What if you are a therapist who doesn’t like working with male clients?

Aug 1

In an article by the American Psychological Association (APA), a psychologist says “the empathy required for therapeutic success is only possible when the therapist basically likes the client." Another psychologist puts it more strongly: “You don't have to like a person to do a good job as a therapist. But if you actively dislike somebody, it's much harder to do a good job."

It has long been recognised that the relationship between therapist and client may be the most important ingredient to successful therapy in psychology as well as medicine, so what do you do if you are a therapist and you basically don’t like male clients very much?

“You don't have to like a person to do a good job as a therapist. But if you actively dislike somebody, it's much harder to do a good job."

Recently I saw a post on the topic of working with heterosexual male clients. It was on the Therapists page of an online forum and was getting a lot of attention, with almost 200 upvotes within two days of being posted.

The thread began with a statement that “straight, cisgender” men were one of the hardest demographics the therapist had encountered. The therapist (who I will call the Questioning Therapist) said these male clients had in common the following four characteristics:

[1] They had reduced access to a felt sense of emotions

[2] They were selfish and were worse at seeing the world from the other person’s perspective (i.e. worse at ‘mentalizing’ others)

[3] They over-intellectualized issues, and tended to believe that others don’t make sense, and

[4] They experienced low self-esteem, self-hate and depression.

After sharing these four opinions, the therapist called for other therapists to share their opinions and any relevant reading material. There were plenty of replies, and before I describe these, I’ll give a few of my own reflections on the above four points.

Firstly, I think the Questioning Therapist should be supported in admitting to having a problem in their work, and seeking the advice of their peers. The fact that they appear to misunderstand men doesn’t mean we should denounce the therapist, rather we should support them in developing their understanding.

With this in mind, the Questioning Therapist’s first point, regarding men and emotions, is all too familiar (e.g. ‘men are too stoical’). However the unacknowledged premise for this suggestion is that men should express themselves more like women do. Some research shows that although women like to explore their feelings in therapy, men prefer to ‘fix the problem ’. Are men wrong to want to deal with stress differently? The idea that men deal with emotions in an inferior way overlooks evidence that men are just as good at recognising emotions as women are, but regulate them using actions rather than words. In defence of the male-typical way of dealing with stress, it should be noted that the philosophy of stoicism is a cornerstone of rational emotive behaviour therapy (REBT), and evidence shows REBT is a successful therapy.

The second point made by the Questioning Therapist had two parts. Firstly there is the suggestion that men have difficulty mentalizing others (i.e. seeing from the other persons’ perspective) is also very familiar (e.g. ‘women are better at empathy than men’). We need do no more here than note the irony of someone asking for help understanding why men are so bad at understanding others. The second part of the Questioning Therapist’s point - that male clients were more selfish - drew several replies from therapists saying they found male clients were the opposite of selfish, very often dealing will the sense that they have to put other people first, possibly due socialisation into the ‘provider / protector’ role.

The third point, regarding over-intellectualization, in context of the first point about feeling emotions, could be interpreted to imply a sense that feelings are more important than facts. Jung considered feelings and emotions as equally important rational functions, and probably many therapists would agree with this view, but perhaps it’s a point that needs to be emphasise in the context of understanding male clients.

The fourth point regarding low self-esteem, self-hate and depression are more serious and complex clinical issues that require more space than this article permits. But before moving on to the replies to the Questioning Therapist, I will briefly comment on the use of the neologism ‘cis’, which risks ‘othering’ the average man, making him feel less understood, or even alienating him from a core part of himself (‘gender alienation’). It also shows the influence of intersectionality, which although is also in vogue, is considered by some people as problematic to understanding people, as it focuses on aspects themselves that might be peripheral to what is important to the client.

“the mix of positive and negative about men – aren’t any better than the overtly negative views, because the negative assumptions about masculinity are ‘Trojan-horsed’ into therapy under cover of positive views of men.”

