Is this therapeutic?

[DaFreak71]

I am in nursing school and will graduate in December. I am currently in the psych semester, which sadly, only lasts 3.5 weeks. I am absolutely convinced (and have been since starting the adn program) that psych nursing is my calling. One thing we have been being taught, in regard to therapeutic treatment of patients who suffer from delusions and/or hallucinations, is that it is standard for the staff at any psychiatric facility (not just the state facility we are doing our clinical at) to not "let" the patient verbalize their hallucinations or delusions more than three times per week.

Intuitively, this does not seem humane to me. I recognize the difference between dwelling on an issue and ignoring it outright, but it seems to me that if a patient is experiencing a delusion or hallucination (which is frightening to them), why is it therapeutic to not "allow" them to express it? Why encourage the patient to keep that distress bottled up inside? I submit that one reason could be for the convenience of the staff.

If we accept the premise that a mental disorder is every bit as valid as a physical disorder, when and under what circumstances would we ever tell a med/surg patient how often they could talk about their condition? How often they were allowed to express pain, fear, anxiety, etc? Some students seem to think this is therapeutic because if we listen to them more than a certain number of times per week, they will just manipulate us into spending all our time with them everyday. So....those with delusional disorders or schizophrenia, etc do not have an underlying biological problem---they are attention seekers? Their delusions/hallucinations are not real to them? They (at whim) can conjure them up or use them as a premise to garner attention? Does this not stigmatize the patient further by attributing manipulative behaviors as a reason to limit the number of times per week they are "allowed" to express their delusions/hallucinations?

And by the way...how would that work in a leap year? And if the patient didn't express any delusions/hallucinations during a whole week, could he/she express six the next week?

[elkpark]

I've been a psych nurse for almost 25 years, and I've never heard of such a thing before. That is certainly not the policy/practice at "any psychiatric facility."

[DaFreak71]

I've been a psych nurse for almost 25 years, and I've never heard of such a thing before. That is certainly not the policy/practice at "any psychiatric facility."

I absolutely believe you. It just didn't pass my innate sense of right/wrong, or humane/cruel test. As a student, I've tried to figure out their rationale for having this standard, and I can't. So could you please back door it for me and explain why it is NOT therapeutic to only "allow" a patient to express their delusions/hallucinations x times per week?

Thank you so very much for replying. This topic is so dear to my heart. :heartbeat

[Thunderwolf, MSN, RN]

Sounds like the formulation of an bad treatment plan ("will not verbalize one's delusional content more than 3 times a week")....lol.

Yes, this is rediculous. It is like saying to the patient, "now, stop that...psychotic behavior is only tolerated between the hours of 3-5 pm". Psychosis is often not in the person's control...to believe otherwise is totally unrealistic and punitive to the patient. Actually, it is not therapeutic at all.

The presence/absence/increase/reduction in the display of psychotic symptoms or behaviors in your patient provides valuable assessment data to you as a clinician. It let's you know how the patient is actually doing and coping. It provides you information about treatment...effective or not. Also, the content and context of psychotic symptoms provide valuable clues to you as well...so a clinician needs to listen/pay attention. As a clinician, pretending that the symptoms don't exist or preventing the patient from displaying them is counterindicative, even in a scientific sense...for it is your objective criteria of measurement...the benchmark of outcomes. Otherwise, what are you treating in the first place and how do you know what you're providing as treatment is even therapeutic at all? As a golden rule, you as a clinician neither encourage or discourage its manifestation...you are there to observe. If it becomes disruptive or harmful, then you intervene with additional steps. Otherwise, leave it alone, but observe and record.

Unless the psychosis is disturbing or harmful to others, it should not be tampered with by such unrealistic "behavioral objectives". As a clinician, you are there to observe, collect pt data, and monitor data trends...are the symptoms getting better, staying the same, or getting worse. You will only know this IF the patient is permitted to be who he/she is, at the moment in the psychosis AND if you (as the clinician) are there to witness its manifestation. Short changing this process, assessment becomes a joke and treatment becomes nothing more than inadequate, bandaid, cookie cutter treatment...which is never the goal.

You are learning a valuable lesson as a student....you are learning from other's mistakes and misunderstanding of psychosis and its treatment.

Thank you for initiating the discussion.