A tripartite relationship theory of voice hearing: a grounded theory study

Background: People hearing voices and in receipt of mental health treatment can experience distressing and disempowering relationships with their voices and other people. Practitioners lack knowledge and confidence to know how to help people when distressed by their voice hearing. Previous research has predominantly situated voice hearing within individual voice hearers but identified that mental health treatment contexts foster power imbalances that undermine practitioner-patient relationships, illustrated commonly through coercion, and experienced as traumatic. Less is known about voice hearing within these treatment contexts, both in terms of voice hearers’ experiences of hearing voices and practitioners’ experiences of providing treatment for voice hearing. This thesis aimed to advance current knowledge and understanding of the relational dynamic involving voice hearers, voices and practitioners, through investigating individual experiences of hearing and treating voices within clinical contexts, in order to develop theoretical explanation of voice hearing and provide an approach that supports people distressed by their voices and practitioners providing treatment. Methods: This was a qualitative study that utilised a constructivist Grounded Theory methodology to explore the experiences of voice hearers (n=15), through semi-structured interviews, and practitioners (n=18) through focus group discussions (n=3). These findings were synthesised in order to construct the final theory. Findings: A tripartite relationship theory situates experiences of voice hearing during mental health treatment within a clinical context, mediated through a voice hearer – voice – practitioner relationship. This consists of five theoretical constructs: Personal bully, Level of agency, Interpersonal dynamic, Who’s making sense, and Medication: helping or hindering. Conclusions: A novel theory, grounded in voice hearers’ and practitioners’ experiences, expands on current knowledge about voice hearing and contributes towards a philosophical shift of situating voice hearing within relationship and clinical contexts rather than the prevailing individual-centric approach. Recommendations are made at policy, service and individual levels.