PROCESS

Male Emotional Intimacy: How Therapeutic Men’s

Groups Can Enhance Couples Therapy
ROBERT GARFIELD, M.D. n

To read this article in Spanish, please see this article’s Supporting Information on Wiley
InterScience (http://interscience.wiley.com/journal/famp). To read this article’s abstract in
both Spanish and Mandarin Chinese, please visit the article’s full-text page on Wiley
InterScience.

Men’s difficulty with emotional intimacy is a problem that therapists regularly en-
counter in working with heterosexual couples in therapy. The first part of this article
describes historical and cultural factors that contribute to this dilemma in men’s
marriages and same-sex friendships. Therapeutic men’s groups can provide a correc-
tive experience for men, helping them to develop emotional intimacy skills while aug-
menting their work in couples therapy. A model for such groups is presented, including
guidelines for referral, screening, and collaboration with other therapists. Our thera-
peutic approach encourages relationship-based learning through direct emotional ex-
pression and supportive feedback. We emphasize the development of friendship skills,
core attributes of friendship (connection, communication, commitment, and coopera-
tion) that contribute to emotional intimacy in men’s relationships. Case examples are
included to illustrate how this model works in clinical practice, as well as specific
suggestions for further study that could lead to a more evidence-based practice.

Keywords: Emotional intimacy; Men’s groups; Couples therapy; Men’s friendship

Fam Proc 49:109–122, 2010

John doesn’t really have any friends. He has people he gets together withFevery so
oftenFto play golf with, things like that. But I don’t think he talks to any of these men. I
mean about things that really matter. I’m probably the person he talks to most. He says I’m
his best friend. But, honestly, we don’t talk very much at all. (Wife, in couples therapy)

INTRODUCTION

H ow to engage men in couples therapy and successfully address their resistances

to therapy is an ongoing dilemma for therapists in clinical practice. Men in our
n
191 Presidential Blvd., Suite W-10, Bala Cynwyd, PA.
The author wishes to acknowledge Jake Kriger, MSS, for his support as co-therapist and in the
development of our men’s groups. Also, Sandra Whipple, M.D., and Ellen Berman, M.D., for reading and
editing all the drafts of this paper.
Correspondence concerning this article should be addressed to Robert Garfield, 191 Presidential
Blvd., Suite W-10, Bala Cynwyd, PA 19004. E-mail: robgar1@comcast.net

109
Family Process, Vol. 49, No. 1, 2010 r FPI, Inc.
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1
culture are often reluctant to participate in psychotherapy of any kind (Addis & Mahalik,
2003; Brooks, 1998; Good, Dell, & Mintz, 1989). This is often attributed to a conflict
that men experience between values related to emotional intimacy, associated with
the therapeutic process, and those values associated with our dominant cultural
norms that define masculinity. The former are represented in behaviors such as emotional
expressiveness, self-disclosure, vulnerability, giving and getting support, letting go of
control, cooperation, and reciprocity, while the latter are indicated by emotional restraint,
withholding, self-sufficiency, achievement, taking control, competition, and autonomy
(Brod, 1987; Brooks, 1998; Levant & Pollack, 1995; Meth & Pasick, 1990).
This conflict also surfaces in men’s friendships with other men: While men express
desire for close relationships with other men, they often avoid pursuing them (Fehr,
1996). Bank and Hansford (2000) found that emotional restraint, homophobia, and low
status for close male friendships, all dominant masculine values in our culture, signifi-
cantly mediated against both intimacy and emotional support in men’s relationships
with each other. Traditional ‘‘masculine identity’’ traits, in particular, the authors
found, reduced the likelihood of intimacy occurring in men’s friendships. After reviewing
the research literature, Fehr noted that while men were capable of intimate communi-
cation, they more often chose not to have this with other men, while complaining about
this situation. Echoing this finding, men in our groups often lament that there are not
‘‘guys out there’’ who really want to be close to them, and yet, admit that they take no
initiative to reach out to these ‘‘other guys’’ as prospective friends.
This ambivalence in men often requires couples therapists to adjust their approach in
order to establish an equitable therapeutic alliance with both partners. Men often enter
therapy feeling deficient in ‘‘relational power’’ or the ability to exert their influence within
the context of an intimate interpersonal relationship (Blanton & Vandergriff-Avery, 2001).
Bourgeois, Sabourin, and Wright (1990) and Symonds and Horvath (2004) found that the
strength of the male partner’s alliance with the therapist, as well as the improvement of
this alliance over time (Symonds & Horvath, 2004), more than the female partner’s
alliance, was an important determinant of positive outcome in the therapy. Particular
interventions have been suggested to reinforce male partners’ engagement in couples
therapy (Garfield, 2004). Emotional resistances around time, money, and work schedules
often require greater attention in order to successfully engage male partners in therapy.
In this paper I will first discuss historical and cultural factors that contribute to
men’s difficulties with emotional intimacy in heterosexual marriages and same-sex
friendships and the challenges these pose for couples therapists. Therapeutic men’s
groups that focus on developing friendship skills can provide a corrective experience
for men facing this dilemma, and help redefine a positive male identity that better
serves their emotional health, while augmenting their work in couples therapy. This
paper describes the principles and core components of our model, as well as case ex-
amples illustrating how it works in clinical practice. Specific suggestions for further
study that could lead to a more evidence-based practice are mentioned.

