Voice Therapy

In my last blog, I described the “voice” as a series of negative thoughts and attitudes toward self and others, which are at the core of a person’s self-destructive ideology and behavior. As such, the voice can be conceived of as the internal enemy or anti-self aspect of the personality. My approach to psychotherapy is known as Voice Therapy because it is a process of giving language or spoken words to the harmful thoughts that strongly influence or control an individual’s maladaptive thinking and behavior.

In early investigations into the voice, participants in our pilot study attempted to express their self-attacks in a rational, cognitive manner and tone. They articulated their self-critical thoughts in the first person as “I” statements about themselves, “I’m so stupid,” “I never could get along with people,” “I never was any good,” etc. Later, I suggested that they verbalize these same thoughts as statements spoken to them in the second person, “you” statements, such as, “You’re so stupid,” “You never could get along with anyone,” “You’re just no good.” When the participants complied with this new method, I was shocked by the malicious tone of their self-attacks and the intensity of the anger with which they attacked themselves. It was surprising to observe even mild-mannered, reasonable individuals being so intensely self-punishing and cruel.

The second-person dialogue technique was what brought these powerful emotions to the surface. I became increasingly aware of how angry people were at themselves, how divided they were, and how much they sabotaged themselves in their efforts to cope effectively in their daily lives. I felt that the new methodology was a valuable discovery because it gave clear access to the negative thought process. Not only could people’s destructive attitudes toward themselves be accessed with the new procedure; but in addition, the exposure had implications for altering their self-destructive propensities.

Voice Therapy has been found to be an effective tool for researching people’s self-critical feelings and self-hatred. It facilitates an understanding of the origins of the self-destructive component of the personality and thereby helps clients therapeutically. They learn to separate from the internalized negative parental view of themselves that is an overlay on their self-image. Furthermore, the emotional catharsis that accompanies the exposure of the voice relieves tension and allows for a more positive feeling and compassionate attitude toward oneself.

The Therapeutic Process in Voice Therapy

My approach to eliciting and identifying the contents of the voice is not didactic; that is, I do not directly try to persuade people to think or behave rationally. Rather, I help them discover the contents of the voice’s malicious “coaching” in various situations and assist them in moving away from these negative attitudes and prohibitions.

There are five steps or stages in this therapeutic process. They are not discrete and often overlap one another.

(1) Identifying critical, hostile attitudes toward one’s self and/or others and verbalizing them in the second person dialogue format, as “voices”

The process of verbalizing voices can be approached either intellectually as a primarily cognitive technique or more dramatically using cathartic methods. In the latter, particular emphasis is placed on the release of affect accompanying the expression of the voice attacks.

The majority of clients seem to naturally adopt an emotional style of expression when articulating their self-attacks, because their sadness or anger is often close to the surface. Furthermore, as they get closer to the emotionally charged content of their voice attacks, there is often a remarkable change in their physical expression and appearance. Their body takes on the posture and mannerisms of a strict parent delivering a demeaning or critical lecture to a child. Sometimes, their tone of voice takes on the accent of one of their parents. All of this is experienced without conscious awareness on the part of the client.

(2) Recognizing the source of the voice attacks

As a result of verbalizing their voices, clients rapidly achieve their own insights and draw their own conclusions about where their distorted views and attitudes came from. They often connect specific voices with negative parental attitudes and/or interactions that defined or labeled them, either explicitly or implicitly.

At times, clients are able to recognize the criticisms directed toward them by their voices as actual statements that were made by their mothers and fathers, as attitudes that were indicated by their parents’ behavior, or as a generalized feeling that they picked up from the atmosphere that pervaded their home. It appears that these angry thoughts and attitudes were internalized at times when parents were the most rejecting or punishing of their children, during events or circumstances children actually may have experienced as life-threatening.

(3) Countering or answering back to the negative voice attacks

There are two aspects of the answering back process: (1) clients offer a rational and realistic evaluation of their own point of view; and (2) clients counter the charges by responding with strong emotions of anger, and sadness.

(4) Understanding the negative effect or impact of the destructive thoughts or voices on one’s present-day behavior, therapeutic goals, and desire to change

Clients identify how voice attacks impose limitations in their everyday life and interfere with their overall adjustment. Becoming aware of these self-imposed restrictions helps them to understand and alter their feelings of being victimized or paranoid. Clients are also able to evaluate any elements of truth in their self-attacks, thereby subjecting the content of negative voice to a process of reality testing. This is an objective analysis that must be free from judgmental or malicious attitudes.

During this stage of the therapy, clients learn that it is not appropriate to attack themselves for their shortcomings or weaknesses. Instead, it is more productive to work on modifying their undesirable traits.

