taking, and Help-seeking among Young Men



taking, and Help-seeking among Young Men





















Violence in Close Relationships, Sexual Risk- taking, and Help-seeking among Young Men





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Department of Psychology University of Gothenburg

Göteborg, Sweden 2020



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3ULQWLQJSTEMA SPECIALTRYCK AB, Borås, Sweden, 2020 ISBN: 978-91-8009-076-6 (PDF)

ISBN: 978-91-8009-077-3 (Print)

ISSN: 1101-718X Avhandling/Göteborgs universitet, Psykologiska inst.

Internet link to Gupea: http://hdl.handle.net/2077/66679

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erection difficulties. A relatively high proportion had been subjected to sexual coercion (14.7%). Study IV explored 30 young men’s descriptions of how members of their social networks had influenced them to seek psychological help. Results showed that young men were influenced by their networks mainly through exhortation and drawing attention to their needs. Friends who were role models were especially influential in helping them overcome ob- structive masculinity norms and move from reluctance toward more construc- tive attitudes regarding help-seeking. This thesis focuses on young men’s ex- periences with relationship violence, as well as their sexual and psychological health needs, all of which have clinical implications.

Keywords: dating violence; young men; sexual risk-taking; social network;

help-seeking





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lence: An international review. Aggression and Violent Behav- ior; 18: 159-174. https://DOI: 10.1016/j.avb.2012.11.015 II Bowen, E., Holdsworth, E., Leen, E., Sorbring, E., Helsing, B.,

Jaans, S., Awouters, V. (2013). Northern European adolescent attitudes toward dating violence. Violence and Victims; 28: 619- 634. http://dx.doi.org/10.1891/0886-6708.VV-D-12-0009 III Helsing, B., Frisén, A., Hwang, C P. (2020). Sexual Risk-Tak-

ing among Young Swedish Men Testing for STI. The European Journal of Contraception and Reproductive Health Care. Pub- lished online: 02 Oct 2020.

https://doi.org/10.1080/13625187.2020.1821355.

IV Helsing, B., Hwang, C P., Frisén, A. How Social Networks in- fluence Young Men to Seek Psychological Help.

(Pending review in Nordic Psychology).



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i fyra europeiska länder. Avhandlingen syftar dessutom till att vidga förståel- sen av unga mäns problem i nära relationer genom att undersöka dels sexuellt risktagande bland unga vuxna män och dels hur unga vuxna män påverkas av medlemmar i deras sociala nätverk när det gäller att söka psykologisk hjälp för problem i nära relationer.

Avhandlingen innehåller en genomgång av tidigare forskning om ovanstå-

ende ämnen och fyra originalstudier. Studie I tar upp några av begränsningarna

i den aktuella litteraturen genom att internationellt fastställa förekomst av våld

i nära relationer bland unga. Studien granskar också riskfaktorer för våld i nära

relationer bland unga och jämför effektiviteten avseende etablerade intervent-

ionsprogram. Studie II undersöker om det finns generella föreställningar i ung-

domars (12–18 år) uppfattningar om våld i nära relationer i fyra europeiska

länder (Belgien, England, Tyskland och Sverige). Studie III utforskar sexuellt

risktagande bland unga vuxna män (18–30 år) som testat sig för sexuellt över-

förbara infektioner (STI) och undersöker om det finns variationer i sexuellt

risktagande vad gäller ålder, etnisk bakgrund och sexuell preferens. Dessutom

beskrivs i vilken utsträckning dessa unga män har erfarenheter av erektions-

svårigheter och sexuella handlingar mot sin vilja, upplevelser som sannolikt

bidrar till sexuellt risktagande och risker för STI. Studie IV utforskar slutligen

hur unga vuxna män (18–30 år) som sökt hjälp för psykologiska problem och

svårigheter i nära relationer var påverkade av medlemmar i deras sociala nät-

verk (partner, familj och vänner) till att söka denna hjälp och hur de upplevde

att medlemmar i deras sociala nätverk påverkade dem.



