It has been said that the hardest three words for a man to say are, “I need help.” While this remains true in many contexts, I have the privilege of working with men from diverse backgrounds, ages, cultures, and socioeconomic circumstances in my practice. I estimate that nearly one-third of my clients are men.
Still, longstanding paradigms of masculinity remain deeply rooted in both the male and cultural psyche. Many men are still taught—directly or indirectly—that their primary role is to protect, provide, and, if necessary, sacrifice themselves in fulfilling that mission. The issue is not that these are inherently unworthy pursuits, but that they are often carried out at the expense of physical health, mental health, emotional well-being, and overall quality of life.
The song “To Be A Man” by Dax speaks powerfully to the experience of many men in society. Its lyrics capture the silent pain and loneliness that men often carry stoically and without acknowledgment. One lyric states, “No wonder most men are so depressed,” pointing to the emotional cost of this way of existing in the world.
Depression is only one of many consequences. Others may include marital distress, strained relationships with children, diminished job performance, substance misuse, isolation, and emotional disconnection. Given the struggles so many men face, an important question emerges: What causes so many men to resist therapy?
Stigma – Many men have internalized the false belief that attending therapy means they are “crazy.” Another layer of stigma comes from traditional gender-role conditioning, which suggests that men should not need help and that asking for it reflects weakness. Fortunately, the stigma surrounding mental health has decreased significantly in recent decades—and we are all better for it.
Difficulty identifying or expressing emotion – Many men struggle to recognize, articulate, or tolerate emotional experiences, often because of early conditioning around masculinity. Anger is one of the few emotions men are socially permitted to express openly, at least to a point. More vulnerable emotions—such as sadness, fear, shame, guilt, or grief—are frequently suppressed and later expressed through irritability, withdrawal, or anger. Because therapy can evoke strong emotional experiences, many men enter the process with little familiarity or comfort in navigating them.
Framing – Therapy is often perceived as “sitting around talking about feelings,” a framing that does not resonate with many men. Men are often more receptive when therapy is presented in terms of performance, functioning, skill development, resilience, leadership, or improving effectiveness in life and relationships.
I often educate clients about the relationship between resistance, risk, and fear. Where there is resistance, there is risk, where there is risk, there is fear. Exploration frequently begins with a simple question: What feels risky about therapy? As awareness of those perceived risks deepens, resistance often begins to decrease. An equally important question then emerges: What are the risks of not doing therapy?
Exploring risk may not be an obvious step for a man considering therapy but most men naturally evaluate whether something is worth the investment of time, energy, vulnerability, and financial expense. The benefits of therapy generally fall into a few broad categories:
Regulation – managing stress, emotions, anger, anxiety, and nervous system overload while developing greater self-awareness, emotional control, resilience under pressure, and healthier ways of responding rather than reacting. Therapy can also help men recognize burnout, reduce emotional shutdown, and improve recovery from chronic stress.
Relationships – improving communication, boundaries, trust, and connection in relationships with partners, family, friends, and coworkers. Therapy often helps men better express emotions, navigate conflict more effectively, strengthen intimacy, and break unhealthy relational patterns that create distance or misunderstanding.
Performance and purpose – strengthening focus, resilience, leadership, discipline, and direction in life while clarifying values, goals, and personal meaning. Therapy can help men improve confidence, decision-making, adaptability, and consistency while addressing the internal obstacles that interfere with growth, motivation, and fulfillment.
Early in clinical training, therapists are taught to “begin where the client is.” For someone resistant to therapy, “I don’t want to be here” may actually be the most honest and appropriate starting point. My response is often simple: Tell me more about that.
“I think about all the men out there who feel like I do now
Who are screamin' on the inside, but won't ever make a sound”
Both men and women carry the burdens of life’s demands and its wounds. Yet, men are often conditioned to bear those burdens in silence. In the two days prior to completing this post, I heard stories of two different men who died by suicide. Both were screaming internally, yet those around them saw no obvious signs of distress.
In the context of men’s challenges and the silence that frequently surrounds them, two questions deserve thoughtful consideration:
What are you carrying that you have never said out loud?
What has that silence cost you?