Therapeutic Writing Workshops: Exploring the Benefits

A group of people sit around a large table set in a well-lit, comfortable room. Everyone is writing about a difficult experience or a health or emotional problem that has been bothering them for some time. They have been working together for several hours or perhaps a day or two. Alternatively, they are in their fourth or fifth week of an ongoing program. The group leader is a personable, organised individual, a writer and a therapist who has carefully led the group through several exercises designed to limber their ‘writing muscles’. She, or he, has just asked the group to write about a significant, perhaps distressing, certainly life changing incident.

‘Don’t worry about spelling, grammar or punctuation,’ the guide says. ‘If you wish to, you can deal with those things later. Let’s just see what emerges as you write. If you find this distressing, stop and let me know. We can sit together and talk through what’s happening.’ The facilitator motions towards a corner of the room where two easy chairs are arranged. Several group members have had occasion, during other writing sessions, to talk with the guide, but by now they trust themselves, their guide and the other participants. If tears fall as they write, they trust them too; tears are a relief and a benediction. After fifty minutes, the facilitator asks the writers to stop, stretch, silently read what they have written and then write a brief reflection about the piece. After another ten minutes the group breaks for refreshments. People discuss what happened as they wrote; some are astonished with what they have produced and everyone is eager to hear the stories and share their own. The facilitator has checked that everyone is comfortable with editing their work and when the break is over they return to the table and begin to craft and refashion their stories.

Workshops like these have been held for several decades but can they be compared, in terms of whether or not therapeutic writing is a useful therapeutic tool, to the carefully controlled and measured writing sessions Pennebaker designed back in the 1980s? Does personal experience measure up alongside scientifically valid trials? What can we learn from comparing the two kinds of writing?

Sophie Nicholls writes that it is possible to transcend cathartic writing, and James Pennebaker’s ‘expressive writing’, by developing a critical approach to one’s therapeutic writing. I think Nicholls echoes and extends Pennebaker’s idea of ‘constructing the narrative’, but does so from a writer’s perspective. She suggests, and I agree with her, that we begin by writing about our bodies, our inner self, our feelings and our experiences, and then edit, craft and redraft our work. When the ‘raw material’ generated through confessional and cathartic writing is turned into a story, the therapeutic writer avoids becoming fixated on a single emotional response and can develop an objective and flexible understanding of their situation. But to do this, therapeutic writers need emotional support and clear writing guidelines.

There are several excellent books that declare their writing activities and exercises are successful but, for the most part, the hard data about the benefit of these exercises is scarce. I think we need to address this problem by moving back and forth between the quantitative and qualitative research methods I discussed in my second post. We need to test what kinds of writing exercises help a writer develop a coherent piece of therapeutic writing and why that exercise worked. It is time research into therapeutic writing examined the part narrative elements (plot, character, dialogue, setting, theme, voice, symbol and metaphor) might play in improving the effectiveness of therapeutic writing.

Reflective writing is also a crucial part of therapeutic writing. When Pauline Cooper divided a therapeutic writing workshop into two groups, one led by a ‘non-therapist facilitator’, the other by a therapist, she made an interesting discovery. The first group were given a warm-up writing activity and then a writing exercise; they were encouraged, but not expected, to share and discuss their writing and provide feedback to other members. They were not instructed to edit their work although they were not stopped from doing so. During their series of workshops, this group’s attention wandered, and they were less amenable to the experience. They also wanted more guidance from the facilitator. Cooper believes they experienced ‘non-engagement with exploring emotion [and this] increased the repetition of harmful narratives.’

The second group were given structured writing activities that included editing their work and reflecting on what they wrote before and after a writing session. They were also asked to share their thoughts with the group and provide feedback. The members of this group developed the ability to deal with their past because, Cooper believes, sharing their work and reflecting on their discoveries helped them find different ways to address their problems.

Therapeutic writing remains an imprecisely understood therapy but rather than contrast or compare Pennebaker’s statistical research with hands-on workshops, perhaps we should see both as part of a continuum. Research verifies many writers’ instincts; writing is healing. Thousands of workshops support the findings and make it possible for people who have never picked up a pen to write and, as a result, feel better about themselves and their lives.

