“I don’t have any friends,” he said. Jack went on: “I don’t know what to do about this. How do you go about finding friends when you’re 50? I had a lot of friends when I was a kid; I had a few friends in high school; I met one or two people in college that were kind of friends; I know a lot of guys at work, and a I know some of my neighbors. But I don’t have any friends.”

I have known Jack for a couple of years. His wife and he came to see me for marriage counseling. As is our policy we did a “marital assessment” to understand Jack and his wife before we would engage in counseling of any sort. Our practice is to understand the people we see before rendering any kind of advice and counsel. More accurately our procedure is this: understand the person, understand the person better, understand the person better than anyone else understands the person. Then we might be in the position to counsel or advise. So after this marital assessment it seemed best to see Jack individually and seek to understand him and help him understand himself better. Now after two years of therapy we have made some progress in the marriage, work, and some other matters. But we have come to a major hurdle, a kind of a problem. I understand him pretty well; he understands himself better; but no one else understands him. As he said, he doesn’t have any friends. In a way, I am a professional friend.

Jack went on. He said that his “best friend,” Sam, is someone he has known for many years. Jack and his friend have spent many hours together over many years doing things, playing, and working. But interestingly, they have never really talked. Jack certainly loves Sam, and I expect that Sam returns the favor. It is likely, however, that they have never used the “L word” (love) with one another. Perhaps it isn’t necessary that they tell one another that they love each other. There are people who insist upon saying, “Love you” when they and a phone call. After a while this kind of “I love you” seems to lose its punch. Yet it is interesting that Sam is Jack’s best friend, and a friend for many years, and a friend that he dearly loves, but yet they do not share words of love. More importantly, they don’t talk, meaning that they don’t talk about what they feel, what they want in life, or who they are. Jack and his best friend have never talked the way Jack and I talk when we meet. Jack and I talk about feelings, like hurt, joy, sadness, fear, anger, excitement, and passion. We talk about work and marriage relationships as well but the heart of these talks is still the feelings involved in these relationships. It is what I do for a living: listen to people. They talk to me about their thoughts, feelings, and doings.

I think the best way to look at valuable psychotherapy is to consider that it is a professional friendship. It is a great privilege to be “friends” with so many people, and I do not take the responsibility lightly. I have many “professional” friends, meaning patients whom I see occasionally or regularly. I recently saw a man, now 24, whom I saw when he was pushed into my office by his mother when he was 15. Now he comes in on his own accord. I saw a young man, now 16, whom I saw when he was seven. I saw another returning patient, a girl now 11, whom I had seen when she was six. She remembers that our friendship was all about playing together. It was good to see them again as I recalled our “friendship” that had existed years ago and now was reinstated. Generally, my deeper professional friendships are with adults with whom I can find some commonality of vocabulary and conversation and well as some years of life experience.

I am privileged to have these many professional/patient friendships, where I can have depth conversation about things that matter. And therapy is not all depth and quality. There are also times of frivolity and talk about the weather. Yet these friendships are exclusive to the office…my office. It is necessary to keep “boundaries” with patients, which usually means that there is little or no outside-of-office contact. It is even a bit awkward to meet a patient while at the grocery store. How do you say, “How’re you doing?” when you know that he is not doing well and struggling to stay alive? It is much harder for me to develop and maintain adult friendships, somewhat because of my professional knowledge, but more because of the dearth of true friendships available in the Western world. I once wrote a lead article in a professional association newsletter entitled, “Do therapists have any friends?” Many of my colleagues resonated with my rhetorical question.

All this about friendship, mostly absent in men’s lives, got me thinking: what is friendship? And what are the ingredients of friendship? And how in the world does a man in, say, his 40’s, 50’s, or older develop a friendship? Establishing and maintaining friendship is no easy task, mostly because of words.

There are many jokes that have as the main ingredient some kind of reference to women talking while men are essentially silent. The data on actual number of words used and the quantity of talking indicates that men talk more than women. The caveat to this interesting fact is that men tell stories and they talk about things. I played basketball last night with a bunch of guys many of whom I have known for 15 years or more. There was plenty of talk, like, “Did you watch the NFL playoff game?,” “What do you think of the Badgers losing two games in a row?,” “It’s supposed to snow five inches tonight,” and the like in addition to the routine teasing me about my 70-year old body trying to keep up with these young bucks of 30, 40, and 50. There was lots of talk, lots of chatter, and lots of friendly razzing. But there was nothing of emotional content, nothing of personal substance, nothing of feelings, and nothing of depth. Now, we might not expect this kind of talk with a bunch of guys playing basketball on a Sunday night. I imagine, however, that if 18 women were playing basketball on a Sunday night, there would be much more than, “How about those Packers?”

