Transcript: Therapy Should Not Be a Last Resort with Bill Sullivan

INTRODUCTION

Bill Sullivan: A core belief tends to be a general belief we have about ourselves or about the world, and low self esteem would typically be a belief such as, I'm a failure, I'm not good enough, I'm unlovable.

It's as if we were a stick of rock. This would be what was written all the way through us.

What I really see a lot is often a feeling of imposter syndrome, people not really knowing their place. Self doubt and low self esteem really underpins a lot of the other conditions.

The diagnostic terms as they walk through the door may be something like anxiety, depression, sometimes trauma, the kind of problems are expressed problems of feeling a bit lost, feeling a bit stuck, almost this kind of existential cry of, is this it? 

Paul Sutton: Bill Sullivan is a psychotherapist with lots of experience of working with midlife men. He says that in middle age, many of the men he works with suffer not only from low self esteem, but with an initial reluctance to understand or accept where that belief comes from.

He also believes that this comes to the fore in midlife, because it's a period of change for many men. If job security is challenged or a relationship breaks down, and someone has built their self worth on their career or their family, self worth can crumble.

So how can therapy help with our understanding of ourselves? Can it address the emotional avoidance that men are famed for? And why do we insist on dealing with things ourselves rather than ask for the help we need? 

<THEME MUSIC>

PS: I'm Paul Sutton, and this is Middle Man, the show for midlife men and the people who love them.

EPISODE

PS: Bill, you're a psychotherapist who, as I understand it, does quite a lot of work with midlife men. Is that an intentional choice, or is it simply that they are the people you're seeing?

BS: It's not an intentional choice. I've found that throughout my career, I've almost tended to match the demographic of the patients or clients that I see. When I was, for example, in my late 20s, men in their late 20s would seem to gravitate towards me, and we would often have quite a good working relationship and quite good outcomes.

Equally, in my 30s, mid-30s, 40s, and so on, it's kind of carried on, really. I think that happens a lot in many industries. You know, we like to work with people in whom we maybe see a reflection of ourselves. In therapy particularly, because there's perhaps a shortage of men, I may stand out a bit more, and people might think, Well, he might understand my position. I'll see what he's about. Yeah, yeah. I think it does work well.

And I think, from my perspective, I quite enjoy it because I do have some resonance, and certainly with people's circumstances, there’s a resonance there for me. So, yeah, I think we get quite a nice flow and quite a nice therapeutic relationship, which is a healthy working relationship in this business. Yeah.

PS: I can see how that rapport is certainly going to help, certainly, you know, between you and a client. That’s got to help, hasn’t it? I mean, do you think that is the case? Do you think that—well, I mean, here’s a question: have any of your clients gone to therapy before, had a female therapist, and not really had that connection? Or is that not something that you ever talk about?

BS: They have. That’s certainly been the case. But I would say it's probably not because they were female. It may just be that it wasn't a great fit for other reasons. It really is about the relationship—whether somebody feels heard, whether they feel they click with the person. So it could be that it’s an elderly female therapist, let's say in her mid-70s, or it could be a young man in his late 20s.

Someone of our age, midlife age, may feel very much seen, heard, and understood. I would say probably less so with the younger generation, because they often haven't been through the same challenges, perhaps, that we may have. So what I’ve found is somewhat of a mistrust—maybe reluctance—to engage with people who haven’t experienced similar situations in their own lives.

PS: Yeah, yeah. And do you find it helps you—on the flip side then, I guess—to be a midlife man who, I don't want to put words in your mouth, but has been through some of the sorts of transitions and challenges that these guys have had? Does that help you in your ability to reflect back to them?

BS: Well, as in, does it help me personally with my challenges, or does it help in my therapeutic work?

PS: Well, both actually.

BS: Yeah, it probably does help both. Certainly from a working perspective, I can be authentic. I can genuinely say, Yeah, I know how that feels. Yeah. So I will self-disclose, but not to an unhealthy degree. That’s quite an important thing in therapy—that therapists don’t share too much of themselves and their personal lives. We don’t want to make it about us. But I think some healthy disclosure is really, really helpful. It shows that we’re human, that we’re flawed, and it normalises, I think, a lot of the challenges people feel.