Do you have any personal experiences, or feelings, about therapeutic writing workshops? If you are struggling with a life-changing experience would you try a therapeutic writing workshop? Do you believe polishing, editing and sharing your work would help or hinder you?

References (Please note that this is a partial list only.)

Gillie Bolton, Write Yourself: Creative Writing and Personal Development (London: Jessica Kingsley Publishers, 2011)

Gillie Bolton, The Writer’s Key: Introducing Creative Solutions for Life (London: Jessica Kingsley Publishers, 2014)

Gillie Bolton, Victoria Field, and Kate Thompson, Writing Works: A Resource Handbook for Therapeutic Writing Workshops and Activities (London: Jessica Kingsley Publishers, 2006)

Gillie Bolton, Victoria Field, and Kate Thompson, Writing Routes: A Resource Handbook of Therapeutic Writing (London: Jessica Kingsley, 2011)

Sophie Nicholls, ‘Beyond Expressive Writing: Evolving Models of Development in Creative Writing’, Journal of Health Psychology (2009), 14.2, 171-180 (p. 172-174).

Jeannie K. Wright, Writing Cures: An Introductory Handbook of Writing in Counselling and Psychotherapy (Hove, East Sussex: Brunner-Routledge, 2004).

Links (Again, this list is partial as I am currently working on building a set of  links to various sites. If you do nothing else, see Rita Charon’s moving talk on the power of Narrative Medicine.)

Celia Hunt

Centre for Journal Therapy

Cumbria Partnership NHS Foundation Trust

Durham University Centre for Medical Humanities

Health Story Collaborative

Lapidus

Metanoia Institute 

Pauline Cooper (The paper I referred to can be found here)

Rita Charon on Narrative Medicine

Susannah Sheffer

Words for Wellbeing

Therapeutic Writing: The Power of Constructing a Story.

As I mentioned in my last post, James Pennebaker was one of the first to research (and confirm) the positive benefits of therapeutic writing. He has written or edited ten books and authored or co-authored over 250 articles on the subject. It is little wonder he is considered to be the founding father of the field, although in recent years his research had shifted to analysing the power words have on people and politics.

Pennebaker’s initial work tested the value of ‘expressive writing’. He started by asking participants to:

  • Write every day for four days about an upsetting experience, major conflict or other stressors. Participants could write about the same issue every day or focus on a different situation
  • Explore, through writing, the feelings and thoughts that emerged about the situation
  • Explore, in the writing, how the experience was connected to their past, present and future identity.

Along with the benefits of therapeutic writing Pennebaker discovered that difficult feelings emerged, either during the writing process or shortly after the writing session. He believes this is similar to the experience of ‘seeing a sad movie’ and should diminish after a few hours. If the distress continues, the writer should stop writing and seek immediate support.

The writing activity Pennebaker set for his participants was ‘free writing’, or what I called in my second post ‘raw material’, unedited emotional writing that has, for the most part, informed decades of research into therapeutic writing. It should be noted, however, that Pennebaker did not discourage working on and editing the written material although he did not promote it.

While there may be several problems associated with Pennebaker’s research methodology, I want to mention just two:

  • A large number of participants in his early research were young, healthy university students who volunteered to take part in the study
  • The written expression expected of the participants may have been too brief to yield conclusive, long term results into the usefulness of expressive writing.

Both concerns have been addressed by numerous studies and, in clinical terms, therapeutic writing is now an accepted, multifaceted treatment where an individual takes part in either an ongoing period of regular writing, and discusses it with a therapist, or a group writing session. Both individual and group writing sessions demand specific skills on the part of the therapist or counsellor. This ‘writer/counsellor’ needs to know how to help the therapeutic writer with the creative process of writing and to work through the initial trauma or reason for therapeutic support.

