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When Your Loved One Refuses Help

by Monica A. Frank, Ph.D.
...try and determine what the reason may be. The best way to do this is to listen to the concerns of your loved one. Use active listening methods to help you further understand.

woman surrounded by hands offering help

One of the most frustrating aspects of living with someone who has a mental illness is when that person refuses to get help. Often, seeing the individual's pain and suffering, the parent or spouse desperately wants to help but feels helpless.

Unfortunately, there's no easy solution. And there's certainly no quick solution which is often why family member's attempts at solving the problem is more likely to cause a deterioration of the situation—they try quick fixes such as telling their family member what to do or giving ultimatums.

The following doesn't offer any magic words to use to convince your loved one to seek help. Instead, it describes a process of understanding your loved one better, improving your relationship, and helping to remove the obstacles to seeking help.

Why do family members resist your help?

Frequently, I have found when providing therapy, my clients have already been told by their family members the very things they learn from me. So why are they able to listen to me and not to their family? Most of the time people believe the reason is due to privacy concerns—a person doesn't want to share problems with a family member who might be involved. Usually, however, the reason a person can listen to a therapist is related to several issues: emotional involvement, approach, and understanding mental illness. The concern about privacy is more likely due to these other factors.

1) Emotional involvement. The closer a person is to a situation, the more desperate they become to change the situation. Many family members see mental illness as life-threatening, sometimes literally due to the possibility of suicide, drug overdose, or living in a dangerous situation. For some, though, the threat may not be as literal but may be the fear of their family member not being able to support themselves or live a satisfying life.

When a person is desperate, they become more demanding: “You can't keep living this way. You've got to get some help!” When heard by the person with mental illness, such statements of desperation sound like condemnations and blame: “You're choosing to live this way” or “You're not capable of managing your life.”

As a therapist, I don't act out of emotional involvement or desperation so I am able to listen to my client, their needs and desires, and gently guide them without putting demands on them. In such a way, therapists are able to bypass resistance. In fact, what I more frequently need to do is help them stop placing demands on themselves. When they have been surrounded by the demands of others they tend to incorporate those demands into their own thinking. And demands are incompatible with change because they create additional stress.

2) Approach. Since family members of those with mental illness often feel an internal demand to make life better for their loved one they feel a pressure to change things more quickly. In response to that pressure, they take the most direct route to change—tell someone what they are doing wrong and how to transform. As a result the pressure is transferred to the loved one in their desperation.

“You need to relax!” may be an accurate statement but the delivery is an unhelpful demand. Not only is it a demand but it does not give the person information on how to accomplish the task of relaxing. Certainly, if problems were as easy to solve as telling someone what to do, we should all be thin, stress-free, financially stable, and in satisfying relationships.

However, approach not only matters but may be the most important part of being heard. So, as a therapist, instead of immediately telling someone what to do, I start with helping them understand what they are experiencing and why making further demands won't help.

Then, I might make suggestions “Why don't we try some things and see what helps?” and will practice the methods with my client until I'm sure they understand. For instance, I teach them the relaxation methods during the session to see how they respond so that we can find the methods that work best for them. Or, we take a situation and write it down using the cognitive diary method and teach them how to examine their thinking.

3) Understanding mental illness. From the outside, when a person doesn't understand mental illness it seems that recovery is a matter of taking some simple steps. “If only you do this..!” Without understanding the challenges faced, they often provide simplified strategies that don't work, and instead, cause their loved one to feel more like a failure.

I have made the same mistake inadvertently. Even though I try to convey the information to my clients that any progress is good, if I say “Try doing this one minute exercise 10 times a day” and they are unable to do it, they will feel like a failure. Even though something might seem simple to you, it may not be for someone with mental illness. So, instead, I say,”Try this exercise for no more than a minute or so as many times as you are able during the day but no more than 10.” That way the message limits them from doing too much rather than too little.

Reasons people are reluctant to get help

First, you need to try and discern the reason your loved one does not pursue getting help. You may not be able to get an answer directly from your loved one because asking the question “Why won't you seek help?” may create further resistance.

Therefore, you need to try and determine what the reason may be. The best way to do this is to listen to the concerns of your loved one. Use active listening methods to help you further understand. Active listening involves rephrasing what they say so they know you are listening which usually helps further the conversation. “So, when you are around other people you feel intense anxiety which is very painful” or “Depression feels like dragging a sack of rocks behind you—although you want to do things it saps your energy.”

When you engage in active listening, it is best to stay away from questions because questions, especially “why” questions, feel like accusations to others. However, with careful phrasing it is possible to ask “how”, “when”, and “what” questions. “When do you feel like that?” or “Do you know what seems to trigger those feelings?”

Once you have some idea of the possible reasons, you may be able to determine some means to encourage your family member to seek help. The following is a list of common reasons people may resist seeking help:

1) Hopelessness. Most people with mental illness have tried to seek help at some point. Unfortunately, many people have had bad experiences and conclude that nothing can make a difference. In addition, the hallmark of certain mental illnesses such as depression is hopelessness. If a person believes that nothing will ever improve, why make the effort? For those who feel hopeless, it is necessary to help them feel hope. But that can't be done by telling them to feel hopeful.

Experience is the best motivator for change. If someone experiences something positive, they are more likely to feel hopeful. That is why in treatment of depression we often encourage people to do something they normally would enjoy. Even if they don't think they will enjoy it, engaging in an activity that normally is enjoyable increases the odds of something positive which can increase hopefulness and motivation.

