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 CBT FOR PSYCHOSIS

Cognitive Behaviour Therapy (CBT) for psychosis is constantly changing and

evolving. Recently, in what is sometimes called the ‘third wave’, therapy has
become more concerned with the individual’s relationship to their experience,
rather than with the content of it. This more process–orientated approach appears
to tap into universal psychological processes. The aim is to reduce distress by
changing the function of the experience, rather than necessarily the experience
itself. Written by some of the leading figures from around the world, CBT for
Psychosis: Process-Orientated Therapies and the Third Wave brings the reader the
latest developments in the field.
Presented in three parts, CBT for Psychosis first explores theoretical perspectives
on recent developments in cognitive behavioural therapies. Part two examines
specific therapeutic approaches, including metacognitive training, mindfulness,
acceptance and commitment therapy, compassion focused therapy and the method
of levels. Finally, part three presents two critical perspectives: the first offering a
reflection on the experience of receiving CBT, and the second looking ahead to
possible future developments.
Offering a cutting-edge collection of theoretical, therapeutic and critical
perspectives, CBT for Psychosis: Process-Orientated Therapies and the Third
Wave will be of great interest to clinical and counselling psychologists, both
practising and in training, as well as psychiatrists, nurse therapists, occupational
therapists and other healthcare professionals working with people experiencing
psychosis.

Caroline Cupitt is Head of Psychology for the Psychosis Clinical Academic

Group at South London and Maudsley NHS Foundation Trust, UK. She has
worked as a clinical psychologist in services for people experiencing psychosis
for more than twenty years. She is also editor of Reaching Out: The Psychology
of Assertive Outreach (Routledge).
 THE INTERNATIONAL SOCIETY FOR
PSYCHOLOGICAL AND SOCIAL APPROACHES
TO PSYCHOSIS BOOK SERIES
Series editors: Alison Summers and Anna Lavis
Series advisor for the monograph strand: Andrew Moskowitz

ISPS (The International Society for Psychological and Social Approaches to Psychosis) has
a history stretching back more than five decades, during which it has witnessed the relentless
pursuit of biological explanations for psychosis. This tide has been turning in recent years
and there is growing international interest in a range of psychological, social and cultural
factors that have considerable explanatory traction and distinct therapeutic possibilities.
Governments, professional groups, people with personal experience of psychosis and
family members are increasingly exploring interventions that involve more talking and
listening. Many now regard practitioners skilled in psychological therapies as an essential
component of the care of people with psychosis.
A global society active in at least twenty countries, ISPS is composed of a diverse range
of individuals, networks and institutional members. Key to its ethos is that individuals with
personal experience of psychosis, and their families and friends, are fully involved alongside
practitioners and researchers, and that all benefit from this collaboration.
ISPS’s core aim is to promote psychological and social approaches to understanding and
treating psychosis. Recognising the humanitarian and therapeutic potential of these per-
spectives, ISPS embraces a wide spectrum of therapeutic approaches from psychodynamic,
systemic, cognitive, and arts therapies, to need-adapted and dialogical approaches, family
and group therapies and residential therapeutic communities. A further ambition is to draw
together diverse viewpoints on psychosis and to foster discussion and debate across the
biomedical and social sciences, including establishing meaningful dialogue with practi-
tioners and researchers who are more familiar with biological-based approaches. Such dis-
cussion is now increasingly supported by empirical evidence of the interaction of genes
and biology with the emotional and social environment especially in the fields of trauma,
attachment, social relationships and therapy.
Ways in which ISPS pursues its aims include international and national conferences, real
and virtual networks, and publication of the journal Psychosis. The book series is intended to
complement these activities by providing a resource for those wanting to consider aspects of
psychosis in detail. It now also includes a monograph strand primarily targeted at academics.
Central to both strands is the combination of rigorous, in-depth intellectual content and accessi-
bility to a wide range of readers. We aim for the series to be a resource for mental health
professionals of all disciplines, for those developing and implementing policy, for academics
in the social and clinical sciences, and for people whose interest in psychosis stems from
personal or family experience. We hope that the book series will help challenge excessively
biological ways of conceptualising and treating psychosis through the dissemination of exist-
ing knowledge and ideas and by fostering new interdisciplinary dialogues and perspectives.
For more information about ISPS, email [email protected] or visit our website, www.isps.org.
For more information about the journal Psychosis visit www.isps.org/index.php/
publications/journal
 MODELS OF MADNESS
Psychological, social and biological approaches to schizophrenia 1st edition
Edited by John Read, Loren R. Mosher & Richard P. Bentall

PSYCHOSES
An integrative perspective
Edited by Johan Cullberg

EVOLVING PSYCHOSIS
Different stages, different treatments
Edited by Jan Olav Johanessen, Brian V. Martindale & Johan Cullberg

FAMILY AND MULTI-FAMILY WORK WITH PSYCHOSIS

Gerd-Ragna Block Thorsen, Trond Gronnestad & Anne Lise Oxenvad

EXPERIENCES OF MENTAL HEALTH IN-PATIENT CARE

Narratives from service users, carers and professionals
Edited by Mark Hardcastle, David Kennard, Sheila Grandison & Leonard Fagin

PSYCHOTHERAPIES FOR THE PSYCHOSES

Theoretical, cultural, and clinical integration
Edited by John Gleeson, Eión Killackey & Helen Krstev

THERAPEUTIC COMMUNITIES FOR PSYCHOSIS

Philosophy, history and clinical practice
Edited by John Gale, Alba Realpe & Enrico Pedriali

MAKING SENSE OF MADNESS

Contesting the meaning of schizophrenia
Jim Geekie and John Read

PSYCHOTHERAPEUTIC APPROACHES TO SCHIZOPHRENIA PSYCHOSIS

Edited by Yrjö O. Alanen, Manuel González de Chávez, Ann-Louise S. Silver &
Brian Martindale

BEYOND MEDICATION
Therapeutic engagement and the recovery from psychosis
Edited by David Garfield and Daniel Mackler

CBT FOR PSYCHOSIS

A symptom-based approach
Edited by Roger Hagen, Douglas Turkington, Torkil Berge and Rolf W. Gråwe

EXPERIENCING PSYCHOSIS
Personal and professional perspectives
Edited by Jim Geekie, Patte Randal, Debra Lampshire and John Read

PSYCHOSIS AS A PERSONAL CRISIS

An experience-based approach
Edited by Marius Romme and Sandra Escher
 MODELS OF MADNESS
Psychological, social and biological approaches to psychosis 2nd edition
Edited by John Read and Jacqui Dillon

SURVIVING, EXISTING, OR LIVING

Phase-specific therapy for severe psychosis
Pamela Fuller

PSYCHOSIS AND EMOTION

The role of emotions in understanding psychosis, therapy and recovery
Edited by Andrew Gumley, Alf Gillham, Kathy Taylor and Matthias Schwannauer

INSANITY AND DIVINITY

Studies in psychosis and spirituality
Edited by John Gale, Michael Robson and Georgia Rapsomatioti

PSYCHOTHERAPY FOR PEOPLE DIAGNOSED WITH SCHIZOPHRENIA

Specific techniques
Andrew Lotterman

CREATIVITY AND PSYCHOTIC STATES IN EXCEPTIONAL PEOPLE

The work of murray jackson
Murray Jackson and Jeanne Magagna

ART THERAPY FOR PSYCHOSIS

Theory and practice
Katherine Killick

CBT FOR PSYCHOSIS

Process-orientated therapies and the third wave
Caroline Cupitt

MONOGRAPHS:

PSYCHOSIS, PSYCHOANALYSIS AND PSYCHIATRY IN POSTWAR USA

On the borderland of madness
Orna Ophir

MEANING, MADNESS AND POLITICAL SUBJECTIVITY

A study of schizophrenia and culture in turkey
Sadeq Rahimi
CBT FOR PSYCHOSIS
Process-Orientated Therapies
and the Third Wave

Edited by Caroline Cupitt

 First published 2019
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2019 selection and editorial matter, Caroline Cupitt;
individual chapters, the contributors.
The right of Caroline Cupitt to be identified as the author of the editorial
material, and of the authors for their individual chapters, has been asserted in
accordance with sections 77 and 78 of the Copyright, Designs and Patents
Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from
the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Names: Cupitt, Caroline, 1966- author.
Title: CBT for psychosis : process-orientated therapies and
the third wave / Caroline Cupitt.
Description: Milton Park, Abingdon, Oxon ; New York,
NY : Routledge, 2018. | Includes bibliographical references and index.
Identifiers: LCCN 2018004294 (print) | LCCN 2018005315 (ebook) |
ISBN 9781315294858 (Master e-book) | ISBN 9781138239869 (hbk : alk.
paper) | ISBN 9781138239876 (pbk : alk. paper) | ISBN 9781315294858 (ebk)
Subjects: LCSH: Psychoses—Treatment. | Cognitive therapy.
Classification: LCC RC512 (ebook) | LCC RC512 .C86 2018 (print) |
DDC 616.89/1425—dc23
LC record available at https://lccn.loc.gov/2018004294

ISBN: 978-1-138-23986-9 (hbk)

ISBN: 978-1-138-23987-6 (pbk)
ISBN: 978-1-315-29485-8 (ebk)

