Therapeutic Letters as Relationally Responsive Practice

Abstract

Therapeutic letters have become a practice adopted by many clinicians as an adjunct to therapeutic conversations. This article presents selected findings from a larger study that examined both the letter-writing practices of nine clinicians as well as the experiences of seven adult clients who received a therapeutic letter or letters during the course of individual or family therapy. A novel aspect of this study is that data from clients were gathered in the form of letters-eight letters written by the clients to the researcher about their experience of receiving a therapeutic letter or letters from their clinician. Thematic analysis guided the analysis of the data. Findings are placed within the context of relationally responsive (or relationally engaged) practice. An invitation is extended to conceptualize letters not as monologic documents but as a means of dialogically relating to clients and to the "goings-on" of therapeutic conversations.

“It's the Little Things That Count”: The Value in Receiving Therapeutic Letters

“…Therapeutic letter writing has a long history in counseling and therapy (Pare & Rombach, 2003;Romback, 2003;White & Epston, 1990) and has recently been highlighted as an effective strategy in advanced family nursing practice (Bell, Moules, & Wright, 2009). The therapeutic value of TLs had been described in many ways, including the promotion of powerful relationships (Rodgers, 2009), bridging time and space to deliver healing words (Moules, 2009a), adding to and extending the therapeutic dialogue (Pyle, 2009) acknowledging suffering, conserving and protecting memories, provoking reflection (Moules, 2009b), cementing the therapeutic alliance, promoting new insights, and clarifying the therapeutic process (Ryle, 2004). According to Pare and Rombach (2003), TLs are specialized tools that help practitioners understand patients' meanings and identities.…”

O uso das cartas terapêuticas na prática clínica

“…Nesse campo, em um trabalho pioneiro na década de 1960, Widroe e Davidson (conforme citado por Pyle, 2009) relatam um estudo com 12 participantes no qual se observou que a partir do processo de leitura e releitura se promovia uma maior observação em relação ao uso de suas palavras e do conteúdo emocional empregado. No contexto da saúde, Brouwers (2001) destaca o uso das cartas em tratamento de grupos de mulheres com bulimia.…”

“…Dessa forma, no que se refere aos campos disciplinares/profissionais, as cartas terapêuticas são utilizadas na terapia familiar (Vidgen & Williams, 2001), na terapia em grupo (Chen, Noosbond & Bruce, 1998), no aconselhamento (Paré & Rombach, 2003) e na prática da equipe de enfermagem (Erlingsson, 2009). Os diferentes contextos de uso incluem desde a clínica psicoterápica em geral (Pyle, 2009) e as consultas psiquiátricas (Couper & Harari, 2004), passando pelas escolas com os adolescentes, pais e professores (Oliver, Nelson, Cade & Cueva, 2007), até o aconselhamento breve nas empresas (Wright, 2005). As cartas terapêuticas também foram utilizadas de maneira efetiva com diferentes populações, seja com pessoas que sofrem distúrbios alimentares (Davidson & Birmingham, 2001), com experiências traumáticas passadas (Esterling, L'Abate, Murray & Pennebaker, 1999), com adolescentes e suas famílias (Goldberg, 2000) e com pacientes em crise (Tubman, Montgomery & Wagner, 2001).…”

The Past and Future of Therapeutic Letters

“…T herapeutic letters, carefully and artfully crafted by clinicians and sent to families between sessions, have been used and recently studied as extensions of clinical work (Epston, 1994;Moules, 2000Moules, , 2002Moules, , 2003Moules, , 2009bPyle, 2009, Rodgers, 2009). These posted interventions that bear the long history of letter writing in our society have perhaps collided against a cultural shift in the way we communicate.…”