So particularly if someone says, I struggle with this kind of social group, or I struggle with this kind of work situation, if I can say, Yeah, I had an experience of that, maybe I’ll quote it, or maybe I’ll just say, Yeah, I know what you’re saying. Tell me a bit more.

From my own perspective, yeah, sometimes just talking aloud with someone helps them work things out, but it maybe helps me work things out afterwards when I reflect. It’s not about doing therapy for myself, but yeah, it’s inevitable that we gain greater understandings of ourselves.

PS: And with the men you see—specifically the midlife men, I guess I’m talking about here—what are the sort of common issues you see among this demographic?

BS: Common issues? So the diagnostic terms they may be given when they walk through the door might be something like anxiety, depression, low self-esteem, sometimes trauma. Those would almost be the labels they would have in the NHS, let’s say. The kind of problems they express, though, are feelings of being a bit lost, feeling a bit stuck—almost this kind of existential cry of, Is this it? What’s it all about? Is this what it’s come down to?

What I really see a lot is this feeling of imposter syndrome—people not really knowing their place or doubting their worth. So self-doubt and low self-esteem are what I work with a lot. I enjoy that work, and it really underpins many of the other conditions. For example, if somebody comes in with anxiety or depression, and it’s maybe a bit of a repeated scenario, we can target that anxiety or depression and, you know, hopefully get some good outcomes. But if there’s underlying low self-esteem, they’re just going to experience a repeat of those problems. There’ll be another scenario further down the track that triggers the anxiety or depression again.

So I work on targeting the low self-esteem to achieve some real, sustained improvement—really helping people understand themselves so they can dodge the pitfalls in the future. It’s what we call teaching them to become their own therapist. And the beauty of targeting low self-esteem is that it doesn’t actually take much longer than just targeting anxiety or depression alone. So it’s really successful, really effective.

PS: Yeah. And I guess what you’re talking about here is targeting the root cause, not just the symptom. So in this case, the symptom is depression or anxiety or whatever it might be, but the root cause is, in this case, low self-esteem.

BS: Absolutely. It’s what we would call a core belief. A core belief tends to be a fundamental belief we have about ourselves or about the world. A healthy core belief might be, I’m okay. The world is a safe place. With my work, I tend to deal with less healthy core beliefs. Low self-esteem would typically manifest as beliefs such as, I’m a failure. I’m not good enough. I’m unlovable. The world is a dangerous place.

If we were a stick of rock, this would be what’s written all the way through us. And if it’s I’m not good enough, people might adopt some quite difficult compensatory strategies. They might become really perfectionist—always needing to excel in order just to feel good enough, which can become quite exhausting. Or, conversely, they might opt out of everything—they might avoid every challenge because they feel they’re not up to it. Either way, they can end up feeling quite unfulfilled or burnt out.

PS: Where do those core beliefs come from? Now, I ask this with a bit of bias, I suppose, because I’ve been reading recently about core beliefs, and what I’ve read doesn’t quite resonate with me. But then, I’m not a psychotherapist. I’ve read that a lot of our core beliefs come from childhood and how we were brought up—the way we saw ourselves at that formative age. And I also read that if you reach midlife—however you define that—and you haven’t addressed the emotions or traumas from childhood, that can lead to a crisis. Does that make sense to you?

BS: It does. Core beliefs certainly come from childhood experiences—generally from our parents, sometimes from teachers, or if there’s been bullying at school, for example. Sometimes they develop later, from difficulties at work.

You’re right—if unresolved, these challenges can show up in midlife. But I find they often appear earlier, in people’s 20s or 30s. It could be the first time they leave home, go to university, take on a position of responsibility at work, or enter a serious, committed relationship or parenthood. These life transitions can bring up unresolved beliefs from childhood.

