Clinical Work With Men: Integrating Masculinity, Mental Health, and Spiritual Concerns - Episode 1

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Transcript

SPEAKER_01 0:01

You are listening to Vital Signs, a podcast for Sentera Providers. This is part one of a two-part series on men and spirituality with Brian Helm, licensed professional counselor with Sentera Health. Have you guessed it? Part one is going to be men. Part two is going to be spirituality. We like to keep it simple. Before we turn things over, here are a few important CME announcements. This episode is accredited for AMA PRA Category 1 credits. For full accreditation, designation, and disclosure information, please refer to the show notes. And now the show. Hi, Brian. Thanks for joining us today on Vital Science, man. So, you know, before we get started, why don't you tell us about yourself?

SPEAKER_02 0:51

Sure. I appreciate you uh bringing me on. Uh so my name is Brian Helm. Uh I am uh trained as a licensed professional counselor, uh licensed substance abuse treatment practitioner. Um, and I have been in the field since licensed since 2010, graduated in 2008, um, and just worked in a lot of different roles, uh, whether it be uh, you know, at the CSB as a clinician, uh in residential treatment with adolescents, um, and then uh just outpatient provider working with uh veterans, first responders, and then also with children. So a lot of wide range of experience uh to uh build off of.

SPEAKER_01 1:36

Right. And where are you now?

SPEAKER_02 1:38

So I am currently a project manager um working with uh several projects uh in the uh centera system, trying to help integrate substance use uh into the health system, substance use programs, and also some behavioral health initiatives uh throughout the system.

SPEAKER_01 1:57

See, and I think people, yeah, before you said that second half, people are like, how do you go from counselor to project manager? I mean, that that makes what that is not a career path. But what I'm hearing though is again, you know, I work in the MCO, uh, and I build I build programs and my LPC background really helps with it. So how does your clinical background help you build these programs now? Because I I do think that's uh a lot of our listeners would want to know.

SPEAKER_02 2:23

Um I think uh, you know, yeah, if I use the weightlifting metaphor, you know, I think uh as a uh full-time clinician, I was doing like bench, you know, I was working my chest, and I think becoming a uh project manager, you use those muscles, but you're also using a lot of muscles you've never used before. So you fall on what you know, and then you use a little bit of instinct and uh uh a lot of request help when a lot more. Um so uh, but how do you use like uh what I already have? Like um, I'm trained in several evidence-based practices, uh, whether it be with couples, substance specific for adolescents, uh uh, you know, dealing with anxiety for uh middle school and high school age, um, all the way up to uh, you know, creating, helping create a program for uh PHP, um, running an IOP program uh for adolescents. Um, and then being on the uh residential side. So you have a lot of background and experience, but it applying it in the project management uh is you just kind of jump in um and offer the information that you have. And uh I think being humble and not assuming I know everything, um, and also being very willing to learn.

SPEAKER_00 3:46

Yeah. So you went from powerlifting to ballet and realized uh there's some muscles you never used before, huh?

SPEAKER_02 3:53

Yes, uh that's a very good transition. It feels like it was a it was a hard transition, uh, but I am learning how to dance and that's something beautiful.

SPEAKER_01 4:01

I love it. So I did hear some background and first responder veterans and things like that. Usually male-dominated fields. So I'm trying to do a very awkward transition to the topic today. We're talking about masculinity, we're talking about spirituality through this podcast series, sis go around. And so, what got you interested in working with men in particular?

SPEAKER_02 4:23

Um, I've you know, that's I have been uh besides you're a guy. Uh I think uh, you know, it's a little bit about my story. Like uh, you know, I uh left uh at an early age, around like uh 17 or 18. Um and uh have always sought out mentors in my life, uh, whether I was aware of it or not. Like uh, and I think uh that has really, really shaped me. And you're gonna hear this reverberate throughout our discussion. Um, but I see a need uh for men. Um, you know, I served with the 82nd Airborne for a tour um uh down at Fort Bragg. Uh and so uh I got to see like if you ever want to see like uh rites and passages for men, um, the military has it nailed. Um and I think also first responders, there's rituals that are a part of their uh that I think uh our culture is missing, but they've now they've navigated it well. Yeah. Um, and so uh there's a real desire to uh come alongside. There's a lot of uh men uh that don't have that, and there's a real need for it. So I think there's a a passion, uh not that I have the answer, but I seem to have found something that worked for me and try and help them either curate their own or at least share some examples of what worked.

