Therapeutic Writing Groups
Therapeutic writing offers a unique opportunity for self-discovery and healing by creatively engaging the inner world..
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What Are Therapeutic Writing Groups?
The aim of the therapeutic writing group is to help members foster insight and self-awareness as well as to generate support from others through the process of writing.
The writing process allows unknown or repressed material to emerge into the conscious mind. That is why we begin the writing periods with journaling prompts, which serve as a tool to prod the unconscious. This process is further supported by the technique of stream-of-consciousness writing, which serves to circumvent our natural tendency to censor our thoughts and feelings. Engaging with oneself on the page in this way can help bring about new insights and meaning–old stories are often told in new ways.
The Therapeutic Writing Group Environment
The therapeutic writing group environment, protected by principles of confidentiality and non-judgement, creates a uniquely safe space for vulnerable, hidden/edited material to find expression. Paying attention to what the writing reveals and then further validating and processing it within the group has a powerfully beneficial therapeutic effect.
An added benefit of group therapy is that people can discover that there is a universal quality to our most vulnerable and private perceptions and impulses. This insight can reduce a sense of isolation, shame, anxiety, and depression; it fosters a deeper sense of connection with others as well as, ultimately, with oneself.
Do I Need Experience as a Writer/Creative Writer?
No experience needed. The idea is to use writing as a tool to facilitate self-awareness, it’s not intended to be performative. The group avoids critique and pays no attention to grammar, spelling or structure. In fact, the intention is to leave all that behind.
How Do I Know That The Therapeutic Writing Group is Right for Me?
The group is suitable for individuals who wish to know themselves more deeply through the process of writing therapeutically. In order to determine whether the group is an appropriate fit and to learn more about individual needs and expectations, I meet with each potential participant before admitting them to the group.
Writing Therapy: How to Write and Journal Therapeutically
Of course, the answer to that question will be “yes” for everyone!
We all fall on hard times, and we all struggle to get back to our equilibrium.
For some, getting back to equilibrium can involve seeing a therapist. For others, it could be starting a new job or moving to a new place. For some of the more literary-minded or creative folks, getting better can begin with art.
There are many ways to incorporate art into spiritual healing and emotional growth , including drawing, painting, listening to music, or dancing. These methods can be great for artistic people, but there are also creative and expressive ways to dig yourself out of a rut that don’t require any special artistic talents.
One such method is writing therapy. You don’t need to be a prolific writer, or even a writer at all, to benefit from writing therapy. All you need is a piece of paper, a pen, and the motivation to write.
Before you read on, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values and self-compassion and give you the tools to enhance the wellbeing of your clients, students or employees.
This Article Contains:
- What Is Writing Therapy?
Benefits of Writing Therapy
How to: journaling for therapy, writing ideas & journal prompts, exercises and ideas to help you get started, a take-home message, what is writing therapy.
Writing therapy, also known as journal therapy, is exactly what it sounds like: writing (often in a journal) for therapeutic benefits.
Writing therapy is a low-cost, easily accessible, and versatile form of therapy . It can be done individually, with just a person and a pen, or guided by a mental health professional. It can also be practiced in a group, with group discussions focusing on writing. It can even be added as a supplement to another form of therapy.
Whatever the format, writing therapy can help the individual propel their personal growth , practice creative expression, and feel a sense of empowerment and control over their life (Adams, n.d.).
It’s easy to see the potential of therapeutic writing. After all, poets and storytellers throughout the ages have captured and described the cathartic experience of putting pen to paper. Great literature from such poets and storytellers makes it tempting to believe that powerful healing and personal growth are but a few moments of scribbling away.
However, while writing therapy seems as simple as writing in a journal , there’s a little more to it.
Writing therapy differs from simply keeping a journal or diary in three major ways (Farooqui, 2016):
- Writing in a diary or journal is usually free-form, where the writer jots down whatever pops into their head. Therapeutic writing is typically more directed and often based on specific prompts or exercises guided by a professional.
- Writing in a diary or journal may focus on recording events as they occur, while writing therapy is often focused on more meta-analytical processes: thinking about, interacting with, and analyzing the events, thoughts, and feelings that the writer writes down.
- Keeping a diary or journal is an inherently personal and individual experience, while journal therapy is generally led by a licensed mental health professional.
While the process of writing therapy differs from simple journaling in these three main ways, there is also another big difference between the two practices in terms of outcomes.
These are certainly not trivial benefits, but the potential benefits of writing therapy reach further and deeper than simply writing in a diary.
For individuals who have experienced a traumatic or extremely stressful event, expressive writing guided purposefully toward specific topics can have a significant healing effect. In fact, participants in a study who wrote about their most traumatic experiences for 15 minutes, four days in a row, experienced better health outcomes up to four months than those who were instructed to write about neutral topics (Baikie & Wilhelm, 2005).
Another study tested the same writing exercise on over 100 asthma and rheumatoid arthritis patients, with similar results. The participants who wrote about the most stressful event of their lives experienced better health evaluations related to their illness than the control group, who wrote about emotionally neutral topics (Smyth et al., 1999).
Expressive writing may even improve immune system functioning, although the writing practice may need to be sustained for the health benefits to continue (Murray, 2002).
In addition to these more concrete benefits, regular therapeutic writing can help the writer find meaning in their experiences, view things from a new perspective, and see the silver linings in their most stressful or negative experiences (Murray, 2002). It can also lead to important insights about yourself and your environment that may be difficult to determine without focused writing (Tartakovsky, 2015).
Overall, writing therapy has proven effective for different conditions and mental illnesses, including (Farooqui, 2016):
- Post-traumatic stress
- Obsessive-compulsive disorder
- Grief and loss
- Chronic illness issues
- Substance abuse
- Eating disorders
- Interpersonal relationship issues
- Communication skill issues
- Low self-esteem
There are many ways to begin writing for therapeutic purposes.
If you are working with a mental health professional, they may provide you with directions to begin journaling for therapy.
While true writing therapy would be conducted with the help of a licensed mental health professional, you may be interested in trying the practice on your own to explore some of the potential benefits to your wellbeing. If so, here there are some good tips to get you started.
First, think about how to set yourself up for success:
- Use whichever format works best for you, whether it’s a classic journal, a cheap notebook, an online journaling program, or a blog.
- If it makes you more interested in writing, decorate or personalize your journal/notebook/blog.
- Set a goal to write for a certain amount of time each day.
- Decide ahead of time when and/or where you will write each day.
- Consider what makes you want to write in the first place. This could be your first entry in your journal.
Next, follow the five steps to WRITE (Adams, n.d.):
- W – What do you want to write about? Name it.
- R – Review or reflect on your topic. Close your eyes, take deep breaths, and focus.
- I – Investigate your thoughts and feelings. Just start writing and keep writing.
- T – Time yourself. Write for five to 15 minutes straight.
- E – Exit “smart” by re-reading what you’ve written and reflecting on it with one or two sentences
Finally, keep the following in mind while you are journaling (Howes, 2011):
- It’s okay to write only a few words, and it’s okay to write several pages. Write at your own pace.
- Don’t worry about what to write about. Just focus on taking the time to write and giving it your full attention.
- Don’t worry about how well you write. The important thing is to write down what makes sense and comes naturally to you.
- Remember that no-one else needs to read what you’ve written. This will help you write authentically and avoid “putting on a show.”
