Throughout a decade of making presentations, Helen and Valerie are often asked, “What can I do when my family member with mental health issues refuses treatment?” A tough situation and difficult to answer until they discovered “When a Family Member Refuses Mental Health Treatment.” They explore this groundbreaking book with co-author Gary Mitchell, a seasoned clinician, researcher and innovator in the mental health field. One of the basic premises is to shift focus from the member who is treat-resistant to the other family members who are seeking help with their own needs. To deal with their issues that can be improved upon, rather than accommodating and enabling their recalcitrant loved one. The end result can create a healthy, productive, healing environment for the entire family.
Find Valerie and Helen at https://www.mentalhealthhopeandrecovery.co
When a Loved One Won't Seek Mental Health Treatment by C. Alec Pollard, PhD; Melanie VanDyke, PhD; Gary Mitchell, LCSW; Heidi J. Pollard, RN, MSM; and Gloria Steketee, PhD
Learn more about your ad choices. Visit megaphone.fm/adchoices
When a Loved One Won't Seek Mental Health Treatment
Episode 53
Helen Sneed: Welcome to our award winning podcast, Mental Health Hope and Recovery. I'm Helen Sneed.
Valerie Milburn: And I'm Valerie Milburn.
Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational true stories of recovery. Our knowledge is up close and personal.
Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals. But we are experts. We are experts in our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.
Helen Sneed: We live in recovery.
Valerie Milburn: So can you this podcast does not provide medical advice. The information presented is not intended to be a substitute for or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers with any health related questions you may have.
Speaker A: Foreign.
Valerie Milburn: Welcome to episode 53 when a loved One Won't Seek Mental Health Treatment. Today's topic is of paramount importance for a multitude of people trying to help a loved one with mental health issues. Their resistance can represent an unyielding impasse to that individual receiving much needed treatment. You know, for family members and friends, a person's refusal can be like hitting a brick wall. So what can be done when sometimes the loved one won't even acknowledge having a psychiatric challenge? Helen, you and I have encountered this dilemma frequently when we're giving presentations and invariably someone in the audience asks us how to deal with this huge obstacle to treatment. You know, I've tried to answer, but I was never convinced that I had helped. And today's guest will provide a host of answers and solutions for those who are dealing with this dilemma. So Helen, tell us what great revelations we have in store.
Helen Sneed: Well, today we are very excited to introduce Gary Mitchell, co author of When a Loved One Won't Seek Mental Health Treatment. This is a groundbreaking book and we are so fortunate to have Gary here to walk us through it. The book is the result of three decades. That said it, three decades of work by the Family Consultation Team at St. Louis Behavioral Medicine Institute and St. Louis University School of Medicine. Gary, welcome to Mental Health Hope and Recovery.
Speaker A: Thank you both. It's really a delight to be here.
Helen Sneed: Well, now I'm going to sort of spill the beans on you here. Here is some of the background of our guest. Gary's credentials are so extensive that it is hard for me to see how he had the time to work on a book. Gary is a senior staff clinician in the center for OCD and Anxiety related disorders at St. Louis Behavioral Medicine Institute. He has been a licensed clinical social worker in the state of Missouri since 1996 and has specialized in the treatment of children and adults with ocd, anxiety disorders and related problems. He is an original member of the Family consultation team at St. Louis Behavioral Medicine Institute and co developer of the Family well Being Approach, which is known as FWBA. Gary received his MSW from Washington
Helen Sneed: University in 1993. He has had previous experience working in residential treatment with children and adolescents as well as inpatient psychiatric treatment. Gary has been a frequent presenter at local and national meetings in OCD and related anxiety disorders.
Valerie Milburn: Well, to begin with, we'd like to remind our listeners that pointing out difficulties within families is not meant to be judgmental. It's simply necessary to investigating and alleviating the challenges for all family members and friends. And we'd like to set up the problem that the book addresses so brilliantly and just jump right in, Gary, with our first question. Can you tell us about recovery avoidance? And while you do that, can you address whether or not it's a two way street and what are some of the real reasons people avoid recovery?
