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To learn more about Getting a conversation started, refer to the blog earlier this year, Small Talk 1: Getting Started and Knowing What to Talk About.

Once you’ve started a conversation, there are a few different skills to keep it going. First, use “signals” to show you’re interested and to see if they are interested in the conversation.

Verbal signals are things you say to let the other person know you’re listening and interested, and things they say to let you know they’re listening and interested. Here are some examples:

• saying “Yeah” or “Mmm-hmm” or “Uh-huh” or “Okay”
• saying “I didn’t know that,” “I hadn’t heard that,” “That makes sense,” or “I never thought of it that way”
• stay on the same topic that they are one, ask follow-up questions about that topic
• watch out for topics that will make the other person uncomfortable or confused—if they seem uncomfortable, try changing the subject
• respond within a very short time, or if you need time to gather your thoughts, you can say “Let me think about that,” or “Well…” or “Hmmm”
• don’t interrupt
• if they seem uncomfortable for any reason, try switching to a new subject

Ask yourself, “Is the other person giving me verbal signals that shows they’re interested? If they’re not, should I go ahead an end the conversation? Or maybe change the subject?

Nonverbal signals are ways you use your body to show that you’re listening and interested, and ways they use their body to show they’re interested and listening.

• eye contact: look at them in the eye–not constantly, just every few seconds (this can be an especially challenging skill for people with schizophrenia, try practicing it if it’s hard for you)
• nodding briefly then they’re talking, not all the time, just here and there
• raising your eyebrows while nodding can show interest
• voice volume should be loud enough to be heard easily, but not shouting
• lean forward a little
• make sure your face expression matches the emotion of the conversation (if someone’s talking about something funny, smile, and if they’re talking about something sad, have a serious expression); this can be a challenge for some people with schizophrenia, practice this skill if needed
• don’t stand closer than arm’s length, face the person or stand kind of to the side

Are you giving signals that you’re interested? Are they? If they aren’t, think about ending the conversation or changing the subject.

If the other person is giving signals that they’re interested, but you’re not sure what to talk about, refer to Small Talk Part 1 earlier in this blog to get ideas of topics to starting talking about. Once you’ve started on a topic, you can ask follow-up questions to keep the conversation going. For example, if the person mentioned they are going to a baseball game this weekend, you could ask one of these follow-up questions:

• “What do you think of how the Twins are doing this season?”
• “Do you go to baseball games often?”
• “What other sports do you watch?”
• “Do you play any sports yourself?”
• “Have you ever been to a St. Paul Saints game? They’re super fun.”

Another example of follow up questions would be if the person just said that they are going out to dinner with family this weekend:

• “Where are you going? Do you like that restaurant?”
• “My favorite restaurant is Pepito’s in Minneapolis, what’s yours?”
• What’s your favorite type of food? Why?”
• “I’m not a chef, but I do like cooking. Do you? What do you cook?”
• “Do you have any restaurant recommendations?”

If you run out of questions or things to say about a topic, you can begin a new topic (see Small Talk 1-Appropriate Topics for Anyone in an earlier blog). If they still don’t seem interested or you can’t think of anything else to say, it might be time to end the conversation: see Small Talk 3-Ending a Conversation for helpful techniques for doing so.

One thing I hear over and over again from clients and their family members is how lost they feel during the early stages of the illness. They don’t know anyone who talks about schizophrenia, and it seems like such a rare and difficult illness. Sometimes just getting connected with other people with schizophrenia and their families is a big step forward.

Schizophrenia.com has several forums with quite a few conversations going on, both for families and for the people with the diagnosis.

Sometimes people with schizophrenia tell me that they have a hard time with small talk. However, people can get better at small talk through learning more about it and practicing it.

Starting a conversation-Icebreakers

“Icebreakers” are questions (or comments) that get a conversation started. They can be very specific if you know the person, like “How’s the new apartment?” or “Did you have fun at Jon’s bar-b-que?” You can ask any question about the person or their lives, or a general question, as long as it’s appropriate (see below).

If you don’t know the person, you may want to ask a more general question. Here are some examples:

• How are you doing?
• What do you do?/Where do you work?
• (If in school) What classes are you taking? How do you like them?
• What do you think of the weather these days?
• How was traffic for you today?
• Did you do anything fun over the weekend? What was it?
• What brings you here today?
• What do you do in your free time?
• What kind of TV or movies do you like?
• What’s your favorite sport?
• Did you see the game on Sunday?

