Rethinking Men and Therapy

By: Joseph Lowe

For as long as I’ve been aware of clinical counseling services, I’ve heard the same mantra regarding men and counseling: “Men don’t seek out counseling as much as they should be.” By looking at the numbers, the concerned masses are not too far off base. Women are much more likely to seek a mental health professional than men with one in four seeking treatment in 2019 compared to just 13.4% of men. Even as I sought out therapy myself, I was praised by my peers for overcoming stigma and putting my mental health at the forefront. As I’ve pursued my therapy career and worked with men though, I’ve slowly begun to believe that perhaps we should revisit the men and therapy conversation.

Men Do Go to Therapy

It should come as no surprise that in 2020, during the COVID-19 pandemic, the global and national use of counseling services increased astronomically. According to a JAMA Health Forum study on insurance claims, the utilization of counseling services and spending on said counseling services increased by roughly 40% and 54% respectively. No big news there – unless you look exclusively at gender-based data comparatively up to September 2020.

By September 2020, the rate of men seeking mental health services increased by 5.5 times over the past year. At that time, men actively tapped counseling services at an even higher rate than women, which as far as I know could be first. The reasoning behind this can be attributed to a number of factors, including job loss/uncertainty, changes in family dynamics, high depression and suicide rates among males or overall health concerns, but the headline is that men – who often are coined as counseling skeptics or unwilling to seek counseling help – actually did just that.

So why am I bringing this up? I bring these statistics up to question how we’re analyzing the men not seeking therapy problem. Perhaps it’s only partly accurate. Commonly cited reasons that men do not go to counseling are social stigma, masculinity gender norms and expectations to be strong and self-sufficient. This isn’t necessarily wrong. Young men are often praised for pushing the limits or breaking the rules. According to an entry in the American Journal of Health, “Toxic masculinity is the demonstration of masculinities that are enforced by restriction in behaviors (e.g, crying, fear) based on gender roles that amplify existing power structures that favor the dominance of men (Chatmon, 2020). This repression of crying or expressing fear is often cited as a reason for men avoiding therapy rooms in which emotional expression is encouraged. However, there are other potential barriers for men seeking therapy that simply don’t get warranted attention.

My Introductory Therapy Experience

Around sophomore year of my undergraduate education, I began experiencing strong feelings of depression, hopelessness and isolation. These feelings weren’t particularly novel concepts for me, but the intensity was getting difficult to bear and I sought out a therapist through my college counseling center. I approached the admin desk of the counseling center, requested an appointment and was seen within the week. To my surprise, the scheduling process felt relatively easy. What I didn’t foresee was my apprehension to attend the appointment to begin with. A few questions that came to mind were:

Will I click well with my therapist?
Will my therapist understand my specific identity concerns or will I have to explain them all the time?
Will my therapist recommend I see a psychiatrist?
What if my therapist tries some interventions I feel uncomfortable with?
What if my peers see me walk into the therapy office?

When I attended my appointment, I sat across an adult cisgender Black man within a well decorated office complete with cultural statues and African wall art. At the time, my primary concerns revolved around my unique identity, so I found these shared identifiers as ideal. Furthermore, after speaking with him at length during our first session about our life experiences, we had a number of similarities even across spiritual and educational views. While complex, the idea of ethnic, cultural or racial matching of counselors and clients has paralleled positive effects for clients, though this heavily varies from client to client. He congratulated me for exploring my identity – pushing against the grain of gender therapy stigma – and discussed his own pathway to counseling despite strong cultural pushback from his family and male peers. We enjoyed a lengthy counseling session, I expressed my thanks for his time, and we went our separate ways. I scheduled another appointment with him. Then I never stepped foot in his office again.

Alternative Reasons Men Don’t Seek Therapy

Alright Joe – what was the hold up? The boxes were checked. Identity concerns – check. Shared identities – check. Comfort levels – check. Super easy scheduling process – check. Well, during the session, the therapist utilized his time mostly speaking about his own therapeutic experience rather than focusing on any of my primary concerns. I realize how paradoxical that might sound as I discuss my own therapy concerns and how they might coincide with other men’s concerns, but bear with me here.

Furthermore, in his comparison of our experiences, it felt as if his discussion around his similar concerns downplayed the severity of my own needs at that point. Leaving that office I felt heard but unhelped, so I decided to take a different approach. I scheduled an appointment with a woman who had no shared identifiers with me and significantly less experience than my initial therapist. She – then an intern – ended up being my therapist for the next two years because rather than comparing her own experience, she gave me the space to review my own. She was the right fit.

Finding the Right Fit: The therapeutic alliance (aka the therapeutic relationship) between clients and counselors are often cited as one of the most salient reasons for success in therapy. The only problem is that it’s not easy to find the right therapist right away. Do a simple Google search, and you’ll find dozens of Quora and Reddit pages dedicated to finding the right therapist and understanding how many therapists is too many to see before finding the right one. Throw in insurance needs, lack of knowledge on specific therapy approaches, traveling distance and a busy schedule, and it’s no wonder some men may avoid exploring therapy altogether.

Lack of Health Focus Across the Board: According to the Census Bureau, women take into account their health more seriously than men across the board – visiting a doctor for their annual checkup 78% and 67% respectively. The U.S. Department of Health & Human Services stated when data was recorded that men were 24% less likely than women to have visited a doctor in the past year. While mental health deserves to be prioritized among any gender, it would seem that men are more likely to neglect any aspect of health regardless of its specialty. Certainly, this was the case for myself.

How Can Men Find the Right Fit

If you’re a man looking for a therapist, we’re happy to hear it! Finding the right fit isn’t always an easy process, but it starts with a little extra effort.

Think & Research: A really good place to start researching is exactly where you are right now. Understanding what therapist is ideal for you starts by simply envisioning who you’d like to work with and writing those attributes down. Is the therapist around your age or someone that has experienced more life? Do you want your therapist to have the same cultural background as you do? Is there a specific intervention expertise level or therapeutic approach you’re hoping to utilize? Can you only meet your therapist online or in person – maybe both? Once you narrow down what your ideal counselor is, you start to create lists of potential therapists to test your hypothesis.

Interview: Several therapists offer clients a 15-minute introductory session at a discounted rate or free of charge so both parties can ask questions and understand therapeutic goals going forward. Create a list of questions you have for your therapist interviews, and don’t be afraid to ask some heavy-hitters. Ultimately, therapy is about you – the client – so ensuring your needs are met is paramount, and only you know those needs.

Ask Your Peers: Do your friends or family members go to therapy? While it might be ideal to find a therapist that is distant from your personal group, asking your peers about previous therapy experiences or specific therapists they’ve seen might allow you to find a therapist that you vibe well with quickly. Note: This will most likely only work out if you vibe well with the recommender!

Lastly, if you’re a friend of a man that is skeptical of therapeutic services and needs it, perhaps a good approach is simply asking him what their hangup with therapy is? Far too often, we default to previous notions on the reasons men avoid therapy without really asking about specific disqualifiers. If there is anything that therapy has taught me as an individual and a therapist, it’s that everyone’s experience and concerns are especially unique. Throwing all men into the social stigma and emotionally unaware bucket might be easy, but it’s not always accurate.