On and Off The Spectrum
How do families react, respond and reorganize after receiving a potentially life altering physical or mental health diagnosis, either for themselves or for someone they love? Dr. Esther Hess and Dr. Ann Kirsch, two experienced and well-known psychotherapists offer strategies, guidance and realistic hope through some of the toughest times that families can face.
On and Off The Spectrum
Where Have All The Male Therapists Gone?
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Drs. Hess and Kirsch sit down with Dr. Seth Kurzban, a community mental health social worker. based in Los Angeles, CA. Dr. Kurzban approaches this question from his own personal and professional experience and relates the way children are being unconsciously gender trained for future careers.
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Composer / Writer / Author: ROSSANO GENTILI - SIAE IPI: 161539866
My name is Dr. Anne Kirsch, and I'm Dr.
SPEAKER_00Estee Hess. It's such a pleasure.
SPEAKER_01And our guest today is Seth Kurzman. He is a community mental health social worker at UFC. And he is going to talk today about some very interesting things. I will not give it all away. I will let Seth explain to us why he's on our podcast. Take it away.
SPEAKER_02Thank you for having me. So I actually have to correct, I'm at I'm at Cal State, Los Angeles now. I left USD.
SPEAKER_01Thank you.
SPEAKER_02Um but uh yeah, uh, I was fortunate enough to uh uh meet you both. And then uh when this article came out, um which was in last week's Wall Street Journal about uh the shrinking presence of male therapists, uh SC invited me to come on and talk a little bit about um about what what I've observed in my own sort of uh journey uh in um mental health. Uh I'm a social worker by training um and have worked in community mental health for a few decades now. Um and uh and it's definitely been uh a change as I'm sure you both know as well.
SPEAKER_00Um you know, I don't know if we want to jump right in or if you want to Well, I I'll tell you what I'm curious, Seth, and thank you again for coming on uh agreeing to be on the podcast. Um first your own journey. How did you happen? You said you've been doing it, like I like to say, more decades than I want to admit, right? But um what drew you into the field to begin with? And let's hear your story, your journey, and then how you would address the fact that there are less and less men going into the mental health uh clinical practices and the impact both um professionally and then for you personally.
SPEAKER_01Yes. And I'd add one thing to that, that as a social worker, you know that uh there are many different things social workers do.
SPEAKER_00Yes.
SPEAKER_01Why and how did you end up in community work? Because that it that got my attention right away, and I think it's amazing and wonderful and needed, especially now.
SPEAKER_02Yeah. Um so uh growing up, I had a cousin who had uh serious persistent mental illness, he had schizophrenia. Um, and as many people uh who have um you know severe schizophrenia, he he used drugs, um, he died way too young. Um, and I was very interested in what you know what could be done, what could we do? Um when I got to college, uh I went to the University of Pittsburgh and they had a bachelor's program in social work, and I didn't really know anything about social work. I don't think most people, most people do growing up. It's not uh it's not a profession. You know, maybe some people have had um contact with social workers, but in general, it's not, you know, one of these glamorous, widely discussed professions, certainly not when I went to college. So uh I remember hearing um the type of work they did, and I was like, you know, this is fascinating. I mean, being able to um have a very applied approach to helping solve community problems. And um at the University of Pittsburgh, they have a great uh psychiatric hospital, the Western Psychiatric Institute and Clinic, where I got to do some work early in my career. Um and uh I just loved it. Um and then went back, got my master's and my PhD eventually. Uh, and I've been a social worker ever since.
SPEAKER_01It grabbed you. That's wonderful. I think that's what happened.
SPEAKER_02But I didn't I realized I didn't answer your question about community. Um so uh because I was interested in this population, um uh one of my one of my first jobs when I still had my bachelor's was working, as I said, at Western Psychiatric Institute um and doing community uh work, which meant largely following people in the community. Uh they had a satellite clinic in a in an uh almost entirely African-American community, and I was I was there um just just walking around in the neighborhood in the community, um, doing outreach to the clients, um uh and it was for people who had serious persistent mental illness. Um eventually an evidence-based practice called assertive community treatment came around, but the it was it was sort of that model early on, but it was really based much more with interdisciplinary team helping people in the community. Um, and that was sort of the work I liked because I think um for me personally, I wasn't I wasn't so interested in being um a therapist in an office. I was far more interested in how do we help individuals who are dealing with serious persistent mental illness um integrate into their social environment. And that's the work that I that I wanted to do.
SPEAKER_01So when you um you mentioned when you first started, I know I would imagine that it wasn't a team, became team work. Yeah. So who are the members of your team?
