Collaborative Writing and Psychotherapy: Flattening the Hierarchy Between Therapist and Client 1032213876, 9781032213873

Citation preview

COLLABORATIVE WRITING AND PSYCHOTHERAPY

Collaborative Writing and Psychotherapy delves into the relationship that develops between client and therapist as they embark on a collaborative autoethnographic writing practice. The book explores the notion that both client and therapist change as a result of engaging in a psychotherapeutic process. The dialogic approach allows both voices to be heard together in the exploration of autoethnographic methods (collaborative autoethnography and dialogic autoethnography) and creative-relational approaches. This book will encourage therapists to be more vulnerable with their own life experiences and how these shape and influence therapeutic encounters with clients. Additional contributions include the expansion of psychotherapeutic literature to explore co-creative (creative relational) methods, and to expand autoethnographic scholarship to include psychotherapy narratives. Finally, the book offers ideas to therapists who might want to develop the ‘fellow traveller’ aspect of their professional identity, either in working directly with clients, or as part of their reflective practice. This book will be suitable for therapists and scholars looking to explore the use of qualitative, autoethnographic and narrative methods in research and practice. Trish Thompson (she/her) is a clinical counsellor, psychotherapist, supervisor and educator in private practice in Melbourne, Australia. Daniel X. Harris (they/them) is a research professor of creative Education in the School of Education, RMIT University, Melbourne Australia, and is the co-director of Creative Agency research lab.

“I can’t wait to read this book. I feel as though we have all been waiting for this book. It seems all set not only to flatten relations between clients and therapists but squash flat the pseudo-professional boundaries that psychotherapy professionals have ducked behind all their (our) working lives. This book moves therapists out from hiding behind their couches and their false veils of ‘expertise’ to stand alongside their clients as fellow, flawed humans. Therapy and therapists need to come out of the closet. Therapy needs queering up a bit and Trish and Dan are exactly the people to perform this feat. I hope this book becomes a core text for all psychotherapy and counselling education programmes.” – Jane Speedy, Emeritus Professor of Education, University of Bristol, UK; Member of CANI-net

“In the spirit of Irvin Yalom’s, ‘Every Day Gets a Little Closer,’ Trish Thompson and Daniel X. Harris share the ever-deepening richness of their therapeutic journey through poignant, vulnerable, and transparent collaborative writing.” – Lawrence Rubin, PhD, ABPP, Editor, Psychotherapy.net

“Collaboration, accessibility, emotional connection: autoethnography allows all three in the client-therapist relationship. Hierarchies are transcended, healing is transformative. This book shows us how.” – Dr Maria Pallotta-Chiarolli AM, Honorary Fellow, School of Communication and Creative Arts (SCCA), Deakin University, Australia

“This is a provocative intervention in the field of psychotherapy, counselling and qualitative and creative research. Trish Thompson and Daniel X. Harris intimately reflect on the relational processes and intersubjective nature of client-therapist relations as they move from therapist/client to collaborators and co-authors. They demonstrate the transformative power of dialogical practice and creative methods, particularly writing, in their own therapeutic relationship, illustrating how it evolved into a collaboration where their vulnerabilities could be explored in relation to each other, in ways that had therapeutic and transformative benefits for them both. Collaborative Writing and Psychotherapy is a must read for anyone engaged in therapeutic practicing or thinking about the potential power dynamics between therapist and client, and/or ethical possibilities for unsettling tradition notions of client/ therapist relationships.” – Professor Katherine Johnson, Professor of Psychology and Dean of Global, Urban and Social Studies, RMIT University, Australia

“This book is a realisation of a beautiful idea. Dan and Trish seek to challenge and dislodge the often unacknowledged power imbalance between client and therapist. Their dialogical process places ‘equivalence of voice’ at the centre of this radical and humanising idea. This book moves me to seriously consider big questions; who am I as I sit in my therapeutic role, who is my client, and what might be possible for two people together in a shared space?” – Dr Stephen Andrew – Psychotherapist and author of Searching for an Autoethnographic Ethic

“This is a rare gem in the plethora of books written for therapists, giving the reader first-hand experience of using dialogical writing for therapeutic reflection. The book is both rigorously academic and sensitively personal, demonstrating the thought processes and reflexivity of master therapists, reflexivity that all therapists strive for but can rarely achieve.” – Dr Judith Ayre, Head of School of Counselling, Psychotherapy and Arts Therapy, Ikon Institute of Australia

COLLABORATIVE WRITING AND PSYCHOTHERAPY Flattening the Hierarchy Between Therapist and Client

Trish Thompson and Daniel X. Harris

Designed cover image: ThomasVogel / Getty Images First published 2024 by Routledge 4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 605 Third Avenue, New York, NY 10158 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2024 Trish Thompson and Daniel X. Harris The right of Trish Thompson and Daniel X. Harris to be identified as authors of this work has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library ISBN: 978-1-032-21387-3 (hbk) ISBN: 978-1-032-21388-0 (pbk) ISBN: 978-1-003-26816-1 (ebk) DOI: 10.4324/9781003268161 Typeset in Optima by KnowledgeWorks Global Ltd.

CONTENTS

Acknowledgements Preface: May we all continue to be brave

ix x

Introduction

1

1 Irv who? (Trish)

11

2 Unstable sense of self (Dan)

22

DIALOGUE 1

How do we define collaborative writing?

33

3 A fine balance (Trish)

45

4 Letting go (Dan)

55

DIALOGUE 2

The book of laughter and remembering

65

5 Writing into healing (Trish)

76

6 Butterfly moves (Dan)

88

viii Contents

DIALOGUE 3

Breaking up is hard to do

98

Conclusion110 References115 Index119

ACKNOWLEDGEMENTS

Trish and Dan would like to thank Hannah Shakespeare and Matt Bickerton at Routledge for their care, support and expert stewardship of this text and of us as authors throughout this process. We thank Jonathan Wyatt for his thoughtful feedback and beautiful preface which frames this book and for his 2018 book Therapy, stand-up, and the gesture of writing: Towards creativerelational inquiry (Routledge), which informed our thinking during the writing of this book. We thank our respective human and fur family members, both present and absent, for their companionship and comfort while we plowed difficult ground. We thank Keiran O’Loughlin, Sara Timms, Stephen Andrew, Lawrence Rubin for their draft readings, encouragement and publishing support. Finally, we dedicate this book to all therapists and clients working hard to change the world, one person at a time, from within.

PREFACE: MAY WE ALL CONTINUE TO BE BRAVE

It is Tuesday 16 May 2023. Preface day. I have begun this preface, begun writing with Trish Thompson and Dan Harris, once already today. The first time, back then, early this morning before the busyness of an ordinary academic working Tuesday, I was sitting at my university office desk. I started writing: a few lines about where I was, my office, the feel of it, the light and sounds of that moment, then into when and how last week I had first encountered this book. I wrote about reading – meeting – Trish Thompson and Dan Harris on a train journey to London as I travelled south for my mother’s 94th birthday. I wrote about how the tracks hug the east coast between Edinburgh and Newcastle, following the edge of the ocean as they pass through and between the coastal towns of Dunbar, Berwick-upon-Tweed, and Alnmouth. I wrote how I had purposefully booked a seat on the left – the east – of the carriage to take in the view. Whatever the ocean’s mood, I would previously have claimed, you can’t but gaze and imagine. Except last week, I had the perfect east-facing view and found I paid no attention at all. My attention and my imagination were elsewhere: I was with Thompson and Harris and with what they conjure in this book. The story of that journey was as far as I got in my early morning halfhour writing. I can’t know where the writing would have gone nor how it might then have led me further into Collaborative Writing and Psychotherapy. I saved the document, or thought I had, and closed the file ahead of moving into the rest my morning. The rest of my morning was this: a colleague and I met online, in turn, three applicants to our psychotherapy training programme. We spent an hour with each, asking them to tell us about themselves. We asked each applicant why they wanted to become therapists and why now; about the (difficult) experiences they’ve had that have shaped this moment; about their experience

Preface: May we all continue to be brave   xi

of being and working with others; about what qualities in themselves they’re bringing that they imagine they will draw from as therapists; and about their hopes and fears. We were online with them even though some live or work nearby. The colleague and I wondered why the institution continues, almost by default, to do these interviews online. We questioned how the pandemic often continues to govern how we all relate to each other. It was a long morning staring at a screen, with difficult decisions at the end of it that will affect applicants’ futures. The responsibility was heavy even as we hastened to complete the task. Returning to writing now in the afternoon on my laptop, after the interviews are done and I have moved across the street to a different setting – a university café – I needed to get away from the office – the preface I was writing then, early this morning, is nowhere to be found. So, I have begun writing this preface again. I have begun writing with Trish Thompson and Dan Harris again. I am with them in a different place at a different time of day. Now is not the freshness of a new morning. Now is writing with this morning’s interviewing, with my sense of those becoming-therapists and the politics of those encounters. Perhaps this is how writing always is: we are always beginning writing again. Perhaps we always are rehearsing writing. We can only write because the writing comes from somewhere, something, something else, some other time, some other encounters, some others. We’re always starting writing in the middle (Deleuze & Parnet, 2002). In the middle of what’s happening. Early morning. Mist over the ocean. The east of a train carriage. Lost words. A long life’s birthday. Conversations about new life directions, longings and fears. Lunchtime in a sterile university café. Because writing is never only writing; it is formed in stuttering efforts to get by. Writing arises as someone tells you their stories of what brought them to becoming a therapist and you take a moment’s look out of the window as those stories land. We’re always starting writing in the middle and always writing with (a sense of) human, non-human and more-than-human others. This sense of being beckoned into writing’s middle – its heart – is what compelled me on that speeding train journey down the coast last week. It’s what compels me now in this empty café. This is what Collaborative Writing and Psychotherapy did, what it does. Trish and Dan – last names have suddenly, here, now, become distant, formal, patriarchal, an outdated academic trope and an echo of my schooldays when it was only last names even between best friends – invite their reader into the middle of their continuing relating. As it’s happening, as it’s always been happening, as it’s been shifting and changing. Into its movements, its politics and its vulnerabilities. Into its hopes and fears. Narrative therapist and pioneer collaborative writing scholar, Jane Speedy (2012, p. 355) claims: All writing is collaborative, insofar as all writing is an embodied and imagined accumulation of selves and stories. All writing … is about love. All explicitly collaborative writing is about bringing what Weems (2003)

xii  Preface: May we all continue to be brave

describes as the imagination-intellect into play and extending the social imaginary of the academy; collaborative writing is about engaging with the highly subversive activity, much neglected amongst scholars, of building loving communities within and across groups of writers, across disciplines and themes, and across continents. To write collaboratively is to engage with reconsiderations of scholarship and of what it means to be a human being living amongst other human beings and other species and elements on this planet. Reading Trish and Dan throughout their text, Jane’s claims for collaborative writing are alive and activated. I sense Trish and Dan would also add “and psychotherapy” to Jane’s claims for writing. For Trish and Dan (and for Jane, surely), psychotherapy also is collaborative. Psychotherapy also is an embodied accumulation of selves and stories. Psychotherapy also is about love. Psychotherapy also is about the imagination-intellect, is also subversive. Psychotherapy – and writing collaboratively about psychotherapy – is to engage with what it means to be human on this multi-species, fragile planet. Today, Tuesday 16 May, has been preface day. A day (not) like any other academic Tuesday. I end in the middle of this day, in the middle of writing. This file is saved, but this preface is not finished. Nor, moreover, is Collaborative Writing and Psychotherapy: it continues to write itself, continues to be written, continues to do its work, as we, its readers, its witnesses, follow what it prompts, what it calls for. What it calls for is both pressing and enriching. Collaborative writing, psychotherapy, and collaborative writing about psychotherapy, are, for Trish and Dan, necessary, urgent, beautiful, and not without jeopardy. So, as they write in the book’s final lines, “Let us all continue to be brave”. Jonathan Wyatt Centre for Creative-Relational Inquiry, The University of Edinburgh May 2023 References Deleuze, G., & Parnet, C. (2002). Dialogues II (H. Tomlinson, Trans.). Continuum. Speedy, J. (2012). Collaborative writing and ethical know-how: Movements within the space around scholarship, the academy and the social research imaginary. International Review of Qualitative Research, 5(4), 349–356. Weems, M. E. (2003). Public education and the imagination-intellect: I speak from the wound in my mouth. Peter Lang.

INTRODUCTION

Writing prompt #1:

Ok let’s begin by centring ourselves. A way to enter the moment. Feel your breath. Invite yourself right there. And let come to mind a time in your life when it felt like things were falling apart. Where the ground really got shaken for you. Ideally one in the past, so you have a bit of distance. A death of a loved one, a divorce, job loss, serious illness, trauma? And just be curious about it, as one of the inevitable expressions of impermanence, of loss, of change. And just reflect: did it change you? How might it have changed you? Did it, in some way, bring you to a deeper resourcefulness, or wisdom, or understanding? Stress, the pain of loss, it’s a messenger in our system. What message was this pain bringing to you? Now see if you can write some words out of this important message. Centring before co-writing can be a way to let go of the self-censor, an outwardfocus on your collaborator and bring it back to “home.” Not unlike therapy, settling in a bit before beginning can help let go of the “day,” whatever busy DOI: 10.4324/9781003268161-1

2 INTRODUCTION

business has preceded this session, and bring each of us into the moment, and the “here.” So we have taken this same approach to the structuring of this book. Each chapter begins with a writing prompt, some of which we have used as provocations in our own collaborative writing sessions, others borrowed or invented specifically for this book. Some of them are simply meditations which aim to centre the writer before embarking on reflexive writing, many of which have been pivotal to Dan’s daily meditation practice since their diagnosis. Some are more practical, instructional prompts. We offer them as gestures of sharing between us, the co-authors, and you, our readers. We encourage you to make your own. We encourage you to adapt them to your own uses, styles, or preferences. And in the conclusion, we offer a more schematic array of prompts that we hope will be useful to readers as a jumping-off point for enacting/maintaining your own autoethnographic and, perhaps, collaborative writing adventure. They are not meant to reflect the content of each chapter, but rather invite readers into a meditative space for receiving this work, and in anticipation of writing your own. Context

The overwhelming majority of psychotherapeutic writing is centred around concepts, theories and techniques. In this text, we are proposing a shift away from this monological way of conceptualising this work to a creative, collaborative and dialogic frame where the therapist and client have an equivalence of voice. This echoes the reality of the successful, post-modern therapeutic space where both parties co-create the healing environment. There are a number of terms that refer to the roles of those who provide and receive therapy, such as ‘counsellor’ and ‘patient’. Throughout this book, we have chosen to use ‘therapist’ and ‘client’, as we believe they are the most recognisable across disciplines. The COVID-19 pandemic has changed the way therapists practice. Much of their work now takes place away from traditional face-to-face, in situ counselling environments. This looks set to continue for some time yet. Therapy now takes across two different places – in the therapist’s space and in the client’s space. These are also places where writing and reflection occur. This new therapeutic topology suggests an increased need for books about new, collaborative ways of working.​​The collaborative, therapist-client dialogical writing approach is a rare methodology. Indirectly, it builds on what some consider to be the most important psychotherapy research of the last 20 years, which posited the therapist-client alliance as the central component of successful therapy (Duncan et al., 2010). This book aims to delve deeper into the relationship that develops between client and therapist with an emphasis on a dialogic/epistolary approach,

INTRODUCTION  3

allowing both voices to be heard together in the exploration of the therapeutic relationship. The majority of literature about psychotherapy focuses on theory and technique and its application to client presentations. This book seeks to redress that, allowing the client voice to be both present and equal to that of the therapist. By drawing on autoethnographic modalities (collaborative autoethnography and dialogic autoethnography) and creative-relational approaches, this proposed book will encourage therapists to be more engaged/in touch with their own life experiences and how these shape and influence therapeutic encounters with clients. How might therapist narratives and different parts of them enter the space and connect with the narratives/ parts of the client? In this book, we argue (through demonstration) that the meeting point/s of these narratives can be a catalyst for creativity and change in both the client and therapist. After all, as Ocean Vuong reminds us, “survival is a creative act” (Vuong, 2022, n.p.). The book’s primary contributions are in this exploration of the notion that both client and therapist change as a result of engaging in a psychotherapeutic process, as well as collaborative writing. Additional contributions include the expansion of psychotherapeutic literature to explore co-creative (creative relational) methods, and to expand autoethnographic scholarship to include psychotherapy narratives. Our collaborative and psychotherapeutic narrative approach is not new: we lean heavily on prolific author and renowned psychotherapist Irvin Yalom, and develop Yalom’s idea of fellow travellers. Like Yalom, we challenge the more rigid boundaries and traditionally-held power dynamics of the client/therapist contract. Lastly, we hope the book will offer ideas to therapists who might want to develop the “fellow traveller” aspect of their professional identity, either in working directly with clients, or as part of their reflective practice. We believe the book will have wide-ranging value not only to health professionals, but as a core text for counselling and therapist training programs, as well as qualitative methods courses. We have worked together in one way or another for over 8 years now. First as therapist/client, now as collaborators, friends, co-presenters. We have used those and other modalities and relational approaches to ask questions about the scholarship of therapy, the art of therapy and the radical potential for joining these two practices. Therapists can sometimes be precious and over-protective of their profession, as can researchers. What is it like to be an autoethnographer engaged in therapy? What does the researcher see (in the therapist and the psychotherapeutic edifice) that the therapist does not? What does the therapist see in the researcher than the sometimes overintellectualised, analytic researcher does not? In this book, we bring together the two practices of psychotherapy and academic research in order to extend them both, to extend ourselves, and to ask readers to consider the ways in which both practices might benefit from cross-pollination.

4 INTRODUCTION

Background

Of course, there is a long history of art therapy, which has its own constraints and affordances. That is not what we are offering here, nor a practice in which either of us is trained. Using autoethnography to jointly explore a therapeutic relationship between therapist and client is not the same, although some of the creative and collaborative aspects do overlap. Throughout this book, we will make links to related therapeutic and scholarly literature and practices, while always leading with our own voices, and our own lived experiences of the therapeutic process. One of the primary reasons we wanted to do the book in the first place is that Trish was aware of a dearth of therapeutic texts that are told equally from both the therapist and client perspective. This has been our main goal, and we are proud of this contribution to the field. This first chapter offers readers an introduction to the value of using creative collaborative methods (specifically co-writing) in therapeutic relationships and contexts. We draw on traditions including autoethnography, narrative therapy, interpersonal/relational therapy, interpersonal psychotherapy and psychosocial approaches. At the heart of our therapeutic literature is the work of Irvin Yalom, but we also draw on others, including Harry Stack Sullivan: Much of Sullivan’s work centered on understanding interpersonal relationships, and his research became the basis for a field of psychology known as interpersonal psychoanalysis. Sullivan’s interpersonal psychoanalysis suggests that the way people interact with others could provide valuable clues into their mental health and that mental health disorders may stem from distressing interpersonal interactions. (Good Therapy, n.d.) Most of all, we are both committed to collaborative writing and to other components of this process relating to flattening the hierarchy between client and therapist. Because Dan is, in a sense, a professional writer (an academic who gets paid for writing and publishing), this allowed a zone in which we could “flip” the hierarchy. That Dan was in a position to guide Trish was definitely part of the process for us. There were times in the writing process when Trish thought, “oh I don’t know what the best thing for blah blah is but I’m sure Dan will know,” and that felt not only fine but good for Trish – it might not be so for all therapists and all clients, but for us it worked. Trish had complete confidence that Dan would get us to where we needed to be, ultimately. That new relationship made Trish think about times when clients would bring things in to show her, or they want to tell her in depth about their knowledge about something, a similar way of flattening the hierarchy. Trish narrates this as a humanising factor, “like they might have problems, but they also have this other part that they bring to me and it might benefit me in some way.”

INTRODUCTION  5

We have both seen co-authoring in this light since the beginning. Of course, not all clients are confident, or good, or published, authors. In this text, we wonder together about whether the subject matter could be more than – or just as – important than writing skill. For example, if clients are able to write about topics that they feel some confident connection to, and they feel that the therapist is helped by reading it, what might that mean for both parties? Our work philosophically challenges the tradition of the psychological treatment approach, in that the therapist positions themselves as the expert and offers treatment to a client. What does it mean for the therapist to relinquish the expert role, and what are they if not the expert? What does it mean for the client to be aware of their therapist’s vulnerabilities? How flat can the hierarchy be without interfering with the therapeutic process? Certainly, we are not the first to ask these questions – Yalom alone has written on this extensively, as have others – but we believe we are the first to write together about these questions, at least extensively. Usually, therapists publish their “case studies” either quoting from anonymous clients, or creating composite characters out of client attributes, or other forms of anonymising. We understand the ethics of that approach, and its value. But in this book, we are modelling one way of flattening the hierarchy by truly collaborating, each attending to our own vulnerabilities in relation to each other, and for the purpose of sharing the therapeutic benefits it has had for us. These are not universal claims, but/and we hope you find it of benefit. Certainly, at those conferences and other public events at which we have shared our work, audiences have found it of benefit. We hope readers of this book will too. This book focuses on the intersubjective nature of the client-therapist relationship. It will explore not only how the relationship and the meanings created are co-constructed but, most significantly, how the therapeutic work impacts both client and therapist. We hope that both the content and form will be of interest to experienced and less experienced counselling and psychotherapy practitioners in its challenging of the more rigid and traditionallyheld power dynamics of the client/therapist contract using first-person voices of therapist and client. We also hope it will be of interest to professional communication and writing audiences as an example of dialogic autoethnographic writing in a context where there is a dynamic interplay between the personal and professional dimensions of a therapeutic relationship. We also hope it will contribute to the literature on critical qualitative research, specifically critical autoethnography for student and experienced researchers in the humanities and social sciences. This book might be used for students in counselling/psychotherapy undergraduate and postgraduate courses across subjects focusing on the clienttherapist relationship. The quality of this relationship has previously been found to be the crucial factor in influencing whether both the process and outcomes of therapy will be successful. However, the nature of and possibilities

6 INTRODUCTION

for the relationship are still under-explored and under-researched. This book will contribute to helping students deepen their understanding of the relationship in a direct and accessible fashion as it is written from the first-person perspectives of client and therapist. This contrasts significantly from most textbooks and DVDs providing examples of therapy in practice which view the relationship from an outsider looking in view, rather than the insider perspectives of therapist and client as is the case for this book. The book could also be used in professional writing and research methods courses as an example of dialogic autoethnography (also known as “duoethnography”) which explores the nature and effects on the participants of a therapeutic relationship. We hope the market for this type of book which explores the intersubjective space between therapist and client using a creative approach will continue to grow for both student and more experienced counsellors/ psychotherapists and professional writers, especially books like this one which provide first-person and highly interactive accounts of therapeutic work from the dual perspectives of therapists and client. One innovative contribution of this text is Trish’s commentary on not only the changes to her practice, but to herself personally, resulted from this coauthoring collaborative approach. She shares the reflexive interface between the personal and professional changes that have taken place (both within her and between her and the client) through this work, a kind of commentary that we believe is of value to others interested in this work. She details how these changes impact herself personally and professionally (including her work with other clients) during and at the end of the process, a contribution we feel is under-researched and sorely needed. The “misery memoir” market is large (both within the academy and IRL) but there is very little clarity around what trauma storytelling does – in both best and worst-case scenarios. There is especially little that gets beyond binary, all-or-nothing, under-theorised allocations of power and virtue – so we have clumsy tools for sense-making in the reciprocal embodied stew of “therapeutic” interactions. Therefore, we hope this book will be of value to those in schools of social work, especially ones that take a critical or structural approach. We hope it may also be useful to many therapists both pre-licensing and as part of their compulsory ongoing training. Critical disability studies may also be interested because that field connects with conversations about the politics of care. The pandemic’s devastating impact on mental health globally seems likely to ensure that books about what might help for isolation will continue for years to come. The specific turn to collaborative writing, imposed by lockdowns, will also have broader interest as that same dynamic produced analogous radical shifts in pedagogies and workgroup interactions. We are interested in the ambivalent effects that this disinhibition can produce (we often write about things we can’t readily discuss – which readers reasonably assume we

INTRODUCTION  7

should therefore be able to discuss). Asynchronous interactions are here to stay, we believe, and so a thorough examination of what they can and can’t achieve will be useful, we hope, in a range of settings. Scholarly context/related literature

We do not claim to be inventing a genre, either in therapeutic literature, or in autoethnographic/scholarly literature. Indeed, Lather and Smithies’ Troubling the Angels has strong resonances in the ethnographic canon, especially in the team-up between a powerful scholar and a therapist (Smithies was a social worker) – however, their focus was on helping and understanding the experiences of third parties (women with HIV/AIDS). Neither author was very personally revealing – but they did discuss the fundamental conflict between Lather’s drive to complicate the narrative (so it was more subtly theorised) and Smithies’ drive to simplify the narrative (so participants could recognise themselves). By appearing within the frame, we hope to be able to provide a more satisfying discussion of how they navigate these (and other) imperatives, especially the pressure to construct a past that makes sense of the present and permits a modest hope for the future. There are also a number of other recent texts that address therapy and/ through the arts in a range of ways. Nicholas Mazza’s 2016 book Poetry Therapy: Theory and Practice, addresses the use of poetry in treating individuals, families, groups, and communities, including young people and other vulnerable populations. It addresses the “theory, research and practice” of poetry therapy which has undergone significant expansion in recent years. Mazza’s emphasis here is on the poetic and therapeutic elements involved in training and offering helpful tools to practitioners. His goal is more specific than ours: we also use poetry in our collaborative writing work, but our focus is on the relational aspect of the writing as an extension of the therapeutic relationship in the room. Written Exposure Therapy for PTSD: A brief treatment approach for mental health professionals (2019), by Denise M. Sloan and Brian P. Marx, is a treatment manual that provides mental health professionals with instructions for conducting written exposure therapy (WET) with clients who have posttraumatic stress disorder. The authors developed WET in response to a growing demand for an effective PTSD treatment that is easier to implement, more affordable, and has lower dropout rates than other trauma interventions. In their unique approach, the client writes about a single traumatic event, and the therapist focuses on the client’s experiences in writing about the trauma, rather than the event itself. While sharing a narrative approach, our book differs from Sloan and Marx’s in our focus on collaboration between therapist and client, which requires more “exposure” of the therapist, and focuses on the two-way investment rather than the client’s singular self-expression.

8 INTRODUCTION

Through our approach of collaborative exchange, we invite professionals into a narrative form of the corrective emotional experience that forms a verbal part of all psychotherapeutic work. Two works that employ the autoethnographic approach that we also use are Jonathan Wyatt’s Therapy, stand-up, and the gesture of writing: Towards creative-relational inquiry (2018) and Stephen Andrew’s (2017) Searching for an autoethnographic ethic. Both authors are psychotherapy practitioners, and include their own stories in the narratives. Wyatt’s book uses narrative, performative and embodied methods, but mostly focuses on the research possibilities for such forms. While a main thread throughout the book is his client Karl, Wyatt maintains the single-voice authorial psychotherapist, narrating the therapeutic experience from his single perspective (not unlike Irvin Yalom does). Our book differs in that we employ both client and therapist voices in order to present a rich, multi-vocal and multi-modal narrative about the power of collaborating in therapy, not just the narrative form itself. These books and others emerging every day signal to us the efficacy of a collaborative, and autoethnographic approach in addressing therapeutic processes and relationships, both for improving service provision but also for a general public that continues to be draw to such stories. Sherry L. Beaumont writes about the power of expressive writing as using “one’s most authentic voice” and reminds that “it comes in many forms, such as free writing in journals, life story, note-taking, or poetry” (Beaumont 2018, p. 55). While she acknowledges that there is a long history in psychology of recognising the benefits of expressive writing, more recently the phenomenon of art journaling offers a synthesis of writing and drawing or visual forms of expression, and has become highly popular. Beaumont says, In my art therapy practice, after educating clients about art journaling, I often suggest that they consider keeping an art journal, one that includes expressive writing, in order to foster self-insights that will create continuity between art therapy sessions. (p. 56) There are other benefits, and obviously expressive and reflective writing is used by others than just art therapists and their clients. In her article, “The Art of Note-Writing: Art Therapy and Clinical Notes,” art psychotherapist Ali Coles advocates for considering the therapists’ clinical note writing as a form of creative practice. In fact, she suggests that “a creative approach to clinical note-taking might benefit the therapeutic process and be helpful to other professionals involved in a client’s care” (2018, p 101). How might extending a therapist’s attention to the potential creativity of the entire writing process of client engagement, expand or extend the ways in which the therapist-client relationship? Of course, this is just one approach to creative, narrative, reflective writing that has an aesthetic attention within it. Autoethnography is also a powerful form of reflective and expressive writing that links the critical reflection on

INTRODUCTION  9

oneself with a critical commentary on society and culture, which we discuss more directly in other parts of this book. Queering therapy

We also see this work as a form of queering therapy, in that it messes with the conventional pseudo-clear framework of power and identity, in part by including discussion of how gender and sexual identity is tangled up in all this. As such, we try to unpack the nature of benevolent and consensual power imbalances – how they are formed, and how they evolve into the next thing. We are using collaborative writing not just as a form of therapy, but as a form of queering therapy, in the ways in which it messes with the conventional pseudo-clear framework of power and identity. This includes rather queer aspects of the therapeutic exchange such as the open-endedness of things and the role of money in all this. The contract between therapist and client is not the same as the contract between co-authors, and the differences here have generated very honest discussion of how we have dealt with this. We have really worked hard to resist the urge to tie it all up with a bow. Everybody wants miracles – including us. But here we have really pushed ourselves to honestly acknowledge what collaborative writing and therapy can’t do, or hasn’t done yet. Our need for hope (in the rooms, and in the writing) has sometimes conflicted with the book’s need for integrity. Perhaps even more challengingly, we have tried to tackle head-on the recovery frame around mental health narratives, and how that erases and turns into failure the episodic, looping, disorganised way these things often manifest. This is not as easy as it seems! The pressure to put difficult pasts behind us can be overwhelming; we have had to be attentive to what this force does in our storytelling. We recognise and always wish to foreground our awareness that this is just one collaborative, therapeutic relationship. As such, the book may be less about what collaborative writing does in general, and more about what happens when agency is differently distributed within therapeutic relationships. Dan’s social and economic status shifts the power dynamics in the therapy room; Trish may have been more open to engaging in reciprocal disclosure or open-ended time commitments because it is easy for them to see each other as peers. Our discussion of the merits and limits of collaborative writing as it relates to therapeutic journeys is always inseparable from these specifics. Dan also recognises the pleasure of writing with their therapist because they can control their voice on the page much more effectively (so Dan can arguably show Trish that they are impressive and clever, not a heap of confused mush). They can explain themself. They are in their element, in words on a laptop – and while this is a boost to Dan’s sense of power, it might take them out of the productive discomfort of a less-controlled presentation. We have attempted to address such things as relevant to how transferrable (or not) our process is to other contexts, and on how we perceive what writing does.

