1. Alcohol (ethanol) enters the body through the oral cavity (i.e., the mouth). The inner surface of the oral cavity is mucosal tissue to keep the cavity lubricated and it is capable of absorbing alcohol into the bloodstream. This absorption is considered “insignificant”.

2. Alcohol flows down the oesophagus to the stomach where 10-20% of ethanol will be absorbed into the bloodstream. Alcohol enters the bloodstream via the mucosal tissue of the stomach wall, and travels straight to the liver. Alcohol can take 5-10 minutes to reach the brain because of the ethanol absorbed via the stomach. If you drink alcohol on an empty stomach, the pyloric sphincter [gateway between the stomach and the small intestine] is going to be more open, and the alcohol is going to immediately enter the small intestine after reaching the stomach. If food is also present in the stomach, the sphincter will open and close at a rate that allows food to enter the small intestine gradually, therefore if alcohol is also in the stomach, it will gradually enter the small intestine.

3. Alcohol flows through the pyloric sphincter into the small intestines where most alcohol absorption occurs. Human intestines are attached the to the posterior abdominal wall by a fold of membrane called the mesentery. Alcohol is absorbed into the mesentery via veins and then travels to the liver.

4. One function of the liver is that it detoxifies toxic elements into non-toxic elements before passing it to the heart and then the rest of the body. The liver sustains considerable “abuse” from a variety of toxic elements and chemicals, and therefore it needs to be capable of full regeneration. NOTE: Many diseases and exposures can harm it beyond the point of repair. These include cancer, hepatitis, certain medication overdoses, and fatty liver disease.

In the liver, ethanol is met with an enzyme called alcohol dehydrogenase and converts ethanol into acetaldehyde [ass-eh-tal-de-hide]. This chemical is more toxic than ethanol, so the liver uses another enzyme to convert acetaldehyde into acetate, which is non-toxic to the human body. NOTE: the amount of alcohol consumed + the timeframe it is consumed [and a variety of other factors] will influence the ability of the liver to effectively convert acetaldehyde all the way into acetate. The liver can’t handle the entire workload effectively therefore ethanol (before being metabolised) will go straight from the liver to the bloodstream and make its way directly to the heart.

NOTE: Genetics will play a role! Certain people do not produce the liver enzymes in enough quantity to properly breakdown ethanol.

5. Blood leaves the liver through the hepatic veins. The hepatic veins carry blood to the inferior vena cava—the largest vein in the body—to the right side of the heart. The heart will beat and send the incoming blood to the lungs to oxygenate and expel carbon dioxide as we breath out. This is how ethanol can be on your breath. Inside the lungs, at the very end of the bronchioles, are hollow air sacs called alveoli where there is a gas exchange. Ethanol evaporates through capillaries into the air sacs and exhaled out of the body. Breathalysers can detect the quantity of ethanol in a person’s system based on the quantity of ethanol in our breath.

6. Not all the ethanol will expel from the body via the breath. The rest will flow back to the heart, with newly oxygenated blood, and then get pumped all the way up to the brain and around the body. NOTE: Ethanol is water soluble. It will be distributed to every cell in the body except bone and fatty tissue [some will enter fat cells but not easily]. Ethanol will interact with every other cell i.e., every organ, gland, nerve, muscle etc.

7. Ethanol will affect and compromise protein synthesis inside muscle tissue. Therefore, if you have been training at the gym, running, swimming etc., your muscles will not effectively be able to repair.

8. Once ethanol has reached the brain, it will cross the blood-brain barrier and begin to affect chemical messengers [neurotransmitters] in the grey matter of the brain. It affects serotonin, dopamine, gamma-amino-butyric-acid (aka GABA), glutamate, endorphins etc. The person will experience pleasure, euphoria, lowered inhibitions [related to dopamine], lowered cognitive ability (e.g., decision making/problem solving, emotion regulation) and lowered coordination and reflexes.

