It’s hard to watch someone you care about struggling with mental health issues. You know that if they’d go to therapy, their life would be so much better, but they just won’t listen, or you’re afraid to even approach them because they’re so prickly and defensive about their issues. Between the research and my years of experience having these difficult conversations, I’ve identified an effective three-step process that helps others become motivated to go to therapy and take the actions needed to change their lives. They say you can lead a horse to water, but you can’t make them drink. That might be true, but today you’ll learn my three-step process to salt the oats.
I’m going to break down today’s teaching, How to Convince Someone to Go to Therapy, into three steps. First is the prep, then we’ll talk about the tools or the meat of what we’re doing, and lastly, I’ll wrap up with some final important tips. I’ve also got an incredible new giveaway with this episode so keep listening for that.
Step I: The Prep
Prepping for this conversation is the first key to success. I’ve gone deep on prepping for difficult conversations in at least two previous episodes, so make sure you check those out so you can get even more tools for preparing for the conversation. Today you’ll learn four tools to get you started.
You’ve got to be in the right mental frame when approaching the conversation. If you’re thinking things like, “This is going to suck. It’s going to be really hard or difficult,” then that’s what you’re going to get. If you’re going in and you’re prepared to do battle, one or both of you are going to end up hurt and defensive. You can’t have an open, connecting conversation if you’re approaching it like a war because you absolutely will both be on the defensive, and you can’t have mutual understanding from that place; it’s impossible.
Identify a Time and Place
Don’t have these conversations “on the run” or as a “by the way.” Set up a time and place that makes sense to have a connecting talk. Don’t have it at the very end of a long day because you’ll both be exhausted, and it’s hard to find the mental reserves. Try to be as fresh as possible and also be mindful of where you speak.
State your intention out loud first (both parties, if possible). What’s your intention for this conversation?
- It’s my intention to listen with an open heart to everything you say.
- It’s my intention to think about how much I love you and how much I want to understand your point of view.
- It’s my intention that we’ll both walk away from this conversation feeling connected and heard.
- It’s my intention that we’re going to have an even better relationship after this conversation.
You’ve got to connect to correct, and stating your intentions helps everyone involved feel safer and more connected. If you do nothing else, do this step, it’s a game-changer!
Step II: The Meat
There’s an awesome, evidence-based tool that we counselors use to deal with resistant and defensive clients to help motivate them to take action and make the critical changes they need to transform their lives. It’s called Motivational Interviewing (MI), and it’s based on the work of William Miller and Stephen Rollnick. This approach has been well-researched and is a Substance Abuse and Mental Health Services Administration (SAMHSA) evidence-based, best-practice model. I’ve been teaching “regular” people (like you) to use MI concepts for years so they can be effective having conversations just like this.
What MI does is create a dialogue where you’re speaking to the other person in such a way that the idea of going to therapy becomes their idea, so they’re motivated to follow through.
There are a few main tools used in MI, and I’m going to teach you three today.
The first tool is to ask Open-Ended Questions with the intention of breaking down their resistant thinking and being more open-minded to possibilities. I’ve talked a lot about asking collaborative questions, but the open-ended questions I’m speaking about today are different. These questions are specifically focused on five key areas, which include:
1. Assessing the other person’s readiness to make a change in their life. How important is it for them to feel happier, confident, stable (insert lifestyle change here)?
2. Assessing their self-efficacy, which means you’re asking questions to figure out how confident (or not) they are that they can actually make changes.
3. Asking questions to get them talking about change. Some examples here might be:
a. How would you like things to be different when it comes to x?
b. What do you see as the benefits of getting therapy/getting sober?
c. What do you think would be a good starting point for you?
4. Helping them develop a discrepancy or a gap between what they’re doing and what they say they want. Questions might include:
a. What do you see your life looking like if you don’t make changes and continue to use drugs/drink/be anxious most of the time?
b. How do you think your life would be different if you weren’t drinking/if you weren’t angry so often/if you could pop out of bed in the morning feeling motivated/happier?
5. Amplifying their ambivalence, which means you help them see past their contradictory thoughts (I want to feel better, but I don’t want to do anything; I want to give up drinking, but then the next day, I don’t want to give up drinking). Questions to help in this area include:
a. How has your behavior (insert specific here) been a problem for you?
b. If you keep heading down this road, what do you see happening?