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aspekter vara särskilt viktiga att ta hänsyn till. (1) Att ungas attityder till våld i nära relationer kan legitimeras under vissa omständigheter är något som behö- ver beaktas i kliniska sammanhang. Professionella personer som möter unga behöver vara initierade för att kunna ställa frågor som kan uppmärksamma fö- rekomst av kränkningar och våld som de unga eventuellt undanhåller. Inter- ventionsprogram som syftar till att öka medvetenheten om och minska våldet i ungdomsrelationer behöver också fokuseras på att undervisa ungdomar om det subjektiva i hur våld tolkas av de inblandade och hur sådana tolkningar kan påverka beslut om att söka hjälp. Det kanske viktigaste budskapet är dock att interventioner behöver förändra arten av befintliga uppfattningar beträffande våld i nära relationer och tydligt förmedla att våld i relationer är fel, oavsett vem som begår det och oavsett vilken situationen det rör sig om.

(2) Det oroande resultatet att en tredjedel av MSM mot sin vilja hade utsatts

för sexuella handlingar, pekar på det faktum att fler frågor om sexuella upple-

velser måste ställas till MSM av professionella personer. Sexualitet och sexu-

ellt tvång är känsliga ämnen som inte bör undvikas. Sexuellt samtycke är ett

område där det kan finnas gråzoner, eftersom samtycke är beroende av både



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%URQIHQEUHQQHU9). Avhandlingen visar hur ungdomars attityder till våld i nära relationer formas och påverkas av övergripande värden som är inbäddade i det större sammanhang som makrosystemet utgör (Bronfenbrenner, 1979).

Det innebär att de accepterar att beteenden som är potentiellt fysiskt eller psy-

kologiskt kränkande eller våldsamma, är oönskade och i allmänhet oaccep-

tabla. På mikrosystemnivån kan det emellertid i kamratrelationer finnas situat-

ioner, där unga tycks acceptera att kränkningar och våld kan ske (Bronfenbren-

ner, 1979), till exempel vid otrohet – om det är en engångsföreteelse –eller i

samband med ett skämt eller som lek (skojbråk). Dessutom var det tydligt att

ungdomar ansåg att behovet av hjälp endast var aktuellt när det gällde allvar-

liga handlingar av kränkningar och våld. På grund av normer som är inbäddade

i olika lager i det ekologiska systemet, kan ungdomar och unga vuxna således

tveka och i sämsta fall även undvika att avslöja att de har utsatts för kränk-

ningar och våld och därmed bära den bördan själva.



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supervision, seminars, discussions, and so on. Accordingly, there are many people who in different ways have contributed to my now approaching the fin- ish line, the doctoral dissertation. While I can’t mention some of these people by name, all of them should know I’m eternally grateful to them.

I would like to thank all the study participants: the teenagers in the Cava project for communicating their perspectives on dating violence, even though this can be a sensitive topic; the young men who answered the survey on inti- mate experiences; and finally, the 30 young men who shared their experiences of how their social network supported them in their help-seeking process, even though many of them were nervous about seeking psychological help for the first time.

The two most important people who guided me along all the tricky trails,

and to whom I will always be grateful, are my two supervisors. I’m happy to

have had the opportunity to have the broad skills of my two supervisors, Pro-

fessor Hwang and Professor Frisén, at my side while writing this thesis. I’d

like to express my sincere gratitude to Professor Philp Hwang, for all your

generous support in guiding my work with great commitment and interest, and



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FOHVDORQJWKHWUDLO And to my second, but nevertheless genuinely involved supervisor, Professor Ann Frisén: I thank you for your clear-minded guidance that always made comprehensible the steps involved in the research process.

The art of accuracy in formulating interview questions that you taught me was extraordinarily instructive.

I would like to specifically thank Professor Linda Haas for both the linguis- tic support as well as pointing out the importance of having a clear focus on the context in which the research takes place. At University West, I am thank- ful to the former Head of the Department of Social and Behavioral Studies, Bibbi Ringsby-Jansson, who convinced me that this was possible. I thank the present Head of Department, Lena Sjöberg, and Manager Marie Westerlind, for their encouragement and support. I also want to express my gratitude to Johan Söderlundh, Manager of the Young Men’s Health Clinic, for always showing interest in and supporting my research. I would also like to thank Pro- fessor Emma Sorbring, Head of Child and Youth Studies at University West, for inviting me to participate in the Cava project, and for sharing the knowledge involved with being in an international research project. I would also like to mention Love Nordenmark, at the Swedish Association of Local Authorities and Regions. Our dialogues about young men, masculinity, and health have always developed my thinking further.

