Therapy Sucks For Men: We’re going to talk about why therapy sucks for men. And that may sound kind of confusing because here I am a man. Here I am a psychiatrist doing psychotherapy with men. So what on earth am I talking about? Why do I think therapy sucks for men? In my experience, as a psychiatrist, I do actually believe that there are systemic biases that make it hard for men to engage in therapy. And today, we’re going to talk a little bit about.
- What those systemic factors are
- How we can understand them,
- How to overcome some of those factors and move towards more emotional health.
So we have to start by understanding where this idea that talk therapy is the gold standard for treating mental illness comes from. So what we really need to understand is that the majority of patients in the history of psychotherapy had been women, about 60 to 70% of patients today, who engage in psychotherapy or women. The other thing is that about 60 70% of therapists today are actually women. So I think what happened early on in psychiatry or psychotherapy is that the majority of people we were helping were women. And so when me as a doctor, when I look at 10 of my patients, and I see, okay, so it looks like talking to people about their feelings, on average, is the most successful thing that I can do. But even though that’s factually correct, I may not be taking into account that seven out of those 10 people are women. And maybe the people who are getting helped the most with talk therapy or talking about their emotions are actually women. And it’s not just me that says this, if you actually look at the American Psychological Associations, guidance for working with boys and men, they sort of point out a systemic bias in the way that we diagnose men and women. And that’s a lot of the diagnoses that women get, like depression and anxiety, which by the way, women are about two to three times as likely to be diagnosed with that stuff. A lot of those diagnoses have to do with feelings, and being able to articulate stuff.
So for example, major depressive disorder involves feeling sad when you’re depressed, right makes sense. And that a lot of men are actually diagnosed with what we call externalizing disorders, things like addictions, or sociopathy, or antisocial personality disorder. So these are disorders that involve behaviors. So I think they’re sort of cluing us in on a really important idea, which is that when men feel something, they act on it, as opposed to articulate it or talk about it. And if we tunnel down into a little bit about how men deal with their emotions, we’ll kind of see that this is true in general as well. Because if you’re a man, an emotion is a problem to be solved, not something to be talked about. Right? So think about, like if you get bullied on the playground, and you feel ashamed of yourself, and people call you a fat kid and beat you up. That isn’t something you talk about. In fact, if you go and cry to mommy or cry to the teacher, you’re actually treated worse, you’re taught that articulating problems and talking to people is cause for punishment. Instead, what you’re supposed to do, if you’re a man is fix the problem, right? So if kids make fun of me for being fat, I’m supposed to lose weight, get ripped, learn martial arts, and the next time they talk, I am going to teach them who’s boss. So if you sort of think about it, the solution to an internal feeling feeling ashamed is to take an action and change the circumstances that make me feel that way. If I’m feeling ashamed, because I don’t have a job, and I don’t have any money. What should I do about that? Should I go cry to mommy about how I don’t have a job or don’t have money? Should I cry to my girlfriend about how I’m broke all the time? No, if you’re a man, you need a man the fuck up, go out there, get a job and start making money. If you’re feeling bad in here, as a man, what we’re taught is you’re supposed to go fix the problem out there. And this also manifests in men’s reluctance to engage in couples counseling.
So oftentimes, if you’re in a relationship, and I’m assuming a heteronormative relationship for a second, and you know, your wife or your girlfriend says, Hey, I think we need to go see a counselor, oftentimes, men will be reluctant to engage in that. And if you actually look at the research for why men are reluctant, what you discover is it’s not that they’re trying to put their head in the sand or they’re avoiding a problem or anything like that. They actually feel outgunned in therapy. They feel like when they go to a couple’s counselor, my partner is so much better at understanding and articulating their feelings, that they can sort of make their case better than I can. And when the therapist tries talking to me, like I just say, I don’t know a lot or I’m not sure like I don’t know how to someone’s asking me to I play basketball, but I don’t know how to dribble. And so what men actually feel like in couples counseling is that they don’t know how to effectively communicate.
So imagine a situation where you’re like going into a court of law and there’s a judge there and your wife makes her case, right? She says, Hey, all look is neglectful. He doesn’t appreciate me, I do so much for him. And I know he works hard, but he’s really short with me sometimes, and it really hurts and I feel really underappreciated. And then as a man, how do I respond to this? I don’t speak the language of motions. Judge Illuminati, I’m gonna, I’m gonna some journal party. I’ve been the roubo PhD, but you want to laugh O’Meara Lupo, pH upon per ci m en la for Matamata, TN and LIFO no more I know my er, but she who Tsugaru. And so as a dude, you’re like, you don’t know how to communicate in the way that therapists like. So men literally feel outgun to engage in things like couples therapy. And that’s because we as men communicate our emotions in a different way. So my favorite example of how men communicate differently is the negative expression of a positive affection.
