Hearing voices approach

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Introduction
Publications
Research and Practice
Videos and Presentations
Organisations
Links


Introduction

“What this research shows is that we must accept that the voices exist. We must also accept that we cannot change the voices. They are not curable, just as you cannot cure left-handedness - human variations are not open to cure - only to coping. Therefore to assist people to cope we should not give them therapy that does not work. We should let people decide for themselves what helps or not. It takes time for people to accept that hearing voices is something that belongs to them.” Professor Marius Romme, President of the International Network for Training, Education and Research into Hearing Voices (INTERVOICE)

The hearing of a voice or voices inaudible to others is a relatively common human experience. Triggered by bereavement, illness, unemployment, divorce or some other traumatic event, voice hearing is experienced by 10-15% of the population in their lifetime. 1% of the populations are labelled by psychiatry as “schizophrenic”. 1% of the population are labelled by psychiatry as “bipolar”. 53% of people labelled by psychiatry as “schizophrenic” are voice hearers. 2.3% of the general population are voice hearers at any one given moment in time.

To hear a voice or voices inaudible to others does not mean that one is severely mentally ill.Can you hear voices and be healthy? Can people who hear overwhelming and distressing voices be assisted to find ways to live successfully with their voices?

Research and practice originating in Europe, developed in partnership with voice hearers and conducted over the last twenty years indicates that this is indeed the case.

There are Hearing Voices Networks in 23 countries of the world. Countries include Scotland, Denmark, Australia and New Zealand. There are 170+ hearing voices groups in England alone.

Can you hear voices and be healthy? Can people who hear overwhelming and distressing voices be assisted to find ways to live successfully with their voices? Research and practice originating in Europe, developed in partnership with voice hearers and conducted over the last twenty years indicates that this is indeed the case. A measure of the success of this work is that there are now networks and activity in over 23 countries across the world with a network now growing in the USA.

This empowering approach to assisting people (both adults and children) who hear voices has had a significant impact on the way voice hearers and mental health services regard the voice experience. This change in perspective has led to important changes in practice amongst service providers with respect to their interventions for people who hear voices, as well as the development of a vigorous peer support network.

Below is a short introduction to the issue and the approach.

Key issues

In a society that stigmatises hearing voices, many voice hearers understandably keep silent about what they are experience and feel very alone this was certainly the case for Ron Coleman, joint founder  of Working to Recovery.

In the early 1990’s, Ron, who had by then spent ten years in and out of the psychiatric system and was diagnosed as having a particularly severe form of schizophrenia. Ron attended the hearing voices self help group held in Manchester, England (the first one to be established in the country. For Ron, finding s safe place to talk about voices was the first step to recovery, Ron says of the impact the group had on his life:

“... at my first hearing voices group a fellow voice hearer asked me if I heard voices. When I replied that I did, she told me that they were real. This does not sound like much but that one sentence has been a compass for me – showing me the direction I needed to travel and underpinning my belief in the recovery process.”

Sharing the experience of voice hearing not only reduces isolation but is also one of the most successful ways to reduce anxiety and distress. To address this, hundreds of self help groups have been established throughout the world, groups that meet regularly to enable voice hearers to share their experiences and to learn more about how to cope. However this is one starting point.

The self help/peer support group began the process by which Ron made a full recovery. Ron, who had for many years experienced severe emotional distress which prevented him from working and even some times from functioning at all picked up his life again. This was a process that was to transform Ron’s life, from being a “victim”, constantly hospitalised, heavily medicated, living a life fragmented by the disruption his “illness” caused him – he became “victor” and found a way of harnessing the people around him to such a constructive effect, that from the point of making the decision that he wanted to recover to the point where Ron could say he was recovered took a surprisingly short period of time. Ron was one of the first people who showed it was possible it was indeed possible to live successfully with voices.

Ultimately, Ron gave up his psychiatric status, although he still hears voices. This was by no means an easy journey but it was a worthwhile one. What this experience did leave though, was a scar, that needed to heal, the recognition that perhaps the ten years in and out of psychiatric care need not have happened at all? Ron has given much thought to what it was that really enabled his recovery and other people who are members of the Hearing Voices Network, so that anyone who wants to take this journey can benefit from the experience of the many other people we have talked to about their own recoveries from overwhelming and distressing voices. Below we indicate some of the key issues that have been identified in achieving this.