Typeset in Times
by Keystroke, Neville Lodge, Tettenhall, Wolverhampton

Front cover photo: Brendan Wilson

 CONTENTS

List of illustrationsix
Notes on contributorsxi
Acknowledgementsxv

Introduction 1
CAROLINE CUPITT

PART 1
Theoretical perspectives7

1 Metacognition in psychosis: Implications for developing

recovery oriented psychotherapies 9
PAUL H. LYSAKER AND ILANIT HASSON-OHAYON

2 Emerging perspectives on the role of attachment and

dissociation in psychosis 25
KATHERINE BERRY, SANDRA BUCCI AND FILIPPO VARESE

PART 2
Specific therapeutic approaches 45

3 Metacognitive training: Targeting cognitive biases 47

RYAN P. BALZAN, STEFFEN MORITZ AND BROOKE C. SCHNEIDER

4 Mindfulness in CBT for psychosis 64

KATHERINE NEWMAN-TAYLOR AND NICOLA ABBA

vii
 CONTENTS

5 Acceptance and Commitment Therapy 79

ERIC M. J. MORRIS

6 Compassion-Focused Therapy for relating to voices 98

CHARLES HERIOT-MAITLAND AND GERRARD RUSSELL

7 A principles-based approach using the Method of Levels 115

SARA J. TAI

PART 3
Critical perspectives 133

8 A step in the right direction or a missed opportunity? 135

RACHEL WADDINGHAM

9 Where next for CBT and psychosis? 150

CAROLINE CUPITT AND ANNE COOKE

Index 168

viii
 ILLUSTRATIONS

Figures
3.1 ‘Girl’ stimuli set for ‘fragmentation exercise’ in the JTC module 51
3.2 Example of a ‘BADE exercise’ (picture order is 3, 2, 1) 52
3.3 ‘Pool scene’ from the memory/overconfidence module; people
often falsely recall items (e.g., towels; sunhat) with high
confidence despite them not being depicted in the picture 53
4.1 Mindful and unmindful relationship to psychosis 67
4.2 Formulation-based rationale for mindfulness (details have been
changed to preserve anonymity) 69
6.1 Sessional measures: (a) social safeness and (b) dissociation 111
6.2 Emotional outcome measures: depression, anxiety and stress 112

Table
1.1 MERIT elements 18

ix
 NOTES ON CONTRIBUTORS

Nicola Abba is a Consultant Clinical Psychologist working in acute care in the

NHS, and lectures at the University of Southampton, UK. She is an accredited
CBT therapist and incorporates mindfulness into her clinical practice with
people with distressing psychosis.
Ryan Balzan is a Clinical Psychologist and Postdoctoral Research Fellow
at Flinders University in Adelaide, Australia. He is interested in improving our
understanding of the underlying psychology of psychosis (particularly on the
formation of beliefs), and investigates the efficacy of psychological treatments
for psychosis including metacognitive training, cognitive behaviour therapy
and cognitive remediation.
Katherine Berry is a Senior Lecturer at the University of Manchester, UK,
Clinical Psychologist and co-Director of the Complex Trauma and Resilience
Research Unit (C-TRU) within Greater Manchester Mental Health NHS
Foundation Trust, UK. Her main area of expertise is attachment theory and
therapeutic relationships in people with a diagnosis of psychosis. She currently
works on the Manchester clinical psychology training programme and as a
clinical psychologist in mental health rehabilitation.
Sandra Bucci is a Senior Lecturer at the University of Manchester, UK, an
Honorary Consultant Clinical Psychologist with Greater Manchester Mental
Health NHS Foundation Trust and co-Director of the Complex Trauma and
Resilience Research Unit (C-TRU) within Greater Manchester Mental Health
NHS Foundation Trust, UK. Her main research interests are understanding the
mechanisms involved in voice-hearing, and developing innovative ways of
extending the reach of healthcare interventions for people with psychosis,
primarily through harnessing technology.
Anne Cooke is a Consultant Clinical Psychologist and a Director of the Doctoral
Programme in Clinical Psychology at Canterbury Christ Church University, UK.
She was the editor of the British Psychological Society report, Understanding
Psychosis and Schizophrenia. She is interested in the power of ideas, particularly
the idea of mental illness.

xi
 Notes on contributors

Caroline Cupitt is Head of Psychology for the Psychosis Clinical Academic

Group at South London and Maudsley NHS Foundation Trust, UK. She has
been working as a clinical psychologist in services for people experiencing
psychosis for more than twenty years. She was editor of a previous book,
Reaching Out: The Psychology of Assertive Outreach.

Ilanit Hasson-Ohayon is a Rehabilitation Psychologist, Associate Professor

and co-director of the community clinic at the Department of Psychology
at Bar-Ilan University in Israel. She is author of over 80 peer reviewed
articles in the field of mental health, mainly concerned with how people cope
with serious mental health problems. She both practices and supervises
psychotherapy.

Charles Heriot-Maitland is a Clinical Psychologist, researcher and trainer.

He holds an MRC Research Fellowship at the University of Glasgow, where
he is currently researching the application of Compassion-Focused Therapy
for people experiencing distress in relation to psychosis. He is also a Director
of Balanced Minds, a UK organisation providing compassion-focused therapy,
supervision, consultation and training.

Paul H. Lysaker is a Clinical Psychologist with over 30 years of experience

providing psychotherapy to adults diagnosed with psychosis. He is also an
active researcher and an author of more than 400 peer reviewed articles related
to the psychological processes involved in the experience of psychosis.

Steffen Moritz is a Psychologist and heads the Neuropsychology Unit at

the Department of Psychiatry and Psychotherapy of the University Medical
Center, Hamburg, Germany. His main interests are group and online inter-
vention programmes for people diagnosed with schizophrenia, depression and
obsessive-compulsive disorder.

Eric M. J. Morris is Director of the Psychology Clinic, La Trobe University,

Melbourne, Australia. Eric’s research focuses on Acceptance and Commitment
Therapy for people recovering from psychosis, carers, and as a workplace
intervention for mental health workers. He is a co-editor of ACT and Mindfulness
for Psychosis, and co-author of ACT for Psychosis Recovery.

Katherine Newman-Taylor is a Consultant Clinical Psychologist with Southern

Health NHS Trust and Associate Professor at the University of Southampton,
where she is course director for the advanced CBT programmes. Her clinical
work and research focuses on CBT for psychosis, including mindfulness and
attachment-based imagery.

Gerrard Russell has worked in a variety of industries and roles, from lead musician
in a rock band, through engineer, to fashion designer. At the age of 40 he had an
intense spiritual (‘kundalini’) experience, and at the age of 50 started hearing

xii
 Notes on contributors

distressing hostile voices. His contributions to this book are grounded in the
wisdom of personal lived experience.
Brooke C. Schneider is a Research Psychologist in the Neuropsychology Unit at
the Department of Psychiatry and Psychotherapy of the University Medical
Center, Hamburg, Germany, and a psychotherapist in private practice. Her main
research interests are the development of interventions for depression and
psychosis, as well as cognitive changes due to ageing.
Sara J. Tai is Senior Lecturer at the University of Manchester and a practicing
Consultant Clinical Psychologist. She has extensive clinical and research
experience of working internationally in multi-cultural inner-city areas and in
training clinicians in psychological interventions. Her research focuses on the
science and practice of psychological treatments using both clinical trials and
qualitative research methodologies.
Filippo Varese is a Lecturer at the University of Manchester, UK, Clinical
Psychologist and Director of the Complex Trauma and Resilience Research
Unit (C-TRU) within Greater Manchester Mental Health NHS Foundation
Trust, UK. His research interests focus on the relationship between life adversity
and severe mental health difficulties, the psychological mechanisms responsible
for this association and the evaluation of psychological therapies for trauma-
related difficulties in those with psychosis.
Rachel (Rai) Waddingham hears voices, sees visions and was once disregarded
as ‘mad’. Informed by the principles of the Hearing Voices Movement, she has
developed innovative projects in the youth, community and prison sectors. An
Open Dialogue practitioner, Chair of Intervoice and Vice Chair of ISPS UK;
Rai is a trainer, consultant and practitioner who is committed to societal change.

xiii
 ACKNOWLEDGEMENTS

I would like to thank Alison Summers, Nigel Bunker, Tony Morrison and Paul
Wilson for their help in developing the original proposal for this book. Thanks also
to Alison Summers, Anna Lavis and Sunil Nandha who gave very helpful
comments on earlier drafts, and to Brendan Wilson for the cover photo.
Most of all, thanks are due to David Hutchens for his help and support throughout
the project.

xv
 INTRODUCTION

Caroline Cupitt

Cognitive Behaviour Therapy (CBT) for psychosis is said to have started in 1952
with a single case study by Aaron T. Beck (Beck, 1952). It was not until the late
1980s however, once CBT for other conditions was firmly established, that atten-
tion turned more firmly to the experience of psychosis. The pioneers took as their
starting point what were known as the two hallmark symptoms: hallucinations and
delusions. What followed were a number of treatment manuals which outlined the
approach (including Kingdon & Turkington, 1994; Fowler et al., 1995; Chadwick
et al., 1996). If Behaviour Therapy is thought of as the first wave of CBT, this can
be thought of as part of the second wave, in which a symptom-based approach to
CBT for psychosis emerged as a significant force (Hagen et al., 2011). Proponents
argued against the idea of a syndrome of psychosis, suggesting that CBT should be
targeting specific individual symptoms.
During the 1990s, researchers worked hard to establish the efficacy of CBT for
psychosis through a series of randomised controlled trials, many of which were
conducted in the UK. These generally showed modest effect sizes, although the
positive effects often outlived the therapy itself (Wykes et al., 2008). However,
there was a debate about the measures used to evaluate CBT in these trials. As with
research on the effectiveness of medications, the most commonly used outcome
measure was the Positive and Negative Syndrome Scale (PANSS), which assesses
a wide range of psychotic experiences – many of which are not the focus of CBT.
What is more, the published manuals describing CBT for psychosis explicitly state
that the therapy aims to reduce distress rather than symptoms. Arguably CBT was
being evaluated as if it was a neuroleptic medication, rather than on its own terms
(Birchwood & Trower, 2006). Nevertheless, this early work clearly established
that CBT can be an effective method for working with psychotic experience.
As the results flowed through into guidance in the UK (NICE, 2002), the US
(APA, 2004), Canada (CPA, 2005), Australia and New Zealand (RANZCP, 2005),
Spain (Working Group, 2009) and elsewhere, there was hope that people within
the mental health system experiencing psychosis could finally begin to expect a
psychological approach to their distress. Unfortunately, despite CBT becoming
widely recommended, access to the therapy has remained limited. There are
many reasons for this, not least the limited numbers of suitably trained therapists

