When Paul impulsively moved from the U.K. to Ontario to be with his long-distance girlfriend, he expected to fall deeply in love. But without any family, friends or any kind of support system outside of his relationship, he fell into a deep depression instead. His downward spiral into loneliness finally bottomed out when he cheated, got caught and was dumped. “And because I wasn’t legally allowed to work in Canada and couldn’t get a flight home to the U.K., I became homeless,” Paul tells me. “I was terrified.”
After a few nights on the street, Paul finally asked his family for help. They got him a plane ticket and allowed him to stay with them — as long as he got help. Unsure of where to start, he made an appointment with his doctor, who referred him to a local outpatient mental health organization. During his intake, a psychologist informed him he was having an “acute stress reaction,” a psychological response to a traumatic event that includes heart palpitations, difficulty breathing, sweating, nausea and general dissociation, or the feeling of disconnection between thoughts, feelings and reality that occurs for a more finite time period than PTSD. To his surprise, rather than setting him up with individual therapy, the psychologist told him that group therapy would help.
“I’m not sure what made him decide to put me in a group setting — perhaps because I was extremely lonely,” Paul recalls. Once a week then, a counselor would lead him and about a dozen others (all of whom were between the ages 25 to 40) through cognitive behavioral therapy and mindfulness exercises. It definitely helped, but what really made the difference was the rest of the group. “It put things in perspective because as bad as my situation was, there were people who had it far worse,” he says.
Paul’s experience is pretty much the platonic ideal of the peer-support model in psychology, or the idea that when people with shared experiences support each other in their mental health, they will have better outcomes. It’s also a perfect example of how support groups and group therapy are particularly beneficial for men, who tend to be more resistant to one-on-one therapy compared to women.
There are many reasons for the therapy gender gap, but the most common explanation is that boys are discouraged from expressing their emotions and learn to equate such expression with femininity and weakness. The consequences are clear: Men are about three to four times more likely to die by suicide, and two to three times more likely to abuse drugs and alcohol. Unemployment and isolation worsen such dangers, both of which have been exacerbated by the pandemic. Consequently, deaths of despair are only expected to keep increasing, and although group therapy has had to make the transition to digital meetings, it may be the best line of defense men have against their demons.
Jeffrey Edleson certainly has found group therapy to be the closest thing to a cure for toxic masculinity. He has spent the last 30 years counseling men who have been violent with their families and forced to attend “batterer intervention programs,” or BIPs. These small groups of men typically meet at least once a week for four to six months, where they discuss the root causes of their violence and how to reverse their negative patterns. “My experience has led me to believe that in a group setting, men are more conducive to change,” Edleson explains.
For one, they listen to their peers over a professional who may not be perceived as an equal — either because they’re coming from a place of greater expertise, or because they’re considered less masculine due to their willingness to discuss feelings. “Their peers give them the same feedback that I might, but when it comes from other men in situations similar to their own, it appears to be better received,” Edleson continues.
But maybe more importantly, an audience can help hold them accountable. “It serves to more effectively break through denial and other forms of psychological protection,” explains David Jenkins, a counselor at Just Mind, LLC who has been running therapy groups for men for 25 years. “This also demonstrates the benefit of a supportive community, which works to overcome a feeling of isolation or of needing to do it oneself, to be the heroic overcomer.”
When cost is a barrier of entry to therapy, the group-therapy model is also the answer. Men can seek out peer-led support groups based on specific issues like grief, sex and love addiction or substance abuse for free, depending on where they live. Likewise, support groups for men that specifically address issues stemming from traditional masculinity have emerged in recent years and are often free or donation-based as well. If they do charge, therapist-facilitated forms of group therapy tend to cost about a third of what individual therapy does. “The cost can definitely be a factor in sticking with it — and sticking with it is a major influence on the success of any intervention,” says Patrick Turbiville, a Texas-based clinical social worker and psychotherapist.