I would like to express my appreciation to all my friendly colleagues and fellow PhD students in the Gothenburg group for Research In Developmental psychology (GRID) at the Psychology Department at Gothenburg University, as well as all my friendly colleagues and fellow PhD students at University West. I want to specifically thank Dr. Jonas Hallberg for our statistical discus- sions, which were very helpful to me. To my fellow doctoral students with whom I shared the office at University West, Olof Wiedel and Mona Tyn- kkinen: I’ve really appreciated our discussions about learning and develop- ment. Looking forward to future discussions, and there’s more to explore around the metaphor of rolling a kayak. My sincere gratitude goes to my very dear and always cheering and encouraging colleagues at the Young Men’s Health Clinic. I’m most grateful for all your help and support during this pro- cess.

Thank you, Professor Karin Aronsson, for carefully reading my thesis and for giving me valuable comments on the manuscript and inspirational feedback on my research.

Thank you, Ann-Sofie Sten for helping me to fix the cover page.



+HDOWK:RUNLQJ/LIHDQG:HOIDUHIRUWKHLUVXSSRUW

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DUHDQGIRUNQRZLQJthat “victory grows through harmony”–\RXWZRDUHWKH

EHVWAnd to Lotta, for the life we have together. Doing chores in the stable

was for some time the perfect relaxation from academic thinking. Nowadays,

however, this has changed to gardening at our allotment, and this activity is

perfect in so many ways. You’re the best!









,QWURGXFWLRQ ... 1

7KHRUHWLFDOSHUVSHFWLYHV ... 3

Bronfenbrenner’s Ecological Systems Theory ... 3

Background–situational model ... 6

Masculinity ... 7

5HVHDUFKRYHUYLHZV ... 11

Dating violence ... 11

Young men, STIs, and sexual risk-taking ... 17

Young men´s psychological help seeking ... 22

*HQHUDODLP ... 29

6XPPDU\RIVWXGLHV ... 31

Study I ... 31

Study II ... 34

Study III ... 36

Study IV ... 37

Conclusion ... 39

*HQHUDOGLVFXVVLRQ ... 43

Dating violence ... 43

Young men and sexual risk-taking ... 48

The social network’s influence on young men to seek psychological help ... 51

Clinical implications ... 55

Limitations and future studies ... 59

Ethical considerations ... 62

&RQFOXGLQJUHPDUNV ... 65

5HIHUHQFHV ... 69

 







 

Introduction

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more responsibility than men. A survey conducted among all 220 Swedish Youth Health Clinics, which offer health services to young people aged 12-25 free of charge, showed that approximately 85-90% of all visitors were young women (SALAR, 2016). Similar gendered patterns are found in regard to seek- ing help for psychological problems (CES, fact sheet 2016: 3; 2017: 2). These gendered differences indicate that traditional norms concerning men’s health issues are still present in Sweden, despite a society-wide emphasis on gender equality (SOU, 2014:6). This thesis aims to contribute important new knowledge about young Swedish men’s experiences with sexual risk-taking and the decision to seek psychological help for relationship problems.

The thesis includes a review of previous research on these topics and a de-

scription of four original studies. Study I addresses some of the limitations in

the current literature by establishing international prevalence rates of adoles-

cent dating violence, reviewing dynamic risk factors for dating violence per-

petration, and comparing the effectiveness of established intervention pro-

grams. Study II was conducted to determine the extent to which a universal set

of themes of dating violence could represent the attitudes and beliefs of ado-

lescents (aged 12–18) across four European countries (Belgium, England,

CHAPTER 1

2

Germany, and Sweden) or whether, given the different levels of gender em- powerment identified across these countries, differences exist in adolescents’

views about dating violence. Study III explores sexual risk-taking among young adult men (aged 18–30) and examines whether there are variations in sexual risk-taking in terms of age, ethnic background, and sexual preference.

Furthermore, Study III examines the extent to which young men testing for STI experience situations such as erection difficulties and sexual coercion, which likely promote sexual risk-taking and increase the risk of catching an STI.

Study IV examines whether and in what way young adult men (aged 18–30) who sought help for psychological problems and difficulties in close relation- ships had been influenced by members of their social network (partner, family, and friends) to seek help, and how men experience the influence they receive from members of their social networks. The thesis covers two age groups of young men: Studies I and II focus on adolescents (aged 12–18), while Studies III and IV investigate young adult men (aged 18–30).

