Monthly Archives: March 2020

@TechCounselor: Managing the culture of breaking news

By Adria Dunbar March 23, 2020

In the very beginning, social media sites, such as Facebook and Instagram, were more about connecting with people you know in real life or updating your profile to reflect the ways in which you hoped others would see you. The addition of the Facebook newsfeed (and its Instagram equivalent), however, changed everything.

The definition of news is “newly received or noteworthy information, especially about recent or important events.” I don’t know about you, but in my experience it has become harder to filter that which is noteworthy and important from that which is not. My newsfeeds are filled with everything from sponsored advertisements to photos of random acquaintances’ travel adventures. Mixed in, there are local events that I’m interested in attending, close friends’ and family’s announcements of major life events, and comments addressed to me. The problem is a newsfeed treats each of these pieces of information with the same attention. It’s all breaking news, and we receive it as such, and this has an impact.

Breaking news! Someone I haven’t spoken to in 20 years made pancakes for breakfast.

Breaking news! A close friend is in need of help finding a counselor for her daughter.

Breaking news! A piece of legislation that impacts counselors and other mental health professionals has been introduced and needs counselor support.

How do we, as counselors, regain control of our newsfeeds? How do we help clients do the same? The first step is reflecting on the impact of this breaking news culture on your personal and professional life. Consider the following:

  • How much time do you spend filtering through your newsfeed? Is this an amount you feel comfortable with?
  • After reading your newsfeed, how do you feel? Happy? Productive? Or distracted and stressed?
  • In what ways do you find yourself mindlessly or mindfully interacting with your newsfeeds?
  • How do you access your newsfeed? Does the context affect your behavior? For example, I do not have the Facebook mobile app on my iPhone. I only check my newsfeed from my laptop to ensure that I am not filling random 5-15 minute downtime intervals with mindless scrolling.
  • Think about the timing of when you ingest breaking news. For example, checking a newsfeed first thing in the morning can set the tone for your day or decide how you direct your morning energy and attention.

The next step is to make changes that help you manage breaking news, such as:

  • Consider removing apps with newsfeeds from your mobile device.
  • Hide your newsfeed completely from the desktop version of social media sites.
  • Eliminate—or hide– people, pages or accounts that are not having a positive impact (both Twitter and Facebook allow you to “mute” rather than unfriend or unfollow).
  • Narrow your follow or friend list to 25-50 people and pages that are most meaningful to you.
  • Turn off notifications to avoid constant distraction

Technology, while helpful in many ways, has created a daily existence that calls for our attention to be pulled in many different directions at once. This can leave us, and our clients, feeling distracted, scattered, and stressed. By intentionally filtering our newsfeeds to better match our values, we can stop the relentless breaking news from breaking through so only that which is most important gains our attention.

Now, more than ever, it is imperative that we take care of ourselves when filtering information through social media and traditional media outlets. Let’s all please take care of ourselves so that we can continue to do the work of taking care of others. It’s OK to set boundaries, create buffers, and take breaks.



Related reading, from Counseling Today: “Helping clients develop a healthy relationship with social media


Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at

@TechCounselor’s Instagram is @techcounselor.


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Counseling Connoisseur: How to talk to children about the coronavirus

By Cheryl Fisher March 17, 2020

The novel coronavirus, which causes the respiratory disease COVID-19, has made headlines for several weeks and has drastically impacted life as we know it. The outbreak, which the World Health Organization recently labeled a pandemic, has disrupted global commerce, shaken the United States stock market and led to travel restrictions and international border closures. Here in the United States, in an attempt to slow the coronavirus spread, major events have been canceled, educational systems are resorting to online forums, and organizations are recommending that employees telecommute. Medical providers are offering telehealth services, and places of worship are examining alternatives to in-person worship services. As of March 13, President Trump declared a national emergency, which may bring additional restrictions.

