All aboard the therapy bus
February 10, 2015 7:30 PM   Subscribe

How do I help my girlfriend get the help she needs?

I have a lovely girlfriend of a year who needs some help. She has had LOADS of crazy trauma in her past, as well as some of the issues that go along with that, like anxiety (which started as PTSD, but she’s doing a lot better) and addiction (alcohol, drugs, self-harm). She has dealt with abuse (mostly verbal, some physical) from her mom for most of her life (which caused bulemia and self-harm), she was molested and raped as a child, had her high school girlfriend die as the victim of a drunk driver…. She’s been through the wringer….

While she was in high school, she went through some therapy, which definitely helped. This was on her own dime, since her parents are not great in the way of support -- they have no idea about her rape, etc. and would almost certainly blame her for it.

These days she’s doing much better psychologically. She’s currently stable and her depression and panic attacks have basically subsided. The addictions are under control. But there are still a lot of issues. Currently, the problems she struggles with are:

- anxiety…. constantly worrying about everything; doesn’t go outside except to get to other places
- body dismorphia / shame about her body…. she believes she is ugly and fat, from being told that by her mother all the time. She pretty much only eats comfort foods, and has so much shame that she can’t stand to go out and exercise...
- extreme sensitivity / jealousy etc
- self-hate in general, thinks that she brought all her problems onto herself (“It’s my fault I was raped / got addicted to things / gained weight”)

I want to help her overcome these problems, and I think she would benefit a lot from therapy and probably anti-anxiety meds (she was on them at one point). I’ve tried endlessly to get her back in therapy. It did happen briefly -- there’s a counseling center for sexual assault victims that she was able to go to, but she said she wasn’t getting much out of it this time around. Since then she’s had no interest in getting help. Part of the problem is that she’s still under her parents’ insurance, so they would get the bill if she went through their provider. And even if they have no idea what that doctor’s bill is for, it would be a Problem. They give her endless shit for medical expenses.

So, our two problems are that she doesn’t want to go to therapy, and that she’s afraid of her parents’ wrath for spending their money on therapy.

I’m completely lost. She’s an absolutely amazing person and I want to see her live her life as fully as possible, and not be held back by anxiety and self-hate. Maybe therapy isn’t the way to go, or maybe the desire to change her life has to come from her… I’m open to that idea. But if there’s any advice you have for what I can do, I would be so happy to hear it. Any help is much appreciated.
posted by switcheroo to Human Relations (18 answers total) 3 users marked this as a favorite
 
This is obviously a very small piece of the problem, but if your girlfriend can afford the copays for therapy, she can pay them at each visit and her parents will not receive a bill. They will receive an explanation of benefits, so they'll be able to see that she's "using" the insurance, but they will not have to actually be the ones to pay. It's completely dependent on their plan, but the copays can be quite reasonable -- when I was in therapy last year, I believe it was $10 per session. I just paid the therapist directly and never received a bill in the mail. Although your girlfriend's parents very well might still give her grief about seeking care, it might go over better if she could say -- look, this isn't costing you anything extra, and I'm taking care of all the bills myself.

Another option is to find a sliding scale provider outside of her parent's insurance. I did this for a while back when my insurance wouldn't cover the therapist I wanted to see, and while it was more expensive, it was affordable for me at least for a limited number of visits. Depending on your girlfriend's income, this might be an affordable option for her.

Finally, while I agree with your assessment that it would be great for your girlfriend to seek therapy, ultimately that has to be her decision. You're not a bad person if you decide you cannot deal with dating someone who has various mental health issues and isn't able or willing to seek help. That's a perfectly fine boundary for you to draw. But you can't force her to go, and even if you could, you can't force her to be in an open frame of mind where she can actually benefit from the process. Ultimately this is a place she has to come to on her own, and your choice is whether or not you can deal with waiting for that to happen or not.
posted by rainbowbrite at 7:42 PM on February 10, 2015 [5 favorites]


Is there some reason she can't pay for these things? I mean when I was under my parent's health insurance, they mostly paid but on occaison I paid or even my other parent (divorced) paid.

But yeah, is she ready? Therapy sounds great but it's actually a lot of work and sometimes a person goes because they feel they should, or their partner thinks they should, and then it doesn't have much effect, which just reinforces this idea they can't be helped.

What is it that she wants? Not what you want for her. Not what she thinks is just outside of the realm of possibility. But what does she want?

Why was the therapy helpful in the past, and not so helpful now? Otherwise, I don't think you will get anywhere.

