mental health advice: tell me what you think

the other day i received a phone call from william (not his real name), very distressed. he was in the psych ward, on his third week now. “i gotta get better, i gotta get better!” he kept saying. his hospitalization had been preceded by a good six weeks of progressively worsening mental health. anxiety, depression and borderline personality disorder were only some of the diagnoses that had been with him for many years. when he is healthy, he is funny and quirky, a dedicated stay-at-home dad who enthusiastically shares his two daughters’ passion with field hockey. when he cycles into his illness, his thought patterns quickly become more and more one-dimensional until all that is left is a looming preoccupation with how bad of a father he is and a clinginess that becomes almost unbearable to his partner, especially since it tends to be laced with hurtful sarcasm.

my involvement with william is only at the margins. when things get bad, though, we often spend a lot of time on the phone. he finds our phone calls comforting; i think it’s because i treat him like a normal human being, because i, too, have personal experience with mental illness, and also because i keep pointing out my boundaries, gently but firmly.

when william called and kept saying, “i gotta get better, i gotta get better”, my instinct made me blurt out, “you gotta make a choice here. either force yourself to get better – the old pull-yourself-up-by-the-bootstraps method – or accept that you’re sick right now, and that this could be a slow process. but if you keep going back and forth between the two, it’s going to drive you around the bend.”

in my observation, one of william’s major problem seems to be that he is stuck in a painful, very tight loop of thoughts and feelings, a cage of unrelenting self-talk of self-loathing, control and neediness (“i’m a failure!” “no-one wants to spend time with me!” “jean bought the wrong kind of potatoes again!”) my blurting and telling him what i think he needs to do – not exactly according to the textbook of counselling – was at least partially informed by this observation. perhaps i was trying to say, “get out of your cage!”

over to you, readers. what do you think? was my exclamation to make a choice clumsy, too directive? if you were william, how would you have reacted? would you feel connected because i simply followed my instinct and therefore related on a real level?


  1. It sounds like you have a good, established relationship with him that would allow you to make that exclamation. If it were my first couple times talking to you, I might have been put off, but had I known you longer, it would have been ok. I probably would have still resisted, though. 😉

  2. There is never a right answer – but you gave him two choices – the move on or the stay put and observe what could be a long and difficult process. Either way, you were there for him and isn’t that the most important thing?

  3. I think it is the relationship that heals and fakeness (even fake supportiveness, a.k.a. handholding 101) doesn’t.

    If he’d sounded offended you could have apologised or explained.

    I think not being directive is a good idea, especially in the initial stages of a relationship (where normally the client is talking to themselves rather than therapist, and the therapist doesn’t have much of a cluse about the client) is a good rule of thumb. Later it can be just a cop-out, the therapist evading the responsibility that their knowledge (which after all is why they are being paid) brings.

    If I was William I probably would have been shocked. It does sound to me like he’s a thinker though, like me, and so he may have stopped to think about what was said. I’d have gone silent and gone into thinking about it I think.

  4. i think that the great thing that shows here is that you have built a good relationship with your client over time. it sounds like he responded well to your comment. of course, you can always go back over it with him to double check how he took it. it’s part of being human, we’re not always robotic therapists 🙂 and it’s great that you were self-aware enough to ask the question.

  5. thanks for your comments so far! interesting that you all agree that the relationship is the important part.

    @antiswer i often wonder whether something like resistance is even a bad thing. sometimes i even use that consciously – i throw out an experimental idea without caring whether it’ll go anywhere, as long as it helps us stay connected and think about the issue.

    @evan @and steven yes – apologizing is always a good thing. we do all kinds of silly and not-so-smart things as therapists, so there is always ample room for apologies!
    .-= isabella mori´s last blog ..the fun in social justice =-.

  6. He sounds like he is in what I call a borderline out of control spin. Being borderline myself even though I have been with my therapist for nineteen years, your comment might have made me think that I was bad, that you were rejecting me, that I wasn’t doing the right thing, I would have withdrawn from you and probably acted out because I would be angry and hurt. I also would not have heard anything else you said after that.

    However, sometimes now I as a patient be able to yell back or call later after I stopped reacting and became more thoughtful. My therapist would then own his part of it and explain why he said what he said and in the manner which he expressed himself.

    I think, in this situation, he is “making” you feel what he feels…hopeless and angry. If it were me, I would have told him that I was getting frustrated because …. or posssibly “I can’t make you better!!” Then, hopefully calm down and talk with him about what better looks like, and how he is the only one that can get there with the support that he has. And, come up with a short-term plan of what he needs to do to get out of the hospital.

    For me, I think of helping him to move from ridged thinking to neuroplasicity.

    Just my thoughts.
    .-= ClinicallyClueless´s last blog .."She is Freedom" ~ Shawn Thomas ~ Worship in Song =-.

  7. Oh…also

    I think that it is important for you as a therapist to be able to be honest, but in the way that you did was clumsy and for me would have been hurtful. But, my therapist always says that everything is fixable. These many moments that my therapist have had have built trust and my own ego strenght and he has learned as well. The whole key is that both work on establishing the connection again. I would check things out with him about how he is with what you said and say that for some people they would feel…which is perfectly understandable.

    My therapist and I have gone through enought of these with positive outcomes that I always have to remind myself that as long as I talk it out everything will be okay. We will be reconnected and he will take responsibility and own his part of the interaction.

    It also sounds like he is “pushing you away,” so that he can substantiate the belief that everyone leaves me!!

    Sorry to go on so.
    .-= ClinicallyClueless´s last blog .."She is Freedom" ~ Shawn Thomas ~ Worship in Song =-.

Leave a comment

Your email address will not be published. Required fields are marked *