Relating therapy for people who hear voices: perspectives from clients, family members, referrers and therapists (original) (raw)
Related papers
Relating therapy for people who hear voices: A case series
Clinical Psychology & Psychotherapy, 2009
This paper presents a series of cases to explore the development and value of a form of relating therapy for people who hear voices. The therapy is theoretically underpinned by Birtchnell's Relating Theory and offers a therapeutic space where hearers can explore and seek to change the relationship with their predominant voice. Five cases are presented to illustrate the processes of: (1) exploring similarities between relating to the voice and relating socially; (2) enhancing awareness of reciprocity with the voice-hearer relationship; and (3) using assertiveness training and empty chair work to facilitate change. Results were encouraging as change in control and/or distress was apparent for four of the cases. Changes in patterns of relating to voices were also apparent.
Relating to voices: Exploring the relevance of this concept to people who hear voices
Psychology and Psychotherapy: Theory, Research and Practice, 2009
Objectives. Conceptualizing interactions between voice hearers and their voices as a 'relationship' has recently become an area of psychological inquiry. To date the literature exploring the details of a hearer-voice relationship has arguably privileged the researchers' account of voice hearing at the expense of the individual's explanatory framework and perspective. The present study aimed to establish the perspectives of voice hearers regarding any 'relationship' they may have developed with their voices. Method. In-depth interviews were conducted with 10 service users who had heard voices for at least 12 months. The interviews were transcribed and analysed using interpretative phenomenological analysis (IPA). Results. Analysis resulted in five major themes, three of which are discussed here: Defining the 'other' which detailed the personification process; 'Me vs. the Voice' which explored oppositional positioning between participants and their voice and strategies employed to retain power and 'the Voice and Me' which considered the union that was apparent, as well as participants' rejection of a relational concept. The concept of a 'relationship' was both accepted and rejected by participants. Acceptance of relating was relative to the poverty of social relationships. Rejections were considered in terms of preservation of self-hood, conflict with personal explanatory models and constructions of the term 'relationship'. Conclusions. This study has provided evidence that supports new developments in working relationally with voices. Working within this frame may help to emphasize hearers' strengths whilst ameliorating distress. However, this concept needs to be posed as a possible rather than an established conceptualization.
Cognitive Behavioural Relating Therapy (CBRT) for Voice Hearers: A Case Study
Behavioural and Cognitive Psychotherapy, 2013
Background: There has been a recent focus on the interpersonal nature of the voice hearing experience, with studies showing that similar patterns of relating exist between voice hearer and voice as between voice hearer and social others. Two recent therapeutic approaches to voices, Cognitive Therapy for Command Hallucinations and Relating Therapy, have been developed to address patterns of relating and power imbalances between voice hearer and voice. Aims: This paper presents a novel intervention that combines elements of these two therapies, named Cognitive Behavioural Relating Therapy (CBRT). Method: The application of CBRT is illustrated through a clinical case study. Results: The clinical case study showed changes in patterns of relating, improved self-esteem and reductions in voice-related distress. Conclusions: The outcomes provide preliminary support for the utility of CBRT when working with voice hearers.
Relating therapy for voices (the R2V study): study protocol for a pilot randomized controlled trial
Trials, 2014
Background: Evidence exists for the effectiveness of cognitive behaviour therapy for psychosis with moderate effect sizes, but the evidence for cognitive behaviour therapy specifically for distressing voices is less convincing. An alternative symptom-based approach may be warranted and a body of literature has explored distressing voices from an interpersonal perspective. This literature has informed the development of relating therapy and findings from a case series suggested that this intervention was acceptable to hearers and therapists. Methods/Design: An external pilot randomized controlled trial (RCT) comparing outcomes for 15 patients receiving 16 hours (weekly sessions of one hour) of relating therapy and their usual treatment with 15 patients receiving only their usual treatment. Participants will be assessed using questionnaires at baseline, 16 weeks (post-intervention), and 36 weeks (follow-up). Discussion: Expected outcomes will include a refined study protocol and an estimate of the effect size to inform the sample size of a definitive RCT. If evidence from a fully powered RCT suggests that relating therapy is effective, the therapy will extend the range of evidence-based psychological therapies available to people who hear distressing voices. Trial registration: Current Controlled Trials ISRCTN registration number 44114663. Registered on 13 June 2013.
