January 4, 2019

How Can I Help a Loved One?

Caring, loving and wanting to help are all natural feelings. However, giving what you intuitively think is needed is often not the help that someone wants, needs or knows how to accept - and this can be very frustrating.

Whether you'd like to truly save someone or to end their pain, or more selfishly have them in your life, you can only lead. They can choose to follow in their own time and way.

Understanding how to lead a person with a mental illness requires skills that many of us do not innately have.


According to Dr. Xavier Amador, professor in Clinical Psychology at Columbia University, denial is a most powerful deterrent to recovery in mental illness. What is often thought to be immaturity, stubbornness, and defensiveness is a much more complex and difficult problem. Amador and his colleagues found in a 1998 study that nearly sixty percent (60%) of patients with mental illness did not believe they were ill. And trying to convince them often made matters worse.

According to Dr. Xavier Amador "People will come up with illogical and even bizarre explanations for symptoms and life circumstances stemming from their illness, along with a compulsion to prove to others that they are not ill, despite negative consequences associated with doing so".

Hard to Receive - Often people with borderline personality will see efforts to help as threatening or condescending. People with borderline personality are known to have difficulty coping with life's challenges. Pathological exhibits of splitting, projection, and introjection by borderlines are characteristic borderline defenses. At the same time, rationalization and denial can similarly be pathologic defenses. If someone can't cope with the information, you cannot easily overcome that.

Ultimately, change is a choice. Change can only take place when a person chooses it for him/herself. It cannot be imposed. We can only support people in their choices. And if we need something in our lives, or in any relationship to change, we, ourselves, must change. We should not crossover their personal boundaries and expect them to change for us.

Amador describes what it is like to work with someone who does not believe they are ill. One patient encountered by Amador was paralyzed on his left side and he had problems writing. When asked to draw a clock the patient thought he did fine, Amador recalled.

However, when Amador pointed out to the patient that the numbers were outside of the circle, the patient became upset. "The more I talked to him [about the drawing], the more flustered he got. Then he got angry and pushed the paper away, saying 'it's not mine-it's not my drawing.' "

Amador finds the same reaction appears when he talks to people with severe mental illness. "Instead of being an ally, I end up being an adversary," he said.

Amador urged family members and mental health professionals to understand that collaboration with treatment by someone who has a severe mental illness is a goal, not a given.

Amador has written about getting people with serious mental illness to accept treatment in a book he coauthored with Anna-Lisa Johanson titled, I am Not Sick, I Don't Need Help: A Practical Guide for Families and Therapists, (2000 by Vida Press.)

It is important instead to develop a partnership with the patient around those things that can be agreed upon.

Amador said that family members and clinicians should first listen to the patient's fears.

Empathy with the patient's frustrations and even the patients delusional beliefs is also important, remarked Amador, who said that the phrase "I understand how you feel" can make a world of difference.

The most difficult thing for family members to do in building a trusting relationship, he said, is to restrict discussion only to the problems that the person with mental illness perceives as problems - not to try to convince them of others.

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