112: When a Loved One Won’t Seek Mental Health Treatment with Dr. Alec Pollard

What do you do when a loved one won’t seek the mental health treatment that they obviously need? We are looking at the very important topic of mental health from the perspective of your concern for a loved one who might be resistant to asking for help, and what you can do about it. I’m joined by Dr. Alec Pollard, a co-author of When A Loved One Won't Seek Mental Health Treatment: How to Promote Recovery and Reclaim Your Family’s Well-Being. With a long career as a clinical psychologist, he is the founding director of the St. Louis Behavioral Medicine Institute. Join us to learn more!

Show Highlights:

• Dr. Pollard’s background and four decades of experience as a psychologist 

• Turning his focus to help those who are concerned about their loved one’s mental health

• Dr. Pollard explains The Family Well-Being Approach/Consultation

• Two types of accommodations that loved ones make: commission and omission

• Differentiation between appropriate and inappropriate accommodations for a loved one

• Recovery avoidance: a pattern of behavior that is inconsistent with the process of recovery

• Creating opportunities for a loved one to get better through support, incentives, and positive rewards

• Dr. Pollard’s book and its approach of finding a balance between long-term planning and crisis management

• Dr. Pollard’s takeaway about his book as his proudest achievement in his career

Resources and Links:

Connect with Dr. Alec Pollard: St. Louis Behavioral Medicine Institute and When A Loved One Won't Seek Mental Health Treatment

Connect with KC: Website, TikTok, Instagram, and Facebook

Get KC’s book, How to Keep House While Drowning

We love the sponsors that make this show possible! You can always find all the special deals and codes for all our current sponsors on our website: www.strugglecare.com/promo-codes.

• Transcript

  KC Davis 0:00

  Music. Hello, you sentient balls of stardust. Welcome to struggle. Care. I'm your host, KC Davis, and I have a guest with me today, Dr Alec Pollard, and we're going to talk about, what do you do when someone that you love doesn't want to seek out mental health treatment that they, in your opinion, probably very much need I talk a lot about mental health on the podcast, but I'm usually talking about mental health from the perspective of you being the person looking for help. But I know that things get really complicated when it's someone that you love that needs help that maybe feels resistant to it, and so for that reason, Alec, thank you for being here. You and some of your colleagues wrote a book, and the name of that book, let me pull it up here, when a loved one won't seek mental health treatment, correct. So tell me a little bit about yourself and how this came to fruition. Well,

  Dr. Alec Pollard 0:55

  I'm a psychologist. I've been practicing, I won't say how many years, but let's just say I was a child prodigy, certainly, of course, but okay, I'll admit it, almost 45 years, I've been practicing at this point, and I started off with my interest in specializing in OCD and anxiety disorders, and that was truly my love for many years, in terms of both research and clinical work and teaching and training, but at some point myself and my colleagues would get these calls, and we're not alone in this, and it would be somebody, it might be the husband of someone, the wife, the parent, the child, the adult child of someone with a mental illness, who would say something along the lines of, he or she has got this serious problem, it's affecting the rest of us, but they won't get help, either because they deny it's a problem, or they agree it's a problem, but they're working on it themselves. They don't need help whatever it is. And so what can you do to help us? And then we would say, well, not much have him call us when he's ready. And that's pretty much what we call in the book, Doctor typical. And we were Doctor typical, because that's what you know to do. You're not a miracle worker. Can't make somebody want to change. And so that's what we said for a number of years. And finally, we were feeling guilty about that, because we had real human beings calling us, it's suffering, and that's kind of what we're supposed to do, is to help people who are suffering, and we were just turning them down. And so we realized that, well, maybe we can help the families, if nothing else, to reduce the impact for the mental illness of their family member on their lives. And so we started sharing ideas and researching the literature. Found that there was very little directly about this topic. There were lots of things to draw upon, which is what we did, and we also learned a lot from our colleagues in the substance use area, who are very used to people not wanting help and denying that they have a problem. So we took some things from them. I'm happy to say that I've never had the original idea in my life. I I just steal from everybody else, and the only original contribution, perhaps, is how we package it, put it together into a comprehensive, holistic approach. And that's nice, but, but really, we were fortunate that there were theories and interventions that we could draw upon to put together this, what we call the Family Well Being approach, or Family Well Being consultation, if it's provided by a therapist. But the book really was designed for some families, at least, to be able to do this on their own and to learn how to deal with a loved one who will not seek treatment, something we call recovery avoidance, and we can talk more about that, if that would be of interest. Well, I,

