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Sex Roles

DOI 10.1007/s11199-017-0819-y

ORIGINAL ARTICLE

Just for Women? Feminist Multicultural Therapy


with Male Clients
Jacob Wolf 1 & Elizabeth Nutt Williams 2 & Megan Darby 3 & Jonathan Herald 4 &
Catherine Schultz 2

# Springer Science+Business Media, LLC 2017

Abstract Feminist multicultural therapy is an integrative ap- working specifically with men. Implications for therapists
proach to psychotherapy that emphasizes a systems-level un- who work with male clients (both the rewards and the chal-
derstanding of psychological distress and the process of ther- lenges) as well as for researchers who wish to study the appli-
apeutic change. In the present exploratory study, the experi- cation of therapeutic interventions with men are discussed.
ences of feminist multicultural therapists working with male
clients were studied using Consensual Qualitative Research Keywords Feminism . Multiculturalism . Counseling .
(CQR) (Hill et al. 1997). Phone interviews were conducted Gender . Qualitative research
with eight female practicing licensed or license-eligible ther-
apists who had worked with at least one male client in the past
6 months. Consistent with the theoretical approach, all of the Feminist multicultural therapy is an integrative approach to
therapists interviewed expressed their belief that psychologi- psychotherapy that emphasizes the role of context and
cal symptoms can be seen as a reaction to a loss of power or intersecting social identities such that therapists help clients
related to the effects of an oppressive system. Additionally, the understand their roles acting within in a larger system of en-
therapists believed that this theoretical model is broad enough vironmental resources and strains (Enns and Byars-Winston
to be used with varying types of intersecting social identities. 2010; Enns and Williams 2013). Feminist multicultural ther-
The findings illustrate the ways in which the counseling ap- apy (FMCT) builds on the work of both feminist therapy and
proach may work similarly across genders, as well as ways in multicultural counseling, emphasizing social change and the
which one’s therapeutic approach may be altered when empowerment of oppressed people (Enns et al. 2013). An
integrated approach to the fusing of feminist and multicultural
therapies into a cohesive model rests on the ideas of power and
Electronic supplementary material The online version of this article
responsibility (Williams and Barber 2004) for both those with
(https://doi.org/10.1007/s11199-017-0819-y) contains supplementary power and those without. The model has the potential benefit
material, which is available to authorized users. of intentionally focusing on the aspects of identity that are
most salient at any one time given a client’s presenting prob-
* Elizabeth Nutt Williams lems (Enns et al. 2013). Thus, the model is designed to be
enwilliams@smcm.edu broadly inclusive of a variety of social identities. Although
research in the field of feminist multicultural counseling psy-
1
Department of Education and Human Services, Lehigh University, chology asserts that the model is applicable to all people (re-
Bethlehem, PA, USA gardless of sex, gender, race, ethnicity, sexual orientation,
2
Department of Psychology, St. Mary’s College of Maryland, 18952 sexual identity, etc.), there is, as of yet, minimal evidence to
E. Fisher Rd., St. Mary’s City, MD 20686, USA support this claim (Brown 2010; Mintz and Tager 2013).
3
Department of Counseling and Educational Psychology, New Unfortunately, general misconceptions about feminism
Mexico State University, Las Cruces, NM, USA may limit the application of the model because some clients
4
School of Social Work, University of Maryland, College Park, MD, may think the model does not apply to them; for example,
USA White men in particular may not immediately see their
Sex Roles

