The current article addresses gender issues that become magnified in prison settings and contribute to heightened resistance in psychotherapy and other forms of mental health treatment. Toxic masculinity involves the need to aggressively compete and dominate others and encompasses the most problematic proclivities in men. These same male proclivities foster resistance to psychotherapy. Some of the stresses and complexities of life in men's prisons are explored. The relation between hegemonic masculinity and toxic masculinity is examined. The discussion proceeds to the interplay between individual male characteristics and institutional dynamics that intensify toxic masculinity. A discussion of some structural obstacles to mental health treatment in prison and resistances on the part of prisoners is followed by some general recommendations for the therapist in this context.

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