Helping A Loved One Help Themself
af30cf5d64 Asks ...
Hi Dr. Schultz,
My son, late 20's, took a medical leave from work to attend a partial hospitalization program, he had been in therapy and feels stuck. He has been extremely frustrated with himself for not feeling like he could follow through on recommendations. He's been diagnosed with depression, also ADHD (Inattentive type) and anxiety. He tried medication for a little more than a month, then had difficulty refilling the prescription and is no longer on medication.
In the meantime, he has lost his job due to downsizing. He no longer receives therapy and has not followed through on a few job leads. I find myself worrying way too much about the situation. I have a hard time not offering support, and find myself trying to help him prevent this situation from getting worse.
I need to know the best way to be supportive. Please give me some suggestions...
Dr. Richard Schultz Says ...
Hello and thank you for addressing these important concerns to me.
First, I wish to say that I am truly sorry to hear about your son's recent struggles, and about the stressful impact his challenges are having on you. There really is no way to go through life as a sentient being and NOT encounter such a conflict, especially if one is living in awareness and is closely connected to others.
After reading your question, I was left with many of my own, regarding family history, severity of his symptoms, the nature of your relationship with your son, etc. Therefore, in order to write an appropriate reply, I had to make some assumptions. Where you find these to be baseless, feel free to disregard that aspect and use what is helpful.
First, with regard to your son's treatment, there have clearly been too many stops, starts, misfires, and abrupt treatment changes during these last few months to reasonably expect a positive, stabilized outcome. This is unfortunately not uncommon. In addition, no specific treatment plan seems to be in place for him at this time.
So, I'm thinking it may be a good time for a do-over. Your son's first order of business is to establish a solid working relationship with a clinical psychologist, preferably one with a CBT perspective, and one who also knows a thing or two about meds. A clearer diagnostic picture (likely involving some additional testing or formal evaluation) will be of immense help in guiding proper treatment; depression, anxiety, and ADHD, can all overlap, exacerbate one another, and/or enable the others. A sharp quarterback/clinician is needed to call the next few plays, to clarify the sequence at work here, and to identify the next best point of additional clinical intervention, layered atop the therapeutic base.
For you personally, I urge you to begin practicing constructively entitled self care immediately, particularly in regard to your son. By setting reasonable boundaries between you two, you will help you, help him, and help your relationship with him. You'll do nobody any favors by getting burned out, by putting up with too much of what you don't need, or by bending over backwards too far.
In any case, your own efforts are best spent on adding structure to the arrangement between you and your son; a specific, quid pro quo "behavioral contract" (and I strongly suggest putting this in writing) that clearly outlines your individual and collective goals for the near term primarily, and for the mid-term secondarily. This will outline the resources and contributions each of you is willing to expend in service of your collective goals regarding your son's general functioning and mental health care, what you are asking for in return, and what contingencies or consequences will be triggered by failure of either party to deliver. I don't know what currency or weight you have in this relationship (residential, financial, or other), but these are your power chips, and they will most likely require some leveraging.
As you well know, your role with your son cannot be that of therapist, even if you were a professional. Any dynamic in which are experienced by him as lecturing, preaching, shoulding, criticizing, or judging, is destined to do more harm than good. Even if he does outwardly tolerate such a stance, oppositional or rebellious feelings and behavior are likely to arise in him, against you, which is counter to the intrinsic motivation you want to help him cultivate for himself.
Aristotle wrote that "nature abhors a vacuum," and the concept is relevant here. The less you do to fill the vacuum of your son's unmet needs, the more room and incentive there will be for him to step forward and do it himself. Avoidance is a key element in anxiety, depression, and ADHD, so your son is surely experienced at ways to dodge the rough spots or perceived challenges in his life. Whatever you do, you don't want to enable ANY such avoidance behaviors as that just makes "the monster" (which is nothing more than his own pain) even bigger and scarier for him. So, no ducking, bobbing, or weaving around such monsters, as these actions only strengthen the anxious thoughts and feelings.
Each time aversive sensations are experienced, humans are strongly inclined to withdraw. By artificially LOWERING this anxiety level, through any means other than facing and "habituating to" the feared situation, negative reinforcement and avoidance behavior will be strengthened. The short term reward of "relief" determines behavior most powerfully.
My final suggestion to you is to seek out a psychological consultant of your own. Having your own "go-to professional" will provide you with objective, behaviorally wise guidance you'll need to stop yourself from filling the vacuum, while maximizing your son's motivation to do it himself. You will also get useful instruction on creating and implementing the behavioral contract. Your own therapist can also teach you to understand how this situation "hooks" you so strongly and painfully, and help you learn how to unhook yourself from worry, sadness or frustration about your son.
I do hope that some of what I have written is of help to you. Please do keep me posted on your situation, and feel free to let me know of any additional questions you may have.