The Men’s Mental Health Crisis

daniel debrocke Nov 28, 2022

The writing of this article was prompted by all the social media posts I’ve seen talking about men’s mental health. Apparently November is men’s mental health month. That is unless you’re struggling with your own mental health issues. Then, every month, week, and day may very well be an ongoing struggle. Although throughout this article I’ll be referencing comparative data between men and women and differing demographics, the point is not to prop up men's suffering above women or anyone else for that matter. It’s simply there to elucidate the current state of men’s mental health, which is the central focus of this article. “Einstein is quoted as having said that if he had one hour to save the world he would spend fifty-five minutes defining the problem and only five minutes finding the solution(1). This mentality exists in contrast to the current lack of awareness pertaining to the drivers of psychological ill-health. Social media and articles routinely discuss what to do if you’re depressed, anxious, suicidal, etc. But seldom does anyone discuss the complexity of the subject. Unfortunately, without truly understanding the issues that lead to ill-health it’s unlikely to come up with an effective solution and subsequent prevention strategies. Therefore the aim of this article is as follows:

 

  1. Identify common misconceptions regarding men’s mental health
  2. Discuss variables that lead to ill-health in men
  3. Review obstacles to health services for men
  4. Provide resources and potential next steps for men struggling with mental ill-health 

 

Exploring Men’s Mental Health

People often share posts on social media encouraging men to talk about men’s mental health. The problem with this is twofold. First, these gestures are often empty. This may sound harsh, but the reality is the overwhelming majority of people would not even consider it without the existence of a popularized social media trend. Granted, the increase in awareness is clearly beneficial regardless of motivation, but the perceived lack of authenticity remains a genuine hurdle to actual connection and support. Second, these posts often demonstrate a lack of understanding of the complexity of mental health, how to approach the subject, and how to offer actual support and resources for individuals who may be struggling. For instance, telling men to “seek out professional help” or “talk to someons” is the equivalent to telling obese individuals to “eat less and exercise more”. Fundamentally the statement is true, but it’s overly reductionist since talking to the wrong person may cause harm. It’s also unlikely these individuals will even be aware of the health service landscape, not to mention how to filter through and identify the appropriate intervention and clinician for them at that moment. Broad recommendations seen on social media also demonstrate a lack of curiosity as to why an individual might be hesitant to seek out help in the first place. An individual might initially seek out help for suicidality, but decline upon discovering that sharing suicidal ideations can risk institutionalization, stigmatization, loss of employment, destruction of relationships, or other consequences.

Consider this, men make up roughly 49% of the population but account for 80% of suicides. This means men commit suicide at nearly four times the rate of women (2). Suicide is now a leading cause of death among men in America. Take a moment to reflect on the magnitude of that finding “suicide is now a leading cause of death for men”. Men are two to three times more likely to misuse drugs than women, and nearly three times as likely to die due to alcohol abuse (3). A common claim is traditional masculinity and gender stereotypes prevent many men from seeking out professional help. However, a 2018 paper by River calls this into question. The paper specifically looked at men who engaged in non-fatal suicide attempts. Participants used various suicide methods including hanging, using vehicles, poison, stabbing themselves, drug overdose, and drowning. Contrary to popular belief, only 17% actively avoided seeking help due in part to the belief that it was unmanly, 33% struggling with increasing distress actively sought help, and 50% were prompted to seek help through unsolicited encounters with health professionals (4). The author noted “for health professionals, these encounters provided a “window of opportunity” to engage men in health services”. Importantly this paper also found that health professionals can block the seeking of treatment and that “Men… overwhelmingly rejected services that framed emotional distress and suicidal behavior as mental illness”. 

