Choosing help, p.1
Choosing Help, page 1
Praise for Choosing Help
“Grounded in cutting-edge science and brought to life through deeply human stories, this book offers practical tools for navigating the most common—and often most difficult—reasons people avoid getting help. Whether you’re a concerned friend, family member, or a clinician, Choosing Help is a must-have resource for effectively guiding others toward the help they need, with empathy, skill, and hope.”
—Sudie Back, PhD, Director of Drug Abuse Research Training, Medical University of South Carolina
“Choosing Help provides concrete, real-life strategies and small steps, to help your loved one say yes to life-changing mental health treatment.”
—Bobbi Conner, producer and host of the Health Focus radio series & podcast
“Friends, parents, teachers, counselors, doctors, and other health providers, especially those who are not familiar with cognitive behavior therapy, will find this book educational and useful. Even experienced therapists will enjoy the examples and benefit from the reminders. I enjoyed and enthusiastically recommend the book.”
—Bob Drake, md, phd, Professor of Clinical Psychiatry, Columbia University
“At times it can feel incredibly daunting to talk to someone about getting help. This book provides practical techniques and easy to understand examples that not only build confidence to initiate that conversation, but to help get your loved one, co-worker, or patient into the treatment they need.”
—Lisham Ashrafioun, PhD, Associate Professor of Psychiatry, University of Rochester Medical Center
“As a clinician and researcher, I see the same barrier over and over: people want help, but anxiety, stigma, and logistics win. This program targets that barrier directly with practical, stepwise strategies and clear measurement. Treatments only work when people get to session one. This gets them there.”
—Nik Allan, PhD, Assistant Professor, Department of Psychiatry and Behavioral Health, The Ohio State University
“Choosing Help’s thoughtful structure—pairing relatable stories with practical, evidence-informed strategies—makes it an invaluable tool for families, healthcare professionals and students learning to build trust and foster meaningful conversations. It’s a gentle guide with a powerful impact.”
—Teresa Kelechi, PhD, Dean of Research in the College of Nursing, Medical University of South Carolina
“We are on the verge of a great opportunity in mental health. At a time when the Suicide Hotline was rolled out and when young people’s mental health fluency is at an all-time high, we need thought leaders to emerge and help us all capitalize on this opportunity. One has, and her name is Tracy Stecker. Dr. Stecker has produced a readable and highly useful book on seeking mental health help. A highly recommended read from a world’s authority on the topic.”
—Thomas Joiner, PhD, Director, fsu Psychology Clinic
“In Choosing Help, Dr. Tracy Stecker breathes compassion into the challenging landscape of supporting loved ones who are struggling with their mental health. The mix of storytelling and concrete strategies set this book apart as a beacon of hope and healing while navigating how best to support those we love.”
—Jennifer M. Gómez, PhD, Associate Professor of Social Work at Boston University
Choosing
Help
Choosing
Help
Your First Step Towards
Better Mental Health
tracy stecker, Phd
Foreword by Charles W. Hoge, md
Hatherleigh Press, Ltd.
62545 State Highway 10, Hobart, ny 13788, usa
hatherleighpress.com
Choosing Help
Text Copyright © 2025 Tracy Stecker, PhD
Library of Congress Cataloging-in-Publication Data is available.
isbn: 978-1-961293-47-2
All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic or otherwise, without written permission from the publisher.
Cover Design by Carolyn Kasper
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10 9 8 7 6 5 4 3 2 1
To my Dad.
To anyone who feels alone.
Light and love.
Contents
Foreword by Charles W. Hoge, md
Chapter 1: Talking to Someone About Getting Help
Chapter 2: Starting the Discussion: A Three-Step Process
Chapter 3: “Treatment Won’t Work”
Chapter 4: “I Don’t Want ‘That’ Type of Treatment”
Chapter 5: “It’s Too Hard to Open Up”
Chapter 6: “I Can Handle It On My Own”
Chapter 7: “I’m Not Ready”
Chapter 8: “What About the Stigma?”
Chapter 9: “I Don’t Need Help”
Chapter 10: “There’s No Time or Money for Treatment”
Chapter 11: Talking to Loved Ones
Final Words
About the Author
Acknowledgements
Resources
Foreword
by Charles W. Hoge, md
Choosing Help is a gem of a book, a roadmap for how to communicate with someone resistant to seeking help. Mental health problems touch all of us in one way or another, either personally, or among our immediate family members, friends, co-workers, or classmates. We all need the skills imparted in this book to know how to best approach conversations in a way that overcomes ingrained thought patterns and other barriers to seeking help when needed. This book is understandable, eloquent, and on point, making accessible to everyone cognitive-behavioral and motivational skills that until now have largely been the purview of health professionals. It fills a critical gap in the literature, highlighting the important role that everyone can play in helping to reduce stigma and barriers to mental health care.
