Workshop Voice Dialogue with people who hear voices

with Robert Stamboliev

Report by Dirk Corstens

In September 1997, a five-day workshop on Voice Dialogue for people who hear voices took place in Maastricht. At the initiative of Marius Romme, Robert Stamboliev—trainer and director of the Institute for Transformational Psychology—was invited to explore the method with a number of experienced therapists from RIAGG Maastricht in work with voice hearers. For the trainer, the participants, and the voice hearers alike, this was an experiment. Our intention was to try to make contact with the voices of the voice hearers. Perhaps this would offer therapeutic possibilities that other methods do not have, and perhaps it would help voice hearers deal with their voices. The method of Voice Dialogue seemed particularly suitable for this purpose.

The workshop was structured so that during the first two days we practiced the method with each other, after which we spent three days applying Voice Dialogue with voice hearers—both with some of our own, well-known clients and with voice hearers whom we barely knew as clients.

We first received a brief introduction from Robert on Voice Dialogue work, which I will summarize here. Some of this is quoted from, and can be read in more detail in, Robert Stamboliev’s book The Energetics of Voice Dialogue (1991), Mesa Verde, Amsterdam, ISBN 9071298043.

Consciousness model

In Voice Dialogue, consciousness is understood as a dynamic process with three levels:

• Awareness: perceiving events without forming judgments or feeling a need to change them.
• Experience of energy patterns: personally determined parts, subpersonalities, and genetically determined parts, archetypes.
• The Aware Ego: the part of us that makes choices; the ego identifies with various energy patterns.

Consciousness is a continuous flow of psychic energy, moving between two poles, like the image of the lemniscate (figure eight).

The goal of Voice Dialogue is transformation on the three levels of consciousness:

1. An increase in Awareness: objectively witnessing more aspects of oneself and the environment.
2. Experiencing energy patterns: including so-called Primary Selves, Disowned Selves, and undeveloped parts.
3. A more Aware Ego: the ego disidentifies from the subpersonality that dominates it and gains access to a much wider range of energy patterns.

The practitioner is referred to as a “facilitator” to emphasize their neutral and facilitating position. The facilitator does nothing more than make visible the process unfolding within a person.

The methodology (or energetics) of Voice Dialogue can be divided into several phases. A session follows this phased model:

Phase 1: The Ego position.
Centering, relaxation, awareness of both energetic and verbal communication. Resonance and so-called scanning. The facilitator attempts to tune into the energy the person is in. It is important not to oppose the dominant energy but to go along with it. If necessary, an agenda for the session can be formulated.

Phase 2: Separating an energy pattern.
The person chooses another place in the room—a place relative to the original “ego position” where this energy pattern (= subpersonality) feels most comfortable. Questions are asked about what this part thinks, feels, or likes to do. The facilitator opens energetically, resonates, and induces. Induction refers to strengthening the energy pattern. Attention is paid to other energy patterns that may emerge. Language and posture are attuned to the Self that is present at that moment—for example, making contact from one’s own Protector with the Protector of the other. The part is invited to reveal itself and allow the energy to flow. Eventually the energy diminishes (lemniscate) and shifts to another part.

Phase 3: Moving to the next part.
Another place in the room is chosen. The facilitator must clear themselves of the energy and posture of the previous part and re-center, relax, and reconnect. Opening to the energy and inducing it. This is usually a part with an opposite function or opposite energy to the previous one.

Phase 4: Returning to the Ego position.
Assessing whether the exploration is complete. The person usually senses this well themselves. Scanning energy fields.

Phase 5: Awareness.
The person stands or sits next to the facilitator, who briefly and without judgment objectively repeats what they have observed.

Phase 6: Grounding the experience.
The person returns to the ego position. The session can be discussed here. The facilitator checks whether the person is in balance and enables them to energetically disengage from the facilitator.

Personally undergoing and practicing the technique clarified much of the method for us. Mastery of the technique is essential. It was experienced as a very useful method for investigating one’s own blockages or difficult-to-understand reactions. It is more an exploration than a goal-directed approach.

The facilitator remains in the background, lending themselves to strengthening and clarifying what is happening in the other person. You get to know the other very well. It is more an intensive encounter that requires a great deal of energy. In this first part, our own personal growth was central.

Regarding the work with the voice hearers themselves, I must be brief for reasons of privacy. A commonly held view and practical rule in psychiatry is that one should not engage with the content of “hallucinations,” as this might reinforce psychosis or disintegration and thus worsen the patient’s condition. Fortunately, we observed none of this in the voice hearers involved. Even after a year, there was no indication that this “experiment” had had any negative effects. We had previously noticed that people often felt heard when we talked with them about their voices. Directly addressing the voices themselves, however, was unfamiliar territory for most of us. It is a direct confrontation with the experiential world of the voice hearer. You make direct contact with the voices—if they are willing, which was not always the case. You then experience firsthand what it is like to live with voices. Needless to say, this is not easy.