The Writing Cure is a book of essays acknowledging Pennebaker’s contribution to therapeutic writing and examining more than two decades of research into it. Jeffrey Berman‘s review of The Writing Cure laments the lack of input from the arts and humanities on therapeutic writing. Because I am interested in the therapeutic benefits of creative, sustained and edited writing needed to produce and prepare a short story or poem, I agree with Berman. The psychological underpinnings and positive benefits of therapeutic writing need to be considered but the effect of reading, rewriting, editing, proofreading, and above all, sharing creative work should also be studied. Perhaps the arts and humanities need to join with psychology and science and discover what happens when a writer sits down and writes?

I am among the several million humans who have, over the years, needed to consult a therapist or counsellor. When a member of my family married overseas I had counselling to discuss my fear of flying so I could travel to the wedding. I have never, however, been treated by a counsellor who used therapeutic writing as a healing tool. I used my journal for that. When I returned to university and started writing short stories I started to feel more confident and more capable than I had in years. Yes, I enjoyed being a student again, meeting new people and learning new skills, but submitting assignments on time and juggling study, work and family was stressful, so why was I feeling so good? Was it because I was turning personal material from my journal into third-person-narrated-stories and sharing them with my classmates? This question drove my PhD research, so imagine my excitement when I read this comment from Pennebaker:

Movement toward the development of a narrative is far more predictive of health than having a coherent story per se. The construction of a story, rather than having a constructed story, then, may be the desired endpoint of writing …

What did he mean? Was my experience typical? Why is the process of narration more helpful than a pre-formed and rehearsed story about an incident? Could creating a narrative while writing about disturbing experiences help change behaviour?  Could others benefit from this information?

Collecting statistics so you can understand how an essentially creative pursuit like writing is therapeutic, is like catching rain drops during a storm. I understand the need for objective, primary data but can we assume there is a ‘universal truth’ that fits all cases? How do we deal with bias in designing the research question and interpreting the results? What about differences in the writers’ backgrounds, education and resources? When and where does the writing occur? What about the context of the writing experience? Is cathartic free writing the only way to write our way into well-being?

By 2008 I had my Creative Arts degree and had enrolled in a PhD in Creative Writing. I wanted to research therapeutic writing that goes beyond ‘raw material’. I did not have the skills or resources to conduct quantitative research so I decided to take Pennebaker’s work into account but explore the potential of writing for therapy using the elements of story: character, plot, dialogue, setting, theme, point of view and narrative voice. It turned out there were other people exploring this form of therapeutic writing and I will discuss them in the next post.

References

Pennebaker, James W., and Janel D. Seagal. ‘Forming a story: The health benefits of narrative’, Journal of clinical psychology, 55.10 (1999): 1243-1254 and Graybeal, Anna, Janel D. Sexton, and James W. Pennebaker. ‘The role of story-making in disclosure writing: The psychometrics of narrative’, Psychology and Health 17.5 (2002): 571-581.

How can research help us understand therapeutic writing?

Once upon a time, only people like Aristotle, William Shakespeare and Graham Greene knew that writing is therapeutic. ‘Give sorrow words.’ Shakespeare told us, ‘The grief that does not speak/Whispers the o’er fraught heart, and bids it break.’ Centuries later Greene added that, ‘Writing is a form of therapy; sometimes I wonder how all those who do not write, compose, or paint can manage to escape the madness, melancholia, the panic and fear which is inherent in a human situation.’ But how do we know therapeutic writing can help us feel better about ourselves and our world?

James Pennebaker and Sandra Klihr Beall are the heroes of this story. In 1986 they realised that not talking about personal problems or trauma added to the stress caused by the trauma. They wondered if writing, instead of talking, about the situation would help, so they measured the effect writing about a problem had on a person’s mental and physical well-being. The results confirmed that ‘expressive writing’ helped alleviate the stress caused by trauma. Pennebaker and Beall’s initial studies were repeated and in the late 90s and the early years of this century independent researchers combined the results of all known research into therapeutic writing. These studies (known as meta-analyses) corroborated nearly three decades of research; writing about one’s troubles can soothe the hurt. Pennebaker and Beall were the first to prove what Aristotle, Shakespeare, Greene, and many others, knew instinctively.

