Articles

Using therapeutic writing to support a client’s new story Issue 27, Spring 2007
By Jan Logan & Stephen Sheasby, The City Lit, London


‘I consider the e-mail dialogue to be important in thickening my new alternative narrative … There is a definite upturn in my mood when I re-read them … My old story was one in which I constantly lived with fear and shame and this became the norm. These pieces of paper encapsulate the ‘sparkling events’ that tell me my life is changing. They are windows through which I see my future life. And I like what I see!” Stephen Sheasby

Jan’s story
I have recently been introduced to therapeutic writing. It was an inspiring experience, but one that challenged some of my assumptions about writing and therapy. As a therapist working in education, record keeping is a professional requirement. Records tend to be ‘official file’ documents, written when the client is not there, and kept primarily to share information and ensure quality and continuity of care. Whilst records are available to clients, I had not used them as part of the therapeutic process. I was interested to find narrative therapists use documents in a different way. ‘Document making’ is a collaborative project and an integral part of the therapy itself. Documents are used in a variety of ways; to record knowledge gained, support sessions, capture key moments, thicken emerging stories and remind people how their stories change over time (Speedy, 2004; Fox, 2003).
Whilst, in stammering therapy, many people revise their relationship with stammering, new stories remain vulnerable as the dominant story tries to reassert itself. Doan (1994) argues it is crucial new stories are given opportunity to thicken whilst ‘in their infancy’.

Steve and I wanted to share our story of how writing and receiving therapeutic documents supported his new story. The timing of our first meeting was significant. Steve had just got e-mail and this opened up a whole new horizon. I had recently completed a ‘therapeutic documents’ course and was interested in the possibilities letter writing offered. Steve and I corresponded via e-mail at all stages of his therapy journey. Interestingly, it was he who initiated the process. In the past, maintaining boundaries led me to limit between-sessions contact however, my course gave me permission to respond. Looking back, I believe writing fulfiled the functions identified by Speedy and Fox.

An e-mail from Steve:
“Thanks for the session yesterday. I forgot to mention the obvious when you asked me why my relationship with my stammer had improved since coming to City Lit, ie, your hard work. But maybe it’s the therapist’s skill that makes the client think they are doing most of the work. A couple of points – maybe Solution Focused Brief Therapy worked because it increased (encouraged) the approach and reduced (discouraged) the avoidance.
Secondly – I couldn’t remember much about my relationship with my stammer when I was a child – but I do remember one thing … it must have been before the age of 12 … I used to scratch the back of my left hand – I think from general frustration at not being able to communicate – I remember the scar being there until I was about 20 …”

I often feel clients fail to recognise the ‘local knowledge’ or skills/resources they regain in therapy and draw on to deal with the problem differently. I responded by encouraging Steve to reflect on the part he had played in re-authoring his story. I was struck by the memory he had regained. It seemed important. I wondered what it had taken to share this with me.
I wrote:
“Hi Stephen,
Thanks for your thoughtful e-mail – I have to say it really is you doing the hard work, as I mentioned before you just ‘take the ball and run with it!’ Hmm, yes, approach/ avoidance, that really does seem to be key … I’m sure Sheehan would agree, but I guess it was you again who did the work and took the risks – no mean feat! As therapists we can really only have conversations with people which hopefully give a bit more information about the way stammering works and what kinds of things other people have found useful.
I was struck by your memory – and will think about it some more. Maybe we can pick up on it when we meet next week …”

Whilst I believed writing had supported therapy, I was interested in Steve’s experience.
Responding to my questions he wrote:
“I think I sent you an e-mail after every individual session we had. I did this off my own bat – I felt I needed to communicate things. Your replies were important – I would print off what I wrote and what you wrote and read them several times over the week. Sometimes I would ask questions – to get info directly related to me (rather than the books I was reading) … Having things in black and white pinned them down and gave them more authority and permanence. This is important because I’ve had many years of negative emotion and avoidance to do with stammering, it was just so exhilarating to have positive things”.

His reflections were illuminating:
“The communicating of ideas was very important – I remember getting quite worried at times if a few days went by without a reply – almost worrying as if I had done something wrong. It’s sort of like with speaking circles: someone speaks from the heart and the feedback validates what they have done”.

This taught me the importance of clarifying how e-mails may be used and when responses will be sent. Failing to do this may leave clients with difficult feelings.
Our writing enabled Steve to share something he may not have done verbally:

“I remember one session in which you gave me some paper and said to do a time-line to do with my stammering. While I was doing it I remembered … scratching the back of my hand … I didn’t tell you during the session, but told you the following e-mail … then a couple of days later I told my wife and it was fine. Something I’d pushed to the back of my memory and hadn’t told anyone was out in the open. I remember your reply – something like ‘thank you for your thoughtful e-mail …’ which I thought was a great response. I wondered if there was an element of testing in this – the books and you had said to be more open about things – so would it phase you if I revealed something which seemed quite odd?”

