Male Clients Research Articles

Discourses of (Dis)trust and Hegemonic Masculinity: Service Providers’ Perspectives on the Disclosure Process of Men Who Have Experienced Sexual Violence in Childhood

ABSTRACT In this article, we explore the discourses of service providers that influence the disclosure process for men who have experienced childhood sexual violence (CHSV). Previous research has shown that it is typical for men to take over a decade to disclose their experiences of CHSV. Disclosing to a service provider can lead to receiving necessary help, yet men who have experienced CHSV often face gendered challenges within the Finnish healthcare system. Several support organizations for sexual violence were contacted using a non-probability sampling technique to recruit participants. The data for this qualitative study were collected through semi-structured interviews with eight service providers who work with male clients. The data were analyzed using critical discourse analysis. Our findings reveal that men typically do not seek help specifically for CHSV; rather, the issue often emerges while discussing other problems. We identified two distinct discourses that affect help-seeking and disclosure of CHSV by male survivors: a) the discourse of (dis)trust, which is closely connected to whether men discuss their traumatic experiences, and b) the discourse of hegemonic masculinities, in which normative masculinities inhibit men from disclosing. We recommend increasing general awareness of CHSV through various campaigns and incorporating sexual violence education into the curricula for healthcare students.

Toward a Typology of the Client: A Latent Class Analysis Approach to the Consumption of Sex Work in the United States

ABSTRACT Previous research on male clients of sex workers has emphasized the diversity of purchasing behaviors; however, we know little about how to organize or categorize this diversity quantitatively. I employed latent class analysis with survey data from cisgender male clients of primarily cisgender female sex workers in the United States to organize client consumption patterns by the type of venue used to contact sex workers and the frequency of using each venue. I found that patterns of consumption emerged around the frequency and context in which sex work is negotiated, generating six distinct patterns of buying: generalists, internet-only buyers, brothel-only buyers, experimenters, routinized buyers, and opportunists. I used multinomial logistic regression to identify relationships between latent class membership, known covariates, and self-reported motivations for purchase. Classes had small but significant demographic differences around age, income, marital status, arrest history, and international sex work engagement. Motivational differences were observed across classes, including the importance of emotional connection, practicing sexual skills, and relaxation. Implications for future research are discussed.

Financial Literacy and Mobile Banking Usage: The Moderating Role of Demographic Characteristics

This study aimed to analyze the relationship between financial literacy and mobile banking ‎usage, considering the moderating role of demographic characteristics among commercial ‎bank clients in the Jordanian southern provinces of Jordan. Using a sample of 1,380 commercial bank clients from ‎Jordan's southern region. To achieve the study's objective and test its hypotheses, the authors employed the quantitative method and utilized SPSS software version 28 for data analysis. The results revealed a strong positive relationship between ‎the level of financial literacy and mobile banking usage, with a moderating role of ‎demographic characteristics on the relationship between the level of financial literacy and ‎mobile banking usage. The study found that male clients and individuals with higher income levels were more inclined to utilize mobile banking services compared to female clients and those with lower income levels. On the other hand, age and educational level did not show a ‎moderating effect on this relationship. Based on the findings, the study recommends enhancing financial literacy through the development of programs and diverse digital banking products to meet client's needs, thereby promoting the adoption of mobile banking services. ‎

African American Men and Mental Health

African American men face challenges that include internalized negative social identities, marginalization, oppression, systemic racism, invisibility syndrome, targets of violence, murder, and erasure. Social workers may place the population at further risk of harm by using methods influenced solely by Eurocentric values. There is a paucity of peer-reviewed journal articles in the social work literature regarding the mental health of African American men. The literature fails to support social workers in acquiring the clinical skills required to provide services to African American men. This article will provide guidance to improve assessment, diagnosis, and clinician engagement with adult African American male clients. Barriers to the care of this population include the stigma of receiving mental health services, avoidance of vulnerability, medical distrust, clinician bias, no knowledge culturally expressed symptomology of mental illness, and an absence of culturally responsive care. Theories that inform the work with African American men in this article are the social determinants of health theory, intersectional theory, and narrative theory.

