Family and Caregiver Schizophrenia Discussion Forum

Any advice on how to use LEAP properly?

Thanks, That is a good strategy.

I might say “Wow, I would be really scared and angry if people were looking at me and thinking mean thoughts.”

Exactly! Works for me with my husband. And because I tend to feel things more strongly than he does, it tends to even help calm him down a bit because he will come up with a less intense way to describe his experience. And it always makes him feel good that I am understanding how hard things are for him.

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I wish that would work with my husband. He doesn’t seem to like when I reference feelings at all, whether about me or about him. I can’t tell him that I care about him or miss him…feelings! He gets angry if I talk “like a therapist or doctor” with him when I use language of LEAP. He does get upset…very upset. I don’t know how to talk with him at all. I really feel “damned if you do, damned if you don’t!”

We are only in communication by phone and email since he moved back to CA. He is still homeless and staying in his car. It is getting colder at night there and I really wish he would try to get into a shelter, but he outright refuses. He was working with a social worker for a while but decided against staying at the shelter at the last minute. He is hoping some rich person in AA will offer him a room for free. I don’t know what to do for him any more except stay in contact and hope he doesn’t die out there.

Thank you for your ongoing suggestions. I still have hope but the situation is not looking good right now.

I used LEAP to make tiny daily changes when my daughter was unmedicated. To me, the L (listen) didn’t mean to listen without response… but more to listen without reproach or put down or negating what my daughter was talking about. It meant not getting upset at the impossibilities being expressed by her. It would listen to whatever she had to say, and then express only simple things like “I’m sure that worries you” Or “perhaps that will change in the future” or “I wish I could have an answer for that”. Actually, it took weeks to get her to talk to me, that was the first subject tackled, as she didn’t talk to me, only to her voices.

The first result of using L & E (empathize) daily was to get her to open her bedroom door to take food from me nightly. It took a few weeks of the same conversation nightly. Then L & E centered around taking a walk around the neighborhood nightly. We STILL take walks around the neighborhood nightly, and it’s been years now.

One behavior at a time can be addressed and changed. L & E over and over, until you can A (agree). Or, as Hope said A can be “agreeing to disagree” so that at least that argument can be over: “I agree it would be great, but disagree that it can happen right now. I understand you want me to move there, but for now, the best I can do is talk to you on the phone and send you money” or something like that. Then perhaps your partnership is daily phone calls and $15 a week… or whatever you work out. Then on to the next subject that needs addressed: Perhaps that you will hang up if he yells at you on the phone, and only talk later.

LEAP worked best for me tackling one small thing at a time that both people wanted to change. L, E, L, E, L, E spaced out over days or weeks until A or “agree to disagree” can be worked out (which is P, partner). Then the next subject goes through the same process.

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Thank you oldladyblue!

I have not considered only trying to perfect one portion of the method until that one works and then moving on to the others. That is a great idea. I will try that today!

My husband has word triggers. He doesn’t like the word “hope” or “wish” or anything that references the future. He says he wants solutions for NOW. I know that for him, that often means money, as much as possible, but I am not in a position to be able to provide that for him any longer. I tell him often that I am doing the best I can do and we are able to talk and message each other any time. He is getting used to that.

I wish he had stayed working with the social worker. CA is so overwhelmed with homeless at the moment and he was extremely fortunate to be offered a place in the shelter and I was so disappointed he turned it down.

I am glad you and your daughter still take walks around the neighborhood. :grinning: That is good for both of you.

There’s a nuance here that practitioners might miss about this. In some ways you’re modeling emotions that the person you are caring for may not be feeling, but should or would absent the disease.

There’s an element of ‘oh yeah, I really should be angry or scared or (insert your emotion here) about this, but I’ve gotten so numb to those emotions either by nature, familiarity or by disease, I completely forgot how to feel about this.’ Conversely, seeing someone expressing and validating your feelings in a more effective and presentable way models more effective expression of emotions.

I experience this when acting often. I tend to think of portrayals of characters from a voice, sound and textual basis, since these are strengths I’m comfortable with. Integrating emotion and movement don’t come naturally for me, and it takes me time to internalize things. Seeing or hearing a director act out the emotional subtext of a scene often jump-starts my process. Cast members and directors who don’t understand this about me, tend to think I ‘can’t act’ until I slowly inch my way to internalizing the character.

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Thank you @LifeIsHard for your kind words. Each subject that was addressed with LEAP has stayed in place. She seeks me out for the nightly walks now. Even if I don’t want to go, even if it is raining, I never turn her down.

At first, I thought LEAP would never work. My daughter was 24/7 psychotic locked in her room, talking herself hoarse to voices and ignoring almost everything I said to her through her door. So, the first step of LEAP was to get her to talk to me.