Speaker A: Yeah, I would be happy to. It's a big and important question really. The hallmark of recovery avoidance is a chronic failure to take advantage of available resources for treatment. We all have some amount of recovery avoidance, but generally it's not chronic. And if it's chronic, it's not causing significant problems in our life. For instance, I intend to start exercising again tomorrow and tomorrow I will probably intend to start exercising again the day after tomorrow. Right. We all, we can all relate to not taking advantage of or doing things that are in our interest. But when you have an individual who is truly suffering and, or is the genesis the source of suffering for the rest of the people in the family and there are resources available to that individual that they're not taking advantage of. That's what we mean by recovery avoidance. It starts with the recovery avoider, the individual who would be sort of classically diagnosed with some mental health condition. Right. And the reasons why an individual might avoid recovery are myriad. You can start with an individual who really does not perceive they have a problem at its most extreme. So you know, they might be saying to those around them, I don't have a problem. It's, you're the one who has a problem for believing that somehow there's something not working well with me. An example of that at times you might have somebody who has a hoarding disorder who, the people around them are very concerned or very even affected by that disorder. And the individual who's, who is doing all the collecting, the hoarding, it doesn't see a problem. They really legitimately don't see a problem. So that's at its most extreme. Right. What are other reasons somebody might avoid recovery? Well, they may have been in therapy a number of times and they might have arrived at a conclusion that therapy just isn't going to work. For me, whatever we mean by therapy, maybe it's medication, maybe it's psychotherapy, maybe it's some other intervention. Right. But they may have arrived at some conclusion that they can't get better. So they're not saying they don't have a problem. Right. They're saying that there's nothing that can be done. So they've stopped taking advantage of available resources that could make a significant difference. What you have in common though is, and it's important to distinguish somebody who has access to resources that they're not taking advantage of that would be very different than somebody who is struggling. But there's no resources for them. We wouldn't call them a recovery order. So it starts of course with the individual, but the, the focus, the understanding, the theoretical framework here is that it's not just a problem with the recovery of order. It's a, it's a situation that affects the entire family.
Speaker A: So the family ends up responding, reacting to the recovery avoider in ways that tend to exacerbate the recovery avoider's avoidance. And I'll give you an example. You have a well meaning set of parents, say with an adult child who's living at home with them, who is significantly impacted, say they're terribly depressed and they're not working, they're spending most of their days in their bedroom, avoiding most activities. And the parents, well meaning, are going into the bedroom and pleading and trying to talk them into getting out of bed and doing what's in their interest, what we would all agree would be in that person's interest to do. And the result, unfortunately, is the. The person feels. The sufferer feels more pressure. They feel misunderstood. They respond with potentially anxiety, sadness, depression, anger. And the family's attempts to get the individual to engage are met with more resistance. So the, the understanding here is that the entire family is caught in a trap. The. It's not just getting the sufferer better, it's helping the family recover.
Valerie Milburn: It's a great overview. Thank you.
Helen Sneed: Yeah. Yeah. I have to tell you that in reading the book, I'm getting ready to ask you about what I found one of the most arresting concepts in the entire book, which is, can you explain to us this important shift from struggling to treat the treatment resistant family member to supporting the family members desiring help?
Speaker A: Yeah. Thank you. It's a fundamental question when, when we would get these calls from family members who would say, my son, my daughter, my husband, whatever, is really struggling and can we get them into you for therapy? We were left saying what most clinicians will say, which is, hey, you know, when they're ready, we, we're open to working with them, but they have to be amenable to, to coming in, to talking, to engaging in the treatment. Otherwise there's really nothing that we know to do. Which was, you know, sort of the genesis of this book because it led to so much frustration for us as clinicians. We're leaving, we're. We're doing the opposite of what's in our nature. Right. We know that we can't, that trying to force the person to engage is likely to be problematic and exacerbate frustration. But what we didn't really think of, and in retrospect, it seems like such a natural solution, what we didn't really think of is, well, we have family members who do want help. And so the focus is on helping the people who are amenable to receiving help. And one of the initial areas of discussion and continued education when we're working with families is that we can help you change your reaction, we can help you focus on having a healthier life, we can help you overarching principle is to decrease the heat, decrease the emotional stress in the family. When you do so, your life is going to be a whole lot better. And interestingly, the recovery avoider is probably going to be in A much better position to potentially engage in therapy. The entire family is going to be better off. And so we focus on those who are willing and amenable to wanting to make changes in their life.