The more ethanol ingested, the more dopamine is secreted and communicated between neurons (i.e., nerve cells). One of dopamine’s functions is to make you feel pleasure or ‘rewarded’ for doing things that are good for humans, hence, from an evolutionary perspective, we are likely to do them again to help us thrive in our environment and social world. Dopamine is secreted when we:

• eat healthy foods (but also recently developed processed foods that are high in sugar and salt)
• exercise
• achieve goals
• be productive (e.g., finish a task like cleaning, cooking, work-related tasks)
• master new skills (e.g., learning an instrument or a new talent), and
• have positive and stimulating social interactions

Ethanol influences so much dopamine secretion and communication that the brain becomes unable to make responsible decisions cognitively. The simultaneous experience of euphoria and lowered cognitive ability means we are more likely to be “happy” about making irresponsible decisions.

Increased dopamine is how drinking alcohol “blocks” unpleasant emotions like fear, stress, anxiety, and insecurity. When we don’t feel these unpleasant, yet necessary, emotions we will behave in ways that are dangerous, abnormal, potentially embarrassing, and generally problematic.

Another significant brain region affected by ethanol is the hypothalamus and the pituitary glad [together known as the hypothalamic-pituitary axis]. These structures control the entire hormonal system. The hypothalamus monitors the body, and it will send instructions to the pituitary gland based on information it receives from the hypothalamus. The hypothalamus is aware that ethanol is flooding the brain and it starts adjusting the secretion of hormones via the pituitary gland.

One of the instructions it gives the pituitary gland is to start modulating the adrenal glands to secrete cortisol (i.e., stress hormone) and epinephrine and norepinephrine (i.e., adrenaline).

Now, our cognitive capacity is diminished, inhibitions are lowered, and we will experience a rush of stress hormones and adrenaline coursing through the body. Cortisol and adrenaline will provide a boost of energy. It will increase the heart rate, blood pressure, body sweat, sugar levels in the bloodstream, and enhances the brain’s ability to use glucose. Glucose is a “fuel” source for brain functioning, including the generation of neurotransmitters. Behaviourally, we can see this in children when we say they are “hyperactive” because they’ve ingested too much sugar.

The pituitary gland will also slow the secretion of anti-diuretic hormone (aka. vasopressin). A diuretic is something that makes us urinate. If the anti-diuretic hormone (also called vasopressin) slows down, then we won’t be “holding on” to water as effectively, hence we begin to urinate more. People call this “breaking the seal”.

9. South of the body, blood is pumped into the kidneys via the renal artery which spreads through the renal cortex. The blood is then filtered into urine and expelled from the body. The lowered anti-diuretic hormone will dilate (become wider/bigger or more open) blood vessels in the kidneys which means more blood gets passed through and filtered, but it also means we lose a lot more body water which leads to dehydration. Vasopressin is essential in the control of osmotic balance, blood pressure regulations, and kidney function, therefore, when vasopressin is lowered, we are losing essential water and minerals/electrolytes. Electrolytes are involved in urination because the kidneys need them to make the process of filtering blood more efficient.

The loss of water and electrolytes will contribute to a hangover. Electrolytes play a role in cellular water absorption so if we are losing more water than we are bringing in, and we are losing the electrolytes that support the absorption of water, we become dehydrated very quickly.

10. The Hangover

Symptoms: nausea, fatigue, diarrhoea, vomiting, paranoia, anxiety, anorexia (i.e., loss of appetite), increased thirst, muscle weakness, irritability, sweating, increased blood pressure, and headache.

The exact cause of a “hangover” is not yet known however variables affecting the hangover are:

• individual differences such as sex, size, body fat, genetics etc
• lack of sleep
• general health
• drinking behaviour e.g., frequency, duration, quantity
• food intake before and during
• water intake before and after
• your body’s ability to metabolise alcohol i.e., excessive amounts of acetaldehyde due to fewer enzymes to metabolise alcohol in the liver before entering the bloodstream
• general behaviour while drinking e.g., poly-substance use, dancing, sexual activity, risk-taking behaviours etc.

