Abstract
This study seeks to locate and evaluate ‘poetry therapy’ as a form of therapeutic method for use by practitioners of humanistic psychotherapy especially when used in responding to the traumas associated with grief and loss. Following an initial survey of the literature, the study will explore some examples of the use of poetry therapy for grief, with an especial qualitative focus upon the insights to be gained from first-hand autoethnographic accounts. The study undertakes a literature review which also includes some consideration of peer-reviewed autoethnographic explorations authored by theorists and practitioners of psychotherapy in order to identify what additional insights, if any, may be gained from accessing these personal accounts of process. In particular, the humanist perspective upon grief should be tempered with pragmatism so as to avoid regarding poetry as a reductive sentimentalising of trauma: encountering loss may be seen as experiencing subjection to a ‘lawless’ world. The study confirms the use of poetry therapy and autoethnographic writing has significant utility and potential, whilst recognising the challenges for empirical confirmation, the need for practitioners to be sensitive to the nuances of the source materials and the subtlety of appropriate application for different client perspectives and groups.
Introduction
[…]Grief in turn becomes unimaginable: not just its length and depth but its tone and texture, its deceptions and false dawns, its recidivism. Also, its initial shock: you have suddenly come down in the freezing German Ocean, equipped only with an absurd cork overjacket that is supposed to keep you alive. - Levels of Life, Julian Barnes (2013, p. 69)
The cathartic value of writing about the experience of loss is clear in the texts of many authors with some concentrated upon the theme. Joan Didion’s The Year of Magical Thinking (2006) charts the terrible year of loss both of her husband and daughter, memorialising not only their lives and characters but also the ‘magical thinking’ which she experienced in coping with such loss. As the introductory quotation indicates, Julian Barnes (2013) writes movingly of the incomprehensible character of loss; a little later commenting ‘You have stepped through a mirror, as in some Cocteau film, and find yourself in a world reordered in logic and pattern’ (2013, p. 72). These passages and many others in the same vein could easily be identified as prose poetry, the use of metaphor and dissociation reflective of the deep shock and incomprehension, the attempt to describe in terms beyond everyday prose and so regain some agency over the indescribable, the violence and lawlessness of loss.
This study seeks to locate and evaluate ‘poetry therapy’ as a form of therapeutic method for use by practitioners of humanistic psychotherapy especially when used in responding to the traumas associated with grief and loss. Following an initial survey of the literature, the study will explore some examples of the use of poetry therapy for grief, with an especial qualitative focus upon the insights to be gained from first-hand autoethnographic accounts. In recognising the client as the best expert on themselves, humanistic, person-centred approaches to psychotherapy (Rogers, 1977) provide support in the journey of self-discovery, paying careful attention to the gestures and speech acts of the client not as a mysterious or peculiar ‘clue’ to some dark inner enigma but as respected signifiers of their powers of expression and struggle for self-understanding. Client ownership and agency in the production and control of narrative is an important and key aspect of the therapeutic space, their autonomy paramount (Kinsella, 2023). ‘Autoethnographic’ and ‘heuristic’ approaches may offer particularly powerful forms of personal agency in gaining direct access to the context of construction of the narrative which has come to structure one’s own identity. This study will consider the use and value of Poetry Therapy, a therapeutic approach outlined by Biscontini (2020) in the encyclopaedia entry for ‘Poetry Therapy’ and defined as the use of ‘poetry to improve mental health and promote healing. It improves the mental health of patients by allowing them to better process emotional experiences, then teaching them to better communicate their emotions’ (ibid). An initial review of the use of poetry in response to loss, both overtly as a therapeutic tool and as an instinctive source of comfort, will be followed by a qualitative reflection upon the particular therapeutic insights to be gained from autoethnographic accounts of the use of poetry as therapy.
Reading and writing poetry in response to loss is a widespread practice of historical and geographical universality, ‘from Catallus to Dylan Thomas’ as Padel (2018) suggests. In Western literature the long history of writing elegies crystallised in the Victorian period, recognising the power of the elegiac ‘poem of loss or mourning written after a death in order to express grief, commemorate the dead, and seek consolation’ (Matthews, 2015). This instinct continues in the poems of acclaimed poets such as W.H. Auden, Dylan Thomas, Seamus Heaney, Ted Hughes, in the pop and rap lyrics of musical artists (Hess, 2010, p. 90) as well as the countless creations of less well-known citizens, responding to bereavement on behalf of themselves or others. Although it may help to experience the shock of shared recognition in ‘found’ poetry or to use such materials as part of a ritual process - for example Auden’s agonised cry in the poem ‘Funeral Blues’ (Auden, 1936; 2007) to ‘Stop all the clocks’ and exhorting that ‘the stars are not wanted now, put out every one’, or the attempted reassurance in the poem of uncertain authorship ‘Do Not Stand at my Grave and Weep’ - the creation of original words celebrating, remembering or responding to the unique person and relationship may provide a more lasting and therapeutic resource.
