How to save someone’s life (or just get them into therapy)

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Part 1 of a series. View Part 2 and Part 3.

I was involuntarily hospitalized for anxiety and ‘mood weirdness’ eight years ago. I had refused every opportunity to help me up to that point. But once I was trapped in a facility for 2 weeks, I decided to try some new things. Since then I’ve had a weird but satisfying run of, ironically, helping other people get into therapy. I have some tips in case you ever encounter this situation. There are no guarantees, but it may make a difference.

STEP 1: Let people come to you.

• Why will they do this? They will come to you more if you have successes but don’t hide behind them, if you share your struggles, show that weaknesses are human, and believe that we’re inherently worthy but also capable of growing. Hint: this is also a good way to live freer and happier yourself.
• If someone doesn’t come to you but you are concerned, lightly reach out and ask them how they are doing. If they don’t bring up an issue with you, they’re probably not ready. If you do think it’s important to bring it up, do so as non-confrontationally as possible: “I really don’t mean to pry but I was wondering if you were having a hard time, and I wanted you to know that I would be happy to just listen and not judge.” If they decline, don’t push. Just say, “Ok, no problem, I just you to know to that I’m here if you ever want to talk.”

STEP 2 (If they want to talk): LISTEN. 99.9% just listen.

• You might feel like you don’t know what to say, remember that you don’t need to say anything to be helpful. Listening is extremely powerful. Just keep gentle eye contact and go mmhmm or nod every few sentences. Be patient and present.
• An effective response to give is to empathize through reflecting. “That sounds hard”. “Wow, that sounds really hard.” “It sounds like it’s been really hard to deal with this for a long time.” “So what I’m hearing you say is [insert: what they just told you] is hard for you”. This is called ‘active listening’, and it’s a simple, highly-underused technique of human communication.

Here are some general do’s and don’ts…

• DON’T minimize their problem. (“Everyone goes through this” or “You’re making a big deal out of nothing” or “It’s all in your head”.)
• DO praise the sharing itself. Tell them you’re really glad they told you about what they’re going through. It really is brave. Encourage that and reassure them it was ok to share.
• DON’T try to solve their problem for them. Don’t become their therapist. You’re doing a lot — and enough — just by listening. Your goal is not to make their problem your problem.
• DO give a particular kind of personal reflection. Highly personalized, as in: “What worked in my life, for me, and this is just my story, it may not work for you… [was to find someone I could talk to a few times confidentially and with no pressure or expectations].”
• DON’T make direct comparisons to your own issues, Don’t go into great detail about your own experience, or turn the conversation around to be about you. And don’t ‘one-up’ someone’s pain or trauma. You don’t know what it’s like for them, and everyone’s struggle is meaningful by itself.

STEP 3: Offer to help get them help.

• The best way to offer help is to ask for permission to help (even, “Would it be ok if I offered to help you?”). Asking permission for very small steps makes people feel like they can control the pace. It reduces anxiety and pressure.
• Accept that they might not want help, at least not yet. People’s journeys are long and sometimes they’re not ready. ‘No’ is an acceptable answer. So is ‘leave me alone’.* Maybe they’re ok with where things are, or getting help already, or trying something themselves.
• To explore, help them consider options by asking unloaded questions (“Do you think you would feel better if you talked to someone privately?”, “Is there something you’re struggling about with the idea of therapy?”). Exploring options and doubts is helpful and adds perspective without pressure. Often people are afraid of therapy, and that’s normal.
• If you can, reduce anxiety about therapy itself. Emphasize that therapy is on their terms. They get to share what they want when they want. They don’t have to talk about anything. They’re in charge of how they get help. Also, whether or not to take medication is a decision they get to make.*

STEP 4: Hold their hand to the hand-off.

• If someone is depressed or anxious or in emotional distress, the first step is often the hardest. Ask permission to check in with them after a day or a week — and then check in with them. If they don’t respond, don’t add pressure or escalate.* If they respond but they haven’t made any moves, ask if they’re stuck and, again, for permission if you can help.
• Handle logistics. Finding a therapist or doctor and getting an appointment is a lot of work for someone who is struggling emotionally or with their mental health. Offer to look up nearby doctors, phone numbers, insurance policies, etc. Keep a light but steady hand involved until there is an appointment, or until they express they think they can take it from here.

STEP 5: Follow up.

• Check in again a few weeks later. How are they doing? Did they make or go to an appointment? Don’t ask for details, just tell them you hope they get some relief, or whatever they’re looking for.
• Once a person is getting help, don’t assume they’ll ever want to talk about it with you again. You did a great job. Feel proud. Let them be as they are, unless they want to talk more. Also, if you don’t want to talk more, it’s always ok to say “I don’t think I can help any more right now.”

STEP 6: Keep confidentiality — but with an escape valve.

• When someone entrusts you with their pain or problems, it’s a special bond. Keep it safe and sacred.
• HOWEVER, and this is where the stars* come in…it is not only ok but absolutely necessary to tell someone else responsible if you think the person is an immediate danger to themselves or others. Note that there’s a difference between having “suicidal/violent feelings or thoughts” and “having suicidal/violent intent to act”. The difference is not always clear, but generally turns when there’s a plan, a timeline, and/or if they are dangerously no longer in control of their own behavior. If you’re unsure, ask a professional or emergency service.
• Remember that helping someone still doesn’t make their problem yours. And many things are out of your control no matter what you do.

Last, having problems is normal! They’re often temporary and resolvable. You might even have some one day! Therapy doesn’t mean you’re sick or broken, but it is a safe and very cool way to air your burdens.

And finally, you never have to do any of this. It’s your free will, your boundaries, your journey. But you may one day face a situation where you want to help, or you are the one responsible for helping. If that ever happens, I hope this helps.

For those seeking support:

• In emergencies, dial 911
• Call the suicide prevention lifeline, 1–800–273-8255 or use Live Chat
• Find local treatment with the SAMHSA Referral hotline, 1–877–726–4727
• Get support as a friend or family member through NAMI, 1–800–950-6264