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Voice hearers’ groups inspire new ways to listen

By Kim Goggins

Traditionally, auditory hallucinations have been considered a symptom of schizophrenia or psychosis, with the solution being medication to get rid of the voices. But for the last 10 years, Dr. Margaret England, associate professor in the Faculty of Nursing at the University of Windsor in Ontario, has tested alternative ways of helping people understand and manage voices, which includes holding voice hearers’ groups.

While it is common for nurses and other mental health professionals to avoid talking to clients about these voices, England says the opposite should happen. “Nurses were taught early on not to get into conversations with people about their voices,” says England. “I found when I first started doing these groups that that was exactly what nurses needed to do but were taught not to. I began to realize that people were not getting accurate information from patients about the problem of the voices,” says England, who volunteers as facilitator for two voice hearer groups, in addition to doing voice hearer research at the university.

A growing number of mental health professionals understand that medication needs to be enhanced with other kinds of treatment, such as psychosocial and cognitive interventions. Some even believe that hearing voices can occur without mental illness. Intervoice and the Hearing Voices Network are two international organizations that propose alternative ways of understanding voices.

These alternative perspectives are beginning to gain attention from the mainstream mental health system. In a March 2009 article in the Canadian Journal of Psychiatry, author Dr. Emmanuel Stip, a professor in the Department of Psychiatry at the University of Montreal in Quebec, notes that many people who hear voices can cope with them and even view them as a positive part of their lives: “Having attended some European meetings and symposia organized by the International Network for Training, Education and Research into Hearing Voices, I observed that this phenomenon can be considered either as a purely pathological or as a completely normal phenomenon.”

Often the problem is not hearing voices, but the voice hearer’s reaction. Voice hearer groups are rare in Canada, but the ones facilitated by England in Windsor and groups offered in Quebec City give voice hearers a non-judgmental place to talk about their experiences, as well as a forum where participants get valuable feedback and suggestions for how to cope.

Le Pavois in Quebec City facilitates social, professional and school integration of people with severe mental illness. In 2007, the organization created a 15-week group called “Vivre avec les voix” (Living with Voices), which was inspired by the Hearing Voices Network.

“This hearing voices group has been created to answer needs that remained unsatisfied despite all the efforts of the mental health system,” explains Brigitte Soucy, one of the group’s founders. “We realized that the voice hearer is left alone with his or her feelings. A lack of comprehension can lead the voice hearer to deny voices, to perceive them only as a symptom of mental illness, to feel helpless and misunderstood and to avoid social relationships.”

People who attend Le Pavois’ groups are able to express their feelings about what is commonly seen as a taboo topic. Sharing common experiences lifts the sense of loneliness and marginalization. Participants describe voice-neutralizing activities, customize coping strategies and choose whether to follow their voices’ advice.

“We have noted that people tend to get more involved in their empowerment; they try new strategies,” says Soucy. “They no longer consider their voices only as a symptom over which they have no power. For some people, distress and negative feelings lighten; voice frequency diminishes and qualitative content becomes more positive. For most, voices are no longer perceived as major obstacles to self-achievement.”

Back in Windsor, for the last five years, England has facilitated a weekly self-help group for people 25 and older in the summer and fall. The 13-week course includes a weekly assessment of voice hearing experiences, information sharing, reflective thinking strategies and critical thinking. England chooses the members from an extensive list of people she has interviewed for her research and forms each group according to whether participants find the voices comforting or distressing.
“I do that because some people hear voices that are very upsetting,” explains England. “If someone is hearing voices telling them to kill people or they’re hearing voices of the devil, that could frighten others.” England adds that once formed, the group is closed to outsiders in order to ensure privacy and secure trust.

To be eligible to participate, individuals must not have been hospitalized in the previous six months and must have had the same home address over that period; they must be able to perform basic activities of daily living; they must not have an apparent impulse to harm themselves or others; and if they take medication, they must adhere to it at least 80 per cent of the time. Participants must also be comfortable with the group sessions being audio-taped for the purpose of education and recall. These tapes are destroyed at the end of the 13-week session to ensure confidentiality.

“I’ve been told that some voice hearing experiences are akin to long, drawn-out rape or invisible beating,” writes England in an article about structured group work with people who hear voices. “Structured group work is a nursing therapy with the potential to emancipate voice hearers from destructive and self-depreciating effects of hallucinated voices.” Ultimately, the intervention strategies provide voice hearers with the relevant structure, stimulation and affirmation they say they need in order to learn how to manage thoughts and feelings associated with their voices.