Questions like this come up again and again and again here. Helpful partner wants to make partner want therapy. I just don't think these things work out too well in reality, because her getting therapy has to be about her wanting to improve her quality of life, and that doesn't happen if she's doing it just for you. Sometimes being a supportive partner means supporting your partner when you don't agree with their choices.
posted by Aranquis at 7:48 PM on February 10, 2015 [3 favorites]


Insurers have a HIPAA form that your girlfriend can fill out to assure privacy in billing, if she is an adult. It covers a lot of situations, such as divorced families that provide insurance coverage between adults. Local crisis centers are often aware of it because of relationship violence dynamics. She can take responsibility for the co-pay, or in-network coverage and no co-pay? and the bill, if any, can come to her. This might be the "sign" that she's ready.

For you, just be there for her. Not to fix everything, but accept where they are, and when asked, being helpful in a manner that is requested, while being true to who you want to be in the relationship...a peer? Someone who is growing alongside her? That lets her work through self-care? A stand-in for a parent? (I mention that because she seems young)

Take it easy. Go for a walk with her. Watch something that makes you both laugh, and breathe a little.
posted by childofTethys at 8:38 PM on February 10, 2015 [2 favorites]


Forget for the moment of how to pay for help because that is not the primary roadblock. I think the focus on the money is largely an avoidance of acknowledging the extent of a deeply troubled relationship with her parents. ... she’s afraid of her parents’ wrath for spending their money on therapy. Loving parents would move mountains to get their child the support they wanted and needed.

You are right to say that the desire to change her life has to come from her. Unfortunately, I think no amount of prodding and wishing on your part is going to create that in her. It has to be self generated. You being a supportive partner can create the space for that to happen, but that is about it.

The prime hindrance here is her failure to declare her independence to her parents and to herself. Again, not in a monetary sense. There comes a point when you reach a certain level of self awareness and stand up to your parents for the first time as an equal, independent adult. It is looking at yourself and where you came from and saying: from here on out, my happiness and the course of my life is my responsibility. Even in the best of families, this can cause some friction; but this is a crucial step in anyone's life, especially one that starts off troubled.

There has to be a moment in her head when said says,
"My parents did x,y,z to me, but starting today my life is mine."
Some people never manage to reach that point.
posted by incolorinred at 8:47 PM on February 10, 2015 [4 favorites]


I think the best thing you can do to help someone in the US who has insurance, is theoretically willing to give therapy a(nother) try, but is practically overwhelmed and throwing up perceived barriers to actually going and doing it is to get ahold of their insurance info and (with their permission) start putting together a list of what in-network therapists close by might see them, and how much that might cost in copays or coinsurance.

This requires research, logging into their insurance account or calling the insurance company using the info on the card, and then if you're feeling really generous and/or your partner's really willing, calling up therapists to see who's actually accepting new patients in a timeframe that might work. It's a pain. I've done it for myself, a friend, and a spouse. Doing it when not in a mental health crisis is much easier.

That said: if your girlfriend truly doesn't want to go to therapy, as opposed to just the excuses about why she/her parents can't or won't afford it, this is not a project I'd suggest you take on right now.
posted by deludingmyself at 9:20 PM on February 10, 2015 [1 favorite]


There's a book called Feeling Good which I love and regularly recommend, but it's particularly good for this sort of situation where you're kind of nervous about the therapy thing, or unable to do it for logistical reasons, but you want to get a taste for how CBT works. It is not as good as real therapy, of course, with a great therapist... but I'd say it's better, for example, than my experiences in therapy with some of my less-compatible therapists. And it's good for practical stuff. I'm at a point in my life where I'm done endlessly rehashing what I've been through, you know? The therapists I like working with have been very oriented on actually setting concrete goals and stuff. Feeling Good is that kind of thing, not the talky thing.

It's not necessarily good to just do that instead of going to see a good therapist at some point, but it's not a bad place to start moving in that direction.
posted by Sequence at 9:44 PM on February 10, 2015 [1 favorite]


I think by validating her experience and letting go of your notions of how she would be better if she were different. I guarantee you she feels your judgments (comfort food, indeed) and is getting the message that she is the identified patient in your relationship. That's only going to inspire struggle and hatred in her for you (for good reason).
posted by macinchik at 11:44 PM on February 10, 2015 [13 favorites]


So, our two problems are that she doesn’t want to go to therapy, and that she’s afraid of her parents’ wrath for spending their money on therapy.

More accurately, your problem is that she doesn't want to go to therapy. Unfortunately, there's your answer. Your girlfriend doesn't want to go to therapy. You can't force her to do this.

I’m completely lost. She’s an absolutely amazing person and I want to see her live her life as fully as possible, and not be held back by anxiety and self-hate.

I'm sympathetic to your feelings but you can't fix people. Your girlfriend is who she is, therapized or not. Sure, you can suggest therapy one last time with the caveat that you need to break up if she doesn't go, but that's a pretty shitty thing to do.

