I work at an organization that assists people with serious mental health illnesses living in the community. I have this one client, let's call her Ruby, that has very intense auditory hallucinations. 

She recognizes the voice as people from her past and feels close to them. She explains that they sometimes visit her as friends, but often abuse her by saying mean things (her words). Daily, I can hear her intensely yelling at them to go away and leave her alone. In these moments, I don't know how to help - she is too overwhelmed and will see those trying to help as threats, as well. 

When not actively experiencing them, she is aware that the voices are not based in reality. However, she will ask how to manage her relationships with them as she believes they are real people (ie she had met them in the past) and appreciates their friendship. 

We have made progress in addressing some of her negative symptoms, but the voices are very disturbing to her and I am struggling to help her. Her psychiatrist is not willing to increase her medications further. 

I have suggested some strategies to help distract her, which she has agreed to, but she is much too overwhelmed and distressed in those moments to distract or ground herself. 

If anyone has any suggestions from their experience, I would really appreciate it.