The experience of voice hearing and the role of self-help group: An interpretative phenomenological analysis

Abstract

Background:

Auditory verbal hallucinations (AVHs) played an important role in the psychiatric diagnostics, but in the last few decades the diagnostic-free complex phenomenological understanding of the phenomena of voice hearing became the focus of studies.

Materials:

Six semi-structured interviews with recovering voice hearers were conducted and analysed using interpretative phenomenological analysis (IPA).

Discussion:

The self-help group gives significant help in identification and dealing with the voices; therefore, it serves as turning point in the life story of voice hearers.

Conclusion:

Applying self-help group in clinical context contributes to better outcomes in treatment of voice hearers.

Keywords

Voice hearing first-person account self-help group interview qualitative interpretative phenomenological analysis

Introduction

Auditory verbal hallucinations (AVH) have historically played an important role in diagnosing psychiatric disorders. In the last few decades, however, there has been an increase in research on the phenomenology of hearing voices in multiple contexts (e.g. Woods, 2013). This change in perspective is due to three factors: (1) epidemiological data suggest several occurrences in the general population (Johns et al., 2014; Linscott & Os, 2010; Nuevo et al., 2012) and hearing voices can be a symptom of other psychiatric diagnoses (Johns et al., 2014; Larøi et al., 2012; McCarthy-Jones et al., 2014); (2) the new models of cognitive and social relationships (Chadwick, 2003, 2006; Falloon, Harangozó, & Bodrogi, 2006; Harangozó, Gordos, & Bodrogi, 2006) and hearing voices have led to therapeutic changes and (3) the recovery model, the recovery movement of voice hearing persons and user-centred experiences (Holt & Tickle, 2014; Jackson, Hayward, & Cooke, 2011) play a crucial role in integrating personal experiences and understanding into therapy. Patsy Hague and Eleanor Longden (whose story was not made public until the 2000s), the first self-identified voice hearer, considered the experience to be meaningful rather than the symptoms (Romme & Escher, 2000; Romme, Honig, Noorthoorn, & Escher, 1992). Their identities were built around voice hearing and they distinguished themselves from the more common psychiatric portrayal of schizophrenic patients. They defined themselves as experts by experience (as opposed to experts by profession), and created a symmetric peer-to-peer relationship with other hearers, which led to the development of the Hearing Voices Movement (HVM) (Corstens, Longden, McCarthy-Jones, Waddingham, & Thomas, 2014; Woods, 2013). The role of Marius Romme, the first hearing voices therapist, is also essential as he was able to help legitimise voice hearing as a non-psychiatric symptom (Romme & Escher, 2000).

Focus in the field has gradually shifted away from the external aspects and the meanings of the voices to a distinct and personalised understanding of voice hearing according to the cognitive (Chadwick, 2003, 2006) and interpersonal (Hayward, Berry, McCarthy-Jones, Strauss, & Thomas, 2013) models. Although the cognitive model emphasises the concept that a voice hearer has about the voices, the personalisation model emphasises the relationship the voice hearer has with the voices (Hayward, 2003).

Chadwick’s (2003, 2006) cognitive model integrates four fields of voice hearing experiences: giving meaning to the voice, connecting with the inner experience (acceptance of the voice), schema (acknowledgment of the positive aspects of the self) and the symbolic self (understanding of the self as dynamic and changing). The basic assumption of the personalisation model is that the relationship between the voice hearing person and the voice can be identified with the same rules as in an interpersonal relationship between two people (Paulik, 2012). The cognitive models, predominantly those developed by Chadwick and Birchwood (Birchwood & Chadwick, 1997; Chadwick & Birchwood, 1994), focus on explaining the reasons of the distress of voices and the ways in reducing this distress with the cognitive behavioural therapy (CBT).