The coronavirus and children’s mental health

Global anxiety is high, and our clients are negatively impacted as they stockpile supplies and prepare for the unknown. Meanwhile, in the midst of the chaos, children struggle to make sense of all that they are seeing and hearing. Overwhelmed with information, children are responding in a variety of ways. Professionals who work with children report an increase in insomnia, rumination, intrusive thoughts, nightmares, and acting out behaviors.

“After twenty years of successful classroom management, I am finding it hard to command the attention of kids whose energy is so amped up,” says Steff Linden, an educator and children’s mindfulness yoga instructor in Annapolis, Maryland. “They are running around, tripping over themselves, and bumping into each other. These behaviors are examples of children who are overstimulated. They know something is going on, but they don’t know how to react, and they feel helpless and stuck.”

Children can’t escape the tension created by the viral crisis, so they begin creating an understanding which is often complicated by misinformation. “I had a kid poke his finger in my arm and yell, ‘You’ve got the coronavirus! I touched you!’” Linden reports.

Children are acting out their fears through behavior and play. Therefore, it is vital to address their concerns in a way that is reassuring and honest. Here are some tips for talking to children about the coronavirus: The acronym CAPES.

C: Create a calm setting. Children pick up on the emotions of the adults around them. Adults need to manage their anxiety before attempting to address the concerns of children. It is essential to provide a calm setting before talking with children about COVID-19.

A: Ask what they already know. Children are already talking about the virus. They may have misinformation that needs to be corrected. Ask children what they have heard about the virus? Ask them about their concerns and fears. Children tend to worry about their own safety and those in their immediate world such as friends, family members, and even pets.

P: Provide age-appropriate answers. Answer children’s questions with honest, factual and age appropriate answers. Provide answers that are bias-free. Explain that COVID-19 is caused by a new virus and makes people feel sick with a cough and fever. Help battle stigmatizing any particular population by emphasizing that the coronavirus is no one person or country’s fault.

E: Empower them with tools. Children feel powerless over this big virus that has people buying out toilet paper and Clorox wipes. Provide them with actual tools to use that will be empowering by teaching them to wash their hands using soap and water while singing a happy tune for twenty seconds, cough or sneeze into their elbows—not their hands—or a tissue that they immediately toss in the trash and use no contact greetings such as jazz hands or Namaste.

S: Safety. Children turn to adults for a sense of safety and well-being. Assure children that it is not their job to worry about the virus and that you have a plan in place to care for them. Explain ways that you are keeping them safe by making sure they get enough sleep and providing them with nutritious meals. Tell them that their regular visits to the pediatrician and daily vitamin (if they take one) help keep them healthy. Even with school closings, provide daily structure that includes time for non-directed play to help children act out and process feelings. Help them make a list of ways they are healthy and safe. There are a lot of unknowns with COVID 19, so focus your conversation on what is known.


As counselors, we can help parents and our child clients better manage the plethora of information that is available. We can assure children that the adults in their lives are up for the task of taking care of them. The acronym CAPES can remind us how to be superheroes in an effective way to the young members of society who are powerless.

And, as always, we must remember our own self-care during this challenging time. Take a peek at my thoughts around a counselor’s guide to surviving flu season my column from February 2018, “The Counseling Connoisseur: Compassion and self-care during flu season.”



Important links:

COVID-19 update and resources from Counseling Today

COVID-19 related resources from the American Counseling Association



Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at



Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling in jail

By James Rose March 16, 2020

To enter my office, I first pass through a series of three heavy steel doors. The lock for each door is controlled from a remote central office. I wait to hear a buzz signaling that the door has been unlocked before proceeding through.

The first time I caught sight of a prisoner, it startled me so badly that I wondered whether I truly wanted to work here. The inmates wear smocks and pants with broad orange and white stripes. Their shoes close with Velcro because shoestrings can be used to strangle oneself. Everything here is geared toward minimizing the risk of suicide.

