26 May What if My Partner is Resistant to Getting Professional Help: Defining Your Botton-Line Position and Utilizing Leverage

Posted at 11:07 am in Couples Therapy, Individual Therapy by jlbworks

Person in bed needing individual psychotherapy

What if My Partner is Resistant to Getting Professional Help:

Defining Your Botton-Line Position and Utilizing Leverage

By Philip Chanin, Ed.D, ABPP, CGP

Board Certified Clinical Psychologist

Assistant Clinical Professor, Department of Psychiatry

Vanderbilt University Medical Center



“If you or your partner is struggling with an issue such as depression, anxiety, phobias, or obsessive-compulsive disorder, you owe it to yourself and your family to get—or insist that your partner get—help. There is simply no way your relationship is going to get healthier when one of you is in a state of emotional distress…Neglecting to get treatment is your individual choice if you live alone, but once you elect to create a family, getting help is no longer a decision that impacts only your life. It is your responsibility to be the best spouse and parent you can be.” (Real, Terrence. The New Rules of Marriage, p. 95)

Frequently in my practice I am talking to patients who are in distress in part because they have a spouse or parent or adult child who needs psychotherapy but is resistant to getting help. We talk in our sessions about what options a person has when a family member continues to resist seeking out help. Terrence Real has written eloquently about why getting professional help is so crucial for anyone in emotional distress who has a partner and/or a family.

Real writes, “If you are the one who has been reluctant to get help, understand that your unwillingness inflicts unnecessary suffering on those around you. And if you are the partner of such a person, you should know that a spouse or parent in disrepair affects everyone in the family. You have an absolute right, even an obligation, to insist on health in your family.”

Real addresses the fears that patients often have about addressing this issue with their spouse or partner: “Some people hesitate to confront their mate’s emotional difficulties for fear that it will ‘set off’ the person and ‘make things worse.’ That might be true in the short run, but I don’t think you have much choice. It is rare for these conditions to get better all on their own, and in many cases, they only grown worse…It is far better for your children to see healthy argument as part of dealing with a tough issue than for them to watch an adult operate as an emotional drag on the whole family.”

Real urges any patient in this position to take any steps necessary to get their partner into treatment: “…my advice is to put principle aside and do whatever it takes to get your partner in front of a mental health professional. Even if you need to make the calls, screen the potential therapists, and make the initial appointment, I suggest you do it…Even if your partner steadfastly refuses to see a therapist individually, that need not deter you. In such cases, you can go ahead and book an appointment for couple’s therapy.” (pp. 95-96)

Many patients struggle with the issue of how to get across to their partners how important it is to seek professional help. Often there have been discussions or even arguments about this issue, without any movement on the distressed partner’s part to reach out for help. Dr. Harriet Lerner, in her first book The Dance of Intimacy and more recently in Marriage Rules: A Manual for the Married and the Coupled Up, has elaborated her concept of a “bottom line position.” Many patients have a very negative reaction to the idea of issuing an “ultimatum” to their partners about getting help. Lerner’s articulation of a “bottom line position” suggests a more nuanced and palatable way to think about taking a stand in our relationships.

In Marriage Rules, Lerner writes, “..a bottom-line position evolves from a focus on the self, from a deeply felt awareness of what one is entitled to, how much one can do and give, and the limits of one’s tolerance. One clarifies a bottom line not to change or control one’s partner (although the wish, of course, is there) but rather to preserve the dignity, integrity, and well-being of the self. A bottom line is about the ‘I’: ‘This is what I think.’ ‘This is what I feel.’ ‘These are the things I can and can’t do.”

Lerner continues: “There is no ‘correct’ bottom line that fits up all. While there is no shortage of advice out there, neither your best friend nor your therapist can know the ‘right’ amount of giving, doing, or putting-up-with in your relationship, and what new position you are ready to take on your own behalf. The rules in this chapter cover a range of ‘bottom lines,’ from those that come up in the dailiness of coupledom (‘You have to clean the kitchen’), to voicing the ultimate (‘If these things don’t change, I don’t think I can stay in this relationship’).” (p. 182)

Often a patient despairs, after trying repeatedly to get her partner into psychotherapy, as to whether she has any leverage she can bring to bear to get across to her partner how important this is, to her and to her family. Terrence Real, in a lecture at a national Couples Conference in San Diego in 2009, addressed this issue of leverage. In this talk, he identified the “blatant” partner as the one who continues to transgress in the marriage or refuses to get help. He identified the “latent” partner as the one, often (but not always) the wife, who backs down and does not push hard enough for what she wants.

In this lecture, Real acknowledged that frequently the wife has “a very real fear that if she sets limits, she may lose her partner.” Real stated, “She has to be willing to risk the relationship if she wants change. In order to have a healthy relationship, one has to be willing to risk it, often multiple times. Adults don’t give other adults unconditional love (We do give it to children.)…Your leverage needs to make the blatant more uncomfortable doing what he’s doing…on any level.”

Real lays out five (5) “Levels of Leverage” that the latent can bring to bear on the blatant. These levels are as follows:

1) Stop acting happy;

2) Withdraw affection in an explicit way by moving into a different bedroom and not having sex; 3) Go on strike and stop doing things for the partner, including going out socially;

4) Separate; this can be either an in-house or an out of house separation;

5) Leave the marriage.

Obviously, these steps are very difficult to take. One takes them as a last resort, when one has tried repeatedly and over time to get a distressed partner to seek professional help, and they have steadfastly resisted. These are actions one takes, when one has exhausted all verbal efforts at persuasion. And these actions are taken, as Harriet Lerner has written, “to preserve the dignity, integrity, and well-being of the self.” The toll that an untreated partner takes on a marriage and a family cannot be overstated. Not taking a strong enough stand can lead one to a lifetime of resentment, loneliness, and despair.