Presents Peter Bullimore Day 2 9.00am – 12.30pm Workshop 1 Understanding & Working with Voices

1. Presents Peter Bullimore Day 2 9.00am – 12.30pm Workshop 1 Understanding & Working with Voices

2. What does hearing voices mean to you? How do you explain them?

3. How Common is it to Hear Voices? • 10-25% of the general population- at least once • A recent study found that 16% of over 1000 people with no psychiatric history had heard voices. • Based on that figure 10 million people in Britain and 47 million in US have heard voices.

4. Calling a person who cannot cope with the voices “ill” is understandable when voices and the emotions or behaviour they provoke are dominating the persons functioning and life. It is reasonable to call the person “ill” when the voices are not integrated part of the person but destroy ones free will.

5. It is not right however to look at hearing voices in itself as a symptom of an illness…it is the coping with that experience that might give rise to the emotions and behaviour that can be called ill. • It is harmful to identify hearing voices as a disease.

6. In many instances voices are reactions to problems in life and between people (Romme et. al). • Voices are real; arguments about whom they are real for, are pointless • Voices in themselves may not be the problem, but rather the relationship they have with them; the power they have and their influence in a persons’ life may be the problem.

7. Some Causes of Hearing Voices • Neurological Reasons • Sexual Abuse • Physical Abuse • Emotional Neglect/Abuse • High levels of stress • Being bullied • Bereavement • Solitary Confinement • The use of certain drugs • Sleep Deprivation • Adolescent problems • Other traumatic experiences (loss, being held hostage etc.)

8. Hearing Voices Exercise

9. 450 people who heard voices responded •  300 were unable to cope •  150 accepted their voices and could cope with them

10.  Hearing voices in psychiatry • Is hearing voices in itself a psychiatric condition? • Does it indicate the presence of a specific disorder? • Do certain characteristics of hearing voices indicate certain disorders?

11. Hearing voices in itself is not a sign of a mental illness, but a sign of a problem. • Becoming a patient is due to the inability to cope with voices and underlying problems.

12. In our society there are more healthy people hearing voices, than there are ill people hearing voices. • Voices are messengers that sometimes bring awful messages. • Hearing voices is apparent in healthy people.

13. The focus of helping at this stage should be the reduction of anxiety through anxiety management techniques. Medication may be useful at this time in helping to reduce anxiety.

14. Help must be given with full recognition and acceptance of the actual voice hearing experience of the person. The next step is to seek possible ways of gaining control over the voices. It is important to foster a sense of security by showing amongst other things, emotional involvement and by taking careful note of events and their timings.

15. Contact with other voice hearers during this phase can be valuable in reassuring people that they are not alone. In due course one should try to bring some fundamental order to the person’s daily routine. It is important for friends and family to be supportive rather than critical at this stage.

16. When the initial anxiety and confusion has been reduced or temporarily suspended it is possible to concentrate on organising the voices and the hearer’s relationship with them. During this stage detailed attention is paid to such issues as;

17. Analysis of the possible significance of the voices to the hearer with the regard to both past and present. This can be done through an exploration of the hearer’s history. • The meaning of the voices in the person’s daily life. • The influence of the family’s attitude to the voices. • Accompanying symptoms of dissociation or emotional repression. • And/or any symptoms suggesting a delayed development of the self.

18. Landmine Lost Cherished Pet Bullied at School Fear Irrational Lost Favourite Grandparent

19. What you did was wrong • I am angry at you for doing it • I am going to stop you doing it again • Helps unlock frozen terror

20. Particular circumstances under which the voices are heard. • What they have to say. • The nature of any triggers and accompanying perceptions. • Attention will be paid to the social position of the person, her or his degree of dependence, the necessary social provisions, and the available opportunities to develop and present a full identity as someone who hears voices.

21. HOUSING •  BEING BELIEVED •  “JOB” • SELF-CONFIDENCE •  SELF-ESTEEM •   SELF-BELIEF

22. In this phase, the focus is primarily on expanding knowledge and developing the personality through the use of various therapies. • This is the period when people have begun to learn to live in balance with their voices, the voices are seen as being a part of the person.

23. The relationship with the voices is more reasonable, they have a more positive influence and become less controlling, but people can choose to follow their advice if they want to. • In this phase people are less anxious about their voices.

24. ‘What this research shows is that we must accept that the voices exist. We must also accept that we cannot change the voices. They are not curable, just as you cannot cure left-handedness-human variations are not open to cure- only to coping. Therefore to assist people to cope we should not give them therapy that does not work. We should let people decide for themselves what helps or not. It takes time for people to accept that hearing voices is something that belongs to them.’ Marius Romme

25. Crazy theories Cats cause schizophrenia Rape seed Pollution Thrush Masturbation Pink spot Red spot Stilettos Chlamydia

26. They may be felt to occur: • In the head • In the ears • In some other part of the body • They can be internal • They can be external

27. They may be: • Male • Female • Genderless • Both sexes • Belong to people known to the hearer • Unknown to the hearer • One voice or several

28. They may: • Mumble • Whisper • Speak in a foreign language • Be critical • Be approving • Tell people what to do • Keep a running commentary of what the hearer is doing • Repeat the person’s thoughts • Instruct

29. They may: • Guide • Advise • Be frightening • Negative • Unwelcome • Helpful • Some people feel that the voices are trying to gain control over their lives • Some people may experience a loss if the voices disappear

30. Coping with Stress • How do you cope with stress? • How would a voice hearer cope with stress?

31. Voice profiling looks at who the voices are and how they influence you. • The purpose of profiling is to make it clearer to yourself and others what exactly are the natures of your experiences and how they influence your life.

