"I AM NOT SICK, I Don’t Need Help!" WITH DR. XAVIER AMADOR 5.2.21

so i want to welcome all i want to welcome all of you to mommy westside la's wellness weekend and our featured speaker the illustrious famous dr xavier amador who has written the bible for nami members across the nation how to communicate how to speak to your ill relative and he has taught all of us that we can coax our mentally ill relatives into treatment by being their friend rather than by being an authority figure and dr amador teaches the leap method of communication which is listen empathize agree and partner and he will explain to us in this next hour and a half uh why is important we reflect back delusions and hallucinations and not argue with our relatives um how do we delay giving our opinion our relatives don't need to give our opinion on everything or advice with us and uh the importance of apologizing even though you don't think you did anything wrong uh to apologize for not getting what they're talking about or disappointing our relative in some ways so in other words to make ourselves available and vulnerable and good listener this is what dr armador teaches us and it's my greatest honor to honor to introduce this incredible author and mental health advocate dr xavier amador sharon thank you very much it's my assistant asking why i'm not in nami west la so whoever contacted him please let jason know uh very happy to be here thank you for the really kind introduction uh uh i was gonna add well i'll add a couple things in just a moment to to your introduction but it's it's an honor to be here i have a lot of connections to west la and and it's it's good to be back if if only virtually uh maybe in person sometime soon uh but why don't we get started and i'm gonna share my screen i'm gonna start by sharing here a little bit and put some slides up and we'll get started and somebody asked me if it was okay to record i'm i am fine with that i'm sorry i didn't chat back fast enough so i'm not sick i don't need help um this is something i've heard you know i i was trying to count the number of years that i've been in the field first as a psychiatric aid and inpatient unit working with mobile acute crisis team then getting my phd working at columbia university being a psychologist working on inpatient units emergency rooms and i've heard many many people with serious mental illness utter these words to me i'm not i'm not sick you know and oftentimes i'd hear you're the crazy one not me uh i don't need help i don't need treatment um i'm gonna tell you uh about the first time i heard this phrase uh back when i was 21 but i want to really focus this afternoon on on leap on and sharon did a really nice uh summary of the leap approach uh it's seven communication tools that are that are designed to engage somebody who doesn't understand they have a mental illness engage them and get their cooperation and agreement to enter treatment that's the whole focus of the leap approach so when did i first hear i'm not sick i don't need help it happened in the context of my relationship with my brother henry this is a picture of of henry and myself we had just immigrated with our mother from cuba our father had been killed in the revolution and it was a very traumatic time for our family that's me driving the car and that's my brother henry looking in the window and if you can if you have a big enough screen you can see the big smile on his face i'd like to think he was smiling because he was hanging out with his little brother and i'm probably right because we were really close we really enjoyed each other we um we listened to each other we uh got each other through this very difficult period of time where our mother had asked for political asylum we arrived with really nothing and started our life in the united states together henry was uh because our father had had died in the in the cuban revolution henry was in many respects also a father figure to me although ultimately we were just really really good friends um despite the age difference fast forward from this picture which was taken in the early 1960s to 1981 it was december of 81 and i was in new york studying psychology as an undergraduate henry was living in tucson arizona with my mother and my stepfather my mom had remarried a wonderful wonderful man who i call dad and henry called me and he said javier up pick up the phone and henry says javier i killed dad you got to come home and he hung up the phone um you know i i didn't think it was possible that my kind gentle uh sweet older brother could possibly have been violent and it turns out he wasn't um i got him back on the phone it took me an hour or so and as i was talking to him on the phone he started describing a delusion he said that he had been playing the guitar and that the music had been transmitted into our stepfather's head causing him to trip and fall while out jogging and that's how he died so i knew something was was very different about henry just with that one phone call i flew to arizona and i was there with all my siblings and it was clear that henry had a number of of delusions including delusions about the devil and was hearing voices he had auditory hallucinations my siblings all gathered i remember this like it was yesterday we were all gathered in a in the living room of our parents house and one by one they pointed to me literally and verbally and said you deal with henry you're the psychologist now any of you who have studied psychology uh as an undergraduate know that you're not a psychologist at that point i think the reason they asked me or they strongly encouraged me to try and help henry accept treatment was because they knew how close we were again look at this picture and you get a sense of of the closeness these two brothers had the two of us had so i went and i talked with henry and i said you know you're hearing voices you've got these strange ideas that you killed our father it's not true you know you really need help and this went on for seven days this back and forth debate about whether or not he was mentally ill whether or not he'd benefit from seeing a psychiatrist i was first gentle and then i became more insistent i got frustrated i got a little bit into tough love with him during those seven days of debate and in the end i got him to the hospital like so many of us do by calling 911. now back then in 1981 in tucson arizona we didn't have crisis teams but i was very fortunate that the police officers that that uh responded to the call uh met me in the front yard i explained my brother's mentally ill he needs help our stepfather who just passed away you know please be gentle i don't know what i said but it was along those lines they were great they got him into a county hospital he got treatment and within really just maybe two weeks the voices were completely gone the hallucinations resolved with treatment with medication and the delusions became very muted he wasn't talking about them he wasn't sure if they were really true he did understand that he hadn't killed our father and i thought this is a miracle drug um the medication he was taking two weeks later and try to imagine a one month hospitalization which today is really hard to get sometimes it's hard to get more than a few days but after a month in the hospital i was at a family meeting with the psychiatrist the social worker the nurse his nurse and it was explained to him that you know henry you have schizophrenia you need to take this medicine and you need to take it for the rest of your life henry nodded said yes okay i understand we go home we go back to my my mother's house that night where do you think i found his his bottle of antipsychotic medication you can't talk to me right now but i i know that many or most of you are are thinking that i found it in the garbage can and that's exactly where i found it uh i picked up the bottle i knocked on his door and i said what's going on he and he said i don't need that and i said henry just hours ago in the hospital you said you understood you have schizophrenia and you need to take this medicine for the rest of your life he said well that was then this you know i don't need it anymore i was having some difficulties before this started a seven-year really the only word that that really captures our interaction is battle this started a seven year battle during which our relationship looked like this picture you know henry running away from me running away from psychiatrists from social workers who are trying to help him running away from anybody who said you've got a problem you've got a mental illness and you'd benefit from treatment he wanted nothing to do with that during this seven year period that this picture symbolizes of henry running away from people he was homeless for a while he had up to four hospitalizations every year most of them involuntary and um he didn't get treatment i mean seven years were talking close to 30 hospitalizations in and out of the revolving door he would get treated get stabilized be discharged stop taking the medication because he was certain nothing was wrong now during that same seven year period i was studying to actually become a psychologist and i ran into patients just like henry and there was one woman in particular i worked with on an inpatient unit who said all the same things i'm not sick i don't need help i just need to get out of the hospital and i was really frustrated with her i was a psychology intern and i went and i talked with my supervisor and as i was telling him the story of what she was saying and what i was saying and how i was trying to explain to her that she was mentally ill and she needed treatment my supervisor put his hand up and said stop he just said stop talking so i stopped talking and then he said no no you don't understand i want you to stop talking to her stop telling her what she needs to do start listening start leading with your ear not with your mouth and ask her what she