Reflecting on our experience: The power of ‘letting it out’

You may, of course, want to destroy what you have written

I have been very fortunate to know Gillie Bolton, the British researcher, educator and author of Reflective Practice: Writing and Professional Development. ¹ At the recent GP24, I ran a workshop on reflective writing based on the work I have done with Gillie.

As health professionals, we witness a huge number of big stories, and it is as if they are stored in our bodies. Sometimes, they trouble us, and it’s good to let them out onto the page.

These exercises can be done on your own, especially as reflective writing is primarily for you as the audience. You can, of course, share what you have written with others, but as soon as we imagine other people reading what we have written, we start to edit it so that we sound better, or nicer, or saner or more reasonable.

The point of reflective writing is not to edit but, instead, to write exactly what is in your head onto the page. This is incredibly liberating and somewhat confronting.

You can be as unreasonable as you like. You can swear if you need to; you can say things you might never say aloud to someone else.

Reflective writing is not about doing good writing. You don’t have to worry about whether the sentences are okay, or the spelling. It doesn’t even need to make sense. In fact, it’s usually best not to go back and read what you have written until you are finished. Just let the thoughts flow onto the page without interruption.

You may, of course, want to destroy what you have written.

You can use a laptop or phone, but there is something embodied about pen and paper. The interesting thing about writing it down is that the thoughts are no longer circling in our heads; they are outside us on the page. We become observers of the thing troubling us rather than immersed in it, unable to make sense of it.

We started our session with six minutes of free writing. This means putting anything in your head on the page. It is a good way of clearing the mind of dross like, what’s for dinner, or I have nothing to say, or this is dumb, or I must remember to buy milk. You can also use free writing to write about a subject. It’s especially good when you are really angry; put all your rage onto the page and keep going. Often, by about page four, you will find yourself being much more reasonable.

Next, we recalled a situation that was troubling us in some way. The instruction was to think about a patient you have cared for who perhaps had some sort of chronic suffering that was not easily solved or who brought out big feelings in you – hopeless, angry, sad or powerless. It’s best to just choose the first person that comes into your head. Don’t judge it; they appeared for a reason.

Shut your eyes and visualise that person. Then, think of 10 words to describe them. Just choose the first words that come into your head; no judgement. Write these words down.

We then moved onto metaphor.

If this person were an animal, what animal would they be?

If this person were a type of weather, what weather would they be?

If this person were a piece of furniture, what would they be?

If this person were a kitchen implement, what would they be?

If you wish, you can arrange these words into a haiku. It usually has three lines, five syllables, seven syllables and five syllables. The arrangement of the words often gives further insights.

We then did a drawing exercise. The instruction, sticking with the same person as above, was to think of a particularly challenging interaction and draw a picture of it. This is also not about good drawing. You can do whatever you like so long as there are no words.

We followed this with a more extended writing exercise of about 10 minutes. The instruction, sticking with the same person/situation, was to write a fairytale about that person. A fairytale is a type of hero’s journey. It always starts with “once upon a time” and must end with “happy ever after”. It is fanciful, imaginative and magical, so you can get to “happily ever after” in any way you like.

Fairytales allow us to access possibilities that may initially be metaphorical but always have some resonance.

A reflective writing structure with a starting line is good for doctors because when we write about patients, we tend to start with something like, “Mr B was a 44-year-old man…”, accessing our medical mind rather than our free-ranging creativity. Sometimes, we want writing to unlock another, more creative way of seeing a situation.

Have fun and take care; big stories create big feelings. No judgement.

Lucy O’Hagan is a medical educator and specialist GP working in the Wellington region