Therapy for guys: what it's like and how to start
Therapy is a conversation with a trained professional, and you don't need to be in a crisis to try it. This post covers what it usually involves, the common types, what it can cost, and how to find someone. It's general information, not medical advice, and it can't tell you whether you need treatment. A doctor or licensed clinician can.
If you're in the US and you're in crisis or thinking about suicide, call or text 988 (the 988 Suicide & Crisis Lifeline, free, 24/7), or call 911 in an emergency.
What therapy is
The US National Institute of Mental Health (NIMH) uses "psychotherapy," also called talk therapy, for a group of treatments that help people recognize and change distressing emotions, thoughts and behaviors. It usually happens one-on-one with a licensed professional, or in a group. It can be used alone or alongside medication.
Therapy isn't only for diagnosed conditions. The NHS in England says you don't need a diagnosed mental health condition to use its talking therapies. The NHS lists problems such as low mood, worry, depression, anxiety, phobias, OCD and PTSD, and coping with long-term conditions. You can also just be unsure what's wrong and want to talk it through.
Who does it
NIMH lists several kinds of professionals who offer psychotherapy: psychiatrists, psychologists, social workers, counselors and psychiatric nurses. Credentials differ by state and country, and prescribing rules differ with them. NIMH suggests asking "Is this therapist able to prescribe medications?" if that matters to you.
What a first session is like
Practices vary, so treat this as a general picture, not a script.
- There's usually a conversation before any treatment starts. NIMH describes a preliminary conversation, in person, by phone or virtually, to help you decide whether the therapist is a good fit, and says "rapport and trust are essential."
- An assessment comes first in some services. The NHS says that before CBT you have an assessment where the therapist asks about your symptoms and goals, and then recommends a treatment, which may or may not be CBT.
- You set the pace. Nothing requires you to have a clear problem statement. "I've been stressed and can't shake it" is a reasonable start. A common piece of advice is to jot down two or three things you want to cover beforehand.
- Confidentiality gets explained. NIMH lists "Are meetings confidential?" and "Are there limits to confidentiality?" among the questions to ask. Asking early is a common approach.
It can feel awkward. Talking to a stranger about your life is unusual. How it feels varies. Some people settle in quickly and others take longer, and either is information about what suits you.
The main types
Therapists may use one approach or combine several, per NIMH. Descriptions below come from NIMH and the NHS.
| Type | What the sources say it is |
|---|---|
| Cognitive behavioral therapy (CBT) | Identifying inaccurate or harmful thinking, questioning it, and changing self-defeating patterns. The NHS says you usually have between 5 and 15 sessions, depending on what it's for, and practice skills between sessions |
| Exposure therapy | A type of CBT used for anxiety. You practice tolerating feared situations until the fear goes down over time (NIMH) |
| Counselling | Exploring your thoughts and experiences to find your own solutions (NHS) |
| Interpersonal therapy | Focuses on relationships and how past experiences affect them (NHS) |
| Guided self-help | A workbook or online course with a therapist, based on CBT principles; often offered first (NHS) |
| Mindfulness-based therapy (MBCT) | Mindfulness techniques to notice thoughts and feelings as they happen (NHS) |
NIMH says evidence-based therapies have research showing they reduce symptoms of conditions like depression and anxiety, and suggests asking a therapist what approach they'll use and what its evidence base is. It also notes that psychotherapies don't go through the same formal approval process as medications.
What it costs, and ways to lower it
Costs differ a lot by country, provider and insurance, and a blog can't quote a price for your area. NIMH suggests asking each provider about fees, whether they accept insurance, and whether they offer a sliding scale. Places it names for finding providers include:
- university training clinics
- state or county health departments
- your insurance plan's provider list
- professional organization directories and advocacy group locators
In England, the NHS says you can refer yourself to NHS talking therapies for anxiety and depression without seeing a GP, if you're registered with a GP and 18 or over (16 or over in some areas). It also notes therapy is sometimes available free through an employer, university or local charity, and that private therapy is an option, where you should check the therapist is registered with a professional body accredited by the Professional Standards Authority.
How to find someone
- Start with a primary care provider if you like. Many people do, since a doctor can refer you, and NIMH says being examined by a health care provider first can help rule out a physical health issue.
- Use a directory. In the US, SAMHSA runs findtreatment.gov. NIMH says it doesn't evaluate the qualifications of individual practitioners listed in directories, so check credentials yourself.
- Book a short intro call where offered. Ask what the therapist's specialty is, how they work, how long they expect treatment to take, and how progress is measured.
- Give it a few sessions, then decide. NIMH says if you've been in therapy for what feels like a reasonable amount of time and aren't getting better, talk to your therapist, and that you might explore other professionals or approaches. Switching is allowed.
Why guys sometimes skip it
NIMH says men are less likely than women to have received mental health treatment in the past year, and that certain symptoms may be more common in men. Among the common symptoms it lists for men are anger, irritability or aggressiveness, misuse of alcohol or drugs, and engaging in high-risk activities, alongside sleep changes, trouble concentrating and physical aches without a clear cause. Those are group-level patterns from one source, and plenty of men have a different experience.
Practical hurdles come up, such as cost, time, not knowing where to start, and not being sure it'll help. Those are fair concerns, and there are alternatives: self-help, a support group, or talking to a friend. Therapy isn't the only option, and it isn't required for everyone. It's one tool, and a reasonable one to try if something has stuck around.
How it connects to dating and social life
Some people go to therapy specifically for anxiety around meeting people, rejection, or a breakup. NIMH describes exposure therapy for anxiety disorders, and teaching social and communication skills, as part of what therapy can include. See social anxiety or shyness, fear of rejection, getting over a breakup and loneliness in your 20s for what those can look like. Dating burnout covers when to take a break.
What to do next
- Write down what's been bothering you and for how long, in three or four lines.
- Pick a route: your primary care provider, an insurance list, a university clinic, or findtreatment.gov (US). In England, look up NHS talking therapies self-referral.
- Make a short list of three providers and book an intro call with each, if offered.
- Prepare a few questions drawn from NIMH's list: their credentials and experience, their approach, whether they suggest a time frame, how progress is assessed, and confidentiality. Add fees and insurance.
- Commit to three sessions, then check in with yourself: do you feel heard, and do you know what you're working on?
- If it's not a fit, tell the therapist or switch. That's a normal part of the process.
- If you're in crisis, call or text 988 now. Don't wait for an appointment.