Provider Insight and Empathy Can Help Improve Outcomes, Preserve Dignity of Patients With Schizophrenia

Although empathy has long been recognized as fundamental to the successful treatment of mental illness, perhaps nowhere is it more pertinent than in the management of schizophrenia – a chronic brain condition evidenced by severe cognitive distortions.

Patients suffering from the hallmark characteristics of schizophrenia, namely hallucinations, delusions and disorganized thoughts, often feel isolated and dismissed, even when in the care of experienced, well-meaning clinicians, explains Cleveland Clinic psychiatrist Amanda Horrigan, MD.

“Schizophrenia can make it difficult to distinguish between reality and fantasy, which is a terrifying place to be,” she says. “Although most of these patients lack insight into their own illness, many are aware that others see them as ‘crazy’ or delusional, which can sow persistent fear and distrust. Unfortunately, when extended to healthcare providers, these suspicions can hinder the patient’s progress and impede treatment.”

Healing through validation

Dr. Horrigan notes that the high emotional burden of caring for patients with severe mental illness may cause some providers to create a “protective armor” that blunts their natural empathy.

“Defensiveness doesn’t serve the patient or the provider,” she says. “It can shut down conversation and compromise the patient’s ability to form beneficial relationships with current and future caregivers.”

Importantly, patient mistrust can also discourage medication compliance and lead to worsening symptoms, including psychosis. The drugs commonly used to treat schizophrenia are notorious for their unpleasant side effects, notes Dr. Horrigan, including lethargy, weight gain and movement disorders. Although these medications can be difficult for many patients to tolerate, they remain an essential part of managing the disease, she explains.

To encourage treatment compliance, Dr. Horrigan stresses the importance of building a therapeutic alliance through sensitive, affirming conversations.

“By earning the patient’s trust and buy-in, providers can improve compliance and more effectively address any drug-related side effects that may disrupt treatment,” she says. “Even patients who distrust their diagnosis or the potential benefits of therapy are far more likely to stay the course when they believe their provider hears them, understands them and respects their opinions.”

A walk in their shoes

In particular, Dr. Horrigan urges clinicians to show sensitivity when addressing patients’ concerns, no matter how far-fetched they may seem. Although persecutorial delusions like being followed by the FBI, stalked by an assassin or controlled by outside forces may seem wildly improbable, providers must remember how terrifying such thoughts can be, she says.

“What would it be like to go through every day thinking someone was trying to kill you? It’s an important question for clinicians to ask themselves,” Dr. Horrigan says. “Healthcare providers have been trained to fix things, so many of us are at a loss when confronted by a tightly held belief that is so obviously false. But it’s critical that we remind our patients – and ourselves – that we’re all on the same team. One way we can demonstrate empathy is by focusing on the patient’s distress rather than on the content of their delusion.”

Instead of trying to talk a patient out of a false belief, Dr. Horrigan urges providers to affirm the strong emotions it elicits. She says a more productive response might be something like, “That sounds really, really scary. Tell me more about what’s going through your mind.”

“Regardless of the words you use, the message should always be: Talk to me about what’s going on. I’m on your side. Let’s figure this out together,” she says. “As obvious as it may seem, we can’t forget that we’re talking to another human being who deserves our compassion and full attention. We want our patients to know that they are more than their disease – and we can reinforce that confidence by responding with empathy.”

Finding purpose and passion

Active listening is another component of empathetic care that can help patients set goals and find meaning in their lives, Dr. Horrigan says. By asking questions and taking the time to understand patients on a personal level, clinicians can help identify interests and goals that foster community involvement and treatment compliance, she adds.

“I remind patients that they have a life to live, and my job is to help reduce any obstacles standing in their way,” Dr. Horrigan concludes. “When addressed with sensitivity, even patients with the most distressing symptoms can learn to trust the intentions of their caregivers and, in turn, advocate for their own well-being.”