Masculinity-Informed Therapeutic Discussions: Strengthening Father Engagement and Family Mental Health Systems

Abstract

OBJECTIVE: Men underuse mental health services in part because of masculine norms. Few interventions focus on masculinity in therapeutic contexts, especially in low- and middle-income countries. This study analyzed transcripts from masculinity-focused therapeutic sessions with fathers in Kenya to explore masculine norms and intersections with the therapeutic process. METHODS: The study examined transcripts from fathers (N=9) who participated in a pilot trial of LEAD (Learn, Engage, Act, Dedicate), a five-session father-focused intervention addressing alcohol use, depression, and family engagement in Kenya. Applied thematic content analysis was conducted to explore themes of masculinity, fatherhood, and facilitators or barriers to clinical processes guided by the gender role strain theory and motivational interviewing research. RESULTS: Fathers described four core scripts shaping masculine identity: financial provision, intergenerational models of authority and alcohol use, fatherhood as an earned identity, and emotional suppression. Facilitators of engagement (e.g., openness) that emerged in transcripts included peer-father counselors' shared identity, masculinity-aligned affirmations, structured reflection that seemed to create emotional safety, and reframing of vulnerability as a strength. Counselors flexibly balanced fidelity with responsiveness, pausing manual content to support fathers' processing of grief and trauma. These processes appeared to scaffold change talk, values clarification, and redefinition of masculine identity, aligning with documented reductions in alcohol use, depression, and family conflict from the original pilot trial. CONCLUSIONS: The findings demonstrate how masculinity-informed discussions can function as intervention and engagement strategies. The results suggest practical strategies for adapting evidence-based treatments to better engage men globally and in family-focused settings.