Tuesday, March 3, 2009

Making The Call

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

When someone we care about is unwell our natural instinct is to get them help. We see examples of this all the time. The extreme case is when we run into a burning building to save a child or an elderly person. The less extreme case is when we bring our sick friend or child or partner or parent to the doctor for a check-up and hopefully get medicine that will make them better. We are hard-wired to help those we care about.
That’s why it is so difficult for people to come around to a different way of thinking when it comes to therapy. If someone is unhappy or behaving oddly or thinking oddly or feeling bad more often than feeling good, we want them to see someone who can help them. Now that works well if the person who needs help realizes and accepts that they need help. In that case making an appointment for them to see a therapist is a relatively straightforward thing to do. Although I will come back to this point because it is not as cut and dried as all that.
If, however, the person is unhappy or behaving oddly and is unaware or unconcerned or uninterested in changing their behaviour, then the problems start. People in the grip of addictions, for example, are notoriously difficult to persuade to seek help until they themselves come to believe it is necessary. With alcoholism, and it equally applies to gambling, drug and sex addictions, the term is reaching ‘rock bottom’, the point at which there is no opportunity left for the person to deny to themselves how bad things are and how much the addiction has damaged their life and the lives of those around them.
In cases where teenagers are difficult or impossible to deal with, especially those who are obviously hurting inside, it can be difficult to ensure therapy will succeed unless they have the will to engage in it. For some, particularly young men, the notion of ‘submitting’ themselves to another person, either male or female, can represent an insurmountable challenge. Now you won’t know until you try and often the most difficult young people can respond well to a listening ear. But if, as with young men sometimes, their issues are around trying to live out an exaggerated ideal of manhood, for example, then talking confidentially about themselves to another person, no matter how well qualified or trained, does not fit well with that ideal.
With young women, particularly those in the grip of eating disorders, the behaviour actually fits into their lives as a ‘solution’ and as such is something they are unwilling to give up. Only repeated work by their surrounding family on how their illness is affecting loved ones around them can trigger the change of attitude needed to undergo therapy.
You can also find it in adults, particularly those in the grip of anxiety or panic attacks. Anxiety and panic are reactions to fear, you could almost say they are a fear response to fear itself, and so a therapist can often represent one more fear object to them. Equally, if they do manage to come for therapy they can shift that anxiety on to a fear of ‘finding out’ something unpalatable about themselves. This is part-resistance to any form of disclosure in therapy but also part-by product of anxiety itself. They need to find the window of opportunity within their own anxiety in which to decide they are going to try and escape the cyclical pattern in which their lives operate.
With some disorders, the business of avoiding therapy comes with the territory. It is part and parcel of sexual offences for example. The claim by serial paedophiles that what they do is acceptable and that it is society that has the problem is an extreme case of this. It is the nature of their illness that allows them believe it is ok to inflict sexual violence on children. And, you find the same thing with sexual exhibitionism. It is conducted almost exclusively by men and they engage in a specifically unique act of exhibiting themselves to females yet they have no idea why they do what they do nor do they see it as being of any harm. It is denial at one level but denial assumes an acceptance of something to be denied. In these forms of sexual disorder there is no acceptance of something being wrong in the first place. So why need a therapist if you are doing nothing wrong?
Some women who have been traumatized by their childhood can find it difficult to seek therapy, often until their lives become unmanageable. And before that happens, there is usually a high degree of collateral damage to their primary relationships, their career and their relationships with themselves. It can take many and varied forms including addictions, personality-, adjustment- and mood-disorders.
I mentioned above that even with those willing to accept help, the case of ringing up and making an appointment on their behalf is not cut and dried. The key to this is that ‘someone else’ is making the appointment. Now you regularly hear people say that if someone isn’t well enough to make the call, then it has to be made for them. The opposite is equally true: if someone doesn’t make the call then the ‘idea’ of getting help was never really theirs in the first place. They have invested little of themselves in the process of getting well. In the therapeutic world you’ll come across the phrase ‘openness to improve’. It can often signal the difference between those who do well and those who don’t in therapy. It is a small thing but ‘openness to improve’ is an indicator of the person’s own desire to get well. Unfortunately, in all types of disorder, there are those who simply do not want to get well. The surest test is whether they can, in whatever way possible, signal their desire for improvement. That can involve simply saying ‘yes’ or it can involve making the appointment for therapy themselves by lifting a phone or sending an email. 'Saying' we want to get better sometimes isn’t enough. If we are lying in a burning building we have to at least try and crawl our way out instead of waiting for someone else to burst in and save us.

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