Communicating With Your Loved One During Psychosis

I've always thought of myself as a good listener. It's my nature to be curious about others and to practice techniques that make them feel heard, like asking clarifying questions and repeating what I’ve learned to make sure I understand.

Communicating with my daughter during psychosis

But when my daughter's onset of schizoaffective disorder led to a months-long period of psychosis, nothing I tried seemed to be working. She was in turns withdrawn and so talkative I couldn't get a word in, frequently did not appear to listen to me, seemed uninterested in my questions, and became irritated by my attempts at "polite" conversation.

When I look back on that time now, I see that I was attempting to force a neuro-typical template onto conversations between two neuro-divergent people. Now, armed with more information and learning, I continue to hone the listening skills I learned by trial, error, and others' lived experience.

Active listening with our loved ones

You may have already learned the basics of "active listening," like not interrupting and resisting judgement. There are some additional practices that have helped me with my daughter. They can be summarized by one of my favorite definitions of active listening, which is to strive to understand the complete message being communicated.

In the case of my daughter, this involved body language cues and some symptoms and behaviors that I found perplexing at first. What I perceived to be anger I later came to understand as frustration or distraction, for example.

Understanding her "psychosis lexicon"

In time I developed a "psychosis lexicon" – the unique set of ways my daughter communicates during psychosis. I stress the word unique because Sally's lexicon is not only different from that of every other person in psychosis but is also different from how she communicate at other times.

In the beginning, I found this process daunting. The outside sources I consulted (literature, clinicians, etc.) were not especially helpful, which I chalk up to the huge diversity of experience of people in psychosis. What did work for me, as a person who loves to journal, was to write down the things that perplexed me and also our successes and breakthroughs.

Navigating communication with schizophrenia

I learned to draw connections between cause (for instance, trying to talk to Sally when she woke in the morning) and effect (frustration for both of us) and, eventually, to ask the questions that resulted in improved practices (no talking before coffee!).

I also learned to focus on Sally's emotion rather than the details of an interaction. When her reactions seemed disproportionate, I tried to understand what she was feeling and where that feeling was coming from.

For instance, she sometimes revisited a perceived slight over and over. This made sense when I considered how much stigma and rejection she had faced, and how fearful she was of further painful rejection. Knowing that, I addressed the emotion and not the specific incident, reassuring her often that I loved and valued her and believed she had a promising future.

Not taking communication challenges personally

A challenge for me, as a highly sensitive person, was to learn not to take it personally when my daughter did not feel like talking. Together, we developed the habit of asking each other if we were "in the mood for talking" or "having a talking day," and not reading anything into it when the answer was no.

I often asked if it was all right for me to listen to a podcast or audiobook instead, and she readily agreed. In time, I learned that when Sally was having intrusive or racing thoughts, the sound of people talking wouldn’t really register with her anyway.

Respecting each other's needs

I also sometimes needed a break from listening – because I was overstimulated, because it was causing me anxiety or worry, or because I was exhausted. Now I say something like, "I need to take a break right now, but I am interested in what you are telling me and would love to hear more about it later," and give a specific time (e.g.m, after lunch, tomorrow morning, when I finish this work assignment, etc.) and follow through.

Like all of these techniques, this is based on the belief that my daughter is a person deserving of respect both in and out of psychosis.

Listening with care

Another time I'll write about the many truly fascinating things I've learned from Sally about her own brain and psychosis in general. By listening with care, I'm rewarded with glimpses into a rich, complex, and sometimes beautiful world that many will never see.