MALE EMOTIONAL INTIMACY: HISTORICAL INFLUENCES

Reviewing historical trends can help us better understand the struggles men face
with emotional intimacy in their marriages and same sex friendships today. Beginning
1
The men referred to in this article, except when otherwise indicated, are heterosexual men.
Similarly, ‘marriage’ will indicate heterosexual marriage.

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with the Enlightenment, and later the Industrial Revolution in 18th Century Europe
and the United States, a new sense of freedom celebrating reason and the emotional
well-being of individuals emerged. Before this period, according to Stone (1977),
family relationships had been less friendly, more utilitarian based, and men and
women lived in separate social spheres (Rosenberg-Smith, 1986). Intense romantic
(though not necessarily sexual) same-sex friendships between both men and women
flourished briefly during this era, as a response to the new emotional freedom (Crain,
2001; Faderman, 1981).
By the middle of the 19th Century, however, Victorian moral concerns, pseudo-
scientific writings, and changing economic forces had begun to redefine the relation-
ships between men and women in more restrictive ways. Two new social paradigms,
the ‘‘doctrine of separate spheres’’ (described in Ruskin, 1864) based on rigid gender
role complementarities between the sexes, as well as the ‘‘companionate marriage,’’ a
new, idealized prototype for couples, based on exclusivity, equality, romantic love, and
close friendship, became defining guidelines for men’s and women’s relationships.
These paradigms powerfully shaped gender role expectations in many ways that
continue for couples today. In their ‘‘separate sphere,’’ women were expected to
function as spiritual and emotional guides for their families, while remaining outside
of the public domain. Men, on the other hand, were encouraged to focus on autono-
mous pursuits, as providers, outside of the home, leaving the responsibility for their
emotional relationships and domestic responsibilities to their wives. They were also
encouraged to avoid or mistrust strong emotions, which could be interpreted as
weakness or ‘‘moral depravity’’ (e.g., homosexual or lustful desire) (Rosenberg, 1973,
p. 137).
Secondly, the companionate marriage’s focus on exclusivity resulted in couples’
same-sex friendships and extended family relationships becoming marginalized. Wo-
men’s friendships with other women were preserved in order to provide collective
support for their families and for themselves around stress that occurred in their
marriages (Oliker, 1989). Men, on the other hand, discouraged from pursuing close
relationships outside of their families, provided and received little emotional support
from other relationships.
The influence of feminism and the sexual revolution has altered some of these re-
strictive mores over the past century. Sherrod (1987), however, points out that their
influence, particularly around emotional restraint and intimacy in men, continues in
the modern socialization practices of the family, and deeper, in the psychological
dynamics that men and women present today in their individual and marital conflicts.

The Case of John and Linda

John and Linda came to therapy two months after discovering that an old friend of
John’s, Sam, had died of cancer. In their phone conversations prior to his death, Sam
had never mentioned the cancer to John.
After Sam’s funeral, John had initially been quiet and removed. Over the past
month, however, he had begun to get irritable, to drink in excess, and had even
threatened Linda, physicallyFto both their dismay. In therapy, he revealed that he’d
been deeply disturbed about his friend’s death and hadn’t been able to talk about these
feelings.

