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An unorthodox therapeutic strategy, letter writing, was used to deal with one client's unexpected dislocation from counseling in an outpatient mental health clinic. In responding to the client's letters, a format was developed that generally contained the following elements: extensive support for any positive behaviors; a problemsolving, educational focus on the content issues raised; anticipation of future events; occasional request for information on a particular subject; and a brief personal comment. In this case, the combination of supportive, cognitive-behavioral, and interpretive interventions provided a basis for the client to extend his self-knowledge and institute changes in attitude and behavior. Writing provides clients with the opportunity to express important and sensitive issues, obtain distance and objectivity, and reconsider what has been communicated between two parties invested in the therapeutic encounter.
The ability to deal flexibly with our environment opens new avenues that were previously unseen. So, too, is the case in the therapeutic encounter. Each client, unique in personality and life situation, presents to us the opportunity to be creative in our therapeutic approach. As a nurse therapist in an outpatient mental health clinic, one client's unusual circumstances led me to try an unorthodox therapeutic strategy: the use of letter writing.
The notion of encouraging clients to elucidate their thoughts and emotions in writing is not original. Many years ago, "Ellis admonished his clients to keep a diary and to correspond with him when they were away" (Adkins, 1985). RyIe (1983) discusses several reported case studies of therapeutic correspondence between client and therapist. Only one research study was found to examine the efficacy of therapeutic correspondence (Hastien, 1974). "Corresponding with patients is, it seems, more commonly done than reported, usually as a result of the patient or therapist moving and usually at the patient's suggestion" (RyIe, 1983).
The Early Client Relationship
I had been seeing a 16-year-old client, Dave, in weekly therapy sessions for approximately 4 months. He had been ordered by the court to attend counseling sessions after receiving probation for a misdemeanor. Dave, slightly built in stature, presented as a defiant, aggressive youth. His history was typical of the "street tough" image he tried to project. He was the middle child in a chaotic family situation in which Dave's father was described as alcoholic....