Mental Health and Wealth – Jan Gerber from Paracelsus Recovery & Dr Leon van Huyssteen


But oftentimes with significant fortunes. And again I know I’m I’m talking to There’s a lot of conditions in the room
and generally we know that purpose is is something that we all need. We need a reason to get out of bed in the morning. And even if it’s reluctantly to go to an office and fulfill the job but it gets us out of bed in the morning and we go on doing something more or less meaningful when you are born into financial privilege and often it’s very very well meant by and by families and parents. You often see kids growing up knowing that there is a trust fund knowing that when they turn 18 there will be beneficiaries to to either regular pay outs or massive fortunes all at once. And which relatives the need to pursue one’s own interests to study for a career. And we see that often especially in very wealthy families where there’s one or two. Often first borns somehow the tradition has it who are earmarked to to it to pick up the family business to or to steer the family office. But other children from that family are often just handed that money and no purpose. and that’s the thing that we find very often You know So I mean I always The alarm bells for me start going off when you look at somebody’s sleep cycle and you realize they’re up till 3:00 in the morning and then go to bed and wake up in 2:00 3:00 in the afternoon because they’ve got absolutely nothing to do you know and even if dad says well you can spend your time at any of the five family yachts there’s no purpose there’s no wish no need to do that because I’ve got nothing to live for And you know most people would grow up with with how do I how do I earn my crust. How do I move from one day to the next. How do I pay my bills for these guys and girls there’s just none of that. And that leaves a sense of purpose listeners that very often gets fulfilled by seeking excitement seeking a thrill which is just a recipe for disaster with addiction usually. And when you… After seeking for pleasure which is a normal human trait. I think we are… We all do that. And when you seek pleasure at the same time try to fill a void because you don’t have a purpose and then you put a lot of money into that mix it becomes very very dangerous because seeking pleasure is one thing and when you have reasonable means at your disposal when you have a massive fortune at your disposal then very quickly cars and boats and other things are not enough. and very quickly it’s about extravagant parties it’s about drug it’s about sex and when money is not an issue that curve where this just can blows completely out of proportion can happen in a very very very short period of time. A dear friend of mine he… When he was 23 years old he landed a job at a hedge fund as a salesperson No formal training. He didn’t go to university but he was you know good in speaking to people. And his first year’s bonus when he was just only 24 was twenty three million pounds and two years later he had had lost his job and sold the house in Chelsea again. That he had bought in the meantime. And he was… He went to rehab for cocaine addiction and he was completely broke and he was still getting hotel bills from rooms he hadn’t checked out in Monaco half a year before. And it’s an extreme example but I spend a lot of time with him trying to understand what’s gone through his mind and he just said there was absolutely no way I could handle this. It came from a relatively poor background and suddenly BOOM so much money and you don’t take your job seriously anymore. His colleague who got a similar bonus actually quit the job and it just went off went off partying. So it’s a it’s it’s a real real danger when you don’t have an underlying purpose that you can keep up when you’re faced with significant funds. Yeah we often when we treat somebody suggest to the parents that we’re starting with the children young looking at not necessarily succession planning but looking at how they learn to manage money you know with the usual chores pocket money etc.. What age is okay for a credit card. You know when does the trust fund pay out 18 or 21 does it pay out in one big lump sum or does it pay off in a piecemeal fashion Because very often as you rightly said These kids are just not ready for it They lived the lifestyle all their lives at once they’ve got the money themselves it goes to pot. And I think it also also very often and it’s like that the rock bottom for these clients they’re not the same as the rock bottom for people out there. People very quickly exhaust relationships exhaust their funds but these guys can carry on for a long bit longer. And by that point significantly damage reputations health relationships etc… If you’re talking about the not classic rock bottom there is another dimension. Why these guys can carry on much longer. And we get into that a little bit later when we talk about family dynamics dimension and but often there are people around bad family members bad friends bad employees and who in one way or another benefit from the dire situation of such an individual and try to cover up for them sometimes even out of a sense of loyalty that they don’t realize to actually do more more harm than good. And so… And actually the first graph I show I just briefly go back to that. Because… and the red bars that show the likelihood of somebody reaching out for help And we see it’s about the same. So even though somebody from the ultra high networth family is about three times as likely to struggle with addiction throughout their lifetime that