Counseling Center

Poor contact with reality

The Student in Poor Contact with Reality

These students have difficulty distinguishing “fantasy” from reality. Their thinking is typically illogical, confused or irrational (e.g., speech patterns 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. This student may experience hallucinations, may report hearing voices, or experience delusions (e.g., someone is/will harm or control them, they may have supernatural powers).

While this student may elicit alarm or fear from others, they generally are not dangerous or violent. If you cannot make sense of their conversation, consult with or refer to the Counseling Center or Hall Mental Health Center as soon as possible.

It is helpful to:

  • Acknowledge their feelings or fears without supporting the misperceptions (e.g., “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 room).
  • 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 less 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 (e.g., “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.