wants and join with her on her goals kind of simple advice but it really quickly when i went back out to speak with her turned everything around i started listening i started reflecting back which you wanted to get out of the hospital you want your mother to stop calling the police on you you want a job is that right you know she was telling me these things she wanted a boyfriend and i was able to partner with her on on those four goals and with that she accepted medication she worked with me as an outpatient that's just one success story the the main point in me telling you this story before we continue is that i had an epiphany i i realized that what i'd been doing with my brother for these seven years during which he was running away from us was was was wrong it was it was you know intuitive to try to educate him and ask him to get help but it had the exact opposite result it got him angry it got more paranoid about me and it and it drove him away from treatment so i called henry on the phone uh he was still in arizona i was in new york and i called him and i said i want to apologize for all the times i told you you were mentally ill and that you needed treatment and then i made him a promise i said i promise i'll never again tell you that you're mentally ill and need treatment and i kept that promise i never again told him that he was mentally ill and needed treatment um within without getting into all the details within six months and for those of you who have read i'm not sick i don't need help uh you know the details within six months maybe maybe it was a little bit less than that he accepted treatment he accepted a long-acting injectable medication and for 18 years our relationship looked like this this is a picture of henry he's the taller one i'm the one with the jerry seinfeld haircut and if you look at his hands and the smile on his face i think that that tells you all you need to know about how we got our relationship back in the way that he was holding me and we were holding each other the paranoia was gone the anger was gone both of us were no longer angry and um importantly he stayed on medication for the next 18 years of his life he was in the hospital once for one day and it was truly a voluntary hospitalization only once in 18 years he went to a clubhouse to hang out with those mentally ill people he called them they were his friends is what he called them but he didn't see himself as a mentally ill person he accepted treatment long-acting injectable medication for 18 years not because he thought he had an illness he was very clear about it he said he accepted the treatment for me and for two other people who were really helpful to him he called them mom and pops that's how much that's how close he felt to them so he accepted treatment because of his relationships with three people my brother passed away not from his illness he passed away in a traffic accident he was actually being a good samaritan and and unfortunately tragically got hit by a car driven by a man who was not being careful or compliant with his insulin injections he had diabetes um but my main point in telling you about his passing is is that i believe if he were still here today he would still be in treatment uh and and and by the way he also had a girlfriend um i'm just remembering talking to her after his death he had two volunteer jobs he had a meaningful life in recovery so i i had this very profound experience when i was 21 29 getting my phd of a transformation not only in relationships but in helping somebody i love very much except treatment so real quickly we we hear about people in in the in the media in the press who have serious mental illness but unfortunately when we hear about them you know the headlines are all about those rare instances when people with untreated mental illness commit crimes and we hear that rather than stories of recovery this is one story i'll i'll just touch on very briefly this is a picture of margaret mary ray and most of you probably don't know who she is or who she was she was known as david letterman stalker so this is somebody who is a very good example of of someone who is seriously mentally ill and ended up getting criminalized in other words she got arrested for showing up at his his home his mansion in greenwich connecticut uh you know she she walked in and was waiting for her husband to come home she had the delusion she was married to david letterman and as most of you know a delusion is a fixed false belief you can't talk somebody out of it and when letterman came home he called 9-1-1 they arrested her she was brought before a judge and she got probation she got time in jail she never got treatment that was this is before we had mental health diversion courts uh margaret mary ray uh had schizoaffective disorder um believed she was david letterman's spouse his wife for a long many many years and never got reliable consistent treatment so this is a a story of of how someone with mental illness that's untreated can end up in our criminal justice system so here's a question i'm going to ask you to think about denial impairs common sense judgment about the need for treatment and services right if you don't understand your ill impairs common sense judgment about the need for treatment would you agree with that i'm guessing all of you are agreeing with that or most of you i actually don't agree with that if i take the perspective of my brother henry or margaret mary ray who i just told you about or roughly six million americans with serious mental illness who do not understand they're ill they have what we used to call denial if i take their perspective it's common sense to refuse treatment and let me put it a different way how many of you would inject yourselves with insulin if you did not have diabetes if you were sure you did not have diabetes would you i'm sure the answer is no you wouldn't and and the reason the first reason is because i don't have diabetes the second reason is it could hurt you and i've heard this many times from countless patients i've worked with and clients consumers that they don't want to take the medication it's just bad for them and most importantly they don't need it but are we dealing with uh denial we're not in most instances in in the majority of cases we're dealing with a a neurocognitive symptom called anasegnosia this was first described by a neurologist in 1919 so 102 years ago now his name was babinski uh anyone who's had a baby might know about the apgar score and one of the items is the babinski reflex he the other the other discovery besides the babinski reflex that is that he's known for is describing anastagnosia and this classic examples of this would be people who following stroke or other kinds of brain injury would be paralyzed but they didn't know it their unawareness it wasn't denial of paralysis it was complete blindness to their to their paralysis unawareness it was so uh severe that they would try to get up out of bed and then fall down because they were their leg was paralyzed i i've actually evaluated patients like this when i did a year on a neurology service and i it was really profoundly it was very profound to see how severe the unawareness of neurological deficits could be and it was during that year that i also had this kind of another epiphany frankly i thought boy this is exactly like what happened with my brother and so many people with serious mental illness i've worked with there's all this evidence surrounding them you know all around them that they're mentally ill they've maybe been hospitalized they've been told they're mentally ill they they have unusual experiences like delusions hallucinations and so on and there is blind to that brain disorder as these stroke patients with paralysis were blind to their paralysis to the neurological disorders um i think it's real important to know how to pronounce this word so i'm going to i'm going to give you a little a little trick because if you're talking with a psychiatrist or or a therapist who's working with your loved one and they don't know that they keep thinking your loved one just needs to develop insight it's really useful to be able to ask them do you know about anastagnosia so i'm going to invite you wherever you are on the count of three to say this out loud and you can use my my little nomik trick here one two three and nose egg nausea andosignosia um i hope you you participated in that little exercise but it is really useful and i would argue important to be able to pronounce uh this symptom of mental illness now i'm calling it a symptom i'm going to summarize and just two three minutes research on anastagnosia in people with schizophrenia and bipolar disorder this is a a slide of the dsm 5. the dsm is the diagnostic manual we use for uh making psychiatric diagnoses it's the authoritative manual on psychiatric diagnosis all psychiatrists have this psychology of social workers nurses we all use it i was asked to submit a text that reflected the research on you know poor insight or what people used to call denial and this was vetted this was discussed and and vetted by the work group in charge of revising the dsm which again is our diagnostic manual and here's what it says it says that unawareness of illness not denial unawareness of illness is typically a symptom a symptom a symptom of the illness not a coping strategy and and what what's an example of a coping strategy well denial right it's not that it's comparable to the lack of awareness of neurological deficits following brain injury termed what you might want to try to say it with me anisignosia so unawareness of illness is typically a symptom called anesignosia that's what's in our diagnostic manual for mental disorders and and still so many uh mental health professionals that you're encountering don't even know about this but you can point them to the purple book that i have a picture of up there and uh and ask them uh to have a look at page i believe it's 