Counselling for Men

Counselling therapy is a collaborative conversation between a client and therapist, and that means that the therapist needs to understand and account for the specific identities of each individual client. And men are no exception. Although at first glance it may not seem that a man’s anxieties, for example, and a woman’s anxieties would benefit from different treatment approaches. The truth is that better outcomes happen when gender is accounted for.

Please note that throughout this article we will use the term “men,” but we are referring to all folks who identify with masculinities. Although the term “mens’ issues” in the medical field might first bring to mind television advertisements for erectile dysfunction, as therapists we know that there are a wide variety of very real struggles which are experienced uniquely by men.

If you have been considered counselling therapy for your struggles, but have wondered about the gender gap, you aren’t wrong. Four out of five Counsellors are women, and the ratio of female clients is about the same. It’s not unreasonable to wonder if men are welcome in counselling spaces, and if typical approaches (which might be informed by female driven case studies) have good outcomes for men. At Nightingale, we are committed to ensuring gender equities in our approach, and recognize that men’s experiences with Counselling, as well as the issues they bring to counselling, deserve specific treatment.

If you’ve wondered if Counselling is right for you (or perhaps where to find a masculine counsellor, then give us a call to see how it fits.

Men and Counselling and Rapport

Men’s Issues

Culture and Masculinity

The Masculine Image

Perhaps the single biggest challenge facing men who could be helped by counselling therapy is the stigma associated with it. For all the Mental Health Day rhetoric that is out there, there still remains loud cultural messaging than boys and men are supposed to act a certain way.  

Masculinity in our culture still often looks something like the following:

●     “No Sissy Stuff”: Don’t show weakness or vulnerability, as women do.

●     “The Big Wheel”: Strive for success, status, power, and respect.

●     “The Sturdy Oak”: Be the strong, silent type, with infinite confidence and self reliance.

●     “Give ‘em Hell!”: Be tough, aggressive, and fearless.

Sure, we might think of these as outdated, but the lingering effect of this messaging is still very much present in the lives of boys and men in Canada.

Men and Counselling

So, how are men supposed to feel good about going to counselling? Doesn’t counselling mean breaking all of these “roles”—ending the silence, asking for help, opening ourselves to vulnerability, admitting to shortcoming, and acknowledging our fears? 

What this means is that the very act of coming to counselling is, for many men, a great act of courage. It is an act of overcoming. And this should be understood and respected by the Counsellor you visit.

The truth is, of course, that no man genuinely meets the requirements of the traditional masculine role. In the early 17th Century, the poet John Donne wrote that “no man is an island.” 400 years later it remains true. All men feel doubts and fears; and each has a point at which we need the help of another to take that next step; and each knows that whatever voice and image we project onto the world, there is inside us a more complex story.

The remarkable and surprising thing is that taking ownership of that authentic self—however it does or does not overlap with our perception of the masculine identity—provides a more stable source of freedom and strength.

The Stoic Man

The way that men are brought up in families and cultures inform how the challenges of life are met. Perhaps the defining word for the way that many men deal with life’s struggles is “Stoicism.” Though the version of Stoicism with which we are currently familiar is a far cry from its ancient Greek roots, it is typically understood as the doctrine of the strong and silent type, the man who can roll with any punches without complaint and without evidence of pain. Stoics are courageous, extraordinary in their pain tolerance and endurance, and capacity to continue on when others cannot. But there is often an unseen toll on the life of the stoic: it is often the case that the pain still exists, it is just not felt by the conscious mind. What does this mean?

Defeating Stress, or Ignoring Stress?

Consider the following story: a client puts their hand in ice cold water, while a hypnotist convinces the conscious mind that the water is warm. The client reports the water as warm. But what happens inside the body? Has the mind truly “overcome” the stimulus, or has the patient simply learned to ignore the effects on his body?

Unfortunately, the ability to disregard the effects at the level of consciousness does not mean that the effects are not registered in one’s body. Simply put, you can disregard the pain, but the physiological cascade of effects remain: the adrenal glands pump epinephrine and stress hormones and the blood vessels constrict.  What this small anecdote tells us is that there is an unseen toll on the brains and bodies of even the most outwardly and happily stoic men. 

Men’s Issues

This helps tell the story of many of the men’s specific issues that show up in therapy:

●     acute stress and chronic stress

●     chronic pain from chronically tense muscles

●     frustration and anger

●     resentment about unfair expectations for work and energy, or lack of reward for all that has been accomplished

●     disconnection from others, lack of intimacy

●     depression, or lack of energy/motivation


And the secondary effects are just as important. Men are supposed to be undefeatable, and when stress, pain, or lack of energy come into the scene, men can feel guilt and shame and loneliness.

Therapy for Men

One of the biggest themes in the feedback our male clients at Nightingale provide our Counsellors is that, if they’ve tried counselling before, they found it to be like talking to a wall! What they mean is that one of the most typical strategies for Counselling Therapy—for the Counsellor to be a blank canvas, who listens 90% of the time and talks 10% of the time—just doesn’t feel right for them.

At Nightingale, we take a different approach. Although compassionate, active listening is one of the foundations of our practice, we believe that therapeutic conversation needs to be a dialogue. We know that outcomes with men improve when the therapist provides more than just soothing affirmations. Instead, we bring ourselves as Counsellors into the room, ready to have an engaged discussion about whatever it is that most needs our attention.

We also approach therapy with a “muscular” approach —this means that we stay connected to your therapeutic goals, to a “larger project” that we are working towards. As therapists we know that conversations can go any which way, and that it’s best to allow that to happen—but we also know that by keeping one eye on how emerging themes fit into our larger conversation, we can build therapeutic momentum and create the foundations for real change.

Outcomes of Therapy

Often, there are at least two levels to the goals of the therapy, and these are reflected in the article.

The first goal of therapy is to deal with the primary problem which has brought you in. Perhaps it’s depression, or persistent pain, or frustration and resentment feelings. 

The second goal is to consider in what ways certain deeper aspects of culture and personality may have led you to this position in the first place. For example, while we work to learn how to contain and release frustration in safe and healthy ways, we might also look at what generates that frustration more generally: are their expectations about what you’ll do, or how you’ll respond to things? Are there prohibitions on how you can express yourself, or how you can ensure your own needs are met?

These and many more questions can often lead us to a place of deeper authenticity. So much of masculine culture asks us to push aside our authentic self in the interest of our social roles: in therapy, we can reclaim ownership of that authenticity and discover a truer source of both resiliency and ease.

What Men’s Therapy Looks Like

If therapy sounds like it could be helpful to you, you may be wondering just what it looks like. On television we see a probing psychoanalyst trying to make their patient cry as quickly as possible. We expect questions about your relationship to your mother!

Modern therapy doesn’t look like it does on TV. Therapy should be a fun and safe adventure with a person who you’ve come to trust and respect, and who feels the same towards you. It should be a dialogue that goes at a pace you’re comfortable with, that works towards goals you’ve chosen for yourself, and that doesn’t ask more from you that you feel right giving. Intimacy and vulnerability are often a part of therapy, but they aren’t a demand, and they aren’t something that happens on the first day. 

At Nightingale we offer a free consultation session just so you can get a feel for it, and decide for yourself if it feels right or not. It’s a quick, 20 minute session, just to say hello and get a lay of the land, as well as an opportunity for you to ask anything of the therapist that might interest you. If you’re curious, give us a call!