Dear Therapist:

My wife has some serious health concerns, including high cholesterol and high sugar. Her doctors have recommended medication and lifestyle changes, but she does not really follow through. She has many reasons why she does not want to take the medication, and the doctors are clearly frustrated.

As her husband, I am very worried. Our children are also frustrated because we all see her becoming less healthy, but whenever we bring it up, she feels attacked and the conversation goes nowhere.

I know she is an adult and I cannot force her to take care of herself. At the same time, it is very hard to watch someone you love make choices that may seriously affect her health.

How should a family respond in a situation like this? Is there a way to encourage someone to take medical concerns seriously without turning every conversation into a fight?

Response:

Of course, you're right that you can't force an adult to do things for herself. I think the solution has less to do with how you can encourage your wife than with how you address her reluctance to care for herself.

If your wife objectively recognizes the need to make changes, there is likely an emotional component to her hesitancy. If so, her first task would be to address that. Although she may consciously acknowledge the importance of change, her unconscious impulses, which tell her not to, appear to be stronger.

Although you and your children are concerned, this is really her struggle. The question is whether she recognizes that it is occurring. When there is a conflict between the conscious and unconscious minds, we are often unaware of our unconscious impulses, and these can masquerade as logical thoughts and beliefs. Since the underlying source is the very dominant and pervasive unconscious mind, it can easily overpower even truly logical thinking.

It doesn't sound like you know the emotional reasons behind your wife's reluctance to follow her doctors' recommendations. Fear of change is a common cause, but it can take many forms and be influenced by many other factors.

I don't think it's your job to address your wife's issues; that's her job. What you can do, however, is encourage her to acknowledge and address any fears or discomfort she has related to making changes. This may be a general resistance to change. It may be a fear of being unwell, or of dying. Or it may be another emotion that blocks her ability to address her physical problems logically.

You've found that raising the problem with her directly doesn't work. If, in a supportive manner, you can gently help her identify any fears, insecurities, or discomfort she has about addressing her needs, you may find that this is more effective.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 adjunct professor at Touro University

 Graduate School of Social Work

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200