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

Abstract

Objective:

Men underuse mental health services in part because of masculine norms. Few interventions focus on masculinity in therapeutic contexts, especially in low- and middle-income countries. This study analyzed transcripts from masculinity-focused therapeutic sessions with fathers in Kenya to explore masculine norms and intersections with the therapeutic process.

Methods:

The study examined transcripts from fathers (N=9) who participated in a pilot trial of LEAD (Learn, Engage, Act, Dedicate), a five-session father-focused intervention addressing alcohol use, depression, and family engagement in Kenya. Applied thematic content analysis was conducted to explore themes of masculinity, fatherhood, and facilitators or barriers to clinical processes guided by the gender role strain theory and motivational interviewing research.

Results:

Fathers described four core scripts shaping masculine identity: financial provision, intergenerational models of authority and alcohol use, fatherhood as an earned identity, and emotional suppression. Facilitators of engagement (e.g., openness) that emerged in transcripts included peer-father counselors’ shared identity, masculinity-aligned affirmations, structured reflection that seemed to create emotional safety, and reframing of vulnerability as a strength. Counselors flexibly balanced fidelity with responsiveness, pausing manual content to support fathers’ processing of grief and trauma. These processes appeared to scaffold change talk, values clarification, and redefinition of masculine identity, aligning with documented reductions in alcohol use, depression, and family conflict from the original pilot trial.

Conclusions:

The findings demonstrate how masculinity-informed discussions can function as intervention and engagement strategies. The results suggest practical strategies for adapting evidence-based treatments to better engage men globally and in family-focused settings.

Globally, men are more likely than women to die by suicide, with harmful substance use and depression being strong risk factors. Yet, men are largely underrepresented in mental health services and prevention, in part because of masculine norms that create barriers to help seeking (1–3) and the lack of services that engage with conceptions of masculinity (4). This gap is especially pronounced in low- and middle-income settings where treatment resources for depression and substance use are limited (5, 6).

Hegemonic masculinity (7, 8) refers to the culturally dominant form of manhood characterized by attributes such as assertiveness and invulnerability. Attempts to live up to this ideal can produce psychological strain (9, 10). The gender role strain paradigm (9–11) conceptualizes this strain as gender role dysfunction, or the negative effects of adhering to rigid norms, and gender role discrepancy, which occurs when men perceive themselves as falling short of these norms. Both have been associated with adverse mental health outcomes. In East Africa, similar patterns have been observed, with pressures to maintain strength and provide financial support leading men to delay care and use alcohol to cope (12). Although men often seek informal support, formal mental health services remain stigmatized and underused unless tailored to men (13).

Growing calls have emerged for approaches that engage directly with masculinity as part of efforts to improve men’s mental health (4, 14). Interventions that address power dynamics and expand conceptions of manhood have demonstrated success in fields such as HIV prevention, family planning, and violence reduction (15–18). Evidence also suggests that fatherhood may be a powerful motivator for change, offering an entry point for engaging men in treatment (19). Despite these advances, few studies have examined how structured, therapeutic discussions of masculinity and fatherhood may enhance men’s engagement in treatment and promote mental health and family outcomes.

Narrow engagement and access are especially true in settings with limited mental health care, such as in low- and middle-income settings. Within these settings, such as in Kenya, task sharing—the training of nonspecialists to provide care—is one strategy to increase care access with the potential to increase engagement (20). Moreover, in attempts to engage harder-to-reach populations, identifying and training providers with social proximity (i.e., shared social and identity characteristics) to target treatment populations can facilitate intervention acceptability and adoption (21–23).

Given these factors and to address the need for mental health interventions tailored to meet the unique needs of fathers with co-occurring depression and harmful drinking practices, Learn, Engage, Act, Dedicate (LEAD) was designed for peer-father treatment delivery in Kenya (24). LEAD integrates behavioral activation (BA) and motivational interviewing (MI) with established evidence-based treatments and explorations of masculinity in the context of marriage and fatherhood, with the goals of reducing depression and alcohol use and enhancing family engagement. In a proof-of-concept trial that used an inferential design with small samples, LEAD showed improvements in fathers’ alcohol use, depression, and family-related outcomes such as positive family-directed behavior (e.g., time spent with family), as well as promising implementation outcomes with peer-father providers able to deliver LEAD with high fidelity and high counseling competencies (21, 25). LEAD and its implementation are currently being tested in a randomized controlled trial in Kenya in a hybrid type 1 study to understand implementation and effectiveness at a larger scale (26).

