Reflection on one patient

I worked with Graham for the last 3 months of his admission to an adult mental health unit.  During that time he came to my writing group on 9 occasions. Several times he told me that they were the highlight of his week in the ward. He was an articulate and intelligent man, well-read and well-educated. He was interesting to talk to and a lovely person. He was also, when I knew him, deeply depressed. I wanted to wave a magic wand to make him better. I often wish I had a magic wand.

Graham had been severely depressed once before, many years previously. But this time he simply didn’t believe people when they said he would get better.

My difficulty was in finding the right approach to working with him and it took me a while to work that out.

As the weeks progressed I realised that Graham was very good at writing and at expressing his thoughts and feelings – which were largely about a lack of hope for himself.

I tried getting him to write about the beauty of the world, but he wrote about a beautiful garden, which turned into his own beautiful garden and then his writing unfortunately went from there to expression of his despair about ever being able to enjoy his beautiful garden again and share good times with his family. He became agitated and upset. He said he didn’t believe he would ever be well again. Sometimes he paced the room, shaking with anxiety and distress. I did all I could to soothe his anxiety, and I brought his case to supervision on more than one occasion to seek the advice of my supervisor. Several clinicians told me they were also struggling to find how to help Graham. He was such an intelligent man and he knew that there was no guarantee that he would recover, and probably wasn’t enough for him.

I tried several techniques with Graham, taking care never to lead him to write about negative thoughts or feelings because writing them down could reinforce them in someone whose thinking is already so utterly negative, and anway he could already express himself very eloquently and so didn’t need to work out what his feelings were.

These are the techniques that worked well with Graham:

1) A guided visualisation followed by creative writing based on the visualisation;

2) Writing the start (setting) of a story in a particular genre but without making the genre too obvious so the group could play a guessing game;

3) Writing about who might own an object – about that person using the object or handling it;  and

4) Devising a new character to use as the basis for a short story.

All the exercises that worked for Graham involved writing from the imagination with no description of real thoughts, memories, feelings, etc. It took me several weeks to realise that was the approach to take because I had never worked with someone who was both highly intelligent and very severley depressed before. I am very grateful to Graham because he taught me a way to work with severely depressed patients. All the patients I work with teach me – without of course knowing that they do. They also inspire me… and many make me wish for that magic wand.

After a few months in hospital, Graham went home and I heard no more about him for some time. I began to worry about that and often wondered how he was doing. Then someone told me that he had died.

I’m glad that I went to his memorial service. I had only known Graham in a time of crisis and it really helped me to come to terms with his death to hear his friends talk about him, how he was the life and soul of the party, a loving husband and father (I knew that already), a successful and conscientious worker. I found out about his passions for old literature and hats. I saw and heard how much he had been loved and respected.

My supervisor also helped me come to terms with Graham’s death. And finally, I have been to see his widow (at the suggestion of a Consultant Psychiatrist you felt it might help the family) to give her some pieces of writing that Graham gave to me and talk to her about the writing group. She talked to me about his life and showed me family photo albums. I think the visit helped both of us. She said she would let the children read their father’s writing (which was beautifully written and not at all negative).

I still feel sad when I think of his death but now I am able to think of him as the whole person who lived a mostly happy and fullfilled life, and not just as the shadow of himself that I knew in hospital.



About Carol Ross

Interested in therapeutic writing.
This entry was posted in Depression, reflective practice and tagged , , . Bookmark the permalink.

6 Responses to Reflection on one patient

  1. Mary Ellis says:

    Your writing made me feel that I could see you and Graham, and I got a great sense of his utter despair. High intelligence can work in favour of, or against, a person; in Graham’s case it was the latter. It also made me realise that the journey to recovery is shared by both the patient and the practitioner, and that the practitioner undergoes suffering as well. I think more should be made of this point, without placing pressure on the patient, so the patient sees that they they are not travelling alone. Thank you also for sharing the techniques you used.

  2. Jenny Alexander says:

    What an interesting story – thank you Carol. I feel all creative work is therapeutic per se – the act of creating is a healing thing – and in my writing for self development workshops I actively steer people off the well-trodden paths of their own difficult experiences, to explore the mysterious and wonderful world of their imagination.

    • Carol Ross says:

      Thanks for dropping by my blog and for your great comment. I totally agree that all creative work is therapeutic. People in the more ‘normal’ roles in the NHS don’t always appreciate that as we do unfortunately.

  3. Thank you for sharing your reflections, Carol. It sounds as though this was a very significant journey for you and I have found it helpful to hear what worked safely when writing with a severely depressed patient. I really admire your courage and willingness to work within Mental Health settings, and with such deeply distressed people. And to continue in spite of there being no magic wand!

    • Carol Ross says:

      Thanks for dropping by and leaving a comment Cilla. I have had quite a journey – and not just in working with Graham. I only started my groups for mental health patients in April 2010 and I feel I have learned SO much. Just before I started, but after I had committed myself to go ahead, I was suddenly afraid that when I threw myself in at the deep end I would flounder back to the side and have to crawl away embarassed. I could hardly believe what I’d said I would do! But I did it anyway and I’m so glad I did. I really feel I make a difference, even if only a small difference, in some people’s lives and that means a lot to me. And the bonus is that I love writing with people and listening to what they have written – much of which is lovely 🙂

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