Most men do not arrive in therapy because they want to. They arrive because something has stopped working: the drinking that used to manage the stress no longer manages it, the marriage has reached an ultimatum, the success that was supposed to feel like something feels like nothing. If that is roughly where you are, you are in the right place, and you are not late. You are exactly on time.
Why men come, and why they wait
Men are trained from boyhood to treat need as weakness. Big boys don’t cry, sort it out yourself, don’t be a burden. The training works: men wait years longer than women to seek help, and they pay for the delay in addictions, in blown-up relationships, in bodies that break down carrying what was never spoken. In my consulting room the sentence I hear most often from men in a first session is some version of: I should be able to handle this myself.
Here is what twenty-five years of practice have taught me about that sentence: the men who come are not the weak ones. Walking into a therapist’s office against your entire upbringing takes more nerve than staying home with the whisky. The strongest thing in the room is the decision to be there.
What we actually work on
Men bring particular material, and it deserves a therapist who knows the territory. The anger that guards every other feeling. The father who was absent, or present and silent, and the hole either one leaves. The pressure to provide and perform that makes rest feel like theft. The addictions that are really anaesthesia: alcohol, cocaine, work, pornography, the phone. The affairs that are really a question badly asked. The retirement or redundancy that takes not just the income but the identity.
The work is confidential, direct, and practical. I am not a therapist who only nods. Men generally do better with an active interlocutor: someone who says what he sees, holds the line, and treats the work like work. And some men specifically look for a male therapist; the preference is legitimate, because some material comes out more easily man to man.
The father in the room
Most of what I have written academically concerns fathers and sons, and it is the part of this work I know best.
A man arrives talking about his drinking, or his marriage, or the job he cannot leave, and somewhere in the third or fourth session a father appears. Usually he appears as an absence. He was away, he was quiet, he was behind a newspaper, he was a man you could be in a room with for an hour without anything being said.
What I found in my doctoral research, and keep finding in the consulting room, is that the father who is minimised is the father who dominates. A man who says his father was not really a factor is often describing the single largest factor in how he now works. The absence is not nothing. It is a shape, and sons grow around it.
This matters practically rather than sentimentally. A man who was never shown what to do with difficulty by someone he could watch tends to improvise, and the improvisation is usually silence followed by something that takes the edge off. That is not a character flaw. It is a gap in what was modelled, and gaps can be filled later, which is a good deal of what happens here.
When the body carries what was not said
Men somatise. The thing that cannot be spoken turns up in the body, in the training, in what is eaten or not eaten, in how the day is controlled.
Male eating disorders are the clearest case, and they are missed constantly. Men present later, are diagnosed less often, and are frequently told by professionals that this is not something that happens to them. My doctorate was on this specifically, and the figures are set out with their sources on male eating disorders in the UK.
But it is not only eating. It is the gym that has stopped being exercise, the discipline that has stopped being a choice, the body treated as something to be managed rather than lived in. The jail of discipline is about that, written from inside the consulting room.
Reading before you decide
If you would rather read than ring, these are the pieces that men most often tell me they recognised themselves in:
- Male depression and what it actually looks like, which is frequently not sadness
- Male burnout, and why men tend not to see it until it has already happened
- The male loneliness epidemic, with UK figures
- The masculinity crisis, on what is actually happening to men
- How to stop watching porn, which is about compulsion rather than morality
- Male eating disorders, the specialist page
Practical details
I see men at Harley Street in London and by secure video worldwide, in English and in French. Sessions are weekly at a fixed time. Nobody needs to know you are coming here, and nobody will.
And if tonight is a crisis rather than a question: the Samaritans are on 116 123, free, day and night. In immediate danger, 999.
See also addiction, the functioning alcoholic, the saviour complex, and the church of self-hatred. For eating disorders in men, visit my specialist practice at menwhoheal.com.
Common questions
Does therapy work for men?
Yes, and often faster than expected once started: men tend to arrive with concrete problems and respond to a direct, active style of work; the myth is that therapy means endless talking about feelings, the reality is closer to structured, confidential work on what has stopped working.
How do I know if I need therapy?
The usual signs in men: the coping that stops coping, drink or work or screens doing more and more of the regulating; anger as the only available emotion; a relationship at breaking point; success that feels empty; if you are asking the question, the answer is usually worth an initial conversation.
What happens in a first session?
A confidential conversation, not a commitment: we map what is happening, what you want to change, and whether we are the right fit to work together; you decide everything after that.
Do you offer therapy for men online?
Yes, by secure video worldwide, in English and French, alongside consulting rooms at Harley Street in London and in Paris.