Traditional talk therapy, while an evidence-based treatment, often presents systemic challenges for men due to societal conditioning that discourages emotional articulation and favors action-oriented problem-solving.
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hey y'all today we're going to talk
about why therapy sucks for men and that
may sound kind of confusing because here
I am a man here I am a psychiatrist
doing Psychotherapy with men so what on
Earth am I talking about why do I think
in my experience as a psychiatrist I do
actually believe that there are systemic
biases that make it hard for men to
engage in therapy and today we're going
to talk a little bit about what those
systemic factors are how we can
understand them and even how to overcome
some of those factors and move towards
more emotional health if you're ready to
take the next step on your mental health
Journey check out Dr K's guide it's an
immersive resource that distills over 20
years of my experience laid out in a way
that is tailored to your needs so if
you're ready to better understand your
mind and take control of it check out
the link in the description below so we
have to start by understanding where
this idea that talk therapy is the gold
standard for treating mental illness
comes from so what we really need to
understand is that the majority of
patients in the history of psychotherapy
have been women about 60 to 70 percent
of patients today who engage in
Psychotherapy are women the other thing
is that about 60 70 percent of
therapists today are actually women so I
think what happened early on in
Psychiatry or Psychotherapy is that the
majority of people we were helping were
women and so when me as a doctor when I
look at 10 of my patients and I see okay
so it looks like talking to people about
their feelings on average is the most
successful thing that I can do
but even though that's factually correct
I may not be taking into account that
seven out of those 10 people are women
and maybe the people who are getting
helped the most with talk therapy or
talking about their emotions are
actually women and it's not just me that
says this if you actually look at the
American Psychological association's
guidance for working with boys and men
they sort of point out a systemic bias
in the way that we diagnose men and
women and that's a lot of the diagnoses
that women get like depression and
anxiety which by the way women are about
two to three times as likely to be
diagnosed with that stuff a lot of those
diagnoses have to do with feelings and
being able to articulate stuff so for
example major depressive disorder
involves feeling sad when you're
depressed right makes sense and that a
lot of men are actually diagnosed with
what we call externalizing disorders
things like addictions or sociopathy or
antisocial personality disorder so these
are disorders that involve Behavior
behaviors so I think they're sort of
clueing us in on a really important idea
which is that when men feel something
they act on it as opposed to articulate
it or talk about it and if we tunnel
down into a little bit about how men
deal with their emotions we'll kind of
see that this is true in general as well
because if you're a man an emotion is a
problem to be solved not something to be
talked about right so think about like
if you get bullied on the playground and
you feel ashamed of yourself and people
call you a fat kid and beat you up that
isn't something you talk about in fact
if you go and cry to Mommy or cry to the
teacher you're actually treated worse
you're taught that articulating problems
and talking to people is cause for
punishment instead what you're supposed
to do if you're a man is fix the problem
right so if kids make fun of me for
being fat I'm supposed to lose weight
get ripped learn martial arts and the
next time they talk I'm going to teach
them who's boss it's if you sort of
think about it the solution to an
internal feeling feeling ashamed is to
take an action and change the
circumstances that make me feel that way
if I'm feeling ashamed because I don't
have a job and I don't have any money
what should I do about that should I go
cry to Mommy about how I don't have a
job or don't have money should I cry to
my girlfriend about how I'm broke all
the time no if you're a man you need a
man the [ __ ] up go out there get a job
and start making money if you're feeling
bad in here as a man what we're taught
is you're supposed to go fix the problem
out there and this also manifests in
men's reluctance to engage in couples
counseling so oftentimes if you're in a
relationship and I'm assuming a
heteronormative relationship for a
second and you know your wife or your
girlfriend says hey I think we need to
go see a counselor oftentimes men will
be reluctant to engage in that and if
you actually look at the research for
why men are reluctant what you discover
is it's not that they're trying to put
their head in the sand or their avoiding
a problem or anything like that they
actually feel outgunned in therapy they
feel like when they go to a couple's
counselor my partner is so much better
at understanding and articulating their
feelings that they can sort of make
their case better than I can and when
the therapist tries talking to me like I
just say I don't know a lot or I'm not
sure like I don't know how to someone's
asking me to play basketball but I don't
know how to dribble and so what men
actually feel like in couples counseling
is that they don't know how to
effectively communicate so imagine a
situation where you're like going into a
court of law and there's a judge there
and your wife makes her case right she
says hey all Oak is neglectful he
doesn't appreciate me I do so much for
him and I know he works hard but he's
really short with me sometimes and it
really hurts and I feel really
underappreciated and then as a man how
do I respond to this I don't speak the
and so as a dude you're like you don't
know how to communicate in the way that
therapists like so men literally feel
outgunned to engage in things like
couples therapy and that's because we as
men communicate our emotions in a
different way so my favorite example of
how men communicate differently is the
negative expression of a positive affection
affection
so when we like someone and we're proud
of one of our homies or our Bros we
don't say that to them right in fact
what we do is we kind of dog them about