they’re not more likely to reach out for help and one reason is exactly that is there is no classic rock bottom they can go on forever and sometimes when such people actually do reach out for help it’s because they hospitalized. It’s because their liver is sending dire warning signs. It’s because they fell downstairs the fifth time and actually seriously injured themselves. It’s not because their spouse leaves them or they’re about to lose their job so the rock bottom is a really hard one. And often happens much much later on. And quite literally some people get away with murder you know with blood money being paid they never face the consequences for their actions which was also a big big problem. But I think I mean Jan is absolutely right in the it’s a U curve the more money you’ve got the more drugs you do. But the highlight mudslide for me is just that fact that it doesn’t mean you’re more likely to seek help. I mean quite the contrary. These people are very worried about the stigma very worried about losing face in society. They are already hounded by so-called well-meaning people until they’re even more careful to seek help. And we’ll talk about that a bit later as well. Sure Because the dimension of public scrutiny. Tabloids and so on. It’s also a reality of that demographic And maybe let’s talk briefly also about isolation and loneliness. We all know the phrase it’s lonely at the top and there is a lot of truth in that when it comes to wealth. And there is several reasons for that. Some are because of the thinking and emotional world of the wealthy person themselves. and how can I know if I can trust my friend. How can I know I can trust the other school kids. How do I know I can trust the potential spouse. And if they… How can trust that they don’t have second motives for their interests in me and that makes very very very lonely. And it’s not a coincidence that we often see celebrity as couples. We see one movie star marrying another movie star and it’s because of the notion that they don’t have anything to gain from being with me or seeing with me other than me as this as a person at anybody else and you see that very rarely and I think Pierce Brosnan as an example if I remember two years ago was actually stayed with a with a… teenager or a sweetheart from his pre-celebrity years and that actually happens relatively rarely. And… it’s not just that it’s when people of wealth Are meeting possible friends meeting potential spouses it’s not just himself it’s also their family and parents that always are in their ear saying Are you sure that’s genuine. You need to be careful about that person or I heard his or her family you know has done this or or done that. And so… All of that can result really in loneliness and all we know all the clinicians in this room now. Loneliness is one of the key ingredients for mental health issues for depression for self medication of that loneliness through substances and other addictive behaviors. You used the phrase it’s lonely at the top but also very common is the poor little rich kid if you wish you are completely emotionally desolate. And I’m going to add a small anecdote to your scenario of you know can you really trust them. Are they truly your friend. I’ve looked after her family from the Middle East not long ago where a family friend somebody that’s been in this lady’s life forever had a set up allegedly set up a charity and it was only when she reached 5 million pounds spent on a house in the Middle East that they thought something’s wrong. So she actually siphoned off money from our patient If you wish and built a house elsewhere so that compounds that paranoia about loneliness that even people they thought they could trust. They can’t. And then they closed ranks even more isolating themselves. Thanks for this Liam because actually I’d like to use this moment on this very topic to make an important point and I would like to clinicians in this room and also treatment providers to to pay attention to this. And because we know that the doctors… therapists were supposed to be who should be who are trusted people of their patients and when they refer a wealthy person to treatment and it happens to us all the time they ask for a referral fee. And people from some cultures are less shameless than others but I think from every part of the world we’ve had psychiatrists we’ve had therapists we’ve had even legal counsels we’ve had family office principals with who called us we even came to meet us and said I have this client for you and I will make sure they come to you. And I know that they could really benefit from the treatment that we offer. And… but I’m asking for a referral fee. And now one thing is the ethics of that. But think about that. A client finding out that they’re trusted psychiatrists they’re trusted sometimes longtime friend got a kickback for having referred them somewhere to treatment that loss of trust that can result from that that trauma that can result from that can mean in an extreme case that this very person will not engage with treatment again will not engage into therapy again because they will rightfully so be suspecting that whoever they face might also be opening their hand for kickbacks when they’re referring them somewhere they could ultimately mean that a person ends up without help and dies. I just want that to sink in for a moment and then we can move on to another topic. Excessive in brackets financial dependence on family and parents. We’ve… We’ve touched on that a little bit already that in wealthy families. Parents all things equal Can be more likely to to interfere