Bjoroy Madigan Nylund The Practice of Therapeutic Letter Writing in Narrative Therapy

HANDBOOK OF COUNSELLING PSYCHOLOGY

EDITION, SAGE PUBLICATIONS.

The Practice of Therapeutic Letter Writing in Narrative Therapy

Anja Bjoroy. Stephen Madigan. David Nylund

The use of letter writing in psychotherapy has a long and varied history (Riordan, 2000). This

chapter describes the application of therapeutic letters from a narrative therapy perspective.

Therapeutic documents from a narrative therapy framework are informed by different

theoretical traditions to those of counseling psychology, psychiatry, family therapy and social

work - namely post-structuralism and anti-individualism.

After a brief overview of narrative therapy, the theoretical justification for narrative letters, guidelines

for the practice, and various categories of narrative letters are discussed. Examples of our most

prevalent and more recent types of narrative therapy letters are illustrated (with actual letters that

were written to clients we work alongside). The categories of letters included in this chapter are:

letters as narrative, letters of prediction, therapeutic letter writing campaigns, therapeutic letters as

‘case notes’ for institutions and group consultations, unique developments in couple relationship

letters, relational letters written to the couples’ relationship, and counter documents. Other types of

letters—letters of invitation, brief letters, and counter-referral documents—are briefly described

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!The!authors!include:!Anja%Bjorøy%works%as%a%family%and%couple%therapist%and%holds%a%Masters%degree%in%

Health%Science%from%the%University%of%Oslo,%and%a%Masters%degree%in%Family%Therapy%and%Systemic%Practice%

from%the%Un iversity%o f%Diak on hjem met.!Stephen!Madigan!MSW ,!PhD!Director,!Vancouver!School!for!

Narrative!Therapy,!Vancouver,!Canada,!David!Nylund!MSW,!PhD,!Professor,!Social!Work,!University!of!

California,!Sacramento,!California!and!teaches!on!the!faculty!of!the!Vancouver!School!for!Narrative!

Therapy.%

without examples. The reader is referred to White and Epston (1990) for more detailed illustrations of

those kinds of written documents.

Narrative Therapy is viewed as a collaborative and non-pathologizing approach to counselling and

community work that centres people as the expert of their own lives. Narrative Therapy, developed by

Michael White and David Epston (1990), is based on the premise that persons make meaning of their

lives through stories. Stories from a narrative therapy perspective are viewed as a sequence of events,

linked by a theme, occurring over time and according to particular plots. A story emerges as certain

events are privileged and selected out over other events that become neglected and ‘un-storied.’ The

stories people live by are not a mirror of a person’s life but are actually shaping of people’s lived

experiences. Narrative Therapy suggests that stories and the lives of the persons we see in therapy

do not exist in a vacuum; they are instead viewed as under the influence of a powerfully shaping

broader context - particularly in the various dimensions of class, race, gender, sexual orientation and

ability. The discursive contexts of a person’s life and relationships are viewed as primary to the

shaping of lives and relationships. By placing a primary emphasis of person and problem making on

the discursive contexts, sets narrative therapy apart from other forms of counseling in the authors

home countries of Canada, Norway and America.

By the time a person has decided to come to therapy they have often developed a dominant story

about who they are as persons. The persons deficit story told to the therapist has often recruited the

person into a ‘thin’ identity conclusion of themselves and - one that is considered problem saturated.

Such negative identity conclusions can invite a powerfully negative influence in the way people see

their lives, values, skills, capabilities and futures. For example, a person may come to therapy and

describe themselves as “depressed” - concluding that these descriptions are predetermined and

biologically innate to who they are as persons (leading to a sense of hopelessness). These thinly

described problem descriptions are informed within structuralist, scientific and individualist theoretical

paradigms that suggest that identity is fixed, ahistorical, and de-contextualized.

Narrative Therapy takes up an anti-individualist approach to therapy that is informed by the post-

structuralist idea that identity is fluid, dynamic, and contextual (Madigan, 1992, 1998, 2011). Hence,

within a narrative perspective, people's lives, identities and relationships are viewed as multi-storied

versus single-storied. By conceptualizing a post-structuralist view of identity, narrative practices are

able to linguistically separate persons from ‘fixed’ and deficit conclusions/descriptions about their

identity. When this point of view is practiced in therapy it is known as the process of externalizing the

problem (White & Epston, 1990). Externalizing problems allows people to consider the problem is not

located and privatized solely inside their bodies. Problems are viewed as contextual influnced,

situational, discursive and communally learned and agreed upon (Madigan, 2011). Hence the rather

simple narrative practice motto is: “The person is not the problem, the problem is the problem.” For

example, when a person in therapy states that “I am depressed,” the narrative therapist might ask a

question such as, “when did you notice that depression first entered into your life?’, or “are there

times when you feel depression gets the better of you as opposed to other times when you get the

better of it?”

