improving communication with young men
Transcription
improving communication with young men
IMPROVING COMMUNICATION WITH YOUNG MEN Wayne V. Pawlowski, MSW, LICSW, AASECT IOWA FAMILY PLANNING UPDATE September 17, 2013 Approach This From Two Directions If we want guys to come to our health centers/clinics, we first have to ask ourselves, what we can do to make ourselves more welcoming of them…and thereby make them feel more welcomed !! Then, once we have them…or have access to them…we can explore how we can communicate more effectively with them. BE AWARE: I Am Going To Be Speaking In Generalities! So, when I say “WE,” I do NOT mean every one of us individually… Nor do I mean family planning programs in Iowa specifically… I do mean “OUR FIELD” in general… So, don’t take my comments “personally” (individually)…but, DO take them as a view of reproductive health-family planning…our work world; And, MAYBE you and/or your particular program. And remember, It is the generalities… the perceptions of our field that inform/influence how guys view/see us. And ultimately how they will respond to our outreach/messages. And ultimately whether they will come to our health centers/clinics or not. Fools Rush In Where Wise Men Fear To Go!!! Five Incredible Sources Of Information/Insight MARS Program, Benton County, OR Male Advocates for Responsible Sexuality Brian Dekker and Andy Chuinard And, William Pollock: Author of Real Boys and Real Boys Voices And, ABC’s 20-20: The Secret Life of Boys (video), And, Michael Gurian: Author of the Wonder of Boys And, Michael Thompson: Author of the book and video Raising Cain Typically The Question, “How Can We Be More Welcoming of Young Men?” Means: What do we need to know about them… So we can get them into our clinics/health centers… So we can provide them the services we have to offer… So we can meet our numbers… So we can increase our revenue… So we can get them to stop behaving badly. None of those things have much to do with what guys want and need… and none of them are reasons why a guy might want to make an appointment. So, The Questions Behind “How can we be more welcoming of men?” Really Should Be: Where are we? Why do we want guys to come to us in the first place? Why would guys want to come to us for services? What services might guys want that we could provide so they might want to come to us? Besides services, what else do WE need to do to make ourselves attractive to guys? How do we need to change to make guys feel welcomed, respected and that we are there for THEM, not for someone else (their partners)? I Suggest To You That Despite Our Talk… We really don’t like guys very much. We see them as “foreigners” with whom we cannot communicate. We really only want to “serve” them as a way of protecting their partners. We really only want to serve them because we have to ($). We really aren’t all that interested in THEM and THEIR needs and issues. We see them as an imposition that makes our work more difficult. They push us to look at and think about issues we don’t really want to address and/or feel very unprepared to address. They make us re-evaluate things we are comfortable with and that we really don’t have the time and energy needed to change. Lets start with what I mean when I say: “We don’t like guys very much.” Or, To put it another way, lets look at how we REALLY feel about guys. What are our real attitudes about men? But, they are good for something… Another Place Where We Get A Glimpse At Our Larger Cultural Attitudes About Males Is In The Jokes We Tell About Men And About Maleness Jokes Aside, When I Listen To Our Field, What I Hear Is That We Believe Men Are: Uninterested in family planning, Unconcerned about the things they “should” be concerned about, Uninvolved, Irresponsible, Unwilling and uninterested in communicating about relationships, UNTRUSTWORTHY!!!!!!!!!!!!!!! If we are going to have any success with male patients, we HAVE To deal with these attitudes and beliefs. We are going to have to reframe our thinking and begin to see guys in new/different ways. We Need To Recognize That Young Men: Are interested, concerned and curious. Want to know about STIs and contraception. Want to be partners in STI and PG prevention. Do not want to infect their partners. Want to be good/better partners. Want to communicate caring and honest concerns. Do not want to be insensitive. Want to be good lovers. Are “involved”…even if not in the way(s) we think they should be! And, ARE TRUSTWORTHY!!!!!!!!!!!!!!! BUT… They simply may not know how!!!!!!!!! They are likely nervous about what they do not know. They fear that if they try to do/be all of these things that they will be judged…and not kindly. They are not likely to admit to these things. The Following Two Cartoons Sum It All Up: ZITS CATHY How we can help guys open up and how we can communicate more effectively with them will be the focus of the second part of this session… …if there is time. In Addition To Jokes and Cartoons, Our Negative Attitudes/Beliefs About Males Show Up In: Our expectations of them (what we expect is what we see/get), Posters that we hang in our clinics, and, Ad images/messages that target both women and men. When I was here last time, we looked at: Advertising Images and Messages Family Planning and STI/HIV Prevention Posters and the Unintended Messages they Convey