How Does a Lead Psychiatrist Treat the Ultra-Wealthy?

Paracelsus Recovery
25 min readSep 19, 2023

Our CEO — Jan Gerber, sat down with Dr. Med. Thilo Beck to discuss why ultrawealthy clientele can experience as much stigmatisation and isolation as those at the far end of the socioeconomic spectrum. His insights from over 30 years of experience are sure to surprise you.

Paracelsus Recovery is the world’s premier treatment provider for mental health, substance abuse, eating disorders and other afflictions. At our lake-front residential penthouse, you will also have a housekeeper, dedicated driver, and personal chef, amongst many other amenities and complementary therapies. Treatment programmes include a four-week residential programme, a seven-day Executive Detoxification programme and a fully online treatment programme. Dr. Med. Thilo Beck is our chief consultant psychiatrist.

Our CEO — Jan Gerber, sat down with Dr. Med. Thilo Beck to discuss why #ultrawealthy clientele can experience as much stigmatisation and isolation as those at the far end of the socioeconomic spectrum.

Find the full discussion below⬇️

Jan Gerber: Hi, I’m Jan. I’m the founder and manager of Paracelsus Recovery. I’m sitting here with Thilo Beck, our lead psychiatrist. Since the very first day, 10 years ago now, we’ve been working together. Thilo, you’ve been working with us all this time with a variety of clients. What’s particular about Paracelsus Recovery is that our clientele is normally from a wealthy, ultra-high net worth background, sometimes also with a background of public exposure, celebrities and so on.

And let’s call it your other job — the work you do is at a non-profit organization where you also are a lead psychiatrist working with people from the other side of the socioeconomic spectrum. I think we both found that quite intriguing from the very beginning, from our initial conversations back then.

I would like to talk to you a bit today about culturally competent care, particularly the demographic we work with at Paracelsus Recovery. But let me start off by asking you, when you compare your work here and at ARUD, the non-profit organisation, do you see commonalities in the clientele, their struggles, and therapeutic approaches that work?

Thilo Beck: We have to deal with people in difficult situations, and it’s not as easy to be wealthy.

Thilo Beck: That’s a very interesting question. I think what I’ve learned is that on both ends, we have to deal with a stigmatised population with people who have a stigma [attached to them]. Wealthy people are isolated in our society in a way, and they don’t have - in certain aspects, they don’t have the same possibilities as regular people have, so to speak. We often have to deal with emotionally deprived people who never had the chance to grow up as we would say a normal person would. And don’t… Are very hesitant to have social contacts with other people because you never know whether people really like you because of the person you are or whether they are just with you because you have the money, right? And so it’s from different angles, but we have to deal with people in difficult situations, and it’s not as easy to be wealthy [as one might think]. That’s what I have learned; it can cause a lot of harm.

Jan Gerber: What I read between the lines is there’s an aspect of loneliness and trust issues that are maybe more present in the wealthy demographic than in the overall population.

Thilo Beck: Very much so. And it’s not only about social isolation; it’s also when we look at medical care. What we often see is that they are badly treated medically because they don’t dare to go to a regular hospital for treatment or to regular doctors. They end up with some, I don’t know, some treatments that are not coordinated and on and off. We often see very badly organized treatments or insufficient treatments.

Jan Gerber: A keyword comes to mind or a key phrase — ‘doctor shopping’ that we sometimes see with a very wealthy clientele because they have the possibility to access expertise from all over the world. But sometimes, when they don’t like the experience or don’t like what they hear, they can just move on to another doctor and maybe get another opinion altogether. Also, second opinions are an economic matter. Most people don’t get second or third opinions when they get a diagnosis, but a wealthy clientele often does, again, because of the trust issues as well. Then, they get very confusing messages.

Thilo Beck: Yes, and treatments are not ended; treatments are started and then interrupted, or a doctor is changed. We really often see people who are badly medicated or hardly medicated, and we have to start from scratch.

Jan Gerber: Yeah, where sometimes conditions are already quantified to a degree where they shouldn’t be.

Thilo Beck: Yes. You wouldn’t think that it would be that way.

