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思覺失調患者拒絕求診 透過教練服務助其家人

Coaching the caretakers of schizophrenia clients

Coaching Can Help Family Members Support Schizophrenia Sufferers Who Refuse Treatment

The Hong Kong Hospital Authority’s 2018 statistics show that there are over 40,000 psychosis sufferers in Hong Kong. Two psychotic symptoms include delusions and hallucinations. Being closest to the sufferer, family members or caregivers are more likely to notice these symptoms before others do. As a result, they often face tremendous distress and stress. Just as a sufferer benefits from getting treatment, a caregiver can benefit from coaching by a counsellor so that he or she can be better equipped to support the loved one embark on the journey of recovery.

Caregivers’ Stress

There are two categories of psychotic symptoms belonging to the catebgory of schizophrenia: Positive symptoms include delusions and, auditory and visual hallucinations etc. Negative symptoms include lack of motivation, looking impassive, and not paying attention to personal hygiene etc. Sufferers can become hyper-sensitive and occupied with thoughts such as being watched by others for a long period of time, their colleagues are trying to harm them or neighbours are trying to poison them etc. When one’s delusion becomes more severe, the delusional thoughts can be out of touch from reality. For example, a sufferer may be afraid to be out on the streets, worrying that he/ she may be kidnapped by aliens.

Sufferers’ initial delusional thoughts often affect their relationships at home. For instance, a sufferer may have thoughts that his or her spouse is cheating and tells everyone about it, including the “reason” and “details”. This is very stressful and troubling for the family and causes a strain to the sufferer’s marriage, posing a challenge to the couple’s relationship. Also, when a sufferer gets too emotional and becomes uncontrollable, family members often have no choice but to call the police for help. As such, the family of sufferers are often physically and emotionally drained.

Caregivers Should Receive Coaching

Family members of sufferers, especially caregivers, can seek help from coaches with a psychological counselling qualification to learn ways to convince the sufferer to receive mental health services, in particular, how to convince him/her to accept a psychiatrist’s diagnosis. As they are also qualified counsellors, these coaches can also guide family members on how to manage and support the sufferer through the use of various techniques and steps to help the sufferer to recover. (see some examples below):

1. Set a Goal

The coach and caregiver can work together to set a goal. This can include: learning to get along with the sufferer, convincing the sufferer to seek treatment, helping the sufferer control his/her emotions, convincing a psychosis or bipolar disorder sufferer to take medication etc.

2. Gathering Information Related to the Condition

Caregivers should gather information related to the sufferer’s condition. This will help provide insight into the root cause. For example, psychosis can be triggered by several factors such as brain- related genetic predisposition, the environment that one grows up in, personality etc. With a deeper understanding of the cause, we can better empathise with the sufferer and hence can communicate more effectively with him or her.

3. Learn Active Listening

Active listening is very important in communicating with sufferers. A coach can conduct role-playing in a safe environment to help caregivers learn how to attentively listen to the needs of a sufferer. For example, if we hear the sufferer saying something illogical during a conversation, do not argue with or tell him or her off. From the conversation, learn to listen to what they truly feel and identify the reasons why they are unwilling to see a psychiatrist. The reasons may be that they are concerned with treatment costs, or they may have sought treatment at public hospitals before but felt that it was not helpful at that time etc. A coach can also train the caregiver on how to help the sufferer establish the confidence to recover.

4. Develop Empathy

Psychosis sufferers live in a distorted reality, hence we should empathise with how they feel. For instance, if a sufferer says: “I hear many voices upstairs, it is so noisy.”. Avoid disputing if the “many voices” are factual, but recognise that the sufferer is distressed because it is “noisy”. As time goes by, the sufferer will feel that the caregiver is on his or her side, thereby trusting the caregiver more.

5. Discover their Inner Thoughts

Talk to the sufferer more frequently. From the conversations, find out what he or she wishes to do or is concerned with. This helps us to understand the sufferer’s inner thoughts.

6. Motivate the Sufferer

Going on frequent walks with the sufferer, having some exposure to the sun, eating his or her favourite food etc., can improve the sufferer’s motivation. This, in turn, enables him or her to return to the normality of everyday life.

The Companions
Alice Lam
Counsellor