For the last half of the 20th century, under the influence of the German psychiatrist Kurt Schneider’s conception of auditory verbal hallucinations as a first-rank symptom of schizophrenia, voice hearing was considered a core psychotic symptom, pathognomic for schizophrenia. However, over the past few decades, this position has been challenged. Research has demonstrated voice hearing to be diagnostically non-specific, common in the general population, and strongly linked to dissociation. According to this view, voices derive from life events which are often traumatic in nature; undermining the concept of ‘pseudo-hallucinations’, the experience of voice hearing appears indistinguishable between groups.
The clinical implications of this changing position on voice hearing have been increasingly recognized. Since voice hearing is now seen as on a continuum with the dissociative identities in dissociative identity disorder (DID), and therapeutically engaging with different dissociative parts has been a cornerstone of DID treatment, clinicians have begun to explore dialogical approaches to working with voice hearers. These approaches – in which the therapist and/or voice hearer has conversations with voices with the goal of improving their relationship (not getting rid of the voices) – will be discussed and the rationale explained. One promising approach called ‘Talking with Voices’, aligned with Compassion-Focused Therapy, will be presented in some detail, as it has been the focus of a series of impressive research studies. At the end, we will consider the implications of this viewpoint on the nature of human personality and identity – whether the notion of a unitary self might be an illusion.
Video Lecture: Dialogic Approach to Voice Hearers
PPT Slides: Dialogic Approach to Voice Hearers
Assessment Component
Andrew Moskowitz, Ph.D. is director of the Forensic Psychology graduate program at George Washington University in Alexandria, Virginia, former president of the European Society for Trauma and Dissociation and a core member of the WHO ICD-11 dissociative disorders diagnoses task force. He is a renowned expert in the trauma/dissociation field, who, for the past 20 years, has used this perspective to inform our understandings of psychosis and violent behavior. As a clinical and forensic psychologist, Dr. Moskowitz has performed therapy and conducted forensic evaluations in the United States, New Zealand, and the United Kingdom, in both prison and forensic mental health settings. As an academic, he has taught undergraduate and graduate psychology and medical students in the United States, New Zealand, Scotland, Denmark and Germany, and was the lead editor of both editions of the influential book Psychosis, Trauma and Dissociation (Wiley, 2008, 2019).