According to this paper roughly 83% of men sought treatment. This is not the only study to question the legitimacy of presupposed gender stereotypes in deterring men from seeking out professional help. That’s not to say it doesn’t play a role, only that it’s unlikely to be the primary barrier many people often assume. Research also suggests many suicidal men involved in health services do not continue and later engage in fatal suicide (5). Therefore engaging in health services alone may be insufficient to address the complex issues of the individual in question. Additionally  “men who are less well-off and living in the most deprived areas are up to 10 times more likely to die by suicide than more well-off men from affluent areas”(6). With one paper finding “we know that there are many risk factors which lead to increased risk of suicide in middle-aged men, including exclusion from a changing labour market, cultural shifts in ideas of ‘how to be a man’, relationship breakdown and social disconnection” (7)

Social disconnection plays an important role in mental health, as a loss of social connection can increase risk of suicide. A 2020 paper by Caballero-Domínguez found “In the present analysis, a statistically significant association was found between perceived stress related to COVID-19 and high suicide risk during confinement. Various investigations observed a significant relationship between perceived stress and suicide behaviors (Anastasiades et al., 2017; Bickford et al., 2020). Perceived stress can increase suicide risk by neurophysiological and psychological mechanisms (Bickford et al., 2020; Turecki & Brent, 2016). Uncertainty about the nature of a highly contagious and life-threatening illness, and problems, social confinement, and economic problems can be sources of stress (Reger et al., 2020; Thakur & Jain, 2020)(8).

A meta-analysis by Johns Hopkins looking at the effect of the average covid-19 lockdown in Europe and America on mortality found “lockdowns during the initial phase of the COVID-19 pandemic have had devastating effects. They have contributed to reducing economic activity, raising unemployment, reducing schooling, causing political unrest, contributing to domestic violence…” (9). Unsurprisingly economic downturns, unemployment, reduced schooling and social interaction, increased stress, domestic violence etc. all play a meaningful role in an individuals mental health status. As previously mentioned “men who are less well-off and living in the most deprived areas are up to 10 times more likely to die by suicide than more well-off men from affluent areas”.

Clinical depression is defined as “when an individual has a persistently low or depressed mood, anhedonia or decreased interest in pleasurable activities, feelings of guilt or worthlessness, lack of energy, poor concentration, appetite changes, psychomotor retardation or agitation, sleep disturbances, or suicidal thoughts” (10). An individual must present with symptoms for at least two weeks in order to be diagnosed with depression. Major depressive disorder has been ranked as the third leading cause of disease according to the WHO (10). There is no single cause of depression, it’s more of a complex network of variables that interact with one another to drive depressive moods and behaviour. Childhood trauma, environmental stress (this could be financial stress, loss of a loved one, social unrest or war, etc.), genetic and epigenetic factors, personality, resilience, and several other variables have all been associated with depression (11)(12)(13)(14)(15). One paper found “epigenetic changes in stress response genes, genes involved in serotonergic transmission, and neurotrophin genes (i.e., NR3C1, SLC6A4, BDNF). These results comport with evidence indicating that these genes are stress-related, epigenetically modified and differentially-expressed in patients with MDD [major depressive disorder]” (16). Researchers also found biological and epigenetic systems can be altered via environmental inputs and childhood abuse. These alterations can also lead to long term maladaptations including depression, along with physical and mental health disturbances. 

One paper aimed to look at stress, memory, and its implications on major depression. Researchers noted the stress response is mainly guided by the “sympathoadrenal medullary system and the hypothalamic-pituitary-adrenal axis, along with the contribution of immune and metabolic systems. It promotes a physiological, behavioral, and cognitive response which is highly adaptive” (17)(18). There is a well established relationship between acute and chronic stress and mood disorders (19)(20)(21). In fact chronic stress has been identified as one of the primary drivers of major depressive disorder (22). Researchers found depressive patients demonstrated a propensity to revisit negative memories, have an attentional bias toward negative stimuli, and greater difficulty retrieving positive memories. As highlighted in the paper “Evidence points to a greater activity of the amygdala in face of negative emotional stimuli, and a blunted response to positive stimuli. Therefore, changes in the processing of emotional memory by amygdala dysfunction will mediate sensitization to negative stimuli, as well as the larger retrieval of negative memories, which are both observed in depression” (18)

