1 Introduction

Consider the junction of masculinities, family, and family therapy in this scenario of a father participating in family therapy. A 45-year-old cisgender heterosexual father, socialized from a young age by his family, peers, and other systems (e.g., media, education, employment) to not value his own or others' emotions (i.e., traditional masculine ideals), is now being encouraged by the family therapist to provide emotional care for his teenage daughter, which he has never done before, who is struggling to communicate her own emotions clearly (e.g., she either shares nothing or lashes out with anger). Both father and daughter have their own caregiving and attachment experiences respectively, but we purport that the responsibility primarily lies with the father to be available and responsive to his daughter's experience. Variations of this scenario are common in family therapy, and such situations need attention, as the implications of this therapy going poorly are substantial. In particular, we call attention to how this father has learned about his own emotions as a cisgender male individual.

The field [of family therapy] has come to recognize that gender is an important aspect of both our clients' lives as well as the process of therapy and supervision. To prepare the new generation of family therapists adequately, it is important that they recognize the many and complex ways in which gender can influence their work. (Williams and McBain 2006, 393)

We continue this recognition and effort in this article through reviewing and integrating theories and research on masculine socialization and fatherhood (which is vast and also primarily focused on cisgender men; Fitzgerald et al. 2020; Molloy et al. 2022) and synthesizing the literature on working with males and fathers in therapy to encourage more effective clinical practice and improve clinical experiences for fathers and their families. We agree that “masculinity is something that entire families ‘do’” and that this perspective is valuable for the field of family therapy (Roy and Allen 2022, 31). We also frame our work as primarily about the experience of cisgender men and fathers as we are drawing from our personal and professional experience as cis men working with primarily cis men. We name this perspective as we are cognizant of the diversity of men and fathers and acknowledge that much of the basic and clinical research we review rests on the harmful conceptualization of gender as binary (Dietert and Dentice 2013; McGuire et al. 2016). Therefore, we urge that the recommendations and approaches that we present here include sensitivity and relevant adaptation to each individual man and father.

We appreciate that our approach to these topics is both personal and professional (England 1994), and thus we socially position ourselves to recognize how our personal characteristics, professional background, and relationships may shape our perspectives. The first author (Allen Sabey) identifies as a white, cisgender, heterosexual man, husband, and father (to four children, including one son). He was raised in a low-income household without a father present in his home. He is a licensed marriage and family therapist (MFT) and clinical assistant professor in a Master of Science MFT program in the Midwest. He primarily draws from attachment theory and other related theories (e.g., interpersonal neurobiology) to inform his clinical work, teaching, and research. The second author (Jakob Jensen) also identifies as a white, cisgender, heterosexual man, husband, and father. He was raised by a loving and stern stepfather, who demonstrated both helpful and harmful parenting behaviors tied to masculinity. He is a licensed marriage and family therapist, AAMFT approved supervisor, the president of his state's MFT association, and works as an associate professor of marriage and medical family therapy. The third author (Brandon Jacobs) identifies as a cisgender gay man. He was raised in southern Alabama by a father who was Christian, served in the military, and emphasized strict rules, limited emotional expression, and traditional masculine ideals, though care for the family was implicitly understood. He holds a master's degree in marriage and family therapy, is currently pursuing a Ph.D. in medical family therapy, and works in a gender-affirming primary care practice.

2 Conceptualizing Maleness and Fatherhood

We acknowledge that “virtually all of human functioning has a gendered cast—appearance, mannerisms, communication, temperament, activities at home and outside, aspirations, and values” (Ruble et al. 2006, 858). Gender, and identifying as male and/or as a father, shapes one's experience and relationships. Defining what it means to be a man or father is complex and nuanced, though most generally, we view men and fathers to be as they identify themselves to be—men are those who identify as males and fathers are men who have children. We operationalize gender and parenthood status in these broad ways to be inclusive (i.e., not limiting gender identity to biological characteristics) while recognizing that these demographic categories include such a heterogeneity of membership (Doucet and Lee 2014; McGuire et al. 2016). Although much of the research operationalizes gender from a binary perspective and compares cisgender heterosexual men with cisgender heterosexual women and cisgender heterosexual mothers with cisgender heterosexual fathers, we view gender as a biopsychosocial idea—that gender has biological, psychological, and social components and that it is both ranging (rather than binary) and fluid (rather than fixed; Bem 1981; de Vries et al. 2014; McGuire et al. 2016). Although conceptualizing maleness and fathers in these ways generally, we aim to address the experience of men and fathers who, in particular, have experienced socialization that leads them towards traditional masculine ideology (e.g., away from emotional experience).

We recognize how identifying oneself as a man or father can include a range of important characteristics that shape the identity and experience. Men and fathers vary drastically by generation, race, ethnicity, social class, sexuality, and family structure. Consider this non-exclusive list of different ways a father may identify as or be a father: fathers may become a biological father through sexual intercourse or through sperm donation or may become fathers through fostering, adoption, marriage (i.e., stepfathering), or gender transition; fathers may or may not have legal rights to act as their child's legal guardian; fathers may or may not live with their children; fathers may or may not have regular contact with their children; fathers may or may not provide financial support for their children; and fathers may have primary responsibility, shared responsibility, or exclusive responsibility for caring for their children. Each of these ways of being a father is not mutually exclusive, fixed, and has varied possible explanations. For example, a father may have chosen an aspect of fathering (e.g., living with his children) or he may not have agency to do so (e.g., if he is incarcerated).

Given that diverse backgrounds and circumstances can substantially influence experience, our more general review, perspectives, and recommendations for men and fathers here may not represent or apply to individuals or certain groups of men and fathers (e.g., stepfathers, trans men). We recognize the reality of unique and consequential circumstances and encourage attunement and cultural responsiveness to any man or father in context. We acknowledge that theory and research on gay and trans fathering is informative and promising (e.g., Barrett and Tasker 2002; Condat et al. 2020; Grigoropoulos 2023; Hafford-Letchfield et al. 2019; Malmquist 2022) but underrepresented and encourage sensitivity to potential differences in what we are presenting tentatively for men and fathers here.

