Why Loved Ones Refuse Therapy and What to Do About It

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You’ve tried — with your friend, your spouse, your adult child. You made the case for counseling. Some hem, some haw, some say they will, but don’t. Others just refuse.

Why?

A few reasons to consider and what you might do about it:

  • Stranger danger. Suspicion of strangers is deeply rooted in the human race, derived from our primitive beginnings and ever-present con-artists. Your friend’s personal experience of betrayal may be a key factor.
  • Saving face. Much in life depends on reputation. How many of our parents admonished us to hide the family secrets and “be sure you don’t tell the neighbors!” Men, in particular, want to project strength, the better to succeed in the world of work and win a desirable spouse.
  • The doctor doesn’t care. He is only in it for the money and measures his patients’ value by the size of their bankroll. Should counselors then give treatment away and make their living after hours by standing on street corners with hat in hand?
  • I’m afraid my employer will find out. I can’t risk it. If you use insurance, the insurer will know your diagnosis, as will every such company in the linked system. They are not supposed to reveal anything to your employer. However, if you work for someone with few employees and his premiums go up the next year … ?
  • Therapy is for the weak, a crutch for the spineless. A therapist argues instead that facing your demons and working to change are signs of strength, not evidence of frailty: an indication of courage, not its absence.
  • I don’t believe in the value of looking back. Sometimes therapy doesn’t require it, but a historical evaluation can remove the bolder from your backpack and allow you to move ahead with pace. On the other hand, baseball’s Satchel Paige said, “Don’t look back, something might be gaining on you!”
  • Emotional pain. Whatever reasons are given, the prospective client can be unconsciously timorous at opening painful issues — digging up a grave bursting with undead horrors of the heart and memory.
  • I’m a logical person, not into feelings. I can solve this logically. Such statements are uttered most often by those who aren’t as logical as they think.
  • A real man does things, he doesn’t talk about them. But what if he doesn’t know what to do after trying everything?
  • Fear of change. Most of us find discomfort in new challenges, in or out of treatment. Yet change can’t be avoided unless you want to wear the same clothes in the same size and color the rest of your life; and continue to travel to the same job site even after your employer bars the door.
  • Fear of the mystery. The counseling office is a bit like the inner sanctum of a haunted house — a place of strange rites and secrets, incense and shadow play, frequented by the ghost of Sigmund Freud. The person who wants control will find few guideposts. Will a wizard cast a magic spell on him?
  • Fear of medication or hospitalization. Though you can’t be forced to take meds as a rule, some are terrified they might hear the doctor recommend it — or worse, a hospital stay.

What’s to be done? I received calls from spouses who wanted to make an appointment for their mate. This is rarely useful. If the individual lacks the courage or motivation to seek treatment himself, the likelihood of his appearance at the appointment is a coin flip at best.

Begging and pleading have their limits, too. The more you push, the more therapy becomes your agenda, not the person you care about. You own it, he doesn’t want to buy it. The more you pester or threaten, the faster he runs. If he does attend a session, his motive is to placate you, not heal himself.

Sometimes it helps to enlist the persuasive talents of one who is respected by the prospective patient: a clergyman, best friend, or close relative. The danger here, however, is an unauthorized revelation to a third-party interpreted as a breach of trust. A similar risk occurs when you plan an “intervention:” getting several friends and family members together to encourage and explain their concern to the doubtful potential client. This technique is more often used with alcohol and drug abuse problems, and is easier to rationalize when the person’s life is out of control and in danger.

I am not speaking here of people who are at risk of harming themselves or others. Thus, legal remedies to force the issue are not available. If your steady expression of loving concern cannot turn the tide, waiting might be the only alternative. The accumulation of pain perhaps will do what you can’t.

You are left in a difficult situation: straining your patience when everything in you wants to scream.

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Most of us spend a good part of our lives wishing others were different: more loving, kinder, attentive to us in a way rarely offered; with an intensity and compassion that finally permits the auditor to “get us.” We want the love of this one, the respect of that one, and wish another would take our words to heart. We think and plot about attracting the dark stranger, selling the human product (ourselves), and winning the vote of the crowd.

The good news here is the presence of one person we tend to ignore. While we work on others to change, he remains in the shadows. We don’t need to run after him, persuade him, make an appointment to meet six weeks in advance, and cause his face to turn in our direction. His visage greets us in the mirror every morning.

When others resist our efforts to influence them we are left to change what we can about ourselves — what we may and what we must: our attitude, emotions, and reactions to the one who refuses treatment — and to the rest of life as well.  The transformation begins whenever we want. The process of self-modification can persist as long as we live. Unlike changing the loved one, however, the necessary alterations are in our hands.

The most important opportunities in life sometimes have been there all along. We wait for the other to wake up while what is changeable in ourselves awaits its own awakening. Imagine standing at a crossroads: one path leads to a darkling state of perpetual hope or desperate preoccupation with a person you can’t control. You pass the time alternately gnashing your teeth or imagining what life might be like if only he changes. The other road directs you to a house of natural light and mirrors revealing all sides of the one human you do control. This workshop evokes the hard work of the master sculptor in everyone, the painstaking job of reshaping our basic stuff.

Become your own work of art.

050613102055--Bristol RWA gallery starting point for Festival of Stone Sculpture Trail

The second image is a Ladies Watch Case photographed by Zeigerpaar and sourced from Wikimedia Commons. The bottom photo comes from the Bristol RA Gallery Festival of Stone Sculpture.

