especially effective in reducing trans- mative processes such as career choices
2005). Such practices include a transfor- phobia in men (Knafo, Iervolino, & Plomin, (Fouad, Whiston, & Feldwisch, 2016) and
mation of traditional approaches to those 2005). These biological factors may be thus contributing to gender imbalances in
that may be more culturally congruent especially helpful for individuals with reli- female- or male-dominated professions.
with their clients’ backgrounds (Cervantes, gious affiliation and conservative social Growing up in a patriarchal society may
2014; Liu & Concepcion, 2010). Effective and political views, who may equate mas- also contribute to important public health
practice also involves learning about the culinity with heterosexuality (Elischberger, concerns such as gender-based violence.
impact of racism and homophobia on the Glazier, Hill, & Verduzco-Baker, 2016). Indeed, early socialization experiences
behavior and mental health of boys and in childhood, such as being repeatedly
men (Helms, Jernigan, & Mascher, 2005), shamed for expressing vulnerable emo-
including how prejudicial assumptions and tions, can have lasting influence into adult-
expectations can negatively alter their gen- hood in ways that shape their intimate
uine talents, performances, and identities relationships (Pollack, 1995). For example,
(Purdie-Vaughns, Stelle, Davies, Ditlmann, several controlled experiments have found
& Crosby, 2008; Vaughns & Spielberg, that adult men who endorse sexist male
2014). Overall, psychologists are encour- role norms are likely to aggress against
aged to attain the attitudes, knowledge, male and female participants who vio-

APA!|!Guidelines for Psychological Practice with Boys and Men! 9

late those norms (e.g., Parrott, Zeichner, In addition to increasing the possi- skills and to tap into their personal and
& Hoover, 2006; Reidy, Shirk, Sloan, & bility of engaging in violence, men who collective resilience in addressing these
Zeichner, 2009). Men who rigidly adhere accept sexist constructions of masculinity difficult experiences (dickey, Singh, Chang,
to sexist, patriarchal masculine norms also are often restricted by codes of conduct & Rehrig, 2017).
tend to endorse and commit higher levels that inhibit their ability to be emotionally Men who understand their privilege
of intimate partner and sexual violence vulnerable and form deep connections in and power may be less apt to rely on power,
toward women (Kilmartin & McDermott, adult relationships. For instance, although control, and violence in their relationships
2015). Feminist scholars have argued that the isolating effects of these beliefs likely (McDermott, Schwartz, & Trevathan-
some men use violence and control in rela- depend on a variety of social and ecolog- Minnis, 2012; Schwartz, Magee, Griffin, &
tionships as a way of maintaining sexist ical contexts (Addis, Mansfield, & Syzdek, Dupuis, 2004). Research suggests that
beliefs and dominance over women (e.g., 2010), numerous studies have provided helping men understand the negative con-
the Duluth Model; Pence & Paymar, 1993). evidence that endorsement of sexist male sequences of sexism for themselves and
Researchers in the psychology of men roles is related to men’s fear of intimacy their relationships with others reduces
and masculinity have identified that inse- and discomfort with physical affection endorsement of sexist attitudes (Becker
curities stemming from early childhood with other men (for a review, see O’Neil, & Swim, 2012). Psychologists can help cli-
experiences (such as attachment insecuri- 2015). In a marital context, husbands’ mas- ents develop awareness of systems that
ties) are linked to adherence to traditional culine gender role conflict has been posi- assume cisgender masculinity expression
masculinity ideology (Schwartz, Waldo, & tively associated with their wives’ depres- is the expected norm, and identify how
Higgins, 2004). Research also suggests sion (Breiding, Windle, & Smith, 2008), they have been harmed by discrimination
that insecurely attached men not only rig- and several studies have found negative against those who are gender nonconform-
idly adhere to sexist gender role ideology, relationships between traditional, sexist ing. Given the connections between sex-
but that they may act on those schemas in masculinities and intimate relationship ism and other forms of prejudice, psychol-
ways that promote or justify intimate part- well-being (O’Neil, 2008, 2015; Moore & ogists may find it useful to link oppressions
ner violence (Mahalik, Aldarondo, Gilbert- Stuart, 2005). Traditional masculinity ide- as a pedagogical strategy, especially when
Gokhale, & Shore, 2005; McDermott & ologies have also been linked to parenting working with boys and men in groups.
Lopez, 2013). concerns, including work-family conflicts Psychologists working with boys and men
An analysis of masculine norms (Fouad et al., 2016). may model gender-egalitarian attitudes
may shed light on the context of violence and behaviors; modeling non-sexist con-
against gender and sexually diverse peo- Application structions of masculinity may be especially
ple, as spaces where this discrimination important. For instance, researchers have
When working with boys and men, psy-
occurs are often marked by traditional found that men tend to overestimate the
chologists can address issues of privilege
masculinity (Leone & Parrot, 2015). An degree to which other men hold sexist
and power related to sexism in a devel-
integral aspect of traditional masculinity beliefs, and that developing awareness
opmentally appropriate way to help them
is the social power awarded to conformity of this discrepancy reduces sexist beliefs
obtain the knowledge, attitudes, and skills
to masculine norms, while aberrant gen- (Kilmartin et al., 2008). To further help
to be effective allies and potentially live
dered behavior is punished through gender accomplish this goal, psychologists are
less restrictive lives. Male privilege tends
policing. Sexual minority and transgender encouraged to explore their perceptions
to be invisible to men, yet they can become
and gender-nonconforming persons may of boys and men and to understand that,
aware of it through a variety of means, such
be seen as transgressing traditional mas- although not all boys and men hold sexist
as education (Kilmartin, Addis, Mahalik,
culine roles and eschewing stereotypes ideologies, these beliefs are ingrained in
& O’Neil, 2013) and personal experience
of binary gender categories. For instance, the culture at large.
(O’Neil, 2015; O’Neil, Egan, Owen, & Murry,
transgender women may be perceived as
1993). Indeed, awareness of privilege and
men who are “pretending” or “dressing
the harmful impacts of beliefs and behav-
up,” while transgender men may be seen
iors that maintain patriarchal power have
as “not real men” (Salamon, 2009). These
been shown to reduce sexist attitudes in
harmful perceptions are validated through GUIDELINE 4
men (Becker & Swim, 2012) and have been
court systems that enshrine “trans panic” Psychologists strive to develop
linked to participation in social justice
defenses for hate crimes against trans- a comprehensive understanding
activities (e.g., White, 2006). When work-
gender women (Smith & Kimmel, 2005).
ing with gender-diverse survivors of sys- of the factors that influence the
Research has carefully detailed the role of
temic gender oppression, it is important to interpersonal relationships of boys
masculinity in aggression (both verbal and
assess for experiences of trauma and bar- and men.
physical) against those who do not con-
riers that are enforced in ways that either
form to strict gender narratives, leading to
favor cisgender masculinity or assume a Rationale
violent and often fatal hate crimes against
binary identity (Richmond, Burnes, Singh,
transgender and gender-nonconforming Throughout the lifespan, males experi-
& Ferrara, 2017). Providers are encouraged
people (Kelley & Gruenewald, 2014). ence many developmental changes and
to help clients to develop self-advocacy

