Tips for Helping People with Paranoia
Social workers are highly likely to encounter people exhibiting some paranoid features at some time in their careers. From features of psychotic disorders like schizophrenia to degenerative brain diseases such as Alzheimer’s to effects from some prolonged substance dependence disorders and even some personality disorders, paranoia of varying degrees is relatively common in the theatre of mental health work.
Effective paranoia treatment is attainable in the social work field.
The U.S. National Library of Medicine defines paranoia as “an irrational fear of harm by or distrust of others.”¹
Paranoia and paranoia symptoms can severely inhibit a person’s ability to function effectively across social realms and relationships, get their needs met, and pursue their hopes and goals. Expressions of paranoia can vary greatly, from a psychotic delusional scale involving bizarre beliefs to more embedded in the client’s personality or worldview, which makes them argumentative and hostile.
Helpful Paranoia Treatment Guidelines for Social Workers
Paranoia can be incredibly challenging to work with, as a person’s insecure connection to reality can elicit deeply fearful reactions and refusals that may thwart the best of your intentions as a helper.
The following are helpful guidelines for working effectively with clients experiencing paranoia:
- Lead with a compassionate perspective: people who are paranoid feel truly alone and often as if the world at large is against them, at times including you. As you can imagine, this can be debilitatingly isolating.
- Mirror the language used by the client – repeat their statements back to them, beginning so that they know you are actively listening to them, beginning with “Ok, so I hear you say that…” Sometimes, hearing a paranoid assertion repeated back to them from a non-judgemental voice can create some space between the client and their irrational belief, and perhaps even the slightest insight into how unlikely the belief is to be true.
- Validate the client’s feelings (believing their feelings are true whether facts agree with their reasoning), then orient the discussion toward logical facts.
- Roll with the client’s resistance to information or change, and strive to maintain a consistent poise of positive regard. Try and keep your tone light; in your effect and poise, reach for the warmth and calm the client is likely lacking internally.
- Be clear, concise, and reiterate. Avoid vagueness. Use concrete language – In your words, stick to the facts, the concrete, and focus on the evidence against the paranoia story the client is momentarily telling themselves about their life.
- Avoid promises. In fact, I would suggest that you never make promises. As the general rule of thumb that I pulled across all realms of practice – promising someone things may seem like the ultimate reassurance in the moment, but is nothing compared to helping someone live through uncertainty wall of holding boundaries and acknowledging limitations.
- Collaborate with the paranoid person on simple codes or patterns for how to answer the phone or knock on the door. This is a way of joining in their process to form rapport and allyship rather than positioning yourself as an argumentative or oppositional force.
- If visiting at their residence, knock in a consistent rhythm every time, so they associate that knock with you. Stand where you can be seen from the eyehole. Always announce if you are not alone, and identify your company. Stand a few feet from the doorway so they have space when they answer the door.
- Encourage meeting in a quiet, uncrowded, public space if they are able. Think empty park or library room. Wherever you end up meeting think about the arrangement of the room and your positioning – where are you in relation to the exit is a person in a corner?
Tips to Remember for Effective Paranoia Treatment
Remember, unless there is a reason to believe they are at risk of harming someone or themselves or are deemed incapable of caring for themselves, you cannot petition (for involuntary hospitalization) a client just for refusing to leave their home.
In severe cases, a person may not have the insight or capacity to join with our efforts to help them reason out the paranoia. In these cases fall back on the foundational social work principles and attitudes of validation and empathy. In some cases, the best service we can offer is simply a committed, compassionate presence while respecting a person’s fundamental right to self-determine. One of the greatest things of value we offer those we work with is simply never giving up on them.
As far as specific theoretical modalities for use when working with people experiencing paranoid symptoms, Cognitive Behavioral Therapy has been shown to be widely effective as a paranoia treatment with many different features of paranoia and levels of severity.