Tips for Talking to a Loved One Who Struggles with their Mental Health
Written by Michelle D Sherman, PhD, LP, ABPP and DeAnne Sherman
When you love someone living with a mental health condition, it can feel important, but sometimes difficult to show up and offer support in a way that’s helpful to them and takes care of you. Keep reading to learn more about strategies recommended by a licensed mental health professional and advocate.
Photo by Anastasia Vityukova on Unsplash
Strategies for Communicating with a Loved One Who Struggles with Their Mental Health
Loving someone who struggles with their mental health can be a challenging, demanding experience. When your loved one is doing well, you may feel hopeful; however, watching them struggle can be truly painful. Your own journey may parallel their unpredictable ups and downs. You may invest a lot of time and energy in supporting your loved one, and it may be easy to neglect your own feelings and needs. Finding ways to communicate effectively with them can be incredibly difficult.
Psychologist Dr. Xavier Amador and colleagues have written about the very important role of meaningful relationships for people living with mental illness. Dr. Amador encourages families to lean into building and strengthening the bond—which can help sometimes difficult conversations such as taking medications, getting treatment, household chores, etc. He created a communication program of helpful skills for families on how to encourage their loved ones to engage in treatment. To learn more about his LEAP method (Listen, Empathize, Agree, Partner), see his book, I am not sick: I don’t need help (Amador, 2000).
In this blog, we focus on communication skills more broadly, which we also discuss in our new book, Loving Someone with a Mental Illness or History of Trauma: Skills, Hope, and Strength for Your Journey. We believe that learning to communicate effectively and keeping open lines of communication with your loved one are two of the best things you can do for your relationship.
Challenges with Communication
Communicating with a loved one managing mental health problems can be difficult. There are many reasons for this, but we’ll cover a few.
When you reach out, your loved one may:
Clam up and not talk
Withdrawing from other people – both strangers and close family members/friends—is a common part of depression for many people. It can just take too much energy to communicate, so people may pull into themselves and isolate.
Become defensive or angry
When you approach your loved one, you may hear, “Leave me alone! Stop bugging me…you’re always on my case!” Hearing such anger and defensiveness can be devastating for families who are often trying to be supportive.
Have trouble communicating due to their symptoms, such as mania or paranoia
People who experience psychosis (schizophrenia, sometimes bipolar disorder) may feel quite paranoid and fearful that others cannot be trusted. Their delusions (irrational thoughts) may tell them that you’re someone else or that you’re trying to control them. Their decision to avoid communicating with you makes all sorts of sense when you understand their delusional thinking.
When people are experiencing a manic episode (part of bipolar disorder in which they have an elevated mood, lots of energy, little need for sleep, etc.), they may have fast and pressured speech. It can be hard to follow them as they may change topics frequently. Communicating during this time can be extremely difficult, and it might actually be best to wait to talk until they’re feeling calmer (unless they’re in imminent danger).
So, given these challenges, what are some tips on how to communicate?
Effective Communication Strategies
Although communication can undoubtedly be challenging, you and your loved one can learn skills that can make a big difference.
Let’s look at two sets of skills: skills for sharing and skills for responding.
Skills for Sharing
Approach with kindness and optimism: Instead of thinking about “me” vs “you,” focus on the two of you working together as a team.
Talk in person instead of emailing, texts, or other virtual messages. Digital communication can lead to misinterpretation, as you miss the nonverbals such as tone of voice, facial expressions, and mannerisms.
Pick a good time. Try to avoid bringing up issues when your loved one is HALT: Hungry, Angry, Lonely, or Tired
Use a calm and respectful tone.
Be brief and stay in the present. Avoid asking a lot of questions.
Speak about your own feelings instead of using blaming words. For example, you might use the following formula: When you (fill in the blank with a behavior), I feel (fill in the blank with a feeling word), and in the future, I would appreciate (fill in the blank with your need)
Skills for Responding
Thank your loved one for sharing.
Listen with your undivided attention (turn off the TV and put phones aside).
