S1: Welcome in San Diego , it's Jade Hindman. On today's show , the role couples therapy can play in men's mental health. This is KPBS Midday Edition. Connecting our communities through conversation. You know , healthy relationships help maintain a healthy mind. So in honor of Men's Mental Health Awareness Month , we're going to talk about romantic relationships and the mental health of men. I'm joined now by Dan Singly. He is a San Diego psychologist and founder of the center for Men's Excellence. Dan , it's great to have you back on midday.
S2: Yeah , thanks for having me on.
S1: Also joining us today is Dan's colleague , psychologist Max Marris. Max , welcome to you. Hi.
S3: Hi. Thank you. Yeah.
S1: Yeah. So. Okay , Dan , I'll start with you. Um , we've had you on before to talk about some of the barriers men specifically face when it comes to getting therapy and other mental health treatments. But those barriers you say are similar for getting help in relationships.
S2: Yes , they overlap with just the sort of general stigma around mental health or mental health difficulties and services. However , I think it runs a little bit deeper when we start getting into closeness and connections and relationship , in part because of what sort of masculinity as usual is , as we're teaching boys and we start thinking about really closeness and intimacy and relationships are only for romantic relationships. And then there's the romantic relationships are about physical intimacy and sex. And so by not teaching boys how to show up in ways that are both , you know , tough and stoic , but also sort of loving and compassionate and empathetic. We don't really give them the tools to have productive conflict , solid relationship hygiene , and we can unpack what that means sort of as a as a developmental barrier. Yeah.
S1: Yeah. I mean , do you think , um , like in couples therapy that it focuses on men enough.
S2: So there is no , to my knowledge and I look , evidence based practice to be male , gender sensitive. In couples counseling , there's very , very well researched and evidence based approaches. Emotion focused therapy , the Gottman there are other well validated , well-researched approaches. However , none of those explicitly address male issues that can come up in relationships and in psychotherapy , but then also how to make the endeavor of therapy of couples therapy that much more attractive to or , let's face it , bearable to two men. Mhm.
S1: Mhm. Hmm. And , Max , I mean , you know. Talk a bit about why it's important to focus on couples therapy with men in mind. Sure.
S3: Sure. Well , by having a sensitivity towards men's issues , having an awareness of what are some of the things that men experience or maybe some of the barriers or biases that they might have coming into a couple session ? The therapist can then better address and include everyone in the process instead of hey , I'm just here because she wants me here. Right.
S1: Right. Well , Dan , you cited some some sobering statistics on the current effectiveness of couples therapy. Tell me a little bit about what you've learned. Yeah.
S2: Yeah. So there is easily a 50 to 60% dropout rate for couples that come into couples therapy , usually around. We call it process and outcome research. When you look at psychotherapy and what works and why does it work ? Um , roughly 40% of couples. So less than half report Making gains by spending the time and the effort and the emotional energy , the money to do it. And then somewhere between 40 to 60% will just drop out. And there are a variety of reasons for that. One really important statistic to hang on to , and that I really want listeners to get , is there are a lot of myths and misinformation out there about couples therapy. It seems scary. People think like they're just going to throw me into a room , and you're going to make me start crying and rip off the Band-Aid. But an important part of of why couples work gets a bad name. It's a very interesting statistic. The average amount of time that passes between when someone is told you have a cardiac problem and when they reach out to make a call about it , is six days. The average amount of time that passes between when one or both members of a couple think , huh , things aren't going great , we could probably talk to somebody else. And when they make that call is six years. Because when things are going well , you don't want to rock the boat when things aren't going well. You really don't want to rock the boat. So your average couple that comes in to do this kind of work , there's been a lot of distance and damage and avoidance and delay.
S1: So , you know , this question is for both of you. You say we all need good relationship hygiene. So walk us through that. What is that and what are some tips to achieve it ? Max , I'll start with you. Sure.
