Negotiation and Mental Illness

For those with loved ones who suffer from mental illness, it is often difficult to communicate with them. Not only is there an adversarial role that occurs, but the lack of insight which mental illness fosters makes it difficult to discuss openly. A friend or family member may have concerns, yet be unable to open a dialogue. It is at these times a less personal approach can be helpful, utilizing techniques that often come from the business community. I am talking about negotiation, making a deal with a mentally ill loved one.

Principle negotiation is a process often used in situations where both parties seek to win their points of view. Unlike other forms of negotiation where one party wins and another loses, principle negotiation is designed so that both parties get what they want. This can be critical when discussing treatment or evaluation with an individual lacking critical thinking brought on by a biochemical imbalance.

A family member may have concerns over a recent change in the behavior of a loved one and sees a need for treatment, while at the same time the ill loved one may be quite happy and believes the concerned family member is the one who needs treatment. After all, she is the one who is upset. What can be done in a case like this? Here is where principle negotiation enters the picture.

Principle negotiation has four main steps:

  • First, we want to separate the person from the problem. Avoiding negative judgment helps to clear the way for an objective view and makes possible focusing on behavior and actions at issue. Although this may be difficult when someone is disturbing the family equilibrium, it is not helpful but corrosive to understanding, if stigma or past conflict colors perception. Anger and upset must be left in the “entry way.” Instead, address the issues. Ask yourself, “What is it about this person’s actions that is getting in the way of family harmony? What is it I am concerned about?”
  • The second step in the principle negotiation process involves negotiating interests, not positions. What this alludes to is reducing the role of the concerned family member as the party with power in the relationship, and the ill loved one as the subordinate. Instead of seeking the upper hand, family members are encouraged to focus on what their interests are. What is it each party wants? 
  •  The third step in principle negotiation is creating options for mutual gain by brainstorming ideas, which reflect gains or answers for both parties. This is what creates a win-win situation. No idea is too outlandish for consideration. In this step, decision-making with various scenarios should be presented. Parties to the negotiation process can brainstorm together or separate. It is important to keep in mind the mutuality of the outcome. The ideas created should strive to encompass answers for all parties to the negotiation. There are no winners and no losers, only satisfied participants. Principle negotiation can be used by any number of interested parties. The question you have to answer is, “What is the best solution for everyone?” 
  • The fourth and final step of this problem-solving process is insisting on objective criteria. Know your facts; don’t attempt to complete resolution without them. If you are not sure of your position or the other party’s, put off reconciliation until you check your information. One way to do this would be to bring in a neutral third party as mediator; someone who doesn’t stand to gain from the final outcome. Most important—this negotiation process can be utilized with a mentally-ill loved one who is resisting treatment. Example to follow:

 ** PART II **

Isabella’s Story – An Example of Principle Negotiation 

Isabella was 19 years old and lived at home with her parents and two older brothers. Though prone to depression, Isabella had recently been feeling unusually good. So much so that she felt a sense of confidence. She slept only two to three hours a night, yet had constant high energy. Walking around the house after her family had gone to bed and staying up listening to music with the volume cranked up high, she would isolate in her room for days, coming out only for food. Her personal hygiene, once a habit of pride, had now become intermittent. Sometimes she would leave the house for days at a time, never telling her family she was leaving, how long she would be gone, or when she would return.

Her family was disturbed by her behavior, fearful of her whereabouts when she would leave, and annoyed at being awoken by her erratic behavior in the middle of the night.

Vocal about their concern for her and at times harshly critical, they called her a “nut job” and took her to task for being an emotional drain on the family. They insisted she go for treatment, a topic Isabella refuted with anger. She told her family she liked her lifestyle and couldn’t understand what she took to be insensitivity. “If you are so unhappy, perhaps you should go for treatment,” she said.

