Trauma/PTSD Archives - Page 4 of 10

Mary Jo Barrett on the Collaborative Treatment of Incest and Complex Developmental Trauma

Posted on October 3, 2023February 24, 2026 by Psychotherapy.net Team

Lawrence Rubin: Hi, Mary Jo, thanks for joining me today and sharing your clinical expertise in the systemic treatment of incest and complex developmental trauma. Just before we went live, you were sharing an experience you had while giving a webinar this last weekend, and something caught my ear that I wanted to ask you about. You suggested that there is something different between what is currently being practiced in the field of incest and complex developmental trauma, and what, in your experience, is correct, or what should be practiced.

Mary Jo Barrett: That’s a good place to begin. When I first started, which was 45 years ago, I was a worker for the state, basically doing in-home counseling. I discovered that in all these child abuse and neglect cases, there was a significant number of cases involving incest and sexual abuse — whether immediate family members or close family members or clergy or whatever. I would go to my supervisors for guidance, but no one really knew how to treat it.

For example, Minuchin told me that I didn’t need to focus on the incest. I just needed to look at restructuring and building a hierarchy, and that the incest would then be alleviated. Carl Whitaker, who I was madly in love with, basically said, “You know what? I don’t know what to tell you.” At least that was honest. He said, “I do schizophrenia. You better figure out how to do incest.” He was my teacher, so I decided I needed to figure it out.

And so, over the years, I started asking my clients more formally about incest and sexual abuse. I also had my supervisees ask their clients. And whether I was conducting training in Europe or here, I began to ask the clients what the most effective thing about their therapeutic experiences was, and what about the therapy they had received made it “good therapy.”

Basically, nobody said “techniques.” They said what we know they would say and did actually say. It was the relationship between the therapist and client. But they even said more specific things. And of the specific things they said, I narrowed the list down to what I call the five essential ingredients of trauma treatment. But what they said applies to all models of treatment. And as we know, none of these models are better than the other I developed what I call a meta-model that applies to any trauma protocol that exists based on these five essential ingredients. And so, whether you do IFS or CBT or SC or any of the alphabet soup of techniques or protocols that are out there, they will be successful if they have the five essential ingredients.

The Key to Effective Trauma Treatment is Collaboration

LR: What exactly are these five ingredients for effective trauma treatment?

MB: People, especially those who have been abused, need to feel that they have value, power, control, and connection. So, these “ingredients” include the client:

feeling valued
learning specific skills in finding resources
understanding contextual variables needed for an engaged mind state
developing workable realities
building a hopeful vision for the future

When a therapist, case manager, or foster care worker gets stuck with a client who has been abused or neglected, I suggest that they don’t go back to the protocol, but instead to the relationship.

LR: Going back to the question that I opened with, how do you see what’s in the zeitgeist now, what’s popular now, as being lacking in comparison to this collaborative model that you developed?

MB: The basic essence is that I go to the client to tell me what to do, versus going to a model or technique to tell me what to do.

LR: Can you think of a recent clinical instance in which the relationship seemed that much more important in the moment than any technique or model?

MB: Larry, every day! That is my model. Every session. In every session when you’re talking about trauma, there will be an impasse. I call it differently. In any moment, there’s going to be what I call a traumatic stress, which means the client, because of their trauma, is going to experience therapy as dangerous.

As we always say, survivors often see danger where danger doesn’t exist. I mean, that’s a standard thing. But that happens in therapy all the time. That’s because the therapeutic relationship is based on hierarchy and attachment. There is a hierarchy, right? I mean the therapist has more power. And the therapist is often controlling the sessions or the direction or what’s going on. And there’s a necessary attachment. There’s going to be an attachment between therapist and client.

Abuse and neglect are embedded in hierarchical attachment relationships. Now, the thing is, every time I say abuse and neglect, people might go, “But we’re talking about trauma.” And I’m saying, again, almost all the trauma cases we talk about revolve around interrelationship violations.

LR: So, if we practice anything other than a collaborative model, then we may in some way be replicating the hierarchical violation in the family that contributed to that abuse.

MB: I’d say that a majority of these clients anticipate and experience, from time to time, that violation in the therapeutic relationship.

LR: So, if the therapist moves too quickly or dives right into the trauma narrative or says, “Tell me about this,” or, “I’d like you to do this,” they are abusing their power? Even using directive words or a tone of voice or body posture can trigger a client so that they feel unsafe. And that’s when you would be cognizant of that, hypersensitive to that, and readjust any of those facets of your approach?

MB: Correct. And the collaborative change model is exactly that cycle. What you just described. And what’s interesting to me is that the collaborative change model is a natural model. And when I describe it, folks at the clinic say, “Oh, my god, yeah!” And the good clinician says, “That’s what I do in my sessions anyway.” And all I’m saying is, make it conscious. It’s a natural cycle of change.

The first phase is creating a context — which is creating refuge, making assessment, figuring out what’s going on — then making a direction, deciding what kind of intervention to use. And then when we start doing our interventions, which is natural, we’re challenging, right? And the relationship becomes embedded in this hierarchy because I’m sort of pushing and challenging by asking them to do something different. And in that moment, the client might experience a moment of fight-flight-freeze-submit. Or fix! And I have to, as a clinician, recognize that.

And in that moment, instead of pushing harder to make an assumption of, “Oh, they can’t tell,” or whatever it is, I need to stop and recreate a context of change. So, at that moment, I stop and say, “What do you need now? What’s going on? How do you feel? Should I slow down? What’s happening?”

I’ll give you an example. I had a client who often during the sessions would say, repetitively, “You don’t get it. You don’t get it. You don’t get it.” And I’d often get defensive. I’d sometimes want to say, “Well, help me understand,” or, “Explain it.” And then one day after the session, I was thinking, “I think that’s a trauma response. So, I said, “I’m wondering if when I’m doing something that triggers you, you experience me as threatening and go into ‘You don’t get it’ as a repetitive response.” And she really thought about it and looked at it and she said, “You know, I’ve often felt there’s things you do that remind me of my mother.”

This client’s mother was like Joan Crawford’s character in Mommie Dearest, and we’re not just talking severely abusive. I asked her what reminded me in those moments of her mother. In response, she said that I talked loudly, and it was the way I dressed in skirts. She experienced me as dressing in a way that was, for her, reminiscent of her mother, which she experienced as provocative. I don’t know that it was, but she experienced it as such, so for her, it was.

So, when we then had that conversation, and from then on, I did consciously change how I dressed on the days I saw her. And I consciously changed my voice. And after that conversation, she never said, “You don’t get it,” again.

LR: So, when she emphatically repeated, “You don’t get it, you don’t get it,” it was metaphoric for something like, “You’re not hearing me, that hurts, stop it, you’re not hearing me, you’re dressing in a way that confuses me. You’re not hearing me. Daddy did this, or Mommy did this, or my brother did this.” It’s like this broad statement of, “I am feeling abused right now.” She may not have been able to put a finger on exactly what element of your relational moment was triggering her, but “You don’t get it,” meant, “I am feeling powerless and unsafe.”

MB: Violated. She was feeling violated.

LR: She was feeling violated. Because you’re much more cognizant about the relationship and the attachment, and breaches in the attachment, you were able to look inward and ask yourself, “What could I be doing? How could how I be talking? What would I be wearing? What might we be talking about? What is it about the way I’m asking questions that could be replicating at some level what happened in her family?”

MB: Yes.

LR: Did I get it right?

MB: You did get it. I should bring up my PowerPoint. You’re doing a very good job. I have three slides that I use in trainings, which I introduce by saying, “These are the three watchwords or phrases of my faith.” The first one is by Mandela that says, “A good head and good heart are always a formidable combination.” The second one was by R.D. Laing who talked about the importance of awareness by saying something like, “If you aren’t aware that you’re not aware, there’s nothing you could do to make change.” And the third one is by Jay Woodman which says that “Life is a series of cycles of getting lost and finding yourself.” And that each time you’re lost, if you look at it as a possibility, then you will find yourself in a new place. And so, my thing is, therapy is a cycle of getting lost and finding yourself again. And once you’re aware of that, you integrate your mind and your brain, your heart, and you’re golden.

The Healing Power of the Therapeutic Relationship

LR: Is there something about trauma, and incest in particular, that drives clinicians to cleave to techniques and theoretical models; bypassing what they truly know to be effective, with is the relationship?

MB: It’s an integration of the two. When we spoke with these clients, it was clear that they did need new skills. It was the third most important thing, not the first. But the first thing they said was connection. The second thing they said was they had to feel valued, and they had to value the clinician. Then they said they had to feel empowered. And then they said skills.

Everybody that’s developed a protocol model is going to argue with me and say the relationship is the basis of all those protocol models. I would say I got you; I believe you. But if you ask the people who are trained in those models, they will say the emphasis is on the protocol and the interventions.

And they would also say that the difference is that when they’re stuck or a client gets activated, that it’s “go back to the protocol,” versus going to the client to collaborate.

LR: I wonder if there’s something about trauma, and particularly incest, that compels clinicians, especially those who aren’t experienced, to have to “do something.”

MB: A hundred percent! This is actually the new thing that I’ve added to the “fight-flight-freeze” paradigm, which is “fix.” So, I think what happens when a clinician becomes overwhelmed — I call it a place of traumatic stress — fix becomes part of a trauma reaction. The traumatic stress reactions.

When a therapist falls into a “fix-it” state, that should be an indication that they are in the trauma field and are feeling dysregulated. They then have to get re-regulated in order to move to a different place. And it’s the same with the client, who at that moment needs skills to re-regulate themself. I don’t believe when a client or a therapist is dysregulating, that’s the time to automatically use a technique.

LR: So, by jumping in with “a fix,” the therapist might be trying to regulate themselves at the cost of their client’s regulation.

MB: I want to say one other thing which is not going to be popular. I believe that when therapists jump in with a technique, they’re hoping it’s a solution for the consumer of their services.

LR: Giving them something.

MB: Giving them something, which is capitalism. Everything is an agreement in the contract with my clients.

The Importance of Working Systemically with Incest

LR: Someone reading this interview might say, “Well, it sounds like she’s working with the individual,” but I know you’re deeply systemic. So, I’m assuming that this collaborative model infuses your family work around complex developmental trauma?

MB: Yes. Most of the clinical work I do is with couples and families. And this goes back to the research we did with these clients who said that rarely, if ever, did other clinicians include their family. So, what would happen is that after those sessions with the “other” therapists, these clients would go home and have abusive fights or get hit. Or a parent would continue the abuse or violate.

Here, I go back to what I said earlier. Abuse, neglect, and childhood developmental trauma are embedded in a relationship of hierarchy and attachment. So, I believe healing should happen in a relationship.

I want the therapy to recreate some of the crisis right in the room with me. So, if there’s a fight, and dissociation, we all can witness it together and address it in the moment — together. If there’s eyeball-rolling that then triggers the other person, I want it to happen in the room, because those are the cycles that cause the traumatic stress at home.

Everything I’m saying to you here and now is what I say in the first session. When I start a session, I want the safety in our relationship to spill over into their relationship. I want their relationship to be a source of regulation. Not me. I don’t want to be the primary person in their lives.

LR: I can see how this would apply working with intimate partner violence. But are you saying that in cases where there is past or present childhood incest, that you would work systemically with either the current or past family members?

MB: Let me delineate two things. One; when the incest is currently happening and its children, yes, I include everybody. But I have all sorts of rules and boundaries. If it’s currently happening, and in most states, if incest is currently happening, then usually the perpetrator, whether it’s a sibling or a parent or not, is kept away from the child, right?

So, I don’t bring the alleged offender, or the offender, into the room with the victim until they’ve acknowledged facts. So, if they’re denying facts and saying, “She made me do it,” or, “He made me do it,” or, “It never happened,” I don’t do family with them. But I would do family with other family members. But I don’t bring the alleged offender into the room until after they’re no longer denying facts.

LR: Is that enough? Just getting past the point of denial? Would they have had to have done some significant reparative work of their own before you brought them into the room with the victim?

MB: They are in therapy. Yeah. I mean if it’s currently happening, then the offender is in individual and group therapy, according to how I think good incest therapy should happen. And the rest of the family are either in individual, group, or family treatment for whatever their issues are. And the kids could be in individual concurrently with the family therapy.And then when the violator has met certain criteria, then they can start coming into the sessions.

LR: So, who’s your client? In a case of incest, where it happens currently, or even in the past, who do you identify as the primary client?

MB: The family. But/and my collaboration is with all. It’s a team. I mean it takes a village. Absolutely. When we’re talking incest, it can’t be done effectively by one therapist.

LR: Do you or can you even work effectively with adult survivors of childhood incest?

MB: I’ve developed what I call the “family dialogue program,” which is for adult survivors with their families. And so, I do bring them together but it’s different. I often do it in these intense weekend workshops because if people live all over the country, it depends on if we’re doing therapy about wanting to talk about the abuse and neglect or are we doing what I call the third reality, which is, let’s just focus on the future. Let’s not focus on, did it happen, didn’t it happen, what’s going on? Let’s just focus on, am I going to come to your funeral? Am I going to come to Passover? How can we be in the room together? Am I going to go to my niece’s wedding? Are you going to ever meet your grandchildren? That kind of thing.

LR: That presumes that the perpetrator must take responsibility. They must be willing to listen, at least. Be present and listen. In other words, if you want to ever see your grandkids, you’re going to listen to me. You’re going to hear me. And that perpetrator may leave not feeling very healed, but at least he or she will have given the opportunity to the victim to be heard.

MB: And that’s why I call it the third reality. Because we’re just focusing on, “it’s not about your reality,” it’s about if you want to see your grandchildren. If I want to come to your house, are you going to be able to tolerate me…you know, me believing this and being in the same room as you.

LR: In a sense, it’s a way for the victim to recapture some power.

MB: Oh, absolutely. And that’s what most survivors will say to me. I mean a lot of people have said, “I was in therapy for 10 years, and that weekend with my father was the most important thing in my healing.”

The Gratification of Working with Trauma and Incest

LR: Okay, okay. My guess is that many in private practice would run when they receive a referral for incest. But you seem to run toward it.

MB: I don’t think people in private practice run from the adult survivors, but they run from when it’s currently happening.

LR: Why is that?

MB: Because I think it is one of the greatest taboos. And they never learned how to deal with it. And I think they never learned how to manage. And they often don’t understand how anybody can even want to see their father or their brother or their mother based on what they’ve done to me. Or done to them. Done to the victim. And so, I think a lot of them experience transference and/or feel inadequate.

I don’t know if it was a particular case, and I said to my husband, “What kind of person likes working with sex offenders?”

And in terms of me, Larry, I supposed we could get me on a couch to figure out why. I do remember very distinctly one time bolting out of bed, like sitting up straight. I don’t know if it was a particular case, and I said to my husband, “What kind of person likes working with sex offenders?”

But I would rather work with incest any day of the week over depression because people I work with change. And I see that change. I have seen plenty of sex offenders change. And I’ve had the fortunate experience of being able to follow up on some of my very first cases. I’ve seen one of my first cases 40 years after they stopped. It was an unbelievable experience.

Well, partly it was fun because I got to ask them all sorts of questions. I’ve always been a very creative therapist, where I just make shit up as I go along, that seems to fit. I remember one of my cases — it was incest and domestic violence. The father was in supervision and was told he couldn’t be within 365 yards of his family when he first got out of jail. He actually parked a mobile home 365 yards from the family home. And he was something else.

About a year into it, maybe less, I went back to court to get permission to have him come to family sessions. And he did. And one time, I was doing a good old family therapy looking for strengths, and I said to them, “You’re not always abusing each other. There are times when you’re not. Let’s talk about those times.” And the kids were younger, like 16, 11, and 10. I handed out these little recipe cards where I asked each family member to write down the recipe for nonviolence. Like a cup of this, and 3 tablespoons of that.

I gathered them all and laminated them, and then had them talk about it. The mother said, “It’s half a cup of going to church, and another quarter of a cup is no alcohol.” I mean that kind of stuff. And so literally 30 years later, I interviewed the same family. And the woman, the daughter who was the incest survivor was 40-something. I asked her a couple questions, one of which was whether she had gone to any trauma therapy. She said, “Why would I? I already had it.” So, I asked, “When you were getting married, or dating, what was that like? Were you always anxious? Were you afraid?” She opened her purse and pulled out the laminated card, and said, “I only dated people that had the ingredients.”

LR: Talk about having an impact. Wow, that must have felt great.