Four of us share a counseling office. The number of rooms where we can visit with prisoners privately is limited, and the rooms are used by others in the jail besides counselors. Seeing an inmate always depends on first winning the competition to find a room.

Inmates who are judged to be dangerous, who are on disciplinary status or who are on suicide watch are shackled with ankle chains and handcuffed. In one room, these inmates are then also chained to the wall. Nothing in my training prepared me for the shock of trying to carry on an intense, personal counseling session with a person in chains.

The individuals being held in this detention facility are most commonly referred to as prisoners, inmates or simply as males and females by the people who work here. But those of us in the counseling office refer to them as patients. We see it as our job to treat them first and foremost as human beings.

Introduction to the blocks

Inmates are screened upon booking, including for suicidality. Among the questions asked are whether this is their first arrest, whether they are detoxing, whether they have any prior suicide attempts, whether anyone in their family has died by suicide, whether they have ever been in a mental institution, and so forth. Inmates determined to be at risk for suicide are placed on suicide watch.

The jail is divided into a series of blocks, a grouping of two-person cells around a central area where the inmates can watch TV, exercise, or play poker for candy bars or cups of pudding. The blocks form a U shape surrounding an outside courtyard where the inmates sometimes go for recreation when the weather permits. There are a half-dozen volleyballs stuck on the spiraled razor wire that surrounds the upper perimeter of the courtyard. S block is for sex offenders. Participants in Project 103, the in-house addiction recovery program, are in R block. Immigration and Customs Enforcement inmates are held in K block. As the only Spanish speaker on the counseling team, it is my job to interview all of the inmates in K block. The women are housed separate from the men in blocks X, Y and Z. When they walk the hall to go to the gym or the library, the men bang the window and wave, and the women look up and wave back.

W block is for suicide watch. Inmates on suicide watch are placed in isolation cells and checked by a guard every 15 minutes. Their clothing consists of a “turtle suit,” a cardboardlike cloth that cannot be twisted into a noose. They are given finger foods only; plastic eating utensils are not allowed. Neither are books. The pages could be torn out and stuffed in the mouth to cause suffocation. The inmates can watch a television through a window in their cell door. They are allowed out of their cells for a few minutes each day to take a shower, under observation.

Counselors interview patients on suicide watch as soon as is practicable. Some of these patients have a history of schizophrenia. Some are detoxing so heavily that they act schizophrenic. Others are bipolar and in a manic or depressive state. Sometimes patients on suicide watch scream or sing loudly or beat on the wall.

They say a picture is worth a thousand words. I know the textbook definition of schizophrenia. It is a breakdown in the relation between thought, emotion and behavior leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation. With all those words, my picture of schizophrenia will always be a guy on suicide watch in a green turtle suit who stuck a toothbrush up his rear end.

A dumping ground for those in need of help

Sometimes patients on suicide watch get placed in a mental hospital. Our state used to have an extensive network of mental hospitals, but most of those facilities were closed during budget cuts decades ago. Today, many people who are mentally ill who previously would have been hospitalized end up homeless. Sooner or later, many of them land in jail.

“Rogue and vagabond” is the legal euphemism for a homeless person. Jails have become a dumping ground for those who are homeless, those who have addictions and those who are mentally ill. Although we are thoroughly under-resourced to deal with all of these individuals, it is our job as mental health counselors working in a detention center to do whatever we can for them.

Our staff includes a part-time psychiatrist who can prescribe psychotropic medicines. Out of hundreds of inmates, our patients appear on the mental health radar screen for a variety of reasons. They may have a prior history of receiving mental health treatment or psychotropic medications, or they may have a prior mental health diagnosis, which we learn from the screening form. In other instances, a patient may ask to see a mental health counselor. Patients suspected of needing medication are evaluated by the counselors, and we make an initial determination of whether they should see the psychiatrist. The psychiatrist determines the official diagnosis. Patients diagnosed with schizophrenia, bipolar disorder or major depressive disorder, or who act out bizarrely, receive a treatment plan and special attention.