A Multi-site Examination of Relationship Violence Intervention Program Attrition for Male and Female Clients

The current study addresses the paucity of research on relationship violence intervention program (RVIP) attrition examining both male and female clients and risk factors for attrition across gender. Bivariate comparison tests and logistic regression were used to examine gender differences among participants from four RVIPs in Maryland that serve both male and female clients ( n = 1,307). Findings showed significant bivariate differences by gender for 14 of the factors examined. Less than half of clients (48%) completed RVIP, and women were significantly more likely to complete than men. A greater number of factors predicted attrition for male clients, but unemployment was the strongest predictor of attrition for both men and women. Implications for integrating gender-responsive practices into RVIP are discussed.

Documenting the Provision of Emergency Contraceptive Pills Through Youth-Serving Delivery Channels: Exploratory Mixed Methods Research on Malawi's Emergency Contraception Strategy.

Emergency contraceptive pills (ECPs) are effective and can be used safely at any age repeatedly within the same cycle. They are often favored by youth yet are underutilized. Private facilities can increase ECP access but present barriers including cost. Identifying effective public-sector ECP distribution models can help ensure equitable access. The Malawi Ministry of Health developed a strategy to improve ECP access in 2020. We documented ECP provision through select public, youth-serving channels recommended by the strategy: general and youth-specific outreach, paid and unpaid community health workers (CHWs), and youth clubs. We conducted this mixed methods study from November 2022-March 2023 in 2 rural districts (Mchinji and Phalombe) implementing the strategy. We conducted qualitative interviews with 10 national stakeholders, 46 providers, and 24 clients aged 15-24 years about ECP service delivery. Additionally, 25 providers collected quantitative tally data about clients seeking ECPs. We analyzed qualitative data using grounded theory and quantitative data descriptively. Stakeholders and providers reported ECP uptake increased in geographies where the strategy was implemented, especially among youth. Providers documented 3,988 client visits for ECPs over 3 months. Of these visits, 26% were from male clients, 36% were from clients aged younger than 20 years, and 64% received ECPs for the first time. Across channels, youth club leaders and unpaid CHWs reported the most client visits per provider and served the youngest clients. However, no ECPs were dispensed during 29% of visits due to stock-outs. While many providers were supportive of youth accessing ECPs, most held unfavorable attitudes toward repeat use. ECP access should be expanded through provision in the studied channels, especially youth clubs and CHWs. However, to meet demand, the supply chain must be strengthened. We recommend addressing providers' attitudes about repeat use to ensure informed method choice.

Sampling Strategies for Assessing Male Clients of Female Sex Workers in Public Health Research: A Compilation of Global Evidence.

Clients of Female Sex Workers (FSWs) are major bridge population in HIV transmission. Any research among them remains challenging because they are hidden within society. The objective of this review was tocompile the global evidence on different sampling strategies used to access male clients of female sex workers for research purpose, the challenges faced during the sampling process andpossible sources of bias. Original articles and reports published globally in last 10years, in English language and those with full text freely available online were included in this scoping review. A comprehensive search was carried out among the electronic peer-reviewed literature database (Pubmed and Web of Science) using a pre-designed peer reviewed search strategy. Narrative synthesis was applied out across all such articles. A total of 36 articles were finally included in this review. The common sampling techniques used include convenience sampling, referral by FSWs/ pimp/brothel manager/clients, time location cluster sampling, use of virtual network, anonymous telephone survey, referred by clinicians of STI clinic etc. Overall response rate varied between 35 and 90%. Major challenges in participant recruitment included non-response, feasibility issue specially to cater non-brothel-based clients, safety issue for investigators, over-representation of clients with lower socio-economic status, higher refusal rate for known HIV positive clients to provide biological sample etc. As different sampling techniques have comparable response rate, it can be recommended that a pilot study should be carried out in local context to finalise appropriate participant recruitment technique for a given population.

Clients’ and providers’ perspectives in informing a digital health intervention to improve linkage to care after Index HIV self-testing in Hai and Moshi Districts, Tanzania

