The Student in Poor Contact with Reality

This student may have trouble distinguishing fantasy from reality. To some extent, this person will appear confused or illogical. As you talk to this student, you may notice that his/her speech jumps from one topic to another with little or no logical connection between the topics. The individual may also pay a great deal of attention to some unimportant detail that is being discussed or may be generally scattered and incoherent. The student may coin new words and expect others to understand their meaning or may put words together because they rhyme, not because they make grammatical sense.

Such individuals may make inappropriate emotional responses. For example, s/he may overreact to her/his feelings, or be very "flat" emotionally. Many times the person knows that her/his emotions are inappropriate, but just feels overwhelmed and cannot control them.

Persons in poor contact with reality may experience themselves as especially powerful or important, or may believe that people are attempting to harm or control them in some way. S/he may also feel that certain actions have special meaning for them (e.g., when people in a small group begin to laugh, they are laughing at him/her). Such students may experience hallucinations, usually auditory, although hallucinations can be experienced through any sensory modality. Generally, these individuals are not dangerous, but are scared, frightened and overwhelmed.

Helpful Responses

• Respond to them with warmth and kindness, but with firmness.
• If you are comfortable in doing so, remove extra stimulation from the environment and see them in a quiet atmosphere.
• Acknowledge their concerns and state that you can see they need help (e.g., "It seems very hard for you to integrate all these things that are happening and I am concerned about you; I'd like to help").
• Acknowledge their feelings or fears without supporting the misperceptions (e.g., "I understand how you think they are trying to hurt you and I know how real it seems to you, but I don't hear the voices").
• Reveal your difficulty in understanding them, as appropriate ("I'm sorry, but I don't understand. Could you repeat that or say it in a different way?").
• Focus on the 'here and now.'
• Switch topics and divert the focus from the irrational to the rational or real.
• Speak to their healthy side, which they have. It is okay to joke, laugh, or smile when appropriate.

Less Helpful Responses

• Arguing, disputing their illusions, or trying to convince them of the irrationality of their thinking. This typically just makes them defend their position (false perceptions) more ardently.
• Playing along (e.g., "Oh yeah, I hear the voices").
• Encouraging further revelations of delusional thinking. It would be more helpful to switch topics and divert focus from delusions to reality.
• Demanding, commanding, or ordering them to do something to change themselves.
• Expecting customary emotional responses.