You may want to take a quick look at my previous post about the nature of delusional thinking. That said, here are some useful strategies to keep in mind when someone you care about struggles with delusional thinking,
First, do NOT jump to conclusions about their beliefs.
Don't judge them for their beliefs.
Just ask questions. Make sure you understand exactly what it is that they believe.
Vincent: They're following me. Monitoring me.
You: Who? Who is following you?
Vincent: The CIA.
You: The CIA? Why are they following you?
Vincent: I don't know. Remember when I went to the dentist? That's when it started. He implanted something in my mouth. In my tooth. He said I needed a filling. Look - see. See - it's back there.
You (looking): Hmm... I don't see anything unusual looking. How do you know the dentist didn't just put a regular filling in your mouth? What do you think he implanted?
Vincent: It's a remote controlled tracking device. Believe me - it's not normal. I can feel it. My primary care doc said it looked normal too. But it's not. They're using it so they can monitor me.
You (summing up the delusion): So, the dentist implanted a radio-controlled monitoring device in your tooth so that the CIA could monitor your whereabouts? But you're not sure why the CIA would do such a thing?
Vincent: Yeah. The dentist is obviously in on it. He must be one of them. The CIA. I don't know why they're after me... But, they are. I've seen them drive past my house 7 times this morning already.
Second, make sure you also understand the emotional consequences of those beliefs. Remember, even if you don't share their beliefs, those beliefs are 100% true and real to the person who suffers from the delusions. Put yourself in their shoes. Imagine that the beliefs are, in fact, true. What would you do? How would you feel?
Back to our Example:
You: That sounds frightening - the CIA following you. Monitoring you. Knowing your every move.
Vincent: It is. That's why I don't want to leave the house. I'm scared of what they will do... I think maybe they are going to try to kill me.
You: Yeah,... Especially since you don't know what they're after... That is scary... Are you also angry? Like angry at them for doing this to you?
Vincent: No, I'm not angry. I just want them to stop. I can't go on living like this forever - constantly watching out the windows and looking over my shoulder. I have to figure out how to make it stop.
You: Do you have any ideas? What could you do?
Vincent: I don't know... I gotta come up with something...
You: Like what? Maybe go somewhere where they can't follow you?
Vincent: They can follow me anywhere. Don't you get it. They put a tracking device in my body. They can follow me anywhere.
You: Then what will you do?
Vincent: I think the first thing I gotta do is get rid of the implant. I gotta find a dentist who I can trust. Someone who will take it out.
You: Yeah. I guess that makes sense. If I felt like I had a tracking device in my mouth, I'd be pretty desperate to get it extracted too...
Vincent: Can you help me? Do you know a dentist who I can trust? Someone who definitely wouldn't be in on it with the CIA?
When someone has a delusion, there is often:
some kind of actual event (like a dental procedure, or, seeing the same color or type of car drive down the block several times over the course of the day)
A belief about the meaning of that event (like the belief that the dentist implanted a tracking device during the procedure, or, the belief that the car keeps driving down the block because they are watching you).
And, those two things become fused. The event and the belief about the event become inflexibly bound together.
In speaking with someone who suffers from delusions, your first goal is to understand the combination of:
The (misinterpreted) life event
The person's fixed beliefs about that event, and,
The resulting emotions (fear, sadness, despair, anger,...).
Only after establishing those factors can you draw conclusions about the beliefs.
And, only then can you ask questions that may open the person's mind to alternatives.
You: Well, yes, I do have a great dentist who I trust. But, I don't think my trustworthy dentist is going to solve your problem.
Vincent: What do you mean?
You: Can you imagine any scenario where you leave the dentist's office feeling better? From what I understand, you believe the first dentist was part of a conspiracy against you. Your primary care doctor wasn't able to reassure you. Neither was I. Do you really think a different dentist could give you the reassurance you are hoping for? What if the dentist says that there is no tracking device in your mouth - nothing for her to remove? What then? Would you believe her? Could you trust her? Or, what if she performed another procedure and said she removed something. Could you trust that she didn't, in fact, implant a new device?
Vincent: I don't know... I don't know... There's definitely something there. If the dentist is honest, she will see it. So she wouldn't say that there's nothing there.
You: So, the only way any dentist could be trustworthy at this point is if the dentist agrees with your fear that the CIA is after you and a tracking device has been implanted into your tooth. If the dentist were to say anything else, it would mean that she is part of the conspiracy?
Vincent: ... Yeah... I guess so. Well, or else incompetent.
You: Do you think it's possible - at all possible - that maybe your mind is playing tricks on you?
Through respectful questioning, you can begin to plant seeds of doubt. With patience, insight into the nature of the delusional thoughts can develop. Or, if not insight, the next best thing may be a calm acceptance that the thoughts are there. They are distressing. But the distress (and the distressing thoughts) don't have to dictate behavior.
It's not an easy process. Nor is it a quick process.
Keep faith. Hold onto hope.
Yes, delusions seem real and important to the person who experiences them.
Help and healing are also important realities for those suffering from mental illness.