Separating the problem from the person allows the narrative therapist to listen for contradictions or

exceptions to the discourse of the dominant problem story being told, otherwise known as ‘unique

outcomes.’ These unique outcomes can serve as entry points into alternative stories that assist

persons to redefine their relationship with the problem. From there, preferred stories that highlight a

person’s skills, abilities, and competencies are drawn out and amplified. With curiosity and

exploration through the careful crafting of questions, these preferred stories and accounts of people’s

lives can become ‘thickened’ richly described and eventually performed. Common lines of therapeutic

inquiry include curiosities concerning the person’s values, commitments, intentions, treasured

memories, influential relationships and how these areas connect with each other and live outside and

beyond the person’s relationship with the problem.

There are many practices in narrative therapy that help enrich and expand the persons preferred

stories. One key aspect of narrative practice is the use of therapeutic documents or letter writing.

Using letters fits nicely with the text analogy (Madigan, 1995, 1998) and is a sensible extension of

doing therapy from a narrative perspective. Stories take on an added meaning and permanence when

they are written down. David Epston (1994), who has been instrumental in the practice of narrative

letter writing, writes:

Conversation is, by its very nature, ephemeral. After a

particularly meaningful session, a client walks

away

aglow with provocative new thoughts, but a few blocks

away, the exact words that had struck

home as so

profound may already be hard to recall ... But the words

in a letter don’t fade and

disappear the way conversation

does; they endure through time and space, bearing witness

to the

work of therapy and immortalizing it. (p.31)

Narrative Therapy letters can provide a very powerful tool for consolidating the alternative story and for

rendering it less likely to be taken over by the problem story. Below are detailed examples of various

types of narrative therapy letters:

Letters as unique development narratives and counter-stories

Unique development narratives and counter-stories letters are the most commonly

used in narrative practice. They are used to depict the linear nature of the client’s

story with a particular focus on documenting the new stories that are developing

(Nylund, 2002). Letters as narrative typically record and summarize the session and

are used for the following purposes:

1. To assure the therapist has heard the client’s story accurately. The letter

positions the client as the final editor of their story.

2. To reflect and think about the meeting and the newly available and emerging

counter-stories they have re-called and re-told outside the therapy session and

thereby take up these ideas without waiting for the next session.

3. To provide an opportunity to document (counter-filing), support and retell the

client their own emerging and preferred story. Through the sessions lettering of

their experience the client is positioned to be a witness to their own life and

forgotten abilities and values.

4. To extend the conversation between meetings supports and maintains the

relevance and more particularly the endurance of the ideas comprising the new

story.

5. To enhance the therapist/client relationship towards a building of trust, and

mutual respect in future sessions.

Freeman, Epston and Lobovits (1997) and Nylund and Thomas (1994) provide

some useful

tips for letter writing. Some of the things they suggest that could be

included in the letter are:

An introductory paragraph reconnecting the client to the previous therapy

session.

Verbatim quotes of the clients.

Statements describing the relative influence of the problem on the client. This

section

usually includes a variety of comments that reinforce the separation of

the

problem from the person and what the person has lost/suffered during their

relationship with the problem.

Questions rather than direct statements regarding areas that were

underexplored in the session.

Questions that punctuate unique outcomes and imply a grammar of agency.

Use of reflexive verbs and/or evaluative questions: For instance “John, does this

mean that

you have been more in charge of your anger rather than it being in

charge of you?” versus, “John you have been controlling your anger.”

Use of humour and puns.

Below is an example of a letter written to a client, Kyle, who has struggled with

anxiety:

Dear Kyle,

This letter, as promised, summarizes our meeting the other day. You shared how

Anxiety has influenced your life; it has a long history. Anxiety had many allies, kids

who teased you a lot, and a culture that ostracizes difference. These allies recruited

you into a negative story about yourself.

Yet in spite of the power of Anxiety and its friends, you never completely surrendered

to it. In looking back, can you remember moments of you standing up for yourself? I

asked you who most appreciated you as a young person. You movingly shared about

your physics teacher. When I asked you what your teachers saw in you, you said, “he

believed in my…he knew I was smart and a strong person.”

Kyle, “What did your teacher see in you that the kids who teased you were blind to?

What might happen if you kept your teacher’s version of you close to you? How might

it help to undermine the power of Anxiety?

Anxiety definitely took a back seat when you found the bravery to approach and meet

your girlfriend, Susan, in San Francisco. I enjoyed hearing about the story of how you

met Susan and what she values about you. When I asked you about what Susan

appreciates about you, you shared how you haven’t been asked that question before.

