Based on TCU Mapping-Enhanced Counseling Manuals for Adaptive Treatment As Included in NREPP

TIME OUT! FOR MEN: A COMMUNICATION SKILLS AND SEXUALITY WORKSHOP FOR MEN

provides guidelines for leading an 8-session workshop for men who are interested in improving their intimate relationships

N. G. Bartholomew & D. D. Simpson Texas Institute of Behavioral Research at TCU (November 1996)

TCU Mapping-Enhanced Counseling manuals provide evidence-based guides for adaptive treatment services (included in National Registry of Evidence-based Programs and Practices, NREPP, 2008). They are derived from cognitive-behavioral models designed particularly for counselors and group facilitators working in substance abuse treatment programs. Although best suited for group work, the concepts and exercises can be directly adapted to individual settings.

When accompanied by user-friendly information about client assessments that measure risks, needs, and progress over time, TCU Mapping-Enhanced Counseling manuals represent focused, time-limited strategies for engaging clients in discussions and activities on important recovery topics. These materials and related scientific reports are available as Adobe PDF® files for free download at http://www.ibr.tcu.edu.

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© Copyright 2002 Texas Institute of Behavioral Research at TCU, Fort Worth, Texas 76129. All rights reserved. Permission is hereby granted to reproduce and distribute copies of this manual (except reprinted passages from copyrighted sources) for nonprofit educational and nonprofit library purposes, provided that copies are distributed at or below costs and that credit for authors, source, and copyright are included on each copy. No material may be copied, downloaded, stored in a retrieval system, or redistributed for any commercial purpose without the expressed written permission of Texas Christian University. Time Out! For Men

A Communication Skills/Sexuality Workshop for Men

Institute of Behavioral Research Texas Christian University Time Out! For Men

A Training Manual from the TCU/DATAR Project

Developed by

N. G. Bartholomew, M.A.

D. Dwayne Simpson, Ph.D. DATAR Principal Investigator

Time Out! For Men i This module was developed as part of NIDA Grant DA06162-06A1, Improv- ing Drug Abuse Treatment Assessment and Research (DATAR-2).

The Time Out! For Men training module and data collection forms may be used for personal, educational, research, and /or information purposes. Permission is hereby granted to reproduce and distribute copies of these materials (except for reprinted passages from copyrighted sources) for nonprofit educational and nonprofit library purposes, provided that copies are distributed at or below costs and that credit for author, source, and copyright are included on each copy. No material may be copied, down- loaded, stored in a retrieval system, or redistributed for any commercial purpose without the express written permission of Texas Christian Univer- sity.

For more information about Time Out! For Men, please contact:

Institute of Behavioral Research Texas Christian University TCU Box 298740 Fort Worth, TX 76129 (817) 257-7226 (817) 257-7290 fax Email: [email protected] Web site: www.ibr.tcu.edu

© Copyright 2002 Texas Christian University, Fort Worth, Texas. All rights reserved.

ii TCU/DATAR Manual Table of Contents

Acknowledgments iv Preface v Introduction vi

Sessions 1 A New Outlook on Relationships ...... 1

2 An Assertive Attitude ...... 17

3 Listening ...... 39

4 Talk It Over, Part 1: Feelings and Needs ...... 57

5 Talk It Over, Part 2: Resolving Conflict ...... 81

6 Man Talk: It’s More than Plumbing ...... 103

7 Loving Relationships ...... 123

8 Making Relationships Work ...... 143

Appendices A Human Sexuality 155

B Reference Section 177

C Client Survey (pretest/posttest) 225

Bibliography 229

Time Out! For Men iii Acknowledgments

Our special thanks to Charlotte Pevoto for conceptualizing the layout and design for this training manual. The user-friendly quality of this manual is due to her skill and creativity. Thanks also to Barry S. Brown for his review and suggestions during the initial development of this manual, and to Jesus A. Sandoval, Director of the Dallas Concilio of Hispanic Organizations, for his advice and guidance.

We especially want to recognize the assistance we received from the Dallas County Sheriff’s Department Jail Chemical Dependency Treatment Program, where this workshop was pilot tested. We are grateful to Charles W. Fawns, Director of Programs, for his support, and we extend special thanks to Charles Beran, Program Coordinator, for his enthusiasm and direction, and to Eric Schmidt, Counselor, for his excellent presentation of the Time Out! For Men material during the pilot workshop.

iv TCU/DATAR Manual Preface

The Texas Christian University/Drug Abuse Treatment Assessment Research (TCU/DATAR) Project is concerned with enhancing drug abuse treatment in order to increase client retention and reduce relapse rates. Research for the DATAR project was conducted by the Institute of Behavioral Research (IBR) at TCU in collaboration with methadone outpatient treatment programs in Texas.

A variety of psychoeducational interventions were developed as part of the DATAR project to help increase client retention and involvement in treatment programs. These interventions use curriculum-based modules to assist sub- stance abuse counselors in leading group sessions that are both enjoyable and meaningful to clients. The treatment modules address such topics as relapse prevention, assertiveness training for women, social support and life skills enhancement, and HIV/AIDS prevention. A contingency management protocol also was developed and evaluated.

The present manual, Time Out! For Men: A Communication Skills and Sexuality Workshop for Men, was developed as a companion piece to an assertiveness and sexuality workshop for women developed by IBR staff for use in the DATAR project. The manual is designed to provide counselors with a structure for helping men in substance abuse treatment programs explore issues related to communication, intimacy, and sexuality in their relation- ships.

Time Out! For Men v Introduction

Time Out! For Men: A Communication Skills and Sexuality Workshop for Men has been developed by the TCU/DATAR project to assist counselors in substance abuse treatment programs who want to lead men’s groups on sexuality and relationship issues. Close, stable, supportive marriages and significant relationships are important anchors for recovery. The workshop addresses communication skills, self-esteem, problem solving, and sexuality in the context of helping men improve their intimate relationships.

The development of this specialized treatment intervention for “men only” followed the success of a similar workshop designed for women (Time Out! For Me: A Sexuality and Assertiveness Module for Women). Counselors who were using the women’s module began to get feedback from male clients and from the women who attended the groups that a companion workshop for men was needed. In fact, requests for information about the women’s Time Out! program from colleagues in the field often would include the question— “Have you developed a similar workshop for men?” It became apparent that there was an interest in, and a need for, male-targeted materials on relation- ship skills in treatment settings.

The module focuses on communication skills such as listening, assertiveness, I-Statements, sharing feelings, and conflict resolution. In addition, sexual and reproductive health information for both men and women is covered, including anatomy and physiology, self-examinations for cancer, symptoms of sexually transmitted diseases, and options for safer sex. Human sexual response and sexual functioning are discussed, and men are provided a forum for discussing and dispelling sexual myths and stereotypes.

The materials are organized for presentation in eight (8) two-hour group sessions. Ideally, groups should be led by a male counselor, social worker, or other treatment staff member who has had experience conducting educational workshops. We do not recommend that the material be presented by a female counselor working alone, based on feedback received from the men who at- tended our pilot workshops. These participants said they would feel most comfortable discussing the issues presented in a “men-only” group. Many also were open to the idea of a male counselor and female counselor serving as co- leaders of the group; however, most said they would have a difficult time “opening up” without some male leadership in the group. Homework assign- ments are included to encourage men to work on specific skill areas with their partners or significant others. Each session contains instructions for prepar- ing class materials, along with handouts, discussion questions, and ideas for presenting information on each topic. In addition, the manual features a reference section which contains informational articles, teaching resources, and a bibliography. vi TCU/DATAR Manual Time Out! For Men encourages the development of intimacy, open communication, and practical problem-solving—important areas of per- sonal growth and stability for recovering men. Research has suggested that improvements in personal relationships during treatment may be strongly related to positive treatment outcomes such as reduced drug use and greater program compliance. It is hoped that by offering men a forum where relationship issues can be honestly discussed they will feel empowered to make changes that can lead to strong, supportive relation- ships.

Time Out! For Men vii

1

1 A New Outlook on Relationships Session Length: 2 hours

Objectives Establish the goals and purpose of the workshop Explore male and female sex roles and their impact on relationships

Define personal goals for improving intimate relationships

Rationale Most men have had few opportunities to seriously explore and define their sexuality and their need for intimacy. This lack of opportunity is perpetu- ated by social and cultural beliefs that often go unchallenged. This session seeks to increase participants’ willingness to explore new ways of thinking about sexuality, love, and intimacy, and to work on personal goals for improving relationships.

Session Procedure Time

Outline Client Survey (pretest) 15 minutes

Getting Started 10 minutes

Group Introductions and Guidelines 20 minutes

Challenging Stereotypes 20 minutes

Break10 minutes

Improving Relationships 35 minutes

Homework: Partner Interview 10 minutes

Total Time for Session 1 120 minutes

Time Out! For Men 1 1 A New Outlook on Relationships Materials Pocket folders (one for each participant) Easel and flip chart (or chalkboard) Magic markers; pencils, pens, writing paper Prepared flip chart Group Goals Prepared flip chart Group Agreement Prepared flip charts Ideal Man and Ideal Woman Copies of handouts

Preparation Notes

Prepare Group Goals flip charts Write out the suggested group goals on a large piece of flip Group Goals chart paper or poster board, as shown. To strengthen recovery by improving our relationships.

To learn more about ourselves.

To improve our health.

To challenge insecurities and improve self-esteem.

Group Guidelines Write out the suggested group Group Guidelines guidelines on a large piece of flip chart paper or poster Stick to the topic. board, as shown. Participate!

Respect ourselves and each other.

What’s said here, stays here!

Avoid bragging, boasting, and other mind-games.

Support each other!

2 TCU/DATAR Manual 1 Ideal Man and Ideal Woman Write out the “shell” for the Ideal Man and Ideal Woman discussion activities on two pieces of flip chart paper or poster board, as shown:

The “IDEAL” Man The “IDEAL” Woman

Physically Personality Physically Personality

Photocopy Client Survey (pretest, pp. 225-227) handouts A New Outlook on Relationships (worksheet, p. 13) Partner Interview worksheet (homework, p. 14) Session Evaluation (form, p. 15)

Procedure

15 Client Survey

Allow about 15 minutes for completion of pretest.

Pretest, Welcome each person as he arrives and ask him to complete a Client Survey pp. 225-227 (pretest).

10 Getting Started

Begin by explaining the purpose of the workshop. Use the 1 first 10 minutes to discuss what the workshop is about and the topics to be covered. Many participants will need some reassur- ance and validation for attending this type of workshop. It’s natural for most of us to have trouble admitting that we have any lack of knowledge or any problems with sex, intimacy, and relationships. It’s important that your opening comments help develop trust and rapport and that you convey a genuine sense of caring and openness.

Time Out! For Men 3 1 A New Outlook on Relationships Read over the following script for ideas on what to say to get started:

This workshop is designed to help us learn more about sexuality, love, and building stronger, better relationships. Everyone has questions and concerns about love, sex, and intimacy—but we seldom get the chance to talk openly and honestly with one another. It’s normal for you to have some doubts about being here and to wonder what you can get out of this class. That’s something each person needs to answer for himself—some questions to ask yourself are: Am I satisfied and happy with my sex life and my relationships? Are there any recurring relationship problems that cause me or my partner unhappiness? Do I ever feel isolated, lonely, “bad,” or unlovable? Am I sometimes confused about how I feel and act? If you don’t sense you are having problems in these areas—that’s wonderful! We encourage you to participate in this group and share with us how you handle relationship problems in a positive way. On the other hand, if you recognize there are things about yourself and your intimate relationships that you would like to feel better about, this group can help. The only requirement is that we agree to be honest with ourselves and each other. We sometimes try to hide our insecurities by boasting, bragging, and playing “one-up” with each other. We’d like for this group to be a place where we can put all of that aside and work to help ourselves and each other feel better about who we are as men and how we can make our relationships work out the way we want them to. As group leaders, we don’t have all the answers. In fact, we probably struggle with the same kinds of problems that you do from time to time. But we do have some ideas about why relationship troubles develop and what we can learn to do differently to help solve some kinds of problems. We believe that relationships are important and worth an investment of time. We also believe that you deserve to have happy, satisfying, intimate relationships and that you have the ability to learn how to make your relationships better. That’s what this group is all about. Men are sensitive, much more so than society allows us to believe. Often it is said that women are the ones who feel, while men are the ones who are logical and levelheaded. The truth is that both men and women have strong emotions and feelings (and both men and women are able to be logical and levelheaded). This is true because both are human beings. However, society does teach men not to express their feelings openly, especially when it comes to the “softer” emotions. The result is that men often feel alienated, lonely, cutoff, and misunder- stood when they try to deal with their feelings. One thing we’ll do in

4 TCU/DATAR Manual 1 this group is look critically at some of society’s “rules” for men and women to see if we really agree with them. Sometimes relationship problems develop because the partners have never challenged society’s stereotypes for men and women. All we suggest is that you keep an open mind as we explore these issues in the group. ;inally, there’s the impact of addiction and recovery on relationships. As we become stronger in our recoveries, we often begin to see the need for making changes in our relationships. We may be carrying some guilt, shame, and sadness over the things we did to ourselves, our partners, and our families in order to support our habits. We need to explore these feelings in order to regain the self-respect and self- esteem needed for a healthy relationship. Our partners may need some help as well—and hopefully this group will give you some infor- mation and skills for helping your partner, too. Addiction is tough on relationships, no matter how resilient, loving, or forgiving a partner may be. If both partners have a shared history of addiction, the challenge may be even harder. The important thing to remember is that change is possible! In fact, change is inevitable. This time next year, we all will have changed to some degree, for better or worse. Our decision for today might be to guide the progress of these “natu- ral” changes for the better. So, over the next few weeks we’re going to talk men-to-men, and try to generate some ideas about how we can be happier with ourselves, our sexuality, and our relationships. We’ll discuss sexuality issues such as anatomy, sexual functioning, reproduction, and staying healthy. We’ll also talk about developing a stronger sense of self-esteem and learning more about managing our feelings and getting our needs met. And most importantly, we’ll look at ways to make our relationships stron- ger, deeper, and closer. Each group will end with a homework assignment. This will be in the form of an exercise or activity that you do with your partner. If you don’t have a partner, you can do the homework with a friend, relative, or anyone who can help give you a woman’s perspective. The assign- ments are designed to help you with your communication skills, and no assignment will be embarrassing or put you on the spot. I’ll close the introduction by saying that we’re glad you’ve come to this group, and we look forward to seeing you at all 8 sessions. The last session, Session 8, will include a “graduation” party. You’ll also be awarded a certificate for the number of hours of this training you complete. If appropriate for your group, show them an example of the certificate. (See page 154.)

Time Out! For Men 5 1 A New Outlook on Relationships 2 Seek feedback with the following questions: What do you think about what you’ve heard so far? Do you have any questions or concerns about this Process questions group?

Group Introductions and Guidelines 20 Use the next 15–20 minutes for introductions and an over- 1 view of the group goals and guidelines.

Begin by introducing yourself, then go around the room and ask each person to introduce himself. Also ask:

How long have you been with this program? Are you currently in a relationship? Process questions How long have you been with your partner? What do you hope to get from this group?

Next, use the prepared flip chart to briefly review the Group 2 Goals. Clarify goals, as needed, by emphasizing the follow- Flip chart ing points:

To strengthen recovery by improving our relationships. We all deserve to find happiness and satisfaction in our relationships. Healthy, stable relationships are an anchor for recovery. To learn more about ourselves. We improve relationships by learning more about ourselves and making important changes. To improve our health. Our sexuality is an important part of our health. By learning more about it, we can lead healthier lives. To challenge insecurities and improve self-esteem. Past failures and disappointments in relationships can shake confidence. Positive action toward change can help restore our sense of self worth.

6 TCU/DATAR Manual 1 Conclude by using the prepared flip chart to briefly review 3 the Group Guidelines. Explain the reasoning for each guide- Flip chart line and encourage questions:

Stick to the topic. We’ll be covering a lot of information, so it’s important that we stay on track and avoid rambling around. As group leaders, we’ll butt-in from time to time if the group starts drifting off the topic. Participate! This workshop is a sharing process and we need everyone’s attention and contributions to make it work. Stretch yourself a little bit and let us hear about your thoughts, feelings, and opinions. Respect ourselves and each other. Let’s avoid put-downs, one-ups, name-calling, and taking things too personally. We all deserve to be heard and we’re all responsible for listening to others. What’s said here, stays here! Enough said. We will respect each person’s confidentiality. Avoid bragging, boasting, and other mind-games. This isn’t a contest, and there will be no prizes awarded for bigger, better, more often, or being a ladies’ man. Support each other! We’re all here to learn. We’ll be discussing sensitive topics, but we’re all on common ground as men. A little understanding can go a long way.

Challenging Stereotypes 20 For the next 20–25 minutes, help participants explore the 1 impact of sexual and gender stereotypes on relationships. Here are some ideas to start the ball rolling:

Growing up as a man or as a woman in our society leaves us all just a little bit confused. We are all swamped with myths, media images, and “ideals” of what a real man or woman is supposed to be like. Often, we maintain these fantasy ideals, and we compare and contrast ourselves and our sexual partners against these images. The result is that we are often left feeling inadequate, frightened, and confused. Because these stereotypes can impact our self-esteem and our expecta- tions, they often create problems in relationships. One way to get beyond this problem is to identify the stereotypes and challenge them.

Time Out! For Men 7 1 A New Outlook on Relationships Let’s start by generating a couple of lists of characteristics of the so- called “ideal” man and “ideal” woman so we can get a better under- standing of what we’re talking about.

Use the prepared flip chart shells of The Ideal Man and The 2 Ideal Woman. Lead the brainstorming activity by encourag- Flip charts ing participants to call out the physical and personality char- acteristics of the “ideal” man and woman. Do the “Ideal” man list first, then complete the “Ideal” woman list. Encourage participants to think about what they learned or observed as they grew up. Ask them to reflect on what they see and hear on TV, in movies, on MTV, and in music. When the lists are completed, tape or tack them to a wall so they can easily be seen.

Process the activity by discussing some of the following 3 questions:

Where do these ideals come from? How real are they in everyday life? Process questions Was it easier to come up with physical or personality characteristics? What does that tell us? What’s different between the male and female lists? Have you ever compared your partner to these so-called female ideals? How do you think this comparison might make her feel? Take a minute to honestly compare yourself against the so- called male ideals. How does this kind of comparison make you feel about yourself? How can these comparisons cause problems in our relationships? What can we do about it?

4 Wrap up the activity using some of the following ideas: The lists of characteristics we came up with are fairly typical, which just goes to show how widespread these sexual stereotypes really are. Whether we are consciously aware of it or not, we are influenced at some level.

8 TCU/DATAR Manual 1 It’s been estimated we are exposed to over 50-thousand messages and bits of information each year through books, movies, TV, and music that reinforce gender and sexual stereotypes. These commercials, songs, plots, and scenes often deliver messages about how relation- ships are “suppose” to be, what kind of sex we are “suppose” to be having, and how the “ideal” man and woman are “suppose” to be thinking, feeling, and behaving. Next time you sit down to watch TV, watch critically for awhile and look for these messages. You’re apt to see women who seem to only be concerned with how their hair looks, and men who fall to pieces when asked to iron a shirt. Ask yourself how fair or “real” these images really are. Anyway you slice it, stereotypes are insulting to both men and women. Just remember that a lot of exposure to such ideas is bound to have some impact. After all, advertisers spend billions and billions each year to reach us with messages—because it works! The best way we can guard against being influenced is to develop a critical eye and ear for the messages society throws at us. The most important thing we can do to create healthy relationships is to learn to value the “real” in each other, and leave the “ideal” to Hollywood.

Thank participants for their input. (“You’ve done some good work on 5 this issue—thanks.”) Tell them the discussion will continue after a short stretch break.

10 Break

Improving Relationships 35

Use the next 30–35 minutes to help participants identify areas 1 in their relationships they would like to improve.

Begin with a “mini-lecture” incorporating some of the follow- ing ideas:

As we start to investigate the root of some of our concerns about relationships, intimacy, and sex we have to look closely at what we’ve learned from our society and from our culture. It’s no wonder that

Time Out! For Men 9 1 A New Outlook on Relationships most of us have the same kinds of concerns and problems—we’ve all been influenced by many of the same messages about men and women. Many conflicts arise out of what our culture teaches us about the expected roles for men and women and how strongly we accept those roles. The so-called “ideal” man and woman lists we created before the break are a good example of those societal role expectations. One idea we want you to think about in this group is that most of our attitudes, beliefs, and values about sexuality and relationships have been learned. We learn from our parents, other relatives, school, church, movies, TV, music, the working world, each other, and on the streets. It’s important to remember that attitudes or behaviors that we learned while growing up can be “unlearned” if we find they cause us relationship problems as adults. Unfortunately, some of the stereotypical things we learned can set us up for “stormy” relationships with women—the so-called “battle of the sexes.” Even the concept that traditional sayings have helped us believe—that man is the opposite half of woman (and visa versa)— suggests that conflicts are somehow unavoidable because of the un- changeable “natures” of men and women. And whereas it’s obvious that men and women do have some differences (and some very nice differences, I might add), the truth is that we are not opposites. That’s something we learn—and what’s learned can be unlearned or re- learned. It is possible to learn new ways of thinking about ourselves and women, and also to learn new skills for making our relationships more solid and happy. We don’t have to live in conflict. What we can do is look inside ourselves honestly and think about possible changes we can make. As men we can take the responsibility in our relationships and families to begin doing things differently, especially if what we’ve been doing and thinking all our lives hasn’t worked well. Let’s take a minute to think seriously about setting some goals for making our relationships better. This involves thinking about what you need from your partner and what you are willing to give. If you are not currently in a relationship, you can think about what you would need from a prospective partner.

Distribute A New Outlook on Relationships worksheets, and 2 ask each participant to read over the questions and answer Worksheet, Encourage thoughtful reflection about the items in this p. 13 them honestly. exercise. Reassure participants that they will not have to hand in the worksheets or show them to anyone else in the group. Allow time to complete worksheets.

10 TCU/DATAR Manual 1 Process the activity by discussing some of the following 3 questions:

Was it easy or hard to complete these sentences? What statement was the most difficult for you to complete? Process questions What did this exercise help you realize about yourself? How did you define love? What goal do you have for making your relationship better? How can you work on that goal?

Thank participants for their input (“Good work, guys!”) and 4 provide closure by highlighting some of the key points raised during the session.

Here are some ideas for closing comments:

We’ve broken some important ground today toward making our rela- tionships better. We’ve challenged some of the myths and stereotypes about the so-called “ideal” man and woman, and talked about how destructive these comparisons can be to our self-concepts and our relationships. The key to good relationships is to be “real,” not ideal, and to accept our partners as they really are, too. We’ve also started the process of thinking about what we need in our relationships and what we are able to give to others. Next week, we’ll concentrate on improving some of our communication skills in rela- tionships. In order to get what we need and give our partners what they need it’s important to be able to communicate in a way that helps avoid misunderstanding, anger, and hurt feelings. It can be done! We just have to work on developing the right skills.

10 Homework: Partner Interview

Use the last 10 minutes to introduce the homework assign- 1 ment. Remind participants about the purpose of the home- work:

As we mentioned at the beginning of the session, we’re going to sug- gest a homework assignment each week for you to work on with your

Time Out! For Men 11 1 A New Outlook on Relationships partner. If you’re not in a relationship, you might want to ask a friend or family member to work with you to give you another perspective.

Distribute Partner Interview worksheets and provide the following instructions. Homework, p. 14 The worksheet you’re taking home is the same one you completed in the second half of the session. You’ll need the one you completed for this assignment. þ Ask your partner to complete the homework worksheet and to answer the questions honestly.

þ When she has finished, take turns reading your worksheets to each other, one statement at a time. Don’t comment or question each other. Don’t argue or debate. Just listen.

þ When you’ve finished, spend a little time discussing the last question.

þ Explore what each of you wants to improve most in your relationship and how you can work together to make it happen.

Thank participants for attending and invite them back next 2 week.

Ask each person to complete an evaluation form before leav- 3 ing. Evaluation, p. 15

12 TCU/DATAR Manual 1

Session 1 A New Outlook on Relationships Worksheet

Complete these sentences based on your honest thoughts and feelings.

The thing I need most from my partner is...

I feel loved when my partner...

The thing I like best about my partner is...

One thing I’d like to change about how I treat my partner is...

One thing I’d like my partner to change about how she treats me is...

The most important thing I give to my partner is...

I feel hurt when my partner...

I know I hurt my partner when I...

The thing my partner likes best about me is...

I show my partner I love her when I...

My definition of love is...

What I most want to improve in our relationship is...

Time Out! For Men 13 1 A New Outlook on Relationships

Session 1 Homework A New Outlook on Relationships Partner Interview

Ask your partner to complete these sentences based on her honest thoughts and feelings. When complete, share your answers from class with her as she shares her answers with you. This is an exercise toward beginning to communicate with each other. Avoid becoming defensive—just relax and listen to each other’s thoughts and feelings. Spend some extra time talking about the last statement—how would you like to improve your relationship?

The thing I need most from my partner is...

I feel loved when my partner...

The thing I like best about my partner is...

One thing I’d like to change about how I treat my partner is...

One thing I’d like my partner to change about how he treats me is...

The most important thing I give to my partner is...

I feel hurt when my partner...

I know I hurt my partner when I...

The thing my partner likes best about me is...

I show my partner I love him when I...

My definition of love is...

What I most want to improve in our relationship is...

14 TCU/DATAR Manual 1 SESSION EVALUATION Time Out! For Men Session 1

THIS BOX IS TO BE COMPLETED BY DATA COORDINATOR:

SITE # |__|__| CLIENT ID# |__|__|__|__| DATE: |__|__||__|__||__|__| COUNSELOR ID# |__|__| [1-2] [3-6] MO DAY YR [7-12] [13-14]

INSTRUCTIONS: Please take a minute to give us some feedback about how you liked this session.

1. Use one word to describe your reaction to today’s class. ______

2. What is the most important thing you learned today?

3. What’s one positive change you plan to make in your relationship?

4. On a scale of 1 to 10, how do you rate today’s class? (Circle your rating)

01 02 03 04 05 06 07 08 09 10 |__|__| [15-16] Poor Pretty Good Excellent

5. Do you have any suggestions to help make this class better?

Time Out! For Men 15

2

2 An Assertive Attitude Session Length: 2 hours

Objectives Understand importance of communication in maintaining relationships Distinguish assertiveness from aggressive and passive communication

Learn how to use “I-Statements” in communication situations

Rationale Many problems in intimate relationships are communication problems. Men often have been socialized to approach communication in relationships from an aggressive or controlling stance and may benefit from learning the parameters of different communication styles, especially the assertiveness option. This session seeks to introduce skills for effective communication by helping partici- pants embrace the importance of an assertive attitude in communication inter- actions with their partners. I-Statements are highlighted as a foundation skill for good communication.

Session Procedure Time

Outline Welcome and Process Homework 15 minutes

An Assertive Attitude 25 minutes

Discussion: Understanding Assertiveness 15 minutes

Break 10 minutes

Using I-Statements 20 minutes

Practice: Making an I-Statement 25 minutes

Homework: Assertiveness Logbook 10 minutes

Total Time for Session 2 120 minutes

Time Out! For Men 17 2 An Assertive Attitude Materials Easel and flip chart (or chalkboard) Magic markers; pencils, pens, writing paper Prepared flip chart An Assertive Attitude Prepared flip chart Making an I-Statement Copies of handouts

Preparation Notes

Prepare An Assertive Attitude Write out the key points on flip charts An Assertive Attitude a large piece of flip chart paper or poster board, as shown: I respect myself and I respect you.

I have needs and you have needs.

My goal is to be open and honest with you.

I am not afraid to listen to you.

I am willing to work on mutually agreeable solutions to our problems.

Making an I-Statement Write out key points on a Making an I-Statement large piece of flip chart paper I feel very angry about this! or poster board, as shown: Instead of You make me angry!

I’d like to finish what I was telling you. Instead of You always interrupt me.

I don’t agree with what you’re saying! Instead of You must be stupid to say that!

I felt put-down by what you said. Instead of You’re always putting me down!

18 TCU/DATAR Manual 2 Prepare Photocopy the sample scenarios for Making an I-Statement (pp. activity 33-36), which are laid out five on a page. Cut them into separate slips.

Photocopy An Assertive Attitude (handout, p. 31) handouts Understanding I-Statements (handout, p. 32) Assertiveness Logbook (homework, p. 37) Session Evaluation (form, p. 38)

Procedure

15 Welcome and Process Homework

Welcome participants as they arrive.

Use the first 10–15 minutes to review and process the home- 1 work assignment. Begin by briefly reviewing a few key ideas from Session 1, such as:

Last week we started this group by looking at how some of the things our society teaches us about being a man and being a woman can get in the way of good relationships. When we have too many expecta- tions or when we compare ourselves or our partners to a fantasy ideal we can end up unhappy. We also started thinking seriously about what we like about and need from our relationship with our partner, and what we’d like to work on to make things better. So let’s talk for a few minutes about the home- work assignment.

Ask for volunteers to share their experiences with the 2 homework. Here are a few ideas for questions to start the ball rolling:

How did your partner respond to the homework? What did you learn about your partner that you hadn’t realized Discussion questions before? Did any strong feelings come up for either of you as you talked?

Time Out! For Men 19 2 An Assertive Attitude How did the two of you handle them? What’s the most important thing you learned from this Discussion questions exercise?

Thank volunteers for their input. (“I know it may have felt awkward, 3 but you got the job done, guys. Thanks for telling us about it.”) Encourage participants to keep up the good work.

An Assertive Attitude 25 During the next 20–25 minutes, lead a discussion on the 1 importance of an assertive attitude for effective communica- tion in relationships. Here are some ideas you’ll want to include:

Good communication is the foundation of a good relationship. Without some level of satisfying communication with another person, love, intimacy, and commitment are difficult if not impossible. The reason is simple—as human beings, we are born to communicate. We want to be known. We want to know other people. We enjoy telling stories and sharing our opinions and thoughts, and we enjoy hearing stories and other’s opinions. But here’s the catch—for all the satisfaction that communication brings, it’s still very hard work! Oh, we learn lan- guage (words) fairly easily and fairly young in life—but learning to communicate well with others is difficult and is something we must keep on learning throughout life. Maintaining good communication in a long-term relationship is a skill. It’s not something that just happens naturally, on its own, without any work. It’s a skill—like riding a bike, or changing a sparkplug, or operating a tractor. And like all skills, it requires that we pay atten- tion to a few basic guidelines, and that we practice the skill frequently. Today we’re going to look at some basic attitudes and skills that are essential for improving how we communicate in our important rela- tionships. Let’s start by thinking about the kinds of characteristics we associate with being a “good communicator.”

Ask participants the following questions, and use a flip chart 2 or erasable board to list the characteristics they describe: Flip chart

20 TCU/DATAR Manual 2 Think about someone you know with whom you really like talking or with whom you really think it’s easy to talk.

Process questions What characteristics make this person so easy to talk with? Why do you like talking with this person?

Briefly discuss the characteristics generated by the group, 3 touching on why each is important for good communication. Conclude with the following point:

As you can see, it was fairly easy to come up with a list of skills that we associate with good communication, although we don’t usually think of them as skills. More often, we think that being easy to talk with has to do with a person’s temperament or personality. And although personality is an important issue, it’s possible for people with all kinds of personalities to learn and practice the skills of good com- munication. The first step is to develop the right kind of attitude— we’ll call it an assertive attitude.

Ask participants if they are familiar with the word “asser- 4 tive,” and ask what the word means to them. Briefly discuss the responses.

Use your prepared flip chart of key points to lead a discussion 5 of the components of what, for the purposes of this work- Flip chart shop, we’re calling “An Assertive Attitude.” Elicit participants’ ideas about each characteristic first, using discussion questions. The main idea here is to stress that good communication in intimate relationships (with people we care about) is based on a foundation or “attitude” of mutual respect, honesty, openness, willingness to listen, and willingness to compromise. As you discuss each characteristic of assertiveness, contrast it with “aggressive- ness” and “passivity,” using ideas provided in the discussion points.

Start off by saying:

The very first thing we have to deal with as men who sincerely want to have better, closer relationships with the women in our lives is our attitude. We want to work toward developing an assertive attitude when we communicate. In order to do this, we have to be willing to give up having an aggressive attitude or a passive attitude. We have to learn to be there, be involved, and be up front. Assertiveness is based on mutual respect, honesty, and openness. Let’s talk about what’s involved in an assertive attitude:

Time Out! For Men 21 2 An Assertive Attitude I RESPECT MYSELF AND I RESPECT YOU.

What are we saying here? How can we show respect for ourselves? &or our partners? Discussion questions Why is this important for good communication?

=irst and foremost, an assertive attitude conveys respect—not only for ourselves but for our partners. We convey respect in different ways. One important way is how we behave when we communicate. This means that we avoid yelling, being hostile, attacking the other person, Discussion using put-downs, saying things that we know are mean or hurtful. Points When we communicate with an assertive attitude, we try to use a calm, level tone of voice and put the other person at ease. By contrast, an aggressive attitude basically says “I only want respect for myself— I don’t care about you!” People with aggressive attitudes tend to talk loud, use put-downs and sarcasm, and try to intimidate or scare others with threats and violence. This conveys not only a lack of respect for their partners, but, in reality, a lack of respect for themselves, too. A passive attitude says: “You deserve respect, but I don’t.” People with passive attitudes often have difficulty standing up for them- selves. They may allow others to verbally push them around and to treat them badly. What we’re saying here is that an assertive attitude is balanced. It says: “I value this relationship—we are both impor- tant.”

I HAVE NEEDS AND YOU HAVE NEEDS. What does this mean? How do we make sure both partners’ needs are equally Discussion questions considered? Why is this important in a relationship?

A lot of men feel awkward or embarrassed talking about their needs. It’s that old socialization BS we talked about last week—men are supposed to be strong, in control, independent, self-sufficient. We sometimes hear people say to their partner: “I don’t need anything from you.” Wrong! We got together with our partners in the first Discussion place because we have a basic human need for companionship, love, Points tenderness, and wanting another person we can depend on, trust, count on when the chips are down, and share our happiness and successes with. Of course, beyond these “soulful” needs, we have basic day-to-day needs as well—jobs, taking care of family, sex, recreation, feeling good about ourselves. An assertive attitude means we are willing to consider our needs and our partner’s needs equally. In contrast, an aggressive attitude is selfish—it says: “Only my needs are

22 TCU/DATAR Manual 2 important, your needs don’t matter.” The passive attitude says: “My needs aren’t important; I’ll ignore my needs to take care of yours.” You can see how these other attitudes can cause problems in a rela- tionship over time.

MY GOAL IS TO BE OPEN AND HONEST WITH YOU. What does this mean? How can we be open and honest with our partners? Discussion questions Why is this important in a relationship?

Honesty and openness are important components of an assertive attitude. When we are open with a partner, we avoid secrets, playing games, and having “hidden” agendas. We try not to hide, pretend, or avoid facing up to problems and concerns in the relationship. To be honest with our partner is to be real or genuine. This requires speak- Discussion ing for ourselves, taking responsibility for our actions, and being Points honest about our feelings, too. An assertive attitude says: “I need to be myself and I need for you to be free to be yourself, too.” In contrast, an aggressive attitude says: “My goal is to control you, to keep you guessing, to play mind-games with you.” People with an aggressive attitude sometimes use honesty as a weapon. They do things and say things to really hurt their partner or put their partner down. When the partner becomes hurt or angry, the aggressive person says: “Hey, what’s your problem? I was just being honest.” Saying things to intentionally hurt someone, then calling it “honesty” is a pretty de- structive mind-game (and it’s pretty dishonest, as well.) The person with a passive attitude is basically shutdown and fearful. This atti- tude says: “I can’t be open and honest with you because I’m afraid you won’t like me—so I’ll pretend to be what I think you want me to be.”

I AM NOT AFRAID TO LISTEN TO YOU. What does this mean? How do we show our partner that we’re willing to listen? Discussion questions Why is listening so important?

It’s been said that listening is the first requirement of love. Certainly listening is one of the most important (if not the most important) communication skill. We’ll be talking about listening in more detail in Discussion our next session. When we carry an assertive attitude, we are willing Points to listen. Not only that, we are not afraid to listen. It means we are willing to overcome the fear of hearing something we don’t like or

Time Out! For Men 23 2 An Assertive Attitude learning something we didn’t realize. As men, it also means we’re willing to overcome the fear of not being in control, of not having all the answers all the time, of appearing to be a little “unmanly” by patiently and lovingly opening ourselves up to our partner’s words. In truth, it takes a lot of courage to be a good listener. People with aggressive attitudes don’t listen well (probably because they are too afraid). When they do listen, it’s usually only long enough to find something they can disagree with. They may monopolize the conver- sation, put down other people’s ideas, or try to analyze everything that is said—they don’t listen! And those with a passive attitude don’t listen very well either. They may let others do all the talking in order to be liked, and they may smile and nod a lot—but you get the feeling after awhile that somehow you’re just not connecting with them.

I AM WILLING TO WORK ON MUTUALLY AGREEABLE SOLUTIONS TO OUR PROBLEMS.

What does this mean? What does it take to work on a mutually agreeable solution? Discussion questions Why is this important for a good relationship?

By now you’re probably beginning to realize that an assertive attitude is the mark of a mature, fair-minded, and caring man (or woman). It is not always easy to work on finding mutually agreeable solutions to problems—in fact, it’s hard to do most of the time. That’s because both people in a relationship are individuals, with individual needs Discussion and different points of view. The key word in this characteristic of an Points assertive attitude is “willing.” Being willing means you stick to it, talk it over, manage conflict, and don’t let yourself go running off in a huff when you hit rough road. What we’re talking about here is compro- mise and negotiation. A man with an assertive attitude wants to settle things in a way that he can live with, and equally important, he wants to settle things in a way that his partner can live with, too. On the other hand, those with an aggressive attitude only want things their way—they come across as selfish, immature, and controlling. And those with passive attitudes get pushed around a lot—they usu- ally back down and let others have their way and then later feel really hurt and angry about it.

24 TCU/DATAR Manual 2

15 Discussion: Understanding Assertiveness

Take about 15 minutes to process the previous information 1 on assertiveness by asking participants to think about the points covered so far.

Do you know anyone who seems to respond to most situations with an aggressive attitude? Describe some of the things they Process do that are aggressive. questions How about someone who mostly responds with a passive attitude? Describe some of the things they do that are passive.

Do you think men are socialized to respond to situations more aggressively? In what ways?

In what ways is an assertive attitude healthier?

In what ways can an assertive attitude benefit recovery?

Distribute An Assertive Attitude handouts, and encourage 2 participants to find time to share this information with their Handout, Encourage them to have an adult-to-adult talk about these p. 31 partners. characteristics and why they are important for healthy relationships.

Thank participants for their input. (“You guys have really done some 3 good work on this issue—thanks for sticking with it!”).

10 Break

Time Out! For Men 25 2 An Assertive Attitude

Using I-Statements 20 Use the next 20 minutes to introduce the use of I-Statements 1 as an important skill for assertive communication. Help partici- pants understand and identify what an I-Statement is and how I-Statements can be used to express feelings and make assertive requests to get one’s needs met (or at least considered).

Use the prepared flip chart to point out the differences be- 2 tween I-Statements and You-Statements. Here are some Flip chart ideas of things to say:

I-Statements are sort of the “gold” standard of an assertive attitude. I-Statements are direct, assertive expressions of your feelings, needs, preferences, ideas, thoughts, etc. I-Statements are especially impor- tant for expressing feelings. An I-Statement is actually a self-aware- ness statement. It expresses your reality without blaming, accusing, or putting others down. I-Statements are honest! One way to understand I-Statements is to compare them to “You- Statements.” You-Statements are usually aggressive and they send a message of blaming and labeling others. In general, I-Statements are honest and respectful (assertive) and they open up the doors of com- munication, while You-Statements may close down those doors. Let’s look at some examples:

I’m very angry about this! Instead of You make me angry!

I’d like to finish what I was telling you. Instead of You always interrupt me.

I don’t agree with what you’re saying! Instead of You must be stupid to say that!

I felt put-down by what you said. Instead of You’re always putting me down!

26 TCU/DATAR Manual 2 =or most of us, learning to use I-Statements is a little like learning a new language. It takes time and practice to get comfortable with it. Using I-Statements reflects a change in attitude, away from an ag- gressive attitude, toward an assertive attitude. Be on the alert for “false” I-Statements. =or example, “I feel that you are taking advantage of me,” is not speaking honestly about feelings. Basically, “I feel” should be followed by a feeling-word (anger, fear, happiness, etc.). A simple way to monitor this is the word “that.” If the statement begins “I feel that...”, then the speaker may be avoiding an honest statement of feelings. In addition, I-Statements may be incorrectly used to disguise what is really a You-Statement. =or example, “I feel you are making me mad,” or “I think you are stupid.” Remember, I-Statements reflect an asser- tive, rather than an aggressive attitude. “I wish you’d go jump off a cliff,” or “I hate you because you are mean and stupid,” may sound like I-Statements, but the intended meaning is angry, critical, and hurt- ful—making them aggressive rather than assertive.

