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15 therapists share the simple, but profound, differences between their male and female clients

"Older men will often complain of physical pain when they really have depression."

A therapist working with a couple.

Although it’s important not to stereotype people based on gender, therapists can’t dismiss the critical role it plays when working with clients. Whether it’s the way men and women are socialized, with men being more likely to repress their feelings and women being pushed into being people-pleasers. Or, if it's the fundamental genetic and hormonal differences that separate the sexes, therapists have to take gender into account when working with their clients.

The interesting thing is that, these days, there is a growing gender equality in mental health. For years, women were more likely to get help from a therapist, but the number of men looking to get help for their mental health has been on the rise. This change is essential given the fact that men are four times more likely to die by suicide than women.


Therapists gain a unique insight into human nature, so it’s interesting to learn the psychological differences they’ve noticed between the sexes. A Reddit user recently posed a question to the AskReddit subforum: “Therapists of Reddit, what are some differences you've noticed between male/female patients?” and the therapists shared the differences and similarities they’ve noticed.

It’s worth noting that for this article, non-binary people aren’t mentioned, because they weren’t highlighted in the Reddit discussion. But that doesn’t mean that their unique psychological profiles are any less important than those of men and women.

Here are 15 of the most intriguing differences that therapists have noticed between men and women.

1. Tough guy/Shocking girl

"I saw a lot of young men who really struggled and wanted help, but 'being cool/tough' was more important. If they felt vulnerable, they lashed out with inappropriate sexual or aggressive behavior. It was often really easy to see where young men learned that anger and violence would get them what they thought they wanted. The girls who struggled to be vulnerable would be avoidant, sarcastic, or try to shock me by telling me the awful things they had done or experienced."

2. Different delusions

"I was a therapist for people with psychosis and schizophrenia, if that counts? Men were more likely to have God delusions. (I am god, or God speaks to me). Women were more likely to have romance delusions. (Michael Jackson speaks to me, I'm Mary and I'm pregnant by a miracle.)"

3. Men don't choose therapy

"Men frequently schedule their first appointment because their wife or girlfriend strongly encouraged it. It’s more rare for them to reach out of their own volition."

therapy, psychologists, psychology, on the couch, men and therapy, male mental health A man talking with a therapist.via Canva/Photos

4. They open up in different ways

"For me, men opened up faster. The first visit or two might be super limited and then the floodgates open all at once. The women are more open at the start, but drop big details ways slower."

5. Older men and pain

"Older men will often complain of physical pain when they really have depression."

"Yeah, in the worst of my depression, it's felt as though my whole body is shutting down. Not sure how else to describe it."

6. Alexithymia

"Alexithymia was also much more common in males - that inability to identify emotions and therefore to explore them without professional support was absolutely crippling for many. (This was observed in session rather than as part of traditional/ structured research.)"

"I used to teach a social emotional learning module to young people (from about as young as kindergarten up to high school). It was just very basic stuff about how to recognize and manage your emotions in a healthy way. Half the time it was basic stuff like 'if you're angry, count to 10 instead of hitting your classmate.' We stopped offering it in part because so many dads got aggressive with our staff accusing us of essentially trying to 'make their sons gay.' Now I see the results of that sort of thinking all the time, adult men who filter everything through anger and aggression, or simply don't acknowledge or address their emotions."


therapy, mental health, psychology, psychologists, gender and psychology A woman receiving mental health help.via Canva/Photos

7. The train metaphor

"Men will whisper 'I’m not sure if I’m allowed to feel sad' after getting hit by a metaphorical train. Women will apologize to the train."

8. They're not really different

"I treat people with cooccurring substance abuse and mental health issues. After 20 years, I don’t think that I could really say. Everybody has underlying issues that drive behavior, so if they have trauma or a personality disorder or an anxiety disorder, everybody presents in a different way. It’s not really specific to gender. It’s based on your history, your coping skills, your insight and judgment into what’s going on."

9. Honesty vs. perfection

"My male clients come to therapy wanting solutions, action, structure, and for me (a woman) to tell it like it is. Over time, we almost always end up going very psychodynamic (lots of talking, open-ended guiding questions, raising awareness of relational/childhood stuff, behavioral patterns) and processing the deeper stuff that they didn't think was relevant or no one gave them space to talk about before.

My female clients are very high-performing, controlling, perfectionist, burned-out, and trying to perform therapy and healing in a perfect way. Over time, we end up working on self-acceptance, processing anger, boundaries, values-driven action, self-image, and raising consciousness on gender roles and capitalism. And actually feeling the emotions in addition to labeling and analyzing them."

