We have found that persecutory delusions, such as fear of being killed or poisoned, represent a belief in one’s vulnerability and a dangerous social environment. Drawing on the content of the delusion, we try to fit an experience or series of experiences that counteract this sense of being defenseless and also, counteract the sense of outsiders being dangerous. We thus, attempt to invocate a sense of safety by forming a “safe relationship” with the individual and then, engage in an activity, which increases the individual’s sense of mastery. One example is the woman who had a fear of being killed and who worked with the therapist to master a coffeemaker and then made coffee for the therapist and other staff members and, ultimately, for everybody in the community mental health center. As she progressed along this pathway, she not only felt safe and secure but her entire demeanor, including the way she dressed, improved.
Grandiose delusions are approached in a somewhat similar way. We try to explore what is the meaning of the delusion—generally, it represents a yearning to be respected, valued, and accepted. The man who wanted to be inseminated by members of the staff had a yearning to have and take care of babies. When given an opportunity to express the basic yearning to take care of others and to do something that was valued, he switched from the delusional mode to an adaptive mode. The trick here was leading him to talk about one of his passions, mainly animals, and then to paste pictures of animals on the walls of his room. The concept of taking care of other creatures was empowering for him. His delusion disappeared.