Often in therapy, clients come in prepared to discuss a single issue, and one that’s relatively minor in their eyes. However, it can quickly become evident they are struggling with severe mental health issues they likely aren’t aware of.
Relatedly, people may come in with a family member or partner who urges them to get help for a specific issue, but the client is defensive about the very idea of having this issue.
To better assist those we feel should seek help for mental illness, it helps to understand common examples where the potential client may not understand our concern for them.
How to Tell if Someone is Avoiding a Mental Health Crisis
Here are a few examples of behavior that indicates potential mental illness, and how the party you’d like to get help for hides behind avoidance or other negative behaviors.
Scenario One: Projection
A wife brings her husband in to counseling to discuss his nightly drinking. He becomes angry and tells her that the real problem is how miserable she makes him. Over the course of couples counseling, it becomes obvious to the therapist that the husband’s drinking meets criteria for alcohol dependence, but he evades any discussion of this, reiterating that if he was happy in his marriage, he wouldn’t need to relax with a drink.
Scenario Two: Avoidance
A mother brings in a 25 year old son who hasn’t moved out. She says that he lays around all day and doesn’t work or have friends. She says this is likely an extension of his childhood depression. The son agrees to individual therapy but spends his time deflecting any discussion of depression and talking about his idea for a small business, which has not come to fruition since graduating college.
Scenario Three: Past Trauma
A woman comes in to counseling to get some parenting coaching. It becomes obvious that she has not processed trauma related to being sexually abused as a child, and therefore she is hypervigilant to the possibility of her child being molested. This obsession occupies all of her thoughts but she gets angry when the therapist suggests that it might be related to her own experiences.
How a Therapist Approaches These Scenarios
In all of these situations, it is imperative that the therapist meets the client where they are at. Trying to force the issue or challenging someone to move too quickly outside of their comfort zone is counterproductive.
The worst case scenario is that someone who very much needs help feels betrayed and attacked by their therapist and terminates therapy prematurely. Then the client is left with the exact same issues, but no support system and an even lower likelihood of opening up to another therapist to address the issues in the future.
Instead, a skilled therapist will gradually lower the client’s defenses as the therapist-client relationship deepens and grows over time. While session one may be the worst time for a client to hear that they sound depressed, session 10 or even 20 may provide just the right moment.
Additionally, it is important for a therapist to provide a positive and genuine reason, that resonates with the client’s own values, for the client to do the hard and scary work of looking objectively at their own issues.
Re-Examining Our Examples to Find Solutions
It may be that the husband in the first example doesn’t want to be an alcoholic like his own father was. Perhaps if he opens up about his relationship with his dad, then he will find the motivation to try to be a better dad for his own son.
The 25-year-old son who is struggling with “failure to launch” issues may need the therapist to validate and brainstorm his business ideas, taking him seriously as a potentially high-achieving member of society, before he can delve into his struggles with depression.
And the woman in the last example would do anything to protect her daughter; over time, she may be gently convinced that working on her own trauma would in fact give her daughter a more present, and less anxious, mother.
What to do if These Scenarios Sound Familiar
If there is someone in your life who struggles with “owning” their mental health issues, encourage them to seek counseling…even if it isn’t for the “reason” that you would prefer. Even if they initially go just to complain about you, they will still be getting in the door and starting to develop a relationship with a therapist.
Over time, this may blossom into a relationship that gives your loved one a safe space to open up and tackle issues that make them uncomfortable and ashamed.