MB: I burst into tears. I didn’t do the initial interview, one of my graduate students did. But I was behind a one-way mirror, because who wouldn’t want to see one of their first clients? I went in and I asked them questions. So, in fact, there’s an example of the use of a particular skill. I don’t know that- would it have been the same if it hadn’t really come from them? I don’t know.

LR: Had you not had a relationship, they wouldn’t have taken the cards to begin with.

MB: Right, right.

LR: Do you see yourself in charge of the treatment village when working with the perpetrator?

MB: I have a case right now of sibling incest, and one of the kids is a young adult, but not even, I mean probably a teenager still, 18, 19, who is in individual therapy. I’m trying to do a family session because the parents have two children. So, the parents are involved, and the son who offended his sister. And I’m trying to coordinate. And the sister’s therapist didn’t call me.

LR: What recourse do you have?

MB: Well, the recourse I have is the parents. He is still a teenager. So, the parents can call this person up and say, “Our daughter signed a release, we signed a release. You need to call.” I’m not saying it in a nasty way. But I try to avoid doing that because I don’t need to start an adversarial relationship. But that’s the recourse I have. If the person was an adult, I mean I’d still have the parents to talk to their child and say, “Look, we want to heal this.” As it turned out, the son’s individual therapist calls me and cooperates. We have a great working relationship.

The Complex Arena of Incest Work

LR: Earlier on in one of our conversations, you said, “Incest is virtually neglected in our field.” Clearly, incest hasn’t stopped.

MB: Incest hasn’t decreased at all since I started in the field in ’78.

LR: What do you mean it’s neglected? By clinicians? By researchers?

MB: : I think everybody’s neglecting it. I think that the problem is that we’ve lumped trauma into one thing — complex developmental trauma.

I think that there is something very important to calling violence or violations what they are. Incest is unique. It’s not just a sexual assault. It’s unique because this is often a relationship where the people also have a very positive connection. “This is my parent,” they might say. I had a client way back, I mean again, 30 or so years, who wrote a poem. The one line that sticks out into my head was — and I don’t think she was writing it just to me, it was in general — she said, “I asked you to put an end to the abuse, and you put an end to my family.”

LR: Oh! Did she write the poem to you?

MB: I don’t think it was to me because I asked her. It was to the system. She’s another one that I still have contact with because periodically she’ll write me and say things like, “I just had a baby, just won a marathon.” I mean that kind of stuff. I think professionals feel anxious. I think they feel traumatized. I think it feels like you said. It’s such a moral violation that, as clinicians, we don’t know how to manage. How do I manage that I care about somebody? How do I manage that this woman stayed married to somebody who sexually abused her child?

I just think the taboo is so deeply entrenched that it causes such distress to those who work in this area. I just was working with a family where one of the children was sexually abused. And the other two weren’t. And when I talked to all of them, I said, “All of you were abused. But what happened to Susie is more of a moral violation.” And so that’s why people can’t tolerate it. I think there’s something about not being able to tolerate it. Like I said, I can find something positive. It makes sense to me that someone can be abused by a family member and still care.

LR: The popularity of complex developmental trauma overshadows the clinical attention on sexual assault.

MB: All I know is that so many clients tell me that people either never asked them or understood it. So, it just gets lumped into a category of trauma. And all traumas are not created equal. I’m not saying incest is worse than being physically abused. I’m not saying it’s worse, I’m just saying it has its own unique connected relationship with somebody they cared about who I also had many positives. And it leaves me even in some ways more confused because it isn’t linear or simple. Even if the person was abused by somebody that came and left like a babysitter or Boy Scout leader, with whom they also had an intimate relationship, it’s very confusing.

LR: The deepest form of betrayal.

MB: Yes. I think sometimes clinicians can’t manage that level of complexity. Which goes back to your question; “Give me some techniques, it makes things less complex. I can feel better about myself if I know how to do this. Do that.” Larry, every single day, I go, “Wait, I don’t know what I’m doing exactly. What do I do now? I just had this explosion.”

I was sitting in the room last week with somebody that got up, grabbed something off my table, threw it on the ground, and smashed it. “I got to go,” they said So, I said, “Wait a minute, okay, let me figure out.” What was I going to say in that moment? “Follow my finger?”

LR: What did you do? How did you handle the moment?

MB: What I did in that moment was said, “I need a drink of water. You need to sit down. I am feeling afraid. And I want to talk about this. But right now, I need to calm down. And you need to. We both need to.” I had been seeing this guy for a while. It made sense to say, “We need to regulate.”

Well, the wife was there, and they have a child. But the child wasn’t there. I had a separate session with the child. And I had a separate session with the wife. I did break them all up. And then I had a session with him, and we just talked about it. And I talked to him. And of course, like every other, he said, “This is what happens when she does blah, blah, blah.” “This is what happens when my child…” And I explained to him that acts of violence are linear. I don’t think I said “linear,” but… “I get it. It is all these other things that activate you. However, you have to make a decision about how you’re going to react to these things.”

LR: I would see where a younger therapist, or a frightened or threatened therapist might have ended the session immediately, out of fear for themselves, out of loss of control of the session. But you saw it as part of the way the system functions, and your role in that moment was to regulate. To me, the external regulator, the governor of sorts. Is apology critical?

MB: Acknowledgment is important, not apology. Because people say they’re sorry very easily.

LR: So, how do you know when an acknowledgment is sincere and productive, moving forward?

MB: So, when somebody is going to make a formal acknowledgment, it’s a planned session where they write a narrative. They write it down, they talk about… Basically, I have them talk about facts, impact, responsibility. So, they’re giving it to me beforehand. And that’s part of the therapy process. They’re writing their acknowledgement as a therapeutic technique. So, they’re writing this, and that’s how I know it’s sincere.

LR: What are some of the common presenting problems that people come to therapy with that raise your incest red flags?

MB: Well, on that level, they probably don’t look any different than any other form of abuse, neglect, or violation. They really don’t. Eating disorders, self-mutilating, suicide. Any of those things. Most of these are symptoms, I think are survival skills. I think they’re skills that people have used over time to survive their abuse and neglect. And now it’s become problematic. The skills themselves are problematic. The skills work. If I drank too much, if I cut, if I was sexually promiscuous, if I was suicidal, if I was dissociating. It might have worked to avoid memory and pain. That’s how I tell my clients; that most of their symptoms are utilized to avoid memory and pain until they don’t.

And now the symptoms themselves are causing the pain. To me, incest doesn’t look any different. What happens is, as I start my sessions by asking people how they heard about me.

If they didn’t know my name, they might have typed in “trauma, abuse, childhood something.” And it’s not just “therapy.” Usually, they got to me, somehow, they typed something else in. Or they got to me through a therapist. And so, when they say trauma, which is usually what it is, I then say, “Look, if we’re going to talk about it, we’re not going to talk about it now. But I need you to know I feel really comfortable talking about incest. I feel really comfortable talking about sibling abuse. I feel comfortable talking if you beat each other up.” So, I’m just saying, down the road, if any of those things come up, I feel comfortable.

LR: Has there ever been an instance where all roads pointed to incest and the person allowed you down that road, right up to the door, and then just closed it in your face?

MB: No. When I take a family history, when I do a genogram, and everything points to incest, I might just say, “You know what? I just need you to know from what you’re telling me; I’m not saying it was incest. But there might be, it could have been. It feels to me like emotional incest at least. Like you are hierarchically your father’s peer. Or it feels like you and your brother turned to each other in ways to get affection that you didn’t get from anyone else or your parent(s).”

So, it doesn’t have to be. And this isn’t your question. But it’s a question people often ask me. Do you need to know all the story to help? And the answer is no.

LR: And I think clinicians sometimes may forget that incest is a violation of hierarchy. It’s a violation of trust. And not all incestuous relationships are sexual. Are there any questions I could have asked or should have asked?

MB: Well, I mean we have maybe a couple of million. But I think what I would say is, you know, we should talk again.

LR: I would like that. Thanks Mary Jo.

Providing Culturally Sensitive Narrative Therapy and EMDR to Original Peoples

Posted on August 31, 2023February 11, 2026 by Psychotherapy.net Team

Finding Strength through Connection in Counselling

We hope to help the reader understand one attempt of working in the most non-colonial way possible with the Onkwehonwe. In this story, playing a minor role, is how a settler of Irish heritage, Linda, committed to honouring the Onkwehonwe. Linda was assisted in her understanding of the Kanien'kehá:ka (Mohawk People), and in how to be helpful, by Juliette, playing the major role. Linda was Juliette’s helper/psychologist and Juliette was consulting with her.

Juliette: When I reflect on the beginning of our sessions doing NT/EMDR, I remember feeling that I would always suffer. I was unclear as to what might come of this type of therapy.

Linda: I was trying to integrate EMDR (1) into Narrative Therapy (NT) to work in a non-colonial way. EMDR uses bilateral movements to change the way memories are stored in the brain, allowing one to restructure trauma memories.

(In the work with Juliette, I asked her to reprocess negative memories and how they made her feel while trying to help her realize differences — for example, if she felt unsafe, she could try remembering experiences of feeling safe).

I tried to let you lead the way with EMDR and then answer NT questions to highlight non-problem stories. With NT (2, 3) the ethics provide a non-colonial way of working by flattening the hierarchy and being non-judgemental.

(NT works with the way people make sense of their lives with stories. Narrative therapists help people be other than what the problem stories would describe. These stories determine how we see ourselves. Narrative therapists believe that stories aren’t fixed. Problem stories pretend to be the truth, but they are not, as Maggie Carey, shared with me in a personal communication in 2018).

I am expected to write an evaluation for Kahnawà:ke Shakotiia’takehnhas Community Services-KSCS) when they refer someone to me. I use special knowledges discovered from the Tree of Life or Journey metaphor (4) as my report. People consulting can thus realize that they are not only their negative stories, but that their life stories can be retold in ways to transform their experience of life, understanding there ARE also non-problem stories.

Juliette: This experience with you would be the very foundation to what gave me the strength and encouragement to push through whatever came my way. Your compassion and technique allowed me to open to you. I could feel the beauty of your spirit.

Linda: I appreciate your comment about spirit.

Juliette: Everything happens for reason I believe. I know in my heart that the Great Spirit sent such a loving and gentle person as yourself to me. I honestly think he hand-picked you for me, since I had so much hurt and pain. I needed a sensitive, well experienced human-being.

Linda: I am drawn to NT because it suits MY spirit. It helps me be a sensitive human being for you.

Juliette: I felt very connected to you, considering your background of living off the land. We may be from diverse cultures and generations, but in some sense, we are the same.

Linda: I feel humbled that someone with your capacity to relate to nature, animals, and spirit could feel such a connection with me.

Juliette: I am the product of multi-generational trauma. With that comes many co-existing disorders. I felt no judgments with you. I could speak about my visions, dreams, and animal experiences. You were interested to hear about it. In the past we were not allowed to speak of such things for fear of being arrested or terminated. Blood memory is important in my People. Even though some of us have not directly experienced certain traumas, it is in our DNA.

Linda: I wonder if the words torture or violence might be more fitting than trauma, (inspired by Cathy Richardson’s work, [4]). If torture is in our DNA, are non-torture stories too?

Juliette: I found NT/EMDR to be immensely helpful in lifting the dark cloud that was hanging over me. It helped to open me up to even further healings. Most of all I think the way you did it and gave feedback, writing what came out of the sessions, was helpful. Three years later, I still have these notes to help me look back on how far I came.

Linda: I write notes for you to have nothing hidden. I give everyone my notes.

Juliette: I cherish the letter you gave me when we finished our sessions.

Linda: Therapeutic letters are a huge part of my work. They help consultees notice their revelations (5). I summarize changes noted in therapy. Now I often co-write letters with the person consulting, to co-construct counter-stories (6).

I love that you wrote back. I appreciate you describing me as medicine woman, mentor, and healer.

Juliette: I think what you are trying to do for Indigenous people is honourable. It is not an easy task to take on collaborating with people who have been so greatly affected by colonialism. I wonder if your background of living a simple life had anything to do with the paths you chose to take on helping people like me. I found you educated and knowledgeable in your field. You are hardworking and always striving to help others. That is a commendable characteristic to have. These qualities remind me of the seven grandfather teachings to live by: to have love, respect, truth, wisdom, honesty, bravery, and humility. You have all those qualities in your healing practices.

Linda: Wow! Thank you.

Juliette: Medicine people come in all forms with each bringing something that the client might need at that time. You were the first I had seen.

In June of 2019, three months after our sessions ended, my grandmother passed. I lost my Stepmother in a tragic accident. We lost our family pets. On July 4th, I had a hard delivery with an emergency C-section. I know that without our work, those hardships might have broken me for good.

I continued to see healers and came to terms with the fact that this will be a lifelong endeavour, considering what I have gone through.

Linda: If I could be considered to have contributed to the beginning of such a lifelong healing journey, I would feel fulfilled.

Juliette: I appreciated and found helpful that you shared some of your life story with me. That made me feel a connection. I felt I was not so alone in some life experiences. From the eating disorder I had, one thing stood out in my mind. You said, “bulimia seems a form of self-punishment.” That one sentence made me think twice about ever doing that again. Why punish myself for what others had done to me? Why give them that power? So, I never did it again.

Linda: I felt the unfairness of this.

Juliette: NT/EMDR is powerful. That helped me relook at my traumas in a different light, helping heal the little girl in me. Since then, I’ve been raising my three children. My son is now three. His name is Keenai (meaning black bear) and his Kanien’keha name is Takarihóntie (news travels fast). I was cleansed by a healer as I was under spiritual attack, which helped. I enrolled to become a traditional healer in mental health and Indigenous addictions counseling. We learn different resources and ways to help my people. We do land-based teaching where we take part in sweat ceremonies, singing our songs, making drums, etc. I kept a consistent A+ average. I am learning what was taken from my people.

Knowing who you are and where you belong is medicine. The more I learn and heal the better my confidence gets and the less the anxiety comes. I am no longer on medications.

Occasionally I need to take an anti-anxiety medication as the course can be heavy, speaking about residential schools and the many injustices that led to the situation we are in today. I have come a long way from where I was. I AM immensely proud of myself. I was told I am the medicine for my family and people.

So many people I met through this journey are medicine for the people. I consider you to be one of them. You gave me that encouragement to keep healing and advocating for my people. For that I will be forever grateful.

Linda: What you just said made me remember questions in the letter I sent you. “if we could invite your welcoming ancestors and your Creator here to be with us and we could have a conversation, how do you think they might express their pride in you?"

Juliette: They would give me a great big smile.

Linda: How would they want you to feel about the way that you were an advocate with me and about the way you have turned your life around?

Juliette: I think they would be so proud and hopeful that things are changing.

Linda: Do you think that they would be honoured?

Juliette: I know I am honouring them by healing and acknowledging their hardships, changing whatever I can to bring back what was taken from them/us.

Linda: I wonder if they might have advice about how to be even more of an advocate for your people and the land.

Juliette: I think they would tell me to be a warrior and to keep fighting for the ones who cannot.

Linda: Do you think that if you continue to speak out and be an advocate to those of your people in need, regarding how to transform a life from one of drugs and alcohol and violent partners like you have done, they would be happy to stand by your side?

Juliette: They are always by my side. I know they are happy with what I try to do.

Linda: Do you think they were at your side every day when you kept yourself safe?

Juliette: They guide me always.

Linda: Now, do you think they would be even prouder by your decision to become an Indigenous healer to those having challenges with mental health and addictions?

Juliette: They ARE proud. They guided me. They want me to help others. It is a part of our ways that if we are well, then we help those who are not so well. If I have a full plate of food and see someone with nothing, then I give them half of mine. That is the concept. Don’t let others suffer if you have the means to help; take my struggles and heal so I have that empathy to help others.

Linda: Interesting. My mother taught me with privilege comes responsibility to help those with less privilege.

Juliette: I have questions to ask. What drew your attention to helping my people and other people who have endured a terrible history?

Linda: Perhaps my mother’s teaching. Also, the stories my grandfather told of how the Irish were mistreated as they were colonized. It might be my wonderful experiences as a child and adult living on a farm and receiving community healing. Maybe, the appreciation I have of your culture bringing back community with the passion to get back to your cultural roots.

Juliette: Was there any moment in your work where you just knew you were doing what you needed to do and were in the right place?