My career in psychiatry has largely been working with military and veteran populations where the stigma of receiving mental health care has long been ingrained in thought processes such as, “I’ll be seen as weak”; “My leaders or peers will treat me differently”; “I’ll lose my security clearance”; “It will harm my career”; or “I should be able to handle problems on my own.” When my research team provided the first detailed numbers in 2004 on the psychological impact of the wars in Iraq and Afghanistan, national news stories fixated on the prevalence rates we reported of ptsd and depression.
However, the most important part of that story, much less emphasized in the news, was that only 20 percent of service members with these conditions were willing to receive help. Since then, the field has come a long way toward improving stigma perceptions and facilitating access to care through screening and education campaigns, though we still have a ways to go; barriers remain, as they do in civilian society. What has been missing all along is a straightforward step-by-step guide, such as this one, for family members, friends, co-workers and even many health professionals, on how to most effectively have conversations around the topic of help seeking. This is a book I wish we had available when we first started studying stigma twenty years ago early in the Iraq and Afghanistan war era.
Choosing Help draws from Dr. Stecker’s years of experience working in the field of suicide prevention, and provides detailed examples, including poignant relatable dialogues that bring to life the inner thought processes of resistance, and the specific words and phrases we can use to help someone begin to see other options they may not have considered or dismissed outright. This book provides clear guidance on effective communication strategies that can open the door to change, or at least improve the chances someone will be willing to consider initial steps in receiving the help they need. This could also be a roadmap for healthy communication in general. The world certainly can benefit now from more empathetic, respectful, genuine listening approaches. When you try out these skills with those in your life you’re concerned about, you might find these tools seeping into other interactions. It’s a whole new approach to conversation that truly meets people where they are.
—Charles W. Hoge, M.D., Colonel (Ret), U.S. Army & author of Once a Warrior Always a Warrior: Navigating the Transition from Combat to Home
Chapter 1 Talking to Someone About Getting Help
Some people believe that, once the pain gets bad enough, that’s when one will ask for help. While severity of the pain one feels is somewhat related to treatment seeking, it is often insufficient to motivate one to come in. We all know someone who never got help and suffered. They can have health, work, relationship, legal, financial, housing, eating, sleeping, and even breathing difficulties and still will not seek help.
Despite this, the medical community is structured so that people need to advocate for their own treatment. In fact, if you try to get help for your loved one with a mental health or substance abuse related disorder, you will commonly be turned away. The individual needs to ask for help themselves, even if they’ve lost the insight to do this on their own. This book provides a roadmap for people who need help but who delay or resist treatment.
Over 20+ years of intervening people who need mental health or substance use treatment but who refused to get help, I have learned the following:
People often don’t seek help because they believe getting help will be uncomfortable.
People may prefer to suffer (even if it is extreme) as long as they don’t have to ask for
People have the capacity to change their mind about getting help.
Changing thoughts about getting help can change everything and improve lives.
Choosing Help is meant to serve as a roadmap to understand why people don’t get help for mental health and substance use concerns and how to encourage them to change their mind. The approach this book takes is straightforward and has been studied extensively in multiple clinical trials. The approach promotes a strategy to effectively listen to someone and help them change their mind on seeking help.
The method of helping someone change their mind on getting help (cbt-ts or cbt for Treatment Seeking) has been tested in more than ten clinical research trials (funded from the National Institutes of Health, the Department of Veterans Affairs, and the Department of Defense) in people with various conditions including: posttraumatic stress disorder (ptsd), substance use disorders, depression and suicidality. Regardless of condition, a common set of beliefs emerges on why people often don’t seek help.
These beliefs include:
They believe treatment won’t work.
They refuse a certain type of treatment.
They say it will be hard or uncomfortable and want to avoid feeling that way.
They want to handle problems on their own.
They say they are not ready.
They are concerned over perceived stigma.
They say they don’t “need” help.
They say they don’t have the time or money for treatment.