Your husband obviously WANTS to talk to you. Yes, your responses can set him off, as you never know what he is really understanding of what you say, but eventually, your conversations can be less upsetting if you use L, E, L, E, L, E, A or Agree-to-disagree to resolve one thing at a time over weeks of daily trying, giving it enough repeating days to work on that one subject.

For me and my daughter, it took weeks. I wasn’t always calm (my mistake). Some nights I lost it. I remember pounding on her door, crying and yelling back exactly what her “voices” were saying to her. She was sooooooo confused that I could hear her “voices”. I heard her say to herself (to her voices) “How can she hear you?”, “I thought she couldn’t hear you” switching voices and answering herself as a “higher being”. She wouldn’t respond to me directly. I realized L and E was to repeat back to her what her voices said and THEN she KNEW I was listening.

Nightly, after work at 5:30, I knocked, listened to what she was saying to her beings, and repeated back through the door, sometimes yelling to match her own loudness of screaming. Finally, she stopped conversing to her voices and said a sentence to me like, “Hi Mom.” I would say, “do you need anything?” and she would say “No” and go back to her voices. Step one of LEAP was done for that behavior, she WOULD talk to me once per day. I always thanked her for talking to me after that.

After a few days of “No, I don’t need anything”, I started “I have dinner for you, please open the door”. She sent me away for awhile, asking her voices if she should take the food. Then one night she started opening her door and taking the dinner I made. (She had a fridge in her room, and shopped sometimes while I was working.)

Weeks later, I came back to her room a second time nightly to take her dishes. And she started opening her door a second time each night. Then, after that was settled behavior, I asked when taking dishes if she would go for a walk with me. First few times she said no, then she said yes.

The first walk and a few after, she turned around back toward home a few houses from ours, then nights later all the way around the block with me while she was yelling nonsense to the neighbors, then nights later no yelling at the neighbors but walking in almost silent whispers to her voices.

Months later it progressed to her going grocery shopping with me for one or two items, yelling at other customers occasionally (and getting kicked out of WalMart sometimes). Then to normal shopping for 15 minutes with no talking to voices (or only silently).

Remember, she was actively psychotic for years, so working on a LEAP step over and over for a few weeks was pretty short to me to see the changes happen.

Medication made using LEAP much easier, so the past 10 months have been very different.

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Thank you for sharing these details. You worked in such a kind and consistent and dedicated way and really managed to connect with your daughter when she was in an incredibly confused and confusing place.

I am so glad she’s been doing better on medication for nearly a year now.

Fingers crossed for a very different Thanksgiving for you and your daughter this year as compared to last.

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@Itsastruggle and others who like and/or reply to my posts, I will always do my best to help anyone who asks. It is so so so very difficult to manage any sort of winning solutions in this trial and error system of handling severe mental illness. The war we wage against sz wears at each of us in terrible and different ways.

I choked up with tears in my eyes at your nice response and compliments. It is always wonderfully warming to my soul for total strangers to have good wishes for us. I choked up tonight because it made me realize not one person of my 24 co-workers has asked even once about how my daughter is doing recently, in months. Even her brothers haven’t called her or me to ask about us in weeks going on to a month. Yet, the kind people on this site say caring words and wish us well. I so much appreciate that.

I think I am going to read my copy of Dr. Amadors book again. The first time it is read, it isn’t easy to sort out how LEAP will work. The second time it makes more sense. It is time for my third read through.

It is a beautiful night here in Florida, I hope everyone has a nice evening.

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It is strange, I suppose, but I don’t feel that we are strangers here, oldladyblue.

We all have a painful common bond, and although I do get emotional support and good suggestions/advice from people who are “really” (i.e. not virtually) in my life, it is really only here that I get to interact with people who can truly understand, in a very visceral way.

My husband clearly had a bad day for reasons he is either unwilling or unable to share due to his paranoia He is upstairs alone right now, trying to pull himself together. I think we both wish he were able to get more comfort from me.

At least I can get some comfort here, and not feel so alone. I wish he had somewhere he could go to feel better. Anosognosia is terrible.

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So true @Itsastruggle we don’t feel so alone, we are not judged, great help and information is always given.

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Yes, when I learned of anosognosia, I cried, literally. I still remember falling apart. And what is weirdest, is that the medical people who treat our loved ones, don’t really recognize it. My daughter’s psychiatrist keeps trying to tell my daughter her diagnosis. It makes things really uncomfortable.

I think it is the illness that makes your husband unable to share, not an unwillingness. He is there with you, but not with you, because of the crowding of his head with things only he can perceive. So very sad.

I am like you, in that I come here for some comfort and not to feel alone. You are very right, we are not strangers. In reality, I have more friends here on this site than I have in real life now. Thank you for pointing that out.

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This is a wonderful story of perseverance to show that it can be successful. You are a great mom!