Words of depth, words of feelings, and words of personal revelation don’t come naturally to men. At least they don’t come naturally to North American men. My wife and I have had the privilege of being in southern Europe, Greece and Italy, a couple of times. We found a remarkable thing: southern European men talk. They talk about themselves. They talk about feelings. They talk about philosophy. They talk about important things. Walk around Athens or some small town in Greece and you will see men talking…and talking…while they drink that awful Greek sludge they call coffee. I think the reason they spend so much time talking about those small café tables is that it takes two hours to drink (or is it eat?) Greek coffee. It is amazing to watch town after town, street after street, café after café where men are talking. Not to be seen in America. Guys here are working, watching TV, or drinking beer…at least most men. When I have the privilege of seeing a man in my office, I am usually the first man he has talked to in his 20, 30, 40, or 50 years. Words, at least important words, don’t come easy to most American men. I often tell men something like, “At your age of 40, your intellectual ability is at least 55, your vocational/work commitment is maybe 60, your personal ethic is 70, but your emotional/social ability is about age 12. Amazingly, most men say, “Yes, I feel like a child, or adolescent at best when it comes to words, friends, and conversation.”

I just had a phone call with a man I saw in my office 15 years ago. I will call him Jim. Jim is a very successful businessman and has had many trials in life, trials I will not elaborate to keep his confidence. I haven’t seen Jim for the past 15 years, but he called me today to ask for help in his process of helping a friend. His friend is dying. His friend is dying of an “incurable” disease. His friend has chosen to take an alternative medical approach to healing, and at least by the report I had today, this approach is not working. Jim has tried to help his dying friend “correct” his direction with his last years or months of life. I told Jim that while his desire to help Jim was admirable and laudable, it was deficient in a central ingredient: feelings. Jim is trying to convince his friend what Jim thinks is the right thing to do. Now, I don’t know if it is right for this guy to continue with alternative therapy or go in a different direction. And I don’t know how he should talk to his kids about his disease. But I know this: Jim’s decision on these matters is not about facts; it is about feelings. And likely, neither Jim nor his friend knows how to find a path into these feelings.

In previous blogs I have discussed the basic feelings in life: fear and anger (defensive feelings), and joy and sorrow (love feelings). These feelings become complex as they are felt and expressed and often combine together in various ways. Feelings are not the only part of a true friendship, but they are a central ingredient. If a friendship is all about feelings, it is insufficient. If it is all about doing, it is insufficient. If it is all about thoughts, it is insufficient. A growing and valuable friendship has to have all three: feelings, thoughts, and doings. Getting men to find and express the “f word” (feelings), as I call it, is usually quite a difficult task.

In many ways women have many more friends than men. And they certainly have the ingredient of feelings in these friendships much more than men do. I envy the way most women can talk about their feelings, sometimes at the same time. This is quite remarkable. I won’t belabor the neuropsychology of this phenomenon here but to note that there are significant brain differences between the male and female brains that allow a more free flowing expression of feelings in words for women. This is the good news.

The bad news is that men are usually quite at a loss to deal with women who have this much better ability to express feelings in words. Women can also express their feelings in tears much more easily. I believe this ability women have is a combination of certain neurological factors and cultural factors. I have seen southern European and Middle Eastern men express feelings in words and tears quite easily and freely. But we are not living in the Mediterranean. We’re in America. We’re in a culture where woman have…dare I say this…the monopoly of feeling words. Men, at least men in this culture, can’t keep up with a normal woman if it is in the realm of feelings, especially feelings surrounding hurt, helplessness, needs, and sadness. I am often with a couple in my office where both of them are hurt and sad, but it is the woman who is crying, not the man. The man gets mad or is just silent. He doesn’t have words for his feelings of hurt and sadness. He thinks that such feelings are a sign of weakness, but more importantly, he just doesn’t have words for these feelings. In our American male culture, you just don’t express such feelings at work or, for that matter, on the basketball court. You just feel them. And then these feelings (of hurt and helplessness) usually deteriorate into analysis, anger, or addiction. I call these the “three A’s” to avoid expressing feelings.

It is no small task for a man to find words for feelings that we might call “softer,” like hurt, helplessness, and sadness. It takes a lot of work. It can be done, but there is little in American culture that truly rewards men finding the process of feeling these feelings, and then expressing these feelings. If a man truly works at establishing and developing a friendship in adult life, he will need to establish and develop his vocabulary for feelings. He has all the feelings he needs to have. I abhor the expression, “Men are not in touch with their feelings.” Men are completely “in touch” with their feelings. They just don’t have a vocabulary for them. When I am the first man in a patient’s life with whom he has expressed his feelings, I feel privileged. Then it is my task to help this man find other men to express these same things.