Joseph Grenny is coauthor of four New York Times bestsellers, Crucial Conversations, Crucial Accountability, Influencer, and Change Anything.
During the month of July, we publish “best of” content. The following article was first published on May 4, 2011.
Dear Crucial Skills,
I have a longtime friend who is an Operation Iraqi Freedom veteran, experiences combat stress, and has been diagnosed with Post-Traumatic Stress Disorder. He was being treated at a Veterans Affairs hospital and things seemed to be going well. But recently, I’ve seen a change and increased symptoms—angry outbursts, avoidance, etc.—and can even see the strain reflected on his face. I tried to gently tell him I was worried about him and he told me he’s fine and “not going to group-hug therapy.” And now that he knows I’m concerned, he is avoiding me.
I know many of the veterans who finally get appropriate help do so under extreme duress. Do you have any suggestions on how to broach this with my friend and let him know he should think about modifying his approach to managing his condition?
PTSD & Me
Dear PTSD & Me,
I asked for some extra advice on your question from my father—a WWII and Korean War Veteran with a PhD in counseling who still helps dozens of vets from the past seventy years of conflicts, even at age 84. Yes, I’m proud of him. I want to be sure I don’t speak beyond my competence in your very sensitive situation with one of our beloved servicemen—so I forwarded your question to him.
He suggests your friend’s delay in getting help is quite common. There are a host of “stories” he may be telling himself in order to justify delay—anything from minimizing the symptoms to trusting time will heal all wounds to doubting the efficacy of treatment to fearing a loss of self-esteem by admitting he has a mental health problem.
The line you walk in this crucial conversation is determining when you are exerting influence and when you are provoking resistance. Push too hard and your friend will resent your intrusion on his autonomy. Say too little and you’re enabling his illness and unwittingly prolonging his suffering. Each of us is likely in a similar situation with one or more loved ones. Here are some thoughts to keep in mind as you find the balance between influence and patience:
Make it about him not you. When someone ignores counsel, it’s easy to take it personally. You can tell you’re taking it personally when you start feeling hurt and angry rather than concerned and fearful. It’s so easy to begin with well-intended motives, but let them drift into a desire to control others—without even being aware of the seismic shift. Keep focused on what you really want, “For my friend to be as happy as he can be on the time schedule of his choosing.”
Make it safe. Make your motives crystal clear—and don’t just create present safety—create it for the likely future conversations you’ll hold. If your friend is resistant to being treated, get ready for the long haul. When you have your crucial conversation with him, anticipate the likely need of periodic conversations until he concludes he is ready to take action. If this were a dear friend of mine, here’s how it might sound. Please adapt to your own level of relationship and verbal style.
“Hey bro—I want to talk to you again about getting checked for PTSD. Would you please tolerate me for the next two minutes so I can make my pitch? If you think I’m full of it at the end, please know that I am okay with that. Even if you disagree with me, I just want to be sure you know that the only reason I’m bringing it up is because I love you. Also, I want to warn you in advance that if I continue to see things that make me think a real friend should speak up, I’ll probably bug you again. Is that cool?”
Your goal here is to clear a path for future conversations while asking permission to have this one. And of course if he says, “Back off!” you are obligated to do so. But even in doing so, I would make the following statement:
“Okay. I’m sorry to come across as crowding you—but I want you to know I am concerned and if you ever change your mind about involving me, I am here. Until you give me that permission, I’ll honor your request to leave it alone.”
Your goal here is to make sure he interprets your silence in the next few weeks not as agreement that there is no issue, but as respect for his autonomy. Of course, you should break this agreement if he begins to do something that puts himself or others in harm’s way.
Share facts not judgments. If he allows you to have this conversation, watch to see if your words sound like judgments or threats, or make him feel guilty. If so, you’ve crossed over to controlling rather than influencing. “You’re blowing it, dude” or “Your family can’t take any more of this” are attempts to coerce him, not influence him. If he is defensive at this point, you cannot motivate him. All you can do is help him find his own motivation to get attention. An attempt to rush it will cross the line into provoking resistance rather than exerting influence.
When you hold a crucial conversation with your friend on this topic, come armed with a handful of the most persuasive facts you can find to help your friend self-discover the need to be treated. For example, you could share that:
Psychological injuries are common. A recent study showed more than one in five Iraqi war veterans received psychological injury.
Typical symptoms include . . . The Nebraska Government has a brief self-survey on their website—you could pick the two to three symptoms which are most akin to what you see in your friend and use them for reference in your conversation.
Treatment can help. Often people avoid taking action not because they aren’t motivated, but because they doubt the efficacy of solutions. So they try to cope with things as they stand. A brief factoid sharing the percentage of people who see reduced symptoms after a couple of sessions might give him more confidence in trying a new treatment. It could be that his mental image is of lying on a couch for five years regurgitating pain with no real benefit.
Invite dialogue about his views. The only way to help a resistant person find motivation to change is to help him or her discover his or her own reasons for changing. You could open that possibility by ending this little monologue with a statement like, “Are things working out the way you’d like lately? If so, then I’m off base. If not, let’s talk about what’s going on, what you don’t like, and what it might cost you in the future if it continues or escalates. We don’t have to have that conversation now—but I’m here when you want to have it.”
I hope something in what my father and I have said provides a useful direction for you and for him. You have my heartfelt and sincere best wishes for your positive influence on this good man.