Voices often arise as a coping or survival strategy

  • To survive overwhelming emotions
  • Point at real life problems in the past and the present
  • Use provoking language that can be translated into real life challenges
  • Are split off feelings - feelings that are unbearable
  • Are awful messages about terrifying past experiences

‘Recovery’ is not about getting rid of voices but about

  • The person understanding their voices in relation to their life experiences
  • The person changing their relationship with their voices so that the voices become harmless and/or helpful.
  • Understanding the relationship between the voice experience and the life history of the voice hearer
  • Recovering from the distress the person who hear voices has to learn to cope with their voice and the original problems that lay at their voice hearing experience

<Important steps in recovering from the distress associated with hearing voices

  • Meeting someone who takes an interest in the voice hearer as a person
  • Been given hope by normalising the experience and showing that there is a way out
  • Meeting people who accept the voices as real; being accepted as a voice hearer by others, but also by oneself
  • Becoming actively interested in the hearing voices experience
  • Between four and 10 per cent of people across the world hear voices
  • Hearing voice is in itself not a sign of mental illness and in itself is not related to the illness of schizophrenia. Only 16% of the whole group of voice hearers can be diagnosed with schizophrenia. Hearing voices are experienced by many people, who do so without becoming ill
  • Between 70 and 90 cent of people who hear voices do so following traumatic events
  • Voices can be male, female, without gender, child, adult, human or non-human
  • People may hear one voice or many. Some people report hearing hundreds, although in almost all reported cases, one dominates above the others
  • Voices can be experienced in the head, in the ears, outside the head, in some other part of the body, or in the environment
  • Voices often reflect important aspects of the hearer’s emotional state - emotions that are often unexpressed by the hearer
  • Hearing voices is often related to problems in the life history of the voice hearer.
  • To recover from the distress the person who hears voices has to learn to cope with their voices and the original problems that lay at their roots of their voice hearing experience
The work has shown

  • Between four and 10 per cent of people across the world hear voices
  • Hearing voice is in itself not a sign of mental illness and in itself is not related to the illness of schizophrenia. Only 16% of the whole group of voice hearers can be diagnosed with schizophrenia. Hearing voices are experienced by many people, who do so without becoming ill
  • Between 70 and 90 cent of people who hear voices do so following traumatic events
  • Voices can be male, female, without gender, child, adult, human or non-human
  • People may hear one voice or many. Some people report hearing hundreds, although in almost all reported cases, one dominates above the others
  • Voices can be experienced in the head, in the ears, outside the head, in some other part of the body, or in the environment
  • Voices often reflect important aspects of the hearer’s emotional state - emotions that are often unexpressed by the hearer
  • Hearing voices is often related to problems in the life history of the voice hearer.

To recover from the distress the person who hears voices has to learn to cope with their voices and the original problems that lay at their roots of their voice hearing experience

What you can do now

If you hear voices you can use your own experiences, your own contacts with services, with mental health workers you trust and with other people who hear voices to start talking about and listening to other peoples’ experiences.

If you are worker you could start by accepting the experience as a reality and ask what has happened in the life of the voice hearer that could possible relate to their problems and to begin exploring the life issue or complaint that first led to the experiences.

To help voice hearers and professionals to develop confidence in working with people who hear voices we offer training and consultancy support as well as producing workbooks, DVD’s and other publications.

One of the most useful tools Working to Recovery has developed is the workbook “Working with Voices”. This is designed for voice hearers and the people they select to support them to follow a systematic approach to unfold their relationship with their voices and by doing so to develop more effective ways of coping. Using this Workbook is a great place to start the process  of recovery.

We have also produced a DVD and CD Rom set to help anyone wanting to set up and run a hearing voices group. There is a wealth of useful information that can be used by voice hearers, facilitators and family members to help people gain ascendency over the voice hearers experience.

Another way of working we are promoting is known as “Voice Dialoguing” to introduce this approach we have brought out a new DVD entitled “Talking With Voices: An Introduction to Voice Dialogue”. In this DVD, psychiatrist and INTERVOICE chair describes the process of talking directly to the voices to help constructively change the relationship between the voice hearer and their voices. We also run courses on how to use this approach.

Most voice hearers who live well with their voices have supportive people working and living around them who accept the experience as part of who they are. You can do this too.

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Publications (date ordered)

Hearing Voices Coping Strategies

Manchester Hearing Voices Group  Download Sheet The sheet lists suggestions for coping with the experiences of hearing voices, and seeing visions and having tactile sensations. It is hoped some of these ideas can help you, or someone you care about, towards living positively with these experiences and to maintain a sense of ownership over them. Remember that you are not alone: Research shows that 4% of people hear voices, this is the same number as have asthma. Voice hearers throughout history have included a great many influential people: religious prophets, doctors and psychologists, philosophers, artists, poets, explorers and politicians. This list was compiled by the Manchester Hearing Voices Group.