The first chapter presents the main theoretical foundation for this thesis, Bronfenbrenner’s (1979) Ecological Systems Theory. The background-situa- tional model was also used to explore the topic of violence in close relation- ships (Riggs & O’Leary, 1989; 1996); this model overlaps somewhat with the Ecological Systems Theory in exploring both distal and proximal influences on violence. Lastly, the theoretical part of the thesis also focuses on the con- struction of traditional masculinities, especially in relation to problems young men face as well as their reluctance to seek help. The next chapter provides an overview of research within the fields included in the thesis. The first section presents an overview of research on the prevalence, risk factors, and prevention of dating violence. In the next section the topic is young men and sexual risk- taking, its prevalence, and these young men’s attitudes about testing for STIs.

The final section presents research on young men seeking psychological help,

with a specific focus on research on how social networks have been involved

in the decision. Thereafter follow the general aims and summaries of the four

studies, including a section presenting their overall conclusions. The following

chapters discuss the studies’ findings, and include sections on clinical implica-

tions, limitations of the studies, and ethical considerations. The final chapter,

containing the concluding remarks, discusses the overall contribution of the

thesis.

 







 

Theoretical perspectives

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Bronfenbrenner’s Ecological Systems Theory

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influence. As such, the interaction between the individual and his or her envi- ronment is characterized by reciprocity, and the environment is not limited to a single, immediate setting but is rather extended to incorporate interconnec- tions between settings, as well as to external influences emanating from the larger surroundings. The environment is conceived topologically as a nested arrangement of structures, each contained within the next. These structures are referred to as the micro-, meso-, exo-, and macrosystems (Bronfenbrenner, 1979).

The microsystem

The microsystem consists of activities, roles, and interpersonal relations expe-

rienced in the layer nearest the individual; it includes settings such as home,

school, and work. In these immediate settings, the individual has roles specific

to the particular environment, such as son, student, partner, or friend. In the

microsystem, the individual engages in face-to-face interaction with, and par-

ticipates in activities with, others. These interactions and activities shape the

course of the individual’s psychological growth.







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The mesosystem

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family, sports activities, and peer groups. A mesosystem is thus a system formed or extended whenever the individual moves into a new setting and en- gages in activities in more than one setting (Bronfenbrenner, 1979). Interac- tions may also have an impact on those with whom the individual has direct contact. For example, in this thesis young men may be affected by their friends’

making sexist remarks on social media (Shen-Miller et al., 2011).

Mesosystemic interconnections can take many more forms, as individuals actively participate in more than one setting, such as family, sports activities, or peer groups; they also participate in formal or informal social networks that link these settings.

The exosystem

The exosystem refers to one or more areas of social structure that are further out and that do not involve the individual as an active participant, but where events occur that affect what happens in the settings closer to the individual (Bronfenbrenner, 1979). This could include legislation, organizational poli- cies, mass media, and health services (Shen-Miler et al., 2011). One example of exosystem activities in the Swedish context relevant to the context of this thesis is the new legislation on sexual crime based on the principle of consent from 2018, which clarifies that whether or not participation in a sexual act is consensual will now represent the boundary of the point at which an act is deemed to be punishable (https://www.riksdagen.se).

The macrosystem

The outermost level in the Ecological Systems Theory is the macrosystem.

Bronfenbrenner (1979) maintains that, within a society, settings such as school,

health services, or leisure time activities look and function similarly. It is as if

the various settings had been constructed from the same set of blueprints

(Bronfenbrenner, 1979). The macrosystem refers to consistencies, in the form

and content of the micro-, meso-, and exosystems that exist, or could exist, at

the level of the subculture or culture. However, the systems’ blueprints differ

 

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Molar activities, roles and ecological transition

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the two elements “molar activities” and “roles”, as well as the basic concept RI

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the individual’s world beyond the immediate situation and thus become a

“PHQWDOPHVRV\VWHP”. As more differentiated aspects are included, the indi- vidual becomes more capable of participating in the ecological environment, both within and beyond the immediate setting in accord with his or her needs and desires. Furthermore, the exposition of molar activities engaged in by oth- ers is important, as they become part of the psychological field of the individ- ual through their involvement or attraction, activities that they themselves can later access (Bronfenbrenner, 1979).

