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Relational Therapies for People Who Hear Voices: Operationalisation and Current Status of an Emergent Group of Psychological Therapies
Journal article   Open access   Peer reviewed

Relational Therapies for People Who Hear Voices: Operationalisation and Current Status of an Emergent Group of Psychological Therapies

Neil Thomas, Thomas Ward, Eleanor Longden, Imogen H Bell, Rachel M Brand, Mads J Christensen, Louise B Glenthøj, Mar Rus-Calafell and Mark Hayward
Schizophrenia Bulletin, Vol.52(1), pp.1-13
2026
DOI: https://doi.org/10.1093/schbul/sbaf142
PMCID: PMC12809787
PMID: 41391108
Appears in  Thompson Institute Research Collection
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Abstract

auditory verbal hallucinations virtual reality avatar therapy voice dialogue psychotherapy relating therapy schizophrenia psychosis talking with voices Other Collaborations Thompson Institute Special Collection
Background A recent theme in the development of psychological interventions for hearing voices (auditory verbal hallucinations) has been the emergence of a group of overlapping approaches increasingly referred to as relational therapies: Relating Therapy (RT), Talking with Voices (TwV), and AVATAR Therapy (AT). Study design Collaborative discussion among a group of researchers involved in developing these interventions combined with a systematic literature search were used to review this new genre, aiming to develop an agreed operationalisation; and identify common and distinctive aspects; potential mechanisms; and collective research directions. Study results Relational therapies for voices can be operationalised as those that “consider patterns of interaction, and/or the relational dynamics between hearer and voice, as targets for therapeutic change, and use an experiential process of dialogue with identities associated with voices as a primary therapeutic method.” Key differences involve the type of experiential hearer–voice dialogue used (ie, role-play chair work, direct dialogue with voices, and recreations of voice hearing using a computerised avatar), plus varying emphasis on models of interpersonal relating, broader relationships, and meaning encapsulated within voice-hearing experiences. AT has been found efficacious in several randomised controlled trials, with RT supported by evidence from two trials, and a multicentre trial for TwV underway. Mechanism domains include hearer–voice relating; habituation; threat and safety appraisals; and reformulation and integration of experiences. Conclusions Common features and mechanisms can be identified across the relational therapies. Key future directions include considering what works for whom; how therapy influences voice phenomenology; the role of relational models; and implementation.

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