Alternative, Scientifically-Literate Guidelines for Psychological Practice with Boys and Men

Alternative, Scientifically-Literate Guidelines for Psychological Practice with Boys and Men

Gregory Gorelik
Gregory Gorelik

#The American Psychological Association’s “Guidelines for Psychological Practice with Boys and Men” have received much criticism from journalists and professional psychologists. Much of the opposition has centered on the guideline’s attack on “traditional masculinity” and the privileging of activism over evidence-based treatment. One of the few redeeming features of the guidelines is their acknowledgement that men face unique physical, psychological, educational, and social challenges and are less likely to seek psychological treatment to meet those challenges. But the guidelines fail in their targeted goal of preparing therapists to help the men under their care.

Throughout the entirety of the APA’s guidelines, discussion of evolutionary influences on men’s psychological development is either unintentionally neglected or willfully avoided (“testosterone” appears nowhere in the document and, out of more than 400 citations, only four mention either hormones or anything brain- or neuro-related). Whatever the reason, the fact that a sharp distinction is made between “sex” as biology and “gender” as “psychological, social, and cultural” experience suggests that the authors of the guidelines subscribe to the fallacy of mind-body dualism. This conclusion is further supported by the following advice to practitioners, contained in the very first guideline: “strive to recognize that masculinities are constructed based on social, cultural, and contextual norms.”

Denying that biology, from genes to hormones to neurotransmitters, plays a role in shaping men’s masculine self-expression is, to say the least, a scientifically untenable position. In the current article, I offer seven alternative, evolution-informed guidelines for therapists treating boys and men—ones that I hope are less ideologically-driven than the APA’s and that take seriously the inextricable link between the mind and the body and the fact that men and women exhibit psychological differences for evolutionary reasons. (Note that the following guidelines lay out a general, high-level approach for therapists with male patients. Specific psychotherapeutic interventions, such as cognitive behavioral therapy, can be incorporated as sub-components of treatment, but they are not presently discussed.)

The Guidelines

Guideline 1: Therapists should assist patients in developing a passion that they can excel in.

Men are uniquely motivated to broadcast their strength, skills,1 and talents.2 This is because the evolutionary pressures of sexual selection favored men who could outcompete their rivals and attract members of the opposite sex. Ancestrally, women’s primary reproductive asset was their fertility, which, for the most part, was evaluated via physical cues such as health and attractiveness.3 Ancestral men, unlike ancestral women, often failed to reproduce because they lacked talent and skill. Men are not necessarily more talented than women, but their passion to refine and develop their talents into observable skills is perhaps an inheritance from their passionate forefathers. And such passions are reflected in men’s propensity to work longer hours and obsessively dedicate themselves to perfecting their craft.

Therapists should acknowledge the importance of such passions and encourage their male patients to heed their motivational calls. Failure to do so may results in patients developing a sense of ennui or low or unstable self-esteem. Passions can vary widely and need not conform to stereotypical gender roles (e.g., wrestling, ballet, engineering, and the creative arts are all equally viable candidate passions). Most importantly, however, patients should be encouraged to dedicate themselves to enhancing their skills so as to develop a sense of pride in their work and achievement.

Guideline 2: Therapists should encourage patients to embed themselves in one or more all-male coalitions.

Given the primacy of all-male coalitions and the socialization of males within them in our ancestral past, their importance to men’s mental health should be taken seriously. As childhood was winding down and boys and girls were slowly growing into their roles as men and women, they had to eke out a place for themselves in coalitions of other members of their sex. It is in these coalitions that maturing individuals learned how to perform the tasks and responsibilities appropriate to their sex-typical roles within ancestral societies. Women’s primary role was tending to the home and gathering edible and inedible material resources nearby. Men’s primary role was venturing far off into the savanna, jungle, or tundra so as to hunt large or medium-sized game.4 Whereas women’s roles could be accomplished alone or in a small group of two or three relatives or friends, men’s roles required the coordination of a much larger collective.5 A large animal such as a woolly mammoth could not be killed by a lonesome hunter, no matter how good a spear thrower he may have been. Success in an ancestral male coalition required boys and men to develop a skill or set of skills (e.g., spear throwing, animal tracking) and the ability to coordinate their abilities in a division of labor within the coalition. With the added influence of intertribal warfare, it becomes clear that men evolved within the context of other men, and learning how to successfully cooperate and compete with other men was necessary for survival and, upon sexual maturation, reproduction.

This is not to exclude the desirability or utility of cross-sex friendships. Indeed, men and women can obtain valuable information about members of the opposite sex from their opposite sex friends—information that can be useful in mating contexts (e.g., who has a crush on whom, what can I do to win his or her heart, etc.) But men might come to feel incomplete or excluded if they do not belong to a relatively large coalition of other men, and therapists should take note of this when treating men suffering from anxiety or depression. As with Guideline 1, male coalitions need not conform to traditional gender norms; a man can find just as much meaning and well-being within a coalition of basketball buddies as within a coalition of guys who are into romantic comedies.

