HY 06/03: Can You Help a Loved One in Denial?

Coping with someone who’s self-destructing

A Few How-To’s

Don’t be “holier than thou.” None of us is perfect, and we all find change difficult.
Don’t blame or nag. It will backfire by making the person defensive.
Speak for yourself. Use “I feel” statements rather than “you should.”
Avoid the “do it for me” argument. People need to change for themselves.
Call in reinforcements. Your loved one’s doctor can be a powerful ally in motivating healthy change—so can friends and family.
Don’t forget your sense of humor. It defuses conflict and helps keep life in balance.
Be patient. A good tactic in early conversations is to say, “We don’t have to talk any more now, but I’d like you to think about this, and I’ll bring it up again next month.”

You love this person, but can’t stand to watch the self-destruction. Maybe it’s a spouse with a serious weight problem, or a sister who chain-smokes. Maybe it’s a parent who won’t take the medication he needs, or your best friend who stays in an abusive marriage.

Don’t they realize how their behavior is hurting them? Not if they’re in denial, says psychiatrist Joel Lerman, M.D., of Lehigh Valley Hospital and Health Network. “Someone in denial honestly doesn’t see the problem,” he says.

Denial is a basic and very common defense mechanism, says psychologist Jeffrey Sternlieb, Ph.D., of Lehigh Valley Hospital and Health Network. “The child accused of stealing cookies blurts out ‘I didn’t do it!’ even though he’s got crumbs on his face. It’s an unconscious reflex.” Denial protects us from anxiety, discomfort and embarrassment, he says, and can even be useful at times—but not when health is at stake.

So how do you help that person you love? “It’s important to speak up,” Lerman says. “But do it gradually, in a way the person can accept, and without getting emotional.” People change in stages, says Julie Dostal, M.D., a clinical teacher in Lehigh Valley Hospital’s family medicine residency program. She teaches a process called “motivational interviewing” that’s geared to where a person is in the change process:

Pre-contemplative — “The person at this stage doesn’t recognize the need to change,” Dostal says. “Have a caring conversation that helps him start thinking about it. You might ask, ‘What benefits do you get from smoking? What might you gain if you stopped?’”

Contemplative — Here, the person realizes he might have a problem. Gently help him make the mental connection between his discomfort and his smoking, and perhaps suggest small changes.

Action stage — He’s ready for a major change. Your role now is to ask, “How can I help you? Are there things I’m doing that get in your way?”

You can’t make a person change, but some situations do call for drastic action. “If the self-destructive person is a child, you can and should insist on treatment,” Sternlieb says. Professional help also may be needed in the case of family- or career-wrecking problems like alcohol or drug addiction, serious depression or compulsive gambling.

If you succeed in helping a loved one make changes for the better, be prepared, Dostal says—your life will change, too. For example, your slimmed-down spouse may spend an hour a day exercising instead of hanging out with you, and a partner’s newfound attractiveness may cause you insecurity.

And if your loved one can’t or won’t give up the self-destructive behavior? “In cases where your own or your family’s well-being is threatened, you have to protect yourself,” Sternlieb says. “But if the problem isn’t devastating, the question is, ‘Can I still have a happy life with this person?’” Counseling may help—but in the end, it’s a matter of whether you’re able to accept him or her, warts and all.

Want to Know More about changing unhealthy habits? For information on a step-by-step process, click here.