older men`s emotions - Roehampton University Research Repository

“It’s like a Gordian Knot”.
How older men in sobriety experience their emotions in therapy, using
Interpretative Phenomenological Analysis
by
By Denise A. Freeman, BA, MSc
A thesis submitted in partial fulfillment of the requirements for the degree of
Doctor of Counselling Psychology (PsychD)
Department of Psychology
University of Roehampton
2014
Table of Contents
Acknowledgements ............................................................................................................ 6
Abstract .............................................................................................................................. 7
Chapter 1. Introduction .................................................................................................... 8
Chapter 2. Literature Review ........................................................................................ 10
2.1 Overview ............................................................................................................................. 10
2.2 Synthesis of theories on aging of older men .................................................................... 16
Table 1: Theories of Ageing .................................................................................................. 18
2.3 Masculinity ......................................................................................................................... 18
2.3.1 Implications of masculinity .......................................................................................... 20
2.3.2 The meaning of masculinity to older men .................................................................... 22
2.3.3 Men in therapy.............................................................................................................. 24
2.3.4 Conclusion .................................................................................................................... 26
2.4 The experience of emotion ................................................................................................ 27
2.4.1 The role of emotion in masculinity .............................................................................. 28
2.4.2 Older men’s experiences of their emotions and masculinity ....................................... 31
2.4.3 Conclusion .................................................................................................................... 33
2.5 Alcohol Use Disorder (AUD)............................................................................................. 34
2.5.1 AUD and masculinity ................................................................................................... 35
2.5.2 Emotion regulation in alcoholics .................................................................................. 36
2.5.3 Alcoholics Anonymous (A.A.) ..................................................................................... 37
2.5.4 Effectiveness of A.A. and the counselling profession.................................................. 38
2.5.5 Conclusion .................................................................................................................... 40
2.6 Summary of the literature................................................................................................. 41
Chapter 3: Methodology ................................................................................................. 43
Part I: Philosophy .................................................................................................................... 43
3.1 Introduction........................................................................................................................ 43
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3.2 Rationale for qualitative methodology............................................................................. 43
3.2.1 Assessing validity and the quality of good qualitative research .................................. 44
3.3 Ontological and epistemological orientation ................................................................... 45
3.3.1 The researcher’s epistemological orientation in relation to the methodology ............. 47
Fig. 1: The philosophical foundations underpinning the present research study .................. 48
3.3.2 Epistemologies of Counselling Psychology and IPA ................................................... 48
3.4 Reflexivity and reflectivity ................................................................................................ 49
3.5 Interpretative Phenomenological Analysis ...................................................................... 50
3.5.1 Phenomenology ............................................................................................................ 52
3.5.2 Hermeneutics ................................................................................................................ 54
3.5.3 Idiography .................................................................................................................... 55
3.6 Limitations of the IPA approach ...................................................................................... 56
Part 2: The Method in Action ................................................................................................. 57
3.7 The phenomena under investigation ................................................................................ 57
3.8 The role of the researcher ................................................................................................. 58
3.9 Data collection .................................................................................................................... 58
3.9.1 Participant demographics ............................................................................................. 58
3.9.1.1 Inclusion/exclusion criteria .................................................................................................. 59
3.9.1.2 Sample size .......................................................................................................................... 60
Table 2: Participant Demographics .................................................................................................. 61
3.9.1.3 Recruitment and situating the sample .................................................................................. 61
3.9.2 Interviews ..................................................................................................................... 63
3.9.2.1 Pilot interview ...................................................................................................................... 64
3.9.2.2 Digital recording and transcription ...................................................................................... 65
3.10 Ethical considerations ..................................................................................................... 66
3.10.1 Informed consent ........................................................................................................ 66
3.10.2 Anonymity and managing data................................................................................... 67
3.10.3 Managing Distress ...................................................................................................... 67
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3.10.4 Benefits to participants ............................................................................................... 68
3.10.5 Ethical approval .......................................................................................................... 69
3.11 Data analysis..................................................................................................................... 69
3.11.1 Analysis stage ............................................................................................................. 70
3.11.1.1 Initial encounter with the text ............................................................................................ 70
3.11.1.2 Identification and development of themes ......................................................................... 71
Table 3: Exploratory Comments ...................................................................................................... 71
3.11.1.3 Clustering of themes .......................................................................................................... 72
3.11.1.4 Progressing to the next case ............................................................................................... 72
3.11.1.5 The hermeneutic circle in action ........................................................................................ 73
Chapter 4. Analysis ......................................................................................................... 74
4.1 Overview of themes: Older Men in Sobriety’s Emotions Experience in Therapy ...... 74
Table 3: Master themes and subthemes ................................................................................. 76
4.2 Master Theme 1: Control/Regulation of Emotions ........................................................ 76
Figure 3: Diagrammatic of Master Theme 1: Control/Regulation of Emotions ................ 77
4.2.1 Subtheme: Challenges to Unlocking Emotions ............................................................ 78
4.2.2 Subtheme: Importance of Emotional Containment ...................................................... 87
4.2.3 Subtheme: Role of A.A. in the Emotion Sharing Experience ...................................... 97
4.3 Master Theme 2: Transformation .................................................................................. 100
Figure 4: Diagrammatic of Master Theme 2: Transformation/Allegiance to Self .......... 100
4.3.1 Subtheme: Self-actualisation ...................................................................................... 101
4.3.2 Subtheme: Emotional-Spiritual .................................................................................. 108
4.4 Conclusion ........................................................................................................................ 109
Chapter 5. Discussion.................................................................................................... 110
5.1 Overview ........................................................................................................................... 110
5.1.1 Challenges to unlocking emotions ............................................................................. 110
5.1.2 Impact of convergence of shared emotions in groups ................................................ 113
5.1.3 Masculine programming and positioning ................................................................... 115
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5.1.4 The gendering of emotions ......................................................................................... 117
5.1.5 Therapist’s containment of older men’s emotions ..................................................... 119
5.1.6 A Transformational Journey ....................................................................................... 121
5.2 Significance of the research ............................................................................................ 124
5.3 Methodological reflections .............................................................................................. 124
5.4 Clinical implications ........................................................................................................ 127
5.5 Suggestions for future research ...................................................................................... 129
5.6 Implications for Counselling Psychology....................................................................... 131
5.7 Personal reflections .......................................................................................................... 134
Chapter 6. Conclusion .................................................................................................. 137
Appendices ..................................................................................................................... 139
References ...................................................................................................................... 140
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Acknowledgements
I feel very privileged to have been able to listen to the emotional lives of some very
remarkable older men. I hope I have served each of you well by sharing your stories in
the way that you shared them with me, and with as much passion. Acknowledgements
also go to Third Age Counselling for the rich placement experience and in being the
catalyst in drawing my attention, to the unique needs of older individuals.
I am extremely grateful and privileged to have been supervised by Dr. Tony Evans,
master of masculinities, and I thank you for always being available to me when I needed
you. Thank you also to Dr. Di Bray for your patience and support throughout these last
few years. Deep gratitude to Dr. Elena Gil-Rodriguez for all your expert IPA advice and
hands-on approach to ensuring that the work was, “firmly grounded in the data”. Thank
you also for your unwavering support from the beginning of my doctoral journey right
through to the very end. I would like to thank the esteemed Ernest Govier for mentoring
me throughout the doctoral writing process and for your cherished advice on the
importance of taking care of my health throughout. Thank you to Toh Yin Li, Alisya Hon
and the gracious Maria O’Conor for editing my work. Thank you also to Dr. KC Lee for
keeping me nourished throughout, both with food and the delicious array of journal
articles that were oftentimes too much for me to consume.
Much loving gratitude to the number one love of my life - my beautiful, wise and
inspirational mother. I continue to learn so much from you!
To the men in my life: my best friend and loving husband, Warren, you’ve been such a
pillar of support and the sole reason I managed to keep it together during the doctoral
process! Finally, to the first man I saw when I opened my eyes, and whom I will forever
hold in the highest regard, my late and very much loved father, Ernie Freeman.
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Abstract
Background and Aims: Older men are an under-researched population in Counselling
Psychology. This thesis explores how older men in sobriety experience their emotions in
therapy and aims to understand the meaning of these experiences from a psychologically
gendered subject perspective.
Method: Semi-structured interviews were carried out with six older men (aged 62 and
above) and interview transcripts were analysed using Interpretative Phenomenological
Analysis (IPA), a qualitative methodology that focuses on the lived experience and the
meaning people give to these experiences.
Results: The analysis highlighted significant challenges for older men when attempting
to unlock, process or discuss emotions in therapy. The analysis also revealed positive
transformational effects by those who were able to transcend the confines of gendered
constructs with concerted emotional investments. The two master themes are:
(1)
CONTROL/REGULATION
OF
EMOTIONS
including
subthemes:
Challenges to unlocking emotion; Importance of therapeutic emotional
containment; Role of Alcoholics Anonymous (AA) in the emotion sharing
experience and
(2)
TRANSFORMATION/ALLEGIANCE TO SELF, including subthemes: Selfactualisation; Going into the heart of emotions as an emotional-spiritual
journey.
Conclusion: Participants expressed challenges to unlocking their emotions in therapy,
which were mainly experienced as controlled or suppressed. Aging, masculinity and helpseeking theories, as well as addiction and recovery literature, are discussed in light of the
findings along with suggestions for future research and implications in Counselling
Psychology. Personal reflections are expressed at various points of the research.
7
Chapter 1. Introduction
The research reported in this thesis aims to provide a rich and descriptive
account of how older men in sobriety (in Alcoholics Anonymous) make sense of their
emotions in therapy. The experience of emotion is an important qualitative aspect of
emotion which from a social constructionist perspective, is the “when, where, and what to
feel, as well as when, where, and how to act” (Ratner, 1989, p.211). Emotions are also an
important clinical phenomenon, a revealing, dynamic database from which all intersubjective experiences are born. Emotion experience therefore, is a meaning-making
activity of an individual and their subjective world, involving content rich events that
illuminate behavior.
The area of focus on “experiencing emotion”, such as, how it feels to express
emotion or how it feels to feel emotion or how it feels to share emotion or, what the
process of experiencing emotion is like, has been intentionally unspecified, so as to allow
participants to naturally follow the path of talking about the particular experience that is
meaningful to them. The research therefore, hopes to learn about what meanings older
men give to experiencing their emotion in therapy.
Locating older men for the present research who had (recently) been in therapy
proved to be challenging (see section 3.9.1.3 on recruitment and situating the sample). As
such, the following chapter begins with a review of two sides to the possible explanations
behind the ‘invisibility’ of older men. It identifies mental-health professionals and
services as over-looking the needs of older men and it explores the outcome of following
typical masculine scripts which tend to prevent older men from using such services.
Related to the active construction of masculine identity is the gendered construction of
emotions. A significant portion of this study therefore, reviews masculine theory and how
living gendered lives may affect how some men manage and express their emotions in
therapy. This section is followed by a review of older men’s susceptibility to alcohol use
8
disorder (AUD) and the relationship between poor emotion regulation and the misuse of
alcohol. Here, literature also draws on unhealthy drinking patterns and behaviour as being
associated with socialised masculinity. The final section reviews the importance of social
support as providing a significant and positive influence on health and alcohol recovery
but it also explores mixed reviews on fellowships like A.A. and its compatibility with
counselling theory.
This research offers counselling psychologists an opportunity to enhance
professional practice (Kasket, 2012) by getting to know an aspect of older men and
improving attitudes to working with the older age group (Kraus, 2012). The research was
carried out through semi-structured interviews using Interpretative Phenomenological
Analysis (IPA) with careful attention paid to contextual meanings, and researcherparticipant (inter)-subjectivity upheld. This process was vigorously iterative; involving
the hermeneutic circle to ensure the interpretation was firmly grounded in the data.
9
Chapter 2. Literature Review
2.1 Overview
In aiming to illuminate how older men in AA experience their emotions in
therapy, as well as to constructively critique previous findings, I researched key areas
with key words from which the following literature review expands on: masculinity
theory, men and aging, the role of masculinity in older men, contemporary
psychoanalytic perspectives on masculinity, emotions, the experience of emotions,
emotions and older men, help-seeking in older and younger men, alcohol use disorder,
Alcoholics Anonymous (A.A.), emotion regulation in alcoholics, masculinity and
alcohol, effectiveness of A.A. and the Counselling Profession, and Interpretative
Phenomenological Analysis (IPA). To further garner knowledge on the wider lens
through which my research is focussed on, I thoroughly read and researched emotional
theories, gender and psychotherapy and aimed to provide relevant up-to-date statistics
throughout the research.
The database employed was from the American Psychological Association’s
database network such as PsychINFO and PsychNET, Academic Search PremierEbscohost, Science Direct, Cambridge Journals Archive, JSTOR Arts and Sciences, PEP
WEB, Project Muse, ProQuest Dissertations and Theses Global (PQDT), Sage Premier
and Wiley Online Library. These were mainly E-books, journals and articles while other
research came from hard copy books.
My initial literature review search garnered substantial coverage of and interest in
the subject of emotions in clinical theory and practice (Aldao & Dixon-Gordon, 2014;
Russell, 2003; Safran & Greenberg, 1991) and extensive literature on masculinity (Burke,
2014; McLean,1995; Seidler, 1997), but a lack of clinical and contemporary scholarship
10
on the masculinity of minority groups, such as older men and their emotions, particularly
in therapy. This is evident in research demographics as college students, women and
young children tend to occupy the majority of population groups under inquiry. Even
research that claims to study age differences seems to neglect the older male age group in
favour of middle-aged and younger men (Thompson, Jr. 1994; Zimmermann & Iwanski,
2014). Watkins (2012) examined six review/meta-analytic investigations on short and
long psychodynamic research covering 1960 to 2008, containing 86 studies and a total of
7,715 research participants and found only 34 percent were male, 11 percent of the
studies did not include males, 9 percent were unclear on the number of males involved
and 23 percent had six or fewer males in either the complete sample or the dynamic
treatment group. Not only might this indicate the degree to which men participate in
psychological research but it also suggests a lack of detailed research into specific male
age groups and it shows, perhaps as a consequence, the tendency to generalise studies
across the lifespan of men. The fact is, older men do not necessarily share the same helpseeking behaviour and predictors as younger men (Oliver, Pearson, Coe & Gunnell,
2005) or older women.
The way in which older men are categorised in gerontology may add to older
men’s ‘invisibility’. Thompson Jr. (1994) argues that there is a blurring between ‘sex’
and ‘gender’ in gerontology as gender tends to be treated as synonymous with sex,
resulting in the aged being treated as a categorical grouping construct. Consequently,
geriatric literature tends to introduce older biological males by virtue of describing a sex
difference in aging rather than cohort-related experiences, belief systems and gendered
social lives. Thompson (1994) stresses that few researchers have paid attention to the fact
that older men have gendered experiences of their masculinities, and contextualisation of
these experiences is a requirement in understanding the complex and highly glossed over
clinical ‘representation’ of older men.
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According to the Improving Access to Psychological Therapies (IAPT, 2014)
website, engagement of psychological services by older men has remained lower than
expected and is contrary to expected numbers, despite its offering as an ‘all age adult
services’ programme. Data collected in the Eastern region of England showed 3.9 percent
of service users were aged over 65. However, figures based on differences in the
prevalence of common mental disorders and age profiles of the population in this region
anticipate a number closer to 13 percent. Only 32 percent of older men in the 66-85 age
group seek IAPT services compared to 68 percent of older women. From the data on
mental health services then, it seems that fewer men compared to women are referred to
IAPT services with much lower usage of mental health services than women. This is
worrying considering males aged 65 and over are said to be less likely to report mental
health issues (Doherty & Kartalova-O'Doherty, 2010). Men tend to be less able to
recognise feelings of distress as an emotional problem (Kessler, Brown & Boman, 1981),
but receptivity towards services also plays a role (Leaf & Bruce, 1987; Vogel, Wester &
Larson, 2007). As age is often associated with mental deterioration, psychological
treatment may immediately and unfairly be ruled out (Garner, 2003). According to AllenMeares and Burman (1995), events associated with the ageing process such as retirement
and bereavement can sometimes lead to post-traumatic stress disorder. This might be one
reason why older men are argued to have a higher rate of depression compared to
younger men (Djernes, 2006) with detrimental effects on mortality.
According to Arber and Davidson (2003) older men tend to be reluctant to access
mental health services because of the perception that they are geared towards the needs of
older women; perhaps also of consideration is that referrals made by general practitioners
(GPs) tended to be lower for older people (Matthew et al., 2014). Unfortunately, there is
strong evidence to suggest that less extreme forms of male distress tend to routinely go
unnoticed (Swami, 2012).
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Fifty-five percent of GPs believe that talking therapies are the most effective
strategies for treating depression, but only 32 percent make these referrals as a first
treatment response (Mental Health Foundation, 2007). The fact that older men exist in
smaller numbers and proportions than older women, and have low use of mental health
services should not be a subject matter that is overlooked.
Older men, on the whole, continue to be underserved and undiagnosed by
healthcare professionals (World Health Organisation [WHO], 2013). The amount of
money spent on healthcare appears to be declining with age for men yet appears to hold
steady for women (Beecham et al., 2008). Of consideration is General Practitioners’
(GPs) gender bias in the prognosis of patients (Stoppe, Sandholzer, Huppertz, Duwe &
Staedt, 1999). Furthermore, developments in services are not specifically designed to
completely meet older men’s mental health needs (Commission for Healthcare Audit and
Inspection, 2009). In addition, projects such as Grouchy Old Men?, established by the
Mental Health Foundation (Williamson, 2011), may be useful in bringing about
improvements to services for a select group of providers but it is unclear if such
improvements have been particularly successful in directly increasing older men’s
commitment to such services. In effect, extending services to include the older population
and incorporating service improvements may not be sufficient in getting older men
through the doors of mental health establishments.
Murstein and Fontaine (1993) argue that older men are not as comfortable as older
women are with psychiatric nurses, marriage counsellors and psychologists. In fact, they
seem to have a distrust of caregivers and the need for privacy (Mackenzie, Pagura and
Sareen, 2010). Anderson and Brownlie (2011) argue that, on the whole, older people are
much less positively oriented towards ‘emotions talk’ or talk-based forms of emotional
support (psychiatry, psychology, counselling or therapy) but, compared to the youngest
adult age group (18-24 years), older people aged 65 and over would consider talking to
13
their GP if they were feeling anxious or depressed. Anderson et al. (2011) also suggest
that the relationship between help-seeking and age is not a linear one, describing it as a
‘u-curve’ whereby “subjective wellbeing is typically highest among the young and the
old, and lowest among those in middle age” (p.59). According to the authors, this means
that those age groups apparently most in need of emotional support may also be most
supportive of it. However, the latter is not tantamount to taking action as only about 16
percent actually consulted with a professional and 6 percent had done so within the past
year across the whole population studied. Anderson et al. (2011) argue that, “ a
significant proportion of all adults have, at some stage, consulted their GP at points when
they have been feeling ‘worried, stressed or down’, but there is little sign of widespread
recourse to explicitly talk-based forms of emotional support ...” (p.60). In sum, although
older men may express positive consideration in speaking to counsellors or therapists if
they are feeling worried, stressed or down, this is not the same as actively partaking in
therapy. Even when men do seek psychological help, about 96 percent do so, because
their GP or intimate partner has influenced them to some degree (Cusack, Deane, Wilson
and Ciarrochi, 2006).
Historical influences in men’s normative patterns of help-seeking behaviour may
explain the lack of focus and lack of clinical and contemporary scholarship on older men.
“Whereas older women have taken advantage of the successful advocacy efforts of
feminists, older men have not benefited from efforts of those in the men’s movement and
there are few, if any, groups or organizations that advocate on behalf of their welfare”
(Kosberg, 2005, p.10). In fact, hegemonic masculinity as a way of being, is said to be
linked to why some older men find it difficult to seek help (Vogel, Wester, Hammer &
Downing-Matibag, 2013). I elaborate further in section 2.3.1.
Crucially, older men may be ‘invisible’ because of their perceived need and selfsufficiency beliefs, tendency for reactance when autonomy is threatened (Mackenzie,
14
Pagura and Sareen, 2010) and the need for emotional control (Olenick, 2011). According
to Mahalik, Good and Englar-Carlson (2003) as well as Vogel, et al., (2013) men’s helpseeking behaviour has much to do with masculine ideologies (i.e. culturally based ‘male’
scripts) and the restriction of emotions. Culturally based scripts tend to validate men as
‘real’ men and the ‘stronger sex’ in the realm of social power and status (Courtenay,
2000) and to go against this would mean violating important masculine gender roles
(Vogel et al., 2014).
Even when talking about emotional subject matter during psychological helpseeking, men continue to preserve their masculinity within the stronghold of masculine
scripts (Vacha-Haase, Wester & Christianson 2011). According to the authors, the
outcome of following masculine scripts for a prolonged period of time is commonly
exhibited in older men by “a lower range of emotional expression, with the exception of
anger or aggression, becom[ing] the preferred mode of communication” (p.3). That is,
men who subscribe to traditional and hegemonic masculine scripts over-privilege anger
as an emotional regulation tool while their other emotions are forced to stay under control
because they may be seen as less masculine.
Another perspective is that the decline in use of help-seeking is broadly consistent
with Carstensen’s (1993) socio-emotional selectivity theory which suggests that as
emotional interactions become more taxing with age so does the choice to be more
selective about relational investments. This could be interpreted as the older people get,
the more competent they become in regulating their emotions (Gross, Carstensen,
Pasupathi, Tsai, Skorpen & Hsu, 1997). See section 2.2. below on aging theories and the
psychological outcome for older men. The subsequent paragraphs thereafter explore the
literature on three key areas: masculinity, emotions and alcohol and recovery. Each
section is supported by research and theories, as relevant to older men, and where limited
literature, men in general.
15
Finally, an important consideration with regards to older men’s masculinity,
emotions and use of alcohol or alcoholism is the wider cross-cultural and intergenerational
variability and implications that exist in the ways older men may express behaviour and
beliefs, across a multitude of contexts such as life adjustments, available support, in the
backdrop of differing communications styles and relational scenarious. Furthermore, each
generation is given a constructed context into how age and gender are performed conforming
to social expectations. For instance, the use of alcohol and cigarettes were greatly encouraged
in the 1930s and 1940s to help relax soldiers during the war but was also a symbol of
masculinity with concepts such as freedom, sacrifice and responsibility to country (VachaHaase, Wetsre & Christianson (2011). Today, use of cigarettes and alcohol is considered to
be destructive to personal health and those around such users, and is no longer considered to
be symbolic of masculinity. Especially since, today many women also consume such
substances.
2.2 Synthesis of theories on aging of older men
The study of aging is represented in several fields, each attempting to explain
different outcomes of the ageing process based on different theoretical perspectives. The
following page includes aging theories and the psychological outcome for older men (see
table 1). In summary, aging can have a positive or negative psychological outcome
depending on how well change is managed, how well one copes, adjusts, acknowledges
acceptance to things that cannot be controlled, openness to help-seeking and efforts to
keeping healthy and active.
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Theories of Ageing
Theoretical
Perspective
Major Assumptions
Outcomes for Older Men
a) Programmed: ageing follows
a biological timetable and
growing old is merely about
staying active for successful
ageing.
How well older men are able to
manage the changes associated
with ageing combined with
their biological make-up will
determine how successfully
they grow old.
b) Damage or error: the cause
of ageing is the result of
environmental
damage
at
various levels in the lifespan.
The stress of coping or failing
to cope with these
physiological changes can have
pathological consequences as
proposed by the stress theory
of ageing (Vacha-Haase, et al.,
2011).
Continuity is more difficult to
maintain with advances in
ageing. Following the same
patterns adopted in early life
may not be conducive to
changes and may keep older
men in a rut, without room for
enrichment (Zurawik, 2014).
Biological theory
(Jin, 2010).
Changes associated with ageing
are better managed using
Continuity theory already
successful
social
(Atchley, 1989). frameworks built over the lifecourse (Sulmasy & Cicero,
2014).
Selection,
optimisation,
compensation
meta–theory.
Psychological
Reactance
Theory
Endocrine theory
Psychological losses tend to May try to compensate for this
exceed psychological gains loss by attempting to maintain
(Vacha-Haase et al., 2011).
their equilibrium (Boker, 2013)
and masculinity by neglecting
to seek help.
Occurs in response to real or Withdrawal from society with
perceived
threat
in
the recluse behavior leading to
reduction or elimination of loneliness and depression
behavioural freedoms (Woller, (Dahlberg, Andersson, McKee
Buboltz & Loveland, 2007).
& Lennartsson, 2014).
Fear of seeking help and being
assessed with a diminished
capacity to take care of
themselves (Jefferson, Karel,
Carpenter, Stiegel & Bernatz,
2008).
Hormones regulate ageing and, Older men struggle with their
as men age, there is a small and virility and sexual prowess
progressive decline in several (Vacha-Haase, et al., 2011).
sex hormones (Araujo &
Wittert, 2011).
17
Theories of Ageing
Theoretical
Perspective
Theory of
Cognitive Ageing
Sociological
Theory
Major Assumptions
Outcomes for Older Men
a) Proximal: age-related effects
occur from more recent factors
which might determine agerelated changes in cognition.
