But what about the boys?

Sitting opposite me is a boy around the age of 15. He is frustrated; visibly angry at life and the world around him. He begins to tell me about the injustices he has faced over the past week – people who haven't understood him, caregivers who have punished him, peers who have mocked him. He describes wanting to punch people and, knowing that would be wrong, has punched walls and trees instead. He shows me the bruises across his knuckles, swollen and sore. I can't tell whether these are a mark of pride or a call for help. I ask him 'what went on for you?' and wait as he decides whether he feels safe enough to expose his vulnerability.

As a school counsellor working in a state boys' secondary school, I see a snapshot of male mental health, at a formative point in their lives. Adolescence is a time where typically, young people pull away from their caregivers, desiring greater autonomy. Yet, emotional expression conflicts with this drive, exposing feelings of vulnerability and dependence. To add to this, biological impacts of hormonal changes may cause mood instability that compounds emotional difficulties. These contrasts and tensions stand to unsettle adolescent mental health. Many of the boys I meet with experience these struggles; a sense of things not being right, with sometimes no known tangible reason.

'Boys don't cry', 'man up' and 'grow a pair' are overused tropes that are making their way out of popular rhetoric, hopefully being replaced by a recognition that male expressions of vulnerable emotions are just as valid as those from any other gender. With men's counselling experiencing low engagement and high drop-out rates, and male suicide being at its highest since 1999 (ONS, 2024), are men really okay discussing what is happening inside their minds or are they adhering to stereotypical alexithymia?

Challenging masculine narratives

It's important for me to acknowledge that discussing gender in such binary and stereotypical terms can be very problematic in a society that recognises and celebrates diversity. In this article, I discuss stereotypes, traditions and perhaps perceived outdated notions in relation to men. I understand that this, in no way, reflects all men or those who identify as male. However, for the purposes of my exploration, I wish to unpick the effects of some of these, in order to examine the intersection with male mental health. 

Sharp et al. (2022) found that men can feel influenced by traditional masculine narratives, including the importance of self-reliance. They felt that showing vulnerability contested this narrative and therefore needed to be muted. I certainly notice that some boys who attend their counselling sessions with me are very keen to express that they don't need anyone, that they can do it by themselves, and sometimes there isn't anyone there for them anyway. Many boys I see in sessions do have friends but express that they feel isolated with their problems and that they cannot relate to anyone. Part of this may be that, developmentally, some attendees are still egocentric, but, equally, this may fit within the bigger picture of masculine narratives; problems are to be dealt with alone. Chandler (2022) and McNeil & Zeman (2020) discuss the way families perpetuate these narratives, forcing feelings to remain unexpressed by not recognising or validating them in their boys and men. If this is the case, encouraging our boys to 'speak out' about their feelings becomes problematic; who is there to listen?

This brings me to the heart of my viewpoint – the crux isn't how men express themselves, what they express or for what reasons, it's the relationship with the person to whom they express it. I cannot escape the fact that I am a female counsellor discussing male mental health and, for part of my job, working exclusively with males. Of course, this adds nuance and I have questioned whether I have the authority to comment on something I cannot truly experience. However, counselling holds empathy at its core and I feel empathic towards those I work alongside. Equally, being a female counsellor may give males the opportunity to not have to 'perform' their masculine role. Chandler (2022) suggests that the quality and nature of the relationship with the person to whom a man talks is the most important factor in reducing a sense of isolation. 

Considering this, the focus of a therapeutic experience should be about building quality relationships, which can then offer blueprints to form, foster and strengthen relationships in the rest of the individual's world. This understanding may offer some context to why males, or perhaps anyone, may not get the support they need from mental health drop ins, support lines or short-course therapy; the relational blueprints cannot be made and internalised from such limited contact.

Stripping away shame

Empathy and belonging can help to strip layers of defence, performativity and shame in a counselling setting. They can begin to support a person through the middle and upper layers of the hierarchy of need, therefore, not only healing but propelling a person forwards. In the past decade or so, there appears to have been a bigger drive for public understanding of male mental health struggles and endorsement of the benefit of speaking out. Identity feels like a big part of this conversation, and this is an area where the promotion perhaps falls short. 