10!APA!|!Guidelines for Psychological Practice with Boys and Men

challenges pertaining to intimacy, sex, and as a brother (Baumeister & Sommer, 1997; & Moon, 2009; Lorenzo-Blanco, Unger,
emotions, beginning with the universal task Cross & Madson, 1997; Way, 2011). Thus, Baezconde-Garbanati, Ritt-Olson, & Soto,
of forming intimate attachments with oth- boys and men are capable of forming close 2012; Schwartz, Unger, Zamboanga, &
ers. Although there is tremendous social attachments with others, and this capaci- Szapocznik, 2010).
and cultural diversity inherent in parenting ty for bonding continues into adulthood in Providing an affirmative and caring
approaches, some boys are socialized from same-sex and cross-sex friendships (Way, environment where clients can explore
an early age to avoid intimacy and deep 2011) and romantic attachments (Carver, the intersecting influence of masculinities
connections with others (Pollack, 1995; Joyner & Udry, 2003; Smiler, 2013). These and race, sexual orientation, and class on
Way, 2011), potentially leading to serious relationships enhance the emotional and behavior is significant to resolving mental
relational difficulties later in life (O’Neil, physical well-being and social adjustment health difficulties for sexual and gender
2015). Indeed, several studies have iden- of boys and men throughout the lifespan minorities (Pelletier & Tschurtz, 2012).
tified connections between adult attach- (Smiler & Heasley, 2016; Vaillant, 2012). Effective clinical care may benefit from
ment insecurity and men’s adherence to It is important to note that gay, bisex- examination of the client’s and clinician’s
traditional masculinity ideologies (Mahalik ual, and transgender boys and men are also own binary notions of gender identity
et al., 2005; McDermott & Lopez, 2013; likely to enjoy strong, healthy bonds with as tied to biology, as well as developing
Schwartz et al., 2004). family members and peers during their insight into how to avoid pathologizing
Additionally, traditional masculini- early years, but they regularly experience clinical language (Carroll & Gilroy, 2002;
ty ideology encourages men to adopt an numerous, stressful relationship challeng- Singh, Boyd, & Whitman, 2010).
approach to sexuality that emphasizes es as they grow older. Family bonds can be Psychologists strive to use a variety
promiscuity and other aspects of risky strained, and in some cases shattered, fol- of methods to promote the development
sexual behavior, such as not learning a lowing disclosure of non-heteronormative of male-to-male relationships. Toward
partner’s sexual history or engaging in sex or transgender identity. For example, indi- addressing this goal, psychologists recog-
without protection from pregnancy or dis- viduals who adhere to traditional masculine nize and challenge socialization pressures
ease transmission (Kimmel, 2008; Pleck, gender roles hold more negative attitudes on boys and men to be hypercompetitive
Sonenstein, & Ku, 2004; Smiler, 2013). toward transgender and gender-noncon- and hyper aggressive with one another
Indeed, heterosexual men’s adherence to forming persons (Tebbe & Moradi, 2012), to help boys and men develop healthy
traditional, sexist aspects of masculini- while affirming families are associated same-sex friendships. Interactive all-male
ty has been connected to sexual assault with superior mental health outcomes for groups, (Levant, 1996; Mortola, Hiton, &
perpetration (Flood, 2015; Kimmel, 2008; transgender and gender-nonconforming Grant, 2007), self-help books (Garfield,
for a review, see McDermott, Kilmartin, persons (Olson, Durwood, DeMeules, & 2015 Smiler, 2016), and educational videos
McKelvey, & Kridel, 2015), as well as McLaughlin, 2016; Ryan, Russell, Huebner, (Hurt & Gordon, 2007; Katz & Earp, 2013)
decreased condom use and increased Diaz, & Sánchez, 2010). may be helpful or utilized. Psychologists
casual “hook-up” sex (Flood, 2008; Pleck also strive to create psychoeducational
et al., 2004; Smiler, 2013). Application classes and workshops designed to pro-
In addition to influencing sexual rela- mote gender empathy, respectful behavior,
Psychologists strive to promote healthy
tionships, traditional masculinity ideology and communication skills that enhance
intimate relationships in boys and men,
discourages men from being intimate with cross-sex friendships, and to raise aware-
where healthy relationships are defined
others and is the primary reason men tend ness about, and solutions for, problemat-
and characterized by respect, emotion-
to have fewer close friends than women ic behaviors such as sexual harassment
al intimacy and sharing, and mutuality
(Keddie, 2003; Klein, 2006); this is partic- that deter cross-sex friendships (Wilson,
(Garfield, 2015; Smiler, 2016; Way, 2011).
ularly evident in all-male peer groups (Way, 2006). Psychologists can discuss with
Recognizing the primacy of early human
2011). Because of the pressure to conform boys and men the messages they have
attachments, psychologists attempt to
to traditional masculinity ideology, some received about withholding affection from
help parents form close bonds with their
men shy away from directly expressing other males to help them understand how
sons through teaching parents about the
their vulnerable feelings and prefer build- components of traditional masculinity
developmental needs of boys, to respond
ing connection through physical activities, such as emotional stoicism, homophobia,
to boys in a nurturing manner, and to
talking about external matters (e.g., sports, not showing vulnerability, self-reliance,
foster a healthy separation and individu-
politics, work), engaging in “good-natured and competitiveness might deter them
ation process with their sons (Lombardi,
ribbing,” exchanging jokes, and seeking and from forming close relationships with
2012). Further, psychologists recognize
offering practical advice with their male male peers (Brooks, 1998; Smiler, 2016). In
how issues of language acquisition, fam-
friends (Garfield, 2015; Kiselica, Englar- that vein, psychologists strive to develop
ily intergenerational conflict, conflictual
Carlson, Horne & Fisher, 2008; Pollack, in boys and men a greater understanding
values between culture of origin and the
1998; Way, 2011). However, the majority of the diverse and healthy ways that they
United States, and differences in accul-
of boys and men indicate that they have can demonstrate their masculinities in
turation compared with parents and
close male friends with whom they share relationships.
elders may be present for first-genera-
secrets, are emotionally intimate, and view
tion boys and men (Kim, Chen, Li, Huang,