While Pennebaker continued his research, writing groups designed to help people deal with trauma (or to support personal growth), were developed. Many of the facilitators were trained counsellors, some were writers interested in writing as therapy and all wanted to support people interested in writing as a healing tool.

This is where things get interesting. The two methods of investigating and practising therapeutic writing are fundamentally different. On one hand, pragmatic, quantitative trials measure the effect therapeutic writing has on large numbers of people, and allow researchers to draw reasonable conclusions about the reliability of therapeutic writing as a healing tool. These trials can be repeated and a range of variables can be controlled. On the other hand, therapeutic writing programs focus on writing techniques and an individual’s experience of telling their story. Workshops rarely produce hard numerical evidence and most researchers are nervous about things like creativity and imagination, variables with the potential to skew or influence the results of an investigation.

Do we have to choose between workshops that support writers striving to portray Greene’s madness, melancholia, panic and fear, and randomised, scientifically constructed trials? Don’t both methods prove writing is a form of healing? Is it time to change our focus and do more research into why therapeutic writing is helpful?

I believe the power of story can help us understand why therapeutic writing works. Stories are everywhere. Many blog posts relate stories of loss and suffering, resistance and hope. Novels, television dramas and comedies, movies, plays and even successful advertising campaigns are all stories. We are immersed in story; we create meaning through story; we create relationships through story. The next time you meet a friend for coffee you will probably tell each other stories about what has happened since you last met. Brian Boyd believes stories are an evolutionary necessity, part of an ancient need to ‘understand ourselves, to think—emotionally, imaginatively, reflectively—about human behaviour.’

If therapeutic writing is another form of story making then maybe it works because it helps us to:

  • Organise distressing events into a coherent, lucid narrative,
  • Share how we overcame adversity, or imagine how we can overcome it,
  • Reflect on how we dealt with our problems (or how we can deal with them better),
  • Understand how a challenging situation changed us,
  • Understand and reclaim our inner world, and
  • Understand the meaning of human suffering.

Writing therapy is ‘story therapy’. Writing our stories empowers us, particularly if they contain symbols, heightened language, metaphors, interesting characters, dialogue and plot. Stories can be a balm for the troubled soul; they make even irretrievable loss bearable. Researchers like Pennebaker, Beall and others handed therapeutic writers a potent weapon for personal and universal change. When we write our stories, we honour the work of these pioneers.

Do you think therapeutic writing can help us feel better about ourselves and our world? Why do you think it works? I look forward to reading your comments.

Those of you who have started following this blog (thank you) will have noticed I post new material at the beginning of the week. Next week’s post will provide more detail about Pennebaker’s research, and the following week I’ll discuss qualitative research into therapeutic writing.

Reflection and Metaphor

For a long time I was the only person who read what I wrote. I was in my late thirties when I shared one of my poems with a friend, in my 50s when I bestirred myself and enrolled in a Creative Writing degree and was obliged to share my work with fourteen classmates. Despite writing since I was eighteen, earning a PhD and writing dozens of short stories and scores of poems, I have only entered my work in a few undergraduate competitions. The few modest prizes I won felt like aberrations; it was as if someone was playing with me, opening the door a crack and then shutting it again.

And now, out of the blue, I am blogging and potentially sharing my writing with thousands of strangers. It feels imprudent; it feels outrageous. Why, after all this time, after hiding from readers and telling people I wasn’t really a writer, am I suddenly craving readers?

All writers experience doubt but I turned my doubts into proof; I converted my suspicions into evidence; I wasn’t writing, just dabbling. If you are a writer you will probably understand that feeling, but I took my reluctance to publish to an extreme level.

I wrote in my first post that I did not want my research into therapeutic writing to languish but there is a deeper reason for starting a blog; I finally want my writing read. I want readers. One would satisfy me, two would be better, and if there were more …?