It might be difficult to get started, but the first step is always the hardest! Once you’ve started journaling, try one of the following ideas or prompts to keep yourself engaged.
Here are five writing exercises designed for dealing with pain (Abundance No Limits, n.d.):
- Write a letter to yourself
- Write letters to others
- Write a poem
- Free write (just write everything and anything that comes to mind)
- Mind map (draw mind maps with your main problem in the middle and branches representing different aspects of your problem)
If those ideas don’t get your juices flowing, try these prompts (Farooqui, 2016):
- Journal with photographs – Choose a personal photo and use your journal to answer questions like “What do you feel when you look at these photos?” and “What do you want to say to the people, places, or things in these photos?”
- Timed journal entries – Decide on a topic and set a timer for 10 or 15 minutes to write continuously.
- Sentence stems – These prompts are the beginnings of sentences that encourage meaningful writing, such as “The thing I am most worried about is…” “I have trouble sleeping when…” and “My happiest memory is…”
- List of 100 – These ideas encourage the writer to create lists of 100 based on prompts like “100 things that make me sad” “100 reasons to wake up in the morning,” and “100 things I love.”
Tartakovsky (2014) provides a handy list of 30 prompts, including:
- My favorite way to spend the day is…
- If I could talk to my teenage self, the one thing I would say is…
- Make a list of 30 things that make you smile.
- The words I’d like to live by are…
- I really wish others knew this about me…
- What always brings tears to your eyes?
- Using 10 words, describe yourself.
- Write a list of questions to which you urgently need answers.
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As great as the benefits of therapeutic journaling sound, it can be difficult to get started. After all, it can be a challenge to start even the most basic of good habits!
If you’re wondering how to begin, read on for some tips and exercises to help you start your regular writing habit (Hills, n.d.).
- Start writing about where you are in your life at this moment.
- For five to 10 minutes just start writing in a “stream of consciousness.”
- Start a dialogue with your inner child by writing in your nondominant hand.
- Cultivate an attitude of gratitude by maintaining a daily list of things you appreciate, including uplifting quotes .
- Start a journal of self-portraits.
- Keep a nature diary to connect with the natural world.
- Maintain a log of successes.
- Keep a log or playlist of your favorite songs.
- If there’s something you are struggling with or an event that’s disturbing you, write about it in the third person.
If you’re still having a tough time getting started, consider trying a “mind dump.” This is a quick exercise that can help you get a jump start on therapeutic writing.
Researcher and writer Gillie Bolton suggests simply writing for six minutes (Pollard, 2002). Don’t pay attention to grammar, spelling, style, syntax, or fixing typos – just write. Once you have “dumped,” you can focus on a theme. The theme should be something concrete, like something from your childhood with personal value.
This exercise can help you ensure that your therapeutic journal entries go deeper than superficial diary or journal entries.
More prompts, exercises, and ideas to help you get started can be found by following this link .
In this piece, we went over what writing therapy is, how to do it, and how it can benefit you and/or your clients. I hope you learned something new from this piece, and I hope you will keep writing therapy in mind as a potential exercise.
Have you ever tried writing therapy? Would you try writing therapy? How do you think it would benefit you? Let us know your thoughts in the comments!
Thanks for reading, and happy writing!
We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .
- Abundance No limits. (n.d.). 5 Writing therapy exercises that can ease your pain . Author. Retrieved from https://www.abundancenolimits.com/writing-therapy-exercises/.
- Adams, K. (n.d.). It’s easy to W.R.I.T.E . Center for Journal Therapy . Retrieved from https://journaltherapy.com/journal-cafe-3/journal-course/
- Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment 11(5) , 338-346.
- Farooqui, A. Z. (2016). Journal therapy . Good Therapy . Retrieved from https://www.goodtherapy.org/learn-about-therapy/types/journal-therapy
- Hills, L. (n.d.). 10 journaling tips to help you heal, grow, and thrive . Tiny Buddha . Retrieved from https://tinybuddha.com/blog/10-journaling-tips-to-help-you-heal-grow-and-thrive/
- Howes, R. (2011, January 26). Journaling in therapy . Psychology Today. Retrieved from https://www.psychologytoday.com/blog/in-therapy/201101/journaling-in-therapy.
- Murray, B. (2002). Writing to heal. Monitor, 33(6), 54. Retrieved from http://www.apa.org/monitor/jun02/writing.aspx
- Pollard, J. (2002). As easy as ABC . The Guardian . Retrieved from https://www.theguardian.com/lifeandstyle/2002/jul/28/shopping
- Smyth, J. M., Stone, A. A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. Journal of the American Medical Association 281 , 1304-1309.
- Tartakovsky, M. (2014). 30 journaling prompts for self-reflection and self-discovery . Psych Central . Retrieved from https://psychcentral.com/blog/archives/2014/09/27/30-journaling-prompts-for-self-reflection-and-self-discovery/
- Tartakovsky, M. (2015). The power of writing: 3 types of therapeutic writing . Psych Central . Retrieved from https://psychcentral.com/blog/archives/2015/01/19/the-power-of-writing-3-types-of-therapeutic-writing/
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What our readers think.
Hello, Such an interesting article, thank you very much. I was wondering if there was a particular strategy in which writing down questions produced answers. I started doing just that: writing down doubts and questions, and I found that answers just came. It was like talking through the issues with someone else. Is there any research on that? Is this a known strategy?
That’s amazing that you’re finding answers are ‘arising’ for you in your writing. In meditative and mindfulness practices, this is often referred to as intuition, which points to a form of intelligence that goes beyond rationality and cognition. This is a fairly new area of research, but has been well-recognized by Eastern traditions for centuries. See here for a book chapter review: https://doi.org/10.4337/9780857936370.00029
As you’ve discovered, journaling can be incredibly valuable to put you in touch with this intuitive form of knowing in which solutions just come to you.
This also reminds me of something known as the rubber ducking technique, which programmers use to solve problems and debug code: https://en.wikipedia.org/wiki/Rubber_duck_debugging
Anyway, hope that offers some food for thought!
– Nicole | Community Manager
I have never tried writing therapy, but I intend to. Its so much better than seeing the psychiatrist for my behavior issues, which nobody has even identified yet.
Hi great article, just wondering when it was originally posted as I wish to cite some of the text in my essay Many thanks
Glad you enjoyed the post. It was published on the 26th of October, 2017 🙂
Hope this helps!
I know you posted this blog a while ago but I’ve just found it and loved it. It articulated so clearly the benefits of writing therapy. One question – is there any research on whether it’s better to use pen and paper or Ian using a PC/typing just as good. I can write much faster and more fluently when I use a keyboard but wonder whether there is a benefit from the physical act of writing writing with a pen. Thanks.
Great question. The evidence isn’t entirely clear on this, but there’s a little work suggesting that writing by hand forces the mind to slow down and reflect more deeply on what’s being written (see this article ). Further, the process of writing uses parts of the brain involved in emotion, which may make writing by hand more effective for exploring your emotional experiences.
However, when it comes to writing therapy, the factor of personal preference seems critical! The issue of speed can be frustrating if your thoughts tend to come quickly. If you feel writing by hand introduces more frustration than benefits, that may be a sign to keep a digital journal instead.
Hope that helps!
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Healing with words — a therapeutic writing group, description.
