Making Peace with Auditory Hallucinations

An excerpt from Clinicians Digest from Psychotherapy Network:

Recent trends in therapy, especially those emphasizing mindfulness, encourage clients to turn their attention toward, and accept, emotions or “parts” of themselves that may initially seem frightening. Although that approach isn’t new—Gestalt therapy advocated this years ago—the prevailing view has been that encouraging psychotic people to acknowledge different aspects of themselves as real encourages splitting and further psychosis. Now a study by a team of British psychologists led by Jasmine Chin of the University of Surrey, reported in the March 2009 Psychology and Psychotherapy: Theory, Research and Practice, suggests that instead of targeting schizophrenics’ auditory hallucinations as symptoms to be eliminated, therapists should consider helping them develop a relationship with their voices.

It’s a counterintuitive and controversial idea. Not only might this approach potentially support the psychotic symptom, but even Chin’s study finds that most people who hear voices don’t want to develop a further relationship with them. But want it or not, the study points out, people with auditory hallucinations already have a relationship with their voices, usually a difficult one, and they expend much time and energy trying to control them.

The study asked 10 psychotic people suffering considerable distress with their voices how they understood the relationship. Most personified their voices, assigning gender or names. (This urge was so strong that the few who didn’t personify them fought the urge to do so). They usually experienced themselves as engaged in a struggle for power and control. “The voices magnify whatever it is I’m concerned about, or they’ll comment on something I’m concerned about, which . . . often makes me more stressed than I was,” one patient reported. But some voices served a potentially healthy function, reminding people they’d made good decisions in the past, or encouraging them to practice their social skills with the voices so they could go out into the world.

Along with these tangential supports for the notion of helping people with schizophrenia come into better relationships with their voices, Chin points out another reason. A study in the November 2004 Psychological Medicine, led by British psychologist Max Birchwood, found that people’s relationships with their inner voices mirrored their social relationships with the external world, often reflecting their sense of being powerless and controlled by others. Chin speculates that when therapists, along with everyone else in schizophrenics’ world, try to drive a wedge between them and their inner voices, it may actually reinforce this internalization of social stigma.

Richard Schwartz, the originator of Internal Family Systems Therapy, who’s worked with nonpsychotic clients who hear voices, thinks there may be something to Chin’s idea. “Once they realize that I’m neither afraid of nor pathologizing their voices,” he says, “most clients are better able to relate to them from a less fearful and more curious, confident, and even compassionate place.”

Taken from Psychotherapy Networker’s Clinician’s Digest

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