  KC Davis 4:09

  my own background is in addiction. I was a therapist in various addiction centers, and then ended up at the end of my code of addiction career working with families, and so I'm a little bit familiar with, at least the conundrum of, you know, when families are so desperate for help. And the way this book is laid out, it's, it very much is laid out. In my mind, being a practitioner, it looks like, Oh, this is someone who has had the same conversation with person after person after person after person, and after person, and then finally, kind of realized, wait a second, there's kind of a pattern here. This could kind of be systematized and given out, you know, at mass to people, because I'm really kind of saying the same things. There's kind of the same principles that I'm repeating, yes, and I find that when I used to work with people that wanted to get their person. Into, like, a drug rehab. There was kind of, like two polar opposites. You kind of had the people that were like, I think the word we would use was, like, enabling. Like, there's this idea that, well, if I just make sure that this person doesn't experience any distress, then you know, I'll get them to stop using drugs. And then on the other side of that, we had the families that were like, you know, if I make their life hard enough, if I punish them enough, if I control them enough, you know, if I if I bring enough consequences, and if I make them hit rock bottom. And I'm curious if that's been your experience, sort of generalized out to other mental health issues, because it seems like you address both of those things in the book

  Dr. Alec Pollard 5:42

  we do that's very, very good observation on your part. And so we came from the field. When we first started doing this work, it was largely with families of people suffering from OCD. And then we started to realize, well, in fact, when we first started the book, it was going to be about OCD families, and then we realized, Now, wait a minute, we've been doing this with the families of socially anxious folks, agophobics, depressed. Why are we just focusing on that so? But the reason I mentioned the OCD focus early on was in the OCD literature, there's something called accommodating, and it's very similar to enabling, and it's the concept gets has the ability to sort of be fine tuned and nuanced in our book, so that we have different types of accommodating and things like that, which are not as critical for our conversation, but it basically is the concept of enabling, and which we call accommodating. And then there's two kinds of accommodations that we're concerned about for family members. One is accommodations of commission. Those are the things people usually think about with enabling or the term accommodating, the things we do for someone that we wouldn't normally do for anyone else if they didn't have who was not disabled in some way, and those are accommodations of commission. But we also learned that something that doesn't get talked about as much as accommodations of omission, those are the things we give up in life for those people because we're accommodating, we're committing those accommodations and the social life the you know, sometimes even more extreme, you have to quit your job and realize we didn't address that early on, when we were Developing this approach, and we started to realize this is something that we're omitting that should be in there, and because we really emphasize a lot with the families the importance of cutting back on those accommodations of omission to start to bring back into their life the things that bring them, that they value the bring them meaning joy, pleasure, because, and this is, again, not a unique idea to us, is that if you, if we go, think about the flight attendant who always tells you when the oxygen mask comes down, put it on yourself first before you Try to help your children or others that you're with, and that's such a great metaphor for our whole approach, which is we're not going to even talk about how to get that family member in treatment until you've taken care of yourself, both because you need to be a model for that person, instead of telling them what to do, why don't you do it and take care of your life, your own well being. And secondly, very pragmatically, when you are stressed, when your well being is not taken care of, you are not very good at dealing with the challenge of what we call recovery avoidance and and that's the pattern. It might be helpful at some point for me to kind of define that term a little bit, but,

