A client with schizophrenia says, 'Can't you hear him, it's the devil. He's telling me I'm going to hell.' What is the best response?

A client with schizophrenia says, 'Can't you hear him, it's the devil. He's telling me I'm going to hell.' What is the best response?

• A. Did you take your medicine this morning?
• B. You are not going to hell. You are a good person.
• C. There is no such thing as the devil. It's all in your mind.
• D. The voices sound really distressing and scary, but I don't hear them.

Answer: (D)

When supporting someone with schizophrenia who is experiencing distressing voices, the most effective approach is to acknowledge the client’s experience and offer empathy without arguing about the reality of the voices. Saying that the voices are distressing and scary, while calmly noting that you don’t hear them, validates what the client is going through and preserves a trusting, nonjudgmental relationship. This response invites further conversation, helps assess safety and severity, and avoids escalating defensiveness that can come from denying or disputing the delusion or pressing about treatment adherence too early. Other options tend to miss the mark clinically: commenting on whether the client took medication focuses on adherence rather than the present distress; denying or challenging the delusion risks increasing mistrust or agitation; and telling the client there is no devil dismisses their experience and can shut down rapport. The chosen reply best supports therapeutic communication with psychotic symptoms.

When supporting someone with schizophrenia who is experiencing distressing voices, the most effective approach is to acknowledge the client’s experience and offer empathy without arguing about the reality of the voices. Saying that the voices are distressing and scary, while calmly noting that you don’t hear them, validates what the client is going through and preserves a trusting, nonjudgmental relationship. This response invites further conversation, helps assess safety and severity, and avoids escalating defensiveness that can come from denying or disputing the delusion or pressing about treatment adherence too early.

Other options tend to miss the mark clinically: commenting on whether the client took medication focuses on adherence rather than the present distress; denying or challenging the delusion risks increasing mistrust or agitation; and telling the client there is no devil dismisses their experience and can shut down rapport. The chosen reply best supports therapeutic communication with psychotic symptoms.