Making sense of voices: the Maastricht approach

In the 1980s, the Dutch psychiatrist Marius Romme could not help one of his patients, Patsy Hage, whose voices tormented her. She challenged him: “Dr. Romme, you believe in a God that you cannot see and cannot hear, so why don’t you believe in the voices I really do hear and which are real to me?”¹ Romme took her seriously. The two of them appeared on a Dutch television talk show, and 450 people who also heard voices phoned in. Many of them were not patients and lived well with their voices.^1,2

From that start, Romme and the researcher Sandra Escher developed what became known as the Maastricht approach, and voice hearers began meeting in groups that grew into the international Hearing Voices Movement.³ Among those it helped was the psychologist Eleanor Longden. She later co-wrote a chapter about the approach with Romme and Escher.³

The ideas behind it

Hearing voices is more common than many people think. Estimates vary widely, but across studies a median of about 13 in 100 people in the general population hear voices at some point.⁴ How the brain can produce a voice no one else hears is the subject of When the brain speaks without our permission (opens in a new tab).

In a Maastricht study, the voices of patients and of people who never sought help were alike in form. The difference was in the relationship: people who were not patients mostly felt in control of their voices and were not frightened by them.⁵

The approach suggests that voices often begin after overwhelming or traumatic events, and carry meaning about them.³ Research supports a link with hard experiences: people with psychosis are almost three times more likely than others to have faced adversity in childhood.⁶ The developers also see voices as a form of dissociation, the mind splitting off what it cannot bear. Studies find a strong link between dissociation and voices, though they vary in quality, and the developers themselves write that this explanation needs more work.^3,7

What it involves

The interview. A therapist goes through 12 topics with the person, in about 90 minutes: what the voices are like and what they say, when each one began, what sets them off, how the person copes, childhood, past treatment and the people around them. The therapist writes a report, and the person reads and corrects it.³ More in Maastricht interview (opens in a new tab), in Treatments A–Z.

The construct. Together, they then work out who or what each voice may stand for, and which problems in the person’s life it reflects. The person’s own explanation is respected, including a spiritual one.³

Coping. People learn to set a time to listen to the voices, for example 30 minutes each evening, and to ask them to keep quiet the rest of the day. Resisting commands, keeping a diary about the voices and joining a peer group are part of it too.³

Talking With Voices. In this therapy, built on the approach, the therapist speaks to a voice directly, and the person repeats the voice’s answers aloud, word for word. The aim is a calmer relationship with the voices, not to make them stop.^3,8 More in Talking With Voices (opens in a new tab), in Treatments A–Z.

What the evidence shows

The developers first tested the construct with 100 people who heard voices. They could work out which problems the voices reflected for 94 of them, and who or what the voices stood for in 78.^3,9 Without a comparison group, this shows the method can be applied, not that it helps.

In 2022, a first randomised trial in Manchester tested Talking With Voices with 50 adults who had a schizophrenia spectrum diagnosis and had heard voices for at least a year. Half had up to 26 sessions over 6 months on top of usual care; half had usual care only. Most stayed to the end, and there were early signs of benefit on measures of voices, dissociation and personal recovery. Overall psychosis scores did not differ between the groups.⁸

A larger trial, with 309 people at four sites in England, has finished. Its results will be presented online on 9 December 2026.^10,11

Where you can benefit from the Maastricht approach

The approach is used today in the Netherlands, Belgium and the United Kingdom, and a trial in France has started recruiting. Some groups and courses are online.

Netherlands

Voice clinics. Each clinic works in its own way, as the table shows.^12,13 Treatment usually needs a referral from your GP.¹⁴

Peer groups. Free, with no referral needed: everyone is welcome.¹⁶

Belgium

In-Spraak in Kontich, near Antwerp, uses the Maastricht interview: 3 to 5 sessions of 45 minutes, after a first meeting to see whether the method suits you. Contact Myriam Bertels: +32 476 73 07 19, in-spraak.be (opens in a new tab).^12,17

A peer group meets in Mortsel, near Antwerp, at De Klapper, Antwerpsestraat 179, on the third Monday of the month, 14:00–16:00: herstelacademie.be/antwerpen (opens in a new tab).¹⁶

United Kingdom

The Hearing Voices Network lists peer groups in England (opens in a new tab), in person and online. It cannot vouch for each group, and is revising its list.¹⁸

One online group welcomes anyone in the UK: Mondays, 17:30–19:00, hearingvoicesonlinegroup@gmail.com. Voice Collective (opens in a new tab) runs online groups for people aged 15 and under, for those aged 16 to 25, and for university students.¹⁸

France

The EDEN trial compares a ten-day course, which includes exercises for dialogue with voices, with the usual group sessions. It is recruiting at CH Le Vinatier in Bron, near Lyon, and seven more centres are due to open. It is for people aged 18 to 65 who have heard voices for at least 6 months, speak French and are in French mental health care. Contact: Baptiste Gaudelus, baptiste.gaudelus@ch-le-vinatier.fr, +33 6 74 49 78 51.¹⁹

Online

A free e-learning based on the Maastricht approach explains how to make sense of voices, and how relatives can support someone who hears them: in Dutch (opens in a new tab) and in English (opens in a new tab).²⁰

Stichting Weerklank, the Dutch network of voice hearers, runs an online peer group in Dutch every other Tuesday, 18:30–20:00: onlinegespreksgroep@stichtingweerklank.nl.¹⁶

The World Hearing Voices Congress (opens in a new tab), for voice hearers, relatives and professionals, meets in Copenhagen on 17 and 18 November 2026, with an online day on 16 November.²¹

What we don’t know yet

• Who benefits most, and who is better off with another approach.
• How it compares with AVATAR therapy and with cognitive behavioural therapy.