Among the jail’s general populations, we expect to see issues of alcoholism or addiction in about 80% of them. My prior work in addictions recovery has served me well in this environment. I share pictures of brain scans from Dr. Daniel Amen with the patients. A normal human brain looks like a soft buttery mass. The brain of someone with alcoholism or addiction looks like Swiss cheese, with large “holes” of areas that are nonfunctioning. The brain of someone addicted to heroin looks like a sea anemone, with dangling tentacles of functioning areas and large masses between of nonfunctioning areas. Patients are often shocked when I show them the impact their substance use has had on their brain.

The point of drug use is to stop the brain from functioning properly. Most of the patients I see carry painful memories deep within them — memories so painful that they cannot hold them in conscious memory and go about living a normal life simultaneously. It isn’t hard to spot the source of their pain. I will ask about their mom, or their dad, or their childhood, and the stories typically come spilling out.

One young man told me he had once hoped to be an astronaut. I asked him why. He said that when he was younger, he asked his mom where his dad was, and she told him that his father was on the moon. In truth, his father was serving an eight-year sentence in a state prison. After years of longing for his father, the boy’s wish came true when his father finally returned home. But instead of experiencing a happy reunion, the boy’s father beat him up. Is it any wonder why this young man became addicted to drugs?

Another young man shared his story with me of addiction and repeated encounters with the law. I said, “I am going to make a wild guess that you had a rough childhood” — a line I often use to begin digging into a patient’s past.

His response surprised me. He said, “You’re the first person who ever noticed.”

Encouragement to look forward

The disciplinary block is the A block, known in jail as “the hole.” Fighting with another inmate may get you 10 days in the hole. Fighting with an officer can get you 50 in. Inmates in A block are given “23+1,” or 23 hours per day in their cell, one hour per day out into the block, one person at a time. No outside contact is allowed. There are no visits, no phone calls, no participation in the classes that are sometimes offered to the general population.

Isolation is punishment, as it is meant to be. As a mental health counselor, my concern with the guys on A block is the tendency to decompensate, to go into the deep and dangerous depression that extreme isolation can create.

One young man who had been on A block clearly showed signs of decompensation. I learned that he had been the valedictorian at his Philadelphia high school before being arrested in a 24-person drug bust. He was intelligent. Our conversations covered such diverse topics as Federal Reserve monetary policy and the use of political power in Niccolo Machiavelli’s book The Prince.

When this young man went down emotionally, I decided to find some books from the jail library that might help bring him back up. I eventually gave him two books. One was a book of jokes. The other was Man’s Search for Meaning by Viktor Frankl. In it, Frankl discusses his time as a Jewish Austrian prisoner in a Nazi concentration camp.

Frankl observed that it is not the outward circumstances of our lives that determine our destinies so much as it is the attitudes we choose to take toward those circumstances. Frankl withstood his concentration camp experience by taking the attitude of an observer of how humans survive in the most extreme circumstances.

My young patient got the point. As bad as his circumstances were, his mental and emotional state were determined by the attitude he chose to take toward his circumstances. He was excited by his new understanding, and his excitement was enough to pull him out of his depression. I had taken a gamble with him and won.

One of the hardest stories I have heard belonged to a man in his early 40s whom I first met on suicide watch. He was arrested for being rogue and vagabond, was intoxicated during his arrest, and had a history that included a suicide attempt.

The man’s story unfolded in fragments over the weeks and months that we worked together. It was like slowly gathering the pieces of a jigsaw puzzle until a full picture emerged. As an 8-year-old boy, he had been held by one of his father’s hands while his father used his other hand to pull out a pistol and unload five bullets into the boy’s mother. A cousin heard the commotion, came around a corner and shot the boy’s father. The father then turned the pistol on the cousin and shot him, still holding the hand of his son who was frozen beside him in shock. Another cousin grabbed the boy and took him to her home next door. From the living room window of that home, the boy watched as all three victims were loaded into an ambulance. Remarkably, each of them survived.