BackgroundDigital health interventions have the potential to improve linkage to care after HIV self-testing (HIVST). This study aimed to understand clients’ and providers’ perceptions of benefits, and barriers of a digital health intervention designed to improve linkage to care after HIV self-testing in Tanzania.MethodsThis exploratory qualitative research study was conducted in Hai and Moshi, districts in Kilimanjaro region, Tanzania. Four health facilities were selected based on their involvement in an HIVST pilot program implemented by Elizabeth Glassier Pediatric AIDS Foundation (EGPAF) Tanzania through the USAID funded program. The study included female index clients and their partners, and healthcare providers at the healthcare facilities. We used a semi-structured interview guide with open-ended questions for data collection. Data collection was conducted from 16th January 2023 to 3rd February 2023. Thematic analysis of the qualitative data was conducted, guided by the Health Belief Model (HBM), and results were developed in collaboration with the community partners.ResultsA total of 42 participants were included in the study, comprising 9 male clients, 17 female index clients, and 16 health care workers (HCWs) (4 male and 12 female) who were involved in delivering HIVST services. The study’s findings revealed mixed feelings about the use of a digital health intervention. Majority of participants perceived digital health as a valuable intervention for enhancing linkage to care, improved health outcomes, improved communication with healthcare workers, and increased privacy. Therefore, they supported scale-up of a digital health intervention. Participants also expressed that the potential benefits of a digital health intervention include the convenience of accessing healthcare services from the comfort of their homes or any location. However, a few participants expressed concerns about potential risks associated with sending health-related text messages. They feared that recipients might not be in a safe space, leading to stigma and avoidance of engagement. A few female participants expressed concerns about confidentiality breaches, particularly regarding shared phones with family or friends. Fear of being judged or misunderstood by others could deter them from reading or acting upon these messages. Most participants recommended tailored strategies that prioritize confidentiality and trust. Recognizing these psychological aspects is vital for customizing digital health interventions to effectively address participants’ concerns.ConclusionsDigital health interventions may improve the linkage of HIV self-testers to care. Recommendations include personalized and culturally relevant communication and technical accessibility to make interventions effective and inclusive. This study provides valuable insights for designing patient-centered interventions for HIV care and treatment.

Understanding the Role of Masculinity through the Perspectives of Countering Violent Extremism (CVE) Intervention Practitioners Engaged in Men’s (de)Radicalization

Within the field of Countering Violent Extremism (CVE) male clients are overwhelmingly represented, which reflects the key and complex significance ‘masculinity’ has for understanding susceptibility to violent extremism, processes of radicalisation and related issues. This article analyses the perspectives of 12 CVE Intervention Practitioners (n = 8 female, n = 4 male) in Australia and their views on the role gender plays in their work. We focus on the practitioners’ experiences with male clients and how they understood the relationship between gender, rapport building and (de)radicalization. The practitioners highlight how a common aspect of their clients’ ideology involved either explicit misogyny or quite rigid opinions regarding the roles of men and women in society. They often mentioned their male clients experienced difficulties in expressing and understanding their own masculinity. However, while it is important to identify commonalities within the gendered dynamics present in CVE work, the data suggest the interaction between practitioner and client continues to be quite varied. We argue that this highlights not only how masculinities are discursively produced, but how male clients may shift between identity positions during deradicalization depending on their interpersonal interactions.

Longitudinal relationships between anti-fat attitudes and muscle dysmorphia symptoms

Weight stigma, and more specifically, anti-fat attitudes, is associated with disordered eating. Furthermore, these anti-fat attitudes influence various appearance ideals. Muscle dysmorphia (MD) is characterized by preoccupation with the muscular ideal and is a potential form of disordered eating commonly experienced by men. Despite theory suggesting that anti-fat attitudes may contribute to MD, research has yet to examine associations between anti-fat attitudes and MD symptoms. Therefore, the current study investigated longitudinal relationships between anti-fat attitudes and MD symptoms. Participants were 269 U.S. men recruited from Prolific who completed three self-report surveys each separated by one month. Primary analyses examined longitudinal relationships between specific anti-fat attitudes and MD symptoms using an adapted three-wave cross-lagged panel model. Results demonstrated that believing that fat people do not have willpower was longitudinally associated with desires to increase muscle size at multiple time points. Furthermore, MD-specific functional impairment predicted fears of becoming fat longitudinally. Practically, men may desire to increase their muscularity to demonstrate their own willpower and distance themselves from anti-fat stereotypes. Thus, clinicians may consider targeting weight stigmatizing attitudes to reduce MD symptom severity among their male clients.