APA!|!Guidelines for Psychological Practice with Boys and Men! 1 1

GUIDELINE 5 so). Father involvement is a function of an ity (Sarkadi, Kristiansson, Oberklaid, &
Psychologists strive to encourage intersection between race or ethnicity and Brember, 2008). Father involvement with
cultural ideologies (Toth & Xu, 1999). infants and young children has been asso-
positive father involvement and
Sociocultural factors such as increas- ciated with advanced language develop-
healthy family relationships.
ing rates of women entering the paid ment, a lower likelihood of cognitive defi-
labor force and the shifting structure of cits on the Bayley Short Form—Research
Rationale
American families from predominantly Edition, a facilitator of positive pre-feeding
There are about 70 million fathers in the married, two-parent households to a wider behavior, and fewer behavioral problems
United States (United States Census variety of family compositions may be con- later in childhood (Bronte-Tinkew, Carrano,
Bureau, 2014). Nationally representa- tributing to the evolution of new fathering Horowitz, & Kinukawa, 2008; Erlandsson,
tive samples suggest more than 80% of behaviors and roles. Many fathers by their Dsilna, Fagerberg, Christensson, 2007;
fathers report being involved in their chil- own volition have reframed traditional Pancsofar & Vernon-Feagans, 2006;
dren’s lives, but little more than half of masculinity norms and roles of fathers Trautmann-Villalba, Gschwendt, Schmidt,
fathers believe they are doing “a very good (e.g., breadwinning) to be stay-at-home & Laucht, 2006). For school-aged chil-
job” as parents (Jones & Mosher, 2013). fathers or fill more nontraditional roles in dren (approximately 4–12), father involve-
Thus, for many fathers, the acceptance the family such as co-parenting (Marks ment has been associated with increased
of new familial and relationship roles is of & Palkovitz, 2004; McGill, 2014; Rochlen, levels of academic achievement, more
particular salience and may include a vari- Suizzo, McKelley, & Scaringi, 2008). This positive school attitudes, literacy devel-
ety of difficult transitions and responsibili- includes spending more time with their opment, academic competence, nonver-
ties (Tichenor, McQuillan, Greil, Contreras, children, assuming more childcare tasks, bal cognitive functioning, fewer internal-
& Shreffler, 2011). Many fathers are unsure and filling new paternal roles such as izing behavior problems, higher levels of
about how to be directly involved with their the primary caregiver as a stay-at-home emotion regulation and math and reading
children given that mothers continue to be dad (Bianchi, Robinson, & Milkie, 2006; skills, and social adjustment (Cabrera,
the primary caregivers, and social services Maume, 2011). In many African American Cook, McFadden, & Bradley, 2012; Cook,
tend to be mother-focused in terms of par- communities, there are higher rates of sin- Roggman, & Boyce, 2012; Pougnet, Serbin,
enting education and support programs gle-parent/women-led households, but Stack, & Schwartzman, 2011). For nonres-
(Broughton & Rogers, 2007). Further, most African American fathers are increasingly ident fathers, children’s well-being is tied
parenting support programs originate from documented as being involved with their less to fathers’ general behaviors (spend-
White middle-class values that do not children (Doyle, Magan, Cryer-Coupet, ing time or money) and more to being
automatically recognize different cultural Goldston, & Estroff, 2016; Jones & Mosher, involved in activities with their children
attitudes toward child-rearing (O’Brien, 2013). For some fathers, active involve- that nurture the father–child relationship
2004). Additionally, the traditional pater- ment is not always an option. Fathers who (Adamsons & Johnson, 2013). For ado-
nal breadwinner role is less entrenched fall outside the dominant construction of lescents, father involvement has been
in modern families and is giving way to a White, able, and heterosexual may face associated with healthier eating patterns,
new focus on the father as a more involved, additional barriers to their social inclusion lower internalizing problems especially
available, and equal co-parent (Cabrera, with their children (De Finney & Ball, 2015). for daughters, higher self-esteem, less
Tamis-LeMonda, Bradley, Hofferth, & Structural and/or financial challenges delinquency, fewer depressive symptoms,
Lamb, 2000). may limit father/parental involvement less violent behavior, better grades, and
Father involvement has been defined for low-income individuals (e.g., work- less substance use (Booth, Scott, & King,
as having three components (Pleck, 2007, ing multiple jobs, time constraints due to 2010; Day & Padilla-Walker, 2009; Stamps
2010) that include positive engagement public transportation, etc.). Issues related Mitchell, Booth, & King, 2009; Stewart &
activities (e.g., more intensive interactions to ethnicity, socioeconomic status, abili- Menning, 2009).
that promote development), warmth and ty, sexual orientation, immigration status, For many men, becoming a father
responsiveness (e.g., the ability to respond language, and religion, among other fac- clearly has consequences for their lives
to the child’s needs with warmth and car- tors, can present barriers that limit fathers’ and identities (Habib & Lancaster, 2006).
ing), and control (e.g., parental monitoring level of contact and engagement with their Being a good father is an important factor
and knowledge of child and child where- children as well as their visibility in debates in their definition of success (Tichenor et
abouts, including involvement decisions about fatherhood (Coakley, 2013). al., 2011). Becoming a father can be a time
about monitoring). Two auxiliary domains Father involvement for resident and for growth by resolving wounds from a
are indirect care (e.g., activities for the nonresident fathers has been consistently man’s own father (Levant, 1996) and for
child that are necessary without the child linked to positive child outcomes (Marsiglio, reinventing fatherhood, or at least trying
being present, such as providing food Amato, Day, & Lamb, 2000). Longitudinal to become the father one always wanted.
and clothing and scheduling health care studies continue to support early findings Paternal identity has been positively cor-
appointments) and process responsibility of the positive influences father involve- related with generativity, which is concern
(e.g., taking initiative to care for the child ment has on children’s behavioral, psy- for future generations and thus important
rather than waiting for someone else to do chological, cognitive, and financial stabil- for fostering healthy family relationships

12!APA!|!Guidelines for Psychological Practice with Boys and Men

 (Christiansen & Palkovitz, 1998). A father also experience grief and loss due to mis- & Rogers, 2010). Psychologists can also
scoring high on generativity would pre- carriages and pregnancy loss (Rinehart & support kinship structures that provide
sumably demonstrate growth and be on a Kiselica, 2010). father figures for gay adults (Levitt, Horne,
positive life course trajectory (Palkovitz & Puckett, Sweeney, & Hampton, 2015).
Palm, 2009). Habib and Lancaster (2006) Application Fathering programs are a valu-
found a positive correlation between able component of family life education.
Provided that positive paternal engage-
increased emphasis on paternal identity Psychologists can identify institutional
ment and inclusive communication tend to
and paternal–fetal bonding, which was resources to promote positive fathering.
have long-term emotional and psycholog-
defined as a subjective feeling of love for For example, high-dosage Head Start pro-
ical benefits for both children and fathers
the unborn child. Therefore, a high impor- grams for fathers have been linked with
(Maurer & Pleck, 2006; Pleck, 1997), psy-
tance placed on one’s identity as a father increased father involvement and higher
chologists strive to promote healthy father
facilitates bonding and investment. mathematics scores for children (Fagan
involvement and father engagement in
Correlational evidence has found a & Iglesias, 1999). Fathering empower-
treatment with their children and families.
positive association between parenting ment programs increase fathers’ beliefs in
Father involvement in clinical treatment
involvement and positive changes in new their ability to teach their children (Fagan
bodes well for improvement in child out-
fathers’ health (e.g., psychological well-be- & Stevenson, 2002). Psychologists can
comes (Bagner & Eyberg, 2003; Lundahl,
ing) (Knoester, Petts, & Eggebeen, 2007; employ special parent education curric-
Tollefson, Risser, & Lovejoy, 2008).
Schindler, 2010). A longitudinal study that ulums to prepare expectant fathers for
Psychologists can promote strengths of
tracked males from boyhood to fatherhood the challenges, duties, and joys of father-
father involvement. For instance, active
(ages 11–31) revealed that following the hood (Hayes & Sherwood, 2000; National
play and physical exercise with their chil-
birth of their first biological child, crimi- Family Involvement Network, n.d.; National
dren have been linked to higher levels
nal behavior and tobacco and alcohol use Fatherhood Initiative, 2007). Specialized
of father involvement and better child
all decreased among new fathers (Kerr, programs can be used with particular
health (Berg, 2010; Fletcher, Morgan,
Capaldi, Owen, Wiesner, & Pears, 2011). populations such as teenagers (Kiselica &
May, Lubans, & St. George, 2011; Garfield
Evidence from a sibling and twin model Kiselica, 2014; Kiselica, Rotzien, & Doms,
& Isacco, 2012). According to Bogels
found that becoming a father after very 1994) and incarcerated fathers (National
and Phares (2008), active play between
young adulthood is associated with fewer Fatherhood Initiative, 2007).
fathers and children has a functional ele-
chronic illnesses among mostly married
ment correlated with several positive child
men (Pudrovska & Carr, 2009). First-time
outcomes, such as competitiveness with-
fathers have reported positive changes in
out aggression, cooperation that buffers
their relationships with health profession-
anxiety, healthy experimentation, social
als, friends, and family; an increased sense GUIDELINE 6
competence, peer acceptance and popu-
of responsibility; and a more united rela-
larity, and a sense of autonomy. Psychologists strive to support
tionship with their spouse (Chin, Hall, &
Daiches, 2011). Other studies have found
Despite changing economic and educational efforts that are
demographic trends, such as more dual responsive to the needs of boys and
that first-time fathers begin to wear their
career families and more mothers in
seatbelts more often, learn new parent- men.
the workforce than previous genera-
ing skills, and engage in positive copar-
tions, paternal financial contributions to
enting practices, less risk-taking behav- Rationale
their children (i.e., being a “provider” and
iors, and more self-care activities (Chin
“breadwinner”) have remained a salient The provision of a high-quality education
et al., 2011; Genesoni & Tallandini, 2009).
aspect of men’s parenting role, identity, and characterized by a safe and supportive
Furthermore, many fathers describe the
involvement. Fathers are still more often learning environment, a challenging cur-
birth of their child as a “magical moment,”
the breadwinners within families, and their riculum, and systematic career education
“jolting,” “transformative,” and the cata-
financial contributions have been shown and counseling enhances the intellectu-
lyst for “settling down” (Cowan, Cowan, &
to contribute to children’s education and al, emotional, and social development of
Knox, 2010; Palkovitz, 2002). As stated by
well-being while also protecting against individuals and helps them to prepare for
Knoester and Eggebeen (2006, p. 1554):
childhood poverty and the associated neg- their future roles in the community and
“In other words, there is evidence that
ative outcomes (Schindler, 2010). At the workforce (Foxx, Baker, & Gerler, 2017).
becoming a new father transforms men’s
structural and institutional level, psychol- Boys who take advantage of education-
lives.” However, some men experience
ogists can help fathers eliminate custodi- al opportunities are more likely to find
difficulties in the transition to fatherhood.
al, legal, psychological (e.g., depression, employment and earn higher salaries than
Postpartum depression affects roughly
anxiety, substance abuse, alcohol abuse, their peers who drop out of school (Bureau
10% of fathers in the 3- to 6-month period
low self-efficacy), interpersonal (e.g., rela- of Labor Statistics, 2008); however, there
following birth and is associated with more
tionship discord/conflict with a coparent), are data to suggest that a disproportion-
negative and fewer positive parent–infant
communication, and economic barriers to ate number of boys are underperform-
interactions (Paulson, 2006, 2010). Men
their positive involvement (Isacco, Garfield, ing academically (Kena et al., 2014), and

