Dear Therapist:

I have a brother who is very anxious but comes across as very cool and like he has it all together. When I finally convinced him to go for therapy, the therapist questioned whether he really needed therapy and took an approach of “it doesn’t seem to be causing too much dysfunction in your life.”  Those who know him know about the constant tension that he lives with and how much he is suffering. Yes, he is successful but he lives in a lot of pain. I am trying to again convince him to give therapy another shot but I don’t think he would be ok with me speaking to the therapist first. How can I prevent the same issue from happening again?

Response:

There are a number of ways in which this situation can be approached. It can be very difficult to watch a loved one in pain. In many cases, a feeling of helplessness exacerbates this pain. This sense of helplessness is often accompanied by a sense of responsibility. Often, the fear of losing control of a situation is what causes us to feel a strong sense of responsibility in the first place.

From this perspective, the question becomes to what degree you believe that your brother is in a place where he is ready to be helped and to what degree you feel a need to help him. Of course, there may be other factors in play as well. You may realize that your brother is not ready to acknowledge his problem and therefore not ready to accept help. He may have based his persona around being the “cool guy.” This can both hinder his willingness to recognize the fact that he has a problem and make him reluctant to accept professional help.

If your brother is affecting a facade, a therapist might help your him to uncover the reasons for his need to maintain it and guide him toward acceptance of himself without it. If your brother refuses to see another therapist (or to open up to one), it can be difficult to help him. Sure, a therapist who recognizes the problem can help your brother to acknowledge and deal with it. However, this is likely to occur only once a rapport is built—which can take a while. It doesn’t sound like your brother is willing to see a therapist long enough for this to be established.

The therapist that your brother saw seems to have indicated that he doesn’t really need therapy due to lack of dysfunction. If the therapist meant that therapy is not necessary when someone is “simply” in pain (and not “dysfunctional”), I disagree vehemently. However, it is quite possible that your brother presented himself, for his own reasons, as basically fine. If he was not willing to share his pain with the therapist, the therapist’s conclusion would have been based on the information that was shared. If this is the case, it would make sense that you brother would not want you speaking with any therapist that he might see. His need to appear to be okay may be too strong to allow anyone to see what he may perceive as a weakness.

You mentioned the sense that you and others have that your brother is very anxious, is under constant tension, and deals with a lot of suffering. What you didn’t mention is your brother’s perspective on this. Has he ever admitted to having these issues? How objective are you and others close with him? Is it possible that he is not suffering quite as much as you believe? Have you ever discussed your concerns with him in a comprehensive way?

Sometimes, we excessively project our own thoughts and feelings onto others. This can cause us to magnify issues in our minds. It can also make us assume that the other person knows what we think and how we feel about their issues. I don’t know what your relationship with your brother is like, and I don’t know how open he might be with you. It sounds, however, like the first step may be for you to be clear with him (rather than a therapist) about your thoughts, feelings, and assumptions. If the two of you can have that kind of rapport, this can help you to get a better handle on the situation. It may also help him to be more willing to open up and create a similar rapport with a therapist.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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