Working with Young Males in Psychotherapy:

Dr Miles Groth

Implications of the Findings of Boyhood Studies

Dr Miles Groth discusses his approach to, and experience of, working psychotherapeutically with young men aged 4 to 24.

The New Boyhood

Boys are now among the most challenging groups with whom we work as psychotherapists. During the past two decades, boyhood has received special attention, and with good reason: boyhood is being radically redefined. As a result, the number of vulnerable boys who require our attention and care has increased significantly. Some of them are just entering kindergarten; others are graduating from high school or college and manoeuvering their way in a world of work that has increasingly fewer places for them; a decreasing number are in graduate school. Ever more are disconnected, disaffiliated and adrift. We witness a group who often make the astonishing claim that they do not feel welcome among us. Some do not articulate it this way, but they indicate it in their actions. Especially disturbing, we see more and more boys who by age fifteen have lost the kinetic playfulness and saying-by-doing typical of boys and young males. Many wander on in an odd, constricting, dimmed-down atmosphere that engulfs them for another decade. We often find that, no matter how long our reach, we cannot touch them.

The features of traditional boyish behavior still make their appearance at about age four when the differences between the sexes register with males but the boy as pre-gender trickster has often been tamed. Given the earlier average onset of puberty at about age twelve, one might suppose that boyhood ends sooner, yet for want of significant and decisive rites of passage, male adolescence has effectively disappeared, replaced by an extended period of boyhood. No longer children, males in the second decade of life are not busy consolidating their identity, the mark of the adolescent passage, as they once did. Very apparent to casual observation and evident in the media, boyhood now extends into the early twenties, when a ragged tear finds young males suddenly dropped off at the curb of a world where they are expected to assume the “elusive status” of manhood.

The behavioral manifestations of the new, two-decade-long boyhood are by now well known and have been documented by clinicians, educators and journalists: lack of commitment to projects and pastimes that once were satisfying to boys; aimless movement from one distraction to another; sullenness, withdrawal and isolation—the Western version of hikikimori which finds an alarming number of Japanese boys staying in their rooms for weeks or months at a time; an alarming increase in the number of suicides at ever earlier ages (4-6 times greater than that of their female age-mates); outbursts of aggressive behavior directed at individuals, especially those representing our major social institutions, the family and school; if attending an educational institution, lack of engagement in learning and a resulting failure to attain literacy; and numbing bouts of abuse of alcohol and both licit and illicit drugs. Such retreat into chemical solipsism is now often iatrogenic; Ritalin, as often as marijuana, is a boy’s introduction to drugs. In the college years, he grinds up the tablets he has been prescribed for more than a decade to dampen his behavior and inhales their contents. This he washes down with beer and tops off with a joint. We hear accounts of experiences of depression, hostility, feelings of rage that cannot be articulated, confusion, lack of motivation, and an almost schizoid retreat into worlds of fantasy mediated by video games and online diversions.

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Boys no longer “will be boys.” More and more, the cliché does not at all apply. In fact, we are relieved if a young boy’s dearest possession is his skateboard, yet he is now often closest to the cyclops of his computer. He may lift weights alone in his parents’ basement or strum his guitar. His emotional outlets are often limited to anger. With decreasing numbers playing organized sports, a boy’s generous physical energy may find an outlet exploding in a rave, playing in a rock band, or enacting backyard wrestling scenarios. Boyhood ends not by being transcended in initiations or symbolical rituals but by being forced underground still very much alive. Typically, this occurs when a boy leaves school, whether early or late. The creature we see then – sometimes inaccurately called a boy-man – is in fact no part man, however. This status has been made even more problematic by the fact that in the past thirty years definitions of manhood have changed in ways that even fully grown men of the past two generations have not been able to understand and accommodate. We cannot expect our boys to fathom what no one can say they are to become.

Understanding the new boyhood is the work of boyhood studies, a discipline barely a dozen years old. At this point, we have only a few hints to help us understand the new boyhood and there is much work to be done. But the new boy is here and he needs our attention. Thymos: Journal of Boyhood Studies, the first source of scholarship on the theme is, like the youngest boy, only four years old. Many of the issues mentioned above are being addressed in its pages, which the reader is invited to consult. As clinicians we cannot wait for the outcome of years of research into boyhood that lie ahead but must do the best we can with what we understand to meet the real and present conflicts boys experience which bring them to our attention.