APA!|!Guidelines for Psychological Practice with Boys and Men! 1 3

although certain college majors continue emphasizing aggression, homophobia, and problem exhibited by boys in schools, it is
to be male dominated, men in general are misogyny may influence boys to direct a recommended that school policies contain
falling behind their female peers in higher great deal of their energy into disruptive specific language addressing bullying asso-
education (Kena et al., 2014). These prob- behaviors such as bullying, homosexual ciated with sexism, racism, and homopho-
lems appear to be particularly salient for taunting, and sexual harassment rather bia (Kiselica et al., 2008). Psychologists
African American and Latino boys (Fergus, than healthy academic and extracurricular are encouraged to develop strategies to
Noguera, & Martin, 2014) and men (Kena activities (Steinfeldt, Vaughan, LaFollette, assist both perpetrators and victims of bul-
et al, 2014). Boys also face greater odds & Steinfeldt, 2012). lying, helping perpetrators to be account-
of being diagnosed with a developmen- able for their behavior, as well as to distin-
tal disability (Boyle et al., 2011) that can Application guish between healthy and unhealthy uses
impair academic functioning and/or result of power and understand how their misuse
Psychologists strive to raise awareness
in placement in special education class- of power hurts others; and helping victims
about the special academic, communica-
es. Moreover, it is well documented that recover from trauma and engage in risk
tion, and school-adjustment problems of
boys of color are disproportionately pun- reduction (Reese, Horne, Bell, & Wingfield,
boys among teachers, educational support
ished more severely for similar behavior- 2008; Wilson, 2006). Psychologists are
staff, school administrators, parents, and
al issues compared to their White peers thus encouraged to assist in the develop-
policy makers. Boys are more likely to be
(Skiba, Michael, Nardo, & Peterson, 2002), ment of positive school climates (Olweus
diagnosed with ADHD (Arnett, Pennington,
and such practices are linked to more seri- & Limber, 2010; Orpinas & Horne, 2010);
Willcutt, DeFries, & Olson, 2015; Willicutt,
ous legal problems later in life for men of this can be accomplished through model-
2012), likely because the presentation is
color (Rios, 2011). Thus, helping boys to ing nonrestrictive masculinity behaviors,
associated with problematic externaliz-
overcome school-related challenges (e.g., awareness of appropriate limit setting, and
ing behaviors (e.g., classroom disruption).
structural, learning, educational, social, affirming and encouraging positive behav-
Girls with ADHD often have more atten-
etc.) is crucial because young men experi- iors (Wilson, 2006; Kiselica et al., 2008).
tional issues than hyperactivity issues,
encing these problems are at risk of drop- Psychologists also strive to promote
which are not as noticeable (Ruckledge,
ping out of school, earning less income, the career development and workforce
2010). Thus, psychologists can be mindful
changing jobs more often, and suffering readiness of boys and men. Ideally, devel-
of the existing diagnostic criteria for ADHD
longer periods of unemployment than opmental career counseling and education
and not let the client’s gender influence
males who complete high school and col- begins with boys at the grade school level
the diagnosis (Bruchmüller et al., 2012).
lege (United States Department of Labor and continues into the high school years
Because many school-related difficulties
Statistics, 2018). These types of labor-re- with services designed to assist young
for boys emerge at an early age, psycholo-
lated difficulties are commonly a source of men to choose a career and make the tran-
gists can initiate changes in practices that
significant stress (Kiselica et al., 2008). sition into the workforce or higher educa-
will enhance the early school adjustment
Addressing the school-related prob- tion (Foxx et al., 2017). A particular focus
of boys who are struggling academically,
lems of boys is also important, because of career education with boys includes
such as remedial reading instruction, train-
many of the problems posed by boys in encouraging them to explore the full range
ing behavioral inhibition, and providing ver-
schools (e.g., classroom disruption, poor of career options, not just those that men
bal experience (Eliot, 2009). Psychologists
organization, sexual harassment, bullying, have traditionally pursued. In addition,
are also encouraged to engage boys in
discourtesy) have a detrimental impact psychologists strive to address the difficult
strength-based experiential groups to
on the academic and social experienc- barriers and the culture-specific issues
promote friendships and support among
es of other students (Juvonen, Wang, & impeding the educational and career
boys while helping them critically exam-
Espinoza, 2011; Lacey & Cornell, 2013). development of racial and ethnic minority,
ine dysfunctional boy codes and restric-
There is also a clear link between school immigrant, boys with cognitive disabilities,
tive notions of masculinity (Mortola et al.,
failure and various other social problems, and low-income boys by creating partner-
2007).
including antisocial behavior, drug abuse, ships with schools, health care facilities,
Psychologists strive to assist school
high-risk sexual behavior, and premature social service agencies, and businesses
officials with the development of anti-bul-
fatherhood, all of which place tremendous to provide them with mentors to guide
lying policies and implementation of
social and economic burdens on society and inspire educational striving, skills to
anti-bullying campaigns (Orpinas & Horne,
(Bradford & Noble, 2000). cope with stressful life circumstances, and
2010). Children with disabilities—sensory,
Moreover, aspects of masculinity ide- incentives to succeed in school, go on to
cognitive, and physical disabilities—are
ology may contribute to the school-related college, and enter the workforce (Kiselica
disproportionately impacted by bullying
problems of boys (O’Neil & Luján, 2009). et al., 2008). For example, gender diverse
(Simpson, Rose, & Ellis, 2016), with some
Dysfunctional boy codes for behavior, such people are 3 times as likely as cisgender
evidence suggesting that boys engage in
as the belief that being studious is unde- people to be unemployed (S.E. James et al.,
higher rates of cyberbullying (Heiman &
sirable, suppress academic striving among 2016).
Olenik-Shemesh, 2015). Further, because
some boys (A.J. Franklin, 2004; Wilson,
sexual harassment and bullying of sexual
2006). Constricted notions of masculinity
minority youth is an especially common