Although larger studies are ongoing, few investigations have examined how norms around masculinity and fatherhood are actively engaged and potentially expanded within therapeutic encounters. Understanding how discussions of masculinity and fatherhood operate in session is needed to increase engagement and promote change for men and their families. Therefore, the aim of this article was to explore how fathers who attended LEAD articulated cultural scripts of manhood and fatherhood and how these scripts intersected with therapeutic processes during fathers’ sessions with peer counselors through qualitative transcript analysis. Because of the exploratory nature of this transcript-focused analysis, we did not test formal hypotheses but instead sought to identify recurring themes and processes within interactions.

METHODS

Setting and Ethics

Research activities were conducted in Eldoret, Kenya, a peri-urban community in the Rift Valley Province. All activities were implemented in collaboration with Moi Teaching and Referral Hospital (MTRH) and AMPATH (Academic Model Providing Access to Healthcare), a long-standing consortium involving Moi University, MTRH, the Kenyan Ministry of Health, and North American partners. We obtained ethical approval from the Moi University Institutional Research and Ethics Committee and the institutional review board at Duke University.

Study Overview

The transcripts analyzed in this study were from a pilot multiple-baseline trial of the LEAD intervention. The design of LEAD was based on formative work that tested feasibility, acceptability, and clinical outcomes of LEAD with nine fathers in Eldoret, Kenya (24, 25). Eligibility was based on respondents scoring 8–20 on the Alcohol Use Disorders Identification Test (AUDIT; possible scores range from 0 to 40, with higher scores indicating greater alcohol misuse), with those showing probable dependence excluded and referred to higher-level care. The mean age of fathers was 38, and the mean AUDIT score was 17, in the harmful range. The pilot demonstrated feasibility of recruitment and retention, high treatment fidelity and counselor competencies, and consistent reductions in drinking and depressive symptoms as measured with the Patient Health Questionnaire–9, alongside improvements in family functioning as measured by the Family Togetherness Scale (27). Full results are reported in Giusto et al. (25, 28).

Intervention

LEAD is a five-session program developed to address alcohol use, depression, and family engagement of fathers in Eldoret, Kenya (24). Each session lasted approximately 60–90 minutes and was delivered weekly. See Giusto et al. (24) for full details. The intervention integrates MI, BA, and masculinity discussion strategies (MDS) to address men’s depression and alcohol use. These are evidence-based approaches for improving alcohol use and engagement (MI), depression (BA), and expanded conception of what it means to be a man (MDS).

In LEAD, MI is used in session 1 to enhance engagement and readiness to change (29–31). MI has demonstrated efficacy in increasing treatment engagement, reducing alcohol use, and improving behavioral outcomes. MI is used to engage fathers in addressing stress and coping by linking behavior change to personal goals for self and family. MI strategies are then integrated throughout sessions 2–5 to support motivation and follow-through.

BA is the core of sessions 2–5. Brief BA, which has demonstrated efficacy in reducing depression and substance use, is incorporated through core components, including values clarification, activity monitoring, scheduling, and problem solving (21, 32–35). The central premise of BA—that increasing engagement in value-driven activities and positive reinforcement reduces unhealthy coping and promotes healthier behavior—is applied in LEAD to both self- and family-directed activities (36).

