Hearing Voices groups

1. Introduction

Version followed: the Hearing Voices Network (HVN, England) Groups Charter (affiliated and full membership criteria) and HVN's guidance on setting up a group, as published on hearing-voices.org (2025 site). Facilitation practice is filled in from HVN-USA facilitator training as Fletcher & Kalofonos (2022) describe it, Mind in Camden's London Hearing Voices Network training, and Schaefer et al.'s (2021) study of Dutch groups. A clinician-led "treatment group" variant (Franks, 2019) is described separately and labelled as such. [source: HVN Charter; HVN setting-up page; Fletcher & Kalofonos 2022; Schaefer et al. 2021]

What it is. Hearing Voices groups are peer support (mutual-aid) groups for people who hear voices, see visions or have other unusual sensory experiences. They come from the Hearing Voices Movement. That movement grew out of work in Maastricht from 1987 by the voice-hearer Patsy Hage, the psychiatrist Marius Romme and the researcher Sandra Escher. The Dutch network Stichting Weerklank was founded in 1987. In 1988 Louise Pembroke and Paul Baker formed a group in Manchester that later grew into the English national network. Intervoice has linked national networks internationally since 1997. [source: Wikipedia, Hearing Voices Movement; Understanding Voices; Dirk Corstens, Maastricht approach]

This is not a therapy a clinician delivers. HVN states that its groups are self-help, "not therapy or treatment" [source: HVN England, quoted by Understanding Voices]. The Charter separates three kinds of group: (1) treatment groups run inside psychiatry, which HVN welcomes but which are not part of the Network; (2) self-help groups, which hold HVN's values; and (3) middle-ground groups, usually started and run by mental health workers, which may share the ethos but are limited by their host organisation [source: HVN Charter]. A clinician's legitimate roles are therefore to refer and prepare clients, work alongside a peer-run group, co-facilitate as an ally in a middle-ground group that is working towards being member-run, or run a clinician-led treatment group that borrows from the approach without calling itself an HVN group. This guide is written for those roles.

How change is thought to happen. Voices are treated as real and meaningful experiences, not as symptoms to eliminate. What matters is the person's relationship with their voices, not the voices themselves. Change comes from meeting peers who share the experience: this reduces shame, secrecy and isolation. It also comes from swapping self-discovered coping strategies, from curious mutual questioning that links voices to life events and emotions, and from belonging to a community in which the person is the expert on their own experience. Groups are meant to help people regain some power over their lives. [source: HVN Charter; Understanding Voices; Schaefer et al. 2021; Wikipedia, Hearing Voices Movement]

2. Framework

There is no session-by-session protocol, and no fixed phases. HVN-USA trainers and Fletcher & Kalofonos stress that groups do not follow a standard format and that regional networks adapt them; they contrast this with structured models such as AA or WRAP groups [source: Fletcher & Kalofonos 2022]. What the sources do describe is (a) a lifecycle for setting up and maturing a group, (b) a typical meeting format, and (c) membership criteria that mark a group's progress towards being member-run. A clinician pathway for referred clients is given in (d) as [synthesis].

(a) Group lifecycle [source: HVN setting-up page; HVN Charter]

Planning group. Recruit people with different perspectives and skills, including at least one person with lived experience of voices or visions. Goal: a shared aim and a team.
Optional focus group or awareness event, useful if helpers are few. It can run cheaply in a community venue: a short introduction to the approach, a personal testimony and discussion. Goal: find members and allies.
Settle the basics without overplanning: aim (members can later change it), membership, facilitators, venue, timing and publicity. Goal: enough structure to open the doors.
Launch: either a larger event with speakers and workshops, or a small start with one or two members that grows over time.
Ongoing open group. Members join and stay as long as they wish. Understanding Voices recommends running continuously, not in fixed 8- or 12-week blocks.
Maturation towards ownership. An affiliated group commits to working towards full membership. A full group makes decisions collectively, does not meet in a clinical setting, is open to people outside services and from other areas, and aims to be user-run. Criterion for moving on: the group meets the full-membership criteria listed in section 3.

