Voices and their relationship with the voice hearer
In our view it is no longer sustainable to think of voices as part of a disease, such as schizophrenia, instead hearing voices can be regarded as a meaningful, real (although sometimes painful, fearful and overwhelming) event, that speak to the person in a metaphorical way about their lives, emotions and environment.
For instance, people experiencing distress as a consequence of abusive or commanding voices can often recognise their voices as those of their actual abusers and the voices have the effect of attacking their sense of self-esteem and worth. It should not be forgotten however, that some people experience helpful and guiding voices, also arising from times of trauma and stress.
Having discovered these kinds of relationships the next step has been to develop techniques to assist voice hearers focus on their experience and get to know their voices better. This is in contradiction to most psychiatric and psychological orthodoxies that assume that such psychopathological symptoms are not open to insight and talking treatments and instead would attempt to distract patients with such symptoms from their voices.
This turns out not only to be bad advice, but actually counterproductive, as such approaches disempower the voice hearer by denying to them their real experience and disarming them from taking on the voices and standing up for themselves. The new approach requires the voice hearer to make space for the voices, to listen but not to necessarily follow, to engage, but in their own time and space essentially to learn how to control them in their own terms, according to their own beliefs and explanatory framework. This acceptance of the voices is crucial to growth and resolution, voice hearers who have learnt these techniques can now say “I hear voices, they are part of me and I am glad they are”.
Exploring the meaning of voices
It became evident that it was important to explore the relationship between the hearing of voices and the life history of the voice hearer in order to see if it was possible to help them to solve their emotional and other problems. This approach emphasises the importance of understanding what the voices were saying to the voice hearer and required them to focus their attention on the voices as a way of finding a resolution to the difficulties they caused. In doing so, however, it was considered very important to develop a way of working that was cooperative and based on mutual trust. As a result the Professor Romme, Sandra Escher and the Maastricht team investigated the following features of the voice hearing experience:
- the identity of the voices;
- the characteristics of their communication with the person;
- the way of talking
- the age of the voices
- what they have to say
- what triggers the appearance of the voices;
- what important changes in the life of the voice hearer were related to the appearance of the voices;
- Characteristics of the voice hearer’s upbringing and any special experiences that occurred in childhood;
What triggers voices?
As a result of this research, which was carried out using questionnaires and one to one interviews the following important information was found out about the triggering of voices: they often arise when experiencing certain threatening or overwhelming emotions such as:
- ones own sexual feelings
- the sexual feelings of others
- losing control
- or when confronted by certain situations (feeling out of control or losing control) such as new situations,
- unexpected situations
- the company of new people
- situations that create stress
- the feelings of others in the same room
- fatigue etc.
- Gaining power over your voices
Voices and their relationship with the hearer
The research also showed it is very important to recognise that the voices know the person who hears them very well, that they always say things that are especially relevant to them and that are related to their problems. The voices usually refer to unsolved problems in daily life and/or emotions related to a trauma that has not yet been resolved, or to unrealised hopes and aspirations that, in some cases, are impossible to realise.
Therefore in working with a voice hearer it is not valid to reject the voices’, instead, it is more appropriate to stimulate the curiosity of the voice hearer about what the voices are saying. As long as the voice hearer is only able to react to the voices in an emotional way, they disempower them and it is therefore difficult to stimulate their curiosity.
This process is difficult to accomplish and INTERVOICE members have been exploring techniques that appeal to people hearing voices.
This exploration was conducted in cooperation with people hearing voices and as a result the following constructive techniques used by people hearing voices to improve their coping skills have been identified:
- Give the voices a specific time;
- talk back to the voices;
- set limits;
- write down what they say;
- find someone with whom you can talk about your voices