An Invitation to Between Session Reflection

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An Invitation to Between Session Reflection

• The Use of Brief Therapeutic Letters in
  Counseling

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Wisdom from the Research

• Letters can reduce the number of counseling
  sessions needed.
• Letters help clients to slow down
• Letters make great milestones
• Letters can provide support during difficult
  times
• Straightforward, genuine letters seem to be
  helpful

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Our Experiences with Therapeutic Letters

• Experience as a Recipient
• validation for progress
• increased commitment for further change
• Client Conceptualization
• journal form
• identify cross and counter-transference

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Accounting for Therapeutic Change
Asay Lambert (1999)
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Considering Letter Content An Intentional
Practice
Asay Lambert 1999
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Unpacking the Therapeutic Letter

• Brief
• Intentional Content
• Questioning / Curiosity Stance
• Language is familiar and is consistent with the
  client's experiences

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The Therapeutic Alliance in Writing

• The Relational Bond
• Validating
• Avoiding role as the reality police
• Agreement of Goals
• What does the client want?
• Agreement on Tasks
• How does the client experience the counseling
  hour?
• What ideas does the client have to contribute?
• What was useful or not useful?

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A Letter of Alliance

• Dear Laura,
• Thanks for being willing to meet with me today.
  Our conversation made me very thoughtful, and I
  just wanted to share some ideas that I had on
  what we talked about.
• As you were talking about those voices today I
  was struck by the open-minded way in which you
  are dealing with them. On the one hand you said
  that you felt that the voices might have a
  spiritual origin, and on the other you said that
  you are willing to consider the doctors
  explanation for the voices. Did I get that right?
• As I understood you today, you are considering
  taking two steps in order to deal with these
  voices. The first step is to get that tattoo
  removed. The second step is to try some new
  medication. I heard you say that you have some
  serious concerns about the medication. You said
  that you do not want to gain weight, and that you
  do not want to walk around like a zombie. That
  makes sense to me! I wonder if it might be useful
  or interesting to you for us to meet again to
  talk about the steps you might take, and are
  taking, to get those voices out of your life, and
  about how you might talk to your psychiatrist
  about your concerns. What do you think?
• Aaron

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Extratherapeutic Factors in Writing

• Inquiring after Problem Irregularities
• Recruiting Helpful Others
• Exploring Preferred Identities

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Exploring the Symptom of Solutions in Writing

• Dear Laurie,
• I just wanted to write and share some questions
  I had about some of things you said today. Two
  weeks ago when you came to see me you said that
  alcohol did not give you any choices about
  whether you drank or not. Yet, when you came in
  today you said that you have not allowed alcohol
  into your life for the last week. I am so curious
  about how you did that. I wanted to share with
  you some of the questions that I have about this
  thing that you have done.
• How did you get alcohol out of your life? What
  steps did you have to take to get that to happen?
  If you were going to continue to keep alcohol in
  its place, what would you need to do? Who do you
  know who would be interested and excited to know
  that you have done this?
• Maybe you can bring me up to speed next week if
  some of these questions were interesting to you.
• Aaron

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Hope and Expectancy in Writing

• Confident Presumptions of Change
• Identifying Pathways to Change
• Exploring Preferred Future

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Letter of Hope and Expectancy for Change

• Dear Helen,
• Thanks for meeting with me today. I was really
  interested to hear your ideas about this
  depression that has come into your life. In
  fact, I found that after you left today, I had a
  few more questions. Maybe you can give some
  thought to these between now and next week when
  we meet again.
• I was wondering how your life will be different
  from how it is now when this depression is behind
  you. I wonder what you will first notice when you
  are starting to leave this depression behind, and
  I wonder who might be the first person around you
  who will notice when you get your energy back?
• I am looking forward to hearing your thoughts on
  this. Ill see you next Wednesday.
• Aaron

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Additional Uses for Therapeutic Letters

• Pre-treatment
• post-assessment/pre-treatment
• impact on clients stage of change
• Post-treatment
• engaging disengagement letters
• closing letters

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Conversations about Letter Writing and Reflection

• Preparing to Use Letters
• Is it okay to send a letter?
• Confidentiality concerns
• Minors
• Discussing the use of the letter
• Who would be involved in reading/using the
  letter?
• Under which circumstances might the letter be
  consulted?
• What are the predicted consequences of consulting
  the letter?
• Invite conversation about how the letter was used
• What was the result of having the letter?
• In what ways was having the letter helpful?
• How might the letter be used in the future?

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A Sample Case

• John is a 11 year old male who has been
  diagnosed with oppositional defiant disorder. He
  was brought to counseling by his parents because
  of frequent tantrums that he throws at school and
  at home. Johns parents state that the tantrums
  seem to be more frequent at times when John has
  bad days at school. These are days when other
  students bully John and call him a retard.
  Johns mother reports that John had even more
  tantrums than usual in the last week. She states
  that he had tantrums every day except for
  Saturday when the family visited a local
  amusement park.