Session 2 includes MDS to elicit father family models and enhance motivation to engage in family-directed behavior (37). MDS draw from gender-transformative intervention literature (17, 18), which seeks to examine and expand rigid gender norms linked to health risk behaviors. In LEAD, rather than directly challenging masculinity, MDS invite structured reflection on inherited models of manhood and fatherhood, encouraging fathers to consider how certain masculine expectations may support or undermine their family and personal well-being. For instance, counselors guided participants to discuss what it means to be a man and a father in their community and how certain ideas of masculinity had been helpful or harmful. Structured prompts included questions such as, “What are the good things about your relationship with your father that you would like to take with you?” This session provided an opportunity for men to articulate masculine scripts, consider them with personal aspirations, and begin to link reflections to family values and behavioral goals.

Counselor Training and Supervision

Counselors were peer fathers recruited from the community through religious and community leaders. Of the 12 fathers who were nominated, six were invited to training because of their interest and availability, and all six completed training. Three fathers were ultimately selected to deliver LEAD on the basis of general counseling competencies coded before and after the training by supervisors in a standardized role-play, knowledge of LEAD based on a written test, and openness to feedback as assessed by supervisor observations (21). Training lasted 10 days and included didactics, role-plays, and practice. Training began with a focus on core counseling competencies (e.g., validation and reflection), core treatment principles and practice, then manual role-playing and practice. Supervision followed a tiered structure: local supervisors (M.K., W.R.) with bachelor’s-level psychology training provided weekly oversight and case review in person, supported by consultation from a U.S.-based clinical psychology doctoral trainee (A.G.) at Duke University (at the time of the study) via Zoom and senior clinical psychologists in Kenya in person. Full details of training, supervision, and counselor selection can be found in Giusto et al. (21).

Data Collection and Analysis

All sessions were audio-recorded with participant consent and subsequently transcribed and translated into English. For this study, we analyzed session transcripts from session 2. We used applied thematic content analysis, a pragmatic approach well suited to the data (38). The analysis combined inductive coding to capture emergent themes with deductive coding informed by the gender role strain paradigm (e.g., discrepancy strain and dysfunction strain) and MI literature (e.g., values clarification and affirmation). A U.S.-based (A.G.) and a Kenyan team member (M.K. or W.R.) independently read each transcript, documented initial impressions with memos, and then met to discuss emerging ideas and develop case summaries. Inductive codes (e.g., masculinity, fatherhood and masculinity, and engagement mechanisms) were refined alongside deductive codes drawn from the gender role strain paradigm and MI, which were used as sensitizing frameworks rather than hypotheses to be tested. A structured coding scheme was developed iteratively, and transcripts and case summaries were re-reviewed and coded into this template. Two coders (A.G., S.J.) then compared coding, discussed discrepancies, and reached consensus on thematic summaries, which were organized into the final analysis. Because of the small, bounded sample, our aim was depth of case-level exploration rather than saturation across a larger population. Nonetheless, we observed strong recurrence of key themes across transcripts, suggesting thematic adequacy (39).

RESULTS

We first present themes related to participants’ perceptions of fatherhood and masculinity. We then present themes clarifying how fatherhood and masculinity intersected with therapeutic engagement and change.

Foundational Themes: Masculinity and Fatherhood Reflections

When reflecting on their own fathers and what it means to be a man, participants described a set of scripts that reflected four main themes: financial provision as manhood, intergenerational masculinity, fatherhood as an earned identity, and emotional suppression.

Financial provision as manhood.

Participants’ responses emphasized that being a man meant providing for one’s family. One father noted, “We used [to] be told that men are people who should be relied on.” Meeting material needs, such as food, school fees, and shelter, was described as a community and family expectation. The participants reflected that their value as fathers and men was judged by their ability to provide and that failure to do so brought shame, conflict, and, in some cases, alcohol use as a coping strategy. One father reflected, “We were always told to work, always work to provide.”

Intergenerational masculinity.

Some fathers described learning expectations around manhood from their fathers. Accounts often included both positive and negative models. “He used to like me and would take us to school,” recalled one participant, whereas another contrasted this experience with, “He used to drink, and I would like to leave that behind.” These reflections demonstrated how masculinity may have been understood across generations as a mixture of provision, authority, alcohol use, and silence. One participant commented on how his father punished him for crying:

There is a time I cried when my elder sister was being disciplined, this cost me. Because my father now turned to me and really disciplined me, not because I had done anything wrong, but because I cried too. Yet as a man, I am not supposed to do that.

