Setting Realistic Goals of Recovery
No one can deny that hearing a diagnosis of schizophrenia will be an unsettling, life-changing event. Fifteen years ago, it would have been even worse. Although there is still no cure, our understanding of the disease and new combinations of therapies have placed patients and caregivers in a better position than many could have hoped for in the not-so-distant past.
Be Realistic
In her book When Someone You Love Has a Mental Illness, Rebecca Woolis suggests guidelines for setting goals for someone with a mental illness. She recommends first evaluating the person's ability to function in three areas:
Living independently. How many of the daily chores required for living alone can the patient perform adequately?
Interacting with others. How well does the person make and keep friends? How comfortable is he around others?
Learning and working skills. What level of education and employment has the person attained?
Woolis suggests that a higher-functioning patient will score well in at least two of the areas, have symptoms under control enough to concentrate on improving skills, and will demonstrate a desire to progress.
She advises caregivers to get the patient to agree to concentrate on one or two skills contained in one of the life-skill areas — independent living, social interactions, and work/education. Break the short-term goal into small steps that the person has a good chance of completing. Knowing he can accomplish something and take steps toward living a fuller life will help motivate the patient to be proactive.
Small Steps
If someone is working hard to achieve small, short-term goals such as getting up on time to keep appointments or looking after his hygiene, don't worry about large, long-term goals. Be content to progress a step at a time. If he asks about his future, don't lie to him. Tell him you are not sure about the future but that you know you will be there to encourage him in his progress. Concentrate on improving the present.
Don't make the steps too difficult. Start with easily attained goals and increase the challenge if the person can handle it. Back off if he gets discouraged or frustrated. Redefine the goals after a time off.
Alert
A person can experience changes during the course of the illness. Symptoms may disappear and be replaced by others. Progress may accelerate and slow. As a caregiver, try to be sensitive to these changes. Adjust your behavior and set goals based on the current mental state and abilities of the person you are working with.
As an example, consider a person who lives by himself and has worked at a part-time job for eighteen months. He takes medications as prescribed and attends therapy but has no social life. If he agrees to work on increasing his social interactions, you might suggest he attend more get-togethers with other mental health care consumers and volunteers.
One short-term goal for the patient might be to talk to two people over the course of the next weekend. Another might be for him to find out if any of his coworkers has a hobby and then ask about them. You can coach him in ways to talk to someone without seeming nosey or pushy. Discuss the results, his feelings about them, and how he might adjust his attempts to connect to people the next time he tries.