Distribute Understanding I-Statements handouts, and en- 3 courage a brief discussion of differences between I- and Handout, p. 32 You-Statements and the possible consequences of each.

Practice: Making an I-Statement 25 During the next 20–25 minutes, allow participants to practice 1 making I-Statements and You-Statements for comparison.

Here are some things to say to introduce this practice activ- ity:

Most of us have used I-Statements before, probably without really being aware that we were using them. Learning to consciously use I-Statements more frequently can help us improve our communication style, not only in relationships, but in all walks of life. The best way to learn and become more aware is through practice. Like most new skills, using I-Statements may feel a little awkward or “phony” in the beginning. When we make a commitment to use I-Statements more frequently, however, we can eventually get beyond the “clumsiness” we may feel.

Time Out! For Men 27 2 An Assertive Attitude As men, we may worry that modifying our communication style may make us appear to be “weak” or “sissies.” Actually, the opposite is true. Assertiveness, including the use of I-Statements instead of You- Statements, is a marker of self-respect, respect for others, and matu- rity. Being assertive and using assertive communication skills separates the men from the boys. Since practice is the best way to learn, we’ll spend the rest of today’s group practicing and learning more about the differences between I-Statements and You-Statements.

Distribute 1 or 2 Making an I-Statement “scenario slips” to 2 each participant, and after going over the following instruc- Scenarios, pp. 33-36 tions, allow time for them to write out their responses. The slip (slips) of paper you’ve been given describes a difficult scenario or situation that you may have encountered before. There is space at the bottom to write out 2 responses—an I-Statement response and a You-Statement response. =irst write out what a You- Statement would sound like, and then how you might say it using an I-Statement. =or example, here’s a scenario: “The guy in the next door apartment always takes your assigned parking place.” If I were to respond with a You-Statement, I might say: “Hey, you jerk, you’re always stealing my parking spot.” Using an I-Statement, I might say: “This is my as- signed parking place. I would appreciate it if you’d park somewhere else in the future.”

After participants have completed the activity, go around the 3 room and ask each person to read his scenario aloud, fol- lowed by his You-Statement and I-Statement responses. Provide feedback and encourage other group members to comment on the responses. As needed, dispell negativity. Some participants may counter that I-Statements and assertiveness would “not work” in the real life situations they deal with. Help them distinguish between the possibility of a negative reaction from others and the probability of that happening (i.e. challenge irrational thinking).

Next, ask participants to think of a current real-life situation 4 they are dealing with that might benefit from an assertive response. Have them jot down a very brief description of the situation, and then how they might respond using a You-Statement and an I-Statement.

28 TCU/DATAR Manual 2 Go around the room again and ask each person to describe 5 the situtation, followed by the You-Statement and I-State- ment responses. Provide feedback and encourage discussion.

Thank participants for their work (“I really appreciate your willing- 6 ness to learn and practice a new skill”) and wrap up the discussion using some of the following ideas: 7 Conclude with the following point: Improving communication is one of the most important things you can do to help improve the quality of your relationships. Assertiveness and I-Statements are skills that can help make communication with those you care about better, and like all skills they take time to mas- ter. It’s important to give yourself time to practice and learn. Remember that an assertive attitude is a mature, respectful attitude. Give it a try!

10 Homework: Assertiveness Logbook

Distribute Assertiveness Logbook homework handouts and 1 provide the following instructions: Homework, p. 37 Your assignment for next week, gentlemen, is to share what you have learned today with your partner. Review the characteristics of an assertive attitude with her and talk about how you both can work toward bringing this kind of attitude into your relationship. Likewise, review the information about I-Statements and You-State- ments, and encourage her to read over the handouts. Your second assignment (and the assignment for you partner, too, if she’s willing) is to make a conscious effort to make at least three (3) I- Statements each day. In other words, you are being asked to make an I-Statement in situations where you might not normally do so. It should be a conscious effort—that means that at least 3 times each day you will stop and think before you speak, and then purposefully choose the assertive option of using an I-Statement. (Give yourself credit for any type of situation in which you are able to do this—home, work, with friends, with strangers, etc.) Use the Assertiveness Logbook handout to keep track. At the end of each day, sit down with your partner and jot down a few notes about the situations where you chose to make your I-Statements.

Time Out! For Men 29 2 An Assertive Attitude Thank participants for attending and invite them back next 2 week.

Ask each person to complete an evaluation form before leav- 3 ing. Evaluation, p. 38

30 TCU/DATAR Manual 2

An Assertive Attitude says...

I RESPECT MYSELF AND I RESPECT YOU

irst and foremost, an assertive attitude conveys respect—not only for ourselves but for our partners. We convey respect in different ways. One important way is in how we behave when we communicate. This means that we avoid yelling, being hostile, attacking the other person, using put-downs, saying things that we know are mean or hurtful. What we’re saying here is that an assertive attitude is balanced. It says: “I value this relationship—we are both important.”

I HAVE NEEDS AND YOU HAVE NEEDS

We got together with our partners in the first place because we have a basic human need for companionship, love, tenderness, and for a relationship with another person we can depend on. Of course, beyond these “soulful” needs, we have basic day-to-day needs as well—jobs, taking care of family, sex, recreation, feeling good about ourselves. An assertive attitude means we are willing to consider our needs and our partner’s needs equally.

MY GOAL IS TO BE OPEN AND HONEST WITH YOU

Honesty and openness are important components of an assertive attitude. When we are open with a partner, we avoid secrets, playing games, and having “hidden” agendas. We try not to hide, pretend, or avoid facing up to problems and concerns in the relationship. This requires speaking for ourselves, taking responsibility for our actions, and being honest about our feelings, too. An assertive attitude says: “I need to be myself and I need for you to be free to be yourself, too.”

I AM NOT AFRAID TO LISTEN TO YOU

It’s been said that “listening is the first requirement of love.” Certainly listening is one of the most important (if not the most important) communication skills. When we carry an assertive attitude, we are willing to listen. Not only that, we are not afraid to listen. It means we are willing to overcome the fear of hearing something we don’t like or learning something we didn’t previously know. In truth, it takes a lot of courage to be a good listener.

I AM WILLING TO WORK ON MUTUALLY AGREEABLE SOLUTIONS TO OUR PROBLEMS

By now you’re probably beginning to realize that an assertive attitude is the mark of a mature, fair-minded, and caring man (or woman). It is not always easy to work on finding mutually agreeable solutions to problems—in fact, it’s hard to do most of the time. That’s because both people in a relationship are individuals, with unique needs and different points of view. To find solutions, you must stick to it, talk it over, manage conflict, and don’t let yourself go running off in a huff when you hit rough road. What we’re talking about here is compromise. An assertive attitude means settling things in a way that you can live with, and equally important, settling things in a way that your partner can live with, too.

Time Out! For Men 31 2 An Assertive Attitude

UNDERSTANDING I-STATEMENTS

How does an I-Statement express feelings?

I feel... I seem to be feeling... I am feeling... I enjoy feeling... I felt... I don’t like feeling...

What else does an I-Statement express?

I think... I like... I consider... I love... I believe... I hope... I will... I am... I want... I wish... I would... I do... I need... I don’t... I won’t... I can...

How do I use I-Statements?

Speak for yourself. Communicate what you feel, think, or want without blaming or making assumptions about other people.

Begin your statements with the word “I,” and express your feelings, thoughts, or needs in a manner that respects the other person.

Avoid beginning statements with the word “you.” You-statements suggest blame, and may lead others to feel defensive.

Examples of I-Statements and You-Statements

You make me angry when you ignore me. You never let me use the car. I feel angry when you ignore me. I want to use the car more often.

You should be more careful. You make me worry when you’re late. I would like for you to be more careful. I feel worried when you’re late.

32 TCU/DATAR Manual 2 Making an I-Statement Practice Scenarios

Situation: Your teenager didn’t get home until 3:30 a.m. last night. You-Message:

I-Message:

Situation: You loaned your brother your car and he brought it back with a big scratch on the door. You-Message:

I-Message:

Situation: You hate “roughing it.” Your partner suggests a camping vacation. You-Message:

I-Message:

Situation: A co-worker distracts you by yakking away when you have work to do. You-Message:

I-Message:

Situation: A persistent salesperson calls you for the 4th time in a week to try to sell you something you don’t want. You-Message:

I-Message:

Time Out! For Men 33 2 An Assertive Attitude

Situation: Your teenager has been negligent in getting his homework done on time. You-Message:

I-Message:

Situation: Your partner is often forgetful. You want to make sure your anniversary is remembered this year. You-Message:

I-Message:

Situation: Your boss is moody and sometimes yells at you in front of other people. You-Message:

I-Message:

Situation: The grocery store clerk is making a mess of your groceries by sacking them incorrectly. You-Message:

I-Message:

Situation: You’re the boss. One of your employees comes in late every morning. You-Message:

I-Message:

34 TCU/DATAR Manual 2

Situation: A friend is constantly borrowing things and failing to return them. You-Message:

I-Message:

Situation: Your partner is in the habit of leaving clothes all over the house. You-Message:

I-Message:

Situation: Your neighbor allows her dog to poop on your lawn every morning. You-Message:

I-Message:

Situation: A store clerk short-changes you then refuses to admit the error. You-Message:

I-Message:

Situation: Your partner is behaving in a stand-offish way and you want to know why. You-Message:

I-Message:

Time Out! For Men 35 2 An Assertive Attitude

Situation: Your partner complains of stomach pains but refuses to see a doctor. You-Message:

I-Message:

Situation: Your teenager is in love and is spending half her life on the family phone. You-Message:

I-Message:

Situation: Your partner has taken to making snide remarks about your weight in public. You-Message:

I-Message:

Situation: The mechanic at the garage is trying to talk you into service you know your car doesn’t need. You-Message:

I-Message:

Situation: Your boss has asked you to work late again for the 5th time in two weeks. You-Message:

I-Message:

36 TCU/DATAR Manual 2 Session 2 Homework Assertiveness Logbook Worksheet

Date My I-Statements My Partner’s I-Statements

1. 1.

2. 2.

3. 3.

1. 1.

2. 2.

3. 3.

1. 1.

2. 2.

3. 3.

1. 1.

2. 2.

3. 3.

1. 1.

2. 2.

3. 3.

1. 1.

2. 2.

3. 3.

1. 1.

2. 2.

3. 3.

Time Out! For Men 37 2 An Assertive Attitude SESSION EVALUATION Time Out! For Men Session 2

THIS BOX IS TO BE COMPLETED BY DATA COORDINATOR:

SITE # |__|__| CLIENT ID# |__|__|__|__| DATE: |__|__||__|__||__|__| COUNSELOR ID# |__|__| [1-2] [3-6] MO DAY YR [7-12] [13-14]

INSTRUCTIONS: Please take a minute to give us some feedback about how you liked this session.

1. Use one word to describe your reaction to today’s class. ______

2. What is the most important thing you learned today?

3. How will using I-Statements more often improve your relationships?

4. On a scale of 1 to 10, how do you rate today’s class? (Circle your rating)

01 02 03 04 05 06 07 08 09 10 |__|__| [15-16] Poor Pretty Good Excellent

5. Do you have any suggestions to help make this class better?

38 TCU/DATAR Manual 3

3 Listening Session Length: 2 hours

Objectives Understand listening as a learnable skill Explore common listening problems

Identify good listening habits and practice listening skills

Rationale Listening is a foundation skill for all good interpersonal relationships, intimate and otherwise. In addition, the ability to listen is associated with both learning and reasoning, critical issues in behavior change and recovery. This session seeks to emphasize that listening is a skill that can improve relationships and facilitate self-growth, and to provide practice toward skills building.

Session Procedure Time

Outline Welcome and Process Homework 10 minutes

Exercise: ocused Listening 30 minutes

Listening Skills 25minutes

Break 10 minutes

Practice: Listening Skills 35minutes

Homework: Listening to Each Other 10 minutes

Total Time for Session 3 120 minutes

Time Out! For Men 39 3 Listening Materials Easel and flip chart (or chalkboard) Magic markers; pencils, pens, writing paper Prepared flip chart Listening Task Prepared flip chart Walls—Poor Listening Habits Prepared flip chart Bridges—Good Listening Habits Prepared flip chart Listening Guidelines Prepared flip chart Rule of Restatement A “speaker’s staff” or other symbolic object (See Preparation Notes.) Copies of handouts

Preparation Notes

Prepare Listening Task flip charts Write out the listening activity topic question on a large piece Listening Task of flip chart paper or poster board, as shown: If you could meet

a famous person,

either living or dead,

who would it be,

and why?

Walls—Poor Listening Habits Walls Write out key points on a Poor Listening Habits large piece of flip chart paper or poster board, as shown: TUNING OUT

BRICK WALLING

DEENSIVE LISTENING

MECHANICAL LISTENING

40 TCU/DATAR Manual 3 Bridges—Good Listening Habits Write out key points on a Bridges large piece of flip chart paper Good Listening Habits or poster board, as shown: STAY IN OCUS

OPEN YOUR HEART

BE AN ACTIVE LISTENER

LISTEN WITH YOUR 3rd EAR

Listening Exercise Guidelines

Listening Exercise Guidelines Relax, ocus. Write out instructions on a large piece of flip chart paper or Concentrate on listening. poster board, as shown: Share the staff—speak then pass it on. Allow others time to speak. Don’t signal that you want the staff— wait your turn.

On a separate sheet, Rule of Restatement write out the Rule Before you speak, acknowledge what of Restatement. the previous speaker has said. Restate his general ideas and feelings accurately.

Obtain Bring to group a stick, staff, wand, cane, or some other item you can use to “speaker’s designate who has the floor. A “speaker’s staff” or other symbol is used in some staff” Native American cultures and in other cultures around the world to remind those involved in a communication event of the sacred obligation to listen. Basically, when someone holds the stick or staff, no other person may speak or interrupt until the speaker finishes his/her thoughts and passes the stick on. The person who takes the stick must first acknowledge what the former speaker said before speaking himself.

Photocopy Walls and Bridges (handout, p. 53) handouts Listening Dos and Don’ts (handout, p. 54) Listening To Each Other (homework, p. 55) Session Evaluation (form, p. 56)

Time Out! For Men 41 3 Listening Procedure 15 Welcome and Process Homework

Welcome participants as they arrive.

Use the first 10–15 minutes to review and process the home- 1 work assignment. Begin by briefly reviewing a few key ideas from Session 2, such as:

Last week we spent some time discussing assertiveness, that is, having the right attitude when we communicate—an assertive atti- tude. Remember that an assertive attitude has to do with mutual respect, maturity, and taking care how we say things. We also talked about the difference between I-Statement and You- Statements, and how I-Statements are more in keeping with an assertive attitude. The homework assignment asked you to pay more attention to I-Statements and to practice with your partner. Let’s talk for a few minutes about how things went with the homework.

Ask for volunteers to share their experiences with the 2 homework. Here are a few ideas for questions to start the ball rolling:

Was the assignment easier or more difficult than you expected? In what ways?

Process questions How did your partner respond to the homework? Were both of you able to make your “quota” of I-Statements each day? If not, what got in the way? Did anyone find themselves actually using more I-Statements than asked for in the assignment? Tell us about that. What did you learn from the homework exercise?

Thank volunteers for their input. (“I know it may have felt awkward, 3 but you got the job done, guys. Thanks for telling us about it.”) Encourage participants to keep up the good work.

42 TCU/DATAR Manual 3

Exercise: Focused Listening 30 Use the next 25–30 minutes to introduce the topic and lead a 1 brief focused-listening activity. The exercise should help participants develop an awareness of the importance of listening and of their own barriers to good listening habits.

Here are some points to include in the opening discussion:

Today’s topic is listening. We’ll spend the whole session on listening because it’s the most important communication skill of all. In fact, it’s probably the most important life skill, too. And, sadly, it’s a skill that most of us take for granted. We confuse hearing with listening, or we assume that if we follow a conversation well enough to jump in with our own opinions, then we are listening. Today’s session will give us a chance to explore these assumptions about listening, and to learn how to listen better. Listening is a skill. Listening is a skill. One more time...listening is a skill. When we talk with couples who tell us they believe they have a good, satisfying intimate relationship, the willingness and ability to listen to each other is at the top of their list of important factors that contribute to the relationship. To put it more bluntly, unless couples can master the skill of listening (really listening) to each other, the outlook is grim. The relationship is likely to become cold and distant, or angry and defensive, or simply to end. As men, we sometimes have to get our minds straight before we can learn to become good listeners. Remember, we talked about society’s stereotypes for men—that men are suppose to be in charge, in control, and always ready to take action. As men, we’re suppose to know it all, right? So why should we listen? In our efforts to appear in control, to keep others from thinking of us as “weak,” to put up a manly front, we may end up sacrificing that very thing that could help us the most— listening. The wise man listens, digests what he’s heard, then speaks. The foolish man talks, talks, and talks. Now that you’ve heard the pep talk, we’ll try an exercise to get things warmed up. As you might guess, the exercise will ask you to really focus on listening.

Introduce the listening activity by asking participants to 2 choose a partner. Ask partners to sit facing each other. Encourage them to move chairs to allow enough distance between others for easy talking.

Time Out! For Men 43 3 Listening Give the following instructions, and display the prepared flip 3 chart of the Listening Task to help keep participants on track: Flip chart @ In this exercise, each partner will talk for exactly two (2) minutes on the following topic:

If you could meet a famous person, either living or dead, who would it be and why would you choose this person?

@ I’ll keep time. I’ll time the first speaker for two minutes, then I’ll call stop. You will then swap roles, and the second person will talk for two minutes.

@ The person who is not talking must listen. The listener should not say anything—not a word. However, the listener must let the speaker know that he is really listening.

@ Basically, you are each going to practice listening to another person for two minutes. Any questions? Take a minute to pick your famous person and decide what you want to say.

Allow a minute or so for participants to organize their 4 thoughts, then begin the activity and monitor the time.

When the activity is complete, go around the room and ask 5 each person to state his partner’s choice of a famous person and then tell why that person was chosen by the partner. In other words, each person is asked to demonstrate how well he was able to listen to his partner’s disclosure.

Process the exercise with the following questions. Encourage 6 discussion, especially around the ways we nonverbally signal to others that we are listening.

How accurately did your partner tell the group about your choice of famous person and your reasons?

Process questions Was it easy or difficult to concentrate on listening? Why? When you were speaking, what did your partner do that helped you sense that he was listening? When you were listening, what did you do to help make sure the other person knew you were listening? In real life, what usually gets in the way of your ability to listen?

44 TCU/DATAR Manual 3 Thank participants for their input. (“You guys have really done some 7 good work on this issue—thanks for sticking with it!”).

Listening Skills 25 Use the next 20–25 minutes to discuss listening skills. The key 1 point to stress is that listening is a skill; in other words, we can all learn how to become good listeners.

Here are some ideas of things to say:

When we see people in counseling who are having relationship troubles, the complaint we are apt to hear most often is: “She just doesn’t listen to me.,” or “He never listens!!” If all you get out of this whole workshop is learning how to listen a little better, you’ll have gotten a lot. Listening is not just important in our intimate relation- ships—it’s important in our jobs, in our recovery work, and in just about every aspect of life. Keep this thought in mind—it’s a skill. With practice and training, we can learn to listen. Listening is difficult because as we hear others talk, our thoughts and our feelings are stimulated, and it’s easy to fall into the habit of listen- ing to our own inner-dialogue, rather than to the person speaking. Sometimes we don’t listen well because we are tired or we become distracted by something else going on. And sometimes, we just don’t want to listen, because we’re doing something else or we don’t have the time. This is okay. There’s no rule or expectation that we must be good listeners all the time, no matter what. We want to learn good listening skills so we can listen well when it’s important for us and for our relationships to listen. It varies from day to day, and from situa- tion to situation, but most of us can judge when it’s important to listen. Aor example, we know it’s important to listen when we want to solve a problem with our partners, when we want to understand why our partner has been upset, when our partner needs to tell us about what’s going on with the kids, when our boss needs to tell us about a new job he wants us to work on, when our treatment counselor needs to tell us about our progress, or maybe when our partner just wants to tell us about what kind of day she had. Some of you may be thinking: “But what if I can’t or don’t want to listen when my partner needs to talk?” Aor example, you’re watching the big game on TV, and your partner wants to tell you all about how the washing machine has been acting up. Keeping an assertive atti- tude in mind, how might you respond?

Time Out! For Men 45 3 Listening Here’s an idea: “Baby, I know you’re worried about that washing machine, and I’ll be glad to sit down with you after the game is over to talk about it. I want to be able to give you my full attention, and right now that’s difficult for me because the Cowboys are down 7 points.” Of course, the ball is now in your court. When the game is over, you must let your partner know you are ready to talk and listen. The point is, if you’re not able to listen, say so. And since you care about the relation- ship, set an “appointment” to talk it over and listen at a later time. Whatever the situation may be, when you know you need to listen for the sake of the relationship, the key is to tear down walls and build bridges instead. Let’s look at the “walls” to good listening that we all stand behind from time to time (consciously or unconsciously):

Briefly review the examples of poor listening habits. Use the 2 Walls—Poor Listening Habits flip chart to focus attention on Flip chart the points.

Use some of the following ideas to lead the discussion:

Tuning Out (Pretending to listen, not paying attention, distracted) Tuning out is a common poor listening habit. We’ve all had the experi- ence of talking with someone, only to realize that they are a million miles away. Or we’ve found ourselves pretending to listen (“Yes, dear. Whatever you say, dear.”). As simple as it may sound, the first rule of good listening is paying attention.

Brick Walling (Planning what you’ll say next, mentally arguing with speaker) The term brick-walling probably comes from the old description: “Trying to talk to him is like trying to talk to a brick wall.” Instead of focusing our attention on the speaker, we are planning our next re- sponse or mentally arguing or disagreeing with the speaker. When we get into brick-walling, we are apt to interrupt the speaker, jump in before he/she is finished, or even finish sentences for the speaker.

Defensive Listening (Listening for perceived put-downs, becoming angry or hurt too easily) Defensive listening is emotional listening. Often, when we’re feeling hurt, angry, or misunderstood, we listen defensively. We scrutinize the speaker’s every word, looking for a hint of a put-down, threat, or insult. This makes us prone to hear insults when none are intended, causing us to start brick-walling.

46 TCU/DATAR Manual 3 Mechanical Listening (Aocusing only on speaker’s words, not the meaning) Words carry only part of the message. A good listener is able to hear not just the speaker’s words, but the meanings and feelings associated with the words. Some people are more prone to mechanical listening than others—they take everything literally. Here’s an example: Mary is very upset with John because he hasn’t been helping out with the kids. John says he’s going out for a beer. Mary says: “Oh, sure, just go on out and leave me with the kids again.” John goes out. When he comes back, Mary is really, really mad. She says: “John , how could you do that!!??” He says: “But you told me to go on out.” Granted, Mary was being a little sarcastic—but John’s mechanical listening means he heard only the words and not the meaning.

Conclude by asking participants to consider some of the fol- 3 lowing questions:

Can you think of any times when you’ve practiced one of these poor listening habits? Which one?

Process questions Did you do it consciously or unconsciously? What effects did it have?

Briefly review the examples of good listening habits. Use the 4 Bridges—Good Listening Habits flip chart to focus attention on Flip chart the points. The main idea to get across is that when people make an effort to listen better, they actually do listen better.

Use some of the following ideas to lead the discussion:

Now that we’ve explored the “walls” or the poor habits that get in the way of good listening, let’s talk about how we can turn those walls into “bridges,” in other words, the basics of good listening skills.

Stay in Focus (Pay attention, concentrate on listening, tune out distracting thoughts) Effective listening means making a conscious, mental effort to pay attention, stay focused, tune-in, open your ears and your mind, and concentrate on what the speaker is saying. This means letting the speaker finish without interrupting, making a commitment to really understand the speaker’s message, and using your mental power to focus, focus, focus. Sometimes our own feelings and emotions get in the way. Under certain circumstances, it is normal to become emo-

Time Out! For Men 47 3 Listening tionally involved with what the speaker is saying. While at these times we can’t avoid emotions that come up while we’re listening, we can make an effort to not respond emotionally and interrupt the speaker.

Open Your Heart (Be supportive, uncritical, interested, concerned—want to listen) Listening is the most loving thing we can do for one another in an intimate relationship. If someone is important to you, it’s natural to want to be supportive, interested, concerned. Really listening to someone conveys all those things, and more. When we really listen, we make the other person feel valued, cared about, and worthwhile. It’s also important to be patient with the speaker. Most of us can hear and understand faster than most speakers can talk—and sometimes we get mentally ahead of the speaker. It’s helpful to relax, stay tuned in, and let the speaker be herself/himself.

Be an Active Listener (Ask for clarification, give feedback, keep eye contact, nod, smile, etc.) As you listen, show that you understand what the other person is saying. Ask questions, ask the speaker to rephrase something you didn’t understand, check out your understanding of what the speaker has said by repeating it back in your own words (“So you’re saying you are really happy with the way things have been going at your 12-step group”). Listen intently, make eye contact, and pay complete atten- tion. If it’s appropriate, smile, nod, pat the speaker on the back, or put your arm around her to show support or sympathy. In other words, really be there.

Listen with your 3rd Ear (Pay attention to the speaker’s feelings as well as to the words) Let the other person know that you understand their feelings as well as their words. If you’re not sure of what the speaker is feeling, check it out. “You seem to be feeling pretty depressed about what hap- pened—is that how you’re feeling?” When we communicate with others, we always communicate feelings as well as literal meanings. It’s important to pay attention to the feeling part of the message, especially in our close, intimate relationships.

48 TCU/DATAR Manual 3 Distribute the Walls and Bridges handout and conclude by 5 asking participants to consider some of the following ques- Handout, p. 53 tions: When is it easiest for you to use good listening skills? When is it difficult? Process questions Which listening skill do you think you most need to improve? Which listening skill would you like for your partner to improve?

10 Break

Practice: Listening Skills 35 Lead a practice session on listening. Use your Listening 1 Guidelines flip chart to highlight the rules. Aor this exercise you’ll Flip chart incorporate Roger’s Rule of Restatement, an aid to active listening (Rogers, 1961), and the symbolic use of a staff or stick to help participants stay focused on the speaker. Help participants grasp the key concepts, but don’t be afraid to relax and have fun with this activity.

Use some of the following ideas to get into the exercise:

We could talk all day about listening, but the way we learn to listen is by listening, so we’re going to spend the rest of the session talking and listening to each other. When you go home tonight, you can show your partner the techniques you’ve learned, and hopefully practice some more. Aor this exercise we’ll be borrowing an idea from older cultures. It’s the idea of using an object to symbolize or show who has the floor. We’ll use this staff and call it the “speaker’s staff.” Here’s how it works. Whoever holds the staff, holds the floor. Whoever holds the staff may speak. All others must focus on and pay attention to the speaker. When he finishes his thoughts, he then passes the staff to another person. The person who receives the staff must first acknowl- edge what the previous speaker said. We’ll call it the “rule of restate- ment.” When you receive the staff, you may speak only after you have restated the ideas and feelings of the previous speaker to that speaker’s satisfaction.

Time Out! For Men 49 3 Listening Ask for a volunteer, and demonstrate how the process should 2 run. Let the volunteer speak first and then hand the staff to you. You then model the way a restatement may be given. If needed, do a second demon- stration with another volunteer until you sense that the group gets the main idea.

Your exchange with the volunteer might sound something like this:

Volunteer: I think the Cowboys (or whatever team is popular in your area) are an overrated team and that they don’t have a chance at the Super Bowl this year. Emmitt Smith (or whoever) is weak as milk— that guy has the wool pulled over everyone’s eyes. (He hands you the staff.) Group Leader: I hear the point you are making, brother. You say the Cowboys are an overrated team and you are less than impressed with Emmitt Smith. I hear a lot of feeling in your voice. I have a different opinion. I believe the Cowboys are the best team in the history of the NAL, and that they will once again be contenders for the Super Bowl. (Hand the staff to another group member to test if folks are catching on to how this is done.)

Ask if there are any questions and clarify rules, as needed.

Use the rest of the time to hold a group discussion, using the 3 speaker’s staff. Introduce a topic or ask the group to select one. Have the group stand in a circle for the duration of this exercise. Pick a topic that is stimulating or even controversial. A topic with absolutely no emotional content won’t work as well as a topic that people have feelings about. If the discussion gets waylaid, refer participants back to the rules on the flip chart, and start again. Do one “round” where the staff is passed in clock-wise fashion around the group. Then do a second “round” in which the staff is passed randomly—helter-skelter. If helpful, do a different topic for each “round.” 4 Process the exercise using some of the following questions: Was this exercise easier or harder than you thought it would be? What was different about the two rounds? Process questions Which round was the most difficult for you? As we stuck with it, in what ways did it become easier to do?

50 TCU/DATAR Manual 3 Did you ever feel like reaching over and grabbing the staff? How did you manage that? Process questions What did you learn from this exercise?

Thank participants for their contributions to the exercise. 5 (“This kind of exercise is not easy. You guys have really come across. Good going!”)

Distribute Listening Do’s and Don’t’s handouts, and encour- 6 age participants to find time to share this information with Handout, p. 54 their partners.

Provide closure by wrapping up on some of the key points 7 raised during the session.

Here are some ideas for closing comments:

So far, we’ve hit on two important things we can do to improve com- munication in our important relationships—practice assertiveness and practice good listening. Remember that communication is the corner- stone of intimacy and closeness in a relationship. An assertive attitude helps us participate in our relationships as equals. It’s an attitude of mutual respect, openness, and willingness to compromise. Part of an assertive attitude is being willing to listen. We spent some time today working on the skills we need to become better listeners. Remember, we are good listeners when we tune out our own thoughts long enough to really focus on the speaker. Next week we’ll move on to more advanced communication skills. So stay tuned.

10 Homework: Listening to Each Other

Distribute Listening to Each Other homework handouts and 1 provide the following instructions. Homework, p. 55 Your assignment for the next week, gentlemen, is to share the ideas you learned today with your partner. Go over the characteristics of an assertive attitude and talk about how you both can work toward handling your relationship with that kind of attitude.

Time Out! For Men 51 3 Listening The same for the listening skills. Talk with your partner about what you learned today (and listen to what she thinks about it all!) Lastly, on your way home, find a nice looking stick, or piece of wood, or something you can call a “speaker’s staff,” and practice using it with your partner like we did here in group. The object you choose doesn’t matter. You could also use a candle, a knickknack sitting around the house, an orange, or an “ear” of corn. You just need something to serve as a symbol. Remember the rule of restatement. You have this information on your handouts so you can refer to it when you need to. It would be great if you could use this technique several times during the week when things come up and you and your partner are having trouble listening to each other. But at least try and use this technique once in the coming week.

Thank participants for attending and invite them back next 2 week.

Ask each person to complete an evaluation form before leav- 3 ing. Evaluation, p. 56

52 TCU/DATAR Manual 3

Walls and Bridges

WALLS BRIDGES

Tuning Out Stay in Focus Pretending to listen Pay attention Not paying attention Concentrate on listening Distracted Tune out distracting thoughts

Brick Walling Open Your Heart Planning what you’ll say next Be supportive, uncritical, Mentally arguing with speaker interested, and concerned— want to listen

Defensive Listening Listening for perceived put-downs Be an Active Listener Becoming angry or hurt too easily Ask for clarification Give feedback Keep eye contact, nod, smile, etc. Mechanical Listening Aocusing only on speaker’s words, not the meaning Listen with Your 3rd Ear Pay attention to the speaker’s feelings as well as to the words

Time Out! For Men 53 3 Listening

Listening Do’s and Don’t’s

GoalsGoalsGoals

1. 1. TTTo imprimpro ooovvve commcomme unicaunicaunicationtiontion

2. 2. TTTo underundero stand the speaker—to rrer—to eallealleally listenlisteny

3. 3. TTTo let the speaker knoknoer w yyw ou ararou e listeninglisteninge

DODODO DON’T

Let the speaker have his/her say Daydream, plan what you want to say next

Show nonverbally that you are Interrupt to object, paying attention and that explain, or correct you’re interested

Respond verbally by giving Nonverbally indicate accurate restatements of the disagreement, hostility, speaker’s message or lack of attention

Begin your restatement with Respond verbally with introductions such as “What I judgment, analysis, hear you saying is” or “So you’re argument saying....” Add anything additional to the message when you are giving a restatement.

Source: Adapted from Communication Today, Sproule, 1981.

54 TCU/DATAR Manual 3 Session 3 Homework Listening to Each Other Partner Information

Listening is a skill. It’s perhaps the most important communication skill for helping make relationships closer and stronger.

Many people throughout history have understood the importance of listening.

In many cultures across the world, when people came together to discuss important things, they would use a symbolic object to help everyone stay tuned-in to listening. Often times this object was a decorated staff. We can use this idea in our daily lives.

Decide on an object you would like to use with your partner as a speaking and listening symbol. It can be anything—a staff, a cane, a candle, a wand, a household knickknack. Just so both of you know what it is.

Use this object to help you both focus on listening and communicating in the coming week. When you need to talk, or you need your partner to lis- ten, just say: “Wait a minute. Let’s get the ______(whatever you’ve chosen to be your speaker’s staff or symbol).”

Here are a few guidelines to follow:

Relax, ocus, Concentrate on listening.

Share the staff—speak then pass it on.

Allow the other person time to speak.

Don’t signal that you want the staff—wait your turn.

Rule of Restatement

Before you speak, acknowledge what the speaker has said. Restate his/her general ideas and feelings accurately.

Time Out! For Men 55 3 Listening SESSION EVALUATION Time Out! For Men Session 3

THIS BOX IS TO BE COMPLETED BY DATA COORDINATOR:

SITE # |__|__| CLIENT ID# |__|__|__|__| DATE: |__|__||__|__||__|__| COUNSELOR ID# |__|__| [1-2] [3-6] MO DAY YR [7-12] [13-14]

INSTRUCTIONS: Please take a minute to give us some feedback about how you liked this session.

1. Use one word to describe your reaction to today’s class. ______

2. What is the most important thing you learned today?

3. What listening habit do you plan to improve in yourself? Why is it important?

4. On a scale of 1 to 10, how do you rate today’s class? (Circle your rating)

01 02 03 04 05 06 07 08 09 10 |__|__| [15-16] Poor Pretty Good Excellent

5. Do you have any suggestions to help make this class better?

56 TCU/DATAR Manual 4

Talk It Over 4 Part 1: Feelings and Needs Session Length: 2 hours

Objectives Explore feelings and how feelings are expressed in relationships Understand the nature of feelings and feeling states

Learn how to use an assertion “formula” to express feelings and needs and negotiate solutions

Rationale Identifying and managing feelings in intimate relationships is a common com- munication issue. Accepting and expressing feelings in constructive ways is often challenging for men. When emotions arise in communication situations, men often attempt to control or minimize what they are feeling, resulting in roadblocks and impasses. This session seeks to help men identify and accept feelings as normal and better understand how inappropriate management of feelings results in communication breakdowns. An assertion formula (Talk It Over) is introduced as a framework for practicing openness and self-expression in intimate relationships.

Session Procedure Time

Outline Welcome and Process Homework 10 minutes

eelings and Communication 25 minutes

Discussion: Accepting eelings 15 minutes

Break 10 minutes

Talk It Over ormula 25 minutes

Practice: Using the ormula 25 minutes

Homework: Talk It Over Practice 10 minutes

Total Time for Session 4 120 minutes

Time Out! For Men 57 4 Talk It Over, Part 1: Feelings and Needs Materials Easel and flip chart (or erasable board) Magic markers; pencils, pens, writing paper Masking tape or thumb tacks Prepared flip chart Accepting eelings Prepared flip charts Talk It Over ormulas Prepared flip charts Examples Copies of handouts

Preparation Notes Prepare Accepting flip charts Feelings Write out discussion Accepting Feelings points on a large piece of flip chart paper or A “feeling” is a powerful, poster board, as shown: body-based response.

A feeling is a label we give to our physical reaction to a situation.

All feelings are valid.

eelings serve a purpose.

Allow yourself to feel your feelings.

Allow others to feel theirs.

58 TCU/DATAR Manual 4 Talk It Over Formula Declaring/Sharing Declaring and Sharing Write out the outline on a large piece The #eeling I feel ______of flip chart paper I felt______or poster board, The Event About ______as shown: When I______When you______

Clarify Because______

Declaration I want______I need______I hope______I just wanted to tell you about it.

Welcome Do you understand? feedback Have you ever felt that way? Or give a smile or a hug.

LISTEN

Talk It Over Formula Write out the Examples Example 1 for Declaring/Sharing on separate pieces of flip chart I feel bad paper. about the fight we had last night

because I realize I yelled at you.

I want to apologize. Will you accept my apology?

LISTEN

Example 2 No, thanks. I feel too tired to go dancing tonight. I need to take it easy

Ever felt like you just couldn’t move another muscle?

LISTEN

Time Out! For Men 59 4 Talk It Over, Part 1: Feelings and Needs

Talk It Over Formula Troubleshooting and Troubleshooting and Negotiating Negotiating Write out the outline The feeling I feel ______on a large piece I felt______of flip chart paper The behavior When you ______or poster board, About ______as shown: Clarify Because______

Request/Suggest I’d like______I want______It would help me if___

Seek feedback Will you agree to try? Is this okay with you? How about it, honey?

LISTEN/NEGOTIATE

Talk It Over Formula Example 1 Write out the Examples for Troubleshooting/ I feel irritated Negotiating on separate when you nag at me for forgetting, pieces of flip chart paper. because I don’t mean to forget. It would help me if you would write down the things you want me to do each day. Can we give that a try?

LISTEN/NEGOTIATE

Example 2 I feel so frustrated when you walk away during an argument because it keeps us from solving our problems. I need for you to stop doing that. Will you agree to try?

LISTEN/NEGOTIATE

60 TCU/DATAR Manual 4 Review case “Case studies” (p. 77) for practicing the Talk It Over formula are studies included at the end of the session. Cut them into strips for the group exercise exercise. You may find it helpful to read over them before group and jot down how the formula can be applied to each situation.

Photocopy Accepting eelings (handout, p. 75) handouts The Talk It Over ormula (handout, p. 76) Talk It Over Case Studies (exercise, p. 77) Talk It Over Practice (homework, p. 78) Session Evaluation (form, p. 79)

Procedure

15 Welcome and Process Homework

Welcome participants as they arrive.

Use the first 10–15 minutes to review and process the home- 1 work assignment. Begin by reviewing a few key ideas from Session 3, such as:

Last week, we explored the importance of good communication and listening in relationships. Good listening skills involve focus, concern for our partners, and the ability to tune out our own thoughts and tune into what our partner is saying. We also reviewed a technique for helping us stay focused on listening. Let’s talk for a few minutes about how things went with the homework assignment.

Ask for volunteers to share their experiences with the 2 homework. Here are a few ideas for questions to start the ball rolling:

irst of all, what object did you use as your “speaker’s staff”? How often did you use the speaker’s staff? Process questions What kind of issues did you discuss? How did your partner respond to the exercise? What did you both learn? Time Out! For Men 61 4 Talk It Over, Part 1: Feelings and Needs Thank volunteers for their input. (“Well done, guys. It takes a lot of 3 guts to try something new like this. I’m glad you gave it a go.”) Encourage participants to keep on using this listening technique.

Feelings and Communication 25 During the next 20–25 minutes lead a discussion on identify- 1 ing and accepting feelings that come up in communication situations.

Here are some ideas to include in the discussion:

Today we’re going to deal with an issue that most men have trouble with at one time or another in their lives—coming to grips with what we feel (our emotions) and how we express what we are feeling in our intimate relationships. Our discomfort, in part, comes from how we are socialized as men. The number one rule we grow up with is “No sissy stuff” or “Always be strong,” and that means that expressing certain feelings like fear, sadness, vulnerability, and even tenderness is taboo or off-limits. We also get the message that feelings and emotions are somehow “inferior” to reason and logical thoughts. The fact is, there’s no escap- ing the reality of either of these aspects of our humanity. We are beings of heart (emotions) and mind (thoughts). We think and we feel. We have feelings about what we think and we think about what we feel. As men, much of our sense of self involves the need to believe that we are “in control” of a situation, to believe we have mastery over a situation. The whole issue of feelings and emotions may make us feel uncomfortable and ill-at-ease, because we can never truly have “control” over what we feel (and we surely never have control over what another person feels). Even though we are unable to “control” our feelings, we do have control over how we express them to others. It’s normal from time to time to be confused and unsure about just what it is we really do feel. Learning to identify feelings, accept them as part of ourselves, and not be afraid of what we feel is an important step toward intimacy and closeness in relationships. In addition, the self-awareness that comes from accepting our feelings and accepting ourselves can help reduce stress and anxiety and improve self-esteem, and these are important issues for recovery as well. So let’s begin to get rid of the uneasiness we may have about dealing with our feelings. The first step is to simply begin talking about them.

