Why Therapy Keeps Failing Men: The Framework That Explains Why

Why Therapy Keeps Failing Men: The Framework That Explains Why

September 14, 2026

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Why do so many men bounce off traditional therapy? What would therapy look like if it were actually built for them?

In this episode of the Men’s Therapy Podcast, host Mark Azoulay talks with Dr. Andrew Smiler, psychologist and author of the brand-new Clinical Work with Men: Understanding Masculinity in Psychotherapy, as well as The Masculine Self, the widely used men’s studies textbook now in its seventh edition. Andrew has spent decades researching masculinity and training clinicians on how to actually work with male clients, not just adapt techniques built for someone else.

The centrepiece of the conversation is Andrew’s “multifaceted masculinity framework,” a way of breaking masculinity down into four connected pieces so therapists (and men themselves) have something concrete to work with instead of vague, one-size-fits-all questions. From there, Mark and Andrew get into why gender training in grad school rarely actually includes men, why problem-solving therapy tends to land better with male clients than coping and validation, and why respect, not just safety, might be the missing ingredient in how men experience therapy.

Who is this episode for?

This episode is for men who feel like they’re always being measured against other men, against a version of themselves they think they should be, and can’t quite name why it’s exhausting. It’s also essential listening for therapists, coaches, and especially female clinicians who want a clearer, less stereotyped way to connect with male clients instead of treating them as a mystery.

What is the “multifaceted masculinity framework”?

Andrew argues that masculinity isn’t one thing; it’s four. Masculine criteria are the everyday “do’s and don’ts” of being a man (what people mean by the “man box” or “man card”). Masculine types are the identities guys can step into, from jocks and nerds to providers and protectors. Masculine achievement is the hierarchy underneath all of it, the difference between being “man enough” and being “the man”, and it draws on the idea of precarious manhood: manhood as something hard-won and easily lost, so it has to keep being proven. Finally, masculine negotiations are where it all meets reality: reconciling who you want to be with what you actually have the skills, context, or desire to pull off. Andrew’s practical advice for men drowning in all four at once is simple: pick your lane. Trying to be everything to everyone, he says, is “a recipe for disaster”: high stress, high depression, and constant pressure to perform.

Why does most therapy training still miss the mark with men?

Andrew’s core critique is that graduate programs teach about gender, but “gender” almost always means women. Men, especially the men who make up the bulk of both clients and providers in psychotherapy, rarely get examined as a gendered experience at all; they’re treated as the invisible “default.” That blind spot even shows up in how the field reacted to APA’s 2018 guidelines for psychological practice with boys and men: nearly all the public criticism targeted the theoretical preamble, while the ten actual guidelines, which call for gender-sensitive, masculinity-aware care, went almost entirely unchallenged.

Why do men respond better to problem-solving therapy than to coping and validation?

Andrew traces a real shift in the field: from therapy as helping people solve the problems in their lives, toward manualized, symptom-focused treatment shaped by insurance and “empirically validated” research protocols. For a lot of men, that shift landed as “coping and validation”, and it can feel like giving up, or like being handed a bubble bath instead of help with a real problem (a maxed-out schedule, a marriage under financial strain). Andrew’s case study of “Gary,” a client who needed boundary-setting skills to stop getting walked over at work and at home, makes the point: many men aren’t missing willpower; they’re missing a specific, teachable skill, and they want to know when they’ve hit the objective.

Why does respect matter as much as safety when treating male clients?

Mark’s working thesis, which the two dig into at length, is that women need safety in therapy, but men need respect, built through self-disclosure, an active mentor stance, and a willingness to challenge a client rather than sit back as a “blank slate.” Andrew adds a sharper edge to this: when a therapist moralizes about a client’s real-world trade-offs, like which partner stays the primary earner given the gender wage gap, it reads as disrespect for a decision the client actually had to make. That’s often where men lose trust in a provider and quietly walk away from treatment.

Where can I find Andrew?

You can find Andrew at his website, where he shares more about his therapy and coaching practice. His new book, Clinical Work with Men: Understanding Masculinity in Psychotherapy, and his textbook The Masculine Self (now in its seventh edition) are available at major booksellers or through independent bookstores and IndieBound.

Ready to go deeper? Men’s Therapy Online offers Individual therapy built specifically for men. Also consider joining the Men’s Group and the free Slack Community where over 250 men have real conversations about growth, identity, and men’s mental health.

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Disclaimer: MTO connects men with licensed practitioners who provide guidance and support for navigating the challenges of modern life. These coaching services are not a substitute for mental health treatment, emergency services, or crisis support.