In my practice I have seen several clients with schizophrenia. In that time I have noticed that a good majority of the therapy and psychoeducation is also needed for the family and loved ones of the person with schizophrenia. I cannot tell you how many times I hear pleas from family members that they just want to know how to help, communicate, understand and engage with their loved one but cannot find enough resources or help. The purpose of this article is to offer some understanding of the cycle of schizophrenia as well as “do’s” and “don’ts” of how to help your loved one.
Responding to Beliefs or Hallucinations
Often times your loved one with schizophrenia will express to you beliefs and ideas that are difficult for you to believe. This may come in the form of feeling they are being followed, watched, or persecuted. Our first instinct is to tell them that it’s not true or real. However, when we do this it is likely to only agitate the person or leave them feeling alone in what they are experiencing.
When someone feels this way they may began to distance themselves reducing your opportunity to help. Typically when any of us are told we are wrong about something we tend to stick to the idea more and become more passionate about proving others wrong. So don’t tell your loved one with schizophrenia that what they are saying is not true. Instead, let them know you understand that they are hearing that or experiencing that (because they are). This may not be real but it is real to them and it is happening, it’s just not happening to you. You don’t have to agree with them though or feed into it. Let them know you believe them but you’re struggling to know if the information they are receiving is true or correct. The goal here is to listen without agreeing or arguing. Don’t challenge their thoughts as this could lead to defensive thinking (just like anyone with or without schizophrenia).
You may be thinking, “So how can I help? I cannot just let them follow these beliefs and stand by and do nothing.” You’re right! While you should probably not challenge their thoughts you can encourage and guide them to challenge their own thoughts. Ask them what other explanations they feel could explain an event that happened. Ask them to think of a simpler explanation.
For example: let’s say they express someone is trying to send them messages through TV shows. Validate their feelings and then ask them if there are any other explanations without dismissing their current explanation. Let them know you are not disregarding their reasoning or belief but that you should also explore other reasons such as some shows have common themes, when we expect to see something we see it everywhere, etc. Therapy is a great place to start this type of challenging of intrusive thoughts setting you up for more reception from your loved one when you try it at home.
If trying to guide them to challenge the thought is not working that’s OKAY. You can focus on showing empathy for what they are feeling due to the hallucination or belief. Ask them how they are feeling and coping and let them express their feelings. Just like you would for anyone going through a difficult time. Remember, to them this is real and it is affecting them. Sometimes the best thing we can do for someone is just be there for them and let them talk about their feelings.
Decreasing Urgency or Intensity
Through my years of working with individuals with schizophrenia I have noticed that hallucinations or beliefs will often lead them to feeling they need to complete a certain action. These may include purchasing a plane ticket to somewhere, signing up for something, etc. Our natural instinct is to try and stop them or talk them out of it. However, telling anyone “no” only reinforces their need or desire to do it.
So how can we stop them from following through on something that could harm them or cause more distress? Listen to them and validate their feelings and then attempt to have them put it off, reschedule the plan for later, take their time, etc. For example. If they insist on purchasing a ticket to another country because they feel they need to solve a problem over there, ask them if they can wait until they can take the time off of work appropriately so they don’t lose their job or if they can plan it out more and purchase the ticket with you later.