connection to the model. Additionally, there is still a great deal example, if one views masculinity as the problem, one is
of stigma surrounding the term feminist which may turn peo- simply shifting the current paradigm, prioritizing femininity
ple away from seeking a service that is labeled as such. For over masculinity. Kahn argued that feminist therapy with
example, Liss et al. (2000) explored the extent to which peo- men should take a more comprehensive approach and
ple identified with the feminist label. They found that even promote a more critical understanding of how gender and
though people agreed with most or all of the tenets of feminist other social identities, such as race, sexual orientation and
philosophy, they were unlikely to use the label Bfeminist^ ability, affect men. Therefore, a model that integrates a
because of the stereotypical social implications of the term healthy understanding of masculinity is critical for working
(e.g., man hating). Additionally, Williams and Wittig (1997) with male clients.
found that men were not likely to associate with the feminist Mintz and Tager (2013) advocate for feminist multicul-
label, despite having opinions in line with feminist ideals, tural counseling to be used with male clients in order for
because of their felt lack of inclusion in the feminist move- men to more fully understand the ways in which patriarchy
ment. Even therapists who engage in therapeutic activities that (in particular the rigid and constraining stereotypes of heg-
are considered feminist do not always self-label as feminist emonic masculinity) may be harmful to them. For example,
therapists (Moradi et al. 2000). Mintz and Tager (2013, p. 325) posit that BMany men who
Past research on people’s willingness to associate with the embrace traditional masculine mandates of power become
feminist movement points out the problem that anything that disempowered through disconnection with others.^
is labeled Bfeminist^ may automatically be seen as only about Feminist multicultural counseling psychology takes a view
females (Anderson 2009; Breen and Karpinski 2008; Yoder of clients that is contextual and focuses on the empower-
et al. 2011). While an exclusive model may have been the case ment of all clients (Mintz and Tager 2013; Williams and
in the early days of the feminist movement and the psycho- Barber 2004). Men as a group experience privilege as a
logical study of women, feminism is now a much more inclu- result of systems level oppression and bias towards mas-
sive model that critically engages the idea of gender and how culinity as the norm (Case et al. 2012). Even as a privileged
it affects all people (Mintz and Tager 2013). Although the group, men are intersectional beings who can experience a
integrated Feminist Multicultural approach to counseling whole host of psychological distress related to their vary-
grew out of the women’s movement and movements for ing intersecting social identities (e.g., race, sexual orienta-
People of Color, its emphasis on power, privilege, and oppres- tion) and life experiences (e.g., trauma histories) (Coston
sion can be useful even for those who may be unaware of their and Kimmel 2012). Gender role conflict, as well as ac-
own connections to these issues. Yet more research is needed knowledging oppression and the varying experiences of
to document how and why men can benefit from a therapeutic power and privilege that come with the different identities
approach that uses a feminist multicultural framework. that a person can have, can all lead to psychological dis-
Male clients are situated in a unique position. For example, tress. An important distinction is that the experiences of
men are at higher risk for suicide than women are (National discrimination that might lead to distress are not based on
Institute of Mental Health 2015); yet, despite the high risk of an individual being male. Rather, these experiences are
suicide, men seek professional psychological help at far lower likely related to the experience of being a male who also
rates than women do (Addis and Mahalik 2003). The low rate identifies with a marginalized identity status. In order to
of help-seeking behaviors by men may be linked to a con- help men cope with the psychological pain and distress that
stricting and rigid construction of masculinity that values be- comes along with being part of an oppressive system (in
ing strong over asking for needed help (Berger et al. 2013). which one is in many ways the oppressor), FMCT may
Highly rigid constructions of masculinity and gender sociali- help men understand what the constraints of masculinity
zation contribute to mental health problems for men and boys and gender-role conflict are.
(Yousaf et al. 2015). O’Neil et al. (1986) have suggested that Despite suggestions that FMCT can be used with male
gender role conflict—the idea that men often feel pressure to clients, very little research has been done to investigate this
suppress Bsofter^ emotions (e.g., distress, depression) that are issue. As an initial step in this research, the current study was
in conflict what they believe they are expected to demonstrate developed to help us understand the experience of FMCT with
as a man (e.g., anger, neutrality)—may be a critical factor in male clients in a broad way. The study was qualitative in
why men are less likely to seek psychological help. In many nature, which provides the freedom to empirically examine
ways, feminist multicultural therapy might be ideally situated issues related to FMCT with male clients in an exploratory
to provide assistance to male clients at the same time as way. As an under-examined area, it is important to explore
allowing them to explore these avoided Bsofter^ emotions. additional avenues to help improve men’s mental health.
However, Kahn (2011) asserted that feminist therapy has Low rates of help seeking and the consequences of suicide
historically either ignored how men could fit into the model and other mental health concerns demand a solution to these
or treated them as Bother^ in highly stereotyped ways. For issues as a matter of public health. Thus, the goal of the
Sex Roles

present research was to broaden the scope of research in the 21-year-old White man, a 20-year-old White woman, a
field and to examine feminist multicultural therapy as specif- 19-year-old White woman). Team members were selected
ically applied to male clients. based on the depth of their coursework in counseling and
gender studies. The auditor was a 47-year-old counseling
psychologist with expertise in Consensual Qualitative
Method Research (CQR; Hill et al. 1997). The research team
members were trained in CQR by the auditor in multiple
Participants sessions that involved reading the research literature,
learning about qualitative methodologies, and practicing
Therapists the coding strategies (of domains, core ideas, and cross
analysis). After training, but before beginning the analy-
Nine therapists were interviewed for the present study. This sis, the team members discussed their expectations and
group was made up of eight women and one man. The re- potential biases (Hill et al. 2005).
search team concluded that the one male therapist did not meet
the inclusion criteria because he did not explicitly identify as a Measures
feminist multicultural psychologist (although he did say that
he practices in a way that is consistent with the principles). Therapist Demographic Form
Although it can be useful in qualitative research to have a
homogenous sample of key informants, the lack of male ther- The therapist participants in the study filled out a basic
apist participants raises an additional question about gender demographic form that asked for their age, gender,
and FMCT (which are addressed in the Discussion section). race/ethnicity, years in practice, practice setting, number
Of the remaining eight female participants, six were of individual clients seen per week, number of male cli-
Caucasian and two were African American. The sample ents per week, educational level, and additional theoreti-
ranged in age from 28 to 39 years-old (M = 33.70, cal orientations beyond feminist/feminist-multicultural.
SD = 3.83). All therapists in the group were currently licensed The demographic form also asked the therapist to indicate
or license-eligible and were regularly seeing clients (at least a convenient time to be contacted for the phone interview.
one male client) within 6 months of their interview. The cur-
rent academic degrees of the therapists included five Ph.D.- Therapist Interview Protocol
level psychologists, two Master’s-level therapists, and one
who listed J.D. as her highest level of training (although she The interview protocol, based on an extensive review of
is currently in a Ph.D. program for counseling psychology). the literature, was designed to explore feminist-
The majority of therapists’ degrees were in counseling psy- multicultural therapists’ experiences of working with male
chology, although one had a Ph.D. in counselor education. clients. The interview contained 12 questions, including
The therapists ranged in experience level from trainees to questions about their feminist multicultural orientation
5 years of post-training (M = 3.07 years, SD = 1.84). All of and the differences and similarities in the application of
the therapists claimed feminist or feminist-multicultural as FMCT with different clients. The questions allowed ther-
part of their primary orientation to therapy, but the other ori- apists to explain their personal connection to the model
entations they utilize included cognitive behavioral (n = 4), and their work with male clients in detail. As is typical in
systems (4), humanistic/experiential (3), integrative/eclectic qualitative, exploratory work, the questions were created
(2), interpersonal process (2), and psychodynamic/ to be open-ended, with minimal prompts to allow the
psychoanalytic (1). Therapists saw an average of ten clients therapists to choose what elements of the model they
per week at the time of the interview (SD = 7.07, range = 0– wished to emphasize. (The full interview protocol with
20), of which an average of four were male clients (SD = 3.17, questions and prompts is available as an online
range = 0–10). supplement.)

