When thought is disorganised, reduce the processing load
One idea per sentence. Short sentences, concrete language, no idioms or metaphors — abstraction is where thought disorder does the most damage, and a metaphor can be taken literally or absorbed into the belief. “Are you in pain?” works. “How are you coping with everything?” does not.
One question at a time, then wait. Latency can be long. Filling the silence with a second question means neither one gets answered.
Cut the noise. Television off, hallway door closed, one person speaking.
Say when you have lost the thread. “I want to understand and I’m losing the thread — can we go back to the part about your brother?” If speech is unintelligible, respond to the affect instead: “You sound really upset.” Affect is the channel that stays open.
Never pretend to follow. People with psychosis are frequently more attuned to insincerity than to content, and nodding along to word salad is read — correctly — as not listening.
Do not decode the delusion. Interpreting symbolic content “the chip represents feeling controlled by your family” is not your role, usually lands as dismissal, and can consolidate the belief. Stay with feeling, function and safety.