The Hearing Voices Network: a different paradigm for working with voices

In 1987, the Dutch psychiatrist Marius Romme and the social scientist Sandra Escher began working with a patient named Patsy Hage, who heard voices and had not been helped by medication. Hage challenged Romme: if no one could make the voices stop, perhaps the question wasn't how to silence them but how to live with them. Romme and Escher made a Dutch television appeal asking other people who heard voices to come forward. Hundreds did. The conversations that followed became the foundation of the Hearing Voices Movement — a peer-led, international network that has grown to include groups in more than 40 countries.

The core reframing

In standard psychiatry, voices are typically classified as auditory hallucinations and treated as symptoms of an underlying disorder, usually schizophrenia. The Hearing Voices Movement does not deny that some voice-hearers meet criteria for psychotic illness or benefit from medication. But it adds two important observations:

• Voice-hearing is far more common than schizophrenia. Population studies (including work by Iris Sommer and others) suggest that 5–10% of the general population hears voices at some point, and many never seek mental health care.
• For many voice-hearers, voices have content and meaning — often connected to trauma, loss, abuse, or unresolved life experiences. Engaging with the meaning, rather than only suppressing the experience, can be therapeutic.

Hearing Voices groups

The most visible part of the movement is the Hearing Voices group — a peer-led support group, usually of 5–10 voice-hearers, meeting regularly to share experiences. Groups follow a few key principles:

• Voice-hearers lead or co-lead the group
• The reality of voices is taken seriously — they are spoken about as real experiences, even if not literally true
• No single explanatory framework (medical, spiritual, psychological) is imposed
• The group is a safe place to talk openly about content that is often stigmatised even within mental health services
• Members support each other in finding personal coping strategies

Groups exist in clinical settings, community centres, peer-run spaces, and even some inpatient units.

The Maastricht Interview

Romme and Escher developed an extensive interview, sometimes called the Maastricht Interview for Voices, that helps a voice-hearer construct a detailed history of their voices: when they started, what triggered them, who or what the voices represent, how they have changed, what helps. This interview is now widely used by clinicians who work in a Hearing Voices–influenced way and forms the basis of their book Living with Voices (2009), a collection of 50 voice-hearer narratives.

What the evidence shows

Rigorous outcome research on Hearing Voices groups is limited and methodologically complex (the model resists manualisation). What evidence exists suggests that participation is associated with:

• Reduced distress related to voices, even when voice frequency is unchanged
• Improved sense of agency and coping
• Reduced use of acute psychiatric services in some samples
• High user satisfaction and reduced isolation

The model is increasingly endorsed alongside conventional treatment. The NICE schizophrenia guideline recommends offering peer support to people with psychosis, and many UK NHS Trusts now host Hearing Voices groups within their services.

Compatibility with medication and CBTp

Hearing Voices groups are not anti-medication, although individual members hold a wide range of views. Many participants take antipsychotics. The movement is best understood as complementary to clinical treatment, not as a replacement. The approach overlaps significantly with CBT for voices and with avatar therapy: all three move from "make the voices stop" to "change your relationship with the voices."

What it offers that clinical care often does not

• Permission to talk about content that other settings discourage
• Connection with others who hear voices — often the first time a voice-hearer has met someone with a similar experience
• A sense of agency and identity not defined entirely by diagnosis
• Frameworks for making meaning out of voices that go beyond "this is just a symptom"

Criticisms and caveats

Critics raise several concerns:

• Some worry that engaging with voice content could reinforce delusional systems
• The peer-led nature means clinical safeguarding is not built in
• Some members may de-prioritise medication in ways that increase relapse risk

In practice, well-run groups address these concerns directly: facilitators are trained, safety guidelines are in place, and groups generally encourage continued engagement with treatment teams.

How to find a group

The international umbrella organisation is Intervoice. National networks include the Hearing Voices Network UK and Hearing Voices Network USA, each of which maintains lists of in-person and online groups. Many community mental health centres, recovery colleges, and peer-run organisations now host groups locally.

For families

Families of voice-hearers can benefit from understanding the movement's basic stance — even if they don't attend groups themselves. The shift from "the voices are not real, ignore them" to "the voices are part of what you are experiencing, let's understand them together" can dramatically change the quality of family conversations and overlap with the LEAP method.

The honest summary

The Hearing Voices Movement is not a treatment in the conventional sense. It is a peer-led paradigm shift that has changed how a generation of clinicians and voice-hearers understand the experience. For many people, attending a group has been one of the most validating experiences they have had in mental health care. For others, it is not the right fit. Like any psychosocial resource, it works best when integrated thoughtfully with clinical treatment rather than positioned against it.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.