If you believe that the person you are trying to help has anosognosia for schizophrenia, rather than denial, then you should not say that this person "refuses to acknowledge he is ill." That would be like accusing someone of refusing to stop being delusional or hallucinating! We don't do that because we understand that these are symptoms of the disorder and not the person's choice. Armed with this knowledge and some additional research, you can become much more effective at convincing someone who has anosognosia—someone with poor insight—to accept treatment and services.
We don't know if anosognosia can be prevented, but if it is anything like the other common symptoms of schizophrenia then early intervention and consistent treatment—both medicine and psychotherapy (psycho-social supports and cognitive therapy) should make a difference.
SC: Tell us about the foundation of your book, "motivational interviewing," its purpose, and why it's effective.
XA: Motivational Interviewing has been around for more than 25 years. It is well studied and proven to be effective in helping people with substance abuse problems accept treatment for their addiction. More recently it has been shown to be very effective in persons with schizophrenia who do not believe they are ill. For example, in 2002, the American Journal of Psychiatry published a review by Dr. Annette Zygmunt and her colleagues of studies published over a 20-year period that were aimed at improving medication adherence in schizophrenia. The researchers found that "...although interventions and family therapy programs relying on psychoeducation were common in clinical practice, they were typically ineffective [with respect to improving adherence to treatment]... Motivational techniques, [on the other hand] were common features of successful programs." By "motivational techniques" the authors meant the main elements of Motivational Interviewing.
Relying on the same evidence base reviewed by Dr. Zygmunt and her colleagues, Dr. Aaron T. Beck (the father of cognitive psychology) and I developed a form of MET we called Medication Adherence and Insight Therapy (MAIT) for an inpatient research study of people who have serious mental illness. At the time (mid-1990s), we taught this method only to therapists. But I realized almost immediately that anyone could learn the specific communication skills and strategies we were teaching.
I came to believe that you don't need an M.D., M.S.W., or Ph.D. to use this therapy effectively. So I developed a lay-friendly version that can be learned by anyone, not just mental health professionals. The result was the Listen-Empathize-Agree-Partner (LEAP) method.
Over the past ten years, since the publication of the first edition of my book "I am Not Sick, I Don't Need Help!" How to help someone with mental illness accept treatment (Vida Press, 2007 see www.VidaPress.com), I have taught LEAP to tens of thousands of people across the country and overseas. Although the focus of LEAP workshops was to show family members and health providers how to convince someone with serious mental illness to accept treatment, people at every seminar have commented on the usefulness of this method across a range of problems. That has been my experience as well. So whether or not you believe your loved one has anosognosia for mental illness or simple denial of illness, LEAP can help.
The method has proven so popular and useful that my latest book I am Right, You're Wrong, Now What? Break the impasse and get what you need (Hyperion, 2008; see www.XavierAmador.com) shows readers how to use LEAP with all kinds of denial, teenagers, spouses and in business.
SC: How does LEAP work?
XA: LEAP is very different than other conflict resolution strategies because it shows you that the best way out of an impasse—as in the "You're sick!" "No I'm not!" variety—is to shut up, step aside, and use your opponent's own argument to win your case.
I remember the worst fight I had with my best friend growing up. We were eleven years old building a fort in the woods behind my house. We disagreed about some aspect of our grand design—I can't even remember what—and got into a shoving match. I was shouting "Stop it!" and pushing him. He was shouting "YOU stop it!" and shoving back harder. We went back and forth like this several times and were about to come to blows when I just stepped aside and he stumbled forward and fell down hard. By the time he stood up and brushed himself off he was laughing. I forgot my own anger and laughed with him.
LEAP shows you how to not push back when you argue and instead use your opponent's momentum to move him to where you want him. It leaves you both feeling like friends again, if not laughing together about the fight.
SC: Do you feel the techniques outlined in I Am Not Sick, will possibly be able to help someone who has refused for MANY YEARS to take his meds?
XA: Absolutely. In fact these are usually the people who ask to consult with me and who have sent me e-mails after reading the book and finding it helpful. The reason is because LEAP focuses first and foremost on the strength of your relationship with the person you have locked horns with rather than on the strength of your argument for why they should believe they are mentally ill. It focuses on building trust, mutual respect and as a result, making your opinion something the person you've been arguing with starts to value. And your opinion will never again be—if you are following LEAP faithfully—"you're sick". Instead your opinion will be focused on linking treatment and services to those things the other person wants (e.g., housing, work, money, a boyfriend or girlfriend).
SC: Robin Cunningham, a blogger at SchizophreniaConnection, maintains that although the
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