“When people hear distressing voices we need to talk to them about these experiences. What voices say often reflects core issues in people's lives and we need to pay attention to these issues. Over the past twenty years we've developed a number of psychological therapies to help people to respond differently to their voices. It's important that these therapies are available to as many patients as possible because they can reduce distress and enhance the quality of their lives by helping people to see themselves differently.” 
- Dr Mark Hayward


What happens in therapy?

It may not be possible to make voices go away for everybody who hears them but there are lots of ways to try and live well despite the continued presence of voices. This is why our therapy focuses on reducing the distress around voices, not reducing the voices themselves. 


We encourage patients in therapy to:

reacting to their voices – as this may not be helping.

QUESTION – their experience and assumptions:

Do voices have all the power and control?
Can voices make bad things happen?
Do voices speak the truth?
Do they have some control?

CHOOSE  how they want to respond, after they’ve taken a step back and re-evaluated some of their assumptions about themselves and their voice hearing experiences. 


1. Initial meeting

If a patient is referred to the Voices Clinic, they will be invited to an initial meeting with one of our clinic assistants. The assistant will explore the patient’s voice hearing experience and well-being, to find out whether the clinic is right for them. The meeting will also involve the completion of a few questionnaires about the patient’s experiences.

This meeting is a chance for the patient to learn more about the clinic, if it is right for them, to consider any worries or fears that they may have, and to ask any questions.


If the clinic is right for the patient, one of the clinic assistants will contact them to arrange a course of therapy. If the clinic is not right for the patient at the present time, they will continue to receive your usual care from their clinical team.


2. Brief individual coping therapy

Most patients coming into the clinic are initially offered four sessions of individual therapy using the principles of Coping Strategy Enhancement. This is one of the original forms of cognitive behavioural therapy and seeks to identify, adapt and systematically implement coping strategies from the patient’s existing range of strategies.


They will meet with a therapist for one hour each week over the course of four weeks.

The therapy will help the patient to identify and use their helpful coping strategies as consistently as possible.


Read the research that helped develop the therapy here.



Feedback from patients:

The first four sessions of therapy aim to encourage patients to begin a conversation about their voice hearing experiences.



Feedback from patients indicates that having this conversation can:


  • Normalise voice-hearing 

  • Promote personal control over voices 
  • Encourage taking an active role in ensuring one’s own wellbeing 
  • Increase confidence to evaluate the accuracy of negative voice comments 
  • Encourage the acceptance of voices 
  • Positively impacts personal and work life

3. Guided Self-help Cognitive Behavioural Therapy (CBT) for voices

If a patient continues to experience distress after the coping therapy, and wants further help, they may be offered a further four sessions of individual therapy that helps patients to re-evaluate the beliefs they have about themselves and their voices.


This therapy is linked to the self-help book using CBT techniques, 'Overcoming Distressing Voices' (Mark Hayward, Clara Strauss and David Kingdon).


See a publication about the therapy here



Feedback from patients:


  • "My life has changed for the better"

  • "I can finally start to look at getting my life back and do the hobbies my voice has never let me do"

  • "I just ignore them now and get on with it…… they’re not going to go away"

  • "I didn’t know if I would stick to it because my voices make it difficult for me. I have trouble waking up early but I’ve only missed one session."

  • "Therapy was brilliant, it taught me a lot and I still use all that stuff now (6 months later)"

  • "Every session I walked out feeling better"

4. Relating Therapy

For some patients, we are able to offer an additional learning opportunity in the form of Relating Therapy.  This intervention was developed within Sussex Voices Clinic and can be offered over a maximum of 16 sessions by our highly trained therapists. Relating Therapy helps individuals to learn how to respond to voices in a different way – through being assertive. Assertiveness when relating to voices involves responding in an honest and respectful way; standing up for ourselves and any different views we may have, but doing this in a way that respects the views of voices. Within and beyond therapy, these assertiveness skills can be used to relate differently to people, as well as voices.Read about the research that has helped to develop the therapy here


Feedback from Ozzy, a therapist delivering therapy at the Clinic: 
  • "I feel the assertiveness part of the therapy can be the most life-changing in a short space of time. By responding differntly in an assertive, planned manner, the voice may quieten or be less frequent, enabling teh client to take back control"
  • "It is a fantastic tool to offer clients who are sometimes consumed and controlled by distressing voices"
  • "You are not alone in hearing voices. Try to talk to someone about your voices and do the things that YOU want to do"
Feedback from Angie, participant:
  • "It's a good therapy because it deals with the voices themselves. It's quite hard work as you're dealing with voices every day and there's a lot of role play, which can be tiring. Mark, my therapist, would be the voices and I would show how I would respond to them. It helps you face the fear. When the voices are being nasty to you, you have evidence, so you can challenge the voice by saying I don't think that's true because....
  • "Another skill I learned is to distract myself or to go out or to change the scenery"
  • "After the sessions had ended, I met with my therapist and my lead practitioner and we all discussed what we'd gone through in the therapy and all the different skills that I'd learned,  so we are all singing from the same hymn sheet. Now when I meet mylead practioner she knows how to respond and what helps and what doesn't to help me cope with the voices"

5. Feedback meeting

After a patient has completed therapy, whether this is after four or eight sessions, they will be invited to meet with one of our clinic assistants again for a feedback meeting.

This meeting is similar to the initial meeting. The patient will be asked about any learning and progress that has been experienced, and asked to complete a few questionnaires about their voice hearing experiences and well-being.

After therapy, most people report reduced levels of distress and improvements in recovery and wellbeing. When asked, 100% of people said they would recommend this service to friends and family.