Jan Gerber: What other factors do you feel, specifically, do you see… So, we talked about loneliness, trust issues to some degree, and emotional deprivation that you see as a commonality between people on both sides of the socioeconomic spectrum. Let’s talk about the emotional deprivation. What is that? What are the implications, and why is that specifically happening in a wealthy clientele? Why, as an outsider, you wouldn’t expect that?

Thilo Beck: I think I see that on two levels. One level is that, so to speak, the founder generations who build wealth often end up in an isolated situation afterwards because they are at the top of the pyramid and have trust issues there. The other problem is then the following generations, the children of these founders or the second generation, who grow up in difficult situations, frequently being left on their own, parents travelling, and they grow up with nannies managing everything and just never get the emotional support or the care, the emotional care they would deserve as children.

Jan Gerber: And that is important for healthy psychological development. Do we have any tips? All things equal, imagine somebody who, let’s say, two parents are very busy running the family business, political and social duties or engagements, and often they want the very best for their children. They hire tutors, they hire nannies. Elite boarding schools are often a topic. What would be the advice to somebody, to parents like that, because often it’s not an option to just say, Okay, now we have children, and we need to drop our duties because it’s a massive responsibility. Often, we have clients who have hundreds of thousands of employees, and there’s an impact if they don’t show up to work. What would you say to them?

Thilo Beck: That’s what we have learned over time, having these family weekends where we usually invite family members to join in and to think about what could be changed for the family system. I think it’s about starting a dialogue and starting to consciously meet each other again and not just to live in some ways on different paths and to really choose to be a family and to have time together. Some people call this quality time, but just…

Jan Gerber: Yeah, they actually just came to mind. Could you say that actually there are many things in life, and quality is more important than quantity? Even if, let’s say, one or both parents travel frequently to different places in the world and don’t have that much time to spend at home, but the time they do have should really be devoted and dedicated to the children to spend quality time, attention, and so on.

Thilo Beck: Often, it has to be practised, i.e. how to do these conversations, how to talk to each other, how to get this quality time together and how to dialogue in a constructive way. Sounds trivial, but it’s not at all. There is much to be done, I think.

Jan Gerber: Especially when a certain dynamic has been in the making for many years, right? Living parallel lives or not feeling seen by each other, by the parents, by the partner. People feel unhappy, they feel something’s missing, but then it always takes, well, at least two or the whole family to actually say, Okay, we need to change something. We are ready to take the time and the emotional investment. Also, in a way, being vulnerable. Because often, especially when you run an international corporation or a political office, your everyday role is actually to carry a bit of a shield around you so as not to appear vulnerable. Maybe it’s hard to take that off when you come home.

Thilo Beck: To create a space where you really interact with each other and where you listen to each other and respect each other, very precious time, actually, but there has to be practice.

Jan Gerber: Let’s talk a moment about affluent neglect, a term that sometimes pops up. I don’t think it has a clear definition. But again, something that’s interesting to compare because there is neglect that is more common on both sides; again, of the socioeconomic spectrum, there are some commonalities. Neglect in a low-income family or household or single parenting, struggling to pay the bills, is in a way more intuitively graspable. But what about affluent neglect? Neglect in a in a wealthy family, wealthy household? What are the parameters? We talked about the lack of time and attention. What other factors can play a role?

Thilo Beck: It’s a lot about lack of structure as well. So everything is possible, and you would not have to do anything, actually, if you don’t want to. And so we often see these people feeling lost and just not knowing what to do with their lives because they don’t have direction and don’t know what values they should invest in themselves. And because it’s all left open in a way. That’s what we often work at — trying to get direction into the lives of these people.

Jan Gerber: I think what you’re talking about is particularly important for the next generations, those growing up in significant wealth. Sometimes, there’s a trust fund; sometimes, not a clear path… You don’t have to work. I think it’s very natural for kids or teenagers if they don’t have to adhere to a structure, well, they don’t. You can get lost in that. We know the importance of structure in poor mental health, particularly mental health recovery.

Thilo Beck: To find your own values, to find what you want to live for. I think there’s a lot of pressure often from the parents, from the fathers, whoever is in charge of the family. And the second generation they ask themselves, Well, I don’t want to become a copy of my parents. I want to go my own way. But what way would that be?

