“Where to look if you’ve lost your mind?” – Bernard Malamud, The Fixer
Recently, the question of how to refer someone to therapy has come up a lot. The topic can be a difficult one to broach, especially with colleagues, co-workers and work friends. On the one hand, you can clearly see that the person is having difficulty of some kind and is in distress. On the other hand, you do not want to overstep your bounds, or worse, offend the person by suggesting that they should go to therapy. For many that would be like calling someone crazy. Only crazy people need therapy. I’m not crazy; ergo, I don’t need therapy. Thank you very much.
Unfortunately, these sentiments arise out of the still pervasive and persistent stigma associated with mental health issues and treatment. The stigma is based on a number of common misconceptions, the primary one being that therapy is for crazy people. Leave aside for the moment that the term crazy is really meaningless. The truth is that therapy is or can be for anyone. It is for anyone who is struggling with stress or anxiety, anyone who is overtaxed at work, anyone who seeks resolution of feelings arising out of past events, or even anyone who just needs someone to talk to. While we are still a long way away from actually publicizing seeking therapy, it is not something to be ashamed of.
Rather, seeking assistance is a clear strength. It proves that a person has recognized his difficulty and taken affirmative action to address it. How many people do you know who are in denial about their issues, who do not act, instead letting things pile up until they erupt in a self-destructive fury? My guess is at least a few. Those are people of whom you think: if they could just get their act together. Well, going to therapy is the act of getting your act together. It is to stridently emerge from denial to face difficulties and fears.
Therapy helps accomplish this by providing a framework for delving into the murky world of feelings, where emotions are typically thought of as bad and scary. This is another common stigma-perpetuating misconception. The reality is that emotions just are. They exist. We all have them. Problems arise when we assign values of good or bad, positive or negative to them. We are socialized to believe that an emotion like sadness is bad. Therefore, we should not be having it, should get rid of it, and should certainly not talk about it for fear that the badness would make us appear bad to others. However, sadness, like all emotions, is not bad. It simply is. It is our evolved response to external and internal stimuli. Emotions help us to process all of the information around us that is constantly streaming in. In the case of sadness, it can be an adaptive response to a loss, from which we can learn to do or think about things differently in the future.
Which brings us to another very large component of stigma – what other people think (or might think). We have all been admonished by someone, usually our parents, “who cares what other people think?” Well, we do. We care. Maybe too much, but we can’t really help it. We tend to judge ourselves as compared to others, the flipside of that being that others are also judging us as they judge themselves. That’s a lot of judging going on. And none of it is particularly conducive to positive self-image or good mental health. Still, if other people knew I was going to therapy, they might think less of me. That maybe true. But it is also true that we cannot control what other people think. And we are often wrong about what others think because we tend to project what we think onto them. Thus the underlying judgment is, I think less of me because I go to therapy. Meanwhile, the other person could just as easily think I am a stronger, self-actualized person because of it. Either way, what they think is up to them, not me.
So now we come full circle back to where we started – how to talk to someone about therapy, even though it comes wrapped up in all of these assumptions and negative connotations. How can we strip the communication of the baggage and express our honest concern?
1. Be honest, but not brutally. These discussions usually start with a person coming to you for advice or to vent about something that is troubling them. Either way, what they mostly want is to be heard. A person feels heard when they believe that you understand what they are saying and where they are coming from. The way to convey that is to reflect what they have said first before offering suggestions or solutions. The therapist’s empathic standbys are “that sounds really difficult,” or “it sounds like you are having a very tough time of things.” Now is not the time to opine or try to solve their problems. Listening is all that is required.
2. Be forthright, but not judgmental. Sometimes people want your opinion and advice. Sometimes. If they ask, give it in a straightforward and gentle way. Try to avoid judgment. Avoid labeling things as good or bad, demonizing another person, or adhering to one particular side too strongly. An honest opinion is still only an opinion. You may give it, but the person need not take it. Rather than judgmentally exclaim, “then why did you ask me?” try to be a model of acceptance. Phrase ideas as suggestions rather than commands. You might say, “have you ever thought about talking to someone?” or “I know someone who has experience with these issues. He might be able to help you. Would you be interested?” You provide the option and the person then feels cared for rather than defective.
3. Be caring, but not aggressive. Most people do not like to be told what to do. In order to maximize the impact of any suggestion, it is important to keep in mind how the person is likely to react. If you make a suggestion of therapy sound like a command it will be met with defensiveness and potentially anger, both normal reactions to feeling judged. In order to avoid that, speaking from a place of empathy can help. Framing things as applicable to you first can reduce the sting suggesting therapy can often bring. For example, “when I went through a similar situation, it really helped to talk about it with a professional.” This normalizes the person’s feelings while de-stigmatizing the idea of therapy itself.
What do you think? Have you had conversations like this with colleagues, and how did you handle them? All suggestions are helpful.
Andrew D. Kang, JD, LICSW, is a former attorney turned licensed psychotherapist. His practice, Boston Professionals Counseling, LLC, focuses on helping attorneys and professionals with the issues they face and is located in Boston, Massachusetts. Contact him at email@example.com or visit his website at www.bostonprofessionalscounseling.com