  KC Davis 9:12

  yeah, I want to get into what recovery avoidance is, but I only want to ask a little more follow up question about this term accommodating, because I'm interested in that term, as opposed to enabling. And I think I like it, but accommodating is also the term that we use when we're talking about, you know, okay, somebody who needs accommodations at school, someone so I'm interested in that being the word. How do you help families understand maybe the difference between, like, an appropriate accommodation for someone's disability or their mental health versus an inappropriate or a kind of accommodation that's not helpful or maybe is sort of like an over functioning on the family's part? Yeah,

  Dr. Alec Pollard 9:55

  that's a great question, and you're right, and we go into some length about. Talking about accommodating as a general term, is a good thing. You know, it's good service at a restaurant. It's, you know, when you accommodate people. And not only do we talk about it in that way, we also use that point to try to destigmatize or unshame people from thinking that somehow there they goofed up because they wanted to accommodate somebody. Their intentions were absolutely positive and good, and in most cases, accommodating is a good thing. The problem is that they don't, and they can't possibly realize this at the time is when you start accommodating a recovery avoider. That's when it's bad. So there is no general strategy that's good or bad in life. Generally, usually okay. I think shooting is bad thing. Don't shoot people, but. But even then, if somebody's attacking your family, you might have to so it's understanding the nuance of when to do something and when not to do it. I use the example of a loaning money to a friend. So it really depends on who that friend is, whether that's a good idea or a really dumb idea. And sometimes you don't know your friend well enough until it's half it's too late, but you that friend who needs that extra money to get through the last last year of college, and they get they graduate, they get a job, they put themselves on a payment plan, they pay you back every month. That ended up being a really good thing. You feel better about yourself. They get through college, it's a win, win. But that friend who maybe isn't so responsible or doesn't have the right attitude about it maybe doesn't pay you back, and then you start calling them, going, Hey, where's the money? And then tension builds, and this is just what happens in families, and then it starts to deteriorate into that conflictual

  KC Davis 12:04

  Well, it's an interesting distinction, you know, accommodating the mental illness versus accommodating the recovery avoidant behavior, yes, which I think is interesting and important, right? Because we're not just talking about, in general, a loved one with mental health. We're specifically talking about a loved one with mental health issues that is not taking the steps towards seeking any treatment, or not taking the opportunities, or not accepting the help, or not really where, where we find ourselves working harder than they are, on a consistent basis on their mental health, right? Exactly. So that's a that's an interesting distinction.

  Dr. Alec Pollard 12:45

  Yeah, no, that's exactly it. And also, you know, it's just in life in general, even without any concepts of accommodating and all the things we all know about, just as you approach life, it's a human challenge to learn and know when to change what you're doing. And you know, well, we all know that. Suppose a quote from Einstein about the definition of insanity is keep doing the same thing, but expecting a different outcome. I'm not sure he said that, but, but he gets credit all the time, but for that. So it's knowing, okay, I don't know anything about accommodating or whatever, but something's not working here. And human beings, God, love us, we sometimes get stuck in things, because, unlike computers, it's not input in analyzed and input, I mean an output. It's we filter things through what we hope and wish for, and so when we get information, we don't always use that information to change our expectations and our tactics. We just keep doing the same thing over and over again we get that's

  KC Davis 13:58

  what we always used to say in in rehab was we would tell families, you know, they'd say, Well, you know, is it right to give them money? Is it wrong to sign them up for therapy without their and we'd always say, it's not about right and wrong or good and bad. It's about what works and what doesn't work. Because if we find ourselves kind of doing these same things, these same accommodations, over and over, and that person is not helping it's not helping them. They're not getting better. They're not, you know, wanting to seek out treatment. So tell me, let's go to that point about what does it mean to be recovery avoidant, and what does that kind of cycle look like?