Focus on Poetry Therapy
Possibilities for communication, exploration, insights and healing are common to all the creative arts. Poetry has much in common with other word-focused media, as a vehicle for narrative and storytelling, journaling, dreams, fantasy and realisation of truths otherwise hard to express. Great latitude can also be afforded to what is understood by the word ‘poetry’ – it does not necessarily require rhyme, rhythm or adherence to ‘classical’ rules. Although in early years we may expect certain poetic forms – the rhymes and repetitions of the nursery – later encounters may present in the form of prose which reveals a heightened expressive power or in staccato, reductive bursts or awkward juxtapositions conveying rage, pain or impotence. The opportunity to tell one’s story or convey difficult experience, is empowering in many settings and critical to the process of therapy although, as with any such exploration, the task should be approached with awareness of its potential to open negative as well as positive pathways – Katz (2017) warns of the risk of delusional self-persuasion associated with the rhetorical power of autobiographical poetics: ‘confessional poetry is not necessarily therapeutic, and in some cases rhetorically may make psychological problems worse’ (2017, p 91).
Nevertheless poetry provides a particularly distilled and accessible form for the therapeutic space and research suggests it has acquired some significant positive standing from an experiential point of view. Although a ‘heterogenous and under-evidenced form of arts therapy’ (Alfrey et al., 2021, p. 1) it is used extensively and with enthusiastic reporting for example from healthcare and other therapeutic professionals. Clients may be supported in the use of creative word-based therapies – narrative and logotherapies and associated deployment of letter, journal and other familiar instruments – and at times poetry in particular may provide a medium sufficiently oblique as to facilitate a tentative approach to a difficult issue, or reveal, subtly, matters otherwise challenging to express in a more direct manner.
In recent years it is widely recognised that the work of Nicholas Mazza has been central to the development of poetry therapy as a discipline. Poetry Therapy – Theory and Practice (Mazza, 2017) provides not only an account of the range of client demographics and types of issue which may be supported through the use of poetry therapy but also highlights the qualities particular to the use of poetry which may prove constructive in supporting the therapeutic journey of the client. Mazza notes the use of metaphor is evident in all word-based therapies, recognising that metaphors are ‘symbols or images for emotions, actions and beliefs’ (2017, p. 23). One might understand further that this ‘Trojan horse’ of metaphor may provide a vehicle by which the client may access and circumvent their own defences, accessing the resistant and vulnerable subconscious which seeks, as a survival mechanism, to continue evading difficult territory.
Whether arising accidentally, through a natural disaster or the imposition of deliberate violence, the experience of trauma and loss effects a disruption of identity and of the ability to communicate the scope of loss. Bullock and Williams (2022) describe their use of poetry, including haiku, to advance effective engagement in supporting military personnel suffering trauma. The authors highlight the potential of poetry to reflect ‘multiple meanings’, deepening ‘the trauma sufferer’s experience of language use’ (2022, p. 16); the power of metaphor and of symbolic language to ‘reconfigure’ and ‘reconnect’ the experience ‘suppressed by trauma’, whilst ‘enjambment’ may also create meaning ‘analogous to metaphor’ as well as reflect the ‘hesitations’ of thought and speech (ibid). Providing clients with examples of poetic forms which reflect these qualities, the authors assert that the ground is prepared for clients to foray into their own creative process, equipped to give expression to their own pain and thereby empower their sense of agency over experience, giving the clients ‘permission to feel and to express ourselves’ (2022, p. 24).
These contemporary sources reflect not only a sensitivity to the nuance of poetic language but also an openness to the potential diversity of applications. As with other forms of creative therapy, the shift to poetic means of communication opens a new access point to thoughts and emotions - sometimes with a visionary clarity - otherwise fenced in by inhibition, shame, fear or denial. In bereavement, such a tool may prove a particularly powerful source of release.
