Delusion Exercise Instructions and Debrief
Rory Allott & Paul Earnshaw
Aims
This exercise was designed for people already trained in MI who are working with people with psychosis. It attempts to give participants a small insight into the impact of how the ‘false beliefs’ that clients’ hold might impact on interviews and subsequently therapists efforts to engage in an MI session. Because this involves the trainers tightly controlling the exercise and engaging in some deception, there is a need to ensure that either side of the exercise the trainers show a deep respect for participants and for those that actually experience paranoia. You will find your own way to do this. We developed a presentation that communicated some of the challenges that people actually experience during paranoia, we have asked someone with experience of delusions to talk about his experiences on audiotape and we provide a gift to all participants at the end of the workshop.
Instructions
- Ask group to get into pairs
- Ask pairs to decide on roles: MI therapist or Speaker with something they want to, need to, should change in next 6 months.
- Askthetherapists togo out (half the group).
- The remaining half of the group are given the attached instruction sheets and are told to consider something they want or should change in next 6mths andconsider:
- What is the single most important reason(e.g.person or value)that you hold that may make you change ?
- Now, the participants are then told that one person in the group has a triangle on their instruction sheet identifying them as the only person that should conceal their value/important reason, they have just identified when discussing their dilemma with the therapist. In fact, they all have this code and are all going to attempt to conceal this information.
- They are then told that the therapists are being instructed that there is one client that is concealing an important part of their dilemma and they need to be especially sensitive to this and use good evocative questions and reflections to explore the clients dilemma and also guess whether they were faced with the concealing client or not (we say they will be rewarded with a prize if they guess right, but in fact we give everyone a prize at the end as a debrief in this rather surreal exercise)
- The therapists are told none of this and are instead instructed to help people explore their dilemmas using MI
- Ask the therapists to come in , not discuss the exercise but get straight into exploring their partners dilemma for 10 minutes.
- Trainers note non-verbal communications of the challenge of concealing information from the therapist (e.g. looking away, talking over therapist etc.)
Debrief and lessons
The debrief attempts to draw out the challenges for the therapist and the client in an attempt to build empathy for people experiencingdelusions and give therapists insight into how they might react to people experiencingdelusions and what might help in working with them. Three flip chart sheets are used to outline challenges for the client, therapist and things that might work or did work.
Possible questions:
The debrief can first ask therapists
How was being the only person in the room concealing your important reason?
Therapists how did you find exploring the dilemma ?
What barriers did you notice in helping the client discuss their dilemma?
Clients we said there was one client in the room who was told to conceal their most important reason for change.
How did it feel being the only person in the room selected to conceal your most important reason for change?
How did it impact on you and the conversation havingto conceal your most important reason?
How did it feel knowing that the therapist were trying to spot who was concealing ?
With this new knowledge Therapists what did you notice if anything
Summarise Impact on Client Impact on therapy
‘You thought you were singled out and had to conceal something most important and knew that someone was trying to find you out.
None of it was true you had to conceal something but weren’t alone and no one was trying to find you out.
Impact of having this false belief (delusion) was...
Impact on the therapist was...’ What does this mean for our practice?
Do not under any circumstances show this sheet to anyone else.
Now, consider something that you want to need to or should change in next 6mths.
What is the single most important reason, (e.g. Person, value or goal) that you think would motivate you to make this change ?
When your therapist returns introduce your dilemma to them and discuss it.
If you have a triangle on this page you must conceal the reason you have identified as most important in your dilemma and under no circumstances can you reveal it.
Do not under any circumstances show this sheet to anyone else.
Now, consider something that you want to, need to or should change in next 6mths.
What is the single most important reason, (e.g. Person, value or goal) that you think would motivate you to make this change ?
When your therapist returns introduce your dilemma to them and discuss it.
If you have a triangle on this page you must conceal the reason you have identified as most important in your dilemma and under no circumstances can you reveal it.
Do not under any circumstances show this sheet to anyone else.
Now, consider something that you want to need to or should change in next 6mths.
What is the single most important reason, (e.g. person, value or goal) that you think would motivate you to make this change?
When your therapist returns introduce your dilemma to them and discuss it.
If you have a triangle on this page you must conceal the reason you have identified as most important in your dilemma and under no circumstances can you reveal it.
Do not under any circumstances show this sheet to anyone else.
Now, consider something that you want to need to or should change in next 6mths.
What is the single most important reason, (e.g. person, value or goal) that you think would motivate you to make this change?
When your therapist returns introduce your dilemma to them and discuss it.
If you have a triangle on this page you must conceal the reason you have identified as most important in your dilemma and under no circumstances can you reveal it.