Healing With Words is an online therapeutic writing group, offered to people who are currently receiving treatment for cancer or who have completed treatment within the last two years . The group, led by an oncology social worker, will feature a variety of topics related to coping with a diagnosis of cancer. Participants will have the opportunity to read several writing pieces, complete creative writing exercises, and create their own unique works. The group will be a space to respond to writing prompts, share work, and participate in discussion surrounding the writing process itself.
Online support groups take place using a password-protected message board format (not live chat or video conference) .
To participate in this writing group, you will need to complete our online registration process. After joining, you can read and post messages 24 hours a day, 7 days a week.
At this time, Cancer Care ’s online support groups are only available to people residing within the United States (including Puerto Rico and U.S. territories).
Wednesday, February 1, 2023 (Group accepts new members after start date.)
Begin registration process now .
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Transformative Creative Writing Group
The "Transformative Creative Writing Group" is an energetic, dynamic psycho-educational group that helps individuals use writing as a powerful tool to aid in personal reflection, self-cultivation, creativity, and healing. You may have something you wish to share or "vent." You may need to "process" something inwardly or use writing to aid in visualizing the wording that feels lacking. Matt is heavily biased that one's experiencing the wonders of creating and reading material which resonates deeply within us is as much a transpersonal experience as anything else. It can also be transformative!
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Types of Therapy: Integrative
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Why Talk Therapy Is on the Wane and Writing Workshops Are on the Rise
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By Steve Almond
- March 23, 2012
1. In Which the Author Reveals a Scandalous Motive for Attending Grad School
When people ask why I became a writer, I tend to emphasize the era, in my mid-20s, when I turned off the television and became a more serious reader. I talk about the sentences of Saul Bellow and Lorrie Moore, how enraptured I was, how I wanted to emulate them. It makes for a nice story.
But it’s not the part of the story that really matters. What really matters, it seems to me now, is that I was bored with my job as a newspaper reporter and depressed. I was living in exile from my family and driving away the people I loved with an astonishing efficiency. What I needed was therapy. As it happened, I applied for a Master of Fine Arts in fiction.
Most of my comrades arrived in similar states of disrepair. We did our best to conceal the worst of it, to play the part of eager newbies grateful for the opportunity to hone what we referred to majestically as “our craft.” But the crazy inevitably surfaced, under the aegis of booze or pot or some brisker narcotic. After parties, we stumbled into the night howling songs of loneliness and sorrow. At least I did.
Around the workshop table, our instructors urged us to focus on technique: point of view, sentence structure, show don’t tell. We were permitted to discuss the suspiciously familiar afflictions of our characters, but to probe too vigorously into psychology was to invoke the cardinal rule of workshop: writing is not therapy.
This made sense to me. As the child of two therapists, I knew the process well enough by then. My sessions were tedious affairs, thick with self-pity and grievance — the trademarks of the young solipsist.
I figured I had gone into the literary racket because I had urgent and profound things to say about the world and because I was a deeply creative person. But looking back, I can see that the instigating impulse for me, for all of us really, was therapeutic. We were writing to confront what Faulkner called “the human heart in conflict with itself.” And not just any hearts. Our hearts.
2. A Theory More or Less Guaranteed to Rankle Therapist and Writer Alike
A generation ago, when “Annie Hall” won the Oscar for Best Picture, talk therapy occupied a prominent place in our collective imagination, whether or not you partook. If you wanted to spend several hours a week baring your soul to a stranger who was professionally obligated to listen and react, you went into therapy. Today you join a writing workshop.
Plenty of folks still seek therapy, of course, including writers. And not all of us are damaged individuals who write to work out our neurotic conflicts. (I’m sure there are plenty of well-adjusted authors, even if I have never actually met one.) What I’m suggesting isn’t a correlation, so much as a broader cultural shift — that literary endeavor has supplanted therapy as our dominant mode of personal investigation.
The waning of psychotherapy has clear roots in the rise of psychopharmacology. Drug companies have been hard at work over the past three decades, marketing meds to troubleshoot our faulty brain chemistry. As managed care has compelled more and more psychiatrists to trade their notebooks for prescription pads, the classic image of the patient on the couch has been replaced by a man with a pill in his palm.
The ascent of creative-writing, particularly in an age dominated by the impatient pursuit of visual stimulation, might seem harder to explain. But my sense is that people remain desperate for the emotional communion provided by literature.
Consider this: Back when I started writing fiction in the early ’90s, there were a few dozen M.F.A. programs in the entire country. I had no idea the degree existed — and I was an English major from a liberal-arts college. Today, there are nearly 200 such programs, along with more than 600 other undergraduate and graduate degrees in creative writing. Thousands of people attend literary conferences and take courses at writing centers. The Association of Writers and Writing Programs’ annual conference, once a lowly gathering of faculty from 13 member colleges, has grown into a kind of sprawling four-day trade show that plays host to more than 10,000 writers, editors and aspirants.
Over the past few years, I’ve visited dozens of these programs and conferences. I’ve met hundreds of students and talked with them about their work. Some are young college grads hot to become the next Dave Eggers. Others are grandmas hoping to document or embellish some bit of personal history. In each case, what strikes me aren’t the particulars — age, attitude, ambitions — so much as their essential motive. What they really want isn’t fame or fortune but permission to articulate feelings that were somehow off limits within the fragile habitat of their families. They are hoping to find, by means of literary art, braver and more-forgiving versions of themselves.
I think now of the student I met last year, a beautiful, nervous young woman of Caribbean descent who had written a comic essay about the grueling ritual of straightening her hair. Despite her breezy tone, glints of despair kept showing through, particularly in those passages when it became clear that her immigrant parents enforced this humiliation.
“It sounds like there was a lot of pressure on you to be perfect,” I said.
The woman, whom I met only a few minutes earlier, began to weep in quiet convulsions.
It is at this point that I can hear the phantom convulsions of my literary comrades. “Damn it, Almond,” they’re saying. “You really are making workshops sound like therapy.” Fair enough. The official job of a workshop is to help a writer improve her prose, not her psyche. But this task almost always involves a direct engagement with her inner life, as well as a demand for greater empathy and disclosure. These goals are fundamentally therapeutic.
What’s more, the workshop is (or should be) only one small part of a larger creative process that involves reading, reflection and writing. It is this solitary work that marks the writer’s most sustained investigation of the self.
As much as we like to indulge in this fantasy, authors don’t create anything out of whole cloth. Like the patient on the analytic sofa, we fixate on particular stories and characters and themes because they speak to the fears and desires hidden within us. Our inventions inevitably take the form of veiled confessions.
J. D. Salinger didn’t write “The Catcher in the Rye” because he suffered a nervous breakdown after the death of his little brother. But he did conjure Holden Caulfield from the deepest part of himself, as a means of wrestling with his own anxieties about loss, madness, and the cruel deceptions of the adult world.
The beauty of the artistic unconscious is that it allows us to sneak up on our own intentions or to disguise them altogether. A few months before the end of Kurt Vonnegut’s life, a fan asked him to identify his central topic. As the author of 14 wildly inventive novels, Vonnegut might have cited the perils of technology or the corrosive effects of wealth or the moral tolls of war. Instead, he said this: “I write again and again about my family.”
