No, Men Should Not Just "Go to Therapy"

One of the mildly amusing memes of the past year has been the one that states that "men would rather do x, y, or z than go to therapy." Variations include, "Men would rather learn everything about ancient Rome than go to therapy," and "Men would rather stare sullenly into the firepit for hours than go to therapy." The implicit assumptions of the meme are that there is something fundamentally wrong with many, if not most, men and that whatever this thing is that is wrong can be "fixed" by "going to therapy."

First, I will state what I hope is obvious: Psychotherapy works. The typical psychotherapy patient is better off after finishing a course of psychotherapy than he was before he started it. For cases of mild to moderate depression, psychotherapy is just as effective as antidepressant medication. For certain conditions, such as insomnia, Post-Traumatic Stress Disorder (PTSD), and phobias, the best scientific evidence suggests that psychotherapy is superior to psychiatric medication. And for serious personality pathology, such as Borderline Personality Disorder, eminent psychologist Marsha Linehan suggests that not only is psychotherapy more helpful, but that medications might make matters worse. For suicidal thoughts and behaviors, psychopharmacology alone is never a sufficient treatment, and when you are thinking about killing yourself, yes, indeed, "You ought to go talk to somebody."

But psychotherapy is not for everyone or for every problem. There is scant evidence that therapy can help people with antisocial personality traits. Being a mean, selfish jerk who constantly puts your own needs ahead of the needs of other people is not "fixable" through psychotherapy. If you are in a relationship in which your partner subjects you to physical or emotional abuse, then wishing him away to therapy is not the fix you think it will be. I have yet to encounter a clinical case example of someone with a psychopathic personality somehow cultivating empathy and conscience through psychotherapy.

The abuse of alcohol or other drugs is also not best approached solely in psychotherapy. As a matter of fact, it is highly questionable whether someone who is actively abusing alcohol or other drugs can derive meaningful benefit from psychotherapy at all. It's true that there are often some underlying contributing factors to a person's misuse of substances, but the first step needs to be abstinence from those substances, which can require a medically supervised detoxification process.

So what if the disseminators of the "men won't go to therapy" memes aren't saying "he's mean to me" or "he drinks too much." What might they be suggesting? My guess is that they are fundamentally dissatisfied with their current or recent romantic relationships with men.

Many women have found the modern online hook-up culture to be brutal and demeaning. Many observers have commented that seeing an apparently endless supply of sexually willing alternatives to one's current partner on dating apps severely undermines men's willingness to commit to anyone. They perversely twist the famous line by Paul Newman on why he remained faithful to his wife: "Why go out for hamburger when you have steak at home?" As one male patient in his 20s said to me, explaining why he had never been in a relationship that lasted more than a few months, "Why buy the cow when you can have a different steak every night for free?"

What is this young man's problem? From his perspective, is it a problem? Being normatively attractive and adequately employed, he finds himself with a seemingly endless supply of attractive young women perfectly willing to have sex with him. Should he tire of one, or should one start to pester him about "getting serious," he can just "stare sullenly into the fire pit" for a few hours and then ghost her. Within a day or two, he will find someone very much like her to take her place.

Someday, when he feels like settling down, he can choose a forever partner, but he doesn't see that time coming anytime soon. After all, why would you want a forever partner? So your children can grow up in a stable home? "Ha!" he thinks. "Who wants children? They're ridiculously expensive. And what are you supposed to do with them when you want to go backpacking in Vietnam?"

So what's the real problem? There are a lot of males in their 20s and 30s who are stuck in a state of prolonged adolescence. This has been called the "Peter Pan syndrome," after "the boy who never wanted to grow up."

Jungians refer to the "peur aeternus," or the eternal boy. This "child-god" can't stand to have any restrictions placed upon him. The most important thing to him is his independence and his limitless options. He won't grow up because growing up means intentionally and consciously restricting your options: If you marry one person, that means there are countless other people you cannot marry. If you commit to one career path, you close down the possibilities of all the other career paths you could have pursued. If you have a child, then their needs become more important than your needs.

Chasing fun and distraction and never committing to one's own life—this is the path many young men are traveling. Could psychotherapy help them? Perhaps. But in my clinical experience, there has to be some level of distress in their lives; there needs to be some kind of pain that they want to relieve. Serially dating a bunch of different women, taking "sabbaticals" from work in order to travel the world, and always believing that your "real life" will start sometime in the far future—these are not the conditions that make people seek out psychotherapy.

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