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How Do I "Make" My Family Member Seek Therapy?

Nearly everyone in the Welcome to Oz community has made numerous attempts to compel their family member to see a therapist. Common methods include

•     Manipulation

•     Bribes

•     Crying

•     Pointing out the person's flaws

•     Logic and reasoning

•     Begging and pleading

•     Leaving self-help books around the house

What happens next is as predictable as the change of seasons.

Stage 1: The BP says it's the non-BP who needs therapy, not the BP. If the non-BP has unwisely put forth BPD as an explanation for their BP's behavior, the BP accuses the non-BP of being the one with BPD. For good measure, the BP also accuses the non-BP of being abusive, unreasonable, and controlling.

Stage 2: In desperation, often during a crisis, the non-BP finally resorts to an ultimatum such as, "Go to a therapist or I'm leaving you," or some other consequence. The non-BP hopes that once the BP is in therapy, the clinician will force their family member to see the light.

If you are serious about limiting or leaving the relationship and and your family member knows this is true, this is the only thing I have seen really work to pursuade the disordered person to seek help.

Stage 3: Apprehensive that their loved one might actually carry out their threat, the BP agrees to see a therapist, perhaps with the partner or other family members. Therapy, however, goes nowhere. That's because even the best BPD clinicians can't help a patient who doesn't want to be helped.

Stage 4: Once the immediate threat dissipates, the BP finds some reason to drop out of therapy. This is especially true if the therapist is a good one, skilled at bringing the focus to the BP's core issues instead of reinforcing the BP's feelings of victimhood. However, if the therapist takes everything the BP says at face value without probing further—and this is not uncommon—the therapist may inadvertently reinforce the BP's twisted thinking, making things worse.

Stage 5: Eventually, the non-BP realizes that forced therapy is not going to work and that no one can "make" anyone do anything (a good life lesson, by the way). Sometimes the whole process needs to be repeated several times before this truism becomes evident.

Stage 6: Months or years later, the non-BP realizes that her efforts to change the other person simply added a thick second layer of conflict on top of the original issues. She becomes even more disillusioned, depressed, angry, and hopeless. As one Welcome To Oz member noted, "My attempt to invade his world with facts only caused more pain."

 

Life-Changing Therapy Requires a Major Commitment

Therapy is hard work. Transforming the way you think, feel, and act while taking responsibility for things you've always blamed on someone else is a tall order. People with BPD who are serious about treatment will pursue it, perhaps with your help, and make a commitment to it. They will make their own appointments, be honest with their therapist, and complete any "homework" the therapists give them. Life coach A. J. Mahari says, "The truth is relative, and each person with BPD must come to their own truth in their own time and way."

That said, for the sake of readability, in this chapter the term "you" (as in, "When you call the therapist, leave a voice mail) could mean either the family member (parents, especially) or the individual with the disorder.

 

Rock Bottom as a Motivation to Take Therapy Seriously

Some BPs will only concede that they need help after they have hit rock bottom—after someone they love does end the relationship or they wind up in jail or under psychiatric observation.

Rachel Reiland, a woman recovering from BP and the author of the BPD memoir "Get Me Out of Here," says:

I believe that there needs to be some kind of major upheaval that serves as a catalyst for a borderline to face the truth. Not wanting to lose something, perhaps. They can no longer blame the power-hungry boss or the bitchy spouse or the scores of people who have it in for them.

But denial is a funny thing. What some of us may see as shocks or the bottom isn't necessarily going to be viewed that way by the BP. So they've destroyed a relationship? They move on to the next one, and so on. They get fired from a job they liked? Blame it on the boss and get another one. Lose custody of the children? It's the damned court system.

The fear of change, the compelling fear of the unknown, is so intrinsic, so vast, so encompassing and overwhelming, that it's greater than the tragic events that would send most people down to their knees. The shock cannot be predicted, nor contrived. It can't be provoked by the greatest of efforts or good intentions on the part of another.

Mahari advises family members to let go of any desire to control what's going on in therapy. "This is their journey, not yours," she says. "You can support them, but it can't be your life plan." She suggests that family members do the following:

•     Emotionally disengage from the outcome of the person's treatment. The less you're involved, the better able they will be to take care of themselves and observe their limits.

•     If your family member talks about what goes on during therapy, take a neutral stance, neither agreeing nor disagreeing with their judgments, complaints, anger, or devaluation. Be positive, but beware that making too much progress can be threatening to your family member. If they enter recovery, the thinking goes, they might lose your intensive support. Plus, if they relapse, you might be disappointed in them. So be encouraging and optimistic, by all means, but be sensitive to this as well.

•     Recovery from BPD (or anything else, for that matter) is a long, winding road, and sometimes it doubles back. The speed limit changes and there's a few stop signs, too. Mahari says, "There are no simple rules here. This is not the rehabilitation of a physical injury. This is the rehabilitation of the entire self."

 
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