Pragmatic Case Studies in Psychotherapy

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December 28, 2020 -- From the Editor 


Inflexibly Enacted Traditional Masculinity Norms (IE-TMNs) and Their Impact on Adolescent and Young Adult Depression: The Hybrid Case Study of “Tommy”

*** Christopher Dewey, Providence College Personal Counseling Center, Providence, RI


*** James Mahalik, Boston College

*** Ethan Hoffman & Michael Addis, Clark University  

*** Ginelle Wolfe & Ronald Levant, The University of Akron      

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         In the words of Dr. Christopher Dewey, the therapist and author of this issue’s target hybrid case of 'Tommy': 

        "Traditional masculinity norms in the United States promote stoicism, self-sufficiency, strength, control, aggression, competitiveness, success, fearlessness, and invulnerability (Mahalik et al., 2003). The list goes on to include sexual virility, financial stability, competence, rationality, and independence (Meth & Pasick, 1990; Pollack, 1998). 

        In moderation, many of these qualities are desirable and adaptive and may facilitate building relationships, pursuing work, finding success, and attaining happiness. However, when an individual boy or man inflexibly enacts these traditional norms to an extent that is no longer healthy or beneficial at the exclusion of a more dynamic definition of masculinity—that is, when he engages in what I am calling inflexibly enacted traditional masculinity norms (IE-TMNs)—this can lead to decreases in physical health, mental health, relationship quality, job performance, and other important areas of daily functioning (Addis & Mahalik, 2003; Courtenay, 2000)" (p. 238). 

        Tommy is an 18-year-old Caucasian, heterosexual male college freshman who was mandated by his university’s residence life staff to attend counseling after three alcohol violations in his first semester of college. At intake he presented with associated problems of depression, anger, moodiness, difficulties in his relationships, and academic difficulties. 

        Dewey formulated Tommy’s difficulties as due in large part to Tommy’s being locked into IE-TMNs. Using an integrated therapy model—including client-centered therapy, motivational interviewing, harm reduction interventions, cognitive-behavioral interventions, and ecological systems theory—Dewey saw Tommy for 16 individual sessions over the course of five months. During this time, Dewey was successful in guiding Tommy to challenge and reconstruct his IE-TMSs, with marked improvement in Tommy’s presenting problems. 

        The three Commentaries are by authors who are prominent researchers and scholars in the psychology of men and masculinities, including James Mahalik, Michael Addis, and Ronald Levant, along with their graduate students, Ethan Hoffman and Ginelle Wolfe, respectively, as co-authors.

        The Commentaries examine the Case of Tommy from a wide variety of perspectives, such as those of Interpersonal Theory; Precarious Manhood Theory; the nature of “positive” masculinity versus “toxic” masculinity; the goal of reconstructing versus deconstructing unhealthy versions of masculinity; masculine depression and alexithymia; the role of social media consumption; and the larger culture war and political ramifications of the concept of masculinity. 

          The issue ends with a response to the commentaries by Dewey emphasizing implications for best practice in treating boys and men in therapy.       


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Vol 16, No 3 (2020)

Table of Contents

Case Study

Christopher Dewey
James R. Mahalik
Ethan Hoffman, Michael E. Addis
Ginelle Wolfe, Ronald F. Levant
Christopher Dewey