Almost all the participants noted how aspects of one-dimensional masculinity can harm. For example, one father reflected on the models his father enacted while pointing out the potential negatives: “When we use force to solve disputes, it can haunt us afterwards, say, when we physically hurt somebody.”

Fatherhood as an earned identity.

Fatherhood itself was often described as something that had to be earned. The men spoke of fatherhood not as an automatic identity but as a role that required work through consistent behavior. Being seen by children and wives as reliable was central to feeling like a “real man.” One father captured this link between action and identity: “A good father is someone who protects his family and listens.” Another emphasized the moral dimension: “Being a man is not about drinking or shouting. It’s about doing what’s right.” In some ways, these reflections highlighted felt pressures while opening discussion to a range of actions that can garner respect and fall within the umbrella of being a good father.

Emotional suppression.

Emotional suppression emerged as another script. The men noted that they rarely spoke about their fathers, emotions, or own family life and that within their communities, men were expected to remain quiet about such matters. As one participant said, “I’ve never talked about this before—not even with my wife.” A few fathers addressed this topic directly, with one noting, “It [ways we are told to be men] does not let one be open and free because fathers [need] to be feared.” Scripts appeared to reinforce a model that equated emotional suppression with strength. Yet, the fathers were quick to point out the limitations and potential harms of suppression as well.

Facilitators of Engagement and Therapeutic Change

Transcripts revealed father and counselor dynamics that seemed to facilitate participants’ engagement and movement toward change. These facilitators included relational dynamics between participants and peer-father counselors, reframing of masculine identity, and structured opportunities for self-reflection. Facilitators fell into two categories: those that fostered participation and openness (engagement) and those that supported rethinking behaviors (therapeutic change). Themes are summarized in Table 1. Facilitators also aligned with constructs from the gender role strain paradigm, particularly discrepancy strain, or the gap between a man’s behavior and his internalized masculine beliefs. Furthermore, facilitators tended to reflect MI strategies, such as affirmation, values clarification, and reflection, with a focus on masculine or family-related content.

TABLE 1.

Facilitators of engagement and therapeutic change^a

Theme	Facilitator type	Description	Illustrative quote	Theoretical lens
Shared father identity and peer normalization	Engagement	Peer counselors’ fatherhood status increased trust and openness	Father: “Because he is also a father, I listened.”	Peer modeling/social proximity mitigate strain
Masculinity-aligned affirmations	Engagement	Participation framed as strength, leadership, and responsibility	Counselor: “You are a leader for being here today.”	MI affirmation; targets discrepancy strain
Emotional safety through structured reflections	Engagement	Session structure supported progressive disclosure and values clarification	Father: “This is the first time I’ve said that out loud.”	MI spirit; mitigates dysfunction strain
Counselor-coached masculinity reframing	Engagement	Counselors praised emotion and change as masculine	Counselor: “Being a strong man can also mean solving disputes in . . . ways other than violence.”	MI affirmation; targets discrepancy strain
Distinguishing inherited vs. chosen masculinities	Therapeutic change	Fathers reflected on which masculine traits may be helpful vs. harmful	Counselor: “What would you like to leave behind?” Father: “Being quick to anger [like my father].”	Discrepancy strain; MI values clarification
Behavioral goals anchored in father identity	Therapeutic change	Men tied change efforts to becoming better fathers	Father: “I would like to take care of my children.”	MI values clarification; resolves discrepancy strain
Reframing masculinity to include emotional expression	Therapeutic change	Emotion seen as strength, not weakness	Father: “We can also be free to let out the pain through tears.”	Reappraising dysfunction strain

^aMI, motivational interviewing.

Peer-father counselors’ and participants’ shared parent identity and peer normalization.

Across all transcripts, participants often referenced the peer counselor’s identity as a father as a facilitator. Some participants reflected on shared experiences as a man who had “also gone through challenges.” This shared identity appeared to create a sense of trust and relatedness between peer-father counselors and participants. Participants often related to counselors as “one of us” and as a person who had perspective and earned respect. This comfort and respect in turn appeared to facilitate openness and reduce felt risk of emotional expression.

