Talking With Voices

What it is

Talking With Voices is a talking therapy for people who are distressed by the voices they hear. The therapist speaks directly with a voice, and the person repeats the voice’s answers aloud, word for word. The aim is a calmer relationship with the voices, not to make them stop.¹ It grew out of the Maastricht approach (opens in a new tab) and is given alongside usual care, including medicines.^1,2

How it works

The therapy sees voices as linked to what has happened in a person’s life, often to overwhelming events and the feelings they left behind.² It moves in steps. First come information about voices and ways to cope. Then the therapist and the person work out how the voices may relate to conflicts in the person’s life, and agree what they would like to change in the relationship. Only then does the therapist talk with the voices. Over time, the aim is more communication and cooperation, less hostility, and a fairer balance of power between the person and the voices.¹

Why it helps, when it does, is not yet known.¹

History

The therapy adapts Voice Dialogue, a method for talking with different parts of oneself, to people who hear voices.² Dirk Corstens, Eleanor Longden and Rufus May described it in 2012.³ Before the first randomised trial, the evidence came from case reports, a series of 15 people and a small trial of 12.¹

How well it works

The first randomised trial, in Manchester, included 50 adults with a schizophrenia spectrum diagnosis who had heard voices for at least a year. Half had up to 26 weekly sessions over 6 months on top of usual care; half had usual care only. 4 in 5 stayed to the end, and 21 of the 24 people offered therapy had at least 8 sessions.¹

The trial was too small to show whether the therapy works. It may help people see their voices as less hostile: after therapy, people rated their voices as kinder. There were also signs of benefit for dissociation and personal recovery. Overall psychosis scores did not differ between the groups.¹

A larger trial, with 309 people at four sites in England, has finished. Its results will be presented online on 9 December 2026.^4,5

Possible downsides

The therapy involves talking about painful life events, and it does not aim to make the voices stop. The trial team advises explaining both before therapy starts. Many people needed months, and flexible appointments, to feel safe with the process.¹

In the trial, serious problems, mostly hospital admissions, affected 4 of the 24 people in the therapy group and 8 of the 26 with usual care. The researchers judged that none were caused by the therapy or by taking part in the trial.¹

Format

One to one with a trained therapist, usually weekly for an hour. In the Manchester trial, clinical psychologists gave up to 26 sessions over 6 months, usually in people’s homes.¹ At the Stemmenpoli Alkmaar, a course of talking with the voices takes 3 to 6 sessions.⁶

Contraindications and cautions

It suits people whose voices feel like distinct persons, and who are willing to talk with them and repeat what they say. The trial did not include people at immediate risk of harming themselves or others, or people whose thinking was very disorganised.¹

Alternatives

CBT for psychosis (opens in a new tab) is the talking therapy recommended in treatment guidelines. AVATAR therapy (opens in a new tab) also works through dialogue, with a digital figure that stands for a hostile voice.¹

What we don’t know yet

• Who it helps most, and for whom it is not suitable.
• Whether any benefits last after therapy ends.
• How it compares with CBT for psychosis and AVATAR therapy.