As more men seek therapy, intimacy, shame and career stresses emerge as key issues needing attention. Photo / 123rf
An increasing number of men are going to therapy. These are the most common topics they bring up, according to professionals.
The cliche is that women talk about life problems with each other while men suffer in silence or cover up emotions with banter.
But an increasing number of therapists say more men are opening up to professionals, wanting to feel better and make healthier choices in their lives.
I asked five therapists from Welldoing, the therapist-matching platform I founded 10 years ago, what male clients bring to the consulting room. From a range of ages, races, beliefs, sexuality and income, there are some strong trends in what pushes men into seeking help.
As one therapist told me: “Men are no less committed than female clients once they are engaged in therapy.” Indeed, many pay to talk about their lives and feelings every week for months, sometimes years.
Younger men seem to be more open about expressing emotions but, according to several of the practitioners, once those over 40 start to talk, the floodgates open. “Answering questions these men have never been asked before can be freeing and therapeutic,” another therapist tells me.
“It sets off an internal process where they open up conversations in their own relationships.”
It helps that today, in the UK, there’s less stigma around seeking help than there was five years ago. Nearly a third of adults have sought help from a counsellor or psychotherapist in the past 12 months, says the British Association for Counselling and Psychotherapy (BACP) in its most recent Public Perceptions Survey.
While the proportion of therapy clients is still weighted in favour of women, psychotherapist Simon Imrie, who sees mostly male clients in Shoreditch, London, says: “We still have a horrible situation where the majority of suicides are men under 50. Addiction services are full of men. Too many men are not coping with what is going on for them and they need to know there are alternatives to how they feel. Talking about your worries and expressing your feelings is a strength, not a weakness.”
So what brings men to the therapy room?
“There is a narrative that men are at the top of the food chain so they shouldn’t need any help and should be able to figure it out for themselves,” says Christian Chalfont, a Manchester-based therapist who sees many of his clients struggling with traditional masculine roles.
“One of the results of the pandemic was that it shone a light on men’s mental health and the long-standing belief that men should be good, strong providers, husbands and sons.” He says many of his clients have “very deeply held fears of being seen as being un-masculine, or as they see it, weak”.
Amy Jo Spitalier, a psychotherapist in London, sees mostly younger men in their 20s and 30s. She says the conversation is similar. “We are seeing men wanting to have a more equal relationship with women. Shouldering so much of the responsibility causes massive resentment in many men. Putting parts of themselves in a cupboard, locking the stuff away that might be seen as vulnerable or emotional.” She helps clients to see that “without being able to be vulnerable, a true connection is impossible”.
Both therapists said it was an enormous relief to their clients to be able to open up and speak without being seen as “toxic males”.
Jane Walmsley, who sees mostly mid-life men in relationships at her north London practice, says her clients often feel the absence of sex in their relationships. “But that is usually related to the dynamic in the relationship, so that is where the focus will usually be.”
“Sometimes the issue is much more about intimacy than sex,” says Imrie, who sees mostly men aged 25-45, middle class and usually working in creative fields such as acting and writing. “If I don’t feel like being sexual, how can I be loving? These are the kinds of subjects that can come up.
“In my experience, affairs are not actually difficult for men to talk about, because they are less exposing of vulnerability. If they were having problems with performing, that is harder. I am seeing that younger men can cope better talking about sex, whereas my generation (in their late 40s) relies on other managing strategies such as denial and avoidance of the issue, seeking comfort from other activities and self-soothing with alcohol, exercise or food. If men do talk about sex and relationships, it tends to be with women, female friends and partners, not other men.”
Psychotherapist Ayo Adesioye, who sees clients online, says: “Men have not been traditionally equipped to express emotions, unlike women. Without that outlet, you are left with guys who think they are defective human beings.” Like the other therapists I spoke to, she talks to clients about how to manage their emotions.
She has, in the past, counselled men who have been referred for treatment after their involvement in criminal acts of domestic violence. Currently, she is seeing more clients with internalised anger. “These clients are not taking their anger out on others, it’s completely projected onto themselves in the form of intense self-loathing and criticism.”
Some men start therapy only because their partners have stipulated it, or as one therapist told me, have been “wife-mandated”. Adesioye is currently seeing only men in relationships, who have all come because they believe something is going wrong. “I usually find there is an openness from the get-go, even if it’s not easy work to get them to acknowledge the defences they have put up, and how they are really feeling.”
Imrie says: “Men coming to therapy are focused on needing to improve themselves. They feel there is something they are doing wrong or struggling with and they have the desire to fix that. As therapy progresses, they realise there is nothing wrong and the results are more about acceptance and emotional expression.” All of this is reflected in how they have relationships with others, from partners to parents to children and work colleagues.
Family background may not always be the impetus for seeing a therapist but, once the subject is broached, it’s an area that sparks rich discussion. Walmsley says: “Early on in sessions, there may be more reluctance. For example, one client came along saying, ‘My wife says I have stuff from my childhood’, but didn’t really want to acknowledge that he believed it. But now, after nine months, we have found a lens that he can tolerate talking about this and how his childhood has impacted his way of being an adult.”
Spitalier is trained in listening to clients talk about their childhood. Many may not have noticed until they talk to a therapist how their upbringing affects their behaviour. “I aim to connect the past with the present, leading them to see how they may find themselves in familiar situations that don’t serve them in the present. For example, they may be with someone who resembles one of their parents, or they may keep going for someone who is not available. We talk a lot about chemistry and what they are attracted to and where that might come from.” Repeating patterns of behaviour with their children is also something brought up commonly.
Workplace dynamics and relationships are on the agenda for the high-earners and middle-aged professionals that Walmsley sees. “They want to talk about situations at work, how to navigate difficult relationships and circumstances.” Most therapy clients come to talk about anxiety or depression, or both, and work is part of where that lies.
Imrie notices that some clients say they are not progressing at work in the way they expect. “It’s easier to admit to that than really questioning expectations. A lot of men are highly aware of what their parents or partners expect of them, even if that is often not said directly to them. They worry that they are failing in some way.” Therapists use such worries as a way to talk in detail about self-esteem, family backgrounds and personal relationships.
Shame is all about secrecy, so talking openly in therapy can be liberating, says Spitalier. She gives a word of caution, though, that talking about it should be done sensitively, with the right timing. “And it should come as much as possible from them. Men can’t stand being lectured to and, as a female therapist, I have to work with that.”
Shame is hard for men to look in the face, especially with another man, Imrie says. “It’s emasculating to feel shame and anything that links to femininity remains exposing.”
Adesioye says that, since she started working more with male clients, “I have had to become better versed around shame. Much of it leads to talking about childhood and emotions that were never expressed or processed and turned into shame.”
Spitalier suggests trying to open a conversation using these guidelines:
Imrie also offers:
The scandalous true-crime murder case that shocked New Zealand.