My research question arose from my first therapeutic experience with a client who hears voices. I felt unprepared and uncertain about how to work with her. I wondered how other therapists experienced working with clients who hear voices. These are voices heard with no physical origin, experienced as real and which psychiatry typically describes as hallucinations. This research provides an empirical account of the individual lived experiences of seven therapists undertaking such work using an interpretative phenomenological analysis. These seven participants were recruited using snowballing emails and included four counsellors, a psychotherapist, a nurse therapist and a counselling psychologist working in various settings. The literature points to which therapeutic approaches are most useful and identifies an important role for Counselling Psychology. There is no research which explores the experience of therapists working with clients who hear voices or what it is like for them to work with such clients. The main body of the research literature focuses on what it means for people to hear voices and how therapists can help them cope. I was interested in the impact this has on the therapist and the therapeutic relationship and what the unique aspects of this work might be. The analysis gave rise to six superordinate themes which were; 'Questioning their competence', 'Relational experience of the work', 'Struggles and difficulties', 'Sense of reality and the unknown', 'Surviving and coping' and Characteristics of client and voices'. These themes are explored in the findings section and discussed in relationship to the extant literature. In gaining this phenomenological perspective this research offers an insight into some of the difficulties of work with this client group. These insights propose a useful contribution towards continuing professional development training courses, initial training programmes, guidelines for supervision and understanding of the impact on therapeutic practice.

The phenomenon of auditory hallucinations in clinical populations of non-psychotic children is an intriguing and little understood area. To date, investigations in this area have reported on a range of correlates, including family histories of psychiatric illness, family dysfunction, and significant levels of stress in the children themselves. The current study reported on 10 non-psychotic children drawn from a number of community based child and family agencies that provide therapeutic out-patient services. Consistent with previous studies this study found strong associations with family dysfunction, specifically family break-up, as well as significant levels of anxiety and depression in the these children. In addition, half the children reported the presence of imaginary companions. Despite some confirmation of previous findings, many other features of this phenomenon remain unanswered including the different psychological functions that hallucinations and imaginary companions serve for emotionally troubled children. Two case studies describe the family histories and hallucinations in more detail. / Thesis (MPsy(Clinical))--University of South Australia, 2006.

The phenomenon of auditory hallucinations in clinical populations of non-psychotic children is an intriguing and little understood area. To date, investigations in this area have reported on a range of correlates, including family histories of psychiatric illness, family dysfunction, and significant levels of stress in the children themselves. The current study reported on 10 non-psychotic children drawn from a number of community based child and family agencies that provide therapeutic out-patient services. Consistent with previous studies this study found strong associations with family dysfunction, specifically family break-up, as well as significant levels of anxiety and depression in the these children. In addition, half the children reported the presence of imaginary companions. Despite some confirmation of previous findings, many other features of this phenomenon remain unanswered including the different psychological functions that hallucinations and imaginary companions serve for emotionally troubled children. Two case studies describe the family histories and hallucinations in more detail. / Thesis (MPsy(Clinical))--University of South Australia, 2006.

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Thesis (Ph.D)--Murdoch University, 2004. / Thesis submitted to the Division of Health Sciences. Includes bibliographical references (p. [503]-531).