(b) Meeting format [source: Schaefer et al. 2021; Franks 2019; Understanding Voices; Fletcher & Kalofonos 2022]

Frequency: weekly (Franks; VA pilot; Bay Area groups) or fortnightly to monthly (most Dutch groups).
Length: about 60–90 minutes; often shorter on inpatient wards (Franks).
Size: typically 4–12 attenders, with a core of about 4–5 regulars (Dutch groups). Franks found 4–8 works best for a clinician-led group.
Facilitation: usually two facilitators drawn from a pool of three or four, ideally including at least one voice hearer [source: HVN setting-up page]. In the US, pairs are either two peers or a clinician with a voice hearer [source: Fletcher & Kalofonos 2022].
Shape: opening reminder of values and confidentiality, open sharing, then a close. Many groups include a break; some add practical activities, relaxation, social meet-ups or campaigning [source: Understanding Voices]. Franks advises against breaks in his clinician-led groups. Both options exist; choose with members.
Open, drop-in membership is the HVN norm. Closed, screened groups exist in some services (e.g. the VA pilot) but would not meet the Charter's full criteria.

(c) Facilitator preparation [source: Fletcher & Kalofonos 2022; HVN-USA NYC training page; Mind in Camden training page; Herzog 2024]

HVN-USA: the standard training is 24 hours of interactive instruction, with a workbook, homework and role-play. Completion leads to certification as an HVN-USA group facilitator. Some local versions are shorter (for example, a 14-hour, two-day course in New York, and Wildflower Alliance's three-day course).
England (Mind in Camden / London HVN): three online days covering diverse understandings of voices, coping and recovery, power and empowerment, practical facilitation skills and difficult situations, and planning and sustaining groups (including online groups).
Netherlands: no specific group-facilitator training at the time of the study; facilitators had usually done a several-day course on coping with voices [source: Schaefer et al. 2021].
Licensing: using the name "hearing voices group" requires no licence, and any group can use it. Only groups that meet the Charter can join HVN, as affiliated or full members [source: HVN Charter]. Training is strongly recommended but not legally required [uncertain: whether HVN England requires a training certificate for affiliation].

(d) Clinician pathway for a referred client [synthesis]

Assess interest and fit → choose a group type → prepare the client → first visit → review after 3–4 meetings → continue, switch group, or pause → integrate what the client learns into individual work. There are no formal move-on criteria. The client decides how long to stay (the Charter allows indefinite membership).

3. Guiding principles

[source for all items: HVN Charter, except where another source is tagged]

Voices and visions are real experiences, and people are not lesser for having them. Meaning: never argue about whether the voice is "really there"; talk about what it is like.
Acceptance. Meaning: welcome people as they are, with no requirement to be stable, compliant or insightful.
Self-determination. Meaning: the member decides what to explore, what to call it and what to do about it.
Each member is the expert on their own experience. Meaning: facilitators, including professionals, do not hold the answers. Hand questions back to the group.
Ordinary, non-professional language. Meaning: say "hearing voices", not "auditory hallucinations", and avoid diagnostic labels in the room [source: also Fletcher & Kalofonos 2022].
Freedom to interpret experiences in any way. Meaning: biomedical, psychological, trauma-related, spiritual and paranormal explanations are all allowed; none is corrected [source: also Fletcher & Kalofonos 2022].
Freedom to challenge social norms. Meaning: members may question psychiatry, diagnosis or medication. Facilitators do not police this.
Anything can be discussed, not only voices. Meaning: housing, relationships or loss belong in the group too.
No assumption of illness (full groups). Meaning: do not frame attendance as treatment or recovery from a disorder.
A social group and community, not a therapy group (full groups). Meaning: belonging and friendship are goals in themselves. Do not run it as a treatment session.
Free to come and go without repercussions. Meaning: attendance is never a treatment requirement, never recorded against the person, and never a condition of anything.
Not subject to referral, discharge or risk assessment. Meaning: people self-select. The group does not screen, discharge or risk-assess. Clinical risk work stays in the person's individual care.
Clear limits on confidentiality. Meaning: in affiliated groups, members are told the facilitator's limits. In full groups, the group itself sets them.
Equality, including the facilitator (full groups). Meaning: the facilitator is a member who holds the space, not the group leader.
Collective decisions and shared problem-solving (full groups). Meaning: rules, topics and problems are decided by the group.
The facilitator is not under pressure to report to anyone outside the group (full groups). Meaning: no reports to the clinical team about what was said.
Open to non-service users and people from other areas; not in a clinical setting (full groups). Meaning: prefer community, adult-education or arts venues [source: also HVN setting-up page].
Aim to become user-run. Meaning: plan from the start how members will take over.
Listen without fixing. HVN wants facilitators who can "listen to members without feeling the need to 'fix'" [source: HVN setting-up page]. Meaning: resist problem-solving, reassurance and psychoeducation reflexes.
Keep it simple. HVN says groups are "NOT rocket science" [source: HVN setting-up page]. Meaning: a safe, non-judging space matters more than technique.
Validation, curiosity, vulnerability, community (VCVC). These are the four values in Wildflower Alliance's facilitator framework [source: Herzog 2024]. Meaning: validate first, ask open questions, share yourself where appropriate, and build connection. (Wildflower's own text is not drawn on here. [uncertain] as to its full content.)
Medication is not opposed, but choice is informed. [source: Wikipedia, Hearing Voices Movement; CCU presentation 2019] Meaning: neither push nor discourage medication in the group.

