Getting a loved one into Therapy: Should you Try?

Why is it an Issue to try to get my loved one into therapy?

Over the years I have received many calls from people inquiring about therapy for an adult loved one, usually a partner or a child or parent. These inquiries seem well-intentioned, and in most cases function as an expression of love.  I try to handle these calls with grace and compassion. It is very distressing to watch a loved one suffer with mental health symptoms and problem behaviors, and to experience the relationship difficulties we may have with that person as a result. What I am going to say here in this post is based on my own observations of people who have tried, both successfully and unsuccessfully, to get their loved one to go to therapy.  I have had a “ring-side seat” you might say, watching family members advocate for their loved ones to get help, and also trying to persuade some of my own loved ones to get help. The outcomes have been varied. I hope my observations can be useful, but again, not instructional. Any conclusions I make here are not based on objective research studies. I am not a subject matter expert.  Always use your own best judgment when getting help for another person and when in doubt, get help for yourself for support in your efforts to help others.

Be Honest About Your Reasons

I have the wonderful privilege of working with clients who are very committed to the therapy process and are making incredible changes toward the life that they want. I often hear from them how they wish they could get their partner or parent or child into therapy as well. Of course we all want to see our loved ones have a better life. Our lives are intertwined and interconnected so when one of us hurts, we all hurt.

As you consider your goal of getting your loved one to start therapy, be sure to examine your own personal agenda. Your motives may be honorable and yet, be on the lookout for red flags: Have you unknowingly assumed the role of “decider” or “truth holder” about what needs to happen in your loved one’s life? Sometimes we do this unintentionally. Without realizing it we begin acting as though we have some expertise on the subject or we may inadvertently express favoritism of our own ideas over our loved one’s perspective. It happens to all of us at one time or another because we tend to feel passionate about our opinions.  Sometimes we think therapy will fix our loved one by changing certain behaviors that have made them difficult to be around. Sometimes we want our loved one to treat us more fairly or we want them to be more loving like they used to be. Living with loved ones who have mental health symptoms can sometimes feel like grieving (even for a time). We miss the person who was once happier. We share their suffering. So it is understandable that we would look to any viable option, including therapy, to  turn things around for them and for us.  But as you will see in the points that follow, we should proceed with caution. Adults living in the United States have the right to determine what help they will seek as long as they are not a safety threat to themselves or others. This truth is hard to swallow when a loved one’s symptoms are severe and affecting the people they love.

Is there anything you can do when you are worried about a loved one experiencing mental health issues? Absolutely. Start by paying closer attention to the feedback you provide, and to your own assumptions about what is going on. Be curious but not invasive. Ask questions. Offer listening without fixing the problem. Stay neutral and don’t pathologize what may be normal thought processes and emotional patterns, such as grieving. Emotions are natural. They serve a function, even if it is painful. We need them. And they don’t last that long when we refrain from attaching stories to them or making a prediction about what they mean. Therapy can help you sort through the multitude of perspectives on what you are seeing in your loved one, and help you determine the most effective way to think about it and respond to the people involved. DBT can help us relate to thoughts in a more balanced way and it can help us be more resilient with the emotions we feel. This can be especially helpful when we believe that one solution is preferable over another. Your own therapist can help you examine your beliefs about how things should be.

Therapy has Limitations

In my view, there has been a shift in the last 2 decades in how people view psychotherapy. It is now widely accepted and even encouraged in many families, communities, and even by employers.  Since the Pandemic, some employers have even expanded their mental health coverage to make psychotherapy more accessible and affordable.

What I have personally observed is that there is a mindset by many that psychotherapy can help anyone. I’d like to believe this is true, but I am going to stop short of saying so. In my experience, therapy does not help people who do not want to be in therapy. DBT Founder Marsha Linehan, PhD wrote that “DBT is voluntary.”  As I have come to understand it, this is true of therapy in general. Of course, therapists are trained to work collaboratively with reluctant clients (who are likely feeling reluctant for all sorts of valid reasons) to build a rapport with them, and inspire the brave work that could lead to a better life. But therapists are not magicians. Therapy is rigorous and hard work, so a client needs to be at the place where they are ready to do that work. Motivation to change is changeable from one day to the next. Therapists know this and are always working to increase a client’s motivation to change. But there is no guarantee that we will be successful, even if the client considers the goals worthwhile. And there are other limitations as well. When a motivated client enters therapy, the therapist does not/should not control what behavioral changes a client will decide to make. Therapists can actually destroy the therapy process and do harm to a client by becoming judgmental, and by being high-pressured or biased about the choices a client makes. All therapists have to work hard to balance many aspects of natural human behavior in therapy, both in themselves and their clients. Good therapists support clients to become their own therapists and their own behaviorists, so that they can make discerning decisions from a place of wisdom, or Wise Mind. Ultimately good therapy is client-centered and client driven.