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Bakgrund: Schizofreni är en psykossjukdom med hög suicidrisk. Det vanligaste symtomenet vid schizofreni är hörselhallucinationer som kan upplevas både i positiv och negativ anda. Det råder stigmatisering kring sjukdomen där kunskapsbrist och rädsla för personen tros ligga till grund. Syfte: Att beskriva vuxna personers upplevelser av hörselhallucinationer vid schizofreni. Metod: Litteraturöversikten baserades på 12 vetenskapliga artiklar där nio av dem hade en kvalitativ ansats och tre med kvantitativ ansats. Dessa artiklar hämtades från databaserna CINAHL Complete, PubMed och PsycINFO. I databaserna användes följande sökord: hallucination, voice hearing, psychosis, patient, life, hearing voices, nursing, people who hear voices, auditory hallucinations, schizophrenia och experiences. Resultat: Resultatet delades upp i fyra teman: I Röstens natur och intention beskrevs röstens ton, känsla, intensitet och varaktighet. Relationen till rösten belyste personens identifiering och personifiering av rösten där den kunde ses som något kroppseget eller som en enskild individ. Meningsskapande och copingstrategier angav olika strategier personen använde i syfte att klara av och hantera rösterna. Påverkan på individen belyste hur personen påverkades av rösten genom förändrad självbild och självskada, isolering och kontrollförlust. Diskussion: Resultatet diskuterades utifrån begreppen livsvärld och meningsskapande där meningsskapandet kunde ses som en central del i personens förmåga att hantera situationen med hörselhallucinationerna. / Background: Schizophrenia is a mental disorder with a high suicidal risk. The most common symptoms experienced with schizophrenia are auditory hallucinations which can be experienced both in a positive and a negative way. The disorder is stigmatized most likely due to a lack of knowledge and a fear of the person. Aim: To describe adults experiences of auditory hallucinations induced by schizophrenia. Method: The literature review consisted of twelve scientific articles of which nine were conducted using a qualitative approach and three with a quantitative research methodology. The articles were found in the databases CINAHL Complete, PubMed and PsycINFO. The following words were used in the databases: hallucination, voice hearing, psychosis, patient, life, hearing voices, nursing, people who hear voices, auditory hallucinations, schizophrenia and experiences. Results: The results were divided into four themes: The nature of the voice described the characteristics of the voice i.e. tone, feeling, intensity and duration. The relation to the voice described how the affected persons identified the voice as a part of themselves. Finding meaning and coping strategies described the different strategies which were used to cope with the voices. The impact on the individual highlighted how the person was affected by the voices by an altered self, added self-harm behavior, isolation and loss of control. Discussions: The results were discussed with the concepts of life world and finding meaning. Finding meaning was found as one of the affected person’s most important coping strategies for dealing with the auditory hallucinations.

This thesis is comprised of three papers. Paper 1 presents a systematic review on the evidence for the relationship between appraisals of auditory verbal hallucinations and voice-related distress in psychosis. A literature search was conducted using the following electronic databases: Web of Science, PsycINFO, Embase and Pubmed. Twenty-four studies were identified that satisfied inclusion criteria for the review. Several types of appraisals were found to be associated with distress in voice-hearers: malevolence, control, power, origin of voices and benevolence beliefs. Evidence for an association was particularly strong for malevolence and control appraisals, indicating that these may be important to target in interventions. Overall findings generally supported that modification of voice appraisals, particularly malevolence, power and control appraisals, in cognitive therapy is associated with a reduction in voice-related distress. Paper 2 presents an experimental study which explored whether people who are exposed to stressful material are more likely to report hearing voices when they are not present (i.e. false alarms). Factors that may predict or moderate voice-hearing were also explored. A non-clinical sample (N = 130) completed measures of trauma history, hallucination proneness, dissociation, affect and attachment styles, before being allocated to view pictures depicting stressful interpersonal scenarios or pictures with neutral interpersonal scenarios. Participants then completed a voice detection task. False alarms were recorded as a proxy measure of voice-hearing. Participants in the stressful group reported significantly higher levels of stress than in the neutral group. No differences were found in false alarms. Physical abuse history and depersonalisation significantly correlated with false alarms. This study indicates that people with physical abuse history and dissociative tendencies may be more vulnerable to hearing voices; clinically, these factors should therefore be assessed. However, findings of this study should be interpreted tentatively due to lack of diversity within the sample. Paper 3 is a critical reflection of the systematic review, the empirical paper and the research process as a whole. Strengths and limitations of the presented research are discussed as well as directions for future research.

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