Schizophrenia: Practical Strategies for Relapses & Reducing Symptoms

In the last section, we discussed coping with positive symptoms of schizophrenic psychosis.  Three specific coping strategies for positive symptoms of schizophrenic psychosis we discussed are reality testing, self talk, and coping when losing control.

In this section, we will discuss six skills for communicating effectively.  As you know, negative symptoms of schizophrenia create a unique set of problems regarding communication.  Jeremy’s father felt frustrated when trying to communicate with him.  Jeremy’s father stated, "I don’t know where Jeremy stands on so many things.  Sometimes he says one thing, but his facial expressions say something else.  At other times, he hardly wants to talk at all.  I want to help him, but I just don’t know what he wants." 

Jeremy, age 22, may have simply needed his family to use effective communication skills to compensate for problems related to the symptoms of his schizophrenia.  Like Jeremy, numerous clients diagnosed with schizophrenia who I treat can clearly benefit from effective communication.  So, as you listen to this section, you might consider how you can use the six skills for communicating effectively to educate a family member of your client who is struggling with clear communication. The six skills for communicating effectively are getting to the point, directly expressing feelings, giving positive feedback, making positive requests, checking out feelings, and taking breaks.   

6 Skills for Effective Communication

♦ Skill #1 - Getting to the Point
First, let’s discuss getting to the point. I explained to Jeremy’s father that clients with schizophrenia often have difficulty following conversations. I stated, "It’s helpful to be brief and stick to one topic at a time. Keep communications simple and direct and avoid complex language and roundabout introductions to topics of conversation."  Would you agree that getting to the point quickly can result in fewer misunderstandings between a client like Jeremy and a family member like his father?

♦ Skill #2 - Directly Expressing Feelings
Next, I discussed ways Jeremy’s father could directly express feelings.  I stated to Jeremy’s father, "People with schizophrenia often have difficulty recognizing other’s feelings.  Jeremy might miss subtle cues about your emotions, such as changes in expression or tone of voice.  To reduce the amount of confusion and tension in your conversations with Jeremy, verbally express both positive and negative feelings."  Jeremy’s father wanted clarification regarding expressing negative feelings. 

He asked, "Should I verbally express being mad or upset as well?"  I replied, "Yes, but avoid using a harsh or critical tone.  One way of being clear about your feelings is to use ‘I’ statements.  For example, you might say, ‘I’m upset that you haven’t taken your medication for two days.’  But be sure to express positive feelings as well, such as, ‘I was really pleased when you set the table tonight.’  Do you agree that taking responsibility for his feelings allowed Jeremy’s father to be more effective than referring to someone else or generalizing? 

♦ Skill #3 - Giving Positive Feedback
In addition to getting to the point and directly expressing feelings, the third skill for effective communication is giving positive feedback.  I have found that clients diagnosed with schizophrenia often feel demoralized and think that they can’t do anything well.  Therefore, would you agree that by receiving praise for specific behaviors, schizophrenic clients can become encouraged do more things that foster the pursuit of personal recovery goals? 

After explaining this to Jeremy’s father, I stated, "Praise can also encourage Jeremy to follow through with treatment recommendations and increase his independent behavior."  Jeremy’s father felt hesitant to accept that giving positive feedback could help.  He stated, "Jeremy is almost painfully aware of his own limitations.  So often I hear him express certainty that he will never be able to do anything right." 

As I explained to Jeremy’s father, giving positive feedback can help Jeremy become more aware of his strengths.  As you have experienced, clients with schizophrenia tend to make progress in small steps. Therefore, would you agree that recognition and encouragement from family members regarding each small accomplishment can help clients see that progress is possible and that effort is rewarded?

♦ Skill #4 - Making Positive Requests
The fourth skill for communicating effectively that I discussed with Jeremy’s father was making positive requests. Jeremy’s father was already familiar with how the skill of making positive requests could improve communication. He stated, "We make requests of each other every day in our family.  But so often those requests seem demanding or nagging.  Jeremy resents demanding requests just as much as I do.  He is very sensitive to criticism and stress.  We have already found out that making requests in a non-demanding manner can minimize Jeremy’s stress and make it more likely that he will comply with the request." 