I think it’s important to say that low self-esteem can develop even from a very good childhood. A typical example is when parents encourage their children to do well at school and heavily reward achievement. If, for example, a child gets an A in a test at nine years old and their parents make a really big deal of it, that’s nice—it makes them feel good. It sends the message: If I work hard, it makes people happy, and I can feel proud of myself. That’s a positive thing.

But unless they also receive general messages of unconditional acceptance, it can become a difficulty. The child may develop a dependency on achievement in order to feel worthwhile. If lesser achievements aren’t acknowledged, they may start believing, I need to excel consistently to feel safe. As adults, we can rationalise this, but as children, we can’t. All we understand is: I need to please Mum and Dad.

I find this particularly difficult when working with middle-aged men, for example, because they may have a deep-rooted desire to strive and excel. When we discuss how these beliefs developed, they can sometimes feel guilty and think, Hang on, I don’t want to blame my parents—this feels like I’m pointing the finger at them. So I have to work quite hard initially to reassure them that it’s not about blame; it’s about understanding.

Usually, our parents were absolutely doing their best for us. They believed that solid encouragement was the right approach. But when we look back at it, we can recognise how certain patterns formed and, more importantly, how we can challenge and reshape them.

PS: It’s an odd one, isn’t it? And what you’re talking about here, I resonate with a lot. I’m sure everyone says this—I had a lovely childhood. My parents were great—but I have become aware in the last six months, perhaps, that I was constantly told, You could do better.

So I might get—I don’t know—I was a good kid at school. I did really well, but I was always told by teachers, and therefore by Mum and Dad, because that’s what they were told, Yeah, but you could do a bit better. And it’s led to this deep-rooted sense in me, like you said, running right through my core, of It doesn’t matter what you do—it could always be a bit better. It’s not as good as it could be.

And I’m suffering with that even now with this podcast, which has gone way better than I ever thought it would. I don’t congratulate myself on it. I think, Yeah, but look at them over there—look at what they’re doing. How common is that sort of feeling among men?

BS: Well, it’s absolutely common, because I share the same experience—more or less a carbon copy. You know, I would consider mine a healthy childhood, but my dad, for example, had a strong work ethic. He believed that if you put your head down, it would serve you well—so do your best at school.

Again, he would reward high achievement but pretty much ignore mediocre achievement. I would have the same reports from school: Could do better. Isn’t really interested. Has potential but doesn’t use it.

So, yes, you’re essentially talking about that I’m not good enough feeling. Absolutely, yeah. So what do you then do with your podcast? Because if you’re thinking, Yeah, but it could be better—you know, I could be Jay Shetty or whatever—how do you compete with that?

PS: You try. But in the real world—this isn’t therapy for me, by the way, of course, ignore me—but in the real world, I am an independent podcaster with something that has been going for literally six months.

I’m not a networked podcast with a studio behind me, publishers, and all that stuff like Jay Shetty. You know, logically, my brain says it’s senseless to try and compete with that, right? I should stick to my lane, do the best I possibly can, build it as much as I can.

But my childhood brain is going, Yeah, but I’m not good enough. I don’t… I mean, I don’t know. And like I said, this isn’t therapy for me, so let’s not go there too far. But I guess the question is—you’ve talked a lot about self-esteem, and I’ve given an example there—how common is low self-esteem among midlife men?

BS: Unfortunately, it’s very common. I think particularly among British men.

PS: Okay. You say British?

BS: Yeah, I think it has a lot to do with our exposure to emotional expression. If I can expand on that—so, as middle-aged men, let’s say around 55-ish, we are the first generation of parents who were born either during or just after the war. Their fathers likely either fought in the war or were certainly affected by it. There wasn’t really much room for emotional expression then, and it certainly wasn’t encouraged.

We were coming out of the Victorian era, where people didn’t discuss emotions. So our parents likely came from households with quite traditional gender roles—Dad went to work, Mum stayed at home raising the children. Dad didn’t really get involved in domestic life, and they passed that approach on to us.

My parents were fairly traditional, though fairly modern in some ways. My dad was a nice man but not overly emotional. So I grew up with this Boys don’t cry attitude—something that I think many British men of my age did. Big boys don’t cry. Dry your tears. Jump up. Get on with things. Don’t dwell on it.