The evidence also suggests most major episodes of depression were preceded by stressful or traumatic life events (23). That does not mean definitively that stressful events will lead to depressive disorders, it’s simply a catalyst in certain contexts. Researchers have also identified that certain individuals appear to be more at risk of developing depressive disorders than others. Personality vulnerability describes a predictive model to assess an individual's risk or vulnerability to depression based on their personality or cognition. As stated by a 2005 paper by Hammen “The hypothesis arose from similar views of Beck (1983) and Blatt (1974) that individuals may have depression vulnerabilities that are specific to critical sources of self-worth, noting the centrality of values attached to sociality or to achievement” (24)

Developmental mediators of adolescent and adult depression are well established. Parental death or illness, early exposure to substance abuse or domestic violence, neglect, sexual and physical abuse, etc. have all been identified as strong correlates with depression and various other disorders (25). One paper found 75.6% of the chronically depressed patients reported clinically significant histories of childhood trauma. 37% of the chronically depressed patients reported multiple childhood traumatization. Experiences of multiple trauma also led to significantly more severe depressive symptoms” (26). One study reviewed data from a 10-year cohort study of a nationally representative sample of students aged 14-15 years in Victoria, Australia from 1992 to 2003 to determine the prevalence of sexual assault among boys and girls. Researchers found roughly 7% of boys were sexually assaulted (27). Another study exploring sexual assault of boys found “Boys at highest risk were younger than 13 years, nonwhite, of low socioeconomic status, and not living with their fathers. Perpetrators tended to be known but unrelated males. Abuse frequently occurred outside the home, involved penetration, and occurred more than once. Sequelae included psychological distress, substance abuse, and sexually related problems. Evaluation of management strategies was limited” (28)

This brings up another crucial point about single parent homes, specifically father-absent homes and its association with mental health and various other outcomes. It comes as a surprise to many that the most reliable indicator of violent crime in a community is the proportion of father absent homes (29). The US Department Of Justice Stated “Fathers typically offer economic stability, a role model for boys, greater household security, and reduced stress for mothers. This is especially true for families with adolescent boys, the most crime-prone cohort. Children from single-parent families are more prone than children from two-parent families to use drugs, be gang members, be expelled from school, be committed to reform institutions, and become juvenile murderers. Single parenthood inevitably reduces the amount of time a child has in interaction with someone who is attentive to the child's needs, including the provision of moral guidance and discipline” (29). The United States census bureau estimates that roughly 57.6% of black children, 31.2% of Hispanic children, and 20.7% of white children are living in father-absent homes (30)

Research has found that children raised in father-absent homes experience greater frequency of psychological distress which may extend into adulthood, increasing risk of depression, suicide, substance abuse, criminality, and impaired scholastic performance (31). Researchers also found an association between father-absent homes and risk of being bullied. Adolescents of fatherless-homes often experience anger and resentment of their abandonment resulting in difficulties developing healthy social bonds (32). Children of father-absent homes are more likely to have developmental issues relating to attachment and an inability to develop healthy caregiver bonds. This can lead to hypervigilance and difficulty developing and sustaining friendships and romantic relationships (33)(34)(35)(36)(37)(38). Children in fatherless homes are at increased risk of physical and sexual abuse compared to a two parent household (39). In these situations the risk of physical and emotional abuse increases by roughly twofold (40).

Children coming from father-absent homes are at increased risk of becoming obese (41)(42). A 2007 paper by Wake et al. found “Higher father control scores were associated with lower odds of the child being in a higher BMI category. Compared with the reference authoritative style, children of fathers with permissive and disengaged parenting styles had higher odds of being in a higher BMI category” (43). Risk of adolescent delinquency also increases in father absent homes, and the degree of father involvement was a predictor of adolescent delinquency later in life (with increased influence reducing likelihood of delinquency) (44). Although parent involvement in youth development is suggested to play a meaningful role in developmental trajectories, it’s important to note that it’s a reciprocal relationship. What this means is although parent involvement influences a child's behaviour, the child's behaviour simultaneously impacts how the parents respond to the child. 

