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Therapy: Man's Last Stand

Never quick to ask others for help, men often don't seek out much-needed therapy.

The woods are burning. The roof is falling in. The guy can't sleep, can't think and now he's having panic attacks.

Maybe it's time to consider therapy.

Then again, maybe not. The men of Metallica, it seems, broke new ground. "The average man is as likely to ask for help with a psychological problem as he is to ask for directions," says Terrence Real, executive director of the Relational Recovery Institute in Watertown, Massachusetts, and author of How Can I Get Through to You? Reconnecting Men and Women. The reluctance is always the same: Therapy is not "manly."

"We teach men to be almost the opposite of what's required for therapy," says Gary Brooks, professor of psychology at Baylor University in Texas and author of A New Psychotherapy for Traditional Men. "By the time they're in elementary school, boys have gotten the message that showing sadness or fear is a sign of weakness," says Ronald F. Levant, dean of the Center for Psychological Studies at Nova Southeastern University in Fort Lauderdale, Florida.

Decades after the much trumpeted rise of the "sensitive" guy, most men continue to keep their feelings hidden—even from themselves. For many men, negative emotions arouse such shame and discomfort that they cease to experience them altogether. "The four words men most dread hearing from women are 'We have to talk,' as that invariably means talking about emotions," says Levant.

Yet somehow men do find themselves in therapy in increasing numbers. Twenty-two percent of men sought mental health treatment from 2002 to 2004, according to Therapy in America, a poll sponsored by Psychology Today and PacifiCare Behavioral Health, Inc. The survey found that men constitute 37 percent of the total number of patients in treatment. "More people are going into treatment overall, but the proportion of men to women has not changed," says Jerome Vaccaro, president and CEO of PacifiCare.

Granted, both men and women often opt for medication over talk therapy, but seek therapy men do. What makes them ink the appointment? More often than not, the impetus is a woman. A typical male patient has been sent—usually by his wife, girlfriend or children, sometimes by his employer. Behind the command performance is a threat: "You change, or it's all over."

"I call them 'wife-mandated referrals,'" says Real.

Although depression, anxiety and shame may lurk beneath the surface, what's on the table is usually relationship problems. To defend against unwelcome feelings, many men adopt an attitude of superiority, entitlement and contempt for others. "They're not in pain," says Real. "The people around them are in pain."

The men who enter therapy of their own volition have often hit rock bottom, says Levant. The despair they've denied or stifled with alcohol or overwork has spiraled until they can't fake it anymore. Often, it's the collapse of a marriage—unexpected, because months or years of warning signs have been ignored. "These men are in a daze," Levant says. "They don't know what hit them."

Then there's the matter of stigma. More than one in five men in the Therapy in America survey said they didn't trust therapists and wouldn't want to be associated with the type of person who receives therapy. Only one in 10 women held these views. But such stigma appears to be in decline, thanks in part to Dr. Phil and Tony Soprano, who have eclipsed the uptight, cerebral Frasier and Woody Allen as exemplars of male therapist and client, respectively.

More good news: Once men get down to business, opening up often brings a rapid sense of relief. "They've admitted something they were ashamed of, gotten it off their chest, and the world hasn't collapsed," says Levant. Indeed, the survey found that men and women were equally satisfied with their treatment experience.

For men, the biggest hurdle, whether you're a world-class rocker or a certified public accountant, is getting in the door.