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John and Sam had been inseparable chums during childhood. While their contact
had become more sporadic over the years, John reflected sadly, these contacts had been
meaningful to him. Linda gently suggested, ‘‘Yes, that’s true. But I had to remind you
when you hadn’t spoken for months. You would just forget. . . . Could that be what’s
bothering you?’’ The therapist helped John understand that his irritability had covered
over intense feelings of grief, and also, perhaps, anger with himself for being oblivious
to his friend’s suffering, all of which had spilled over into their marriage.
Many men like John long for closeness and honesty in their relationships. However,
they avoid (as did both John and Sam) taking responsibility for nurturing emotional
intimacy in their relationships, and rely on their wives or female partners, generally,
to ‘‘do the heavy lifting’’ for them. Their friendships with other men from childhood
and youth often fail to thrive as they let these go because of the demands of work,
marriage, and parenting. The friendships they do maintain often become emotionally
shallow because they are not sufficiently nurtured. With these restrictions, couples
therapists often find it a daunting task to get men to take on their share of emotional
responsibility in therapy for marital problems as well as their friendships with
other men.

A CULTURE OF MASCULINITIES
Cultural expectations play a critical role for men in terms of the problems they
struggle with in therapy. Dominant, or hegemonic representations of gender and
masculinity always coexist along with alternative forms in every society. Men and
women, in actuality, do not strictly conform to any one particular model, any one
specific set of traits or behaviors that define their gender. Thus, as Brod (1987) sug-
gests, we live in a culture of ‘‘masculinities’’ (or ‘‘femininities’’) in which each person
expresses their gender in a unique way, as a blend of mainstream traits along with
alternative features or behaviors that give their maleness or femaleness its own un-
ique character. Moreover, expectations about masculine (and feminine) behavior vary
across cultures, over an individual’s life cycle, and, as mentioned earlier, evolve his-
torically as well.
Therapists, in general, can help their male patients become aware that while ad-
herence to ‘‘masculine ideology,’’ or mainstream male values can indeed provide an
opportunity for identification, communication, and bonding with other men, it can
also contribute to their alienation and suffering. In his theory of ‘‘gender role strain,’’
Pleck (1995) asserts that culturally prescribed gender roles are often psychologically
dysfunctional for men. Even though these roles are inconsistently followed, he adds,
painful consequences and social condemnation, can result when men violate them. A
common example of this can occur when a man feels that the emotional expectations
in his marriage or from his cultural heritage seem to be in conflict with the expected
masculine attitudes and behaviors that prevail in his workplace environment.

The Case of Angelo and Marie

When Angelo was promoted to a management position in his automotive repair/parts
company, he began to appear depressed, but wouldn’t speak about it. His wife, Marie,
expressed disappointment that this ‘‘wonderfully open Italian guy’’ that she’d married
had become withdrawn and sullen. She wondered if he were having an affair.

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Angelo was from a working class Italian family. His father, whom he loved very
much, was born in Italy and had constantly complained during Angelo’s childhood
that he couldn’t succeed at work because of his heavy Italian accent and because ‘‘he
wore his heart on his sleeve.’’ Angelo had demonstrated an aptitude for academic
studies in college, but dropped out when he married Marie, to take a job with this
company ‘‘for financial reasons.’’ He had moved up in the system quickly because of his
intelligence and hard work ethic.
In therapy, Angelo reluctantly admitted he felt intimidated and unsophisticated
around the other managers. He worried that theyFas well as his wifeFwere ulti-
mately going to discover that he was a ‘‘fraud’’ and didn’t deserve the position, or the
esteem that they had granted him. He was clearly tense and angry about these thoughts.
Finally, Marie got him to laugh in a session, saying, ‘‘So what if you don’t talk about
opera with these guys. None of them can curse in Italian half as good as you.’’ As he
started to relax, Angelo began to feel less anxious about his self worth, understand the
origins of his anxiety, and was able to reconnect emotionally with Marie.
Men such as Angelo often encounter stress around ethnicity and class values in
their marriage and work life as they move up the socioeconomic ladder into higher-
level positions in society. These experiences can also trigger family loyalty issues, such
as Angelo’s reconciling his own success, his ethnic and working class values, with his
father’s failure to integrate socially and emotionally into a new culture. Under these
circumstances a man may shut down emotionally, as Angelo did.
Cohen (1992) and Franklin (1992) observed, respectively, that working class White
and African-American men were more accessible to each other in their friendships
than were their middle-class counterparts. Emotional intimacy, according to Frank-
lin, could be preserved, because ‘‘working class black males experience greater iso-
lation from mainstream society than upwardly mobile black men, (and) may not
internalize the same taboos against male same sex friendships, which result in non-
self disclosure, competitiveness, and non-vulnerability’’ (p. 203).
Similarly, intimacy in gay men’s relationships may find protection in its distance
from mainstream male values: Peter Nardi (1992) observes that while gay relation-
ships often follow the traditional masculine path of pursuing sex as a means to inti-
macy, when these relationships do not develop as primary love interests, gay men are
often more easily able to continue them as emotionally intimate friendships.
In most situations, however, men, including men who do not share Angelo’s obvious
class and ethnic differences, tend to become more emotionally restricted as they
achieve educational and economic success, and acquire more power and prestige in
society. Even though they are lonely and unhappy, they are often resistant to learning
and adopting emotional intimacy skills when they enter couples therapy.