Have you given that question any more thought? How might thinking more about this

question help you to further embrace a “modest bravery”? Perhaps you can share this

with me next session. Yours against Anxiety,

David Nylund

Letters written to a young person often have a playful quality to them. Here’s an

example of a letter written to an 8 year-old boy who was experiencing night fears

and his mother:

Dear John and Mom,

Thanks for our talk the other day. I got a sense that fear took a back seat to our

conversation. Do you agree Mom? John, I really like how you, your mom, and I came

up with the Rules of Fear:

1. Fear grows the more you don’t confront it;

2. Fear can lurk around the corner;

3. It tricks kids into thinking they are not brave;

4. It grows smaller by taking small steps.

So, we were thinking about what can help you to find your bravery. Your mom

brought up Popeye and how he got stronger after eating spinach. BTW, Mom have

you shown John an episode of Popeye yet?

Yes, I know you don’t like spinach. But you’re in luck because your Mom is Greek!

And she makes a great Spinach Pie (Spanakopita). And just your luck—you love

Spinach Pie! So, Mom you agreed to make Spanakopita and John will eat a slice

around bed time. Then his Popeye will come out to fight Fear!

I can’t wait to find out how it went!!! Mom, could you bring me a piece of the spinach

pie to our next meeting? I love it too; you see, my Dad grew up near Greektown

Detroit and he introduced Spinach Pie to me when I was kid. I think if I eat some, the

team of us three-the Spanakopita Fear Busting Trio-can tackle any Fear.

Yours against Fear,

David the Sailor Man.

Letters of invitation

Given that narrative therapy looks at the wider relational social context, it is

advantageous to involve multiple members of a family and/or the other important

members of the person’s community. There are often times when a member of the

family is not present at a therapy session though their presence can be useful. With

the consent of the attending family member, these confidential letters are sent to both

recognize an understanding of the person not being ready to attend the counseling

and/or encourage the person to attend a session by sharing some of the new

narratives of the attending people with the absent person(s).

Letters of prediction

In these letters the therapist writes a new narrative which encompasses the visions

and hopes of the client. These documents have a future temporal dimension. The idea

is that the client will consider the future story and the conviction in the new story will

result in the forecast coming true. These letters of prediction provide an opportunity

to envision a future where the problem story is in the background or the past. Here’s

an illustration of a prediction letter written to Steve, a 12 year-old, who was caught up

in conflict and bickering with his mother. The letter was written and given to Steve in

January 2004 and sealed stating to not open till December 25. The document predicts

a future of Steve stepping more into responsibility, less conflict, and more

appreciation of his mother. Of course, Steve could not wait till Christmas as he opened

it up two days after he received the letter (February 2004)! And, to be sure, he

followed through with most of the developments suggested in the letter.

Don’t open till Dec 25, 2004!!!!!!!!!

Hi Steve,

Growing up has been hard huh? You can’t blame others (especially your mom) for

your problems anymore. And there are more responsibilities which can kind of suck!

So this has made your move towards growing up even that much more remarkable. I

remember the turning point though. Do you recall? Was it when your mom asked you

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to clean your room and you went ahead and did it without arguing or complaining? Or

was it when you did your homework without your mom having to remind you?

Now that you are becoming a teenager, there are advantages however, eh?-more

freedoms for sure. Do you like it so far? What’s it like for your mom to stop

commenting on your homework and other things and just turn it over to you trusting

that you will complete on your own (or you won’t complete it)? That she has actually

come to trust that you can make the right decision for yourself.

What’s it like to no longer bicker with your mom? What’s it like for you to be the

supervisor of your own life rather than your mom supervising your life for you? Are

you impressed more with yourself or more with your mom and the two of you

breaking the “never ending teenager/mom bickering pattern”? What is it about your

recent mother-son relationship that had led it to be so bicker-free? Have you asked

David how surprised he is? Is he proud of you? Why do you think I knew you could do

this?

BTW, I was blown away when you actually complimented your mom and several

occasions throughout early 2004 year even asking her how her day was. And you

definitely shocked your mom when you planned and threw your mom a mother

appreciation party!!!

Yours sincerely,

David

Counter-referral letters

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In these letters the new narrative is sent to the person who referred the client or

family to the therapist such as a child welfare worker, teacher, and probation officer

(Nylund, 2000). This letter is a means of spreading the new narrative and offering a

follow up with the referral source.

Brief letters

There is a vast array of content that might be included in brief letters, and there

seems to be one consistent theme. The theme is to let the client know that the

therapist is thinking about the conversation after the meeting. These letters offer a

brief summary of the newly emerging preferred narratives of the previous session.