 

18 thoughts on “Why Loved Ones Refuse Therapy and What to Do About It

  1. Hi thank you! Your article makes to think…. And change….

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  2. Another great post, thank you 🙂
    I was wondering what your thoughts were on how we can avoid becoming resentful of being the one making the changes and trying to mould ourselves differently, and accept the things we may not like (whether that is a loved one’s intransigence, or the boundaries of therapy). How do we move from thinking ‘I want _you_ to give a little ground here’ to really deeply emotionally accepting that we can’t control someone or persuade them to give that ground, and that the self-moulding and changing really does have to be completely self-motivated rather than relying on someone else’s willingness to ‘give’, reassure, or commend our efforts…. ?

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    • The complicated answer would mix remembering the person’s good points, recognizing that perhaps his changing is not as essential if you change yourself, grieving, and looking for fulfillment elsewhere. All very abstract and perhaps not applicable in individual cases. Much of life is giving things up, though we focus most on acquisition. I’d also add some Buddhist or Stoic philosophy to the mix. A while back I wrote an essay on Colonel James B. Stockdale, for years a prisoner of war during the Vietnam War. He was a remarkable model of someone who apparently wasn’t consumed by resentment at his externally unchangeable circumstances and a person who focused instead on changing himself. Thanks for your good words and your question.

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  3. Very interesting post. Speaking from personal experience, another reason can be that the person trying to persuade you into therapy seems to be doing so because they’ve decided that you are a problem to be solved so that everyone else can be happy. Nobody likes to be treated as a problem or made the scapegoat for the family’s issues, after all! (I am in therapy and not denying my part in resolving problems but I am doing it how and when is right for me.)

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  4. “We wait for the other to wake up while what is changeable in ourselves awaits its own awakening.”
    ~ Love that! Taking that other road to the house full of mirrors requires lots of courage and a willingness to face our own frailty.

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  5. Hi Gerald, this post has been surprisingly painful but very true. I have tried for years to get mum to go to therapy to deal with her anxiety problems to no avail, but it’s only in the last year or so from my own therapy that I realised how much I have been carrying her emotional burdens because she couldn’t. Finally last year she saw someone for 10 visits but has not renewed going this year. It’s been disappointing especially after all these years of her promoting my own therapy for my good and well being. What you said is true, the only person you can change is yourself, so I don’t carry her anymore
    (well I try to recognise when I do and stop it) I have also finally addressed with her how much her own anxieties have contributed to my trauma, which to her credit she is willing to acknowledge. It’s been personally painful being ‘ the sick one’ in the family, the one who needs therapy. It’s complex because my family members are ones that I love very much and I know they have been massively traumatised as well and I am willing for them to have their failings because of their past experiences. At the end of the day I do therapy because I want to be well and let my family make their own choices for themselves.

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  6. Thank you for this. I am caretaker to someone who refuses to do anything to treat his depression citing that he doesn’t see the urgency. Three years of being a listening ear and trying to gently suggest professional help hasn’t “worked”. I can only change myself and sadly draw boundaries that will enable me to prevent my own troubled mental health from deteriorating. I already financially support another loved one’s therapy.

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  7. As someone on the other side (one who hasn’t managed to muster up the courage to go to therapy), I wanted to add a few other reasons why we might still be waffling and not getting help.

    1) Finding a therapist. There’s so many names, so little information about most of them online. What if I can’t seem to trust or feel comfortable enough with the first one enough to divulge my story, my secrets, my fears? or the next one? or anyone? The process of starting and staying in therapy just seems daunting.

    2) Time and money. What if you can’t take an hour off every week during the workday to go to therapy? Also students don’t make much money.

    3) Work culture/expectations. I feel in the medical profession we are supposed to be invincible- needing to be the helpers, not the helped. If my professor accidentally finds out I sought therapy from another Northwestern doc, would they view me negatively when it comes time to grade me? What if my patients found out I was in the same psych ward as them at one point? Would they lose faith in my abilities? Will I be judged as weak and not competent to practice medicine because of my moods or thoughts? Even if I didn’t think there should be any stigma for seeking help, that doesn’t mean other people don’t have negative biases.

    4) Level of distress. I think this would be what ultimately determines whether I seek help. If my problems (in my own opinion) are severe enough to impair my work or home life and overwhelm me, then I might be finally motivated enough to do something about it. Borrowing from chemistry, there’s a high activation energy required given all the above barriers/reasons you listed as to why I still resist therapy, but the amount of distress I am in could end up be my catalyst.

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    • Well said, J.Z. All of your concerns are real, but let me address them a bit:
      1) The limits to available information about therapists is a problem, but some potential patients can get a better “feel” for potential therapists by speaking with friends who have been in therapy or booking an initial session from more than one therapist before taking a chance on a longer commitment.
      2) A good many therapists will operate on a “sliding scale” if you can make the case for limited resources. As you say, however, it does take much time both in the session and after it (to process the experience).
      3) I can think of some famous therapists (Kay Redfield Jamieson and Marsha Linehan come to mind) who had extensive psychiatric treatment. Doubtless some people in or out of the health care field would judge you negatively. On the other hand, there are ethical safeguards against professionals divulging this information. It can also be forcefully argued that any experience you have on the “patient” side of the medical field can give you a much needed perspective and make you a better healer. Indeed, in an internship program where I was one of the supervisors within a psychiatric hospital, all the new interns spent their first day at the hospital as “inpatients.” That is, they got a feel of what it was like to spend 24 hours in the patient role and none of the other “real” patients knew this was a part of their training.
      4) Yes, I think most people have to overcome many reasons for hesitation before they enter treatment. One way to think about getting over the hurdle is that your list looks only at the downside. Moreover, the clock is always ticking on our lives and the more “good” time we can afford ourselves is to some degree a function of how quickly we get started on the job of dealing with whatever issues we have. Good luck!

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