Rapport & Bridge Building for the Caregivers

Karen Shein, at the time of the interview, is 3rd-year graduate student at San Diego State University in the Psychiatric Rehabilitation Counseling Program. She has an extensive history of supporting and educating caregivers of a loved one living with severe mental illness. She has worked with the local NAMI chapter, Jewish Family Service of San Diego, and has been a “Family to Family” program teacher, and she is a “Peer and Family Support specialist.”

Her experience with other mental illnesses in addition to schizophrenia is quite valuable to our listeners. She related the personal history of her then college-age son with his first episode of severe Major Depressive Disorder with nihilistic and suicidal thinking. These self-destructive thoughts may also a part of the young adult’s early experience with schizophrenia. Getting into a closed-locked safe treatment setting can be traumatic, and we both hope to add our impact to change the mental health delivery system & associated components to be more compassionate in that situation.

Karen then described her journey of self-education when she came across what is called “Motivational Interviewing” as a way to build rapport with a loved one living with mental illness. The hallmark is to put aside your own judgments
and urges to correct delusional and grossly distorted thinking and accept the loved one’s thinking. At the same time acknowledging and empathizing with those thoughts and emotions while internally not agreeing to their validity. Simultaneously, one is trained to accept the loved one’s thoughts and not argue nor correct the very odd or frankly delusional material. This is quite a dance and a discipline for the caregiver. Of course, keeping things & people safe from harm is key.

Dr. Ken Campos related part of his experience of 20 years in the closed locked acute hospital setting. There found that paying attention to and really intending to understand the beliefs and experiences of those living with what we call severe mental illness helped build trust and rapport with his patients. Ultimately, this stance, this way of being with the patients helped their healing process. Karen agreed that by accepting (but internally not completely agreeing with) her son’s personal narrative it helped both his acceptance & serenity and her relationship with him. It was a game-changer.

Karen outlined some of the key featured of “Motivational Interviewing” which one can study using the link below.

The legal privacy rules and laws for psychiatric hospital patients were discussed. In an earlier podcast, one local psychiatrist spoke about the acute psychiatric hospital stay and the value of the family making a phone call to the treatment team and giving the history of medications, observations, and symptoms related to their loved one. This was recommended when the treatment team is not allowed to acknowledge or admit that their loved one is even a current patient in the hospital. It is the team psychiatrist’s discretion to allow communication between the hospital staff and the family when it is deemed to be in the patient’s best interest.

Karen spoke highly of the programs of NAMI, the National Alliance on Mental Illness, and encouraged listeners to explore their programs. Dr. Ken Campos invited listeners to his FaceBook support group, too.