Strategies for Controlled Drinking

• Setting personal drinking limits and sticking to it
• Alternating alcoholic drinks with soft drinks i.e., one alcoholic drink then a water, soft drink, or juice
• Have a meal before drinking
• Switching to low alcohol drinks
• Having regular alcohol-free days/weeks/months
• Identifying high risk situations for heavy drinking and creating a management plan

Engaging in alternative activities to drinking

Emotional intelligence is defined as the ability to understand and regulate your own emotions, as well as identify and influence the emotions of others’. The term was first coined in 1990 by researchers John Mayer and Peter Salovey and was later popularised by psychologist Daniel Goleman.

Emotional intelligence (EI) is the ability perceive, control, and evaluate your emotions. Some people can do this with ease while others require practice in this area. This ability is necessary for anyone who wants to function effectively in a society – it pertains directly to our ability to interact well with others and respond effectively when situations are outside our control.

EI is best described as a way of thinking that enables people to perceive their own emotions, understand the emotional states of others, and behave appropriately in response (Cherry, 2022). People with high EI can feel empathy for others, determine their own emotional responses (including the process of suppressing an emotion as a defence mechanism), and think through situations before responding emotionally. Emotional intelligence is strongly linked to many positive outcomes. Those with high EI are likely to become financially stable, have meaningful and healthy relationships, respond effectively to stress, and maintain desirable physical and mental health (Salovey & Mayer, 1990). They are also likely to avoid dangerous situations (such as driving under the influence), interrupt negative thinking patterns, and use healthy coping skills rather than self-destructive or maladaptive coping mechanisms.

Here are some key features of a person with high emotional intelligence (Drigas & Papoutsi 2018):
– An ability to identify how they are feeling (i.e., the can name what they’re feeling)
– An ability to identify how others are feeling
– An awareness of strengths and weaknesses
– The ability to let go of mistakes and forgive others
– The ability to accept change
– Curiosity about oneself and others
– The capacity for empathy and compassion
– The ability to regulate emotions in the moment

The ability to regulate emotions is a skill that anybody can learn with practice.

How to develop emotional intelligence

The following tips may be helpful if you’re interested in developing or improving your emotional intelligence. Pioneers in the field Salovey and Mayer (1990) have identified four levels of emotional intelligence that are person should aim to move through in order – these are:

1. Perceiving emotions: The first step is to be able to acknowledge that emotions are occurring in the first place. This might involve understanding nonverbal signals from other people or associating internal bodily states with certain emotions. Some clients, especially those who have suffered from trauma, may have a sense of detachment from their bodies, making it difficult to discern emotional states. As such, this lack of internal data will make it harder to recognize emotional states in others. Practicing mindfulness and other self-awareness exercises can help clients to perceive their emotions more effectively.

2. Reasoning with emotions: Once an emotion has been identified, the second step is to learn how to think about emotions appropriately. Many people will shut down in the presence of strong emotions, but emotions can be used to promote thinking and cognitive activity. Developing a sense of curiosity and openness toward emotions can help to facilitate this process, and result in less aversion towards certain experiences.

3. Understanding emotions: The third step is understanding the meaning of emotions in more detail and recognising complex relationships between different emotions. Once emotions are perceived and reasoned with, a person can evaluate them and find the underlying causes of them. This is where emotional intelligence really starts to develop, as it fosters the ability to become less reactive to emotional content and learn to listen deeply to emotions and discern their origins.

4. Managing emotions: Finally, in the fourth step we learn to regulate emotions effectively. This involves a person developing their ability to problem-solve and identify healthy coping strategies for dealing with an emotion. It also involves being able to use the skills learnt in previous steps – perceiving, reasoning, and understanding – to resolve emotional conflicts peacefully. This is the highest level of emotional intelligence.

Generally, building emotional awareness through mindfulness helps to propagate EI within oneself, and learning to perceive nonverbal cues helps to attend to others; outlines of these two angles are as follows:

Building Emotional Awareness

Perceiving emotions is the foundational skill of emotional intelligence, and mindfulness has been identified by research as being one of the most efficacious ways of developing this capacity. Mindfulness involves paying attention to the present moment without judgement or interference. Mindfulness is correlated with greater clarity of feelings and thoughts, and less reactivity and distraction, making it the perfect catalyst for emotional intelligence (Feldman et al., 2007).

