A stubborn stereotype haunts discussions of men’s mental health, and particularly men’s disproportionate rates of suicide. It is the idea that men aren’t seeking help. This assumption permeates culture, as the silent stoic archetype of masculinity remains venerated and mental health care is considered a feminized space, at odds with an invulnerable standard.

It took Tony Soprano sitting down in the therapy chair to highlight to many that men can and do belong there. Over the past two decades we’ve seen considerable effort focused on increasing men’s help-seeking behavior, with investment in research and public health campaigns encouraging men to reach out and share the load. Progress has been made here. While still a minority, more men than ever are reaching out for mental health support and are often enthusiastic about doing so.

Therapy is not welcoming enough to men

The focus on getting men through the therapy door has led to a neglect of what happens once they get there. When we have a mental health system that has been historically under-catering to a male demographic, it follows that without a reorientation and sensitization to the needs of this group, it just might fail to meet men’s needs.

The fact that our team at Movember has conducted some of the only research exploring what is happening for guys in therapy is worrying. It speaks to the strength of sentiment reflected in the literature framing men as “bad patients”, with poor outcomes in care placed on the shoulders of men and boys for being emotionally avoidant and not being willing and able therapy participants.

We cannot create campaign after campaign telling men to open up, be more vulnerable and reach out, if we are not creating an environment that is truly ready to listen to men’s distress. In a survey of over 2,000 men, 45% said they had prematurely dropped out of therapy without telling their practitioner. And 27% accessed therapy just once, and never returned. When that many men are talking with their feet, it’s important we don’t blame them, but that we listen. Continuing to blame men for not fitting into a mental health system that has fundamentally not been designed with their needs in mind will not solve the problem.

Change therapy, not men

We also asked men why they dropped out of therapy. Dominant myths would suggest men do so because of stigma, cost, discomfort or inconvenience. These reasons did appear in our data. Yet most striking was that 55% of those that dropped out, did so because they experienced a lack of connection with their therapist. This presents an untapped opportunity for intervention. Therapy is not meeting men where they’re at, so it’s time we create a system that responds to their unique needs and experiences. Rather than continuing to focus on how to change men to fit therapy, let’s change therapy to fit men.

Encouragingly, the pendulum is now swinging towards understanding how practitioners are responding to men in the room and their capacity to enact truly engaging, gender-responsive treatment. Therapists often have a short but critical window to engage men, reinforcing the need for timely and targeted engagement and connection with male clients.

When we followed up with a study of over 400 therapists working with men, the extent of many therapists’ shortfalls regarding working with men became clear. A central theme therapists communicated was that men are “ill-equipped for therapy”, that they are “not psychologically minded” and that there is no “no teachability in some young men.” This came from therapists of all ages and genders.

This deficit-based mentality, writ large across a group of practicing therapists, in addition to a lack of confidence in detecting illness and responding to men’s needs more broadly, spoke to the reality of what expectations, attitudes and biases men were facing when they entered the therapy room.

A deep dive into the curricula and training offerings on men’s mental health and suicide for these therapists, whether in grad school or as continuing professional education, explained our findings. There was nothing out there that moved beyond broad sweeping generalizations and delved into the messiness of manhood, how masculinities can interact with distress and suicidality, why depression might manifest in unique ways for men and how to effectively motivate and communicate with men in treatment.

Recent scholarship has shown that if men are to be given the best chance of benefiting from therapy, finding ways to broadly upskill practitioners working with men is of utmost importance. Without appropriate awareness and training, therapists will continue to be unaware of their beliefs and biases about men’s mental health and be complicit in perpetuating rigid and unhelpful stereotypes about male emotionality or help-seeking.

Helping therapists help men

Importantly, however, therapists’ expectations, attitudes and self-efficacy are readily amenable to intervention.

That’s why we created Men in Mind, the world’s first evidence-based training program upskilling therapists on how to engage men in therapy. The overarching aim of the program was to develop a standalone, online training for therapists to develop gender competency in male therapeutic engagement, and male-specific adaptations to therapy. The end goal was to ensure practitioners could improve their engagement with men while also raising practitioners’ awareness of any biases or stereotyped expectations of men’s preferences for, or likelihood of engaging in therapy.

Importantly, this training was developed through a strength-based lens, seeking to offer practitioners a perspective of men’s mental health that reinforces men’s capacity over deficiency and promotes opportunities for connection over rupture. Practitioners were provided with an educational deep dive into the psychology of men and masculinities, how men’s mental health can manifest in therapy, and most critically, evidence-based strategies for engaging and retaining male clients in care.

What we’ve shown is that Men in Mind is effective at improving therapists’ self-efficacy to engage men. Across a pilot study of 158 practitioners, and a subsequent randomized-controlled trial of 587 practitioners, we found the training significantly increased the competence and confidence of participants to work with men, an effect which held at 3-month follow up.

At the same time, we realized this is a wicked challenge with no single solution, so we also need to upskill men about what therapy really is, and what it can be. We want men to be met by a therapist that can effectively engage them. But it is equally important that men enter the room open to the experience they’re about to receive. So we did what we do best at Movember: created a series of videos demystifying the process, called ‘What is Therapy?’, trying to speak to men in ways they understand and trust. The first clip is titled: “Therapy: It’s F*cking Excellent.”

This is early work in a growing field. Working with boys’ and men’s mental health is often considered a specialization, despite them making up half of our population. What is clearly needed is wider uptake and acknowledgement of the need to adapt our mental health system, our messaging and communication and importantly modes of therapeutic engagement, with men in mind.

Dr Zac Seidler

Dr Zac Seidler is a clinical psychologist, researcher and leading men’s mental health expert. He currently holds dual roles as Global Director of Men’s Health Research at Movember and Senior Research Fellow with Orygen at the University of Melbourne. He is a member of AIBM's Advisory Council.