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On the last track 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.
On this track 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."
Skill #1 - Getting to the Point
Skill #2 - Directly Expressing 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
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
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
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
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 on this track 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 track for the family member of a client you are treating?
On this track 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.
On the next track 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.
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