Table 1 Description of the content of the seventraining sessions

Meeting 1: Goal-oriented interaction

The meeting started with a personal introduction. To improve caregivers’ knowledge of severe mental illness, this was followed by psycho-education and a description of the training program. The participants learned to distinguish between concrete behavior and interpretations. They were also asked to describe specific behaviors of the patient they found hard to deal with. They were then informed about the purpose of the mat in the training. Finally, the participants were asked to formulate their personal learning objectives and were introduced to the homework assignment that would follow each meeting.

Meeting 2: My own life

The homework assignment was discussed. This meeting revolved around challenging the participants to discover how much control they actually had in their own lives. They were asked to write down what they needed in order to feel good, and how much time they needed to perform these activities. If they felt like missing out on these activities, they were asked to draw up a goal plan to serve their needs. Finally, the participants had to come up with three ways of communicating their needs to the patient.

Meeting 3: The communication process

The homework assignment was discussed. The main focus in this meeting, which involved psycho-education, lay on getting a better understanding of transmitting clear messages and listening effectively. The conditions for communicating properly were discussed. Participants practiced their communication skills on the mat.

Meeting 4: My position

After discussion of the homework assignment, the different communication styles and their effect on interaction with the patient were discussed. Participants practiced with the communication styles and with drawing a line when making an issue negotiable. They also learned to make the switch between expressing disagreement properly and listening actively to understand another person’s behavior. To achieve an effective strategy for confrontations when the patient showed resistance, they ended the meeting by practicing the switch.

Meeting 5: Dealing with conflicts

After discussing the previous homework assignment, participants discovered the capacities and incapacities of patients with a severe mental illness with regard to solving a conflict or problem effectively. The participants gained a better understanding of the crucial difference between ‘cannot cooperate’ and ‘will not cooperate’. At the end of the meeting, this psycho-educational form of learning was used on the mat to practice situations in which this problem could arise.

Meeting 6: Working together as a strategy

After discussing the previous homework assignment, participants learned how to cope with the patient when he or she ‘cannot’ cooperate in performing a task, and how to influence the interaction positively. At the end of the meeting, participants were asked to create a management plan to use in teamwork between caregiver, patient and staff as a strategy when contact breaks down.

Meeting 7: Going back home

The last meeting revolved around practicing the skills learnt during the previous six meetings. The learning experiences were translated into real life situations. Finally, the personal learning objectives were discussed and remaining questions were answered.