Linda: Every day. Especially after this conversation with you. If any of the work we did together played even the smallest part in where you stand today, can you guess how proud I might feel of the work I do? I believe that you will help your people remember their roots, their strong culture, and what they can teach us non-indigenous people. If I played even the smallest part in this journey you have taken, I would know I am in the right place, doing what I need to do.

References

(1) Shapiro, F., Kaslow, F. W., & Maxfield, L. (2007). Handbook of EMDR and family therapy processes. John Wiley & Sons.

(2) White, M., & Epston, D. (1990). Externalizing the Problem In (Eds.). Narrative means to therapeutic ends. W.W. Norton & Company.

(3) Freedman, J., & Combs, G. (1996). Narrative therapy. The social construction of preferred realities. Norton.

(4) Richardson, C. (2021). Facing the Mountain: Indigenous healing in the shadow of colonialism. Charlton Publishing,

(5) Denborough, D. (2014). Retelling the stories of our lives: Everyday narrative therapy to draw inspiration and transform experience. W.W. Norton & Company.

(6) Ingamells, K. (2016). Learning how to counter-story in narrative therapy (with David Epston and Wilbur the warrior. Journal of Systemic Therapies, Vol. 35, No. 4, 58–71.

(7) McAllum Pickington, S., (2018) Writing narrative therapeutic letters: Gathering, recording and performing lost stories. Journal of Narrative Family Therapy: Special Release 20-48.

Katja-Writing: Being Author and Audience to Fictionalized Stories of Trauma- Part I

Posted on July 25, 2023February 11, 2026 by Psychotherapy.net Team

“Love of the Written Word”

Poem by Irene

I feel like singing, dancing, — yes, even weeping,

I feel like playing music, loudly rejoicing, — yes, even singing psalms,

I feel like exploring, re-experiencing, — yes, even dreaming,

Each time I look to the written word.

I feel special, chosen, — yes, even honored,

I feel pure, poetic, — yes, even pretty,

I feel happy, joyful, — yes, even worthy,

Each time I look to the written word.

I enjoy paper, pencils, — yes, even glue,

I enjoy stanzas, verses, — and rhyming too,

I enjoy letters, notation, — yes, even grammar,

Each time I look to the written word.

I fill with harmony, trust, — yes, even wisdom,

I fill with loss, sorrow, — yes, even wrath

I fill with zeal, loyalty, — yes, even love,

Each time I look to the written word.

This paper describes a writing-based, storytelling approach to engaging with the consequences of extreme violence and sexual assault in childhood. This approach emerged spontaneously during a therapeutic collaboration between myself, psychologist Christoffer Haugaard (Aalborg Psychiatric Hospital, North Jutland Region, Denmark), and Irene. We wish to provide an insight into how this approach arose, how we practice it, and what effects it appears to have. In doing so, we hope that others may derive some benefit from these experiences towards finding ways to live a life beyond trauma that maintains and empowers one’s dignity and humanity.

Irene is in her early thirties. Throughout her childhood, her parents had subjected her to a multitude of forms of violence, including rape and physical as well as psychological violence. Shortly after reaching adulthood, she started seeking help in order to deal with the traumatization caused by her parents. This eventually led her to contact psychiatric services. Prior to this, Irene had some experience with self-harm practices, but this was inconsequential. This changed dramatically upon becoming a psychiatric patient, after which extreme and even life-threatening self-harm was a persistent hazard (Irene has not performed self-harmed since 2015). She was diagnosed with a personality disorder.

The Early Therapeutic Relationship

I met Irene after she was referred to psychotherapy for the second time within the hospital. This was in early 2012 when Irene was in her twenties. By then, she had frequently been hospitalized on account of dramatic self-harm and suicide attempts over the previous seven years. We have had weekly meetings since then and up until the present. Finding a way to engage with Irene’s story proved to be a significant challenge in itself. The fact that I am a man made it no easier for Irene. Therefore, our collaboration has also very much consisted of a search for, and a testing of, ways of talking about matters of concern. We would like to begin by describing some of the history of how the approach to therapeutic conversations that we discovered emerged:

Christoffer: We were attempting to talk about your life, Irene. I was focused on understanding how the things you were subjected to through so much of your life had been a shaping force on your way of being, and how you had resisted that power and the violence. I think that sometimes led to rather divergent characterizations of your person, whether your past self should be regarded as wrong, selfish, dirty, and guilty, or alternatively be regarded as caring, intelligent, and strong-willed.

At that time, I began to write abbreviated stories about you to convey what it was that I saw in you. I remember you telling me that when you read those stories, you were seized by a strong urge to refute the veracity of my claims, as if the text was subjected to an intense criticism because I dared to propose a different perspective on your character to the dominant version. At some point, you named this urge to criticism The Shadow Side. It readily reacted against attempts to challenge the heavy and dark interpretation of your story and your moral character. I recall you forcefully bringing The Shadow Side’s refutation to my attention at one point regarding the significance of me referring to you by the pronoun “you.”

Irene: I could hardly read the texts when you referred to me as “you.” The Shadow Side, the judging side of me, got angry and became automatically defensive. It wanted to tear the paper apart and shout at you, but it knew nothing was to be gained that way. Instead, it scolded me for being so stupid as to talk to you or read anything from you. We talked about how it was nearly impossible for me to read anything that portrayed me in first- or second-person grammar, so you changed your text into the third person. It was still a tough read, but it was acceptable because The Shadow Side perceived a small victory in this.

Christoffer: The first time I wrote to you addressing you in the third person was in 2013. You made me aware of The Shadow Side, and we described it and tried to deal with it through 2014. Would you mind describing The Shadow Side as it was at that time to provide an impression for our readers?

Irene: The Shadow Side destroyed my possibilities by repeatedly telling me that I was too ugly for anyone to like me, too fat to have friends, too dirty to receive a hug, too stupid to give my opinion, too wrong to breathe, and more insults like these. It constantly brought my attention to similarities with my parents whenever I said or thought anything that could remind me of their cruelties. If I got angry, The Shadow Side immediately made me think that I was evil and therefore capable of becoming violent or otherwise mean-spirited. Even though I never became violent, it had me believe that I was. The Shadow Side convinced me that I had anger like my parents and therefore I was identical to them and their atrocities.

The Shadow Side was a merciless judge or a desperate prosecutor. It devised well-thought-out and devious methods of making me portray myself as stupid and unworthy. Every time the cautious Defence managed to argue well, the desperate Prosecutor convinced everyone in the court with 10 strong arguments to the contrary. Some were a little far-fetched and had no truth to them, but when you listen to something long enough it is likely that you will come to believe it.

The Shadow Side was always hard, indifferent to anything anyone else said and always awake and alert. It never took a break. The Shadow Side made me become hard and live my life in a self-destructive bubble. It made me harm myself so that I could cope with everyday life, keep others out so that I would not be let down, live a façade so that I did not fully realize the horrors, ignore possibilities for getting help so that I could be strong, and so on. The Shadow Side made me believe that I was insignificant, as if I wasn’t even alive. It always told me how wrong and useless I was. The Shadow Side was my thoughts, beliefs and actions. It took over everything and swallowed my identity.

Christoffer: We arrived at me attempting to write about a fictional person instead. Someone not you, but similar to you and having endured similar trauma. In 2013, I started writing such stories about a fictional version of you in the third person that I called Kate. These stories were surprisingly not attacked by The Shadow Side. They were allowed, and you were able to read them, and we could talk about them without The Shadow Side attacking the veracity of the facts in the story or Kate’s moral character. It also made it easier for me to write stories, because now that it was fiction, I had creative license and consequently didn’t have to worry so much about getting all the facts right. Instead, I could focus more on the moral of the story. You have told me that when you read these stories about Kate, you were able to have an opinion and feelings concerning the subject matter. It became possible for you to feel compassion for Kate in the story.

Irene: That is correct. Kate came alive through third-person stories.

Christoffer: In 2015, we were focusing on circumstances, events, and actions that have contributed to your survival and to the moral character that you have today [Christoffer and Irene looked through examples from her childhood with a focus on her ways of taking care of herself and her dignity, as well as her survival strategies]. There were many things, but two things are of particular relevance in this context:

Having an Audience

As a child, Irene was the one amongst her siblings who took care of most of the practical tasks on a daily basis, while her parents did nothing. At a young age, her parents charged her with the responsibility for cleaning the house, tidying up, cooking, doing the dishes, looking after her younger siblings, including comforting them, protecting them from violence and rape, helping with their schoolwork, washing clothes, tucking in her siblings at night, getting them up in the morning, getting them to school and so on. She was also held responsible for unjust chores, such as chores given to other siblings that they had neglected or avoided, in addition of course to the basic unfairness of being forced to do all the work parents normally do.

Irene was often given additional tasks on top of this, or their demands were increased with the intent of punishing or humiliating her. She was forced to live such a slave-like existence by means of threats of violence, humiliation as well as acts of brutal violence leading to physical injuries.

How does a 10-year-old child survive such circumstances? Irene did so by imagining she was the main character in a fairytale like Cinderella. She would make believe that all these exhausting, humiliating, and unfair chores were like Cinderella’s, and that she herself was a kind of Cinderella in a movie and had an audience that witnessed everything.

This audience understood Irene to be the main character of the story and felt sympathy for her. They could see all the injustice that was otherwise hidden from everyone’s view and never spoken of as anything unjust within the family. The audience saw what happened, understood the injustice and reacted to it. This type of fantasy contributed to Irene maintaining a sense of dignity and justice throughout her childhood.

Writing Stories

Irene only revealed to me that she had previously invented a similar writing practice for herself after we had already developed our method of writing fictionalized versions of her life in the third person. She had begun writing stories about a fictional alter ego when she was around 10 or 11 years old and had even made an illustrated story prior to having the skills to author a written narrative. Irene’s fictional alter ego was called Katja, and Irene continued to update Katja as the years passed. The latest additions were written when Irene was in her early twenties. I was quite amazed when Irene told me this. Had we reinvented a new version of a practice that Irene had in fact invented for herself many years before? Unlike Irene, Katja of the story fled her home and had adventures and faced dangers in the wide world, finally becoming a physician and married with children. However, this alter ego was more to Irene than a character of this unfolding narrative. She was also a sort of invisible friend and companion to her. Here is Irene’s poem about her, written in July 2018:

Who Is Katja?
Katja was once a little girl who fled from her home.
She is the girl who held my hand when mom yelled at me.

She played with me when no one else was around.
Katja was moved to a foreign land.
She is the girl who held me when I fell.

She helped me when life was hard.
Katja was subjected to horrible things by her own parents.
She is the girl that hid with me when dad beat me.

She whispered words of comfort into my ear when dad left my bed.
Katja hurt herself.

She is the girl who carried the pain when I cut my body.

She managed fear so that I could breathe.
Katja experienced many betrayals.
She is the girl who suffered with me when dad kicked me.

She gave me sustenance when mom starved me.
Katja was assaulted many times.
She is the girl who never complained when we were tortured.

She sang for me so that I could fall asleep.
Katja never grew up.
She is the girl who shielded me from evil.

She followed me my whole life as a side of myself.
Katja’s life is my life.

Looking back and wondering what may have inspired the character of Katja, Irene points to fictional characters that were significant to her in her childhood: Astrid Lindgren’s “Pippi Longstocking” and Katarina Taikon’s tales about the Roma girl Katitzi that she had seen on television (Use of the name Astrid in the stories about Kate is in tribute to Astrid Lindgren).

We did not consciously create a therapeutic method out of these elements, but we discovered in hindsight that these survival strategies seem to foreshadow the approach that we arrived at. For that reason, we have chosen to name our approach after, and in honor of, Katja. The step from me sometimes writing to Irene about a fictitious version of her that I called Kate (Both names — Kate and Katja — are short for Katarina, a name that means “The Pure.” What a fitting name!) and to the approach containing precisely those two elements described above didn’t happen until 2017.

The World of Katja-Writing

Irene had been haunted by several nightmares her entire life. They were connected to her childhood but were not simply horrifying memories on repeat. Some of them did indeed take place in her childhood, but they contained twists and events that belonged in other periods of her life and even contained events that had never happened in waking life. An example was a nightmare about her school years in which she self-harmed in a way that was not part of her life until later. It also happened that she discovered her parents’ violence in a dream, and that someone tried to help her, even though that did not happen in waking life.

Anticipating such nightmares prevented her from getting any proper sleep. She would wake up in shock every morning due to the extreme content, feeling as if the events of the dream had really just taken place. It took half a day to get out of this state of shock and it was difficult for her to relate to other people due to the nightmares. She would have this surreal sense of something catastrophic having just happened; by contrast, all the while the whole world acted as if nothing had happened.

This chronic lack of sleep resulted in periodically occurring depressive states that involved an increase in risk of self-harm and suicide attempts. This pattern had led to frequent hospitalizations for years, often involving physical restraint. Irene and I had been working since 2012 on escaping the emotional numbness she had experienced for many years, so that she could feel and react to these bouts of depression at an early point and reduce the intensity of these cycles. We hoped that this would lead to less dramatic hospitalizations and a reduction of the risk to Irene’s health and life. This part of our collaboration was quite successful.

In June of 2017, we were focused on finding ways of alleviating these nightmares. I had the idea that perhaps Irene could influence her dreams by bringing moods with her from the waking to the dreaming state and thus create a less devastating course of dreaming. Irene had said that she was sometimes able to become lucid towards the end of her dreams and then be able to influence the events to some extent. Could this be expanded so that Irene could act within the dreams or shape them? I suggested writing a kind of good night story to investigate if elements of such stories could be brought into the dream if Irene read it just before retiring. The nightmares felt indescribably horrible to Irene, and therefore she had not described them to me in great detail. Based on what impressions I had, I wrote a short fiction about the girl Kate, and let the story take a turn in which Kate fled her parents and sought refuge at the house of a kind woman living next door. This woman realized that Kate was a victim of violence and called the police. Irene took this story home to read before bedtime.

It did not work!

Irene had become annoyed and frustrated with my story. It did not succeed at all in describing the reality of an 11-year-old girl who is a victim of rape and violence from her own parents. Irene was shocked at how ignorant I was and realized that she had assumed that I understood a lot more than I actually did. I could do nothing but admit to this and say that my own life experiences had not equipped me to know what it is like to grow up amidst such violence. It became very apparent to us both that we were on opposite sides of a deep gulf in understanding and experience.

We came from very different life experiences that amounted to inhabiting different realities, each lacking insight into that of the other. She felt compelled to write a story of her own and wrote an account of the fictional Kate, based on one of her many recollections of being brutally beaten by her parents. Like me, she allowed the story to end with Kate running away with her younger sister. She then gave me this story to help me gain some insight into the reality that she knew only too well.

I admit that her story was horrible to read. It confronted me even more directly with what I already knew I did not comprehend: How can parents do that to their own child — or any child for that matter? It was painful to read and to know that it was based directly on Irene’s reality as a child. The story also taught me something of what it is like to be a child under such circumstances that I obviously had great difficulty imagining dependent on my own imagination and disparate life experiences.

For example, the sympathy she felt for her father as he kicked her again and again. Or how guilty she felt for every blow she received, as if she deserved it. And how most of her attention was directed at her little sister who was hiding nearby, and how Kate was preoccupied with keeping her parents’ attention fixed on her, so that her sister was not discovered. It was so painful and heartrending to read that I felt I could not refrain from some kind of response. But how? This was a fictional version of something that happened many years ago. I had the spontaneous inspiration to write a reaction to the events, much like a witness that sees all these things unfolding, but who cannot be seen or heard by any of the people involved until many years later. I read the story again, but this time I marked every place in the text that made me think, evoked an emotion — whether it was anger, despair, compassion, hope, or that provoked my sense of justice and morality — and made comments that were sincere, immediate, and spontaneous responses to everything I had marked out. I gave this, unedited, to Irene to read and then we talked it through at our next meeting.

Without knowing it, we thereby created a method that we would continue to use with a number of Irene’s nightmares and memories from several periods of her life, a method that uncannily seemed to contain those two prominent survival strategies from Irene’s childhood: Writing fictional versions of her life about an alter ego in the third person, and having a sympathetic and responsive audience, advocating for the protagonist of the story.

In August 2017, Irene decided to convert one of her recurring nightmares into such a story about the alter ego Kate, who had now become our shared version of Katja. We agreed to follow the same procedure as before: I would write down my immediate, unfiltered responses while reading the story and send this back to Irene.

