Supporting Someone Who is Working on their Mental Health, Part 3: Choice & Voice

What the heck?  My loved one went to therapy today but I don’t see her getting better! Shouldn’t she just be powering through, overcoming the things that make her anxious? She is making changes at home – like we can’t watch TV right before bed anymore.  Sometimes she leaves the room right in the middle of one of our discussions and won’t talk about it until later. She wants to take a break from hanging out with people we used to hang out with. 

Therapy is supposed to make life easier, right?

Yes. But sometimes the part before life gets easier can feel uncomfortable because it is a sorting process, a learning process.

Therapy can be a hard thing for everyone involved, because mental health struggles are a hard thing for everyone involved.

I’ve written already about the importance of being mentally healthy yourself and of cultivating empathy when you are supporting someone with their mental health. Today’s article focuses on some things you need to know about the process of therapy. I hope to shed light on some of the ways someone in therapy for anxiety or trauma may need your support. 

This is not perfectly applicable to every mental health issue, although empowering choice & voice are generally important to any relationship. I am particularly focusing on anxiety and trauma here because that is the scope of my practice.

Even with that narrowed focus, there will be differences in how this article applies to each woman in therapy for anxiety or trauma, because each woman is unique. So is her story, so is the way she is working through it, so are her needs.

I work with women who are dealing with some type of anxiety-related issue. Usually, there are limiting beliefs forged out of something traumatic that maintains the anxiety. For me, to work with anxiety is also to address trauma. You can read more about the ways trauma might connect to anxiety in this post.

Choice and Voice are important considerations that lay a foundation for someone to successfully move through therapy.

Choice

In my work, I start with the assumption that trauma is probably a player, and I place a huge emphasis on choice.  Often, people who have gone through something traumatic felt out of control or powerless in the situation. In therapy, I want them to have a sense of control over how soon they share things with me, the pacing of therapy. I want them to feel confident that they trust me before they let me in on things that may be hard to share.

Usually, people who have had choices taken away from them no longer know how to make choices. It might feel scary to them, and they may honestly not be able to articulate why they make a certain choice.

You can help by:

• Honoring her choices.

  Do not push them for details on how therapy is going, or express frustration that it is not moving faster.

  If something about you is associated with their trauma, it is critical that you empower their choices. This comes up often with husbands and sex. Maybe your sex life has changed in frequency, or she is saying “no” when she used to say “yes” since starting therapy. She may not have realized she had a choice before, and now she needs to practice exercising it. She may logically know she has a choice, but she needs to teach her body that she has a choice, and that you are safe.

• Go to couple’s (or family/relational) counseling if you are having a hard time with this.

There may be some things you both need to work on to help “yes” be the choice she wants to make. Couple’s counseling is not always necessary if you can understand that she could just be working through some past things and needs to be able to be really confident that her “no” actually means “no.” (And I am not only talking about sex here - this could apply to a number of behaviors/activities/types of interactions that just do not feel ok to her right now). It is also possible that you can ask to join one of her therapy sessions - not for couples work but to talk to her therapist together about how you can better understand the choices she needs to make.

• Be patient.

  The changes you are seeing could be temporary – and you will help immensely if you can respond well to her choices. Quite often circumstances that look like a pause can actually be the fastest way forward.

Respecting her choices communicates safety to her.

Voice

This is so similar to choice that I almost combined the two. Trauma survivors are not only robbed of choice, but also of the ability to speak up.

She may have been taught (by someone else; not even you) that it doesn’t matter, she will be humiliated or hurt if she speaks up.

She learns to push her emotions and opinions down. It feels safer to do that than to risk conflict, embarrassment, isolation, or pain.

She may be speaking up more, letting you know when something you are doing is not okay with her. Maybe she just surprises you by voicing an opinion.

She may be setting boundaries with you.

I am sure that doesn’t feel great, especially if you are used to her never pushing back. It is no picnic for her, either. It usually feels scary. It gets better as both of you get used to it. You both can learn that conflict can actually bring you closer together because it allows you to fully know what the other person thinks and feels.

You can help by:

• Trying to be open to what she is saying.

  She is not going to say it in a kind way all the time, because she is learning how to do this. I previously wrote about taking a break if you find yourself getting reactive. The two of you may benefit from couples work as you figure this out.

• Try to keep a bigger-picture persective.

  Find a way to remind yourself, “This is new for her. She is speaking up because she wants us to work this out. It’s better that she speaks up and I know what is going on in her heart than if she stays quiet and seethes with resentment towards me.”

• Ask for her opinion.

  Just like with choice, she may be so used to not voicing her desires and needs that she doesn’t even know what they are. Start with little things, like which video to watch or where to go for dinner.  She may genuinely not know. 

  Don’t badger her about that or force her to make a decision, because she may very well be engaged in some serious brain chatter with her inner critic because she doesn’t have an opinion.  It is really hard to have an awareness of the changes we want to make but not yet be in that place where they are easy to make. We usually have pretty negative self-talk before starting therapy, and those habits are hard to break. 

  Do overtly give her the option to voice her opinion, though.  She may need you to do that for a while until it feels more natural for her to speak up spontaneously.

• Communicate connection.

  Let her know that you love her even if you disagree with something she says.

  Often, people in therapy have attached meanings to others’ reactions to them.

  Disagreement = I’m not good enough; I’m wrong

  Conflict = rejection

  Argument = disconnection

  If you can find a way to communicate your loved one’s value to you in the heat of a difference of opinion, that will go a long way in creating safety for her to speak up.

Choice and Voice are broad areas that lay a foundation for the rest of therapy.

Supporting someone in therapy will require you to have some patience, an open mind, and did I already say patience? The person in therapy may be bringing up stuff she has pushed down for a long time. It can be a little overwhelming. I’ll talk more about that in the next post, but for now, lay that foundation of choice and voice wherever you can.  Use the tips for cultivating empathy I already wrote about, and make sure you are taking measures to be mentally healthy yourself. 

The flip side of persevering with someone as they work through their mental health issues is that you get a front row seat to witness the positive changes she is making. If you can be a safe support to her through this time, your relationship will likely grow stronger and more satisfying.

Jennie Sheffe is a National Certified Counselor ™ who helps women find freedom from anxiety and peace in their chaos. She sees clients virtually in the state of Pennsylvania, or in her downtown Carlisle, PA office. She offers Christian counseling and EMDR Therapy.