A note about men and therapy: While there is a wide range of differences among any group of people, traditionally men have been less likely than women to seek out psychotherapy. This is usually attributed to men’s upbringing emphasizing the need to be strong, self-sufficient, and keep emotions in check.

My practice has always included a large proportion of men, straight and gay, which is likely due not only to the city in which I have worked, but also to my appreciation of men’s evolutionary biological makeup, as well as their traditional upbringing, and my efforts to understand the psychological pressures and coping challenges they face. They have taught me about the stress that comes from their need for achievement and support for their families; from their competition with each other; from their bewilderment about women; from the expectations or neglect of their fathers; and from their devotion and anxiety as fathers themselves.

These issues have been compounded by a current culture which often demeans and rejects masculinity, elevates femininity as moral and masculinity as immoral, and increasingly demands not just equal but preferential treatment for women, especially in the workplace. Men today face hostility and shaming and, in some contexts, discrimination just for being men.

When men are stressed, they do not tend to reach out for support as women typically do. They tend to withdraw, isolate, pull themselves together, minimizing and suppressing distressing emotions in order to continue to function. Sometimes, they are able to release tension through physical action–exercise, and sex. Unfortunately, however, for both behavioral and biological reasons, men are much more likely than women to suffer from stress-related maladaptive behaviors, like substance abuse, and stress-related illness, like high blood pressure and heart disease.

So for men, learning to be more aware of their stress is important. Therapy is most useful in helping understand, reduce and manage stress in healthy ways. Therapy is most accessible and acceptable when it provides understanding and respect for strengths; treats anxiety, is attentive to symptoms of depression; offers positive and specific ways to deal with relationship problems; helps sort out confusions about the meaning of masculinity today; and supports clarification of challenges, values, and goals. Men will seek therapy when it is clear that it does not undermine but supports greater self-sufficiency, efficacy, and emotional stability.