62 TCU/DATAR Manual 4 Ask participants to help you generate a list of feelings. Use 2 flip chart or erasable board to list them. You may want to assist in Flip chart making sure a full range of emotions are represented. Keep the list visible to use as a guide. A well-rounded list may include:

affection anger anxiety boredom excitement fear frustration grief guilt happiness jealousy joy loneliness love sadness sexual desire shame tension

Lead a discussion by going around the room and asking each 3 participant to respond to the questions you will present to them. Give each member a chance to respond to one question before moving on to the next. You may choose to do this “round-robin” style with the first few questions (to get folks warmed up) and then use the rest of the questions in a general group discussion style—whatever seems best for your group. The main idea here is to help participants acknowledge that they do experience a range of feelings, to explore their comfort level with feelings, and to think about how they express their feelings and how they react to expressions of feelings from others.

Introduce the discussion as follows:

We’ve come up with a fairly good list of the kinds of feelings we all experience and deal with on a regular basis. Now let’s move to the next level—let’s talk about how we “feel” about the feelings—how we express them and how we react to them when we see them in others.

Which of the feelings on our list do you feel most comfortable expressing? Give an example of a situation where you are most

Discussion likely to express this feeling. questions Which of these emotions do you find it difficult to express? Give an example of a situation where you are most likely to find it difficult to express this feeling. What feelings are you most comfortable with when your partner expresses them? Can you think of a situation when you became uncomfortable or angry when your partner tried to express feeling? What was the feeling? What made you uncomfortable?

Time Out! For Men 63 4 Talk It Over, Part 1: Feelings and Needs Thank participants for their input. (“This is the kind of discussion that 4 separates the boys from the men, and there ain’t nobody but men here based on what I’ve heard. Thanks for being so honest, guys. Good job!”)

15 Discussion: Accepting Feelings

Use the next 15 minutes to highlight and discuss some key 1 issues about understanding and dealing with feelings in the Handout, p. 75 real world. Distribute the Accepting Feelings handout and use the prepared flip chart to lead the discussion. Encourage questions and provide clarification, as needed.

Flip chart Include the following points:

Learning to accept our own feelings and being able to accept what our partner may be feeling are equally important for a good, intimate relationship. Remember that we are discussing the acceptance of the feelings themselves, which may be different from accepting how people respond to or act on their feelings. In other words, I can learn to be okay with and accept it when my partner feels angry. However, if she decides to slap me because she’s angry, I don’t necessarily have to accept that kind of behavior. This goes both ways. I have the right to express my feelings to my partner—but I don’t have the right to express them in a way that is physically or emotionally hurtful to her. Let’s review some ideas or ways of thinking about feelings and emo- tions. As with most things, the more we understand, the more we are able to accept.

n A “feeling” is a powerful, body-based response. A feeling is a label we give to our physical reaction to a situation.

It is believed that all feelings originate in our bodies—that is, we really feel our feelings. As we experience the feeling, our brains try to put a label on it, often based on our bodily reactions (for example, increased heart rate, nausea, stomach sensations, sweaty palms, etc.). Some of our ways of describing feelings reflects this. ?or example:

u the “broken heart,” of sadness or depression may actually involve a heavy feeling in the chest from shallow breathing;

64 TCU/DATAR Manual 4 u being on “pins and needles” when we are anxious accurately describes the prickly feeling on the outer skin when an anxiety-producing situation causes circulation and blood pressure changes;

u a great loss or disappointment may indeed “just make me sick,” reflecting stomach sensations brought on by increased gastric juice production in response to the situation;

u fair-skinned folks may turn “as red as a beet” when an embarrassing or uncomfortable situation stimulates respira- tion and circulation changes;

u and being “hot under the collar” describes a physical sensa- tion that many of us experience when a situation results in anger or frustration.

Can you think of other examples? What are some physical sensations that you experience Discussion questions related to certain feelings?

Instead of thinking about feelings as complicated and mysterious, it may be more helpful to practice getting a “feel” for your feelings. Pay attention to your body’s reactions to situations—breathing, blood pressure, chest and stomach sensations, heartbeat, etc.—and begin to learn how to identify and accept what you are feeling at any given time.

n All feelings are valid. eelings serve a purpose.

Even when the actual feeling itself is pretty rotten or uncomfortable (for example, grief, shame, or embarrassment) it’s helpful to remember that feelings are part of being human. ?eelings are sort of like our barometer in life—they alert us when things are going well for us and when our needs are being met. Under these circumstances we may feel happy, content, peaceful, hopeful, etc. ?eelings also alert us when things are not going well, when our needs are not being met, or when our rights are being violated. ?or example, we might feel angry, afraid, sad, fed-up, suffocated, etc. Respecting feelings and under- standing that all feelings happen for a reason (both in ourselves and in others) can help us become more comfortable about acknowledging what we feel and accepting what others feel.

Time Out! For Men 65 4 Talk It Over, Part 1: Feelings and Needs What would happen to us if we experienced no feelings whatsoever?

Discussion questions Give an example of a situation when you realized how important feelings are.

n Allow yourself to feel your feelings. Allow others to feel theirs.

An important word to avoid thinking to yourself, or saying to others, when it comes to feelings is “should” (or “ought”). ?or example, when we say to others, even though we are just trying to comfort them, things like: “you shouldn’t feel that way,” “you shouldn’t let it upset you,” or “you should feel happy about that.” Or when we say to our- selves “I shouldn’t have felt so angry,” or “I’m a man, and a man shouldn’t feel scared,” or “I really shouldn’t be feeling this way.”

We feel what we feel—no one can argue with that. Other people feel what they feel. We can’t argue with that. Instead of trying to “rescue” others from their feelings or trying to hide or discount our feelings, it’s usually better just to take a deep breath (or two) and let feelings run their course.

Have you ever told someone, “you shouldn’t feel like that?” When we want to comfort or show support, how could we Discussion questions say it differently?

2 Conclude the discussion by adding: ?eelings come and feelings go. That’s the nature of feelings. In the course of a day and over the course of a lifetime, we experience many, many different feelings. And while it’s important to not burden our- selves or others with “should feel” and “should not” feel, an exception needs to be pointed out. Having certain unpleasant feelings “all the time,” with little let-up, constantly, day-in and day-out, is not healthy. ?or example, constantly feeling sad and depressed, or angry and rageful, or guilty and ashamed, without relief, will wear even the strongest man down. This kind of intensity in feelings needs some counseling, and in some cases maybe even some medication (anti- depressants) to help get things back on a more even keel. When it comes to behavior (what we do with our feelings), however, we must respect the restrictions implied by the word “should.” ?or ex- ample, it is unacceptable (to most individuals and to the law) to hit

66 TCU/DATAR Manual 4 others or use violence or threats just because we feel angry, jealous, or provoked. We can file hurting others because of what we’re feeling under “SHOULD NOT DO.” Likewise, others do not have the right to hurt us or hit us because they happen to feel “upset.” That’s acting on or acting out feelings, as opposed to being aware of them, accepting them as part of who we are, and then managing them like men (in- stead of kids). After the break, we’ll spend the rest of the session learning how to do just that. We’ll look at a skill-formula we can use in our relationships to help us manage our feelings, and express what we feel and what we need in a healthy way.

3 Thank participants for their input.

10 Break

Talk It Over Formula 25 Use the next 25 minutes to introduce the Talk It Over “formu- 1 las” that can be used to make requests, begin negotiations to resolve conflict, or express feelings and needs.

Begin by asking the group to explain the difference between I-Statements and You-Statements. Provide clarification, as needed. Include points about the importance of an assertive attitude, as well.

Here are some ideas to include in the discussion:

I-Statements are a major component in the skill of communicating effectively. Within intimate relationships, the ability to speak hon- estly to each other, listen (really listen), and resolve conflicts and problems in a way that leaves both people feeling content is critical. Unless couples are willing to learn the skills that allow this type of communication to happen, they’re likely to have a rough time in their relationship. The skill-formulas that we’re going to look at today can help build more effectiveness into how we handle important communication in our relationships. Keep in mind, there’s a lot of communication that goes on in relationships—we joke around, we talk about what to have

Time Out! For Men 67 4 Talk It Over, Part 1: Feelings and Needs for dinner, we share “gossip” or stories about our day with each other. Some communication is light and lively, and some communication is more critical or important. The Talk It Over method that we’ll discuss helps highlight skills for talking through the important stuff. ?or example:

u Sharing feelings or ideas important to either partner u Settling conflict and solving problems u Negotiating changes in behavior or attitude u Apologizing u Refusing requests

Let’s look at the steps (or structure) of the Talk It Over formulas and examples of how they sound when used.

Use the prepared flip charts to highlight the structure of the 2 Talk It Over formulas and discuss their uses in important Flip charts communication within relationships. Use masking tape or tacks to post charts on the wall after discussion so participants can refer back to them. Emphasize that although these “formulas” may seem awkward or artificial, like all skills they become easier to use with practice. Encourage participants to keep an open mind and give them a chance.

Declaring and Sharing Troubleshooting/Negotiating Example 1 Example 1 I feel bad I feel irritated about the fight we had last night when you nag at me for forgetting, because I realize I yelled at you. because I don’t mean to forget. I want to apologize. It would help me if you would write down Will you accept my apology? the things you want me to do each day. Can we give that a try? LISTEN LISTEN/NEGOTIATE

Example 2 Example 2 No, thanks. I feel too tired to go dancing tonight. I feel so frustrated I need to take it easy when you walk away during an Ever felt like you just couldn’t move argument another muscle? because it keeps us from solving our problems. LISTEN I need for you to stop doing that. Will you agree to try? LISTEN/NEGOTIATE

68 TCU/DATAR Manual 4 Emphasize the following points during the discussion:

The formulas follow the same steps, but there’s a different “twist” for each of them. In the first example, the formula steps are used to “share and declare” things with your partner (or others). This formula is helpful for telling others about your ideas and feelings, sharing your inner world, apologizing, or saying “no” (refusing). When you use the “share and declare” formula, you aren’t really asking for anything or expressing concern about a problem. You’re simply telling about yourself, your ideas, your feelings, or your intentions. And you’ll notice the formulas end with an invitation for feedback—a signal to the other person that you’re open to listening to them, too. Depending on the situation, include the steps or parts that seem right for what you are trying to express. ?or example: u “I felt really sad when I saw that TV program about orphans because it reminded me of a guy I used to play football with. Did I ever tell you about him?” u “I feel bad about the fight we had last night because I realize I yelled at you. I want to apologize. Will you accept my apology?” u “No, thanks. I feel too tired to go dancing tonight. I need to take it easy. Ever felt like you just couldn’t move? The formula steps are also used when you need to bring issues “to the table” to talk over with your partner. Most often, this includes ex- pressing your feelings or concerns about your partner’s behavior/ attitude, negotiating to make changes, or solving conflicts and prob- lems. These situations are sometimes more emotional than others because disagreement or conflict may be involved. In these situations, if both partners are willing to stay as calm as possible and use the formula steps to guide their discussion, a solution or compromise will be easier to get to. Here are some examples: u I feel irritated when you nag at me for forgetting, because I don’t mean to forget. It would help me if you would write down the things you want me to do each day. Can we give that a try? (Listen) u I feel so frustrated when you walk away during an argument because it keeps us from solving our problems. I need for you to stop doing that. Will you agree to try? (Listen) u I feel myself getting really resentful when we always have to do things your way because it feels like my needs don’t matter. I’d like for us to talk about ways we can compromise on some things. Will you sit down and talk this through with me? (Listen)

Time Out! For Men 69 4 Talk It Over, Part 1: Feelings and Needs As you can see, there are six (6) steps or parts to the Talk It Over technique. We state them in a style that is most comfortable for us. The main thing is to understand the reason for each step and why it’s important. l We want to let out what we are feeling in words, not actions (“I feel,” “I felt,” “I am starting to feel”). Sometimes all we can do is give the other person a sense of what we are feel- ing, based on what our bodies are telling us. ?or example, “I’m feeling tense,” or “I felt on edge all night,” or “I have a nice, warm feeling in my chest right now,” or “I can feel a lump in my throat when I think about home.” Other times, we may want to spend time thinking through the feelings, getting to their “root,” and then tell our partner about them. ?or example, “I started feeling really tense when you called your brother. When I thought about it I realized that I feel angry and worried when you call him because he’s still dealing.” l Occasionally, we may need to say “I don’t know what I’m feeling, exactly.” When we feel that way, we usually have to do some serious thinking to get to the “root.” Because we are all complex, we may feel more that one thing at once—even feelings that appear to be opposites, like happy and sad. (?or example, people cry at weddings.) When we state what we are feeling, it may be necessary to use more than one “feeling word”—we may need two or three to get our point across. l We also want to describe the behavior that is causing us a problem or concern. By staying focused on behavior, rather than making personal attacks or making assumptions about the other person’s motives, it is easier to stay focused on making changes and finding solutions to the problem. l It’s also helpful to clarify what’s going on for us, to help the other person better understand our position. This is often worded as “because ”. l Requesting a change or suggesting a possible solution helps keep the ball rolling toward resolution. l Inviting feedback or making a direct appeal for cooperation opens the door for the other person to give you their thoughts, and indicates that you are willing to listen. l Timing is important. It’s a good idea to make sure your partner has the time and energy to sit down with you and

70 TCU/DATAR Manual 4 use the formula to talk things out. ?or example, you might say: “Honey, something’s been bugging me and I need to talk about it—do you have a minute?” However, you can also use the formula right on the spot, if needed. ?or example, if you become angry, hurt, or frustrated about something, use the formula right on the spot to express your feelings in a respectful way, rather than holding in those feelings and stewing. l Another important thing to keep in mind is your body language and tone of voice. The Talk It Over formula is designed to smooth out communication and allow partners to express their honest feelings and needs. Avoid sending a “double-message.” Keep your tone of voice level, make eye contact, and avoid sarcasm and other roadblocks. Remember, this is not a formula for getting your way all the time, or for ordering your partner around. It’s an assertiveness tool. It gives you and your partner a “formula” for expressing feelings and asking for what each of you needs in an open, honest, and respectful manner.

Encourage discussion and practice by asking participants to 3 jot down an example of a relationship problem or issue they experienced recently. Go around the room and ask each person to briefly describe the issue, and then to practice how he would have responded had he used the Talk It Over technique. Provide guidance and clarification, as needed. Give lots of encouragement and compliments.

Process the discussion with a few of the following questions:

How did it feel to use this formula? What did you find most difficult about using the formula? Process questions In what ways do you think this technique might improve communication?

Time Out! For Men 71 4 Talk It Over, Part 1: Feelings and Needs

Practice: Using the Formula 25 Distribute the Talk It Over Formula handout and use the next 1 25 minutes to practice the formula, using case studies of

Handout, communication situations. Encourage a mix of both “request p. 76 making” and “declaring” uses for the formula. Use the provided Exercise, p. 77 case studies, or if your group is open to it, ask them to suggest more “real life” situations to practice with. Work on one case study or situation at a time, calling on volunteers to practice using the formula. Encourage group mem- bers to provide constructive feedback to each other after each practice. Re- mind them to pay attention to body language, tone of voice, and maintaining an assertive attitude, as well as the parts of the formula itself.

After practicing with a couple of case studies, you may want to suggest that group members role play with each other in order to practice the listening and negotiating component, as well. Role play can be an effective technique for allowing people to practice skills and put those skills into their own styles. You’ll need to judge for yourself whether or not your group would be comfortable with role play. (?or more suggestions on role play, see article in Appendix B, pp. 183-185). 2 Process this exercise using some of the following questions: Was it easy or hard to apply this formula? What did you have the hardest time with? Process questions What do you think is most helpful about using this formula? How will you be able to use this formula in “real life?”

Thank participants for their input. (“Good job, guys. Learning a new 3 way of doing things is always challenging—you all did great!”)

Provide closure by wrapping up on some of the key points 4 raised during the session.

Here are some ideas for closing comments:

We’ve spent today’s session exploring some of the “heavier” issues involved in improving communication in our relationships. In order to

72 TCU/DATAR Manual 4 be close and stay close with someone we care about, we have to be willing to be brave and share what we feel in a positive way. As men, many of us have had a lifetime of avoiding our own feelings and being uncomfortable with our partner’s feelings. In order to have stronger relationships and a stronger recovery, we’ve got to take a chance and begin growing beyond that. We’ve touched on a couple of skills or techniques we can begin practic- ing that will help. I know that these techniques may seem silly and feel really awkward—that’s normal because they’re new. All we’re suggesting here is that you give it a chance, give it a try. Remember, too, to keep working on an assertive attitude. It’s an attitude of mutual respect, openness, being willing to listen, and being willing to compromise. 5 Highlight next session: Next week we’re going to continue looking at ways to express our- selves clearly in relationships. We’ll look at how to apply these new skills to resolve conflict with our partners. Today we learned the foundation. Next week, we’ll learn how to use it in “tough” relation- ship situations.

10 Homework: Talk It Over Practice

Introduce the homework assignment and distribute Talk It 1 Over Practice handouts. Homework, p. 78 Your assignment for the coming week is to share the ideas you learned today with your partner. Talk to her about I-Statements and the Talk It Over formula, and show her how it works. Hang the handouts describing I -Statements and the steps for the Talk It Over formula where you both can see them during the week (on the refrigerator or the bathroom mirror). Practice using these techniques in your day-to-day dealings. The only “rules” are to be patient and understanding with each other. Don’t get hung up arguing or debating about who used the formula correctly and who didn’t. (Keep on using your “listening” staff, since that will help you both stay focused on listening). Remember that you are both trying to learn a new skill, a new way of doing things. Nei- ther of you is expected to be perfect at it—just give it an honest try. I think you may find that after a while it will get easier.

Time Out! For Men 73 4 Talk It Over, Part 1: Feelings and Needs

Thank participants for attending and invite them back next 2 week.

Ask each person to complete an evaluation form before leav- 3 ing. Evaluation, p. 79

74 TCU/DATAR Manual 4

ACCEPTING FEELINGS

A “feeling” is a powerful, body-based response.

A feeling is a label we give to our physical reaction to a situation.

All feelings are valid.

eelings serve a purpose.

Allow yourself to feel your feelings.

Allow others to feel theirs.

Time Out! For Men 75 4 Talk It Over, Part 1: Feelings and Needs The Talk It Over ormula

I feel ______I felt ______

When you ______About______

Because ______

I want ______It would help me if______Let’s try______

Will you agree?

LISTEN

76 TCU/DATAR Manual 4

Case Studies Talk It Over with I-Statements

Your partner is in the habit of leaving clothes all over the house. Half the time the place looks like a tornado hit it, and it’s embarrassing when friends drop by. You want your partner to pick up her clothes.

Your partner frequently keeps you waiting, especially when you both are leav- ing the house together. It’s a little thing, but it gets on your nerves. You want to tell her how you feel about it.

Your partner is forgetful. You’re never sure if she is going to remember impor- tant details, like paying the light bill. You want her to work on this problem.

Your partner is moody. Sometimes you feel like you’re walking on egg shells around her. You can’t tell what’s going to set her off. You want her to know how her mood is affecting you.

Your partner doesn’t get along with one of your cousins. She sometimes puts this person down. You like your cousin and don’t like listening to her put him down.

Your partner has been sick lately, but she refuses to go see a doctor. You’re worried about her. You want to tell her about it.

You have been feeling frustrated and irritable lately. You can tell that your partner is put-off by your mood. You want to tell her that you’ve had a lot on your mind lately.

Your partner is very “mothering” toward you. You know she’s just trying to be nice, but it gets on your nerves. You want her to chill.

Your partner has trouble handling money. You’re on a tight budget, and her spending is getting out of hand. You want her to stick to the budget.

Your partner often forgets to put gas in the car. Yesterday, you ran out of gas on the way to work and your boss got mad. You want your partner to be more mindful of keeping gas in the car.

Time Out! For Men 77 4 Talk It Over, Part 1: Feelings and Needs

Session 4 Homework Talk It Over Practice Partner Information

Here are some communication skills to practice during the coming week.

Practice using the Talk It Over formulas when you have something to say or to suggest new ways of doing things to avoid problems:

Troubleshooting and Negotiating Declaring and Sharing

The feeling I feel ______The -eeling I feel ______I felt______I felt______

The behavior When you ______The Event About ______About ______When I______When you______Clarify Because______Clarify Because______

Request/Suggest I’d like______Declaration I want______I want______I need______It would help me if___ I hope______I just wanted to tell Seek feedback Will you agree to try? you about it. Is this okay with you? How about it, honey? Welcome Do you understand? feedback Have you ever felt that way? LISTEN/NEGOTIATE Can you accept this? Or give a smile or a hug.

LISTEN

Example

I feel irritated Example when you nag at me for forgetting, I feel bad because I don’t mean to forget. about the fight we had last night It would help me if you would write because I realize I yelled at you. down the things you want me to do each day. I want to apologize. Can we give that a try? Will you accept my apology? LISTEN/NEGOTIATE LISTEN

78 TCU/DATAR Manual 4 SESSION EVALUATION Time Out! For Men Session 4

THIS BOX IS TO BE COMPLETED BY DATA COORDINATOR:

SITE # |__|__| CLIENT ID# |__|__|__|__| DATE: |__|__||__|__||__|__| COUNSELOR ID# |__|__| [1-2] [3-6] MO DAY YR [7-12] [13-14]

INSTRUCTIONS: Please take a minute to give us some feedback about how you liked this session.

1. Use one word to describe your reaction to today’s class. ______

2. What is the most important thing you learned today?

3. How might using the Talk It Over formula help your relationship?

4. On a scale of 1 to 10, how do you rate today’s class? (Circle your rating)

01 02 03 04 05 06 07 08 09 10 |__|__| [15-16] Poor Pretty Good Excellent

5. Do you have any suggestions to help make this class better?

Time Out! For Men 79

5

Talk It Over 5 Part 2: Resolving Conflict Session Length: 2 hours

Objectives Understand common issues involved in partner conflicts Identify rules for “fair fights” and negotiation

Discuss and practice a conflict resolution model

Rationale The ability to resolve relationship conflicts in a way that improves intimacy rather than weakens it is an important skill. Unsettled or recurring conflict creates emotional turmoil in relationships that can work against recovery. This session seeks to introduce men to a model for conflict resolution, emphasizing solutions rather than blame. The importance of “fighting fair” and active prob- lem solving is highlighted and assertiveness skills are reviewed.

Session Procedure Time

Outline Welcome and Process Homework 10 minutes

Conflict in Relationships 25 minutes

Conflict Resolution Skills 25 minutes

Break 10 minutes

Exercise: Conflict Case Studies 40 minutes

Homework:
ighting
air 10 minutes

Total Time for Session 5 120 minutes

Time Out! For Men 81 5 Talk It Over, Part 2: Resolving Conflict Materials Easel and flip chart (or chalkboard) Magic markers; pencils, pens, writing paper Prepared flip chart Conflict Areas Prepared flip chart ighting air Prepared flip chart Steps for Conflict Resolution Prepared flip charts Talk It Over ormula (Session 4) Prepared flip chart Using I-Statements (Session 2) Copies of handouts

Preparation Notes Prepare Conflict Areas flip charts Write out the key points on a large piece of flip chart paper No Problem Areas or poster board, as shown:

Problem Areas

BIG Problem Areas

Fighting Fair Write out key points on a ighting air large piece of flip chart paper or poster board, as shown: Keep the fight in the present.

Be specific about the problem.

Don’t hit below the belt.

Violence is not okay.

82 TCU/DATAR Manual 5 Steps for Conflict Resolution Write out the outline Steps for Conflict Resolution on a large piece of flip chart paper Define problem. Write it out. or poster board, Tell your partner what you want or as shown: need. Listen to your partner’s wants and needs. Agree on the problem. Write it out. Make a list of possible solutions. Evaluate the solutions, agree on the best one. Take action.

Photocopy ighting air (handout, p. 93) handouts Steps for Conflict Resolution (handout, p. 94) Conflict Resolution Worksheet (handout, p. 95) Conflict Case Studies (exercise, p. 96) Ten Rules for Avoiding Intimacy (handout, pp. 97-99) ighting air (homework, p. 100) Conflict Resolution Worksheet (extra copies for homework) Session Evaluation (form, p. 101)

Procedure 10 Welcome and Process Homework

Welcome participants as they arrive.

Use the first 10–15 minutes to review and process the home- 1 work assignment. Begin by reviewing a few key ideas from the previous session.

Last week we looked at a couple of techniques for improving communi- cation in relationships. Rather than avoid discussing our feelings with our partners, it’s important to talk things over. This is part of an assertive attitude—we show respect for ourselves and for our partners when we’re honest about what we feel and what we need.

Time Out! For Men 83 5 Talk It Over, Part 2: Resolving Conflict Using I-Statements (instead of You-Statements) is an important communication skill. Also, the Talk It Over formula for getting our feelings out in the open and suggesting solutions to problems opens the door for more positive communication. Let’s talk for a few minutes about how things went practicing these skills:

Ask for volunteers to share their experiences with the home- 2 work. Here are a few questions to start the ball rolling:

How did using the Talk It Over formula work out? What kinds of issues did you discuss with your partner? Process questions How did your partner respond? What did you find most difficult about using these skills? What was most beneficial? What did you learn from the homework?

Thank volunteers for their input. (“Good going, guys. Keep up the 3 good work.”)

Conflict in Relationships 25

Use the next 20–25 minutes to discuss the nature of conflict 1 in relationships and common causes of conflict.

Make the following points in opening the discussion:

Conflict in relationships is a reality of life. By conflict we mean prob- lems, disagreements, arguments, etc.—anything that sends your relationship “ship” out into rough waters. In truth, there’s no way around conflict. If you live with someone, have a close relationship, or have emotional or social ties, sooner or later, there will be conflict. Since all people are different and have different needs, wants, beliefs, and opinions, it’s fair to say that conflicts are bound to occur. If we expect life to be free of conflict, we are setting ourselves up for disap- pointment and grief. A better approach is to accept conflict as a natural part of life. Conflicts may be unpleasant, but they can be dealt with in a way that actually strengthens relationships. Resolving

84 TCU/DATAR Manual 5 conflict peacefully is a skill that most people can master. The key is to be honest, to listen, and to compromise—in other words, to approach conflict with an assertive attitude. In today’s session we’ll explore ways of resolving conflict peacefully. Learning to “fight fair,” (and helping our partners learn to “fight fair” with us) will bring us closer together. After a fair fight, we are less likely to feel resentful, frustrated, or hopeless—emotions that can build up and threaten recovery. Let’s talk about the nature of conflict.

Use prepared flip chart of Conflict Areas to discuss areas of 2 conflict and non-conflict in relationships. Provide examples and Flip chart encourage discussion. Use space on flip chart to list issues raised by partici- pants in response to the discussion questions for each area. These can be revisited during the second half of the session when conflict resolution skills are practiced.

Include the following points in the discussion:

No Problem Areas

These areas are pretty self-explanatory. It’s smooth sailing. In these areas of the relationship, things are “clicking.” It includes issues in your relationship that you and your partner agree on and are both satisfied with. It can also include choices, decisions, or plans that you have no strong feelings about. @or example, grabbing a hamburger at Wendy’s vs. McDonalds’, wearing the blue shirt instead of the green one, or visiting your cousin on Saturday.

What “no problem” areas can you identify in your relationship (or from past relationships)?

Process questions What happens in your relationship that you want to have continue to happen?

Problem Areas

These are the rough water areas. One or both partners is unhappy about something. There’s conflict of interest. This includes situations in which either partner feels their rights have been stepped on, their needs have not been met, and/or their feelings have not been consid- ered. Remember, both people in the relationship have rights, and both

Time Out! For Men 85 5 Talk It Over, Part 2: Resolving Conflict have legitimate needs and feelings. Here are some examples of rights both partners have:

u The right to express thoughts, feelings, or opinions (in ways that don’t hurt or humiliate others) u The right to ask for what you want or need

u The right to ask others to change their behavior

u The right to refuse requests or reject ideas

u The right to be treated with respect

Keep in mind that the right to express or ask does not mean that either partner has the right to expect that all their ideas should be accepted or that they should always get everything they want or ask for. Both parties also have the right to refuse or to reject ideas. Obvi- ously, this can lead to conflict. The key to resolving conflict maturely is treating each other with respect—a right both partners have.

What types of conflicts do you and your partner sometimes have (or what type of conflicts do you remember from past

Process relationships)? questions What’s difficult about solving these kinds of problems?

Big Problem Areas

If problem areas are the “rough” waters of relationships, then big problem areas are the hurricanes. These areas are very difficult to resolve, and too many of them may signal that the healthiest thing for both people is to leave the relationship behind. Most often these are not conflicts about day-to-day things (like doing chores or handling routine disagreements). These conflicts involve a collision of values or the realization that the other person is unwilling or unable to change despite repeated requests. It also may involve a personal realization that you are unwilling or unable to change. @or example, a partner who won’t respect your recovery program, a partner who continuously lies or steals, or a partner who is violent are types of “big” problem areas that may represent a conflict of values and be very difficult to resolve.

What “big” problem areas have you run across in relationships? What makes these types of conflict so hard to resolve? Process questions

86 TCU/DATAR Manual 5 Thank participants for their involvement. Mention that the re- 3 mainder to the session will focus on learning skills to help resolve the most common types of conflicts found in relationships.

Conflict Resolution Skills 25 Use the next 20–25 minutes to review assertiveness and in- 1 troduce conflict resolution skills. Encourage discussion and offer examples, as needed.

Conduct a brief review of the “assertive attitude” (versus 2 passive or aggressive attitudes), I-Statements, and the Talk It Flip chart Over formula. Post flip charts from previous sessions to help refresh participants. Ask members to tell you what key points they remember. Clarify as needed.

Distribute handout Fighting Fair, and use a flip chart outline of the 3 material to discuss guidelines for handling disagreements fairly. Handout, p. 93 Include the following points in the discussion:

Conflict is a natural and unavoidable fact of life. Even in the closest relationships, people rarely agree about everything. The issues and problems people fight about are varied and may change over time, but no matter what the issue, a style of “fair fighting” can be used so that loving feelings are not destroyed, and both people are able to resolve the issue satisfactorily. Whatever the conflict, it’s important to keep “fair fighting” guidelines in mind whenever you have a disagreement, argument, or conflict with another person. Here are some of the most important ones: Keep the fight in the present: Discuss and resolve the issue or problem at hand. Avoid reaching back into the past and bringing old, unresolved anger and hurt feelings into the present argu- Flip chart ment. Stay focused on today’s problem. Be specific about the problem: Don’t expect the other person to be a mind-reader. State your side of the issue clearly and honestly. Avoid statements like “You should know what’s wrong,” or “You know what I’m talking about.” Don’t hit below the belt: It’s unfair and destructive to attack your partner on things she is sensitive about. People we care

Time Out! For Men 87 5 Talk It Over, Part 2: Resolving Conflict about often tell us about the things that hurt and trouble them, and it’s unkind to bring those issues into a fight to score a point or knock the other person off-guard. Violence and physical abuse are not okay: @irst of all, it won’t resolve the problem, only make it worse. No matter how angry you are, or how justified your anger, you never have the right to physically hurt or harm others.

When we finally sit down to discuss a problem, and work out a solu- tion, the most helpful thing for the relationship and for our own sense of well-being is to find a solution both parties feel good about. There are three possible outcomes of any conflict: (List on chalkboard or flipchart.) Win-Lose: In this case, one partner “wins” and the other partner “loses.” One person is satisfied and gets what he wants, the other person loses out on what he wants. This is not the best outcome, because the “loser” may come away with unresolved angry feelings. @or example, Jane and her partner Jack decide to eat out. Jane wants to eat at a salad bar buffet and Jack wants to eat at a sit-down restau- rant. They end up eating at the buffet, so Jane “wins” and Jack “loses.” Their relationship may suffer over time, especially if one is always the “winner” and the other is always the “loser.” Lose-Lose: In this case, both parties lose. Neither person is satisfied with the outcome. In the case of Jane and Jack eating out, an example of lose-lose would be if they both became so angry trying to decide on a place to eat they end up deciding not to eat out at all. Most of the time, lose-lose is brought about when people agree to accept compro- mises that are really unacceptable to both. This usually means they haven’t spent enough time negotiating and exploring alternative solutions. Win-Win: This happens when both parties “win” by finding a solution in which at least some of each person’s needs are met. In the case of our dinner partners, Jane and Jack, an example of win-win might be deciding to eat at a sit-down restaurant that also has a buffet salad bar. In this case, both Jane and Jack “win” and have their needs satisfied. It usually takes time and energy to discover a workable win-win solution acceptable to both people, but in the end, it’s worth it. It does little good to win a fight if it means losing the relationship. The key word in finding a win-win solution is compromise. In most cases, a win-win solution to conflict or disagreement helps strengthen relationships and resolve angry feelings. When we negoti- ate with others, staying focused on fairness and compromise rather than victory is important. Assertive negotiation recognizes the impor- tance of our rights, as well as the importance of the rights of others.

88 TCU/DATAR Manual 5 However, be aware that all of us have some issues around which we are unwilling to compromise. Often these are in areas where one person’s values conflict with the others. @or example, if my partner wanted me to get involved in drug activity, criminal activity, or some- thing else dangerous or harmful, I might draw the line. That’s an area of my life that is not open to compromise. In this case, I accept the benefit of a win-lose outcome. I will insist on “winning” in the sense that I refuse any involvement in those activities, and I also refuse to even discuss or negotiate the point. @or the most part, these “non negotiable” issues are rare. Most of the common disagreements and conflicts we experience in relationships are open to a win-win out- come if we give it a chance. Next, we’re going to talk about and practice some steps that can help us resolve conflicts in a win-win way.

Distribute handout Steps for Conflict Resolution, and use flip 3 chart outline of the material to lead a discussion on using the Handout, p. 94 formula to resolve conflict. Provide examples, and model assertive alternatives for working through each of the steps. Answer questions and provide clarification, as needed.

Include the following points:

When a conflict or problem comes up in your relationship, remember to point your thoughts toward fair solutions, rather than “winning” or arguing about whose “fault” the problem is. @ollow these steps: Flip chart

1. Define the problem and write out how you see it. This may be simple or complex. Try to define exactly what the problem is from your point of view. Think of one or more solutions that will resolve the problem for you. 2. Tell your partner what you want or need. Use I-statements, and an assertive style to state your case. Make your statements descriptive of the issues involved. Don’t judge or blame your partner. @ocus on behavior that can be changed and on solutions. 3. Listen to your partner’s wants and needs. Listen carefully, ask for clarification, don’t interrupt. Show respect for your partner by listening to her thoughts and feelings on the subject. Restate your understanding of your partner’s viewpoint to make sure you really understand what she wants or needs. 4. Agree on the problem. After both partners have stated their needs and wants, create a shared definition of the problem that needs

Time Out! For Men 89 5 Talk It Over, Part 2: Resolving Conflict to be solved. Write it out. Be specific. Make sure you both agree what the problem is. 5. Make a list of possible solutions. Working together, both people can brainstorm as many solutions as they can think of that will satisfy both of their needs and wants. Both partners must agree to remain open, be honest, and not be defensive. 6. Evaluate the solutions, and agree on the best one. Once all the possibilities are on the table, both partners discuss them. Each solution is looked at in terms of its ability to satisfy some of the wants and needs of both people equally, based on their shared definition of the problem. A solution is agreed on, and a plan of action is discussed and agreed on. The plan should outline action steps required and who’s responsible for doing what. 7. Take action on the solution. Implement the solution by follow- ing the action steps decided on during negotiation. Keep the lines of communication open so that each partner is free to speak up if the plan is not working. Be prepared to try another solution if the first one doesn’t work.

Thank participants for their attention. Tell them they’ll have a 4 chance to practice using this formula after the break.

10 Break

40 Exercise: Conflict Case Studies Use the next 40 minutes for conflict resolution practice. Ask 1 participants to choose a partner, and distribute a Conflict Worksheet, p. 95 Resolution Worksheet and a Conflict Case Study to each pair. Case Examples of “conflict case studies” are provided; however, you can generate Studies, your own, or ask participants to brainstorm examples of personal conflicts p. 96 they would like some help with. To lead the exercise:

n Ask participants to read their case study, and then to choose the “part” they want to represent in the case study. n Next, ask the pairs to role play their case study, working through the Steps for Conflict Resolution. The only rules are that they must follow the steps, and they must use assertive communication and listening skills to help reach a resolution.

90 TCU/DATAR Manual 5 n When pairs finish their role play, instruct them to complete their Conflict Resolution Worksheet to recap the issues that came up during the role play.

Process the exercise using the following discussion ques- 2 tions: How did it feel to do this exercise? Were you able to reach a “win-win” solution to the problem? Process questions What helped you get to “win-win?” What part did listening play in your problem-solving? How would you describe your past conflict resolution style? In what ways will this method improve how you manage conflict in the future? 3 Conclude the discussion using the following points: Conflict is a part of life, and it can be dealt with in a constructive way that enhances relationships rather than destroys them. The key is to address and deal with conflict when it happens. If we ignore areas of conflict, we set ourselves up for bad feelings, health problems, low self- esteem, and a lot of frustration. When dealing with conflict, it’s important to remember that resolution is the key. Recognizing and accepting anger during conflict is impor- tant, and it’s also important to express and talk about angry feelings that either partner may experience. However, “true relief” comes only through resolution of the problem or situation that sparked the anger. Sometimes, we are able to resolve anger by simply talking it through, either inside our heads, or with a third party. In other cases, we may need to use conflict resolution skills and work with our partners to solve the problem satisfactorily.

Thank participants for their involvement. Distribute handout 4 Ten Rules for Avoiding Intimacy, and invite participants to Handout, pp. 97-99 read it over and to share it with their partners.

Time Out! For Men 91 5 Talk It Over, Part 2: Resolving Conflict

10 Homework: Fighting Fair

Use the last 10 minutes to introduce the homework assign- 1 ment. Distribute extra copies of the Conflict Resolution Homework, p. 100 Worksheet (2 extra copies per participant). 2 Use the following instructions to introduce the homework: u Your take-home assignment for this session is to go home and have a fight with your partner. Well, not exactly, but your as- signment is to pay attention during the week to naturally occur- ring conflict in the relationship. u When you get home, share the handouts from today’s session with your partner, and tell her some of the things that we discussed here today. Go over the ighting air points, and discuss the steps for Conflict Resolution. u When there is a conflict during the week, pull out these handouts, and use them to find a solution to the conflict. Use the Conflict Resolution Worksheets to make notes about how the “fight” was settled in a “win-win” way. u Ideally, you’ll complete two of the worksheets. One for a problem that you bring to your partner, and one for a problem that your partner brings to you.

Thank participants for attending and invite them back next 3 week.

Ask each person to complete an evaluation form before leav- 4 ing. Evaluation, p. 101

92 TCU/DATAR Manual 5

Fighting Fair

Keep the fight in the present: Discuss and resolve the issue or prob- lem at hand. Avoid reaching back into the past and bringing old, unresolved anger and hurt feelings into the present argument. Stay focused on today’s problem.

Avoid “gunnysacking”: Make sure the conflict and your anger are resolved by dealing honestly with issues and problems as they come up. Don’t store up all your anger and grievances in a “gunnysack” then suddenly explode.

Be specific about the problem: Don’t expect the other person to be a mind-reader. State your side of the issue clearly and honestly. Avoid statements like “You should know what’s wrong,” or “You know what I’m talking about.”

Don’t hit below the belt: It’s unfair and destructive to attack the other person on issues he/she is sensitive about. People we care about often tell us about the things that hurt and trouble them, and it’s unkind to bring those issues into a fight to score a point or knock the other person off-guard.

Violence and physical abuse are not okay: &irst of all, it won’t re- solve the problem, only make it worse. No matter how angry you are, or how justified your anger, you never have the right to physi- cally hurt or harm another human being.

Time Out! For Men 93 5 Talk It Over, Part 2: Resolving Conflict

Steps for Conflict Resolution

1. Define the problem and write out how you see it. Try to define exactly what the problem is from your point of view.

2. Tell your partner what you want or need. Use I-statements and an assertive style to state your case. Don’t judge or blame your partner. &ocus on behavior that can be changed and on solutions.