32. You need to try and identify who the voices are and how they affect you. • If you do not know who the voice/s are give it a name maybe one that sums it up. • A voice profile is a representation of who your significant voices are and how they affect you.

33. This helps in two ways. Firstly, when you can be clear about the identity of the voice/s you tend to feel more in control. •  Secondly, if people want to help you they can see from profiles what the real problems are and when you need them most. • Remember profiles can change over time, for many people there are many voices, only one or two of them are usually problems, sometimes the other voices can be helpful. • To start voice profiling use a I have just heard a voice check list.

36. Voice intensity levels 5am 6am 7am 8am 9am 10am 11am 12am 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm 9pm 10pm 11pm 12pm 1am • Use the chart to identify the intensity of the voices simply draw a line to represent the intensity (0 just a mumble, 5 very loud) • Why is this information useful • What do you notice about your voices and their intensity levels • What is the best time of day for you to work on your voices

37. Thought stopping This is a technique originally developed for people with disabling obsessions. It is used to try to control unwanted intrusive thoughts. For some people there are a lot of similarities between these kind of thoughts, voices and persecutory feelings and so it was thought that the technique might be useful.

38. FIRST SESSION – You raise your hand when the voices start. The person with you then shouts, “stop it”, until you drop your hand to indicate that the voices have stopped. This is then repeated. Counting the number of times “stop it” is shouted before there is an effect can be a useful barometer of progress as this usually decreases with repeats of the exercise. SECOND SESSION – Everything is the same apart from now it is you that shouts, “stop it”, until the voices go. You can try decreasing the volume of your voice as you get more practised.

39. Practice between sessions before saying, “stop it” in your head if in a public place. THIRD SESSION – As before but you whisper “stop it”, until the voices go. FOURTH SESSION – As before but now you practise just thinking “stop it”, until the voices go.

40. Focussing Focussing on your voices can have positive effects for a number of reasons. Firstly, unless you know who your voices are and what they are saying it is hard to understand them and take some control. People who hide or run from their voices end up with little peace. Focussing on voices has been shown, for some people, to reduce the frequency of and distress caused when people hear voices. This approach has worked best for people who can attribute elements of their voices to how they themselves feel. Focussing looks at your experience today and by knowing more about that, things can be made less frightening and your power over your voices can be increased.

41. FOCUSSING ON YOUR VOICES QUESTIONNAIRE How many voices are you hearing now? 0 1 2 more than 3 Crowds Are they separate or mumbling? Separate Mumbling Do you know who the voices are? Yes No Can you tell what they are saying? Yes No Are the voices the same gender as yourself or different? Same gender Different No gender

42. How loud or quiet are the voices? Compare them to someone speaking to you. Whispering Quiet Normal Loud Shouting How do they make you feel? Nothing Good Bad Happy Sad Afraid Powerful Special Overwhelmed Other.................................................................. How do you hear them? Ears Body In my head Telepathically Other............................................................. Can you communicate with the voices? Yes No

43. Sue Aged 21 I hear two voices They are separate I know who they are I know what they say One is male and one female They shout and make me feel bad and sad I hear them in my head I cannot communicate with them

44. A Conversation between myself and Sue Aged 21 Me) So there are two voices, you describe as male and female and you know their identities. Can you tell me who they are? S) Mum & Dad Me) They shout at you and this makes you feel bad & sad. Can you tell me what they say? S) At times we wish you had never been born Me) Do you hear this constantly in your head? S) Yes Me) Do you believe what they say is true? S) Yes because they said it

45. Me) Can you tell me when they said it?S) When I was 16 years old Me) Do you no why?S) YesMe) Can you explain the circumstances?S) I had stopped out until 4am with my new boyfriend and not told them where I wasMe) Do your parents love you?S) YesMe) Could they have been really worried?S) I Guess so

46. Me) Did you ever apologise to them? S) No Me) Your parents said at times we wish you had never been born, not we wish you had never been born. Would you have been angry if you had been in their situation? S) Guess so I would ground a child of mine if they stayed out that late Me) Do you think you are feeling guilty still for not apologising? S) I do feel guilty Me) Do you think the voices might be trying to help with your guilt? S) It makes sense

47. Me) Did you ever apologise to them? S) No Me) Your parents said at times we wish you had never been born, not we wish you had never been born. Would you have been angry if you had been in their situation? S) Guess so I would ground a child of mine if they stayed out that late Me) Do you think you are feeling guilty still for not apologising? S) I do feel guilty Me) Do you think the voices might be trying to help with your guilt? S) It makes sense

48. Checking if what they say is true...

49. Postponing orders/ Extending time

50. Creating boundaries/ Chastise them/ Don’t accept abuse We all have rights as human beings and can use these in our discussions with our voices. We should not expect to be spoken to or treated badly and the same is true of the voices that you hear.