1
 C. CUPITT

available in many healthcare systems – but continued controversy about its effec-
tiveness has also played a part, with some having argued that its effectiveness has
been seriously overstated (Lynch et al., 2010). There are others who point out that
in CBT generally, content-orientated cognitive change has not been shown to add
very much to the effectiveness of previously established behavioural approaches
(Longmore & Worrell, 2007).
Given this context, it is therefore of no surprise that CBT-trained clinicians and
researchers have sought to extend and improve the approach. This work has been
informed by an increasing volume of studies demonstrating that voice hearing and
unusual beliefs are common in the general population (Romme & Escher, 1989).
Once the experiences themselves are not viewed as inherently distressing, there is
the exciting possibility that they may not be symptoms at all, but rather aspects of
human experience that only sometimes become problematic. The traditional focus
on a person’s appraisal of their unusual experiences now does not seem to go far
enough: the underlying processes by which we all relate to difficult experiences
are brought now into question.
The beginning of this change appears with an increased understanding of the
role of metacognition. Morrison & Wells (2000) investigated the strategies people
use to suppress unwanted intrusive thoughts, known as thought control. They
found that people experiencing psychosis used more worry and self-punishment
to control thoughts than the general population. It follows that understanding more
about thinking, and specifically the uncontrollable nature of many mental events,
offers the possibility of freeing people from the distress they may experience
on hearing an unwanted voice. Metacognitive Training (Chapter 3) applies this
understanding in a very accessible and normalising way. It is distinctive in taking
an educational approach and regards change in metacognition to be central to
relieving psychosis-related distress.
At a similar time, mindfulness techniques were being established for the
treatment of depression. Chadwick (2006) saw these as offering another route to
changing someone’s relationship to psychotic experience, in this case using expe-
riential exercises. Although at first these two developments appear very different,
they share an emphasis on adopting a new stance in relation to experience. Someone
in the midst of a distressing psychotic experience is being asked to observe the
process without seeking to suppress or change the experience. Developing this kind
of ‘decentering’ capacity is of course a part of traditional CBT (Hofmann et al.,
2010), but previously it was typically spoken of in terms of rationalising thoughts.
The introduction of mindfulness techniques provided a means to enable people to
develop greater metacognitive awareness without simultaneously requiring them
to change the content of thoughts or voices.
The more effectively someone is able to develop and utilise skills to unhook
from a distressing experience, the less likely they are to rely on habits of experiential
avoidance, which in turn creates the possibility of accepting – rather than battling
against – the elements of experience that a person cannot change. Here we more
firmly enter what is commonly considered the ‘third wave’ of CBT. Acceptance is

2
 Introduction

not based on passivity or resignation, but instead on an understanding of the mind

and its uncontrollable nature. CBT would previously have focused on reducing
voice power and control by seeking to change someone’s appraisal of the voice
hearing experience. Now the horizon has expanded and a more relational approach
is taken, in which the process of engagement with the experience is targeted, rather
than a person’s appraisal of that experience. In Acceptance and Commitment
Therapy (ACT) this is spoken about as attention to context in order to change
the function of psychological events (Hayes et al., 2006). It is an approach that
values acceptance over change, albeit recognising that acceptance then brings
with it change.
A difficulty with the concept of acceptance is that it can make it all sound too
easy. Research tells us that the quality of someone’s relationship with an unwanted
voice is very similar to their other relationships (Hayward, 2003). Many people
have suffered severe trauma and their voice content often reflects this. If trauma
occurred early in life it may have affected someone’s ability to conceptualise their
own and others’ mental states. It may also have made it difficult to relate to others
with trust and confidence, be they embodied or just a voice (Chapter 2). In these
circumstances, asking someone to accept the nature of their experience without
also wishing to change it will not be straightforward. It requires people to
considerably expand their repertoire of coping, in the context of a safe and secure
relationship. One way of describing that change is in the development of more
compassionate responses for the self and other (Chapter 6).
Collectively all these developments have at times been referred to as ‘third
wave CBT for psychosis’. However, they do not all identify as CBT or as third wave
approaches (Chapter 9). For example, Compassion Focused Therapy, whilst
described as arising from within the cognitive behavioural tradition, is now an
approach in its own right (Gilbert, 2010). In other reviews of third wave CBT, dif-
ferent therapies may be included, and others left out. For example, in his review
Kahl (2012) includes Behavioural Activation as a third wave approach. Although
at first this might seem odd, there are striking connections between some third wave
approaches and traditional Behaviour Therapy. For some, the third wave is part of
a return to and reinvigoration of what would otherwise have been known as Radical
Behaviourism (Chapter 5).
Difficulties defining third wave CBT have led some to argue that the concept
should be abandoned. Hofmann et al. (2010) argue that these developments
are simply an extension of what has always been ‘a family of CBT approaches’,
which have in common the idea that cognition exerts a causal effect on behavior
and emotion. Whilst there certainly is a debate to be had, there nevertheless
does appear to have been an evolution in CBT over the last ten years which merits
attention. It has excited clinicians, many of whom have adopted these new
approaches in advance of their being subject to robust evaluation.
This book takes a pragmatic view, including the cognitive behavioural
approaches that a practising clinician or client is most likely to encounter. It
understands the third wave as having a focus on process rather than content, and

3
 C. CUPITT

being more concerned with someone’s relationship to experience than the content
of experience itself. Since this is a change of emphasis in CBT, rather than an
entirely new idea, metacognition is included for this is where it all appears to start.
Metacognition is important because thinking about thinking is the start of moving
away from a focus on the content of thoughts. It has led to a form of therapy called
Metacognitive Training (Chapter 3), in which people are explicitly taught about
thinking. What is more, the principles learnt apply to all thinking and do not
single out psychosis as a special case. As such, the approach steps firmly away
from a symptom-focused perspective. However, this may only be the first step in
understanding the role of metacognition in psychosis, which has the potential to
take us into wider questions about the nature of the self (Chapter 1).
The Method of Levels (Chapter 7) is included in this book, although it is only
part of the family of cognitive behavioural approaches in its broadest sense. It is a
metacognitive form of therapy, which seeks to change someone’s relationship
to experience. It therefore seems to make the same kind of departure from tradi-
tional cognitive behavioural therapies that we see in the other, more obviously
third wave approaches. It is also trans-diagnostic in approach, again moving us
away from a focus on symptoms.
Mindfulness-based approaches (Chapter 4) and Acceptance and Commitment
Therapy (Chapter 5) are centre-stage, widely regarded as third wave approaches.
We begin with mindfulness because it forms part of the other, and yet is often
also practised as an adjunct to traditional CBT. ACT is rapidly becoming the first
order third wave approach, in part due to its originators’ enthusiasm for the term
(Hayes, 2004).
Compassion Focused Therapy (Chapter 6) also critiques the emphasis previ-
ously given to cognition within CBT, but is different in that it takes an evolutionary
perspective. It explicitly seeks to work with the older affiliative motives and
emotions, albeit using recognisably CBT techniques (Gilbert, 2014). Again it
offers a trans-diagnostic approach and also the beginnings of a more social view
of mental distress.
A book on process-orientated therapy and the third wave of CBT would
not be complete without some critical reflection on these diverse developments.
This comes firstly from someone who has experienced CBT (Chapter 8) and in the
final chapter (Chapter 9) we ask the question of where next for both CBT and
psychosis?

References
American Psychiatric Association (2004). Practice guideline for the treatment of patients
with schizophrenia. Washington DC: APA.
Beck, A. T. (1952). Successful outpatient psychotherapy of a chronic schizophrenic with a
delusion based on borrowed guilt. Psychiatry, 15, 305–312.
Birchwood, M. & Trower, P. (2006). The future of cognitive-behavioural therapy for
psychosis: Not a quasi-neuroleptic. British Journal of Psychiatry, 188, 107–108.

