Ask a Therapist - Sep 18 2020

I have a family member who has depression combined with other mental health issues. However he also has Anosognosia - he is in denial, has not been taking medications and does not accept therapy. What can we do to get him to see a therapist so he gets the help required?

- Kritika

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Dear Kritika

Your situation sounds really difficult. I’m sorry to hear that your family member is not in a position to accept the realities of his condition, and seems to be struggling with symptoms of depression.

When supporting someone who we think might be suffering from anosognosia -- an inability to perceive the realities of one’s own condition -- or someone with depression, it is natural to feel frustrated and helpless at times. The condition can manifest in strong ways, as denial is a defensive mechanism that kicks in when the realities of a situation are too hard to bear.

It is important to understand the possible factors driving your family member’s inability to accept help. Cultural and/or generational assumptions about therapy and masculinity could be at play here, manifesting in false beliefs that those who seek therapy are weak or unworthy, and that vulnerability should be avoided at all costs. 

It may be helpful to start by sharing some information about mental health, specifically around male mental health statistics -- to encourage your family member to know that they are not alone in their struggles, and that it is okay to seek help.

Understanding what therapy can do for your family member can also help them feel more comfortable in a counselling setting. There are different therapeutic approaches that vary in length, approach, techniques applied, and more, that can be beneficial for different individuals. Online therapy can also help provide a more comfortable setting where your family member can try out therapy in a more familiar setting, such as in their own home.

At the same time, mistrust of therapy and psychotropic medication could indicate a fear of change, e.g. that medication could alter one’s personality, or that therapy could bring up feelings too painful to handle. In the context of depression, aversion to change can even be comforting to the sufferer, due to the lack of confidence and emotional safety needed to embrace new choices. Denial becomes a security blanket that justifies holding onto old unhelpful habits as a way of warding off any threat of change. 

As long as your family member suffers from anosognosia and depression, it is unlikely he would gain insight into how his condition is affecting the rest of the family. You can draw up all the evidence to try convincing him of his need for help, but ultimately, you can’t convince someone to seek help if they’re not ready. After all, your family members’ thoughts, behaviours, and decisions lie outside your circle of control. 

Within your circle of control, however, are your own thoughts, behaviours, and decisions. Psychologist Carl Rogers stresses the importance of therapists treating clients with “unconditional positive regard”. Whilst your family member is not your client, nor you a therapist (I’m assuming), this approach can be useful. It’s important in this time to make sure that you take care of your own mental health and not to assume the role of a savior. The caregiver role, when it comes to mental health support, can be confusing and increase your own stress. Even if your family member remains in denial, he can still feel your love, care, and support. If he consistently feels that he is accepted by the family regardless of his mental health issues, he can gain the strength to contemplate new directions.

Of course, communication can be challenging with someone who is constantly on the defense. Assertive communication is helpful in ensuring that all participants of an interaction feel respected and heard, and above all, more connected. “I feel” statements help communicate feelings without the other party feeling the need to defend himself, e.g. “when you repeatedly refuse help, it makes me feel sad and helpless.” Focusing on letting your family member know how his behaviour makes you feel can enable him to recognise that the issue at hand is not him per se, but the situation itself. In this way, assertive statements serve to highlight an emotional experience without shifting blame onto another person, whilst enabling reflection about one’s own behaviours.

Finally, I encourage you to tap into the support networks in your life both for yourself and your family. To your knowledge, who does the family member in question respect and feel safe with? If you can find people outside of the family who are trustworthy and can engage in dialogue with him, this could open up new perspectives and opportunities -- likewise for yourself and other family members.

As for you, how are you seeking the support you need as a caregiver? Apart from relying on friends and family for reassurance, do try to check in with yourself and your needs through building in quality “you” time into your days, with routines of self-care and reflection. This is key to ensure your own mental health is intact whilst confronting the challenges of your circumstances.

Going forward, your family member may or may not be ready to accept help, but you can certainly explore therapy for yourself, focusing on coping strategies, rather than on changing the situation outright.

I wish you courage, patience and hope in the days ahead.

Best wishes,

Holly

Holly Mak is a Social-Emotional Counsellor at Common Care Central providing 1:1 professional talk therapy online. Get to know Holly

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Ask A Therapist is an advice column operated by Common Care Limited answered by professional therapists. This is not intended for the purpose of diagnosis of any mental health condition.

If you would like to get advice, you can submit your question anonymously to us at our column here.

