Getting an Unmotivated Son into Therapy

Reader’s Question

My son is a college graduate who was diagnosed with ADHD in his senior high school year. Three months later he experienced some paranoia during and after a spring break trip. After graduation, he volunteered with an organization and, not long after, displayed mania and came home. He was diagnosed with bipolar disorder, and prescribed medication while under the care of a respected psychiatrist. Treatment seemed to help, and in the three years since, he did not appear to display any more episodes. He convinced the doctor to re-introduce ADHD meds about a ago. Six months ago, the doctor and he agreed to stop all medications; he concluded that my son does not have bipolar. The episodes were attributed to recreational drinking and some drug use. My conversation with the doctor about this new revelation ended with his thoughts that my son has a personality disorder of some sort, that would be best treated by a psychologist.

My problem is that my son does not acknowledge the need to talk with anyone. He stays at home, unemployed, and frankly, is not motivated enough to get out and do something. He does go to a gym and runs, but has no social life at all. He was a good athlete and, although a bit shy, had friends and girlfriends until this whole situation started. He expects someone to open doors for him to get a job, and seems resentful that this has not happened. How can we get him to talk with someone?

Psychologist’s Reply

Your son’s lack of success in forging an adult life for himself is certainly cause for concern. His withdrawal from age-appropriate activities and social relationships, as well as his psychiatric history suggest that he might meet a diagnosis for either a Schizotypal or Schizoid Personality Disorder. People with either of these disorders tend to withdraw from others and find building relationships mystifying and anxiety-provoking. The timing of your son’s symptoms also fits these diagnoses, as they tend to express themselves in early adulthood.

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Seeing a psychologist would be a very reasonable next step for your son to pursue. However, getting him in the door might be quite a project. As you point out, he is unmotivated to seek help, and may not even see that he has a problem. While he is waiting for doors to open, however, you do not have the luxury of that illusion. Your best option at this point will be to seek out a therapist who has experience working with this type of personality disorder, and go in to consult with them yourself to strategize about how to encourage your son to enter treatment more willingly.

It may be that your best leverage is the fact that your son is living with you and you are paying the bills. If you and the therapist are comfortable with a more tough-love approach, you can gently inform him that a condition of his ‘tenancy’ is that he begin seeing Dr XYZ. If he objects, you let him know that he is free to make that choice, but that he will need to move out of your house within the next month. I recognize that this type of ultimatum is a drastic step, which is why I suggest you consult with your son’s future therapist before adopting this method. Taking a team approach to getting your son some help will offer you some much-needed support as you address this long-standing and difficult problem.