The more efficient older men
are in their cognitive functions,
the better they are in
functioning every day.
b) Distal: age-based differences
occur earlier in a person’s life
but contribute to coexisting
levels of cognitive performance
(Diehl et al., 2014).
Disengagement theory posits
that as older men age, they are
likely to increasingly withdraw
from their social world and turn
inwards.
A man can develop new areas
of cognitive competence that
his gender role could not afford
him in earlier life.
Mutual
withdrawal
of
interaction with others which
benefits the individual and
society (Sulmasy & Cicero,
2014).
Activity theory holds that a
positive correlation exists
between keeping active and
ageing well.
Older men and society would
both benefit if they continue to
maintain
a
meaningful,
productive, active life right
into old age.
Table 1: Theories of Ageing
2.3 Masculinity
It was not too long ago that men were viewed as a homogenous group under the
guise of the “biological fact of maleness” (Connell, 1985, p.265). However, this view has
since evolved to that of “sex is fundamentally biological, and gender is fundamentally
social” (Thompson Jr., 1994, p. xi), and in recognising multiple forms of masculinity,
(rather than one single masculinity) including hegemonic, complicit, marginalized and
subordinate, and differences and diversity among men (Schofield, Connell, Walker,
Wood & Butland, 2000) there are several different ways of being masculine.
Hegemonic masculinity is a dominant form of masculinity in some cultures, subgroups and geographical locations, internalised to the point of it being synonymous with
maleness. It so widespread and ingrained it is taken as a normative male process and
largely accepted by both women and men in a society (Connell & Messerschmidt, 2005).
18
Hegemonic masculinity has four main features: power; ambivalence towards femininity;
domination and objectification of nature and the psyche; the avoidance of emotion
(Garde, 2003) and anything beyond hegemonic descriptors seemed to be dismissed nonmasculine (McQueen & Henwood, 2002).
Hegemony is about the winning and the clinching of power as one social
group dominates over others and, in some instances, the domination (and abomination) of
nations over others. “The ability to impose a definition of the situation, to set the terms in
which events are understood and issues discussed, to formulate ideals and define morality
is an essential part of this process” (Donaldson, 1993, p.644). When the ruling class
establishes and maintains its domination, it does so in a way to punish non-conformity.
Displaying competence in specific social domains such as sport, alcohol, drug use, and
sexual activity is akin to performing hegemonic masculinity (Connell, 1987, 1995;
Courtenay, 2000). Hegemonic masculinity positions some ‘types’ of boys, and all
females, as subordinate or inferior to others (Laemmle, 2013). Hegemonic masculinity is
still very much present in certain cultures (Charlebois, 2009) and amongst some age and
socio-economic groups (Greene, Robles & Pawlak, 2011), in settings such as prisons
(Evans & Wallace, 2008), the army (Locke, 2013) and in gang culture (Luyt & Foster,
2001).
Complicit masculinity (Connell & Messerschmidt, 2005) describes those men
who do not fit the dominant characteristics of hegemonic masculinity, do not challenge it
but they enjoy the benefits of it and support it, even at a cost to others and themselves. In
fact, these men often admire the characteristics of hegemonic masculinity and tend not to
see the harm in hegemony and may even view it as playful and teasing. Complicit
masculinity suggests that men tend not to challenge hegemonic behaviour because it
brings their own masculinity into question (Meyer, 2010).
19
Marginalised masculinity (Connell & Messerschmidt, 2005) describes men who
may subscribe to certain facets of hegemonic masculinity like physical strength and
aggression but cannot fit into the hegemonic mainstream because of certain
characteristics which would hegemonically exclude them, such as race.
Subordinate masculinity (Connell et al., 2005) describes qualities that are the
opposite of those valued in hegemonic masculinity, for instance gay masculinity and
heterosexual men and boys with effeminate characteristics, or any over-expressiveness of
emotions and the exhibition of physical weakness.
According to Connell (Connell et al., 2005), a degree of overlap between
masculinities can be expected. Cornwall and Lindisfarne (1994) also reject the idea of a
fixed notion of masculinity suggesting that masculinity has varied meanings (though
many are ambiguous) which are interwoven, shaped and altered according to context and
over time. ‘Being masculine’ or ‘doing masculinity’ is varied and manifold with very
different versions of masculinity coexisting within the same setting. According to
Connell at al., “ “masculinity” represents not a certain type of man but, rather, a way that
men position themselves through discursive practices “ (p.841).
2.3.1 Implications of masculinity
Pleck (1981) emphasised that men’s subscription and over-adherence to
conforming to traditional gender roles of masculinity is a personal, psychological and
interpersonal strain. Research shows that the more men endorse traditional masculinity
ideologies, the more they experience a host of presenting issues including poorer selfesteem (Reilly, Rochlen & Awad, 2014), problems with emotional intimacy (Lindsay,
2014), greater depression, anger and anxiety (Genuchi & Valdez, 2014; Zimmerman,
Morrison & Heimberg, 2014), substance abuse (Uy, Massoth & Gottdiener, 2014),
problems with interpersonal violence (Allen, 2014; Franchina, Eisler & Moore, 2001),
20
implications in suicide (Garnham & Bryant, 2014), masculine-related crime (Doude,
2014) as well as reluctance to seek psychological help (Sullivan, Camic & Brown, 2014).
In what Pleck (1981; 1995) deemed gender role discrepancy it is theorised that a
number of men are likely to fail to fit in to their traditional gender role with perceived
differences between the idealised male role and actual self. Gender role conflict (GRC)
(O’Neil, 1981a) has been associated with men’s psychological distress and its negative
outcomes that result in the “restriction of the person’s ability to actualize their human
potential or the restriction of someone else’s potential” (p.203). Those who succeed in
their masculine roles and act on their gender-emotion beliefs may do so but with gender
role trauma (Pleck, 1981; 1995). This can be exemplified by the emotional disconnect
between older men and their adult sons living with the same socialised gender role
standards (Vacha-Haase, et al., 2011). Extending interpersonally, if a man is able to fulfill
his gender role it may be at cost to all others around him, which is when gender role
dysfunction is experienced. That is, what works for him may not necessarily work for
others around him.
According to McLean (1995), hegemony “creates the emotional splitting and
illiteracy that allows men to abuse others, as well as making them susceptible to
emotional manipulation by those in positions of power” (p.88). This emotional illiteracy
can be described as ‘learned’ and an intentional loss of voice in the realm of emotional
expression. Gender-emotion beliefs are said to have an impact on men’s self-perception
(Shields, 2013), and this is thought to cause emotional suppression and emotional conflict
(Galasinski, 2004; Hanlon, 2012; Rowan, 1997; Seidler, 1997; Walton, Coyle & Lyons
2004). Some have argued that such an approach to emotions has pathologised men to the
point of creating a form of male alexithymia (Walton, 2007), a diagnostic term applied to
people with difficulty identifying, describing and expressing their emotions (Chen, Xu,
Jing & Chan, 2011). In fact, Levant, Hall, Williams and Hasan’s (2009) empirical study
21
across several measures combining both clinical and nonclinical samples found that men
tend to have higher levels of alexithymia.
Gender-emotion beliefs also impact evaluation and perception of others (Shields,
2013). According to McLean (1995), one way to divide men amongst themselves is
through homophobia and any sign of affective difference, particularly in the expression of
affection or weakness. Yet boys receive conflicting messages and “self-contradictory
baggage” (Shields, 2013, p.424,) as on the one hand there is the idea that they should
embrace an androgynous sex role yet, on the other, they are admonished for becoming
too feminine.
On the other hand, it is argued that men’s and women’s brains are simply built
differently. For example, empathy, as defined by Baron-Cohen, (2011) is “our ability to
identify what someone else is thinking or feeling and to respond to that person’s thoughts
and feelings with an appropriate emotion” (p.10) appears to be lower for men than
women on the Emotion Quotient scale and higher for men on the Systemizing Quotient
scale. This suggests that men appear to be better at analysing and exploring systems and
rules (Wakabayashi, Baron-Cohen & Wheelwright, 2006). Baron-Cohen (2011) argues
that empathy works on a spectrum and can be depicted in a bell shaped curve or normal
distribution and explains that variations in empathy has to do with an empathy circuit that
functions like a dimmer switch. In summary, generalisations on masculinities are
problematic because the masculinity paradigm assumes all men to be a certain way.
2.3.2 The meaning of masculinity to older men
Men raised with traditional notions of what it is to be ‘a man’ are said to be virile,
tough, strong and in control (Levant, 1995) but physical ageing can have a profound
impact on how older men sustain and negotiate hegemonic masculine ideals (Gutmann,
1987; Whitehead, 2002). While the youthful, strong, muscular male body exemplifies the
22
prototypical form of masculinity (Dutton, 1995; Wienke, 1998), older men’s decline in
strength and physical competence tends to signify a sense of loss in the normative
construction of masculinity (Shilling, 1993) such that some older men are considered
feminised (Fleming, 1999), gender absent (Hanmer & Hearn, 1999), ungendered (Saxton
& Cole, 2012) and have been described as a homogenous group (Thompson Jr., 1994)
and a paradoxical social category (Hearn, 1995).
According to Coles and Vassarotti (2012), older men are able to negotiate their
masculinity to accommodate their age and ageing bodies and tend to maintain their
dominant masculine identity by making comparisons to other men of the same age. A
Swedish study (Alex, Hammarstrom, Norberg & Lundman, 2008) about the construction
of masculinities among men aged 85 derived three themes surrounding masculinities:
‘being in the male center’, ‘striving to maintain the male facade’ and ‘being related’.
‘Being in the male center’ described older men in these masculinities as valuing their
ability and activity in society and their tendency to dominate the public space. Such men
are unaffected by modern discourse regarding gender equality and tend to construct and
reconstruct their differentiation from women and are incapable of putting others ahead of
them. The men ‘striving to maintain the male facade’ appeared to need other men to help
them feel as though they were in the male center and rejected the idea of being physically
weak. The masculinity of ‘being related’ shows a ‘moving in with the times’, an
evolution of masculinity that involves fluidity and flow in the building of positive
relationships. This study shows the cultural diversity and subjectivity of pronounced or
nuanced masculinities in which older men are seen to negotiate, accommodate or adhere
to normalised constructs of their gender. It seems clear, therefore, that deeper attention
should be given to not just the variety of ways in which older men perform gender but
how and what meaning older men give to experiencing emotions in therapy. This can be
carried out by asking men to reflect on their subjective experiences (de Visser, 2006).
23
2.3.3 Men in therapy
In The Male In Analysis, Gaitanidis argues that, “maleness can emerge from a
more subtle exchange than the one-way phallic penetration of some ambient empty
vaginal space waiting to be procreative” (p. 134). Moving away from such ‘classical’
Freudian notions of the construction of masculinity (without Freud’s actual use of the
terms ‘gender’ and ‘gender identity’) indeed with its focus on phallic privilege and
exclusivity to family dynamics, contemporary psychoanalytic perspectives tend to
approach and understand masculinity interpersonally, interpsychically and
intrapsychically, with multiple points of view. Diamond (2015) suggest that gender
identity could have first been constructed out of early, preoedipal identifications and
integrations with both parents, unconsciously absorbing messages, desires and identifying
with both parents while being influenced by biological, drive-based variables. Gaitanidis
(2011) describes a disidentification occurring on two counts, “..first for the establishment
of a self-identity and second for the consolidation of a male identity” (p.3).
Contemporary psychoanalytic perspectives address the omission of the other’s
significance in gender structure formation and considers complex psychic coordinates of
masculinity (Reis & Grossmark, 2009) its ambiguities and contradictions (Dunlap, &
Johnson, 2013; Laurie, 2015) with multiple identifications integrated into an evolving
bodily/mental sense of masculinity. Stanton, in favour of the concept of interpersonal
maleness, suggests that it is negotiated by all males as part of their psychological
development, which he describes as a kind of transference effect that is essentially
unconscious. Gaitanidis (2011) adds that,“.. the male-effect inevitably subverts enclosure
either in fixed gender discourse (essentialist masculinity) or in family role stereotypes
(i.e. mother/father). The progressive subversion of gender family stereotypes by maleness
engenders an ongoing living crisis of masculinity, which inevitably looms large in the
24
consulting room and is mirrored in the transference” (p. 2). Gaitanidis outlines the male
identity crisis that psychically invests in clinging to normative ways of masculinity but
which may no longer serve them well in the face of social changes and has “undermined
the emotional life of men whose best hope of connection with human beings lies in
detachment” (p. 135).
Good, Dell and Mintz (1989), when examining specific elements of Gender role
conflict (GRC), reported that men who adhere to restrictive emotionality and affectionate
behaviour between men tend to be reluctant to seek psychological help. In other words,
men who adhere to traditional gender role norms tend to be less willing to disclose their
emotions verbally (Robertson, Woodford, Lin, Danos & Hurst, 2001) and are reluctant to
seek psychological help, more so if they are expected to explore their emotions in therapy
(Cusack, Deane, Wilson and Ciarrochi, 2006). According the authors, even when men do
seek psychological help, about 96 percent do so only because their GP or intimate partner
has influenced them to some degree.
Traditional masculinity scripts (Mahalik et al., 2003) can be tied to many stressors
for men and those around them and are said to play a role in men’s psychological distress.
Mahalik et al. (2003) listed seven “masculine scripts” (p.124-126) that tend to arise
during psychotherapy with males. The “strong and silent” script portrays men as
unemotional and stoic and this emotional construct helps them validate and live up to
gender expectations. Mahalik et al. (2003) suggest that there are longer-term
consequences to men’s health as a result of this suppression of emotions. The “toughguy” script builds on the latter script and represents extreme indestructability, aggression
and fearlessness. The emotional construct associated with this is on the forceful
suppression of emotions associated with any potential feelings of vulnerability. Mahalik
et al. (2003) stress that application of this script requires a high level of coping with
unhealthy consequences. The “give-em-hell” script focuses on the values of physical
25
action, outward aggression or violence as a way to attain goals. Emotions in this context
are acceptable but feelings of discomfort or shame are hidden and ignored. The “play
boy” and the “homophobic” scripts refer to the perception that so-called ‘real’ men are
sexually active, heterosexual, emotionally detached and behave non-relationally. Both
scripts are related to the fear of being seen as vulnerable, hiding guilt and shame with the
homophobic perspective, even taking on a violent form to reinforce a sense of
masculinity, in particular where they may have difficulty dealing with same-sex
attraction. According to Mahalik et al. (2003) the “winner script” and the “independent”
script are about the single-handed, winning attitude of competition and achievement of
what it is to be a (successful) man. Men are expected to perform independently without
seeking help; such pressure to perform and the inability or unwillingness to express
complaint adds to stress and poor health over time. Emotions are poorly regulated with
independent emotional scripts constructed as detached and alienating. Mahalik et al.
(2003) suggest that masculine scripts may be interconnected as “men’s individual
constructions of masculinity are likely to focus on some normative messages but not on
others” (p.127).
2.3.4 Conclusion
Men are socialised to have a specific set of attitudes, which are internalised to the
point that they are played out throughout their lifespan despite personal costs. For older
men, multiple masculinities and their auxiliary scripts are added to the complex and
multifactorial process of ageing, causing them to negotiate multiple aspects of their
gender. They may learn to emotionally desensitise or disconnect themselves for fear of
seeming weak or vulnerable. As a consequence, some men learn to fear intimacy and
reject whatever causes them to experience fear (French, 1991). Enduring the suppression
of emotions can be pressured, stressful and, at worst, have negative psychological
26
consequences. Yet older men are unique in their circumstances when it comes to the
construction of their masculinities and how they practice masculinity. It has been
theorized that age brings about changes in the meanings of masculinity (Schaie & Willis,
2002; Henry, 1988) and it is important to recognise that this later stage of life can be
fulfilling and rewarding. Rowe and Kahn’s (1998) theory of successful ageing suggests
that rather than a period of decline, older men can spend time minimising disease and
illness, maximising good physical and cognitive heath and maintaining relational, social
activity with others. Furthermore, although health does decline in older age, it does not
decline at the same rate for all older people (Vaillant & Mukamal, 2001).
2.4 The experience of emotion
Emotion is a dynamic, multidimensional phenomenon that manifests through
physiology, emotional experience and expression. Barrett, Mesquita, Ochsner and Gross
(2007) describe the experience of emotion as a conceptual structure stored in memory
which includes current perceptions of the world, cognitions (thoughts, memories and
beliefs), actions and core affect (pleasure or displeasure) that bind together to form a
single, meaningful experience. This conceptual knowledge about emotion is what allows
people to identify emotions in others. That is, the understanding of the experience of
emotion from someone else’s perspective necessitates a level of comprehension of those
feelings.
Barrett (2006) proposes that emotions are not causal entities and they do not cause
behaviour. Emotions are states that are caused, with scripts regulating behaviour and
offering clear guidance on how one is supposed to act in society. Therefore, the way
people learn about categories of emotion and use of conceptual knowledge determines
what they see and feel. It is believed that emotions become intelligible when considered
from a personal perspective (Eatough & Smith, 2006).
27
As emotion experience can be described as a conscious event with
phenomenological features, Barrett et al., (2007) proposed this is an opportunity for
science “to study these subjective content-rich, events in an epistemologically objective
manner” (p.4). As agreeable to the present study, Barrett et al., (2007) refer to the
experience of emotions as “affect, perceptions of the world, and conceptual knowledge
about emotion are bound together at a moment in time, producing an intentional state
where affect is experienced as having been caused by some object or situation” (p.5).
2.4.1 The role of emotion in masculinity
In Western societies, beliefs about emotion and their related practices have played
an important role in characterising gender difference (Crawford, Kippax, Onyx, Gault &
Benton, 1992; Chentsova-Dutton & Tsai, 2007; Shields, 2013). Men, for instance, are
believed to be ‘the inexpressive gender’ (Averill, 1980; Solomon, 2008) expressing fewer
positive emotions such as affection, love and joy, and experiencing fewer negative
emotions such as fear (Brody, 1999; Duncomb & Marsden, 1993; Galasinski, 2004;
Hanlon, 2009; McGill, 1985).
Gender socialisation theory (Cole, 2014; Eisenberg, Cumberland & Spinrad,
1998; Fivush, 1989; Heinze & Horn, 2014; Kuebli & Fivush, 1992; Witt, 1997) posits
that boys learn to be less emotional than girls because parents, teachers and peers respond
negatively to displays of emotion and men’s expressiveness (Balswick, 1988; Good &
Sherrod, 2001). It can be said, therefore, that some men are socialised to have a specific
set of attitudes (strength, dominance, independence, sexual prowess) that manifest in
gender differentiated behavioral expressions of emotion (Brody, 1997; Fabes & Martin,
1991; LaFrance & Banaji, 1992).
According to Seidler (1991), years of hiding or denying their feelings results in a
form of emotional numbness which allows some men to inflict pain on others without
28
being affected by it themselves (McLean 1995) and which also prevents others from
inflicting power and abuse over them. Sattell (1989) believes that inexpressiveness is
necessary because it prepares some men for positions of power and privilege, enabling
them to reduce their emotional involvement in the consequences of their practices. “For
men, two things seem to go inextricably together—the desire for power and the fear of
failure. No other alternative seems to exist” (McLean, 1995, p.83). There is a sense,
therefore, that a gendered approach to emotions serves as an important role in setting
gender boundaries and as a way to validate the normalisation of hegemonic masculinity.
“Thus, the nature of emotional experience, as a distinctively human quality, can be
claimed or contested as a property of status and power” (Shields, 2007, p.93). Some men
however, feel pressurised to repress any emotions that might make them seem vulnerable
as expressing these emotions might seem unmanly or feminine (Pease, 2012). In some
instances men are reproached when vulnerability or public displays of any emotion other
than anger is expressed (Kingerlee, Precious, Sullivan & Barry, 2014). Gender policing
and the power of social ‘discourses’ suggest how very young boys in school try to
negotiate and articulate their own sense of masculine identity within a social context of
‘peer police’ but Frosh, Phoenix and Pattman (2003) describe a contemporary
masculinity crisis, with boys who are “engaged in the process of identity construction in a
context in which there are few clear models and in which the surrounding images of
masculinity are complex and confused” (p.84). Considering the literature on genderrelated differences in emotion, there seems to be a direct link in relation to gender and the
emotional experience, stemming from gender-coded beliefs about emotional experiences.
The belief that men are less emotional than women has manifested in various
empirical studies proposing differences in intensity of emotional experience (Brody,
1985; Zimmermann & Iwanski, 2014) and behavioural expression of emotion (Collier,
1985; McClure, 2000; Thompson & Voyer, 2014). Men are also described as practicing
29
restrictive emotionality (Levant, 1995) and are said to have a lack of awareness of
emotion (Wong & Rochlen, 2005; Heesacker & Prichard, 1992) which may be attributed
to a more general willingness to report emotions nonverbally rather than verbally (Moore
& Haverkamp, 1989).
The view that men are less emotional is challenged by Wester, Vogel, Pressly and
Heesacker (2002) as they are also frequently seen as aggressive, angry and jealous
(Walton, 2007). In fact anger and lust appear to be the only permissible emotion within
hegemonic masculinity styles as it is not perceived as feminising and is seen as culturally
appropriate for males (Cummins, 2006). Men are taught to regulate their emotional
experiences by adopting aggression and hostility to counter vulnerable emotions such as
fear or shame (Dutton, 1998; Gilligan, 1996; Long, 1987; O’Neil & Harway, 1997).
Furthermore, Fischer and Good (1997) found that the degree to which men have
internalised traditional notions and roles of masculinity says more about their willingness
to express their emotions than their ability to identify their emotions (as cited in Wong &
Rochlen, 2005).
Other researchers suggest that differences in emotion in gender may be the result
of differences in emotion regulation and reactivity (Chaplin & Aldao, 2013; Domes et al.,
2010; Zimmermann & Iwanski, 2014). Emotion regulation can be described as
encompassing processes that are used to influence and regulate which emotions we have,
when we have them, their duration, intensity and how we experience and express them
(Gross, 1998; Gross 2007). Emotion regulation also includes physiological reactivity and
has social, behavioral and cognitive influences (Adam, Schönfelder, Forneck & Wessa,
2014; Giuliani & Gross, 2009; Garnefski, Legerstee, Kraaij, van den Kommer & Teerds,
2002; van’t Wout, Chang & Sanfey, 2010; Thompson & Calkins, 1996).
However, Wester et al. (2002) reviewed sex differences in emotionality and
concluded that men’s and women’s emotional behaviours are more similar than different.
30
Any differences are likely to be small, inconsistent and context dependent. In sum, as
with masculinity, emotional behaviour is not a stable entity but a multidimensional
construct that is contextually based with many different triggers, modes, effects, levels of
emotional intensity, ways of expressing emotions and a multitude of consequences.
2.4.2 Older men’s experiences of their emotions and masculinity
For many older men today, their lives were governed and restricted by historical
influences. As Hooyman and Rubinstein (1997) observe, “... most older men and women
were brought up in times that emphasized the skill limitations of women and provided a
natural ‘logic’ to explain this: Skills for each gender were said to be largely ‘natural’ or
‘innate’ and therefore unavailable to the other gender” (cited in Kosberg, 2005, p.31).
Thus the older generation’s behavioural patterns are likely to evolve throughout their
lifespan and may become less relevant as society moves forward. Vacha-Haase, et al.,
(2011) describe this as a type of disconnect and how it encroaches on the disconnect that
older men feel with general expression of emotions, in particular tender emotions. That
is, society tends to actively discourage men from openly expressing their emotions
(Wester et al., 2002). According to Vacha-Haase, et al. (2011) this can lead to “conflicted
sensibilities captured by the gender role constructs of restricted emotionality and
restricted affectionate behaviour between men patterns” (p.29). It is not until the man gets
older that he might unlearn his gender-constructed emotional expressions.
Bennett (2007) applied grounded theory and content analysis methods to semistructured interviews with 60 male widowers, with a mean age of 79, to develop
understanding of how older men negotiate their conflicting emotional experiences of
widowhood together with hegemonic masculinity and its related ideas of emotional
suppression. Bennett’s study revealed that, older men negotiated and reconstructed their
31
masculinity and bereavement in the context of where emotional expression takes place,
such as in the private sphere. Bennett drew from Brannon (1976) revealing that older
men, in aspiring to be the ‘sturdy oak’, tend to act tough behaviorally and emotionally
and not require help. Similarly the ‘no sissy stuff’ type of man who stigmatizes “all
stereotyped feminine characteristics and qualities including openness and vulnerability”
tends to demand composure, even when losing a life partner (Bennett, 2007, p.348).
Bennett’s own analysis revealed that widowers do not completely refrain from doing
‘sissy stuff’ “but they negotiate the situation by describing their engagement in terms
which reflect the dominant masculine ideal, and which fit comfortably within Brannon's
notion of ‘the sturdy oak’” (2007, p.355). Bennett noticed a calm and deliberate
demeanor, despite the emotional content, presented in a masculine manner that exuded
“control, rationality, successful action, and responsibility towards others” (2007, p.355)
as a way to continue asserting their masculinity, although perhaps this may be done
unconsciously. Widowed men are described here as powerless since they are not as virile
nor have sexual prowess, they are not young and are mainly retired hence not compatible
with the subscribed norms of hegemonic masculinity. While Bennett’s (2007) study
focused on masculinity and emotions, it was specifically aimed at widowed older males
and not generalised to other older men and other important emotional milestones in an
older man’s life. Barusch (2000) supports the idea that older men may not necessarily be
comfortable with open and spontaneous sharing of emotions, particularly in a group
setting. Kosberg and Magnum (2002) suggest that this may be due to an inability to
articulate feelings, feeling shy around females and the tendency of some older male
minorities, in particular, to not participate if females dominate the group.
