Useful Resources

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Suggested Session Formats

 

Session One:  Introductory Session  This session is essential for...  click here to read on.


This session is essential for the rest of the sessions and the group to run properly. It needs to concern itself with the following issues:

  • Introduction of the group members and facilitators (basic first name how came to group, what hopes to get out of attendance.)

  • Setting of ground rules for the group

  • Introduction of standard format for following groups

  • Introduction to CAVIS (depending on time) - This is a system devised by researchers based in Birmingham designed to help structure people's experience of hearing voices in terms of what they say, how they say it and the effects this has on the person having to listen to it.

  • Introduction of future sessions, handing out of booklet plus other information as necessary


Ground Rules

The following ground rules have been used in the past by other Voice Groups and may provide a useful starting point for further discussion:

  • All participants are subject to any 'rules' that are attached to the venue. E.g. Day Hospital rules relating to smoking, access to tea/coffee and personal conduct.

  • Confidentiality: members and staff should not share information they hear in the group about members with others outside the group unless permission is given by individual members and included on the standard "consent to share information" paperwork. Information relating to risk where staff feel that members may be at risk of harm to themselves or others may be shared without consent providing the level of harm is greater then that suffered as a result of breaking confidentiality.

  • The group should aim to start promptly at the agreed time

  • Group members expect each other to attend sessions

  • The focus of the group is the origin, content, experience, meaning and understanding of the voices/other perceptual problems and ways to cope with them.

  • The group members aim to include everyone in contributing to the group. Everyone must have the chance to have their say. Sharing is an important part of the group work.

  • We aim to support each other within the group and work towards supporting each other outside the group as necessary and appropriate as time passes.

  • Humour is important, but laugh with us and not at us.

  • Group facilitators will be available for an agreed period to talk to individual members after the group if needed.


Standard Session Format

Experience from other groups suggests that sessions are divided into two; the first half focussing on members' experiences of voice hearing/perceptual problems during the week and the second half focussing on an activity that aims to address the way in which their experience has developed and affected their lives in terms of thinking, emotions, responses and even physical problems.

The first half often tends towards a problem solving exercise in which all group members can participate with voice hearing/perceptual experiences opened up for discussion along lines that are more or less influenced by the facilitators.

Suggestions for various activities that take up the second half of each group session are outlined through the remainder of these guidelines.


The following 19 sessions are suggestions for activities that the group may wish to consider as ways to address the overall experience of voice hearing and other perceptual difficulties. Although numbered, they do not have to be followed in any particular order, or even at all, they are simply a collection of ideas that seem to have worked well with previous groups or other ideas that seemed good but are as yet untried.

 

Session Two:    Video about voices. BBC Horizon...  click here to read on.

First half:

Usual discussion centred on past week's experiences. We understand that this it is likely to be difficult to talk about the voices at this stage due to objections from the voices and unfamiliarity with the other group members. Hopefully as time goes on this will become easier as members get to know each other better and start getting the benefit of sharing experiences.

Second Half:

Video about voices. BBC Horizon Video introducing the idea of working with the voices to general population. This contains numerous interviews with voice hearers, psychiatrists and other health workers and introduces people to Ron Coleman and his experiences, a subject to return to in some form at a later session.

The video lasts around 50 min, and may run into the next session. It is worth spending time discussing some of the things that come up during the video and time is needed for this.

 

Session Three:    Either finish Video off or...  click here to read on.

First Half: As above.

Second Half:

Either finish Video off or Talk on Romme and Escher and the voice hearer's network.

The purpose of this session is to build upon the introduction to Marius Romme and the Dutch experience outlined in the video. The focus of the teaching session is on Romme's research into "copers and non-copers", their attributes (personal and what they do with the voices) and the differences between them. This can then lead on to discussion of how these findings may relate to you as a group member. It is worth looking at the examples on the CAVIS to help this process and provide some structure.

 

Session Four:    Introduction to the Stress Vulnerability Model...  click here to read on.

