Introduction
Most men who sit down in my room didn’t decide to come.
Someone made it a condition. A wife who said she couldn’t carry on like this. A GP who asked one question too many. A boss who noticed. Occasionally a brother who said the thing nobody else would say. The man arrives, sits down, looks at the clock, and says some version of: I’m not really a therapy person.
Fine. Neither were most of the men who ended up finding it useful.
November is Movember, when the moustaches come out and everyone talks about men’s mental health for four weeks. This post is about the part that gets skipped: not why men should go to therapy, but why they don’t, and what the hour actually involves if you do.
Therapy for men has an image problem in this country, and it isn’t helped by the way it gets sold: soft lighting, a box of tissues, a stranger asking how that makes you feel. That bears very little resemblance to the hour most men actually have.
The Number Behind This
South African men die by suicide at a rate roughly four times that of women. Some reports put men at close to 80% of recorded suicides in this country.
Sit with the shape of that. Women are more likely to be diagnosed with depression. Women make up the great majority of calls to helplines. And men are the ones dying.
What that gap tells you is not that men don’t suffer. It’s that a lot of male suffering never gets named, never gets counted, and arrives at a crisis without ever having been a conversation.
It Isn’t Simply Pride
The easy explanation is ego, and it’s too easy.
Researchers who study this describe a few specific things that make asking for help harder for men. One is how normal the problem seems: if you think almost nobody else feels like this, you assume something is wrong with you specifically. Male depression hides well, so every man in the queue at the hardware shop looks fine, and so does every man in your WhatsApp group.
Another is what the problem threatens. If your sense of yourself rests on providing and coping, then a problem that says you can’t cope isn’t a difficulty, it’s a demolition. Men will tolerate an enormous amount rather than say that sentence out loud.
The third is reciprocity. Men are far more comfortable in arrangements where help flows both ways. Therapy is one-directional by design: you receive, you pay, you leave. For a man used to being the one who helps, that’s an uncomfortable seat.
And then there’s the company you keep. If the men around you treat counselling as something for people who can’t hack it, that view becomes the water you swim in.
What It Looks Like in Men
Depression in men often doesn’t present as sadness, which is why it gets missed by everyone, including the man himself.
The anger is the part everyone notices. Shortness with the children. Rage in traffic that would have been irritation a year ago. A fuse that burns faster every month. Most men I see have been told repeatedly that they have a temper problem. Fewer have been asked what’s underneath it.
Then there’s the retreating. Longer hours at work, longer rides, longer scrolling, more drinking, more gambling, a hobby that has quietly become a place to disappear into. From outside it reads as being busy or distant. From inside it’s often anaesthetic.
The body carries a lot of it too. Sleep that stopped working. A back that hurts. Chest tightness that sends a man for a stress ECG, which comes back clear, after which nobody asks the next question.
And flatness. Not misery. Flatness: the sense of running on empty for a long time, doing the things, feeling very little about any of them.
A Word About Drinking
It needs saying, because in this country it is the default equipment for male feelings.
Beer at the braai, whisky after the kids are down, a bottle of wine that used to be shared and now isn’t. Very few men I see describe themselves as having a drinking problem, and a fair number describe drinking every evening to get the volume down. Those aren’t the same thing, but they live on the same street.
Two things worth noticing: Alcohol is a depressant, so the thing you’re using to manage the flatness is deepening it. And it reliably wrecks sleep, which is usually the first thing that needs fixing. If you’ve tried to cut back and found it harder than expected, that’s information rather than a moral failing, and it’s worth mentioning to your GP.
What Usually Brings a Man In
In my experience it’s one of a handful of things, and almost none of them is “I’ve been feeling low”.
A marriage at the edge. Often after the same fight on a loop for years, or after a wife has said something final. Sometimes it’s a marriage that has gone quiet rather than hostile, which men often notice much later than their partners do.
A crisis at work. Retrenchment, a business that failed, a year where the money didn’t come. In this economy that is a great deal of men, and the shame attached to it is heavy and rarely spoken.
A death. Fathers especially. Many men get through the funeral on competence, handling the admin and the arrangements, and fall over three months later with no idea why.
