How can you help a peer who is in denial about their situation?

You say “denial” like it’s a fact. But I suggest it is your “opinion” of a persons circumstance / experience. Are you the expert in another’s experience? Even in the experience of another peer? Good peer practices inherently respects a person as the expert in their own experience. It should actually be part of every mental health practitioner’s set of values though ordinarily it is phrased as “unconditional positive regard”. What steps have you taken to understand your peer’s experience before you belabour them with your opinion / judgement about their “denial”? How would that feel for you? I wonder? 🤔

Denial about what? Denial that the treatment they have been forced to take is helping them and may be making them feel much worse? That isn’t denial; that is them telling what is happening. Denial about their diagnosis? If the diagnosis was a normal response to PTSD then more of us might be far more open to that diagnosis but to diagnose us with an “illness” that can’t be medically proven; why wouldn’t we deny that kind of diagnosis? Especially when that diagnosis is accompanied with such statements as “you have a serious and enduring mental illness; Your unlikely to ever be able to hold down a job or a relationship or be a valuable member of your family and community!” Of course we want want to deny that as any kind of reality we want.

I strongly urge recommending the best-trained clinicians to treat your colleague for the presenting complaint. It is risky to attempt to actively engage in violating the boundaries between you and your colleague.

While it's understandable for many of us to feel frustrated, especially when our well-intentioned help is rejected, it's equally important to understand the reasons behind this denial. Are they concerned about the potential outcomes of addressing the issue? Or rather, do they perceive it as a problem at all? Therefore, it's vital for us to emphasize personal responsibility and ownership. As peer supporters, our role is to provide informative resources that enable individuals to make informed decisions. However, we must trust that they know their lives better than we do. We can offer help, but we can't impose it. These are my 2 cents on the matter.

I think "denial" may be a misunderstanding. Not acknowledging chronic stress, strain, depression, anxiety to your work colleagues is sometimes a defence mechanism not a coping mechanism! Conscious and unconscious bias about mental health conditions is rife in the workplace. Let's acknowledge and deal with that issue first. Then perhaps our colleagues in "denial" may be more prepared to discuss their mental health concerns!

In cases where I have been able to help a peer, it was important to already have a strong camaraderie with them. It allows for the topic to be discussed openly. Us acknowledging the fact that denial (of something being an issue) has been built up over a significant period of time allows us to ensure we are not trivializing the issue. But at the same time we are able to discuss the topic as something that needs acknowleding as an issue and hence requires addressing. Doing this gently and at an easy pace is super important.

Empathy is trying to see another persons perspective by standing in their shoes. To be empathic is to be curious and openminded about another persons beliefs even if we would not see it that way. Empathy is a way of joining with another person to help them feel safe and understood.

Use active listening to find out possible exceptions in the peer's behaviour. What are exceptions? These are occasional moments where the peer might be doing things that does not support his/her own denial. Ask them questions to probe gently and getting them to share more on these exceptions and the motivation behind them. Active listening is a means to an end. Here we apply active listening to allow us to engage the peer more deeply and encouraging them to see discrepancies in their behaviour that support the change, rather than the denial.

Listening is so important. It is really the key to success in so many situations such as this. I’ve actually had people in some sort of denial talk to me about it and figure it out themselves by listening to themselves speak and reflecting on it.

While many of us possess the ability to listen, not all are gifted with the art of active listening. This skill serves as an invaluable cornerstone for establishing trust, building rapport, and nurturing empathetic connections. When we engage with individuals, taking into consideration their thoughts and feelings, we create a profound sense of validation and support. It's vital to recognize that many issues in our lives remain unspoken. Active listening unveils these hidden concerns, providing a platform for individuals to voice their struggles. This, in turn, helps alleviate the sense of isolation often experienced by those dealing with mental health challenges.

As a psychotherapist, active listening is crucial in understanding the client. As a part of active listening, it's important to ask questions that may elicit responses from the other person that can add depth and breadth to what they are experiencing. It's also important to not lead the other person and let their perspective to unfold naturally.

It's common for us to approach conversations with the intention to reply and counter arguments. However, it's essential to take a step back and learn the art of reflection, as it can reveal unspoken issues. Whether it's about our own thoughts or interpretations, reflection enables us to take a step back to process what an individual has expressed. This practice is invaluable as it demonstrates that we've genuinely heard and understood the other person. This fosters a sense of acknowledgment and respect, vital for building trust and rapport. With this, we are then able to recognize and acknowledge the existence and experiences of someone's emotions and thoughts.