Then, as we got to our teens—certainly, in my late teens or early 20s—people started talking about men being more emotionally expressive. The term metrosexual became popular—men talking more about their feelings.

But then we started getting conflicting messages. There were phrases like man up or grow a pair, which made things confusing. What are we supposed to do? Even things like chivalry became inconsistent—Do you give up a seat? Do you hold a door open for a woman? Do you pay the bill on a first date?

I think a lot of men don’t really know where they stand. Their self-esteem is often built on their achievements—typically through their work, sometimes through their family. If they’ve felt able to provide or perform well, they may have achieved a sense of success.

But not all men feel that way. And when one of those pillars begins to shake, that’s when low self-esteem can surface. If my sense of worth is built on my success at work, and suddenly I start feeling outdated—maybe younger colleagues are overtaking me, or my role seems less relevant—then my sense of worth is suddenly up for grabs.

PS: Yeah, that makes a lot of sense. The emotional avoidance thing you’ve talked about—that is a big issue among men, isn’t it? It really seems to be at the crux of a lot of these struggles, from what I’ve read.

How does therapy specifically help with emotional avoidance? How do you get people to express themselves more?

BS: First, we look at the type of emotional avoidance. Is it personal emotional avoidance—where someone doesn’t even allow themselves to feel emotion?

For example, are they quite shut down? Do they rely on unhelpful habits—drinking to dampen emotions, over-exercising to offset them?

Or is it about emotional connection with others? Some men do understand their own emotions, but their communication with friends and family is limited to banter, task-focused talk, or emotionally safe topics—like sport, DIY, and other clichés.

First, we’d identify what’s going on. Then, we assess their emotional intelligence or emotional knowledge—because sometimes, people genuinely don’t have the vocabulary for their emotions.

Some men say, I don’t know what I’m feeling, but I don’t feel good. So we work to pinpoint what that is.

We might start with physical sensations—Where are you feeling it in your body? What is it stopping you from doing? We might determine that it’s fear, guilt, shame, jealousy, anger—whatever it is.

I would literally use what we call an emotions wheel, which contains dozens of different emotions, and ask, Which one does it feel like? We start with something broad, like anger, and then refine it.

The goal is to give someone a vocabulary for their emotions and, more importantly, fluency in using it. Often, the words are in there somewhere—they just need practice in expressing them.

PS: Is there a difference between men and women when it comes to this? Because what you’re describing is almost an inability to even identify emotions—how you’re feeling. I mean, I can’t verbalise that, for example.

Do you find that women, generally speaking, are more tuned into that?

BS: Massively. They are so much more used to it.

When women get together, they can pick up exactly where they left off in emotional conversations—How’s this situation going? How are you feeling about that? Is it still a problem?

With men, it’s extremely difficult. It’s quite rare among middle-aged men, though we have got much better at it in recent years.

Culturally, men’s social interactions have often revolved around the pub, the sports field—places where there wasn’t much room for emotional discussion.

There’s also the fear of being seen as weak—that’s a massive factor. Many men are reluctant to open up.

Before today, I ran a quick survey online among middle-aged men. The response was great. I asked, What might discourage men from approaching therapy?

One issue was cost, but the biggest one was: I prefer to deal with things on my own.

What was interesting is that 80% had a positive view of therapy—yet 70% still said, I’d rather deal with things myself.

I found that really striking. Yeah, therapy is great—but not for me. I prefer to handle things on my own.

PS: I don’t know where to go with that. I guess, like you’ve said, it’s the way we’ve grown up—this self-sufficiency, this idea that maybe it’s weak to seek out support. I don’t know. It’s odd, isn’t it? But yeah.

BS: And I think there’s maybe also this thought of, Look, I’ve got to this age—I should be able to talk about it. And maybe they see fault in that, particularly because younger men are getting really good at this.

What I love hearing is when younger clients say things like, I went for lunch with my friend Jake the other day. For a start, I think—That’s different. Men didn’t do that when I was in my teens or 20s. You wouldn’t really meet for lunch—it wasn’t a thing. So that’s great.