Health impact, budget impact, and price threshold for cost-effectiveness of lenacapavir for HIV pre-exposure prophylaxis in eastern and southern Africa: a modelling analysis

Injectable lenacapavir administered every 6 months is a promising product for HIV pre-exposure prophylaxis (PrEP). We aimed to estimate the health and budget impacts and threshold price at which lenacapavir could be cost-effective in eastern and southern Africa. We adapted an agent-based network model, EMOD-HIV, to simulate lenacapavir scale-up in Zimbabwe, South Africa, and western Kenya from 2026 to 2035. Uptake assumptions were informed by a literature review of PrEP product preferences. In the main analysis, we varied lenacapavir coverage by subgroup: female sex workers (40% coverage); male clients of female sex workers (40%); adolescent girls and young women aged 15-24 years with more than one sexual partner (32%); women aged 25 years and older with more than one sexual partner (36%); and males with more than one sexual partner (32%). We also assessed a higher coverage scenario (64-76% across subgroups) and scenarios of expanding lenacapavir use, varying from concentrated among those at highest HIV risk to broader coverage including those at medium HIV risk. We estimated the maximum per-dose lenacapavir price that achieved cost-effectiveness (<US$500 per disability-adjusted life-year averted), infections averted, and 5-year budget impact, compared with daily oral PrEP only. In the main analysis, lenacapavir was projected to achieve from 1·6% (95% uncertainty interval [UI] 1·5-1·8) to 4·0% (3·4-5·1) population coverage across settings and to avert from 12·3% (5·4-19·5) to 18·0% (11·0-22·9) of infections over 10 years. The maximum price per dose was highest in South Africa ($106·28 [95% UI 95·72-115·87]), followed by Zimbabwe ($21·15 [17·70-24·89]), and lowest in western Kenya ($16·58 [15·44-17·70]). The 5-year budget impact was US$507·25 million (95% UI 436·14-585·42) in South Africa, $16·80 million (13·95-22·64) in Zimbabwe, and $4·09 million (3·86-4·30) in western Kenya. In the higher coverage scenario, lenacapavir distribution was projected to reach from 3·2% (95% UI 2·9-3·6) to 8·1% (6·8-10·5) population coverage and to avert from 21·2% (95% UI 14·7-18·5) to 33·3% (28·5-36·9) of HIV infections across settings over 10 years. Price thresholds were lower than in the main analysis: $88·34 (95% UI 83·02-94·19) in South Africa, $17·71 (15·61-20·05) in Zimbabwe, and $14·78 (14·33-15·30) in western Kenya. The 5-year budget impact was higher than the main analysis: $835·29 million (95% UI 736·98-962·98) in South Africa, $29·50 million (24·62-39·52) in Zimbabwe, and $7·45 million (7·11-7·85) in western Kenya. Expanding lenacapavir coverage resulted in higher HIV infections averted but lower price thresholds than scenarios of concentrated use among those with highest HIV risk. Our findings suggest that lenacapavir could avert substantial HIV incidence and that price thresholds and budget impacts vary by setting and coverage. These results could inform policy deliberations regarding lenacapavir pricing and resource planning. The Bill & Melinda Gates Foundation.

Knowledge and Attitudes of Circumcision among Adult Male Clients Receiving Care in a Teaching Hospital in Kigali City, Rwanda

Knowledge and Attitudes of Circumcision among Adult Male Clients Receiving Care in a Teaching Hospital in Kigali City, Rwanda

Task‐Designated Identities in Danish Homeless Shelters

This paper is based on an ethnographic study of how domesticity is enacted and adapted at homeless shelters for determining which clients are “service worthy .” The study draws on nineteen placement meetings with homeless men and focuses on institutional mechanisms for encouraging homemaking skills or domesticity among clients. Adapting Robert K. Merton's typology of adaptations to social norms, as well as Jaber Gubrium's “task‐designated identity,” we showcase male clients' self‐presentation strategies for adapting to the institutional mandates of domesticity. Specifically, our qualitative analysis reveals four modes of task adaption: (1) task conformity by professing the desired norms in their service encounters, (2) task evasion to avoid conversations and related tasks, (3) task transformation by linking the task at hand with something other than originally intended, particularly by reframing biographies to meet the local goals of domesticity, and (4) task protestation, which involves questioning the rationale and necessity of assigned tasks.

