Ellen Berman MD
David Wohlsifer  DHS, LCSW
May 8, 2006

Use the basic tools of good communication. 

  • Problem solving should be done when no one is exhausted or angry.
  • Keep discussions to one topic at a time.
  • Use time outs if the stress of conflict becomes too high.
  • Keep personal criticisms out of problem solving.
  • Have respect for each family member’s hot buttons.

Foster an attitude of respect in the family.

The stress of dealing with illness often means that consumers and other family members become critical or dismissive of each other.  This adds to the stress of mental illness and caregiver burden.  The enemy is the illness, not the consumer or the family; everyone needs to try their best to care for one another.

It is particularly important to remember that having a diagnosis does not make all of your opinions wrong, and not having a diagnosis does not always make one right.

Much of the time, both people are partly right, and it is helpful to start discussions by finding the areas in which you agree before you tackle the disagreements.

Have an agreed upon set of signals that indicate when someone is having an exacerbation of symptoms of their mental illness, and a plan for rapid response. This agreement is best done when both consumer and family members are feeling well.  If possible, such discussions should not be held during a very high stress period in the consumer’s (or the family’s) life.

For example: A teenager’s first signs of returning depression are refusing to shower, and sleeping during the day and staying awake most of the night.  Parents and child may make an agreement that if this happens for more than 3 days there will be a plan of action. This might be: if the teen stays in bed during the day for more that 2 days and does not shower for 2 days the parents will call the therapist and/or psychiatrist and alert them of the problem. The family may decide that if symptoms recur they will resume medication monitoring (which the teen had been doing himself).  The contract may include situations in which the parent will not intrude. For example, the teen may remain in bed until 11:00 on Sundays without showering, as long as they get up for school on Monday.

Know the therapists and other care providers.

Know how to contact them in case of emergency, discuss with them what constitutes an emergency, and have agreements about what it is acceptable to discuss decided in advance. For example, there could be an agreement that worries or fantasies of the consumer are confidential, but if serious suicidal thoughts or drug use occurs everyone needs to know.

It helps to have one person be the family spokesperson when contacting health care providers. If there is a disagreement between family members regarding how to handle situations, this should be discussed with the therapist with all family members present so that it is possible to resolve things.

Ellen Berman, MD     (610) 667-4617

Last updated in February 2020.