3 Men and Fathers as Different

Vast research has examined gender and sex differences in a range of relevant domains, typically assessing for differences between heterosexual cis males and heterosexual cis females (from the gender binary perspective; Del Giudice 2022), which unfortunately omits other gender identities (e.g., trans individuals) from consideration and inclusion and perpetuates the oppressive view of gender as binary. To review briefly that literature, there are mean and qualitative differences in biology (e.g., endocrine and neurobiological systems; Burris and Knox 2024; Eliot 2021; Rajhans et al. 2019), personality and normative psychological characteristics (e.g., cognitive functioning, attachment security; Del Giudice 2019; Hofmann et al. 2025; Kheloui et al. 2023), psychopathology and related behaviors (e.g., violence, substance use; Eliot 2021), and parenting between cis men and cis women. The empirical literature on parenting generally finds that cis heterosexual fathers are less involved, less sensitive, more likely to discourage emotional expression, and have less secure attachment relationships with their children than cis mothers (Havighurst et al. 2019; Pinquart 2022, 2023; Pleck and Masciadrelli 2004; Suzuki et al. 2022; Yaffe 2020). Although studies indicate significant gender differences with many important parenting behaviors, media portrayals or popular psychology discussions of these differences are typically exaggerated as differences are generally small and declining (Paquette et al. 2020) with within-gender variation indicating substantial overlap across domains. Research comparing primary caregiver cis fathers with primary caregiver cis mothers has shown no differences in quality of parenting (Jones et al. 2022), possibly leading to the explanation that differences between mothers and fathers could be attributed to historical role differences and patterns of socialization rather than biological sex characteristics or that differences reflect a conflation of other relevant variables (Biblarz and Stacey 2010). Heterosexual cis males demonstrate substantial variability and tremendous overlap with other genders and other identities (e.g., race, sexual identity) in all these generalized empirical differences. Therefore, demographics (e.g., social class, age) always need to be considered as gender is never sufficient as a full explanation for individual characteristics (Hyde 2014).

Fathering experts have generally concluded, albeit with minor dissenting perspectives, that there is insufficient empirical evidence to support the essential father theory, which purports that fathers are unique in their effects on children because of their maleness and masculine identity (Adamsons et al. 2022; Pleck 2007; Wolfe and Levant 2022). Rather, Pleck (2010) offered the important father theory, asserting that although fathers are not an all-determinative factor on children's development, they do provide an important influence on their children when they are present and engaged. Empirical evidence supports the effect that fathers have on children's health, well-being, and development when present in a family (American Psychological Association, Boys and Men Guidelines Group 2018; Booth et al. 2010; Brown and Aytuglu 2020; Deneault et al. 2021; Hennigar and Cabrera 2024; Jeynes 2016). At the same time, research indicates that children raised without cisgender fathers (e.g., lesbian mothers) can fare equally, if not better, than children in families with a cisgender mother and father (Patterson 2022; Zhang et al. 2023), highlighting the key factors of family processes, family stability, and demographics for child development (e.g., socioeconomic status).

Although theories can emphasize certain factors of development over others (e.g., biogenetics, social constructionism), interactions between individual/biological and environmental factors contribute to the presence of masculine characteristics of men and fathers. Environmental factors are manifold but include the ideologies of masculinity. Although difficult to concretely define, masculinity, or masculinities, can refer to both a process and norms (e.g., attributes) of what it means to be male (Roy and Allen 2022).

4 Privilege and Oppression

Another important aspect of considering gender and the experience of men is that of privilege (Case et al. 2014). Privilege refers to having certain unearned advantages in a community or society (i.e., context) based on perception of social identities (e.g., gender, race, age, SES) and/or membership in certain groups (e.g., religious or political affiliation). Cis males are typically considered the most privileged gender and afforded associated protection from oppression and other negative life experiences. Opportunities and experiences are not equally available to all gender identities and cis males experience the world with many and typically invisible or unclaimed advantages; males and fathers have more access, more safety, and more power in many domains of most societies in the world than other gender identities (Case et al. 2014; Clements et al. 2022). This privilege by gender also intersects with sexual identity and race/ethnicity to further grant white, heterosexual cis males and fathers more unearned benefits than non-white, non-heterosexual, and/or trans men (Schwiter et al. 2021). Given that all people have multiple identities or parts of self, scholars have recognized how individuals can experience both privilege and subjugation (McIntosh 2012; Moradi 2019). Females, transgender and nonbinary individuals, or those with other gender identities have privilege in their lives because of the array of other identities or group memberships they may have and hold, and males can experience disadvantage or oppression, also because of other identities or memberships, including that of being a father (Adamsons et al. 2022; Coston and Kimmel 2012).

The ideologies of patriarchy and male supremacy, which are socially constructed concepts that declare males and fathers as dominant, are also relevant and related here. These structures and ideologies create and maintain gender inequality. The other end of the continuum of access and opportunity can refer to disadvantage, subjugation, or oppression, with other gender identities and ideologies (e.g., feminine and non-hegemonic masculinities) considered inferior. For example, employment and career policies and accompanying social processes are often unfavorable for women and mothers, putting them at a disadvantage for advancements, promotions, and raises compared to men and fathers (Yu and Hara 2021). The field of family therapy is not exempt from these realities, and many scholars have called needed attention to it since the late 1970s (Smothers 2017). The development of feminist family therapy came in response to the overt and subtle reinforcement of patriarchal family structures in family therapy approaches (Hare-Mustin 1978).

We recognize the reality of these gendered dynamics and experiences for men and fathers in many societies and in the field of family therapy and that these privileges and inequalities are perpetuated by a lack of attention and action, which is part of the privileged experience. This includes ignorance or denial of the existence of unmerited advantages because it seemingly would lead to loss or disadvantage for the currently privileged identity (i.e., males). Disturbingly for all, many boys and men are socialized away from this awareness, which we address here.

