Here is a typical situation at our practice. A colleague of mine will be working with their client on a particular issue. This could be weeks, months, or even years of work together. Over the course of that time, the client may inform their therapist that they “really wish” my husband, boyfriend, or partner would come to therapy too. The client and therapist may even discuss communication strategies on how to bring this up to their partner. My name will be mentioned. Then, after what I’m assuming is a lot of talk or debate by the client and their partner, we will receive a submission form asking for me by name.
This is how a majority of my male clients come to see me. There are a few exceptions, mind you — a husband going through a divorce, a college student’s grades are slipping, an ADHD diagnosis that they need managing, or parents referring adult male child or adolescent to the practice — but by and large the majority of men are resistant to seeking therapy. The question is, why?
Let’s go over the lowest hanging fruit answer: there is a stigma around men talking about their problems. This is definitely true. In an article published in 2019, 73% of the male sample (569 males) said that solving one’s own problems was a barrier to mental health treatment. This goes back to capability and competency. Men draw self-esteem and value from themselves and from society when they are capable and competent at solving problems. The car is broken down — I can fix it. The can of tomato soup is on the top shelf, can you get it? Sure can. Can you also open it? You bet. I joke but seriously men pride themselves on these things and when we are not able to solve problems, especially our own, there are multiple layers of shaming that occur, the first layer is with ourselves, the second is the societal layer. The most common example of this is the husband telling me his partner is asking for him to be more open and emotionally vulnerable, talk about things, but when he does, he feels that his partner does not want to listen or trivializes the issue.
Whether we are aware of it or not, society, women included, play into this belief of men as well. Even good friends I interact with have never asked if I’ve gone to therapy to talk about a said issue I’m having. I will ask them if they have for their issues and they look at me like I’ve conjured an evil spell — and I’m a clinical psychologist!
“Have you talked to someone?” It’s like muttering a curse that will doom the entire race. No man speaks it.
To add further depth here, it isn’t simply that men want to solve problems by themselves. That’s part of it, but it gets devoured by an overarching masculine identity some men adhere to in society. Stoicism. Dominance. Assertiveness — these traits are what men admire but as I’ve touched on in previous articles, they come with misconceptions and assumptions. For instance, it is assumed that practicing stoicism means I must embrace suffering in silence. I am a huge proponent of stoicism but stoicism does not advocate for the suppression of emotion. It advocates for the acceptance of suffering in our lives, unconditionally, deciding what we can and cannot control, abstaining from destructive behaviors, and living a virtuous life free from the stain of sin. That doesn’t mean we don’t have moments of vulnerability or that we can’t talk to others to abstain from destructive emotions and behaviors.
We must change how we view our masculine identity and re-frame that discussion and processing emotions is not weakness but strength. The strongest, most resilient people I know are able to sit in a room, discuss their pain, feel the breadth of it and all its horror, and let it wash over them unfettered. That’s power. That’s true dominance. Men need to practice that but before they can they need to be educated on the subject matter: masculinity and strength can come in different forms, not just silence.
But let’s divert from here, because honestly, the above issues I would say make up 1/3 of the reasons men don’t seek therapy. There are others, just as important, and I would be remiss if I didn’t address them in the same depth. One of them is the lack of public health funding, education, and awareness around seeking mental health treatment for men. We have several initiatives for women, funded through federal government, or organizations specifically dedicated to helping women manage their mental health. However, men don’t feel they are offered the same, and the data supports this. Men have reported greater distrust with the medical model of mental health care. They also believe that mental health professionals will try to take away their masculine identity or label it as a problem.
In short, there is a lack of understanding from the public health organizations about the struggles men experience and why they experience them. Who would want to seek therapy if every ad, psychoeducation resource, or “expert” got it wrong about why you were struggling? I know I wouldn’t. Yet Men complete suicide at a rate five times higher than women. This struggle isn’t difficult. It’s deadly. This disconnect reaches down to the therapists too. Many men feel that therapy is too feminine and to a point it’s true. Roughly 30% of therapists are male.
Read this from the APA:
The shift is reflected in the work force as well. Data from APA's Center for Workforce Studies show that women make up 76 percent of new psychology doctorates, 74 percent of early career psychologists and 53 percent of the psychology work force.
The phenomenon is not unique to psychology. Other fields such as law and education have seen an influx of women as well.
While psychologists applaud the gains women have made in the field over the past 30 years, some are concerned that the lack of men may have a downside.
No kidding. Ya think?
I can safely say there is a fundamental difference in how men approach therapy than women. This is coming from someone who sees both but has seen more and more men over the years. The biggest difference for me is men want solutions to problems. They want concrete ways in which they can see and apply what is discussed. There is less “feeling a moment” or “sitting with pain.” Although I ask it of them, because sometimes this is necessary for healing, they report therapy being rewarding when they can take a solution or insight with them rather than a shared emotional exchange.
I think of one particular client who says “Okay Doc, what do I do?”
I have to resist the urge to jump in with a solution and like opening a wine bottle, let the issue breathe a bit. I ask them pinpointed questions that help them discover their own solution to the problem. They often will feel a strong sense of accomplishment and capability as a result, but there are times that the most rewarding part is hearing a bit of insight that they hadn’t thought of and then learning themselves through trial and error on how to apply it.
Men also want a man who understands what they’re going through. Men look for that connection. They look for men to recognize men in their struggle because they very rarely experience such validation and connection with others. We are too often on an island alone. When a man comes to me and explains that he’s having intimacy issues and struggles with pornography, he knows I have a greater understanding of what he’s going through than a female therapist simply by being a man. There is a willingness by him to go there with me and deal with his struggles because as men we all understand the universal problems we are forced to confront day to day. Oftentimes the wives, partners, or family members do not. I can be more honest when a female therapist couldn’t.
Finally, there is the sociological piece to this. For the last ten years or so, men have been told they are a problem that needs to be dealt with rather than seeing them men who have their own pain, trauma, and grief they need to work through. In being told the problem, men isolate. They go into their rabbit holes, man caves, and dens to wash their problems away in alcohol, video games, weed, and other destructive behaviors because there is a belief — and it’s growing — they carry: no one wants to come help them. Now add that to masculine ideals and traits you want to espouse, a lack of public heath initiatives for men, assumptions health campaigns make about men’s mental health and the dismissal of their identities, and a declining group of male therapists, whaddya get? You get men refusing therapy that’s what you get.
-Dr. Moffitt