SPEAKER_02Yeah, so back then I was obviously the most junior person. Um, but there was usually a psychiatrist. Uh there was usually um we had psychiatric nurses, um, and we had um uh some peers who were themselves going through recovery. And it's interesting for this topic, almost all of those were were men at the time.
SPEAKER_00Um But now have you have you seen a change as you say we started off making the joke about the decades issue, but over time, and certainly in the most recent observations, what have you seen in terms of uh are men going into the field? Uh the article says no, but what is your personal observations? And do you have any thoughts as to why that could add to what was already written?
SPEAKER_02Yes, uh put to both those. So um uh there are still some men going in, but largely like I'll just give you in social work, um, and I've taught some interdisciplinary classes as well. I mean, it's it's maybe 10 to 20 percent are men. I mean, it is it is skewed far more than than the average college classes um um uh towards um female students um and and other you know genders as well. Um but but men are definitely the a a small minority. Um and uh yeah, so going back decades, I mean, you know, I think a lot of mental health and and a lot of therapy came from you know a psychoanalytic framework. Um, and all those uh founders of those movements, Jung, Freud, I mean, they were all men. Um and there was definitely a time period, I mean, you you both probably know better than I, but where almost all the therapists were men. Um it was a very, very male-dominated field. Um I have some thoughts as to to to why it's changed a little bit different than the the Wall Street Journal. Um but I think largely um in a good way we wanted to have sort of the feminization of um both therapy and care, but even in teaching, right? Like uh teaching used to have, and I'm talking about primary school, middle school, used to also be uh lots of men, uh, and we see far less men going into teaching as well. Um, and I think there was this I'm saying feminization, I don't mean that in a derogatory way, I mean that in a good way. There was an effort to have women be in these spaces. Um uh and I think there was some thinking as well that that that would be a good thing because they have different skills and these are um sort of social emotional environments where where it'd be great to have more women. So I think it was uh a good idea to have more women in therapy and schools and counseling. Um but I think the the sort of side effect of that is men started retreating from those places as the environment shifted a little bit. Um and I don't know if it was even conscious, um, a sort of a conscious decision, but it definitely is something, you know, if we just look, it has definitely occurred.
SPEAKER_01Well what is your thinking? And you also mentioned um that your your thoughts were a little bit different than the article. So can you talk about that?
SPEAKER_02Well, I don't want to I the the article, you know, I I encourage people to read, but I I I my take is a little bit more as um again because I'm not an I'm not a private therapist who's office-based. And so um so for me, just looking more largely at community settings, um uh there's definitely been uh you know, as I said, just a different different approach to try to include more women, which led, I think, to um men seeing this as maybe not right. Like so now when we think of teaching, just you know, teaching's a more clear example, but when we think of teachers, we think we think of a woman. And you know, and I again not any sort of judgment attached to that, um, but it has shifted, whereas there was a period in in, you know, where if you you know if you even look at pop culture and movies from the 50s and 60s, it's always men, male male teachers.
SPEAKER_00Right. Well, listen, when I was you know going for my PhD in psychology, the male-dominated area of psychology was always forensic and second to industrial, right? But private practice, community work was always uh you know, still very much female driven. I'm also wondering about the the financial piece if um you know that as as challenging as the clinical aspect is, does it does it pay the bills, you know, so to speak, in the context of we still whether we want to go ahead and acknowledge that men and women are paid equally and and certainly in I don't think most of the households today and and certainly in the United States can manage without a dual income. But does that impact this decision where I want to put my strengths because I I will do that just separately, I'm sorry, because I also we also teach at the medical school at at UCLA, and there are far less men going into medicine in general for those for the financial reasons. It's much easier and and faster delivery of the dollar to go into tech or banking, for example.
SPEAKER_01Right, right.
SPEAKER_00And that's profoundly different.
SPEAKER_02Yeah, and I don't know if it's a chicken egg type situation where we started have started encouraging more women in these spaces, and then the pay, right? So it was an area where women I think could enter more easily than some other jobs. But then, for example, now men see medicine used to be very lucrative, right? Now men see this is this is not as lucrative, and so they're fleeing to something else. So I don't know, I don't know what came first, if the money incentive uh drew men out, or if it was more um as more women entered, the pay became lower, or at least capped in medicine and and therapy and and teaching. Um it's an interesting, it's an interesting thing to think about though, uh, and we should have more data on on what that what that looked like.
SPEAKER_00I I uh I'm also wondering something else. In the article, they referenced that men often do better with their same gendered clinician, certainly in a one-on-one in a private practice kind of scenario. And I'm just wondering what because you you're no longer the junior fellow on on the ladder there, um how would you rewrite the social work curriculum now to encourage young men to come into the field? Because I do think that there is an enormous need, particularly because this is a tech-obsessed and somewhat emotionally cut off population that we're all dealing with. I mean, today I heard an article, a very interesting podcast about the fact that you add tech to you know to a classroom and you stop getting learning, you know. So this is this is uh emblematic of I think just a tremendous amount of need for uh emotional context. How do you go ahead and encourage young men to to you know join the field um overcoming a lot of these obstacles that we're talking about?
