Voice Dialogue and the intercultural dimension

Account of a master class
by Mariëtte Hoogstraten and Nurey Sönmez, of MIKADO (knowledge center for intercultural mental health care)

In September 2004, MIKADO, in collaboration with Robert Stamboliev of the Institute for Transformational Psychology organized a master class on the Voice Dialogue method and social assistance to migrants.
Worldwide, Voice Dialogue is used as a method of therapy  and coaching, helping people realize their strong sides and the opposites. The method is based on the assumption that people include many different aspects or ‘selves’ in their personality, and that these can be addressed separately (Halbertsma & Stamboliev, 2002; Van Dijk, 2003).
The organizers of the master class are of the opinion that Voice Dialogue is quite useful as a method to help and coach migrants. Specifically, tensions and dilemmas stemming from different (cultural) identities may be explored and solved by Voice Dialogue. This notion corresponds to the importance that has always been given to communication and system theories by the (intercultural) assistance to migrants (Jessurun, 2002).
Two trainers and twenty experienced health care professionals participated in the master class, people who frequently work with migrants[i] in mental health care or in education. Almost all participants, moreover, were themselves migrants of the first or second generation. The aim of the gathering was to introduce the participants to Voice Dialogue as a method, and to discuss the possibilities of applying it to migrant assistance. In addition, the trainers were looking for partners in the development of intercultural Voice Dialogue.
Consequently, the aim of the master class was not only the transfer of knowledge by the trainers, but also an exchange of expertise between the trainers and the health care professionals.

Introduction to Voice Dialogue

Many psychological theories support the idea that the human personality does not consist of one undivided ‘self’, but of many ‘selves’ (qualities, parts, subpersonalities, voices, energy patterns, archetypes). Voice Dialogue was developed by married psychologists Hal and Sidra Stone. They take the point of view that all these parts in a human being may be addressed separately. Every part, every subpersonality has its own will, thoughts and feelings, and its own voice (Stone & Stone in Halbertsma & Stamboliev, 2002).
The parts are arranged according to polarities. One pole contains the parts that have enabled an individual to survive. Being in control, a perfectionist and critical, are qualities that some people adopt to be in command of the way they live and work. Another example of the way many people have learned to survive is the – constant – pleasing of other people and being nice. The other pole contains parts that we are less conscious of, or not conscious of at all. Rational qualities exist, as opposed to emotional qualities and energies, and strong qualities as opposed to weak and vulnerable qualities. The opposite of the pleasing quality is the selfish part.
Often, we do not function well as human beings in our work or our private lives, because we are not aware of the polarities, of the hidden parts of our personalities. We then live by our strategies for survival only, by our primary part. This is true for individuals, but also for people who work together in an organization, or live together in a society, thus keeping alive a (sub)culture in which one type of behavior is appreciated and another is not. This can also be the case with an entire civilization, including one dominant culture and different minority cultures – accepted or not.

Voice Dialogue literally gives a voice to each different part within a person. These parts may be primary and strong (well developed, often used, necessary for survival), underdeveloped, vulnerable or even disowned. Each part has its own energy patterns (posture, voice, bodily tensions, all kinds of non-verbal expression), and may be recognized as such.
In addition, much attention is given to developing a consciousness that is situated ‘above’ the different parts as it were, that takes control and is able to make choices.
In contrast with many other methods, Voice Dialogue is never out to suppress the parts which enabled an individual to survive – the primary self; on the contrary, it will invite them to come forward. Voice Dialogue aims at teaching people that they need not be identified with their primary system (the Thinker, the Perfectionist, the Pleaser), but that these parts are simply acknowledged and contribute to their personalities.
In different (sub)cultures different parts are primary and acknowledged. Depending on the setting, other primary systems might present themselves in order to survive. In The Netherlands the Thinker and the Perfectionist are highly valued archetypes. In many non-western countries physical or emotional parts are appreciated rather than rational qualities.

Voice Dialogue is a means of communication, a way to get to know yourself and others. Communication is established not only mentally and verbally, but also physically and emotionally; Voice Dialogue uses all of these channels.
The method originated as a communication method for partners in a relationship. Moreover, Voice Dialogue may be applied as a method of self-reflection, coaching, mediation and psychotherapy.
As is the case with many methods of communication and therapy, the range of Voice Dialogue is dependent on the range and depth of the facilitator’s skills. A facilitator should be able to at least meet and recognize the voices/parts, which are coming forward, and preferably also ‘know’ their presence within himself or herself.

