Voice hearing in a biographical context: A model for formulating the relationship between voices and life history

Abstract

Growing evidence suggests a meaningful association between life experience, particularly trauma and loss, and subsequent psychotic symptomatology. This paper describes a method of psychological formulation to analyse the relationship between the content and characteristics of voices (“auditory hallucinations”) and experienced adversity in the life of the voice-hearer. This systematic process of enquiry, termed a construct, is designed to explore two questions: (1) who or what might the voices represent; and (2) what social and/or emotional problems may be represented by the voices? The resulting information provides the basis for an individualized psychotherapeutic treatment plan that examines the influence of interpersonal stress in creating vulnerability for emotional crises (i.e. psychological predisposition) and the personally significant events that cluster before onset or relapse (i.e. the actual stressors which provoke voice onset or continuance). A case example using this method is presented.