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Communicating Effectively with Loved Ones Who Have Psychosis

Tips for navigating a complicated disorder.

Key points

  • Psychosis is an often-misunderstood, highly stigmatized psychological condition.
  • If you have a loved one who is suffering from psychosis, you can help reduce symptoms by cultivating an open, trusting relationship with them.
  • You can provide your loved one with the security they need to recover by showing up for them consistently and predictably.

Psychosis is a widely misunderstood, highly stigmatized psychological condition. Despite the fact that individuals with psychosis pose a greater threat to themselves than to anyone else, they’re often portrayed as dangerous. This misperception increases the chances they'll face severe discrimination and social isolation, making it more difficult for them to get the help they need to recover and live personally gratifying lives.

Strong support networks can counteract the negative effects of the misinformation surrounding this condition. If you have a loved one who is suffering from psychosis, you can help reduce the severity of their symptoms by cultivating an open, trusting relationship with them. Doing so requires frequent communication, and although the cognitive and emotional effects of psychosis can make that challenging, there are steps you can take to overcome barriers and connect meaningfully with your loved one.

1. Understand what psychosis is and how it affects your loved one.

Broadly, psychosis refers to a disruption in an individual's experience of reality. It can be caused by a mental health condition, such as schizophrenia or bipolar disorder, or it can be triggered by environmental factors, such as prolonged sleep deprivation, certain prescription drugs, or substance abuse. Symptoms can manifest as delusions, which are false beliefs, or hallucinations, which are false perceptions. While not objectively real, delusions and hallucinations are present and palpable to the individuals in whom they occur. At minimum, they're extremely distracting; often, they're downright distressing.

As a result, psychosis is often accompanied by disorganized thoughts and speech, executive dysfunction, and odd and/or misplaced behaviors. Meet such symptoms with compassion, and avoid becoming frustrated with your loved one for any impulsivity or lack of focus they may exhibit. If you persist in conversing with them in spite of the impediments, you may find that their symptoms cause less interference as time goes on. There is evidence that the act of speaking itself can reduce the severity of certain types of hallucinations.

An individual's first psychotic episode often occurs during young adulthood, interrupting a critical phase of growth. Consequently, many who suffer from the condition feel robbed of key life experiences. If your loved one has or is expressing interest in starting a job, dating, or another "normal" young adult activity, don’t waive that off as untenable because of their condition. Doing so could fuel resentment between you and your loved one, preventing the cultivation of a trusting relationship. Instead, facilitate an honest discussion about how your loved one could pursue their interests with their condition. Not only will this reinforce the notion that you are their ally but it will also help them become more self-aware.

2. Set the stage for effective communication.

The symptoms associated with psychosis can be extremely sensitive to environmental conditions. This is why it's important to select a setting for interactions with your loved one that they find comfortable. If they feel as though they’re being surveilled when out in public, for example, don’t invite them to a coffee shop. Instead, meet them at home, and ensure that the room in which you initiate conversation is uncluttered. An orderly environment is soothing for everyone, especially those with high degrees of internal stimulation.

The space in which you choose to interact with your loved one should be orderly and also free of triggering objects. Say your loved one believes that the CIA has tapped all of the devices in their house. You can prevent the belief from derailing your communication attempts by putting all electronics temporarily out of sight.

You can also choose to interact with your loved one outdoors. Walking promotes focus and stimulates creativity; it can be an extremely effective tool for encouraging the taciturn to volunteer more information. Be sure to choose a route that’s relatively free of noise, crowds, and other distractions. The more tranquil the context, the less disruptive your loved one’s symptoms will be.

In general, individuals with psychosis tend to fare much better in one-on-one conversations than in groups. Group dynamics can be overwhelming and even distressing; those who suffer from paranoia may be especially prone to unease when forced to interact with multiple people at once. To set your loved one up for communication success, put their peace of mind first, and avoid inviting others into your conversations with them.

