Helping Patients Learn How to Say No To People They Love

is self-efficacy an antidote for burnout for therapists?Boundaries are one of the most common issues that bring patients to therapy. Whether bad boundaries have directly or indirectly had a negative impact on their mental health, it’s common to trace things like exhaustion, resentment, anger, low self-esteem, and even poor physical health back to an inability to say “no” when it is necessary. 

 There are many reasons why people struggle with saying no. From co-dependent patterns learned in the family during developmental years, to low self-esteem and a resulting belief that overextending is the only way to keep people around, saying no can be intensely challenging for people who aren’t used to it.

In “The Dialectical Behavior Therapy Diary”, authors and clinical psychologists Matthew McKay, Ph.D, and Jeffrey Wood, Psy.D, provide clear and concise guidelines for saying no to someone you care about that can boost your interpersonal effectiveness and create and maintain healthier relationships.

 An important thing to note about this method for saying no is that it only applies to situations with loved ones in which the patient is safe and not in physical danger. There are cases in which validating the other person’s feelings is not necessary because a loud, clear “no” is going to be most effective.

If your patient is unclear about the difference between these two situations, spend some time discussing it so that he or she have a sense of when to utilize this method and when to keep it simple and just say no.

 Step 1: Validate the other person’s feelings.

 Assuming that the client is dealing with a loved one or person they care about, this first step is all about making the other person feel seen and understood in what they’re requesting. Validating someone does not mean saying that the person is right or that you agree with him. It simply means that you let him know you hear him and understand from where he’s coming.

In the case of a mother with a son who struggles with substance abuse, she may be plagued by his intermittent requests for money followed by feeling abandoned when he disappears for weeks and months thereafter. When he calls to ask for money to pay the rent, the mother may validate him first by saying “I understand that you need money to pay the rent and that must be stressful.”

 Step 2: State your preference.

 Even though the mother in this example can understand where her son is coming from and why he is reaching out for help, she knows that if she gives in to him, she will regret it in the days after when he no longer returns her calls or responds to her text messages. Her anxiety may be heightened as she wonders whether the money she gave him really went to the rent, or if it went to feed his drug addiction. She may even catastrophize and begin to believe that he overdosed on drugs that he purchased with the money she’d given him.

Needless to say, the mother would prefer not to experience that situation. Further, through work with her therapist, she has determined that she should say no the next time her son asks for money in order to preserve her own mental health.

 After validating her son’s feelings and telling him that she understands where he’s coming from, she states her preference. “I understand that you need money to pay the rent and that must be stressful. I would rather not give you money.”

 Step 3: Depending on the situation, decide whether you want to elaborate on your preference.

 Sometimes, getting into details about why you’re saying no puts you at risk of sounding unsure about your decision or being manipulated. The mother’s son is desperate for money and will most likely push back—especially if he is used to her providing cash on demand. In her case, or any time there is an established precedent for emotional manipulation, it may be best to avoid getting into details about why she doesn’t want to give him money because in dragging out the conversation, she boosts the likelihood that he will manipulate her into backtracking.

 In other cases, though, it may make sense to offer some background around why the answer is no. For example, say a patient is purchasing a home with her partner and the partner has his heart set on something that would triple the duration of the patient’s daily commute. If the patient is willing to provide some explanation around why that house doesn’t work for her, the partner would probably be more open to empathizing, and less likely to shut down.

 Because the roots of people-pleasing, co-dependence, and bad boundaries often require some processing to resolve, having a formula doesn’t mean saying no will instantly become easy. But having a clear idea of how to say no can be a good first step toward starting to put it into regular practice.

Helping Patients Learn How to Say No To People They Love

Jessica Dore

Jessica Dore is a behavioral science and spirituality writer with several years of experience in clinical psychology publishing. She blogs weekly about tarot cards and psychology on her website In her free time, she is a devoted ashtanga yoga practitioner, food enthusiast, and DJ. Follow her on twitter @realJessicaDore.


APA Reference
Dore, J. (2018). Helping Patients Learn How to Say No To People They Love. Psych Central. Retrieved on August 10, 2020, from


Scientifically Reviewed
Last updated: 2 Apr 2018
Last reviewed: By John M. Grohol, Psy.D. on 2 Apr 2018
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