Expressive Writing at Maggie Cancer Care Centres

Maggie’s provides a comprehensive cancer support programme for people and their families affected by cancer. Maggie’s is about empowering people to live with, through and beyond cancer by bringing together professional help, communities of support and building design to create exceptional centres for cancer care. Maggie’s Centres are for anyone affected by cancer. They are places where people are welcome whenever they need us – from just being diagnosed, or undergoing treatment, to post-treatment, recurrence, end of life or in bereavement.  We also welcome family and friends, as they are often deeply affected by cancer too. We know that those who love and look after someone with cancer can feel just as frightened, vulnerable and uncertain.

from the home page:
The centres are thoughtfully designed to feel like a home with most windows looking onto garden. There is as much light as possible. A “welcome sanctuary” is part of the architect’s brief. There are small rooms for counselling and a large room for all sorts of group activities including expressive writing. Every centre has a library. All services are free. . . .
Whatever you write is right, you can’t write the wrong thing….” began a writing prescription at a GP surgery in Dumfries. This was used in a feasibility study carried out by Dr. Gillie Bolton and Dr. David Hannay suggesting that “therapeutic writing could reduce (healthcare) costs of time and money by involving patients in their own treatment . . . And this same “prescription” has been adapted and used as guidelines for expressive writing at the Maggie Cancer Care Centres. The people attending these groups report back that “it works”. For this article, we invited three other facilitators who lead groups in different Maggie Centres – Edinburgh, Dundee & Fife, Inverness and Glasgow – to write a short piece giving a taste of what they do and how they do it.

Writing and Walking: Glasgow Maggie Centre – Larry Butler

“That’s the way writing often starts, a disaster or a catastrophe of some sort, as happened to me . . . And I think that’s the basis for my continued interest in writing, because by writing I rescue myself under all sorts of conditions, whatever it may be that has upset me, then I can write and it relieves the feeling of distress.” William Carlos Williams, MD
I usually begin each new group with the above quote, followed by an Ode to Inarticulateness then seven minutes of timed writing where we keep the pen moving . . .

from a word

to a word

I was led to a word

from a deed

to another deed

(The Poetic Edda AD1200)

I promote writing as a way of healing. One of my favourite activities I call “Owl Vision” which makes you aware of what is happening on the edge of your vision as well as in front. Start by facing straight ahead and spreading your arms out at shoulder level. Then bring your arms around so you can just glimpse a hand out of the corner of each eye. That is your entire field of vision defined. Now you need to keep watching everything in that field of vision equally rather than fixing on one point or another and being only dimly aware of what is happening on the periphery. It is as though you become more a part of the rest of the world; you feel and experience your surroundings more intensely, directly and freshly….This widening of the eyes sharpens all the senses. Then I give the following instruction: Now walk for 700 steps using owl vision. At exactly the 700th step – Stop. Listen. Look. Touch. Smell. Maybe Taste too. There will be something – some Thing – there that speaks to you. Take a note of what it says in words or images and bring it back.
This idea is explored by Thomas A. Clark, in his prose poem, “In Praise of Walking”, when he notices:

That something exists outside ourselves and our preoccupations,
so near, so readily available, is our greatest blessing.

The slower the pace the more there is to see. Even a gravel path beside a car park holds an infinity of textures and an infinite number of responses… When the group re-gathers, we often write a collective piece, sometimes a spontaneous song. Here are a few comments from some group members:

I love the writing group because I rarely know what’s inside me waiting to be said on a blank sheet of paper and there’s an excitement and anticipation in that. Sometimes I can be surprised at what I write about and the sudden connection with an emotion that I did not know was there. It could be anything, joy, laughter, pain,sadness, but it is always real and alive. Other times words have been swirling around in my head for days, waiting for the right moment to be committed to paper. And then it is there on the page, safe and contained and I feel a relief that I have expressed something that may have come from deep inside, or just describes my joy in the world.