The interpersonal theory is more consistent with the HVM (Hayward et al., 2013). Qualitative findings have demonstrated interconnection between the relational theory, the HVM and the experience of recovery (Chin, Hayward, & Drinnan, 2009; Holt & Tickle, 2014; Jackson et al., 2011). The results of relationship therapy (see Hayward et al., 2013) and recovery experiences (de Jager et al., 2015; e.g. Holt & Tickle, 2014) could all be explained with the help of the relational theory. Chin and colleagues’ (2009) interpretative phenomenological analysis (IPA) study explained the relationship between the ‘I’ and the voices using elements of Birtchnell’s relating theory (Birtchnell, 1993, 1994): the personalisation of voices, the opposition or united relationship between the ‘I’ and the voices, the proximity between the ‘I’ and the voices. A grounded theory study (Jackson et al., 2011) revealed three explanatory factors of the positive relationship between the person and the voices: reduction of fear, recognition of positive feelings and the establishment of control. These factors were grounded in different processes: personalisation of voices, personal connection to the voices, strong self-sense (the sense of independence), connection to the community and a personal and meaningful narrative about voice hearing in the life story. Consequently, these experiences led to the recovery-centred approaches and to the functional concepts of self-help groups.

Holt and Tickle (2014) emphasised the importance of the personal perspective and use of first-person singular in understanding voice hearing. The empty chair technique offers a therapeutic space where hearers can personalise the utterances of the voices and explore and seek to change the relationship with their predominant voice (Hayward, Overton, Dorey, & Denney, 2009). Woods (2013) offered a Geertzian thick description of voice hearers through her study concentrated on the social and symbolic meanings of voice hearing. Kapur and colleagues (2014) investigated the role of mental health and psychiatric institutions in voice hearers’ lives. They stated that hearers – in the initial phase of voice hearing – struggled with their providers. They anticipated receiving medical explanations for voice hearing but were met with confusion from these professionals (‘What is voice hearing? Is it a disease?’). As a result, patients were primarily frustrated and dissatisfied with these service providers. Hearers recounted more positive accounts about having the opportunity to meet with a group of people with similar problems (e.g. self-help groups and communities). In summary, the hearers (and parents of younger hearers) expected more holistic services from psychiatric institutions (e.g. groups for voice hearers, destigmatisation programmes, family and interpersonal support groups).

The aim of this study was to explore the lived experiences of voice hearing individuals by applying the IPA method to examine the ways in which participants make sense of their voices, as was previously explored by several existing IPA studies (Chin et al., 2009; de Wet, Swartz, & Chiliza, 2015; Holt & Tickle, 2015).

Methods

Participants

Based on IPA methodology (Smith, Flowers, & Larkin, 2009), a purposive sample was recruited. The research participants were from the Semmelweis University Community Psychiatry Centre Awakenings Foundation voice hearers’ self-help group. Seven female and four male participants aged 31–57 years were selected by personal contact of the interviewer or by recommendation of the treatment team or staff psychiatrist. The criteria for participating were having both a diagnosed mental health problem and a personal experience of recovery. The exclusion criterion was the presence of acute symptoms. Ethical approval was obtained from the Hungarian Medical Research Council Scientific and Research Committee.

Data collection

The study interviews were conducted in a psychiatric institution where the recovery approach is used. The institution includes an outpatient service and a daytime care unit. Treatment is based on community psychiatry (Falloon et al., 2006; Harangozó et al., 2006), in which a recovery approach is used. This includes self-help groups for voice hearers, persons with bipolar disorder, trauma survivors, and alcohol or drug addicts. The voice hearing group is self-organised based on the Mérey (2013) self-help books for voice hearers. The sessions of the self-help group of voice hearers are held every second week of the month. The group works with two professional experts (one psychiatrist and one expert of voice hearing) and two experts by experience. The sessions last for 2 hours. Participants share their experiences about voice hearing and learn how to apply the Voice Hearing Method. The Voice Hearing Method was translated by Mérey (2013) to Hungarian from study materials of the HVM (see Intervoice, 2017). These study materials, which consist of information about voice hearing and the Voice Hearing Method as well as stories of people who live with voices, are available for all self-help group participants.

To collect data, the study interviewer made an appointment with each participant. Semi-structured interviews were conducted. The initial question was a broad, generative narrative question: ‘I would like to ask you to tell me freely about your life, and especially your psychic disorders, problems or difficulties and about the recovery’.

The participants narrated their stories differently. Some of them thought there was an expectation to talk in logical, coherent narratives and others talked in time fragments and did not have a complete recovery story. The length of interviews was between 38 and 77 minutes. The interviews were recorded and transcribed.