Research Team Procedures

The interviews were conducted by a 22 year-old White Recruiting Therapists


man who had substantial counseling experience (in both
coursework and as a peer counselor). He was trained in After securing IRB approval, a message was sent to the
interview techniques and was supervised by the auditor (a listservs for Divisions 17 (counseling psychology) and 29
licensed counseling psychologist with 20 years of experi- (psychotherapy) of the American Psychological
ence). The research team included three other students (a Association. The email specified that the scope of the study
Sex Roles

required that participants be currently licensed or license- auditor’s feedback, the team moved into the final stage in
eligible and practicing (i.e., having worked with clients in the data analysis: cross analysis. Cross analysis involves
the last 6 months) feminist or feminist-multicultural thera- comparing the core ideas under each domain across cases
pists who were currently working with at least one male to identify similarities (i.e., categories). A copy of the
client. Therapists who were interested in participating were cross analysis was sent to the outside auditor who again
asked to complete the online demographic form indicating provided feedback to the research team. Once the team
their interest, their consent to participate, and a good time to reviewed the auditor’s feedback, categories were assigned
contact them. Confirmation of the phone interview was sent frequency labels: general, typical, or variant. Categories
via e-mail upon receipt of the demographic form. were considered to be General if they applied to all cases
(8), Typical if they applied to half or more of the cases
Therapist Interviews (4–7), and Variant if they applied to less than half, but
more than one case (2–3).
The interview protocol was piloted with one nonpartici-
pant volunteer. This pilot interview, supervised by the Results
auditor, allowed for corrections to be made in question
structure, clarity, and order. After training was complete, The cross analysis revealed specific categories that emerged
the interviewer contacted interested therapists to set up under each of the 10 domains. See Table 1 for a list of the
an interview time. The phone interviews lasted between domains, categories, and frequencies. For the sake of brev-
35 and 60 min. Therapists were reminded that the inter- ity, only categories that were General or Typical are includ-
view would be audiotaped and that they had a right to ed in Table 1. See Table 2 for background information about
withdraw from the study at any point. Therapists were each participant who is quoted in the following results.
also reminded that all information would remain confi-
dential and all identifying information would be removed
from the analysis. At the completion of the interviews, Critical Elements of FMCT
the interviews were transcribed verbatim in preparation
for data analysis. All participants described their belief that psychological
symptoms need to be understood within the context of an
Data Analysis individual’s life for the framework to be feminist multi-
cultural. All eight participants focused on issues of power
The coding procedure of CQR is composed of three main and oppression. For example, one participant clarified, BI
parts (Hill et al. 1997, 2005): domains, core ideas, and believe that psychological pain is the result of when we
cross analysis. Domains represent the broad areas of in- lose power in our lives…^ (Participant ID 1). Typically,
terest generated primarily from the interview protocol. An participants also noted the importance of context (e.g.,
example of a domain was Bdefinition of feminist therapy^ intersecting social identities) in FMCT. Additionally, they
because it is broad and related to the content of the inter- typically emphasized the importance of an egalitarian
view question asked. The research team independently therapeutic relationship, as opposed to a hierarchical or
read and coded the transcripts, using a domain Bstart list^ Bexpert^ model. Interestingly, fewer than half the partici-
(Miles and Huberman 1994) based on the interview pro- pants (a variant category) explicitly mentioned the femi-
tocol. Then the team would meet to argue to consensus nist motto, Bthe personal is political.^
over the domain’s breakdowns. In the next stage of data
analysis, the team would take the transcript, re-ordered by Reasons for Being a FMC Therapist
domains, and independently generate core ideas (for each
domain, for each interview) before meeting as a team to In describing why they became a feminist multicultural
determine consensus. A core idea is a concise form of the therapist and why they are committed to this model over
content of what that the participant said in the interview others, most participants (6) noted that this model fit with
under each domain. In particular, the research team took their individual worldviews. Additionally, most of the par-
care to stay true to the participants’ words and meanings. ticipants (6) reported that feminism and multiculturalism
At this stage of the analysis, the coded transcripts were are important to them both personally as well as profes-
sent to the auditor, who provided detailed feedback to the sionally. One participant said: BI think I was a feminist
team. The use of an auditor provides a counter to the before I knew I was a feminist^ (Participant ID 8), indicat-
possibility of groupthink as the team works to balance ing that this is not just a professional choice, but rather it is
power dynamics in the consensus process. After a part of her identity. In fact, many of the participants (6)
reviewing and making decisions about incorporating the indicated that this model fit for them much better than other
Sex Roles