INTIMACY SKILLS AND THERAPEUTIC MEN’S GROUPS

Therapeutic men’s groups can be a valuable resource for men who struggle with
traditional male role behaviors and emotional intimacy in their marriage and
friendships. Successful therapy for these men must help them redefine ‘‘healthy
masculinity’’ with an increased status for emotional intimacy behaviors. Gender-aware
couples therapists have done much to help both partners realize how culturally based
stereotypes interfere in their relationships (Rampage, 2002). Many new techniques to
improve emotional intimacy skills have been added to these therapies. When progress

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stalls or an impasse arises around intimate communication, however, therapeutic

men’s groups can help to catalyze or revive this process in men’s therapies.

HISTORY OF MEN’S GROUPS

Beginning in the 1970s, men’s consciousness-raising (CR) groups formed in soli-
darity with the woman’s liberation movement. They developed to help men address
problems related to stereotyped gender roles, privilege, and power, and to explore
nontraditional, egalitarian modes of communication and role behaviors in their re-
lationships (Farrell, 1974; Goldberg, 1976).
In the 1990s, the men’s Mythopoetic Movement, spearheaded by the poet Robert
Bly (1990), originated to help men express themselves more fully by connecting with
primitive archetypal images around masculinity. Their groups attempted to help men
find renewed emotional energy and deeper connections with other men, as well as to
overcome what was seen as a passive response to feminism.
More recently religious and social organizations, such as the Promise Keepers and
the National Congress for Men, have called for a unification of men around issues of
parenting and family commitment, as well as legal issues around child support and
custody. Other groups have focused on helping men resolve violence or addiction-re-
lated behaviors (men’s recovery groups) as well as injury related to physical or sexual
abuse.
Today, we believe, the most important task for men’s groups is to address the neg-
ative impact of gender role stereotypes on emotional intimacy in men’s marriages and
their friendships with other men. The relationally oriented therapeutic approach de-
scribed below is our attempt to meet this challenge.

ORGANIZATION AND STRUCTURE OF OUR MEN’S GROUPS

We have been running men’s groups for 13 years, and have worked with over 100
men during this time. Our group members are generally White, upper-middle class,
heterosexual men from professional backgrounds. Most are successful in their careers,
but seek help because of relationship problems, feelings of loneliness, and disaffection
from important others. We usually run two groups concurrently, with 6 to 8 men per
group. They meet every other week in the evening and run throughout the year with a
break in the summer. Our groups are run by a male co-therapist team.
Referrals: Many of our men are referred by therapists who see them in couples or
individual therapy. We also advertise in a quarterly newsletter that describes our
groups. Because we have a reputation for helping men work on emotional intimacy
issues and are eager to collaborate, therapists will often suggest that male patients
contact us for additional or conjoint work. This happens when the man reports or
demonstrates difficulties with emotional intimacy in his relationships with others,
generally his primary female partner.
Screening Interview: Before a man is accepted into the group, he meets
with both co-therapists, who provide him with an overview of the experience, and
assess whether he would be a ‘‘good fit’’ in the group. Most men understand that our
groups focus on emotional intimacy skills, but sometimes the man discovers that his
interests do not match with the group’s. In some situations, when a man presents with
an undiagnosed or untreated psychiatric problem (drug addiction, bipolar disorder,
depression), we will suggest that he get appropriate treatment elsewhere.

