How To Use the LEAP Method From ‘I Am Not Sick, I Don’t Need Help’

Medically reviewed by Anna Kravtsov, D.O.

Written by Kate Harrison

Posted on June 30, 2026

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Key Takeaways

The LEAP method, which stands for listen, empathize, agree, and partner, is a research-backed communication approach developed by clinical psychologist Dr. Xavier Amador to help family members and caregivers connect with loved ones who have schizophrenia and do not believe they are unwell.

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If you’ve ever tried to convince someone of something they don’t believe to be true, you know the effort can leave both parties angry and frustrated. When someone you love has a serious mental health condition, like schizophrenia, and insists nothing is wrong, these types of conversations can happen often.

The LEAP method offers a different approach for communicating with someone who doesn’t believe they have a health condition — a symptom called anosognosia.

Developed by clinical psychologist Dr. Xavier Amador, LEAP stands for listen, empathize, agree, partner. The method — described in his book “I Am Not Sick, I Don’t Need Help” — is built on the idea that trust and connection can help improve communication for people with anosognosia.

Supported by clinical research, the LEAP method has been taught by mental health professionals at the LEAP Institute and National Alliance for Mental Illness (NAMI) for over 25 years.

In this article, we’ll explore what the LEAP method is, how it can help, and tips for how to use it to communicate with your loved one.

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What Is Anosognosia?

Anosognosia is a medical term often used to mean “lack of insight.” It refers to the brain’s inability to recognize a health condition or process a problem.

Anosognosia can cause someone to be unaware they have a health condition. It’s not the same as willful denial, a psychological defense mechanism in which a person is subconsciously or consciously choosing to avoid or reject something upsetting.

Anosognosia is a common symptom of schizophrenia. It’s reported to affect between 50 percent and 98 percent of those living with the mental health condition.

The symptom can come and go, meaning someone may be able to acknowledge and have awareness of their condition at certain times, but not others. This fleeting insight can complicate a loved one’s attempt to communicate and interact with someone who has schizophrenia.

The inability to consistently recognize the condition can lead many people with schizophrenia to refuse treatment. In fact, anosognosia is the most common reason that people with schizophrenia stop taking their medication, which can lead to worsening symptoms and quality of life.

What Is the LEAP Method?

The LEAP method is an evidence-based communication framework for family members and caregivers of people with schizophrenia. It aims to address anosognosia through four main steps — reflective listening, empathy, agreement, and partnering.

Listen

The foundation of the LEAP method is reflective listening. The goal of this type of listening is for you to understand the other person’s experience and show them that you understand it.

To use reflective listening, focus on understanding what your loved one is saying. Then reflect that understanding back to them. Do this without judging, debating, or reacting to what they’re saying.

Reflective listening doesn’t mean you’re agreeing with the person’s beliefs. You’re not reinforcing delusions (false beliefs). You’re just acknowledging what they’re saying.

Even if you disagree with them, focus on asking questions and summarizing what they’ve said to make sure you’re understanding them correctly. Avoid telling them that you disagree with their point of view and why, as this could lead to conflict.

This approach can help reduce conflict, build trust, and improve your relationship. If your loved one feels heard and understood, they’ll be more likely to talk openly with you, which could help with treatment adherence down the line.

Empathize

After you’ve carefully listened to your loved one’s perspective, you’ll empathize with them. This doesn’t mean you need to accept any false beliefs they hold. Instead, you’ll recognize and validate the emotions they’re experiencing.

To empathize, you’ll focus on your loved one’s emotional experience rather than whether their beliefs are rooted in reality. If they tell you about a delusion, acknowledge the feelings they express rather than the false belief itself.

For instance saying, “That sounds scary,” can show your loved one that you understand they may have felt scared in a certain situation.

The idea here is that people are more likely to trust and engage with someone who shows a genuine understanding of how they feel. When people feel judged, dismissed, or misunderstood, they can become defensive and less willing to talk.

By showing respect for a loved one’s feelings and experiences, you can nurture your relationship with them. Building trust helps make it easier to find common ground.

Agree

The goal of the agreement step is to find areas where you and your loved one see things similarly. This doesn’t have to include whether they have schizophrenia or need treatment — in fact, it likely won’t at first.

According to Dr. Amador, “Common ground always exists, even between the most extreme opposing positions.”

Productive conversations don’t require complete agreement, only enough shared understanding to move forward together.

If you accept that you might not reach an agreement about your loved one’s mental health condition, you can focus on issues where agreement is possible. Look for goals, concerns, or problems that you can both agree on.

For example, you may disagree about whether or not your loved one has schizophrenia, but you might agree that your loved one is having trouble sleeping, finding it difficult to stay employed, or feeling stressed.

Instead of debating with your loved one about their diagnosis, you’ll shift the conversation toward these shared concerns. By doing so, you’ll create opportunities to work together.

Although your loved one may not believe they have a health condition, they may be willing to work with you to achieve goals they value, such as feeling safer, keeping a job, or reducing stress.

Partner

During the partnering step, you’ll use the trust and common ground you’ve established and turn it into action. As a team, you’ll work to address your loved one’s concerns and priorities.

If your loved one feels they have a voice in the process, they’ll be more likely to accept help. While focused on shared goals, you’ll invite them to participate in decisions and problem-solving.

Help your loved one look for practical ways to achieve the goals that are important to them. Your partnership should be based on mutual respect and collaboration, not pressure.

How To Use LEAP With a Loved One Who Has Schizophrenia

Changing the natural way you communicate can be hard. Here are some tips that can help you successfully use the LEAP method with your loved one.

Listen

Practical tips to help you listen effectively include:

Plan to talk with your loved one at a specific time.
Go into the discussion with a set agenda. Don’t allow your loved one to steer the conversation and change the subject.
Listen to what your loved one says about their beliefs and sense of self, including their symptoms and treatment.
Without judgment or emotion, repeat back what they’ve said to see if you heard them correctly. Ask clarifying questions if you need to.

Empathize

To empathize with your loved one, you need to show them you respect and care about how they’re feeling. When they express fears, frustrations, or other emotions, try responses like:

“That sounds scary.”
“I understand what you’re trying to say.”
“I sympathize with how you’re feeling.”

Agree

To agree effectively, you’ll focus on identifying challenges that you both agree on. During this step, you’ll ask questions. For example, if your loved one stopped taking their medication, you might ask neutral questions like:

“What happened after you decided to stop taking your medication?”
“Did the voices quiet down after you stopped?”
“After you stopped taking the medication, how long was it before you went to the hospital?”

How your loved one answers these questions can help you identify shared goals. They may respond that they felt more energetic but had trouble sleeping or were scared, for example. If so, you can identify sleeping better and feeling less afraid as potential shared goals to address.

Partner

To partner, you’ll commit to working as a team to address your shared goals. Invite your loved one to participate as you brainstorm how to work through their challenges.

First, focus on small, shared goals — such as sleeping better. Use these as jumping off points for talking about possible next steps. For sleep issues, you might talk about ways to adjust their bedroom to create a better sleep environment, like getting black-out curtains or adjusting the temperature in the room.

Although your loved one may not believe they have schizophrenia, they may be more likely to accept treatment — medications, psychotherapy, or other forms of support — if it will help them reach the goals that are important to them.