Working With Voices

Whilst research into ways of supporting people distressed by the voices they hear has often focused on medication or time limited CBT – there is a growing number of studies which look beyond this.

Hearing voices and listening to what they say: The importance of voice content in understanding and working with distressing voices.

Authors: Beavan, V. & Read, J. (2010)

In: Journal of Nervous and Mental Disease, 198(3), 201-205.

Background: Traditionally voice content has not been considered clinically relevant, meaning that many voice hearers are not asked about what their voices say.

Aims: To investigate voice hearing content and the emotional impact of voice utterances on the voice hearer.

Method: 154 individuals completed questionnaires about their voice hearing experiences. A sub-group of 50 participants then completed semi-structured interviews. The sample included a mixture of patients and non-patients.

Results: Individuals reported a diverse range of voice utterances, including instructions, guidance, commands, premonitions and nonverbal sounds. Content could be either negative or positive and was of high personal relevance in terms of life events. Voice content was extremely significant in predicting whether individuals experienced emotional distress and/or required mental health care.

Conclusion: Voice content is a central aspect of the voice hearing experience, and can be of great relevance in therapeutic work.

Talking with voices: Exploring what is expressed by the voices people hear.

Authors: Corstens, D., Longden, E. & May, R. (2011).

In: Psychosis: Psychological, Social and Integrative Approaches. Advance online publication.

Background: Voice hearing, including that in the context of psychosis, is increasingly understood as a dissociative experience that relates to overwhelming events in the life of the voice hearer. As such, therapeutic techniques that aim to engage with the emotional and psychological aspects of voices may be beneficial.

Aims: To discuss the utility of directly engaging with voices in order to heighten awareness and understanding of voice characteristics and improve the relationship between hearer and voice.

Method: The rationale of the Talking With Voices approach is described, a relational model of working with voices that is derived from the theory of Voice Dialogue (Stone & Stone, 1989: Embracing our selves: The voice dialogue training manual, New York: Nataraj Publishing).

Results: There is a convincing clinical and theoretical rationale for applying the Talking With Voices approach with people who hear distressing voices.

Conclusion: For some individuals, support in dialoguing with their voices can help enhance awareness of underlying emotional and social problems related to voice presence, improve communication patterns, and ultimately develop a more peaceful and productive relationship between hearer and voice(s).

Voice hearing in biographical context: A model for formulating the relationship between voices and life history.

Authors: Longden, E., Corstens, D., Escher, S., & Romme, M. (2011).

In: Psychosis: Psychological, Social and Integrative Approaches. Advance online publication.

Background: Increasing evidence suggests a meaningful link between experiences of trauma and loss in a person’s life and their so-called psychotic symptoms.

Aims: To use Romme and Escher’s concept of ‘a construct’ to demonstrate how voice content and characteristics are personally significant to the voice hearer, and how this information can be used in a way that is of therapeutic value.

Method: The process of devising a construct is described; a systematic method of psychological formulation that explores (1) who or what might the voices represent; and (2) what social and/or emotional problems may be represented by the voices.

Results: Voice characteristics are personally relevant to the voice hearer. This information can be used for the basis of an individualised, psychotherapeutic recovery plan.

Conclusion: Voice hearers and mental health professionals can work together collaboratively to discover the personal meaning and significance of voices.

Are attitudes and beliefs about symptoms more important than symptom severity in recovery from psychosis?

Authors: Stainsby, M., Sapochnik, M., Bledin, K. & Mason, O. J. (2010).

In: Psychosis: Psychological, Social and Integrative Approaches, 2(1), 41-49.

Background: Evidence suggests that service-users who are supported to see psychosis as a coherent, meaningful, and potentially formative response to psychosocial events may make better recoveries than those individuals who see psychosis as a random, aberrant event that is beyond their control.

Aims: To explore whether a person’s beliefs about their psychotic experience, and their capacity to adjust to it and make sense of it, affects clinical outcomes.

Method: 50 patients with a diagnosis of psychosis were assessed two years apart on various measures, including levels of distress, quality of life, engagement with mental health services, and their expectation of recovery.

Results: Clients with a lower capacity to make sense of their experiences and a more pessimistic expectation of recovery had poorer outcomes.

Conclusion: Interventions that support mental health service-users to explore the personal meaning of experiences like voice hearing in a coherent way may be of considerable value in promoting recovery.

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