The Real Reason Men Aren't in Therapy
This episode is sponsored by Klarify, the AI tool helping therapists focus more on their clients and less on paperwork by automating case notes in seconds. Today I'm talking to Simon, a psychologist who challenges the common belief that men are resistant to therapy. He argues the real problem isn't men. It's that mental health services aren't designed for how men actually seek help. We talk about why standard therapy practices often drive men away and his refreshing take on why ChatGPT might make therapists better at their jobs, not replace them.
Moody:I can't even imagine 8 to 10 client sessions a day, like, 8 hours of meetings a day.
Simon:Yeah. Absolutely. Yeah. No. And and I've done it, and and it hasn't always been, like, 8 one hour sessions.
Simon:There was a time over COVID when I was working in in publicly funded care where there was just this massive need. And it would like, it wasn't exactly 8 solid hours, but I could easily do 15, 16 half hour phone calls. Not easy like, easy that it would happen frequently. Not easy for me because it wasn't easy. It's a heck of a lot of work.
Simon:And there's been other times where I've worked and publicly funded stuff with persistent and chronic mental health care and people who have great deals of need. I did an internship in an inpatient ward, and you're just you're there and you're on. And that's kind of it. Moving into private practice, I tried to spread that out a little bit better, and I certainly tried to educate my supervisees. Do not make my mistakes.
Simon:But every once in a while, one one will creep in, and I will absolutely overbook my day terribly. Or, again, because I don't have the control, I I can't really say necessarily on this day, this person I know needs a little bit more time. I can sometimes do that.
Moody:Mhmm.
Simon:But if they're booking their own appointments, right, I can't always schedule my day with such nuance.
Moody:What is your practice focused on?
Simon:My practice is focused on men's mental health. We're focusing on clinical diagnostics, clinical treatment for men's mental health disorders. We also do some work on men's sexual health. So erectile dysfunction, premature ejaculation, libido does stuff. So, yes, it's very much men's focused, the demographic.
Simon:It tends to be I work with adults exclusively, but it's usually about 35 up as the the big group. I do work in a university town, so there's a small but strong population of younger people. But that's what we're focusing on. I do treat a number of women also because I speak Spanish. I'm one of the few Spanish speaking therapists around, so I absolutely will.
Simon:And there's lots of women for whom the types of services that we're offering really fit. But general rule, yeah, focusing on men's mental health care.
Moody:How do you define therapy?
Simon:Therapy, and from my particular point of view, is the direct clinical application of psychological science. And that's really the way I take it. That's really the way I teach my supervisees. I I do get attracted by the very sort of glamorous, valances, really intense human interaction where 2 biographies overlap. And that is true, to an extent, but I think we we will lose focus if we get really too focused on human interaction and lose sight of the psychological science behind it.
Simon:So that's certainly the pitch from the outset. Therapy, in this case, psychological therapy would be the direct clinical application of psychological science.
Moody:And do you find that men are traditionally resistant to therapy?
Simon:Yes and no. I think statistically, it looks as if men are resistant to therapy. Right? So of of all of the 1 in 5 Canadians that need mental health care, only about 50% of them actually access mental health care. Of that 50%, about 30% are actually men.
Simon:Right? So there's a big difference in terms of the access to care piece that I think some would interpret it as having to do with men being resistant to seek therapy, full stop. And I think that's where we insert a whole bunch of tropes and stereotypes about men and their emotional avail in availability or sense of not not liking, feeling vulnerable, or something like that. And, to an extent, perhaps that could be true, but that still doesn't substantiate this huge gap in service use. What men are really averse to, again, in my experience, is therapy itself.
Simon:Right? It's the system. It's not the men. Right? The men are just fine.
Simon:They're struggling with their stuff. But there's nothing wrong with men being men or bracing on masculinity or or working from that perspective. The problem is the services that do not conform to men's expectations. Right? Men, as a rule, have specific requirements, needs, wants, and a good deal of the mental health system.
Simon:And and may by by and large, perhaps, the the greater health system. I'm not so familiar with those statistics, but I'd imagine there'd be a similar trend. That men aren't coming because the surgeons aren't right. Men aren't coming because men aren't right, essentially.
Moody:And you actually mentioned to me how you set up your office to be more welcoming and also Yeah. Outside of your office, your own the way you conduct therapy.
Simon:So there there are some subtle differences. Like I said, the psychological science is basically the same for everybody. If I'm delivering a CBT protocol, obviously, it's individualized per person. There's no sort of massive gender differences, but the you know, the differences come off is in the the way the service is established. And sometimes that's really subtle things.
