Going along with delusional thoughts

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Qwerty
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Going along with delusional thoughts

Post by Qwerty » Mon Apr 16, 2012 5:59 pm

What do people think about going along with delusional thoughts to discover more about the thought processes of the client?

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fledgling
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Re: Going along with delusional thoughts

Post by fledgling » Mon Apr 16, 2012 7:15 pm

I think that depends on exactly what you mean by 'going along' with the thoughts? There is a difference between discussing delusional thoughts/psychotic experiences as real experiences that the client is having, and discussing them as though the content itself is real (which could be seen as deceptive and not very collaborative?).

I don't have much experience of working psychologically in this area though, so it will be interesting to see what others have to say...

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Re: Going along with delusional thoughts

Post by Borrowed Cone » Mon Apr 16, 2012 7:37 pm

I don't think any decent therapist would turn around and say "what you are telling me is not true", or "it isn't real". Asking more about a person's experiences is integral to the therapeutic process, whichever model you are using.
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Qwerty
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Re: Going along with delusional thoughts

Post by Qwerty » Mon Apr 16, 2012 7:47 pm

I completely agree. However, what about letting a client talk to the Spirit in a darkened room for a length of time and going along with the delusion that way instead of turning on the light and saying "can you explain to me what is going on here" or somethign similar?

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Re: Going along with delusional thoughts

Post by Borrowed Cone » Mon Apr 16, 2012 8:27 pm

AliMartha wrote:I completely agree. However, what about letting a client talk to the Spirit in a darkened room for a length of time and going along with the delusion that way instead of turning on the light and saying "can you explain to me what is going on here" or somethign similar?
Rufus May adopts a similar approach involving an empty chair, in which the client is encouraged to "talk" to the voices or personalities they experience. You might find more information on his website, although I'm not familiar with it myself.
"We can rebuild him. We have the technology. But I don't want to spend a lot of money..."

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matt.berlin
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Re: Going along with delusional thoughts

Post by matt.berlin » Tue Apr 17, 2012 12:47 am

"Going along with" might sometimes be called "colluding", but personally I find both terms troublesome. For me, the most important thing when someone you are working with has an experience that you (or indeed many others) do not share, is to understand the emotion that is connected to that experience rather than getting into questions about delusions versus reality, or right versus wrong. For example, it might seem that it is unlikely that a client is being spied on by MI5 - but instead of labelling that as a delusion, we can try and understand how that makes them feel (perhaps anxious and scared?) and what might help to reduce any distress they are experiencing. For me it makes sense to work with someone's beliefs, rather than against them. Tamasin Knight has written about how she came to believe that her water supply was contaminated but instead of having someone else change those beliefs for her, she decided the best way for her was to simply get bottled water from another area.

So I guess I would be reframing the question. Rather than "is this going along with a delusion?", I would be asking "am I comfortable sitting with this person talking to a spirit in a darkened room and if so, do I think this could be helpful in our work?". However, whatever the answer to that I think it is also fine to ask what the person is experiencing and to try and understand that better (even if it isn't done 'live' in the room).

Although clients can say things which we find hard to believe or have experiences that we don't share, we need to be careful of how we might be imposing our world-view on them and try to understand as best as is possible the ways in which they experience things.
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Re: Going along with delusional thoughts

Post by Ruthie » Tue Apr 17, 2012 1:16 pm

I use CBT with clients with distressing psychosis (and I say distressing because unless someone is distressed by their experiences there is no need for CBT). The way I see this is that we want to foster clients' curiosity and interest in their experience so they can find other ways of understanding it. If we aren't prepared to be interested and open-minded as therapists, we don't stand a chance of helping our clients to be.

Not sure specifically about your example of talking to a spirit in a darkened room - sometimes we do things in therapy that look odd from the outside but when you understand the context and the rationale they make perfect sense (e.g. toilet licking). So whether it was appropriate or not would depend on the formulation with that individual client.