I love to hear what others have written and I love when we work together to produce a joint piece of writing. It’s great to engage with others in this way and to get to know them a little from their writing.

One person recently had major surgery for a cancer and wrote about it while sitting in her garden. The words had been forming in her head for days as happens when we write about matters that have affected us deeply. The words go on the paper when they are ready. Here is what she wrote.

Remember This

This is not me with crooked mouth and drooping lip and swollen face.
This is not me with criss cross scars and limping gait.
This is not me breathless and weak and full of misery.
This is me dancing with easy grace upon the stage.
This is me shaking with fear on Sharp Edge precipice.
This is me surmounting impossible hurdles in my dreams.
This is me at peace in sunshine in my garden.
This is me, is, was, will be again.
Living, not dying.

A veteran of five consecutive groups has found writing “very helpful with the stress of living with cancer. You never know what you are going to get when you turn up. . . finding and hearing other people’s stories and experiences is all part of the make up of the group and you really grow and form a bond together in those six weeks.”

With a handout about the therapeutic benefits expressive writing by Dr. James Hawkins, I encourage everyone to continue writing at home or in a boat, on the bus, in cafes, on a park bench, in hospital waiting rooms, keeping a notebook with them all the time.

Photography and Writing: Maggie Centre Edinburgh – Valerie Gillies

We are a very visual society and many people find it easier to write when they can combine word and image. Their powers of observation are increased by taking part in a ‘dovetail’ writing workshop. Here, a portrait photo can prompt a character sketch. A landscape photo or a study of rocks or trees can open up the writer’s thoughts on time or place. It can be hard to write a character sketch, even of someone you know very well. A photographic image helps the writer to concentrate and think about the person in greater detail. For people who have suffered a critical illness, or who have been stunned by a turn of events, this writing enables them to ‘see’ the world again, to see like a writer or photographer. The following example is one of a series of expressive writing workshops designed for Maggie’s Centres.
Before the workshop, group participants are invited to bring in a photograph of one person. ‘Vintage’ photos in black and white work very well. However, if they don’t have one of these, people can bring in a more recent photo, or even an anonymous photo cut from a newspaper or magazine.
On the day, participants exchange photos, without saying anything about the subject. Each person studies the photo they’ve received, while asking themselves questions about the character who is portrayed. What’s his name? What’s he looking at? What’s he wearing? How does he sit or stand? How would he walk? What can he hear? If he has a house, what’s in it? Does he look after any animals or birds? What’s just outside the photograph on his right? What did he do after the photographer had gone?
Participants jot down notes in response to each of these questions. They read through these and re-draft them as a brief character sketch, in prose or poetry. After this is written, the photo will be passed around the group so everybody can see it, while the person who brought it in originally will tell who it shows and what they were like. Then the writer who has described the unknown character will have a chance to read the sketch aloud or to comment. The written description is often very accurate in the details, or appropriate in some particular way.
The workshop concludes with everyone looking at their photo once more. ‘There’s always something you haven’t noticed before… what is it?’ There’s a real sense of surprise when this detail jumps out at the end! If we have time, it’s also helpful to read an example of extraordinary writing such as Bruce Chatwin’s character sketch of the twin brothers in the first two pages of his novel, On the Black Hill, Cape, 1982. This is a good warm-up, with reflection and discussion to be followed by the photography and writing session. Ideas from several different facilitators have augmented this workshop, including Helen Dunmore and Paul Matthews. For a non-fiction book of prose and poems with portrait photographs, see Valerie Gillies and Rebecca Marr, Men and Beasts, Luath, Edinburgh, 2000.