The Minnesota Psychological Association stated “Youths who never had a father living with them have the highest incarceration rates, while youths in father-only households display no difference in the rate of incarceration from that of children coming from two-parent households. In addition, children who come from father-absent homes are at a greater risk for using illicit substances at a younger age. The absence of a father in a child’s life may also increase the odds of his or her associating with delinquent peers” (45).  Children living in father-absent homes often exhibit aggressive behaviour and are more likely to experience depression, suicidal ideations, anxiety, anti-social behaviour, and increased psychological distress (46)(47)

By now you should start seeing a pattern emerging. Environmental factors, especially in adolescence play a monumental role in the development of depression, suicidal ideation, and various other mental health issues later in life. Regarding PTSD treatment, men drop out at a higher rate than women, and women appear to have higher recovery trajectories while men tend to experience delayed onset (48). Lack of availability of social support is one of the strongest predictors of PTSD, and women appear to seek social support much more frequently than men (49). A 2017 study found “women are more likely to show a “tend-and-befriend” response to stress, which is clearly related to the availability of support from their social network”(49)

Roughly 60% of men experience at least one trauma in their lifetime (50). Men are less likely to access psychological therapies than women: only 36% of referrals to NHS talking therapies are for men (51). The significant majority of the US military is male (roughly 73%), and according to the US Department of Veterans Affairs as of 2016 there were roughly 20.4 million veterans (51). These figures depend on the era of military service which include OIF (operation Iraqi freedom), OEF (operation enduring freedom) [11-20%], Gulf War (desert storm) [12%], and the Vietnam War [15%] (51)(52). These are crude figures, and I’m unaware of whether these numbers represent service members who were deployed or active duty but domestically stationed. The proportion of male and female service members also differed across these eras biasing less female involvement in previous wars. However, even if we cut this figure by 80% and assume only 4.08 million veterans were deployed for active duty, that's still 408,000 - 816,000 veterans who experienced PTSD. These figures represent men and women respectively so if we factor in that men make up roughly 73% of the military you’re still looking at 297,840 - 595,680 male veterans who experienced PTSD. I want to reiterate that these are crude figures and the point is not perfect precision but to create a general awareness of the prevalence of PTSD in male veterans. 

Homelessness is a pervasive issue affecting men, since in America the overwhelming majority of the homeless population (roughly 70%) are men (53). One paper found “The personal psychiatric histories of the subjects were remarkable for high rates of psychiatric disorders… more than three-quarters (76.7%) of the men qualified for a lifetime diagnosis. A history of substance abuse was reported by 74.7% of the men, leaving virtually no psychiatric disorders in men uncomplicated by a substance abuse history” (54). Researchers looking at the differences in stressful life events (SLE’s) between men and women experiencing homelessness found “​​Experiencing SLEs at an early age is one of the main risk factors for individuals to be chronically subject to situations of poverty and social exclusion (Stein et al., 2002). Several studies have found a high prevalence of childhood SLEs in people experiencing homelessness (Edalati et al., 2016; Stein et al., 2002). Studies conducted on both European and US‐based samples have shown that these individuals often present indicators of dysfunctional home backgrounds, with a history of physical and/or sexual abuse in childhood, parental substance abuse or mental illness, running away from home, and institutionalization (Padgett et al., 2012; Panadero et al., 2018; Wong & Piliavin, 2001). In addition, it has been found that exposure to adversity during childhood and adolescence is the main trigger for leaving home and early homelessness (Mar et al., 2014)” (55). Research has shown homeless men tend to have higher rates of substance abuse and run-ins with the legal system which are both associated with homelessness in men (55)

 

Social Media And Mental Health Awareness

A popular belief is the negative impact social media has on mental health. With various studies reporting increased time spent on social media increases the risk of depression and anxiety in adolescents (56)(57)(58). However, several studies have questioned the validity of these claims. A 2017 meta-analysis by Huang found time spent on social media had either no effect or a weak effect on depression or loneliness (59). A 2014 systematic review by Best et al. found “contradictory evidence while revealing an absence of robust causal research regarding the impact of social media on mental wellbeing of young people. Online technologies are increasingly being used for health and social care purposes, but further research is required to give confidence that these are appropriately designed to promote the mental health care and support of young people” (60). To clear up some of the conflict within the literature, it’s unlikely that social media is either wholly good or bad across the board. Rather, the effect it has on an individual (whether it’s positive, negative, or neutral) is likely contingent on several other mediating factors. To draw a crude comparison, tracking calories does not inherently lead to disordered eating. However, individuals with a predisposition to ED or disordered behaviour are at higher risk of such developments. 