Introduction to the Stress Vulnerability Model (Neuchterlein)

This 'model' is away of thinking about how the voices work in response to things that happen in your life. The idea of introducing this relatively early is that the idea of stress affecting the way in which voices are experienced in terms of what they say/do or the level of distress that they cause is important. This will be looked at repeatedly throughout the remaining sessions and the idea of medication reducing vulnerability to stress may be discussed in the next session.

 

Session Five:    Where do voices come from? Pharmacist's perspective...  click here to read on.

First Half: The Usual

Second Half:

Where do voices come from? Pharmacist's perspective.

Juliet Shepard is coming to discuss medication issues with individual members. Examining the relationship between voices and medication often asked questions may include:

  • How is the medication supposed to help?

  • Is it supposed to make the voices go away?

  • Side Effect issues

  • Relationship between medication and the ability to cope with the voices - do I need to be able to think straight to cope with the voices? Will medication affect my ability to think?

  • This is an opportunity for group members to share their experiences of medication and the extent to which they have been told why they are taking it.

  • What to do if you are unhappy about your medication.

Session Six:    Psychiatry's Perspective on Voice Hearing...  click here to read on.

Second Half:

Psychiatry's Perspective on Voice Hearing

Opportunity to meet with guest psychiatrist (Dr Kelwyn Williams) and perhaps get an impression of how the idea of hearing voices has tended to coincide with other difficulties with how people think and can manage to cope with daily life. How these problems have been grouped into diagnoses and what they mean in general terms.

  • What you can expect from your psychiatrist and what they will probably expect from you.

Likely Questions:

  • Can Psychiatrists make voices go away?
  • Are psychiatrists doctors?
  • Is there something wrong with my brain that makes me hear voices? If so which bit?
  • Do you believe me when I say I can hear voices?

Sessions Seven and Eight:    Voice: Job Description...  click here to read on.

Second Half:

Voice Job Description

Equipment Required:

Flip Chart Paper and Pens. Examples of job adverts from the press or journals.

This is an opportunity to take a look at how people's experience of voices can be very similar to each others. The purpose of this exercise is to pull together a number of core aspects of member's voices and take a look at how these affect their lives. Those aspects that are seen as key attributes of the voices are listed and incorporated into a job description. Last time we did this, the aspects that were regarded as 'key' were generally negative and those that were more likely to turn people's lives into a misery. Examples of this included:

  • Ability to repeat the same phrase endlessly without getting bored
  • Ability to trawl through people's memory banks and use the information that is in there against them
  • Ability to keep people up all night
  • Ability to work flexible hours
  • Tendency to predict the future
  • Ability to adopt different voices depending on the situation and who you want to pretend to be
  • Ability to be convincing
  • Work for no pay
  • No sense of humour
  • Angry for no apparent reason
  • No conscience

Having brainstormed the various attributes, the idea is to create a catchy advert including a job description. The value of this exercise is to see how similar voices can be and to see what attributes are the most frustrating and difficult to endure. It is a good opportunity to step outside or 'objectify' the voices; an exercise that can lead towards distancing from them in the hope that by doing so, they become easier to control/cope with. The exercise is also a good way of getting the group to work together about the voices and has in the past helped to consolidate the group. There can be much humour involved in this exercise.

 

Session Nine:    Brainstorm of attributes of a "Host"...  click here to read on.

Brainstorm of attributes of a "Host"

Using the information gathered from the job description for a voice, the group is asked to identify things about a person that might make them more susceptible to their voices. Again, the purpose of this exercise is to identify aspects about themselves that you can change with help from the service. In previous runs of these exercises the sort of attributes identified included:

  • Low Self Esteem
  • Depression
  • Anxiety
  • Drug/Alcohol use
  • Loneliness
  • Looking for the voices when they take time off
  • Gullibility
  • Lack of support
  • Stressed

When things that make people more susceptible to voice hearing have been identified, it may be helpful to look at ways in which you can change and how to go about it.In the long run, this can help in making you less attractive to the voices and cope with them more effectively.

