NAMI (National Alliance on Mental Illness) has a free Family Caregiver HelpLine to support caregivers. It’s only available from 10 a.m. to 10 p.m. Eastern time Monday through Friday. But it’s a start.
To reach the HelpLine by phone, call 1-800-950-NAMI (6264) and press “4.” That will connect you to a family caregiver specialist. The specialists have lived experience as caregivers for loved ones with mental illness. They are trained to offer others support, guidance , tools and strategies for dealing with your issues.
Other ways to reach the specialists are:
Texting the word “family” to 62640
Emailing helpline@nami.org
Mailing a letter to NAMI HelpLine 4301 Wilson Boulevard, Suite 300 Arlington, VA 22203
Of course, if you have a crisis situation, call 988 immediately.
NAMI Books for Caregivers
NAMI’s “You Are Not Alone” book series now includes a volume for caregivers and parents who have children and teenagers dealing with mental illness.
Child psychiatrist and NAMI Associate Medical Director Dr. Christine Crawford wrote the book. “You Are Not Alone for Parents and Caregivers” discusses how mental health conditions manifest from preschool to high school.
The book is available at Amazon, Target and Barnes & Noble. More information about the book is here.
OnDemand NAMI Basics Class
My husband and I benefited from NAMI’s Family-to-Family classes. We also gained a lot from the support groups. This was particularly helpful in the early days of our child’s schizophrenia diagnosis. Now you can get the information without leaving your home.
The OnDemand NAMI Basics Class is for parents, caregivers, older siblings and other family members who support a child or teenager living with mental illness. This free, online program gives you information and tools for navigating the changes.
You can sign up for the NAMI Basics OnDemand class here. This is a self-paced class that you can access at any time.
If you don’t know what to do, you are likely to make things worse. You must have knowledge of available resources to get the best support for your loved one. NAMI’s resources are getting better all the time. Other books and websites that helped my family are found on the Resource page.
Information is from “When Someone You Love has a Mental Illness” by Rebecca Woolis, “The Complete Family Guide to Schizophrenia” by Dr. Kim T. Mueser and Susan Gingerich and the Palo Alto Medical Foundation.
I’ve found that it’s difficult to get immediate response from my loved one’s treatment team or anyone else when my loved one is dealing with symptoms of mental illness. My first response is to call them. While I’m waiting for a response, I’ve found this advice from the sources above useful.
Responding to Hypomania
Mania and mixed states are a medical emergency, so medical help is needed. If you can’t get a response from the treatment team, consider going to the emergency room or a psychiatric emergency room.
Hypomania can be a common symptom, which your loved one may have to live with repeatedly.
The best advice for those who love them: Don’t take the symptoms personally. When in the midst of a bipolar episode, people often say or do things that are hurtful or embarrassing. When manic, your loved one may be reckless, cruel, critical and aggressive. Try to remember that the behaviors are symptoms of your loved one’s mental illness, not the result of selfishness or immaturity.
Be prepared for destructive behaviors. When your loved one is well, negotiate a treatment contract that gives you advance approval for protecting them when symptoms flare up. Agree on specific steps you’ll take, such as removing credit cards or car keys, going together to the doctor, or taking charge of household finances.
Spend time with the person. People who are hypomanic often feel isolated from other people. Spending even short periods of time with them helps. If your loved one has a lot of energy, walk together. This allows your loved one to keep on the move but still share your company.
Avoid intense conversation and arguments.
Prepare easy-to-eat foods and drinks. It’s difficult for your loved one to sit down to a meal during periods of high energy, so try offering them peanut butter and jelly sandwiches, apples, cheese crackers, and juices, for example.
Keep surroundings as quiet as possible. Avoid subjecting your loved one to a lot of activity and stimulation.
Allow your loved one to sleep whenever possible. During periods of high energy, sleeping is difficult, but short naps throughout the day can help.
Responding to Agitation
Decreasing stimulation can reduce agitation. You can encourage your loved one to try relaxation exercises, deep breathing or blocking sound using ear plugs.
Responding to Disorganized Speech
Speaking in gibberish is a frightening thing to observe. If you can’t get ahold of the treatment team quickly, you may want to go to the emergency room or the psychiatric emergency room.
