Over the past three and a half years, Hearing the Voice has worked closely with the Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) on a number of initiatives designed to improve therapeutic practice in cases where people find their voices distressing. In 2013, we held a Best Practice in Psychosis Conference and a Follow-Up Day to enable local clinicians and mental health professionals share and showcase areas of good practice and find out about the latest translational research into voice-hearing and other unusual mental states. We are now delighted to announce that we are collaborating with the TEWV tertiary psychosis team to produce Working with Voices – a four-day training course that aims to equip TEWV staff working with people who experience distressing voices with hands-on skills that can be used in their clinical practice.
The first day of the training took place earlier this month at Durham University, and focused on the theme of the assessment of voices. HtV’s Ben Alderson-Day opened the session with an interactive quiz designed to gauge participants’ knowledge of voice-hearing, and provide them with an update on some of the latest academic research into this experience. Valentina Short (Nurse Consultant, TEWV) then gave a presentation on hearing voices and diagnosis, which stressed the fact that voices can occur in a range of contexts and are not necessarily a symptom of serious mental illness. Although the terms ‘true’ and ‘pseudo’ hallucination are no longer regarded by researchers as useful, the idea persists that voices that are experienced as coming from outside the head are somehow more disruptive and disturbing, and are typical of schizophrenia. Drawing on recent research that undermines this view, Valentina explained that ‘internal’ and ‘external’ voices occur across diagnostic categories, and that characteristics such as the perceived location of voices should not be regarded as clinically relevant.
What was striking about the training was the emphasis placed on learning from lived experience. (In fact, all sessions in Working with Voices will be co-produced and co-presented by people with personal experience of hearing voices or other unusual mental states.) To facilitate a better understanding of what it’s like to hear voices, we screened Adam Plus One – a short film about personal experience of psychosis that was initially produced by Hearing the Voice for the 2013 Cinema and Psychosis festival at The Barbican. This was followed by a lively question and answer session with Adam, which explored a range of issues including his experience of being assessed by clinicians, the link between his voices and previous trauma such as bullying, and the way in which compassionate and respectful care can facilitate recovery. Many people found it useful to hear about the different characteristics of Adam’s voices, how they became personified, and the strategies he has used to cope with his experiences. One participant remarked: ‘Learning from someone with lived experience is invaluable’.
The remainder of the day was devoted to an exploration of practical tools for the assessment of voices. Tim Grace (TEWV) led a session on the Maastricht interview – a semi-structured questionnaire devised by Marius Romme and Sandra Escher in collaboration with voice-hearer Patsy Hague, which aims to provide a framework for people to make sense of their voices within the context of their life history. And finally, Ben Alderson-Day explained the pros and cons of different scales and measures for assessing auditory verbal hallucinations, including the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptoms Rating Scale (PSYRATS). Drawing on the results of our Lancet Psychiatry study (Woods et al, 2015), which call into question the presupposition that hearing voices is always and exclusively an auditory experience, he explored the complexity of voice phenomenology and reflected on the challenges this presents for clinical assessment.
Hearing the Voice would like to thank everyone who contributed to the first day of Working with Voices. It was great to have your feedback on how what you learned from the session will inform your clinical practice, and we’re looking forward to collaborating with voice-hearers and the TEWV tertiary psychosis team in the continued delivery of this course.
The next session in Working with Voices will take place on 6 June 2016, and will explore core skills in the treatment and management of distressing voices. For more information about the course, please see this flyer. Resources for training participants are available here.