When Someone You Love has Chronic Mental Illness

What if you have an adult son, daughter, parent or sibling who has serious mental illness? How can you help? How can you get them help? What is your role? How do you deal with your own feelings of loss, sadness, anger, frustration, worry or helplessness? How do you set some limits?

You may notice self-destructive behaviors, racing thoughts, delusions, hallucinations, or other breaks with reality. You might be aware of rapidly cycling moods in your loved one, or angry rants.

If your relative is under 18 years old, parents can intervene, and get a psychological evaluation. Your family member may be helped by medication and counseling. Parents have the legal right to seek mental health assessment for a minor child.

After age 18, the situation becomes much more difficult. The individual themselves has to be willing to get treatment unless they meet the specific criteria for involuntary hospitalization, which are: danger to self, danger to others or gravely disabled.

As a family member, it is essential that you get informed about mental health/chronic mental illness and get support for yourself. One of the best ways to do both is to contact the National Alliance on Mental Illness at www.nami.org  In many areas of the United States there is a local chapter of NAMI which offers information, support groups, lectures and more. In Orange County, California where I have my counseling practice, the local chapter can be reached at www.namioc.org/
Getting to know other families who are also dealing with a family member with severe mental illness, like schizophrenia, personality disorders and untreated bipolar disorder can be incredibly helpful.

Another valuable resource is your local Mental Health Association, which can help you identify local resources for a family member you are concerned about. In Orange County, our local chapter can be contacted at www.mhaoc.org/  If you live elsewhere in the US, contact the Mental Health America national office at mentalhealthamerica.net and they will put you in touch with your local MHA office.

If your family member has a personality disorder, be aware that many people who have this diagnosis do not see themselves as having a problem and will probably blame others and be reluctant to get help. There are different types of personality disorders, including narcissistic, borderline, paranoid, schizoid, schizotypal, antisocial, histrionic, avoidant, dependent, and obsessive-compulsive. All personality disorders are an enduring pattern of inner experience and behavior that varies far from what we normally expect. Most are difficult to treat, especially if the individual does not acknowledge their situation.

Family members need support in learning the best ways to help the mentally ill member, as well as how to set reasonable boundaries and limits for your own self-protection. For example, if you have an adult son or daughter who refuses to get help, but does not meet the strict criteria for involuntary hospitalization, you will need to sort through what your role will be. Perhaps you can see them and be emotionally supportive, but set limits that you will not accept physical, emotional or verbal abuse. It might be that you can help the grandchildren. You might be willing to help with the cost of some treatment, depending on your circumstances. You might be able to see them in limited amounts and provide emotional support, but not have them live with you.

A family therapist can help you learn not be codependent, and sort out how you can help and how you can  take care of yourself as well. Many people with chronic mental illness won't consistently take their prescribed medication or participate in talk therapy. As a family member who cares you won't be able to fix everything for another adult. Figuring out what you can do to help, and what is beyond your limits is key.

Parenting as a Team

I like it when parents get on the same team in parenting. Children and teens really respond better to it. Being on the same page really helps the parent's marriage as well. Nobody wants to play the bad cop all the time.

I taught Active Parenting classes for years, and still call on the program's clear description of the three most common parenting styles when I'm counseling parents and families.
The three parenting styles are:

Dictators: Set clear rules but enforce them by screaming, yelling, threats, spanking, punishment and taking things away. This style might work for a while, depending on your child or teen's  temperament, but at some point your child will shut you out and stop confiding in you. (Think about it- would you open up with a problem to a parent who yelled at you?)

Doormats: These parents either don't have rules or they only enforce them at times. Other times they let things slide, and their children and teens often get too much power by learning to manipulate these softies. Doormat parents are loving, but don't set limits effectively. The children of doormats may be delayed in developing skills for independent living in their future.

Active Parents: Have clear rules that are developed with the children and are consistently enforced. Active parents use natural and logical consequences, and offer choices. They try their best to stay calm and reasonable. Active parents care about being loving and approachable, but also raising children who can accept limits. They give children and teens expanding or contracting limits based on how responsible they are being.

Can you identify your parenting style here? How about the styles your own parents used?

Just imagine the challenges and resentment that develops when one parent is a dictator and the other parent can see how they are alienating their child. Equally bad is when one parent is a doormat parent and the remaining parent feels undermined because they are always the heavy in the parenting department. When both parents are doormats, children learn to manipulate to get their own way.

Whether parents are married, divorced or single, parenting from the active parenting style (where you are loving, but carry consequences, choices and clearly defined limits) is the way to go. We want to parent with the end game in mind: raising caring, loving, responsible and independent young adults who contribute to the world around them.  Consider holding weekly family meetings with school age children to get the whole team working in the same direction on cooperation, chores, homework, the morning and evening routine. Children need a place to have a say about what is going on in the family, and how we can work together to improve it.