Your job is to communicate that you care. Respond to emotional tone if you can see it. If you sense fear, talk about how hard fear is to deal with. If you can pick out a sentence that makes sense, you can respond to that.
When one of my loved ones spoke in gibberish, I was able to pick up the tone. I did say that I couldn’t understand what they wanted, which they seemed to understand. We were in an institutional setting so I felt comfortable with this, as I could get help if the frustration spilled over into throwing things.
As I hope I’ve made clear, your treatment team is the best source of information for how to deal with the symptoms of mental illness. If you cannot talk with the treatment team regularly, continue to educate yourself with articles like this and useful books. To see our recommended resources, click here.
Note: The information is from NAMI, Mental Health America, “When Someone You Love has a Mental Illness” by Rebecca Woolis, “The Complete Family Guide to Schizophrenia” by Dr. Kim T. Mueser and Susan Gingerich, and the Palo Alto Medical Foundation. It also reflects what I have learned through personal experience.
Some questions that I have heard in our support group include:
“What do I say when she says someone on television is sending her secret messages?”
“What do I do when he gets the locks changed because he thinks the FBI is trying to get into our house?”
“What do I do when he disassembles the pipes to find out where the voices are coming from?”
All these questions are related to delusions and hallucinations, which are symptoms of schizophrenia, bipolar disorder (in some cases) and other forms of mental illness. Three factors that can influence symptoms are inadequate medication, substance abuse, and high levels of stress. About half the people with schizophrenia have symptoms most or all the time, even with medication. Symptoms also can be signs of relapse coming.
Of course, we always point people to the experts. When problems develop, call the treatment team. But it can be hard to get in touch with a social worker or a psychiatrist, whether you have a HIPAA release or not. So I’m providing the information that I have collected and used in real-world situations as support.
Responding to Delusions and Hallucinations
People vary in their sensitivity about their delusions or hallucinations. Previous medical history is a fairly good predictor of this. Some signs that a hallucination is taking place include when your loved one is:
Talking to themselves as if responding to questions or comments, but not in a conversational way, such as: “Where did I put my purse?”
Staring into space, or being distracted or preoccupied.
Laughing for no apparent reason.
Appearing to see something that you can’t see.
Hallucinations and delusions often start out as benign, but can become more troubling over time.
People can learn to deal with hallucinations through therapy (including cognitive behavioral therapy), medication, ignoring the hallucination, telling the voices to leave them alone or playing music loudly. Shifting attention to music or television can help. Working toward acceptance through prayer also helps.
Principles to Keep in Mind
When you are dealing with a loved one who seems delusional or may be having auditory or visual hallucinations, there are some basic principles to keep in mind.
While the things they say that they see, hear or believe are not apparent to you and may not make sense, they are very real to that person. They actually hear voices and see images. They believe the things they are telling you. Do not dismiss or minimize the impact of this.Do not get into an argument about whether the voices are real.
Research shows that confronting people about their delusions may result in an initial decrease of belief in them, followed by a rebound that makes the belief in the delusion stronger. This discredits you. If you are forced to take a stand on this situation, just say that you know the experience is true for them.
People, particularly those who have been in treatment for some time, may not be entirely convinced that the delusion or hallucination is true. They know that this can be a symptom of their illness. If they check with you to see if what they are seeing or hearing is true, you can tell them that it is likely that this is a trick that their mind is playing or whatever term is comfortable for them.
Respond to the Emotional State
A variety of emotional states accompany delusions and hallucinations, ranging from pleasure to terror. It’s more important to respond to the emotional state you detect than to the content of the delusion or hallucination. Use listening skills like paraphrasing and asking clarifying questions to reflect what you hear. Ask: “What can I do to help you feel safe?”
You can ask if the person is seeing or hearing something. Try to get enough information to determine how they are feeling and focus on that.
Do not make fun of the person or try to have a lengthy conversation about the content of the hallucination.
Keep in mind that your statements may be confusing to the person as well. If a voice is saying that you are going to kill him, and you are saying everything is fine. You see the problem.
