My son has been diagnosed with psychosis, now what?

The role of the family in the recovery of a person diagnosed with psychosis is key. Many studies have shown that family support is one of the most important factors in being able to face difficulties and recover satisfactorily.

In order for the family (parents, siblings, etc.) to be able to offer good support to the child or adolescent after a psychotic episode, they must be able to understand the diagnosis and manage the emotions it can generate from the very beginning. For this reason, they will need help to:

• Understand what is happening to your son or daughter.
• Face the situation with less stress.
• Learn what to do to help him.
• Improve communication and family relationships.

To begin with, the reaction to this news is very important.

How does the family usually react to the diagnosis of psychosis?

The most common reactions to a diagnosis of psychosis, both from the person receiving it and from their relatives in the case of children and adolescents, are:

• Denial: Denial is the tendency that people have to ignore or deny what is difficult for us to accept. Thus, many mothers and fathers have difficulty realizing the symptoms of psychosis in their sons or daughters, and even deny the diagnosis.
• Loss: They often experience feelings of loss, a kind of grief, because the symptoms can make their son or daughter act very differently, and “seem like a different person.” They also often have to grieve the expectations they have placed on him or her, which may have to be adjusted to the new circumstances.
• Guilt: They may also react by experiencing feelings or beliefs of having done something wrong, such as being responsible for their son or daughter's problems.
• Shame : At other times, and sometimes linked to guilt, they feel shame about the diagnosis. The stigma that still exists around mental health problems also plays a role in this shame, which sometimes makes them not want others to notice the changes the person has experienced.
• Anxiety: sometimes they also have a whole series of catastrophic, anticipatory and negative thoughts, and they think about everything that could go wrong. The emotion that drives all these thoughts is anxiety, and even distress.
• Sadness and hopelessness: it is also common to experience sadness, a feeling of not seeing the solution, of not being able to imagine a more or less satisfactory future.

What doubts do families usually have?

Families usually have many doubts about the disorder and everything surrounding it (prognosis, treatments, etc.). These are some of the most common:

• The cause of the disorder and the symptoms. Why does my child have this disorder? Is it hereditary? Is it because of something we did wrong? Is it because of some traumatic experience he has suffered?
• The prognosis, or possible prognosis. Will he always have these problems? Can we do anything to speed up his recovery?
• The most appropriate treatments and the duration of treatment.

The treatment of psychotic disorders in adolescents

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What can I do to help my son or daughter with psychosis?

First of all, it is essential to be able to understand the disorder, understand the symptoms and know the difficulties that the person with psychosis experiences. Some basic tips to support and help them:

• Understanding: Understanding the symptoms and the changes they produce in the person's reactions and behavior is the first step to being able to empathize and act in the most favorable way. For this reason, it is important to read reliable scientific information, but at the same time understandable and simple. In addition, most therapeutic teams carry out psychoeducational groups for relatives, which aim to explain the most frequent symptoms and reactions, and to guide families.
• Non-judgmental: Sometimes there is a blaming attitude towards the lifestyle of the person who has psychosis and the belief that they have developed it because of it. It is necessary to maintain a non-judgmental attitude when a person has had a psychotic episode.
• Coping: facing the diagnosis and the associated changes involves overcoming the first reaction and controlling the unpleasant emotions of the first news, in order to be ready to do what is necessary to help in the best way.
• Learning helping skills: Being able to offer a stable, safe, welcoming and non-invalidating environment is key to recovery, but it will not always be easy. You have to learn to stay calm in difficult situations, not invalidate the person when they react in a way that we cannot understand, etc. All of this requires learning some skills, among which effective communication is one of the most important.
• Changes in communication: people diagnosed with psychosis usually have difficulty identifying and managing their emotions, and they also tend to be very sensitive to the emotional expressions of the people around them. In particular, they are very stressed by the high emotional expressiveness of others. For this reason, it is important to learn to communicate without showing exaggerated emotional expression. This does not mean that we have to hide our emotions from them. On the other hand, it is also advisable to communicate clearly, avoiding the confusing messages that can be given when we say one thing with language and say the opposite with non-verbal communication or behavior. It is also important to be consistent and assertive when asking for changes in behavior or setting limits, showing warmth and affection. And, finally, it is also necessary to show empathy and a non-invalidating communication style. We are invalidating when we ignore, do not give enough importance to or trivialize their emotions.

Keys to communicating with people with psychotic disorders

• Use short sentences. Don't try to give long, complicated explanations.
• Be concrete and specific. Avoid using very abstract or very general and ambiguous comments.
• Avoid using words with negative content and prejudices (negative labels).
• Consistently praise the person and their behavior.
• Do not repeat the same messages excessively , if it has already been validated that the person has heard and understood them.
• Do not discuss the symptoms (for example, questioning the reality of hallucinations or delusions, etc.). Their perception is their reality and confrontation is better than "delegating" it to the therapeutic team.
• Do not let yourself get involved in the perceptions or ideas of the person who has the disorders, to the point of agreeing with them or reinforcing the delusional ideas.
• Try, when the person explains the symptoms (altered perceptions, delusions, etc.) to listen to them actively and reflectively , empathizing and validating their experience, but without reinforcing these experiences derived from the symptoms. The latter is complicated, but it can be learned. It can be helpful to ask the therapeutic team for advice to learn this skill.

How to promote effective family communication

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How can the family participate with the therapeutic team?

The family can collaborate with the therapeutic team in many ways. Some of them are:

• Provide information about your son or daughter. No one knows the person as well as the family, and all information is always very valuable. To the extent possible, it is always important to inform the person of these communications between family and team, and to have their consent, especially when it comes to a mature minor.
• Maintain frequent contact with the therapeutic team, attending all appointments and interview proposals, and participating in the various therapeutic activities offered to them (psychoeducational groups, etc.).
• Have an attitude based on trust and respect with the therapeutic team, but without ceasing to be critical and open in relation to any doubts that may be had. It is important that, if the family does not understand or does not favorably evaluate the proposals of the therapeutic team, they can share these doubts and resolve possible discrepancies, in order to be aligned and not give the person with the diagnosis of psychosis confusing and contradictory messages.

And at 18, what then?

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