In order to have a meaningful conversation with a confused person, it is essential to build trust into the relationship. Even though it is important not to directly correct the delusion, it is also important not to patronize, ridicule, lie or play along with a mistaken reality. On one level a confused person may realize you are toying with him and consequently feel you cannot be trusted with his or her intimate thoughts and feelings.

Building trust takes time and may require repeated visits. Trust is built as a confused person turns towards you, and his or her face becomes more animated and expressive. He or She will seem more interested in the conversation and less hostile or evasive.

Unless a confused person asks directly, most do not want insight into his or her feelings or behavior. Hence, the caregiver needs to avoid asking questions that directly confront the feelings or behavior. While a lucid person is capable of expressing his or her needs, a confused person will prefer symbolic ways to communicate through objects, storytelling, body language and fantasy.

A way to build trust is to understand the value of reminiscing. Ask questions that begin with who, what, when, where and how.  However, it is important to avoid the use of why. Why may put a person on the defensive.

Mrs. Bee, a resident in a local nursing home, began a search for her late husband. Mr. Bee had passed away several years ago. “Have you seen my husband?” she asked a nurse. The nurse responded, “What does he look like?” “Oh, he’s tall, dark and handsome,” Mrs. Bee said with a glimmer in her eye. “You must have loved him very much,” continued the nurse.  Suddenly, Mrs. Bee began to open up and reminisce, telling favorite stories from their 50 years of marriage. You can only imagine what would have happened if the nurse had responded, “Why are you looking for him?” Or worse, “Mrs. Bee your husband died 10 years ago.” While the nurse did not go along with the delusion, she did not confront it either. Instead, Mrs. Bee was given an opportunity to express grief and hope through reminiscing.

Another way to build trust is to offer choices. Rather than telling a person what to wear or what to eat, try offering two or three choices. The goal is to develop an adult-to-adult style of conversation. The caregiver will also want to be on the same level physically; eye to eye, as much as possible. The care setting often lends itself to an imbalance of power favoring the caregiver. Often the person receiving care feels he or she is being scolded or is inferior. However, our basic nature senses this inequality and rebels against it. Ignoring this principle will cause a meaningful relationship to be stymied and, so too, the quality of life of a confused adult diminished.

Emphatic listening to the confused person can lesson his or her anxiety and lead to cathartic and therapeutic experiences. Effectively done, the caregiver can have many successful encounters with confused persons built on trust.