Poetry Therapy in the Trauma of Grief and Loss
Use Across Grief Experiences
Poetry therapy appears to be used very widely in relation to the trauma associated with end of life situations, both in the support of the terminally ill and the prospectively and actually bereaved as well as those involved in professional support in this field. Care for clients at the end stages of life has improved over recent decades, with the palliative care field much enhanced by the adoption of creative forms of therapy, providing quality of life enhancement. In their review of the use of poetry therapy in palliative and end of life care, Gilmour et al. (2019) confirm the beneficial effects not only for patients but also healthcare professionals and family members in attendance. Davies (2018) recognises an established interest within palliative care ‘in how poetry may help patients and health professionals find meaning, solace and enjoyment’ (2018, p. 266). Her study of existing reported practice looked not only at the use of poetry in supporting patients but also in the training and support of healthcare professionals. Noting that medical professionals have become increasingly appreciative of the value of poetry to medical practice – both reading found poetry and creating new poetic materials responsive to experience and reflection – Davies lists (2018, p. 268) a number of professional medical organisations and journals which provide resources for the exploration and support of poetry use by and for medical professionals. For terminally ill patients, Davies notes that poetry therapy may be helpful both for the patients themselves and for their friends and relatives providing, quoting Pennebaker, ‘a healing process because it opens up the opportunity for self-expression not otherwise felt through everyday words’ (2018, p 269). Cautioning that most evidential support for the use of poetry therapy is drawn from case reports and experiential expert opinion, Davies nevertheless frames her review and conclusion very firmly in favour of a more dedicated use of poetry therapy within palliative care, rather than regarding it merely as an ‘extracurricular’ activity. Indeed, in their description of the use of story and poetry during the era of coronavirus, Barrett et al. (2020) highlight the relief afforded to clinicians at risk of ‘burnout’ – experienced most recently and intensely during the coronavirus pandemic - when provided with opportunities to reflect upon relevant literary materials. As part of this initiative, the medical facility Barrett references published to staff a daily recording of a poem to create a moment for pause in the rush of the day, providing a moment of ‘more calming ideas and structures’ (2020, p. 280) and providing ‘a point of contact for people in isolation and on the frontlines, struggling to find words for a new reality’ (2020, p. 281).
Although discrete studies may focus upon different ‘categories’ of loss – the prospective loss of self or other in palliative care, the retrospective loss of a friend, spouse or family member - publications on grief therapy both within and beyond the field of poetry therapy do not reveal a further stratification of approaches or text recommendations. Parents bereaved of a child may find some comfort in the support of others similarly bereaved, partners or spouses too may gain from identifying some of the common aspects of such loss yet, as Barnes comments (2013, p. 70) ‘Grief, like death, is banal and unique’. Although some texts provide suggestions as to potentially evocative sources (see for example, Mazza, 2017) there is little point in seeking to anthologise poems commemorating the loss of a child specifically for use with bereaved parents, or those marking the loss of a spouse or partner for the survivor client for example. Although ‘found’ poetry might be helpful in generating thought and releasing emotion, the sensitive circumstance of supporting the grieving person suggests that the therapist should be particularly alive to the inclinations and views of the client in their conceptualisation of their loss. A found poem about the death of a spouse may or may not ‘speak’ to the client bereaved of their spouse, for whom perhaps a poem reflecting the vitality of the lost loved one may provide the most solace or stimulus.
The trauma of loss may leave a bereaved person disorientated and significantly disabled from being able to function and find meaning in their life. The process and duration of therapy must be responsive to these constraints, recognising the need, especially where the loss was accompanied by trauma, for the client to revisit the events moment by moment, or circle and circumvent them before daring to approach (Tofthagen et al., 2022). For Penwarden (2022) support may extend to converting conversations with the bereaved – recorded with their consent – into commemorative poems, providing tangible and spiritually enriching representations of their loved ones. Using ‘poetic narrative analysis and research poetry’ Gerber et al. (2022, p. 5) argue that such support, both in writing poems for and with the bereaved, may be of singular value to older people, for whom grief may well be deep, especially shocking and intransigent, challenging ‘the notion that grief has any expiry date’ (2022, p. 1). Thus, whilst recognising that physical as well as mental pathological states may arise in response to grief, Gerber et al. do not seek to pathologize grief itself, but rather recognise the need to understand and support, through empathic means, the breadth and complexity of the experience.
The magnitude of a particular loss, whether of an adult or child, cannot be quantified according to category but depends upon a plethora of factors, the characters and status of the individuals involved and their degree of connection, cultural, practical, physical, emotional, spiritual, intellectual. Although there is an ongoing need to recognise and respond appropriately to the often profound and hitherto poorly acknowledged grief and loss experienced by parents suffering early miscarriage or termination of a foetus (Grauerholtz et al., 2021), there is widespread appreciation and acceptance of the fact that, statistically individuals in a lifetime are more likely to experience the loss of a parent, spouse, partner or friend than that of a child. Referred to frequently as ‘against nature’, the loss of a child is recognised as a very particular type of tragedy.
