How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 37

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Make your observations as concrete and objective as possible, e.g. ‘Spent all morning in bed. Appeared to watch
television in afternoon but showed no reactions to the programmes or to changes of channel by others.
Unresponsive to efforts to hold conversation’ (rather than ‘withdrawn’).
3. Reassure, encourage and support the positives
People with a psychotic illness are likely to feel confused, distressed, afraid and lacking in self-confidence, both
during the acute phase and for a long time afterwards. The illness has probably caused them to lose control of
their thoughts and to feel overwhelmed by the world around them. As they recover, it is common for patients to:
• sleep for long hours every night (or during the day) for 6–12 months after the psychotic episode
• feel the need to be quiet and alone more often than other people and
• be inactive and feel that they cannot or do not want to do much.
It is helpful to explain to the patient what is happening to them, e.g. that psychotic symptoms usually appear as a
response to severe stresses (see What causes psychosis above) and that additional sleep and inactivity is the
body’s natural way of slowing down to allow the brain to recover following the shock of an acute episode.
It is also helpful, as the patient recovers from the most acute stage of the illness, to encourage them to resume
activities gradually that they have been able to do and have enjoyed in the past. Encourage the patient to help
with simple jobs around the healthcare centre or to chat with you or to join in any art or other therapeutic
activity on offer. If the patient refuses, do not pressure them but make it clear that they are welcome to come
when they feel able to join in. Make it clear that they are welcome simply to sit in the company of others and
watch or listen to people without joining in more actively. You may find that the patient likes to listen to loud
music a lot of the time. This may be a way of drowning out distressing voices or thoughts. Earphones or a
Walkman may be helpful.
Most importantly, it is helpful to relate to the patient as a human being who has interests and strengths separate
from his/her psychotic symptoms or lack of them. This may be crucial in rebuilding some self-esteem and hope
for the future. Find out what the patient’s interests are and, if you can, discuss them with the patient. If the
patient has contact with family members who are supportive, try to arrange a visit. It may be very helpful for the
family members to have information about psychosis. This can be provided by an organisation such as the
National Schizophrenia Fellowship (for details, see Resource directory).
4. Reduce stress and conflict
Because environmental stress plays such a prominent part in triggering episodes of psychosis, reducing such
environmental stress is an important part of both treatment and prevention. The particular kind of stress that
studies have found to be detrimental to patients with schizophrenia consists of high levels of ‘expressed
emotion’. This means:
• hostility: not only just bullying or physical aggression, but also angry shouting
• emotional over-involvement, eg ‘Can you tidy your cell for me?’ and
• criticism, eg calling a patient ‘lazy’, blaming him/her for being uncooperative.
Staying calm and using the communication tips in Communication/engagement above will be helpful.
Ensuring that the patients are in an environment safe from bullying is also important. If the patient returns to
normal location when the acute episode is over, residential managers should be aware that the way the patient is
treated by staff and prisoners will significantly affect the likelihood of relapse. Additional patience and ‘giving
leeway’ may be required.
5. Look out for depression and suicidal thoughts
People who have psychotic illnesses are at significantly higher risk of depression and suicide. They tend to have
low self-esteem, to feel hopeless about their lives, to misuse drugs and alcohol, to l