3. Listen to your partner’s wants and needs. Listen carefully, ask for clarification, don’t interrupt. Show respect for your partner by listening. Restate your understanding of your partner’s viewpoint and what he/she wants or needs.

4. Agree on the problem. After both partners have stated their view- points, create a shared definition of the problem. Write it out. Be spe- cific. Make sure you both agree.

5. Make a list of possible solutions. Working together, brainstorm as many solutions as you both can think of that will satisfy at least some of your needs. Both partners must agree to remain open, be honest, and not be defensive.

6. Evaluate the solutions and agree on the best one. Each solution is looked at in terms of its ability to satisfy some of the needs of both people equally, based on their shared definition of the problem. Agree on a solu- tion, and make a plan to put it into action. The plan should outline action steps required, and who’s responsible for doing what.

7. Take action on the solution. Put your solution into action. Keep the lines of communication open so that each partner is free to speak up if the plan is not working. Be prepared to try another solution if the first one doesn’t work.

94 TCU/DATAR Manual 5 Conflict Resolution Worksheet

1. How was the problem defined by the person presenting the problem?

2. How were the wants or needs of the presenter stated?

3. What needs did the receiving person present?

4. What possible solutions did you brainstorm together?

5. How did you evaluate the solutions?

6. What solution was agreed on?

7. What “test” period did you agree on?

8. Did the solution meet at least some of both people’s needs?

Time Out! For Men 95 5 Talk It Over, Part 2: Resolving Conflict Conflict Case Studies

Case Study # 1

John and Mary are married and both of them have equal paying jobs. John has a concern about how Mary spends money. A least once or twice a week, Mary likes to go to the mall shopping, and she seldom comes back empty handed. John would like for them to be saving more money to buy a house. In this study, John is the presenter of the problem and Mary is the receiver.

$______

Case Study # 2

Joe and Thelma are the parents of a two boys. One child is 9 years old and the other child is 13. Thelma has a problem with Joe’s reluctance to take a part in disciplining the children. Often, when Thelma lays down a rule for the boys, they go to Joe, who then gives them permission to break her rule. Thelma would like more support and cooperation from Joe. In this study, Thelma is the presenter of the problem, and Joe the receiver.

$______

Case Study # 3

Sammy and Elena have been in a relationship for 10 years and really care about each other. Sammy is working full time and Elena has a part-time job. Elena has a problem because Sammy always has the car that they must share. He even refers to it as “my car,” even though they bought it together. Elena often feels angry because she seldom gets to use the car. In this study, Elena is the presenter of the problem and Sammy the receiver.

$______

Case Study # 4

Cathy and Freddie are married and trying to get by on Freddie’s job. Cathy comes from a very large family with 9 brothers and sisters and a score of nieces, nephews, aunts, uncles. Most of her relatives live in another city, and Cathy very often invites them to come and visit. It seems her offer is taken up a lot, because to Freddie’s mind, the house is always full of Cathy’s relatives. They are nice people, but they seldom offer to chip in and pay for groceries, gas, etc., when they visit. Freddie is starting to feel angry about this situation. In this study, Freddie is the presenter of the problem and Cathy the receiver.

$______

Case Study # 5

Joe and Laura are room-mates, sharing a large, old house in the country. Both of them really enjoy living outside the city and having plenty of space for gardens, horses, and pets. Joe is having a problem with Laura because Laura often goes to stay with her friends in the city. Joe respects Laura’s right to live her own life, however, Joe ends up stuck with all the chores, housework, tending of the garden, and feeding the ani- mals. Joe is fed up. In this case, Joe is the presenter of the problem and Laura is the receiver. 96 TCU/DATAR Manual 5

Ten Rules For Avoiding Intimacy Bryan Strong

If you want to avoid intimacy, here are ten rules that have proven effective in nationwide testing with men and women, husbands and wives, parents and children. Follow these guidelines and you’ll never have an intimate relationship.

Don’t Talk

This is the basic rule for avoiding intimacy. If you follow this one rule, you will never have to worry about being intimate again. Sometimes, however, you may be forced to talk. If you have to talk, don’t talk about anything meaningful. Talk about the weather, baseball, class, the stock market—anything but feelings.

Never Show Your Feelings

Showing your feelings is almost as bad as talking because feelings are ways of communi- cating. If you cry, show emotion, express sadness or joy, you are giving yourself away. You might as well talk, and if you talk you could become intimate. So the best thing to do is to remain expressionless (which, we admit, is a form of communication, but at least it’s giving the message that you don’t want to be intimate).

Always Be Pleasant

Always smile, always be friendly, especially if something’s bothering you. You’ll be sur- prised at how this will prevent you from being intimate because you can hide negative feelings from your partner. It may even fool your partner into believing that everything’s okay in your relationship. Then you don’t have to change anything to be intimate.

Always Win

Never compromise, never admit that your partner’s point of view may be as good as yours. If you start compromising, that’s an admission that you care about your partner’s feelings, which is a dangerous step toward intimacy.

Source: ©ETR Associates. All rights reserved. Reprinted with permission from Family Life Educator, 4(2) 1985, ETR Asssociates, Santa Cruz, CA. For information about this and other related materials, call 1-800-321-4407. Web site: http://www.etr.org

Time Out! For Men 97 5 Talk It Over, Part 2: Resolving Conflict

Always Keep Busy

If you keep busy at school or work, your work will take you away from your partner and you won’t have to be intimate. Because our culture values hard work, your partner may never figure out that you’re using your work to avoid intimacy. Instead, he or she will think you’re a hard worker and consequently will feel unjustified in complaining. Inciden- tally, devoting yourself to your work will nevertheless give your partner the message that he or she is not as important as your work. This method is especially effective because you can make your partner feel unimportant in your life without even talking!

Always Be Right

There is nothing worse than being wrong because it is an indication that you are human. If you admit that you’re wrong, then you might have to admit that your partner’s right and that will make him or her as good as you. And if he or she is as good as you, then you might have to take your partner into consideration and before you know it, you’re intimate!

Never Argue

If you argue you might discover that you and your partner are different. And if you’re different, you may have to talk about the differences so that you can make adjustments. And if you begin making adjustments, you may have to tell your partner who you really are, what you really feel. Naturally, these revelations may lead to intimacy.

Make Your Partner Guess What You Want

Never tell your partner what you want. That way, when your partner tries to guess and is wrong (as he or she often will be), you can tell your partner that he or she doesn’t really understand or love you. If your partner did love you, then he or she would know what you want without asking. Not only will this prevent intimacy, it will drive your partner crazy as well.

Always Look Out for Number One

Remember, you are number one. All relationships exist in order to fulfill your needs, no one else’s. Whatever you feel like doing is okay. You’re okay—your partner’s not okay. You are beautiful just as you are; you are perfect. (The corollary to this is that your part- ner is not beautiful and is less than perfect.) If your partner can’t satisfy your needs, he or she is narcissistic; after all, you are the one making all the sacrifices in the relationship.

98 TCU/DATAR Manual 5

Keep the Television On

Keep the television turned on at all times, during dinner, while you’re reading, when you’re in bed, while you’re talking (especially if you’re talking about something important). This rule may seem petty compared to the others, but it is good preventive action. Watching television keeps you and your partner from talking to each other. Best of all, it will keep you both from even noticing that you don’t communicate. If you’re cornered and have to talk, you can both be distracted by a commercial, a seduction scene or the sound of gunfire. And when you actually think about it, wouldn’t you rather be watching “Miami Vice” than talking with your partner, anyway?

We want to caution the reader that this list is not complete. Everyone knows additional ways for avoiding intimacy. These may be your own unique inventions or those you learned from your boyfriend/girlfriend, friends, or parents. To make this compilation of rules more effec- tive, list additional rules for avoiding intimacy on a separate sheet of paper.

Bryan Strong, Ph.D., is adjunct lecturer in psychology at University of California, Santa Cruz. He is the author of two college textbooks: Marriage and amily Experience, 3rd edition, in press, and Understanding Our Sexuality, 1982, both published by West Publishing Company.

Time Out! For Men 99 5 Talk It Over, Part 2: Resolving Conflict

Session 5 Homework Fighting Fair Partner Information

Here are the instructions for practice during the coming week.

@ Your take-home assignment for this session is to go home and have a fight with your partner. Well, not exactly, but your assignment is to pay attention during the week to natu- rally occurring conflict in the relationship.

@ When you get home, share the handouts from today’s session with your partner, and tell her some of the things that we discussed here today. Go over the ighting air points, and discuss the steps for Conflict Resolution.

@ When there is a conflict during the week, pull out these handouts, and use them to find a solution to the conflict. Use the Conflict Resolution Worksheets to make notes about how the problem was settled in a “win-win” way.

@ Ideally, you’ll complete two of the worksheets. One for a problem that you bring to your partner, and one for a prob- lem that your partner brings to you.

100 TCU/DATAR Manual 5 SESSION EVALUATION Time Out! For Men Session 5

THIS BOX IS TO BE COMPLETED BY DATA COORDINATOR:

SITE # |__|__| CLIENT ID# |__|__|__|__| DATE: |__|__||__|__||__|__| COUNSELOR ID# |__|__| [1-2] [3-6] MO DAY YR [7-12] [13-14]

INSTRUCTIONS: Please take a minute to give us some feedback about how you liked this session.

1. Use one word to describe your reaction to today’s class. ______

2. What is the most important thing you learned today?

3. What parts of the “fighting fair” technique do you think are most useful?

4. On a scale of 1 to 10, how do you rate today’s class? (Circle your rating)

01 02 03 04 05 06 07 08 09 10 |__|__| [15-16] Poor Pretty Good Excellent

5. Do you have any suggestions to help make this class better?

Time Out! For Men 101

6

Man Talk: 6 It’s More than Plumbing Session Length: 2 hours

Objectives Explore how myths about sexuality impact sexual learning Understand male and female anatomy and reproductive functioning

Recognize symptoms of male sexual health problems

Rationale ew men have had the opportunity to learn basic, factual information about sexual and reproductive health. Often this gap has been filled by the myths born out of locker room talk and men’s magazines. This lack of solid informa- tion may result in unnecessary concerns about normal body functions, sexual response, and sexual functioning. This session seeks to provide men with a better understanding of human sexual anatomy, physiology, and functioning. In addition, issues related to overall health, such as cancer screenings and sexually transmitted diseases, are covered.

Session Procedure Time

Outline Welcome and Process Homework 10 minutes

Sexual Myths 25 minutes

Reproductive and Sexual Anatomy 25 minutes

Break 10 minutes

Men’s Health Issues 15 minutes

Sexually Transmitted Infections 25 minutes

Homework: Sexuality Myth Quiz 10 minutes

Total Time for Session 6 120 minutes

Time Out! For Men 103 6 Man Talk: It’s More than Plumbing Materials Easel and flip chart (or erasable board) Magic markers; pencils, pens, writing paper Illustrations of male sexual anatomy Illustrations of female sexual anatomy Prepared flip chart Steps for Testicular Self-Exam Prepared flip chart Symptoms of Prostate Problems Prepared flip chart Symptoms of Sexually Transmitted Infections Optional: Videos and slide presentations (see Preparation Notes) Copies of handouts

Preparation Notes Study amiliarize yourself with information about sexual and reproductive sexual health anatomy and physiology. Consult a textbook or see information on textbook human sexuality contained in Appendices A and B of this manual (pp. 155-218).

These appendices contain a brief summary of male and female anatomy, sexual functioning, and health issues, along with anatomical illustrations and handout materials on sexually transmitted diseases and contraception.

Prepare Steps for Testicular Self-Exam Steps for Self-Exam flip charts Write out the key points for testicular examination on a large 1. Visual examination in mirror piece of flip chart paper or 2. Manual examination in shower poster board, as shown: 4
eel surface of each testicle. 4 Gently slide testicle back and forth to examine all areas. 4
eel for small, hard lumps on side or front 4 Tumors are usually painless and easy to feel. 4 A lump or bumpy area should be checked by a doctor. 3. Testicular exam should be done once each month.

104 TCU/DATAR Manual 6 Symptoms of Prostate Problems Symptoms of Prostate Problems Write out key points for symptoms of prostate Urge to urinate frequently disease on a large piece of flip chart paper or Trouble urinating; trouble starting poster board, as shown: the flow Slow or dribbling flow of urine Strong ache or pain in pelvic area or lower back during urination Pain during ejaculation (“coming”) Pus in the urine; fever, chills

NOT ALL SYMPTOMS MAY BE PRESENT; SYMPTOMS MAY COME AND GO

Symptoms of Sexually Transmitted Infections Symptoms of Sexually Write out key points for Transmitted Infections symptoms of sexually trans- Sores, blisters, or warts on penis, mitted infections on a scrotum, or rectum large piece of flip chart paper Burning or pain when urinating or poster board, as shown: Pus or milky discharge from penis or rectum Swelling, inflammation, or pain in the testicles Weight loss, swollen glands, diarrhea, fatigue, fever, night sweats White patches or coating in mouth or throat

Teaching See Appendix B (pp. 222-224) for a list of suppliers of videos, slide aides presentations, pamphlets, and other teaching aides that may be used to present information about sexual health issues.

Photocopy Sexuality Myth Quiz (worksheet, p. 116) handouts Sexuality Myth Quiz Answer Sheet (handout, pp. 117-119) Male and female anatomy illustrations (Appendix B, pp. 186-189) Important Health Issues for Men (handout, p. 120-121) Sexuality Myth Quiz (extra copies for homework) Session Evaluation (form, p. 122)

Time Out! For Men 105 6 Man Talk: It’s More than Plumbing

Procedure 15 Welcome and Process Homework

Welcome participants as they arrive.

Use the first 10–15 minutes to review and process the home- 1 work assignment. Begin by reviewing a few key ideas from the previous session.

Last week we looked at a couple of ideas for managing conflict in relationships. We talked about “fighting fair” and the importance of “win-win” solutions to problems that allow both people to have their needs met. We also went over some steps for conflict resolution that require that we use all the communication skills—listening, assertiveness, I-statements, and negotiation. Let’s talk for a few minutes about how the homework assignment to practice conflict resolution worked out:

Ask for volunteers to share their experiences with the home- 2 work. Here are a few questions to start the ball rolling:

How did using the conflict resolution steps work out? What did you find most difficult about using this approach? Process questions What kinds of problems did you discuss with your partner? How did your partner respond to this approach? What did you learn from the homework?

Thank volunteers for their input. (“Good going, guys. Keep up the 3 good work.”)

106 TCU/DATAR Manual 6

Sexual Myths 25 During the next 20–25 minutes, lead a discussion on sexual 1 myths and the often inaccurate things we learn about sex as we grow up.

Here are some ideas for introducing the discussion:

Today we’re going to talk about sex. It’s a chance to learn about some things that most of us have never had a chance to learn about. It’s unfortunate that our society is uptight about the subject. It means that many of us never got good, factual information in school or at home. We ended up having to rely on movies, magazines, or what we heard in the locker room. Today’s session is a chance to ask questions and learn more about our bodies, women’s bodies, and issues that affect our health.

Ask participants to think back to when they were children. Ask for volunteers to share the very first thing they ever learned Process or were told about where babies come from. questions What were you told and who told you? What was your reaction?

There are a lot of myths out there about sex, anatomy, and reproduc- tion. A myth is a story that sounds believable but has no factual basis. A lot of myths come from folk beliefs, locker rooms, or sex magazines. Just for fun, let’s take a quick look at some of these myths and see if we can clear the air just a little.

Distribute Sexuality Myth Quiz worksheets and ask partici- 2 pants to complete them as quickly as possible. Reassure them Worksheet, that it’s not a test and that they don’t have to show their worksheets to any- p. 116 one. Handout, pp. 117-119 When participants have finished, go over the quiz items as a 3 group asking participants to volunteer their answers. Discuss correct answers to each question in detail using information from the answer sheet for the quiz. Encourage discussion and further questions. Conclude by distributing handouts of the Sexuality Myth Quiz answer sheet.

Time Out! For Men 107 6 Man Talk: It’s More than Plumbing

Reproductive and Sexual Anatomy 25 Use the next 20–25 minutes to review male and female re- 1 productive and sexual anatomy. Use handouts of anatomical drawings to illustrate the male and female reproductive sys- Illustrations, pp. 186-189 tems. Discuss where major organs are located and their function. Encour- age questions throughout your presentation.

Here’s an idea for leading into the discussion:

Many times when sexual problems happen in relationships, one underlying cause is a simple lack of biological information. Counselors who work as sex therapists spend a lot of time just supplying couples with information about male and female bodies, how those bodies develop, and how those bodies are designed, by nature, to function. Sexual relationships between couples is more than just plumbing, but knowing about the plumbing is very important. So let’s start with the basics and review male and female sexual and reproductive organs, where they are located, and how they work. 2 Cover the following information: Male sexual anatomy Erections and ejaculation How the body changes during puberty ;emale sexual anatomy Menstruation; the menstrual cycle ;ertilization and pregnancy Childbirth Contraception (birth control methods)

Encourage questions and discussion. Move through the informa- 3 tion at an easy pace. Your main objective is to dispel mythology, provide accurate information, and encourage comfort with the topic. Men often are reluctant to admit that they have any questions or lack any factual knowl- edge. If you’re comfortable doing so, use self-disclosure about the misconcep- tions, misunderstandings, and concerns you yourself had before doing reading

108 TCU/DATAR Manual 6 and research for this session. Stress that learning about sexuality is a life- long process and all of us are confused or have questions from time to time. Attempt to normalize the importance of having a healthy curiosity about getting the facts straight. (Additional handouts on birth control methods are in Appendix B, pp. 198-208).

Note: You may prefer to use videos, slides, or a guest speaker. If you feel uncomfortable with the idea of presenting this material or being able to answer participants’ questions, a guest speaker may be a good idea. Local health departments, doctors, nurses, or family planning organizations such as Planned Parenthood are good sources for guest speakers. These groups also may be able to lend you appropriate videos or slide presentations.

10 Break

15 Men’s Health Issues

Use the next 15–20 minutes to review information about tes- 1 ticular and prostate health. Read the material in Appendix A (pp. 159-165) of this manual to help you cover these issues.

Here are some ideas for the discussion:

As we’ve seen from our discussion before the break, women’s anatomy and physiology is a little more complicated than our own. In general, women view their reproductive functioning as more of an overall health issue than we do. They experience a monthly period that requires special care (pads, tampons, etc.) and it sometimes makes them feel a bit uncomfortable or out-of-sorts for a few days. Women also should have annual examinations of their cervix, uterus, and ovaries to screen for cancer or other problems, and their breasts need special care as well. Women should learn to check their breasts each month for lumps because breast cancer is a real concern—about 1 in 9 women will develop breast cancer in their lifetime. Starting at about age 40, women need to begin having a mammogram every two years and after age 50 they should have a mammogram every year. A mammogram is a special X-ray that can detect breast cancer early. The point is that we are all fairly aware that women’s “plumbing” requires special health care—but what about men’s?

Time Out! For Men 109 6 Man Talk: It’s More than Plumbing As men, we’re lucky. Our plumbing is relatively trouble-free from a health perspective, but there are a few things we should pay attention to in order to stay healthy. The first one we’ll talk about is testicular cancer. Younger men (men 35 and under) are at risk for testicular cancer (cancer of the testicle). Testicular cancer is a rare form of cancer—but it is one of the most common cancers in men aged 15–35. Men in this age group should learn how to perform a monthly testicle examination, much like women examine their breasts. The most common symptoms of testicle cancer are a change in appear- ance or size of one testicle, a small, hard lump on the side or front part of the testicle, and sometimes a dull ache or feeling of heaviness in the groin area (the area between the navel and the pubic hair). Let’s review the steps for checking out the testicles for problems:

Briefly review the testicular examination steps. Use the pre- Flip chart 2 pared flip chart to focus attention on the steps. Encourage discussion and answer participants’ questions. Conclude by distributing the Important Health Issues for Men handout. Handout, pp. 120-121 Briefly review the symptoms associated with prostate prob- 3 lems. Use the prepared flip chart to focus attention. Encourage participants’ questions and discussion.

Flip chart Here are some ideas for discussion:

Another area of our sexual and reproductive machinery that we need to have knowledge about is the prostate gland. As we discussed earlier, this gland is located inside the pelvic area below the bladder. Here’s the bad news—most of us will have some kind of prostate trouble at one time or another in our lives. The older we get, the more likely we are to have a problem. The good news is that if we do have a problem, the symptoms are very easy to recognize. The most common prostate problems are infection, enlargement, and cancer. Cancer is most likely in men over 40. After age 40, a man should have his prostate checked each year by a doctor as part of a routine checkup. The symptoms for any prostate problem are very similar, so it’s a good idea to be familiar with the symptoms and to see a doctor if you de- velop problems.

110 TCU/DATAR Manual 6

Sexually Transmitted Infections 25 Use the next 20-25 minutes to review the most common 1 types of sexually transmitted infections and their symptoms.

Here are some ideas to include in the discussion:

The most common sexual health problem that we should be concerned about as men is sexually transmitted infections or diseases, often called STDs. We are all fairly familiar with HIV infection and AIDS because we hear about it in the media a lot. But each year there are millions of new cases of other STDs, and although most of them are not fatal like AIDS, they do cause a lot of pain, discomfort, and suffer- ing. Also, these diseases spread very easily. If a man has an infection he can spread it to his sex partner. Some of these diseases become serious in women. Another thing we should worry about is that if we pass an infection to our partner and she is pregnant or becomes preg- nant, the infection can be spread to our children. Some infections are very serious in newborns and may cause blindness, lung problems, brain damage, and even death. Sexually transmitted infections are very common, yet no one likes to talk about them. Part of the reason is shame. We somehow believe these diseases are “dirty,” mostly because of our discomfort with sex. STDs are no more “dirty” than any other disease. A cold infects our nose and throat because the germs that cause colds can take hold in those organs. A stomach flu takes hold in our stomachs and intes- tines, because that’s where those germs can live. And sexually trans- mitted diseases take hold in our genital and urinary organs only because that’s where those germs can survive. Colds are transmitted by sneezes, stomach flu by touching a contaminated surface and then touching your mouth, and STDs are transmitted by sex. STDs aren’t “dirty” diseases, they are simply “specialized” diseases. The germs invade a certain part of the body and that just happens to be the part of the body we use when we have sex. STDs aren’t “dirty” but they are serious.

Ask participants to tell you the STDs they have heard about 2 and what they have heard about them. List the diseases they mention and what they know about those diseases on flip chart paper or erasable board. The main idea is to clarify misconceptions and dispel myths

Flip chart and half-truths about these infections. You may want to use a video to cover this information.

Time Out! For Men 111 6 Man Talk: It’s More than Plumbing Give information on the following STDs:

Gonorrhea: Gonorrhea is caused by bacteria. In men, gonorrhea causes burning and pain during urination and pus or a thick discharge from the end of the penis. If left untreated it can go on to cause com- plications and scaring in the urinary tract. In some cases it can settle in the joints and cause a painful kind of arthritis. Women usually don’t have any symptoms of gonorrhea when they are first infected. Later they may develop a discharge from the vagina. If a woman goes too long without treatment she can develop a serious infection up inside in her ovaries and uterus. If she gets pregnant, the infection can be spread to the newborn baby during childbirth. Gonorrhea can be treated with antibiotics. Chlamydia: Chlamydia is a bacterial infection similar to gonorrhea. or the most part, it causes the same symptoms and problems as gonorrhea for both men and women. If a woman is infected, her newborn may become infected during childbirth. Chlamydia also can be treated with antibiotics. Herpes: Herpes is caused by a virus. There’s no cure for herpes. Herpes causes clusters of small, painful, fluid-filled blisters on the sex organs or around the rectum. These blisters take about 6 to 8 weeks to heal. Once infected with herpes, people may have outbreaks of the blisters several times a year. If a woman has herpes her newborn may become infected during childbirth. Herpes is very serious for new- borns and can cause brain damage, nerve damage, blindness, and death. Syphilis: Syphilis is caused by bacteria that enter the blood stream during sexual contact. It is a very serious disease and can cripple and cause death if not treated. The first symptom is the appearance of an ulcer or sore called a chancre (pronounced “shanker”). This ulcer is painless and usually shows up on the penis or in the genital area. It lasts about 2–4 weeks then heals itself. But the disease stays. Later on, symptoms may include hair loss, a rash on the body (including the palms of the hands and soles of the feet), swollen glands, and flu-like symptoms. After that there are no symptoms, but the disease is still there. It can destroy the heart, brain, spinal cord, and circulatory system. If a woman is pregnant or gets pregnant when she has syphi- lis, her newborn will become infected. The disease can cause death, deformity, and other problems in newborns. Syphilis can be easily treated with antibiotics. It must be treated early in order to avoid serious damage. Genital Warts: Genital Warts (also called condyloma) are caused by a virus. These warts are different from the warts that people get on their hands or feet. (Warts on your hand cannot be spread to the genital area.) The genital wart virus causes flat, dry warts and clus-

112 TCU/DATAR Manual 6 ters of warts to grow on the penis, around the vagina, inside the vagina, and/or around the scrotum and rectum. This virus is very difficult to control. The warts may be removed but often will return. Some types of genital warts have been linked to cancer. They can cause problems with urination and childbirth. HIV/AIDS: AIDS is caused by the human immunodeficiency virus (HIV). When a person is infected the virus enters the bloodstream and lives in white blood cells. This virus is spread through sex and by sharing injection equipment. It is the most serious STD. There is no cure for AIDS. HIV slowly destroys a person’s immune system. Without this natural defense against diseases the person with HIV may become ill with cancers, pneumonia, stomach infections, and brain and nervous system infections. A woman with HIV may pass the infection to her newborn. Although there is no cure, many of the infections and diseases brought on by HIV can be treated.

Briefly review the symptoms of STDs. Use the prepared flip 4 chart to focus attention. The main point to get across is that any type Flip chart of symptom or problem should be checked by a health clinic or doctor immedi- ately. The list of symptoms is very broad and general. The best advice is to avoid self-diagnosis and seek medical attention for any of these symptoms. Be sure to mention that sometimes STDs cause no symptoms or the symp- toms go unnoticed. If someone knows or suspects that they’ve been exposed, they should visit a clinic for tests regardless of whether or not symptoms are present. (Additional handouts on STDs are in Appendix B, pp. 209-218). 5 Conclude with the following ideas: Sexually transmitted infections and diseases are nothing to take lightly. As we’ve been discussing, they can be serious, life-threatening diseases. By knowing about symptoms and what to watch for we can know when to get medical attention. If you ever experience any of these symptoms (or if a friend or family member tells you they are having these kinds of symptoms), the best advice is to visit a health clinic or doctor immediately. Only a clinic or doctor can treat these infections—each one requires evaluation to make sure the correct antibiotic or other medicine is given. It’s a bad idea to treat infections yourself or to use folk medicines. olk medicines may be helpful for some illnesses, but they are useless for treating STDs. Last week we talked about how blaming can be a communication problem. That’s especially true with STDs. When a person finds out he’s got an STD, the first thing he (or she) may want to do is blame the person he had sex with. Although blaming is an understandable angry response to the situation, it’s not helpful or realistic. irst, most

Time Out! For Men 113 6 Man Talk: It’s More than Plumbing of the time a person who is infected with an STD is not even aware that he or she is infected. Women often will not have noticeable symptoms and therefore don’t know they are infected. Men may not have symptoms, either. Second, if two people have sex they are both equally responsible for the sex act. Prevention is always better than a cure. It’s hardly fair to “blame” someone for giving you an infection when you could have used a condom to protect yourself. That’s the bottom line here. We are responsible for keeping ourselves healthy. If you ever have the slightest doubt, whip a condom out! The most foolproof way to avoid a sexually transmitted infection is to not have sex. Since few people choose this option, the next best thing is to not sleep around. A longtime, committed, faithful relationship will protect both people from sexual infections. (This protects your future children, too.) Using condoms also is important. If you have sex outside your primary relationship, always use a condom. This way you won’t bring an infection home with you and you protect your family from harm.

Provide closure by wrapping up on some of the key points 5 raised in this session.

Here are some ideas for closing comments:

We’ve covered a lot of ground today. We included this information in the workshop because we believe it is important. This workshop is about improving our relationships, and our sex life is an important part of relationships. The more we know and understand about our bodies and our partner’s body, the more comfortable we can become discussing sex. We show respect for ourselves in a lot of ways, and one important way is taking care of our health. Although men don’t have as much to worry about as women in terms of sexual health, it’s important to know the signs and symptoms of potential problems.

Briefly go around the room and ask each participant to tell 6 you the most important thing he learned today.

Now that we’ve gone over the “medical” type of information, we’ll have some background for discussing other types of sexual issues that come up in relationships. That’s where we’ll take up next week. If any questions come up for you during the week, jot them down and bring them to group.

114 TCU/DATAR Manual 6

10 Homework: Sexuality Myth Quiz

Use the last 10 minutes to introduce the homework assign- ment. 1 Distribute extra copies of the Sexuality Myth Quiz. Homework, p. 116 Here are some ideas for introducing the homework:

When you get home or sometime during the coming week, sit down with your partner and share with her some of the information you learned today. Talk with her about myths and folk stories about sexuality that she may have heard while growing up, and share with her some of the stories you once believed. or fun, ask her to complete the extra copy of the Sexuality Myth Quiz that you’ve just been handed. You have the answer sheet already. When she’s finished, go over the answers like we did in group. Show her your quiz and talk about your answers.

Thank participants for attending and invite them back next 2 week.

Ask each person to complete an evaluation form before leav- 3 ing. Evaluation, p. 122

Time Out! For Men 115 6 Man Talk: It’s More than Plumbing SEXUALITY MYTH QUIZ

Check an answer box for each question based on what you have been told about sexuality.

DON'T QUESTION TRUE FALSE KNOW

If a woman is menstruating (having her period), she will cause well water to go bad, if she drinks from the well.

It is possible for animals such as chimpanzees or dogs to breed with human beings.

After menopause, a woman has no desire for sex.

Homosexuals are born that way.

A man with a big penis is better able to satisfy a woman.

Masturbation is dangerous and immature.

Sexually Transmitted Diseases (STDs) always cause symptoms.

When men get older they can no longer have erections.

Alcohol increases sexual desire and makes you a better lover.

Women don't need sex as often as men do.

116 TCU/DATAR Manual 6

SEXUALITY MYTH QUIZ

Answer Sheet

If a woman is menstruating (having her period), she will cause well water to go bad, if she drinks from the well. (.ALSE)

Menstruation, the female “period,” is the subject of myth and taboo. Many religions, includ- ing Judaism and Islam teach that women are “unclean” during their periods and must purify themselves afterwards. Many ancient cultures made women stay in special “menstrual huts” during their periods. They believed that if a man touched a menstruating woman, he would die. If she walked across his fields, all his crops would die. If she drank from the well, then the water would turn poisonous. These superstitions probably have to do with the fact that menstruation involves blood, and blood was viewed as powerful magic. Today we understand that menstruation is a clean, natural function of the human body. When a women menstru- ates, her uterus (womb) is simply shedding a lining made of tissue and blood that would have nourished a fetus if pregnancy had occurred.

It is possible for animals such as chimpanzees or dogs to breed with human beings. (.ALSE)

rom time to time, supermarket tabloids carry headlined stories such as DOCTORS AMAZED! WOMAN GIVES BIRTH TO PUPPIES or I WAS RAPED BY A GORILLA AND HAD ITS BABY! Rest assured that it is not genetically possible. Human sex cells will not accept genetic material from another species, nor will other species accept human genetic material. So MAN .ATHERS PUPPIES is not possible, either. In fact, other species won’t voluntarily copulate with human beings, although they may appear to be trying (such as when a pet dog wraps around your leg). In “sex shows” that feature humans and animals, the animals have been trained and are not behaving instinctively.

After menopause, a woman has no desire for sex. (.ALSE)

The most important factor in desire is a woman’s feelings for her partner and her attitude toward sex. Menopause indicates that a woman’s ovaries have stopped producing eggs and that hormone production is reduced. Most women continue to experience satisfying and fulfilling sex lives after menopause. Reduced amounts of naturally-produced estrogen may cause vaginal drying or thinning in some women, but there are a variety of lubricants and hormone replacements available to provide relief. Menopause is a natural, healthy aspect of sexuality.

Time Out! For Men 117 6 Man Talk: It’s More than Plumbing

Homosexuals are born that way. (.ALSE/DON’T KNOW)

Research has not found an answer to why some people are homosexual. Genetics, hormones, overbearing mothers, and mental illness have all been suggested at one time or another. None is correct. What we know is that homosexuality exists in all cultures, in all parts of the world, and at all times in recorded history. It is estimated that 15% of the world’s population is homosexual or bisexual. This allows for speculation that it is a normal, natural phenom- enon. It is also important to bear in mind that many people who are not “homosexual” en- gage in same-sex sexual encounters.

A man with a big penis is better able to satisfy a woman. (.ALSE)

Maria Muldaur said it best: “It ain’t the meat, it’s the motion....” The center of sexual excite- ment and release for a woman is the clitoris, a small, pearl-like organ located above the urinary opening. Whereas some women may prefer a large penis, it’s not necessary for sexual satisfaction. The vagina itself has relatively few sensitive nerve-endings. This is because the vagina is the birth canal. If the vagina had as many sensitive nerve-endings as the clitoris, no woman would ever be able to give birth — it would be too painful.

Masturbation is dangerous and immature. (.ALSE)

Masturbation is sexual self-stimulation which may or may not be carried through to orgasm. In Victorian times, doctors preached that it could lead to insanity, blindness, warts and hair growing on the palms of the hands. Masturbation is harmless. People of all ages, including people with a steady sex partner, may masturbate. Many religions have strong taboos against masturbation, which may cause some people to feel guilty. If masturbation causes excessive guilt, it should probably be avoided. Otherwise, it’s normal to masturbate and it’s also normal not to masturbate.

Sexually Transmitted Disease (STDs) always cause symptoms. (.ALSE)

Unfortunately, this is not true. Public health officials believe that the primary reason why Sexually Transmitted Diseases (STDs or VD) are so prevalent is because they are unknow- ingly transmitted from person to person. or example, chlamydia and gonorrhea seldom produce obvious symptoms in women, and as many as 20% of men may have no symptoms. In the case of syphilis, a chancre (a painless ulcer) appears in the first weeks after exposure then heals on its own. It can easily go unnoticed, especially if it is located inside a woman’s vagina. New evidence shows that herpes may be transmitted even when herpes sores are not present. The HIV virus that causes AIDS can produce no symptoms for years. In fact, most people with HIV who are in danger of passing the virus to someone else don’t even know they have it. They look and feel fine.

118 TCU/DATAR Manual 6

When men get older they can no longer have erections. (.ALSE)

Erections are caused by blood flowing into the spongy tissue of the penis, causing it to en- gorge (swell). If a man stays healthy, he can have erections until the day he dies, even if he lives to be 95. Studies show that about three out of four men in the 60s and 70s have satis- factory erections; two-thirds of men in their 80s have erections; and nearly half of all men in their 90s do also. Diseases such as prostate cancer or cardiovascular (heart and circulatory) problems may interfere with erections. Also, certain drugs such as high blood pressure medication may reduce erection capacity. Other drugs such as alcohol, tobacco, heroin, high dose methadone, marijuana, and cocaine may also cause erectile dysfunction.

Alcohol increases sexual desire and makes you a better lover. (.ALSE)

Actually, the opposite is true. Alcohol in small amounts may cause relaxation and openness to sexual experiences, but in large amounts and with chronic use it reduces both desire and performance in men and women alike. Heavy drinking may cause men to have problems keeping an erection and may cause both men and women to have problems achieving orgasm.

Women don’t need sex as often as men do. (.ALSE)

Sex is a basic biological drive with physical and emotional rewards for women as well as men. Within a fulfilling sexual relationship, men and women establish patterns as to when and how often they need and want sex. or women and men alike, need for and interest in sexual intercourse varies over the course of a lifetime. It may be stronger sometimes, weaker others. Culture and religion may place restrictions on women vocalizing their need for sex, but that doesn’t mean it doesn’t exist.

Time Out! For Men 119 6 Man Talk: It’s More than Plumbing Important Health Issues For Men

Testicular Health

• Cancer of the testes (testicular cancer) is rare, BUT it is the most common kind of cancer in men aged 15-35. • Symptoms include: •A lump or hardened area, often painless, on one testicle. •One testicle becoming larger, firmer, or swollen compared to the other. •Swelling, pain, a feeling of fullness, or any change in the normal feeling or appearance of the testicles. • Visit a doctor or health clinic for a complete check-up if you have any of these symptoms. Early detection is the key to a successful cure.

Prostate Health

•Prostate cancer is the most common cancer in men. Over 30% of all cancer diagnosed in men is prostate cancer. Men aged 50 and over are at greatest risk. •Early prostate cancer may have no symptoms. Later symptoms may include: • Problems with urination; slow urine stream; trouble empting the bladder completely. • Trouble getting or keeping an erection. • Blood in the urine. • Pain, swelling, or a feeling of heaviness in the pelvis, lower abdomen, spine, or hips. •Early detection is a man’s best weapon, because prostate tumors are generally slow-growing. Routine screening is an important part of men’s health.

Contact the American Cancer Society for more information about cancer risks for men www.cancer.org 120 TCU/DATAR Manual 6 Important Health Issues For Men Testicular Self-Examination

•The best time to do a testicular self-exam is during or after bathing, as the skin of the scrotum is more relaxed. •First, stand in front of a mirror carefully examine the front and back of each testicle. Look for changes in the shape or size of one testicle compared to the other. •Continue the exam by holding each testicle between the thumb and fingers using both hands, and gently rolling it between the fingers. Feel for any hard lumps or bumpy or grainy-feeling areas under the scrotum skin. •Tumors are usually painless and easy to feel during an examination. •Visit a doctor or health clinic if you see or feel any lumps or changes. Early Detection of Prostate Cancer

•Starting around age 45-50, men should have a Digital Rectal Examination (DRE) and a special blood test (called PSA) that checks for traces of proteins related to prostate cancer. These tests should be done every year. •African-American men, and men with brothers or fathers who have had prostate cancer may be at higher risk for the disease and should begin these tests at a younger age. •If the rectal exam or the PSA test reveals a potential concern, a biopsy or sample of cells from the prostate is needed. A biopsy is the only way to confirm that a man has prostate cancer. During biopsy, a small probe is used to remove a sample of tissue from the prostate for microscopic examination. •Talk with your doctor or health clinic about establishing a schedule for routine rectal exams and screening tests for prostate cancer.

Contact the American Cancer Society for more information about cancer risks for men www.cancer.org Time Out! For Men 121 6 Man Talk: It’s More than Plumbing SESSION EVALUATION Time Out! For Men Session 6

THIS BOX IS TO BE COMPLETED BY DATA COORDINATOR:

SITE # |__|__| CLIENT ID# |__|__|__|__| DATE: |__|__||__|__||__|__| COUNSELOR ID# |__|__| [1-2] [3-6] MO DAY YR [7-12] [13-14]

INSTRUCTIONS:II Please take a minute to give us some feedback about how you liked this session.

1. Use one word to describe your reaction to today’s class. ______

2. What is the most important thing you learned today?

3. What did you learn today about men’s health that you didn’t know before?

4. On a scale of 1 to 10, how do you rate today’s class? (Circle your rating)

01 02 03 04 05 06 07 08 09 10 |__|__| [15-16] Poor Pretty Good Excellent

5. Do you have any suggestions to help make this class better?

122 TCU/DATAR Manual 7

7 Loving Relationships Session Length: 2 hours

Objectives Understand stages of human sexual response Explore common concerns about sexual functioning

Discuss sexual responsibility in intimate relationships

Rationale Issues related to sexual functioning and response often are anxiety-producing for men. Many men grow up believing that it is solely the man’s job to initiate sex and make sex enjoyable. Perceived problems in this area may have a nega- tive impact on self-esteem and comfort with intimacy. This session seeks to reduce anxiety by providing factual information about sexual response (Masters and Johnson, 1984) and sexual functioning, including the impact of stress, fatigue, and drugs and alcohol. In addition, sexual responsibility issues in intimate relationships such as trust, birth control, and safer sex are discussed.

Session Procedure Time

Outline Welcome and Process Homework 10 minutes

Human Sexual Response 20 minutes

Concerns about Sexual unctioning 25minutes

Break 10 minutes

Responsibility in Sexual Relationships 20 minutes

Safer Sex Issues 25minutes

Homework: Partner Interview 10 minutes

Total Time for Session 7 120 minutes

Time Out! For Men 123 7 Loving Relationships Materials Easel and flip chart (or erasable board) Magic markers; pencils, pens, writing paper Prepared flip chart Human Sexual Response Prepared flip chart What Women Say... Safer sex demonstration materials (See Preparation Notes) Copies of handouts

Preparation Notes Prepare Human Sexual Response flip charts Write out key points on a large piece of flip chart paper Human Sexual Response or poster board, as shown: Excitement Phase “Ready”

Plateau Phase “Building Up”

Orgasmic Phase “Wow!”