S3: Sure. To me , relationship hygiene is similar to a regular hygiene right of regular maintenance , making sure that you're paying attention to the things that need to be paid attention to. And so that looks like in a relationship. Regular check ins of hey , how are things going ? Are we ? Are we talking about the things that we should be talking about or want to talk about ? What are the things that are going well where we have an exercise , we we call the state of the Union , where we have the couples say something that's going well , a moment that they felt it was difficult or challenging and then end with this is something that you did that made me feel more in love with you , and you kind of package that together. And it's a it's a really great way to maintain the open lines of communication in a relationship. And the magic is not in the words that you say , but in the practice of what am I going to say to my partner when we bring this conversation up ? And so your relationship is really at the forefront of your mind. And so when we talk about relationship hygiene , it's paying attention to the things that are most important to you and addressing them instead of avoiding or neglecting them.
S1:
S2: I'd say that really , the two broad buckets of work that we do with , with couples around , around their relationships and relationship hygiene are one attachment. What are the ways that they are attached and attuned and connected as a couple ? But then also , what are some of the barriers that are that are getting in the way of that. That's the attachment bucket. The other broad bucket is productive conflict. How do we fight fair. Like it's actually a problem if in your in your relationship , your romantic relationships , you just never get into any kind of conflict. People say like it's great. We never fight. I'm like , that's actually not a good thing , because sooner or later they're going to be like , why don't you wash the dishes , right ? Or I don't like the way you talk to my mom or , you know , whatever the thing is like. And it's about then when we have something that needs to get sorted out , can we do it in a fair way that that makes it more likely that we're going to develop ? This might sound bad , but relational scar tissue , in other words , we're stronger on the other side of it. That's what productive conflict is. Yeah.
S1: Yeah. Another term I , I often hear is conflict loops.
S3:
S2: The demon dance. Yeah.
S3: Yeah. Or whatever the the dance that you and your partner may get into where the argument might start with like the the dishes or or something small , but really it's the underlying conflict that is never really addressed. And so couples who don't learn to fight fair or or maybe never develop the skill set to fight fair , they continue to attack this surface level issue of the dishes or of , you know , interacting with your in-laws and not really this underlying discontent. And so it's that constant loop where you're just addressing the most recent fire and not the kind of smoldering ashes underneath.
S1: Well , Dan , long lasting relationships have their ups and downs. Obviously. You say relationship satisfaction generally follows a you curve over time. Yeah.
S2: Yeah. So if you think about , you know , it's kind of a typical graph on the y axis going up and down. Think about that as relationship satisfaction low to high. And then the x axis is time like now to then. And it's a big old U-shape meaning. So at the very beginning of the relationship it's the honeymoon period , right ? You're dating a lot. You're going out a lot of physical affection. And then as you move along , you move in together. You got to work 2 or 3 jobs to to make ends meet. Somebody develops an addiction problem. Somebody else is , you know , screwing around and you have kids. You got maybe a mortgage , you got to get the rent going. And sort of as you move through the some of those typical milestones in relationships , it can do damage. Like statistically it does correlate with a drop in in the couple's relationship satisfaction. And depending on what meta synthesis or research you're looking at , you kind of hit rock bottom either around 12 years or 25 years until you start , you know , heading back up into the they call it the second honeymoon or the or the golden honeymoon. Um , for our purposes , that's just research. That's millions and millions of cases smooshed together in many years of social science research. But that's not something that has to happen. In fact , part of our work in helping men to manage relationships. They're very malleable in terms of how do I talk about what I have going on , that's upsetting to me. Guys can learn this. How do I talk to my partner in a way that is fair and productive ? When I have conflict , what are the ways that I can ask for help when I need it ? And basically so the like the state of the Union tool that Max was just talking about , hardly anybody does that as a couple. Unless you have a shrink like one of us that's hassling you for it , because you're you're talking in a proactive way about the relationship in the present , And you're doing it in a balanced way. It's good , bad , good. And just that kind of an intervention can go so far to mitigate that sort of slow slide into relationship dissatisfaction.
S1:
S2: So the dude to dad transition. Therefore we have a good number of of couples who are in the pregnancy postpartum. You know , or you know , kids under three period. And I'm like , I'm heading into this is going to this is like super het centric and potentially sexist sounding. But hear me out on this , because when I train folks , they're like , oh yeah , oh yeah , it goes like this. So the father of the baby , it's funny , like Max is his new dad. So I'm like , ah , I'm not , this isn't about you. But , you know , I'll be watching your nods.
S1: It's not an attack , you know , Max.
S4: Not , um.
