On the last track we discussed the four basic steps to developing a relapse prevention plan. The four steps are deciding how to conduct a family meeting for preventing relapses, discussing past relapses, discussing past stressful experiences, and putting together a relapse prevention plan.
On this track we will relate the implementation of Gary’s relapse prevention plan. Phil, Gary’s father, effectively implemented the relapse prevention plan using the four basic steps covered on the last track. We will also look at three steps a single family member or close friend can take to make it easier to head off a relapse. Three steps a single family member or close friend can take to make it easier to head off a relapse are finding help, developing stronger relationships with the treatment team, and joining a self help advocacy association.
As you listen to this case study, you might consider filtering it through your therapeutic experience regarding your client and his or her family. In addition, you might evaluate the interactions between Gary and his family. In what ways does Gary’s family show empathy for him?
During a period when Gary’s symptoms were under control, he and his family held a meeting to develop a Relapse Prevention Plan. The meeting was attended by Gary, his father Phil, his mother, brother, sister, and brother-in-law.
First they discussed Gary’s last relapse and the early warning signs that preceded it. Then Gary and Phil made a list of warning signs with input from family members. Gary stated, "Before my last relapse I felt real wound up, and had a hard time sleeping." Gary’s parents and his brother noted that Gary had become preoccupied with talking about a girlfriend he’d had in high school more than ten years ago. Phil recorded these three warning signs on the Relapse Prevention Plan.
Next the family reviewed what had been most stressful for Gary in the past. Gary stated, "I get real worked up, and sometimes feel like I’m going to freak out in large crowds. But, sometimes, deep breathing helps a little." Gary’s sister mentioned that Gary sometimes flew off the handle during arguments or when involved in disagreements. Gary agreed that arguments were upsetting. He stated, "I usually need a break to cool off. Sometimes, talking to Dad helps." Phil recorded these stressors on the Relapse Prevention Plan.
In discussing how to hold future meetings when early warning signs were noticed, the family decided that Gary’s mother would call the meeting at her home. Gary asked to include his uncle Larry, because he felt close to him. Phil listed the individuals to be included in future family meetings on the Relapse Prevention Plan.
Several months later Gary’s mother heard him pacing back and forth in the hall in the middle of the night. This occurred on three separate occasions before she asked Gary about it. Gary reported that he was getting only 2 or 3 hours of sleep each night. Because sleeping problems had been identified as a warning sign, Gary’s mother called a family meeting. At the meeting, when asked about the other two warning signs, irritability and preoccupation with his past girlfriend, Gary said he hadn’t been feeling tense or irritable, but had been thinking of his ex girlfriend quite frequently in the past few weeks.
Gary was taking his medication as prescribed, and he was not abusing drugs or alcohol. When the family asked about stressful situations he might be experiencing, Gary said he was enjoying a new computer course but was feeling stressed by the crowded bus ride to the community college. When various strategies for dealing with the bus ride were suggested, including getting rides from uncle Larry, Gary stated, "I like the independence of taking the bus. Maybe I’ll try to take an earlier and less crowded bus. And I’ll try to use deep breathing to calm down."
Gary’s sister suggested he listened to music on earphones to help him stay calm, and Gary implemented that as well. Phil recorded Gary’s plans for reducing stress on the Relapse Prevention Plan.
One week after... the meeting was held and the suggestions for reducing stress were enacted, another family meeting was held. Gary said he was feeling better and was no longer thinking about his high school girlfriend. Gary had been listening to music and practicing deep breathing on the bus and was feeling significantly less stressed out by the ride. However, Gary was still experiencing difficulty falling asleep at night.
After the meeting, he called his doctor and described his early warning signs. The doctor set up an appointment for him to come in the next day. At the appointment, Gary’s doctor made an adjustment to his medication. The following week another family meeting was held. Gary reported that his sleep had returned to normal. One more follow-up meeting was held a week later, and Gary said his sleep problem was still resolved.
Both Gary and his family agreed that no more meetings were needed at this time. By addressing early warning signs promptly and holding follow up meetings, Gary and his family began to learn to prevent possible relapses.
Think of your Gary. Could he or she prevent relapses by using a Relapse Prevention Plan and having family meetings?
If your client has few close relatives to support a Relapse Prevention Plan or if he or she has only one person with whom to implement a plan, preventing relapses can be much more difficult. Here are three steps a single family member or close friend can take to make it easier to head off a relapse when one threatens.
Step 1: First, find help. Would you agree that the single family member will be more productive if he or she finds someone to talk to or maybe help develop a Relapse Prevention Plan?
Step 2: Second, develop stronger relationships with the treatment team. By exploring in advance which team members would be accessible and willing to discuss concerns, the single family member or close friend can access resources quickly in the event of an impending relapse. Likely candidates in the treatment team might include the client’s psychiatrist, social worker, case manager, or therapist.
Step 3: In addition to finding help and developing stronger relationships with the treatment team, the third step a single family member or close friend can take to make it easier to head off a relapse is joining a self help advocacy association. Clearly, the National Alliance on Mental Illness is one resource. Would you agree that having the support of other families with similar experiences can help single family members or close friends prevent relapses?
A Relapse Prevention Plan can be an effective way to reduce symptoms in some clients. Does the family of your client currently use a Relapse Prevention Plan? If so, how can the information on this and the last track enhance that plan?
On this track we have related the implementation of Gary’s relapse prevention plan. We have also discussed three steps a single family member or close friend can take to make it easier to head off a relapse. The three steps a single family member or close friend can take are finding help, developing stronger relationships with the treatment team, and joining a self help advocacy association.
On the next track we will discuss coping with positive symptoms of schizophrenic psychosis. Three specific coping strategies for positive symptoms of schizophrenic psychosis we will discuss are reality testing, self talk, and coping when losing control.
What are three steps a single family member or close friend can take to make it easier to head off a relapse? To select and enter your answer go to Answer Booklet.