Talking with Voices article and video

Ideas on how to talk supportively with voices

Article to accompany the video ‘Talking with Voices’

by Elisabeth Svanholmer and Rufus May

Background to this approach

In Western culture there can often be a lot of fear about voice hearing. Both mental health services and religion have promoted the approach that voices were something to be got rid off – something dangerous and un-understandable.

However, over the last thirty years, within hearing voices groups, many voice hearers have found ways to co-exist with their voices. The hearing voices self-help movement was inspired by research that found there were many people (who were not known to mental health services) who described hearing voices and having a good relationship with the voices. This included being able to talk with their voices and negotiate ways to live together as equals.

This co-existing approach to hearing voices was not invented by the hearing voices self-help movement. You can find it in different forms in many different cultures and traditions where voices might for example be seen as part of spiritual experiences or as ancestors. But you don’t need to see voices as spiritual to build a better relationship with them.

Some people who have had problematic voices have tried adopting a ‘living with voices’ approach and have been able to improve the relationship with their voices.

As part of this ‘living with voices’ approach many voice hearers have found it helpful to learn to engage and talk with their voices. For example, finding ways to both set boundaries with their voices and also negotiate with them. So instead of trying to get rid of their voices many have found it more helpful to change the relationship with their voices to one that is more mutually respectful.

One technique that can aid this process is for someone else to facilitate a conversation with the persons voice. Talking with voices is a technique which aims to better understand the function of the voice. It can help people find new ways to relate to and communicate with their voice(s) and build confidence in negotiating with the voice(s).

The Voice Dialogue approach

This ‘Talking with Voices’ technique has been influenced by the Voice Dialogue approach. You can read more about this in the book ‘The Voice dialogue manual: Embracing Ourselves’ by Hal and Sidra Stone.

The Voice dialogue approach suggests we all have different sub-personalities or parts of self (selves) and that it can be helpful to better get to know these different parts. Rather than being one personality with a couple of traits we try to see ourselves as a whole team of selves that we can become more aware of and organise. Each part has its strengths and weaknesses and no part or sub-personality is either good or bad. An assertive part of us might be good at speaking up for our rights, but bad at being caring and supportive. Whereas a caring part might be good at listening and offering sympathy but bad at saying no and being assertive.

One way to get to know parts of ourselves is to have somebody else interview one particular part. This is done by asking the person to move chairs and speak on behalf of the part that has been identified. So for example Person A can talk with Person B’s ambitious part. This part can be asked questions about its relationship to person B and what it wants for person B. Then when the conversation is complete, Person B moves back to their original chair and together Person A and Person B reflect on what has been learned from the conversation. The ambitious part may say it wants the person to get up earlier and create more of a routine and believe in themselves more. Person B can then reflect with the facilitator about the views of their ambitious part and whether they want to incorporate some of its advice or not.

The aim of the voice dialogue approach is to increase the person’s awareness of their inner team and support them to better manage and negotiate between different selves and their different needs.

The person asking the questions (the facilitator) does not try to change the part/self /sub-personality. The facilitator takes a more curious and neutral stance exploring the role of the part, its history and its opinions. Questions might include: ‘How are you?’, ‘What is your job?’, ‘What do you want for the person?’, ‘What would their life be like if you were not there?’, ‘Do you have any advice for the person?’.

The interview is conducted in a non-judgemental and respectful way towards the part of the person. When the interview is finished the part is thanked for their contribution.

There is an emphasis on a balanced approach to negotiating with parts. One does not want to give a part of self too much power but also there are risks of denying a part of self as it can become rebellious and go in to opposition to the rest of the self. Voice dialogue therefore recommends a middle way where parts are listened to and negotiated with but not blindly followed. This is called honouring the different parts of self. So using the example above Person B may find it helpful to listen to their ambitious part but also create space for their selfcaring part that allows them to rest and recuperate.

Talking with Voices

We can use the Voice Dialogue interviewing style to help voice hearers better understand their voices. We can ask the person to sit in a different chair and report to us what the voice is saying. We can ask the voice similar questions that are asked in Voice Dialogue outlined above. E.g.: ‘How are you?’, ‘What is your job?’, ‘What do you want for the person?’, ‘What would their life be like if you were not there?’, ‘Do you have any advice for the person?’.

It can be more comfortable to interview a voice indirectly. This involves asking the person to ask their voice questions and asking them to report indirectly (in the third person) what the voice is saying.

An example of direct questioning would be to ask a voice ‘How are you?’ and the person would then say exactly what the voice tells them e.g. “I am not happy Christmas is coming”.

An example of indirect questioning would be saying ‘Can you ask your voice how is he?” and the person might respond: “He says he is not happy because Christmas is coming.”