The boy was deeply scarred from witnessing the scene, however. Nightmares of what had transpired continued throughout his life, including during his time of incarceration.

The boy grew up, eventually married, and had a son. One evening, while arguing with his wife, he pulled out a pistol and would have shot her in a reenactment of his nightmares had his mother-in-law not intervened and stood between them. Unable to control himself, he took the pistol and shot into his abdomen. This was the suicide attempt noted on his record.

The man’s life was marked by episodes of violence, as was his son’s life. The son got involved with gangs and was murdered in a gang fight, having his neck sliced nearly through.

When I met the man on suicide watch, he had a new girlfriend, and a second son had been born to him. He had a second chance at fatherhood. He could determine to live in the past or in the present. His newborn son needed him.

I said to him, “You can’t drive a car with your eyes firmly fixed on the rearview mirror. At some point, you have to look forward.” He later told me that comment was the turning point for him. He realized that he had to stop looking backward constantly. If he wanted his newborn son to have a chance at life, he had to look forward.

He worked hard on his issues and took the recovery program. Over our months of working together, he grew able to speak openly about the events he had suffered. Recently, he was released to a halfway house. Maybe the demons within him have finally been exorcised.

To the police, he was a drunken man on a park bench. To me, he revealed a life of trauma and tragedy that was the underlying cause for his behavior. That is our work as counselors — to help people understand the dark forces that drive them to behaviors that they know are harmful to themselves.

I have heard such stories over and over again. There was a young man who was a bully and was shuttled from one juvenile facility to another until, at age 19, he landed in an adult jail. He shared with me the story of witnessing, when he was 12, his cousin gunned down in the street and the life of fighting and violence that had followed him ever since.

I have worked with people who were pimps and people who were prostitutes, people who had molested others and people who had been molested, people caught in unhappy marriages who had assaulted their spouses, and countless people with addiction or alcoholism. With each, I have heard a similar story of unresolved grief, tragedy and trauma. Sometimes I can help them. Sometimes that is limited to helping them maintain their emotional balance while they do their time in lockup. Most seem grateful to meet someone who will at least listen to their story. Sometimes giving them a chance to vent is all that I can do.

Sowing seeds

At 5 o’clock, I pass through the three steel doors and walk out of jail. I am free to drive to my apartment and wonder about the impact I may have had. I think of the Parable of the Sower found in three of the four Gospels in the New Testament. Some of the seed from the sower lands on rocky soil or other inhospitable places. But some of the seed falls on fertile soil and takes root.

We do what we can as counselors. We try to do no harm and pray to do some good. There is a line in the Talmud that says he who saves a single life, it is as if he saved the whole world. And, so, we do what we can inside the jail, one person at a time.

In the evening, I am free to have dinner with my kids, play my guitars, sleep in a comfortable bed. I can go shopping when I want, soak in sunshine, breathe fresh air, go to yoga classes.

Tomorrow, I will pass through the three heavy steel doors again. The men and women in the orange-and-white-striped suits will still be there.



James Rose is a licensed graduate professional counselor working as a mental health counselor at the Frederick County Adult Detention Center in Frederick, Maryland. He is a graduate of the clinical counseling program at Loyola University, Baltimore. Contact him at


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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

COVID-19 update and resources

The American Counseling Association is working to keep its members and the public informed as the new coronavirus, COVID-19, becomes an increasing reality and issue of concern across the United States. Updates will be posted at the ACA website,

Relevant resources and information:


Recent articles at CT Online on coronavirus and related topics:


Related reading, from the Counseling Today archives:


Hearing voices: A human rights movement and developmental approach to voice hearing

By Laren Corrin March 12, 2020

In 2016, shortly after I entered a CACREP-accredited graduate program for clinical mental health counseling, I began hearing, outside of the class setting, about an international human rights movement centered around the “voice hearing” experience — what would be called auditory-verbal hallucinations in clinical mental health settings. The movement includes people with unusual perceptions that often get labeled as psychosis.