The Questioning Therapist received dozens of replies from therapists of various schools. The overall view was that lots of therapists either struggled in their therapy with male clients, and/or had a somewhat negative view of men. Some of the comments were somewhat flippant, such as the suggestion that therapists love to complain that men won’t seek therapy, but when men do seek therapy, therapists start complaining about them. Some replies echoed the Questioning Therapist’s problems, for example, one reply sympathising with the Questioning Therapist for having such ‘an awful client list’.

Other comments were very useful and insightful. Several female therapists said they had no more problems with male than female clients. Some psychodynamically-orientated therapists suggested the Questioning Therapist might be experiencing countertransference with these male clients i.e. the problems she was experiencing were her problems, not her clients’ problems. One reply suggested that the Questioning Therapist refer on male clients to therapists who felt more comfortable with them. It was a relief that the most popular answer was one that gently coaxed the therapist in a more informed and empathic direction.

Comments tended either to be negative about men, or be supportive of them. Interestingly, a third variety of comment combined elements of positivity and negativity, resulting in a somewhat ambivalent view of men. For example, some therapists suggested we need to understand men better, which sounds good, except that this person’s understanding was that that men’s problems are due to socialisation into traditional masculinity / patriarchy. Another therapist commented that although “cishetero men” are the most privileged demographic, compassion for them was a basic requirement. The ability to feel compassion for the problems of the privileged is, in one way, to be admired, though many people would question the idea of privilege in this context. Some replies made reasonable suggestions for how to engage with and communicate with men in way they will feel more comfortable with e.g. not delving into emotions too early in therapy, but these often were couched in the patronising sense that men’s coping and communication styles are inferior to women’s, and might even be pathological (e.g. alexithymia).

“Empathy is perhaps the key component in therapy, and encouraging therapists to adopt an ambivalent attitude to men seems like introducing an unnecessary barrier to empathy.”

I didn’t do a content analysis on the thread, but my impression was that about a third of replies were supportive of the Questioning Therapist’s views, about a third took a more male-friendly view, and about a third were an ambivalent mix of, for example, seeing themselves as male-friendly but expressing views that were somewhat undermining of men. Understandably, everyone thought their perspective was the best one.

Getting back to the central question of this article: is it possible to empathise with a client, or treat them successfully, if you fundamentally misunderstand them? If you find out a male client was abused by his mother throughout childhood, should you anyway presume the cause of his depression is patriarchy? Would that be treating him with compassion? There is a risk that even a therapy that is ‘male-friendly’ in other ways can be a ‘Trojan-horse’ for negative views of men, which might undermining the success of the treatment. This has been seen in interventions for domestic violence by men, where the assumption that it is caused by patriarchy reduces how well the treatment works.

So what is the best approach to therapy for men? Empathy is perhaps the key component in therapy, and encouraging therapists to adopt an ambivalent attitude to men seems like introducing an unnecessary barrier to empathy. Therapy should be based on research into what causes men’s problems, how they understand their problems, how they best cope, how they seek help, how they react to different approaches to therapy, and how they overcome their problems. Therapy that ascribes men’s problems overwhelmingly to social factors such as patriarchy or masculinity are treated with suspicion by most men, and rightly so, not only because these ideas limit the client’s sense of agency, locus of control, and ability to ‘fix the problem’, but because men who have a negative concept of masculinity tend to have worse mental wellbeing.

“increasingly, white heterosexual men are the only demographic that therapists are influenced in their training to withhold empathy from”.

People who practice ‘male-friendly therapy’ tend to believe that therapy training isn’t helpful regarding male clients. Sadly, training of therapists has got worse in the past few years. For example, the training of clinical psychologists in the UK now encourages an intersectional view of male clients, invoking ideas such as white male privilege. This means that although people don’t like it when their gender (masculinity or femininity) are seen as the cause of their problems, their therapist might take a different view. Instead of taking an empathic and client-centred approach to the needs of the individual, the problems of male clients might be seen - by the therapist - as a product of their gender or gender socialisation. Because the intersectional (or ‘woke’) view almost inevitably prevents the therapist from seeing the world from the client’s point of view (unless the client is woke), I think it’s fair to say that increasingly, white heterosexual men are the only demographic that therapists are influenced in their training to withhold empathy from.