it if my friend has been single for a
while after a bad breakup and starts
dating someone else and I feel really
proud and good about that I don't say
hey friend I'm really proud of you and
I'm proud that you've been able to find
someone who sees The Lovable qualities
within you that I see I'm proud that you
found someone who treats you the way
that I think you deserve to be treated
who loves you for who you are in the way
that I love you for who you are in the
history of humanity I do not think that
sequence of words has ever been spoken
by a single man that's not what we say
what do we say we say brah GG Noob
you're whipped I guess we'll never see
you again and we're smiling the whole
time we're not like
why don't you text me anymore I know you
haven't been texting me I feel hurt
instead what we do is we actually dog on
this guy right we're like we call him
whipped and we call him a wuss and we
call them like we say all these negative
things right like oh where's the Apron
Strings we'll say all this like
misogynistic crap but the whole time
we're like expressing appreciation and
smiling at him so men have this negative
expression of a positive affection when
we feel good about something we can't
just say that right because that's not
what we were taught instead of what we
have to do is we have to insult the
person that we're proud of
that's not how Psychotherapy works right
so if this is my mode of communication I
go see my therapist and my therapist is
proud of me they don't say hey [ __ ]
you got a job you suck I guess you're
not going to be coming to therapy
anymore because you ain't got this time
because you got all this this work to do
you know Screw you that's not what your
therapist says in fact we're trained to
say the opposite so the way that we're
trained to speak in therapy is first of
all don't speak very much right don't
solve problems just sit there and listen
and ask this person lots of questions
that they're gonna say I don't know to
how do you feel about that how does that
make you feel I don't know well how does
that make you feel
I don't know and so then if you're a
dude and you go to therapy you feel like
an idiot right because they're asking
you all these questions you're supposed
to know what you feel but you don't know
and that's because of the way that we've
been taught about our emotions the last
thing to consider is that when it comes
to emotional health men are very
physical with it so even if I ask a dude
hey like you know you're it sounds like
you got dumped tell me a little bit
about how you feel the dude may not be
able to say I feel unlovable I'm full of
fear that that perhaps I I won't be able
to find a partner I'm afraid that I'm
fundamentally broken in some way that
precludes me and maybe destins me to be
alone for the rest of my life that's not
what dudes say what dudes say is it felt
like she ripped my heart out it felt
like she stomped on my balls and if you
say that as a dude the other dudes will
know exactly what you mean right like we
all know like oh man like oh it's not
just ripped your heart out it's also a
stomp on the balls I felt that man the
last time I got dumped I found out my
partner was cheating on me felt like she
kicked me in the nuts dude I know
exactly how you feel that's how we talk
we're very physical in nature the other
thing is if you talk to men about who
support each other right and they say
say if you get dumped what's the first
thing you should do hit the gym baby and
that's where we may assume that there
that this relates to confidence that if
you start working out you get buffed and
you look at yourself in the mirror and
you're like I'm so sexy but we don't
even acknowledge for a moment that there
may be a physiological aspect to improve
your mood and one of the biggest
mistakes that I think we've made in the
field of psychotherapy is that we've
separated out the Mind from the body
whereas if you look at modern science we
know that anxiety is not just an emotion
it's not just in your mind that emotions
have physical ramifications that anxiety
can induce diarrhea and change the rate
of your peristalsis anxiety activates
your sympathetic nervous system and
reduces blood flow to places like your
stomach and increases blood flow to
other parts of your body
so we know that emotions are actually
very physiological in nature so why is
it as a society that we've kind of
gotten on this track of simply talking
about them instead of acting physically
and a lot of the men that I've worked
with I've sort of noticed that this
physical component is way more important
than the talking component at least
compared to the women that I've worked
with just to give you all a simple
example I find that the men in my office
need hugs way more than the women now
there are a lot of complications to that
there's a gender Dynamic right between
me and the woman where maybe the woman
doesn't feel as comfortable to hug me
maybe I don't feel as comfortable to hug
the woman so I'm not saying that that's
like a statement of fact but what I've
noticed is that like hugging men the the
patients in my office who are dudes
leads to like a lot more emotional
healing and sometimes tears and all this
kind of stuff and like more dick jokes
after we're done right so there's
something very physical about the way
that men deal with their emotions
and so if we assume all of this is true
what does this mean for you as a dude so
I know this sounds kind of weird but the
first thing that I'd recommend is that
you actually seek Psychotherapy if
you're struggling in some way and that
may sound weird because you said Dr K
there's a systemic bias yeah but it's
still the best evidence-based treatment
that we have for dealing with mental illness
illness
medication is just as good by the way
and another thing we need to keep in
mind is that there are randomized
controlled trials on many types of
psychotherapy which show that they are
equally effective for men and women so
it's not like Psychotherapy works it's
just that if you're engaging in
Psychotherapy as a man there may be a
couple of things that we can arm you
with to really make that Psychotherapy
really worthwhile
so the first recommendation that I have
is that you see at least three
psychotherapists or at least you see at
least three
before you give up on therapy if you
love the first one then stick with them
and so a lot of psychotherapy is about
