When someone rejects a diagnosis of mental illness, it’s tempting to say that he or she is “in denial.” But someone with acute mental illness may not be thinking clearly enough to consciously choose denial. They may instead be experiencing “lack of insight” or anosognosia. Anosognosia is a common symptom of certain mental illnesses, perhaps the most difficult to understand for those who have never experienced it.
LEAP is a communication process developed by Dr. Xavier Amador, a psychologist at Columbia University, New York to assist families and mental health providers to help someone living with mental illness recognize the signs of their condition and seek treatment. It can also help when talking about other sensitive topics and with day-to-day communication.
This video below is addressed to mental health providers, but is equally helpful for family members and friends of someone who may not be recognizing symptoms.
The four components of LEAP are: listen, empathize, agree and partnership.
“The first step is to walk in the other person’s shoes to gain a clear idea of their experience of the illness and treatment.”
- Set time aside for discussion
- Agree on an agenda: what will be discussed – and stick to it. Don’t allow your family member to control the discussion by changing the subject.
- Listen to your family member about his beliefs about self and the illness and treatments
- Do not react emotionally
- Repeat what you hear to find out if you have heard correctly
“If you want someone to consider seriously your point of view, be certain he feels that you have seriously considered his.”
Having empathy means being able to put yourself in the shoes of the other person and to appreciate their experience from their perspective. It requires the ability to understand, be sensitive to and care about the feelings of the other person. Empathy doesn’t mean that you have to agree with what the person is saying, rather it is letting the other person know that you appreciate how they feel... Showing empathy can help encourage a person to open up about their feelings, worries and concerns.
It is important to convey empathy for the other person’s frustrations, fears, discomforts and desires. Empathy helps to communicate respect for each other’s point of view. Little statements, such as “I understand what you are trying to say” or “I sympathize with how you are feeling” go a long way towards reassuring your family member that you are listening and want to help.
In this step you must focus on your shared observations and find the facts that you both agree on. If there is disagreement, agree to disagree. It is often helpful to find common ground. For example, your loved one may be drinking to ease the pain of mental illness and you may be seriously worried that he is abusing alcohol. Can you reach an agreement that he won’t mix medications with alcohol? In a discussion that has escalated to a heated argument, it is always a good idea to agree to leave things for the moment and wait until emotions on both sides are under control. Just agreeing to “cool down” rather than continue with the confrontation signals to your loved one that you are being supportive.
This has to do with making a shared decision to work together on a plan of action. People living with mental illness can often feel isolated and afraid, sure that no one else understands what they are going through. By creating a partnership, you are telling your family member that you do care and you are willing to be supportive in a constructive way. It is worth remembering that sometimes support is not constructive. Enabling a loved one to continue his substance abuse because you think it is one way he can cope with mental illness is not constructive and is not a partnership. In a partnership, you help your family member deal with their fears and deal with their substance abuse in a positive way.
Resources to help:
Book by Dr. Xavier Amador: I am Not Sick I Don’t Need Help!