Sustained Attention and DenialHow can sustained attention deal with denial?

Let’s say an older parent is refusing to get necessary medical care, afraid that going to the doctor will uncover a feared illness, cancer or dementia, what to do?

The seriousness of the problem suggests the need for a heroic intervention. Thoughts come up about performing an “intervention” in the way that is done sometimes for someone in denial about a substance abuse problem… Bringing in family and friends for a one time, intense, meeting designed to overcome resistance.

This past week I saw many examples of an alternative strategy that seems to low key to have a chance of working and yet which can be remarkably powerful.

It involves increased engagement with the person in denial. Visiting them more often, being more present in their lives. Trying to see the world from their perspective.

And then, after becoming more engaged, mentioning in a low key way the issue of concern. Without trying to come to any agreement about what should be done, but just so that you can share your concern and your perspective.

And doing this over and over again, so that it becomes clear that the topic is one that you are really committed to attending to.

A woman whose mother has clearly been gradually developing dementia, but who has angrily responded to several planned conversations on the topic… suddenly scheduled an appointment with her doctor after the daughter started showing up several times a week to spend some time with the mother, mentioning, in passing, each time, her concern.

The father of one of my close friends, who had been refusing potentially life saving heart surgery, despite many well thought out and articulate discussions about the urgency of the matter, finally agreed to get a work up after the family took turns spending “time with Dad” and “noticing” how hard it was for him to get around due to his fatigue… “wondering” if he had thought any more about the operation…

The problem with the “intervention” approach is that a one time meeting may be, in some ways, easier to resist, than the ongoing and consistent expression of concern from someone who seems to genuinely care and who has taken the time to really understand a person’s fears and concerns.

 

Writer Julie Fast wrote an article on this topic for BP Hope in 2011 which is one of the most commonly read and commented upon articles on that website.

She had some points to consider:

Find the sweet spot. Are there periods when your loved one is more open to discussion? Often people are more receptive during a mild depression…

Hold on to hope. I’ve known many people who accepted treatment after years of denial, often when loved ones learn simple strategies and get them help at the right time. It isn’t easy to hang on until then. Nothing with bipolar disorder is easy! But bipolar is treatable, even for those who currently refuse to admit they are ill.

I think her point about timing is an important one, as is the embedded idea that, in most situations, dealing with denial is something that is likely to take weeks or even months and having realistic expectations (and also taking care of yourself in the process) is an important part of achieving success. Too many people alternate between a sense of urgency about getting the problem taken care of and interspersed periods of not talking about it at all. Find your moment to talk about it but also don’t pretend that the problem doesn’t exist even when it might not be timely to bring it up.

It is helpful to conceptualize the process of dealing with denial as one that involves a marathon rather than a sprint.

The idea of setting expectations touches upon another important point. For most people what they most care about is people’s behavior. This is something that is objective and less likely to be a topic of disagreement than the more abstract notion of “being bipolar.” Focus on the behavior is often helpful and more realistic than focusing on “insight” about what is going on. To put it in a different way, it’s okay if the person takes medication or agrees to see a mental health professional just “to please you.” That is often the first step.

Dr. Xavier Amador is another writer who has written books on the subject (I Am Not Sick I Don’t Need Help) that I often recommend to loved ones as a starting point.

For More Information

Julie Fast’s article

Xavier Amador’s website

The Problem of Denial: How to Help Loved Ones with Substance Use and Other Destructive Habits

Denial: I’m not Bipolar, Doctor