Other family members often really want to help a family member with a mental illness. The challenges can be great, especially with a serious mental illness, including behaviors that cause problems for the rest of the family, worries for the person’s safety, and unwillingness of the person to seek help. Families don’t cause mental illnesses, but what they do can make a big difference in the progress of their loved one. A lot of this concerns their thoughtful choices in how to communicate.
A “CHOICE” in How You Communicate
As it happens, the acronym “CHOICE” is a good reminder of things to watch out for in communicating with a family member with mental illness. (By the way, this is also helpful with the rest of the family.)
Criticism: Criticizing often, creating stress or discouragement for your loved one.
Hostility: Frequently communicating anger or contempt in the tone or volume of your voice.
Overinvolvement: Trying too hard to change others. Doing things for them that they resist doing and/or can do themselves. Pressuring or nagging others to change. Impatience.
Invalidation: Being too quick to judge what others think or feel as wrong, immoral, or foolish before you hear and understand it. Assuming, or jumping to conclusions about, what others think, feel, or intend. Speaking for others.
Confusion: Overwhelming the person with too much information at once, especially when they are sad, stressed, or preoccupied. Speaking in complicated or poorly thought-out ways.
Expectations: Expecting too much and overwhelming or discouraging your loved one. Expecting too little and slowing change or implying criticism or invalidation.
Perfection is not the goal here, but high levels of these kinds of communication have been shown in multiple studies to increase the risk of mental health symptoms and hospitalization.
Supporting a Family Member with Serious Mental Illness
So what are the helpful ways to communicate with a family member with mental illness? I present two sets of guidelines, both of which use the acronym “LEAP”.
The first I’ll call “LEAP Toward”. This is from the work of psychologist Xavier Amador. It helps build trust and repair or prevent damage to relationships.
Listen with the goal of understanding well enough to accurately summarize what you’ve heard. Encourage your loved one to state their wishes and point of view.
Empathize, even if just with the feeling behind statements you disagree with, and with reasons change is difficult for the person.
Agree: Express agreement when you agree, diligently.
Partner on projects and tasks you both agree are helpful and where the person is willing to accept your help. This is a time to offer extra resources and support.
The second LEAP is a “LEAP Forward” that can help encourage your loved one’s motivation to change.
Limits: Ask for change in the behaviors that affect you directly. Choose your battles. Use emotion words (e.g., “worried”, “sad”, “frustrated”) to express how you feel about the behaviors. Engage the person in solving the problem.
Expectations and reciprocity: Communicate clearly what you expect the person to do as part of the relationship and the household (if they live with you). Make sure these are realistic. Discuss what you are giving, or what they can expect from you in return.
Aspirations of the person: Ask about your loved one’s goals and dreams, and discuss the daily actions or longer-term steps to achieve them.
Positive reinforcement: Watch for what your loved one does that you admire or appreciate. Compliment, pay attention to, discuss, or financially reward even small steps of progress. Work to have five times more of these positive interactions than complaints or criticisms.
If your family is struggling to cope with a loved one who has a serious mental illness. You may find my all-day class for families or my ongoing group for families helpful.