Hey, sometimes we are with people with whom we see so much untapped potential, and we see fixes for what ails them, but the tough-love answer here is you can't change people. Your choice here is to either accept her as is or to break up.
posted by kinetic at 3:23 AM on February 11, 2015 [4 favorites]


I would like to put it a little more friendly-like. I have a lot of sympathy for your position, both for your wanting to help her, and for hoping for a better life for her. I also think it right to believe that she might benefit from therapy (if she finds a good match and all that). But as others have said, therapy is something one needs to pick as an individual, as one also benefits from it as an individual.

The very important thing you must realise is: you can't (even remotely) serve as a substitute for a therapist. Own that thought. It helps you to let go, if stuff doesn't always go great on her side. It also helps you to establish reasonable boundaries, should she at some point ask for a kind of support that you are not able to give. Indeed, you can't change people, and the art of helping people change from within can't be combined with forms of co-habitation that in the long run are functional for both sides.
posted by Namlit at 5:03 AM on February 11, 2015 [1 favorite]


It sounds like she *is* the patient in the relationship. It's a fraught past that gets more and more heavy over time if she feels any misplaced guilt. If she resents that but you as her partner feel it's what she needs most then it's entirely incumbent on her to take some steps to getting therapy and incumbent on you to decide how long to stick around before giving up. With no ultimatum because you certainly are going to stick it out and only give up at some ridiculously climactic moment. . If she truly needs it but is refusing, you could be the one force in her life that makes her feel "together enough" not to feel a burning need for help.
posted by aydeejones at 5:12 AM on February 11, 2015


And I benefit personally from getting the benefit of the doubt from a partner who knows I have a lot of room for improvement. I acknowledge it and appreciate it and remind them that I know when I'm out of line and going manic or whatever. I am not fixed by any means but have the insight to be a better partner by identifying my own emotions and impulses as they wash over me like a thunder storm. Blah. It would be miserable without her in my life and by having stability I am able to hold down a job for a long time knowing it's part of maintaining a comfortable living situation. Tricky as fuck
posted by aydeejones at 5:15 AM on February 11, 2015


You have reached the point in your relationship where you have to decide if you want to stay with things being as they are.

I'm a fixer. I know exactly what other people need to do to put their lives in order. As my history here demonstrates. So you and I know that if your girlfriend would get therapy, exercise, eat better and tell her parents to go hell that her life would be fantastic. Then you could be happy too.

One thing you get with Obamacare is a full, free physical. And luckily, GPs can evaluate and prescribe for depression and anxiety.

But the thing is SHE needs to see this, and decide that she wants to go. You can tell her, "Sweetheart, I love you and it hurts me to see you hurting so much. You're an amazing person and you deserve to live a wonderful, happy life. Right now it seems that you're stuck. Your mental state is telling you lies about how hard it would be to get therapy, to get help and to move on from where you are. I think you may be depressed, and frankly it's making you see things incorrectly. Let's go to your GP for an evaluation. After that you can decide how you want to move forward. You get one free physical every year, make the appointment, I'll go with you so that we can cover everything with your doctor and make sure that you get what you need."

But after that, if she refuses, or decides she doesn't want to move forward, what's your plan? How invested are you in her getting 'fixed'? Because she may never decide to be different. So you need to think about what YOU want in the relationship.

Good luck to you.
posted by Ruthless Bunny at 5:44 AM on February 11, 2015 [9 favorites]


Since then she’s had no interest in getting help
The only thing you can do is take care of yourself, then. Maybe she'll get therapy. Maybe she won't. I would drop the subject entirely with her and start asking myself: "Am I happy now in my relationship? And if this is the relationship I will be in for the rest of my life, will I continue to be happy?"

I dated a man that treated me like garbage because of something. He had demons. I begged and pleaded and cajoled and hoped that he'd get help. I learned something very sad: No matter how much someone else should change (and yes, he needed to change - he was an abusive, abusive man) -- you cannot change another person. Sad fact in situations like this.

You can lead a horse to water...

Best of luck to you.
posted by sockermom at 5:57 AM on February 11, 2015 [1 favorite]


I want to help her overcome these problems

Oh man, I know you do. Just the way you wrote this indicates that you want very deeply for her to get better and live a happy life with you, but you have to be prepared for the possibility that she won't ever seek help. And even if she did, her personal version of "getting better" might not agree with yours. You personally can't undo years of trauma and abuse, no matter what you do. I know what it's like to love someone with mental health issues and to be blunt, I'd be long gone if they didn't manage it proactively.