Data analysis

The interviews were analysed using IPA (this method is applicable for research on complex and dynamic topics, see Chin et al., 2009; Rosen et al., 2015; Smith et al., 2009), which involves working with a small sample size so that each case may be analysed in great detail. Six interviews were rich enough in descriptive and interpretative narratives to be included in the analysis. Small sample was also applied in previous IPA studies (Chin et al., 2009; de Wet et al., 2015; Mawson, Berry, Murray, & Hayward, 2011). Double hermeneutics were used to explore how the participant interpreted their own experiences. The text transcript was analysed and primary themes, keywords and notes were identified. After active re-reading, emerging themes were characterised. By merging the emerging themes, master themes were defined and were illustrated with quotes from participants (who were assigned pseudonyms) (Smith et al., 2009; Smith & Osborn, 2007). According to Rodham, Fox, and Doran (2015), reliability of the IPA analysis could be ensured if conducted by multiple authors who are familiar with the research process and the method of IPA. Thus, all five authors participated in the analysis and reached consensus on emerging and master themes.

Results

During the analysis, four master themes emerged: (1) the role of the voice; (2) the relationship between the voice and ‘I’; (3) the role of the self-help group and (4) the role of the voice hearing method.

The role of the voice

The role of the voice is to make the voice hearer pay attention to an inner crisis or to other problems that are suppressed but participants did not interpret it in this way when they first began to have voice hearing experiences. The narratives about the role of the voice included a change through time in how the voice was defined initially and how it was defined at the moment of the interview. At the beginning, some had an impression that ‘hearing voices is normal. I found it normal because I knew a lot of people are hearing voices’ (Csaba). Some participants recognised that this was something different: ‘These are thoughts that differ from the average, something that excels from the others and something not ordinary’ (Iván). The voice, in almost all cases, was rough, negative, critical, direct, and in one case the voice gave positive feedback about the person being ill: ‘The voice was always convincing me, that this is not a disease’ (Veronika).

The role of the voice was reassessed over time. In contrast to the initial (mainly negative) experiences, the voice had a supportive and helper role in the present time. These changes have been largely attributed to the crucial role of the voice hearer method. In these narratives, the voice is described as positive, supportive and assisting. This encourages the person to move on, ‘to get a new direction’ (Iván), ‘to a functioning state’ (Veronika). To confront and solve the problems behind the voices requires a hearer to accept and control the voice itself.

The relationship between the voice and the ‘I’

As voice hearers learn how to handle the voices, the relationship between the voice and the ‘I’ changes. As a result, a parallel, peaceful symbiosis develops.

Narrators personalise the voices. According to the literature and previous IPA studies on the experience of voice hearing (Chin et al., 2009; Paulik, 2012; Rosen et al., 2015), this personalisation offers an opportunity to analyse the relationship between the voice and the ‘I’ as an interpersonal relationship. Therefore, the analysis focused on how participants related to their voices, how they made sense of this relationship, and if the relationship changed over time. During the examination, two relational subthemes were emerged: (1) the symmetric and asymmetric relationships and (2) position of voice.

The symmetric–asymmetric relationships

In some cases, especially in the initial phase of voice hearing, there was a one-way relationship between the voice and the individual. In this asymmetric relationship, the voice was direct and critical and several participants expressed feelings of vulnerability:

At that time there was this symptom, which was not voice hearing, but it was only a thought, like, there were like, half-like strange thought could have been … I wanted to be good for these thoughts, these were criticizing and such and … umm … and then I was always trying to suit these, so I could stop the voices. Then I was doing everything, without thinking. And … umm … this was accompanying me along, and frustrating me as well. The voices, the apparition and that it was making the man a fool, I was making myself a fool. And how exposed I was, and really, how I was acting, and such. (Aszter)

Conversely, a symmetric relationship also existed. This is when the voice takes on the helper role and the person begins to recover with the help of the voice. When the voice hearer negotiates with the voice, it is defined as a symmetric relationship. Thus, the voice hearers could change voices’ control over them by communicating with the voices, this inner conversation becomes adaptive throughout the recovery.

In the asymmetric relationship, the voice causes anxiety for the person. When the relationship becomes symmetric, the individual begins to view the voice as a governable phenomenon, considering it as an equal partner or friend. The application of the voice hearer method encourages the voice hearer to initiate conversation with the voice (Mérey, 2013). The role of shaping a symmetric relationship is to retrieve the control from the voice and allow the hearer to become less exposed and vulnerable.

