Clinical Work with Men | Andrew P. Smiler Spotlight

Why It Matters

Understanding and addressing the specific masculine scripts that drive male clients’ behavior can reduce dropout, improve outcomes, and mitigate the broader public‑health costs of male suicide and substance abuse.

Key Takeaways

• Men often disengage from therapy, leading to high dropout rates.
• Masculinity comprises criteria, achievement, types, and negotiations frameworks.
• Therapists can use CBT and values clarification to address masculine criteria.
• Case study shows shifting violence to self‑sufficiency improves client outcomes.
• Understanding multifaceted masculinity boosts therapist effectiveness with male clients.

Summary

The video features clinical psychologist Andrew P. Smiler introducing his new book, *Clinical Work with Men: Understanding Masculinity and Psychotherapy*. He highlights the growing difficulty therapists encounter when engaging teenage boys and adult men, noting high no‑show rates and stagnant progress.

Smiler links these therapeutic hurdles to broader societal trends—a loneliness epidemic, poorer education and employment outcomes, and markedly higher rates of suicide, substance abuse, and overdose among males. He references the 2018 APA guidelines that call for gender‑sensitive practice and outlines his four‑facet “multifaceted masculinity” framework: masculine criteria, achievement, types, and negotiations.

Illustrating the model, Smiler walks through the case of Nissan, a 25‑year‑old gay Black man whose early adherence to violent masculine criteria earned him status but also deep trauma. Through CBT‑style belief work, values clarification, and narrative negotiation, Smiler helped Nissan replace violence with self‑sufficiency, reshaping his masculine type and improving therapeutic outcomes.

By applying this framework, clinicians can better align interventions with men’s cultural scripts, increase session retention, and address the underlying gendered pressures that fuel mental‑health crises. Smiler’s approach promises a pragmatic tool for therapists seeking to close the gender gap in mental‑health service utilization.

Original Description

Explore a fresh approach to understanding and engaging men in therapy.

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APA – https://at.apa.org/men-clinical

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Why do so many men avoid therapy—or never return after the first session? And how can clinicians better connect with them?

In his book, Clinical Work With Men, psychologist Andrew P. Smiler, PhD, offers a groundbreaking guide for therapists seeking to better understand and engage with male clients by exploring masculinity from the inside out. Instead of pathologizing men’s behaviors, this book helps clinicians see the world through their clients’ eyes, examining the roles, values, and identities that shape how men understand themselves.

Drawing on extensive research and clinical experience, Smiler introduces seven common masculinity types—from the breadwinner and the protector to the angry man and the player—each with its own strengths, struggles, and therapeutic implications. Through vivid clinical vignettes and actionable strategies, therapists will learn how to:

Recognize the core values and identity themes that drive male clients’ behavior.

Build rapport by aligning therapeutic approaches with clients’ self-understandings.

Address emotional development, social connection, and intersectional challenges.

Apply practical interventions tailored to diverse masculinities.

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