therapy

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."

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."

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.'"

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."

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)."