Some Rights Reserved by Travis Hightower at Flickr

I spent years in therapy, depressed the whole time, perhaps getting a temporary lift, but quickly losing whatever short-term benefit it may have provided. Apparently, this is a common experience for men, and usually the problem is traced back to the difficulty many men have in expressing feeling. They’re not comfortable with emotions, resist therapy and won’t let it work, even if they give it a try.

For the most part, I’ve accepted that explanation. Even though I had many doubts about the different types of therapy I had tried, I well knew that I had never really let the therapists see everything going on in my emotional life. I had rarely found therapists (luckily there were a couple of wonderful exceptions) who were willing to discuss, let alone rethink, their own approaches in any depth. The guiding assumption: We know this form of therapy works. It’s all up to you.

It was startling, then, to read an entire issue of a professional magazine devoted to the question: Why aren’t therapists more effective with men? The editors start with a couple of facts. Only a third of all psychotherapy clients are men, and that can’t mean they have fewer emotional problems than women do. They also regress after treatment much more often than women. So what’s wrong with what we in the psychotherapy community are doing?

I’d never heard therapists evaluating their own methods and suggesting that the reactions of men, though obviously not good for them, weren’t all that surprising. Yet that’s what these articles are all about. They find that many in the profession don’t really know how to respond and adapt to the needs and styles of men.

Writing in the latest issue of Psychotherapy Networker, four therapists describe the psychological dynamics that guide many men and offer examples of the techniques they’ve used to create more responsive and effective therapeutic experiences. The articles don’t talk specifically about depression, but many of the ideas are particularly relevant to depressed men. While all these articles are full of interesting insights, I found one especially helpful.

David Wexler, in Shame-O-Phobia: Why Men Fear Therapy, focuses on two critical dimensions in the lives of many men.

First is the effect of shaming experiences men often have in childhood at the hands of parents and others whose support and respect they most need:

A shamed boy becomes a hypersensitive man, his radar always finely tuned to the possibility of humiliation. His reaction to slights—perceived or real—and his ever-vigilant attempts to ward them off can become a kind of phobia. Tragically, the very men who are most desperate for affection and approval are the ones who usually can’t ask for it: instead, they project blame and rejection and perceive the worst in others.

The second dimension is what he calls the “broken mirror.” By that he means the need of people with inner shame to gain approval from others in order to feel good about themselves. Those reactions – imagined or real – assume tremendous psychological importance. Getting approval is a desperate need, losing it a devastating experience.

Shame-driven fear and the impact of mirroring make therapy difficult because it asks such men to do something they already know they don’t do well. Since it’s geared toward disclosing emotion, therapy can seem designed to meet the needs of women who are often more comfortable expressing and talking through feelings. The environment doesn’t feel safe to a great many men.

Wexler believes that emphasizing the need for emotional openness from the start of therapy only plays into the fear of failure. To make therapy more welcoming to men who are skeptical and nervous about it, he recommends to other therapists several methods that have worked in his practice.

Here are of some drastically edited summaries of these techniques.

Destigmatize Self-Disclosure: Therapeutic self-disclosure can be an effective way to reduce avoidance and defensiveness by nipping shame in the bud. … I often tell men stories about times I’ve yelled at my kids, said nasty things, and stupidly overreacted to them. I tell men about the many times I’ve stubbornly insisted that my wife and I do something my way without really thinking through how this would affect her. … I reassure them that self-revealing will not lose them my esteem or confirm their worst fears of what will happen if they let down their guard. This is destigmatizing.

Permission to Disclose Gradually: In the beginning of therapy, it’s … important to give men permission to disclose gradually. It’s easy for therapists to get impatient when men take a while to warm up to the counseling experience. Often I’ll treat a man who initially minimizes the mistakes he’s made, blaming everyone else—his wife, his kids, his girlfriend. I don’t mess with this at first, because I know he needs to do this until he feels safer and more confident that he’ll get a fair shake in my office.

Provide Specific Plans: Since many men feel anxious about what they perceive as the vagueness of the whole therapy process, give them as much concrete information as possible. Tell them exactly how long the sessions are, what the length of therapy might be, the role you can and can’t play, and what’s expected of them to get therapy right. Offer homework, action plans, and the rationale for using them, since men’s needs and learning styles favor direct, clearcut explanations and instructions. I’ve found this valuable with almost all the men I see.

Clear, Brief Assignments with Time Limits: Recently, one of my male clients told me that his son had complained that he was making that “angry face” again—and my client had no awareness of it. The instant homework assignment: “Ask everyone in your family to let you know every time they notice your angry face or angry voice, and tell them that this is a direct assignment from your therapist.” He understood the rationale: you need feedback to improve performance. And he liked the clarity of the task.

Another problem comes up when men are urged to begin discussing their feelings and relationship issues with their partners. Many men delay this because they’re afraid it will turn into unbearable marathon sessions. So Wexler suggests setting a limit. “When you talk about this issue at home, set an alarm for 10 minutes. Discussion ends then, no matter what.”

Recognize Heroism: I tell men that, every day, they have an opportunity to give to their loved ones, including their kids, a man who’s generous, empathic, and honorable. A man can choose to inform his partner about what he’s feeling, rather than just withdrawing or acting out. I call this, or any of a thousand other “unnatural” pro-relationship behaviors, an act of genuine heroism. To choose a path that’s hard, unfamiliar, awkward, and even frightening—but which is more in keeping with what really matters to them—takes the kind of courage and resolve that characterizes, well, real men. … Men perk up when I implore them to act like heroes or reward them for doing so—rather than simply telling them to be more sensitive or more accommodating.