Simon:For example, having fully online booking. So the the men that use my service have total freedom to book at their leisure. They can book many appointments, few appointments. They can search the time. They can find it.
Simon:They can decide the frequency. We'll negotiate that, of course. But there's that control aspect is absolutely huge. And, again, one reason why men are generally refractory to traditional services is they don't have that control. Right?
Simon:The other thing we try to infuse is a lot more confidentiality at a very overt level beyond the confidentiality of note taking, which we, of course, discuss. The idea that you can, again, book an appointment by yourself from the comfort of your own home. You don't have to go through the the barrier of the reception staff. The way my physical space in the office is organized reflects that as well. So it's in a very much an office building rather than a medical center.
Simon:There's a confidential check-in digital board when someone comes in so they can I know that they're here? The building itself is very non I mean, it's very beautiful building, but it looks very nonmedical. There's very large open waiting room with available coffee and things like that. Other logistical stuff that we work in is having weekend and evening appointments. It's huge.
Simon:So, again, like, these are the barriers that men are receiving. Right? It's not that men are unwilling to book time off work, but that's a barrier. If they had an option, they would certainly take it. Right?
Simon:So we we work on those things as well. In the therapy office, one of the huge issues for men specifically is feeling humiliated, educated, or talked down to in therapy. And this is where I see, you know, my refractory guys. We recently cracked out some statistics for some marketing initiatives. And it turns out about 1 third of the people that are in my practice currently are what we call refractory.
Simon:So they have been to a mental health service somewhere before and have bounced off because they didn't like it. Right? Didn't like it because, obviously, a lot of it has to do with availability, accessibility. They didn't like it because they felt it wasn't effective, which is another huge barrier for men. Right?
Simon:Their perception of mental health as being grossly ineffective, which, I mean, depending on the statistics you look at, it might be debatable. Right? Some of the work of like Richard Bentall and some of the really profound anti psychiatry movement would certainly imply that there's not a lot of great data. Or at least there's some very good data to question the the total efficacy of mental health stuff. Pitching that makes it huge.
Simon:When men come into the office, we're often talking about science. We're often looking at statistics and adhering to protocols that are proved to be fine, and men are generally very sensitive to therapist drift. I see. I see that a lot. Therapist drift is when we start talking about one thing and end up with something else.
Simon:So you come in to talk about CBT for managing anxiety depression and by session 3, we're exchanging recipes. It's not a very effective therapy protocol. It's it's clearly. And again, men are particularly sensitive to that. So my refractory guys that will come in will come in saying, look, my previous experience was either a, not available because I couldn't get an appointment in 6 months.
Simon:It was either b, ineffective because we're talking about recipes or just talking about my day and not really getting down to the stuff that I wanna talk about. And then they're like perhaps even the bigger and the one that's more difficult to manage in session is when men are feeling talked down to, misunderstood, not respected, not listened to, feeling like re educated. Right? Especially like I said, we work with a lot of men with sexual dysfunction issues or issues of a sexual nature in the first place. I gotta say people coming in with a subjective query around pornography addiction, easily 10 to 20% of my practice currently.
Simon:Not an easy conversation to have at the best of times, much less when I feel as if I'm gonna be judged, looked down to, etcetera etcetera. So this is something that's absolutely really delicate and sensitive to manage in the session, but all all around the session. We have to speak with exquisite professionality at all times. We have to treat the issue as it was scientific, and we have to respect the integrity of the person in a way that is really overt.
Moody:You mentioned how even the language that you use, like, in your intake with the person, because you guys do 15 minute, like, free intakes, is how much do they swear? How casual are they? Tell me more about that.
Simon:Yeah. So a lot of that is just good therapeutic skills in the first place, just so, like, mirroring the language of the person that we're talking with Just to make sure there's no, sort of, gross misunderstanding here. Right? So if someone is coming in speaking very casually about what's going on, and maybe not using exact scientific terms to describe the issue, it doesn't do me or them any good to get on my scientific high horse and correct the way that they're pronouncing the word or to educate them and turn especially in that first 15 minutes, educate them to what that's actually called and how this actually works. Right?
Simon:That stance does not fly, because again, nobody likes to speak down to. Men specifically are very sensitive to it. So you know, that mirroring detecting the type of language that we're using. And I use with my supervisees, we talk about swearing quite often. It comes up quite often in session.
Simon:And there's ways of using it fantastically effectively to build a bit of a a sense of shared vulnerability and shared humanity. Reading that language is nuanced. It's difficult. It's something that experienced therapists do very well. Novice therapists, not quite so much.
