Men’s mental health and seeking therapy – What’s the story from the clinical therapy room?

An interview with Dr Siobhan McCarthy, Clinical Director at– Reflections on working with men in 25 years of clinical practice.

In my work with clients over the years have I noticed a difference in the willingness of men to take up therapy or open up while in therapy? There’s lots of talk about mental health in the press, but do I think this translates to more men seeking help or opening up about issues?


There is still a predominance of women seeking therapy. Women are socialised from an earlier age to explore and communicate emotions and are much more likely to seek help and to work part-time so are more able to attend therapy sessions in the day. It is still hard for men to feel entitled to ask for extra time off work to attend therapy. In my private practice my caseload would be approximately one third men, so we still have a way to go in creating equality of access to therapies. Men’s emotional language and willingness to explore emotions has definitely increased over time, especially looking back over the last 10 years. It’s more common for men to be the main initiator for couple work, something that I feel would have been rather unusual 15 years ago.


2. What are the kinds of barriers that men in particular tend to have to overcome in order to get the most out of therapy? E.g. masculine tropes such as being stoic and strong. How present are these themes in therapy?


The first challenge is to feel legitimate in acknowledging the need for help and to access it. It is well known that men are less inclined to seek help in all areas and this includes accessing therapy. To feel vulnerable is hard for many men. It goes against the narrative of the strong male presence where they are taught to believe from a young age that they should work to solve their own problems. Overall, men may delay seeking help, often waiting until they are already experiencing considerable distress. However, getting help earlier is key to keeping psychologically healthy and robust.


3. What about men’s views on self-care?



The next barrier is feeling able to take time off work for self-care; how will their manager respond to them taking time off work to attend therapy? There’s a fear of being judged or appearing to be in need of psychological help, which can trigger inner fears of perceived inadequacy in themselves. There are also the patterns of how men are socialised and their relationship to emotions. Unfortunately, the “stiff upper lip” or “boys don’t cry” mentality is still present in our culture. We are a language-based species, which means we only really “feel” or recognise emotions through language and we need other adults to help us understand and identify our emotions. Without this, we have no way of articulating and processing emotions effectively. Coming to terms with events, oneself and one’s emotions may require getting in touch with levels of emotional pain. If a man has been socialised to suppress emotion or has a limited emotional language, it would be totally understandable that therapy might seem a challenging, painful or potentially fearful place.


3. Is there a noticeable trend in the kind of therapy that men tend to gravitate towards, or benefit most from? E.g. CBT?


It is hard to generalise, but in my experience men’s preferences tend to be towards goal-orientated therapies where structure is present such as solution-focused or CBT work. While these are very effective therapies, a more structured approach may mask a greater need, which is developing the ability to sit with emotions at a slower, more unstructured pace. Many men have been denied this experience in their upbringings. For example, if one is raised in a family where emotions were not shared, communicated or explored, how comfortable and confident are you going to be with the “feelings” of emotions such as pain, humiliation, hurt, shame, guilt and injustice? One of the great gifts of therapy is having an unstructured, safe space to explore such emotions and not just remaining at the level of logic or thoughts.


4. Are there any issues you see in your practice that aren’t talked about enough in relation to men’s mental health?


There are, I believe, wider issues of how to express and live out being a man in a society where greater equality is desired and the differences in the genders are minimised. There are genuine challenges for how men see themselves and express their strength and masculinity without fear of being misunderstood – to be comfortable, and indeed proud, of their benign masculinity and its contribution to our society. I believe there is a confusion about masculinity and whether it is welcome or not.


Similarly, the rise in family breakdown means around a quarter of families are headed by a lone female parent and there is a concern for how boys obtain appropriate, present and supportive role models and mentoring from other adult males. It is well documented that the absence of a male presence for boys is linked with anger, depression and self-esteem issues as well as a higher use of drugs and alcohol. This leaves a large proportion of our young male population easy prey to inappropriate or subversive male role models in their communities.



While issues of social and emotional isolation are an issue for both genders, I believe this is a particular risk factor for men who may work long hours, have a greater propensity to use alcohol to dull painful feelings and have an increased difficulty reaching out for help. Social isolation can put men at risk of self-harm and suicide which is the leading cause of death in men under 50, where three quarters of all suicides are from men. Sadly, 73% of people prior to suicide do not seek any professional help, with some of the factors here contributing to this situation.


5. Is there anything you would like to add on the topic of men’s mental health that you have observed or want to comment on?


Anxiety is on a significant increase in society and I am concerned about the growing pressure on men around issues concerning body image and comparisons through the use of social media platforms. TV shows such as Love Island promote idealised bodies which can undermine men’s confidence, self-esteem and promote distorted body image, which is thought to contribute to the current rise in eating disorders in boys and men. Similarly, the increasing free and easy access to pornography means men can get a distorted idea about sex and intimacy, leaving them at a disadvantage when it comes to developing healthy real relationships with partners, where men can become desensitised by what to expect from a normal sexual life which can leave men feeling inadequate and anxious in sexual areas.




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