When a patient reports distressing auditory hallucinations but the PT does not hear them, which response is best?

• A. The voices are real
• B. The voices sound distressing and scary, but I don't hear them
• C. Ignore the voices
• D. You must take medication

Answer: (B)

When a patient reports distressing auditory hallucinations and you don’t hear them, respond with empathy that validates the patient’s experience while maintaining your own perspective. Saying something like the voices are distressing and scary, but I don’t hear them, acknowledges the patient’s suffering and shows you’re with them in the moment without endorsing the hallucination as real. This approach preserves trust, invites the patient to share more about what the voices are saying and how they cope, and keeps reality testing intact.

Saying the voices are real would dismiss the patient’s experience and undermine trust. Ignoring the voices leaves the patient unspoken for and unsafe. Pushing medication as an immediate directive without discussion can undermine autonomy and rapport.