<p>A psychologist, in his/her professional capacity, is trained to listen and observe without immediately jumping to conclusions. Key indicators for delusions are the firmness of the belief, resistance to change even when confronted with contradicting evidence, and the impact of these beliefs on daily functioning.</p>
<p>In your scenario, when the woman presents her story as a 'story,' she's not insisting on its objective truth, which is inconsistent with typical delusional thinking. Delusions are not usually presented with such self-awareness or flexibility. They are typically firmly held beliefs that are out of touch with reality.</p>
<p>Moreover, the psychologist would pay attention to her general presentation, mood, thought processes, and how she interacts with the therapist and discusses other aspects of her life. Are these areas of her life also affected by unusual beliefs or perceptions? Does she show other signs of a psychotic disorder like hallucinations, disorganized speech, or grossly disorganized or catatonic behavior? If not, a conclusion of delusion would be unlikely.</p>
<p>The supernatural story she tells could be understood from several perspectives:</p>
<ul>
<li>Narrative or Creative Expression: The woman might be using the story
as a way to communicate her feelings or thoughts indirectly.
Therapists often encourage this kind of narrative sharing because it
can reveal a person's internal emotional state.</li>
<li>An Expression of Anxiety: Given her history of anxiety, the therapist
might interpret the story as a reflection of her underlying worries,
fears, or insecurities.</li>
<li>Metaphorical Communication: The story might serve as a metaphor for
her lived experience. Supernatural elements could symbolize elements
of her real life that she's struggling to articulate directly.</li>
</ul>
<p>Therefore, a trained psychologist would not hastily label her as delusional. Instead, they'd consider a multitude of factors before drawing any diagnostic conclusions. They would be more likely to see the supernatural story as a therapeutic tool she's using to convey her thoughts and feelings, rather than a sign of a severe mental illness.</p>

CC BY-SA 4.0
2023-07-11T12:21:43.997Z
thanks, that's very helpful
Retrolink
CC BY-SA 4.0
2023-07-12T02:22:13.593Z
However, since the woman actually believes the story, sooner or later when he finds out that she really believes it, what would be label her? Also, you say that "delusions are not usually presented with such self-awareness or flexibility". So there are cases that the delusional patient has self-awareness and flexibility, right?
Ooker
CC BY-SA 4.0
2023-07-12T06:00:48.170Z
Psychologists don't hastily label someone as delusional based on their storytelling. The patient's insight, belief flexibility, mental status, and the impact on life are considered. If the patient truly believes in their supernatural tale, possible explanations like delusional disorder or severe anxiety are explored. The ultimate goal is to understand and help, not just categorize.
Ali Bahrami
CC BY-SA 4.0
2023-07-11T08:00:51.223Z
2023-07-11T08:00:51.223Z
Ali Bahrami
<p>I'm writing a story which is largely told by a patient to a psychologist in a therapy session, but the story which the patient is describing involves the supernatural, and it is set in present day modern world, so the psychologist is unlikely to believe in the supernatural.  In the story, the patient is telling the truth (more or less), and she starts off by telling him that she's going to call it a story so that he doesn't think she's crazy.  Would the psychologist just assume that the patient is delusional (sorry if this is incorrect terminology but I hope you know what I mean), or would he be able to tell that this is unlikely given the way which she is acting?</p>
<p>If it helps, she does suffer from anxiety and has been treated for it in the past, but her real objective for telling him her story is because she knows that something is going to happen to him and it is going to be a lot harder for him to deal with if it comes as a complete shock to him.</p>

CC BY-SA 4.0
2023-07-10T15:03:13.560Z
Welcome Retrolink. Also consider joining [worldbuilding.se] and our [writing.se] stacks at your leisure.
Jiminy Cricket.
CC BY-SA 4.0
2023-07-10T17:43:17.550Z
It might be helpful if you mentioned whether you are writing from the POV of the therapist, his client, or third-party omniscient.
MDeBusk
<diagnosis>
Is it generally obvious to a therapist if someone is delusional?
Retrolink
# Is it generally obvious to a therapist if someone is delusional?

(Asked by: username_0 on 2023-07-09)

I'm writing a story which is largely told by a patient to a psychologist in a therapy session, but the story which the patient is describing involves the supernatural, and it is set in present day modern world, so the psychologist is unlikely to believe in the supernatural. In the story, the patient is telling the truth (more or less), and she starts off by telling him that she's going to call it a story so that he doesn't think she's crazy. Would the psychologist just assume that the patient is delusional (sorry if this is incorrect terminology but I hope you know what I mean), or would he be able to tell that this is unlikely given the way which she is acting?

If it helps, she does suffer from anxiety and has been treated for it in the past, but her real objective for telling him her story is because she knows that something is going to happen to him and it is going to be a lot harder for him to deal with if it comes as a complete shock to him.

**Tags:** diagnosis

> **Comments:**
> **username_1**: Welcome username_0. Also consider joining [worldbuilding.se] and our [writing.se] stacks at your leisure.  
> **username_2**: It might be helpful if you mentioned whether you are writing from the POV of the therapist, his client, or third-party omniscient.  

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## 1 answers

### Answer by username_3 on 2023-07-11. Score: 4

A psychologist, in his/her professional capacity, is trained to listen and observe without immediately jumping to conclusions. Key indicators for delusions are the firmness of the belief, resistance to change even when confronted with contradicting evidence, and the impact of these beliefs on daily functioning.

In your scenario, when the woman presents her story as a 'story,' she's not insisting on its objective truth, which is inconsistent with typical delusional thinking. Delusions are not usually presented with such self-awareness or flexibility. They are typically firmly held beliefs that are out of touch with reality.

Moreover, the psychologist would pay attention to her general presentation, mood, thought processes, and how she interacts with the therapist and discusses other aspects of her life. Are these areas of her life also affected by unusual beliefs or perceptions? Does she show other signs of a psychotic disorder like hallucinations, disorganized speech, or grossly disorganized or catatonic behavior? If not, a conclusion of delusion would be unlikely.

The supernatural story she tells could be understood from several perspectives:

* Narrative or Creative Expression: The woman might be using the story
  as a way to communicate her feelings or thoughts indirectly.
  Therapists often encourage this kind of narrative sharing because it
  can reveal a person's internal emotional state.
* An Expression of Anxiety: Given her history of anxiety, the therapist
  might interpret the story as a reflection of her underlying worries,
  fears, or insecurities.
* Metaphorical Communication: The story might serve as a metaphor for
  her lived experience. Supernatural elements could symbolize elements
  of her real life that she's struggling to articulate directly.

Therefore, a trained psychologist would not hastily label her as delusional. Instead, they'd consider a multitude of factors before drawing any diagnostic conclusions. They would be more likely to see the supernatural story as a therapeutic tool she's using to convey her thoughts and feelings, rather than a sign of a severe mental illness.

> **Comments:**
> **username_0**: thanks, that's very helpful  
> **username_4**: However, since the woman actually believes the story, sooner or later when he finds out that she really believes it, what would be label her? Also, you say that "delusions are not usually presented with such self-awareness or flexibility". So there are cases that the delusional patient has self-awareness and flexibility, right?  
> **username_3**: Psychologists don't hastily label someone as delusional based on their storytelling. The patient's insight, belief flexibility, mental status, and the impact on life are considered. If the patient truly believes in their supernatural tale, possible explanations like delusional disorder or severe anxiety are explored. The ultimate goal is to understand and help, not just categorize.  

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