Jeremy’s father had also found that it helped to be brief and specific about the request while using a calm pleasant voice.  He stated, "I always start out by saying, ‘I would appreciate it if you…’ or ‘Would you please…’" 

♦ Skill #5 - Checking Out Feelings
The fifth skill for communicating effectively was checking out feelings.  As I stated earlier, Jeremy’s communication was affected by negative symptoms of schizophrenia.  The result was a lack of facial expression and reductions in speech, leaving Jeremy’s father to guess at what Jeremy was thinking or feeling.  Jeremy’s father stated, "When I have to guess his feelings, I’m usually wrong.  Then we both get frustrated." 

I replied, "Rather than guessing, listen carefully to what Jeremy says when he does talk.  Ask questions when you don’t understand and check out what you’ve heard to avoid misunderstandings.  One way of checking out Jeremy’s feelings, is, rather than saying, ‘You must be at angry at me,’ say ‘You haven’t spoken to me today.  I’d appreciate it if you could tell me what’s on your mind.’  Another way to verifying your perception is to paraphrase what you heard and ask Jeremy if that was what he meant."

♦ Skill #6 - Taking Breaks
In addition co making positive requests and checking out feelings, the sixth skill for communicating effectively is taking breaks.  If the family member of your client finds themselves in a stressful or emotionally charged situation with the client in spite of the other 5 effective communication skills, he or she may need to take a break. 

As I explained to Jeremy’s father, taking breaks can help both him and Jeremy calm down so that they are better able to communicate and solve problems later.  Jeremy’s father avoided staying in stressful or emotionally charged situations by using statements such as, "Our conversation is becoming stressful.  Let’s take a break.  We’ll feel calmer and better able to solve the problem later."  Could your client and family member benefit from taking breaks?

Clearly, the communication skills in this section may enhance communication in a number of contexts.  However, do you agree that these skills may be especially productive regarding communication between your client and a relative to compensate for communication problems related to the symptoms of schizophrenia?  Would it be helpful to play this section for the family member of a client you are treating?

In this section, we discussed skills for communicating effectively.  The six skills for communicating effectively are getting to the point, directly expressing feelings, giving positive feedback, making positive requests, checking out feelings, and taking breaks.  

In the next section, we will discuss five strategies for managing conflict.  These are avoiding blame, speaking calmly, being concise, discovering points of view, and focusing on the present.

Peer-Reviewed Journal Article References:
Barrios, M., Guilera, G., Hidalgo, M. D., Cheung, E. C. F., Chan, R. C. K., & Gómez-Benito, J. (2020). The most commonly used instruments in research on functioning in schizophrenia: What are they measuring? European Psychologist, 25(4), 283–292.

Bechi, M., Bosia, M., Agostoni, G., Spangaro, M., Buonocore, M., Bianchi, L., Cocchi, F., Guglielmino, C., Mastromatteo, A. R., & Cavallaro, R. (2018). Can patients with schizophrenia have good mentalizing skills? Disentangling heterogeneity of theory of mind. Neuropsychology, 32(6), 746–753.

Kymalainen, J. A., & Weisman de Mamani, A. G. (2008). Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: A review of the literature. Cultural Diversity and Ethnic Minority Psychology, 14(2), 85–91.

Mosher, L. R., & Wynne, L. C. (1970). Methodological issues in research with groups at high risk for the development of schizophrenia. Schizophrenia Bulletin, 1(2), 4–8.

Riehle, M., & Lincoln, T. M. (2018). Investigating the social costs of schizophrenia: Facial expressions in dyadic interactions of people with and without schizophrenia. Journal of Abnormal Psychology, 127(2), 202–215. 

QUESTION 9
What are six skills for communicating effectively? To select and enter your answer go to Test.