Think therapy won’t work for you? A psychiatrist breaks down the facts

You lie on a couch in the center of a dimly-lit room filled with leather-bound medical tomes. Behind you, the stern-faced doctor eyes you, silently judging your every word as you free associate for hours about your innermost feelings and deepest, most repressed memories.

Stereotypes like these can make talk therapy sound intimidating and unwelcoming—but it’s an impression that today’s practitioners would like to change.

Marek Hirsch, MD, is a psychiatrist at Memorial Hospital in Jacksonville, Florida who specializes in treating men with depression and other mental health issues. He’s passionate about demystifying mental health treatment for men, and wants them to know the facts about talk therapy, including what it’s really like in practice and how it can help men with their mental health.

For most therapists and patients, the classic psychoanalytic set-up—in which the patient talks and the therapist analyzes—is largely a thing of the past. In fact, therapy is often a lot more conversational, practical and goal-oriented than you might imagine.

Cognitive behavioral therapy (CBT), for example, is an increasingly popular form of talk therapy that typically takes an active, structured approach, often involving homework to complete between sessions. It differs from classic psychoanalysis in that it tends to focus on solving current problems, rather than focusing on past conflicts. CBT may help men dealing with issues including depression, anxiety, substance abuse and even sleep disorders or sexual problems.

“I think men can very much benefit from the structure provided by CBT,” Dr. Hirsch says. In an old-fashioned setting, it might take many months of therapy before patients come to some kind of revelation. But in a more formalized, structured therapy such as CBT, patients might start to see benefits after the first session or two. Gaining insight right away into how behaviors and thoughts affect a patient’s mood can make them more inclined to come back and continue treatment.

Hirsch concedes it can be difficult for some men to open up in front of a stranger. “I don't know whether we don't enjoy it because it's uncomfortable, or if it's uncomfortable because we don't enjoy it,” he says, “but talking free is just not what most guys do.”

For that reason, having a less formal, more active environment in the therapeutic process—to help inspire and facilitate conversation—can be helpful for men.

Hirsch deploys icebreakers such as jokes to engage with and get to know his patients. This can increase the comfort level between patient and therapist, which helps patients more efficiently get to the heart of the problem at hand.

CBT is one example of a type of talk therapy, “but there are a lot of different ways to perform therapy,” Dr. Hirsch explains. “It can be a much more comfortable experience than a lot of people realize.”

Hirsch explains that there are three different approaches that psychiatrists tend to take with patients: maternalistic, paternalistic and—located approximately between those two—an approach called the “scientific sibling.”

“The maternalistic approach involves taking a supportive, more motherly approach with the patient,” says Hirsch. “Paternalistic is more of the stern, ‘This is what you should be doing, this is what you shouldn’t’ approach.” The scientific sibling, meanwhile, involves working in parallel with the patient, with the therapist offering their expertise as you go along.

While some men might benefit from the maternalistic approach, Hirsch says that most men he sees prefer and benefit from the scientific sibling or paternalistic models because those tend to be more direct.

When looking for a therapist, it’s always smart to talk to a few therapists and ask them about their credentials, background and therapeutic approach before making a decision.

Hirsch often encounters the following scenarios: A guy comes to see him because he has a problem in his marriage and wants to know whether he should get a divorce, or he has a problem at work and want to know whether to quit. “That’s really not for me to decide or tell you one way or the other,” he explains. “Ultimately a therapist should never be telling a patient what to do directly.”

What a therapist can do is help men develop the tools needed to help better manage emotions, deal with stressful situations and communicate more effectively—all things that may not come easily to them. In that way, a therapist can help men come to decisions and conclusions on their own.

“Women tend to be comfortable in an ongoing therapeutic setting, talking openly about what's going on with them, how they're feeling about things,” Hirsch says. “But that goes against the grain of a lot of guys.” And the prospect of therapy as an open-ended, life-long commitment can be also be intimidating to men.

The good news? CBT is designed to be a short-term treatment, and many patients may find benefit within a few sessions. You may continue treatment for a few weeks or several months, but generally speaking you can expect a course of treatment to last about 10 to 20 hour-long sessions.

Hirsch says he looks at depression the way an orthopedist might consider a broken leg: as a medical problem that can be solved with treatment. Mental health differs from physical ailments, of course, in that mental illness diagnoses may linger and issues may resurface. But, Hirsch explains, treatment can be finite.

“It's a problem, and we have treatments, and if you access the treatment, we're going to fix you,” he says. “It might take a few months, but once you're doing well, you may not need to be in therapy and you may not need medication anymore. The expectation is that there's an endpoint for treatment.”