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The Importance of Working together - Families and Clinicans as Partners:  Dr Xavier Amador Phd:


Dr Amador was an inspirational speaker on "The importance of families and clinicians working together as partner's at the recent Mental Illness Summit.  Perhaps even more credible because he wears two hats -  both as an experienced clinical psychologist, and as a family member (his late brother suffered from paranoid schizophrenia). 
The following is Dr Amador's article "Working together - Communication and consideration" which covers the basics of his talk, and outlines why (in his experience) there are better outcomes for Consumers when families and clinicians work together and what we can all do to try to make that happen.  Dr Amador has written several interesting articles which are available on his website www.xavieramador.com .   

An important lesson I have learned time and time again is this:  when a consumer and his or her clinician work together, treatment and recovery are optimised.  When there is no team, or when there is poor communication - bad things happen (For our purposes the term clinician includes doctor and or any other provider).  I wont tell you my horror stories because we all have them - whether you are a  consumer, a relative or a clinician (or all three).
Communication between the consumer and his/her therapist and loved ones has been studies and written about a great deal.  But why don't clinicians and family members talk to each other more?  Lets look at it from different perspectives.
What is the clinicians view?  I can tell you from personal experience and from countless remarks I have heard from colleagues that fear plays a role.  But it's more than just the fear of breaking confidentiality regulations.  We also fear betraying out patient's trust.  In fact I think its fair to say this is the biggest fear of all.  We worry that talking with family will weaken the alliance and leave us powerless to help.
With Family  - and again I can speak from personal experience - the barrier is not only the therapist's reluctance to talk with us, but often our own prejudice.  Too often we assume that providers just don't care.  Or we assume nothing will be gained because we don't think the therapist is right for our loved one.
All of these barriers are surmountable - quite easily in fact - if we understand each other's perspectives and take them all into account when building our team. 

Communication: The road to hell is paved with good intentions.  I can think of few better examples of this than mental health laws that are designed to put up a wall between mental health professionals and their patient's families.  And yet one of the most important things a family member can do is to stay in touch with their loved ones mental health care providers.  This is true whether your loved one is in the hospital or is an outpatient, seeing his clinician weekly or, more commonly, only once a month.
I remember my brother Henry's first hospitalisation for schizophrenia.  During one meeting with Henry's doctor and social worker, my mother and I should have asked about the discharge plan and shared our observations about what we thought would and would not work. 
The most important observation we could have shared was that Henry did not think he was sick.  We should have helped the professionals come up with a more realistic plan than the one they had.  We could have asked "given that he does not believe he's ill what good will your prescription and outpatient appointment do?"  but we didn't because we were new to it all
With my brother's future clinicians I did eventually try to ask more questions and provide what I felt certain would be useful information - like the fact he continued to think he wasn't sick.  But I encountered the same problem most loved ones do; no one would talk to me.  Strict privacy regulations make it difficult for mental health professionals to share information; often they cannot even confirm whether or not an individual is a patient.  It's enough to make you want to scream.  And yet, this obstacle is not coming from an evil place, nor is it immovable. 
Consideration:  If you're a therapist, you have to overcome your preconceived belief that family members may distract you from your work or have nothing to share.  Family members usually have a wide range of vital information….but there are times when they don't. 
Relatives who call their loved one's clinicians to vent - and basically get free therapy - are tapping into an inappropriate resource.  I often think about that at the end of a very long day when a family member wants to talk to me about how hard their relative's illness has been on them.  Of course I understand and sympathise, but that's not the point.  If you have more than one patient, it's impossible to be available to all of your patients' involved family members in this way. 
What I have learned, however is that if I explain my limitations and suggest to the stressed relative that he or she get help for him or herself, it helps to refocus the conversation on what we should be talking about
.  I strongly suggest that he or she go to an organisation that supports families [such as SF Nelson] and gain support from other people who are in the same situation.

If you are a family member you may make the mistake of thinking an unresponsive therapist (one who doesn't return phone calls or who wont talk to you) doesn't care.  I can't say you'd be wrong in every instance, but I can that, in my experience, this assumption is much more often wrong than right.  Most therapists get into this line of work because they care.  They chose the career because, like me, it has personal meaning for them and they want to help.  So if that's the case, why do they sometimes appear so uncaring?
Often the reason is, in a word, burnout.  That being said,
family members can help by being focused on specific issues when they call.  For example: "I want to tell you about some warning signs or relapse I am seeing" or "I am concerned about the discharge plan because…." Don't call to vent - for that kind of support call a friend, relative or SF Nelson..I am reminded of an old anti-stigma campaign slogan that read' "Mental illness is not a flaw in  character, it is a flaw in   brain  chemistry".
When talking to relatives about therapists who seem to not care, I sometimes say "Therapists did not get into the field because of a flaw in character, they did it because they care:

Tips for sharing information without violating the doctor-patient relationship:

For the Clinician

If the consumer knows certain types of communication will occur between therapist and family, confidentiality is not being violated.
Clarify the limits of confidentiality with your patient up front.
Tell him/her you would like to hear from his/her family from time to time "to get a feel for how they think you're doing"

For the Family:
There are no regulations prohibiting a therapist from listening. Try saying "I know you can't talk to me about my loved one and that's not what Im asking you to do.  All I am asking is that you let me share some observations and concerns about my loved one, and that you listen for a minute."
To get a clinician to talk with you about your loved one try saying "I know you cannot confirm my relative is your patient, I understand and respect that.  But, hypothetically speaking if the person I just described were your patient, what would you say about…..?"
Ask your relative to give their permission for clinicians to discuss aspects of their treatment they are comfortable with.
Assume your loved one's clinician cares and communicate that assumption.  Say "I know you are trying to help my relative" and it will usually open doors.

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LIBRARY NEWS

We have two excellent new books and a DVD in our library and all are available to loan on request:  Contact Susan 5458162 or Michael 5466090
What Happens Next? by Wendy Lyons and Tricia Irving Hendry
A practical, supportive and informative handbook for parents, carers and other family members who are looking after and supporting a teenager or young adult with a serious mental illness. Parents and family members regularly feel not only overwhelmed by their child's situation and its consequences, but frustrated that information to help them manage whatever comes next is very hard to find. This makes their journey extra difficult.
What Happens Next? has been co-written by two Wellington parents who have supported their young adult children through mental health challenges. Wendy couldn't believe the lack of information available. She linked with a range of other parents and began to gather their experiences and input for a handbook that others could use.
Linking up with the experience of Skylight's Tricia Irving Hendry, and using Skylight's expertise and AXA Hearts in Action funding, this new handbook is now made available to support, encourage and inform others in this unique and demanding situation.


I'm right, You're Wrong - Now what?
By Xavier Amador Phd

Dr. Xavier Amador, a Columbia University professor and clinical psychologist shows you how to break nearly any impasse and persuade your opponent--for that's what people become when you've reached an impasse--to give you what you need.
I'm Right, You're Wrong, Now What? is based on Dr. Amador's LISTEN-EMPATHIZE-AGREE-PARTNER (LEAP) method. A highly successful program that has been taught to tens of thousands of people in seminars around the U.S. and overseas, LEAP teaches you how to turn even toxic arguments into healthy disagreements that end with you getting what you need.