Another limitation in therapy that may surprise you is that some people just naturally do not enjoy talking–formulating words to describe their thoughts and feelings. I receive frequent inquiries from partners who want to change this “problem” citing valid reasons. As a culture, we assume that talking about our feelings is needed for wellness. Venting our thoughts and feelings is considered healthy and a behavior to be expected in friendships and intimate partnerships. However, I have personally met many people who seem content with their life of few words.  There are cases where talking can make things worse. And some people do not share thoughts and feelings because it simply doesn’t help. I believe we should always assume valid causes for why people do what they do.  Our loved one’s behaviors are not necessarily rooted in a problem just because it causes us problems. When our loved ones don’t talk to us about “the important things” or when they seem to struggle to express themselves verbally, it can make us feel disconnected from them. It can feel frightening to us. And, I would suggest, this discomfort is our own problem to solve, and is possibly best addressed when WE go to therapy. Communication is complex and most of it is nonverbal. A good DBT therapist can work with you on developing your own personal communication style and finding strategies that can help you increase closeness with your diverse loved ones.

A Loved One’s Therapy May Not Address the Issues you Think are Important

Let’s say you have managed to “sell” your loved on therapy and you find them a great therapist with solid training and experience. What do you expect will happen? What are your expectations? For instance, what will you do if you sense that your loved one is not discussing the issues you feel are most pressing for them? I have heard clients express that they have “no idea what (their loved one) is talking about in therapy because they haven’t changed their behaviors at all.”

Clients get to talk about whatever they want to talk about in therapy. Period. The client has the right to determine what is important to them, and talk only about those topics. Clients have the right to conceptualize for themselves what the causes are for their distress and sadly, their loved ones may not agree with them at all. In fact, your loved one may even decide to talk about YOU in their sessions, and may determine, upon reflection, that they object to some of your behaviors. I have seen this happen. What your loved one decides to work on in therapy may be the last thing that you ever imagine. In fact, when a loved one goes to therapy and begins to explore what is most important to them, it can be the beginning of new problems in their relationships.  Good therapy can help us let go of our agenda for how others should change and offers us strategies to cope with life on life’s terms–and that includes the feelings, beliefs, and behaviors of others that we cannot change.  DBT-informed therapy offers powerful coping strategies, including setting limits with others (and enforcing them).  DBT helps us ask for what we want/need in a straightforward and neutral manner, without using games or shame. Communicating with proper timing and in language that is drama-free and validating helps to shape new behaviors in everyone.

Therapy should be “Pitched” like an Opportunity

DBT therapists assume that we are not experts on other people, so we do not decide for others if they need therapy. We are not experts on other people’s lives. Taking a “dialectical” stance on the subject of therapy, which means welcoming all perspectives on it, enables us to avoid a tug of war with our loved one and it keeps the communication lines open. What is often more effective than pushing our own point is offering our loved one a “window” into what we are learning with our own therapist, and a front row seat to the change that has been made possible in our own lives. When we allow others to see our own growth and changes, we bring the idea of therapy to them from a position of equality. We say “I am not the expert on you, but for me, therapy was life changing.” I have heard stories about the tactics used to pressure a loved one to go into therapy. There is almost always a theme of authority in the script. The rapport quickly deteriorates, causing anger and shame.  When relationships get out of balance, with one person feeling too powerful, communication is thwarted. People who feel oppressed by the ideas of others stop listening. They often push back. Power imbalances in relationships are a genuine threat to closeness and connection. I invite you to read the research online about how important closeness and connection are to mental health and well being.

If you become stuck with your loved, where you think they need to go to therapy and they disagree, try letting go of the polarities. Drop the debate. Validate the valid in both of your positions. This is done with wholeheartedness and honesty. There is usually some point that we can both agree on and identifying that can help us both to hear one another better.  Then ask what is being left out here? Is there information that you are not communicating to me that could help me understand? Are there assumptions that I am making about you that I need to let go of? What am I forgetting that could be helpful to me as I try to accept that we do not see this in the same way? What could help either of us feel better about this disagreement or arrive at a middle path? The answer just may surprise you, and will most certainly begin with you, as you shift focus on the changes you need to make in your own life.

Call Christina Unruh, LCSW today for a free consultation because what you are going through with your loved one matters too…just as much. And it is a great place to start.