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Once a firm, supportive therapeutic relationship has been established, the therapist can begin reinforcing positive gains and behaviors the individual makes in his or her life, such as in educational or occupational gains. It is important to reinforce these life events (such as getting a job), because it reinforces in the patient a sense of self-confidence and self-reliance.
Only when the client has begun to feel more secure in their social or occupational world can more productive work be accomplished in therapy. This involves the gradual but gentle challenging of the client's delusional beliefs, starting with the smallest and least-important items. Occasionally making these types of gentle challenges throughout therapy will give the clinician a greater understanding of how far along the individual has come. If the patient refuses to give up his or her delusion beliefs, even the smallest ones, then therapy is likely to be very long-term. Even if the client is willing, therapy is likely to take a fair amount of time, from at least 6 months to a year.
Clinicians should always be very direct and honest, especially with people who suffer from delusion disorder. Professionals should be even more careful than usual not to impinge on the client's privacy or confidentiality, and to say plainly what they mean in therapy sessions. Subtlety and sarcasm may be easily misinterpreted by the patient. Therapy approaches which focus on insight or self-knowledge may not be as beneficial as those stressing social skills training and other behaviorally and solution-oriented therapies.
Anti-psychotic medication is the preferred medication used, though, although it is only marginally effective. There are few studies done which confirm the use of any specific medications for this disorder.
Hospitalization should be avoided at all costs, since this will usually go to reinforce the individual's distorted cognitive schema. Partial hospitalization and/or day treatment programs are preferred to help manage the individual under close supervision on a daily basis.
Phillip W. Long, M.D. writes that "other treatments have been tried (electroconvulsive therapy, insulin shock therapy, and psychosurgery), but these approaches are not recommended."
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