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Research with People who Hear Voices

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I conducted six years doctoral research into dramatherapy and psychodrama as psychotherapeutic interventions with people who hear voices (auditory hallucinations) being registered at the Manchester Metropolitan University. That research, whilst building on the work of previous therapists and researchers, was ground breaking because there had not been previous focused research into what people who heard voices found helpful or not helpful in dramatherapy and psychodrama.

The Research in brief:
The research was carried out between 1996 - 2002 in two adjacent N.H.S. psychiatric services: over the years I gradually received a total of 42 referrals. I saw all referrals individually: some people chose not to follow through after the first meeting, others were seen several times and either they or I decided not to proceed for a variety of reasons. Just half of the 42 people referred, 21 people: 9 women (aged 24 - 44) and 12 men (aged 20 - 50), completed an assessment of six sessions and chose to enter the study, taking up offers of individual or group therapy. Six (4 women and 2 men) were offered 44 sessions of individual therapy. Another woman was offered 40 sessions of individual therapy. Three men who were waiting for a group were given 17 sessions of individual therapy. (All individual therapy was in weekly one hour sessions.) There were three groups (20 weekly sessions of up to two hours duration) offered sequentially: a men’s group and two mixed gender groups. Two men chose to attend two groups (of these, one man dropped out of the second group) and one woman chose to join a group after her individual therapy had ended. The low drop out rate (one woman and three men) suggests the long and careful assessment had built up a sufficient therapeutic alliance to sustain the person through the therapy. The first group suffered one drop out, the second group two drop outs, the third none. Only one person left individual therapy (after 30 sessions). Three people (two men and one woman) had experience of both individual and group therapy. For this study I was not able to gather the opinions of those who dropped out, except in one case: so the results of the study are based on the opinions of 18 people.

Not counting assessment sessions the research comprised 349 possible individual therapy sessions (of which 293 were actually attended) and 60 group sessions (60 x 17 clients = 340 client sessions (of which 237 were actually attended). This shows that people were more likely to attend individual therapy (which suggests the therapeutic alliance was stronger in individual therapy).

The following description of the characteristics of the participants reveals the rich diversity of the study, including people of different ages, ethnicity, sexuality and ability.

Age (at time of entry into the research) range from 20 - 50: 6 in their 20s; 10 in their 30s; 4 in their 40s, one aged 50.

Ethnic Diversity: One African; one S.E. Asian; one Asian; one half Jewish; one descendant of 2nd World War Ukrainian immigrants; one half Spanish adopted at birth by British couple: all of these had experienced the impact of racism; three experienced the dislocation of being a refugees from violent political upheaval: they had survived terrorism and genocide.

Disability: One wheelchair user.

Sexuality: one lesbian, one bisexual man, the others heterosexual.

Schizophrenia: 7: five women, two men (2 survivors of rape, 3 of sexual abuse, 1 of physical abuse.)
Paranoid schizophrenia: 7: five men, two women (2 survivors of sexual abuse, 2 physical abuse.)
Depression: 3: two women, one man (1 survivor of rape, 2 of physical abuse, 1 of sexual abuse)
Paranoid psychosis: 2: men (1 survivor of physical abuse, 1 of bullying)
Drug induced psychosis: 2: one man, one woman (both survivors of physical abuse)
Organic psychotic illness: 1 man (survivor of physical abuse)
Personality disorder: 2 women (both survivors of rape, 1 of sexual abuse)
‘Neurotic with voices’ (originally diagnosed schizophrenic when 21): 1 man (bullied)
Several had more than one diagnosis. Two people did not have any diagnosis of a mental illness: both were survivors of abuse. Once diagnosed with a mental illness other elements of a person’s experience, such as experiences of childhood physical or sexual abuse, may not be attended to: however there is evidence to suggest that hearing voices is a response to traumatic experiences (Romme & Escher, 2000).

Experiences of trauma:
Survivor of sexual abuse as a child: 7 (women)
Survivor of rape as an adult: 4 (two women, two men)
Survivor of physical abuse as a child: 7 (five men, two women)
Survivor of bullying as a child/young person: 3 (men)
There were many other traumas: the death of siblings, assaults, head injuries, near death experiences, witnessing murder, other losses and the traumas of mental illness. There were traumas in the parents’ and grandparents’ lives.

It is possible, even likely, that there were some traumas that were not disclosed: in the case of two men I had some evidence that they had been sexually abused: they did not disclose. Abuse may be disguised in psychotic/dissociative experiences.

Research results:
The results of my research are reported in my PhD thesis, a copy of which is available on CDRom (£ 15.00: apply to They are summarised in my book: Drama, Psychotherapy and Psychosis: Dramatherapy and Psychodrama with People who Hear Voices published by Brunner-Routledge. A brief summary of the main benefits of these creative action methods, properly applied, is as follows:


The emergence from isolation is therapeutic and leads to a reduction of voices. Social skills can be learned and practised. People can be encouraged to become more assertive, to voice feelings and opinions. These activities lead to an improvement in a person’s relationship with themselves and in their relationship with others.

Relief from tension:
Since stress exacerbates voices, the person can benefit from relieving tension through relaxation, being able to express self, feelings, frustrations/aggression. Being creative raises self-esteem, and expands people’s role repertoires, freeing them from debilitating constraints. Laughter resulting from having fun relaxes people.

Insight and integration:
Therapy can enable people to gain insight into the sources of voices in earlier experiences. Working through these enables the person to own their voices and previously split off feelings, and thus achieve some resolution/integration of the intrapsychic difficulties that were the origin of the voices. Creative activity facilitates the integration of unconscious material, strengthens the ego, and promotes personal development.

Rehearsing a future:
Recovery must be a possible future: the instillation of hope is in itself therapeutic. But hope cannot just be given to people: they must discover hope for the future through their own practical efforts and experiences. Dramatherapy and psychodrama offer the possibility of rehearsing situations and practising behaviours to achieve competence and confidence.

Distance and empowerment:
Essential to safe and effective work are the therapeutic relationships (with the therapist and other group members) and the degree of distance the person needs at any one time so as not to be overwhelmed and further disempowered. The method can empower through choices and decisions being made by the people who hear voices. Their creative expression of will and responsibility for what is co-created is empowering. In dramatherapy and psychodrama people can experience being in control or letting go of control.

Prevention of suicide and self-harm:
There is some evidence in my study that therapy reduces self-harm and suicidal behaviour as a result of the opportunity to express feelings and receive support. Therapeutic relationships hold people back from the brink.

Overall the research results suggest that dramatherapy and psychodrama, for the majority of participants, promoted intrapsychic and interpersonal change. From what participants said it is possible to assert that dramatherapy and psychodrama tended to reduce voices and their impact; to change the voices so that those that remained were less aggressive and threatening; to improve people’s coping ability, enabling personal change and a change of attitude towards the voices in the direction of people feeling more in control.

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