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Facilitator Peter Bullimore 450 people who heard voices responded 300 were unable to cope 150 accepted their voices and could cope with them Full day.

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Presentation on theme: "Facilitator Peter Bullimore 450 people who heard voices responded 300 were unable to cope 150 accepted their voices and could cope with them Full day."— Presentation transcript:

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2 Facilitator Peter Bullimore

3 450 people who heard voices responded 300 were unable to cope 150 accepted their voices and could cope with them Full day working with voices workshop

4 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?

5 There are quite a few voice-hearers who cannot be diagnosed with a psychiatric diagnosis when using an appropriate diagnostic instrument. The number of such people in the general population is even higher that those voice- hearers who can be diagnosed with a psychiatric disorder.

6 Hearing voices is found in many different conditions. When it appears as part of a complex of symptoms diagnosed in schizophrenia, the complex consists partly of hearing voices as a reaction to a serious event or identity which cannot be coped with, and partly of a secondary reaction, to an inability to deal with the voices. In other words the whole complex of schizophrenia symptoms does not have to be the consequence of illness.

7 Hearing voices is a very personal experience, differing from person to person in terms of what the voices say, and the life events and ideals that provoke them. When analysed properly, the relationship between the voices and the life-history can show that the voices make sense when looking at the circumstances in life which provoked them.

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

9 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.

10 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.

11 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.

12 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.

13 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.

14 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;

15 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.

16 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.

17 HOUSING BEING BELIEVED “JOB” SELF-CONFIDENCE SELF-ESTEEM SELF-BELIEF

18  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.

19  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.

20 Romme and Escher say; ‘Acceptance of the voices seems to be related to a process of the growth towards taking responsibility for one’s own decisions. Always blaming others is non-productive. Or as some described it, you have to learn to think positively.’

21 Building Up A Relationship Of Acceptance

22  Short term interventions promoting control over the voices

23  Engagement with the voices  Cognitive Interventions  Relationship with the life history  Working through experiences of grief, guilt etc

24  Reconnecting  Self-esteem  Network  Social Roles

25 ‘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

26  Spirit guide  Native American  Sat on her shoulder and whispered in her ear  In tongues  And appeared not as a native but as a chipmunk

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28  Went to Crimea  Came Home  Went to bed until she died  Oh and the pet Barn owl

29  He was Gods messenger  Now is actually God  Colours resonate and colour of god is turquoise  The Al Saud, Fayed, Bush, Windsor, Halliburton conspiracy  Reptiles people from another planet engineering us all

30  The Homosexual spray  1972 Pentagon decided homosexuality was biological and so can be caught!!  Developed aerosol spray to cause “raving uncontrollable sexual desire amongst troops”  They would be too busy molesting each other to fight  It didn’t work and was outlawed as a biological weapon

31 They called me mad And I called them mad And damn them! –They out voted me Nathaniel Lee “the mad poet”

32 One in four people are crazy!! Think of your three best friends Are they Okay? Then its you Vita Sackville West

33 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

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

35 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

36 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

37  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.

38  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.

39 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.

40 TimePlace Identity of voice What it said How you felt What you did

41 Name of voice Gender What the voice normally says (content), any patterns i.e. time of day, is it linked to my feelings The influence of the voice, how it makes me feel and what I do in response to it. Origins, where it comes from, my explanation

42 GIVE RECOVERY A MEANINGACCEPTANCE FIND AN EXPLANATION TAKE INTEREST TALK ABOUT VOICES ( TO PEOPLE YOU TRUST) GAIN TRUST EXPRESS ANGER (SAFELY OR PRODUCTIVELY ) TRY TO REDUCE ISOLATION SELF EDUCATE

43 “DO SOMETHING” It’s difficult to listen to voices whilst doing something else- either mentally or physically Playing a video game may be helpful aggressive games can help to release tension -games requiring concentration help the voice –hearer to think about something other than the voice/s

44 CONCURRENT VERBALISATION (CONTINUOUS TALKING) This works by: -distracting the voice hearer -teaching selective listening -shows voice-hearer can begin to control response to voice -provides temporary relief You can do this by: -reading out loud ( Doesn’t need to be a novel-could be notices/leaflets) - stopping and naming (Useful when alone/ when difficult to have conversation)

