Finally there needs to be consideration of the evolving service contexts for the delivery of psychological therapies for voices. In the United Kingdom, dissemination of psychological therapies for psychosis has been supported by leadership from pioneers of therapies for psychosis and by prioritization in the National Institute for Clinical Excellence guidelines. However, there have been significant challenges, and implementation has been limited in other countries.9 While this may in part reflect conflicting service priorities, it should be acknowledged that therapeutic approaches for voice hearers described to date usually require advanced levels of therapy skill, which is a barrier to widespread dissemination. In addition there may be variable levels of client demand for formal psychological therapies. In the context of these barriers, it may be important to shape interventions suitable for routine delivery in service contexts, which may require going beyond the traditional model of consultation room delivery by an expert therapist.