The female-dominated industry is built on shaky evidence and fraught with devastating outcomes. What if we invested in wellness that actually works for men?
This is such a timely and thought-provoking piece that challenges a deeply embedded assumption in our culture: that therapy is always the default solution. I particularly appreciate the courage to question outcomes, not just intentions, and to ask whether current approaches are genuinely serving men...
The emphasis on community, physical activity, purpose, and real-world connection feels especially important. These aren't “alternatives” in a lesser sense; they are foundational to human wellbeing, and often align more closely with how many men process life and build resilience. Here I also credit Tom Golden and John Barry and so many other people of goodwill, who we stand upon the shoulders of to see reality more clearly.
At the same time, I think there’s an opportunity to continue refining this conversation by distinguishing between where therapy can help, and where broader social and cultural interventions may be far more effective. It’s not about rejecting support, but about designing it to be much better (and very different)...
Overall, this article is a valuable contribution that pushes us toward a more balanced, evidence-based, and human-centred approach to men’s wellbeing. One that meets men where they are, rather than trying to reshape them to fit a system.
Thank you Emma, for offering the beacon of hope and a vision to move forwards constructively.
Clinical psychologist here and director of our clinical training doctoral program here at USC. Although you make some great points in this piece, there are also a lot of distortions of the evidence base. First of all, there's quite solid meta-analytic evidence for the efficacy of psychotherapy to relieve symptoms; a course of CBT works about as well as an antidepressant, and with fewer symptoms. Exposure therapy for anxiety can cure panic, agoraphobia, and social anxiety better than any medication and is the gold standard frontline treatment. Second, this piece conflates talk therapy with the overprescription of antidepressants and other medications. This is almost the opposite of the actual state of affairs. Most talk therapists don't prescribe (unless they are MDs, and very few MDs do talk therapy these days), and psychotherapy is an alternative to medication that is often underutilized. Most psych meds are prescribed by primary care doctors who don't have extensive mental health training. Therapy is often just as effective in the long-run and doesn't have the costs and long-term dependency risks. I also disagree that psychotherapy was created by women for women; most treatments were originally developed by men and the mental health workforce used to be overwhelmingly male. I agree that it is way too female-dominated now but that's largely because men are reluctant to enter what is now considered a 'feminized' profession.
Agree I could have done a better job detailing the therapist<>Rx relationship, but you know as well as anyone (I hope!) the influence psychoanalysts have on the psychotropic drug industry and client habits.
Darby, your pat dismissal of the widespread criticisms of the talk therapy industry are remarkable to me. Do I understand you believe the status quo is good/acceptable?
I'm not sure what you mean by the 'status quo,' or what you mean by the 'talk therapy industry.' Certainly talk therapy is less of an industry than the pharmaceutical industry, which has pushed its treatments very aggressively despite evidence that many of them are less effective than psychosocial interventions like talk therapy.
There is definitely a proliferation of different providers who subscribe to different schools of thought and theoretical orientations, and some are less empirically supported than others. When I talk about 'psychotherapy,' I'm talking about the evidence-based practice (EBP) movement, which is to say the therapies that are well-supported by research. I teach in a PhD program where we only train students in EBPs. Many of the practitioners in the community have master's level training or went to PsyD programs that aren't focusing on empirically supported interventions. So its very important for prospective clients to be discerning about their choice of provider and try to look for clinicians trained in EBPs.
Great piece Emma, I’m so pleased you are shining a light on this! My father is a retired psychotherapist. He always used to say that therapy isn’t right for everyone. I wonder how many of today’s psychotherapists would be as honest as my father and turn down a fee from someone who didn’t really need their help … Don’t get me wrong, I think therapy can be extremely valuable. However, this notion that we must all “do the work” on ourselves does strike me as being very effective marketing for an industry that has exploded in recent decades.
Thanks, Nick. I think the bigger challenge is that there is no way to control the quality of the therapy. The whole industry has gone off the rails, and was only vaguely evidence-based to start with.
I share your concerns. Especially about professional standards and regulation. I have limited insight and don't feel knowledgeable enough to say more on it, so will defer to you!