If you are seeking professional 1:1 therapy, learn more about our Online Therapy services. We care about your mental well-being and we want to simplify the process of getting help for you. With Online Therapy, you can get help anytime, anywhere with qualified professionals. We help you find the right therapist based on your needs, preferences, language, budget and goals in therapy. Get Started

Ask a Therapist - Sep 3 2020

Sometimes I can't handle my emotions, I will feel angry without reason, and it feels too hard, can you reply me on how to settle down my case?? Thank you.

- Amelie

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Dear Amelie

Thank you for your question. It sounds like your emotions, especially anger, got hold of you at times and you seem to feel frustrated and helpless as you don’t know why you felt angry and how to deal with it. Anger management starts first with increasing self-awareness and practicing healthy ways of managing your emotions and feelings of anger.

Anger is a normal emotion

Anger is one of the four primary emotions (alongside happiness, sadness and fear), ranging from the mild ones like annoyance, irritation, hostility etc. to more intensive ones like aggression, rage, fury etc. 

Every emotion has its functions. Feeling angry is a signal to us that our boundary has been compromised, we are treated unfairly, or we and/or our loved ones are under real or perceived threats, which triggers us to react by fighting back and protecting ourselves. In other words, anger, which has its survival benefit to human beings, is a normal emotional experience for any of us. 

It becomes an emotion with a negative connotation because of our subjective judgment, social and cultural norms and the mere fact that anger, when expressed unhealthily, often leads to abuse, violence and legal consequences.

Why do we feel angry?

Sometimes, it is easy for us to notice what provokes us when there is a clear precipitating event, e.g. being jumped the line, or being forced to apologize even it is not our fault. At other times, when we feel angry, there doesn’t seem to be a single trigger that we can pinpoint to and by the time we realize it, it becomes a feeling that appears to come out of the blue. However, it is not really the case. Often, we lack sufficient self-awareness of our inner processes, such as emotional/ mental state, bodily sensations, thoughts, which hinders us to recognize our feeling of anger as it occurs. Perhaps, we have been feeling annoyed, having mild headaches and struggling to concentrate due to a series of minor anger-provoking incidents but we fail to recognize it until it builds up to a point of explosion then we know we are really mad. 

In addition, we might feel angry about our feelings, e.g. irritated by getting upset or feeling jealous easily, rather than concerning a specific person or incident. Our feelings of anger and reasons for feeling angry can be more subtle to notice and may only be accessible when we reflect deeply and consistently or are guided by professional helpers in therapy.

Possible ways to cope with anger effectively

Generally speaking, one can use some ‘calming/soothing strategies’ or ‘venting strategies’ to help effectively relieve feelings of anger. Some prefer to calm themselves immediately, e.g. refocusing on each in-breath and out-breath, counting 1 to 10, or doing some repetitive actions without any thinking involved like tidying up, doing dishes. Others prefer to vent it all out and some healthy options are e.g. punching a pillow or a stuffed animal, squeezing a stress ball, or hitting a punching bag.

Of course, we can’t stress more the role of social support; it would help if you can find somebody whom you trust to talk to. If you catch yourself getting provoked in a social situation and you feel like you cannot handle it, it would be helpful take a break and remove yourself from the situation.

Doing so is to buy yourself some time to pause and cool down, and once you regain a sense of control or peace, you can then work on problem-solving and respond more wisely. What is more fundamental is to improve our self-awareness so that we can notice more easily what inner or outer conditions have contributed to our impending or full-blown anger, and then figure out how we really want to respond.

Anger is a normal and healthy emotion and doesn’t hurt us, but it does when we handle it unhealthily. Unhealthy ways of dealing with difficult emotions such as feelings of anger is by suppressing it, distracting ourselves from it, letting it override us and leading to violence and aggression. If you continue to find that your anger is bothering you which significantly disrupts your daily functioning, perhaps, you should consider seeking help from a professional counsellor or psychologist.

Hope the above response provides you some tentative help, Amelia.

Best wishes

Jessica

Jessica Tang is a Clinical Psychologist at Common Care Central providing 1:1 professional talk therapy online. Get to know Jessica

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Ask A Therapist is an advice column operated by Common Care Limited answered by professional therapists. This is not intended for the purpose of diagnosis of any mental health condition.

If you would like to get advice, you can submit your question anonymously to us at our column here.

If you are seeking professional 1:1 therapy, learn more about our Online Therapy services. We care about your mental well-being and we want to simplify the process of getting help for you. With Online Therapy, you can get help anytime, anywhere with qualified professionals. We help you find the right therapist based on your needs, preferences, language, budget and goals in therapy. Get Started