Expressive Writing: Counseling and Healthcare [book]

The latest in a series of books on expressive writing has recently been published and I’m delighted to say that it contains a chapter from me. The publisher is R&L Education, and the book editors are Kathleen Adams (who is also the series editor) and Kate Thompson. The chapters cover a range of topics by a wonderful selection of people with experience of using expressive writing in different settings. My chapter is about the therapeutic writing I do in mental health units in Cumbria.

It’s a great book for anyone working  in therapeutic writing. If you are interested, here’s a link to more information on the book on the publisher’s website: https://rowman.com/ISBN/9781475807721.

At the moment the UK Amazon site only has the hardback (£48.65) and Kindle (£22.75) editions. However, the paperback edition is available on the Book Depository (£23.95) – click here, and on Amazon.com ($29.46) – click here.

Best wishes, Carol.

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Writing projects update

At last I can tell you a bit more about one of my writing projects. The chapter I was commissioned to write last year was for an American book on expressive writing in counseling and healthcare edited by Kathleen Adams and Kate Thompson. The book, which is one in a series, is due to be published in September and I’ve just pre-ordered a copy on Amazon. Here’s a link to the book on the publisher’s website: https://rowman.com/ISBN/9781475807721

And last week, after several years of trying to get around to it, I submitted an article on therapeutic writing in acute psychiatry to the British journal Mental Health Practice. Wish me luck on getting it accepted please!

Meanwhile, the HTA monograph I contributed to on therapeutic writing in long term conditions is due out this Autumn I hope.

It’s all very exciting!

Best wishes, Carol.

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One hour creative therapeutic writing workshop

This post is based on a handout I produced for a one-hour workshop for Adult Learner’s Week:

Workshop exercise 1: Freewriting

Freewriting means writing for a timed period without stopping to think, punctuate or correct your writing in any way. The idea is to just keep writing whatever comes into your head, without stopping. If you stop and don’t know what to write next, just write: “I don’t know what to write” a few times and more thoughts will come.

The workshop exercise: one by one for each of a set of 5 words, do some freewriting for 2-3 minutes per word. The words are: castle, house, cottage, garden, door. [10-15 minutes]

Workshop exercise 2: Fictional characters

Choose a piece of fabric. [Note: I have a selection of fabric squares for group participants to choose from. You might get your inspiration for this exercises in a shop that sells fabrics on the roll, or a charity shop.] Imagine who might own something made of the fabric, for example, an item of clothing, curtains, a tablecloth, a cushion. Write about the person, and write about them wearing or using whatever the thing is that is made of the fabric. [15-20 minutes]

Workshop exercise 3: Mindful descriptive writing

The workshop exercise (mindful writing about something in the real world): (1) Write for about 5-10 minutes to describe an object in detail – how it looks, smells and feels (this is the mindful writing bit). You could choose a favourite ornament, a piece of fruit, a tree – whatever catches your eye. (2) Optional second part: write for another 5 minutes about any thoughts, memories or associations that spring to mind. This second part of the exercise is not mindful writing – so let the writing take you where it will, and write from your imagination if you wish. [10-15 minutes]

This workshop provides a taster of three types of writing that can be therapeutic in different ways.

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10-week plan for a ward writing group

A few weeks ago I decided to create a rolling 10-week plan for my writing groups. As this is working pretty well so far, I thought I would share it with you.

Link to plan: Ten week plan for ward writing group

The first column in the plan indicates the week number within the plan. Week 1 is the first week of the first 10-week course, but when I get to week 11, week 1 will actually be week 11 (counting from the beginning).

The plan for most weeks has 3 writing exercises described. The exceptions being weeks 7 and 8, which are about published poetry.

I have briefly described the writing exercises in the Core Exercise column and indicated some variations for both less and more able/well participants in another column.

The Resources column lists what I plan to bring along to each session for writing inspiration – prompt words, pictures, objects, and so on.

The plan initially covers 10 weeks but it is intended to then restart for weeks 11-20, and again for weeks 21-30, etc. For each new start of the plan I will choose different photos, poems, objects, etc. The numbers in brackets indicate resources choices that I plan to use in later weeks, i.e., (1) is for weeks 1-10, (2) is for weeks 11-20, (3) is for weeks 21-30, and so on.

Feel free to use the plan, and to reblog this if you wish, and do let me know if you find it useful, or want to share any of your writing exercises or session plans, or just have any comments you want to make.