This is the second of a series on handling the symptoms of mental illness with your loved one. Next time: responding to agitation and hypomania. As always, if you can get advice from the medical team treating your loved one, use that advice instead.
Information is from “When Someone You Love has a Mental Illness” by Rebecca Woolis, “The Complete Family Guide to Schizophrenia” by Dr. Kim T. Mueser and Susan Gingerich, and the Palo Alto Medical Foundation.
The best answers for how to respond to the symptoms of your loved one’s mental illness come from their treatment team. However, I’ve found it can be hard to get answers from the team quickly. This information below is from respected sources and my own experience to help when you need to respond immediately.
Responding to Anger
First, if you are angry or upset at your loved one, separate until you can calm down. To deal with their anger, you need to remain as calm as you can, and stay in control of yourself. When your loved one is angry:
Do not approach or touch your loved one without permission.
Give your loved one an escape route out of the situation.
Don’t give into angry demands that violate your boundaries.
Do not argue with irrational thinking.
Acknowledge the person’s feelings.
Protect yourself from injury.
If necessary, call 988 to get connected to a mental health team. If you feel you are in immediate danger and can’t get a rapid response, call the police and ask for an officer trained in dealing with the mentally ill.
If angry outbursts become routine, you need to discuss this when everyone is calm and can agree to some steps. This could include:
A medication review
Venting energy via exercises, such as hitting a punching bag or yelling in a place where it won’t bother anyone.
Dealing with Bizarre Behavior
Bizarre behavior is a symptom and is often related to delusions. This can include strange rituals and OCD-like activity and unusual beliefs acted out.
If the behavior is harmless, you can ignore it if you wish. (For example, if your loved one can’t go get ice cream because everyone can read his mind at Graeter’s). Focus on positive behavior, and ignore bizarre behavior.
If it constitutes a problem (running around the neighborhood naked, doing dangerous things, damaging property, etc.), you can ask the person to stop. They may or may not be able to do this.
Focus on the consequences. Tell the loved one that the behavior may end up with them being in jail or the hospital. You can remind them of previous experience, if applicable.
If necessary, call 988. If you feel you are in immediate danger, you may need to call 911 and ask for an officer trained in dealing with the mentally ill.
Dealing with Negative Symptoms
Blunted Affect is a facial expression that’s almost blank and conveys no emotion. The person still feels emotions, but they don’t show them. Ask how they are feeling.
Poverty of Speech means that the person barely speaks. The person cannot help this. Do things together where the focus is not on talking: shopping, nature walks, movies.
Apathy and Anhedonia are when your loved one no longer enjoys activities or things. Apathy is a symptom, and not under the person’s control. At the core of this is a belief that activities will not be fun.
Acceptance is the first step. “I know he’s doing the best he can.” “He’s not lazy; this is a symptom of his illness.” “Difficulty doing things and following through are part of this illness.”
Invite the loved one to join you in day-to-day activities (grocery shopping, going to the dry cleaner, etc.).
Regularly schedule enjoyable activities (going to a museum, going to get pizza, going to a park). Lower your expectations.
Take baby steps and praise progress.
Increase daily structure.
Focus on the future, not the past.
This is the first of a series on dealing with symptoms. More to come soon.
Mental illnesses, especially bipolar disorder, schizophrenia and clinical depression, are usually episodic. Symptoms vary over time. When your loved one experiences another episode, it’s called a relapse.
You can help minimize the results when you recognize the early warning signs. Many people have a specific set of signs called a relapse signature. Knowing that in advance can help you prepare. You also can learn to tell the difference between a bad day and a relapse.
First, it’s important to know the difference between a relapse and treatment-resistant symptoms. People who experience persistent symptoms even when the illness is stabilized have treatment-resistant symptoms. When a person’s symptoms get worse, that’s a relapse.
Before a relapse, people often experience changes in feelings, thoughts and behaviors. Those changes are early warning signs. Studies indicate between 50% and 70% of people experience early warning signs over a period of one to four weeks before a relapse.
Looking for early warning signs allows you to start working with your loved one and his treatment providers to minimize the setback. When you are the most frequent contact with your loved one, you are the person who sees these warning signs. The ill person will not be able to see them.