3. The Internet Enters Our Story
Back in the old days, the Internet was billed, rather quaintly, as an “information superhighway” that would ease the exchange of data and ideas. As anyone with a smartphone knows, at this point it functions more frequently as the world headquarters of narcissistic recreation, a place people prowl when they’re feeling lonely and restless and unrecognized. The central innovation of the social media has been to offer a public forum for our private lives. The Midwestern wife who once devoutly guarded the intimacies of her kin, now posts essays about them on her blog and tracks her hit count.
But the Internet, while it might excite the desire for creative self-expression and sudden acclaim, does little to slake our deeper yearnings. What we want in our heart of hearts is not distraction but just the opposite, the chance to experience what Saul Bellow called “the arrest of attention in the midst of distraction.” We want to be heard and acknowledged. It’s the difference between someone “liking” our latest Facebook update versus agreeing to listen to our story, the whole bloody thing, even and especially when it runs up against bruising revelations.
For those with the means, therapy used to serve this function. But it did so in a covert and stigmatized fashion. Creative-writing programs represent a return to the ancient pleasures and virtues of storytelling, a chance to break the frantic cycle of screen addiction. Students join a flesh-and-blood community of writers, readers and critics, all of whom have chosen the rigors of narrative over the emotional fragmentation of the digital age. They receive professional guidance, and the possibility exists, however gossamer, that they will mature into genuine artists. Try finding that online.
4. A Word in Defense of the Writing Cure
It’s become something of a trope for critics to grouse about the creative-writing boom, particularly those critics who cling to the Hemingway model: that artists should be forged by the fires of “real life,” not trained in academies. It’s certainly true that the modern literary landscape can feel, from the inside, like an elaborate Ponzi scheme in which naïve acolytes subsidize the careers of their betters.
I recently began leading a new workshop composed of students in their 50s and 60s. All have children and busy careers. And I sometimes wonder, as I look around the room, why at this late stage they’ve chosen to write at all. I fear that perhaps I’m giving them false hope. But it’s hard for me to remain cynical when I think about their motives. What they’re seeking is exactly what I wanted: the refuge of stories, which remain the most reliable paths to meaning ever devised by our species.
A few weeks ago, we critiqued a novel excerpt about a trio of fractious sisters who travel to a family reunion in the country of their birth. The author was prone to comma splices and garbled exposition. But I spent most of class gently suggesting that she work to expose the dynamics roiling beneath the family bickering. Afterward, she told me she was grateful the class had discerned what the piece was really about. She paused, shifting from one foot to the other. “It’s tough with my sisters. There was a lot of unhappiness.”
I have no idea whether my student will do the lonely, dogged labor necessary to get her novel published. I’m not sure that’s what matters in the end. What matters is that she and her comrades have found a way to face the toughest truths within themselves, to begin to make sense of them, and maybe even beauty. In a world that feels increasingly impersonal and atomized, I can’t think of a more thrilling mission.
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Nyssen OP, Taylor SJC, Wong G, et al. Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations. Southampton (UK): NIHR Journals Library; 2016 Apr. (Health Technology Assessment, No. 20.27.)
Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations.
Chapter 1 background.
- Therapeutic writing
Writing as a form of therapy to improve physical or mental health has a long history 1 and is widely reported in psychology textbooks as being of therapeutic value. 2 – 5 It can take many formats including those from a psychotherapeutic background, such as therapeutic letter writing, 6 specific controlled interventions, such as emotional disclosure/expressive writing, 7 to more recent approaches, such as developmental creative writing 8 and other epistolary approaches, such as blogging. 8 With the development of UK organisations such as Lapidus (Association for Literary Arts in Personal Development), dedicated to the promotion of therapeutic writing (TW) based on the premise that it has health benefits, and an increased interest in the potential of non-pharmacological adjunctive therapies, it is important to evaluate the effectiveness of a variety of different approaches within this field. These include two main categories: written emotional disclosure [or emotional writing (EW)] 9 and creative writing, such as poetry. 7 Other forms of creative writing include alpha writes/poems (a poetic device in which each successive line of the poem starts with the next letter of the alphabet, or a predetermined word or phrase written vertically down the page); 10 writing from published poems/narratives; acrostics; and haiku poems (traditionally a haiku contains three lines of five, seven and then five syllables, making a total of 17 syllables; the tradition is modified so that no more than 17 syllables are arranged in no more than three lines, but the shorter the better); 11 autobiographical writing (such as reflective diaries, journaling); descriptive writing; genre writing (e.g. fairy tales); free writing; short stories; drama or fictional narratives; unsent letters; diary/journaling; collaborative writing (workshops); writing accompanying other art forms; life writing or memoirs (such as reminiscence, life review); list writing; redrafting or sentence stems writing; scribing for others; writing from visual/sound stimuli (e.g. writing from mindfulness); writing from the senses; and writing in form and writing from music (as part of a music therapy). 10 , 12 Newer forms of writing include blogging or participating in web-based forums. 13 , 14
- Dimensions of therapeutic writing
Within each type of TW there may be significant process variability, for example in the flexibility and number of topics; the dose (frequency and duration); group or individual delivery; computerised compared with handwritten exercises; participant recruitment; and financial compensation. However, a major distinction lies in whether the writing is facilitated or unfacilitated.
Facilitated therapeutic writing
Facilitated TW interventions, when a facilitator is present at some stage before or during the writing, might be delivered in many different ways and contexts: in a health-care centre, as part of a programme in a rehabilitation clinic or within a group of people with common or different chronic conditions, face to face or via the internet. People using these therapeutic tools may receive feedback from someone else, a health-care professional, a group of persons or not receive feedback at all. 10
Furthermore, the topic of the writing can be varied, from positive to negative expression of emotions through neutral topics (e.g. childhood/birth, life aims and goals, places, relationships). 10 TW can also be used in children, adolescents or adults and among different clients, such as the chronically ill (e.g. cancer, mental health problems, chronic infections) or healthy individuals, and assessed from different angles such as community carers, doctors and nurses, peer training, patient’s family and/or friends or the participant him/herself – the most usual perspective. 10
The writing event should not be considered as solely an isolated exercise but as a sequence of exercises, not necessarily all of which encompass a written component. As such, a common practice is that writing starts with (visual) stimuli 12 or with mindfulness meditation in order to inspire people and to act as a form of distraction from reality. 15 The following examples of the work of facilitated writing practitioners in the UK exemplify the variety of this type of TW ( Box 1 ).
Examples of facilitated therapeutic writing Writing practitioner Carol Ross (CR) facilitates weekly TW groups for inpatients in mental health units in a UK NHS Foundation Trust. CR has developed her own practice, influenced by a number of published research (more...)
Perhaps the last thing to add is that clinicians at Freedom from Torture continue to send more clients than can be coped with, which is some vindication of the practice. As a bridge between intense therapy and the outside world, giving clients a skill they can take with them and a means of self-discovery, self-healing and personal growth, it seems, as the Hippocratic Oath puts it, to do no harm, and a great deal of good.
