Supporting someone through therapy

When someone you love starts therapy, the temptation is to become useful in the wrong ways. You want a report. You want to know whether the psychologist is any good. You want to fix the homework, drive the conversation at dinner, and measure progress by whether they seem sunnier on a Wednesday. I have done versions of this from Adelaide kitchens and hospital car parks, as a partner and as an adult daughter, and I can tell you that the useful work is almost never the work that feels like helping.

This is not a guide to treating anyone. We are not a clinic. If the person is in immediate danger, you call 000. If the night is long and you are both frightened, Beyond Blue and Lifeline exist for that hour. What follows is about the ordinary stretch: the weeks when someone is going to appointments, coming home tired, and living in a house with you.

What you are not entitled to know

A psychologist’s duty of confidentiality belongs to the person in the room. If that person is your partner, your father, your adult child, or your friend, you will not receive a file note. You may not even be told whether they attended, unless they tell you. Parents of younger children are in a different position — the clinician has to work with the family — but even then, a child needs a pocket of privacy that is not immediately relayed at the school gate.

This can feel like being shut out of a project you are funding, driving to, and absorbing at 7pm. The feeling is understandable. The remedy is not a phone call to the practice demanding a briefing. The remedy is to ask the person what, if anything, they want you to know, and to live with a thinner story than you would prefer.

If you are the one who found the psychologist, booked the GP, and sat in the waiting room, you have already done a great deal. Our essays on therapy and getting help are written partly for that person — the organiser who still has to wait in the corridor.

Practical help that does not turn you into a clinician

The useful list is almost embarrassingly concrete. Offer the lift, the childcare, the reminder on the calendar, the quiet house for a telehealth hour. Help them gather the Medicare card and the referral the night before. If money is tight, sit down once with the numbers — fee, rebate, gap — so the appointment does not become a weekly argument about the bank account. Then stop managing.

Do not sit outside the door of a video session “in case they need you,” unless they have asked. Do not rewrite their thought record. Do not phone the psychologist with additional history you think the session missed, unless there is a safety issue and you have no other path. Extra information offered in secret puts the clinician in an impossible position and teaches the person that the people they live with have a back channel.

If they want a debrief, listen the way you would listen to someone back from a difficult medical appointment: a few questions, no cross-examination, no improving their metaphors. “That sounds like a lot” is a better sentence than “Have you tried writing it down?” They have, if the method is CBT, a person whose job is to suggest that.

Meals, walks, and an ordinary evening that is not a case conference belong here too. The everyday wellbeing habits we write about — sleep, a short outing, a conversation that is allowed to be about the garden — are not treatment. They are what a household can still offer when treatment is happening somewhere else.

The messy middle

People in therapy are not always nicer. Exposure work can make them edgier. Talking about a marriage can make dinner sharp. Dropping a safety behaviour — the extra check, the late-night reassurance text — can look, from the outside, like they have stopped trying. They may have started the harder trying.

You will be tempted to monitor. Mood charts on the fridge, questions about whether they did the homework, a review of how they “were” with the in-laws. Monitoring is how anxiety spreads through a house. If they ask you to change a habit of your own — less interrogation, fewer “you’ll be fine”s, no more solving their worry in real time — try to treat that as part of the work, not as a criticism of your character.

There is a particular strain in later life that I want to name, because it is easy to miss. An older person may start therapy after a bereavement, a diagnosis, or a retirement that hollowed out the week. The adult children often want speed. They want Mum “back.” They want Dad to use the sessions properly. Grief and adjustment do not run to a school term. Your job is to keep offering the lift and the leftover soup, not to mark the essays.

Couples have an extra trap. If only one person is in the room, the other can become the problem in every story, or the hero in every story. Neither role is livable. If the therapy starts to be used as a verdict on the relationship, you can say, calmly, that you will not try the case at the sink. A couples session, or a GP conversation about whether the work should include you, is a better path than a nightly appeal.

When the person in treatment is also caring for someone

Households stack. A woman in her sixties may be going to a psychologist on Tuesday and sitting with a sister in aged care on Thursday. A father may be in CBT while a teenager is refusing school. Support then means noticing the stack, not adding a motivational speech to it. Help them keep the appointment when the week tilts. Help them cancel early if they truly cannot go, so they are not punished by a fee and a sense of failure at once.

If a child is the one in therapy, the supporting adult has more formal work: attending reviews, practising the plan at home, talking to the school, not turning every feeling into a session. Our writing for children and families is the better place for the detail of that age. The principle is the same. You are a parent, not a junior psychologist. Warmth and routine will do more than a perfect feeling-word.

What not to say, and what to say instead

Some sentences arrive automatically and land badly. “At least you have a psychologist” can sound like a request to be less upset. “Just be honest with them” assumes that honesty is a tap. “I don’t know why you’re still anxious, you’re getting help” treats therapy as a product with a receipt. “You seem worse” may be accurate and still not useful at 9pm.

Better sentences are smaller. “I am glad you went.” “Do you want company or quiet?” “I can do pickup on Thursdays for the next month.” “I am finding this hard too, and I am still here.” If you need to name a worry of your own — money, a drinking pattern, a silence that has gone on too long — name it once, at a time that is not the half-hour after their session, and without demanding an immediate repair.

Humour helps when it is shared. It does not help when it is a way of changing the subject. You will learn the difference if you watch their face.

The kindest thing you can do, some weeks, is to remain a person they do not have to educate.

That means keeping your own friends, your own GP if you need one, and one weekly activity that is not about their inner life. Support people disappear into the role and then become another person who needs care. A short walk that is yours is not selfish. It is how you stay in the house as a companion rather than as staff.

When to step in harder

There is a line between respect and neglect. If they are speaking about suicide, giving away things, or not making sense, you do not honour confidentiality by staying quiet. You stay with them, you ask directly whether they are thinking of ending their life, and you use the emergency services or a crisis line. You can also call the practice and say you are worried, knowing the clinician may not tell you what they do next. That call is still worth making.

If they stop attending and also stop leaving the house, or if the drinking has taken over the week, a GP appointment — for them, with you attending only if they want — is a better intervention than a family meeting conducted as an ambush. Ambush conversations make people lie more carefully. A planned conversation, with one or two points, is harder and more useful.

If the psychologist seems to you to be unprofessional — if you hear about cancelled sessions without notice, blurred fees, or anything that sounds like exploitation — encourage the person to look the practitioner up on the AHPRA register and to raise it with their GP. You cannot file their complaint for them if they are an adult who has capacity. You can sit with them while they write it.

A long view from the hallway

Therapy is a patch of weeks inside a longer life. Some people will have a focused course under a Mental Health Treatment Plan and then not need a room for years. Some will return each time the year tilts. Your support does not have to be equally intense across all of that. It has to be adjustable.

I think of the park bench: two people sitting, not necessarily talking, the appointment already over. The work of the household is to make that bench possible — time, money, a bit of quiet — and then to let the person look at the trees if they want to. You will not be mentioned in the case notes. You will be in the life that the case notes are trying to return them to. That is the better credit.