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

• The Early Therapeutic Relationship
• The World of Katja-Writing
• Irene’s Evaluation of Katja-Writing in November 2020
• References

“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 this way became more right, in a way, because it was me and yet not me. That is also what it is like to think back on that time.

I thought it was interesting that Kate and I were not the same, and still were. His responses were not for me, but still they were. It may be a little confusing to put it like that, but perhaps this confusion was precisely what was needed to confuse The Shadow Side so it would tolerate such talk!

In the past, The Shadow Side often caused me to have many trains of thought going in my head — mean, accusing, and demeaning “voices” that commanded and commented on everything I said or did. I could rarely achieve peace in my head during a normal conversation with Christoffer — especially if he said anything positive about the person I once was. The Shadow Side would be there immediately to remind me of my mother’s mean-spirited reproaches: “You can never do anything right,” and, “You are always in the way.” It became hard to think straight, for who did this mean I was? The one who was always in the way and doing everything wrong? Or could I be Kate? Was I the same as Kate? Kate, who had endured so many terrible things, but still had an understanding and empathic audience?! I smiled. If I was Kate, it wasn’t so bad. Then the future was not so bad as the past, because then I wasn’t alone anymore.

It may still happen that I get excited about something and have many trains of thought in my head, but then it is usually because I have been captured by something that interests me. Then it is a positive thing. Yes, the many trains do come when I feel bad, but they are not nearly as vicious or pronounced any longer. They do not stand alone like their own “voices,” and no longer have a life of their own. Today I am the one who is more in control. They are no longer there every day.

Now that The Shadow Side no longer attacks me in the same way, this has affected a change in how I write and think. It is really liberating.”

This work led to changes for The Shadow Side — that entity that, in a way, was the occasion for our first steps towards this way of working. This became apparent in October and November 2017:

Irene: When we wrote about Kate in third person, The Shadow Side wasn’t busy demeaning and opposing. The Shadow Side finally got the space to be the child it had needed to be for a long time. It got the first break of its life. Naturally, it couldn’t take a break in the form of complete disappearance, but it sat down in your office and started drawing. It felt as if The Shadow Side had taken possession of the office with its crayons, while just listening in. Sometimes it positively disappeared into the drawings. At other times it just listened. [Ed. Note: Irene added the following in September 2022: “I don’t think The Shadow Side is a little girl anymore. I think she has gotten older — a teenager perhaps. She is no longer making drawings at the desk but is now lying in a garden chair with her legs crossed, sunglasses on, reading a magazine and blowing bubbles with her chewing gum. She is still paying attention but sometimes it seems she is intrigued by something in her magazine and forgets to listen. She feels reasonably safe.”

Christoffer: I recall the day we talked about this, and you said that The Shadow Side was sort of sitting up at my desk and drawing while we talked. I find it immensely warming to consider and it makes The Shadow Side lovable to me. Someone I want to look after and be kind to.

A conversation about Katja-Writing in May 2018

Irene and Christoffer shared an example of Katja-writing with David (Epston) in 2018. This led to the following correspondence:

David: Would you be willing to tell me in some detail how you consider Christoffer is different from other therapists you have known?

Irene: Yes, there are many differences, but probably the biggest is that I can keep pace without there being an expectation that I should achieve something within a set timeframe, that I do not have to feel pressure to talk about unpleasant details to feel worthy for treatment, that I do not have to cry or cut myself to convince the therapist that I am a human being, that I do not have to feel bad in order to be able to talk to him, and that I am allowed to be me. In contrast to other clinicians, Christoffer does not attempt to “cure” me to be me. I decide for myself, who I want to be. If I want to be me, then that is completely fine. I do not feel ill or wrong or different from the rest of the world. Maybe I am different because of what I have been through, but that does not make me a non-human. And it really is not that relevant whether I am like others or not.

