Top Ten Reasons Why Familiies With Mental Illness Issues Avoid Counseling

By Matt W Sandford

People don’t always do what’s best. Actually, in the grand scheme, probably most of us would, if we could look back with objectivity, need to acknowledge that many of our choices were full of self interest and didn’t work out as we hoped nor satisfied our long term goals. But when it comes to mental illness in our family, there’s more at stake than our own comfort or the comfort of our loved one, isn’t there? There could be a lot of motivations behind someone’s choice to not pursue mental health services for a loved one. I am going to offer ten “thinking traps” or ways folks may get hung up and so avoid doing what is needed, in no special order.  

1.      “What Will People Think”

Many people still shy away from getting help through counseling, seeing it as stigmatizing or embarrassing to the person and the family that raised that person, as if having mental illness means that someone must have done something wrong. They chose to hold people’s opinions in higher regard than the best interests of their family member.

2.      “I Don’t Want Them To Be Labeled or Treated Differently”

      In this case the family member believes that if someone gets mental health treatment that their family member will forever be relegated to a segment of society that is looked down upon and either pitied or bullied or taken advantage of. And there is reason for such concerns – because it does happen. There will always be people who misunderstand and mistreat those who are seen as different. And yet, their family member is likely already being misunderstood and mistreated, because they have a mental illness that is going untreated and therefore is not managed and not making improvements. The best way for the family member to overcome being labeled and mistreated would be to get the treatment they need and improve their functioning.

3.      “It’s Not That Bad” or “They Are Doing Okay”

            This is straight up denial of the severity of the dysfunction their family member is suffering. They may not have an understanding of the nature of mental illness, thinking “they are just going through a phase”. Or they may be attributing the problems to circumstances and saying – “well, when such and such changes they will recover or snap out of it”. It may just be stone walling, putting off the inevitable. Or it may be they simply can’t accept reality. In some cases it may be due to mental illness on the part of the family member as well, or that they grew up in a family environment that was so dysfunctional that they really do have trouble defining what is healthy or appropriate in terms of behavior.

4.      “I Am Against Medication”

           I have encountered many folks who have an aversion to psychotropic medications. They somehow see them very differently from medications used to treat biological conditions, somehow deciding that brain chemistry is different in some way than being biological. Many say they fear their family member becoming dependent on a medication for the rest of their life, as if it would become a crutch or become an addiction. Well, crutches help people who can’t walk effectively without them. It seems that walking effectively would be the issue. As to the addiction issue, if they simply mean the person would need it to function effectively, then it is the same as the crutch issue. If they fear that their family member would develop tolerance of the drug and/or go through withdrawal if they were to go off the drug, then I can appreciate those challenges. However, these issues still seem less threatening than the predicament of the family member who needs medication to go through life going without something that would improve their quality of life in the present. These are common issues that a psychiatrist should be able to help them navigate.

5.      “We Can’t Afford It”

           This is certainly a common objection and I can appreciate the complexity and distress of this issue. Certainly all the available opportunities should be pursued to see if there is help available – insurance, government aid, community services, family or friends or the body of Christ, as well as pro bono services. The point is, is this an excuse, or has the family actually explored the options?

6.      “It Will Expose Family Secrets” or “I Can’t Face the Family Stuff That Would Come Up”

           This thought is tied to the “what will people think” idea, but in this case the fear is not about what people will say or think about my family member or about the stigma of mental illness, but what may be “found out” through the grape vine about our family secrets. (Let it be stated here that all counseling is covered by confidentially laws). Or it may be about a family member who believes that they cannot deal with the family issues that may be uncovered through the psychotherapy process. And so what it means is that they don’t get help for the family member because they are avoiding dealing with their own psychological issues.            

7.      “Counseling is All About Blame” – Meaning it Would Require the Family to Change Their Dysfunctional Coping

           Not only do some family members fear having to confront family secrets or their own skeletons, but beyond that they may comprehend (or it can also be subconscious) that exposing a family member’s mental illness may require something of them, meaning they would have to change in some way. Families subconsciously gravitate towards the status quo, clinging to unspoken family rules and roles and expectations. And so, if their family member gets help and changes, it will affect them and they will have to change as well – maybe change their habits, their priorities, give up something important or comfortable to them or take responsibility in some new way.   

8.      “I Want to Take Care of Them Myself” 

          This viewpoint may be motivated by a few of the other objections that have been stated, but it may also stand on its own. In that case, what is behind this thinking could be the belief that “only I really know what is best for my family member” or “I am more loving and devoted to them that some professional”.  However well meaning this family member is, they simply are not likely to possess the knowledge and experience concerning mental health issues to provide the treatment that is necessary. There are a number of serious mental illnesses that require a treatment team of professionals, including medical doctors, psychiatrists and psychotherapists to treat the individual in coordination. This team approach is very important when it comes to addressing co-morbidity, which means situations when a patient carries more than one diagnosis at the same time.

9.      Fear of Rejection/Disapproval/Anger/Retaliation by the mentally ill family member

           There is certainly a real possibility of such reactions from the mentally ill family member and the concerns are warranted, especially in situations when this family member has demonstrated that they can be violent. And yet, where does that leave the family? Because the family member has this proclivity, they may become harmful or violent at other times they don’t get their way and thus the family will live in this fear for themselves and others so long as the family member does not get treatment. The family will need to be courageous and accept that the road to safety is through risking rejection by the mentally ill member. Besides, if they get help for this family member, it may be that some day they would be able to appreciate what was done and why.  

10.  Sometimes, someone in the family subconsciously, or consciously, is getting their needs met through the family member’s dysfunctional living style

          Maybe they are benefitting in some way. Maybe the person intimidates people that they don’t like, or had a grudge against? Maybe the mentally ill family member keeps the heat off of them, that is, serves as a suitable family scapegoat? Sadly, it is possible that a family member holds resentment or spite towards their mentally ill family member and so wants them to stay in their state of suffering. An example of someone getting their needs met consciously through the family member staying stuck in their mental illness would be the person who fears that if their family member’s condition would improve that it would mean they would lose the person’s disability check.

I want to express that this list is not intended to communicate that there are no legitimate concerns involving participation in counseling. No doubt, counseling for a family member can be challenging, disruptive and costly. But avoiding counseling is like the passage in James about the man who looks at himself in the mirror and then goes away and forgets what he looks like.  James says that rather the one who acts on what he sees and perseveres, “will be blessed in his doing”. James 1: 23-25

And wouldn’t we all do well to heed the statement of James 4:17 “So whoever knows the right thing to do and fails to do it, for him it is sin.” If you really don’t know if your family member needs counseling, but you have concerns, it cannot hurt to seek out a psychological evaluation, rather than simply ride it out.

It’s all about the courage to get help.


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