How older men experience their emotions may be linked to how they regulate
their emotions. One study (Nolen-Hoeksema & Aldao, 2011) showed that older men use
more strategies to suppress emotions then younger men (refer to section 2.5.2). Such
32
strategies are likely to have been in place and encouraged since boyhood (Vacha-Haase,
et al., 2011). Older men are also said to ruminate less than younger men which, according
to Vacha-Haase, et al., (2011), may be suggestive of a socialisation effect. Hence the
regulation of emotion is said to play a role in adaptive functioning (McRae, Misra,
Prasad, Pereira & Gross, 2012). Older people are said to effectively control their
experience and expression of emotions (Phillips, Henry, Hosie & Milne, 2008) however,
when it comes to gender (Zimmermann & Iwanski, 2014), no differences in adaptive
emotion regulation were found. According to Saarni, Campos, Camras and Witherington
(2006), differences in reappraisal and suppression may develop out of gender roles or
gender differences in socialization. Similarly, there is evidence to suggest that emotional
experiences are very similar throughout one’s lifespan with the argument that older
people tend to learn from past experiences and optimize on their present emotional
experiences (Strongman & Overton, 1999). That is, older people become better at
regulating their emotions (English & Carstensen 2014; Gross et al., 1997; Zimmermann
& Iwanski, 2014).
2.4.3 Conclusion
In summary, men are socialised to have a specific set of attitudes and gender
socialisation has much to do with men’s attitudes toward emotionality and genderdifferentiated behavioral expression. Yet masculinities are multifaceted and practiced
differently throughout a man’s lifespan and how they are practiced has an influence on
the multitude of attitudinal consequences. Emotion is also a multidimensional construct,
experienced as something that is linked to the psyche with conceptual structures; it is
(self) regulated, context dependent, based on the subjectivity of the individual and
expressed according to conventions of the society. Simply put, emotion functions as a
gendering construct between and within genders, but personality, culture, biological sex,
33
social roles and conventions are all factors that may contribute to, involve, construct,
activate and affect emotions.
Given that the present study’s participants are all in recovery from alcoholism, the
final section discusses key aspects of alcohol use disorder (AUD), emotion regulation and
recovery, as it relates to older men. The section also provides some insight into A.A.,
drawing on a comparison of compatibility between its principles and counselling theory.
2.5 Alcohol Use Disorder (AUD)
AUD applies to anyone meeting any two of 11 criteria during the same 12-month
period. The scale of AUD is defined as mild, moderate or severe based on the number of
criteria met which include: craving or a strong desire or urge to use alcohol; persistent
desire or unsuccessful efforts to cut down or control alcohol use; tolerance and the need
to drink more alcohol to enjoy intoxication (DSM–5, 2013). AUD tends to affect those in
early or middle adulthood, defined as early onset, or those in late onset, which tends to be
after the age of 60 (Vacha-Haase, et al., 2011).
Revisions were made to the substance use disorders (SUD) to identify and resolve
issues in DSM-IV based on data that provided evidence. According to Goldstein et al.,
(2015), these issues were greatly varied, which has implications directed at the new
categorisation. For instance, the authors note that many of the data sets that were used to
inform these new categories were collated more than ten years ago. Questions and
concerns were also critically raised with regards to the relevance of particular criteria
across substances (Room, 2011) and that includes variables across sex, race or ethnicity,
age groups categories, and developmental stages (Babor, 2011; Beynon, 2011; Caetano,
2011; Room, 2011; Winters et al., 2011). According to Goldstein et al., concerns also
exist with regards to the assigning of “equal diagnostic importance to core dependence
criteria and to “problems” or psychosocial consequences operationalised by abuse criteria
34
on the basis of statistical considerations, despite conceptual differences between these
criteria sets and their differential implications for intervention approaches” (p.379). The
problem then, lies not just in definitions of current populations but it puts into serious
question the DSM-5’s decisions for its AUD criterion, its classification’s usefulness,
reliability and validity with regards to treatment needs and in its informing of appropriate
provisions.
According to the NHS (2014), high-risk drinkers for men are those who regularly
consume more than 8 units a day (equivalent to three and a half pints of 4% beer) or 50
units a week, making them more prone to alcohol-related health problems. In England,
the number of people between the ages of 60 and 74 admitted to hospital with mental and
behavioural disorders associated with alcohol use, for example alcohol-related dementia,
anxiety and depression has risen by over 50%, more than in the 15-59 age group, over the
past 10 years (Rao, 2013). This report also found that in the last decade there has been a
140% increase in the number of over 60s being admitted to hospital with WernickeKorsakoff syndrome, a form of brain damage caused by alcohol use. Statistics in England
by gender in 2012 show that men are twice as likely to die from alcohol-related causes
compared to women (ONS, 2014). Older men tend to be more prone to AUD, in part
because they may carry previously acquired ways of drinking into later life and do not
realise the body may no longer be able to handle the same quantities of alcohol. Over
time, drinking may also become a habit.
2.5.1 AUD and masculinity
Discourse exists on men’s use of alcohol as being related to beliefs about
masculinity and the importance of drinking as being part of masculine identity (de Visser
& Smith, 2007; Hinote & Webber, 2012; Iwamoto, Cheng, Lee, Takamatsu & Gordon,
2011). Isenhart (2005) suggested that men use alcohol to fit better into the traditional
35
masculine role and to better manage stress, which tends to be related to the pressure of
having to conform. Mahalik, Good and Englar-Carlson (2006) attribute a tough-guy script
(aggressive, fearless, invulnerable) for men who tend to suppress and cope with emotions
by turning to substance abuse. In many instances, men tend to avoid help-seeking for
AUD because of shame and may remain silent, believing that they can manage and cope
with the issue. According to Vacha-Haase, et al., (2011) this may have to do with men
adhering to the strong and silent script, which tends to depict men as unemotional and
stoic or else risk the label of, being less of a man.
2.5.2 Emotion regulation in alcoholics
AUD is highly correlated with affect-related disorders. For example, alcohol
consumption and depression tend to co-occur with late-life anxiety symptoms (Forlani et
al., 2014) and alcohol use and misuse both have significant links to antisocial, borderline,
histrionic and narcissistic personality disorders (Maclean & French, 2014). Empirical
evidence points to an emotional neural network with neurochemical systems such as
dopamine, endorphins, serotonin and glutamate being involved in drug abuse and
addiction, the same key systems involved in the biological bases of emotion experience
(Robbins & Everitt, 1999; Vengeliene, Bilbao, Molander & Spanagel, 2008). This may
explain why alcoholics use substances to cope, manage or escape from unpleasant
emotions in exchange for more pleasant ones.
Marlatt and Witkiewitz (2005), in their relapse prevention model, proposed that
relapse is likely to occur in high-risk individuals facing high-risk situations with
insufficient coping skills required to deal with such situations effectively. High-risk
situations include affect-related disorders, which allude to affect regulation as being a
significant contributor to alcohol use (Berking et al., 2011). Using the Difficulties in
Emotion Regulation Scale (DERS) which contributes to overall emotional functioning,
36
and examining it against problematic alcohol use, Dvorak et al. (2014) found emotionregulation difficulties to be broadly associated with alcohol-related consequences such as
lack of emotional clarity, impulse control difficulties, and difficulties engaging in goaldirected behaviour. This is similar to Matthias et al.’s (2011) study of poor emotion
regulation contributing to misuse of alcohol. In combination with poor emotion
regulation, older men may find it difficult to stop using alcohol because of isolation,
loneliness, insomnia, chronic aches and pains and other medical disorders associated with
aging.
In summary, unchanging alcohol patterns throughout the years and negative
affects bolstered by unhelpful masculine attitudes to help-seeking tend to prevent many
older men from getting the early help they need to resolve potential AUD. Social support,
however, especially that which enhances his or her self-esteem (Booth, Russell, Soucek
& Laughlin, 1992) has been known to have a significant and positive influence on health
and recovery.
2.5.3 Alcoholics Anonymous (A.A.)
A.A. is a worldwide fellowship that has been helping millions of alcoholics
through a nonmedical approach in achieving and maintaining sobriety – or freedom from
alcohol (Vaillant, 2014). Although A.A. has roots in radical liberal Protestantism, it
claims not to be allied with any sect or denomination and accepts people from all
religious backgrounds. Its approach however, in addition to having social and emotional
elements, has strong spiritual associations. A.A.’s teachings are known as the ‘Twelve
Steps’, which describe the experience of the earliest members of the fellowship, and the
‘Twelve Traditions’, which provides guidelines for relationships between the twelve-step
groups, its members and society at large. A.A. organises ‘closed’ meetings (often daily),
which is intended for alcoholics, or ‘open’ meetings, which is open to the public and held
37
according to A.A.s ‘traditions and guidelines’. A.A. claims not to have a leader or a
figure of authority running its programme but rather the fellowship is made up of men
and women who share in the work of helping each other. Fellowship members tend to
have a ‘sponsor’ though again, the relationship is one of equals.
Zakrzewski and Hector (2004), using an existential-phenomenological method
with 7 adults aged between 32 and 65 years in sobriety from 1-25 years, relayed themes
around the silence of alcohol abuse as partly occurring because of negative views within
society. Participants, however, expressed a keen desire to discuss and address their
alcohol experience on their own terms, preferably with someone who had also
experienced addiction. In A.A., the ‘sponsor’ is one such person. He/she tends to be
someone who has made some progress in their recovery, understands the struggles of
being alcoholic, works to share their experiences on a regular basis, and offers guidance
with another alcoholic who is attempting to attain or maintain sobriety. The A.A.
handbook for Great Britain (2013), describes A.A. as a service concept whose message is
to share the principles of A.A. to those who need it, as exemplified in the 12th step.
2.5.4 Effectiveness of A.A. and the counselling profession
A.A. is accessible to everyone, is free and available in many countries and
neighbourhoods worldwide and has a large online community. It has even been shown to
reduce costs in health-care (Humphreys & Moos, 2001). Research into A.A. places
emphasis on social factors, as it is said to help reduce feelings of isolation (Talbott,
1990). According to Kelly, Hoeppner, Stout, and Pagano’s, (2012) research, A.A.
attendance during the first 3 months was associated with recovery-related benefits over a
year later, with increased self-efficacy in high risk social situations. The researchers also
found that attending A.A. had a positive effect on alcohol outcomes mediated by
spiritual/religious practices. Not everyone however agrees with the spiritual programing
38
side to A.A. as its teachings can be perceived as religious and as such may turn away
atheists and people who do not believe in a higher power (Sharma, & Branscum,
2010). Furthermore A.A. has the belief that there is no direct cure to alcoholism, that
‘once an alcoholic, always an alcoholic’. For some, the thought of not being able to
alleviate the problem of alcohol may actually have the opposite effect of helping them
into recovery.
According to Lê, Ingvarson and Page (1995), research has not been clear about
A.A.’s effectiveness in achieving sobriety mainly because of methodological flaws and
difficulty in conducting robust experiments with high drop-our rates. Randomised
controlled trials may also be difficult to organise because it is unethical to withhold
treatment from those who may need it (Sharma, & Branscum, 2010). A review of
literature on A.A.’s effectiveness based on six criterion required for establishing
causation, showed higher levels of attendance to A.A. meetings as being related to higher
rates of abstinence. In terms of magnitude, abstinence was about twice as high among
A.A. attendees and prior attendance was predictive of subsequent abstinence. However,
rigorous experimental evidence establishing the specificity of an effect for A.A. seemed
to be mixed (Kaskutas, 2009).
Lê, et al. (1995) compared A.A.’s 12 steps to counselling theories from various
psychologists including Rogers (1961, 1980), Maslow (1968); Jung (1933); Horney
(1950); Frankl (1959); Perls, Hefferline, and Goodman (1951); Ellis (1989); and Bandura
(1982). These included person-centered, humanistic, analytical, Gestalt, existential and
cognitive approaches to counselling. The authors concluded that the principles and
philosophies of A.A. are in conflict with those of counselling theory. They suggested that
A.A.’s 12 steps revolve around themes of powerlessness, defenselessness and
dependency with members being encouraged to give-up self-direction and ‘handing their
39
lives over’ rather than directing their own lives, being responsible for themselves and
developing their own strengths and abilities which is more of the basis of counselling.
In another study (Mosher-Ashley & Rabon, 2001) between three age groups of
under 40s, 40-65s and over 65s involving 72 males and 87 females attending A.A.
meetings, tested measures of emotional support, depression, loneliness and life
satisfaction. The study found significant results in the over 65 age group as having the
lowest number of depressive symptoms and the greatest amount of life satisfaction, yet
according to the authors, the positive outcome has failed to attract the interest of others in
this age group to seek out recovery programmes. According to Van Lear, Brown and
Anderson (2003), “a theory and approach to recovery must consider both the short-term
and the long-term aspects of social support” (p.26). Their study showed that the
recovering alcoholic’s relationship with their A.A. sponsor and other members in the
fellowship has long-term consequences in predicting and adding to their emotional
quality of life.
Despite the absence of consistent scientific evidence of A.A.’s efficacy, the
fellowship continues to be popular because of its strong social support and a sense of
having a meaning and purpose when attending meetings. Testimony perhaps, of A.A.’s
80 years in serving alcoholics.
2.5.5 Conclusion
Although participants are in sobriety, it is important to consider the background of
alcoholics, the levels of AUD and how older men tend to be more susceptible to AUD.
This is particularly the case, since poor emotion regulation tends to act as a contributing
factor to the misuse of alcohol and possible relapse. It is important to also note the
relationship between drinking and masculinity and how allegiance to normalised
masculinity may prevent help-seeking. Social support such as fellowships like A.A. has
40
been said to be important in enhancing self-esteem, providing a significant and positive
influence on health and recovery. There has however, been mixed reviews on the
effectiveness of A.A. and whether it is compatible to counselling theory.
2.6 Summary of the literature
Overall, the literature on masculinities and emotions reflects their respective
historical evolution, interwoven with structures of power, class and ethnicity, internal and
relational complexities as well as how the two constructs are explicitly and implicitly
connected. Understanding the role masculinity plays in older men’s emotions during
help-seeking can aid the practitioner in helping older male clients cope, adapt and
manage their feelings, even restoring their feelings of autonomy and independence. This
is especially true for older men who are socialised to believe that one dominant
masculinity standard is applicable to all men’s lives (Kosberg & Mangum, 2002). The
lack of older men’s engagement with mental health care services is considered troubling,
particularly in light of ageing and projected growth of the older population (ONS, 2011),
hence more directed efforts which meet the specific needs identified through researching
this group are required to increase their engagement.
Currently a gap in the research into the experiences of older men’s emotions in
relation to masculinity and help-seeking exists as it appears to be overshadowed by
research that focuses on younger men, women and children in general, further
compounding the problem of neglect in the older generation. This study is interested in
older men who have perhaps transcended or negotiated the traditional confines of
hegemonic masculinity and have recently been in therapy.
The following chapter explores the methodology in two parts: part 1 discusses the
research philosophy and part 2 describes how the research was approached. Part 1 of the
methodology chapter also covers the rationale for the choice of methodology, which is
41
Interpretative Phenomenological Analysis, or IPA. It assesses validity, the quality of
good qualitative research, the ontological and epistemological orientation of the research
and the researcher’s own epistemological orientation in relation to the methodology, as
well as exploring the epistemologies of Counselling Psychology and IPA. Part 1 also
discusses the major theoretical underpinnings of IPA: Phenomenology, Hermeneutics and
Idiography and offers reflections on the limitations of the IPA approach. Part 2 of the
methodology chapter describes the phenomena under investigation, the role of the
researcher, ethical considerations, and it explores how the data was collected including
participant demographics, the recruitment process, how the data was analysed and how it
is stored. (Refer to Appendences 11 and 12 for reflections on the data collection stage and
reflections on the data analysis stage).
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Chapter 3: Methodology
Part I: Philosophy
3.1 Introduction
This chapter, presented in two parts, reviews the theoretical underpinnings that
drive the investigation of the present study, which aims to explore how older men (as
defined in the participant demographic under section 3.9.1) experience their emotions in
therapy. It covers the principles, structures and application of Interpretive
Phenomenological Analysis (IPA) (Smith & Osborne, 2008; Smith, Jarman & Osborn,
1999), an experiential, qualitative and systematic approach used to inform research in
psychology. The prime reason for choosing IPA over any other qualitative approach is
because it is a methodology that reflects and is consistent with my own epistemological
position and the epistemological position of my research question.
3.2 Rationale for qualitative methodology
Qualitative research is used to analyse aspects of life and living in real situations.
Specifically, researchers who are interested in personal and individual experiences,
attitudes, behavioural changes and meanings attached to behaviour, between groups and
categories of people (Stuckey, 2013). Qualitative research is the preferred choice when
more depth into a subject area is required and with little knowledge about a subject area
(Sofaer, 2002) or when some aspect as a way of being is not easily identifiable (Morrow,
2007). Methods of inquiry are achieved through inductive and interactive (SánchezAlgarra & Anguera, 2013) approaches with participants’ and researchers’ interpretations
of events contributing to this process.
43
The current research explored how older men make sense of their emotions in
therapy, as there appears to be no qualitative literature and research into the subject
matter. As such, a detailed idiographic insight would be considered valuable to
Counselling Psychology. A qualitative methodology is not predictive, instead providing
vivid, dense and in-depth description of such phenomena. It is hoped that the present
study will be useful in contributing to the construction of more effective mental health
strategies for issues arising in an ageing population (ONS, 2012).
3.2.1 Assessing validity and the quality of good qualitative research
As a qualitative researcher, I am aware of the importance of reflecting a degree of
quality, integrity and value throughout my research. Yardley’s (2000) evaluation criterion
for good qualitative research is that it should show sensitivity to the context of the area
that is being researched. That is, the analysis and subsequent interpretation should be
sensitive to the theoretical underpinnings, the research data, the social and historical
context and the relationships between researcher and participants. Such elements as the
nature of the researcher's involvement, how the researcher may have been influenced by
the participant’s actions and balance of power should be considered.
Willig (2013) suggests that qualitative research should provide evidence of good
practice with a systematic, clear presentation of analysis, which can be demonstrably
grounded in the data and which places serious emphasis on reflexivity, credibility and
transferability. Finlay (2007) suggests that the research should be clearly and coherently
described in a way to captivate and draw an audience while Elliott, Fischer and Rennie
(1999) stress the importance of researcher integrity and preserving nuances in the data.
Evidence of quality in qualitative work is described as the degree of relevance and
of how much it contributes to research. Henwood and Pidgeon (1992) value the
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importance of providing an audit trail – a comprehensive account of what was done and
why, and sensitivity to the researcher’s as well as the participants’ respective realities.
Finlay (2006) also argues for researchers to be explicit and reflexive about strengths and
limitations in qualitative research. Participants’ perspectives must be authentically
represented within the interpretation and report of findings to fit the data and can,
therefore, be said to be trusted. Importantly, emphasis should be placed on
trustworthiness and rigour of research. As a relativist interpretivist-constructivist
researcher I have used reflexivity in co-constructing the research account, which, as
Finlay writes, is “not fact or truth” (p.17).
3.3 Ontological and epistemological orientation
As a Counselling Psychology researcher, I am encouraged to locate my ascribed
mode of inquiry or epistemological position within a philosophical paradigm – an overall
theoretical research framework which informs the choice and application of the
methodology. Incorporated within the philosophy of science are assumptions and beliefs
regarding ontology, epistemology, rhetorical structure, axiology and methodology
(Gialdino, 2009). These are associated with research paradigms of positivism, postpositivism, interpretivism-constructivism and the critical-ideological perspective
(Mackenzie & Knipe, 2006).
Ontology looks at what exists, what is real for an individual, and is a view on the
nature of reality and being (Lawson, 2004). I believe that all knowledge, experience,
thought and truth are relative to some other thing. As such, I am generally grounded in an
interpretivist-constructivist paradigm ontologically and would position myself as a
relativist. However, I am open to the idea that an individual can be selectively relativist or
realist, depending on such aspects as the context, topic in question and values (Miller,
45
2010). “Ontological assumptions of interpretivism are that social reality is seen by
multiple people and these multiple people interpret events differently, leaving multiple
perspectives” (Mack, 2010). The aim of an interpretivist researcher is to understand and
interpret participants’ experiences and the meanings they have attributed to those
experiences as opposed to generalising, seeking to explain and predicting cause and effect
(Mack, 2010).
Epistemology is concerned with the theory, study and nature of knowledge
(Willig, 2013), that is, how we acquire knowledge and our perceived relationship with the
knowledge that unfolds before us. It is about “the relationship between the knower
(research participant) and would-be knower (the researcher) (...) which is central to
capturing and describing the lived experience of the participant” (Ponterotto, 2005,
p.131). It could be argued that the empiricist, positivist and objectivist positions have the
view that all knowledge comes through and is testable though our senses. Statements
about the world are viewed as either true or false and are objectively justified by
experiment or what can be shown by observation.
My own epistemological orientation is symbolic interactionist – a type of social
constructivism. This constructionist position views the human’s experience and reading
of the world as mediated historically, culturally, linguistically and socially such that there
are “knowledges” rather than ‘knowledge’ (Willig, 2013, p.7) and that each and to the
other exists multiple constructed realities as opposed to a single true reality, and multiple
meanings of a phenomenon with multiple interpretations.
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3.3.1 The researcher’s epistemological orientation in relation to the
methodology
In relating my epistemological orientation to this study, I have to gain access to
participants’ viewpoints, to try to see their experiences as they do and capture the essence
of these experiences. My assumption is that people will construct realities and truths
based on their respective experiences, which are subjective, personal and meaningful to
them. This means that older men are likely to experience the impact of their emotions in
therapy in very different ways. My position, as such, is not to draw conclusions or
assumptions surrounding participants’ accounts as true undisputed reflections of any kind
of external reality. Thus, as an approach to the creation of knowledge, social
constructionists in psychology (Boiger & Mesquita, 2012; Harre, 1986; Fisher & Chon,
1989) would find ‘the emotions of older men in therapy’ epistemologically amenable.
IPA does not profess to make claims about the world, neither does it subscribe to
the view that our external world is determined by our perception of it (Willig, 2013). IPA
works on the premise that our perception of reality is constructed, and such a position
views knowing or knowledges as based on lived, subjective experiences. In this sense,
IPA can be said to place itself somewhere between critical realism and contextual
constructivism and is influenced by a symbolic interactionist perspective (Shinebourne,
2011). I reflected on Willig’s (2013, p.96-97) three fundamental epistemological
questions surrounding IPA methodology which ask “what kind of knowledge does IPA
aim to produce?”, “What assumptions does IPA make about the world?” and “How does
IPA conceptualize the role of the researcher in the research process?” I reflect on these
questions more thoroughly in the sections on reflexivity and reflectivity and interpretative
phenomenological analysis below.
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Fig. 1: The philosophical foundations underpinning the present research study
3.3.2 Epistemologies of Counselling Psychology and IPA
According to van Deurzen-Smith (1990) the philosophical underpinnings of
Counselling Psychology emerged in response to psychology being preoccupied with
scientism, for it neglected to inform our understanding of the dilemmas of human
existence. Though Counselling Psychology engages with a number of different
epistemological models (Larsson, Brooks & Loewenthal, 2012), it has a ‘humanistic value
base’ (Cooper, 2009), and privileges the personal and subjective nature of human
experience. According to Cooper, practitioners “strive to engage with their clients, first
and foremost, as agents who cannot be reduced to, or treated as, objects of natural
scientific inquiry” (p.6). It seems fitting then that IPA epistemology is an appropriate
methodology for understanding human experience and that my own orientation is
48
consistent with the humanistic value base in which Counselling Psychologists practice.
3.4 Reflexivity and reflectivity
“Reflexivity is finding strategies to question our own attitudes, thought processes,
values, assumptions, prejudices and habitual actions, to strive to understand our complex
roles in relation to others” (Bolton, 2010, p.13). To be reflective is to stand back and be
critically aware of ourselves (personal reflexivity) as researchers (philosophical
reflexivity) of our chosen ontology, epistemology and selected methodology (Borg,
2012). IPA is grounded within hermeneutics and phenomenology to which reflexivity is
an important component (Smith, Flowers & Larkin, 2009).
As a researcher necessarily implicated in the research process, I am aware that
any insights gained from my analysis of the participants’ text are the outcome of my
reading and interpretation. IPA acknowledges the researcher’s presuppositions and how
they can both hinder and enhance the interpretation of participants’ lived experiences
(Smith, Flowers & Larkin, 2009) and subsequently the research process. IPA proposes a
reflexive way of working (Willig, 2013) and examining my own attitude, that of the
participants’ as well as what is laid between us in our relationship. For this purpose, I
have a reflective journal - extracts shown in appendices 11 and 12 and use supervision
and peer support. I have integrated my reflexivity within the analysis as a way of directly
seeing my reflections within the words of the research.
I am also aware that I am necessarily implicated in the process because of my
therapeutic training in psychology, which makes bracketing even more challenging. Yet
IPA with its focus on interpretation and conceptual coding (Smith et al., 2009) does
require the use of the therapist’s psychological mind to aid it in its nuanced meanings
embedded in the data and add depth. “The potential for this type of reflexive engagement
will defer from analyst to analyst and from project to project (p.90).
