Boys and men have historically been the focus of psychological research and practice as a normative referent for behavior rather than as gendered human beings (O’Neil & Renzulli, 2013; Smiler, 2004). In the past 30 years, researchers and theorists have placed greater emphasis on ecological and sociological factors influencing the psychology of boys and men, culminating in what has been termed the New Psychology of Men (Levant & Pollack, 1995). For instance, socialization for conforming to traditional masculinity ideology has been shown to limit males’ psychological development, constrain their behavior, result in gender role strain and gender role conflict (Pleck, 1981, 1995; O’Neil, 2008; O’Neil & Renzulli, 2013), and negatively influence mental health (e.g., O’Neil, 2008, 2013, 2015) and physical health (Courtenay, 2011; Gough & Robertson, 2017). Indeed, boys and men are overrepresented in a variety of psychological and social problems. For example, boys are disproportionately represented among schoolchildren with learning difficulties (e.g., lower standardized test scores) and behavior problems (e.g., bullying, school suspensions, aggression; Biederman et al., 2005; Centers for Disease Control and Prevention, 2015). Likewise, men are overrepresented in prisons, are more likely than women to commit violent crimes, and are at greatest risk of being a victim of violent crime (e.g., homicide, aggravated assault; Federal Bureau of Investigation, 2015).
Despite these problems, many boys and men do not receive the help they need (Addis & Mahalik, 2003; Hammer, Vogel, & Heimerdinger-Edwards, 2013; Knopf, Park, & Maulye, 2008). Research suggests that socialization practices that teach boys from an early age to be self-reliant, strong, and to minimize and manage their problems on their own (Pollack, 1995) yield adult men who are less willing to seek mental health treatment (Addis & Mahalik, 2003; Wong, Ho, Wang, & Miller, 2017). Further complicating their ability to receive help, many men report experiencing gender bias in therapy (Mahalik et al., 2012), which may impact diagnosis and treatment (Cochran & Rabinowitz, 2000). For instance, several studies have identified that men, despite being 4 times more likely than women to die of suicide worldwide (DeLeo et al., 2013), are less likely to be diagnosed with internalizing disorders such as depression, in part because internalizing disorders do not conform to traditional gender role stereotypes about men’s emotionality (for a review, see Addis, 2008). Instead, because of socialized tendencies to externalize emotional distress, boys and men may be more likely to be diagnosed with externalizing disorders (e.g., conduct disorder and substance use disorders) (Cochran & Rabinowitz, 2000). Indeed, therapists’ gender role stereotypes about boys’ externalizing behaviors may explain why boys are disproportionately diagnosed with ADHD compared to girls (Bruchmüller, Margaf, & Schneider, 2012). Other investigations have identified systemic gender bias toward adult men in psychotherapy (Mahalik et al., 2012) and in other helping services such as domestic abuse shelters (Douglas & Hines, 2011). Broader societal factors, such as the stigma of seeking psychological help, also negatively impact men’s help-seeking behaviors and the subsequent delivery of psychological services (Hammer et al., 2013; Mackenzie, Gekoski, & Knox, 2006; Mahalik et al., 2012).
In addition to specific mental health concerns and help-seeking behaviors, a combination of biological, social, and economic factors 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 orientation, or social class (Courtenay, 2011).
In summary, contemporary studies indicate that the physical 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 undergraduate or graduate levels (O’Neil & Renzulli, 2013), including multicultural 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 additional rationale are presented.