I slowly came to learn about the movement through an introductory workshop, a three-day group facilitator training, attendance in online and in-person groups for a year, and the reading of the literature on the topic. Most recently, I traveled to Montreal for the 11th World Hearing Voices Congress, where I was able to shake hands with and hear one of the movement founders, Dutch psychiatrist Marius Romme, speak.

With this article, I hope to familiarize counselors with the Hearing Voices Movement and related international networks of recovery groups. I believe the Hearing Voices Movement is in alignment with the values and ethical principles of the American Counseling Association.

History and current development of the movement

The Hearing Voices Movement started in the 1980s in Europe when a patient confronted Romme about the limitations of the psychiatric care being provided. Why, the patient asked, was it OK for Romme to believe in a God whom he could not see or hear but not OK for her, the patient, to believe in voices that she really did hear? To learn more about the voice-hearing experience and to try to help his patient, Romme had the woman’s story told on TV and asked for other voice hearers to contact him. Approximately 550 reached out.

Remarkably, many of the people who heard voices did not need clinical help. Writing in the Journal of Mental Health in 2011 after conducting a literature review, Vanessa Beavan, John Read and Claire Cartwright asserted that it was safe to say that 1 in 10 people in the general population will hear voices. Romme eventually compared psychiatric treatment to eliminate voice hearing to conversion therapy for sexual orientation.

How did he come to that conclusion? By accepting the reality of the voices rather than just checking them off as a symptom to be treated, Romme said, he could learn much more about their origin and meaning and identify ways to help his patients. He discovered that voices were often a reaction to problems in life, such as bullying or abuse, with which the person could not cope. In other words, there was a relationship between the voices and the person’s life story.

The Hearing Voices Networks (HVN) are the network of community groups that emerged from the Hearing Voices Movement. As of early March, the Hearing Voices Network USA had 119 groups listed on its national website. At the World Hearing Voices Congress that I attended, it was reported that Brazil has quickly grown over the past few years to have 35 groups, whereas the province of Quebec in Canada started with one group in 2007 and now also has 35 groups. The majority of groups are in Europe, where the Hearing Voices Movement started.

The groups developed when people with experiences of voice hearing got tired of not being listened to and of being labeled as having mental disorders. They were also frustrated by the coercive nature of the often ineffective treatments. Individuals with experiences that might be labeled as psychosis in clinical settings can meet in these groups and explore their experiences in spaces that are free of clinical judgment. If a clinician brings a person to attend a Hearing Voices group, the clinician will often be asked to wait outside or in another room while the voice hearer attends. Members of these networks believe in the freedom of voice hearers to interpret their experiences in any way they see fit. The key to this approach is for individuals to be listened to in a curious, nonjudgmental way as they describe their experiences.

People are discovering that when listened to in this way, profound healing can occur. Eleanor Longden’s TED Talk, titled “The voices in my head,” is a great introduction to this approach. Longden describes how changing her perspective on hearing voices — from a disorder to be treated to experiences with meaning if one could just open up their metaphorical wrapping — led to a huge developmental shift that allowed her to make peace with her experience.

Treatment alternatives

I firmly believe the Hearing Voices Movement is in alignment with ACA values. ACA has a rich tradition of promoting social justice, honoring diversity, and supporting the worth, dignity, potential and uniqueness of people. In clinical practice, counselors work to promote the ethical principle of client autonomy, fostering the right of clients to control the direction of their treatment and lives. This aspiration is realized with all range of mental health concerns, but experiences that could be labeled psychosis are generally approached differently in the U.S. mental health system, potentially indicating a blind spot in the field of mental health.