Brief letters can also be sent to a former isolated client to simply let them know that

you are thinking about them. The act of receiving mail can help the client to feel

valuable, connected and less alone in the world.

Therapeutic Letter Writing Campaigns

The purpose of our designing therapeutic letter writing campaigns was a response to help

people/clients re-remember preferred aspects of themselves that had been forgotten within the

limitations and restrains of a dominant problem story. We initially developed the therapeutic letter

writing campaign from within specific contexts of fear. More specifically, the relationship to fear that

we experienced as therapists was a response to construct new methods of practice when problems

posed a serious threat to the very lives of the people we were working with.

The therapeutic context(s) we found ourselves in involved consulting families whose loved ones had

ended up staying for long periods of time on psychiatric wards. Living terribly frightening and limited

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lives involved with massive regimes of psychiatric drugs, long durations of ECT, forced feeding tubes,

isolation etc. We were working alongside people who had given up on hope when confronted with

retirement, the death of a young child, anorexia, bullying, despair, financial loss and an assortment of

other contextualized tragedies that – they themselves had not invented on their own but had

somehow blamed themselves for. Many of the persons we were working with had been convinced by

the problem that death was a far better option than living.

The initial letter campaigns were designed to assist persons to be re-membered back towards

membership systems of love and support from which the problem had dis-membered them. Creating

letter writing campaigns through communities of concern was a therapeutic means to counter-balance

the problem saturated story and dominant memory of despair and failure (Madigan & Epston, 1995).

These therapeutic situations felt desperate and many (if not most) of our clients bodies had been

inscribed with a diagnosis of ‘chronic’ meaning – that according to the psychiatric teams they were

encountering, the problems our clients were encountering were viewed as a life sentence. Our clients

were viewed by the institution as persons who could not be helped.

Letter-writing campaigns were invented as a response to these life-threatening problems and our

disbelief in chronic identities. The campaigns recruited the client/persons community of concern

(Madigan and Epston, 1995) as re-membering, loving others who held onto different, competing and

preferred stories of the client - while the client’s idea of themselves remained restrained by the

problem and expert discourse. The community of concerns written stories solicited were quite a

different version of the person (a counter-version). The community counter-stories written and told

lived outside the professional and cultural inscriptions of failed personhood. The communities’ letter

campaign told stories of hope, revised histories and offered a preferred imagination and future

possibilities. The client’s community stood in support of the person and on the firm belief that change

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for their loved one - was possible.

What stood out early on was the dramatic way problems and the professional discourse supporting of

problems had convinced persons to remember to forget anything worthy, trustworthy or valued in

themselves. We viewed the story clients told and the problem story they were living through as

severely restrained by negative imagination and the public discourse of a less than worthy/not

measured up lifestyle.

Over the last 18 years, the authors therapeutic letter writing campaigns have been designed for

persons as young as 6 and as old as 76. We found that persons receiving letters began to rediscover a

discourse of the ‘self’ that assisted them to re-member back into healthy living situations from which

the problem has most often dis-membered them from (Madigan, 2008, 2011). These include claiming

back former membership associations with intimate relationships, school, sports, careers, health and

family members, and - reacquainting themselves with aspects of themselves once restrained by the

problem identity.

Letters for Couple Relationship Futures – re-remembering health in the face of anxiety, lost

hope and depression

Travels with Oscar

A psychiatrist colleague referred 70 year old Oscar and his wife Maxine. In our first session, Oscar

informed us that he had been struck down by a truck at a crosswalk a year before. He was not

supposed to live but he did; he was not supposed to come out of his three month long coma but he

did; and it was predicted that he would never walk again - but he did, and so on. As you might

imagine, it didn't take long to realize we were sitting before quite a remarkable man. However, it

seemed that Oscar had paid dearly for his come back because somewhere along the way he had lost

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all “confidence” in himself. He also told us he would panic if Maxine (his partner) was not by his side

"24 hours a day." Maxine had spent the year before organizing the complicated task of Oscar's medical

care, and stated at our first visit, she was “absolutely exhausted”, and “looking forward to getting

back to her own business pursuits”. Unfortunately, her interests were being pushed aside and taken

over by what they both called “anxiety”.

The conversational experience of his relationship to anxiety that had been the “legacy” of Oscar's

accident, had him believing that "I am only half a man," and further more "Maxine will leave me for

another man - and I believe she is planning to put me in an old-age home." There was also a

seemingly odd twist in that anxiety had him believing that "I did not deserve a good life" and

furthermore "I should kill myself." The relationship with anxiety was allowing him to remember to

forget “the lovely sweet life” Maxine explained he had lived prior to the accident. Oscar also let us

know he was becoming more and more “isolated and depressed”.