While many warning signs are common, individuals may have their own specific signs or “relapse signatures.”
Common Warning Signs of Relapse
Feelings of tension, anxiousness or worry
More irritability
Increased sleep disturbance (either reported or when you hear them in the night more often)
Depression
Social withdrawal (more extreme than usual, such as not leaving their rooms to eat)
Concentration problems (taking longer to do tasks, having trouble finishing tasks, having trouble following a conversation or TV show)
Decreasing or stopping medication or treatment (refusing to go to the doctor or case manager, skipping the vocational program)
Eating less or more
Excessively high or low energy
Loss of interest in doing things
Lost interest in the way they look or poor hygiene
Being afraid of “going crazy”
Becoming excessive in religious practices
Feeling bothered by thoughts that will not go away
Feeling overwhelmed by demands
Expressing worries about physical problems
The most common relapse indicators for schizophrenia are:
Restless or unsettled sleep
Nervousness or tension
Having a hard time concentrating
Isolation
Feeling irritable
Having trouble taking care of routine things
Lack of energy
Feeling sad or depressed
Feeling confused
Change in appetite
The most common relapse indicators for bipolar disorder are:
Disturbed sleep or insomnia resulting in no sleep
Talking quickly and more often than usual
Acting reckless
Feeling very tired
Feeling very depressed
An Off Day or the Start of Relapse?
Everyone can have an off day. You can feel down in the dumps with no energy. Or you can seem a little manic. If a person has had mental health problems, it’s important to consider whether this is an off day or the start of a relapse. The indicators that it is the start of a relapse are:
A cluster of changes
Happening together
Lasting over a period of time
Gradually getting worse
Following the same pattern as in previous relapses
Your Loved One’s Relapse Signature
If you are reading this, you are probably the best person to decide what the relapse signature is. Think about the last time your loved one got worse. If you keep a journal, go look at what you wrote. Things to consider include:
What was the time of year?
Did your loved one say how they were feeling physically?
How was your loved one’s mood? Ability to concentrate?
Did any unusual changes in behavior take place in the weeks before the last relapse?
Did your loved one do things that seemed “out of character” before the last relapse?
Have the same behaviors preceded other relapses?
Thinking about what was happening in the person’s life when you start to notice these changes can help, too. Many relapses in major mental illness do involve the person stopping medication, experiencing stress or abusing alcohol or drugs.
Sources for this article include NAMI.org , va.gov (U.S. Department of Veterans Affairs), adaa.org (the Anxiety and Depression Association of America) and caregiver.org. Other sources included the U.S. Department of Health and Human Services, “Identifying and Addressing Family Caregiver Anxiety” by Karen O Moss, PhD, RN, CNL; Colleen Kurzawa, MSN, RN, MFA; Barbara Daly, PhD, RN, FAAN; and Maryjo Prince-Paul, PhD, RN, FPCN. The article “Hidden from view” in Breathe magazine, issue 57, also provided insight.
Are caregivers vulnerable to anxiety?
More than one in five Americans today are caregivers, providing care and support to an adult or child with special needs. That is 21.3 percent of the population.
A study of family caregivers cited above found roughly 38 percent find their situation extremely stressful. Caregivers are a vulnerable population for psychological distress, including anxiety. In fact, the caregiver’s anxiety can even exceed the levels that their loved one’s experience. This study covered caregivers of people with cancer and dementia, but I’m sure the statistics for families dealing with mental illness are similar or even worse.
How anxious are you feeling? Are you managing too many responsibilities? Strain because you can’t control your own life? Fear for a loved one’s well-being? Deal with financial and healthcare coverage stressors? As a caregiver, you may spend many more hours a week providing care than in a regular job. Caregivers report employment problems, health issues, lack of sleep and little time to do the things they enjoy.
What is anxiety?
Anxiety is the most common form of mental illness in the U.S., affecting 14% of the population. That includes 18% of adults and 8% of children and teenagers. (These figures are from the National Institutes of Health.)
It is a common emotional response to a perceived threat, often accompanied by tension, worried thoughts and physical changes like high blood pressure and insomnia.
