Dirk Corstens Praktijk Psychiatrie - Hearing Voices Maastricht

Self-help guide to dialoguing with voices by Rufus May and Elisabeth Svanholmer

1. How can I talk to the voices I hear?
Here are some different ways you can try:
• Talking out loud – if in public maybe use a mobile phone or wear a headset. Talking out loud can feel scary but some people who hear voicees find that it helps them be firm and assert themselves.
• Inner speech – talking with the voices inside your head or mind.
• Writing out a conversation – you can write questions to the voices and write down their answers. Or you can just write down what they say – a bit like a secretary. Voices tend to like to get your full attention and writing down what they say can be a way to pay attention to them.
Whichever way you try, it may be worth considering making it time limited. Tell the voices in advance that you will be talking with them or listening to them for 10, 20 or 30 minutes. If you are worried about losing track of the time you can set an alarm to help you.
You don’t want to spend all your time talking with the voices. Some people describe getting drawn in to the voices world and forget to spend time with other people and doing things they like. It’s important to get a balance and limiting the time you spend with the voices (as described above) can be a way of finding that balance.

2. What if I find the voices too controlling?
It is not uncommon that the voices are demanding you carry out actions. They may make threats or try to bully you into doing things, promising they will be nice to you or go away if you do what they say.
The first thing you might want to learn to do is to assertively set boundaries.
You can practice standing up to your voices with a friend or supporter.
If a voice says: “cut yourself”, you can practice saying something like “no I want to find another way to cope with my distress”
If a voice says: “kill yourself”, you can practice saying back “I want to live” or “I choose life”.
If a voice says: “don’t go out”, practice saying “I want to go out because I need/want... (fresh air/to see my friends/exercise/do the shopping etc)”
Practice saying back things clearly and confidently.
Look at the kind of things the voices you hear usually say and think of things you can say back. Practising with yourself or a friend is good because you may feel overwhelmed when the voices come along and then it is easy to forget what you had planned to do. When you have practised it, it can be easier to do. Like practising sport or playing an instrument – when we rehearse things they come more easily to us when we are under pressure.

3. What if the voices are too offensive?
If your voices are insulting you can try saying: ‘when you say “……………..(example of the words the voice uses)” I feel hurt or sad because I need respect to feel safe. So please can you talk to me in a more kind / respectful way’.
If a voice continues to be disrespectful and you feel upset you can terminate the conversation and let the voice know that you need to be talked to respectfully to engage in a conversation.

4. How do I start a conversation with the voices?
You can try being a role model for how to do respectful conversation by greeting the voice saying: “hello” and asking: “how are you?”.
Think about how you would start a conversation with someone you’ve just met. Even if you have heard the voice for a long time, you may feel that you don’t really know it very well. When we meet new people, what do we do to show that we are curious about them?

5. What if the voice does not want to talk to me?
There may be times when voices don’t want to talk. It can create difficulties if you try and force a voice to talk with you when it doesn’t want to. The hope is that you can create a better relationship which means being respectful. If you try and force a conversation it can easily turn into an argument.
If a voice doesn’t want to talk you can ask it: “when would be a more convenient time to talk?”
Even if the voices do not respond to what you say, you can say ‘yes’ or ‘no’ to yourself in response to things they say. You make your own opinion and standpoint clear. This is a way to let the voices know you are listening and that you have your own way of seeing things.
Voices might behave dismissively at first or try to deter you from talking with them by being avoidant, aggressive or patronising. Some voices refuse to respond at first and pretend like they can’t hear you.
Don’t give up if this happens.
Voices might like to know if you are going to stick with them, like they are testing you to see how determined you are. If you stick to doing things respectfully and keep letting them know you are interested in them, things can change over time.
Voices might have learned not to trust anyone who is nice to them or they might think your new way of treating them is just a strategy to get rid of them or manipulate them. They might not like new things or that things are changing so at first, they can try and keep things the way they are by ignoring or intimidating you. If they have had a lot of power in your life, they might not like the idea of losing control over you.

6. What if the voice uses a lot of swear words?
Voices might be aggressive when they are angry or confused. Or it might be because they know it will make you pay attention to them.
You can try and ask a voice that swears, whether he/she feels angry or upset about something. You can also tell the voice that you will pay attention properly to what he/she has to say for 5 or 10 minutes but only if he/she stops swearing.