4. Intervention inventory

The inventory has four parts. Part A covers clinician procedures for referral and partnership. Part B covers setting up or co-facilitating a group. Part C covers the procedures used inside a meeting, as published. Part D covers related individual methods that groups draw on, and a clinician-led variant. Example wording is illustrative unless quoted.

A. Working with groups as a clinician

A1. Assessing interest and fit

Purpose / when: any client who hears voices, sees visions or has unusual beliefs, especially if they feel ashamed, isolated or alone with the experience, or keep it secret from services. [source: Schaefer et al. 2021 on shame and secrecy; Understanding Voices on benefits and drawbacks]
Steps: (1) Ask how the client understands their voices and whether they have ever talked to anyone else who hears them. (2) Describe what a group is: peers, no diagnosis needed, any explanation welcome, and you may sit and listen. (3) Ask about preferences that predict a poor fit. Some people prefer one-to-one or professional support, or want a structured, outcome-focused format. Some find group talk distressing, or may feel like outsiders if friendships already exist in the group [source: Understanding Voices]. A client who sees their voices strictly as an illness may find others' recovery or medication-reduction stories hard to hear [source: Schaefer et al. 2021]. (4) Leave the decision with the client. Never make attendance a treatment condition, because that conflicts with the Charter's free coming and going.
Example language (illustrative): "There are groups where people who hear voices meet and talk about it in their own words. Nobody there will tell you what your voices are. Would hearing how other people manage be useful to you?"
Watch for: interest mixed with fear of exposure; worry that the group will report back to your team. Answer the confidentiality question honestly for the specific group (see B3).

A2. Matching the client to a type of group

Purpose / when: once the client is interested. Groups vary widely [source: Understanding Voices], and the Charter's three types (treatment, middle-ground, self-help) feel different.
Steps: (1) Find local groups. Check the HVN "find a group" listing, then confirm with local Mind branches, community mental health teams and GPs, because online lists may be out of date [source: Understanding Voices]. (2) Name the type of group to the client. A self-help group in the community is peer-run and does not report to services. A group run inside a service may have staff facilitators and limited confidentiality; in some places it is only open to that service's patients [source: Schaefer et al. 2021; CCU presentation 2019]. (3) Consider specialist groups: young people (Mind in Camden's Voice Collective runs a 16–25 group); prisons, secure units and immigration removal centres (Voices Unlocked); and women, Black and minority ethnic communities and people in prison [source: Mind in Camden pages; Wikipedia, Hearing Voices Movement]. In the US there are family-and-friends groups [source: Herzog 2024]. (4) Where nothing is local, consider online options: the HVN England forum, the Voice Collective forum (for under-25s), Intervoice's Facebook page, and HVN-USA's weekly Zoom groups [source: Understanding Voices].
Example language (illustrative): "This one meets in a community centre and is run by people who hear voices themselves. The other runs here, with one of our staff. What's said there isn't fully private from the team. Which sounds more comfortable?"
Watch for: a client who would only feel safe with a professional present. Some Dutch members valued that [source: Schaefer et al. 2021]. That is a legitimate reason to start in a middle-ground group.

A3. Preparing the client for the first meeting

Purpose / when: before the first visit. Joining can feel daunting [source: Understanding Voices].
Steps: (1) Tell them they can attend without speaking and can leave if it doesn't suit them [source: Understanding Voices]. (2) Tell them that groups differ, so they may need to try more than one [source: Understanding Voices]. (3) Explain that talking about voices can briefly make them louder or more active. Plan what they will do afterwards [source: Franks 2019 says to warn of temporary worsening]. (4) Agree what they want to share and what they want to keep private. (5) Agree whether and how they will tell you about it. This is their choice, not a report from the group. [synthesis for steps 3 to 5 as applied to referral]
Example language (illustrative): "You don't have to say anything the first time. Plenty of people just listen. If your voices kick up afterwards, that's common after talking about them. Let's plan what you'll do that evening."
Watch for: voices that object to the group, or threaten the person for going. Explore this in session: what the voice is worried about, and whether there's a smaller first step.

