Friday, October 3, 2014

Setting limits and mental illness

The mentally ill family member is out of control: rude, irritable, uncooperative, has no respect for order or cleanliness in the home, does not abide by family rules, intrudes on other family member’s lives. The mother and father are against each other about what to do. The siblings do not want to come home. There is so much tension and nervousness in the home. They settle for anything just to keep the peace.

On second thought, the mentally ill family member is not OUT OF CONTROL; he/she is actually IN CONTROL of the family and is being allowed to destroy the family peace. Is there any hope to turn things around?

The following are limit setting concepts:

1. Goals. Regain authority over the household. Create an environment that is comfortable and manageable for you and other family members.

2. Attitudes. Effective limit-setting requires a spirit of determined toughness, not kindly persuasion or angry criticism.

 3. Tactics. Focus your efforts on one or two aspects of behavior that especially trouble you. (Defining and limiting the problem are key skills taught in Family-to-Family.) Ignore other matters until you have these issues under control. Focus on behavior you can consistently monitor and influence: smoking in the house, clothes on the floor, loud and intrusive talking, dirty dishes left on the table, intruding in other’s business, excessive ordering online, cursing, bringing strangers to the home. Determine consequences for non-compliance that will inconvenience your ill relative yet will not be too onerous to administer. Or determine rewards for compliance. Obtain help from friends, relatives, the family member’s therapist if necessary.

 4. Communication. Clearly state expectations for appropriate behavior and consequences for non-compliance. Expect that these limits will be tested, and you will administer consequences. Inform him or her that you will do A if they do B.  Do not engage in lengthy discussions of the appropriateness of your expectations. Going on and on is futile. Learn to say what you mean and STOP. These communication skills are taught in the NAMI Family-to-Family course.

 5. By-products of effective limit-setting. Besides establishing a more livable family environment, effective limit-setting greatly enhances the credibility of family members and can lead to more productive discussions of other issues. It can also motivate your ill relative to work toward independence in order to escape from rules they do not prefer to live under. Learning that one must conform to the expectations of others in order to enjoy satisfying social relations, people with mental illness often behave more appropriately outside the home. Often they are more amenable to rules when they are very sick and confined in a psychiatric hospital.

 Words of caution: Be aware that the general rules of limit setting will not apply to families coping with severe Anxiety Disorders, particularly agoraphobia and Obsessive Compulsive Disorder. Most families must have professional help in making contracts to alter ritual avoidance behaviors.

Also one must examine the issues of setting limits on a parent or spouse.

Effective limit setting can lead to a more peaceful home. There is HOPE.

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