49
As a younger woman, compared to the older interviewees in this research, my age
and gender were also implicated in the interview process and the analysis of the findings.
Of consideration were cohort effects, life-marker differences and contextual gendered
constructions surrounding relational constructs. IPA does demand that the interpretations be
inspired and stay true to the words of the participant and which is solidly grounded in the
data, rather than be mediated by other external, extenuating factors.
I therefore acknowledge that the investigation of my participants’ emotions in
therapy is their personal experience and viewpoint and I acknowledge that my role as an
IPA researcher is to interpret the meanings of their experiences not just by carefully
constructed semi-structured questioning and gathering detailed accounts of their
experiences, but by being reflexive throughout the entire process. Detailed thoughts on
reflexivity and reflectivity are referred to throughout chapters.
3.5 Interpretative Phenomenological Analysis
IPA works to explore in depth and in detail accounts of participants’ personal,
lived experiences. This framework suggests that people are social and regularly engage in
meaning-making in their interactions with others and in the events of their lives and this
is seen as a natural precondition that shapes their experiences (Smith, 2004); the aim of
the researcher is “to make sense of the participant trying to make sense of their personal
and social world” (p.40) and to interpret it. This is known as a double hermeneutic.
The perspectives of participant/researcher and client/therapist of IPA/Counselling
Psychology are similar in that the researcher, therapist and Counselling Psychology
advocate reflectivity and pay close attention to personal accounts, intrinsic and extrinsic
meanings and affective processes in therapy. In fact, IPA is not dissimilar to the way we
communicate and interpret each other’s subjective experiences every day.
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IPA seemed to be an appropriate methodology to use as I knew about older men,
there was no available research on older men’s emotion experience in therapy, so I had
no basis from which a theory or hypothesis could emerge from. This was mainly why I
came to choose IPA and not grounded theory (GT). Unlike IPA, which uses a
homogenous sample (for example, all older men in this research were in sobriety and all
were in A.A.), GT uses the data/results of each interview to guide the next, produces a
model and comes up with something universal. In addition, GT requires a larger sample
and my own research was insufficient to generate any hypothesis from. IPA however, is
in search of depth and nuanced data, looks for differences but also similarities which
enables a good opportunity to see the many themes across participants and their
phenomenological experience of emotions.
From my clinical experience working as a Counselling Psychologist trainee with
older clients, I have learned of their predilection towards the sharing of memories and
vivid personal accounts of significant meaning to them, either because it affected them or
someone they know. This appears to be a form of reconnecting to memories but also
serves as a way of connecting and engaging with the therapist. IPA then, is an appropriate
methodology to help gain insight into the emotional experiences of the older male. Given
my own ontological and epistemological paradigms (Figure 1), it seems fitting that the
key theoretical perspectives underpinning this research are connected to hermeneutics
(interpretation) and phenomenology (Smith, Flowers & Larkin, 2009) to form an
idiographic method committed to understanding individuals' lived experience; all three
theoretical perspectives are explained below.
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3.5.1 Phenomenology
Phenomenology is related to ontology – the study of being or what is, and
epistemology – the study of knowledge. Phenomenology is described as the study of how
we experience things in the world, our perception of these experiences and the meanings
we attribute to them from the subjective or first person point of view (Smith, 2013).
Phenomenologists seek to capture the phenomenon or experience of whatever ‘it’ is, as
‘it’ is lived by humans. Phenomenology differs from the kind of objective thinking
observed in science as it does not explain behaviour nor generate theories (Finlay, 2011).
There are different approaches to phenomenology with different conceptions,
points of focus, different methods and different results. IPA is said to be
phenomenological because it aims to deconstruct the subjective accounts of participants’
perceptions as opposed to aiming to construct an objective measurable record of such
accounts.
Phenomenology in IPA originated from Edmund Husserl (1931) with the impetus
to leave everything we think we know behind. Husserl famously called for “a return to
the things themselves” (Finlay, 2011, p.3) and, by doing so, staying true to the purity,
complexity and richness of the lived experience, at the core of which lies the essence of
consciousness. According to Finlay, Husserl describes the “intuition of essence” (...)
where the “researcher attempts to intuit consistent or fundamental meanings” (p.48). Such
meanings might be considered to be invariable in our consciousness. Husserl encouraged
the setting aside of prior scientific assumptions, the leaving behind of previous
understanding and suspending what we know or think we know, in order to study
descriptions anchored rigorously in the data and not distort the phenomena. Husserl
described employing a reductionist attitude as a way of bracketing our own thoughts,
feelings and theories. I expand on this, in section 3.8, in the role of the researcher.
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Heidegger (1962/1927), as Husserl’s student and assistant, developed Husserl’s
ideas by moving away from consciousness and asking simple phenomenological
questions such as, ‘what is it meant, ‘to be’?’ (Finlay, 2011). He approached this question
ontologically, that is, Heidegger was concerned about human existence and the state of
being in the world, describing the human being as Dasein – or being in the world.
Heidegger emphasised that we are thrown into a world that already exists and cannot
separate ourselves from it. Subject and object, language and understanding, self and
world all belong together in the single entity ‘I’. He argues that it is only through
language, in other words interpretation, that our being in the world can be understood.
Merleau-Ponty (1962) explored the fundamental role of perception as
understanding and engaging with the world in a bodily way. Such that we can be both
object and subject, Merleau-Ponty emphasised holistically combining bodily senses of
sight, sound, smell, touch and taste to communicate, connect and live in the world
(Finlay, 2011). Consciousness then is also seen as embodied and we can only relatively
understand the world as it is revealed to us (i.e. through the bodily senses of being a
researcher), never truly sharing anothers’ experience as this belongs to the others’ own
embodied experience of the world.
Sartre (1956/1964) argued that experiences, together with objects, tend to be
perceived and conceived by consciousness as beings in themselves (Finlay, 2011) yet are
without essence. Sartre described it as seeing oneself because he is seen and it is only
through this reflective consciousness of being seen that he sees himself and becomes an
object to the other. He describes this as, “existence comes before essence” (Sartre, 1948,
p.26).
Through the lenses of these prominent phenomenological figures, I have tried to
show that at the heart of phenomenology exists the lived experiences of the individual,
53
calling attention to rich description and its meaning. As phenomenology aims to be
descriptive rather than explanatory, I have chosen interpretive or hermeneutic
phenomenology, which asserts itself in a Heideggerian way, in that the meaning of a
descriptive experience lies in its interpretation and is the core of our very being. This
interpretative process based on hermeneutic understandings is described below.
3.5.2 Hermeneutics
The field of hermeneutics can be seen as separate from yet overlapping with
phenomenology (Finlay, 2011). It is the second major theoretical underpinning of IPA
and is known as the theory of interpretation. According to Ponterotto (2005), the
constructivist position adopts a hermeneutical approach which asserts that meaning is
often hidden and can be brought to light through close reading of what is already in the
passage and with deep contemplative reflection on the text. Such reflection, Ponterotto
argues, can be instigated by the interactive researcher–participant dialogue. IPA’s
hermeneutic phenomenology is based on the perspectives of three important figures:
Schleiermacher (1998), Gadamer (1990/1960) and Heidegger (1962/1927).
Smith and Osborn (2008) suggest that to enter into a participant’s inner world, the
researcher could engage in a two-stage interpretation process, or a double hermeneutic,
where the researcher tries to read into the meaning of cultural texts by writing, in turn,
their own texts. IPA draws from both Schleiermacher’s and Gadamer’s perspectives so
that the process of analysing a participant’s account provides an opportunity to gain an
understanding of both the content of the account and the person providing that account.
IPA, in trying to get close to the participant's personal world and in making sense of it,
which cannot be done directly or completely, the researcher uses their own conceptions
through a process of interpretative activity or hermeneutics. Simply put, to understand
54
and analyse the phenomenon that is investigated, the researcher works in such a way as to
understand a particular part of the text in detail in relation to a single word, sentence, or
whole interview, as well understanding the whole text. Together with the hermeneutic
circle, this process helps to ground interpretation within the original text in the data
analysis stage.
3.5.3 Idiography
The third major influence in IPA is idiography, the study of the particular, that
contrasts with the nomothetic approach which seeks to generalise experiences and
patterns from a group of people (Ponterotto, 2005). Idiographic research respects
individuality, viewing the individual as a unique and complex entity. In IPA this would
mean researching, exploring and analysing in great depth how a single person, in a given
context, makes sense of a particular phenomenon until some degree of closure or gestalt
has been achieved. Yet IPA operates close to the text; the researcher works in the same
way with each participant until they are satisfied with their reading of it. From here the
researcher conducts a cross-case analysis as themes for each individual are drawn out,
then interrogated for convergence and divergence.
IPA works to bring the particular individual’s experiences into a collective
experience by rigorous, systemic analysis of the particular, which may or may not include
transferability of findings from group to group. Analysis may reveal themes which
participants share but are illustrated in distinct ways or it may reveal a slice of the
particular lived world of participants who have shared their accounts (Smith, 2004). IPA
does not speculate that this is a shared experience with the rest of the population studied
(Smith et al., 2009). Since IPA already has its theoretical origins in phenomenology and
hermeneutics, with their focus on individual experience, idiography helps to further instill
55
the importance of ensuring each individual experience is treated separately before a more
macroscopic view of the phenomenon is investigated. Thus IPA’s focus on idiography
and on the particular is a shard-like perspective that can, on its own, illuminate the
universal.
3.6 Limitations of the IPA approach
Like many forms of phenomenological research (e.g. realistic, constitutive,
existential) IPA is not immune to conceptual and practical limitations. Based on Willig’s
(2013) assessment IPA relies on language and, since a phenomenon can be experienced
in different ways (and as the researcher may be very different from the participant), the
words we choose to describe an experience can only ever be a construction of a version
of that experience. The researcher, therefore, can never really capture a mirrored
understanding of the experience. That is, a transcript of an interview tells us more about
how someone talks about an experience rather than the experience itself.
Willig (2013) mentions ‘suitability of accounts’ in that phenomenology as a social
scientific research method relies on participant’s descriptions, arguing that such a method
requires participants to be able to describe a particular phenomenon in depth and detail.
Some descriptions may be difficult to articulate for some participants and this may be a
limitation for the rich detail and elaboration that IPA requires.
Willig (2013) also makes the distinction between explanation and description. She
argues that phenomenological research, including IPA, relies on people’s perceptions to
describe, document and interpret their own lived experience of a phenomenon but does
not seek to explain it. The idea exists that “exclusive focus on experiences” (p.95) is only
one aspect of getting to know a phenomenon but not knowing its cause or effect may
limit our understanding of it.
56
Finally Willig (2013) suggests that the emphasis on cognitive aspects of IPA, as
proposed by Smith (1996), is not entirely compatible with some aspects of
phenomenological thought. IPA tends to encourage participants to think about how they
experience a phenomenon, thereby seemingly relying and focusing on cognitive
processes. For example, during interviews, participants may have to think about their
experiences, and may describe events based on cognitive outcomes-instead of felt
experiences. The aim of phenomenology, however, is to transcend or bridge ‘the knower’
and ‘the known’ and ‘the person’ and ‘the world’ and tends to focus on the precognitive,
unmediated stance and naturalness of descriptions.
Part 2: The Method in Action
3.7 The phenomena under investigation
To date, there is no existing study utilising IPA on how older men might experience
their emotions in therapy. In investigating this phenomenon, I questioned:
•
What is the experience of talking about emotions like for older men in therapy?
(descriptive interpretation)
•
What meanings do older men give to experiencing their emotions in therapy?
(critical hermeneutic interpretation)
•
What do these experiences look like from a psychologically gendered subject
position? (theory-based interpretation)
The questions outlined are concerned with the interpretative aspect of IPA and begin
with descriptive interpretation, moving on to critical hermeneutic interpretation then
interpreting the findings from masculine theory framework. A full list of questions used
in the interviews can be found in Appendix 4. Armed with these sets of questions, the
57
role of the researcher is now considered along with exactly how the phenomena and their
respective questions have been investigated.
3.8 The role of the researcher
The role of a researcher begins with the journey of identifying their
epistemological position which, in my case, is symbolic-interactionist. Based on this
position and having a research question in mind, I aim to ensure that the research
question and its aims are consistent with the epistemological position of the research
methodology, its aims and assumptions. Taking participants’ emotion experiences into
account (phenomenology/hermeneutics/ idiography) and with the corresponding
methodology (IPA), I established the foundations necessary to commence in the role of
researcher and interviewer.
An important aspect of an IPA researcher is being able to capture the experience
of the participant as they make sense of the phenomena in question themselves. To
facilitate this, the researcher must be able to clinch its essence whilst staying grounded in
the data. It is therefore important for the researcher to highlight the different perspectives
or voices and examine the impact of “power differentials” (Finlay, 2006, p.18).
Importantly, the role of the researcher is to provide evidence of systematic work (Smith,
2004), to show ethical integrity, to be transparent in the way they work and to enable
findings to be evaluated with ease (Madill, Jordan & Shirley, 2000).
3.9 Data collection
3.9.1 Participant demographics
According to data from the European Social Survey (2008, as cited in Abrams &
58
Swift, 2012) comparing perceptions of ageing amongst 55,000 individuals across all age
groups in 28 countries, old age is perceived to start at 62. Specifically in the U.K. old age
was thought to begin at 59 years. Taking the U.K. government’s (Gov.U.K., 2013) state
pension age of 61-68 years and the current default retirement age of 65, I felt that a
minimum age of 62 would be acceptable for this study.
A minimum number of 6 therapy sessions within the recent timescale of 6 months
to a year was applied as I wanted to be able to reach participants while the phenomena
were still fresh in their minds (and hearts); experience of 6 therapy sessions was thought
to be sufficient to capture the phenomenon investigated as short-term therapy has been
found to make a significant impact to mental health and well-being, long after
termination (Salzer, Winkelbach, Leweke, Leibing & Leichsenring, 2011; Barber,
Barrett, Gallop, Rynn & Rickels, 2012). Refer to appendix 11 for reflections on the data
collection stage.
3.9.1.1 Inclusion/exclusion criteria
The main inclusion criteria, therefore, were that participants were males of 62
years and above, living in and around London who had received a minimum of six
therapy sessions in the previous six months to a year. No exclusion criterion regarding the
kind of therapy that participants received was applied and the research accepted
participants from various psychological modalities.
The fact that older men were investigated meant that older women were excluded
from the study along with younger males and females. Older men who had not had the
required number of therapy sessions were excluded, as well as men who had not had
therapy in the previous six months. Finally, because of the snowballing effect, difficulty
in obtaining participants and after several interviews, I opted to exclude all other
59
participants who were not currently in sobriety (I elaborate further in section 3.9.1.3
below). This was mainly done to preserve the homogeneity of the participants who are all
current and active fellowship members of A.A.
3.9.1.2 Sample size
Smith, Flowers and Larkin (2009) argue that there is no objectively finite sample
size for IPA as it would depend on the researcher’s “degree of commitment to the case
study level of analysis, and reporting” (p.51) of individual cases. It would also depend on
the depth and richness that these individual cases offer and organisational commitments
experienced by the researcher. Yet Smith (2004) argues that it is only ever possible to
conduct such detailed, nuanced analysis associated with IPA on a typically small sample.
Smith et al. (2009) suggest that between three and six participants is a reasonable size as
exemplified in more recent IPA studies (Burgess, 2013; Cooper, Fleischer & Cotton,
2012; Glueck, 2013). When a topic is rare or complex the sample size tends to be smaller
leading to a homogeneous sample (Smith et al., 2009); a larger study would de-emphasize
IPA’s commitment to idiography and the investment of time for critical reflection. I
chose a sample size of six, deemed suitable for a Professional Doctorate study (Smith et
al., 2009). According to Hefferon and Gil-Rodriguez (2011), good IPA is about
investigating a particular phenomenon at depth and in detail, focusing on the richness of
the participants’ experience. Such studies offer important and powerful contributions,
particularly where little is known about certain phenomena and where therapists can
benefit greatly from such knowledge. Participant demographics are displayed in table 2
in the following page.
60
Pseudonym Age
Marital
Status/
Sexuality
Nationality/
Cultural
Background
Most
Recent
Occupation
Therapy
Length
Therapy Type/
Description
KEIGH
(Pilot
study)
62
Divorced
(Straight)
British
White
Retired
Marriage
Counselling
(Integrative)
1.
ANDY
67
Irish White
Retired
2.
CARL
66
British
White
Retired
Divorced
(Straight)
British
White
Presenter
13 years
completed
#
Single
(Straight)
Single
(Straight)
2 sessions
8 sessions
completed
60 sessions
completed
3.
JACK
62
4.
NED
73
Partner
(Gay)
South
African
White
Playwright
24 years
completed
5.
STEVE
64
Single
(Straight)
British
White
Taxi
Driver
Long term
completed
6.
BILL
67
Single
(Straight)
Irish White
Taxi
Driver
12 sessions
completed
Mean Age
65.8
Bereavement
(Gestalt)
Relationship
(Psycho-analysis)
Alcohol &
Marriage
(Integrative/
Cognitive
Behaviour
Therapy)
Alcohol Related/
Anger Issues
(Eclectic)
Alcohol
Integrative/
person centered
Bereavement
Table 2: Participant Demographics
3.9.1.3 Recruitment and situating the sample
Purposive sampling (Willig, 2013) and snowballing (Patton, 2002) were primarily
used to recruit participants. That is, initial participants were recruited according to criteria
relevant to the investigation but the majority was recruited through recommendation by
someone they knew who fitted the research criteria. Crucially, all participants in this
study were active members of Alcoholics Anonymous (A.A.). Three participants, in
addition to A.A., were members of Debtors Anonymous (D.A.) and Sex and Love
Addicts Anonymous (S.L.A.A.). Incidentally, participants also described A.A. as a
61
fellowship because it involves men and women who share their experiences with each
other so that together they may solve their common problem and help others to recover
from alcoholism.
Participants in this study were found to have engaged in personal and group
therapy from a period of 8 to twenty four years, throughout the years. How these
participants who have had a history of alcohol and/or drug addiction, have come to be
familiar with help-seeking could be explained by the cohort phenomenon (Vacha-Haase,
et al., 2011) of counter-culture, anti-authoritarian, anti-psychiatry movements of the
1960s and 1970s, a time when the tenets of humanistic psychologies, which centre on
human needs and fulfillment, may have been compelling and attractive. The use of
Lysergic acid diethylamide (LSD) and ‘ecstasy’ was also popular in psychedelic therapy
with the belief that such drugs were able to facilitate the exploration of the psyche
(Baker, 1964; Rosenbaum & Doblin, 1991). In fact, a majority of participants had already
begun therapy by their late twenties around the time clinical trials for LSD was found to
be effective in the treatment of alcoholism (MacLean, MacDonald, Byrne & Hubbard,
1961). Such factors could have played an important role in participant’s help-seeking
styles and, in reaction to a known environment, may have continued in the engagement of
therapeutic services today.
Five participants who are now in their early to mid sixties, commenced therapy in
their mid to late twenties for alcoholic related issues, depression, bereavement and
anxiety. Participants used the terms psychoanalysis, cognitive behavioural therapy,
eclectic therapy, gestalt and integrative therapy to describe therapy they received; one
participant was uncertain about the type of therapy he had most recently engaged in.
62
3.9.2 Interviews
Data was collected via semi-structured interviews designed to explore
participants’ experiences of their emotions during therapy. The advantage of semistructured interviews for IPA is that participants are primary experts on the topic in
question and they are allowed to share their stories in a space and form that is meaningful
to them. Interviews can be described as “a conversation with a purpose” (Smith, Flowers
& Larkin, 2009, p.59) but, for the most part, the interviewer asks few key questions and
listens attentively whilst the participant speaks at length. The interaction is an active, nondirective one. The agenda is loose so, for the researcher, it means they are able to be in a
position, in real-time, to respond and follow up on any interesting and important issues
that arise during the interview process (Smith, 2004). Prompt questions (Appendix 4)
either pertaining to masculinity or emotions, are used to facilitate further disclosure from
the participant. However, in keeping with the framework of IPA, minimal probes should
be used and the effect that the interview has on the participant should be noted. Sessions
are audio-taped and transcribed for analysis.
A semi-structured interview schedule is used across interviews to ensure
consistency amongst participants about how they experience their emotions in therapy.
This helps us, as researchers, to think explicitly about how we will explore the lived
experience of the participant, work with more reserved participants and how we may
introduce sensitive topics (Smith et al., 2009). Questions used in this study were
discussed with supervisors, peers and tested on a pilot study; they were designed to be
open with few assumptions and to facilitate ease in exploring feelings, events, thoughts,
actions and comfort in sharing of accounts. The interview schedule contained ten
questions beginning mainly with “Can you tell me…” which focused on experiences,
with a few more probing questions on process that asked “How...”. These open-ended
63
questions enabled focus on what participants thought, believed and felt and the impact
that had upon them.
Participants were given preference options regarding location and style of
interview. As such interviews were conducted face-to-face, in the homes of participants
and in the home of the researcher. Interviews were conducted in a conversational style to
build rapport and enable the exploration of experiences to unfold with ease. Questions
were asked naturally in a flexible order and without hurrying participants. I did, however,
funnel my questions, firstly to set the scene then to slowly hone in on the interviewee’s
emotions and experiences in therapy.
Interviews lasted between 42 minutes and 1 hour 57 minutes and I was aware that
during the interview process I was to leave my research world, park my assumptions and
join the hermeneutic circle to participate actively in the interviewee’s world. I discuss
challenges to these in Appendix 11 and 12 .
3.9.2.1 Pilot interview
A single pilot interview was conducted with Keigh, a 62 year-old divorced white
British male. The pilot interview was used to practice my interview technique and to test
whether the planned interview schedule was appropriate to garner the desired
information. Although the idea of an IPA study is to allow space for participants to share
their experiences, I was aware that in the pilot study it felt like I was a therapist as
opposed to a researcher. I quickly reflected on myself and learned the importance of
disclosing to subsequent participants in the briefing and debrief that I was a Counselling
Psychologist researcher and, if required, they could contact the organisations available to
them for therapy should the interview bring up feelings that are unresolved or needed
attending to. I also realised that the very nature of the topic, ‘emotions’, could well create
64
unintended effects of feeling emotional in the interview myself, but I resolved to remain
as grounded as I could as a researcher, yet empathetic. This exercise demonstrated the
value of reflexivity in my role as interviewer. Later on in Appendix 8 of my reflections, I
describe the near impossibility of completely divorcing one’s own sense of self from
participant interviews and interpretations, as any interpretation would seem to implicate
the researcher. However, in trying get as close to the workings of the actual study as
possible, the pilot interview was recorded, transcribed and an IPA analysis conducted.
However, I did not include the analysis of the pilot data in the final study as Keigh had
only completed two therapy sessions with his therapist and had no intentions to continue
with sessions.
3.9.2.2 Digital recording and transcription
All interviews, including the pilot, were recorded using a digital Dictaphone then
transcribed. In aiming at all times to protect participants’ confidentiality, all identifiable
information was changed and treated with the strictest anonymity. Identities are also
protected in the publication of any findings. Recordings were replayed several times to
ensure verbatim accuracy of transcriptions and a similar approach was used while
conducting the analysis. The coding format and data analysis are further discussed in
sections 3.11.
Personal reflections on the data collection stage (Appendix 11), data analysis
(Appendix12) and other aspects of the research process evidencing how I kept myself in
check by seeking to question and understand any assumptions, beliefs, biases and
preconceptions (section 5.7 of the discussion chapter) are detailed.
65
3.10 Ethical considerations
As an ethical researcher working in accordance with the British Psychological
Society’s Code of Ethics (2009) Section 3.3 in standards of protection of research
participants, I endeavoured to remain mindful of the older age of participants and had
taken into consideration fragility or disability, education, ethnicity, language, national
origin, race, religion, marital or family status, or sexual orientation. I was also vigilant
over potential accidental harm or unintended negligence in particular when sensitive
issues were raised. I aimed to keep my interview questions considerate and respectful of
my participants and put steps in place should participants become distressed. I elaborate
in detail below.
3.10.1 Informed consent
I obtained written and signed informed consent from each participant pertaining to
their involvement and willingness to participate in the research process including
interview and subsequent recording, collection and presentation of data. Two copies of
the consent form containing the researcher’s name, the research topic and explanation of
what was being investigated, statement about the interview being digitally recorded,
confidentiality and anonymity (see Appendix 2) were produced. One was signed by the
participant and returned to me, the researcher, the other was retained by the participant for
their information and safe-keeping.
Before each interview began, I explained my research and informed the
participant again about their consent. I also informed participants of their right to
withdraw at any time. Just as participants were briefed before interview, they were
debriefed with a debriefing form (see Appendix 3) about the application and use of the
data. I adhered to Roehampton University’s Lone Working Policy which included
66
phoning participants before and after interviews and having contingency plans in place in
case no call was made after the interview. As I followed these steps closely, no issues
pertaining to the research arose, but I maintained open contact with the University’s
Health & Safety Manager with regular updates throughout the data-gathering process.
