Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression
Family members of someone with a personality disorder – or other mental illness for that matter – often have a hard time figuring out what to do and how to be helpful to the person they care about. It can be hard to see your loved one suffer, and it can be frightening to watch the pain of someone we are close to. It is sometimes puzzling to see a family member endure emotional pain and it can at times be a challenge to understand what they are going through.
“Interpersonal family communication is often the number one problem” says Dr. Elizabeth Wade, a clinical psychologist who facilitates a group for family members at the Columbia East 60th Street Day Treatment Program. It can be difficult to figure out how to talk openly about what is going on. The feeling of not knowing what is going on with the family members, but knowing that they have felt awful in the past, is difficult to address. Often, communication in the family has broken down.
Dr. Wade explains that the group she facilitates spends a lot of time working on interpersonal skills, addressing the question of how to talk about what is really going on. “It can be difficult for family members to express concern,” she says, “Sometimes, there is a tendency to express concern in form of anger, which frequently results in the troubled family member feeling that they are not sure they can be honest about how they feel.”
In the family group, members practice ways of having these difficult conversations without anyone in the family feeling judged or criticized. People learn to ask direct questions, for instance, about how the other person has been feeling lately. The group also works on conveying that they want to be respectful of their loved one’s privacy, but that at the same time they are wondering how they can help. “If I am feeling concerned, what would be the best way to approach you?” models Dr. Wade, suggesting that families talk about and plan a protocol in advance. In doing so, non-judgmental communication is really important, as much as it is important to validate the other person and to show that you understand how they feel. Part of that is communicating to your family member that you are on their team.
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Sometimes, your family member may not be willing or motivated to seek treatment. “This is difficult to accept”, acknowledges Dr. Wade, “and there may not be much you can do, other than providing your family member with information about treatment. Unless your family member is in immediate danger, in which case you need to call 911.”
Dr. Wade notes that it is often hard for parents to find a balance between being an over-involved parent versus providing parenting and support that are needed. The line between dependence and independence can be tricky. An area that is particularly complicated is often the question of financial support, especially when a child is dropping out of responsibilities. Parents may realize that their child is involved in using substances or flunking out of work or school, and they may be worried that their child has no options. Setting limits with the child about what parents are willing to support and what they are not willing to support is frequently an effective way to help the child confront what is going on. This is hard to do, because there is the worry that setting limits will push them over the edge. “It is not easy to spell out what this actually means in each individual situation.” explains Dr. Wade, “We can’t give a one-fits-all answer to these issues, because these things are very complicated. That’s why we offer a family group.”
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