Dear Therapist:

What options are there for someone who clearly needs treatment but refuses to get it? I am currently involved with two cases where the person has serious issues that are affecting themselves and their families but won’t go for help.  In one case the person is so depressed they barely leave the house for anything and won’t even hear of it. In the other case the person thinks there is nothing wrong with them but they are extremely angry, rigid, and paranoid. Obviously, we can’t force them but are there any legal options, ways to confront them, or tricks we can use to get them to a psychologist and/or a psychiatrist?

Response:

It sounds like you’re dealing with a couple of difficult situations.  You didn’t describe your relationships with the people whom you’re trying to help.  You also didn’t speak about whether they recognize or acknowledge their problems.  For the sake of this response, I’ll assume that they do not. 

Depending on your individual relationship with each of these people, you might be able to help them to acknowledge that they have problems.  If this is a possibility, it sounds as if it would likely take some time.  It can be difficult for people to admit to themselves (or to others) that they have a problem.  This is especially true for personality issues.  If you think that you might be able to help these people to recognize that they have problems, try to see this as a process rather than something that can be quickly solved.  Your approach should be patient, non-judgmental, and understanding.  Rather than attempting to explain your perspective, create an environment in which they feel comfortable discussing their perspectives and feelings.  When a person is allowed to arrive at his own conclusion, he is much more likely to accept it and to address it.  Remember that each person is different and each relationship is different.  You might be able to speak with the person who is depressed in a more direct manner, while the other person might require a milder approach.

You speak of your involvement with these people, but you don’t discuss other people in their lives.  Though you mention their families, you don’t speak of their relationships with friends or with family members.  Are there others who might make a stronger impression on them, or whose opinion they might more readily accept?  Although we sometimes feel the burden of responsibility for others, sometimes our purposes are better served by stepping aside and allowing someone else to assume part of the burden.

As far as “tricks” are concerned, in my experience it is likely that evasive and misleading strategies will backfire, leading to a situation in which the person is even less likely to seek help.  Likewise, although there might be legal options (like guardianship and OAT orders), these can produce problematic results if used improperly.  In addition, legal options are generally not considered unless there is a danger to the person or to others.  It doesn’t sound as if this is the case.  Hopefully, perhaps with some help, these people will recognize that they need help and that assistance is available.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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