How to convince my friend to go to counseling

July 29, 2012 1:15 AM

Help me convince my friend to talk to a therapist

I'm trying to convince my best friend, with whom I talk on a daily basis and have known for about 6 years, that she should talk to a therapist. She's going through a very difficult time in her life and while I am trying to help, I am not that experienced with the issues she's dealing with and I also feel that she has deeper issues that could be worked out by a professional. Important details:

1) She is a student and her health insurance through the school provides full coverage for counseling sessions

2) She dated her first boyfriend for 1.5 years and they broke up around December; this has led to considerable depression and rumination on the relationship and conviction that her self-worth is depleted; she is also experiencing stressful health issues that have clinical depression as a common symptom; these are at the root of why I think she should talk to a counselor, along with some general cognitive distortions.

3) I started seeing a therapist when I started grad school in fall 2010 and it was very successful for me in improving my depression and social anxiety. My success (and previous extreme skepticism about therapy) are part of why I think it will be so helpful to her.

4) Her opposition to the therapy suggestion wavers, with her sometimes almost agreeing and other times not being willing to even consider it. When pressed, she has a few root objections: a) culturally and personally she sees seeking therapy as admitting brokenness/failure; b) she fears that a therapist will tell her she is a horrible person and she must "fix" herself in order to be ok, and she doesn't think she can handle that emotionally; c) she is afraid of being brainwashed by the therapist. I see these answers as further support for the idea that therapy will be helpful, in the very least to alleviate some of these irrational fears.

Questions:

- What can I say that may be more convincing?
- What alternatives could I suggest if she remains steadfast in her opposition?
- What am I doing wrong and what could I do for her additionally?

posted by grokfest to human relations (22 answers total)

Ask her if she's happy the way she is.

When she says no, explain to her that its crazy not to try something assuming it won't work for whatever reason, and that surely trying to feel better is better than continuing to feel like she does. And that if she tries it and its not for her, she is always free to quit.

Worked for me.
posted by Effigy2000 at 1:31 AM on July 29, 2012 [1 favorite]

Effigy - I've actually used almost that exact same argument, and her response has been that seeking therapy will make her feel worse because she will feel she has failed and broken, because she cannot deal with the problem on her own but "should" be able to do so. She is afraid to confront these problems because that requires admitting they exist and I think she is afraid that there is no solution that she will like, and yet she will lose plausible deniability.

I don't mean to threadsit but this is a fundamental issue that is difficult to get around, partly because it's the kind of irrational thinking that therapy could help improve.
posted by grokfest at 1:52 AM on July 29, 2012

I would ask her a) what makes her think that? b) why does she think that? c) why does she think that? In other words, you have to challenge her assumptions and make her think about why she thinks those things, because they are irrational. Also emphasize how helpful therapy was for you, and point out that a b and c did not apply to you.

I found this book interesting and helpful, maybe she would too.

I would also emphasize to her how lucky she is to have mental health coverage and how you would totally take advantage of it if you were her. Why not? It's free and could make her feel a lot better!
posted by smartypantz at 2:01 AM on July 29, 2012 [1 favorite]

One can only change if one want to, and if she clearly doesn't want to but is persuaded to go by a friend, the likely outcome is that she will find the therapy to contribute negatively to her mental health just like she assumes, and may traumatize her from ever going to a therapist again, and will feel bitter against you for making her suffer all that. No matter how great the therapist is in reality, if she's not ready, it's not gonna go well. All you can do is from time to time, check in with her and let her know that there is this option to talk to a professional, but if she resists, let her. and don't insist. She's already depressed, she doesn't need to feel the pressure or the need to defend how she feels. This is her life and her health, and it's her choice whether she wants to feel better about herself, or wallow in depression for a while, not yours. Therapy might have worked in your case, but you two are not the same people.
posted by snufkin5 at 2:12 AM on July 29, 2012 [4 favorites]

Well, she's not going to go is she - talk therapy isn't for everyone. Plus it's kind of the antithesis of counselling - forcing someone to go for their own good.