Valerie Milburn: Yes, that's so important. And, and that is so reminiscent of what my sponsor told me when I first came into recovery. I was, you know, in a very bad place. And she told me, if you get better, the people around you will get better too. And I was the one struggling. But you just described the other beautiful flip side of that, that as my family
Valerie Milburn: got better, as I was sick. And you're talking about in your model, in this wonderful book you've written. It shows how as the family members get better, the recovery avoider gets better because the family members know how to create this family well being, you know, through these new skills that you lay out so beautifully in the book. So that is where we want to go next. Is that how these skills that you lay out bring the family out of what you call the family trap? And can you talk about that family trap, how taking care of themselves, this help that the family gets brings the recovery avoider and the family out of that trapped behavior and brings, brings them into the well being. That's everyone's goal.
Speaker A: Yeah. Thank you. One of the things that we need to remind ourselves of as therapists and then consistently remind the participating family members is our job is to, during the bulk of the treatment here, our job is to help the participating family members pull themselves out of the trap. We are hoping that it will help create the conditions where the sufferer, the recovery avoider, is more likely to then get help for themselves. We can't guarantee it, of course, but it certainly increases the likelihood. So we think about the family trap. You have a family. I'm going to use an OCD presenting problem as an example because that's, that's the water I swim in. Say you have a family member who is not amenable to getting treatment. They are really suffering. They are struggling. Say they have contamination related OCD and they are demanding that the family engage in hand washing and all kinds of rituals in order to make the sufferer feel better. So what happens? The family members start down this unfortunate slide where they give in a little and before they know it, they are, their entire life is controlled by them giving in to these rituals, these compulsions for the sufferer. They naturalistically become frustrated because of the impact on their lives and they, they've lost. Not just they're giving, they're spending time engaging in these activities that's taking time away from being able to do other things. So that's irritating and frustrating. They're also very likely missing out on opportunities. They've given up activities in their life because they're so stressed. And that's also causing them to be frustrated and irritated. So what's their natural reaction? The natural reaction is, you know, after they've accommodated so much, they've enabled so much, they end up getting upset, whether that's yelling or screaming or name calling or just, you know, acting in ways that are frustrated or irritated. And what's the message that's being sent to the recovery avoider? Right. They're upset with me. And what are they interpreting? You know, the. Some. Some smart person said years ago that the meaning of our. Of our communication is not necessarily what we intend. It's what the other receives. So what is the sufferer perceiving? They're perceiving that. Let's. That mom and dad just don't get it. They have no idea how hard this is. Right. So you know, those kinds of messages that are focused, essentially they're saying, pull yourself up by your bootstraps. You just need to stop this. Those are what we refer to as minimizing messages. And the family gets caught in this pattern of minimizing and then accommodating and minimizing. And the sufferer, everybody's more frustrated with each other. So that's the trap.
Helen Sneed: I
Helen Sneed: can say that for me, it absolutely not only made me livid, but it did would make me worse. It was a setback to here. Oh, just buck up.
Valerie Milburn: You'll be fine, you know. Yeah, yeah. Just go for a walk every morning. You'll feel better.
Helen Sneed: Yeah.
Valerie Milburn: Now that we're in recovery, you know, it does make us feel better to do all those excellent behaviors and, you know, have a daily wellness plan. But, you know, you got to get on the road to recovery before those types of skills keep you healthy.
Helen Sneed: This is something again where we are this, you know, get into the section of the book that breaks down the challenges to promoting recovery and also, you know, to proclaiming to reclaiming the family's well being. And Gary, one important concept is preparing for crises. Can you explain this to us?