Jan Gerber: I think we have a few interesting topics that we just scratched the surface on. One is lack of structure, often because of economic possibilities and not the necessity, but then getting lost and not really having a purpose. Basically, summarising — having a reason to get out of bed in the morning and then looking forward to the day and purpose we know is super important. Then you have possibly the opposite, and we see that, too, is the limiting factor. The expectation of pressures from the previous generation, from the parents, limiting factors with regards to the expectation that you follow in the footsteps, that you take over the helm of the family company at some point. What should you study? Maybe you want to study art, but actually, the parents want you to start studying economics or law, but also with regard to who you are approved to entangle with as friends or romantic partners. On one side, we have this lack of structure and too much freedom. On the other side, we have these stringent limitations that often are not experienced as much by the average.

Thilo Beck: Or overwhelming expectations from the first generation, from the parents, to what these children should do or what they should be able to do.

Jan Gerber: It’s very scary.

Thilo Beck: Yeah, absolutely paralysing sometimes and also then creating resistance and -As a coping mechanism. -yes, and trying and saying, No, this is not possible. I can’t do that, or I don’t want that.

Jan Gerber: Let’s talk about that a little bit. Because I’d always imagine when you grew up basically in the shadow of the achievements of your parents. And it’s probably not only in a family business, but let’s say you’re the son or daughter of a world leader, head of state, or a successful, famous entertainer; you will always be the son or daughter of so-and-so. And it takes more. It’s more difficult to feel like you’re a person in your own right. Especially when everybody says, Oh, your father is so-and-so, or your mother and all these achievements are praised. What does that do to your self-esteem as a kid or as a teenager?

Thilo Beck: I think that it’s difficult under these circumstances to develop a self, a feeling of self-worth in a way. So, what are my strengths? What I’m good for? What am I as a person, and who am I? And that’s what we often do here also with these second-generation children, trying to give them a new direction, trying to give them a new understanding of what they could do in their lives. We work a lot with career councillors and try to support them in finding their own path, which is not that easy.

Jan Gerber: Then also developing that is one thing. But then, going back, they’re still a part of a group, and often there are family, dynasties, friends, advisors, family members and so on. It must be really tough to break through that from a self-esteem.

Thilo Beck: Definitely feels overwhelming and difficult to break free of and to go your own way. That can be scary.

Emotional Neglect

Jan Gerber: That overwhelming feeling, let’s talk a bit about how we see members of such families, how we see them coping in maybe not-so-healthy ways that eventually lead them down the path of seeking treatment or therapy. How do you deal with that when you’re 10, 15 years old or coming of age and you are always the son or daughter of?

Thilo Beck: First of all, you feel the pressure to be as good or even better than the person you’re compared with. And that creates a lot of pressure not to fail and to be perfect, right? I think then the question is how people deal with pressure, and there are different ways to cope with that.

Jan Gerber: Is that possibly a reason why all things equal and we see more substance abuse issues in both ends of the socioeconomic spectrum versus the general population instead?

Thilo Beck: Definitely. I think substance use is a coping strategy, right? It’s either to feel better or to deal with overwhelming stress or other uncomfortable feelings, emotions, or thoughts. We see that on both ends, for sure.

Jan Gerber: Let’s jump a bit back and forth. But one particular thing I’ve been interested in, and I’ve been asked a lot, is in many of these wealthy international families, schooling is a big topic, often with the best intentions for the parents; they want the kids to have a better education than they were able to enjoy themselves. There is an offering of elite, academically, quite reputational boarding schools around the world. But what does it do? Again, all things equal, the different characters. But what are the risk factors, let’s say it that way, when a kid goes to a boarding school, and what difference does the age make? Because there used to be early boarding, which is now not so popular anymore, I think. But still, what does it do that they let a 12-year-old or 14-year-old be away from home?

Thilo Beck: I’ve seen kids who really thrived, benefited from this additional input, and grew with it and others who suffered and got lost and didn’t find their way there and just suffered.