Yes, yes, yes!!!
This is such a timely and thought-provoking piece that challenges a deeply embedded assumption in our culture: that therapy is always the default solution. I particularly appreciate the courage to question outcomes, not just intentions, and to ask whether current approaches are genuinely serving men...
The emphasis on community, physical activity, purpose, and real-world connection feels especially important. These aren't “alternatives” in a lesser sense; they are foundational to human wellbeing, and often align more closely with how many men process life and build resilience. Here I also credit Tom Golden and John Barry and so many other people of goodwill, who we stand upon the shoulders of to see reality more clearly.
At the same time, I think there’s an opportunity to continue refining this conversation by distinguishing between where therapy can help, and where broader social and cultural interventions may be far more effective. It’s not about rejecting support, but about designing it to be much better (and very different)...
Overall, this article is a valuable contribution that pushes us toward a more balanced, evidence-based, and human-centred approach to men’s wellbeing. One that meets men where they are, rather than trying to reshape them to fit a system.
Thank you Emma, for offering the beacon of hope and a vision to move forwards constructively.
Clinical psychologist here and director of our clinical training doctoral program here at USC. Although you make some great points in this piece, there are also a lot of distortions of the evidence base. First of all, there's quite solid meta-analytic evidence for the efficacy of psychotherapy to relieve symptoms; a course of CBT works about as well as an antidepressant, and with fewer symptoms. Exposure therapy for anxiety can cure panic, agoraphobia, and social anxiety better than any medication and is the gold standard frontline treatment. Second, this piece conflates talk therapy with the overprescription of antidepressants and other medications. This is almost the opposite of the actual state of affairs. Most talk therapists don't prescribe (unless they are MDs, and very few MDs do talk therapy these days), and psychotherapy is an alternative to medication that is often underutilized. Most psych meds are prescribed by primary care doctors who don't have extensive mental health training. Therapy is often just as effective in the long-run and doesn't have the costs and long-term dependency risks. I also disagree that psychotherapy was created by women for women; most treatments were originally developed by men and the mental health workforce used to be overwhelmingly male. I agree that it is way too female-dominated now but that's largely because men are reluctant to enter what is now considered a 'feminized' profession.
Agree I could have done a better job detailing the therapist<>Rx relationship, but you know as well as anyone (I hope!) the influence psychoanalysts have on the psychotropic drug industry and client habits.
Darby, your pat dismissal of the widespread criticisms of the talk therapy industry are remarkable to me. Do I understand you believe the status quo is good/acceptable?
I'm not sure what you mean by the 'status quo,' or what you mean by the 'talk therapy industry.' Certainly talk therapy is less of an industry than the pharmaceutical industry, which has pushed its treatments very aggressively despite evidence that many of them are less effective than psychosocial interventions like talk therapy.
There is definitely a proliferation of different providers who subscribe to different schools of thought and theoretical orientations, and some are less empirically supported than others. When I talk about 'psychotherapy,' I'm talking about the evidence-based practice (EBP) movement, which is to say the therapies that are well-supported by research. I teach in a PhD program where we only train students in EBPs. Many of the practitioners in the community have master's level training or went to PsyD programs that aren't focusing on empirically supported interventions. So its very important for prospective clients to be discerning about their choice of provider and try to look for clinicians trained in EBPs.
Great piece Emma, I’m so pleased you are shining a light on this! My father is a retired psychotherapist. He always used to say that therapy isn’t right for everyone. I wonder how many of today’s psychotherapists would be as honest as my father and turn down a fee from someone who didn’t really need their help … Don’t get me wrong, I think therapy can be extremely valuable. However, this notion that we must all “do the work” on ourselves does strike me as being very effective marketing for an industry that has exploded in recent decades.
Thanks, Nick. I think the bigger challenge is that there is no way to control the quality of the therapy. The whole industry has gone off the rails, and was only vaguely evidence-based to start with.
I share your concerns. Especially about professional standards and regulation. I have limited insight and don't feel knowledgeable enough to say more on it, so will defer to you!