4
 Introduction

Canadian Psychiatric Association (2005). Clinical practice guidelines: Treatment of

schizophrenia. The Canadian Journal of Psychiatry, 50(13) Suppl. 1.
Chadwick, P. (2006). Person-based cognitive therapy for distressing psychosis. Chichester:
Wiley
Chadwick, P., Birchwood, M, & Trower, P. (1996). Cognitive therapy for delusions, voices
and paranoia. Chichester: Wiley.
Fowler, D., Garety, P. A., & Kuipers, L. (1995). Cognitive behaviour therapy for psychosis:
Theory and practice. Chichester: Wiley.
Gilbert, P. (2010). Compassion focused therapy: The CBT distinctive features series.
London: Routledge.
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal
of Clinical Psychology, 53(1), 6–41.
Hagen, R., Turkington, D., Berge, T. & Gråwe, R.W. (2011). CBT for psychosis: A symptom-
based approach. Hove: Routledge.
Hayes, S. C. (2004). Acceptance and Commitment Therapy, Relational Frame Theory,
and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35,
639–665.
Hayes, S. C., Luoma J. B., Bond F. W., et al. (2006). Acceptance and commitment therapy:
Model, processes, and outcomes. Behaviour Research Therapy, 44, 1–26.
Hayward, M. (2003). Interpersonal relating and voice hearing: To what extent does relating
to the voice reflect social relating? Psychology and Psychotherapy: Theory, Research
and Practice, 76, 369–383.
Hofmann, S. G., Sawyer A. T. & Fang, A. (2010). The empirical status of the ‘new wave’
of cognitive behavioral therapy. Psychiatric Clinics of North America, 33,701–710.
Kahl, K. G., Winter, L. & Schweiger, U. (2012). The third wave of cognitive behavioural
therapies: What is new and what is effective? Current Opinion in Psychiatry, 25,
522–528.
Kingdon, D. & Turkington, D. (1994). Cognitive behavioral therapy of schizophrenia.
Hove: Lawrence Erlbaum Associates.
Lynch, D., Laws, K. R. & McKenna, P. J. (2010). Cognitive Behavioural Therapy for major
psychiatric disorder: Does it really work? A meta-analytical review of well-controlled
studies. Psychological Medicine, 40, 9–24.
Longmore, R. J. & Worrell M. (2007). Do we need to challenge thoughts in cognitive
behavior therapy? Clinical Psychology Review, 27, 173–187.
Morrison, A. P. & Wells, A. (2000). Thought control strategies in schizophrenia: A
comparison with non-patients. Behaviour Research and Therapy, 38(12), 1205–1209.
National Institute for Clinical Excellence (2002). Schizophrenia: Core interventions in the
treatment and management of schizophrenia in primary and secondary care. London:
NICE.
Romme, M. & Escher, S. (1989). Hearing voices. Schizophrenia Bulletin, 15(2), 209–16.
Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines
Team for the Treatment of Schizophrenia and Related Disorders (2005). Royal
Australian and New Zealand College of Psychiatrists clinical practice guidelines for the
treatment of schizophrenia and related disorders. Australian and New Zealand Journal
of Psychiatry, 39, 1–30.
Working Group of the Clinical Practice Guideline for Schizophrenia and Incipient
Psychotic Disorder. Mental Health Forum, coordination (2009). Clinical Practice
Guideline for Schizophrenia and Incipient Psychotic Disorder. Madrid: Quality Plan for

5
 C. CUPITT

the National Health System of the Ministry of Health and Consumer Affairs. Agency for
Health Technology Assessment and Research. Clinical Practice Guideline: CAHTA.
Number 2006/05–2.
Wykes, T., Steel, C., Everitt, B. & Tarrier, N. (2008). Cognitive behaviour therapy for
schizophrenia: Effect sizes, clinical models and methodological rigor. Schizophrenia
Bulletin, 34(3), 523–537.

6
 Part 1

THEORETICAL PERSPECTIVES
 1
METACOGNITION IN PSYCHOSIS
Implications for developing recovery
oriented psychotherapies

Paul H. Lysaker and Ilanit Hasson-Ohayon

Psychosis in its many different forms leads to myriad psychological and social
challenges that affect not only the lives of persons diagnosed with these conditions,
but also the lives of their friends, families, and others in their communities. Our
scientific understanding of the course of psychosis, however, has taken an
optimistic turn in the last several decades. While it was once firmly asserted that
people with psychosis could only hope to have a life in which, at best, they were
‘stable’ and free from acute disturbances in emotion, cognition, and behaviors,
careful field research found that many recover (Leonhardt et al., 2017; Silverstein
& Bellack, 2008).
In exploring how to characterize recovery, disparate groups have agreed on
at least two things. First, recovery can mean different things to different people.
Recovery can involve objective phenomena such as symptom remission or the
attainment of psychosocial milestones, and subjective experiences including self-
appraisals of an acceptable quality of life and the recapturing of a coherent sense
of oneself as a valuable person in the world. Second, regardless of what kind of
achievements constitute recovery, the person diagnosed with psychosis must
feel a sense of ownership of their recovery. This is to say that the person diagnosed
with mental illness must be ‘in charge’ of their own recovery. Recovery is thus a
matter for the whole person. It is more than a person ‘fixing’ or finding solutions
for one or more dilemmas: it requires persons to make their own sense of what they
are experiencing in the moment and decide what they want to do about it. Recovery
requires that the person be an active agent in that process.
The recognition that recovery is possible and should be the goal of treatment
has spurred on efforts to understand the barriers to recovery. After all, if services
are to promote recovery, a clear idea of what stands in the way would seem neces-
sary. To date, some of the most widely identified obstacles to recovery from
psychosis include anomalous experience such as experiences of permeable bound-
aries around the self, neurocognitive impairments, isolation, and poverty, as well

9
 P. LYSAKER AND I. HASSON-OHAYON

as trauma history and stigma or stereotyped ideas. In this chapter, we will go

beyond this work and look at another set of barriers to recovery and their implica-
tions for developing treatments. We are referring here to reduced metacognitive
capacities or difficulties forming a sufficiently complex sense of self and others,
needed to decide how to respond to the challenges of psychosis and – more broadly
– life itself. We will focus on these reduced capacities as they are intimately tied
with the potential of persons to be active agents in their recovery. Indeed, helping
to restore metacognitive function could help many not only decide what recovery
means to them but also to take charge of that process.
To explore the implications of studies on reduced metacognitive capacities for
developing psychotherapy, we will first offer a definition and then detail literature
supporting the role of metacognition in psychosis. We will explore the implica-
tions of this for developing cognitively oriented psychotherapy for psychosis, both
in theoretical and technical terms. We will lastly describe recent efforts to opera-
tionalize a recovery oriented metacognitive approach to psychotherapy, offering
thoughts on how the metacognitive approach can be distinguished from others on
the basis of its focus on meaning-making and a person’s sense of self in the human
community.

Metacognition

The construct
In this chapter, we use the term ‘metacognition’ to conceptualize and operationalize
the processes involved when persons notice and integrate information about them-
selves and others. However, the term is complex and requires some consideration
of its use in different disciplines. By the strictest definition, a metacognition is a
cognition about other cognitions. It was first used in education research, to look
at learners’ awareness of their own learning (Flavell, 1979). The use of the term
metacognition has since been expanded, for example, to deal with self-regulation
(Dinsmore et al., 2008), attentional biases (Wells, 2000), and the ability to monitor
and correct behavior and one’s own reasoning (Moritz et al., 2007). Taking all
of these activities into account, a broader understanding of metacognition has
emerged as a larger process in which information is integrated into complex repre-
sentations of the self and others (Lysaker & Dimaggio, 2014). Here metacognition
is seen as a spectrum of activities which, at one end, involves awareness of discrete
mental experiences such as specific thoughts, feelings or wishes, and at the other
end the integration of those discrete experiences into a larger complex sense of
oneself and others. These different ends of the spectrum are also not conceptualized
as completely independent activities. The larger senses we form of ourselves are
based on awareness of discrete elements of experience, just as we assign meanings
to our discrete experience on the basis of our larger sense of ourselves.
This view stresses the representational nature of reflection, emphasizing that
the metacognitive process allows us to form a sense of ourselves and others by

10
 Metacognition in psychosis

bringing together an ocean of pieces of information across unique settings over

time, rather than being a mirror of reality. It also emphasizes that metacognition is
a crucial and not a causal activity. It is intimately tied to meaning-making, which
is essential to survival. Metacognition is not an academic activity but is the basis
for how one decides what to pursue, with whom, where, and when. Metacognition
occurs and evolves intersubjectively. Metacognition requires that selected states
and experiences are given meaning and expressed in ways that can be shared
and acknowledged between people, in real or imagined interactions (Tomasello
et al., 2005; Cortina & Liotti, 2010). Finally, metacognition describes the pro-
cesses which make available a sense of self and others from moment to moment
depending on slightly or grossly changing circumstances.
Different terms in the broad field of psychology have been used to refer to
similar phenomena. These terms, which include mentalizing, theory of mind, and
social cognition, all share similarities with metacognition. However, the concept
of metacognition differs from those terms in several conceptual ways. First, while
theory of mind and social cognition are expressly concerned with the correct
detection of a thought or feeling, metacognition concerns the integration of those
details into a whole; one whose coherence, rather than pure accuracy, is at issue.
In contrast to mentalizing, metacognition explicitly distinguishes from one another
the formation of integrated ideas of the self, the formation of an integrated sense
of other people, and the use of that knowledge. Metacognition also differs from
mentalizing in that it understands reduced metacognitive capacities can result
from multiple factors, including decrements in neurocognition, social isolation,
and stigma. It does not share the view that decrements in reflectivity occur almost
exclusively in the context of disturbed attachment and emotion dysregulation
(Fonagy et al., 2004). From this view, metacognition may have a bidirectional
relationship with both attachment security and emotional regulation.