Simon:It's a tough thing to go at.
Moody:Kinda brought up in our intro call about, like, how AI could help. And one of the ways was helping understand the client language patterns.
Simon:Absolutely. And I I'd said that from the outside. I'm I'm far from an expert in AI and exactly how the the science works behind it. I'm interested to see exactly how it can read strategies and patterns, and what kind of useful information would that be able to give to us. And of course, I'm thinking my application mostly about supervision, but being able to have a junior staff or have a call that is somehow reviewed through AI that could help them detect some of these patterns.
Simon:Hey, this guy swore 15 times around this particular issue. I wonder if maybe that is something that's coming up. Or this person used a certain degree of scientifically educated terminology. Should we be going that way? This person uses a very pronounced business language.
Simon:Something also comes up with my client base quite often. Executives who are just, like, using corporate speak all the way through. To be able to detect that, feed that back to a supervisee in terms of treatment planning going forward, I think would be absolutely massive. A really cool potential application. Yeah.
Moody:Yeah. I I will say that is fully feasible and possible. As on this topic of AI, traditionally, people had Google to become educated. As clients become more self educated, whether it's through a chat g p t, you know, they're asking it about CBT or they're asking it, how do I handle my depression? How do you see a therapist's role evolving or dealing with that?
Simon:Yeah. Therapists are absolutely have to become educated on it as well. And without beating the same drum again, it is something that definitely comes up working in a practice dedicated to men. General rule, the duration of untreated in illness for men is far longer than for women in terms of access to therapy. So when men come, they've been brooding on this for a little bit longer.
Simon:And in my experience, they're quite often much more likely to do their own research, however that looks. And more commonly than not recently, it's I asked at gbt how to get over my panic attacks and this is what it told me. So they're almost even coming in for for me to review it. But essentially, it's like this is a feasible treatment plan based on what, you know, AI told me. So I think it it's an important strategy for therapists to get to know what their clients are reading and what they're studying.
Simon:The same sort of way that maybe 10 years ago I would have told the lots of supervisees. Go out there and grab the absolute crappiest, trashiest, pop psychology garbage off the shelf. Read it and understand it because that's the language that people are gonna be speaking to. I think AI has got that same sort of expectation. It's immediately available.
Simon:It's not all bad. In fact, it's general general rule at the times that I've played with it in terms of generate a therapy plan and see what happens. It's fantastically good. There's some really amazing potential stuff there. But we do have to be aware of hallucinations, and we do have to know exactly what clients are expecting.
Simon:So I think a therapist role is often going to be, in the future, kind of gravitating more towards expertise rather than technician. I don't know if that's making sense. But the same sort of way, like, so that client that comes in, having not only downloaded their chat gpt treatment plan, but actually tried to implement it. And then they're coming to us for why isn't this working? Right?
Simon:Where are the snags? How was it not going? So I think therapists over time in general are gonna have to become much more experts in how the techniques work. Right? And much more experts in how people are gonna be tempted to do this by themselves.
Simon:So just like we have to know the self help literature, chat gpt is like the new self help literature.
Moody:Right. How do how do you actually balance that validation of self research? Because self research is a form of seeking help. Right? It's, like, one of the stuff.
Moody:How do you balance that while maintaining this expertise?
Simon:I would always encourage people to do it. Like I said, any implication in the therapeutic process, a part of what happens in the office, any implication is good implication in terms of a treatment goal. So I'm constantly encouraging people, yeah, go do your research, have a look, check this term out, look at this sort of stuff. Sometimes we have to correct it if they're grossly off base or if they're fantastically misguided. So if you're, I don't know, if your depressive episodes are actually a trauma response and you really want to focus on depression because I can't even bring up trauma, I'm obviously, it's my job as a clinician to explain that to you.
Simon:Right? If we're someone is totally off base. Right? But encouraging people to do their own research, get involved, it puts a little bit more onus again on the therapist to to know what's out there. Because we are not any longer, like, the exclusive custodians of psychological science.
Simon:Like, it used to be that there were massive pay barriers. Right? If if any client want to send me an article on x, you you gotta have a a university subscription or something. You gotta be able to access these things that most people can't. And then, of course, they're written in a language that's not really accessible to most people anyway.
Simon:Here's a Cochrane meta analysis on CBT, knock yourself out. It's not a very useful strategy. Whereas, again, a synthesized version through AI is absolutely immediately available. Right? So our clients are are becoming more astute and have way more access to the stuff that we already have too.