Mindfulness generally involves meditative exercises; you sit or lay down, and use the breath and other sensations (i.e., the feeling of feet on the floor, or sounds in the room) to anchor into the experience. As you enter an observational state, encourage yourself to simply notice how your experiences arise, change, and pass away. When using mindfulness to develop emotional awareness, specifically connect to your emotional state. The key focus here is not necessarily on the breath or on acceptance, as per common mindfulness strategies; rather, simply become familiar with the process of having and noticing feelings. If you have difficulty identifying your emotions, try to explore the characteristics of your emotions such as where it is located in the body, how it feels (e.g., warm, cold), how big or small it feels, or perhaps what colour they associate with it.

Regularly performing this exercise will habituate the brain to approach emotions with curiosity rather than avoiding or repressing them. As such, the processes of emotional functioning will become more familiar, resulting in greater emotional intelligence.

Decoding Emotions by Analysing Speech, Body, and Face

Created by Hugo Alberts, this exercise helps people to accurately identify and understand the emotions of other people through ‘reading’ their body language and other nonverbal cues. This is a very valuable skill, as research has shown that cultures all around the world express emotions through similar facial expressions (Friesen, 1972). Similarly, it has been found that deciphering body language can accurately provide insight into emotional states such as anger, fear, pride, joy, and more (Gelder & van der Stock, 2011). Speech patterns are a more nuanced area than body language and facial expressions, but valuable nonetheless; people use thousands of micro semantic terms to express their emotions beyond the words themselves (Sabini & Silver, 2005). By learning to attune to these three aspects of communication (i.e., face, body, speech), a person will be able to exercise enhanced emotional intelligence with the people in their life.

One activity to develop this skill is to use videos that you are familiar with (e.g., films or tv shows) and to spend time evaluating how the actors use speech, body, and face to communicate their emotions. Depending on your current level of EI, you might be able to identify the emotions being expressed but not understand the role of nonverbal cues to communicate this. Another strategy would be to become more self-aware of your own nonverbal conduct during different emotional experiences. Notice your posture, get a sense of your facial expression, notice your stance, hands, chest etc. You could keep a journal of what your speech, face, and body language is like during various experiences throughout the day. Over time, you will come to understand how to decipher these elements and associate them with emotional states. Please be patient with yourself. It is challenging to mindfully pause and think about your nonverbal language when you’re caught in an emotional experience. You may like to ask others whom you trust to give you feedback.

Additional skills

Having covered the internal (emotional awareness through mindfulness) and the external (nonverbal cues), you can then use these new understandings to develop further practical skills. A person can embody emotional intelligence by practicing empathy, active listening, and assertiveness.

Empathy

Empathy is the capacity to understand another person’s experience through their frame of reference (Cuff et al., 2014). Whilst an aspect of empathy is being able to relate other people’s experiences to your own, it is further positioning yourself within the other person’s perspective and relating to them from that place. This is what is meant by “putting yourself in someone else’s shoes.” Empathy is a useful skill to practice because it both requires and fosters emotional intelligence; EI is required to relate fully to another person and is developed further through this process. It is recommended to cultivate compassion for others when developing empathy. It can be an uncomfortable experience, one which people may resist or tense up against.

Active listening

Activate listening can help conversational partners interact in more meaningful ways. It offers people space to explore their feelings, disclose important information, and feel like they are heard, validated, and cared for. Joseph Topornycky has identified some fundamental attributes of active listening (2016). These include:

• Being non-judgmental: Reserving judgment allows speakers to exercise freedom in exploring and expressing their ideas and feelings.
• Patience: Being patient when somebody is speaking, and not rushing them or interrupting them, is crucial for them to feel heard and understood.
• Minimal encouragers: These are small indications of engagement, such as nods and smiles, as well as words like yep, mm-hmm, uh-huh, and more.
• Questions: Asking the person questions will show that you are interested in what has been said and are engaged enough to want to know more.
• Summaries: It can be a useful bonding behaviour to repeat what the person has just said back to them, but in different words.

Assertiveness

Assertiveness is often be perceived as rudeness, however, if the person communicating in an assertive way maintains a compassionate undertone, it is very effective for improving EI and self-esteem. Many people lack EI because they were never taught or encouraged to explore their emotions and express their feelings. By learning to express ourselves truthfully and appropriately, a person can validate themselves, protect themselves and set boundaries with others (Makino, 2010).

