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Diagnosing delusion
angst kitten
danaeris wrote in psychology
So, I have a question. This is the second time I've run into it (with separate people -- first a friend, and now a relative), and I'm kind of at a loss as to how to handle it.

Essentially, when a person has beliefs that are potentially delusional, how does the mental health professional determine their validity? Some beliefs are clearly delusions (tinfoil hats and aliens, for example). But others are not so clear.

With my friend, she was clearly bipolar with some paranoia, and yet she was clever enough that her doctors never seemed to see what was really going on. It was never clear to me how we, as her friends, were supposed to get her the help she needed when the mental health professionals didn't seem to be catching on.

With my relative, she says that A is happening, and her immediate family says that it is a delusion. I'm not there on the ground, so I can't judge for myself, but A is in the realm of possibility. Her family is insisting on being present for her appointments with the psychiatrist they chose, and she feels like she can't trust that psychiatrist because she didn't choose him/her. My initial instinct is that she has a right to a therapist and/or psychiatrist who she believes is on her side. But then I think about my friend and the frustration of knowing that her doctors couldn't see what I could see, and I'm not sure.

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Delusions aren't the priority. Don't presume the client has fooled the therapists, in a manner of speaking, the client is entitled to their delusions - we all believe things that cannot be quanitated and qualified, including our religions and spiritual beliefs.

The issue with delusions are simple - 1st, do they lead the client to harm themselves or others? If the answer is no, then they aren't important clinically. Benign delusions are just that. If the delusions are harmful, then appropriate steps will be taken - medication, inhouse treatment, appropriate outpatient treatment. Then next question is - do they impede our ability to live our life to our fullest ability to do so? If that answer is yes, then again, appropriate steps will be taken.

Please do not enable any excuse your Aunt may be using to discontinue treatment. I have no doubt that getting her to treatment is a huge burden for the family. She may require supervision to the therapy sessions, they are most likely NOT in those treatment sessions, but outside in the waiting room. Whether your Aunt chose the therapist or not in the beginning has no bearing on whether the therapist is "on her side", but instead was likely chosen for their background, training and ability to handle your Aunt's problem. It does not sound like your Aunt is capable of choosing a care provider on that sort of level, by herself.

This comment is amazing. It kinda blew my mind and gave me some great insight. Thanks.

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