"Expanding the Spectrum": Experiences and Perceptions of Participants and Facilitators in Hearing Voices Groups

Hearing voices, seeing visions, and holding unusual perceptions and beliefs about reality are phenomena typically labeled as psychosis within the mental health system and associated with the psychiatric diagnosis of schizophrenia. The primary psychiatric treatment for individuals with this diagnosis is pharmacological, with the central aim of reducing and eliminating the voices. However, the biomedical model underlying this approach has been subject to considerable criticism, addressing doubts regarding its scientific validity, the ineffectiveness of pharmacological treatment, and the stigmatization produced by the use of psychiatric models and diagnoses. In contrast, alternative approaches to understanding and coping with these experiences have emerged. One such approach is the Hearing Voices Movement, which is the focus of this study.

The Hearing Voices Movement challenges classical psychiatric conceptions and views the spectrum of voice-hearing experiences as part of the continuum of human experience. The movement proceeds from a stance of respect for the experiences themselves and for those who have them, creating group spaces for sharing, exploration, and learning ways of coping with these experiences, with an emphasis on expertise by experience and peer support. Today, after approximately 35 years of development in Europe, the United States, and Australia, hundreds of Hearing Voices groups exist worldwide. Research on their activity, impact, and participants' experiences is still developing, yet existing findings point to beneficial effects across several domains and to participant satisfaction. In Israel, the movement is taking its first steps, and to date no research has been conducted on such groups in Israel.

The aim of the current study was to shed light on the experiences and perceptions of participants and facilitators in Hearing Voices groups in Israel, at the initial stage of their establishment, given that research elsewhere in the world has been conducted at more established stages of the groups and the movement in those countries. The study sought to understand what characterizes the dynamics and group processes occurring in the groups, how these are experienced by the interviewees, what meaning these experiences hold for participants, and in particular what significance the context of the approach entering the field for the first time carries for these experiences. In addition, the study focused on understanding the relationship between the meaning of experiences and coping with voice-hearing, as well as the experiences and perceptions of facilitators within the group space. The study was conducted using a qualitative approach based on critical phenomenology. It employed purposive sampling and semi-structured interviews with 14 participants and facilitators in Hearing Voices groups in Israel. The interviews were analyzed using thematic analysis.

Five central themes emerged from the findings. The first theme described the group space as a space of intimacy, listening, and sharing, and traced the process through which trust was gradually built despite initial apprehensions, enabling deep sharing of experiences that have no place in other spaces in participants' lives. The second theme addressed the components that enable renewed movement in self-identity: an ethics of radical acceptanc and curiosity, belonging to a peer group, the development of critical social consciousness regarding power relations and language within therapeutic systems, and the re-appropriation of the concepts of "normality" and "madness" as part of one's identity. The third theme revealed processes of meaning-making for non-ordinary experiences: from a pre-group state of confusion and absence of language, through initial processes of naming and exploration, toward a diverse repertoire of meanings encompassing a spiritual and supernatural axis alongside a psychological axis, and from there to the translation of meanings into everyday coping strategies. The fourth theme identified the group space as a fluid and flexible space, characterized by internal interpretive fluidity and interpersonal pluralism regarding the meaning of experiences, flexibility in the roles between facilitators and participants, and a paradox whereby the stable holding of the group setting was precisely what enabled the flexibility within it. The fifth theme focused on the value that facilitators derived from the group, both as a space of emotional nourishment and mutuality, and as an arena of practice and learning in which they deepened their understanding of non-ordinary experiences and practiced a humanistic, non-hierarchical stance.

In the discussion chapter, three theoretical perspectives were proposed for conceptualizing the findings. The first perspective suggested viewing the groups as fulfilling a function of cultural expansion, arguing that beyond intra-group processes, the very existence of the groups as a legitimate category in the cultural space expands the repertoire of meanings available to people who experience non-ordinary experiences, enabling them to enter, for the first time, a process of meaning-making. It was argued that elements of a collective quality — both extra-group and intra-group — complement one another and constitute a vital dimension for addressing the social wound of stigma and exclusion of people with non-ordinary experiences. The second perspective proposed understanding the group space as a "liminal-potential space," integrating Victor Turner's ideas on liminality with Donald Winnicott's concept of potential space. The group space was characterized as a threshold state in which social norms are suspended, hierarchies soften, and creative play with meanings becomes possible. The liminal logic was illuminated through theories of ontological multiplicity and epistemic pluralism, and it was argued that liminality may be not merely a transitional phase but a legitimate existential mode in its own right — the capacity to live within an open and ongoing process of meaning-making. The third perspective addressed the facilitators' experience and proposed the concept of mutuality in liberation, inspired by Paulo Freire, the relational approach, and Martin Buber's dialogical philosophy. It was argued that facilitators are not merely holders of the space but subjects who themselves undergo processes of change and growth, and that the groups function as a "humanistic-critical praxis" in which the values of the humanity of non-ordinary experiences, equality, and the destabilization of power relations become a living practice of engagement and experience.