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Men's Mental Health: Reflections From The Therapy Room
- Juandri Buitendag
- Jun 12
- 9 min read
I find it incredibly difficult to write about men's mental health as a woman and a feminist therapist.
Not because I don't care about it. Quite the opposite.
I care enough to know how important it is to get right.
Conversations about mental health can sometimes feel a little like trying to poke a very large elephant with a very small stick and hoping it moves. Men's mental health feels particularly like that. The more I sit with it, the more I realise how much complexity lives inside it.
I also know that writing about men's mental health isn't the same thing as saying other groups do not also struggle. Multiple truths can exist at the same time. People struggle in different ways, and for different reasons. Acknowledging that men face unique barriers to recognising, expressing, and seeking support for their mental health does not diminish anybody else's experience. It simply allows us to look directly at a problem that continues to exist. This is simply one conversation about one group of people that I spend a lot of time working with.
In fact, the majority of clients I see in private practice are men.
That often surprises people.
After all, we hear repeatedly that men are less likely to seek support for their mental health. The statistics tell us that's true. Men are less likely to access psychological therapies, less likely to talk openly about emotional difficulties, and far more likely to die by suicide.
But sitting across from the men who do make it into therapy has taught me a few things.
The men who find their way into therapy are still a relatively small proportion of the men who are struggling. They are the ones who have made it through multiple barriers to arrive in the room.
And in working with them, I have noticed some patterns.
Not universal truths.
Just observations from the therapy room that I find myself returning to again and again.
1. Men Often Arrive at Therapy Differently
One of the first things I have noticed is that men often arrive at therapy differently.
Research suggests that men are more likely to speak about difficult emotions with women than with other men. As a female therapist, I find myself thinking about that often.
I don't know exactly what to make of it.
Perhaps many boys first learn to bring difficult feelings to their mothers, and later in life, to a partner. Perhaps women are perceived as safer recipients of emotional vulnerability. Perhaps women are simply given more opportunities throughout their lives to practise talking about emotions.
Women often seem to arrive at therapy with a baseline familiarity with emotional language. Not necessarily a greater understanding of themselves, but a greater familiarity with identifying and talking about feelings in the first place.
Many of the men I work with arrive with what I call "thinking words."
They tell me what happened.
They explain the facts.
They analyse the situation.
They rationalise.
But often, when I ask how they felt, there is a pause. Not because they don't have feelings about what happened. But perhaps because they have had fewer opportunities to practise noticing, naming, and expressing them.
Sometimes I wonder whether emotional literacy is a little like any other skill. The more opportunities we have to practise it, the more natural it becomes.
For some men, therapy can also feel like a challenge to identity.
As though needing support somehow means they have failed to cope, failed to manage, or failed to be enough.
I often find that by the time men arrive in therapy, they have already spent a very long time trying to carry things on their own.
2. Many Men Seek Therapy After a Crisis
It means that men rarely arrive at therapy at the first sign of distress.
More often they arrive after a crisis. After a relationship breakdown. After burnout. After years of carrying something alone.
Or, more commonly - after every conceivable medical test has ruled out a physical explanation for symptoms that are, ultimately, psychological.
This pattern has always fascinated me.
It often feels as though many men have learnt to endure, manage, and push through for as long as possible before reaching out for support. Especially those who perhaps do not have the fortune of having a mother or partner that they are able to speak to about their experiences (even if it's not emotional talk).
I think this is partly why the statistics around help-seeking behaviours in men continue to interest me. It isn't simply that men don't struggle. We know they do.
It is that many men seem to spend an extraordinary amount of time trying to cope alone before seeking support. The men who arrive in therapy are often not arriving because they noticed the first signs of difficulty.
They do not proactively seek help. They retroactively or reactively seek help.
They are arriving because something eventually became impossible to ignore.
And that, perhaps, is what I find myself wondering about most.
How many men are carrying things long before anybody else realises they are struggling - including themselves?
3. Men's Bodies Speak Before Their Emotions Do
One of the things I have noticed is that many men's mental health challenges seem to show up in the body before they show up in words.
Story time.
As someone who likes to think of herself as emotionally reflective (and let's be honest, professionally trained to be emotionally reflective), I can usually recognise when my uneasy stomach is anxiety rather than bad food.
Not long ago, my partner had a particularly big important day ahead of him.
II made him a nice breakfast, which he completely out of character barely touched.
Instead, whilst staring at his very full plate, he announced:
"Oh, my stomach is a bit sore. I think I ate something weird."
We spoke about it for a while, trying to figure out what it could possibly have been, seeing as we had both eaten exactly the same things.
Eventually, I had to admit to him (as a partner, not a therapist) that it sounded a lot like he might be anxious about the day ahead.
His predictable reaction was that it couldn't possibly be that and that he genuinely felt sick in his stomach.
(Cue all the women reading this rolling their eyes whilst thinking about partners, brothers, fathers, sons, or friends who have said exactly the same thing.)
It got me thinking about how physical experiences often seem more acceptable than emotional ones. I have often wondered whether physical symptoms simply feel safer for men to talk about. Perhaps because of stigma. Perhaps because of the pressure to be strong, capable, or put together. Perhaps because talking about a sore stomach feels easier than talking about fear, loneliness, stress, or overwhelm.