S2: But it boils down to the father might want to care for the baby in ways that are a little bit different than than than his partner. Probably the gestational partner. Right. And most of us are socialized to think of early parenthood. I mean , the field is called maternal mental health. We don't tend to think about including the dads as much , but they are a family. It's a family unit. And so if the dad feels like , look , you don't let me do things like I don't clean the bottles , right , or when I swaddle or diaper or whatever , and the partner will kind of come and be critical about it or get upset or kind of not let him do it. It's called gatekeeping. And in the research literature it's called maternal gatekeeping. But I've seen some OCD dads that do plenty of gatekeeping in their own. And essentially it's avoidance by proxy. His partner feels anxious , doesn't allow the dad to have the opportunities to get in and do some of these hands on fathering things that he's excited about. And then therefore , he gets resentful , his partner gets upset , and they get this is an example of a very common kind of early parental demon dance. And my guy will inevitably say something like , well , I don't know how she won't let me take my you know what ? I'm just going to take my baby and , and go to my parent's house for the weekend. And I'm like , bro , when's the last time you were completely alone with your baby ? For more than 15 minutes. And he's usually like , well , I have it. And I'm like , okay , so kidnapping your baby and going to your parent's house is actually not the next step here. Let's talk. And then we look at anxiety and relationship dynamics. And he basically set up kind of an exposure hierarchy.
S1: That's so interesting. The gatekeeping. Mhm.
S4: Mhm.
S1: And I would imagine people do that even with just house chores or you know , and probably you know it's a it's a large thing. Max what are you hearing from soon to be parent couples about the that transition of becoming a dad , especially since you're a new dad. Sure.
S3: Sure. Yes.
S1: Congratulations on that , by the way.
S3: Thank you , thank you. Um. from the men that I work with , there's obviously apprehensions and with the research that Dan does and part of our practice , we really emphasize the the involvement of the father. And so there's kind of a self-selecting bias that a lot of the men that come into our offices are our dads that really want to be involved , but they either don't know how or are anxious to. And so they're more proactive in if this thing was to come up , what do I do next ? And so I see a lot of men and new dads interested in being involved and shouldering the messages of be strong , be stoic , be reliable , in conflict with I have no idea what I'm doing. I'm scared. How do I do all of this ? Right ? And so sometimes what occurs is he retreats to his career because he knows I can be a protector and provider by making money for the family , when his partner might want something more or different from him. And so that's where some of the conflict that I see in in Couples and New dads is. Look , I'm doing everything for my family. I'm working , I'm providing , I'm taking care of all the bills and all the business. But my partner is still upset at me and they complain that I'm not doing enough. Yeah.
S1: Yeah. How do you help build confidence then , in your partner to be able to do those things that they may be anxious about so that it doesn't , like boil over or or someone just , you know , checks out of the relationship ? Sure.
S3: So first I assess what are the things that you are doing in helping out , and how do you see that being helpful to your partner ? Are you asking , hey wife , mom , mother of the of my child. What are the things that I could be doing more of ? And can you ask for help or , hey , I don't know how to do this. Can you ask your partner to help you out with that ? When we see men coming with issues , we we come from a strengths based approach. And so we like to broaden and build on the things that they're already doing. In addition to that is creating balance and flexibility. So if you are dedicated , hard working perseverance in your career , how do you then expand that to applying those same values to your relationship to fatherhood ? So what does it look like to be committed and hardworking in being a parent ? What does it look like being hardworking and committed to your partner ? And so we we kind of walk through some of those exercises. And and it it may feel awkward and forced at first , but it's all exposure and it's all it's all skill. And so when we frame it as a skill , men are a little bit more apt to to try it out because they're like , oh , if it's a skill , I can get better at this. It's not something inherent that maybe I just don't have or I don't feel like I have.
S1: But like , so say , as a wife or a partner , how do you help your , uh , the man in your life ? Mhm. Get the get that confidence like there's a certain level of patience. Right. That one must must use and have. Yes.