14!APA!|!Guidelines for Psychological Practice with Boys and Men

GUIDELINE 7 than those who are not violent (Renner & teria (American Foundation of Suicide
Psychologists strive to reduce Whitney, 2012). Gender-diverse men are Prevention, 2015; Lynch & Kilmartin, 2013).
disproportionately targeted by the crim- A more detailed analysis of the health
the high rates of problems boys
inal justice system and incarcerated. For consequences facing racial and ethnic
and men face and act out in their
example, documented rates of arrest for minority and sexual and gender minority
lives such as aggression, violence, transgender and gender-nonconforming populations of boys and men encounter-
substance abuse, and suicide. people range from 35 to 72%, and 35% of ing trauma, substance abuse, depression,
transgender people have been victimized and violence can be found in the Health
Rationale while imprisoned by inmates and guards Disparities in Vulnerable Boys and Men
(Beck, 2014). report made to the APA (2017b).
Although the vast majority of males are
not violent, boys and men commit nearly Suicide rates are also higher for men
90% of violent crimes in the United States who have been abused or witnessed abuse Application
(United States Department of Justice, in childhood (Cashmore & Shackel, 2013),
Psychologists strive to understand the
2011). Many boys and men have been and men in general constituted more
multiple cultural and individual difference
socialized to use aggression and violence than 70% of suicide deaths in the United
factors that lead to aggression and vio-
as a means to resolve interpersonal con- States between 2000 and 2012 (American
lence in men and boys (Reese et al., 2008),
flict (Moore & Stuart, 2005). Family, peers, Foundation of Suicide Prevention, 2015).
including the intersection of exposure to
and media often reinforce the connection Childhood suicide rates have increased
adverse childhood experiences and tra-
between aggressive behavior and mas- among school-aged African American
ditional masculine socialization where
culinity (Kilmartin & McDermott, 2015; males in relation to White males (Bridge
applicable (Liang & Rivera, in press). By
Kilmartin & Smiler, 2015). Childhood phys- et. al., 2015)
having empathy for the causes (e.g., lack
ical and/or sexual abuse victimization has In addition, suicide rates in men over
of personal and social resources to cope
been found to be a significant precursor 70 are higher than in any other demo-
with trauma) of aggressive and violent
to aggressive behavior in boys and men graphic group worldwide (World Health
behavior, psychologists strive to prevent
(Jennings, Piquero, & Reingle, 2012; Tyler, Organization, 2014). The suicide rates of
violence by adopting trauma-sensitive and
Johnson, & Brownridge, 2008). Other risk American Indian and Alaska Native men
gender-sensitive approaches with young
factors for aggressive behavior include have increased by 38% in recent years
boys in schools (Liang & Rivera, in press)
poor parental and teacher supervision, low (Case & Deaton, 2015). In epidemiologi-
and by using psychological methods that
academic achievement, frequent viewing cal studies, substance abuse and alcohol
increase empathy for others, model con-
of violent media, and living in high crime abuse were correlated with higher suicide
trol of aggressive behavior, and increase
neighborhoods (Reese et al., 2008). For rates among men (Pompilli et al., 2010).
communication skills or problem-solving
some men, perpetrating violence, includ- Many men use alcohol or other drugs as
(Kilmartin & Smiler, 2015; Reese et al.,
ing violence against gender-diverse peo- a trauma-related avoidance response to
2008). In educational, correctional, and
ple, serves to protect and enhance the difficult emotional situations and uncom-
therapeutic settings, psychologists are
perpetrator’s own masculinity (Reigeluth fortable affective states (Elder, Domino,
encouraged to work with boys and men
& Addis, 2016). Therefore, aggression may Mata-Galán, & Kilmartin, 2017), and
who have had difficulties with aggres-
serve as public behavior wherein men can investigators have uncovered strong
sion and violence, and to focus on treat-
prove their masculinity, either against a links between alcohol and suicide com-
ment and remediation when working with
worthy rival or against those considered pletion (Kaplan et al., 2013). Although
incarcerated individuals. In such settings,
unworthy of the label man (K. Franklin, the depression rates among men are
psychologists strive to have empathy
2004; Whitehead, 2005), in order to bol- 50% that of women (Martin, Neighbor, &
for men’s traumatic pain while also hold-
ster confidence in their masculine identity. Griffith, 2013), researchers believe that
ing them accountable for their behavior.
Men are at high risk of being the vic- many men express depression covert-
Furthermore, given that further research
tims of violent crime (Federal Bureau of ly, manifesting as irritability, interper-
is needed to understand the efficacy of
Investigation, 2015). For African American sonal distancing, sensitivity to threats to
violence intervention programs focused
males ages 10 to 24, homicide is the lead- self-esteem and self-respect, compulsivi-
on men’s issues, psychologists are encour-
ing cause of death; it is the second leading ty, somatic complaints, and difficulty with
aged to conduct such effectiveness studies
cause of death for Hispanic youth of the motivation and concentration (Martin et
and to test the consequences of modifying
same ages (United States Department of al., 2013). Lending credence to the covert
existing programs to include issues rele-
Justice, 2011). Men who have experienced aspect of many men’s depression are sui-
vant to boys and men (e.g., rigid adherence
violence and abuse in childhood are more cide rates 4 times that of women, despite
to restrictive masculinity ideologies).
likely to have higher rates of mental illness the lower depression rate for men as
Many boys and men do not willingly
(Cashmore & Shackel, 2013). Men who defined by the Diagnostic and Statistical
reveal the extent of childhood trauma to
are violent toward their partners are more Manual of Mental Disorders (DSM) cri-
others (Lisak, 2001). Psychologists are
likely to have been physically abused and/ encouraged to be attentive to the shame
or witnessed domestic violence as children many men feel about discussing abuse and