10. They do breakups differently

"I work with a lot of college students and guys always take break-ups much harder and are more likely to cry about them."

"I heard a line from a comedian that made sense to me: 'Women take breakups so well because they breakup with you months before they tell you. That's why they want to be friends after. You're the dude that got her through her breakup with you.'"


therapist, female therapist, psychology, psychologist, mental health A therapist speaking with her client.via Canva/Photos

11. Safety vs. appreciation

"In most couples i saw as a therapist, the woman wants to feel emotionally safe while the guy wants to be appreciated for what hes doing. Also, most men don't seem to identify getting angry easily as emotional and only think crying is emotional. More men asked if they could be put on medication, and women preferred talk therapy."

12. Sense of self vs. sense of worth

"My male clients often struggle with their sense of self and masculinity, especially in relationships. There’s a lot of pressure tied to being the 'provider' or 'the emotional/stoic rock' in the relationship. Many were raised to believe that their value (or what they provide) is based on what they can materially/financially contribute, not on emotional presence. Vulnerability is often uncomfortable because they weren’t given the language or space to express it growing up.

With my female clients, I often see issues around self-worth, confidence, anxiety, people-pleasing, and difficulty expressing needs. Many grew up being taught to prioritize others and to equate self-sacrifice with goodness. That shows up in a lot of different ways, such as avoiding conflict, staying in unhealthy relationships too long, or struggling to set boundaries and enforce them."

13. Encouragement vs. attention

"I have learned that men need support and encouragement to thrive. Constant criticism is hard on a man; it causes him to lose his confidence, and in that situation, he has a hard time relating to his partner. Women, on the other hand, need attention. They need to feel seen and heard. They don't need to be understood as much as they need to feel heard. Women don't usually accept excuses. They want acknowledgment. When a woman is not feeling seen or heard. She doesn't feel loved and has a hard time relating to her partner."


therapy, psychologists, psychology, on the couch, men and therapy, male mental health A young man talking to a therapist.via Canva/Photos

14. Societal impacts on gender

"I've seen women whose life problems are frequently attributable to beliefs, events, and relationships that are derived from patriarchal society. Or women who struggle with making friends because they find it difficult to deal with the prevalence of social aggression in female friendships (particularly autistic women). Some also tend to overgeneralize their (reasonable) fear of what dangers men pose to them into avoidance of men, even when they want to be in a relationship. Some struggle with the attractiveness expectations towards women, either by failing to meet them and having the body image/self-esteem consequences, or by succeeding and then finding it difficult to navigate the consequent objectification by men (and women) in their lives.

In men, I've seen problems related to loneliness (lack of meaningful friendships), difficulties/disinterest in expressing emotions (to friends/partner), callousness in romantic relationships and views of women (likely encouraged by the manosphere internet), and fears of being a burden on society and their families (often reinforced by their wives or girlfriends' pressure on them). Some men's overgeneralized negative views of women (e.g., "they're too stupid/materialistic/shallow") lead to their problems in relationships across their families, friends, and partner."

15. Women get PTSD more often

"As a therapist, I also agree with this. At the end of the day, there were no inherent differences between genders in terms of the issues they were working on or how they approached therapy. The only slightly gender-skewed pattern I've noticed was in the frequency of PTSD diagnosis/symptomatology (more women). Differences between individuals that I've personally observed were more often related to other demographics than gender (such as cultural background for symptom presentation/approach to therapy: and age for the approach to therapy/therapeutic relationship part)."

A couple arguing before bedtime.

Just about everyone who has been married has been told countless times by older, more experienced couples that one of the most essential rules is, “Don’t go to bed angry.” They swear it’s best for a relationship to hash out the disagreement before bed and ensure it’s resolved before anyone gets any shut-eye.

That advice makes a lot of sense. It’s hard to get to sleep after fighting with your significant other. The argument keeps playing over and over again in your head. You may be angry. You may be hurt. That’s a bad position to be in, if you need to get your 40 winks.

However, making a big problem solvable by the time we go to bed is like watching a big family problem get fixed in 23 minutes on a sitcom. It's just not realistic. Some issues deserve more thought and conversation.


Dr. Alexandra Solomon, a licensed clinical psychologist at The Family Institute at Northwestern University and a clinical assistant professor in the Department of Psychology at Northwestern University, recently made the case that it’s “loving” to go to bed angry in the caption of a myth-busting Instagram post.



Dr. Solomon is also the host of the “Reimagining Love Podcast,” where she challenges some of the questionable messages we’re given about love and relationships.