Thilo Beck: I wouldn’t generalize that because that’s a very individual thing. I’ve seen kids who really thrived, and they benefited from this additional input and grew with it and others who really suffered and got lost and didn’t find their way there and just suffered.

Jan Gerber: There’s no one-size-fits-all when it comes to boarding school?

Thilo Beck: Definitely not. I think it’s important to see how your child fares with it and whether they get along with this in this system. Really, some of them enjoy it and benefit from it.

Jan Gerber: I reckon it can also be nice to step out a bit of certain family dynamics or certain exposed environments into your own world where you can actually develop your independent character.

Thilo Beck: It can be an enriched environment with important new inputs and learning fields. I really wouldn’t generalize that.

Jan Gerber: But would you agree then that it’s important to… I don’t know, maybe have a bit of a pre-assessment in a way to see if a kid could be particularly vulnerable to the boarding school and to particularly pay attention the first weeks or months, how somebody is faring to filter out somebody who would really possibly get damaged?

Thilo Beck: I think it’s good to check in regularly and to see how the kids are doing. It’s about how they feel at boarding school. But then again, what is also important is that they have the feeling that they can come back to a healthy family environment.

Jan Gerber: So, to avoid an experience of abandonment, I think that’s crucial, right? I once heard about a concept called boarding school syndrome when I attended a lecture on mental health of boarding school kids and the notion was a combination of abandonment trauma and imprisonment trauma, limiting freedom because some of these boarding schools can be quite destructive.

Thilo Beck: How good is the school, and what’s the family providing? I think if children know there’s a family back home where I’m looking forward to coming back to and who is waiting for me and looking forward to me coming back. It makes a big difference. That helps a lot.

Jan Gerber: And not feeling like you’re being pushed away to a school you’re uncomfortable in or that you’re a nuisance. We’re actually happy for you to be away; that can trigger abandonment issues that can sometimes go through a lifetime as an adult.

Thilo Beck: Absolutely.

The Importance of a Purpose

Jan Gerber: Abandonment can be, we talked about that, emotional neglect when raised by nannies or relatives. Can that trigger an abandonment trauma?

Thilo Beck: Absolutely. Children who grow up in a family where they feel isolated and left alone that is severe trauma, I think. That’s prolonged trauma, chronic trauma. And that’s what we afterwards see as complex trauma.

Jan Gerber: With all the implications it has on various mood disorders, self-medication and so on, that we then clinically therapeutically try to untangle. But it can often be traced back to early childhood or generally to the growing-up experience.

Thilo Beck: In such difficult circumstances and challenging circumstances where children are not seen and heard by the family and grow up on their own, right?

Jan Gerber: When we talk about mental health and wealth, the intersection of the implications of significant wealth on mental health, there are few other notions that we seem to come across regularly and people ask about.

Jan Gerber: When we talk about mental health and wealth, the intersection of the implications of significant wealth on mental health, there are few other notions that we seem to come across regularly and people ask about. One of them is boredom. We talked about that a bit in a sense of lack of structure, but boredom maybe on a more meta level. What does significant wealth do so that you can basically fulfil most of your material wishes, without having to save for it, without feeling possibly guilty, if you spend money on something and then you just leave it on the side, you don’t enjoy it, that can lead to significant boredom. It’s like, what do I do with my life? What brings me pleasure is, I guess, a different question when you have a lot of time on your hands and a lot of buying power.

Thilo Beck: Well, I think that’s very similar to what you experience when you use substances. It’s just stimulation without much of a purpose, or you wouldn’t get any results that would be the purpose of that. And that’s frustrating, right? So it’s just passing time and not really satisfying. And it’s frustrating. And so you have to do more and more and more, but you wouldn’t feel really good about it. And that’s what we often say. That’s not the way people want to live, actually. All human beings have the need to have a purpose, I think. And that’s underestimated, I think.