In relation to this thesis, molar activities can be exemplified by activities that expose others with negative behavior. Young men who are more accepting of sexual dating violence were found to associate with peers whom they viewed to be sexually abusive toward their dating partners (Sears, Byers & Price, 2007). The concept of molar activities has also been used to invoke positive behavior, for instance in order to prevent sexual violence using bystander in- tervention (Banyard, 2011).

Roles are usually identified by the labels used to designate various social

positions, typically differentiated by age, sex, kinship relation, occupation, or

social status. In this way the role, as an element of the microsystem, is embed-

ded in the larger context of the macrosystem with its ideology and institutional

structures (Bronfenbrenner, 1979). With the role comes expectations about

how to act and how others are to act toward an individual. These expectations







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socioeconomic and normative expectations, or other cultural experiences. As such, these activities develop the individual, as these steps are expressed through behavior in a more extended differentiated environmental context (Bronfenbrenner, 1979).

While Bronfenbrenner’s Ecological Systems Theory has generally been well received, it has encountered some criticism. This criticism mostly focuses on the difficulties of empirically testing the theory. Its wide scope, describing the important impact of factors at different levels of social structure on indi- viduals, is a strength. At the same time, this wide scope makes it challenging to empirically evaluate the distinct components of the theory. Criticizing his own theory, Bronfenbrenner (2005) points out that it is more useful in under- standing the nature and developmental contribution of the social environment than individuals’ own experiences. Despite this criticism, the Ecological Sys- tems Theory offers a valuable perspective for describing the potential influence of ideologies of masculinity on different levels in society.

Background-situational model

A second theoretical framework used in this thesis, and somewhat overlapping with the Ecological Systems Theory in terms of both distal and proximal fac- tors, is the background-situational model. This model was specifically devel- oped to shed light on courtship aggression (Rothman, 2018; Dardis, Dixon, Edwards, Turchik, 2015).

The background-situational model, formulated by Riggs and O’Leary

(1989), suggests that violence in the family of origin brings about an ac-

ceptance of aggression as a response to conflict. This includes (a) exposure to

models of aggression in intimate relationships, (b) exposure to parent–child

 

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(a) alcohol and/or drug use, (b) partner’s use of aggression, (c) SRRUSUREOHP

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Masculinity

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PRGHOGHYHORSHGby Michael Messner (2000). According to Messner, a critical

understanding of masculinity must simultaneously consider three factors. The

first factor is the institutionalized privileges that men as a group enjoy at the

expense of women as a group. Second, men incur costs when embracing the







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alternative masculinities. As such, the current conceptualization of hegemonic masculinity might be replaced by a new one that acknowledges the possibility of democratizing gender relations and is open to equality with women, rather than simply reproducing hierarchy (Connell & Messerschmidt, 2005).

In Sweden, for many the interest in masculinity is linked to gender equality and the focus has been on how men as a group enjoy institutional privileges at the expense of women as a group (Messner, 2000). In line with this, most re- search on men in Sweden has focused on structural gender power relations and the hierarchical order between men and women and between groups of men.

The interest in hegemonic masculinity and the problems of men’s violence and men’s health did not become part of the official gender equality agenda until the past decade (Hearn et al., 2012).

Another perspective on masculinity concerns the concept of masculinity

ideologies. Ideologies are assumed to be systems of values, expectations, be-

liefs, or ideas shared by a social group, presumed to be natural in a society. In

this way, the concept of masculinity is understood as a body of socially con-

structed ideas and beliefs about what it means to be a man and against which

men are appraised within their communities (Bennett & Thompson, 2017).

 

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have been critically discussed. Although a large body of empirical work has demonstrated that masculinity ideologies matter, there is a debate concerning whether they should be conceptualized as norms external to the individual and located within society, or as a set masculinity beliefs, which are norms that have been internalized (Bennett & Thompson, 2015).

Most research on masculine ideologies has examined problematic aspects of masculinity (Wade, 2015), targeting attitudes such as dominance, antifemi- ninity, and other traditional masculinity values (Bennett & Thompson, 2015).