Scents & Smells: Maggie Centre Dundee and Fife – Jayne Wilding

I began working as a writing facilitator in 1998. For the first ten years most of my work was with adults with mental health difficulties in the Edinburgh and Lothians. I worked for Artlink and a nursing home which specialised in caring for older people with dementia. I am a poet and I have kept a journal for many years.
In 2008 I was asked to work at the Maggie’s Cancer Caring Centre in Dundee. Larry Butler and Valerie Gillies had completed a pilot study for the Dundee Centre which showed that people found writing helped them to deal with a cancer diagnosis, treatment and beyond treatment. I now run writing workshops every week at Maggie’s Dundee and Fife centres.
I ran a session this week that I found many people enjoyed. I took along various poems to share about scents and smells. At the beginning of the session I asked people to write a list of things they like the smell of. People wrote for about five minutes and then I asked them to write a list of smells they dislike. Some people in the group had lost their sense of smell due to treatment so I encouraged them to make it up or remember what they had liked or disliked. Listing is a useful exercise, especially for people who have not written in a long time or are new to writing. People are encouraged to share writing only if they would like to. I asked the group to share in pairs either their lists or what it was like for them to write. The sharing is very important and helps people to get to know each other and their stories. I also read out little poems about the smell of fried onions, gutting herring and lastly burning incense.
Some people report they gain confidence from writing and reading out. Others find it helpful to be able to write down things that they would not say out loud. There are also those who find it is a pleasure to play with words at a time when they may feel very anxious – it gives them ‘me time’ and time out.
After the tea break I unveiled a selection of things to smell: from fresh lemon balm to a box of matches. It was very playful and people said, ‘Ooh lovely,’ and equally, ‘Pooh, what is that?’ to the strong smell of vinegar. I then asked the group to free write whatever came into their minds for five minutes. Then I asked them to try to write a very short poem. We finished up by sharing any of the written work that people wished to share. Many memories, thoughts and feelings are evoked by a simple exercise like this and people are amazed by what they write when they allow themselves to let the words flow on to the page without thinking too much.

like a comet from the sky: Maggie Centre Inverness: Margot Henderson

So what do we do in an Expressive Writing group? One clue is in the title, ‘expressive’ writing rather than ‘creative’ writing. That’s not to say that it isn’t a creative activity, but that the emphasis is on self-expression rather than on the craft of writing. The main focus is on using writing as a therapeutic process to share experiences, perceptions and feelings in a supportive environment.
We begin every session with a check in round, where each person has space to say how they are and to talk about what is going on for them right now. That is a really important part of the session and often the issues raised provide the themes for that day’s writing.
Some of the themes touch on aspects of people’s experience of living with cancer such as dealing with pain, fear, insomnia, side effects of treatment and loss. There are so many losses; loss of health, work, sense of identity, vitality, hair, memory… So we write about it, all of it. I might pick out a key word or phrase someone has used to serve as a writing prompt such as :

‘when sleep won’t come’, ‘I do alone very well’
‘from the chemo chair’ , ‘on not being a nuisance’…

The whole group will write on the theme and there is always a huge sense of relief for the person who raised the initial issue, a sense of not being alone in it and the chance to share insights and perspectives with others. Other times I might offer prompts in response to what is present for people. Often I will use balancing statements like,

‘What really gets my goat’ and ‘This is my medicine’
‘taking the lid off and ‘taking comfort’

This is a way of encouraging people both to get things off their chests and to draw on what nourishes them. The whole group will write on the theme and there is always a huge sense of relief for the person who raised the initial issue, a sense of not being alone in it and the chance to share insights and perspectives with others. This is a way of encouraging people both to get things off their chests and to draw on what nourishes them. Sometimes we touch directly on cancer, sometimes through metaphor.

“It came like a comet from the sky. I thought I saw its icy tail
But did not recognise the speed of fall. It sits like a filing cabinet in the city hall
Needing a decision”

Sometimes we might look at what cancer brings with it, a sense of the preciousness of life:
“It brings opportunities to find out more about myself and other people.
It brings new people, new experiences new places. It also brings a new appreciation of the life I have. It says, never be complacent.”
Both excerpts are from poems in our anthology ‘Leaves From The Same Tree’.
*This article was first published in the Journal of Holistic Healthcare ( August 2012)