  Dr. Alec Pollard 14:32

  Well, we think we felt that we needed a term for this to study it, we needed to label it, to give it a term that we could begin to talk about it with, and recovery avoidance was the term that we picked. There's a and recovery avoidance we define as a pattern. First of all, it has to be a pattern. It can't be once or twice something happens, but a real pattern of behavior that is inconsistent with the process. US of recovery from whatever the problem is. And we're very adamant about emphasizing that this does not describe intentionality. No person wants to not recover to wants to be impaired. It is not no decision is made consciously. I'm going to be an impaired individual, and that is part of why the thing you were talking about the people who are maybe more conflictual in their dealings with a person with a mental illness, we call that minimizing. And again, I'll say why we did which is that it trivializes the forces that drive recovery avoidance, that make people act in ways that are inconsistent with their own welfare, and by sort of suggesting that if I lecture you one more time, you'll snap out of this, and in fact, they're not capable of snapping out of it, and certainly not on command. So So So what happens is that that the minimum we talk about two ways that families interact with recovery avoidance. One is the accommodating, and then the other one is the lectures, the nagging, the prodding, the shaming, the shaming, the guilting, the on and on and on, all the uglier sides of being human and and we try to help people not feel so ashamed of that when they look at themselves. We try as much as we can to help people feel that this is all just natural ways of reacting to very challenging situations for which none of us is prepared. Well,

  KC Davis 16:44

  a lot of people I know, at least me, I mean, most of us, I think, vacillate right. We maybe are trying the accommodating, and then it, you know, we kind of blow up and get frustrated and swing to this other side, and then we feel guilty about being so harsh, and then we come back over here, and we just kind of swing back and forth, and neither side is really working, and we're we're not really even reacting to the person we're trying to help. We're just reacting to our own internal frustrations and fears.

  Dr. Alec Pollard 17:13

  Yes, absolutely, and we would not say that you're either Accommodator or a minimizer. Everybody is both. Now some people might do more of one than the other and and that's certainly true, because we see that. But to really understand what we call the family trap, you have to understand both dynamics, the because both minimizing and accommodating. Not only do they not when we say not work, we're talking about more than not working. We're talking about actually making things worse. So we have to understand that these both accommodating and minimizing, are toxic in that they it's not just that they're ineffective. We would say at best, they're ineffective, but most of the time, they actually contribute to this trap that the whole family is in. So the more that the individual avoids recovery, the more the family accommodates, the fewer opportunities the individual has to engage in recovery behavior, and their motivation to do so goes down because they're protected from the consequences of their own disorder, which is what drives us to go to go see the doctor. For the most part, people don't go to a doctor to be a better person. Okay, maybe in some parts of California. But other than that, don't do that. And I can say that because I lived in California for four years at least. So, any rate so, and then the other part of this, and I don't have, you know, we don't have visuals here, my diagram, that's in the book. But so you have that circle of interaction, more recovery avoidance, more accommodating, fewer opportunities and and incentives to actually work on recovery. And that cycle, then you have this other loop where, because you're accommodating, you are burdened by the extra responsibilities that jeopardizes your well being, which means you're going to be cranky, irritable or anxious and afraid. None of those things help you deal effectively with recovery avoidance. So when you start the lecturing and whatever, the recovery avoider now feels number one, more afraid because you don't get it. You don't understand how hard this is. So they're distrustful of the family because they don't feel that they get it. They're more anxious, more defensive, dig their heels in, which reinforces recovery avoidance. So that's the whole thing we call the family trap. And everybody's stuck in it. They don't know how to get out. And so all right, of course, I'm going to say that our book is the way out. I'd like to think at least for some it will be you. But it's easy to see how just normal human beings can get stuck in that cycle.