Like voice dialogue the interviewer is not trying to change the voice but rather explore what is important to the voice, what its intentions are and how it perceives things. New information may emerge from the interview that can help the person understand their voice in a different way. For example, a voice that tends to talk a lot when the person is trying to sleep, may explain in an in interview, that it feels anxious at night time and would like a bed time story to help it get to relax.

Voices that sound like abusers sometimes will share that they are not the abuser but a younger part of the person that was around and took some of the abuse.

The aim of a facilitator talking with another person’s voice is to help the person themselves find new ways to relate to their voice. So the person is encouraged to find time to regularly talk with their voice themselves. (see our self-help guide for talking with voices).

How to supportively talk with voices in a nutshell

Creating safety

1. Relationship

The interviewer/facilitator and person who hears voices need to be comfortable with each other.

2. Willingness

The voice needs to be willing to participate in the interview

3. Space

You need a quiet space where you will not be interrupted

4. Support

Friends, supporters or family members can be present if that helps the person who hears voices feel more supported.

Things to agree on before the interview

5. Prepare questions together

It can be helpful to prepare some questions together in advance e.g.:

Can you say hello to the voices?

Can you ask the voice how they are?

Can you ask the voice what they are concerned about at the moment (and if so a follow up question could be can you ask them why)?

Can you ask the voice if they have any advice for you?

Can you ask the voice is they have anything else to say?

Please tell the voice thank you for speaking with us.

6. Mutual respect

It can be helpful to invite the voice to ask the facilitator questions if that helps the dialogue feel more respectful.

7. Taking notes

It is helpful to write down what the voice says and when the person and facilitator reflect together the words of the voice are read aloud by the facilitator.

8. Direct or indirect

Before the interview it is important to decide together whether direct questioning or indirect questioning is going to be used.

Direct questioning involves the facilitator talking to the voice directly and the voice hearer responding by saying the exact words of the voice.

Indirect questioning asks the person to ask their voice questions and report back in the third person what they are saying.

Many people find indirect questioning helps them feel a bit more in control of the process.

During the interview

9. Using chairs/space

When the interview is ready to start, the person who hears voices moves to a different chair to listen to and speak on behalf of the voice and they return to the original chair at the end of the interview.

10. Optional

If at any point in the interview either the facilitator or the person who hears voices feels too uncomfortable they can stop the interview. The person comes back to the original chair and debrief together.

11. Taking time to finish and debrief

When the interview is over the voice is thanked and the person who hears voices returns to their original chair. The facilitator and the voice hearer reflect back on what has been learned from the interview.

Other useful things to be aware of

12. Focus is on the person

The person who hears voices is encouraged to try talking with their voice themselves regularly for limited periods of time (e.g. 10-20 minutes) to work on the relationship with their voice. A guide for the person to talk with their voices is available HERE.

A balanced approach is important. Spending too much time dialoguing with voices can become confusing, exhausting or overwhelming. Its recommended that people get a balance between spending time with the voice(s) and engaging with the wider world.

13. Practice with a facilitator

The voice hearer may find it helpful to work with the facilitator more on talking with their voices by having a series of facilitated conversations with their voices, but the aim is always that the person who hears voices carries on that dialoguing approach themselves so as not to become dependent on the facilitator.

14. Negotiating compromises

People using this approach may find it helpful to make compromises with voices who make demands. For example, if a voice wants the person to self-harm they might find they can use a grounding technique instead. Or if a voice wants someone to be aggressive to a friend they might be able talk with someone about the conflict they have with that friend.

In the Bradford Hearing Voices group some voice hearers have found it helpful for limited periods of time to do some things their voices enjoy (e.g. listen to certain music eat certain food, watch certain TV programmes or read certain books). It is important this is done in a balanced way where the person also spends time doing what they themselves want to do – so they are not letting their voices dictate and dominate what they do. We have found that voices are often less controlling if this compromising approach can be adopted.

15. Communicating with voices that are being aggressive or manipulative

If voices are aggressive or manipulative it can be important to communicate non-judgmentally, assertively and also respectfully give feedback to the voice about the impact of its behaviour. We have found it helpful to learn communication skills that can support difficult conversations and enable both facilitator and voice hearer not to get drawn into escalating arguments with voices. We recommend the book ‘Nonviolent communication a language of life’ by Marshall Rosenberg. In nonviolent communication attention is paid to feelings and needs on both sides of any conflict in order to find a way forward.

Special thanks to the work of Dirk Corstens. You can read more about ‘Talking with voices’ here http://www.dirkcorstens.com/talking-to-the-voices/