Chapter

Understanding and shaping adaptive coping with voices

John Farhall

in Hallucinations

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199548590
Published online February 2013 | e-ISBN: 9780191754623 | DOI: http://dx.doi.org/10.1093/med/9780199548590.003.0012
Understanding and shaping adaptive coping with voices

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Lisa, who has struggled with voices for almost 10 years, is on the couch in her room, her coat pulled tightly around her, quietly saying, ‘No! No!’ Arriving for a home visit, Paul, her mental health worker, asks if she is speaking to one of her ‘voices’, and comments to Lisa that she sounds a bit stressed. Although Lisa says little other than acknowledging hearing voices, the worker gently persists: Is it the sun-god, or the old man that you're hearing now? —The old man. Is the voice as loud as yesterday? —He's gone away now because you came. How long were you caught up with the voice before I arrived? —I don't know—half an hour maybe. I see, so you had noticed the voice for about half an hour, but it stopped when I spoke to you, or when you spoke to me just now? —Yes. I think so. Ah, now that's interesting—it reminds me of an idea from your coping list—wasn't there something about the voice stopping when you're listening or talking? —Yes, I know, and singing and humming too, but I think it just went away anyway this time. Yes, well, it might be co-incidence, but it did seem to stop when we started talking…What do you think might have happened if you had hummed your favourite tune when you were hearing the voice just now? —It probably would have got bored and gone away.

This scenario illustrates some elements of a coping approach for assisting voice hearers that we will take up in this chapter. Paul assists Lisa to disengage from the voice and reflect on the experience, seeing it as a phenomenon about which she can deliberately take coping actions. He utilizes in-the-moment work and learning from experience to extend her repertoire of effective coping, even though insight is relatively low. The suggested strategies involve vocalization—an element of coping that has empirical and theoretical support. Finally, although implementing an evidence-based intervention, this home visit gives Paul an opportunity to work informally, illustrating how enhancement of coping can be applied by family caregivers, residential care staff, and voice-hearers themselves.

Chapter.  11978 words.  Illustrated.

Subjects: Psychiatry

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