For a lot of men, the idea of therapy is about as off-putting as a nightmare. You know the one—where you show up wearing nothing but your underwear. The opportunity to lay bare their most private thoughts, emotions, and shortcomings is not something many men pursue. In fact, it’s more “typical” for men to resist this type of interaction altogether, having been systemically conditioned to believe that examining feelings is a weak and feminine trait.

But what about the men that do find themselves sitting on a counselor’s couch—what do they divulge? What are their common concerns? Dr. Drew Ramsey, a psychiatrist, author, and two-time TEDtalker reveals a slice of what brings the male therapy-seeker to his doors time and time again.

1. Effective communication skills

A lot of men have good intentions but poor execution. Sometimes they just don’t know the right thing to say. And this makes sense—men aren’t pushed to openly discuss their feelings or to respond to those who openly discuss feelings with them. Whereas women foster a deep emotional maturity at a young age that follows them throughout their lives.

Ramsey wagers that this is the number one subject brought up during his counseling sessions with men.

2. The pressure to fix things

It’s no secret that men and women tackle problems differently. This has been established via numerous studies and research. Where women tend to approach problems globally, men are more pragmatic and logical. Women—the contemplators—try to obtain a comprehensive understanding of the problem. Men, on the other hand, are the “fixers.” Looking for the hole to patch or the crack to repair.

When conflicts do arise, men feel a pressing desire to fix it. Even if that’s the last thing their partner wants from them.

3. Their hidden half—the genuine, unabashed self

They’re told to be strong. To be self-sufficient and mostly emotionless. When Dr. Ramsey gets the chance to peak beyond their walls he states he is, “often struck by the sweetness and richness they keep deep in their past.” Whether it’s “their struggle to be cool in seventh grade” or “bigness of their ambitions and fears,” there is often so much more beyond the macho exterior.

4. Utilitarianism—their desire to be useful

Men like to fix things—we established this a couple paragraphs ago. They enjoy a strong sense of pride and contentment when they are useful. Whether that means opening a pickle jar or building a backyard deck. Their pragmatism is often intimately connected to their self-esteem and sense of self-worth. If they can fix things, they feel good. If they can’t, the opposite will hold.

Even Dr. Ramsey admits to this, stating, “It’s my usefulness as a man that helps me feel secure.”

5. The one we all thought would be number one: Sex

It’s no surprise that this topic would turn up in therapy—who else is a man going to discuss this with? There’s a perception that men engage in frequent sexual thoughts or activities, which is accurate for the most part, however, rarely is a man in a situation where he can openly discuss questions or concerns about it. When it comes to sex, men are expected to be robots—just doing it. But it affects them emotionally just as much as it does women, maybe even more so when you consider that many men don’t confide in others about it the way women do.

Ramsey also offers that women and their sexual desires “are a frequent topic.”

6. Depression

Just as men and women approach conflict differently, so too do they respond to depressive symptoms differently. While women may be more open about their abject sadness, men have a tendency to shut down or become irritable or short-tempered. They’re often quicker to deny having symptoms altogether since they’re “supposed to be” strong and “manly.”

This explains the stark disparity in the numbers of men versus women who seek treatment for depression.

7. Dating angst

Women, all the discontent and anxiety you feel over dating—men share these feelings too. Despite their seemed enthusiasm about “playing the field” or “dating around,” many men openly admit that it’s not all it’s cracked up to be. And, in fact, most men genuinely want something serious. “A partner that’ll love them, guide them, tolerate them, and better them.”

8. Living up to the ideal of “Manhood”

The fragility of the male ego is very real, but for a good reason. They are constantly striving to emulate an unrealistic notion of manhood—simultaneous protector, provider, and leader. And if any dimension of this capital “M” Masculinity is threatened, it causes inner turmoil.

While we may still technically be living in “a man’s” world, the moral of the story here is that even some men have a hard time finding their place in it.

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