Lifetime prevalence rates of AVH among
patients with psychiatric disorders is much higher
than in community samples, about 80% in dissociative disorder, 70% in schizophrenia, and 30% in
bipolar disorder (16). This may explain why the
dominant professional focus is on treating negative
AVH. However, in various studies one-third to
over 60% of voice-hearers report pleasant or
positive effects of AVH (17–22). Others report
the support of positive voices against negative ones
(23, 24). These studies focused on psychotic
patients, mainly in the schizophrenia spectrum.

Two examples may illustrate the complexity of
useful voices. Detailed analysis of a 42-year-old
woman seeking treatment for negative imperative
voices revealed the recent presence of another
female caressing voice that reminds her not to
forget appointments. This useful voice has aided in
treatment compliance, the patient loves the voice
and wants to keep her. A 56-year-old single male
patient wants to get rid of a voice commanding him
to get up and get dressed. He acknowledges the
positive and useful effect of the voice, but still
wants to get rid of it because he feels a reduced
sense of control.