Perhaps the body becomes a messenger for feelings that have not yet found words, or have never had the opportunity to learn the skill of naming them. Many men are more likely to describe fatigue, headaches, stomach issues, disrupted sleep, chest tightness, or a sense that something just doesn't feel right physically before they identify (if at all) anxiety, sadness, grief, or overwhelm.
Cue another story.
I had a male client I think about fondly who arrived at therapy almost a year after going through a crisis. When he first came in, he explained that he was really only there to tick a box because he had "tried everything else already."
What was everything else, you ask?
Medical tests.
Lots of medical tests.
He had been suffering from severe chest pains, headaches, poor sleep, and a whole range of physical symptoms that understandably sent him to the doctor. After almost a year of investigations and every conceivable medical test coming back clear, his doctor (female, may I add) gently suggested that perhaps this was more psychological than he realised.
So yes, technically he was sitting in therapy.
But he didn't genuinely believe he needed to be there.
Which leaves me wondering whether there is also a whole population of men who aren't represented in the statistics because they don't even realise they are struggling with their mental health in the first place. Never mind the men who know they are struggling and are too frightened to seek help.
Spoiler alert: it was psychological.
And the last time I heard, he was doing really well and no longer experiencing the physical symptoms that had brought him into therapy in the first place.
4. Men Find It Easier to Recognise Anger Than Vulnerability
What do I mean when I say anger or "bad" emotions?
Well, if you have never seen an emotion wheel before, please go and have a look (https://feelingswheel.com). It is one of those things I find myself referring to all the time in therapy.
What I mean is that when men do begin talking about emotions, many seem to find it easier to recognise emotions that sit under anger - frustration, irritation, resentment, annoyance, or anger itself - than emotions like fear, loneliness, sadness, shame, or vulnerability.
Not because those emotions aren't there. But perhaps because they have had less opportunity to practise recognising them, naming them, or using them to explain their experiences.
It is often easier to say:
"That is so annoying."
Or:
"I'm just tired."
Than it is to say:
"I'm scared."
Or:
"I'm feeling overwhelmed and out of control."
And to be fair, if we think about the messages many men receive growing up, that makes a lot of sense to me.
Anger is often seen as acceptable.
Vulnerability is often not.
Perhaps recognising and naming emotions is a skill, and like any skill, it requires practice.
I sometimes wonder whether, collectively, we have simply not given men enough opportunities to develop that skill.
(Big elephant. Small stick. Remember?)
5. Men Want Doing Words, Not Just Emotion Words
I have also noticed that many men seem to want something slightly different from therapy than we might traditionally imagine.
The stereotype of therapy is often two people sitting in a room talking endlessly about feelings. Whilst feelings matter, many of the men I work with seem to value something more active alongside that.
They want to understand what is happening, but they also want to know what they can do about it. They often appreciate practical tools, clear direction, goals, and a sense of movement. Not because they are avoiding emotions, but because action can help them feel capable, engaged, and connected to the process.
Understanding matters.
But so does momentum.
And if I am honest, this can sometimes create what Leslie Knope from Parks and Recreation would refer to as a bit of a "poo tornado."
Part of the challenge is that many men want to move on from emotions through action.
A major part of therapy is often asking people to stay with the emotion long enough to understand it first.
(I love my job. I love my job. I love my job.)
So it can be a bit of a journey therapeutically.
The men I work with often teach me that therapy doesn't always have to look the way we imagine it should look.
Sometimes it looks like insight.
Sometimes it looks like action.
Most often, it looks like both.
So...
I guess the major thing I've learnt is this:
Behind the silence, the frustration, the self-reliance, and sometimes even the resistance, there is often someone longing for exactly the same things as the rest of us:
to be heard.
to be seen.
to be understood.
to be comforted.
to be reassured.
Perhaps that isn't a male thing at all.
Perhaps that is simply a human thing.
Further Reading
If this topic has sparked your interest, or perhaps made you reflect on your own experiences, here are a few places you might find useful:
The Mental Health FoundationA wealth of information on men's mental health, help-seeking behaviours, and the statistics referenced throughout this article.
The Movember FoundationResearch, campaigns, and resources specifically focused on men's mental health and suicide prevention.
The Emotion WheelA surprisingly useful tool for anyone who has ever found themselves saying "I don't know what I'm feeling."
Andy's Man ClubA UK-based peer support organisation creating spaces for men to talk openly about mental health.
CALM (Campaign Against Living Miserably)Support, information, and resources aimed at preventing male suicide and challenging stigma around mental health.
Books Worth Reading
The Will to Change: Men, Masculinity, and Love by Bell Hooks
One of the most thoughtful books I have read on the emotional lives of men. Hooks explores the ways boys are socialised, the costs of emotional suppression, and what becomes possible when men are given permission to connect more deeply with themselves and others.
I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression by Terrence Real
A fascinating look at how depression often presents differently in men. Real explores the ways emotional distress can show up through anger, work, withdrawal, substance use, and other behaviours that are not always recognised as depression.
You may also find my recommended reading list helpful.
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