The position of the voice

The participants’ intentions to understand and interpret the voices was clear from their attempts to place their voices on the self-non-self axis (although not always consciously). The positioning of the voices changes as the hearer gains acceptance for the voice.

The identification of the inner voice was present in the interviews where participants discussed recovery and the evolved relationship with the voice. This revelation demonstrates recognition and acceptance of the disorder. Acceptance is a learning process in which the hearer has to cooperate with the voices.

The role of the self-help group

During the process of learning to handle the voices, self-help groups play a significant role. In the self-help groups, participants received guidance for and explanation of their condition, which is a great crutch in the learning process:

The real breakthrough is the (Awakenings) group: they interpreted differently than the doctors … and here at the voice hearing group I come closer to what is this originating from. Let it be a symptom, for me this word is enough and also if it’s an altered state or it is caused by different troubles … this part of it began to set here. I think since I’m here at the Foundation, somehow this consciousness of the disorder, which was only depressing, it’s starting to fade away. (Veronika)

In the self-help group, the participants recognised that other people also live with this condition and the group was the place where they first experienced the acceptance which helped them overcome the anxiety caused by stigma related to their condition. Other recovered peers stood as examples and as experts by experience, providing success stories and sources of joy, making activities and suffering more meaningful.

The role of the voice hearing method

The participants noted in the interviews that the voice hearing method is the most important tool in making the shift from a passive sufferer, enabling them to initiate contact with the voices and begin communicating with them.

If the method helps the person to challenge the voices and begin communicating, the anxiety often declines, and the relationship between the self and the voice will change. In the process, the intention of the voice is reframed, the hearer’s own experience and the relationship to the self and the positive intentions are getting attention; thus, the persons regain their agency and they become able to integrate the message of the voices as a personal psychic state, emotion, thought and meaning.

The aim of the voice hearing method is to help the voice hearer learn to live with the voices. When participants recounted reconciling with the voices, subthemes emerged: building relationships with the outside world and reconciling with the outside world. The voice hearing method not only helped to control or master the voices, but also allowed some participants to live with the voices integrated into a full life. But the voice hearing also had a negative effect on some relationships with the outside world noted in one participant’s narrative: ‘It’s not that I, that I was totally incapable (laughing) of functioning, but I had problems, and because of that I didn’t have a harmonic relationship with the outside world’ (Iván).

Discussion

This study investigated the voice hearing experiences of individuals using the IPA data analysis method. IPA is often used to analyse the experience of voice hearers because it is applicable for research on complex and dynamic topics (Chin et al., 2009; Mawson et al., 2011; Milligan, McCarthy-Jones, Winthrop, & Dudley, 2012; Rosen et al., 2015; Smith et al., 2009). This study focused on how the recovery and self-help group experiences impacted the voice and the self, the change and the process of learning to coexist with the voices. Four master themes were identified: (1) the role of the voice; (2) the relationship between the voice and ‘I’; (3) the role of the self-help group and (4) the role of the voice hearing method.

Existing studies of voice hearers are typically interpret and identify the voices. Both in recent studies and in this study, the voices have a different status and meaning for the hearer and the identification is different. The relationship with the voice is not static, but is dynamic as Milligan and colleagues (2012) have argued. The meaning can change with the help of the self-help group’s different external stories, as well as with combating the condition. Finding the proper explanation has an important role in reducing anxiety and regaining control (Newton, Larkin, Melhuish, & Wykes, 2007). Rosen and colleagues (2015) found that when hearers recognised real (e.g. family members’) voices, they felt more ability to influence the voices. The personalisation makes it possible for the relationship between the voice and the self to be analysed using interpersonal relationship rules (Paulik, 2012). Hayward and colleagues (2013) emphasise that the voice hearer has to break the complementary role in the voice hearer relationship in order to end the voice’s control over the self. This complementary relationship was identified through the symmetric and asymmetric relationships discussed in this study. Participants broke the voices’ control by applying the voice hearing method. The hearer changes the relationship with the voice and its role and position by giving anti-complementary replies (i.e. asking the question or having a conversation) (Hayward et al., 2013).