Better Sleep Booklet

Better Sleep for Voice Hearers York Hearing Voices Group Download Sleep Booklet Many voice hearers report problems sleeping. Poor sleep can mean not being able to fall asleep in the first place, waking during the night, waking up too early or not feeling refreshed on waking. It is common for voice hearers to report that their voices are worse at night, and that the night time means they cannot use their usual coping strategies such as going for a walk. People are also often alone at night, lacking distraction, and in trying to unwind for the night, their lack of occupation may bring on their voices.This booklet, written by voice-hearers for voice-hearers, provides some tips and guidance on how people manage difficulties sleeping because of voices, visions or intrusive thoughts.

Cover of Parents Booklet

Voices & Visions #1: A straight talking introduction for parents and carers of children and young people who hear voices Voice Collective, 2012  Download Booklet No. 1 A pdf booklet aimed at parents/supporters, but also suitable for anyone else who wants to understand a bit more about voices and visions. Includes an overview of the range of experiences people can have, how this can affect them and basic tips on how to speak with your child about them.

Voices & Visions #2: A guide to coping and recovery for parents and carers of children and young people who hear  voicesCover of Parents Booklet 2 Voice Collective, 2012  Download Booklet No. 2 A pdf booklet aimed at parents/supporters, but also suitable for anyone else who wants to understand more about how young people can learn to cope with difficult voices and visions. Includes a range of strategies, including finding safety, expressing yourself and taking the power back.

Working with Voices – Victim to Victor 2nd Edition by Ron Coleman & Mike Smith P&P Press Limited, 2004

The new, second edition, Victim to Victor Workbook is for voice hearers and the people they select to support them. It will enable people who have difficulties to cope with their voices and to discover different sides to their voices. It will unfold their relationship with the voices and by doing so will stimulate them to acquire more effective ways of coping. Most important in this process, and well stimulated in this workbook, is to take ownership of the voice hearing experience. The workbook provides the opportunity for the person to begin the process of growing from victim to victor by writing his or her own life history in relation to their voice hearing, then moving forward to other positive growth exercises. This book will stimulate the person to plan their own future and life again, and is especially helpful for those who are presently feeling too overpowered by their voices to become their master. More information here

Children Hearing Voices: What you need to know and what you can do Dr. Sandra Escher and Dr. Marius Romme (2010) PCCS Books, UK. This is a unique, innovative book providing support and practical solutions for the experience of hearing voices. It is in two parts, one part for voice-hearing children, the other for parents and adult carers. Sandra Escher and Marius Romme have over twenty-five years experience of working with voice-hearers, pioneering the theory and practice of accepting and working with the meaning in voices. More information here

Living with Voices: 50 stories of recovery Marius Romme, Sandra Escher, Jacqui Dillon, Dirk Corstens, Mervyn Morris, 2009, Birmingham City University, PCCS Books. A new analysis of the hearing voices experience outside the illness model resulted in accepting and making sense of voices. This study of 50 stories forms the evidence for this successful new approach to working with voice hearers. More information here

The Voice Inside: A practical guide for and about people who hear voices, 2009, Written and edited by Paul Baker with contributions from Marius Romme, Sandra Escher and Ron Coleman. This handbook is an updated and combined version of two previously published booklets about hearing voices with new sections on talking to voices; hearing voices and schizophrenia; children and hearing voices. More information here

How to set up and run a Hearing Voices Group DVD P&P Publications 2009, Find out how you can set up and run a successful hearing voices group. The DVD includes the opportunity to see hearing voices groups in action; interviews with members and group facilitators. This step by step guide includes information and discussion material. More information here

Hearing Voices: A Common Human Experience John Watkins, Michelle Anderson Publications, 2008 This book explores ways of working creatively with voices and other inner experiences to foster personal growth, healing and recovery. More information here.

Recovery – An Alien Concept, 2nd Edition Ron Coleman P&P Press Limited, 2004 This is an exploration of the concept of recovery. It is the life story of Ron Coleman, and tells how he gave up being a chronic schizophrenic and went back to being Ron.  In ‘Recovery – An Alien Concept’ Ron attempts to reflect on the past and learn the lessons of history in the psychiatric system, by exploring recovery and encouraging professionals, clients and carers to begin their own personal journeys towards recovery. More information here

Starting and Supporting Voices Groups Julie Downs, (Ed), 2001 Hearing Voices Network, England. A Guide to setting up and running support groups for people who hear voices, see visions or experience tactile or other sensations. Hearing Voices Network, Manchester, England