Ask how you could be helpful, such as:
How can I show up for you right now?
Do you want me to just listen, offer advice, or get involved?
Important Notes about Specific Situations
Psychosis: If your loved one is experiencing psychotic symptoms (hallucinations or delusions), avoid debating or trying to convince them to change their beliefs.
Substance Use: Similarly, avoid trying to have meaningful discussions when your loved one is drinking alcohol or using drugs.
Anosognosia: This symptom involves having little or no awareness or understanding of one’s illness. Estimates are that 30-60% of people with schizophrenia and 20-40% of people with bipolar disorder have anosognosia, and it is a common reason people are not interested in treatment or stop taking their medications. It’s helpful for families to understand this symptom as part of the illness rather than seeing their loved one as “in denial” or being stubborn….and it has huge implications for communication. (See Amador’s book noted above for more information)
Violence: Most people experiencing mental illness are not violent. However, dangerous situations can occur, especially in the context of psychosis and substance misuse. Avoid trying to reason with your loved one when they’re upset. Attempting to calm them down when they are agitated usually does not work.
If you ever feel unsafe, remove yourself, your children, and any pets from the situation, and call or text 988 (Suicide & Crisis Lifeline) or 911 if there’s immediate danger. The National Domestic Violence Hotline has advocates available 24/7 to provide support and connect you with local resources. You can reach them by calling 800-799-7233, or chat via their website: www.thehotline.org.
New Resources
We have been creating resources for families managing mental illness/trauma for 20 years In addition to Loving Someone with a Mental Illness or History of Trauma, we have also written a similar book for teens, I'm Not Alone: A Teen’s Guide to Living with a Parent Who Has a Mental Illness or History of Trauma. We hope both will be helpful for families managing a broad range of mental health problems.
The Table of Contents, sample pages, and additional free resources are available here: www.SeedsofHopeBooks.com
Although the books provide a lot of information, they are also highly interactive--offering evidence-based tools, skills, opportunities for reflection, and stories from adults and teens with lived experience.
Communication: A Cornerstone of Support
As a couples therapist for 30 years, I (Michelle) know that communication in close relationships can be very challenging…and mental illness in a loved one can add to the complexity. Investing the time, energy, vulnerability, and courage into improving your communication with your loved one can reap considerable benefits for you, them, and your relationship.
“The most healing gift you can give to someone in pain is the awareness that you are honestly trying to understand what they are going through, even if you get it wrong” (Hudson, 1999).
Sources
Amador, X. (2000). I am not sick, I don't need help! How to help someone accept treatment. Vida Press.
Hudson, T. (1999). Compassionate caring: A daily pilgrimage of pain and hope. Eagle.
mORE ABOUT THE AUTHORS
Michelle D. Sherman, PhD LP ABPP (she/her) is a licensed clinical psychologist who has dedicated her career to supporting families dealing with a mental illness or trauma/PTSD. She has worked in diverse settings, including the Veterans Affairs (VA) healthcare system, private practice, and academia, as a Professor at the University of Oklahoma and University of Minnesota Medical Schools.
Dr. Sherman is a Fellow of the American Psychological Association (APA) and is Board Certified in Couple and Family Psychology. She is the editor-in-chief of Couple and Family Psychology: Research and Practice, the journal of APA’s Society of Couple and Family Psychology, and was named their Family Psychologist of the Year in 2022. She has published over 75 articles in peer-reviewed journals and has given several hundred workshops nationally and internationally. She served on the Board of the Oklahoma National Alliance on Mental Illness (NAMI) for 14 years and now enjoys volunteering with the Minnesota NAMI affiliate.
DeAnne M. Sherman (she/her), Michelle’s mother, is a mental health advocate, French teacher, and choreographer. A volunteer with NAMI-Minnesota, she gives workshops with her daughter about mental illness in the family, and mentors people of all ages in the performing arts. DeAnne's mission is to affirm, educate, and empower others; she has strong passions for combating stigma, offering hope to people who are hurting, celebrating diversity, and promoting open discussion about mental health.