Mar 27, 2023

Why Men With Suicidal Ideation May Not Seek Therapy

Saying the opposite of these 16 words can break barriers.

This article appeared on Psychology Today in March 2023

Key points:

• In the UK, 76% of all suicides are men.

• The majority of men will not see a counsellor or therapist to talk about their mental health, often due to shame, stigma, or depression.

• The feminine world and language used in “therapy” is alienating them.

• Reframing these 16 words by saying the opposite will engage men before it is too late.

The majority of men will not see a counsellor or therapist to talk about their mental health, often due to shame, stigma, or depression. We are sleepwalking into a male mental health crisis: Around 76% of all UK suicides are men (ONS, 2021). Suicide is also the biggest killer of men under 45. In a survey of 1,000 British men, a staggering 77% also reported mental health difficulties at some point in their lives (The Priory, 2022).

For boys, from around the age of 5, opening up about feelings and vulnerabilities has been programmed societally and across cultures as a sign of weakness and incompetence. As such, most men are usually referred for mental well-being interventions by someone else in their network but often far too late.

Talking treatments are broadly as effective as medication for resolving symptoms of depression and suicidal thoughts, but are actively avoided by men. Reframing help-seeking as masculine behaviour, using more masculine language increases the chance of men seeking input when they need it. To start, let’s name the “therapy” session a “consultation,” a “meeting,” or an “appointment”. Better still, design interventions more appropriately set within the community. Men prefer group settings rather than one-on-one consultations, ideally with other men and with a psychoeducational component. Men also prefer community interventions led by peers or mentors with lived experience, or by a representative of their own faith.

The female-dominated delivery of mental health is through one-to-one therapy, because this is what women prefer. As this set-up is a more psychologically threatening environment for men, why not bring in their “goals” and “aspirations” rather than medicalising their symptoms and naming their “deficits”? How about focusing on their “strengths”, “goals” and “resiliences” rather than their “regrets” and “personal weaknesses?” Offering “help” may sound belittling, so it might be preferable to ask how sessions will be “useful” to them rather than “helpful”.

Men use other terms to describe their feelings and emotions such as “moods.” Formulating the function of those moods — and linked behaviours — can provide helpful tools and insights for the intervention, so moods are visualised less as weakness. For example, using CBT to link beliefs about infidelity, and how this relates to anger and mistrust, causing an increase in drinking behaviour, may bring the psychological processes to life for the client more, and how they are linked. This is likely to be more effective than simply asking how a man feels about the trigger, which can feel exposing.

Under pressure, men are more likely to externalise a problem, and attribute it to context and bad luck, rather than internalising the problem and blaming themselves as more women tend to do (Best, 2022). Why not draw on this and externalise the language you use as therapists, too — talk about “the pressure” they are under rather than internalising the “stress” they show — as an emotion?

Consider mentioning their “mental resilience” above their “mental health”. They may have used toxic, avoidant or unhealthy coping strategies such as drugs, sex, violence or alcohol (as women do as well, but statistically to a lesser degree). However, where it is safe to do so, focus on enhancing the many “skills, tools and resources” they have to survive and “endure” the “trauma” to be where they are today.

Rather than talking about treating your male client, they might prefer you to say you’ll work with them to achieve their “goals”, and “collaborate” with them, instead of “supporting” them. This will reduce the power differential in the therapeutic relationship. It might be more useful to highlight where “problems” actually bring “opportunities”, such as a job loss opening up new potential avenues and solutions for a new and better work environment.

Nobody wants to feel damaged or broken; so the idea of “fixing” the man or the problem may well bring resistance. Alternatively, you could talk about “building” a future, and bringing in purpose around important and meaningful “roles” in their lives, rather than focusing on their “losses”. They’ve had enough “criticism” and self-critical voices in their lives; now they can respond proactively to “positive affirmation and praise”.

It’s also less likely that a session that has purely involved active listening would be as galvanising. Try being action-oriented at the end of sessions and have a plan men can pursue between sessions. Focus on “doing” rather than “being”.

“But isn’t this reinforcing avoidance of discussing their suicidal feelings or dealing with the trauma?”, you may ask. With many of the male clients I’ve worked with, we would not have built rapport, and gone through the whole process together, without building a quality working relationship; by reframing the feminine language of therapy from the outset. Reframing and resonance bring psychological safety so you can work at the client’s pace. Have a think about how you would like to be spoken to if you felt that the bravest action you could do today would be taking your own life.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. In the UK, call the national emergency number — 999 or 112 — or The Samaritans or the Campaign Against Living Miserably (CALM).