Hearing voices: embodiment and experience Lisa Blackman 2001 Drawing on the practices of the Hearing Voices Network, an international group of voice hearers who are challenging the notion that hearing voices is a sign of mental illness, this book shows how the phenomenon is intimately tied to broader questions of embodiment, practices of government and regulation, as well as to the production of new forms of subjectivity emerging within and between psychiatric and psychological knowledge. More information here

Raising Our Voices, An account of the hearing voices movement Adam James, Handsell Publishing, 2001

In this comprehensive book, Adam James demonstrates why he was made ‘Mind Journalist of the Year 2001’. He has brought both the philosophy and struggle of the Hearing Voices Network to life. In this compelling book, the history of the Network from Julian Jaynes’ work on the bicameral mind to the development of the UK Hearing Voices Network as a pseudo mainstream organisation is explained in terms that anyone can understand. More information here

Hearing Voices: Contesting the Voice of Reason Lisa Blackman. Free Association, Books 2001. The hearing of voices is generally regarded as a pathological phenomenon, a form of mental illness. This belief in the pathology of hearing voices underpins the diagnostic systems of psychology and psychiatry and most forms of treatment. Hearing Voices, however, would appear to be far more common than often believed. Drawing on her research with the Hearing Voices Network the author reveals how many voice hearers are not suffering from mental illness, and that voice hearers who develop non-psychiatric explanations of their voices may live with them quite well. The pathological consequences of voice hearing are, to a large extent it seems, linked up with the social and psychiatric reaction to the experience. Lisa Blackman has written an important book that bears directly on some of the central assumptions of psychology and psychiatry and questions our understanding of ourselves as rational autonomous human beings. More information here

Voices of Reason, Voices of Insanity – Studies of Verbal Hallucinations: Ivan Leudar and Philip Thomas. Routledge/Psychological Press, 2000 In this challenging book, psychologist, Ivan Leudar traces voice-hearing and its interpretations through 2,800 years of history. Through six cases of historical and contemporary voice-hearers, Leudar assisted with some contributory chapters by psychiatrist Philip Thomas demonstrates how the direct experience has been changed from being a sign of virtue to being a sign of insanity, signalling ‘psychosis’ or ‘schizophrenia’. Leudar asks the question if the experience should be taken out of the hands of psychiatry and rehabilitated as a normal, although uncommon human experience. More information here

Making Sense of Voices – A guide for professionals who work with voice hearers: M. Romme and S. Escher, Mind,  2000 Marius Romme and Sandra Escher triggered a seismic shift in the understanding of voice-hearing. They put the powerful case for accepting and validating people’s own interpretations of their voices, and showed how such interpretations often enabled people to live with them far more effectively than bio-medical approaches. This handbook for practitioners builds on this work. It combines examples with guidance on the various processes involved in enabling voice-hearers to deal with their voices and lead an active and fulfilling life. More information here

Accepting Voices: A New Approach to Voice-hearing Outside the Illness Model, M. Romme & S. Escher. Mind, 1993 This acclaimed book illustrates how many people who hear voices come to terms with their experience without recourse to psychiatry, focuses on techniques for dealing with voices, emphasising the importance of personal growth. More information here

Talking with Voices: An Introduction to Voice Dialogue Many people who hear challenging voices have found that a turning point in coping with the experience is finding different ways of talking with and understanding them.  In this ground breaking DVD Dirk Corstens explores both the theory and practice of voice dialoguing techniques. This DVD will provide a step by step guide for voice hearers and workers to constructively help change the relationship between the voice-hearer and their voices. More information here

Knowing You, Knowing You In this moving account, Eleanor Longden tells her own story of recovery and discovery, her journey through the psychiatric system; from being told she would have more chance of recovering if she had cancer; to becoming an award winning psychologist working in mental health. In the DVD Eleanor talks candidly about her experience of abuse, self-harm and voice hearing. This DVD is challenging, inspirational and full of hope for people who have these types of experiences, their families, friends and workers. More information here

How to Set up and Run a Hearing Voices Group Step by Step Guide on How to Set up and Run a Hearing Voices Group, Working to Recovery, 2009. More information here

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Research and Practice

A review of hearing voices groups: Evidence and mechanisms of change, A Ruddle, O Mason – Clinical Psychology Review, 2011.

Working with voices: Victim to victor: Evaluation of a Mentored Self-Help Intervention for the Management of Psychotic Symptoms: Results from research study show that using the “Working with voices!!” workbook led to statistically significant improvement in the Brief Psychiatric Rating Scale (BPRS) factor Anxious Depression for Intervention group participants, over those in the Comparison group.

Recovery from Voice‐Hearing Through Group work K. Coupland – 2007 – Wiley Online Library.