fit and it may just be hard to find
someone who's able to communicate with
you in a way that is helpful so a couple
of things that I would recommend some
language that you can use if you go to
psychotherapy so the first is just
simply let your therapist know hey I'm
not really aware of what I feel all the
time and I'm not very good at
articulating my feelings because
oftentimes therapists will say how do
you feel and as dudes we don't know how
to answer that so just be transparent
with them at the beginning another thing
that I recommend is that you all check
out this idea of normative male
alexithymia which is this idea that men
or by default it's normative so it's
like most men are colorblind to their
internal emotional state so check out
our video on Alexa thymia if you all
want to and then you can even tell your
your therapist that hey I'm concerned
that I'm a little bit alexithymic so
you're signaling to them that you may
not be able to participate in therapy in
a default way the next thing that you
can can do is ask your therapist to
change their style a little bit if it
isn't working for you so you can tell
them hey I've noticed that you're really
quiet and then you kind of ask these
questions like how do you feel over and
over and over again and then I keep
answering I don't know can you try to be
a little bit more active or offer a
little bit more guidance instead of
being quieter and asking only open-ended
questions can you help me understand
software guide me in some way and some
therapists may feel really uncomfortable
with that they may turn that around into
a question why do you feel like you need
more guidance
I don't know because this doesn't seem
to be helping very much so you can just
ask them to change their style a little
bit and the third thing that you can do
if number one and number two don't work
is after two or three sessions I would
just go to them and say hey I don't feel
like I'm actually getting a whole lot
out of this therapy so you seem to be
asking certain questions that I have
difficulty answering and I'm hoping that
you can recommend a different therapist
who's a little bit more active can offer
a little bit more guidance or ask
questions in a way that can help me
understand my emotions better and I know
that this sounds mortifying oh my God as
a dude why would I ever do that as
anyone as any patient why would I ask to
see a different therapist it means that
I don't think they're good and it
doesn't mean that they're not good it
just means that they're not really
helping you very much or at the minimum
you can have a conversation about what's
working and what isn't and then
hopefully you all can work through that
stuff so I as a therapist actually don't
feel I mean I feel bad in some ways but
I'm really grateful for all of my
patients who have come to me and said
hey Dr K this is not working because
then one of two things happen one is
either we work on it and then we
actually make a breakthrough of some
kind and now we're really jiving
together or I recommend that the person
go see someone else and what's my duty
as a doctor or someone's Duty as a
therapist it's to help the person not
help the person myself
it means giving that person whatever
kind of help they need
so oddly enough I'm still recommending
that you'll try Psychotherapy because it
is still an evidence-based very
effective approach
the other thing to consider though is
that a lot of emotions live in our body
and as men sometimes we need to do more
bodily stuff so there are studies that
show that Tai Chi and yoga for example
are effective treatments for a lot of
things like mood disorders or anxiety or
things like that so adding a physical
component to your emotional health is
very very helpful the other thing to
consider is that there's a range of new
and kind of in Vogue things called
somatic therapies so these are therapies
that incorporate the body in some way so
good examples of this are EMDR or EFT
which is the emotional freeing technique
or tapping so when I first encountered
these studies about 10 or 15 years ago
and I used to sort of my area of
Interest was evidence-based
complementing alternative medicine I
thought all this stuff was like kind of
BS right so it's like the idea behind
tapping is that your emotions are stored
in your body and that you can tap on
certain parts to free emotions and I was
like this doesn't make any sense I'll be
yes and it turns out that over the last
decade or so there have been some
studies that actually show that this is
a pretty effective technique we're not
really 100 sure you know the studies
aren't super high quality but there's
more and more evidence that stuff that
is not classically effective may be
effective and specifically that a lot of
somatic therapies seem to be gaining a
lot of weight and gaining a lot of
interest so I encourage you all to seek
out more bodily oriented kind of
evidence-based techniques
and the last thing that I just want to
share with you all is that I've seen
that across the globe there's a lot more
men's work kind of going on and this
isn't psychotherapy but it's just sort
of groups of men will get together and
will participate in all kinds of either
communication or even like some sorts of
like physical rituals or like taking
hikes there's sort of this very like
physical component to to their emotional
health which they all sort of get
together and do so I can't speak to
specific things like that I'm just sort
of pointing that out is a trend so at
the end of the day I know it sounds kind
of weird but I do think that therapy
sucks for men for a lot of reasons some
of that has to do with the way that
we're raised some of that has to do with
the way that Psychotherapy was developed
and so as men we sort of really need to
think a little bit about how can I
become emotionally healthy so I
definitely give therapy a shot but go in
with some of these disclaimers in mind
go in understanding that you may not be
perfectly suited to this that you're
stepping onto the basketball court but
you don't necessarily know how to
dribble and so just recognize that and
ask your therapist for help and the
second thing to consider is that
especially as men a lot of our emotions
live in our bodies we may need to
leverage our bodies or do some kind of
bodily work to really help us achieve
emotional health [Music]
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