Breaking Out of the Entrenched Pattern
The therapist’s ability to soothe some of the patient’s fears often produces an interest in goal-setting on the part of the patient. Dynamically, the patient is now ready to risk further disappointment in return for the prospect of self-satisfaction because he knows the therapist will be there to offer solace if he should stumble. In essence, the therapist’s empathic attunement provides a “safety net” to ensure that when the patient is let down, his feelings can be contained rather than subjected to a downward spiral.
Goal-setting must be handled with much caution and delicacy since it spurs action in one director or another. First it must be understood as both a catalyst for growth, and a potential resistance to growth. From a positive standpoint, defined and measurable goals are critical at certain points because men often need to see themselves as moving forward and “acquiring the masculinity” inherent in attaining each benchmark on their own “measuring stick.” But from a negative standpoint, goal-setting can function as fertile ground for self-defeating patterns and provide further evidence of not “measuring up.” Therefore, the therapist must anticipate how failure to meet one’s goal at any given point will be experienced as a general failure in the man’s quest for a masculine self.
For instance, one man with a history of childhood obesity recalled many painful memories of being teased for his ineptitude in sports and his weight. Food became a ready source of comfort when he was beleaguered by self-hatred and peer ridicule. Although he was no longer obese when he began therapy, the symbolic value of food remained the same: it comforted him when he felt unmanly. Due to his childhood experiences he saw a soft, uncontoured body and self-indulgent eating habits as less than manly.
In positing goals, he placed weight lifting/working out and maintaining disciplined nutrition as especially important for his sense of masculinity. His attainment of these goals brought enhanced self-esteem due to their masculine value to him. He soon expected himself to fulfill both goals on a daily basis, and as a further condition, he allowed no “cheating” in his diet and he implicitly instituted minimums upon his workout times. This eventually led to his daily moods becoming tied to his ability to satisfy the goals. When he was unable to satisfy one he became disillusioned, depressed, and disinterested in the goals. Clearly, his sense of masculinity became dictated by meeting the goals without any consideration to his circumstances, energy level, rewards, and other issues that impacted upon goal achievement.
When goals become subverted as they did in this case, the therapist must offer comfort, interpretation, and objectivity. First, the patient needs to know that his feelings count even if they arise out of unrealistic expectations. For example, “I see how weak you feel when you eat something rich in calories or don’t make it to the gym.” Next, the therapist needs to make clear that the patient is doing to himself what others did to him as a boy: imposing arbitrary conditions for masculinity. For instance, “When you judge yourself so strictly you are only allowing another form of submission into your life, but this time, it’s in the form of inflexible rules for masculinity.”
Richfield, S. A. (8 February 2008). The Treatment of Ego-Dystonic Homosexuality: The Development of a Masculine Self-Image., from http://narth.com/docs/richfield.html