Many therapists have made a plan, without first consulting me, for where I should preferably be within a set time. For example, “after 2 years it is embarrassing to self-harm, because then she is too ill for treatment,” or, “now she is ready to talk about the assaults.” I feel no pressure — and that is all important for trust. When I started seeing Christoffer, I knew I would never tell him about the details of the assaults— and in order to prevent coming to like him and “fall in” anyway, I distanced myself from him. I still do not want to, but now it is not because it is him. Now it is not so relevant for me if I choose to talk about it or not, because we already have something to talk about. I do not have to perform, as I have felt I had to with other therapists. It is also pleasant that I may say something crazy or poorly phrased without immediately being analysed or put in a box.

I also like that I am allowed to be an active part of my own recovery in the sense that I am also the therapist myself. With other therapists, I have experienced just having to sit in a chair and talk, while the therapist does the hard work of analysing and drawing up conclusions, but with Christoffer, I feel rather that I am getting help to save myself. I become an important element in my own treatment, rather than just being a thing that talks and walks out after an hour.

Occasionally, Christoffer has also taken extra time when there has been a need to talk for longer than the given 60 min. Or has called me on the phone when that has been required. Those things contribute to me feeling like a human being getting help, rather than a thing that needs changing because it is broken.

Christoffer may at times say “forbidden” things about psychiatry, such as criticism. That is a big contrast to other psychologists; and that gives me an enormous freedom to also say what I feel — even if it is “forbidden.”

That Christoffer takes time to read and write to me is also very different from other therapists who preferably spend only the designated 60 minutes because their time is more important. I feel grateful, but not in a humiliated or demeaned way. Christoffer’s approach gives me an overview that I have not had before. It gives me energy and allows me to have an opinion about it. It is a relief. It is in fact also essential to my decision to keep seeing and speaking with Christoffer.

David: Irene, do you consider this approach more effective? If so, why? Can you tell me about that in some detail?

Irene: It is easier to speak when you can breathe. When you are drowning, you can only focus on getting out of the water. When you are on the bank and looking at the water, you can talk about the water — even about other things. You may be afraid of the water when you look at it, but on the bank, you are not at the same time in a panic or struggling for your life. It is more effective because it opens more possibilities — both in one’s thinking and in one’s relation to the one you are speaking with. Who would like to be close to drowning once a week if they can avoid it? Do you ever get used to drowning? I do not think so. Who can speak about deep matters when they are drowning?

[Ed.Note: In the above paragraph, Irene is referring to a metaphor for approaches to trauma described by White & Morgan, which likens the effects of trauma to struggling to keep yourself above water in a raging river, and therapy to getting up on the banks of the river where you are no longer struggling to keep yourself alive, and are able to see the river before you. Christoffer shared this metaphor with Irene during their conversations at the time.

Christoffer: Something we also talked about with this practice is that it requires some work ahead of introducing it. You have to have some knowledge of each other. I also speculate that it is very important to be able to get a sense of my personal ethics and moral values. This work involves me putting my personal ethics on the line and relating them directly without filter to her stories.

David: Irene, what would you say? And how would you say it? I know people have told me that they had to “trust” me but when I think about it, I left it there. Perhaps I should have asked why they trusted me? How have I proved myself trustworthy? After all, if your trust had been betrayed by those you should have been able to trust like your parents, then it would make good sense to be very judicious about who you should trust and how you might evaluate the trustworthiness of another? In fact, many have told me they could “see into another’s heart” as they had to spend a great deal of time “heart-watching” I guess you might call it...to form very careful assessments of another's trustworthiness.

Irene: I agree with Christoffer. Without having an idea of what he stands for and his opinions, it would be very difficult for me to entrust him with my work. I do not think, however, that trust is critical for, well, how can you have trust when you have been let down all your life? I do not think it is only about trust but also about will and maybe stubbornness or persistence. It is my will to get better, and it is my will to work on myself even if it is hard. But do I dare? That depends on the therapist. I am prepared to trust someone, but are they prepared to contain what I have to tell? And what is the alternative? If you talk to someone and risk that someone is not good at listening or seems indifferent, then maybe you lose, but if you do not talk to anyone then you definitely lose.