Counselors also often drew on these shared identities as fathers and men in sessions to facilitate sharing and model emotional expression and engagement. For instance, one counselor noted, “I am also a father like you, and we are here to build a new path to help you reach your goals,” and another counselor said, “You are a father, and I am a father, too.”

Masculinity-aligned affirmations.

In addition to shared identity, peer-father counselors frequently used statements that affirmed masculine-aligned values, such as leadership, responsibility, and strength, to emphasize session participation as masculine. For example, when one participant hesitated to share, the counselor said, “You are a leader for being here today,” which seemed to facilitate disclosure later in the session. Such affirmations targeted aspects of discrepancy strain by offering expanded ideas around masculinity that included emotional reflection. Rather than being framed as weak, showing up and participating were framed and affirmed as being strong and admirable: “It takes a real man to come and sit here and listen” and “You have taken another step in the path towards your vision and being a leader just by being here.” Such statements seemed to target and reinforce engagement and participation in session, in part by reinforcing aspects of masculine identity and self-efficacy.

Emotional safety through structured reflections.

LEAD’s structured content moved from broad discussion of past family models to current values and goals, which seemed to help facilitate engagement with content related to fatherhood and masculine identity. Many participants started sessions slightly guarded, evidenced by short or terse answers, but gradually engaged through affirmation, reflection, and appropriate self-disclosure from the counselor. In the following excerpt of a structured section, the counselor normalized expression and talking and then reflected (i.e., reinforced) father expression.

COUNSELOR: Okay, thank you. So, the anger is something you would like to leave behind?

FATHER: Yes.

COUNSELOR: As I had explained to you earlier, is that there are many things that I learn as we continue with our sessions. It is true that in life we continue to learn a lot. As we are seeing here, there are things that are hidden that only come to our minds whenever we talk about them.

FATHER: That is true.

COUNSELOR: I would also like to know about the good in the relationship between your father and mother that you would like to take and use it with your wife.

FATHER: His relationship with my mother was so good. Even though he passed on when I was young, I know for sure that they were good.

COUNSELOR: Yes . . .

FATHER: Because I never saw him cane my mother. He also never sent her back to their home.

COUNSELOR: Okay, so your father respected your mother.

This structured approach appeared to help reduce dysfunction strain by facilitating expression as acceptable, especially when framed around fatherhood. Another excerpt underscored how the structured reflection helped highlight motivators for change by emphasizing goals.

FATHER: It can affect us because, at the moment when you[’re] persevering, you could really be hurting yet you would just have cried it out and healed. Also, as a man, it is unlike [us] to seek help from someone about something that is stressing you, yet you could have maybe found someone that could have helped.

COUNSELOR: Are there things that we should leave behind?

FATHER: Yes.

COUNSELOR: Tell me more.

FATHER: We could change the issue of connecting seeking help with weakness. Because maybe what you are going through, someone else may help you get a solution and therefore by keeping quiet, you may not have solved anything.

COUNSELOR: So, what I am getting from you is that you would like to change the issue of not seeking help to solve your problems just because you are a man.

FATHER: Yes.

Counselor-led masculinity reframing.

Another facilitator of in-session engagement, closely related to affirmations, was counselors’ verbal reframing of participant statements to expand views on masculinity. Counselors reflected and framed fathers’ specific behavior changes as caring, courageous, and committed. These moments may have helped participants internalize emotional disclosure and self-examination as a strength. In one session, a counselor reflected and reframed a statement, saying, “You have also noticed that being a strong man can also mean solving disputes in . . . ways other than violence.” Such comments modeled scripts in which reflection, accountability, and growth were reinforced as manly. This facilitator may mitigate discrepancy strain.

Facilitators of Therapeutic Change

Intergenerational fatherhood: inherited versus chosen masculinity.