An Example of Katja-Writing

Irene and I would like to share with you an example of this work as we believe demonstration is the best possible explanation for it. We also hope that the contents of the example may contain knowledge about the effects and the responses of a survivor of severe childhood trauma, sexual assault, parental violence, and horrification. We hope such knowledge may be of some assistance to others seeking to address such problems. This specific example is the second story of this kind that Irene wrote to me in August 2017, based on a recurrent nightmare. It makes reference to sexual assault and parental violence but does not contain explicit descriptions of such actions. It does, however, contain an explicit description of self-harm which might affect some readers and therefore reader discretion is advised. To read this material, we refer you to Part Two of this paper, which will be published separately.

How We Do It

Irene writes a fictional story about an alter ego going through something very much like real events from her life or an actual dream. I receive this story and respond to it in writing as I read it. The concept of responding that guides me is this: I read the story as if I were a fly on the wall, an invisible presence in the story as if it were reality, or like an audience watching a live documentary in the cinema. I take Kate to be real, but someone I can only reach with considerable delay. I respond as a human being and not a therapist delivering psychological interventions to some determined effect. I am a representative of humanity and a moral universe that is against violence and oppression and holds the person to be of fundamental worth, and life to be sacred.

When I have received such a story, I find the time to privately commit myself to it without having to hurry or be interrupted. I return the text to Irene with my comments and when she has read it on her own, we have a conversation where we go through it comment by comment and discuss the significance and meaning of it. Conversations emerge that are by no means limited by the story but go beyond it. Sometimes Irene writes a response to my responses. And sometimes I also write a response to her responses to my responses, creating a written record of effects and reflections emanating from the story. Such material has been an invaluable source of learning for me.

Effects of Katja-Writing.

The following is Irene’s account of the effects of working in this way for about a year:

Irene: Having this heap of accounts is evidence. Evidence for reality and existence. It is hard evidence of a history and a life. It is there — no matter what anyone else thinks. It makes it possible for me to be a person, and not to just have to fit in, in the eyes of others. These accounts give me a place to stand. It makes it possible for me to live and exist and find peace with myself and not have to “pretend” so much to other people, in place of the feeling that I always have to please others by approaching them, being polite and similar things. The heap of tales make up my life and give me the right to be — in my own way. This is a great change. Being able to feel that way just some of the time is unbelievable!

Living with these stories about Kate and the responses to them is a whole other way of living your life. It makes a very big difference. Everyday life itself becomes different. For example, it matters in daily life that I can say to myself that, “I am allowed and have the right to go and buy groceries.” This gives me a place to stand in life that makes it possible to be. My history still takes up space and haunts me, of course, but suddenly without being heavy and depressing. I can breathe.

All those things I have been called so many times, I have always just had to take it. These words tear one’s personality apart – one’s whole identity that you try to build up — and divide body and soul. It is ripped to pieces so that it is in rags and tatters, but the stories about Kate make it possible to sometimes accept myself.

Working with Katja-writing means that I don’t have to be the main character and carry all the burdens. Instead, it is “someone else,” even if it is about me. It is not remote, but there is more distance. It is almost like becoming part of the audience, and there it doesn’t hurt the same way. There is space to have an opinion about the story. When it is not “yourself,” then maybe you don’t need to keep your guard up to defend and explain yourself so much.

Reading the stories about an alter ego makes it possible to think about the content. It makes it possible to feel something, to see clearly, and to have compassion for the person in the stories. It sort of takes all the “noise” away so that you are able to look at something ugly, but at the same time relate to it. When it is written about someone else, then you can feel something without it being “wrong.” If it is written about me, then it is dangerous and forbidden.

The stories and the responses are enticing. They give me a desire to read them again and again, both inside my head as well as reading it aloud to myself. It is fascinating that it is your own story that you suddenly gain access to.

Katja-Writing and The Shadow Side

In October 2017, Irene explained to me something of the conduct of The Shadow Side when she read my responses to her stories. It had basically given us permission to do this writing practice and seemed to have an interest in it. Irene told me that she got the impression that The Shadow Side is like a frightened child acting in a violent and repellent way to keep everyone away. It doesn’t trust anyone. It had helped and protected Irene and she feels she has an obligation to it. Hearing Irene’s impressions of it, I began to feel sorry for The Shadow Side and desired to recruit it “on our team” rather than seeing it as something “evil.” Irene explained to me that it can take on many guises and speak with different voices, but she could tell that at its core, it is basically a frightened, rejected child.

Irene has kept a continuous diary of every conversation she has ever had with me. In May 2021, she decided to share an entry with me as part of a letter from her, concerning our work on the story Freedom:

“Around the summer of 2017 I suddenly felt a stomachache — in a good way. I started to look forward to reading Christoffer’s responses to my Katja-stories about Kate. I think it was when I read the responses to the story Freedom that I quietly smiled to myself. It was responses like: “Dear Kate. You protected your sister in this ugly night. That is what you did. Your love is so great that I struggle to fathom it. And the injustice is so great.” Did he just praise Kate? And if it was praise for Kate, then was it not also praise for me who survived that ugly night?

In the same text, Christoffer responded: “You are giving something good to your sister’s life, Kate…” Did Christoffer think that Kate did a good thing when she looked after Little Sister? In that case, would that also be what he would think of me, if he had been around at the time?

I smiled and got all warm inside — someone thinks I am doing well. That I did well when everything was at its most chaotic and I didn’t know what to do.

For some reason, I was not attacked by The Shadow Side when I read these responses to Kate. That was probably why — because they were for Kate. But I was Kate! The responses had to apply to me too! Apparently, that was all right with The Shadow Side, who began to empathize with me instead of acting like a harsh judge.

In a diary dated August 18th 2017, I wrote about a conversation with Christoffer:

“We started talking about those responses he has written for the first part of the dream. I asked him if he wrote these responses for ME or Kate?! He replied that it was probably for Kate, but that he was also aware that there was a certain connection between me and Kate. He told me that he didn’t try to analyze what was me and what was Kate but responded very directly to what the story said. I was happy with this. I made a point that I was not Kate and at the same time not not-Kate [This is similar to the ‘Insider Witnessing Practices’ of Epston and Carlson (1)]. So, he chose to respond in the same way. I felt gratitude that he could be so liberated and honest, without hidden motives about achieving something definite. That he was willing to share his immediate thoughts with me without reservation. I explained to him that by doing this, I actually felt that Kate was finally getting a response! Yes, and maybe I am getting it too through Kate, but that is really good, because when I reflect on all that has happened, then it feels so real and at the same time so unreal. Almost like Kate — or Katja.

I said that this in a way made the past easier to deal with. And that someone could react to it. I added that at home, I had imagined that I had to remove everything that didn’t fit into the story. Make it chronological and detailed — and as such write a completely truthful account of that time. I would not have been able to do that. It would not have been nearly as free — and it would have been way too hard. But th

How to Use Inner Processes in Play Therapy to Help Traumatized Children

Posted on May 30, 2023February 11, 2026 by Psychotherapy.net Team

I am a Safe and Sound Protocol provider (SSP.) In my clinical experience with the protocol, I have worked with children who have experienced severe trauma including physical abuse, sexual abuse, neglect, disruptive behaviors, dysregulation, and the disparities accompanying rural living. I have also worked with individual/family needs associated with neurodivergence.

In this work, I have relied heavily upon Stephen Porges’ Polyvagal Theory because I have found that looking at behavior through this particular lens provides a framework that depathologizes clients and emphasizes safe relationships. This lens also promotes an understanding from within the client and between the systems in which the client is embedded. James is one such client.

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A Tale of Therapeutic Attunement

Seven-year-old James (a fictitious name) was referred for his disruptive and aggressive behaviors. James was being raised by his paternal grandparents as his father died by suicide when James was young, and his mother was unable to care for him due to her complications with mental illness. James’ behavior with me was often the exact opposite of what the adults in his life reported.

Outwardly, he appeared calm, engaging, sociable, and playful. What, I wondered, was going on with this seemingly cherubic child to provoke him to rage and violence against his grandmother? What might be happening within the family system — within him?

James had experienced significant losses, so anger made sense. But, in spite of his placid and seemingly sociable demeanor, he was also quite emotionally disconnected; a protective strategy that helped him to feel safe and secure amidst all of the changes and losses he experienced. For many years, it was safer for James to simply not feel the pain of all these stressors. Not until we started play therapy, that is. James and I played together almost every week for many months.

Being a client-centered therapist and a play therapist, I allowed James to guide me in and out of his world, in his own time, with his own stories, items, and creativity. I noticed how he would go into a deeper part of himself, but only after many months of building emotional safety, and then it was only for a brief “nugget” of time. As I began to learn about James’ story, his past and his present, I learned to go with and trust the “ebb and flow” of the process that unfolded for him and between us in the playroom.

I recognized the importance of matching my pace to his, which can be difficult because there is a temptation to more immediately address the disruptive behaviors. I knew how vital it was for me to regulate myself so that both he and I could “dive deep” together into that private inner world he so fiercely protected.

As I worked with James, I often calmly and patiently reflected on what he was showing me through his chosen play activities which included Sandtray-world-making, art therapy, or even video games. Over the course of a few particular sessions, I noticed what is referred to in Polyvagal theory as Polyvagal countertransference — my own physiological response to the process between myself and James as we played together.

James might, for example, briefly create a sparse scene in the sand before abruptly bouncing to another activity. As this pattern continued, I patiently tracked him, monitoring my own internal physiological state so as not to become dysregulated or distracted by the rapidity of his changing play. In one particular session, a shift occurred. He created an elaborate, deep and lengthy sandtray scene, replete with a wide variety of miniatures.

I noticed myself becoming very excited, mirroring his own physiological state, and thought, “he is finally going to ‘let out’ a large piece of his trauma story.” For a brief moment, my own inner experience bordered on fight-or-flight, not as much because I felt fear or that I was scared, but because I was excited with and for James. I recall also sensing danger arising from his play, likely a mirroring of his own fear as the trauma story became revealed.

Fully connected and engaged in that amazing moment, our nervous systems met. He brought all of him, I brought all of me. If only for a moment, it was in that sliver of spacetime that healing was happening. In that space I could say to James, I see you. I see your pain, I see your loss. I see this anger, confusion. I see all of it in this story that you just told me. I see how this big storm came and wiped out the entire town, and how your mom was swept away. How you tried to save her, and how you still want to save her.

In that magnificent moment, all of James’ heavy and painful feelings finally surfaced. I was able to contain those emotions for James because my own nervous system was responding to his. And that level of attunement was not shown with words but through and with a shared energy. The within and between.

Questions for Discussion and Thought

How have you used the work of Stephen Porges in your clinical work with children? With adults?

What about the way the therapist worked with James do you appreciate? Why?

How might you have worked differently with James?

A Therapist Uses Her Grief as a Resource for Working with Trauma

Posted on April 11, 2023February 23, 2026 by Psychotherapy.net Team

A Place of Emotional Safety

My Mom recently posted photos on a social media site of birthday flowers that my and my sister’s family sent this year, along with others from years past. One of the photos showed flowers sitting in my grandparent’s kitchen.

Seeing the yellow cabinets and green tiles again brought back memories of cooking and baking with my grandmother in that kitchen. I can no longer smell the warm, sweet, and all-encompassing aromas that wafted effortlessly through their home but, as I remember them fondly, a sense of calm washes over me. My grandparents’ home was a safe place for me, where my creativity reined. When I was a young adult, my grandfather reminded me that I called their house “the happy place” when I was little. That description still fits for me today, though I can never revisit that place and time again like it was in my mom’s photo. After my last grandparent’s death, their house was sold to another family.

In the wee hours of this morning, I revisited that kitchen in the small interstice between sleeping and waking, simultaneously sensing the welcomed echo from my Mom’s flowers post and an invading sadness, tinged by a dull ache of homesickness from living so far from my family of origin and missing those who have died (several anniversaries of which have just recently passed). When the alarm on my smartphone sounded, I hit the snooze button to remain in the tenderness of the memory of that time where everyone still lived and gathered in that happy place, if only for a few more minutes.

The tinge of sadness, grief, and disenfranchised grief that grew as my consciousness expanded through the end of my intentionally prolonged dream reminds me that that place, as it was, and that time, when I was carefree and loved ones lived on, can no longer exist in my current reality.

The Privilege of a Happy Childhood

As I write this, I am aware of the privilege I carry to having had loving family members and safe places to rest my head, with food on the table every day and dessert in the oven on some of those days. That is not the case for many of my therapy clients, the majority of whom have experienced multiple forms of abuse embedded within precarious living situations that stagger fine lines between poverty and unintended negligence. Their grief, embedded within traumatic life events, is permeated by a kind of disenfranchisement that holds an invisible but unyielding grasp on their wellbeing and potential to positively evolve.

If grief could be described as ice cream, I would say it is quite like vanilla, a standard flavor, the most standard flavor. Everyone will eventually be served a scoop alongside some other more desirable option, whether they ask for it or not. Disenfranchised traumatic grief, then, would be like ribbons of lemon sorbet being folded into the mix with filaments of tart lemon zest that are neither easily seen (recognized) nor able to be dissociated from the rest of the scoop. The sting of the tartness sharpens the senses as one eats the part of the dessert, they neither ordered nor wanted in the first place but couldn’t push away once it was in front of them, either.

Several of my past and present child clients live in care situations outside of the homes occupied by their families of origin. They did not choose to be born; they did not choose to be neglected or abused; and they also did not choose to be removed from their families of origin, which represents another form of grief for them, though their circumstances did not promote healthy wellbeing or allow for a normal course of development. Often, their ambivalence oscillates between longing for the happy days they lived with their loved ones, which may have been few and far between, and wishing for something that never existed for them, in a mother that held them, made them feel wanted and loved or in a father that fixed boo-boos rather than creating them.

However, holding on to that place in my memory serves as a resource when I’m feeling down, discouraged, or otherwise off balance.

Memory as Resource

As Easter is nigh, revisiting my grandparents’ kitchen reminds me of dying eggs, baking cookies, and blending homemade orange slushies at the countertop with my grandmother. The sliding glass door from the kitchen opened to a small wooden porch at the back of the house. On that porch, I remember rubbing “motion” (my word for “lotion,” which was sunscreen) generously and gingerly on my grandfather’s head before he took me on the riding mower to cut the grass around the yard and over the hills behind their house.

At every turn past a small pompom tree that grew in the front yard, I would pull off a budding white flower or a leaf and squeal in delight as I put it on the hood of the riding mower and watched it shake off to the side with the vibration of the motor. I would usually finish the ride asleep on my grandfather’s lap, soaking in the sun from a warm summer’s day, not feeling a care in the world.

My grandmother’s death preceded my grandfather’s by 11 years. After my grandfather died, a young couple bought their house and land and made changes and new additions. Some changes were voluntary, like repainting the kitchen and rebuilding a bigger, sturdier deck onto the back of the house as an outdoor extension to the kitchen in summer months. Some changes were involuntary, but necessary, like removing the vestiges of trees that had died, which opened the landscape to reveal different views of the house and land.

My family has remained in contact with the new family in the house, and my mom has been on a walk-through tour of the updates and renovations they have made to the over-100-year-old house that she grew up in. I, however, do not believe I will ever be able to walk through it again, not because I wouldn’t be invited, but because I am afraid that it will change my capacity to continue to hold my happy place in my mind and heart.

As an expat living thousands of miles away, I count on my happy memories as resources to wash away the vanilla- and lemon-tinged grief that shows up on the dessert plate of my current existence, unwanted and unexpected, across the oceans and continents that divide me from my family back home. These memories, and the soul-nurturing feelings I can still feel upon revisiting this place and these people in my dreams, provide palate-cleansing relief to the sharp contrast of my therapeutic work with traumatized individuals and families.

So, in that short interstice between the still-sort-of-sleeping and not-quite-waking early hours of the morning, when a visit to my grandparents’ kitchen is ever-so-real and still possible, hitting the snooze button becomes a worthwhile endeavor, if only to hang on to a place and a time that does not exist anymore, except in my mind.