  KC Davis 20:11

  I like the term opportunity. It's funny, you know, I actually just turned in the final manuscript for my book. It's about relationships and how to make decisions in relationships, and it actually pairs nicely with a lot of things that you're talking about, because it deals with, you know, what do you do when you're in a relationship with someone that maybe has some mental health difficulties, and you feel stuck between the compassion of, well, I understand where they're coming from and the reality of, okay, but this is really hurtful. And you know, what do I do and what are my obligations? And one of the things that I that I talked about is this idea of opportunities where you can't control whether someone gets better or not, whether they're willing to, or whether they're able to, or some mix of it, but we, we can look at whether or not our behavior is robbing that person of the opportunities to get better. Yes, and you know, we, all we can do is create those opportunities, not get in the way of the opportunities that would be there and be healthy enough to be the kind of support system that a person would need when they are able and willing to take those opportunities. Yes,

  Dr. Alec Pollard 21:17

  absolutely. And we would say, probably there is one more thing you can do besides creating the opportunities. You can create incentives for it. You can actually incentivize people to take advantage of those opportunities, but, and big but, well, that didn't sound right, you know what I meant? So you we don't even talk about that, that's the last step in our five step approach, because we you won't do it well if you haven't taken care of yourself first and reduced the conflict in the family. Yeah,

  KC Davis 21:55

  I was going to ask, how do you help somebody distinguish between creating incentive in a healthy, appropriate way, versus the kind of controlling, you know, oh, I'll just bribe them, right? I'll bribe them, or I'll threaten them, or I'll make these ultimatums, you know, because I can see someone engaging in those behaviors thinking, Oh, I'm creating incentive. I'm telling them I won't pay for college if they don't go to therapy. Or I'm telling them I'm going to get a divorce, if they won't, you know, take the medication?

  Dr. Alec Pollard 22:24

  Yes? Well, that the answer to that could take up the rest of our talk so, but I'm going to try to bullet point it here a little bit. Alright, so you won't be upset with me, Casey. So there's a couple of things that that distinguish sort of what we would call productive use of incentives and incentivizing versus what families often tend to do people violate. So in step five, by the way we talk about that very issue, like, well, what's the difference now you're you told us for the first four steps, we should take care of ourselves, and now you're turning us back to trying to influence the recovery avoider. And the answer is, yes, we are, but it's some fundamental differences. First of all, if you've done it right, your household is no longer filled with conflict. Not saying that the recovery avoider is cured or better, even just saying there's less conflict. So for a while you're gonna All right, so he sleeps till noon. So what? Leave him alone. You go play golf, whatever. I know I'm oversimplifying it, but it's basically stop creating unnecessary conflicts. Save your battles for if they're standing in front if they're in their room doing rituals and it bothers you. Well, you got to learn to let go of that. If they're standing in front of the television doing the rituals and you can't see it, that's different. That's what you have to focus on the things that directly interfere with your life, and then you try to let go of the other stuff. And so the whole goal of Step four is to dismantle those arguments, those contentious things, and focus on yourself more and treating both you and the recovery avoider better. So before you even get to trying to influence them directly. You are trying to get rid and you know, we have a quote before each step, you know, like some kind of defining quote. And the defining quote of step four is, if you can't do anything good, first, do no harm. That was Kurt Vonnegut quote. And so we're saying, let's stop doing harm, which means let's stop the arguments and the conflicts that are unnecessary right now and get the environment better between you and the recovery voider. That is a huge difference, because when you're mad at each other, you can't do any healthy and. Incentivizing. It's, you know, and so, so that's one big difference. The other big difference is that we focus on incentives that are immediate. So when people say, Oh, I'll pay for college if you do this, well, that's too far off, because you have to understand that the reason that people behave in ways that are sort of self defeating are not because of long term things. It's because of the immediate influences on their behavior, mostly the avoidance of something bad or the pursuit of something good. We really are not that complicated at that level, right? So I'm either going to get a high if I smoke this and or if I do this compulsion, I won't feel so bad. And so the incentives have to be more up closer in time to really be so if we just use the example of homework, that's not the big issue for everybody, but let's just pretend, instead of saying, Johnny, I'll get you a new car. Like, take the huge incentive, like, I'll get you a Mercedes Benz. Now, most of us couldn't even think about using that as an incentive, but if at the end of the semester you have straight A's, okay, well, first of all, that's pretty high straight A's. It's all or nothing. So that's a bad incentive, and it's way off better to say when you've done your homework tonight, you will earn screen time tonight based on that you got your homework done on whatever contingency, however you set it up. But that's going to be much more powerful than delayed, and because you're battling against immediate incentives that are keeping people impaired. So any rate, there are nuances to it. We go through the definition of good incentives and bad ones and healthy and most importantly, we focus almost exclusively, with some exceptions, on positive rewards, rather than because often what families have gotten themselves into is threats and negative trying to influence things through negative consequences, whether it's just yelling, arguing, threatening to kick them out, which that's an in a lot of times, the concept of tough love. One version of it is, you know, the idea that you're kicking them out of the house and tell you get treatment, you can't live here, and all that kind of stuff. And that all sounds good, and sometimes people can do that successfully. But the problem is most families can't follow through with that, and so what they've done when they kick them out of the house and then they let them back in after the first call from a homeless shelter, they've now done more harm because they've lost their credibility. So we emphasize for families do lesser things, but make sure you're ready to do them and don't do them out of impulse. Plan them all that's in the book talking about how to plan your interventions, do things that you'll follow through with, because it's about building credibility in part over time, so that when that family member hears you say, starting in June, I will no longer, or I will start blah, blah, blah, whatever it is, and they believe it. And so you reduce testing you, yeah, and that you start to get credibility, right? So that's another thing that we emphasize a lot, is don't be so ambitious. Start easy and make sure you can follow through with it, because that's going to build on your ability to be effective with that person down the road.

