Psychofarm Podcast Detecting Subtle Signs of Psychosis: Assessment of Voices, Delusions, and Psychosis
Feb 24, 2026
Clinician emotional reactions are used as clues to subtle psychosis. Techniques for mirroring feeling without agreeing with false beliefs are explored. A structured OLDCARTS-style method for taking a voice-hearing history is presented. Practical alliance strategies for paranoia and steps to bridge treatment gaps and choose medications are discussed.
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Side With The Patient Not The Persecutor
- Sit psychologically alongside paranoid patients to triangulate the feared object rather than facing them as an interrogator.
- Dr. Fu recommends creating a you-and-me-against-the-world stance so the clinician doesn't become perceived as the persecutor.
Suspend Disbelief To Elicit The Patient's World
- Live in the patient's belief world during assessment using suspension of disbelief without endorsing delusions.
- This stance changes microexpressions and phrasing and helps elicit richer, honest narratives from the patient.
Mirror Emotions Without Agreeing With Delusions
- Use empathic mirroring: acknowledge the emotion without validating the delusional content.
- Say things like, 'That sounds terrifying' and name fears and risks to show understanding while avoiding agreement.