10 INTRODUCTION

While learning trust in mutuality is important, it is not the same as learning that you can be in a dependent or relatively weak position and be secure even if it never evolves into a mutual thing. Dan suspects they developed a capable, analytical brain as a way to suppress or work around the bodily effects of distress. There is only so far language can go, and sometimes it can be a way of avoiding even while it seems to be aimed at directly encountering things. We negotiate and theorise and narrate and reframe and while this can be lifealtering or even life-saving, it can be a kind of busy-work that prolongs misery by failing to produce the escape from ourselves – from visceral feeling – that we thought we were writing into being. So here we have refused a sparkly recipe for collaborative writing as a method of self-transcendence (not because we don’t want one, but because we are clear about knowledge’s false promises). We also acknowledge that transcending our roles as client and therapist (even though we have now left those roles) is a slow and ongoing project of its own. We continue to ask ourselves and each other questions about boundaries, limits, and transitions, especially regarding Trish’s role: Can Trish be really honest with Dan, or does her vestigial, non-reciprocal sense of a duty to support still drive her? How many Dan’s could she support in this way? Has this kind of engagement and time-commitment had an impact on her family or other aspects of her life? How does this work with her own therapeutic supervision? We recognise that this account can’t gloss over such things without losing credibility. Structure of the book

The book is divided into individual chapters written in the first person by both authors (Trish wrote Chapters 1, 3 and 5, while Dan wrote Chapters 2, 4 and 6). These individual chapters are not antithetical to the shared approach overall, but rather provide an opportunity for each author to speak individually of our shared and singular experiences. Each of these chapters opens with a writing exercise or reflection that we have used in our collaboration or our teaching, and which we hope might be of use to readers. These are punctuated by three dialogic interstitial sections called “Dialogues,” in which we discuss more jointly our shared method, questions and observations of one another. Finally, our conclusion jointly examines some of the messy, openended questions that remain, and offers readers a number of writing prompts that might be useful in getting started on a collaborative writing relationship between therapist and client. It also returns to a final reflection on the ethics of this kind of work, and some useful considerations that potential collaborators might discuss before embarking on a co-authoring journey. We hope the book is useful to readers, and that you may experience some of the freedom, belonging, and creativity that we have. Lastly, we thank all of those therapists and clients who have continued to do the brave work of showing up, taking risks, being vulnerable and to expanding the ways in which we come together for mutual healing.

1 IRV WHO? (Trish)

Writing prompt #2

Bring to mind a person who inspired or influenced you at an important time in your life. Whatever this person did or said to you, it made a difference. Write a conversation between you and that person today, exploring the outcome of that past moment. Irvin Yalom? Never heard of him

My first introduction to Irvin Yalom was through the Master of Counselling programme at La Trobe University, Melbourne, in 2006. We had several academic texts and journals to read, which was great; I loved reading and discussing theory one day and then putting it into practice in sessions with clients the next. Isn’t that what study is all about – the direct connection between what you learn about and what you do? But then there was Yalom. The storyteller, the dreamer, the encourager and the guy that says, “I urge you to let your patients matter to you, to let them enter your mind, influence you, change you - and not to conceal this from them” (Yalom 2002, p. 26). I hadn’t read that before in any textbook. His name kept coming up in classes, so I got several of his books … and fell in love. As a psychiatrist, psychotherapist, group facilitator and teacher of many years, Yalom is hugely respected in his field. But that is not the place he writes from, or even what he cares about. In fact, he sees himself as someone who sits outside of traditional psychiatric practice, and is prepared to risk that reputation because of his belief that psychotherapy is about the interpersonal connection between two people with the labels of therapist and client, and DOI: 10.4324/9781003268161-2

12  Irv who? (Trish)

that the healing happens in this space. When I bring an image of him to mind now as I write this, I see an old man, one who has recently lost his wife. His face shows wisdom and frailty, as well as strength that comes from bearing what he has spent his life helping others confront. And he is saying, “don’t be a blank screen, that won’t help anyone.” In his memoir, Becoming Myself (2017), Yalom reflects on his own experience as a client during his 3-year psychiatric residency at John Hopkins Hospital in Baltimore in the late 1950s. He saw an orthodox Freudian analyst four times a week (yes, four times!) who apparently revealed nothing about herself. He muses, “Many times I have had the unkind thought that the main thing I learned in my analysis was how not to do psychotherapy” (Yalom, 2017, p. 97). In contrast, he talks about his therapy in the 1970s with Rollo May very differently. May (1909–1994) was considered the founder of existential psychotherapy. His work was based on the theory that most human suffering emerged from a fear of death and that facing these feelings of anxiety was the path to personal growth and finding meaning in life (May, 1953). In his psychotherapy with May, Yalom says that he felt accompanied by him to the darkest places; his greatest gift being his presence. Yalom often cites May as one of his major influences on his own work, and Yalom himself went on to write Existential Psychotherapy in 1980. Yalom identifies the four “ultimate concerns of life” – death, freedom, existential isolation and meaninglessness, and that we all face them, and they will enter the space of therapy for both client and therapist (Yalom, 1980). Yalom was also the first writer-therapist who drew my attention to the use of “the here and now” in therapy. This technique is about paying attention to what is present in session as it unfolds from moment to moment for the client and also “in the space between”; that is what is co-created by client and therapist. This could be considered a Gestalt therapy approach. Gestalt therapy was developed by Fritz Perls, Laura Perls and Paul Goodman in the 1940s and 1950s, and focuses on process (what is happening) rather than content (what is said) (Perls et al., 1951). I see the work of Yalom also as sitting in this space, but prioritising what is happening through the interactions between the client-therapist as it occurs. Yalom would particularly ask his patients how they are feeling towards him in the session. Did they feel distant or close? Why might that be? This overt privileging of the relationship and curiosity about the client’s direct experience of their therapist still takes me aback at times, as I wonder how likely it is that health professionals (in Australia) would have such an invitational discussion with clients. That a therapeutic relationship with our clients exists is like an unspoken expectation that we therapists have. But has anyone actually said to a client, “I will build a connection with you and this will be the vehicle of change”? That’s probably too blunt, but more and more I think about what it would be like

Irv who? (Trish)  13

for a client to have both awareness and input into the exploration of the change process through this relationship, rather than it being a discussion clinicians have with each other or in an educational space. My interest in Yalom’s work, which began during my studies, found an on-going relevance as my career developed. I volunteered as a therapist at the Victorian AIDS Council (VAC), now Thorne Harbour Health, in 2006 as part of my Masters in Counselling at La Trobe University and then got a job there, initially co-ordinating the therapeutic groups programme. Group work has always been a strong interest of mine, maybe because of my high school teaching days, when working with groups of students was the primary vehicle for learning. In the years since, I have facilitated many groups for different purposes – social skills groups, parenting groups, anxiety groups and men’s behaviour change groups, to name a few – and I believe it is important for counselling services to offer a group programme wherever possible due to the additional therapeutic benefits they offer. Irvin Yalom in practice

To my delight, the existing structure for the groups programme at the VAC was very much grounded in Yalom’s work in group psychotherapy, as the manager of the Counselling Services programme and other clinical staff there were also strongly influenced by his work. In his book, The Theory and Practice of Group Psychotherapy (Yalom & Leszcz, 2005), Yalom identified 11 therapeutic factors of group therapy, including three that stand out to me: universality, instillation of hope and interpersonal learning. Groups offer participants an experience of “we are all in the same boat,” of not being alone in present suffering. We know how isolating suffering can be. When people gather together and are seen and understood, there is hope for a different reality. I have lost count of the number of times in which a group participant has said something like, “It is such a relief knowing that it is not just me who feels this way.” And then when a group has built trust, great things start to happen. Group members invest not only in their own growth, but that of the other participants. It’s not just about “I can feel/be better.” It becomes “we can feel/be better” and somehow that experience has deep, long-lasting effects. Perhaps the most challenging yet rewarding opportunity that group therapy offers is the space for interpersonal learning. This is where group participants, using the “here and now,” talk to one another about what is unfolding in the group sessions and help one another process how this is indicative of the difficulties they might be having in the “outside world.” One of the first therapeutic groups I co-facilitated at the VAC in 2008 was a group for gay identifying men who were experiencing anxiety. Naturally, the participants brought this anxiety to the group, and it was evident in the interactions between them. I

14  Irv who? (Trish)

remember the brave men of this group, who shared so many stories of fear – of being bullied, of “straight acting,” of being hypervigilant of their surroundings. Gradually, they were willing to “be with” their anxiety in the group setting and work towards a different experience of it. No learning can be more powerful than the one that is alive in the mind and body and is able to be processed as it unfolds in the moment, with others who can witness it with curiosity and support. Years later, in 2018, I was teaching the subject of Group Work as part of the Bachelor of Counselling degree at the Australian College of Applied Psychology (ACAP). I loved the students so much. I’ll never forget them, never stop being grateful for their desire to learn. I was determined to influence this cohort of emerging therapists through a thorough acquaintance with Yalom’s group psychotherapy approach. Gosh, I think they were a bit horrified by some of the video clips I showed them. In particular, a re-enactment of a Yalom style group therapy, in which participants would draw attention to one another’s behaviour in the group, followed by an exploration of how said behaviours might be causing trouble for participants in their lives. I recall one student commenting on the group process and likening it to “throwing one another under the bus.” Of course, we practised group therapy ourselves in this class, and we gently tried out this here and now approach at times while keeping an eye on the road. Perhaps it’s not surprising then that during the process of writing our first article together, I suggested to Dan (the American) that they read Yalom (the other American), given my belief that Americans are more comfortable with these upfront “let’s process what just happened” types of conversations. Also, we were doing our own version of the “here and now” as we put a spotlight on the unfolding process of our therapy together. I remembered one of his books that I read years ago, Every Day Gets a Little Closer (Yalom, 1974/1991), a collaborative writing exercise that not only draws attention to the client’s experience of therapy but also explores Yalom’s belief that they possibly have a different experience to that of the therapist. The book follows approximately a year of therapy in which both Yalom and “Ginny” write their accounts of each therapy session conducted. It revealed much, including how each of them might attach meaning to different aspects of the session as being important, but ultimately that the relationship was a significant one – and that change happened – for them both. Dan did read this book, and another as well, Love’s Executioner and Other Tales of Psychotherapy (1989), stories of Yalom’s therapy with fictitious clients facing a variety of issues. I recall reading the notes that Dan had made in the margin of that book, and feeling unsettled. Some of the notes would be critical of things that Yalom might say or do in session with a client. But what made me uneasy was that when I first read the book, I didn’t see what Dan saw. Yes, that makes sense; I read this book through

Irv who? (Trish)  15

my “giving therapy” eyes, and they read it through the eyes of the receiver. But still. When I looked again, using their eyes, I could see what they meant. As I write this now, something dawns on me. That even with that first step of our collaboration, both reading two of Yalom’s books, we were flattening the hierarchy. In the reading about therapy, in the writing about therapy and in the doing of therapy, Dan and I can have different experiences of the same thing. But it’s in the knowing about these differences that the space comes alive with possibility. Beyond Yalom

In October 2020, at the encouragement of a past ACAP student, I offered an online supervision group for therapists early in their career. I think this was the group I have been waiting for. Here was the opportunity to co-create an expansive, creative and playful learning space in which we could be open to what was needed by those present, with unconditional positive regard (Rogers, 1961). Yes, I wanted it to be a space for clinical reflection, but also for the participants to be curious about the intersectionality of themselves as people with their therapist selves and the selves of their clients. Yalom’s work naturally found its way into this group as well, and what developed organically was the practice of sharing the work of many different writers, musicians and artists, recognising what influenced us then flowed into our work with our clients. 15 July 2021 – group supervision reflection notes

Gabrielle talks about a session she had with her therapist, who is normally very well “held together,” but had recently had a miscarriage and was “raw.” Gabrielle says that this helped her to drop into that raw space; “It’s Ok when my therapist isn’t perfectly put together. In that space it can feel like anything is welcome.” Gabrielle uses her hands to show that when the therapist is “held together” they both might occupy the space as shown by two hands held in a stiff, upright position. The therapy session after the miscarriage is described by Gabrielle holding both hands in a softer, more curved position. This sparks something in Jodee and she mentions a friend who said that it is better to see a therapist rather than a psychologist because the therapist has “a personality.” Her stand-out comment was, “I need to feel the humanness of the person.” Ironically not long after this supervision session, a psychologist joined our group. It encouraged us to be mindful of biases. Therapists (counsellors/ psychotherapists) in Australia often feel like the poor relations in the mental health system, despite our training. The complexities of the system, however, are beyond the scope of this book.

16  Irv who? (Trish)

26 August 2021 – group supervision reflection notes

At the previous group supervision session, Jules reads out a dynamic piece of writing by Dr Shefali Tsabary from her book “A Radical Awakening” (2021). It speaks to women’s empowerment and desire for authenticity and it strongly resonates with the all-female group, who are awe struck by the power of the words. This sharing has a profound effect on the group, and the warmth and connection is palpable – even across the multiple screens that joined us to one another that night. We wonder about other writing we might share, and plan to continue the exploration. A few days later, Dan sends me a podcast they thought I would be interested in – Tara Brach in conversation with Natalie Goldberg (Brach, 2021) about the practice of writing in daily life. I listen to it through headphones, phone attached and in my pocket, as I go about mundane chores, moving from one room to the next with the vacuum cleaner. With the wise and compassionate voice of Goldberg in my ear, I take in the invitation to write every day, just make a start and don’t worry about how the words sound, just do it. And better still, use a pen and paper for that hand/brain connection. Damn! I like to write notes into my phone, so easy to whip it out and quickly capture the thought before it drifts off and gets watered down by all the other thoughts that compete for attention. I put the vacuum cleaner down and post the podcast into my group supervision WhatsApp group, feeling sure they would want to listen as well. And one by one they respond, full of appreciation and wonder, with the request of exploring how we might incorporate writing into our fortnightly group meetings. I pause for a minute and reflect on this flow of influence that ripples outward, beyond even what might be in my current awareness. I think of the offering from Dan, which speaks to their love of writing but also their deep belief in how the sharing of words, ideas and creative spirit is life-affirming. I then pass on this offering to my supervisees, who embrace this spirit with open arms and ask for more. Open arms that create a circle, no clear division between client, teacher, student, mentee. The group meeting that follows is rich with enthusiastic creativity – a haiku, a poem, a few lines from the notes in a phone. Jules, who is a therapist at a boys’ secondary school, tells us about how she is developing the practice of sending an email to a student after a session to draw attention to something that stood out, or to offer an observation about something she saw in him, hoping it might be of use. And often she would get a grateful response or some curious questions. How nice it is for an adolescent to have an adult with no obligatory vested interest in him, take the time to show that he is thought of. That he matters. And he can see it in the words, with his own eyes, read it repeatedly and let it soothe. I am in awe of how we all connect to and affect one another in ever growing circles.

Irv who? (Trish)  17

I get a text message from Jodee later that evening, referring to “your/our beautiful top down/bottom up group.” It soothes me. I read it repeatedly. 23 September 2021 – group supervision reflection notes

Jodee reads a poem that a client wrote (shared by another colleague). It is incredibly beautiful. Gabrielle reads out a poem she wrote earlier that day, inspired by something another group member talked about the time before. It speaks to a collective power and strength. Then Gabrielle remembers a group activity that she did at school, where you create a poem or story together. Someone writes a line of text on a bit of paper and folds it over, passes the paper to the next person, who writes a line, folds it over and passes it on, etc. The result is bound to be amusing nonsense. Hmm … clearly Gabrielle would like us to write together, so I suggest we write a progressive poem. I say that I’ll write a line and email it to someone, who will add a line, then email those two lines to the next person, who will add the next line, etc. Immediate assent. I request a title for this poem, and Karen suggests “Worthiness.” This is an interesting take on how a supervision group writes collaboratively together. I can’t wait to see the result. 7 October 2021 Worthiness

I look in the mirror and glimpse my whole life in my eyes. I know I am the imprint of my ancestors. Because in the lifelong process of becoming, I am a relational outcome. Seeking the wise inner light of my true, timeless Self Being willing to accept all of my imperfections I surrender to what is meant to be and unlimited and bound to none, I run. Tonight we read the collaborative poem that we wrote and each person talked about the line they contributed and their internal processes around it. Ana commented that even though the process was such that she only knew who wrote the line that preceded her own due to the email chain, she could tell who wrote the others because our personalities came through the writing. The session tonight also saw some group members being more vulnerable in the space than usual. Building trust through collaboration. I’m really curious how writing/words can both be a way in and a way of keeping things/people out. At the heart of it all is a story that gets told, for a reason and for an audience. The story can be retold when the time is right.

18  Irv who? (Trish)

Jules (10 October 2021) “Our unity and generosity and our shared vulnerability unlock new insights for me and is so life affirming.” * “Writing with Dan” notes 7 July 2022

I imagine dominoes lined up and the act of tipping over one causes all the others to tip over in suit. The first domino is Dan inviting me to co-write our article (in response to a request from Stephen Andrew, the editor of the PACFA journal Psychotherapy and Counselling Today). Or maybe the first one is sitting in class and hearing my teacher read a piece about love in psychotherapy? What I do know is that my Masters class at La Trobe and my discovery of Irvin Yalom is allowing me to honour what began years ago as I sat with high school students as they revealed their struggles. I didn’t want to fix them for their teachers and parents. I wanted to see them. Tonight in group supervision Jules reads out a Mary Oliver poem called Today (Oliver, 2012) and encourages us to be still in order to access our greatest wisdom. I probably couldn’t have created this group without the writing with Dan, or my love of Yalom. We all have profound impact on one another. Where does it start and end? Does it even matter? The ripple effect

Since becoming a devotee of Yalom’s work, I have bought every new book he releases as soon as I can. In 2009 I attended a huge international conference called The Evolution of Psychotherapy, and Yalom was a keynote speaker. After he gave his presentation, I lined up with hundreds of others to get a book signed. I was clutching Staring at the Sun (Yalom, 2008), stories about therapy with clients who are confronting death. The excitement I felt as I was surrounded by other fans made me think I might as well have been at a rock concert. We were probably better behaved and more sensibly dressed, but still. I spoke with him briefly, told him of the many clients that have been influenced by him because of his influence on me. He has probably heard that countless times. I can’t imagine him getting sick of hearing it, though. In June 2021 I took delivery of Yalom’s latest offering. As I opened the package I couldn’t help but wonder if it could be the last one. This book was different. It was a collaboration with his wife, Marilyn. She had been diagnosed with multiple myeloma in 2019, the very illness that my mother died from in 2017. In this book, A Matter of Death and Life (Yalom & Yalom, 2021), they wrote alternate chapters, and when Marilyn died, Yalom finished the book alone. While Staring at the Sun gave us the stories of courageous clients

Irv who? (Trish)  19

searching for meaning, A Matter of Death and Life is the deeply personal narration of how his life’s work became his own story. Towards the end of the book, Yalom contemplated his work of some years ago, before Marilyn’s death, with “Irene” who was grieving the death of her husband. She complained that he couldn’t really understand her experience, and in her frustration, she tells Yalom that even the shirt he wore told her something about him. “It says, I’ve got all my problems solved. Tell me about yours” (p. 210). There it is. A client experience of the “all-together” therapist, being “smug and cosy” (p. 214) while listening to the one with the problems. On recalling this exchange, Yalom reflected on how important it is to share the lived experience of something with a client, and how it would enrich the work. This spoke to him in contemplating things like timing, depth and extent to which self-disclosure is of use. He has explored this for all of his career, noting that he will not always get it right. He mused that if he saw “Irene” now, the work with her would be different, better – and more genuine (p. 214). I am struck that even in mourning, even in the twilight of his career, Yalom allowed his clients to influence him and show him how to be a better therapist. 23 February 2023 “Writing with Dan” notes

Today the sun shines warmly as summer starts to slip away … but not quite yet. I typically struggle at this time of year, when the mornings are darker and my beloved favourite season lets me know it is on its way out. I think back to November last year, when the light that greeted me in the morning was crisp linen shirt white; brighter and stronger than the yellow hues of today’s offering. But the light is gentle and makes me mellow. On 19 November 2022, sitting at my computer, I reluctantly adjusted the blinds against that white light. My colleague is making commentary at a session of the PACFA on-line Festival of Ideas, sharing an educational philosophy that would be known to many; “the best type of education is where the more you learn the more you realise you don’t know.” Oh god, yes. And also oh no. Often when this knowing presents itself to me, it scares me. And excites me. But maybe it mostly scares me. It demands that I sit with the vulnerability of truly seeing my limitations and the assumptions I make without my own consent. And then I’m aware of the errors that may ensue. It’s that retrospective lens that’s a killer, though. I learn more and use that learning to recall those earlier times of being less aware and I cringe. And then I realise that this will happen to me again. Future learnings will bring future cringes. Yes, this is the best type of education, but what a pity it has to hurt. Mistakes in the therapeutic realm are perhaps better described as a rupture, or a failure to truly understand or attune to the person in front of me. I find these types of errors are much harder to be OK with, as they affect

20  Irv who? (Trish)

the very people I want to help. Why should clients have to experience the less positive parts of my growth and education? This is a tension that I have found hard to resolve over the years. Kottler (2010) reminds me that no matter how hard I try, I will do good therapy and bad therapy. The key take home message is, “just hope you can tell the difference” (p. 139). In recent years, I have found a way to be with this tension more compassionately, which feels important, particularly as I have a responsibility to the less experienced therapists that I supervise, who look to me to guide them in their own learning journey. Sometimes when I uncomfortably take an inventory of things I have said or done in sessions with various clients that pre-date some particular learnings, I shake my head. Like assuming pronouns without asking the client what ones they use, based on what I see. As if this alone gives me the information I need. Cringe. When applying this now, and the reply has a “thanks for asking” attached, I cringe again, but this time it is tempered with the gratitude of learning. Or like letting two people get caught up in unproductive conversations about their relationship for too long in a session, thinking I am learning about “their dynamic.” Yes, but also – they need help to contain this. Cringe. When I think of some of the clients with whom I have made mistakes, I also note that many of them have stayed with me for long term therapy work. Along the way, I know I will have checked in with them from time to time, saying something like, “last week I was not sure if my comment about such and such was quite right. How was that for you?” Yes, it’s a relief to know I do that, but the scary/cringy part is when I don’t realise something might have been rupture-making, and the discussion doesn’t happen. But still, the work goes on. This client-therapist relationship is not different to other, “real life” types in which mistakes are made, there are good times and not such good times, and the process of communicating is so often full of missteps and misunderstandings. Not perfect. Not effortless. Sometimes disappointing. But I won’t stop trying. Conclusion

I love the idea of a therapeutic community in which all the people involved affect one another. Images come to mind, like ripples on a pond or Venn diagrams perhaps. I wonder what it would be like for clients to know that when they participate in therapy, they impact and influence their therapist, who then may internalise something from a session and take that to their own life and the lives of others. What if we all knew about the positive and significant effect we are able to have on others? How we all matter? Maybe things like depression would be less of a thing.

Irv who? (Trish)  21

The other day a client noticed a book on my shelf and asked me about it. It was Becoming Myself (Yalom, 2017). I asked him what made him notice the book. He said that he likes to look at my books when looking at me and me at him becomes a bit intense. And suddenly that title leaped out and he got to wondering how he was also in the process of doing that – becoming himself. I asked him if he had any ideas about how he was doing that. After some thought, he said that he got to understand himself through his relationships with his friends, his partner and family. He then said he probably needed to talk to me about his relationship with his mother – it really needed some attention. I told him that it was so interesting that he should choose Yalom’s memoir to rest his eyes on. “His work has influenced me a lot,” I said. “He is all about how our relationships with others reveal ourselves. And also – he had to do quite a bit of work around his relationship with his mother!” My client says, “Hmm, I might have to read that book.”

2 UNSTABLE SENSE OF SELF (Dan)

Writing prompt #3: BPD hundreds

African American scholar and poet Emily Bernard created a writing practice called “100-Word Collective” in 2009. Writers have used a 100-word limit to meditate on or amplify the resonance of things that happen in the rhythm of our encounters with other people, objects, ideas and worlds. For example, here’s a 100-word entry on the topic of distress tolerance: Sometimes. Things go along just fine and then. Then the kids cry, or the dog barks, or the phone rings, or someone walks out on me. It comes with a force like a jet plane overhead, only its inside me. Don’t see it coming but then I’m left in the jetstream. I’m at 110% before I know it: heart racing, throat constricted, stomach churning, head pounding. This is BPD. I try to remember my distress tolerance skills: STOP. TIPP. Radical acceptance. I count my breath. Sloooooow. Ice face. Pause. Observe. Count. Sprint. Willing hands. In this pause I return to my senses. Dan’s first experiences of Yalom 23 November 2020

Dan:

I’ve been reading Yalom’s Love’s Executioner. I’m enjoying it as a book and I’m enjoying it as a window of sorts into Trish. There is so much more of the therapist in this one, understandably, than in A Dialogue on Love (Sedgwick, 1999). It’s interesting to see his investment in Ginny. I have never thought about my therapists’

DOI: 10.4324/9781003268161-3

Unstable sense of self (Dan)  23

investments in me, only mine in them. I think of them as concerned with keeping me away, at a professional distance, with boundary maintenance. But then, isn’t patient transference with therapists also pathologised to some degree? I’ve been a bit horrified at how Yalom comments so often on Ginny’s appearance, her looking “pretty” or not, etc. I wonder if that’s about me, or it’s about this text being 45 years old. And it’s interesting that he talks about his potential attraction to and care for her, in the writing, but not face to face. And then the first time he reviews their journals, he says he edits his and feels anxious. All of that is interesting but I don’t think gets processed in the session, because, presumably, it is Ginny’s session, so he keeps the focus on her. But isn’t that an example of unequal power relations, not “fellow travellers”? Her feelings and actions come under scrutiny between them; his don’t. I wonder about the ethics of Yalom telling Ginny he’ll treat her for free if she writes about their sessions, and admits that he did hope to publish them even from the beginning. And that he thinks that his experiment will help her get back to her writing? It seems a bit patronising and manipulative, given that is not a goal stated by Ginny herself. I’m not liking him very much yet (about halfway through) and wonder if that’s a reaction I’m having to the idea of seeing a 3-dimensional therapist and whether I will have that reaction to Trish at some point. Do I resent the idea of Trish (or any therapist) having personal motives, desires, preferences, or manipulating me, even for my own good? I have had the opposite with Trish so far in our writing: seeing her have excitement, gratification, perhaps some longheld desire coming to fruition. This has all been gratifying for me, has made her feel more real to me. I don’t feel resentment about that. I’ve also been wondering if Trish knows the books by M. Scott Peck that were popular in the 1970s–80s: The Road Less Travelled (1978/2002) and People of the Lie (1983). My mother turned me onto them when I was young and they are saturated with Christian ideology, but they were also fascinating to me, mostly because I wanted to become a therapist. Of course, reading the blurbs now – at this age and in light of my diagnosis – horrifies me with examples like this: “Peck describes his encounters during psychiatric therapy with patients who are not merely ill but manifestly evil, and forces us to recognise that, without spiritual or religious dimension, psychiatry cannot claim to understand human nature.” Wow. I would hate to think of my therapist talking about me as “manifestly evil,” but I’m sure many of those working with borderlines do just that, as is well-documented in the literature. For me, being diagnosed with borderline personality disorder (BPD) unlocked many roads to freedom, not just in the mental health category.

24  Unstable sense of self (Dan)

And yet, these links remain some of the trickiest terrain to explore. I think those within the mental health field, and especially in the lived experience of BPD world, do understand. But not always as much in the wider community. How to share these links with the reader? When I was diagnosed, there was a predictable shock, shame, grief. Confusion. I did not believe the difficult things that had happened to me in my childhood and young adulthood were legitimate examples of “trauma,” in a clinical sense. Strangely, this was the hardest part for me to accept. I suppose I had spent a lifetime minimising my own experiences in order to live with what had happened. But I also had a persistent feeling of victimisation, of persecution at times, so I would have expected a clinical diagnosis of legitimate trauma would have been vindicating for me; it wasn’t. Adoption, sexual abuse, violence in my family of origin over many years in my youth, rape, sibling suicide, parental mental illness, the list went on. But in my mind, as perhaps others have experienced, these were just difficult things that had happened to me, but not as bad as many others have experienced. It took a long time for my health care providers’ affirmations that these indeed constituted deep trauma to sink in. I came to see how my feelings about – and coping mechanisms in response to – these traumas were playing out in my difficult behaviours and feelings. Once I started to accept that I did have BPD, and that in some part it wasn’t my fault, self-compassion started to seep in. Slowly but surely. And with that self-compassion, my self-impression started to change, and with it my self-esteem. I went from feeling like a failure to someone who had probably exceeded my expectations, given what I’d suffered. One psychiatrist told me that most of the other clients he had seen with my level of trauma were either dead or institutionalised. That was sobering. I went from feeling constant shame and disappointment, to feeling like everything now was “gravy.” I was tired of performing. I was tired of trying to please, trying to win love. When I was finally able to lift my eyes off the ground and dry the tears, I looked around and thought that everything now is for me. Whoever “me” was. I had done my time for others – my mother, my friends, lovers, employers. Whatever time I had left was for me. And then the desire to actually make a gender transition started to flood in. Nobody wants to go around making connections between our gender affirmation transition and mental illness though, right? After all, that’s the stereotype: if you want to be another gender or someone other than you are, you must be unstable. And an “unstable sense of self” is one of the nine diagnostic criteria of BPD. But in reality, the mental health field does it for us. Beyond the inclusion of gender dysphoria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), contemporary psychiatric assessments are still required for access to gender affirmation surgery, at least here in Australia and I believe in most countries where gender transition medical assistance

Unstable sense of self (Dan)  25

is available. In my case, it was with a psychiatrist I had been seeing for some time, for my BPD. He was not licensed to assess me for the WPATH requirement in Australia, so he referred me to a friend of his, a psychiatrist who has been doing these assessments for more than 25 years, and a gay man himself. And yet. I went to see Quinan Diamond (not his real name) and thought it would be a rubber stamp consult. He even insinuated as much in his “this is just a hurdle, so bothersome” pre-assessment patter with me. He was operating out of the same rooms at a private hospital where I’d done life-saving dialectical behaviour therapy (DBT). His waiting list, I was to discover, was more than 18 months and I only got to see him because my psych asked him. And still. Despite debunking all the schedule of questions that remain focused on a kind of lifelong (or at least extremely extended) experience of masculinity, he still (apologetically, conspiratorially) asked me about whether I had these feelings as a child: did I want to pee standing up? (yes, dammit). Did I want to go around without my shirt on, like boys (who wouldn’t?). Did I feel comfortable wearing dresses (oh god no). Did I prefer to do traditionally boy things (play with “boys” toys, do things boys were allowed to do, etc.). Again, resentfully, I had to say yes with the caveat that many of these were things “tomboys” or other country girls like myself also wanted to do. I questioned these questions, and I resented them, just as I had the “boys” things when I was a child. Why were they boys’ things, anyway? While I felt resentful that I shouldn’t need to have felt this wish to be more male my whole life to be “legitimate,” I also had to admit I had been feeling most of these things for as long as I could remember. And yet. Once he finished, he read me back his letter to the surgeon, which in some universe was perceived as respectful and kind and consultative, but for me it was humiliating. He mentioned that he saw me at the request of his colleague, my usual psychiatrist. He mentioned that, despite the fact that I have BPD and have been treated for it in recent times, he did not see this gender dysphoria (yes, they still call it that) to be a symptom of the “unstable personality disorder” that accompanies BPD. How humiliating. Yes, it matters to me that I was at that time a 55-year-old professor at a major university. Yes, it matters that I’m a grown up person with capitalist accomplishments. What does it take to be an “adult” in the eyes of the mental health system? Why, in the 21st century, can women who want an exaggerated breast enlargement or face augmentation be able to walk into a plastic surgery clinic on their lunch hour and get these procedures, but a “woman” who wants a breast removal cannot? It’s insane. That is not to suggest that even young people, or old people, with no social capital, should not be able to just claim what they want if they are able to pay for it (this is not even touching the public health funding debate). We remain second class citizens. Then add to that any degree of mental ill health – and why wouldn’t we have, in this

26  Unstable sense of self (Dan)

heteronormative global culture? – and we are even more precarious subjects. It’s deeply invalidating, and rarely spoken of outside of queer and trans communities. And yet, on that afternoon, the humiliation was short-lived, but I secured the letter needed to get my top surgery, and that was all that mattered. So how could a BPD diagnosis be a gateway into being able to come out as trans? Part of it is the “let go of living for everyone else” bit above, but also – importantly – part of it is the BPD symptom of personality shattering, that same “unstable sense of self.” I began to wonder if it might be a portal to greater awakening, not just to crisis. While it feels risky to articulate this link, for me it feels related in a beautiful, positive and fascinating way. * These and other issues were safe for me to discuss in my sessions with Trish, given our long history and the trust factor that had been established. When I was first diagnosed, Trish helped me find appropriate services and treatments, partly through other clients she had worked with who presented with BPD. When there were no immediate openings in DBT, I enrolled in a Schema therapy group, which lasted for most of that first year. I was still seeing Trish then, weekly or fortnightly. But once I found a spot in a DBT programme the following year, it became very time-intensive. Even with my flexible academic schedule, I felt like I was doing full-time therapy. The DBT centred around a 4-hour session every Monday, then a one-on-one session for an hour later in the week. I also had DBT homework to complete before the next session. And I frequently got together with other borderlines between sessions. I was learning a lot, but also at times mentally and emotionally exhausted from all the work. Soon after that, the COVID pandemic hit and Melbourne began the longest lockdown in the world. All of these conditions contributed to Trish and I shifting our sessions to online. Then, when I was invited to write an article on autoethnography and therapy, I asked Trish if she’d consider writing it with me. For a time, we co-wrote into a Google document, and used that writing in our sessions as well as our articles. Before long, however, we both recognised a natural shift. That shift in the relationship gradually led to us discontinuing therapy but growing our collaborative writing. 14 April 2021

Today’s therapy session was so different. I felt way more clearly and powerfully the shift to the focusing on “us” and how that is both incredibly personal and intimate as Yalom says, but also always about what I (we) do in our outside relationships. And because I’m the client, I’ll focus on me (but isn’t the point to focus more on “us” now?). Trish was brave today, in a way that made an invitation for me to potentially focus on her, but which feels simultaneously

Unstable sense of self (Dan)  27

like an opportunity for me to stay with myself and my reactions to the transference/countertransference and how I handle these kinds of things in the outside world. Always hard for me but today I showed up and we worked through some tricky things, and I didn’t feel dysregulated and I don’t now. That is a win. Although I can feel myself moving into the space of worrying about Trish – was she ok after the session? – and reminding myself that she is perfectly capable of looking after herself and seeking support, and that my job is to focus really on me. It is interesting to watch my mind do its weird summersaults in these new conditions. We wonder whether it is important that both of us have investment (and/or skills) in this creative form. For example, if a client were willing but not skilled, how would that be? Or if it were not publishable? It is a powerful space of mutual risk, and of course the discussion of “mutual” is new. So today we experimented with establishing some “rules” or “guidelines,” to assist in the shift in roles/relationship: 1 Time limits on talking (like, I only talk for 5 or 10 minutes straight and then throw to Trish to talk, not ask questions) 2 We talked a lot about truth-claims and whether getting to a/the “truth” about things is necessary for the writing. We both agree that lying might be ok. LOL 3 We both agree that if we are lying, we have to admit it (but not necessarily say the truth, because the truth might be too hard) 4 We begin and end each session with one new comment of validation for each other. I wonder whether (or to what extent) Trish and I are involved in a kind of fusion as described by Yalom, which he describes as “the softening of one’s boundaries, the melting into another” (1989, p. xix). How does this fit with the “black and white thinking” that can accompany BPD? I struggle with binaries more than she does, I suspect. Ironic, given my non-binary subjectivity. I struggle with rigid categorising such as Trish as therapist/me as client, her as “straight,” me as “gay,” and why that should even matter anyway. And yet, last night on This Is Us, Randall’s white female therapist provokes him about why he has come specifically to her, who is a different race and age than him, but the same as his mother – and suggests that in his selection he is trying to work out something about his mother. I laughed out loud when she said, “The number of black males coming to me is a very small number,” and I remembered so many conversations about this with Trish, about the “natural” inclination to seek out those like us, or different from us for a reason. Trish’s allyship is powerful, but is it the same as seeking out a queer therapist? Trish seems to hate the idea of being seen as “other.” I guess we all do.