Simon:So, again, the importance is on us to be able to use expert wisdom to to guide people in using it effectively.
Moody:Are you going from custodians of knowledge to curators of
Simon:Yeah. And, like That's a great way of saying it. Yeah.
Moody:Down adding boundaries to what people do. I got 2 questions here. 1 Sure. I wanted to comment on
Simon:Mhmm.
Moody:Actually how effective AI is in translating resources like you mentioned. And 2, how do you comfort your supervisees? Or just in general, what would you say to therapists who might be scared that, well, AI is taking up a lot of what I do? Like, I am the knowledge holder. Yeah.
Moody:And that there is a fear there. The
Simon:Totally. Yeah. So to to the therapist who's worried that patients will have access to information that I have and that's what I paid for when I got my degree, I think you're terribly wrong. Right? You you never were.
Simon:If you thought you were wrong in the first place, we do not have exclusive access or or containers of knowledge, and and that's not what people are paying us for. That is not our job to dose or distribute information to people that otherwise don't have it. It's, essentially as you said, I think curating is the best way of describing it. It's our job to make sure it gets applied in a way that is most clinically relevant. Because from the perspective of the client, they might not see that.
Simon:They're they're looking in a mirror. They're not seeing things the way they are. It's it's our job to find the information or to coach them to use the information in the wisest way possible.
Moody:It feels especially more relevant, in today's age where there's so much misinformation, information, and this inform like, this just it's an onslaught. Before the Internet, there were custodians of knowledge and and gatekeepers that did this due diligence to make sure things were not too far fetched. You had yet to meet a certain process before something could be published, before something could be news, a book. Now anybody can self publish. Anybody can spread things everywhere on Facebook, on Twitter, on whatever.
Moody:So I think the role of the curator the therapist plays is even more important now.
Simon:Yeah. Absolutely. And you're right in in coaching people through it. And and if anything in terms of education happens, I think I oftentimes have to educate people on what is appropriate sources of information and what's not. And again, not everybody's had the luxury of the pre internet age when some of this was pre Jude for us.
Simon:But being able to critically read an article, no matter what the format is really important. And and if anything, I see it as, like, a risk in AI, it's the the general optics of credibility that that comes through all the way. Right? So if I asked chat gbt something and I asked chat gbt as the synthesis of all the knowledge in the universe existing on the Internet, it must therefore be right. And I think certain formats had just have that a little bit more a lot of social media.
Simon:Right? Now it just has the sort of guise of credibility or self published authors that can produce a product that looks to the untrained eye as if it were something credible. There's certainly a danger there. Now that being said, the danger is that people would be misinformed. For the therapists who are worried that they're gonna be at a job soon because everybody's got access to the information, I think the best evidence against that is that people still show up to the office, even having read all this.
Simon:Right? Of of all the people that I've seen, again, who've been refractory, they've been refractory to services. The people that I found that have been very unserved, they've been unserved by doing their own research. Right? They can get access to it.
Simon:They can't understand. They can't curate it. They can't implement it in real life. And I think there's still a huge ask for a real human being to do that. And I think that's again, this is the the novelty of our role is to take very educated people and educate them better still, to to help them shape and form what they're learning in ways that are really clinically appropriate.
Moody:You mentioned that the special sauce of therapy is not the modality or the information you're sharing. It's the alliance that you're building.
Simon:Yeah. I mean, essentially, and I like, goes back to Smith Glass and Miller 1985. Right? I don't think it's exactly quite so open. And again, and and maybe that's something that an AI and an open information tech culture would assume that any therapy is good therapy as long as there's connection.
Simon:I said, that's not exactly true either. Again, psychological science is something we can't lose sight of. There are effective therapies, and there are therapies that are not proven to be effective. And frankly, there are therapies that are just frankly bad. Right?
Simon:Obviously anything delivered ineffectively is not gonna be effective. So someone holding a a a really complete CBT protocol and not implementing it properly or not working a report to do it is gonna be complicated. But clearly, from a self help standpoint, even the very best CBT literature, if just read, is not the same as being administered therapeutically. Right? So there certainly is a a fundamental role for rapport in human relationships through mechanisms of coregulation, basically, up until and including expert implementation or decoding of what that means, or even just having a fresh insight.
Simon:Like I say, a a patient is looking at this through a mirror, they're not able to see the same sort of thing that an unbiased trained observer would see. So I don't think we're gonna be out of work anytime soon. I just think that work is absolutely gonna change. And the work, as you said, has to do with rapport building and being able to establish a meaningful relationship, which, again, just go back to that same job I've been meeting, is not exactly the same as establishing scientific credibility or because I've got a bunch of diplomas on my wall, therefore you have to listen to me. Right?