APA!|!Guidelines for Psychological Practice with Boys and Men! 1 5

emotional distress (Shepard & Rabinowitz, with regular screenings, were significant- Neighbors, 2010), and college student
2013) and strive to remain empathic, sup- ly higher than women’s, suggesting that alcohol use (Halim, Hasking, & Allen, 2012;
portive, and patient with their interven- many men do not engage in preventative Korcuska & Thombs, 2003), Likewise,
tions with boys and men who may man- care (American Cancer Society, 2015). social norms have been implicated in het-
ifest defensive and masked reactions to Men’s higher rates of circulatory system erosexual and sexual minority men’s con-
educational and therapeutic interventions. diseases before age 65 are also likely due dom use (Albarracín, Johnson, Fishbein, &
Psychologists are especially encouraged to higher rates of smoking, alcohol use, Muellerleile, 2001; McKechnie, Bavinton,
to assess for early psychological trau- and diets higher in fats and red meat and & Zablotska, 2013). The perceptions of
ma in men who present for depression, lower in fruits and vegetables (Courtenay, other men are also associated with men’s
substance abuse, post-traumatic stress, 2011). In addition to metabolic diseases, seat belt use, fighting, seeking out social
and intimate partner violence (Lisak & men, especially men who have sex with support, getting an annual physical exam,
Beszterczey, 2007). Psychologists strive to men, are disproportionately impacted by using tobacco, exercising, and dietary
be aware of potential underlying affective preventable conditions such as HIV (for a choices (Hammond, Matthews, Mohottige,
disorders such as depression and anxiety review, see Zeglin, 2015). Agyemany, & Corbie-Smith, 2010; Mahalik
when considering therapeutic interven- Although men’s health problems are & Burns, 2011). The more men perceive
tions with men who display aggression and related to a complex interplay between that their male friends were seeking help
violence (Cochran & Rabinowitz, 2000; biology and environment, including socio- either in the form of talking to someone
Fleming & Englar-Carlson, 2008). political factors such as race, socioeco- about a troubling problem or getting an
nomic status, and other variables relat- annual physical in the last year, the more
ed to power and privilege, many gender likely men report having done the same
health disparity patterns can be tied to (Hammond et al., 2010; Mahalik & Burns,
heightened risk behaviors for men begin- 2011). Finally, men may be more likely to
GUIDELINE 8 ning in early adolescence (Mahalik et al., attend to their health in contexts where
2013). Gender role socialization often their efforts to maintain good health and
Psychologists strive to help boys
encourages men to adopt masculine ide- functional capacity strengthen their claims
and men engage in health-related ologies that may be associated with health to manhood (Calasanti, Pietilä, Ojala, &
behaviors. risk behaviors and existing health dis- King, 2013) or when their functional,
parities (McDermott, Schwartz, & Rislin, physical capacity is required to perform
Rationale 2016; Wong, Owen, & Shea, 2012) such their jobs (Springer & Mouzon, 2009).
For most leading causes of death in the as substance abuse (de Visser & Smith, Perception of the nature of the problem as
United States and in every age group, 2007; Iwamoto, Cheng, Lee, Takamatsu, normative also influences help-seeking.
males have higher death rates than & Gordon, 2011; Peralta, 2007), coro- In addition to social norms that
females (Courtenay, 2011; Gough & nary-prone behavior (Eisler, 1995; Watkins, impact most men’s health behaviors, the
Robertson, 2017). Despite having greater Eisler, Carpenter, Schechtman, & Fisher, health challenges for men from historical-
socioeconomic advantages than women, 1991), violence and aggression (Moore ly marginalized groups (e.g., men of color,
men’s life expectancy is almost 5 years & Stuart, 2005; Kilmartin & McDermott, men with disabilities, gay and bisexual
shorter than women (76.3 years for men, 2015), less willingness to consult medical men, transgender men) are long rooted in
81.1 for women); in every ethnic group the and mental health care providers (Addis sociopolitical (e.g., the unequal distribu-
age-adjusted death rate is higher for men & Mahalik, 2003), less utilization of pre- tion of power), sociohistorical (e.g., biased
than women (Hoyart & Xu, 2012). A sex ventive health care (Courtenay, 2011), and inaccurate histories of peoples), and
difference in risk-taking is largely responsi- and risky sexual and driving behaviors sociostructural (e.g., legal, education, and
ble for this discrepancy. For example, acci- (Courtenay, 2011; Mahalik et al., 2013). economic systems) forces that oppress
dents are the leading killer among all males In addition, Courtenay (2011) noted that, and stigmatize individuals (Jones, Crump,
aged 1 to 44 in the United States (Centers overall, men engage in fewer health-pro- & Lloyd, 2012; Liu & Ali, 2005). Men and
for Disease Control and Prevention, moting behaviors, more risk-taking behav- boys of color suffer from higher rates of
2010). Men’s age-adjusted death rates iors, are more likely to be the perpetrators HIV, cancers, heart disease, cerebrovas-
for heart disease and cancer—the two and victims of physical abuse and violence, cular disease, diabetes, and other health
leading causes of death, which account have few social supports and less effective conditions compared to their White coun-
for almost half of all deaths—are 50% and behavioral responses to stress, and use terparts (for a review, see Jones et al.,
80% higher, respectively, than women’s fewer health care services. 2012). Insensitivity to racial stereotypes,
rates (Department of Health and Human Perceptions of social norms may the interaction of race and gender, cultur-
Services, 2009; Jemal et al., 2008), and 1 shape the health behaviors of men. al values and mores, immigration status,
in 2 men, compared with 1 in 3 women, will Research indicates that perceived social and social and economic conditions have
develop cancer in his lifetime (American norms of men are associated with adoles- a significant impact on the health of men
Cancer Society, 2008). Between 2011 and cent smoking (Gunther, Bolt, Borzekowski, of color as well as those who live in pov-
2013, men’s mortality rates for colorectal Liebhart, & Dillard, 2006), drinking and erty (Liu & Concepcion, 2010; Takeuchi,
cancer, a generally preventable disease driving (Perkins, Linkenbach, Lewis, & Alegria, Jackson, & Williams, 2007). For

16!APA!|!Guidelines for Psychological Practice with Boys and Men

instance, investigators have found evi- and men build health-promoting behaviors GUIDELINE 9
dence that being exposed to chronic stress such as resisting social pressure to eschew Psychologists strive to build
due to poverty or other systemic factors health concerns, engaging in self-accep- and promote gender-sensitive
is directly related to poor health behav- tance, fostering a positive identity, engag-
psychological services.
iors (e.g., smoking, alcohol use, drug use, ing in preventative medical services, and
overeating), possibly as potential coping developing the habits of healthy diet, sleep,
Rationale
mechanisms for poverty-related stress and exercise. Psychologists strive to under-
(Jackson & Knight, 2006). Transgender stand some men’s reluctance to seek help A disparity exists between the occurrence
and gender-nonconforming individuals by recognizing the influence of masculine and severity of men’s mental health prob-
also typically face hardships in accessing gender role socialization. For instance, lems and the disproportionately low num-
competent care (dickey, 2017), including although men are less likely than women ber of men served by psychological ser-
discomfort revealing their gender history to receive certain psychological diagnoses vices (Englar-Carlson, 2014). It has been
to their medical providers, which may be (e.g., depression, anxiety), psychologists suggested that many men do not seek psy-
critical to the care they are seeking. For recognize that these discrepancies may chological help because services are not in
instance, if a gender-diverse person needs be due in part to gender role socializa- alignment with masculine cultural norms
to be catheterized, it would be important tion (Addis, 2008), which impacts men’s that equate asking for assistance for psy-
to discuss one’s urinary tract configuration. help-seeking behaviors and how they chological and emotional concerns with
For many, the crux of working with present their physical and psychological shame and weakness (Addis & Mahalik,
men is the understanding that masculin- distress (Cochran & Rabinowitz, 2000). 2003). An understanding of gender norms
ity is both associated with a wide range Psychologists also strive to help men when designing services for boys and men
of health (physical and mental) concerns obtain the necessary knowledge, attitudes, may lead to greater participation among
and less willingness to seek help for those and behaviors to use their social influence this population (Mahalik et al., 2012).
problems (Addis & Mahalik, 2003). Good to promote health behaviors in other boys Mental health difficulties of sexual and
and Wood (1995) classically defined that and men with whom they come into con- gender minority men are frequently relat-
puzzle as double jeopardy: Those that tact. Perceptions of other men’s health ed to masculine identity. For example, one
need the most help are also the least like- behaviors may provide information about national sample found gender noncon-
ly to seek it out. Although there is signifi- how individual men should or should formity associated with experiences of
cant public stigma in the United States in not act. Because men often hide or mask discrimination (Miller & Grollman, 2015).
regards to seeking help for mental health feelings of depression (Lynch & Kilmartin, Access to transgender- and sexual-minori-
concerns (Vogel, Bitman, Hammer, & 2013; Rabinowitz & Cochran, 2008), for ty-affirmative care is critical to resolution
Wade, 2013), men typically report higher instance, many men may believe that of these problems, though adherence to
levels of stigma compared with women depression is abnormal or associated with traditional masculinity is associated with
(Vogel, Heimerdinger-Edwards, Hammer, a character flaw. These concerns under- reluctance to seek psychological help
& Hubbard, 2011; Vogel, Wade, & Hackler, score the importance of public informa- (Yousaf, Popat, & Hunter, 2015).
2007). They are more likely to underutilize tion campaigns highlighting the fact that Researchers have identified norma-
health (White & Witty, 2009) and mental depression is a normative problem for tive practices in therapy that can be iat-
health services (Addis & Mahalik, 2003) men (National Institute of Mental Health, rogenic for men (Mahalik et al., 2012). On
due to not perceiving a need for them 2008; Rochlen, Whilde, & Hoyer, 2005). one end of the spectrum, clinical methods
(Mojtabai et al., 2011). Indeed, men do not Psychologists are encouraged to dissemi- that emphasize the language of feelings,
go to counseling as often as women during nate information to the public to reshape disclosing vulnerability, and admitting
any given year or over their lifetimes (Addis attitudes about men and mental health. dependency needs can create expres-
& Mahalik, 2003; Good & Robertson, To best accomplish the aforemen- sive difficulties for males who adopt and
2010; Moller-Leimkuhler, 2002). This tioned health-related goals for boys and adhere to traditional masculine roles
is true across diverse groups of men men, psychologists recognize the impor- (Rabinowitz & Cochran, 2002; Rochlen &
(Holden, McGregor, Blanks, & Mahaffey, tance of and need for interdisciplinary Rabinowitz, 2014). On the other end of the
2012; Good & Wood, 1995; Vogel et al., collaboration (Jones et al., 2012). Health spectrum, therapists can sometimes make
2011), with evidence suggesting that men disparities represent a complex interplay harmful assumptions that men are unable
of color seek psychological help even less between biological and environmental fac- to express emotions or are hypersexual or
frequently (Chandra et al., 2009; Hammer tors. Accordingly, reaching out to medical, aggressive (Mahalik et al., 2012). Likewise,
et al., 2013). public health, and allied health professions in the realm of assessment, practitioners
is critical. can struggle with diagnosing depression
Application in boys and men because symptoms may
not conform to traditional DSM criteria
Psychologists strive to educate boys and
(Addis, 2008; McDermott et al., 2016). For
men about the restrictive nature of mas-
example, psychologists may not interpret
culine ideologies and their relationships
acting out or externalizing behaviors such
to health risk behaviors. At the same time,
as aggression, addiction, and substance
psychologists are encouraged to help boys

