Family and Caregiver Schizophrenia Discussion Forum

How to use LEAP when goals and fears aren't based in reality

I’ve been reading the LEAP book and its all very well but with all the examples of conversations in the book, the person at least appears to have some contact with reality, for example their goal might be to get a job. But how can you apply LEAP when the person you are dealing with has virtually lost contact with reality, here are some real examples taken from my wife:

  • A goal might be to turn into an alien because humans are all evil and her husband has already turned into an alien.

A fear of going to see the doctor is that they are evil and will try to kill her

A fear of taking medication will be that it will stop her from becomming a fairy and then she won’t be able to visit the moon.

I have no idea how to proceed using LEAP in these sorts of situations.

@mungbeans, I agree with you! I find this to be humorous, except for the someone’s trying to kill me part, hope you do too.
My son was in a auto accident and suffers from a TBI, he also suffer from MI.
examples of his reality:

  1. his magic shoes turn him into an elf with magical powers
  2. use the 2 brooms and the mop in a swirling motion on his floor in the bedroom and his $50k will appear
  3. The FBI are watching his every move, and they exchange secret notebooks, which contain government level information.
  4. his special car keys, we drive around the city looking for the really cool car that someone gave him. It’s parked in a parking lot, somewhere in the city and he moves it everday so he doesn’t have to pay parking meters, but cannot remember where he left it.
    Take care AnnieNorCal

This is exactly why I never made it past the Listen and Empathize steps, which are helpful.

I tried to hear the person’s emotions without somehow supporting the content of the delusion or hallucination.

And the goal was often safety, which I tried to provide in the most basic average ways.

LEAP isn’t about trying to fulfill their delusional goals or solve their paranoid fears:) For working on paranoid fears and delusions you can learn about Cognitive Behavior Therapy. Don’t try to become a therapist by reading, personally I think it should be left to trained professionals, more knowledge is always good. Many of our family members need to be on meds to even begin to work with CBT. Some of our family members can work on CBT without medications.

LEAP is about opening lines of communication so you can find a motivation (or a bribe) to work towards medication. In the meantime - its helping our family members with scz feel they are heard and helps you gain some conversational trust. By opening up communications you can begin to learn their concerns and their desires. You are listening for a a “normie” type desire. In the meantime, while they are voicing their delusional goals and paranoid fears, you get to practice your listening and empathizing skills while gaining trust.

If your family members are 100% of the time as sick as you are describing, they possibly need much more than LEAP could accomplish. While scz is the most severe mental illness, there are those who suffer on the extreme end of the spectrum. If there are times that they are in less severe distress, those would be the times to work with LEAP. It would be quite futile if I was to attempt LEAP on my son while he was raging around the yard yelling at voices - a victim of extreme psychosis suffering a total break from reality. If your family members are like that all the time, you really need to be looking at different options.

The worry about reinforcing delusions is addressed by Dr Amador. He does not believe that letting them voice their delusions reinforces those delusions. Repeating the delusions can be scary. My husband absolutely hates the concept of repeating a delusion back to our son. For me, it was a good time to jump to “agree to disagree”. Example. “Dad wants to kill me” My response “you are worried that Dad wants to kill you - that must be frightening - I don’t believe Dad wants to kill you, we will have to agree to disagree”.

My son was quite comfortable with the “agree to disagree” I had to be careful to not repeat what he said too often or he would become frustrated that I was repeating what he had said. Highly intelligent still, he would say frustrated - “why do you keep repeating what I say?”

For those of us who didn’t understand what was happening to our family members in those early years of their illness, we addressed their concerns with rational statements. Rather than being comforted by those rational statements, they become suspicious of us, we became a part of the delusion when we argued or rationalized with them. They shut down from confiding their concerns in us. LEAP is about undoing that damage.


Thank your very much for your detailed reply. Unfortunately those quotes from my wife were from when she was at her most calm and at a time when she was open to talking with me, so yes she basically is like that all the time.

Family to Family is a tough journey. To me it felt like every class had a piece of crucial information that we needed, every class also came with a dose of reality.

One of the harsh realities was how long it can take for us to get any sort of positive progress. I used LEAP methods for over a year just to get my son to a psychiatrist so he could be diagnosed.

Twice now I have been able to get him to try meds using LEAP, its been over a 5 year period.

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I’m shooting from the hip but I think it may go like - That must be very stressful not to be able to turn into and alien and protect yourself. (or just protect yourself). I’m sure that must cause you some anxiety. Perhaps a specialist (?) can suggest what we can do to lower the anxiety. When you are ready we can talk about how to make you feel safer.

This is a tough one. I have a feeling there is going to have to be some forced medication for your wife. Which of course doesn’t happen over night. You may not have seen this quote yet - It’s a marathon not a sprint. Did the crisis team call you back?

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I was looking at a few articles yesterday which were proposing that that antopsychotic drugs could cause [quote=“DianeR, post:7, topic:5729”]
Did the crisis team call you back?

Yes but unfortunately it was at a time when she in an angry mood and demanding to know what I was on the phone too (this has only ever happened a few times in total, but by bad luck it did so both times the crisis team called).