Use follow-up comments/questions to keep the conversation going–make a statement about the topic or ask questions about the topic. An example would be:

Natalie: “Hi, nice to meet you. I’m Natalie. So, what do you think of the weather these days?”

Isaac: “I’m so sick of winter!”

Natalie: “What’s the worst part of winter for you?”

Isaac: “Feeling stuck inside. I like to get out and go for walks and play Frisbee, but it’s impossible when it’s so cold.”

Natalie: “I agree. I walk my dog every morning, and sometimes it’s really hard to motivate myself to go.”

Isaac: “What kind of dog do you have?”

Natalie: “She’s a lab mix. Her name is Molly. She’s super sweet, but she gets hyper if she doesn’t get walked every day.”

Isaac: “I love dogs. When I was a kid I had a Basset Hound named Harvey. He was never hyper, haha. It was hard to even get him to go for a walk. But he was still so awesome, he was super mellow. I wish I could get another dog.”

Natalie: “Why can’t you get one?”

Isaac: “I can’t really afford one right now. Plus my roommate is allergic to dogs.”

Natalie: “Oh, dang, that sucks. But you’re right, dogs are expensive. Molly got an ear infection once and seeing the vet plus medications was like $200, it was so expensive.”

Isaac: “Wow. Well, I gotta head out. It was nice talking to you, maybe I’ll see you again soon. Take care.”

Natalie: “Good talking to you too. Bye.”

As you read the conversation, notice how Natalie starts the conversation with an introduction and a general question about the weather. Then when Natalie says something about walking her dog in the cold weather, Isaac changes the subject to dogs. Since Natalie had just mentioned her dog, this is a good way to change the subject.

Starting a conversation-appropriate topics

Appropriate Topics for anyone

It’s important in small talk conversations to talk about topics that everyone is comfortable with. Below is a list of general topics that most people will be comfortable talking about, no matter how well you know each other.

• weather
• sports
• your job
• school
• news headlines
• hobbies
• TV shows
• interesting things you saw on the internet
• movies
• books
• food
• travel
• celebrity gossip
• upcoming events or holidays
• pets
• new babies/kids
• traffic

In the conversation between Natalie and Isaac above, they talked about two of these topics, weather and pets.

Topics to Avoid

Some topics aren’t appropriate for small talk, or will make people uncomfortable or upset. Try to avoid talking about these things during small talk conversations. Some of these topics are:

• religion
• politics
• schizophrenia (unless they know you have it and accept you)
• dating
• things of a sexual nature
• personal medical issues
• personal or psychological issues
• family problems
• relationship problems
• money
• bad news
• gossip
• details-most people aren’t interested in the small details of things, just the general
• anything that makes the person seem uncomfortable

Good friends and family members

The better you know someone, the more subjects that are appropriate during small talk. The list above is good for anyone, someone you don’t know or someone you do know. But if you do know someone, there are a few more topics you can talk about. Some of these are:

• religion (but be careful, avoid this topic if people get upset)
• politics (but be careful, avoid this topic if people get upset)
• schizophrenia and other symptoms
• dating
• personal medical issues
• personal or psychological issues (though people don’t want to talk about these things very often)
• family problems
• relationship problems
• money
• bad news

Partners, very best friends, very close family members, and your mental health providers

For the people you are closest to, there are a few more topics you can talk about:

• deep personal issues
• things of a sexual nature (be careful and appropriate)
• fears
• worries

Remember, small talk is a skill that can be learned. Practice. Ask someone you trust if they are willing to chat with you, and then ask afterward if they have any advice or ideas for how you could do better. A lot of people feel awkward during small talk, not just people with schizophrenia disorders.

Check the blog out for Small Talk Part 2: Keeping the conversation going, on how to show you’re interested in a conversation, and for tips on concluding one, Small Talk Part 3: Ending a conversation.

When clients tell me they’d like to have more friends, I ask them first if they have an idea of where they are planning to go to meet new people. If you’re not sure about where to meet new people, see part 1 (the previous blog). Once you’ve figured out where you’re going to meet new people, the next step is how you talk with them to get to know them and possibly become friends.