A4. Reviewing and integrating group experience into individual work

Purpose / when: after 3–4 visits, and then periodically [synthesis on timing].
Steps: (1) Ask what has been helpful and unhelpful. Use the processes the Dutch study found as prompts: feeling validated, picking up coping ideas, connection, and being asked curious questions [source: Schaefer et al. 2021]. (2) Bring coping strategies the client has picked up into your joint plans. (3) If the client is building a personal understanding of their voices (who or what they may stand for), you can take it further individually using the Maastricht approach (D1). Corstens notes that group discussion can help generate the "construct" [source: Corstens, Maastricht approach]. (4) Respect the boundary: do not ask for details about other members.
Example language (illustrative): "What did you take away from the group this month? Is there anything someone said that you'd like to try, or to think about here?"
Watch for: belonging, reduced shame, new coping, and voices that feel less frightening. These are the outcomes groups report [source: Understanding Voices; Schaefer et al. 2021]. A client who is consistently more distressed after meetings needs a review of the group's fit (section 5).

B. Setting up or co-facilitating a group

B1. Planning group and awareness event

Purpose / when: when there is no suitable local group, or a service wants one.
Steps: follow the lifecycle in section 2(a). Recruit a mixed planning group that includes people with lived experience. Optionally run a low-cost awareness event (an introduction to the approach, a personal testimony and discussion), ideally in a community venue [source: HVN setting-up page].
Example language (illustrative): for a flyer: "Do you hear voices, see visions or have experiences others don't share? A new peer group is starting. All explanations welcome."
Watch for: a planning group made up only of professionals. Treat that as a signal that the group will drift towards a treatment group [synthesis].

B2. Settling the basics

Purpose / when: before launch.
Steps [source: HVN setting-up page]: (1) Aim: draft one as a starting point that members can change. (2) Membership: decide who it is for. Test any restriction (for example, only one organisation's patients) by listing reasons for and against. Note that full HVN membership requires openness to non-service users. (3) Facilitators: usually two, from a pool of three or four, ideally including at least one voice hearer, all open-minded. (4) Venue: look beyond mental health centres to adult-education, community and arts centres. Consider accessibility, religion and culture, and transport. Free space can sometimes be swapped for awareness training. (5) Timing: ask potential members. Evenings or weekends suit people in work; late mornings may suit parents. (6) Publicity: do not rely on flyers in mental health centres. Use libraries, colleges, places of worship, GP surgeries, community groups, personal contact with agencies, social media, local press and radio, and the HVN website listing. (7) Launch: a big event or a small start.
Watch for: low early attendance. This is common and grows by word of mouth [source: Herzog 2024]. One inpatient-unit group averaged about three attenders [source: CCU presentation 2019].

B3. Fixing the confidentiality and recording arrangements

Purpose / when: before the first meeting. This is where clinician-facilitated groups most often depart from the Charter.
Steps: (1) Decide, honestly, what a staff facilitator must report (for example, safeguarding or an immediate danger to life) and state it to members. This meets the affiliated criterion [source: HVN Charter]. (2) In a group aiming at full membership, let members set the confidentiality limits themselves [source: HVN Charter]. (3) Decide about notes. Practice varies. Bay Area groups take no notes or names [source: Herzog 2024]. The VA pilot wrote general notes on themes under a standard note title in the medical record [source: Fletcher & Kalofonos 2022]. One Australian service had to develop privacy protocols so that group content "does not get used adversely" [source: CCU presentation 2019]. (4) Agree with your team, in writing, that nothing said in the group will be used in risk assessment, discharge or detention decisions except within the stated limit [synthesis].
Example language (illustrative): "What's said here stays here. The one exception for me as a staff member is if I believe someone's life is in immediate danger. Then I'd talk to that person first about what happens next."
Watch for: members testing whether the limit is real. Any breach will end trust in the group.