Successful Trauma Therapy Does Not Require Forgiveness

Posted on January 19, 2023February 11, 2026 by Psychotherapy.net Team

Research indicates that forgiveness can positively impact physical and mental health. Yet, few studies explore the impact of forgiveness on trauma survivors. Existing studies suggest that forgiveness can be beneficial. However, these few studies have small sample sizes and are often conducted or funded by forgiveness advocates. If we can’t rely on the research, clinicians must ask themselves, “Does forgiveness benefit trauma survivors as a part of their recovery?” Can CBT Truly Benefit Trauma Survivors? To find an answer, consider this question, “Does CBT — frequently used in the treatment of trauma survivors, benefit their recovery?” The answer is yes and no. Some survivors do, while others do not. The same applies for forgiveness. Some survivors benefit from forgiving their offenders, while others do not. There is no universal treatment for trauma. There is not one intervention that works for all survivors. If forgiveness may or may not benefit survivors in their recovery, could incorporating it into treatment harm them? And by “incorporating” it into treatment, I am referring to those instances when the therapist does so, not at the request of the client, but because they believe it will be beneficial. By “harm” I suggest that survivors could potentially: end therapy prematurely and not resume with a new therapist for years (as seen below in the cases of Marcus and DeAndre) continue to sacrifice their safety to forgive (which April, also below, was able to avoid) avoid, postpone, or try to skip vital emotional processing, which is often necessary for trauma recovery (such as with DeAndre) repeat old patterns of self-sacrifice, or pleasing their offenders to support their safety (continuing the flight, freezing, or fawn response) encourage silence, preventing survivors from embracing their narrative and sharing it with others, which can support recovery interfere with reporting dangerous people to the authorities if needed After 15 years as a trauma psychotherapist, I’ve discovered that when forgiveness is pressured, recommended, or even encouraged, it can cause harm in any of the forms noted above. I assume that many well-intended clinicians believe that trauma survivors will progress in therapy if, and perhaps only if, they forgive. These clinicians may unintentionally cause damage when they advocate forgiveness in circumstances where it doesn’t meet the needs of survivors. “Forgiveness Was Never for Me; It Was Always for Them” Marcus experienced emotional abuse as a child from ages 6-12. His father would scream at him, call him derogatory names, or ignore him for weeks. At age 14, he began instigating physical fights at school and was suspended. Therapy was recommended. When Marcus disclosed the abuse, his therapist encouraged him to let go of his anger by forgiving his father. There was no exploration of Marcus’ capability, readiness, or willingness to forgive. Instead, it was determined by the therapist, the school, and the family that Marcus needed to forgive so that he would stop physically assaulting others. A few months after starting individual therapy, Marcus participated in his first and only family therapy session with his father. Under the watchful eye of Marcus’ therapist, his father gave a one-minute apology for six years of emotional abuse, and Marcus sheepishly replied, “I forgive you.” Since that family therapy session, Marcus was not allowed to express anger directed at his father, mother, or anyone else. When he did, people would say to him, “What are you so angry about? Didn’t you forgive him?” and “It’s time to move on.” Five years later, at age eighteen, Marcus ended all communication with his parents. “Please, don’t ask me to forgive them,” 32-year-old Marcus told me during his first therapy session since he was 14. “Forgiveness was never for me; it was always for them.” “Deal,” I said without hesitation. “We are officially taking forgiveness off the table.” “Really?” “Yeah, we don’t have to focus on forgiveness. What would it be like if we focused on what you need instead?” Marcus looked shocked. He glanced around the room with fluttering eyes. Then, he placed his head in his lap and cried. For the next five years, Marcus learned to embrace, express, and process his anger, fear, and grief. Then, gradually, he experienced authentic forgiveness. This was never the focus of our treatment. Instead, it was an organic result. When he ended therapy with me, Marcus decided not to reestablish contact with his parents, whom he hadn’t spoken to in 14 years, a reminder that forgiveness is not the same as reconciliation. Marcus focused his efforts on the people he believed could provide safe and trusting relationships. “Women Are Supposed to Always Forgive, Even If It Kills Them” April began therapy when she abruptly left her physically and financially abusive husband. It was her third attempt at leaving and what she called “My last Hail Mary.” She moved out of the state with her children and ceased communication with her husband. She worked with an attorney and a case worker to pursue a divorce and full custody. Yet, her family members and friends encouraged her to resume communication with her husband, and at times passed messages along to her from him. They had good intentions. They didn’t want her to return to her husband; they wanted her to experience an uncontested divorce to minimize the financial burden and to participate in co-parenting to support the childrens’ relationships with both parents. When April began therapy, her therapist, who was not trained in working with survivors of domestic violence, agreed with them. In therapy April was encouraged to consider reestablishing contact with her husband to experience relationship closure by embracing forgiveness. Her therapist wanted her to “not have long-term trauma symptoms,” as April recalled. Therapy consisted of April learning coping skills to use when she was ready to reestablish contact with her husband and visualization exercises to help her to be open to forgiveness for the sake of her children. A month later, April ended therapy and all communication with her family and friends. Two months later, her case worker recommended that she work with a trauma-trained therapist, and she agreed to participate in a consultation call with me. “If I talk to him, I’ll go back,” April said in a tone that sounded angry, but all I heard was fear. “If I go back, he will kill me, or I’ll kill myself. You need to understand that.” “I get it. You have no plans to reestablish contact. All communication will go through your attorney or case worker. Is that correct?” I asked. “Yes. It’s like, people don’t get it. Women are supposed to always forgive, even if it kills them.” April agreed to try trauma therapy with the understanding that she could end treatment at any time. She didn’t. Instead of reestablishing communication with her husband and seeking forgiveness, April’s therapy focused on establishing safety. With a trauma therapy recipe consisting of EMDR, Somatic Experiencing, Internal Family Systems work, self-defense classes and support groups, April learned to create and maintain safety in her new home and city with new friends. Three years later, she resumed contact with a few family members and friends who were receptive to following firm boundaries regarding their interactions with her and her ex-husband. At that time, her ex-husband had ceased contact with all of April’s family and friends, had given April full custody of the children, ended contact with his children and remarried. “I Thought Forgiving Her Would Save Me” DeAndre’s mother would become rageful without warning. She’d scream, mock and belittle her children and damage property. As a result, he developed a fear of anger, as his childhood experiences taught him that anger was an unsafe emotion that should be avoided. He learned to suppress feelings and expressions of anger and was considered an easygoing guy. Yet, his relationships lacked closeness, and at 27 years old, DeAndre began therapy for the first time. DeAndre and his therapist discovered that his anger and fear prevented him from engaging in healthy conflicts, establishing boundaries, and presenting his authentic self in adult relationships. This avoidance caused a lack of vulnerability and closeness, leaving him feeling isolated. DeAndre’s therapist recommended that he engage in conflicts with others to achieve forgiveness. The therapist suspected that DeAndre would feel safer with his anger if he could do something healthy with it, which would be forgiving. As a result, DeAndre became a prolific forgiver. He forgave his mother, his friends, and everyone who had ever wronged him. He didn’t require acknowledgment, accountability, or apologies from his offenders. He quickly forgave them. After a year, he ended therapy because his relationships did not improve, he continued to feel isolated, and thought that people were taking advantage of his easy-going, forgiving nature. Twelve years later, DeAndre was married with children. He began therapy with me to address his lack of boundaries in his relationships. “I feel angry for a few minutes,” he said in the session. “What happens after those few minutes?” I asked. “I don’t feel anything,” DeAndre described. “That’s when I forgive them and move forward.” After working with DeAndre, it became clear that he was not forgiving; he was dissociating. Experiencing anger was so overwhelming that his mind and body could not tolerate it for more than a few minutes at a time. DeAndre and I focused on increasing his tolerance and feelings of safety related to anger. As therapy progressed, he discovered that he was angry at his mother for her abuse. He resented his extended family members for not protecting him. He was also disappointed in himself for being unable to protect his younger sisters from his mother’s rage. “The truth is, I haven’t forgiven her,” he said. “I thought forgiving her would save me from my anger, but it didn’t. It just helped me avoid it for forty years.” Two years later, DeAndre was able to experience anger for extended periods and safely express this anger to others. Once he discovered his anger did not harm others, he could engage in conflicts and establish boundaries in his relationship with less fear. He was now participating in closer relationships with his sisters, wife, and children. When DeAndre ended treatment, he had not forgiven his mother, but that was never the goal.

***

If forgiveness can harm trauma survivors, what should mental health clinicians do? Clinicians should not force, encourage, or recommend forgiveness. Instead, they should allow trauma survivors to decide or discover their needs regarding forgiveness. Survivors might choose to forgive, or they might embrace organic forgiveness. Survivors might choose to withhold, resist, or forgo forgiveness. Some survivors might not be capable of authentic forgiveness no matter how hard they try, and others may wish to take forgiveness off the table. The giving or withholding of forgiveness is a choice that should always be left to the survivor. Questions for Thought What are your thoughts about the author’s approach to forgiveness with trauma survivors? What is your approach to integrating forgiveness into your own trauma work? Can you think of instances where forgiveness helped the client? Can you think of instances where forgiveness did harm instead?

Dreams, Nightmares, and the Key to Successful Trauma Therapy

Posted on January 17, 2023February 11, 2026 by Psychotherapy.net Team

A client of mine dreamt that she had sat so long in the bath that the water had turned cold. While I have heard thousands of client dreams, this one brought me to a realization about how dreams may be graphic depictions of client’s shifting autonomic states — images from and of the body. Far less filtered by our internal censor than waking thoughts, dreams are more image-based, visceral and fluid. Spending time with my clients’ dream images in a calm and curious way has been inherently soothing for them, and of late, I am beginning to suspect why this is so. While many have offered opinions on the nature and purpose of dreams, this notion that they are images the body projects onto the dreamscape has become clinically compelling to me. Nightmares Can Be Most Useful Dreams The late Ernest Hartmann, a celebrated dreamworker and researcher, famously said, “The nightmare is the most useful dream.” This is not meant to dismiss the real distress and terror that our worst dreams can bring. Nightmares are perhaps the most troubling symptom of post-traumatic stress injury and are prevalent in fully two-thirds of those with a mental health diagnosis. The benefit of nightmares is that they represent extreme emotional and physical states, and as such, ones that we can learn the most from. I’ve spent the last few of years investigating the link between nightmares and the autonomic nervous system (ANS) through the lens of Porges’ polyvagal theory. Although I think the implications of this for nightmare formation and treatment are still largely unexplored, I started the ball rolling with the recent publication of an article with an optimistic title: Solving the Nightmare Mystery. In it, I imply that the role of the nervous system is a missing link in our understanding of how to treat nightmares. I have been working clinically with those who experience deeply disturbing dreams for many years. One of the main things I do to help is facilitate the search for, and embodiment of, cues of safety that help alter the dreamer’s perception and experience of these dreams. Clients tell me that this embodied process of dreaming their dreams forward (called ‘rescripting’ in modern nightmare treatment literature), changes how they hold the dream in their body. Typically, the memory remains, but the emotional and physical “charge” dissipates. For example, during the pandemic I dreamt of a woman falling to her death. She is a dear friend of mine with a highly compromised immune system, and it’s clear that the dream depicted my fear for her safety. I worked with this dream and found some hope in the athletic way she leaped onto the roof (before losing her balance). In dreaming it forward from there, she used that virtuosity to land safely. This dream session helped me feel better about the situation, and later she did indeed survive a nasty bout of COVID. Nightmares as Lived Bodily Sensations Nightmares are often quite dramatic depictions of current fear and/or past traumas. There is clear autonomic activation during sleep state shifts for those who experience them frequently. Nightmares are easily recalled, and their impact is tangibly felt, as is the relief one experiences when they begin to fade or shift into a more benign form. In a clinical setting, we can easily track clinical progress for those with intense dreams because when they shift toward more normal dreams, the change is welcome and obvious. In a recent class I taught on the clinical use of dreams, I realized that all dreams might be expressions of our autonomic state, even the quieter ones. A student brought a dream with the central image of a still, dark woman in a tub. She had sat there for so long the water had gone cold. When I invited the dreamer to allow the dream to continue, her impulse was to turn on the hot water faucet, to bring some warmth to the bath and to the woman’s body. At my invitation to enter the dream further, she took notice of the tub itself. It was older, more ornate and beautiful than the one in her bathroom, where the dream was set. I encouraged her to enjoy the details of this tub, and it began to feel like a precious heirloom. Details in dreams that depart from waking reality (called counterfactuals) warrant particular attention. The dreamer’s demeanor changed in this process of warming the bath; her face coloring and smiling as she described making the bath a sanctuary, adding scent and oils, and dipping into the enjoyment of it. Later, she told me, “I continued to experience ‘mini shifts’ in the following days and was able to access and carry the felt sense of the warmth and beauty of the bath into many areas of my daily life. I noticed I feel more present when I bring a sense of aesthetics, a little beautifying and warming detail, to tackling some of the mundane daily tasks which have been weighing me down lately.” The Critical Role of Polyvagal Theory This entire dream process could be seen as an image of the autonomic nervous system (ANS) as described by the polyvagal theory. Porges’ theory updates the former conceptualization of the nervous system as paired opposites that shift between sympathetic arousal and parasympathetic relaxation/shutdown. Instead, the theory suggests that we automatically shift states in a specific order depending on our sense of threat: we move from safety and social engagement to activation in the face of threat (fight/flight), and lastly, to immobility if the threat is perceived as overwhelming. And the theory suggests we move out of these states in reverse order. The woman in the dream followed these steps as she shifted from a cold, immobilized (dorsal vagal) state, into one of animation. The changes were clearly visible on her face. Her fellow classmates remarked on the change as the color returned to her cheeks, and her physiology demonstrated a clear shift into a state of social engagement and warmth (ventral vagal). This kind of shift is depicted in the imagery that arises in working with dreams. For example, the images from nightmares are clear representations of autonomic states. Activation or fight/flight – being chased or engaged in a battle are among the most prevalent nightmare themes. What I am suggesting is that nightmares are the most obvious expression of what happens in all dreams. They are our bodies expressing, in image and sensation, our fluctuating internal state. They are a doorway into its expression, particularly valuable for those clients who have trouble hearing what’s going inside. This brings me to another of Hartmann’s famous statements: that dreams are ‘picture-metaphors’ for our most salient emotional concerns. Sometimes our most pressing feelings are repressed, historic, or fleeting enough that we don’t think about them during the day. But our dreams have an uncanny way of picturing what matters most, even if we have repressed it. Our bodies carry the charge of feelings and memories that are unmetabolized, and these find expression in our dreams. The True Purpose of Dreaming? My sense, which is shared with many dreamworkers and researchers, is that the purpose of dreaming about emotion is not to upset us, but to help us process and shift such feelings. Sometimes, the dreams do this all on their own, like a nocturnal therapist, and sometimes it helps to have another person process the dreams with us. Sharing our dreams and bringing them into company and the light of day helps them do their job better. And increasingly, I’m beginning to think that a large part of their purpose is expressing and regulating the state of our nervous system. However, I need to give the dreamer the last word here. In the example of the woman in the bathtub, the dreamer accepted that yes, the dream did depict welcome state changes. But there was more — an invitation to sink into the beauty and warmth of an elegant bathtub, and a new way of being with life’s mundane chores. In other words, the shift in physiological state is welcome and accurate, but the invitation to appreciate beauty was compelling. And please forgive the very intended pun — to focus solely on physiology and ignore the depth and nuance of dream expression would be like throwing the baby out with the bathwater. Questions for Thought How does the author’s clinical use of the client’s dream fit with your own approach to dreamwork? What might you have done differently with this client regarding her dream? What is your own theoretical understanding of dreams and their “purpose?”

How Mental Illness Protects Clients Wounded by Trauma

Posted on January 12, 2023February 11, 2026 by Psychotherapy.net Team

All persons, those with and those without a mental disorder, exhibit both conscious and unconscious defense mechanisms. Conscious defense mechanisms are organized by, and act in service of the ego and seek to preserve the integrity of the person’s self-image. Unconscious defense mechanisms are organized by the unconscious mind — the mind’s mind — and serve the integrity of the whole person.

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Rationalizations and Reflections

Rationalizations about the symptoms of a mental illness (for one with a mental illness), or about the vagaries of one’s actions (for one without a mental illness), are a form of conscious defense. Reflect briefly on the excuses you make, and you can see examples of a conscious defense in service of your projected or preferred self-image.

In my clinical experience, some persons with a mental illness devise alternate explanations for their diagnosis in ways that help preserve a sense of personal integrity. “I don’t think I have schizophrenia, I am a psychic,” said one female resident at a nursing facility where I provide counseling. “I don’t use the word schizophrenia, I think I have time-travel and mind-travel,” said a male resident. “It’s not right to say I have schizophrenia,” said another woman. “I have PTSD because of the things I’ve heard and seen being done by the government and the mafia.”

If the person admits to the disorder of their mind as an illness, it could imply that they cannot rely on their mind for coherence or integrity, and so feel like a kaleidoscope of fragments without coherence. That would truly be terrifying.