SPEAKER_01 5:53

I love it. And I'm and I'm I'm thankful you mentioned law enforcement. Um I was I'm a former police officer too, and and you know, we're both LPCs, we're both counselors. Uh not exactly a um, okay, hey ladies, close your ears. Um, not exactly a male-dominated field, right? There's a there's we're we're definitely in uh a minority here in the uh in the field. And then let me let me let me say something potentially controversial. Um, that a lot of the men in our field, you know, it's of course there's a wide range, but you know, that they're not we're all we're so diverse that like my experience in law enforcement, I had bros, you know. I'm sure in the 82nd Airborne you had bros.

SPEAKER_02 6:39

Yes, right? But tight net crew.

SPEAKER_01 6:42

Yeah. Um, but in the in the counseling world, our our male colleagues, they're they're colleagues, they are very sensitive, they are thinking differently than a lot of our bros in in the uniform services. So uh I think it is a different experience, and there is no right of passage in our field. So I I do think I I think that the the the difference, the contrast is very stark. And I I gotta tell you, being at former law enforcement, I don't miss the pay, I don't miss the hours, I don't miss the uniform and the danger, but I miss I miss my my tribe. I missed it terribly. Yes, something I do not have anymore. And I know you probably have a similar experience.

SPEAKER_02 7:23

Yes, I uh, you know, I remember uh counting down the days, like you know, 90 days and a wake up uh till I could get out of the military. I remember uh, you know, signing out at Fort Bragg, and I remember leaving and heading on down to uh start my undergrad at UNC Wilmington. And I remember missing the camaraderie, uh not realizing and trying to go back and uh to the barracks and see all the guys. And the reality was like that door had closed when I took the uniform off and um that connection to my tribe was gone. And it was that was a hard one for me. Um, because uh, you know, there's something to be said for dealing with adversity amongst brothers, uh amongst men, um, that forms a bond. And I'm sure as a law enforcement, you know that well. Having to go through some, I've seen the LEDA training. I mean, it's some of it's very similar to boot camp training, uh, and it it does form uh a forge you together.

SPEAKER_01 8:20

And there's something no other organization can quite understand. When I meet another Leo or former Leo, I know they know, you know, and I bet if you meet another soldier, you're like, I know you know. And I don't know, I'm not a soldier, I've never been in uh uh in the army and I have no idea. And there's a things about y'all that I have no idea, but that's your tribe, right? And it's but there's a lot of comfort in knowing that I can find a guy that was behind the blue line and say, I I already know that I'm safe with you in some regards.

SPEAKER_02 8:51

So yeah, and I think you know, that's one of the things that I think a lot of men, you know, when I work with um the number one focus when I'm working with uh young man or older man is uh in therapy. The goal is to help you. How can you find your tribe? Like if you can't find one that's already existence, how can you create something that's attractive to bring others in to create your tribe?

SPEAKER_01 9:17

Because yeah, that's definitely a need. And then, you know, I I'm talking about myself a lot. I lost my father early, right? And not having that mentor in my life, someone that I can call. I mean, thank God. I mean, I'll talk about what I've personally gone through to help with that, but um you know that that's a that's once once once that mentor, that leadership figure out of your is never or never never exists or or is out of your life, that absence is very, very real. Right? Yeah, yeah. So you know, and I know we can we kind of beat around the bush, but how do these tribes and these mentors how do they influence, you know? Let's go back to our our our field, we're counselors. How do they influence, you know how we we express our emotions?