We know the crossovers between poor mental health and demographics such as unemployment, ethnic minorities or care-leavers, for example, and yet the ambassadors for male mental health often do not represent these. Chandler (2022) describes celebrities trying to destigmatise male mental health struggles as missing the shameful stories that some men's mental health is based on. They are often powerful and wealthy men and therefore the content and context of their struggles may not appear to align with most, potentially serving to alienate this community more. For many men who struggle with self-worth and not measuring up, seeing polished, financially stable and articulate ambassadors may stand to perpetuate feelings of worthlessness even more. Just talking isn't enough; belonging and empathy is essential.

Perhaps this is why initiatives such as Andy's Man Club are successful – there is more of a level playing field between members and contextual factors such as location are considered. Sharp et al. (2022) found that many men recognise the need to connect to each other to overcome mental health challenges and that locations and context were key to this engagement being successful. Some of what is expressed can be so unsettling that a safe and comfortable space to put this is part of unlocking the door to recovery. This may also shed light on why therapy in a clinical setting has lower engagement rates rates for men (Marotti et al. 2020). The space may create distance, a power imbalance is unescapable and the trust in being able to safely emotionally communicate may be harder and take longer to foster. A sense of belonging lies at the core to growth and yet this stands at odds with stereotypical male values such as self-reliance, independence and leadership. In order to take the pressure off these values, where the therapy takes place could make all the difference.

What lies beneath

Many of the boys I work with are referred because of behavioural difficulties – whether that is challenging behaviour in the classroom, aggressive behaviour with peers or shutting down responses completely. Taking a non-judgemental standpoint allows the boys to experience a relationship that isn't at odds with their experiences and doesn't attempt to correct their behaviour. Instead, it accepts that this is a part of them at this moment. 

This standpoint allows me to work alongside a learner's difficulties, rather than push against them, which they may experience in other relationships in life. Their conversations in early sessions often entail unprompted justifications of actions and blame allocated elsewhere. This may be a default defence that has been built in response to adults. However, as boys begin to trust the acceptance and positive regard offered, they often begin to talk about what is happening for them. Gentle curiosity, as the relationship builds, about what might sit beneath the behaviour can extend the therapeutic work beyond descriptions of events and begin to tap into their emotional literacy; they are no longer working from a present, surface-level but are starting to look beneath this. 

The iceberg analogy is relevant here; boys may identify what the world sees (often behaviour-related) but looking at the feelings causing this can be much harder to identify. Building trust, having an environment without expectation or pressure, and conveying a sense of valuing the boy sitting in that chair, paves the way for them to strip away traditional masculine narratives and consider what might be important to them.

I am always keen to explain to the boys that I am not a teacher, I do not report back to teachers or caregivers, and that I am there for them, within the parameters of safeguarding. Most boys visibly relax when they hear this, perhaps because they do not need to adhere to expectations or censor their experiences, based on how they will be seen or understood. For some, this trust takes a long time to gain, and for others, it may never come. Marotti et al. (2020) found that teen boys who engaged in counselling valued non-judgment and engaged listening the most, as this led to a shared understanding of experiences. This is certainly what I witness; boys 'try out' vulnerability and carefully monitor whether this changes my perception of them. By not judging and by being gently curious, they see that vulnerability does not cause rejection or judgement but instead allows them to share the weight of their experience. In time, they can recognise that their voice is worthy of being heard. 

Marotti et al. (2020) argue that when unconditional positive regard is received, it can outweigh feelings of depression by conflicting with the conditions of traditional masculinity. I would argue to be open to receiving that positive regard, a strong relationship must be built first. We cannot expect our boys and men to learn to talk about their deepest hidden emotions without a sense of trust. By offering the time, space and patience to my clients, my role as a school counsellor thrives. In accepting the boys as they are, they learn that they are acceptable, without having to rely on stereotypical notions to measure their worth. 

Sometimes these notions are so inherently entwined with a sense of self, that it may be a life time's work for them to discover who they truly are. But it's a piece of work that can start with an empathetic, accepting and non-judgemental listener. I am truly privileged to be that person.