Social media presents a unique opportunity to advance mental health awareness and increase the effectiveness and utilization of such interventions. It’s estimated that between 83-90% of 18-29 year olds use social networking sites (61)(62). Social modelling is another potential benefit of social media and mental health programs. Since individuals tend to model behaviour of others in their social network, viewing a post on mental health may create interest where previously there was none (63). It may also increase the likelihood of sharing posts or participating in trending challenges. A great example of this is the ice-bucket challenge in support of ALS which became wildly popular and increased the ALS associations research funding by 187% (64). Social media campaigns are cost effective and with roughly 4.48 billion worldwide users have an incredible potential reach (65)(66)

However, in spite of several upsides there remain significant challenges. Authenticating information and data shared presents a major barrier since only a small percentage of individuals thoroughly vet and verify information before sharing or engaging with the content. Thus, you end up with a haphazard game of telephone whereby the original data may become so skewed it’s no longer representative of the original claim. Another limitation of social platforms is the minimal barrier to entry to join campaigns. This is a benefit when it promotes accurate and effective education and interventions. However, it can just as easily lead to the rapid spread of inaccurate information. Additionally, there is no direct relationship between social engagement and behavioural change (67)(68). This was a point I mentioned at the beginning of this article whereby the authenticity of the individual sharing a piece of content comes into question. Sharing a post gives the feeling of being an active participant without actually having to invest anything. A resulting complication is the reluctance of an individual to seek support from someone in their social network if they’re deemed as disingenuous. 

 

Exploring Solutions And Active Participation

If you are struggling with mental ill-health it’s recommended that you seek help from a qualified healthcare provider. This section is intended to be educational and is not prescriptive in any way. Below we’ll explore some of the potential treatment avenues to explore. 

Health complications and the significant lifestyle changes often associated with them can lead to significant stress and reduction in quality of life. Thus individuals struggling from physical ill-health are at an increased risk to develop depression and anxiety. Regular physical exercise has been shown to have a positive impact on mental health and reduce anxiety and depression in individuals struggling with various health complications (69). Physical exercise can also present an analgesic (pain reducing) effect on patients (70). Physical exercise is also associated with increased strength, muscle mass, and physical resilience leading to greater improved survival rates in patients with CKD (71). A 2016 paper by Dziubek et al. found “Undertaking physical training during dialysis by patients with ESRD is beneficial in reducing their levels of anxiety and depression. Both resistance and endurance training improves mood, but only endurance training additionally results in anxiety reduction” (72). A great place to start might be looking for nearby community centres, gyms, group exercise classes, running meet-ups, or other social activities that are physical in nature. 

Additionally, the social support a gym environment can offer also confers a significant benefit on psychological health. Social support has been shown to positively affect individual psychology in patients struggling with health complications (73). It’s been shown to bolster self esteem, manage stress, enhance compliance, and reduce depressive symptoms (74)(75)(76)(77). A 2012 paper by Carayanni et al. found meeting with friends reduced anxiety and engaging in outings and church offered a protective effect against depression (78). As noted in a 2018 paper by Gerogianni et al. “social support was related with a reduction in respiratory and musculoskeletal disorders in dialysis patients since it improves physiological functioning, leads to a decrease in negative emotions and improves survival rates. However, low levels of emotional support are associated with greater levels of depression” (79). So not only does social support present a meaningful benefit to psychological well being, but a perceived lack of social support can actually have a destructive effect. Potential avenues for seeking social support are joining a church or other spiritual congregation, tele-nursing programs, network support groups, friends and family, community programs, etc. 