5 Masculinity Socialization

Masculinity comes in many forms. Although some men have made significant strides in expanding how masculinity is demonstrated, the notion that there are socially constructed norms and expectations regarding how men should think, feel, and behave certainly persists, commonly referred to as hegemonic masculinities (Connell 1987; Messerschmidt 2019; Thompson and Bennett 2015). Wedgwood et al. (2023) defined hegemonic masculinities as “the configuration of practices that represents the most honored way of being a man in a given social context, distinguished from less respected masculinities and providing legitimacy for the overall subordination of women in the society” (p. 1). As the most familiar form of masculinity, traditional masculine ideology captures how most boys in the United States are socialized to suppress vulnerability and sadness; exude confidence, self-reliance, and independence; be assertive, powerful, and take charge; assume dominance, superiority, and privilege; and display toughness, competitiveness, and financial prowess, viewing traits like empathy or emotional openness as weaknesses (Addis and Mahalik 2003; Levant 1992; Mahalik et al. 2003; Seidler et al. 2016; Wong et al. 2017). This ideology includes the perspective of a false heterosexist gender binary, that males and females are opposites, that masculinity exists in juxtaposition to and greater than femininity, and that heterosexuality is the norm and desired sexual identity (Garlick 2003; Jones et al. 2025).

These social prescriptions, accompanying masculine behaviors, and the rejection of femininity are seen throughout relationships, industries, and systems. From the nursing field, Rivera and Scholar (2020) asserted and described how behavioral trends resulting from cultural structuring have been driven by three influential theories: (a) the sustainable male theory, (b) positive masculinity, and (c) social masculinity. All three elevate a white cis male heterosexual perspective, suggesting that those of diverse races, genders, sexual orientations, and ability statuses are inherently inferior. One's definition of masculinity is often linked with gender, social class, sexual orientation, race, age, and other social locations (Connell 2005). From a feminist perspective, Wong (2017) explained that men enjoy unearned societal privilege given that sexism, misogyny, and patriarchy are pervasive and negatively impact how girls and women develop a sense of their gender identity and gender expression, as well as how they navigate relationships, institutions, and social systems. Due to increased fear and likelihood of rejection, men possessing minority identities must navigate approaches to masculine ideologies with even more caution than those of majority groups. Rigid gender expectations and the perspective of a gender binary can have especially detrimental effects on families (Wiseman and Davidson 2012) and marginalized communities (e.g., young black males, sexual minority groups; Lin and Liu 2023; Quam et al. 2020). Researchers and clinicians must acknowledge that historical discussions about masculinity are almost certainly influenced by racist, sexist, and homophobic assumptions steeped in male privilege, and therefore must be vigilant to strive for awareness of such privilege and bias and overtly call attention to it.

To briefly review the three theories above, first, the sustainable male theory is prevalent across many cultures and posits that men should develop a hard, impenetrable emotional shell that protects them from weakness. Proponents of this theory surmise that men are predisposed to violence and dominance, and that such behaviors make them most desirable to female partners who will want their offspring to carry such traits for survival (Searcy 1982). The sustainable male theory carries many of the heteronormative assumptions guiding mate selection and evolutionary theory (Rosenthal and Ryan 2022). Second, a theory of positive masculinity (different from the notion of positive masculinity referenced by Kiselica and Englar-Carlson described later in this paper) originates from elitist and privileged racial theories of the 18th century to define a global ideal for hegemonic masculinity (Rivera and Scholar 2020). Those perpetuating this theory work to undermine and feminize values, characteristics, and behaviors that are not assertive or dominant. According to this form of positive masculinity, which is heavily influenced by male privilege, all negative behaviors are categorized as unmasculine or feminine, which rationalizes the inferiority of other races, cultures, genders, and sexualities. For example, in promoting slavery, theorists of positive masculinity argued that African men were inherently lazy and promiscuous and consequently needed to be given work.

Finally, the theory of social masculinity (see Rivera and Scholar 2020) suggested that men needed to climb a certain social ladder with specific behaviors representing advancement in masculinity. These behaviors included being married to a woman; providing for wives and children; establishing authority over wives and children; autonomy to move at will between the home, the workplace, and social gatherings; expressing sexual desires only within the bonds of marriage; and controlling family size to a man's chosen preference (Brady 2009). As behaviors based on this theory became more common, the achievement of masculinity could be gained over time despite physical ability. Laws that criminalized same-sex relationships, extramarital relationships, and open sexual relationships also perpetuated this line of thinking.

An understanding of these historical, cross-cultural social movements is essential for an informed discussion regarding masculinity, male privilege, and patriarchy today. Although masculine ideals continuously permeate nearly every domain and dimension of social interaction, perhaps nowhere are the pressures to adhere to historically masculine traits more keenly felt than among young men who participate in team athletics. Messner (1992) points out that sports serve as a training ground for boys to adopt and be rewarded for dominant masculine traits such as competitiveness (which can take form as social posturing and dominance) and emotional stoicism. Drummond et al. (2022) found that among male adolescents in Australia, traditionally male-dominated sports, such as Australian football and cricket, can perpetuate hegemonic masculine ideals, emphasizing strength, dominance, and stoicism. These environments may hinder mental wellbeing and emotional expression among young male athletes and contribute to the perpetuation of unacknowledged privilege and patriarchy. A growing body of research has linked youth sport participation to aggressive and violent behaviors (Newman et al. 2021). Such behaviors may be problematic for romantic relationships and parenting behaviors later in life as Newman et al. (2021) contend that the aggressive socialization that occurs in sports extends to other life areas including interpersonal and family relationships. Traces of aggression, violence, anger, and stoicism rewarded by coaches and teammates in adolescence may be carried forward by some men into parenting behaviors later in life.