The defensive rationalization might provide an explanation that bestows a special significance to the person—I am gifted; set apart from others, unique, contending with things others know nothing about. Such rationalizations exist in a borderland between the conscious and unconscious mind; they are partly delusion and partly ego repair. Rationalizations are at least partially conceived by the conscious mind, while delusions are sensed as received, and incontrovertibly true; they have the authority of otherness.

Delusions, like defensive rationalizations, tend to serve a purpose yet they may originate from a deeper element of the psyche. Delusions can sometimes offer a glimpse into the working of a broader intelligence within the psyche. Fortunately, we are more than the contents of our conscious minds. We each are served by a deeper source of intelligence and creativity, the unconscious mind that envelopes the ego and seeks to broaden its understanding and foster its wholeness.

Manifestations of the individual unconscious can be seen in dreams, and the power of the archetypes of the collective unconscious can be seen in large social situations—witness the power of the archetype in the world-wide response to the recent death of Queen Elizabeth, for example (I think it is important, though, to view Queen Elizabeth as a rare living exemplar of the four Cardinal Virtues: Prudence, Justice, Temperance, and Fortitude).

Dream-Digging as Archeology of the Soul

Many years ago, I wrote a master’s thesis entitled “Dream-Digging: Archeology of the Soul,” in which I excavated through a stack of journals in which I had been writing my dreams over a 17-year period, examining the appearance and actions of a particular recurring image, that of a snake.

As part of my preparation for practicing psychotherapy, I had undertaken a two year long Jungian dream analysis. Each week I would type — on a manual typewriter with a sheet of blue carbon paper between two sheets of paper, so that I would have a copy — the dreams I had collected that week in my journal and would explore their meanings with the analyst.

Noticing the sometimes-ingenious incursions of the unconscious mind into daily life is not limited though, to dream analysis or to the study of archetypes. One can even notice the protective functioning of the mind's mind in the tragic consequences of trauma with dissociative features. Consider the following examples from my clinical work in nursing facilities.

Hazel’s Front Line Defense

Hazel was a 94-year-old lady living in a nursing facility. She was alert and quite talkative and actively wheeled through the building daily in her wheelchair—and always wore a red terry cloth bathrobe over her clothes. In childhood, she and her sisters were repeatedly sexually assaulted by their father who eventually went to prison for his crimes.

Hazel had an encapsulated psychosis with delusions involving possible threat from demons. She believed that many years ago demons had entered her childhood bedroom through hidden doors, and she claimed that one time while brushing her hair, she saw in the mirror that Satan was in her bedroom doorway. She felt the need to be perpetually on guard to notice and defend against any re-occurrence of demon activity.

Through the unconscious and protective functioning of dissociation, she split off awareness of her father sneaking into her room or looming ominously and projected it as having a supernatural source from which she might thereafter protect herself, if adequately vigilant. Her omnipresent red bathrobe also pointed symbolically as a sort of alarm, a warning about the earlier scene of the crimes.

Lucy’s Isolation as Protection

Similar in many ways to Hazel, Lucy was serially raped by her father and uncles over several years in her early adolescence. Lucy described leaving her body and floating at the ceiling and watching what was happening to her body below during assaults.

Due to severe trauma, she subsequently suffered from mental illness with dissociative features. She rarely chose to tell others of her thoughts and feelings because, “they’ll think it’s just all schizophrenic stuff.’ She isolated herself in her room at the nursing facility, wearing only hospital gowns, and kept the curtains drawn around her bed. She complained periodically that something had gone wrong with her mattress, and that she needed another one or it would make her ill. Lucy believed that she was supernaturally ordered not to wear clothes, and that they would make her ill if she did.

Lucy told me that the men who assaulted her were not actually to blame, because they were under the control of an evil spirit who made them do what they did. Again, we see how the symptoms of wearing only nightclothes and the sometimes-sickening mattress point to the earlier scene of the crimes. Her unconscious dissociative and psychiatric symptoms allowed her to imagine that her persecutors were not responsible for her abuse, and that she might be safe now if she lived within restrictive parameters.

Her goal in psychotherapy was simply to sustain her daily stability with as little change as possible in her daily routines. Lucy described living in her own world, which was more satisfying for her because the outer world had been so painful for her. She viewed psychotherapy conversations as a kind of visiting at the doors of our different worlds, where she could greet me and offer a report about how she was doing in her world.

***

The symptoms of mental illness can sometimes seem chaotic, yet while irrational, they may still be filled with meanings, and can point to their origins and to the unconscious strategies that help sustain a broken psyche. As a psychotherapist, I have come to notice and work with the often-clever manifestations of the “mind’s mind” as I have tried to decipher the hieroglyphic language of disordered thinking and acting that has been brought about by trauma, and by the creative efforts of the unconscious to try and manage the destruction.

Questions for Clinical Thought

Can you think of clients with whom you’ve worked where this perspective might have helped, or may help?

How useful or not are the unconscious mind and ego defenses as therapeutic concepts?

How to Help Veterans Haunted by War Reclaim Their Humanity

Posted on November 29, 2022February 26, 2026 by Psychotherapy.net Team

“I try to not fall asleep, because then I’ll just have another nightmare.”

Rick was a sniper in the Vietnam War. He was sent on “high-low” missions in which he was taken by plane at night to a “high” altitude (above radar) where he would jump out with his rifle, and his parachute would automatically open at a “low” altitude of 1000 feet. He was given a photo of a high-level North Vietnamese commander who was his target on the mission. After completing his mission, Rick would run through the jungle, then swim down the river where he was picked up by an American patrol boat. Rick successfully completed six of these incredibly dangerous missions. He subsequently suffered recurrent nightmares in which he would see the dreadful sights in his rifle scope at the moments of successes, and then be chased through the jungle by groups of North Vietnamese soldiers.

After returning from war Rick became alcoholic, lost his marriage and relationships with his two young daughters, became homeless, and suffered degradation to his health. Now, in the nursing facility, Rick was gaunt, wheelchair-bound, with straggly hair and beard, and largely mute, rarely speaking to anyone. He did begin to speak with me after a few months of my quietly and patiently talking to him.

Rick talked of how he and his sister grew up with alcoholic and abusive parents. To escape, he would shoot tin cans for hours at a local quarry. In our therapeutic work together, Rick was willing to explore the associations with his recurrent nightmares. Even though Rick knew he had acted under the command of superior officers, had skillfully fulfilled his military duties, and was viewed as a hero, he had deep feelings of guilt and shame about his role as a sniper. In part, his guilt stemmed from fantasies he had as a teenager that involved shooting his parents as he took aim at the tin cans. Rick felt remorse over the killing of targeted enemy commanders, even though he knew they were directing their own troops to kill him and his comrades. Rick had imaginary conversations during therapy with the men he had shot.

Rick felt deeply ambivalent about being labeled a “hero.” We considered if it was heroism to jump repeatedly from a plane over enemy territory at night, or to fulfill six sniper missions, or to overcome his trauma and recover his human concern for others, or to begin communicating with others at the nursing facility, or to have a meeting with one of his now-adult and long-estranged daughters, or to reconnect lovingly with his sister.

Rick came to laugh as we speculated that maybe it should be the North Vietnamese soldiers having nightmares after an invisible American sniper jumped from the sky six times and killed their commanders then escaped unseen. As therapy continued over the next two years, Rick reported gradual reductions in the frequency of nightmares from nightly, to once weekly, to “only once in a while now.”

In working with Rick, and others who shared similar trauma, I have come to learn that war is truly hell on earth, and that while heroism surely revolves around the strength and valor to fight, it also includes the courage to reclaim one’s humanity and one’s relationships, and to regain some degree of peace within a wounded soul.

Healing Conversations: Giving Life to the Life of a Person Who Died by Suicide*

Posted on November 8, 2022February 11, 2026 by rezendevknowfully.com

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org

Rushing to work for an early start at the Shriners Hospitals for Children–Canada, I decided to listen to my messages in the event an important call had come in. I often have young people consulting me at 7 am, either because of an operation that day and a child needing help facing ‘fears’, or because a conscientious young person does not want to miss school. I knew I had one such conscientious person that morning. There was a call from the mother of a young woman I was to meet that morning. She had called late the night before.

“Linda, can you call me back as soon as possible; this is an emergency.” “Oh, no,” I thought to myself. I only gave the number to Shriners patients who talk of suicidal ideas because other calls could be screened by the hospital.

This young woman had expressed such ideas but had felt certain she would not act on them. As she was 21 years of age, and had assured me they were only ideas, not to be put into action, I had not informed her parents. We had worked out a list of people she could call if she felt unsafe, and she had said she would go to emergency if uncertain she could control such ideas. We had discussed vulnerabilities, as well as reasons to stay alive. “What could this emergency be?” I tried calling back, but there was no answer.

When I arrived at work, feeling extremely worried, I saw the young woman. She asked to speak to me immediately. “Linda, I want to give up my appointment this morning for Trevor’s parents”. She then hesitated before adding: “Trevor took his life early Sunday morning, and they really need your help”.

Trevor – Prologue

My thoughts flew back to the few consultations I had had with Trevor, a lovely and talented young man who had been so sad and disturbed about falling away from the Christian beliefs of his parents. He had just gone through an extremely complex and quite perilous chest surgery for a deformity. He had assumed such risks in order to live a better life. He was booked to see me the next day.

I was in shock and soon realized that I would have to immediately pull myself together for his parents. I urged myself on with deep breaths; “Be strong, be brave,” I instructed myself. Although I did not know Trevor’s parents, I could only imagine what they had been through these past weeks with Trevor so very despondent while not understanding what led to such despair in their son.

“They must be wondering why he had chosen to have this surgery if he had not wanted to improve his life and to live,” I thought to myself. I reminded myself to be curious about what they were thinking and feeling, to ask them how they were living through this experience and not assume that my thoughts were their thoughts.

The young woman introduced his parents to me in the waiting room. I told them how very sad and sorry I was. I asked myself, “What does one say in such a situation?” I made sure not to say that I was sorry for their loss.

That was said to me when my sister had died, and at the time it felt very wrong, “Does that mean I can soon find her?” I had thought at the time. Little did I know that, yes, I could find her in a new re-membered way(1). I reminded myself to keep that in mind.

I have accompanied parents through the death of a child in my work in palliative care(2,3) and also in oncology with unexpected deaths(4) but I had never accompanied parents through a death of a child by suicide. This had never happened to me.

My thoughts immediately went back to Trevor. I had helped so many other children make legacies when they knew they were dying, and I knew they were dying(2) but I really had come to believe that Trevor was planning to live. I did not think from our conversations that he was planning to die. Yes, he had told me about feeling suicidal and even about those two weeks of desperation a month or so ago during which he made some attempts, but more recently in our sessions, he spoke so fervently about living.

He explained to me that when he tried to suicide, first by pills and alcohol, that combination made him feel terribly sick. His next attempt a week later by carbon monoxide poisoning involved driving into a garage on a cold Montreal night thinking he would just fall asleep. However, he began feeling so sick and dizzy that he abandoned his car. It was then, he informed me that he decided this was a message from God. He was fated to live!

He told his parents of his attempts and assured them that he had work to do in this world and must live. He was going to help other young people. His parents told the young woman, who had generously given up her session for them, about the suicide attempts and that was when she suggested he meet me for help.

Reading the medical notes in his file, I felt extremely sad since it was clear that he had had a very strong psychological reaction to his deformity, that had been expressed to the surgeon. This contact and discussion about his negative psychological reactions had occurred eight months prior and no one had made a referral for psychological support.

I regretted that we could not have met earlier. “If so, might he have found a way to keep on with his life?” I wondered. “Did I miss something? Did I do something wrong?” We had spent some of the first session talking about warning signs that a crisis might be developing. He talked of memories of his ex-girlfriend, who had said that she was Christian but was behaving in ways that he found immoral. He said certain smells, senses, and even songs might bring up the memory of her which could lead to suicidal thoughts.

This young woman was finding worrisome ways, according to Trevor, to secure money. Trevor was trying so hard to assist her to find another way to resolve her financial needs. He prayed at length as well as read the Bible. He told me that under these circumstances he was reluctant to consult his pastor as he might have for other matters to protect her confidentiality.

When God did not answer his prayers for a way to assist this woman, he began to doubt his God. The more he lost his faith, the sadder and more desperate he had become.

We also talked about what he had been doing to manage the thoughts recently. He mentioned running, playing video games with his best friend, watching movies, drawing and playing his guitar. I referred him to art therapy because of his interest in drawing.

At the end of that last conversation, he had stated categorically, “However, I will not try. Period! This is over”. When I asked what was over, he replied, “This trying to take my life is over.”

He stated that he had felt very sad and hopeless after trying to bring this young woman, whom he felt in love with, to believe in Christianity in the way that he had been taught to believe in it. His decision for surgery had been because he had decided that he needed surgical correction to live and to help others, including his ex-girlfriend.

Trevor did not know how to tell his parents that, although he still believed there was a God, he did not believe in the way they believed. “I am a theist,” he said. “There is a lot of good to follow in my previous learnings, being kind, forgiving, learning from mistakes.

Seeing the best in this world is something that I will not follow.” Trevor’s family belongs to a very close-knit religious community. He felt that leaving this faith would mean losing his family and friends. We discussed the subject of love and wondered together whether the love might be great enough to outlive a change in his beliefs. He decided it was a possibility.

Trevor did believe that he was loved. He related a story of another young man of his community who had left the faith and was still part of his family. However, Trevor was still certain that he would disappoint his parents greatly with this loss of faith.

He felt that his ‘deformity’ now with scars from the corrective surgery, (“deformity” was Trevor’s own word regarding his chest difference), would not be accepted by others. Thus, he felt with the loss of faith he also lost an accepting community regarding ‘deformities.’ We explored the possibilities that there are others in this world who accept ‘deformities’ even if they were not of his faith.

We wondered together what he might be able to do for Shriners Hospital for example, where every patient has a ‘deformity’ of some kind? We explored the implications of ‘deformity’ and how his negative feelings about having a different body from others might be culturally developed from our Canadian society and did not have to be taken for granted as true. That even the word ‘deformity’ is a culturally created word. He thought maybe he could be of help to other Shriners patients.

Regarding accepting deformity, I contemplated inviting a past colleague as an outsider witness(5) to speak with us. She is a young woman who is wheelchair bound, due to what is known colloquially as ‘brittle bone disease.’ She is currently studying to become a clinical psychologist.

As a prior Shriners’ patient and later part of our employee community, she had assisted me several times previously, telling her story of how she managed to escape from shame of deformity and fear of others’ judgements. Those consulting her had found these conversations helpful. She is such an inspiration and has many humorous stories. But now, he had died. Taking his own life. None of these ideas could be put into action.

When Trevor and I had further conversations together we spoke at length about his plans for life and for living. We explored the idea that even with his altered faith, he was creating his own but slightly different moral code.

These discussions seemed to give him hope for finding a new life without his former religious beliefs. I had written in his notes that he had said, “I can take what I have learned and try my best to be a good person”. When I asked how he thought he could use this new moral code he replied with, “I have to find new hopes.”

I learned that Trevor was a musician, an artist and a writer. He had planned to use his talents to promote his past faith and now he had lost his goal in life. I remembered in detail his creativity. “I was writing a book trying to get through my current life story troubles. My character had to redeem himself for mistakes he had made. That person is really me.” “Are you thinking that you have made some mistakes for which you need redemption?” I asked. Trevor answered, “Maybe I could go and take fine arts at Concordia University.” I realize now that he did not answer the question of redemption and mistakes.

I now think that in a manner of speaking, I had been doing palliative care practices with him as might all narrative therapists in that we are always creating legacies. The book he was writing might now become a legacy that his parents could appreciate. Trevor had planned that his main character, really himself, who lived in a completely different Trevor-created world, would die. We talked of what the ending might be now that he planned to live.

He stated when he left this last session; “I have some ideas that I can use to write a new ending to this book. Do you want me to bring this to our next session?” I replied with a hopeful, “Yes.” Maybe I was too presumptuous. I truly expected to see him another time.

All these memories were going through my head in a whirlwind as I invited Trevor’s parents into the room. I felt that it was probably too soon to discuss legacies with his parents, even though Trevor and I had discovered resources, hopes and dreams, which could now allow him to leave legacies. He had written a book, he had his art, and he told me that he had recorded music with his guitar. There were the plans of finding a way to use these arts to help others.