101 and and and read this description what what else is there this symptom of unawareness of illness like my brother had and margaret mary ray had and and i i suspect many many of your relatives have this symptom is the most common predictor of somebody refusing treatment not adherence to treatment is the term refusing treatment or if they accept it uh dropping out of treatment stopping without telling anybody it's the most common predictor it also predicts other things anastagnosia also predicts higher relapse rates more involuntary hospitalizations poor psychosocial functioning what does that mean the ability to work the ability to form intimate relationships relationships with family members also has been measured the ability to go back to school so if you have anesthesia recovery really is what the sm is saying is much much harder to achieve if not impossible i don't believe it's impossible and that's why we're going to get into the leap approach it also predicts an increase in aggression which kind of makes sense to me if people keep telling me javier you're mentally ill you're mentally ill and i'm certain i'm not i'm going to start getting angry maybe paranoid certainly upset and maybe a little aggressive it also predicts a poor course of illness and and that's measured in a number of different ways so i told you about anastagnosia some of you have read about it in in the book that sharon mentioned which i don't think is a bible by the way but but i'll take the compliment um the i'm not sick i don't need help book i so you know about anastagnosia and if you didn't i've just told you a bit about it just now um how you talk about it really matters a lot because it it reveals how you're thinking about the problem you're dealing with in your loved one uh who doesn't understand he or she is ill so i would strongly encourage you to not say things like she doesn't accept she has a mental illness because that suggests it's a decision that you know deep down inside she knows she's mentally ill but she's just not going to accept it don't say things like refuses to acknowledge he has schizophrenia i used to say that to my brother during the seven years that we argued you know why do you refuse to admit acknowledge that you have mental illness you know it's obvious that you've got this problem denies she has mental illness she has bipolar disorder i would encourage you not to to use those terms doesn't admit won't admit refuses to admit all those all those phrases uh when we use them even when we use them just talking with other loved ones who don't have mental illness we're reinforcing the idea that the person can be convinced they're mentally ill and what the research shows is that the level of unawareness the symptom of anesthesia is stable over time in other words it doesn't improve almost always not always but almost always it doesn't improve with treatment with antipsychotic medication so hallucinations improve delusions can improve just like happened with my brother but his anesthesia did not improve he never ever believed he was mentally ill yet he accepted treatment and that's where we're headed when you talk about anastagnosia um and again i think language really matters i would encourage you to say things like she cannot comprehend she has a mental illness or he's unaware that he has this mental illness unaware not denial not refusing but unaware unable to see or understand she has a mental illness or my preferences you say has anastagnosia for mental illness just like you would say somebody has auditory hallucinations or my loved one has delusions about me you could also say anne has anesthesia for the mental illness doesn't understand that that he's mentally ill so real quickly what about awareness of illness and treatment well awareness of being ill being aware that you have an illness is among the top two predictors of long-term medication adherence my brother is a perfect example of of actually he's not a perfect example of this i'll bring him up in a second um uh i'm a perfect example i i was diagnosed decades ago with major depressive disorder i take medication because i'm aware that i have this mental illness so i accept treatment i've been in cognitive therapy uh i've taken medication i'm one of those people who because he's aware of having a mental disorder accepts treatment and stays in it so what's the other top predictor do you think just pause for a moment what else would predict someone accepting treatment and staying in treatment for for years and decades now some of you might be thinking side effects the experience of side effects because that's what our loved ones tell us i don't want to take the medication because of the side effects that is not the reason the research is very clear that side effects and negative negative experience with side effects doesn't predict uh whether somebody will refuse treatment now side effects are important don't don't misunderstand me we need to address them but they don't predict refusal of of medication some of you may be thinking well supportive relationships predict uh you know some somebody's willingness to accept treatment um i was very supportive of my brother during those seven years we we argued to be debated but i told him i loved him i told him you know that my advice that he get help was based solely on my love for him i was very supportive but that didn't work you know that that led to his running away from me because i i persisted in trying to educate him about his mental illness trying to convince him that he was mentally ill the research and there's been a lot of research on this focus on therapeutic alliance on professionals working with people with anesthesia shows that it is a relationship not simply a supportive relationship but a very specific relationship with someone that can predict that person's willingness to accept treatment it's somebody who listens to you without judgment so when you say you're not mentally ill i don't i don't counter that with evidence that they are mentally ill i don't judge it so it's an active form of listening the person who respects the point of view of the mentally ill person so you know when my brother said that he had killed our father had i known what to do you know back in nineteen i probably would have gotten a lot further a lot faster instead of stumbling around for seven years arguing with him uh i told him oh henry you didn't kill dad obviously you didn't kill dad i didn't engage with him and listen to him and respect his point of view now obviously i don't want to pretend to believe that he did that and we're going to get into that as we get into the leap tools how you can honestly respect somebody's point of view even when you don't agree with it the third element of this relationship that leads to acceptance of treatment is that i the person says i'd like to see you try treatment now notice the wording it isn't it isn't um i believe you really need treatment again that's getting educational and getting educational gets the person to run away from us it's simply a statement of what i would like what i would like is for you to try the treatment to try the medication so listening without judgment respecting the other person's point of view and then you do have an opinion but you give it hum with humility you don't say you need medication you know you say things like i'd like you to try this so what do we know you know i just want to give you a summary of research on how we can engage people who don't understand their mentally ill how we can engage them in treatment what do we know about unawareness of illness and acceptance of treatment we don't win on the strength of our argument of our education of our evidence that the person is mentally ill we don't win on that we win on the strength of our relationship a non-judgmental respectful relationship so i've talked a bit about how we can just an introduction to how we can engage people in treatment and i talked quite a bit about anastagnosia and and let's circle back to antisegnosia and see if we can't have an experience together of of what it feels like to have the symptom of serious mental illness so we're going to need a volunteer uh if you look from left to right i need you to have a webcam so that we can turn on your camera and we can see you and this is very important plea please pay special close attention to volunteer for this role play uh i would like you to be married and to be currently working so you have a job right now and you're married and living with your spouse okay so if you'd like to volunteer and role play with me and and please if you've seen me do this role play don't volunteer i like somebody who's never seen it before uh click on reactions and then raise your hand and elizabeth is going to choose somebody at random uh so elizabeth you're you're on and i will stop sharing my screen i think so that you can put my face and our volunteers face up great i have brought colleen on okay great colleen can we can you unmute yourself the little red microphone button i think most of us are used to zoom do you want me to start the video as well that'd be great if i could see you yeah i would be grateful hi hi how are you i'm well thank you thank you for this opportunity you're very welcome and thank you for uh agreeing to help me out um what what is your spouse's name mike mike and how long have you been together 41 years 41 years and you're working right yes i am i'm a counselor you're a counselor what's the first name of your supervisor of the person you work for uh ed ed okay i i forgot um that his name was ed and and i should explain to the group and and to you that um what i'm going to do right now is attempt to help you uh and this is not leap ed asked me to to help you because he knew you were attending this the seminar and he knew the title was i'm not sick i don't need help ed believes that you do have an illness a mental illness and he's asked me to to intervene with you and