When you have been let down by the people who should have taken care of you, I think you will always be missing something. No one can replace a mother and a father. That is a giant betrayal. But the therapist isn’t supposed to have the place of a mother or a father, really, so I do believe you can actually try as you go and slowly open to a psychologist. But yes, it requires trust. But don’t all relations require that?

Yes, I think you become very good at seeing through people and consequently only open to the ones who can contain it. Actually, it is not because we do not open up; perhaps we are just more sensitive to little things that may signal that the other person cannot deal with it. It may be words said, but also moods or events.

David: Do you know what Christoffer is referring to as “without filter?” I am not so sure I do. Can you explain to me what you think Christoffer is talking about here if you do?

Irene: Yes, I believe I know what Christoffer means by that. A filter may be the fact that you are a professional, and distance yourself. Perhaps even having hidden agendas or ideas about wanting to move the patient to a specific place with what you are saying or writing. When Christoffer’s comments are without filter, it means they come from the heart, without a specific agenda.

Christoffer: This requires a lot of trust and confidence that I am, well, ‘good’ in the moral sense. This reminds me of one of Michael Guilfoyle’s papers (2) that I have been reading. He wrote about making the therapist’s ethical landscape available to the other. To me, this seems to support an understanding of therapeutic practices as more about being ethical than being technical.

David: I agree entirely with you here Christoffer. How about you Irene? Or do you see this differently? And if so, I would be glad to hear about it.

Irene: Yes, I also agree. With machines, you can be technical, but with people you should be ethical. And you should remember that both parties are human beings — the therapist as well as the patient.

Dreams

In late 2019, we had been using Katja-writing for a number of situations and accounts from Irene’s life. Some were longer stories; others were short descriptions of specific events from Irene’s childhood. Apart from accounts of childhood events, Irene also wrote stories about her experiences as a psychiatric patient. Around late 2019, however, our attention returned to those nightmares that originally inspired us to write fictions based on Irene’s life, hoping that they might slip into her dreams and affect the nightmares. We did not immediately observe such an effect but discovered that it had other effects in her waking life that consequently pre-occupied our attentions.

We considered the possibility that these dreams might be more than simply repetitions of traumatic memories, but perhaps also be communicative. Might the dreams be trying to tell Irene something? I had come across people who are able to hear voices with whom I have discovered that voices may be trying to communicate something and have some intention behind the things they say, although it may require some effort to understand it (3, 4). Might nightmares also have intentions of communicating something to Irene? I wrote a letter to her nightmares in the style of how I sometimes write to voices, hoping to appeal to any benevolent intentions the nightmares might have, and informing them that Irene could better realize her potential and her good character if they were easier on her.

This did seem to have an effect on her dreams, as not long after, Irene had a dream that was completely unlike the nightmares that otherwise occupied all her dreaming. It was a dream in which she was compensated for her suffering and the crimes against her, and in which she used the money she got to give presents to her loved ones. The amount of money she got in compensation in this dream was huge! This was nothing like the nightmares and we really wondered if it had some connection to our attempt to appeal to her dreams.

Discussing this, I mentioned our earlier hopes of influencing the nightmares through the stories about Kate, and how this had not seemed to work. Irene’s comment to me about this almost had me fall off my chair, and I certainly had to pick up my jaw from the floor: Now that I mentioned it, Irene searched her memory and noticed that in fact, that nightmare that we wrote about had not occurred in quite a long time. In fact, it ceased to haunt her in the time after we wrote about it. This was the nightmare that we have included in this paper (see Appendix). Irene recalled that it began to fade after we worked on the story and then it disappeared and has not re-occurred. Somehow, she didn’t even notice at the time.