Oscar and Maxine had let us know that they had moved from England to Canada 10 years earlier and

that their life together had been “blissful” prior to the accident. In the first session we all agreed the

anxiety was gaining on Oscar and that the situation was – as Oscar stated – “desperate”. During the

next session we decided to design an international Anti-anxiety letter-writing campaign. Below is the

letter we coauthored in five minutes near the end of the second session (it can be viewed as a

‘standard’ letter writing campaign letter). As Oscar was concerned that his friends might consider the

letter "a crazy idea," he insisted that we include my professional credentials to give the letter

“credence”. Oscar’s words from our sessions are directly included and written within quotation marks.

Dear Friends of Oscar and Maxine:

My name is Stephen Madigan and I have an MSW as well an MSc and PhD in family therapy. Your

friends Oscar and Maxine have asked me to write to you so that we might solicit your support. As you

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are probably aware, Oscar suffered a terrible accident 14 months ago, and since then - has instituted

a remarkable comeback. What you may not know is the after-effects of the accident have left Oscar a

captive of anxiety, and – this anxiety is currently bossing him around. You may not believe this but

some of the messages anxiety gives to Oscar is that "he is a good for nothing," that "he is a useless

human being," and that "sooner than later all of his friends will come to know him the way anxiety

knows him." Through anxiety's influence, Oscar is beginning to “give up on himself”, and we ask your

support in bringing Oscar back from anxiety's grip. We think you can help Oscar win back his life from

this terrible anxiety. Could you please send Oscar a brief letter expressing 1) how you remember your

history with him, 2) your thoughts and feelings about his physical comeback and his person in the

present, and 3) how you believe you would like to see your relationship with Oscar and Maxine grow

into the future.

We hope that your letters of support are not too much to ask, and we want you to know that they will

be greatly appreciated. Oscar would also like all of you to know that he will respond to all of your

replies.

Warm regards,

Stephen Madigan PhD, Oscar's anti-anxiety consultant

The structure of the therapeutic letter writing campaign letters are usually the same. Together with

the client(s) I write a letter to selected members of the family/community (who the client and/or

family member selects), and ask them to assist in a temporal re-remembering and witnessing process

through lettered written accounts outlining their a) memories of their relationship with the client, b)

their current hopes for the client, and c) how they anticipate their relationship growing with the client

in the future.

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These written accounts are directed squarely at countering the problems’ strategies to re-write a

person’s past as entirely ‘negative’ and – only predict a future filled with the hopelessness of worst-

case scenarios. The community letters also begin to re-write any negative professionalized stories

found to be unhelpful to the person and helpful to the problem. Community letters are always

diametrically different to what had been written previously in the client’s professional mental health

file. Campaign letters written by the person’s community of concern re-present a counter file.

A few months later, Oscar wrote to me from his long awaited ‘anti-anxiety’ trip to France with Maxine.

He once stated his trip to France would mark “my arrival back to health." He told me through the

postcard that he was sitting alone, drinking espresso, while Maxine had gone site-seeing for the day.

He wrote, "I am thanking my lucky stars that I am no longer a prisoner of anxiety." His said the only

problem now was “keeping up with all of his return correspondence!” He stated that the return

correspondence was a problem he could manage and was willing to take full responsibility for.

Without the recruitment of a community of concern, Oscar might never have rebounded to re-

remember all his personal abilities/qualities/values and the contributions he had made during his

lifetime – that the problem had dis-remembered from.

Letter-writing Campaign Structure

Letter-writing efforts can take on a variety of shapes and forms, but the most standard campaigns

involve the following (Madigan, 1995, 1998, 2008, 2011):

1. The campaign emerges from a narrative interview when alternative accounts of who the person

might be are questioned, revived, and re-remembered. The person is asked to consider whether there

are other people in his/her life who may regard the person differently from how the problem describes

them. These different accounts are then spoken of. I might ask the following questions: "if I were to

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interview __________ about you, what do you think they might tell me about yourself that the

problem would not dare to tell me?" Or "do you think your friend's telling of you to me about you

would be an accurate telling, even if it contradicted the problem's telling of you?" Or “whose

description of you do you prefer, and why?"

2. Together, the client and myself (along with the client's family/partner, friend, therapist, insiders,

etc., if any of these persons are in attendance) begin a conversation regarding all the possible other

descriptions of the client as a persons that she/he might be, but has forgotten to remember because

of the problem's hold over her/him. We dialogue on who the client might be, who the client would like

to be, and who the client used to be well before the problem took over her/his life. We recall their

forgotten alternative lived experiences of herself/himself that the client may have forgotten through

the problem's restraining context.

