My name is Wendy O’Leary and I am the Impact Director at CONNECT Summit County. I would like to tell you about one of the most impactful training programs that CONNECT Summit County offers to our community.
The name of this program is L.E.A.P – which is a method for helping individuals who have serious mental illness accept help and treatment.
I was first introduced to L.E.A.P. in the fall of 2018 at a CONNECT Summit County event featuring Dr. Amador, the founder of the LEAP method. At that time, a family member had been experiencing symptoms of serious mental illness, including psychosis and mania, for the preceding ten months. During that time, our family had tried to convince our loved one that he needed to get help but he had refused. It seemed like our efforts to help him were only making things worse and he was becoming alienated from us.
After learning about LEAP, taking the training to become an instructor and reading the book, my family and I began practicing LEAP with our loved one. Although nothing changed right away eventually he did get treatment and is doing well today. LEAP gave us the tools to persist in building a relationship of trust with our loved one at a time when we had exhausted all of our best efforts.
The reason our family member refused to get treatment for his symptoms was due to something called “Anosognosia” which is a medical term used to describe a neurological deficit that causes an unawareness of symptoms in an individual. Anosognosia is not denial. It is a symptom of schizophrenia and bipolar disorder that does not respond to medication. Anosognosia remains fairly constant throughout the duration of a mental illness although it can wax and wane. With bipolar disorder, there is often an awareness of symptoms during stable periods and unawareness during manic or depressive states.
LEAP is a method or set of tools for helping people who are unaware of their symptoms to accept treatment and services. Like my story illustrates, often our sincerest efforts to convince someone to seek help result in increased anger, frustration, alienation and resistance in the person we are trying to help. The usual approaches DO NOT work and often make things worse.
This was the experience of Dr. Xavier Amador who developed the LEAP method as the result of his own lived experience with his brother, Henry, who was diagnosed with schizophrenia in 1981. Dr. Amador was studying to be a clinical psychologist at New York University when his brother Henry began having hallucinations, delusional thinking and other symptoms of serious mental illness. Dr. Amador had no success in trying to convince Henry to seek help.
After several years of frustration and failed attempts at helping Henry seek treatment, Dr. Amador started using some of the tools he was learning during his training and started focusing instead on building a better relationship with Henry. He learned to stop badgering and arguing with his brother and instead built a closer relationship with him. This eventually led to Henry complying with medication and treatment and leading a fulfilling life for 18 years before his untimely death when he was hit by a car while helping a lady get on the bus with her groceries.
Henry died being the kind, compassionate and generous person that he had always been. He died being a Good Samaritan. This fact is a stark reminder of the seven years wasted on arguing and fighting with him over the question of whether he had a mental illness and needed treatment. It is a reminder to Dr. Amador that he had lost sight of who his brother was during those first seven years. He had confused the illness for who Henry was. Henry was not uncaring, ungrateful, lacking empathy or compassion for others. He never stopped being a person who was kind, responsible and compassionate. He had always cared deeply about others.”
I think many of us can probably relate to this sentiment. Remember, “never let a problem to be solved become more important than a person to be loved.” – Barbara Johnson.
So, what does L.E.A.P. stand for? What are these tools?
L is for listen reflectively.
E is for empathize strategically.
A is for agree on things you can honestly agree with.
P is for partner. Partner with your loved one on agreed-upon goals and needs they have identified.
What does Listening Reflectively mean?
It means active listening. Giving your full attention to the person who is speaking. Listen without an agenda. Listen to understand, not respond. Reflect back what you hear the person saying and make sure you are hearing the message correctly. Do not summarize or paraphrase. You can listen to delusions, anosognosia and desires. Remember that listening does not convey agreement – it conveys respect.
Some common mistakes we make while practicing reflective listening include omitting some of the things the person is saying because it makes you feel uncomfortable, reacting with problem-solving and/or empathy before the person believes we have really listened to them and understand them.
How do you empathize strategically?
Empathy only works AFTER you have done enough reflective listening that the person thinks you understand them. You can empathize with the full range of underlying human emotions that are common to us all.
Agreeing means that you agree with the person on anything that you can honestly agree on. Look for common ground and celebrate it. Do not be dishonest – ever.
Partnering means you are building a relationship in which you respect their point of view as much as you respect your own. We seek to establish a relationship between equals. We can only create that kind of relationship when everyone feels safe enough to be honest and vulnerable with each other.
Additional tools include how to delay giving your opinion until the trust has been built or the relationship has been repaired. When you do give your opinion it involves the 3 A’s – apologies first before giving your opinion, acknowledge your fallibility (I could be wrong about this) and learn how to agree to disagree.
There are challenges, to be sure, when using and practicing LEAP. Some of these include:
- Fear of validating delusions and paranoia
- Fear of saying the wrong thing and making it worse. Instead, we want to get our loved one into treatment so someone more qualified can talk to them
- Our own hurt, sadness and fear when we observe our loved one suffering and/or lashing out at us
- Our anxiety about the future of our loved one
- Our impatience – we want them to get help NOW!
- Our feelings of overwhelm, exhaustion and resentment
Here are some important takeaways that I hope you will remember:
- Anosognosia is not a stubborn denial. It is not responsive to education or persuasion.
- Attempts to educate or persuade a person that they have a mental illness often result in increased anger, alienation and resistance to treatment.
- The usual approaches don’t work – they make matters worse.
- “We never win on the strength of our argument. We win on the strength of our relationship.” – Dr. Amador
- “The front-line treatment for persons with serious mental illness is RELATIONSHIPS!” – Dr. Amador
- Relationships built on trust, respect and non-judgment are the key to helping a person with serious mental illness accept treatment and help.
If you live with, love or work with persons who have serious mental illness and would like more effective tools for helping them seek treatment, please consider taking a local LEAP workshop. LEAP has made a significant difference in the lives of those who have a family member with serious mental illness. LEAP is endorsed by Substance Abuse and Mental Health Services Administration as a promising practice.
What you will learn at a LEAP workshop:
You will learn evidence-based communication tools to help you create a trusting relationship that can lead to treatment and recovery. You will learn how to
- Lower anger, resistance and defensiveness
- Re-establish broken relationships
- Reduce involuntary hospitalizations and criminalization
Our local LEAP instructors have the lived experience of using LEAP in their own lives and they generously volunteer their time several times each year to share their skills and expertise with others through CONNECT Summit County-sponsored LEAP workshops and support groups. These exceptional trainers have all been trained and certified to teach LEAP directly by Dr. Amador himself.
For more information on upcoming workshops click here or go to our guide How to Help Someone Accept Mental Health Treatment for additional resources.