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matt.berlin
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Re: Going along with delusional thoughts

Post by matt.berlin » Tue Apr 17, 2012 5:55 pm

Ruthie wrote:Not sure specifically about your example of talking to a spirit in a darkened room - sometimes we do things in therapy that look odd from the outside but when you understand the context and the rationale they make perfect sense (e.g. toilet licking). So whether it was appropriate or not would depend on the formulation with that individual client.
I'd say that thinking that toilet licking is OK is an unusual belief ;-)
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Re: Going along with delusional thoughts

Post by Ruthie » Tue Apr 17, 2012 8:04 pm

matt.berlin wrote:I'd say that thinking that toilet licking is OK is an unusual belief ;-)
Well how can we test that out... :lol:
If God invented marathons to keep people from doing anything more stupid, the triathlon must have taken Him completely by surprise.

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Re: Going along with delusional thoughts

Post by astra » Tue Apr 17, 2012 9:57 pm

AliMartha wrote:I completely agree. However, what about letting a client talk to the Spirit in a darkened room for a length of time and going along with the delusion that way instead of turning on the light and saying "can you explain to me what is going on here" or somethign similar?
Doesn't sound much different from having to go to church with my mother at Christmas - it would have felt really inappropriate to challenge everyone's behaviour and question the reality of what was going on, particularly as no-one seemed too distressed by it.
From the point of view of mindfulness, as long as you're breathing there's more right with you than wrong with you. Jon Kabat-Zinn

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matt.berlin
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Re: Going along with delusional thoughts

Post by matt.berlin » Tue Apr 17, 2012 10:08 pm

Ruthie wrote:
matt.berlin wrote:I'd say that thinking that toilet licking is OK is an unusual belief ;-)
Well how can we test that out... :lol:
A survey with two groups: CBT therapists vs normal controls ;)
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Toria
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Re: Going along with delusional thoughts

Post by Toria » Wed Apr 18, 2012 9:51 am

The Paranoia Network (linked to the Hearing Voices Network) might also be a helpful resource: http://www.nationalparanoianetwork.org
You can't stop the waves, but you can learn to surf - Jon Kabat-Zinn

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Re: Going along with delusional thoughts

Post by Kentucky_Freud_Chicken » Wed Apr 18, 2012 4:05 pm

I'd say it isn't as important as going along with them because they're important, valuable, valid and often functional to the client.

David Harper has published a good paper on helping people live with unusual experiences that positions the job of an ethical therapist as helping people to live in a world that doesn't widely accept their perspective rather than changing their perspective to suit the world around them. I don't have a link, use your google-fu.

Borrowed Cone wrote:I don't think any decent therapist would turn around and say "what you are telling me is not true", or "it isn't real". Asking more about a person's experiences is integral to the therapeutic process, whichever model you are using.
I think this happens quite a lot unfortunately. I had to read Garrety's "CBT for Psychosis" with a sick bucket next to me.

Qwerty
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Re: Going along with delusional thoughts

Post by Qwerty » Wed Apr 18, 2012 8:33 pm

Thanks, this is all really interesting. I have read some bits by Tamasin knight that are interesting. I do not agree with 100% of the tips/techniques and the distinction between being open to peoples' beliefs and colluding still makes me a bit uncomfortable but it is all good to think about! If only there was x, y and z to do with every client, eh?! Although the profession would be a lot less interesting... ;)

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_Dasein_
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Re: Going along with delusional thoughts

Post by _Dasein_ » Thu Apr 19, 2012 9:42 pm

I think it's interesting to be curious about the potential functions that the delusional beliefs might serve. That in some sense having a delusion might be a way of dealing with anxiety or some form of nameless dread. The delusional belief might be an attempt to make sense of some prior psychological collapse within the subjects structure. In working with this I don't think it's about agreeing or disagreeing with the delusion but stepping inside of it and trying to understand it, and why and how this belief might be helpful for the person holding it. For psychological work to be effective with a delusional patient I think there needs to be at least a part of the ego that can join with you in this exploration, a small part that might think the delusion is a delusion. Obviously this capacity might be transient and come and go.

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