How do I get my partner or family member to consider therapy if they don't want help?

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

I get a fair few enquiries from people enquiring about a family member. They say something like ‘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 someone you are concerned about and explain some of the factors that might influence whether or not someone decides to get help.

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

I find that family members are often motivated by crisis to contact me. Perhaps they are aware that there is been a recent decline in their loved one’s mental health or they are concerned about mentions of suicide or maybe they see the ways that someone is trying to cope with their situation. This can include drinking too much, drug taking, over or under eating, putting themselves in dangerous situations, spending money that they don’t have or staying in difficult or abusive relationships.

what Should I do?

I always recommend that if you are concerned about a friend, family member or partner that you start by listening 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 might sound like you are not listening to them. 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.

If they find it difficult to talk to you about what’s going on, being with them can still be helpful and supportive. You could say ‘You don’t seem to want to talk about this at the moment. Would you like to talk about it another time? I’m happy just to go for a walk/sit next to you/hold your hand if that will help.’ People often underestimate their role in being there and feel like they need to do something. Sometimes your presence is enough.

You can put forward your desire for them to get help but ensure that it doesn’t become your only topic of conversation to avoid them feeling that they are disappointing you or increasing their stress levels.

‘I think you would really benefit from talking through what you’re going through with a therapist or your doctor. 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.’

SETTING BOUNDARIES

If they only want to talk to you about their problems or feelings and it becomes too much for you, it’s ok to take a step back. Decide how much you can support them without losing yourself. You could say ‘I don’t know what you should do about being depressed because I’m not a therapist. I think it would help you to see a professional to talk about it and get more support. 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 agreeing when you are available or turning your phone off when you are sleeping. 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. Or maybe, 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 own.

It is also important to consider the risk of alienating someone who is not ready or is scared of change and who may therefore feel misunderstood if pushed to do something they are not ready for. If you wish to stand alongside someone, it is sometimes necessary to accept that making their own decisions allows them to remain in control of their own situation and take responsibility.

Family dynamics and scapegoats

In some cases, the person encouraging someone to seek 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’. In dysfunctional or abusive situations, they might be the only ones who see what is going on but can end up being manipulated into believing they are the problem.

If you recognise yourself as the scapegoat or have been frequently told that you are a problem you can benefit from therapy and helping to sort through what has happened and your experience. Clients learn to be more independent, to challenge unhealthy behaviour and to stand up for themselves. This is unfortunately not always welcome by the other family members or partners (though it nearly always results in the client feeling better and their symptoms improving).

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.

Why it’s important for clients to be on board with therapy

Sometimes clients 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. It is important that the client is motivated to understand what is driving their behaviour and consider their story. Whilst the therapist plays an important part in therapy, the clients who derive the greatest benefits from therapy are the ones with the most motivation to change and heal.

An option here would be for you to seek your own therapy. You might learn how to set boundaries and to separate your own responsibility from theirs and whether something from your past is triggering your own response in the present. Therapy can also provide an emotional support and outlet for people who are used to being the one doing the listening and caring. We all need to vent sometimes!

Sarah Lee