Isabella’s parents decided they needed to speak to her about the situation and called a family meeting. Before Isabella’s parents and brothers could speak, Isabella rebuked them for the way in which they spoke to her, calling her a loser and a “nut case.” Her family quickly agreed that was a mistake, began to itemize the problems she evoked, and apologized for their behavior. Isabella responded by shouting them down. Her father tried to reprimand her, taking charge as head of the family, but Isabella would have no part in this. She felt she was an adult and should be shown some respect. Finally, her father asked the family to share their concerns about Isabella’s recent behavioral changes, how they impacted the family, and what they wanted from her. In return, they asked her for her concerns and what she wanted from them. The list of family interests was as follows:
  1. Getting treatment for Isabella. 
  2. Return of family routine and stability. 
  3. Isabella’s desire to not be labeled a source of dissention. 
Isabella’s brother Jeff pointed out the family concerns, but how does the family put their goals into action. As the family sat around the dining room table, they began to brainstorm, putting out ideas to one another as possible solutions. Soon there were a number of suggestions, some of which focused on satisfying the goals of everyone at the table, not only the family, but Isabella’s as well. The major options, which stood out, were these:
  1. Isabella would agree to see a psychiatrist. 
  2. Isabella’s parents were willing to support her financially to satisfy her goal to return to college. 
  3. Set a list of house rules the entire family would create and adhere to. 
  4. Every family member would abide by a third party evaluator to resolve any lingering family dissention. 
The family felt good about their brainstorming options for mutual gain. Only one thing remained. Who would be their third party mediator? Family members suggested relatives and family friends, but they were caught on the horns of a dilemma. They needed someone who would be neutral. That ruled out family friends and relatives. They agreed they needed someone who would take all the information the family had and be objective, using objective criteria. The family decided to put themselves in the hands of a psychiatrist who could evaluate Isabella’s mental state and offer a professional view on how they could best return to a state of normalcy. This turned out to be a win-win situation as Isabella got treatment without feeling harassed by the family, and the family regained a sense of goodwill. Eventually, with medication, Isabella was able to return to college and home life returned to normal. A sense of unity was rekindled for all concerned.

Isabella’s Story is an example of principle negotiation as it works in a family dispute. Family members were able to come together, grapple with an issue, and eventually heal. There is no magic here, but rather, an example of those making a commitment to stand by one another. It is not an instance of a technique that brings a family together, but rather, a story of a family dedicated to one another which used a technique, which worked for them.

If you want more information regarding principle negotiation, the book, which is a classic in this field is, “Getting to Yes, Negotiating Agreement Without Giving In,” by Fisher & Vry of the Harvard Negotiation Project. It’s a short book of exceptional worth. If you’re looking for hope in communicating with ill-loved ones, this straightforward book is a MUST.


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Donald Kern said...

Thank you for your interest and your comment

Anonymous said...

Thank you very much for this column and all the other sub columns you have written. I am gaining great insight into my newly diagnosed 21 year old son. I have worked extensively to get him help, and now Ibelieve I too need some help to get through this, and proactively proceed. I "don't do the victim thing very well". I am a doer, and yes a helicopter mom, who believed that with intense guidance, schedules and extensive support for my son, we could beat this. I am not sure I knew what "this" was. I totally got aspergers...I knew what to do, how to do it, how to help....but the added diagnosis of BP in January has thrown me, even though I was the first one to mention it to his psychiatrist....I knew. It doesn't however, make it any easier. Negotiation has been my second name. To negotiate however, requires two parties willing to achieve resolve. I continue to pray for him to understand however, in the process, I am learning that I too must be proactive with MY understanding, and limitations having a child with bipolar. As an individual with BP, I truly value your insight. You have walked the walk! He is a highly intelligent individual, and know that he can do this....he can learn...but I may have reached the point where its someone elses turn for a while to give it a chance. He leaves this week to go spend time with his paternal grandmother 1500 miles away. I pray for them both....for love, strength, guidance, insight, healing, and understanding. Thank you Donald Kern!

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