New dialogues on voices

Psychminded, February 13, 2009

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Cognitive behavioural therapy has long been accepted as a valid therapeutic intervention for people who hear voices. So what does the future hold for more radical approaches, such as voice dialogue, asks Adam James.

Rewind to 1993. It was the year Accepting Voices by Professor Marius Romme and Sandra Escher was published.

The book argued that voices (aka aural hallucinations) experienced by people diagnosed with psychosis should be accepted as real. Don’t pathologise and seek to rid people of voices. Better, help people cope with them, they argued.Some professionals were truly alarmed. In the British Medical Journal, Raymond Cochrane, a professor of psychology, slammed the book’s message as “potentially dangerous”. It meant colluding with delusions, he argued

In April last year the scientific community was similarly perturbed. This time after clinical psychologist Rufus May was shown on a television documentary using “voice dialogue” to help a voice-hearer. Directly communicating with the voices of a woman diagnosed with bipolar disorder was one of the psychological interventions Dr May used.

Dr May was also “dangerous” and should be reported to the British Psychological Society, NHS psychiatrists wrote on the bulletin board of doctors.net.uk. One of Dr May’s colleagues at Bradford NHS Trust joined the fray, accusing May of “flagrant self promotion”. “Don't let him [Dr May] near me if I become mentally ill,” weighed in Lisa Brownell, a psychiatrist at Queen Elizabeth Psychiatric Hospital in Birmingham.

But supporters of voice dialogue – involving conversing with a person’s voices to understand that person’s life experiences and the voices’ “motives” – point to some similarities it has not only with traditional cognitive behavioural therapy (CBT) but with a new wave of CBT techniques. These include Person-Based Cognitive Therapy (PBCT), Dialectical Behaviour Therapy, Acceptance and Commitment Therapy, and Relationship Theory. The solid “evidence-base” of CBT was recognised seven years ago when the National Institute for Health and Clinical Excellence (Nice) recommended it be available for all people diagnosed with schizophrenia.