Expectations versus reality: psychology trainees’ experiences working with men

ABSTRACT Despite increasing engagement with mental health services in Australia, therapy dropout rates for men remain high, most commonly due to a lack of connection with their therapist. Previous studies have examined the challenges men face when attending therapy, the obstacles therapists encounter when working with male clients, and the subsequent recommendations for therapist training that have emerged from these findings. However, to date there has been no investigation into the experiences and needs of trainee therapists working with men. It is unclear how their status as trainees influences their perception and adaptability when providing care for male clients. The current study therefore explored psychology trainees’ expectations, experiences, and preparedness regarding their psychotherapeutic work with men. Qualitative interviews were conducted with 12 students undertaking clinical psychology training from a single Australian University, focusing on their experiences working with male clients throughout their clinical training. Reflexive thematic analysis was undertaken to develop three themes: (1) Mismatched expectations of manspeak, which explored the ways in which students expected and experienced male engagement, (2) Gratifying work, which highlighted elements of therapeutic work with men that shaped participants’ sense of competence, and (3) Working with the “macho man”, which described the challenges of working with men, such as managing boundaries, misogyny, and personal safety. Findings suggest psychology trainees may benefit from additional training in university curriculums which specifically addresses some of the complexities of therapy with men. This training could illuminate how masculine socialisation affects men’s engagement in psychotherapy in practice and provide strategies for trainee therapists to support male engagement.

Implementing a male-specific ART counselling curriculum: a quality assessment with healthcare workers in Malawi.

There is little HIV counselling that directly meets the needs of men in Eastern and Southern Africa, limiting men's knowledge about the benefits of HIV treatment and how to overcome barriers to engagement, contributing to poorer HIV-related outcomes than women. Male-specific approaches are needed to improve men's outcomes but may be difficult for healthcare workers (HCWs) to implement with fidelity and quality in low-resource settings. We developed a male-specific counselling curriculum which was implemented by male HCWs and then conducted a mixed-methods quality assessment. We audio-recorded counselling sessions to assess the quality of implementation (n = 50) by male HCWs from two cadres (nurse, n = 10 and lay cadre, n = 10) and conducted focus group discussions (FGDs) with HCWs at 6 and 9 months after rollout to understand barriers and facilitators to implementation. Counselling sessions and FGDs were translated, transcribed and analysed using thematic analysis adapted from WHO Quality Counselling Guidelines. We assessed if sessions were respectful, informative, interactive, motivating and included tailored action plans for overcoming barriers to care. All data were collected September 2021-June 2022. All sessions used respectful, non-judgemental language. Sessions were highly interactive with most HCWs frequently asking open-ended questions (n = 46, 92%) and often incorporating motivational explanations of how antiretroviral therapy contributes to life goals (n = 42, 84%). Few sessions included individually tailored action plans for clients to overcome barriers to care (n = 9, 18%). New counselling themes were well covered; however, occasionally themes of self-compassion and safe sex were not covered during sessions (n = 16 and n = 11). HCWs believed that having male HCWs conduct counselling, ongoing professional development and keeping detailed counselling notes facilitated quality implementation. Perceived barriers included curriculum length and client hesitancy to participate in action plan development. Findings were similar across cadres. Implementing high-quality male-specific counselling using male nurses and/or lay cadre is feasible. Efforts to utilize lay cadres should be prioritized, particularly in low-resource settings. Programmes should provide comprehensive job aids to support HCWs. Ongoing training and professional development are needed to (1) improve HCWs' skills in tailored action plans, and (2) sensitize HCWs to the need for self-compassion within male clients to promote holistic sexual health.

‘Lads are daft though, aren’t they?’ Exploring men’s narratives of mitigating food insecurity and navigating food aid

Research on food insecurity and food aid has focused overwhelmingly on the experiences of women, particularly mothers, with little focus to date on exploring single men’s experiences. This article will explore the experiences of single men across two independent studies of food insecurity and food aid, based on an ethnographic study undertaken with predominantly male clients of food aid schemes in north-east England and a photo-elicitation study undertaken with single men experiencing food insecurity in Scotland. The article will explore how austerity measures heightened men’s levels of food insecurity and need for food aid, and how men’s perceptions of gender roles and stigma influenced where and when they asked for support. The article argues that adverse life events, such as homelessness, contribute to heightened levels of food insecurity. In addition, the social role of food aid will be explored, with participants using sites of food aid not just for physical nourishment but also as a space to connect. Finally, the article will explore the participants’ insights into high male attendance at sites of food aid, often blaming other men’s lack of basic budgeting and cookery skills so as to justify their own deservingness. The article seeks to contribute to addressing a gap in the literature in relation to men’s experiences of food insecurity, and concludes with recommendations on how to support men at risk of using food aid and experiencing food insecurity.

