mother talking to son with delusions about treatment
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Summary: If you want to know how to talk to someone with delusions when trying to get them to accept schizophrenia treatment, it’s important to follow a specific set of guidelines established by mental health treatment experts. These guidelines can help you build or enhance a good rapport, based on trust, which is essential for people with schizophrenia considering professional mental health treatment and support.

Key Points:

Schizophrenia: Definition and Symptoms

To learn how to talk to someone with delusions when you’re tying to get them to accept schizophrenia treatment, the first thing to do is learn as much as you can about schizophrenia itself. To stat, we’ll offer this official definition of schizophrenia published by Merck Manuals:

“Schizophrenia is a mental illness characterized by loss of contact with reality, hallucinations, delusions, abnormal thinking and behavior, reduced expression of emotions, diminished motivation, a decline in mental function (cognition), and problems in daily functioning, including work, social relationships, and self-care.”

People with schizophrenia generally show five types of symptoms, which clinicians identify as follows:

  • Hallucinations, i.e. seeing and hearing things that aren’t there.
  • Delusions, i.e. demonstrably false, untrue, or distorted beliefs.
  • Disorganized speech and thought, i.e. problems thinking and speaking in a logical manner other people can understand.
  • Disorganized movement, i.e. atypical/uncontrolled movements, and/or catatonia, and/or inappropriate
  • Negative symptoms, i.e. significant reduction in motivation to socialize, reduction in emotional expression, reduction in speech, reduction in ability to experience pleasure, reduction in motivation to set and pursue goals.

The most effective treatment approach for schizophrenia is a combination of medication, psychotherapy, psychoeducation, family support, peer support, and shared decision-making in the recovery process. One challenge families and treatment providers often encounter among people is resistance to accept or commit to treatment.

One reason for this is that while a person with schizophrenia will often recognize their hallucinations are not real, they may not accept that their delusions – i.e. false of distorted beliefs – are indeed delusions and not based in fact or objective reality.

That’s what we’ll focus on in this article: how to talk to someone with delusions when trying to get them to accept schizophrenia treatment. To learn more about various topics associated with schizophrenia and schizophrenia treatment, please refer to these resources on our website:

Schizophrenia Treatment Page: Schizophrenia Treatment: Crownview Psychiatric Institute

Blog Topics: How Does Schizophrenia Affect Daily Life?

What are the Early Signs of Schizophrenia? 

Why Do Some People With Schizophrenia Hear Voices That Aren’t There?

Those resources will give you a solid understanding of schizophrenia, the symptoms people with schizophrenia experience, and what typical treatment looks like. Now we’ll address our primary topic: how to talk to someone with delusions when you’re trying to get them to accept schizophrenia treatment.

Talking to Someone With Schizophrenia Who Has Delusions: Lead with Empathy and Compassion

The most important part of this is establishing trust between you and the person with schizophrenia you’re trying to get into treatment. They may already trust you on many levels, especially if you’re a friend, spouse, or family member. However, think about this:

They need to trust you about the atypical thought and emotional experiences they have, too. That means it’s crucial not to judge, appear dismissive, appear critical, or project callousness or negativity about their experiences. Your primary job is to listen and establish trust so that they, in turn listen to and trust your ideas about seeking treatment.

To help you understand how to do that, we’ll draw on three sources throughout this article:

  1. Psychosis and Schizophrenia in Adults: Prevention and Management – National Institutes of Health (NIH)
  2. Schizophrenia: National Institutes of Health (NIH)
  3. Schizophrenia – National Institute of Mental Health (NIMH)

We’ll also adapt helpful tips and insights published by the British Columbia Schizophrenia Society, which includes expert input from therapist and author Tamara Hill, MS, NCC, LPC. Let’s get right to the helpful content we have to offer on this topic.

Guidelines: Five Things You Can Do When You Talk to Someone With Delusions When Trying to Get Them to Accept Schizophrenia Treatment

These are general concepts that therapists learn when they receive training in supporting patients with schizophrenia or mental health disorders with features such as delusions. If you’re trying to steer a friend or loved one toward treatment, let these ideas form the foundation of your approach whenever delusions appear in the conversation.