to see if i could help you decide to get some some treatment and the reason for this uh is because uh you know and this is gonna sound i'm sure very far-fetched to you mike is is not your husband mike is is married to to susan that's his wife they have three children together i know you believe you're married to mike right yes yeah for 41 years yes but actually you're not um ed has um has put you on a medical leave of absence pending an evaluation by a psychiatrist um what do you think about that is that something you'd be willing to do go get evaluated for this this delusion that you have that you're you're married to my you can't return to work until and your clients have all been informed and they're going to be seeing somebody else that you're you're out on a medical leave of absence they don't know the details uh it it it's happening as of tomorrow morning as of monday morning you can return to work if you get a psychiatric evaluation and ultimately ed would like to see you get treatment because apparently there's a number of restraining orders i have them copies of this right here with me that mike has gotten mike and susan both have gotten because you keep showing up at their house my well anyway there's more detail i have but what what do you think about going to see a psychiatrist because we've arranged for somebody who will see you today on a sunday it's an it's an emergency room psychiatrist but but he's willing well i'm shocked and i'm scared and and well my question is would you be willing to stand up go outside uh we've called the crisis team the mobile acute crisis team they're out front and they're willing to talk to you and take you to the hospital to get evaluated uh ed moved heaven and earth to make this happen and i'm right on time he asked me to do this at 20 till the hour i trust him so i would say yes really i would okay so you go to an emergency room for a delusion that you're married to mike is that what you're saying you do just to prove to prove that this is incorrect okay so you are evaluated by a psychiatrist a nurse takes your vital signs then psychiatrist gets copies of the restraining orders you tell the psychiatrist that you're married to mike right yes for 41 years the psychiatrist decides uh this is a delusion it's an erotomanics illusion and tells you uh colleen uh we've got a bed available for you upstairs we'd like to admit you to our psychiatric inpatient unit what would you like to do you're not colleen you're not a danger to yourself or others so you're free to go but we'd really recommend that you come up to the i'm a psychiatrist right now i'd really recommend that you come up to our to our unit and and accept some treatment there some medication for your delusion that you're you're married to mike what would you like to do i've got a lot of other patients waiting for me and i just need to know if you're going to accept our offer no okay well i wish you the best of luck if you change your mind you know where we are i can't promise that'll be available but but there is one today if you change your mind today we could probably admit you so so the doctor shakes your hand you walk out and where do you go you go home yes okay you can't get in the door is locked mike's wife susan calls the mobile acute crisis team they show up the police are there with them and they take you into custody and they bring you to the same psychiatric emergency room it's a different psychiatrist now and you get the same information what do you do do you go to the psychiatric inpatient unit or do you say because again you haven't threatened to kill anyone or hurt anybody you're not threatening suicide they can't hold you against your will oh wait i just they just got a phone call from from mike and his wife they've insisted that that you keep criminally trespassing that they're going to bring charges against you so the psychiatrist says you know what colleen we're going to put you on a 72 hour hold we're going to involuntarily admit you for just 72 hours so you're brought up to the psychiatric inpatient unit they relieve you of your of your you know your personal belongings get your vital signs taken it's later tonight and a nurse comes up to you and he's got a little cup and in it are some pills and he points to them and says this is an antipsychotic this is for the side effects tries to hand you the the little cup of pills do you take it no so you're refusing all right and now i i'm suspicious okay i'm gonna ask you about your feelings in just a moment um you go to bed that that night in the inpatient unit the next morning they offer you medication again do you do you refuse again yes all right so they let you go after 72 hours they discharge you right do you where do you go do you go home i try okay same thing happens only this time they call the police and they say that that this woman is criminally trespassing and stalking us the police bring you uh to a mental health diversion court i'm the judge ms ecker i'm really sorry to see you here i have a number of restraining orders in front of me uh you've been charged with criminally trespassing as well as violating a restraining order i'm going to give you a choice we can either uh you can post bail and we'll arraign you and and go to trial on friday for criminal trespassing and and violation of restraining order or if you agree you could go to the hospital we've arranged for you to go to a psychiatric hospital to get evaluated and treated and 30 days from now i'll ask for a report from your treating psychiatrist and there's a chance i can expunge these charges what would you like to do man go to the hospital to prove that this is all incorrect okay do you go to the hospital same thing happens you're offered medication do you take it no so you refuse and the psychiatrist explains to you because you're refusing i have to inform the judge the police come they arrest you they take you into custody and they can do that on an inpatient unit they bring you back before the judge the judge says the same things to you i'm going to give you one more chance to get treatment because you because ma'am i want you to stop harassing these people and violating these restraining orders or we can go to trial and and [Music] what would you like to do comply i'm fine well i'm fine it's not an answer ma'am i need an answer hospital or we go live comply so are you going to go to the hospital yes all right so you're back in the hospital you're offered medication again what do you do cheek it so you pretend to take it okay so this cycle goes on colleen for the next six months every time you try to text my call mike go to his house you end up in the criminal justice system you end up in hospital in the psychiatric involuntary psychiatric health care system after six months do you think you'd finally understand you're not married to mike and you never were no what if this goes on for two years you never see mike do you have kids together do you believe you have kids together yes four sons so you believe you have four sons and for two years you have no contact with those four sons because they also call the police because they have restraining orders their parents susan and mike have have warned them about you and you've got a delusion about them as well so after two years of not being able to contact mike this man you believe you're married to and these four young men who you are certain are your sons but they're not after well that's what the the world is saying to you that they're not after two years would you finally understand that you're not married to mike and these are not your boys no five years no contact okay no that's what anastagnosia for mental illness is like the belief is unshakable no matter how much evidence no matter how much involvement of police psychiatrists you talk to other family members they also tell you you're delusional that you're not married to mike maybe you talk to a a close friend no matter how much you hear this it doesn't change your belief right now now i'm going to ask you since you started to offer um what it felt like what what kind of feelings did you have if any even though this was a role play tremendous fear um and and and also i felt unsafe and scared and my heart was was swelling your heart was swelling you felt fear and and scared anything else helpless hopeless helpless helpless helpless unheard i'm just writing down your your feelings imagining that that five for five years you have no contact with mike or your sons did you feel any what would you feel lonely lonely anything else before disco disconnected disconnected and and lonely what about an emotion connected with loneliness what's the feeling tremendous sorrow and sadness and sadness colleen thank you for participating in this as soon as we're done go give mike a hug all right thank you because mike is your husband and your boys as well yeah thank you everybody appreciate it you've really been really helpful thank you all right thank you and elizabeth i'm going to share my screen again sounds good and thank you colleen thank you i can find my cursor which always disappears on me there it is so when working with somebody like i was with with colleen and you can see my slides right elizabeth yes okay so when dealing with this symptom of anesthesia for mental illness the the the father the mother the police officer the judge or the doctor knows what's best for you that approach doesn't work because there's no collaboration colleen and i can't collaborate because she knows she's married to mike and has four sons together but everybody is telling i'm telling her she's not so i can't expect her to be grateful for my diagnosis that she's delusional about mike i can't expect expect her to be receptive to that i can't expect her to be adherent in other words to accept medication what i can expect is is frustration anger hostility fear she talked about fear she talked about loneliness and depression and isolation and look the those