We encountered, for example, a very angry voice that spoke only German. It proved important not to be too intimidated but to acknowledge the anger of that voice. When this energy is acknowledged, relaxation eventually follows, along with insight into its opposite pole—usually a repressed energy or state. The difficulty lay in not letting one’s own fear dominate and in maintaining one’s own sense of safety.

In another case, it was difficult for the person to view the voices from a distance, to place them as parts of themselves. The voices were experienced as not belonging to the self.

In yet another case, it was very easy to make contact with one voice, which even seemed to enjoy it. Another, much more negative voice, however, refused to reveal itself. For this person, it was a relief that the therapist could experience what they themselves went through daily.

One voice hearer experienced the sessions as pleasant because they finally felt they were not being “diagnosed”—someone who had had many traumatic experiences within psychiatry.

In another case, the subpersonalities emerged very easily. This gave both facilitator and voice hearer more insight into certain traumatic events that the person could not clearly remember. Here too, we noticed that helpers tend to take over too quickly and fail to let the energy emerge in its full intensity. In one case, a positive voice also emerged—a voice that shed more light on the reasons behind certain behaviors.

Difficulties we encountered with the method included truly “facilitating,” meaning asking open questions, moving with the energy, and supporting it. We are inclined to take over and to look very concretely at how things function, rather than allowing them to “be.” In our daily practice, we are constantly interpreting; with this method, you immediately run into that tendency. Here, you must do the opposite: not interpretation, but acceptance (of the energy) comes first.

All these experiences are difficult to describe. What was clear, however, is that the experiences were positive for all of us. It seems to be a useful method for bringing conflicts expressed through voices to the surface. At the same time, our experience with the method is limited, and longer-term work may provide more clarity about its place within a broader range of treatments. It is not a panacea; other methods are also useful in working with voice hearers, and this method may not always be an entry point.

On the final day, Robert offered a number of recommendations based on the week’s experiences. With regard to working with people who hear voices, several entry points can be chosen within Voice Dialogue:

• Inviting the voice and speaking with it directly, or via the person themselves, making contact. It is helpful to clearly distinguish between ego position and subpersonalities (energies), but this is not always possible. In any case, do not make this a major issue. If the voice is experienced as ego-dystonic—belonging not to the self—then (at least initially) contact can only be made via the ego position.
• Making contact with something in yourself that resonates with the voice; connecting with a part that has contact with the voice.
• Channeling: from the ego position, without external help (energetically), making contact with subpersonalities within oneself. In principle, this can also be done with the voice, though people generally need experience working with subpersonalities.
• Working with subpersonalities via the chair technique, contacting primary parts without directly addressing the voice.
• Working with the side that can express itself more easily, based on the understanding that the voice is difficult or impossible to reach (for example, when “the door” is closed).

In addition to direct techniques, there are several indirect techniques for encountering the voices. One can work at the (sub)person level or at the voice level.

From the thesis by Anouk Barteling (Hearing Voices and Voice Dialogue, 1996), who assisted during the first two days of the training, several conclusions and recommendations also emerged:

• Safety and the function of Protectors are crucial when working with voice hearers. However, protective functions are often insufficiently effective. The Protector is a subpersonality recognizable in most people, aimed at stopping painful experiences. There is always a risk that too many painful issues surface too quickly. To work with Voice Dialogue, protective functions must be at least somewhat developed.
• Voice Dialogue develops an aware and stronger ego that can make choices and, through Awareness, observe what is happening.
• By stretching the energy of the voice, tension can decrease and an opposing pole may emerge that counterbalances the voice. In other words, a voice that is heard and acknowledged calms down and makes room for other experiences.
• The facilitator starts from the client’s experience; the client determines what they want to work on. The goal should not be, for example, “getting rid of the voice,” but rather “what do you want to explore with this method?”
• The method provides insight into primary and disowned subpersonalities, thus offering information about how the client relates to the voices and to others in general.
• Anxiety that arises must be manageable; medication may be necessary. Even though our experience is positive, it is not advisable to apply this method indiscriminately with every voice hearer. As noted earlier regarding protective functions, we do not yet know whether there are contraindications. It seems obvious, for example, not to apply it when someone is psychotic (when everything outside the person takes on an unconditional personal meaning), but where exactly is the boundary?
• Good support at home is important.
• The facilitator must also be clinically trained and have experience with psychiatric symptoms.
• A clear, limited number of sessions and well-defined goals should be agreed upon to ensure proper closure, with interim evaluations to assess whether goals still align.
• The facilitator must be well acquainted with their own energies/subpersonalities that may arise, such as fear, powerlessness, spiritual and instinctive energies. Experience with and supervision in working with this group is therefore essential; self-knowledge is crucial.

Conclusions

All in all, it was a fascinating workshop that provided much material for reflection and, in some cases, a useful method for working with voice hearers and moving forward. Future experiences will need to provide more clarity about its possibilities and limitations, but a first step in developing this knowledge has certainly been taken.

Dirk Corstens, Maastricht 1997