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Collaboration with Other Therapists: Collaboration with other therapists is an
extremely important aspect of our work with men. If a man is accepted into our
groups, we ask his permission to confer with other therapists who are involved in his
treatment. Speaking with other therapists allows us to better help a man articulate
and get support from the group about a difficult emotional issue he faces, such as one
he might have in his marriage. He can then go back to couples therapy and address
this issue in a more positive way. Sensitivity to boundaries, what is permissible to
share or not between therapists, is an important aspect of collaboration, and must
always involve the man’s participation. We have found that this process helps to model
positive intimacy-related skills for our men.
Collaboration also provides therapists with different perspectives on their clients
and the opportunity to reinforce healthy new behaviors. Another benefit is avoiding
splitting and triangulation that can occur when clients are involved in multiple
therapies (Berman, 2008; Garfield, 2004).

THERAPEUTIC ORIENTATION
Our groups emphasize relationship-based learning through direct emotional ex-
pression and supportive feedback. We encourage men to think about how women to-
day feel, and how their own gender-stereotyped assumptions may interact with those
of women and other men to impede the development of intimacy in these relation-
ships. We encourage them to try out new ways of responding in these relationships.
Our groups provide many experiences that psychotherapy groups in general offer,
including universality, group cohesiveness, imparting information, altruism, and in-
terpersonal learning (Yalom, 2005). We relax certain traditional restrictions, for ex-
ample, around participants meeting outside of the group socially, or calling each other
between sessions. These initiatives help men to overcome culturally based stereotypes
about reaching out to each other, to give and get emotional support. When men make
contact with each other outside of the groups, we ask them to communicate important
emotional issues they discuss back in the group.

FRIENDSHIP SKILL DEVELOPMENT

We have found that the capacity for emotional intimacy in men is best fostered
through their development of friendship skills. Close friendship is considered to be
one of the most-valued relationships in our culture (Fehr, 1996). Because friendship is
viewed both as a free-standing relationship, as well as an important aspect of other
relationships (e.g., marriage, family, and work), we have found that friendship skills
tend to promote intimacy in a wide variety of relationships, including heterosexual
marriages as well as same-sex friendships.
While both men and women agree in principle that trust and emotional intimacy
are critical in developing close friendships (Fehr, 1996; Pahl, 2000), women have been
better able to integrate this feature into their friendship practices (Oliker, 1989), for
reasons discussed earlier in this paper.
Enduring friendships often develop between men in our groups; whether or not this
happens, however, our primary objective is to help men learn how to have them, to
develop friendship skills that enable them to better relate to others, and care for
themselves both physically and emotionally.

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Core Attributes of Friendship and Emotional Intimacy

Core attributes of friendship have been described in the writings of Fehr, as well as
Adams and Blieszner (1992). Many of these have been identified as behaviors asso-
ciated with emotional intimacy, described earlier in this paper. They include the
discovery of commonalities, emotional expressiveness, self-disclosure, and vulnera-
bility, giving and taking support, cooperation, letting go of control, and reciprocity.
From the above, we have identified four important aspects of friendship that men
struggle with today: (1) Connection (finding common emotional ground with others);
(2) Communication (sharing feelings, establishing safety, and developing emotional
competence); (3) Commitment (forming meaningful loyalty bonds); and (4) Coopera-
tion (sharing power/establishing flexible authority). These issues arise often with men
during the process of our sessions. When they do, we try to identify them and may
introduce particular structured exercises that provide opportunities for them to better
address them.
(1) Connection: finding common emotional ground:
Friendship research tells us that people are drawn to each other because of
important similarities in their lives (Adams & Blieszner, 1992).
Men in our groups identify with each other more readily through their professional
accomplishments, educational and socioeconomic status, than through the common
emotional struggles they face.
We attempt to help men develop deeper connections through structured exercises
and discussions. We focus on their relationships with their fathers, boyhood messages
about being a successful man, strengths and weaknesses in one’s role as a husband,
and challenges of being a father and a working parent. We also consider their rela-
tionship to sex and money. These connections often help them to better address
problems in their marriages.

