The Student in Poor Reality Contact

This student may have trouble distinguishing fantasy from reality. To some extent, the person will appear confused or illogical.

You may notice that the student's speech jumps from one topic to another with little or no logical connection between topics. This student may also pay a great deal of attention to some unimportant detail that is being discussed or may be generally scattered and incoherent. This 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.

The student may make inappropriate emotional responses; for example, the student may overreact to his or her feelings or be very "flat" emotionally. Many times the person knows that his or her emotions are inappropriate, but just feels overwhelmed and cannot control them.

Individuals in poor contact with reality may experience themselves as especially powerful or important or may believe that people are attempting to harm or control him or her 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, then they are laughing at him/her.)

This student may experience auditory hallucinations, although visual, tactile, or olfactory hallucinations may also occur.

Helpful Responses

• Respond to the student with warmth and kindness, but with firmness.
• Reduce as much stimulation from the environment as possible.
• Acknowledge the student's concerns and state that you can see he/she needs help.
• Acknowledge the student's 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 what the student is saying ("I'm sorry, but I don't understand. Could you repeat that or say it in a different way?")

Responses to Avoid

• Arguing and disputing the student's illusions or trying to convince him/her of the irrationality of his/her thinking.
• Playing along (e.g.,  "Oh yeah, I hear voices. See the devil!")
• Encouraging further revelations of delusional thinking. It would be more helpful to switch topics and divert focus from the delusions to reality.
• Demanding, commanding, or ordering the student to do something or to change.