28  Unstable sense of self (Dan)

Trish and I continue to work online as the first of six lockdowns (totalling 246 days) begins. As others experienced, our lives moved online and we stayed home, at times only allowed out for 1–2 hours of exercise per day and not beyond a 5-kilometre radius. Apart from my partner, Stacy, and our dogs, I saw no one in person for that entire time. It was frequently lonely, but it was also peaceful. My DBT classes and one-on-one DBT treatment also moved online. I liked it but not everyone did. I also had more time to immerse myself in a number of social media groups of those with BPD, as well as those who were gender transitioning. There is a lot of discussion in BPD groups about the value versus cost of being diagnosed. One recent post echoed my own feelings: There is something quite “profound” in knowing. It often is the first step toward healing. It will open doors that will help you understand who you are as a person, your past wounds but more importantly opens the door for you to live a life that you were always meant to live. Acknowledgement is key, accepting that not everything in the past makes sense and finding the will to let go. Digging in deep, to educate yourself, to put in the hard work, TO WANT better for yourself. It is all very doable, yes with a lot of setbacks along the way. But with awareness comes hope, and with hope you let go of hopelessness. It can only be good for you. I wish you the very best. This exchange moves me deeply. It perfectly describes my process with my BPD diagnosis. The long-term therapy relationship that lays the foundations for acceptance of this difficult truth; the questions about what labels give and don’t give, or even take; the reassurance of another BPDer that with truth comes hope and that hope is everything. The power of information, acceptance, hard work and hope. I love this kind of post, and it’s why I continue my participation in a number of online BPD social media groups. It reminds me constantly what a liberation that hard, hard diagnosis was, and how much has changed for the better since then. * Always the ethnographer, one of the first things I did to make sense of my experience of living with BPD was get university ethics, and put out a call in my online groups for anyone interested in being interviewed. Ten people said yes, from a range of demographics. I was interested in hearing humorous stories about their lived experience, not more of the “horror show” stories that immediately come up when searching BPD in online search engines. I wanted to see if there was another side to this disorder. Flash forward:

Unstable sense of self (Dan)  29

All the rage 9 December 2021

Theatreworks (a local Melbourne theatre) had its 2022 season launch a couple of weeks ago. It was so thrilling to see my play in the mix – a first for me in a long, long time. Such a visceral experience, making theatre. It’s one of those things that I want to write in boring minute detail, but the adrenaline that surges through me the minute I say the word is impatient with prosaic descriptions, metaphors, similes. It’s an atmosphere, a movement of the guts. A rushing of the blood, a quickening. Here my creativity researcher and playwright collide in the intersection of BPD and DBT and psychotherapy and love. There are, I have found over and over again, never words for the most profound of experiences. It has often pushed me to ask, then, what’s the good of words at all? But there is goodness in words. Power. It’s not one or the other; it’s the both/and that keeps cycling back in my life these days. So they launched the season, and my play, All the Rage, in its slightly tacky neon pinks and disco ball glory, seemed to fit right in. I felt no imposter syndrome for once. I didn’t wish for a different cast, a different theatre and a different me. I was in the moment, and the moment was glorious. The play will be part of the mainstage season for a week in late June, early July 2022. It’s been a long wait – since my 20s really for a mainstage production – and it feels great. The Artistic Director of the theatre wrote a week ago to say that now that she was feeling confident about what the play was, and how it fits into their world, did I want to add another week to the run? I felt validated, proud. It felt like a vote of confidence, not just a programming hole that needed filling! I’ll take it. I asked my friend Louise and she was hesitant. “I mean, that’s great,” she gushed before an ever-so-slight pause. “But do you think you could fill the theatre for two weeks? I mean, that’s a long time.” Is it, I thought? Is two weeks a long time really? In a small theatre like that, with what, maybe 80–100 seats? Breathe in, breathe out. Breathe in for a count of four, breathe out to a count of six to engage the parasympathetic nervous system and de-escalate. I sigh. Maybe so. Maybe it’s asking for trouble. Maybe this is one of those Icarus and Daedalus moments – don’t fly too close to the sun, son. We never learn. That night, I wonder about Louise’s response. Did she mean that the play maybe wasn’t good enough to sell out two weeks? Or was she talking about a play – any play – about BPD being too – what? – specialised? Weird? Not universal enough to appeal to the common person? This is exactly what my playwriting career in my 20s was like. Everyone loved the work but really, plays about working class dykes were not going to sell out any theatres. Can’t you write about something else? My agent asked. Straight love story perhaps?

30  Unstable sense of self (Dan)

Just change the gender of one of them, what’s the big deal? How about a spec script for “ER” or “Ally McBeal” instead of this dark shit all the time. They want to hire you! Just give them something they can work with. Breathe in, count four. Breathe out, count six. Every person who has worked for any amount of time in the arts knows about the phenomenon of crossover successes. These are stories that are essentially not mainstream stories, but told in such a way that the universal aspects are able to touch a wide audience and bring them that most soughtafter of commodities: a reassuring sense of “this is me” while at the same time feeling like they’ve discovered something completely fresh and new. Think Fun Home – the first lesbian-protagonist story on Broadway. There are a lot of reasons why that musical has set worldwide records and is beloved by all, and it’s not really because it’s about a lesbian. Or take Hannah Gadsby: we don’t love her because of autism. That was a bonus! It made her even more “fresh.” It’s a fine balancing act, and one that I’ve never got quite right if I’m honest. The impulse to write a funny play about borderline personality disorder was, I’ll just say it, a good idea. That part is fresh. People want to be able to laugh about a scary mental illness, both those of us with it, and those who don’t have it. Tick. But it’s also a little bit of a lie, right? Like Hannah Gadsby’s hook being her self-liberation from the self-loathing awkward lesbian material she traded on for years – saying she was done made us love her. Wow, what a risk! But coming back subverts that. Are we still as impressed, just because the structure was clever? It’s still satisfying, sure, but the magic is a little bit faded. So a funny play about BPD that never really gets as dark as the disorder? Not sure what I think about that. Not sure what I think about my dramaturg’s injunction not to alienate the audience, although I know she’s right of course. But the whole suffering of BPD is that we DO alienate our audiences, repeatedly! So isn’t it just a little bit like making a film about a sympathetic mass murderer? Sure, everyone’s got a loveable side, but what’s the point in loving a mass murderer? I can see I’m heading down an unproductive comparative road. I think I’ll go to bed. That production of All the Rage was cancelled due to rolling lockdowns in Melbourne throughout 2021. Instead, we made lemonade out of lemons by doing an online creative development to at least progress the play. Director, dramaturg, two actors and a sound designer. All fabulously talented, nice and excited about the work. Still, it was hard to let go of the stage production. It’s just postponed, we told ourselves. The video of the online creative development of the play was shared with about 110 attendees at an annual personality disorders conference in October 2021, hosted by the excellent Project Air centre at the University of Wollongong, a world leader in personality disorders research. They liked it. They said it was “funny and moving.” There were only two critiques that

Unstable sense of self (Dan)  31

were voiced on the day: both were from people with lived experience. One said the line “I’ll cut you!” was going too far (although admittedly cutting is mainly of the self-cutting variety in this disorder, but I didn’t want to split hairs). The second was another lived experience person (I refuse to use the term “consumer”) who is also closely affiliated with the centre, doing her Masters in Social Work there. She wrote in the chat, “please remember that this is only one person’s perspective on a very complex mental illness. If anyone needs support please inbox xxxx.” I took offence, just for something completely different. I responded that it wasn’t actually one person’s view, given it was based on ten interviews. But that wasn’t really the point, even I could see that. I’ve been in this situation so many times over the past 35 years, in Q&As about lesbian plays, African American characters I have written, South Sudanese Australians, queer Australians, queer youth, adoptees, you name it. I’m drawn to the stories of minoritarian, marginalised and usually oppressed groups and individuals, because I either belong or identify with them. My whole life has been filled with the work of bringing these stories to life. Yet even when it is the story of someone “like me,” or even ME, yes me myself, people object. They mistake an invented character as a symbol, a representative or representation of a whole group or culture. Is it they who imbue these characters with added meaning, or I? I have also spent a lot of time writing against representation, especially in performative research. But it doesn’t matter. Because when one writes from a position of privilege, including as a paid researcher employed at a university, those characters take on a broader representative meaning almost by themselves. Is this based on the history of scholarly research and its truth-claims, or just that any character – especially minority ones – imbued with the weight of its former invisibility? Take, for example, the first trans character played by a trans actress on Orange is the New Black – Laverne Cox playing Sophia. Cox was raked over the coals about which trans folks do and don’t get seen on mainstream television. So perhaps it’s just a human response to a dearth of representation. So what does this mean for the commercial potential of All the Rage? Arts based researchers have discussed these multiple demands for more than a decade. Ultimately, the work must be creatively strong enough to stand for itself in an artistic or commercial context, while at the same time the research which underpins it must be ethically sound enough to stand up to research interrogation. It’s kind of like the feminism of scholarly research: what appears to be a liberation of research from its social science traditional bounds is actually the construction of an unachieveably high new benchmark. Women can become CEOs now, sure, but so far still have to have the children and most often provide primary care. Arts based research outputs like All the Rage similarly have to do it all, or fail at both.

32  Unstable sense of self (Dan)

Conclusion

What started out as a cataclysmic event for me personally (the BPD diagnosis) was soon overshadowed by the global cataclysm of the COVID-19 pandemic. It’s impossible still, now in May of 2023, to talk about the pandemic as “over.” Most are beginning to realise it will never be over, in that we have been irrevocably changed. In many ways, for me, those changes have been overwhelmingly positive. Now that my DBT treatment has ended, I still maintain a rigorous daily schedule of immersion in the DBT skills and mindfulness meditation. Since ending therapy with Trish, I have not started with another one-on-one therapist, but I know it’s there when and if I need to. The play still hasn’t been produced, but I haven’t given up, and each time it is shared informally, people love it. My gender transitioning experience continues. All of these waves rise and fall as time goes on, and I have developed better skills to deal with those waves and the great big ocean of life, whether the sea is choppy or calm.

Dialogue 1 HOW DO WE DEFINE COLLABORATIVE WRITING?

Defining collaborative writing

Trish:

Dan:



Dan, so what do we mean when we say collaborative writing? Does it have to be writing with each other, or can it be writing to each other? Or can it be considered more broadly, including things like one-way writing about collaborative sessions? This is an interesting question Trish, and one (in my view) that is framed by disciplinary considerations. There are different ways of responding to it, whether you are coming from psychotherapeutic, autoethnographic, narrative writing or creative writing perspectives. One entry point might be the work of Jane Speedy, who is both an academic and narrative therapist. Her 2017 book Narrative inquiry and psychotherapy offer many responses to your questions. For example, Speedy offers, “My own interest in narrative research is very much as a collaborative co-inquirer, first in relation to the problems that have come to overshadow and shape peoples’ lives, and secondly in terms of re-telling these stories in writing” (2017, p. 61). Further, she defines “meaning-making as collaborative activities and ‘reality’ as the space between people engaged in conversation” (p. 16).   There is no hard and fast rule. It can mean a wide range of things, but if it is “collaborative,” I think there has to be that element of working together, not just reporting to each other what we have done individually or independently. For example, you have described using writing with other clients in which they write to you things between sessions. If you read those works and then you DOI: 10.4324/9781003268161-4

34  How do we define collaborative writing?

Trish:

Dan:

Trish:

work on the content in their session, I would not consider that collaborative writing. If you both read your writings to each other, and change each other in that exchange, then for me that’s moving into the realm of collaborative. Or maybe, more accurately, that would be considered “interdependent” writing! Yalom falls somewhere in there, I think. While I appreciate the efficacy of those approaches, and the many diverse ways in which writing is used in art therapy, I’m more interested in the mutuality of what we have done together. That to me is the “radical” bit: how can one part of a pair (the client) be helped by the therapist’s trained knowledge, through a multidirectional exchange that requires vulnerability and sharing from both sides? That’s truly collaboration. Ah yes, I like what you are saying here. It makes me think about our writing process, particularly for this book, and the different ways we worked together. What about when we recorded a Zoom chat and then converted the conversation to text? Didn’t seem to make a heap of sense on the page. Technology at fault, surely! Our writing sessions were more productive – 45 mins of writing, screens off (I wonder if your dogs are at your feet?) and then sharing what we had written after. You had always written about three times as much as me, the words pouring out of you, capturing your experience so evocatively. But for me it is slow work, as if I have to coax out reluctant words that are not sure whether they should show up in case they don’t get along together when they arrive on the page, despite my pleading! I remember telling you about my writing imposter syndrome, saying that there are so many great (much better) writers out there, what do I think I’m doing? And you said something like there is room for lots of writers to be out there. That was so helpful to me. Trish, what difference does it make to co-write for publication, rather than just as a therapeutic tool (and does that mean they have to be good writers)? The first question I ask myself whenever I write something is, “who is the audience?” This to me is fundamental in shaping the purpose of the words. Using writing as a therapeutic tool has its focus in deepening the shared understanding of the issues being explored in sessions. It is endlessly provoking in the material it continues to throw up. I am writing with a client at the moment, and the face to face sessions are so enlivened by the picking up of the threads of the email exchange, once they have also been through the reflective cycle. This client uses visual imagery to great effect in her writing, which I love and respond to. She says she loves how I capture and summarise her therapeutic journey

How do we define collaborative writing?  35

so clearly. But this co-creation is done with little thought to skill or form, it is just about an illustration of our process that continues to build connection. But if a client/therapist pair are writing for publication, they are allowing others into the intimate space of therapy because they believe that what they have to say will be of benefit to others. It could raise feelings of vulnerability when imagining what are usually confidential words reaching the eyes of an unknown audience. I think if therapy writing is to be published, it would be important that the client and therapist can write well enough to convey meaning, create interest and inspire the audience (gulp!). The ethics of this issue is also touched on in Dialogue 3.

When narratives meet

We wonder how might therapist narratives and different parts of them enter the space and connect with the narratives/parts of the client? We argue that the meeting point/s of these narratives can be a catalyst for change in both the client and therapist. As Speedy states, collaborative writing between therapist and client, researcher and researched, can “take issue with the low- and highground positions in relation to ‘writing’ and ‘research’… and to promote and encourage ideas of scholarship (alongside research) within the therapeutic domain as collaborative …” (p. 145). This problematisation of the unequal power dynamic that typically haunts both kinds of engagement is at the heart of this book. Dan:



Collaborative writing doesn’t have to be of equal investment. Clients are looking for witnessing more than a therapist would. They don’t need the writing to witness/reflect them. It’s okay that what the client gets out of it is different from what the therapist gets out of it. Narrative therapy tells us that what a lot of the therapeutic work does, written or not, is bearing witness to someone’s pain or joy or hardship. Validating. It takes the experience from being in one’s psyche to being made real in “real life.” Validating the difficulty of an experience.   But what allowed Trish to accept that invitation? What allowed her to become playful in ways that I experienced as deeper, more or different than in the room? We agree there is something alchemical in the movement of being in, stepping out, looking. This is both a feeling, and also is materially shown spatially by the text and the comments down the side. We were doing that together. It wasn’t just Trish going to supervision and thinking about the therapeutic work.

36  How do we define collaborative writing?





Trish:





It felt like there was a collaboration going on around what was going on. There was a shared analysis of what we were doing. Some therapeutic models absolutely flatten the hierarchy: the therapist is not there to tell the client what it “means,” or what to do.   What did it feel like for Trish? You don’t often get a client doing that. Reflecting on the last session, or the work, or where this was helpful – you invite it, but it doesn’t happen a lot. Therapists spend a lot of time wondering if techniques work, or not. We have talked a lot about the tendency of therapists to workshop these questions with one another, but less so with clients. How would you know if something worked, if you didn’t ask the client?   This collaborative process speaks to something deeper in Trish, rather than therapist Trish. She doesn’t want to assume or believe things if they’re wrong. She wants to know. This kind of dynamic has been a long-term struggle for her, so the explicitness of the conversation in the writing (of the first article) really jazzed her because “the dialogue is open.” You get to know, understand, no matter how hard it is; so much better than wondering. We think that’s why Yalom did that exchange of, ‘I’ll write my version and you write yours.’ He talks about how there are some moments he thinks are pivotal successes, but then the clients debunk that. What I have particularly enjoyed in the collaborative writing with you Dan, is the energy I felt when reading something you had written. I would then have a rush of ideas and start making connections – with things we had talked about in the past, with things that were happening in my life, or questions I wanted to ask you or other clients. And then in writing a response, something would click in me about my own journey in finding myself. The writing constantly challenged my self-perceptions.   May 2023: I have been reading your chapter Unstable Sense of Self. So many emotions came up for me. And then the anger came. People don’t see. People think they know better. And because of this you have to endure the experience of the deep knowing that comes from a life’s work of amazing youness being minimised, whether it is by psychiatrists or dramaturgs. God, who doesn’t want a play that makes you laugh and scares you shitless at the same time?   I am reminded of a pathetic little story of mine, but I’ll offer it up, anyway. I was about 9 or 10 years old and it was the school sports carnival, one of my favourite days of the year. There must have been about 30 of us in this sprint race – the starting line went for ages. I was at the far end of the line up, furthest away from the group of judges, my father being amongst them. I won by a mile, but I

How do we define collaborative writing?  37

was missed crossing the line, and so the second place getter was awarded first and third awarded second, and so on. I tried to be heard, to tell people I won. My mother and grandmother who were watching told my father to do something. He didn’t. My knowing fell on deaf ears. Fifty years later my anger bubbles up. Let’s maintain the rage, Dan. It’s got to serve us somewhere, some time. 29 November 2020: ‘Taking charge’ as collaborators and as client/therapist

Trish:

Dan: Trish:

I’m interested in the idea that as a therapist, I might have personal motives, desires and preferences. When I was studying for my counselling qualification we were drilled with the maxims of “do no harm” and “the clients’ needs are paramount” and that there in fact can be no personal gain for therapists. It is easy to understand this in the context of, say, not allowing a client to arrange to get you the best table at the restaurant they happen to work at, or free tickets to a concert through their connections. So what about our writing together? You are right about a long-held desire coming to fruition. Not that I haven’t already written, having had three other articles published and many letters to The Age newspaper! The fact that the experience of writing our article has been so positive for both of us equally has felt like a relief. I have been thinking about how it might be for you to feel like my desire to write creates an obligation for you to meet this need. So it seems like the arrangement is that I can meet your needs, but if you meet mine, there is an ethical problem. And yet you say that to see my excitement and investment is gratifying for you, and you don’t resent it. Not yet, anyway. I wonder what might happen to make you resent it? I can’t imagine that. I feel that we entered into this mutually – in fact, I suggested it. Dan, I knew you wrote for a living and I remember when your email came through, suggesting we co-author an article about the process of arriving at the diagnosis of Borderline Personality Disorder (or BPD). A light inside me flicked on. Can this be something clients and therapists do together? Something about our therapeutic relationship suggested that it could work. Those many hours of therapy built trust, and this would allow for a story to be told – not just from one perspective (be that client or therapist) but from both. We did due diligence around ethics (spoke to the editor of the PACFA journal, my supervisor and even the CEO of PACFA). Green light given. The writing allowed for a stretching, bending,

38  How do we define collaborative writing?

Dan:

Trish:

Dan:

flexing and reworking of traditional client/counsellor dynamics and enhanced the work in possibly unexpected ways. We tried writing separately, as Yalom and his client “Ginny” do in his book Everyday Gets a Little Closer (1974/1991). But eventually we returned to co-authoring in a shared Google doc that has a satisfying interactivity and vibrancy. The fluidity of being able to write into the same document, and comment on each other’s and our own writing as we go, seems to form a big part of the “energy” of this new kind of shared work. (Harris & Thompson, 2021b). It also calls to mind the important work done by Wyatt et al. (2018), who have offered an overview and history of collaborative writing (CW) in general, one that might be helpful to readers who are wondering how collaborative writing might be distinct from collaborative autoethnography, for example, or from narrative therapy, as we’ve discussed elsewhere in this book. I often think that the client-therapist relationship resists a definition that truly lands, no matter how hard we might try. An intimate partnership that grows and deepens over time, though it does not find representation in photo albums, social media posts or at family dinners. But this relationship can be in existence one day, and not the next. When the therapy ends, chances are the client and therapist will not ever meet again. All that sharing, all that caring comes to an end when the decision is made that the work has been completed. The relationship is very contextual though; I know that people want to experience their therapist in a different ways, whether that be as a person who will ultimately tell them what to do, or as someone who will help them feel differently about themselves. As a person-centred therapist, I know I resist taking on the role of the “expert.” Clients are experts of their own lives and I am there to hold the torch in a good spot so they can see more clearly what’s up ahead and choose the path. I’m interested in what “expert” means to you. I love your ethos, but I also want to challenge you on your unwillingness to hold a position of power or expertness in the room or in this relationship. For example, when I was a teacher, I tried to do the same thing, but the students resisted it. They WANTED a parent/expert/person in charge. We were taught that it makes them feel safe. Maybe this is the same for the client in your rooms, inviting clients into agency and power and self-determination and collaboration is one thing, but eschewing power or control altogether may be a bit disingenuous? I’m interested in what kinds of feelings it gives you to be “in charge” and how you relate to those feelings and where they come from.

How do we define collaborative writing?  39

30 November 2020

Trish:



Trish:

I have to respond to some pressing client issues in the next few days, so may not get back to writing till Wednesday, but I wanted to respond to this comment, as it is wonderfully provoking. I did not say I was unwilling to hold a position of power in the room, just unwilling to label myself “the expert.” I am very aware of holding power and in fact recognise it goes with the territory. We are trained to understand this, and I think it is only in recognising it that you can be mindful of not abusing it. There are times I will be directive with clients, and even strongly suggest what should happen next. I agree that so often clients want to sink into the feeling of being held and directed by someone more powerful than them. I have also had the experience of wanting that myself as a client, from my own therapist. I am very interested in the power dynamics between client and therapist and think there is much we can write about and explore here. I note that you feel rebellious when Yalom uses his power in a paternalistic way and it makes me wonder if that has anything to do with him inhabiting the role of “expert” to the extent that it takes the client into an infantile space. I know he doesn’t want to do that, but maybe that also goes with the territory of being a white male of his time and circumstance.   So for me, what I reject about the expert stance is creating a vibe that puts me in a position of being “all knowing” and bestowing the answers from a superior position, creating some idea of the client having a deficit that I will “fix.” I have training, experience and skill which allows me the authority to occupy this role and do the work. I love the question around what “being in charge” means to me. I have often thought I am more comfortable with a second in charge role. I know I have leadership skills, have often been told that, and have also been in a number of leadership positions over my career. But as the youngest of four siblings (by a long shot) and older parents, I could never have been the “expert,” or “in charge” in a million years! You said to me that as a result of our writing the article together, you felt you trusted me more. Initially I think I assumed that the trusting me more was about the fact that the writing went smoothly, and that nothing went wrong. Then I wondered about what it might have been like for you to read about my experiences of you as a client and to see my care in the words I offered. Not only that I wanted so much for you to be happy and fulfilled in your life, but that I saw you as vital and full of life. But now I am

40  How do we define collaborative writing?



Dan:

wondering more about the process we engaged in to produce the article. There was a spark that was ignited as we poured what was in our minds and hearts into the document. You would write something and it would create a flash of an idea in me, and then a rush of energy in trying to capture it in words. I think the same might have happened for you. There was a synergy that I don’t know we could have predicted, but maybe it was not so surprising, given the successful therapeutic space that we have created.   We have been exploring the issue of the power dynamic in the client-therapist relationship. It is a strange beast because it seems like it is both needed and rebelled against simultaneously. Sometimes as a client you want me to take the reins and show you the way, and at other times you are aware that as you bare your life to me, I keep mine under wraps. You step into a vulnerable space and I have a boundary that keeps me safe. And I want to offer support and guidance but reject labels like “expert” and get cosy with terms like “fellow travellers.” Did our writing together even the score? For in that space I saw you as the authority and looked to you to have the answers on how the work would come together. I completely trusted that you would take us to where we needed to be with this piece. Did you knowing that I trusted you result in you trusting me even more? Trish, I’m feeling the resonances of this co-authoring work with you in other places in my life. At the time of this writing, I’m also co-writing a chapter with one of my doctoral students, and cosupervisor, Julia and Elise. The chapter is using autoethnography to explore how our relationship changed during lockdown. Julia, the student, is talking about how previously she was trapped in a perfectionist student persona that didn’t allow her to share her mental health challenges, but through COVID, widespread attention to each other’s mental health in general, and us as supervisors sharing our own mental health challenges (to a degree), she has been freed to be “imperfect” and more open, thereby allowing a richer supervisory relationship. Sound familiar? In a material way, we even saw into each other’s homes through our online video sessions. A snippet, reminiscent of our conversations here:

Importantly, this turn to the personal and emotional in the context of the pandemic and consequent reduced hierarchies does not undermine Dan and Elise’s roles as supervisors, including as intellectual guides, advisors,

How do we define collaborative writing?  41

and supporters; on the contrary, it creates a culture of care that enables Julia to further develop as a researcher by generating an ecology of empathic collaboration which fosters curiosity, connection, understandings, confidence, risk-taking, and expressivity. (2022, p. 192) I love the resonances of this work we are doing as it truly does echo out into the other parts of my life. What happens underneath “what happens”?

Dan and Trish: Y  alom and many others teach some foundational tenets: that the therapeutic relationship is a microcosm of outside life. That whatever occurs between them, the focus and benefit must always be on the client, not the therapist. Yet Yalom also says therapists should let clients affect them, challenge them, even change them. For him, therapists must honestly and rigorously examine what it is they are bringing to this. So here we ask ourselves from both the client and therapist perspectives: Can/should we go beyond the Yalom client-centred writing, and if so, for what purpose? These questions are informed by our enquiry into the potential risks and ethical considerations identified in our creative collaboration, a challenge we have continuously held at the forefront throughout our practice together and throughout this book. Our boundaries required constant negotiation and adjustment. The foundations of our current questions in this section are underpinned by our discussions of how those risks were processed, and resolved. For example, sometimes our writing in our shared documents veered toward the therapeutic. In one case, Dan wrote about a dream they had had about Trish, and once we started to discuss it, we both realised it felt like it had crossed a line into the “therapy” space. We acknowledged it, and moved back into a more shared enquiry.   Always in relation to these questions, we wonder together about the mystery of the therapeutic encounter. What happens, and what happens underneath “what happens”? Common factors theory (Browne et al., 2021) suggests that the most important influence on therapeutic change is the strength of the alliance between therapist and client. Looking beyond technique and intervention (the old-school referents of mechanistic schools of psychotherapy), we instead

42  How do we define collaborative writing?

look at what happened in the room with the two of us, and what has changed during and after the process of our collaborative experience as client and therapist. The power of dialogue

Dan: Trish:

Hey Trish, What do you call a homeless horse with Borderline Personality Disorder? Unstable. (Harris & Thompson 2021b)



Trish:

Dan:

Dan:

Trish:

  We both love to laugh, and humour was there in the room but burst out even more unrestrained once we were “on the page.” It opened up new areas of exploration and trust, and helped us both relax a little as well, while we explored this new relationship. We started co-writing online during the 2020 Melbourne lockdown, while maintaining fortnightly therapy sessions, as face-to-face sessions had been prohibited by home isolation, and the humour was there from the beginning. Yalom (2002) talks about the therapeutic relationship between client and counsellor as being one of “fellow travellers,” So when you share your life with me, in all of its realness, I want you to experience the humanity that connects us to one another. And so over the years, we’ve built a strong alliance, one in which talking about disorders hasn’t really figured (Harris & Thompson, 2020). Hey Dan! How many psychotherapists does it take to change a light bulb? Probably just one, as long as they take responsibility for their own change. This could be called having “a light bulb moment” (Harris & Thompson, 2021b). “We wonder together: what if we were writing a novel instead, or painting a picture? We’re writing about our therapy, not something else, so it reinforces the therapeutic relationship. We reflect on the fact that Trish is also a teacher and practice supervisor, and in those roles she encourages her students to be prepared to walk the talk, to consider the ethics of asking clients to go further than they’ll go themselves” (Harris & Thompson, 2021b). We use many of the suggestions Yalom offers for calling attention to the bond between client and therapist including: doing process checks, inquiring about the state of the encounter during the session, me asking if Dan has questions for me. Through creative collaboration, the trusting here and now becomes multi-modal and multi-directional in ways that can offer new forms of corrective emotional experience (2021b).

