Some forms of talking therapy are aimed at encouraging people to be kinder and more accepting of themselves, their voices and other people. In what follows, we consider two of these: Compassion Focused Therapy (CFT) and Acceptance and Commitment Therapy (ACT). Both of these therapies are supposed to reduce distress by making difficult voices easier to manage.
Compassion for voices
Compassion Focused Therapy (CFT) is often used for the treatment of mental health problems linked to shame, self-criticism and self-hate, including anxiety, depression and psychosis. It was originally devised by a psychologist called Paul Gilbert.
CFT is based on the idea that our emotions are governed by three different systems:
- The Threat System – which alerts us to dangers and activates defensive strategies such as anxiety, anger and shame;
- The Drive System – which motivates us to seek resources and rewards; and
- The Soothing System – which provides feelings of safety, rest and contentment.
If we have experienced repeated trauma (particularly during childhood), our threat focused system dominates so that our thoughts, feelings and behaviours are taken up with fear, danger and trying to keep ourselves safe. (It’s not our fault we do this – humans have simply evolved to be this way.) CFT aims to regulate threat by building feelings of safety through breathing and grounding exercises, use of imagery to activate the soothing system, and through cultivating compassion for ourselves and for others.
Charlie Heriot-Maitland has recently adapted CFT for the treatment of distressing voices in the UK. On this approach, voices are viewed as meaningful strategies for dealing with distress, rather than symptoms of an illness. The client is encouraged to develop a compassionate self – a safe, non-judgemental perspective from which they can explore the function and meaning of their voices and how they might be linked to difficult life experiences. The aim of the therapy is not necessarily to make the voices go away, but to reduce distress by giving the voice-hearer new ways of relating to them and understanding what they mean.
Compassion Focused Therapy for distressing voices is available through the NHS in some parts of the UK but it is not available in all services. If it is not available in your area, there are private practitioners who are trained in CFT and can offer support. More information can be found on the Balanced Minds website.
Compassion Therapy for Voice-hearing
Find out more
Charlie Heriot-Maitland (2018). Social Connectedness and the Future of Compassionate Mental Health. Compassionate Mental Health Blog.
Charlie Heriot-Maitland (2016). Charlie Heriot-Maitland on Compassion and Psychosis. Psychology Today.
‘Engaging with Voices with Charlie, Rufus and Elisabeth’
A YouTube playlist of 15 videos intended as inspiration and support for people interested in engaging with voices.
Acceptance and commitment therapy
Acceptance and Commitment Therapy (ACT) encourages people to accept the fact that they hear distressing voices and commit to living a valuable and worthwhile life in spite of having these experiences. Acceptance often involves ‘just noticing’ thoughts, feelings and difficult experiences without trying to resist, avoid or suppress them. It isn’t just about passively tolerating difficult voices, but about actively making space for them in your life without an unworkable struggle.
The aim of ACT is to change the way a person reacts to their voices rather than the content and frequency of the voices themselves. This helps to reduce their impact and enables the person to focus on more valuable activities. For example, through acceptance work, someone who usually reacts to hearing voices by isolating themselves and arguing with them may develop different ways to respond. This might include going for a walk, having a conversation with another person, or deliberately engaging in something else they like or want to do.
The NHS does offer ACT for distressing voices, but this is dependent whether or not there is a clinician trained in ACT in your area. It is also available privately, but for a fee.
ACT for Recovery disrupted my revolving door, long sessions in locked psychiatric hospitals, and led to my learning how to productively identify constructive approaches and manage challenges to ensure my enjoyment daily, of a quality of life with my mental health diagnoses, that had been denied to me before this therapy. Prior to ACT, my psychosis was indeed so pronounced, aggressive and bleak, that I also spent time in prison. ACT for recovery was my final attempt at therapy.