7. How can I keep the conversation respectful?
You can request that the voice treats you with respect and make an agreement that, if the voice is unable to do this, you will need to stop the conversation. Remember to stick with the agreement yourself too. Be respectful but also remember to stop the conversation if the voice is being disrespectful. The voice may be testing your resolve and try and push your buttons. Try not to get drawn in to a shouting match. If you do, remember to be kind to yourself. You are trying to do things differently and that can be hard at first.

8. What if the voice does not seem to make any sense?
You could try writing down what the voice is saying and look at it later with somebody to see if you can find some meaning in what it is saying.
You can ask the voice to clarify or you can ask it questions for it to answer with a ‘yes’ or ‘no’.
You can try and ask the voice why it is talking the way it is; maybe it likes to be mysterious, maybe it has its own language or is speaking a language you don’t know or maybe the voice is feeling very confused and overwhelmed.
Sometimes building a relationship means you have to try and find a common language that you can speak to each other. It’s the same with people – like some professions have their own jargon or some areas have their own dialect. Some people like to talk using abstract and philosophical words and other people have a very down to earth way of talking. Sometimes we have to ask each other what we mean when we say certain things or use certain words. Maybe you and the voice you hear need to negotiate a way of talking that you are both okay with.

9. What can I talk about?
One aim of dialoguing can be to find out what the voices underlying intention is.
It can be helpful to try and find out what the voice is feeling and needing or what is important to the voice. You can maybe see yourself as an investigating journalist. You are trying to gather more information so that maybe you can better understand why the voice is there, what it thinks its job or mission is and how you can live better together.

10. What questions can I ask the voices?
Here are some ideas and suggestions:
How are you?
What’s important to you right now?
How are you feeling?
Do you have any advice for me?
What would my life be like if you weren’t there?
What is your job?
What music/food do you like?
What situations do you dislike?
How do you relax and get rest?
How are you finding talking to me?
If you are beginning to have more of a dialogue with a voice you can try and ask it questions like:
When you say (…repeat something the voice often says…) what do you mean?
Why do you say this? Why do you say this now?
How do you feel when I (describe an activity e.g. go to the shops)?

11. How can I build a better relationship with the voices?
Can you find common ground with your voice? E.g. For half an hour a week listen to music a voice likes or eat food it likes once a week. You can negotiate what clothes to wear – e.g. let the voices choose which socks/scarf to wear or ask them if there is a particular piece of jewellery they like.
Keep your voice(s) informed of your plans for the day. Especially voices that feel anxious can calm down when you keep tell them what is going to happen. It makes things more predictable and might help the voice feel safer.
Building relationships based on equality and respect can be hard work. Equality means that both parties take responsibility for what they say and do, you try to express yourself clearly and with honesty (which can be scary) and you respect difference of opinions. You don’t try to impose your way of doing things or your way of seeing the world on others.

12. What are things to avoid in dialoguing / talking with the voices?
Talking with them all the time. Try to balance it with engaging with the outside world (E.g. dialoguing for half an hour a day). Being aggressive towards voices.
Trying to force a voice to talk.
Not sticking to agreements – like any relationship sticking to agreements will help build trust and respect.
Being dishonest.

13. Using humour
Humour can be a helpful way to lighten a conversation or build bridges. There may be things you can laugh about with voices you normally disagree with. Some voices like irony and witty comments.
Once you get to know the voices you hear they may turn out to have a great sense of humour or you might find that together you can see the funny side of things.

14. Using creativity
Changing how we relate to each other doesn’t have to always be about talking. Sometimes it can be nice to do things a bit differently.
Here are some things that other people who hear voices have done:
Created facebook profile for their voices. The voices had to choose their name and profile picture and it created a dialogue about what the voices liked and didn’t like. If you don’t want to create a real facebook profile you can ask the voice what kind of things it would like to put on a profile if you were making an account for it.
Making puppets to represent the voices. Together with the voice decide on looks etc.
Making collages. Together with the voice choose images and words to create a collage that tells a story about the voice or says something about how/who the voice is.
Writing poetry/rap.
Writing for the voice.
Drawing or painting the voices, how they feel or stories they tell.
Invite the voice along when you do things e.g. go for a walk, do pottery together etc.
Dedicate an activity to the voice – e.g. eating something comforting, doing yoga or exercise, listening to music. Let the voice know you are doing this thing because you know he/she likes it.