Reducing Voices by Direct Dialogue

One central idea of the recovery movement is to work with voices to accept them somehow. I have often heard that voices are associated with life events, people we know and things that have happened to us. The fears from these experiences are being played back to us in the form of what we are hearing. The key to my partial recovery along these lines has been the power that the authority of the therapist has had in refuting what the influence of what voices were saying about or to me and how this suggests a new approach to dealing with them.

The first therapeutic step was along the line of the recovery movement: to try and involve the voices in some kind of self-dialogue and to work with what they were saying in a further attempt to make them go away. Crucially, here the voices told me I was to be punished for causing 9/11. Did I deserve this punishment? I said no, but my voices said otherwise.

My own voice was pitted against the various voices of the hallucination and neither one had power over the other. For every argument I could produce the voices had a criticism. One side had to win out and silence the voice but how was this to be done? The voices were at least as intelligent as I was, perhaps because they were emanating from my own mind, and the result was an impasse.

I experienced a constant fear of punishment that had to be tackled. This fear wore me down and as time went on my strength to fight the voice became more and more sapped and I was becoming submissive to the criticism. Standing up to the voice was becoming a problem and my existing debates with them were not working. Therefore, I started therapy.

Having spent a long time in an academic environment, the clinic had all the feel of a tutorial room and it felt like being a student again. I was readily impressed by the knowledge of the therapist and her seniority. It was like talking to a professor and I felt at ease talking about my problems. I noticed the people skills of the psychologist were excellent and I began to listen to what she had to say about my problems. I was regarded with respect and was given theory to help me understand my problems and make choices.

It first took a long time to establish a relationship with a therapist as meeting new people generally made me paranoid––the other main symptom of my illness. Nevertheless, after a while I began to trust the clinician as it was obvious she was professional (paranoia about the professional could halt the process I am describing).

I was describing to my psychologist what was happening regarding the voices. I knew her for a lengthy period of time and I believed she knew me well and understood the viewpoints of my voices too. As a result—and this was the crucial step—my voices allowed her to talk to them directly without any mediation from me.

I have always been fearful of allowing anyone other than long-standing friends or family into my mind like that because I felt it might destroy my own control over what was happening to me. Someone else might antagonize the voices by coming into conflict with them and I feared terribly that I might never hear the last of it from the voice. This could have been damaging from the point of view of my mental health.

Gradually, as I described the situation of the voices to the therapist and what they said, it made much more sense to try to dialogue with this. The therapist was mainly challenging their sermonizing and moral criticism, and the more I got to know her the more I knew she could not mess this up and make things worse for me.

The voices had never talked to anyone else before. That they began to do so was because my therapist was able to establish a relationship of trust with me and to build on this trust in a number of ways. It felt like I was not facing the voice alone, which is what has tended to happen with the medical and cognitive treatments I had previously. Voice dialogue approaches like this tend to emphasize this vital relational aspect and can deal more effectively with the moral and emotional needs of the patient.

So then the psychologist’s direct dialogue with the voice began to take on the aspect of having authority over them. Instead of the constant battle with the voice in which no side was more convincing than the other, the voice began to listen to the psychologist in a way that it would never listen to me. As I trusted what the psychologist was saying so did the voices and they began to listen.

The psychologist talked with some expertise and her compassion for my plight persuaded the voices to be quieter still and less punishing. Having also had compassion focused therapy with the same therapist also helped lessen the severity of the voices criticisms here. One of the things that may have helped this was that she listened to the voices and discovered that sometimes they had a point to make and sometimes they were even trying to be protective of me. Perhaps seeing the value and the fears behind the voice helped understand them.

There were a number of other significant changes: I felt less shame about my psychotic experiences and what my psychologist called my own inner critic was less punishing as well. The voices said I didn’t deserve compassion and was a bad person but the psychologist taught me this was not true and that I was worthy of respect, the same as everybody else.

With less criticism from the voice my confidence began to increase and I was more able to begin challenging the voices on my own. My therapist, was able to provide a space in which my own voice became audible again and thus able to rejoin the struggle with the hallucination. We did lots of compassionate image work, trying to build a representation of compassionate strength and wisdom. Eventually, I found my own compassionate inner voice. It felt like my true self. Because it was my true core, its wisdom could not be wrong. This was crucial in trying to combat the hallucination. I was arguing with the voice and it was me, and not just my opinions, that were putting up the fight.

The process started by the psychologist now became possible to do by myself and as time went on I was less dependent on the context of therapy sessions and the voice of the psychologist. A virtuous circle began in which my confidence increased and the voice became quieter and quieter. My fear decreased and this in turn made the voices less powerful.

The next step was to try and pin down who these voices were as people, as it had always been a number of different people who were doing the talking. Sure enough, these people seemed to embody values from politics and religion. To be more specific, they included an army general, a Christian woman, an upper class conservative and a couple of other less identifiable people. By establishing who they were, I came to realize that none of them appeared to be any more knowledgeable or authoritative than the psychologist about my being responsible for 9/11 and this aided in resisting their opinions and silencing them. I realized voices were just ordinary people and what they said was just an opinion and nothing more than that.