In every session, participants discussed qualities they associated with their own fathers. Many fathers compared their past models of fatherhood with the kind of father they wanted to become. Some reflections included comparison and identity reevaluation, with a few participants expressing a desire to choose different paths, particularly related to harshness, absence, and alcohol use. For example, two fathers noted the following: “My father never had a conversation with me. I want to talk with my children” and “He used to beat my mother, and I feared becoming like him. But I want to be better.” Fathers often balanced identities they wanted to “leave behind” with specific actions they wanted to carry forward. For example, one father focused on new activities he wanted to use with his children:

FATHER: I would like to encourage my children to always follow their hearts. I will be observant of what they like to do, then help them continue.

COUNSELOR: Thank you. So, you’re saying that your father did not look at all children generally, he was able to identify what each of you are best at differently [and] then helped you out.

FATHER: Yes, I always see some parents forcing children [to] do what they do not want to do, but as for my father, he did not do that. He observed that I loved spending time with him while he was doing his carpentry work, and he took the opportunity to teach me.

COUNSELOR: That was good. So, you would like to use that with your children, too.

FATHER: Yes.

These reflections suggest that some participants were de- and reconstructing inherited masculinities, intentionally considering what they wanted to claim. This process reflects identity reappraisal and is consistent with discrepancy strain resolution, in which men begin to construct aspirational but achievable versions of manhood and parenting. When they do, they often note concrete motivators for change, as evidenced at the end of the following exchange:

FATHER: Like I said, he used to like me and would take us to school, and I would like to do that [for] my kids, too.

COUNSELOR: And what are the things that you would like to leave behind?

FATHER: He used to drink, and I would like to leave that behind.

Values and behavioral goals anchored in father identity.

Across transcripts, participants tied intentions to reduce alcohol use, improve communication, or be more available directly to their role as fathers, family leaders, or family providers. Many participants noted the joy and fulfillment in being a father. For example, one father shared, “The way God blessed me with children, when I am at home [and] they call me dad I feel very happy, so their needs are my responsibility.” Conversely, top problems described by participants typically centered on pressures to provide for one’s family. In identifying values, most fathers chose being a good provider or family leader. Scheduled activities to improve mood and reduce alcohol then reflected these values, with statements that often used future-oriented language, such as wanting to be “present,” “better,” “looked up to,” or “someone they can be proud of.”

FATHER: For me personally, I would like to be a good role model. And for my family, I would like to be a good father. . . .

COUNSELOR: Now we will schedule activities that will help you get to your goals. Let us begin with being a good father. What would you like to do to be a good father?

FATHER: I would like to meet their needs. . . . I would like to look for work so that I can get some money to provide for them.

Fatherhood often served as a motivator for behavior change, consistent with MI mechanisms such as values clarification and change talk.

DISCUSSION

In this study, we analyzed session transcripts of fathers participating in LEAD, a five-session intervention addressing alcohol use, depression, and family engagement in Kenya. Discussions provided a picture of masculinity and fatherhood in this context. Peer-father counselors seemed to facilitate emotional expression by framing vulnerability as part of fatherhood and masculinity, aligned with principles of MI (e.g., strengths based). This exploration facilitated behavioral goal setting anchored in broadening definitions of fatherhood. These therapeutic processes seemed to support later documented improvements in alcohol use, depressive symptoms, and family functioning reported in companion studies (21, 24). Findings also reflect recent guidance on how to consider masculinities in health interventions targeting norms, including reflection on masculine norms, peer modeling, and the creation of new behavioral scripts tied to caregiving roles (14).

Results demonstrated how MI techniques could be blended with masculine-aligned language throughout sessions. Values clarification, affirmations, reflections, and structured summarizing, which all appeared as facilitators, are key MI skills (24). Here, they were integrated with masculine and fatherhood identity to expand conceptions and identify behavioral activities aligned with values. For instance, when counselors asked fathers what kind of men they wanted to be, they were helping to clarify values, an MI technique, but anchored in masculine identity. Affirmations served to build self-efficacy while reframing help seeking as masculine, and when fathers expressed change talk (e.g., wanting to be different from their own fathers), counselors reflected these expressions as evidence of leadership. This approach aligns with change drivers seen in MI and evidence from male-tailored interventions, which recommend affirmational rather than confrontational strategies for engagement (18, 40). For instance, our results converge with prior gender-based adaptations of MI to reduce psychological threat and enhance engagement among men (41). In contrast to brief gender-tailored MI approaches, LEAD embeds masculinity-informed strategies within fatherhood identity and integrates them with BA and peer-father delivery in a non-U.S. context.