Suggest that she try journalling. Once she processes her thoughts a bit, she might change her perspective on what counselling can be and can achieve for her. If not, she's at least done some work on herself by herself.
posted by heyjude at 2:17 AM on July 29, 2012 [3 favorites]

If someone breaks their arm, does that mean they failed to keep their arm healthy? There are people who know how to fix this stuff, use them.
posted by rhizome at 2:17 AM on July 29, 2012 [6 favorites]

I don't think you can convince her. It sounds like you've already made the case strongly and repeatedly; if there was any one thing you could say to change her mind, you'd probably have stumbled over it already by now.

It does seem, though, that you're having this conversation with her a lot and that she's getting something out of it (otherwise, why not just tell you to drop it?). You're both stuck in this pattern where you go round and round in circles about the topic, and she's getting the support of you effectively playing therapist along with the reinforcement of her belief that nothing can be changed for the better. If she's curious at any level about whether counselling sessions can help her, she can get all that curiosity out of her system by talking to you without ever having to actually try it. But this isn't really helping her, and it's probably not good for you either.

So if I were you, I'd declare the topic closed. Tell her one last time "Look, Friend, you know I love you and want you to be happy, and you know I think therapy could really really help you get there. We've talked about how much it helped me. But you say you don't want to go and I respect that, even if I disagree with you about it, so I'm just going to drop it from now on. If you ever do want to try it, I'll be happy to help you make an appointment." You could try suggesting alternatives - self-help books, online resources like MoodGym - but again, suggest them once and accept it if she says no.

And then drop it, both the talk about therapy and the talk where you're play-acting therapy yourselves. Resist getting sucked into your role in this - you might well be right about her health issues having roots in depression or her thought patterns being negatively affected by cognitive distortions, but you aren't her counsellor and you can't play that role for her. If she wants to talk about what a bad person she is or how hopeless her life looks - "Friend, it really hurts me to hear you talk about yourself that way when I know it's not true, but you already know my thoughts on speaking to a counsellor about this so let's change the topic." "Friend, you know I disagree with you on that, but if you don't want to try my suggestions then there's not much else I can say." "Friend, I hate seeing you unhappy and I wish you'd try talking to someone about it who can help you more than I can, but I'm not going to push you into anything. Lunch?"

And finally:

What am I doing wrong and what could I do for her additionally?

I appreciate that you're in a tough spot and it's horrible to see a friend suffering, but you can't fix this for her and you can't take the burden of it on yourself. Don't blame yourself for being unable to do that.
posted by Catseye at 2:57 AM on July 29, 2012 [9 favorites]

One way of looking at therapy that has helped me and mine: it is education. We aren't born with the innate knowledge and capabilities for dealing with every possible challenge, we have to be taught. Sure, a small number of folks luck out with a degree of native talent combined with great parenting or friendships at the perfect point in time, but most don't. Just about everyone I know or am acquainted with has had some form of counselling, coaching or therapy at some point in their lives. It's just a tool.
posted by likeso at 3:42 AM on July 29, 2012 [1 favorite]

Cannot like heyjude's comment hard enough. It's MeFi's favorite panacea, but (it may be good if we have a lie-down here) therapy isn't for everybody.
posted by Emperor SnooKloze at 5:15 AM on July 29, 2012

The old joke applies here. How many psychologists does it take to change a light bulb? One but the light bulb has to want to change. The point is that your friend does not yet want to change an d no amount of cajoling will change that. If you want to help her you can give her options and information and support her if and when she asks for your help.
posted by The Violet Cypher at 8:12 AM on July 29, 2012 [1 favorite]

I wholeheartedly agree with Catseye. I had a friend who desperately needed help for so many mental health issues and I finally realized that she was using me as a very unqualified and unpaid therapist. We would rehash her issues and I would listen patiently and make suggestions which she would ignore only to spend our next hang out talking about all the same things. I finally challenged some of her assumptions (or cognitive distortions regarding our shared reality) and she reacted badly so we don't talk anymore (her decision). You need to shut this pattern down or you are going to end up annoyed at her and it could potentially damage your friendship to keep doing this.

