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In our culture, hearing voices can be an uncomfortable topic 鈥� pushing even the most grounded of counsellors outside of their comfort zone. Media images of madness and violence can mingle with ones of genetics, mental illness and schizophrenia 鈥� creating a strong sense that such experiences fall outside the bounds of mainstream counselling practice and are best left to the experts. This article presents an alternative overview of hearing voices in childhood, with the intention of showing how counsellors can be an important part of people鈥檚 healing journey.

The diversity of voice-hearing experiences

Voice-hearing is as diverse and individual as we are. Some people hear voices very clearly outside of themselves, with all the auditory characteristics one might expect 鈥� gender, age, identity, tone, emotion and content. The voices may sound as if they鈥檙e coming from a particular place in the room, from next door or from an object (like a TV). They can be heard in the distance, or felt shouting loudly into someone鈥檚 ear. Other voices speak with similar clarity and characteristics, yet are experienced as being located inside a young person鈥檚 mind 鈥� despite feeling very separate.

Sometimes, people hear voices that are harder to differentiate, speaking in whispers, crowds or echoes. It might be voices jeering, laughing, shouting or creating a wall of noise 鈥� and while the words themselves may get lost, they can convey emotions and provoke a strong reaction in those that hear them. 鈥楬earing voices鈥� includes more than just auditory voices, though. Some young people talk about experiences that belong in the hinterland between voices, thoughts and identity 鈥� wordless voices that are experienced as strong ideas, thoughts, impulses or emotions that feel separate to their own. They might describe there being another person inside them.

What might young people hear?

The content of voices is as individual as the way they are experienced. They can be:

• Reassuring: reminding the young person that they are strong, that they have something to offer the world, or that things will work out OK.
• Encouraging: helping them to reconnect with friends, see someone else鈥檚 point of view or think beyond current difficulties.
• Confusing: saying seemingly nonsensical words or phrases, giving them the wrong answers in exams or questioning people鈥檚 motives.
• Critical: criticising their appearance, intelligence or character, or picking apart the things they do.
• Commanding: telling the young person to do something specific 鈥� this can be relatively benign (e.g. 鈥榙o your homework鈥�), but it can also be more controlling (e.g. 鈥榙o it again... and again鈥�) or destructive (e.g. 鈥榗ut yourself鈥�).
• Funny: telling jokes, making fun of people or using a funny voice.
• Predictive: telling the young person things that will happen 鈥� or claiming responsibility for things that have happened.
• Descriptive: talking about what the young person is doing and what鈥檚 happening around them.
• Sounds: knocking, scratching, footsteps, animal noises, echoes and other sounds.

The voices people hear can have many layers. For some, we see just the surface 鈥� a word or a phrase that keeps repeating with little context. Other times, we see experiences with increasing depth and complexity. Understandably, young people may have developed some beliefs as to why they are hearing voices. Sometime these beliefs can sound strange (e.g. aliens, telepathy, technology, witchcraft or demons). However, it鈥檚 important to recognise that all beliefs make sense in context. The more our sensory experiences diverge from the consensus, the more we might need highly individual ways of making sense of them.

Who might hear voices?

Once upon a time, voice-hearing was thought of as synonymous with a diagnosis of schizophrenia. It was seen as a rare and pathological sign of severe mental illness in childhood 鈥� one that indicated treatment from a psychiatrist rather than a counsellor. Thankfully, our knowledge base has moved on since then. Research varies, but it seems that eight to thirty per cent of primary school children have had some experience of hearing or seeing things that others don鈥檛. And it seems that the experience becomes less common as people grow up 鈥� with one study suggesting that seven per cent of fourteen to sixteen year olds have experience of voice-hearing, and another suggesting that around four per cent of adults have this experience. If we look at particular groups (eg evangelical Christians or cultures where voice-hearing is more accepted), this rate increases dramatically.

The ability to hear voices or see visions can be understood as part of the human condition. Most children and young people who hear voices aren鈥檛 bothered by the experience. It may be transient, comforting or fit into a personal or cultural framework that helps them make sense of it. For example, some families talk about members having the gift of sensitivity that enables them to see visions or hear spirits, and this is accepted and doesn鈥檛 cause a problem.