Choosing Help provides the building blocks for effective communication, how to talk with someone about getting help, and how to have specific conversations depending on why someone is not getting help. I will outline 20+ different ways to approach a discussion on help-seeking (see Chapter 2 for the full list). These include discussions about when help is needed, what kind of help is needed or wanted, coping strategies, listing pros/cons of seeking help, etc. Talking about thoughts on these aspects can help people make better decisions on whether or not they will get help. Each chapter outlines 1) strategies for talking through a particular barrier to help-seeking (i.e., stigma) and 2) first-person stories to demonstrate how to use the strategies. The stories show how anyone (family members, friends, doctors, neighbors, or even a stranger) can talk to someone about seeking help.
A Bit of Background
This book is necessary because mental health and substance use concerns are ubiquitous, touching nearly all of us in one way or another, either personally or our family members or close friends. The vast majority of individuals who need help do not seek help, and in general, people will not get better if they do not seek help for these concerns.
Mental Health and Substance Use Disorders Are Common
About 1 out of every 5 individuals (between 20–22 percent) experience a mental health or substance use disorder at some point in their lives. This includes disorders such as major depression, anxiety, ptsd, and drug/alcohol dependence. Approximately 5–7 percent experience a serious mental health condition, including disorders such as schizophrenia or bipolar disorder.
Evidence-based treatments, such as therapy and medications, exist for these conditions, improving symptoms, functioning, and quality of life. Which treatments work best for any specific person depends on many factors, including individual preference. Data suggest that individuals do best in treatment if they participate in decision-making about their treatment and are given the treatment they prefer.
For information on evidence-based treatments for mental health conditions, please visit websites such as niaaa, nida, nimh, afsp, nami, Webmd, apa, or other sources that provide the most up to date information. Additional information on resources is available in this book in Chapter 11.
People Don’t Get Help
The majority of people with mental health and substance use disorders do not seek treatment. As many as 75 percent of people who die by suicide never seek treatment, and between 50 and 75 percent of people with other mental health and substance use conditions never seek care. Even for those who do seek treatment, many delay getting help which may cause unnecessary suffering. In general, people fit into one of three groups with respect to treatment seeking: about a third go to treatment immediately; another third delay treatment, thinking that things might get better on their own; and about a third do not consider getting treatment at all—even if they are experiencing catastrophic symptoms. The approach outlined in this book is designed for individuals who delay or do not consider treatment for mental health and substance use concerns.
Skills & Attributes to Guide Conversations on Help-Seeking
In order to talk with someone about getting help for a mental health or substance use problem, certain skills are helpful for healthy and effective communication, and helping individuals to feel heard and understood. You can’t effectively communicate if you do not take the time to understand someone’s point of view. Some people are easy to talk to; some are hard. And, because we bring our biases to every interaction, these skills allow for easier communication with anyone.
These four skills are:
Empathy
Genuineness
Positive Regard
Active Listening
Empathy is the capacity to understand someone else’s point of view. You do not need to agree with their point of view, but having empathy is defined as being able to see the world from someone else’s perspective. It is the act of validating or acknowledging their perspective.
Examples of empathy include tearing up when you see someone else’s suffering; feeling joy when you see someone happy; feeling pain watching someone suffer.
In terms of help-seeking, being empathic means that you are able to put yourself in someone else’s shoes enough to understand their situation from their point of view (not yours). You might meet someone who has a different lifestyle than you do. This might be someone who has a serious addiction to drugs or alcohol or a gambling problem or someone who is morbidly obese and has an addiction to food. When one is different than you, are you capable of putting yourself in their shoes to see their point of view? Do you judge them without considering the circumstances that led them to make their choices? Are you able to have a conversation with them to find out more about their thoughts and behaviors that contributed to their current situation? Do you make assumptions without checking in with them to see if the assumptions are accurate? Empathy is the capacity to see and feel the other person’s point of view and is essential for productive discussion.
Genuineness is also essential for good communication. To communicate well, you need to be your authentic self. For example, you can tell when you hug someone how they feel about the hug. You can tell if they love a good, long, strong connecting hug or if they want it to end quickly. Being genuine is being your true self (which may mean saying no to a hug).
We sense when someone is not being genuine. We all know people who are over the top during basic conversation. They might be overly effusive when just saying hello or respond to a greeting on the weather with extreme emotion not appropriate to the situation. It’s easier to accept someone who is overly effusive when we know that they truly have joyful energy, but when they force it, it can be off putting. Conversely, we know people who have difficulty being kind even if they adore someone. They might grunt as a hello because they have difficulty expressing their true feelings. Consider your own capacity to be genuine and when and in what situations you struggle with authenticity? Being genuine is the ability to be one’s true self in every situation.