Operationalization and research in psychosis

One of the first efforts to operationalize the construct of metacognition was offered
by Semerari et al. (2003). Influenced by work in attachment (Main, 1991), this
group created the Metacognition Assessment Scale (MAS). The MAS offered
several advances in the study of metacognition. First, it made the leap of using
the term metacognition to describe the processes that go beyond momentary
self-awareness and allow emergence of a broader sense of self. Second, it differ-
entiated different forms of metacognition on the basis of their foci: the self
(Self-reflectivity); other people (Awareness of the mind of the other); and the use
of metacognitive knowledge to respond to emergent psychological and social
challenges (Mastery). It also offered an additional subscale concerned with aware-
ness of other, namely Decentration, which concerns the awareness that events can
be understood validly from multiple perspectives. This brought to light that our
sense of ourselves and others requires the ability to shift back and forth from one’s
own perspective to the valid and differing perspectives of others. As originally

11
 P. LYSAKER AND I. HASSON-OHAYON

applied, the MAS was used as a tool to detect the frequency of successful meta-
cognitive acts during psychotherapy.
Applying this conceptualization and operationalization of metacognition to the
field of psychosis, Lysaker et al., (2005) created the Metacognition Assessment
Scale-Abbreviated (MAS-A). The MAS-A is an adaptation of the MAS and
retained the general four-scale structure, though Decentration was designated as
an independent scale because of its centrality as an outcome. The MAS-A contains
four scales: Self-reflectivity (S), Understanding other’s minds (O), Decentration
(D), and Mastery (M). There were major changes from the MAS to the MAS-A.
The most substantial change was that MAS-A revised the original MAS items so
that each scale was transformed into an ordinal scale. Each item of the S, O, and
D scales of the MAS-A represents a mental act which involves a higher level of
integration than the item below it. In other words, each ascending item requires a
new element to be integrated into one’s self of self, others, and the larger commu-
nity respectively. For example, the fourth item of the S scale (a sense of self as
having distinct cognitive operations and nuanced affective states) produces a more
integrated sense of self than the third item level (self as composed only of cogni-
tive operations), but which is less integrated than the fifth item (a sense of self
experiencing affective states as changing and thought processes as subjective). For
the M scale, each item now represents a response to distress which requires
a higher level of metacognitive activity than the one below it. This allowed the
MAS-A to assess a person’s maximal capacity and assign a single value separately
to the S, O, D, and M scales of the MAS-A.

Research using the Metacognition Assessment

Scale-Abbreviated
Research using the MAS-A has suggested it has adequate psychometric proper-
ties (Lysaker & Dimaggio, 2014), and that it reflects mental processes which are
distinct from social cognition (Lysaker et al., 2013; Hasson-Ohayon et al., 2015).
The use of this scale has enabled studies to examine the prevalence and effects
of reduced metacognitive capacities in psychosis. This work has found that MAS-A
scores of persons given a diagnosis of first episode or prolonged psychosis have
more significant reductions in metacognitive capacities than persons with pro-
longed non-psychiatric medical conditions or substance abuse disorders (Lysaker,
Leonhardt et al., 2014; Lysaker, Vohs et al., 2014), minor anxiety and affective
disorders (WeiMing et al., 2015), and community members without mental
health conditions (Hasson-Ohayon et al., 2015; Popolo et al., 2017). Reductions in
metacognitive capacities have also been noted in other mental health conditions,
including depression (Ladegaard, et al., 2014), post-traumatic stress disorder
(Lysaker, Dimaggio et al., 2015), borderline personality disorder (Lysaker et al., in
press), and bipolar disorder (Popolo et al., 2017). Metacognition as a process of
integration has been found to be more closely related to function than specific
dysfunctional metacognitive beliefs (Popolo et al., 2017).

12
Another random document with
no related content on Scribd:
elevated in either the ballads or the fable, yet enough to stir the
heart, and keep the busy hands from weariness—and to do that, is
to do well and merit a hearty blessing of the world.
Cuthbert was loth to disturb this pretty home scene, as he did at his
entrance; but notwithstanding, Cuthbert was very well satisfied with
the bright surprise and shy pleasure, which one at least of the little
group displayed, and took his place among them like an old friend.
Violet’s copy-book lay open on the table; and Violet made very bad
pot-hooks indeed, and hated the copy intensely, though she liked the
poetry. The copy lines set for her were not very beautiful either,
though they were written in a good, sensible, female hand, which
had some individuality in it, and was not of the fashionable style.
Such copy lines! stray lines out of books, as diverse and
miscellaneous as could be collected, differing most widely from
those sublime, severe, abstract propositions, which in common
cases introduce the youthful student to wisdom and half-text.
Cuthbert could not help a visible smile as he glanced over them.
“I have interrupted my little friend’s lesson,” said Charteris, as he
laid down the book.
Rose was shy of him. She did not answer.
“Violet has a great appetite for verse,” said Martha, “we shall have
all the rest of it at night.”
“Triermain.” Cuthbert was a little surprised that the child should be
so far advanced—innocent Cuthbert! he did not know what a host of
books, of all kinds and classes, the little Violet had devoured already.
“How is Mr. Muir?” asked Cuthbert. “I heard at the office he was not
at home, and I was very glad to find that he was able for travelling.
Have you heard from him? How is he?”
“He is getting strong rapidly, Agnes writes,” said Martha. “They are
with my uncle in Ayr. We were brought up there, all of us, and so we
say Harry has gone home. I hope it will strengthen him—every way,”
she added, with a suppressed sigh.
“And so you like Sir Walter, Violet,” said Cuthbert; “come and tell
me what you have read besides Triermain.”
 Violet came shyly to his side, and drooped her head, and answered
with bashfulness, “I have read them a’.”
“Read them all! not quite, I think—how many books have you read,
altogether?” said the puzzled Cuthbert.
Violet looked up with mingled astonishment and pity, and opened
her eyes wide. She, who had already begun to look at
advertisements of books, and to tease Mr. Syme, the librarian in the
Cowcaddens, about new publications, which he had never heard of,
and which in the ordinary course, would not reach him these
hundred years—she to be asked how many books she had read!
Violet was amazed at the want of apprehension, which such a
question displayed.
“I have read a great heap—and I can say the Lord of the Isles, by
heart, and bits of the Lady of the Lake.”
Cuthbert’s ignorance had given Violet a little courage; but as she
met his eye, her head drooped again, and she relapsed into her
former shyness.
“And how old are you, Violet?”
“I shall be eleven next May.” Violet had already had very grave
thoughts on this subject of her age. It seemed a stupendous thing to
pass that tenth milestone.
“Violet—where did you get that pretty name of yours,” said
Cuthbert, drawing his hand over her small dark head.
“It was my mother’s name,” said the little girl reverently.
The conversation came to a sudden pause. Conscious that he had
a motive in asking those seeming simple questions, Cuthbert felt
confused, and could not go on—so he turned to the copy-book.
“Have you written all this yourself, Violet?”
He had gone back to the beginning, and there certainly was to be
traced the formation of a different hand from Violet’s—the
respectable, womanly writing which had placed those odd copy lines
on the later pages; he traced it as it improved, through a good many
different steps of progress, and at the end found a clear, good-
looking signature, proclaiming it to be the work of Rose A. Muir.
“Rose A. Muir,” he repeated it unawares aloud.
The bearer of the name started with a slight blush. Martha glanced
at him with grave scrutiny—and little Violet, looking admiringly at her
sister’s handwriting, explained, “Rose was called after my
grandmother.”
“It is not a common name,” said Cuthbert, growing embarrassed
under the grave eye of Martha. “May I ask Miss Rose, what is
represented by this A.”
“It will be Anne or Alice, or some stupid woman’s name,” he said to
himself, while his heart beat a little quicker.
“I was called after my grandmother, Mr. Charteris, as Lettie says,”
said Rose, shyly. “It is Rose Allenders—that was her name.”
The young man started visibly. He had no idea of falling on anything
so clear as this; but Martha looked at him with sudden curiosity, and
he felt himself compelled to make some explanation.
“It is by no means a usual name, Miss Muir,” said Cuthbert, turning
to the elder sister. “I know something.—I am slightly acquainted with
a family called Allenders. Did this lady—your grandmother, Miss
Rose—come from the east country?”
“I cannot tell, indeed,” said Rose. “She died very long ago—before
any of us were born.”
“I think they came from London,” said Martha; “I have heard my
uncle say so—there were two sisters of them; and their father died in
Ayr. Mrs. Calder, in the old town, was very kind to the orphans, and
took them in: and there the younger sister—her name was Violet—
died; and my grandmother married Mrs. Calder’s son. I have heard
she died young too, and called her only child, who was our mother,
after her little sister. It is a sad story altogether; but we heard my
uncle speak of it often; and I remember how many of the old people
in Ayr recollected Rose Allenders.”
 “My mother’s name was Violet Calder,” said Lettie, “but I am only
plain Violet. She did not call me after all her name; but Rose has got
two names because she’s after my grandmother.”
“I am going further west,” said Cuthbert. “I shall be in Ayr for a day
or two, I believe. I think I must ask you to introduce me to your uncle,
Miss Muir.”
“He will be glad to see you,” said Martha, quietly. “But if you go now,
you will find Harry established there. Give Mr. Charteris my uncle’s
address, Rose—but indeed you hardly need that, for every one
knows my uncle.”
But Cuthbert had not the least desire to meet Harry in Ayr. So he
was careful to excuse himself, and suddenly discovered that he
could not be able to make acquaintance with Alexander Muir, the
uncle, for a full fortnight, by which time it was certain that Harry must
have returned.
 CHAPTER VIII.