And his children. A surprising number of men come because they heard themselves speak to their son the way their own father spoke to them, and it frightened them. That one usually arrives as a single sentence, quite late in the session.
The Cost of Waiting
Men tend to arrive at the point where something has already broken, which makes the work longer and harder than it needed to be.
There’s also the part men underestimate most, which is what your children learn from watching you. A boy watching his father handle twenty years of pressure in total silence learns exactly how a man is supposed to do it. He will apply that lesson to his own life, at some cost, and you will not be there to tell him he got it from you.
Nobody is asking you to become a man who talks about his feelings at braais. The question is narrower than that: is the way you’re currently handling this working, for you and for the people in your house.
What the Hour Is Actually Like
Since the unknown does most of the resisting, here is the plain version.
You sit in a chair. Nobody lies on a couch. There’s no analysis of your childhood unless it turns out to be relevant, and no requirement to cry; plenty of men never do. You talk, I ask questions, and if you’d rather start with the practical problem in front of you rather than your inner life, that’s a perfectly good place to start.
It’s confidential, with the usual limits around safety. It has an end point; this is not a subscription for life. Many men come for a defined stretch, sort out what they came for, and leave. And it tends to be more practical than men expect, which is usually the thing that keeps them coming back for the second session.
Some men prefer online sessions, in the car between meetings or at home once the house is quiet. That works, and for men who don’t fancy sitting in a waiting room, it removes an obstacle that genuinely stops people.
What Men Say in the First Ten Minutes
Almost always one of four things.
“I don’t really know where to start.” Fine. Start anywhere; the order sorts itself out.
“This is probably stupid compared to what you normally hear.” It isn’t a competition, and the man who says this is usually carrying more than he’s admitted to anyone.
“I’m only here because of my wife.” Also fine. Plenty of good work has started from that sentence.
And the one that tells you the most: “I’ve never actually said this out loud before.” That often arrives around minute forty of the first session, after which the whole thing usually becomes easier.
If Someone You Love Is the One Not Going
Nagging rarely works here, and ultimatums work only sometimes.
What tends to work better is naming what you see rather than what you think he is. “You haven’t slept properly in months and you’re not yourself” lands differently from “you need help”. Make it specific, and make it about the problem rather than his character.
Practical help removes more obstacles than persuasion does: finding the number, offering to make the appointment, handling the school lift so the hour is free. And give it time. Men often say no, think about it for weeks, then book without mentioning the earlier conversation.
One more obstacle worth naming, because it’s practical rather than psychological: the hour itself. Most men work the hours therapists work, and taking a Tuesday afternoon slot means explaining an absence to someone. Early mornings, lunch hours and online sessions exist precisely for this, and it is worth asking rather than deciding in advance that it can’t be arranged.
If You’re Reading This at Midnight
If things are bad enough that you’ve wondered whether the people around you would be better off without you, please treat that as the emergency it is rather than a thought to ride out alone.
SADAG’s 24-hour suicide crisis line is 0800 567 567, and they offer free telephonic counselling on 0800 20 50 26 between 8am and 8pm. You can also phone your GP in the morning. None of that is a commitment to anything long-term. It’s one conversation, with someone who has heard it before.
Conclusion
Men aren’t absent from therapy because they feel less. They’re absent because most of them were raised to handle it, and because the first appointment costs more in pride than it does in rands.
It isn’t a verdict on you. It’s an hour with someone whose job is to help you sort out what you’re carrying, so you can put some of it down.
I see men in person in Claremont (close to Rondebosch, Newlands, Kenilworth and Wynberg) and online across South Africa, and plenty of them walked in saying they weren’t really a therapy person.
You don’t have to be. You just have to come once.
About Me
I’m Paula Marais, a registered specialist wellness counsellor based in Claremont, Cape Town. I hold an Honours in Psychology (Unisa) and a Master’s in Creative Writing (UCT), and I’m registered with the Association for Supportive Counsellors and Holistic Practitioners (ASCHP).
I offer individual and couples counselling, in person in Claremont and online across South Africa. Online sessions are equally as effective as in-person sessions.
There’s no pressure and no judgment. You can reach me at info@paulamaraistherapy.com or on WhatsApp at 072 633 7661.
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