Resolution Phase “Resting”

What Women Say . . . What Women Say . . . Write out key points on a large piece of flip chart Never Use orce paper or poster board, It is never alright to use force as shown: or violence. Share Responsibility In a Sexual Relationship Both partners are responsible for birth control and safer sex. Communicate Openly Share feelings, thoughts, and needs. Be Considerate Care about your partner’s feelings. Respect Sexual Privacy Don’t brag or tell stories.

124 TCU/DATAR Manual 7 Obtain Assemble items for conducting a safer sex demonstration, including a demonstration penis model, condoms, spermicides (nonoxynol-9), water-based materials lubricants (K-Y), and the female condom. Local agencies such as public health department, AIDS service organizations, or family planning clinics such as Planned Parenthood may have safer sex kits available for loan.

Photocopy Another Myth Quiz (worksheet, p. 135) handouts Another Myth Quiz Answer Sheet (handout, pp. 136-138) Self-Help for Sexual Problems (handout, p. 139) Condoms and Safer Sex (handout, p. 140) Partner Interview (homework, p. 141) Session Evaluation (form, p. 142)

Procedure 10 Welcome and Process Homework

Welcome participants as they arrive.

Use the first 10–15 minutes to review and process the home- 1 work assignment. Begin by reviewing a few key ideas from the previous session.

Last week we reviewed information about male and female bodies, how they’re put together and how they work. We also talked about some of the health-related issues that concern men like cancer, pros- tate, problems, and sexually transmitted infections. Knowing more about our bodies and our partner’s body, and more about taking care of our health helps build a sense of pride and respect. We also talked a little about sexual mythology—the “tall tales” we grow up hearing about sex that most of the time aren’t true. Let’s talk for a few minutes about the homework assignment:

Ask for volunteers to share their experiences with the home- 2 work.

Time Out! For Men 125 7 Loving Relationships Here are a few ideas for questions:

How did your partner handle the “myth” quiz? Did she miss any of the questions? Which ones? Process questions How did it feel to have a matter-of-fact conversation about sex? What did you learn from this exercise?

Thank volunteers for their input. Encourage participants to keep up 3 the good work.

Human Sexual Response 20 Use the next 15–20 minutes to lead a discussion about hu- 1 man sexual response. (See Appendix B, p. 178, for a short article on sexual response.)

Here are some ideas to include in the discussion:

The more we learn about sex, the better our sex lives can become. A mutually satisfying sex life is an important part of a strong, commit- ted relationship. A strong, stable relationship is good for our hearts, good for our minds, good for our children, and good for our recoveries. In today’s session, we’re going to continue talking about sexuality and issues related to sexuality in our relationships. The history of sex is fascinating. There are several good books on sex history that trace man’s feelings, practices, and rules about sex from the days of the Pharaohs to modern times. But with all this history, it wasn’t until about 30 years ago that medical researchers actually got around to studying and identifying what happens physically when people have sex. Granted, even the Pharaohs had a pretty good idea about what was going on, but only recently have we gotten the medical or biological facts straight. The first thing we’ll talk about today is some basic information about how we respond sexually as humans. Our sexual responses are unique and different from the responses of any other living creature on the planet. Ask participants if they can guess why that is. As human beings, we choose to have sex—we are not driven toward sex by instinct. As human beings, having sex is not tied to the

126 TCU/DATAR Manual 7 female’s fertility cycle. In most other animals, sex only happens when the female is fertile and sends out a signal that she is fertile. Human beings may choose to have sex at any time during the month or year, not just when the woman is releasing her egg. The one thing we share as human beings is how our bodies respond during a sexual act. This is called the human sexual response cycle. It is the same for all adult males and females. It is the same regard- less of which type of sexual act is performed—masturbation, vaginal sex, oral sex, or rectal sex. Let’s quickly review the stages of this response cycle.

Lead a discussion on the stages of sexual response identified 2 by Masters & Johnson. Use the prepared flip chart to focus Flip chart attention on the points. Encourage questions and discussion. The key idea to stress is that both adult men and women may experience these phases of sexual response and that these responses are physical in nature.

Cover the following points:

1. Excitement Phase — “Ready” Blood flow increases to the genital tissues; penis becomes erect; vagina lubricates; clitoris enlarges.

2. Plateau Phase — “Building Up” Blood flow increases to the genital tissues; increased heart rate, blood pressure, breathing; tension in muscles.

3. Orgasmic Phase — “Wow!” Muscles in pelvic area, vagina, along the urethra contract rhythmi- cally; contractions produce waves of pleasurable feelings; males ejaculate (release semen).

4. Resolution Phase — “Resting” Muscles relax, blood pressure and heart rate return to normal; blood flow to genitals returns to normal; erection subsides.

The sexual response cycle starts with the bodily changes that happen in the “excitement” phase. The person (or people) involved in the sex act may choose to proceed on to orgasm and resolution, or may choose to stop anywhere along the way. Although it may feel a little uncom- fortable or frustrating, there is no biological necessity to finish the cycle just because it got started. In other words, sometimes the phone rings, the baby cries, or the mood is lost.

Time Out! For Men 127 7 Loving Relationships

Concerns about Sexual Functioning 25 Use the next 20–25 minutes to discuss common issues and 1 concerns about sexual functioning (performance).

Here are some ideas for introducing the discussion:

The sexual response cycle describes how our bodies are capable of responding. Unfortunately, for all of us, our bodies (or our partners’ bodies) don’t always respond the way we would like them to. And guess what? That’s completely normal. We have bodies, not ma- chines. Our feelings, our health, our history—all of these things can play a part in how we respond and function sexually. Unfortunately, again, as men we grow up with a lot of myths that may hurt our self- esteem, increase our anxiety, and make us worry needlessly about things that are completely normal. Just for fun, let’s take a look at some more of these myths.

Distribute Another Myth Quiz worksheets and ask partici- 2 pants to complete them as quickly as possible. Reassure them Worksheet, that it’s not a test and that they don’t have to show their worksheets to any- p. 135 one in the group.

When participants have finished, go over the quiz items as a 3 group asking participants to volunteer their answers. Discuss correct answers to each question in detail using information from the answer sheet. Encourage discussion and further questions about the issues raised in the quiz. Distribute handouts of Another Myth Quiz answers at the end of the Handouts, discussion. pp. 136-139

Conclude by quickly reviewing handout Self-Help for Sexual 4 Problems. You may want to include phone numbers/referral information for agencies in your area that may provide counseling services (e.g., Planned Parenthood; community mental health agencies; private practitioners).

10 Break

128 TCU/DATAR Manual 7

Responsibility in Sexual Relationships 20 Use the next 15–20 minutes to discuss responsibility issues 1 in sexual relationships.

Here are some ideas for starting the discussion:

Now that we’ve clarified some concerns many of us have had about what we do in bed and how we do it, let’s talk a little while about who we are in our sexual relationships. I’ve never met a man who, at some level, didn’t like to think of himself as a “good lover.” So, what makes a man a good lover?

Ask participants to help you list the characteristics of a “good 2 lover.” List characteristics on flip chart paper or erasable Flip chart board and discuss them. Use some of the following ques- tions:

How do we learn what a “good lover” is? What images do we get in the media, movies, TV? Process questions Are these images helpful or realistic? How can we learn to be better lovers?

3 Wrap up with the following ideas: To summarize this discussion, I think what we’re hinting at here is that being a “good lover” is more about who a man is and how he treats his partner than it is about what he does or how he “performs” in bed. Once again, a lot of it comes back to that idea of having an assertive attitude—an attitude of mutual respect, openness, listening, and compromise. I can guarantee that 97% of women would choose a man who respects her and listens to her over a man with a large penis, any day. In fact, we have the results of an informal survey in which women list what’s important for men to remember if they want to be good lovers, husbands, and partners. Let’s see what we can learn from the ladies. Here’s what women say:

Time Out! For Men 129 7 Loving Relationships Use the prepared flip chart What Women Say to highlight the 4 issues. Encourage participants’ questions and discussion. Flip chart Here are some ideas for leading the discussion:

Never Use Force It is never alright to use force or violence with a sexual partner. The media and other fantasy sources of information about relationships have presented a lot of unhealthy myths. The most unhealthy myth is that good sex is violent, rough, and aggressive and that all women have a “secret desire” to be taken by force, overwhelmed, or swept away. Another unhealthy myth is that men have a “right” to sex whenever they want it and that they can take it from a partner if it’s not given freely. “No” means “no”—any person, man or woman, has the right to refuse sex and not have to argue about it. Iorce, violence, and aggression work against healthy, intimate relationships.

Share Responsibility In A Sexual Relationship Both partners are responsible for contraception and STD prevention. Ior some crazy reason many men believe that “protection” is the woman’s responsibility only. We sometimes hear guys say “She got pregnant” or even “She got herself pregnant.” Well, she didn’t do it by herself! When two people have sex, both people are responsible for the consequences. A man who’s a good lover does what he needs to do to share the responsibility.

Communicate Openly It’s important to share feelings, thoughts, and needs with a partner. In the media, we see the strong, silent type a lot. Have you ever wondered why these characters are usually loners? The importance of communication in a close, intimate relationship cannot be over- stressed. The biggest sex organ you have is your brain. Next is your heart. A good lover is willing to open up and share who he is with his partner. It’s also very important to communicate with your partner about your sexual relationship—what you like, what you don’t like, what feels good. Using I-Statements can help you communicate your needs and your preferences without sounding demanding. Ior ex- ample, “I really like it when you massage my shoulders.” Be Considerate Just as it’s important to communicate openly with your partner, it’s also important to be concerned about your partner’s feelings, thoughts, and needs. Patience and a willingness to compromise can go a long way in showing your partner you care about her. Many women are socialized to be shy or unassertive about their bodies and their sexual-

130 TCU/DATAR Manual 7 ity. A good lover can show consideration for his partner by being willing to ask about her needs and what she likes or doesn’t like. As we’ve discussed before, listening is another way to show love and consideration for a partner.

Respect Sexual Privacy This is a fairly self-explanatory point. It’s not okay to brag or tell stories about you and your partner’s sex life, past or present. Such talk is disrespectful of yourself and your partner, and it’s also imma- ture and childish. A close, intimate relationship is built on trust and respect. Telling stories “out of school” can shatter that trust and hurt the relationship.

Conclude by asking participants to discuss the following 5 questions:

What would you tell your son is the most valuable characteristic he can develop as a husband or partner? Why?

Process questions What would you tell a daughter is the most valuable characteristic to look for in a husband or partner? Why?

Safer Sex Issues 25 Use the next 20-25 minutes to lead a discussion on safer sex 1 issues.

Here are some ideas for opening the discussion:

One of the burdens we bear as men is that we are socialized to equate sexual conquest and sexual performance with our worth as human beings. Media messages about sex roles, relationships, love, etc. begin working on us very early—it’s probably the way most of us first learned about sex and women. What we end up with is a pretty distorted way of relating to women. We get the message: “Go for it!! Sex is manhood! To be a ‘real’ man, you gotta carve notches on the bedpost. Having lots of sex proves you’re a man!” By learning that the only thing that can prove our manhood is how we “score” sexually we’re cheated and cutoff from our total selves. It doesn’t allow us to know and understand our feelings. It puts a lot of stress on us to perform, be in charge of sex, and always be on the make.

Time Out! For Men 131 7 Loving Relationships It hurts our self-esteem, too. Sexual conquest and sexual performance become how we judge our manhood. Sex becomes almost an obsession. We feel we have to keep proving ourselves in some way. And we feel very threatened when we sometimes can’t deliver the goods. Being unable to perform sexually can upset us clear down to our souls. That’s the price we pay for buying into the idea that sex somehow proves our manhood. Nowadays, there’s another price to pay. HIV infection and AIDS has entered the picture, on a collision course with this male “ideal” that the more sex you can have, the better. Hundreds of thousands of men have died or are dying from this disease. Countless others have brought the infection home, and their wives, partners, and children are dead or dying from the disease, too. As men, we have a responsi- bility to take this disease seriously, protect ourselves, and protect our families. The public health folks will tell you that abstinence (not having sex) is the only 100% sure way to prevent getting or spreading HIV. This is true, and abstinence is always a choice. We have the right to turn down or refuse sexual contact anytime we want—and it won’t make us any less of a man. Women have the right to not have sex, too. As men, we need to learn to respect that. Let’s have a heart-to-heart about the main safer sex options that we can use to protect ourselves and those we care about—condoms and monogamy (or being faithful).

Discuss issues related to monogamy as a safer sex option. 2 Write the word “monogamy” on a piece of flip chart paper and ask partici-

Flip chart pants to help you list alternative definitions or descriptions for the term. (Ior example, being faithful; just one partner; not sleeping around; being a one- woman man; bringing it home to mama.)

Use some of the following questions to lead the discussion: Even if HIV/AIDS were not around, why is being faithful important for a close, stable relationship?

Process questions Why is monogamy difficult for some men to accept? How do we make monogamy work in a relationship? What do we have to do? Why is trust important for a good relationship? What are the benefits of monogamy?

132 TCU/DATAR Manual 7 3 Wrap up with the following ideas: Monogamy has been described as “building a safe fence around your playground.” By keeping sex as something you reserve only for your primary relationship, you do a lot to protect yourself and your family. The use of condoms is another thing that makes sex safer. The most important things to know about condoms are how to use them cor- rectly, and to remember to use them.

Distribute the handout Condoms and Safer Sex and lead a 4 discussion about using condoms and demonstrate safer sex Handout, Use the safer sex materials to demonstrate correct condom use. p. 140 materials. Also provide information about the female condom and show how it is used. (See Appendix A, pp. 171-176, for an outline on how to conduct condom dem- onstrations. Modify as needed for your group.)

Safer Sex Materials Use some of the following questions to lead the discussion: What are your feelings about condoms? Why do men tend to have a negative attitude about condoms? Process questions How can men improve their attitudes about condoms? What are the benefits of condoms?

Discuss the importance of condoms if either partner contin- 5 ues to inject drugs.

Many women and children have been infected with HIV, not because they are unfaithful or their men are unfaithful, but because their men inject drugs. Sharing needles, syringes, cottons, or cookers can spread this virus. Even in a faithful relationship, a man who shoots up has the responsibility to protect his partner and his children from the threat of HIV by using condoms.

Provide closure by wrapping up on some of the key points 6 raised in this session.

Here are some ideas for closing comments:

Sex is an important part of our lives and our well-being. We’ve talked today about some of the biological aspects of the sex act, and some of

Time Out! For Men 133 7 Loving Relationships the day-to-day aspects of sex, as well. Remember that learning about sex is a lifelong process. The more we know the more comfortable we become in our relationships. It’s unfortunate that many men have been brainwashed to think that what they do sexually is a reflection of how much of a man they are. A man’s self-esteem and sense of pride should come from who he is, and how he treats others—not from how well or how often he performs a physical act. Ior many men, staying faithful is difficult. The more difficult it is for a man, the more courageous and strong he is when he’s able to do it. Next week is the last session of this workshop. We’ll spend some time tying up loose ends and bringing together all that we’ve learned. We’ll also have a graduation “party” and graduation certificates to recognize the good work that’s been done in this group.

10 Homework: Partner Interview

Introduce the homework assignment and distribute the Part- 1 ner Interview worksheets. Homework, p. 141 Here are some ideas for introducing the homework:

Your homework assignment is to sit down with your partner and share with her some of the information you learned today. Also, since this is the last “homework” assignment, there’s an inter- view exercise to do with your partner. This is similar to one from the first session. Your role is to find a quiet time to sit with your partner. Ask her to complete the questions on the homework sheet. When she is finished, sit together and discuss her answers. Remember to listen, to ask for clarification when you need it, to not argue, and to relax.

Thank participants for attending and invite them back next 2 week.

Ask each person to complete an evaluation form before leav- 3 ing. Evaluation, p. 142

134 TCU/DATAR Manual ANOTHER MYTH QUIZ 7 Check an answer box for each question based on what you have been told about sexuality. DON’T QUESTION TRUE FALSE KNOW

Age-wise, a man is at his sexual peak from age 18 to 25; after that it’s all downhill.

The average couple has sex about 6-10 times per week.

In a good relationship, the man and the woman should have orgasms at the same time (come together).

It is very unusual for the average man to have trouble getting or keeping an erection.

A man is responsible for a woman’s sexual pleasure.

If a man experiences “premature ejaculation,” (coming too quickly), there is nothing that can be done to help him.

All women know where their clitoris is located.

The average man always wants and is always ready to have sex.

Good sex must always end with intercourse.

A woman with large breasts is more sexually sensitive than a woman with small breasts.

In order to have good sex, the man must have an erection.

Which of the following things can interfere with wanting sex or being able to have sex: (Circle all that apply)

Marijuana Alcohol “Downers” Tension Depression Pain Past experiences Heroin Cocaine “Uppers” Stress Medications Fear Anger Methadone Diabetes Illness Fatigue High blood pressure

Time Out! For Men 135 7 Loving Relationships ANOTHER MYTH QUIZ Answer Sheet

Age-wise, a man is at his sexual peak from age 18 to 25; after that it’s all downhill. This is not a completely true statement, although there are changes in sexual patterns as both men and women get older. A lot has to do with what the term “sexual peak” means. If we think of a sexual peak as simply the ability of the body to respond sexually, then there is some truth that younger men may have a stronger sex drive. However, men (and women) remain interested in sex into their 30s, 40s, 50s, 60s, 70s, and beyond. As we become older and more experienced, our focus of sexual pleasure becomes more well-rounded, so that instead of just being concerned with erections and genital pleasure, we have a deeper sense of total sensuality. With age we learn more about pleasing our partner, more about relaxing and enjoying the moment, and more about our own bodies. Ior most men, the true “sexual peak” comes with years and maturity.

The average couple has sex about 6–10 times per week. How often a couple has sex varies a lot, and may change during the course of a relationship or marriage. Newlyweds or new partners may have sex more often than those who have been together for many years. Couples without children may have sex more often than those whose parenting duties require time and energy. A recent survey of Americans showed that most couples are satis- fied with their sex lives, and that most couples report having sex an average of 2 or 3 times a week.

In a good sexual relationship, the man and woman should have orgasms at the same time (come together). A good relationship is about meeting each others needs, not about exact timing. Once again, media- based mythology has a lot of influence. In movies we see couples making love who appear to reach a dramatic climax at the same moment. In real life, it doesn’t always happen this way, nor should it. People have bodies, not machines, and each person’s level of sexual excitement may not always be the same at the exact same moment. It’s often much easier for partners to take turns having an orgasm - that way, each can take turns concentrating on pleasing the other. Placing demands on each other to “come together” or to “come” at a certain time can bring anxiety and pressure into what’s ideally a relaxing, pleasurable event.

It is very unusual for the average man to have trouble getting or keeping an erec- tion. No, it’s not. In fact, it is quite common for men to occasionally not be able to get or keep an erection. There are a lot of reasons and most have to do with the fact that a man is a total human being, not just a penis. Stress, depression, or just being tired and run-down can interfere with sex. A quarrel with a partner or worries about the bills or the children can be on a man’s mind, and although he’s not conscious of it, it can affect sexual performance. The main thing is to not worry about it. In most cases, the more a man worries, the worse it becomes. If the problem goes on for a long time, there might be another cause. Alcohol, street drugs, and prescription medicines may cause prob- lems. The man should check with his doctor first to rule out a physical cause. If the problem isn’t related to alcohol or illness, marriage or relationship counseling may help.

136 TCU/DATAR Manual 7

A man is responsible for a woman’s sexual pleasure. It is not possible for one person to be “responsible” for how another person’s body reacts or doesn’t react. This is another myth that men have been burdened with, and one that has placed a lot of pressure on men to think of sex as performance. (It works the other way, too—a woman isn’t “re- sponsible” for a man’s pleasure, either.) Both partners are responsible for telling each other what they like or dislike. Neither partner is supposed to be a mind-reader who can guess what the other person wants or needs in bed. Once again, the solution is assertive communication—talking, listen- ing, respect, caring, and patience.

If a man experiences “premature ejaculation,” (coming too quickly), there is noth- ing that can be done to help him. Premature ejaculation or coming faster than he intends to is a common concern for men, and almost all men have experienced it. It may happen if a man is overly excited or hasn’t had sex in a long time. If it is a recurring problem, there are several solutions the man can try. Some men are helped by using a condom when they have sex because a condom can help reduce sensitivity. The most successful approach is a special kind of control training that helps the man learn to recognize the sensations of an approaching orgasm and control his response. The man can learn to enjoy several “peaks” of intense sensations before he allows himself to come. With practice and patience, prema- ture ejaculation can be overcome.

All women know where their clitoris is located. This is not always true because many women grow up with taboos and restrictions about their bodies and about touching themselves. The clitoris is the most sexually sensitive organ in a woman’s body, located above the vagina and the urinary opening where the skin folds (labia) join. It is very small, about the size of a pea, and is made of the same tissue as a man’s penis. Many women mistakenly believe that the vagina is the center of sexual stimulation or that the clitoris is located inside the vagina. However, the vagina has very few nerve endings and the clitoris has as many nerve endings as the man’s penis. Touching and stimulating the clitoris in a way the woman finds arousing will usually result in orgasm.

The average man always wants and is always ready to have sex. This is another example of a myth that places a lot of pressure on men to be sexual and to base their self-esteem on performance. A man is a human being, not a machine that can just flip a switch and turn on. If a man believes this myth, he may think he must engage in sex even when he doesn’t really want to. Ior example, he may push himself to have sex when he’s too tired, not really at- tracted to the woman, or too stressed out. This can lead to performance problems that hurt his confidence. A man doesn’t always have to be interested in sex to be a real man. A real man is interested in sex when the time is right, the partner is right, and he’s able to relax and enjoy the experience. He doesn’t need to “prove” himself to himself, or to anyone else.

Time Out! For Men 137 7 Loving Relationships

Good sex must always end with intercourse. This myth shows how goal-oriented we are in our society. We’re always trying to get where we’re going, and we forget to enjoy the journey. Good sex can happen even when intercourse is left out. Holding, touching, kissing, massage, and other types of “foreplay” can be just as enjoyable as “doing it,” and many couples find it to be a nice change of pace. Intercourse is not the be-all and end-all of sex—there are many variations and options that a couple can try. To limit our definition of “good sex” to just having intercourse is like going to a fancy dinner party and only eating one thing.

A woman with large breasts is more sexually sensitive than a woman with small breasts. This is not true. A woman’s breast size has nothing at all to do with her sexual sensitivity. Breasts vary a lot in size, shape, texture, and appearance, and breast development is mostly influenced by heredity (one’s parents and grandparents). All breasts function the same way—they are designed to produce milk to nourish an infant. The size and shape of a breast or nipple does not affect the amount or quality of the milk produced. In some women, the nipple and surrounding skin are very sensitive to touch and sexual stimulation: other women may not enjoy having their breast touched: size, however, has nothing to do with it.

In order to have good sex, the man must have an erection. A couple can have very good sex even if the man does not have an erection. If you think of sex as a total body experience that is more than just the genitals, you’ll understand why this is true. Touch- ing, kissing, holding, massage, and other kinds of stimulation can happen without an erection. Sex is more than a performance and more than just having an orgasm. Men can do a lot for themselves by learning to let go of the pressure to perform and have an erection, and practice learning to relax, getting in touch with their whole bodies, and showing their partner how they like to be touched and caressed.

or the last question all of these items should be circled. One myth we live with as men is the myth of “superman”—a real man is supposed to want sex and be able to perform, no matter what. The truth is that many things can cause problems with our sex lives. (This is true for women as well as men.) Heavy use of alcohol or marijuana can lower test- osterone (male sex hormones). In addition, alcohol causes problems with blood flow and circulation. Heavy drinkers may have a difficult time getting and keeping an erection. Heavy use of heroin, cocaine, and other street drugs cause problems with sexual functioning as well. Illnesses such as high blood pressure and diabetes affect blood flow and circulation and can cause problems with erections. Certain medicines used to treat illnesses may have an impact on our sexuality. Negative feelings such as anger, tension, guilt, fear, depression, or shame can crawl in bed with us, too, and cause problems. Past experiences that were painful, humiliating, or frightening can leave us wounded and unable to respond sexually in the present. This is especially true for people who were sexually abused or raped.

138 TCU/DATAR Manual 7 Self-Help for Sexual Problems

v Talk it over with your partner. Be patient, gentle, and understanding with each other. Don’t rush things.

v Keep communication open and stay close in other ways. Hug, touch, kiss, and express af- fection in other ways. Don’t pressure yourself or your partner to be sexual.

v If you use alcohol, marijuana, or other street drugs, assume that these substances are likely connected to the problem. Stop using. Talk with your substance abuse counselor for advice.

v Talk with a trusted, experienced friend or family member about the problem. Choose someone who you know will keep your confi- dence.

v Go to the library or bookstore and read up on the problem. You can call a local help line or family planning clinic to ask for advice on books that may be helpful.

Time Out! For Men 139 7 Loving Relationships CONDOMS AND SAFER SEX Condoms provide safety and protection, but they must be used properly. It is recommended that only latex (latex rubber) condoms be used. Condoms made from animal skin membrane are not effective for preventing diseases. Here are some tips to help make condoms more effective.

COVERING ALL THE BASES

Place a tiny dab of K-Y jelly rings and jewelry when or other water-based lubri- putting on the condoms. Putting On A Condom cant in the tip of the con- Nails or anything sharp can dom before rolling it on. tear the condom. A condom should be put on Keep in mind that too much when the penis becomes may cause the condom to Use only water-based lubri- hard, not before. slip-off. However, a tiny cants like K-Y jelly. Oil- dab will help increase sensa- based lubricants such as Always use a new condom. tions for the man. Vaseline, baby oil, hand lotion or cooking oil can Place the rolled condom over Keep several condoms ready cause the latex in the con- the end of the erect penis for use when having sex. If dom to break or tear. and squeeze the tip end of you are interrupted, or if the the condom to remove any erection is lost, you’ll have a trapped air. (Trapped air in condom handy to start Taking the condom off the end of the condom could again. After the man has come, cause the condom to break, withdraw the penis while it like a balloon.) Have fun with your con- doms. Condoms come in is still hard. One partner should hold on to the con- Once the air is squeezed different colors, with pretty dom at the base of the penis out, roll the condom down patterns, even in flavors like to keep it from slipping. the shaft of the penis, strawberry and peppermint. leaving space at the tip of Remove the condom so that the condom to catch the the semen (cum) can’t spill semen (cum). Keeping the condom on either of you. Gently from breaking slide the condom off the penis. Wrap in tissue and Making the condom Never store condoms where dispose of in the trash can. they are exposed to heat or comfortable Avoid flushing condoms freezing. Heat or freezing down the toilet as they may Choose the style and brand can destroy the latex and clog pipes. of condom that best fits the make it break. Store con- man. It’s a good idea to try doms in a cool, dry place different brands (they are (such as a medicine cabinet not all the same). Most men or closet). Don’t keep them prefer a condom that allows in a wallet or glove box of a bit of friction and is thin the car. enough to conduct warmth. Be careful with fingernails,

140 TCU/DATAR Manual 7 Session 7 Homework Loving Relationships Partner Interview

Ask your partner to complete the following sentences. When she is finished, sit down together and discuss her answers. Be sure to listen. Don’t argue or try to comment on the answers.

One change I have noticed since you’ve been in the workshop is

One thing I really appreciate about you is

One thing I’d like you to work harder on is

One thing I’ve learned about myself is

One thing I’d like to do better myself is to

One thing I think that has really improved in our relationship is

One thing I would like for us to keep working on is

Time Out! For Men 141 7 Loving Relationships SESSION EVALUATION Time Out! For Men Session 7

THIS BOX IS TO BE COMPLETED BY DATA COORDINATOR:

SITE # |__|__| CLIENT ID# |__|__|__|__| DATE: |__|__||__|__||__|__| COUNSELOR ID# |__|__| [1-2] [3-6] MO DAY YR [7-12] [13-14]

INSTRUCTIONS: Please take a minute to give us some feedback about how you liked this session.

1. Use one word to describe your reaction to today’s class. ______

2. What is the most important thing you learned today?

3. What advice would you give a teenager today about safer sex?

4. On a scale of 1 to 10, how do you rate today’s class? (Circle your rating)

01 02 03 04 05 06 07 08 09 10 |__|__| [15-16] Poor Pretty Good Excellent

5. Do you have any suggestions to help make this class better?

142 TCU/DATAR Manual 8

8 Making Relationships Work Session Length: 2 hours

Objectives Explore techniques for enhancing self-esteem Review skills for improving communication in relationships

Identify solutions to common relationship problems

Rationale A healthy sense of self-esteem is important in maintaining close, intimate relationships. This session seeks to increase participants’ awareness of the importance of self-esteem and to introduce affirmations as a positive self-help technique. In addition, the session provides closure for the workshop by review- ing relationship skills and discussing the application of those skills.

Session Procedure Time

Outline Welcome and Process Homework 10 minutes

Self-Esteem and Affirmations 20 minutes

Review: Communication and Relationships 15 minutes

Break 10 minutes

Handling Problems in Relationships 25 minutes

Workshop Closure 10 minutes

Graduation and Client Survey (posttest) 30 minutes

Total Time for Session 8 120 minutes

Time Out! For Men 143 8 Making Relationships Work Materials Easel and flip chart (or erasable board) Magic markers; pencils, pens, writing paper Prepared flip chart Affirming Yourself Prepared flip chart An Assertive Attitude (from Session 2) Prepared flip chart Good Listening Habits (from Session 3) Prepared flip chart Talk It Over ormula (from Session 4) Prepared flip chart ighting air (from Session 5) Copies of handouts Prepared certificates

Preparation Notes

Prepare Affirming Yourself flip charts Write out key points on a Affirming Yourself large piece of flip chart paper or poster board, as shown: Write out 15 positive statements about yourself:

5 about your body/appearance

5 about your personality/ character

5 about your successes and accomplishments

Assemble Assemble prepared flip charts from Sessions 2, 3, 4, and 5. They’ll be flip charts used to review key skills from the workshop.

List of Make a list of common relationship problems that can be described in relationship one sentence. 0or example, one person in the relationship is more problems interested in sex than the other; one person in the relationship shuts- down and won’t talk; one person in the relationship gets jealous easily and without cause. You’ll use these example problems as the basis of a discussion exercise during the session.

144 TCU/DATAR Manual 8 Prepare Prepare a graduation certificate for each participant. Use the certificates example shown at the end of this session, or purchase generic certificates from an office supply store.

Plan party Make arrangements for invited guests, refreshments, decorations, etc.

Photocopy E is for Esteem (handout, p. 152) handouts Session Evaluation (form, p. 153) Client Survey (posttest, pp. 225-227) Graduation certificates (sample original, p. 154)

Procedure 10 Welcome and Process Homework

Welcome participants as they arrive.

Use the first 10–15 minutes to review and process the home- 1 work assignment. Begin by reviewing a few key ideas from the previous session.

We started this workshop 8 weeks ago, and we’ve covered a lot of ground. We’ve been getting together each week because we’re inter- ested in learning how to make our relationships closer and more rewarding. A healthy, stable relationship is good for you, good for your family, and good for your recovery. Along the way we’ve covered new ideas, learned some skills and techniques for improving communication in our relationships, and tackled some of the mysteries and myths about sex. Let’s talk for a few minutes about the homework assignment:

Ask for volunteers to share their experiences with the home- 2 work.

Time Out! For Men 145 8 Making Relationships Work Here are a few ideas for questions:

What’s one change your partner says she’s noticed for the better since you started coming to this workshop?

Process questions What’s one thing your partner says she appreciates about you? What did she ask you to work on a little more? What did you learn from this exercise?

Thank volunteers for their input. Encourage participants to keep up 3 the good work.

Self-Esteem and Affirmations 20 Use the next 15–20 minutes to lead a discussion about self- 1 esteem and affirmations.

Here are some ideas to include in the discussion:

Since today is our last session, we’re going to try and keep everything on a “feel good” level. When it comes to your relationships, your family, your recovery—all those things—the most important thing you can work on is feeling good about yourself. That’s what we want to spend some time doing today—breaking down some of the barriers and hang-ups that keep us from realizing how valuable and special we really are. The fact that you are here today, coming to this workshop and working on your recovery, says a lot about just how courageous and special you are. Self-esteem refers to the feelings, beliefs, and perceptions we have about ourselves. Simply put, self-esteem is our own opinion of our- selves. This sense of self (self-concept, self-esteem) is learned, and the most critical time for that learning is during childhood and the teen years. We learn through being told that others (usually parents, friends, other adults) perceive us to be good/bad, sweet/mean, lazy/a good worker, cheerful/grouchy, smart/stupid. Very often we accept these perceptions of others without question. If we are lucky enough to hear mostly positive assessments (or at least an even balance of positive strokes) we are likely to grow up with a fairly healthy self-concept. On the other hand, if we receive mostly critical or negative feedback from others as we grow up, then we may

146 TCU/DATAR Manual 8 need some help in gaining a healthy sense of self-esteem. The good news is that we can learn to feel better about ourselves, and to not judge ourselves so harshly that we stay down most of the time.

Write the following quotation on flip chart or erasable board 2 and ask participants to think about its relationship to self- Flip chart esteem.

“Whatever you believe to be true either is true or becomes true in your mind.” (John Lilly)

What does this quotation mean to you? What does it tell us about our self-esteem? Process questions What’s an important point you’ve learned about improving self- esteem?

3 Wrap up with the following ideas: If we are living with painful or confusing memories from childhood or adolescence that center on having been told a lot of critical, rejecting, or negative things about ourselves, the most important thing we can learn to do is let go of them. This may be difficult to accept, but the truth is, it wasn’t your fault. Just because you didn’t fit your parents’ ideal doesn’t mean you were bad, worthless, or that you deserved rejection and harsh treatment. If you struggle with these issues, you may want to schedule some time for individual counseling so that you can begin working through your feelings. As adults, our mature sense of who we are, as well as our sense of being able to succeed and accomplish things contributes to maintain- ing our self-esteem. One way we can get in touch with these things is through practicing affirmations, or positive thoughts and reflections about ourselves. Affirmations can help us contradict thoughts and feelings of worthlessness that can pull down our self-esteem.

Distribute paper and pencils and lead the group in the 4 affirmations exercise. Use the Affirming Yourself flip chart of Flip chart instructions for the affirmation exercise. Provide participants with examples of affirmations for each of the three areas. Tell them to write their affirmations as sentences that begin with the word “I.” 0or example, “I have a strong chin,” “I have a great sense of humor,” “I am a good listener,” “I came to all 8 workshop meetings,” “I’ve been clean for 5 years,” etc. Encourage

Time Out! For Men 147 8 Making Relationships Work participants to think about their affirmations, and not to be afraid to be open and honest about themselves. Anticipate that some group members may find this exercise difficult.

When everyone has finished, process the exercise with some 5 of the following questions.

How did it feel to write positive things about yourself? Was it difficult or easy? Process questions Which of the three areas was the most difficult? What thoughts came to mind as you did this exercise? In what ways could this type of exercise improve self-esteem?

Go around the room and ask each person to share one or two 6 statements from each of the three areas. Model support and Handout, encouragement after each participant reads his statements in such way that p. 152 the group joins in. In other words, each statement should be met with ap- plause, cheers, and other positive “strokes.” (Pump each other up.) Distrib- ute the E Is or Esteem handout.

Thank participants for their input. Encourage them to keep their 7 lists and to consider adding to them. Point out that it’s often difficult for people to give themselves permission to think and say good things about themselves. This may be because we grow up hearing that we’re not sup- posed to be “conceited” or “big-headed.” Remind participants that building positive self-esteem is healthy and good for themselves, their relationships, and their recoveries. We have the right to feel good about ourselves. Practic- ing affirmations can help.

15 Review: Communication and Relationships

Use the next 15 minutes to briefly review communication 1 skills and relationship issues. Use the prepared flip charts for An Flip charts Assertive Attitude, Good Listening Skills, Talk It Over ormula, and ighting air. Review the key points and invite participants to discuss their experi- ences in beginning to use these skills over the past few weeks.

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10 Break

Handling Problems in Relationships 25 Use the next 20–25 minutes to lead a discussion exercise on 1 handling problems in relationships. Most people can come up with good ideas for solving problems in relationships. The idea behind this exer- cise is to create a “think-tank” atmosphere about what makes relationships work. Participants are encouraged to think about and share ideas that may be helpful to the entire group.

Exercise instructions:

1. Divide the participants into work teams of 2 or 3 people.

2. Distribute sheets of paper and pencils to each work team.

3. Assign each work team a specific relationship problem, or let them come up with their own.

(0or example, one person in the relationship is more interested in sex than the other; one person in the relationship shuts down and won’t talk; one person in the relationship gets jealous easily and without cause. Keep the scenarios simple, but true to life.)

4. Tell the work teams to discuss these problems and to write down possible solutions to the problems, steps that should be taken for the solutions, and the skills that could be used to put the solutions in action.

5. Allow time for the work teams to finish.

6. Ask for a volunteer from each team to come to the front of the room, explain the problem his team worked on, and describe the solution they recommended.

7. Encourage the “rep” to use the flip chart or erasable board to list the steps and skills needed to help work on the problem.

8. Allow time for the group as a whole to discuss each problem and solution.

Time Out! For Men 149 8 Making Relationships Work 2 Process the exercise with some of the following questions. What feelings came up for you during this exercise? Did any of the problems sound familiar? Which ones? Process questions How confident did you feel when working on your solutions? What did you learn from this exercise?

Conclude by noting that the group was able to come up with 3 a lot of really fine ideas for making relationships work.

Thank participants for their input. Point out that in only 8 weeks 4 they’ve started to think like relationship “experts.”

10 Workshop Closure

Provide closure by wrapping up on some of the key points raised in this workshop. 1 Here are some ideas for closing comments: Learning to make our relationships stronger and happier is important for our well-being and for our recovery. We’ve spent the last few weeks talking about ideas and skills that we can use to make our wishes of happiness a reality. We believe that deep down, we all want closeness and intimacy with another person. Sometimes, though, we get stuck. We get into “bad” habits of relating to each other, we feel hopeless, confused, and lost— we feel afraid. This workshop was designed to help you set some goals, learn some new skills, and begin feeling better and more confi- dent about your ability to make a close, intimate relationship work. Sometimes it seems safer, easier, and more comfortable to just con- tinue with old attitudes and ways of doing things. Change is always a little bit scary and difficult. Change requires courage. And you guys are some of the most courageous I’ve met. The fact that you’re here today, and that you’ve been coming to this workshop tells me you’re all going to make it happen, and make it work—not just in your relation- ships, but in your recoveries as well.

150 TCU/DATAR Manual 8 Remember that practice is the key. It’s very easy to drift back into old patterns and habits. One way to overcome this is to review the mate- rials from this class from time to time, and to encourage your partner to be open to reviewing materials and making changes when needed. As with all things related to living a good life—strive for progress, not perfection.

Thank participants again for their involvement in the 2 workshop.

Go around the room and ask each person to state the most 3 important thing they learned in the workshop and the one skill they plan to keep on using.

Graduation and Client Survey 30 Use the remainder of the session time to complete evaluation forms and to hold a graduation “party.”

1 Ask participants to complete an evaluation form. Evaluation, p. 153 Posttest, Then ask them to complete the Client Survey (posttest). pp. 225-227 2

Distribute graduation certificates or some other form of 3 recognition. Certificate, p. 154

Provide refreshments and allow time for socializing and 4 chatting.

Time Out! For Men 151 8 Making Relationships Work

nergize yourself! At least once a day practice affirmations, which are positive healthy thoughts about yourself. Use the word “I”, and learn to cherish it. “I am lovable and capable!”; “I am worthy and strong!”; “I can decide my own destiny!”; “I have the right to love and feel good about myself!”

tomp-out negative thoughts! Whenever you hear a negative thought about yourself inside your head, stomp it out! Learn to rebel against the tyranny of these negative thoughts—they were most likely taught to you by others. If you hear yourself thinking thoughts like: “I can’t do anything right,” or “I’ll never be able to change,” stomp them out! Inside your head, replace those thoughts with positive ones. “I am learning how to improve my life and improvement takes time,” or “I am powerful and I can change.”

rust yourself! Accept that you are the best person and the most able person to know what is right or wrong for you. Trust in your own strength, and in your own ability to manage your life. Trust that you can change your life, that you can develop positive self-esteem, and that you can be happy.

ndear your body! Learn to love and hold dear your body and your person. Take care of your health. Develop good health habits, such as diet, rest, exercise, and medical care. Respect your body. Avoid people or substances that harm your body.

nd destructive relationships! (Or at least limit the amount of time you spend with destructive people.) Don’t keep company with anyone who puts you down, hurts you, or tries to destroy your self-respect. Never accept mental or physical abuse from anyone. Don’t let other people lay their negative trip on you!

ove on! 0ind ways to leave the past behind. Don’t dwell on past problems, failures, disappointments, or relationships—let them go! Imagine you are packing for a long journey. Carefully pack all of your positive memories, and leave the rest behind. Think of past mistakes the way the Japanese do: they are “golden nuggets,” and they represent an opportunity to learn and improve, rather than a mark of failure.

