Rub Some Dirt on it: The Common Reasons for Male Resistance to Therapy

For America’s male population, the statistics are staggering as it pertains to difficulties with mental health. Approximately 1 in 5 adult men struggle with a mental illness (Substance Abuse and Mental Health Services Administration, 2024), approximately 6 million struggle with depression (Anxiety and Depression Association of America, n.d.), and an estimated 4 in 5 suicides in the United States are committed by men (Centers for Disease Control, 2024). As scary as these statistics are, it is also sad to see that less than half of men who have a mental health diagnosis seek treatment (Substance Abuse and Mental Health Services Administration, 2024). So why is this the case? In this blog we will explore three common reasons as to the resistance we see in men when it comes to seeking mental health treatment: conformity to traditional male norms, fears of judgment and vulnerability, and availability of preferred therapists. 

When we think about the emotional expectations that men take on from the beginning of their lives, there is an understanding that they will be self reliant, suppress emotion, and be problem solvers (Wong et al., 2017). So when men face significant emotional challenges, it only makes sense that their typical approach to coping with such challenges will be to bury their pain and suppress their emotions (Staiger et al., 2020). This is a heavy emotional task when this is combined with the heavy societal pressures that men also face; being financial providers, familial protectors, and chasing constant achievement. Seeking mental health treatment for these emotional challenges means that men have to challenge the long-standing expectation that they have to work out their problems on their own, thus making it difficult for them to seek out a counselor or therapist. Seeking help also requires something that many fear most of all, vulnerability.

The best results in therapy come as a result of being emotionally open with a therapist that one trusts, and in the case of relational counseling, expression of their emotional struggles and needs, allowing one to explore the source of their emotional challenges and changing their maladaptive coping skills and communication strategies. This openness and vulnerability is a direct contradiction to the typical emotional expectations that men face, therefore making it difficult for them to seek out mental health treatment (Wong et al., 2017). Many men struggle with a fear of judgment or abandonment due to childhood attachment injuries or trauma, which makes it difficult for them to be emotionally vulnerable with their partners, friends, or mental health clinicians. This fear of judgment or abandonment can be reinforced for many different reasons such as childhood bullying, abusive households, and being punished for emotional expression. In my own practice in working with individuals and couples, I have come across many who present with maladaptive communication and conflict issues due to emotional avoidance and intense withdrawal. This fear of emotional vulnerability can therefore make it difficult for many men to willingly consent to exposing their emotions to a complete stranger, like a therapist. But let’s say that a male is willing to be open with a clinician, what if they have a hard time finding the right fit?

Being a male therapist, I’ve lost count of the amount of clients that I have had that only came to therapy specifically because I was a male. It is no secret that the health care crisis in the United States makes it difficult for anyone to have access to affordable health care, let alone mental health care with the kind of  therapist one is specifically looking for. Many men are afraid of being ridiculed, marginalized, or viewed as “less of a man” by the public, their partner’s, or their families, so many find it more comfortable to find a clinician who is like them. The truth is that only 20-25% of mental health clinicians are male, so males who are looking for male therapists will generally have a hard time finding one depending on the type of care they are looking for (American Institute for Boys and Men, 2024). Having the willingness to see any clinician of any gender will obviously open up options for males seeking treatment, but those who would be more comfortable with a male therapist may have difficulties finding one, therefore being more resistant to moving forward with treatment at all.

In putting all of this together, male resistance to therapy generally tends to come from traditional male expectations, societal stigma, and access to care. As a country we need to increase awareness to the mental health struggles of men, promote emotional expression in their youth, and decrease the stigma of men in treatment. As with anyone who seeks help, the therapeutic experience for men should be one that is safe, validating, and judgment-free. If you are seeking help, there are people who want to listen; you are not alone.

By Lucas Kompare, LMFT