One way to practice this is through role playing with a counsellor or someone you trust. You can also practice by yourself, playing the role of both parties in an interaction. Practice expressing what is most important for you in a conversation and express the emotion e.g., “I feel worthless, like nobody cares about my opinion” and then offer yourself assurance as if you are the other person e.g., “I really value your opinion, and I am interested in hearing it.”).

If you’re someone who hasn’t been able to assert your needs, wants or feelings in the past, you may feel rude initially. Like I always tell my clients,

1. self-awareness is always the first step so you may need to spend time meditating, educating yourself, or reflecting on what it is you’re feeling, what you want or need. The second step is to:
2. identify what you think or feel you need to do
3. allow that to be there (try not to resist your reality – what we resist persists)
4. make an intention to ask for your needs or wants – or express your emotions with language
5. act on your intention

References

Cherry, K. (2022, August 3). How emotionally intelligent are you? Verywell Mind. Retrieved from https://www.verywellmind.com/what-is-emotional-intelligence-2795423#citation-5

Cuff, B. M. P., Brown, S. J., Taylor, L., & Howat, D. J. (2014). Empathy: A review of the concept. Emotion Review, 8(2), 144–153. https://doi.org/10.1177/1754073914558466

De Gelder, B., van den Stock, J., Meeren, H. K. M., Sinke, C. B. A., Kret, M. E., & Tamietto, M. (2010). Standing up for the body: Recent progress in uncovering the networks involved in the perception of bodies and bodily expressions. Neuroscience and Biobehavioral Reviews, 34, 513–527.

Drigas AS, Papoutsi C. A new layered model on emotional intelligence. Behav Sci (Basel). 2018;8(5):45. doi:10.3390/bs8050045

Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J.-P. (2007). Mindfulness and emotion regulation: The development and initial validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMSR). Journal of Psychopathology and Behavioral Assessment, 29, 177–190.

Friesen, W. V. (1972). Cultural differences in facial expression in a social situation: An experimental test of the concept of display rules. Unpublished doctoral dissertation. University of California San Francisco

Gosling, M. (n.d.). MSCEIT 1 Mayer-Salovey-Caruso Emotional Intelligence. Retrieved from https://www.mikegosling.com/pdf/MSCEITDescription.pdf

Makino, H. (2010). Humility-empathy-assertiveness-respect test. PsycTESTS Dataset. https://doi.org/10.1037/t06420-000

Mayer, J. D., Salovey, P., & Caruso, D. R. (2012). Mayer-Salovey-Caruso emotional intelligence test. PsycTESTS Dataset. https://doi.org/10.1037/t05047-000

Sabini, J., & Silver, M. (2005). Why emotion names and experiences don’t neatly pair. Psychological Inquiry, 16, 1-10.

Salovey P, Mayer J. Emotional Intelligence. Imagination, Cognition, and Personality. 1990;9(3):185-211.

Topornycky, J. (2016, June). Balancing openness and interpretation in active listening – researchgate. Retrieved October 23, 2022, from https://www.researchgate.net/publication/315974687_Balancing_Openness_and_Interpretation_in_Active_Listening

In our previous article (read it here), we asked why men do not seem to express emotion as easily as women do. Was there some pathology, or should we just put the differences down to male-female tendencies? We identified Dr Ron Levant’s notion of “normative male alexithymia” as representative of one side of the controversy: namely, that, yes, men do have a restricted range of emotional expression compared to women, but it’s so pervasive in society that it’s normal (Schexnayder, 2019).

On the other side of the debate were researchers such as James Thompson (2010), who – while acknowledging men’s relatively greater “stoicism” or restriction emotionally – nevertheless insisted that it’s invalid to conflate alexithymia with maleness, especially given that men’s holding back from emotional expression is largely culturally induced. Yet we observed that the issue should be dealt with, given the male-female suicide ratio in Australia, the U.K., and the United States of about 3:1 – and the fact that suicide is on the rise in all three countries.