However, in this beginning of our journey together with his parents, I needed to listen to their pain, listen to their story. We were challenged that morning, because at least three times there was a knock at my door. This was very unusual because when my door was closed, most of my colleagues knew I was with someone.

Finally, I answered the door since the knock was so insistent and persistent. I discovered my lovely supervisor standing just outside. She explained that she and my colleagues wanted me to know that they were there to support me at any time. This knowledge gave me strength to return to the room and have courage to start my uncharted journey with Trevor’s parents.

“How does one start such a journey on the day after a child has died by suicide?”

Linda and Brian – First Session

LINDA: Again, I want you to know how sorry I am. How do you feel that I might be of help to you?

Trevor’s mother (MANDY): I need you to hear what happened. We were so sure he had decided to live. (I identified with that). He had made an appointment with you for tomorrow, and also made an appointment with the art therapist.

Trevor’s father (BRIAN), interjected: I asked him how strong the suicidal thoughts were, just Saturday morning, the day before he died. He died in the middle of the night sometime between three and four am. Trevor reassured me by saying, ‘Dad, you know I have decided to live’. And he went to the church youth group.

LINDA: It sounds like you were working really hard to be sure that he was safe. Is that so? (This felt like such a feeble response).

However, Trevor’s dad’s answer seemed to suggest appreciation of this question:

I don’t know what else I could have done! He was sleeping in our room for the first few nights after he told us about his suicide attempts; then he asked to sleep back in his room. He had his computer set up there and he liked to play both games and his guitar late into the night, and we thought he was better. He seemed better. We had taken him to see a psychiatrist a few weeks ago and they kept him over night and then discharged him the next morning.

We figured if the psychiatrist thinks he can come home, he must be OK. Actually, two psychiatrists sent him home, first from our local hospital, they sent him home with medications, then we took him to the city psychiatric hospital, and they sent him home. We asked for a diagnosis and they said, ‘Well, here we are not big on diagnoses. They just suggested he keep seeing the psychologist.

LINDA: Would you say that you were trying your best to get professional help for him and thus thought you could relax a little and let him sleep in his own room?

BRIAN: He was almost 19 years old and had confided in us. We had to trust him at some point, though we would both wake up in the middle of the night and go down to his room and check on him. I asked him almost daily, ‘On a scale of 1 to 10…’ and every time Trevor answered with ‘Zero’. The local counseling center would call him every day and ask him how he was doing. His youth pastor contacted Trevor regularly and took him out to coffee to talk with him. I took him out a few times for coffee to talk to him outside of the home. We couldn’t keep him in our room forever.

MANDY: I woke up about three am that morning. I prayed and prayed to God to guide me in how to keep him safe. I prayed for nearly an hour. Then I got up. I thought of checking Trevor’s room and then I felt, no, he went to the church group last night, he said he was fine, so I decided not to check. In some ways I am so glad I did not check. I do not think I could have stood it, to find his room empty and know that he was dying while I was praying.

I thought it might be helpful for her to understand more about this.

LINDA: Mandy would you be willing to help me understand what it means to you that you prayed that whole time?

MANDY paused as she considered my question, she seemed to want to think about this question:

God was telling me that it was his time to go. Trevor had been suffering so. He could not stand it. That is what he said in his note. He told us not to blame ourselves, that we were good parents, but that he was suffering too much, so he had to go. The file where he wrote the note was called, ‘I am sorry’. I know that he is no longer in such pain, but I am in so much pain now. If only he had known how much I love him.

I worry for my husband, Brian, who found him hanging in the garage and had to cut him down. He dropped Trevor because he was so heavy. I worry that my husband will not be alright.

BRIAN: I didn’t know how I would tell my wife. How will she stand this? She is not so strong physically and has many family members not so strong psychologically. I went to try to gently tell her and she insisted on seeing the body. She wanted to see him before we called the police. I didn’t want her to remember him like that.

MANDY: I had to see my son. I had to hold him one last time.

LINDA: Does that mean you were showing him your motherly love or were you trying to figure out how your heart would not break, how to hold your heart together or something I totally could not even think of?

MANDY: I think it was a bit of it all. I didn’t want the police touching him and moving him but now I don’t know what to do because I cannot get that image out of my mind. That was not my son lying there on the floor.

LINDA: Sooo that was not your son lying on the floor. What are your thoughts about what your son is like now, or where he is now?

MANDY: I know that he is with God. He is no longer in harm’s way; he is safe.

I tried to formulate my next question.

LINDA: So, (so is a word I realized I use as I try to organize my thoughts and think of what I want to ask), if you wanted to replace the image of something that is not your son with another image that is your son, what image would you want to be thinking of?

Mandy paused and then she actually laughed. What a lovely sound for this moment. I truly felt it was not that the situation was in anyway lightened, but I could see her eyes go off to the side and she was for a moment somewhere else.

MANDY: He used to say, even sometimes recently, “Mum, look at me, see how fast I can run”. That is the image I want to hold on to. That was a bit of the Trevor that we lost when he was about 12 years old. He changed then. He withdrew from us, isolated himself in his room. Maybe something about his deformity at a time when boys care so much about their bodies. But sometimes he would come out of his room and say, “Mum watch me”. Just like that lovely little boy he used to be. That is my ‘true boy’.

I do not know whether you know or not, but we have a lot of mental illness in my side of the family. I was especially concerned about his hatred of his brother. I thought he had experienced some trauma he was too afraid to share with us that kept him isolated and angry. He denied it when I asked him. I kept searching for anything else I could think of and asking everyone I could think of like doctors, counselors, social workers, other people who had sibling hatred in their family.

Yes, he had this deformity and I know that for teens that can be terrible. But it seemed to me to be something more. Then we found you, and I felt hope, he was coming for therapy; he was even going to start art therapy; he had seen a psychiatrist; he was going to get better. But then, it was too late.

LINDA: If you could hold that image of that little boy, your ‘true boy’ and that young adult who is saying, “mummy watch me, see how I can run”, what difference might that make to this horrible pain that you are experiencing now, and that horrible image of something that is not your son?

MANDY: Yes, it would make a big difference. That is what I need to remember.

LINDA: Would you be interested in having some more conversations so that we could re-member Trevor as Trevor used to be before he withdrew from you and to learn what you appreciate about him?

Mandy responded with a strong “yes.” Brian said that he felt that Mandy was the one who really needed the help.

BRIAN: I think I will get the help that I need from my community and from my pastor.

I asked Mandy if she might want to bring some pictures, or other memories of Trevor to the next session, cautioning her to do so only if she wanted to and thought it might be helpful to her.

LINDA: I don’t know that person who asks his mum to watch him run, your ‘true boy’, and maybe the pictures could introduce him to me.

After this session, I reviewed the chapter that Michael White(6) had written called ‘Engagements with Suicide’ to get some ideas regarding how best to work with this family. Michael stated that often the person who took his or her life could become invisible, and the suicide could be cloaked in shame. I did not want this to happen.

I thought about how I could discover from the parents the values or skills required of Trevor to both live and to take his life? What kind of decision would this have been to make? Was the suicide mindful of what Trevor gave value to throughout his life? And thereby, we could try to link his living life and the decision to take his life to what he stood for so these parents could still feel connected to Trevor.

I also remembered Michael saying that some cultures think differently than ours about death by suicide. I remember the old Japanese Samurai movies where suicide was considered an act of honour. And as Michael had suggested, perhaps it would be possible to investigate and honour the ‘insider meaning’ of suicide.

I also wondered if a book I had co-authored with parents whose child had died of a medical condition, might provide helpful ideas for the family(7).

Trevor’s Created World

The next session, both parents arrived for our therapeutic conversation together. They wanted to know what Trevor had told me in our sessions together. Again, my thoughts went into a bit of a whirl. “Do I let them know that it was a change in faith that was troubling him? What about what he had told me about this girl who he was so worried about? They may know her.”

I decided to begin more generally and to refrain from discussing the information about the girl that Trevor did not want to tell the pastor about. I did not know whether they would have the right to read his file because we are a children’s hospital even though he had turned 18. I had given no such details. (I always work out with the adolescent I am consulting regarding what they agree can be placed in the medical file, after explaining the limits of confidentiality and the way we, at the Shriner’s Hospitals for Children, work as a team). I was conscious that this was all new to me.

I had never, even after many years of working with those who expressed suicidal ideas, experienced someone who had consulted with me end their life by suicide. “How do I navigate this? What are Trevor’s rights? What difference does it make if I do not tell them about his change in faith? Could telling cause them potential harm?”

However, I soon found out that they had read what was on Trevor’s computer. They knew about the young woman in Trevor’s life and how he felt so hurt because of decisions that she was making. They also knew that he questioned their faith. I decided to discuss the potential legacies that Trevor and I had discovered together. In particular, I thought of the book he told me he was writing.

LINDA: Did you find the book that he was writing, and the ‘Trevor-created new world’?

MANDY: No. We did not find that on his computer. I wonder where he put that book. I would love to read it. However, what I really want to know is what diagnosis you gave him. Did he have a mental illness?

It was evident that Mandy was interested in other things than legacies right now. In narrative therapy, we want to follow the lead of the person who is consulting us.

This question, however, produced another dilemma for me. I wondered what it meant to them to have a diagnosis. Psychologists have the right to diagnose mental illness, but this is not my usual way of working and I had not been thinking in diagnostic terms but in therapy terms. When working with a young person I am aware of how diagnoses can make it hard to distinguish the young person from the problem(8). I wondered if a diagnosis could help these parents heal from their grief.

LINDA: What would it mean to you if there had been a mental illness?

MANDY: Well, I have a sister who has been diagnosed with bipolar, an aunt and my grandmother had agoraphobia and my father may have had depression, so it runs in the family. Having a diagnosis would mean a lot to me because someone else who met with Trevor would have insight into his life and I so desperately want to know everything about my son, especially now that there are no new things to ever learn about him.

LINDA: Well Trevor and I named the problem ‘Trauma’. He felt that some of his experiences with his ex-girlfriend were very traumatic, and he felt that having a deformity was traumatic. When his ex-girlfriend did not want anything more to do with him after he tried so hard to help her, that felt like trauma for him. But he also told me in our last session, “It seems pretty amazing with all that ‘trauma,’ I still want to try to live”. Do you think, ‘trauma’ just got too strong for him?

BRIAN: I think that trauma got stronger when he was playing his videogame with his best friend and the game died. His friend whom he was playing with said that the last thing Trevor said to him was that on his screen it said, ‘Fatal Error’. He then wrote a letter to the girl asking her if it was worth it not changing her life and doing wrong actions. He actually used much stronger language. That also was so unlike him.

We have another letter he wrote this girl that was just beautiful. Then he wrote us a most beautiful letter. He can write beautiful letters. In his goodbye letter he said he was only trying to survive so that he could join the military and die in battle. But he was too ‘tired of fighting’ and gave up and that is why he committed suicide. He had to have had the idea of hanging because we discovered that he had studied knots on his computer and he had a rope, so I don’t know if trauma was what it was or not?

LINDA: Might it help to think that ‘trauma’ had gotten too strong, and that the game ‘dying’, and ‘fatal error’ somehow gave trauma its hold on him and these ideas of suicide or something different?

Brian thought that this would be better than thinking he had planned suicide all along and was being devious to them all in making them believe he planned to live.

MANDY: The letter we have that he had written before is of grace and love and kindness and mercy.

LINDA: Could it be a bit helpful to remember how he was able to write such beautiful letters? Could that be more helpful than trying to understand whether he was planning this or not? Or maybe, do you think Trevor was a ‘mindful’ young man? A ‘true boy’ of grace and love and kindness and mercy? It seems that ‘mindful’ might be a word to describe the beautiful letters and the having a rope and studying knots?

MANDY: I actually have his note here to his friend. He just said there was some sort of error. At 2:57, the game ‘died’ – I do not like that word anymore but that is what they use. At 3:08 he wrote to this girl. And at 3:21 he wrote to us. I think he was going through a spiritual battle. It was Trevor’s own will to go through with the decision of death. Yes, I think he was mindful all his life. But I think his death was really something like depression trapping much of him inside a sick mind. Maybe that was trauma caused.

LINDA: Might it be helpful to find your own term for this feeling of Trevor being trapped – trauma caused or something different?

MANDY: I woke up at three am that night and I prayed and prayed for Trevor. I prayed for angels to circle him wing to wing. Angels are ministers sent to help. I wanted them to help break the chains that bound him. I realize now that the angels were also for my benefit. The breaking of the chains I thought were to free him from pain. I just did not know that this freedom would be for him to die. I do need some help with the memory of his body and how it looked after the hanging. It haunts me.

LINDA: Well might that be something that we can work on next session if that is something you would want?

The Issue of Diagnosis

Mandy came to the next session with a photo book. She had created a photo book of her family every year and wanted to show me the year that Trevor changed. She also wanted me to see some of the pictures of the beginning of that year when he was the happy little, ‘watch me run mummy’ boy, her ‘true boy’.

There was a note to Mandy written by Trevor saying, ‘I love you the most in the hole world’. Written exactly like that. I discovered from Mandy that even his voice changed that year. He would speak, either in a robot voice or in a kind of baby voice when he was asking, ‘Mummy, come see me’. She discussed how she so much wanted to help her son. She had searched and searched for help. Mandy said that she and her husband had telephoned the psychiatrist from the psychiatric hospital which had kept Trevor overnight. The psychiatrist stated that Trevor had been diagnosed with ‘major depressive disorder’. Both Mandy and Brian seemed relieved to get such a diagnosis.

(Trevor’s dad later explained the meaning of diagnosis for him:

Trevor’s suicide provoked not only trauma and grief, but an investigation. Suicide was not something we, in our wildest nightmares, would ever think our family would struggle with. Trevor was so talented, so full of life and self-confidence. He was the first to get a full-time job on his own, buy a car, buy his own cell phone, get a bank account.

When we got the diagnosis from the psychiatrist that he had a Major Depressive Disorder we felt that it explained so much to us. In his last weeks I saw his feelings of worthlessness and inappropriate guilt. He felt he was a failure. Suicide presents multiple layers of trauma and inquiry that are not present with a simple tragic death.

During this session Mandy explained that she was feeling very upset having to live in this world where her son had hanged himself. She wished she had a chance to get help for him early enough.

(Brian later recounted that he felt similarly:

This has been hard for me too. Now that we have a diagnosis, every fatherly instinct in me craves the chance to go back in time to help him through this illness, and to explain it to him. He suffered all those years thinking he was just a jerk. He couldn’t help it. He was suffering and didn’t know it had a name. This had to play into his perception, somehow attaching to his deformity. He suffered alone, in my home, under my care, without any help. That destroys me inside. This is an added layer of severe grief in my heart, almost unbearable).

Mandy and I did some work around the image of seeing her son dead and how it made her feel that she failed because she could not save him. She also, in times of great distress, would feel that she was not loveable enough because it felt at times that Trevor did not love her. We discussed the possible relationship of this, ‘I am unlovable’ thought to her thoughts as a young child when her mother left the family for another man.

Mandy wanted the little boy Trevor, who needed her to watch him run, to stay with her. She remembered again praying for her son during the time that he was organizing to take his life. She believed that praying was for God to protect him and to protect herself. She kept going over and over what Trevor must have done that night. But she came to the realization during our conversations, that she was praying him out of this life and into another life without pain and with God.

She stated that this realization was helping her feelings of panic reduce in intensity. She also explained that she believed it was Trevor’s responsibility to make his own decisions now that he was almost nineteen, and it was her responsibility to pray for him.

When I arrived at work the next week, I had a telephone message from Brian. He was concerned that Mandy might have the same diagnosis as Trevor. She had been very upset that morning and wanted to climb on the roof to be closer to Trevor. Brian restrained her and asked her if she was feeling suicidal. She said that she was feeling sixty percent suicidal.

I phoned him back and suggested that Mandy might be feeling intense grief. I told him of other parents I had worked who had a child die explaining to me such very strong feelings, especially at first. It had only been a few weeks since Trevor died. I also stated after talking to Mandy, that if either of them were worried about being suicidal they could go to the same psychiatric hospital where Trevor had been admitted. They did decide to go.

God’s Peace

Mandy came to her next session saying that the psychiatrist told her that she was having a normal grief reaction. I was beginning to like the psychiatrists at this hospital who were not so ready to think of DSM diagnoses and medications. Mandy had been given Ativan by her family doctor after Trevor’s death and Mandy believed that maybe these medications were making her have suicidal ideas. She therefore had decided to take no medications for now and was feeling better.