Speaker A: Sure. This is one of the areas that impedes families from taking action, from really focusing on recovery. Their fear, and it's not an unrealistic concern, is that if, for instance, I start to disengage from the enabling that is keeping my loved ones stuck. Right. They might react and they might react, you know, God forbid they might react by attempting suicide. They might react in ways that are violent. And this is a fear that people have. And often it's, it's rather legitimate. They have history with their loved one of these kinds of behaviors. So before we really start focusing on helping people change their behavior, we want to make sure they have a plan to deal with actual potential crises. And it's idiosyncratic. It's got, it's different for each family. And I'm not married to them having to have the Gary plan. Right. But I am concerned that they do have a plan that they are confident they will use if they need it that will address their concerns about an immediate crisis. Right. And one of the other things that we need to consider is the distinction between a crisis and other behavior that's disruptive and unpleasant, but not a crisis. And so a crisis would be if somebody's life or welfare or you know, some belongings that were rather valuable were at risk. Right. The rest of it, yes, we want to have a plan for, but it wouldn't be a crisis. So an example, you have a family that's worried about if they start withdrawing accommodations that their loved one is going to become suicidal. Well, we don't have the time here to go into that would be another podcast what to do if you're worried that somebody might be suicidal, but they need a plan to Be able to talk with
Speaker A: the individual and to be able to reasonably well assess if the person is legitimately at risk and if they're really feeling like this is dangerous, that their loved one is at risk, to have a plan for what they're going to do. If that's calling an ambulance, if that's calling a family member who can sit with them for a little while and metaphorically hold their hand for a little while, that can become. With a recovery avoider, though, giving too much attention to trying to stay safe can actually backfire because it can result in more of that behavior. I don't know if I'm explaining this well.
Valerie Milburn: No, you are. Yeah, you are explaining it well. And when you mentioned the Gary plan, one thing I like about the book is that it's not the Gary plan in any of the, you know, making plan worksheets outlines. They're all frameworks to make your own plan that is individual for your family. And they're very well done. So I'm glad you mentioned that. And there's also a quote in the book. The quotes you have are really great. And the one about the crisis approach is from Stephen King, and it says there is no harm in hoping for the best as long as you are prepared for the worst. And that is importance of the crisis plan. And as we move into the next topic about the redefining the problem, there's also another great quote from Mary Katherine Bateson that you have in there. And it really got my attention. And the quote is solutions to problems often depend on how they are defined. And I love that because it's another necessary action for the family is redefining the problem. And can you talk about how you go about doing this?
Speaker A: Sure, we try to. There's some very well thought out, I think, worksheets that assist the families here. And there's three areas of focus, Right. One is helping the family look at the accommodations of commission they have been engaging in. In other words, the things they. The enabling they've been doing and deciding which of those things they want to start decreasing and in what order they intend to start decreasing. One of the areas that we keep going back to with families is now remember, you're at this point in the process, your job. We are not trying to change your loved one, we are changing you. So we're not focusing on, oh, gosh, if I decrease this enabling, that'll get them to get better. No, it's the things that are most upsetting and affecting your life so that you can have more of your life back and what is the order in which you intend to do that? And the order can be driven by any number of things. What's most important to you? Or it might be driven by what do you think would be easiest for. For your loved one. Right. And the reason we might decide what's easiest for your loved one is that makes it easier for you. We also have then the accommodations of omission, that is the things that I'm not doing enough of in my life and that I want to start doing more of. So we have people then decide what they're going to do more of in their life and to make a list of the things they've been missing out on and ideally intend to start doing more of. And then.
Helen Sneed: I'm sorry.
Speaker A: No, go ahead.
Helen Sneed: I was just saying this kind of leads to the next question. You're sort of already there. Which is what is involved in embracing valued activity?
Speaker A: Yep, great question.
Helen Sneed: So important.
Speaker A: Yep. I'm going to. I'm going to just add one last piece to preparing. So there's three bits. There's things the enabling I'm going to do less of, the things I'm going to do more of for myself, and the minimizing messages that I'm going to do less of as well. So those kinds of things that I've been saying or communicating to my loved one that I intend to decrease or just continue. So then the next natural question is exactly that. Right. What is embracing valued activity look like? Well, so there is an approach that is. Has gained a lot of steam in the last 10, 15 years to depression
Speaker A: called behavioral activation. And the increasing valued activity is very consistent with that approach. It's helping people even if they're not depressed. Right. Helping people to get more of that valued activity that they've been avoiding into their life in order to support a healthier life. Again, think big umbrella. We're trying to decrease the heat in the family. And what is one important strategy for decreasing heat in the family? People being. Being healthier in their own lives. So the focus is on encouraging people to choose an activity, starting with one that you're going to start ideally doing differently. And this is where the behaviorist in us comes out. Right. If. If somebody says to me, well, I'm going to start exercising more, great, but what do you mean by that? Right. So ideally, what you identify is what I'm going to do, when I'm going to do it with, who I'm going to do it with, where. Right. To have a very specific plan and to be realistic about that plan. If I haven't exercised in, you know, a year, I'm probably not going to go out and run two miles tomorrow.