S3: Yes. And I think that's what Dan was alluding to with the maternal gatekeeping. Right , is understanding my own anxiety and my own tolerance for. Yeah , maybe he didn't put the diaper on quite right this time. Is he open for some suggestions right now , or is it really not that big of a deal that the tab is just a little bit over the edge and you know the baby's going to get scratched a bit ? Maybe next time he'll , he'll see the the error of his ways. But allowing him to build confidence and and if it looks or feels really scary , do it in a very slow and gradual way. Introduce him to diapers. Introducing bottle feeding like allow him to be involved if he has this desire to be involved. Allow it invited. Provide opportunities for him to build that confidence. Because then it's going to build confidence for both of you. Yeah.
S1: Yeah. Well , finally , any advice for men on ways to improve their relationships with their partners , regardless of the stage they're at ? Dan.
S2: So , yeah. This is. How much time do you have ? Um , we see a lot of men who have experienced unproductive conflict , and that's a that's a polite way of saying that. Um , and oftentimes these these guys will retreat into a sort of traditional male shutting down. And the thought process sounds something like , well , whenever I try to talk or talk about it , it just goes badly for me. So I'm not going to talk about the relationship or my concerns. And then you're falling in line with fairly , you know , traditional way of being a dude like you stuff it and move on and that can that can work in the short term , but usually in a relational context , it just builds up more and more pressure and resentment and tends to come out as emotional rock throwing or vomiting and being able to have built in the ability to talk in a productive way about what's going well and what isn't. Those are really important skills. And so , for example one , we have a new offering through our clinic that is for it's relationship training for men. And to our knowledge , there was saying there there are not established protocols , but the way that we go about it is to first we pull the men themselves into day one. And so it's only the men that come on. It's it's like a weekend , Saturday , Sunday. And so it's only them and we run through how to better handle difficult emotions , emotional regulation. How do we look at , you know , nuts and bolts communication. How do we have difficult conflicts , assertive communication and so forth. And then the next day they bring their partner and we go back through it again , generally , and then we break them out and they get a chance to practice. And then of course there there are points of follow up. So that's all kind of tactical relational stuff. One other point I would make and dudes never want to hear this one , but it's a fact. A very common part of our treatment plans in doing couples work is to assess outside of the couple's relationship. Who are your sources of social support ? And your average guy doesn't have any. He has a little. Or it's like , I don't really talk to them that much , but it's super , super common that he has a partner that's like , dude , go out , go do Bible study or to surfing or coffee or whatever. The thing is , and your average guy is really good at not doing so , in part because of the awkwardness , closeness and relationships Ships are in a heterosexual context. That's for that's for women. That's for my wife. That's for my girlfriend. However , what you fail to understand and what folks will find kind of confusing when they're talking to a couple is like , hey , I'm here to work on my marriage. And I'm saying , yeah , we're going to do that. And part of the way to do that is you need to slightly expand and deepen your relationships with friends , because essentially what we're doing here is working on you all as relational beings , like in couples , in couples therapy. It's it's the relationship that's that's the patient. Not not either one of them. You got to keep it balanced. But being able to say to them , look , man , um , let's see how you establish a little more closeness in friendships and let's see how that can do double duty and help improve your marriage. Because as you're getting better at relationships and closeness over there , inevitably that's going to flow into your marriage. Yeah.
S1: Yeah. And that goes back to a previous conversation that I know we've had about men and , um , friendships and friendship circles and how to make friends. Yeah. Yeah. Well , Max , you've got the final word here. Great.
S4: Great.
S3: One point I would like to add is the way that we communicate. Our emotions look different to everyone. And a common , maybe pitfall or point of frustration in couples therapy is that it's very emotion focused. And I've heard guys complain about , like , I'm sharing how I'm feeling. You're just not listening. And for some men , that might mean they need to increase the way that they're expressing themselves , either through actions , either through some words or say. And their partners also need to increase their kind of perception or understanding that , hey , he's he's off in the garage quite a lot these days. Is he mad at me or is he just going through something at work ? Is he is he dealing with his emotions in a way that I'm just not understanding. And so instead of getting mad and picking a fight , it might be meeting him with some curiosity and openness.
S1: Good advice from the both of you. I've been speaking with Max Marris. He is a psychologist with the center for Men's Excellence here in San Diego , along with its founder , Dan Singly. Max. Dan , thank you so much.
S3: Thank you for having us.
S2: Thanks for having us.
S1: That's our show for today. I'm your host , Jade Hindman. Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.