Simon:It's a little bit more in-depth and nuanced than that, and that absolutely changes, you know, not just in terms of gender, but it changes on a person to person basis. Right? We have to adapt and assess the language of the person that we're speaking to to make sure we can translate the all the information in the world into something that's receivable and usable to them. And, again, I don't see his chatty chat g p t being quite there yet. But for now, yeah, there's absolutely a role for a real breathing human being to do this.
Moody:On that note to our earlier point that we keep pushing away, Chatuch BT, for all the therapists listening, is incredibly amazing at taking a resource that you may have that might contain jargon or might be in a like, you mentioned in the start, men just communicate differently or have different expectations of how to be spoken to or various aspects of communication. Chat gpt is great at translating things. So you can take a document and say, I have a male client who maybe hears a transcript of our session. This is how they talk. This is how my client speaks.
Moody:Can you take this document and put it into language that uses their voice?
Simon:And Sure. Could you translate this treatment plan into something that they're gonna really get? Sure.
Moody:Yeah. And that could take a therapist hours to do, a lot of mental effort to do, or it could take Chat GPT, like, 10 seconds. We should be using these tools to help us help people, and I think that's one of the really cool ways to do that. Now on that note, used as a supervisor, you train and try to help people go down that this career path. But what what patterns have you noticed in this gap between the intended and the actual therapy delivery?
Simon:To gross the quote Mike Tyson, everybody's got a plan until they get punched in the mouth. Right? Every therapist I've worked with has a great treatment plan going into session. Right? And then quite often, especially with the more junior people, we're going over that before they even sit down.
Simon:What do you plan to do? What's your agenda for the day? Let's look at that. And of course, that all flies out the window the first time the patient comes up with something that's totally different. Right?
Simon:Or they oh, they mentioned this. Right? Or the the proverbial hand on the door problem. So as they're leaving, say, oh, by the way, let me tell you about this incredible trauma that I didn't mention 3 sessions ago. That's because the thing on your feet that that loses step.
Simon:Something happens and that can be a transference thing, a counter transference thing, it could just be a new information thing. It could be something that comes up that keeps us from pivoting around. And realistically, I think that's a mark of an experienced versus an inexperienced therapist. And how quickly I can bounce back in session in real time as it goes. We've got to be able to concede that our treatment plans are not our darlings.
Simon:Right? We gotta be able to get rid of these. If it doesn't work, toss it. Come up with something new. And an expert therapist is able to do that in real time.
Simon:A lot of the people need a little more practice.
Moody:But as a clinic owner and a supervisor, how do you ensure this consistent quality across your staff or your supervisees without becoming like a McDonald's approach to therapy?
Simon:That's yeah. And, yeah, great to bring that up. That's absolutely the the case. So we're I'm going through currently with my supervisees on a regular basis, and then I review notes. And then I'll do review.
Simon:So I won't do, like, in session direct observation just because it's humiliating for the client, but I will do in the case of video calls. I'll I'll go through recordings. Right? I'm much more focused on, like, the content as established and then the responsiveness to the patient. And that's something that kinda comes up in supervision sessions quite regularly.
Simon:Like, I'm not quite so big on, did you stick to the CBT script? I'm a little bit more concerned with, how did you respond to when the patient did this? So we said we were gonna do 3 sessions of relaxation. By session 2, it was like abort mission because something terrible is happening here. How do you pivot around that?
Simon:And how do we make sure that we don't stick to, like, a cookie cutter? I I like to make sure that by the end of an assessment session or 2, therapists are able to present a rudimentary structure of a treatment plan. I get a little bit concerned when that is detailed down to the 15 minute interval about what we're gonna do in house. A chat g p t does that extraordinarily well. I've seen it.
Simon:They're really cool. But if we stick to that without being a little bit flexible, that's the problem. And, again, this is how it boils back to men's specific needs. Right? If I feel that I'm not being listened to, if I feel that this is not effective, I'm gone, and I'm not coming back, and I'm not coming back for a hot minute.
Simon:Not that I'm not coming back this week. Right? I'll I'll I'll bail for another 5 years and continue to tank my life until I can't stand it anymore, and then I'll find someone else. Managing treatment adherence certainly does have a lot to do with the technical. Did you hit all of the steps of the protocol that we're using as a structure?