Jan Gerber: I think it’s ironic because, in a way, the entertainment world, the media world, it’s idealized, just to have a life of leisure. You can chat around the world, you can shop whatever you like, you can attend parties and do anything. You don’t have the responsibility to show up for work. In a way, that seems to be idealized ever since at least movies exist and now with social media and so on. In a way, it’s ironic because it seems to me that a lot of people who then get into that lifestyle or are born into that lifestyle with a lot of possibilities - they don’t know, nobody tells them, nobody teaches them how important purpose, structure, and also work is and also adversity and hardship and stressful times as we all experience. When at some point we have to get a job to pay our bills, we have to pass exams at school, and so on, that all form us in a way, and when we see through a difficult period or event, then we feel fulfilled, we feel a sense of achievement. But it seems to be, is it human nature or is it more conditioning because of these movies and social media and so on that if we are not told and have the possibilities, we tend just to let things go because it brings us pleasure? What does it have to do with that?

Thilo Beck: I think somehow it’s an illusion we might always carry with us, the thinking that paradise would be to be happy all the time and to have all needs fulfilled. But I think if you think about this, this is terribly boring. If it’s always perfect and you’re always happy, what is life about then? I mean, we need to have these fluctuating moods, and we need to have times when we feel better and others when we suffer or go through hardship. That’s part of life. Life can’t just happen on the happy signs. That would be terrible.

Jan Gerber: But intuitively, and I guess it comes a bit with life experience to be able to make that statement and feel it. Because intuitively, naturally, I think, and again, especially for younger people, that seeking happiness and often confusion of happiness and pleasure and avoiding pain and discomfort seems to be an intuitive way to go.

Thilo Beck: Well, I think basically it’s more that’s avoiding the core or the essence of life and trying to lead a life that doesn’t come with challenges. But then people, I think, realise quite quickly that there is something missing. We need to have challenges, and we need to have the opportunity to grow and to practice, to learn. That only comes when we also challenge ourselves.

Jan Gerber: In a way, ironically, because when somebody has material privilege to seek such a lifestyle, then the problems come automatically, right? That’s also why we see clients coming through our door, often from the outside or the out-group or people who are not living with that significant wealth; there’s often a misconception that money buys happiness. And if you can afford everything, then that’s absolutely wonderful.

Thilo Beck: Money is not the answer, and money is not the solution. It can be a problem in that way, I think.

Culturally Competent Care

Jan Gerber: Let’s talk about culturally competent care or how, as clinicians, yourself as a psychiatrist, here we work with teams of psychologists, counsellors, various people who help a client, a patient heal, in how far the specific experience, modalities, mindset of the clinician matter in order to be able to really provide the best possible care for that demographic? Question short, can any trained clinician equally provide the best possible care for anybody from anywhere on the socioeconomic spectrum? Or do we need specific know-how or approaches, insights, and experience with a wealthy clientele?

Thilo Beck: I think experience helps to know the environments that these people live in and to understand the challenges and the problems that might come up with it, to know what they are talking about and where they’re coming from, that helps. But I think the most important is to be open and to be open and to understand what client we have to work with here and whether this is from the super wealthy spectrum or from the other side; I don’t think that makes much of a difference. It’s about understanding the individual you’re working with at the moment and only intervening when you really know what this person is about to have a bond with this person and know together what you want to work on. I think for this process, it doesn’t really matter what the background is. It’s more to be really respectful and to be truly interested and to understand what this person is about. Sounds trivial, but I think in psychotherapy, therapists often have this one-size-fits-all approach; they think I have a method, and I work with this method, and the client has to fit into the method in a way. And that’s what we have learned here. We really try to design the treatment for every individual client and use different methods, different parts from various methods, and put them together according to the needs of the individual client. So it’s really important to take the time to understand this person and before you start to treat them.

Jan Gerber: To understand their, not just their psyche, but also their reality, their understanding of reality, which includes dynamics in the family, their environment, their view of themselves.

Thilo Beck: To get the whole picture. And only then can you plan interventions or come up with suggestions for therapy.

The Role of Stigma in Mental Health Issues

Jan Gerber: We started out by you saying that it’s a stigmatised population in a way. So, stigma often comes with shame. And do we see with a wealthy clientele, is that a particular issue or is it with everybody else? I’m asking it particularly because for some exposed individuals or families, reputational consequences if they or a family member struggles emotionally or more significant consequences than you might have from somebody on the other side of the socioeconomic spectrum?

