Understanding AVATAR therapy: who, or what, is changing? Ben Alderson-Day Nev Jones

To understand the complex dynamics of this kind of treatment, we need to look both back and forward. If auditory verbal hallucinations can be dialogued with in this way, is this a possibility only for those with many years of developing voices, or might it be relevant for the young person using early intervention services for the first time? In other words, how does a voice come to be agentic, personified and characterful?11 If we think that the voices or their power relations have changed, does this actually persist beyond therapy, and why are gains apparently not maintained when compared with control interventions? It might be that we need to look beyond the individual and their voices to understand how social relationships and contexts, more broadly, might invoke relapse and distress once someone finishes therapy. Longitudinal qualitative research, possibly combined with ecological momentary assessment, could elucidate the potentially diverse and multifaceted factors contributing to changes relevant to the voice-hearer. We should applaud the efforts of the AVATAR team and the considerable benefits they have enabled for voice-hearers in their trial, but put simply, the question now is this—how does the conversation continue?

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