Following these athletic experiences, many boys face increased pressure to maintain stereotypical and toxic masculine behavior in middle and high school as adolescent males police masculine behavior through homophobic or transphobic teasing and bullying (Pascoe 2011). For instance, Stanaland et al. (2024) found that adolescent boys who felt pressured to conform to traditional masculine norms from a gender binary perspective, especially those with parents endorsing hegemonic masculinity beliefs, exhibited increased aggression when their gender identity was challenged. The consequences of such pressures are readily seen with increases in bullying, violence, and loneliness plaguing middle school boys (Orpinas et al. 2015).

Into early adulthood, through the formation of young adult romantic relationships, men are often rewarded for and lean into embracing the provider and protector roles assigned to them from childhood. When society gives men the message that their primary or only role is to provide for and protect others, it diminishes their likelihood of embracing nurturing, sensitive, and compassionate behaviors. As other emotions are suppressed, anger becomes pervasive, and many men embrace aggression and competition as an inherent part of their role as provider and protector. Embracing aggression and competition is problematic as it perpetuates the notion that men must prove their manhood via demonstrations of learned dominance, aggression, oppression, and exploitation (Roy and Allen 2022; Schwalbe 2015).

Within the narrow space of socially acceptable roles men can hold, they also discover which emotions should be amplified or suppressed. Through men's early adult developmental experiences, they continue to learn through socialization that vulnerability and emotions are to be kept in check, with one notable exception—anger. Anger stands out as a rare emotion that men are socially permitted, even encouraged, to express (Logoz et al. 2023). Anger is the solitary emotion that men can openly display without fear of others perceiving them as weak or incompetent (Okuda et al. 2015). Whether it be the examples of prominent sports figures or male celebrities, or perhaps by viewing popular media and playing video games that are rife with examples of men showing intense anger and violence, young adult men are given the same message on repeat: Anger and violence are an “acceptable” way for men to handle problems (Grossman and Paulsen 2018). This normalization (i.e., privilege) sustains gender inequality through ignoring harmful systems that advantage males and acts of patriarchy that are passed around and down through society.

6 Men Are Scared, but Don't Know It

In this process of male socialization, where boys and men learn about what it means to be male in society and strive to perform masculinity to maintain their privileges, what is rarely acknowledged in theories, research, and in public forums around masculinity is the relevant underlying emotional experience. Socialization can be defined as how people learn to be accepted or rejected by society (Dodge et al. 2003). Given the fundamental need to belong to a family or community, not only as children for actual physical survival but that all people experience throughout life, gender socialization is a way of navigating this need to belong. To the extent that basic need is uncertain about being met, boys and men would experience fear of not belonging. For example, if a boy is not comfortably dominant and athletic, he may not feel confident (i.e., feel afraid) that he can consistently or authentically act in ways that will allow him to belong to his community. This feeling can also be manifest related to the privileges and advantages that boys and men are granted. If a male perceives the potential or real loss of his status or unearned benefits or positions of power, this would be experienced as a threat and similarly activate their fears (Levant and Powell 2017).

Many if not most boys are socialized to believe that if they do not adhere to masculine norms, they will be rejected and not be considered a “real man”. Vandello et al. (2008) highlighted the concept of precarious manhood, which argues that masculinity is a status that must be continually earned and can be easily lost, often resulting in fear of rejection for not conforming to traditional masculine norms. This fear could even be a matter of life or death for some males. Consequently, men's fear of being perceived as weak or feminine (from a gendered binary perspective) and ultimately being rejected because of this perception perpetuates unhealthy and avoidant emotional socialization patterns as well as problematic behaviors. The need for boys and men to continuously prove that they are “real men” and maintain their privileged status can result in ongoing, perpetual acts of misogyny, bullying, violence, and emotional avoidance that undermine healthy social and family relationships (Vandello and Bosson 2013).

Maté and Maté (2022) describe this emotional tension (i.e., gender role strain; Levant and Powell 2017) as occurring between the two universal needs of attachment and authenticity and that when both are not available (e.g., because to be accepted as a male means having certain attributes and not others), attachment will win out because of its absolute necessity throughout childhood. Men may disconnect from parts of their natures (e.g., authenticity, vulnerability, curiosity) to be accepted by others, even when that requires harmful behaviors (as exemplified in the novel Lord of the Flies). This dilemma suggests that the central emotional experience that boys and men feel, therefore, is fear. We could call this low self-esteem or anxiety, and it may show up in defensive and angry ways such as bullying, dominance, or aggression or as being unfazed and indifferent. We propose that this may be a substantial part of understanding male supremacy, which shows up as patriarchy, misogyny, homophobia, transphobia, male violence, and the like. Informed by research (e.g., Dodge et al. 2003; Pollastri et al. 2018; Vandello et al. 2008; Wong et al. 2017) and following this line of thought, we theorize that men who position themselves or who accept and maintain their societally granted positions above others could be described as terrified. This positioning can take many forms and may occur with consciousness and intention or not.

Among the many researchers who have investigated masculinity, Brene Brown has conducted influential research regarding men's shame. Brown (2012) asserted that, on average, men feel most shame when they feel incompetent, believe that others see them as weak, are required to ask for aid, and are unable to provide for the needs of others or protect them. Brown shares that men often feel trapped by cultural expectations to be stoic, strong, and emotionally controlled. Perceived “weakness” may be physical, emotional, or even moral. Any sign of vulnerability is often interpreted, both by others and by men themselves, as failure. For most men, fear of coming across as incompetent is guarded and is expressed as displays of anger, avoidance, or aloofness and results in unhealthy interpersonal dynamics (Addis 2008).