“There is all hope in thee, sweet Spring, sweet Spring!

Dull voices, speaking of thee, unawares,
Bewray themselves to sing.
For every name thou hast such music bears;
Whether ’tis March, when all the winds are gay—
Or April, girlish in her wayward way—
Or sweetest May.”

Day by day passed, of Harry Muir’s last bright week at Ayr—passed

no less happily to the three sisters, than to himself and his little wife
—and at last, fresh, healthful, and in high spirits, the youthful couple
and their baby returned home.
To walk to the coach-office to meet them, was of itself a jubilee for
the home-dwellers, and Mrs. Rodger herself held the door open for
them, in stately welcome. Mrs. Rodger was a tall old woman, gaunt
and poverty-stricken, in her dingy widow’s cap, and black cotton
gown; but Mrs. Rodger had been “genteel” once, and never forgot it.
She extended one of her long arms, and gave Harry’s hand a swing,
as he stopped to greet her. “I was just telling our weans,” said Mrs.
Rodger, “that the house wasna like itself, wanting you—and I hope
you find your leg strong, Mr. Muir; bless me, how the wee boy’s
grown! I would scarce have kent him; bring him ben, Violet, and let
the weans get a look o’ him. What a size he’s turned!”
Miss Aggie, the youngest of the aforesaid weans, plunged out of
the kitchen, and seized the baby with loud expressions of admiration.
The little wife was easily flattered by praise of that blue-eyed boy of
hers, and was by no means unwilling to accompany him herself, and
exhibit him to the assembled “weans” in Mrs. Rodger’s kitchen.
 This apartment, which answered all purposes to the family, was a
good-sized room, showing an expanse of uncovered floor, not over
clean, and a great wooden “bunker” for coals, as its most noticeable
feature. The “bunker” is an article which belongs exclusively to the
household arrangements of Glasgow. This one was not very high as
it happened, and on the corner of it sat Miss Jeanie, her hands busy
with her work, her feet deposited on a chair below. Miss Aggie, in like
manner, occupied a corner of the table in the window. Their work
required a good deal of light, and they were fettered by no punctilios
as to attitude. Miss Rodger, the eldest sister, flitted in and out of a
dark scullery—and withdrawn as far as possible from the light, in the
dusky corner, by the fireside, sat a shabby and not very young man,
with shuffling indolent limbs stretched across the hearth, and pins,
the sole gathering of his idleness, stuck in the lappel of his dusty,
worn coat, and a face that promised better things. This was
“Johnnie,” as they called him, Mrs. Rodger’s only son. Poor Johnnie
had begun this sad manner of life by a long illness, and now,
between his rheumatism and his false shame, incapable, as it
seemed, of any strenuous endeavour to make up for what he had
lost, had sunk into the state of an indolent dependant upon the little
earnings of his sisters. They had their faults, these women; but never
one of them murmured at the burden thus thrown upon them. Living
very meanly, as they were constrained to do, they were still perfectly
content to toil for Johnnie. It never seemed to occur to them at all,
indeed, that the natural order of things was reversed in their case.
Sometimes, it is true, there was a quarrel between the mother, who
was a termagant, and the poor indolent shipwrecked son, whose
temper was easily galled, having always this sore consciousness to
bear it company—but never one of the sisters upbraided Johnnie, or
made a merit of labouring for him. Amidst all their vanity, and
vulgarity, this one feature elevated the character of the family, and
gave to those three very common-place young women, a standing-
ground of which no one could possibly be less conscious than they
were themselves.
The large good-humoured hoyden, Miss Aggie, danced the baby in
her arms, and carried him to the fireside to her brother. Poor Johnnie
took the boy more gently, and praised him to his mother’s heart’s
content, while Violet, no longer shy, but at present very fluent and
talkative, stood by the side of her special friend and ally, Mr. John.
The little girl and the poor indolent man, were on very intimate terms.
“I was just telling our weans,” repeated Mrs. Rodger, “that the wee
boy would be just another creature after a while in the country; and
cheeks like roses you’ve gotten yoursel, Mrs. Muir. It would be unco’
dull though, I’m thinking—if it had only been the saut water—but its
no the season for the saut water. I mind when Archie was living—
that’s their father—we gaed down regular to Dundoon, and it was
just a pleasure to see the weans when they came hame.”
“Agnes, Martha says the tea’s ready,” said Violet, “and I’m to carry
little Harry ben.”
The tea-table in the parlour was pleasantly covered, and still more
pleasantly surrounded, and Agnes’ basket, which the good uncle’s
own hands had packed, remained still unopened; so the baby was
given over to the safe keeping of Rose, and the busy young wife
began to distribute uncle Sandy’s tokens of remembrance.
“This pot of honey is for you, Martha,—uncle Sandy thought you
would like to give it to us all, now and then, on high days—and here
is a bottle of cream from Mrs. Thomson, at the corner, and a little silk
handkerchief to Rose, and the last of the apples to Violet—and see
here, look, all of you, look!”
Two little flower-pots carefully packed with moss, one of them
bearing a tuft of fragrant little violets, the other proudly supporting a
miniature rose-bush, with one little bud just appearing from its green
leaves—good gentle uncle! He had been at so much trouble getting
this fairy rose, and cherishing it in his little sitting-room, till this
solitary bud rewarded his nursing. It was hailed with a burst of delight
from Violet, and by the elder sisters, with a pleasure which almost
reached to tears.
“It is so like my uncle,” said Rose.
And then with some happy excitement, they gathered round the
tea-table. Harry had a great budget of local news to open, and the
blithe Agnes interrupted him every moment to tell of her first
impressions, and new acquaintance. There had been beautiful
weather, sunny and soft, as it often is in the early part of April, and
the young wife had left all cares behind her on the grave shoulders
of Martha. Harry had been so well, so happy, so considerate—
enjoying so thoroughly the simple pleasures of his old home, and the
society of his pure unsophisticated uncle—Agnes thought she had
never been so happy.
And Harry’s face was sparkling with healthful blameless pleasure.
He looked so man-like, the centre of their anxieties and wishes, and
was in reality so fresh-hearted, and capable of innocent enjoyment,
that Martha’s troubled heart grew glad over the success of her
experiment. He had been home—he had seen again in these old
scenes, the pure heroic fancies of his earliest youth, and many days
hence the anxious sister thought the happy effect would remain.
They closed the evening, as it was always closed in the house at
Ayr—with the simple and devout worship of the family. Harry, with his
fine mind so clear to-night, and happily elevated, a young household
priest, conducted those simple fervent devotions—for the religious
emotions were strong within him. They swayed him much
sometimes, as, unfortunately other feelings swayed him at other
some; but he was deeply susceptible at all times to all the beauty, all
the grandeur of the holy faith he professed. The young man’s voice
trembled, and his heart swelled as he appealed to the Great Father
for the sake of the wonderful Son. And as, most humbly and
earnestly, he asked for strength against temptation, the tears in
Martha’s eyes were tears of hope—almost of joy. She thought that
surely never again this young ingenuous spirit would fall—never
again forsake that holy brotherhood, at whose head He stands, who
was once tempted for the sake of us—to defile its garments with the
mean sins of former times. There was a shadow of deep quiet upon
all their faces as they rose from their knees; they thought they had
come to the beginning of a purer, happier time. They, these anxious
women, thought so for him; and he, poor Harry! for himself, with
those joyous eyes of his, looked forward to the future, without fear.
 CHAPTER IX.
“I was gay as the other maidens—all the springs and
hopes and youthful things of the world were like me:
prithee, lady, think not I say so out of envy of your fair
estate; for in good sooth, youth is estate enough for a free
heart. But before youth goes, troubles come—yourself
must meet them anon—and be not fearful, gentle one; for
it may be they will leave rare wealth with you, and take but
a little sunshine away.”
old play.
The next day Harry entered blithely upon his old duties again. The
morning was sunny, and bright, and Agnes stood at the window with
the baby, to watch him as he emerged from the outer door below,
and turned to look up to her, and take off his hat in playful salutation.
He had a little cluster of fresh spring primroses, pulled last morning
in the Ayr garden, gracing his button-hole, and there was a spring in
his step, and an elastic grace in his manner as he went away, that
made glad the heart of the little wife. They were all very blithe this
morning—the gladness came involuntarily from Agnes’ lips in the
familiar form of song; she sang to the baby—she sang to them all.
She was still a girl, this pretty wife of Harry Muir—a girl belonging to
that very large class, who never discover that they have hearts at all,
until they have sent them forth on some great venture, perilling all
peace for ever. Agnes had been a very gay, perhaps a rather foolish
girl—liking very greatly the small vanities which she could reach, and
managing to keep out of sight the graver matters of life. She knew
what it was to be poor—but then she had known that all her life, and
the difficulties fell upon elder people, not on herself, and Agnes
sailed over them with innocent heedlessness. The heart slumbered
quietly in her bosom—she scarcely knew it was there, except when it
beat high sometimes for some small merry-making; scarcely even
when she married Harry Muir were those gay placid waters stirred.
She liked him very much—she admired him exceedingly—she was
very proud of him—yet still she had not found out her heart.
But when the cloud began to steal over the gay horizon of her life—
when she had to watch for his coming, and tremble for his
weakness, and weep over his faults those sad apologetic tears, and
say, poor Harry! then this unknown existence began to make itself
felt within the sobbing breast of the little, pretty, girlish wife. The sad
and fatal weakness, which made him in a certain degree dependant
upon them—which aroused the feelings of anxious care, the eager
expedients to protect him from himself, gave a new character to
Agnes. In sad peril now was the happiness of this young, tender,
sensitive heart; but the danger that threatened it had quickened it
into conscious life.
He went away with smiles, and hopeful freshness to his daily
labour. He came home, honestly wearied, at an earlier hour than
usual, having his conscience free of offence that day. So happily