We concluded that therapy might be able to help, and that is where we go with this article: to a discussion of just how we as mental health professionals might be able to help men deal with an outdated but strongly held socialisation pattern which has impacted their emotional expression, and through that, their capacity for growth, satisfying friendships, and intimate relationships. 

We tackle the question in two parts. First, we share psychologist Barbara Markway’s (2014) take on how to help men out of the double bind that leads to their emotional repression. Then we suggest therapies which might be able to assist.

Deciphering the code

Markway (2014) insists that dismissing men as “the feelingless gender” is not only unhelpful, but also wrong. They just, she says, express their feelings using a secret code: one which even they themselves cannot decipher. Let’s do some translation.

Men convert one feeling into another

Let’s say you’re a guy, and you’ve just found out that a good friend of yours has been cheated in business by her business partner: a business you yourself helped them set up. The cheating transactions will cost your friend thousands, and maybe her whole business. You may erupt volcanically, vowing to help your friend sue the partner for all they are worth, or maybe go threaten the partner within an inch of their life. If you react this way, you are showing anger and not a little pride, which are acceptable “male” emotions to express. Hiding underneath them could be sadness for your friend, and even a shared sense of vulnerability, but these are more “feminine” emotions, which by socialisation you are not “allowed” to express. So you convert them into “male” emotions of anger and pride.

Men may shift their feelings into another domain

Are you male, and basically an exuberant, affectionate sort? Markway claims you may not necessarily let this show in your personal relationships, but on the sports field, lookout; you’ll be hugging, high-fiving, and butt-slapping with the best of them. It’s ok in that domain, she says, for men to express strong feelings of delight (over a goal made, say) and affection.

Men may somatise their feelings

Let’s say now that you’re female, and in an intimate partnership with a guy. You make plans to get away for a holiday, but no sooner have you checked into the five-star hotel at the fabulous beach than he gets a migraine and is out of action for that day at least. What’s going on? Markway observes that, with the structure of work, many men are able to squash down feelings, but when they are away from that structure, such as on weekends or holidays, their emotions and needs surface. Not wanting to acknowledge them, many men will convert strong emotions into physical symptoms, such as headaches or back aches. If asked about it, some men would have the conscious belief that women do want them to show their emotions, but only certain ones, and only in amounts they (the women) can handle. Men who deviate from this are, as we have noted, judged to be poorly adjusted or not “manly enough”, because – at the root of it – they are bucking their whole socialisation model.

Men’s emotional expression can put us all off balance

When men do get in touch with emotions, the result can catch everyone off guard, as it may seem to come “out of the blue” and be overwhelming. In fact, for any of us, when we chronically stuff down feelings, we don’t get the practice of handling strong emotion. When it does come up, then, we are ill-prepared to deal with it. Think, for example, of the person stoically putting up with an in-law criticising their partner, probably repeatedly. At some stage, there will be “the straw that breaks the camel’s back” – just one criticism too many – and the person may unleash a massive emotional response, consisting in part of stored-up feeling from previous violations (adapted from Markway, 2014). 

It’s not that these ways of directing emotion “sideways” are bad, but if a more direct emotional expression is desired, how can we help our male clients escape from the clutches of restrictive socialisation?

Re-setting the code

It’s a big job to help someone move past lifelong “training” in a given direction. In the case where the client is keen to make changes in his way of dealing with emotions (that is, his issues with emotional expression are ego-dystonic), psychodynamic therapies and the social constructionist narrative and solution-focused therapies may be hugely helpful; we briefly highlight these, while acknowledging that other therapies, such as motivational interviewing and CBT, may also have a role to play. In the case where the man is dragged into session because his partner is experiencing huge frustration but the man himself does not see that he has a problem (that is: his issues with emotional expression are ego-syntonic), we can look hopefully to emotionally focused therapy, although family therapy and other couples modes, such as imago therapy, likely have much to offer.

We put the psychodynamic therapies right up front in our discussion. Why? If, as is generally claimed, men’s emotional responses are because of socialisation and/or attachment processes, then that therapy may be most efficacious which can take the client back to the root of those processes: the early childhood years when all of us – for better or worse – began to be socialised into our respective “tribes”.