SPEAKER_02 10:16

Um I think uh the the tribe that you work with, the people that you're around, they did they really set the parameters for men about what's okay and what's not okay. Um, you know, and uh in the the military, I would say I know in the army probably uh uh in others, you know, the the saying suck it up and drive on, um, you know, is very common, suck it up, butter cup, um, you know, put your feelings in a bag, you know, whatever it is, like uh um there there's a culture around like what how you deal with emotion. Um, and it uh becomes very uh I don't know, very narrow. Like anger is approved in uh in most male settings, it's understood, but the more nuanced or more vulnerable emotions is uh very risky.

SPEAKER_01 11:08

Yeah.

SPEAKER_02 11:08

Uh depending on the tribe.

SPEAKER_01 11:10

Uh in my tribe, we you know, some said warrior mindset, but we had guardian mindset. And if you think of that, just if if you can close you don't have to close your eyes. Listener, close your eyes and think of a guardian. What do you see? I personally see a guy with a shield, you know, standing there, very stoic, you know, the guy in front of Buckingham Palace that nobody can nobody can flap, right? That that's not that's not uh conducive for emotional expression, is it? Right, warrior mindset. That's a conducive for uh anger, aggression, right? But uh that that is a specific thing, but that those are the cultures that you and I have been uh kind of came of age in in many ways. But what about other men in the in the world? What what do you think they're they're experiencing?

SPEAKER_02 11:54

Um you know, I think uh the men that I've interacted with, uh there is this idea of you know Western masculinity. I think we've heard things like uh that are being thrown around alpha male, beta male, toxic masculinity, all these different things. Uh but you know, I don't know. Um I just don't see a lot of healthy masculinity uh being presented as this is kind of who we are trying to be. They love to tear down, but there's very few that try to build up and say this is what a healthy guy looks like, or you know, and I I think um I think masculinity is not static. I think you know, there's different stages where you know uh we present differently. I think masculinity at, you know, as a family man looks very different from masculinity as a 20-year-old single guy. Um, and it should. I don't think it should stay static. I think there are some principles that should, you know, uh stay the course, but they have to change and morph.

SPEAKER_01 13:02

Um and you say that that you know there's differences in presentation throughout your um throughout, of course, the lifespan, but then men have specific presentations of things, multiple different issues, depression, anxiety, you name it. What so when we think anxiety, when we think depression, we have pretty specific as counselors and just any any profession in this field have pretty specific ideas of what that looks like. But are there some nuances with men that tend to I think lead to underdiagnosis of issues among men? Well, yeah, what are there are there ways men present things that just show oh he's just uh he's just a rage rage head um or uh uh uh um you know personality disorder narcissist or he has no emotional you know what I'm talking about? Like this it when really in my experience, a lot of those guys may have extreme anxiety and insecurity because um they were abandoned by their mother when they were nine and now they don't know they were not emotionally developed, you know what I mean? So um it's not because they're just angry jerks. So what do you see in in the um in the field?

SPEAKER_02 14:21

You know, I I think you're hitting it. I think a lot of times uh people come in because they're angry. A lot of uh people that I work with come in because they're having marital issues or relational issues.

SPEAKER_03 14:33

Yeah.

SPEAKER_02 14:34

Um and uh, you know, they present angry, they present irritable, you know, if you you pick at the anger. Um there's often like uh grief uh that's not sexy to feel.

SPEAKER_03 14:48

Right.

SPEAKER_02 14:49

Um, you know, there's uh shame. Uh, you know, every man's uh constantly has to ask, do I have what it takes for the situation? The constant question of a man. And so if they can't answer that well, like no, I don't, then there's that shame that can come up and that uh will often mask itself as anger. It's a quick defensive, it's the armor to hide behind the little boy in us, you know. And so I think uh um being aware of what's underneath, and I do want to call men out and say just because there is this underneath, we are still need to be held accountable for how we act and what we say. Um, accountability is definitely, I think, a key piece to healthy masculinity. Um, and so uh, but I do see it uh come up in different ways uh throughout, but there are some key themes of that, you know, the shame, the grief, um depression.

SPEAKER_01 15:51

Are you telling me guys feel all the same emotions that women do?

SPEAKER_02 15:55

You know, I think they I mean, I think there's research that has consistently shown that it's just the expression of it is very different, culturally different, um, and also just uh gender different.