with decisions that that their children and teenage descendants take when it comes to career planning. What do I want to study with regards to friends and spouses and so on. And it’s hard there. Again all things equal. I’m trying not to generalize but it’s it’s harder All things equal for a kid or a teenager or even a young adult to say to the parents you know what I make my own decisions. Because they are financially dependent on the family. And. I want to give you one example there in my previous life. I studied finance and in economics in London and then I started working as a management consultant and at uni I met a young lady was in my same class and then went on to work at the same company as me. She was the daughter of an ambassador of a larger country of the ambassador to the UK and from a country where it’s normally wealthy people who get the ambassador assignments and when we started working our base salary as far as I remember was about two and a half thousand pounds a month. And I learned that her parents gave her three times that on top of it just so she could maintain the standard of living she was used to at the time I… my reaction was like You know I’m living fine so why don’t you just move into professional ??? it’s fun anyways. It’s what I’ve done. And her parents had also bought her a three bedroom unit in Chelsea and already during uni. And but now over time and having worked with the clientele for some time I really understand it’s not that easy if you’re used to a certain comfort and you have never known a different reality. It can be If you can feel the same if I ask anybody in this room to move out of their house move into a tent move it two into a neighborhood that you wouldn’t normally want to move into. And because it’s all relative. you always have to as especially as conditions. Try to think or take the perspective of your clients to really re-understand them and to try to develop empathy for their situation So it’s it can feel like shackles when you… if I may add there’s another caveat to that is that the money we know gets used to control Very often there’s also a real risk that they might be cut off and even worse that the clinicians involved in treating these people if they haven’t got experience actually advise that cutting off of the funds which is for the client completely devastating complete devastating. And it sounds sensible there’s no rock bottom so let’s give them one. It just doesn’t work it isolates them further it makes them more vulnerable and puts them through a trauma she can be a trauma of abandonment. Absolutely That happens if somebody is cut off. Yeah And. Two more points to touch on briefly on on this slide and public scrutiny schadenfreude. It’s a German word. But there is no sensible English translation schaden means harm freude means pleasure or happiness. So schadenfreude is as when when people draw pleasure or happiness from the harm that happens to somebody else and tabloids scandal stories are typical example of that. And a few years ago when I read about you know when we were reading about Lindsay Lohan going from one rehab to another rehab that was the general public reaction to it to that situation it is like you know she has it all but she’s messing up so in a way that makes me as a average person feel better. And people of wealth and particularly people of wealth who have a family name to it. that’s a reality that they are aware of. So again that’s one of the reasons why they’re not more likely to reach out for help even though they’re much more likely to suffer from mental health and addiction issues. If you remember the first slide. And another. Point that goes in ties into that is actually a fear for safety and fear for safety doesn’t only mean physical safety. So fear of kids being kidnapped or somebody you know throwing a bottle at you because they don’t agree with what you stand for but also more and more cyber security and social media and online extortion becomes a real risk again. And if you look at the average billionaire family they will have very very clear rules in place how their kids can use social media for the kids. That’s again a limitation of the freedom which again ties into all of the points that we’ve been talking about. You can add something to that. I think we the fear of being publicly shamed or seeing it happen to ??? remember that would usually be that when it happens to somebody it might even be their friends given the circles because they move in and that for many many people is a reality that they then feel the very same although they sort of relish the happening to a competitor of somebody else the likelihood that might even happen to them. That’s one point just from there and then also the whole… You know people that have in this room have looked after patients with bodyguards and entourages whenever I’m involved. Firstly I’m usually and it’s natural somewhat awestruck that you know I’m going to see one person in 15 just walking to the room. But also it’s very usual for that patient. But in my mind also very unnatural that’s not the way people usually seek help. They usually come by themselves with a concerned relative. I think it’s a very unique setting. The whole bodyguard thing that we see quite often and there’s a real safety aspect to it when I see people I often often suggest they book out the whole afternoon because we’re going to clear the clinic for them for safety. But it feels always feels somewhat artificial and you have to put that beyond you and to see the patient for who they are. I think that’s the point that we want to pick up. When