Severe and persistent anxiety typically has these aspects:
Extreme fear and dread, even when there is nothing to provoke it
Emotional distress that affects daily life
A tendency to avoid situations that bring on anxiety
How is anxiety different for mental health caregivers?
As we see above, anxiety can be extreme fear without reason. Caregivers for people with mental illness have plenty of reasons to experience fear and ongoing grief, including:
Fear of living life without the personality we loved.
Grief over our loved one’s lost potential and possible future.
Fear of being overwhelmed by the issues surrounding mental illness.
Fear of future pain.
Fear of losing your own identity and life.
Grief over lost plans for retirement.
Once my primary care doctor said to me: “If you weren’t anxious, I’d be worried that you didn’t understand the situation you are in.”
While some caregivers probably do have generalized anxiety disorder, many caregivers are just plain anxious. The study I read was focused on caregivers for people with cancer and dementia, but many of the aspects are the same.
I once attended a retreat for mothers of children with severe mental illness led by Kay Warren. She said: “We receive wounds of many sorts. Some forms of pain and loss we just don’t get over. A soul wound damages the architecture of the soul. What is grief, if not love persevering? The “natural order of things” and the depth of the love impact the grief.”
What are the symptoms of anxiety?
Signs and symptoms of anxiety are similar to the symptoms of depression. They can co-exist. Among caregivers, the symptoms are:
Cardiac: Increased pulse rate, chest pain or discomfort, palpitations.
Respiratory: Dyspnea
Digestive: Diarrhea, loss of appetite, nausea, dry mouth, indigestion.
Mood: Nervousness, irritability.
Musculoskeletal: Muscle tension.
Sleep: Insomnia
Skin: Sweating
Urinary: Frequency, urgency.
Do you have high functioning anxiety?
Daily anxiety can affect your health long before it affects your productivity. High functioning anxiety means that you suffer internally from anxiety without it affecting your productivity. People with high functioning anxiety may become more irritable, withdraw socially or self-medicate through alcohol use.
See if these questions reflect things happening to you:
Do you worry every day?
Are you a perfectionist?
Do you suffer from sleep disturbances and muscle tension most of the time?
Do you find that your mind is always “on the go,” preventing you from living in the present moment?
Are you tired or mentally exhausted most of the time, even after a good night’s sleep?
Do you sometimes forget what you were saying or doing?
How to manage your anxiety
Be sure that your doctor knows that you are a caregiver for a person with mental illness so they can test for and monitor anxiety. Many caregivers do not seek out help for anxiety because they are concentrating on their loved ones, giving themselves little or no care.
Remind yourself it’s normal to have fears and anxious thoughts in our situations.
Talk to others who understand. Sharing your fears to a support group helps us realize we are not alone. Therapy can help with marital problems, changed relationships or family issues as a result of the change.
Take care of your body. Caregivers should exercise, get enough sleep, eat healthy meals, take their own medications and get regular check-ups. Walking, biking, yoga, swimming and running can reduce anxiety.
Rest in God. God wants you to experience his compassion during this time. Jesus himself was overwhelmed and deeply shaken as he faced his coming suffering and death at Gethsemane. He said, in Mark 14, “My soul is overwhelmed with sorrow to the point of death.” He knows.
Increase your times of prayer, maintain regular church and small group attendance, and read uplifting materials. “Humble yourselves, therefore, under God’s mighty hand, that he may lift you up in due time. Cast all your anxiety on him because he cares for you.” (1 Peter 5:6-7)
So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand. (Isaiah 41:10)
Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid. (John 14:27)
Assisted Outpatient Treatment is an attempt to stop the revolving door of hospitalization-release-hospitalization-release for some people with mental illness. This court-ordered treatment is usually for individuals with mental illness who have a pattern of noncompliance with medication.
The first Assisted Outpatient Treatment law, called Kendra’s Law, was in New York. It became law after a person with untreated several mental illness killed Kendra Webdale by pushing her in front of a subway train in 1999.
Some form of this law is on the books in 47 states and the District of Columbia, but it’s not really available everywhere that it’s legal. Connecticut, Maryland and Massachusetts do not have Assisted Outpatient Treatment at all. If you live in any other state, the Treatment Advocacy Center can provide information about your state’s resources.