they all gathered about the little tea-table; so gaily Agnes presided at
its tea-making, and Martha placed on the table the little crystal
vessel full of honey—odorous honey, breathing out stories of all the
home flowers of Ayr—so much the travellers had still to tell, and the
dwellers at home to hear.
“And now, Martha,” said Harry, “put on your bonnet, and come out. I
believe she has never been out, Agnes, all the time we have been
away.”
“Yes, indeed, Harry—Martha was always at the Kirk,” said the literal
Violet.
“But we are not going to the Kirk to-night—come Martha, and taste
this April air.”
Martha looked at her work. “It is a temptation, Harry; but I think you
had better take Rose—see, Rose looks white with working so long,
and I have to go to the warehouse to-morrow.”
“To the Candleriggs!” said Harry, laughing. “Where you scarcely can
tell when it is June and when December; and if Rose is white, you
are absolutely green with sitting shut up here so long—come,
Martha.”
It was not very complimentary, but the pallid faded cheek of Martha
actually bore, to eyes which had been in the sunshine, a tinge of that
undesirable hue. Save for the beneficent rest of the Sabbath-day,
and the walk through the hushed streets to church, Martha had
indeed, since her brother went to Ayr, never been out of doors. The
luxury of sending Harry to the pure home atmosphere was not a
cheap one. She had been labouring for, while he enjoyed it.
“But what if Mr. Charteris comes?” said Rose, with a little shyness:
no one else seemed to remember that Mr. Charteris was to come.
“We shall not stay long,” said Harry; “you must keep him till we
return.”
Rose seemed half inclined to go too; but she remembered how
often Martha had sent her out to enjoy the walk which she had
denied herself; and there were a great many “holes,” as those very
prosaic sempstresses called the little spaces in the centres of the
embroidered flowers, at which they worked, to be finished before
they were returned to the warehouse to-morrow—so even at the risk
of a little additional conversation with the formidable Mr. Charteris,
Rose made up her mind to stay.
And Martha and Harry went out alone. They were not within reach
of any very pleasant place for walking, but they struck off through
some of those unsettled transitionist fields which hang about the
outskirts of great towns, to the side of the canal. Those soft spring
evenings throw a charm over the common place atmosphere, of
even such ordinary haunts as this—and it is wonderful indeed, when
one’s eyes and heart are in proper trim, how the great sky itself
alone, and the vast world of common air, in which we breathe, and
through which human sounds come to us, can suffice to refresh our
minds with the Nature, which is beautiful in every place.
The distant traffic of the “Port,” to which this canal is the sea; the
flutter of dingy sloop sails, and a far-off prospect of the bare cordage,
and brief masts of little Dutch vessels, delivering their miscellaneous
cargoes there, gave a softened home look, almost like the quiet
harbour of some little seaport, to a scene which, close at hand, could
boast of few advantages. But the air was bright with the haze of
sunset, and in the east the sky had paled down to the exceeding
calmness of the eventide, lying silently around its lengthened strips
of island cloud, like an enchanted sea. Dull and blank was the long
level line of water at their feet, yet it was water still, and flowed, or
seemed to flow; and along the bank came the steady tramp of those
strong horses, led by a noisy cavalier whose accoutrements clanked
and jingled like a steam-engine, piloting the gaily-painted “Swift” boat
from Edinburgh, with its crowds of impatient passengers, to the end
of their tedious journey. These were homely sights—but the charmed
atmosphere gave a harmony to them all.
And there were some trees upon this side of the canal—and grass
as green as though it lived a country life, and stout weeds, rank and
vigorous, by the side of the way—and the hum of the great town
came softly on their ear, with here and there a distinct sound,
breaking the inarticulate hum of that mass of busy life. Better than all
these, there was such perfect confidence between the brother and
sister, as had scarcely been before, since he was the unstained boy,
innocent and ignorant, and she the eager teacher, putting forth a
second time in this young untried vessel, the solemn venture of her
hopes. It was not that Harry had anything to confide to the anxious
heart, which noted all his thoughts and modes of feeling so narrowly;
but the little daily things which sometimes have so weighty a bearing
upon the most important matters of life—the passing fancies, the
very turns of expression, which show the prevailing tone of the
speaker’s mind, were so frankly visible to the eye of the watchful
sister, that Martha’s heart rejoiced within her with solemn joy.
Meanwhile, Rose sat alone in the parlour doing her work,
somewhat nervously, and hoping fervently that Mr. Charteris would
not come till “somebody was in” to receive him.
The baby lay sound asleep in the cradle. Agnes had gone down to
Mrs. McGarvie to negotiate about some washing, and was at this
moment standing in Mrs. McGarvie’s kitchen, near the small table
where Mrs. McGarvie herself, with the kettle in one hand, and a
great horn spoon in the other, was pouring a stream of boiling water
into a bowl half filled with the beautiful yellow peasemeal, which
keeps the stomachs of Glasgow in such superlative order,
compounding the same into brose, for the supper of Rab, who newly
come in, had just removed his blue bonnet from his shaggy red head
in honour of his mother’s visitor. Mrs. McGarvie had undertaken the
washing, and Agnes in her overflowing happy spirits, was telling her
about the journey, from which they had just returned.
Violet, last of all, was in Mrs. Rodger’s “big room,” a very spacious,
fine apartment, which was generally occupied by some lodger. They
had no tenant for it at present, and were this evening entertaining a
party in the large, lofty, shabbily-furnished dining room. Violet had
gone in among these guests with the natural curiosity of a child, and
poor Rose, nervously apprehensive of the coming of this formidable
Mr. Charteris, sat in the parlour alone.
Her busy fingers began to flag as she filled up these “holes;” and
now and then, the work dropped on her knee. The ordinary
apprehensions about Harry, which generally formed the central
object of her thoughts, were pleasantly hushed to-night. Rose was
not thinking about anything particular—she would have said so, at
least—but for all that, long trains of indefinite fancies were flitting
through her mind, and her thick blunt needle was altogether stayed
now and then—only recovering in hysteric bursts its ordinary
movements, when Rose trembled to fancy that she heard a step on
the stair. If Agnes would only come in—if Harry and Martha were but
home again!
At last a step was on the stair in reality. “Maybe it is Agnes,” said
Rose to herself as her needle began to fly again through the muslin
—but it was not only Agnes—it was the foot of a man—poor Rose
wondered if by any possibility she could run away.
And there he was, this sad ogre whom Rose feared, quietly opening
the parlour door, as if he had some right to be there. Mr. Charteris
was almost as shy as Rose herself. He sat down with pleased
embarrassment, and looked exceedingly awkward, and spoke by no
means so sensibly as he was used to do. Rose eagerly explained
the reason why she was alone, and went to the window in haste to
look for Agnes.
Mr. Charteris’ eye had been caught by something of a very faded
neutral hue, in a black frame, which hung above the mantelpiece. He
asked Miss Rose if it was embroidery.
Miss Rose was moved to laughter, and her laugh dispersed the mist
of shyness very pleasantly. “It is only an old sampler of my
grandmother’s, Mr. Charteris.”
Mr. Charteris rose to look at it.
“There is not much art in it,” said Rose, “it seems that all the
landscapes on samplers are of one style—but my mother gave it to
me when I was a girl—a little girl—and I used to be proud of it,
because it was my own.”
Mr. Charteris took it down to examine its beauties more closely. It
bore the name of the artist at full length “Rose Allenders,” and had a
square house, and some very original trees, like the trees of very old
paintings, elaborately worked upon it.
“I think you said she had been long dead,” said Cuthbert.
“Long ago—very long ago,” said Rose. “When my mother was only
a child, my grandmother died. Her name is on the stone, among the
rest of the Calders, and her father and her little sister are near her, in
the churchyard. Uncle Sandy used to take us there when we were
children. I believe he thought they would feel lonely in their very
graves, because they lay among strangers.”
There was a pause. Cuthbert again hung up the faded sampler, and
Rose worked most industriously at her opening. Each was earnestly
endeavouring to invent something to say—and both of them were
singularly unsuccessful. It was the greatest possible relief to Rose to
hear Harry’s voice in the passage.
The two young men greeted each other heartily—it seemed that
there was some charm in these very faults of poor Harry—for
everybody learned to like and apologise for, even while they blamed
him.
 “And so you are going to Ayr,” said Harry, “why did you not come a
little earlier, Mr. Charteris, that I might have shown our town to you.
You will not appreciate the beauties it has, unless some one, native
to it, points them out.”
“For which cause I am here to seek an introduction which Miss Muir
promised me to your uncle,” said Cuthbert.
“To my uncle? are you a character hunter, Mr. Charteris?” said
Harry quickly, and with something which Rose thought looked like
rudeness.
“No, I don’t think so—but why do you ask me?”
“Because the vulgar call my uncle a character and an original,” said
Harry. “I thought your cousin, who saw him once, might have told
you so,—and he does not like the imputation. We are jealous of my
uncle’s feelings, as we have a good right to be, for he has been
father, and teacher, and companion alike to all of us.”
“I had some business in the neighbourhood of Ayr,” said Cuthbert,
with a little conscious embarrassment—“one of those things in our
profession that border upon the romantic,—there are not many of
them, Miss Rose;—I want to trace out some links of descent—to find
some lost members of an old family. I shall find them only by means
of gravestones I apprehend, but that will answer my purpose. It is not
quite in my department, this kind of business; but it is pleasant to
have some excuse for seeing so fine a country in this time when ‘folk
are longen to gon on pilgrimages.’—I think you must begin to feel
this longing, Miss Muir?”
“It is wonderful how easily one can content oneself,” said Martha,
with a smile which spoke of singular peace. “We have only to shut
our eyes, Rose and I, and straightway we are at home—or to send
some one else to enjoy it, Mr. Charteris. Harry and Agnes, have
brought us so much of the atmosphere that I scarcely desire it now
for myself.”
 CHAPTER X.

