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Helping Those in Need Find Counseling

Just about everyone knows a friend or relative who has shown signs of emotional or behavioral turmoil. Yet trying to reach that person can sometimes feel overwhelming. Author Dr. Mark Komrad offers guidance on helping others find help.

Excerpted from his book for family members, psychiatrist Dr. Mark Komrad provides practical advice on engaging people most in need of and most resistant to therapy.

It is not unusual for a troubled person to be unwilling or even unable to observe himself or herself objectively. This can present a real barrier - to be successful you need to start with mutual agreement that there is a problem. Your first goal may be to get the person to acknowledge that she may be in some kind of emotional trouble. To achieve your goal, you will need to use basic principles of negotiation.

The starting point is trying to establish that you and the other are on the same side. You are both looking at a similar goal: a better business relationship, a happier marriage, less suffering for the other (and maybe for you, too), an improved personal relationship, more independent functioning, and so on. This isn't a business negotiation with conflicting interests on each side. You are on the same side. But what if you encounter resistance?

One of the best ways to get through the resistance is to make a genuine effort to listen to what the other is feeling. This goes way beyond the usual perfunctory, "How are you?" to which most people reflexively answer: "Fine." In Persuasion and Healing, Jerome Frank points out that listening in a non-threatening way and taking another person's suffering seriously, giving the person the feeling that his or her emotions are visible to you, are features common to the different kinds of professional psychotherapy (and there are hundreds) and other related healing techniques. As a matter of fact, this is one of the most basic skills new physician residents learn on the path to becoming psychiatrists--how to listen seriously.

Amazing as it might seem, for some individuals a psychiatrist is the first person who has ever really listened, asked deeper questions about feelings, and not only allowed but also welcomed full responses. Carl Rogers, the great psychotherapist, noted that this kind of listening (and the underlying openness in the listener), which he called "unconditional positive regard," was probably key to how psychotherapy helps people change. This can produce very positive and receptive feelings in the person to whom you are listening. One of the best compliments that people tend to give out is, "She is a great listener." Those are the people we often remember the most fondly since, as Maya Angelou said, "People will forget what you said, people will forget what you did, but people will never forget how you made them feel."

Of course, listening is not all there is to psychiatric treatment, but it's a vital foundation. I compare it to a sterile field in surgery. There is much more to a good surgical operation than having a sterile field in which to operate, but without this foundation it's unlikely that the outcome of the surgery will be optimal.

In his bestselling book, Getting Past No, negotiation guru William Ury offers tips for overcoming objections to your argument or desire. He believes that building a bridge to the other side is an absolutely essential part of negotiating agreements. He writes an entire chapter entitled "Step to Their Side," which includes these strategies:

  • Listen actively
  • Give the other side a hearing
  • Acknowledge the person's feelings
  • Tune into the person's wavelength
  • Acknowledge the person

These are all variations on the same theme: be receptive and receive the other through listening. This is a powerful tool for the task you have at hand.

Make the Other Feel Safe
Some people have been so profoundly damaged in their early trust-building years of life, made to feel invisible, that the offer of visibility is scorned because it doesn't feel safe. In childhood, they may have experienced adult figures who should have been trustworthy but who were masquerading while intending to satisfy their own needs. These are the trickiest cases because these individuals will interpret your attempts to help them as threats. These are the people for whom a sense of safety is critical.

Certain psychiatric conditions, like paranoia, by the very nature of the pathology, reinforce invisibility. Indeed, paranoia seeks to preserve invisibility at all costs. The condition involves a fundamental breakdown in the apparatus that the mind uses to make bridges and connections to others, sometimes damaged by brain diseases, such as schizophrenia and autism, or occasionally broken from early life trauma.

You do not have to become a therapist to draft someone into a psychiatrist consultation. But you can borrow some of the language professionals use and thus establish yourself as being on the same side; you are a non-threatening ally who wants to help. Here are examples of ways to start the conversation and promote a sense of safety. They are taken from my own medical practice:

  • "I am really interested in how you are feeling; tell me."
  • "You seem down, or blue; tell me how you feel."
  • "What's on your mind? Please talk to me, I'll listen."
  • "I'd like to understand."
  • "You seem to be in some pain; would you like to talk about it?"
  • "Why do you think you are not eating [not sleeping, not getting up in the morning, not able to concentrate, losing weight, so often angry, crying so often, etc.] ?"
  • "What are your tears about?" (This is one of my standard questions when someone is crying in my office.)
  • "You seem to not be feeling [sleeping, concentrating, eating, etc.] well. How do you feel?"
  • "I'd like to listen to how you are feeling."
  • "How are you? Really how ARE you? I have some time to listen."
  • "I know it's hard, but can you put your feelings into words?"
  • "What are your worries?"
  • "Do you have some worries about yourself that you'd be willing to share with me? Maybe I can help."

Excerpted from You Need Help!: A Step-by-Step Plan to Convince a Loved One to Get Counseling by Mark S. Komrad. Hazelden, 2012.

How to Intervene When Loved Ones Need Counseling

See an interview with the author Dr. Mark S. Komrad.

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