Jung’s psychoanalysis

Carl Jung espoused the essential wholeness of all human beings, but believed that most of us have lost touch with important parts of ourselves. Life’s goal of individuation demands that we give expression to the various components – often conflicted – of our psyche. These typically repressed components cause psychological disturbance until they are made conscious. Each person has a story and when mental illness occurs, it is because the personal story has been denied or rejected; healing comes when the person recovers and owns his or her own personal story (Sonoma.edu, n.d.).

The story will include symbolic archetypes. A man could, for example, be modelling after the archetype of the Invincible Warrior, which could express part of who he is, but he may have repressed the complementary Nurturing Earthmother part of himself (due to that part being discouraged culturally). The task in therapy, then, would be to help the man discover his Nurturing Earthmother side. The two sides, harmonised together, could transcend either archetype and help such a client come into greater wholeness (Geist, 2013).

Psychosynthesis

Similarly, Psychosynthesis, a transpersonal psychology, asks clients to work with body, feelings, and mind to synthesise, or integrate, the various “selves” inside them into a harmonious whole. Psychosynthesis postulates “subpersonalities”: parts of ourselves which constellate and act out in order to meet needs or to defend against needs which seem unable to be met (Assagioli, 1965). Thus, the same man – in angst because of being constrained from tender, loving expressions or emotional sentimentality – may discover an angry subpersonality within himself: one which, he later discovers, is in conflict with its opposite number, a “Sentimental Sally” subpersonality which, while weaker, nevertheless is driving the man’s behaviour from underground because it is not acknowledged; its needs for permission to express a softer side will continue to cause it to act out in some way until those needs are met.

Thus in this mode, therapy consists of finding out what conspired to prevent the man expressing his softer side and working out how it can find expression appropriately in the man’s life. Sentimental Sally also has to work in with the angry subpersonality (as the two will vie for dominance), and both must cooperate with the man’s greater, whole psyche. Somewhere along the way of this, the man is likely to recall early events which shaped his way of being: for example, leaning into his mother for a cuddle when upset and being pushed out and told, “Big boys don’t cry”.

Schema therapy

In some ways, schema therapy would seem to combine the best of several worlds. From its psychodynamic predecessors, it inherits its basic notions that mental health troubles arise from early needs not being met. Five areas of basic human needs are outlined, such as for secure attachment and autonomy/competence. Frustration of these engenders 18 domains of early maladaptive schemas (EMS), from mistrust and abandonment to emotional inhibition (Young, n.d.). The schemas are perpetuated in a person’s life, say practitioners, through cognitive distortions, self-defeating life patterns, and unhelpful schema coping styles, which cause others to respond negatively, thus reinforcing the schema(s) (Young, 2012a). 

In the psyche’s effort to heal, individuals set up relationships similar to the unsatisfying ones which originally engendered the EMS, and thus the unhealthy object relations which stultify growth are continued. The therapist can ask the “lonely child” or “angry child” in a person to set up dialogue with the “healthy adult” in order to heal the overcompensating, avoidance, or surrendering responses that perpetuate a given schema (Young, 2012b). From cognitive behavioural therapy (schema therapy’s other “parent”), there are therapeutic interventions to reframe the cognitive distortions: irrational thoughts are collected in journals/diaries, for example, which are then refuted through rational replacement thoughts.

Narrative

Narrative therapy assumes no single absolute reality, but that realities are constructed by individuals, families, and cultures, and then communicated through language. They are organised and maintained by stories. What is true for us may not be true for another person or even for ourselves at another point in time. In the narrative, social constructionist paradigm, there are no essential truths and we cannot know “reality”; we can only interpret experience. The narrative mind frame, unlike empirical work searching for facts, exhorts us to bring forth our novelist selves. This means that we can understand our client’s story from many perspectives. The work of narrative therapy is to elicit various experiences of the client’s whole self, determine which selves (parts of the client) are preferred in the new narrative, and then support the growth and development of those new selves and their accompanying stories (Ackerman, 2017; Archer & McCarthy, 2007). 