Unfacilitated emotional writing
Unfacilitated EW means writing, completed without any assistance, feedback, comment or any other form of support. Therefore, in the current review, an unfacilitated writing intervention has been defined as when a facilitator was simply not present in person during the writing exercise, as opposed to facilitated writing (described above). Typically, in unfacilitated writing interventions, participants are instructed to write for 15–30 minutes on 3 to 4 consecutive days (or at weekly intervals). Instructions on these unfacilitated writing assignments can be delivered in writing via leaflets, verbally over the telephone or even via video or the internet. Participants are asked to do their writing unassisted and alone at home or on their own in a given clinic or laboratory setting. In the most commonly evaluated form of unfacilitated EW, there is a single writing topic that can be chosen (usually disease or treatment focused), for which participants are directed to write emotionally and disclose about their deepest thoughts and feelings or about a self-selected trauma. Thereafter, either the writings may be collected by the practitioner without any feedback or the participant can simply decide what to do with the writing. Sometimes, practitioners provide participants the option to make telephone calls during the writing exercise should any concerns emerge; however, this action has not been considered as facilitation in this review.
The Pennebaker writing paradigm: expressive writing or written emotional disclosure
This is the most common form of unfacilitated EW. It is a technique whereby people are encouraged to write (or talk into a tape recorder) in private about a traumatic, stressful or upsetting event, usually from their recent or distant past. They write for 15–30 minutes typically for 3 or 4 days within a relatively short period of time, such as on consecutive days or within 2 weeks. The format has been relatively consistent since the earliest randomised controlled trials (RCTs), 1 , 18 but more recent studies have varied the duration, number of sessions and topic of writing, including positive events and thoughts and feelings about illnesses. 19 RCTs of expressive/emotional writing have been conducted in a wide variety of participants, including healthy students, people undergoing psychological stressors, such as bereavement or being in a caregiving role, or in people with long-term physical conditions, such as rheumatoid arthritis (RA) and asthma. Variants of the technique include disclosure in front of a listener, who can be a confederate, a researcher or a doctor. For the purposes of this project, these activities are not considered to be EW and lie outside the scope of this review. The presence of a listener is likely to affect outcomes, as it potentially adds a counselling dimension.
Positive writing can be delivered either as part of a facilitated TW or unfacilitated EW intervention. The exercise involves writing about positive topics only, including positive emotions, typically for 20–30 minutes, three or four times per week if delivered as an unfacilitated EW intervention. Otherwise, the duration and length of the positive writing can be very varied when facilitated (see Appendix 1 ). Pennebaker et al. 19 found in a review published in 1997 that the description of positive emotions could predict improvements in health outcomes. Since then, researchers have studied the positive effects of the positive emotional disclosure, advocating that participants writing about the positive aspects of past traumas (benefit finding by describing any positive outcomes of the disease experience or treatment in detail) or simply about positive life events, could achieve comparable health improvements as those writing about past traumas. 20
Although the above require the individual to write as part of therapy, other forms of therapy use existing texts. The most commonly encountered type of bibliotherapy, Reading Bibliotherapy, involves reading material specifically selected for its therapeutic potential for that person. 21 In the UK, Books on Prescription Schemes have been running in primary care for several years, and in 2013 a national scheme was launched in England by the Society of Chief Librarians and the Reading Agency. 22 Such reading bibliotherapy is not covered by this review.
In contrast, interactive bibliotherapy has been defined as the use of literature to bring about a therapeutic interaction between participant and facilitator. 21 The triad of participant, literature and therapist is viewed as critical. In fact, interactive bibliotherapy does not restrict itself to the written word: it can include the spoken word, for example in film or theatre but it must involve the coherent use of language. When interactive bibliotherapy uses poetry, it is synonymous with poetry therapy and they are both encompassed by the term biblio/poetry therapy. 21 Sometimes the literature involved in biblio/poetry therapy is new writing generated by the participants themselves. This type of creative writing biblio/poetry therapy is the principal form of facilitated TW included in this review and it is the form of TW used by the practitioner experts collaborating in the current systematic reviews (see Box 1 , in which the TW expert practitioners describe their different facilitated biblio/poetry therapy practices).
Nonetheless, little has been published around all the different types of facilitated TW, and literature shows that the most evaluated form of TW is the EW intervention, described by Pennebaker and Beall 1 Comprehensive research around the writing paradigm 18 , 23 – 27 and narrative analysis within the health-care setting 28 – 31 has been performed through the last decades.
- Long-term conditions
The prevalence of long-term conditions (LTCs) increases with ageing populations. In 2002, the leading chronic diseases [cardiovascular disease (CVD), cancer, chronic respiratory disease and diabetes] were responsible for 29 million deaths worldwide. 32 According to the UK Department of Health (DH), 33 more than 15 million people in England (including half of all those aged > 60 years) are living with at least one LTC, and the risk of death is particularly high in those with three or more conditions occurring concurrently. 34 LTCs also result in a huge burden on UK NHS resources. Although some are preventable, for most LTCs the only realistic management strategy is continuing care, as biological and psychosocial mechanisms regulating disease progression are not yet fully understood. As LTCs are difficult to improve, especially for elderly populations, health-care programmes, such as self-management support and patient education, often combined with structured clinical follow-up, have been suggested as a way to improve the quality of life (QoL) of such patients. 35 New therapeutic approaches, such as TW, have the potential to improve the QoL in people with LTCs.
- Possible pathways linking memory, emotions and physical health
There are several potential ways that writing might impact on physical health. For example, cognitive restructuring or behavioural mechanisms (e.g. reflection on health behaviours) may lead to improvement in outcomes. However, many of the types of TW described above engage emotions and memories (both positive or negative) and there are physiological pathways linking memory, emotions, chronic stress and physical health.
Two interdependent memory systems are thought to be associated with remembering events in humans. 36 Episodic memory is linked to the hippocampus and this structure is vital for processing events that eventually become long-term memories. 37 Emotional memory is linked to the amygdala, part of the limbic system involved with emotions, in particular fear-related responses and general pleasant and unpleasant emotional processing. 38 Although the episodic and emotional memory systems are independent, they affect each other in a variety of ways. 36 Emotion enhances perception of, and attention to, the memory-provoking stimulus, as well as the long-term storage of the memory. 36 Episodic memory also influences emotional memory by, for example, causing the autonomic effects of emotional arousal (e.g. the sweaty palms and dry mouth) when remembering a past situation. 36
The limbic system has links with the cerebral cortex, the brainstem and the pituitary gland (part of the hypothalamic–pituitary–adrenal axis). Parts of the cerebral cortex have a role in cognitive appraisal and the conscious awareness of emotional states, and can regulate amygdalar activity. 38 Through the brainstem, areas in the limbic system can control many internal conditions of the body, for example cardiovascular regulation. The hypothalamic–pituitary–adrenal axis is both responsive to psychological inputs and has significant influences on the immune system, which, in turn, influences physical health. 39 This pathway may be one of the ways chronic stress is linked to poor health. 39 – 42 It is therefore possible that a psychological intervention might improve aspects of physical health, and if modification of such pathways had even a small effect then this could have profound public health significance.
