Working therapeutically with people who hear distressing voices

One of the most debilitating symptoms of psychosis is the experience of hearing distressing voices. Research has demonstrated the benefits of helping people to understand and attach meaning to their voices, along with coping strategies aimed at alleviating the accompanying distress.

One of the goals of working therapeutically with people who hear distressing voices is to explore the specific content of the voices. Understandably, this can be distressing for the person, hence it is important that this is done in a way that is validating and non-judgemental. The rationale for exploring the voices is to enable a shared understanding between client and therapist to be developed, with particular emphasis upon:

1. Developing an understanding of the factors that may have predisposed the person to experiencing distressing voices e.g. traumatic events, along with core-beliefs and schemas that have emerged as a result. Making the link between negative life experiences and distressing voices can be extremely validating for people who experience psychosis.
2. Exploring the specific beliefs that people hold about their distressing voices. In their Cognitive Behavioural model of psychosis, Chadwick and Birchwood (1994) found that people who perceive their voices to be powerful, controlling and harmful experienced greater levels of distress and functional impairment. The Revised Beliefs about Voices Questionnaire (BAVQ-R) is useful for exploring these beliefs in detail.

This shared understanding then forms the basis for treatment. Whilst various cognitive and behavioural strategies can be utilised, this is with the overarching goal of modifying the beliefs that the person holds about their voices i.e. for the person to gradually learn that voices are not as powerful, harmful or controlling as they may perceive. Behavioural experiments are particularly useful in this process.

Distraction and relaxation techniques can also be utilised to manage the anxiety and anger that often accompany and exacerbate distressing voices. As with any therapeutic work the foundation for recovery should be the individual’s strengths and resilience. To compliment treatment, excellent self-help resources are available including ‘Overcoming Distressing Voices’ (Hayward, Strauss & Kingdon, 2012), as well as resources produced by the Australian and UK Hearing Voices Networks.

Article submitted by Dr Mark Franks, Senior Clinical Psychologist, Mental Health, Justice Health and Alcohol & Drug Services (MHJADS), ACT Health, Canberra, Australia.