Of course, there are peer-led groups like AA, too, which can be likewise beneficial. But it’s important to note that the distinction between those groups and therapist-led ones is that therapists are trained to make recommendations for more intense treatment when necessary. Further, they’re required by law to contact the appropriate authorities (police, Department of Child and Family Services, etc.) if someone is a danger to themselves or others. “Licensed mental-health professionals are bound by laws and codes of ethics that don’t apply to members of peer-led groups,” Turbiville explains. “They’re also more likely to have training in addressing specific symptoms of mental illness, including suicidal thoughts and issues that may require referral for medication or more specialized treatment.”
That difference can be especially crucial for men who wind up in group therapy as a condition of staying out of jail, like it was for Nick after he was jumped by multiple drunk bros trying to steal his table at a bar. As a former MMA fighter, he got caught up in defending himself, and when a cop tried to break up the fight, Nick mistakenly planted the officer with a “basic judo hip-throw right on the concrete.”
Facing a felony charge of assaulting an officer and unable to afford a lawyer after losing his job, he took a public defender’s advice and pleaded down to a misdemeanor assault charge, which landed him in six months of weekly anger-management classes. For him, group therapy was more dark and complicated than it was for Paul, who went on the advice of loved ones rather than the courts. “Group therapy can be helpful with lower stress and expectations, but if it’s compulsory, it’s hard to judge who is trying to make actual progress, who is playing the game to get it over with and who’s keeping their head down to get through it,” Nick says.
Nick eventually connected with some people, including a father who was ordered to be there after beating the shit out of a reckless driver who almost killed his kid. “It was understandable, if not justified, until he told everyone that his dad being alive is the only thing that keeps him from killing people,” Nick says. If it wasn’t for the skilled therapist they had leading the group, Nick isn’t sure it would have added up to much. “It definitely needs a firm leader to keep things on track, otherwise groups tend to fall into boastful storytelling and a circle jerk of confirmation bias.”
To Turbiville, the issue here is actually something much bigger — our system only addresses men’s mental-health issues once they’ve spun out-of control. “Men often end up as involuntary participants in treatment for these kinds of issues because of gender differences in conditioning regarding emotional issues,” Turbiville says. Basically, it takes an ultimatum — either from the courts or family and friends — for them to get help.
Along those lines, the most vital, life-saving aspect of the group-treatment model is that it equips men who struggle with chronic suicidal ideation with a support system, comparable to the ones recovering addicts in 12-step programs turn to when they’re on the verge of a relapse. “The support of a group helps to counteract the sense of isolation common to those suffering in this way and gives the opportunity to hear useful problem-solving advice from others whom one trusts,” Jenkins explains.
Turbiville agrees that having a space to say when you’re feeling self-destructive and having others respond empathetically significantly reduces the intensity of those thoughts. “This is in contrast to dismissive responses, or non-responses, that are all-too-frequent from friends and family,” he says — not that he blames loved ones for responding this way. “Suicidal thoughts of a family member can feel like such an intense idea that it’s a natural response to brush them off or shut down communication.”
In a group discussion about suicide, a therapist may guide the conversation gently to refrain from triggering participants, or assess an individual in crisis after the session is over, but they won’t shut down a conversation like that when it could save lives. Or as Turbiville puts it: “Discussing shared experiences can decrease feelings of isolation, a major contributor to suicide, and offer hope that such thoughts can be overcome.”
In the end, the main problem with group therapy goes back to a broader issue with mental-health services in general: There aren’t nearly enough of them, and the resources that are available are difficult to navigate, which is especially true for group therapy. “It’s hard to market group psychotherapy to people who aren’t already looking for it, who aren’t already in contact with mental-health professionals or who don’t have friends or family who have shared that they’ve benefited from group therapy specifically or psychotherapy in general,” Turbiville says.
And so, the reality remains that group therapy is difficult for men to find out about until it’s forced upon them. That said, Turbiville is optimistic that through social media and other new educational efforts, this will eventually change. It’s too powerful not to. “Men have more power for influencing other men to give up toxic and dysfunctional ways of coping with emotions and being in relationships by modeling the possibilities for other men,” he says. “Group therapy can be the place where that seed is planted.”