How do I get my partner or family member into therapy if they don't think they need help?

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MY NAME IS SARAH LEE AND I'M A PSYCHOTHERAPIST WORKING IN MANCHESTER CITY CENTRE IN THE UK AND ON SKYPE.

I get a fair few enquiries from people along the lines of ‘my partner/sibling/parent needs help but they won’t admit it/don’t want to get help, what should I do/can you help them?’ so I thought I would write about my thoughts on how to approach this and explain some of the factors going on behind the scenes.

Those who try to get their family members or partners into therapy fall broadly into two categories in my experience: those who wish to change someone’s behaviour because it is problematic for them and those who wish the person would get help because they see them suffering and it is very difficult to watch.

Those who find their partner or family member’s behaviour problematic

I once had someone (A) bring their partner (B) to my office because they ‘needed therapy’ (I no longer permit this arrangement). The person who brought their partner spoke for them. They interrupted them, they finished their sentences, and they spoke on their behalf. ‘B does X, Y, Z and needs to stop!’ they exclaimed before ‘B’ struggled to defend their behaviour. ‘B’ did not get a chance to finish. I could see I was not in control of the situation early on in the session and that I was not a participant but a spectator. At the end of the ‘performance’ I was expected to tell ‘B’ that they needed therapy. Instead I told them both that what ‘B’ wished to do was up to ‘B’. If they wanted to see me, then we could discuss this without ‘A’ being present. ‘B’ was adamant they did not want to be in therapy. The pair left and I suspect the argument continued at home.

I am not sure whether A was expecting to escort their partner to my office each week? Would they sit outside the door and ensure their partner did not escape?

Family dynamics and scapegoats

In some cases, the person trying to get someone into therapy is the one with the problematic behaviour. When the person not wishing to receive therapy complains about something they do, they are labelled as ‘oversensitive’ or ‘difficult’. I get a lot of clients who were or are the ‘family scapegoat’. Not willing to accept whatever dysfunctional behaviour is going on in their family, they speak up and point it out. This rarely goes well for them. They are branded overemotional and the family will often close ranks and gang up against them. They end up in therapy asking me to ‘fix them’. They are often the only ones who see what is going on but can end up being manipulated into believing they are the problem.

The irony here, is that the person can often benefit from therapy however the result is not always as expected. Some clients learn to be more independent, to challenge unhealthy behaviour and to stand up for themselves. This is not always welcome (though it nearly always results in the client feeling better and their symptoms improving).

Lack of motivation on the client’s part

Another client whose family member sent them my details and gave my client the money for the session, attended a couple of times. They had nothing much to say to me although they agreed they were suffering. They dropped out after a couple of sessions.

Sometimes clients will have family members pay for therapy but continue to act as adolescents, saving their own money for activities they deem more important than therapy. They claim to be willing to attend therapy but their behaviour says otherwise. Some clients are late to therapy, cancel last minute or simply don’t show up. Their inability to tell me that they don’t want to come is instead manifested in their behaviour. They often drop out without notifying me.

When a family member or partner is suffering from addiction, depression or suicidal thoughts

It is true that some clients are indeed suffering and that family members are concerned. Some clients may have addiction problems, or depression and it is unbelievably painful for their loved one to watch. Their motivation is more for the other person’s benefit than their own because they cannot bear to see them in pain.

Sadly, until someone is ready to get help they will not seek it out. You cannot coerce someone into believing they have a problem if they do not think they do.

So what to do?

You can listen to them. You may have different perspectives on what’s going on. That’s ok. You can respect someone’s perspective without agreeing with them. You can also empathise with their point of view by imagining how you might feel in their position. It is important to remember that it is their own perspective. Someone’s opinions and feelings cannot be wrong because they are theirs.

So if your partner says ‘life isn’t worth living. I’m worthless and there’s no point in carrying on’, to tell them they are wrong is invalidating. You could disagree and give your own perspective e.g. ‘I’m really sorry that you feel that way and I feel really sad hearing you say that. I don’t agree that you are worthless. You are a good husband to me and a great father to our children. Spending time with you both is what keeps me going’. You are disagreeing without taking away their right to have their own feelings and thoughts.

You can put forward your desire for them to get help but don’t make it your only topic of conversation.

‘I think you would really benefit from talking through what you’re going through with a therapist. If you’d like me to help you find someone, then let me know. It may not feel like it would help, but I think it would be a good idea to try so that you can see for yourself whether it makes a difference.’

If they continue to use you as their therapist and it’s too much for you, it’s ok to step back. Decide how much you can support them without losing yourself. ‘I don’t know what you should do about being depressed because I’m not a therapist. As we discussed I think it would help you to see a professional to talk about it. I’m happy to listen to you though if that helps’. It’s important to ensure that your life does not become only about them because then you also run the risk of joining them in their suffering. If they call you night and day you may need to set boundaries by not picking up the phone. If this is hard for you to do you could offer them alternatives; seeking therapy, calling the samaritans or a crisis line, speaking to their doctor and perhaps seeking medication, calling another friend who may be available. It’s not selfish to take care of yourself or enjoy doing things with other people and actually it can give you strength to support them in the long run.

Behind the desire to help can lie the dynamic of ‘I can rescue you’. Some people were brought up to be the ‘fixer’, the ‘peace maker’ or maybe they were children that took care of their parents. In these cases it’s common to feel as if their role is to help. In other cases, the person offering help comes from a place of having been there and knowing what it was like and wanting to help the other person out the other side. Whilst these are admirable intentions, when the other person is an adult, it is important to respect their autonomy. If you struggle to do this, you may wish to consider where your need to take responsibility for them comes from. We cannot change someone else’s behaviour; we can only change our response to it.

Respecting the other person’s autonomy

Of course, it’s helpful and caring to try and help someone if they are struggling. It is fine to offer help, or to offer to help someone find help. When it becomes problematic, is when the person you are trying to help is not interested or you find you are making more effort to get help than they are. At this point you may wish to ask them if they are still motivated to seek help, have they changed their mind or has something changed? Check in with them to see whether they are still committed to seeking help and reassure them that it is their decision how to proceed.

Pushing someone into taking help they do not want is rarely successful. In pushing for something that the other person does not want you may alienate them and they may feel further misunderstood. If you wish to stand alongside someone, you may need to accept that they must make their own decisions as and when they are ready.

Sarah Lee