Persons in the predominately male domains of high-risk occupational groups (police, fire department, rescue teams, prison guards) often show difficulties in accepting psychological help after traumatization. The paper presents case reports and conceptual discussion of the relationship between masculinity and treatment motivation. Clinical experiences on male-specific complications of posttraumatic stress disorder (PTSD) and a high-risk profile of male work-related trauma victims (‘alpha-man’) are discussed. Theoretical discussion furthermore includes social cognitive theories of masculinity and of development of PTSD. The paper concludes with suggestions for interventions relevant to the outlined problems.