Rachel, 31, has been living with her long-term boyfriend for over a year now, and suspects he may be depressed. He seems to have lost interest in his job, his friends, his family, and her — and he’s been drinking a lot, too. He admits that he feels stuck and unhappy, but when she suggests professional help — a therapist — he says it’s too expensive. She understands that it’s a financial reach, but she thinks his mental well-being — not to mention their relationship — is well worth the cost. He’s a project manager for a nonprofit and she’s a teacher, so they’re not exactly swimming in extra cash, but they can’t go on like this. Would it help if she tried to scrape together the money and paid for his initial sessions? How else can she convince him that it’s “worth it”? What should she do?
A few years ago, a friend of mine — let’s call her Kate — was in a similar position. Her kind, considerate longtime boyfriend morphed into a sad, pizza-eating lump that could barely peel himself off the couch, but when she urged him to get help, he retorted that he’d rather spend the money on a dog. (Considering he couldn’t even take himself for a walk, Kate was skeptical.) “I offered to go to therapy with him, and help him find someone he liked,” she told me. “He said it was too expensive, and dug in his heels. I was at a total loss. It got to the point where I was fantasizing about breaking up.”
Despite Kate’s best efforts to tackle the problem and rescue her nose-diving relationship, reprieve came out of left field. Her boyfriend found out that his cousin had been diagnosed as bipolar, and recognized some of the same symptoms in himself. “When he brought it up, I wanted to be like, ‘That’s why I’ve been telling you to see someone, you moron!’” Kate said. “But instead, I tried to act neutral, and suggested that he make an appointment with one of the people I’d researched.” Her boyfriend was treated for depression — an expensive, difficult, and ongoing process, but one that he was ultimately committed to. They’re still together, and much happier. (And they eventually got a dog.)
There’s an old joke about therapy: How many shrinks does it take to change a light bulb? The answer: Only one, but the light bulb has to want to change. It’s dumb, but true — even if your boyfriend were a billionaire, and even if he did decide to shower money on therapy, it wouldn’t help unless he really wanted to stop rolling around in beer and misery. In other words, even if therapy is your idea, he has to take ownership of it. Kate may have planted the seed, but her boyfriend had to come around to it on his own terms.
So, how can you make that happen? “You can’t,” says Michelle M. May, a Washington, D.C.–based psychotherapist who specializes in couples. “You can put forward an argument for your partner to be in therapy, and if you want him to, then you should. But if your partner goes to therapy purely because it’s what you want, as opposed to what he wants, then he will make little to no progress.” Still, May says she sees it all the time. “When a patient says, ‘My girlfriend thinks I have an anger problem,’ I’ll immediately stop and ask, ‘Do you think you have an anger problem?’” she explains. “Therapy is most effective when the patient truly believes in the reasons for being there, and as a therapist, it’s important to determine if that’s the case.”
Of course, the money concern is legitimate. Therapists can bill somewhere between $80 to more than $400 per hour, depending on their location and qualifications, and while insurance can help bring down the price, it’s rarely cheap or convenient. “For someone who hasn’t experienced the value of therapy, the cost can seem prohibitive,” says Amanda Clayman, an L.A.-based financial therapist. To shield your boyfriend from sticker shock, she recommends laying groundwork in advance: Try finding one or two providers in his insurance network, as well as a few more who might accept out-of-network benefits or charge on a sliding scale. “You can even interview them beforehand, and try to get a feel for whether they’d vibe with him,” she says. “If you can simplify his options with a few different price points, it will give him a greater feeling of agency. Too many choices can be overwhelming and keep people stuck.”
Still, just because you grease the wheels and give him a shove doesn’t mean he’ll go anywhere. “Cost can be just one form of resistance,” says Clayman. “It’s the easiest and most impersonal excuse people can point to, when in reality, they just don’t want to go to therapy. It’s part of the spectrum of factors that can keep someone from getting the support that would be useful to them.”
So, it’s not really about the money — but you knew that already. Instead, it’s about worth: defining what money can do for you. May says it’s quite common for couples to disagree on the value of therapy; when it happens, she’ll often present them with a straight-up cost comparison. “I’ll bring up hard numbers, and ask if it’s worth addressing the problem that they have, from a financial standpoint. For example, I’ll say, ‘Here’s the cost of your therapy. When you think about the cost of your problem — anxiety, or depression, and any drugs or other coping mechanisms that you’re using to mitigate it — can you afford to keep living your life this way? Can you afford the loss of productivity the mental illness causes? Is the short-term cost of therapy really so unaffordable, and is the long-term cost of the problem really less?’ And the answer is usually no,” she says. “This is a tactic that a partner could try as well, but it needs to be said with compassion. The other person still needs to have complete autonomy.”
Clayman also recommends a numbers-based approach. “If you have any personal experience with therapy, I’d encourage you to introduce that — say, ‘I worried about the cost, too, and this is how I made it work with my budget,’” she says. “Also, try to explain the benefit that you got from it. A lot of people are simply scared of the unknown aspect.”
Both May and Clayman have patients whose therapy costs are covered by a concerned loved one. Footing the bill for your boyfriend’s initial sessions could be an option — if you can afford it — but it’s only a potential tool, not a solution. “I haven’t seen a correlation between efficacy and who’s paying, as long as the patient owns the will to be there,” says May. Again, if your boyfriend doesn’t want treatment or won’t put forth the effort it requires, it’s not worth anyone’s money — least of all yours.
“Paying for your partner’s therapy is similar to saying, ‘I’m going to get a gym membership for you, and hire you a trainer,’” says Clayman. “You might mean it in the best way possible, but you’re still implying that you want your partner to change. You can always see how things would be better if they just fixed that one thing. But ultimately, that’s up to them. What’s up to you is whether to stay with them if they don’t make the change you’re asking for.”