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
|PEOPLE WITH MENTAL ILLNESS||YOU NEED TO DO THIS|
|Have trouble with reality.||Be simple & truthful.|
|Are fearful.||Stay calm.|
|Are insecure.||Be accepting.|
|Have trouble concentrating.||Be brief. Repeat as needed.|
|Are overstimulated.||Don’t force discussion.|
|Easily become agitated.||Recognize agitation. Allow escape.|
|Have poor judgment.||Don’t expect a rational discussion.|
|Have changing emotions.||Disregard the changing emotions.|
|Have changing plans.||Keep to one plan.|
|Have little empathy for you.||Recognize that as a symptom.|
|Believe delusions.||Ignore it and don’t argue about it.|
|Have low self-esteem.||Stay positive.|
|Are preoccupied.||Get their attention first.|
|Are withdrawn.||Initiate relevant discussion.|
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
Focuses on the outcome
|The Pharisee||Blames and shames|
Focuses on the person being “bad”
Says “You should” or “You ought to” often
|The Labeler||Oversimplifies problems|
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|
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.
The holidays can be some of the worst days of the year when your family is dealing with mental illness. Not only is it TOO DARN DARK AND COLD, but it’s also a time when expectations of being Merry and Bright can seem especially hard for your family.
Why the holidays can be hard
Having a mental illness makes you extra vulnerable to the demands, pressures and expectations of the holidays. We deal with:
- The demands of the culture, like parties, shopping, baking, cleaning and entertaining.
- The changes of schedule, which can be really challenging for a person who has a mental illness. Getting out of normal routine can lead to forgetting meds and getting self-care out of balance.
- Family functions and crowds that trigger anxiety.
- Financial stresses because your loved one is not being able to participate.
- A pronounced sense of the passing of time. Gathering with cousins, friends and family reminds your loved one of all the “normal” parts of life that seem out of reach to him.
- The noise, which can make the noise in their heads worse.
The stress can make your loved one have more symptoms. In fact, a NAMI study found that 64% of people with mental illness report that their symptoms are worse during the holidays. And that can make you even more anxious.
Make your loved one a priority in planning
Yes, you can make the holidays a little less stressful for your loved one with mental illness. Their health comes first. And you may be surprised to see that this helps your mental health as well.
Any family member who is inconsiderate or otherwise difficult to your loved one should be kept away. I banned a brother-in-law for horrible comments during a holiday dinner. We didn’t make a big deal of it; we just never invited him again. He’s now dead, and I’m still glad I did it.
Let your loved on know the plans ahead of time. Make the holiday as consistent as you can.
For you, accept that your holidays are different now. If you can get rid of your unrealistic expectations and be honest with your loved one and all the other family members, it will go better. Just remember: You can’t force anyone to be happy.
Know your loved one’s limits … and your own
Is being around family a trigger? Are crowds? You need to be aware of this.
Acknowledge your feelings. If someone close to you is suffering from a mental illness, it’s normal to feel sadness and grief. If it’s a child, a sibling or a parent, Christmas can hold a lot of memories.
Avoid feeling guilty. Around the holidays, many people want to be many things to loved ones. We don’t want to hurt anyone’s feelings. So we put pressure on ourselves. Pleasing everyone is unrealistic.
At the same time, let participation be your loved one’s decision.
Keep your routine
Try as much as possible to maintain routines like:
- Regular meals and good nutrition
- Taking medication
- Keeping appointments with mental health professionals
- Attending support groups
Think about the warning signs of relapse. If you start to see them, encourage them to retreat to a normal routine.
Help your loved one to keep her dignity. Provide a gift fund or another way to allow her to give gifts, so she won’t feel left out if she has no money.
If crowds or frenzy are a problem, encourage them to shop online. Or offer to help pick up the things they need.
Consider volunteering. The satisfaction of giving to others can help you put your own problems in perspective.
Scan every situation that’s coming up to make sure that your loved one won’t get unwelcomed attention.
Keep the celebration small and safe
Hey, it’s a good excuse to keep the unofficially crazy family members away. You want a small gathering of your own family. Period. Otherwise it’s too stressful for your loved one.
