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Family Therapy: Tips to Improve Communication

Communication problems can raise any family’s stress level. When a family member has co-occurring disorders, communications can sometimes require extra effort. Mental health disorders can cause people to withdraw or misread people or miss social cues. Substance use can further complicate communications by worsening psychiatric symptoms or driving disruptive and dishonest behaviors.

Effective communication serves as preventive maintenance, reassuring family members that they care about each other and appreciate each other's efforts. Good everyday communication can also make it easier to bring up issues, make requests when needed, and resolve conflict when it arises.

How Can Co-occurring Disorders Affect Communication in a Family?

When a family member has co-occurring disorders, communication may take extra effort and awareness on everyone's part. Sometimes a psychiatric disorder can hinder an individual's communication. For example, the person may

  • withdraw and not talk when feeling depressed
  • feel irritable, have angry outbursts, or behave unpredictably because of mood instability
  • perceive other people inaccurately, which can lead to social anxiety or paranoia
  • make unreasonable demands of others, or show a lack of concern for them, because of preoccupation with fears or anxiety
  • miss or misinterpret common social cues, such as facial expressions or hints, which can lead to misunderstandings

These problems can be magnified when the person also has a substance use disorder. For example:

  • Interactions with others can be influenced by the immediate effects of substance use, cravings, or withdrawal symptoms.
  • Addiction-related conflicts with others can arise, resulting from lies, broken promises, or failure to meet obligations.
  • Substance use can worsen the symptoms of psychiatric disorders and interfere with following treatment recommendations.

Good communications can help address conflict in a productive way, let family members be heard, and help them stay connected to one another. Family group work can help families work on crucial communication skills, and the handout “Effective Communication" from the Co-occurring Disorders Program provides a number of strategies for family members. Here is an excerpt: 

Strategies for Good Communication

Download Effective Communication (PDF)
Try these strategies for improving communication, resolving conflict, and building a supportive family environment.

Get to the Point

Be brief and up-front when you're talking with someone with co-occurring disorders. Long-winded, roundabout statements are hard for anyone to follow, but especially someone who has trouble concentrating-as do many people with mental health disorders and/or substance use disorders. Get to the point quickly to be sure you are heard and understood.

Express Feelings Clearly with "I" Statements

Describe your own feelings and avoid putting others on the defensive. By using words such as "angry," "happy," "upset," or "worried," you can tell your own truth and help prevent the misunderstandings that can occur when people have to guess each other's feelings.

"I" statements, such as "I feel anxious when . . . ," are direct, and they make an impression. When upset feelings are involved, "I" statements work better than blaming "you" statements. For example, instead of saying "You pissed me off when you were late for dinner last night" (a blaming statement), try this: "I was angry when you came home late for dinner last night. I'd appreciate it if you'd be on time or call if you're going to be late."

Speak for Yourself and Not for Others

People often speak for others because they think they know what the other person is feeling. In some families this takes the form of indirect "backchannel communication" (for example, "Your mother is angry with you"). Be alert to these habits and try to change them.

If you are on the receiving end of a backchannel message, you might want to gently question it as well. All of these habits naturally lead to misunderstandings-since each person is truly an expert on only his or her feelings. Such problems can be avoided if everyone is responsible for expressing only their own feelings-nobody else's. This may seem hard at first for family members who are not used to direct communication. But in the long run, it can be helpful to everyone.

Focus on Behaviors Rather Than on Traits

People can change their behavior-what they do-more easily than they can change internal qualities or traits such as personality, attitudes, or feelings. When you are upset with someone's actions, focus your communication on behavior rather than on traits, making it clear what you are upset about. Make it a complete statement, linked to behavior.

For example:

Instead of saying: "I'm concerned about your health."

Say: "I'm concerned about your health because you've started drinking again."

Instead of saying: "You're thoughtless because you only think of yourself."

Say: "I sometimes think you don't care about me because you rarely ask about my feelings. I wish you would show more concern by asking how I'm feeling more often."

Fact Sheets

Download these PDFs for more information about the following disorders:

This fact sheet can help explain the causes of co-occurring disorders:

Clinicians' Guide
to Engaging Families
The Co-occurring Disorders Program helps treatment programs implement effective, integrated services for people with non-severe mental health disorders that co-occur with substance use disorders.

Family ProgramOne component, Family Program, helps family members learn about the client's specific psychiatric disorder and how it interacts with the substance use disorder. Learn more

Professional Development

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