In contrast to the ACA values I learned in my first semester of graduate school, I began to have a growing concern when learning about counselor roles that stood in opposition to those values. Specifically related to psychosis were the two roles of providing psychoeducation and monitoring adherence to medications. This involves instructing the client in the medical model, explaining that hearing voices and other unusual experiences are symptoms of a brain disease process, asserting that symptoms have no personal value or meaning to be explored, and teaching that treatment should consist of attempting to arrest that disease process. In taking that approach, psychoeducation essentially serves to impose a particular value or framework on the client’s experience of hearing voices.

The American Psychiatric Association established the medical model upon its founding in 1844, writing in its journal at the time that “we consider insanity a chronic disease of the brain …” That is the lens and approach that the organization has taken and buttressed with evidence. Of course, the medical model framework is useful for some people, and many useful treatments have been derived from it. However, there are other people who prefer alternative social or developmental models and lenses that are more in alignment with ACA values.

A 2017 United Nations Human Rights Council report concluded that one of the barriers to mental health and wellness was a lack of free and informed consent. Specifically, “In order for consent to be valid, it should be given voluntarily and on the basis of complete information on the nature, consequences, benefits and risks of the treatment, on any harm associated with it, and on the availability of alternatives.”

The availability and awareness of alternatives and complementary approaches may be a key piece that needs some work. It is important for counselors to identify innovative approaches in line with the ACA ethical principles of client autonomy and nonmaleficence, or avoiding actions that cause harm. I believe the Hearing Voices Movement is one such promising innovative approach, with evidence building in academic journals and books, including Living With Voices: 50 Stories of Recovery, by Romme and colleagues (2009).

A developmental model

In contrast to the medical model, counselors rely heavily on a developmental model of client concerns. The Hearing Voices Movement comes very much from a developmental perspective and fully acknowledges that voices are often a reaction to problems in life. Having learned that with 70% of adults the onset of voices was related to trauma or conflicts, Romme and colleagues studied 80 children who heard voices and published the results in 2004 in the International Journal of Social Welfare. They found that 75% of children had an onset of voices in relation to circumstances they felt powerless over.

Although the Hearing Voices Movement acknowledges a trauma connection to the onset of hearing voices for the majority of people, a blanket causal explanation for all voice hearing is not declared. All explanations are given space to be heard in the Hearing Voices Networks groups, including the medical model, psychological models such as voices being subpersonalities of the voice hearer, spiritual beliefs that the voices are spirits, and other possibilities.

As a side note to the developmental perspective of hearing voices, there is a new culture emerging of tulpamancers — people who intentionally work to develop voices they call “tulpas” to interact with as friends, based on an ancient Buddhist practice. A researcher at McGill University, Samuel Veissière, has done phenomenological research on tulpamancers, and Tanya Luhrmann of Stanford University is working on a neuroimaging study of these individuals.

The book Living With Voices outlines a three-phase developmental recovery framework identified from people who recovered from the distress of hearing voices:

1) Startled phase: Anxiety and a feeling of being overwhelmed dominate. Sigmund Freud wrote about his experience of being a voice hearer while living alone in a strange city in The Psychopathology of Everyday Life. His description of his experience was translated into English as the voice suddenly pronouncing his name.

2) Organization phase: Interest in the experience is developed, and the voice hearer looks for more information.

3) Stabilization phase: Person recovers their own potential and capacity to live the life they choose.

Although this may appear to be a linear process, in actuality the process may be repeated each time that a new voice makes itself know to the voice hearer.

To clarify, in the Hearing Voices Movement, to “recover” does not mean that symptoms have been eliminated but rather that the person has recovered from the distress of hearing voices. As was the case in the not-too-distant past when homosexuality was termed a mental disorder, the solution is not to force people to be different than they are but rather to change society to allow people to accept themselves as they experience life and love. 

A role for the counselor

In the U.S. mental health system, clients who hear voices are most commonly acculturated into the perspective that their voices reflect a disease process with no inherent meaning. Frequently, once a mental health professional identifies voice hearing as a symptom, the voice hearer’s underlying traumas are systematically ignored and invalidated. The only history then asked about is family history of mental illness to confirm the diagnosis, even though the person’s trauma history could be addressed in counseling.