152 TCU/DATAR Manual 8 SESSION EVALUATION Time Out! For Men Session 8

THIS BOX IS TO BE COMPLETED BY DATA COORDINATOR:

SITE # |__|__| CLIENT ID# |__|__|__|__| DATE: |__|__||__|__||__|__| COUNSELOR ID# |__|__| [1-2] [3-6] MO DAY YR [7-12] [13-14]

INSTRUCTIONS: Please take a minute to give us some feedback about how you liked this session.

1. Use one word to describe your reaction to today’s class. ______

2. What is the most important thing you learned today?

3. List 3 affirmations about yourself you plan to be more aware of in the future.

4. On a scale of 1 to 10, how do you rate today’s class? (Circle your rating)

01 02 03 04 05 06 07 08 09 10 |__|__| [15-16] Poor Pretty Good Excellent

5. Do you have any suggestions to help make this class better?

Time Out! For Men 153 8 Making Relationships Work

154 TCU/DATAR Manual Appendix A

Human Sexuality TABLE OF CONTENTS PAGE Introduction...... 156

Male Reproductive and Sexual Anatomy ...... 157

Reproductive and Sexual Health ...... 159 Testicular Self-Exam ...... 160 Problems of the Testicle...... 161 Problems of the Penis ...... 162 Prostate Gland ...... 163 Problems with Sexual +unction ...... 164

Sexually Transmitted Diseases ...... 166

Women’s Reproductive and Sexual Anatomy ...... 167

The Menstrual Cycle ...... 168

Pregnancy and Prenatal Care ...... 169

Supplemental discussion outline: Condoms and Safer Sex ...... 171

Time Out! For Men 155 Appendix A Human Sexuality

Human Sexuality

Introduction

This section is designed to help you review information about men’s sexual and reproductive health issues. In order to become comfortable with the subject matter you also may want to do further reading. A few references are listed below and most libraries and bookstores will have general textbooks on human sexuality that will be helpful.

Ortiz, Elizabeth, Your Complete Guide to Sexual Health, Prentice-Hall, Englewood Cliffs, NJ, 1989.

McCary, James & McCary, S. P. , Human Sexuality, 3rd Edition, Wadsworth Publishing, Bellmont, CA, 1984.

Nowinski, Joseph, Becoming Satisfied: A Man’s Guide to Sexual "ulfillment, Prentice-Hall, Englewood Cliffs, NJ, 1980.

Oppenheim, M., The Man’s Health Book, Prentice-Hall, Englewood, Cliff, NJ, 1994.

Wertheimer, N. (Ed.), Total Health for Men, Rodale Press, Emmaus, PA, 1995.

Sessions 6 and 7 of the module deal with sexuality, health, and safer sex is- sues. You may prefer to invite a guest speaker to help you lead these sessions, using this manual as a guide. The following organizations may be able to pro- vide guest speakers or other assistance. Check your telephone book for offices that serve your area:

Planned Parenthood or other family planning organizations Public health departments Medical societies or physician’s associations Nurse’s associations Hospital education departments AIDS/HIV resource and service organizations

156 TCU/DATAR Manual Appendix A

This section contains a brief, general discussion of men’s reproductive and sexual health concerns, including information about anatomy, human reproduc- tion, testicular and prostate health, sexual dysfunction, and sexually transmitted diseases. Because men often will have questions, information about women’s physiology, including menstruation, menopause, and pregnancy also is included. In Appendix B you’ll find additional information about reproductive health issues, including "ACT SHEET handouts and a glossary of sexual terminology.

Our socialization often creates the expectation that men are supposed to be totally knowledgeable, worldly, and in-control. Unfortunately, this mind-set prevents many men from being able to ask questions and admit the need for more information, especially in the arena of sexuality. The rationale for present- ing this material is to provide a nonthreatening setting where men can ask questions, gain knowledge, and learn appreciation for their bodies (and women’s bodies). This is seen as an important step toward improving health, intimacy, and relationships.

Male Reproductive and Sexual Anatomy

A man’s sexual anatomy is complex and surprisingly delicate. There are both internal and external organs in the male reproductive system, including the penis, the testicles and scrotum, the vas deferens, the urethra, the prostate, and various glands.

The penis is the major external sex organ in men. It has both a reproductive function and a urinary function. The size of the penis varies, but for the average adult the flaccid or limp penis measures 3 to 4.5 inches and the erect penis measures between 4.5 and 9 inches. The size of the penis is unrelated to height, weight, or other physical characteristics. Also the size of the penis is not related to sexual potency, fertility, or the ability to satisfy a woman.

The penis is a fairly complicated organ, made up of specialized tissues and hollow spaces that fill with blood during sexual excitement. This swelling and stiffening of the penis is called an erection. Inside the body or shaft of the penis there are two sections called corpus cavernosum and corpus spongiosum. These are the specialized tissues that fill with blood. The end of the penis is rounded and covered with very thin and sensitive tissues. This area is called the glans, and the ridge-like area where it joins the shaft is called the corona. The urethra is a long, tubelike organ that runs through the inside of the penis into the pelvis where it connects with the prostate and the bladder. This is the tube through which both urine or semen exit the man’s body. The opening at the tip of the penis is called the urinary opening.

The penis is covered in thin, loose skin that is somewhat wrinkled when the penis is limp. This skin forms a loose sac that covers the glans and corona and

Time Out! For Men 157 Appendix A Human Sexuality

Reproductive is called the foreskin. When a male is circumcised, this foreskin is removed. and Sexual Circumcision is usually performed on newborn infants. Although some religions Anatomy require that males be circumcised, doctors nowadays believe there is no medical (continued) reason why all newborn males should undergo this procedure. If an adult man who has not been circumcised develops an infection or other health problem, he may need to undergo circumcision as part of treatment.

The testes or testicles are important organs in a man’s sexual anatomy. The testicles are small, round organs about the size of walnuts. They are covered and protected by a sac of loose skin called the scrotum that changes in size and shape in response to cold, heat, and sexual stimulation. A special muscle called the cremaster muscle pulls the testicles and scrotum closer to the body when it’s cold, and relaxes to allow them to hang lower when it’s warm. These changes in response to temperature are not under a man’s conscious control. They happen as a normal bodily response, designed to protect the functioning of the testicles.

The testicles produce sperm cells and the primary male hormone testosterone. In this sense, they function much like the ovaries in the female that produce egg cells and the female hormone estrogen. Inside each testicle there are areas made up of tiny, coiled tubes called seminiferous tubules. This is where the sperm cells are produced in an ongoing process. It’s estimated that each tes- ticle contains about ½ mile of these tiny, coiled, sperm-producing tubes. Newly produced sperm take about 10 weeks to mature. The sperm cells leave the seminiferous tubules and are collected in larger tubelike structures called the epididymis that lie along the back side of each testicle.

The sperm cells continue maturing in the epididymis and are eventually funneled into larger tubes called the vas deferens that run from each testicle into the pelvis. The vas deferens loop behind the bladder and join with seminal vesicles, which are glands that produce some of the fluids found in semen (“cum”). These connect with the ejaculatory ducts and run through the prostate gland. The prostate gland produces most of the fluids that make up semen. The urethra, which carries urine out of the bladder, also runs through the prostate gland and joins with the ejaculatory ducts. During sexual intercourse or stimula- tion the ejaculatory ducts close off the bladder so that urine cannot be passed when a man ejaculates (or “comes”). Two tiny glands called Cowper’s glands are situated just below the prostate. They secrete the clear, sticky fluid that appears at the opening of the penis when a man first becomes sexually aroused. This fluid is designed to “clean” the urethra so that sperm cells are not damaged by traces of urine that may be present.

During sexual stimulation (which can be triggered by touch, sight, smell, or thoughts), the nerves in the penis respond and blood vessels in the area expand, causing an increased flow of blood that fills the specialized spongy tissues in the core of the penis causing an erection. About 5 times the normal amount of blood flows into the penis during an erection. As stimulation increases, through touch or sexual intercourse, the urethra, prostate, and seminal vesicles begin to

158 TCU/DATAR Manual Appendix A

contract rhythmically and semen and sperm cells are expelled from the penis during ejaculation.

About a tablespoon of fluid is released during ejaculation, and it may contain as many as 300 million sperm cells, depending on the man’s general health, fertil- ity, and how often he has sex. During his lifetime, a man may produce several hundred billion sperm cells. Age does not completely diminish sperm produc- tion, although it does slow it down. However, there are records of men in their 90s fathering children.

Sperm cells are among the tiniest cells in the human body. Each one has a body and a taillike structure that wiggles back and forth to push the sperm forward. When sperm cells are deposited inside a woman’s vagina, they begin to “swim” upwards into her uterus (womb), then out into specialized tubes connected to her uterus where an egg cell from her ovaries may be present. When a sperm cell succeeds in penetrating an egg cell, fertilization occurs and a pregnancy may follow. (See “What About Women?” section at the end of this article.)

Reproductive and Sexual Health

General health concerns

Sexual health is a part of a man’s general, overall health and is influenced by many of the same things. By paying attention to good health practices over which he has some control, a man can help ensure a healthy and vigorous life. These include:

Nutrition A man’s daily diet should include several servings of fruits, vegetables, and lean meats in addition to carbohydrates or starches. It’s a good idea to avoid high- fat foods, sugar, and too much salt. Most public health departments can pro- vide a pamphlet on general nutrition and health.

Exercise Regular exercise is important for muscle and bone strength, weight mainte- nance, stress reduction, and heart and lung fitness. Special strength building exercises, such as sit-ups, leg lifts, and weight training help prevent back prob- lems and injuries, an important consideration for men who work in physically demanding jobs.

Substance abuse Alcohol, illicit drugs, and tobacco contribute to many of the health problems experienced by men. Avoiding use of these substances can help improve health and fitness. These substances may impair a man’s fertility and sexual function- ing, especially when used in heavy amounts.

Time Out! For Men 159 Appendix A Human Sexuality

Reproductive Hygiene and Sexual Attention to hygiene and cleanliness is important for good health. Daily baths or Health showers with careful attention to cleansing the genital and rectal area is recom- (continued) mended. Men who have not been circumcised (who still have a foreskin) should take care to pull back the foreskin and wash the skin underneath when bathing. This helps prevent the build up of secretions that can contribute to irritation and infections.

Self-examination of the testicles

Most men are unaware that they should perform a self-examination of their testicles each month. Cancer of the testicles is rare, but it is one of the most common types of cancer in younger men (under age 35). When treated early, testicular cancer can be cured. When it spreads, it most commonly spreads to the lungs, liver, or bones, and it can be fatal. Treatment involves surgery to remove the affected testicle and also may involve radiation, chemotherapy, or hormone treatments. A tumor in one testicle normally will not spread to the other, so treatment involves only the diseased testicle.

The Testicular Self-Exam (TSE) can be easily performed after a warm shower or bath, and should be done each month. The warm temperature of the bath or shower encourages the scrotum to relax so that the testicles can be easily examined.

The following steps are recommended by the American Cancer Society for TSE:

1. Stand naked in front of a mirror and visually examine the testicles and scrotum, looking for any type of swelling or bumps.

2. Use your fingers to gently and carefully examine the surface of each tes- ticle. Use your thumbs and fingers to gently slide or roll the testicle back and forth so that all surfaces can be felt. The testicle should feel firm and slippery, a bit like the firmness of a boiled egg. Each testicle should feel completely smooth, except for the epididymis (discussed earlier). The epididymis will feel like a soft, firm ridge or cord running up the back side of each testicle.

3. Testicular cancer may first appear as a small, hard, pea-sized lump or nodule on the side or front of the testicle. These lumps are painless and can usually be easily detected.

4. A lump, thickening, or bumpy area discovered in the testicle should be examined by a doctor at once. Pain, swelling, and lumps in the testicles may be caused by many kinds of problems or infections. Most are not cancer, but it’s always a good idea to have any problem with the testicles checked out.

160 TCU/DATAR Manual Appendix A

Other testicular problems

Men do not usually need frequent medical care for their sexual and reproductive systems (compared to women for whom annual exams are recommended). However, men should be aware of problems that can develop and seek medical care when needed. Some common problems that can affect a man’s testicles include:

Mumps Most adult men are immune to mumps through vaccination or from having had it in childhood. However, when adult men are infected by mumps, there is a 1 in 3 chance the virus will move to the testicles, a complication called mumps orchitis. The testicles become swollen and painful to touch and the condition lasts about a week. There is a high probability that the infected testicle(s) will be damaged, rendering the man infertile. Men who never had mumps in child- hood or who were not vaccinated should avoid exposure to children who have the disease. A man may want to talk with a doctor or clinician about having a mumps vaccination.

Torsion Under some circumstances, a testicle may become twisted inside the scrotum, cutting off its blood supply. When this happens, the testicle rapidly becomes swollen and painful. If the testicle doesn’t become untwisted on its own within an hour or so, medical attention should be sought immediately. Without a blood supply, the testicle will be severely damaged and lose the ability to make sperm cells and testosterone, the male hormone. Symptoms of torsion of the testicle include sudden onset of severe pain and swelling in one side of the scrotum. Treatment may involve manipulation by a trained physician in order to untwist the testicle. In some cases surgery is needed to correct the condition.

Epididymitis Epididymitis is an inflammation of the epididymis, the tube that runs along the back of each testicle where sperm are stored until they mature. In some cases, infection in the urinary tract or prostate gland can enter the epididymis and cause problems. In other cases, epididymitis is caused by sexually transmitted bacteria such as gonorrhea or chlamydia. Symptoms include pain and swelling in the testicle, fever, pain when urinating, and sometimes pus in the urine. In mild cases, a man may experience pain and soreness in the testicle that seems to come and go. Treatment requires antibiotics to eliminate the infection. Often the doctor or the clinic will run tests to determine what organism caused the infection. If the infection can be sexually transmitted, the man’s sexual partner(s) also must be treated with antibiotics.

Time Out! For Men 161 Appendix A Human Sexuality

Reproductive Problems affecting the penis and Sexual Health There are relatively few disorders that affect the penis. Nonetheless, it’s helpful (continued) for a man to be aware of indications of a possible problem so that he can seek medical attention promptly. The most common problems include:

Injury The penis may be bruised or injured by being struck or during a fall. It’s also possible to bruise the penis during rough sexual intercourse. These minor bruises or injuries, while painful, are not serious and will usually heal with time. Aspirin or other over-the-counter pain medication and cool compresses may help relieve the discomfort. Although there is no bone in the penis, it’s possible for the penis to be fractured or sprained. This can happen when the erect penis is violently pulled to the side or bent. This causes the supporting structures (liga- ments) of the penis to become torn from the groin area, resulting in internal bleeding, pain, and bruising. Surgery may be needed to repair the damaged ligaments.

Priapism In rare circumstances the penis can become erect and stay erect over an un- naturally long period of time without subsiding. This often painful condition is called priapism and it’s considered a serious medical problem. If an erection stays over several hours, the tissues inside the penis can become damaged permanently. This will result in impotence (inability to have future erections). Priapism develops when there is some damage to the circulatory or nervous system that controls blood entering and draining from the penis. This may be caused by diseases such as leukemia, sickle-cell anemia, tumors, or infection. Certain drugs and medications may also bring on priapism. If a man experiences a painful erection that lasts several hours without subsiding, he should seek medical help immediately. Treatment may involve medications or minor surgery to drain the blood from the penis. Without medical help permanent damage to the penis can occur.

Peyronie’s Disease In this disorder, patches of scar tissue form in the connective tissues under the skin of the penis, causing the penis to curve upward at a bent angle when erect. The cause of Peyronie’s disease is unknown and it is not considered serious. However, the curvature of the penis may make erections painful and may make penetration of the vagina during sex difficult or impossible. The condition develops slowly over several years, and in some cases it will regress and disap- pear on its own. A mild case is usually left alone since it causes few problems. Severe cases may be helped with surgery.

Cancer Cancer of the penis is very rare and usually tends to develop in older men. It may be associated with a previous history of viral infections such as herpes or genital warts. Penile cancer is slow growing, but requires surgery to keep it

162 TCU/DATAR Manual Appendix A

from spreading. The major symptom is a sore, lump, ulcer, or growth that does not heal. The sore or lump is usually located near the head of the penis (the glans), but also may be located on the shaft. Pain, bleeding, and difficulty urinating also may occur. These symptoms are similar to those of some sexu- ally transmitted diseases, and should be checked by a doctor. Small tumors may be treated with chemotherapy or radiation; larger tumors may be treated with laser surgery. In some cases amputation of the area of the penis where the tumor is located is required.

The prostate gland and men’s health

The prostate gland is about the size and shape of a small plum and is situated near the lower end of the bladder, close to the wall of the rectum. A healthy prostate is very important for a man’s sexual functioning. It produces the fluids in semen that nourish sperm cells, and many of the blood vessels and nerves near the prostate influence a man’s ability to have an erection. Muscles near the prostate contract during orgasm, contributing to pleasurable feelings.

Although men of any age can experience prostate problems, they are much more common in men over age 45. An examination of the prostate gland is a common part of a routine checkup for men. A doctor or clinician checks the prostate by inserting a gloved finger into the man’s rectum while he is bent forward. This allows the clinician to feel the surface of the gland and check for swelling, inflammation, or hard, small lumps, which may be a sign of cancer. Although somewhat uncomfortable and embarrassing, the prostate examination is an important part of a man’s health care. The most common prostate prob- lems include:

Enlargement As a man ages, his prostate gland enlarges (a condition known as benign pros- tatic hypertrophy). Almost all men will develop problems associated with an enlarged prostate as they grow older. These problems may be minor and cause little discomfort, or they may be extremely uncomfortable, disrupting the quality of the man’s life. The most common symptoms associated with benign enlarge- ment include needing to urinate frequently, difficulty urinating, a slowing down in the force and flow of the urine stream, and difficulty starting the urine flow. A man should consult a doctor or clinician if these symptoms are experienced. In some cases, the condition can be treated with medications; in other cases surgery may be required. In severe cases, the prostate becomes so enlarged it interferes with the ability to urinate at all. This is a severe medical emergency that usually requires surgery in order to avoid infection or kidney damage.

Infection and inflammation The prostate gland can become swollen and inflamed, causing pelvic pain during urination. The condition is known as prostatitis and it can occur in men of any

Time Out! For Men 163 Appendix A Human Sexuality

Reproductive age. In some cases, sudden changes in frequency of ejaculations (coming) may and Sexual cause temporary prostatitis. +or example, it may occur when a man used to a Health certain level of sexual activity experiences either a dramatic increase or decrease (continued) in frequency. Prostatitis caused by changes in sexual frequency will usually resolves itself through either rest or masturbation. Sitting in a bath tub filled with hot water may help smooth the discomfort.

However, prostatitis commonly occurs because of infection or other health problems. The primary symptom is a strong ache or pain experienced in the groin or pelvic area during urination. Low back pain and sudden urges to urinate may be experienced, along with fever, chills, and pus in the urine. Symptoms of prostatitis should be checked by a doctor or clinician. Urine specimens will be taken to determine if bacteria (infection) is causing the problem, and if so, antibiotics may be prescribed. In some cases, the man’s sexual partner(s) also may need to be treated.

Prostate Cancer Although men of any age can develop prostate cancer, it is most common in men over 50. The American Cancer Society recommends an annual prostate exam (digital rectal exam or DRE) for men in this age group. During the prostate exam, the doctor or clinician will insert a gloved finger in the man’s rectum to check the gland for lumps, nodules, swelling, or enlargement. In addition, men over 50 should consider having a special blood test called the prostate-specific antigen test (PSA) each year. The PSA measures levels of antigens in the blood that may increase when cancer is present. If the PSA or the rectal exam indi- cate a possible problem, further evaluation may be needed. A biopsy (micro- scopic examination of prostate cells) may be ordered by the physician to determine if cancer is present, and what type of cancer it is. Some types of cancer of the prostate are slow growing and slow to spread, and may respond to medication or minor treatment. Other types of prostate cancer are faster growing and may spread to the bones, spine, liver or lungs. When caught early, prostate cancer is treatable. This is why it’s important for older men to have their prostate checked each year as part of a regular physical exam. Surgical treatment for prostate cancer may cause impotence, however, newer surgical techniques such as laser surgery reduce this risk. Radiation, chemotherapy (anti-cancer drugs), and hormone therapy also may be used for treatment.

Problems with sexual functioning

Men often are reluctant to discuss sexual functioning, afraid that their manliness may be drawn into question. Many men grow up believing that a “real man” is willing and able to make sex happen whenever the opportunity presents itself. Unfortunately, men still receive these unrealistic sexual messages from the media, music, and society in general. In truth, all men experience problems with sexual functioning sometime during their lives. A man’s body is not a ma-

164 TCU/DATAR Manual Appendix A

chine—there are many physical, emotional, and/or drug-related reasons why sexual problems occur. If a man is experiencing trouble with sexual functioning, the following recommendations may be helpful:

Quit using drugs and alcohol. Alcohol has long been known to have a negative impact on a man’s sexual functioning. Even Shakespeare kidded that “wine increases the desire but takes away the power.” Heavy alcohol use over time interferes with both desire and the ability to have an erection. In addition, heroin, other opiates (including methadone), barbiturates, and tranquilizers, such as Valium, may negatively affect sexual functioning. Studies show that over time, most men who use cocaine or crack (especially heavy users) end up reporting a lack of interest in sex, along with problems getting and keeping an erection. When alcohol is used in combination with other drugs, the potential for problems increases. Quitting alcohol and drug use will usually reverse the problem. If a man is on methadone maintenance, he should discuss any sexual problems he may be experiencing with the clinic physician. In most cases, methadone dose can be adjusted over time to relieve the problem.

Have a physical exam (checkup). If a man is not using alcohol or drugs, yet continues to have sexual problems, the cause may be health-related. Medical conditions such as diabetes, high blood pressure, heart and lung diseases, thyroid disorder, severe depression, prostate inflammation, or simply being fatigued or exhausted may cause prob- lems with sexual functioning. In addition, some drugs used to treat medical problems, such as high blood pressure medication, interfere with the ability to keep an erection. A doctor or clinician should be consulted if there is concern that the problem might be health-related or caused by medications.

Seek marriage or relationship counseling. Some problems with sexual functioning may be related to anger, stress, ner- vousness, or other feelings and emotions, and may reflect troubles in a man’s marriage or relationship. Sometimes sexual partners are unable to talk openly with each other about their feelings, fears, needs, or resentments. This kind of breakdown in communication can lead to sexual problems for men and women alike. Psychological or emotional difficulties can sometimes create an uncon- scious mental block that interferes with getting and keeping an erection or having an orgasm. Counseling (either individually or as a couple) can provide education, reassurance, and helpful techniques for improving communication, dealing with feelings, and overcoming sexual problems.

Time Out! For Men 165 Appendix A Human Sexuality Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are infections that result from having sex or close intimate contact with an infected person. (Years ago these infections also were known as Venereal Diseases or VD.) Sexually transmitted diseases are very common in the United States, infecting an estimated 25 million people each year. On average, about 1 in 4 people between ages 14–55 will become infected with some type of STD.

There are over 25 different types of infections that can be transmitted sexually, each one caused by a different organism. It’s possible to be infected with more that one STD at a time; in fact, it’s fairly common. STDs may be caused by bacteria, viruses, or fungus, and in the case of pubic lice (“crabs”), the infection is caused by infestation with tiny, bloodsucking insects. Most STDs can be cured with antibiotics or other medications. However, STDs that are caused by a virus usually cannot be cured, although there are treatments available to relieve the symptoms.

All STDs have one thing in common—they are spread through some type of sexual or intimate contact. This includes vaginal, oral, and anal sex. Some diseases, such as herpes or genital warts can be spread through direct contact with the sores or infected skin. There is a tendency to think of STDs as “dirty,” but in truth, they are no more “dirty” than any other disease. Most of the organisms that cause STDS require a warm, moist environment in order to survive. The mucous membranes that line the genitals, mouth, and rectum provide the right environment for these organisms, as do the fluids and secre- tions associated with sex. During sex with an infected person there may be direct contact with infected areas or with sexual fluids and this provides an easy route for the organisms to pass from one person to another. This is also why condoms help prevent the spread of STDs. A condom blocks direct contact with infected skin or body fluids, and this prevents the spread of infection.

Many times STDs are spread by people who have no idea that they are infected. This is because some STDs cause no symptoms for months or even years. In some cases the symptoms may be so mild or difficult to see that the infected person fails to notice them. It’s not uncommon for symptoms to come and go on their own. However, even if the symptoms go away, the disease may still be present. Any symptoms of STD should be checked by a doctor or health clinic. Special tests must be run to determine the cause of the infection and to pre- scribe treatment. Some of the most common signs or symptoms of STD in- clude:

Sores, bumps, blisters, or warts around the sex organs or rectum Burning or pain when urinating Swelling, redness, blisters, or sores in the mouth or throat

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Pus or milky discharge from the penis Swelling, inflammation, or pain in the testicles Swelling, burning, itching around the sex organ or rectum

If an STD is diagnosed, a man should inform his sexual partner(s) so that they also can be treated. Women often don’t develop noticeable symptoms of STD, so it’s very important for a man to tell a woman if he knows he’s infected. If a woman becomes pregnant, she can pass an STD to her unborn child during pregnancy or childbirth. Some STDs cause blindness, brain damage, pneumo- nia, and even death in newborn infants. If a man is too embarrassed or uncom- fortable to tell his sexual partners, he should contact the nearest public health department. The health department can contact exposed sex partners without revealing names. This gives the person exposed to the STD an opportunity to get treatment and avoid possible complications from the disease.

Using a condom during sex is the best protection against STDs for men (and for women, too). Properly used, the condom prevents exposure by creating a barrier that protects against infected fluids (vaginal secretions, semen, blood) or infected skin areas (e.g., herpes blisters). To provide the best protection, a new latex condom should be used for each sex act (vaginal, oral, or anal sex). Lubri- cants or gels containing the chemical Nonoxynol-9 also may help prevent the spread of STDs. Nonoxynol-9 is found in many types of birth control products, including foams, suppositories, and gels. Birth control pills do not provide protection against STDs for either the woman or the man. Reducing the number of sexual partners helps reduce the chance of exposure to an STD. Sexually active men with more than one partner should have regular checkups and re- quest tests for STDS. Information about symptoms and treatment for the most common STDs can be found in Appendix B of this manual.

What About Women?

Reproductive and sexual anatomy

A woman’s reproductive and sexual anatomy is also fascinating and complex. The internal organs are small in size and located below the navel. The uterus or womb is about the size and shape of a small pear (about the size of a woman’s closed fist.) The uterus is lined with a layer of tissue called the endometrium, (sometimes called the endometrial lining.) The uterus resembles a hollow muscle, lined with the spongy, blood-rich tissue of the endometrium. The function of the uterus is to contain the developing fetus until birth. The en- dometrium sustains the fertilized egg. After an egg has been fertilized by a male sperm, it will implant itself in the endometrium and begin to grow.

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What About Extending from either side of the uterus are two hollow, tubelike structures Women? called the fallopian tubes. Directly below these tubes are the ovaries, which are (continued) held in place on either side of the uterus by bands of ligaments. The ovaries have two primary functions: 1) they produce the female hormones estrogen and progesterone, and 2) they produce and release the female egg cells called ova. When the ovary releases an egg, it is collected by the adjacent fallopian tube. The fallopian tube holds an egg cell during fertilization. The egg cell lives about 24–48 hours, during which time it may be fertilized by sperm in the fallopian tube. If it is not fertilized, the egg cell simply dissolves.

The lower end of the uterus is called the cervix. The cervix is located at the upper back portion of the vagina, the elastic, muscular passage that leads to the outer body. The cervix is like the “door” of the uterus. Through the cervical opening, sperm pass during intercourse. The menstrual flow leaves the uterus through this opening. Also, during childbirth, the cervical opening stretches to allow a full term infant to pass. The vagina serves to hold the male penis during intercourse so that sperm will be deposited at the opening of the cervix. During childbirth, the vagina becomes the birth canal and stretches to allow the infant to pass through.

The vaginal opening is centered within two folds of tissue. The innermost folds are called minor labia; the outermost folds are called major labia. These “lips,” as they are sometimes called, serve a protective function. Directly above the vaginal opening is the urethral or urinary opening through which a woman empties her bladder. Directly above the urinary opening is the clitoris, which is surrounded by a tiny fold of skin called the clitoral hood. The clitoris is the center of sexual sensations for the woman. It contains many nerve endings and blood vessels. It is made of the same type of tissue as the male penis. During sexual excitement it fills with blood and swells, much like a tiny penis. The clitoral hood is the equivalent of the male’s foreskin.

The Menstrual Cycle

The onset of menstruation signals the beginning of reproductive maturity in the female (but not necessarily psychosocial maturity.) Women are born with about 400,000 immature egg cells, called follicles, in their ovaries. As a woman enters puberty, her pituitary gland increases production of special hormones that influence the ovaries to produce estrogen and progesterone. Menstruation usually begins between ages 9 to 15; the actual age is determined primarily by heredity.

As estrogen and progesterone are produced, some of the follicle egg cells in each ovary begin to mature. The lining of the uterus, the endometrium, begins to thicken and become rich with blood vessels. When hormone production

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peaks, an egg cell is released by the ovary and enters the fallopian tube. The release of the egg cell is called ovulation. Ovulation is most likely to occur at the midway point in a woman’s cycle. If this egg cell isn’t fertilized within 24 to 48 hours, it dissolves. Several days later, hormones begin to slow and the endometrium breaks down. Approximately two weeks after ovulation has occurred, this endometrial lining is completely destroyed and is pushed from the uterus, along with blood and other secretions. This is the menstrual flow, which can vary from 3 to 7 days in duration. The first day of flow (bleeding) is consid- ered the first day of the cycle. Over the next 25 to 35 days, depending on the woman, the cycle will repeat itself. This cycle of increased hormone production, buildup of the endometrial lining, ovulation, decreased hormone production and shedding of the endometrium will continue until a woman reaches menopause.

+or most women, menopause, or the end of menstruation, occurs between age 45 and 55. Menopause is part of the natural aging process for women and is brought on by reduced estrogen production in the ovaries. The exact age that a woman will experience menopause is usually based on heredity. Menopause is a gradual process that may begin in the early forties with a decline in ovulation and estrogen production. The first symptoms are usually irregular periods that become less and less frequent. Eventually menstruation stops altogether and estrogen production diminishes. Estrogen will continue to be naturally produced in a woman’s body throughout the remainder of her life in smaller quantities.

These changes in hormones are responsible for many of the physical and psy- chological symptoms that some women experience during menopause. The most common symptoms include hot flashes, insomnia, depression, and vaginal dryness. The majority of women have only mild symptoms during menopause that cause few or no problems. Some women are helped with estrogen replace- ment therapy; others choose not to use synthetic hormones. A woman’s physi- cian is the best source for information about hormone replacement.

Pregnancy and Prenatal Care

Pregnancy occurs when a fertilized egg implants in the endometrium (lining) of the uterus and begins to grow. When an egg cell is released by the ovary, it may be fertilized in the fallopian tube by a sperm cell. The release of the woman’s egg usually happens mid-cycle (3–15 days after her last period and about 14 days before her next period.) If the egg is fertilized it travels down the fallopian tube into the uterus, a journey that takes about five days. Once im- plantation has occurred, the woman’s body will begin producing increased amounts of hormones to sustain the pregnancy.

Most pregnancy tests available today are able to accurately detect pregnancy within a week of a missed period. Pregnancy tests are based on the presence of special hormones that are produced once the embryo has implanted. These

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What About hormones can be detected in a woman’s blood and urine. If a sexually active Women? woman who is able to conceive misses her period, a pregnancy test should be (continued) considered. There are many things that may cause a woman to have a missed or delayed period. However, since the early stages of pregnancy are extremely critical for the developing fetus, a pregnancy test is recommended so that a woman can begin prenatal care.

After implantation has occurred, the placenta begins to form. This is specialized tissue that is filled with blood vessels and serves to connect the fetus to the mother via the umbilical cord. Through these structures the fetus gets nutrition and oxygen from the mother, and wastes from its body are removed. The placenta grows as the fetus develops. After an infant is born, the placenta is expelled and is usually referred to as “afterbirth.”

The first 12 weeks of pregnancy are a critical time for the development of the brain and other organs. During this time, drugs, alcohol, and diseases such as German Measles are most likely to seriously damage the fetus.

A pregnant woman should be concerned about over-the-counter medications, in addition to illegal or street drugs. The best advice is to consult a physician before taking any drug, even aspirin, when pregnant. Some women believe that the fetus is naturally protected from drugs and other substances that the mother might take. This isn’t true. The function of the placenta is limited, and many drugs, including alcohol, can reach the fetus and cause damage at any stage of pregnancy. Smoking cigarettes also has an impact on the fetus and may retard its growth. Babies born to women who smoke may weigh less than babies born to women who don’t smoke. Cigarettes also seem to increase the chances of miscarriage, and for women with high blood pressure, the chances of having a stroke during delivery.

Babies born to women addicted to heroin or methadone will also be addicted and must go through withdrawal. Cocaine and amphetamines may increase the mother’s blood pressure and may cause brain or cardiovascular damage to the fetus. In addition, for women who inject drugs, there is the added risk of con- tracting the AIDS virus (HIV) which can be fatal to both mother and infant.

170 TCU/DATAR Manual Appendix A Supplemental discussion outline: Condoms and Safer Sex n Include the following key points when discussing condoms for safer sex:

Condoms provide protection by covering the penis, keeping semen and vaginal fluids from coming in contact with membranes or broken blood vessels. Latex condoms provide the best protection — “natural” condoms made of animal membranes aren’t as effective in blocking the virus (and they’re unbelievably expensive as well). Latex condoms are inexpensive in stores and may also be available through many public health and family planning clinics at low cost or no cost.

The first step is deciding.

Sometimes denial about being at risk for HIV can interfere with our decision-making. Accepting our right to protect ourselves from HIV is the first step toward planning how we’ll protect ourselves from sexual risks. If using condoms makes sense to you, then you’ll give them a try.

If you’re not ready to use condoms, then you’ll want to think seri- ously about other ways to protect yourself from sexual risks.

As we discussed earlier, monogamy with a non-infected partner who avoids other HIV-risky behaviors is an option. +or this option to work, both partners should be tested for HIV and counseled about risk reduction.

When we make the decision to use condoms, here’s what we need to think about:

The key to successful condom use is communication. Talk with your partners and agree about using condoms before having sex.

Source: Approaches to HIV/AIDS Education in Drug Treatment (DATAR Training Manual), Institute of Behavioral Research, Texas Christian University, +ort Worth, Texas, 1995.

Time Out! For Men 171 Appendix A Human Sexuality

Condom If you wait until you’re caught up in strong sexual feelings, you Demonstration may forget to use a condom. Talking about it ahead of time will and Practice help strengthen your decision. Remember, you have the right to (continued) protect your health by using a condom or asking your partner to use a condom.

Have a condom available, at all times.

One of the primary reasons given for not using a condom is “I didn’t have one/she didn’t have one/we didn’t have one.” So, have one with you. Better yet, have two or three.

Know how to use a condom.

Also, know how to prevent them from breaking and how to make them comfortable and pleasurable.

n Demonstrate the correct way to use a condom as you present the following instructions.

Encourage questions and comments. Use a condom demonstration model, condoms, and lubricants. If a model is unavailable, demonstrate by rolling the condom over two fingers (or ask for a volunteer, and roll the condom over his/her fingers). Cover the following key points:

Putting on a condom:

1. The condom is put on when the penis gets hard, not before. Always use a new condom. A condom is used the same way for vaginal sex, oral sex on a man, and rectal sex.

2. Place the rolled condom over the end of the erect penis, then pinch the tip of the condom and squeeze it gently to push out any trapped air. (Trapped air in the tip is like a little balloon— it could burst during sex.)

3. Once the air is squeezed out, roll the condom down over the shaft of the penis. Leave space at the tip of the condom to catch the semen (cum).

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Make it comfortable:

Try out several brands until you find the one that’s most comfortable. Believe it or not—not all condoms are shaped the same. Condoms are available in different shapes and sizes.

Many men prefer a condom that allows a bit of friction at the tip and is thin enough to conduct warmth. Latex is strong, so even thin condoms offer good protection.

Condoms and lubricants containing nonoxynol-9, a type of chemical used in some birth control foams and gels, may help protect against HIV. However, many people are allergic to nonoxynol-9, and may develop irritation, burning, or a rash. If you develop irritation, switch to a condom or lubricant that doesn’t have nonoxynol-9.

Before putting the condom on, put a tiny dab of lubricant (like K- Y®, Lubrins, etc.) in the tip. (Don’t use too much or the condom might slip off.) Then roll the condom on as discussed before. The tiny dab in the tip of the condom will help the head of the penis move smoothly inside the condom, and provide extra pleasure and sensations for the man.

If possible, keep several condoms “peeled” (with the wrapper off), and ready to go when you have sex. This way, if you are interrupted or if you like to start and stop while having sex, you’ll have a new condom ready and waiting. You can use more than one condom per sex act — there’s no rule that says one condom is the limit when you have sex.

Try out different colors and flavors. +lavored condoms are especially popular for oral sex.

Keep the condom from breaking:

Latex is a strong type of thin rubber, strong enough to bear up to even the most passionate love-making. However, it can be weakened — so be careful.

Never store condoms in extreme heat and don’t freeze them. Don’t use a condom that’s been exposed to heat (for example, left for hours in a car in the summer time) or has been frozen (especially if it hasn’t thawed out yet!).

Time Out! For Men 173 Appendix A Human Sexuality

Condom Be careful with fingernails, jewelry, rings, or anything sharp that Demonstration could break or tear a condom while it’s being put on. and Practice (continued) And most important — use only water-based lubricants with condoms. +or example, K-Y® or any kind of lubricant sold in the condom section of stores. Some brands are called “personal” lubricants. When you read the box, it will say that the product is safe for use with condoms. Oily lubricants (like Vaseline®, baby oil, hand lotion, or massage oils) can actually weaken latex and make it easier to break. So don’t put anything greasy/oily on your condom.

Take care when you take it off:

After coming or climaxing, the penis should be pulled out soon. One partner should reach down and hold on to the condom at the base of the penis while pulling out. This will prevent the condom from slipping off.

Pull out carefully and take off the condom so that nothing spills out. You can tie a knot at the top so the cum can’t spill out. Wrap it in some tissues and throw away in the trash can. Don’t flush it down the toilet because it can clog up your pipes.

n Demonstrate additional safer sex techniques for non- intercourse behaviors.

l Discuss the use of flavored or unlubricated condoms to cover the penis during oral sex.

l Demonstrate how to cut an unlubricated or flavored condom lengthwise down one side to create a barrier for covering the vaginal and anal area during for oral sex. If available, demonstrate how dental dams also may be used as barriers. Also demonstrate the use of plastic food wrap (e.g., Saran Wrap®) for covering the vaginal and anal areas. Mention that these barriers should also be used for any oral-anal contact or foreplay activities (e.g., “rimming, “ etc.). Stress that plastic wrap should not be used as a condom. Wrapping the penis in Saran Wrap® for intercourse or oral sex is not considered an effective barrier because semen can leak out.

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l Demonstrate the use of a thin latex glove for mutual masturbation and sexual activities such as fingering, “fisting,” and other activities where broken skin on the hand may come in contact with semen or vaginal fluids.

n Allow each participant to practice with condoms and barriers.

You can invite them to gather around the demonstration table, and take turns with the teaching model, if you only have one. Another approach is to put people in pairs, and have them demonstrate proper condom technique to each other using models, vegetables, or their fingers. Have them practice with barriers as well.

n Distribute CONDOMS AND SAFER SEX handout.

Ask: What did you learn today about condoms that you didn’t know before?

n Discuss the Reality® “female condom” (vaginal pouch).

Review how the pouch is used, and pass a sample around for participants to inspect, if you have one available. Encourage questions and comments. Let participants know if and where the pouch is available in your community. Cover the following key points:

The female condom is a thin, long pouch made out of a special type of strong plastic.