In The Netherlands, Voice Dialogue is not (yet) recognized as a official form of therapy, but is categorized as an alternative method of therapy (Van Dijk, 2003). The Riagg in Maastricht has adopted the method from the 90ies on for its own clients, both with regard to regular psychotherapeutic problems and more complex psychiatric cases, for example people who hear voices. The client association of people who hear voices also makes use of the method.

Demonstration sessions

During the master class two demonstration sessions were given: two coaching sessions between health care professionals dealing with migrants and Robert Stamboliev as facilitator. The other participants were observing the talks. The sessions were ‘real’, and did not involve role-playing. The two clients had agreed beforehand to introduce a theme from their own lives and working environment during the demonstration session. The duration of the sessions was about 30 minutes. The talks developed more or less along the following lines: make contact, indicate the context; point to (vital) theme; identify polarity; give a voice to the primary self and other parts; develop consciousness; integration.
It was impossible to predict beforehand to what extent the coaching sessions would bring an intercultural dimension to the surface. However, in both cases the health care professionals came themselves from a background of migration and worked or had worked with migrants. An account of the first session now follows.

Session with Paula

Paula[ii] had had one previous coaching session with Robert as facilitator. They had not seen each other again in the meantime. Paula and Robert are sitting on chairs, opposite each other, without a table in between.

Context and themes
Paula (P) introduces her topic of conversation. Below are quotes, which have been summarized. Robert (R) is asking questions, trying to clarify things (what do you mean by ‘deadlock’? what do you mean by ‘lethargy’? can you elaborate on that?).

It is as if I am deadlocked in my work. I notice I am becoming allergic to always having to play the expert. I am relying more and more on my intuition and it bothers me that I am diverging from the method. I have a plan and a method, but when I am seeing a client, I am struck by completely different things that I would like to tackle. I am even wondering if I want to continue to work in this way, independently, with all the stress that comes with it. If I started working with my own methods, I could resolve the deadlock, but the only thing I feel is lethargy.
I am an experienced trainer and presenter, but more often than not I am questioning myself: “What am I going to say here, what is really worth telling?”

On the one side I see you have plans for an approach and a method, and on the other side your ideas, your intuition; last time you called this your Indonesian side.

It is as if my intuition is claiming more space all the time, and this makes me nervous.

Vital theme and polarity
The vital theme seems to point to the integration of thought and intuition, structure and improvisation. This polarity contains two important energy patterns, The Thinker/Structure and Intuition/Improvisation.

Next, Robert asks Paula to sit in another chair so that he may talk to the Thinker. Paula chooses a chair that stands a little bit to the left in the room. It becomes clear that the Thinker has originated in The Netherlands, and has profited a lot from studying and training. In the previous session, this part got a good chance to indicate the rules that Paula’s work must comply with: a sound scientific basis, well prepared and documented. Furthermore, she must keep to the methods used by the institute she is working for. After an extensive exploration of this voice, there is room for the other side.

The second voice, Intuition, is seated to the right of Paula. This voice is not so verbal, there are many silent moments, but apparently there is much being exchanged between Paula and Robert as a facilitator. The voice is much more connected to Paula’s Indonesian background. She empathizes with people and visualizes energies. Intuition indicates that she wants to be more present in Paula’s life. In some situations she is already present, both in Paula’s private life and in her work. Often this leads to better results. She would gladly have Paula allow her to do more and be used more frequently.

Once Paula is back in her original position – ‘the position of the Aware Ego’, in Voice Dialogue terms – something unexpected happens. Paula says, in a more timid voice than before, that she feels less strong than it appeared a moment ago, and that someone is interfering. Robert asks if they can try to find out who it is.

Paula stands up and takes a position behind her own chair. Robert asks this new, as yet unknown, voice how she did it, breaking in like this?

I don’t know how I did it, but it is not an acceptable thing to do, it has no cachet (looking at Intuition’s position].
She does have distinction [pointing at the chair she sat in as The Thinker], working with structure and planning so well.
[Looking at Intuition’s chair again] It is as if it’s not suitable, as if it is forbidden.
I am worried about her [pointing to Paula’s chair, the Ego-position], she may let everything go to pieces without there being an alternative. Precisely at the moment the bureau is really on track.

I would like to hear more about the objections against Paula’s intuition. [Paula who had been behind her chair all this time, now takes a few steps back, straightens herself and the energy shifts, becomes more powerful and solemn]
Can you tell me who you are?

