How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 86
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Hallucinations
Hearing the experience (24/28)
The patients experience can be explored by observing the impact voice hearing has on them,
noticing their distraction, their talking back to the voices and their body language. However their
experience can also be explored by asking such questions such as: ‘how loud’, ‘how long does it
last’, ‘how many voices’, ‘what do they say’, ‘how frequently does it happen’, ‘is it saying anything
about me’, etc., in order to ‘try to get to the heart of their experience’. Some nurses used structured
questionnaires in order to systematically understand what patients were experiencing. That
understanding could extend into interpretations as to what the hallucinations might represent for the
patient, such as ‘some bereavement that they didn’t address and manifesting itself at some level’, or
‘a reflection of some kind of relationship they’ve had’. Conversations might have to be timed to
periods when the patient is not actively hallucinating, or the patient might not wish to talk about
them, in which case this needs to be respected.
“In some ways, I guess it’s tied in with the talking about what’s going on and the thinking level
with the hallucinations as well, and sometimes I’ll just sit down with somebody and we’ll have
quite, for want of a better word, crazy conversations about whatever’s going on that are very left
field, and just about, what that persons beliefs are, and just exploring the terrain of, all right, so you
think this is possible and you see this stuff, and the implications of it and the symbolism of it.”
Hearing the effect on the patient (17/28)
The interviewees stressed that it was important to be calm, accepting and not frightened of these
strange experiences related by patients. Patients themselves could find their hallucinations
frightening, so to hear their experience calmly ‘gives people some relief’, and ensures they are ‘not
alone in their personal hell’. The voices patients hear can be persecutory and abusive, causing them
great distress. Visual hallucinations could also be frightening, with one nurse describing a patient
who was reluctant to go to bed as he saw eyes all around him and thought he was a ‘sitting duck’ in
bed. Nurses recommended talking with patients about the impact their voices were having on them,
in a calm and confident manner, as a first step towards offering help. Some nurses suggested
concentrating on the emotional impact of the voices more than anything else, as ‘feelings are very
real and the consequences of the feelings are real’.
Hearing to assess safety (9/28)
Hallucinations could posed safety risks for the patient or those around them. Examples given
included ‘voices that are telling them that the food is poisoning them’, becoming so distressed by
the voices that ‘they are a serious risk to themselves’, be unpredictable, ‘suddenly lashing out and
attacking’ someone, especially in the case of auditory hallucinations that command them to do
things such as harm themselves or others: ‘telling them to jump off a building’ or ‘telling them to
kill such and such a person’. Nurses needed to hear about and explore the nature of these
hallucinations in order to work out how best to help the patient and keep everyone safe.
Respecting the experience (15/28)
Respecting equals openly talking about it and acknowledging its impact on communication, the
disruption, distraction and difficulty that the experiences causes for the patient: ‘you’ve got to
acknowledge it and make it real, although you can’t experience it you’ve got to act as if it’s
happening in the room’. Not respecting meant ‘ignoring the hallucinations and talking about
something else’ or saying things such as ‘snap out of it’ or ‘threatening them … if you respond or
talk to the voices, that means you stay in the hospital longer’. Totally dismissing the patients
experience was also not respectful, saying things like ‘you have got an illness and these are all not
real and let’s try and not talk about them’, or it’s ‘all tricks in your mind, it’s all in your head’, or
‘it’s just not real, it’s not happening’ This ‘invalidates their experience’, adds to the person’s
distress, simply doesn’t work, is not helpful to the patient and pushes them ‘away from services’.
Such approaches were said by one nurse to be linked to biological medical model that sees
hallucinations as essentially meaningless and irrelevant psychotic phenomena. “I think people can
be quite dismissive of people who are experiencing voices and think that there’s’ no point, that
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