Voice Therapy® was developed by Robert Firestone, PhD. Voice therapy is a cognitive/affective and behavioral therapy that brings internalized negative thought processes to the surface with accompanying emotions, allowing clients to confront alien components of the personality. Therapist and client collaborate on corrective suggestions to challenge self-destructive behaviors.

A man listens to his therapistThe Theory Behind Voice Therapy

Voice therapy is the process of giving language or spoken words to negative thought patterns that make up the foundation of maladaptive behavior. The “voice” speaks the language of the defensive process, or an integrated system of thoughts and attitudes that are antithetical to the self and hostile toward others.

Robert Firestone’s separation theory forms the basis for voice therapy. Separation theory integrates psychodynamic and existential approaches by explaining how the defenses that children develop early in life in relation to interpersonal pain in the family are strongly reinforced and become well established in the personality after they learn about death. The therapy involves separating from fantasies of fusion with others, known as fantasy bonds, as well as from critical inner voices that interfere with one’s movement toward individuation and autonomy.

Voice Therapy Goals and Techniques

The ultimate goal in voice therapy is to help clients achieve a more independent and free existence, to remain vulnerable to both the sadness and joy inherent in life, and to maintain the ability to respond appropriately to both positive and negative events in their lives. The method has been utilized as an adjunct to other therapies and has been applied in work with individuals and couples and in group therapy settings.

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The voice therapy process consists of five steps designed to help clients move away from compulsive, self-limiting, and destructive lifestyles so that they can apply corrective strategies for positive behavioral change.

  1. Identify negative thought processes. The therapist and client collaborate in identifying and understanding destructive ways of thinking. The voice can be revealed by focusing on the person’s cognitions, or by voicing the emotions associated with the thoughts. Clients practice voicing the thoughts from a second-person point of view in order to get some distance from the hostility that they frequently direct at themselves. Prior to articulating and evaluating their voices, clients have generally accepted these negative thoughts as being true evaluations of themselves and others. In many cases, clients may reveal deeper beliefs about themselves that they were previously unaware of, beliefs that may have been incorporated in early childhood.
  2. Develop insights into the sources of the negative thoughts. As the client expresses his or her negative cognitions, the therapist may ask where the client might have heard such a statement before in order to identify where the negative beliefs came from. Often people make the discovery that their parents or early caregivers voiced the same beliefs, whether they did so verbally or otherwise. This insight helps people develop self-compassion and have a fuller sense of self, which then allows them to have more empathy for others.
  3. Respond to and resist the voice. Next, the client will speak back to the voice, in defense of oneself. Rational statements are crafted in this phase that help emphasize the client’s true nature, and the truth of others. This phase can be difficult for someone with low self-esteem or who is reluctant to give up negative view of self and projections onto others. Insight into childhood experiences and a person’s style of attachment may be revealed at this time.
  4. Recognize self-destructive behaviors. At this stage, clients are encouraged to identify the way in which the voice of negativity imposes self-destructive or self-limiting behaviors on a person. Everyday self-imposed limitations come to light, and the specific thoughts governing self-destructive behaviors, such as addiction, are revealed. Feelings of fear, guilt, or shame can keep a person from more constructive behaviors and progress, and those same self-defeating thoughts that rule self-destructive behaviors can keep a person from creating change.
  5. Develop corrective suggestions to create change. In order to move forward and defeat self-limiting behaviors and thoughts, the therapist and client collaborate to design interventions in line with a person’s goals, interests, and ambitions. The interventions will also reinforce the person’s sense of self and shift his or her perspective on the world. This phase is particularly challenging because it disrupts the psychological defenses that were developed to help the person avoid emotional pain. Sometimes those destructive defenses flare up at this point, making the person resistant to moving forward. As a result, the client may feel particularly vulnerable in this phase, and the therapist can help by addressing potential anxiety and fears associated with the change.


  1. About Voice Therapy. (n.d.). Retrieved from http://www.glendon.org/post-topic/voice-therapy/
  2. Firestone, R. W., & Firestone, L. (1998). Voices in suicide: The relationship between self-destructive thought processes, maladaptive behavior, and self-destructive manifestations. Death Studies, 22(5), 411-443. Retrieved from http://search.proquest.com/docview/231406581?accountid=1229
  3. Firestone, Robert. (2001). Voice Therapy: A Psychotherapeutic Approach to Self-destructive Behavior. Santa Barbara: The Glendon Association