Many families trying to support someone in psychosis fall into the same trap professionals find themselves caught in: power struggles: “How can I make my relative change? What should I do to get them to see they are sick?” While it’s hard to argue with wanting someone to get better, control and conformity are at the heart of everything wrong with the standard psychiatric approach. The deeper families dig themselves into forcing change on their relative, the more they flounder.
Madness has a way of presenting us with paradoxes. Trying to get someone to change more often than not just leads to failure and desperation — and drives them into isolation. Gentle encouragement becomes pleading and pressure, and then coercion, and soon family members have formed alliances with professionals and are entrenched in medications, forced treatments, and disease explanations. Exerting control might lead to apparent momentary gains, but it is more likely to obscure deeper reactions that show up later: throwing meds away, apathy, self-destructive behavior, or even violent outbursts. Add the dimension of young people testing independence from their parents, and the age-old drama of adolescent rebellion is played out on the stage of mental health.
While all families are different, one way out of this impasse is to let go of changing the relative. Easier said than done, of course, when it’s your child in crisis, but in family after family, recovery for a person struggling with psychosis means a shift from controlling the other to controlling yourself. It means looking at how you relate to your relative, rather than what’s wrong with them. And it means getting support to make change.
I learned a lot about putting this perspective into practice from Krista Mackinnon and the Family Outreach and Response Program (FOR) of Toronto Canada. (I should say that Krista is my friend, and a colleague on a number of mental health projects.) When I discovered FOR’s work seven years ago it was a revelation — a pro-survivor, anti-oppression, and recovery based family support organization, publicly funded with a solid track record of success. I wrote about it for my Icarus Project blog at the time, and have been learning from FOR ever since.
Now Krista — who began work as a counselor after surviving her own psychotic crisis as a teen — has done an extraordinary service to families and everyone supporting people in psychosis. With the encouragement of FOR and director Karyn Baker – who is herself a family member – Krista expanded the curriculum she taught Toronto families into a training class and support group that everyone can take. Don and Lisbeth Cooper also deserve praise for the farsightedness of investing in Krista’s work via Mother Bear, taking the risk of partnering with psychiatric survivor-led teaching. The new class, offered online, has been a resounding success for the more than 200 family members, professionals, survivors, and recovery researchers who have taken it so far. Krista has gained wide acclaim for the clarity of her teaching and the practical usefulness of the skills she offers.
Krista designed the class to be affordable — 8 weeks of training and support for less than the cost of two therapy sessions — and completely flexible, fitting anyone’s schedule and requiring only a limited time commitment. Drawing on her years of work as a family counselor and her personal insights into recovery from madness, training topics include the limitations of a disease model approach, working with boundaries, how to communicate with someone in psychosis, rekindling hope, untangling power struggles, understanding medications, and wellness strategies for the whole family. I recommend the course to virtually every family I meet, as well as professionals, survivors, and anyone interested in psychosis recovery. The positive response has been tremendous, and I see firsthand how the skills learned can make a real difference for family support. Krista’s partners Family Outreach and Response and Mother Bear are now working on an outcome study with University of Northern Colorado researchers, in order to document the training’s effectiveness and demonstrate it as an evidence-based practice.
I was able to finally get Krista, a mother of three with a busy professional schedule, back on Madness Radio as a guest after our previous interview in 2007. Our new interview focuses on the common dilemmas families face and the skills Krista teaches in her course and counseling practice. In less than an hour interview Krista casts bright illumination on practical ways families can move forward.