Valerie Milburn: Helen, you hearing smart goals?
Helen Sneed: Oh, I know. I was just sitting here thinking about that, that this is, these are just such, well, goal setting and you know, and manageable goals is something that we're both very big on. Oh, and, and it's what you're describing, you know, and also I just wanted to say one of the things that I like about the. But I really like about the book is that it's, it's action oriented. So much of, I think, treatment and therapy, you know, it's, well, talk therapy, you know, it's, it's all, it's talking and talking, but, but yours is. So here's your problem, here's what you can do and that, and that's what, that's what I've found. One of the things I find so compelling about it.
Speaker A: Yeah, no, it's a, it's a great intervention. The, you know, the main treatment that we do here at the clinic is cognitive behavioral therapy. And of course, cognitive is focusing on beliefs and thoughts. Behavioral focuses on making changes in what you do. It really should be called cognitive emotional behavioral therapy because there's a lot of emotion that arises in the treatment. And as long as, you know, the, the idea is, for instance, it helping people face their fears. If we can aid somebody in facing their fear in a healthy way, over time they will learn at a deep emotional level that the thing they were afraid of is actually not particularly dangerous. Right. So the, in a, in an ideal world, we do a little bit of cognitive work to, to set the framework for people to take action. Then we have them take action to prove to themselves. Right. That the thing's not dangerous. You know, when I, when I lived in Texas many years ago, I lived out, I lived in Dallas and outside of Dallas, yearly they would have a rattlesnake roundup and bar just come to my ranch.
Valerie Milburn: You don't need to go to Dallas.
Speaker A: I used to joke with folks, I would say, you know, what is the thing that you probably hear just before someone gets bit? And it's probably something like, hey guys, watch this. Right? There are some things that we should be at least respectful of, if not afraid of. But the things that keep us stuck, the anxiety conditions, by definition, we're responding with anxiety to things that are not particularly dangerous. So the focus really is action oriented in great part. Our hope is that it helps enough people. I've had These lovely interactions with folks where we have them read the book first and then contact us if they need therapy, if they need more. And I've had these experiences where people will email me and they say, all right, now I'm on step three. Things are going well. Just wanted to tell you, which is lovely. Right. There may be.
Speaker A: It may well be that I don't know what percentage of people are going to be able to use the book without guidance, but it may well be that the folks who get stuck, it might be in part because they have beliefs that are keeping them stuck and interfering with their ability to take advantage of the behavioral strategies that we're suggesting. So that's a long way to say it's behavioral by design, because that's so much. It's so straightforward and so helpful for those who can do it. And some folks need more help.
Valerie Milburn: Right? Well, it takes a village, not just of people, but of treatment methods sometimes. But your book is definitely a good start and a good framework and can be done. So let's talk about action steps in another area, and that's about easing family distress. And I have to use one more quote that you have, because my husband talked about this in our episode where he and my sister talked about my journey. He talked about sometimes not knowing exactly what to do, but doing the best he could from an area, you know, from the point of a loving approach, you know, just doing what he could do out of love and compassion. And the quote is from Kurt Vonnegut, and the quote is, you can do no good, at least do no harm.
Speaker A: That's nice.
Valerie Milburn: It's a. Yeah, that's. It's in your book. And so we're talking about easing family distress here. And you have methods and action steps. And can you share some of those for easing family distress?