 (5) Collaborating with the therapist in the planning and implementation of corrective suggestions to challenge negative traits and behaviors dictated by the voice   

Suggestions for behavioral change fall into two categories: (1) those that help control or interrupt bad habit patterns, such as addictive behaviors, passivity, or self-limiting dependency bonds; and (2) those that expand the client’s world by encouraging new behavior that involves taking emotional risks and gradually overcoming fears related to pursuing their wants and priorities.

During this step in Voice Therapy, clients formulate the values that give their lives special meaning. Then, with the therapist’s help, they plan methods and means of pursuing these goals. And lastly, as they cope with the necessary risks inherent in self-actualization, they attain a new level of vulnerability and learn to tolerate the anxiety involved in making positive changes.

Clients report that, although there are often strong voice attacks after significant positive movement, these self-attacks tend to diminish after the new behavior has been maintained for an extended period of time. The importance of teaching clients to “sweat out” progressive changes in their identity and style of relating cannot be overstated. Only by coping with the anxiety generated by positive change can people hold on to the psychological territory they have gained.

Voice Therapy differs significantly from most cognitive-behavioral models in its emphasis on the expression of deep feelings. My technique brings to the surface previously suppressed primal emotions of shame, fear, rage, and sadness, which need to be uncovered and addressed in order for lasting changes to take place.

According to Greenberg, Rice and Elliot (1993), “Direct emotional experience has a salience that overrides other cues or concepts to reorganize and restructure people’s views of themselves and the situation. While thinking usually changes thoughts, only feeling can change primary emotions.” The importance of accessing emotion in psychotherapy as a way of actually changing the brain has been extensively studied and is increasingly supported by research in the neurosciences. Because the brain has the potential to grow and change continuously throughout life (neuroplasticity), new learning takes place in the presence of emotional arousal that is repeated over a period of time.  Louis Cozolino (The Neuroscience of Psychotherapy) has asserted that, “Therapy is successful to the degree that therapists are able to create an experience that results in neuroplasticity.”


Voice Therapy is a valuable tool that brings internalized destructive thought processes to the surface, with accompanying affect, through the use of a dialogue format that allows a client to confront alien components of the personality. Clients involved in Voice Therapy tend to develop powerful insights in a relatively short time. It is both an experimental laboratory procedure that yields valuable data and a psychotherapy methodology. As a psychotherapy, it can stand on its own or be used as an adjunct to other therapeutic approaches.

In the laboratory setting, it has provided the means for eliciting and identifying partly conscious or unconscious negative thought patterns that impair personality functioning and damage relationships. Overall, it has been a valuable research methodology. The insights it yields are relatively free of therapist theoretical bias or influences because there is little need for therapeutic interpretation. As noted, clients readily form their own assessment and evaluation about where their problems originated.

Voice Therapy has been successful because it combines three important components that have proven effective in changing the brain: (1) developing personal insight and understanding; (2) experiencing deep emotional release; and (3) planning and taking constructive action to change behavior. It has been utilized in both individual and group therapy formats. It is particularly beneficial in the group context because participants have a strong impact on one another. They get cues about how to express their self attacks and are stimulated emotionally by observing other clients utilizing the dialogue method.

Voice Therapy techniques have been found to be useful to therapists with diverse theoretical orientations. In addition, the methodology has been helpful in evaluating suicide and violence potential and determining clients’ prognoses. Lastly, it has been demonstrated to yield significant therapeutic progress in clients suffering from a variety of psychological maladies.

In my next blog I will discuss the fantasy bond in couple relationships.


Cozolino, L. (2006). The neuroscience of human relationships: Attachment and the developing social brain. New York: W. W. Norton.

Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment-by-moment process. New York: Guilford Press.

About the Author

Robert Firestone, Ph.D Robert W. Firestone, Ph.D. is a clinical psychologist, author, theorist and artist. He is the Consulting Theorist for The Glendon Association. He is author of numerous books including Voice Therapy, Challenging the Fantasy Bond, Compassionate Child-Rearing, Fear of Intimacy, Conquer Your Critical Inner Voice, Beyond Death Anxiety The Ethics of Interpersonal RelationshipsSelf Under Siege, and recently his collection of stories Overcoming the Destructive Inner Voice.  His studies on negative thought processes and their associated affect have led to the development of Voice Therapy, an advanced therapeutic methodology to uncover and contend with aspects of self-destructive and self-limiting behaviors. Firestone has applied his concepts to empirical research and to developing the Firestone Assessment of Self-destructive Thoughts (FAST), a scale that assesses suicide potential. This work led to the publication of Suicide and the Inner Voice: Risk Assessment, Treatment and Case Management. He has published more than 30 professional articles and chapters for edited volumes, and produced 35 video documentaries. His art can be viewed on www.theartofrwfirestone.com. You can learn more about Dr. Firestone by visiting www.drrobertwfirestone.com.

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One Comment


I need to find a psychologist who practices in the Overland Park, Kansas area. My adult daughter suffers from self loathing, etc.

Help me please!

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