we talk about the therapeutic and last point the left side is just as ADHD and it’s it’s a little side note there. But when you see self-made entrepreneurs and there is a high likelihood that they have an underlying ADHD issue and I don’t wanna go into a lot of details there but if you see some of the possible traits of ADHD behavior it does make sense when you see such a client So financially successful very very very hardworking committed to the work It more often do not make sense to ensure they get a proper a proper ADHD assessment every single self made entrepreneur we’ve had as a client Did get a positive diagnosis in the end. Do yourself a favor and have a look at entrepreneurship, ADHD see which names come-up Definitely, It’s all that Yes some very Interesting people Interesting very well-known people and bizarrely the opposite happens to… If you don’t treat the ADHD They’re at risk usually That risk of getting more and well and also a risk of loosing this their success All right, So let’s talk about your therapeutic alliance Some of the things we’ve talked about you know about the implications for… when we as clinicians work with this demographic and I think I would like to get back to the point Liam just mentioned It can be that You are meant to see one client and 15 walk into the room It can be that You are called to a hall home or hotel visit and you realized they have ??? the whole floor or sometimes a whole hotel that extreme cases and…but… there are a lot of wealthy people out there who are unwell some of them reach out for help and when you face them as clinicians You are also faced with their reality with their life of wealth and the first point there we wrote all clients are not the same to be mean with that and for me it’s a red flag when A clinician tells me that I don’t care if Richard Branson or George Clooney or anybody looks into my office I will react the same way I will treat them the same way as if anybody else walks into my office and that simply cannot be true We as human beings we do have a reaction to wealth we have a reaction to fame and and It’s our professional duty to do a justice to this reaction to acknowledge this reaction because otherwise It will be the elephant in the room because if Richard Branson walks into your office he knows that you know who he is So now we get into you know transference account transference topics I think it is very important to just acknowledge that and possibly address that you need a moment to digest especially if you haven’t been warned and for us more often when we work high profile celebrity clients We don’t know until last minute or we don’t know until we actually walk into the room or they walk into the room. Who is actually going to be sitting there and I think you’ve had this experience, you know Indeed, I think. I think just one step back from that and what Dan said there is absolutely true. They are not the same as every other client you know and when we started working together back in 2012 I remember you describing this unique bunch of people and they are. Unique in the way they live. They are unique in their spending power. They’re unique in their family dynamics. Everything is different. But it’s perfectly normal for a clinician to think he or she will sit there as therapists saying I’ll just be myself I’ll just be normal. I’ll just treat it like anybody else until they walk through your door. And I think if you can’t acknowledge that you’re already in trouble. And I will just show one story of a child that sadly died a few years ago but he was a very well-known British pop star and he walked through my door and I forgot his head. That’s just amazing Came with his wife and his sons and so forth. And then within 10 minutes he got up and he stormed out. I remember thinking that I’m going to run after him I have to talk to him something’s wrong. And I sat it out and he came back and we effectively treated him in the end. But I think it’s important to recognize that he’s George Clooney there. I’m sure most of us will be awestruck when he walks through. But we have to acknowledge that And the key in that is supervision supervision supervision. If you cannot share the fact that you were all struck something’s wrong already and then we can come to another topic that we as as clinicians often face working with that specific demographic and they can be very activating clientele that can be tremendously frustrating to work with. And and when we are asked to work with them to help them to help them deal with and process their suffering we have to always keep in mind we are dealing with a vulnerable human being. We cannot just dismiss and ignore the reality because it’s also partially what makes them and and what makes their suffering. but the reality is when when somebody of significant wealth goes to rehab when they don’t like something they can just walk out. Sometimes they even have their own plane just waiting for them and they have the means. And so the approach when you work with them either in individual therapy or as a treatment provider and I’m saying pragmatism is something you always have to keep in mind. You have to meet them where they’re at. It’s possibly a bit more diplomacy requiring all things equal than with your average client if you confront them they’ll shut the door on you. That’s a lose lose lose situation, they will lose, their family will lose. And you as a clinician also have loss. So it sometimes takes a bit more prodding around getting to know each other and building that trust and that trust is not built you know within the first therapy