A key part of this emotional experience and the correlated manifestations is that this fear that boys and men are experiencing is unknown, unprocessed, stuck, or suppressed so that it exerts its powerful influence over thoughts and behaviors unconsciously and unintentionally. The literature on male privilege supports this idea that ignorance is common (Schwiter et al. 2021) and that there is active “blindfolding” (i.e., making queer identities and associated experiences of oppression unseen) of the privileges and disadvantages that gender inequality reflects (Smith and Shin 2014). We suppose that most men are unaware that they are scared and would sincerely deny the reality of this part of their experience, even though their behavior and attitudes signal otherwise. Even an attitude of indifference and a lack of action likely represent emotional dissociation resulting from chronic activation of one's nervous system. We argue that the lack of awareness and inclusion of this key piece of men's experience is a constraint to progress towards gender equality and men's wellness. For example, in a recent TED talk by Gary Barker (2023), the CEO of an organization aimed at gender equality through involving and educating men, named that men and boys feel lost, confused, and lonely and how they “close themselves off”, but did not mention this central emotional theme of being afraid and not knowing it. Thus, organizations, programs, research, theories, and clinical approaches aimed at helping societies and communities move in these important directions would be enhanced if the vulnerable realities of men are directly included in conversations and interventions to address problematic patterns in relational and societal dynamics involving men who are socialized in this way. For example, Eckerle et al. (2023) recently emphasized the importance of acknowledging the activation of men's shame in interventions aimed at confronting male privilege, and literature on queer blindfolding frames the underlying intrapsychic motivations using an emotional lens (Smith and Shin 2014).

We offer this commentary and framework, not to justify or minimize the reality of male and father privilege or the negative acts and consequences of associated acts and systems (e.g., patriarchy) on individuals and society, but to inform perspectives and offer additional places of intervention. We recognize that the effects of this reality (men's unacknowledged fear and subsequent negative acts) have undesirable to terrible consequences on everyone, including males themselves (Connell and Messerschmidt 2005). The negative and unfortunate outcomes of traditional masculine ideology have been consistently documented, including mental health challenges and interpersonal conflicts (Courtenay 2011; Green et al. 2018; Hill et al. 2020; Murnen et al. 2002; Pollastri et al. 2018; Smiler 2024; Wong et al. 2017).

In contrast, more positive and inclusive forms of masculinity—such as positive masculinity, inclusive masculinity, and compassionate masculinity—promote emotional intelligence, egalitarian relationships, and vulnerability as alternatives to hegemonic masculinity. Positive masculinity emphasizes traditional traits such as responsibility, integrity, and care for others, allowing men to engage in nurturing roles without stigma (Kiselica and Englar-Carlson 2010). Inclusive masculinity theory suggests that in less homophobic and less rigidly gendered contexts (i.e., recognition of gender as non-binary), men are freer to express themselves emotionally and form close, non-competitive, healthy male relationships (Anderson 2009). These approaches support pluralism, mental well-being, healthier relationships, and more flexible gender norms. Modern masculinities challenge the idea that strength and care are mutually exclusive, helping to dismantle stereotypes that harm both men and those around them. We seek to promote flexibility in gender roles and “masculine” behaviors, and we acknowledge that stereotypical or traditional masculine traits (e.g., assertiveness, self-reliance, courage) are not inherently harmful and may have positive outcomes (Kiselica et al. 2016). It is that the habitual or rigid limitation of men's behavioral and emotional expressions to only include those matching stereotypical masculine traits is problematic.

7 Fathering From an Attachment Lens

Attachment theory, as originally developed, primarily describes the nature of the mother–child bond. Scholars have also considered and studied the father-child relationship using an attachment lens which frames and focuses the conceptualization of fatherhood and fathering around fathers' provision of a secure base and safe haven to their children (Brown and Aytuglu 2020; Dykas and Smiler 2022; Grossmann and Grossmann 2020). Fathers, like mothers, will ideally be consistently available and responsive to their children's physical and emotional needs through the activation of their caregiving behavioral system (Bowlby 1969; Lamb 2010; Lombardi et al. 2022). The extensive literature supports that children form an independent and important attachment bond with their fathers (Palm 2014) and that the father-child attachment relationship has significant effects on their children's health and development (Diniz et al. 2021; Rodrigues et al. 2021).

As an application of attachment theory to fathering, and substantially situated within certain (e.g., Western) cultures, Daniel Paquette (Paquette 2004; Paquette et al. 2020) developed the theory of father-child activation, which recognizes how fathers are more apt to support their children's exploration of the world (e.g., play) through the provision of a secure base than provide emotional comfort in the role of a safe haven. This preference may be related to traditional male emotional socialization which discourages boys and fathers from valuing emotional experience and can lead fathers to send the message to their children that they are emotionally unavailable and that they, the children, are on their own emotionally. Rather, being a secure base to encourage a child towards play and exploration may align more with fathers' gendered socialization and the more comfortable role to prompt children to take initiatives in unfamiliar situations, to explore, to take chances, to play aggressively, to overcome obstacles, to be braver in the presence of strangers, and to stand up for themselves (Grossmann and Grossmann 2020). Research has begun to show support for the value of this quality of father-child attachment (Lee et al. 2021).

Attachment theory provides a framework for understanding the merger of fathering with masculinity and how traditional masculine ideology might constrain fathering (Dykas and Smiler 2022). A foundational premise of attachment science is that fathers have innate caregiving instincts that are naturally activated to attend and respond to their child. Given children's developmental needs over time, these instincts and associated caregiving actions would require a father to have a range of and flexibility in the ways they respond to their children, particularly when it comes to being emotionally responsive. Just as traditional masculine ideology prescribes how men should be masculine in certain ways, the societal or hegemonic norms of traditional masculinity could also translate to how fathers can only be fathers in certain ways, thus limiting them from accessing and acting from the full range of their caregiving instincts (Doucet and Lee 2014; Fernández-Cornejo et al. 2025). For example, a father may feel uncomfortable about his child expressing sadness or grief and respond in a non-coregulating manner (e.g., being silly to try to cheer them up quickly). To the extent that fathers' caring instincts and behaviors are restricted because of socialization and gender role strain, a father could be neurobiologically activated without resolution, that is, afraid that they cannot fulfill their inherent and natural function to be available and respond to their child's needs. Continuing the example, the child may not cheer up quickly and the father may feel ineffective in helping his child cope with their emotional distress. Thus, fathers are frightened, not only because they may not be accepted or belong as a man (as described above), but also because they sense their inability to care for their children in certain ways (e.g., tending to children's emotional needs). Unfortunately, similar to how being afraid may be outside of men's perception more generally, fathers may be largely unaware of this chronic activation and emotional experience of inadequacy, which perpetuates a pattern of limited or even harmful caregiving behavior.