My previous suggestions are basically how I would react if she kept bringing things up - ie not just letting her make these wild assumptions regarding what getting help looks like. But if she continued arguing her point and ignoring your very well meaning suggestions, shut her down like Catseye suggests..:

If she wants to talk about what a bad person she is or how hopeless her life looks - "Friend, it really hurts me to hear you talk about yourself that way when I know it's not true, but you already know my thoughts on speaking to a counselor about this so let's change the topic."

And then make sure you change the topic every time it comes up. If she keeps coming back to the same thing even if you keep redirecting, and won't get help, you might have to tell her that you are having a hard time being a good friend to her if she won't get help...

"Friend, I hate seeing you unhappy and I wish you'd try talking to someone about it who can help you more than I can, because whatever I'm doing isn't helping, and I can't keep doing this. You know I care about you but I find it hard to be around you when all you want to talk about is _____. If you want to keep talking about this, that is exactly what a therapist is for! But I'm not a therapist, so I would really like to change the topic now, thanks."
posted by smartypantz at 8:57 AM on July 29, 2012 [2 favorites]

I agree with Catseye, that if you're rehashing your friend's issues with her over and over again, you should stop. Don't be her pseudo-therapist. However, since you don't mention that kind of dynamic (I don't think), I'm going to answer as if you're mostly just seeing her in pain, and wishing you could help.

So. I suggest you first make peace with her following her own path on her own timeline. Understand that therapy was a good thing for you, and may or may not be right for her (for now). And then say something like this:

"Anne, I've been encouraging you to try therapy for a while now, but not because you're broken or inadequate or a horrible person--rather, because you're hurting, and it seems like you haven't been able to find a way on your own to feel better.

I care so much about you that maybe I've overstepped with giving you advice, trying to force a solution on you. Because when I was hurting and felt like I couldn't work my way out of it, therapy helped me. It helped me to find new ways of seeing and thinking about the issues I was dealing with. It helped me to grow, and to feel better. I didn't experience the things you fear, and honestly, I don't think you would, either, if you tried working with a therapist.

However, it's up to you to decide what to do. If it would help, I will happily tell you about my experiences with therapy. If you want to talk about how to find a good therapist and avoid those things you fear, I will gladly do that. But if you're not interested in trying therapy, if you want to try other things for now, I respect that. Let me know what I can do to be supportive."
posted by Meg_Murry at 9:10 AM on July 29, 2012

Catseye hit the nail on the head - it's definitely gotten to the point that I feel like a pseudo-therapist, and an unqualified one at that. She even gives as another objection the fear that if she gets over her insecurities, etc. she wouldn't have friends anymore because that's most of what we talk about. And there was a time in college when we basically stopped talking for about 6 months because I felt like we had nothing to talk about anymore except tedious things, so she's afraid of that happening again.

I am very much in agreement with the "stop being the pseudo-therapist" advice, but how exactly do I do that? She sees this kind of discussion as the hallmark of a close friendship and so it will be an adjustment to not do this kind of ruminating. We talk almost every day, usually via g-chat, and a large proportion of the conversation revolves around how she's been feeling and what is bothering her/occupying her emotional life. Why just her emotional life and not mine? Because I'm overall much less emotional and I only have significant such events once in a while.

Should I cut off the bar at talking so often? Should I stop the conversation when she says something like "I'm really tired and nervous today"? Or just when it gets to particular topics of discussion? Where should the line be drawn, between what and what?
posted by grokfest at 9:51 AM on July 29, 2012

It may be cruel, but you may have to just not be so receptive to her daily attempts to talk.

Once she realizes she can't use you in that way, all she will have is to face her troubles frankly and without a proxy. Like smartypantz's friend there are some folk that just allow their troubles to be the main play on their stage and refuse to face them. Most usually find trouble to be something they have to push off their stage. Your friend actively dances with it on the stage...
posted by Bodrik at 10:15 AM on July 29, 2012

Now that you've clarified that point, I'd say you need to assess your level of contact. First try some of Catseye's scripts so she knows where you're coming from. Especially mention this: "it's definitely gotten to the point that I feel like I'm your pseudo-therapist, and an unqualified one at that".