- Realist synthesis
In this review, a conventional systematic review of the effectiveness of unfacilitated EW and facilitated TW was conducted, but, in addition, the findings of a realist synthesis are reported. Realist synthesis is a theory-driven interpretive approach to evidence synthesis. Rather than producing a judgement on whether (or not) an intervention works, realist syntheses attempt to explain outcome patterns in data using theory (or theories). It is particularly useful when interventions are complex and evidence is mixed or conflicting and provides little or no clues as to why the intervention worked or did not work when used in different contexts, by different stakeholders or when used for different purposes. 43
In brief, realist syntheses ask what works for whom in what circumstances, how and why? To do so, realist syntheses use a particular logic of analysis that deliberately breaks down how an outcome has arisen. An outcome is considered to have occurred because it is caused to do so by a causal process known as a mechanism. In addition, the contexts in which an outcome has occurred are also considered to be important as they cause mechanisms to be activated. This logic of analysis thus provides an approach for understanding how and why it is that context can influence outcomes. In summary, the realist logic of analysis used in a realist synthesis considers the interaction between context, mechanism and outcome (sometimes abbreviated as CMO). That is how particular contexts have triggered (or, conversely, interfered with) mechanisms to generate the observed outcomes. 43
To elaborate further, in order to understand how outcomes are generated, the roles of both external reality and human understanding and response need to be incorporated. Realism does this through the concept of mechanisms, whose precise definition is contested but for which a working definition is ‘. . . underlying entities, processes, or structures which operate in particular contexts to generate outcomes of interest.’ 44 Different contexts interact with different mechanisms to make particular outcomes more or less likely – hence, in general, a realist synthesis produces recommendations of the general format ‘In situations [X], complex intervention [Y], modified in this way and taking account of these contingencies, may be appropriate’. This approach, when done well, is widely recognised as a robust set of methods, which is particularly appropriate when seeking to explore the interaction between CMO in a complex intervention [e.g. see Berwick’s editorial explaining why experimental (RCT/meta-analysis) designs may need to be supplemented (or perhaps in some circumstances replaced) by realist studies aimed at elucidating CMOs]. 45
The philosophical basis underpinning a realist synthesis is realism. Realism assumes the existence of an external reality (a real world) but one that is filtered (i.e. perceived, interpreted and responded to) through human senses, volitions, language and culture. Such human processing initiates a constant process of self-generated change in all social institutions, a vital process that has to be accommodated in evaluating social programmes. In other words, the way individuals interpret and respond (or not) to the world around them has the potential to cause changes to this world around them. Such changes may then cause additional responses from individuals, potentially leading to a series of feedback loops. Within a realist synthesis, where possible, attempts are made to understand these feedback loops.
A realist approach is particularly useful for this project because TW is a complex intervention that could be useful in a variety of patient groups, and currently it is unclear whether it is effective for all or some, and how and why it might be effective.
Realist syntheses often use input from content experts to help develop the programme theories needed to explain how complex interventions work. In this project, input from practitioner experts was deliberately sought. During the second programme theory-building meeting with practitioner experts, they were asked for their feedback on what their views were on how TW was meant to work, for whom and why (see Chapter 5 , Methods , for more details). Two practitioner experts [Carole Ross (CR) and Victoria Field (VF)] provided written responses (see Appendix 1 , Tables 76 and 77 , respectively) and have been included in this report as they provide an insight into how facilitated TW is used in the NHS and voluntary sector.
- Previous systematic reviews on therapeutic writing in long-term conditions
There have been a number of systematic reviews on expressive writing, 18 , 23 , 46 , 47 published in psychology journals, that have conducted meta-analyses according to normal practice in psychology, combining different types of participants and outcomes across different conditions, and using Cohen’s d or Hedges’ g statistics. Their results are difficult to interpret because effect sizes for specific populations and interventions are unclear. There have been three recent systematic reviews on TW in LTCs. One concerned post-traumatic stress disorder (PTSD) only and included five studies. 27 One of the included studies is on cognitive–behavioural therapy (CBT) rather than TW, 48 and another 49 is a very small, non-randomised study with students. A second, unpublished systematic review was accessed via the internet. 26 This assessed TW for psychological morbidity in people with long-term physical conditions. The review included 14 RCTs and searches were conducted up to May 2011. It is unclear why this review did not include a number of potentially includable studies including Abel et al. 50 [human immunodeficiency virus (HIV)], Graham et al. 51 (chronic pain), Halpert et al. 52 [inflammatory bowel syndrome (irritable bowel syndrome, IBS)], Henry et al. 53 (breast cancer), Hughes 54 (breast cancer), Kraaij et al. 55 (HIV), Petrie et al. 56 (HIV), Stark 57 [fibromyalgia (FM)] and Theadom et al. 58 (asthma), as all of these studies measure psychological morbidity and were published before the search end date. It may be that they did not include some of these because of their definition of long-term physical conditions, as there is no uniform definition as yet. It is unclear how the results might have differed if some of these studies had been included. The third systematic review evaluated the impact of support on the effectiveness of written cognitive–behavioural self-help 59 and thus was not really focused on TW per se. It included 38 studies, none of which are included in this project.
- Hypotheses tested in the review (research questions)
Overall aims and objectives of this review
- What are the different types of TW that have been evaluated in comparative studies? What are their defining characteristics? How are they delivered? What underlying theories have been proposed for their effect(s)?
- What is the clinical effectiveness of the different types of TW for LTCs compared with no writing or other suitable comparators?
- How is heterogeneity in results of empirical studies accounted for in terms of patient and/or contextual factors, and what are the potential mechanisms responsible for the success, failure or partial success of interventions (i.e. what works for whom in what circumstances and why)?
- What is the cost-effectiveness or cost–consequences of one or more types of TW, in one or more representative LTCs, when there is sufficient information on the intervention, comparator and outcomes to conduct an economic evaluation?
Included under terms of UK Non-commercial Government License .
- Cite this Page Nyssen OP, Taylor SJC, Wong G, et al. Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations. Southampton (UK): NIHR Journals Library; 2016 Apr. (Health Technology Assessment, No. 20.27.) Chapter 1, Background.
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Writing Works: A Resource Handbook for Therapeutic Writing Workshops and Activities (Writing for Therapy or Personal Development) Paperback – August 15, 2006
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The use of creative writing as a route to personal development is a powerful therapeutic tool - a fact that is recognized in the growing numbers of workshops and writing groups within professional contexts, including clinical, health and criminal justice settings.
Writing Works is a guide for writers or therapists working with groups or individuals and is full of practical advice on everything from the equipment needed to run a session to ideas for themes, all backed up by the theory that underpins the methods explained. Experienced practitioners in the field contribute detailed illuminating accounts of organizing writing workshops for a wide range of different clients, together with examples of their outcomes.
This book will be an invaluable start-up reference for arts therapists and professionals working across the health, social care and caring professions, and one that will be referred to again and again.
- Print length 256 pages
- Language English
- Publisher Jessica Kingsley
- Publication date August 15, 2006
- Dimensions 6 x 0.58 x 9.25 inches
- ISBN-10 9781843104681
- ISBN-13 978-1843104681
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Writing therapy: types, benefits, and effectiveness, thc editorial team august 7, 2021.
In this article
What Is Writing Therapy?
How does writing therapy work, types of writing therapy, potential benefits of writing therapy, conditions treated by writing therapy, summary and outlook.
Writing therapy, or “expressive writing,” is a form of expressive therapy in which clients are encouraged to write about their thoughts and feelings—particularly those related to traumatic events or pressing concerns—to reap benefits such as reduced stress and improved physical health. 1 Writing therapy may be used in many environments, including in person or online . It may be supervised by a mental health professional or even occur with little or no direct influence from a counselor. There are several types of writing therapy, including, but not limited to narrative therapy, interactive journaling, focused writing, and songwriting. Although traditional psychotherapy , or talk therapy, has been standard practice in many therapeutic and counseling environments, evidence shows that writing therapy has many potential physical and psychological health benefits. 2
What Is the History of Therapeutic Writing / Expressive Writing?