The Case of Wally

Wally was referred to our group by his couples therapist, who described him as
‘‘having advanced the skills of passive-aggressiveness to the level of a new art form.’’
Wally was a successful corporate lawyer, married twice previously and left twice by
former wives. While he was highly regarded by professional colleagues, he was con-
stantly in trouble with his wife and children because he so often failed to follow through
on promises he made to them.
Wally confessed that he agreed to ‘‘go along to get along,’’ but he never followed
through on what he really didn’t want to do. Though he rarely described these episodes
in the group, his couples therapist reported to us that when his wife confronted him, he
would typically complain that he was tired, start drinking, and throw a temper tan-
trum. These worked to temporarily deter his wife, but always resulted in her eventually
increasing her complaints. He had grown up in a household where his parents fought
constantly, and his father dealt with his mother’s disappointment by being around the
house as little as possible.
During a structured exercise on the topic of marriage in which each man is asked to
describe how he is (or is not) succeeding in his role as a husband, Wally announced that
he felt tremendous relief hearing that other men had feelings of intimidation around
their wives. ‘‘I’m not the only one that gets picked on.’’ When we encouraged him to ask
one of the more experienced men in the group how he’d handled his situation, he was

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stunned to hear the man say, ‘‘I’ve had to look at why my behaviors piss my wife off and
why I’m not holding up my end of the bargain.’’ It was the first time he’d solicited and
received constructive feedback from another man about his marital problems.
After a number of months of group work, the couples therapist reported that Wally’s
attitude had started to change. In a session, when his wife, Carol, pressed him for long-
overdue information about dates for a family vacation, Wally, usually evasive, an-
swered her directly: ‘‘I know I’ve been stalling.’’ He continued, with some frustration,
‘‘I don’t want to fight with you and the kids. I just can’t see spending all that money on
a vacation now.’’ He was clearly uncomfortable, but his wife was able, for once, to
calmly discuss with him his concerns about their financial situation. The therapist
complimented Wally on his directness. She had been pushing him for some time to be
more forthcoming. He smiled, sheepishly, and said, ‘‘The guys in the men’s group have
been all over me about how I try to get around Carol. I guess I need to stop running
away.’’ Carol responded positively to his honesty and their conversations became more
productive. Over time the couples therapist was able to help them establish a more
genuine emotional connection in their marriage.
(2) Communication: sharing feelings, establishing safety, and developing
emotional competence:
The ability to share feelings in an atmosphere of safety is essential if men are to be
able to develop intimate friendships and trust in relationships. In our groups, we help
men develop emotional competency by encouraging emotional expressiveness, self-
disclosure, vulnerability, and honest feedback in their communication with each
other.
We insist on confidentiality outside and respectful sharing inside the group to create
an atmosphere of safety. Our men agree that they will not repeat what is discussed in
the group with anyone outside, even with intimate partners. If they wish to share their
own experience with a partner, it is at their discretion.
Within the group, we encourage men to express their feelings openly and to respond
to each other genuinely. We teach communication skills that focus on ‘‘I’’ statements,
taking responsibility for what one says, and immediate feeling responses (versus
problem-solving or intellectual analysis). Expressing genuine affection and empathy is
encouraged. We discourage ‘‘innocent’’ put-downs, dismissals, and jokes at another
man’s expense. Men will often put up with this kind of banter; but they will not open
up when it is going on.
In a communication exercise focused on emotional sending and feedback, one of the
men was asked to share his feelings with another whose wife had just been diagnosed
with a severe type of cancer. In these exercises we ask men to focus primarily on the
feeling component of their response, rather than the cognitive or problem-solving as-
pect. Nonetheless, this man responded with a long-winded, intellectual analysis of the
survival rates of patients with this kind of cancer. The man whose wife was ill was
clearly disturbed by the remark. ‘‘How about saying, ‘I feel bad about your wife’s ill-
ness,’ he said. ‘That’s not the kind of response that comforts a man in pain.’’ Each man
learned something from the other: the first, that flaunting his intellectual expertise
could come across as emotionally insensitive, and the other, that he could speak up
when he was hurt.
We call upon men who have difficulty with anger and self-control to talk about
(rather than act out) these feelings in the group. Sensitive and compassionate feed-
back from other men often helps them to handle their feelings more appropriately.

