Medical News
When [and how] to refer a friend to a mental health professional
By Susan West
Mar 18, 2010 - 11:07:56 AM

Psychologist Susan West tackled this delicate and meaningful mental health question, posed by one of our readers: "If I believe that a valued friend’s behavior seems to suggest the need for help from a mental health professional, how should I proceed?"

It can be particularly challenging to see a friend struggling. Your question raises a great dilemma; how to approach someone you care about and suggest that they need professional help. Usually there are two scenarios that are going on 1) you are concerned and your friend is not talking about an issue or 2) your friend is talking to you at length about an issue and you do not feel equipped to handle the situation. Either way, you are going to need to confront your friend. Now many people have negative connotations associated with the word confrontation, with good reason. Yet, when a confrontation is done respectfully and with love, it can be a wonderful way to express concern in a non-judgmental manner.

Why do many of us dread confrontations? Usually it is related to fear. Think back to good old sixth grade science class and the lesson on "fight or flight." Animals when stressed, use their basic instincts, get aggressive and attack or become passive and flee. This is a great survival skill. As humans we still use fight or flight. Fleeing can get us out of a fearful situation yet it does not resolve the issue. That is where assertive confrontation comes in. We need to be able to address our concerns in a safe and respectful manner.

So how do you assertively suggest to your friend that she might benefit from seeing a mental health professional? Consider these key points to consider when approaching your friend:

Find a "neutral" time to talk. How and when you approach someone is important. It’s best to talk about your concerns when you are not in a heated discussion or frustrated with the person or you feel that they are frustrated with you.

Express concern. Tell your friend how worried you are about the changes that you have noticed. You might ask her if she is okay or if there is something that she might like to talk about. Be prepared that you might get the answer, "I’m fine" or "oh, I can just talk to you about it." Either way you need to re-iterate your concerns.

Provide specific support for your concern. This is key; especially when you are met with resistance. Provide specific examples, "Oh, I guess that I was worried that you might be sad or blue because you have missed our last two play dates," or "I was feeling concerned because the last two nights we have been out you drank five drinks."

Don’t use labels or make judgments. It is crucial that you make sure that you express support for your concern without being judgmental while sticking to the facts.

For example, if you approach your friend and say, "You have been really angry lately and flaking out on our play dates" or "You are so drunk all the time I think you need help," then you probably are going to be met with a great deal of defensiveness (and anger). Use your words wisely. "I feel worried that you are struggling with depression because you have been skipping play dates, not returning phone calls, and seem sad."

Talk about how psychotherapy can help. Psychotherapy allows people to have a licensed professional who can be an objective listener who can prescribe behavioral interventions to help reduce their distress and/or symptoms.

Express your support while acknowledging your boundaries/limits. Social support and friendship are critical to our happiness. Unfortunately, because of our friendships we cannot be objective. Remind your friend you care and will still like to listen or help; yet acknowledge your limitations e.g., "I am happy to help you or listen yet I do not know how to help you feel less depressed or how to stop abusing alcohol, etc."

Offer referrals. Have some recommendations or referral options available for your friend. Having these on hand will make taking the step toward psychotherapy much easier. Individuals often will follow through on a referral if it is someone recommended to them, or they know something about the provider. Psychotherapy is a relationship and finding the correct provider is key.

About the writer: Dr. Susan West has been practicing on Daniel Island since 2005. She has a special interest in providing psychological services tailored to meet needs of individual, families, and couples. Dr. West can be reached at 843-278-5402.