Steps For Working With Delusions

Working with delusions is similar to hallucinations, except that more non-verbal techniques are required. You will need to sit in silence longer and with more patience, as delusions do not tend to go away, ever. The person may not verbally express them as often, but they are usually omnipresent.

1. Establish a trusting, interpersonal relationship:

  • Do not reason, argue, or challenge the delusion. Attempting to disprove the delusion is not helpful.
  • Assure the person that s/he is safe and no harm will come.D
  • Do not leave the person alone – use openness and honesty at all times.
  • Encourage the person to verbalize feelings of anxiety, fear, and insecurity – offer concern and protection to prevent injury to self or others.
  • Convey acceptance of the need for false belief
  • Center on the person, rather than the need to control symptoms – remain calm.

2. Identify the content/type of delusion:

  • Assist in understanding the person and the purpose the delusion serves.
  • Clarify any confusion of the person’s verbalization by asking what they are saying.
  • If you do not attempt to clarify confusion, the result may be even greater confusion, anxiety and reaffirmed delusion.
  • Do not confirm or feed into the delusion by asking questions about it when the person is not delusional. For example: NEVER ask, How’s the CIA today?
  • Identify the presence of a central topic.
  • Identify the presence of a central feeling tone.

3. Investigate the meaning of the delusion:

  • Assess areas in the person’s life that they are no longer able to manage, control, or participate in.
  • Assess the concrete ways in which the delusion interferes with the person’s functioning.
  • Ask whether the person has taken action based on his/her delusion.
  • Without agreeing or arguing, question the logic or reasoning behind the delusion. For example: If the CIA are harassing you, who is the contact person?

4. Assess the intensity, frequency, and duration of the delusion:

  • Fleeting delusions can be worked within a short time frame.
  • Fixed delusions, which have endured over a long period of time, may have to be temporarily avoided in order to prevent them from becoming stumbling blocks in the relationship.
  • Does the person always greet you with the delusion? If so, just quietly listen and then give direction for the task at hand.
  • If it appears that the individual cannot stop talking about the delusion, ask gently if s/he recalls what you have been doing and that it’s time to resume that activity.
  • If the person is very intent upon telling you the delusion, just quietly listen until there is no need to discuss it any further. Remember that it is helpful to give the person reassurance during the delusion that s/he, as a person, is okay.

Barriers to Successful Intervention

1. Becoming anxious and avoiding the person

This leads to annoyance, anger, a sense of hopelessness and failure, feelings of inadequacy, and potential for laughing at the person.

2. Reinforcing the delusion

Do not ‘go along’ with the delusion, especially to get the cooperation of the person.

3. Attempting to prove that the person is wrong

Do not attempt a logical explanation.

4. Setting unrealistic goals

Do not underestimate the power of a delusion and the person’s need for it.

5. Becoming incorporated into the delusional system

This will cause great confusion for the person and make it impossible to establish boundaries.

Reference: Lego, S. (1984) The American Handbook of Psychiatric Nursing. Philadelphia: J.B. Lippincott Company