Thilo Beck: I think the stigma is more the pressure you feel to fulfil a role. You might doubt yourself whether you are fit to live and know that people think that you must be happy and perfect. And that’s a lot of pressure. And behind all of that, ask yourself, Well, can I really do that? I think the stigmas did the expectation to be on the top, right? And to be the best and to have no problems.

Jan Gerber: When you perceive this as an affected person, and you feel not up to it, that can create a significant gap, dissonance.

Thilo Beck: A lot of pressure and suffering and hardship.

Jan Gerber: For a patient to feel heard and seen and respected for their reality and their experience.

How to Build Trust in Therapeutic Relationship

Jan Gerber: When working therapeutically or engaging therapeutically with a client who knows that they’re, you’re a psychiatrist, we are clinicians, and they know what they’ve achieved and how we might perceive them, the therapeutic dynamic, the trust that has to be built, is that different? Is it more challenging, or is it similar to providing therapy or, again, treatment in a therapeutic process with somebody from a different socio-economic group?

Thilo Beck: I think, in many ways, it’s very similar. It’s the same process to open up to somebody and to have enough trust to open up. You have to build that trust first and take the time to do that. And that’s what we do here. We really take as much time as it takes to get to that point before we start doing therapy, as I said before. I think that’s a general principle in psychotherapy. For a patient to feel heard and seen and respected for their reality and their experience. We give every single client we have here the space and the time to express themselves and to share with us and then develop hypotheses and theories about what should be done.

Jan Gerber: You mentioned time a lot. It seems that time for a productive therapeutic process is in a way of the essence. Time is money is something we often hear. It’s in the public health sector, particularly, there’s a certain amount of capacity for therapists and also what the insurance or the state pays for. Do you feel that’s an issue? That when you have one session a week or one session every two weeks, 45 minutes, does it just take longer to get to that spot? Or is it even impossible to get to a certain point therapeutically compared to when you have several therapeutic interactions a week?

Thilo Beck: Well, my feeling, what I’ve experienced in this setting here, is that we see amazing progress with this intensive approach where we work as a coordinated team on different levels in the same direction. And that we see effects we wouldn’t see in a regular treatment setting, not as quickly and maybe some of them not at all. Because I think we can reach the client on all these different levels, and they all interact. And so that results in a much greater effect in the end.

Jan Gerber: Working as a team, also different individuals have a bit different approach, different insight, maybe different accessibility to client specific issues and then complementing that, coordinating that together, it’s faster.

Thilo Beck: Yeah, it all adds up. So we get much… You see amazing effects out of this coordinated approach, and it all adds up one to the other. So, the one and one results in more than two.

Jan Gerber: Is that experience to work in this environment approach as a clinician, is that very different for you than, you know, when you work one on one in, you know, therapeutically with a client? Like, how do you compare the experience?

Thilo Beck: I think it’s a much broader view we can take on the on the client. And because all the people working here and the team, they have their own expertise and they have different angles. And when we share this all together, we get a much better understanding of the client, and we can intervene in a much better-informed way. So we have results we wouldn’t get otherwise. That’s really amazing to see.

Jan Gerber: And it seems to me, and I’m interested in your thoughts there as well, in between therapeutic sessions in this intensive treatment program, there are other treatment modalities that help to integrate, to reflect, also to relax. It’s kind of all carefully choreographed. And for somebody who doesn’t have access to an intense treatment environment or coordinated treatment environment like that, do you feel that there’s something that could be done easily for people to benefit more in psychotherapy? Let’s say if one session today, if another session in one week or two weeks like the in-betweens, the integration, the carrying forward or what comes out of the therapeutic session when you just walk out of the psychiatrist’s office, you’re on your own again.

Thilo Beck: That’s what we do very well. We’ll call it regular psychotherapy. We try to give homework to sort of things to practice or to think about between sessions. But still, it’s a much more intense setting we can create here where we stimulate the client constantly and also give enough time to process. But it’s really individually adapted to get the best result.

