Speaking just for my own practice male clients (coming as individuals and not as part of a couple) make up just 25% of my caseload. The absence is striking - not because men are unaffected by emotional pain but because so many still continue to carry it alone.
Recent UK research from the British Association for Counselling and Psychotherapy (BACP) found that 41% of women have accessed therapy at some point in their lives, compared with just 29% of men. Nearly half of men surveyed still believed there was stigma attached to counselling or psychotherapy. Another report suggests men account for only around 36% of NHS therapy referrals.
And yet the need is undeniably there. Men in the UK remain significantly more likely to die by suicide, less likely to seek help before things get really difficult and more likely to keep feelings of loneliness, emotional isolation and the pressure to ‘keep going’ to themselves.
Why the resistance?
Perhaps the more important question is still what messages have men received for generations about what it means to struggle emotionally?
Many boys still grow up absorbing a quiet but persistent lesson - that competence means self-sufficiency, that vulnerability is dangerous and that emotional expression risks humiliation or rejection. The phrases may have softened over time but the underlying narrative often remains intact. Deal with it yourself. Be resilient. Be emotionally capable. Stay composed. Don’t burden others.
‘My problems sound so trivial’
Even now many men arrive in therapy apologising before they have even begun that their issues are minimal. They frequently play down their distress or intellectualise it. Many describe feeling as though they have somehow failed by needing any support at all.
This is not because men are incapable of emotional depth or reflection. Far from it. Beneath the guardedness is an enormous longing to feel understood and connected to someone who understands without shame or judgement. Funnily enough just like women.
But therapy itself can still feel culturally unfamiliar to men. The language of ‘opening up’ may sound exposing or abstract. Some men fear being judged, analysed or expected to speak fluently about feelings they were never encouraged to name in the first place. Others simply do not recognise their distress as something therapy is for or (yet) have the language to put a name to their feelings. Anxiety may present as irritability. Depression may look like withdrawal, overworking, numbness or anger. Emotional pain can become hidden inside excess productivity, exercise, alcohol, humour, avoidance or simply silence.
‘Can I trust this space to be different?’
There is also the question of trust. Many men have learned that emotional honesty is risky. If vulnerability has previously been met with ridicule, dismissal or discomfort why would they expect the therapy room to feel any different?
Perhaps as therapists we need to ask ourselves consciously and compassionately whether some men experience therapy as a place designed about them rather than for them. This is not about blaming therapy but it may mean broadening our understanding of how emotional distress is communicated. In practice some male clients may find movement, humour, metaphor or practical problem-solving safer entry points than direct emotional exploration. Some need permission to arrive gradually.
Therapy with men often begins not even with disclosure but with proving that the space can tolerate silence, avoidance, uncertainty or scepticism without judgement. The encouraging reality is that men who do engage in therapy frequently find it helpful. The same BACP survey found that 73% of both male and female clients described therapy as beneficial. The issue is rarely whether therapy works for men. It is whether men feel allowed to access it in the first place.
So how do we reach them?
Perhaps this is best achieved by reframing the conversation from vulnerability as weakness to vulnerability as courage. By speaking about therapy not solely as ‘talking about feelings’ but as a space to understand patterns, relationships, pressure, identity and survival. A space to think. To breathe. To not carry everything alone for just one hour a week. And not to feel guilty for that hour.
Representation matters too. The therapy profession remains predominantly female and while many men work very effectively with female therapists, some may struggle to imagine themselves reflected and understood in the therapeutic space by a woman. Visibility of male therapists and male conversations around emotional wellbeing right now for men may help challenge the idea that therapy belongs only to certain kinds of people.
But perhaps most importantly we need cultural patience. Destigmatisation is not linear. Public campaigns may encourage men to ‘talk’, yet many still inhabit environments - workplaces, friendships, families, social media spaces - where emotional expression feels unsafe.
Who am I meant to be?
The contradiction can leave men stranded between two competing expectations. Be emotionally aware but not too emotional. Seek help but stay strong.
Maybe therapy’s role is not to force men to abandon strength but to redefine it. Because real strength is not enduring suffering indefinitely in silence. It may be the willingness to turn toward oneself honestly. To recognise pain before crisis. To allow another person to witness what has always had to remain hidden. And perhaps the men who never arrive in the therapy room are not resistant to help at all. Maybe many of them are simply still waiting for permission.