It protects both partners by lining the vagina so that there’s no contact with semen or vaginal fluids. It has an outer ring to hold it in place around the opening of the vagina, and an inner ring used to guide it during insertion and hold it in place inside the vagina.

Time Out! For Men 175 Appendix A Human Sexuality

Condom It is put inside the vagina, much like a diaphragm or tampon. Demonstration The inner ring is folded and guided into the vagina, using a and Practice finger to push it into place past the pubic bone. Lubricant is (continued) then added to the opening of the pouch. Lubricant may also be placed on the man’s penis. The man’s penis is then guided to be inside the pouch, surrounded by the outer ring.

After sex, the pouch is removed before standing up by gently pulling and squeezing the outer ring.

Wrap it in tissue and dispose of in the trash. Each pouch can only be used once. The female condom should not be used together with a male condom.

n Conclude with the following key points:

Condoms and female condoms are barriers for making oral, vaginal, and rectal sex safer.

+or oral sex on women, you should use plastic wrap as a barrier, or an unlubricated (or flavored) condom cut lengthwise down the middle. These barriers should be placed over the entire vaginal and/or anal area. +or oral sex on men, the penis should be covered with an unlubricated (or flavored) condom. (Lubricated condoms will work, but they may have an unpleasant taste.)

Other types of contraception, such as diaphragms, contraceptive sponges, or contraceptive gels and foams are not effective by themselves in stopping HIV. They must be used with a condom for complete protection.

Condoms, female condoms, and barriers should be used every time you have sex.

If you and your partner are moving into a steady or serious relationship, both of you may want to have HIV tests, and if that shows you are both non-infected, you may want to switch to exclusivity/monogamy as your safer sex choice. Don’t stop using condoms or female condoms until you both have been tested and given a clean bill of health.

176 TCU/DATAR Manual Appendix B Reference Section TABLE OF CONTENTS

ARTICLES PAGE The Human Sexual Response Cycle ...... 178 Human Reproduction ...... 181 Chart: Prenatal Development ...... 184 Chart: Stages of Labor ...... 185

ILLUSTRATIONS The Male Sex Organs ...... 186 The Female Sex Organs ...... 187 The Male and Female Sex Organs (Side View) ...... 188 The External Female Reproductive Organs ...... 189

GLOSSARY OF SEXUAL TERMINOLOGY...... 190

BIRTH CONTROL FACT SHEETS Contraceptive Implants (e.g., Norplant) ...... 198 Birth Control Pills (Oral Contraceptives) ...... 199 Intrauterine Device (IUD) ...... 200 Diaphragm ...... 201 Condoms ...... 202 Female Condom ...... 203 Contraceptive Foam, Gels, and Suppositories...... 204 Vaginal Contraceptive Sponge ...... 205 Vasectomy (Male Sterilization) ...... 206 Tubal Ligation (Female Sterilization) ...... 207 Natural Family Planning (Fertility Awareness) ...... 208

SEXUALLY TRANSMITTED DISEASE FACT SHEETS Sexually Transmitted Diseases and Men’s Health ...... 209 Sexually Transmitted Diseases and Women’s Health ...... 210 Pelvic Inflammatory Disease (PID) ...... 211 Gonorrhea ...... 212 Syphilis ...... 213 Herpes ...... 214 Chlamydia ...... 215 Genital Warts (Papilloma Virus) ...... 216 HIV and AIDS ...... 217 Pubic Lice (“Crabs”) and Scabies...... 218

SPECIAL INSTRUCTION MATERIAL Using Role Plays to Build Assertiveness Skills ...... 219 Resources for Teaching Materials ...... 222

Information in this section has been adapted with permission from the FACTS Project, Planned Parenthood of North Texas, Fort Worth, Texas.

Time Out! For Men 177 Appendix B Reference Section

The Human Sexual Response Cycle

Throughout this article, the human sexual response cycle (Masters & Johnson, 1981) is referred to in the context of penis-to-vagina sexual intercourse. It is important to understand that these responses are not different when they occur during other sexual activities, such as mastur- bation, oral sex, anal sex, or use of vibrators or sex toys.

The physiological process that occurs during sex is similar to many other body functions. Most people are aware of having experiences of sexual response, but are at a loss when trying to describe what occurs.

It was not until the mid-1950s that scientific studies of the physical act of intercourse were carried out. Most of what we know about the physi- ology of sexual intercourse and sexual response is from the studies of William H. Masters and Virginia E. Johnson in St. Louis. )or the first time, many men and women began to view sexual intercourse as an aspect of overall health and something to be discussed and appreciated. The research of Masters and Johnson produced a number of startling new findings.

Research 1. The physical reactions that occur during intercourse involve much Findings more than just how the genitals or sex organs work. In fact, many of the physical feelings that occur during sex are caused by an increase in blood pressure, heart rate, breathing, and muscle ten- sion. In other words, sexual response involves the entire body, not just the sex organs.

2. Masters and Johnson also found very little difference between male and female orgasm. Both are caused by contractions of the muscles in the pelvic area. These contractions may occur in both males and females with equal intensity. In reading anonymous descriptions of the sensations felt during orgasm, it is difficult to tell whether the writer is male or female.

3. The clitoris is the most sensitive organ of female pleasure during sexual activity. Up until the 1960s, there had been a lot of debate as to whether female orgasms came from the clitoris or the vagina. Stimulation of the clitoris, with or without vaginal penetration, leads to orgasm in most women.

4. Masters and Johnson also identified four separate stages or phases of sexual response. They called these stages the Sexual Response Cycle. The stages are excitement, plateau, orgasm, and resolution. These stages occur in both men and women and usually follow the same order. What is felt during these stages is, of course, different for each individual but there are some amazing similarities.

178 TCU/DATAR Manual Appendix B

Phases of )or example, during the excitement phase, the first physical signs of sexual excitement appear. In males, the penis becomes erect (an erec- Sexual tion) and the testicles are pulled close to the body by the muscles in the Response scrotum. In females, the vagina becomes lubricated and the part of the vagina closest to the uterus expands. The clitoris becomes larger and more visible. Most women and some men notice that their nipples be- come erect and sensitive.

Plateau is the second stage of the sexual response cycle. In males, the blood flow to the testicles increases. In females, the labia (the skin folds surrounding the opening of the vagina) receive more blood and may flush to a reddish color. )luids from both male and female lubrication glands are released. In males, this fluid may contain sperm cells. These sperm can cause a pregnancy to occur, even if the penis is removed before ejaculation. Both men and women may develop flushing in the face, neck, chest, and stomach area. During this phase, increases in blood pressure, heart rate, breathing, and muscle tension continue to occur.

The orgasmic phase for males culminates when semen is released from the penis. Strong contractions push the semen along the urethra, produc- ing feelings of pleasure. In females, the clitoris becomes extremely sensitive and withdraws into the clitoral hood, a small layer of protective skin. Inside the vagina and pelvic area, muscles contract and relax every ¾ of a second, producing waves of pleasurable feeling. The muscles of the uterus or womb contract, which slightly opens the cervix (the opening between the uterus and the vagina). As mentioned before, the contrac- tions of the muscles in the pelvic area are responsible for the sensation of orgasm in both men and women.

The final stage is called resolution. It is the stage where the body returns to a restful state. It is characterized by feelings of relaxation and well- being, and many people may sleep or doze for a while. This stage usually lasts about twenty to thirty minutes. During this time, if sexual stimula- tion doesn’t begin again, muscles relax, blood pressure and heart rate return to normal, and swelling in the pelvic area decreases.

One of the more interesting ideas posed recently describes a phase that may occur prior to excitement called transition. This phase involves a person’s ability to make the change from a day-to-day state of mind to a mental state that’s open to the prospect of sexual activity. )or example, a person who had a very stressful day may not be able to make the transition needed to engage in pleasurable sexual activity.

It is important to point out that sexual response involves more than physical reactions. There is a lot of truth in the statement that the most important sex organ is the brain! Many factors can affect our physical responses during sex. These may include our feelings about our partner, our physical health, past sexual experiences, alcohol or drug use, religious and moral beliefs, prescription medications, stress, illness, and so on.

Time Out! For Men 179 Appendix B Reference Section Obviously, it is not necessary to completely understand human sexual response in order to engage in pleasurable sex. However, the complex physical changes experienced by men and women during sex are no less worthy of study and appreciation than any other aspect of the human body. When we understand our sexual responses, we are less likely to fear them and more likely to be able to deal with them in a realistic and healthy way.

Reference

Masters, W. H., & Johnson, V. E. (1981). Human Sexual Response. New York: Bantam.

180 TCU/DATAR Manual Appendix B

Human Reproduction Human reproduction is a process involving so many complex chemical and biological changes that a space mission seems simple in comparison. In ancient times, conception (becoming pregnant) and pregnancy were poorly understood. Some people thought that each male sperm contained a tiny person that was placed into the woman during intercourse. The tiny person was then fed in the womb (or uterus) until birth. Another theory was that the miniature child was already in the woman and “acti- vated” by the male sperm.

Fertilization Today, medical researchers have shown in amazing detail how concep- and tion, pregnancy, and birth occur. The process begins with the union of a female egg cell with a male sperm cell. About 250 million sperm are Genetic deposited in the vagina when the male ejaculates during sexual inter- Material course. The sperm are equipped with whiplike tails which move them rapidly into the uterus (or womb) shortly after ejaculation. These sperm pass through the uterus and out into each of the female’s fallopian tubes. If an egg has been released from an ovary into one of the fallopian tubes around the time intercourse happens, sperm may eventually reach it. )ertilization occurs in the fallopian tube. When a single sperm unites with the egg, a chemical message is released by the egg that locks out all other sperm. Then the genetic material (chromosomes) of the sperm and egg unite. It takes several days for the fertilized egg to travel down the fallopian tube to the uterus, where it implants and begins to grow.

The chromosomes carry the plans for the characteristics of each indi- vidual. These chromosomes carry the genes that will determine the color of a person’s hair and eyes, the height of the person, and many other physical features. )or the next nine months nothing will develop without the guidance of the chromosomes. There are 46 of these chromosomes, 23 from the male, and 23 from the female. The male’s 23rd chromo- some determines the gender of the child. If the 23rd chromosome is a “Y” chromosome, the child will be a male. If it is an “X” chromosome, then the child will be female.

Types of Some women will occasionally release two eggs at the same time. If Twins both are fertilized, fraternal twins will result. They may be as different as any brother or sister and, in fact, may be brother and sister. Identical twins come from a single egg that splits after fertilization. Identical twins will always be the same sex and very similar physically. Siamese twins result when a single egg fails to split completely apart and the developing fetuses remain partially attached throughout the pregnancy.

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Pregnancy When the sperm and egg meet and unite, the newly produced cells are called the zygote. As the zygote moves down the fallopian tube toward and Prenatal the uterus, it divides continuously. These cells move down the fallopian Development tube and implant in the wall of the uterus. The growing ball of cells is called the morula, blastocyst, and embryo at different stages of growth. At about the seventh or eighth week of development, the embryo is called the fetus.

The fetus is connected to the wall of the uterus by the placenta. The placenta is created by specialized cells from the egg. The placenta filters food and oxygen from the mother for the fetus. )ood and oxygen travel from the placenta to the fetus by a tube called the umbilical cord. After the baby is born, the umbilical cord is cut and the place where it was attached becomes known as the “belly button.” The placenta is delivered after the baby and is then called afterbirth.

A “normal” pregnancy lasts about nine months. More precisely, a preg- nancy is expected to last about 10 lunar months (the time it takes the moon to go from full moon to full moon) of 28 days each, or about 40 weeks. It is calculated based on the date of a woman’s last menstrual period before conception. These calculations are sometimes subject to error and the actual duration of a pregnancy can vary. Hospital records show that a mother has less than a 1 in 3 chance of delivering during the week predicted by her physician.

Medical science has made tremendous advances in understanding preg- nancy and prenatal development. Many of the problems newborn babies have experienced in the past can now be prevented or treated before birth. )or this reason, it is extremely important for a woman to seek medical or prenatal care as soon as she thinks she might be pregnant. To protect herself and her unborn child, women should avoid alcohol, smok- ing, and any type of drug use during pregnancy. A diet rich in vitamins and nutrients is also important for pregnant women.

Labor The physical processes leading to the birth of a child are called labor and and delivery. Essentially, labor occurs when the fetus moves into birth posi- tion (usually head first) and the muscles of the uterus begin to contract. Delivery As this happens, the cervical opening of the uterus dilates and opens. There are a number of stages involved in the process of labor. As these stages progress, the length and duration of the birthing contractions intensify. The contractions become stronger and stronger, pushing the fetus into the birth canal (vagina). The doctor or attending midwife then helps ease the baby into the world.

During labor, the doctor or midwife will routinely monitor the vital signs of both mother and fetus, as well as the position of the fetus. If compli- cations arise a Cesarean delivery may be required. During Cesarean

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delivery, the baby is removed from the woman’s uterus through a surgical opening made just below the navel.

Traditionally, labor has been viewed with a great deal of fear because of the physical discomfort that can occur. Anesthesia can eliminate much of this discomfort, and several kinds of anesthesia may be used. Many types of anesthesia (such as spinal, local, and epidural anesthesia) allow the mother to be awake during childbirth. Some women choose to attend classes, such as Lamaze, to help prepare them for what to expect during childbirth. These classes help teach different ways to lessen the discom- fort of childbirth naturally through breathing and relaxation.

After After the baby is delivered, the uterus continues to contract in order to Childbirth expel the placenta. The uterus will continue to contract for several hours after delivery. These mild contractions reduce bleeding and begin helping the uterus return to its normal size. When the newborn baby is put to the breast to nurse, the breasts are stimulated to produce milk (lactate), and at the same time, the uterus is stimulated to contract. Mothers who choose not to nurse are given medication to aid these uterine contrac- tions and to inhibit milk production.

)or the first few days after childbirth, the mother’s breasts produce colostrum, a high protein fluid that helps protect the baby from infections and prepare its digestive tract to function properly. Beginning around the third day after birth, the mother’s breasts produce milk. Milk is stored in special milk sacs within the breast and let down through the nipple in response to the baby’s suckling. The milk produced by the mother meets her baby’s nutritional needs for the first six to twelve months of life. Milk not used by the baby will gradually be reabsorbed by the mother’s body. Although breast feeding reduces a woman’s chances of becoming pregnant, breast feeding is not an effective method of birth control. If an additional pregnancy is not desired, it is important to either abstain from sexual activity or use an effective method of birth control while breast feeding.

Despite our scientific understanding of the process of reproduction and birth, we still regard it with awe. That two people can come together and create another human being is amazing, if not miraculous. The fact that we understand it does nothing to lessen the wonder of it all.

Time Out! For Men 183 Appendix B Reference Section

Prenatal Development

TIME NAME SIZE WEIGHT DESCRIPTION

1-3 Days Zygote 1/200" 1/7 mil oz Fertilized egg begins dividing. Basic cell division occuring. Egg remains same size. 3-6 Days Morula 16 cells Solid ball of cells.

6-14 Days Blastocyst 1/100" Hollow ball of cells. Implantation in uterus begun and finished. 14-21 Days Embryo Different cell layers can be seen. The different layers are the beginning of different body systems. 21-28 Days Embryo Beginnings of embryo's support systems: amniotic sac, placenta, and umbilical cord. Week 5 Embryo 1/4" Backbone begins to form. Length of backbone extends past the body giving the embryo the appearance of having a tail. Week 6 Embryo 1/3" Beginning of arms and legs can be seen.

Week 7 Fetus 1" 1/1000 oz Tail disappears, large brain apparent. Week 8 Fetus 1 1/4" 1/30 oz Fingers and toes can be seen. Week 10 Fetus Fetal heart contracting regularly.

3 Months Fetus 3" 1/2 oz Fetal muscles contract at random.

4 Months Fetus 8 1/2" 6 oz Sex may be determined by sonogram. Fetal movement may be felt. 5 Months Fetus 12" 1 lb Hair on head appears. 6 Months Fetus 14" 2 lbs. If born now, fetus has only a small chance of survival. 7 Months Fetus 16" 4 lbs. If born now, fetus may survive with extensive medical care. 8 Months Fetus 18" 5 1/2 lbs. Continued growth. All organs formed.

9 Months Fetus 20" 7 lbs. Fetus fully develped. Ready for birth.

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Stages of Labor

STAGE PHASE TIME IN LENGTH OF HOW FAR WHAT HAPPENS STAGE OR CONTRACTIONS APART PHASE 1st Prodomal 6 - 15 hrs* irregular irregular Baby moves into birth 2 - 4 hrs** position. Mother feels ready to go.

Latent 3 - 10 hrs* 30-45 sec 5 - 20 min Doctor is contacted. 1 - 7 hrs Woman usually goes to hospital when contractions are 10 minutes apart. Usually very mild contractions. Active 3 - 5 hrs* 40-60 sec 3 - 5 min Breathing relaxation 1/2 - 2 hrs** techniques help. Pain medication may be started here. Fetal monitoring done. Transition 3 - 5 hrs* 60-90 sec 2 - 3 min Mother may have 1 - 2 1/2 hrs** difficulty concentrating. (May be shorter Mother may be anxious for second and/or irritable. deliveries) 2nd 1/2 - 2 hrs* 90-110 sec 3 - 5 min Cervix is fully open or 5 - 45 min** dilated. Child is delivered.

3rd 5 - 30 min 120 sec 3 - 5 min Placenta is expelled. Contractions not as intense.

4th 1 hour 100 sec 5 min Recovery period continues until vital signs are normal.

* 1st Delivery ** Deliveries other than the first

Time Out! For Men 185 Appendix B Reference Section a male gland located behind a small, walnut-size gland walnut-sized organs that the tube that carries sperm from smooth, the sac of skin at base penis the tubelike organ that transports urine an expandable saclike organ in the pelvic the external male sex organ that becomes erect BLADDER — region that stores urine until it is expelled. SEMINAL VESICLE — the prostate that produces much of fluid in semen. The seminal vesicle fluids nourish and protect the sperm cells. PROSTATE GLAND — located just behind the bladder in males. The prostate produces much of the fluid content semen. COWPER’S GLANDS — two pea-sized glands situated along the urethra just below prostate gland in males. They secrete an alkaline fluid to neutralize the normally acid chemical condition in the urethra. This assures more sperm will survive the trip into female reproductive system. VAS DEFERENS — each testicle to the prostate and seminal vesicle. The two vas deferens merge with the urethra, which transports semen outside the body during ejaculation. URETHRA — produce sperm and the male sex hormone testosterone. Testicles are covered and protected by a skin sac called the scrotum. SCROTUM — from the bladder to outside body. In males it also transports semen and sperm during ejaculation. PENIS — during sexual excitement. It has a reproductive function (semen and sperm pass through it) a urinary function. EPIDIDYMIS — small organs located at the back of each male testicle where immature sperm are stored until they mature. TESTICLES — that holds the testicles. Muscles in scrotum tighten or relax in response to temperature, sexual excitement, or other factors. Bladder

186 TCU/DATAR Manual Appendix B two small, tubelike structures the female reproductive organs that the muscular, elastic, organ that creates a the lower end of uterus (or womb) that CERVIX — extends into the vagina. A tiny opening in cervix allows sperm to enter the uterus, and menstrual flow to leave. During childbirth, the cervix stretches allow passage of the infant from uterus into vagina. FALLOPIAN TUBES — extending from the uterus to ovaries through which an egg cell is transported. Fertilization of the by male sperm occurs in the fallopian tubes. OVARIES — produce the ova (egg cells) and female sex hormones, estrogen and progesterone. UTERUS (womb) — a muscular, pear size organ where the fetus develops during pregnancy. The lining of uterus is shed monthly during menstruation. VAGINA — passageway from the uterus to outside of body. It holds the penis during heterosexual intercourse and serves as the birth canal during childbirth.

Time Out! For Men 187 Appendix B Reference Section

188 TCU/DATAR Manual Appendix B the outer folds the area of skin between genitals and the tubelike organ that transports urine a tiny bump of tissue located directly the muscular, elastic organ that creates a the external female genitals, including VULVA — the anal opening. ANUS — opening of the bowels in males and females; solid waste from the colon leaves body through this opening. labia, the clitoris, and vaginal opening. CLITORIS — passageway from the uterus to outside of body. It holds the penis during heterosexual intercourse and serves as the birth canal during childbirth. LABIA MAJORA/LABIA MINORA — of skin and tissue around the female vaginal opening. The labia majora are the larger outer folds that protect more sensitive labia minora or inner folds. PERINEUM — above the urinary opening in females and made up of same type of tissue as the male penis. The clitoris is part of the female body most sensitive to sexual stimula- tion. It becomes enlarged during sexual excitement URETHRA — from the bladder to outside body. In males it also transports semen and sperm during ejaculation. VAGINA —

Time Out! For Men 189 Appendix B Reference Section

Sexual Terminology Glossary ABORTION — the ending of a pregnancy before birth, either by miscarriage (spontaneous abortion), or through medical intervention (therapeutic or induced abortion).

ABSTINENCE — refraining or abstaining from sexual intercourse; not having sex.

ANDROGENS — hormones produced by the adrenal glands which influence masculine sex characteristics; in women, androgens help produce estrogen (female hormones) after menopause.

ANUS — opening of the bowels in males and females; solid waste from the colon leaves the body through this opening.

APHRODISIAC — foods or substances said to stimulate sexual desire; often used to describe substances which supposedly produce sexual desire against a person’s will, such as “Spanish fly.”

BARTHOLIN GLANDS — pea-sized glands located on either side of the vagina that release lubrication fluids during sexual excitement.

BISEXUAL — a person whose sexual interest in adulthood is for both men and women.

BLADDER — an expandable saclike organ in the pelvic region that stores urine until it is expelled.

BREASTS — a secondary sex characteristic of women which develops after puberty. Breasts are made up of fatty tissue and mammary glands, which produce milk after childbirth. Other parts of the breasts are the nipples, through which milk is passed during nursing, and the areola, a ring of tissue immediately surrounding the nipple.

BREECH PRESENTATION — a condition that develops during late pregnancy or during labor and delivery in which the baby is not in the normal head-first position for birth.

CESAREAN DELIVERY — the delivery of a baby through an incision in the mother’s abdomen.

CELIBACY — a permanent or temporary lifestyle choice involving the deci- sion to abstain from sexual relationships.

CERVIX — the lower end of the uterus (or womb) that extends into the vagina. A tiny opening in the cervix allows sperm to enter the uterus and allows the menstrual flow to leave. During childbirth, the cervix stretches to allow passage of the infant from the uterus into the vagina.

CHLAMYDIA — a sexually transmitted organism that causes symptoms similar to gonorrhea and is a leading cause of infertility. (See NGU and Chlamydia ACT Sheet.) 190 TCU/DATAR Manual Appendix B

CIRCUMCISION — surgical removal of the foreskin of the male penis, usually performed shortly after birth for religious or personal reasons. There are no medical reasons for routine circumcision of newborn males.

CLITORIS — a tiny bump of tissue located directly above the urinary opening in females and made up of the same type of tissue as the male penis. The clitoris is the part of the female body most sensitive to sexual stimulation. It becomes enlarged during sexual excitement

COITUS — a medical term for sexual intercourse or having sex.

CONCEPTION — the point at which a fertilized egg implants in the uterus; the beginning of a pregnancy.

CONDOM — a sheath or covering made of latex or animal membrane which is placed over the erect penis before intercourse to prevent pregnancy or the spread of disease. (See Condom ACT Sheet.)

CONTRACEPTION — products and methods used to prevent pregnancy; the use of birth control to prevent pregnancy.

CONTRACEPTIVE OAM — a method of birth control that uses spermicide, a chemical that kills sperm, to create a barrier inside the vagina. (See Contra- ceptive oam ACT Sheet.)

CONTRACEPTIVE IMPLANTS — a method of hormonal birth control. Small, thin capsules containing hormone are inserted under the skin of the upper arm of females and provide about five years of contraceptive protection.

COWPER’S GLANDS — two pea-sized glands situated along the urethra just below the prostate gland in males. They secrete an alkaline fluid to neutral- ize the normally acid chemical condition in the urethra. This assures more sperm will survive the trip into the female reproductive system.

DIAPHRAGM — a flexible, rubber birth control device that is placed over the cervix to prevent sperm from entering the uterus during intercourse. (See Diaphragm ACT Sheet.)

DOUCHE — the use of water or medicated solutions to rinse out the inside of the vagina. Douching is not necessary for hygiene.

DYSPAREUNIA — a medical term for pain experienced during sexual inter- course. Pain during intercourse may indicate a medical problem such as infection or endometriosis, and should be checked by a doctor.

ECTOPIC PREGNANCY — a term for a pregnancy in which the embryo begins to develop outside of the uterus, usually in the fallopian tube. This is some- times called “tubal pregnancy” and is considered a medical emergency that requires surgery.

EJACULATION — the expulsion or release of semen from the penis during male orgasm.

Time Out! For Men 191 Appendix B Reference Section

EMBRYO — the name given to a fetus in its earliest stages of development, usually the period between two weeks and two months after conception in humans.

ENDOMETRIOSIS — a painful condition that occurs when small pieces of tissue normally lining the uterus (the endometrium) begin to grow outside the uterus. The cause of endometriosis is unknown, and the condition may result in chronic pain, infertility, heavy menstrual periods, and discomfort during intercourse.

ENDOMETRIUM — the lining of the uterus, which thickens and is discharged each month during the menstrual period.

EPIDIDYMIS — small organs located at the back of each male testicle where immature sperm are stored until they mature.

ERECTION — the enlargement and stiffening of the penis, caused by in- creased blood flow into the spongy tissues inside the penis and usually brought on by sexual excitement or stimulation.

ESTROGEN — one of the two primary female sex hormones. Estrogen is manufactured by the ovaries and helps regulate the menstrual cycle, preg- nancy, and physical development during puberty.

ALLOPIAN TUBES — two small, tubelike structures extending from the uterus to the ovaries through which an egg cell is transported. )ertilization of the egg by the male sperm occurs in the fallopian tubes.

EMALE CONDOM — a soft, loose fitting device made of a plastic material and shaped like a large condom with a soft plastic ring on one end. It’s also called a “vaginal pouch.” The ringed end is inserted in the vagina and posi- tioned to cover the cervix. It protects by completely lining the vagina during sex. (See emale Condom ACT Sheet.)

ERTILITY — the ability to reproduce; the ability to bring about a pregnancy.

ERTILIZATION — the union of the female egg with the male sperm. )ertili- zation occurs in the female fallopian tube.

ETUS — the developing infant inside the uterus from around the sixth to eighth week after conception until birth.

ORESKIN — the thin skin which covers the head or tip of the penis. The removal of the foreskin at birth is called circumcision.

GENDER — a person’s sex, as determined by having either male or female reproductive organs.

GENITAL HERPES — a sexually transmitted disease caused by the herpes simplex virus (HSV). Herpes causes painful clusters of blisters in the genital area of males and females. (See Herpes ACT Sheet.)

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GENITALS — refers to the male and female reproductive organs; most com- monly used to refer to the external organs such as the penis, testicles, vulva, or clitoris.

GONORRHEA — a sexually transmitted disease caused by a type of bacteria. It causes burning during urination and a discharge of pus in males. )emales usually have milder symptoms in the beginning, but without treatment they may develop a serious pelvic infection. (See Gonorrhea ACT Sheet.)

GYNECOLOGIST — a doctor who specializes in the care of the female repro- ductive system.

HERMAPHRODITE — a very rare condition in which a person is born with both male and female sex organs. Doctors will usually correct the condition surgically after birth, using chromosome tests to determine the correct sex for the infant.

HETEROSEXUAL — a person whose sexual interest in adulthood is for people of the opposite sex.

HOMOPHOBIA — an unrealistic fear or hatred of homosexuality.

HOMOSEXUAL — a person whose sexual interest in adulthood is for people of the same sex.

HORMONE — the chemical secretions of the endocrine glands which influ- ence bodily processes. The primary sex hormones are testosterone in males and estrogen and progesterone in females. Sex hormones regulate develop- ment during puberty, sex drive, and reproduction.

HYMEN — a thin membrane that partially covers the entrance to the vagina. As females mature, the hymen may be stretched or torn during physical exercise. In some cases it remains intact until first intercourse.

INCEST — traditionally refers to any type of sexual relations between blood relatives; however; the broader definition includes sexual abuse of children by adults who are not blood relatives, such as stepparents, and those who have power over children, such as a parent’s friend, neighbors, or clergy.

INERTILITY — the inability to conceive (in men to impregnate) or to main- tain a pregnancy long enough to give birth. Infertility is caused by a variety of factors and is equally likely to involve male or female problems.

INTRAUTERINE DEVICE (IUD) — a small birth control device made out of plastic. It is placed inside the uterus to prevent pregnancy. (See IUD ACT Sheet.)

LABIA MAJORA/LABIA MINORA — the outer folds of skin and tissue around the female vaginal opening. The labia majora are the larger outer folds that protect the more sensitive labia minora or inner folds.

Time Out! For Men 193 Appendix B Reference Section

LABOR — the physiological processes which accompany childbirth, such as contractions, opening of the cervix, and urgency to push, etc.

LIBIDO — refers to the hidden drive behind actions; most commonly used to describe sexual desire or drive.

LUBRICATION — the release of fluids into the vagina, usually brought on by sexual excitement. The term also refers to cremes and gels (such as K-Y jelly) used to ease dryness during intercourse.

MASTURBATION — self-stimulation of one’s genitals (and other sensitive areas) to produce sexual excitement, arousal, and/or orgasm.

MENOPAUSE — refers to the ending of menstruation. Menopause is brought on by normal hormone changes associated with aging in females and usually begins between the ages of 45 and 55.

MENSTRUATION — the normal, periodic shedding of the lining of the uterus (the endometrium) and blood through the vagina. The menstrual cycle (the number of days between bleeding) is controlled by hormones and ranges from 21 to 35 days.

MISCARRIAGE — the ending of a pregnancy by natural causes before the fetus is capable of survival. Many miscarriages happen very early after conception, often before the female even knows she is pregnant.

MONOGAMY — traditionally, marriage to one person. In current use, it refers to a relationship in which both partners are sexually faithful to each other.

NATURAL AMILY PLANNING — a birth control method based on avoiding intercourse during the time when the female is most likely to be ovulating (releasing an egg). Effectiveness depends on calculating the female’s “fer- tile” period as accurately as possible. (See Natural amily Planning ACT Sheet.)

NOCTURNAL EMISSION — orgasm during sleep in males, resulting in ejacula- tion of semen (“wet dream”). )emales may also experience orgasm during sleep and increases in vaginal lubrication.

OBSTETRICIAN (O.B.) — a doctor who specializes in the care of women during pregnancy, labor, and delivery.

ORGASM — often referred to as climax or “coming,” it is the pleasurable release of physical tension that builds up during sexual excitement.

OVARIES — the female reproductive organs that produce the ova (egg cells) and the female sex hormones, estrogen and progesterone.

OVULATION — the periodic release of a mature egg cell from the ovary. If the egg cell is not fertilized in 48 hours, it disintegrates.

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PAP SMEAR — a test to detect cervical cancer and infection. Cells are gathered from the cervix during a pelvic examination, and are examined with a powerful microscope to check for cancer cells.

PELVIC EXAMINATION — examination and palpation (pressing/touching) of the ovaries, uterus, and vagina to check for lumps, swelling, infection, and other signs of possible disease.

PELVIC INLAMMATORY DISEASE (PID) — a severe infection of the fallopian tubes, ovaries, and/or uterus. PID may be caused by sexually transmitted diseases such as gonorrhea and chlamydia, or by other types of bacteria that invade the reproductive tract. (See Pelvic Inflammatory Disease ACT Sheet.)

PENIS — the external male sex organ that becomes erect during sexual excitement. It has a reproductive function (semen and sperm pass through it) and a urinary function.

PERINEUM — the area of skin between the genitals and the anal opening.

PLACENTA — an organ made of spongy tissue that develops during preg- nancy to nourish and remove waste from the developing fetus.

POLYGAMY — having more than one husband or wife at the same time.

POSTPARTUM — refers to a period of time after childbirth, during which physical recovery and adjustment to the new baby occur.

PREMENSTRUAL SYNDROME (PMS) — a variety of physical and emotional symptoms experienced by some women just before their menstrual periods.

PRENATAL — refers to the period from conception to birth; pregnancy.

PROGESTERONE — a primary female sex hormone produced by the ovaries that regulates physical development during puberty, the menstrual cycle, and pregnancy.

PROSTATE GLAND — a small, walnut-size gland located just behind the bladder in males. The prostate produces much of the fluid content of semen.

PUBIC HAIR — coarse, cushiony hair that begins to grow below the pubic bone and around the genitals as males and females reach sexual maturity.

RECTUM — the lower part of the colon that opens at the anus.

SCROTUM — the sac of skin at the base of the penis that holds the tes- ticles. Muscles in the scrotum tighten or relax in response to temperature, sexual excitement, or other factors.

SEMEN — fluids produced by the prostate and seminal vesicle glands that are released along with sperm cells during ejaculation.

Time Out! For Men 195 Appendix B Reference Section

SEMINAL VESICLE — a male gland located behind the prostate that produces much of the fluid in semen. The seminal vesicle fluids nourish and protect the sperm cells.

SEXUAL DYSUNCTION — a term used by therapists to describe a variety of problems that may arise in sexual functioning in men and women, including lack of desire, problems related to orgasm, or inability to maintain arousal. Sexual dysfunction may be related to psychological or physiological prob- lems, including substance abuse.

SEXUAL INTERCOURSE — sexual activity between two persons (“having sex”); most commonly used to describe genital sex or penis-in-vagina sex.

SEXUALLY TRANSMITTED DISEASE (STD) — an infection or disease that can be transmitted through sexual intercourse or close sexual contact. In the past STDs were sometimes called VD or venereal disease.

SPERM — male reproductive cells produced in the testicles.

SPERMICIDE — a chemical used in some birth control products (such as foam and the sponge) that stops sperm from being able to fertilize an egg cell.

STERILITY — inability to conceive (in men, to impregnate). The term is most commonly used to refer to infertility due to accident, injury, birth defect, disease, or surgery.

STERILIZATION — surgery performed specifically to end reproductive ability. Procedures for both males and females involve cutting or blocking the tubes that transport egg or sperm cells (fallopian tubes in females and vas deferens in males).

SYPHILIS — a sexually transmitted bacteria that enters the body during intimate sexual contact with an infected person. Left untreated it can be fatal. (See Syphilis ACT Sheet.)

TESTICLES — smooth, walnut-sized organs that produce sperm and the male sex hormone testosterone. Testicles are covered and protected by a skin sac called the scrotum.

TESTOSTERONE — the primary male sex hormone that influences sperm production, development during puberty, and sex drive.

TRANSVESTITE — a person who enjoys dressing in the clothing of the oppo- site sex (“cross dressing”). Most transvestites are not homosexual.

TRANSSEXUAL — men and women who feel they are members of the oppo- site sex trapped in the wrong body. These feelings may be strong enough to lead the person to seek a sex change operation.

TUBAL LIGATION — refers to a surgical procedure used to close off the

196 TCU/DATAR Manual Appendix B

fallopian tubes and bring about permanent birth control in females. (See Tubal Ligation ACT Sheet.)

UMBILICAL CORD — a hollow structure that connects the fetus to the placenta, the spongy tissue that nourishes and removes waste during prenatal development.

URETHRA — the tubelike organ that transports urine from the bladder to outside the body. In males it also transports semen and sperm during ejaculation.

UTERUS (womb) — a muscular, pear size organ where the fetus develops during pregnancy. The lining of the uterus is shed monthly during men- struation.

VAGINA — the muscular, elastic organ that creates a passageway from the uterus to the outside of the body. It holds the penis during hetero- sexual intercourse and serves as the birth canal during childbirth.

VAGINITIS — a mild infection of the vagina. Vaginitis is usually caused by bacteria, yeast fungus, or hormonal imbalance. (See Vaginitis ACT Sheet.)

VAS DEERENS — the tube that carries sperm from each testicle to the prostate and seminal vesicle. The two vas deferens merge with the urethra, which transports semen outside the body during ejaculation.

VASECTOMY — refers to a surgical procedure used to cut and close off the vas deferens and bring about permanent birth control in males. (See Vasectomy ACT Sheet.)

VENEREAL DISEASE (VD) — another term for sexually transmitted dis- eases.

VULVA — the external female genitals, including the labia, the clitoris, and the vaginal opening.

WITHDRAWAL — an unreliable birth control method in which the male attempts to remove his penis from the vagina before ejaculation.

YEAST INECTION — a common type of vaginitis caused by an over- growth yeast fungus organisms in the vagina. (See Vaginitis act Sheet).

ZYGOTE — the cell formed by the union of the egg and sperm that goes on to become an embryo and later a fetus.

Time Out! For Men 197 Appendix B Reference Section

FACT SHEET Contraceptive Implants (e.g. Norplant) WHAT IS IT? Small capsules (shaped like thin match sticks) containing the female hormone progestin. Implants are placed under the skin of the woman’s upper arm.

HOW IT WORKS: The capsules slowly release hormone into the woman’s system. The hormone interferes with ovulation and makes the woman’s vaginal fluids thicker so sperm are unable to reach the egg.

HOW IT’S USED: Six of these small capsules are placed under the skin of the upper arm by a doctor or trained clinician. A local anesthetic is used to deaden the arm. The capsules are inserted one at a time through a small incision. These capsules can stay in place for up to five years. However, a woman can have them removed at any time. Implants should always be removed by a doctor or clinician.

ADVANTAGES: J Implants are about 98-99% effective J Simple; nothing to remember; long-lasting J Reversible; does not hurt future fertility J Very low amount of hormone

DISADVANTAGES: K Irregular bleeding (missed periods; heavier periods) K Minor side effects (weight changes; headaches) K May leave a small scar after removal K Not good for smokers or women with heart problems

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FACT SHEET Birth Control Pills (Oral Contraceptives)

WHAT IS IT? )emale hormone pills. Most pills contain estrogen and progesterone.

HOW IT WORKS: Pills work by stopping the release of an egg from a woman’s ovaries each month. Birth control pills do not affect a woman’s ability to get pregnant after she stops taking them.

HOW IT’S USED: A pill is taken by mouth daily. To start taking the pill, a woman must have an exam and Pap Test. A doctor or health clinic will then give the woman a prescription. At family planning clinics (such as Planned Parenthood) a woman can get an exam and a supply of pills at low cost.

ADVANTAGES: J If taken correctly it’s 99% effective J Simple and easy to use J Does not interrupt sex act J Has few serious side effects for healthy women J Reduces cramps and heavy flow of monthly periods

DISADVANTAGES: K Some women have weight gain or weight loss K Not recommended for heavy cigarette smokers K )orgetting to take pills may result in pregnancy K Spotting or light bleeding between periods is common

Time Out! For Men 199 Appendix B Reference Section

FACT SHEET The Intrauterine Device (The IUD)

WHAT IS IT? The IUD is a small, specially shaped plastic device. It is inserted into a woman’s uterus or womb. Some IUDs contain copper and hormones.

HOW IT WORKS: The IUD seems to work by irritating the lining of the uterus so a fertilized egg cannot implant.

HOW IT’S USED: The IUD is placed inside the uterus by a doctor or family planning nurse using a special instrument. It stays in place for a year or longer. When a woman no longer wants to use it, she returns to the doctor or family planning clinic to have it removed.

ADVANTAGES: J Between 95% and 98% effective J Provides continuous protection J Does not interrupt the sex act J Nothing to remember

DISADVANTAGES: K Insertion may cause cramps for a few hours afterwards K Periods may be heavier (more cramps & bleeding) K Increased chance of infection or PID*

*Pelvic Inflammatory Disease (PID) is a serious infection of the reproduc- tive organs in women. Women who use the IUD should become educated about the symptoms of PID, and visit their doctor or clinic if problems develop. (See ACT SHEET on PID.)

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FACT SHEET The Diaphragm

WHAT IS IT? The diaphragm is a soft latex device shaped like a shal- low cup. It is inserted in the vagina before having sex.

HOW IT WORKS: The diaphragm covers the opening to the uterus. This prevents sperm from being able to fertilize the woman’s egg. A special creme or gel that kills sperm is used with the diaphragm to make it more effective.

HOW IT’S USED: Diaphragms come in different sizes. A doctor or family planning clinic nurse will do an exam to determine the correct size. The diaphragm can be inserted in the vagina up to six hours before having sex. A small amount of sperm-killing creme or gel must be spread inside the diaphragm before it’s used. After having sex, the diaphragm is left inside for about 6 hours before taking it out. It is then washed with soap and water, and stored until needed again.