Since I live in Ohio, I am going to quote from my state’s Civil Commitment criteria (State law 5122.01 (8) (1) to (5). Mentally ill individuals can be subject to court-ordered treatment if they:
Represent substantial risk of physical harm to themselves or others OR
Are unable to provide for their own basic physical needs OR
Have behaviors that create grave and imminent risk to the rights of themselves or others.
Are unlikely to survive safely in the community without supervision.
Have a history of treatment non-adherence that has led to either:
Two hospitalizations in the last 36 months spent in the community OR
An act/threat/attempt of serious violence in the last eight months spent in the community
Are unlikely to voluntarily participate in treatment
Need treatment to prevent relapse or deterioration likely to result in substantial risk of serious harm.
A judge orders Assisted Outpatient Treatment in civil court. The judge also becomes the primary motivator due to the Black Robe Effect. Because they command respect as a symbol of authority, the judge motivates both the treatment system and the individual. Treatment usually takes 12 to 18 months.
If either the treatment professionals or the individual do not adhere to the treatment plan, the judge can:
Extend the length of time in the program.
Increase the frequency of appearance in court.
Order reviews of the treatment program.
Pick up the individual for evaluation.
Rehospitalize the individual.
Pathways to Getting Assisted Outpatient Treatment
The best way to get someone into the Assisted Outpatient Treatment program is to start talking to doctors when a loved one is in the hospital, especially if the loved one has had an involuntary hospitalization. Ask the doctor to file an affidavit with the court requesting Assistant Outpatient Treatment. Family members also can file an affidavit for mental illness treatment at the probate court.
Another good time is during a transition from jail or prison to the community. Ask the doctor at the jail to initiate this.
Assisted Outpatient Treatment works. The program began in New York, where it is used most extensively. Study results show that those in the program has a 87% decrease in incarceration, a 74% decrease in homelessness, an 83% decrease in arrests and a 77% decrease in rehospitalizations. More information is available from the Treatment Advocacy Center.
Getting a loved one with mental illness to actually comply with a treatment program … that’s hard. Here are some suggestions from NAMI, Mental Health America and others on ways to improve your chances of success.
Use the LEAP method. Listen. Empathize. Agree. Parter. This method developed by Dr. Xavier Amador has a research-tested, proven success rate. You can learn more about it on Dr. Amador’s site here. Following the LEAP method, openly discuss the loved one’s complaints about treatment and medication. Try to “normalize” medication issue with our loved ones.
Encourage injectables as treatment.When your loved one takes an injectable as treatment, they only have to make the decision to take their medicine once a month. With pills, your loved one will have to make that decision every day or, sometimes, several times a day. With injectable, the doctor knows when they don’t come in for the medicine. Cost can be a big issue, however.
Avoid calling the medication a treatment for “your mental illness.” They may take the medicine more easily if you say the medicine “helps you sleep” or “helps you deal with stress.”
Have a workable plan for monitoring medications if your loved one is not dependable about taking them. If your loved one is living with you, you can monitor the medication. Ill people may be too disorganized to do this themselves. Managing their own medication is a higher level skill for independence. Be the one to call in and/or pick up the prescription, have the pharmacy use your phone number, count pills, etc.
Educate the patient. If your loved one will agree, help them understand how medications work and why it’s important to take them.
Keep a written record of the medications your loved one has taken, the dosages, the results and the side effects. As caregivers, we are the best “historians” of the illness. This is important when our loved ones change doctors, nurse practitioners, case managers or social workers.
Get a HIPPA release OR call the psychiatrist to tell them what’s happening.
If your loved one is refusing to take medication, prepare a crisis plan. Remember that sometimes a relapse is the way for them to understand that they need help.
Medication Adherence Tips and Tricks (from NAMI)
Here are some tips for making medication adherence easier from NAMI.
Take medications at the same time every day.
Set an alarm on your cell phone.
Pair medications with something you do every day. (drinking your first cup of coffee, brushing your teeth, putting in contacts, etc.)
Put medication in a weekly pill box.
Enroll in your pharmacy’s automatic refill program. Use your phone number.