I was amazed to hear this and could hardly contain my enthusiasm and the idea that was forming in my head. I said to her: “You know what we have to do Irene? We have to put this to the test. You have to write the story of the king of your nightmares. The big one that you never dared to talk about in detail. The one that traumatizes you more than anything every night. Write that up as a fiction for me to respond to!” In early 2020, Irene did so. In a matter of weeks, this most powerful, most haunting of her nightmares did in fact fade and fall apart and ceased to haunt her for a whole year. This, however, takes us beyond the confines of the present paper.

It does seem to indicate, however, that this way of working may have some potential to affect dreams and even dissolve trauma-related nightmares. Irene’s sleep improved significantly over the following months. Her dreams were not dominated by trauma-related nightmares, but instead concerned many different themes more related to her present circumstances, and she no longer suffered from shock every morning.

Irene’s Evaluation of Katja-Writing in November 2020

Irene: Again and again have I seen various accounts from people who are victims of sexual assault that tell of their grim consultations with psychiatric professionals. They describe how bad they feel after consultations with psychologists — that they are breaking up and don’t have the strength to live anymore. People saying that exposure therapy retraumatizes them and destroys them slowly. That made me think of how I do therapy.

With my psychologist, it is not like this at all. There are times when I feel spent or sad after a conversation, but I am not ruined or ready for hospitalization like the people I hear from. Why this difference? I think their treatment is wrong! Not the people — not the patient nor the therapist. They are not wrong people, but the treatment of the people is. It is not the right treatment for people who have been subjected to this kind of trauma that is sexual assault.

It is important that the professional has an external perspective. There must be a gulf between the two. A gulf that means that the professional’s sense of morality is shocked by the accounts of trauma. The gulf is a good thing — it leads to greater understanding and places a focus on how we people who have survived these things survived the nightmares we were in. The sense of morality of the professional must be under attack to such an extent that he or she will say something like: “That is horrible! Whatever did you do?” Meaning: “It is so amazing that you did something and that you are alive today!” To survive something like this is heroic! The professional must dare to engage themselves and their own sense of morality in the treatment of traumatized people.

We write stories about real life as a kind of fictional third-person account that reduces the factual details but promotes the emotional. An example could be the story of Kate self-harming in school. I did not cut myself when I was at that age, but the thinking and the events around the self-harm is consistent with my experiences at the time. Therefore, I get to say something about a particularly difficult time in my life without the factual details getting all the attention. I can distance myself from the events and be creative because I don’t have to force out memories to get the right age, right location and so on, but instead focus on what it did to me to self-harm. This means that we can have a good talk about it afterwards. It also makes it easier for me to mention difficult subjects like assault for example. In a way it provides more distance – and yet it gets closer to it so that you can work with it.

Katja-writing helps you to feel sympathy for yourself. You can suddenly see yourself in a different light. It is like watching a documentary about your life instead of living it. Contrary to exposure therapy where you are re-traumatized. Katja-writing makes it a lot easier to relate to your life and evaluate it and generally have an opinion about it. Fiction allows the brain to play along, and you can go into more detail because you kind of trick your brain. It is a light way to deal with something difficult and heavy.

A fiction-in-third-person is a small linguistic change that makes a huge difference. You become more visible to yourself — your own sense of morality and values show up more. You stop being an exception to your own values. An example may be that you are able to feel sympathy and have understanding for others, but when it is about yourself, you are hard and unfair. Katja-writing helps you see that. It helps you to see yourself from outside. To see the poor neglected child. See how unjust the violence was. Understand that you actually survived torture!

Many psychologists or professionals are frustrated and lost when it comes to us people with these problems. They see us as a big mouthful. Like someone who is very demanding for attention and cannot get enough care and love, and who is in some cases not receptive to proper psychological help. But who says exposure therapy is the only right thing? Who says we have to sink deeper into a hole in order to stand up again? We already did get out of one hole! Why force us into another one? I do not believe it has to be that hard to be in therapy. Hard, yes, but not so hard that you are almost breaking apart. It is hard to realize what you have been through, and it is hard to talk about it, but it doesn’t have to be that hard. Christoffer believes therapeutic conversations ought to be revitalizing – I think so too!

