It will be evident that working with disturbed families, and the children and adolescents, is not always like a well-ordered hospital ward—nor should it be. Though I suppose the more lurid hospital soaps (not naming any) come near it! I would often have to visit a home that was really difficult to sit in for mess, hoarding, dog poo or other signs of disturbance. I only remember one in all that time where I literally could not bring myself to accept the usual cup of tea—I think better not to describe it!

After those early weeks, I got quite used to chatting to reluctant children in all sorts of places, tolerating interruptions and acting-out behaviour. Though one did tax me considerably: being called out in the early hours to drive from Cardiff to the unit, where an angry teenager had managed somehow to evade all the protective devices and climb onto the roof of Pollards Well. I’m not sure if it was me and the night nurses who talked him down, really. I think he just got bored and hungry. But it was long enough for all the potential lurid newspaper headlines to invade my head.

Only slightly less dramatic was the lad from a farming family who came to every outpatient session carrying a strong rope with a business-like noose in one end, refusing to discuss the obvious symbolism, though I wasn’t sure if it was meant for him, me or someone else. He was a nervous, polite and very likable youngster. It would be possible to dismiss such an obvious sign of his depression as histrionic, but unfortunately young people can miscalculate, as well as the doctor doing so. I never dismiss anything outright. The first time he came like this, I rang the GP afterwards to discuss it. This was a country practice in Gwent where the doctors are used to dealing with anything thrown at them. “Not to worry,” he said, unfazed. “I’ve known him and his family for years. I’ll keep an eye on him.” I think that if it had been a town case, it would have been much harder to deal with calmly like that. The lad did very well.

Going out at night was quite rare, though towards the end of my working life I had a call from a GP who had himself been phoned from the Brecon Beacons by a foster mother known to our service. I agreed to deal with it and drove straight up there, sometime after 11pm. It was summer and an eerie moonlit night. I was looking for a black girl, 16 years old and pregnant, who had only just been taken into care and had run away from her new home on the edge of the Beacons. She was closely followed by the foster mother who luckily had her mobile phone with her and talked me in. This lady hopped in with me, explaining she had only received this new girl a few days previously from a terrible abusive situation and hadn’t had time to build up trust.

We followed the girl, driving very slowly, through the countryside, giving her plenty of space for quite a while. Eventually she decided enough was enough and got into the car too, shivering and crying. She was hugged and comforted by the excellent foster mother whose response was clearly totally unexpected by this much-abused child. We all returned to the house for a cup of tea and I dozed until all was settled again. I visited a few days running, then handed over to a nursing team member and I don’t remember learning the outcome.

So, I am telling stories, carefully anonymised for anyone who is interested. But let’s not forget that we are all making up stories all the time—for what else is the narrative of our lives that we hold within ourselves and share at times with others?

I remember the very first, very early ‘case’ in which I consciously used this story-making approach. Jamie, a little 8-year-old boy, came in with a phobia of water. Washing him was a nightmare, rain panicked him and he obsessionally followed the weather forecast, refusing to go to school if it might rain. Asked about stories, he told me a scary one from the telly. It led fairly easily, however, to some nice things about water: his favourite drinks, cooling down on a hot day. I then facilitated a jointly imagined made-up tale of two boys who wanted to be friends, but lived on opposite sides of a river—he came up with several ingenious and fantasy ways they might meet without getting wet, ranging from flying on a bird to building a boat.

He enjoyed this and we followed a similar pattern in subsequent visits. He did extremely well, essentially devising his own ‘treatment’ by making up heroic stories in which he was clearly the protagonist. An early one was about a boy risking his own life rescuing a cat from a pond. In his last session, with his life returned to normal, was his story of a pair of big welly boots who learnt the fun of stamping in squishy muddy pools and took their owner into every puddle in the park. He enjoyed the power in this invention of his, and you can imagine the fun I had acting out the delight of the welly boots in my retelling back to him of his story!

I developed this approach in many cases. The important features were that the child did most of the invention, though often needing help and encouragement and we always had a little ritual at the last bit of the session in which I would say “that’s a wonderful story you’ve made. Would you like me to tell it back to you?” They always said yes and I would then tell them their own story in my best dramatic mode. I learned storytelling essentially from doing this

Of course my job overall, especially with the adults, involved a certain amount of sifting ‘truth’ from ’embellishment’ and ‘downright lies’, and I could bore anyone for hours in discussing that, but it’s not a major interest. One question I’m quite often asked is “but how do you know your patients are telling the truth?” Almost as if they expect the mentally ill to be automatic liars! My answer is “the same way you or anyone else does.” Apart from a rare subset of patients (often known as Munchausen Syndrome, better as ‘Factitious Disorder’) where this is the defining feature, it is very important to take—certainly initially—a warm accepting line to what the patient tells you and allow people to talk freely. Forensic psychiatrists obviously have to take a different line, they too want to encourage openness, but within an honest statement as to why they are there.

In addition, it is a well-recognised path in cognitive therapy to encourage people to ‘rewrite’ their inner story, the inner dialogue they have with themselves. For example, many of us have nagging inner voices, often from adult unkindness long ago, which say things like: you’re fat, you’re ugly, you’re stupid, you’ll never amount to anything. These may be replaceable with positives: you’re beautiful, you’re kind, you’re clever, you’ll go far.

Christine’s story

Let’s give one of my lovely teenage patients her own words. She was a long-term patient, both as an outpatient—I visited her at home for a while—then she attended our day unit on and off for several years. My connection with her and the family was close, terminated only by my retirement.

Some of this was literally a present to me on my last day. I asked if she would allow me to tell her story and show it to other people. “Yes, but I don’t think boys would like it,” she said. I think anyone would like it! (I have of course changed all names). In this, she showed how she understood the purpose of the stories and other sessions.

Christine needed extensive psychotherapy and social care, CBT and autohypnosis teaching for a clothing phobia, other phobic symptoms and behavioural problems over a long period. Her story is about a little girl called Alice, with blue eyes and blonde hair (Christine is a brown-eyed brunette). Alice wears dresses all the time, white with flowers on, and frilly short sleeves. “Alice is my second name,” says Christine. She dictated parts to me very carefully, at other times she told me fast and at length and I’ve had to summarise it.

She starts slowly: “She went to the beach, and when she was digging she found a box. It was all rainbow colours, with flowers on it—wildflowers and roses and daffodils. Inside was a big huge rose that played music and sparkled… it was soft, slow music like opera.”

She tells me that if Alice is naughty, the petals fall off, day by day, and the music stops.

“She starts to be good because she knows the rose is special to her. She keeps it a secret no-one else knows about. She is good and she feels better.”

When I retired, in 1997, Christine wrote this little story herself, with another name, and included it in a farewell card (spelling and punctuation as in original).

“Once upon a time there was a little girl called April and she had big very big problems. She had so many problems you couldn’t say them all. Her mum was very ill because of all the problems her daughter had until one day she met a lady called Dr. Kapp and she said she will help April get through these problems she had and by and by April was getting better and every day Dr. Kapp came to see April, April seemed to be getting better two weeks later Dr. Kapp saw that April’s problems were gone away so Dr. Kapp didn’t need to come anymore, three weeks later on Dr. Kapp had to retire so everyone done something nice for her retirement and it was the happiest day of her life. The End.”