3.10.2 Anonymity and managing data
All participants were considered legally competent for disclosure of confidential
information and provided informed consent. However, for the purposes of this research
they will remain anonymous in transcripts, analysis and presentation of their data with
limitations to confidentiality. In addition to myself, transcripts were viewed by my
supervisors and peer researchers who were involved in various stages of the analysis so
pseudonyms were applied when quotations were used within the write-up. In adhering to
the University’s Code of Good Research Practice and Data Protection Policy, participants
were informed that their anonymised data may be publicly accessible should results be
published in psychological or mental health related journals. All participants’ names and
identifying information such as locations were also changed to protect the participants’
identity. I established a code, known only to myself, to link personal details with research
data and I informed participants that all confidential data and recordings would be stored
securely at my home; in accordance with the University’s Code of Good Research
Practice, data will remain intact for a period of at least ten years from the date of any
publication.
3.10.3 Managing Distress
There were no procedures knowingly involved that would have put participants’
health at risk and it was not the intention of this study to deceive participants in any form
67
or manner. As an ethical researcher, I exercised particular caution in the event there was
advice solicited from research participants concerning psychological or other issues, and
ensured that information pertaining to professional services was available to them should
they have required it. This was not needed however. I was also aware that since this study
concerns emotions and difficulties surrounding expressing emotions, the interviewer’s
questions may have invoked or stirred deep emotions, anxiousness or distress within
elderly males. As such I remained vigilant throughout the interview process and offered a
list of contact numbers in the event that the participant may have needed assistance
immediately after the interview. Details of support groups are provided in the Debriefing
Form (Appendix 3) and contact details of the Ethics Committee Deputy Chair in the event
they had any concerns surrounding the interview, or any other aspect of the research.
3.10.4 Benefits to participants
Whilst I acknowledge that this study is of value to Counselling Psychologists,
General Practitioners and me, since it is a requirement of my examination as a trainee, I
consider the beneficial aspects and effects of participation to be important. Of particular
importance and value is the perspective on this topic of an age and gender group that
rarely gets heard and about which little is known. By giving these older men time and
space to reflect on their emotions during therapy, I was also providing them an
opportunity to share more of what it feels like to talk and be listened to. That their
accounts were important, meaningful and took courage to share could bring to the
forefront lost voices that have longed to be heard. Participants, after the culmination of
the research and pending approval by research supervisors, will be informed of the
research outcome, in the form of a report.
68
3.10.5 Ethical approval
As a doctoral trainee in Counselling Psychology, I was required to obtain a
general approval from the Ethical Committee at the University of Roehampton before
conducting my research. This approval was granted on the 21 February, 2013, the ethics
application reference being PSYC 13/ 068 and is available with the ethics committee via
hard copy at Roehampton’s psychology department. No changes were made to the
research during the life of the project. All participants were snowballed and no additional
ethical approval was required. The next chapter covers the analysis and themes derived
from the six participant accounts.
3.11 Data analysis
As the participants’ experiences are not directly accessible, IPA suggests a
systematic analytical procedure to gain insight and knowledge into those experiences
(Willig, 2013). Initially the researcher is required to engage with the transcript by reading
and re-reading the text and making interpretations. In the reading of the text Smith et al.
(2009) suggest noting in the left or right margin, next to the text, detailed descriptive,
linguistic and conceptual elements that draw the researcher to the text. These may be
questions, ideas, observations and thoughts that, once documented next to the original
text, will enable the researcher to see, consider and understand the participants’
phenomena from a more holistic perspective. Although it is not meant to be prescriptive,
I found this approach suitable for the analytical needs of my research. Willig (2013) has
outlined detailed yet flexible descriptions of the analysis stage which I drew on for my
own analytical processes, as outlined below.
69
3.11.1 Analysis stage
The analytic strategy and process offered by Smith et al. (2009) is flexible as there
is no single procedure or definitive approach. For that matter, any claims to truth are also
considered to be tentative and the analysis subjective. Five stages to the data analysis
have been identified “moving from the particular to the shared, from the descriptive to the
interpretative” (Smith et al., 2009, p.79; Willig, 2013). The analysis began with an
intensive line-by-line examination of a single participant’s account using an idiographic
approach which was repeated across all participants. Using the researcher’s interpretive
engagement, a collection of super-ordinate themes that captured the essence of
experiences from across participants’ transcripts was collated. The end result draws on
the double hermeneutics of how the participant is thinking and how the analyst thinks.
The five stages of reflective engagement with each participant’s account are explained
below. Refer to appendix 12 for reflections on the data analysis stage.
3.11.1.1 Initial encounter with the text
The first stage involved listening to the original audio recording of the participant
interview several times, then immersing myself in transcription. This involved a slow,
deliberate but active engagement of reading and re-reading the text line-by-line so as to
focus solely on the participant. The reading allowed me to look at the text
macroscopically then microscopically to gain a sense of the overall structure as well as
parts of the structure. I wrote initial and immediate thoughts in a research diary to ‘reduce
the noise’, bracket off my thoughts and capture my first impressions, observations and
feelings then left it aside. In a separate wide-columned sheet, I wrote exploratory
comments to the right of the original text and after re-reading the text drew out in-depth
observations such as how the text was chronologically accounted for, descriptors,
70
concepts, contradictions, metaphors, paradoxes, nuances and anything that could be
embedded in their life stories. These exploratory comments were systematically
categorized into: ‘descriptive comments’ which capture the participant’s subjective
experience; ‘linguistic comments’ on how language is used and its significance;
‘conceptual comments’ which focus on the context of the participant’s experience and
any tentative abstract notions and concepts (Smith et al, 2009). Descriptive, linguistic and
conceptual comments each had a different colour so I was able to immediately discern
between them. To the left of the transcript I added a column for line numbers to facilitate
easy reference. The overall aim was to produce a comprehensive, clear and detailed series
of notes tied closely to the script. These are located in the audit trail, represented in a hard
copy of a file and stored in a safe place.
3.11.1.2 Identification and development of themes
After writing the exploratory comments in the column to the right of the
transcript, emergent themes were drawn out chronologically and placed in the far left
column, as exemplified in Table 3 below. See appendix 7 for the audit trail.
EXPLORATORY COMMENTS – Participant 1 “Andy” (Example)
Emergent
Line Original Transcript
Exploratory Comments:
Conceptual Descriptive Linguistic
themes and
#
Theme #
1. Withholding 11
“Mmmph, I’ve never had How can Andy never have any
Emotions
any emotions, I wouldn’t emotions yet claim he won’t let
let them go”.
them go? He “wouldn’t let go” of
his emotions lends the notion that
he wants to keep his emotions to
himself. “Let them go” sounds like
emotions are to be held back. The
‘Mmmph’ sounded like it was
distasteful.
Table 3: Exploratory Comments
71
The transcript and detailed exploratory comments produced a very large data set
but the idea was to work with the exploratory comments rather than the transcript itself.
The themes drawn out from the exploratory comments encapsulate a significant or key
experience of the participant and relate to the research question. This formed the initial
stages of the hermeneutic circle whereupon I proceeded to complete a similar
examination of each participant’s transcript and, in so doing, formed a set of parts that is
contrasted to a whole which, in turn, is interpreted in relation to the parts.
3.11.1.3 Clustering of themes
The next stage involved looking at all the themes derived from a single
participant’s lived experience. I used abstraction, polarization and contextualization
(Smith et al., 2009) to see if there were any themes that could be drawn or clustered
together based on connections between emergent themes, patterns, similarities in ideas,
thoughts or shared meanings. Once I had clustered together themes I applied labels that
would capture the essential core of their shared meanings. In consideration of the number
of clusters, where appropriate theme-clusters were clustered together further to form
super-ordinate themes; in the final analysis of each participant’s account, I derived
between four to six super-ordinate themes per participant.
3.11.1.4 Progressing to the next case
After analysing the first participant’s transcript and establishing themes, themeclusters and super-ordinate themes, I progressed to the second participant, repeating the
same analytic process as above. I applied this analysis to each participant yet treated the
data as separate entities and, in doing so, worked ideographically. It was difficult not to
72
be influenced by what I found from one data set that may have been carried over to the
next so a concerted attempt was aimed to bracket any thoughts, ideas, feelings or
assumptions in a research diary. Eventually, this enabled new themes to naturally emerge
from each participant’s data set.
3.11.1.5 The hermeneutic circle in action
Having produced a summary table containing super-ordinate themes from each
participant’s transcript, I began to look for patterns across transcripts to form a master
table of themes that reflected the experiences of the group. While the group was relatively
homogenous, I noted that some super-ordinate themes were idiosyncratic while others
appeared to share higher order qualities. Master themes were aimed at capturing the
essence of participants’ shared experiences of the phenomena. That process involved
taking all theme-clusters and super-ordinate themes of each participant and reviewing
them for similar connections. In doing so, I checked to see if themes could be further
clustered and, when satisfied, I derived master themes. This process is iterative,
painstaking and involved moving from close case-by-case inspection and interpretation of
individual accounts to a more abstracted and synthesised account of the group as a whole.
Willig (2013) suggests that it is important to thoroughly cluster themes to the
point where complete saturation has been achieved and it is no longer possible to merge
or cluster them. It was by moving through the hermeneutic circle of comparing parts and
the whole and of re-reading the original transcripts that I derived the master themes. I
kept track of decisions and choices I made whilst keeping and discarding themes as a
means of reflecting on decision-making. Through supervision and peer reviews, I
remained open and flexible to ensure that the essence of the data was maintained. The
master table of themes, and subthemes are presented in Figure 2, in the following chapter.
73
Chapter 4. Analysis
The master themes and its accompanying subthemes that emerged from the IPA analysis can
be seen in the following illustration:
4.1 Overview of themes: Older Men in Sobriety’s Emotions Experience
in Therapy
Interpretative phenomenological analysis (IPA) of the six interviews resulted in the
identification of two master themes pertaining to older men in sobriety who are currently
in A.A and their emotion experience in therapy:
-
CONTROL/REGULATION OF EMOTIONS
-
TRANSFORMATION/ALLEGIANCE TO SELF
74
Master theme one, illustrates how emotions tend to be controlled/regulated with
difficulties surrounding the unearthing of emotions in therapy and the second theme
explores the journey into the heart of emotions, as a transformational experience. It is
important to note that the analysis forms one interpretation of older men’s emotion
experience and it is recognised that different researchers may also choose to focus their
interpretation on different areas of participants’ experiences. The themes identified, were
selected due to their relevance to the research question and therefore, may not cover all
aspects pertaining to emotion experience. Master themes and its five constituent
subthemes are shown in Table 3, in the following page.
In order to reference quotes and extracts from the interview transcripts, I have
used a universal notation system of which an example is given here: (Ned, 11–12). This
represents an extract from Ned’s interview and refers to lines 11 to 12 within the text.
Additionally use of square brackets […] refers to editorial elision where non-relevant
material has been eliminated and … refers to a pause in the participant's account. Any
identifying information has been changed to ensure confidentiality and anonymity as
discussed in chapter 3 of the methodology section. The subsequent sections offer close
interpretation of participants’ accounts from which each master theme and subtheme has
been derived. This research, with its small sample group, is not intended to represent all
older males, rather it takes into account the unique and subjective ways of being of each
participant studied.
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MASTER THEME 1
MASTER THEME 2
CONTROL/ REGULATION
OF EMOTIONS
TRANSFORMATION/ALLEGIANCE
TO SELF
Subtheme 1
Subtheme 1
“A bank vault with doors closing,
“What therapy has mostly done for me, is to
triple switch locks” Challenges to
make me […] my own man”. Self actualisation
unlocking emotions
Subtheme 2
Subtheme 2
“A prerequisite to spiritual growth!”
“My emotions may be too powerful for Emotional-Spiritual journey
her (the therapist) to manage”
Importance of emotional
containment by therapist
Subtheme 3
“It’s therapeutic but it’s not therapy”
Role of A.A. in the emotion sharing
experience
Table 3: Master themes and subthemes
4.2 Master Theme 1: Control/Regulation of Emotions
Master theme one, Control/Regulation of Emotions with its three subthemes
(see figure 3 below), encapsulates how some participants attempt to regulate their
emotions by controlling, avoiding, suppressing and/or modifying their emotional
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reactions (in order to cope, manage or be consistent with social norms or perceived male
identities). Such behavior, with individual differences, has been identified as occurring in
therapy as well as in fellowship meetings like Alcoholics Anonymous (A.A.). Emotions
have also been described as being difficult to access for some participants, and for others,
emotions are described as layers that hide further emotions beneath. Some participants
who are more aware of their emotions describe emotions as having a life of their own,
with fears of not being able to manage the power of emotions once unleashed. The
facilitation of the unlocking of emotions tends to be governed by a degree of emotional
containment in the form of therapist competency, the gender of the therapist, and the
element of time.
Challenges to
Unlocking Emotions
Importance of
Emotional
Containment in
therapy
Control/ Regulation
of Emotions
Role of AA in the
Emotion Sharing
Experience
Figure 3: Diagrammatic of Master Theme 1: Control/Regulation of Emotions
The findings however, establish that participants’ depth and range of emotion
experience varies according to these older men’s sense of masculine self or masculine
identity, details of which, are explored in the following subthemes.
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4.2.1 Subtheme: Challenges to Unlocking Emotions
Participants were asked about what the experience of talking about emotions was
like in therapy. In analysing the transcripts it was striking how emotions were sometimes
described as that part of the self, which manifests as a heavy, undesirable object that is to
be cordoned off lest it cause destruction to the self and others. Delving across and deeper
into participants’ accounts, a conceptual image from four participants began to form, of
which a composite of quotes was extracted:
Emotions are “sick”, a “lump of rubbish”, “you become emotionally arrested”,
“bagged down”, “handcuffed”, “locked up”, “imprisoned” and “guarded”,
“they keep us, we become prisoners”. (Bill, 103-113; Andy, 27, 51 & 140; Jack,
68; Steve, 117 & 124)
The passage above offers a composite imagery, as to what some participants feel
about their emotions. The following narratives explore and delve deeper into how these
emotions tend to be experienced and it explores the meaning that participants attach to
their emotions. For instance, Andy and Steve paint a conceptual picture made up of
masculine metaphors of the enormity and weight of unresolved emotional issues. Both
Andy and Steve try to manage their emotions by suppressing or preventing emotions
from spilling into the lives of others, but often this is done with great difficulty. Below,
Andy describes emotions as a strong undercurrent:
“[…] in the last 11 years it’s as if the Titanic has sank and I’m living in the
aftermath of massive upheaval, you know?”. (Andy, 47)
Andy’s account manifests as a deep sinking feeling that continues to ripple across
time to the present. The metaphor of the “Titanic” is described by Andy as leaving
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something pervasive in its wake, with emotions that seem too deeply entrenched to
unearth. The “aftermath” also lends an image of the quiet of the sea that hides a “massive
upheaval” underneath, as if to say that Andy, on the surface may appear to be sailing
through life but, in reality, harbours deep painful emotions underneath. It appears that I,
as the researcher, am expected to understand what lies underneath Andy’s emotions
because he asks if “(I) know?” One reading of this is that Andy may conceive that even
though his emotions are hidden underneath, those around him may still feel them.
Andy’s interpretation may be similar to Jack’s whose account describes carrying
feelings of shame that seem to affect others. He uses the metaphor of a shipwreck to
describe the prolonging of emotions:
“I carry an awful lot of shame about that. And although I’ve actually been sober
now for 12 or 13 years I sometimes liken it to (pause) reaching the shore after a
shipwreck, so I’m safe but the rest of the shoreline is covered with the wreckage
of my past life and that wreckage is, is my family” (Jack, 16-17).
Jack uses the word “shame” to describe his emotions relating to his drinking
years. Similar to Andy, he uses the words “awful lot”, to mean the greatness or enormity
of his shame, and the weight of carrying it around. There is a sense that this carrying of
emotions affects Jack internally and those around him, especially when he implies that
the “wreckage” is both his past and his family. Jack also describes these emotions of
shame as having a life of their own with Jack’s wreckage from the past spilling
uncontrollably into the present day. The word “safe” connotes that Jack is safe from
himself but he describes this as if there are after-effects suffered from his period of selfdestruction. Like Andy, he appears to want to contain or hide the wreckage of his
emotions and prevent them from spilling out and perhaps hurting others. By using the
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words “reaching the shore” Jack may be attempting to draw a line between his internal
pain, which he tries to suppress, and keep from others.
In both Jack and Andy’s narrative the ocean can be seen as a metaphor for the
embodied self, safe at times but rough and stormy at others, and the shipwreck could be
taken to mean the embodied expression of the self which has sunk so deep and been
drowned by sorrow, guilt or shame that makes it virtually impossible to rise to the
surface. Both Andy and Jack’s “titanic” and “shipwreck” conjure images of boys and
boats, and the masculine objects that grew with them in size.
Andy’s narrative below describes his attempts at emotional unfolding in therapy,
which seemed to be difficult throughout:
“Erm, I found myself guarded when I went for the last session, largely and
because a girlfriend said to me, she said er (pause), I think I can be quite open but
I can close down and retreat and erm, a Jamaican girlfriend … described me like
a bank vault with doors closing, triple switch locks and where somebody doesn’t
come in, you know? And emotionally sometimes, I suppose it’s some form of
protection, whereby you retreat, behind a carapace ... I was quite guarded, I think
there is a bipolar problem”. (Andy, 51-57)
Andy describes being “guarded” with his emotions, which, in one sense could
mean that he was being cautious about unlocking the “triple switch locks” he uses to
protect himself, possibly from fear of feeling exposed and vulnerable. Perhaps the
consequence of thinking “somebody doesn’t come in”, has the same effect of not letting
emotions out. “Some form of protection” and “retreat(ing), behind a carapace” evoke
images of him both retreating from enemy forces of superior power (in this case before a
defeat) and of him feeling safe, protected and comfortable (like a place of retreat or
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refuge). Therapeutically and unconsciously, it may mean for Andy that retreating in the
manner of taking steps back preserves him from the emotional pain of opening up in
therapy, without the conscious awareness that this very process could help him to
psychologically progress. However, Andy appears to need to say that two people, a
“girlfriend” and a “Jamaican girlfriend” have vouched for his guarded emotions thereby
verifying this, but there is a sense that Andy finds it difficult to own these feelings he has
about his emotions and attempts to rationalise this by suggesting that he may be bipolar,
without being officially diagnosed. Whereas Andy seems unable to understand his
emotional behaviour he also tries to rationalise it, which in some way exonerates himself
from unlocking his emotions and allowing people in to work with them in therapy.
Jack, who has had therapy for many years, feels he only skimmed the surface of
his feelings because of his difficulty in feeling his emotions:
“I feel, I feel, that there is a fairy story wasn’t there? Called the Ice Princess or
something like that. It’s a block of ice (prodding his heart). It takes a lot
nowadays, if anything, for me. I can’t, I can’t, I can’t remember when I last cried.
For whatever reason, tears of happiness, tears of sadness, its like I’ve almost
gone into neutral”. (Jack, 125-127)
Jack describes his difficulty in feeling emotions and begins by saying, “I feel”
twice, as if thinking about feeling his emotions but also perhaps because he is trying to
access his feelings about his lack of emotions during the interview. He does not use the
words ‘fairy tale’ as they generally tend to be described, but instead uses fairy “story”
possibly because ‘story’ sounds less fictional than ‘tale’ especially since the story seems
to affect Jack personally as he prods where it matters emotionally, in his heart. Jack also
says “I can’t, I can’t, I can’t” in a manner of resignation, using the word “neutral” to
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mean devoid of feeling, or being unable to access his feelings. The ice princess story
however, is about good and evil battling each other but, perhaps by using a metaphor of
the icing over of his heart for the controlling of his emotions, Jack has suspended his
emotions from thawing, thereby preserving a fairy story ending where no one wins and
no one loses.
Ned’s account below exemplifies the experience of an older man willing to
discuss emotions, but from a safe distance, so engaged the services of a psychoanalyst to
deal with his depression, anxiety and anger issues:
“She helped with the sort of consciousness of my moods, I think, consciousness of
my ability to see it in perspective, to get a perspective on them and feel outside
them. I suppose and to get some distance from them”. (Ned, 80-83)
By “consciousness”, Ned describes the state of being aware of his emotions, with
a sense of him stepping out and looking into his emotional self. Ned seems to be
describing a disconnect within himself as he seems not to look within his emotions, but
views them from the outside, peering in. This is evident when he says he was able to “feel
outside (his moods)” and describes getting “some distance from them” as if to say he
needed to disassociate himself from his emotions in order to get a perspective on them.
This is a conundrum seeing that his moods and emotions are a part of him, yet Ned seems
tentative when he says “(he) think(s)” and “suppose(s)” which lends the idea that he may
not be certain or convinced that he was helped in “the consciousness” of his moods
because, if he were, perhaps he would be experiencing them from the inside and not from
the outside.
A point to note is that Ned first owns his emotions by saying “my moods” but later
describes them as “it” and “them”. There is a sense that he may have felt discomforted
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owning his emotional state but then recants by reiterating the separation of his moods
from himself, not once but twice. The above account therefore lends the interpretation
that Ned wanted to “get a perspective” on his emotions from a safe “distance”, because to
experience his emotions in therapy would require delving inside them, to see how he feels
experiencing himself.
Some participants who had long-term therapy had more success in accessing and
being able to experience and express their emotions. For instance, unlike other
participants, Bill seemed to cross the threshold of withdrawing from, suppressing or
trying to control his emotions. In his candid account, Bill describes how past emotions
came alive in therapy as he enacted anger and rage with his deceased parents:
“I remember being in his (the therapist’s) office at the time and started shouting
at them and telling them (his parents) to get the hell out of my life that they were
not just inhibiting my life but they were controlling it […]”. (Bill, 22-24)
Bill describes an enactment where he was able to raise unresolved emotional
issues and address them in therapy, in so doing relieving himself from his anger and rage.
Although Bill described his parents as still controlling him long after they had died, this
could be interpreted as Bill having to feel in control of and suppress his own emotions
(rage). In other words, for as long as Bill controlled or suppressed his anger surrounding
his parents, his parents would continue to have a “hold” over him and his emotions. Bill
used the word “inhibiting” to mean his parents inhibiting his life following this
interpretation, but this probably applies to Bill inhibiting his own emotions in relation to
his parents. Once Bill was able to address his emotions and no longer needed to control or
be controlled by them, he was able to enact his felt emotions in therapy and feel
emotional release, thereby releasing his parents from his life.
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In the next three narratives of Steve, Andy and Bill began to shed light on being
conditioned from a very young age and how for the most part, they had conceded to
aspects of socialised masculinity. But there is also a sense that this ‘way of being’ has
been evolving slowly over the years. Below, Steve describes conditioning as a no-wayout scenario with few options against powerful constructs:
“I don’t believe this culture, this society um (short pause) makes it a possibility …
that the program and the conditioning is so kind of prevalent, you just get on, bite
the bullet and just get on with it or have a drink, … get pissed a couple of times, or
you know or actually get in a fight or do something, break up the house or have,
have sex with you know, just do something but you know, sharing about this, you
don’t need to talk about this stuff you know, um because we’re not here to, we’re
not, I mean, there’s part of it that goes to a whole different ball game … people’s
interest to keep people separate, separate from themselves or just separate from
other people”. (Steve, 146-151)
Steve speaks in a way that suggests an impossibility of going against the
widespread and powerful constructs of masculinity and expresses a kind of resignation
and pressure to conform. He describes it as a collective programme or agenda to divide
and control, and his way of managing it is by bearing it but when pressure builds he
resorts to drinking and getting physical. Similar to Bill, who sometimes accepts rather
than challenges normative ways of being, Steve ends up reaffirming masculine values
with reckless and physically destructive behaviour by “just do(ing) something”. His pause
in the first sentence seems as deliberate as the conditioning he speaks of. This
conditioning can also be read in Steve’s use of masculine metaphors such as, “bite the
bullet” and “ball game” which conjure images of tough men and heroes who don’t talk
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about feelings but fight on or endure without complaint. “Bite the bullet” has
connotations of someone who endures pain intentionally, consciously and who keeps
silent, a sign of toughness, characteristically crucial to being masculine. It also evokes
images of cowboys and guns, classic symbols of masculinity. Steve’s reference to “ball
game” means taking conditioning to another level but also leads to another aspect of the
ball game, ‘taking one for the team’ which usually means leaning in and getting hit by a
pitch intentionally. It is also interesting that Steve uses the language of war and sport to
describe this emotionality which tend to be the sanctioned arenas for the performance of
hegemonic masculinity. Additionally, by Steve’s account, talking about or sharing the
pressure is socially unacceptable, “because we’re not here to, we’re not, I mean”; Steve
uses “we” which sounded like he was speaking on behalf of all men but then corrects
himself and uses “I” demonstrating that he was able to make a distinction between the ‘I’
of his constructed self and the ‘we’ that he feels forced to subscribe to.
