How to get someone into therapy?

  • #1
    Sooo my best friend needs help, but every time I've suggested it to him, he says he doesn't think therapy would help.

    Let me give some background. My friend has always been the "strong, silent type", with the emphasis on silent. He almost never shares his emotions with anyone, and reacts to any sort of prodding with evasion or stonewalling. He also has a huge aversion to anything that makes him seem weak.

    About three years ago, his father died of a brain tumor. I was away at school at the time. He didn't tell me, or anyone really, that his dad had died until three months after it had happened, in a terrible night of drunken sadness. He was also dealing with some romantic issues at the time, and also was applying to medical school, and had only received rejection letters. At the time, I suggested that he needed to talk to a therapist that wasn't me, since I have zero training or inclination in that area, but he rejected that idea out of hand.

    Flash forward to the present. He's been in medical school in the Caribbean for about a year now, and while I'm happy that he's moving forward again, I'm also extremely worried about him. He's started drinking very heavily over the past year, and while I know that this is semi-standard for med students, I think he's taken it too far. He's always been muscular and a big eater, but while in medical school the combination of alcohol and not exercising have made it all just turn to fat. He's gained about 30 pounds in the past year, and I'm pretty sure it's mostly alcohol weight. I can't say for sure, but it's my opinion that he's still really upset about his dad, and that he's using alcohol as a way to not have to think about it. If I try to talk to him about it though, I risk making him not want to talk to me about anything. There are very few people that he opens up to at all, and the last thing I want is to make him feel like I'm judging him.

    As his friend, I want to help him, but he doesn't seem to think there's an issue, or at least he won't admit that there's a problem to anyone. Is there anything I can do? Is there anything I should do?
  • #2
    There's only one way.

    He has to be more afraid of NOT going to therapy than going.

    Find out what he's afraid of and make it very real.
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  • #3
    He's afraid of emotional openness Frown
  • #4
    Invite him to a party.

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  • #5
    Alcohol and inactivity is somewhat standard for medical students. If he is using alcohol as a crutch, he's only aggravating his depression and messing up his body, and I'd be concerned, as you are now.

    Try to not go behind his back when organising an 'intervention', at which his closest and loved will be present, or via confrontation. Interventions are sometimes successful but they're crude and not necessarily the best approach. Be honest in both intent and actions, and be prepared to listen if and when he does bear his soul; don't rescue, enable, or gratuitously pressure your buddy.

    An alternate approach might be planting the seed of going to therapy or counselling and nurturing it through support for and faith in the therapy and your buddy.
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    He's afraid of emotional openness Frown
    Does he have a living mother and siblings with whom he's on decent terms? Enlist their help.

    When you say he's afraid of emotional openness, you do mean beyond the normal level that's expected of males, right - or is this amount, say, consistent with having being brought up in a family that bottled up emotions, being abused as a youth, or something?
  • #6
    Does he have a living mother and siblings with whom he's on decent terms? Enlist their help.

    He's on good terms with them, but I'm not certain either one of them would listen to me. His mom is a good person, but she's also very much the stereotypical Chinese mom - uncommunicative and rather stubborn. I think part of the reason he's so resistant to the idea of therapy is that Asians tend to be rather dismissive of the whole concept of psychological counseling.

    His sister might help, but she's in school on the East Coast, and he doesn't usually talk to her about anything of substance. For instance, he didn't find out that she had even been looking for graduate programs until after she had already been accepted and was a few days away from starting school.

    The rest of your advice seems pretty solid, though. I had thought about the whole intervention idea, but had dismissed it for most of the reasons you mentioned.
  • #7
    Suggest it and gently push him in that direction unless you have some actual sentinel events that tell you he is an alcoholic or mentally ill. His letting himself go and get fat is not necessarily a direct indicator that he needs to go to detox/rehab or have an intervention. Let him know your concerns and your honest thought, but demanding a specific course of action on his part, while playing amateur psychologist seems like it would likely be taken the wrong way.

    I always offer this kind of advice with some kind of preface to the effect of "you're an adult, a smart person, and nobody can tell you what you should do. I don't know what you are experiencing or what is in your head, but as your friend, these are the reasons I am concerned: X, Y, Z... ... I think you're holding it together remarkably well considering your father's death, much better than I would have, and all the pressure of medical school, etc. but I feel that all the things I mentioned suggest that you could use some help. I don't know exactly what that help is. I just don't know but clearly somethin wrong right and as a friend I want to help. Maybe I'm just way off and worry too much, but I found I had to talk to you about this even though I knew it would be awkward and risk looking like an idiot. What do you think? Either way you think, I'll still be there for you if you want to talk."
  • #8
    I agree strongly with dcartist, a reasoned expression of concern and mixed with a reaffirming of friendly relations and a desire to support with possible suggestion(s) is the way to go. And I know I'd respond better to something like that in writing, so you might consider writing him a letter/email on it instead of bringing it up face to face.
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  • #9
    Otherwise, you let them decline to a point and then try again and show evidence to the family. It took someone that was close to me 3 marriages, two jail sentences, losing license a few times, and a bunch of minor charges before waking up. It took fifteen years.

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  • #10
    How good of friends are you 2?
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  • #11
    FYI - In Medical School, it's called the Freshman 50 for a reason (as opposed to the freshman 15 for undergrads).

    You can't force anyone into therapy who doesn't want it. They wouldn't benefit, and the more you push the less he is going to listen. Your best option is to let him live his life, and if there is another episode, or a good moment, just ask him if he is happy. If he says no, ask why, and then listen. If it seems to be chronic, tell him you think talking to a professional would help, and that you'd like to help him but don't know how... and then leave it alone. Again, by pushing you are acting counter to what you want.
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