Aligned with attachment theory, we purport that “ideal” fathers are unrestricted by traditional masculine norms and therefore comfortable and able to act in creative and flexible ways to ensure the development of their children (Fernández-Cornejo et al. 2025; Rodrigues et al. 2021). Societal expectations of men matter (Cassidy 2000; Palm 2014), particularly as they lead to fathers being unable to effectively and consistently provide care for their child. Therefore, we assert that fathers' capacity to act in development-promoting ways for their children is not solely an individual characteristic that exists within each individual father (Doucet and Lee 2014). Fathering is also a communal characteristic. Fortunately, as societal shifts gradually occur, fathers are more able to demonstrate attuned and flexible ways of fathering (e.g., being more emotionally expressive), and we encourage all people to contribute to these societal shifts in diverse ways, including through forms of psychotherapy.

8 Working With Men in Therapy

In our review and perspectives on the theory and research related to men, masculinity, and fatherhood above, we centered the emotional experience of being afraid but not knowing it to organize and understand a commonly neglected yet significant feature of the experience of men and fathers in the world and in their families. The presence of this aspect of men and fathers' lives, recognizing that not all men and fathers experience being scared in these ways, is a potential target for intervention to work towards flexibility and reassurance in their identity as men and fathers in their families and society. The various forms of psychotherapy—individual, couple, and family modalities—are common and potential places for this sort of intervention. Thus, our aim in this section is to review and build upon the ways that forms of psychotherapy have offered on working with “traditional” men and fathers (Silver et al. 2018) and frame them as ways of attending to men's fears as they relate to their masculinity, associated patterns of behavior, and their experiences of socially granted privileges. We begin at the individual level with reviewing guidelines and recommendations that have been offered for working generally with men in psychotherapy. We then present and discuss relevant models of couple therapy and family therapy and provide additional commentary and directions to enhance the field.

8.1 Methods to Working With Men Individually

Drawing from various sources, here is a non-exhaustive and non-mutually exclusive list to summarize and introduce methods of working with men at the individual level, which mostly encourage various ways of considering the role of masculine emotional socialization in men's distress and relevant patterns of behavior generally and in therapy (American Psychological Association, Boys and Men Guidelines Group 2018; Ashfield and Gouws 2019; Englar-Carlson et al. 2010; Liddon et al. 2019; Silver et al. 2018; Walters 2011; Whitley and SpringerLink 2021; Wolfe and Levant 2022). Although these are described in the context of individual work, they may also be applicable for working with men in relationships. These are broad recommendations for working with men for whom they are considered relevant; they may not be applicable or helpful for men who were not socialized toward traditional masculine ideology or who are more flexible in their gender role. We recognize how various backgrounds, identities, and social positions will inform men's experiences, and while we do not speak to the potential nuances here, we encourage awareness and sensitivity to idiosyncrasies of each man that participates in psychotherapy.

First, therapists can reflect on their own experiences with men and fathers to identify any potential biases so they can minimize countertransference issues. For example, if a therapist is highly activated by a verbally aggressive or indifferent male client, they will likely struggle to keep their emotional balance and be less able to provide both therapeutic warmth and healthy boundaries and guidance in a way that is helpful for the client. Second, therapists can be aware that symptoms of anxiety and depression may look different for men (e.g., depression showing up as anger). As the main thesis of Terry Real's (1998) book, I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression, men and people in their lives may not easily recognize the presence or severity of depression in men because it can commonly manifest as reactive behaviors (e.g., irritability) rather than what many typically would note as depressive behaviors (e.g., lack of motivation).

Third, therapists can directly and indirectly address men's reluctance to participate in treatment. Historically, men have been less likely to seek professional help (Addis and Mahalik 2003), and although trends may be shifting, there remains a difficulty for many men to need and receive help, as it can imply a personal deficiency and vulnerable dependence. Fourth, and related to the previous point, therapists can have patience in earning men's trust. Men may be more skeptical of therapy, which may show up as low engagement in sessions, lack of openness to the therapist about their own experience, ambivalence about potential benefits, or frustration with parts of the therapeutic process. Expect to proceed slowly. Fifth, therapists can assess directly and observationally current beliefs about and adherence to traditional masculine ideology (e.g., emotional stoicism, social dominance, heterosexism, patriarchy). There are both informal and formal ways of conducting this assessment (Thompson and Bennett 2015), including measures such as the Conformity to Masculine Norms Inventory (Levant et al. 2020).

Sixth, therapists can expect a minimization of or unfamiliarity with emotional experience (his and others') and earlier relational experiences (e.g., family of origin) by male clients. As therapists ask traditional questions about feelings, men may respond with logic and explanations or not know how to answer or what to say. Some have conceptualized alexithymia, the difficulty with identifying, understanding, and expressing emotions, as a normative male phenomenon (Levant 1992). Seventh, therapists can explicitly acknowledge the impact of male emotional socialization through linking content or process in sessions with societal discourse around masculine socialization or specific examples from his past. For example, referring to a pattern of behavior, therapists could ask, “What are some experiences you remember that taught you to behave this way?” This is done not to condone the behavior, but to create awareness and increase the possibility of flexibility around it. Lastly, therapists can patiently work towards building emotional competence (Root and Denham 2010) through psychoeducation, exploration, validation, emotional deepening, etc. There are many clinical methods that address this in various ways such as Internal Family Systems, Acceptance and Commitment Therapy, Somatic Experiencing, and Emotion-Focused Therapy.