All you can do is be supportive and loving. That's it.
posted by futureisunwritten at 6:08 AM on February 11, 2015


You cannot make her want to go to therapy, and you cannot fix her situation with her parents. All you can do is let her know that you are ready and willing to support her in seeking help if she wants to, including practical help such as researching whether she can get a HIPAA insurance waiver like the one mentioned above, calling to set up appointments for her, etc.

If she is not ready to seek help right now, for whatever reason, then you pushing the issue beyond that is as likely to drive a wedge between you as it is to help. She's a grown-up, she's done therapy and meds and has a sense of what they can and can't do for her and what the costs and benefits were, and she gets to decide whether she wants to go down that path again.

You get to set your own boundaries, to practice your own self-care, and to decide whether you want to be in your relationship even she never seeks additional professional help.
posted by Stacey at 6:16 AM on February 11, 2015 [1 favorite]


It sounds like she doesn't believe therapy can help her, because she didn't get much out of her last therapy experience. Sometimes it's just not a good fit between the counselor and counselee. Maybe if you talked to her about how you have to shop around to find someone who is a good fit, that would encourage her to try again. And everyone has good advice on how to keep her parents out of her business WRT insurance.

That said, it's true as noted above my many that you can't force someone into therapy or fix someone. If they're willing to work on their issues, having a supportive partner certainly helps, but if they're not doing it because they truly believe it will help them, just to placate someone, they won't get anything out of it. I've seen that happen a lot. Good luck, it is hard to watch someone you love be in pain. Remember to take care of yourself.
posted by Beethoven's Sith at 6:17 AM on February 11, 2015


Since then she’s had no interest in getting help...

...our two problems are that she doesn’t want to go to therapy...


Sorry, but I don't think there's much more you can do here. One of the biggest truths about human nature is that you cannot change other people. You've done all you could reasonably do and there isn't really anything else you can do to make her want to get treatment.

It's admirable to want to help her but I think you need to be mindful of avoiding the white knight dynamic where you try to rush in and save the wounded princess from her troubles and live happily ever after or whatnot. There comes a point where it becomes more about your needs ("I have to fix her! I have to save her!) than about hers. At the end of the day, the only ones we can save are ourselves.

Being in a relationship with a person with untreated mental illness/substance abuse issues is very difficult. Would you be okay with staying in this relationship if she never changed?
posted by fox problems at 7:25 AM on February 11, 2015 [1 favorite]


In the day to day, I think it's really important that you do not validate her negative self-worth and indeed push back against these when she expresses them to you. You will never convince her that she isn't fat and ugly and a bad person. But you can stick to your guns that you think she is beautiful. Her issues aren't allowed to touch your own opinions, because they are yours. You think it was not her fault that she was raped. You think she is a great person. And so on. Her instinct is probably going to say "no I'm not" - again you can remind her that you're not saying whether she is or isn't, just what you think, and you are very confident and solid in your opinions and she might as well give up trying to change your mind, and in fact she is not allowed to try to change your mind, because these are your opinions only and you have a right to them.

I agree that you can't save her and it is not your responsibility to do so. However, you might be able to motivate her to save herself, by letting her feel the consequences of her behavior. If for example she gets really anxious if you go out and see friends without her, but you really want to see your friends, then reassure her that you are doing something normal and healthy and there is nothing wrong with it, and go anyway. Don't pander to her issues, in other words; don't take responsibility for them or make them your problem to fix; instead live what you believe is a healthy and normal life for yourself, and if she feels left out or like her issues are holding back the relationship, she is more likely to want to work on herself.

One thing you can do is help her if she asks for it. And if you're not sure if she wants help or not, ask her. If she expresses problems you can ask her "can I help you with this". Such as, "would you like me to help you find a therapist". Or "would you like me to call that place for you". However, you have to respect her answer, and it might be no.

A final thought. It can be really tempting in such a situation, where her problems are so obvious, to focus on them and conveniently forget to be a flawed human yourself. Eventually you might come to inhabit roles of "the perfect one" and "the broken one". You might start to suppress your own needs in order to try to help her, because she so badly needs you, and it feels good to be needed. You might even start to get comfortable with her being in that space and unconsciously reinforce her patterns. This is codependence. If you are a normal human being, you are prone to anxiety, jealousy, fear, self-doubt, and all these other things too. You may have them in lesser degrees, or perhaps you are just better at stuffing down your emotions. Please don't forget to be human and imperfect. I said above that you should not validate her negative self-worth, but you can still empathize with the feelings around it, like "it makes sense that you feel this way"or "I feel that way sometimes too" or "I would probably feel the same in this situation". An important part of feeling less broken is feeling like your emotions are normal and valid, and one of the best ways to feel this is to foster a relationship in which emotions flow freely from both of you.
posted by PercussivePaul at 8:30 AM on February 11, 2015 [3 favorites]


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