The Power of First-Hand Accounts: Autoethnography, Poetics and Loss
It is perhaps unsurprising that published reflections concerning the loss of a close family member are most prevalent, with the loss of a parent, sibling or child generating attempts to respond, rationalise and mark the loss. As the quotation from Julian Barnes at the beginning of this paper indicates, the laws of physics, of time, space and of self-identity are wholly disrupted by the lawlessness of grief, adrift only with an ‘absurd cork overjacket’. Two of the most prominent poetry therapy scholars, Nicholas Mazza and Ted Bowman each chart their own personal experiences of the loss of a child and the value of writing poetry as therapy in responding to those experiences. Mazza’s Poetry Therapy: Theory and Practice (2017) dedicates a chapter to considering poetry therapy in relation to ‘Death and Loss’, beginning by recounting the loss of his own son Chris, 21, in a car crash and confessing that, despite 30 years of therapeutic practice and use of poetry therapy, this tragedy betrayed his professional persona, feeling his ‘“expertise” in the area of death and loss seemed more of a cruel joke than an aid in trying to deal with the unimaginable’ (2017, p. 126). The humility reflected in this admission frames the subsequent discussion of various published accounts of the use of poetry therapy in relation to a range of grief contexts, some using ‘found’ poetry and others encouraged to write their own, sometimes with the assistance of ‘prompt’ phrases or questions such as ‘Who am I now?’ and ‘Who do I want to be?’ (2017, p. 128) supporting the framing of a response often in poetic form. Referencing use of his RES model, Mazza goes on to describe a case example of a bereaved son and continuing mother-son antagonism and communication failures which are resolved by the movement from an initial use of found lyrics, to support for an expressive/creative mode between mother and son in the production of their own poetic lines to a final, healing symbolic/ceremonial mode involving the writing of a letter to the deceased, emphasising the humanistic agency and authorship accorded to the client/s.
The child lost to Ted Bowman is his grandson, whose death Bowman attempts to grapple with through an autobiographical and autoethnographic written reflection upon his own grieving process (Bowman, 2020). Charting his own response to the loss over time, Bowman reproduces his poem ‘Beginnings’ written within days of the death and recording his incredulity at that time, the strange comfort derived from the admission of another grandson that there were ‘no words’ for the loss as well as the additional comfort drawn from the elegiac lyrics of Pink Floyd’s ‘Wish You Were Here’ (Bowman, 2020, p. 62). Written by Roger Waters and David Gilmour in response to the loss of their early band member Syd Barrett, Bowman identifies with the lyrics of loss so strongly that he imagined himself ‘temporarily a member of the group’ (ibid) and this supports his sense that his healing process may be assisted not only by the continued poetic response but also by looking for further sources of musical as well as visual meaning whilst also accepting that sometimes the natural world, the world ‘beyond words’ may aid the pain. Whilst the debate may continue in relation to whether ‘prolonged grief’ is pathological, elements of the grief experience are likely to re-emerge at different times in life: we do not so much ‘overcome’ grief as learn to accommodate it. With brutal honesty, Bowman shares the fact that, even three years after the loss he can be brought to sudden and unexpected tears by the phrase repeated by a speaker in church ‘sometimes I feel like a motherless child’ (2020, p. 70) whilst continuing to recognise the value to his healing process of reading and writing poetry. A significant element of the paper is dedicated to ‘Metaphors of Ambiguity’, recognising the value of metaphor and therefore the relevance of the poetic form, in responding to grief. Highlighting the fact that any loss, but particularly the loss of a child, heralds the loss of a dream, of potentials still unknown, Bowman concludes that his process has led to an ‘adjusted dream’ and an ‘acceptance of ambiguity’ (2020, p. 71) reflected in his poetry writing and surely a key mindset towards which the bereaved and the therapist might aspire.