3. We then begin to make a list of all the persons in the client's life who would be in support of

these alternate descriptions. Once the list is complete, we construct a letter of support and invitation.

4. If finances are a problem my office supplies the envelopes and stamps for the ensuing

campaign.

5. If privacy is an issue, we use the office as the return address.

6. If the person comes to the next session (with letters) alone, I will offer to read the letters back

to them as a textual re-telling. However, my preference is to invite as many of the community of

concern letter writers to attend the sessions. The therapist can never predict how many letter writers

may come to the session, however planning the session at days end and for more than one hour can

easily accommodate the number of people attending. Three other letter writer support persons is

generally the average, however upwards of seven to ten is not unheard of.

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7. The client is asked to go through the collection of letters as a way of conducting a "re-search" on

herself/himself.

The ‘general’ structure for reading and witnessing the letters in therapy is as follows:

1) All campaign writers are invited to the session (if this is geographically possible) and in

turn are asked to read aloud the letter they have penned about the person. In

attendance is usually the client, myself, the other writers of their community and

sometimes a therapy team that may include insiders.

2) After each writer reads aloud, the client is asked to read the letter back to the writer, so

both writer and client can attend to what is being said/written from the different

positions of speaking and listening.

3) After each letter is read by the writer and discussed with the client, the community of

others in the session (who are sitting and listening) offer a brief reflection of what the

letter evoked in their own personal lives.

4) This process continues until all letters are read, reread, responded to and reflected upon

5) Each response team member (usually but not always made up of professionals

) then

writes and reads a short letter to the client and his community. They reflect on the

counter-view of the client offered up by the person and their community, the hope that

was shared and aspects of the letters that moved them personally.

6) Copies are made of each letter and given to everyone in attendance.

7) We then follow up the session with a therapeutic letter addressed to everyone who

attended the session including the client, the community of concern and reflecting

team.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

In some campaigns I have asked former client insiders on the problem or members of the Anti-

anorexia/bulimia League to sit in on the session as ‘insiders’..

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Letter Writing Campaign Contributors

Our experience has shown that once community of concern support persons have received a letter

inviting them to contribute to a campaign, they will often feel compelled to write more than once

(three and four letters are not uncommon). Contributors often state that they have had the experience

of feeling "left out" of the helping process. Contributors to the campaign have reported feeling

"blamed" and "guilty" for the role they believe they have played in the problem's dominance over the

person's life. They suggest that many of these awkward feelings about themselves have been helped

along by various professional discourses they have encountered as well as self-help literature. Being

left out can often leave them with the opinion that they are "impotent" and "useless." As one older

man who committed himself to an anti-depression campaign for his 22 year old nephew explained,

"the letter campaign helped me to come off the bench and score big points against the problem so my

nephew could pull off a win. In helping him I helped myself."

Therapeutic Letters used as ‘case notes’ for institutions and group consultations

We have found that when used creatively and explained rationally, therapeutic letters can be used

within even the most conservative and scientific psychology supporting institutions and hospitals. For

example, the usual protocol for writing up notes on patients in hospitals is an individualized procedure.

Meaning, each patient performance in the group gets separately written up and shared with other

members of the professional team. It is rare the patient themselves receives a copy of these

professional notes written about their lives and relationships. We find this practice of withholding

information from the person about the person by the professional; keeping secrets in a landscape

supporting of trust; holding private privileged/professional information/conversations away from

clients, etc. - quite an odd ‘therapeutic ‘practice.

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I had the wonderful opportunity to consult two days a week to a psychiatric in-patient eating disorder

ward in Vancouver, Canada for a few years. My job was to run in-patient groups as well as facilitate

multiple family groups. A narrative therapy-supporting psychiatrist who gave me free reign to run my

part of the group therapy program through a narrative therapy practice ran the ward. This included

the way the groups were structured, who would be involved and how, recruiting an ongoing response

team from the other mental health departments of the hospital (representatives form social work,

psychiatry, nursing, psychology, nutrition etc. would sit in on all the groups and respond from a

narrative practice point of view that I’d taught them), and the writing of patient files/charts/reports.

The psychiatric eating disorder wards practice of having separate discussions about person/patients

when they were not physically present and writing private professional notes about patients and not

sharing these notes with them - never fit well with me. As an alternative the hospital allowed me to

write one letter after each group to all parties involved. Meaning – I would write one therapeutic letter

to the group after each group and this letter to the group members was shared with the entire

professional staff. The therapeutic letter was the only professional correspondence/conversation I took

part in. I was also afforded the grace to not be asked to consult on patients if they were not present.

Below is an example of a therapeutic letter to the group that was shared within the institution and

documented professionally as a ‘case note/file’.

