In clinical supervision, the nurse caring for the patient with a paranoid personality disorder tells the advanced practice nurse, "I tried being caring and empathetic, but the patient just kept telling me to stay away."

Question

Which response by the advanced practice nurse would be best? a. "Acting somewhat cynical and aloof, like they do, will make it easier for paranoid persons to bond with you over time. That, plus humor.".
b. "You may be trying too hard too soon. Back off, give him some time to get used to you, then try your caring and empathetic approach again.".
c. "Mistrustful people do not bond as others do, so first it's important to be realistic. Second, a neutral yet courteous approach will work better.".
d. "You are on the right track, but give it more time. Actively conveying empathy and care will work, but paranoid persons respond more slowly.".

Answer 1

C
Paranoid persons rarely bond with others in the way that most people do, and efforts to achieve this are counterproductive. Therefore, it is essential to understand the perspective of the patient and develop realistic expectations regarding the nurse-patient relationship. A detached, neutral, straightforward, and courteous approach is most effective. Overt expressions of caring, tenderness and other emotions which are not within the repertoire of the paranoid person tend to increase their suspiciousness. Acting in the manner of the patient (e.g., being mistrusting or cynical yourself) is never appropriate; if the patient believes he is being mimicked, it will increase his mistrust and drive him further away.