APA!|!Guidelines for Psychological Practice with Boys and Men! 1 7

abuse as potentially masking depression plete list of clinical resources for working their self-esteem and mental health (Herr,
(Lynch & Kilmartin, 2013). However, it with boys and men, see division51.net). Cramer, & Niles, 2003; J.B. James et al.,
is not unusual for some men to under- Psychologists also may strive to identi- 2016; Romo, Bellamy & Coleman, 2004).
state mental health problems (Paulson fy ways that psychological services can Psychologists are encouraged to advocate
& Bazemore, 2010). Normative male be more adaptive to the ways men have for public policy that supports and enhanc-
interpersonal behavior can, but does not been socialized (Englar-Carlson, 2014). es teenage boys’ career prospects, espe-
always, involve an absence of strong affect, Depending on the expectations, psy- cially in settings where there may not be a
muted emotional displays, and minimal chologists strive to correct erroneous variety of career prospects (e.g., low socio-
use of expressive language, making it dif- assumptions about psychological inter- economic status communities). These may
ficult for primary care physicians and other ventions or change the structure of inter- include developmental career counseling
health professionals to determine when ventions to be more congruent for the and development in the schools, and GED,
men are actually experiencing depressive male client (Rochlen & Rabinowitz, 2014). job training, and job placement services
disorders (Martin, Neighbor, & Griffith, Psychologists also strive to find ways to for adolescent and adult males who have
2013). Instead, many men express them- increase the perception of normativeness dropped out of school or struggled with
selves in terms of externalizing behaviors, for particular problems (e.g., depression), underemployment or unemployment
many of which are problematic (Cochran train professional helpers to recognize the (Romo et al., 2004).
& Rabinowitz, 2000). Additionally, in ego-centrality of certain problems (e.g., Psychologists assessing boys and men
responding to the problematic externaliz- unemployment for men who view their strive to be aware of traditional masculine
ing behaviors of boys, such as hyperactivi- family role primarily as “provider”), and gender role characteristics that render
ty, aggression, and substance abuse, there create alternative, nontraditional forums underlying psychological states difficult
has been a tendency for professionals to more congruent with masculine socializa- to assess. Psychologists in clinical settings
focus on addressing deficits rather than tion (e.g., psychoeducational classes in are encouraged to ask boys and men ques-
strengths (Kiselica et al., 2008). Evidence work settings) (Addis & Mahalik, 2003). tions about mood and affect and to be will-
also suggests that medication may be Affirmative couples and family ther- ing to probe more extensively when faced
relied upon over psychological interven- apy can be utilized to assist family sys- with brief responses. Psychologists are also
tions with boys, especially in relationship tems in exploring gendered values and the encouraged to note discrepancies between
to ADHD diagnoses (Kapalka, 2008). impact traditional masculine roles have self-expression and the severity of precip-
Clinicians may also assume that mas- on gender and sexual minority individuals. itating factors, which might have resulted
culinity is not a significant topic for gay and Clinicians can be instrumental in expand- from many men’s relative emotional inex-
bisexual men. However, internalized het- ing masculine norms to help facilitate a pressivity (Rabinowitz & Cochran, 2008).
erosexism dramatically shapes masculine more positive, affirming relational system Psychologists work to accurately assess
identity, due in part to the importance of that improves mental health outcomes for masculine socialization and ideology
gay and bisexual men of appearing heter- sexual and gender minority persons (Olson using the aforementioned gender-sensi-
onormative. For instance, gay men rated et al., 2016; Ryan et al., 2010). Couple and tive assessment tools and to learn spe-
masculine gay men as significantly more family therapy can facilitate discussions of cific assessment strategies for masculine
likeable than feminine gay men (Skidmore how multiple identities work together, why depression (Cochran & Rabinowitz, 2003)
et al., 2006) and, on average, wished to be some identities are more salient than oth- and alexithymia (Levant, Hall, Williams, &
more masculine than they perceived them- ers, and how various identities are enacted Hasan, 2009). Additionally, psychologists
selves to be (Sánchez, Vilain, Westefeld, in different spaces (Budge, Thai, Tebbe, & are aware of the connections between
& Liu, 2010). This may lead gay men to Howard, 2016). mental health stigma and traditional mas-
be extremely conscious about masculini- For boys and adolescents, shorter ses- culinity ideologies, which may influence
ty and inhibit emotional disclosure (Elder, sions, informal settings outside the office men’s responses to traditionally stigma-
Morrow, & Brooks, 2015; Haldeman, 2006; (e.g., playground), instrumental activities, tized mental health problems (e.g., depres-
Sánchez & Vilain, 2012). using humor and self-disclosure, and psy- sion, anxiety). Psychologists also strive to
choeducational groups may provide more reduce mental health stigma for men by
Application congruent environments than traditional acknowledging and challenging socialized
psychotherapy (Kiselica, Englar-Carlson, messages related to men’s mental health
Psychologists can take advantage of the
& Horne, 2008). Psychologists strive to stigma (e.g., male stoicism, self-reliance).
numerous gender-based adaptations
provide supportive counseling and career Importantly, psychologists strive to
derived from theoretical work or clinical
guidance to men with histories of sporadic attain a level of gender self-awareness
expertise to accommodate male clients
employment, job adjustment difficulties, that allows them to act with intentionality,
of diverse backgrounds (Brooks & Good,
and long-term unemployment. Such ser- resisting the imposition of their values and
2005; Englar-Carlson, Evans, & Duffey,
vices would be aimed at addressing the per- biases on male clients (Wisch & Mahalik,
2014; Englar-Carlson & Stevens, 2006;
sonal issues that might have contributed to 1999). Gender self-awareness may help
Kiselica et al., 2008; Pollack & Levant,
their work or retirement transition prob- psychologists recognize when they may
1998; Rabinowitz & Cochran, 2002;
lems and the impact of those problems on be framing a psychological problem from
Rochlen & Rabinowitz, 2014; for a com-