45 LEARN TO RECOGNISE BEHAVIOUR THAT ISN’T PART OF THE VOICE VOICE HEARING EXPERIENCE CHECK CONTENT OF VOICES ARE THEY TELLING YOU IT’S TIME TO MOVE ON? LISTENING TO A WALKMAN/MP3 PLAYER

46 AGREE TO DISEMPOWER THEM ASK THEM WHY CHALLENGE DOMINATE VOICE EXERCISE WHEN POSSIBLE (Endorphin Theory) VISUALISATION IDENTIFY TRIGGERS (E.g. comments, sounds, smells) Race and Culture IS IT REALLY A CONVERSATION?

47 My experience of mental distress

48 SETTING TASKS BRING ON TO TAKE CONTROL SELECTIVE LISTENING BE NON-JUDGEMENTAL NEVER ATTACK BELIEF SYSTEMS ACCEPT FRAMES OF REFERENCE (SUSPEND OWN BELIEFS) BUILD UP LIFE HISTORY

49 WORK WITH NOT FOR A PERSON CHALLENGE THE VALIDTY OF THE CONTENT OF THE VOICES E.G Draw on past experiences when they said similar things REINVENT YOURSELF FOCUS ON POSITIVE VOICES (IF ANY) REMEMBER VOICES CAN’T INFLICT ANY PHYSICAL PAIN ON YOU DON’T BE A VICTIM: MOVE BEYOND ILLNESS MODEL

50 Nelson Ear plug therapy Tape recorder Empty box

51 A Critical Voice is a "self", that criticizes the person before anyone else can. The Critical Voice is extremely anxious, almost desperate, for the person to succeed in the world and to be accepted and liked by others. The Critical Voice does not know when enough is enough. It has a tendency to grow until it is out of control and begins to undermine and to do real damage. At this point, its original intent gets lost.

52  Example:  Voice: ‘You are worthless, you would be better of dead ’.  The ultimate protector in a situation when the primary self cannot cope. A reaction to life stresses, when experiences are overwhelming, in a vulnerable person.  Translated: ‘ Don’t feel anymore, don’t be anymore ’.  Or: ‘ Don’t live this life anymore, live a new life ’.

53  Initial contact with a person hearing voices:  Most people, who hear voices, find it helpful to talk about the experience.  Initially, it may be difficult to be open about the presence and content of the voices.

54 There may be a number of reasons for this such as stigma, negative experiences of contact with services or that the voices are telling the person not to reveal their existence. Initially, it may help to just ask what is happening, thus giving a choice to the person about how much to disclose, whilst acknowledging a change in their emotional reactions.

55 Talking to someone while they are hearing voices: It can be very difficult to concentrate on conversations and other interactions with others, whilst hearing voices. It can be helpful to keep things simple such as asking questions which just require a 'yes' or 'no' answer, or using more non-verbal communication.

56  To maintain trust in your working relationship, you should be honest about your own beliefs.  Whilst you may not personally share their beliefs, it is still possible to seek solutions which may be appropriate for coping with a given situation.

57 Being with people who are hearing voices:  Simply being with someone who is hearing voices or going through other intense or distressing experiences, is very valuable.  Not having to say or do anything, but letting the person know that you really with them, without using words, is often underestimated, but is highly valued by people in distress.

58  Working with a supportive other, or alone, to identify different voices.  Work is then directed at challenging aspects of the experience which hinder wellbeing or growth, by entering into a dialogue with the voices and increasing the sense of control.  This can include making appointments with voices, e.g. Allowing certain times each day, in which to listen to and converse with the voices.

59 It is not oriented towards “illness” nor is it focused upon discovering what is wrong. It offers a neutral but assertive attitude to work with voices -acceptance is the core. It offers a positive model for the existence of voices. Voice dialogue helps to build up an Aware Ego aim to create a more fruitful relationship between voices and voice hearer.

60 Do you have a name How old are you? Does …. know you? When did you come into the life of …. ? What was the reason for coming into the life of …. ? What were the circumstances when you came to ….? In what way do you look after …. ? What do you pursue for …. ? What would happen if you were not with …. ? How does …. relate with you? What difficulties do you experience in your relationship with...?