They’re meeting up and chatting, and it’s not all about alcohol or football—that’s great too. And then they’ll say, Yeah, and Jake—or Mike—told me they’re struggling with something at uni, at work, or in their relationship. So they’re getting really good at it.

And I think middle-aged men, although they’re feeling exactly the same things—probably even more intensely—find it difficult to say it. However, in my work, when we focus on emotional expression, we often start with Who’s the first person you could tell that you’re struggling?

We try to build a bit of a support team around them. They might say, Well, I might be able to speak to my brother, or my wife, or maybe there’s a neighbour I get on with.

It’s really about taking some emotional risks—expressing something and seeing how it goes. Seeing—Are you laughed at? Do you collapse in a heap? And I haven’t yet found one person who’s taken that risk and regretted it.

PS: That’s the thing, isn’t it? Like you said, it’s perceived as a risk, but it really isn’t—or at least, it can’t be for most people. Because normally, if you open up to someone—whether it’s a woman or a man, it doesn’t matter—you’re going to be met with empathy and sympathy, not mockery.

BS: I agree. But I think it is perceived as a risk because some men genuinely fear that they will be mocked—that’s the risk for them, because they just don’t know how others will respond. And in reality, neither do I.

So we use what’s called a behavioural experiment. I’ll ask someone to make a prediction. They might say, Okay, well, if I tell my sister that I’ve been really anxious for the last year and I haven’t been able to get into work for the past month, she’ll probably laugh at me. Or she’ll probably just say, ‘Well, sort yourself out and get on with it.’

And I’ll say, Okay, that might happen. I can’t 100% guarantee that it won’t. But shall we give it a go?

And this is where it really takes courage for that person to go forward and carry out the experiment. With men, I really reinforce the idea that courage doesn’t mean being without fear. So we spend some time exploring, What are your fears? What does that feel like? And then, Despite that, you’re still going forward. You’re still engaging in the experiment.

PS: You talked earlier about success—or perceived success, at least. And on this podcast, we’ve had a lot of guests who, not by design, but by chance, fit into this idea of midlife men who have what we’d call objective success.

They’re married, they’ve got kids, they’ve got a nice house, a car, a good job, a solid salary—all the things you’d associate with a 45- or 50-year-old man. But they still feel lost and trapped and unfulfilled—all those things you mentioned. And I’ve talked about this myself, because that was me.

But I know you have a view that there’s another group of men who say, Yeah, but I don’t even have that stuff.

I get emails from guys saying, I’m 45, I’m single, I got divorced five years ago, I don’t have a high-paying job—all those ‘success markers’ people talk about aren’t there for me.

And I know you have a view that perhaps those men are the most vulnerable to things like suicide. I don’t want to put words in your mouth—can you talk more about your thoughts on this?

BS: Yeah, absolutely. And what you’ve said is right.

Now, I can’t categorically say that men who do have those material achievements are not at risk of suicide—because, of course, they are. But suicide is often linked to a sense of hopelessness, and it can be more prevalent in those who feel they haven’t succeeded.

That may mean they don’t have the material stuff, but it may also be that they feel they haven’t made the most of their life.

Perhaps they feel they’ve made poor choices, or bad decisions that have really impacted their life—or the lives of people around them.

Or maybe they’re somewhere in the middle. They’ve just tried to get by. Sometimes life has felt hard, sometimes it’s been satisfying, but now they find themselves thinking, I don’t have much to show for it. Maybe I’ve got another third of my life to go, but I don’t know if I can do much more with it. Maybe it’s too late for change.

There are different stages in life. Erik Erikson, a psychologist, talked about life stages—you have to successfully move through one stage before progressing to the next.

The stage from 18 to 40 is about intimacy—forming relationships. If we manage that successfully, we move on to the next stage: generativity versus stagnation.

This is the stage from around 40 to 65, and generativity is broadly about making our mark on the world. That doesn’t have to mean having kids or having a high-powered job.