Simon:But it also has to do, are you staying on track for this person? Right? Are you getting lost in the weeds of your own technical stuff, which is a much bigger sin, I think, than getting the patient got sidetracked on going on to a work issue when we're here to talk about relationships. Right? If you're stuck on it needs to be CBT and this is how it needs to be CBT, then you're absolutely doing a disservice to the client.
Simon:If you don't get the client buy in, that's another issue. Right? So, again, we're talking science here. This is what I say. You know, if for your particular issue, 8 to 12 sessions of CBT is what the science recommends.
Simon:Pitch it. Sell them on it. And if they're understanding it, they'll participate. Absolutely. But if something goes sideways halfway through, don't blame the patient.
Simon:Right? Chain change up. Right? Be flexible. So this is, again, something that I'm definitely looking for in supervision sessions is your ability to to pivot as it comes up and as is required.
Simon:It's not just adherence to protocol as if it were like a research design, right, where we gotta make sure that the person hits the the 6 data points that the protocol says you gotta hit today. Right? That's not exactly how it works in real life therapy, but that ability to pivot is huge.
Moody:I think this is what makes therapy such an art more than a science is there is psychological science that has been studied for years years. But humans are so complex that 2 people can have the same symptoms and different underlying problems and 2 different symptoms. And this is, you know, obviously, this similar case with biological issues, but I think less so. Like, your body is well more of a well oiled machine that gives you this symptom. When you have a liver issue, it's like the symptom is very clear.
Moody:So how do you balance this with what you've been saying about not making it too standardized?
Simon:I actually I had this conversation not too long ago with someone today. Is it an art or a science? And those cause it was about universities and the arts and science departments. So which is it? Again, like, my my my my education was very much sciency where I did it.
Simon:Others maybe a little bit less. And what we came up with is a reasonable compromise, but it's probably more like craftsmanship than anything else. Right? There is clearly a a technical acumen that needs to happen. Right?
Simon:You can't be an amateur therapist. You can't do this for fun on the side. And if that's what caught you here, you need to correct that. It's not something you can just pick up, and I've got an aptitude, so I'm good at it. There is a clear technical acumen you need to develop and need to be able to the development to develop it rather in varying circumstances.
Simon:So where it's not a science is in the sense that it does not occur in a laboratory, by any means. Right? And laboratory models have difficulty gelling onto real therapy rooms for very good reasons that our our clients are not standardized. Right? They are not genetically modified rats to be exactly the same every time.
Simon:Right? So it takes the the expertise of our craftsperson to be able to do that. Right? To deliver the technical stuff that we've been trained to do in an exquisite way and be able to make that bang on for the needs of the particular person or horseshoe or piece of wood or whatever it is that we're crafting here. So I think that's the balance.
Simon:That's where I I see that we need to strike it here. Like, we cannot abandon technical acumen. We cannot abandon being exquisite practitioners and, you know, of of science. But we need to be the practitioner. We need to actually, you know, be able to pull that into real life in a way that is feasible, amenable, and and understandable to people.
Simon:Right? If it's art, it might be pretty, but it's it might not be as functional. Right?
Moody:I would think that, like, in the art argument, it's more about to me, arts the power of art is that it is it can trigger emotions that make you think of things. And I, personally, I view when I go to therapy, the goal of therapy is to get an epiphany that then changes my behavior, my thoughts, my life. So in that way, I relate it to art in that. I can get an epiphany by watching an incredible movie at the right time. Right?
Moody:You can watch the best movie on Earth at the wrong time, and it'll just fly over your head. You watch it another time, and it'll completely change you. You go traveling around the world, like, after watching secret life of Walter Mitty or whatever. But the craftsmanship is such an interesting analogy because I think why don't we have therapists who go, hey. I've been doing this for decades.
Moody:I know I've helped a lot of people with anxiety. I can help you with your anxiety, and I'll charge you x as a project as opposed to, like, per session fee. It's that classic story of you hire an expert to fix your machine, and he fixes it in 5 minutes, but charges you $10,000. And you're like, what the hell? And he's like, I it's 10,000 because I spent years figuring out how to fix that quickly, not spend time doing it.
Moody:What do you think about that kind of model?
Simon:I think the the the colleges that regulate us may may take issue with a standard curio amount, And I think there's some difficulty just like on the logistic end of it. I I do like the idea though of being able to stick around for the epiphany. The idea that I'm gonna deliver 6 sessions of CBT and that's what you get, and then you're good. And if you're not good, that's on you, bro, because I know the science here. You're right.