How do we define collaborative writing?  43

Collaboration extends to co-presenting

Dan:

In May 2021, we were invited to co-present on our collaborative creative work at an art therapists conference near Melbourne, on the beautiful Morning Peninsula. We were well-prepared, drawing on our three already-published articles together, and having rehearsed. We were excited for the day. But the night before, I had this dream:

Dan’s dream: So we show up at Inverloch but arrive late for some reason – just before our session. We are getting ready and I have to go to the bathroom and we are both fussing around and Carla is getting impatient. All the participants are sitting at their tables, waiting for our “performance” to begin. I take out my script but it’s not the right one – a previous draft. I ask you if you have yours and basically we just spend a lot of time fussing around and you tell me I can read off yours, and then you say I can use your computer, etc., but all these versions of the script are wrong. Things are getting tense. The audience impatient. Finally, I say to you to just follow me. I start improvising, narrating that I don’t have the right script and narrating what we are going through out loud. Then I start blaming you – your script isn’t right either. Why don’t you know your script isn’t right? What are we going to do. You start laughing. I say “don’t laugh out of nervousness, we need to do our show for these people.” It’s funnier than it sounds here. The audience is not sure what to think. Eventually we do a series of audible asides and morph into a full blown “fight,” where we move around the room and then up to a semi-private space still in view of the participants. By now we are arguing about the performance, and you are telling me I’m projecting and that this is the problem with doing stand up with your client! The audience start to wander away, into the dining room for their meal, and we realise we need to re-engage them by asking for their help. I woke up and realised that we could perform therapist-client and that it might be funny but also instructive in a “‘show-not-tell” kind of way. I also remembered that I had done this with a student teacher in one of my first university classes. We pulled a prank where I went into class first and started complaining loudly about the teacher not being there, being late and got the students kind of riled up, and then when Nick arrived we were all difficult to control. He did some expert redirecting, and when it was finally calm, I would go up to the front of the room and say I was the lecturer and they always loved it.

44  How do we define collaborative writing?

Trish:

Dan:

Trish:

I remember you telling me about this dream on the drive to Inverloch. I thought it was hilarious and it got me imagining what we could do after we do the collaborative writing gig. We should so do stand up comedy! I mean how great would that be, telling insider therapy jokes and making people laugh and cry. Did I tell you that on the drive? I can’t remember if I said it or just thought it. And we had a great experience presenting to this gathering of arts therapists, who were familiar and comfortable with our methods, but also affirmed the radicalness of the reciprocity of our approach. It’s challenging and at times risky work. Work that’s asked us both in different ways to re-examine the power of letting go: letting go of what we thought we were good at, who we thought we were … but the rewards are a powerful experience that is changing our self-awareness as both client and therapist. We have used a number of other writers in our shared work, including the meditation master and psychologist Tara Brach, and one of her favourite poets, yoga practitioner Danna Faulds. We ended our workshop with the arts therapists with the following poem by Faulds, called LET IT GO:

Dan: “Let go of the ways you thought life would unfold, the holding of plans or dreams or expectations, Let it all go. Save your strength to swim with the tide. Trish: The choice to fight what is here before you now will only result in struggle, fear, and desperate attempts to flee from the very energy you long for. Dan: Let go. Let it all go and flow with the grace that washes through your days whether you received it gently or with all your quills raised to defend against invaders. Trish: Take this on faith: the mind may never find the explanations that it seeks, but you will move forward nonetheless. Dan: Let go, and the wave’s crest will carry you to unknown shores, beyond your wildest dreams or destinations. Trish: Let it all go and find the place of rest and peace Dan: and certain transformation. (Faulds, 2002)

3 A FINE BALANCE (TRISH)

Writing prompt #4

Imagine that in your dream you could have a one-on-one meeting with the true inner-you: your subconscious. You can ask this inner-you any questions you want to find out about your identity, your desires and your destiny. What questions do you ask and how does your subconscious respond?

25 October 2021

I had a dream last night – I am at mum and dad’s, and mum is setting the table as she is expecting visitors. Dad is in the other room watching television. Mum says to me that she is feeling that there isn’t enough Trish around and she is emotional and teary. I hug her and say, “I miss you too.” I feel mum’s vulnerability in a way I never have before and respond emotionally – I feel so close to her. The hug in the dream feels real and visceral. I feel her need of me. It brings up my own vulnerability as well. The dream suddenly speaks to the therapist me. Can there be more Trish in the therapy room?

14 January 2022 “Writing with Dan” notes

I have a memory. I am sitting in my supervisor’s office, maybe it was a few months after my father died and nearly a year after mum’s death. I have a wave of emotion, a kind of desperation, a recognition of a dull but perpetual

DOI: 10.4324/9781003268161-5

46  A fine balance (Trish)

kind of suffering that I wanted – no, needed – to shift. “Something has to change,” I think to myself. But what the “something” is, feels elusive … In the beginning

The act of psychotherapy, particularly in person-centred traditions, is considered a relational, co-created experience, grounded in the theory that anxiety and other forms of human suffering can be understood in the context of interpersonal relationships (Klerman et al., 1984; Rogers, 1961; Sullivan, 1968; Teyber & Holmes McClure, 2011; Yalom, 2002). I recall the early days of starting my Master of Counselling at La Trobe University in Melbourne in 2006. I had spent 7 years as a high school teacher and later 10 years as a school counsellor at a large co-educational secondary school in Melbourne’s northern suburbs. It’s tough being a client of counselling at a school. Often the goal in referring students to the school counsellor is about fixing something (or them). But many of the students that I have worked with over the years selfreferred, and really wanted space to sit with someone who cared about them, as opposed to whether they were passing their subjects or pleasing their parents and teachers. They had stories to tell that needed to be heard and understood. Sitting and listening to my teachers in the Masters talk about the importance of the therapeutic relationship (Duncan et al., 2010) was an incredible experience. Finally, there were words for how I wanted to work: to really see the person in front of me and be with them in the vulnerable space; and what’s more I was being given permission to do it. Once again, Yalom speaks to my experience: “Mourning is the price we pay for having the courage to love others” (Yalom, 2021, n.p.). My first experience of having counselling myself was after my sister Pauline died. She was born with a “hole in her heart,” as it was described back then. My parents were determined that she would live life to the full and so she did. Until she had a heart attack at home on a warm spring day. She was 25, and I was 18 and at university. I don’t remember who called an ambulance but it took forever to come. All was chaos and I tried to revive her myself, with only a sketchy knowledge of CPR, from who knows where. And I will never forget her eyes. They told me she was gone and nothing could be done. Even if help had arrived in five minutes, nothing could be done. It took years for that to sink in, though. About 6 months later, I knew I wasn’t managing well when I failed an English essay. It was always my favourite subject! What did this mean? It’s funny that this was what made me recognise I needed support, rather than the knowledge that I felt lonely, isolated, fearful, despairing, and that I believed I couldn’t talk to anyone in my family, who were all grieving themselves. The

A fine balance (Trish)  47

university counsellor offered me a safe space to unburden myself of the guilt of being a sibling that was still living. 6 October 2021 notes from webinar: Loss, grief and how it can manifest in the body

There is no evidence that there are stages of grief. There are a range of emotions and a movement of backwards and forwards, in and out rather than a linear movement. Telling the story helps to accept and process the loss and to embody the grief experience. Grief doesn’t shrink, we grow around it. Our bodies somatize grief. There is nervous system arousal and the immune system can be suppressed. In grief counselling, therapists can co-regulate with clients with their own bodies, using deep breathing and tone of voice. We need to use our bodies in the grieving process – in moving, writing, painting, singing. “Pain lives in the flesh as well as in words,” (Gleeson, 2021). Telling the story

​​ client Jennifer (not her real name) looks at me, but finds it hard to meet my My gaze while trying not to cry. “I’ve got too much work, I just have to get over this,” she said. Her mother died in April. Ok. That means our mothers had been dead for 2 months. They had probably never crossed paths, my mother and hers, and yet here they are with us in the same room. I hope my mother isn’t listening. “What’s your plan for getting over this?” I ask her. She responds quickly, “Well that’s what I am here for, why I need your help.” Grief: such an inconvenient emotion. It hides in the corners of any old room, like even in a room that you’ve never been in before. And when your back is turned, it creeps out and stands behind you. You feel its breath on your neck, and you shiver as the goose bumps form on your skin. Have I got the energy to feel this right now? Do I have a choice? Life insists on going on, despite a declaration that this couldn’t be possible not so long ago. I think of W.H Auden’s poem Stop All the Clocks (Auden, 2010). Yeah right, that didn’t happen. But what an enticing thought, some hidden-away pocket of time and space that could be occupied for a while, and just let grief flow like some kind of rich indulgence. Is grief a luxury, not an entitlement? “Jennifer, can you tell me what you would like to do with your grief?” I ask. She goes on to tell me that she knows that it is sad to lose her mother but that she is afraid that she won’t be able to work efficiently if the grief takes too long. If she could just get through it, then things could get back to normal.

48  A fine balance (Trish)

And my grief? I didn’t want to just get through it. I wanted to feel every agonising moment. But could I do that and still work effectively with my clients? We shared that worry, Jennifer and I. Can we still function if we are unexpectedly tapped on the shoulder by grief, wanting to tell us something suddenly remembered? * I am sitting on the ottoman in Mum and Dad’s room at their aged care facility. Mum is in her chair and feeding some treats to my dog Pepper. Pepper is my therapy dog, much loved by clients. The residents here love him too. Dad has one eye on the television and one eye on us. We are all in our happy places for that moment in time. Mum and I are talking about old times and the conversation turns to my sister. Mum says, “I didn’t realise how hard it must have been for you when Pauline died.” Oh, this longed for conversation. Why didn’t it happen years ago? I don’t care, it’s happening now, and a weight falls away from me. The gift of those words, given not long before Mum died, infuses the sadness with a kind of out of focus, hazy gratitude. I grasp it and press it to my chest but it pierces my skin all the while, as I take a painful breath. Ah yes. Grief. * I say to Jennifer, “Well grief has a lot of different emotions attached to it. I guess it’s a process and I’m not sure how well we can force ourselves to get through it. (Am I saying ‘we’ right now?) Would it help to know a bit about the grief process? I have something you could read.” “That would be great, I’d like that,” she says. Jennifer and I have had a few sessions now. I am getting to know her mother. She doesn’t know mine. Her mother had just retired and was looking forward to a new phase of her life. It was not to be. My mother was granted the gift of all phases of life, including the one which tells you that “this age” and “this living” could be incompatible, especially with cancer in the mix. And in this room, Jennifer and I face our grief, in different ways. Or maybe not. “Jennifer, I feel like I should tell you something. My mother also died in April. She had multiple myeloma. Given what we are talking about I thought you should know.” Jennifer looks at me directly and nods her head. * I’m trying to get Mum to move from the chair into the hospital bed. She looks exhausted and I’m hoping she will be more comfortable in the bed and sleep. She can’t settle, so instead we decide to get her into the wheelchair and

A fine balance (Trish)  49

walk the corridors of the hospital ward. Mum seems to find the movement comforting, for a while at least. I feel vaguely useful, wheeling her around, and the staff say hello, and ask how we are. There are signs of life all around us, every person we see has a reason to be there, every object has a purpose, except I wish that clock would find some other wall to hang on. If we keep walking, if we keep talking, will life go on? “Trish, can we go back now?” she asks. We go back to her room, and Mum wants to sit in the chair again. I try again to suggest she rest in bed, but she is adamant and gets agitated. “No, I don’t want to lay down!” “Why not Mum?” “I’m frightened.” “What is it? Why are you frightened?” “I’m afraid if I lay down, I’ll die.” I wonder how much she understands what is happening. What do I understand? She hasn’t eaten for days. The hospital staff is using words like “hospice” and “palliative care.” And yet we hope that somehow life will find a way to continue. But I can’t do this hope thing anymore, I’m exhausted. “Let me get into that bed, if you won’t,” I think. I always thought Dad would die first. Mum and Dad seem to take it in turns as to who is in more need of medical care and attention. Maybe that’s because he is 3 years older than mum, and he’s had a number of small strokes, dementia and heart failure. I think she assumed the same. I remember how tired she felt sometimes by the constant demands of caring for dad. I think part of her yearned for some time to be free of that responsibility. Just to be quiet for some extended period of time, to lose herself in whatever captured her attention. Mum has always been the one who “cared” in the family. It’s a role she relished, and it was one that she linked definitively to her gender and roles as wife and mother. But she wanted some peace in the sun, she told me once. To just wander off somewhere without checking the time, and thinking she should get back. By then she had been “caring” for my father for over 67 years. And then she was diagnosed with multiple myeloma. It stayed low level for a while, until it wasn’t. She had treatment, and for a couple of years she wasn’t too bad. Mum and Dad moved into an aged care facility in February 2016 and settled in quickly. They made friends and loved all the staff, who loved them back. I imagine Mum relished finally getting a turn at being looked after on a daily basis. She enjoyed expressing her gratitude about this care she received. She had her favourite carers, had a secret stash of lollies, chocolates and little bags of chips that she would slip into the hands of those who tended to her. So her “family” grew and her love found many homes. *

50  A fine balance (Trish)

“Trish, help me go to the toilet,” Mum says. My sisters and I are sitting with mum in the hospital room, knowing that a move to the palliative care hospice is probably just days away. I don’t remember when she last ate. She has been aggressive with the nurses, demanding that she be ordered a taxi and sent home, or else she would yell the place down. Then she did. I wonder about the place she conjures in her mind when she thinks of “home.” Maybe it’s not a place but a feeling: warm, easy and comfortable. Home is nowhere to be found right now. She has been put on an antipsychotic drug to help her distress, but she is still distressed; we are all distressed. “Ok, come on then Mum, let’s use the walker.” When we get to the bathroom, she just ignores the toilet. She grabs my hand and lowers her voice, drawing me into a plan she seems to have come up with. “Trish, you have to get me out of here. I need to go home,” she says to me. “Mum, you aren’t well, you need to be in the hospital,” I tell her. “Come on, Trish. You’re my baby. We won’t tell the others, we’ll just go. Please help me, I don’t want to be here.” The urgency of her words hit home and I find myself contemplating this possibility. Guiltily I recall my belief that Dad would die before Mum, and that I would get some time to have the non-carer, free and relaxed mother to myself. We would do things together – coffee and scones were high on this list – and we would be the babies of the family together, both the fourth born children, both much younger than our siblings. We knew what it could be like, but this knowing didn’t often find words. And here we were, but I sure didn’t imagine this conspiratorial time would actually take place in a hospital bathroom. I wonder if we could get an Uber without detection? I pull the “older siblings will be cross” card and say, “Mum, there is no way Karon and Cathy would let us go. Dad wouldn’t either. You need to be looked after in the hospital.” Her look of bitter disappointment feels unbearable to me. * It’s only a matter of time now. Mum has been moved to the hospice. I tell a few clients that my mother is seriously ill. They are the ones for whom I have to reschedule appointments in the next few days. They need a reason, and I want to be honest about it. But surely the clients I will be seeing in a week or two don’t need to know anything yet. Thank goodness we are heading into Easter, and I can have a run of days that I don’t have to account for. I feel anxious about the impact of Mum’s deterioration and probable death on my diary of appointments. There is a confused tension in my mind and I feel it in my chest. This feels messed up. Of course I need to take time away from work, I need to be with this impending loss, to give it space. But my clients

A fine balance (Trish)  51

have appointments. Their names in my diary stand for trauma, heartache, loneliness, despair, fragility. Or could that be me? Mum died on Good Friday. I think she would have actually liked that fact. She was in a number of church choirs and singing groups over the years, and the Easter service was always her favourite. The choir inhabited a mezzanine type space at the back of the church we attended when I was a kid. I used to love going up there with her, and watching the proceedings of mass from above, while being close to her as she sang. I have additional memories of sitting below in the pews, and hearing her voice ring out from on high. I could pick her voice out from the rest, a pure soprano, strong and true. Surprising perhaps, given her rapidly deteriorating hearing loss, which was well on the way even back then. The family spends the day with Mum at the hospice, sitting by her bed, keeping vigil. She is heavily sedated because of her level of distress. Does she know we are here? One of the hospice staff (the nice one) says that hearing is the last sense to go, so we should talk to her. We don’t know what that means for someone who can’t hear well at the best of times (did she have her cochlear implant in?). So we talk, we hold her hand and we don’t know what to make of any of it. When does life become not living? I bring to mind a client, one whom I had been seeing as she faced the final years of her partner’s cancer diagnosis. She was telling me how she sat with him as he endured his last hours. He seemed to hang on, she said. It dawned on her that she needed to set him free, so he could just stop. So she told him that it was OK, she would be fine and that he could die. And so he did, not long after that. 9 February 2022: A fine balance

I remember that fear I had of how my grief felt like a threat to my work. And while I knew I wanted to accept and feel my grief, I was still concerned about the possible negative impact it might have on my work with clients. But was it that, really? Maybe it was more about some idea that my clients needed to experience me as one hundred percent available for them; that there was nothing in my life that would detract from the importance of what was going on in theirs. I bring back the dilemma that I ran through in my mind when my mother was dying. Would I tell some clients, all clients, any clients? If I wasn’t due to see a client for a couple of weeks after the funeral, I wouldn’t need to mention anything, would I? They would have no reason to know. I notice a panicky feeling in the pit of my stomach as I write this now. Seeing myself as not giving an inch – I will grieve and I will suffer, but I will not bring any of this to my clients. I will stretch myself as far as it takes… except I can’t do it. It seems so at odds with my desire to be an open and authentic therapist, to be human and a “fellow traveller.” Well, it would seem that I am happy to be a fellow traveller as long as I can be “on top” of my own difficult emotions. Or as long as clients don’t see

52  A fine balance (Trish)

that vulnerability in me. Because if they do, then what? Will they think I’m not up to it? That I can’t help them? I’m no good to them? Harsh words. It strikes me that there is such a fine balance between the self you bring that is real, alive, attuned to the emotions present (no matter to whom they belong) and the self that is the “role,” the one who carries out the task that is required on the day. How we as therapists constantly walk along this line. I have written in an earlier piece with Dan, that I imagine myself walking a tightrope and carrying one of those long poles. What does the pole represent? I imagine the pole leaning to one side, and then the other, and me as a tightrope walker traversing that unsteady and thin piece of wire. But the pole is flexible and creates the balance, allowing for a flow between states of being within; as I move from empathy and joining to a “being there for” and responding. When I was awash with grief, I think I lost sight of this balance. I thought I was walking the tightrope unaided. It wasn’t about whether I needed time off or not, or how much, after Mum’s death, and later, Dad’s. It was the pressure I was putting on myself to do my work and thinking I had to keep my grief in a firmly locked box, outside of the therapy room. This view of myself comes almost as a shock; it makes me feel sad that I could believe that my clients needed protection from very human, genuine grieving. That I didn’t trust that I could hold the space even though I was actually doing it speaks to how out of touch we can be with what is going on right before our eyes. It was that self-inflicted pressure which led to that “something needs to change” moment, not the grief itself. * Jennifer is telling me that she thinks it will take a year for her to recover from her mother’s death. I wonder where she gets that time frame from? I am reminded of times past, when people wore black for a year after a family member’s death. Maybe there is something to the creation of some arbitrary period of time to fit grief into. Here is the season to miss and yearn and despair and to feel like nothing can be the same again. And when that is done, the colourful clothes come out and the world opens up again. If only it could be so straightforward. “And so what will this year look like, Jennifer?” I ask her. She thinks she will find it hard to want to do her usual activities. She is worried about how to look after her grandmother because her mother did so much of that. But mostly she is worried about her job. She is in such a highly pressured position with so many people relying on her. When I ask her if she can work fewer hours, if she can delegate, if she can put some boundaries in place, if she can prioritise seeing friends, the answer is no. I tell myself later that I would hate to be putting so much pressure on myself at a time like this. Oh, the irony. *

A fine balance (Trish)  53

Dad died just over 6 months after mum. In the months after mum’s death, my sisters and I would sit with him and worry for him. We didn’t know how to help him. His grief was the quiet despair of someone trying not to put anyone out. He just cooperated with his carers, did what he was told, had his meals and lost interest in anything other than watching TV. Well, it was on, I’m not sure he was watching. Not long before the end, I got a call in the middle of the night from a staff member at the aged care. She said that dad wasn’t feeling well and was asking for his daughters to come. Before I hung up to get on my way there, she said, “I think I should tell you that your dad has been asking for something to let him die, but I have told him we can’t do that.” While it didn’t surprise me exactly, hearing it felt devastating. My sisters and I stayed the night with him, watched over him, and a few weeks later, on 10 November 2017, he died. When I think back to that time, I don’t know how any of us got through it. I didn’t know where I was at with my grief for mum. I didn’t know how to start all over again with mourning dad. I didn’t know what to do with any of it. But I think I was softening around the edges. In the days before dad died, I told a client my father was very ill and I couldn’t see her. She told me to take my time. I messaged a client on the morning of dad’s death and told him I had to cancel because my father had just died. His message back was warm and caring and he told me he knew what it was like, he had been through it too. I felt a rush of relief, as I welcomed his offering. Losing Pepper

Pepper died in August 2020, just as we were about to go into a long Melbourne lockdown during the pandemic. He started his therapy dog career when he was only a few months old. I was working with some Indigenous young people and wanted to find a safer way for them to feel able to talk, recognising the understandable barrier of my white middle-aged privilege. Pepper was the bridge I was looking for. Over time he became a fixture in my therapy rooms, both in community organisations and private practice, and he offered his calm, loving and empathic presence for 14 years. I could even send him down the hallway by himself to collect clients from the waiting room. I think that was a highlight for all of us. Because therapy sessions were online for so much of 2020, my clients were spared from seeing his deterioration. He kept rallying though until the last couple of days when he couldn’t really leave his bed without help, and it was clear the time had come. The vet who looked after Pepper from puppyhood helped us with this precious moment of stopping his life, despite the complications of COVID and social distancing. And here finally was a grief that was shared in its fullest with my clients, who needed to grieve him too. Tears were shed and stories were told. Dan

54  A fine balance (Trish)

and I hadn’t started writing together at that point, but I remember their sadness and empathy when I told them the news. Being a dog lover themselves, Dan always greeted Pepper so enthusiastically when they arrived for sessions. Actually most clients would greet Pepper before me when they arrived, and then be apologetic about it. But I loved it. The other day, a couple I saw some years ago came back to do a bit more work. When they arrived, they looked around the room, and then looked at me, crestfallen. “Oh, no,” they managed. “Yes,” I replied. Nothing else needed to be said. I am grateful that I still have clients who had therapy in “the time of Pepper.” We can remember him and miss him together. He gave so much love. Rogers would be proud of his perfect display of unconditional positive regard. 28 March 2023 “Writing with Dan” notes

Yesterday I had a session with a client, the one that I am doing the “let’s watch this show/movie and talk about it” therapy. A close friend of hers had committed suicide and her mother died within a couple of years of one another, when she was in her early 20s. The anniversary of her mother’s death was a few days ago. We talked about how these significant losses in her young adult life affected her; she spoke of “lost years,” where just coping put her life on hold. I told her that I was 18 when a death affected me in that way. We agreed that the experience was one of feeling utterly lost. For her it was more like “not dying” rather than “living.” For me it was not knowing what to do with the life I still had. We also noted that things just changed over time. No great epiphany. We were just living again. Conclusion

I sometimes wonder if I helped Jennifer much. When I think about it now, I can see that she was able to tell the story and have a place for her conflicted feelings. She came back to see me a few years later, in order to work through a decision she was facing in her career. When she made the appointment with me, I wondered if there was some unfinished business around grief we would be attending to, but no. Our mothers died in April 2017. This fact remains and is something we share, Jennifer and me. And the client who told her partner that he could die? I attended his funeral at her request. I was part of the journey, she told me. It was important to her that I was there. It really tells me that grief is better shared, not endured alone. And that my own grief has a place in the therapy room. I don’t have to be “strong,” and in fact that is not the message I want to give. I wish our society was better at seeing grief as not something to get over or get through, but an integral part of the human experience that can connect us, not separate us.

4 LETTING GO (DAN)

Writing prompt #5: BPD as a room of my life

This is a list poem built from the “ingredients” list below. Begin by developing your ingredients by responding to the following prompts: 1 2 3 4 5 6 7 8

the person who “gets” you (don’t write the name, just describe them) a loved object from when you were small a person or place you love(d) a person or place you fear(ed) the sweetest thing someone ever said to you an object that reminds you of the person who said these words what you do when you’re nervous a place where you feel safe

Consider BPD as a “room in your life.” Begin your poem with a line from Anne Sexton’s poem, Here in the Room of My Life: “Here, in the room of my life” Continue from this line, considering how your experience of BPD is a space/takes up space in your life. Include everything from the ingredients list in your poem. What would #1 be doing? Where would the person in #5 be standing in this room? Where would #6 be positioned in the room? Would it be on the dining table? Stuffed into a drawer? Which object or person in the list is doing #7 now?

DOI: 10.4324/9781003268161-6

56  Letting go (Dan)

Collaborative autoethnography

The art and practice of writing together shares many similarities with solo authoring, yet presents unique challenges. The very process of negotiating the specifics of a co-authored piece of writing – whether an essay, a poem, a book or something else altogether – is distinct from the skills needed to write well, and in some cases (like this one) to write a cohesive, extended work. Some scholars have written about these methodological challenges explicitly (Chang, 2013; Chang et al., 2016; Lapadat, 2017), while others continue to use this approach under other names, including duoethnography (Norris et al., 2012; Sawyer & Norris, 2015), and collective autoethnography (Fixsen, 2021; Liggins et al., 2013; Wężniejewska et al., 2020; Kidd & Finlayson, 2010). Lapadat (2017) also points out that: In addition to approaches that have involved a group of researchers working together, several approaches include just two (or perhaps three) researchers dialogically co-constructing autoethnographic research. These have been labelled variously as autoethnographic conversations, co-constructed (auto) ethnographies, co-constructed narratives, collaborative writing, duoethnographies, ethnographic memoirs, interactive interviews, layered accounts, and polyvocal texts (Berry & Patti, 2015; Chang et al., 2013; Denzin, 2014; Ellis, 2007b; Ellis et al., 2011; Ellis & Rawicki, 2013). There also are a host of labels and gradations of method describing the inclusion of an autoethnographic component in research primarily focused on the stories of others. (p. 591) Others have written about the ethics of autoethnographic storytelling as a “porous self” in which one’s own story inevitably includes that of others’, others who may or may not have given consent to be included (Tolich, 2010). In this book, we have considered such ethical concerns as especially pertinent in mental health research. For us, methodological texts like this one do not seek to be prescriptive. Collaborative autoethnography alone has come a long way through its intersection with posthumanism towards going beyond singular notions of the “self” in considering the limits of the “auto” (Harris et al., 2022; Holman Jones & Harris, 2018; Iosefo et al., 2020). Like best practice in psychotherapeutic work, good autoethnography seeks to offer a “fellow traveller” experience to readers, rather than offering some predetermined advice for unpredictable situations and relationships in which readers may find themselves. Chang (2013) first popularised the term collaborative autoethnography, and defined it as a qualitative research method that combines autobiographic self-study with ethnographic interrogation of the social, political and cultural landscape within which the co-authors are situated. Importantly, it demands

Letting go (Dan)  57

that the co-authors interact dialogically to analyse the “data” at hand, although some foundational autoethnographic scholars reject this more social science approach to the evocative power and relational process of doing autoethnography. Lapadat addresses the relational ethics of using autoethnography, particularly in relation to the strengths of collaborative autoethnography: These include issues that arise from the enactment of relational ethics; researcher vulnerability; the problems of existing within a bureaucratic framework designed to accommodate value-free ethics; degree of rigor; a risk of leaning toward self-indulgence, superficiality, and sensationalism; and restriction of scope. (p. 602) Lapadat (2017) and Chang et al. (2013) claim that collaborative autoethnography is more rigorous than individual autoethnography, given the multiple perspectives on both the autobiographical and ethnographic cultural data, and that individual autoethnography often suffers from being “too close” to the material. This social scientific approach which includes traditional analysis represents one approach to autoethnographic methods, but not all. This is, in essence, a positivist approach that supposes objective or nearer-toobjectivity research is possible, and preferable. Many autoethnographers – and we – reject this approach. While we agree that multiple voices strengthen ethnographic research and therapeutic narratives, and that “working with collaborators who are situated within a community beyond the university may push the research to move beyond description to action” (Lapadat, 2017, p. 593), we value the power of autoethnographic accounts to carry their own affective impacts both within and outside of the academy; such is the very reason for the rapid uptake of creative and auto-methodologies over the past 30 years. Further, we agree with Lapadat (2017) that “collaborative autoethnography is a powerful method of team building as it enhances trusting relationships among co-researchers, provides for deep listening or witnessing, promotes creativity, and offers collegial feedback and mentorship” (p. 602), all urgently needed benefits in today’s academy and therapeutic spaces alike. Autoethnography, evocative storytelling and psychotherapy

I’m reading the recently released Reimagining Narrative Therapy Through Practice Stories and Autoethnography (Heath et al., 2022). The voice in some of the stories remind a bit of Yalom’s: the older male therapist who is coaxing along these confused unhappy people. He gets to be such a daddy (which is not necessarily a bad thing). I’m wondering if there is a

58  Letting go (Dan)

kind of feminist or queer perspective that our approach brings to this work (Holman Jones & Harris, 2018), the less hierarchical approach that Trish is always seeking, and the ethics behind how we are attempting to extend both autoethnography and psychotherapeutic practice, even Yalom’s notion of “fellow travellers.” Their book, however, makes the excellent point that narrative and storytelling in therapy have a long history, going back at least to Milton Erickson (1991), and his writing of “practice stories,” and how Epston (Epston & White, 1995) used these in some ways as the basis for his development of narrative therapy. One main distinction, however, between these tales and our collaborative writing, is that we break the tradition (including Yalom’s mostly) of the tales being told in the therapist’s monologic voice. For us, it is the multivocal experience that promises a fuller evocative picture of the practice described, as well as a truer sense of its efficacy. At most, much of the previous work around narrative and other “practice tales” involves reflective conversations between health practitioners, but not with clients or others’ patients. So as Trish often asks, “How can we even be sure our strategies are working, if we don’t hear back from the clients?” As Epston concedes, these stories are “markedly one-sided.” We acknowledge, however, what Epston recounts in their book, of his first encounter with Michael White who was then – 1981 – the editor of the Australian Family Therapy Journal and who accepted Epston’s practice tale for publication, despite its more subjective approach than what was then (and is largely still) the “objectivity” – preferred norm. It is remarkable to see how little progress, in some ways, has been made in the last 40+ years in this regard, notwithstanding the growing popularity of arts therapies, and other forms of narrative and dialogic therapy. Epston does some synthesising work in his chapters (as we try to do in this book) between ethnography and psychotherapy, in drawing on the anthropologist Ruth Behar, and the phenomenologist Max van Maanen, two academics. Their book makes the point that the stories must be evocative, like autoethnography, to have true impact or what Epston calls lasting power. Epston recalls Michael White’s (2007) question of whether narrative therapy might be a “therapy of literary merit” and I would claim the same is true of autoethnography in the academic field. As recently as 2018, Epston was publishing journal special issues (Journal of Systemic Therapies, for example) on what he calls the “exemplary practice tales” genre. For us, an important contribution of this book is how we bring together autoethnography (or, evocative tales within/for academic contexts and fellow travellers) with evocative tales within/for the therapeutic communities and fellow travellers. We are mindful that different contexts mean different conversations, sometimes different language, and often different goals. But the impact and value can be equally powerful, and the work of the

Letting go (Dan)  59

modern academy is to have demonstrable impact in “the real world,” or the world outside of academe. * 17 August 2021 It’s been about a year now, Trish reminds me, since I asked her to write that first article with me. It’s been a transformative year in many ways, and this collaborative writing seems to be representative of it, or at least threaded through all of it. It seems to me as time goes on, and for so many readers who have responded to our collaboration, that there is a particular “perfect storm” or perfect set of circumstances that has enabled our moving into this work, and across that iron-clad rule against client/therapist relationships morphing into something else or something additional. I’m aware as I begin to write out this thought that I’m anxious about seeming to present myself in some kind of exceptional way, like “I’m not your run-of-the-mill client!” I feel self-conscious, but this is a book of taking risks, as this whole collaboration has been, so I’ll go on. The more I sit in this space, or in my bird’s eye view of Trish’s space of therapist (when she chooses to share those reflections with me), I realise how common our human concerns really are. I am in awe of how therapists can sit there for 5, 6, 8 hours back-to-back and probably listen to such similar stories, such unexceptional challenges. I too am interested in people, in their stories, in their sufferings, but when I listen to Trish talk about her long days I think I really could never be a therapist (as I had wanted to when younger), and I’m glad I suppose that I didn’t go that way. I’m probably way too self-focused, and nobody needs a therapist who keeps relating it back to themselves. Or do they? Isn’t this part of exactly what Yalom does that Trish and then I (and so many others) love so much about him? Isn’t this in some way what we are urging others to consider in their counselling practices, this bringing of the self to the rooms? When younger, I was conscious of using self-stories to make others comfortable. To tell vulnerable stories about myself, which made them in turn feel safe to tell their own vulnerable stories. This seemed to be an effective “active listening” strategy. But then why don’t therapists use it? How do we know what it is before it’s a thing?

