The Three Phases of Hearing Voices:

In listening to the experiences of voice hearers and during their research Professor Marius Romme and Sandra Escher identified that there are three distinct phases to hearing voices (Romme & Escher 1989, 1993).  They are the Startling phase, the Organisation phase and the Stabilisation phase. 

1. The Startling Phase

During the startling phase many voice hearers are not able to talk about their voices, and are overwhelmed by the experience. The Startling Phase is named this way because of the Hearer’s discovery of the voices often startles them and causes them to deny the experience and withdraw into themselves. This leads to a sense of isolation, and a fear of madness itself.  Most voice hearers describe the onset of the experience as being quite sudden, startling and anxiety provoking, and can vividly remember the precise moment they first heard a voice.

Voices are often triggered by traumatic or emotional experiences such as accidents, abuse, divorce or bereavement, illnesses, psychotherapy sessions, or a time of great suffering. They can also be caused by cannabis or induced by other street and prescription drugs.

The age of the onset of the initial experience of voices varies widely, as does the intensity of the startling phase, which appears to be most severe when it occurs during adolescence. The confusion seems to be less when voices are heard from an early age, or did not make an appearance until later in adulthood. (In a survey 6% heard voices before the age of 6; 10% between the ages 10 and 20; 74% after 20).

The impact of the voices fall into two main types:

1. Some people perceive the voices as helpful and they evoke a feeling of recognition. These people feel the purpose of the voices is strengthening them and raising their self-esteem. The voices are experienced as positive and as an understandable aspect of their internal selves.
2. Others experience the voices as aggressive and negative from the very beginning. For these people the voices are hostile and are not accepted as part of themselves. They suffer from negative voices that can cause chaos in their minds, demanding so much attention that communication with the outside world is extremely difficult.

2. Organisation or Coping Phase

During the Organisation (or Coping) phase voice hearers want to break free from the anxiety and confusion caused by the voices.  To come to terms with the voices or to successfully organise them requires some form of acceptance to take place. Denying the voices does not work. In this phase people seek to find meaning and understanding, and to cope and control, their voice hearing experience. Helpful strategies include:

• Ignoring the voices (by using distraction methods)
• Listening to them selectively
• Entering into willing dialogue with them
• Making specific appointments with them (at a chosen time)

Attempts at distraction and ignoring the voices rarely work, and although this is a strategy many voice hearers attempt, it seems the effort involved often leads to a severe restriction of life style. Unsurprisingly, initial feelings of panic and powerlessness are replaced with a period of anger at the voices, and this anger does not appear to be part of a useful coping strategy. The most useful strategy described by voice hearers is to select the positive voices and listen and talk only to them, and to try to understand them.

An important element in coping successfully with voices is to accept them. With the right help voice hearers learn to think in positive ways about themselves, their voices and their problems:

• Another strategy is to set time limits, or boundaries, and structure the contact with the voices. 
• Learning to understand the possible significance of the voices in terms of a person’s current and past experiences.
• Understanding the meaning of the voices in a person’s everyday life; and
• Thinking about the particular circumstances when the voices are heard.

3. Stabilisation Phase

Once the existence of the Voices becomes accepted, some voice hearers are able move on to make the voices part of their everyday life.  In the stabilisation phase, with help, a more balanced relationship with the voices is built up. People can and do learn to cope with their voices and find an equilibrium, and in some cases voice hearers can even discover that the voices are capable of a positive influence. During the stabilisation phase, an individual is able to choose between following the advice of the voices or the follow their own thoughts and ideas, and can say “I hear voices and I’m okay about it. I can cope”.

^{Information in the above text was compiled from the results of questionnaires sent to voice hearers and the subsequent interviews – It was adapted from  Accepting Voices (pages 17-23)  by Marius Romme and Sandra Escher, and The Voice Inside (pages 60-62) by Paul Baker.}