Andy also occasionally feels the need to ‘perform’ his masculinity by trying to
win and control his therapist:
“It’s like a sense of erm, I dunno, a sense of, erm you want to win somebody, you
know, I talked to her about literature and things and erm I guess I am looking
for certain areas to control in certain ways you know? Well, it’s like if you are
presenting something you want to keep the interest of the audience and if you
lose them it’s harder to get them back […] ”. (Andy, 151-154)
Andy refers to “winning” and “control”, features which tend to be associated
with normalised masculine traits. His account depicts a man who perhaps feels
emasculated and challenged by a therapist and needs to regain control by attempting to
perform for her or, as he says, “win” her, but he uses the word “somebody” instead of her
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which could mean a universal desire to be in competition and win. This is evident when
he also uses the word “lose” in the same account. That is, winning and losing seem to be
more of a universal masculine trait than a personal trait. His words, “if you lose them it’s
harder to get them back” imply “them” as his personal audience. Again, there is a sense
of having to perform; his male ego needing an audience to applaud him. One reading of
bringing literature into therapy could be that Andy is trying to deflect from the
emasculation of being in therapy and tries to regain what he thinks he has lost or is a sign
of weakness. However, Andy may also have brought literature into the frame because it
shows refinement, someone who is perhaps polished and contained because to show
otherwise is, again, a sign that he is unable, as a man, to carry himself. Andy uses “you”
throughout his account, never really bringing himself into the picture, lending the idea
that he may have disassociated himself from his process because it seemed he was in the
guise of a performer. While Andy was brought up having to perform his gender but has
moved on in some ways as his overall narrative seems to show, Bill affirms moving on
from the socialised masculine constructs but admits to “reverting to type”:
B: “If there’s something wrong with your eyes, there’s something wrong with
your eyes, you can’t do anything about it and acceptance is usually the answer to
all my problems. But there are times when I am not too accepting. That’s what I
mean by fear […] I revert back to type sometimes”.
I: “Mmm, so why do you think that there’s a tendency for you to revert to type?”
B: “Conditioning”. (Bill, 130, 134)
Bill is describing the possibility that he may have issues with his eyes and his
reluctance to seek help. Perhaps acknowledging failure with his eyesight constitutes
having to accept himself as being less of a man, more so since being male is synonymous
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with strength, male prowess and independence. Not being able to drive for instance may
strip him of his independence. This is perhaps what Bill means by fear, as he seems to
link the word “acceptance” with “fear”. That is, to accept something is also to welcome
the fear and uncertainty of it. Not being too accepting, as he says, and choosing to ignore
or fight it, may somehow show courage and toughness. In other words, not accepting his
weakness is a sign of courage, a favoured and desirable masculine trait which is what Bill
means when he describes, “reverting to type”. When Bill repeats “when there’s
something wrong with your eyes, there’s something wrong with your eyes”, it lends the
notion that even when presented with facts, he may feel the need to revert to type,
alluding to the idea that conditioning is so potent and masculinity so strong that it blurs
the vision of truth from romanticised, heroic fiction. Although Bill says that “acceptance
is usually the answer” it seems that his fear, on this occasion, is too powerful to find its
own meaning in not being able to see, a fear that perhaps strongly correlates to the power
of masculine norms that keeps people like Bill in fear of being isolated from having to
challenge socialised masculinities.
4.2.2 Subtheme: Importance of Emotional Containment
The facilitation of the unlocking of emotions tends to be governed by a degree of
emotional containment in the form of therapist competency such as appearance, neutrality
and listening skills; the gender of the therapist; and the element of time. That is,
participants describe areas that they feel are conducive or important in being able to talk
about emotions but also feel that it is important to feel emotionally contained by the
therapist. Therapeutic competence for example, seems to take priority over who
participants’ therapists were, where their therapists originated from or what their
respective religious backgrounds were. Andy however describes his therapist as:
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“Some kind of hippie erm, lots of rings on her fingers, double, dual-tone hair
colour and a hit of raucousness and vulgarity in her laughter”. (17)
And later, from the narrative below, Andy makes links not just with her appearance but
with her informal behaviour and her level of psychological expertise:
“There was a hint of informality and vulgarity in her behaviour and, erm, I asked
what kind of therapist she was and she let me know that she was Gestalt,
Integrative forms of therapy and I don’t know to what extent if there was an
element of con, in what she was telling me, is this the best that the National
Health can offer me, you know?” (Andy, 116-117)
Andy’s description of his therapist looking like a hippie with her rings and dualtoned hair colour may have been perceived as unprofessional which suggests that Andy
had preconceived ideas about how a therapist should look, and may have expected a
certain standard to be adhered to considering she was an NHS therapist. Her appearance
and behaviour, therefore, suggested something of the quality of NHS therapists, which
seemed to disappoint him greatly. The “hint” of “informality and vulgarity” could be
taken to mean that he prefers a degree of formality surrounding his therapy and any
“hint” of it being otherwise could allude to therapy not being a safe and contained space
for Andy. In asking his therapist about her psychological orientation, Andy may have
been trying to match her appearance to the orientation and may have found an
uncomfortable disparity between them, which is why he may have wondered about “an
element of con”, either by her or the NHS. Furthermore, Andy appears to assess his
therapist’s competence based on her appearance and this seemed to prevent him from
completely and emotionally unfolding.
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For Bill, a non-practicing Catholic, the therapist’s origin, religion, who they were
or even if they were liked were not as important as their ability to resolve problems:
“I didn’t know until about the sixth session, sixth session that he was an Anglican
Parish priest but (laughs) I thought that if he could help me, I couldn’t give a
monkey’s about what he is, he was American, a lovely guy.” (Bill, 17-18)
In Bill’s narrative, he mentions “sixth session, sixth session” twice, as if to
suggest an element of surprise and that a lot of time had gone by before he became aware
of the background of his therapist. Perhaps knowledge of this would have mattered
previously as Bill was raised with the strict divide between Catholics and Protestants, but
alludes to the religion aspect as not being of significance or importance because he was
more interested in the therapist’s ability to help him. However, the “I didn’t know” and
laughter has a sense of irony in that the very thing Bill was taught, the divide in religion,
should in some way be responsible for his integration. Bill uses a polite euphemistic
shortening, “I couldn’t give a monkey’s” to mean that he had no concerns about what his
therapist was, but very quickly mentions he was American. One reading of this was that
Bill felt comfortable with his therapist even though he was Anglican and despite being an
American. Bill felt his own needs and getting help were more crucial and of higher
priority over the background of his therapist.
For Steve, the unfolding of emotions begins with the therapist using their listening
skills and making appropriate interventions, yet managing therapy in such a way that it
allows for the client to resolve his own issues with the therapist facilitating this process:
“You know you got to get listening skills and also intervention and you know
you’re not here to fix anybody or give advice for it although that’s what happens
a lot it’s allowing, you know, which is the premise of psychotherapy is that, you
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know, you allow other person to find their way through their own, you know,
intelligence or whatever, it is how the therapeutic process works” (Steve, 110111).
Steve uses “you” in his account several times and by that it seems he is also
referring to me, as the researcher, when he talks about “listening skills”. It feels that Steve
is using his knowledge that I am a therapist in training to tell me or advise me of the
importance of listening skills as a trainee, and tell me that listening is a skill he feels is
important to him as a client, and perhaps as an older man. “Got to get” is used to mean
that if one does not innately have it, the skill must simply be acquired and learned. Steve
says this in a way that implies listening is simply a necessity that one has “got to get”, no
options. Steve links listening skills to intervention and it can be assumed that he means
active listening, which requires that the therapist offer feedback to what is being heard.
The word “fix” from “you’re not here to fix anybody”, suggests that Steve is aware that
the intention of therapy is not to straighten clients out, but also “fix” lends the notion of
something fast and easy, so Steve probably means that therapy does not offer a quick fix.
Steve also alludes to being aware that therapists are not meant to offer advice because it
is the “premise of psychotherapy”, but says this tends to happen anyway, implying
perhaps that therapists may start with that premise but end up offering advice. Steve
believes in the importance of therapists allowing the client to “to find their way through”
but implies that, in itself, is a skill. Steve also uses the word “intelligence” as a variable
necessary for processing emotional material, but this might be taken to mean emotional
intelligence.
Jack’s account relates the importance of therapist neutrality and feeling safe in
therapy:
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“You know I think it’s, it’s incredibly useful to be able to speak to, you know,
what I’d be able to consider a neutral party and my wife is very skeptical … I
always find it incredibly valuable erm, even though you know, I feel in all my
years of, of therapy, erm, that if you like, I’ve only kind of skimmed the surface,
erm. I never really, I never kind of, really opened up”. (Jack, 133-136)
Jack’s first sentence above talks about the usefulness in “speak[ing] to”, which
has an air of referring to someone with authority or someone professional as opposed to
‘talking to’ which sounds more casual and relational. “Speak to” also has an element of
becoming informed in some way or meeting with someone to validate thoughts, which
perhaps he cannot seem to do with a skeptical, biased wife. However, perhaps he was
also trying to establish a contrast between his wife’s ideas or opinions as a lay person in
comparison with someone he describes as “neutral”, “useful” “valuable” “helpful”. Yet
despite therapy being described as such, Jack admits that he “only kind of skimmed the
surface” saying that he “never … really opened up” which may be linked to earlier views
expressed in his narrative, “you’re wondering to yourself all the time whether they’re
being judgmental […]” (47). The idea that Jack may feel judged by his therapist might
mean that he does not feel safe and contained enough to go deeper than the surface
without enough trust established to let someone in. When Jack says it is valuable to speak
to his therapist, there is a sense that he is using the therapist to offload his woes or to find
a masculine alley (where his wife was not), and this may have prevented him from
delving deeper into his processes and just “skimming the surface”.
Two aspects of time, that is how well the therapist manages their time in therapy
and how many sessions are allocated, seem integral to the process of emotional unfolding
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for some participants. Andy seems to describe a particular type of trust that he expects to
have with his therapist and alludes to this trust as taking a number of years to develop:
“And I think, that form of trust has developed over that period of time in organic
consistent steps and I think also somebody who takes time with you”. (Andy, 45)
He makes the point of saying that this process should be organic, meaning a
naturally developing and unfolding process. Andy also feels that it is important to be
allocated an appropriate number of sessions as it takes time for trust to build but, equally
important, is a therapist who takes time with him and their clients. He adds:
“Some eight sessions came though which I found I was just marking time […]”.
(Andy, 16)
The sessions Andy describes as “came through” had to do with the long wait for
his therapy appointments. Andy seemed to express disappointment with his number of
allocated sessions as, together with the previous narrative, he felt the importance of being
able to trust his therapist and his ability to comfortably unfold emotionally depended on
it. One interpretation is in feeling like he wasn’t given enough time he decided against
allowing himself to unfold and, instead, attended therapy to mark time. It felt as if he was
trying to say that the amount of time given to him did not match the extent of his
problems and may have, instead, insulted him, added to the fact that he was unimpressed
with his therapist’s appearance.
Bill enjoyed how his therapist managed her time with him. Before the
commencement of each session they would make small talk, building rapport as he put it,
then gently easing into therapy:
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“But she had the ability of being like that but not overstepping any professional
boundaries, you know? I mean we discussed the weather or whatever, but the next
55 minutes, was devoted to working on me”. (Bill, 98-100)
Bill’s account suggests that his therapist was able to balance her time between
small talk and in ensuring that she worked with Bill efficiently. “She had the ability”,
could be interpreted as a skill but “being like that” sounds as if Bill may have thought it
was a personal characteristic. “Overstepping” means his therapist respected his time and
there was the idea that she also gave him his space. He uses “professional” but also
“being like that” which could be taken to mean his therapist was able to strike a balance
between boundaried professional actions and being herself. The word “devoted” in this
instance is reflective of a therapist who, according to Bill, is not only dedicated and
attentive to his needs but is very present in the room with Bill.
The gender of the therapist appears to be an important aspect to older men feeling
emotionally contained in therapy. For instance, when talking about their emotions, a
majority of men said they preferred talking to female therapists. This is largely due to
male perceptions and expectations surrounding female therapists (explored further in the
discussion chapter). But crucially, this perception also brings into question, with some
participants, female therapists’ ability to manage some of men’s more powerful emotions
such as, anger.
Interestingly, those participants who engaged female therapists seemed to be
more descriptive of the way their therapist looked compared to any male therapist seen by
the same participant. It seems unlikely that participants would describe male therapists in
the same way. No participants were prompted to describe their therapists, rather they
were simply asked if they had a preference for a male or female therapist. There is a
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sense therefore that the gender of the therapist as female elicits more scrutiny by older,
male participants. This scrutiny sometimes extends to female competence in therapy.
Steve, who is 64 years old, says he chose a female therapist because he felt he was
able to express himself comfortably, but also alluded to using her gender as a means to
relearn intimacy with “another human being” which I took to mean a female:
“So I can, I can, express um who I am, to my therapist who’s about sixty years
of age. She’s a woman, so I choose to have a woman because uh, I think after
having left my marriage … I hadn’t had a relationship, a sexual relationship, an
intimate relationship, with a woman, or a man (clears throat) or you know, I’m
not bisexual, but you know, I’m just, I hadn’t had an intimate sexual relationship
with another human being”. (Steve, 85-87)
Importantly, in the quote above, Steve feels he is able to express who he is to a
female therapist, meaning he feels more comfortable opening himself, more so since it
appears that he wants to talk to her about intimacy and having a “sexual relationship with
another human being”. This, of course, may lead to the assumption that a male therapist
may restrict Steve’s self-expression. Steve is also likely to have chosen a female therapist
because it would help him understand women of that, and his, age group better, and also
because it offered an opportunity to be in the presence of a female with whom he could
be intimate in order to feel, once again, what it would be like. Steve chose a therapist
closer to his age, perhaps because he felt this meant they would be on equal gendered
ground, but there is also a sense that he chose someone older because they would
represent therapeutic experience. The fact that he felt the need to bring the age of his
therapist into the interview may validate this idea. Steve clears his throat when he talks
about not having an intimate relationship even with a man, and there is a feeling of
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embarrassment in the air of the interview because of the connotation that he may be
bisexual that he needed to clear up.
From the account below, we get the sense that Andy may have had prescribed
ideas about the impact of unleashing strong male emotions onto a female therapist. In fact
even he sounded surprised at how powerful they were.
“I was concerned at the time for the person that was taking the session that my
emotions may be too powerful for her to manage … but she was obviously more
experienced than what I thought and, as I left, I said, “I can manage this” and
she said, “I know you can.” (Andy, 24-25)
In the first instance, what was apparent was Andy’s use of “the person”, instead
of describing the therapist by their gender or referring to them as his therapist. But later
“the person” actually begins to take shape when Andy uses “her” then “she” at crucial
points in the narrative. That is, the “person” becomes established as a woman who can
handle the power of Andy’s emotions and who becomes more defined when he says
“she” was more competent than he expected. In some ways Andy’s therapist may have
ceased to become anything other than “the person” had she not been competent, and
competent as a female.
Furthermore, Andy’s perception of his therapist’s competency seems to have been
formed before he was able to realise that she could contain his emotions. Yet the fact that
Andy still felt the need to tell her that he could “manage this” may imply that he was
trying to regain control of a possible emasculating moment and, in doing so, obliterate
any sense of being seen as weak or vulnerable as a man. In some ways, his therapist
saying, “I know you can” gives Andy the courage and strength that he may have lost in a
perceived moment of weakness.
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Bill, on the other hand, felt no qualms about opening up emotionally to a female
therapist about his female-related issues but there is a sense that this is a somewhat new
type of behaviour for him:
“What? Tell a woman that you couldn’t make love to your wife or to your
girlfriend or whatever? No bloody way. It doesn’t matter to me. It really does not
matter to me, today”. (Bill, 83-84)
Bill describes a persona non grata scenario in discussing male sexual problems
with “a woman”. However, in analysing his choice of the word “woman” and not female,
it might be that “woman” has more of a personal nature to it than ‘female’ which has
more of a gendered, general meaning. That is, telling a ‘woman’ such a matter would
seem even more personal and possibly more demeaning than telling a ‘female’.
Furthermore, Bill’s “no bloody way” has a ring of finality and dismissiveness which
could be seen as bringing shame and embarrassment if he concedes, thereby making
himself seem vulnerable to the weaker sex. However, Bill repeats that it does not matter
to him, as if to get his point across to women, females and anyone who chooses to listen
(more so in therapy) that his views have changed.
In summary, some older men have perceptions of their therapists, especially
female therapists, and may seek out females to help them resolve certain issues that they
would not otherwise see a male therapist for. The perception of women is also grounded
on the belief by some participants that they may not be able to contain the powerful
emotions of men in therapy and this perception seems to be linked to female therapists’
competence. Hence, there is the notion that older men view a female therapist as someone
they can talk to about emotional issues or use to get in touch with their emotional side,
but there seems to be an undisclosed feeling surrounding female competency, rationality
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and objectivity in psychotherapy. For other older men who previously would not have
seen a female therapist this is no longer of relevance, however age also seems to be a
factor as some older men prefer female therapists closer to their own age.
4.2.3 Subtheme: Role of A.A. in the Emotion Sharing Experience
This subtheme describes how participants come to either listen to and/or share
their emotions with others beyond therapy, which becomes part of their emotion
experience in therapy; A.A. is used as an example of a fellowship as all participants in
this study are with A.A and mention it consistently, as part of their healing process. From
their accounts, it seems that older men exposed to fellowships may not necessarily
become articulate speakers themselves. Jack, for example, disclosed that although he had
been a member of A.A. for 12 years he had only ever accepted 4 chairs (an opportunity to
speak about a subject matter to an audience) because of his tremendous reluctance to
expose himself to mass scrutiny. For most participants however, fellowships are
described as tending to awaken and expand emotional awareness, emotional expression
and emotional vocabulary by being with and watching others. Jack’s narrative below
suggests that fellowship sharing offers hope to many:
“That’s one of the wonderful things about A.A., it’s that I think, you get better
because you realise that an awful lot of the stuff that you’re thinking, other people
are thinking as well. And that decreases your sense of, sense of isolation. But you
know the kind of weird thoughts you have, preoccupations you have, your
tendency to catastrophise situations. Erm, other people are thinking them as well.
And you know that’s ... I mean A.A. is, er, if you strip it down, it’s a combination
of aversion therapy, sitting there listening to all of these shocking stories of how it
was when people were drinking”. (Jack, 144-147)
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Throughout his account, Jack uses the words “you” and “your/you’re” seven times
seemingly leaving himself out of this process. Even though Jack states “you get better”,
he earlier established that he doesn’t share too often in the fellowship meaning he is
present, but keeps his emotions and feelings to himself. In fact, Jack does not use the
words ‘emotion’ or ‘feelings’, he uses “thinking” for instance when he says “the stuff that
you’re thinking, other people are thinking as well”. There is the sense that Jack’s emotion
experience in and outside of therapy still does not enable him to completely divulge
emotions.
From Jack’s account, however, it is apparent that he gains some level of
assuredness in being with a pack who think about things in the same way as he does as
this decreases his sense of isolation (even though he seems to have unconsciously
separated himself from others by his descriptors of “you”), offering acceptance to a
problem such as alcohol.
Jack’s tendency to “catastrophise situations” is also perhaps normalised when he
has others to compare against. In fact he may even consider himself to be apart from the
other fellowship members as he uses the words “aversion therapy” as if repulsed by the
possible contagion of narrative from fellow members. It is interesting that Jack uses the
words “strip it down”, as he disclosed in his narrative that he feels like the ice princess
who perhaps has to peel the layers of his own emotions because of his fear of being
exposed.
Carl feels differently. He expresses that years of active fellowship sharing and
listening have had a direct impact on his ability to share feelings in therapy. He says:
“Nearly thirty-five years of listening and sharing in A.A. meetings has
disinhibited me from sharing difficult feelings, it’s furnished me with several
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different emotional vocabularies, from nuanced intra-psychic observations by
deeply reflective psychologically aware folk, to hip West Coast recovery […]”.
(Carl, 153-157)
Carl explains somewhat candidly that exposure to various fellowships in America
as well as the U.K. has not only enabled him to encounter a myriad of people furnishing
him with “several different emotional vocabularies” but he carries an air of confidence in
his dialogue. Carl’s cultural exposure may have aided his ability to share and express his
feelings in different ways, with different types of people in different scenarios. But more
importantly, there is a sense that the number of years in fellowship has made him rather
seasoned at expressing and sharing to the point of not allowing others to affect how he
feels when he needs to get what he wants to, across. Even when there are no words,
through “nuanced intra-psychic observations” he is still able to pick out the subtleties of
what is being, or not being said, in part because of the psychologically aware people he
was with.
Carl talks about being “disinhibited […] from sharing difficult feelings” based on
the number of years of fellowship sharing. However, another reading of this could be a
desensitising towards one’s own feelings that may occur with prolonged exposure to the
sharing of emotions, almost as if the process has become methodical and with decreased
impact in emotional meaning.
In summary, participants under this subtheme talk about the impact of emotion
experience beyond therapy, for example in fellowships, which becomes part of their
emotion experience in therapy. Participants, who are all with A.A., describe a mixed
response, some feeling that it aids them with emotion experience of a private nature in
therapy while, for others, it offers an opportunity to be with like-minded fellows who
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enable them to expand their emotional expression and vocabulary. However this may not
necessarily mean that participants are comfortable talking about and experiencing
emotion in a public sphere.
4.3 Master Theme 2: Transformation
Self-Actualisation
Transformation/Allegiance
to Self
Emotional-spiritual
Figure 4: Diagrammatic of Master Theme 2: Transformation/Allegiance to Self
The second master theme Transformation/Allegiance to Self consists of two key
subthemes (see figure 4 ) derived from participant accounts: self-actualisation and
emotional-spiritual. Transformation is the felt experience of the process of unearthing and
unfolding emotions in therapy. It also adds to the knowledge of the ‘older’ aspect of men
who in this sample, describe themselves as accepting their age and aging, being very
aware and conscious of living in the present and being committed, at this juncture of their
lives, to themselves. Here some participants describe stepping away from traditional
masculine norms, and because of long-term therapy, fellowships, life experience, cultural
awareness or aging have begun to find their own masculine identities, which suit them.
For some participants, the idea of having a masculine identity has little meaning
compared to the concept of simply being human. In the transformation master theme, a
majority of participants describe their emotion experience as a spiritual journey, with or
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without religious connotations, that brings transformation in their lives, with new
meanings and awareness.
4.3.1 Subtheme: Self-actualisation
Bill describes accepting where he is in his life using his age as a determiner of
what he thinks he can and cannot do. There is also a distinction, he says, between what he
would like to do and what he can do because of his age:
“I, I’m sort of contented. I accept that I am where I am, I’m 68 years old. Erm
you know when I am sitting down I can be full of vigor and I can run a hundred
yards in 8 seconds and I know of course when I get up and get off the seat it will
be a bit more difficult. I’m very accepting of where I am and what my programme
has taught me. There’s no point in me wanting to be younger, older in any way. I
have to be accepting of, of where I am. For me yesterday is history and tomorrow
is mystery. We only have today and if I try to make the best of each day, because a
big red bus might come tomorrow and knock me down and I’d hate to be dying
and think, ‘Jesus I didn’t enjoy yesterday’. Unacceptable.” (Bill 170-180)
Bill begins his account by stammering with “I’s” but the second “I’m” sounds
more of a conviction, or he is trying to convince himself that he is content to be where he
is, at and with his age. But he says “sort of contented” meaning there are some things
about aging that he is not entirely content with, and this example may be the physical
aspect of aging because he says that in his mind he is able to do the things that his body
will not let him do.
There is also a dichotomy between the word “accept” used in the narrative and his
last word “unacceptable”. One reading may be that Bill can either accept his older age or
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not accept his older age for there is no in-between and, as he says, “no point in me
wanting to be younger, older”. Curiously he does not say younger or older. It seems that
in Bill’s mind this should be a smooth transition, that one goes from young to old. In the
narrative Bill says three times, “I accept that I am where I am” sounding like a matter of
fact, then “I’m very accepting of where I am” as if he was defending himself and “I have
to be accepting of, of where I am” sounding slightly less convincing, as if he was actually
trying to think of where “where” is. Together, these repeated sentences sound as if Bill is
still trying to convince himself, and perhaps others, that he simply has to accept where he
is because the other option of not accepting could be just as fatal especially when he says
“a big red bus might come tomorrow and knock me down”. Bill also mentions what his
“programme has taught (him)” meaning what A.A. has taught him, although it is
interesting that he does not mention this outright. “Programme” has connotations of a
guided, fail-safe structure that one follows which presents itself as something more fixed
than the uncertainty of death, and perhaps the reliance of a programme helps Bill work
with things he can control, like attending the programme and adhering to its principles.
The phrase, “yesterday is history and tomorrow is mystery” might mean for Bill
that he doesn’t look back and he doesn’t plan ahead but tends to live out his life in the
present time. The metaphor of the “big red bus” suggests that something ordinary could
take him away but it is also the size that suggests something big could happen to take him
and the colour “red” suggests warning and danger meaning Bill has little control over
what could happen as his fate lies in someone else’s hands, or even “Jesus’s”. Bill ends
his sentence with the word “unacceptable” lending the idea that Bill makes strict and
disciplined attempts to adhere to the programme to help convince him of his own
intentions of conviction, of simply “make(ing) the best of each day”.
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In the narrative below, Carl finds it hard to stay present because he thinks about
his future:
“Well I try to stay present as much as I can and it’s hard but, in what I attempt
pretty successfully to do is not worry about the future but I am planning […].
