Psychiatric patients with persistent systematized delusions in the absence of major behavioural abnormalities have been traditionally regarded as largely inaccessible to verbal modes of treatment. This viewpoint is summarized in a standard textbook of psychiatry (Slater & Roth, 1969): ‘… it is a waste of time to argue with a paranoid patient about his delusions…’. Because of such views, and the related emphasis on a pharmacological approach, there is little to guide the clinician in his verbal dealings with patients in whom systematized delusions are the main feature. In contrast to the traditional view, Watts, Powell & Austin (1973) obtained significant changes in the delusional beliefs of three chronic paranoid schizophrenics after less than six hours of verbal intervention. Their procedure was designed to avoid direction confrontation, since they believed that this would induce ‘psychological reactance’ (Brehm, 1966) and might increase, rather than decrease, the strength of the delusions. They were unable to test this hypothesis. The present study aims to examine the effects of two contrasting types of verbal intervention in a larger sample of persistently deluded patients. It was predicted that (i) both interventions will reduce the strength of delusions and (ii) confrontation will produce less change in delusions and any associated behavioural abnormalities than belief modification.
This article describes a large group in a district general hospital serving a defined catchment area. Fifteen consecutive meetings were studied and three types of meeting were observed; manic meetings, depressed meetings and, thirdly, more balanced meetings not dominated by any powerful affect. The main topics discussed in the meetings included depression, illness, anxieties about treatment or recurrence, doctors, bereavement, loneliness, religion, and death, the more medical subjects possibly reflecting the medical orientation of the treatment programme. The principal themes in this meeting differ from those described in therapeutic communities, when themes of violence, rejection, sexuality and dependence conflicts figure more prominently. In the setting of the district general hospital, the character of the meeting appeared to be largely determined by the composition of the ward at the time, and patients with affective disorders, by virtue of their powerful moods, often assumed a dominant role.
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