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My experience is that many psychiatrists handle this very poorly. And don’t even explain it to the family.

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Thanks for the compliment @hope4us . I appreciate being called a great mom, that makes me smile. The key was to never give up, and to start taking care of myself better, so I could give more without wearing myself down.

You are so right, I have never heard the words “lack of insight” from anyone treating my daughter. Nor “anosognosia”. Not once in the past year. It seems horribly unfair that psychologists and psychiatrists don’t let families understand why, why, oh why it seems so impossible for their loved one to understand they are acting oddly. Thank goodness for NAMI and this site letting families get to an understanding of lack of insight.

The LEAP method has NOT resulted in her insight, but rather her cooperation with me. And a big increase in love and trust between us. That is the A and P part of LEAP. It comes after lots and lots of L and E.

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I always assumed that LEAP was not intended to help people find insight. I admit I haven’t yet read Dr. A’s book but I have watched a few videos and read about the underlying concepts. Having inside knowledge of how schizophrenic thinking works, it makes absolute intuitive sense to me.

Is anyone expecting changes in levels of insight? I could see why people might think this if a subject becomes medication and treatment compliant, or even less fearful and belligerent without treatment. Does Dr. A caution people not to expect this? And even if they observe insight, to understand that it might not last?

Too many times, I have seen relapses happen because people make assumptions. Appointments are missed and no one is told. Medication is skipped or dosages self modified, prescriptions not filled, or filled and stockpiled. Listening and Empathizing is a lifelong check on these realities.

[quote=“Maggotbrane, post:36, topic:7279”]
Is anyone expecting changes in levels of insight?
[/quote]Does Dr. A caution people not to expect this? And even if they observe insight, to understand that it might not last?

I don’t think Dr. Amador is completely clear in his book as to what LEAP does regarding insight, probably because his take (that anosognosia is neurological rather than psychological) was not widely appreciated at the time (and clearly not always appreciated now).

In the introductory chapters, his goal is to persuade readers of the organic nature of anosognosia. And because he knows that for most of people, “organic/biological” means “fixed/unchangeable” and “psychic” means “changeable”, he makes efforts to emphasize that “psychic” denial actually tends to be a lot harder to address than anything neurologically based (as neurons have the capacity to make new connections and important functions in the brain can sometimes be recovered in cases of stroke/brain injury etc. by reassignment/rerouting of functions).

So I think there is an implication that LEAP has the potential to change insight over time. But his basic approach is much more behavioral than what might be called psychodynamic, and ultimately I think he is pragmatic and much more concerned with changing behaviors than with inner attributions.

Also, because his views were formed by his ongoing interactions with his schizophrenia brother (who died a few years ago) as well as in his professional work as an inpatient psychologist, I suspect he initially viewed his brother’s increasing willingness to state that he was schizoaffective as some gain in insight but then perhaps modified this view a bit over the years.

There is a very poignant online interview in which he talks about a conversation he had with his brother not too long before his brother’s untimely death in an accident. He asks his brother something like, “So you have been saying you have a mental illness for a long time now. It’s just the two of us here, so, be honest with me, what do you really believe?” And he says his brother replied, “Ah, Javi [his pet nickname for Dr. Amador], you know I don’t believe it”.

In my experience with my husband, I’d say he has little bubbles or pockets of insight that come and go. So perhaps there have been times when he was complying with medication due to “insight”. But by and large, I’d say that he never really saw it as necessary and mostly continued because he knew it was important to me.

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Yes, very true.

“mostly continued because he knew it was important to me.” Yes, I can agree @Itsastruggle .

I don’t really remember all of Dr. Amador’s book now, I know there were parts that confused me, or seemed not as important as others. I have never read any of this other works or seen any lectures. I took what was valuable to me and used those parts. And expanded use into enough success that I recommend the book to others.

But it is time for me to read it again :slight_smile:

What a great analysis you have given on this subject! Thank you. I have heard some people say that persons with SZ sometimes mellow out as they get older. Of course, there are no guarantees. While complete recovery from the SZ illness itself is not expected to ever happen, I concur that “organic/biological” symptoms can change or even fluctuate over time. I had been given the impression from others that a person on medication could gain insight. I know of a person with SMI that stated he “realized that believing the FBI had planted a chip in his head was crazy”. So there was obviously greater awareness of his situation. Our own non-med-compliant son has been voluntarily (enforced) on meds for well over a year without complaint and not long ago (in the one support group meeting I was able to get him to attend) I heard him say “I have a diagnosis of schizophrenia”. That was a first. Whether that means he actually has gained some insight, I do not know, but it seems like it. Can I count on it? Unfortunately, I know I can’t. But LEAP still helps with our relationship.

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yep, mine has, more mellow but still completely gone

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