Table 1 Domains, categories,


and frequencies Domain

Category Frequency

Definition of FMCT
Focus on power and oppression General (8)
Focus on client context (experiences, identities, current events) Typical (7)
Focus on egalitarian roles and sharing power Typical (6)
Focus on intersecting social identities Typical (6)
Reason for being FMC Therapist
Consistency of model with own worldview Typical (6)
Fusion of personal and professional beliefs Typical (6)
Lived experiences with power and privilege Typical (5)
Application of the Model to Male Clients
Males seem less reflective and aware of power issues Typical (7)
No difference in application between male and female clients Typical (6)
Maintains focus on empowerment Typical (6)
But viewed differently by male clients Typical (5)
Focus is egalitarian and collaborative Typical (4)
Advertising FMCT
Therapist explains worldview without using explicit terms Typical (6)
Focus is more on therapeutic relationship rather than approach Typical (5)
Use terms Feminist/Multicultural intentionally if helpful for client Typical (4)
Strategies for Non-Receptive Clients
Explain where therapist is coming from (in terms of FMCT model) Typical (5)
Remain open/candid with the client Typical (4)
Ask clients to explain worldview/experiences (Narrative focus) Typical (4)
Intentionally Modifying Approach for Male Clients
Therapist doesn’t change therapy approach with male clients Typical (7)
Therapist does change interventions Typical (6)
Therapist uses different terms (but same approach) Typical (5)
Changing approach for individual clients is feminist in nature Typical (5)
Therapist uses CBT techniques Typical (4)
Problems Therapists Have Experienced
Sexualization of the therapeutic relationship Typical (5)
Rewarding Experiences
Helping clients feel validated/empowered Typical (7)
Providing first space for client to open up Typical (6)
Helping clients reconcile conflicting identities Typical (5)
Challenging Experiences
When client did not make progress in therapy General (8)
Feeling physically afraid of clien Typical (5)
Applicability for Male Clients
More education needed about feminism (i.e., not just for females) Typical (7)
No change to model needed; broad enough for all social identities Typical (6)
Model works for male clients in a way that other models don’t Typical (4)

General categories were mentioned by all participants (8); Typical categories were mentioned by at least half of
(but not all) participants (4–7)

models because of their personal viewpoints and their lived responses included previous work in domestic violence
experiences with power, privilege, and oppression. Variant treatment and education in feminist training programs.
Sex Roles

Table 2 Background
characteristics of female ID Age Highest degree Race/Ethnicity Practice setting
participants
1 28 J.D. African American Private Practice
2 32 Ph.D. Caucasian College Counseling Center
3 39 Master’s Caucasian College Counseling Center
4 39 Ph.D. African American Private Practice
5 35 Ph.D. Caucasian Private Practice
6 33 Ph.D. Caucasian College Counseling Center
7 29 Master’s Caucasian College Counseling Center
8 35 Ph.D. Caucasian Hospital

Application of the Model to Male Clients that they focus more on the therapeutic alliance rather than the
terms Bfeminist^ or Bmulticultural.^ Typically, participants (4)
Participants were asked to explain any similarities and differ- said that they would, however, use those terms explicitly with
ences in the way that they apply FMCT with male and female clients if they thought it will be helpful for their client. For
clients. Most of the participants (6) did not make changes to example, one participant explained:
the model with different clients; they consistently focused on
identity, socialization, power, and privilege regardless of the The times that I use it [the terms Bfeminist multicultur-
social identities of the client. Four participants also mentioned al^] are very intentional. So when I know that we’re, the
the egalitarian nature of the therapeutic relationship as impor- client is specifically seeking empowerment and I get the
tant for both male and female clients. However, five partici- impression that they’re going to buy into therapy more if
pants also pointed out that although there are not real differ- I use the term feminist, that’s when I tend to use it.
ences in the application of the model, it may be viewed dif- (Participant ID 7)
ferently by male and female clients. For example, one partic-
ipant said: BI think that certainly some of the conversations As a variant response, some participants would address
that happen look a little different with male clients than [with] their orientation explicitly if the client asked. They gave ex-
female clients…^ (Participant ID 2). The explicit content, ter- amples of clients who would notice books in their office and
minology used, and pacing might appear different if a thera- ask questions about their scholarly interests. In addition,
pist was working with a man or a woman. In a related way, whereas some participants openly talked about their feminist
nearly all participants (7) mentioned that male clients are usu- multicultural orientation in explicit terms, others felt that tell-
ally less emotional or aware of their place in the system of ing a client in explicit terms about one’s orientation felt like
power, privilege, and oppression. One variant response was Bcoming out^ to one’s client.
that some therapists did act differently, or have been uncom-
fortable, with male clients. For example, one therapist said: Strategies for non-Receptive Clients

