| Mental state
examination
• Use therapeutic strategies to bring forward detail, enrich
understanding and support agency
Inquiring about symptoms relational
externalising can increase sense of agency and mindfulness,
promotes a relationship with the person who has some agency with
respect to the symptom.
- “Are you noticing any unusual experiences?”
- “Have you had a sense that you can read other people’s
minds, or that others could read your mind?”
We can inquire for agency:
- “As I tell you that I am not trying to harm you but
am interested in helping you, are you working out in your mind
whether to believe me?”
- “As you experienced this thought that the man was going
to kill you did you find yourself questioning it at all, or
accepting the truth of it?”
Researching difference
and movement can bring forward detail:
- “How did you develop the sense of certainty you have
that spies are after you?”
- “Are you aware that I don’t hold the same certainty
about this that you do? I’d like to invite you to discuss
the difference between the view you hold and the view I hold.
As I suggest that do you notice a little bit of interest, no
interest, some discomfort, or something else?”
Working in the present
moment can increase the richness of the understanding we develop
with respect to engagement, rapport and insight:
- “I notice that as I talk about the idea of illness
and medication you look down and away. Is that what you notice?
Does that indicate that you have very little interest in that
discussion?”
- “From where I am sitting it looked as if you felt a
bit uncomfortable or annoyed when I started to ask you about
voices and cameras watching you. Did you notice any feelings
like that? I noticed, as I asked you about reading minds, that
you looked up and looked animated. Do you have some interest
in that?”
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