8.2 Relational Approaches to Working With Partners and Fathers

Shifting to relational clinical work with men, several models of couple therapy have integrated gender and masculine socialization directly into treatment. Socioemotional Relationship Therapy (SERT; Knudson-Martin et al. 2015) and Relational Life Therapy (Real, n.d.) work with male partners to recognize the contextual and gendered influences on how they show up in relationships, softening internalized expectations and restrictive norms that hinder intimacy and connection. Although not a historically central piece of Emotionally Focused Couples Therapy (EFT), Ceniza and Allan (2021) offered practical guidelines for applying EFT with White heterosexual working-class rural males as this population is commonly more tightly constrained to traditional masculine norms. Collectively, these approaches highlight the need to compassionately and directly deconstruct the ways gendered expectations operate socially and internally to promote relational equity and emotional capacity.

Looking at fathers in family therapy, the field has undergone a gradual transformation in its conceptualization of masculinity and fatherhood. Earlier models, such as structural and strategic family therapy, often upheld conventional family hierarchies by positioning fathers as rigid authority figures or disengaged participants (Friedman 1995; Minuchin 1974). These portrayals paralleled hegemonic masculinity, which historically and currently elevates emotional restraint, dominance, and productivity over relational attunement (Connell and Messerschmidt 2005). Feminist family therapy provided an essential counterpoint by challenging these embedded gendered assumptions (Silverstein and Brooks 2010). By emphasizing power dynamics and the constraining effects of patriarchal norms on both women and men, feminist scholars urged therapists to critically examine the gender ideology that shapes fathering. Avis (1989) highlighted the risk of replicating oppressive structures, whereas Dienhart and Avis (1994) demonstrated how fathers' emotional expression is often restricted by internalized masculinity norms. Emotionally Focused Family Therapy (EFFT) further contributes by emphasizing attachment needs and supporting fathers in becoming more emotionally accessible and responsive, particularly when vulnerability has been socialized as weakness (Furrow et al. 2019). As a result, therapeutic engagement with fathers was limited and obscured the emotional complexity and variability of men's experiences.

Later developments continued expanding this relational understanding of fatherhood. Dienhart (2001) dialogical model positioned fathering as an evolving narrative shaped through relationships and meaning making, especially relevant given men's frequent emotional isolations and limited models for nurturing behavior (Mahalik et al. 2003). Frosh (1997) similarly noted the psychological costs of traditional masculinity, linking emotional suppression to intergenerational patterns of disconnection. Additional systemic models, such as Narrative Therapy (White and Epston 1990) and collaborative approaches (Anderson and Goolishian 1992), offer pathways for reconstructing masculine identities to include caregiving and emotional presence. Integrative Systemic Therapy (IST) extends this work through its gender metaframework, encouraging therapists to identify and lift its gender-based constraints that shape family dynamics, even without explicitly addressing masculinity or male socialization (Pinsof et al. 2018).

9 Clinical Practice With Men and Fathers

We frame this review of interventions and models as ways of attending to the behavioral manifestations that can result from unconscious activation of fear within the socialization of hegemonic masculinity. We emphasize the clinical value of identifying and connecting to the activation of men's fear experientially and working with and from that place for the benefit of men and fathers and the people and systems around them. Relatedly, Silver et al. (2018) offered:

Clinical work with traditional men may be especially impactful to the extent that it advocates for the rights and needs of those vulnerable individuals toward whom such men are most likely to direct their aggression and misuse their power: their women partners and children. (p. 104)

In clinically-relevant terms, we assert that men and fathers may be afraid of their own emotional experience, afraid of judgment, rejection, loss, abandonment, and being inadequate or deficient within their families. These are core human needs that are going unmet for men, partners, and fathers and, in our clinical experience, most families do not know it. Therefore, we highlight the value of therapists supporting men and fathers to recognize and connect with their emotional experience of being afraid to encourage access to their vulnerability and reshape their narrative about what a man and father can feel and do. This direction is counter to the restrictive aspects of masculine ideologies that limit awareness and expression of emotional vulnerability as reviewed above. In these interventions, we want to strongly emphasize the importance of the therapist's curiosity, validation, acceptance, and empathy for male clients in order to provide a corrective emotional experience of trust and safety as reassurance to the unknown fear that men have presumptively lived with for most of their lives. We believe this is necessary to soften the potentially tight grip of a problematic identity, beliefs (e.g., male supremacy), and behavioral patterns (e.g., “investment in the narrative of queer blindfolding”, Smith and Shin 2014, 956) that, although perhaps believed by men to be functional, interfere with authentic connection to self and others and can perpetuate unowned privilege and subsequent harmful behaviors (Franklin-Paddock et al. 2025). Compassion and accountability can occur simultaneously (Silver et al. 2018).

A common clinical situation that we and our (first and second authors') students regularly encounter is a father who is not engaged with family therapy as much as a child and mother. This may stem from the self-reliant socialization and privileged positions that boys and men have experienced throughout their lives. There may be legitimate constraints to his involvement, but we also want to encourage productive efforts here to involve the father as much as possible, as father involvement in clinical treatment bodes well for improvement in child outcomes (Bagner and Eyberg 2003; von Klitzing and White 2020; Lundahl et al. 2008). We affirm that “engaging the peripheral father is a key task for those who work with families” (Walters 2011, 106). Therefore, here are our recommendations to the process of inviting a father into family therapy as they are relevant to the family and situation:

• Speak to the father directly
• Acknowledge his intentions of caring for his family.
• Cite the shared concern and his hope for the child and their relationship.
• Affirm how he has supported his family.
• Emphasize his importance, value, perspective as a leader in the family.
• Validate the potential challenges and fears regarding treatment and his child.
• Ask about hopes, concerns, and potential goals for family.
• Clarify regarding the purpose of sessions and your role as therapist.
• Frame the process as temporary, collaborative, and solution-focused.
• Invite him to participate directly.
• Share your hope and commitment to treatment
• Creatively persist over time with having him engage in treatment.

If fathers are not involved directly, discuss with others about their understanding of this and express empathy for their possible anger and/or sadness. We recommend still including him, even if not present physically, with such questions as, “If your dad were here, what might he say?”