Inspired by DiLollo (2006),1., I asked Steve to write something from the perspective of stammering. He responded:
“Dear Ms Logan,
I wish to make a complaint. I am the ‘little man’ who sits down Steve Sheasby’s throat next to his vocal folds … when a light comes on, I slam shut the vocal folds. Light comes on, I slam the door … . But over the past year I’ve noticed things are changing … I blame you and your colleagues at City Lit! For a start the light is coming on a lot less frequently, a lot less! There are strange things resonating round here: phrases like ‘double-approach avoidance conflict’… Don’t ask me what they mean. But I have learnt one thing, that the light is controlled by something or somebody called ‘the avoidance’ … Things ain’t what they used to be … I remember the good old days when I would slam the door and hold my foot against it for 7 to 8 seconds. Then on the very next word, slam it shut again. If things don’t buck up soon … I’m not ruling out early retirement!”

This not only shows how Steve’s story changed over time but also how his use of humour underlined his progress.
As Manning (2004) suggests, ‘humour reflects a person’s ability to step away and distance himself from his situation in order to gain a degree of insight’.
Whilst letter writing takes additional time, Fox (2003) draws our attention to evidence for the effectiveness of therapeutic documents. Clients considered documents to be equivalent in value to 3.2 – 4.5 sessions. Furthermore, 40% to 90% of ‘positive outcome of therapy’ was attributed to the letters. I have found letter writing to be time effective rather than time consuming. Writing/reflecting on our writing has, for me, been a valuable (and enjoyable) aspect of Steve’s therapy journey.

Steve’s story It was in January 2005 that Jan and I started to co-author my new story. This story reconnected me with some of my preferences for living. Therapeutic documents, via e-mail, have been instrumental in my journey from a problem-saturated description of my life to a new and exciting narrative. I’d like to explain what therapeutic documents mean to me, but first maybe I should give a brief account of the effects of the problem, so you know the starting point of my journey.
Two years ago, if I got to my local train station and the ticket machine was out-of-order and I didn’t have a pen and paper to write down what I wanted, I would walk two miles to the next train station – all to avoid one moment of stammering. I was in the grip of ‘the Avoidance’! Cue scary music! I was the subject of all Sheehan’s seven levels of avoidance, 2., and a few other ones as well!
I’d had stammering therapy between the ages of four and 18 but left thinking I was a failure. White (2004) has some interesting things to say about addressing personal failure. He talks about the ‘willful abandonment of the pursuit of adequacy’. As someone who, to a large extent, defined myself as failing to live up to the expectations of society vis-à-vis my speech, I found this breathtakingly radical. I’m now working on an alternative identity project.

Morgan (2000) writes: ‘To be freed from the influence of problematic stories, it is not enough simply to re-author an alternative story … alternative stories … [need] to be richly described and interwoven with the stories of others’. So, two elements are needed for lasting change, ie, the alternative story needs to be ‘richly described’ and it needs to be ‘interwoven with the stories of others’. I will now consider these in turn with reference to therapeutic documents.
‘Richly described’
Jan has described and illustrated how our e-mail dialogue supported sessions, captured key moments, thickened emerging stories and reminded us about how my story changed over time. When I started e-mailing Jan I knew nothing of narrative practice, but soon found I was printing out some of our e-mails to have them in black-and-white. I would read and re-read these many times in different situations, e.g., on the train travelling to work or at home when I was relaxed. Interestingly, I found that reading my part of the e-mail dialogue was as important as Jan’s. Why was this I wondered? I now think it was because there was, in these e-mails, a flow and depth that I had very rarely experienced in communication before. Yes, flow is the right word. Csikszentmihalyi (1975) has some interesting things to say about the state of flow. When in a flow state:

• people become absorbed in their activity, the focus of awareness is narrowed down to the activity itself, action and awareness merging.
• people concentrate and focus. They have the opportunity to delve deeply.
• the activity is intrinsically rewarding, so there is an effortlessness of action.
• there is a loss of self-consciousness, the merging of action and awareness.

• The ‘telling’: a person recounts a sparkling moment or an aspect of their developing story to the group.
• The ‘re-telling’: the group responds to the ‘telling’ by recounting or talking about anything that resonates for them in their own life.
• The ‘re-telling’ of the ‘re-telling’: the person responds to the ‘re-telling’.
• Stage four: all the persons involved have a chance to reflect on the process.