Having conversations with children and young people who are hearing voices

In this short video, Dr Rob Allison introduces the issue of young people hearing voices.

The following four broad steps are a guide for practitioners in their efforts to reduce distress related to voice hearing for a child or young person.

First, be collaborative with the child or young person. Show genuine interest in them and their voices by spending time with them, asking questions about voices, talking openly about voices, including the voices in conversations. For example, saying out loud something such as “I wonder what voice X might say about that”? Acknowledge that voices might listen in on conversations and might feel threatened or agitated by what is said. This recognises that voices can be more or less distressing in response to what practitioners say or do.

Second, support the child or young person to be curious enough about their voices to explore why they hear them. This begins a longer personal journey of making sense to help reach a meaningful explanation for their experiences.

Third, and extending the previous point, support the child or young person to understand the purpose of any treatment and to develop control over their own treatment decisions. This relates to the final step.

And finally, recognise the role or power in voice hearing. Support the child or young person to gain confidence through developing some influence over their voice hearing experience and their treatment decisions as noted in the previous step. For example, through using a simple diary, they could record what they do, think and feel when they experience their voices. They might recognise a pattern, such as when they feel low in mood or when they engage in certain behaviours, they can identify that their voices react and become more distressing. Or, through trying to explore and make sense of their voices (discussed in step two), they might move beyond the initial shock of hearing voices and begin to consider their voices are the consequence of an earlier life experience from which the young person can learn about ways to avoid repeating previous experiences. In doing so, this could help change the perception of a voice to become a more helpful source of information.

Examples of questions you could ask about a child or young person’s voices:

• When did you start hearing voices?
• How many voices do you have?
• What is it like to hear voices?
• How do you experience your voices (i.e., do you hear them, see them, smell them, taste them, feel them)?
• How would you describe your voices (i.e., how do they sound or look, do you experience them as positive or negative)?
• How do your voices normally communicate (i.e., do they tell you to do things, do they comment on what’s going on, do they speak to you or about you, do voices speak with other voices)?
• What do you think is the reason for your voices coming into your life (i.e., why do you hear voices and what do they want to happen from being in your life)?
• Are your voices listening in on our conversation? Can I reassure your voices that I don’t mean to be of any threat towards them?
• What would you like to happen with your voices?