Jan Gerber: I just imagine, you know, somebody engages in psychotherapy or seeks psychotherapy, they’re not in a good place, at least initially. And when you’re on your own, and you get homework, and you should practice, but you feel really down and don’t have the energy, it’s much harder than if you have somebody who just, you know, kind of tries to motivate you or if you have a structured program.

Thilo Beck: It’s a setting that holds. And I think that’s what we see here and the feedback we get from the clients that they really feel at home. It’s like being in a family, and they feel cared for, and that creates an environment where people can learn and grow. So I think that’s a very important aspect to give our clients this feeling of being in a safe place and being cared for.

Jan Gerber: Especially in those first weeks of any treatment, that can be quite painful and tiresome. So, feeling left alone in between therapeutic sessions can be quite tough.

Thilo Beck: Absolutely. That’s really one of the key points, I think, of this treatment approach that we use every single moment to support the client on his or her journey and are able to adapt the treatment and use every single second and for this purpose.

Importance of Social Connections

Jan Gerber: And maybe last but not least, let’s talk about the importance of family, and I’d say peer network, but particularly family. When somebody goes to treatment at a clinic such as Paracelsus Recovery, they leave their home environment. They engage in quite an intense journey, often very transformational. And the family stays at home. You know, maybe they communicate, but they don’t really embark on the same journey. What are the risks, you know, when a client goes back home, how do we best mitigate that possible gap, and what can be done if family members are not really willing to engage? Which we sometimes see as well.

Thilo Beck: I think one way how we deal with it is with these family weekends that we invite family members in and share the work that has been done and the progress that has been done and anticipate together and look forward and think what can every single family member do to support the client and also to grow as a family and to give them a new a new direction here as well. And I think that’s really important and must be considered. That’s why we also offer aftercare to sort of support this process after the end of the program. To send somebody home with the client to help to…

Jan Gerber: Yeah. That integration can be almost as important as the treatment experience itself.

Thilo Beck: Otherwise, the progress might be challenged or frustrating because it’s not supported back home.

Jan Gerber: Sometimes, we also see clients come from a more dysfunctional family where a lot of the family dynamics and problems are projected onto one individual.

Jan Gerber: So that support from back home, part of it probably comes from, you know, not understanding what’s what’s going on or the journey a family member has been on. And we can mitigate that by involving them with educational work, with family therapy and so on. But sometimes, we also see clients come from a more dysfunctional family where a lot of the family dynamics and problems are projected onto one individual. And it’s difficult to engage, you know, the family on a, let’s say, productive level for that patient’s return home. And what do we do then when we realize that there’s only so far we can get with the family?

Thilo Beck: First of all, we try to get the family on board and to make it their mutual journey. And if this doesn’t work, then I think we have to strategize, strategize with the client, how they can go on their own journey and have their own life and care for themselves without the support of the family in that way and how to draw boundaries as well and to protect themselves, so to speak.

The Importance of Boundaries

Jan Gerber: We’re running out of time soon. But you mentioned boundaries. So one thing I would like to touch upon how does one hold boundaries if your father is, you know, this uber-successful, powerful, sometimes very dominant figure, and you financially depend on them, your family name, your reputation, everything is kind of dependent or entangled with the patriarch. That’s something we sometimes see. What do we advise to somebody with regard to boundaries?

Thilo Beck: There’s not much you can advise in that way. It’s about growing into another role, and that takes time as well. And to learn that you yourself are a valuable person and to develop self-compassion and to be proud of yourself as the person you are, and totally realizing that you will never be the same success as your father might be, but still be proud of yourself.

Jan Gerber: Or maybe realizing that success is relative, right? It doesn’t necessarily make you happier or a better person if you achieve the same, you know, material or career success, but it’s very individual. And to find your own purpose.

Thilo Beck: And to be proud of that and to say, well, I might not be the same, I might not go the same way as my father or as my mother did, but my way is still valuable.

Jan Gerber: It’s not less valuable. I think that’s important. Self-compassion and self-respect which can translate into self-esteem. Based on that, one can nurture purpose. Thank you, Thilo; that was a very interesting exchange.

Thilo Beck: Okay, thank you for having me. It was interesting to discuss.



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