Humans have expressed belief in the healing power of the written word since ancient times. For example, in the fourth century B.C.E., certain groups in Egypt believed that ingesting meaningful words written on papyrus would bring about health benefits. Words were thought to have medicinal and magical healing powers, so much so that inscribed above Egypt’s famed library of Alexandria was the phrase “The Healing Place of the Soul.” 1
However, the roots of modern therapeutic writing may be found in bibliotherapy , a form of therapy that employs literature and reading to help people deal with challenges in their own lives. 3 This practice dates back to the fifth century B.C.E. when it was thought to cure a condition called melancholia, or a deeply experienced depression .
More recently, writing therapy gained momentum in the United States in the early 19th century, 1 and it was popularized in the early 20th century with psychoanalyst Sigmund Freud’s Creative Writers and Day Dreaming. Though talk therapy was still the go-to approach, writing therapy gained steam in the 1930s and 1940s as creative therapies involving the arts , such as music, dance, and writing grew. The 1965 American Psychological Association (APA) convention, held in Chicago, Illinois, hosted a symposium that focused on written communications with clients. This symposium, organized by a division of the APA called Psychologists Interested in the Advancement of Psychotherapy, generated a boom in writing therapy research in the 1970s. 1
In the 1980s, social psychologist James Pennebaker emerged as a leading advocate and researcher of writing therapy. His research focused on the benefits of writing about or discussing one’s emotional disturbances, including reduced stress and improved immune function. He also claimed that writing about traumatic events could help people cope. His work helped propel writing therapy into the mainstream of psychotherapeutic practice. 1
There are two main theories as to how writing therapy works. The first posits that inhibition or suppression of emotions , traumatic events, or aspects of one’s identity constitutes a long-term, low-level stressor and has adverse health effects, such as an increased likelihood of becoming ill. Writing therapy can serve as an act of disclosure, and of written emotional expression, and therefore remove the stressor. However, this theory has become less accepted because research has shown that different acts of expression do not reap the same health benefits as writing therapy. 4
For example, Pennebaker conducted a study in 1996 in which one group of participants was asked to express a traumatic experience through physical movement, and another group was asked to express themselves through both physical movement and writing. Only the group that used both movement and writing showed significant physical health improvements. Pennebaker found that the specific language used while writing is associated with the physical and mental health benefits. When people’s emotional writing compositions were analyzed by judges and by the Linguistic Inquiry and Word Count software, positive emotion words like “happy” and a moderate number of negative emotion words like “sad” were associated with good physical health, while high and low levels of negative emotion words were associated with poor physical health. Compositions that showed an increase in causal words like “reason” and insight words like “realize” showed the most improved physical health in their writers. 4
When engaging in writing therapy, clients are asked to write about a traumatic experience. A standard practice might involve writing for 15 to 20 minutes for three consecutive days. 5 A 2002 study published in the Annals of Behavioral Medicine found that of three groups assigned to journal for one month, the group asked to write about “cognitions and emotions related to a trauma or stressor” enjoyed the most benefits of writing therapy; they had a better perspective on the stressful experience about which they wrote. 6
Sometimes this practice is self-generated. The act of journaling has increased in popularity, especially with the growth of aesthetic practices such as bullet journaling, which combines a journal, calendar, and planner. 7
Photo by Brent Gorwin on Unsplash
There are several types of writing therapy, which generally fall into two categories: writing therapy conducted with the guidance of a mental health counselor and self-motivated writing therapy, the latter of which anyone can take up at their own pace.
A counselor or mental health professional might use writing therapy with clients who find it difficult to verbalize their thoughts or emotions. Narrative therapy, a form of writing therapy that clients and therapists can use together, is often helpful in this situation. 8 Narrative therapy involves the client and mental health professional “reauthoring” a traumatic or problematic story from the client’s life. 9 This method helps the client recontextualize their experience by removing the assumptions and context they have assigned to it to see it from a more objective perspective. 8
Another common format, which can be practiced with or without the guidance of a mental health professional, is called interactive journaling. It combines aspects of writing therapy and bibliotherapy. In interactive journaling, clients are provided with a journal prompt, or a starting point, which they then use to inform their writing. This method is especially effective in substance abuse treatment because it can educate patients and promote reflection and exploration of their experiences. It can also benefit students in the health care field because it can help them empathize with and understand their clients’ experiences. 1
Two other types of writing therapy are focused writing and songwriting. Focused writing incorporates worksheets that educate and guide clients, 10 and songwriting combines music therapy and writing therapy to provide clients with an avenue to reminisce and express their emotions. 11
Researchers have found that expressive, or therapeutic writing, can have numerous physical and psychological health benefits, some of which include: 1
- better immune function
- fewer doctor visits
- less stress
- improved grades in school
- reduced emotional and physical distress
- decreased depression symptoms
- lower blood pressure
- improved liver function
- fewer missed days of work
- strengthened memory
In addition to its general benefits, writing therapy has been an easily accessible resource to treat people with many different conditions and stressful or traumatic experiences.
Posttraumatic Stress Disorder
Evidence suggests that writing therapy can posttraumatic stress disorder (PTSD) symptoms and the symptoms of depression often associated with PTSD. The potential effectiveness of writing therapy in helping people cope with trauma makes it a useful alternative when more traditional modes of therapy are ineffective or impossible to access. 12
For example, a study published in 2013 in the Journal of Sexual Medicine used writing therapy to treat 70 women who had experienced childhood sexual abuse. Researchers asked the women to write about trauma or sexual schema (the “cognitive generalizations” someone has about their sexual selves, informed by prior sexual experiences) during five 30-minute sessions, which occurred over up to five weeks. 13 At three different intervals—two weeks, one month, and six months—the study participants were asked to complete interviews and questionnaires regarding their sexual function, PTSD, and depression. Researchers found that between pretreatment and posttreatment, participants reported fewer symptoms of PTSD. According to study findings, participants who wrote about sexual schema were also more likely to recover from sexual dysfunction. 14
Some studies have found that engaging in writing therapy can help reduce anxiety . 15 , 16 In a study conducted in 2020 by faculty of Tabriz University of Medical Sciences in Iran, researchers administered three writing therapy sessions to pregnant women, plus two telephone calls between the sessions and basic pregnancy care, over four to six weeks. During the first session, the women were asked to write about their concerns regarding pregnancy and brainstorm solutions that would help relieve the anxiety they induce, and the phone calls encouraged them to follow through with the solutions. In the second session, researchers employed narrative therapy techniques and asked the women to write a story that outlined their concerns about pregnancy and then applied the solutions they had previously generated. The final session fostered a group discussion between the participants about the previous assignments. The study concluded that the women who engaged in writing therapy had significantly less anxiety than a comparison group who received only the standard pregnancy care. 17
Studies have shown that symptoms of depression decrease among people who utilize writing therapy. For example, in one study published in a 2014 issue of Cognitive Therapy and Research , one group of undergraduate students was tasked with non-emotional writing, or writing that does not focus on difficult or traumatic experiences and feelings, and another group was tasked with expressive writing, writing that does deal with emotional distress and trauma, focused in this case on emotional acceptance . The students in the latter group who experienced low or low to mild symptoms of depression saw a reduction in their symptoms. 18
Another study, conducted by researchers from the Catholic University of the Sacred Heart in Italy with women who had recently given birth, again divided participants into two groups; one performed expressive writing, and the other simply wrote about neutral topics. The women who used expressive writing had lessened depressive symptoms, whereas those in the neutral writing group saw no significant change. 19
People suffering the loss of a loved one can benefit greatly from writing therapy. It can reduce the number of negative feelings surrounding the event and allow for closure. It promotes self-care and therefore helps the client recover after a loss. 20 Writing therapy can also help reduce the separation anxiety that grief can prompt, gives clients a fresh perspective on their loss, and recognizes their bereavement journey. 21
A 2011 study published in the Journal of Psychosomatic Obstetrics and Gynaecology conducted 10 writing sessions over five weeks with people who had lost pregnancies. The participants were asked to write about their pregnancy loss, write a letter to a friend as if the friend were experiencing the same loss, and write a letter to themselves or to someone who witnessed the loss. The participants’ levels of grief and loss decreased after the writing therapy treatment. 22
Technology has made many forms of therapy more accessible for many people. The internet can connect people in nearly any geographical zone to therapists who may be physically distant. Writing therapy, in particular, transitions easily to the virtual world; most forms don’t require face-to-face meetings at all and can be conducted over email.