feelings are already up here and you know how was i able to get those feelings on this slide before i heard them from colleen and colleen wasn't a plant she as far as i know she didn't know what was going to happen because these feelings are really common uh in in in my work with people with anesthesia anesignosis for mental illness these are some of the loneliest people i've ever encountered and and fearful very fearful and and often angry because everybody's telling them they're mentally ill the last bullet point on what i can expect what i do expect is overt and secretive non-compliance so colleen sure enough said she'd refuse the medication overtly says no and then later when pushed into it further by this imaginary judge that i created she said i'll cheek the meds and for those of you don't know what cheeking is it means putting the pill in your cheek and you open your mouth to show that you've taken the pill but you actually haven't then you spit it out so that's secrets of non-compliance so let's talk about leave let's let's talk about some solutions leap stands for listen reflectively i'm going to get dive into that with you in just a moment empathize very strategically around certain feelings look for areas where you agree and partner on those areas and then you also want to delay giving your opinion that the person's mentally ill that they need treatment and other opinions for example let's say colleen asked me do i think she's married to mike i want to delay giving that opinion because when i give that opinion and if i say to her i don't think you're married to mike i've already lost her i've lost the respectful non-judgmental relationship i'm trying to build when i give my opinion i give it in a humble way and you see in parentheses three a's i'll explain what those are in just a moment and we look for uh opportunities they're actually opportunities to apologize for any thing that we said or did that was hurtful to the person so let's let's talk about well let me back up for one moment leap is is focused on developing relationships that result in acceptance of treatment and services just like my brother he never believed he was mentally ill but he accepted not only treatment but services uh going to a clubhouse and other services uh samsa uh chose leap to use in their family toolkit and it's based on a psychotherapy but you don't have to be a psychotherapist to use this this is a communication approach and i'd like you to imagine the tool belt with seven empty communication tools um the the the leap acronym and the doa acronym uh those those seven tools are going to go into your tool belt and by the way you might think that doa is an unfortunate acronym but i actually believe and as do many of us who who use leap that our relationships are dead on arrival if we're not using one or more of these of these tools these are not steps these are communication tools so here's some examples of leap reflective listening i mean you all know how to listen right you don't need me to tell you how to listen but active non-judgmental respectful listening requires active reflective listening so someone says to me i don't need any medicine there's nothing wrong with me here's if i was using leap how i would reflect that back you're saying you don't need medicine and there's nothing wrong with you right now you'll notice the two bold faced pieces that kind of make a sandwich we start with a preface you're saying uh or something like if i heard you let me see if i got this right and then we reflect back what the person said we can paraphrase we don't have to use their exact words and then we asked them did you did i get it right you know in other words it's another way of asking the person do they feel heard here's another example someone says to me and and this comes up a lot in families i know that you're poisoning me this is someone who has a delusion that i'm poisoning them you know if i heard you i'm poisoning you did i get that right you can reflect that back i'm not admitting to poisoning i'm being monitored and it's the cia well what i'm hearing is the cia is is monitoring you correct did i hear you the cia is monitoring you i mean this is a way we can reflect back when you called the police they abused me and i was wrongfully locked up in the hospital here's how i'd reflect that back so if i heard you when i called the police they abused you and and they wrongfully locked you up all right did i hear that right so i can reflect those things back am i agreeing with what the person says i'm not i'm reflecting back what they've said if i was agreeing let's look at that first example i don't need medicine there's nothing wrong with me agreeing would be saying you know what i agree with you you don't need medicine and there's nothing wrong with you that's not the example i gave the example i gave was you're saying you don't need medicine and there's nothing wrong with you right so it's very different than agreeing all of these examples are not agreeing so we're going to do another quick role play we need a couple of volunteers for this one elizabeth i need your help again yes i'm here thank you all right we have one volunteer anne-marie okay already ready great all right don't see her yet all right there he is there you go and do we have another volunteer is anne marie our only brave soul out there oh good king coke king coke all right we can work with two folks that's good uh can you both unmute yourselves and turn your cameras on would that be all right thank you am i saying am i saying your name correctly king coke okay okay yeah okay okay okay and anne marie so here's what i'm gonna do i'm gonna role play a young man i worked with with schizo affective disorder who had some delusions and had anesthesia all you need to do is reflect back what he said okay using leap reflective listening okay anne marie you want to go first because you're not you look you look eager to go all right here we go anne-marie i'm not sick and i don't need these damn medicines if you want to help me you can help me with the people upstairs every night they flush the toilet to communicate with the people who are trying to kill me fred what i hear you saying is you're not sick and you hear people flushing and that they want to kill you do i hear that correctly nice very nice job um but also of reflective listening but also a really nice job of the common old habits that interfere with reflective listening one of the first ones is omitting many important things the person said you actually left out a few things that were really important let's go to kk and i'm going to come back to you okay and now people say this is loud and fast and it makes it harder so i'm going to slow it down okay and go softer you ready kk all right okay i'm not mentally ill i don't need these damn medicines if you could help me with anything and be with the people upstairs every night they flush the toilet to communicate with people who are trying to kill me so you are saying that you are not sick you don't need any medications and then the people upstairs are flushing the toilet every night in order to communicate with people who are trying to kill you is that correct very nice job like anne marie you did a really nice job of reflective listening and like anne-marie you omitted something really important that was fantastic thank you it's important one of the reasons we do this role play is to uh reveal some just old habits that we have that that interfere with pure reflective listening now in the real world you don't have to reflect back every single thing the person says so all of you and the two of you especially don't misunderstand me using leap in real life you might only reflect back what the two of you reflected okay but for the purposes of this exercise i want you to get it all so anne marie i'm going to come back to you okay okay no no no no no no no that's cheating no notes extensive listen with your ear and with your heart okay this young man was really upset okay ann marie i'm not mentally ill i don't need the damn medicines if you could help me with anything it'd be with the people upstairs every night they flush the toilet to communicate with the people who are trying to kill me okay what i'm hearing you say is that you're not ill you don't need medicines and every night you hear the people upstairs flushing the toilet to try to communicate with people they're not trying they aren't they're not trying they are communicating that are communicating to people that are trying to kill you is that correct yes really nice job in the real world i'd be really happy with that but in the world of this seminar you revealed one of the old habits you're omitting something really important there's two other habits i'm going to talk about in a minute that get in the way of leap reflective listening but you omitted something do you know do you have any idea what it was maybe his emotion nope we're going to get to empathy kiki okay sorry let's do it don't say what you think was admitted let's see if you can do it okay okay one more one more time okay i'm not mentally ill i don't need the damn medicine if you can help me with anything it'd be with the people upstairs every night they flush the toilet to communicate with the people who are trying to kill me fred i hear you and you said that you are not sick and you would not you don't need to take any medication but you want my help you want my help to see what i can do with the people who are flushing the toilet every night upstairs and that you believe that they are communicating with people i don't believe it i don't believe it is true thank you so much no thank you stop stop this is fantastic because you guys aren't making many mistakes um you slipped into a form of omitting what was said called diminishing making smaller so the p he doesn't believe that people are trying to kill him he knows they are right so saying things like well you feel or you believe or you