How do you effectively work with someone who is experiencing paranoia?

Sometimes influenced by prior experiences, individuals may be suspicious or fearful of the mental health system or providers (Kreyenbuhl, Nossel, and Dixon 2009). When working with someone experiencing paranoia, expect skepticism and understand that you will have to earn their trust. Always do what you say you are doing do, when you said you would do it. Be consistent, reliable, calm, and respectful. Create a safe space, meeting somewhere with minimal distractions (if possible).

Maintain a curiosity about a person’s life and take a non-judgmental stance. Consider mirroring the amount of eye contact the person gives you. Emphasize with the emotions generated by their thoughts, rather than collude with delusional content. Avoid arguing. Proactively ask yourself are there ways what you did or said could be misconstrued. Provide context for why you might be asking certain questions. Minimize “closed-door” discussions without the person being involved or having input. Sometimes inquiring directly about the degree of trust can be helpful. For example, asking to what extent does someone trust you, or if there is anyone the person may trust. If there are others that person may trust, consider engaging those individuals in the conversation. Always partner around a shared goal.



Kreyenbuhl J, Nossel IR, Dixon LB: Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophr Bull 35:696-703, 2009

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