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Anger management programs are sometimes recommended. This can provide a sig-
nificant component of healing for men who have suffered physical and emotional
abuse earlier in their lives.
We emphasize that emotional competence involves hard work and that the group’s
collective effort promotes the individual member’s growth and vice-versa. It does not
take long for men in our groups to appreciate these concepts: Emotional skills that had
formerly been dismissed as ‘‘female’’ or avoided altogether become a real part of their
curriculum. They learn from experience just how difficult these are to master.
(3) Commitment: forming meaningful loyalty bonds:
Men want friends they can count on, who will ‘‘‘cover their back’’ when they face
hard times and in whom they can confide. Loyalty traditionally evokes images of men
bonding under duress, for example, during wartime or in sporting events, to overcome
an adversary.
In today’s culture, where individuality and ‘‘going it alone’’ are highly prized, men
are often hard pressed to find ways to show support and genuine caring for each other.
Their loyalty is most often reserved for their families or their workplace, and is pri-
marily aimed at proving their worthiness to others.
Within our groups, we promote a different kind of loyalty, one that calls upon men to
look out for each other in health and everyday lifeFnot just in times of adversity or
war. We define self-care as an important value in our groups, and encourage men to
support each other in these efforts. Men often ignore their physical or emotional
needs, and rely on their female partners to call these issues to their attention.
We strongly encourage regular attendance at our meetings and members calling
each other or getting together outside the group, especially if they have missed a
group. Taking initiative to call a man about whom one is concerned or just feeling out
of touch often feels risky to men. They may fear that this desire for contact will be
interpreted as weakness, intrusion, or even as a homosexual advance.
We periodically do a ‘‘Reaching Out’’ exercise, in which we ask the men to call or
make a brief social date with another man in the group to get together outside of the
group. This exercise is more of a challenge than most of the men imagine. Reaching
out to another man for purely social reasons raises many resistances, including ho-
mophobic attitudes. Discussing this exercise provides an opportunity for these
straight men to acknowledge their desire to care for and be cared for emotionally by
other men. It also gives them permission to identify with and appreciate gay men’s
desire for intimacy with each other, even without the sexual component. We reframe
this behavior as caring for oneself and honoring the other man’s importance.

The Case of Bob

Bob was an entrepreneur who was referred to our group by his couples therapist. He
presented with symptoms of depression, which began shortly after his aging mother
had moved in with his family. Tension began to mount, with increasing verbal fights
between Bob and his wife. The couple’s therapist thought Bob needed additional work
with our group.
Bob was a large, expansive character, who was able to connect with men in the group
quickly. He had a strong, usually empathic and positive, opinion about everyone. He
often overwhelmed people with his commentary, but was mostly liked by the group
members.

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When it came to feeling loved and cared for, however, particularly by his wife and
children, Bob was bitterly disappointed. ‘‘My wife has always been limited in being able
to show love. Since my mother has moved in, she’s been worse than useless. I have to
take care of my mother all by myself!’’ The couples therapist reported to us that Bob’s
wife was a shy person who did struggle to assert herself, but that Bob managed to
consistently dismiss her genuinely caring efforts.
History revealed that Bob was a highly responsive, but overburdened child, who had
been recruited by his mother to be her confidante during her lonely marriage to Bob’s
father, an inaccessible alcoholic. When the group discovered that most of Bob’s rela-
tionships were characterized by over-giving on his part, coupled with inevitable dis-
appointment and anger, several members began to point out to him how he had
managed to block letting people care for him. For a long while, Bob dismissed these
observations.
During one session, Bob casually reported that he would miss the next group because
he would be out for hip replacement surgery. Asked how long he had known about this,
he replied ‘‘Oh, several months. But it’s no big deal. I haven’t even told my wife the date
(of surgery) yet.’’ ‘‘Yet,’’ was two weeks away. Several group members’ eyes popped open
at this revelation. They unanimously urged him to tell his wife when he got home. The
therapists also insisted that he discuss this with their couples therapist in the next
session before the surgery.
After the meeting, a number of the men organized a schedule of visits to Bob while he
was recovering in the hospital. They also continued to visit him when he came home.
When Bob and his wife returned to couples therapy several weeks later, the therapist
noticed that Bob’s attitude toward his wife had changed. He seemed sad when he de-
scribed the attention he’d received from the men in the group. His wife reported, ‘‘He
was a lot happier when they visited.’’ Then she added, wistfully, ‘‘He’s never that
happy with me. Even when I help him with his mother.’’ Bob sighed, frustrated, ‘‘She’s
right. I can’t seem to let her in. To give her credit for the good things she does for me.
The guys in my group keep asking me why.’’ The therapist seized on this opportunity to
talk with Bob about his lost opportunity for dependency during childhood, the painful
feelings triggered by his mother’s stay, and how all of this had translated into his
critical relationship with his wife. These conversations led to a gradual relaxing of the
marital tension and Bob’s increased positive acknowledgement of his wife’s caring for
him.
(4) Cooperation: sharing power/establishing flexible authority:
Mutual respect, a sense of equality, and the ability to manage conflict and com-
petitive feelings are critical ingredients in a close friendship. The men in our groups
often function in leadership roles at home and in the workplace, and are routinely
asked to make important decisions. Social expectations about maintaining power and
control, however, often make them reluctant to share authority or ask for help from
others. While they may advocate egalitarian values, they struggle about giving up
control in their relationships with other men as well as in their marriages.
We try to help men become secure with their own authority, while learning to share
power and address conflicts when these arise in their relationships When we sense
that there is unspoken tension or competition between men in the group, we often
introduce the topic of competition and sharing, which gives the men a chance to ac-
knowledge these feelings. We frame these conflicts as the responsibility of the entire
group, because when they go unaddressed everyone is affected.