Working with Boys

As psychotherapists, we are often asked to do something when we do not know what to do. That has always been part of the unique charge of our calling, but it is especially poignant when we work with boys, who require that we be something to them that will make a difference and allow them to come to recognize their own inner resources available for emotional growth. I will briefly discuss what I take to be several essential characteristics of the psychotherapist who would work effectively with boys. This is only a short list. I will conclude with a case vignette to illustrate the approach I take.

Characteristics of the Psychotherapist Working with Boys

The psychotherapist working with boys age four to 24 will be male. He will be perceived as accessible, intimate and boyish. He will be light-hearted, playful, and tactile—and non-interventional.

Children of both sexes will probably always work better with female psychotherapists, but it is my conviction that in the dramatically changing gender landscape where the new boyhood has appeared, when a child begins boyhood he will respond only to a male psychotherapist. This is because his therapeutic encounter will be with the boy in the psychotherapist and the therapeutic alliance will be based on a relationship with that part of the psychotherapist’s personality. The therapist’s own boyhood must be authentically available to the client; it is the other side of the bridge that makes him accessible to the boy. Not disavowed by the psychotherapist, his own boyhood will draw the boy to relate to him much as he might to a chum, even while the measured elements of the psychotherapist’s personality frame the therapeutic situation and provide a holding environment. A boy needs an older male’s boyhood but also his steadiness and sense of self-assurance to partner with. This does not imply that the psychotherapist will dominate the game of the therapeutic situation, but only that he will contain the boy in it. It is crucial that he not be perceived as intervening in the boy’s life, as my case vignette will illustrate. But someone must begin and end the game, and this will be the psychotherapist. The encounter must be experienced by the boy as playful, taking place in that world between fantasy and consensual reality.

Psychotherapists who work with boys must be prepared to meet a boy at his own time. Parents must be ready to bring a boy to the psychotherapist when he has reached an emergent moment of existential change, and the psychotherapist must be flexible enough to adjust his schedule to meet such moments. A boy’s world moves quickly. His sense of time is such that he lives very much in the now. We must keep pace and meet him on a day’s notice or sometimes, even sooner. An older boy must know he can call on us out of the blue. If too much time passes, we may have lost the only opportunity for meaningful encounter we will be allotted by the boy. Psychotherapists who are not willing to be called at an odd hour by a parent or an older boy in college should not work with boys. Their “demand” is not an imposition but only the requirement that we be willing to respond when the moment is right for the boy.

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Emotional intimacy with boys is strongest in an atmosphere of few words. We must be able to read the subtle signs of connectedness, since boys will not usually be able to tell us that and when we have made contact with them. The closeness they demand has a very visceral quality about it; we need only recall boys’ fondness for rough and tumble exercise and indiscriminate contact with the physical world around them. Therapeutic proximity with boys has a tactile feel, especially when we meet his gaze. We must not be afraid to make physical contact when necessary—judiciously yet spontaneously. A tall order.

With a boy in psychotherapy we sense the presence of an organism relentlessly guarding its boundaries. For boys, the therapeutic setting must be experienced as a body that is alertly poised to break their fall when necessary. We must be playful with boys. Early on, this involves things—a ball or board game. With older boys, words become our shared playthings. In general, words have greater concreteness for boys than for girls and adults. Boys relish feints and will have confidence in us to the extent to which we can anticipate their next move; they engage with us in an ambience of bluff meets bluff; they enjoy this jousting of wits. In psychotherapy, we first take the game seriously—not the boy. Eventually he will become the game, and that requires our patience. In a further phase, he allows us to take him seriously, and this is profoundly therapeutic for him. The ludic quality of psychotherapy with boys mirrors their world, in which nothing seems to be taken seriously.

Any encounter with boys that is interventional is experienced as intrusive. The psychotherapist must not intervene; instead, he must make way for a boy’s movement toward realizing his inner strengths. Such way-making is most often accomplished by means of the liberating use of humor. A boy’s wit is by turns crude and subtle. More liquid than solid (but both), it has the flexibility of mercury. Like boys themselves, a boy’s wit is inventive and often sardonic; at the same time, its contents reveal a boy’s conflicts without explicitly admitting their presence.

While having spoken only in very general terms about ways of relating to clients who are boys, I will close with a case vignette and some discussion of it in relation to what I have said about the new boyhood. The case will also illustrate some elements of my approach when working with boys.