Dear Anti-anorexic group and response team members:

I want to write and thank you for quite an inspiring anti-anorexic filled two hours. As always, your

conversations with one another inspired questions in me after you left. I thought I’d share a few of

them with you for you.

Sheri when you supported Gwen’s story of standing up to anorexia’s habit of predicting “nothing but a

negative future” you said - ‘yes and if we all agree with anorexia’s future for us as Gwen’s says, then

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everybody here will all end up dead”. When you and Gwen tutored me on this anorexic tactic Sheri I

wondered how it was that anorexia gets away with always predicting a negative future for women.

How it was that anorexia tricked this group of women’s minds into thinking the future was only futile?

If all of you as a group stood against this anorexic tactic what kinds of futures do you predict for one

another and for your selves?

The other comment that stood out was when Julie said to Akeiko that she “totally recognised” her

stepping up and “defying anorexia by stepping backwards on the weigh scale” during her doctors

check-up (so as to not see the weight registered). I wondered what other group members felt about

Akeiko’s defiance and Julie’s noticing of this defiance? Do you notice any other acts of anti-anorexia

rebellion? Does it ever feel fun to rebel against anorexia’s rules and regulations? As a group I

wondered what anorexia would do if you all protested what Megan called anorexia’s ‘terrible lifestyle”?

Do you believe there is strength in numbers and if so what effect do you think your group strength

might have on anorexia?

Thanks again for tutoring me and including me in your insider’s view of anorexia.

Yours anti-anorexically

Stephen Madigan

Relationship Letters to Couples Experiencing Conflict

The authors write many different kinds of letters to Couples. We will outline the letters we tend to

send most often. Anja and Stephen were seeing couples at her clinic in Oslo, Norway. Written below

are two common forms of letter writing specific to couples in conflict.

Letters Outlining Unique Developments

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Dear Pier and Anita,

We are writing as a follow up to our last session. Anita, In conversing together after you left we were

both struck with your comments regarding how you both had abilities in other relationships you have

in your lives to be “patient”, “service minded”, “ to say nice things” and “to understand’ other people.

We enjoyed how both you and Pier contemplated how you might bring these relationships skills you

already have to your own relationship with one another. If you were to transport your skills of

relationship to your own relationship what do you imagine the result would be? Do you feel your

relationship abilities would flourish with these abilities? And if so, in what ways? What difference would

your own relationship to one another notice? How would it feel?

And Pier when you said that you were beginning to notice how you wanted to choose your

conversations with Anita “at the right time and in the right place”, we wondered how you managed to

come up with this plan and – what you thought Anita might experience if you were to do this? We

were also quite touched with your “hidden plan” to make Anita a CD of songs. We wondered if these

songs had a particular meaning and history that were once meaningful at one time to you both.

We also wondered what it meant when Anja noticed you were both looking into each other’s eyes

during the session – something that we’d never witness you doing before. What were you seeing and

how did this feel to look at each other?

And finally, when Pier mentioned that he wanted to “hold you up high” above all other relationships,

and Anita you laughed and stated to Pier “I’d like this!” we were curious about what specifically you

like about this elevated position in his life the most? And Pier what would it be like to raise Anita up

and hold her up high would be most likely to happen to the relationship if you were to hold her in this

position in your life?

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Looking forward to discussing these new developments further,

Anja Bjoroy and Stephen Madigan

Relational Letters Written to the Couple’s Relationship

Another form of therapeutic letter writing is to write directly to the couple’s relationship when we are

working with couples experiencing conflict. From a post-structural perspective we theoretically view

couple relationships as relational. At times, dominant psychological and self-help ideas about couples,

along with the neo-liberal individualizing contexts influencing of couple relationships, can act to

wrongly inform the couple relationship that it is an individualized relationship/enterprise. To counter

these individualizing ideas about couples and to assist in the acknowledgement that ‘the whole of the

relationship is greater than the sum of the parts’, we write the relationship of the couple - ‘directly’.

From this narrative therapy practice position we begin the letter with a simple Dear X and Y’s

relationship. As part of the letter writing practice, we ask each member of the couple to write a letter

back from the relationship to the couple and - from the relationships point of view.

For example: To Jon and Monica’s relationship; we are couple therapists working with Jon and Monica

and - we wondered if you might write a letter to them to express your relationships view of them as a

couple. We were hoping you might write a few thoughts on: a) how they first formed you as a

relationship, b} comment on what their growing love felt like, c) what you believe currently gets in the

way of them being able to continue to nourish and feed you, d) what would it mean to you if the

arguing and complaining stopped and trust was renewed , and e) what hopes do you have for them

being able to bring you back towards a renewed loving relationship like they once had with you.