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North Country Bus

Rosie the vintage bus

Rosie the 1946 Leyland Tiger visited Carleton Clinic recently for Dementia Awareness Week and inspired my next couple of writing groups.

This lovely north country bus parked up outside the Ruskin Unit at Carleton Clinic as part of a Dementia Awareness Open Afternoon on Monday 18th May. I sat in the bus for an hour or so handing out old fashioned sweets, and talking to the patients who climbed aboard for a quick trip down memory lane, and to the carers and ward staff who accompanied them. There was an eclectic collection of nostalgia items laid out on Rosie’s back seats: bus tickets, a ticket machine, a bus driver’s hat, a travelling gentleman’s grooming case, assorted hats, trinkets and jewellery, cigarette cards, and much more. I had made a small pile of postcards of Rosie and as people boarded the bus I asked them where they would like to go on Rosie if they could go anywhere at all that they wanted. I wrote their answers on the postcards and gave them to the ward at the end. Where people wanted to go varied from “Carlisle” to “home” to “Cornwall” to “the mill near Shap” to “Brazil”! A few people took away a postcard as a souvenir.

The postcards of Rosie went down very well in my next few Carleton Clinic writing groups. In the Hadrian Unit, which is an adult mental health ward, everyone wrote on the back of their postcard and we all wrote something quite different. The brief was that we could go to any place and time in Rosie, with any people we wanted. An 18-year-old young man who loves motocross wrote that he would adapt Rosie to accommodate two motorbikes in the back and then he and his friend would go travelling on with their bikes, sleeping and cooking on the bus. A middle-aged female patient wrote that she would adapt Rosie to be like a campervan to take on holiday with her family. I wrote that I would go back in time on Rosie with my sister and my son and visit my Mum and Dad when they were younger and stronger, and when my Dad could walk (he became left-side paralysed because of a stroke last year).

In the older people’s ward, one patient did not write about Rosie at all, or even about a journey. He wrote instead about his own early life. However, he wrote clearly and lucidly, and he read the piece of writing aloud to the group. This was a good achievement given that he is often confused and delusional. Another patient wrote on her Rosie postcard a message to her dear friend, who happens to be called Rose.

Relating a writing exercise for a group to a recent event can, I find, help to engage participants with the exercise. And once their interest has been caught, a simple thing like a postcard of an old country bus can spark inspiration in people of widely varying age and differing symptoms. The key factors for this exercise were to engage participants’ interest in the postcard exercise by first telling them about the visit of Rosie to Carleton Clinic; and then give them instructions that were sufficiently clear for someone with memory problems to cope with, but at the same time flexible enough to give freedom of choice to the more imaginative and able participants.

Thinking about Rosie the north country bus has reminded me about Jake Thackray and his lovely song “Country Bus”. If you have not come across singer-songwriter Jake Thackray (1938-2002) then please do have a listen to some of his songs, which are mainly witty tales of rural Yorkshire. Being from Yorkshire myself, I am somewhat biased in favour of his lovely Yorkshire baritone voice. I was lucky enough to see him in concert twice and even chatted to him briefly in the interval. In my opinion – to use a phrase I stole from Jake himself – he was “head, shoulders and knees” above any other comic singer I know of – living or dead.

Lyrics to Jake Thackray’s “Country Bus” and Jake singing the song.

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The ten year itch?

10th-birthday-cake

I stayed for ten years in my last job, so should my boss be worried that today is my tenth anniversary with the Cumbria Partnership NHS Foundation Trust (CPFT)? Have I got itchy feet? No, I have not (no need to worry Rob).

The secret to my contentment has been in finding the right combination of two parallel careers – having discovered many years ago that working full time in one post does not suit me. There are many part-time workers in the NHS and I have been fortunate enough to work part time for all my 23 years in NHS clinical audit. Which has freed me up to regularly exchange my clinical audit hat for at least one other type of headgear. I am beginning to sound like The Cat in the Hat!

For well over a decade my parallel career was in scientific publishing: writing abstracts, proof reading, copy-editing, indexing, and so on. This was a reasonably interesting combination for me, but not quite perfect. Then in 2005 two things happened: my son inspired me to re-visit creative writing; and I started work at a mental health and learning disabilities Trust (the CPFT). Those two steps set me on a writing ramble that has lasted ten years so far.