Yeah, my plan is to get credentialed and practice as a psychotherapist because its
something I can do as long as I am sentient. You know I don’t have to climb on
ladders or lift bricks. As long as I am present and alive. You know, conscious and
committed, I could do that”. (Carl, 105-110)
Carl’s makes a distinction between worrying about the future and making plans
for the future. He alludes to working at “attempt(ing)” to “not” worry and feels that he is
successful at doing so but the word “successful” here can also be taken to mean that he
wants to be a success elsewhere in his life, in his future. This is perhaps evidenced by
Carl’s future plan to practice as a psychotherapist. Another way to look at it is that Carl is
not worrying about the future because he is making plans for it which could indicate selfreliance, self-assured confidence or, as he says, “commitment” to indicate that he is in
control of his future, even if age diminishes his capacity to do physical things like “climb
on ladders or lift bricks”. By using the word “sentient” Carl indirectly refers to age as not
being a deterrent to fulfilling his future plans for he mentions a more important need to be
conscious and emotional. Interestingly, Carl’s use of the words “climb on ladders or lift
bricks” are metaphors that conjure traditional, manly work. There is a suggestion
therefore that age may bring with it the acknowledgement of being less able to do
physical, manual work, but work may still continue in other forms available to Carl. In
fact just being “present and alive” and “committed” are enough for Carl to continue with
his journey. The words “conscious” and “present” are used often in Carl’s account,
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similar to Bill’s, and this indicates an acute awareness of the one-day-at-a-time approach
of A.A. Nonetheless, Carl has a quiet determination to ensure he has a future with few
worries as opposed to worrying a lot about the future.
These participants, looking back at their lives, describe feeling remorseful over
some of the gendered cultural and social expectations that were enforced upon and
expected of them. Today, these older men tend to possess a clear awareness of their
masculine identities, of who they are and who they are not, and have the courage and
confidence to allow their subjective masculine selves to shine through. For example
Carl, when asked about his views on masculinity, described a men’s liberation movement
he was involved in:
“You know, look at what all the feminists are doing for each other, and we’re
not. We’re just stood in competition. So the idea was to show men how they can
unfold and stop being men”. (Carl, 135-141)
In the account above, Carl describes men as being in competition with each other
and draws a comparison between men and “feminists” taken to mean females’ organised
behaviour. “Stood” seems striking against the active “doing” nature of women. The
words “to show men” as opposed ‘to explain to’ men appear an interesting choice for
Carl, as “to show” has elements of still being in competition (a masculine trait) amongst
men. Nonetheless, Carl’s proposition for men to “unfold” has a gentle, feminine quality
to which the opposite would mean to be fixed and firmly held by normalised masculine
constraints. Furthermore, “stop being men” seems to be loaded with all the socio-cultural
constraints of gender roles and the stress and costs of traditional masculinity, as it seems
to have affected men like Carl.
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When asked how expressing his emotions felt from a male perspective, Carl
remarked:
“A ‘male’ perspective? What the heck is that when it’s at home? That’s in macro
society behaviour … I only have ‘my’ perspective, which of course is a blend of
eight zillion experiences and ‘my’ responses to them”. (Carl, 162-170)
In asking men to stop being men, Carl offers his perspective which he alludes to
being made up of the journey of his experiences. In fact, in Carl’s account above he
describes only knowing what his perspective of “maleness” looks like. He is very clear in
his distinction between his perspective, which he is at “home” with compared to the
normalised and societal view of masculinity. At “home” is also taken to mean feeling
comfortable with. In Carl’s narrative he states his perspective is made up of his journey
of experiences, and his responses to them which includes his experience of cultural and
normalised up-bringing, although he does not tend to agree with “macro society
behaviour”. Carl’s two narratives therefore offer the idea of the importance of men
needing to pay allegiance to themselves as men, and not to the confines of societal
expectations of what it is to be a man.
Like Carl, Ned makes no apologies for not conforming to normalised
masculinities:
“I was brought up with a consciousness of the dichotomy between masculinity and
femininity and that you had to choose one or the other. So that … I’m really sorry
about that love, it’s a shame, it’s pity because, it’s much better to grow up more
integrated than that. But I definitely decided to be girlish exactly but aesthetic or
artistic and to reject the kind of, masculine thing. I mean I regret that, I’m sorry
about that. A lot more fun, I’m having a lot more fun, now”. (Ned, 111-113).
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Ned, above, uses sarcasm to mean that it is actually a shame and a pity that his
parents and/or society had strict dichotomies of being masculine or feminine and he does
not really “regret” or feel “sorry” about his decision to feel more “integrated”. He uses
the word “consciousness” to mean awareness but also having to choose, meaning it was
expected that Ned was one or the other. Ned implies that such an imposition was
alienating to those who did not feel the same way, offering little choice or alternative,
however another meaning is that gender dichotomies set males and females apart and
differentiated them from one another. Ned uses the words “girlish”, “aesthetic” or
“artistic” which can be taken as an umbrella term and a preference for feminine or
feminine-related things. Being “artistic”, for example, could have creative connotations
associated with the feminine. There is a sense, however, that not having to choose to be
one or the other, masculine or feminine, offers a kind of freedom for Ned to be who he
wants to be, and this is more the case as an older man, for he stresses that he is having
more fun now, but also because he previously mentioned that age has caused him to
“care less about what people think”.
For Bill, therapy has provided a way to unlearn and discover who he really is and
that ‘who’ is a product of his design and making:
“And I supposed what therapy has mostly done for me, is to make me, make me
my own man”. (Bill, 22-27)
From the narrative above, it seems that Bill’s journey, inclusive of therapy, has
given him a sense of awareness and courage to decide what kind of man he wants to be.
That is, to be his “own” man as opposed to being an owned man whose life has been
dictated by gendered norms. He repeats “make me” twice as if to say in the first instance
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that therapy gave him no option but to see, and then a second realisation occurred by his
own making where he allowed himself to see, hence becoming aware of the possibility of
being his own person. The words “make me” also allude to someone who is “self-made”,
of someone who has become successful in his own right, by his own efforts.
Bill who does revert to ‘type’ from time to time, expands on the view that he sees
no significant difference between males and females, further instilling the idea that
society has placed too much emphasis on the importance of being a man:
“Being a man, basically, not that terribly important. Men, women, I, I don’t think
there’s a whole lot of difference … Really, sincerely, doesn’t mean as much as it
used to mean to me, about being a man. I’m a human being”. (Bill, 165-167)
Here Bill seems to express a ‘what’s all this fuss about’ tone. He communicates
the idea that being his own man (from previous account), a man or a woman, makes little
difference to him and what really matters is being human. It feels that Bill is a human
who is being, acting in accordance to how the meaning of gendered constructs have
changed for him. He shows his conviction using “really, sincerely” as if to say the idea of
subscribing to his own sense of (non-masculine) subjective truth was not going to change
anytime soon.
In summary this subtheme highlights these older men as coming to the stage in
life of needing to be more integrated, as responding to situations according to their
perspective and not society’s normalised expectations, especially gendered. What seems
to be apparent in the accounts above is that the meaning of what it is to be “a man” seems
to have lost its significance or become less important. What shines through these older
men’s experiences and the emotional miles they have covered is the importance of their
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own perspective, their own responses and being able to derive their own meanings from
their subjective encounters in life.
4.3.2 Subtheme: Emotional-Spiritual
This subtheme draws on the transformational emotional-spiritual feelings that
participants describe as deriving from their therapeutic journey of unearthing and
unfolding their emotions. This process offers a sense of emotional release and liberation
where journeying into the self has been described as a spiritual experience or necessary
for spiritual growth. Participant descriptions of the spiritual varied; some were closely
linked to the fellowship of A.A. which has a spiritual element attached to it, some were
religious and others were not, but almost every participant described the spiritual
elements involved in the process of emotional awareness. Carl’s narrative encapsulates
this theme:
“ ... in the last couple of years I’ve been learning how to experience deeply
painful emotion without recourse to anesthetic. A prerequisite to spiritual
growth!” (Carl, 151)
Carl describes the experiencing of emotion, as opposed to rationalising emotions,
as a requirement that precedes spiritual growth. His narrative alludes to a strong
emotional awareness that comes from experiencing and not masking pain. This, he says,
is something that he has learned, suggesting that it was not taught to him. One reading of
this is that Carl was taught gendered ways of dealing with emotions, which may mean
avoidance, control or suppression of emotion. Carl’s experiential awakening appears to
have added to his emotional miles and, as a consequence, seems to have also put him on
the path to spiritual growth.
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In summary, it seems unlikely that participants could have a spiritual
transformation without also having an emotional one. Either way, participants all seem to
share awareness surrounding their emotional awakening with a spiritual connection,
which seem to add a positive and impactful dimension to their personal recovery. The
transformation master themes covers the journey of emotional miles that spans the
experiences of older men’s rich emotional lives, of learning and unlearning, exploring
and experiencing, discovering and challenging gendered ways of being, and evolving to
new ways of being (human).
4.4 Conclusion
When analysing how older men make sense of their emotions in therapy, we can
surmise that their experiences of emotions are linked to their masculinities and how and
where they are at, can affect how they relate to their therapists which, in turn, can affect
their emotion experience. The findings also reflect the importance of therapeutic
emotional containment that helps facilitate the emotion experience. The unearthing,
talking and sharing of emotions seems to be a transformational experience for older men,
with some finding it a release and others as a journey into the realm of the spiritual. (See
appendix 12 for reflections on the data analysis stage).
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Chapter 5. Discussion
5.1 Overview
The aim of this research, using Interpretative Phenomenological Analysis (IPA),
was to provide a rich and descriptive account of older men's emotion experience in
therapy. During interviews it was established that participants were in a period of sobriety
from alcohol addiction and, in addition to personal therapy, had been exposed to
fellowship programmes for various types of addiction. All participants however, were
A.A. members. As such, discussions on emotion experience included participants’
experience with addiction and A.A., which seemed to strongly influence and permeate
their emotional lives.
From the findings it is evident that these older men have mostly evolved from the
constructs and confines of hegemonic masculinity (as a stable and trait-like component of
identity or way of being) to adopting a more malleable approach to masculinities (as
flexible ways of being). Depending on the context, however, participants may preserve or
negotiate elements of gendered constructs and, in so doing, preserve and/or negotiate
emotions in therapy. That is, interactions between gender and emotions tend to be
invariably connected (Shields, 2013). From a social constructivist perspective, gender and
emotions can be seen as fundamentally social processes and as both learned and
practiced.
5.1.1 Challenges to unlocking emotions
The findings from this subtheme show that some participants experience emotions
as vaulted and guarded or large and heavy, using typically masculine metaphors to
illustrate this. Long-term suppression of emotions, perhaps as a result of prolonged
gender-coded emotional behaviour (Shields, 2013), is said to manifest with decreased
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emotional expression (Gross, 2001) but, over time, has the propensity to improve (Ecker,
Ticic & Hulley, 2012). As Bolen (2009) suggests, anything in the psyche that is cut off or
buried is still very much alive so “may go ‘underground’ and be outside of conscious
awareness for a time, but it can reemerge or be ‘re-membered’ when (for the first time
ever, or the first time since childhood) in a relationship or in a situation” (p.14). There is
evidence to suggest, however, that long-term abstinent alcoholics have difficulty in
processing and detecting the emotional content of words, which may be exacerbated by
long-term alcohol consumption (Endres & Fein, 2013).
Of interest is that some participants who controlled and suppressed emotions
did so because of the fear that inner felt emotions would permeate into relationships and
possibly hurt others. For those with permeable emotional boundaries (Hartmann, 1991),
this might indeed have been a reality. In fact, some participants experience emotions as
having a life of their own which they describe as manifesting in fights (Longwood, 2006),
risk-taking activities such as sexual promiscuity and alcohol abuse (French, Tilghman &
Malebranche, 2014) and which tend to be exemplified through participants’ transferential
enactments in therapy (Thompson, 2014). Participants’ control of emotions seems to
relax, however, when in the knowledge that therapists, either male or female, are able to
emotionally contain their emotions in therapy, and therapists of both genders are able to
do this equally well (Pace & Sandberg, 2011).
The findings also indicate that some participants who make attempts at
understanding emotions in therapy tend to discuss emotions from a safe distance or, as
Behr (2009) puts it, from an observer position, which tends to occur in the interim when
clients are faced with direct and challenging interactional experiences by their therapist. It
is possible that the observer position helps participants to distance themselves from
feelings of shame, embarrassment and of losing independence, all associated with
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masculinity (Smith, Braunack-Mayer, Wittert & Warin, 2007), which may also be
evocative of earlier developmental experiences (Osherson & Krugman, 1990).
Some participants seem to rationalise their way through emotions, causing
emotion experience to become an intellectualised and controlled event. In some ways this
is similar to when men try to rationalise their pain before help-seeking, doing so because
of masculine feelings of invincibility (White, 2000). Another explanation for participants’
rationalisation and emotional disengagement, however, may actually have to do with
recovery approaches which encourage emotional sobriety, or the idea of not ‘giving-in’
emotionally to alcohol temptation (Herbert, 2012), evidenced by an alcoholic’s
deficiency in regulating negative emotions which cause individuals to pick up a drink
(Berking et al., 2011). Such alcoholic tendencies and penchant for immediate
gratification may be so deeply entrenched that they continue to live on and affect other
areas of life, even in sobriety.
With this in mind, the present research draws attention to some participants’
tendency to perceive therapy as a place to quickly fix and resolve problems without
necessarily expecting to explore their emotional selves relationally (DeYoung, 2014).
According to Herbert (2012), however, the idea of engaging with intense emotions may
not be suitable for some alcoholics in early recovery, and under extremely adverse
conditions emotional disengagement may actually be helpful. According to the author,
who cites recent studies by psychological scientist Gal Sheppes of Stanford University,
the use of distraction as a recovery maxim, for example keeping busy with fellowship
meetings, prayers and meditation, is one strategy for emotional regulation that is argued
to work because it acts as a buffer against allowing emotional information to enter into
memory. Other research suggests a tendency to lean towards rationality (O’Neil, 1980;
1982) because of the emotional unknown. “By becoming highly rational and tightly
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controlled, the shame of experience can be buffered from awareness and drained of its
emotional charge” (Osherson & Krugman, 1990, p.332). Perhaps participants’ tendency
to perceive therapy as a place to quickly fix problems may also have to do with what
Rollo May describes in an interview as attributable to new age psychotherapy, which
sells quick fixes and gimmicks, instead of asking more of patients and delving deeper into
their anxieties (Schneider, Galvin & Serlin, 2009).
5.1.2 Impact of convergence of shared emotions in groups
This subtheme of fellowship and sharing of emotions describes how
participants come to either listen to and/or share their emotions with others beyond
therapy, which becomes part of their emotion experience in therapy. Research shows that
men who reject traditional masculine ideology tend to show a greater need to discuss
private feelings and tend to develop larger networks with increased involvement in these
networks (Thompson Jr. & Whearty, 2004). This was evident in the present findings with
some participants feeling that emotional exposure, such as that in fellowships like A.A.,
tended to awaken and expand emotional awareness and expression of themselves and of
others and, in some cases, expand emotional vocabulary. It also seems that emotional
responses are further understood by watching others, with comfort in the knowledge that
others may feel and think in the same way. Such environments, in particular for men, are
said to provide good opportunities to model male emotional expression and all-male
groups are said to help with male identification (Johnson & Hayes, 1997). However, there
is also evidence to suggest that some men are resistant to group formats (Robertson &
Fitzgerald, 1992), similar to the present research.
The findings indicate that exposure to the concept of emotional sharing in
fellowships, is not an indicator that older men are more likely to be comfortable with it or
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become articulate speakers, neither does it mean that older men find it easier to talk about
their emotions, even in private. It does seem, however, to enable some older men to find
their own meaning and new experience through interaction with others in fellowships.
Indeed, some older men in this research continued to feel challenged with emotions, more
so in a group setting which, according to Campbell et al. (2014), may have to do with the
emotional paradox of being unable to separate self-change from experiences of others due
to over-exposure or desensitising to emotionally evocative events. Given an option, many
older men prefer talking about their emotions in personal therapy than in fellowships,
possibly because emotional expression is more permissible for older men in a private
setting (Bennet, 2007), although outcome results between group and individual therapies
seem to be relatively similar (McRoberts, Burlingame & Hoag, 1998).
A study on men’s talk and emotions showed that men do see themselves as
emotional beings, but more so in specific ‘rule-governed contexts’ when it is acceptable,
such as death (Walton et al., 2004). It must be acknowledged that the nature of the topic
may play a role in emotion experience and the ease or unease of talking (Thompson,
Devis & Louder, 2012), just as age and generational differences may make a difference to
how participants in this research may communicate (Ruffman, Murray, Halberstadt &
Taumoepeau, 2010).
It is important to mention that deficits in emotion regulation are considered a
primary motive in the misuse of alcohol (Berking et al., 2011) but successful fellowships
like A.A. do appear to encourage access to emotional depths, unlike patriarchal cultures.
According to Vaillant (2014), A.A., which tends to use cognitive behavioural techniques
as a way to teach reinterpretation of emotional events, is able to induce positive emotions
such as joy, awe, hope, love, trust, forgiveness, compassion and, especially, gratitude by
virtue of its principles.
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5.1.3 Masculine programming and positioning
The existence of different discourses of masculinity leads to the question of how
men come to identify with a particular discourse of masculinity. Positioning theory
(Davies & Harré, 1998) proposes that individuals will tend to position themselves along
dominant and subordinate discourses, creating an identity for themselves that demand
particular patterns of behaviour. Evans (2009) suggests that, “one masculinity position
will tend to dominate much of the time, particularly within the man’s private internal
world and in his closest relationships” (p.113). Perhaps this can be exemplified by the
way in which older men tend to perform gender with members of the same sex (West &
Zimmerman, 1987), as was the case in the early stages of the present research’s
recruitment process. Andy, the first participant, on his own merit recruited all seven
participants (including the pilot participant) in what appeared to be a ‘show’ of
comradeship. This is distinctly different from friendship, yet allows men to have intense
yet trivialised, non-intimate group membership (Levy, 2005). Twohey and Ewing (1995)
succinctly said that, “for men, togetherness seems to be more of an activity than a state of
being” (p.465). Consistent with continuity theory, and in maintaining continuity by
matching similar role needs in new environments (Vacha-Haase, et al., 2011), Andy’s
behaviour in rounding up his comrades can be explained as someone who continues to
maintain his (social) network after retirement. Although I acknowledge that Andy’s
pattern of behaviour may have been on-going while he was employed, it is likely that
men's groups tend to place reciprocity in help-giving as central and important to
therapeutic work (Andronico, 1996). It is also hard to ignore that Andy’s enthusiasm for
the present research (and keen participation by his comrades) may have been linked to a
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sense of having a purpose (Thompson Jr., 1994) and in feeling useful as an older adult
(Troutman-Jordan & Staples, 2014).
The present research’s findings show older men’s emotion experience in therapy
as being predicated and influenced by their subjective masculinities, the gender of the
therapist, how emotionally contained they feel, and the number of sessions allocated, as
well as therapist use of time in therapy. For the most part, these older men learned the
concept of maleness, with its gendered expectations, from a very early age, which led to
the formation of their masculine identities (Crespi, 2004). It is not the purpose of the
findings to establish where these older men are specifically located on the masculinity
spectrum (Evans, 2009) but there are reasons to suggest that as a result of many years of
addiction therapy (Satre, Blow, Chi & Weisner, 2007), the emotional stability that comes
with aging (Williams et al., 2006) and a combination of life experience, these older men’s
masculinities tend to be malleable and, as a consequence, they are able to be more
flexible to include a broader range of masculine ways of being. However, men who reject
hegemonic masculinity and adopt other ways of performing masculinity, tend to do so
with reference to the hegemonic standard (de Visser, 2006).
The findings show masculine conditioning as being so prevalent that it can
sometimes blur even objective truth, especially in the face of ill health, which fits with
Nobis and Sandén (2008) who studied links in hegemonic masculinity and denial of helpseeking with fears of dependency, vulnerability, loss of freedom and an altered body
image. But participants’ subjective masculine identities and their underlying roots in
conditioning continue to play a role in many other different contexts. In the therapy room
through transferential enactments and projections, it becomes clear that men’s emotional
world are not just framed by learned and ascribed hegemonic masculine scripts but are
actually psychically invested by them. For some older men, gender roles may have
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afforded them privilege, and accomplishment associated with that privilege while for
others such psychic investments may have negative consequences. According to VachaHasse et al., “ Working with older men requires and overt effort to acknowledge the
degree to which men themselves suffer from the expectations placed on them by
traditional socialised male gender role (p. 51). The authors, in guideline for working with
older men and in strengthening working alliance with older men, propose: 1) A multidisciplinary approach 2) Paying attention to age, gender, language use and presenting
issues 3) Engaging the client: empowering change 4) Honoring men’s developmental
heritage 5) Empathy and becoming fluent in the masculine voice 6) Reevaluating current
gender role assumptions, challenging and encouraging the client to build new learning
upon the basis of what he already knows.
5.1.4 The gendering of emotions
Shields (2000) proposed that emotions function as a gendering construct and what
is learned about emotions, or beliefs about emotions, are significant in the acquisition of a
gendered sense of self. That is, according to Shields, “gender-emotion stereotypes not
only matter in how individuals think about themselves and others, but also are deeply
implicated in how gender itself is understood” (2013, p.425). The practice of gendercoded emotional values and behaviour may also explain why, when it comes to talking
about their emotions, the majority of participants in this research preferred talking to
female therapists. This is similar to Snell, Hampton and McManus’ (1992) study where
male as well as female participants showed more willingness to discuss matters of the
heart with a female therapist but were open to disclosing sexual information to both male
and female therapists.
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In the present research, one participant explained that seeing a female therapist
allowed for a felt ability in expressing all of himself and that was seen as an opportunity
to relearn intimacy with another. Several studies have indeed demonstrated the effect of
gender on the therapeutic relationship and the outcome of therapy with mixed results
(Johnson & Caldwell, 2011; Werner-Wilson, Michaels, Thomas, & Thiesen, 2003). There
is a sense, however, that based on the nature of the presenting problem, older men are
more likely to request their preferred gender rather than accepting what is allocated to
them.
Some participants came with stereotypical attitudes about therapists’ gender
(Banaji & Hardin, 1996), for example female therapists were seen as displaying more
emotional and powerless behaviour (Fischer, Rodriguez Mosquera, van Vianen, Annelies
& Manstead, 2004; Timmers, Fischer & Manstead, 2003) particularly in not being able to
contain men’s powerful emotions in therapy. Shields (2000) suggests that stereotypical
beliefs about women may act as prompters, particularly when uncertain how to act with
regards to fuzzy concepts like emotions. Participants in this research also seemed to link
gender to competence, through the notion that some participants view female therapists as
someone they can talk to about emotional issues or use to get in touch with their
emotional side, but there appears to be undisclosed beliefs surrounding the female
therapist competency (Rees & Garnsey, 2003), rationality (Lloyd, 1979) and objectivity
in psychotherapy which, according to Stivers (1986), may be explained by masculine
models of personality theory and developmental psychology. Sweet (2012), however,
suggests, that female therapists “might help establish a strong therapeutic alliance and
make them (men) feel more cared for in the therapy hour” (p.6). According to Jones and
Zoppel (1982) female therapists tend to form more effective therapeutic alliances than
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male therapists and female therapists tend to be significantly more positive towards male
substance abuse clients than male therapists are said to be (Artkoski & Saarnio, 2012).
For certain older men, having a same-sex therapist may feel restrictive to their
sense of self-expression in therapy because being in the company of another male may
elicit the need to preserve masculine norms (West et al., 1987). It could be argued,
however, that male therapists are likely to understand masculine norms from their own
socialisation and may, therefore, be more successful at approaching therapy from a place
that already focuses on cut and dried, solution and action-oriented therapeutic goals
(Sweet, 2012). The author suggests that too much openness and emphasis on emotions
might be unsettling for men who have been taught that their emotions are to be kept
inside at all costs.
In the findings of the present research, older men were also seen to make
judgments on the competency of female therapists based on her appearance and attire. In
fact, a few participants made direct links between the informal behaviour of their
therapists and their therapeutic competence. This seems congruent with how people rate
well-dressed individuals, for example someone in a tailor-made suit is perceived as being
more confident, successful and flexible compared to someone wearing a high street
equivalent, even if the impression is actually unfounded (Fletcher, 2013).
5.1.5 Therapist’s containment of older men’s emotions
The findings indicate that emotional containment in the form of therapist
competency such as listening, neutrality of the therapist, being able to hold and contain
emotions in the sessions and the therapist’s ability to make older men feel safe are
important for participants. It was felt that a certain quality standard of therapist was
expected from the National Health Service (NHS), with a preference for formally as
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opposed to casually held sessions. For half the participants, however, therapeutic
competence seemed to take priority over who their therapists were, where their therapists
originated from or what their respective religious backgrounds were. It is likely that when
participants refer to therapist competence they mean “the extent to which a therapist has
the knowledge and skill required to deliver a treatment to the standard needed for it to
achieve its expected effects” (Fairburn & Cooper, 2011), hence assessing the therapist’s
capabilities in providing an acceptable level of treatment.
The findings also reveal that emotional containment in therapy is facilitated by
how safe and contained older men feel in a non-judgmental environment with a neutral
therapist. While trust does take time to establish, it is essential to remember that it
emerges from the client-therapist interaction. Good and Robertson (2010) suggest that
when men do decide to attend therapy the second challenge is getting them to trust
therapists enough to openly share their presenting problems. The authors list gendered
beliefs and fears of men in therapy as: when they are mandated or coerced to seek help,
they feel powerless; if they don't trust someone they don't know, then they feel they won't
be let down; their problem could be worse than they think; it is embarrassing to
acknowledge a problem.