2) Low self-esteem. Often people don't believe in their ability to make changes in their life. They already feel bad about their situation and blame themselves. When others try to tell them what they should do, it just confirms their feelings of failure. Even though my series 20 Steps to Better Self-Esteem was written for those with low self-esteem, it can provide you with understanding how to best help someone when self-esteem is an issue. However, be careful and don't make the suggestions demands. Instead, use it as a guideline to increase your understanding as to how you can approach your loved one.

3) Stigma. Seeking help may make people feel worse because of the stigma associated with mental illness. The bias against those with mental illness leading others to blame them or see them as less capable increases their feelings of failure. As a result many people refuse help because they don't want to acknowledge mental illness.

4) Emotions or anxiety is intolerable. People with mental illness already have intense emotions that overwhelm them. They may try to ignore or avoid these emotions as a way of managing the illness. In this case they might not seek therapy because of the fear of confronting the emotions. Many of my clients have told me that they are afraid of losing themselves in the emotions and feeling that way forever. Or, they're afraid they will do something they might regret: "If I let myself feel the anger, I might hurt someone!"

5) Fear of discrimination and rejection. Many people with mental illness are fearful that if others knew of their problems they may be avoided or ignored due to the stigma associated with mental illness. This reason is more about how others might treat them than about the stigma itself. For instance, they might not want to take a leave of absence from work because of how others might react towards them or gossip about them.

6) Offended by pity. Some people with mental illness feel that seeking help is associated with pity. They don't want to be treated like a child and seeking help implies they can't take care of themselves.

7) Resistant to demands. Most people react negatively to authoritarian demands. They don't want to be told what to do because it implies they are incapable of knowing how to make decisions in their lives. People with mental illness have probably been told more than most what they should do so they have built up even more barriers than usual to demands from others.

How can you help your loved one get help?

1) Treat them as an adult. Although I was not a child psychologist and didn't think I knew how to relate to them, I often found that children liked to see me. Eventually I came to the conclusion the reason children liked me was because I treated them as I would an adult. I listened to them, asked what they wanted, and I didn't tell them what to do but asked if they wanted me to help. Then I gave them control over the options: “We could do this or this. What do you think?” This is especially important when helping young adults. They need to develop a sense of self-efficacy—the belief that they have the ability to make a difference in their lives. The way to do this is to respect how they feel and think and their ability to make choices.

2) Process vs. outcome. People often want to get right to the solution when helping others but often the process is more important. If you focus on pushing a solution you don't help the person learn to solve problems. Understandably, it can be especially difficult to allow them to process a problem when you can see their choices will lead to bad consequences. But I don't think we can fully know that to be the case. As a psychologist, I've learned that I don't always know the outcome of decisions even though I might think it will end badly. It would be arrogant of me to think that I know better than the person who is making personal life choices. So when I help people I try to not tell them what to do, but instead, assist them in the decision-making process.

3) Respect differences. All lives are different and we can't expect that someone should pursue the path we think is best. When my son was a teenager and played chess in tournaments I noticed that a number of the adult players lived in their cars and traveled from tournament to tournament to make a few bucks. I said to my son, “I guess if that is what made you happy in life, I would be okay with it.” He responded, “It's really hard to have a girlfriend living that way.” But my point is that we can't presume to know what is best for different people and we need to respect their life choices.

4) Try not to use words that mean “should.” Shoulds imply demands and expectations. It tells the other person that they are bad or wrong and don't know how to solve problems in their lives.

5) Active listening. Instead of telling them what you think, listen to what they are saying. Instead of trying to convince them otherwise, reflect back their emotions. “Yes, it can be really scary to see a therapist and tell a stranger how you feel.” Active listening helps a person explore their concerns and options. Your loved one is more likely to open up when you use active listening whereas telling them what to do or asking “why” questions is more likely to shut them down.

6) Develop compassion, not empathy. Empathy gets you too close to the emotional state of the other person and since that emotional state can be fairly intense, the inclination is to want to solve the problem so you can escape the intensity of the emotion yourself. Too much empathy drives people to desperation. When, as a parent, you feel the pain of your loved one, you also more desperately want to change the situation. And as we discussed previously, desperation leads to pressure which only worsens the problem.

Often people have asked me how I can listen to other people's problems all day long and not become overwhelmed by them. The answer is that I have to keep my empathy in check and rely more on compassion. Feeling the emotions of others who are in intense emotional states would be unbearable after awhile and wouldn't allow a therapist the emotional distance they need to help others. Compassion, however, involves some distance so that you can feel for the other person but not feel the demand to solve the problem. The emotional distance of compassion allows a person to be more helpful.

7) Use the cognitive-behavioral (CBT) methods yourself. The methods used in CBT are helpful with solving any kind of problem. By using the methods yourself, you will have a greater understanding of them and will be able to share information at a more personal level. These methods can help you examine your own thinking that may put pressure on your loved one. It can also help you manage your stress. When you feel less stress you experience less internal demand to make things change which allows you to be more effective. In addition, it sets a good example for your loved one.

8) Examine co-dependency. Even though you want your loved one to get help you may inadvertently set up obstacles. I once treated a bright young woman with a great sense of humor who could have been an asset to employers but she quit therapy telling me, “Therapy is too hard and I know my mother will take care of me.” If you are overly involved in solving your loved one's problems and making life easier for her, therapy for yourself may help you look at co-dependency issues and how to be appropriately supportive.

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