by Terry Harrell, J.D., MSW, LCSW, Executive Director, JLAP
Volume 23, No. 3. Indiana Trial Lawyers Association quarterly journal, The Verdict. Reprinted with permission
Sheriff Bart: "Need any help?"
The Waco Kid: "Oh. all I can get."
- Blazing Saddles
"I think I might have a problem, what I can do to get help?" We hear that question occasionally, but more often the question we are asked is, "I think my spouse/partner/associate/golf partner/friend/neighbor/attorney-I-know-through-school-board-meetings may have a problem. Is there anything I can do to help him or her?" Well, the answer is LOTS. and nothing. Nothing you do will guarantee that your friend or acquaintance successfully resolves his or her problem or even seeks help. You cannot fix the problem for your friend. So, then, what do I mean by lots?
There are many things you can do to encourage your friend to seek help or otherwise take some action to resolve the problem. I call these "first line" interventions. Keep in mind that they must decide how to solve the problem and that they want to solve the problem. Remembering that they must ultimately decide on the solution, you can help them to identify the problem, clarify the problem, recognize the extent of the problem, and help motivate them to take a step toward solving the problem. A good motivating technique is helping someone identify the costs and benefits of continuing with the status quo vs. trying to make a change. You can also be instrumental in helping to identify options. During times of stress we all tend to narrow the options we are capable of recognizing or considering. You may be able to make a referral to the appropriate helping professional or support group. Finally, you can offer ongoing support to your friend as he or she attempts to address their problem by celebrating their successes and cheering them on after setbacks. But how do I even approach the topic, people often ask.
I always advise people to start simple. Your plan of action needs to be well thought out, but it need not be complicated or dramatic. If your relationship allows it, I believe in starting with a one-on-one conversation. You can always increase the intensity of your intervention efforts later. Your goals should be to explore what you perceive to be a problem (because the problem might be quite different from what you think it is) and then motivate the person to do something toward resolving the situation. Often, people are living under the false belief that no one else has noticed their problem because no one has said anything. It is easy to convince yourself that your problem must not be that bad if no one else has noticed. By letting the person know that you have observed a problem you are providing valuable information that may help the person to see their situation more realistically. You have made him or her aware that at least one other person has noticed the problem.
"Just the Facts, Maam."(Sergeant Friday to just about everyone - Dragnet)
Talk about what you have actually observed and not what you guess is causing the behavior. Guessing at the underlying problem can create at least two problems. First, you might be totally wrong about what is going on with your friend. This will enable the person to totally disregard what you have to say, not to mention embarrassing you both. Second, even if you are right about the underlying problem you are setting the stage for denial to emerge and reducing his or her ability to hear what you are saying. Most people will respond much better to concerned questions about observable behaviors than they will to any kind of label, no matter how carefully you suggest it. Stick to the facts! It is not necessary or advisable to make a diagnosis at this point.
Here is an illustration of why you should stick to what you observe. Several lawyers observed that a judge was slurring his words while on the bench. They further observed that the judge was excusing himself to go to the restroom every 10 to 15 minutes. These well-intended lawyers decided that the judge was drinking on the bench and must have a problem with alcohol. Not knowing what to do they called the judge's wife anonymously telling her that her husband was intoxicated on the bench and why they believed that to be the case. Thankfully, the judge had a very sensible wife. She simply went the judge and told him what people were saying. The judge acknowledged that he had been visiting the restroom frequently and expressed concern that people thought he was slurring his words, as he was unaware of this. At his wife's suggestion, he willingly agreed to see his primary doctor. It turned out that he had developed diabetes.
Listen and Motivate
If the friend is willing to talk, then listen. Listen carefully to what your friend is concerned about and learn as much as you can. If your friend is going to seek help or begin solving the problem it will have to be because of his or her own concerns, not those of others. Sometimes you may be surprised by what is concerning your friend. Go with their concern, even if it is not exactly the same concern that you had in mind. Their concern is where they are motivated to make a change and your primary goal is to get the ball rolling in the right direction.
Be prepared to make a referral for treatment if that is appropriate and the person is receptive. (Feel free to call JLAP if you need help locating appropriate referral sources.) However, it is more important that the friend agree to take one step. That first step may be calling their primary doctor, reading an article you suggest, taking a day off work, or even agreeing to talk to you again at a later date. Do not think that you have failed if the person does not respond right away. Be satisfied that you have increased their knowledge of how others perceive their problem and opened the door to further communication. At this point keeping communication open is more important than being rigid about what the friend will actually do. Some people need time to decide on a course of action and some may need more evidence (from others, perhaps) before they decide to take action. That is human nature and to be expected. You have added to the cumulative evidence it may take for the person to take action. At the very least you have not strengthened their denial of the problem by pretending you have not noticed.
I have another example of an intervention that was so simple and so well executed that you might not even recognize it as an intervention. A group of professional men would meet every Wednesday morning for coffee. As the group was breaking up one day a doctor in the group asked one of the attorneys to stay for a minute so he could ask him a question. (The doctor was an acquaintance, not the attorney's doctor or best friend.) The doctor then asked the attorney if he had noticed that he (the attorney) had lost weight. The attorney smiled broadly and answered that he was quite proud of his weight loss accomplished by spending more time at the YMCA and less time at Baskin Robbins. The doctor congratulated him but then went on to explain why he had asked. The doctor explained that sometimes people are aware they have lost weight but sometimes they are not. He said that he makes a point of commenting on it because it can be a sign of illness or stress. By inquiring about the observable weight loss he opened the door for the attorney to talk to him about an illness he was fighting or stressors he was experiencing. If the attorney had not been aware that he had lost weight the doctor could have brought it to his attention and suggested that if the attorney could not explain the weight loss he should see his primary doctor. At the same time, by not making assumptions, he was able to simply congratulate this particular attorney in doing something positive. This intervention sticks with observations and makes no assumptions. Think of the different result in this case if the doctor had started the conversation with "are you sick?"
As I said earlier, this is the type of intervention I recommend as the first choice of action. I believe that most of us are more likely to have the opportunity to implement one of these "first line" interventions than we are to participate in the more intense and formal interventions. However, there are individuals who will not respond positively to this kind of intervention. In cases where a problem has existed for a long time and the individual has been resistant to more gentle types of intervention it is sometimes necessary to implement a more formal intervention. Even these formal interventions are much more motivational and gentle than they were in the not so distant past. Future articles will address these more intense forms of intervention and I would be happy to discuss the options with anyone who calls our office.
If you are considering an intervention of any type please feel free to contact us. We are eager to assist at any level, as consultants, referral agents, facilitators, or participants.