And What About the Family?

In all these articles I talk to you about clients. Sometimes more directly than others, but in the end it’s always about them. They’re the main characters in therapy, and so, in many cases and without realising it, we leave the family in the background… or further back still… or nowhere at all. The client is the one who suffers most and the one who comes asking for help, but in quite a few cases the family suffers almost as much as the client.

It’s important to make clear to family members that taking part in therapy, getting involved and following the therapist’s guidance is one thing, and carrying the responsibility for the client’s recovery is something very different. The responsibility rests on the client’s shoulders, not the family’s. Family members help and support. The client acts and moves forward. I always stress to families that their support matters and that we all need to pull in the same direction, but that we (the family and I) only have so much power, and however hard we try, if the client doesn’t want to change, we can’t make it happen.

Quite often one of the relatives (there’s usually one who’s more involved than the rest) says to me: “I just don’t know what else to do to make them change”, and my answer is usually much the same every time: you’re looking at it the wrong way; you’re not the one who has the power to make them change. They’re the one who has to take the bull by the horns. You’re already doing everything you can.

Sometimes a relative calls you simply to unburden themselves to someone objective who understands the situation, and to share feelings that many people might consider socially “unacceptable”, which is why they don’t share them with friends or people close to them. Sometimes relatives cry in front of you out of sheer desperation. Sometimes they shout, not because they’re angry with you but because they’re angry with the situation, with life. Sometimes relatives tell you about outlandish options they’ve considered simply because they don’t know much about the subject, and you can use the opportunity to steer them with what you know, so that they don’t fall into hands or options that, at best, will just leave their bank balance in freefall. Sometimes relatives ask you to lie. This is something I find particularly hard to accept, because I’m someone who needs to express herself very freely, and lies force you to watch what you say. And they tend to cause problems. They’re always white lies, lies that in a way justify the end. Well-meant lies, always with the client’s interests at heart. There are always cases and cases, there are always exceptions, but as a general rule I don’t think it’s advisable, for ethical reasons.

When you see worried relatives who are keen to get involved, and as long as the client (if an adult) agrees to that involvement, the very first step in therapy is psychoeducation about the problem being treated. Knowledge is fundamental. Clear, concise ideas in language adapted to the person sitting in front of you: what their son, brother or partner has, how it develops, how it’s treated, how they can help, what they shouldn’t do and why, because what they’ve been doing until now and thought was right isn’t… These are some of the basics. Let them ask their questions, even if they think they’re silly: let them ask.

In some cases relatives ask for sessions for themselves, so that they can let off steam with more than a phone call and learn to cope better with the situation at home, not for the client’s sake but for their own. This happens in only a minority of cases, but it’s a good idea if it can be done.

In any case, the message I want to get across with this article is a reminder to us all of the self-sacrificing role families play. In the shadows, making little noise, but always there, holding the fort.