The Origins: When Women Were the “Problem”
Not that long ago, the mental health field, especially psychiatry, operated from one basic idea: the woman is the problem. She was the patient, often brought in by her husband, and diagnosed with vague terms like hysteria or neuroticism. But the real conversations did not happen with her. They happened between her psychiatrist, usually a man, and her husband, also a man. Together, they discussed how to manage her irrational behavior.
Her distress was not something to explore. It was something to control. Emotionality was seen as a flaw, not a signal. The husband was considered the reasonable one. The wife was seen as too emotional to take seriously. What passed for treatment was often a set of recommendations for how the husband could restore order at home by “handling” his wife better. She was labeled. He was consulted.
This is the origin story of modern couples work. And even though the faces and language have changed, the pattern of talking about a partner instead of with them still lingers.
Modern Therapy: A Different Direction, Same Blind Spots
Today, therapy looks very different. More therapists are women. More women are in therapy. And the cultural tide has shifted, at least on the surface.
Now, it is common to hear women expressing valid pain and exhaustion over emotionally shut down, dismissive, or unempathetic male partners. Many therapists, trying to validate and support these women, quickly jump to labels like narcissist, emotionally immature, or Asperger’s. Often, these diagnoses are made without ever meeting the partner being described.
This is not real progress. It is just a new version of an old dynamic, pathologizing one partner based solely on the other’s perspective. Back then, the woman was the irrational one. Now, the man is the emotionally unavailable one. And still, there is no real dialogue.
Patriarchy’s Lasting Imprint on Relationships
Terry Real, a respected voice in couples therapy, offers a more complete lens. He does not blame men or women. He blames the system—patriarchy. A structure that trains men to disconnect from emotion and teaches women to overfunction and overcompensate.
Men are taught from a young age to prize independence, control, and emotional detachment. They learn that vulnerability is weakness and that emotional needs are something to avoid or bury. Most men were never taught how to name what they feel, let alone express it safely.
Women, in contrast, are raised to manage emotional labor. They are expected to maintain connection, anticipate needs, soothe tension, and absorb blame. When a relationship begins to break down, it is no surprise that she ends up in therapy while he avoids it. She is trying to make sense of what is happening. He may not even have the language for it.
This disconnect is not just personal. It is cultural. And when therapists do not account for that, they risk reducing deeply human struggles to clinical labels that do not tell the full story.
The Harm in Diagnosing from a Distance
Labeling a man based solely on what a partner says in therapy may feel validating in the moment, but it does lasting harm in three key ways:
Curiosity dies
Once someone is labeled, there is no incentive to ask deeper questions. The label becomes the explanation.Empathy erodes
The man becomes a caricature—cold, damaged, unreachable—instead of a person with context and history.The relationship stalls
The woman feels more certain that her partner cannot or will not change. The man, never given the benefit of engagement, is written off.
Yes, real narcissism exists. So do deeply harmful relationship patterns. But most of the time, these issues are far more complex. Labels like narcissist or emotionally immature are often shorthand for deeper issues like trauma, fear, grief, or shame.
What Responsible Therapy Looks Like
The answer is not to swing the pendulum back and start blaming women again. The answer is to move beyond blame entirely.
Good therapy sits with complexity. It validates pain without jumping to villainize. It acknowledges gendered patterns without reducing people to stereotypes. And it asks hard questions: What shaped this pattern? What has been learned, and what could be unlearned?
Therapists must do more than mirror back frustration. They must create space for both partners to be human. Patriarchy has damaged everyone's ability to love and be loved. Recognizing that is not about excusing harmful behavior, it is about understanding where it comes from and what might change if both people are truly seen.
Stop Diagnosing Ghosts, Start Inviting People
When we label men instead of listening to them, we miss the full truth of who they are. And when we assume women are always more emotionally evolved, we burden them with a different kind of weight. Neither story is helpful. Neither leads to healing.
Therapy should not confirm the worst things people already believe about each other. It should challenge us to see more. To ask better questions. To sit with the discomfort of two truths existing at once.
We have come a long way since the days of calling women hysterical. But if we are still assigning blame without understanding, we are not much further down the road.
We can do better.