Something very angry crops up now. It is crazy to throw away everything you have built up so far. Yes, you should address me with deference, and I do not give her permission to come forward.
[Long silence ensues]

She is too generous, gives away her intuition too easily, while in the past this was not treated with respect. Let them screw around with their own methods.
She has to be careful, too. Before she even knows it, it will be used against her.

[to Paula, standing] What is your relationship with her (points to the chair with Intuition], does she know you exist? Are there any situations you can think of in which she is allowed to show her strong side?

No, I don’t think she knows me, time will tell. Before she can show herself, she must become more assertive of her own originality. But it has to do with the outside world, too, that does not recognize intuition and does not appreciate it.

Integration and evaluation
After some time Robert invites Paula, who is still standing, to take a seat on her first, her own chair. After a few moments Robert asks her to bring this chair and sit next to him. Paula and Robert sit next to each other for a few minutes. Nothing is discussed, or analyzed, or solved; there is only observation of what has happened. This is called ‘being aware’ in Voice Dialogue terms.
Next, Paula returns with her chair to sit opposite Robert, and they talk about the session. This is a moment of ‘integration’. They discuss whether Paula recognized what was happening: the Thinker, Intuition and a powerful, formal, but rather angry part that stood behind her.
Paula experienced the anger, the resentment and the protection of her ‘standing’ part. It felt new, she did not recognize these emotions within herself, but knew them from family members. Paula: “It felt as if I had to protect a treasure which I am not allowed to part with. At the same time I am very inspired in my work.” She was obviously surprised by the existence of the ‘standing’ Paula.

The session with Paula alerted us to an interesting intercultural theme: the ‘heritage’ of migrants that they do not automatically want to share with people outside their own ethnic and cultural society. The theme was definitely recognizable for the other participants. The content of that ‘heritage’ may be different for every society or for every person, but its existence was acknowledged by almost all participants. Resistance against preserving and automatically sharing this heritage is probably linked to acknowledgment and appreciation by the dominant culture.

Session with Hatice

Robert and Hatice have never met before. In the session, a few minutes are dedicated to getting acquainted. They are sitting opposite each other on chairs during this process.
Hatice was born in Turkey and came to The Netherlands with her parents and her brother when she was in elementary school. She is now a woman in her forties and successfully trains migrants.

Context and themes
Hatice introduces her topic of conversation. She had been invited last summer to give a lecture in Turkey about her work in The Netherlands. She had returned to Turkey often between her childhood and the present time, but never in connection with her work. In the weeks before the lecture she noticed she was very nervous, anxious and tense. It affected her much more than she had expected, and much more than the nature and content of the lecture warranted. She would like to talk about this in the session.
Robert tells Hatice that he considers this a pretty ‘large’ and ‘deep’ theme to be discussed in this context. There is less than a half hour’s time for the session, and they have never met. He does not know what this theme will bring to the surface with it, and considers it too risky. Hatice understands this and agrees. Robert then changes the subject and asks ‘what’ or ‘who’ within Hatice wants to ‘quickly’ discuss such a complicated theme, and in a demonstration session, no less. Robert asks if he can talk to the Hatice who thinks this ‘should be possible’.

Vital theme and polarity
A conversation follows with the voice that is pushing her, who thinks Hatice should be strong and be able to handle anything. While she is giving a voice to this part, Hatice is standing up and walking around. This ‘primary self’ does not pay any attention to her vulnerability. The vital theme apparently has to do with power and vulnerability.
This theme somehow also plays a large role with regard to her original question, about the anxiety she experiences during her work in Turkey. Back in her original position, Hatice says that she would like to identify less with her powerful side, and wants to deal with her ‘disowned’ self, the vulnerability, in a more conscious way.

Integration and evaluation
After being surprised at Robert’s refusal to accept the theme she wanted to discuss, Hatice is now amazed by the final result of the session. She acknowledges that some voices within her presented themselves that are important for her at this time in her life. During the session she experienced these voices as ‘persons’: “I really am those identities, I feel I am that.” She sees a big difference between just being present at a session (like she was during the session with Paula), and taking part in a session. “As a witness, you can still think that someone is ‘playing’ all those different roles, but as a participant you feel that you are those roles physically.”

The intercultural dimension

After the two demonstration sessions the possible intercultural dimensions of Voice Dialogue came up for discussion explicitly. Can the method be applied to different groups of migrants? And if so, are adjustments necessary? An initial stocktaking resulted in the following topics.

