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5. USING INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS ® 73
is external (‘the voices are not inside me’). Consequently, the hearer cannot exert
control over the voice because it is beyond their physical boundaries. Thus, the
voice overtakes the self (Chadwick, 2006). The agency relationship of the voice
and the self relates to the internal voice; thus, the person does not feel threat¬
ened. This relationship allows the hearer to cope and successfully take control
over the voices (Newton et al., 2007). In this study, the internal interpretation
was a consequence of the acceptance of the voice hearing condition. It was also
an adequate explanation for the voices when the relationship between the voice
and the self changed and the role of the voice changed. Voice hearers who
identify internal voices (thus have an adequate explanation) talk more often
to the voice and feel a greater sense of control. However, it is important to note
that in these cases the voice is positive and provides help during everyday
activity; therefore, the hearer is less willing to control it (Rosen et al., 2015).
This can result in a peaceful partnership with the voice, which Chin and col¬
leagues (2009) called the construction of. The hearer recognises that the voice
will not disappear (long-term understanding) and believes that it is therefore
better to accept it than fight against it (Chin et al., 2009; Mawson et al., 2011;
Milligan et al., 2012; Rosen et al., 2015). The self-help group significantly
helped the participants identify and deal with the voices. Previous IPA studies
of voice hearers have found that self-help groups serve as a turning point in
the life story of voice hearers (Hendry, 2011; Mawson et al., 2011; Milligan et
al., 2012; Newton et al., 2007). Ruddle, Mason, and Wykes (2011) summarised
the factors that help voice hearers cope. They noted that the change provided
by the self-help group is primarily due to its safe (friendly, tolerant, etc.) envi¬
ronment, where participants can share their experiences and feel less alone.
The support of others and the acceptance experienced in the group helps in
the coping. Hearers receive an explanation for the voices (in this study group,
doctors, peers and reading were other factors that helped), making successful
coping and control possible (Newton et al., 2007).
The self-help group also helps participants improve their social skills (Ruddle
et al., 2011). The voices often set boundaries in hearers’ social relationships
(Mawson et al., 2011), making it a calming experience to be with similar people
(Newton et al., 2007). The group also increases self-esteem (Ruddle et al., 2011),
as for the voice hearer it is closely connected to the relationship with the voice
and how the voice accepts her (Mawson et al., 2011). The group is not only
functioning as a social support, but also enables members to see their experi¬
ences as precious and as a personal encounter. The lessons learned are value for
peers to hear (e.g. coping repertoire) (Newton et al., 2007). This helps with
destigmatisation (Ruddle et al., 2011). The primary aim of self-help groups is
to change the relationship between the voice and the self - similarly in our study
the method played a crucial role in changing the relationship - which decreases
distress as a consequence (Ruddle et al., 2011).