think the ways we distance ourselves from the person so thank you for revealing that one that was that's a really important one okay you said uh if i'm gonna paraphrase you tell me if i heard you correctly you said uh when you were reflecting back uh you want my help with the people upstairs right it's not actually what he said you you you are remembering the thing that you you both you and emery are missing but you didn't reflect it back accurately let me can should i can i just do it for both of you or do you want to try it do you want to try it either one of you no you do it you guys you guys get an a you're just not getting an a plus that's all which is good i don't want you to get an a plus i need you to reveal these old common habits okay here's what it would sound like so i'll be talking to myself javier let me see if i understood you let me make sure i got this right you're not mentally ill you don't need the damn medicine if i could help you with anything it'd be with those people upstairs who are trying to kill you and they're using the toilet to communicate is that right if i could help you with anything it would be that he didn't want my help it was more of a challenge right so i'll say it one more time and by the way you see how i mixed it up i didn't have to you don't have to do it exactly the same way javier if i understand you there's people upstairs trying to kill you they're using the toilet to communicate did i hear that right and you're not mentally ill and you don't need these medicines and if if i could help you with anything you'd be with that with what's going on you can mix it up you don't have to do a linear you know step-by-step exact thing in real life what did i say to him his name was matt well i'm gonna invent his name as matt that's why i call him in the book uh so matt if i if i hear you correctly let me see if i got this right you're not mentally ill you don't need medicine uh your your major concern sounds like and tell me if i'm right so there's people who are trying to kill you upstairs i just reflected three things back right uh and i kind of listened with my third ear my heart like what seemed to be most important to him and he needed me to understand he was not mentally ill and that his life was in danger so thank you so much for volunteering anne marie and you so much you guys are great thank you all right i'm gonna share my screen again you guys are great so just to review um the common old habits that can that can interfere with leap reflective listening include omitting important things that the person tells us and also diminishing i was really happy when kk said you believe because that was a good example of diminishing what the person said so for example with colleen i i said you believe you're married to mike that's a way that we separate ourselves from the person it's not respectful we also react oftentimes by saying well let me see if i can help you or i'd like to you know or how do you how do you know the people are trying to kill you that's a way that we're reacting instead of reflecting we also sometimes rush to empathy now empathy is really important but if you lead with an empathic response like well you sound really scared are you i've missed an opportunity to join the person where they're at by reflecting back exactly what they've said even if they've if they've said something like i know that you sexually abused me and that you're trying to kill me so if i heard you you know if i heard you son you're saying that i sexually abused you is that right did i sexually abuse you i mean you can reflect things like that even like that back with the goal of having in this instance that i just uh shared the the young man feeling heard and respected so why do we resist reflecting back many important things our relatives tell us we fear we're going to make it worse like the delusion that that something terrible that we've done something terrible to the person maybe they have that delusion we're not going to make it worse delusions are fixed false beliefs or the negative attitudes about treatment so with this young man that i was portraying uh you know you don't need the damn medicines he's got a negative attitude about treatment he doesn't believe he's ill i'm not going to make it worse we're afraid we're going to be asked to do something we can this young man after i reflected back so you're not mentally ill you don't need medicine if i could help you with anything you'd be those with those people who are trying to kill you he said great so will you help me by writing a letter saying i'm not mentally ill so i don't get kicked out of my apartment i was working with him on a psychiatric inpatient unit and i diagnosed him with mental illness so i couldn't write that letter um we were able to get around that and if we have time for q a i'll tell you about that if you're interested we worry that we're being dishonest but if you're if you're being faithful to the leap approach you're not being dishonest our emotions can also interfere we get too frustrated or or feel defeated or sad about what our loved one is saying to us and so we react to it i would never have done that to you or i did that because i cared about you that's why i called the crisis team um that's reacting to the person instead of taking the opportunity to reflect back uh what was said so what about delaying giving your opinion so let's say colleen asked me let's say i'm working with her let's imagine a nurse working on the psychiatric unit she's come to for the third time she hasn't seen mike or her four sons because they're delusions right let's pretend they're delusions um and she says you know i hate the medicine i don't need this medicine and and i really hate it well what do you think do you think i should take the medicine do you so she asked me that and i'm the nurse working with her i would i wouldn't run right to yes i think you really need the medicine colleen because nobody is listening to her about her belief about being married to mike so instead i would delay i'd say i promise to answer your question colleen i promise i'll answer your question about whether you should take the medicine but if it's all right with you if it's all right with you i'd like to hear more about why you hate the medicine would that be okay so there's three elements to delaying promise to answer the question and the last element is ask permission to delay what's in the middle is getting the person to talk about something that's important to them let's say she asked me do you think i'm married to mike and i say to her but i would say if i didn't want to tell her right away my opinion i'd say i'll tell you what i think about whether you're married to mike i'd like to keep listening to your views on this because i'm learning things i i didn't know can i tell you later what i think so i would ask colleen for permission to tell her later and i try to get her talking more about this to delay i want her to ask me for my opinion more than once two times three times maybe more than that and i you don't delay so much that you frustrate the person you delay so that you don't injure the communication the relationship and also so the person is asking for our opinion notice i didn't use the word but as in i'll tell you i'll tell you but first right and the reason for that is and you all know this in your day-to-day conversations with anybody somebody says well i agree with you you know i think you're right but and you know what's coming and you and you've stopped listening to them uh so i i encourage people often to avoid using the word but in the middle of a sentence when you're trying to engage with somebody and communicate with somebody here's some quick examples um a person asks me if i think they're sick i promise i'll tell you whether i think you're sick first i don't say but i say first if it's okay with you i'd like to hear more about how you ended up in the hospital would that be okay if i tell you later i'll answer your question about the cia somebody's delusional about the cia and they ask me if i s if i believe them i'll answer your question first can i ask you to give me some details about about what happened the other night when you said they were they were surveilling you would that be okay right same three elements promise to answer the question get the person talking about something related or unrelated but important to them and ask permission you've asked me whether i think you're delusional colleen asked me that i promised to answer before i tell you what i see could you tell me more about what happened when you attended that seminar with dr amador now would that be okay can i tell you later i promise to answer your question about whether you should take medicine before i do i want you to know that your opinion about the medicine is far more important than mine can can you tell me more and and i'll i'll tell you my opinion after is your opinion about medicine more important than your loved one's opinion what do you think i would argue and and i'm sure some of you agree with me that my opinion about the medicine when i'm working with patients clients consumers or when i was working with my trying to convince my brother to get help my opinion doesn't is squat doesn't matter the opinion that really matters is the opinion of the person we're trying to help their opinion about about treatment whether it's medicine or other kinds of treatment will drive their behavior so their opinion is far more important and why not respect that and communicate that we know that their opinion is far more important so remember earlier i talked about the relationship that can lead to acceptance of treatment you give your opinion you do give your opinion but you do it in a humble way we apologize colleen asked me if if i think she's married to mike and has four sons so i'm finally going to tell her what i think i want to apologize because my opinion might might feel hurtful to you colleen