What if My Patient’s Partner is Resistant to Getting Professional Help:
Defining A Bottom-Line Position and Utilizing Leverage By Philip Chanin, Ed.D, ABPP, CGP Board Certified Clinical Psychologist Assistant Clinical Professor, Department of Psychiatry at Vanderbilt University Medical Center www.drphilchanin.com philchanin@gmai.com “If you or your partner is struggling with an issue such as depression, anxiety, phobias, or obsessive-compulsive disorder, you owe it to yourself and your family to get—or insist that your partner get—help. There is simply no way your relationship is going to get healthier when one of you is in a state of emotional distress…Neglecting to get treatment is your individual choice if you live alone, but once you elect to create a family, getting help is no longer a decision that impacts only your life. It is your responsibility to be the best spouse and parent you can be.” (Real, Terrence. The New Rules of Marriage, p. 95) Frequently in my practice I am talking to patients who are in distress in part because they have a spouse or parent or adult child who needs psychotherapy but is resistant to getting help. We talk in our sessions about what options a person has when a family member continues to resist seeking out help. Terrence Real has written eloquently about why getting professional help is so crucial for anyone in emotional distress who has a partner and/or a family. Real writes, “If you are the one who has been reluctant to get help, understand that your unwillingness inflicts unnecessary suffering on those around you. And if you are the partner of such a person, you should know that a spouse or parent in disrepair affects everyone in the family. You have an absolute right, even an obligation, to insist on health in your family.” Real addresses the fears that patients often have about addressing this issue with their spouse or partner: “Some people hesitate to confront their mate’s emotional difficulties for fear that it will ‘set off’ the person and ‘make things worse.’ That might be true in the short run, but I don’t think you have much choice. It is rare for these conditions to get better all on their own, and in many cases, they only grown worse…It is far better for your children to see healthy argument as part of dealing with a tough issue than for them to watch an adult operate as an emotional drag on the whole family.” Real urges any patient in this position to take any steps necessary to get their partner into treatment: “…my advice is to put principle aside and do whatever it takes to get your partner in front of a mental health professional. Even if you need to make the calls, screen the potential therapists, and make the initial appointment, I suggest you do it…Even if your partner steadfastly refuses to see a therapist individually, that need not deter you. In such cases, you can go ahead and book an appointment for couple’s therapy.” (pp. 95-96) Many patients struggle with the issue of how to get across to their partners how important it is to seek professional help. Often there have been discussions or even arguments about this issue, without any movement on the distressed partner’s part to reach out for help. Dr. Harriet Lerner, in her first book The Dance of Intimacy and more recently in Marriage Rules: A Manual for the Married and the Coupled Up, has elaborated her concept of a “bottom line position.” Many patients have a very negative reaction to the idea of issuing an “ultimatum” to their partners about getting help. Lerner’s articulation of a “bottom line position” suggests a more nuanced and palatable way to think about taking a stand in our relationships. In Marriage Rules, Lerner writes, “…a bottom-line position evolves from a focus on the self, from a deeply felt awareness of what one is entitled to, how much one can do and give, and the limits of one’s tolerance. One clarifies a bottom line not to change or control one’s partner (although the wish, of course, is there) but rather to preserve the dignity, integrity, and well-being of the self. A bottom line is about the ‘I’: ‘This is what I think.’ ‘This is what I feel.’ ‘These are the things I can and can’t do.” (Continued on page 5) 4