The loss of a very young child presents particular challenges in accepting ambiguity and the loss of a dream. Still so unformed, perhaps unnamed, the as yet unknown individual is both intimately close and impossibly far away. Again, metaphor and the invocation of a narrative connection may provide a tentative means of assuaging grief. For Norwood (2021) the prospective and actual death of her son Gabriel 72 minutes after birth heralded an engagement with ‘metaphors of liminality’, exploring ‘how strategies from life writing and palliative narrative therapy can re-enfranchise bereaved parents by helping to articulate a loss that is uniquely under-served’ by society (2021, p. 114). Writing in prose form, Norwood adopts a poetic mode of expression in exploring and connecting with her fatally ill but as yet unborn child, imagining an alternative mode of being which could offer a fleeting fantasy future: ‘As long as he did not surface he was safe, I thought, like a sort of fish, who would drown in air’ […].’ I could learn to dive, to open my eyes and hold my breath underwater, and when he was born he would never need try his lungs, only his gills, and we could dwell together’ (2021, p. 117). Norwood explains the profound value of story and particularly poetry as a form when dealing with neonatal death. As she so movingly writes (2021, p. 122): The finely tuned instruments of poetry, metaphor and creative narrative thought – underwater thought – can access and probe and magnify the lived experience of grief, can make unknown known and the unspeakable speakable.
Barak and Leichtentritt (2017) explore, specifically, the use of poetry writing in the reconstruction of meaning following the trauma of losing a child. With a broad openness to the identification of ‘meaning’ which does not reference Frankl or Logotherapy, the authors adopted Gadamer’s philosophical ‘theory of understanding’ (Gadamer, 1976), requiring researchers to meet with humility the wisdom of the subject in order to absorb and integrate the insights provided by the clients in relation to their bereavement experience. Findings highlighted particular themes: parents often wrote dialogues with the deceased which appeared, ultimately to ‘seek permission from their child to move forward’ (Barak & Leichtentritt, 2017, p. 943), some composed poems which ‘rewrote the past’ so that the deceased was resurrected in the imagination to be present at moments missed (2017, p. 944); a third approach granted the deceased ‘continuity’ through imagining them continuing in the afterlife (2017, p. 945), giving new meaning not only to the conception of the life lost but also to the continuing life and future death of the bereaved. Therapists may provide support and reflection not only in the formulation of such creations but also, the authors conclude, in supporting the ‘editing and reshaping meaning’ process, so helping the bereaved author to identify ‘the most accurate meaning possible’ (2017, p. 949).
Unlike the loss of a child, the natural mortal conditions of existence suggest that we should be able to accommodate the death of a parent as part of the ‘natural order’ of things. Although this may be true in part, especially where the loss provides an opportunity to review, or where necessary, resolve shared family experience and the tensions and triumphs of specific events and relationships, individual cases frequently reflect complexities and issues unresolved which continue to haunt the bereaved child or children. For Thatcher (2021) the prose outpourings of memories which followed the death of her drug-addicted father appeared to give some temporary ‘relief’, providing a stock of memories redolent of his physical presence. Yet this relief soon proved transitory, provoking the realisation that a more profound enquiry into the deeper aspects of trauma and memory, conducted through the medium of writing poetry, would be likely to provide a more lasting resolution, especially given her prior experience of this as ‘a familiar and appropriate way to explore my grief’ (2021, p. 243). Often employing the use of short poetic stanzas and forms such as haiku, Thatcher found that she could gain direct access to some of the more difficult emotions generated whilst giving expression to the abrupt shock of the loss (2021, p. 245). Thatcher describes a depth of grief unexpected given the distance placed between herself and her father in the context of his addiction and made more resistant to her own understanding and that of others given the social stigma attached to addiction. The writing process not only allows access to the difficult territories of unplumbed depths and stigma by association but also, Thatcher hopes in publishing the process in her poems, may signpost help for others experiencing similar circumstances (2021, p. 253).
For Sharma (2019) writing poetry in response to loss was an anchor in the context of the loss not only of his father, but also the sudden death of a young brother. Sharma advances a particularly powerful argument in defence of the value of examining the use of poetry in qualitative and autoethnographic enquiry, asserting that ‘The poetic way of presenting a lived experience and its subsequent emotions affect the reader in such a way as can be neither done nor aimed by a scientific inquiry’ (2019, p. 24). Through poetry writing, Sharma gains some insights as well as comfort from exploring the meaning of the deaths not only in individual but also cultural terms. The unexpected death of his young brother in particular heralds a new consciousness of mortality in the self and the suicidal thoughts and writings arising from this, which Sharma recognises as a form of ‘processing’ through imagination the reality and inevitability of one’s own mortality and ultimately emerging with a new appreciation of life (2019, p. 30). Reflecting back on these poems helps Sharma gain a sense of how the experience of the deaths both of his father and his brother become imbricated into his own life picture and understanding.