More than just a place to talk: Young people’s experiences of group psychological therapy as an early intervention for auditory hallucinations, E Newton, M Larkin, R Melhuish, 2007.

Research on peer support and self help groups

A review of hearing voices groups: Evidence and mechanisms of change, A Ruddle, O Mason - Clinical Psychology Review, 2011. See article here

Working with voices: Victim to victor: Evaluation of a Mentored Self-Help Intervention for the Management of Psychotic Symptoms: Results from research study show that using the “Working with voices!!” workbook led to statistically significant improvement in the Brief Psychiatric Rating Scale (BPRS) factor Anxious Depression for Intervention group participants, over those in the Comparison group. See article here

Recovery from Voice‐Hearing Through Group work K. Coupland - 2007 - Wiley Online Library. See article here

More than just a place to talk: Young people's experiences of group psychological therapy as an early intervention for auditory hallucinations, E Newton, M Larkin, R Melhuish, 2007. See article here

Work with voice hearers: evaluation of effectiveness of hearing voices groups (parts one and two) Terry McLeod, Mervyn Morris, Max Birchwood, Alan Dovey British Journal of Nursing, 2007, Vol 16, No 4. See article here

The voices don’t like it… Sara Meddings, Linda Walley, Tracy Collins, Fay Tullett, Bruce McEwan and Kate Owen, Mental health Today, September 2006. See article here

Hungry researchers: The tensions and dilemmas of developing an emancipatory research project with members of a hearing voices group Emma Snelling, Journal of Social Work Practice, Volume 19, Number 2, July 2005 , pp. 131-147 (17). See article here.

I Leudar, P Thomas and M. Johnston: Self Repair for in dialogues of schizophrenics: effects of hallucinations and negative symptoms, 1992’ Brain and Language 43: 487 – 511

Research and Practice re. Children and young people who hear voices

Don't Panic is written by Dr. Sandra Escher for parents of children who hear voices

http://www.intervoiceonline.org/information/children-and-young-people/dont-panic

10 points for parents: bullet points for parents re coping with voices

http://www.intervoiceonline.org/information/children-and-young-people/10-point-checklist

New publication by Sandra Escher: Children Hearing Voices: What you need to know and what you can do Dr. Sandra Escher and Dr. Marius Romme (2010) PCCS Books, UK

http://www.intervoiceonline.org/information/children-and-young-people/new-publication

and http://www.pccs-books.co.uk/product.php?xProd=549

Voice Collective a project based at Camden Mind, young peoples’ hearing voices project for 12-17 year olds, parents and carers http://www.voicecollective.co.uk Contact Rachel Waddingham, the coordinator at [email protected]

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Videos and Presentations


Compassion for Voices: a tale of courage and hope Cultural Institute at King's College, London, UK, 2015A film about the compassionate approach to relating with voices, with potential for use as a therapeutic, educational, and de-stigmatising tool. This project is a Cultural Institute at King's project led by Dr Charlie Heriot-Maitland, Department of Psychology at King’s, in collaboration with Kate Anderson, independent animation director. It is part of the Cultural Institute at King's Collaborative Innovation Scheme for Early Career Researchers.


Eleanor Longden: The voices in my head TED, 2013 To all appearances Eleanor Longden was just like every other student, heading to college full of promise and without a care in the world. That was until the voices in her head started talking. Initially innocuous, these internal narrators became increasingly antagonistic and dictatorial, turning her life into a living nightmare. Diagnosed with schizophrenia, hospitalized, drugged, Longden was discarded by a system that didn't know how to help her. Longden tells the moving tale of her years-long journey back to mental health, and makes the case that it was through learning to listen to her voices that she was able to survive.


Olga Runciman Hearing Voices Network Denmark, 2013 Olga Runciman is the Chair of the Danish Hearing Voices Network. Originally a psychiatric nurse, she became a patient, and experienced the full force of psychiatric treatment before making a full recovery.

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Organisations

INTERVOICE For general information on the hearing voices approach and the movement see the website of INTERVOICE (International Network for Training, Education and Research into Hearing Voices. www.intervoiceonline.org

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Links

Working To Recovery www.workingtorecovery.co.uk

 Ron Coleman and Paul Baker, Youtube Talk on hearing voices and groups in Eugene, Oregon, USA http://www.youtube.com/watch?v=dbiMyR5aCmY

 Hearing Voices and Self Help Rufus May and Eleanor Longden http://rufusmay.com/index.php?option=com_content&task=view&id=85&Itemid=9

 Voice Collective a project based at Camden Mind, young peoples’ hearing voices project for 12-17 year olds, parents and carers http://www.voicecollective.co.uk

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