B4. Facilitator training, pairing and support

Purpose / when: before and throughout facilitation.
Steps: (1) Complete recognised training (see section 2(c)). (2) Pair a clinician with a voice hearer or peer worker where possible [source: Fletcher & Kalofonos 2022; Franks 2019]. (3) Build in a debrief of about 30 minutes after each group to talk through the experience [source: HVN setting-up page]. (4) Hold regular facilitator supervision or networking. The VA researchers met facilitators every two months [source: Fletcher & Kalofonos 2022], and HVN runs a facilitators' networking call [source: HVN setting-up page links]. (5) Pay peer facilitators where possible. Unpaid volunteer facilitation proved hard to sustain [source: Herzog 2024].
Watch for: tokenism, where one peer sits among several clinicians. Fletcher & Kalofonos recommend a more balanced ratio.

C. Procedures inside a meeting

Peer groups have no scripted structure; the items below are the recurring practices the sources describe. Members, not facilitators, decide how they are used [source: Schaefer et al. 2021; Fletcher & Kalofonos 2022].

C1. Opening: restating values and agreements

Purpose / when: at the start of every meeting, to make the space safe and to orient newcomers.
Steps: (1) Welcome everyone, and say that speaking is optional. (2) Read or restate the group's values. Bay Area groups repeat values taken from the HVN-USA charter at each meeting: no assumption of illness, respect for everyone's experience, each person as the expert on their own experience, and undoing stigma [source: Herzog 2024]. (3) State the confidentiality agreement. In the Dutch groups, "what is said here stays here" was one of the few explicit rules [source: Schaefer et al. 2021]. (4) Mention practicalities: the break, the finishing time, and the option to step out.
Example language (illustrative): "Welcome. Here every explanation of voices and visions is respected, and nobody is assumed to be ill. You are the expert on your own experience. What's said here stays here. You're welcome just to listen."
Watch for: newcomers' body language. Offer a brief one-to-one hello at the break [synthesis].

C2. Sharing round (check-in)

Purpose / when: early in the meeting, so that everyone has a chance to be heard.
Steps: (1) Invite each person, in turn or in any order, to say how they are and anything they want to bring. Members may share whatever matters to them: voices, visions, beliefs, problems or good news [source: Understanding Voices]. (2) Allow people to pass. (3) Note themes that members may want to return to. [The round format is common practice; the exact procedure is not specified in the HVN pages, so treat it as [uncertain] / [synthesis].] In a clinician-led variant, Franks uses a 0–10 rating of how distressing voices have been over the past few days as an icebreaker (see D3).
Example language (illustrative): "Let's go round. Just how your week's been, and anything you want to bring tonight. Passing is fine."
Watch for: one person's share taking most of the time. See section 5.

C3. Peer validation

Purpose / when: throughout. This is the first core process in the Dutch study: meeting others who hear voices reduces shame, isolation and secrecy [source: Schaefer et al. 2021].
Steps: (1) When someone describes an experience, invite others to say whether something similar has happened to them. (2) Acknowledge the feelings without judging the content, whatever the explanation. (3) Facilitators trained in the HVN-USA approach let people talk without rushing to challenge, explain or change their experiences [source: Fletcher & Kalofonos 2022].
Example language (illustrative): "That sounds frightening. Has anyone else had a voice that gets louder at night?"
Watch for: relief, people saying "I thought it was only me", and disclosures that people have never made elsewhere. These are the signs it is working [source: Schaefer et al. 2021].

C4. Exchanging coping strategies and self-acquired knowledge

Purpose / when: when a member is struggling with a particular voice, situation or time of day.
Steps: (1) Ask the person whether they would like ideas. Experienced members in the Dutch groups were careful not to impose advice [source: Schaefer et al. 2021]. (2) Invite members to say what has worked for them. Strategies come from personal experience rather than clinical advice, and are often unconventional [source: Understanding Voices; Schaefer et al. 2021]. (3) Let the person choose what, if anything, to try, and invite them to report back. (4) Occasional input on psychoeducation or research is possible, but keep it light. Some members find it useful and others find it irrelevant [source: Schaefer et al. 2021]; HVN-USA trainers advise avoiding heavy psychoeducation [source: Fletcher & Kalofonos 2022].
Example language (illustrative): "Would it help to hear what others do when the voices start at work? Then you can take or leave whatever you like."
Watch for: members presenting their own strategy as the right one, for example around medication. Reframe it as "what worked for me".