It could mean being active in your community. It could mean finding a purpose at work. But we don’t need material wealth or status to feel we’ve contributed.

Someone could be unemployed or long-term ill, but still feel a strong sense of purpose through volunteering, online communities, or simply by supporting those around them.

If we don’t get that, though, we move towards stagnation—which is about social isolation and disconnection. That’s when we start taking stock of life, thinking, Have I done well so far? Am I ready for my next chapter? Or, Is this a stage of regret, looking back on missed opportunities?

When that regret turns into It’s too late for me, that’s when hopelessness sets in. And that’s dangerous.

PS: Do you see many men coming to you in that stage—thinking, It’s too late for me to change my life, or I haven’t got the success that those other guys have?

BS: Not so much with the envy—as in, I don’t have what they have—but with a sense of social comparison? Yes.

If someone comes to me with that mindset, it’s actually a relief—because at least they’re not sitting with it alone. There’s never been a person I’ve worked with where we couldn’t find some sense of value in their life.

And this isn’t about false positivity or empty cheerleading—it’s about genuinely exploring, What’s your function? Where are you useful? Where could you be useful?

So if they do come through the door, that’s great—it shows they’ve reflected and they’re ready for change.

It’s the people who don’t reach that point—the ones who never get through the door—who I really worry about.

PS: Okay. So you reached out to me initially with a thought around therapy and coaching—not in opposition to each other, but as complementary.

And I guess what struck me was that, in my own situation, I’ve always thought of coaching as what I need, and therapy as the next step if things get really bad.

What are the differences between coaching and therapy? And when should someone turn to a psychotherapist like you, rather than a coach? How do they work together?

BS: Together? Yeah. I mean, firstly, I think your word complementary is right. It’s not in opposition at all. There are two main distinctions, and these are about approach.

Broadly, coaching takes a solution-focused approach, whereas therapy takes a problem-focused approach.

If I can broaden that out a bit—let’s say someone is in a bit of a hole, professionally. I know we keep coming back to work, but it often feels like the most relatable way to explain this.

So maybe someone has worked their way up through their 30s, 40s, 50s, and now they’re either sick of their job or have been made redundant, and they want to explore something else.

A coach would say, Okay, you’re in this hole. You have a rough idea of where you want to be. You seem to have some clear goals and motivation. Let’s look at how we can get you from where you are now to where you want to be, quickly.

Now, if someone feels, Actually, I’m in this hole, but I don’t know why I’m here. Maybe I’ve been here before. I don’t know where I want to be, I don’t know what I’m about, I don’t know what I want from the future—or maybe I’ve tried to move forward, but I keep falling back in, then therapy would work to understand:

What got you into this hole in the first place? What patterns are keeping you there? How do you feel when you’re in it? What are the underlying issues that are weighing you down?

Once we understand that, we can then look forward and work on moving out of it.

The idea is that if we can understand why we keep falling into these struggles, and how we’ve responded to them in the past, then we’re much better equipped to prevent the same patterns from repeating. Therapy helps people gain clarity and a stronger sense of where they want to be.

That was a work-related example, but the same applies to loneliness, disconnection, relationships—anything at all.

So really, that’s the main distinction. Therapy is problem-focused, coaching is solution-focused.

The other key distinction is level of function—the starting point of the client.

With coaching, we generally see people who already have a relatively high level of motivation. They may have a strong skill set behind them and often some degree of social safety—for example, they’re not at immediate risk of eviction, and they may be in an industry that offers transferable skills. So, there’s a level of stability.

With therapy, the level of function is often lower, and there is usually a higher level of distress. People coming to therapy are in some form of emotional difficulty.

That doesn’t mean they’re necessarily in crisis or breaking down in tears all the time. It could just mean that they feel lost, disconnected, and don’t have anyone to help make sense of what’s going on.

In therapy, we explore what’s happening, whether there are relevant childhood experiences to look at, or if not, we move quickly to the here and now and focus on making changes.

If someone finds themselves stuck in sadness about the past or caught up in fear about the future, that’s a good reason to consider therapy.