Decolonising integrative practice with Black queer men who experienced trauma: A thematic analysis

AbstractAimBlack queer men in the UK are increasingly at risk of mental health problems related to anxiety and depression, often triggered by traumatic experiences. This study explored the efficacy of integrative practice with Black queer men who experienced trauma from a decolonised, intersectional and queer‐affirming perspective.MethodOne‐to‐one semi‐structured interviews with nine integrative practitioners were completed. Data collected from these interviews were analysed using Braun and Clarke's six stages of reflexive thematic analysis (RTA).FindingsRTA identified four subordinate themes: (1) understanding the experience of Black queer men, (2) developing the working alliance and use of self in practice, (3) effective integrative practice and (4) intersectional differences and considerations. Findings discussed the varying forms of trauma Black queer male clients experienced that impacted their mental health and how developing a strong working alliance with Black queer men was crucial when supporting them to recover from trauma. Additionally, the participants described a breadth of trauma‐informed integrative counselling and coaching practice. A decolonised approach utilising the intersection of race, gender and sexuality of Black queer men was successfully integrated into the approach used by practitioners in this study.ConclusionOverall, this study evidenced that a decolonised perspective to integrative practice effectively supports Black queer men to recover from trauma. Future research should focus on an integrated approach with Black queer men and other gender and sexual ethnic minority clients who experienced trauma.

Equity in Mental Health Care Receipt among Youth Who Use School-Based Health Centers

Youth experience significant mental health (MH) needs, and gender- and racially/ethnically-diverse youth are less likely than peers to receive care. School-based health centers (SBHCs) are a healthcare delivery model that may decrease disparities. This study examined the role of SBHCs in reducing disparities in MH care receipt among SBHC clients. Data from electronic health records of 5,396 youth ages 12 to 21 years who visited 14 SBHCs in one California county from 2021-2023 were analyzed in 2023-2024 using multiple logistic regression to assess disparities in MH care receipt and depression screenings. Receipt of MH care from SBHCs varied significantly by gender but not age, sexual orientation, or race/ethnicity. Compared to female clients, males had reduced odds (AOR: 0.50) and gender-diverse clients had higher odds (AOR: 2.70) of receiving MH care. For receipt of depression screenings, male clients had reduced odds (AOR: 0.86); Latino clients had higher odds than white clients (AOR: 1.80); and older adolescents and young adults had higher odds than younger adolescents (AORs: 1.44 and 1.45, respectively). Receipt of follow-up MH care after a positive depression result varied only by gender, with male clients having reduced odds (AOR: 0.63). SBHCs may reach youth who are traditionally less likely to seek care in other settings, including racially/ethnically- and gender-diverse youth. As in other settings, engaging males in healthcare is an area for improvement. These findings help to demonstrate the potential of SBHCs for decreasing disparities in mental health care.

Integrating the science of epigenetics with existential–humanistic counseling to increase wellness with Black males

AbstractThe recent emphasis on racial unrest and systemic inequality perpetuated by COVID‐19 has made the counseling profession seek more appropriate methods for clients, especially with Black males. Epigenetics, a science examining how behaviors and environment intersect to impact gene expression, could serve as this tool. This article advocates for providing therapy through an epigenetics framework, integrated with existential–humanism to give counselors the tools necessary to work with contemporary Black male clients.

Levels of Therapeutic Relationship When Working With Male Clients

At a time when men are seeking therapeutic support at increased levels, identifying and responding to the type of engagement sought by male clients increases the possibility for stronger engagement and retention of men in therapy. This highlights the importance of the perceived challenges of engaging and working with male clients, particularly in attempting to overcome the temptation to label such clients as “resistant”. In 1988, Steve de Shazer and the Brief Family Therapy Centre proposed that clients present seeking different levels of therapeutic engagement (visitor, complainant, and customer relationships). A more recent solution-focused model originating in Bruges has suggested similar levels of engagement between client and practitioner (uncommitted, searching, consultant, and expert relationships; Isebaert, 2016). This paper compares and discusses the two models of therapeutic engagement levels and considers the clinical implications of these for working therapeutically with male clients.