Power Through Dialogue

 Distress needs to be spoken. And it needs to be heard. By our loved ones and peers. And by the people with the social power, training and responsibility, and our taxes, to provide the resources that could alleviate our distress.

Supportive dialogue between peers is the basis and strength of the ‘Safely Held’ sessions that we have been holding in Cambridge over the past months. The compassionate listening and validation that can be offered by other group members who have lived through similar experiences feeds the inner strength and self-esteem of the participants. It also helps them to see ‘personal’ problems as not their fault but as part of a wider social context in which social justice can be lacking. And it gives the confidence and the opportunity to take action together to challenge those with social power and campaign for social justice.

For some members of the group, the ‘Safely Held’ sessions are the fruit of decades of working with dialogue to these ends.



One of the roots of the ‘Safely Held’ sessions is the ground-breaking work carried out within an initiative called the ‘Patient Voice’.

The ‘Patient Voice’ was a project initiated here in Cambridge at Addenbrooke’s Hospital Clinical School in the late 1980s into the 90s, bringing in colleagues from the work we began in 1978 in Manchester with the University Department of General Practice. We have continued to develop the practice to the present day, at Leeds University and with postgraduate medical education in London.

The work focuses on helping doctors and the medical team to really listen and share understanding, so that patient needs are met with compassion, understanding, and the best possible appropriate medical response – whether the patient’s distress is physical, mental or both. The work has now become a standard component of GP and other specialty training and undergraduate medical education, nationwide.

The aim is to remake the professional-patient relationship as a discussion between equals, recognising that there is expertise in both parties. The patient is an expert in their own condition. True to its roots in the community (specifically the community theatre of North West Spanner in the 70s), the work involves lay people acting as ‘patient teachers’ to do role play with professionals and give feedback. Later work in the 90s, with the community organisation Westside Health Authority in Chicago, encouraging a group of patient teachers from the bottom up, helped keep our community roots solid.

From the beginning, these simulated’ patients have created their own roles, based in their own lived experience and responding to professionals learning needs, independently developing and leading methods of reflection and feedback. They are not audio-visual aids but embody an independent performance practice which gently challenges, and then enables authentic change for individuals. In recent years, the practice has deepened to include patients and professionals learning together to develop their situations, including ward-based work in secure mental health units.  Learning from this work fed into the core support of London’s psychiatry trainees needing help to improve their communication with patients and teams.

With its emphasis on equal relationships, the work has now come full circle, returning to its roots in the community. Mutual support in a group of our peers has allowed carers and survivors of mental health issues to talk about our experience, and, in a Safely Held group, to reflect on what we have done, and can do, to support listening and voicing. Being heard, being recognised and receiving a caring response is a crucial part of healing difficult lives.

From our photo album…

In the 1970s the community theatre group, North West Spanner, based in Salford, created plays in response to local events and concerns, performed in and outside workplaces, clubs and community centres, including:

‘The Sinking of HMS NHS’, in support of the nurses strike. Trafford Park, 1973

‘Safety First or Last?’ performed at British Leyland works canteen, Birmingham, October 1976

This photo of the play in the work’s canteen is taken from ‘The Spanner Experiment’.


Andrea McGoverin, Senior Teaching Fellow in Communication, Patient Perspective,
University of Leeds Medical School and London Professional Support Unit facilitator,
working from lived experience, with Darren Hart, expert patient teacher, supporting
psychiatric team members at a secure unit.

The flyer (below) shows courses in London for doctors mentioning the role of expert
patient teachers


For ongoing developments of this practice, see also Delia Muir: 



For more background information, see:

Whitehouse C, Morris P, Marks B. (1984). The role of actors in teaching communication. 


Morris P, O’Neill F. (2006).  Preparing for patient-centred practice: developing the patient voice in health professional learning.

Whiteman J, Morris P, Halpern H (2013). Professional Support, London: the professional development unit supporting professional well-being, refreshment, remediation and revalidation.