For Hanauer (2021) such poetic autoethnography is all the more therapeutic given its value not only in coping with bereavement but also in dealing with ‘difficult personal contingencies’ in the context of the ‘familial trauma related to the Hanauer, (2021, p. 37) at the time of the death of his survivor father. Utilising the ‘transformation-through-writing’ model of poetry therapy advocated by Lengelle and Meijers (2009) Hanauer sets out to record an initial and rudimentary narrative account of the response to trauma, later transforming, through poetic rewriting, this initial coarse account into a second, ‘life-giving’ form (Hanauer, 2021, p. 372021, p. 43). Hanauer’s writing journey charts not only his experience during the days leading up to, including and following the death of his father but also his attempt to incorporate and thereby understand, the traumatic family history. Describing, through recollection and through poetry, not only his father’s character, vitality and death but also his own subsequent visit to the family’s former home in Wurzburg, the site of trauma and transportation, Hanauer is forced to conclude that the process has not offered ultimate ‘resolution’ but that, nevertheless, despite the unresolved trauma and pain, incomprehension and horror, there has been a shift: ‘still there is a transition’ […]’Mourning writing is a container and an acknowledgement of that which is most painful’ […]’Mourning writing is life affirming’ (2021, p. 43).
A Note on the Contribution of Autoethnography to Poetry Therapy
As demonstrated, a significant number of examples of autoethnographic studies may be found linking personal experience of grief to the use of poetry as a therapeutic tool including some of those cited above. As a practising psychotherapist, Bowman focuses upon the particular lessons for himself and for others in practice deriving especially from the emergence, and utility of metaphor in the writing process producing his poems. Although not overtly identifying or utilising the methodology of autoethnography, Bowman recognises his own shifts in process and identity weaving between the personal and professional. Describing his work as simply ‘addressing’ the loss of his grandson with ‘commentary and reflections from poetry, song lyrics and the literatures of grief, bereavement and bibliotherapy’ (Bowman, 2020, p. 61) the use of such materials and consideration of the context of his status as professional therapist as well as grandfather, the ruminations upon addiction and referencing of cultural iconography associated with addiction, makes a nod towards a kind of autoethnography. Thatcher identifies more readily with the term ‘autobiographical’ writing, though her reflections upon dealing with social stigmatisation in relation to death from addiction suggest some ethnographic consciousness. Hanauer overtly identifies his reflection upon poetry use in grief therapy as an autoethnographic study, located as it is in the broader cultural, historical and political tragedy of the Holocaust. Sharma too overtly identifies the autoethnographic approach chosen as appropriate to his experience, noting that his grief poetry is written within the larger context of his Hindu culture and religion. Norwood recognises her reflective and reflexive narrative and poetic responses to the decline and subsequent death of her newborn infant as a work of autoethnographic practice, especially given the silencing effect of prevailing culture in such matters. Lee (2020) asserts the potential offered by ‘creative autoethnography that blends story and poetry which offers readers a poetic and performative inquiry into the author’s reality of recovering from the grief’ (Lee, 2020, p. 393) and this access to authentic lived experience is an important element. With this access to the ‘auto’ – the self – of the experience, the ‘ethnographic’ element of autoethnography should also be borne in mind; the cultural environment which so directs individual responses. Together the elements provide an appropriate methodology for providing a critical appraisal of the value of poetry in the therapeutic response to grief. Whilst autoethnographic writing is by its nature an ‘internalised’ process sometimes documented by practitioner therapists as a self-reflective, reflexive account, the insights gained in charting the mercurial flow between internal psychological and external cultural experience and perceptions – especially through the radical shift in language and meaning-making offered by poetic forms - may be utilised by practitioners when supporting clients ensnared in the vortex of grief trauma.
Comparative Reflection: Lessons for Practice
Both qualitative group and individual autoethnographic studies in the use of poetry therapy may provide a rich resource for practitioners in understanding the utility and reach of the medium. In the particular context of grief therapy, the poetic form, with its powerful use of metaphor and symbolism, may bridge the otherwise unsayable nature of the loss and the plethora of published studies now emerging reflects an openness to the possibilities of use. The autoethnographic examples of Norwood (2021) and Hanauer (2021) share intimate accounts of the internal, tentative journey from grief towards meaning-making supported by recourse to poetic linguistic forms. The autoethnography of Hanauer (2021) is an intimate sharing of a personal and immersive journey through the familial history of the holocaust trauma, the enormity of which impedes achievement of any ‘resolution’ – ‘I am not resolved. The past is not repaired. Writing has not healed me’ and ‘the fear is still with me and my father is not’ (2021, p. 43). Yet Hanauer nevertheless acknowledges that the writing and poetry effect ‘a transition’: ‘In some small way, my father and grandparents live on in this text and this offers me some relief’ and concludes with the hope that the shared example of process might be of use to others facing such incomprehensible life challenges.
