A Helping Hand

July 15th, 2010 by Jay Dixit

One writer learns the best ways to reach out to a friend in psychological need.

Brought to you by Liberty Mutual's
The Responsibility Project

Dave was the guy who rescued me from fourth-grade social oblivion, adopting me when I was shy and friendless and bringing me into his social circle. At the time, Dave was a popular kid in striped Benetton shirts, with a knack for getting picked in touch football. He helped me buy Levi's red tab jeans, showed me how to mousse my hair, and introduced me to his friends. Soon we were inseparable.

But in high school, after his parents divorced, Dave started to change. He grew his hair long, stopped eating meat, and started talking like a stoned-out surfer even though he’d never tried drugs. At the time, I thought it was an affectation—that Dave was cultivating this rebel, caveman persona as a countercultural pose and a way to attract girls. But ten years out of college, he’d retreated further into himself. He worked as a bike courier and lived in his mom’s basement. When I’d come into town and brought him out with our friends, he was timid and quiet, seeming to cower in the corners. He flinched easily, and his voice was submissive. Yet it didn’t occur to me to do anything until a friend’s wife brought it up. “Dave needs professional help,” she said.

At first I resisted; who was I to question the lifestyle he’d chosen for himself? But the more I thought about it, the more I saw she was right. As Dave’s best friend, the duty to say something fell to me.

What is your responsibility to a friend when your friend doesn’t seem to want your help? How do you balance a respect for someone’s autonomy with a genuine instinct to intervene when someone seems to be harming himself?

“As a friend, you have to at least try to talk to him about what you see as the problem,” says Javier Garcia, an emergency room psychiatrist at Staten Island Hospital. But the first step is to examine your own motives. It’s essential to act out of concern for your friend’s welfare, not because you want him to conform to your values, and to bring your own feelings of fear, embarrassment, or anger under control, says J. Ryan Fuller, a cognitive behavioral therapist in private practice in Manhattan. “You don't want to let these emotions shade your judgment.”

Therapy is a delicate topic; suggesting it can make a person feel criticized. When Tuan Nguyen, a science journalist, accidentally read a troubling note on a friend’s computer, Nguyen told her he thought she needed therapy. “She became very defensive,” says Nguyen. “She felt I was casting her as sick, emotionally weak, and not well enough to solve her own problems.”

When you do raise the topic, it’s important to express two things: that you respect your friend as a person, and that you have her best interests in mind. Otherwise, says Garcia, “the person will get defensive and the conversation will become about something else.” Some people will openly welcome your guidance. When a friend’s marriage fell apart, Simone Levine, a lawyer in Albany, N.Y., realized she needed to take action. “She was clearly in so much pain,” says Levine. “She was grasping at straws.” Levine gently suggested therapy, explaining how much it had helped her in her own life. The friend accepted the advice—and credits the therapist for getting her through her depression.

But even if you do everything right, you may find your advice brushed aside. Engineer James Luria noticed that after a friend saved the life of a woman who had tried to kill herself, the friend began showing signs of post-traumatic stress. “You may not have any interest in hearing this from me,” Luria told his friend. “But I’ve been thinking about this and I care about you.” He suggested therapy and offered to provide the name of a counselor. Despite Luria’s best efforts, the friend didn’t take the advice. “He said what he thought he needed to say to make me feel better,” says Luria, “knowing he wasn’t going to actually do anything about it.”

When a friend is ambivalent about receiving advice, a technique called motivation interviewing can be helpful, suggests Fuller. Ask nonjudgmental questions that expose faulty logic or highlight the need for action without imposing your own value system onto your friend’s world. Originally developed for addicts, the technique is designed to elicit behavioral change without creating an adversarial dynamic. “You’re trying to walk that fine line between being constructive and cornering the person,” explains Fuller. The goal is to build tension. “‘It sounds like you don’t enjoy where you’re working right now,’” you might say. “‘What steps are you taking to address that?’”

If motivational interviewing doesn’t work, you may need to try a more direct, assertive approach, says Fuller, particularly since a lack of motivation to seek help is itself a symptom of depression. “‘Maybe you don’t feel sad,’” you might say. “‘But I always imagined you’d be dating a little more, pursuing other career paths. I’m concerned there may be something that could fulfill you more, but you just haven’t taken the time to examine your feelings and values to see.’”

Even if you can’t guide a friend into therapy, you can still help pull her out of depression by guiding her toward social support, exercise, and what psychologists call behavioral activation: getting her and out and engaged in pleasurable activities that build her confidence.

After several failed attempts, I finally worked up the courage to say something to Dave. “I hope you don’t feel like I’m judging you,” I began. “And if you reject what I say, I’ll still love you. But I think you could be so much happier.” And with that I told him what I saw: that he lacked motivation; that he was socially isolated; that he didn’t seem to pursue what he wanted; that I thought he was depressed and could benefit from seeing a professional. I asked him to consider just a few sessions—if he didn’t like it, what did he have to lose?

Dave listened carefully. “Thank you,” he said finally. He thanked me for my concern and said he’d think about it. When I followed up a couple months later, he assured me he was fine, that I needn’t worry, that he wasn’t unhappy and didn’t need therapy. In truth I felt disappointed; I’d hoped that my reasonable perspective and good intentions would be just the push he needed to reevaluate his life and embark on a new path. I wish I could have helped him more. But my job now is to accept Dave as he is, to respect his choices, and remind myself that I’d done what I could to try to help. And that’s the final lesson: As a friend, there’s only so much you can do. “After that,” says Fuller, “all you can do is to support your friend.”

Jay Dixit is writer in Brooklyn. He’s currently working on a book about the psychology of modern love.