Thank you all for the Support and Creative Examples in dealing with Delusional or Demented Patients.
I agree that LTC's Xeroxed Checks and Hygiene Queen's Xeroxed Money really "Fit the Bill" (Pun intended.)
Often times, as in CBOS' example, a Therapeutic Response to some Demented Remarks are difficult to come up with. Luckily, since I work straight MN's, I can always reinforce their desire to be responsible, however, also advise them to take care of Business during Regular Business Hours. I often tell them that their Rest is the Most Important Thing, and they'll need their Rest in order to Adequately take Care of Business. This Approach has a High Success Rate.
I wanted to Address TerpGal's Excellent Example:
Quote from TerpGal02
the pt states, "The CIA is coming to kill you" I would say, "It must be very scary to have those thoughts".
TerpGal not only lets the Patient know that she/he is being heard, but also Addresses the Meat of the Matter, which is the Patient's Feelings.
In fact, TerpGal doess not Acknowledge whether the Patient's Belief is Real or Not, but instead Focuses on that which is Objectively Real. Good Job!
Originally, with my Example Patient, I attempted to Address her Delusion by focusing on her Viewpoint. In Essence, when the Patient said something like, "You're Stupid!" I would reply with something like, ""Well, you are entitled to Your Opinion". To which the Patient would reply, "You're G.D. Right I'm entitled to My Opinion!" and on she would go. I found out that if I Ageed
with the Patient, that gave her No Obstacles or would not Fuel Her Fire. The Therapeutic Goal of De-esculation was attained.
I also want to mention that these Outbursts were Sporadic, i.e. the patient was labile. This Patient could be Sweet as Potato Pie or Mean as a Venomous Snake.
As always, we usually need to Adjust Our Approach to the Specific Patient and/or Situation.
Thanks again for your Posts!