I feel like Trish and I have taken this long series of blind baby steps into this evolving collaborative writing relationship. For two middle-aged, fairly intelligent and reflective people, it seems to me when I think back over this first year that seemingly neither of us had much of a clue about what we were doing, or why it was working, or where it might go. There was, too, a good

60  Letting go (Dan)

deal of surprise at the enjoyment stage, at the capability stage, at the positive feedback from others stage. There were also what now appear to me as telltale signs that it had a good chance of “working”: we both love writing, we both have had feedback that we are good writers, we both have spent a lot of our lives in therapy, we are both actively interested in and passionate about the human mind, feelings, relationships and the power (and power dynamics) of psychotherapy. Does it matter, too, that we are both white, middle-class people with somewhat similar backgrounds and hobbies? Importantly, one reviewer of this book proposal noted that I as the client have considerable social capital which perhaps puts me at less “risk” or serves to “even out” some of the client/therapist power inequalities. As we note throughout this book, this “flattening of the hierarchy,” though never complete, plays a big role in how and why this has worked for us – and may work for others. Or at least that’s our best guess. For now. Story #1

My father died in February 2001, seven months before the September 11th terrorist attacks in the United States. He died quietly as he had lived, after a long battle with congestive heart failure. My mother had gone home to change her clothes, and the hospital called and told her to come back. It bothered her that she was not with him when he died. My mother died six years later, in August 2007, after a long period of strokes, mental illness, electroshock therapy (in her 80s), and stroke-induced blindness. I was living in Australia and she was back in southern Indiana surrounded by her conservative Christian siblings, who all wanted her to agree to electroshock therapy to treat her depression, and her more recent refusal to eat. Day and night, I was involved by phone, but my distance made me powerless. My brother and I agreed that we would fight it for her. He lived in Atlanta, and would drive to Evansville to try and advocate for my mother, as he was her power of attorney. On the phone I said to her, “Mom, what do you want? I will try my best to get you what you want.” She said, “Don’t let them do it to me. I’m afraid I’ll forget who I am.” I’m afraid I’ll forget who I am. Of course, once my brother was with the rest of the family, he quickly gave in, and the next night at dinner in her assisted living facility, he shoved the consent form under her cutlery and told her she needed to sign some paperwork for her bank account. She signed it without questioning. She was 80 years old with a heart condition, and they gave her 10 excruciating rounds of shock therapy. She did start to eat. She did forget who she was.

Letting go (Dan)  61

And she died three months later. She died in hospice with my brother at her side, while I went outside for a cigarette. She had a hard time dying, as she did living. After her last, catastrophic stroke, after the doctors sent her to hospice and said she’d be gone in 48 hours, she lasted 11 days of agony, of loud moaning, unsettled but unconscious, days of cycles where her extremities turned blue and the hospice nurses prepared us for the end, to the blood all rushing back, warm and pink. We were confused. What was happening, we asked them? “She doesn’t want to go.” “What do you mean she doesn’t want to go? She’s not conscious. You said her brain is not functioning in the way we understand brains to function, even though she’s still breathing. How can she have thoughts?” “Not thoughts. It’s spiritual. She’s scared.” It was a punch to the guts. For days, she’d been moaning loudly no matter what we did to comfort her: ice cubes in the mouth, massaging her limbs, singing to her, cool rag on her forehead. We begged the nurse to up her morphine, for the love of god put her out of her misery! The nurse said “she is not in pain, not physical pain. It’s her spirit. She is frightened. She is not having thoughts anymore, per se, it’s just fear.” We asked again to have her morphine increased. “If I increase her morphine any more, we will kill her.” Ummmm …. we looked longingly at her drip. “You have to tell her to let go,” she says to us. “We have! We have for 11 days now.” “You have to tell her again,” says the nurse. “And mean it.” So we do. I tell her again. It’s unbearable. Every time we go through these cycles of saying goodbye, letting go, it’s excruciating and we – my brother and I, and my partner who has arrived from Australia – sob, kiss her, hold her, our hearts crack into a thousand pieces. We quiet, exhausted. Time passes. And then she doesn’t die. So this time feels like a return. But we do. Ruth and I lean over both sides of her bed, kiss and stroke her, I tell her everything I can possibly muster even though I don’t really believe it myself: “I’ll be ok. It’s time for you to rest. Don’t be scared. You are not going to hell. You’re a beautiful person and you’ve lived a good life and you’re just going to sleep. You are not in trouble. It’s ok to let go.” It’s so hard. It’s hard even to write these words now, 14 years later. We go outside for a smoke. We have been here night and day for 11 days, through the shitting herself, the thrashing, the incessant moaning, the wasting, the distress. We go outside for a smoke, Ruth and I, and before I can get the cigarette lit, the nurse comes out and says, “She’s gone.” Goddammit.

62  Letting go (Dan)

Story #2

By 2018, I had hit rock bottom. My life was completely out of control, and Trish was trying to keep me on the planet. She stuck close. She recommended considering medication quickly. She supported me to put other measures in place. And one session, she took a big, deep breath and said she wanted to suggest something with me. That I should just consider it, go home and read about it, and if it didn’t feel right, let it go. She told me she thought I might have borderline personality disorder. She asked if I knew what that was. I said no, but it sounded like multiple personality disorder, so I was pretty alarmed. She told me about the nine criteria. I felt a strange combination of peaceful, sad, ashamed, exhausted … and curious. I went home and read about it. It hit home completely. I couldn’t believe that after a lifetime of psychotherapy, in my 50s, I could discover such a profound new me that would, since then, completely alter my understanding of myself, my life and others. I have been working hard since then, and my life has changed in so many positive ways. But something else has happened. Apart from learning to understand BPD, and learn the lifesaving skills of DBT and daily mindfulness practice, I was able to let go of who I was. One of my other gurus apart from Trish is psychologist and mindfulness teacher Tara Brach. One of her regular prayers is this: “May whatever arises serve my greater awakening.” Whatever arises. She teaches that the stories we have of ourselves can keep us locked in patterns that no longer serve, that don’t fulfil us, and that keep us from realising our full potential through ongoing and sometimes radical change. For me, one of those stories was that I was a bad, aggressive person that always ended up ruining (or leaving) my relationships. Getting that life-saving diagnosis of BPD helped me to let go of that story, which then let me begin to change in so many unexpected and magical ways. One of the other stories that I was able to let go of, was that I was too old to transition away from female, a desire I have had in different ways since I was a child. I used to say to Trish, “I’m 55 years old, how much longer do I have? Seriously, it’s too late.” And Trish said something like, “It doesn’t matter how long you have left, even if it’s one day it’s worth living that day how you really want to be.” And so I’ve finally started to do that, by changing my name and other beautiful steps that have made me feel freer and more settled in myself, and more loved than ever before.

Letting go (Dan)  63

I’m finally able to let go – slowly – of who I had been. And both of these transits have indeed become portals to my greater awakening, like Tara Brach says. The reason I put these stories together is this: one of the core principles of mindfulness practice is coming to accept that all we love and hold dear will eventually be lost, and that includes our own bodies and minds. So when I felt like I couldn’t change my gender presentation because I had lived too much of my life as female, had been socialised as female, had inhabited female spaces and groups, I was wrong. I was holding onto an old script of who I was, and afraid to let it go, due to fear. The same held true for my BPD. The ironic thing about getting a mental illness diagnosis later in life is that despite a lifetime of trying to change, it was finally this very serious diagnosis that made me realise, I actually could change. For all those years of not knowing what was wrong with me, not being able to find treatments that fitted my symptoms, I solidified a self that was bad, wrong, dangerous, unpredictable, unlovable, controlling and crippled with fear of abandonment and rejection. But once I was able to say, “Hey, this is a disorder. It’s not my fault, but it is my responsibility. And now I know what to do,” things began to change for the better. What I wish for my mother, most of all, is that I could go back to that moment in time and say to her, “I know it’s scary mom, but we all lose our minds and bodies eventually. Maybe we can just spend this time grieving. Maybe forgetting and letting go can be freedom instead, can be a portal to your greater awakening.” To both our awakening. 9 November 2021: How time flies. Here we are again, our collaborative relationship zooming (literally) forward, while our in-person lives emerge from the chrysalis. My relationship with Trish is so back and forth, so up and down, so in and out. How do you deepen an emergent and fragile post-therapeutic friendship and collaborative relationship, during a pandemic lockdown period in which there is almost no face-to-face contact? We, like the rest of the world, meander. We meet weekly. We talk about our shared and individual experiences of this book, on the ethics and principles of this work. We discuss my BPD community, my social media groups where there is a promise of anonymity and safety, and which I inhabit as both an “insider” person with a BPD diagnosis, and an outsider, as a researcher lurking in the wings, attentive to pivotal and educative stories about good practice, restorative justice in therapeutic relationships. Is this creepy? Why must these worlds be so separate, so separated. Why can’t “high-achieving” professionals also be fragile battlers with BPD diagnoses? Why are these perceived as antithetical, contradictory and at odds?

64  Letting go (Dan)

Not-so-conclusive conclusion: November 2020

My experience over the past few months in the clinic’s “grad group” co-creation has been mixed. This follows the year I spent in the intensive DBT skills group, which I wanted to repeat, but was not allowed as they deemed me sufficiently “recovered,” a diagnosis I reject. I liken my BPD now to diabetes: if I continue to look after myself and the condition, I’ll be mostly ok, but if I don’t, I could die. They didn’t agree, and there is a long waiting list for others, so I had to go. The compromise was to be a founding participant in a new initiative there: a peer support group which a few of us with lived experience will co-create with one of the psychologists. On the positive side, I see it as an affirmation of the need to do “business” differently, even within psychiatric treatment of complex personality disorders. They are coming to the party! An exciting prospect. I want to do all I can. And at the same time, I have my long-term relationship with Trish, who has provided the continuity in my mental health journey regarding not only my critical diagnosis, but everyday life. What does this mean? How do the long-term nurturing and therapeutic relationships that inhabit the nonmedical model, non-psychiatric model, play together with the positivist and medical DSM approach to those like me? Are psychiatrists from Venus, and psychotherapists from Mars? Are we lashed to still more binaries that just don’t work anymore? Ugh. It sounds so easy. I hate ambiguities. But my life, gender, sexuality, and politics are ambiguous. I’m co-writing this book in order to make sense of my own experience, and to help others with BPD who seek out psychotherapy. I want to break down all the binaries. I want to speak to researchers who are therapists, researchers who have mental illness diagnoses. I want to speak to the research community that desires and needs to do things differently, better. I want to say we can all be, are all, in this together. How can we help each other? How can we make practice better? How can we make research standards better? How can we exceed binary expectations in therapeutic/research/practice/ service provision relationships and communities?

Dialogue 2 THE BOOK OF LAUGHTER AND REMEMBERING

15 March 2021: The radical risk of humour

Dan:

Trish:

Dan:

Trish, I’m wondering if there is something radical about the notion of therapist and client having fun together? Goofing around even? It seems to me that was a kind of disruptive space in our shared writing. What is your perspective on that? How interesting that therapist and client having fun together might be called radical! This feels particularly relevant given we actually did this today in session. You said something about your previous therapist like “same therapy, just the faces changing.” I thought this was absolutely hilarious in an almost “black humour” kind of way. And in fact that moment did kind of feel risky, but I could help myself when I said, “write it down.” Are we pushing a boundary? It did feel bold, but I noted that the conversation about gender that we had subsequently still felt therapeutic. Our goofing around didn’t prevent us from taking up our places on the metaphorical couch and chair. Awful! I kept thinking about what a client – me? – would feel like if their therapist – you? – said the same thing back the other way. I probably wouldn’t even have thought about this earlier, given I don’t think I thought of you or my other therapists in a kind of threedimensional way. This other kind of engagement is bringing my attention to your subjectivity. Me considering how my words affect you – affect anyone – is something I have not always attended to enough. I would have, in the past, thought of you as “my” therapist for hire, and that that’s the exchange. So why would you get your DOI: 10.4324/9781003268161-7

9781032213873_Dialogue02.indd 65

06/10/23 6:16 PM

66  The book of laughter and remembering

Trish:

Dan: Trish:

Dan:

feelings hurt? Put another way, I wouldn’t have thought I had the power to hurt any therapist’s feelings. Wow Dan, that is really interesting. You are saying a lot but I also feel like saying that the more of the real me you see, the more you become aware of your impact on me, on others in general. Yalom would have a lot to say about that. Absolutely. So in that sense, is humour a risky space? A space of potential transgression? What if the client takes it the wrong way? I know for myself, I can turn to humour to cope with feeling uncomfortable. I’ve seen how humour can also be used by clients and group therapy participants to try and break through the therapeutic wall, to take power. Or to deflect of course. So I guess using humour in the therapeutic realm is risky, but effective therapy is full of potential risks. The hope would be that if the client takes it the wrong way, as you wonder, that this also becomes part of the work – a rupture to repair and grow from. Maybe it’s good for me to have been able to see you more as a whole person. Not all of you, of course, because you’re still in the therapist role at all times, but to see you in this fuller way. Because I do think that part of my disorder is that even though I think I’m capable of great empathy, and even though I have intense and almost incessant curiosity about people, that I can be quite objectifying or transactional. That I can see people not in their fullness as individuals but as what they bring to me. And obviously, a therapist relationship seems like this would be reasonable. But actually, if I take the metaphor or trope that this relationship is a rehearsal for all other relationships, then I’d have to say that it feels like a kind of maturing to wonder “well what does Trish want out of this?” or “how does this make Trish feel?” or “what are Trish’s aspirations, or hopes in this encounter?” etc. Surely that is a good thing.

Power and vulnerability

Trish:

Yes, therapy is transactional, isn’t it? Money changes hands, a service is provided. A colleague once said that her clients pay her to think. Still not quite sure how serious a comment this was. I admit I have struggled with the idea of “getting something out of” the therapy with clients. How can I charge for something that is also valuable and enriching to me? Maybe I should offer a discount when a session really rocks my world. And do you know what? I don’t know that I have actually, deeply thought about a client (you) really wondering about what I might get out of a session, or

The book of laughter and remembering  67

Dan:

Trish:

how it makes me feel. Or about what my hopes are. So what do I want? A predictable and yet still true answer is that I want to be useful. You come to me with a desire for growth and change and I want to satisfy that need. I can tell myself that it is up to you to make that happen, but I wouldn’t be honest if I didn’t own that I want to play a part in that. I guess I want to be good at what I do. When I think about what I want in a therapeutic encounter with you (and other clients), it would be that I want to be present with you and welcome whatever is there in that moment. And the next moment, and the one after that. I hope that the therapy can be meaningful and make a difference. Maybe most importantly, I want the therapy to be felt as an experience of (mutual?) trust and care, which allows us to be genuine in our thoughts and emotions. Something then gets co-created and the space comes alive with possibility. You don’t need to be good, I don’t need to be the perfect therapist and defences drop away. Is this describing freedom? Where we are each free to be real and there are no negative consequences? Is there any exchange in which there are no negative consequences? I know I still, after all these years, find the vulnerability and the one-sidedness of therapy to feel like power over me, which is not negative per se, but uncomfortable. I might tell a good friend the same exact thing I’d tell you, but wouldn’t feel that they had “power over” me in the same way. Is that because our relationship is one-sided? Or because you have training that means you have more skills to help me? I’m so curious about the idea of paying a therapist to help you and experiencing them as having power over you. It’s like you simultaneously want their skills and expertise and resent them for exercising them. Dan, I feel like asking, “so how long have you had authority issues?” Maybe for about as long as I have! I could tell you a few bad boss stories and when I think of one in particular, bringing him to mind right now is inducing a long rant peppered with obscenities from which I will spare you. For me, authority creates distance. And a lack of safety. I really want to know if my clients feel a sense of distance from me, whether it comes from life outside of the therapy room or is specific to how I am with them inside it. Something I am doing. Or maybe just who I am. So, what is the way in which you (a client) can receive the skills the therapist (me) has to offer and it not feel like “power over”? It feels like a central question in this book and we are answering it with every sentence we write. *

68  The book of laughter and remembering

Gender and sexuality, or “identity therapy” 21 September 2021

Trish:



Dan: Trish:

Dan:

I think it’s true that it often feels easier to say something difficult when the emotion of it is less visceral. You told me something the other day, about a time in our therapy. It happened a while ago, so maybe the feeling you had that day you remembered it sat in your mind rather than your body, as we talked. But what was the feeling back then, in that moment in therapy? I imagine it was disappointment. No, stronger than that. Of not being seen, of being missed, of having your life experience marginalised by someone sitting comfortably in heteronormative privilege. What would I know? What indeed. You spoke to me the other day of that time in therapy in which your experience was one of me not remembering something. Not just anything, something really important. Crucial, in fact, to the amazing and awesome turn your life has taken.   We were discussing the men’s group that I facilitate, and the skills that the guys aim to develop as part of the process. That sounded good to you, like something you could benefit from and you asked if you could join. You recalled that I said you would have to identify as a man to be part of the group. I reckon I said something more direct than that like, “you have to be a man to join the group.” Not that it makes much difference, it’s still awful. You thought my comment was based on me forgetting our earlier discussions in therapy about your gender. But I hadn’t forgotten, I just didn’t get the extent, the importance; just how core it was to who you are. There were always other stories, other problems, more immediate concerns. I remember telling myself maybe you just weren’t ready to really explore this yet. I wish I had asked myself, what can I do to make this OK to talk about? What questions didn’t I ask, what things didn’t I say? Or maybe I was just too me. What does that mean? I’m curious. Can you say more? Meaning that I wasn’t a good enough fit for you to discuss the gender stuff, too straight, too mainstream, too reluctant to make you uncomfortable perhaps? Yes I think that could be true. We have talked about this a lot, the ways in which queers (or other minoritarian folk) need or want to see a therapist from their own tribe. Why that should matter, if it matters, etc. And the challenges you have had to endure as an ally therapist largely working with queer communities.

The book of laughter and remembering  69

Trish:

Dan:

Trish:

Dan:

Trish:

All the things we didn’t talk about and maybe don’t talk about still. It’s not so different, then – to real life, that is. You didn’t tell me at the time, in the moment, that you thought I didn’t remember the issue of gender. You couldn’t tell me. And I constructed some other narrative. And there it is, what we all do with one another all the time. We tell ourselves stories, and then we construct a reality to fit them, and all the world’s a stage and we are merely players. I know that we have found our way closer to really knowing some stuff, whether that has been through writing together, or finding relief in the safety of the online space, or both. But I’m not going to let myself feel better about that right now. I want to be with the shit in my gut that knows you had yet another experience of feeling silenced. Maybe of feeling other. In the room with me. I think I had another experience of feeling too embarrassed to challenge whatever comment you actually did make. I couldn’t say “but I do identify as male” or “but don’t you remember me saying I identify as … (whatever) … wouldn’t that qualify me to join the group?” or even “But because I am somewhere on the gender spectrum, and my anger issues are expressed in so-called masculine ways, and I would really benefit from being in that group. Is there any way I can join? And if so, why not?” Shame about the anger AND the gender “dysphoria.” That really makes sense about the shame and embarrassment. So many layers. I am really interested in what helps to overcome feelings like that so that more open conversations could be possible. Not just your feelings of shame but also my feelings of being “not right.” I think I was avoiding putting a spotlight on how we are different. It actually didn’t help. So maybe back then you couldn’t trust me enough. You said that our writing together helped you feel you could talk more about the gender stuff. Ah yes, that is true but I wonder why. Is it only that trust built here can then be generalised? Is it the “distance” of the page that allowed me to say things that are/were too embarrassing face to face? I keep going back to that scene in that Netflix show Feel Good where the queer girl told her girlfriend all the bad things with her hands over her face. I really identify with that. We also had some phone sessions during COVID last year which meant that you didn’t have to see my facial expressions in response to what you might say. In my supervision group a couple of weeks ago, one of my supervisees talked about really struggling with a male client and some difficult transference stuff, and when they went to phone sessions, things really improved. She had a theory

70  The book of laughter and remembering

Trish: Dan:

Trish:

about the lack of visual cues, particularly around potential judgement going in both directions being removed, made a huge difference and the therapy then progressed. That scene you mention from Feel Good and Mae covering their face was so poignant, heartbreaking and endearing all at once. I get how it spoke to you, and can imagine it resonating with a lot of people. Dan, can you say more about why the writing built trust? It seemed, Trish, like you shared more of yourself, or other parts of yourself. Bridged that distance between the couch and the chair, but I’m not sure why. Maybe it’s something as simple as a shared endeavour. Is it about a certain type of experience? Shame for example. Many clients don’t want to know anything or much about the therapist. Should there be a focus like “shame,” if there is a potential block in the work, for example, trust, difficult experiences, whatever – that makes it hard to open up, then maybe it’s a vehicle for that. Some clients wouldn’t be interested, don’t want to know about their therapist. It’s clear that with some of your clients, Trish, it’s helpful for them to know more about you, but others don’t care. We talk about how some clients don’t want you to be “3 dimensional,” they want you to be there for them, and keep it all about them. Other folks, like me, really seek out the knowing about others, including Trish and previous therapists, as a measure of safety, security. When clients worry about being judged, and they have an experience of the therapist being more human or relatable, then that really helps. For me and other survivors of trauma, shame is a major obstacle to connecting with others, including a therapist. The writing might help by simultaneously bringing us closer together in the intimate/trusting space of a “shared document,” while at the same time providing a kind of ersatz anonymity by not having to look at you while talking about hard and vulnerable-making things. Dan, I feel like what you are saying about clients knowing about their therapists as a measure of safety and security is so important. As part of my involvement with the PACFA Diversity in Gender, Body, Kinship and Sexuality Interest Group, I have come to understand the significance of therapists positioning themselves with their clients, in terms of their gender and sexuality at the commencement of therapy. In this way, there is clarity around differences and similarities of lived experience. There is no guessing, just being upfront and transparent, which would hopefully contribute to building safety. But I know that the feeling of being “other” can be isolating and shame inducing, even in supportive environments (Thompson, 2019). Just showing empathy and actively not judging isn’t enough. I like what you said about therapists being more human and relatable, Dan.

The book of laughter and remembering  71

Trish: Dan:

Trish:

A favourite lockdown show has been My Mad Fat Diary. In the show the teenage protagonist tells her therapist that she wants him to be real rather than professional, and the more real he became the more the therapy progressed. I reckon our writing together opened up that space of realness even further. Dan, could knowing more about the therapy process affect your participation in it? I think so. I’ve always asked all of my therapists about what techniques they were using, what psychotherapeutic schools they studied in, adhered to, etc. I’ve always been interested in therapy, as I say elsewhere in this book, both from the therapist side and the client side. I realise not all clients have that interest, they just want help with a specific problem or set of issues. I know the idea of transference is sacrosanct in therapy, but/and I wonder whether the “Wizard of Oz curtain” really needs to be in place for it to work. For example, you have your own therapist, and presumably know what process she is using with you in your sessions, but it’s still helpful isn’t it? I also think of it as like a parent/child relationship, in which the child at times knows the parent is using some kinds of techniques with them, and may rage against it or resist, but it can still be perfectly effective. So, I think it depends on the client. If they are analytical, curious or resistant to being “treated,” maybe like me it helps for us to know about the process itself. For others, it’s probably more effective for them just to come in and allow you to “work your magic” in ways they might not understand. Co-writing doesn’t necessarily change this, but it doesn’t flatten the hierarchy to some degree, so it’s not for everyone. I love what you are saying here about the client/therapist relationship. I have certainly felt “held” by my therapist in a parental way, which also felt completely right for the moment I was in. And I’ve also experienced times when I know what technique she is using with me, and half of me just goes with it and the other half says to myself, “gee, that’s a good idea, I must try that out with my clients!” I guess ultimately it’s about attunement, and as you say Dan, it depends on the client what works best for them. Including co-writing. It’s not for everyone.

The role of love in therapy

Psychologist and meditation master Tara Brach (2022) says, Whether in the care of a therapist, a close friend, or a teacher, we begin to find ways to create a sense of trust and love that can hold our experience and a connection where we are reminded of our intrinsic worth and basic

72  The book of laughter and remembering

goodness. We are wounded in relationship; we heal in relationship. This is how we start to loosen the deep shame that accompanies trauma and come back into the wholeness of our being. Natterson (2003) and others have written about the role of “love” in therapy, in which he argues the importance of a reciprocity of feelings of love between client and counsellor. While this does not preclude therapeutic change occurring without love, it seems obvious that it might play a role in major change or transformation. Trish:

Dan:



I remember years ago I went to a PD on group facilitation, run by the Centre for Existential Therapy, which really felt like a fit for me, given my interest in Yalom’s work on group therapy. I had been facilitating groups for a while by then, and loved it. The people attending this PD were all pretty nice, but I do remember some feeling in the room that felt like competitiveness when we took turns to facilitate some group sessions. I recall a discussion about what we bring to the role of group facilitator and how we work with the group participants. Before I knew it, I found myself talking about my feelings towards the participants in groups I have facilitated, and actually revealed that I loved them. No one said anything. I immediately wished it unsaid, and the feeling of vulnerability made me want to disappear into my chair. No one approached me later to ask more, and two colleagues that I attended the PD with did not raise it. It still feels uncomfortable when I think of it now, but the words are still true. Trish, it’s interesting in so many ways how this creative writing and creative reading/discussing work you (and we together) is finding its way into your other therapeutic practices and contexts. I love thinking about your supervisees entering into your love of literature, and being able to share that with you, as I (and other clients?) have been able even intermittently to share that common space, common passion with you. It’s a kind of universal language that can open up not just creativity, but also an affective and symbolic channel into emotions and memories that a client might not have clear narrative access to.   I also love the expansive potential of what’s happening in your group supervisions: your excitement about writing then transfers to your supervisees, who then are able to have their own experiences with a love for writing, and bring that back “to the grid” of the group and their relationships with you as supervisor. They also, iteratively, enjoy the bonding or deepening of their relationships with one another, as shared creative practice allows or facilitates.

The book of laughter and remembering  73







Trish:

  It causes me to wonder why, after my 55 years of creative practice, and psychotherapy, why I never thought of asking to combine my creative writing practice with my therapy. Perhaps it’s because I’ve always been such a talker. A facility with language that has maybe more often allowed me to obfuscate my issues or needs, rather than present them. Yes, I can tell a vivid story, and I have an entire childhood of training for active listening, mirroring, selfreflection and talking about emotions. But that never really got to the heart of things, and I think in the therapeutic setting it might have at times blinded some of my therapists to my wordlessness about the worst things, feelings, events.   When therapists suggest other modalities like drawing, writing, music, it seems like it’s always for clients who “can’t talk” or can’t put into words what “really” happened, or what they are “really” feeling, etc. It is such a vivid memory to me when you asked me about shame, and I very convincingly (to myself!) said, “Shame? Oh no way. No. Guilt perhaps, but not shame.” Not so many years ago, but now I basically feel like everything in my life is underlined or driven by shame! There are the stories we can tell, and then always the stories that we can’t. Or can’t yet. But back to you and your group supervision.   Reading this is perhaps a little like pulling back the curtain, as you mentioned. It is nice to think of you with your group of supervisees, and imagine the dynamism in that group, and how you allow fun and humour and experimentation into the rooms. It’s so beautiful to imagine the uniting potential for literature and one’s own creative writing in the rooms. But pulling back the curtain? Hm. That phrase makes me think more about you with your supervisor, or your own therapist, or other clients besides me. Those are really the places with emotion for me. Doesn’t every client feel weird about your other clients? No matter how much we know that they exist, even politely nod in the hallways, aren’t we all a little bit jealous, and imagine our relationship with you is just a little bit better than yours with anyone else? Maybe that’s just me. Maybe it’s not just you. When clients come to me, and they have had other therapists, I find myself cringingly wanting to be as good as, ok better than, their past therapist. That WE will do the really meaningful work together. It makes me think that when we feel special to someone, we feel valued and seen. You want that in your life and so do I. Actually, the psychoanalytic psychotherapists (think Freud) like to make sure that clients never run into one another in waiting rooms, etc. They want the therapy space to be uncontaminated by the real world so that the transference can play

74  The book of laughter and remembering

Dan:

Trish:





out. It’s a bit creepy, I reckon – like making the therapist a bit like an all powerful figure. The Wizard of Oz maybe? Ha! I like thinking of you as the Wizard of Oz somehow. Then again, he was quite vulnerable in the end, wasn’t he? Doesn’t every client imagine their therapist vulnerable with their family, their own therapist? I imagine you – and my previous therapists – are like me in that you have the stories and self-narratives that you share, and then the ones that you don’t, and the mysteriousness of writing/literature/art/co-writing, to me, is that experiencing those moving, beautiful, provocative, aesthetically-curated, symbolic prompts can take us beyond the specificities of the everyday, and bring us closer together without the details that constitute so much of therapeutic treatment. Wow, look what you did just then, capturing moments of meeting so exquisitely! I feel like you are saying that there is a way even beyond the talking and the writing, that creates connection. In therapy terms that might be called the “space between.” But maybe it’s to do with not just knowing there is realness in the room, but really feeling it. Like a felt sense in your gut and differences just fall away.   Your wonderings about me and your past therapists being vulnerable in life outside of the therapy room really touch something in me. In your chapter Letting Go, you reflect on how we can all be in this together – the therapeutic/research/service provision/lived experience communities engaging in a way that is about what is shared, not what is separate. There is so much overlap, why can’t we be honest about it and be on the same team?   It brings to mind a recent session with a client who admits that they worry about how frustrated I might get with hearing the same things from him over and over. First of all, I give him the more traditional therapist answer about repetition and the process of working through each cycle until something shifts. Then I take a moment and stop ignoring the resonance in my gut that reminds me I have the same worries with my own therapist … and that once I pretty much asked her the same thing. So I shared this with him, and then he told me about a show he is watching in which the therapist tells his clients exactly what he thinks. Note to self, I have to watch this! My client asks, “Will you tell me if you get frustrated with me?” I say, “I promise.” But also – I have been much more willing now to share with clients my own experiences of mental ill health, and if any ask if I have ever used medication like anti-depressants I tell them the truth and say yes.

The book of laughter and remembering  75



  Dan, I have learnt so much from your groundbreaking work in blending research, lived experience and creative arts. Your play All The Rage is both provocative and inspirational in showing truths in people’s lives in ways that touch you deeply and demand a response from you. When I watched it, I was overcome by the magnificence of being human and what a beautiful mess we all are. And meanwhile there is the mental health field, which seems bogged down by things like the DSM and “evidence based practices.” The creative space has so, so much to offer in helping us all in our desire to find meaning in our lives and to support others to do the same.

5 WRITING INTO HEALING (Trish)

Writing prompt #6:

• You are walking through a forest; describe it. • Through this forest is a path; describe it. • Along the path you come upon a key; what does it look like; what condition is it in? Do you pick it up? • Farther along the path you find a cup; what does it look like; what is it made of; what condition is it in? Do you pick it up? • As you continue walking, you come to an obstacle; describe it. • What do you do? If you go around it or past it, then how? • Next you happen upon a body of water; describe it. Do you get in it? How fast is it flowing? • As you walk along, you come to a shelter of some sort; what does it look like? Do you spend the night? • Finally, you’re walking along when you reach a fence; what does this fence look like; what is it made of; what condition is it in? • Beyond the fence is a field; describe that. Do you go over the fence into the field? (Converse, n.d.)

