You know that your friend or family member is depressed, but they seem so stuck in their own world that it’s hard to figure out how to reach them. You wish there were something more you could do. Perhaps you have already gently suggested to them that therapy could help but have been met by a resounding “No!” Not surprisingly, I’m going to recommend that you listen carefully to that “no” in order to discover the best way to respond.
(This article assumes that the person you’re concerned about is not in suicidal crisis. If they are in crisis and danger is imminent, a different and very proactive approach is required. Please call 911 or take them to your local emergency room immediately.)
There is some guidance that I’ve found elsewhere that I think is particularly helpful here. It’s in a book by Jean Illsley Clarke and Connie Dawson called Growing Up Again: Parenting Ourselves, Parenting Our Children, (Hazelden, 2nd edition, 1998). In it, the authors include a section on “Denial: The Glue That Keeps Us Stuck.” They identify four types of denial, or “levels of discounting” as they call it, that people engage in as they refuse, consciously or otherwise, to consider change. I’m going to present these four levels here so that you can become more empowered to help the people close to you.
Clarke and Dawson’s four levels of discounting (described on pages 154-155) are:
1. NO PROBLEM – The Discounter doesn’t believe there is a problem.
2. NOT SERIOUS – The Discounter accepts that the problem exists but ignores it, seeing it as having little impact.
3. NO SOLUTION – The Discounter accepts that the problem exists and is serious but believes no solution exists for it whatsoever.
4. NO PERSONAL POWER – The Discounter accepts the problem exists, is serious, and has possible solutions, but believes he or she has no power to solve it or help solve it.
The purpose of identifying these different Discounters is to be able to fashion a response tailored to each one of them, increasing the chance that they’ll move out of denial and into taking a chance on change, or a chance on beginning therapy.
The No Problem Discounter: While this person’s lack of enthusiasm for life, their lack of self-care, their difficulty in meeting daily responsibilities, or other symptoms alert you to their depression, they themselves simply don’t believe they’re depressed. You may feel your own frustration mounting as they claim “Nothing’s the matter,” – but you know you need to curb that frustration because wagging your finger at them will only make matters worse. Instead, take a step back and recall what made them special to you, what made you smile when they were their former selves – full of life, with a ready laugh, willing to participate and face what came their way. Gently share these memories of them, perhaps photographs of the good times as well, and tell them how much you miss them. Help them sense the distance between who they were before they became depressed and where they are now. Introduce the idea that their depression is a real problem and that it’s okay to acknowledge it. Other ideas about what to say may occur to you as well. Say what feels appropriate to you, in bite-sized portions, and watch what feels heartwarming to them. Don’t expect a change in their position in one fell swoop; rather, you’re “planting seeds” in their mind that you recall how they used to be and you can envision them well again.
The Not Serious Discounter: While listening carefully to this sort of Discounter, you realize they’re saying “Sure, there’s a problem – I’m a little depressed, but it’s no big deal.” You have a couple of different options for responding. One option is to explore with them “how big a deal” it is for them and compare it, gently again, to “how big a deal” it is for you. For example, they may view their unintended weight loss as not very significant while you think their 12-pound loss in two months does really matter. They may view their frequent absences from work as not problematic, but you are increasingly concerned that their boss will arrive at a different opinion. They may think that missing their kid’s soccer game once again isn’t a problem, while you sense that their child is frequently experiencing disappointment. Try to discuss these matters thoughtfully without descending into a power struggle or making yourself right and them wrong. Your goal is to bring these issues to their attention in a warm and matter-of-fact way so they will continue to ponder these issues after your conversation has finished.
An alternative approach to folks who discount problems by viewing them as “not serious” is to inquire about how bad things would have to get in order for them to decide that it’s time to ask for help. Perhaps they’d say, “I’d have to lose 18 pounds before I’d take this weight loss to be a real problem.” Or, “If my boss mentions my absences in my next performance review, I’ll know this is serious.” Or, “I’ll ask my partner if they think our kid is suffering.” Using this approach, you provide some benchmarks for them to consider.
The No Solution Discounter: You’ve heard this Discounter say, “Sure there’s a problem, and it’s bad, but nothing can be done about it! It is what it is.” Or you might hear a version of “Yeah, I’m really depressed but this whole society is sick. Until society changes, there’s nothing I can do.” It may be time to point to the fact that depression is a treatable problem. Take into account what you know about them to see if (1) they’ll be more receptive to research findings, (2) they’ll be better moved by personal anecdotes of who you and they know who have been helped by therapy (without breaking any confidences), or (3) some combination of both these approaches. Follow up with them in a later conversation to see what they’ve absorbed.
The No Power Discounter: “Sure, it’s a serious problem and I know there are solutions available, but I just don’t know what to do,” is what you hear from this type of Discounter. Providing them with specific information regarding resources may work best here. Give them a menu of possibilities so that they can decide which feels best to try first. Don’t just throw this list at them; be there to discuss the pros and cons of each:
• A good self-help book about depression
• a support group to join
• information about low-cost agencies
• speaking with their physician
• finding an experienced therapist in their community
Knowing the resources available to them will allow them to determine their next best step. Given their lack of energy due to depression, they may still ask for your actual help in getting there, which is fine.
Hopefully, this discussion of the four levels of discounting has opened up some possibilities for you as you consider how to approach the person you’re concerned about. If something doesn’t quite fit, use the “Four Levels of Discounters” as a platform for brainstorming ideas of your own. Additionally, don’t expect your friend or family member to immediately respond “Yes, I’ll change!” at the end of your conversation. It’s very reasonable that they take time to mull over what you’ve discussed in order to arrive at new conclusions.
You have probably realized by now that these four levels form a progression from “no problem at all” to “I don’t know what to do.” The person you’re speaking to might pass through all four stages, or more likely, pass through at least two – ending with “I don’t know what to do.” This is the stage where they can move into empowerment and take realistic steps to improve their situation.
Throughout all these conversations, the quality of your caring may be the most important thing that matters. Depressed individuals might remember few details of what you say but instead absorb the idea that you care about them and that they’re worth it… they’re worth getting better. Renewed hope and the possibility of reconnection may ultimately be what guide them into asking for help for themselves and entering therapy.
I trust that this discussion about helping others has been beneficial to you. Of course, if you’ve read this article because you actually had yourself in mind as the person you most want to help – beautiful! Just make sure you speak with yourself as kindly as you would with your very best friend.
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Janet Niederman, Ph.D. is a Los Angeles psychologist in private practice. She’s worked with clients with a variety of issues for thirty-five years and has provided clinical supervision to doctoral-level psychology interns as well. She specializes in treating anxiety, depression, and ADHD.