 

Session Ten:    Guest Speaker: Jim Welch Family Work for Voice Hearers...  click here to read on.

Guest Speaker: Jim Welch Family Work for Voice Hearers

Explanation of the broad principles of family work as used by Thorn Trained staff. Broad overview of concepts of "Expressed Emotion." This is a theory put about by various psychologists and psychiatrists that says that the amount of expressed emotion within a family can affect people's experience of illness including voice hearing. Psychologists and psychiatrists define expressed emotion in terms of the amount of critical comments flying around within a family couple with the extent to which one parent may be very emotionally involved with the children. This can appear as being over involved at times and can overwhelm the kids. Jim helps families who are experiencing problems because of this in addition to other practical support.

 

Sessions Eleven thru' Fourteen:    Timeline work: This involves looking into...  click here to read on.

Timeline work:

This involves looking into the history of the voices by plotting them along a line that includes other life experiences. Art Therapist Angela Burton will be helping with these sessions and we can use some of the art materials that she has in her art room. It is an opportunity to reflect on how voice hearing experience changes as time passes in relation to changes in people's lives. The reasons for embarking on this work are as follows:

  • It can be fun

  • It attempts to make sense of the experience of voice hearing through time

  • It brings together changes in voice activity and life events in an attempt to test the idea that voices depend on their host for things to talk about and then feed off their emotions

  • It roots the voice hearing experience in individual's lives and is part of the process of understanding why the voices come and getting some idea of what it's all about. The benefits of this process are that by making sense of something that seems entirely irrational or bizarre, feelings of fear relating to that thing may be diminished

How to construct a time line:

The idea of placing significant or critical events along a line that represents someone's life was promoted back in the 1930's by Adolf Meyer (American Psychologist completely unrelated to German Tyrant). The idea is to draw a long line on a piece of paper and marking off years along it from 0 to your present age. Then below the line, the names of various voices are marked off according to when they first came into people's lives with an indication of how long they remained. Above the line significant events are charted whether negative or positive with some indication of the extent to which the events coincided with changes in voice hearing activity. Other aspects such as time off from voice hearing or patterns of treatment including changes in medication can also be put onto the line.

The charts may be used as the focus for discussion in sessions thirteen and fourteen if the individuals involved feel ok about this.

Experience from previous groups suggests that this exercise was generally enjoyable. People enjoyed experimenting with the art materials and found that representing experiences with pictures made talking about events in their life easier then usual.

 

Session Fifteen:    Social: Meet up with other Voice Hearers...  click here to read on.

Social

Opportunity to meet up with other Voice Hearers and eat something! Needs to book transport and liaise regarding arrangements.

 

Session Sixteen:    Guest speaker: Ron Coleman...  click here to read on.

Guest speaker: Ron Coleman

Opportunity to hear Ron's account of voice hearing. Introduction to Network and the idea of mutual support. We may not be able to get Ron because he is such a busy man, but we will try.

 

Session Seventeen:    What is depression?...  click here to read on.

What is depression?

Introduction to ideas about depression, how to recognise it and what to do about it. Useful in previous group as the tendency for psychiatric treatment to focus on voices/other perceptual problems means that these issues tend to be overlooked. Idea of this session is to raise awareness and provide advice about from where further help can be sought should individual group members need it. In previous groups, the tendency to attribute internal feelings and thoughts to the voices meant that they had never considered that they may be actually experiencing depression.

 

Session Eighteen:    What is anxiety?...  click here to read on.

What is anxiety?

This session can aim to deal with anxiety in a similar way to the way session seventeen deals with depression. We may end up spending more then one session covering these topics.

 

Session Nineteen:    Visit to Group at Weston Rd...  click here to read on.

Visit to Group at Weston Rd

Opportunity to meet facilitators of on-going self-help group and discussion of concepts around moving on. Future directions.

 

Session Twenty:    Evaluation and Closure...  click here to read on.

Evaluation and Closure

Member led session possibly involving food. There may be a short questionnaire or two to do.