Maastricht interview

What it is

The Maastricht interview is a structured conversation about a person’s voices. The psychiatrist Marius Romme and the researcher Sandra Escher developed it in Maastricht, as the first step of the Maastricht approach (opens in a new tab).¹ It is not a treatment on its own: it gives the person and the therapist a shared understanding of the voices, on which coping and therapy can build.²

How it works

A therapist goes through 12 topics with the person: what the voices are like and what they say, when each one began, what sets them off, how the person copes, childhood, past treatment and the people around them. The therapist writes a report, and the person reads and corrects it.¹

Together, they then work out what the developers call the construct: who or what each voice may stand for, and which problems in the person’s life it reflects. The person’s own explanation is respected, including a spiritual one. The construct leads to a recovery plan: coping with the voices, learning to bear painful feelings, and working through past events.¹

History

Romme and Escher built the interview from the experiences of 500 people who hear voices. It has been translated into 12 languages.²

How well it works

The developers tested the construct with 100 people who heard voices. They could work out which problems the voices reflected for 94 of them, and who or what the voices stood for in 78.³ Without a comparison group, this shows the method can be applied, not that it helps.

The Dutch care standard for hearing voices describes the approach among the psychological treatments for voices. It notes that there are no data on its effect, because it does not aim to reduce the voices themselves.²

Possible downsides

The interview asks about painful life events, including childhood, and it does not aim to make the voices stop.^1,2 For some people, a focus on life events may not feel right; the developers name this as a question for research.¹

Format

An experienced interviewer takes about 90 minutes for the full interview. It can also be spread over several sessions, and the developers advise taking time to build trust before starting.¹

Contraindications and cautions

Before the interview, the developers advise sharing examples of other people who have learned to cope with their voices, to help the person talk about their own.¹

Alternatives

Talking With Voices (opens in a new tab) builds on the same approach and talks with the voices directly. Coping training (opens in a new tab) and CBT for psychosis (opens in a new tab) focus on dealing with the voices day to day.

What we don’t know yet

• Whether it reduces distress or improves daily life, compared with usual care.
• Who it suits, and for whom a focus on life events does not feel right.
• How the approach works for people who cannot link their voices to a threatening or traumatic event: about 3 in 10 patients in the developers’ own studies.¹