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When a new man joined the group, an older member became competitive with him,
and began pointedly challenging his opinions. The riposte that developed between
the two felt childish and distracting to the other group members. After a few sessions,
one member observed, ‘‘You two seem like siblings squabbling over who’s the favorite
child.’’ One of the rivals, taken aback by the remark, said, ‘‘Well if you had a brother
like I had, you’d understand.’’ His counterpart, surprised, said,’’ Did you have one of
those brothers, too?’’ Both men were enlightened to discover that their competition had
roots in each of their unresolved conflicts with dominant older siblings. With this
recognition, their scurrilous battles ceased, and over time they developed a friendly
admiration for each other.

THE ROLE OF THE CO-THERAPISTS

In our groups, we model flexible authority through our roles as co-leaders, in which
we function both as facilitators and, at times, participants. We assume responsibility
for determining the structure of sessions and for monitoring the group process; yet, we
also share our own personal experiences when we believe these might contribute to
the group’s progress. Moreover, as our groups mature, we often invite members to
participate more in decisions regarding their own process. A co-therapy leadership
model also allows us to provide each other with emotional support, to share different
clinical perspectives, and to challenge each other in our work.
As co-therapists, we meet after every group, as well as between sessions, to discuss
the men and their group’s dynamics. We have found that the men are touched by this
ritual. Our discussing and thinking about them outside of therapy indicates to them a
form of caring, or, as one group member described, ‘‘a way that men can hold other
men, other people, in their heads.’’ It is precisely this kind of caring that we hope to
instill in them about themselves, each other, and the important relationships in their
lives.

CONCLUSIONS
Therapeutic men’s groups can help facilitate the development of emotional inti-
macy skills in men who experience conflict around traditional male role behaviors.
These conflicts are rooted in historical and cultural expectations about masculinity
that often do not fully represent (or may even run contrary to) a man’s genuine
emotional experience. Men’s groups can help by legitimizing emotional intimacy be-
havior as an essential component of healthy masculinity. Developing intimacy-related
friendship skills can help men become emotionally proactive in their marriages and
reinforce this goal in their ongoing couples therapy. Close male friendships can be a
valuable resource for men for their own personal health and in supporting intimacy in
their marriages.
The continued development of men’s group models and studies that evaluate their
efficacy would be of great value for both clinicians and researchers toward building
more evidence-based practices.
These studies would aid therapists to better help men develop emotional intimacy
skills in their marriages and friendships with other men.
Further steps here might include (1) assessing the applicability of existing scales
that measure individual and couples intimacy (such as the EIS [Sinclair & Dowdy,
2005] or PAIR [Shaefer & Olson, 1981]), that can be used to determine outcome in

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these studies; (2) identifying, refining, and evaluating particular interventions and
exercises used to promote emotional intimacy in men’s groups; (3) determining
whether alternative interventions are needed to help men from different cultural
backgrounds achieve the same outcomes. The observations of Arcaya (1996), Sutton
(1996), and Sue (1996), who have written, respectively, about Latino, African-Amer-
ican, and Asian men in groups, could be useful here; (4) finally, measuring the
differences in effects on outcome of men’s concurrent versus nonconcurrent in-
volvement in other therapies, as well as therapists’ collaboration versus noncollabo-
ration in their treatment. All of these steps could be helpful in generating data that
could improve the quality of men’s group interventions.

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