When you first go to a social event, try to talk to at least a few people. Start a conversation with a general topic that you think you’d have something to say about, like:

• How are you enjoying the weather lately?
• Did you catch the latest Vikings game?
• I’m new to this group/event. Have you been here before? What’s it like?

You can also start a conversation specifically about the group or event you are at. If you’re in a hiking group, you could ask, “Where is your favorite place that you’ve hiked in the past? Why?” If you take a cooking class, you could say, “I’m not that familiar with this kind of food, do you like it? Why?” (More details on these conversations in Meeting New People, Part 3—Small Talk.)

Some people will talk with you for a while, others will talk for a few minutes and then excuse themselves to go talk with someone else or do something else. Don’t worry about the people that don’t end up talking very long with you. You are looking for people that you have a connection with, and some people are not a good match for your personality or have their own issues going on. Just move on to the next conversation when someone excuses themselves.

Also, remember that it may take more than just one conversation to get to know someone or be friends with them. Especially in Minnesota, people are slow to feel comfortable with each other.

You’ll probably end up having several of these “small talk” conversations before they may be ready to start doing social things outside the group together.

If you think you’ve made a connection with someone and would like to be friends with them, after having several conversations, ask if you can Facebook friend-request them or email them. Get their email/Facebook address and write it down. Then, a couple of days later, Facebook or email them and ask if they’d like to hang out sometime for coffee or something like that. If you think it might be confused with asking for a date, make sure that you state directly that you’re just looking for friendship, nothing more. (More on Dating Relationships in a future blog). When you first ask someone to do something social with you, invite them to do something that will take only a couple of hours or less and that is in a neutral place (don’t invite them to your place, for example). Good examples are going for coffee, going out to eat, going to a movie, going bowling, or going to a concert. Try to come up with some interesting things to talk about ahead of time, so you don’t have to think about them during the activity.

Be careful about telling someone you don’t know well about your illness–it usually works out better to have them get to know you first and then tell them.

Also, keep in mind your own safety when you don’t know someone well. Offer to meet them in a neutral place, tell a friend or family member where you’re going, don’t invite them over to your place or go to their place. Leave the situation if you feel creeped out or threatened.

One of the most common questions people ask when they’re getting to know new people is “Where do you work?” or “What do you do?” If you are a person who isn’t working right now, it can be helpful to think ahead of time how you’ll answer this question. Some replies to this question are:

• “I’m looking for work.”
• “I’m between jobs”
• “I’m looking into going back to school.”
• “I do volunteer work.”
• “I’m retired.” (if over 55 or so)
• “I’m self-employed” (if applicable)
• “I’ve got some medical issues and I’m not working right now.”

Remember, you don’t have to give more detail than that, especially when you barely know the person.

When you’re done with the activity, if you had fun, tell them you enjoyed it and would like to do it again. If you didn’t really connect with the person, you need to decide whether you want to give it another chance, or if you’d rather just go your separate ways and meet other new people. Keep in mind that you may have to meet several new people before you find one that is a good personality match with yours. Meeting new people can be hard, but the short-term challenge of talking with new people is definitely worth the long-term benefit of making new friends.

Often clients tell me they’d like to make more friends, but don’t know how or where to meet new people. This is a skill you can work on, you can get better at it. Meeting new people isn’t always easy, and it can be nerve-wracking, but it’s worth it. Also, remember that many people feel nervous around meeting new people, not just people with a schizophrenia disorder.

Where to meet new people

The first step to meet new people is to go to places or join activities where you are likely to meet people that you have some things in common with. Some people meet new people at work or at a volunteer position, though you may have less time to talk about interests or to socialize at your work/volunteer job. If you aren’t working/volunteering or if you don’t have things in common with people there, here are some other ideas for places to meet others.

Often, if you have a certain interest or hobby (like old cars or reading or hiking), you can find a social group of people who have the same interest. This is helpful because you then have a built-in conversation topic, since you know the person is interested in the same activity as you are. If you have a computer with internet, you can look these up pretty easily. (If you don’t, go to your local library and use their computer for searching). For example, you could Google “classic car festival in Minneapolis” you’ll find several helpful links with websites that list dates and locations of these festivals. You can also join MeetUp, which is a free website that lists a huge number of social group by location and interest. MeetUp usually doesn’t have any fees or obligation to go if you join and then change your mind.