61  So what has been helping you to survive?  How have you been getting through?  How come you have not given up hope?  So how come you have managed to get here today?  How do you cope?

62 That situation sounds pretty overwhelming: how do you get by? What is it that even gives you the strength to get up in the morning? So what have you been doing to stop things getting even worse? When are the times when that doesn’t happen? When are the times that it seems less intense?

63  When you have faced this sort of problem in the past how did you resolve it?  What other tough situations have you handled?  If you read about a woman who had been through what you have been through, what do you imagine you would think of her?  What does this teach you about yourself?

64  What have you learned from this experience?  Have you always been a survivor or did you learn the hard way?  How did you manage to keep your sense of humour/kindness/sense of justice - is this one of your qualities which has kept you going?

65 Case studies ANDY STAY SAT ON YOUR ARSE WHERE YOU AND DIE GO OUT INTO THE WORLD TAKE A SHOT AND DIE

66 KATIE VOICES ARE GOD AND DEVIL DEVIL SAYS GOD IS ONLY KEEPING YOU ALIVE TO BE TORMENTED 4 MAIN POINTS 1 SHE IS INVOLVED IN A CULT 2 VISITED DAD ON A FRIDAY THROUGH LOYALTY BUT HE WAS ALWAYS DRUNK 3 VOICES 4 BAD SELF HARM

67  Jo suffered sexual abuse at the hands of her father and his friends. She started to hear voices aged 12 yrs old, she entered psychiatric services 3yrs after getting married aged 26. she has 2 children a boy and a girl. She develops a drink problem so does her husband, her marriage breaks down after 10yrs she gets custody of the children but she finds it difficult to cope. Her voices increase she starts to self harm she drinks a bottle of brandy a day and cuts of all her hair. She is physically assaulted by a gang of youths and has back problems and uses a walking frame. She starts to question her sexuality. She looses custody of her children to the father, whom she believes will kill them as he drives them around in the car at night when he has been drinking.  What do you think is Jo’s biggest fear?  How could you help her rebuild her life?

68 GAVIN A THE ACTIVITIES EVENTS HE HEARS FOUR VOICES ONE DOMINANT A BLACK MALE AGED YR OLD HE BELIEVES IT TO BE THE HEAD OF A GANG OF RASTAFRIANS TRYING TO KILL HIM HE IS TOLD IF HE EATS OR DRINKS HE WILL HAVE A HEART ATTACK THE OTHER VOICES LAUGH AND BELITTLE HIM THEY GET LOUDER WHEN HE IS AT A DINING TABLE B THE BELIEFS ABOUT THE VOICES HE BELIEVES HE WILL BE KILLED BY THE GANG OF RASTAFARIANS THAT LIVE IN THE PITSMOOR AREA OF SHEFFIELD WHEN HE DOESN’T DO AS THEY SAY HE CAN FEEL A TIGHTENING IN HIS CHEST AND BELIEVES HE IS GOING TO HAVE A HEART ATTACK C THE CONSEQUENCES HE STAYS IN HIS ROOM WHERE HE DRAWS A CIRCLE OF TALCUM POWDER ON THE FLOOR WHICH WHEN HE STANDS IN HE SAYS THE VOICES ARE QUIETER AND HE FEELS SAFE

69 You have to be aware of your own fears and traumas before working with another persons experiences

70 Focus on bits they don’t want to see ask them to explain in their own words

71  You need to know the persons trauma is over  Your task is to convey this fact from you to them ( Without parenting or re-traumatising )  So a pre-requisite on your part is to believe it yourself at least to believe that this is the problem  Until cognitions start again ( the fog lifts)  It releases the cognitive traction this begins to reduce painful memories, the person can see they are 40yrs old not 4yrs old

72  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

73 Understanding – Acceptance – Recovery “He will stay, Minerva, because he needs to understand,” said Dumbeldore Curtly. “Understanding is the first step to acceptance, and only with acceptance can there be a recovery...’ Harry Potter and the Goblet of Fire J.K.Rowling. Bloomsbury: London, 2000 P. 590.

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