“Ay, even here, in the close city streets,

’Tis good to see the sunset—how the light,
Curious and scornful, thrusts away the masses
Of vapour brooding o’er the busy town,
Yet leaves a trace of rosy light the while
Even on the thing it scorns.
And the rich air gives sweetness to all sounds;
And hazy sunbeams glorify young faces—
And labour turns aside, glad of its hour
Of aimless idling.”

Cuthbert Charteris, much against his will, was detained a week

longer in Glasgow. His uncle, a man of unbounded hospitality, an
almost invariable characteristic of his class, was not without a little
family pride in Cuthbert’s attainments and position—and such a
succession of people had been already invited to “meet” Mr.
Buchanan’s advocate nephew, that Cuthbert’s good humour, though
already sufficiently taxed, would not suffer him to disappoint them.—
Neither was it until the very last evening of the week, when he had
made positive arrangements for going to Ayr next day, that he had
leisure to call on the Muirs.
The sun was setting on the soft April evening, and the slanting level
sunbeams streamed through the dusty streets, drawing out in long
shadows the outline of the houses. Within these shadows the
bystanders felt almost the chill of winter, while in the sunshine at the
street corners, lounging groups congratulated each other that
summer had come at last.
Here the light fell on a white “mutch” or two, and on the sun-burnt
heads of innumerable children, of whose boisterous play the gossip
mothers took no notice.—There it glimmered and sparkled in braids
and curls, and plaits of beautiful hair which a coiffeur might have
studied for the benefit of his art, and which you could scarcely fancy
the short thick toil-hardened fingers of these laughing mill-girls able
to produce. But toilsome as their factory life was, it had its edge of
enjoyment, quite as bright and enlivening as the evening recreations
of any other class—and with those young engineer workmen
clustering around them, and the evening sunshine and the hum of
continual sound—sound which expressed repose and sport, and
scarcely had the least admixture of the laborious din of full day—
filling the atmosphere, there were many scenes less pleasant and
less graceful, than the street corner and its groups of mill-girls. And
here, up the broad road, now almost free of the carts which usually
crowd it, dashes at full speed a bright little equipage glowing in green
and gold, which draws up with a flourish at the corner. Straightway
the “closemouths,” and “common stairs” pour forth a stream of girls
and women, carrying vessels of every form and size, from the small
china cream-jug from some lonely lady’s tea-table, to the great
pitcher under which little Mary staggers as she carries it home in her
arms to supply the porridge of a dozen brothers and sisters; and you
never were refreshed with richer milk under the deepest umbrage of
summer trees, than that which gives forth its balmy stream from the
pretty green barrels hooped with brilliant brass, which rest upon the
light framework of the Port Dundas dairy cart.
Rose Muir stood at the door as Cuthbert approached—he had
chosen a later hour than usual for his visit, that he might not disturb
them at their simple evening meal—but as he glanced at the
downcast face of Rose, over which an uneasy colour was flushing,
he saw that the old anxiety, the origin of which he had guessed at
before, had now again returned. The long wistful glances she cast
along the street—the eager expectant look with which she turned to
himself—once before the herald of poor Harry—would have almost
sufficed to reveal the secret of the family to Cuthbert had he not
guessed it before.
“Harry has not come home yet,” said Rose, with an unconscious
apology in her tone; “they are sometimes kept very late at the office
—but my sisters are up stairs, Mr. Charteris, will you come in?”
Cuthbert followed her silently. He had become so much interested
in the fortunes of the family, that he felt his own heart sink, as he
remembered that “the office” had been closed a full hour ago.
Agnes was alone when they entered the parlour, and Cuthbert,
roused to observation, saw her sudden start as they opened the
door, and the pallor and sickness of disappointment which came
over her pretty youthful face, when her eye fell upon himself. The
work she had been busy with, fell from the fingers which seemed for
the moment too nervous to hold it. The little wife had been so
confident—so sure of Harry’s reformation,—and her heart was
throbbing now with a positive agony of mingled fear and hope.
Cuthbert seated himself on the sofa, and began to talk of the baby
—it was almost the only subject which could soothe the young
mother—but even while he spoke, he could see how nervously
awake they both were to every sound; how Rose suspended her
work and held her breath at every footstep in the street below which
seemed to approach the door—and how the needle stumbled in the
small fingers of Agnes, and the unusual colour flickered on her
cheek.
“You are very late, Harry,” said Martha, entering from the inner room
—Cuthbert’s back was towards her—she thought it was her brother.
“It is Mr. Charteris, Martha,” said Rose.
There was a fiery fight in Martha’s eyes—an impatience almost
fierce in the evident pang, and short suppressed exclamation with
which she discovered her mistake. She too had been strong in her
renewed hope—had began to rest with a kind of confidence in the
changed mind of Harry.
But now the former chafing had commenced again, and the bitter
hopelessness which once before overpowered her, returned upon
her heart—Cuthbert thought of the old grand picture of the bound
Prometheus—of the lurid background, and the cold tints of the
captive figure, rigid in his manacled strength, with the vulture at his
heart. Bitterest of dooms, to be bound to this misery, without one free
hand to struggle against it.
But Martha took her seat in silence, and a conversation was very
languidly carried on. Insensibly Cuthbert felt the same anxiety steal
over himself—he felt that he ought to go away, but yet he remained.
By degrees the conversation dwindled into broken remarks from
himself, and faltering responses from Rose and Agnes; sometimes
indeed Martha spoke, but her words were harsh and bitter, or else
full of a conscious mockery of lightheartedness, which was more
painful still.
The tea-tray with its homely accompaniments stood on the table—
the little kettle sang by the side of the old-fashioned grate,—but the
night was now far advanced, and reluctant to shut out the lingering
remains of daylight, the sisters had laid aside their work; it was
almost dark, and still Harry had not come.
“Where is Violet, Agnes,” said Martha, after a long silence.
“She went out to play,” said the little wife. “Some of her friends were
down here, and they wanted her. I could not keep Lettie in, Martha,
on so fine a night.”
“I was angry at the poor bairn,” said Martha, with a singular humility,
“I did wrong. I will go myself and look for her—our troubles are not so
few that we should make additions to them of our own will.”
There was a strange pathos in the low tone in which Martha spoke,
and in the sudden melting of the strained vehement heart. Cuthbert
saw the trembling hand of Agnes steal up to her eyes, and heard the
appealing deprecatory whisper of Rose, “Oh Martha!” He could see
its meaning—he could hear in it an echo of that other exclamation—
poor Harry! so common in this house.
Little Violet had been at play in the street below, carrying the vague
blank grief of childhood into her very sport. As Martha rose, the little
girl suddenly burst into the room. “Agnes, Harry’s coming.”
They were all very quiet—a sort of hush of deep apprehension
came upon the sisters, and Rose went out hastily to the door.
 In another moment, Harry had entered the room—looking very pale,
and with an unmeaning smile upon his face. He came forward with
great demonstration to greet Charteris, and hurried over an
elaborate account of things which had detained him—the strangest
complication of causes, such as came in no one’s way but his.
“Why don’t you light the candles?” said poor Harry, with an
ostentatious endeavour at high spirits. “Have you been sitting in the
dark like so many crows? Rosie, quick, light this, and get another
candle. You don’t think we can see with one, and Mr. Charteris here.
Have you not got tea yet, Agnes? Nonsense, what made you wait for
me? I can’t always be home at your hours, you know—when a man
hasn’t his time at his own disposal, you know, Mr. Charteris—what is
it now?—what do you want, Lettie?”
The solitary candle had been lighted, and placed on the table. It
threw a painful illumination upon Harry’s perfectly colourless face, as
he stood in the middle of the room, with an unsteady swing in his
movements. Agnes had left the arm-chair to him, but still he stood by
the table—while Rose, with a paleness almost as great as his upon
her face, went about painfully arranging things that needed no
arrangement, and Martha sat rigid in her chair.
“I say, what is it, Lettie?” repeated Harry.
“Nothing, Harry—only you’ve torn your coat,” said Violet.
She showed it to him—some one had seized his skirt apparently, to
detain him, and a great rent was visible. It brought a sudden flush to
the damp face of poor Harry, but the flush was of defiance and
anger. He struck Violet with his open hand, and exclaimed
impatiently, “Get away, what business have you with that?”
It was a very slight blow—and Violet shrank away in silence out of
the room; but a deep red burning colour flushed over Martha’s faded
face, and with a quick impulsive start, she rose from her chair.
“Harry!” Her harsh hoarse voice seemed to sober the unhappy lad.
He looked round him for a moment on those other pale faces, and on
the grieved and embarrassed Cuthbert, with the defiant stare which
he had tried to maintain before; but as his eyes turned to Martha,