1. Working with Voices & Unusual Beliefs Skills Session

2. Focus of the Session talking to people about their voice talking to people about their voice hearing experiences & unusual hearing experiences & unusual beliefs beliefs

3. Theories psychotic experiences lie on a continuum with normality psychotic experiences are more extreme expressions of traits in the general population people who report psychotic experiences are having either unusual perceptual experiences (having hallucinations that are unusual in themselves) or interpreting normal experiences in an unusual way ( having strange intrusive thoughts that appear alien) stress vulnerability

4. unusual beliefs are often associated with an increased tendency to jump to conclusions (British Psychological Society 2000)

5. Approaches for Voices and Unusual Beliefs Traditional: medication ignored them challenged them focused on the emotions that accompany experiences labelled them as a symptom of illness

6. Contemporary Approaches medication diagnosis used to provide one explanation service user in collaboration with the worker develops an understanding of why these experiences have arisen and how they can cope effectively

7. Aims when working with voices & unusual beliefs Develop a positive therapeutic relationship with the service user Clarify the person’s experiences/beliefs, to see what impact, if any, the experiences are having on their life To increase the sense of power and control and reduce the amount of distress associated with the experiences/beliefs in order that the person can engage more in a meaningful and valued life

8. The aim is not to challenge experiences/ beliefs head on or remove beliefs, or take away ‘symptoms’

9. Exercise Think about and list 1. What things make it difficult to discuss people’s unusual experiences/beliefs, and what may threaten engagement with that person? 2. What things have been important in helping you talk to people about their unusual experiences? Write up your responses on flip chart.

10. Tips for engagement in therapeutic work with voices & unusual beliefs Provide a safe environment Empathise with the person’s feelings Believe the person until proved otherwise or at least suspend your disbelief Talk to the person naturally Avoid collusion- agree to differ Don’t push too hard- be prepared to back off ( Nelson 2005)

11. Understanding Experiences let the person lead; explore their models of their mental health problems first: Why are you in hospital? What does the doctor say is wrong with you? Why are other people in hospital? Do you know anyone with psychosis/ schizophrenia? How do you know that he has…? (Nelson 2005)

12. use stress/ vulnerability model to explain difficulties: identify vulnerabilities: family history, birth difficulties, ‘sensitive personality’, brain injury identify stressors: work, school, university, sexuality etc drug or alcohol abuse

13. Useful Questions ‘ What don’t you like about… or hearing..?’ ‘Are there good aspects of hearing…?’ ‘If you woke up tomorrow and found it had all been a dream would you be relieved?’ ‘Is there anything at all you would miss ?’

14. Other Ways of Getting Started: Using a normalising rationale This involves discussing the circumstances in which ‘delusions’ or odd ideas are more likely to occur in non psychotic people (Kingdon & Turkington 2005)

15. Sharing experiences of having odd ideas The main purpose of this strategy is to share with the service user any odd/ abnormal experiences you may have had (Nelson 2005)

16. Introducing doubt by asking questions, displaying puzzlement and doubt areas of agreement/disagreement are identified and areas of inconsistency are made explicit

17. Identifying the positive and negative of beliefs for the service user by use of questioning a hypothesis about the possible function of beliefs can be developed. Possible consequences of altering the current beliefs can be identified

18. Useful Questions Use questions which clarify what’s in the person’s mind- don’t lecture or persuade When, where, what, how & why questions are often useful ‘When did you first notice… under what circumstances?’ ‘Can other people hear the voices?’ ‘How do you know the voice is from this person?’

19. Approach with genuine curiosity, not an answer you you want to get to Help the person think about information outside their usual awareness Use summaries and check joint understandings

20. Nelson, H.E. (2005) Cognitive Behavioural Therapy with Delusions and Hallucinations. A Practical Manual 2 nd Edition. Stanley Thornes.