It’s easier for me to ask my female clients certain ques- When considering what specific things they do when a male
tions if they’re talking about sex …I just don’t feel like client seemed to be dismissive of ideas that are feminist mul-
it’s a big deal. And with them [male clients] I don’t ticultural in nature, most participants (5) would explain to their
know if it’s because I feel like it is [a big deal] or I feel client why they were asking a certain type of question as a way
like I’m going to make them uncomfortable. (Participant to be transparent about their work and as a way to remain open
ID 2) and candid with the client. Another typical response was to
have the client explain his worldview using a narrative focus;
Additionally, some participants made a note that the differ- in other words, they would prompt the client to use his own
ences between clients’ experiences are individualistic and that words and then tie them back to the model. There were mul-
it is hard to (and sometimes inappropriate to) draw a distinc- tiple variant responses for this domain including: meeting the
tion based on gender. client where he is and not trying to change him, integrating
other elements (i.e., techniques and strategies) from other ther-
Advertising FMCT apeutic models, and challenging the client in the moment (i.e.,
use of confrontation to break through a resistance). Yet, some
Most participants (6) did not use the explicit term Bfeminist participants noted that they rarely encounter resistance be-
multicultural therapist^ or a variation of those terms when cause of the way they advertise themselves or where they
advertising their practice. Typically, the participants (5) said are located geographically. In other words, clients specifically
Sex Roles

seek them out because they are feminist multicultural or be- male clients. The only typical response to emerge (from five
cause they suggested that some regions in the United States participants) was the sexualization of the therapeutic relation-
may be generally more knowledgeable about and open to ship. For example, one therapist said:
these ideas.
The counseling relationship is so different than any oth-
Intentionally Modifying Approach for Male Clients er relationship, this really quick intimacy. You know,
assuming there is that rapport, where you talk about
Most participants (7) did not alter their approach for a client things that you don’t talk about with other people and
who is not receptive to feminist multicultural work because there’s this emotional intimacy that I think occurs that
the model is integral to their worldview. They would change sometimes gets confused. (Participant ID 6)
interventions, but not the way they orient themselves to ther-
apy or conceptualize the client. For example, four participants Some variant responses included feeling disrespected or hav-
noted that they would use cognitive-behavioral therapy (CBT) ing one’s competency questioned, concerns over physical
techniques with clients who were not receptive to the FMC safety, and feeling that the client is not being genuine because
work. Typically, participants (5) noted that changing their of the therapist’s gender or education. One therapist said:
style to meet the client where he is is feminist in nature and
that they can use the approach without using the specific terms I often find that I’m given a certain kind of power. I do
(e.g., feminist, empowerment, social justice, multicultural). feel like I primarily get a lot of respect from my male
A variant response was that some participants did actually clients at least in their explicit interactions. Sometimes it
change their orientation for their clients who were unrecep- feels like there’s this privilege point where… I have a
tive. For example, one therapist said: Ph.D., but I’m female so they feel like they can share
feelings with me, maybe a little more than they would in
I think there are certain clients who have room for other aspects of their life. (Participant ID 5)
growth and others who are not interested in growing.
So when I meet someone who makes consistent sexist Additionally, some participants felt uncomfortable ap-
and racist remarks without any insight or awareness, I proaching certain issues (e.g., sexuality) with male clients.
know to switch to cognitive behavioral therapy and just Another participant’s point ties together these last two
focus on their thoughts or behaviors and helping them categories:
move through their treatment plan. I try not to do the
other part. It will only frustrate me and alienate them. I had one client pretty recently who was struggling with
And I don’t want them to have a negative experience wanting to cheat on his girlfriend and he just kept saying
with counseling and so I just, yeah, I go to CBT. Once I BI feel like such a pig in talking about this^ and I think
realize that the person is there and comfortable being that maybe he would not have said that to a male ther-
there, so that’s not even something that they’re thinking apist, but I don’t know. I felt very much like he didn’t
about, then I switch to just focusing on thoughts and want, he wanted me to not feel like he was disrespecting
behaviors and feelings and we just work through our women and that was an issue in our relationship.
goals that way. (Participant ID 4) (Participant ID 3)

This therapist was in a minority of therapists who said they


completely alter their framework to what the client is ready to Rewarding Experiences
handle. The explanation given by this participant is similar to
those who focus on meeting the client where he is comfort- Participants were asked to share an experience of working
able; however, this therapist said that she completely drops the with a male client that was particularly rewarding. Six of the
framework and moves toward a conceptualization of clients participants felt an experience was rewarding when they pro-
that emphasizes thoughts and behaviors rather than context vided the first space for a client to open up about something,
surrounding social identity. and nearly all of the participants (7) felt it was rewarding when
the client felt validated and empowered. For example, one
Problems Therapists Have Experienced participant said:

In order to explore the intersectional approach to gender and I could see a difference in the way he would assert him-
therapeutic orientation, participants were specifically asked self in therapy and examples of him asserting himself
what problems came along with being a woman and a feminist outside of therapy, so, it just, having that voice and val-
multicultural therapist, particularly in relation to working with idation and a space to kind of be heard and explore what
Sex Roles

that means, like for himself and also his community felt theoretical orientations are and because she feels personally
very powerful. (Participant ID 5) passionate about issues of social justice (power, privilege, and
oppression) from her own lived experience.
Additionally, most of the participants (5) felt it was rewarding Dr. C asserts that the application of the model in therapy
to help a client reconcile conflicting social identities (e.g., does not differ substantially with male clients versus female
being gay and religious). Some variant responses included clients. With both male and female clients she always helps
when the client was able to redefine experiences for himself them examine power and privilege through a strong and col-
and when an initially resistant client had some sort of laborative therapeutic relationship. However, she notes that
breakthrough. the way those conversations play out tends to be different
for men and women. For example, her female clients tend to
Challenging Experiences be more aware than are men at the beginning of therapy of
their place in the system of power and oppression. In addition,
Participants were also asked to share an experience of working she is more careful about her use of terminology with male
with a male client that was not as rewarding. All eight of the clients, avoiding words like Bfeminist^ or Bmulticultural^ and
therapists felt challenged when the client did not make prog- instead explaining her worldview in more general terms.
ress in therapy. In addition, it was difficult for participants While remaining open and candid with the client to promote
when they were physically afraid of or intimidated by a violent her egalitarian ideals, she typically asks the client to explain
client. As variant categories, some also felt challenged by his worldview and then tries to Bmeet him where he’s at^ by
working with emotionally closed off clients, feeling integrating other techniques (such as from a cognitive-
undervalued (or having their competency questioned) by the behavioral approach) that may seem less threatening at first.
client, and working with a client whose perspective and goals She states clearly that although she does not change her ori-
were so different from their own. entation to therapy with different clients (always using the
FMC model to conceptualize the client’s concerns), she does
Applicability to Male Clients alter her intervention strategies and use of terminology to best
fit the client.
Most participants (6) said that FMCT is applicable to male Using a FMCT approach to therapy is not always easy. She
clients Bas is^ and that the model is broad enough to work has had some clients simply not make any progress. She has
with any combination of social identities; it is not just about also, at times, been physically afraid of some of her male
gender or racial minorities. However, nearly all the therapists clients, has felt objectified and disrespected as a woman, and
(7) said there needs to be more education about feminism has had her competency questioned by male clients. Whereas
(e.g., that it isn’t just for women), and half the sample noted Dr. C has encountered problems in therapy vis-à-vis her the-
that the model may do something for men that other models do oretical orientation or approach, she finds FMCT very reward-
not by explicitly examining power and privilege. A variant ing on the whole. She has seen male clients Bopen up^ in
response was that there needs to be more research that is surprising ways. She feels rewarded herself when her clients
specifically on the application of FMCT with male clients. feel empowered and validated, particularly when they are en-
gaged in the difficult work on reconciling conflicting demands
Narrative Case Example of their different social identities. Thus, overall, she feels that
the FMCT model is broad enough to encompass all
To summarize the most common findings across cases, we intersecting social identities but that more education is needed
present the typical and general categories in a narrative case (broadly speaking) about the terms feminism and multicultur-
example: Dr. C, a composite case who represents the aggre- alism. In particular, she believes that the model works for male
gate experiences of the participant therapists. Dr. C is a 33- clients in a way that other models do not and so it is a valued
year-old White, female counseling psychologist who has been Btool^ in her therapeutic toolbox.
in private practice for 3 years. She takes a primarily cognitive-
behavioral and systems approach to her work with clients and
labels herself as a feminist multicultural (FMC) therapist. She Discussion
understands FMC therapy in the context of issues of power,
privilege, and oppression where the clients’ context and The intention of the present research was to understand how
intersecting social identities are key to the therapeutic work. feminist multicultural therapy (FMCT) is conducted in prac-
She feels that the most important elements of the model are a tice with male clients. There has been theoretical work laying
collaborative, egalitarian therapeutic relationship and a focus the groundwork for feminist multicultural counseling with
on empowerment. She became a FMC therapist because the male clients (Mintz and Tager 2013); however, there is very
model is more consistent with her own worldview than other little empirical evidence to support these theoretical claims.
Sex Roles