So when we like someone, and we’re proud of one of our homies or our bros, we don’t say that to them, right? In fact, what we do is we kind of dogged them about it. If my friend has been single for a while after a bad breakup and starts dating someone else that I feel really proud and good about that. I don’t say, Hey, friend, I’m really proud of you. And I’m proud that you’ve been able to find someone who sees the lovable qualities within you that I see. I’m proud that you found someone who treats you the way that I think you deserve to be treated, who loves you for who you are in the way that I love you for who you are. In the history of humanity. I do not think that sequence of words has ever been spoken by a single man. That’s not what we say. What do we say? We say bruh GG noob. You’re whipped. I guess we’ll never see you again. And we’re smiling the whole time. We’re not like, why don’t you text me anymore? I know you haven’t been texting me. I feel hurt. Instead, what we do is we actually dog on this guy, right? We’re like, we call them wept, and we call them a wuss, and we call him like we say all these negative things, right? Like, oh, where’s the apron strings will say all this like misogynistic crap.
But the whole time we’re like expressing appreciation and smiling at him. So men have this negative expression of a positive affection. When we feel good about something. We can’t just say that right? Because that’s not what we were taught. Instead, what we have to do is we have to insult the person that we’re proud of. That’s not how psychotherapy works. Right? So this is my mode of communication. I go see my therapist, and my therapist is proud of me. They don’t say, hey, fucker, you got a job, you suck. I guess you’re not going to be coming to therapy anymore. Because you ain’t got this time because you got all this work to do. You know, screw you. That’s not what your therapist says. In fact, we’re
trained to say the opposite. So the way that we’re trained to speak in therapy is first of all, don’t speak very much, right? Don’t solve problems. Just sit there and listen, and ask this person lots of questions that they’re going to say, I don’t know, too. How do you feel about that? How does that make you feel? I don’t know. Well, how does that make you feel? I don’t know. And so then if you’re a dude, and you go to therapy, you feel like an idiot, right?
Because they’re asking you all these questions, and you’re supposed to know what you feel, but you don’t know. And that’s because of the way that we’ve been taught about our emotions. The last thing to consider is that when it comes to emotional health, men are very physical with it. So even if I ask a dude, hey, like, you know, you’re it sounds like you got dumped, tell me a little bit about how you feel the dude may not be able to say I feel unlovable. I’m full of fear that, that perhaps I won’t be able to find a partner. I’m afraid that I’m fundamentally broken in some way that precludes me and maybe destined me to be alone for the rest of my life. That’s not what dude say what dude say is it felt like she ripped my heart out. It felt like she stomped on my balls. And if you say that as a dude, the other dudes will know exactly what you mean. Right? Like, we all know, like, oh, man, like, oh, it’s not just ripped your heart out. It’s also stomp on the balls. I felt that man last time I got dumped, I found out my partner was cheating on me felt like she kicked me in the nuts. Dude, I know exactly how you feel. That’s how we talk. We’re very physical in nature. The other thing is if you talk to men about who support each other, right, and they say if you get dumped, what’s the first thing you should do? Hit the gym baby. And that’s where we may assume that they’re that this relates to confidence that if you start working out, you get off then you look at yourself in the mirror, you’re like, I’m so sick, see, but we don’t even acknowledge for a moment that there may be a physiological aspect to improve your mood. And one of the biggest mistakes that I think we’ve made in the field of psychotherapy is that we’ve separated out the mind from the body.
Whereas if you look at modern science, we know that anxiety is not just an emotion, it’s not just in your mind that emotions have physical ramifications, that anxiety can induce diarrhea and change the rate of your peristalsis anxiety activates your sympathetic nervous system and reduces blood flow to places like your stomach and increases blood flow to other parts of your body. So We know that emotions are actually very physiological in nature. So why is it as a society that we’ve kind of gotten on this track of simply talking about them instead of acting physically. And a lot of the men that I’ve worked with, I’ve sort of noticed that this physical component is way more important than the talking component, at least compared to the women that I worked with. Just to give you a simple example, I find that the men in my office need hugs way more than the women. Now, there are a lot of complications to that there’s a gender dynamic, right between me and the woman where maybe the woman doesn’t feel as comfortable to hug me, maybe I don’t feel as comfortable to hug the woman. So I’m not saying that that’s like a statement of fact. But what I’ve noticed is that like, hugging men, the patients in my office who are dudes leads to like a lot more emotional healing, and sometimes tears and all this kind of stuff. And like more dick jokes after we’re done, right, so there’s something very physical about the way that men deal with their emotions. And so if we assume all of this is true, what does this mean for you as a dude?
So I know that sounds kind of weird, but the first thing that I’d recommend is that you actually seek psychotherapy if you’re struggling in some way. And that may sound weird, because you said, Dr. Kay, there’s a stomach bias. Yeah, but it’s still the best evidence based treatment that we have for dealing with mental illness. Medication is just as good, by the way. And another thing we need to keep in mind is that there are randomized controlled trials on many types of psychotherapy, which show that they are equally effective for men and women. So it’s not like psychotherapy works. It’s just that if you’re engaging in psychotherapy, as a man, there may be a couple of things that we can arm you with, to really make that psychotherapy really worthwhile. So the first recommendation that I have is that you see at least three psychotherapist or at least you see at least three, before you give up on therapy, if you’ve loved the first one, then stick with them. And so a lot of psychotherapy is about fit. And it may just be hard to find someone who’s able to communicate with you in a way that is helpful. So a couple of things that I would recommend some language that you can use if you go to psychotherapy. So the first is just simply let your therapist know, hey, I’m not really aware of what I feel all the time. And I’m not very good at articulating my feelings. Because oftentimes therapists will say, How do you feel?