In comparison, the autobiographical/autoethnographic journey described by Norwood (2021) charts an equally personal though radically different experience in the loss of her newborn, ‘colliding’ with her ‘research specialism in metaphors of liminality’ (2021, p. 114). Beginning from a mortal pre-birth diagnosis, Norwood records her own process of engaging with her unborn child through her thoughts and writing, an ongoing conversation, mother to child, exploring how together they might suspend the awful reality through a shared magical thinking, an offering to the child of a mystical continuation as well as ultimately crafting a lasting acknowledgement in words ‘something from nothing’ (2021, p. 123) – the ‘nothing’ so poorly acknowledged by culture that is a neonatal death - through harnessing the power of poetic metaphor. With their suggestions for future practitioner use (Norwood highlights the potential to bring means of expressing such rawness into more everyday discourse, ibid p. 122) the revelation of such intimate, internal processing, whether of generational holocaust trauma or neonatal loss, provides a valuable window into the realities of the individual lived processing experience.
Close consideration of qualitative studies such as those of Barak and Leichtentritt (2017) and Penwarden (2022) provide inspiring examples of research projects reflecting sensitivity and integrity in the delivery of the therapeutic approach. The eight participants in Penwarden’s study collaborated with her acting as a kind of amanuensis to their recollection of the lost loved one in working towards the production of a poem marking their ‘continuity in the life of the bereaved person, and the way the bereaved person desires to live life’ (2022, p. 16). This involved ‘four distinct practices: attuned listening, selecting/privileging particular expressions, arranging them on the page, and offering them back to the client’, creatively retelling ‘the client-participant’s exact words on the page’ (ibid). As one client, Edwina later commented, this material resource “made it very concrete. That Ive got something there. I’ll value them. I’ll always know where they are” (2022, p. 18) - homage to the ‘values/legacy’ of the loved one in the ‘onward life’ of the bereaved (2022, p. 21). In their research project with ten bereaved parents, qualified therapeutic social workers in Israel, Barak and Leichtentritt (2017) specifically identified subjects ‘who had lost their child in a sudden traumatic event’ (2017, p. 939) thus posing a more extreme challenge for therapy in the construction of meaning. The process of data collection and analysis involved five steps in accordance with Gadamer’s hermeneutics: preliminary readings (involving the sharing of existing poems authored by the parent or identification by them of found poems holding personal significance); interviews which included a discussion of the role of poetry and/or writing in the grieving process of the individual; post-interview analysis, synthesising the interview findings with analysis of the poems; follow-up interview to review, validate and improve that understanding and a final ‘integrative thematic analysis’ allowing the researchers to identify common mechanisms and themes in the relationship between poetry writing and the grieving process. Three key themes emerged: poems which produced ‘a dialogue with the deceased’ (2017, p. 942), ‘writing an alternative reality’ (2017, p. 944) and ‘editing poems and reshaping meanings’ (2017, p. 945) – all processes which the authors of the study identified as contributing to ‘generative writing’ – a vehicle for creating ‘new meanings and emotions’ (2017, p. 947). In conclusion the study made practical recommendations endorsing the use of the three key themes identified as the basis for exercises which potentially could be used with bereaved clients, with the caveat that practitioners should ‘first assess the willingness and agency of clients to engage in this kind of exploration’ (2017, p. 948). The results of the study suggested that the reflective engagement with the process of writing poetry had provided, through these various thematic approaches, means of empowering bereaved parents in crystallising some reconstructed meaning and connection in their loss. The studies by Penwarden and by Barak and Leichtentritt provide exemplars of the use of poetic forms, demonstrating the fundamentally interactive and collaborative approach to practice, a collaboration which is respectful of the autonomous journey which the client must chart for themselves.
Conclusion
Poetry therapy sits within the cluster of creative arts and narrative therapies which provide the client with a means to access the difficult, usually resistant, aspects of the psyche, memory and perception and may be used as a sole resource or as part of a broader set of supportive materials and approaches. Given the plasticity of definition which may attach to the word ‘poetry’, especially given the poetic form which may arise spontaneously in prose narrative where the writer is seeking to give expression to challenging, subliminal or traumatised emotions and experiences, this fluidity of approach is to be expected. In particular, review of the literature – both sampling research studies and autoethnographic journeys - provides powerful examples of therapeutic efficacy where poetics either in prose narrative or in conversion to a more overt poetic form, arises in response to the challenging and desolate states of mind and emotions which relate to grief and loss. The sources suggest a process whereby the crushed and wounded mindset is first ‘reduced’ to an instinctive withdrawal into metaphor and the symbolic which may thereafter provide new avenues of understanding and expression in the midst of the otherwise unsayable.