“I’ve been a couples therapist for over a quarter of a century and I’m here to remind you that it’s OK to go to bed mad,” she wrote in the caption of a viral Instagram post. She adds that it can be “loving” to go to bed angry under the following circumstances:

  • You’re exhausted.
  • You don’t have privacy.
  • You’ve been drinking or using drugs
  • It’s late and you’re talking in circles
  • One of both of you has a big day tomorrow
  • You have little kids who’ll be up at the ass crack of dawn needing pancakes
  • You’re at risk of saying or doing something that you’ll regret because you’re upset and exhausted

couple fight, go to bed angry, conflict resolutionA couple fighting before bed.via Sasint/Pixabay

However, she also shared 5 reasons when it’s not OK to go to bed angry:

  • Not every night, not even lots of nights.⁣
  • Not to prove a point.⁣
  • Not to get the upper hand.
  • Not to punish your partner
  • Not to show your partner what a jerk they are

Dr. Solomon says being tired makes us more likely to make extreme arguments and be more hostile than when we are well-rested. She believes that when couples go to bed angry, they should do so consciously with their partners by calling a “time out” on the argument and acknowledging the difficult situation.

“This is a really hard conversation,” or “I think we both feel pretty hurt and misunderstood,” you could say before tabling the discussion for the following day. You can also perform a loving gesture, such as getting your partner a glass of water or squeezing their foot before bed to let them know you are still safe.



Relationship myths such as “don’t go to bed angry” can become a real problem for couples who fail to live up to what’s seen as the relationship gold standard. When couples violate the relationship commandment and go to bed angry, they blame themselves when really, they’re not doing anything wrong. Conflict is natural. So is being tired.

That’s why Dr. Solomon’s myth-busting, Disney-did-us-wrong approach is so important.

"We grow up on this study stream of fairytales, song lyrics and romantic comedies that give us a view of love that is simplistic and unrealistic," says Dr. Solomon told Parade. "Then, when we bump into problems and challenges in our own lives, we end up feeling like we are the problem, rather than the myths being the problem."

cvouple fight, conflict resolution, relationshipsA couple fighting before bed.via RDNE Stock project/Pexels

Ultimately, relationships are complex, and myths such as “don’t go to bed angry” and the “happily ever after” story we’re told as children give us a false impression about what love and true partnership are all about. Then, when we fail to meet those expectations, we find fault in ourselves and our partners.

"Going to bed mad is painful enough on its own," Dr. Solomon says. "It feels lonely. It feels yucky. To add another layer of shame—[that] somehow this is wrong, I'm wrong, you're wrong, we're wrong—makes a hard thing harder."

Dr. Solomoan wants us all to realize that relationships are complex. So there’s nothing wrong with giving each other a break and sleeping on it for a night.


Therapist gives hilarious advice on how to mess with your therapist.

A therapist on TikTok is wreaking havoc with his advice to clients, putting out information that could be detrimental to the mental health of therapists everywhere. OK, I'm being melodramatic, but from the comments, you can see he's at least giving them a few heart palpitations.

Jeff Guenther, who goes by Therapy Jeff on TikTok, is a licensed professional counselor (LPC) who not only owns a successful private practice and a therapist directory for clients called Therapy Den, he also creates content on TikTok. In one of his latest videos, his sense of humor is on display, which could be debated by those affected.

It's all in good fun, messing with his global colleagues by telling clients exactly how to prank them. Yup. A therapist is giving away the code on how to mess with your therapist in session and I have to say, as a therapist, my heart would skip a beat or four if a client did any of these things. But then, we would have a good laugh, so it seems like a pretty harmless prank.


In case you were unaware, your therapist probably has anxiety and if they don't, pulling this trick will likely induce it. Guenther tells his 2.4 million followers, "Three ways to mess with your therapist," before listing them off. The first one being to start the session with, "Well I did exactly what you told me to do," before telling his viewers to watch the therapist have an internal freak-out trying to remember what they told you to do. Come on, Jeff. That's just not nice.

Of course, therapists jumped into his comments immediately. One commenter said, "As a therapist myself, please don't do this lol," complete with a nervous smiling emoji. Another therapist chimed in with, "I am a psychologist. I would CRUMBLE." While many comments were fully in support of these hijinks, one person replied, "Sir, my therapist is trying to help me. Only one of use can be unhinged…"

Guenther is clearly trying to create a situation where the client is reminding the therapist how to handle an anxiety attack. Check out his other ways to cause your therapist to panic, below:

More

Feeling hopeless? A therapist explains why you might be grieving the state of our world.

Even without seeing tragedies firsthand, it’s still likely that most of us are grieving.

Last Sunday night, my fiancé and I went to an early evening viewing of "Ghostbusters."