In addition, writing therapy is a form of self-help intervention that anyone may practice. Many writing prompts (such as these links from Disability Dame and Dancing through the Rain ) are available online and enable people to immediately begin writing and benefit from this therapy. 23 Whether practitioner- or self-guided, writing therapy is an accessible practice that offers many potential benefits to those who use it.
- Moy, J. D. (2017). Reading and writing one’s way to wellness: The history of bibliotherapy and scriptotherapy. In Higler, S. (Ed.), New Directions in Literature and Medicine Studies (pp. 15–30). Palgrave Macmillan. https://doi.org/10.1057/978-1-137-51988-7_2
- Holden, J. D., & Mugerwa, S. (2012). Writing therapy: A new tool for general practice? British Journal of General Practice, 62(605), 661–663. https://doi.org/10.3399/bjgp12X659457
- THC Editorial Team. (May 22, 2021). Reading as therapy: Bibliotherapy and mental wellness. The Human Condition. https://thehumancondition.com/reading-as-therapy-bibliotherapy/
- Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), 162–166. https://doi.org/10.1111/j.1467-9280.1997.tb00403.x
- Qian, J., Sun, S., Sun, X., Wu, M., Yu, X., & Zhou, X. (2020). Effects of expressive writing intervention for women’s PTSD, depression, anxiety, and stress related to pregnancy: A meta-analysis of randomized controlled trials. Psychiatry Research, 288. https://doi.org/10.1016/j.psychres.2020.112933
- Lutgendorf, S. K., & Ullrich, P. M. (2002). Journaling about stressful events: Effects of cognitive processing and emotional expression. Annals of Behavioral Medicine, 24, 244–250. https://doi.org/10.1207/S15324796ABM2403_10
- Normark, M., & Tholander, J. (2020). Crafting personal information: Resistance, imperfection, and self-creation in bullet journaling. Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems, 1–13. https://doi.org/10.1145/3313831.3376410
- Goodrich, T., Hancock, E., Kitchens, S., & Ricks, L. (2014). My story: The use of narrative therapy in individual and group counseling. Journal of Creativity in Mental Health, 9, 99–110. https://doi.org/10.1080/15401383.2013.870947
- Madigan, S. (2011). Narrative therapy. American Psychological Association.
- McGihon, N. N. (1996). Writing as a therapeutic modality. Journal of Psychosocial Nursing & Mental Health Services, 34(6), 31–35. https://doi.org/10.3928/0279-3695-19960601-08
- Ahessy, B. (2017). Song writing with clients who have dementia: A case study. The Arts in Psychotherapy, 55, 23–31. https://doi.org/10.1016/j.aip.2017.03.002
- Kamphuis, J. H., Reijntjes, A., & van Emmerik, A. A. P. (2013). Writing therapy for posttraumatic stress: A meta-analysis. Psychotherapy and Psychosomatics, 82(2), 82–88.
- Anderson, B. L., & Cyranowski, J. M. (1994). Women’s sexual self-schema. Journal of Personality and Social Psychology, 67(6), 1079–1100. https://doi.org/10.1037/0022-35220.127.116.119
- Lorenz, T. A., Meston, C. M., & Stephenson, K. R. (2013). Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: Results from a randomized clinical trial. The Journal of Sexual Medicine, 10(9), 2177–2189. https://doi.org/10.1111/jsm.12247
- Barrett, M. D., & Wolfer, T. A. (2001). Reducing anxiety through a structured writing intervention: A single-system evaluation. The Journal of Contemporary Social Services, 82(4), 355–362. https://doi.org/10.1606/1044-3894.179
- Shen, L., Yang, L., Zhang, J., & Zhang, M. (2018). Benefits of expressive writing in reducing test anxiety: A randomized controlled trial in Chinese samples. PLoS One, 13(2), Article e0191779. https://doi.org/10.1371/journal.pone.0191779
- Esmaeilpour, K., Golizadeh, S., Mirghafourvand, M., Mohammad-Alizadeh-Charandabi, S., & Montazeri, M. (2020). The effect of writing therapy on anxiety in pregnant women: A randomized controlled trial. Iranian Journal of Psychiatry and Behavioral Sciences, 14(2). https://doi.org/10.5812/ijpbs.98256
- Baum, E. S., & Rude, S. S. (2013). Acceptance-enhanced expressive writing prevents symptoms in participants with low initial depression. Cognitive Therapy and Research, 37. 35-42. https://doi.org/10.1007/s10608-012-9435-x
- Camisasca, E., Caravita, S. C. S., Di Blasio, P., Ionio, C., Milani, L., & Valtolina, G. G. (2015). The effects of expressive writing on postpartum depression and posttraumatic stress symptoms. Psychological Reports, 117(3), 856–882. https://doi.org/10.2466/02.13.PR0.117c29z3
- Kristjanson, L. J., Loh, R., Nikoletti, S., O’Connor, M., & Willcock, B. (2004). Writing therapy for the bereaved: Evaluation of an intervention. Journal of Palliative Medicine, 6(2), 195–204. https://doi.org/10.1089/109662103764978443
- Thatcher, C. (2021). Whys and what ifs: Writing and anxiety reduction in individuals bereaved by addiction. Journal of Creativity in Mental Health. https://doi.org/ 10.1080/15401383.2021.1924097
- Kersting, A., Kroker, K., Schlicht, S., & Wagner, B. (2011). Internet-based treatment after pregnancy loss: concept and case study. Journal of Psychosomatic Obstetrics and Gynaecology, 32(2), 72–78. http://doi.org/10.3109/0167482X.2011.553974
- Wright, J. (2002). Online counselling: Learning from writing therapy. British Journal of Guidance & Counselling, 30(3), 285–298. https://doi.org/10.1080/030698802100002326
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Gestalt Therapy and The Path to Wholeness
Bibliotherapy: Process, Benefits, Effectiveness
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The Feelings Book Journal
By lynda madison.
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By corinne sweet.
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By pema chödrön, related organizations.
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