It’s well established that nutrition impacts your psychology. It’s not uncommon for individuals struggling with depression to have less than ideal dietary habits. Common prescription drugs for depression have several side effects which often deters the patient from adhering to the protocol (80). Additionally, “noncompliant patients who have mental disorders are at a higher risk for committing suicide or being institutionalized” (81). It’s therefore important to adopt beneficial nutritional habits that can be scaled over time to enhance both physical and psychological well being. If you’re looking to improve your diet, I wrote an article that walks you through the step by step process of designing a diet. It was written to help people gain muscle, but I also discuss weight loss, weight maintenance, and how to transition between the different phases as well which all apply to health. I’d also recommend reading my other articles The Importance of A Needs Analysis For Nutrition. Additionally, if you want to understand the broader landscape of successful weight loss and management and how to develop lasting routines, and positively impact behaviour change read this article I wrote for Kabuki Strength. Between these three articles you’ll have more than enough resources to start making a meaningful impact (however, keep in mind these do not address potential physical health complications that may require a more specialized dietary approach like CKD, celiac disease, etc).

Exposure to nature also appears to have a positive impact on anxiety and depression. A 2022 systematic review and meta-analysis by Grassini found “nature walks effectively improve mental health, positively impacting depression and anxiety. The within group and between group results argue in favor of the effectiveness of nature walk. Despite the absence of adequate studies performing follow-ups to help determine the long-term effects, a positive effect of nature walk was reported for up to three months. The current findings are critical in demonstrating the empirical value of nature-based walk interventions for improving mental health” (82). Also noting “The study by Bielinis et al. also showed that the qualitative aspects of natural environments are important for mediating positive health effects. The experiment conducted by Iwata et al. found that the participants preferred forest walks due to the qualitative features, such as quietness and an almost total absence of people. The break away from a normal routine and the uptake of the freedom and escape provided by the natural settings were also reported to be other attractions towards the intervention. It is possible that these characteristics of natural environments may mediate the positive effects of nature walk when compared to therapeutic-directed walks implemented in urban settings” (82). The affordability and virtual universality of accessibility of nature walks makes them an excellent adjunct intervention strategy.

Sleep is an incredibly important aspect of mental health. One study aimed to determine whether depressive symptoms in conjunction with sleep disturbances would lead to increased psychiatric symptomatology and functional impairment.  Researchers found “college students with depressive symptoms with SD [sleep disturbances] may experience a greater burden of comorbid anxiety symptoms and hyperarousal, and may have impairments in functioning, compared to students with depressive symptoms without SD” (83). A paper by Demirci et al. found “Depression, anxiety, and daytime dysfunctions components of PSQI were significantly higher in the high smartphone use group than in the low smartphone use group… Regression analyses indicated that higher levels of smartphone use and poor sleep quality predicted depression/anxiety. In addition, depression and anxiety predicted poor sleep quality. Consequently, depression and anxiety are mediators between smartphone overuse and poor sleep quality. Moreover, high depression, high anxiety, female sex, and low age were independent predictors of smartphone overuse. To the best of our knowledge, this is the first study to show the relationship between the severity of smartphone use and depression, anxiety, and sleep quality in university students” (84)

A systematic review looked at the bidirectionality between sleep disturbances, anxiety, and depression. They found sleep disturbance, anxiety, and/or depression were associated, and although they did observe bidirectionality it was not consistent across all mental health problems (85). As with many things in research, when there is conflicting evidence it often requires more precise contextualization to tease out the critical elements that drive a particular response. For example, if an individual is depressed it’s not uncommon to experience sleep disturbances. If they are sleep deprived, emotional self regulation becomes impaired to a degree which may worsen their depressive symptoms. I wrote an article on sleep extension techniques and although the article is directed toward performance, the practical recommendations and information pertain to this discussion. If you really want to go down the rabbit hole on recovery modalities and sleep you can check out my other article on optimizing recovery.

Earlier in the article I discussed the utilization of health services and potential barriers to access. Although various obstacles can exist (ie. geography, financial cost, poor education, etc.) a significant barrier is the relationship a clinician has with their client. In fact this relationship is a meaningful driver of patient results. A paper titled Evidence-Based Therapy Relationships: Research Conclusions and Clinical Practices identified various qualities that were detrimental to the patient’s treatment which are as follows (86):

 

  1. ​​Confrontations. Controlled research trials, particularly in the addictions field, consistently find a confrontational style to be ineffective. In one review (Miller, Wilbourne, & Hettema, 2003), confrontation was ineffective in all 12 identified trials. By contrast, expressing empathy, rolling with resistance, developing discrepancy, and supporting self-efficacy, characteristic of motivational interviewing, have demonstrated large effects with a small number of sessions (Lundahl & Burke, 2009)

  2. Negative processes. Client reports and research studies converge in warning therapists to avoid comments or behaviors that are hostile, pejorative, critical, rejecting, or blaming (Binder & Strupp, 1997; Lambert & Barley, 2002). Therapists who attack a client’s dysfunctional thoughts or relational patterns need, repeatedly, to distinguish between attacking the person versus her behavior.