We grabbed our snacks, settled into our seats, the lights dimmed, and then the standard pre-movie reminder about "noticing which exits are around you in case of emergencies" was announced. And I felt a wave of panic grip me.

"What on earth is this about?!" I thought to myself shakily.


Taking some deep breaths, I put on my therapist hat and suddenly remembered 2012’s "Dark Knight" shooting in Colorado and 2015’s "Trainwreck" shooting in Louisiana.

Photo by Kevork Djansezian/Getty Images.

My panic was tied to a subconscious fear of being in danger at a movie theater.

It was a very real stress response to the seemingly endless violence and tragedy I've been seeing on the news.

And it was especially poignant for me after watching mass shootings on the news in recent years and the past few weeks, many of which have taken place in otherwise "safe," contained environments like dance clubs, concert venues, cafés, McDonald's, traffic stops, and churches.

In fact, scientists now know that this is pretty common. Being exposed to violent news events via social media can cause us to experience symptoms similar to post-traumatic stress disorder (PTSD).

According to a 2015 paper from The British Psychological Society:

"Social media has enabled violent stories and graphic images to be watched by the public in unedited horrific detail. Watching these events and feeling the anguish of those directly experiencing them may impact on our daily lives."

This phenomenon is called "vicarious trauma."

It is something that helpers like psychotherapists, social workers, doctors, and aid workers (among others) often deal with as an occupational hazard from being exposed to the repeated violent or traumatic stories of those they serve.

But because of everyone’s constant exposure to terrible events on the news these days, all of us are at a heightened risk for experiencing vicarious trauma, no matter where we are.

So those feelings you have after watching the news these days? The numbness, the apathy, the persistent anxiety, the intrusive thoughts, the feelings of hopelessness and helplessness? Those are all normal. You’re probably experiencing grief.

"Vicarious grief" might look familiar to you because you've probably seen the stages of it in your news feed: denial, anger, bargaining, depression, and acceptance.

This five-step process of grieving is sometimes called the Kübler-Ross model after the pioneering grief work of Swiss psychiatrist Elisabeth Kübler-Ross, M.D. And now, social media has given us all a way to see and express our individual and collective grief in public.

Photo via iStock.

Here’s what I mean:

Scrolling through our feeds, we’ve all inevitably seen people express sentiments of shock, disbelief, and denial about yet another mass shooting, another incident of police brutality against unarmed black men, another horrific hostage situation, or a frustrating election cycle.

Denial can be seen when hashtags emerge and trend; shock is expressed, and disbelief is shared.

Anger, the second stage of grief, can be seen when a social media wave of anger breaks across our smartphones and laptops. We see and feel anger over someone who was taken away too soon from us, and we feel anger that we live in a world where traumatic news weeks are the norm, not the exception.

Changing profile pictures and banners, sharing and signing petitions, making donations and sharing articles of thought leadership — all of this can allow us to use social media take some kind of action, however small. For many of us, this can help to counter the inevitable feelings of helplessness and hopelessness these traumatic events can trigger. This, in essence, is bargaining — an attempt to take action to avoid encountering bad things again.

And as for depression and acceptance? Perhaps these stages of grief are less visible online. Often, depression can look more like what you might be feeling this week — perpetual feelings of apathy, numbness, and hopelessness. Perhaps depression looks, for you, like avoiding all media consumption. Or maybe it even looks like an increased sense of irritability and weariness in your own life.

As for acceptance, it’s debatable whether or not that’s even possible online or off these days given the never-ending series of tragedies. My hope is that we’ll get there.

Grief — whether online or off — is not clear cut. It’s not compartmentalized.

The people who were present at a traumatic event will experience grief and trauma differently than the rest of us will as secondary witnesses.

But without seeing an event firsthand, it’s still likely that most of us are grieving the tragedy, terror, and loss of direction that is 2016. You are allowed to have, and to share, those feelings.

Plus, grieving online is a new phenomenon: It is complex, multilayered, and often unconscious, and it looks far more like a tangled wire ball than a linear line of conscious emoting.

So what’s to be done, then, about the state of things?

We live in challenging, hyper-connected times. Social media is at the core of many of our interactions, if not constantly in our hands.

What’s the balance to strike when it comes to using social media to stay informed and to grieve in this new digital age while being mindful of how strongly this can affect our own emotional well-being?

As a therapist, I’d like to recommend that you practice self-care, get support from those who love you, seek out help from professional mental health experts when you need it, and remember that watching these events from afar can affect you.

As you work through your own grief, as you make your way toward acceptance, as you take action against the difficult things you’re seeing, and as you scroll through Facebook before bed, please take very good care of yourself, online and off.

Feel what you feel. Share what you need to share. You are worth it.