The other day, I met with a new patient and her family for the first time. The patient’s primary problem was a personality disorder, a problem with the way she copes with stress and functions in relationships. They had dragged her to me – away from another doctor they had grown to distrust. It felt like an intervention. The new patient sat in a room full of family members, who explained why they had pulled her out of the last treatment relationship and brought her to me. Her sister summed up the reason they had come: “We didn’t like the last doctor. My sister went to him for 6 years and she thought he was great, but as far as we could tell, he didn’t help her at all.”
I had a feeling the family might end up feeling the same way about me that they had about the last doctor. For one, personality disorders don’t (usually) respond quickly and completely to treatment. There’s not a magic pill to change the way you interact with the world. But I also saw another reason the family was unlikely ultimately join my fan club: the family and the patient might not share the same treatment goals. The family wanted an easier relationship with her, whereas she probably just wants to feel better. Living with a personality disorder can be torture. She probably feels fearful and overwhelmed most of the time. Even if I can successfully help her feel better, that doesn’t necessarily improve the relationship in the ways the family is seeking.
I didn’t have time to delve into the reasons I thought they might end up mad at me, too, but here’s what I wanted that family to understand:
1. “Can you fix her” is not the same as “can you help me”
When you bring your teenager or your spouse or your sister to a mental health professional and say, “Can you ‘fix’ her?” it’s not the same thing as when you schedule and appointment for yourself and say, “Can you help me?” When you come in asking for help, you are subject and object of the treatment. Care for your loved one has a different subject from object.
2. Different end goals
For your loved one, your goals are probably behavioral. You want someone else’s actions to change, or you don’t like they decisions they make, or the way they deal with stress. If you brought yourself in with a goal of making better decisions, you’d probably get there faster.
3. She may not talk about the relationship in treatment
Your sister or daughter or spouse doesn’t necessarily sit in counseling sessions and think about how their behavior affects you. At least, they don’t do that in the majority of sessions. Most sessions are spent seeking ways to feel better. And how a person feels is not necessarily going to change their behavior toward you.
4. The solution for you may be letting go
The hardest thing for worried families is accepting that they cannot be in control. Your loved one may not change in the ways you’re envisioning- maybe not quickly, or maybe not at all. In that case, you may have to find a way to accept your difficult family member as she is.
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