Use a STRENGTHS-BASED approach
Many parents will feel responsible, guilty, afraid, or powerless. In order to help them tolerate and manage their vulnerability more productively, affirm their strengths and highlight strengths and resilience in their child.
EDUCATE them about psychosis or psychosis risk
Be specific in your feedback and check the family's understanding. Emphasize that psychosis is a medical term for difficulty discerning what is not real from what is real, and that psychosis is treatable. Don’t overwhelm them. Focus just on what they need to know to take the next step.
Help them EMBRACE UNCERTAINTY
This is an opportunity to gather additional information and provide early treatment for symptoms. Support getting information, but prepare them for not getting all of the answers. Let them know that they will not be alone.
Have a genuine conversation about concerns. Convey hope, and don’t emphasize labels. Make sure that they know that what they see on TV or in movies is not the norm.
Don’t get so caught up in what you are going to say that you forget to listen to what the family is feeling, what they’ve noticed and are worried about, their cultural context, and their understanding of and language about mental health.
Be DESCRIPTIVE about your concerns
When adolescents/young adults have disclosed details to you, discuss ahead of time what to tell their parents, and how. In talking to parents, be as specific as you can about what behaviors or symptoms are concerning.
Don’t provide a big lead-up as if you are giving dreadful news. Use a calm, straight-forward, “I want to look out for and do right by your child” tone.
Ex. “I think it would be good to have someone who knows more about these types of experiences in children/ adolescents/ young adults conduct an assessment. I know a resource that has been really helpful to other young people and families. I think we should call them.”
(See Resources for Families)
1. Spend time with the person and keep lines of communication open.
It is easiest to express your concerns in a helpful, non-threatening way when you maintain regular communication. Even if the person has been withdrawing from you, continue to invite them to talk about these concerns, but also be willing to take no for an answer if the person isn't up for it.
2. Express your concerns.
Be open and honest as much as possible. In a gentle, non-judging way, let the person know that you have noticed these changes, and that you are available to listen and help when they are ready to talk about it. Framing this discussion as a medical concern may help to reduce stigma and guide the conversation towards treatment options.
3. Let the person know they are not alone.
Between 4-17% of young people report experiencing sub-clinical (mild) psychotic-like symptoms. These experiences are not rare, and there could be a number of reasons why they occur. Letting the person know that you are familiar with what they are going through and that they are not alone can be very reassuring.
4. Let the person know that there is hope and practical help available.
Clarify what the young person may want to gain from seeking help. Balance talking about what the young person wants and what you think would be helpful. Both medical and psychological therapies (for the individual and his/her family) can help to reduce symptoms, distress and daily difficulties associated with clinical risk. If you live near the Boston Area, you can help the person to get a careful assessment and practical help through the CEDAR Clinic. You can also see a list of other clinics specializing in services for young people experiencing early signs or risk for psychosis (see Making Referrals).
5. Be patient and avoid pushing too hard.
When you first express your concerns, the young person may not want to talk about it. Let the person know that you respect their privacy but are available to talk and share information about potentially helpful resources when they are ready. Then keep the lines of communication open with the person so that they can warm up to the idea of talking with you about their concerns.
6. Treat the person as responsible and capable of making (or at least having some say in) decisions about whether and when to seek help.
Be honestly interested in what the young person has to say by taking a respectful, curious, open, and non-intrusive and non-controlling stance.
1. Ignore changes in functioning or recurrent odd behavior as being "just a phase" or "teenagers being teenagers."
Contrary to popular belief, research shows that it is not typical for adolescence to be a time of significant turmoil and distress. While increases in privacy concerns are common, it is not typical for teenagers to refuse contact with friends over long periods or to withdraw significantly from family. If a young person has recently begun to withdraw, behave oddly, and/or struggle at school and with friends, it is important to offer support. A careful assessment can help the young person (and you) better understand what is going on and what types of supports and/or treatments might help.
2. Act as if you are giving dreadful news when talking about risk for psychosis.
There is a lot of available knowledge about treating psychosis and hope for recovery, especially when psychosis is treated early. Educating a person about risk can be an important opportunity for them to better understand what is happening to them, and to get effective treatment to prevent further distress and negative changes in functioning. If you are comfortable explaining this, the young person will often take your lead and feel reassured. Using everyday language such as "stress" and "changes in experiences or functioning" is also helpful in normalizing people's experiences.
3. Push too hard or argue with the person if they deny that anything is wrong.
If the person denies experiencing difficulties or refuses to talk with you about your concerns, respect their privacy and let them know that you are there to help if and when they want to talk. You might gently describe some specific behavioral changes that you have noticed (e.g., "OK, I had just noticed that, since December, you have been spending a lot of time in your room, your grades have gone down, and you have been wearing sunglasses most of the time. I know that a lot of young adults can experience stress during their senior year of high school, and sometimes it can help to talk to someone about it.")
4. Give up on the patient.
A patient may seem more interested in engaging in treatment at some times compared to others, and steps forward may often be followed by steps backwards. To help a young person start treatment and stick with it, you may have to try several times and even enlist the help of others. Keep a sense of priorities, and avoid "sweating the small stuff". Focus your efforts on the important activities and tasks that matter the most in the long run (school, safety, relationships). Your patient is being challenged by a significant change in functioning that may be due to a neurodevelopmental process or disorder, and is trusting you to guide them through this part of their care.