When I started writing for pleasure again I discovered, as many before me have, that writing is good for you. So I began reading about therapeutic writing, did some training, joined Lapidus, and started to wonder whether I might be able to do some writing work in our mental health wards. My therapeutic writing career breakthrough came in 2009 when I saw a poster for the CPFT’s very own Dragons Den. I bid for and won funding to lead a “Year of Writing” project. And as part of the “Year of Writing” I started my first weekly writing group in a psychiatric ward.

My combination career is now made up of a part-time, permanent post in clinical audit, and sessionally paid work leading weekly therapeutic writing groups in four psychiatric wards. A combination career may not be for everyone, but it has worked for me for more than twenty years. It is definitely a good option to consider if you feel the need to retain financial security, but at the same time yearn to pursue a new career in an intellectually stimulating (but notoriously low paid) field such as writing.

For those who are interested here are some milestones of the last ten years:

2005            started writing fiction and poetry again (after twenty five years)
2005            joined CPFT
2007-08        Introduction to Counselling Certificate
2008            Introduction to Mindfulness training
2009            achieved Certificate in Creative Writing (Lancaster University)
2009            two poems published in “Pinhole Camera 3” (University of Cumbria)
2009-10        in-house Psychological Skills training (levels one and two)
2009            led my first writing workshop
2010-11        led the CPFT “Year of Writing” project
2010            started therapeutic writing in a mental health ward
2011            organized the “Writing in Healthcare Conference”
2011            started this blog
2011            started weekly therapeutic writing group in Psychiatric Intensive Care Unit
2011            Ty Newydd Writing in Health and Social Care course
2012            published the “Words for Wellbeing” book
2012            started weekly therapeutic writing group in 3rd mental health unit
2013            won a prize in the poetry installation “Beneath the Boughs”
2013            joined the STyLUS project team
2014            story published online by “Page and Spine”
2014            commissioned to write a chapter in a forthcoming expressive writing book
2015            started weekly therapeutic writing group in 4th mental health unit

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The Art of the Essay

If you had asked me a month ago whether I was interested in writing essays, or even reading them, my answer would have been a fairly emphatic no. This is because until then my only experience of essays were the sort one has to write as assignments on academic courses. That being said, I do remember enjoying writing one particular essay. It was while I was studying for my biochemistry degree, and I think the topic was something along the lines of: “Those who communicate discoveries to the people are as important as those who may discover them. Discuss in scientific terms.” In hindsight I think the reason I enjoyed that particular essay was because it was entirely my own creation – there was no requirement to impart knowledge to the reader.

In our last workshop, my creative writing tutor (Brindley Hallam Dennis aka Mike Smith) showed the group a volume containing the 2013 winners of the William Hazlitt Essay Prize. As I flicked through the attractively bound volume, one essay caught my attention. I only had time to read the first few lines of “The art of waiting” by Belle Boggs (Boggs 2013). But I later read and enjoyed the whole essay, plus an article or two on the art of essay writing (especially Walker 2013), and was persuaded to have a go at essay writing myself.

So at tomorrow’s workshop, where I would usually take along a piece of short fiction to read aloud, to be discussed by Mike and the group, this time I will be taking my first attempt at a literary (as opposed to academic) essay.

Brindley Hallam Dennis blogs here: https://bhdandme.wordpress.com/

Boggs, Belle (2013). The art of waiting. In: William Hazlitt Essay Prize 2013 – The Winners. Notting Hill Editions, 2013. Retrieved 31/05/2015 from: http://www.nottinghilleditions.com/uploads/essaywinners/NHEessayBOGGS.pdf

Walker, Cameron (2013). The Art of the Essay. Retrieved 31/05/2015 from: http://www.theopennotebook.com/2013/06/25/the-art-of-the-essay/

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Updated NICE guideline on managing violence and aggression

NICE NG10

The National Institute for Health and Care Excellence (NICE) has just updated its guideline on managing violence and aggression in inpatient psychiatric settings (NICE 2005). The new guideline is called: “Violence and aggression: short-term management in mental health, health and community settings” (NICE 2015).

