Therapeutic Letters

A therapist’s written letter to a client between sessions — documenting alternative-story gains before they fade.

Why it works

Memory is reconstructive and selective: without intervention, problem-saturated accounts tend to reassert themselves between sessions because they have more repetition behind them. A therapeutic letter, written by the therapist (or by the person themselves) summarizing what emerged in session, functions as a between-session anchor — a concrete, re-readable document that preserves the alternative story in the person’s own words and can be returned to when the problem story re-dominates.

How to do it

1. At the end of a session where significant alternative-story material emerged, note the key unique outcomes and preferred qualities in a brief letter.
2. Write in the person’s voice and language — use phrases they actually said.
3. Ask questions in the letter that the person can sit with until the next session.
4. Invite the person to write their own letter to their future self from the vantage point of the progress made.
5. Re-read the letter at the start of the next session as part of reevaluation.

Evidence

White and Epston’s original work documented that clients valued therapeutic letters highly and estimated they were "worth" multiple additional sessions. This is clinical and anecdotal; no controlled trial has studied therapeutic letters independently. (anecdotal)

The evidence for letters is from survey and client self-report; controlled comparisons are absent. The mechanism (externalized, re-readable alternative story) is theoretically sound.

Sources

• Epston (1994), "Extending the conversation" — clinical case and survey data on value of therapeutic letters

Common mistake

Writing letters in clinical, professional language rather than in the person’s words — a letter that reads like a progress note carries none of the relational weight of one that sounds like you.