Another finding in the present research relates to the therapist being able to
facilitate therapy in a way that allows participants to retain their sense of autonomy. In
fact, research shows that autonomy motivation or experience of client participation in
therapy as a freely-made choice is a better predictor of outcome than therapeutic alliance
(Zuroff, 2007), notwithstanding respect for the client's right to be self-governing as a
fundamental ethical right.
The findings indicate that the number of sessions allocated and the use of time
within therapeutic sessions are integral to the process of emotional unfolding for some
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participants. In fact, the number of sessions allocated seems to directly influence how
much participants can and are willing to share of themselves. In addition, it is felt that the
number of sessions allocated should be sufficient to cover problem-solving, building of
trust and rapport which are felt to facilitate emotional unfolding. Participants also
stipulate the need for a therapist who takes time with them.
5.1.6 A Transformational Journey
The findings established participants as being adaptive to their older age and
falling, as it were, out of the Procrustean bed (Bolen, 2009), the stereotype of what a man
is expected to be, and that older age tends to bring with it the idea of caring less about
what others think. As these older men move away from traditional masculine norms there
is a tendency for a few participants to develop awareness and knowledge of the masculine
self as being made up of a journey of experiences, and the autonomy of choosing the
myriad of available responses to them, which does not exclude experience of cultural and
normalised up-bringing. For some participants, therapy is helpful in encouraging the
awareness and facilitating courage in becoming the kind of man they can and want to be,
though the idea of simply being human is also advocated. Additionally, a number of
participants related the importance of staying present/conscious, alive and committed to
embracing an existential living. Rogers (1951) subscribed to the idea of the human need
to self-actualise, or fulfill their potential. He believed that self-actualisation occurs when
the “ideal self” of who a person would like to be, is congruent with their actual behavior
or their self-image. Rogers believed that people who continually work on becoming
actualised, as some of these older men in sobriety clearly do, eventually evolve to
become fully functioning individuals.
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Loevinger (1976) also posits an ego development theory of human potential that
propels development and influences the way individuals think, feel and act, which rings
true for some of these participants who have continued to work past the age of retirement.
Truluck and Courtenay (2002) also outline a trend towards higher stages of ego
development up to the age of 74, which they postulate as being due to generational
factors such as having been brought up at a time when individuality was valued and
expressed. Importantly, education levels in Truluck’s study were shown to be statistically
significant in ego development, even into later years. That is, human beings have the
capacity to learn, be flexible and adapt to change. As Bolen (2009) writes:
“If a boy or a man tries to conform to what is expected of him, at the cost of
sacrificing his connection to his own truest nature, he may succeed in the world and
find it meaningless to him personally, or fail there as well, after failing to keep faith
with what was true for him. In contrast, if he is accepted for who he is and yet he
realises that it is important to develop the social or competitive skills he’ll need, then
this adaptation to the world is achieved not at the cost of his authenticity and selfesteem but helps to round him out” (p.11).
The findings show participants as describing the process of awakening emotions
as a spiritual journey. Of consideration is that since all participants are members of the
A.A. fellowship, it should be recognised that A.A. has spiritual foundations attached to it,
especially its belief in a ‘higher power’, or God, which is not necessarily linked to
religion. Nonetheless, the transformative experience adds a positive and impactful
dimension not just to older men’s personal recovery but in how they experience their
emotion in therapy.
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It is unlikely that participants can have a spiritual transformation without first
having an emotional one. This idea is perhaps congruent with Vaillant’s (2008)
proposition as he argues that spirituality is directly linked to positive emotion and social
connection and that positive emotions such as “awe, love (attachment), trust (faith),
compassion, gratitude, forgiveness, joy and hope” constitute what is meant by spirituality
(p.1). He argues that this aspect to emotion has been ignored by mental health
practitioners because of the tendency to focus on negative aspects of emotion which are,
“all about me ” as opposed to positive emotions which “free the self from the self” (p.5).
Vaillant suggests that spirituality, like positive emotions, is generated by the limbic
system and positive emotions as well as negative emotions can be viewed from a
biological or evolutionary stance. Vaillant succinctly says that “spirituality reflects
humanity's evolutionary press towards connection and community building even more
than it reflects humanity's need for solace and revelation” (2008, p.14).
It can be concluded that emotion experience in therapy is contingent upon and
varies according to where these older men tend to be located in terms of their
masculinities and whether they feel emotionally contained in therapy, as therapist
competence, gender and elements of time all seem to play a role in whether older men
preserve or negotiate themselves in therapy. Perhaps it is also important to consider
where each man is at, in relation to their sobriety and recovery process and the level of
social support that is received (Van Lear, Brown, & Anderson, 2003). The next section of
this chapter outlines the clinical significance of this study, methodological reflections,
clinical implications, implications for Counselling Psychology, and personal reflection on
the research as a whole. It also presents suggestions for future research with older men.
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5.2 Significance of the research
This research provides an important contribution to older men’s emotion
experience in therapy, with added contribution to knowledge gained from this unique
group’s experience in recovery. Searches on the literature have shown neither published
IPA research on older men’s emotion experience in therapy nor IPA research on older
men in sobriety and their emotion experience in therapy. The idiographic nature of IPA
has truly enabled the voices of older men to be heard, especially in light of the ‘minority
status’ of older men. Of course, the research becomes more significant in light of the
increasing older population yet alarmingly low rate of older men as service users of
IAPT. As such, this research appears to research a topic that has not been addressed and
provides the first qualitative analysis (of any sort) on the emotion experience of older
men in therapy.
5.3 Methodological reflections
As a novice to qualitative research and IPA, I attended lectures in university and a
two-day introduction and analysis workshop as well as read recommended books on IPA.
In addition to regular supervision and more than twelve IPA peer review meetings
facilitated by an experienced IPA researcher, I had the opportunity to attend an IPA
conference as part of my induction into the world of IPA.
The strength of IPA was in its ability to obtain specific, rich, in-depth accounts of
older men’s experiences, which were carefully and rigorously analysed through an
iterative process of looking at the parts and the whole, cross-analysing and reviewing the
entire process several times to ensure interpretations were grounded in the accounts. This
also served as a means of improving the rigour of the research. Quality and transparency
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of the analysis was supported in the form of two audits by university supervisors and an
external IPA expert, as member-checking was deemed unnecessary.
The pilot study brought to light the necessity to be more aware of my time
management as the pilot interview extended to slightly over two hours. Secondly, I
realised that the interview was fast becoming a therapeutic session, mainly because it
explored the topic of emotions and my role as a researcher and therapist became blurred.
Subsequently, in actual interviews I clarified my role and read out and handed
participants printed information about who to contact in the event the interview brought
up unresolved issues and they needed to talk to someone. The pilot study also enabled me
to improve on my interview techniques. I also took the opportunity to conduct an analysis
on the pilot study, to trial IPA methods. This was also discussed with peers.
IPA as a methodology made researching enjoyable, as I was able to be creative
with how I collected information about participants. I created six separate dossiers, one
for each participant, containing typed and hand-written reflective notes and used colours,
charts, tables and different shaped stickers to code each dossier. In addition, I used the
private space of my study, observing confidentially and anonymity, to pin master themes
and subthemes on a wall. All of these were useful in establishing a clear picture of
accounts and kept me focused and grounded in the work.
Difficulties occurred when, through a snowballing approach, all participants
individually declared that they were in recovery, ranging from 3 years to 28 years and
that all were, in addition to therapy, active members of fellowships such as A.A., D.A.
and S.L.A.A., but this only came to light after the seventh interview (including the pilot).
In communication with supervisors, and being aware that I had originally intended to
recruit older men who simply had engaged in therapy, I was advised to either continue
interviewing older men in sobriety or end the recruitment process. I was determined to
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continue with the process of recruiting but after a lack of response over several months, I
attempted to reach participants beyond the U.K., but to no avail. Eventually, I settled for
the six participants, in part because of time constraints. This sample size of six, which
although may be interpreted as small, enabled a level of thoroughness and ensured that
each account was given the attention it so rightly deserved, thus meeting the idiographic
commitment of IPA (Smith et al., 2009).
The problem with IPA is that it relies on the representational validity of language
unlike discursive methodology where language can be used to recreate and reconstruct
realities as opposed to providing a direct description of them (Willig, 2013). That is, the
researcher’s interpretation is but one of many possible interpretations. In trying to stay
close to the descriptions without creating or encountering gaps, I managed to work on
parts of the research over the course of the three year study and in the last seven months
was fully engrossed in reviewing transcripts, working on the analysis and its iterative
process seven days a week. Further limitations to IPA is discussed in the methodology
chapter under section 3.6 of limitations of the IPA approach.
In terms of validity, all participants had recently completed therapy, as was the
prerequisite to this research. It is acknowledged, however, that the impact of participants’
experiences may be difficult to capture through their descriptions with the passing of time
and due to some participants’ inability or avoidance in talking about emotions.
Furthermore, emotions of men in sobriety may be harder to capture because of emotion
regulation difficulties that tend to be associated with alcoholics, even after a period of
sobriety and therapy (Berking et. al, 2011; Dvorak, et al., 2014). Furthermore, by nature
of emotions not being directly measurable, this leaves room for a broader notion of what
reports of experiences can illuminate (Frijda, 2000). Also, the extent to which and how
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language is used can represent many different things to oneself, and to others, on what
emotion experience is and what it means.
The question of whether emotions can be accurately retained and recalled
warrants an understanding of how emotions are stored or retrieved from memory. In one
study, Levine (1997) found distortions in memory of emotions when recalling past
emotions as a function of changing appraisals, but current appraisal of events were more
likely to be accurately recalled or overestimated. Any discrepancy in what was originally
or previously experienced emotionally and what was recalled about emotion experience
in therapy would thus bear an effect of discrepancies in remembering the circumstances.
Some researchers propose human episodic memory as facilitating the conscious
re-experiencing of specific personal events from the past (Tulving, 1983), others evidence
an ability to recall circumstances, especially those related to emotions such as disgust and
sadness, and the recollection of circumstances seems to reinstate emotional feelings
(Strongman & Kemp, 1991). More recent research advocates a unique memory
for emotions (Saive, 2014), but there is also the issue of false memories which can be
implanted into people's minds (Wessel & Wright, 2004). As a researcher, in wanting to
know about the experiences of older men’s emotions in therapy, I am also reminded not
to mistake the account of the experience for the experience itself.
5.4 Clinical implications
This research, with its small sample group, is not intended to represent all older
males rather it takes into account the unique and subjective ways of being of each
participant studied. The above studies do suggest some within-group and across-situation
variability in older men’s emotion experience, and under what conditions they feel
comfortable in exploring their emotions. However, there were more similar than
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conflicting themes across participants (Appendix 9) especially in the malleable quality to
older men’s masculinities.
The older man’s sense of his masculine self, which as a learned construct, tends to
determine his emotion experience in the therapeutic encounter. Masculinities may be
further shaped by a cohort effect, early experience with therapy, attending recovery
programmes, life experience and circumstances or a combination of all of these. The
outcome of each experience then, tends to be varied, with some men preserving,
negotiating or continuing to expand on masculinities depending on the context, making it
a dynamic and subjective experience which means their masculine ‘positions’ are
transitional or, as Evans (2009) stipulated, have a “strong temporal component” (p.114)
and can be worked with for a positive outcome in therapy. This is also in response to
strength-based approaches or positive dimensions of masculinity (Englar-Carlson &
Kiselica, 2013) and the influence of context and cultural dimensions in defining strengthbased ways of understanding and working with male clients. Such an approach aims to
capitalise on men’s strengths and virtues, in creating an optimum setting to accommodate
older men’s masculine positions even if temporal.
Counselling psychologists should be mindful that although these men all had a
traditional male upbringing, and have all been exposed to sharing of emotions in
fellowships and personal therapy from an early age, some of these men continue to
experience challenges in opening up to their emotions, either because of having to
conform to normalised expectations of masculinity, deficiency in emotion regulation due
to years of alcohol consumption or because the topic of discussion that simply makes it
difficult to do so.
Counselling psychologists should, therefore, help older men to realise that
communicating their problems and concerns does not compromise their masculinity
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(Yousaf, Popat & Hunter, 2014). Nonetheless, while acknowledging that older men are
generally physically and psychologically diverse from one another, the problems that
they bring into therapy are significantly different to those of younger men. Older men are
more likely to experience events that affect emotional well-being such as retirement,
lower socio-economic status, onset of illness or disability, loss of sexual prowess, loss of
strength, separation from a loved one, bereavement and loneliness. Although suicide rates
in males aged 75 and over are lower now compared with historic levels (ONS, 2011),
counselling psychologists should still pay close attention to this neglected group.
Although participants had been exposed to emotional sharing in recovery
programmes, many continued to feel uncomfortable with the idea of ‘exposing’
themselves in group scenarios and, for some, even in the privacy of personal therapy.
What is apparent, however, and relevant to counselling psychologists is that exposure to
recovery programmes has the propensity to awaken and expand emotional awareness and
expression amongst participants as they offer opportunities to expand emotional
vocabulary, which is useful for emotion articulation in therapy. The idea, perhaps, is to be
patient with older men and their emotions and allow for them to take their time in
expressing emotions, especially since men are taught not to feel or express themselves, or
they have feelings but do not know how to describe them (alexithymia), or know what
emotions they feel but are reticent in expressing them for fear of feeling embarrassed.
5.5 Suggestions for future research
Of utmost importance is adding to the modest literature in Counselling
Psychology pertaining to older men. In getting to know this population, it would seem
necessary to understand help-seeking behaviour such as willingness to express emotions
in therapy, which may help to reduce the underutilisation of mental health care provision
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by older adults (Garrido, Kane, Kaas & Kane, 2011). Future research can also help
illuminate older men’s attitudes towards masculinity, which vary according to their social
context and type of relationship involved (Levant et al., 2003). Older men are known to
benefit greatly from psychological treatment with measurable improvements to their
mental well-being (Wilkins & Kemple, 2011). In addition, the service pathway can be
better researched in order to understand and remove potential barriers in accessing
services.
Furthermore, it is important to conceptualise older men’s feelings and experiences
surrounding their mental health with contemporary thinking and empirical support, in
particular where so little is known about older men who are already engaging in
psychological help-seeking (Commission for Healthcare Audit and Inspection, 2009;
Kosberg & Mangum, 2002; Mackenzie, Gekoski & Knox, 2006).
Future research may also explore quantitative learning regarding differences in
experience of emotion expression between older men in general and older men in
sobriety. Such knowledge may shed light for counselling psychologists on the
relationship between such variables as deficits in emotion regulation, aging and alcohol
consumption. It would also be useful to analyse emotional scripts for older men in
therapy, similar to emotional scripts for men as researched by Mahalek (2003). Of
interest would be research into comparisons of the differences between older and younger
men’s emotional scripts, particularly in a changing environment. Of further interest
would be research into comparisons between the emotional regulation of older men and
emotional regulation of older men in long-term sobriety combined with therapy.
Research could also focus on the types of therapies that work best with older men
in sobriety. Psychodynamic therapy appears suitable for clients in recovery who are
stable and receptive to a higher level of self-knowledge and who are at the right stage in
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their readiness for treatment (Center for Substance Abuse Treatment, 1999). According to
a review by Longabaugh and Morgenstern (1999), numerous studies have failed to
identify specific cognitive-behavioral coping-skills training (CBST) components that
could account for the treatment’s effectiveness. The authors propose, instead,
incorporating components of other treatment approaches. Such research can add to the
understanding and speed of recovery from substance addiction and establish frameworks
that will restore normalcy after dependence.
5.6 Implications for Counselling Psychology
As Counselling Psychology is concerned with the integration of psychological
theory and research with therapeutic practice, this research offers a unique insight into
how older men experience their gendered emotions in therapy, how masculinities are
sometimes performed in therapy and how emotions and gender tend to form a related
construction. It also highlights older men’s relational styles in therapy with a view to
enhancing professional practice (Kasket, 2012). As such, this research provides a rich and
descriptive account of emotion experience from two perspectives, older men in therapy
and older men in sobriety who are active in recovery programmes.
The research fills a gap in the Counselling Psychology literature, especially in
view of the ‘rare sighting’ of the older male population (in therapy), which results in
them tending not to be a well-investigated population. This research also adds to the
limited knowledge and insufficient training of counselling psychologists when working
with older men’s issues (Lievesley, 2009; Myers & Harper, 2004). Practitioners and
trainees have been known to have less favourable attitudes towards working with older
clients as they perceive talking treatments as not being as relevant for older people’s
problems and/or believe that older people are less able to develop adequate therapeutic
131
relationships (Helmes & Gee, 2003). In addition, practitioners may have insufficient
gerontological knowledge and, therefore, lack competence (Lee, Volans & Gregory,
2003; Richards et al., 2013; Rosowsky, 2005; Zank, 1998) or they may possess negative
counter-transferential feelings about the idea of ageing or see older people as incapable of
change (Morgan, 2003). Ageist attitudes and the general lack of interest in older people
have significant implications for the education and training of counselling psychologists,
as does the amount of research currently generated and the extent to which counselling
psychologists are able to understand this age group.
Emotions are an important clinical phenomenon that is very much central to the
process of Counselling Psychology. Emotions help shape and organise experiences and
interactions with others and are active agents of psychotherapeutic change. It is essential
that counselling psychologists learn how to skillfully engage and work with older men’s
emotions, in particular where emotions may be controlled, suppressed or guarded.
Furthermore, once in therapy, trust, bonding and perceptions of treatment helpfulness
tend to be more important to future help-seeking intentions than a man’s difficulty or
discomfort with emotional expression (Cusack, Deane, Wilson & Ciarrochi, 2006).
As feelings represent the subjective experience of emotions, and emotions are
learned reactions to situations, this research offers an opportunity to understand the array
of themes, similarities and differences in older men’s emotion experiences and how best
to attend to and work with them, including the tendency to retract and restore their
feelings of autonomy even though they have reached out for help (Addis & Mahalik,
2003).
From the research it appears evident that the engagement of therapy complements
recovery programmes by extending the effects of professional treatment. That is, where
older men may feel unable to voice their emotions in groups, they is the opportunity to
132
explore feelings in the privacy of one to one therapy. Furthermore, the programme of AA
is not designed to take on board all the other issues that alcoholics may have.
The methodology of IPA facilities these voices to be heard against theories that
tend to only tell one side of the story. In the background of older men’s masculinities that
are continuously expanding and changing, a one-size-fits-all theory may not be sufficient
to learn about the subjective experiences of older men and their emotions in therapy. As
this research shows, emotion experience is a meaning-making activity of the older male
as an individual and as part of their subjective world, involving content-rich events that
illuminate behaviour that is different for every older man. From a Counselling
Psychology perspective, such knowledge is crucial in ensuring that older men are best
supported and not treated under the umbrella perception of the elderly who are too stuck
in their ways, or whose usefulness in life has expired. Just as older men’s ways of being
and doing masculinity are changing, counselling psychologists need to reflect and keep
up with older men. What is apparent from this research is that older men want to continue
working and having a future but, equally, are aware of living and staying conscious in the
present which can add to the outcome in therapy. Finally, it is hoped that GPs, as a
trusted source, will begin to make more recommendations to include Counselling
Psychology as part of the older man’s healing process and, in so doing, tackle some of the
stigma associated with help-seeking.
This research also adds value to the way institutions invest in the mental health of
older men and how Counselling Psychology hubs for the elderly, community counselling
centers and old age charities can customise outreach efforts, in particular for older men.
133
5.7 Personal reflections
This thesis was an important undertaking to add to the lack of literature and
attention given to older men. As such, I was conscious of my need to give older men a
voice, and in the deep reflection process, had begun to ask myself about the male voices
emanating in my own life. What came to the fore was a memory of my late father when I
was aged seven. We were caught in the confines of our car with bad traffic, a heavy
downpour and a flooding of water seeping and rising in the car. I recall desperately
needing to go to the bathroom and my father turning around to hand me his rather
enormous shoe. The shoe was taken because in my mind at the time, father knew best and
what father said was always adhered to. Furthermore, being born into an Asian
patriarchal country and family, women tended to be subservient and simply did as they
were told. My father’s shoes had taken on a whole new meaning as I became aware that it
stood for me as something masculine, powerful yet containing. Growing up, I recall
occasionally putting my feet in his big shoes. But as the years went by, I became
increasingly challenging as a teen and found myself acting out in rebellion to most things
that were mandated to me. I once over heard my father saying I was, “too big for my own
shoes” and for a long time pondered about the irony behind the very shoe he had himself
handed to me. But the irony continues as I find myself putting my feet into the shoes of
my participants as older men and earnestly try to bracket my own upbringing, which
proved to be challenging. Hence the reflective diary, as a means to checking myself
during participant’s retelling of accounts and in their interpretations.
I began to ask myself if there were other things that were likely to stand in the
way of getting close to the data and made a concerted effort to note these down too.
Coming from an Asian country, all older men were considered as “uncle”, and all older
women “auntie”, respect being automatically granted with age. Older age was indeed
134
revered and care was taken to ensure the aged remained comfortable and taken care of by
their families, never to be placed into a home or a care center. Being female also meant
that we spoke less, did all the household chores and were not really expected to gain
employment, let alone a career. What was expected was that I was able to cook, learn
how to stitch and be in preparation for the roles of wife and mother. Being the youngest
of three girls, I had the advantage of watching the women in my family conform to such
expectations without much joy. My own curiosity and ideas of ‘being’ overtook any
notion of what everyone else wanted me to be. And perhaps the shoe that my father
handed to me was indeed an offering to challenge the status quo.
The one nagging thought throughout was whether I had enough data to support
the thesis question, even though all participants were verbose. The next nagging thought
was how I was going to select themes because everything seemed so important and there
wasn’t enough word count to tell the whole story. In the end however, such that the
process is painstakingly iterative and with advice from IPA supervisors and peer groups, I
was able to collapse themes, feeling confident that they were a good interpretation of the
phenomenon researched.
The pilot study was a good opportunity to iron out any confusion between my
role as a researcher and my role as a counselling psychologist and all subsequent
interviews were managed with that in mind. I found that my work placement with older
individuals helped me substantially, although in those two years I only had the privilege
of counselling one older man. I wondered also if the fact that I was a doctoral trainee,
and/or if my gender and appearance affected how participants responded to me during the
interviews, but I felt that all participants were comfortable and open in talking, possibly
because of the privacy of the interview environment. I also wondered if age made a
difference to the interview process and to responses, as there was about a twenty to thirty
135
year age gap between myself and some of the participants. It was possible that these older
men may have wanted to impress upon me their accommodating nature, and also very
likely that they were trying to help a fellow fellowship friend of theirs out. Nonetheless,
there was a sense of deep privilege and gratitude in being able to listen to and share in
their world, with the hope I was able to succinctly and accurately interpret their
experiences.
136
Chapter 6. Conclusion
The current research explored older men in sobriety, who were in AA, and who
described their emotion experience in therapy using a semi-structured interview
approach. Several important aspects that may be useful for mental health professionals
who intend to work with older men were identified. First, depending on their ascribed
masculine identities, many older men, found emotions difficult to access in therapy. They
experienced emotions as being controlled, suppressed, guarded and difficult to access.
Second, older men may attempt to control emotions by drawing a line between their
experiences of internal pain and preventing it from crossing over externally and hurting
others. Third, some of these men may be willing to discuss emotions but from a safe
distance, or they may try to understand emotions by attempting to rationalise them.
Fourth, some older men may have stereotypical attitudes about therapists’ gender and
may adjust their behaviour accordingly. Sometimes, they may even feel that their
emotions may be too powerful for female therapists to manage. However, older men may
intentionally seek female therapists to help them resolve certain issues they have, that
they would not otherwise have seen a male therapist for. Fifth, there is a need for older
men to feel emotionally contained in therapy, as a way to facilitate emotional unfolding.
Some of these men were able to successful enact emotions of past events in therapy.
Finally the research showed that some older men find the emotional process to be a
spiritually transformational one, which in itself, may be connected to the spiritual
principles of A.A.
Older men in this research have long since departed from hegemonic
masculine ways of being and have in the process, journeyed many emotional miles. These
are extraordinary men with a myriad of rich experiences, including many years of
137
investment in therapy and conviction and faith in attending recovery programmes. Their
journey has not been without challenges, for many continue to experience difficulties in
undoing learned ways of ‘doing’ emotions and a past with a lifestyle of numbing
emotions with the anesthetic of alcohol. For these older men, however, the active
determination in restoring normalcy after dependency and the openness to new ways of
being has given them the opportunity to lead more positive, healthy and fulfilling lives.
One day at a time.
138
Appendices
Appendix 1
Recruitment Letter
Appendix 2
Participant Consent Form
Appendix 3
Debrief Letter
Appendix 4
Semi-Structured Interview Schedule
Appendix 5
Letter to Place Poster in Premises
Appendix 6
Recruitment Poster
Appendix 7
Example Participant Transcript “Andy”
Appendix 8
Table of themes for Andy
Appendix 9
Cross-Analysis Recurrent themes
Appendix 10
Reflexive Interview Questions
Appendix 11
Reflections on Data Collection
Appendix 12
Reflections on Data Analysis
139
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