Naturally – as I lead therapeutic writing groups in acute psychiatric units – I am always interested to find out what NICE guidelines may say about the provision of creative groups/activities in psychiatric wards, and particularly whether writing groups get a mention. So I was pleased to see that the new guideline does indeed mention the provision of writing groups for inpatients in one of the domains of “a framework to anticipate violence and aggression in inpatient psychiatric wards” (NICE 2015, p9). Specifically, the domain states: “Ensure that service users are offered appropriate psychological therapies, physical activities, leisure pursuits such as film clubs and reading or writing groups, and support for communication difficulties.”

Although disappointed to see writing referred to merely as an example of a “leisure pursuit” (rather than as a complimentary therapy), I nevertheless see this specific mention of writing groups as an incremental step forward for therapeutic writing in the UK.

The wording in the new guideline is definitely an improvement on the old, which stated: “Services should be able to accommodate service users’ needs for engaging in activities and individual choice – there should be an activity room and a dayroom with a television, as boredom can lead to disturbed/violent behaviour” (NICE 2005, p14).

Unfortunately, most NICE guidelines do not mention provision of creative activities in their recommendations. The small number of current NICE recommendations that do refer to creative therapies and activities include:

“Ensure that service users in hospital have access to a wide range of meaningful and culturally appropriate occupations and activities 7 days per week, and not restricted to 9am to 5pm. These should include creative and leisure activities” (NICE 2011, p22).

“Consider offering arts therapies to all people with psychosis or schizophrenia, particularly for the alleviation of negative symptoms. This can be started either during the acute phase or later, including in inpatient settings” (NICE 2014, p25).

Getting therapeutic writing embedded into the recommendations of UK clinical guidelines is probably not going to happen anytime soon, but with the publication of the new NICE NG10 guideline we have taken a small step forwards.

References

NICE (2005). The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. London: National Institute for Health and Care Excellence, CG25, February 2005. Retrieved 30/05/2015 from: https://www.nice.org.uk/guidance/cg25/resources/guidance-violence-pdf

NICE (2011). Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services. London: National Institute for Health and Care Excellence, CG136, December 2011. Retrieved 30/05/2015 from: http://www.nice.org.uk/guidance/cg136/resources/guidance-service-user-experience-in-adult-mental-health-improving-the-experience-of-care-for-people-using-adult-nhs-mental-health-services-pdf

NICE (2014). Psychosis and schizophrenia in adults: treatment and management. London: National Institute for Health and Care Excellence, CG178, March 2014. Retrieved 30/05/2015 from: https://www.nice.org.uk/guidance/cg178/resources/guidance-psychosis-and-schizophrenia-in-adults-treatment-and-management-pdf

NICE (2015). Violence and aggression: short-term management in mental health, health and community settings. London: National Institute for Health and Care Excellence, NG10, May 2015. Retrieved 30/05/2015 from: http://www.nice.org.uk/guidance/ng10

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Finding a poem

found poem

[Image from Mr Miller’s English Language Arts Blog and found using Google Images]

Creating found poetry means taking words, phrases and lines from other sources and using them to create poems. I’d like to tell you about two kinds of found poems I have been introduced to and enjoyed.

1. Finding poems in published prose

I first heard about this type of found poetry from Kirsty Stanley, who is an occupational therapist and a writer. On her blog, Kirsty has included found poems she crafted by photocopying a page of a book or magazine and creating a poem by artistically highlighting selected words and phrases on the page. This is a fun technique that can create something quite unexpected – for example a poem on a topic that is different both from your usual poetry and from the source text.

For the poem I have included below (Stalled), I didn’t use quite the method Kirsty describes on her blog – she creates a poem directly on the photocopied page (like the example above from Ezra Miller’s blog), whereas in my poem I typed the words up and inserted line breaks where I wanted them. However, like Kirsty, I didn’t add or change any words or change their order.

The method I used was: (i) photocopy a page (two pages in this case) from a book; (ii) select and highlight words, phrases and sentences to include; (iii) type them up; (iv) insert line breaks; (v) fine tune, e.g., by adding or removing words (ensuring that any words added are taken from the text and in the original order).

I have scanned and highlighted the double-page spread from a novella, A Penny Spitfire by Brindley Hallam Dennis, published by Pewter Rose Press, that I used to create the poem ‘Stalled’ (see below). I used pages 82-83 (reproduced with permission).

BHD extract

If this type of found poem is new to you, my tip would be to choose a page with plenty of words and little or no dialogue. This is a technique to play with – just have a go and see what you find.