Identify what they really want to do.
Don’t overschedule. Pick and choose. If your loved one will be uncomfortable in a situation, it’s ok not to go.
Encourage your loved one to keep connected and not be isolated. Spending time with a friend or family member … even just one … can help.
Keep it short. Keep it informal.
If you have to do the Big Family Thing, let your loved one stay home. Big groups can be too much for your loved one, especially when you have to Put On a Happy Face. If you have a large family and lots of traditions, you can encourage your loved one to pick her favorites and let go of the rest.
Setting specific times for family traditions, like baking special food, decorating the house, wrapping gifts or attending community celebrations, gives the person something to look forward to.
If any of your extended family members really want to see your loved one, they know your phone number and where you live. Something private is better. And try not to be bitter if no one asks. (There’s a reason God chose you to be this person’s lifeline. Not everyone can deal with this.)
When people ask
The best answer I’ve found to the question … How is he? … is “About the same.” That’s tough enough for you to answer. So please don’t put your loved one in a situation where he or she has to answer the question.
During this time, we may find ourselves at extended family gatherings or at parties with people who do not understand the illness. Some people may be uncomfortable and not know what to say to you. Others may say hurtful things or offer cliché advice out of ignorance. It is helpful to prepare by knowing who may be at a gathering.
When the event is at your house
If you are having an event at your house, discuss it in advance with your loved one so he or she knows what to expect. Accept his limits. Accept her choices. Acknowledge his feelings.
If the person wants to be more visible during the holiday, brainstorm some things in advance. What will he say when asked how he is? What will she do during the gathering? Is there a quiet place to retreat if needed?
Work out a plan. The loved one can walk a dog, or go outside.
If someone offers to help you with any holiday preparation, ACCEPT.
Finally, don’t drink alcohol, especially if you are around family.
When you go to other people’s houses
Don’t overschedule. Ensure that the person will be able to do their regular nightly routine.
Tell the person whose home you are visiting what you may need in advance.
Go in multiple vehicles or take other modes of transportation so you can leave when you need to go.
Please don’t put yourself in a position … helping cook at someone else’s home, for example … where you can’t leave with little notice. If you are stuck, have someone … a sibling or spouse … available to get the person home if needed.
All your great preparation may result in your loved one refusing to participate at the last minute. And that’s OK.
Have yourself a merry little Christmas
When you make out your own Christmas wish list, ask for things that will reduce stress, whether it’s a massage, a day trip, a cleaning service or a gym membership.
Eat right. Avoid the alcohol. Sleep. And write out a list of things that you are grateful for this year.
Live in the now.
I also create my own holiday rituals that are 100% under my control. I celebrate Advent, with a creche, a reading plan and activities that mean a lot for me.
Advent is a time of waiting. We are all waiting for the days when our loved ones will be well, whether here on Earth or in Heaven. You can lift this thought up as you celebrate.
For Addiction, Eating Disorders and Mental Health Issues
SouthJerseyRecovery.com is a free web resource providing information about addiction, eating disorders, and mental health issues.
Studies have found that when someone with a depressive disorder abuses alcohol, both disorders are impacted and often become more severe. In the same vein, major depressive disorder is the most common co-occurring mental health condition among those with alcohol use disorder.
To spread awareness to the public, the organization recently published a guide covering depression and addiction where we expand on the connection between depression and drug addiction, treatment options, FAQs and more. You can find it here: https://www.southjerseyrecovery.com/treatment-programs/dual-diagnosis/depression/
Suicide and drinking are linked, and it is important to be able to tell when someone who drinks may be at risk of killing themselves. You can find that information here:
For Children’s Mental Health
We’re previously recommended Nationwide Children’s Health’s programs for families dealing with childhood mental illness, including the On Our Sleeves campaign. The pandemic has worsened the situation, with one in 5 children experiencing mental health issues in a year.
If you would like to learn more addressing the policies and problems that are making it difficult to help children with mental illness, visit the Collaboratory for Kids & Community Health website.