ADVANTAGES: J Up to 97% effective when used correctly J Used only when needed J Almost no side effects J Provides some protection from sexually transmitted disease

DISADVANTAGES: K May be forgotten in the heat of passion K Learning to use it correctly takes time and practice K Some people may be allergic to the creme or gel K Must remember to use it every time you have sex

Time Out! For Men 201 Appendix B Reference Section

FACT SHEET Condoms

WHAT IS IT? Condoms are also called rubbers or prophylactics. They are made out of very thin latex rubber. Some types are made from animal tissues. Condoms are made to cover a man’s erect penis during sex. Only latex condoms should be used for disease protection.

HOW IT WORKS: The condom traps the man’s fluids and sperm when he ejaculates (“comes”). This prevents the sperm from entering a woman’s vagina and fertilizing her egg. A condom also prevents infection by blocking contact with semen or vaginal fluids.

HOW IT’S USED: Condoms are unrolled over a man’s erect penis before sex. Space is left at the tip of the condom to catch and hold the sperm. After sex, the condom is carefully removed so that the fluids don’t spill. Condoms must be used every time you have sex in order to protect against pregnancy and disease. Sperm-killing creme, gel, or foam can be used with a condom to increase protection. If you are having sex, latex condoms are the best way to protect yourself against HIV/AIDS and other infections spread by sex.

ADVANTAGES: J Up to 98% effective when used correctly J Has no known side effects J Protects against sexually transmitted diseases J Low cost and easy to use

DISADVANTAGES: K May be forgotten in the heat of passion K Some men complain of reduced feeling K Must be stored and handled carefully K Must be used every time for complete effectiveness

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FACT SHEET Female Condom (Vaginal Pouch) WHAT IS IT? A soft, loose fitting birth control device shaped like a large condom with a soft plastic ring at one end. It’s also called a “vagi- nal pouch.”

HOW IT WORKS: The female condom is inserted in the vagina. The end with the ring is positioned to cover the cervix, much like a diaphragm. It protects by completely lining the vagina during sex. Semen and sperm are blocked from entering the vagina.

HOW IT’S USED: The female condom is inserted into the vagina before sex. Each condom comes with a packet of lubrication that helps make it more comfortable. Be sure to read the package instructions carefully. After sex, it is carefully removed and thrown away. A new condom should be used every time you have sex. The female condom provides good protection against HIV/AIDS and other infections that may be spread by sex.

ADVANTAGES: J Up to 94% effective when used correctly J Has no known side effects J Protects against sexually transmitted diseases J Gives the woman control in disease protection

DISADVANTAGES: K May be forgotten in the heat of passion K Learning to use it correctly takes time and practice K Must remember to use it every time you have sex K Penis must be carefully guided during penetration

Time Out! For Men 203 Appendix B Reference Section

FACT SHEET Contraceptive Foams, Gels, and Suppositories

WHAT IS IT? Contraceptive foam is a foam that comes in a small aero- sol can. Contraceptive gel comes in a tube. Contraceptive suppositories are small waxy tablets that dissolve when placed in the vagina.

HOW IT WORKS: Contraceptive foams, gels, and suppositories contain spermicide, a special chemical that kills sperm. When used before sex, the spermicide creates a barrier. This stops sperm from reaching the woman’s egg.

HOW IT’S USED: )oams and gels are inserted into the vagina just before sex. (An applicator comes in the packages.) The suppository tablets are inserted before sex using a finger to push them deep inside the vagina. Be sure to read the package directions on all products carefully. In order to be the most effective, either foam, gel, or a suppository must be used every time you have sex. Using a condom at the same time increases protection. These products can be bought in most supermar- kets or drug stores. Some people may be allergic to spermicides.

ADVANTAGES: J Up to 90% effective when used correctly J Up to 99% when used together with a condom J You can buy foam, gel, or suppositories almost anywhere J Has no bad side effects; low cost and easy to use

DISADVANTAGES: K May be forgotten in the heat of passion K Must be used every time for complete effectiveness K May be messy; may cause allergic reactions K Must be used correctly

FACT SHEET

204 TCU/DATAR Manual Appendix B

Vaginal Contraceptive Sponge

WHAT IS IT? The sponge is a small, soft disk made of a spongy mate- rial that contains spermicide, a chemical that kills sperm.

HOW IT WORKS: The sponge acts as a barrier. It prevents sperm from reaching the woman’s egg. Sperm are killed by the spermicide contained in the sponge.

HOW IT’S USED: The sponge is moistened with water to activate the spermicide. It’s then inserted deep inside the vagina. It can be inserted several hours before sex, and should be left in place for at least six hours after sex to kill all the sperm. Read the package instructions carefully before using the sponge. In order to be the most effective, a sponge should be used every time you have sex. Using a condom along with a sponge will increase protection. Sponges are sold in supermarkets and drug stores. Some people may be allergic to the spermicide in contracep- tive sponges.

ADVANTAGES: J Up to 92% effective when used correctly J Available in drug stores and supermarkets J Can be inserted hours before sex happens J Has no bad side effects; low cost and easy to use

DISADVANTAGES: K May be forgotten in the heat of passion K Must be used every time for complete effectiveness K May cause allergic reaction or irritation K May be difficult to remove

Time Out! For Men 205 Appendix B Reference Section

FACT SHEET Vasectomy (Male Sterilization) WHAT IS IT? Vasectomy is a permanent method of birth control for men.

HOW IT WORKS: Vasectomy is a minor surgical procedure, usually performed in a clinic or doctor’s office. A local anesthetic is given to deaden the scrotum. A small incision is made above each testicle. A tiny section of each vas deferens (the tube that carries sperm from each tes- ticle) is removed and the ends are sealed. The whole operation takes about 20 minutes. Most men are fully recovered within a few days. When the man ejaculates (comes) in the future, his semen will not contain sperm cells. Vasectomy does not interfere with pleasure or sensation during sex.

HOW IT’S USED: A man consults a doctor (usually a urologist) or a family planning clinic to discuss vasectomy. Vasectomy is permanent so he should be certain he doesn’t want more children.

ADVANTAGES: J Vasectomy is 99% effective J Causes no problems with hormones or sexual ability J May help reduce worry about unintended pregnancy

DISADVANTAGES: K It’s permanent and not easily reversed K May be psychologically troubling for some men K Slight risk of infection or other surgical complications

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FACT SHEET Tubal Ligation (%emale Sterilization) WHAT IS IT? Tubal ligation is a permanent method of birth control for women. It’s sometimes referred to as “having her tubes tied.”

HOW IT WORKS: Tubal ligation is an operation that is usually per- formed in a hospital or as outpatient surgery. General anesthesia is given, and two small incisions are made between the navel and the pubic bone. The doctor uses special instruments to look inside the abdomen and locate the fallopian tubes. The tubes are then cut and surgically sealed off. The whole operation takes about 30 minutes. The woman’s ovaries will continue to release an egg each month, but sperm can no longer pass through the fallopian tubes to fertilize the egg. Tubal ligation does not interfere with hormones or sexual feelings.

HOW IT’S USED: A woman consults a doctor (usually a gynecologist) or a family planning clinic to discuss tubal ligation. Having her tubes tied is permanent so she should be sure she doesn’t want more children.

ADVANTAGES: J Tubal ligation is 99% effective J Causes no changes in menstrual periods or interest in sex J May help reduce worry about unintended pregnancy

DISADVANTAGES: K It’s permanent and not easily reversed K Surgery usually requires general anesthesia K Slight risk of infection or surgical complications

Time Out! For Men 207 Appendix B Reference Section

FACT SHEET Natural Family Planning (%ertility Awareness) WHAT IS IT? Natural )amily Planning is sometimes called fertility awareness or the “rhythm method.” It’s a method of birth control based on avoiding intercourse around the time when the woman’s egg is re- leased.

HOW IT WORKS: The couple learns to recognize and keep a record of monthly changes in the woman’s body that indicate her egg is about to be released. During those fertile days, intercourse is avoided or a barrier method of birth control is used (for example, condoms or a diaphragm).

HOW IT’S USED: A couple interested in Natural )amily Planning should get advice and training from a family planning clinic. The woman must learn how to take her temperature each day (there is a slight rise in tem- perature during ovulation). She learns how to check the natural fluids in her vagina for signs of fertility. She also keeps a calendar showing the dates of her menstrual periods. Some or all of this information may be used to help calculate when ovulation is about to occur.

ADVANTAGES: J It’s safe, inexpensive, and has no side effects J It’s acceptable to all religions J It helps a couple understand the woman’s body and her fertility

DISADVANTAGES: K On average, it’s only 76–85% effective K It requires a large amount of paperwork and charting K Abstinence or a barrier method must be used during fertile days

208 TCU/DATAR Manual Appendix B

FACT SHEET Sexually Transmitted Diseases (STDs) and Men’s Health

Sexually transmitted diseases (STDs) are caused by bacteria and viruses. These organisms prefer to invade warm, moist body tissues, so the geni- tals, the anus, and the mouth are common sites of infection.

An STD is spread by having sex with an infected person. This includes vaginal sex (penis-in-vagina), anal sex (rectal), and oral sex (mouth on vagina or mouth on penis).

Men are more likely to have symptoms from STDs. Early diagnosis and treatment are important in order to avoid complications. Some STDs can cause serious problems if not treated, including infertility, blindness, and even death. The most common symptoms are:

l Sores, bumps, blisters, or warts around the sex organs or rectum l Burning or pain when urinating l Pus or milky discharge from the penis l Swelling, inflammation, or pain in the testicles l Swelling, burning, itching around the sex organ or rectum

If you ever have any of these symptoms, visit a doctor or health clinic for an examination and tests. Many STDs can be treated and cured. How- ever, prevention is always the best bet. To reduce your risk of getting an STD:

l Always use a latex condom when you have sex. Condoms provide the best protection against STDs.

l Don’t have sex with anyone who has symptoms of an infection. If you suspect you may have been exposed to an STD, get tested and treated.

or confidential information, call the National STD Hotline: 1-800-227-8922.

Time Out! For Men 209 Appendix B Reference Section

FACT SHEET Sexually Transmitted Diseases (STDs) and Women’s Health Sexually transmitted diseases (STDs) are most often caused by bacteria and viruses. These organisms prefer to invade warm, moist body tissues, so the genitals, the anus, and the mouth are common sites of infection.

You can catch an STD by having sex with an infected person. This in- cludes vaginal sex (penis-in-vagina), anal (rectal) sex, and oral sex (mouth- on-penis or mouth-on-vagina).

Women are more likely to have complications from STDs. Watch out for any of these symptoms:

l Discharge, pus, foul smell, or irritation in the vagina l Sores, rash, blisters, or warts in the genital or anal area l Pain or burning when urinating l Pain in the lower abdomen with fever, chills, or vomiting l Pain or bleeding during or after sex

If you ever have any of these symptoms, visit a doctor or health clinic for an examination and tests. Many STDs can be treated and cured. How- ever, prevention is always the best bet. To reduce your risk of STDs:

l Always use a latex condom when you have sex. Condoms provide the best protection against STDs. The new “female” condom also works.

l Use a vaginal spermicide (e.g., nonoxynol-9) and a condom when you have sex. These chemicals may help kill STD germs. Don’t use nonoxynol-9 if irritation develops.

l Don’t have sex with anyone who has symptoms of an infection. If you suspect you may have been exposed to an STD, get tested and treated.

For confidential information, call the National STD Hotline: 1-800-227-8922.

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FACT SHEET Pelvic Inflammatory Disease (PID)

WHAT IS IT? Pelvic Inflammatory Disease (PID) is a severe infection of a woman’s internal reproductive organs (uterus, ovaries, and fallopian tubes). PID is usually caused by gonorrhea or chlamydia, which are spread through sex.

SYMPTOMS: l Pain in the lower abdomen; cramps l Pus or heavy discharge from the vagina l Pain or bleeding during or after sex l Pain and burning when urinating l )ever, chills, fatigue

COMPLICATIONS: PID can be very serious. It can lead to infection of other organs in the abdomen and may be life-threatening. PID can also cause infertility. In some women, scar tissue continues to cause pain even after the infection is cured.

TRANSMISSION: Most PID is caused by gonorrhea or chlamydia, which are spread by sex. Other types of bacteria may also be involved in PID. Men can carry these bacteria without showing symptoms. Women who have an IUD (a birth control device) may be more prone to infection. Using condoms during sex helps reduce the risk of PID. If a woman has symptoms, she should see a doctor or clinic immediately.

TREATMENT: Mild cases of PID can be treated and cured with the right type of antibiotics. In some cases, hospitalization and IV antibiotics are required. In severe cases, an emergency hysterectomy may be per- formed.

Time Out! For Men 211 Appendix B Reference Section

FACT SHEET Gonorrhea WHAT IS IT? Gonorrhea is an infection caused by a type of bacteria. This bacteria can infect the reproductive organs, anus, and mouth or throat. Symptoms usually appear from two days to three weeks after exposure.

SYMPTOMS: In Women: l Milky discharge or pus from the vagina l Pain in the lower abdomen (belly), fever, chills l Painful urination or pain when you have sex

In Men: l Pus or milky discharge from penis l Painful urination (burning and stinging) l Redness or swelling of the testicles

COMPLICATIONS: Untreated gonorrhea may lead to abscesses in the prostate gland or epididymitis in men and pelvic inflammatory disease (PID) in women. In both men and women it can lead to sterility (inability to have children). In rare cases, it may cause heart damage or arthritis.

TRANSMISSION: Gonorrhea is spread through sexual contact (vaginal, oral, or anal sex). In addition, an infected pregnant woman can pass it to her newborn during childbirth. Using condoms can help you avoid catch- ing gonorrhea. If you notice symptoms, see a doctor or clinic immedi- ately. Avoid sex with people who have symptoms.

TREATMENT: Gonorrhea usually can be treated and cured with the right kind of antibiotics. Visit a doctor or health clinic for a gonorrhea test and treatment. Your sex partners should also be tested and treated.

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FACT SHEET Syphilis WHAT IS IT? Syphilis is an infection caused by bacteria that invade the bloodstream. The bacteria usually enters the body through sexual con- tact. The symptoms of syphilis appear in three stages:

SYMPTOMS: l First symptoms: (Ten days to three months after infection). A small, painless sore, the “chancre” (pronounced shanker), appears at the site of infection (usually on the penis, genitals, mouth, or anus). It heals by itself and disappears, but the infection is still there.

l Second symptoms: (One to six months after infection). A body rash may develop, including the palms of the hands and soles of the feet. Raised patches may develop around the genitals. Other symptoms in- clude fever, fatigue, aching joints, headache, loss of hair.

l Late symptoms: (Two to thirty years) By this time, there are no outward symptoms. However, the disease continues to cause damage to the body.

COMPLICATIONS: Untreated syphilis can infect the brain and heart and cause paralysis, insanity, heart attack, or stroke. A pregnant woman can pass syphilis to her baby, causing birth defects or death.

TRANSMISSION: Syphilis is usually spread through sex (vaginal, oral, or anal sex). Infected women who become pregnant can pass syphilis to their newborns. Using condoms can help you avoid catching syphilis. If you notice symptoms, see a doctor or clinic immediately. Avoid sex with people who have symptoms.

TREATMENT: Syphilis usually can be treated and cured with the right kind of antibiotics. Visit a doctor or health clinic for a syphilis test and treatment. Your sex partners should also be tested and treated.

Time Out! For Men 213 Appendix B Reference Section

FACT SHEET Genital Herpes

WHAT IS IT? An infection caused by a virus that invades the nerve cells. The virus usually enters the body through sexual contact and can infect the genitals, anal area, and mouth. Symptoms appear two to twenty days after infection.

SYMPTOMS: l Painful blisters on the penis, or around the genitals or anus l In women, the blisters may be inside the vagina l Swollen lymph nodes (armpit or groin area) l )lu-like symptoms (fever, aches, feeling tired)

Herpes blisters are small sores filled with clear fluid. The blisters break open and ooze, forming painful ulcers. Eventually the sores crust over and heal. However, outbreaks of blisters usually reoccur, in some cases several times a year.

COMPLICATIONS: An infected woman can pass herpes to a newborn during childbirth causing brain damage, blindness, or death. People with HIV/AIDS may develop hard-to-treat cases of herpes.

TRANSMISSION: Genital herpes is usually spread through sex (vaginal, anal, or oral sex). It is most easily spread when the blisters are present, but it also can be spread when there are no visible symptoms. Herpes can also be passed from mother to child during vaginal delivery. Using condoms can help you avoid catching herpes. If you notice symptoms, see a doctor or clinic immediately. Avoid sex with people who have symptoms.

TREATMENT: There is no cure for herpes. However, there are several treatments to help reduce the pain and discomfort. A doctor or health clinic can diagnose and treat herpes. Your sex partners should also be checked and treated.

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FACT SHEET NGU and Chlamydia WHAT IS IT? NGU stands for Non Gonococcal Urethritis. (The name refers to an infection that is not caused by gonorrhea, but has the same symptoms.) NGU is most often caused by a bacteria called chlamydia. This bacteria can infect the reproductive organs and the rectum. Symp- toms usually appear one to two weeks after exposure.

SYMPTOMS: In Men: l Pain and burning when urinating l Milky discharge or pus from the penis l Swelling, pain, or inflammation in the testicles l Men may have no symptoms

In Women: l Increased discharge from the vagina l Bleeding or pain during sex l Pain in the lower abdomen often with fever and chills l Most often, women have no symptoms or very mild symptoms.

COMPLICATIONS: Even though the symptoms of NGU or chlamydia may be mild, the disease can cause damage to the reproductive organs. If untreated, men may develop infection in the prostate or the testicles. Women may have serious complications such as pelvic inflammatory disease and infertility. In men, chlamydia also can cause infertility.

TRANSMISSION: NGU or chlamydia is spread through sex (vaginal or anal). It also can be passed from an infected mother to her baby during childbirth. Using condoms can help you avoid catching NGU. If you notice symptoms, see a doctor or clinic immediately. Avoid sex with people who have symptoms.

TREATMENT: Chlamydia can usually be treated and cured with the right kind of antibiotics. Visit a doctor or health clinic for a chlamydia test and treatment. Your sex partners should also be tested and treated.

Time Out! For Men 215 Appendix B Reference Section

FACT SHEET Genital Warts

WHAT IS IT? Genital warts are caused by a virus. This virus can infect the genitals and the anal area. Genital warts are different from common skin warts. Symptoms usually appear one month to six months after exposure.

SYMPTOMS: l Small, painless warts or hard spots on the penis or around in the genital or anal area l In women, warts may appear inside the vagina. l In men, warts may appear inside the urinary opening l May cause burning and itching

COMPLICATIONS: Untreated genital warts may enlarge and multiply. In severe cases they may block the urinary opening. In women, genital warts may cause an increased risk of cervical cancer.

TRANSMISSION: Genital warts are spread through sex (vaginal, anal, and oral sex). Using condoms can help you avoid catching genital warts. If you notice symptoms, see a doctor or clinic immediately. Avoid sex with people who have symptoms.

TREATMENT: Genital warts are difficult to treat and cure. A doctor or clinic nurse may apply a chemical liquid to burn them off. In more ad- vanced cases it may be necessary to remove them with laser or surgery. Visit a doctor or health clinic for diagnosis and treatment. Your sex part- ners should also be checked and treated.

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FACT SHEET HIV and AIDS

WHAT IS IT? HIV infection is caused by a virus (HIV) which destroys the immune system. When the immune system is destroyed the body is open to many infections and cancers. When these infections or cancers begin to appear the disease is called AIDS. The HIV virus is carried in the blood, semen, and vaginal fluids of infected people. Symptoms may take ten years develop. Many people with HIV infection are not aware they have it.

SYMPTOMS l Weight loss, loss of appetite, diarrhea, fatigue l )evers, night sweats, swollen lymph nodes (neck, armpits, groin) l White patches in the throat, problems swallowing l Dry cough, chest pain, problems breathing l Painless purple or brown spots on the skin l In women, recurrent vaginal yeast infections or pelvic infections

COMPLICATIONS: HIV/AIDS may lead to a variety of serious and life- threatening infections and cancers, including a type of pneumonia. A pregnant women may pass HIV to her newborn.

TRANSMISSION: HIV is usually spread through sex (vaginal, oral, or anal sex) and through sharing needles, syringes, or “works.” In rare cases it’s passed through a blood transfusion with infected blood. If you think you may have been exposed, visit a doctor or health clinic for an HIV test and counseling. Using condoms when you have sex can help reduce your risk of HIV infection.

TREATMENT: There is no cure for HIV/AIDS, but many of the infec- tions and cancers it causes can be treated. Several drugs are available to help control the activity of the virus and reduce its damage to the immune system.

Time Out! For Men 217 Appendix B Reference Section

FACT SHEET Pubic Lice (“Crabs”) and Scabies

WHAT ARE THEY? Both pubic lice and scabies are tiny insects that can infest the body. Pubic lice (called “crabs” or “lobsters”) will infest the pubic hair, chest hair, and underarm hair, where they feed on blood and lay their eggs. Scabies are tiny mites that burrow under the skin in areas of skin folds such as the inside of the elbow, around the buttocks and genitals, in the back of the knee, or around the wrists. Scabies feed on skin tissue and lay their eggs under the skin.

SYMPTOMS: The primary symptom of pubic lice or scabies is intense itching. Pubic lice bite their host to suck blood, resulting in irritation, rash, and red- dish bite marks. They lay their eggs (called “nits”) on the hair shafts and new lice will hatch out every 10 days if not treated. Scabies burrow under the skin producing rash, red welts, bumps, and intense itching, especially at night.

COMPLICATIONS: Although neither parasite is dangerous, infection can eventually develop from scratching the bites.

TRANSMISSION: Pubic lice and scabies may be spread during sex or close intimate contact. However, they also may be spread through sleep- ing on infected bed sheets or mattresses, or by sharing infected clothing or towels. Scabies are too small to be seen easily with the naked eye. However, pubic lice can sometimes be seen by combing the pubic hair over a piece of white paper using fine-toothed comb. The dark gray lice can then be seen moving about on the paper.

TREATMENT: Both pubic lice and scabies are treated the same way— with a special shampoo or lotion that contains a type of insecticide. There are several treatments sold over-the-counter in drugstores. Ask the pharmacist for advice. All clothing, bedding, and towels should be washed. All household members exposed through skin contact, bedding, clothes, or towels should be treated if symptoms develop. If the itching and rash continue after treatment, see a doctor or health clinician.

218 TCU/DATAR Manual Appendix B Using Role Plays to Build Assertiveness Skills

Role play is often used in both educational and therapeutic settings. Clinicians use it in individual or group counseling sessions; educators use it to enhance classroom learning. Most often role play is used to help people practice interpersonal communication skills and is sometimes referred to as “behavioral rehearsal.”

)or HIV/AIDS prevention groups, role play can help participants understand the benefits of assertive communication for negotiating risk reduction. Role play allows participants to gain an understanding of what assertiveness sounds like and feels like, and it provides an opportunity to practice specific skill areas. Role play activities based on real-life situations help participants learn and rehearse effective responses to pressures to engage in HIV-risky behavior.

Group role plays provide benefits for the players and the observers alike. Group members have the opportunity to discover that many real-life problems are shared, and this awareness may help reduce feelings of isolation. The role player who practices the assertiveness techniques (the “asserter”) has the opportunity to think about, feel, and actually do a new behavior. The co- player and other observers have the chance to learn by seeing themselves in the role play and reflecting on what their own strategies might be in a similar situation. The observers also are given a chance to help others by providing insightful and constructive feedback.

INTRODUCING ROLE PLAY ACTIVITIES

Once they get the hang of it, most people enjoy role play activities and are enthusiastic about participation. It’s helpful to introduce the purpose of and process for role playing before getting started.

Here are some introductory ideas to share with group members:

n The purpose of the role plays is to practice and observe assertiveness skills. When you take part as a “player,” you get a chance to see what it feels like to actually respond assertively. When you take part as a co-player or observer you can see assertiveness in action, and think about how you would respond in a similar situation.

n No one will be forced to role play; however, you may be encouraged to volunteer.

n Observers and co-players will be asked to give constructive feedback after the main player practices an assertive response. Constructive means helpful and respectful. Try to think of positive suggestions about how the player might improve his/her style as opposed to telling the player what he/she did “wrong.”

n Help keep distractions to a minimum for the role players. Avoid laughing, snickering, giving instructions, interrupting, etc.

n Listen carefully to what goes on in the role play. How might the role player improve his/ her assertiveness skills? Think about how you would use assertiveness skills in the same situation.

Time Out! For Men 219 Appendix B Reference Section

Here are some ideas for the role players:

n Participating in the role play exercise allows you to practice being assertive and to get a feel for how others may respond when you are assertive. Your job as a role player is not to be a comedian or a great actor or actress. Be yourself, have fun, and concen- trate on learning more about how you can use assertiveness skills to protect yourself in HIV risky situations.

n There are two “roles” in each role play. We can think of them as the star and the co- star, or as the asserter and the assistant. The person in the asserter role focuses on practicing specific assertiveness techniques; the person in the assistant role helps create and define the potential risk-taking issue or situation by playing to the asserter.

n The assistant should avoid giving in completely and also should avoid making the situation impossible to deal with. The assistant’s job is to help the asserter practice, not to trip him/her up. It’s most helpful if the assistant can provide honest, “real-life” reactions (or comebacks) to the asserter.

Here are some ideas for the group leader:

n If either role player begins to feel uncomfortable, upset, angry, embarrassed, or afraid —stop the role play. It’s not useful to continue if either player is experiencing discom- fort. If this happens, encourage sharing of feelings and take time to process the issues behind the feelings. Likewise, avoid forcing an overly shy or introverted person to be a player or co-player. Some people will learn more from observing than they will from being “on stage.”

n It’s not necessary to wait for the role players to reach closure on the issue in the role play. In fact, some role plays could go on for hours if allowed to do so. In general, the longer the role play goes on, the less effective it becomes for skills practice. Both players and observers may get muddled if more material than can be realistically processed is raised.

n Stop the role play and process the interaction as soon as useful material is raised. One, two, or three “volleys” or exchanges between the players will usually generate enough feelings and skill concepts for discussion. Since, ideally, the focus is on building and practicing specific assertive responses, limiting the length of the role plays allows the asserter several chances to repeat his/her assertions (i.e. “take two”) after receiving constructive feedback from the observers and group leader.

n Allow the asserter role to have at least one more “take” after the role play is processed and feedback is given. This repeated practice helps build confidence and reinforces learning. Ideally, if time is not an issue, the asserter should be allowed to continue practicing (do several “takes”) until he/she is satisfied with his/her use of assertiveness techniques.

n Process the feelings and experiences of both role players before asking the observers for feedback and before giving feedback yourself. Both the asserter and the assistant should be given the chance to talk about their feelings, their perceptions, and their reactions to their interaction in the role play. In most cases you’ll want to allow the asserter to debrief first, then the assistant, and then the observers (the rest of the

220 TCU/DATAR Manual Appendix B

group). Save your feedback and suggestions for last, and then encourage the asserter to try a second or third “take.”

n When giving feedback, use lots of praise and be gentle. Avoid criticism; instead, provide positive direction or suggestions. )or example, “How do you think you might make your refusal a little stronger next time?” rather than “That was a really weak refusal!” Encour- age observers also to give this type of constructive feedback, and model for them how it’s done.

FORMATS FOR ROLE PLAYS

The format or method used for leading group role plays can vary. There are several methods that are useful for skills rehearsal, and group leaders may want to experiment with formats in order to discover which ones best suit their needs.

Whole group as observer. This is the method described in the Core Curriculum in this manual. In this format, an asserter role plays with an assistant, and the rest of the group observes and provides feedback.

Single observer. With this structure, there is an asserter role, an assistant role, and a “formal” observer role. After the role play interaction occurs and the two players have discussed their feelings, the designated observer provides direct feedback to the asserter. After the observer has commented, the rest of the group is invited to give feedback.

Small groups (triads). In this variation, the larger group is divided into smaller groups of three. One person begins as the asserter, another as the assistant, and a third as the observer After the role play, the observer provides feedback and all three participants discuss the experience. After a few rounds of practice, the participants change roles and practice using another role play situation. The group leader circulates among the triads, providing encouragement, feedback, and direction as needed.

Script plays. Group members work in pairs or in groups of three. Each pair or triad is given a situation (or asked to generate its own), and then instructed to write a script. The script writers should focus on developing assertive responses for the main character to use in dealing with the HIV-risk issue in their scenario. The pairs or triads then read their scripts to the larger group (with different people playing the different parts), and the use of assertiveness techniques is discussed. A variation is for the participants to ex- change scripts and read each other’s aloud, then discuss them and offer feedback.

Time Out! For Men 221 Appendix B Reference Section

Resources for Teaching Materials

Testicular For information about breast models available for loan in your Self-Examination area, contact: Models The American Cancer Society Headquarters 1599 Clifton Road, N.E. Atlanta, GA 30329 Telephone: 1-800-227-2345 (toll-free) Texas Division, 2433 Ridgepoint Dr., Suite A Austin, TX 78754 Telephone: 1-512-919-1800 http://www.cancer.org

For purchase, contact:

HEALTH EDCO P.O. Box 21207 Waco, TX 76702-1207 Telephone: 1-800-299-3366 (toll-free) http://www.healthedco.com

Videos and For information about films and videos for loan in your area, Films about contact: Testicular The American Cancer Society Headquarters Exam and 1599 Clifton Road, N.E. Prostate Health Atlanta, GA 30329 Telephone: 1-800-227-2345 (toll-free) Texas Division, 2433 Ridgepoint Dr., Suite A Austin, TX 78754 Telephone: 1-512-919-1800 http://www.cancer.org

Planned Parenthood Federation Affiliates Check your phone book for an office in your area.

To purchase or rent the video Your Pelvic and Breast Exam, which is used in Session Four, contact:

Perennial Education 930 Pitner Avenue Evanston, IL 60202 Telephone: 1-800-323-5448 (toll-free)

222 TCU/DATAR Manual Appendix B

Safer Sex Many of the materials suggested for use in Session 7 are Demonstration usually available for sale through drug stores and pharmacies. Materials For information about materials available for loan in your area, contact:

Planned Parenthood Federation Affiliates Check your phone book for an office in your area.

Any AIDS Services or AIDS Resources organization Check your phone book for an office in your area.

To purchase a safer sex demonstration kit (condoms, penis demonstration model and instruction tape), contact:

Lifestyles Condoms Ansell Healthcare, Inc. 200 Schultz Drive Red Bank, NJ 07701 Telephone: 1-800-327-8659 (toll-free) http://www.lifestyles.com

For information and samples of the female condom, contact:

The Female Health Company 515 North State Street, Suite 2225 Chicago, IL 60610 Telephone: 1-800-274-6601 (toll-free) or 1-800-635-0844 (toll-free) http://femalehealth.com

Sources for The American Cancer Society Headquarters Pamphlets and 1599 Clifton Road, N.E. Atlanta, GA 30329 Literature about Telephone: 1-800-227-2345 (toll-free) Prostate Cancer Texas Division, 2433 Ridgepoint Dr., Suite A and Testicular Austin, TX 78754 Exam Telephone: 1-512-919-1800 http://www.cancer.org

Planned Parenthood Federation Affiliates Check your phone book for an office in your area.

Time Out! For Men 223 Appendix B Reference Section

Sources for U.S. Department of Health and Human Services Public Health Service Pamphlets and )ood and Drug Administration Literature on 5600 )ishers Lane HIV/AIDS, Safer Rockville, MD 20857 Sex, and Telephone: (301) 443-3285 Sexually American Red Cross National Headquarters Transmitted HIV/AIDS Education Diseases 1709 New York Avenue, N.W., Suite 208 Washington, DC 20006 Telephone: (202) 639-3223 or contact your local Red Cross Chapter

Planned Parenthood ederation Affiliates Check your phone book for an office in your area.

Any AIDS Services or AIDS Resources organization Check your phone book for an office in your area.

In Texas, contact:

Texas Department of Health Bureau of HIV and STD Control 1100 West 49th Street Austin, TX 78756 Telephone: (512) 458-7207

224 TCU/DATAR Manual

CLIENT SURVEY

TIME OUT! FOR MEN

TO BE COMPLETED BY STAFF: [FORM 58; CARD 01]

SITE #: CLIENT ID#: TODAY'S DATE: COUNSELOR ID#:

|___| |___|___|___|___| |___|___||___|___||___|___| |___|___| [5] [6-9] MO DAY YR [10-15] [16-17]

SEQUENCE: 1. PRETEST 2. POSTTEST 3. 10 WEEK 4. 6 MONTH |___| [18]

PART ONE.

INSTRUCTIONS. Please answer the following questions based on whether you think the sentence is TRUE or FALSE. Circle 1 (True) or 2 (False) after each statement.

True False

1. In the true nature of things, men and women are opposites...... 1 2 [19]

2. Testicular cancer is most common in men under age 35...... 1 2 [20] 3. Television, movies, and music may influence how we expect men and women to behave and feel...... 1 2 [21] 4. If a person is an active listener it means he will interrupt the speaker to give his point of view...... 1 2 [22]

5. Logic is more important than emotions in dealing with people...... 1 2 [23] 6. Problems with urination (such as trouble getting the flow started) may indicate a problem in the prostate gland...... 1 2 [24] 7. Conflict and disagreement are unlikely to happen in a good relationship or marriage...... 1 2 [25]

8. Society and culture create the roles men and women are expected to play...... 1 2 [26] 9. A person who is a good listener tries to tune out distractions when communicating with others...... 1 2 [27] 10. Some sexually transmitted diseases such as gonorrhea and syphilis are rare and hard to catch...... 1 2 [28]

11. An I-Statement is something used by people who are self-centered...... 1 2 [29] 12. Sperm cells that are not released through sex may build up in a man’s testicles and cause health problems...... 1 2 [30]

Time Out! For Men 225 1 of 3

13. An assertive attitude means respect for self as well as respect for others...... 1 2 [31]

14. To resolve a conflict, both people involved must agree on who is to blame...... 1 2 [32] 15. Only latex condoms should be used to protect against HIV and other sexually transmitted diseases...... 1 2 [33] 16. In human beings, sex drive is based on instinct, just like it is with other living creatures...... 1 2 [34] 17. If you have an assertive attitude it means you only accept your own point of view...... 1 2 [35]

18. Men do not experience most feelings as strongly as women do...... 1 2 [36] 19. The man’s penis and the woman’s clitoris are made out of the same type of skin and tissue...... 1 2 [37] 20. To settle an argument with someone, it’s helpful to bring up similar disagreements from the past...... 1 2 [38]

PART TWO.

INSTRUCTIONS: Circle the answer that shows how much you agree or disagree each item describes you or the way you have been feeling lately.

DISAGREE NOT AGREE STRONGLY ...... SURE ...... STRONGLY

1. It is entirely up to the male partner to take the lead in sexual activities...... 1 2 3 4 5 6 7 [39] 2. I accept the fact that my sex life will sometimes be highly frustrating. .... 1 2 3 4 5 6 7 [40]

3. The primary goal of sexual activity should be intercourse...... 1 2 3 4 5 6 7 [41] 4. If my partner treats me unfairly, I can express how I feel without losing my temper...... 1 2 3 4 5 6 7 [42] 5. For real compatibility, my sex partner should desire sex as frequently or as infrequently as I do...... 1 2 3 4 5 6 7 [43] 6. Sexual pleasure should be easy and spontaneous, not something I must work hard to achieve...... 1 2 3 4 5 6 7 [44]

226 TCU/DATAR Manual 2 of 3

DISAGREE NOT AGREE STRONGLY ...... SURE ...... STRONGLY

7. Men are generally more interested in sex than women...... 1 2 3 4 5 6 7 [45] 8. I listen carefully to what my partner has to say...... 1 2 3 4 5 6 7 [46] 9. I can't stand it when my sex life is not the way I want it to be...... 1 2 3 4 5 6 7 [47] 10. Having intercourse is the best way to express sexual desire...... 1 2 3 4 5 6 7 [48] 11. I intend to talk to my sex partner about how we can have safer sex...... 1 2 3 4 5 6 7 [49]

12. It is okay for a woman to initiate sex. .... 1 2 3 4 5 6 7 [50] 13. My sex partner should be sensitive enough to know exactly what I want sexually without my having to say anything...... 1 2 3 4 5 6 7 [51] 14. Since men seem unable to control their sex drive, women must control theirs. ... 1 2 3 4 5 6 7 [52] 15. I have the right to jump in and make decisions for my partner...... 1 2 3 4 5 6 7 [53] 16. I plan to use condoms more often in the future...... 1 2 3 4 5 6 7 [54] 17. My sex partner must follow the same sex rules and customs that I do...... 1 2 3 4 5 6 7 [55] 18. If I fail as a lover, this means that I'm an inadequate person...... 1 2 3 4 5 6 7 [56]

19. Orgasm from manual stimulation can be as satisfying as intercourse...... 1 2 3 4 5 6 7 [57] 20. Sexual urges are strong but manageable by most men...... 1 2 3 4 5 6 7 [58] 21. I would object if my partner suggested that we use a condom...... 1 2 3 4 5 6 7 [59] 22. Sexual intercourse between a man a woman is the only mature way to satisfy sexual needs...... 1 2 3 4 5 6 7 [60] 23. It is difficult for me to talk to my partner about sexual concerns...... 1 2 3 4 5 6 7 [61]

Time Out! For Men 227 3 of 3

Bibliography

Bartholomew, N., Chatham, L., & Simpson, D. (1994). Time Out! or Me - An Assertiveness and Sexuality Workshop Specially Designed for Women. ort Worth: Texas Christian University, Institute of Behavioral Research.

Bartholomew, N., & Simpson, D. (1994). Approaches to HIV/AIDS Education in Drug Treatment. ort Worth: Texas Christian University, Institute of Behavioral Research.

Bartholomew, N., Simpson, D., & Chatham, L. (1993). Straight Ahead: Tran- sition Skills for Recovery, ort Worth: Texas Christian University, Institute of Behavioral Research.

racher, J. C., & Kimmel, M. S. (1987). Hard issues and soft spots: Counsel- ing men about sexuality. In M. Scher, M. Stevens, G. Good, & G. A. Eichenfield (Eds.), Handbook of Counseling & Psychotherapy with Men. Beverly Hills: Sage Publications.

Gross, A. E. (1980). The male role and heterosexual behavior. In T. M. Skovholt, P. G. Schauble, & R. Davis (Eds.), Counseling Men. Monterey, CA: Brooks/Cole Publishing.

Kramer, P. (1988). The Dynamics of Relationships. Kensington, MD: Equal Partners

Levant, R. . (1990). Psychological services designed for men: A Psychoedu- cational approach. Psychotherapy, 27(3), 309-315..

McCary, J. & McCary, S. P. (1984). Human Sexuality, 3rd Edition, Bellmont, CA: Wadsworth Publishing.

McCarthy, B. W. (1980). Secondary impotence: Understanding, prevention, and treatment. In T. M. Skovholt, P. G. Schauble, & R. Davis (Eds.), Counsel- ing Men. Monterey, CA: Brooks/Cole Publishing.

Meth, R. L., & Pasick, R. S. (1990). Men In Therapy: The Challenge of Change. New York: Guilford Press.

Nowinski, J. (1993). Hungry Hearts: On Men, Intimacy, Self-Esteem, and Addiction. New York: Lexington Books.

Nowinski, J. (1980). Becoming Satisfied: A Man’s Guide to Sexual ulfillment. Englewood Cliffs, NJ: Prentice-Hall.

Ortiz, E. (1989). Your Complete Guide to Sexual Health. Englewood Cliffs, NJ: Prentice-Hall.

Time Out! For Men 229 Bibliography

Petrich, B., & McDermott, B. (1988). Intimacy Is or Everyone. (Available from Planned Parenthood of Santa Barbara, 158 Garden Street, Santa Bar- bara, CA 93101).

Picchioni, A. (1992). Men, masculinity, and therapy. TCA Journal, 20(2), 9- 17.

Pollack, W. S. (1990). Men’s development and psychotherapy: A psychoana- lytic perspective. Psychotherapy, 27(3), 316-321.

Rogers, Carl R. (1961). On Becoming a Person. Boston: Houghton Mifflin Company.

Roen, P. (1974). Male Sexual Health. New York: William-Morrow.

Sproule, J.M. (1981). Communication Today. Glenview, IL: Scott, oresman, and Company.Psychotherapy, 27(3), 316-321.

230 TCU/DATAR Manual Session 1

A New Outlook on Relationships Session 2

An Assertive Attitude Session 3

Listening Session 4

Talk It Over, Part 1: Feelings and Needs Session 5

Talk It Over, Part 2: Resolving Conflict Session 6

Man Talk: It’s More than Plumbing Session 7

Loving Relationships Session 8

Making Relationships Work Appendix A

Human Sexuality Appendix B

Reference Section Appendix C

Client Survey (pretest/posttest) Bibliography