session. Because as we remember from an early topic people of wealth have an ingrained sense of mistrust towards anybody from the outgroup really anybody who is not as wealthy or famous as they are. And I think it’s fair to say that they are used to getting what they want. So if they don’t like what they see in front of them they’ll dismiss it and move on. And but that’s where the therapeutic rapport is so important. I mean that patient has to really believe that you there to help and if you can’t do that you’ve lost him already maybe in this context we should also briefly talk about how to deal with flattery and generosity meaning gifts meaning tips or invitations to a wedding to a gala and maybe I let you directly talked about that. I think the easy way in for me though is to think back to when I was a specialist registrar when in the mid 90s it was common practice for the pharmaceutical firms to fly young doctors all over the world for conferences. And most people that have been through medical training will now know that it’s hard to get even a biro out of a pharma firm whereas before we were literally wined and dined all over and the rules then changed the bureau changed rules and the very simple rule was that it shouldn’t be a gratuity that any reasonable doctor would be able to afford more not be able to afford on his or her usual salary. And that shifted everything. So we now get pyros but I think I think this is quite important in this clientele because the gifts or gratuities or flights or holidays or invites are way way out there. It’s something that most people wouldn’t reasonably afford and that again highlights for me supervision because it’s a very tricky situation. You get somebody, a celebrity somebody famous somebody that has a lot of money that is used to also culturally sometimes used to giving gifts just for the sake of you’ve gone to their home therefore you will receive a gift and you’ve got that difficulty whether do I accept ethically or do I insult. By saying sorry I can’t. And that might be enough to break the therapeutic rapport you might lose your patient just there. So I think again the thought comes back to supervision. I mean there are simply things that you from a monetary value just cannot accept and no GMC or NMC or BACP or BHP or BPS would condone that. And I think I think that’s very black and white. But how you approach it with the client is not. That’s where the trouble lies. And I think we’ve had situations where. If I may. You can fill in where people have accepted it initially went to supervision and then gifted to charity and told the client thereafter which is an acceptable way That might still not be good enough for that client. But I think it highlights you know, I mean any anybody in this room probably have accepted you know the bottle of perfume or you know the tickets to whatever, that would be reasonable. You feel like I don’t. I’ll mention it at my appraisal but I don’t make much of it. But when you’re being gifted you know fifty thousand pounds worth of painting or some kind of relic or cash cheque or whatever you have to go back to supervision I think and when you’re faced with that, I mean is it’s … You don’t expect it so you don’t know how to react. So you’re probably lost of words at the moment and an easy way out or a thing that I would recommend to do is Acknowledge the size or the significance of the gesture and say ah I will accept it for now but I will, It’s my professional duty, to go back, And discuss this with my supervisor or supervisory body because we do have professional standards that guide or even dictate what’s OK and what’s not OK. And then I will come back to you and we can discuss it further. So that’s a non-committal way. But at the same time you can avoid possible insult by not accepting a gift and then you actually have to go back and also do this. So and we have a few more minutes so we should talk about family dynamics that two up there is not a footnote. We put it up with family dynamics squared and because in our experience we know the family dynamics is something that we often face as clinicians as an underlying topic that’s there when you even when you don’t work with family but you work with an individual patient they have to try to make sense of those dynamics and see what needs to be addressed with the family and the squared is there because in our experience when there is significant wealth. Or fame involved and this family dynamics can take whole different complexity proportions and a force that can also be tremendously destructive not only for the family members but if you’re not careful to the therapist and a therapeutic team. If I if I can.. I think that squared is definitely supposed to be there. These are not normal family dynamics I mean usually in my experience if you if you take a family history very carefully you’d find that. .. These are often families that have fled countries that have been victimized that have been taken for a ride that have been blackmailed. And they close ranks and they look after their own. And that brings problems of its own kind. And that’s something that as the treating team We’re acutely aware of because they are very powerful often in the same vein of family of origin trauma. You’ve got generational trauma you know and they’ve looked after each other forever and they’re going to carry on doing that. And for a therapeutic team to intervene and position yourself in a position of trust is really hard because they are profoundly careful. I think that highlights what we tend to see. And another thing that we often encounter is the