Case Vignette: Kirk

I met Kirk with his mother after she had contacted me, reporting that he was failing several classes in junior high school. I suggested that we meet on a Saturday morning in a café midway between their home and a park where Kirk, age 14, was going to meet friends for some skateboarding. Tall and lean with dark eyes and crew-cut hair, Kirk arrived with his skateboard—and his mother. I asked Kirk about his skateboard, which he held gently but firmly between his feet and knees. He described his weekly Saturday meetings with several other boys at a well-known skateboarding site. Kirk began to speak to the skateboard, describing for me its construction and features. It was, of course, a symbol of his own body. When he opened his cellular phone to check on his friends’ whereabouts, I asked him whether it contained any images that memorialized his feats with the skateboard. He showed me an image of a friend executing a turn in the air. He enjoyed the fantasy.

By now about a half-hour had passed and Kirk was anticipating being outside, coursing along gently curving concrete surfaces with his friends. So far, there had been no talk of his school performance. Kirk’s mother eventually brought it up. I waited. Kirk complained about the teachers in two classes he was failing, detailing their perceived shortcomings, unfairness, and lack of awareness of what and how he wanted to study. He assured his mother that he knew full well what he needed to do to improve his grades, but made it clear that this was not the time—this six-week period—to do anything about it. I broke off the theme and segued into asking him about the tools he used to repair his skateboard. He quickly produced one of them from his knapsack and explained to me how it was used. Here he had competence, I suggested, adding that he had himself said he was always about improving his skills riding his board. But now we had had enough talk. Kirk made clear by his body language that it was time to move on.

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His mother got up to go to the restroom in preparation for their departure. Kirk and I would have about three minutes alone. I asked another question about the skateboard and again reminded him to have someone film him riding it. He should definitely post it to YouTube, I added, where he would then be “famous.” We both smiled at this prospect. Then I leaned in—since the other patrons around us didn’t need to hear this—and said: “You know your mother’s worried about your grades. That’s why she brought you here.” “Yea—I know that.” I closed the conversation that lasted about forty-five seconds: “By the way, I told her you’ll do just fine in school and she shouldn’t worry about your grades.” After a very brief pause, I added: “You know?” I didn’t look for a response. In fact I interrupted one by reaching for the skateboard, which was still under the table. “Does this thing have a name?” I looked him briefly in the eye.

Kirk’s mother returned, they gathered things together, I grasped his hand and forearm warmly and said: “Have fun!” Kirk led the way to the door and they were gone.


My approach to Kirk during a single session illustrates what I have said above. The three of us could have met in my office, but I chose a neutral space – neither his mother’s nor mine, neither home nor consulting room – but one that was en route to his space and an activity that was central to his experience. I let him take the lead that focused on things, performance for the sake of performance, and his interests. Talk about his skateboard and what he could do with it was, of course, talk about what he could do with his body as an agent of his experience. I did I not treat Kirk as a child. I avoided the topic he very well understood was the reason for our meeting – his school performance – although I listened to the discussion between Kirk and his mother about teaching styles that did not currently suit him and about his accomplishments in spite of perceived impediments to greater involvement and success in academics. I waited to broach the theme when we were alone – person-to-person – and I would not be perceived as an immanent ally of his mother. I addressed him, as I did his mother, about the issue of school performance while allowing him to be in a position of possible agency.

Two weeks later, I spoke to Kirk’s mother. He had not passed one of the courses but had rallied in the other. The school would require him to spend time during a break to remedy the deficiency. He was ready and willing to do it, she said with some surprise in her voice, even though it would mean missing at least three skateboarding sessions. I was pleased to hear from his mother several days later by email that he had reported to her: “That guy understands me.” I can’t say that I understand Kirk, but I do understand him to mean that I took him seriously, valued the boy in him and did not pressure him to become something that he and contemporary society seem to want him to be, without being clear about just what that is.


Miles Groth, PhD, is professor of psychology at Wagner College, Staten Island, NY. A psychoanalyst in private practice since 1980, he has contributed to Existential Analysis, the Review of Existential Psychology and Psychiatry, The Humanistic Psychologist and the International Review of Psycho-Analysis. Dr. Groth has contributed chapters in a number of books on psychotherapy, including Embodied Theories. His areas of special interest are existential-phenomenological psychotherapy and psychotherapy with boys and men.


Image: Portrait (Brothers, side-face) by


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