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by Robert W. Firestone, Ph.D.
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Voice therapy is a method of eliciting and assessing pervasive negative thought processes that represent an alien part of the personality. The methodology combines cognitive, affective and behavioral components into an integrated treatment strategy. | |
The following steps aid in combating destructive thought processes:
In collaboration with the therapist, patients develop and initiate corrective actions to change self-limiting, self-debilitating behaviors -- a process that requires a positive therapeutic alliance, strong motivation and personal courage on the part of the client.
The primary technique consists of asking clients to verbalize their negative thoughts toward themselves in the second person "you" as though they were talking to themselves, instead of the first person "I" statements about themselves. Statements such as "I'm so incompetent. I always make mistakes. No one likes me," become "You're so incompetent. You always make mistakes. No one would like a person like you." Putting self-attacking statements in this form tends to release strong emotions followed by spontaneous insights. The degree of self-hatred and animosity toward oneself that is uncovered in sessions where individuals verbalize their self-critical thoughts or voices is startling even in "normal" subjects.
Following verbalization and the release of feeling, patients often have a clearer picture of the emotional climate in which they grew up as well as the forces that had a negative impact on their development. In this atmosphere, corrective suggestions arise spontaneously. The client, in collaboration with his or her therapist, formulates ideas about altering routine responses and habitual patterns of behavior governed by these cognitions. Challenging psychological defenses based on these incorporated patterns that originally protected the individual from experiencing painful emotions leads to increased autonomy, individualization and a broader range of experience.
The techniques of voice therapy bring internalized, negative thought-processes to the surface with accompanying affect in a dialogue format so the patient can confront elements of the personality that are antagonistic toward self. It is referred to as "voice therapy" because it is a process of giving language or spoken words to critical thought patterns that are at the core of an individual's defensive behavior and lifestyle. This method has been used in a variety of clinical populations and is particularly valuable in understanding and working with patients with depression and diverse forms of substance abuse.
In the case of substance abuse, the destructive thought process takes two forms. Soothing or comforting thoughts urging the use of substances, e.g., "You've worked hard, you've had a tough day. You deserve to relax with a drink," are followed by painful self-recriminations, "You weak-willed jerk! You can't live up to any of your resolutions," after the individual acts on the addictive behavior.
A necessary goal in treating addicted patients is to provide them with an authentic relationship during the transition from relying on addictive substances to seeking and finding satisfaction in genuine relationships outside the office setting. The therapist in a sense becomes an important "transitional object" -- an intermediary -- to assist patients in coping with the addiction, while impressing them with the fact that as long as the addictive patterns are maintained, there can be no real insight. The therapist helps them identify the voices controlling the addictive process and understand how these destructive thoughts have provided a kind of comfort as part of a self-parenting, self-nourishing process. This understanding strengthens the resolve to relinquish the addictive habit pattern. The techniques of voice therapy combined with the therapist's powerful, nonjudgmental intermediary role, are an effective intervention in treating patients with problems in substance abuse.
Some clients, in treatment with a strong therapist and positive transference, have maintained abstinence from the beginning, even through many critical points in therapy. In one case, a 27-year-old woman was referred to treatment by an internist who reported that she was close to death because of her abuse of alcohol. She was anorexic and seriously depressed, but from the first session she never drank again. Identifying the destructive thought that had controlled her drinking helped during the
various phases of treatment. This patient's entire demeanor and body structure changed. Her life was saved, although she eventually substituted smoking and other less life-threatening habit patterns. Controlling the addiction allows for understanding and working through of underlying emotional trauma. It is valuable here to note that all clients manifest addictive components of their personalities that must be worked through for maximum psychological development.
Destructive thoughts and attitudes arise as a part of a defensive process. Under stress conditions derived from faulty parenting practices or existential anguish, children tend to turn against themselves, identify with the aggressor or the environmental conditioning they are exposed to, and incorporate negative attitudes toward self. In the process, they internalize a complex of destructive thoughts and associated feelings that the author refers to as the "antiself."
Negative voices lead to an essential dualism within the personality. This "division of the mind" reflects a primary split between forces that represent the self and those that oppose or attempt to destroy the self. These elements can be conceptualized as the self-system and the antiself-system. The two systems develop independently; both are dynamic and continually evolve over time.
The self-system consists of the unique characteristics of the person including his or her biological, temperamental and genetic propensities; identification with parents' positive qualities and strivings; and the effects of experience and education. Parents' positive attitudes and qualities are easily assimilated into the self-system through the process of identification and imitation. These become part of the child's developing personality, whereas internalized negative parental attitudes, defenses and hostile feelings remain alien. The antiself-system refers to the accumulation of destructive internalized voices that represent the defensive aspect of the personality.
Individuals possess conflicting points of view about themselves, others and events in the world, depending upon which aspect of the personality -- self or antiself -- is dominant. One point of view is rational, objective and life-affirming, while the other is made up of the destructive thought process that is opposed to the ongoing development, or even survival of the self. Destructive cognitive processes that make up the antiself-system have a dual focus: they are antithetical toward the self as well as cynical, distrustful and hostile toward others. Both lead to alienation from others.
Assessing negative cognitions has predictive value in relation to their effects on interpersonal relationships, achievement of personal and vocational goals, self-destructive behavior and suicide. Unchallenged, destructive thought processes represent an overall predictable negative trend in a person's life functions. People adjust their behavior or live their lives according to the dictates of the "voice." They become progressively more maladapted, gradually relinquishing activities they once found gratifying and give up more and more aspects of self. Suicide is the ultimate abrogation of self; it represents the extreme end of a continuum of self-destructive mental processes.
"Voices" vary along a continuum of intensity from mild self-reproach to strong self-accusations and suicidal ideation. Similarly, self-destructive behavior exists on a continuum ranging from self-denial, self-defeating behaviors, accident proneness, substance abuse and eventually to direct actions that cause bodily harm. For this reason, it seemed logical that an assessment of self-destructive thoughts could be utilized to predict self-destructive behavior and suicide potential. Empirical research with over 1300 subjects demonstrated the predictive power of the concept of the voice in suicide. A scale to assess suicide based on the voice concept was found to distinguish between suicidal and nonsuicidal subjects more effectively than other instruments currently used in clinical practice.
Although the techniques are relatively simple to apply, voice therapy is a serious approach, requiring an experienced clinician with a strong theoretical background and tolerance of feeling who ideally is relatively free of his or her own defenses or defensiveness. Although the destructive voice process is readily accessible through this technique, voice therapy is not necessarily a short-term procedure. Therapeutic progress is not a result of merely identifying negative thought patterns and uncovering repressed material; indeed, personal growth ultimately must involve constructive behavioral changes that oppose self-limiting or self-destructive patterns and lifestyles.
References
Robert W. Firestone is a clinical psychologist and
author of six books, over 20 published articles and the producer in
conjunction with the Glendon Association of 35 video documentaries
used for training mental health professionals.