Overall, themes aligned with the gender role strain paradigm (42). Fathers frequently described tensions between their current way of being and their expectations (discrepancy strain). They also identified harmful effects of rigid norms, consistent with dysfunction strain (43). When themes arose, counselors often used MI techniques (facilitators) to help fathers explore other ways of expressing masculinity. This nonconfrontational, collaborative style parallels evidence that MI may be effective with men because they affirm autonomy (1, 44). In practice, counselors reframed vulnerability as strength and care as masculine, consistent with positive masculinity approaches that expand rather than discard masculine definitions (45). These patterns extend understanding of how MI can operate within gender identity frameworks.

The processes observed during the sessions demonstrated potential for small changes that might directly influence family systems (14). Discussions of masculinity and past family models seemed to facilitate broader definitions of fatherhood that included emotional availability and caregiving responsibilities. Data from the original pilot study supported this observation, showing positive changes within family systems, including men’s increased efforts to communicate and be involved in the home, reported on by partners and youths (28). Mothers and youths also reported changes in how fathers saved, spent, and communicated about finances. Fathers’ redefinition of masculine responsibility may have helped facilitate changes in alcohol spending and increased spending on household resources. Family-level impacts point to how masculinity-informed interventions with individual men can function to potentially improve family-level problems. This approach may be relevant for engaging men directly in family-based care as a “first step” or addressing father behavior as a driver of family conflict. Our results align with research showing that broadening from “breadwinning” roles to include caregiving behaviors is associated with increased positive father engagement and family well-being (46, 47). Our findings extend this literature by exploring how therapeutic discussions that expand masculine identity might facilitate family benefits.

Findings further highlighted the role of peer-father counselors in scaffolding masculinity-informed therapeutic engagement and change. Counselors’ shared identities as fathers and community members seemed to create credibility to reduce stigma and encourage disclosure; this finding is consistent with prior work emphasizing the role of social proximity and peer providers as masculine-congruent engagement strategies in men’s mental health (48). From an implementation perspective, training and supervision practices can consider balanced approaches to flexible delivery.

This study had several limitations. First, analyses were limited to transcripts only, which restricted our ability to trace masculinity-related processes across the full course of later outcomes. Second, the sample was relatively small and drawn from a single periurban Kenyan setting, limiting generalizability of specific masculine norms and therapeutic processes to other cultural or clinical contexts. Finally, our analysis relied on in-session dialogue rather than independent observation, which may have further strengthened objective understanding of processes.

CONCLUSIONS

This exploration offers a contribution to the literature on engaging men in mental health interventions. By demonstrating how structured discussions of masculinity and fatherhood, facilitated by trusted peer-father counselors, can both address potential psychological threat and anchor motivation for change, our findings extend the gender role strain paradigm into applied therapeutic contexts. The work also illustrates how MI mechanisms can be adapted to engage masculine identity, a strategy that holds promise for expanding men’s participation in care. This strategy aligns with broader calls to integrate masculinity-informed and family-focused approaches into global mental health programming. For global and U.S. contexts wherein men underuse mental health services, our findings point to the potential of fatherhood-anchored, masculinity-informed adaptations of existing evidence-based practices.

HIGHLIGHTS.

• Structured therapeutic discussions of masculinity and fatherhood created openings for men to reflect on inherited scripts, link values to behavior change, and frame vulnerability as a masculine strength.

• Peer counselors’ shared identity as fathers and respected community members reduced stigma and encouraged disclosure, underscoring the importance of social proximity in engaging men in care.

• The findings extend the gender role strain paradigm into applied therapeutic settings and suggest that masculinity-informed strategies anchored in fatherhood can strengthen engagement in global mental health and family-focused interventions.