The Boy Code The Be a Man Box And the film, The Secrete Life of Boys, which gave us some tips on how to help boys open up and communicate. I am not going to repeat most of what was covered last time… Rather we will build from there. If you were not here last time that’s OK. What we are doing this AM stands on it’s own. Moving On… What do I mean when I say: We only want to “serve” guys so we can protect their partners. In family planning settings, women have traditionally been our primary clients and our primary concern. Therefore, it is not unusual for male concerns to be responded to through our concerns for women rather than directly to the concerns of the men themselves. This shows up most clearly during our interactions about: EC Unintended pregnancy/abortion What do I mean when I say: We really aren’t all that interested in THEM and THEIR needs issues. According To The MARS Program The most common question male college freshmen asked the MARS staff was… How many guys are having sex? What’s behind that question? Am I normal? Am I like other guys? Am I a “real man?” According To Michael Gurian The Top 5 Concerns Of Adolescent Males Are: 1. 2. 3. Am I normal? Am I attractive? Homophobia 1. 2. 4. 5. Fear being gay Fear appearing to be gay Sexual Prowess Penis size How Many Of These Concerns Are We Prepared To Address… Or, Do We WANT To Address? If these are the top concerns of young men, why are they not asking us about them? What are we communicating that suggests we are not approachable about these concerns? The young men who talked with MARS staff, asked about sexual prowess and being normal when they asked how many guys are having sex. Why did they ask the MARS staff and why don’t we hear these questions being asked of family planning staff (and generally we don’t)? So let’s look at some of these questions/issues/concerns and see how we tend to respond as a field. Let’s start with Gurian’s 5th male concern… penis size. Regarding Penis Size: Do You Know The Average Size Of An Erect Male Penis? If you don’t, you don’t know what most men want to know!!! And if they come to a family planning clinic they will THINK that you DO know!!! The average erect male penis is about the same size (length) as… …a Starbucks Grande Coffee!!!!! (…but not as thick) And that size is 5.877 inches. The average “range” seems to be between 5.1 and 6.2 inches And Penis Size Relates To Condom Use And Condom Use Education These two things CLEARLY fall under family planning’s umbrella. The Two Most Common Complains We Hear From Men About Condoms Are: Too tight/too small/I’m too big. Loss of feeling/don’t feel as much/like showering with a raincoat. There are others but these are the most common. So How Do We In FP Tend To Respond To These Complaints? We blow up condoms like balloons. We pull them over our arms. And we say, “No one is THAT big!!!” or “So, is size really a problem?!?!?!” We assume an “ego problem.” With loss of feeling, we respond with some version of “Well, if she is smart, you won’t be feeling anything if you don’t wear one!” By Assuming “I’m Too Big” Is An Ego Problem We Completely Miss The Point For Most Guys And, thereby we give them the message that we really are not interested in them or in their problems. The best response/reply to “They don’t fit” is: “Tell me when you have a problem.” In the absence of an ego problem, what we are most likely to hear are some versions of: Can’t get the ring of the condom over the head of the penis. The pressure of the ring at the base inhibits ejaculation. If Either Of These Are A Guy’s Concern… Our quick, flip, “ego problem” response is a quick way to shut guys down. And to make them believe (rightly?) that we really are not interested in knowing what is going on with them. With Loss Of Feeling… It IS like showering with a raincoat! YES, you don’t feel as much! But, that doesn’t mean guys can’t or won’t use them. It doesn’t help to tell them they have to use them. We have to explore the extent of the problem with them and then help them problem solve. It is one conversation if he looses sensation and takes a long time to cum. It is another conversation if he looses so much sensation that he can’t ejaculate at all. To Improve Condom Education and Condom Use, We Need to: Be honest, direct, clear, knowledgeable, and HELPFUL. Know about and recommend thinner condoms. Know how to help a guy “size” his penis for condoms. How to “Size” a Penis Check how big around it is at its largest point. Less than 5 inches, go with “snug” condoms. Snugs are 1.75 inches wide. Width is measured FLAT, not the circumference. Around 5 inches, go with “regular” condoms. Regulars are 2 inches wide. Sizing…continued Bigger than 5 inches, go with large or “magnum” condoms. Large/magnums are more than 2 inches wide. If more “headroom” is needed look for condoms that have extra headroom. What’s the simplest way for a guy to size his own penis for condoms? Use the tube from a standard role of toilet paper!! (which is 5 ½ inches around…circumference) Important Facts About Condom Strength The length of a condom does not matter. Condoms are very strong when you stretch them length-wise. Their weakness is when you stretch the width. That is why, condoms should be chosen by width. Appropriate width will increase comfort and safety. And, Of Course, Thickness: Thinner and Stronger