The current research provides some evidence, although ex- social identities that feminism, at least FMCT, works to in-
ploratory, that this model may work with male clients (at least clude and explore. Participants’ frustration with common mis-
when delivered by female therapists) and that it may work in a conceptions about feminism is reflective of the research (Liss
way that other models do not. et al. 2000; Williams and Wittig 1997). Some participants
An important distinction of FMCT is the focus on even expressed that their geographic locations or the political
intersecting social identities and the varying degrees to which climate around them influenced how a term like feminist or
those privilege or marginalize a person. An emphasis on the multicultural might be perceived. These participants also re-
varying social identities is consistent with the theoretical work ported that their own social identities may affect how others
on this model (Mintz and Tager 2013; Williams and Barber perceive what they mean by these terms.
2004). It is important to note that all of the therapists who Despite those challenges, the current study demonstrated
elected to participate in our study were women. It was the that some (female) therapists are using the FMCT model with
intention of the research team to recruit a more diverse sample their male clients. Participants suggested not only that FMCT
of FMC therapists in terms of gender as well as race, ethnicity, works for male clients, but also that it works in a way that
and other identities. However, no male therapist self-identified other orientations do not—that is, by creating a space for male
as FMC and volunteered to participate in the study. We are left clients to open up about what masculinity or other identities
to wonder if only female therapists use this therapy orienta- mean to them and examine the influence of these identities on
tion. Although we do not believe so, it is an interesting re- their life. These ideas are similar to the assertion that Mintz
search question for the future. and Tager (2013) made: Using FMCT is not just feasible with
Although our participants included only female thera- male clients, it is necessary for male clients to reach their full
pists, this group of participants can be considered a group potentials.
of key informants (Hill 2015) on the topic of feminist mul- But is there a difference in how FMCT is applied with male
ticultural counseling. The group of participants gave varied clients as opposed to female clients? Many of the therapists
responses about their unique experiences, but their re- who participated in the present study emphasized a differ-
sponses also highlighted the general experiences that it ence between their worldview (or conceptualizations) and
seems many feminist multicultural counseling psycholo- their techniques (or intervention strategies). For example, a
gists have when working with male clients. The first domain therapist may understand people contextually or as part of the
served as a litmus test to make sure that this group of infor- system of power and privilege yet use interventions from
mants all shared a common understanding of FMCT. Their cognitive-behavioral or psychodynamic orientations. Many
responses are also consistent with previous studies of the of the therapists mentioned that they differentiate between
feminist therapists who also focused on issues of oppression conceptualizations and interventions in response to the ques-
(Moradi et al. 2000) and power sharing (Rader and Gilbert tion about changing their orientation if the client is not recep-
2005). tive to a feminist multicultural framework. The therapists
In addition, regardless of our intentions, our interviewees mentioned that being a feminist multicultural therapist meant
represented a predominantly White and female perspective. meeting the client where he or she is comfortable; however,
Therefore, one cannot ignore the perspective from which these this does not change the way the therapist understands the
experiences come. The power differential that exists for these client conceptually. For example, clinicians reported that
therapists in working with male clients reverses the power their time with clients is not necessarily spent discussing
imbalance that is evident more typically in other social inter- feminism and multiculturalism. They described utilizing
actions wherein men have more power (Blazina and Marks skills from other theoretical orientations that are more tech-
2001; Mintz and Tager 2013). Some of these therapists nique oriented or implement mindfulness-based strategies. A
discussed how some topics, namely sexuality, made this im- feminist multicultural framework seems to commit the ther-
balance more noticeable in the sessions. Similarly, we wonder apist to being intentional in their use of feminist multicultural
how the gender of the interviewer may have impacted the intervention strategies. If the goal is to meet the client at a
interaction with the female interviewees. FMCT is focused conceptual place that is comfortable for him, it will likely
on understanding how privilege and social power are at play involve some restructuring of therapeutic techniques.
in relationships; therefore, an acknowledgment of the social Using techniques that have developed from other theoretical
locations of the interviewees as well as the interviewer is orientations speaks to the integrative nature of this model and
important. gives the model strength. FMCT with male clients is an ap-
Beyond gender identification, is a broad understanding of proachable way to help men understand the contextual nature
feminism and multiculturalism required in order to appreciate of identity and the influence of power, privilege, and oppres-
the way that this model can be useful? Participants in the sion. The current findings suggest that this model could be
current study suggested that people’s reaction to the term fem- empowering for male clients, although additional empirical
inism may be part of the barrier to including the wide range of evidence will be important to acquire.
Sex Roles

Limitations and Future Research Directions treatment models, processes, and outcomes to ascertain how
similar and compatible these models are to the work of FMC
Our study is qualitative in nature, which provides an excellent therapists. Our sense is that FMCT includes a broader array of
way to explore a relatively under-examined topic. However, social identities; thus, whereas the other models will work for
this methodology also has several weaknesses. Our study is men in general, a FMCT approach will work well for men who
representative of the views of eight female feminist multicul- also identify strongly with other salient identities (e.g., racial
tural counseling psychologists and therefore cannot be gener- or sexual). More research in this area is sorely needed.
alized to the whole population of feminist multicultural thera-
pists or therapists in general. The number of interviews, Practice Implications
though, is within the appropriate range for the CQR model
(Hill et al. 2005). The sample was also all female and predom- Many of the questions about the role of men in feminist ther-
inantly White and is thus not fully representative of all femi- apy focus on the man as the client in the counseling relation-
nist multicultural therapists. ship. It is also important to consider the man as the therapist;
Additionally, the current study only includes responses can men be effective feminist therapists? Szymanski et al.
from therapists. Ideally we would be able to compare the (2002) studied male therapists to see if there were differences
responses of the clients who were working with specific ther- between male therapists who do and do not identify as femi-
apists. A client’s perspective is needed in order to truly under- nist. The researchers found a relationship between liberal gen-
stand the effectiveness of feminist multicultural work with der ideas and use of feminist therapy intervention techniques
male clients. (even if the men did not identify as a feminist). They conclud-
Finally, the current study focused on male clinets. In some ed that male therapists could be effective feminist therapists
ways the binary distinction of male-ness versus female-ness is who empower clients and work toward therapeutic change.
contributing to a hetero- and cis-normative culture where gen- Szymanski et al. (2002) argued that male feminist therapists
der and sexual minorities are silenced. It was not the intention may be particularly helpful as feminist therapists because they
of our study to ignore the voices of those in a minority group. can use their male privilege to enact change. What is still
Many of the participants pointed out that identities besides unclear, however, is how many male therapists explicitly
gender were often much more salient to clients. The intention adopt a FMC orientation to therapy.
of our study was to explore how constructions of masculinity Thus, it may be interesting to consider whether feminist
and a rigid sense of gender can be explored through this therapy must include a female in the dyadic relationship to
framework. Future research should explore the ways those be considered feminist. If male therapists can be feminist ther-
clients who do not fall within the heterosexual or cis- apists and the feminist multicultural model is inclusive of all
gendered norm can also benefit from a feminist multicultural types of social identities, it is then conceivable that a male
framework. feminist therapist could be working with a male client.
More research needs to be done on the application and Although that statement may seem obvious, the concept of a
outcomes of feminist multicultural counseling psychology male only FMCT dyad is not one that has been empirically
with a male population. Although our exploratory study sug- examined. Further examining the integrated feminist multicul-
gests that the model can be effective, larger-scale outcome tural model of counseling as it relates to male-male dyads
studies are needed. In addition, the social identity of mascu- would be a fruitful avenue for future research, as well as pro-
linity does not exist in a vacuum. It is important to study how vide helpful ideas for practice. In particular, more process
the intersections of different social identities, which carry research is needed that examines the techniques and strategies
varying amounts of power and privilege, affect the application employed by practitioners to best facilitate mental health treat-
of a feminist multicultural framework. Many of the partici- ment for men.
pants in the current study emphasized this point: Men have
varying degrees of power and privilege. The intersection of Conclusions
race, class, ability status, and sexual orientation, among other
aspects of identity, involve varying degrees of social privilege. The results of the current study serve as an initial exploratory
Finally, although we are intrigued by the possibility of foray into the under-studied area of the relationship between
using FMCT as an overarching therapeutic model for all types men and feminist multicultural therapy. There is a need for
of social identities, other feminist and gender-egalitarian much more research in this area. Our findings, although a
models for men do exist (e.g., gender aware therapy: Good good first step, raise many additional questions. We do not
et al. 1990; gender role journey therapy: O’Neil 2015). yet know, for example, what feminist multicultural therapy
These models appear to rely heavily on ideas introduced by is like from male clients’ perspectives, nor do we understand
feminist therapists, such as the use of gender-role analysis the role of the male feminist multicultural therapist. We hope
(Worell and Remer 2003). It would be interesting to compare that future research examines the strategies and approaches
Sex Roles

