Experiences of staff working with voice hearers in acute mental health: an interpretative phenomenological approach

Introduction: Staff in acute mental health settings work with voice hearers at times of
crises, when experiencing high levels of distress. Research has demonstrated the
importance of exploring the subjective experiences of voice hearing yet there has been
little focus on staff experiences of working with voice hearers. The present study
therefore sought to explore staff experiences of working with voice hearers in an acute
mental health service.
Method: Eight staff members (three mental health nurses and five healthcare support
workers) from one acute mental health hospital were interviewed about their experiences
of working with voice hearers. These interviews were transcribed and analysed using
Interpretative Phenomenological Analysis. Individual analyses were conducted for each
participant before conducting a group analysis.
Results: Three master themes and seven super-ordinate themes were identified from the
group analysis. Participants described ‘struggling to exercise control’ in their work with
voice hearers, moving from positions of ‘powerlessness’ to ‘feeling powerful’.
Participants experienced the ‘emotional impact of the work’ to different intensities, often
going through an initial ‘startling phase’ and transitioning to feelings of ‘performance
anxiety and self-doubt’. ‘Ways of managing feeling overwhelmed’ were described
including going through a ‘process of making sense’, ‘forming relationships’ with voice
hearers and feeling a ‘sense of duty and responsibility’.
Discussion: The present findings relate to power literature and previous research on
empowerment and control in mental health services. A parallel process was identified
between voice hearers and staff, both experiencing an initial ‘startling phase’ but
transitioning to an ‘organisational phase’ where they make sense of their experiences.
The research findings were also consistent with previous studies demonstrating staff
anxiety around opening up conversations about the content of voices, highlighting staff
training and support needs.