Serena Chaudhry, DSW, knows how helpful family therapy can be for those affected by schizophrenia. The clinical social worker cares for young people after their first episode of psychosis.
She sees firsthand how traumatic the experience of entering the mental health care system for the first time -- usually through psychiatric hospitalization -- can be for everyone involved.
“When they land with us, they’re often pretty disoriented, confused, and overwhelmed,” says Chaudhry, who is also public health director for the Early Psychosis Intervention Clinic in New Orleans. “That’s a reason in and of itself for why families would benefit from seeking therapy or support.”
Family therapy can help you better understand what your loved one is dealing with. It may also lower your chances of burnout. And because of your support, your loved one is more likely to:
- Stick with treatment
- Have fewer relapses and hospitalizations
- Better adapt to life with mental illness
What Can Family Therapy Teach Me About Schizophrenia?
Behavior that surrounds psychosis and schizophrenia spectrum disorders can be unusual and sometimes scary, Chaudhry says. Psychoeducation in a family therapy setting can provide a clear explanation for what’s happening and guidance for the next steps you need to take.
When Chaudhry meets with individuals or families, she shares up-to-date information about schizophrenia, including:
- What causes it
- Symptoms that might show up
- The role of treatment in recovery
She also takes time to talk through myths and misinformation about the disease and its treatment.
Laura Yoviene Sykes, PhD, is a clinical psychologist and director of the STEP Learning Collaborative, a statewide program in Connecticut that helps individuals and families affected by recent-onset schizophrenia. She’s also director of Direct Family Services at the STEP Clinic, a specialized center in New Haven.
During therapy, Sykes supports the family’s experiences and gives examples of what schizophrenia might look like in real life. For instance, she explains how certain symptoms can be mistaken for something else. She reminds caregivers that these behaviors may not be something your loved one is doing on purpose but stem from the illness. You might think your loved one is lazy when they’re not motivated, which is a symptom of schizophrenia.
“There can be more empathy,” Sykes says. “And it helps with compassion.”
Can I Learn More Problem-Solving or Communication Skills?
Chaudhry also helps families brainstorm how to respond to problems that may arise. Your loved one may have problems sticking to their medication schedule or managing overall symptoms. Or you may struggle to communicate with them.
“How do you speak with someone who’s scared of what’s going on in their mind?” Chaudhry says. “How do you speak with them effectively to help them remain calm and actually hear and engage with what you’re saying?”
If Sykes only has a couple of minutes with a family she may never see again, she stresses the power of validation. In other words, acknowledge your loved one’s underlying feelings without directly challenging symptoms like paranoia or delusions.
For example, let’s say your child comes to you frightened because they think someone is following them and tracking their every move. Instead of trying to convince them that what they believe isn’t true, you can say something like, “Wow, that must be scary. Tell me more.”
When a person with schizophrenia is already confused or feels unsafe, helping them feel understood and connected shows you’re on their side, Sykes says.
People with schizophrenia are more likely to relapse if they live in a hostile, critical, or overly emotional environment. While everyone gets upset sometimes, you may have more success defusing a tense situation between your child, their siblings, or other family members if you “keep the emotional climate in the home cool,” Sykes says.
There’s growing interest in teaching families how to use cognitive behavioral therapy (CBT) for psychosis. That’s a goal-oriented type of talk therapy that addresses unhelpful thoughts and behaviors. With schizophrenia, it can help you and your loved one:
- Figure out triggers
- Form strategies to manage symptoms
- Learn how to openly talk about symptoms such as delusions or paranoia
In line with CBT for psychosis, Sykes encourages family members to ask open-ended questions without judgment if someone with schizophrenia starts to have symptoms or lose touch with reality. For example, if your loved one thinks they hear voices and they know you’re a safe person to check in with, they may feel less stressed if they can ask, ‘Mom, do you hear that, too?’
How Do I Manage a Schizophrenia Crisis?
According to Sykes, a key part of family treatment should be coming up with a crisis management plan. Here are some questions to ask your family therapist about what to do when things escalate at home:
- When should I call 911?
- When should I call the 988 Suicide & Crisis Lifeline?
- What are the schizophrenia crisis resources in my area?
- When is a hospitalization necessary? How do I make it less traumatic for everyone?
Ask your therapist how to spot the early warning signs of a relapse and to let you know when to alert your loved one’s treatment team. You may be able to avoid a crisis if you notice the not-so-obvious signs of a relapse. “Things rarely go from 0 to 60,” Sykes says.
Where Can Caregivers Get More Support?
As a caregiver, it’s important to prioritize your own well-being and be kind to yourself. Use family therapy as a safe space to share how hard things are for you and your family. Don’t hesitate to speak up when you feel overwhelmed or have trouble managing stress and anxiety.
Sykes typically refers caregivers or other family members to individual therapists if they need extra help dealing with their emotions. But she also suggests embracing self-care strategies like mindfulness and meditation or connecting with other families for support.
Chaudhry created a support group for schizophrenia caregivers several years ago. Folks still meet regularly (now virtually), where they discuss problem-solving and communication skills that’ve helped them overcome real-life challenges in a more compassionate way.
“One of the biggest joys of my clinical career is sitting with these moms who, in my opinion, are heroes and have learned to manage a very difficult situation,” Chaudhry says. “And I hear time and time again how helpful it is for them to not feel alone.”
Ask your doctor if there’s a schizophrenia caregiver support group in your area. The NAMI Family Support Group directory is another good way to find folks in a similar situation.
Other resources that may be helpful include:
- STEP Learning Collaborative
- Psychosis REACH (Recovery by Enabling Adult Careers at Home)
- National Alliance on Mental Illness (NAMI)
- University of Washington’s SPIRIT Lab
- Clear Answers to Louisiana Mental health (CALM)
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Serena Chaudhry, DSW, LCSW-BACS, MPH, associate professor of psychiatry and behavioral sciences, Tulane University School of Medicine; adjunct professor, Tulane School of Social Work; public health director of the Early Psychosis Intervention Clinic - New Orleans (EPIC-NOLA).
Laura Yoviene Sykes, PhD, assistant professor of psychiatry; Yale School of Medicine; director, STEP Learning Collaborative, New Haven, CT.
Frontiers in Psychology: “Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis.”
Journal of Public Health Research: “Family support and adaptation mechanisms of adults outpatients with schizophrenia.”
Indian Journal of Psychiatry: “Clinical Practice Guidelines for Psychoeducation in Psychiatric Disorders General Principles of Psychoeducation.”
National Alliance of Mental Illness (NAMI): “CBT for Psychosis: Approaches Families Can Use,” “NAMI Family Support Group.”
University of Washington SPIRIT Lab: “Cognitive Behavioral Therapy for Psychosis (CBTp).”
STEP Learning Collaborative: “Resources for Families & Friends.”
Clear Answers to Louisiana Mental Health (CALM): “Resources for Family, Friends & Allies.”