that work best in order to assist male clients. We know from Enns, C. Z., & Williams, E. N. (2013). The Oxford handbook of feminist
multicultural counseling psychology. Oxford: New York. doi:10.
the current research, for example, that some therapists alter
1093/oxfordhb/9780199744220.001.0001.
their strategies (such as employing cognitive-behavioral tech- Enns, C. Z., Williams, E. N., & Fassinger, R. E. (2013). Feminist multi-
niques) with their male clients even while conceptualizing the cultural psychology: Evolution, change, and challenge. In C. Z.
client from a feminist multicultural worldview. How well does Enns & E. N. Williams (Eds.), The Oxford handbook of feminist
multicultural counseling psychology (pp. 3–26). New York:
this work? Are there alternative strategies? How does the
Oxford. doi:10.1093/oxfordhb/9780199744220.001.0001.
model compare with other gender-based models? Good, G. E., Gilbert, L. A., & Sher, M. (1990). Gender aware therapy: A
We believe, based on the theoretical work in this area and synthesis of feminist therapy and knowledge about gender. Journal
through past empirical work on feminist therapy and multicul- of Counseling and Development, 68, 376–380. doi:10.1002/j.1556-
6676.1990.tb02514.x.
tural counseling, that FMCT provides an important way for
Hill, C. E. (2015). Consensual qualitative research (CQR): Methods for
therapists to help clients with a variety of intersecting social conducting psychotherapy research. In O. C. G. Gelo, A. Pritz, B.
identities. This approach may become even more important as Rieken, O. C. G. Gelo, A. Pritz, & B. Rieken (Eds.), Psychotherapy
men struggle with the possibility of increased gender role research: Foundations, process, and outcome (pp. 485–499). New
York: Springer-Verlag Publishing. doi:10.1007/978-3-7091-1382-0.
conflict (O’Neil 2015) and toxic masculinity (Kupers 2005;
Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., &
Liang et al. 2011) so evident in U.S. culture. Feminist multi- Ladany, N. (2005). Consensual qualitative research: An update.
cultural therapy may offer a way to help male clients explore Journal of Counseling Psychology, 52, 196–205. doi:10.1037/
their social identities in new ways and thus may be an impor- 0022-0167.52.2.196.
tant avenue for both future research and practice. Hill, C. E., Thompson, B. J., & Williams, E. N. (1997). A guide to
conducting consensual qualitative research. The Counseling
Psychologist, 25, 517–572. doi:10.1177/0011000097254001.
Kahn, J. S. (2011). Feminist therapy for men: Challenging assumptions
Compliance with Ethical Standards We have complied with all eth-
and moving forward. Women & Therapy, 34, 59–76. doi:10.1080/
ical standards of the American Psychological Association in the
02703149.2011.532458.
conducting of this original research and in its written submission.
Kupers, T. A. (2005). Toxic masculinity as a barrier to mental health
treatment in prison. Journal of Clinical Psychology, 61, 713–724.
doi:10.1002/jclp.20105.
Liang, C. T. H., Salcedo, J., & Miller, H. A. (2011). Perceived racism,
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