C5. Mutual curious questioning and exploring meaning

Purpose / when: when a member wants to understand their voices, not only cope. This is the fourth Dutch process, "mutual self-reflection" [source: Schaefer et al. 2021].
Steps: (1) Check that the person wants to explore. Some members prefer just to share, and that is respected [source: Schaefer et al. 2021]. (2) Invite open, curious questions from the group about when the voices started, what was happening in the person's life then, what triggers them now, and how the person responds [source: Schaefer et al. 2021; Fletcher & Kalofonos 2022 on exploring links with adversity]. Some facilitators draw on the Maastricht approach, which links voices to the life events that preceded them; others do not emphasise it [source: Schaefer et al. 2021]. (3) Let the person arrive at their own explanation.
Example language (illustrative): "Can I ask a curious question? When did that voice first show up, and what was going on for you around then?"
Watch for: trauma disclosures. Members value being able to share them [source: Schaefer et al. 2021], but facilitators need to watch for overwhelm (section 5).

C6. Holding multiple explanatory frameworks

Purpose / when: whenever explanations are discussed or come into conflict.
Steps: (1) Treat biomedical, psychological, spiritual and paranormal explanations as equally welcome [source: Fletcher & Kalofonos 2022; HVN Charter]. (2) When members disagree, reflect that each person's view fits their own experience. (3) Do not correct a belief, and do not endorse one as true for everyone.
Example language (illustrative): "We've heard three different ideas tonight about where voices come from. In this group they can all sit side by side."
Watch for: a member who holds an illness model feeling out of place among recovery and alternative stories [source: Schaefer et al. 2021]. Name their view explicitly as welcome.

C7. Facilitator self-disclosure ("practicing vulnerability")

Purpose / when: to build connection and to model equality.
Steps: (1) Share relevant personal experience briefly where appropriate. HVN-USA trainers call this "practicing vulnerability" [source: Fletcher & Kalofonos 2022]. (2) Clinicians do not need to have heard voices to validate feelings. They can share their own experiences of fear, loss or stigma [source: Fletcher & Kalofonos 2022]. (3) Keep it short, then return the focus to members [synthesis].
Example language (illustrative): "I don't hear voices, but I know what it's like to keep something to myself because I was afraid of how people would react."
Watch for: a facilitator's disclosure that becomes the centre of the meeting.

C8. Background facilitation and keeping the space respectful

Purpose / when: throughout.
Steps: (1) Stay in the background. Handle logistics and enforce the agreed rules, and let participants lead the discussion. This is how experiential facilitators worked in the Dutch groups [source: Schaefer et al. 2021]. (2) Support members to keep the group respectful and welcoming; members carry the main responsibility for shaping it [source: Understanding Voices]. (3) Hand questions back to the group rather than answering as the expert. Professionals in the Dutch groups were more directive, especially when members expected it [source: Schaefer et al. 2021].
Example language (illustrative): "That's a good question. I'd be interested in what others here think before I say anything."
Watch for: members deferring to the professional. That is a sign the group is drifting towards being a treatment group.

C9. Social and community activities

Purpose / when: to build belonging. Full groups are communities, not therapy groups [source: HVN Charter].
Steps: with members' agreement, add a tea break, practical or creative activities, relaxation, social meet-ups, or campaigning [source: Understanding Voices]. Some networks run game nights [source: Herzog 2024]. Some groups support friendships beyond the meeting [source: Schaefer et al. 2021].
Watch for: cliques that newcomers find hard to break into [source: Understanding Voices].

C10. Collective decision-making and moving towards being member-run

Purpose / when: from the beginning. Full groups decide collectively and aim to be user-run [source: HVN Charter].
Steps: (1) Bring decisions about the venue, rules, topics and new members to the group. (2) Rotate tasks such as opening up, welcoming newcomers and keeping time. (3) Offer facilitator training places to members. Mind in Camden's training is open to people with lived experience, and London Mind offers free places to voice hearers [source: Mind in Camden training page; Understanding Voices]. (4) Plan for staff to step back over time. [Steps 2 and 4 are synthesis.]
Watch for: members who are reluctant to take over. Go at their pace.

