‘You’re the voice (or not?) try and understand it’: An exploration of a possible relationship between voice hearing experiences and schema modes

Objectives: Theories of voice hearing suggest that trauma and dissociation can lead to a fragmentation of the self, experienced as distinct ‘parts’ that may manifest as voices. Schema Therapy offers a related framework, proposing that the state expression of early maladaptive schemas—dysfunctional emotional and cognitive patterns formed in response to adverse experiences— are represented by schema modes. These modes represent distinct parts of the self, such as vulnerable child parts, coping parts, critical parent parts, and healthy adult parts, which influence moment-to-moment experiences. This exploratory qualitative study investigated whether the content of voices experienced by voice-hearers maps onto schema modes as described in Schema Therapy. Method: Seven participants took part in semi-structured interviews exploring the characteristics and content of their voices. Interview transcripts were coded according to established schema mode definitions and analysed using Thematic Analysis. Results: Results indicated that most participants described voices that could be classified within the schema mode framework, with dysfunctional parent modes being the most frequently identified. Conclusions: These findings offer preliminary support for using Schema Therapy concepts to better understand and potentially treat distressing voices, suggesting value in further exploring this approach in clinical settings.