Stalled (‘found’ in A Penny Spitfire by Brindley Hallam Dennis)

His workshop
stood untouched,
encrusted with dirt
and cobwebs.
Spiders hunted in
threads of silk.

He’d changed.
Raw edges where his
life had torn,
had hardened.
Pain turned
to numbness.

She too changed,
The simplest things
divided them.
They began to live
as strangers.

He tried to remember
what they had before
but it seemed far away.
They had lost something,
did not mesh anymore.

They could not talk
about the past.
Yet he sensed
through words they could
come back together.

But how did you do that?
How tell the things
he wanted to tell?
Even thinking about them
made him shake inside.

2. Poems ‘found’ in conversations with others

On a Writing in Healthcare course at Ty Newydd I learned about another kind of found poem from poet, tutor and cofounder of Lapidus, Graham Hartill. Graham told our group about found poems he has created from notes he made of conversations with inmates when working as a poet in a prison. This technique can be used or adapted to give someone who doesn’t consider themselves to be very creative, or who does not or cannot write much, the experience of writing a poem.

Here I describe using the technique to create a found poem about a child’s experience of World War II. My mother was 10 when WWII began. To create a found poem based on her memories I first interviewed her about the war. During the interview I made rapid notes and also recorded the conversation. Later I typed up the main ideas from her responses, sometimes but not always using her words. I played with the order of the ideas until I felt I had them grouped and in a logical order. Then I played with the lines themselves, editing and refining to turn whole sentences into the lines of a poem that I hope has rhythm and flow. Finally I checked back with Mum to see whether she was happy with my poem ‘Make do and mend’ (see below).

Make do and mend

I was 10 when war started.
We kids didn’t hear much about the fighting. Just
what was on Pathé news at the pictures.
The man had a funny voice.

None of my family joined up.
Young men had a choice: go down the pit or go to war.
My Dad was a miner, and my brothers,
those that were old enough.
I remember seeing young men on the buses though,
off to start their training.

There was an army camp near us.
The soldiers unwound electric cable
right through the village. To untangle it.
Then they wound it up again.
Our Mary tripped over it, broke her leg.
She got fifty pounds.

Clothes were on ration.
Mostly it was make do and mend.
A lot of folk knitted. Pulled out old things
to knit new. Cut down women’s dresses
to make clothes for kids.

You had to queue to get stuff.
Me and Lil walked four miles to queue for a pork pie.
Dad grew vegetables. And mushrooms.
Mushrooms were dear then.
He dug a pond in the garden and kept ducks.
God they made a mess.

He raised cockerels for Christmas.
And in our stocking: an apple, an orange
and a few pennies.
We made cakes with powered egg.
Grated carrot in the Christmas pud
made the fruit go further.
Mam could make a meal out of anything,
a ham bone and a few peas.

You couldn’t get Christmas trees.
Me and our Jamie cut the top off a holly tree.
From up the top I could see a Lancaster
belly up in a field. Jamie wanted me to get down
so he could climb up and see. But I wouldn’t.
We crept along the hedges to get a better look,
snuck past the men in uniform,
the army and air force police.

One night the Germans dropped incendiaries.
Mam made us hide on a mattress under the stairs,
me, Jamie and Lil, while she stood at the door
watching planes trying to bomb the mines.
They missed. And me and Jamie crept
under the kitchen table while Mam wasn’t looking
and pinched some raisins.

…now go and find a poem or two – play, have fun, enjoy!

This post (most of it) first appeared on the Poetry Space blog.

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Red Rucksack

Red RucksackIt’s lasted well,
his red rucksack.
Zip often strained to bursting
but not bursting.

Thin and light when empty
bulky and heavy as he
jogs and it bobs
down our road and
across the field
to school.

And such a comfort
the brilliant red of it.
I see it as a small
scarlet blur
crossing the school yard
safely arrived
unaware of my gaze.

It has lasted well
but its days are
numbered now.
Big school beckons.
The new cool black bag
already waiting in the hall,
making the old look
childish and small.

I wrote this poem (and took the photo) when my son was about to start secondary school seven years ago. I’m posting the poem now because my son went to his secondary school Leavers’ Assembly yesterday, and when his exams are finally over on 18th June his school days will be over too. He is about to start a new chapter of his life – hopefully at university.

And it seems scarcely two minutes since I watched his red rucksack bobbing along as he jogged towards his last day at primary school.

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