It seems a good idea to republish this sequence from almost four years ago to complement the current new sequence on collaborative conversation. This is the second of six.
Using Conversation: a Surface Approach
Following on from his comments about trust and the importance of being helped to work on issues in-between sessions, Ian also talked of two main ways he felt he had been helped by the conversations with me. He felt he had learnt how to “bargain” with the voices.
P.: And you feel that [dealing with emotions: see below for more] was a very important aspect of what we were doing together?
I.: And the suggestion that I could bargain with the voices.
P.: Right. So in fact there were then two things. One was the emotions that you got in touch with about the separation from your partner, and there was also it was suggested to you that you could bargain with the voices.
P.: Can you say a bit more about one or other of those? Why you felt they were important?
I.: Well, because I’d tried telling them in the hospital, you know, that I’d been trying to talk to the voices. And they kept discouraging me and said I shouldn’t talk to the voices. I should ignore ’em. And I kept saying `Well, I should talk to them, you know, because I can get in touch with them.’ I’d felt that all along. And you supported it. And told me to talk to the voices, you know. With a bit of confidence.
P.: And what did you say to the voices? What was your approach to them?
I.: I said `I know that you’re unhappy. But I don’t know why you’re unhappy, but I’ll talk to Peter about it. And see if we can’t get to the bottom of it. And I’ll try to make you happy.’
P.: Yeh. And did you ask them if they could do something in return?
I.: Yes, I asked them if they could let me sleep.
P.: Right. And did they?
P.: Did they do it straightaway or . . .?
I.: No, it took a coupla nights.
P.: Right. But then after a couple of nights they did give you a break?
I.: Yeh. They give me a break, yeh.
P.: I need to ask you this as well. Did you think that that was actually going to be of any use before you did it?
I.: No, because I didn’t think I could get in contact with the voices so easily. I thought it would take a lot longer, you know? But I found that it happened pretty quickly.
P.: Yeh. It was important was it that it happened quickly?
P.: Do you think you would have had the patience to keep going if it didn’t?
I.: I don’t know.
This I would describe as a surface approach and bargaining in this way has been used by many others as well as Ian. Surface approaches range from recommending that people use earplugs or Walkmans as a distraction from the voices, through reading out loud as a way of disrupting the voices, to examining in detail the experience of the voices in its own right, which is called focusing (see below).
Using Conversation: a Depth Approach
Ian also mentioned how he had realised that the pain of breaking with his partner had contributed to his experience of the voices.
I.: I knew there was something wrong with me. But I didn’t know what it was. And I knew something was bothering the voices. And I think it was over the split up with my partner, you know, and the pain that that caused.
P.: Yeh. Which you hadn’t dealt with?
I.: Which I hadn’t dealt with. I just pushed it to one side.
P.: So is that why it was important to deal with that then, with that pain?
P.: Can you explain that, rather than me putting the words into your mouth? Why do you think it was important to deal with the pain of that?
I.: Because I hadn’t come to terms with it, you know? I still loved my partner and I was still hoping that somehow we could get together, you know? But I’ve give up that idea now. And I’ve put her in the past.
P.: Right. So, do you feel that that sadness was something that had some kind of effect on the voices or . . .?
P.: What kind of effect do you think it had?
I.: Because I was sad inside and because I was still hanging on, really, they kept plaguing me, you know? They were feeding on my unhappiness. And it was being unhappy that was causing the voices to be unhappy. But having talked about my partner and coming to terms with it and crying and feeling it, you know, and it really hurt and I didn’t want to go on with it at first because I thought it hurt too much but I knew that I had to go on with it, if I wanted to have peace of mind.
P.: Right. And that’s what kept you going was it?
I.: Peace of mind, yeh.
P.: Right. And presumably the fact that the voices did respond to your bargaining earlier on, did give you some hope that if you actually carried doing this process, that they’d leave you alone even more.
I.: Yeh. I thought that if I got it all out in the open, you know? And – er – I was able to think for the first time in eight years.
This is more of a “depth” approach. We were looking at what might lie behind the experience of the voices. Ian discovered that by acknowledging his emotional pain he could dispel the voices. Discounting emotional pain can lead to problems of other kinds as well as voices, but hearing voices is often the result of trauma and therefore connected with emotional pain.
Many people discover that working on what lies behind the voices can help them control the voices. Other people find this too painful and prefer to stick with surface approaches which are nonetheless quite powerful. There is evidence to suggest that distraction is not quite so good in the long run, leaving people with a lower sense of self-efficacy and a greater vulnerability to depression.
Focusing, which is still a surface approach, is better if the person can cope with it. Self-efficacy is enhanced and subsequent depression less likely.
Focusing involves turning your attention to the patterns contained in the experiences you are having. When your experience is dominated by threatening and demonic voices, focusing is a scary business. However, if you can make yourself do it, it brings dividends.
The characteristics of the voices (in Ian’s case a bullying male voice) and the specific content (with Ian it was orders such as ‘Get out of bed you lazy bastard’) can help identify why the voices have taken this particular form: Ian’s first breakdown had been in the army when he was under the command of a particularly unpleasant sergeant-major. His army experiences proved important in understanding other aspects of his psychotic experience as well, but that is another and much longer story. So, it was very useful to get this early hint about that.
When they occur, how often, and under what circumstances, can help us see what triggers them.
My only one session successful intervention was with a someone who heard sadistic voices insisting that he would be tortured if he did not find out where bombs were being planted. Until a couple of years before, his voices, which had been with him 25 years or more, were always friendly and helpful. We tried to work out what had changed. It turned out that about two years ago he had developed a strong interest in the Second World War and was reading avidly and constantly about the Gestapo and the Resistance Movement. We decided between us that he should experiment with desisting from any reading around this subject for the next four weeks and then we would meet against to compare notes.
As he believed the voices were real, and therefore in his view autonomous and beyond his influence, he did not have a great deal of confidence in this approach! He agreed to do it, I believe, in part to prove me wrong. He decided to pursue his other main interest at the time and to read the National Geographic magazine instead.
He was plainly astonished but delighted when the sadistic voices disappeared and his friendly voices returned.
Focusing can be very effective especially when it is linked to practical action in this way on the basis of what you have learned.
In the next post we will be looking at some complicating factors.