1: Introduction Hearing voices seems to be a natural part of being human… click here for more.
Hearing voices seems to be a natural part of being human for some people. Many of these voice hearers are not troubled by these voices. However, hearing voices is often seen as a symptom of an illness, usually some form of psychosis. Hearing voices is associated with many other conditions, from toxic confusional states to depression.
The conventional approach to voice hearing in psychosis is treatment by medication. This can sometimes stop voices straight away. However this is not fully successful as a treatment for at least 30% of sufferers. This project grew out of the need to provide additional support for people with psychosis and it was designed to be part of a long-term project to integrate social, medical and psychological approaches to psychosis.
The theoretical underpinning for the work was the stress vulnerability model, which sees the causes and course of psychosis as many and varied and that stress and trauma can both precipitate the onset and relapses. It is also believed that reducing stress, improving coping mechanisms and having faith in your own ability to work through and control psychosis can be protective against relapse and helps the process of recovering . Having belief in recovering from hopelessness and despair and valuing oneself is also very important
2: Planning The group work for psychosis project was begun in 1997 following a… click here for more.
The group work for psychosis project was begun in 1997 following a multi-disciplinary meeting led by Keith Coupland, Eric Davis & Vicky Macdougall. The long-term plan was to produce a coherent understandable approach to psychosis that drew users, carers and professionals together. It would help to exemplify close working between disciplines, organisations, users and carers
The Hearing Voices Network (HVN) based in Manchester, an organisation dedicated to self-help approaches, inspired the project. Ron Coleman of HVN gave us hope that the group would succeed. We wanted to extend the work to a service setting, using the strong evidence base of cognitive behavioural therapy for psychosis in individuals. It had been argued by Kanas (1988), that group work in a service setting, for people with psychosis is important because group members feel less loneliness, stigma, isolation & misunderstanding about psychiatric illness.
Support was gained from the local health authority by submitting a proposal to evaluate the group in a systematic way and the local research ethics committee reviewed the proposal. It was then passed through the clinical board of psychiatry and senior managers within social services in Gloucestershire. It was given full approval. However, no specific funds were made available to the group.
To secure funding the Barnwood House charitable trust in Gloucester was approached. Initially two trust members visited the team to hear about the project; it was at this point that it was decided to ask one of the group members, Steve, to explain the purpose of the group. He could really articulate and present what the true meaning of psychological work on voice hearing and what it would mean to sufferers and carer’s, using their own experiences, in a group setting. The visitors from the Barnwood House Trust said, “it suddenly became clear what the work was about”. As a result the group was awarded £5,000 and it was agreed that we would keep using the group members’ expertise wherever we could.
3: Implementation It was felt that the best way to achieve this was a group… click here for more.
It was felt that the best way to achieve this was a group activity where group members took an active part in the “transformational process”, thus encouraging the patients to realise their expertise in their own condition. The target patient group was chosen to incorporate the more severe of the “severely mentally ill”, those most distressed and disabled by troubling voices.
The first group meeting was held at the social services day centre, Milsom St., in Cheltenham. Each session lasted for one and half hours and was divided into two forty-five minute intervals with a coffee break in between; this was to allow for the concentration abilities of the patients. Each group would require two facilitators, and ideally each would be trained in psychosocial interventions for psychosis and skilled in groupwork. Their key role would be to facilitate the sharing of patients’ expertise in coping in a safe group setting.
The sessions were initially planned for a block of twelve consecutive weeks. The first session set the ground rules for the facilitators & participants. The following sessions had a prescribed format that focused on education, information on psychosis and sharing coping mechanisms. Group members often agreed to work on issues at home depending on what arose during the sessions. In this initial period the group was evaluated with the support of a research assistant, Kate Edgar. She found that it took 24 weeks for signs of recovery to take place. Eventually we decided not to use short term psycho-educational groups but to have a continually ongoing group format.
The groupwork format has been duplicated across Gloucestershire. Members of the hearing voices groups continue to provide education on the subject of hearing voices throughout the county and are generally available to give presentations. Highly successful conferences have been held, which focus on providing information and support to patients, carers and professionals alike. Now, in 2011, some of the groups still continue to operate, including two separate groups for men and women which are based at Milsom Street.
4: Outcomes A series of hearing voices videos has been compiled so that… click here for more.
- A series of hearing voices videos has been compiled so that other users, carers & professionals can benefit from the group’s success.
- Members of the group have gone on to produce videos of the assessment and therapeutic processes that are used in the hearing voices groups.
- The group members are the most inspirational & important resource within the group…they are the experts! The concept of the group has changed mainstream practice with professionals respecting and enquiring about group members’ experience.
- An example of the confidence gained by the group is shown when an ex-user of the day centre stopped work because of a return of voice hearing. He came to a hearing voices group and asked for help. All the group members gathered to express their ways of coping and filled the person with hope and knowledge and he was able to go back to work.
- Another group member who had been diagnosed with schizophrenia attended the hearing voices group until he felt that he was in control of his situation. He was able to return to work, and he is now married with a young family. He has also been able to cease taking his medication.
- As a result of group members gaining a better understanding of their voice hearing they were able to use the group to talk about issues such as medication management. As a result, most of the group had their medication reviewed and often updated to the newer atypical preparations…this enhanced their quality of life even further by reducing side effects. Their psychiatrists were very supportive in this process as they were clearly able to see changes within the group members.
- At the end of the twenty-four week pilot study there were improvements in anxiety, voice hearing and delusional thinking. There were modest decreases in the level of depression and suicidal ideation & also social functioning was improved across a range of dimensions.
- Key workers noticed clear improvements in their patients, which resulted in further interest including medication review.
- A greater level of engagement between the service and the user has been achieved and continues to grow & expand today.
- One voice hearer was initially too frightened to come in to the day centre but was encouraged by group members to join the group and this member has since developed so much, that he enjoys his artwork and poems being published and has taken part in teaching sessions.
- Members of the multidisciplinary team, including psychiatrists have been convinced of the value of the work.
- To date, many group members have benefited from the hearing voices groups in Gloucestershire, however numerous others i.e. patients/carers attended for one or more sessions. Many professionals have visited the group e.g. students, social workers, nurses and psychologists.
- Another group member successfully published poetry about his voices. He is now very resilient and has became an author and teacher of courses. He is at present a student nurse.
- Conferences have been held at regional and also on a national basis.