Guideline 3: Therapists should encourage men to find constructive means of hierarchical advancement within male coalitions or outside of them.

Social status striving and hierarchical advancement are necessary motivations that underlie goal-setting and achievement for men. This is because reproductive success for ancestral men required overcoming obstacles set by other men. And the evidence for this is in our DNA. The Y chromosome, which is passed down only from father to son, is a lot less genetically varied than mitochondrial DNA, which only mothers can pass down (though a recent discovery presents a rare exception to this rule). What this means is that a majority of men in our ancestral past did not reproduce and only the ambitious few who did became our ancestors. Furthermore, men exhibit distinct hormonal and behavioral signatures in response to competitive social cues—signatures that bear the marks of biological adaptation. If you are a modern man, chances are good that you inherited your forefathers’ will to climb the social status hierarchy. If you or those around you stunt your ascent, you can expect to feel stress and disappointment. If you are a modern man who encounters social or professional setbacks, feeling stressed and disappointed does not mean that there is something wrong with you; on the contrary, it means that your brain and body are working exactly as they were designed to by evolution.6

What this means for therapists is twofold: (1) Therapists should not be averse to encouraging their socially defeated male patients to show some courage and get back in the ring. Of course, therapists should take precautions that their patients do not needlessly hurt themselves or others (ancestral and even some modern battles over social status in a male hierarchy were and often are violent). But helping patients to figure out which battles are worth fighting and which risks are worth taking is the mark of an effective therapist. (2) Because all people, whether men or women, have unique skills and talents, therapists should assist their patients in finding the competitive arena that is right for them, be it sports, finance, music, or video games.

Guideline 4: Because men’s sense of well-being is inextricably tied to their sense of sexual fulfillment, therapists should pay particular attention to their patients’ sexual lives.

Obviously, sexual and romantic fulfillment is important for men and women alike. But men might be reluctant to discuss their sexual desires with a therapist—particularly because their desires often have little to do with emotional attachment or commitment. The reason for this is that one of the most common biological characteristics of a male—and not just a human male—is reduced investment in childcare relative to the female. If given the opportunity, men could have exponentially more offspring than women. Stemming from this inequality in potential reproductive output, men evolved a more pressing sex-drive and a less discerning sexual appetite.

Even after the advent of the sexual revolution, it is often assumed that healthy sexuality involves romance and emotional intimacy. Although most men are capable of romance and emotional intimacy, they are also far more adept than women at severing their emotional selves from the sexual act.7 And such a cleavage should not automatically be viewed by society—and especially not by therapists—as pathological. As long as men are not coercive and are honest with themselves and their partners about their intentions, there is nothing wrong with sex as an end in itself.

Men differ. Some are more monogamy-oriented, others more promiscuity-oriented. Therapists should avoid passing judgments on their patients’ reproductive strategies. Instead, therapists should assist their patients in figuring out what strategy is right for them and help them to constructively implement that strategy. Therapists should also be prepared to encourage their patients to modify their strategy over time such as setting appropriate expectations with respect to a prospective partner’s mate value, and transitioning from a mating motivation to a parenting motivation, and so on.

Guideline 5: Therapists should assist men in communicating their wishes, desires, and concerns within the context of a sexual or romantic relationship.

Because they are generally more sexually driven, men are more likely to accept casual sex offers, are more likely to desire sex earlier in a relationship,8 and are the overwhelmingly majority of the consumers of pornography9 and commercial sex work. This difference in sex-drive is likewise reflected in different relationship expectations. Men should be encouraged to not be judgmental of their own desires (so long as they are consensual) and be given assistance in honestly and respectfully communicating their desires to their partners. Couple’s therapy might be especially helpful in this endeavor.

Guideline 6: Therapists can help fathers to develop healthy and happy relationships with their children based on investment and support.

Despite the fact that men do not invest in childcare to the same extent as women, humans are one of the few mammalian species where fatherhood is important. In addition to selecting strong, resourceful, and dominant men to mate with, ancestral women valued men who had the capacity and willingness to invest in their offspring.10, 11 And because ancestral men who were good fathers went on to have more surviving and reproductively successful offspring, their modern male descendants have what it takes to be good fathers, in turn. Although the provision of resources (and, today, the provision of economic resources) is an important contribution on the part of fathers, it need not be the only one. Fathers can also be protectors, teachers, and sources of social support.

Helping men to see themselves as invaluable to their children’s lives, whether financially, pedagogically, socially, or as role models, can give men a sense of purpose and fulfillment. Therapists can also help family members appreciate their unique roles and contributions within the family unit, which can lead to a healthy and reciprocal division of household labor. Of course, no two families are alike, and therapists should be sensitive to not impose their own personal or ideological beliefs about gender roles onto their patients and their families. Moreover, not every man wants to become a father, and therapists should not pathologize their male patients who share this with them.

Guideline 7: Therapists should help men to become socially engaged, whether politically, philanthropically, or culturally.