Literature review of the fields of therapy utilising a narrative framework demonstrates not only the richness, flexibility and ubiquity of such methods but also highlights the profound truth at the heart of them – that of the urgent need to communicate and so mark one’s experiences. The motivation behind ‘communicating’ experiences is not only or always in giving paramountcy to sharing them but often to gain access and perspective for oneself upon the resistant interior of the mindset holding on to the trauma. As humanist and existential theory appreciates and advocates, in giving space - through active and reflective listening and unconditional positive regard - to the client to ‘listen’ to their own ‘telling’ they may, perhaps for the first time ‘hear’ their own inner voice/s and understand the drives as well as the potential for resolution, of their own suffering. For the client, when words are liberated from everyday constraints and expectations, they may accord their creators the true power of speaking their pain in the struggle of life.
As the examples examined herein have demonstrated, poetry therapy - and poetry therapy through autoethnographic process particularly - provides a flexible template for the practitioner and/or client to draw together the disparate, difficult and frequently resistant aspects of their experience, reflecting upon them reflexively as aspects become processed. Whilst ethnography, and autoethnography in particular, are both recognised as vulnerable to subjective bias in the conception of what constitutes appropriate ‘data’ (Walford, 2021) and some have argued for the promotion of an ‘analytic’ form more attuned to empiricism (Anderson, 2006) the ‘evocative’ form of autoethnography provides an opportunity for the experience of one individual to ‘speak’ to others and in this fluid sense has a capacity for ‘generalisability’ (Ellis, 2004, pp. 194–195). As just one approach to reflecting, reflexively upon the unfolding of such emerging insight, the methodology of autoethnographic poetics through the use of both prose and poetry may provide a conduit for practitioners and clients in supporting the process.
Whilst a therapist may over time draw together sourced material to their field and mode of practice and may find for example that they are able to identify resources pertinent to that particular field, such as grief, trauma through war, violence or accident, it seems evident that the most fundamental aspect required of this, as with all forms of therapy, is sensitivity to the needs, insights and agency of the client herself. Review of published literature associated with the use of poetry as therapy reveals a wide range of contextual use and methodology and a broadly shared appreciation of the resource whilst recognising the difficulties posed in attempting to amass reliable data as to application and efficacy.
Nor does the methodology dictate an entrenched ideological position. Hansen (2007) discusses how a critical appreciation of the perspective underpinned by pragmatic humanism may relate directly to the context of therapy. Noting the particularly relational location of humanism in contrast with more reductive, scientifically-oriented approaches to treatment, Hansen analyses the extent to which a humanistic stance, particularly one engaging pragmatic humanism may - but need not necessarily - include a ‘transcendental’ element. Whilst a traditional humanistic use of relational counselling could ‘facilitate the emergence of a more congruent, transcendental client self’ (2007, p. 139) a wholly pragmatic humanism would aim to facilitate the emergence of ‘adaptational narratives’ rather than the identification of ‘objective truths’ (ibid). As the examples explored herein reveal, depending upon the nature and philosophy of the individual client and the methodological exercises advanced, the use of the creative arts, including poetic forms, may speak either to such transcendental possibilities, or to more pragmatic adaptational narratives in the context of grief therapy.
The survey of literature undertaken in this study confirms the oft-repeated assertion that, in the field of humanistic psychotherapy, the value of an approach cannot always be measured empirically (Malecka & Bottomley, 2022) although large-scale studies, carefully tailored to factor the likely variations in delivery have begun to emerge with carefully curated conclusions as to positive effects (Alfrey et al., 2021; Smriti et al., 2022). Mazza (2017) demonstrates that, whilst it is appropriate to afford priority to the existential choices and inclinations of the client, a systematic approach in the use of poetry therapy may nevertheless be offered, a system especially calibrated to accord balance in the interaction between the creative and therapeutic processes and the healing role offered by ritual and symbolism.
To suffer trauma is to experience a kind of violence, an existential lawlessness. The sensitivity of narrative and poetry therapy approaches to individual traumas, individual experience and personality, and the histories and narratives underpinning them highlight with great clarity the importance to therapy of ensuring provision of the core conditions identified by Carl Rogers. Such attention, appropriately offered, may take both client and therapist into realms unimagined by them both as part of the journey towards insight and reflection necessary to the process of healing. Poetry, or the narrative forms which attach to the term, may provide a potent additional means of accessing and expressing the deep matters otherwise impervious to the offer of support and partnership that is humanistic therapy.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