When working with fathers in family therapy, along with the approaches and methods reviewed above, we encourage that therapists show that they value him and his perspective through collaboration and balancing attention and affirmation across the client system. Therapists can directly discuss what is important to him about being a father, how well he feels he is doing, and how he learned about being a father (Owen and Glass 2009). Address fathers' fear and potential lack of flexibility in their identities, self-concepts, and behaviors to promote availability, openness, and responsiveness to their children. Attend to the presence of patriarchy and male privilege in family dynamics and the associated domains of division of labor (e.g., childcare), making family decisions, and providing financially. We assert that fathers can be both strong and vulnerable, open and sturdy, and understanding and dependable. They need not feel compelled to choose between traditionally “masculine” and “feminine” behaviors. It is about reconnecting to their paternal caregiving instincts and their own emotional experiences and needs. Clinicians should recognize that fathers may be starting from a place of low trust in the availability of others to support them if they are not exclusively and effectively operating as a traditional protector and provider. A recent client of the first author referred to this perceived expectation to be “superman” and stated how he was afraid of what his children would think if he admitted his struggles in any way. Fathers can still be the bigger, stronger, and kind adult that children need (Coyne et al. 2019) and be allowed to be scared, sad, or ashamed. We assert that fathering leadership is inclusive of all of those emotions and characteristics.

We additionally assert that assessment and attunement to each individual man and father is essential when considering if and how to attend to masculinity and fathering. Although there may be common themes for fathers in family therapy, norms are never absolute nor universal realities (von Klitzing and White 2020). We cannot presume to perfectly comprehend any father's experience in their unique family. At the same time, men and fathers will show up within systems of power and privilege and, related to gender and sexual identity specifically, may hold values and biases of heterosexism, homophobia, and heterosexual privilege that will shape their worldviews and conceptualizations of themselves, their families, and the challenges they face and present in therapy (Owen and Glass 2009). Cultural humility is needed here, just as it is with each client and client system.

The American Association for Marriage and Family Therapy recently published guidelines for gender affirming care that are relevant for this conversation of masculinity, fatherhood, and family therapy.

As marriage and family therapists (MFTs), regardless of specific models and theories, we approach all our work, including supervision, systemically. This means that we need to consider all the sociocultural and historical variables that both supervisee and supervisor bring to the table, besides, of course, the psychological and emotional ones. One of such variables is gender, not just as a personal identity and/or expression, but also as a sociocultural and historical construct. Gender is also key to consider when working with individuals, couples, polycules, families and really any relational system that comes into our office given that research has demonstrated how much this variable can influence the way we think about and act within all types of relationships, as well as influencing the way we relate to our own mental health and even the way we approach our therapy practices as MFTs. If we do not consider gender, as supervisors especially, we risk leaving important areas of engagement and development unaddressed, which will then likely be reflected in how uncritically supervisees might potentially approach their own clinical work. (Carrington et al. 2025, 15)

10 Future Directions

Our review and recommendations here allow and lead to several avenues for continued exploration in addressing men and fathers' emotional (i.e., fear-based) experiences and behaviors in family therapy, as informed by attachment theory and as perhaps relevant to their masculinity. Future directions should prioritize the development of clinical interventions at both the individual and relational levels that directly acknowledge and address men's and fathers' fears surrounding masculinity. In addition to diversifying population sampling, future research and practice need to identify how emotional fears can shape engagement in therapy, influence family roles, and affect fathers' emotional availability and fathering behavioral patterns. Therapeutic models must continue evolving to explicitly and simultaneously integrate constructs of gender, power, privilege, and vulnerability (e.g., feared loss of authority) in ways that help men confront and reframe masculinity-related anxieties (Dienhart 2001; Frosh 1997; Silverstein and Brooks 2010).

Future work would also need to consider diverse father identities and work towards a more inclusive framework. For example, clinicians could investigate how stepfathers' fears of inadequacy in non-biological roles impact their authority and attachment processes, or how same-sex families and transgender fathers encounter unique challenges when traditional gendered expectations of fatherhood are disrupted (Condat et al. 2020; Malmquist 2022). Similarly, single fathers and chosen families may experience heightened anxieties about fulfilling what can be described as adequate masculinity (Doucet 2004), whereas navigating stigma and limited systemic supports (Barrett and Tasker 2002; Roy and Allen 2022). Examining these diverse contexts and identities of men and fathers through the lens of their fears provides an important entry point for designing interventions that normalize vulnerability, challenge restrictive masculine and fatherhood norms, and strengthen relational resilience across diverse fathering experiences. Attending to the fears of failing to meet cultural ideals of masculinity for a range of men and fathers will allow therapy to more effectively promote connection, resilience, and relational health.

11 Conclusion

Family therapists may still unconsciously and unfortunately reinforce traditional gender roles, perpetuate male privilege, and/or fail to adequately explore how masculine socialization affects relational functioning (Scourfield and Drakeford 2002). Continued training in gender competence and reflexivity is necessary to address potential blind spots and foster inclusive therapeutic environments that validate diverse expressions of fatherhood and masculinity. Collectively, these contributions signal a growing awareness within family therapy of how masculinity and fathering can be shaped by sociocultural forces and internalized ideologies. From feminist critiques to dialogical and attachment-based approaches, the field is increasingly equipped to help fathers construct more authentic, emotionally engaged identities within the therapeutic space and grow in awareness, safety, and connection with themselves and others. von Klitzing and White (2020) emphasize the multiplicity of present-day fatherhood roles, describing them as emotionally varied and relationally complex. They argue that evolving paternal roles increasingly straddle being a protector, playmate, and caregiver, each influenced by sociocultural shifts in gender expectations. Their perspective echoes the idea that fathers guide children into a wider symbolic world, facilitating both separation and reintegration into the family system. This dynamic role, once seen through a fixed lens, now invites a broader exploration of the emotional and symbolic capacities of fatherhood. We advocate for these theoretical and clinical advances to continue to be gradually ushered to the forefront of therapeutic practice to provide consistent application of gender-aware practices across the field. This historical foundation sets the stage for a broader, more systematic integration of gender-sensitive practices in future clinical work and training.