Original Article
Men In and Out of Treatment for Depression: Strategies for Improved Engagement
Zac E. Seidler,
Simon M. Rice,
John L. Oliffe,
Andrea S. Fogarty,
Haryana M. Dhillon,
Corresponding Author
Zac E. Seidler
School of Psychology, The University of Sydney
Correspondence: Zac E. Seidler, School of Psychology, The University of Sydney, Level 6 (North), Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.
Email: [email protected]
Search for more papers by this authorSimon M. Rice
Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne
Search for more papers by this authorJohn L. Oliffe
School of Nursing, University of British Columbia
Search for more papers by this authorAndrea S. Fogarty
Blackdog Institute, The University of New South Wales
Search for more papers by this authorHaryana M. Dhillon
Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney
Search for more papers by this authorZac E. Seidler,
Simon M. Rice,
John L. Oliffe,
Andrea S. Fogarty,
Haryana M. Dhillon,
Corresponding Author
Zac E. Seidler
School of Psychology, The University of Sydney
Correspondence: Zac E. Seidler, School of Psychology, The University of Sydney, Level 6 (North), Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.
Email: [email protected]
Search for more papers by this authorSimon M. Rice
Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne
Search for more papers by this authorJohn L. Oliffe
School of Nursing, University of British Columbia
Search for more papers by this authorAndrea S. Fogarty
Blackdog Institute, The University of New South Wales
Search for more papers by this authorHaryana M. Dhillon
Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney
Search for more papers by this authorAs a cross-institutional and cross-continental research team, the authors of this manuscript make up a unique mix of early, mid-career and long-time leading experts in the men's mental health field. This team was responsible for the first systematic review of the area and continues aiming for rigorous, innovative empirical contributions.
Abstract
Objective
While the prevalence of major depressive disorder continues to rise, many men are reticent to seek and sustain psychotherapy. The current study explored Australian men's experiences with treatment for depression with a view to guiding recommendations for improving treatment engagement.
Method
Twenty men (23–64 years) who had received psychotherapy for depressive symptoms in the past 3 years took part in individual, semi-structured interviews. Interviews were transcribed verbatim and coded in line with interpretive descriptive methodologies.
Results
Findings suggested men's preference for a transparent orientation to treatment, including the provision of a clear structure for therapy. Men's preferred structure included focusing on individualised goals and expected progress, establishment of trust, and a sharing of decisional control. Providing an action-oriented functional treatment with targeted skills attainment was recommended as most engaging. The focus on “doing” in treatment, as distinct from pure talk therapy, engendered feelings of strength and empowerment in the men, bridging self-management of symptoms and wellness. Most participants, however, did not receive a treatment style that properly engaged them, and articulated clear recommendations for changes needed.
Conclusions
Findings highlight the potential for development and dissemination of gender sensitive, strength-based clinical training and treatment options for better engaging men in psychotherapy for depression.
Supporting Information
| Filename | Description |
|---|---|
| ap12331-sup-0001-AppendixS1.docxWord 2007 document , 18 KB | Appendix S1. Qualitative Interview Schedule—Men with Depression Study. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. The American Psychologist, 58(1), 5–14. https://doi.org/10.1037
- Anderson, E., & McCormack, M. (2017). Inclusive masculinity theory: Overview, reflection and refinement. Journal of Gender Studies, 1–15. [EPub ahead of print]. https://doi.org/10.1080/09589236.2016.1245605
- Barbour, R. S. (2001). Checklists for improving rigour in qualitative research: A case of the tail wagging the dog? BMJ, 322(7294), 1115–1117.
- Beck, A. T. (1979). Cognitive therapy of depression. New York, NY: Guilford Press.
- Bedi, R. P., & Richards, M. (2011). What a man wants: The male perspective on therapeutic alliance formation. Psychotherapy, 48(4), 381–390. https://doi.org/10.1037/a0022424
- Berg, B. L., & Lune, H. (2004). Qualitative research methods for the social sciences. Boston, MA: Pearson.
- Boman, E. K. O., & Walker, G. A. (2010). Predictors of men's health care utilization. Psychology of Men & Masculinity, 11(2), 113–122. https://doi.org/10.1037/a0018461
- Bridges, T., & Pascoe, C. J. (2014). Hybrid masculinities: New directions in the sociology of men and masculinities. Sociology Compass, 8(3), 246–258. https://doi.org/10.1111/soc4.12134
10.1111/soc4.12134 Google Scholar
- Calear, A. L., Batterham, P. J., & Christensen, H. (2014). Predictors of help-seeking for suicidal ideation in the community: Risks and opportunities for public suicide prevention campaigns. Psychiatry Research, 219(3), 525–530. https://doi.org/10.1016/j.psychres.2014.06.027
- Charmaz, K., & Henwood, K. (2008). Grounded theory. In C. Willig & W. Stainton-Rogers (Eds.), The sage handbook of qualitative research in psychology. (pp. 240–259). Los Angeles, CA: Sage Publications.