And as dudes, we don’t know how to answer that. So just be transparent with them at the beginning. Another thing that I’d recommend is that y’all check out this idea of normative male alexithymia, which is this idea that men are, by default, its normative. So it’s like most men are colorblind to their internal emotional state. So check out our video on alexithymia if y’all want to. And then you can even tell your your therapist that, hey, I’m concerned that I’m a little bit alexithymia. So you’re signaling to them that you may not be able to participate in therapy in a default way. The next thing that you can do is ask your therapist to change their style a little bit if it isn’t working for you. So you can tell them, Hey, I’ve noticed that you’re really quiet. And then you kind of ask these questions like, How do you feel over and over and over again? And then I keep answering? I don’t know, can you try to be a little bit more active or offer a little bit more guidance? Instead of being quieter? And asking only open ended questions? Can you help me understand suffer guide me in some way. And some therapists may feel really uncomfortable with that, they may turn that around into a question, why do you feel like you need more guidance?
I don’t know. Because this doesn’t seem to be helping very much. So you can just ask them to change their style a little bit. And the third thing that you can do if number one, and number two don’t work, is after two or three sessions, I would just go to them and say, Hey, I don’t feel like I’m actually getting a whole lot out of this therapy. So you seem to be asking certain questions that I have difficulty answering. And I’m hoping that you can recommend a different therapist who’s a little bit more active can offer a little bit more guidance or asks questions in a way that can help me understand my emotions better. And I know that this sounds mortifying, oh, my God. As a dude, why would I ever do that? As anyone has any patient? Why would I ask to see a different therapist, it means that I don’t think they’re good. And it doesn’t mean that they’re not good. It just means that they’re not really helping you very much. Or at the minimum, you can have a conversation about what’s working and what isn’t. And then hopefully, you all can work through that stuff. So I as a therapist, actually don’t feel I mean, I feel bad in some ways. But I’m really grateful for all of my patients who have come to me and say, Hey, Dr. Kay, this is not working. Because then one of two things happen.
One is either we work on it, and then we actually make a breakthrough of some kind. And now we’re really jiving together. Or I recommend that the person go see someone else. And what’s my duty as a doctor or someone’s duty as a therapist, it’s to help the person not help the person myself. It means giving that person whatever kind of help they need. So oddly enough, I’m still recommending that you’ll try psychotherapy, because it is still an evidence based, very effective approach. The other thing to consider though, is that a lot of emotions live in our body. And as men, sometimes we need to do more bodily stuff. So there are studies that show that Tai Chi and yoga for example, are a factor of treatments for a lot of things like mood disorders or anxiety or things like that. So adding a physical component to your emotional health is very, very helpful. The other thing to consider is that there’s a range of new and kind of invoke things called somatic therapies. So these are therapies that incorporate the body in some way. So good examples of this are EMDR, or EFT, which is the emotional freeing technique or tapping. So when I first encountered these studies about 10, or 15 years ago, and I used to sort of my area of interest was evidence based complementary alternative medicine. I thought all this stuff was like kind of BS, right? So it’s like, the idea behind tapping is that your emotions are stored in your body, and that you can tap on certain parts to free emotions. And I was like, This doesn’t make any sense. It’s all BS. And it turns out that over the last decade or so there have been some studies that actually show that this is a pretty effective technique, we’re not really 100% Sure, you know that the studies aren’t super high quality.
But there’s more and more evidence that stuff that is not classically effective, may be effective, and specifically that a lot of somatic therapies seem to be gaining a lot of weight and gaining a lot of interest. So I encourage you all to seek out more bodily oriented kind of evidence based techniques. And the last thing that I just want to share with you all is that I’ve seen that across the globe, there’s a lot more men’s work kind of going on. And this isn’t psychotherapy, but it’s just sort of groups of men will get together and will participate in all kinds of either communication, or even like some sorts of like physical rituals or like taking hikes. But there’s sort of this very, like physical component to their emotional health, which they all sort of get together and do. So I can’t speak to specific things like that. I’m just sort of pointing that out as a trend. So at the end of the day, I know it sounds kind of weird, but I do think that therapy sucks for men for a lot of reasons. Some of that has to do with the way that we’re raised, some of that has to do with the way that psychotherapy was developed. And so as men, we sort of really need to think a little bit about how can I become emotionally healthy. So I definitely give therapy a shot, but go in with some of these disclaimers in mind going understanding that you may not be perfectly suited to this, that you’re stepping onto the basketball court, but you don’t necessarily know how to dribble. And so just recognize that and ask your therapist for help. And the second thing to consider is that especially as men, a lot of our emotions live in our bodies, we may need to leverage our bodies or do some kind of bodily work to really help us achieve emotional health.
This Article Credit: Dr. K’s Guide