Men derive a sense of purpose from intergroup competition, be it in the realm of sports or politics. This is because men are, on average, more groupish than women when their group is under threat. Our male ancestors evolved in an environment marked by intertribal warfare. As a result, men possess multiple psychological adaptations that cause them to be both defensive of their ingroup and offensive toward enemy outgroups. Men—especially physically strong men—are generally more militaristic than women. Although these instincts can veer into ethnocentrism and xenophobia, they can also be directed toward more prosocial ends. Starting wars is one way in which men can pursue their groupish interests. Volunteering in the community (e.g., building homes for the poor) or contributing to a worthwhile cause (e.g., waging a “war” on cancer or drunk driving) are alternate routes.

Identification with an overarching collective or cause is often obstructed if men’s sense of belongingness cannot be expressed in the context of like-minded others, whether men or women. In our world of increasing digital connectedness, there is growing social isolation. In the United States, drug overdose deaths among men are at record levels and, despite a worldwide decline in suicide, American men are taking their lives at much higher numbers now than two decades ago.12 Mental health practitioners are vital in helping to address this crisis, but they cannot do so if they do not understand the male mind. They can start by realizing that a sense of meaning, one that can best be achieved within a group of one’s own, might offer salvation to millions of men who are currently in the pits of despair. Although virtual communities certainly have a role to play, therapists should encourage their male patients to form connections with others in the real world and should not judge their patients with respect to the political, social, or cultural content motivating those connections.


The work of addressing men’s psychological health cannot sidestep masculinity’s ancient roots. More generally, we cannot allow transitory political commitments to obscure our understanding of human nature and how best to address its ailments. The authors of the APA guidelines failed to understand men’s evolved nature and, furthermore, sought to pathologize it. I hope that the guidelines presented here offer a more promising alternative.


Lee, A. J., Jones, B. C., & DeBruine, L. M. (2019). Investigating the association between mating-relevant self-concepts and mate preferences through a data-driven analysis of online personal descriptions. Evolution and Human Behavior.
2 Madison, G., Holmquist, J., & Vestin, M. (2018). Musical improvisation skill in a prospective partner is associated with mate value and preferences, consistent with sexual selection and parental investment theory: implications for the origin of music. Evolution and Human Behavior39(1), 120-129.
3 Buss, D. M., & Schmitt, D. P. (2019). Mate preferences and their behavioral manifestations. Annual review of psychology70, 77-110.
Dennis, C., Brakus, J. J., Ferrer, G. G., McIntyre, C., Alamanos, E., & King, T. (2018). A cross-national study of evolutionary origins of gender shopping styles: she gatherer, he hunter?. Journal of International Marketing26(4), 38-53.
Geary, D. C., Byrd-Craven, J., Hoard, M. K., Vigil, J., & Numtee, C. (2003). Evolution and development of boys’ social behavior. Developmental Review23(4), 444-470.
A note on mental health and evolution: A Darwinian approach to medicine sets mental health, and disorders of mental health, on a foundation of species-typical functioning. In other words, a mental disorder occurs when an evolved psychological mechanism responsible for the regulation of one or another adaptive behaviors (e.g., sleeping, socializing, mating, parenting, etc.) malfunctions in a way that would have imperiled an ancestral individual’s survival or reproduction. At the same time, a seemingly uncomfortable or even painful feeling or mood (e.g., a depressive symptom) might be experienced because it is an adaptive response to a species-typical setback, not because it is a sign of mental disorder. There are caveats, however. Otherwise adaptive mechanisms that would have been functional in an ancestral environment might not be optimally designed for a modern, post-industrial environment. Moreover, individuals may value their subjective well-being more than their reproductive well-being. But even in such instances, being evolutionarily informed may equip patients and therapists with the tools to overcome one or another ancestral burden. For review, see link and Nesse, R. M. (2005). Twelve crucial points about emotions, evolution and mental disorders. Psychology Review11(4), 12-14.
Townsend, J. M., & Wasserman, T. H. (2011). Sexual hookups among college students: Sex differences in emotional reactions. Archives of Sexual Behavior40(6), 1173-1181
8 Buss, D. M., & Schmitt, D. P. (1993). Sexual strategies theory: an evolutionary perspective on human mating. Psychological review100(2), 204.
Emmers-Sommer, T., Hertlein, K., & Kennedy, A. (2013). Pornography use and attitudes: An examination of relational and sexual openness variables between and within gender. Marriage & Family Review49(4), 349-365.
10 Winking, J., & Koster, J. (2015). The Fitness Effects of Men’s Family Investments. Human Nature26(3), 292-312.
11 Mattison, S. M., Scelza, B., & Blumenfield, T. (2014). Paternal investment and the positive effects of fathers among the matrilineal Mosuo of Southwest China. American anthropologist116(3), 591-610.
12 Hedegaard, H., Curtin, S. C., & Warner, M. (2018). Suicide Mortality in the United States, 1999–2017. NCHS data brief, (330).
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Gregory Gorelik

Gregory Gorelik has a Ph.D. in Evolutionary Psychology and is currently working in behavioral research and data science.