The goals of therapy remain the same, but these adaptations can make the experience much more approachable for many men. I’m not so sure, though, that they would have worked for me when I was trying hard, often quite unconsciously, to defend against revealing my deepest feelings. It was so unthinkable to let myself go that often I wasn’t even aware of what I was doing. Looking back, I realize I intuitively resorted to strategies designed both to seal off spontaneous emotion and to win the approval of the therapist. In my case, Wexler gets it right. Shame-driven fear and broken mirrors guided me all the way.

Adapting therapy, as Wexler suggests, to help resistant men open up is certainly a good idea. But a therapist can only do so much. A lot of depressed men like me can outmaneuver any number of sound methods. Getting lasting benefit from therapy is still up to me.

Some Rights Reserved by AngelsWings at Flickr

Do you think it’s possible to be going through some phase of depression and have your emotions so locked away inside you that you don’t notice a thing? I’ve written about feeling anger and rage and never associating those feelings with depression, though they were tightly bound together. But here I’m thinking of an earlier time in my life – mostly in high school and college.

Through the teenage years, I sealed all feeling up tight. I guess that was an extension of childhood and being one of those kids teachers admired as so precocious, so adult. The other kids might rage, cry, scream where I would analyze and shake my head at their childish behavior. That distancing got more extreme as a teenager. I didn’t show anything but mildly friendly feeling to anyone. I did feel things deeply, at least fear, anxiety and anger – but these were no-shows externally. I was calmly cheerful most of the time. There was a mask in place, and the only symptom I thought I had were frequent migraines. But that was something inherited from my mother. I knew that because she explained it to me as she lay on the sofa sinking fast into her own depression. I would grow out of that, she said.

There was a gradual loosening up in college when my life seemed to make up some rather amusing anecdotes. I remember laughing off the splintering of my family – Mom staying in New York, Dad off to Florida and the Bahamas, my brother first to the Bahamas, then as far away as he could get – to Australia, (where he still lives) and I to college, never to return to anything like a home.

I would toss off things like that and laughingly move on to the next story. Of course, there were odd things going on too. I had a great interest in acting, but if I couldn’t perform in front of a group, I was lost in what would now be called social anxiety. Back then I called it agony. A screen went up in dealing with even a handful of people I didn’t know. I froze, projecting judgment, condemnation, contempt for me into the first glance of a new person. I seemed cut off by an invisible membrane of pure tension. And naturally, if I could say anything at all, words would be shaped out of the anxiety waves emanating from me. They often made no sense or were some inept joke – I usually felt I wasn’t the one talking. It was the idiot I had already planted in the new person’s mind who carried my name, my face.

Going to parties, especially the arranged mixers between men’s and women’s schools, provided opportunities for total humiliation. I often took advantage of those. The guys would usually arrive first and take up their watchdog stations in some common-room where these encounters took place. A moment would arrive when the young women would march in the door, often in single file and be picked off by the waiting marksmen. Little time to choose, just get to your choice before anyone else did. At one of these, I lurched at an appropriately good-looking blond and proceeded to mash suitably intellectual references into my smalltalk. We were doing OK, that is, I wasn’t assuming an English accent or otherwise going into deep disguise, when she suddenly suggested going for a walk. Aha! What else were these events all about but getting off into a secluded spot for some action.

What she really wanted to do, though, was to play squash. That made sense since she was freshman crew and screamed fitness through every pore. I, however, did not. In fact, sports involving round projectiles speeding in my direction seemed rather hostile. Having the eye-hand coordination of the Hulk and the depth perception of a Cyclops, I was a little off my game – any game, at any time. I also had a way of getting strangely entranced by the sight of a ball heading right at me. More than once I would just watch that thing get bigger and bigger and then – thwack. For example, I took my first tennis serve in the throat.

Squash uses a very nasty hard little ball that shoots around at light speed. This was not promising, but I dutifully took up my position in the court, my confident party mask beginning to crack. Smiling, the blond crew captain launched the ball, and I watched it rocket off the far wall and then disappear behind me where it hit another flat surface, bounced fiercely and punched me in the back. Meanwhile I had sifted the air nicely with a marvelous swing. OK, this happened a second time, though the ball didn’t hit me, and she graciously suggested that it might work better if I served. Sure, I said.

On the second swing I triumphantly connected, only to see the rubber bullet blast through that very spot in the air where my partner’s head had been before she hit the floor. It was now a huge effort of will to keep my mask in place, though a smile, even a little laugh came through, as the blond athlete suggested that a game of pool might be better. We walked off the court to the snickers from the gallery above of two of my roommates who had wandered in. I was immersed, even drowning in shame and humiliation, but still the brave, only slightly reddened face spoke no feeling except a bit of self-deprecating amusement. “I guess it’s not my thing,” I smilingly managed to say.

What I came to understand later on was that it took a vast amount of energy and willpower to keep the natural feelings and reactions bottled and capped. And another burst to construct and keep in place the persona I needed to project to the world. While I was doing this, I was always thinking: Oh, this is just an act. Wait till they see what I’m really like. Of course, I didn’t really know the extent of all I was keeping hidden. That included a lot of pain, hurt, grief, anger that I was not even aware of. After a while, I had to face the fact that I had become a concealed person and couldn’t just put a mask aside. There was too much at stake – it was too risky to relax. Nor was I aware of everything in me that was trying to push that mask aside forever.

How does that painful emotional history break through to consciousness so that at least you start to know there is plenty to work on? What can produce that shock of recognition that begins the process of recovery?