30 November 2021

I’m now a runner. Well, I was a bit of a sprinter in my youth, the 100 metres being my favourite event at sports days. But running longer distances was not my thing, I really hate being out of breath – that constricting feeling of your DOI: 10.4324/9781003268161-8

Writing into healing (Trish)  77

chest straining to get the air in doesn’t do it for me. All that panting and puffing, and for what? I’ll tell you for what. To find that solitary, meditative space that comes from the simple act of placing one foot in front of the other. And to combine that with the company of every shade of green imaginable, as I traverse the Merri creek path, is nothing short of an epiphany. With my usual exercise routine of attending classes such as Body Step at the local gym no longer available due to COVID, I decide that I will give this running thing a go. And despite lockdown, a whole new world opens up. It’s being surrounded by the sky, the water and the trees. I mean who knew that there were so many shades of green – and not just in one tree, let alone the hundreds that are gathered together along the banks of the creek, just chilling. Being the same reliable trees day after day. Promising to wait for me when I come back, and no word of discouragement if it takes a while. Along with all those vivid greens comes the scent of pepper, lemon, aniseed and loamy earth. Have I never noticed this before? I have walked this path often in the past, why would running it instead change my senses? And the water flows, sometimes gently and sometimes in a rage, to the point of blocking the path under the bridge after heavy rain. But there is always a way round and the run can be had. After many years of hating the winter I finally have a reason to appreciate it, as the cool, crisp air and cloudy skies mean I can let my body embrace the movement without being deterred by sun and heat. As much as I encourage clients to try meditation, I haven’t done much of the “sit still for half an hour and breathe” type. I have lots of meditation apps on my phone but I just don’t seem to find the time. Maybe it’s because the best type of meditation waits for me. And there are rituals around it. The day of the week, the time of day, the clothes I wear. I wake up on my run mornings and can see the path in my mind: the starting place just over the bridge, where people are already walking their dogs or riding bikes. I like conjuring up this scene and notice that my legs are testing out their readiness and it brings a tingle of anticipation. I enjoy matching my running gear to suit the temperature in the air, if I am comfortable I will forget everything else and what I think about will be whatever emerges through the intersection of body, movement and path. The best part is lacing up my runners, noticing how they both hug my feet and give them space to breathe. It’s like they know they have a job to do and are up to the task. How I love my runners in all their blueness. The hardest part for me is finding the pace and rhythm so that my breathing can settle. Meditation is all about the breath, isn’t it? It is the anchor that keeps us alive and keeps us connected to our being, even when everything else might be falling apart, or wonderful and joyful. In the early days of running, I found it hard to tolerate the laboured breathing, the feeling of my chest constricting and not allowing my breath to flow steadily. At first I would stop and walk for a bit until the feeling subsided. Then I thought that maybe I could just push through and cope with this

78  Writing into healing (Trish)

discomfort. I heard somewhere that the first 20 minutes or so of intense exercise is the hardest, and then your body settles, you just have to get over the hump. Slowly but surely I find this to be true. I am able to notice the way my lungs tighten up for a bit, and know that almost miraculously the breath will start to flow more easily and my legs can keep going. They made some deal I think – my lungs and my legs, without me quite knowing about it. They have a plan and I am going with it. Maybe the plan also involves part of my brain as well – the part that doesn’t want to analyse anything in particular, but throws up a whole bunch of thoughts, in this watery stream of consciousness, next to the Merri creek, weaving their way through the endless greenscape. These thoughts are not planned and yet my God how interesting they are, as if they were sitting in wait. They are about my work, my clients, me with my clients, my life or my clients’ life, or both? An understanding or connection starts to form and I realise I have been unaware of my lungs or my legs (is that what they wanted?) as I feel absorbed in the story. Another ritual forms – to capture the thoughts in writing as part of the cool down. I might not remember it later. I get home and go inside. Even before I have a drink, I reach for my phone and just get the thoughts down, without too much worry about form. I don’t want the “not Merri Creek” surroundings in here to dull what seemed so clear to me out there. Writing as a relational process

I recently came across a journal that I kept for a couple of months as a 16year old. Ah, the feelings it evoked! The adolescent that jumped out of those pages was not unlike many young people I suppose; with moods shifting from despair to ecstasy in a moment; with the day ruined if it started with family conflict in the morning, to have it turn around by catching a glimpse of a crush on the way to school. Reading her experience of day to day life made me feel protective towards her suffering and striving, but I could also see her steadfastness in the times that she showed up anew with the dawning of another day. I saw the me of now in the girl of 40 years ago. What creates the therapeutic value of writing? There are no doubt a number of things, like finding stillness and being with the present moment. To sit and write is to stop all else; that alone is a challenge. Many clients will report that once they start writing, the story just flows out of them; as if the act of writing itself unearths what has been sitting there, perhaps not yet fully formed. A felt sense searches for meaning and language is its vehicle. What is interesting about journalling is that there is a sense of an audience – writing about the self, in search of self while being witnessed by the self. The process takes on an active, relational quality as the different parts of the self take on certain roles – the documentor, the reflector, the listener.

Writing into healing (Trish)  79

In the action of writing, and particularly in the practice of writing, there is repetition; of what the hands do to create the words on the page and of the tracing of a life’s story as it unfolds. Therapy too is a repetitive process, as client and therapist sit opposite one another and speak out words every time – thousands of words fill the room, put together in a variety of ways, hoping that a particular combination will bring clarity. Clients often express frustration over this repetition, why do they find themselves returning to stories that they have told before? It can feel so disheartening – as if in the repetition, no further ground has been covered. Of course the repetition is all part of the process and I have been wondering whether the witnessing of the journey that happens in the therapy room, by giving it visual qualities through the written word, can alter something. What would it be like to see this therapeutic co-creation come alive on the page? And what would actually happen in the process for client and therapist? In the first article that Dan and I wrote together, we talked about the therapy we had done together in arriving at Dan’s BPD diagnosis. The idea was to share a therapeutic journey with a wider audience, but what we found in the process of writing together was a deepening of connection and understanding. It was an expansive process, as the writing enabled unlocking of ideas that seemed to take on a life of its own. When I asked Dan what the writing did for their experience of our therapeutic relationship, they said that they trusted me more. And what was it for me? What was it for us, together? The writing tapped into a part of me that is usually felt but not necessarily seen in the therapy room. This is the part that opens up a little wider to the emotions that are present. It is the part that reveals my experience of these shared stories and the influence it has on my own sense of who I am. Mostly it’s the part that risks being seen by the other as unequivocally human rather than some wise counsel who has the answers. This is hugely uncomfortable at times, and yet ultimately freeing for us both, as it flattens the hierarchy. But still this doesn’t quite capture it. It feels bigger than what I have just written. Will I find the words that convey the expansive feeling? Lessons from the collaboration about boundaries

Writing with a client changes the boundaries. Constant communication and negotiation is needed when you move away from the boundaries that are already set, boundaries that require less thinking because they existed long before I worked as a therapist. Being in the grey area requires more work and attunement. It becomes much more of an interpersonal exercise due to the need to focus on how each impacts the other. Something has shifted in my mind about the idea of unconditional positive regard; well maybe not that so much, maybe more my willingness to

80  Writing into healing (Trish)

bracket off my own feelings in order to validate Dan’s. If I feel frustrated or angry, that’s useful information. It speaks to rupture, conflict, difference, sadness. If it doesn’t find its way into the space, where does it go? I feel it in my chest as I write this now. I want to be seen and understood. If I am to have authentic relationships, I want the other to have the chance to know who I am, at any given moment, and have a response. To disagree, to get annoyed, to ask for clarification or maybe to understand better. Think of all that won’t be said, all the thoughts that won’t arise, the ideas that won’t bubble up if feelings are withheld or censored. Could it be that this seems more possible when the frame is different, when the relationship is called “collaboration”? See it on my face, and I turn away. I won’t hide it behind a blank screen. What happens for Dan when they see my frustration? I actually want to know that, but I am more interested in whether I can manage the flex in the role of the ever understanding therapist who is the less understanding collaborator. Or maybe it’s just that the understanding is more up for negotiation as it turns a greyer shade of pale. And as I note the feeling in my chest settling, I find myself wondering what that would look like in the therapy room. The sacred space of unconditional positive regard making way for real emotional exchanges between the humans that sit together in search of truth. In the Gift of Therapy, Yalom (2002) refers to his work with patient Ginny, in which they shared with one another summaries of their impressions of their therapy work together. As Ginny had idolised Yalom, as apparently many clients do when it comes to their therapists, he notes that he deliberately revealed his “very human feelings” in these summaries, “my frustrations, my irritations, my insomnia, my vanity.” (p. 81). I have often told my students and supervisees that showing/referring to your feelings in response to what a client reveals in therapy is a form of therapist self-disclosure. Your reactions offer some information, and if the client takes the offering, it can illuminate the story that is being told. The client might think, “she just said that this makes her feel hopeless. Is that what I feel? Is the situation hopeless?” Ok, but what if I say to a client, “when you tell me week after week that you can’t actually do anything different because you just don’t know what will happen, I feel pretty frustrated. Like I don’t know how to help you.” How would that go? I actually did a version of this with a client last week. My hope was that she would get in touch with her frustration at herself and maybe even that of her friends, who tend to try to help her for a while and then stop calling. So what is going on with us is out there too. And do you know what, she took it well. She came back the next week. And she said, “I just don’t know” again. Sigh. I guess we won’t know for quite some time yet. But at least we aren’t pretending that knowing is just around the corner. When re-reading this excerpt from The Gift of Therapy this evening (how many times have I read this?), something Yalom said leapt out from

Writing into healing (Trish)  81

the page, and it was as if I was reading it for the first time. It was that the exercise of revealing his frustrations and irritations to Ginny liberated him considerably in his subsequent therapeutic work. What? I’ve been emphasising to my mentees that this business of self-disclosure is for the benefit of our work with clients. As Dan said in our article for Psycotherapy.net, “And what would that mean for you as a ‘therapist-ever-becoming,’ who considers what might be possible when a client is so caught up in their own woes that they miss the you-ness? A you-ness that might be able to push them further toward better interpersonal relationships?” (Harris & Thompson, 2021). But it’s not just for the clients, is it? When I think about showing up in the therapy room and being real; I mean counsellor real and Trish real, something happens inside me. The tight feeling in my chest has dissipated. Writing with clients

Some years ago, a client and I decided to read and discuss a chapter of a particular book, based on acceptance and commitment therapy (ACT) for each session. It produced such rich discussions and we enjoyed bringing the subject matter of the book alive as we integrated theory into practice. Thinking back on that time now, I see it as a type of collaboration – a shared experience rather than one of giver and receiver. Many clients will bring a notebook to session, determined to cover the points of importance they have written down before coming. I love it. I often have a desire to actually see what they have written – something about the words on a page does it for me. And then if we come up with some bit of gold in the session and I just want to say, “quick, write that down!” Does the written word make it more real? Scanning the years of client sessions in my mind, I think about how important it was for many to read their words, or the words of others, out to me. Maybe a story or poem they or someone else had written, or a text exchange with someone. More recently a client and I have been taking turns to nominate a movie or show to watch and the subsequent analysis brings forth meaning in both our lives. My main collaborative writing tool with clients is email. Since writing with Dan, I have used this with some clients in a deliberate way. A client might say they would like to reflect on and write about something we’ve explored. We might then wonder together whether it would be helpful to email me what they’ve written and that I in turn would email a response. We would then set some guidelines for this exercise by deciding on an email exchange of a certain number and within a certain timeframe, usually in between sessions. The expectations about how soon to expect a reply are discussed, to provide clarity.

82  Writing into healing (Trish)

White (2007) explains that the important part of outsider witnessing in narrative therapy is in how to respond to someone telling a significant life story. It is about expressing how you are drawn to and personally affected by what they are saying or writing. It is the meeting point of lives – as witness and storyteller find resonance. I think of an email exchange in this way; maybe you could call it “enhanced journalling.” For the client, the audience expands beyond the self and the response I provide is an offering of recognition in my own life; hence a connection is formed. What I really like about this type of collaboration is that it is a way of gathering up and holding onto those precious therapeutic words, while meaning is co-created. 14 October 2021

My finger hovers over the send button. What is my motivation in emailing Sara the article I wrote with Dan for the PACFA journal, I wonder? What is it that I want her to see? Sara has been seeing me for about a year now. She talks about how she has kept herself safe for so many years, when the people closest to her have not been able to. But she has so many emotions that have been squashed away for so long, all in the service of keeping her alive. She wants to know these feelings better, but it is so hard. And she likes to write – about this brave journey she is on, where she is making sense of all the parts of her. She wants those parts to be OK because they are real and authentic. Sometimes in session she will read a story she has written, or later she will send me videos or suggestions of things I can watch. She is inviting me on the journey. How best do I accept the invitation? In a recent email to me, she reminds me that I have told her she should write a book. She writes, “Maybe we should write a book.” It gets me wondering about where I fit in her story and what our co-creation looks like. But I also want her to know she’s got this. Then I bring to mind the work I’m doing with Dan, and the benefits of collaboration. Maybe her knowing about this could be a step into telling her story. She has a particular story to tell, and I think that there is an audience who will benefit greatly from hearing it. Perhaps I could be her audience to begin with, as she contemplates a larger one. Isn’t that also collaboration? So I tell her about that first article, and a bit about the philosophy behind it – how therapy and writing co-inform and make space for long held emotions. Yes, she wants to read it. Shit, should I send it to her? I’ve said I would now. What if I am just wanting to let her know that I can write too, that I have written and been published. Damn, I should have thought of that before I said I’d send it, maybe I needed more time to investigate my inner workings. Sometimes I am weary of doing that, it’s so tiring. I drag myself internally again. OK,

Writing into healing (Trish)  83

when I consider one of the key things I think is important about writing this book with Dan, it is to elevate the voice of the client, so often buried underneath the mountain of books and articles that privilege theory and “expert” opinion. But clients’ words don’t just belong in the therapy rooms. I press “send.” At the next session, she says she really loved the article and commented on the risk that we both took in writing it, and that there was clearly a lot of trust between us to be able to do this. Then she told me that reading the article seemed to allow something in her, a willingness perhaps, to invest in her own therapy – and be curious about what our therapeutic relationship might be provoking in her. “I didn’t know I was going to talk about this today,” she said with some wonder. I happen to think that there is always a reason for the words that clients offer up in the therapy hour, and I have marvelled at how many times clients say, “I’ve gone off on a tangent,” when in fact they couldn’t be more on point if they tried. I say, “There is a second article that Dan and I wrote, about trust. Would you like to read that?” “Yes please.” When Dan and I thought about who we thought would read our articles, the mental health community were the target audience. We certainly thought that it would be interesting to the eyes of clients as well, but the idea was to bring the therapeutic relationship to life through dialogue. When desiring to understand what is helpful in the therapy process, why go through “the middle man” (or person) via academic texts when you can get it straight from the client’s mouth? But somehow what I didn’t anticipate was a client – my client – reading the articles and it influencing her choices for herself in therapy. After reading the second article, she said to me, “that first article – the academic one, I couldn’t find you so much in it. This isn’t the Trish I know. But in the second one I saw you more. What reading the articles did for me was tell me that this is the place where I can bring my pain.” I asked her, “So there was something about reading words that allowed that for you? You found that in the writing, more so than in our sessions?” “No, I did know that the door was open, but the articles pushed it all the way open. I was thinking that maybe I had met the goals that I had set for myself when I first started seeing you. But I realise that I have been suppressing threatening feelings for so long, in order to keep myself safe. I had to do that back then, but I don’t want to any more. There is more work to do and I know it is Ok for me to be vulnerable.” When Sara left, I thought about this turn of events. Here I was thinking I was encouraging the writer in her by sharing the articles; that she would take up the

84  Writing into healing (Trish)

keyboard and start that book. She might do that one day, or she might not. For the words that Dan and I shared with her allowed for something to take hold. Which clients could really be served by collaborative writing? 3 October 2022 “Writing with Dan” notes

A thought from Saturday’s run – journaling is an accepted method in therapy of working through/processing/understanding yourself and feelings – the process is fluid and unfolds as the writing happens. What happens when the voice of the therapist is added to the writing/product and includes therapist’s own processing as well – if there is written evidence of therapist’s own vulnerability and humanness, the client may feel less “objectified” as the one who has the problems. How odd it is at the beginning. To go to some unknown place and tell a stranger such intimate things. In talking about this over the years with clients and colleagues, it’s clear that the top priority for clients when embarking on therapy is to not feel judged. A look in a certain direction, a movement of the body, a gesture – all of these things are pieces of information, as clients try to determine whether it is safe. That fear of judgement comes up constantly in stories of everyday life for my clients. Such as the story of “I feel great about my identity as a woman but I won’t go to a place I don’t know because if I am misgendered I won’t want to leave the house for days later.” It just tells me that we cannot escape this fear, because we need other people, whether we like it or not, and if they withdraw from us, it threatens what makes us human. Judgement is such a fundamental way that we distance ourselves from one other. How crucial it is that there is a reprieve from this with a therapist, who will hear what might be words of shame and fear. Amanda Stuart and Tammy Robinson (Stuart & Robinson, 2016) are a counsellor and client who have written an article together about their therapy work. Robinson is a survivor of childhood sexual abuse and sought counselling 20 years later. In their article they explore how trust took time to build given the debilitating shame that was present. They talk about writing the article as being therapeutic, but also that their other written correspondence was significant in its healing. Stuart says: Her emails were sometimes long and detailed, and I felt that writing them was therapeutic in itself. At times it was possibly easier to write it for me than to tell me in person. This way of communicating between sessions became a feature of our counsellor-client relationship. When I reviewed our correspondence I was surprised at how many text messages and emails were exchanged over two years. (p. 135)

Writing into healing (Trish)  85

I find myself wondering whether I would write with my therapist. We have uttered such a multitude of words to one another over the years. I know I would have benefitted from this exercise at some stage. But is there anything that I couldn’t say to her by now, that writing it to her would help instead? Interestingly she has been asking me to write about some things recently, and I have been reading to her from my “phone diary.” She jots down notes as we talk. I wonder what she is writing? I remember a moment in which I was struggling with a decision about how best to support my own mental health at that time, and my therapist disclosed a similar experience for herself. Oh, the relief in that moment when she shared this. That desire to be not alone is such a profound human experience and to feel connected to her in that way was hugely significant, and helped me take positive action. My therapist has been with me for so long now, that if I had indeed been a baby when I started with her, I would now be an adult. That is one developmental story right there. And suddenly I am overcome with a sense of gratitude. I remember that first ever session and the chair by the window; it was cane and had floral cushions. The room was big but the space by the window felt intimate and safe. I don’t recall much of what I said but knew I wanted to come back. I didn’t know I’d be coming back on and off, mostly on, for the next 20 odd years. And I realise that maybe any writing we might have done together would have happened years ago, in earlier times. For these days I know I can speak the words. When shame comes, as sometimes it does, tears help it flow into the space. I know it won’t be judged – that was established in times gone by. When I lean into what insight my own experience as a client might offer about collaborative writing as a therapeutic tool, it seems that timing is important – so the when in the course of therapy is particularly relevant. There may be something brewing, but the client is finding it hard to approach it. Maybe to write about something together rather than speak about it could provide the bridge that is needed, as Tammy found with Amanda. Certainly this seemed to be the case with the first article that Dan and I wrote, when Dan was wanting to explore their gender more in therapy, and felt freer to do so through the process of the writing. May 2023

I am back in the space of trying to find the words for the expansive feeling that I referred to earlier. I know it’s a relational thing and it’s about trust and it feels mutual and reciprocal. I need to get my head out of the traditional unidirectional therapy frame of giver (therapist) and receiver (client). Gosh, just let it go for a minute … Now I find myself going back to that Natterson article, the one about love in psychotherapy that we refer to in Dialogue 2. I remember when I first

86  Writing into healing (Trish)

read it back in 2020, after our first journal article for PACFA. Then, it sparked another memory – of me sitting in one of my Master of Counselling classes with a sense of wonder as the teacher was reading something. I don’t know from what source, but it was in the voice of a therapist, speaking to a client and expressing love. Wow! And now here is Natterson (2003) describing the therapeutic relationship and saying “through therapy the self becomes able to enlarge its loving horizons” and that “the currently growing consensus that business of therapy is the strengthening of self then logically requires that the experience of love grows in therapy. Furthermore, because love can flourish only in a situation of reciprocity, it becomes evident that the fostering of love in the patient is possible only in a mutually loving relationship” (p. 514). Ok, this feels like it is getting closer. I feel the urge to capture Natterson’s picture of the intersubjective therapy room. So the client is receiving the therapist’s love through the help the therapist offers. Yep, makes sense. And in being seen and loved, the client has a desire to give love back, which the therapist has a need to receive. Yes, of course. It makes me think of the “microcosm lens” and I sit with a knowing this therapeutic process that I engage in with my clients forms part of the universal need for love and recognition. In August 2020, Dan’s offer to me to co-write an article with them felt like Natterson’s loving reciprocity. A stirring, an excitement and flurry of something and so I accept the offer. And we write, and we banter and we expand. And then we write some more and we disagree and we get annoyed and we misinterpret things and we work it out or we don’t. We get over it and still, we expand. And for now, I will talk about my expansion. I have wanted to write for as long as I can remember. Early, primary school attempts at poetry come to mind, where rhyming couplets were the aim. I can still remember one poem, about spring. I was obsessed with the weather even then. A true Melbournian. There were lots of short stories and an attempt at a novel when I was in year 8, abandoned after about four chapters. Who cares about horses, anyway? Then some plays in high school, with one performed when I was in year 11. Definitely nothing grand but I think of that one fondly and reckon it was pretty alright. The serious business of writing at university was a creative process of sorts but mostly with the aim of proving to an institution that I could understand and think about the writing of others. This writing thing with Dan – what an incredible gift. They couldn’t have known at the time what it would mean to me. I bring to mind the fearful anticipation of those beginning moments. What if I’m shit? Oh well, I guess I can put that little corner brain dream to bed, if that’s the case. But actually, that doesn’t matter right now. It’s not about that. I get what Natterson is saying about recognition. An act of love is truly, madly, deeply seeing someone. Not just an image or a projection but the absolute reality of who they are. I feel the vulnerability of that in my fingers on the

Writing into healing (Trish)  87

keyboard. But Dan did see me. They saw me and it was OK. And it gets even better. In their seeing, they extended another kind of invitation to me. I just needed to look. Conclusion

My colleague Kieran has asked me multiple times how the writing with Dan (and others) has changed me. I had a painful realisation some months ago. I never thought of myself as a perfectionist, I am a “go with the flow” type in so many ways. But there is one area in which I am, and that is in my relationships with other people. I hate letting people down, want to communicate well, want to bring whatever is needed to whatever the situation might be, whomever I’m with. What sits with me now, and is still being processed, is that I can be truly seen by a client. I can see myself as a flawed therapist who can still have the type of relationship with my clients in which my failings are part of the fabric of the collaboration. I can be less-than with my vulnerabilities and insecurities on display and be valued for who I am and the work I do. I see me too. I see me in the therapy chair, on the running track by the Merri creek, on the dance floor, behind the decks at Daddy Bar in Brunswick, playing 80s vinyl records that the 20 somethings somehow sing along to. I see me now, taking hours to get these few, happy words out onto the page. I see I trust I love I am seen I am trusted I am loved

6 BUTTERFLY MOVES (DAN)

Writing prompt #7: The town

The following exercise, adapted from Rachel McKibbens’ (2013) exercise of the same name poetry writing workshop, asks you to write into space, discovering the geography of experience through the metaphor of a town (see Rachel’s website for hundreds of poetry writing exercises). Choose one of the towns from the list below. The condition of the town should be based on its name. Write the atmosphere of the town, starting with the ecology (relationships among animals and plant life), then considering the architecture (roads, buildings, houses, lighting) and then turn to the people who inhabit the town. Make sure you provide yourself with as many details as possible. Next, answer the following questions: What thrives in a town like this? Who or what is its mayor? What is considered a crime? What is considered a gift? What is the soundtrack? What is the sky filled with? What runs in the rivers and streams? What is empty or vacant? What is too plentiful? Use the description to generate a scene, monologue or poem about your town, focusing on the rhythms, repetitions, spatial relations and kinds of “attention” you want to create. Possible names for your town might include: The Town of Forgetting The Town of Hunger The Town of Hollow Women/Hollow Men The Town of Misunderstanding The Town of Unclaimed Children The Town Without Death The Town of Missing Soldiers DOI: 10.4324/9781003268161-9

Butterfly moves (Dan)  89

The Town of Gossips The Town of Superstition The Town of Absent Parents The Town Without Sadness The Town of Lost Dogs (Harris & Jones 2016, p. 62)

14 April 2021 - last session

Today we talked about how we didn’t really plan our final session, which seems strange after so much processing of the writing relationship, so much progress in our work together especially since my BPD diagnosis. How can it be that this most important of transits for clients (and therapists?) could go by so unremarked? We try this morning in our writing session to remember how it went down. We had been writing together for a year or so and the thrill of being published in three articles across two different contexts (one Australian, one American) was intensifying the co-writing. The iterative and co-informing relationship between the co-writing and the talking therapy remained strong. The sheer hours of interaction did grow for a while, as we in essence had three forms of engagement: therapy, co-writing and sessions where we continued to negotiate the terms, boundaries and efficacy of working together in these multiple ways. There was overlap between them, yes, but there were also important differences. Sometimes, in the margin comments of our shared Google doc, Trish would ask me the meaning of comments I made, or other kinds of potentially “therapist” questions. One or the other of us would call it out, have a laugh and move on. It didn’t feel threatening or painful, at least to me. I wonder if Trish has the same feeling, or if it struck her differently. We get a lot of questions about how we each keep safe – and keep each other safe, when/as appropriate. Often these questions focus on how Trish maintains her boundaries, as though I have no boundaries or no right to boundaries because I’m the client. Sometimes the questions are about how we negotiate the messy middle ground. To these I usually say, “But isn’t therapy (and life) messy?” And if therapy is about rehearsing for “real life,” then where exactly is the line between “real life” and “real therapy?” I mean, is it possible that this is itself a fantastical (if comforting) therapeutic construct? Performance and digital media scholars plow this ground regularly. The acceleration of digital technology developments during and since COVID has caused digital and social media scholars to increasingly problematise the previously pervasive view that dualisms like “online/offline” and “real/virtual” life create a false and limiting dichotomy, and that in fact real life happens

90  Butterfly moves (Dan)

online just as (and sometimes more) vividly and authentically than face to face. So, I wonder if – similarly – we need to find new words to discourage the false binary of “real life” and “therapy.” Everything that has come up between Trish and I – inside and outside of the rooms – has always enhanced, reflected or impacted on my life with others. They have all been “corrective emotional experiences” for my life and relationships, and that includes the messiness. It feels reductive to be “practicing” my other relationships with Trish or any therapist (or post-therapist) in some kind of contained way, and yet I understand the need for these containers. But what does that mean for us now? Have we moved from practicing a relationship to having a “real” one? That also doesn’t feel right. Did Yalom and Ginny only have a “real” relationship when she came to that party where she met his wife, or when they wrote to each other, or when they spoke after she finished up? 27 August 2021

It’s been a few months now since I discontinued therapy with Trish. I thought I’d go seek out a new therapist right away, but I haven’t. I’m still co-designing the new grad group with a few others. In March, I started taking testosterone (T) as part of my gender experiment. I feel great. It’s a mysterious hormone – for some, it makes them more aggressive, which is one reason why Stacy and I were nervous about me potentially starting to take it. But for others – including me – it has a quietening effect for some reason. Calmer, quieter, less talkative. It’s been surprising in so many ways, and changes over time of course, which prompts the writer in me to want to document. For the first time, I can see why transgender folks photo-document their journey, or audio-document their voice changes. It’s dramatic, exciting and temporary. So I’ve wanted to, and I’ve done a few little things like taking a few photos, writing a bit. But like many of the most profound transitions of my life, I haven’t quite been able to put them into words. So in short, it’s taken a lot of my attention and feels like an exciting trip to an unknown destination, but it’s been vying for psychic space with a lot of other things happening in my life: changes in my marriage, my work roles, my mental health continuing to improve (with constant work!), my physical fitness. And then there’s the loss of Trish-as-Therapist. At the time, it felt like a no-brainer. I think I said something inadvertently hurtful like “I can get a new therapist anywhere, but a collaborator like you? One in a million!” Ouch. Trish was like “Oh thanks. Ok.” But then. I mean, I didn’t mean it that way! (my usual). It wasn’t the right answer, even I could see that. I guess I was trying to say, Trish and I had already talked about whether our therapeutic relationship had “run its course,” and that therapy doesn’t (at least in Australia) go on forever. But we were both taken by surprise, I think, by the power of our collaborative writing engagement, or at least the power of its outputs. It’s one

Butterfly moves (Dan)  91

thing to enjoy it interpersonally, therapeutically, but quite another to have folks from a range of disciplines and sectors resonate. Powerful. Validating as writers, collaborators, but what about the ““therapeutic”” relationship? And how is this abstraction of the “therapeutic relationship” different suddenly from our collaborative writing one? We agreed, from the beginning of this collaborative experiment, that “it is all the work.” Everything that arises is “the work.” But that doesn’t address the ethics and rules. The ethics and emotions of shifting into a new kind of relationship rather than just discontinuing as therapist/client are complicated, it’s true. And even that brings me new insights about my own boundaries, abilities and limitations. 19 September 2021

This day is the death anniversary of my brother Michael, gone now 39 years. Incredible to think of so much time passing. It is also, strangely, the birthday of my birthmother, Dorothy. She is 25 years older than me; or, put another way, 25 when I came out of her body reluctantly, only with the help of forceps. Perhaps I knew how hard this life was going to be and I tried to stay inside for as long as possible. So she is turning 80 today. I’ve still never met her, and that’s looking increasingly unlikely as the years inch away. Eighty is a big milestone. A tricky day for us all maybe. Her last sibling died not long ago, and my birth cousin Carl (the only birth family member I’m still in touch with now) reached out to her on my behalf, thinking she might have softened given all the losses and her advanced age. Nope. She didn’t even respond. I’ve resolved myself to never meeting her, but I know it will be yet another grief when she finally goes and the possibility is removed forever. Today I’ve been thinking about how my relationship with Trish has changed since we discontinued our therapeutic relationship and started nurturing our collaborative one exclusively. I’ve been thinking about how it brought to a close our (short) dual relationship of both therapy and collaboration. That was a bright, exciting productive time but it was short-lived and I think that’s ok for us both. It was strangely hard too, and I ask myself why. The same things that were exciting and deep about it, I suppose: the rich folding back in on itself, the hours, the intensity. It was like one huge therapeutic feedback loop. I think with stopping the therapy, I feel some distance here to talk about process, without it necessarily folding back in on me, a specific problem at least, or multiple problems, but just allows me to consider, reflect, talk about our mutual process, which feels more manageable. Trish says she thinks she might have found it less intense than I did. She agrees about the therapeutic feedback loop, but she found that very stimulating and exciting in terms of the work. She points out that on the “client end” of that, it might feel a bit exhausting and one-sided, like we are doing this work together in the writing, but then moving it into the therapy space, where the spotlight is more on me