Simon:Like, that that I would be cautious of. I I think it's important to stick around. And maybe that's a kind of a craftsmanship thing too. Right? Like, not all wooden blocks are the same.
Simon:Not all projects are exactly the same. To be able to discern that and know it and and stick around to find it. Because, again, the epiphany is not coming out of the books. Very seldom is it that I read something and that just clicked. The epiphanies happen in in session general, sometimes between if we're doing the work.
Simon:But I think that being able to stick around for the full project is absolutely important. I'm not sure how that would affect billing, but maybe we could look for different models for it. Right.
Moody:But I think it's one of the biggest issues that the therapy profession faces that people are hesitant because they don't know what they're paying for. They don't know what they're getting.
Simon:And Yeah. You know? Yeah. Client clients are daring with their question. Right?
Simon:They're they're they're absolutely trusting you to custody their well-being and their finances. Right? A therapist that doesn't appreciate that does a pretty crappy job in in my respect. All the better issue, you know, all the better reason to talk about building right off the start. Another way around it that I do our practice that it's all posted online.
Simon:So when you're booking an appointment, you know exactly what an appointment fee is, exactly what the rules are about cancellations, about no shows, about things like that. I try to make that really overt so people get in there knowing that. Right? But it's yeah. It it's a great risk on a client end to pay for something, the outcome of which is uncertain Yeah.
Simon:To begin with. If I go to my dentist, I expect he's gonna remove the tooth. Yeah. That's what we've talked about. That's what's gonna happen.
Simon:Right?
Moody:And imagine you go to your dentist, and he's like, I'm gonna charge you by the hour. I don't know if I'll fix this cavity.
Simon:Exactly. I'll see how far I get today. Yeah. Exactly. No.
Simon:Yeah. That that would be challenging, I should say. Or the the dentist explaining, oh, I told you I was gonna remove the tooth, but while it was there, I found something else. We should probably talk about that for a few more hours. Right?
Simon:You you're right. And detailed assessments help that too. And again, it's it's part of our practice around here absolutely to make sure that we've got a formulation going before we even start. And a lot of those first sessions could be educating clients about what to expect here just to be sure. Be sure what you're asking for and and try to give a it's a a little bit short of giving a detailed quote like a contractor would.
Simon:But but it's something like that. So look, if we're gonna talk about mild to moderate anxiety symptoms, we should probably be looking at 8 to 12 sessions of CPT. It would probably look like this, and that's what we can work around. Now if we find something else while we're there, we might need to to reschedule and and reframe it. But being really forthright about that from the beginning is essential.
Simon:Not not just in terms of managing men and men's therapy, going back to the same issue, but just in terms of, like, good ethical practice. Like I said, I would certainly run afoul of the the Canadian code of ethics for psychologists if we were just keeping people around by keeping them talking for an hour at a time for as many sessions as we possibly could.
Moody:This is such a good point because every therapist I speak with at heart wants to help their clients. And Yeah. Is there you know, they get excited when their clients has progressed to the point where you don't need therapy anymore. But at the same time Mhmm. That client is paying your rent, is helping you pay to get groceries.
Moody:And so there's this, like, really tricky situation of you want people to graduate, but you also have a fear of what do you do then if you're not getting a a cost of
Simon:That is absolutely something that that certainly newer therapists would they really struggle with termination, with effective termination. I said the literature, but it was quite good. Like, we know we have to. And and think of it even beyond the literature just ethically. Like, what kind of job am I doing if I'm training dependents here?
Simon:If this person needs to come see me, I'm doing a garbage job without question. Yeah. Just if you raise an adult child that still lives at home, it's like you you lost at that point. That's not how that works. Right?
Simon:We had one job, and you didn't do it. I I think a lot of people and and maybe it has something to do with the youth of the therapist. Although I'm thinking about it out loud. Maybe it also has to do with the age of the practice. So again, obviously, someone in private practice just starting out, new clients are difficult to get a hold of.
Simon:It's difficult to sell your wares and prove to people that you know what you're talking about when you've got a very short resume and a really uninteresting bio. So there's, I think, probably a temptation to hold on a little bit longer than we need to. We try to be really forthright in terms of what we're offering using outcome measures that are very understandable, psychometrics that kinda hit and being able to explain, hey, man. You dropped 50% on your PHQ 9. That's probably relevant.
Simon:Right? Using client centric goals, super important. And whenever those are logistic, like, I I wanna get back to work or I wanna be able to rejoin my soccer league or I wanna be feeling comfortable in my relationship with my spouse. Those are great ways of navigating that termination stress so I don't have to keep I keep coming around. Another strategy did that works pretty well again with the the way that I run the practice with open booking and and without holding on to rigid rosters.
