A nurse is beginning a therapeutic relationship with a client who has paranoid personality disorder. Which of the following strategies should the nurse plan to use?

• A. Be vague when answering the client's questions about instructions.
• B. Demonstrate a neutral demeanor.
• C. Use an overly friendly approach.
• D. Ask the client why he is suspicious of others.

Answer: (B)

Maintaining a neutral demeanor helps establish trust in a therapeutic relationship with someone who has paranoid personality disorder. People with this condition tend to interpret others’ actions as hostile or deceptive and have pervasive mistrust. A calm, even, and nonreactive presentation signals reliability and fairness, reducing the likelihood that the client will perceive interactions as threatening. This approach also supports clear, direct communication and consistent boundaries, which are essential for building safety and predictability in early contact.

Being vague would feed the client’s mistrust, as uncertainty can be interpreted as concealment or manipulation. An overly friendly approach may be viewed with suspicion, seen as insincere or as a attempt to coax compliance. Asking the client why he is suspicious can come across as confrontational or accusatory, which can escalate defenses rather than foster openness. By staying neutral, the nurse can set the stage for honest dialogue and gradually address concerns within a safe, professional framework.