D. Related individual methods and a clinician-led variant

D1. Maastricht approach (individual, used alongside groups)

Purpose / when: for a client who wants to understand their voices in depth. It was developed by Romme and Escher; Corstens co-authored the description used here [source: Corstens, Maastricht approach]. It is not a group procedure, but members and facilitators often know it, and group discussion can feed into it.
Steps (paraphrased from Corstens): (1) Build rapport through a broad interest in the person. (2) Conduct the Maastricht Hearing Voices Interview, a structured interview of roughly 90 minutes. It covers the nature and characteristics of the voices, personal history, triggers, content, the person's own explanation, impact, relationship with the voices, coping, childhood, treatment history and social network. The authors suggest a dissociation screen beforehand. (Do not reproduce the interview items. Obtain it from Romme & Escher, Making Sense of Voices, 2000.) (3) Write a report under the interview headings, then review it with the person and correct it together. (4) Negotiate a "construct": a formulation of who the voices may represent and what problems they may represent. (5) Build a plan with three aims: tackle the most hindering aspects of the voices; build a better relationship with emotions and alternative ways of coping; and work through past trauma. (6) Reduce anxiety and increase control, for example with set listening times, separating listening from obeying, and a diary. (7) Address emotions and trauma, with a trauma-experienced therapist where needed. (8) Support recovery through self-help and social support, including groups.
Example language (illustrative): "Would you like us to go through your voices in detail, when they started, what they say, how you cope, and then write it up together?"
Watch for: the report review. The authors note that it often starts recovery on its own.

D2. Talking with voices / Voice Dialogue ("voice diplomacy")

Purpose / when: for people who can communicate with their voices. A facilitator speaks with the voices about their aims and their original protective function, so that the person gains awareness and choice. The method was adapted from Voice Dialogue under Robert Samboliev's guidance [source: Corstens, Maastricht approach]. HVN-USA training in New York teaches "voice diplomacy": exploring where voices come from, speaking with them, understanding their motives and negotiating the relationship [source: HVN-USA NYC training page].
Steps: a specialist individual technique, not used as a routine group exercise. Detailed procedure is [uncertain]. Train in it before using it; do not improvise it in a group.
Watch for: destabilisation in people with high dissociation or recent trauma [synthesis].

D3. Clinician-led "treatment group" variant (Franks)

Status: a psychologist-run, structured group that borrows from the approach. Under the HVN Charter it is a treatment group, not an HVN group, and should be described to clients accordingly [source: Franks 2019; HVN Charter].
Steps (paraphrased): weekly sessions of 60–90 minutes with 4–8 members. (1) Set a tone of understanding, respect and support. (2) Brief mindfulness (breathing or body scan). (3) Icebreaker: members rate how distressing their voices have been recently on a 0–10 scale. (4) Part 1, understanding voices: guided questions about the number of voices, their gender, age and familiarity, what they say, triggers, impact, and the person's own explanation. Discuss causes beyond biology, including stress and life history. (5) Part 2, managing voices: collect members' existing strategies on a whiteboard, then introduce relaxation, distraction, self-care, mindfulness and problem-solving. (6) Values and goals work, to reduce avoidance and challenge beliefs about the voices' power. (7) Voice diaries. Franks also suggests co-facilitating with a voice hearer.
Example language (illustrative): "On a scale of 0 to 10, where 10 is the worst your voices have ever been, where have they been this week?"
Watch for: Franks presents psychosis as a form of extreme stress. That framing may clash with members' own explanations, so offer it as one view among several [synthesis].

5. Handling problems

The sources say little about handling problems in the room. The Dutch study and the VA paper both note that they do not describe safety or crisis procedures [source: Schaefer et al. 2021; Fletcher & Kalofonos 2022]. Most guidance below is therefore [synthesis], written to stay within the Charter's values. Source-based points are tagged.