SPEAKER_01 16:07

Yeah. So and and sometimes that expression, and this is my experience, the that expression of the you know, same emotions, different expression, but that expression is is shamed in our culture sometimes.

SPEAKER_02 16:19

Um yes, absolutely. I think uh, you know, uh what's the one, you know, if uh uh you see on the playground like a uh you know kindergartner, three, four-year-old crying, um, telling just get up, dust off, you know, stop crying. Um, and so uh the message is kind of toughening up, um encapsulating some of the initial emotion. I think that's not necessarily what parents may want, but I think that is kind of the unsaid cultural message. I hear you.

SPEAKER_01 16:53

And so I can I can see this really present preventing men from engaging fully in in a therapeutic relationship. I think some of that's going down where they would at least walk into the counselor's office, but then being present and letting the guard down with the counselor, I think that's still a challenge. How do you address that that that resistance?

SPEAKER_02 17:17

Um, so I have uh I have a ton of things going in my favor. Uh, and I will be very honest, like uh, you know, one, I'm male and I think there's I'm gonna probably get some pushback on this. Um but I would say there are certain things uh when in therapy that I think only men should be working with men on. And before anyone pushes back and says, no, that's not well, I would say what if we flip that in reverse, would you still disagree? Like, are there certain things that women should only work with women on? And I think there are some gender differences. Some are nuanced, but some are profoundly important. Right. And so um uh how I do that, I think, you know, just uh being a man has a piece. I think uh I think uh sharing, I try to be as uh transparent as I can up front about certain things, about what I can and can't do. I try, I am more transparent, especially with um well, I always put out there first responders in military, because there is such a stigma about uh therapy that I tend to be more transparent about certain things around my experiences uh um to help them understand that, you know, I've been on the other side of the couch. This has been my experience. Um, so uh I definitely do transparency. And I think uh, you know, there's a saying uh it's kind of relevant, power achieved is power power perceived is power achieved. Um when I'm working with men, you will lose a guy instantly if they think you can't handle what they have to present. Um so you I have to make sure that they know that I can handle whatever they're bringing. You know, and um initially on, especially like some of you know, I've worked some of the guys that have uh gone through combat and um have uh shared some of the the horrors of war. Like, you know, initially I have to present in a way um to let them know like I can handle it, I am trained, you know, you can present this and uh it's okay. Um on the inside, uh, you know, there's definitely shock and horror, but over time, as they know that um I can handle it, I can also be human and say what's really going on, but they have to know initially that I got this, like it's okay.

SPEAKER_01 19:56

Um what what you know and and what's more traditionally masculine than the um than the uniform services, right? Like and and so people think like, well let's let's think think of our other men in the audience, like, well, I've never been to war, I've never been to boot camp, or you know, I've never held even held a weapon, you know. Am I still a man and and are those masculine issues, do I still have masculine issues? Well, you know, what what what what about me here? You know, I don't have anybody like you you went to war and you were celebrated and you did those hoorah things and now you know I I I show up and I'm uh um I do clerical work. Am I a man still? You know, like what how would you get past their barriers?

SPEAKER_02 20:43

Um I I think uh kind of where you're going, and let me know if I'm going in the wrong direction, is how would you define a healthy man outside of a uniform? Because, you know, what you're bringing up, like the the military and the law enforcement, it's it's it's seen as culturally masculine, so it is an easier path uh to go that route. Um, but I would say, you know, I I like the metaphor, uh, I stole it from the recovery community, but I think it's very relevant of like a healthy man as a healthy lake. Um, you know, you a lake can't be, it has to have areas of depth and it has to have areas of shallows because it has to be able to provide uh nutrients to that which is uh in the lake. Um, so there's areas where men have to have depth, but they also have to be able to do the small talk thing on the edges. Um the key piece to a healthy lake is something nourishing has to be pouring into it. Um, and that is where we can talk more about the spiritual piece, but something has to be pouring into it a mentor, a faith based uh something, or spiritual of some type. But the key piece, and I think is really important because if you have water pouring into a lake but nothing else, it just keeps pouring in, it's going to flood around it. Um, and that is destroying the environment around it. And so I would say I see that a lot where I see men that are getting poured into and doing nothing with it but for themselves, and it's destructive. And I think the key other piece to that is a healthy man pours out into something else. Um he takes what he's given and he pours it out, whether in a mentorship or in a role or something like that. Um, and so I would say, you know, when you look at masculinity, like, you know, we don't think of, you know, the clerical person, you know, doing paperwork in a desk job, not really going out and seeing sunlight a whole lot. But if that is how he's pouring, you know, giving to the company, but he's also doing something maybe as like a boys and girls club or uh um, I don't know, like uh uh something at their church working with uh you know disadvantaged youth, whatever it would be, something where this person he is giving, pouring back out, then I would say that's very masculine. That's the very nature of it.

