Balk Therapy

Posted by fxckfeelings on March 14, 2013

Most of us feel driven to help someone who’s in pain, whether they want it or not, but as sitcoms, Jodie Foucault books, and alcoholics have tried to teach us over and over again, stepping in to relieve or prevent suffering isn’t always a good idea. The sad reality is that lots of pain can’t be helped, and the sufferer is the only one who can make the tough decisions required to manage that pain effectively. Helping, then, is often less a matter of providing relief and more of encouraging people to ignore pain that they can’t change and take credit for the good things they do about it. The outcome isn’t as dramatic as it is when you attempt to rescue someone, but it’s often a lot more meaningful for everyone involved.
–Dr. Lastname

I’m a resident advisor in a college dorm (it’s free room and board, and I’m a psych grad student, so it’s training of sorts), but I’m stuck because I don’t know how to help one of the kids on my floor. He’s severely depressed and it’s complicated by the fact that his parents, who are Middle Eastern, don’t believe in mental illness and think he’s supposed to just get over it, so they won’t pay for treatment and would probably accuse him of shaming the family if they knew he got it. For a couple years, he was cutting his arms while keeping it a secret and not letting it affect his grades. Lately he says he’s stopped cutting but often thinks of suicide and sometimes gets into a strange, spacey state of mind where he’s caught himself standing on balconies and thinking about jumping. He’s a good kid and he denies being traumatized (I think he might be in the closet, and with his parents, I understand why he’s afraid to come out), but he obviously needs help. My goal is to find him the help he needs.

Before trying to help someone who’s suicidal and restricted by his own beliefs from getting help, you’ve got to remind yourself that your powers are sharply limited, and that, even under the best circumstances—if you had a practice and he was a willing patient—his case would be a challenge. This is the stuff they don’t teach you in school, or you’d switch your degree to finance.

You can coach him on his options, but the alternatives are all painful and there’s no guarantee of relief, so don’t expect to make him feel better; what you can do, however, is help him see his choices as meaningful and positive. In other words, if the desire to heal others is what’s driving your degree, it’s time to begin your coursework for Life is Unfair 101.

To begin with, keep in mind that there’s no cure for depression, particularly when it’s been dragging on for years, and that it could do more harm than good for him to feel he should be able to make himself better, whether it’s through self-help, psychotherapy, prayer, or medication. Because treatment is often slow to work and frequently fails, it requires successive trials to find things that work. Patients have to be patient, active, critical, and methodical in deciding what treatment to try first and gathering data about effectiveness.

Taking that into consideration, as well as the fact that there’s nothing you or he can do in the short run to ease his pain, you can nevertheless do lots of good by advising him he’s got a painful illness that isn’t his fault, and for which there are lots of treatments. He’s been doing a terrific job of soldiering on and pursuing his values by getting his education in spite of his symptoms, and in that way, he’s self-discovered one of the best treatments for depression; keeping busy if at all possible, doing good, worthwhile things.

Demystify talk therapy, and make it less scary, by explaining that people with depression often think very negative thoughts about life, their future, and their actions—in other words, they feel like worthless failures regardless of all evidence to the contrary. Therapy can give them weapons for fighting those negative thoughts and, by the way, if there’s anything else bothering him, it can give him a chance to talk about it. You hope he’ll get relief from talking about his feelings and/or sexuality, but not before he’s ready.

Demystify medication as well by explaining that, since it’s not a cure and takes a long time to work, deciding to use it is a personal decision made by patients, not doctors, depending on how much they believe depression hurts and interferes with their lives. Fortunately, the risks of antidepressants are low, though not non-existent, and he should find out more about medication and other treatments so he can decide what’s worth trying.

If he calls his medical insurance company, he may be able to get them to send any documents about his visits to him, and not to his parents. Your college may also provide him with treatment benefits that don’t go through his parents.

Above all, you hope that hopelessness or fear of disappointing his parents won’t stop him from doing whatever he thinks might be good for him; you might not have the answers, but if you can get him to believe in his right to ask questions, you’ll do well in our field.

STATEMENT:
“I’m very worried about the suicidality and safety of my counselee, and I won’t hesitate to intervene directly if I think he might hurt himself, but otherwise I will encourage him to think rationally about taking good care of a problem he’s not responsible for having, but is certainly responsible for dealing with.”

My girlfriend says I need help but I think she’s being ridiculous. It’s true, my mother was an alcoholic and my father was sometimes pretty rough with me, but I get along well with my brothers and I lead a pretty normal, healthy life—I’m not a drunk, never been a criminal, I have a good job and, except for her therapy obsession, a great girlfriend. She says because I sometimes cry out in my sleep and look tense and moody, I’m a time bomb and just afraid to let someone mess with my head. And while I would like to keep strangers out of my head, I also don’t think it needs fixing in the first place. My goal is to figure out whether I need help and how to deal with my girlfriend if I don’t.

Back when shrinks thought that bad childhoods were the cause of mental illness, it seemed reasonable to treat people who had them with psychotherapy to prevent problems later on, whether or not they had symptoms. Now it’s disturbing to know that genetics and other, yet unknown medical factors are the predominant cause of mental illness and that psychotherapy is not a powerful preventative. On the other hand, it’s amazing how resourceful some people are in surviving difficult childhoods and going on to be good parents, even without the help of preventative therapy (or anything else).

Putting aside old theories and your girlfriend’s worries and forgetting about psychological testing or Rorschach tests, ask yourself how you would determine the mental stability of a prospective partner. If one of their parents was an alcoholic, you’d want to know whether they had control over their own drinking and knew how to honor their own priorities, even when they were strongly motivated to help others. If they were traumatized, you’d wonder whether they were vulnerable to depression, anxiety, or a bad temper, but what you’d really want to know is how they handled such problems if they had them. If their parents’ relationship was unstable, you’d wonder whether they were able to make lasting relationships with friends, family, or prior sweethearts. You wouldn’t fault them for having problems; you’d rate them by how well they were able to manage them.

Of course, if your girlfriend can’t stand being around people who are occasionally moody and irritable, you may be the wrong guy for her; even if you talk to someone, psychotherapy would not necessarily make you a new, cheerful, mood-less man. Even if she dumped you for such a guy, however, there’d be no reason for you to see yourself as sick or defective. On the contrary, you should be proud of how you live your life, which seems successful by any standard, no matter how happy or miserable a childhood was had.

If you do measure up to your own standards, let your girlfriend know that you are who you are. You might wish you had a sunnier disposition and a more sober papa, but you don’t expect to change, you do fine with what you’ve got, and you believe you can be a good partner and parent. If she thinks she can tolerate your disposition, you think you’ll be good together. If not, she’d be better off with someone else.

Of course, f you ever feel you’re getting symptoms of mental illness that seriously interfere with your life, you’ll go see a doctor, but for now, you just have symptoms of being a slightly grouchier-than-average guy. She could do worse, and would be wise to back off a bit and appreciate what she’s got.

STATEMENT:
“My miserable childhood may sometimes give me nightmares, but it hasn’t stopped me from getting ahead and having good relationships. Though I wouldn’t wish it on anyone, it made me strong and taught me what can go wrong and when people should get help. I hope my girlfriend will see my experience as an asset and not a risk factor.”