18!APA!|!Guidelines for Psychological Practice with Boys and Men

a gendered lens. For instance, psycholo- and gender disparities may be the result (Eaton et al., 2012) indicated that teenage
gists may overlook or discount important of racial, ethnic, and gender stereotypes. boys were significantly more likely than
problems in men (e.g., depression, body Indeed, compared to White and higher teenage girls to report carrying a gun to
image concerns) because those issues income men, African American, Latino, school. Investigators have also noted that
have historically been a focus among and Native American men and low income nearly every school shooter in the past 30
women. Thus, psychologists strive to rec- men are more likely to be detained by law years has been an adolescent male (Kalish
ognize the relational style of many men enforcement (Center for Constitutional & Kimmel, 2010; Kaufman, Hall, & Zagura,
and adapt by substituting other terms for Rights, 2013). 2012; Kimmel & Mahler, 2003). For adults,
psychotherapy such as consultation, meet- Men of color also have less access to the National Center for Victims of Crime
ing, coaching, or discussion; using less jar- addiction treatment, a significant cause of (2013) estimates that 90% of all homicides
gon; being more active and directive; and racial disparity in the criminal justice sys- in the United States are committed by men,
matching relational style to the client’s tem, as more than 60% of federal inmates and men constitute 77% of all homicide
needs (Englar-Carlson, 2014). Technology- are incarcerated because of drug offenses victims. State and local data also indicate
oriented interventions (e.g. biofeedback, (Federal Bureau of Prisons, 2014). Thus, that men are far more likely than women
telemental health) can also be used to African American men are many times to be arrested and charged with intimate
engage men who are uncomfortable with more likely to go to prison for drug offens- partner violence (Hamby, 2014).
the intimacy of traditional psychotherapy es (e.g., possession of marijuana or crack Although most violence is perpe-
approaches (McDermott, Smith, & Tsan, cocaine) than White men (Felner, 2009), trated by men, most men are not violent.
2014). In addition, Wester and Lyubelsky even though they are less likely to use Consequently, men are often stereotyped
(2005) have suggested the use of explicit illegal drugs (Wu, Woody, Yang, Pan, & as aggressive and violent. These stereo-
goal-setting with men and straightforward Blazer, 2011). Another population of focus types can have negative consequences
cognitive interventions to reduce ambigui- due to social and political implications is for heterosexual men who experience vio-
ty and encourage engagement. undocumented boys and men, who are lence in intimate relationships from their
overrepresented in federal detention facili- female partners. Although abusive women,
ties (Carlson & Gallagher, 2015). For these on average, may do less physical damage
males, the accumulation of risk factors than abusive men (Archer, 2000), phys-
(e.g., psychological, familial, socioeconom- ical assaults from female partners have
GUIDELINE 10 ic, environmental), co-occurring within been shown to create myriad psycholog-
multiple contexts (i.e., dislocation from ical problems for men (Randle & Graham,
Psychologists understand and
one’s community, probability of physical 2011). In addition, male victims of intimate
strive to change institutional, and psychological trauma during the immi- partner violence (Randle & Graham, 2011)
cultural, and systemic problems gration journey and at border crossings, experience significant barriers to finding
that affect boys and men through unpredictable reception and insecurity in help because the domestic violence sys-
advocacy, prevention, and detention centers) often negatively impact tem has historically focused on helping
education. their lifespan development (Arbona et al., battered women (Douglas & Hines, 2011).
2014; Henderson, & Bailey, 2013; McLeigh, Likewise, men who have experienced sexu-
Rationale 2010; Suarez-Orozco et al., 2011). Such al abuse from women or men may face sig-
institutional inequalities have a profound nificant personal and professional barriers
Some men encounter institutional, cultur- impact on the mental and physical health to seeking help (Allen, Ridgeway, & Swan,
al, or systemic barriers to their well-being, of minority men (Jones et al., 2012). 2015).
as evidenced by societal problems where- Another area disproportionately Housing is also a significant area of
in men are disproportionately overrep- associated with boys and men is vio- gender discrimination. Reports demon-
resented. For instance, one of the major lence. Epidemiological research indicates strate that 20% of transgender people
areas affecting boys and men is the high that men of all races are at an increased have experienced housing discrimination,
incarceration rate in the United States. risk for being either a victim or perpetra- another 20% have experienced homeless-
Data obtained from the Federal Bureau of tor of violence, especially during adoles- ness, and 10% have been evicted specifi-
Prisons (2014) reveals the extent of the cence. The Centers for Disease Control cally for their gender identity at some point
problem. For example, men account for and Prevention (2010) reported that vio- throughout the lifespan (National Center
93% of all adults in federal prison to date, lence is the second leading cause of death for Transgender Equality, 2015b). Research
and although African American and Latino among people between the ages of 15 and has demonstrated the link between hous-
males constitute approximately 7% and 24, and reports from state and national ing access and better health outcomes,
8% of the general population, respectively, surveys of youth behaviors suggest that including less sexual risk-taking (Sevelius,
they make up 37% and 34% of the federal young men are more likely than young Reznick, Hart, & Schwartz, 2009),
prison population. Native American men women to engage in serious aggressive decreased intravenous drug use (Fletcher,
are imprisoned at more than 4 times the behaviors. For instance, findings from
rate of White men. These racial, ethnic, the National Youth Risk Behavior Survey

APA!|!Guidelines for Psychological Practice with Boys and Men! 1 9

Kisler, & Reback, 2014), and reduced odds
of suicide attempts (Marshall et al., 2016).

Application

Psychologists strive to disseminate

research findings to legislators and poli-
cymakers to inform public health policies
and funding for research, prevention, and
intervention efforts that can enhance the
lives of boys, men, and their families. For
example, psychologists strive to support
public policy initiatives to ease problems
associated with incarceration, such as
humane treatment for prisoners, access
to drug treatment and other rehabilitation,
job training, accessible housing, and alter-
natives to incarceration. Likewise, psychol-
ogists aim to recognize that male violence
affects everyone (men and women) and,
concurrently, that men can also be victims
of abusive relationships with women.
Psychologists also strive to increase
awareness of the influence of gender role
socialization practices associated with vio-
lence and problem behaviors for boys and
men among public health officials, other
mental health professionals, and policy-
makers. Work with public health officials
to disseminate information regarding
the destructive aspects of rigid notions
of masculinity may result in inclusion of
gender-sensitive public health initiatives
for boys and men. Psychologists also are
encouraged to advocate for more finan-
cial support for research studies aimed
at boys and men with special attention to
neglected areas of research, such as exam-
ining masculinity with other social identi-
ty–based experiences (e.g., racism, ability,
socioeconomic status) in relation to social
problems impacting boys and men. Indeed,
despite the disproportionate number of
men of color in the prison system for violent
crimes, most popular theories of violence
and aggression do not take into account
men’s gender role socialization and racial
experiences (Kilmartin & McDermott,
2015). Such research may attend to the
complexities of gender minority people’s
multicultural identities (APA, 2015; Singh,
Hwahng, Chang, & White, 2017), and pro-
vide insight into mental health outcomes
for those facing multiple layers of oppres-
sion (Budge et al., 2016).

20!APA!|!Guidelines for Psychological Practice with Boys and Men

EXPIRATION

This document will expire as APA policy in 10 years (2028). Correspondence regarding
the 2018 Guidelines for Psychological Practice with Boys and Men should be addressed to
the American Psychological Association, Public Interest Directorate, 750 First Street, NE,
Washington, 20002-4242.

ACKNOWLEDGEMENTS

Guidelines for Psychological Practice for Boys and Men was developed by several groups
of individuals beginning in 2005 and continuing with updates and revisions through 2018.
The final draft was compiled and updated by Fredric Rabinowitz, Matt Englar-Carlson, Ryon
McDermott, Christopher Liang, and Matthew Kridel, with assistance from Christopher
Kilmartin, Ronald Levant, Mark Kiselica, Nathan Booth, Nicholas Borgogna, and April Berry.
Guidelines recommendations and selected literature were determined with the assistance
and expertise of several scholars: Michael Addis, Larry Beer, Matt Englar-Carlson, Sam
Cochran, lore m. dickey, William B. Elder, Anderson J. Franklin, Glenn Good, Michele
Harway, Denise Hines, Andy Horne, Anthony Isacco, Chris Kilmartin, Mark Kiselica, Ron
Levant, Christopher Liang, William Liu, David Lisak, James Mahalik, Ryon McDermott,
Michael Mobley, Roberta Nutt, James O’Neil, Wizdom Powell, Fredric Rabinowitz, Aaron
Rochlen, Jonathan Schwartz, Andrew Smiler, Warren Spielberg, Mark Stevens, Stephen
Wester, and Joel Wong. The authors gratefully acknowledge the APA staff support for
several years under the leadership of Ron Palomares.

APA!|!Guidelines for Psychological Practice with Boys and Men! 21

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