difficulty when the family or parents pay for The treatment of an adult child. And in Switzerland the legal age from a medical secrecy perspective is 14 years old. And then in some cultures even more so And it’s just normal that the parents take care of everything. But at same time they want to know everything. And what do you do as a therapist or a treatment provider when you work with somebody with a person, with an individual And there’s a lot of sensitive issues that you need to work through and then you have the mother on the phone you have the father waiting in front of the office and asking how did it go? What did you talk about? And it’s not just straightforward as I can tell you I have… You know this information is privileged and because there’s a real risk that the family will just pull the plug on treatment. If you’re not cooperating with us we’ll go somewhere else. So again it’s diplomacy that’s required and it’s not a clear line. It’s again pragmatism in some cultures It’s okay or it’s expected or you have to Discuss some topics with parents that you otherwise would not. At the same time that’s just what I would like to say to you if you ever face such a situation. You always have to be transparent and open to your client and say I’ve been asked to discuss this with your parents. Let’s discuss it first and then I will have to face that inquiry and do something I think for me it’s a really really tricky situation because very often it feels like it and it should be a one way street. The client tells you something and I can’t let Dad know this. And very often you find out that already knows everything. And you find that there are very very little secrets because everybody knows everything about your poor client because he or she is probably being scapegoated and been the problem for the last 25 years. And what Jan is saying there is for me crucial it’s about transparency with your client. It’s about always working with our client saying but I’m trying to engender trust between you and I. This therapeutic alliance is crucial. There are things that you may not want to share with your parents. I’m going to tell you they probably already know. And that’s really really tricky because they do financially control and they control the process and they are used to getting what they want which makes it really hard. And I think it gets very tricky but important to have Multidisciplinary meetings family meetings with the right people there. It’s also crucial And you mentioned the scapegoat. And actually, it’s a bullet point, the black sheep or scapegoating. And what does that mean now? We see that sometimes with wealthy families. So one individual one of the kids often is just really not doing well and everybody else’s attention around well-being and health is focused on that sick member of the family when they come to treatment. We sometimes encountered a situation where we realize some of family members are starting to torpedo the treatment process but that doesn’t make any sense but actually does make sense because a scapegoat is particularly in line with such entrenched family dynamics when it’s about significant wealth there’s lots of politics around it. You know who gets how much down the road and so on. It’s often convenient for a family to have somebody they can point the finger to and say that’s the reason for all our trouble. So this is something to do well especially when there’s family meetings or there’s a family therapy component to the work you do. Be aware of this when suddenly there’s crossfire. It could be for that very reason And I think to add if the treatment for whatever reason and the team’s are aware of these family dynamics the team will become the scapegoat and the focus of all the anger and the fact that you couldn’t help And therefore, you must be useless and that brings us to the last point of this presentation And just in time difficult choices for therapists and providers And we face this with common clients in the past A few times only luckily. But it does happen that… The treatment provider, the therapy team or the individual therapist becomes the scapegoat. And this can just happen out of nowhere. There are no warning signs but it’s families whose coping mechanism with the problems has always been externalizing and blaming others. And sometimes that’s why we face difficult choices for therapists. Sometimes it does more good than harm. If you as a therapist or a therapy team say we’re very sorry but we can’t help you any further because if and it’s very hard because we have the professional duty, we become clinicians because first and foremost we want to help people. but when we realize we can’t help and we then realize we are being seen as the problem or part of the problem it’s not sometimes not the right thing to do stay on board and try everything to help But to have this conversation with a client or with the family that this is not working out if there are questions we’ll be happy to answer them There’s a microphone for you I really enjoyed the presentation. Very very interesting. Thank you for the time and effort one of the things that really interested me was when you spoke about the acknowledgement of being awestruck and I was just wondering because the first thing that stuck out for me based on what you said at the beginning of the presentation as well was that it felt to me like you were almost creating the environment. That’s the problem in the first place. So I’m just wondering how will you transfer? What are some of the methods For transferring from being awe struck in this person being kind of different