If you are overwhelmed as a parent, or find yourself yelling or frustrated with your children, consider taking a parenting class or meeting with a family therapist who can help you and your partner get on the same team and build a less stressful, better family. Even divorced parents are actually still on the same team in terms of the parenting until every child is successfully launched into adult life. Let's work together and keep that goal in mind.

Giving Ourselves Permission: Women Pursuing Dreams of their Own

I like to ask women of all ages in counseling about their hopes and dreams, and what they would really be doing if they could. Too many women are awaiting permission from someone else to go for really want to be doing, creating or experiencing.

Writer Elizabeth Gilbert, who wrote Eat, Pray, Love speaks and writes about the importance of women giving themselves the opportunity to define their own life purpose, and considering  other paths than our mothers and grandmothers took.  Other women want to be brave enough to choose the same path their mother followed.

The messages that girls get while they are growing up often encourage women to defer, consider the needs of others, and accommodate. While awareness of the needs of others is valuable, women and girls need encouragement to develop their own dreams and their own voice in relationships and planning their lives.

Here are some of the situations where I want to have us all encourage the women in our lives:

To have life goals beyond being a parent or wife.

To decide to work it out to be a stay-at home-parent and raise our own children if we choose to.

To take time to develop our friendships with other women.

To end relationships that are abusive, demean or belittle us.

To start a business of our own.

To recreate our lives when children are grown if we choose to.

To create art.

To tackle issues, causes and problems we care about.

To do things that make us happy.

To spend time alone, in our own company.

To advocate and speak up on our own behalf.

To set our own goals.

To challenge ourselves.

To be brave.

To keep learning new things.

To ask for what you really want, at work and in your relationships.

To develop and utilize your talents and gifts.

It's important to encourage the girls and women in our lives to nurture their own dreams, and not just support the dreams of others. Being "nice" is overrated and doesn't really make you fulfilled. There are no prizes for suffering or being a martyr.

As women we deal with the way we were raised, and the feminine archetype of being selfless and all giving, which may set us up to be pleasers. It is essential to listen to that still small intuitive voice inside us which wants to express who we really are, outside of roles and other people's needs and expectations.

Perhaps now is a good time to be asking yourself what you could give yourself permission to do that would make you more fully alive and closer to your own true north. Maybe the permission you need is really your own.

Why Sooner Is Better For Couples Counseling

Men can be reluctant to come in for counseling. Often it's their partner who talks them into coming. Men can be depressed and not want to talk about it. Sometimes women start the conversation about getting couples counseling, and men can drag their feet until the marriage is at a breaking point.

It makes me sad as a couples therapist to see people delay and let a relationship deteriorate without getting professional help. Divorce is expensive and emotionally difficult for both adults and the children involved. Why ignore the signs of relationship tension, your distress or your partners? What if you wait too long and it's too late to save things?

What if we shifted the paradigm to working on couples or individual concerns when they are still small? I think we could prevent a host of relationship cancers developing. Even a tune-up, a couple of sessions with a couples therapist can help you get things back on track, more connected and communicating better. Sooner is better!

What are signs a couple should get some counseling, because there are couples issues developing?

1. One or both partners feel unappreciated.

2. Physical affection is tapering off or stopped. You don't hug, kiss, hold hands or have physical intimacy. You can't talk about your physical needs and preferences with your partner comfortably.

3. You are completely consumed by your children's needs and there is no energy or time left for you as a couple.

4. You can't recall your last date night with each other.

5. You are sleeping in separate bedrooms, or different places in the house.

6. You feel misunderstood on a frequent basis.

7. Your partner won't listen.

8. You can't solve problems together.

9. You're not having any fun together.

10. You don't feel respected by your partner and/or you don't respect them.

11. You or your partner are not emotionally available for any reason: working too many hours, alcoholism, substance abuse.

12. Your parenting styles conflict. One of you always has to be the bad cop.

13. One or both of you shut down, pout, threaten divorce, swear, rage, scream or otherwise make communication impossible. You can't fight fairly.

14. One of you doesn't set appropriate boundaries with others: your family or friends of the opposite sex.

15. There are difficult conversations you need to have with your partner, but you don't feel safe to have them.

Any of these relationship issues is so much easier and quicker to fix sooner rather than later. While counseling is a cost, you must consider what your happiness is worth. If your relationship isn't satisfying, not much else in life is enjoyable. When it comes to solving couples, family or individual counseling issues, recognize the value and intelligence of a tune-up rather than waiting for the point of no return. Why suffer with a mediocre relationship, when you can co-create something much better with some coaching and effort? Life's too short not to go for the marriage you really want. It makes me so happy to be a part of making that happen for couples.