The APA Guidelines — Part II

This is Part II of a three-part series. Part I examined the roots. Part III examines the consequences.

In August 2018, the American Psychological Association released its Guidelines for Psychological Practice with Boys and Men — the first such guidelines in the organization’s history.

The guidelines were thirteen years in the making. The APA Board of Directors began the process in 2005, providing funding in September of that year. They were developed largely by the Boys and Men Guidelines Group of Division 51 (Society for the Psychological Study of Men and Masculinities).

The APA announced the guidelines with a tweet and an accompanying article in the APA Monitor that stated: “They draw on more than 40 years of research showing that traditional masculinity is psychologically harmful and that socializing boys to suppress their emotions causes damage.”

The New York Times declared: “Traditional masculinity can hurt boys, says new APA Guidelines.”

The guidelines identified “traditional masculinity” — marked by stoicism, competitiveness, dominance, and self-reliance — as psychologically harmful. Critics argued this pathologized normal male development.

As the journal Current Opinion in Psychology (2026) reported: “Not surprisingly, this ignited a significant firestorm with widespread concerns that the APA had chosen to disparage men with traditional values and endorsed a far-left worldview that was ideological rather than clinically helpful. Given that the practice guidelines could shape the form of therapy for men and boys, the concern arose that, in essence, the APA was endorsing clinical malpractice.”

The APA guidelines were not universally accepted. A substantial body of scholarly criticism emerged — much of it from within the psychological profession itself.

Christopher J. Ferguson, a professor of psychology at Stetson University, published a comprehensive critique in New Ideas in Psychology (2022). Ferguson’s review found that “though the guidelines were offered in good faith, many of the critiques are likely valid.”

Specifically, Ferguson concluded that the guidelines:

1. Failed to acknowledge biological influences on gender — The guidelines ignored “significant evidence for biological influences on gender (e.g., hormonal, and hypothalamic influences on gender identity and gendered behavior).”
2. Were unintentionally disparaging of traditional men and families — The framing of traditional masculinity as inherently harmful alienated the very population the guidelines were meant to serve.
3. Were too closely wedded to specific sociocultural narratives — The guidelines were “incurious of data not supporting those narratives.”

Ferguson concluded: “There are reasonable concerns that the current guidelines may do more harm than good by dissuading traditional men and families from seeking counseling.”

The guidelines are set to expire in 2028. Ferguson and others have called for substantial revision.

The authors of the guidelines did not remain silent. In a formal rebuttal published in New Ideas in Psychology (2023), they defended their work.

The rebuttal made six points:

1. Criticisms reflect anti-feminist and gender essentialist perspectives — The authors argued that opposition to the guidelines was ideologically motivated rather than scientifically grounded.
2. The guidelines followed all APA rules and regulations — They “met all the criteria for acceptance, as specified in the formal APA procedures applicable at the time,” including “reliance on research literature, expert consensus, and public comment and review.”
3. The guidelines are routinely mischaracterized — The authors pointed out that the controversy was “precipitated by a tweet from the APA Public Affairs Office and not by the Guidelines themselves,” and that the tweet “distorted the public perception of the Guidelines.”
4. APA Guidelines are not research reports — Ferguson’s methodological critiques “would be much more appropriate for a research report, systematic review, or meta-analysis than for a set of guidelines for professional practice.”
5. Ferguson conflates men with masculinity — The authors argued that criticizing masculinity is not the same as criticizing men.
6. Ferguson makes bold claims without justification — The rebuttal accused Ferguson of lacking familiarity with the field.

The debate remains unresolved. What is clear is that the guidelines represented a significant shift in how the psychological profession views masculinity — and that shift has had real-world consequences.

The APA guidelines were not issued in a vacuum. They were the culmination of decades of diagnostic expansion that increasingly treated normal boyhood behavior as pathological.

The diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD) expanded dramatically over the past three decades, and boys were diagnosed at rates far exceeding girls.

In 2019, 8.8% of children aged 3–17 had ever received an ADHD diagnosis — and boys were more likely than girls to receive one overall and within every age group. By 2020–2022, that had risen to 11.3% of children ages 5–17, with boys at 14.5% versus girls at 8.0%.

The CDC’s National Health Interview Survey data shows the pattern is not merely one of biology but of diagnostic practice. The male-to-female ratio in diagnoses has shifted over time, suggesting that environmental and institutional factors — not just neurological ones — drive the disparity.

The APA guidelines had a predictable consequence: they made men less likely to seek help.

When the professional organization that governs psychological practice formally declares that your natural instincts are harmful, the message is received loud and clear. Men who might have benefited from therapy declined to seek it.

As Ferguson concluded: “Portraying traditional masculinity as ‘toxic’ is likely to cause harm, not only in stigmatizing many men and their families, but also by reducing trust in the profession. As such, many men who would have benefited from cognitive behavioral therapy (CBT) will decline to get it.”

The evidence supports this conclusion. According to SAMHSA’s 2025 report, only 17% of men received mental health treatment or counseling in 2024 — compared to more than 28% of women.

According to CDC data, only 13.4% of men received mental health treatment compared with 24.7% of women. Of those with a known mental illness, only 40% to 42% of men received treatment, versus 52% to 59% of women.

Nearly one in five U.S. adult men (19.7%) live with a mental illness. Yet fewer than half (41.6%) of men with any mental illness receive professional care.

The gap is not explained by men being healthier. It is explained by men staying silent — and by a profession that told them their silence was the problem, while offering no alternative that affirmed who they were.