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Schizophrenia and the Family: Learning to Communicate

Understanding the challenges to meaningful conversations.

Key points

  • Schizophrenia often has an impact on people's speech.
  • Those with schizophrenia can experience difficulty in both expressive and receptive speech.
  • Cognitive behavior therapy psychosis can help people with schizophrenia know the difference between their thoughts and reality.
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One of the keys to our well-being is the ability to connect and communicate our wants and needs to others. For someone diagnosed with schizophrenia, communication with family can become a major problem for all involved. It may often seem as though everyone is speaking a different language with no one understanding the other.

Someone who has schizophrenia can experience difficulty in both expressive and receptive speech. You may not understand what they are saying and they have trouble comprehending what you have said. Even nonverbal communication can be confusing for them. Disordered thought is a hallmark of psychosis. It therefore follows that speech will also be disordered. Disordered speech refers to a number of speech abnormalities that you might encounter when talking with someone with schizophrenia. Below is a list of some of the different types:

  1. Alogia refers to having difficulty with spontaneous speech. Speech may be limited to only one or two words. Thought-blocking is another component of alogia in which the person stops speaking in the middle of talking because they lose their train of thought. Anxiety and stress only worsen alogia.
  2. Loose associations are when speech seems random and does not follow a logical order. It can be tangential and off-topic.
  3. Neologisms consist of made-up new words.
  4. Echolalia is repeating the words that were said to them.
  5. Glossomania occurs when the speaker chooses words based on their sound or rhyming.
  6. Schizophasia or "word salad" refers to the use of unrelated words or words with no meaning. Speech is incomprehensible.
  7. Perseveration is when the individual keeps repeating words or sentences.

As an example, the following is an excerpt from Elyn R. Saks' book The Center Cannot Hold, a book about her own experiences with schizophrenia. In this example, Saks is going to her professor to ask for an extension on her work and says the following: “The memo materials have been infiltrated. They’re jumping around. I used to be good at the broad jump, because I am tall. I fall. People put things in and then say it is my fault. I used to be God but I got demoted. My head is too full of noise.”[2]

As can be seen, there are a number of severe hurdles to overcome for productive conversations with someone with schizophrenia. Medication is needed to address these speech disorders. It should be noted that not everyone will exhibit all of these features. In addition to their expressive speech difficulties, there are also decreases in their nonverbal expressive behaviors such as spontaneous smiles or hand gestures, further impairing their social interactions.[3]

In 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a statement that cognitive behavior therapy psychosis (CBTp) should be the standard of care for those with psychotic disorders.[4] CBT has been utilized effectively for a number of psychiatric disorders such as depression and anxiety. IT is based on the idea that what we think determines how we feel and how we act. CBTp is especially beneficial in working with delusions and hallucinations. It is particularly effective in helping people learn to differentiate between their thoughts and reality.

There is a mental health training program at the University of Washington, Psychosis Reach, that teaches families the use of CBTp to facilitate healthier communication. There is also a more extensive program for additional training. Those who complete the advanced work are referred to as family ambassadors. A prerequisite for these individuals is having a family member with a psychotic spectrum disorder. After their training, the ambassadors are available for teaching and coaching families in the use of CBTp, psychosis education, and caregiver self-care. The ambassadors come from different states and can work with families in their region.

Research assessing the Psychosis REACH program suggests that the training can improve the mental health and relationships of the family, as well as the caregivers of the individual with psychosis. At the end of their training, caregivers reported a positive impact on their depression, anxiety, and stress levels. They report that these factors also help to lessen the risk of relapse and hospitalizations for their loved one.[5] The combination of medication and CBTp has been shown to be beneficial in improving communication and understanding within the family, as well as increasing their quality of life.

To find a therapist, please visit the Psychology Today Therapy Directory.


2) Saks, Elyn (2008). The Center Cannot Hold: My Journey Through Madness. Hyperion Books, New York.

3) Sebastian Walther, Katharina Stegmayer, Jeanne Sulzbacher, Tim Vanbellingen, Rene Muri, Werner Strik and Stephan Bohlhalter. Nonverbal Social Communication and Gesture Control in Schizophrenia. Schizophrenia Bulletin vol.41 no.2pp338-345,2015.doi:10.1093/schbul/sbu222.


5) Sarah L. Kopelovich, Ph.D.,Bryan Stiles, B.A., Maria Monroe-DeVita, Ph.D. Kate Hardy, Clin.Psych D., Kevin Hallgren, Ph.D., Douglas Turkington, M.D. (2021). Psychosis REACH: Effects of a Brief CBT-Informed Training for Family and Caregivers of Individuals With Psychosis. Psychiatric Services 2021:00:1-7; doi: 10.1176/ 202000740

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