92  Butterfly moves (Dan)

again. It was always difficult to get the spotlight off me, as collaborators too, because that was the foundation of our therapeutic relationship. Trish was reluctant to share much of her feelings in the beginning, and I can understand why. What’s interesting to me now is the irony of that decision to end the therapeutic relationship in favour of the writing collaboration has not necessarily made the nature of the current relationship singular, as maybe we’d imagined. For example, while it has ended the formal part of our therapeutic relationship, it has not ended a kind of shared attention to the “work” that happens between us, now from a different perspective. Would this always be true, for any relationship like this one that evolves into a collaboration, or is this a by-product of us having been client/therapist? We have sung its praises often enough. We have co-celebrated the wins: the joy of collaboration, the pleasure of finding an easy co-authoring relationship, the excitement of the work, the surprise of others’ interest in our work. But I think, in an interesting way, the complexities continue as well: How does Trish lean or release into being a full person with me, including frustrations, hurt, disappointments, anger? How does Dan let go of therapist Trish when collaborator Trish hurts or frustrates them? How do we navigate differing professional investments in this work? What can we share of this with readers that may be helpful to them as they explore these “grey” areas? Sometimes I think we are both being vigilant about the emerging friendship now, perhaps even more so than when I was still in treatment, because it was a “no go” zone. I also have ambivalent feelings: both grief at the loss of one kind of engagement, and satisfaction at the gaining of the new. I do sometimes feel a tinge of sadness when something challenging happens or a juicy topic comes to mind, and I think about exploring that with Trish in therapy, and then I feel myself pull back from that. But I also know that when the time is right, I will find another therapist and begin again. And I wonder what that will be like, after this very special experience. My Catholic childhood echoes: Ecclesiastes 3: For everything there is a season, a time for every activity under heaven. A time to be born and a time to die. A time to plant and a time to harvest. It’s been wonderful getting to know Trish intellectually as co-authors, and I guess that also carries with it a kind of flattening of the hierarchy. I like how she takes seriously her professional commitment to not friend ex-clients, or at least recent ex-clients. As an ex-high school teacher, I understand and value these ethical commitments. I guess what’s interesting to me – and might be to psychotherapy students – is how these ethical commitments can be honoured, valued, foregrounded even and complicated work can still occur. How the practices of psychotherapy – like research – might continue to evolve and stretch. Certainly a large part of my intellectual and work life is bound up in

Butterfly moves (Dan)  93

pushing at traditional research methods and theoretical frameworks, always tied to “real world” concerns and what might help address the particular social concerns of this moment. It seems to me that therapy sits right in that same space, and might need to evolve in similar ways. I hope this book can contribute to those kinds of evolutions and considerations. 2 February 2022

Going back over some of this earlier work, today I read Trish’s account of losing her mom (and subsequently her dad). I think about losing my own parents and what a reckoning that was for me. Somehow that quiet “behaving for parents” voice in my head stopped, I was free. I didn’t have to be good anymore, I wasn’t “not enough” anymore. I was just me. I could do what I wanted. How does that reflection sit with the past 3 years of breakdown, diagnosis, hard work, reckoning, gender transitioning and “graduating” from DBT – does one ever graduate from recovery, from treatment, from healing? I don’t think so. I have experienced all of these momentous phases mostly as celebration, especially once I emerged from the crisis period. But today I’m reflecting that there is grief, certainly there is grief. Denial Anger Bargaining Depression Acceptance In 1969, Swiss American psychiatrist Elisabeth Kübler-Ross described these five common stages of grief (Kübler-Ross & Kessler, 2005). I read her as a teenager, and became interested in Stephen Levine, who worked with her in prisons. I read so much about death and spirituality as a young person. I’m pretty sure it didn’t start with my brother’s suicide when I was 16, but before that. My parents were considered older parents at that time, although today having children in your 40s isn’t particularly remarkable (my mother was 40 and my father 44 when I was adopted). But they talked a lot about their own deaths, and they were Catholic lay ministers who brought communion to the elderly and dying in their spare time. So I was just surrounded by the notion of death and spirituality from a very young age. I wonder how that has played into the evolution of my BPD, my “internal dialogue” of a life of writing, my collaboration with Trish now? Being of service

We’ve tried together and separately to articulate why we think this is such a powerful modality that other therapist/clients may want to try, and we always come up short. In the beginning, we worried about it: what are we trying to

94  Butterfly moves (Dan)

say? Who are we to recommend “our thing” to others? What is it exactly that we are recommending, anyway? I think I’m trying to say that it’s not a failure if this kind of collaborative work together leads to discontinuing, how that can be ok, how indeed it is expected (as it is in all therapy), but in a particular kind of way. I’m curious about how our experiences may or may not appeal to some readers. Some clients may want to try the co-writing experience as a modality with their therapist, but not want or be able to handle the intensity of the (seemingly endless) negotiation of boundaries, the pressure of publishing, the shift in hearing from their therapist rather than a constant focus on the client. Is it possible to do this work without the intensive negotiation of boundaries? I wouldn’t think so. And then there is the question of therapist vulnerability. That old chestnut. For me there was a momentum in our co-writing which opened up new liminal space of Trish saying more about the impact on her of our work together. I say liminal because this led in part to more disclosure from Trish about her personal life overall (her mother’s death, to start with). In a sense, it raised the question for me of whether that opening up would or should remain if we continued “in the room” strictly speaking. It doesn’t mean that if we continued our therapeutic work, and our co-writing work, that those roles couldn’t be different, but it’s hard. Given how our collaborator relationship has evolved since we discontinued, Trish has also described how it is hard for her to let go of that role, or to step out of the commitments of that role in terms of still being more “receptive” to me, than perhaps I am of her, even when I welcome this as collaborators. The takeaway for me here is that both therapist and client must remain committed to ongoing negotiation if this is to work, and that’s a big ask with lots of factors determining the outcome. Collaborative writing as transitioning out of therapy

So we have raised the idea of whether this kind of practice could be a doorway from relational psychotherapy to ending or other modes of work. I love this idea because it is a way of humanising the therapist and while I know that it’s a common trope that many clients don’t want to see the more flawed or “human” side of their therapists, for me it was important and helpful in transitioning from the work in the rooms to my ongoing work outside of the room. That is, after Trish offered me years of a “corrective emotional experience,” it seemed natural and helpful for me to build my tolerance of hearing harder feedback about some of my difficult behaviours (for example, when I hurt her feelings, when I was harsh, when I was stubborn or insistent). Behaviours that have negatively impacted my life in other relationships. And if the therapeutic relationship may or may not be a practice zone for so-called real life, I like that collaborative writing might be a shared space where this reality-checking can increasingly happen.

Butterfly moves (Dan)  95

Not that therapists don’t do this increased “honest responding” as a matter of course, I’m sure they do. But for me, I felt an increase of this from Trish once we started collaborating, albeit slowly, and that was good for me. Then – as I’ve written about elsewhere – it increasingly caused me to be more interested in Trish’s experience of our relationship. That was something I was working on in all my relationships, not just trying to get “what I wanted” from others, but being able to care more about them and their experiences, particularly when I was feeling distressed or needy. And for me, this was often easier to practice in writing, because it could be really overwhelming in person to hear that I had hurt Trish or upset her in any way. What I’m learning from my groups 4 November 2021

I’ve been thinking about BPD and creative arts modalities. Partly because I’m working on a large research project doing arts workshops with people with lived experience of BPD, and partly because of things that keep coming up on my social media feed and in the DBT group. A number of borderline folks keep writing online about the creative work they are doing with, for, or about their therapists. They draw pictures for them, they use photographs, drawings or paintings as provocations for their talking sessions, they write back and forth with their therapists either on email, text or elsewhere. One observation that’s come up in the workshops is that oftentimes the visual artworks are more brutal than the written words. I wonder aloud to our research team whether this may be because so often when overwhelm descends, words don’t come, or are insufficient, to convey the experience or the depth of emotion. The intensity so often lends itself to visual artmaking in bold intense colours. Others often write poetry, mostly about sadness, loneliness or relationship breakdowns. Memes and other comics or cartoons are effective in conveying the more humourous aspects of living with BPD. Of course, these different modalities will be standard practice for arts therapists, but I’m curious about their efficacy for non-arts trained therapists. What if, for example, Trish, who seems to enjoy her work with borderlines, had a kind of creative protocol that worked from more individual, independent creative arts work along a continuum of collaboratively making work with her clients? I think this would be amazing for borderlines, who so often can’t put into words our feelings, and also maybe for the loved ones of borderlines, as another and less aggressive or “over-the-top” way of communicating when things get rough. So what if a client, for example, was asked by Trish to draw a picture for the next session (kind of like photovoice research method) about their worst moment that week, or their best

96  Butterfly moves (Dan)

moment? They come to the next session and use it as a talking point. Does Trish keep the artworks? Do they become a kind of archive of treatment, of recovery in some cases? Draw the most precious thing, or one thing or person you could love this week. Make a sensory poem. I use these techniques in my research workshops all the time. Presumably Trish (or any therapist) wouldn’t have the time to add on top of the session itself, so it wouldn’t be that great to send ahead work like stories, which would have to be read outside of session, then discuss in session. But maybe clients could write work (as some of her other clients already do), then bring them and either read or summarise it for her. Maybe there are other ways to collaborate too: maybe Trish could write to the client, what she thought about their session, how it made her feel (somewhat like Yalom’s technique). Maybe reading that would be less confronting for the client (like it was for me, to think about how I’m affecting her/others). I’m interested in us together exploring ways that aren’t necessarily “art therapy” ways, but various ways of being in collaboration with her clients – that is sustainable though, not doing so much out of the session. We have both felt fatigue around this. It’s extremely time-consuming. How could that be sustainable, and with how many clients? I think about how many of those in my online groups seem to have been at least initially introduced to the notion of BPD or “soft-diagnosed” as BPD by their psychotherapists, whom they often leave after that to seek more clinical treatment if the diagnosis is confirmed by others. For me, it was so important to have the suite of services and the whole system of support in place, and recognise that each service provider offered different but equally crucial services. I could never have left treatment with Trish during that time, and I’m so glad I didn’t. The kinds of work we did in long-term psychotherapy was a foundational trust relationship where I built the muscles to be able to embark on the other treatments. With Trish, I had the consistency and bedrock to allow myself to be open to Schema therapy at first, and then DBT after that. Seeing a psychiatrist (periodically) at the same time, as required by the DBT program, was also helpful, but totally different. The idea of someone with a new diagnosis leaving their long-term or at least trusted psychotherapist to start DBT or psychiatric treatment from a “stranger” feels sad and overwhelming when I think about it. Of course, everyone is different, but from my perspective and that of many in my groups, one of the most challenging aspects of being in a mental health crisis – particularly if hospitalisation is required – is the ever-changing cast of characters, all with their own views, expertise, recommendations and demands, most of which at least partially contradict one another. I know some of this is sector politics, but it really frustrates me that psychotherapy seems to be the lower status treatment option (and not covered by insurance either). Psychotherapy should be held as equally important as other modalities of treatment.

Butterfly moves (Dan)  97

Conclusion

I ask myself – for the therapist and client who might want to engage in something like what Trish and I have tried, but are worried about repercussions – “what is it like now, having given up that really excellent, productive and valued therapeutic relationship?” My answer is, it’s great. On an abstract level, I guess it’s great to see myself capable of evolving in a relationship and being able to manage that emotionally, including the tricky parts. It’s great in being able to move on when I felt that the therapy had run its course, and not hang on just because I was fearful, or nostalgic, or felt obliged. It’s great to move beyond a kind of “instrumentalism” in my therapeutic relationship with Trish in that I need her to be there for me. And still sometimes, I know we both go “oh, that would be such a good topic to explore in therapy!” and it’s a bit sad, and then it passes. This is an important topic to explore between therapist and client working this way, I would imagine, and probably more than once. Ethically, it will come up for others who attempt this work, and it has been interesting and immensely helpful to see how Trish and I circulate back to this regularly, like a design thinking kind of process of iteration. Perhaps there is a mutuality about it now, like how we can talk about the contributions we each can make to how things are interpersonally. Could that happen in the therapy room? Could we have made that happen if we had continued as client/therapist? That was actually the plan, and we started it, dipped our toes in, but it was difficult to shift the relationship “in the room,” having been so long established in the more traditional way. Maybe one day other therapists will do this with other clients and go further; I’d certainly be interested to follow those experiments. For now, I’m deeply grateful for what we have done.

Dialogue 3 BREAKING UP IS HARD TO DO

Finishing therapy 15 July 2021

Trish:

Dan:

Trish:

I have been thinking about the finishing of the therapy: that Dan has integrated parts of self/experiencing more coherent self, and so our therapeutic relationship also changes, with less dependence on me (my role). This “dependence” is seen as negative in some schools of psychology/psychotherapy and understandable and part of the process in others. Clients will often “need” their therapist at particular stages of therapy. It doesn’t mean this need is unhealthy or wrong. My experience is that in having their needs validated and worked with, clients can feel more able to meet them for themselves or within their relationships with others. I also want to focus more on how easy/difficult/gratifying/not gratifying it is for you to shift to a role with me where you can have needs/wants and share your own stuff. Because it still feels like predominantly focused on my stuff, and I’m wondering how that would be for you but importantly for other therapists if/when they do something like this and discontinue, so that the relationship does need to evolve. I’m curious how you feel about this, Trish. I think it’s one of the biggest shifts. Oh, do we have to talk about my needs? Well, I admit it hasn’t been easy for me to shift roles. Because we have been writing about therapeutic engagement, I feel my therapist’s hat has been hard to take off. Like I had to make sure constantly that I wasn’t impacting

DOI: 10.4324/9781003268161-10

Breaking up is hard to do  99

Dan:

Trish:

Dan:

Trish:

you negatively by sharing more. But that has changed and I think I have become more comfortable with it as time has gone on. I came to understand that if you stopped being a client with me, for me to continue to respond to you all “therapist” would not be balanced. I guess I have needed you to understand how hard that has been for me and for you to be patient. Sometimes you would ask me questions, and I couldn’t even formulate an answer! One question was something about what my kids would find annoying about me. I mean, a lot I’m sure, but I don’t think anyone had ever asked me that before! You have been great at inviting me to take up space, and being curious about my experience of our interactions, and how I am in the world. This openness has flowed back into my work with clients, as I have discussed in other chapters of this book. What has been fascinating to see is how well we have been able to talk about our developing/changing communication and what we might trigger in each other at times. That has been both hard and rewarding! And yet – it is interesting that we have both commented on missing the client/therapist relationship. Do we hang onto it in some ways, and resist change? (Ok, still being therapisty here, I admit). I think so. It seems like a natural part of letting go. Of course, your perspective is different from mine, but it’s still a relationship in which we have both invested. Actually I don’t know if my perspective is all that different to yours. I can relate so much to things you said in your Butterfly Moves chapter, especially about both the loss and the excitement tied up in our transformed relationship. I feel like I have learnt so much about me and you post therapy, and kind of wish that our past therapeutic relationship could benefit from that learning. Like, imagine what more we could do?? Some readers may wonder then, “why stop working together as client and therapist if this works so well?” For me it was because of the amount of time we started to devote to it – the session, then the writing, then the processing the writing, then bringing that into the next session. We didn’t stop because of this method, this method accelerated our work. It started for the purpose of creating the article that we were invited to do. We didn’t choose to do it as a method for the therapy. We came to it for another reason, and we discovered something because of that process. It built more trust. The amount of time was definitely related to the fact that we were producing something, not just extending/enhancing the therapy work. But then it was like an unexpected gift – write this article for publication and just watch the flow-on effect into the therapy

100  Breaking up is hard to do

Dan:



Trish:

work. I remember being so excited by that! And then how inspired we felt about doing more and inviting communities of therapists/ writers/artists to consider this as a method of growth and healing. Yes, we were really confronted with a choice in the end, though. To me that was about being willing to give more time to collaborative writing and take it into the public space, knowing that we had reached the point that therapy could come to a natural closure. But still, it was hard to let go of what we had done together in the therapy space. It seems like we are both pulling back at times, trying not to go into an overtly therapeutic space, given the terms of engagement have shifted. How does the power imbalance of therapist/client unhinge, or should it, or can it? It seems as though there might be a period of grief, of letting go, and maybe that’s ok. It’s a relationship loss, after all, no matter how good the reasons are. And rejection and loss of relationships is at the centre of BPD terror. Ok Dan, stop trying to “make sense” of it all. The analytic/interpretive voice is bullying you. Just say how it is for you. Ok I’m going to write to you Trish, which always works better.   Trish, I miss you as my therapist, I do. You are a great therapist. You are kind, and present, and funny. You saw me through the darkest days. I could absolutely have expressed a desire or need to keep you there, you gave me that option for sure. Sometimes I wonder why I didn’t. Because still I really don’t want another therapist. Not because I’m beyond therapy, I don’t believe in that (I’m a New Yorker, after all). But because I really can’t imagine starting over. Not yet. So has it been worth it? Like everything relational, it’s not so black and white. It’s interesting being in new territory, and so far I’m enjoying it. It’s great collaborating with you, and getting to know you as a person. I’m still learning from you, and I do think the “work” is continuing, because really, life itself is the work, isn’t it? Of course, it continues. And do you know what, Dan? I miss you as my client. You were a great client! I love that you saw therapy as a regular part of doing life; after all it’s the examined life that is worth living, isn’t it? Our therapy conversations had this sense of being continuing and on-going. You always “showed up.” We could enjoy a session and have fun, or it could be so hard and feel crap, but I knew you were in it. To me that expressed hope – we will keep going and meaning will come. But what I loved about moving into the collaborative writing space was seeing you in all of your mastery. To actually witness this skill and expertise first hand was a profound experience. I’m not quite sure how to

Breaking up is hard to do  101

express this, but there was something kind of humbling to have been able to see the struggling parts of you, and see them co-exist with the parts that excel and inspire. You say you are still learning from me, and I would say “same here.” And not just about the skill of writing. When therapists talk about benefit gained from the therapeutic relationship, it is the client who we commit to having primary benefit. But this co-writing process also benefited me. As I wrote in Chapter 5, my learning through our work together has altered my self-perception. I start each work day the same way: I open the blinds, put my laptop on my desk and check whether the plants need any water. I turn on lamps, fill up the water jug and gather up some glasses. I spend some time anticipating who will sit with me today. But into this space I take a different me, a different therapist. And now I wonder: would it have changed our therapy work back then if you had had this version of me? Beyond therapy November 2022

Dan:



Summer’s coming on, and we’ve come to a holiday house at Rye, near the ocean (or rather near Port Phillip Bay), on Victoria’s Mornington Peninsula, for a writing retreat. We’ve been doing this work for so long now, we sometimes lose the thread. But the good thing about ongoing collaboration, like long-term therapy, is that it’s not hard to pick up the threads again, like a conversation with a good old friend. And so it is this weekend – we check back into this book manuscript, see where we’re up to, where we still have to go. I have found walking on the beach – especially during COVID but now still – helps me coalesce the long view with the short view – the details of a project, with the overall picture of what we are trying to say. As many writers have said before, walking is also a great part of writing practice – it somehow mysteriously unlocks the mind, the body, and provides a kind of sensory immersion in otherness that gives just enough distraction to allow the thoughts to flow once again.   Today it’s finally getting warm. There are hints of the southern hemisphere summer on its way – after a cold and prolonged wet spring. As Nancy Pelosi steps down from Speaker of the House in U.S. politics, as the Republicans take the House and the Democrats take the Senate, as DT once again announces his run for the 2024 presidential elections, as Ukranians head into a brutal winter with

102  Breaking up is hard to do







little electricity and few resources save for their indefatigable fighting spirit, it seems we are on more of a precipice than ever. Nature gives solace in the anthropocentric chaos, but so too does writing. Writing (together or individually) can give a deep sense of connection. The reader is always implied – a present absence – even if not here in the room in corporeal form.   Journaling and writing of all kinds was always part of my life, as far back as I can remember. It’s not that we didn’t talk in my family, we did. We talked a lot but only about the “right” things. Not anger, not sex, not desire, not politics, not class. Nothing too upsetting, let’s just say. In the pages of my writing I could say anything and everything. I could rage, I could curse people, I could imagine a different, maybe better, life for myself. I could come out without all the difficulty, I could say what I really thought. I could lust after people or things or success or belonging without having to examine why. I guess that’s one reason why I like the idea of co-authoring in therapy, because therapy too is a context in which we’re supposed to be safe, to be able to speak the unspeakable. And in many ways, throughout my life and many therapeutic relationships, this has been true.   But in other ways it hasn’t, because I’ve never totally been able to override the need or tendency to please. There are just some things I wouldn’t say to a therapist, any therapist. What are they? I can hear Trish asking. But that’s not the point here. The point is that writing does give me (and I believe anyone) the place to be able to say those things with complete impunity: the page won’t judge, and ultimately I have the control, the power to delete what I don’t want others to see. But I hear you, reader, saying that too is a game, an illusion. Many young people I’ve worked with as a teacher have said they don’t feel safe keeping a journal because their parents would read it. I remember being shocked that their parents wouldn’t respect their privacy: that is one thing I did receive from my parents, and I value it deeply. There are countless other stories we have all heard about people being “found out” in one way or another by the traces we leave. Traces are risky, it’s true. They open a door, but they also give something back, leave a trail along which we can track our progress, our evolution, or not. For me, writing has always given back a place where I can be as authentic as I know how to be, without fear of rejection.   Of course, co-authoring is a little different, especially with one’s therapist. But it’s not completely different, or as different as readers may imagine. For one thing, it’s a way of having a conversation but with a sort of … delay. For me it’s also been a place where I can

Breaking up is hard to do  103

Trish:



Dan: Trish:

engage a therapist in a kind of less formal way, and in the case of writing with Trish, she did seem more dialogic on the page, without taking the necessary focus off of me and my treatment. It felt a little like getting rid of the “couch” and instead having a coffee or a walking meeting with my therapist – it’s still therapy, but I can sort of look away without having to feel awkward about that. You know that awkward couch moment when the therapist is just staring at you, and you want to bring something difficult up, but it’s just too …. weird?! Somehow co-writing is like driving in a car where you can both stare out the front and still have an uninhibited conversation – it’s kind of nice. Or yes, having a coffee and just looking around at the passersby while you (seemingly casually) just drop a bombshell. As I sit at the house in Rye, grateful for some space to bring writing back into focus, I think back to what it felt like to write that first article, which was two years ago now. It was during the first long Melbourne lockdown, and I recall my study taking on a life of its own, as it is where I saw my clients on-line, and where the writing happened. Lockdown life was hard, but there was something comforting about the daily movement from the kitchen, coffee in hand, into the study.   It is a cosy space, with its warm, gentle light and the heating duct right at my feet, under the desk. The window did not offer a particularly impressive view, but I came to enjoy looking at the fence, the birds that would perch there, and the neighbour’s tall camellia bush that poked its head over the top of the fence and shared its blooms on my side. The rain on the window would just heighten the cosy feeling and there was a type of contentedness it created for me, which held me in the work. So when I think of the process of the co-writing, I do wonder whether this secure space I inhabited was part of the whole picture. I think so, as when I think back to writing then, the whole image of where I was feels important. It makes me think of what you say Dan, about therapy being a context in which you are supposed to feel safe, and so co-authoring would/should also be that] And there I was, as the therapist, also feeling safe. Trish, did you experience our Google-doc co-writing in similar ways? Or in what ways did you experience it differently? The initial parts of the writing together felt unknown and yet exhilarating. There was something about reading your written account of the work that felt different to whether I had just asked you a question in person. Maybe the page does allow for more honesty; certainly there are no immediate facial expressions,

104  Breaking up is hard to do





Trish:

gestures or other bodily feedback of the therapy room that might lead to self-censoring. And likewise I found myself writing more directly, more honestly, as if there was more room for what is said to be held and digested, rather than responded to quickly. Writing also suits my naturally slower way of working something through. When working with clients, I often come back to something that they said the week before, because I have thought of something that didn’t come to me during the session, but want to say to them. Or want to say to them when the emotional climate has changed. Yalom has said that sometimes it’s good to “strike while the iron is cold” (2002, p. 121). If things feel awkward, it might feel easier to talk about it once the weirdness has tempered.   A lot of the time during the co-writing of our articles, I felt vulnerable. Some of it might have been the fact that you are an established writer and I was tentatively entering into your territory. I may well be writing about something I know about (therapy) but I felt worried about my writing not being to a standard of others that you have collaborated with, and that being disappointing for you. That I would not be up to the task. Of course, not being enough is something I also worry about as a therapist, but maybe I have structures to support that, such as supervision. So I felt anxious about my writing not being good enough, and/ or you knowing I was worried about not being good enough, and then you losing trust in me as someone who could help you. But actually, you said you trusted me more.   The vulnerability was about revealing more of myself, on the page. I know that as a therapist I self-disclose all the time, with my expressions, gestures and reflections that are about what you and other clients are saying to me, and the self I reveal in what I say in response. But in writing it down I was somehow showing even more. Showing how much I cared. It reminds me of the story I shared earlier in the book, of me sharing in a public forum that I loved my clients, and how I wished it unsaid not long after. Sometimes after a writing session, I would feel compelled to close my laptop and walk away, for fear of deleting what I had just written, the vulnerability of it all feeling almost unbearable. When I take a step back it hits me that there has been a parallel process at play. Therapy for Dan: the more vulnerability, the more discomfort in being seen; writing for Trish: The more vulnerability, the more discomfort in being seen. Dan, did you experience my vulnerability? If so, how did it affect you?

Breaking up is hard to do  105

Dan:

Trish: Dan:

Trish:

Trish:

Dan:

Yes I did see the increased vulnerability, almost immediately. It was a very different stance: questioning, unsure, seeking advice from me. It felt good. I guess one interpretation could be that it felt good because I had power, I was “in control” or at least more in control than I experience the therapeutic relationship in the room. But there was more to it than that. I felt like you were finally seeing a more balanced version of myself; that I could still have significant emotional challenges that I needed your expertise for, but at the same time I could have my own competencies and expertise, and that you came to me for that was empowering. It made me feel less “crazy.” So how can it still be a powerful therapeutic intervention and not necessarily lead to discontinuing? Well for one thing, I don’t think leading to discontinuing is necessarily a bad thing. It’s like (your partner) Philip said to you that time – maybe it was time to discontinue anyway. And maybe at some stage the collaborative writing becomes a stepping stone to “autonomy” for your (or some of your) clients. And of course there’s always the possibility that you could do this practice with other clients and it would not lead to finishing. Maybe one form of collaborative writing with clients could be some kind of ending ritual that happens as a part of the process when therapy finishes. I am always interested in hearing more about a client’s experience of therapy. Not just what it is like for you to sit on the couch, but also what the co-creation of the therapy process looks like from your perspective. In our collaborative writing I reckon you’ve had some insight into what goes on “behind the scenes” of the therapists’ world. Your responses to this are so interesting and important; like you are feeding back into the grid. I really love the idea of collaborative writing as an ending ritual for therapy finishing. I reckon I’m going to incorporate this into my regular practice. Can I tell clients it was your idea? Dan, after all the things we have written together about therapy, in all its guises, what is some advice you would give to therapists to help them be more effective? Wow, that’s a hard one. I wouldn’t presume to offer advice to therapists. For therapists who wish to co-author with their clients though, I’d suggest attending to its aesthetic possibilities, even if they or the client are not “good” writers. By aesthetic attention, I mean really allowing yourselves to both experiment with the form, style, language and texture of the words – be it poetry, memoir, creative nonfiction, whatever. Don’t come to the writing in an instrumental way, as a “tool” to get them to open up. Help

106  Breaking up is hard to do

them (and yourself) to experience the freedom of letting go into the artful play. This requires dismantling cultural norms and inhibitions about being “talented” but it also involves undoing some of your own notions, perhaps, about needing to “lead” the client or be in charge. Ethical considerations

Dan:

Trish:

Dan:

Trish:

Dan: Trish:

Trish, for therapists wanting to engage in this kind of work, or the email epistolary work, what is your advice or guideline for “how much” time outside of sessions should therapists spend with a client’s work without charging for that time/work? It is interesting to think about what gets considered “chargeable” time in the profession of psychotherapy and counselling. So much is attended to outside of the therapy hour: writing emails, keeping notes, participating in supervision, etc. As someone who writes clinical notes later, not during sessions, this is a key part of my work with clients that I spend time on that is not charged for. I note in another section of this book, you refer to an article that talks about client notes being a creative process. I wish I felt that way about writing session notes! True, but to me those represent a distinct break between “contact” hours (billable), and the ancillary work that goes along with your role as therapist (just like a teacher has so much prep and grading work outside of classroom contact hours). Surely there is a limit to how much contact any therapist will entertain with a client, without charging for that time? Ha! I notice you are pushing me on this point and I’m feeling resistant. Role reversal, much? I can think of one or two times that I have charged for more lengthy email exchanges, and that would have been because of needing an alternative to an actual session. I think that if a client and therapist decide to add a creative element of collaborative writing to the therapy, they should negotiate what feels right in terms of any extra charge. The important thing is there are clear guidelines set around out of session communication. I tell you though, I would much rather spend time out of session engaged in some collaborative writing with a client, than writing session notes – much more enlivening and engaging! Trish, how much is too much when a therapist is brave enough to be vulnerable with their clients? Good question. I know this sounds a bit clichéd, but it depends on the client. And the context. An example of vulnerability in a therapy session might be when a therapist cries with their client.

Breaking up is hard to do  107





Dan: Trish:

Dan:



And in collaborative writing it might be describing how the issue being explored has touched their own life. Showing genuine emotion and responding to what a client is talking about can be very validating, even healing. In either case it would be important for this process material, that is, what is happening in the space, to always be up for discussion.   But what is too much? If a client feels like they need to take care of their therapist, they may end up self-censoring and not being fully honest. I believe that it is important for clients to trust that they don’t need to protect their therapist – that the hard stuff can be shared and their therapist can hold it.   It is also important to be clear about what happens to the pieces of writing that are produced. In the therapeutic collaborative writing space, questions like where the writing is stored, who has access to it, etc., should be clarified. The writing should still be considered a confidential document and not to be shared without permission. If the collaborative writing goes into the public domain, the audience changes. It would be important for robust and honest discussions to take place about what it would be like for others to read the piece, should names be changed and whether there is any sense of obligation to please the therapist (or client) by publishing work. This reminds me that the power dynamic, as we have explored elsewhere, is ever present. In what circumstances would it not be OK to use collaborative writing as a therapy tool? There could be times when some clients would not be in a place to engage with the reciprocity of collaborative writing. If a client was experiencing times of severe depression, anxiety or even psychic disturbances, then that would be a time for the utmost care and containment for the client. The focus would be on restoring wellness, with the therapist taking an active role in facilitating this process. That makes perfect sense, Trish. As always, ethics needs to remain at the forefront of both this kind of therapeutic collaboration, and for autoethnography as a research methodology as well.   Lapadat (2017) reminds us that autoethnography is inherently concerned with the ethics of power inequalities in research claiming to be objective and usually conducted between a more vulnerable “participant/subject” and an invisible, omnipotent “researcher/ narrator.” She goes on to detail the ways in which autoethnography has been described and enacted as a “relational ethics approach and support a praxis of care” (p. 592). Drawing on Chang (2008), Lapadat identifies three core components to autoethnography: “It

108  Breaking up is hard to do







is autobiographic in content, ethnographic in terms of its methodology, and interpretively oriented toward enhancing social and cultural understanding” (2018, p. 590). It is important to remember that truth-claims attached to “autobiographic” narratives have long been challenged, from literary studies to critical autoethnography (Harris, 2014). Yet the focus on vulnerability and relationality makes autoethnography a perfect modality for client-therapist collaborative writing, and we have brought this ethic of care into our shared practice together throughout.   Chang et al. (2008) draw out the power of collaborative autoethnography, arguing that research is inherently communal – an argument that can equally be made about psychotherapy. “Dealing with multiple voices in collaborative writing is a persistent challenge. At the same time, multi-vocality is a unique aspect of this work that can enrich the final product” (p. 130), and one which – we claim – can enrich the therapeutic relationship as well as any formal or informal outputs. Chang et al also offer multiple useful models for writing collaborative autoethnographies, which might be of use to readers (2008, p. 123), as have Joe Norris and Rick Sawyer in their articulation of “duoethnography” (Sawyer & Norris, 2012; 2015).   The leading scholar in the development of autoethnography, Carolyn Ellis (2007; 2016), has articulated a “relational ethics” required by critical autoethnography, a kind of ethical test that goes beyond typical university “practical ethics” approval processes that ensure – in a practical sense – that “no harm is done,” and also focuses on “situational ethics” which articulates considerations that come up unexpectedly when working with others autoethnographically.   We discuss this in our first article for American online journal Psychotherapy.net (run by Yalom’s son Victor), back in 2021: The expertise and insights that those with lived experience of BPD could bring to research into this area continue to largely be excluded from much BPD scholarship. Clinical BPD studies position medical practitioners as singular “credible knowers,” who interpret and draw meaning from clients’ behaviours through a still-persistent objectivist biomedical lens. Clients’ inclusion in these texts continues to most frequently take the form of short case studies or vignettes recording their behaviours. We offer this collaborative essay as one contribution toward expanding that body of knowledge for both travelers – the client and their therapist. (Harris & Thompson 2021a, n.p.)

