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Do you know someone who struggles with delusions or odd patterns of thinking?

As discussed in last week’s article on this topic, a delusion is a firmly held thought or conviction that is incorrigibly held despite evidence to the contrary. It is a fixed and pervasive way of thinking that is not easily derailed by logic.

For many people who are attempting to cope with loved ones who have delusions, it can be extremely difficult to communicate with the person or live peaceably with them.

Another component that results in much stress in families is the fact that not all individuals with delusions have what are known as bizarre delusions. Some delusions make sense and could be possible (i.e., non-bizarre delusions). The individual may seem to go in and out of “consciousness” and show moments of insight, emotional awareness, and engagement. However, this may only last for a short duration or not occur at all in some cases.

This article will discuss the things we can do to make communication slightly better with those who struggle with delusional thoughts.

Living with or trying to have a relationship with someone who is suffering from delusional thought patterns can literally flip your world upside down. Everything that was once very logical to the person becomes questionable and the delusions begin to take over. When delusions take over, there is nothing you can do to stop them.

Delusional disorder or other mental illnesses where delusions may be present (i.e., schizophrenia, psychotic disorder, major depression with psychotic features, etc) can result in the individual becoming suspicious, hyper-vigilant, angry or hostile, confused, and paranoid.

It can be very easy for the person to become confused and paranoid which often leads them to make accusations, easily lose perspective, and maybe even experience a change in temperament. For example, a wife who is struggling with delusional thoughts may believe that her husband is out everyday after work taking a female co-worker to dinner (i.e., paranoia). Although there may be no proof of this (i.e, a delusion), she may consider ending the marriage anyway (i.e., confusion and hostility). Many of my clients have reported feeling deeply afraid of their loved one because their mind is no longer “logical.” The refusal of treatment and medication can cause further deterioration in the suffering person.

As a result, it is important that we learn how to cope with someone who has delusions. Interacting with someone who has delusions can be an absolute challenge. You may even feel hopeless and helpless yourself. But when I meet with hopeless clients, I discuss the following ways to protect oneself from someone who has delusions:

  1. Pay attention to the emotions of the person: Delusions and paranoia can be very difficult to understand. What is logical to us may not be logical to the person suffering from paranoia or firmly held inaccurate beliefs. Because of this you want to train yourself to avoid arguing your point or arguing over what is reality and what is not. You want to pay attention to the emotions of the person and how the person is feeling in regards to their inaccurate beliefs. If you try to argue facts or logic, the person will shut down. Try to stay focused on consoling the person, offering support in ways that you can, or just listening in a nonjudgmental fashion.
  2. Discuss the way you see the delusion: Although you do not want to argue facts and logic, you can express that you see the situation in a particular way and while you want to understand their view of situation to the best of your ability, you cannot. Sometimes it might be wise to say something like: “I understand this is hard for you. I would feel the same way. I’m sorry I cannot understand this 100%, but I certainly get why you feel the way you do.” You are not trying to be correct. You are not trying to be analytical. You are simply trying to be understanding while also expressing how you see the situation.
  3. Express that you are concerned about the person: There may come a time when you simply have to tell the person that you are concerned about them. You certainly do not want to express this in a condescending manner. You want the person to know that you care and are concerned about how their thoughts and feelings are affecting them. You can say something like: “it is obvious that you are stressed and overwhelmed. Have you thought about seeking a therapist, someone who can hear you out and provide unbiased support?”
  4. Offer to pursue therapy together but be strategic: You can offer to attend a few therapy sessions together or accompany the person to an appointment. This strategy gives the impression that you are not only supporting the person in their recovery but also seeking insight into your own beliefs about the situation. You might also benefit from therapy yourself. A good therapist will teach you how to respond, interact with, and cope with the person who is suffering from delusions or paranoia. Seeking therapy together also helps the individual see that you too are in need of support in some way.
  5. Ask the person why they believe as they do and be open-minded: It is okay to ask the person why they believe as they do. You can also ask the person to explain when their beliefs began and why. The person may be very open to sharing their fears with you. But some people may become suspicious and paranoid as to why they are being questioned about their beliefs. Either way, you don’t want to make the person feel defensive. You just want to get “inside their head” and see how far into their beliefs/paranoia they are. This can be helpful information for when/if the person seeks therapeutic intervention.
  6. Avoid getting frustrated and expressing that to the person: It is important to remember that the person is ill and in need of compassion. This can be extremely difficult, especially if the individual suffering begins to attack loved ones or a spouse. When you are the target and trigger of the suffering person, you may not feel as if you can avoid getting frustrated or defensive. That is understandable. But you want to learn how to derail inaccurate thoughts and beliefs by “downplaying” them in your mind. If you get frustrated or angry in response to a paranoid belief, you will likely inflame the situation.
  7. Learn about Cognitive Distortions or Thinking Errors: We all engage in thinking errors at some point in our lives. We can exaggerate details, we can look at only the negatives in a situation, we can be judgmental without appreciating imperfection, we can become defensive if things don’t go our way, etc. It’s inevitable. I encourage you to learn more about cognitive distortions and how they may influence your reactions to the person suffering from delusions.
  8. Model engagement in reality testing: Weighing the evidence for or against the delusion(s) can be helpful not only to you but the person suffering. The person may argue with you or find ways to defend their point of view. Despite these behaviors, it may be helpful to model weighing the evidence for or against a belief. When you show that you are able to consider various points of view and question things, you are modeling normal thought processes and behaviors. This may or may not be helpful but it is worth a try.

As difficult as it may be, there are some situations in which separation or divorce is the only way to cope with a loved one who is suffering from delusional thoughts and beliefs. If the individual is refusing to seek psychiatric treatment (medication or therapy), it will be important to determine what is worth salvaging in the relationship, and what is not. Safety is important. Emotional health is important. If both safety and emotional health are in jeopardy, you may have to make some very tough decisions.

Looking forward to connecting with you here.

As always, I wish you well

This article was originally published April 16, 2016 but has been updated to reflect comprehensiveness and updates.