Christoffer’s Reflections

This collaboration with Irene has had quite a significant impact on my view of my work as a psychologist. It has shown me that there are different ways to do things and that it is possible for a psychologist and a person seeking help to use therapeutic conversations as a form of exploration of the different realities that people may inhabit and take a not-knowing approach to difficult and overwhelming problems. It has also given me the impression that ethics can be an essential aspect of psychotherapy. By that, I mean that my work as a psychologist may not necessarily consist of the administration of a technique or a method but may rather involve making my humanity and my moral reality available for another person and equally receiving the same from them. It doesn’t feel like using a technique on a patient. It feels more like having become an apprentice to Irene. She has taught me about the reality of her origins and how one survives in such a place. This is a knowledge that we have put into practice as a way for us to collaborate.

To the extent that there is a technique involved here, it consists of writing fictions about yourself and having an audience to your life. These are “techniques” that I have not learned in university or in any book. Irene taught me. I can see that this also affects how I collaborate with other people who consult me. Both explicitly in that I have introduced Katja-writing to others, but also in my way of being in other conversations. A way of being that I can best describe as responsivity. That is a readiness to respond as a human, emotionally and morally, to the stories that people tell me like I do in the written responses to Irene’s stories. I see this in contrast to engaging in an intellectual or analytical manner. Perhaps it is not always the sharp analysis that heals, but the plain and authentic response of another human being? Katja-writing does have a technical element, but it is one that depends on something ethical. It cannot be practiced dispassionately.

To be continued...

References

(1) Carlson, T. S. & Epston, D. (2018): Insider Witnessing Practice: Performing Hope and Beauty in Narrative Therapy: Part Two. In Journal of Narrative Family Therapy, 2017, Release 1, pp. 19-38. www.journalcnt.com

(2) Guilfoyle,M. (2016): Storying Unstoried Experience in Therapeutic Practice. In Journal of Constructivist Psychology, 0(0), 1-16, 2017. Routledge. Taylor & Francis Group.

(3) Haugaard, C. & Max (2019): Respectful letters for aggressive voices: Max’s story. In Journal of Narrative Family Therapy, 2019, Release 3, pp. 19-36. www.journalcnt.com

(4) Haugaard, C. & Trish (2021): Trish and a Frustrated Voice. In Journal of Contemporary Narrative Therapy, 2021, Release 3, p. 69-85. www.journalcnt.com

Wade, A. (1997): Small acts of living: Everyday resistance to violence and other forms of oppression. In Contemporary Family Therapy, 19(1), March 1997. Human Sciences Press, Inc.

Wade, A. (2007). Despair, resistance, hope: Response-based therapy with victims of violence. In C. Flaskas, I. McCarthy, & J. Sheehan (Eds.), Hope and despair in narrative and family therapy: Adversity, forgiveness and reconciliation (pp. 63–74). Routledge/Taylor & Francis Group.

White, M. (2004): Working with people who are suffering the consequences of multiple trauma: A narrative perspective. In The International Journal of Narrative Therapy and Community Work, 2004, No. 1. Dulwich Centre. Adelaide, Australia.

White, M. & Morgan, A. (2006): Narrative Therapy with Children and Their Families. Dulwhich Centre Publications. Adelaide, Australia.

Yen, A. (2009): Less pain, more gain: Explorations of responses versus effects when working with the consequences of trauma. In Explorations: An E-Journal of Narrative Practice, 2009, Number 1, 6-16. Dulwich Centre Foundations. www.dulwichcentre.com.au/e-journal.html


* This article (the first of two parts re-printed here) was originally published in the Journal of Contemporary Narrative Therapy (JCNT), 2023, Release 2, pp. 20-68 and reprinted here with permission of the authors.

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