Speaker A: Sure. And we have worksheets that guide this as well. What we're essentially doing is putting into action the principles that we've discussed so far. So we are now, the family members have identified those activities that they are going to decrease the enabling, they're going to do less of. They've identified the activities they're going to do more of for themselves, and they identified the minimizing messages that they're going to discontinue. And, oh, I should go back and say, at each of these steps, when we develop a crisis plan, for instance, the most families are encouraged to create a little letter to the, to the sufferer, to the recovery of order, saying, this is what we're going to do from now on. If these behaviors arise, what it does is protect people from surprises. There may be instances in which it's not necessary or not helpful. So if I have a family, for instance, that is saying, look, it's been years since my loved one has talked about suicide. I really don't anticipate that's going to happen, but I want a plan just in case they might say, look, I don't think it's helpful or necessary to send a letter to my loved one saying that if you should become suicidal, this is what we're going to do because the odds of it are so otherwise we want family members to be informed of what's going to happen. And the same thing is true in this particular action step. So the family members initially, they're developing, as we talked about, valued activity, they're going to, if it's appropriate, if they're worried increasing their valued activity, like going for a walk or going out with friends is going to upset their loved one, then they might send them a little note saying, hey, this is what I'm going to do. Here's why I it's I love you, I care about you, but this is me taking care of myself. This is what I need to do. So now, these next couple of steps, same thing, we're going to encourage the family to identify the enabling that they're going to start discontinuing and start with one thing and it meet, it might be, it need not be an all or nothing proposition. So it may be that they're going to say if you have somebody who is seeking reassurance, constantly seeking reassurance from their parent, the parent might say, look, I will give you reassurance, but only twice a day at X time and Y time and I'll do it for five minutes at each of those times. But when you ask me at other times, I'm going to let you know, to bring it to me then when, when we have it planned,
Speaker A: right. So it need not be withdrawing all of the, a particular accommodation at one time. It can be done very gently and a little bit at a time. It takes some creativity, but it's often, it's often likely to be more successful if you're not doing something that feels extreme with the withdrawal of accommodation. So we encourage people to decide then the accommodation they're going to decrease or discontinue. But the good news, and there's good news here is this is my commitment to you. I have, I've been reactive and I've been acting in ways that might be upsetting to you. And I sometimes I even feel guilty when I do that. And I am so sorry. It's me speaking. This is my issue and I've been reacting out of my frustration and I'm going to make a commitment to stop doing that as well. I know I'm going to be imperfect. I know I'm going to mess up, but this is my commitment to you. So the idea then is to craft a letter and let their loved one know what they're planning to do and when they're planning to do it and how they're planning to do it. And then experiment with withdrawing that accommodation, taking better while they're taking better care of themselves and decreasing the minimizing. And what people often find is they are their anticipation about the negative impact of that. They're far more anxious than the actuality is.
Helen Sneed: Well, I guess this sort of leads to one thing that I consider really one of the great goals, overreaching goals of the, of the book, which is so bearing all of this in mind, how can a family create a recovery friendly environment?
Speaker A: There's a. That's a big question. So first I will say when we talk about recreating a recovery friendly environment, all of the steps we've talked about up to this point are in service of that, right? We're decreasing stress or decreasing the, the emotional tension in the household. And so it, you know, this is the step that families naturally want to jump to. And they keep wanting to jump to. Of course they do, right? How, you know, because they're. And, and it's seductive for the therapist to want to jump to that as well. And so what we need to keep coming back to is that step five is contingent on us getting the other steps, getting our crisis plan in place, being confident that you can use it, deciding what you're going to change, right? Decreasing your enabling, decreasing your minimizing, getting more activity in your life, all of those things are preparatory for now, creating a recovery friendly environment. And so when we talk about a quote unquote, recovery friendly environment, what we mean is setting the conditions to make it more likely that my loved one is going to engage in healthy behavior that is, if not specifically focused on recovery, is recovery adjacent, right? Is recovery friendly is moving in that direction. And so ideally we disabuse folks of the tendency toward using punishment, right? If you don't do X, then Y is going to happen. That's not a particularly low stress way of getting things done and often results in more stress. So what we try to do is guide the family in identifying. And sometimes this isn't easy. For instance, if you have, if you have some power over the recovery avoider, you know, if you're providing them money, for instance, if they're a young adult or a teen. Right. Then you can make that money contingent on them engaging in some healthy behavior. Sometimes we don't have control over other adults and it's harder. You have to be more creative to.
Valerie Milburn: Come up with incentives. You're talking about incentives.