The first point of discussion involved the capacity of the facilitator to understand the various internal dialogues of the client and facilitate them during the session. Is it necessary for the facilitator to recognize the client’s intercultural voices, dilemmas and different selves? If so, what are the requirements for a facilitator who has no knowledge of the client’s cultural background? How will a facilitator be able to recognize themes that concern migration, transition and dominance, when the facilitator has not had the experience himself?
These questions actually concern all forms of therapy, when a health care professional and a client have different cultural backgrounds. The two demonstration sessions showed that it is possible to bring intercultural dilemmas to the foreground – even without being prepared for it. The facilitator need not know from his own experience how the client is feeling, but he must be able to sense (mentally or physically) what tensions or other problems are present. The effectiveness of the facilitator is determined by the extent to which he is sensitive to diversity. Next, pursuing further questions and a welcoming manner are necessary techniques. A facilitator gives direction to the conversation, but does not determine the outcome. The client is on a voyage and can take the facilitator along.

The next point of discussion involved the question whether the method would be applicable to poorly educated first generation migrants. For a Voice Dialogue session to be effective, it is important that the client be motivated to investigate the different aspects of his own problem or question. This investigation can focus on internal dilemmas (e.g.: I would like to grow old in The Netherlands, versus I would like to grow old in my home country); on somatic disorders (I suffer from headaches); or on external factors (e.g.: it is all the fault of my boss). A capacity for self-reflection is quite important. A client who is not up to this kind of investigation, may be better off with a different method.

Some participants wondered if working with this method is at all feasible when the facilitator and the client do not speak the same language (or not well enough). In Robert Stamboliev’s experience, conducting Voice Dialogue sessions with an interpreter present, works quite well. However, it is not advisable to work with an interpreter on the telephone. The subtlety of the different voices cannot be communicated satisfactorily by telephone.
Participants also wondered if the method, for many migrants, would not be too fast and direct a technique. The ‘playful’ elements, like changing position and moving chairs, will probably not appeal to everyone.

Many migrants stem from a ‘we’-culture, in which it is often difficult to think in terms of ‘I’, let alone in terms of several ‘I’s’. And so the facilitator must have the skill to adapt to his client’s context when choosing his words.
Moreover, Voice Dialogue is a psychodynamic method, whereas the narrative of migrants tends to externalize matters. Problems are identified as related to the environment or to the different countries of origin.
The direct consequence of these issues is the necessity for the facilitator to introduce these external factors in the sessions, for example by giving voice to the opinion of the family. According to Robert Stamboliev the method is very much suited to this. It is important to open up energy in people, but it does not matter what you call this energy. It may be done in terms of ‘selves’, but also in terms of relationships, of persons in the family or in the community, or in terms of somatic concepts. If someone is suffering from ‘pain in the heart’, and all kinds of somatic complaints, a conversation is struck up with someone’s ‘heart’.
In the demonstration sessions, Paula en Hatice came up with well-formulated questions for help. This may happen during the coaching of competent professionals, but it will not always be the case during therapy sessions. Several participants stressed the importance of exploration, and clarifying the question for help. Their experience has taught them that not only the migrant is present with his or her problems, but the entire family and the system. It forces the facilitator to include these relations in the session, for instance by asking the ‘subpersonality’ to identify its relationships with other people in the family or the community. Questions may then be formulated differently, like “who of the people around you is aware of this?”. The intercultural practice of Voice Dialogue could make use of the terminology and the experiences from system and family therapy with migrants.

Many participants concluded that they consider the method specifically suitable for second and third generation migrants. In their daily lives, they are used to moving in different subcultures, and by means of Voice Dialogue they can become more aware of the power of their (cultural) identities. Based on this awareness they will be able to give more direction to their lives.

Research and development

The first exploration of the intercultural dimension of Voice Dialogue in a Master Class resulted in a number of starting points for making the next steps. In October 2005 a Training Course of Voice Dialogue and Migrants was initiated. Experienced health care professionals assisting migrants will be trained in Voice Dialogue, and will use the method with their clients, under supervision. At the same time an independent study will take place, further looking into the feasibility of using the method with migrants. This study is conducted under supervision of Mikado.

Translated by Jeroen Koolbergen

(Dutch) Literature

Dijk, P. van (2003). Geneeswijzen in Nederland. Compendium alternatieve geneeswijzen, 9e
druk. Deventer: Ankh Hermes.

Halbertsma, L. & Stamboliev, R. (2002). Polariteiten in personal coaching. Opleiding &
ontwikkeling, 10, 23-26. Click here to read the English version.

Jessurun, N. (2002). Transculturele vaardigheden. Amsterdam: Beta Gamma.