The collaboratory focuses on four main areas:
- Improving neighborhoods.
- Addressing inequities.
- Creating population health strategies to address the national shortage of providers to care for children’s mental and behavioral health.
- Developing value-based care programs for those with limited financial resources.
For Seniors and Their Caregivers
Caring for seniors, no matter how much we love them, comes with a lot of challenges, including higher levels of psychological stress. This becomes worse when the senior has mental health issues. We will be covering this issue soon on Loving Someone With Mental Illness.
Meantime, caring.com has a caregiver’s guide that covers burnout and stress, including how to identify and manage each. We also discuss respite care options and share a list of helpful resources for caregivers.
You can see them here:
If you know of other helpful resources, feel welcome to let me know. Thanks!
Even today, it’s hard for medical institutions and doctors to piece together a medical record. So it can be helpful to create your own medical treatment record for your loved one with mental illness. That way you have something ready when you need to provide information.
The excellent book “When Someone You Love Has a Mental Illness” by Rebecca Woolis suggests that your record contain information about:
- Your loved one’s level of functioning before becoming ill.
- Highest level of school attained
- Work history
- Level of basic life skills (cooking, cleaning, money management, experience with independent living)
- Social skills and relationships with peers
- Significant achievements
- Their symptoms.
- What they are
- When they began
- Worst episodes with dates
- Most effective treatment so far
- Treatment history.
- Dates of psychiatric hospitalizations
- Types of medication used and their effectiveness (with dates if possible)
- Types of therapy used and their effectiveness (with dates if possible)
- Your loved one’s level of functioning between hospitalizations and treatments.
- The names, addresses, phone numbers and emails of all members of the treatment team (psychiatrist, therapist, social worker or case manager).
- Medical insurance information.
When you are dealing with mental health professionals, you want to appear credible. You make the best impression when you are courteous and respectful of their time. Try to understand that these professionals are under constraints such as:
- Not being able to be effective with those who refuse treatment.
- A heavy caseload.
- Lack of adequate funding.
- HIPPA and other confidentiality regulations.
Even if the illness is decades long, try to go back through your documentation to create a medical record. It will probably be more helpful than the record that the treatment team has.
Loving Someone With Mental Illness is a support group for friends and families of those with severe and persistent mental illness. Meeting twice a month on Zoom, we share our stories, learn more about dealing with mental illness and pray together.
During October and November 2022, we are holding a series of conversations about things we question in our lives. This is a judgment-free space to connect and process questions about things, such as “Why did God allow my loved one to get sick?” and “Does God heal?” These discussions are part of our Alpha series.
If you’d like to join us at Loving Someone With Mental Illness, contact email@example.com.
Navigating the mental health system can be quite difficult. But once you have your loved one there, what happens?
For severe and persistent mental illness, the best practice is to use traditional psychotherapy or “talk therapy” with medication. If the brain is not functioning correctly, all the therapy in the world can do little good. So stabilizing the brain is the first priority.
What types of medication are used?
- Antipsychotics reduce or eliminate delusions and hallucinations by impacting the brain chemical dopamine.
- Antidepressants improve depression by impacting the brain chemicals associated with emotion: serotonin, norepinephrine and dopamine.
- Antianxiety medication reduces the emotional and physical symptoms of anxiety. This includes meds like Xanax and beta-blockers.
- Mood stabilizers are medicines that treat and prevent mania and depression. They are most commonly used for bipolar disorder. Examples include carbamazepine (Tegretol), divalproex sodium (Depakote), lamotrigine (Lamictal) and lithium.
What types of treatment are used?
Once the medications are working, doctors and social workers have a variety of options for psychotherapy. In each case, the person works with a therapist in a safe, confidential environment to understand their feelings and behavior, while learning new ways to cope. These types of treatment may include:
- Cognitive Behavioral Therapy (CBT) is based on the relationship between thoughts, emotions and behaviors. The therapist works to uncover unhealthy patterns of thought that cause self-destructive behavior and beliefs. Once those patterns are identified, the patient can identify them and learn to find more constructive ways of thinking and responding. Used for depression, anxiety, bipolar disorder, eating disorders and schizophrenia.