SPEAKER_01And I would just add one thing to that, I without I hope I'm not overwhelming you, but uh along with that, your experience you have a long experience in the field with a group that's uh all working together, male and female. Are you seeing a difference in who wants to go into that field? In do are there more men? Are there more women? I know you should probably strive to have it balanced, and also the people that you're working with, are they more comfortable with women? Are they comfortable with men? Is it men comfortable with men, and vice versa?
SPEAKER_02Yeah, uh so I'm gonna answer Estee's question first, and if I forget yours, and please um but I would I would say I think going back again into into uh it starts, I think, in elementary education or or even nursery. Um we we brought in again, not not as in a pejorative way, but women are are the majority of the teachers in that space. And I'll give you an example as social workers, um, you know, a lot of LAUSD and other school systems around the countries want to have way more social workers in their schools. And so one of the things we do is like social emotional learning, and this might touch a little bit on some of uh both of your work, but I I often tell my students, they'll they'll talk to me about you know doing social emotional learning, and I'll ask them, what about the kid who doesn't want to participate? And a lot of times they'll say, Well, they have to. And I think this gets to a big gender difference, right? And I think um boys are more likely to not want to participate and act in a way where they're not wanting to sit in the group, they're not wanting to share. And our instant reaction is, well, they have to. But it's sort of ironic because the whole thing we're trying to focus on is that you're comfortable enough sharing your feelings. And I think what happens, um, so starting at a younger age, is we're increasingly in mental health spaces and educational spaces, giving boys the message that they have to participate in a different way than they want to. And that right then and there changes the trajectory of how they can express themselves. Now, there can be arguments about if that's right or wrong, but a boy who says I don't want to sit in the circle is still communicating, right? Um, but the mental health or the prof or the teacher is missing the opportunity to hear that. And instead they're saying, no, no, you have to participate my way. Um, and so I do think there are gendered styles of communication. Um uh and they may they may lessen over time, but certainly in younger years. And I think we are consistently not letting boys express themselves in that way. Um, and I think that spills out later on in life too, as they as they progress. The message they're getting to be a teacher or to be a therapist is you have to communicate in in a certain way. And it's not including people who may be less verbal but more emotive anyway, right? Like it's not only that you have to participate, you have to participate in a very defined way, which goes against the whole idea, you know, of this social emotional and in therapy, you know, looking at nonverbal, but that's that's the the sort of model we've been following for for the last few decades for sure. Um, and I think it pushes um boys in a in a tough choice about where they feel comfortable, um, because they're consistently getting the message that when they're engaging in some of these spaces, now obviously we're we're talking in generalities, there are some boys and and young men who have no problem with that, but there are some who don't. And we're not making the space for that gendered um expression. And I think that's that that filters through through the years of both education all the way through professional school, um, where people feel comfortable. Um so I I think that's part of the part of the the struggle.
SPEAKER_01It's a very powerful observation that you're making.
SPEAKER_00So how would you change that to encourage young men to to who I think are comfortable with that social emotional intelligence, that awareness to go into this field because the field needs you. I mean, I will tell you, when I am recruiting interns, I will constantly say, you know, we need more good young men to be these like good daddy figures for the I mean, I work with an autistic population overall, and you know, for the these kiddos that I'm with, so that that and they feel good about that. They feel very complimented that they can walk in and into this very um lovely emotional role for themselves, but I don't know how much that's encouraged overall.
SPEAKER_02Yeah, and I and I I think it's it's sort of again a subconscious weeding out that we're we're saying, not directly, but indirectly through the language of mental health, through the the way we we discuss it and talk about it, that we are we are putting an expectation and sort of boundaries on what that looks like. And that looks like a much more verbal, uh I'm uncomfortable saying feminine approach, but it's definitely not um it's not, even though I don't think I think most mental health people would see themselves as very open, um, there's not a lot of uh acceptance for people who don't want to talk a lot, right? Like therapy is about talking. Um uh how much nonverbal communication, like what are the gender differences around that? What are the what are the hobbies or things men would want to do that maybe they can't do um in in schools, right? You can't play rough, you can't, right? Again, I'm not I'm not saying these are the right things. I'm just saying there is a clear um language and culture that gets that gets spread through again education and and the mental health and therapeutic worlds. Um, and you have to sort of confine confer that conform to those those expectations. And I'm just saying that it's possible that we are excluding men in particular who maybe don't feel comfortable following that that um expectation.
