They may resent being told what to do, and so suggestions may need to be reframed as conclusions that are reached collaboratively between client and counselor. As a result, male clients may develop combative or competitive relationships with male treatment group members and staff or may appear resistant to others' suggestions. Men are also expected to be competitive and, at times, aggressive. Their need to be self-sufficient may result in a false sense of accomplishment or security in their recovery, which may manifest as unwillingness to follow through with continuing care or attend mutual-help meetings. This too is, in part, a reflection of men's stoicism. They may also have trouble analyzing their own problems, particularly feelings related to those problems. Men often have concerns about privacy and need reassurance that treatment will pose no threat to their image or standing. Consequently, they may have trouble identifying or expressing weaknesses or problems within treatment, which may be perceived as a lack of trust or an unwillingness to be open with counselors or fellow clients. Men are expected to be independent, self-sufficient, stoic, and invulnerable. The other considerations of which behavioral health service providers need to be mindful follow from an understanding of the factors that define masculinity and male roles in our society, which are discussed in Chapter 1. In treatment planning, consider approaches that have been found effective with men or with men who have particular characteristics (such as a high degree of anger)-these, too, are discussed in Chapter 5. Providers should also recognize the motivations that typically bring men to treatment (such as criminal justice system involvement, referrals from other behavioral health resources, and family or work-related pressures, discussed in Chapter 5) and the possible resentment of treatment staff that can result. Small adaptations can be made to improve treatment for men, such as ensuring that waiting rooms have decorations and reading material that appeal to men, and asking about client preferences regarding types of treatment (many men prefer more instrumental approaches, such as cognitive–behavioral therapy) and behavioral health service provider gender (see the discussion on therapist gender later in this chapter). As noted in Chapter 1, most clients in substance abuse treatment are male, and most research into treatment methods has used populations that reflect the composition of treatment programs. Many treatment approaches useful for men are the same that have been found useful for all clients.
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