SPEAKER_01 23:14

So he's even using his clerical work as a vehicle to to provide for others, too.

SPEAKER_02 23:19

Yeah, absolutely.

SPEAKER_01 23:20

Is provision and protection a core masculine trait? Is that something we should hang on to? Like, okay, we have our traditional and toxic stuff, but is provision and protection something we we we really need to think about as a healthy male?

SPEAKER_02 23:36

Yeah, um, yeah.

SPEAKER_01 23:40

I think uh the the very need concept of should, like I said should there. Is that is it is that something we need to let go, you know?

SPEAKER_02 23:49

I I'm I don't know. I mean, perhaps not all, but I would say the vast majority. It's a just a natural inclination to try to uh in a healthy situation. Um there are of course, you know, we are in uh this uh profession where we're looking at uh deviations from the norm. But I think yes, I think that would be healthy to try and protect um and to provide for.

SPEAKER_01 24:15

So in this in this and I know we're we're we're wrapping up on this first segment here, uh but you know, what for for our listeners, what are some common things that kind of spin out of these things? That they don't have mentors, they they don't have a tribe, um, they're hearing these messages about what a man should or should not be. Um they're not a soldier, you know. They they um they got an MBA, you know, you know, and uh what what are these things that tend to spin out clinically? Um are we seeing more depression anxiety? I know one of the highest suicide rates are among middle-aged white men that have existential crises, right? That is the one of the actually the highest suicide rate and you never hear from them, you know. I never when I did pre-admission screenings, I never TDO'd any um, well, I did, but like more often than not, they were more they succeeded, I guess for lack of a better way of putting it, or completed their suicide rather than come and and ask for help. And so um what what are the things that are happening when when when it goes awry? Um, what what what clinical issues?

SPEAKER_02 25:27

Um I was uh saying go, be careful you don't climb the ladder your whole life to realize you've been leaning against the wrong building. Um I think uh I think a lot of people uh go after or chase after something that they think is relevant that they think will bring meaning, meaning. And I think it they become to realize the facade of what it is. I think there's uh uh not a not always a lot of thought into uh what we do. We uh I think now more with uh you know this uh a lot of the younger professionals are not buying into the innocent status quo and looking at other uh means of going about uh how to uh how to do life. But I think uh, you know, that is often like the existential crisis, the midlife crisis is you begin to like take stock, you know, in your middle 40s and you start to really consider like, is this is this really it? Like there's more life behind me than before me, or you're kind of at that apex of like, and people, you know, uh don't always like what they see. Um, and I think uh, you know, if you don't have, you know, when you start to really assess that and take stock, if you don't have people around you, uh, if you don't have um firm foundations of uh, you know, what you're standing on, it can get really shifty. Um and then you have this culture uh that would say, you know, if if you're a white male, you know, you should be doing you should be doing better than everyone else. And so, well, if I'm supposed to be doing better than everybody else and I'm not, then I'm a failure. And so you can see how that could spiral.

SPEAKER_01 27:27

So with that, I think we're gonna take that. I think we have identified the problem. Next part, we're gonna talk about treatment and and how we assess for all this. So thank you, Brian. Yeah. Thank you for joining us today, and we hope to see you in part two of this Men in Spirituality series. You've been listening to Vital Signs, a podcast created by and for Sintera providers. As a reminder, please check today's show notes for details on how to claim your continuing education credits. That's it for now, and we'll see you in part two.