The Student in Poor Contact with Reality


These students have difficulty distinguishing “fantasy” from reality. Their thinking is typically illogical, confused, or irrational (eg. speech patterns that jump from one topic to another with no meaningful connection); their emotional responses may be incongruent or inappropriate and their behavior may be bizarre and disturbing.


The student may experience hallucination, often auditory, and may report hearing voices (eg. someone is/will harm or control them). While this student may elicit alarm or fear from others, they generally are not dangerous or violent. However, there are some situations in which they can become violent (eg. experiencing “command” hallucinations). These hallucinations are telling them what to do, such as “you must destroy that evil person.” If you cannot make sense of their conversation, consult with or refer them to the counseling center. If you fear you or someone else may be in danger, contact campus security.


It is helpful to:
  • Acknowledge their feelings or fears without supporting the misperceptions (eg. “I understand you think someone is following you, and it must seem real to you, but I don’t see anyone and I believe you are safe.”)
  • Remove extra stimulation from the environment (turn off the radio, step outside a noisy classroom).
  • Acknowledge your concerns and verbalize that they need help.
  • Acknowledge your difficulty in understanding them and ask for clarification.
  • Respond with warmth and kindness. Use firm reasoning.
  • Focus on the “here and now.”

It is not helpful to:

  • Argue or try to convince them of the irrationality of their thinking, as this commonly produces a stronger defense of the false perception.
  • Play along (eg. “Oh yes, I hear voices, devil, etc.”)
  • Encourage further discussion of the delusional processes.
  • Demand, command, or order them to do something to change their perceptions.
  • Expect customary emotional responses.