Hearing voices can be frightening, though. Some young people find that the voices they hear occur at a time of emotional distress or confusion that leads them, or their family, to seek support from CAMHS or a counsellor. Young people who reach out for help may, eventually, receive a range of diagnoses beyond those of 鈥榩sychosis鈥� or 鈥榮chizophrenia鈥�. The voices may be linked to difficulties that could be labelled as post-traumatic stress disorder, depression, obsessive-compulsive disorder, bipolar disorder, anorexia, anxiety, dissociative disorder, autistic spectrum disorder or emerging personality disorder. Some young people receive no diagnosis at all, with their difficulties being framed as an understandable response to adversity. While it used to be thought that certain types of voices indicated certain types of diagnoses, it is now clear that the picture is far more complex. So it is important to look beyond diagnosis and reflect on how these paradigms can shape what we are able to see.

Why might young people hear voices?

There are lots of different theories as to why young people might come to hear voices. Proponents of each of these can give a clear rationale, cite evidence (research or experiential) and give examples of how their perspective can help us better support young people struggling with difficult voices. These ideas include:

• Trauma and adverse life experiences (including bullying, childhood abuse, physical injury, loss and victimisation)
• Dissociation as a creative survival strategy to manage difficult experiences, psychological conflicts and emotions
• Epigenetics (the mix of genetic and environmental factors)
• Legal and illegal drugs (including cannabis, hallucinogens, anti-malaria medication, antipsychotics and antidepressants)
• Physical health conditions (including temporal lobe epilepsy)
• Neurotransmitters (the hypothesised imbalance of dopamine in certain areas of the brain)
• Sensory deprivation and/or isolation
• Misattribution of inner speech (and other cognitive theories)
• Spiritual experiences (including shamanic crises, the voices of ancestors, possession experiences, angels, demons and other religious phenomena)
• Human diversity (the ability to hear voices can be seen on a continuum of human experience).

It is likely that you will feel comfortable with some of these explanations, but others may seem a little strange. In a multicultural and diverse society, it is important to recognise our familiar psychological and medical perspectives as frameworks rather than a universal truth. Frameworks can help guide us, but they can also give us blind spots 鈥� things we are unable to see if we hold on to our frameworks too tightly. Widening our understanding of different perspectives can really help us to work alongside young people and families, valuing differences rather than prioritising our own understanding above all.

Voices, emotions and life experiences

鈥業 hear a voice and she needs my help. It kinda reminds me of when I needed help.鈥�

Rather than spend my time on 鈥榳hy鈥� young people might have come to hear voices, I find it most helpful to work on exploring how these voices might relate to a young person鈥檚 inner and outer worlds. This relationship can take many forms, including:

• Giving voice to difficult feelings or thoughts that the young person is struggling with (e.g. a young person who feels bad about feeling angry at a younger sibling may hear a voice telling them that they are evil, or that their brother or sister is going to die).
• Taking the form of someone, or something, that fills an important need in the young person鈥檚 life (e.g. a parental figure, guide, friend or someone that helps them make decisions).
• Signalling a difficulty in the young person鈥檚 life (e.g. a voice that only appears at school may relate to a difficulty within the school environment, or worries around leaving a family member).
• Echoing a relationship pattern that the young person is struggling with (e.g. feeling disempowered, controlled, attacked or undermined).
• Holding memories that the young person cannot think about, sometimes split into fragments and reflected in the voice鈥檚 content, tone or identity, or in the response it provokes in the young person.

Within the Hearing Voices Network, we often think of voices as messengers that bring us important messages. Sometimes these messages are obvious, but often they require some patience, creativity and exploration to understand. Similar to a work of art, voices can have multiple meanings depending on who is looking at them and the layers they feel able to see. Each meaning is neither 鈥榯rue鈥� nor 鈥榝alse鈥�, but can simply be judged by how useful it is to the young person we are supporting.

What might the future hold?

If we consider voice-hearing as inextricably linked to young people鈥檚 emotional lives 鈥� whatever its ultimate cause 鈥� then we see the prognosis for each young person as fluid, changing as they find ways of managing their emotions and their experience of the world. Even if we step back from the personal and look at the research evidence, we see that the majority of children and young people who hear voices do not go on to have long-term problems. For example, Sandra Escher鈥檚 landmark study over three years 鈥� on the experience of eight to eighteen year olds who hear voices 鈥� found that sixty per cent stopped hearing voices within that time frame. Others find ways of coping with their voices so that they no longer affect their lives adversely.