Means… More pleasure. Better protection. The condom that is most consistently ranked Number 1 by users is (no surprise), 50% thinner than the average condom. And that condom is CROWN SKINLESS SKIN And remember… Condoms come in a WIDE variety of colors, textures, sizes and flavors. And, if you are shopping for them yourself for the first time, the selection can be (IS!!) overwhelming! LATEST INFO ON “NEW” CONDOM MATERIALS There are two new condom materials that have recently been introduced. Both are more expensive than latex and polyurethane. But by report, they are “worth the difference.” Microsheer: New “medical” polyurethane. Thinner and stronger than latex. Transmits body heat more effectively. Nonallergenic. No taste or smell, Which makes it great for oral sex. Tactylon: Thinner than latex. Nonallergenic. Stretches more easily and comfortably than latex. Also Remember, Appropriate Humor Can Go A Long Way In Helping To Talk With Guys About Difficult Subjects As we saw last time, condom manufacturers are GREAT at using humor in their advertising. We are not going to revisit the ads we looked at last time but we will watch one brief condom commercial to remind us of the effectiveness of humor. Let me say, I have NO investments in any condom manufacturers!!!!!!! So, I am NOT pushing any brand of condom!!!!!! I am just sharing a creative and fun ad!!!!!! Durex Television Ad Another Issue That Is Frequently On The Minds Of Men Is Masturbation Masturbation is an almost universal practice among American men. But many men wonder if they masturbate “too much.” Some fear if they enjoy masturbating too much it means they are gay. So, with this level of activity, this concern and this mis-information, do family planning staff ask men, single and/or married, about their masturbation habits? If not, why not? Masturbation (continued) Research suggests that the more men ejaculate between the ages of 20 and 50 the less likely they are to develop prostate cancer. So, there are good, research-based reasons for not just asking about masturbation but for encouraging it too. Yet, how many of us are prepared to talk with guys about how often they masturbate, their concerns about masturbation, and the possible health benefits of frequent masturbation? This discussion about masturbation brings us back to the point that male issues and concerns: Make our work more difficult. Push us to look at, think about and talk about issues we don’t really want to address and/or feel very unprepared to address. Are experienced as an imposition. The last point is that male patients make us reevaluate things we are comfortable with and don’t have the time and/or energy to change. Our hours, Our appointment schedules, Our posters (already mentioned), Our materials/brochures/info sheets/fact sheets/after-care information, Our whole clinic/agency environment. So, one way to start is to assess your current environment for “male friendliness.” And remember, “male friendliness” does not mean simply having Sports Illustrated in your waiting rooms!!!!!!!!!!!!!!!!!! Male-Friendliness Assessment Tool (a brief and easy tool to use/place to start) Assessment and Action Plan Assess Seven Aspects Organizational Support Position and Reputation in the Community Agency Policies and Procedures Staffing/Human Resources Services Physical Environment Communication and Interaction Action Planning: Short and Long Term Actions to Take You have a copy of the Male-Friendliness Assessment Tool as one of your handouts. Once you have done an assessment, as part of your action plan you should look at the services you provide. Because in the end, that is what guys will be coming for. And that brings us to the question: What do we mean by “comprehensive male services?” Guidelines for Male Sexual and Reproductive Health Services (Region II: 2009) Screening Health Promotion/Education and Counseling Clinical Diagnosis and Treatment Guidelines at a Glance These Guidelines Are Downloadable On-Line At: http://www.cicatelli.org/titlex/downloadable/guid elilnesformalesexualreproductivehealthservices.pdf A couple of last points/ things to think about: To Be Long-Term Successful at Providing Male Services You Have Too Look Inside FIRST Some staff may need to be told and/or periodically reminded that “Being Welcoming Of Men” Does Not Mean Being Less Welcoming Of Women!!! In An On-Going Way Staff Attitudes and How Attitudes Influence/Impact Communication and Interactions with Clients HAVE TO BE ADDRESSED!!! If you want guys to feel welcomed in your clinics/health centers… you can’t ignore negative attitudes/feelings on the part of new staff or existing staff. These attitudes HAVE to be addressed... and not just by supervisors, but by colleagues/peers as well. Lastly, Remember: As yet, no one has solved the question: “How do we get more guys into our health centers?” There are and have been lots of interesting outreach efforts…but so far, no effort has uncovered the “magic bullet.” So, you are not alone in this struggle. BUT, SO FAR, ANECDOTALLY, THE BEST RECRUITMENT METHOD FOR GETTING GUYS INTO OUR CENTERS APPEARS TO BE: CURRENT CLIENTS… TYPICALLY FEMALES WHO REFER THEIR PARTNERS!!!!! If CURRENT CLIENTS… seem to be the best starting access point… How can we use this access point? What can we do if: He is in the waiting room while she has her appointment? He/she