Extending the Conversation: Extending the Conversation

By Epston, David | Family Therapy Networker, November/December 1994 | Go to article overview

Extending the Conversation: Extending the Conversation


Epston, David, Family Therapy Networker


Letters from therapists to clients can be powerful tools for reauthoring lives.

CONVERSATION is, BY ITS VERY NATURE, EPHEMERAL. After a particularly meaningful session, a client walks out aglow with some provocative new thought, but a few blocks away, the exact words that had struck home as so profound may already be hard to recall. Two of us reconstructing a conversation we had even minutes before may not agree on what was actually said because we each hear selectively. Family members accustomed to their usual fights may listen only for what they expect to hear and simply not register anything unfamiliar.

But the words in a letter don't fade and disappear the way conversation does; they endure through time and space, bearing witness to the work of therapy and immortalizing it. A client can hold a letter in hand, reading and rereading it days, months and years after the session. I have had clients tell me that they regularly reread letters I sent them years ago to remind themselves what they endured, how far they had advanced their lives, and the extent to which they considered themselves to have changed. I often feel that my job as a therapist is to be a kind of amanuensis, a scribe who faithfully notes down the proceedings for posterity and makes readily available a client's history, capturing on paper the particular thoughts and understandings with which they now make sense of their lives. From the very beginning of my career, this is what I have considered to be one of my principal roles.

In 1977, I secured my first job as a family therapist at a child psychiatric outpatient unit in New Zealand. In that medical environment, case notes, or "the file letter," as we called it, were somber documents written to an imagined quorum of colleagues or to oneself, but certainly never meant to be shared with patients. I felt a certain distaste for the customary practice of reducing clients' rich and complex stories to a sterile, medical diagnosis. Although I had never been taught to do this in my training, nor had I ever heard of other therapists doing so, I found myself writing a letter to my very first client family after our initial session. It seemed to me the most natural thing in the world, like an extension of the conversation we had been having. I also put a copy of it in their case file in lieu of the standard clinical assessment. I was sure the typist, a very formal woman near retirement, would disapprove of my unorthodox case notes, but she became my biggest supporter, confiding to me that my letters were so much more enjoyable to type than the usual diagnostic pronouncements.

The family was surprised and gratified to receive my letter, and we read it at the beginning of the next session to give us a jumping-off point. We were all so pleased with having a letter in hand to refer to that I wrote to them again at the conclusion of the second session. Since that first letter, I have written thousands of letters; the great majority of my clients have received one after each session. We begin every therapy hour with a reading of the last letter, which not only reminds us of what had been discussed, but also inevitably connects us to where we were the week before. Even now, if I pick up a file and pull out a letter written to a client years ago, just reading it will carry me back to the session's emotional tone and collapse the time and space that separated us. Clients have described feelings of sorrow, delight, elation (even a compelling urge to dance!) upon reading these accounts of our conversations together.

Because therapeutic letters evolved as a way for me to include and privilege the clients' viewpoint in the official record, I tried to stay very true to the exact words they used, quoting them as often as possible. In the beginning, I needed more than an hour to write each letter, because I mentally had to reconstruct the session to compose what I hoped was an accurate accounting of the meeting. …

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