if you like to creating an environment where they can start to Recover and feel a part of I could probably answer that one. I think that very simple stock answer is that It becomes painful very quickly and the awestruck list goes very quickly. So although these clients present with unique family dynamics they threw out three times more likely than going public with depression anxiety and addiction. You will find that At the first consultation maybe the second you’re still a bit in awe and then very quickly the very real mental health stuff comes through and you become that collision you know you are I think that you have to take it back to Supervision always and to acknowledge that it’s there to acknowledge if somebody walks through your door that you are going to be slightly taken aback You know that they live on Instagram don’t they? Or on the news and suddenly they’re in your therapy suite. So I think it’s the acknowledgement that it happens is discussing it in supervision and the realization that it’s going to happen maybe one session maybe two maybe three but thereafter The nitty gritty mental health stuff will come through And that’s what you’re gonna be focusing on So I think supervision and and a bit of time Thank you for a great great session. I’m interested in the scapegoat element of it. And that child being the sort of valve for the uncontainable feelings for the whole family and the question is about the systemic approach and how willing these families are ultimately either because part of that child when that child recovers a whole lot of other things are uncovered and yeah that’s the question. Thank you. The crux of the matter is that when we deal with And usually rather big families we make sure that we’ve got a family therapist looking after the family away from the client to address some of those dynamics And we also have a therapist within the multidisciplinary team to look at the dynamics within the team because very often it replicates. The scapegoat a phenomenon is extremely common. You will find in most families there is the one that didn’t succeed in school or did badly so they didn’t go to university of choice and did whatever he or she pleased and very quickly all the family problems in the family’s mind come from that one individual. That’s not doing what he or she are expected to do. and you’re up to right systemic family approaches, what we do we tend to have a family therapist on board usually with a trauma perspective and we have a therapist within the treating team to explore the dynamics within the team itself. And you cannot leave them undone. I’m just thinking of one specific case where you will face situations where there is absolutely no way the family will not engage in any therapy or any sessions that they do attend to. They will just keep externalizing. So in an extreme case and I have an example in mind we switch to a different mode as a therapy provider and the mode is focus on that individual who has been entrusted to enter into our care and help that person survive. Maybe not thrive maybe not make their fullest after life but given all the limiting factors that they are and they are often just given they can’t just leave the family they can’t just move away and let’s focus on how can we help you to survive in that toxic environment. It’s pragmatism again Thank you for delivering a very good presentation in terms of what you were saying that there is no rock bottom in a sense I can continue because I’ve got almost like an unlimited runway. How do you target the client and market to them so they get the help? That’s One of the hardest things we do because you know I’ve sat with many young men young women thinking with him or her What are you doing with your life? And that’s just it. You know the sense of purpose and it’s not that you suddenly need a bevy of life coaches they just need to find which things interest them. What do they enjoy doing What do they want to do with their lives Because for many of them the succession to the chairmanships is sorted, they’re going to do that whether they want to or not but it’s finding what they enjoy. So boredom, lack of purpose are the big ones. You know these guys and girls go out and spend as much money as they want buy as many sports cars as they want as many villas as they want but they’re still empty And I think it’s that lack of purpose and that is the hardest thing for us finding something that they really want to do. And I don’t know if it was part of your question but how if there is no classic rock bottom how can we make aware that there is help and that they actually do need help? And that’s one of the reasons also why we’re here. And also one of the reasons why there is not only clinicians in the room but there are people working with that demographic. And that’s one of the missions that I am personally on as well is we need to spread awareness so when as a divorce lawyer when as as a family office principal and any other adviser a possibly even a nanny. And when you work with that clientele and you realize that is something just not right with that person or a dynamic as a whole what can I do? Who can I ask for advice? And that’s often the first step. So more often it’s either concerned family members or it’s professionals working with the family that are the first ones to raise the flag and not the individual themselves. Because again we know denial and denial takes a whole different dimension when when there’s a lot of money in the game. We are out of time. Thank you very much for having us

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