Skepticism

When to Pull the Therapy Card

As someone who is fairly open about their mental health life, I’ve had a fair number of people tell me to go to therapy. That hasn’t happened in a long while since I’m also fairly open about the high number of hours of therapy that I commit to every week and have committed to for the last 3+ years. However before I made a serious commitment to therapy, I had many people badger me into going. And as Suey Park pointed out, a lot of the time people tell you to see a therapist when they simply don’t want to deal with your problems or are uncomfortable with how open you’re being. Being told over and over to go to the therapist or get on medication is obnoxious and invasive. It feels like being brushed off. It feels a bit infantilizing: I know how to take care of myself thanks.

However on the other hand, going to therapy is also an incredibly useful thing. If people hadn’t pushed me to do so I may not be alive today. The best evidence we have today suggests that CBT is probably the best way of improving your mental health (and for those mental illnesses that tend to be more treatable with medication you can usually find that out through a therapist). And quite honestly, your friends should not be your therapists: they do not know how to help you when you want to self-harm or restrict or when your anxiety is spiking. Particularly if you go to your friends quite regularly for serious emotional support, it is within their rights to ask you to take some of that weight off of them by going to a professional. It makes sense that they might feel overwhelmed (imagine if I kept telling my friends that I had a broken leg but refused to go to the doctor…they’d probably be a little frustrated).

When you want to talk about your mental health, both parties in the conversation get to weigh their emotional needs. You deserve support and help, but your friends deserve the ability to say that they are overwhelmed or just honestly out of their depth. So when is it appropriate to tell someone who is being open about their mental health status to go see a therapist? When is it really less ok?

I don’t imagine there are hard and fast rules here, but here are some thoughts and potential guidelines to approaching the “please get therapy” talk.

1. Know the person
Unless you know someone and have some conception of what they’re dealing with, how they’re dealing with it, whether they’ve sought help in the past, whether they have the resources and ability to seek help, and whether they’re coping ok, do not give them health advice. Don’t get on someone’s Twitter account and tell them to seek therapy. Don’t tell a friend who has just opened up to you about their mental health to get therapy. That’s really dismissive. At least take the time to learn something first.

2.Make an effort to figure out what the person wants/needs from you
Do they just want to vent a little bit? Cool! Did they just want to let you know so you can be aware of why they might be pissy or lethargic or something else? Great! Was this simply something about themselves they see as pertinent? Woohoo! Support the shit out of that person. Do they want you to solve their problems? Mmmk, here’s where it becomes less great. You can’t do that. You can’t really even help them cope that much unless they give you some specific things they’d like you to do. If you ask what they need from you and they say something along the lines of “make me feel better” then maybe a little suggestion of therapy wouldn’t go amiss because no, their mental health isn’t your responsibility.

3.Communicate
Seriously, even if it means coming clean about the fact that you’re uncomfortable openly talking about mental health issues. Why? Because then you can OPENLY TALK ABOUT MENTAL HEALTH ISSUES. This also lets you talk to the other person about how you feel as a potential support person and/or ally and what energy you’ve got to give right now. There’s no way people with mental illness can expect all their support people to be on all the time, so please tell us about your mental health too so that we can have a relationship that’s healthy for all parties. It makes it easier for everyone. When you check in about how you’re doing, we feel more ok checking in about how we’re doing.

4.Assume we know that therapy exists
This is especially true for those of you who are throwing this out as the first option or who casually encounter our mental illness and start shoving therapy down our throats. EVERYONE with a mental illness knows that therapy exists: it is in our faces a lot. We know that we’re supposed to keep quiet and not talk about it except in a confidential room. We know that we’re supposed to go see someone and get all better and never worry anyone ever again. We know that. Unless you have something more helpful to say than just informing us of its existence, then please keep your mouth shut on this one.

5.Be aware of the gender and racial implications of what you’re saying
If you’re a man and you tell a woman who’s emotional that she needs therapy, you’re really perpetuating the idea of the crazy womens with their emoshuns. If a person of color is frustrated and you tell them you can’t be bothered they just need to go see a professional, you’re really playing into some of the problematic ideas of black people being always angry or totally irrational. If you’re about to throw out the th word give yourself a second or two to ponder whether your perception of the situation might be colored by certain norms and stereotypes. If that’s the reason you’re saying it, then please don’t.

I’d love to hear any more suggestions about how to navigate when to really dig in and help someone and when to openly admit you don’t have the resources to do so. Being a support person for someone with mental illness is tough, so let’s talk this one out.

Olivia

Olivia is a giant pile of nerd who tends to freak out about linguistic prescriptivism, gender roles, and discrimination against the mentally ill. By day she writes things for the Autism Society of Minnesota, and by night she writes things everywhere else. Check out her ongoing screeds against jerkbrains at www.taikonenfea.wordpress.com

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6 Comments

  1. If you’re very close, immediate family close, maybe think about going to therapy yourself. Dealing with another person’s illness is stressful, and resentment can easily fester. You might need a pressure valve, too.

  2. What really helped me was people being open about seeking therapy themselves.
    So, I would say that if you have been or are in therapy yourself, mentioning this might help, because it allows the person to see that “people in therapy” are actually a group of people that overlaps with “everybody in your life” a lot. It allowed me to see therapy as a way to get help, not as the ultimate proof that I was a worthless piece of shit who couldn’t manage her own life.

  3. Hmm, I kind of disagree with a lot of this. If someone was talking to me about symptoms of their physical illness, I’d casually suggest they see a doctor. This is no different. I’m not going to badger someone about it incessantly or anything, but I am very quick to suggest seeing a therapist. We’re not going to de-stigmatize seeking help for a mental health problem by not bringing it into mainstream conversation.

    1. Oftentimes someone just wants to gripe and pulling out “you should go to therapy” is for many a way to get out of an uncomfortable conversation (e.g. they don’t want to hear about your mental health). That was what I was addressing here. You should be able to disclose a health condition without getting advice piled on you. I certainly think it should be on the table (as I suggested here) and that people shouldn’t be afraid to mention it, but at least take the time to get to know what they’re doing and where they are with their mental health.

    2. Really? If someone just wanted to vent to you about their bad knee, you’d tell them to go to a doctor even if you have no idea whether they have insurance, whether they maybe already did and it didn’t help, whether they’re already getting physio, etc.?

      Cuz if so, that kinda makes you an annoying asshole. Just sayin’.

  4. This is good stuff. I would add:

    6. Do your part to destigmatize therapy and mental illness. Don’t perpetuate stereotypes or the idea that therapy is for hopeless cases. People won’t be open to a suggestion they think you will judge them for if they take you up on it. These ideas run deep. I’ve been fortunate to never need individual therapy, but I’ve done couples therapy. I resisted the idea at first because I thought our marriage was strong and our problems weren’t that bad. I was right; our marriage was and is strong and our problems were not that bad. But I was also wrong; we found an awesome therapist and benefited a great deal. If we ever need him again, we’ll go back.

    7. Timing is important. The time when it occurs to you that someone might benefit from therapy might not be the best time to bring it up. This also gives you time to consider the overall pattern and the proper way to handle it rather than just blurting it out as a reaction. I learned a similar lesson with my wife, who suffers from depression, but my advice wasn’t therapy, it was going back on her meds. I suggested gently a number of times that maybe she should talk to her doctor about going back on the meds before a bell finally went off in my head that just maybe the times when she was feeling her lowest were not the best times to offer constructive solutions. When I chose better times to bring it up, she was more receptive and is now back on the meds and much happier.

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