When you love someone who has a mental illness, you talk to them. Or, in many cases, you talk at them. Using elements of therapeutic communications, such as reflective listening and I statements, can make the conversations more successful.
Using I Statements
Many of us have heard about using “I statements.” This approach is less threatening to a person with mental illness, who can easily interpret comments as attacks. Rather than saying “You make me mad” or “You did a stupid thing,” you would first identify your own feelings as you express your viewpoint.
I statements usually follow this format: “I feel … when you do …”
I feel sad when you ignore me.
I feel glad when you take your medicine consistently.
I feel angry because you broke our agreement.
It’s doesn’t hurt to practice these statements with others in the family. You may find that your overall communication improves.
Applying Reflective Listening
Reflective listening is a pattern of communications that social workers and counselors often use. It can help you understand what your loved one is saying. It also allows you to comment on their statements without agreeing with them.
The reflective listening formula has four steps:
Start with a tentative opening. (It sounds like … or What I hear you saying is …) This gives your loved one an opportunity to tell you if there’s a misunderstanding.
Identify the feeling involved. The main categories are mad, sad, glad and afraid.
Use a connection word such as about, because or when.
Identify the thought you see.
So the sentence is:
Tentative opening + feeling + (about/because/when) + thought. Such as:
It sounds like you are feeling sad about what she said to you.
I hear you saying that you are feeling mad because of what he did.
If I am hearing you correctly, you are feeling afraid because your friend has cancer.
You seem to be saying that you are feeling happy because your sister is coming over.
I’m not sure I’m following you. Are you feeling ashamed about wanting to move back with your parents?
Using Body Language
Nonverbal communications is powerful. Most of the impression that someone gets from talking to you comes from your body language. When you are talking to your loved one, you want your body language to convey your caring and concern. Some ways to do that are:
Hold the person’s hand.
Make direct eye contact.
Place your hand on their shoulder.
Pat the person’s back.
Sit close to the person.
Lean forward when the person is speaking.
Ask Good Questions
Some things that you can say to keep the conversation going are:
Tell me about what happened to you.
Go on. Tell me more.
What do you see as the problem?
What do you mean when you say that?
Give me an example of what you mean when you say …
How did it feel when that happened?
I’m not sure what the sources are for this overview, as I’ve used it for years. But this is
Good communications with people who have mental illness starts with listening well. Really hearing someone’s feelings and thoughts is a great gift of love and respect.
People with mental illness could be experiencing auditory hallucinations, overwhelming feelings of depression, intense anxiety, and cognitive disorganization. So we need to avoid arguments and heated communication.
They may feel lonely, inferior to others and disrespected. You may be able to have an influence on these feelings when you demonstrate your positive regard for them. When you show that you accept them and have compassion for them, you offer hope and understanding. As a positive benefit, they may respond better to your requests.
What Not to Do: Types of Bad Listeners
This list is from Listening for Heaven’s Sake – Class Notes by Equipping Ministries International. Do any of the listeners below remind you of you? Particularly when you are under stress?
Type of Listener
Characteristics
The Interrogator
Asks lots of questions Focuses on the details Satisfies their own need to know Focuses on facts rather than feelings
The General
Gives orders Takes command or control Assumes responsibility Focuses on the outcome
The Pharisee
Blames and shames Condemning outlook Focuses on the person being “bad” Says “You should” or “You ought to” often
The Labeler
Oversimplifies problems Pigeon-holes people Believes that putting a name to it equals a solution Has a quick-fix mentality
The Casserole Person
Tries to cover over pain with food Avoids the unpleasant Expects kind actions to remove pain
The Historian
Focuses on the past Can’t remain in the present Speaks triggered memories Loses focus on the speaker
The Bumper Sticker
Gives trite answers Oversimplifies problems Is quick with clichés
Steps Toward Being a Good Listener
Relax and be calm.
Minimize distractions. (Can I turn off the TV?)
Make eye contact unless it is threatening.
Discuss one topic at a time.
Ask for opinions and suggestions.
Don’t take it personally when it’s the illness talking.
Avoid bringing up the diagnosis.
Don’t use sarcasm.
Speak simply and directly.
Next time we’ll discuss the basics of therapeutic communications: using reflective listening and I statements.