I recently attempted to describe this feeling to my partner. ‘My decision to start a blog is one of the most significant I have ever made,’ I said. But is that true? What about the life changing decision to return to university at 52; to leave my marriage; and, years later, buy a house with my current partner? Surely blogging isn’t as important as these decisions?

I’ve read what other writers say about publishing: it’s like walking naked into a room full of strangers (if you have seen Birdman you’ll understand the feeling); it’s bearing your soul; it’s pure hell. But I have written and submitted a PhD, which means I’ve been through the butt naked and soul baring fires of hell experience and survived. Why does starting a blog feel so different?

I suspect it’s because I am kicking a long-term habit. I am conquering an addiction; I am so used to keeping my work to myself, to writing for myself, to holding on to my art, I don’t know how to do anything else. Like all addicts I have been selfish, stingy and disagreeable. I haven’t allowed myself to risk criticism, and I’ve missed innumerable chances to learn and to share insights that might be valuable to others.

In The Courage to Create, Rollo May wrote,

If you do not express your own original ideas, if you do not listen to your own being, you will have betrayed yourself. Also, you will have betrayed your community in failing to make your contribution.

In other words, potential reader, dear reader, I have let you down.

Why am I sharing this? It is because I want to explore what it feels like to finally send my writing out into the world, I want to reflect on that statement, to mull over what it means to commit myself to my reader(s). I want to explain reflective writing by demonstrating it, by examining my fears, my assumptions and my prejudices about the experience of starting a blog.

To use an Australian metaphor, I feel like a wallaby caught in the headlights. I am mesmerised by those beams, frozen but desperate to flee, blinded and with no idea whether those behind the light are friend or foe. If foe, there is a gun pointing at my head and I’ll be dead before I hear the gun shot. If friend, I have to trust they will dim the lights so I can see and approach them. It’s a terrifying image (and, sadly, one played out nightly in outback Australia) but it is the kind of metaphor reflective writing, a painstaking contemplation of experience, is meant to conjure. Whether or not my wallaby-in-the-headlights image pays off depends, on one hand, on the readers standing behind the headlights. On the other hand, it symbolises, for me, what sharing my writing feels like. It is an image of the vulnerability all writers, all artists, must learn to live with.

When we reflect on an experience we are curious and critical about what happened, and what we did. We analyse our behaviour, examine our assumptions, think about how to incorporate what we have learned, and what we might do differently as a result. Research indicates that reflecting on, and articulating our insights about, what we have learned leads to deeper awareness and enhances the learning experience. Reflection also makes us responsible for our learning. Articulating my fears by using an image of the wallaby has eased my discomfort, while evoking, for my reader, what I experience when my finger hovers over the ‘publish’ button.

Having to learn a new skill is not easy and writing a blog is a completely different skill to writing a private journal, undergrad essay or a PhD. Fortunately, I love exploring new ideas and discovering different ways to perceive the world. Starting a blog satisfies my need for knowledge. I have learned more than I imagined I would. A reader, therefore, is not strictly required although it would be awfully nice to know the headlights I stand in are not a sign of my imminent demise as a writer, but will help light my path.

Therapeutic Writing: Names in the Sand

Twenty years ago, just as my children were blossoming into adolescence, we spent Christmas camping at Moana beach about an hour’s drive from where we lived. While the children played board games or French cricket, I slowly wound down from the year, reading novels my friends recommended six months earlier. In the mornings, instead of our usual cereal or toast, we ate bacon and eggs cooked on a small gas stove. We spent our days swimming in surf perfect for children accustomed to gentle swells but not yet ready for bulkier surf or a stronger rip. In the evenings we walked along the shore, talking about the day and watching the sun slide beyond the horizon. One evening I used a piece of driftwood to write my name in the wet sand, as close to the water as possible and within reach of the incoming tide. Each of the children wrote their name near mine and we stood together, holding hands and waiting. Within minutes the tide nibbled at our bare brown toes then swept across our names and carried them off. ‘No matter where you travel,’ I said, ‘when you grow up and leave home, you’ll be recognised. The sea will transport your names to every shore on the planet; you have been introduced to the world.’