Thus, if a male client has experienced being emotionally stifled in the interest of becoming “manly”, he can be helped to understand how such definitions of masculinity are inherently constructed by society rather than being empirically true. He can be helped to, first, find “sparkling moments” when the issue of being emotionally constricted was not as much of a problem, and then to find ways to “grow” the self – and/or the moments – that were less restrained, more inclusive of perhaps a softer, more emotionally permissive self. In doing this, he is re-storying himself and re-constructing the “reality” that he and those around him will live about what constitutes appropriate masculinity. 

Solution-focused therapy

Like its narrative cousin, solution-focused therapy emanates from a post-modernist, social constructionist paradigm, meaning that it shares with narrative therapy the understanding that there is no such thing as an objective, absolute reality. Rather, reality is co-constructed, so the “truth” of a client’s life is negotiable within a social context; fixed, objective “truths” are unattainable. Clients’ lives have many truths (O’Connell, 2006). Just as narrative therapy tries to elicit the “sparkling moments” in which the problem wasn’t as much of a problem, so too solution-focused therapy enquires into what a miracle would look like if the problem were to be “fixed” or to go away; in fact, much of the therapy has this present or future focus. 

The therapist thus elicits the client’s preferred future. Suggestions for change are based on clients’ conception of their lives without their symptoms (i.e., the healthiest, most empowering vision of themselves and their lives that clients can generate). Changes the client makes will have a ripple effect, generating behaviour to change the whole system (Seligman, 2006; Archer & McCarthy, 2007). Thus a solution-focused intervention could see a male client generating a vision of himself as a fully expressive man living in a community which accepts both his “traditional” male side and also his more emotionally liberated self. The therapy would be likely to search for times and places when this had already occurred.

Emotionally focused therapy (EFT)

Obviously in cases where it is the partner expressing angst and the man sees no problem in his flatter emotional demeanour, the therapies which may be more helpful are those which work with both partners to see how to accommodate both sets of needs and behaviours.

EFT is an empirically supported humanistic (couples) treatment that includes elements of experiential, person-centred, constructivist, and systems theory, but is firmly rooted in attachment theory. It is based on the concept that distress in intimate relationships is often related to deeply rooted fears of abandonment, as an individual’s emotional response to these fears may be harmful to relationship partners and put strain on a relationship. The insecurity may show up as partners asking questions such as, “Do you really love me?” “Am I important to you?” “Are you committed to our relationship?” “Can I trust you?” When intimate partners are not able to meet each other’s emotional needs, they may become stuck in negative patterns of interaction driven by ineffective attempts to get each other to understand their emotions and related needs. 

EFT reinforces positive bonds that already exist, and fosters the creation of a secure, loving bond between partners where there is not one. It does this through expanding and reorganising important emotional responses, which help to shift each partner’s position of interaction while initiating new cycles of interaction that are more beneficial for the relationship. In the non-judgmental environment of session, participants are able to contact and express deep emotions and experiences. In voicing their deepest concerns and conflicts without criticism, they are able to address them and move on to more collaborative, productive behaviours (GoodTherapy.org, 2018). 

Thus if the female partner is experiencing the despair of little emotional validation from a man who does not readily show emotion, he can be helped to see how, if he learns to do that in a way that is meaningful to her, it can benefit not only her but also the whole relationship. She can be assisted to recognise the ways in which he does show emotion – albeit “sideways”, such as Markway (2014) describes above – and to learn to accept how he is without criticism, asking directly at times for her needs to be met. EFT helps people learn to interact with their partners in more loving, responsive, and emotionally connected ways, which can result in a more secure attachment and – we say – greater freedom of emotional expression.

Summary

It’s easy to agree that men generally do not show as many emotions, or as intense of emotions, as their female counterparts. What we have seen to be more difficult is assessing whether a given man is pathological or not in the apparent emotional holding back. Without judging that, this article has demonstrated that there are several options for response if a man’s emotional expression seems greatly inhibited. One is to understand the ways in which men “convert” emotions: to other emotions, to other domains, or to their bodies. The other option is to encourage the man – either alone or with his frustrated partner – to attend therapeutically to the roots of the inhibition, which are likely to reside in insecure early attachments and/or socialisation against expression.

References

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