and you know i could be wrong i i don't know everything i i do know i don't want to argue with you about this um i don't see that you're married to mike um but i could be wrong i'd circle right back to acknowledging my fallibility i you know i could be wrong i don't see it that's that's where i i fall on this issue i know i don't want to argue with you because our you know our relationship you know is is is far more important to me than being right i don't need to be right about this same thing with medication you know i want to apologize you've asked me whether you should take this antipsychotic medication and you know i could be totally wrong about this i know i don't want to argue with you since you've asked me i'd like to see you try it i'd like to see you just give it give it a try you know maybe just for a month since you've asked me that's why one of the reasons we delay we want to be asked we want to be able to say since you've asked me my opinion this is what i think and i don't want to fight with you about it don't get into a debate a debate gets you nowhere enlightening time really fast so here's some examples do you think i should take the medicine all i know is that i'd like you to take the medicine and maybe i'm crazy for wanting this that's a way of acknowledging fallibility maybe i'm crazy for wanting this i hope we don't argue about this because there's so much we agree on and i'd rather focus on that if it's okay with you you know when you use leap you may have noticed you ask a lot of questions if it's okay with you do you think i'm mentally ill i think your thoughts and perceptions are different than most people you know i don't need to be right i just want to have a good relationship with you now in this example i only use two of the a's right gave my opinion and i acknowledge my fallibility use one two or all three of them you don't have to use all three of them every time but the the the headline here is that you are giving your opinion with humility not as an absolute truth an absolute truth opinion would be um since you've asked me uh yes i believe you're mentally ill and you really need to be on medication why not say hey i'm sorry about my opinion i think it's going to be hurtful i could be wrong i'd like to see you on the medication well why i think you do better when you're on it i could be wrong why not give it in a humble way so that it's no pun intended it's an easier pill to swallow you know the the opinion that we're giving um i remarked that apology was another tool we can apologize for not sharing the same belief about mike let's say colleen and i were working together and she really was delusional uh or about the person being mentally ill we can apologize for being disappointing not giving the person what they want um we sometimes hear from people why are you repeating everything i say when somebody learns leap their relative will say you know why do you sound like a parrot or a therapist um my my suggestion is you would you could say something like you're right i'm repeating a lot of things that you're saying because i want to make sure i understand you and i'm sorry if you want i'll stop doing that you know you can you can own the fact that you're using reflective listening why not i'm sorry i've been repeating everything and i'm just the reason i'm doing that is because i want to make sure i understand you i'll stop if you want me to um we we really should take the opportunity to apologize for not doing what the person asked us to do or for an involuntary treatment that that we initiated um you know if you're taking notes like emory was about to um i would encourage you to take a note what else you know might i apologize for with my loved one that would be helpful to him or her to help them heal heal the relationship that you have with them we want to empathize uh you know don't get me wrong empathy is really important especially feelings that come from delusional beliefs so feelings like fear of of from paranoia the feelings that come from anesthesia the anger the frustration the loneliness you know if i if i was in your shoes i feel lonely too everybody's telling you you're mentally ill and you're not did i hear you right i'm not agreeing with the person i'm reflecting it back and with what the person wants and always and empathy if you're using the leap approach by normalizing their experience let me give you some examples of that um but before i do you know why these feelings because these are the the feelings that leave people feeling really alone and colleen even in a role play talked about feeling really alone and sad so here's some examples of course i'm scared they have cameras and bugs everywhere so here's my empathic response you know i'd be scared too anyone would be now i'm not agreeing with them that i believe there's cameras and bugs everywhere i'm simply empathizing with them now if after i say i'd be scared too anyone would be the person that asked me well do you believe me perfect opportunity to delay i promise i'm going to answer your question but before i did that but i slipped before i do i promise to answer your question before i do can you tell me more about about the bugs you found last night would that be okay and i asked permission and then the person may push me and say no i want to know if you believe it's true you know i'm really sorry and and i could be wrong i don't know everything um i don't see the same evidence that you see one of the things you can say when you're giving your opinion that i find is very powerful is i wish i saw it the way you see it i really wish i saw it the way you see it i wish i i understood this the same way you do because then we wouldn't be far apart and and i don't want to argue with you i'm sick and tired of you saying i'm mentally ill you sound angry and exhausted because i said you were mentally ill yes did i get that right all i need is to get married and get a job i don't need the damn medicine you sound really frustrated because all you need is is to get married and get a job you don't need the medicine i'd be frustrated too anybody would be that's my way of normalizing the experience i hate these drugs i'm not sick and i'm angry you're telling me i need them you sound like you really hate the medicine and resent me for telling you you need them yeah you know i'd be angry too anyone would be now think about saying that to your loved one and the next time they tell you that they're they're that they hate the drugs i'm pissed that you keep trying to poison me if i heard you you're very angry that i'm trying to poison you yes and the person says yes i'd say you know i'd be pissed too so are you admitting it are you trying to poison me promise i'm going to answer that question i'm going to delay now before i answer the question can you can you tell me and i would fill the blanket with something that's important for them to talk about and i'd ask permission can i tell you later no i want to know right now all right you want to know if i'm poisoning you let me start by apologizing and and this is gonna i think this is probably gonna upset you um maybe i'm forgetting maybe i don't you know i certainly don't know everything um i don't believe i'm poisoning you i just don't see it the same way you see and i don't want to argue with you about this now it sounds bizarre to to to say give your opinion in that way um but it's it's working hard to not argue with the person and and of course i'm gonna say i don't believe i'm poisoning you but i'm not gonna say it in a pedantic absolute way like i would never poison you how could you even accuse me of that why would you say that to me that's reacting that's um not reflecting back and empathizing with the person what can we agree on the the goals and the problems that the person sees and always agree to disagree what are what are some examples staying out of the hospital i can agree to work on somebody with that on that goal finding a job having a relationship agree that we both would like it if we didn't argue so much we both agree that having a better relationship with each other is is something that we we both would want and those are the goals that we partner on the goals that you can work on together if we had a longer period if this was one of our uh we have a non-profit called the henry amador center on anastagnosia in our longer seminars we have time to practice these the partnering part but let me give you the headlines just some examples staying out of the hospital i'll help you with that to do that can we partner on your agreeing to try this medicine for the next month finding a job to help you find a job i'd like you to and then fill in the blank with something we'd like the person to do meet with his therapist what do you think i need that i whether you need it or not um i don't want to argue with you about it um all i know is i'd like you to do it uh the person we've been asked for money i know many of you have been asked for money i was asked for money by my brother henry which i was able to utilize to help him accept treatment i'll give you what what you need what i need this is what i said to henry what i need is for you to accept this injection just do it one time and then we'll talk further about it that's actually the conversation i had with my brother so many years ago that resulted in his accepting medication taking injections for 18 years reliably i mean it was much more surrounding this but that's what we were able to partner on so listen without judgment or reactions express empathy for feelings that come from delusions anastagnosia and what the person wants find areas that we can agree on and abandon your goal of getting the person to agree with you that they're mentally ill if that's your goal then i mean you pardon the expression go for it but has it been working for you you know have you been able to convince your loved one they're mentally ill partner on those things that you can actually partner