Tuesday October 6, 2026
Men underuse therapy. In several years of private practice, I can count on one hand the number of men who have come to see me, and that isn’t unusual. The numbers are lopsided everywhere.
The standard explanation is that men are avoidant, emotionally shut down, afraid of asking for help. But there is another possibility: the prevailing discourse about men and mental health arrives with a picture of what a man should be, and men notice. It says your masculinity has the wrong shape and tells you the shape it should have. That is not a therapeutic stance. That is a prescription, delivered before anyone has listened.
The Prescription
The instructions are familiar: be vulnerable, open up, talk about your feelings. Each one states who the man should become, before anyone has met him.
Therapy starts from the person. It listens for what is actually there. Deciding in advance what the patient needs to become is not therapy. It is something else wearing a therapeutic face.
Consider the demand that men need to cultivate “vulnerability.” In an everyday context, “vulnerable” plainly means “easy to hurt, damage, or attack.” In every other context than therapy, this is a liability, something you try to reduce, not cultivate. If what is meant is trust, say trust. If what is meant is openness, say openness. Both are earned, not given on demand. Redefining “vulnerability” as a virtue doesn’t change what the word means. It just hides the actual nature of the demand.
“Toxic masculinity” is the same move in diagnostic form: a verdict on a category, reached before meeting the individual. It tells a man that something about what he is, is poisonous. Whatever clinical intention may lie behind it, what the man hears is: you are the problem. It is not surprising that he doesn’t come back.
The Unasked Question: Is Anyone Listening?
The discourse is entirely about what men should say and do. It has almost nothing to say about what happens when they actually suffer.
A few years ago, I went looking for clinical literature on men and child loss. I wanted to understand how men grieve the death of a child, a miscarriage, infertility. Against a large body of research on child loss overall, I found almost nothing on how men experience it.
The fact is worth sitting with. Men are told to talk, by a field that has not studied how they grieve, or what they say when they do.
Feeling Isn’t the Issue
Men have always felt deeply. Male Romantics built entire artistic traditions around the conviction that emotional life is the centre of human experience. This is not new, and it was never in doubt.
There is more than one way of being in contact with your own emotional life, and more than one way of expressing it. Some men talk readily, in their own register: directly, practically, with humour, about what happened more than about how it felt. Some work things through in action, or by making something. Some need time alone with it first. None of these is inherently avoidant. Apparently fluent talk about feelings can itself be a way of avoiding them. The issue is whether the person is in contact with what he feels, not whether he expresses it in a way of which his therapist approves.
What a Non-Normative Stance Looks Like
There is no template for what emotional health should look like from the outside. An unexpected form of expression should not be read as resistance. Words like “avoidant” and “alexithymic” should not be used as clinical shorthand for “not doing it the way the therapist expects you to.”
There is no special therapy for men. Therapy for men is not a new program or a masculine rebrand. It is the stance owed to any patient: meet the person who is actually in front of you, rather than measuring him against a model he never agreed to.
And there is no replacement norm. I am not arguing that men should be stoic, or tough, or silent, or anything else. I am arguing that the therapist’s job is to find out who this person is, and who he can become.
The work is listening for the shape the person already has and the one into which he could grow in future, not forcing him into one that was never made for him in the first place.
Related: What People Get Wrong About “Processing” Their Emotions · When Therapy Doesn’t Work · Therapy for People Who Hate Therapy
If this way of thinking resonates, I invite you to get in touch.