Examining the position of voices, two types could be discriminated; the hearers’ regard the source of the voice internal or external. Newton and colleagues (2007) connected understanding the source of the voice and role with the agency-based explanations in psychotherapy. The passive (non-agency) explanation of the voice and the self-relationship is that the source of the voice is external (‘the voices are not inside me’). Consequently, the hearer cannot exert control over the voice because it is beyond their physical boundaries. Thus, the voice overtakes the self (Chadwick, 2006). The agency relationship of the voice and the self relates to the internal voice; thus, the person does not feel threatened. This relationship allows the hearer to cope and successfully take control over the voices (Newton et al., 2007). In this study, the internal interpretation was a consequence of the acceptance of the voice hearing condition. It was also an adequate explanation for the voices when the relationship between the voice and the self-changed and the role of the voice changed. Voice hearers who identify internal voices (thus have an adequate explanation) talk more often to the voice and feel a greater sense of control. However, it is important to note that in these cases the voice is positive and provides help during everyday activity; therefore, the hearer is less willing to control it (Rosen et al., 2015). This can result in a peaceful partnership with the voice, which Chin and colleagues (2009) called the construction of. The hearer recognises that the voice will not disappear (long-term understanding) and believes that it is therefore better to accept it than fight against it (Chin et al., 2009; Mawson et al., 2011; Milligan et al., 2012; Rosen et al., 2015).

The self-help group significantly helped the participants identify and deal with the voices. Previous IPA studies of voice hearers have found that self-help groups serve as a turning point in the life story of voice hearers (Hendry, 2011; Mawson et al., 2011; Milligan et al., 2012; Newton et al., 2007). Ruddle, Mason, and Wykes (2011) summarised the factors that help voice hearers cope. They noted that the change provided by the self-help group is primarily due to its safe (friendly, tolerant, etc.) environment, where participants can share their experiences and feel less alone. The support of others and the acceptance experienced in the group helps in the coping. Hearers receive an explanation for the voices (in this study group, doctors, peers and reading were other factors that helped), making successful coping and control possible (Newton et al., 2007).

The self-help group also helps participants improve their social skills (Ruddle et al., 2011). The voices often set boundaries in hearers’ social relationships (Mawson et al., 2011), making it a calming experience to be with similar people (Newton et al., 2007). The group also increases self-esteem (Ruddle et al., 2011), as for the voice hearer it is closely connected to the relationship with the voice and how the voice accepts her (Mawson et al., 2011). The group is not only functioning as a social support, but also enables members to see their experiences as precious and as a personal encounter. The lessons learned are value for peers to hear (e.g. coping repertoire) (Newton et al., 2007). This helps with destigmatisation (Ruddle et al., 2011). The primary aim of self-help groups is to change the relationship between the voice and the self – similarly in our study the method played a crucial role in changing the relationship – which decreases distress as a consequence (Ruddle et al., 2011).

Clinical implications

This study emphasises the changes as a result of the voice hearing method that is connected with the change in hearers’ relationship with their voices (Figure 1) and that affected the development in hearers’ social relationships (Figure 2). In the initial phase of voice hearing, social relationships decline as the voice hearer intentionally avoids those situations where they are uncomfortable. Mawson and colleagues’ (2011) study showed that voice hearers thought their voice hearing was a burden for others and therefore avoided social interaction. In the case of smaller social networks, there is a bigger emphasis on the voice, as the voice can replace the role of a friend. This relationship is considered asymmetric because the voice makes the voice hearer believe that they do not deserve the relationship. Thus, the voice hearer refuses social relationships and believes that they would be refused by others. This study shows an opening to the outside world parallel to the change in the relationship with the voice. In their study, Mawson and colleagues (2011) observed an improvement in social relationships helping with communication with the voices. Hayward and colleagues (2013) and McCarthy-Jones and Davidson (2013) indicated that there is adequate overlap in the relationships between the voice hearer and the voice and others. Therapeutic strategies that aim to restore social relationships are applicable in the voice and self relationship as well. Furthermore, the recovery from voice hearing includes a process. Relationships with others like friendship and love, along with relationships with colleagues, family members or friends that were discarded because of the voice hearing can or will be restored. A more assertive approach to do so facilitates joining the voice hearing group and work in group sessions.

Figure 1.

Relation with voices.

Figure 2.

Relation with voices and social others.

The destimatisation in the relational concept expands the function of the group in the lives of voice hearing persons. The self-help group for voice hearers is an important element of the integrated and community psychiatric approach, which could significantly improve the quality of life of voice hearers.