However, some young people who struggle with voices do go on to be diagnosed with a mental health problem in adulthood or struggle to manage their social, work or academic lives. This may sound like a gloomy prospect, but it can be helpful to unpick what it is that may lead to longer-term difficulties to help ensure that the broad brush of statistics and likelihoods does not define the young people we meet.

It can be helpful to think of distressing voices as an onion, an experience with many layers that can compound difficulties. For example, the voices may induce a sense of fear, anxiety and be difficult to speak about. They may stem from painful life experiences or challenges that the young person has not had support to overcome. The young person may have experienced bullying or prejudice as a result of their voice-hearing, or they may anticipate negative reactions and feel they need to hide this part of their life away from friends and family for fear of rejection. At an important stage in development, they may create a narrative of themselves that includes the sense of being a 鈥榝reak鈥�, a 鈥榝ake鈥� or 鈥榗razy鈥�. If they seek help, they may be given a diagnosis that can increase their sense of difference from their peers and leave them feeling 鈥榖roken鈥�. Thinking of these layers, it becomes clear that negative outcomes may be as much to do with the context of the young person as with the voices themselves.

Even when young people do go on to be diagnosed with a form of psychosis or another severe mental health issue (such as bipolar disorder or schizophrenia), all is not lost. If you search the internet for people such as Jacqui Dillon, Eleanor Longden, Peter Bullimore, Lisa Forestell, Ron Coleman, Kellie Stasny, Rufus May and myself, you will read stories of people who have been to the hard end of the mental health system and found their way back. Diagnoses do not define people鈥檚 future.

Helping young people who hear voices

鈥業t is hard for people to understand how it feels to hear voices and see things. When I was in hospital, someone told me I was imagining the voices. This really upset me, because it was not true. I began to feel as if people thought I was lying and I did not want to talk about it to anyone. When I do, I feel embarrassed and worried about how they will react.鈥�

The following are some tips for those wanting to support a young person who hears voices.

• Create a safe space: If you can create a safe and non-judgmental space where the young person feels able to talk about taboo experiences, you are creating a space where they can mention voices and other things that can be hard to talk about.
• Don鈥檛 panic: Remember that hearing voices and seeing visions is relatively common in children and young people. It is not, necessarily, the sign of a problem. If someone says they hear voices, take a deep breath and take time to explore what this experience means to them.
• Find a flexible framework that works for you: Young people sometimes tell us that they know when a counsellor isn鈥檛 comfortable with talking about voices. Frameworks can help orientate us to have difficult conversations in a way we feel comfortable with. Just try to make sure that the framework you use is held lightly and not imposed on the young person themselves.
• Tolerate uncertainty: Even seemingly strange experiences make sense in context. The more we understand about a young person, their voices, their beliefs and their life, the easier it is to find that context. This sense might evolve gently over many sessions 鈥� but never forget that it is there.
• Think relationally: If the young person is willing, it鈥檚 OK to explore their relationship with voices in a similar way that we might explore their relationship with peers or family members. We can draw relational maps, ask what the young person thinks about what the voices say 鈥� or what they think the voices think about them.
• Be aware of, but don鈥檛 rely on, coping strategies: If you check out the Voice Collective website you will find lots of different ideas on how to cope with difficult voices. It鈥檚 helpful to be aware of these, but also to recognise that we might sometimes unhelpfully reach for practical strategies when it feels too difficult to listen to a young person鈥檚 distress.
• Don鈥檛 be afraid to ask for help: This approach can sit alongside other forms of interventions and support. CAMHS can provide a really useful service to young people in distress 鈥� and sometimes people need more forms of support than we鈥檙e able to provide.

"I don鈥檛 think 鈥渞ecovery鈥� and 鈥渘ot hearing voices鈥� are the same thing. My voices have been a very formative experience in my life, and with Voice Collective鈥檚 help, I鈥檓 discovering more about myself and my experiences than being labelled or medicated ever could."

Rachel (Rai) Waddingham is Interim Project Lead at Voice Collective, Mind in Camden鈥檚 London-wide project for children and young people who hear voices, see visions or have other unusual sensory perceptions. She is Chair of Intervoice, Vice-chair of ISPS UK, Hearing Voices Network trustee, an independent trainer/consultant and a voice-hearer.聽

Additional resources

• Voice Collective 鈥�
• Hearing Voices Network 鈥�
• ISPS UK 鈥�

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