The Hearing Voices Movement allows many voice hearers to discover relationships between their voices and their life experiences. Some voices have the tone or use the language of a childhood bully or an abuser. Often, voices express difficult emotions that the voice hearers are not able to express themselves.

The Maastricht interview, named for the Netherlands university city in which it was created, was originally a research tool designed in collaboration with voice hearers to learn more about their experiences, but it was found to have clinical value in the beginning process for clients to explore their experiences. The Maastricht interview can be considered a voice-mapping process in which the interviewer asks the voice hearer questions about the voices. Through this process, voices are discovered to serve different purposes, such as representing unfelt emotion, protecting the voice hearer, or attempting to solve loneliness or social isolation.

Among the questions the Maastricht interview uses to accomplish this are:

  • Have you noticed whether the voices are present when you feel certain emotions?
  • Are you able to carry on a dialogue with the voices or communicate with them in any way?
  • Does the manner or tone of the voices remind you of someone you know or used to know?
  • Can you describe the circumstances when you first heard them (each voice)?
  • Please describe your own interpretation of what causes your experience and what your theory is for why you have this experience.

The Maastricht interview can be found on Intervoice, the International Hearing Voices Network website.

The Maastricht interview features eight specific questions that explore potential trauma experienced in childhood at home, in school or in the neighborhood. In addition to the counselor facilitating the organization phase of recovery for the client, these questions provide validation of the client’s life experience and raise awareness of unprocessed trauma that may be worked through more effectively with counseling than in the Hearing Voices groups.

Similarities with internal family systems

In Richard Schwartz’s internal family systems (IFS) model, a person is conceived as being born with several distinct parts (like subpersonalities), each of which can pick up burdens or traumas in life, and a core self that is not affected by traumas. The parts interact within the person, much in the way that different members of a family interact as a system.

I asked Schwartz if the IFS model could work with people who hear voices. He told me that it could. The voices can be worked with as parts in the IFS model, and Schwartz has done work with people with schizophrenia diagnoses.

In the Hearing Voices Movement, voices are seen as being very interactive within the individual who hears them. Likewise, in the IFS model, voices can be looked at as parts that interact as a family system. Additionally, in the Hearing Voices Movement, the goal is not to eliminate the voices (although that sometimes happens). Similarly, in IFS, the goal is not to eliminate the person’s distinct parts but rather to help the person discover and release unprocessed trauma burdens so that the system can live in a harmonized way. Much like in the Hearing Voices Movement, in which voices are acknowledged as real, IFS is best carried out from the understanding that a person’s distinct parts are real and can act within the internal family system.

In one last similarity of note, at the World Hearing Voices Congress, Romme said that most voice hearers know the age of their voices. At his workshop, Schwartz had some participants check in with their parts and find out what their ages were. 


Romme has drawn comparisons between using treatment to try to eliminate a person’s voice hearing with using treatment to try to change a person’s sexual preference. I was struck when I first read this comparison because I at the same time kept reading about ACA’s push to support bans on conversion therapy for sexual preference. Romme repeated this comparison at the World Hearing Voices Congress.

Initially, I kept thinking about the level of distress people must feel who hear voices that tell them to harm themselves or others. But I have since met, talked with and listened to so many people who hear voices — and who have really taken control of their lives by changing their relationship to those voices — that I am beginning to think that Romme is right. In my lifetime, homosexuality was included as a diagnosable mental disorder in the Diagnostic and Statistical Manual of Mental Disorders. It took a rights movement to change that. The Hearing Voices Movement — a human rights and social justice movement — is now well underway, with networks in 37 countries and counting.



Laren Corrin is a counseling graduate student at the University of Southern Maine. Laren is an advocate for alternative frameworks for psychosis and complementary approaches to wellness. Contact Laren at


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