Simon:So it's not like I can only see 40 people at a time. I'm not feeling that anybody is using a space if I say, you know what? We've completed the mission for now. That being said, if anything comes up, reach back out. If I take that control and give it over to the client to say, you can book an appointment anytime you want.
Simon:If something comes up, please let me know. Realistically, I don't see people abusing that at all. I I can't think unlike a dentist. Like, I don't have anybody coming in just because I really wanna burn through my benefits this year. Right?
Simon:But I I think it's nice to know that we've got a contact person if we need it. And I think we can undo the termination stress for both of us by calling this a see you later rather than calling it a goodbye. So it's like you can always come back exactly where I am. You can book an appointment. In our case, we use a direct messaging system that works as well.
Simon:So it's similar to a protected text message that if someone needs to reach out for something, they can absolutely do that. They can contact with the therapist again in a heartbeat. So we can keep that kind of open and alive. I've even gotten quite a few men that'll come in now. We call it a mental floss.
Simon:They'll come in like once a quarter, and we'll just go through, hey, how are things? Let's review those goals that you were working on last time. Right? Let's set some new ones if you're looking at it. Let's make things kind of work.
Simon:It's not exactly not terminating. It's making very clear about a specific therapeutic modality that terminates. Right? We got to the end of CBT. Right?
Simon:We got to the end of the acceptance commitment therapy protocol that we pitched. Now it's follow-up and maintenance, and we can extend that over time. Again, easier for me to do because I've got a very busy practice. I don't feel like I need to get bums in the seats.
Moody:You also have a practice that has or you're using CBT, which as a modality, has, like, an end. A practice that has or you're using CBT, which as a modality has, like, an end Correct. Absolutely. It's it's got yeah. It it's got
Simon:there's and and
Moody:I would
Simon:say, like, any of the protocols that we're using have that sort of flavor to them. Right? We're not currently not using anything brutally psychoanalytic that would take forever and always. I'm not expecting people to come in all the time. And like I say, even if we're looking at acceptance commitment therapy, which can stretch out sometimes, or if we're doing some mindfulness stuff, we always wanna keep that really manageable and adhere to a protocol, which is usually an area around that sort of line.
Simon:And then we start talking about termination.
Moody:I think what's so interesting about this space, this problem, is 1, as humans, we're never really trained to let go of people in a good way. It's always a bad thing to stop talking to somebody. It's a breakup. It's sad. It's a death.
Moody:It's whatever. We are okay with saying goodbye to somebody who provides us a service like a contractor because it's not intimate, really. But the second you get in a therapy room and you're, like, divulging more information and we're being more vulnerable than you are with your friends and your family, it feels you're my friend or more.
Simon:No. There there's certain analysis of the research, but there's there's ample experience. And I think we see that in clients who are not only distressed and that's the reason they're coming here, but who are also isolated, disenfranchised. Right? I've got a few people with whom, if they see me once a week, that's probably more than they talk to anybody else.
Simon:There's absolutely a thing there. But even that, again, we need to detect that in therapy and move on it. Right? That needs to become a treatment goal. Right?
Simon:I I cannot be a surrogate friend. That's not how this works. That's not how that relationship works, and it's not what's good for you or for me. I like friends. I've got lots.
Simon:I think they're great people. But if we're confusing clients with friends, we're doing a poor job. And I and you're right. And I think that would trickle into that difficulty with termination. I think realistically, we gotta celebrate successes.
Simon:Right? Especially for clients. And I think that's how we do that. Right? It's to an extent heartbreaking.
Simon:Right? When the nest gets empty. Right? When our children leave the home, when our coworker gets an amazing job and they go somewhere else, or when our client does extraordinarily well in therapy, and they don't need to be here. It it's awesome.
Simon:It's awesome to be able to tell them that. It's great to be able to celebrate it. And then you're right, that doesn't necessarily mean there has to be a cutoff and you can never come and see me again because you're cured. Go on about your life, but you're better. Enjoy that.
Simon:Celebrate that. Let's use that as an opportunity for changing up what we're talking about.
Moody:I think that's a great note to end on. Thank you for your time.
Simon:Thank you. Thank you so much for having me. It's been a delight.
Moody:I hope you enjoyed this conversation with Simon about making therapy more accessible to men, adapting mental health services to meet client needs and embracing tech while maintaining the human element in therapy. This was made possible by Klarify, the AI tool therapists are using to create case notes in seconds. Thank you for listening.
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