I often think of delusions like dreams. Some are nightmares — frightening, overwhelming, and deeply distressing. Others feel more like good dreams — comforting, protective, or even joyful.

When someone feels trapped in a nightmare-like delusion, my role is to help them “wake up.” This might involve medication, but therapy can also gently open space for new ways of seeing what’s happening. I do this carefully and with empathy, because challenging the delusion too forcefully can feel invalidating or frightening. There is usually a real-world situation happening alongside the delusion that needs compassionate attention, and we can work toward addressing that together at a pace the client can tolerate.

When someone is in a positive or comforting delusion — a good dream — I generally allow them to wake up naturally, unless there is a risk to their safety. If the delusion puts them or others in danger (for example, during acute mania or when suicidal thoughts are present), then medical intervention is necessary. Otherwise, I focus on helping them connect with things in real life that feel safe, meaningful, and valuable, so returning to reality does not feel like a loss.

Delusions often protect a person from pain or conflict that feels too hard to bear. Together, we work to understand why a particular delusion developed and what purpose it serves. If we only focus on correcting the belief, without addressing the deeper problem, progress is limited. Over time, by strengthening coping skills, building social support, and addressing underlying trauma or stress, the client will often no longer need the delusion to manage their distress.

Throughout this process, I stay mindful of my own role in the person’s experience. Individuals living with psychosis can feel easily misunderstood or mistrustful. I do my very best to be transparent, genuine, and emotionally present. My ultimate goal is to support clients in creating a more grounded, fulfilling life, while learning to live with and manage psychotic experiences. However, I recognize that many individuals who experience psychosis would never want to give up their symptoms, and that’s completely okay! Yet, if they’re open to it, I want to support them in restoring or achieving their highest level of functioning.