Limitations

Our study has several limitations. The sample was homogenous; therefore, generalisability of the results is limited. In addition, the participants attended the same psychiatric centre where the voice hearing method was applied. Other voice hearers outside of the centre may have different experiences of voice hearing and recovery from psychosis. Further limitations are based on the applied methodology. Because IPA aims to explore subjective experiences that cannot be examined with quantitative measures and IPA examines each participants’ account in great detail (Smith et al., 2009), this method is not appropriate to measure frequency and causality.

Footnotes

Acknowledgements

We are thankful to the Awakening Foundation’s colleagues and clients for their contribution, especially Dr Judit Harangozó, Head Psychiatrist, and the members of the voice hearing self-help group.

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

References

Birchwood

Chadwick

(1997). The omnipotence of voices: Testing the validity of a cognitive model. Psychological Medicine, 27, 1345–1353.

Birtchnell

(1993). How humans relate: A new interpersonal theory. Westport, CT: Praeger.

Birtchnell

(1994). The interpersonal octagon: An alternative to the interpersonal circle. Human Relations, 47, 511–529.

Chadwick

(2003). Two chairs, self schemata and a person model of psychosis. Behavioural and Cognitive Psychotherapy, 31, 439–449.

Chadwick

(2006). Person-based cognitive therapy for distressing psychosis. Chichester, UK: Wiley.

Chadwick

Birchwood

(1994). The omnipotence of voices: A cognitive approach to auditory hallucinations. British Journal of Psychiatry, 164, 190–201.

Chin

J. T.

Hayward

Drinnan

(2009). Relating to voices: Exploring the relevance of this concept to people who hear voices. Psychology and Psychotherapy: Theory, Research and Practice, 82, 1–17.

Corstens

Longden

McCarthy-Jones

Waddingham

Thomas

(2014). Emerging perspectives from the hearing voices movement: Implications for research and practice. Schizophrenia Bulletin, 40, 285–294.

de Jager

Rhodes

Beavan

Holmes

McCabe

Thomas

Hayward

. (2015). Investigating the lived experience of recovery in people who hear voices. Qualitative Health Research, 26, 1–15.

10.

de Wet

Swartz

Chiliza

. (2015). Hearing their voices: The lived experience of recovery from first-episode psychosis in schizophrenia in South Africa. International Journal of Social Psychiatry, 61, 27–32.

11.

Falloon

Harangozó

Bodrogi

(2006). Közösségi pszichiátria kézikönyve. Budapest, Hungary: Ébredések Alapítvány. /The Hungarian Handbook of Community Psychiatry. Budapest, Hungary, Awakeing Foundation/

12.

Harangozó

Gordos

Bodrogi

(2006). A pszichózisok kognitív viselkedésterápiája. In Mórotz

Perczel

F. R.

(Eds.), Kognitív viselkedésterápia (pp. 611–656). Budapest, Hungary: Medicina. /The cognitive-behavioral therapy of psychosis, In Mórotz

Perczel

F. R.

(Eds.), Cognitive behavioral therapy (pp. 611–656). Budapest, Hungary: Medicina /

13.

Hayward

(2003). Interpersonal relating and voice hearing: To what extent does relating to the voice reflect social relating? Psychology and Psychotherapy: Theory, Research and Practice, 76, 369–383.

14.

Hayward

Berry

McCarthy-Jones

Strauss

Thomas

(2013). Beyond the omnipotence of voices: Further developing a relational approach to auditory hallucinations. Psychosis, 6, 242–252.

15.

Hayward

Overton

Dorey

Denney

(2009). Relating therapy for people who hear voices: A case series. Clinical Psychology and Psychoteraphy, 16, 216–227.

16.

Hendry

G. L.

(2011). What are the experiences of those attending a self-help hearing voices group: An interpretative phenomenological approach. Leeds, UK: The University of Leeds.

17.

Holt

Tickle

(2014). Exploring the experience of hearing voices from a first person perspective: A meta-ethnographic synthesis. Psychology and Psychotherapy: Theory, Research and Practice, 87, 278–297.

18.

Holt

Tickle

(2015). ‘Opening the curtains’: How do voice hearers make sense of their voices? Psychiatric Rehabilitation Journal, 38, 256–262.

19.

Intervoice. (2017). The International Hearing Voices Network. Available from http://www.intervoiceonline.org/

20.