I may often say, "Correct me if I am wrong, but this is what I heard you say." This gives the other person a chance to tell you that yes, that's what they are trying to convey or "no, it's more like this." The listener needs to be careful not to validate inaccuracies, but to explore them together to try to ascertain what they are actually saying.

If you want them to be in the same position and to have an even stronger sense of the same problem that they have now, go right ahead and validate. People do not need validation, they need to create something new in their lives that changes their experience. Making them feel the same thing but stronger does nothing to them in the long run but not even in the short.

Open ended questions can give the other person a chance to elaborate on how they are feeling without the pitfalls of a black or white answer. Asking the other person to "tell me more" encourages them to add details to what they are trying to convey so that a better understanding of their situation can be better understood and explored.

Asking open-ended questions is a fundamental skill in the field of mental health, as it facilitates meaningful conversations and promoting self-expression. These questions help individuals to share their thoughts and feelings more freely, without being limited to simple "yes" or "no" responses, allowing for a deeper exploration of their experiences while also providing them with a safe space to articulate their concerns, uncertainties, or emotions. As a mental health professional, it allows me to gain a comprehensive understanding of an individual's unique perspective and challenges, by fostering trust and a stronger therapeutic alliance, vital to the healing process.

Some suggestions on open-ended questions that we can ask to help someone is in denial: How is this denial help you to move towards your goal? What would you do differently when this denial is absent? What feelings do they evoke in you when you hold on to your denial? Taking a chance to release the denial slightly, what difference do you notice in your body? These open-ended questions show curiosity in the experience of my peer and hopefully it will also create curiousity in them that they would want to explore and understand themselves.

Okay, the reason they are in this problem, is because they cannot think critically. So asking them questions that are supposed to do that will do nothing for them. Also, you do not want them to relive and reinforce the same feelings and problems they have. Instead of them looking at what they do not want and causing them problems, take them internally into a mental state where they could be looking at a different future outcome and start thinking about that, and not the past that got them to where they are.

In my own instances, reflecting on times when the person is in denial (of having developed a bad habit), was spending time doing other constructive work, being engaged in and delivering their projects, helped to exemplify their will and self control. This created a positive trigger that let us discuss strategies to increase their time away from the habit and give it up completely over a course of time.

Assisting a peer in denial involves diverse approaches to sharing information. Telling a story related to a similar situation, while prompting their thoughts on possible solutions, can help them distance themselves from any shame, anger, or fear associated with the issue they are currently denying.

Recognizing that they are humans, rather than merely a pit of 'problems' that require us to be technicians to solve their issues, is the very first step in helping them learn and accept their autonomy and assume responsibility for improving their well-being. While it is easier to be a technician, what we need to learn is to take a step back and be 'human' to connect with them. We all make decisions for change when we feel comfortable. While change is inherently uncomfortable, that's precisely why we need to be there to provide support and connection, showing that it's okay to make the change. Sometimes, just being there itself is the solution we've all been waiting for.

Always give the control and autonomy to the peer. Resistance and denial happens because they are fearful of the perceived pain and that control will be removed from them. Support their autonomy by reminding them that they are in control in making the decisions for themselves. That they are permitted to give themselves the time and space to help themselves to be ready and to address any ambivalence that they may feel during this time. It requires patience on the our part to support the peer who is struggling. When we model how to be patient and respectful of their autonomy, they too can pick up the skill and give themselves the permission to do what is good for themselves.

People in denial are dealing with feelings of fear. They feel vulnerable and resist facing painful reality. The last thing they need is to feel judged or coerced. They need clarity and kindness. That is the most effective combination to help them get to the truth they’re avoiding.

In a way, nobody can change unless they decide to. So they always are the ones who are in control of that. However, the mind will not let them to take a different decision, so they will need to understand what they have to say yes to and what happens if they do not. Plus it helps to understand how the brain and the mind function and they understand why fear is going to be generated on the new path. I found it that when people understand all that, mostly without any push will say yes, to going down a new path.

One support I always provide for a peer /colleague is to always be available for them to talk to when they need to. In this way they are in control of when they need support and any decision they make .

First, listen to understand why the person feels the way they do. Then ask questions that helps the person dig deeper into their thoughts of why they feel that way. Then give suggestions of why & what could help. Then give an open invitation that you’re there for them if they need to talk some more. Most importantly no judgement.