10.4135/9781848607927.n14 Google Scholar
- Connell, R. (1995). Masculinities. Los Angeles, CA: University of California Press.
- Courtenay, W. H. (2000). Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science & Medicine (1982), 50(10), 1385–1401. https://doi.org/10.1016/S0277-9536(99)00390-1
- Creswell, J. W., & Miller, D. L. (2000). Determining validity in qualitative inquiry. Theory Into Practice, 39(3), 124–130. https://doi.org/10.1207/s15430421tip3903_2
- Curtin, S. C., Warner, M., & Hedegaard, H. (2016). Increase in suicide in the United States, 1999–2014. Hyattsville, MD: National Center for Health Statistics.
- Danielsson, U., & Johansson, E. E. (2005). Beyond weeping and crying: A gender analysis of expressions of depression. Scandinavian Journal of Primary Health Care, 23(3), 171–177. https://doi.org/10.1080/02813430510031315
- Dixon, L. B., Holoshitz, Y., & Nossel, I. (2016). Treatment engagement of individuals experiencing mental illness: Review and update. World Psychiatry, 15(1), 13–20. https://doi.org/10.1002/wps.20306
- Englar-Carlson, M. (2006). Masculine norms and the therapy process. In M. Englar-Carlson & M. A. Stevens (Eds.), In the room with men: A casebook of therapeutic change. (pp. 13–47). Washington, DC: American Psychological Association.
10.1037/11411-002 Google Scholar
- Englar-Carlson, M., & Kiselica, M. S. (2013). Affirming the strengths in men: A positive masculinity approach to assisting male clients. Journal of Counseling & Development, 91(4), 399–409. https://doi.org/10.1002/j.1556-6676.2013.00111.x
- Fusch, P. I., & Ness, L. R. (2015). Are we there yet? Data saturation in qualitative research. The Qualitative Report, 20(9), 1408–1416.
- Harding, C., & Fox, C. (2014). It's not about “Freudian couches and personality changing drugs”: An investigation into Men's mental health help-seeking enablers. American Journal of Men's Health, 9(6), 451–463. https://doi.org/10.1177/1557988314550194
- Harris, M. G., Diminic, S., Reavley, N., Baxter, A., Pirkis, J., & Whiteford, H. A. (2015). Males’ mental health disadvantage: An estimation of gender-specific changes in service utilisation for mental and substance use disorders in Australia. Australian & New Zealand Journal of Psychiatry, 49(9), 821–832. https://doi.org/10.1177/0004867415577434
- Johnson, J. L., Oliffe, J. L., Kelly, M. T., Galdas, P., & Ogrodniczuk, J. S. (2012). Men's discourses of help-seeking in the context of depression. Sociology of Health & Illness, 34(3), 345–361. https://doi.org/10.1111/j.1467-9566.2011.01372.x
- Kiselica, M. S., & Englar-Carlson, M. (2010). Identifying, affirming, and building upon male strengths: The positive psychology/positive masculinity model of psychotherapy with boys and men. Psychotherapy, 47(3), 276–287. https://doi.org/10.1037/a0021159
- Kivari, C. A., Oliffe, J. L., Borgen, W. A., & Westwood, M. J. (2016). No man left behind: Effectively engaging male military veterans in counseling. American Journal of Men's Health, 1–11. [Epub ahead of print]. https://doi.org/10.1177/1557988316630538
- Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 505–515. https://doi.org/10.3928/0048-5713-20020901-06
- Lizardi, D., & Stanley, B. (2010). Treatment engagement: A neglected aspect in the psychiatric care of suicidal patients. Psychiatric Services, 61(12), 1183–1191.
- Lorber, W., & Garcia, H. A. (2010). Not supposed to feel this: Traditional masculinity in psychotherapy with male veterans returning from Afghanistan and Iraq. Psychotherapy: Theory, Research, Practice, Training, 47(3), 296–305. https://doi.org/10.1037/a0021161
- Mahalik, J. R., Good, G. E., Tager, D., Levant, R. F., & Mackowiak, C. (2012). Developing a taxonomy of helpful and harmful practices for clinical work with boys and men. Journal of Counseling Psychology, 59(4), 591–603. https://doi.org/10.1037/a0030130
- Mansfield, A. K., Addis, M. E., & Courtenay, W. (2005). Measurement of Men's help seeking: Development and evaluation of the barriers to help seeking scale. Psychology of Men & Masculinity, 6(2), 95. http://dx.do.org/10.1037/1524-9220.6.2.95
10.1037/1524-9220.6.2.95 Google Scholar
- McKelley, R. A., & Rochlen, A. B. (2007). The practice of coaching: Exploring alternatives to therapy for counseling-resistant men. Psychology of Men & Masculinity, 8(1), 53–65. https://doi.org/10.1037/1524-9220.8.1.53
10.1037/1524-9220.8.1.53 Google Scholar
- Möller-Leimkühler, A. M. (2002). Barriers to help-seeking by men: A review of sociocultural and clinical literature with particular reference to depression. Journal of Affective Disorders, 71(1–3), 1–9. https://doi.org/10.1016/S0165-0327(01)00379-2
- Norcross, J. C., & Beutler, L. E. (1997). Determining the therapeutic relationship of choice in brief therapy. In J. N. Butcher (Ed.), Personality assessment in managed health care: Using the MMPI-2 in treatment planning. (pp. 42–60). New York, NY: Oxford University Press.