I sometimes wonder if therapeutic writing, particularly if it remains private, is as ephemeral as writing our names in wet sand, but what do I mean by the term therapeutic writing?

I define therapeutic writing, (also known as expressive writing, writing to heal and developmental creative writing), as writing that soothes emotional or mental disquiet, boosts self-confidence, fosters a more flexible sense of self,[i] and facilitates personal self- development.[ii] Therapeutic writing has been extensively researched and there are numerous books and websites about the topic. My local writing centre recently ran a workshop about it and Lapidus, in the UK,  runs programs and training sessions for therapeutic writing practitioners, as does The National Association for Poetry Therapy in the USA. In Western Australia, Edith Cowan University offers topics on writing therapy and a double major in Psychology and Writing. The medical and nursing profession use reflective and therapeutic writing to help understand the needs of their patients and themselves. Therapeutic writing can be a short story, poem, personal journal entry, unsent letter, list, Facebook post, tweet or blog. Writing that describes one’s fear of flying (something I struggle with), writing that reduces worry, anxiety or depression, writing that inspires hope and resilience, is therapeutic writing.

I am writer, not a psychologist or therapist, but human psychology fascinates me. I understand talking about trauma is better than staying silent. This may be one of the reasons that writing, or ‘talking on paper’, alleviates emotional, mental and even physical health conditions caused by stress and trauma. The benefits of therapeutic writing, particularly in cases of trauma, depend on the individual, their problem, the type of therapeutic writing practised and the facilitator or counsellor who conducts a writing session. It is possible to follow guidelines from books or websites but because writing about trauma can reactivate, albeit for a short period, the initial distress, anyone who has experienced a major trauma needs to consult a trained professional who will provide expert, objective support. Despite decades of research into therapeutic writing, it is a relatively new therapeutic tool and, in certain circumstances, is best used in conjunction with other forms of counselling. Nor will therapeutic writing help everyone; people who experience psychotic episodes should not use it.

A lot of therapeutic writing is what I call ‘raw material’, cathartic, unstructured, often ungrammatical pieces drawn from the depths of the unconscious. There is nothing wrong with this. Naming what ails us in a raw, unedited form is powerful; naming and sharing what ails us in deliberately crafted, publishable work is an act of formidable agency. This is because writing  develops the five senses, exercises our imagination, and cultivates symbolism and metaphor. I believe the benefits of therapeutic writing are intensified when we use the elements of narrative: voice, setting, plot, character, dialogue and theme. Thinking about, or reflecting on, the experience of writing, and how we use different narrative elements, has the potential to deepen and expand our understanding of why therapeutic writing works.

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In a way, cathartic writing is like etching one’s name in the soft, crumbling sand that lies far from the shoreline where it is unlikely to be swept into the vast ocean of published writing.  When we write our name in wet sand we risk the waves; we proclaim, not simply name, our intent to survive what ails us. Yes, keeping what we write to ourselves is healing, but  crafting, reflecting on and disseminating a piece of therapeutic writing enhances its therapeutic benefits and has the potential to change how others behave. Maybe it is time researchers looked into crafted, edited writing as a source of healing.

The first step, however, is to understand what therapeutic writing is so we can choose how to apply it to our individual needs.  I’m interested in what you choose; are you comfortable with the idea of sharing therapeutic writing or do you want it to remain private? Do you have a piece of raw material in your drawer that you could reshape, edit and polish? If you published your therapeutic writing, if you wrote your name in the sand and offered it to the tide, what might happen?

REFERENCES

[i] Fiona Sampson, ‘Writing as Therapy’, in The Handbook of Creative Writing, ed. by Stephen Earnshaw (Edinburgh: Edinburgh University Press, 2007), pp. 312-319 (p. 312).[i]

[ii] Sophie Nicholls, ‘Beyond Expressive Writing: Evolving Models of Development in Creative Writing’, Journal of Health Psychology (2009), 14.2, 171-180 (p. 172).