I’ve got a WONDERFUL handout I made for you with multiple questions in each of these five categories!
The second MI tool we’re going to discuss is Affirmations.
Affirmations are all the supportive words that make us feel warm and gooey inside. The key here is that you have to be sincere; you have to come up with affirmations you believe. Tell the other person the good/healthy things you see them doing or saying or what you appreciate about them.
Examples: “I appreciate what a great dad you are and how hard you try to fight through your depression every day.” “You’re such a good friend to everyone, and you deserve to be a good friend to yourself too.”
The last tool to use is Summarizing:
This is something you’ve likely done before. It’s when you summarize what you heard and take a guess as to what the other person is trying to say. The easiest thing to say here is, “What I hear you saying is….” Then ask the person if you got it right and if they’ve anything they’d like to add or change to what you restated.
Be on the lookout for signs that the other person isn’t listening and they’ve gone into defensive/resistance mode. These include:
- Arguing (challenging, discounting, hostility, overall defensiveness)
- Interrupting (talking over, cutting off the other person, jumping into the conversation in a defensive manner)
- Denying (blaming, disagreeing, excusing, minimizing, pessimism, reluctance, unwillingness to change)
- Ignorance (inattention, non-answer, no response, sidetracking)
They might come at you with these kinds of statements:
- I’ve tried therapy before, and it didn’t work.
- It’s too expensive.
- I don’t have time.
- Can’t I just speak to you when I’m upset?
- I feel weird talking to a stranger.
If you hear or see any of these, it’s time to switch between your tools. A healthy and lively dialogue moves between the three. For example, you might start off on a positive note with an affirmation and then ask an open-ended question but then find some resistance (maybe they’re defensive or start arguing) so move to a summarizing statement.
Then you might ask another open-ended question, have some other resistance show up (maybe now they’re interrupting you), and switch to an affirmation. The key is to be self-aware and take your time. Remember that you’re trying to help, not control.
Step III: Final Tips
I. Don’t Give Up
It’s an ongoing discussion, not a lecture. If your loved one had cancer and didn’t want to go to the doctor, you wouldn’t give up. But make sure you’re coming back with love, not your fear!
Make sure your motives are pure. Are you doing this for them or yourself? Is it for them to be happy or that they’ll stop being so annoying? Do that prep work!
II. Jewish guilt works sometimes
I’ve been known to use my relationship with another person as loving leverage. For example, when my aging mom lived in Florida while I was living in California, she would often refuse to have a caregiver come in and help her. Her ego was in the way, and she was fearful, but she’d get so obstinate about it, leaving me frustrated and annoyed.
Finally, I asked her to let the caregiver come in as a favor to me. I told her that I loved her so much, and I was often anxious and worried about her being alone so far away (she’d also refused to move closer to me). By asking her to do it for me to make me feel better, she was able to set aside her ego and save face. I never threatened or gave an ultimatum. I simply let her know it would help me in my life.
III. No diagnosing or labeling.
Don’t diagnose or label the person you’re speaking to. There are two ways this is wrong. First, if the person hasn’t been diagnosed, calling them bipolar isn’t cool! Even if you’re a psychologist yourself, have an unbiased professional make that call. Second, even if the person has been diagnosed, they are not bipolar. They’re experiencing bipolar symptoms, but they’re not that label. This is the same as saying someone is motivated. No one is motivated 100% of the time. They might be experiencing motivation in a moment, but it’s a state, not a trait.
IV. One step at a time
When you get to the place where they’re willing to see someone and go to therapy, remember there’s still likely going to be ambivalence. So, if you want them to see a psychiatrist because you think they need meds, make it clear that you’re just asking them to go for an assessment, nothing more. They don’t have to take any of the recommendations. We’re just getting an opinion, and then we can discuss it further. If you want someone to see a therapist, make it clear that you’re not asking them to commit to long-term therapy. Ask them to go to therapy five times and give it a chance. If, at the end of that, they don’t think it’s helped at all, tell them you can regroup and brainstorm other options.