“Keshet”: Enhancing Cognitive Communication Skills in Families
Family interventions in mental health focus primarily on consumer outcomes, and family well-being is viewed only as an intermediate outcome. Because they are usually the most stable entity in the lives of people with mental illness, families can benefit from exposure to intervention strategies and instruction in the techniques and methods that are typically used by professionals as part of their therapeutic practices. One such area is a deeper understanding of cognition, to learn how it is affected in mental illnesses, how to identify cognitive strengths and weaknesses, and how cognitive communication skills based on mediation can enhance learning, adaptability, participation, and recovery.
Keshet (“rainbow” in Hebrew) is a course designed for family caregivers seeking support, techniques, and methods within academic settings to improve coping. It is a standardized cognitive educational course that helps family caregivers appreciate and develop skills for empowering communication. The Keshet course focuses on teaching parents about cognition and mediation, which are considered a basis for the concepts of brain plasticity, cognitive modifiability, and the conversion of experiences into a source of learning. Mediating interaction is a specific human intervention that differs from providing exposure to stimuli. The mediator—a parent, caregiver, teacher, or therapist—interposes him- or herself between the world of stimuli and the consumer, child, or student in order for him or her to assimilate the stimuli into internalized cognitive structures that can lead to change. An interaction becomes a mediating interaction when there is at least an explicit intentionality on the part of the mediator, with the child or consumer reciprocating that intention. Other elements of a mediating interaction include transcending the here-and-now, relating to other situations, adding a meaning to the stimulus, regulating behavior, boosting feelings of competence, and sharing experiences. Emphasis is placed on relationships between cognition and emotion and their impact on effective communication. One of the central aspects of Keshet is knowledge translation, whereby caregivers are provided some practical tools traditionally used by therapists in translating research to actual practice. One of the central methods used in Keshet to meet this need is the use of “meaningful interactional life episodes” (MILEs). Participants use written dialogue to describe actual interactions they have had. For example:
“I picked up the phone to call my daughter. I asked her, ‘How are you?’
“She replied, ‘The same, not well. Nothing helps me to get over this depression, I don't have any strength, and I don't want to go on living.’
“I replied, ‘You're not making enough of an effort to get out of it, you're not occupying yourself with things you enjoy that'll help you overcome the depression.’
“My daughter answered, ‘Okay, you don't understand,’ and she slammed down the phone. “After the episode, I felt guilty that I had hurt her, not being able to understand that she's incapable of leaving her house and doing things that she enjoys.”
We analyze these MILEs, according to the themes introduced as the course progresses. The above example was used to demonstrate and teach the significance of different perspectives. Other areas of focus include emotions, cognition, and actions; mediation parameters; and clear and masked intentions.
Since Keshet's initiation in 2001, over 300 parents have participated in the 45-hour biweekly three-hour program. One or two participants from each group have become moderators of future Keshet groups. We developed a moderator manual and structured outline of theoretical content using standardized presentations and assignments. Moderators receive standardized training, and there is ongoing supervision and instruction. The course consists of lectures, workshops, home assignments and exercises, reading of material, viewing and analyzing documentary films on recovery concepts, and writing and analysis of the MILEs.
Participants have reported a higher level of knowledge and confidence and an improvement in their interactions after the completion of the course. A quasi-experimental study (N=49) found that Keshet significantly increased the hope of families concerning the well-being of their ill family member and the family's relationship with him or her. A study of five Keshet courses (N=88) focusing on the perceived value of participating caregivers found that Keshet changes the ways participants perceive and think about the diverse life situations with which they have to cope. Participants reported that analysis of MILEs was beneficial and useful in linking theory and practice. Among the changes experienced by participants were feelings of improved communication with the family member with mental illness, improved marital relationships, improved caregiver organizational skills, and more time invested in personal goals and interests.