Speaker A: So first thing we want to look at is target behaviors, behaviors that we want to see increase. And then we want to develop incentives to increase the likelihood that behavior will occur. And one of the things that we're consistently focusing on is getting out of trying to cudgel to try to push the person to engage in these behaviors. Let the rewards do their job or not. Right. But then we're getting out of the risk of getting back into minimizing in order to get the person to earn their reward, in a sense.
Helen Sneed: Can you just give us one example of using money where it can be effective?
Speaker A: Oh, sure. Especially if you have somebody who is money driven. Right. They want, they want the things that money can get them. So if you have a young adult who is, who likes to buy things, whether it's games or whether it's clothing or whatever it is. Right. We can say, well, I'll give you an example of another target behavior. There is this book that talks about ocd, and if you spend a half hour reading the book, we'll pay you five bucks it needs to be in. If you trust the person completely, you can say, just tell me that you read it for a half hour. If you're a little dubious, you might say, well, do it. If you read the book at the kitchen table from 6 to 6:30, we'll give you $5 each time you do this. Right. I can't promise, I can't guarantee the person's actually reading. They might be, they might be thinking Mary had a little lamb in their head while they're opening the book. Right. But it's at least approaching a recovery like behavior. They're engaging in an activity that isn't getting stuck in their condition and it's moving in the direction of getting better. So the, the beauty of money is it's just representative of so much that a lot of people want. There are some folks who just are not moved by it. They have most of, of what gets them by, and they're not particularly incented to get other things. But when it's helpful and in Fairness and all fairness, when the family can afford can be very incenting.
Valerie Milburn: Well, that's a great example. And I think what it comes down to is know your loved one, know what's going to work for them. And you just made me think of something I hadn't thought of in a long time. We wanted my daughter in high school to get a tutor for just one subject she was really struggling in. She was very resistant. And then I found this really cool college kid and I said, you know, you can study with her about the subject for an hour and then you guys can go do something fun for another hour. And they went to coffee shops, they went onto campus and you know, learned about where the college student was hanging out on campus and went into the campus libraries. And my daughter actually ended up learning things about life and growing up and she saw an older person's perspective, a very healthy college girl's perspective. Anyway, that worked for her. Then, you know, I found an incentive, knowing what I knew about my daughter, that she wanted to be cool and hip like a college girl. But she got so much out of that tutoring and her grades went up. So it was a win win. So I knew my kid. And that's what you're saying, know what's going to work for your loved one who's struggling and you know, make it be a win win. And I just love that advice. And I'd love to know, as we're heading toward, unfortunately, the end of our time, we have a couple more questions. What is the most valuable advice you have for a family struggling with a member who won't seek mental health treatment? Just kind of hone in on the best, please.
Speaker A: Yeah, well, I have to go back to big principles, right? Focus on what you can control, which is your own well being and your life. Have a crisis plan available in case you need it and then focus on pulling your own yourself out of the trap. That's, you know, it's big picture, but that's my advice. I can, I can expound if you like. The.
Speaker A: You look at how narrow people's lives become as a function of getting caught in this trap, right. And we go back to basics. I. When's the last time you went out to coffee with a friend or whatever it is that you're not doing and start doing more of that and you know, how if you are stuck in a whole lot of, of accommodating, anticipate how you're going to gradually start withdrawing that.
Valerie Milburn: Thank you.
Helen Sneed: Well, this is, you know, we have the word hope in the name of our podcast. And so this is the, the, the final question I want, we want to ask you, and that is, with all your experience and the years that you've given to the field, what gives you hope for people facing these challenges today?
Speaker A: It's a great question. The, the, in part, I go back to that example I gave you of, of families who are reading this book and who we're not hearing from. Right. You know, the, the intake process now says if you call to get in with a clinician, it's read the book first and then call if you need to see a clinician. And there are a number of folks who aren't calling. My, my presumption is they are doing what is in their interest to do and starting to decrease the heat. Getting out of the family trap. Right. That gives me hope. And the another thing that gives me hope is, you know, when I started in, in this field in 1993, there were relatively few places that somebody. Now I'm speaking from my area of expertise, which is obsessive compulsive disorder, there was no place you could go except for one. That was the program that we had at the time. If you had severe obsessive compulsive disorder and you needed a program, there were clinicians across the country who were trained, but if you needed a program, there was only one place you could go. And now there are these really well created, well run, strong programs across the country. And there are clinicians, there are so many more well trained clinicians across the country. That gives me hope. That's all good stuff. There's still a lot of people hurting, but there's a lot more resources available for people as well.
