Relational work with distressing voices mirroring experiences of discrimination and marginalisation: Three illustrative cases of an extended form of AVATAR therapy ( AV ‐ EXT )

Background For voice‐hearers from minoritised communities, voices may reflect interpersonal and societal discrimination, including experiences of feeling silenced or ‘voiceless’. AVATAR therapy is a relational approach involving facilitated dialogues between a voice‐hearer and a digital embodiment of their main distressing voice (the avatar). The aim is for the voice hearer to gain understanding, acceptance and empowerment. Aims This paper illustrates an extended form of AVATAR therapy (AV‐EXT), which seeks to understand a person‘s voices within their developmental and relational context. Methods We present three therapy narratives in which voices mirrored experiences of discrimination and marginalisation based on aspects of the person‘s identity. Personalised avatars were used during dialogues to re‐enact the lived experience of voice‐hearing. Results Avatar dialogues offered opportunities to rescript disempowering experiences, target associated meanings and connect individuals with the power of their own identity. Conclusions Implications for the continued refinement of AVATAR therapy and other relational approaches are considered. This paper aims to support wider reflection on the impact of discrimination on distressing voices.