Jackson

Hayward

Cooke

(2011). Developing positive relationships with voices: A preliminary grounded theory. International Journal of Social Psychiatry, 57, 487–495.

21.

Johns

C. L.

Kompus

Connel

Humpston

Lincoln

T. M.

Longden

… Larøi

(2014). Auditory verbal hallucination persons with and without a need for care. Schizophrenia Bulletin, 40, S255–S264.

22.

Kapur

Hayes

Waddingham

Hillman

Deighton

Midgley

(2014). The experience of engaging with mental health services among young people who hear voices and their families: A mixed methods exploratory study. BMC Health Services Research, 14, 527.

23.

Larøi

Sommer

E. I.

Blom

J. D.

Fernyhough

Ffytche

D. H.

Hugdahl

… Waters

(2012). The characteristic features of auditory verbal hallucinations in clinical and nonclinical groups: State-of-the-art overview and future directions. Schizophrenia Bulletin, 38, 724–733.

24.

Linscott

R. J.

(2010). Systematic reviews of categorical versus continuum models in psychosis: Evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annual Review of Clinical Psychology, 6, 391–419.

25.

Mawson

Berry

Murray

Hayward

(2011). Voice hearing within the context of hearers’ social worlds: An interpretative phenomenological analysis. Psychology and Psychotherapy: Theory, Research and Practice, 84, 256–272.

26.

McCarthy-Jones

Davidson

(2013). When soft voices die: Auditory verbal hallucinations and a four letter word (love). Mental Health, Religion & Culture, 16, 367–383.

27.

McCarthy-Jones

Trauer

Mackinnon

Sims

Thomas

Copolov

D. L.

(2014). A new phenomenological survey of auditory hallucinations: Evidence for subtypes and implications for theory and practice. Schizophrenia Bulletin, 40, 231–235.

28.

Mérey

(2013). A hanghalló önsegítő csoport anyagai I-II. Budapest, Hungary: Ébredések Alapítvány. /Self-help exercise group for voice hearers I-II. Awakenings Foundation/

29.

Milligan

McCarthy-Jones

Winthrop

Dudley

(2012). Time changes everything? A qualitative investigation of the experience of auditory verbal hallucinations over time. Psychosis, 5, 107–118.

30.

Newton

Larkin

Melhuish

Wykes

(2007). More than just a place to talk: Young people’s experiences of group psychological therapy as an early intervention for auditory hallucinations. Psychology and Psychotherapy: Theory, Research and Practice, 80, 127–149.

31.

Nuevo

Chatterji

Verdes

Naidoo

Arango

Ayuso-Mateos

J. L.

(2012). The continuum of psychotic symptoms in the general population: A cross-national study. Schizophrenia Bulletin, 38, 475–485.

32.

Paulik

(2012). The role of social schema in the experience of auditory hallucination: A systematic review and proposal for the inclusion of social schema in a cognitive behavioural model of voice hearing. Clinical Psychology and Psychotherapy, 19, 459–472.

33.

Rodham

Fox

Doran

(2015). Exploring analytical trustworthiness and the process of reaching consensus in interpretative phenomenological analysis: Lost in transcription. International Journal of Social Research Methodology, 1, 59–71.

34.

Romme

M. A.

Escher

(2000). Making sense of voices. London, England: MIND.

35.

Romme

M. A.

Honig

Noorthoorn

E. O.

Escher

A. D.

(1992). Coping with hearing voices: An emancipatory approach. British Journal of Psychiatry, 161, 99–103.

36.

Rosen

Jones

Chase

Grossman

L. S.

Gin

Sharma

R. P.

(2015). Self, voices and embodiment: A phenomenological analysis. Journal of Schizophrenia Research, 2, 1008.

37.

Ruddle

Mason

Wykes

(2011). A review of hearing voices groups: Evidence and mechanisms of change. Clinical Psychology Review, 31, 757–766.

38.

Smith

J. A.

Flowers

Larkin

(2009). Interpretative phenomenological analysis: Theory, method and research. London, England: SAGE.

39.

Smith

J. A.

Osborn

(2007). Interpretative phenomenoligical analysis. In Smith

J. A.

(Ed.), Qualitative psychology: A practical guide to research methods (pp. 53–80). London, England: SAGE.

40.

Woods

(2013). The voice-hearer. Journal of Mental Health, 22, 263–270.