- Dialectical Behavior Therapy (DBT) combines CBT with teaching skills in mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. It emphasizes validation, or accepting uncomfortable thoughts, feelings and behaviors. The therapist helps the person find a balance between accepting themselves and changing by learning new skills and coping methods. Originally developed for people with borderline personality disorder, it is now used for other illnesses as well.
- Eye Movement Desensitization and Reprocessing Therapy has the patient focusing on two things at once: emotionally disturbing thoughts and an external stimulation, like eye movements. For PTSD.
- Exposure Therapy involves gradually exposing the patients to their phobia or the cause of their anxiety without causing them any danger. For obsessive-compulsive disorder, PTSD and phobias.
- Interpersonal Therapy focuses on relationships by improving the patient’s interpersonal functioning. For depression.
- Psychodynamic Therapy includes free association and open-ended questions. For depression, anxiety, borderline personality disorder and other illness.
- Mentalization-Based Therapy combines psychodynamic, CBT, systemic and ecological therapies. It’s used for borderline personality disorder because the illness often causes feelings of emptiness or unstable self-image. Mentalizing allows the patient to consciously perceive and understand their own feelings and thoughts. It also allows them to understand more about the feelings and thoughts of others.
- Therapy Pets help reduce symptoms of anxiety, depression, fatigue and pain.
Next time we’ll cover the best ways to work with mental health professionals and how to keep a treatment record.
An urgent public health crisis. Yes, we’ve had quite a few of those lately. But that is exactly what the U.S. Surgeon General’s office called the state of children’s mental health, starting in 2021.
It’s easy to understand why. The national statistics about mental health in children were getting worse before the pandemic. The Center for Disease Control and Prevention announced this year that more than one-third (37%) of high school students reported poor mental health in the pandemic and 44% reported that they felt persistently sad or hopeless during 2021.
And it’s not just the teenagers. ADHD, anxiety, behavioral issues and depression are the most commonly diagnosed mental disorders in children.
Nationwide Children’s Hospital in Columbus started the On Our Sleeves campaign to encourage families to talk with children about mental health issues. One aspect of this campaign is Operation: Conversation, an excellent way to start the school year.
Asking the right questions
By asking important questions and listening carefully, parents, grandparents and others can detect the signs of positive mental health as early signs of emotional problems. Some of the conversation starters include:
- Did you talk to anyone new today?
- Did anything happen at school today that you weren’t expecting?
- What’s your favorite song right now. How does it make you feel?
- What animal do you think is most like you?
- What made you proud today?
- How did you cope with hard emotions today?
- What is a problem you solved today? How did you do it?
- What do you do when you want to cheer up?
- When you feel worried, sad or any, what is going through your mind.
The free, expert-developed resources for starting these conversations, talking with kids about mental health and giving advice are found here.
Although the number of problems are going up, most parents do find indicators of positive mental health, such as:
If you hear something that worries you, you are not alone. (Information about early signs of mental illness in children is found here.) Don’t ignore it. Seek help. If you work with reputable people, you can help your child learn techniques for dealing with difficult thoughts. You also may find a brain chemistry issue so early that it can be treated, allowing your child to experience a happier life.
Columbus-area caregivers now have a free program that helps both the caregiver and a loved one with mental illness. ADAMH, Concord Counseling Services and NAMI have teamed to provide this respite program for caregivers to all Franklin County, Ohio, residents.
Please Google “mental health respite programs” to find similar programs in your area.
A respite program allows a trained professional to spend time with your loved one so you can do other things. You’ll get a three-hour block per week to yourself so you can enjoy self-care and tend to other responsibilities. Even better your loved ones with mental illness get to enjoy activities they pick and interact with other people safely, with a trained mental health professional nearby.
The mental health specialist spends up to three hours a week or 12 hours per month between 7 a.m. and 9 p.m. with your loved one. They can do activities at home or out in the community. Flex funds are available to help pay for the activities. There’s no waiting list at this time.
For more information about the Concord respite program, call 614-501-6264 or click here.