I was working with an individual who was struggling with a number of difficult mental health concerns. She had a history of trauma, struggled with substance use and engaged in eating disorder behaviors.
As we worked together, I became aware that she was finding it difficult to make some of the behavior changes that would result in recovery. Instead, she expressed a desire to be “forced” to eat and wanted some severe consequences that would keep her from purging. In other words, she wanted her treatment team to take responsibility for her recovery.
On other days, she became fixated on external challenges, such as, a situation that resulted in her being emotionally activated, or an interaction with someone that upset her. These events often led to self-destructive behaviors followed by statements that made it clear she believed these events were the cause of those behaviors. In these situations, she had not yet come to understand that one’s emotions do not necessarily cause behavior responses.
Another person I worked with was adamant about how treatment should look for her. She often argued about treatment recommendations, length of stay, how often she should be allowed breaks and what groups to attend. She wanted to be responsible for her treatment.
These two main aspects of a person’s healing, treatment and recovery, need to be clearly understood in order for the best outcomes. When we confuse who is responsible for what, healing slows and sometimes goes backward.
It is very important to remember, as a clinician, that recovery is the responsibility of the person with whom we are working, not the clinician. When a clinician begins to take responsibility for a person’s recovery, the person will typically feel disempowered, belittled, less motivated, and sometimes relieved.
We may be able to see small victories, but no lasting change. As clinicians, we can become so invested in wanting to see a good outcome for the person with whom we are working that we lose sight of how detrimental that is.
Sometimes it isn’t the person, but their family who want to be in charge of treatment. The person seeking help may long for someone to rescue them rather than take the steps needed to heal. A lot of family systems have developed over time to collude with this thinking and attempt to push a clinician to do one thing or another they believe is best, second guessing our clinical judgment.
Whether it is the person or their family who are trying to be responsible for treatment, the result is that our interventions become ineffective. It would be like going to the emergency room with a severe injury and telling the doctor how to perform a procedure, or being diagnosed with cancer and choosing not to accept the recommendations of all the doctors on our case.
Controlling the treatment is definitely our responsibility. When we begin to make accommodations that are not clinically sound, healing stalls. Many of the justifications for “giving in” to some of the requests made by the person or their family often stem from our own emotional responses to their distress. Let’s face it, we therapists are an empathetic and compassionate bunch. Sometimes we may be moved with sympathy for the difficulty caused by the changes they are being asked to make. We may want to respond to circumstances in their life by making accommodations for a missed birthday, or graduation, or other event.
However, it is important that we maintain a clear understanding that recovery, or making the appropriate behavior changes, is the responsibility of the person we are treating. It isn’t our responsibility and it isn’t the responsibility of anyone else in that person’s life. Our job is to support them as they make that difficult decision to change and as they take the steps needed to free themselves from the grip of the disorders that are harming them. The way in which we support them, the rapport, the evidence-based therapies, the meal supports, and all the rest is what treatment is.
The clarity of those two responsibilities can help us in our decision making and help us to see what those individuals with whom we work need. When we couch all of this in the compassion and value we hold for them, healing is possible.