As one of the replies above noted, the therapy profession repeatedly bemoans the fact that not enough men seek therapy, but then do things that push men away from seeking therapy. This is a classic double-bind, which – as consultant clinical psychologist Martin Seager said in a recent webinar – is in itself not good for men’s mental health. In my opinion the greatest barrier to successful therapy for men today is the distorted view of men held by many therapists, in part due to a lack of adequate training in regards to men. It should go without saying, but good quality therapy for men needs to be guided by good quality non-ideological research into safety and efficacy. However the distorted and negative view of men – which is an aspect of the pervasive cognitive distortion gamma bias– needs first to be recognised and overcome.

We sometimes think of therapists as being saintly in their patience and ability to empathise, but the reality doesn’t always live up to this image. For example, a recent article highlighted how some therapists may be harshly candid or use questionable humour when sharing views about their clients, albeit entirely anonymously online. Of course we can’t expect human beings to be saints, but perhaps there are important lessons to be learned that will benefit both clients and therapists.

The fact that some people find male clients more difficult to work with, or find they are better at working with one sex rather than the other is not new, but the issue of working successfully with male clients is, I think, a topic that urgently needs proper examination. The advice from the APA for therapists regarding working with clients they don’t like includes: asking yourself if you will be able to competently work with this client; ask yourself if you can overcome your antipathy; ask advice from colleagues. If the conclusion is that it’s unlikely to work out with your client, then refer them to someone else, and resist seeing this as a failure on your part as a therapist. But an alternative view is that “therapists could also turn these struggles into transformative experiences for their patients”. Indeed many therapists will take this approach.

It is no secret that lots of men view therapy with suspicion, as shown by the reaction to the APA guidelines in early 2019. In my opinion, therapists should always have access to training that makes them understand and feel more comfortable with male clients, and although not everyone has to work with men, most therapist should feel competent to do so.

Further information
If you want to find out more about therapy for men, you can find the British Psychological Society (BPS) guidance on therapy for men, this online course which is approved by BPS for the purposes of continuing professional development (CPD), and this CPD live webinar.

Selected references / recommended reading

Liddon, L., Kingerlee, R., & Barry, J. A. (2018). Gender differences in preferences for psychological treatment, coping strategies, and triggers to help‐seeking. British Journal of Clinical Psychology, 57(1), 42-58. doi.org/10.1111/bjc.12147

Seager, M., Barry, J.A. (2019). Positive Masculinity: Including Masculinity as a Valued Aspect of Humanity. In: Barry, J.A., Kingerlee, R., Seager, M., Sullivan, L. (eds) The Palgrave Handbook of Male Psychology and Mental Health. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-04384-1_6

Barry, John; Walker, Rob; Liddon, Louise; & Seager, Martin. (2020). Reactions to contemporary narratives about masculinity: A pilot study. Psychreg Journal of Psychology, 4(2), 8–21. https://doi.org/10.5281/zenodo.3871217

Liddon, L., & Barry, J. (2021). Perspectives in male psychology: An introduction. John Wiley & Sons. ISBN: 978-1-119-68535-7

Barry, John and Liddon, L. and Walker, R. and Seager, MJ, (2021). How therapists work with men is related to their views on masculinity, patriarchy, and politics. Psychreg Journal of Psychology 5 (1), 50-64, https://doi.org/10.5281/zenodo.4889456

Barry J. (2023). The belief that masculinity has a negative influence on one's behavior is related to reduced mental well-being. Int J Health Sci (Qassim). PMID: 37416841

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