Client won't try a group, or drops out after one visit. Respect the choice: free coming and going is a Charter value. Explore what put them off. Consider a different group (groups vary), an online option, or a middle-ground group with a professional present [source: Understanding Voices; Schaefer et al. 2021]. Many members leave and later return to the same or a different group [source: Schaefer et al. 2021]. Keep the door open. [synthesis for the response]
Voices feel worse after meetings. Temporary increases after talking about voices are expected [source: Franks 2019]. Plan the evening after a meeting with the client. If distress persists over several meetings, review fit: the client could share less, try a group with a different focus, or pause. [synthesis]
Overwhelm from too many explanations, or from talk of reducing medication. Some members find this hard [source: Schaefer et al. 2021]. Facilitators can say at the opening that people should share their own experience, not prescribe for others. In individual work, help the client sort out which ideas fit them. Refer any medication decision back to the prescriber and to the client's informed choice. [synthesis]
A client with an illness model, or with only positive voices, feels out of place. These mismatches are documented [source: Schaefer et al. 2021]. Name all views as welcome (C6). If the mismatch persists, find a better-matched group, for example by age or setting. Offering several local groups improves matching [source: Schaefer et al. 2021].
A member dominates. This is a documented drawback [source: Understanding Voices]. In peer groups the agreed rules give the facilitator a basis to intervene. Use a time-limited round; gently interrupt ("I'm going to pause you there so others get a turn"); speak to the person privately at the break; and bring "how we share the time" to the group as a collective decision (C10). [synthesis]
Content others find hard to relate to, or a member who appears acutely unwell. Dutch members sometimes found some stories hard to relate to [source: Schaefer et al. 2021]. Do not challenge the content. Acknowledge the person's feelings, and check at the break whether they have support. If a co-facilitating clinician has concerns, those belong in that person's individual care, raised with them directly, not through the group. [synthesis]
A voice commands suicide or self-harm, or someone discloses current risk in the group. HVN-USA training role-plays a voice urging suicide, and teaches facilitators to validate emotions, ask questions and reassure [source: Fletcher & Kalofonos 2022]. Self-help groups do not risk-assess members [source: HVN Charter]. In practice: (1) respond in the group with validation, and ask whether the person feels safe right now. (2) Offer to talk privately straight after. (3) In that private conversation, a staff facilitator acts within the confidentiality limit stated at the opening. Ask directly about intent and plans, agree a safety plan, and involve crisis services or the person's team, ideally with the person's agreement. Lethal-means counselling covers safer storage or removal only. (4) Debrief with your co-facilitator. Clinicians should hold the clinical risk in the person's individual care, not in the group. [synthesis, consistent with standard risk practice]
Disclosure of abuse, or a safeguarding concern (child or adult at risk). Explain the limit stated at the opening, then follow local safeguarding procedures. Tell the person what you will do. Fletcher & Kalofonos list abuse, self-harm, hostility and bullying as topics needing further facilitator training. [synthesis; source for the training gap]
Hostility or conflict between members, or between voice hearers and family members. Bay Area groups worked through anger and suspicion between people who had been detained and frightened relatives. They did this by listening, committing to shared principles and dropping diagnostic labels [source: Herzog 2024]. In the room, return to the agreements, pause the exchange and invite the group to decide how to proceed. [synthesis for the in-room steps]
The professional facilitator gets pulled into the expert role. Members may expect a professional to take charge [source: Schaefer et al. 2021]. Hand questions back (C8), let the peer co-facilitator lead the opening, and review the balance in the debrief. [synthesis]
Conflicts between the service and the group: reporting, notes, risk, "stability" requirements. Some clinicians questioned whether participants needed to be "stable" first. Trainers said the approach can be used in any setting, including hospital and forensic ones [source: Fletcher & Kalofonos 2022]. One Australian service found that sensitive disclosures could quickly escalate a service response, and that limited confidentiality was a weakness [source: CCU presentation 2019]. Agree the arrangements in writing in advance (B3), educate colleagues about the approach, and be honest with members about the limits. [synthesis]
Low attendance and fragile group dynamics. Attendance usually grows by word of mouth [source: Herzog 2024]. The atmosphere can change a lot as members come and go [source: Schaefer et al. 2021]. Publicise beyond mental health services, run continuously rather than in blocks, and avoid cancelling sessions [source: HVN setting-up page; Understanding Voices; synthesis].
Newcomers feel like outsiders. This is documented [source: Understanding Voices]. Assign a member to welcome newcomers, use a short values reminder, and give a brief recap of how the group works. [synthesis]
Facilitator burnout or unsustainable volunteering. Debrief after every group [source: HVN setting-up page]. Pay facilitators [source: Herzog 2024]. Keep a pool of three or four facilitators [source: HVN setting-up page]. Join a facilitators' network.
Online-specific problems. Digital access is a barrier; the VA lent tablets [source: Fletcher & Kalofonos 2022]. Before each session, agree how the person can be contacted if they disconnect while distressed, and confirm where they are physically. [synthesis]
Rupture with your client over the group (for example, the client feels pushed into it, or hears criticism of services there). Acknowledge it, restate that the choice is theirs, and treat criticism of services as legitimate material. The Charter values the freedom to challenge norms. [synthesis]

Sources

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