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I think healthcare professionals need to be cautious to suggest to a client that the voices are "real" and should be "listening to the voices," particularly command hallucinations or delusions.
Just accept it: the voices are real: accepting the reality of voice-hearers can open the door to change and recovery, says psychologist
CBT has been proven beneficial in tackling command hallucinations. Lack of insight and formal thought disorder may not necessarily disqualify CBT for AVH; nonetheless, negative symptoms may pose a barrier to this form of psychological intervention.
Cognitive behaviour therapy for command hallucinations. London:Routledge, 2006.
A multi-centre randomised controlled trial of cognitive therapy to prevent harmful compliance with command hallucinations. BMC Psychiatry.
Pharmacological and non-pharmacological interventions for persistent auditory hallucinations in schizophrenia
The clinical significance of command hallucinations. Am J Psychiatry 1987;144:219-21.
Schizophrenia and suicide/[TEXT NOT REPRODUCIBLE IN ASCII]
Research on factors associated with a patient acting on harmful command hallucinations has been mixed.
Much of the literature examining the relationship between a patient's actions and command hallucinations has examined the patient's response to all command hallucinations, without delineating factors specific to violent commands.
These factors also have been found to indicate increased compliance with acting on violent command hallucinations. (18), (20) Studies that have examined compliance specific to harmful command hallucinations provide additional guidance when evaluating the patient's risk of harm.
Evaluating psychotic patients' risk of violence: a practical guide: investigate persecutory delusions and command hallucinations
(13) Although most patients ignore violent command hallucinations to harm others, the presence of command hallucinations may increase the likelihood of behaving violently, (14) particularly if:
Assessing potential for harm: would your patient injure himself or others? Questions to ask, steps to take when evaluating tendencies toward suicide and violence
For some patients with schizophrenia, symptoms in this cluster prevent treatment engagement (such as impairing paranoia) or pose a risk to the patient or the community (such as command hallucinations).
Schizophrenia? Target 6 symptom clusters

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