Coaching tends to involve experts in a specific field, but those experts are usually not clinically trained. Therapy, on the other hand, is delivered by professionals who have undergone clinical training in various therapeutic approaches and have the expertise to work with emotional distress.

PS: Yeah. That emotional distress—while you were talking there, I was thinking that therapy seems more focused on emotions, and their underlying causes. Is that right?

BS: Absolutely. Coaching is much more about behaviours, whereas therapy is about emotions and why they occur.

PS: Yes. Okay—emotions versus behaviours. That makes perfect sense. That distinction is really clear in my mind now.

Do you find that men come to you of their own accord, or are they more commonly pushed into it by their partner—sort of a You need to sort your shit out kind of thing?

BS: It was certainly the latter in previous years. I used to get a lot of, I don’t need to be here—my wife sent me.

That can be problematic because if someone is sitting there thinking, I don’t need to be here—my family made me come, my partner thinks I’m the problem, then therapy isn’t going to work.

I usually ask, Do you think you have any part in this? Are there any changes you want to make?

If the answer is No, then it’s going to be difficult, and I might not be able to work with them.

That said, this happens much less frequently these days. More often, I hear something like:

Yeah, my partner sent me along because they’re finding me difficult to live with, and I have to agree—I want to change, I just don’t know where to start.

That’s great. If they’re willing to work on things, we can make real progress.

But increasingly, I’m seeing more men coming spontaneously, of their own accord.

Sometimes it’s word of mouth—they say, A friend saw you, or a friend of a cousin saw you, and I thought you might be a good fit for me.

They often say, Your approach to therapy wasn’t what I expected. I think that’s because it’s quite straightforward, no-nonsense, and common-sense-based.

I don’t mean that in a rough or dismissive way—I mean making therapy as accessible and practical as possible. It doesn’t need to be as painful as people expect.

I think a lot of this fear comes from media representations of therapists. When you look at therapists in TV or film, they tend to be awful.

They’re either unethical, borderline abusive, or completely uninterested.

So I try to be as human as possible—being open about flaws, normalising struggles, but at the same time working with evidence-based models that help create real change.

Some men find me online, some come via their GP in the NHS, and sometimes women do encourage their partners to reach out. There’s still that female push behind it in some cases.

PS: Well, it’s good to hear that more men are coming to you organically rather than being forced through the door. That sounds like real change, even if it’s a slow one.

BS: It is. And that’s why coaches play an important role. I think men gravitate towards coaching because it’s fixing things, and they see it a bit like going to a personal trainer.

That’s how I want therapy to be seen, too. Many of my clients will work with me for weeks or months, then after that, they might drop back in every couple of months—just as a tune-up.

It works really well as maintenance—keeping them on track, giving them a space to reflect, and making sure they don’t slip into old patterns.

PS: The coaches I know are very aware of the boundary—they know when someone needs therapy rather than coaching, and they’re quick to refer people on. It’s not competitive, it’s complementary.

BS: Absolutely.

I’ve had coaches reach out and say, We’ve done some great work, but there’s something deeper going on that needs addressing in therapy.

Equally, I’ve worked with clients who’ve been in a low-functioning state, and once we’ve built up their confidence and clarity, I’ve referred them to a coach because they’re ready to focus on strategy and execution.

So it works both ways.

PS: So, with that in mind—here’s the big question: How does someone know if they would benefit from psychotherapy?

BS: I’d ask: do you feel your life could be better—in relationships, work, health, or general fulfilment?

Do you find yourself stuck in unhelpful patterns of behaviour or thinking? Has this happened before? Is it a recurring issue?

If the answer is yes to any of those, therapy could be hugely beneficial.

Even if someone just wants to understand themselves better, therapy can be an enriching experience.

OUTRO

PS: You can connect with Bill on LinkedIn.

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Next week, we're talking about the potential benefits of cold water immersion on our mental wellbeing.

Heather Massey: When people go in for really short periods of time, and they're experiencing that cold shock response, and then they get out, they feel lighter in terms of their mood. They feel happier, more content, more attentive.

PS: See you then.