I agree with Dr. Stamu-O'Brien. In clinical practice, experts often address issues related to delusions rather than attempting to resolve a delusion completely as the latter is frequently unsuccessful.

As a humanistic psychologist, my sense is that the best strategy is not to focus too closely on the delusions. These delusions often seem to be focussed on places where my clients are feeling disempowered. If I challenge the delusions too much, then they tend to cling to them and feel invalidated by me in a way that prevents me from being able to form a therapeutic alliance with them. So I focus on forming a good relationship with them rather than to challenge the delusions. This tends to help my clients to gradually feel more validated and empowered to figure out what they want to do with their life through joining the community in some way rather than to cling to their delusions and private worlds.

Often the delusions are irrelevant to their actual goals in life. For instance, I once had a client who was convinced he was a mafia hit man. He was afraid of answering the telephone for fear it would be the mafia calling him and giving him an order to kill. I worked with him to form a good relationship. What came out of this was of course a good deal of talking about the mafia. But also, a good deal of talking about how he felt so inferior to other people because he was diagnosed as a psychotic and he believed that he could never join the working world despite being physically healthy and quite intelligent. I assured him that he was the equal of anyone and that we could find a place for him to work where his delusion wouldn't really interfere with anything. I helped him to get a job that didn't require him to use a phone and he learned in fact that it didn't matter to his employer that he had a delusion. He just needed to be able to get his work done which he in fact excelled at because he was proud of being able to work. Over time, the delusions became less important to him as he was absorbed into enjoying the feeling of being a member of the working world and was experiencing less alienation. He later became a manager at his job site and very few people knew about his former struggles with delusions.

Hi Ian Wickramasekera, I love your anecdote!

Sir,

If your client is under remission, it means he has come down to the stage of idea and not delusion, guided discussion along the history of initiating such ideas and soft hammering on those ideas with relevant examples will gradually make him to drop such ideas and regular anti psychotics will help him not to form such ideas again.

First of all, it's very significant that you don;'t mention what the delusion is? or why this person might have had this delusion. A person who feels meaningless, made worthless in his life by how he was treated, might compensate with a delusion of grandeur, a special relationship with god, or as the colleague above mentions, being a mafia hit man.

Consider this possibility: what made this person have THIS specific delusion. WHAT DOES IT DO FOR HER - as Ian above says, concentrate on the PERSON not on the symptom.

and consider that the antipsychotics render patients unable to deal with life - see the logitudinal studies of long-term antipsychotic patients versus those who got off them after the initial period. They also make them passive and less interested in anything. I had a patient for many years who had come already on antipsychotics and she showed all the vagueness and inability to act in life that most patients show with long-term use. When she finally decided to get off them, she became able to talk, to be critical of a manipulative husband, leave and get a job and become independent.

Based on my 40+ years as a clinician, I have dealt w/ many who experience hallucinations and delusions. Once they are in reasonable remission, I explore them as I do w/ dream analysis. The content of the delusions can be considered to be like dreams or nightmares reflecting important themes in the person' "real" life. I find some themes to be ego-syntonic and some are dystonic.

Very intriguing topic.

Rich

Hello,

With my limited understanding and experience I would think that development of delusions is a constant and ongoing part of human life. Not just clients/patients, but we ourselves are always forming and resolving 'delusions'. So in my opinion, a psychologist/therapist should only focus on the delusions of his/her client that NEED to be resolved in order to let the client feel HEALTHY again.

We'll realise that it's not us, but the client who guides us through his/her mind all the way to the delusion that they want resolved, and we have to be very careful because while we are trying to resolve a delusion, we can also unintentionally plant a delusion in out clients' mind.

Hence, it is important to be aware and make judicious use of our skills as therapists. Too much medicine is bad for the patient, too much surgery has many complications, similarly, too much therapy is not always an answer. Hope that makes sense. Caroline Stamu-O'Brien

Kind regards,

Manzar

Dear Caroline,

Thank you for your response. I understand what you mean.

Kind regards,

Manzar