Does Therapist Gender Matter When Working With Men?

Exploring men's preferences for therapist gender, and therapists' gendered confidence working with men

Every time we present our research, whether it be for clinicians or the broader public, the same question rears its head: does therapist gender matter when working with men? Our studies have illuminated patterns and preferences among help-seeking men, and therapists who work with them.

What a guy wants

In our 2021 study published in Counselling Psychology Quarterly, we surveyed 2,002 Australian men about their preferences for therapist gender. The findings challenge common assumptions:

• The majority (60.5%) of men expressed no gender preference for their therapist

• Among those with a preference, nearly equal proportions preferred therapists who were men (19.1%) or women (20.4%)

What drives these preferences? For those preferring to see a man, the most common reasons were:

1. Feeling better understood by male therapists (26.2%)

2. Feeling more comfortable opening up to male therapists (45.8%)

Men preferring a therapist who was a woman cited:

1. Perceived greater empathy in these therapists, and feeling more comfort in opening up to women (69.2%)

2. Feeling less judged (14.7%)

Interestingly, specific demographic factors predicted preferences. Men who were undergraduate-educated, non-heterosexual, or identified more strongly with traditional masculinity were more likely to prefer to see a man. Meanwhile, men with severe depression more frequently preferred to be treated by a woman.

Perhaps most importantly, our research team found that men who saw a therapist matching their gender preference reported significantly higher satisfaction with therapy. The mismatch between preference and reality was mediated by feelings of emasculation – men felt "less manly" when working with a non-preferred therapist gender, contributing to lower satisfaction.

An untapped opportunity: Increasing representation of male therapists

Our findings on men's preferences are important considering the gender imbalance of the mental health workforce. In many Western nations, the psychology profession is predominantly female (Australia: 80% female; UK: 77% female; US: 65% female). This means that for the significant proportion of men who prefer a male therapist, options are likely to be limited. Given men often delay help-seeking until crisis point, the need to broaden the mental health workforce to meet all men's preferences is critical. This is especially important when considering our findings that men identifying more strongly with masculine norms (a group already at elevated risk for mental health challenges and suicide) demonstrated stronger preferences for male therapists. We must ensure when these men reach out, they are met with a system capable of meeting their needs.

How can we address this imbalance? Tertiary institutions could strategically recruit more men into mental health professions, with targeted initiatives to increase representation. This recruitment should emphasize the vital role male practitioners play in creating a diverse workforce that can respond to the preferences and needs of all clients. Increasing the representation of men in the helping and healing professions could also have intergenerational impact - communicating to young men that professions centred around empathy and care are not exclusively the domain of women.

The Therapist Confidence Gap

Our research has also highlighted that while men's preferences are important to understand, therapist confidence in working with men also has room for improvement. In our 2023 randomized controlled trial published in American Psychologist, we evaluated "Men in Mind," a training program developed by the Movember Institute of Men’s Health to enhance practitioners' competencies in working with male clients.

Among the most striking findings: women initially reported significantly lower confidence in working with men compared to their male counterparts. However, after completing the gender-responsive training, women’s confidence rose to match that of men in the field – with no significant difference between genders post-training.

How can we explain the shortfalls in confidence among female practitioners? Our 2021 research published in Journal of Clinical Psychology highlighted some of the unique challenges women can face when working with men. The therapy room is a clearly gendered environment, where women can often experience discomfort when trying to manage some men's anger or resistance to engage. In addition, some women described challenges when trying to relate to men's unique experiences of mental ill-health.

While this confidence gap might be concerning, we've shown that the right training and professional development can help to address self-efficacy issues faced by therapists. Given the current mental health workforce is predominantly made up of women, it is critical to roll out and scale up initiatives designed to improve confidence and competence to meet men where they’re at. With increasing numbers of men seeking help yet suicide rates continuing to rise, closing this confidence gap could be crucial for improving men's mental health outcomes while we simultaneously work to address the shortage of male practitioners.

Implications for Practice

Our research at the Movember Institute of Men’s Health points to several important considerations for mental health services:

1. Increase men’s representation: While training women in male-responsive care is essential, we must also invest in recruiting and retaining more men in the profession to ensure client preferences can be accommodated.

2. Explore men's preferences: Given 40% of men seem to have a preference for the gender their therapists, exploring men's initial preferences, past experiences of help-seeking and aiming to tailor therapy to best meet men's needs can be critical.

3. Address the confidence gap: Training programs like Men in Mind can effectively equip women with the skills and confidence needed to work effectively with male clients.

4. Consider masculinity dynamics: Men with stronger masculine identification tend to prefer to be treated by a man, possibly seeking to "masculinise" the therapy environment. Practitioners can reflect on how gender dynamics might influence the therapeutic relationship.

Improving men's help-seeking and retention in therapy requires a multi-pronged approach. We must build up the confidence of the mental health workforce to engage men; while also increasing the diversity of the practitioner workforce to ensure we can meet the preferences of all help-seeking men. The time is now: men are reaching out more than ever, and we must be ready to meet them on the other side.