  KC Davis 28:55

  Well, we're running up out of time here, but I just wanted to say that the book is chocked full of really, really practical things. And I like the balance between long term planning and like crisis management. Like, what do I do right now when this thing's in front of me, speaking of in front of me, I think I have a child about to run in here. That's life. It's okay. And I do, I do, honestly, really like the book. It does seem to mirror a lot of the lessons that I learned, you know, just in working with people in addiction, which I, you know, is my stamp of approval there. And so again, for everybody, it's when a loved one won't seek mental health treatment, how to promote recovery and reclaim your family's well being. And so I really encourage everyone to check that out. Do you have any last kind of things that you want to say about the book? What is the thing you're most proud of in

  Dr. Alec Pollard 29:48

  the book? Well, I will say, I think this is the thing in my career, which is, I've already admitted has been rather long. I think it's the thing I've done a lot of things, and I. I won't go on about it, but just I've done a lot of things I think I'm proud of in my career, but I think this is the one that I'm the most proud and mostly because I think we've started to create thinking about and again, other people have, you know, set the tone for us, and we used their information to go a step further, but I hope that we've opened up the door for a whole group of people that otherwise were ignored and neglected, and not the recovery avoiders, although them too, they will benefit, but these family members that so many of us have been ignoring for years, They're suffering, and I'm hoping that we can do some good there.

  KC Davis 30:43

  Well, it's a great book, and I'm going to be recommending it to people, for sure. I'm actually going to send it to some of my therapist friends that still run rehabs, because I think you're right. It's not that, it's, you know, you know, I know. You're very you're humble and saying, oh, you know, we're really building upon, you know, work that's been out there, but this is such an excellent synthesis of all of that wisdom, and I appreciate the way that you laid it out. I mean, my whole thing is kind of talking about moral neutrality, where, you know, we don't want to shame you for what you've been struggling with, and not put these moral labels on it. And I think that's something that the book does well. It's not good bad, right or wrong, it just is. It's just human, understandable, human reactions, and some of them work, and some of them don't. And let's get you on the right path. And so Alec, I want to thank you again for your time and for the all the effort that you guys put into this book.

  Dr. Alec Pollard 31:34

  Thanks so much. It's been my pleasure. You

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