WellCat Counseling Center

The Student in Poor Contact with Reality

This student has 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 and disturbing. They may experience hallucinations, often auditory, and may report hearing voices. Generally, these students are not dangerous and are very frightened and overwhelmed. If you cannot make sense of their conversation, they may be in trouble.


  • Respond with warmth and kindness, but with firm reasoning.
  • Remove extra stimulation from the environment and see them in a quiet atmosphere (if you are comfortable doing so).
  • 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 they are trying to hurt you, and I know how real it seems to you, but I don't hear the voices (see the devil, etc.)."
  • Reveal your difficulty in understanding them, e.g., "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 the real.
  • Speak to their healthy side, which they have. It's OK to joke, laugh, or smile when appropriate.
  • Seek help from the Counseling Center or University Police


  • Argue or try to convince them of the irrationality of their thinking, which may lead them to defend their position or false perceptions more ardently
  • Play along, e.g., "Oh year, I hear the voices (or see the devil)"
  • Encourage further revelations of craziness
  • Expect customary emotional responses.