Every year, tons of phone calls pour in to my St. Louis counseling practice inquiring about referring some family member or loved one. You know -- wayward children, beloved siblings, aging parents, etc. Many times, the callers are so concerned they're considering paying for therapy themselves.
Of course, these kinds of phone calls naturally pile up around the holiday season. People frustrated with the excess and commercialism surrounding Christmas mull over their options for a truly useful gift. Or, perhaps more likely, people frustrated with their loved ones look for a natural inroad to suggesting counseling. Holiday gift-giving seems like the perfect opportunity. And New Year's resolutions to support are now upon us.
In principle, gifting counseling services to a loved one is a sound proposition, I think. Still, before you go blindly referring, here are a few things to consider.
Them or you?
If I had a nickel for every time a parent called me wanting counseling for their son or daughter, I'd be rich. Okay, not rich, but definitely upper middle class.
This is increasingly true with the well-documented phenomenon of millennials failing to exit their parents' homes. After parents finish telling me that college educated, otherwise talented, 24-year-old Johnny sits at home in his underwear eating Fruity Pebbles and playing World of Warcraft all day, I ask a few simple questions.
"Well, who pays for his meals?" The parents do.
"Okay. Who pays the Internet bill?" The parents do.
"What about his car? And the insurance? And the gas?" The parents do.
You see the trend.
Presented thusly, that Johnny is less than motivated to move out, all things considered, may actually be a marker of his shrewdness more than mental pathology.
During initial referral consults, I often tell parents, "I wish I had a deal like that." To this they nervously laugh, then wait for me to tell them how I'll wave a magic wand to make their 20-something adolescent prefer reality over the cocoon they've provided him.
It doesn't work like that.
The real conundrum in a situation like this is that for some reason, otherwise rational parents can't bear the thought of their adult children being forced to find their own way. Even with a down economy, this probably looks less like skid row and more like sleeping on a friend's couch, eating ramen noodles, and having a cell phone with no data plan.
I don't mean to poke fun -- parents of millennials feel this burden in a real way. But it is hard to not to label their approach as the one that's pathological.
And of course they aren't the only ones who do this.
Anecdotally, half of the people who call me referring a relative or loved one actually probably need therapy themselves, in addition to, if not in lieu of the person they're trying to refer.
So, honestly take a look at your situation. Who needs the gift of therapy -- them or you?
More often than not, people looking to gift counseling cite financial lack as the primary barrier to service for the one they're referring. While research consistently indicates that financial barriers are often a real obstacle to treatment, my experience in years of mental health practice suggests it may not be the most powerful one. I've watched client after client from varying socioeconomic strata come up with the money for out-of-pocket services, or claw tooth and nail for private or public services they could find and afford.
Perhaps the other factors are more attitudinal than structural. One recent study indicated that 33 percent of Americans were uncertain that mental health counseling could be effective. Another found that 64 percent of Americans who'd considered services but ended up declining believed that "the problem went away by itself -- I did not really need help."
In case you're wondering, the answer to these Jeopardy clues is "Phrases I've heard a hundred times from clients struggling with motivation."
People who want to go often find a way. Those who don't find reasons not to. This isn't to say there aren't ineffective therapists or problems that resolve without help. But as a rule, people who don't need counseling aren't sitting around wondering whether they do or whether it will work. While it's possible one's sole motivation for not going to counseling is that they just needed your financial help, there's probably more to it.
A lot more.
In the late 1970's, James Prochaska and Carlo DiClemente discovered that people considering the possibility of change go through predictable stages of change, the series of which are a part of their transtheoretical model.
Here's what the stages might sound like, from the point of view of a client:
Pre-contemplation: "There's a problem? What problem?! What are you talking about?!"
Contemplation: "Okay, there's a problem. But I'm not sure we agree on what it is. And even if we do, I'm not even sure I want to do anything about it. And even if I did, counseling probably won't work."
Preparation: "Alright... there's a problem. We can finally agree about what it is, and I'll concede that it probably has something to do with me. I'm thinking I'm ready to do something about it. I need to figure out what that is."
Action: "I've worked super hard to figure out this thing. There's a problem. I contribute to it, or at least I can see my part. We've mapped out what to do about it. Here goes nothing!"
Maintenance: "This change thing is hard. But I'm willing to keep working at it. The misgivings are worth it. This needs to keep going."
Relapse: "This change thing is too hard. I don't want to do this anymore! Why did I ever do this in the first place? Things were better the way they were."
So, why is all this relevant?
At any given time, the potential referral's placement along The stages of change may be among the largest variables in whether or not they're genuinely ready for growth. Many people referring friends and family members are often guilty of a monumental amount of wishful thinking, wanting desperately to believe their loved one is in preparation or action. Most of the clients I see, even those who are self-referred, start out in pre-contemplation or contemplation. And that's why all of that advice you give them ain't workin'.
Many good therapists can work with attitude and motivation, but dysfunction, like all else, possesses an inert quality. Against all evidence indicating people ought to be ready to change, most simply aren't. Unless you're in it for the long haul, this may be a barrier to change that's very expensive to overcome.
Still want to refer?
If you still want to refer a loved one for counseling after reading the above, good for you! It probably means you're doing so out of genuine concern, and you accept that part of change means acknowledging that your loved one has to want it, too. It can still be tricky, and somewhat akin to gifting a gym membership to someone who is overweight.