Helping Distressed or Distressing Students

University Counseling Center (UCC)

The Student in Poor Contact with Reality

These students have difficulty distinguishing fantasy from reality, the dream from the waking state. Their thinking is typically illogical, confused, or irrational; their emotional responses may be incongruent or inappropriate; and their behavior may be bizarre or disturbing. They may experience hallucinations, often auditory, and may report hearing voices. While this student may elicit alarm or fear from others, they are generally not dangerous and are more frightened and overwhelmed by you than you are by them. If you cannot make sense of their conversation, they may be in need of immediate assistance.

DO:

Respond with warmth and kindness, as well as with firm reasoning.

Remove extra stimulation from the environment (turn off the radio, step outside of a noisy room).

Acknowledge your concerns and state that you can see they need help.

Acknowledge their feelings or fears without supporting the misperceptions, e.g., "I understand you think someone is following you, but I don't see anyone and I believe you're safe."

Acknowledge your difficulty in understanding them and ask for clarification or restatement, e.g., "I'm not sure I understand what you're trying to tell me, can you try to explain it more clearly?"

Focus on the "here and now." Ask for specific information about the student's awareness of time, place, and destination.

Speak to their healthy side, which they have. It's OK to laugh and joke when appropriate.

DON'T:

Argue or try to convince them of the irrationality of their thinking as this commonly produces a stronger defense of the false perceptions.

Play along with or encourage further discussion of the delusion processes, e.g., "Oh yes, I hear the voices (or see the devil)."

Demand, command, or order.

Expect customary emotional responses.