After that conversation, if she brings things up, don't engage, just acknowledge and move on. Then, if it continues...

her:"I'm really tired and nervous today"
you:"Sorry to hear that, I'm having a pretty good day myself. Did you hear about that new movie... blah blah blah
her:"Yeah, it really sucks, I am so nervous about this thing and I didn't sleep because blah blah blah"
you:"that's too bad, anyways the actor in the movie is sooooo hot...blah blah blah
her: "so I don't know what to do about my awful life"
you:"yeah, that sucks... oh hey, I have to go (my cat just puked on me/I have to work on this urgent thing/ I have an appointment to get to/ I am otherwise occupied), have a good day/hope your day gets better! Bye!"

Whatever you do, do not ask follow up questions. People usually eventually take the hint if you never seem interested in their drama.

I don't know your friend, but the people who I knew who are like this are what I call a "psychic vampires". (I am now remembering more people like this *who I don't talk to anymore*) They will take all your energy and then some, but only give minimal energy back...

her:" how was your day"
me:"well there was this thing that happened..."
her:"oh that reminds me of my thing that was awful that I now have to talk about for an hour"

If that's what she's like, then you will have to decide if you are willing to continue having as much contact with her, because she's not likely to change as it's partly a personality trait, IMHO.
posted by smartypantz at 10:40 AM on July 29, 2012

To your point about psychic vampires, she does this same kind of emotional supporting for other people pretty regularly, not just venting/spouting by herself. We've also been friends long enough for me to know this isn't her default setting; we used to have a lot of fun just goofing on random stuff. She's just going through a really hard time.
posted by grokfest at 10:45 AM on July 29, 2012

If it's health issues that are really the concern, I hope she has told her doctor about her depression. You mentioned that it was a common side effect of her health issue. Perhaps she could address it medically? If she's done all that and refuses to change, I'd still try the distraction technique after a compassionate talk re Catseye. Focus on good times and happy activities, and keep gmail chats brief?
posted by smartypantz at 11:55 AM on July 29, 2012

As someone who was once as your friend is, I agree with those who say you cannot cajole her into therapy. It's her decision, and it's a difficult solo journey not to see therapy as a personal failure.

As far as redirecting the conversation away from the venting, it's common for the depressed person to feel shame for being a bore on others, particularly if, like your friend, she provides emotional support for others. I think flippantly changing the subject without acknowledging her state in a gentle manner may have the effect of confirming her fear/paranoia of being a burden. Others have suggested great ways to shut the venting down gently, and I would advise letting her vent maybe 10% of the time you usually do - just so she doesn't feel like she's been completely shut off - again that might confirm her paranoia.

Also, if she thinks she has nothing to talk about, start doing more things with her that give you something to talk about. Instead of coffee or drinks, which can put pressure on a depressed person to make good conversation, go see a movie or an exhibition - something external you can talk about. Or something in which you can be silent. If there's a project you are working on and she can help. Or if you both have projects you can work on independently but side by side. I used to go to crafternoons where I could be among friends but be silent, where I could be present without having to perform.

When you're stuck in a depressed hole, it can be too hard to see how simple the solutions can be. Yesterday, when confessing my own rut to a friend, as we said goodbye she said "do something for the rest of the afternoon that inspires you, I saw this amazing doco on the weekend about such and such and I think you'll love it..." and when I got home there was an email from her with a link to it. It was a teeny kind gesture that showed sympathy without going into the hole with me. My point being that gentle, small, easy, unpressured positive suggestions and tips from the other side of the wall eventually make an impact, even if it feels like it's going nowhere to you. The trick is being gentle but understanding and acknowledging where they are WITHOUT the tone of being "well, sucks for you! Later dude!"