The voice and you: development and psychometric evaluation of a measure of relationships with voices
Clinical Psychology & Psychotherapy, 2008
The experience of hearing voices has recently been conceptualized within a relational framework. Birtchnell's Relating Theory offers a framework capable of exploring the power and intimacy within the relationship between the hearer and the voice. However, measures of relationships with voices derived from the theory, such as the Hearer to Voice (HTV) and Voice to Hearer (VTH) by Vaughan and Fowler, have lacked robust psychometric properties. Data were available from 71 participants who completed the HTV and VTH, and analysis of these data generated a new 29-item measure, the Voice and You (VAY), capable of assessing the 'interrelating' between the hearer and the voice. The VAY was completed by a further 30 participants and was found to be internally consistent, stable over time and associated with other measures of the voice-hearing experience. The VAY offers a psychometrically stable measure of the relationship between the hearer and the voice. It may be used as an adjunct to the clinical interview and/or a measure of outcome.
The paper presents a clinical case study of a psychotherapeutic intervention, based on the model developed by Romme & Escher (2000), with an adult man in acute psychotic crisis who hears voices. The aim of this intervention was to decode the meaning of the voices and link the voices to the person's history. At the same time, the person was trained in the use of cognitive and behavioural coping strategies, in order to manage the hearing voices experience and gain control over it. The specific case study was chosen because it highlights, amongst others, issues pertaining to disturbed communication and dynamics between family members, which createdouble-bind conditions and obstructthe development of an adult identity. The impediments in developing an adult identity pose obstacles to the achievement of the person's autonomy and their detachment from their family of origin. In the paper we present the successive stages of the intervention, with emphasis on the changes achieved in each phase regarding making sense of and managing the client's voices, and discuss its overall effectiveness for acquiring control over the hearing voices experience.
Frontiers in Psychology, 2016
The experience of hearing distressing voices has recently attracted much attention in the literature on psychological therapies. A new "wave" of therapies is considering voice hearing experiences within a relational framework. However, such therapies may have limited impact if they do not precisely target key psychological variables within the voice hearing experience and/or ensure there is a "fit" between the profile of the hearer and the therapy (the so-called "What works for whom" debate). Gender is one aspect of both the voice and the hearer (and the interaction between the two) that may be influential when selecting an appropriate therapy, and is an issue that has thus far received little attention within the literature. The existing literature suggests that some differences in voice hearing experience are evident between the genders. Furthermore, studies exploring interpersonal relating in men and women more generally suggest differences within intimate relationships in terms of distancing and emotionality. The current study utilized data from four published studies to explore the extent to which these gender differences in social relating may extend to relating within the voice hearing experience. The findings suggest a role for gender as a variable that can be considered when identifying an appropriate psychological therapy for a given hearer.
Schizophrenia Research, 2020
Background: The effectiveness of psychological treatments for auditory hallucinations ('voices') needs to be enhanced. Some forms of novel treatment are working within relational frameworks to support patients to relate assertively to distressing voices. Yet, no measure of assertive relating to voices is available to assess the extent to which this skill is developed during therapy. This study aimed to assess the factor structure and validity of two new questionnaires: a measure of relating to voices and a measure of social relating. Methods: The relating measures were developed in consultation with members of the international research community and validated in a large sample (N = 402) of voice hearing patients within the UK. The measures were subjected to factor analysis and compared to measures of voice hearing, mental health and well-being to evaluate construct, convergent, discriminant, and criterion validity. Results: Factor analysis confirmed a three-dimensional set of items that measure assertive and non-assertive (passive and aggressive) relating. This resulted in the validation of the 'Approve' questionnaires-two 15-item measures of relating to voices and other people. Conclusion: The Approve questionnaires can be used to assess a patient's suitability for relationally-based psychological therapies for distressing voices and the extent to which assertive relating skills are developed during the therapy.
The experience of talking about hearing voices with family, friends, and others
Psychosis, 2019
Objective: There is evidence to suggest that close social networks and wider social influences have a significant impact on people who hear voices. The aim of this research was to explore people's experiences of talking about voice hearing with family, friends, and others. Method: Transcribed interviews with five participants, recruited through mental health services, were analysed using Interpretative Phenomenological Analysis (IPA). Results: Two superordinate themes, each with multiple subordinate themes, were developed from the interviews: "Who can I talk to about this?", which explores the way people communicate carefully about their voices to manage their experiences of shame, and "I was shocked by how they responded", which considers others' reactions to participants disclosures and the impact this had on the participants. Conclusions: The research findings are compared to the existing literature, limitations of the research are considered, and clinical considerations for supporting people who hear voices are explored.
The experience of hearing voices: An interpretative phenomenological analysis
This article presents an analysis of two case studies of people who hear voices. In accordance with a phenomenological approach, the meanings which the participants attribute to their voices are highlighted in the analysis (specifically in relation to the nature and origin of the voices) and the influence which these interpretations have on their efforts at managing and reducing their disruptive effects is explored. It is concluded that if this analysis has accessed general processes in voice hearers’ experiences, therapeutic practitioners may need to work with voice hearers in promoting psychologically satisfying meaning-making around their experiences, from which contextualised responses to managing the voices can be developed.