Psychiatric Bulletin (2001) 25: 280-281. doi: 10.1192/pb.25.7.280
© 2001 The Royal College of Psychiatrists
Psychiatric Bulletin (2001) 25: 280-281
© 2001 The Royal College of Psychiatrists
Letters From the Clinic. Letter Writing in Clinical Practice for Mental Health Professionals
By Derek Steinberg
Raj Persaud, Consultant Psychiatrist and Honorary Senior Lecturer
The Maudsley Hospital and Institute of Psychiatry, London
London & Philadelphia: Routledge. 2000. 130 pp. £ 15.99 pb. ISBN:
0-415-20504-2
We all send, read and receive acres of letters about our patients and
clinical work, indeed writing and reading letters could even be said to take
up the majority of the time of senior psychiatrists. Yet it's amazing how
little discussion about the process of letter writing exists, and how
impoverished the literature is on improving clinical practice through the more
deliberate use of letters. The primary point of this unique book is the power
of words, and the value of choosing thoughtfully what we say in our
letters.
There was a tradition in the professorial unit at the Maudsley Hospital
where a group of registrars would be required to read each other the letters
they had written that week, not, as would firmly be pointed out, for the
purposes of mutual congratulation. The issues for discussion included the
internal logic of letters, their ability not just to inform, but to persuade
and convince the receiver to collaborate in a shared therapeutic perspective
of the problem.
This book suggests a reappraisal of the use of letters in clinical practice
and argues their potential power has been underestimated to improve
relationships between professionals and service users. Indeed, given how
closely letters are tied in the popular imagination with the deepening of
relationships, and how emotionally powerful it is to receive a letter from a
friend or relative, it is odd psychiatrists of all professionals have
neglected their potential.
A particularly intriguing suggestion from the book is the use of the letter
to the patient to summarise and clarify what had happened in a just ended
session with the therapist as an aide to heightening the therapeutic impact of
the clinical encounter.
The book, to this end, does raise some overlooked issues, like the
importance of the initial letter a patient receives about his or her first
appointment to see a psychiatrist — the invitation as the author puts
it. Yet while effectively and provocatively exploring this topic, perhaps in
line with the consultative tradition of the Tavistock, where the author
received some of his training, directive solutions are not as comprehensively
looked into as perhaps is possible.
For example the rich potential of this kind of letter in assisting the
patient in starting to work on his or her problem, preparing him or her for
the first session and even helping him or her to start treating him- or
herself by suggesting avenues for self-help, are not discussed.
However, in the rest of the book the issue of improving our letters in most
situations is investigated in depth, and the true power of this book is that
after reading it, your letters, and your practice, will never be the same
again.