- Ogrodniczuk, J. S. (2006). Men, women, and their outcome in psychotherapy. Psychotherapy Research, 16(4), 453–462. https://doi.org/10.1080/10503300600590702
- Oliffe, J., & Mróz, L. (2005). Men interviewing men about health and illness: Ten lessons learned. The Journal of Men's Health & Gender, 2(2), 257–260. https://doi.org/10.1016/j.jmhg.2005.03.007
10.1016/j.jmhg.2005.03.007 Google Scholar
- Owen, J., Wong, Y. J., & Rodolfa, E. (2009). Empirical search for psychotherapists' gender competence in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 46(4), 448–458. https://doi.org/10.1037/a0017958
- Pederson, E. L., & Vogel, D. L. (2007). Male gender role conflict and willingness to seek counseling: Testing a mediation model on college-aged men. Journal of Counseling Psychology, 54(4), 373–384. https://doi.org/10.1037/0022-0167.54.4.373
- Primack, J. M., Addis, M. E., Syzdek, M., & Miller, I. W. (2010). The Men's stress workshop: A gender-sensitive treatment for depressed men. Cognitive and Behavioral Practice, 17(1), 77–87. http://doi.org/10.1016/j.cbpra.2009.07.002
- Rabinowitz, F. E., & Cochran, S. V. (2007). Men and depression: Implications for counselors. Counselling and Human Development, 40(1), 1–10.
- Rice, S. M., Aucote, H. M., Parker, A. G., Alvarez-jimenez, M., Filia, K. M., & Amminger, G. P. (2017). Men's perceived barriers to help seeking for depression: Longitudinal findings relative to symptom onset and duration. Journal of Health Psychology, 22(5), 529–536. https://doi.org/10.1177/1359105315605655
- Rice, S. M., Fallon, B. J., Aucote, H. M., & Möller-Leimkühler, A. M. (2013). Development and preliminary validation of the male depression risk scale: Furthering the assessment of depression in men. Journal of Affective Disorders, 151(3), 950–958. https://doi.org/10.1016/j.jad.2013.08.013
- Richards, M., & Bedi, R. P. (2015). Gaining perspective: How men describe incidents damaging the therapeutic alliance. Psychology of Men & Masculinity, 16(2), 170–182. https://doi.org/10.1037/a0036924
- River, J. (2016). Diverse and dynamic interactions: A model of suicidal mens help seeking as it relates to health services. American Journal of Men's Health, 1–10. [Epub ahead of print]. https://doi.org/10.1177/1557988316661486
- Robertson, J. M. (2001). Counseling men in college settings. In G. Good (Ed.), The new handbook of psychotherapy and counseling with men: A comprehensive guide to settings, problems, and treatment approaches. (Vol. 1 & 2, pp. 146–169). San Francisco, CA: Jossey-Bass.
- Seidler, Z., Rice, S., River, J., Oliffe, J., & Dhillon, H. (2017). Men's mental health: The case for a masculinities model. Journal of Men's Studies, 1–13. [Epub ahead of print]. https://doi.org/10.1177/1060826517729406
- Seidler, Z. E., Dawes, A. J., Rice, S., Oliffe, J. L., & Dhillon, M. (2016). The role of masculinity in men's help-seeking for depression: A systematic review. Clinical Psychology Review, 49, 106–118. https://doi.org/10.1016
- Seymour-Smith, S., Wetherell, M., & Phoenix, A. (2002). “My wife ordered me to come!” a discursive analysis of doctors’ and nurses’ accounts of men's use of general practitioners. Journal of Health Psychology, 7, 253–267. https://doi.org/10.1177/1359105302007003220
- Silverman, D. (2013). Doing qualitative research: A practical handbook. London, England: Sage Publications.
- Sloan, C., Gough, B., & Conner, M. (2010). Healthy masculinities? How ostensibly healthy men talk about lifestyle, health and gender. Psychology & Health, 25(7), 783–803. https://doi.org/10.1080/08870440902883204
- Thorne, S., Kirkham, S. R., & O'Flynn-Magee, K. (2004). The analytic challenge in interpretive description. International Journal of Qualitative Methods, 3(1), 1–11.
10.1177/160940690400300101 Google Scholar
- Thorne, S. E. (2016). Interpretive description. New York, NY: Routledge.
10.4324/9781315426259 Google Scholar
- Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
- Westwood, M. J., & Black, T. G. (2012). Introduction to the. Canadian Journal of Counselling and Psychotherapy, 46(4), 285–291 Special issue of the counseling et de psychothérapie.
- Wexler, D. (2013). Why men fear therapy. Psychotherapy in Australia, 20(1), 1–12.