As such, past research findings may not accurately represent the male role

norms of today (Wade, 2015). Young men who are the subjects of research

may agree that traditional norms of masculinity exist and are practiced in the

culture by men in general. However, these young men may not personally ap-

prove of these norms. Consequently, the concept of masculine ideologies may

not adequately address the ideologies that actually channel the lives of men

who are satisfied, socially engaged, and resist the reproduction of inequalities

between men and women as well as among men (Bennett & Thompson, 2015).

 







 

Research overviews

Dating violence

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:LQFHQWDN&RQQROO\&DUG+DPE\ 6KHUU\, 2017). An increased awareness of the importance of addressing the issue of dating violence among adolescents and young adults has grown among researchers and public health agencies in recent decades. This chapter begins by defining behaviors that are included in the concept of dating violence, followed by a presentation of prevalence, risk factors, and prevention in relation to dating violence.

Different terms are used for dating violence, e.g. teen dating violence, vio- lence in romantic relationships; when abusive behavior takes place in the con- text of the Internet and social media, it is called cyber abuse and technology- based dating violence.

In the Swedish context, the concept of “dating” is not as clearly established as in the Anglo-Saxon context, especially in the US, where dating is a central part of youth culture. In Sweden, the topic of dating violence is referred to as

“våld i nära relationer” (violence in close relationships), with the addition of

“bland unga” (among young people) when younger age groups are addressed (Brå, 6/2018). This concept is connected to “intimate partner violence” (IPV), which seems to be a more internationally established concept today (used by, e.g., the National institute of Justice in the US). Studies I and II in this thesis were conducted in an international research project, and these articles use the concept of dating violence, which is why this term will be used in this intro- ductory framework.

Definition of dating violence

Partners involved in dating relationships can include current or former spouses, partners, boyfriends or girlfriends, dating partners, or sexual partners. Accord- ingly, this means that relationships can vary from casual to more ongoing; and the closeness of the relationship, the emotional connectedness, and the regu- larity of contact can also vary, as can the physical contact and/or sexual inti- macy (Breiding, Basile, Smith, Black & Mahendra, 2015; Mulford, Blachman- Demner & Auchter, 2013).

Dating violence can be divided into four main types: physical violence, sex-

ual violence, psychological/emotional aggression, and stalking. Stalking is not







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Prevalence

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Prevalence, gender similarities, and gender differences?

A core issue that complicates our ability to get a clear picture of dating violence involves the differences in what studies actually measure. In a review of 130 studies, Smith et al. (2015) identified 48 different behavioral measures; a ma- jority of these did not include all types of dating violence and either focused on victimization, knowledge, attitudes, or intentions rather than distinguishing between victimization and perpetration behaviors.

What further complicates the picture of prevalence has to do with the measures used in studies. When multi-item scales are used to assess physical dating violence, higher reports of both victimization and perpetration for males and females are found, compared to studies that use a single-item measure (e.g.

Sussman, Jones, Wilson & Kann, 2002) or a narrower definition (e.g. Hamby

& Turner, 2013). Similarly, when a broader definition of sexual victimization is used, more victimization among both females and males is found, compared to when narrower definitions of forced sex or attempted forced sex are used (Wincentak et al., 2017). The pattern that emerges according to broader or nar- rower definitions of dating violence is that it is related to gender differences.

Gender differences are smaller for less serious offenses, and multi-item scales’

self-report measures tend to include items with less severe acts of violence.

Gender differences also appear to be smaller for nonphysical than physical ag- gression (Hamby, 2009).

To further investigate these gender differences, Hamby and Turner (2013) examined the impact of various ways of operationalizing dating violence on rates, using data on sexual victimization, injury, and fear in a national sample in the US. Females reported incidents of physical dating violence leading to injury three times more often than males did. When sexual, physically injuri- ous, or fear-inducing violence was combined in one measure, it produced sta- tistically higher rates of female victimization compared to male victimization.

Hamby and Turner (2013) suggest that when behaviors that are physically forceful but do not meet the traditional definition of violence are included – so-called false positives – this makes it challenging to distinguish “signal”

from the “noise” in measures of violence. According to them, no existing meth-

odology is known to accurately distinguish between acts that fall near the def-

initional borders of violence versus playful or other nonaggressive uses of

physical force. This raises questions regarding how the same types of incidents

are reported by males compared to females (Hamby & Turner, 2013).