asks to have him accompany her during her appointment? He is not present but you KNOW she has a regular partner? You don’t know if she has a regular partner? She has/had a one-time partner? Other situations??? How about general outreach to males? What have you done/tried? What else might you do/try? In Terms of General Outreach…. What can we learn from men’s magazines? How do they “target” their market…which is not all that different from our “market?” What do they do/use to get men’s attention? Let’s start by looking at Men’s Health…one of the best selling men’s magazines in the US. Now Let’s Look at Three Other Popular Men’s Magazines…. GQ, Esquire and Details. Their cover presentations and the things they focus on are slightly different…but not totally different. Based on what we “know” about men, what themes do you see in use on these covers? GQ February 2013 GQ April, 2013 Esquire September, 2013 Esquire May, 2013 Details August, 2013 Details September, 2013 So, if we use: Sex/Sexy women… Abs… Muscles… Style… The way to do something/what you need to know… Recognizable, successful, sexy…but not too gay…”manly” men… …Then we have men’s attention. So, we have looked at ourselves, explored what we can do to make ourselves more welcoming, and identified some ways to reach out to male partners/males in general. So now let’s look at how we can communicate more effectively with males once we have access to them. Let’s begin by bridging from something we looked at last time and that was mentioned earlier: posters frequently found in family planning clinics. What’s Wrong With This Message/Poster? A GOOD MAN takes care of himself and those he loves Are You a Good Man? WE CAN HELP YOU START SO THERE IT IS! This is our part of the equation…the unintended negative messages that contribute to our difficulties communicating with young men. But, equations have at least two parts. so now let’s look at what guys bring to the equation that contributes to the communication difficulties. And then we will explore ways to get around these roadblocks. The Stereotypes About What It Means To “Be A Man…” Get in the way of men reaching out for/asking for help. Get in the way of men being able to express their feelings and/or their needs. Get in the way of communication between m-w, between m-m, and between men and health care providers…and not just family planning/reproductive health providers. So what can we do to communicate more effectively with young men? From the video THE SECRET LIFE OF BOYS we identified the following tips: Tips For Helping Boys/Young Men Identify and Communication About Feelings…From The Secret Life…. Create/provide a safe space/private space. Protect their “shame.” It can feel “shameful” just having feelings men are “not supposed” to have…especially fear and/or anxiety. It can feel “shameful” not knowing what’s going on. It can feel “shameful” knowing you behaved in a way that got you or your partner(s) in trouble. And, in some more traditional cultures, simply. reaching out for help is experienced as not “manly” and therefore shameful. TIPS (continued) Provide “action” / Do something / Let THEM do something: Use models and samples and let them handle them. Help with expressions of feelings. Share your own feelings (appropriately). Allow time and space (“Time-Silence Syndrome”). WAIT!!! Don’t go after them…don’t push. Read their signals of openness. Wait for the moment and grab it when it is there. Let them lead. SHUT UP and let them talk. Going Beyond Those Original Tips, Other Suggestions To Keep In Mind When Providing Services to Guys: If you offer “counseling”…DON’T!!! Instead, offer “1:1 Appointments.” Other Suggestions To Keep In Mind When Providing Services to Guys: Seriously talking with a stranger about sexual health and sexual experiences can be VERY intimidating…especially for guys. This creates anxiety, fear and discomfort. Anxiety, fear and discomfort can bring out the worst in people and not surprisingly, it can bring out the worst in many guys. Male “bravado”/some version of insensitivity is often a cover for fear and/or discomfort. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) To the extend possible, be as culturally competent as you can be. The more conservative his cultural background, the more traditional his gender role expectations are likely to be…both for himself and for his partner(s). This applies both to sexual interactions with the other gender (MSW) and with the same gender (MSM). Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Remember that not all men are heterosexual. Remember that sexual identity does not necessarily tell you anything about a guy’s sexual behaviors. If you reach out to/overtly serve gay men, be prepared to serve gay men. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) To the extent possible, be aware of the male norms and lingo/slang of the guys you work with. But, having said that… BE YOURSELF! Don’t try to use their language or be like them; it will only come off as fake! Use your OWN language but be sure they understand you…again, be yourself. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Don’t ask, “Did you understand/get that?” Say, “Lots of guys find that complicated so, can you summarize it back for me so I can be sure I gave you all the important information?” Don’t jump in talking about health or sex-related concerns; warm up by discussing casual topics first. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Communicate that you are genuinely concerned about THEM and THEIR issues and concerns. Be clear you are there for THEM, not for someone else (their partners). Communicate that you are there to help, support, and inform; not to criticize/lecture/judge. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Be sure you provide a private space for all conversations. Read their body language and respond accordingly. Simultaneously, be aware of your own non-verbal communication including your body language. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Ask what they think about something before asking how they feel about it. Start “feeling” conversations by talking about physical feelings before emotions. Suggest “many” and/or “most” guys “feel that way”/“would feel that way.” Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Don’t interrupt; if they are talking, let them go. Your silence between their statements is often golden. Avoid direct eye-contact to start and avoid continuous eye-contact. Face-to-face discussion can be intimidating and is often experienced as confrontation in male culture. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Sit down before they do…standing over them can feel intimidating. Let guys move chairs/seats around any way that is comfortable for them… invite them to do that. Wait for the invitation/hint and grab it when it is there. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Boys/men are supposed to “know.” Part of “being a man” is knowing what to do and how to do it. Not knowing what is going on can be very disconcerting to guys and can result in their slipping into some version of “bravado.” Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) So, don’t put them into a place that suggests they “don’t know.” Having said the above, it is still safer for them to say “I don’t know,” than it is to actually be wrong/answer incorrectly. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) If you ask “yes-no questions”, you will likely get “yes” / “no” answers. So, emphasize asking open-ended questions. Avoid “why” questions. To guys, “why” often gets interpreted/experienced as “why are you an idiot?” Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) Sometimes the “why” may not be “pretty” and it may be hard to admit/acknowledge. And, for most of the work we do in family planning, we really rarely need to know the “why” behind a behavior. Other Suggestions To Keep In Mind When Providing Services to Guys: (continued) For younger men in particular, what the male peer group thinks/feels (or what the guy BELIEVES the peer group thinks/feels) is far more important than what you think/feel or what girls think/feel. Use appropriate humor (remember those condom ads). Some Tips Specifically For FP/RH Settings Men coming to a family planning clinic are coming into unknown territory…help them get and stay as comfortable as possible. Explain the clinic process and everything that is going to happen. This can help to relieve the stress and anxiety of “not knowing.” Tips Specifically For FP/RH Settings (continued) When guys are sharing personal/sexual/embarrassing information it can feel DIS-empowering to do so… meaning…it can feel like they are handing power over to the receiver. Tips Specifically For FP/RH Settings (continued) Power and control are big issues in male culture so handing power over is a HUGE deal…it is not experienced as simply communicating information. Tips Specifically For FP/RH Settings (continued) Don’t start by asking if he “has any questions.” Begin with something like: “Most men have questions about XYZ so if it’s OK, I would like to go over that/explain that to you;” or, “Can I share with you some things that have worked for guys I have worked with in the past?” Tips Specifically For FP/RH Settings (continued) Or, more directly, “Most men have questions about this so to be sure I am doing my job I am going to explain it all to you even though I know I am likely to go over things you already know.” Tips Specifically For FP/RH Settings (continued) If they ask a question, don’t OVER answer; With males less is often more; But of course you have to give all of the information needed. When A Male Comes To A Family Planning Clinic With A Female Partner…. Most FP clinics will screen for the female’s comfort and ask something like: “Are you comfortable with him being here with you today?” When A Male Comes To A Family Planning Clinic With A Female Partner…. What is/are the unstated message(s) to the men…and to the women…in that question? Don’t leave the unstated message(s) floating in the air. When A Male Comes To A Family Planning Clinic With A Female Partner…. (continued) Acknowledge the negative message; explain why you asked the question; and, acknowledge that what he is doing is right and good (He is THERE!)…but since it is HER appointment, you are obligated to make sure she is as comfortable as possible. When A Male Comes To A Family Planning Clinic With A Female Partner…. (continued) And, it would be a good idea to acknowledge the negative message(s) to the female patient also even if her male partner is not present when the question is asked. WHEW!!!!!!! OTHER TIPS/SUGGESTIONS? QUESTIONS? COMMENTS?