Externalization of Voices

What is the Externalization of Voices?

The Externalization of Voices technique, developed by Dr. David Burns, is a powerful role-play method that helps people give shape and voice to their inner critic. By "externalizing" these negative thoughts-treating them as if they came from an outside voice rather than from within-it becomes easier to respond, challenge, and fight back against them.

Most people experience a stream of negative self-talk that repeats over and over in their minds. It can be difficult to fight something intangible. But when those thoughts are externalized and voiced, we create the opportunity to confront them directly.

Case Example: "I'm a failure"

Stephanie, a doctor, recently received feedback from her hospital that she needed to catch up on her charting. Because of the COVID surge, she had been prioritizing patient care and empathy, which left her behind on paperwork. She told me: "I'm a failure."

Me: I'd like to show you a tool called Externalization of Voices. It might help with that thought, "I'm a failure." Want to try?

Stephanie: Sure.

Me: Great. This is a role-play technique. There are two parts: Negative Stephanie and Positive Stephanie. I'll play Negative Stephanie and give voice to your critical thoughts. You'll play Positive Stephanie and respond with acceptance, evidence, a plan of action, or a counterattack. Ready?

Stephanie: Okay, let's try it.

Roleplay begins

Me (as Negative Stephanie): Hey Stephanie, don't forget-you're a failure.

Stephanie (as Positive Stephanie): Yes, I didn't finish my charts on time, but that doesn't make me a failure. Many of my colleagues have been behind too, especially with the patient surge. It's not because I was lazy. I was helping people who needed me most. I already have a plan to catch up on Monday. Honestly, the charts are a small problem compared to the harm you cause when you tell me I'm a failure. I don't need you in my life!

Me: That was a strong response! Who won? Me or you?

Stephanie: I did. I knocked it out of the park. I don't need Negative Stephanie in my life.

How You Can Use This Technique

Step 1. Identify a negative thought running through your mind. Write it down:

Step 2. Imagine a "Negative You" attacking with that thought.

Step 3. Respond as "Positive You" using these strategies:

Acceptance: Find the grain of truth but respond with self-compassion.

Evidence against: Point out why the negative statement isn't accurate.

Plan: Create a specific step to address the issue.

Counterattack: Push back. Tell the negative voice why it doesn't belong.

Step 4. Combine your responses and notice what feels most helpful.

Clicking this will open your device's print menu. Select "Save as PDF" as the destination.

Important Things to Keep in Mind

If your responses don't feel believable, pause and reflect on why. There may be deeper reasons you're holding onto the negative thought.
This technique isn't for everyone. If it doesn't fit, another method may be more effective.
You don't have to use every strategy. Choose the ones that resonate with you.
If it doesn't work the first time, try again. Each round of practice strengthens your ability to respond.

Final Note

Externalization of Voices is a flexible and empowering skill. It allows you to turn abstract, discouraging thoughts into something you can face, examine, and ultimately defeat. Sometimes this process leads to lasting change in behavior or mood; other times, it simply brings greater clarity and understanding. Both outcomes are valuable, because the real goal is learning how to relate to your thoughts in a new way.