3. Acknowledge and affirm your loved one’s humanity.

Make a concerted effort to understand your loved one’s experiences and express compassion for them. If they tell you they're hearing voices or seeing terrifying figures, don't blithely assert those things aren't real: It won't make their hallucinations go away, but it will create distance between you and your loved one.

Instead, validate their emotions while remaining candid about how your experience of reality differs from theirs. You might say something to the effect of, "That sounds really hurtful/scary. I don't hear that same voice/see that same figure, but I believe you do." It is a common misconception that talking about hallucinations or delusions eggs them on, but the reality is: Engaging in nonjudgmental conversation around your loved one's lived experiences removes taboos associated with them, reducing the amount of distress they cause.

To that end, try to employ the same language they use to describe their delusions or hallucinations. Directly and unambiguously addressing their experiences will mitigate confusion and increase the chances that your loved one views you as a source of support. If they refer to the things they're seeing as "entities," don't respond with, "I believe you're seeing things," which might lead them to think you don't understand what they're trying to articulate. Instead, say, "I believe you're seeing entities."

The human craving for autonomy doesn't go away just because someone has experienced or is experiencing hallucinations or delusions. Honor your loved one's agency by helping them understand the choices they have rather than forcing them to comply with what you would choose for them. This is especially important in conversations around medication. Studies have shown that shared decision-making decreases prescription non-adherence among individuals with schizophrenia.

If your loved one wants to stop taking their antipsychotic medication, ask them why and listen nonjudgmentally to their reasons. Then, respond with both an acknowledgment of their feelings and an explanation of the consequences they'd face, like this: "I can understand how frustrating it must be to feel dulled emotions, but if you do decide to stop taking your medicine, you'll start to believe that [insert loved one's symptoms here]. This will cause you to behave in ways that are unsafe for yourself and others, and that will result in a [enter consequences here]."

4. Meet your loved one where they are.

Because most people's delusions or hallucinations are upsetting, it's important to assure your loved one that they're safe while you interact with them. You can do this by maintaining an even-tempered expression, avoiding overly animated body language, and giving them plenty of personal space.

Verbal affirmations are also helpful. If your loved one believes the CIA has tapped their phone, for instance, try sharing something to this effect: "I understand how stressful it must be for you to believe the CIA has tapped your phone, but I have no evidence of that, so I don't share your belief. If I did, I would take immediate action to protect our privacy, because my top priority is making sure you and I are both safe."

The symptoms of psychosis wax and wane according to both internal and external conditions, so pay close attention to your loved one’s behaviors. If they’re exhibiting signs of escalation, refrain from trying to initiate conversation then. Prioritize de-escalation, and in the event that your loved one has entered crisis territory, safety should be your number-one concern. Get to the hospital or call 911 if necessary. You should wait until they've regained stability to start the work of relationship building.

5. Be consistent.

Having psychosis can feel like living on perpetually shifting grounds. You can provide your loved one with the security they need to recover by showing up for them consistently and predictably. Do what you say; say what you’ll do. When you need to collect dirty clothes from their room, for example, let them know beforehand: “I’m going to go into your room to grab your laundry now so I can wash it.” Or, if you know a representative from the cable company will be coming over to troubleshoot wifi issues, give your loved one plenty of advance notice.

In addition to accommodating their needs, it’s important to set and reinforce clear boundaries with your loved one so that they can learn how to cope with symptoms. When living in the same house as you, they can’t bar you from entering certain rooms, for instance. Communicate this rule with them, then remind them of it when necessary. In the event that they become defiant, calmly explain that their behavior is not acceptable, and hold them accountable for their actions. Just as you wouldn’t want your loved one’s symptoms to run their lives, their symptoms shouldn’t run yours, either.

Consistency can require a lot of effort, especially when having to hold boundaries your loved one doesn’t like. To ensure you don’t react in an inflammatory way when they defy or break rules, don't forget to tend to your own mental health. Lean on your community, ask for help, take space when you need it, and engage in regular self-care practices. By getting the support you need, you enable yourself to give your loved one the support they need, too.

By: William Anixter, M.D., with Courtney Kelly

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