LINDA: Mandy, are you worried for your life now?

MANDY: No, I am not worried that I will actively do something, but I sometimes wish that I would get the Coronavirus and die. I have weak lungs and I could just die. I miss my boy so much.

LINDA: Does that mean that you feel that you do not have reasons to live anymore?

MANDY: That is exactly what my pastor said. He reminded me that it is not my time. That my work is not over here on earth. I have three other children and many other reasons to live. I am reminded that Mary, mother of Jesus, suffered too. She had to watch her son be tortured and to see him die tragically. I was watching my son in a different sort of torture. I just need peace. I just need God’s peace and I find that in scripture.

LINDA: How can you live God’s peace?

MANDY: Knowing that Trevor is in heaven with God, and I will be there with him some day, but he will be waiting so long, too long. I can read the Bible and it brings me peace. But that long time of waiting hurts me. However, I will see him again.

LINDA: Do you believe that the time in heaven will be the same as the time on earth? Might it be that Trevor will only feel it as minutes when you feel it as years, or something at least differently than here?

MANDY: Yesss. Time would be different. He is in heaven after all. And here I am and here I will stay, even if it will be hard to live in a world without Trevor. I know I tried. At least I do not feel guilty.

LINDA: Do you see this as a gift, knowing that you did the best you could and tried so hard to help him?

MANDY: It IS a gift. I never thought of it that way. It is truly a gift; I tried so hard.

LINDA: Mandy, what are some of the many ways that you think the pastor was thinking of when he told you that your work on earth is not over?

MANDY: Well, we have decided to help others who might have problems like Trevor’s and use his life and him taking his life as an example and a message for others. We want to help parents to find help for their children. We are working on suicide prevention. Thank you for giving us that document that can be used in the youth group. We plan to have his funeral as both a homage to Trevor and as a message about youth problems and ideas for how to get help.

LINDA: Do you think this is showing some of your heart’s concern that you showed for Trevor now being used to help other young people in difficulty? Trevor wanted to help others as well.

MANDY: Yes, I must not forget that this is my plan for life, and this was Trevor’s plan. I need to help other children to get the services that they need.

Sun on Wood

Our fifth session started just after isolation for the coronavirus began. Mandy was having the telephone session in Trevor’s room where she could have privacy and thoughts of Trevor’s death felt very close to her heart.

MANDY: I am having a lot of incorrect thinking. I wake up every night at the time he died. I am so sad.

LINDA: Mandy, could you help me understand something? When ‘incorrect thinking’ tries to take over, what is it saying to you and how do you respond to it?

MANDY: It is that coronavirus idea thing. I could easily go into public and expose myself to the virus. ‘Incorrect thinking’ keeps saying, this could be good, this virus. I would probably die with my lung problems.

LINDA: Might ‘incorrect thinking’ be kind of ‘missing Trevor’ thinking? You said last week, ‘I am here to stay’, but staying might still be pretty challenging?

MANDY: Yes, I AM here to stay. I just don’t like a world that I have to stay in when my son died by suicide. We were looking for the book and for notes about it. We did find some little notes and a long letter. I printed them out. They are precious. That was my ‘true boy’- those notes and letters.

LINDA:    Mandy, I wonder if you would be so kind as to describe that precious ‘true boy’ for me?

MANDY: I remember two-year-old Trevor with his red tennis shoes. He had a scooter, and he was so agile that even at that age, we put him on the scooter, and he rode in circles, his little shoes so eye catching. His bright blue eyes so sparkling. I always wanted a fair boy who looked like my side of the family, the others are dark haired. I began praying, asking God specifically if my next baby could please have blonde hair, and blue eyes, and if it weren’t too much to ask, curls on top of all that. God gave me it all!

He had a yellow and black coat. He was so happy and thoughtful then. He asked such hard questions about God. I am so blessed to have been his mum.

LINDA: Is that one of Trevor’s legacies to you, to give you the opportunity to be so blessed to be his mum? Do you have some ideas how to get even closer to the reasons why you are so blessed to be his mum, while still living in this world that you have decided to stay in and find the precious ‘true boy’?

MANDY (very tearfully): I blogged daily, writing little stories about all my children. I was recording it for my family who were far away. They are invaluable now. I sleep with his two stuffies (soft toys) called Nache and Thunder that he always slept with. I kiss them on the nose and tell Trevor that I will take care of them for him.

LINDA: Mandy what do the tears speak to?

MANDY: That I forgive him. I am in his room and his smell is disappearing. That frightens me.

LINDA:   Do you have some ideas how you can keep his smell closer to your heart and soul?

MANDY: I have no idea; it scares me. I am losing him.

LINDA:     Could you describe the Trevor smells?

MANDY: The smell is a bit of outdoors, like sun on wood; it is warm skin, Trevor’s warm skin. Independence.

LINDA: We are creatures of words. Would it be helpful if I write this down on a separate paper that I can give to you when we are out of this coronavirus isolation or mail to you now?

(I always make notes during the session that usually those consulting me can take with them, but I am doing these sessions by telephone, and I wanted to write these beautiful ways of re-membering Trevor very carefully. I thought I might type or send all our re-membering in a written narrative letter 9-13 .

LINDA: Mandy, I am curious, what does independence smell like?

MANDY: It smells like sun on wood. That’s my ‘true boy’, independence. Oh yes, please write it all down.

LINDA: I am writing this, ‘sun on wood, a bit of outdoors, warm skin, Trevor’s skin, independence’.

Do you think he can feel that forgiveness?

MANDY (very softly): Yes, he knows that I forgive him.

LINDA:   What do you think that would mean to Trevor to hear you saying that you will look after Nache and Thunder for him?

MANDY: He would know that there is nothing he could tell me that would make me love him any less. But it is a bit painful to think of bringing him back to hear what I am saying. I don’t want him to know that pain I feel of his loss. You know, a mother is only as happy as her saddest child.

LINDA: You don’t want him suffering through knowing the pain that you feel. Do you believe that he is suffering now?

MANDY: No, he is at peace. His body and mind are healed, in the presence of God. HE NO LONGER IS SUFFERING. His place and his job is in heaven. But he left us with a job on earth.

LINDA: What is that job on earth?

MANDY: My job now is, as is part of his job, to help others who suffer like him. I was reading Genesis 50:20. It is the story of Joseph. His brothers wanted to kill him, and he managed to escape and save Egypt. He said to his brothers when he saw them again, ‘You meant evil, but God meant it for good to bring this about’.

LINDA: Mandy, can you help me understand your meaning of Genesis 50:20?

MANDY: Well, we are going to help others benefit from Trevor’s experience and his death. God meant it for good. I hope he knows now that what he did was not him but the illness, and we will help other young people who are suffering like he was.

LINDA: If he were to hear you now, even though it is a bit painful as you told me, what might he think of your idea of carrying on his wish to help by helping other young people who might be suffering like he was?

MANDY: He would feel relief that he did not ruin our lives. If he could have stayed on this earth longer, he would have been able to turn around the voice of depression, he would have had more tools in the toolbox. If he only will know that his dying was not for nothing. That we are going to use his life and his way of dying to help others. He would know that he didn’t ruin our lives, and his life had meaning. He actually is going to help others live a better life than he was able to live.

LINDA: Mandy, I can’t imagine a better legacy for Trevor than the one you plan to bring to us all. I am so curious about your ideas, how are you going to make Trevor’s life and death be helpful to other young people who are suffering. (I realized that in my role as a narrative therapist, I need to lead people to find their own legacies of their child. This was a much more powerful legacy than what I had first considered, which was the book Trevor was writing).

MANDY: Well, we have developed this website. It is to help others find hope. We are discussing what tools he had and what tools we wish he had. We are going to give resources, where you might go.

LINDA: Yes, you told me about how you organized his service to be both a memorial to Trevor and a help to others. Would you be willing to describe this in a bit more detail?

MANDY: Well, we had twelve counsellors come to be there for the young ones of our congregation. They are all so close we were concerned about them. The counsellors talked to the young ones on an individual basis and gave them ideas of where to go if they need help. We had moved here from another country and did not know what services existed.

The surgeon who did Trevor’s chest surgery asked if he could have Brian’s talk at the memorial service. Brian talked about what it was like to be a parent of someone with such problems that Trevor had suffered from. The surgeon hopes to use this in some way to help other children at the Shriners with deformities as a way to try to prevent such an outcome as happened to Trevor.

LINDA: Oh, I am very interested in how he might use this. I will talk to him, perhaps I can be of some assistance to your ideas and to his, in relationship to the Shriners Hospital for Children.

What would you like to do about appointments?

MANDY: Well, I know you are so busy, Linda.

LINDA:   It is truly up to you.

MANDY:   I think I would be OK for two weeks.

Keeping Her True Boy

Mandy called and cancelled her next session. I had planned to spend our last few sessions exploring ideas about how she and Brian could help other young people. We were still in isolation for coronavirus isolation when we began to co-write this article.

Mandy told me again about blogs when Trevor was so happy and living what she called a wonderful life. She was reading books to understand suicide and discussed them with me. She would still question the cause of Trevor’s challenges. She talked some more of all that she had done to try to find the cause when he was alive and to get help for him. With a few questions she came to the conclusion that Trevor died to protect his parents from more pain, pain that he lost his beliefs, pain that he couldn’t feel better.

She also talked of her ‘true boy’ who could be around even later in life. For example, she mentioned how he wanted to be so independent, he wanted to pay for his own counselor. He even wrote in his ‘I’m sorry’ note that they could sell his car, perhaps to pay for his funeral.

She suggested this was his warmhearted way of showing that he did not want them to be in debt by his death. And most importantly she discussed how she believed Trevor had a healed mind and a healed body and that now he is free. She read to me his wonderful, kind letters. She told me beautiful stories of navigating the parenting journey as Trevor developed from childhood into adulthood and of walking alongside him even when he was making choices she would have preferred that he not make.

But mostly Mandy described her hopes and dreams for being of service to other youth, to follow Trevor’s hopes and dreams. She understood better what Trevor stood for. Mandy believed that God has a purpose for every life, and both her purpose and Trevor’s purpose was to call greater awareness to youth challenges and help youth with this calling. There was no more talk of catching the coronavirus and meeting Trevor sooner.

Mandy felt that she and Trevor now had a common, earthly goal that her husband and her complete congregation were getting involved with. She felt that this was keeping her ‘true boy’ in her heart and soul. Mandy requested that we do one last bit of work together when the isolation due to the Coronavirus was over.

This was to work to help her manage better some of what might be called day and night dreams of the last image of ‘her boy who was not her boy’. She planned to replace these images with her ‘true boy’ and with other young people who were living instead of dying. Finally, Mandy explained to me, that somehow, Trevor did not disappear but will live on in the helped lives of others.

Brian wrote to me when I asked him to edit this paper. In his letter he expressed words similar to those I have heard from others who have had a child die. They were so poignant and heartfelt that I wanted to honour his thoughts here. This is Brian’s perception of his particular experience of having a child die by suicide.

“I am not the man I was before February 8, 2020. When Trevor died my life changed. My wife changed. My family changed. I changed. And I’m trying to come to grips with the new me and my new world. Life has a different meaning. My faith has more gravity. My perspective on my life in this world has been elevated beyond the temporal in a way it has never been before.

When I walk beyond the curtains to grief and back into life where my heart and mind are released from the shadow of my son’s suicide, who will I see when I look in the mirror? My grief is not just grief. A transformation is occurring. A lot of people who lose children have a very difficult time getting past the loss, as if their legs have been cut off from under them, and they will never stand on their two feet again. I have been in the depths of these waters, but I will not stay there. I know that these ashes that cover me now will be redeemed by God.”

I feel so honoured to be a part of such conversations which could explore what Trevor gave value to and then to witness Mandy and Brian finding ways to use what Trevor gave value to help others. I was able to assist them to develop Trevor’s legacy and to carry it forward with their family and others who loved him. I feel that this journey that we took together was also a healing journey for me.

I got to know both parents so much more through our co-creation of this paper. I have co-written papers before with those who consult me and am always so appreciative of the experience. I am happy to add Mandy’s final remarks when she returned this final draft to me:

“I also just want to say thank you again. As I was reading through the paper as a whole, it helped to be ‘counseled’ again. In grief, your mind so quickly forgets what you've determined, or learned. Now I will have this paper to get a quick reminder of the progress and conclusions you've helped me with. Brian wants to say he really enjoyed working with you on this paper. Me too! Blessings.

All names are changed at the request of the parents. The young man’s parents have read this version of the paper and feel comfortable for it to be published so others can learn how they managed to survive the almost unsurvivable and to carry on their son’s legacy wishes.

Reprinted with the consent and express wishes of the parents, Linda Moxley. and the editors of the Journal of Contemporary Narrative Therapy

[If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org]

References

(1) White, M (1988). Saying hullo again. The incorporation of the lost relationship in the

resolution of grief. Selected papers (pp. 37-46). Dulwich Centre Publications.

(2) Moxley-Haegert, L. (2015a). Leaving a legacy. Using narrative practice in palliative care

with children. The International Journal of Narrative Therapy and Community Work, 2,

58-69.

(3) Moxley-Haegert, L & Moxley Haegert, C. (2019). Little steps toward letting the legacy live: Fine traces of life to accompany families grieving the death of a child. Journal of Narrative Family Therapy, 28-53.

(4) Moxley-Haegert, L. (2012), Hopework. Stories of survival from the COURAGE progamme: Families and children diagnosed with cancer. Retrieved from narrativetherapyonline.com/moodle/mod/ resource/view.php?id=577

(5) White, M. (1995). ‘Reflecting teamwork as definitional ceremony.’ In M. White: Re-Authoring Lives: Interviews and essays (pp.172-198). Dulwich Centre Publications.

(6) White, M. (2011). Narrative practices: Continuing the conversations. Engagements with suicide. (pp.135-148). Chapter 10. David Denborough (Ed). W.W. Norton

(7) Moxley-Haegert, L. (2015b). Petit Pas/Little Steps. www.hopitalpourenfants.com/patients-et-familles/information-pour-les-parents/petits-pas (French) and www.thechildren.com/patients-families/information-parents/little-steps (English)

(8) Marsten, D; Epston, D., Markham, L. (2016). Weird science, Imagination lost. In Narrative Therapy in Wonderland; Connecting with children’s imaginative know-how. (Chapter 7, pp. 157-173). W.W. Norton & Company.

(9) Bjoroy, A., Madigan, S., & Nylund, D. (2016). The practice of therapeutic letter writing in Narrative Therapy, In B. Douglas, R. Woolfe, S. Strawbridge, E. Kasket, & V. Galbraith (Eds.). Handbook of Counselling Psychology, 4th Edition. Sage Publications.

(10) Epston, D., & White, M. (1992). ‘Consulting your consultants: The documentation of alternative knowledges.’ In D. Denborough (Ed.). Experience, Contradiction, Narrative and Imagination (pp. 11-26). Dulwich Centre Publications.

(11) Ingamells, K., (2018) My romance with narrative letter: Counter stories through letter writing. Journal of Narrative Family Therapy, Special Release 4-19. www.journalcnt.com

(12) Pilkington, S.M. (2018). Writing narrative therapeutic letters: Gathering, recording and performing lost stories. Journal of Narrative Family Therapy: Special Release 20-48.

(13) Palijakka, S., (2018) A house of good words: A prologue to the practice of writing poems as therapeutic documents. Journal of Narrative Family Therapy, Special Release, 49-71.

* Dedicated to the young man who chose to take his life and to his parents who chose to survive

his death.

Author Note: “Parents I worked with in palliative care co-wrote a resource document with me and the nurse practitioner in palliative care at the Montreal's Children's Hospital in Montreal. This might be a resource that could be added for reference if you thought it might be helpful to the readers.

Questions for Reflection

How did this clinical narrative impact you?

What are your thoughts about the therapist’s approach?

Which techniques might you use in your own clinical work?

What about the way the therapists worked with Linda and Brian would you change? How?

What are your own strengths and challenges when working in the shadow of suicide?

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References

The Early Therapeutic Relationship

The World of Katja-Writing

A Tale of Therapeutic Attunement

A Place of Emotional Safety

The Privilege of a Happy Childhood

Memory as Resource

Trevor – Prologue

Linda and Brian – First Session

Trevor’s Created World

The Issue of Diagnosis

God’s Peace

Sun on Wood

Keeping Her True Boy