This chapter describes a method of psychological formulation to explore the relationship between the content and characteristics of voices and experienced adversity in the life of the voice-hearer. We argue that this systematic process of enquiry, termed ‘a construct’ by Marius Romme and Sandra Escher, is designed to explore who or what might the voices represent in terms of social, emotional and/or attachment-related conflicts. We go on to describe how the resulting information provides the basis for an individualised psychotherapeutic recovery plan that examines the influence of interpersonal stress in creating vulnerability for emotional crises (i.e., psychological predisposition) and the personally significant events that cluster before onset or relapse (i.e., the actual stressors which provoke voice onset or continuance). We present case material using this method, as well as empirical research on the applicability of this approach. The role of safe attachment relationships in supporting voice hearers is also considered, including: the therapeutic alliance and family and peer-support. Recommendations are also made for how mental health services can be structured to better establish safe, healing environments and a ‘secure base’ for working with distressing voices.