Persons with brain disorders can have problems with realities, be fearful, agitated and withdrawn, use poor judgment, have little motivation or empathy for you, and believe their delusions. It is difficult for family members to witness the effects of mental illness on their loved ones. Here are some tips to help you communicate with your loved one with a mental health condition.

Communicate using “I” statements.  

I feel, I think, I sense, I become, I can do, I am able to do, I feel disappointed, I am successful when…., I feel proud, etc.  Sharing with “I” statements allows the other person to hear you without feeling attacked by you. “I will” and “I won’t” are clear words, setting boundaries that can be understood by another.  When we use “I” statements, the other person does not feel threatened and can hear you. Stay focused and communicate only about the present event.   

Be like a video camera in a personal exchange.  

Mirror back to the person exactly what you hear them say to you.  Repeat their words. Some examples: 

“Ben, I heard you say you can’t sleep at night because you think the FBI is coming after you.  I know the voices really bother you. They haven’t really hurt you in the past and they won’t hurt you now. This is your brain chemistry talking.”

“Son, I heard you say you are not going to take your meds now. You know you deal with stress much better when you are on your meds.  Are you sure you want to risk having more stress again?”

“Sara, I am hearing you want to come home from rehab now. You know we didn’t do too well when you lived here in the past. I doubt I have the ability to make it much better in the present.”

“Tom, I know you believe that you are not ill and there is nothing wrong with your brain. If I were you, I would believe the same thing. It is just that we know the meds you take help reduce your anxiety and you feel less stress.”

To mirror back what you heard satisfies the other person’s need for attention.  If they feel really listened to, they may be able to lessen their inappropriate unusual behavior.  

Back off and make space for the illness to be expressed.

If you see your loved one being unusually intense with their anger, make space and back off.  Say to them, “How much room do you need to express these feelings?” Do not take their anger personally. It is their ill brain talking and it is not the person that you have known. Do not share the goal of changing your family member. Acknowledge their anger or other feelings and then you can share with “I” statements what you are willing to do or not do about the situation. Do not move forward and do not touch them. They need space.

Control only what you can, which is how you are going to handle the situation.  

Share to set your own limits. Your ill relative is  wanting limits, as their own lack of impulse control makes it hard for them to set their own limits. No one else will love them enough to help them set limits. If you feel unsafe, ask your relative to leave the premises. If they are unable to adhere to the limits, call for help from the emergency services. You are their advocate, so keeping yourself safe will help to keep them safe. 

Let go of needing them to see what you see. 

People in psychosis often have strange opinions and thoughts. Recognize the “critic” within yourself and the “critic” within them. Usually, they are devaluing themselves if they devalue you. They have a right to their opinions, even if you perceive them not assessing reality as you see it. People with brain disorders may seem really “off,” compared to your way of thinking. You might say, “I am not experiencing that, but I know that you are experiencing that at this time. It must be awful to have that be your experience.” Just let your “inner witness” observe and reflect back.

Don’t take it personally when you feel attacked or blamed; don’t defend yourself verbally.  

The person talking has a lot of psychological issues dealing with his or her illness, his or her mental or physical limitations. Their dialogue can be born out of deep hurt or anger coming from the limitations that come with their illness. They may say the anger is about you, but it actually wells up from some deep feelings of frustration or disappointment in their own self. Instead of reacting back with hurt or anger, use a wall of calm and say: “It’s really interesting that you feel that way. Let me think about it. I will consider what you have told me. I can see that you are angry. I’m sorry that this is upsetting to you. I will think about what you have told me,” and comments along these lines. Using these mirroring responses can help to de-escalate a conflict. People usually calm down when they feel heard and understood. Using these tools, we are more likely to lessen their reactivity and reduce the stress levels for our ill relative. 

Find others ways to reduce your own stress levels.

Consider seeing a therapist, attending a NAMI family support group, and taking a Family-to-Family class (our support groups and classes are free!). It takes time to adjust to adopting these communications techniques.  Do you prefer to be right? Or do you prefer peace of mind? There is a purpose to keeping things simple and staying focused on what is happening in the present moment. It is so we can de-escalate conflict and create a calm environment in which our loved ones can heal.


About the Author: Sharon Dunas is the co-President of NAMI Westside LA’s board of directors. More about Sharon.

7 Tools to Improve Communication in Families Coping with Mental Illness