  3. Assumptions. Psychotherapists who assume or intuit their client’s perceptions of relationship satisfaction and treatment success are frequently inaccurate. By contrast, therapists who specifically and respectfully inquire about their client’s perceptions frequently enhance the alliance and prevent premature termination (Lambert & Shimokawa, pp. 72–79, this issue).

  4. Therapist-centricity. A recurrent lesson from processoutcome research is that the client’s observational perspective on the therapy relationship best predicts outcome (Orlinsky, Ronnestad, & Willutzki, 2004). Psychotherapy practice that relies on the therapist’s observational perspective, while valuable, does not predict outcome as well. Therefore, privileging the client’s experiences is central.

  5. Rigidity. By inflexibly and excessively structuring treatment, the therapist risks empathic failures and inattentiveness to clients’ experiences. Such a therapist is likely to overlook a breach in the relationship and mistakenly assume she has not contributed to that breach. Dogmatic reliance on particular relational or therapy methods, incompatible with the client, imperils treatment (Ackerman & Hilsenroth, 2001).

  6. Procrustean bed. As the field of psychotherapy has matured, using an identical therapy relationship (and treatment method) for all clients is now recognized as inappropriate and, in select cases, even unethical. The efficacy and applicability of psychotherapy will be enhanced by tailoring it to the unique needs of the client, not by imposing a Procrustean bed onto unwitting consumers of psychological services. We should all avoid the crimes of Procrustes, the legendary Greek giant who would cut the long limbs of clients or stretch short limbs to fit his one-size bed.

The researchers made several important conclusions that are highly relevant to an individual seeking mental health services, which are as follows:

 

  1. The therapy relationship makes substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment.

  2. The therapy relationship accounts for why clients improve (or fail to improve) at least as much as the particular treatment method.

  3. Practice and treatment guidelines should explicitly address therapist behaviors and qualities that promote a facilitative therapy relationship.

  4. Efforts to promulgate best practices or evidence-based practices (EBPs) without including the relationship are seriously incomplete and potentially misleading.

  5. Adapting or tailoring the therapy relationship to specific patient characteristics (in addition to diagnosis) enhances the effectiveness of treatment.

  6. The therapy relationship acts in concert with treatment methods, patient characteristics, and practitioner qualities in determining effectiveness; a comprehensive understanding of effective (and ineffective) psychotherapy will consider all of these determinants and their optimal combinations.

These findings demonstrate the significant role of clinician/patient relationships in the success or failure of an intervention. Therefore it’s important for anyone seeking therapy to ensure they “vibe” with their clinician so to speak. I can attest to the importance of this dynamic through personal experience. I have complex dissociative PTSD. A while back I started using an online service called Better Help. Their mission is “Making professional therapy accessible, affordable, and convenient — so anyone who struggles with life’s challenges can get help, anytime and anywhere”. My personal experience has been great, and the therapist I’m currently working with is an excellent fit for what I need. However, when I first started I went through three separate therapists in order to find the one I’m currently working with. As mentioned earlier in the article if an individual has a bad first experience they are likely to terminate further support. Therefore I strongly recommend you keep this in mind when exploring potential clinicians to work with. It may require a few attempts before finding the right clinician and intervention for you. 

 

In closing, I hope you enjoyed the article and gained a new level of awareness regarding the issue of men’s mental health. I also hope you find the resources I’ve provided helpful, and would encourage you to continue to pursue the subject, learn, and grow. If you have any additional questions you can always reach out to me personally via Instagram @daniel_debrocke. I’m not a clinician but I’m happy to help in any way that I can including assisting you in finding an appropriate resource. Good luck!

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