Not only do I work in the ever-interesting mental health field, but my specialized niche of schizophrenia spectrum disorders makes most outpatient offices look boring. Schizophrenia and other similar psychotic disorders are primarily characterized by hallucinations, delusions, and paranoia among a plethora of other symptoms. Hallucinations are perceptual disturbances related to the five senses such as hearing voices or seeing shadows, while delusions are beliefs that have little to no factual foundation to them.
This week I filled in for two therapists who were out, which gave me the opportunity to work with some clients I did not typically see. One such client was an eighteen-year-old kid who apparently was not doing so hot. He went months without having psychotic symptoms, but recently there was a resurgence of his auditory hallucinations. I pulled up to his home and knocked on the door. Luckily, I met him several times before, so I knew what to expect when he opened the door. He greeted me with a smile and invited me in. We sat on the couch, but the smile seemingly wiped itself off this young man’s face the moment he sat down. Something troubled him.
I pulled out my phone to call our interpreting line, as he solely spoke Spanish. I grew concerned with using the line since there was a lot of background noise from the television, his family shuffling around the house, and his neighbors outside beeping their horn. The entire time he sat there staring straight ahead and avoided eye contact with me. However, the moment I got the interpreter on the phone, the young man leaned in a bit to the side. I knew he was engaged at least and ready to talk.
I told him what his counselor told me about his voices. He muttered, “Yes.” I started asking him open-ended questions, but he would barely give me anything more than a few words. I pieced together what I could at this point in the session. He was hearing five separate voices arguing with each other. He said that he did not understand what they were saying, and he was frightened rightfully so. I offered to teach him one or two ways to cope with the voices. He responded a few moments later, ” [I want to] get control back of my life and fight back against the voices.”
My client already used several distraction techniques like watching television or listening to music. He needed some next level intervention. I went to my go-to preferred method and utilized a cognitive approach. I tapped into a technique dubbed “inference chaining. Essentially, an individual engages in a line of questioning of what will happen next. I adapted it for my client to combat his voices.
With my client, I used the example of a friend asking to use your brand new car. As soon as they ask you to borrow it, you are likely put on the defensive. Why on earth would my friend ask to use my car that I worked so hard for and bought myself? They probably know this too, so they have some big balls to be asking. They ask to borrow your car to go down the street and grab some groceries. They tell you that it will only take fifteen minutes. You continue questioning them. How come they cannot ask anyone else? How do they know they will take only fifteen minutes? Your friend says that they need to stop at the grocery store and drop it off the food to another friend. All of sudden, you caught your friend lying by omission.
Another classic example is having your mom asking you to do a chore you just recently did. Your mom comes into your bedroom that is relatively clean and asks you to straighten it up. You tell her that it was just recently cleaned and ask how come you need to clean it up. Slightly irritated, she says that there is company coming over that evening. You proceed to ask who would even be coming upstairs to see your bedroom. She huffs at you and says, “Do it ’cause I said so!”
In both instances, by questioning the other party, their side of the argument loses power. You remain calm and retain control of the conversation. My client and I role played what he could ask his voices.
“What are you doing here?” “What do you want?” “Where did you come from?”
I asked him, “What if they don’t answer?”
“Then, that’s good.” At that point, he realized that he could take back control. They would not have the answers to his questions. A smile grew across the face.
Now, this approach can also be used by individuals without hallucinations or delusions. For both an individual with a psychotic disorder and the “everyday” person, the mind provides the source content. Hallucinations are inner thoughts often externalized through the five senses. Delusions are irrational beliefs taken to the extreme. However, they still line up with cognitive distortions and maladaptive beliefs that we all experience.
Engage your inner dialogue. If you can catch your mind producing frightening, nerve-racking, or depressing thoughts, turn it into an interrogation. Pull the chair up to the table and begin your line of questioning. Even if your mind has answers for your questions, examine their validity. If the response feels like it doesn’t hold water, it probably doesn’t. It will ground you in reality and pull you away from irrationality.
Stick to the 4 W’s and H.
Who? What? When? Where? How?
Notice I left out an important one. I did so on purpose. Never ask yourself, “Why?”
I had a history teacher growing up that would always say, “Why is the most dangerous question in the world.” Even as a counselor, we are trained in graduate school to avoid asking why at all costs. When you ask it, people become defensive and guarded. It elicits fear. Furthermore, we often ask why when we likely know the answer but just want to hear from the other party. If that question can do that to another person, imagine turning that inward.
“Why am I doing this?” “Why is that happening to me?” “Why me?”
Your thoughts do not control you. You create them. Question them. Examine them. Take back control.
-The Caring Counselor