Refusing to Get Help

By Kevin Murphy MSc.,
Psychoanalytic Psychoanalyst,
Dublin, Ireland.


A question I get asked regularly is how can someone get their son, daughter, husband, wife or partner who is in bad need of therapy to agree to go? It is usually asked by a distraught loved one who has watched, witnessed, or taken the brunt of some pretty bad behaviour over an extended period of time.
And it is usually asked because the person in need of help is refusing to entertain the notion.
The problems can range from the sexually inappropriate, to aggressive acting out, to binge drinking and other addictive behaviours, on to emotionally manipulative and controlling acts. There is no end to what some people can inflict on those around them in a seemingly unending cycle of unhappiness and negativity.
So, is there a way of ‘getting’ someone to go to therapy when they don’t want to? The short answer is no. Therapy is often the last thing that these people will want to undergo. They are, to put it this way, in love with their way of doing things. It brings them a form of pleasure – one that may come disguised as un-pleasure – and they are usually very unwilling, or unable, to give it up.
It is only when, like those addicted to alcohol, they hit a personal ‘rock bottom’ that they eventually wake up to what it is they have been doing. But there is still no guarantee that everyone will do so. One person’s ‘rock bottom’ is another’s ‘half way down’ and vice versa. And there are those who, despite having chaotic lives, continue to blame everyone else for their woes.
Sometimes an extreme outcome makes them see sense. It is when a loved one has been driven away, or when their mental or physical health or their financial independence is at risk, or when their actions have brought them to the attention of the law, or when they have simply had enough of their own downward descent, that’s usually when they choose to seek help on their own account.
I was reminded of this reading Sigmund Freud’s 1937 paper ‘Analysis Terminable and Interminable’ in which he talks about resistance. Resistance is a classic psychoanalytical concept in which the person in therapy actively ‘resists’ letting out any information about themselves. Freud argues coherently that our defense mechanisms are laid down at an early age in our lives when we are facing external and internal experiences that may not be pleasant and so constitute threats that we are pretty much powerless to deal with.
In order to deal with external threats we can complain, or cry, or move away in what ever way we can. But internal threats, such as anxiety or surges of energy, or fear or discomfort, or anything unpleasurable that causes us to resist the experience, means we must put into effect defense mechanisms.
These mechanisms can be denial, repression, shock reaction, introverted-ness, a splitting off of ourselves from reality and so on. The point Freud makes is that while they were once directed against former perceived dangers they recur in the therapy in the form of resistances. And what do these resistances act against? They act against recovery itself, he says. Or as he put it: “It follows… that the ego treats recovery itself as a new danger.”

Taking this concept and applying it to those who refuse, despite the evidence all around them, to accept that they need help of some kind, we come to an interesting perspective. If you accept what Freud says, then you are left with a picture of people who are resisting anything that might help them recover. This not only happens within the therapeutic setting but it is also a factor in people deciding not to enter the process in the first place. The difference being, however, that while resistance can be a challenge within therapy, at least the person has entered the process to begin with so their resistance can be dealt with in that context.
The person who refuses to go at all is a bigger challenge. Usually it is not until their own defenses have broken down, and so allow for the desire to recover to take root, that they can begin to help themselves.
Even getting someone through the door of a therapist’s office is not the victory that it might seem. If someone is unwilling or unready to undergo the necessary engagement and examination of themselves, then it will be just a sham. And do people engage in it for spurious reasons?
Unfortunately they do even if thankfully it is the exception rather than the rule. Why? Sometimes it is to keep troublesome family members off their backs. Sometimes it is to make it look like they are doing something about the problem when in fact they have no interest in doing so.
Some people like being the way they are. You could say they like their symptom and they can’t imagine life without it.
The harsh fact is that like so many endeavours in life, the more people put in to therapy the more they get out of it. It’s a simple proposition. But convincing some people of that idea is not simple at all.