SPEAKER_01It's really uh very interesting hearing what you're saying. Um I think for both of us who've been in the field for a long time now, um for me, going to schools, seeing young children, watching how the teachers interact, the messages that are sent, verbal and nonverbal, um, it is striking that after 30, 40 years in the field. The messages are the same. It's the little boy who gets in trouble for talking, and the little girl does not as much. Even for teachers who are very aware, and when I speak to them separately about these aspects of teaching, um, they say all the right things. They've they know what they need to do, but they come from a time and place where maybe they were born in the 50s or 60s, and that's how they were acculturated. And so now they see these little kids, and without even knowing it, there is a bias towards how the little girl is treated and how the little boy is treated. And I remember that from my childhood. Absolutely.
SPEAKER_00Well, I'm I'm appreciative of your insight, Seth, and it is pushing this discussion into how we can sort of break gender stereotypes to begin with and expand to the advantage of really assisting in mental health mentorship. Because I do think that if you are in a situation where you're a troubled teen and you can look and see that there is someone of your gender that is reaching out and they can help you and they can support you. Obviously, it it works both ways. If there's a good female, there's a good male, okay. But the point being, if there is someone who looks like you, we had we had last uh our last session was with a wonderful uh pediatrician who was sharing that she happens to be a a person of color, and she said that her patients are so gratified that they can see someone first off, perhaps the same gender as themselves, but it's the same skin tone, uh, the same language, perhaps even the same last name. She has a common last name, and you know it it makes a sort of an automatic and and more immediate trust issue, which is kind of the basis for all further types of communication. So I'm I'm very really appreciative. And um any last words of wisdom that you would like to um share regarding your journey uh or how to encourage the next generation of uh clinical uh student entrants?
SPEAKER_02Yeah, I I mean I I think uh all of us who work in the field, um, you know, I think this article is a great jumping off point for people who weren't aware to now be aware. But I think all of us in this field have probably noticed um what we've been talking about, these sort of exodus of men. But also, you know, you read about the data, the struggles that that young boys and men are having in the US right now. Um, and I think there is a definite awareness that we need to do something different. Um, and I would say, you know, to to in terms of encouraging, I would say the very first thing we need to do is think about the things that we make us comfortable and the things that we are really asking. So in schools, we're really asking people who can comply with rules to listen to teachers versus the boy who's talking, right? So we've gotta we've gotta be aware of what makes us comfortable and uncomfortable and ask ourselves what would it take to have a little more discomfort, but a little more um representation or spaces where boys can maybe act out, um, you know, not in a bad way. I don't mean act out like a bad way, but I just mean um uh if they have more energy, if they have more talking. These are things as you pointed out that we know exist. Um uh and then in mental health too, um when you were you know you're talking about teens who are looking for young teen boys looking for mentorship and guidance, um we have to be a little more comfortable there too, with the with this comfort around um the fact that maybe they feel awkward talking to, you know, being a teenager is a tough time, right? Especially uh in your early teens, uh especially around gender and and different genders and and just um instead of trying to impose this idea that that everyone should be fine with any therapist, um, instead thinking about, you know, there's there are discomforts. Um, how can we how can we minimize clients' discomfort, even if it means expanding our own discomfort? Um uh and I think that's that's the starting point because I think um we have created, you know, I always being back to the well, I'll go full circle, being a community-based mental health worker versus a a private practice therapist. Um, I'm not working in the world where the thing that matters is how I talk and how my clients talk, which is a lot of what therapy is. And so um we need to, I think, get away from the the overfocus on verbal um communication, and we need to focus much more on social and communal interactions. Um and and that would be, I think, the place we really need to also look.
SPEAKER_00That's very nice, yeah. I I'm hoping that we'll ultimately create a kinder, gentler world, which I know we certainly uh we certainly all can use. Uh well I want to thank you. It has been absolutely our pleasure. This is Dr. SD Hess.
SPEAKER_01And I'm Dr. Ann Kirsch.
SPEAKER_00And this is on and off the spectrum. We've had a wonderful interaction with Seth Kurzman and your insights uh exceptional in terms of why men are not going into the fields of of mental health and how we can possibly turn that around. We if you if you enjoyed in terms of uh our viewership, if you enjoyed tonight's episode and would like to add your comments or perhaps to be a guest on our show, please don't hesitate to reach out to on and off the spectrum the podcast. Um and if you like us, please do follow us, please subscribe. And other than that, I just want everybody to be well and stay safe.
SPEAKER_02Yes, thank you for having me.
SPEAKER_00Seth, thank you so much again. And tonight, Dr. Cruz. Okay, please be well. Bye bye.