Together the psychologist and I began to look at other aspects of what the voices were saying from the point of view of international terrorism. This felt like having a lawyer on my side to fight my case, and that was very empowering. I felt the therapist was able to argue in a way I could not. In fact, the sense of my therapist acting as my lawyer was most interesting because my delusion was that I felt like I was at the Nuremburg Trials and that some kind of court room judgment was going to happen to me. This involved the feeling that both sides had to be heard and having established a defence the voices were prepared to listen to it.

The psychologist then began to challenge these voices on an everyday level, having now vanquished their academic stature and legal force. By identifying the voices involved as people made the voice less all powerful and they were reduced to just being ordinary people. In fact, they were too uni-dimensional to even be ordinary. They didn’t have sophisticated arguments or reactions of full personalities and recognition of their shallowness helped lessen their power.

At this point, a new force was brought into play: that of common sense. Was I a bad person for causing 9/11? In everyday life people criticize each other all the time and come into all kinds of conflicts, whether these are moral and political or over who is the best football player. We all know that these conflicts are not about academic viewpoints or legal culpability, but are just a matter of opinion: One person’s view against another. Dwelling on such conflicts in my own life showed this to be true. I began to see that the way the voices were criticizing me felt very much the way other people would argue about which political party or religion was correct. People can be for or against an issue—we are all entitled to our point of view whether we believe it to be true or not.

The next step in my therapy was to direct dialogue with the voices and to ask why they were there in the first place. The oppositional dialogue I had developed with the voices calmed some down and even silenced some completely. To further try to manage them it was necessary to go more into the phenomenon.

Consistent with the model of the recovery movement, we began to wonder where these voices sprang from and if they were projections from my life. It was necessary to work with the emotions and try to neutralize the harmful abusive content so that it was possible to contextualize what I was hearing.

Again this required a bit of leap of faith with the therapist because the process was now involving sensitive emotional issues from my past which could be hurtful and possibly harmful to my mental health.

Dialoguing with the voices on these emotional issues would in turn require some compassionate focusing, but there were important difficulties for me in developing such compassion. Aspects of my psychology involved an outlook on life that rarely or never included emotion because feelings tended to cause me a lot of unwanted problems. This attitude is difficult to give up because it has served to protect me from bad feelings as well as good ones. It has also provided a source of motivation: nothing is ever good enough and there is always the need to succeed beyond current levels; emotions just get in the way of what the mindset is trying to do. So there was a problem in talking to my emotionally projected voices because I have always regarded them as unnecessary and irrelevant. Indeed there was no need to bring emotion into the equation because of the problems it would cause.

Then the realization from the therapist hit me. She had the insight to know that my emotional problems were not being avoided but were being played back in the form of voices. They couldn’t be avoided and something had to be done—otherwise I was going to be suffering for the rest of my life. Once I realized this I was willing to get into an emotional dialogue and to try and uncover why it was I was hearing these voices. The therapist soon isolated a probable cause that stemmed from childhood which up until that point I had always tried to ignore.

My parents divorced when I was very young and this had been an emotionally traumatic event that I felt I was responsible for. That trauma led to a pattern wherein rather than dealing with emotions, I escaped into the fantasy realm of schizophrenia.

Still, that traumatic experience could not be escaped altogether. If I felt responsible for my parents’ divorce and all the ensuing fallout from that, I might (under the influence of that delusion) feel responsible for all sorts of other things happening in the world, including 9/11.

Now the psychologist could talk to my voices again and ask—why did the voices think I was responsible for my parents’ divorce? Having just ignored the emotional trauma until now, I had never questioned whether I was responsible or not for what had happened in my childhood and I began to see what had happened through grown up eyes. My father had felt trapped in a relationship he didn’t want and my mother was stranded with two kids. I recall the rejection I experienced when my mother said, “I don’t want you.” When I talked it through with the therapist I began to realize such situations were very common and were simply just a part of life. They were not necessarily my fault.

The next question was, if I was not responsible for my family break up, was I still responsible for causing 9/11 and all the other things I felt I had caused with my thoughts? Again, my therapist asked the voice and the people talking to me if they still thought I was responsible given this new explanation of my thinking. At this point it emerged that the voices were parasitic—that is, feeding on my delusions for having been responsible for this catastrophe. Whatever the therapist said about my feelings of responsibility for 9/11 being based on childhood trauma, I believed I had caused it anyway because I was delusional about it.

So it was necessary to deal with the trauma in ways that did not include the voice and to modify the effect of the trauma. Simply arguing with the voices wasn’t going to change the delusion and this had to be done by other means. I have learned that my memory systems store the emotional memory of unresolved childhood adversities and that I need to learn how to sooth and regulate these fears.

So far I am 2 years into this psychological therapy. The direct dialogue approach with my voices has given me much hope and some examples of its effectiveness in my case might be applied more widely.