Breaking up is hard to do  109

Trish:

Dan, what I like about our collaboration is how different it is to the singular, clinical voice of the texts that discuss psychological theories and their effectiveness. It is even different to the more progressive texts that include the experience of the client. Ours is one of a shared voice. We offer our lived experience and the different roles we inhabit and how they intersect, and most importantly, how we impact one another. As we attend to our relationship and take that learning to our other relationships, we aim to increase the knowledge base for those who work and take interest in the field; as they in turn have their own relationships in which to invest.

CONCLUSION

Writing prompt

Bodhisattva prayer: ‘May whatever circumstances arise serve our greater awakening. Serve the awakening of heart and mind. May it serve. The awakening of compassion and wisdom. (three deep breaths) Write your intention for today. We hope you have found both the scholarship and the openness of this book to be helpful in your own journeys towards more vulnerable, collaborative and creative therapeutic and writing practices. We align with Maria Popova’s claim that: To place our hope in another person is to instantly entwine destinies, linking self and other in a tender and tenacious recognition of interdependence. All love is a form of hope. All hope is the work of absolute sincerity, which is the emblem of being fully human. (Popova, n.d.) We hope the sharing of our different but “entwined destinies” inspires you to be more fully human in your endeavours also. While neither creative writing nor therapeutic healing can be reduced to simple models or formulas, we thought it might be helpful, in this conclusion, to offer readers DOI: 10.4324/9781003268161-11

Conclusion  111

some explicit exercises through the use of “models,” which you might find useful in trying out some of the techniques we discuss in the book. We also include a section on further reading, with suggestions grouped by approach to each technique. This is not a comprehensive list, and we recognise that this is an exciting and emergent area of enquiry that is expanding rapidly at this time, so lists like this can become quickly out of date. However, in the interest of offering as much practical assistance to readers as possible, we include it here. Model #1: The epistolary approach

In this approach, therapists and clients write letters back and forth to each other, a practice made famous by Irvin Yalom in his books. Here the client might, for example, write to the therapist and share it with the therapist in a range of ways: first, client can send it to therapist prior to next session, and then they can discuss in the session; second, client might read out their letter to therapist in the session (still effective in helping clients say things that might not be possible saying off the top of their heads in session, more like reading a script); third, the client and therapist might conduct an epistolary exchange alongside the in-person sessions, dealing with different material in each strand of engagement, or the same. Of course, if this were a regular part of the treatment, the epistolary exchange time needs to be acknowledged and paid for by the client, just as face to face sessions are. One approach to this model that Yalom used effectively is having the client keep a journal of reflections on the sessions written after each one, but written fairly directly to the therapist. The client shares these “letters” with the therapist not weekly, but regularly, and the therapist writes “back” to the client. This can serve a “check the facts” function, or less instrumental aims such as having a kind of mutual “backchannel” that enhances the work being done in session. Model #2: The co-constructed approach

This is the kind of approach we have used in most of our writing. We typically set up a Google doc into which we can both write. That way, we can write in our own time (as we’ve described elsewhere) given we have different schedules and rhythms to our days, or also have the option of writing together in “real time” into the same document, optimally when mutually planned and agreed upon (it can be jarring to find the other in the document unexpectedly). We also have the comments tool to facilitate a kind of side-conversation of “remind me to tell you …” or “I like how you describe this …” kind of commentary. This dynamic helps us keep the writing process informal, dialogic and often brings the humour.

112 Conclusion

Model #3: Email therapy when sessions can’t occur

Sometimes when clients (or therapists) are away, they reach an agreement to have an email exchange rather than a session in person or online. While this is not, in itself, an innovation in therapeutic communication, it does still constitute a co-written form of therapeutic exchange, and we argue that by its written (co-written) nature, it performs the communication differently. A case of Marshall McLuhan’s “the medium is the message” – that is, the content does change according to the form. So in this model, we encourage therapists to look for changes in content, tone and frequency of communication when using this approach with clients. Model #4: Shared weekly inventory approach

This approach uses a similar format to the DBT-style of daily “diary cards” in which the client tracks their emotions, target behaviours and use of skills. Therapists might offer their client a template (table, graphic, whatever) that the client can fill in to track their progress on the goals they are working on with the therapist. By using a written reflection format first, and then bringing it into the session for joint discussion second, clients can easily see the differences between talking reflections and writing/discussing them together. The initial written format might also unlock the client to be more honest about their challenges that week than by direct questioning from the therapist. Model #5: Discussion-Into-Writing approach

In this model, the therapist is asked to share more with the client than in other approaches. It also has the added advantage of placing the client in the “lead” position, and can be a platform for discussing how it feels for the client to have agency with their therapist. To begin, the client might ask: “What emotions came up for you while you were listening to my share today?” After the therapist responds, the client might continue with, “In working with me today, what part/s of yourself do you want to be seen?” Following the therapist’s response, the client might ask, “And in thinking about the parts that are seen, can you say what you want this to then make possible from me?” After the therapist responds, both client and therapist take 5 minutes to write responses to this exchange. Model #6: The wounded healer

Jung often spoke of the increased efficacy of the wounded healer. He even claimed that therapy worked best when the patient brought the perfect

Conclusion  113

salve for the therapist’s wound and that if the therapist doesn’t change, then the patient doesn’t, either. Perhaps wounded healers are effective because they are more able to empathize with the wounds of the patient; perhaps it is because they participate more deeply and personally in the healing process. (Yalom 2002, p. 107) For therapists: Write a letter to your client, at a time when things were falling apart for them. What do you wish you had been able to say to them? Now write a letter as your client, responding back to you. For clients: Write a letter to a therapist you have had in the past, or to this one, when things were falling apart for you. What do you wish they had been able to say to you, that they didn’t, and that you weren’t able to ask for? Now write back to yourself as that therapist. For both: Read these letters out loud to each other. Either discuss or write what feelings it brings up. Conclusion

We hope this text has opened some new ground for questioning the ways in which clients and therapists of all kinds might work together, using co-writing at its centre. We have seen in our own work together how writing is not simply a documentation of spoken communication, but rather offers alternative ways of languaging our lives. Through trial and error, vulnerability and agency, we have both grown through trying these new collaborative techniques, and we hope you do too. Ultimately, what matters most is the authenticity of intention that you bring to the work, not the quality of writing. Lastly, we’d like to reinforce the value of risk. Therapists and clients alike know the risk involved in a new client walking through that door and starting to open up about our histories, and ask for help with our troubled presents. But less well discussed (outside of professional therapeutic communities of practice perhaps) is the risk involved for a therapist when they open that door and invite a new client in. We hope this book goes some way towards contributing to understanding about the mutual risk and mutual benefit of evolving therapeutic relationships – for the partners, and for the world at large. May we all continue to be brave. “… That even as we grieved, we grew … That even as we hurt, we hoped. That even as we tired, we tried. That we’ll forever be tied together, victorious ….” (Amanda Gorman, 2021, from The Hill We Climb, on the inauguration of Barack Obama)

114 Conclusion

FURTHER READING Cuijpers, P., Reijnders, M., & Huibers, M. J. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15, 207–231. ‘Common factors psychotherapy’ – BPD treatment, focuses on collaboration with the therapist, is relational, and focuses on emotion and affect. Haeyen, S. (2018). Art therapy and emotion regulation problems: Theory and workbook. Springer. This book comes highly recommended by both those with lived experience, and art therapists here in Australia. The therapists in particular have cited how practical and useful the text has been. It contains Professor Haeyen’s entire program. Hernandez, R. (2010). Overcoming overwhelming. International Journal of Narrative Therapy & Community Work, 2010(4), 57–71. Koerner, K. (2011). Doing dialectical behavior therapy: A practical guide. Guilford Press. Moreira, A., Moreira, A. C., & Rocha, J. C. (2022). Randomized controlled trial: Cognitive-narrative therapy for IPV victims. Journal of Interpersonal Violence, 37(5–6), NP2998–NP3014. Robinson, P., Skårderud, F., Sommerfeldt, B., Robinson, P., Skårderud, F., & Sommerfeldt, B. (2019). Hunger: Mentalization-Based Treatments for Eating Disorders. Springer. Shiell, M. (2021). My journey as an art therapist focusing on DBT and art making. DBT-informed art therapy in practice: Skillful means in action, 56–72. Shiell, M. (2008). Art psychotherapy, dialectical behaviour therapy, and borderline personality disorder. The Australian and New Zealand Journal of Arts Therapy (ANZJAT), 3(1), 51–65. Springham, N., Findlay, D., Woods, A., & Harris, J. (2012). How can art therapy contribute to mentalization in borderline personality disorder? International Journal of Art Therapy, 17(3), 115–129. Tadros, E., Cappetto, M., & Kaur, L. (2019). Treating symptoms of borderline personality disorder through narrative therapy and naltrexone. The American Journal of Family Therapy, 47(2), 87–101. van Schie, C. C., Jarman, H. L., Huxley, E., & Grenyer, B. F. (2020). Narcissistic traits in young people: Understanding the role of parenting and maltreatment. Borderline Personality Disorder and Emotion Dysregulation, 7, 1–10. Explores the efficacy of creative and narrative modes in their “Creative Identity Program,” for which therapists don’t need an art therapy background.

REFERENCES

Andrew, S. (2017). Searching for an autoethnographic ethic. Routledge. Auden, W. H. (2010). Selected poems. Faber. Beaumont, S. L. (2018). The art of words: Expressive writing as reflective practice in art therapy (L’art des mots: l’écriture expressive comme pratique réflexive en artthérapie. Canadian Art Therapy Association Journal, 31(2), 55–60. https://doi.org/ 10.1080/08322473.2018.1527610. Berry, K., & Patti, C. J. (2015). Lost in narration: Applying autoethnography. Journal of Applied Communication Research, 43(2), 263–268. Brach, T. (2021). Tara Brach in Conversation with Natalie Goldberg | Writing and Haiku as Spiritual PracticeInsight Meditation Centre of Washington, DC. Available at: https://www.youtube.com/watch?v=hVj-T40bVto Brach, T. (2022). Blog: Soul Recovery: Healing the Shame of Trauma. Available at: https://www.tarabrach.com/blog-soul-recovery-healing-the-shame-of-trauma/ Browne, J., Cather, C., & Mueser, K. T. (2021). ‘Common factors in Psychotherapy’. Oxford Research Encyclopedia. https://doi.org/10.1093/acrefore/9780190236557.013.79. Chang H. (2008). Autoethnography as method. Left Coast Press. Chang, H. (2013). Individual and collaborative autoethnography as method. In S. H. Jones, T. E. Adams, & C. Ellis (Eds.), Handbook of Autoethnography (pp. 107–122). Left Coast Press. Chang, H., Ngunjiri, F., & Hernandez, K. A. C. (2016). Collaborative autoethnography. Routledge. Chatham-Carpenter, A. (2010). ‘Do thyself no Harm’: Protecting ourselves as autoethnographers. Journal of Research Practice, 6(1). https://jrp.icaap.org/index.php/jrp/ article/view/213 Coles, A. (2018). The art of note writing: art therapy and clinical notes (L’art de rédiger des notes: l’art-thérapie et les notes cliniques. Canadian Art Therapy Association Journal, 31(2), 101–104. https://doi.org/10.1080/08322473.2018.1522795. Converse International School of Languages (n.d.) “Creative writing exercise”. Available at: https://cisl.edu/creative-writing-exercise-what-our-dreams-tell-us-about-ourpersonalities/

116 References

Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (2010). The heart and soul of change: Delivering what works in therapy. American Psychological Association. Ellis, C. (2007). Telling secrets, revealing lives: Relational ethics in research with intimate others. Qualitative Inquiry, 13(1), 3–29. Ellis, C. (2016). Revision: Autoethnographic reflections on life and work. Routledge. Ellis, C., Adams, T. E., & Bochner, A. P. (2011). Autoethnography: An overview. Forum Qualitative Sozialforschung Forum: Qualitative Social Research, 12(1). https://doi .org/10.17169/fqs-12.1.1589 Epston, D., & White, M. (1995). Termination as a rite of passage: Questioning strategies for a therapy of inclusion. In R. A. Neimeyer & M. J. Mahoney (Eds.), Constructivism in psychotherapy (pp. 339–354). (Reprinted in modified form from “Dulwich Centre Newsletter,” 4, 1990, pp. 1–11) American Psychological Association. Erickson, M. H. (1991). My voice will go with you: The teaching tales of Milton H Erickson. Norton. Faulds, D. (2002). ‘Let it Go.’ Go In and In: Poems from the Heart of Yoga. Available at: https://www.mokshayoga.com.au/let-it-go-danna-faulds/ Fixsen, A. (2021). Fragile minds, porous selves: Shining a light on autoethnography of mental illness. Qualitative Social Work, 22(1), 14733250211046657. Gleeson, L. (2021). The Physiological Manifestation of Grief. Webinar presented by PACFA on 6 November 2021. Available at: https://shapesofgrief.com/ Good Therapy. (n.d.) ‘Harry Stack Sullivan’. Available at: https://www.goodtherapy. org/famous-psychologists/harry-stack-sullivan.html Gorman, A. (2021). ‘The Hill We Climb’. Available at: https://theworld.org/ stories/2021-01-20/even-we-grieved-we-grew-poet-amanda-gorman-gives-powerfulperformance. Harris, A. (2014). Ghost-child. In T. E. Adams, & J. Wyatt (Eds.), On (writing) families: Autoethnographies of presence and absence, love and loss (pp. 69–76). Sense. Harris, A., & Jones, S. H. (2016). Writing for performance. Brill. Harris, D., Luka, M. E., & Markham, A. (Eds.) (2022). Massive/Micro autoethnography: Creative learning in COVID times. Springer. Harris, A., & Thompson, T. (2020). ‘A dialogue on hope: Long term therapy and borderline personality disorder’. Psychotherapy & Counselling Today, No. 2, 2020. ISSN: 2652-2489, pp. 5–16. Harris, A., & Thompson, T. (2021a). ‘Long Term Psychotherapy and BPD, Part 1: A Dialogue on Hope’. Available at: https://www.psychotherapy.net/article/ long-term-psychotherapy-and-bpd-part-one Harris, A., & Thompson, T. (2021b). ‘Long Term Psychotherapy and BPD, Part 2: A Dialogue on Trust. Available at: https://www.psychotherapy.net/article/long-termpsychotherapy-and-bpd-part-two Heath, T., Carlson, T. S., & Epston, D. (Eds.) (2022). Reimagining narrative therapy through practice stories and autoethnography. Taylor & Francis. Holman Jones, S., & Harris, A. (2018). Queering autoethnography. Routledge. Iosefo, F., Holman Jones, S., & Harris, A. (Eds.) ( 2020). Wayfinding and critical autoethnography. Routledge. Kidd, J. D., & Finlayson, M. P. (2010). Mental illness in the nursing workplace: A collective autoethnography. Contemporary Nurse, 36(1–2), 21–33. Klerman, G. L., Weissman, M., Rounsaville, B., & Chevron, E. (1984). Interpersonal psychotherapy for depression. Basic Books.

References  117

Kottler, J. (2010). On being a therapist (4th ed.). Jossey-Bass. Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief through the five stages of loss. Simon and Schuster. Lapadat, J. C. (2017). Ethics in autoethnography and collaborative autoethnography. Qualitative Inquiry, 23(8), 589–603. Liggins, J., Kearns, R. A., & Adams, P. J. (2013). Using autoethnography to reclaim the ‘place of healing’in mental health care. Social Science & Medicine, 91, 105–109. May, R. (1953). Man’s search for himself. W.W. Norton and Company. Mazza, N. (2016). Poetry therapy: Theory and practice. Routledge. McKibbens, R. (2013). http://rachelmckibbens.blogspot.com.au Natterson, J. M. (2003). ‘Love in Psychotherapy. Psychoanalytic Psychology, 20(3), 509–521. Norris, J., Sawyer, R. D., & Lund, D. (2012). Duoethnography: Dialogic methods for social, health, and educational research (Vol. 7). Left Coast Press. Oliver, M. (2012). A thousand mornings: Poems. Penguin Press. Peck, M. S. (1983). People of the lie. Simon and Schuster. Peck, M. S. (2002). The road less traveled: A new psychology of love, traditional values, and spiritual growth. Simon and Schuster. Perls, F. S., Hefferline, R., & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. The Gestalt Journal Press. Popova, M. (n.d.) On hope. Available at: https://www.themarginalian.org/ Rogers, C. (1961). On becoming a person. Houghton Mifflin. Sawyer, R., & Norris, J. (2015). Duoethnography: A retrospective 10 years after. International Review of Qualitative Research, 8(1), 1–4. Sawyer, R. D., & Norris, J. (2012). Duoethnography. Oxford University Press. Sedgwick, E. K. (1998). A dialogue on love. Critical Inquiry, 24(2), 611–631. Sedgwick, E. K. (1999). A dialogue on love. Beacon Press. Sloan, D. M., & Marx, B. P. (2019). Written exposure therapy for PTSD: A brief treatment approach for mental health professionals. American Psychological Association. Speedy, J. (2013). Where the wild dreams are: Fragments from the spaces between research, writing, autoethnography, and psychotherapy. Qualitative Inquiry, 19(1), 27–34. Speedy, J. (2017). Narrative inquiry and psychotherapy. Palgrave. Stuart, A., & Robinson, T. (2016). Adaption and change in both client and counsellor, in a sexual abuse case. In C. Noble, & E. Day (Eds.), Psychotherapy and counselling: Reflection on practice (p. 135). Oxford University Press. Sullivan, H. S. (1968). The interpersonal theory of psychiatry. Norton. Teyber, E., & Holmes McClure, F. (2011). Interpersonal process in therapy. An integrative model. Cengage Learning. Thompson, T. (2019). Trauma in everyday life in the heteronormative world. Psychotherapy & Counselling Today, 1(1), 40–42. Tolich, M. (2010). A critique of current practice: Ten foundational guidelines for autoethnographers. Qualitative Health Research, 20(12), 1599–1610. Tsabary, S. (2021). A radical awakening: Turn pain into power, embrace your truth, live free. Harper Collins.

118 References

Vuong, O. Fresh Air interview. April 5, 2022. Available at: https://www.npr.org/2022/ 04/05/1091065634/poet-author-ocean-vuong Wężniejewska, P., Szwabowski, O., Szczepaniak, C., & Pławski, M. (2020). The praise of collective autoethnography. Cultural Studies↔ Critical Methodologies, 20(4), 336–349. White, M. (2007). Maps of narrative practice. W.W. Norton & Company, Inc. Wyatt, J. (2018). Therapy, stand-up, and the gesture of writing: Towards creativerelational inquiry. Routledge. Wyatt, J., Gale, K., Gannon, S., & Davies, B. (2018). ‘Creating a space in between: Collaborative inquiries. In N. K. Denzin, & Y. S. Lincoln (Eds.), The sage handbook of qualitative research (pp. 738–756). SAGE. Yalom, I. (1974/1991). Everyday gets a little closer. Basic Books. Yalom, I. (1980). Existential psychotherapy. Basic Books, Hachette Book Group. Yalom, I. (1989). Love’s executioner and other tales of psychotherapy. Penguin Books. Yalom, I. (2002). The gift of therapy. Piatkus Books. Yalom, I. (2008). Staring at the sun. Scribe. Yalom, I. (2017). Becoming myself. Scribe. Yalom, I., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). Basic Books. Yalom, I., & Yalom, M. (2021). A matter of death and life. Scribe.

INDEX

adoption/adoptee 24, 31 aesthetic 8, 105 agency 38, 112, 113 aggression/aggressive 50, 62, 90, 95 AIDS/HIV 7, 13 anger 36, 37, 63, 69, 92, 93, 102 anxiety 12–14, 46, 107 art therapy/ists 8, 34, 43, 44, 58, 95, 96 arts based research 7, 30, 31, 75, 95 attune/attunement 19, 52, 71, 79 audience 5, 17, 30, 34, 35, 43, 78, 79, 82, 83, 107 authentic 8, 16, 51, 80, 82, 90, 102, 113 authority 39, 40, 67 autobiographic/al 56, 57, 108 autoethnography 3–6, 26, 38, 40, 56, 57, 58, 107, 108 binary/ies 6, 27, 64, 90 black and white thinking 27 blank screen 12, 80 body 9, 14, 24, 47, 59, 68, 70, 77, 78, 84, 91, 101, 108 borderline personality disorder (BPD) 22, 23, 24, 25, 26, 27, 28, 29, 30, 32, 37, 42, 55, 62, 63, 64, 79, 89, 93, 95, 96, 100, 108, 114 boundary/boundaries 23, 27, 40, 41, 52, 65, 79, 89, 91, 94 Brach, Tara 16, 44, 62, 63, 71

clinical 8, 13, 15, 24, 96, 106, 108, 109 collaborate 96, 104; collaboration 15, 17, 18, 34, 36, 38, 41–43, 59, 79–82, 87, 91–93, 96, 101, 107, 109; collaborative autoethnography 3, 38, 56, 57, 108; collaborative writing x, xi, xii, 2, 3, 4, 6, 7, 9, 10, 14, 26, 33–36, 38, 44, 56, 58, 59, 81, 84, 85, 90, 91, 94, 100, 105–108 co-construct 5, 56, 111 common factors theory 41 compassion 16, 20, 24, 110 control 38, 43, 62, 63, 102, 105 corrective emotional experience 8, 42, 90, 94 counselling 2, 3, 5, 6, 11, 13, 14, 18, 37, 46, 47, 59, 84, 86, 106 COVID 2, 26, 32, 40, 53, 69, 77, 89, 101 creative/creativity 2–4, 15, 16, 27, 30, 31, 33, 41–43, 57, 72, 73, 75, 86, 95, 105, 106, 110; creative practice 8, 72, 73; creativerelational 3, 8 cry 22, 44, 47 cutting 31 death 1, 12, 18, 19, 45, 50, 52–54, 88, 91, 93, 94 depression 20, 60, 93, 107

120 Index

desire 14, 16, 23, 24, 37, 45, 51, 62, 64, 67, 75, 81, 85, 86, 100, 102 despair 43, 51–53, 78 diagnosis 2, 23, 24, 26, 28, 32, 37, 51, 62–64, 79, 89, 93, 96 dialectical Behaviour Therapy (DBT) 25, 26, 28, 29, 32, 62, 64, 93, 95, 96, 112 dialogic 2, 3, 5, 6, 10, 56, 57, 58, 103, 111 dialogue 10, 22, 33, 35, 36, 42, 65, 83, 85, 93, 98 diary cards 112 distress 4, 10, 22, 50, 51, 61, 95 dog 22, 28, 34, 48, 53, 54, 77, 89 dream 11, 41, 43–45, 86 DSM 24, 64, 75 dysphoria 24, 25, 69 dysregulate/ion/dysregulated 27 email 16, 17, 34, 37, 81, 82, 95, 106, 112 empathy 52, 54, 66, 70 epistolary 2, 106, 111 equal/equality 3, 4, 35, 37, 58, 96, 108; inequality/ies, unequal 23, 35, 60, 107 ethics 5, 10, 23, 28, 35, 37, 42, 56–58, 63, 91, 107, 108 ethnographer/phy 7, 28, 56–58, 108 evidence based practice 75 existential therapy 12, 72 expert/expertise 5, 38–40, 43, 67, 83, 96, 100, 105, 108 father/dad 36, 37, 45, 48, 49, 50, 52, 53, 60, 93 fear/scared xi, 11, 12, 14, 44, 46, 51, 54, 61, 63, 84, 86, 97, 102, 104 fellow travellers 3, 23, 40, 42, 51, 56, 58 feminism 31 Freud/Freudian 12, 73 fun/funny 30, 43, 46, 65, 73, 100 Gadsby, Hannah 30 gay 13, 25, 27 gender 9, 24, 30, 49, 63–65, 68–70, 85, 90; gender affirmation 24; gender dysphoria 24, 25, 69; gender transition 24, 28, 32, 93; misgendered 84 Gestalt therapy 12 gratitude 20, 48, 49, 85

grief 24, 47, 48, 51–54, 91–93, 100 group therapy 13, 14, 66, 72 group supervision 15–18, 72, 73 guidelines 27, 81, 106 ‘here and now’ 12–14, 42 hierarchy 4, 5, 15, 36, 60, 71, 79, 92 heteronormative 26, 68 hope xi, 2, 3, 5–7, 9, 10, 13, 20, 23, 28, 47, 49, 66, 67, 70, 80, 93, 100, 110, 113; hopelessness 28, 80 hospice 49, 50, 51, 61 humour 42, 65, 66, 73, 95, 111 hypervigilant 14 insider 6, 44, 63 interpersonal/interpersonal psychotherapy 4, 11, 13, 46, 79, 81, 91, 97 intersectionality 15, 29, 58, 77 intersubjective 5, 6, 86 laugh/ter 27, 30, 36, 42–44, 65, 89 lesbian 30, 31 limits 9, 10, 27, 56 lived experience 4, 19, 24, 28, 31, 64, 70, 74, 75, 95, 108, 109 loss 1, 47, 50, 51, 54, 90–92, 99, 100 love 1, 2, 14, 16, 18, 19, 20, 22, 24, 29, 30, 32, 34, 38, 39, 41–43, 46, 48, 49, 51, 54, 55, 59–63, 71, 72, 77, 81, 83, 85–87, 94–96, 100, 104, 105, 110 lying 27 manipulative 23 masculinity/male/masculine 25, 27, 39, 57, 69 May, Rollo 12 meditation 2, 32, 44, 71, 77 mental health 4, 6, 7, 9, 15, 23–25, 40, 56, 64, 75, 83, 85, 90, 96 mental illness 24, 30, 31, 60, 63, 64 microcosm 86, 41 mindfulness practice 32, 62, 63 modality/ies 3, 73, 93–96, 108 mother/mum/mom 18, 21, 23, 24, 27, 37, 45, 47–52, 53, 54, 60, 63, 91, 93, 94 mourning 19, 46, 53 multi-modal 8, 42 multi-vocal 8, 108 multiple myeloma 18, 48, 49

Index  121

narrative 3, 7, 8, 9, 33, 35, 56, 57, 58, 69, 72, 74, 108; narrative therapy xi, 3, 4, 33, 35, 38, 57, 58, 82 Natterson, Joseph 72, 85, 86 negotiation 41, 79, 80, 94 objectivity 57, 58 online x, xi, 15, 26, 28, 30, 40, 42, 53, 69, 89, 90, 95, 96, 108, 112 outsider 6, 63, 82 overwhelm/ing 2, 9, 32, 95, 96 PACFA 18, 19, 37, 70, 82, 86 pain 1, 35, 47, 48, 61, 83, 87, 89 pandemic xi, 2,6, 26, 32, 40, 53, 63 peace 28, 44, 49, 62 Pepper 48, 53, 54 person-centred 38, 46 play/ful 15, 25, 29, 30, 31, 35, 36, 64, 106 poem/poetry 7, 8, 16–18, 44, 47, 55, 56, 81, 86, 88, 95, 96, 105 power dynamics 3, 5, 9, 39, 60 power relations 23 practice stories 57, 58 privilege 31, 53, 68, 83 Project Air 30 psychiatry/ist 11, 12, 23–25, 36, 64, 93, 96 psychotheraphy x–xii, 64, 108 Psychotherapy.net 108 PTSD 7 qualitative method 3, 5, 56; critical qualitative research 5, 6, 9, 108 queer/queering 9, 26, 27, 31, 58, 68, 69 rage 29–31, 37, 71, 75, 77, 102 recognise/tion 2, 7–9, 10, 15, 23, 26, 39, 45, 46, 53, 82, 86, 96, 110, 111 recovery 9, 93, 96 reflective 3, 8, 34, 58, 59 relational 4, 7, 8, 17, 46, 57, 78, 85, 94, 100, 107, 108 risk/risky 10, 11, 26, 27, 30, 41, 44, 57, 59, 60, 65, 66, 79, 83, 102, 113 Rogers, Carl 15, 46, 54 running/runner 17, 29, 50, 59, 72, 73, 76, 77, 84, 87, 88, 90, 97, 101, 108 rupture 19, 20, 66, 80

safe/safety 26, 38, 40, 47, 53, 55, 59, 63, 67, 69, 70, 81–85, 89, 102, 103 Schema therapy 26, 96 self-disclosure 19, 80, 81 sensory/senses 22, 77, 96, 101 sex/uality 9, 24, 64, 68, 70, 84, 102 shame 24, 62, 69, 70, 72, 73, 84, 85 siblings 24, 39, 47, 50, 60, 91 social capital 25, 60 social media (online groups) 28, 38, 63, 89, 95 somatize 47 space 2, 3, 6, 12, 13, 15, 17, 27, 33, 35, 39, 40, 41, 43, 46, 47, 50, 51, 52, 55, 57, 59, 63, 65–67, 69–75, 77, 80, 82, 85, 88, 90, 91, 93, 94, 99–101, 103, 107; ‘space between’ 6, 12, 33, 74 stages: of grief 47, 93; of therapy 98 stories xi, xii, 8, 14, 18, 28, 30, 31, 46, 53, 56–59, 62, 63, 67–69, 73, 74, 79, 84, 86, 96, 102, 113 straight (heterosexual) 14, 27, 29, 68 struggle 18, 19, 27, 36, 44, 66 subconscious 45 subjectivity 27, 65 suffering 12, 13, 24, 30, 46, 51, 57, 59, 78 Sullivan, Harry Stack 4, 46 supervisor 37, 40, 42, 45, 72, 73 symbol/ic 31, 72, 74 technology 34, 89 therapy/ist 2–9, 12–15, 18, 20, 23, 25, 26, 28, 29, 32–35, 37, 38, 41, 42, 44, 45, 46, 48, 52–54, 57, 58, 60, 62, 65–68, 70–74, 79–87, 89–94, 96–107, 112; therapeutic 34–37, 40–42, 46, 57, 58, 63–67, 72–74, 78–86, 89–92, 94, 97–99, 101, 102, 105, 107, 108, 110, 112, 113 transference / counter-transference 23, 27, 69, 71, 73 trans/transgender/transition 24, 26, 28, 31, 32, 62, 90, 93 trauma 1, 6, 7, 24, 51, 70, 72 trust 10, 13, 17, 26, 37, 39, 40, 42, 52, 57, 67, 69–71, 79, 83–85, 87, 96, 99, 104, 107 truth 27, 28, 31, 74, 75, 80, 108 unconditional positive regard 15, 18, 54, 79, 80 universal/ity 5, 13, 29, 30, 72, 86 unstable 22, 24–26, 36, 42

122 Index

validate/validation 10, 27, 29, 35, 80, 91, 107; invalidate 24, 26 visceral 10, 29, 45, 68 visual 8, 34, 70, 79, 95 voice/s 3–5, 8, 9, 16, 31, 47, 50, 51, 57, 58, 83, 84, 86, 90, 93, 100, 108, 109 vulnerability 18, 19, 34, 35, 45, 52, 57, 66, 67, 72, 84, 86, 94, 104–106, 108, 113

WET (written exposure therapy) 7 worth/worthiness/worthlessness 17, 62, 71, 100 wounded healer 112, 113 WPATH 25 Yalom, Irvin 3–5, 8, 11–15,18, 19, 21–23, 26, 27, 34, 36, 38, 39,41, 42, 46, 57, 58, 66, 72, 82, 90, 96, 104, 111, 113 Yalom, Victor 108