If you go to church, churches often have social or special-interest groups that meet regularly. There are also lots of volunteer opportunities at most churches, though some are social and others are not.

If you have some extra cash, you could take a class. One type of class would be a Community Education class (which is listed online by county) such as woodworking or learning new computer skills. Another type is a class held at a retail store, like a cooking class at a kitchen store or a craft class at a craft store like Michael’s or JoAnn Fabrics. There are also classes offered by drop-in centers and other programs (like Artability and SEED classes in St. Paul and Spectrum ArtWorks in Minneapolis).

Finally, sometimes people meet others that they get along with in support groups for people with mental illness, like those through NAMI, or though a local mental health clinic. The advantage of these groups is that the people in the group already understand what mental illness is. They may have had some similar experiences and will understand what you’re going through.

Once you’ve gone to an event to meet new people, the next challenge is how to get to know them and become friends if you get along. This will be addressed in Meeting New People, Part 2.

With all the talk of Robin Williams’ recent death, and the renewed focus on clinical depression and suicide, it seems really important to address depression in people with schizophrenia. Sometimes people forget, or never think of, how often people with schizophrenia have depression. Over three dozen research studies have examined this very thing, and though rates between different studies varied, most often in these studies, at least 25% of people with schizophrenia had depression at some point in their lives, and sometimes the numbers were much higher. There are several ideas of why this is (though that discussion is for another day), but the important thing is the “occurrence of depression in schizophrenia has often been associated with worse outcome (5), impaired functioning, personal suffering (6), higher rates of relapse or rehospitalization (7–10), and even suicide (8,11, 12).” (Am J Psychiatry 2000;157:1379-1389. doi:10.1176/appi.ajp.157.9.1379)

Yesterday I came across a NAMI blog addressing Mr. Williams’ death and the things we all can do to identify, treat, and support people struggling with this disorder (see link). As you read it, please keep in mind that you or your loved one can get depression on top of schizophrenia, but that it is treatable and people get better. Many people in my practice struggle with depression at times, and I and their psychiatrist help them through it. Signs of depression to look for (some of which occur in schizophrenia, too, so talk to a mental health professional to be sure) include having the following for two weeks or more:>

• sad, empty, or irritable mood for a lot of the day
• having trouble enjoying things, everything seems “blah”
• a big change in sleep patterns
• a big change in appetite, or a major weight change without a change in eating
• low energy or being really tired
• problems with memory or concentration
• lots of negative thinking, like “I’m no good, nothing will ever get better, and this is all my fault”
• feeling sluggish or slow, or sometimes, feeling really jittery
• thoughts about death or suicide, whether or not you’d actually do it

If these symptoms sound familiar, take action. Get help. Don’t listen to the lies depression tells you. Talk to someone—your therapist, psychiatrist, a family member, call a crisis/suicide prevention hotline, or call 911. Don’t let depression take another person from us.

The following is a list of resources for suicide prevention:

• if you need immediate assistance call 911
• go to a hospital emergency room.
• 24-HOUR HOTLINE & HELPLINE INFORMATION
• National Hopeline Network 1-800-784-2433 (1-800-SUICIDE)
• National Suicide Prevention Helpline 1-800-273-8255 (1-800-273-TALK)
• Local Suicide Prevention Line: 612-347-2222
• Crisis Connection: 612-379-6363 or 1-866-379-6363
• Dakota County Crisis Line: 952-891-7171
• Fairview University Crisis Line: 612-672-6600
• Ramsey County Crisis Line: 651-523-7000
• Hennepin County Crisis line: 612-873-2222

Websites:

• http://www.hopeline.com/
• www.crisis.org (the Crisis Connection website)
• www.crisischat.org
• www. suicidal.com
• www.the-bright-side.org
• Suicide Hotline Listing by State http://www.suicidehotlines.com/
• American Association of Suicidology http://www.suicidology.org/
• American Foundation for Suicide Prevention http://www.afsp.org/
• Prevent Suicide Now http://www.preventsuicidenow.com/
• Suicide prevention resources, worldwide hotline links:
  http://www.psycom.net/depression.central.suicide.html
• http://www.befrienders.org/
• Families for Depression Awareness http://www.familyaware.org/
• Suicide Prevention Action Network USA http://www.spanusa.org/