Helen Sneed: Well, I just want to say that I think for both Valerie and me, one of the things that gives us hope is to be able to refer people now to your book. But I have now the unwanted task of bringing this great conversation to a close. And Gary, thank you for this wealth of vital information and expertise that you've given to us and to our listeners today. And thank you also for this extraordinary book, When a Loved One Won't Seek Mental Health Treatment. It's a real gift to the field and to everyone who has faced the brick wall of resistance. And I just foresee great, great for success for it. And it's becoming just a standard usage as time goes by. And now, Valerie, will you lead us in a mindfulness exercise which we always need?
Speaker A: I just want to say very quickly, I have very much enjoyed meeting with the two of you and very much appreciate what you do. It really is an extraordinary service you're providing in your podcast.
Helen Sneed: Well, you've done us a great honor and a great favor by doing this today. And also you're helping a lot of people.
Valerie Milburn: Yes, thank you. Thank you, Gary. Thank you so much. Yes, I will. Helen and I always give a definition what is mindfulness? It is a mental state achieved by focusing one's awareness on the present moment while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations without judgment. Today's mindfulness exercise is called what if to what is Worry or anxiety about the future can lead me to focus on what if this happens? Or what if that happens? For me, these types of questions are a fear of the future that I can actually quell by a mindful shifting to the present moment. And I can do this by turning my what if questions to what is observations. Let's try it. Let's get mindful.
Valerie Milburn: If you're driving or walking, please adapt this mindfulness exercise in such a way that it works in your current surroundings. If you can find a comfortable seated position, try closing your eyes if it's safe to do so. As always, let's begin with a few diaphragmatic breaths. Whether your eyes are open or closed, let's steady our breathing with two diaphragmatic breaths. When you do this on your own, take as many breaths as you need to become calm and centered. I take about 10 diaphragmatic breaths to begin my mindfulness and meditation practice. Let's breathe. Inhale through your nose, expanding an imaginary balloon in your stomach. As you inhale, exhale through your mouth, pulling your stomach in. As you do. Again, inhale through your nose. Drop your shoulders. Expand that balloon in your stomach. Exhale through your mouth. Exhale forcefully. Pull in your stomach. Keep this slow, steady breath going. Now, bring to mind a current situation that you are worried or anxious about, or maybe a recent situation that was accompanied by similar emotions. What are or were your concerns about that situation? Can you phrase the concerns as what if questions? Now, can you rephrase these what if questions as what is Factual statements about the situation Focus on the positive aspects of the situation. Now, let's bring ourselves to our current surroundings. Let's find the beauty in our current surroundings. If your eyes are closed, please open them. As you take in your surroundings, take a deep breath in through your nose and breathe out through your mouth. Again, look around. What do you see that brings you pleasure? What do you see that elicits a fond memory? What do you see that you are grateful for. Dwell in these pleasant feelings. Take slow, deep breaths. Relish the power of mindfulness. Thank you for doing this mindfulness exercise with me.
Helen Sneed: Well, thank you, Valerie. And I like that phrase, the power of mindfulness, because that's something that I have come to appreciate as the days and months and weeks go by in my life. And I don't know what we would do without your leading us in mindfulness at the end of every episode because I, for one, need it now. It's a struggle to find the words to adequately express our gratitude to Gary. All I can say is that I'll constantly be using his book.
Helen Sneed: In fact, it's well worth a second read. And as always, we send our thanks to our listeners around the globe for joining us. This podcast is created for you and your loved ones. Our upcoming episode faces head on one of the greatest challenges for anyone who's living in recovery. And very few of us are exempt from this problem. We'll investigate what happens when life in recovery is disrupted by a setback. A major setback can threaten hope and belief in the ability to recapture mental health and to recover. And what can a person do to climb out of such a reversal? Is it possible to thrive again? We'll feature a very special guest whose experience with recovery and setbacks will inspire and inform us all.
Speaker A: All.
Helen Sneed: Don't miss her remarkable story. And now I leave you with our favorite word. Onward.