on and during this whole process we're delaying giving hurtful and contrary opinions we're redirecting the person to talk about something else and we're asking permission to delay when we do finally give our opinion we do it with humility we give our opinion in a way that respects our loved ones point of view their truth and we apologize for those acts and interactions that feel disrespectful hurtful or disappointing these are not steps we mix and match remember the tool belt analogy we we pull these tools out as we need them we mix them almost like paint on a pallet and the picture we're trying to paint is of our loved one feeling heard respected not strong-armed into accepting treatment but invited to try something we'd like them to try in terms of treatment learning leap is just like learning a new language practice with with your loved ones if you're an anami support group practice in the nami support group um bring up a difficult conversation that that difficult statements that your loved one makes and practice reflective listening and empathizing practice delaying giving your opinion those of you who are bilingual or polylingual you did not learn to become fluent in in your second or third language by reading a book and attending a class you had to immerse yourself with other people who spoke the same language so learning leap is just like learning a foreign language you really do have you can't come away from this this webinar and expect yourself to be uh adept at this you really to do this in my experience anyway you need to practice it i i'm practicing leap all the time uh with my 17 year old son who's not mentally ill but but also with mentally ill loved ones general guidelines what's sort of the overarching principles here it's absorbing what we've heard instead of reacting to it so using things like reflective listening and empathy then we emotionally connect with the person by empathizing by apologizing right so we absorb what we've heard we emotionally connect with the person and then we can start problem solving we can start finding areas of agreement and partnering on those areas of agreement introducing the idea that we like the person to try something use these tools as you need them i've already talked about that but it can't be emphasized enough these are the these are steps in terms of an overall guideline but the seven leap tools their tools so i want to thank you for taking sunday part of your sunday to to participate in this i want to especially thank uh colleen and kk and anne marie i really appreciate your help and elizabeth what a great job you did uh moderating this um if you'd like to get more exposure to leap if you haven't already been to the ha center dot org website it stands for henry amador center i invite you to go there you will be asked to support our mission i i hope you'll think about that to help other families but more important there are free resources there's videos there that you can watch a large number of videos now um that that demonstrate leap conversations so again thank you very much it's been a really great pleasure to be here and with that i'm going to turn the screen back over to elizabeth great thank you so much dr amador it was such an incredible presentation and thank you for taking your time on a sunday to share with us i know this is so valuable to our communities and we talk about your book and your strategy all the time in our family support groups i'm not sure what your schedule allows but there are a few questions and if you are open to a little bit of a q a uh we can do a little one yeah if that's all right that may be five minutes would that be all right yeah that yeah that sounds great would it be helpful if i read them out yes please okay so the first one is what if you have a loved one that doesn't want to talk to you at all about what is going on i get this one a lot uh and and it's really difficult because here we are talking about a communication strategy and we have somebody who doesn't want to communicate um if they will accept text messages um i would i you could use text messages generally not all the time when a loved one doesn't want to talk not all the time but generally it's because they're really angry with us because we've told them they're mentally ill because we've told them they need treatment so um apologizing for those statements like i did with my brother henry is usually a way to get somebody to open up and start talking so what i said to my brother henry was i promise i'm never gonna first of all i'm really sorry for all the times i told you you had schizophrenia i'm never gonna do it again and why should you if you haven't succeeded why continue to do it and i'm sorry for all the times i told you you needed medication i hope you can forgive me and that opened the door to him talking to me again so apologize for for those things that you think might have been really hurtful to your loved one thank you that's that's really helpful we also have another question asking can it develop can someone originally have believed they were mentally ill and then believe it in the beginning or maybe they were ill once and then off their meds so is this something that develops and changing come and go yeah it's interesting uh for the majority of of people with schizophrenia schizoaffective disorder anastagnosia the the insight stays kind of stable if they don't have it they continue not to have it for years but that shouldn't make you feel pessimistic they're the whole point of leap is how do we engage people in treatment even though they don't believe they're ill in bipolar disorder it tends to come and go so it's a symptom just like mania can come and go um depression can come and go the anesthesia also comes and goes so and it gets it gets really confusing for for families because we think oh she understands she's she's mentally ill she's she's depressed now and she's talking about the manic episode and she understands it and then a week or a month later she says there's nothing wrong with her so don't get confused by that it's a it's a symptom like other symptoms it can come and go yeah and that's something we talk about a lot in our educational classes it's really you know recovery isn't linear so that no it's not it's not what you look for is an overall positive trajectory but it goes up and down along the way yeah um we have another question so in the listening phase what if your loved one goes on and on and on ruminating about the same thing over and over how do you move to the next step the next step of emphasis empathizing you you just you you do it along along the way you you mix the two together so um there's a family i'm working with where the sun keeps saying you know i'm really i'm really i'm really pissed off i'm tired of all this mental health stuff and you're always putting me in mental health programs and and i've been teaching the family to reflect that back and to empathize you're really angry with us and you're really upset and we can see why you're upset so you can empathize and reflectively listen at the same time you mix mix them together and if the person continues to go on and on and on you may eventually have to and this is not leap per se but it's something that facilitates a leap conversation you may have to draw a boundary and say you would apologize i'm really sorry but i'm going to stop talking because i i kind of feel like i've heard you i hope you feel heard and this we're kind of going round and round so i'm going to i'm going to hang up the phone right now we can talk we can talk again later or if it's in person you know i'm gonna i'm gonna step out and and and i'm really sorry but i i can't but i'm really sorry i can't keep talking about this right now later we can talk again i think we have time for another question yes we have one someone asking so if someone does become aware of their mental health uh conditions but they still refuse help do you have any recommendations for that um like sharon said at the beginning make friends with that person if it's an adult child you know as a parent i'm a parent of an adult child and my daughter doesn't need me to be the parent i was when she was a little girl she needs me to be her father who's a friend befriend your family member so that means take an interest in their perspective through that friendship you can start to suggest that they try treatment but before you get there i i want to understand why you don't like it why you don't want to do it and i and then you convey your respect for that oh i can see why you don't want it i can see it the side effects are really bothering you you know what i'd have a hard time with doing that too you know it's it's it's called the change paradox and cognitive psychology when we stop arguing with the person fighting we stop we end up moving with them so when we say things like you know i wouldn't want to take the medicine too now now i get it so are you agreeing with me well i'm sorry yeah maybe i'm wrong i'd like you to try it but you understand why i don't want to try it oh yeah i do understand you ask me what i think so this is what i think that idea of moving with the person i think is so so important yeah and such a this was such an amazing uh workshop thank you so much i'm gonna go ahead and put your um website info in the chat for all of our participants to check out the henry amador center and um thank you go to free resources is the tab to find the videos perfect well thank you so much and thank you everyone for coming out to our wellness weekend check out our other events that are happening throughout the month of may and have a great rest of your weekend and thanks to my nami family you guys are family to me you feel the same way we're so lucky to have you thank you

Channel: NAMI Westside LA

Views: 303

Rating: 5 out of 5

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Id: 58WzJAsKT0E

Length: 93min 55sec (5635 seconds)

Published: Mon May 24 2021