Thanks a lot relationship!

Anja Bjoroy and Stephen Madigan

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Counter Document Letters

These are awards or diplomas for the successful completion of a goal in therapy. They are a visual

reminder of success. For example, a 12 year-old male, Sam who had a history of bullying his peers in

school and had earned a reputation as a “bully,” “trouble-maker,” and “defiant” was awarded a

certificate of accomplishment for “Reputation Re-Working” due to his anti-bully behavior, improved

grades, and holding others responsible for harassing other students.

The certificate read: Reputation Re-worker Certificate

This diploma recognizes Sam’s efforts to change his reputation from a “Trouble-

maker” and “Bully” to “Kind” and “Accountable.” Since earning a new reputation is no

small task, it is important that we recognize this achievement. Congratulations Sam!

You have helped change the school climate. David, President of the Reputation Re-

worker’s Club

At the present time, there is not much evidence for the effectiveness of therapeutic

letters in narrative therapy. However, both David Epston and Michael White

(Freeman, Epston & Lobovits, 1997) have conducted

informal clinical research, asking

clients questions such

as these:

1. In your opinion, how many sessions do you consider a

letter such as the ones

that you have received is

worth?

2. If you assigned 100 per cent to whatever positive

outcomes resulted from our

conversations together,

what percentage of that would you contribute to the

letters you have received?

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The average response to Question 1 was that the letter

had the equivalent value of

4.5 sessions. In response to

question 2, letters were rated in the range of 40% to

90%

for total positive outcome of therapy.

Such findings were

replicated in a small scale study performed at large medical facility

in California. Nylund and

Thomas (1994) reported that their respondents rated the

average worth of a letter to be 3.2 face-to-face interviews (the range was 2.5-10) and

52.8 percent of positive

outcome of therapy was attributed to the letters alone. As

supported by this research, the amount of time it takes to write letters seems worth

the effort.

Conclusion

The narrative therapist’s primary purpose within the written tasks in all the many

forms of therapeutic letter writing is to work with and acknowledge the complexity of

the persons story being told so that contradictions can be opened up and used to

bring forth something different (by sustained reflection), moving towards a sparkling

alternative undergrowth needing attention. It is through letter writing, that dominant

problem stories missing relational context and contradictions are exposed, and this

allows for the elaboration of alternative and competing perspectives as the person’s

story unravels. These different competing perspectives seem to lie side-by-side and fit

together, but for the client there is now an undeniable proposed tension between

them. Therapeutic letters help to try and make us see the world in different ways at

one and the same time with the hope that preferred change occurs.

References

Epston, D. (1994). Extending the conversation. Family Therapy Networker, 18(6), 31-37, 62-63

Freeman, J., Epston, D. & Lobovits, D. (1997): Playful approaches to serious

problems: Narrative therapy with children and their families. New York: Norton.

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Madigan, S. (2011). Narrative Therapy - Theory and Practice (211 pages). The

American Psychological Association, APA Publications, Chicago.

Madigan, S, (2008) Anticipating Hope within Conversational Domains of Despair. In,

Hope and Despair. Imelda McCarthy & Jin Sheehan (ED.s), Bruner Mazel, London, UK.

Madigan, S. (1992). The Application of Michel Foucault’s Philosophy in the Problem

Externalizing Discourse of Michael White. Additional Commentary by Deborah Anne

Leupenitz, Re-joiner by S. Madigan. Journal of Family Therapy, London, England-

August 1992 edition.

Madigan, S., Goldner, E., (1998) A Narrative Approach to Anorexia: reflexivity,

discourse and questions. In Constructive Therapies, M. Hoyt (Ed.), Jossey Bass, New

York

Madigan S., Epston, D., (1995). From "Spychiatric Gaze" to Communities of Concern;

From Professional Monologue to Dialogue. In, the Reflecting Team in Action:

Innovations in Clinical Practice. S. Friedman (Ed.), Chapter 14, Guilford Press, New

York, London

Nylund, D. (2002). Poetic means to anti-anorexic ends. Journal of Systemic Therapies,

21(4), 18-34.

Nylund, D. (2000). Treating Huckleberry Finn: A new narrative approach with Kids

diagnosed ADD/ADHD. San Francisco: Jossey-Bass

Nylund, D. & Thomas, J. (1994). The economics of narrative. Family Therapy Networker, 18(6),

38-39.

Riordan, R. J., & Soet, J. E. (2000). Scriptotherapy: Therapeutic writing for couples

and families. In R. E. Watts (Ed.), Techniques in marriage and family counseling, Vol.

1 (pp. 103-110). Alexandria, VA: American Counseling Association.

White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.