Good luck.
posted by mooza at 5:55 PM on July 29, 2012 [1 favorite]

And gosh, journalling is awesome.
posted by mooza at 5:57 PM on July 29, 2012

I don't like the suggestions to avoid those conversations all together and to send a message that only a counselor will deal with her problems, and that if she wants to get better, that's her only choice. I think in her mind, even if you're not a professional, she thinks you'd be better to talk with because you are her friend, and I sympathize with that. In essence, there is no better "therapist" than friends and family. However, that doesn't mean you have to become a martyr and sacrifice your life and sanity to make her feel better and move forward. I suggest you to express your frustration and pain to her when she brings up that subject. Let her know how tough it is for you to see her suffer, and how it takes a toll on you when she doesn't seem to value your advice and that you have to repeat yourself. This way, you won't be shutting her out, yet she'll be forced to think of you and your perspective, and hopefully she will not talk about it everyday, and have more respect for your feelings. I'm pretty confident that there will come a time when she becomes more considerate of your feelings. I'm saying this, because I've been in this situation and even though you feel like you're repeating yourself and the other person is not listening, the truth is, they are. It's just that the change you see isn't as fast as you want it, but that doesn't mean that person is not changing or getting better. It takes patience, and I've had several friends thank me later saying they're indebted forever (which I don't think is true) for hanging in there with them when all the others just got fed up and told them to "move on". I don't blame them at all, but if you do really care for this friend, then there's always a way to balance things, and not make it all or nothing, and I believe the key is mutual communication and expressing emotions. If you don't do that, and just offer her advice and loyal support, you'll start feeling like a punching bag, and your friend will not be emotionally challenged to think outside her mind. Good luck!
posted by snufkin5 at 11:18 PM on July 30, 2012

Yeah, I do want to clarify that for the OP, because I see looking back that my comment could be read as 'emotional problems should be dealt with by professionals and not friends' and that's not what I was going for. Of course friends and family are a valuable resource for dealing with problems and stress, and of course you're morally obliged as a friend to provide support and a listening ear when the occasion calls for it.

The "this has to change" advice is for when that is clearly not working (and if you're at the point where your friend is saying that she needs to hold on to her problems to keep her friends, then it's clearly not working). Like, if your friend has a bad cold, you can help by bring them tissues and soup and a blanket - but if their temperature keeps rising and rising and their symptoms keep getting worse, they need a doctor, not more tissues and soup and blankets. Likewise, if they start identifying with their illness so much that they think the only friendship they can have with you is you bringing them tissues, then "That's not true, let's watch a film or something" is going to do more good than "Can I get you some more tissues?"
posted by Catseye at 5:51 AM on July 31, 2012 [2 favorites]

I would like to also clarify, as I can see how my post sounds harsh. I was not talking about being heartless to someone in pain or cutting them off all together. I was trying to give advice based on the fact that OP said they felt they were being pulled into a role and a cycle they were not comfortable with, and which didn't seem to be helping either party. As we don't know OP's friend, it's hard to know exactly how this person is behaving, but the idea that this person wants to hold on to problems in order to keep friends involved is something that eventually needs to be addressed. I of course encourage OP to continue offering loving support, but the friend needs to know you don't feel comfortable in this pseudo-therapeutic role.

My suggestions are for when you have already done all you can to help and you need to enforce your boundaries in this matter. The script of changing the topic abruptly is for a last straw situation where someone is seemingly ignoring your previously stated preference to stop rehashing the same thing over and over again, after you have offered gentle suggestions and redirected lovingly.

I feel like I also qualified the "psychic vampire" part as just a data point, and OP said it didn't apply, so that's great! But there are definitely people out there who have no intention of changing and who feed off of the attention they get for their problems ...cutting them off abruptly may not be kind, but in certain situations it is necessary.

As far as OP's follow up question about what to say, or how to direct the conversation: don't give direct advice, but question her in such a way that she figures stuff out for herself. You might want to look into Motivational Interviewing as a format to apply to these conversations. This might reinforce your therapeutic role, but you could use this technique to help her discover her own path to get whatever kind of help she needs.
posted by smartypantz at 9:56 AM on July 31, 2012