#1: Affirm the Trusting Relationships

  • Avoid challenging the delusion
  • Avoid arguing about the delusion with logic/facts: this almost never works, and most often degrades trust
  • Ensure they feel safe, that they are safe, and that nothing bad will happen if they talk to you about the delusions
  • Help them talk about the emotions around the delusion, with a focus on any fear or negative emotions it/they may cause, and ensure them you will help keep them – and others – safe
  • Accept their need to espouse the delusion/false belief
  • Stay calm, avoid getting frustrated, and focus on trust and communication: attempting to exert control over their thoughts is not helpful

#2: Recognize the Category/Type of Delusion

  • Lead with empathy and work to understand the function/purpose of the delusion
  • Repeat back to them – paraphrasing in your own words – to get clarity and understanding about what they’re tying to convey, i.e. get it right so they know you hear them
  • Interrogate, or question, specific components of the delusion. For instance, if they say they’re a secret FBI agent, ask them where they were trained, or the name of their immediate superior.
  • If they’re not in a delusional state, don’t bring up the delusion. For instance, if they’re not in an active state of psychosis, avoid saying things like how’s the secret mission going.
  • Attempt to identify the core components of the delusion, and focus on identifying the primary emotions/tone associated with the delusion

#3: Find Out How It Affects Their Life

  • Learn whether the delusion/their delusions disrupt their ability to meet the basic functional activities of daily life, such as sleeping, eating, personal hygiene, or going to work or school
  • Learn about the impact of their delusions on their relationships with friends, family, spouse, or peers
  • Ask whether they’ve taken any actions or changed their behavior in response to their delusion

#4: Find Out More, But Different Specifics

  • If appropriate and possible, make a record of the frequency, intensity, and duration of the delusions/delusive states:
    • Some are infrequent and short
    • Others may be frequent, and long-lasting
  • Look for patterns
  • Learn if certain delusions have specific triggers, which could be things like:
    • Time of day
    • People
    • Places
    • Emotions
    • Activities

#5: Redirect, Refocus, or Distract

  • If the person talks about the delusion when the two of you have another topic or task to discuss or engage in, listen carefully, politely, and respectfully – read not impatiently of frustratedly – then talk about the task or topic at hand: give instructions, convey information, whatever is on the agenda
  • When they have trouble transitioning from talking about the delusion to the task at hand, then – calmly and patiently – ask them if they remember what the two of you planned to talk about or do, then remind them it’s time to do that
  • If they still need to talk about the delusion, listen until they’re done
  • If appropriate, while they’re focused on the delusion offer constant reassurance that they’re safe with you

Those are the concepts you need to remember in order to have a productive conversation about seeking treatment for schizophrenia. We’ll close this article with a short list of practical tips to apply during these conversations.

Help is The Goal, Treatment is a Form of Help

Remember: if you want them to talk openly and honestly, and in turn listen to what you say, then they need to know you don’t judge them, think poorly of them, or have critical opinions about how they think, feel, or see the world.

They need to trust that you accept all of them, including their experience of their symptoms.

With that in mind, use these tips when having these conversations.

Top Five Tips for How to Talk to Someone with Delusions When Trying to Get Them to Accept Schizophrenia Treatment

  1. Learn about schizophrenia first, and prioritize understanding the nature of the cognitive distortions and false beliefs at the root of many delusions
  2. Focus on their underlying emotions: try to understand the feelings you can perceive, in them, when they discuss their delusions
  3. Keep your emotions out of it. Your emotional input – aside from compassion and understanding – is unnecessary and unhelpful. Avoid showing frustration.
  4. From a place of acceptance, it’s okay to ask why they think the way they think, and it’s okay to reality-test some delusions by asking what kind of evidence they may have for the belief. It helps to frame this as information-seeking, in order to better understand them and where they’re coming from.
  5. Suggest trying therapy together, concurrently. You can go to the same therapist after or before their session or go to a different therapist on the same day and meet up to compare notes later. The idea here is to normalize the idea of therapy and support and show that you may need help working on some things, too.

That’s all we have on this topic for this article. It’s essential to remember that a person with schizophrenia can learn to manage their symptoms – most often with a combination of medication and therapy – and live a full, fulfilling, and productive life, and you can help them find their way there. Here’s a final thought that may motivate you to keep trying:

The earlier a person with schizophrenia gets the evidence-based treatment and support they need, the better the long-term outcome.

Finding Help: Resources

If you or someone you know needs professional treatment and support for schizophrenia, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.