How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Página 88
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which the voices are trying to convince them that they are’. One nurse described using one sense to
cast doubt upon the hallucinatory sense. A patient was seeing snakes all over, and was encouraged
to touch the floor and the walls, ‘so they could feel the solidness’ and realise that they weren’t there,
getting temporary relief. Others spoke about openly doubting what the voices were saying, or their
reality, by remarking gently on how strange the experience was or occasionally, in appropriate
cases, direct authoritative contradiction could bring the patient some relief of anxiety and
perplexity.
Delusions
Acceptance and listening (18/28)
Nurses responses reflected the fact that patients had a need to talk about their delusions, ‘so giving
them that space to talk about them, and to feel that you're actually listening to them I think is very
important’. This importance to listen derived from the fact that ‘for that person their world is real,
what’s happening to them is very real’. Many nurses enjoyed or were fascinated by patients strange
ideas about ‘what was happening to them, their family, the government or the country, … so I like
listening’. One nurse gave the example of a patient who believed he was a member of the Royal
Family (who had even had an official card printed for him and had on one occasion tricked the
Police), ‘and he told me everything about it ... and nothing that he said was true … but talking to
him about what he believed to be the truth built a relationship’. Another remarked that ‘sometimes it
just pays to be quiet and listen and see that stuff come past’ after relating the case of a patient who
had ‘grandiose beliefs about his part in the world and the Iraqi conflict’ and spent all his time
‘shouting his beliefs at me’. The interviewees also recommended attending carefully to the
emotions engendered by the delusions, mentioning fear, elation, anger, distress and upset as
possibilities. Exploring those delusions was not always just a matt er of passive listening. In addition
it required nurses to ask about how the delusions started, how intensely it is believed, what sense
they make of it and how it relates to their background, upbringing and culture. Such enquiries could
be quite extensive, as delusions were usually part of a whole belief system that could take time to
unravel and understand. In order to make this telling safe for patients, it was necessary for nurses
not to leap in with contradictory evidence or identify glaring holes in the argument, instead listening
with ‘attentiveness’, ‘respect’ and ‘not disagreeing with the delusion, but maybe thinking about the
effect of the delusion on somebody’. Seeking to ‘pick holes in them’ or ‘show they are wrong’
during conversation ‘is going to have an atmosphere of threat to it’ and is an unsuccessful strategy,
as ‘we all hold our beliefs strongly and defend them’.
“Just taking the heat out of them by listening, and respecting the emotional impact of them is a good
way to take some of the sense of isolation away that comes with thinking differently to other
people.”
Explore to understand the person (16/28)
Accepting and listening to delusional material was a way to generate a deeper understanding of the
patient and their experience. Nurses spoke about this as getting to grips with the ‘texture’ of patients
delusions, how they all ‘link together’, what the underlying ‘concept’ ‘or ‘symbolism’ might be,
‘tuning in to the underlying feelings’, ‘learning what it actually means for them’ and understanding
how delusional systems may have a protective function. Occasionally this level of understanding
was capable of generating interpretive insights, linking delusional material to the past or current real
experiences of patients, ‘making sense of it’ in ways that could sometimes be shared with the
patient concerned.
“It’s to not necessarily just chuck it in the medical box as a symptom, so therefore we are, or down
medication, but to try and unlock it really. What might be the idea, why are they experiencing that?
Where’s that come from?”
Explore delusions to assess risk (7/28)
Interviewees realised that delusional beliefs had the capacity to be linked to actions that risked the
safety of the patient or others. They therefore specifically explored the potential for such actions to
occur. One nurse gave two clear examples of this. In the first case, a patient had delusions about a
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