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Writing therapy

Writing therapy[1][2] is a form of expressive therapy that uses the act of writing and processing the written word in clinical interventions for healing and personal growth.[3] Writing therapy posits that writing one's feelings gradually eases feelings of emotional trauma;[4] studies have found this therapy primarily beneficial for alleviating stress caused by previously undisclosed adverse events and for those suffering from medical conditions associated with the immune system.[5] Writing therapeutically can take place individually or in a group and can be administered in person with a therapist or remotely through mailing or the Internet.[6]

The field of writing therapy includes many practitioners in a variety of settings, usually administered by a therapist or counselor. Writing group leaders also work in hospitals with patients dealing with mental and physical illnesses. In university departments, they aid student self-awareness and self-development. Online and distance interventions are useful for those who prefer to remain anonymous and/or are not ready to disclose their most private thoughts and anxieties in a face-to-face situation.[7]


As with most forms of therapy, writing therapy is adapted and used to work with a wide range of psychoneurotic issues, including bereavement, desertion and abuse.[8] Many interventions take the form of classes where clients write on specific themes chosen by the therapist or counselor. Assignments may include writing unsent letters to selected individuals, alive or dead, followed by imagined replies from the recipient, or a dialogue with the recovering alcoholic's bottle of alcohol.

Research[edit]

Expressive writing paradigm[edit]

Expressive writing is a form of writing therapy developed primarily by James W. Pennebaker in the late 1980s. The seminal expressive writing study instructed participants in the experimental group to write about a 'past trauma', expressing their very deepest thoughts and feelings surrounding it.[9][10]In contrast, control participants were asked to write as objectively and factually as possible about neutral topics (e.g., a particular room or their plans for the day) without revealing their emotions or opinions. Both groups wrote continuously for 15 minutes per day for 4 consecutive days. If participants felt they could not write any more details, they were instructed to return to the beginning, potentially repeating what they wrote or writing it in a different manner.[11]


The following text provides an example of writing instructions for expressive writing:

Role of distance therapies[edit]

With the accessibility provided by the Internet, the reach of writing therapies has increased considerably, as clients and therapists can work together from anywhere in the world, provided they can write the same language. They simply "enter" into a private "chat room" and engage in an ongoing text dialogue in "real-time". Participants can also receive therapy sessions via e-text and/or voice with video, and complete online questionnaires, handouts, workout sheets, and similar exercises.[41]


This requires the services of a counselor or therapist, albeit sitting at a computer. Given the huge disjunction between the amount of mental illness compared with the paucity of skilled resources, new ways have been sought to provide therapy other than drugs. In the more advanced societies pressure for cost-effective treatments, supported by evidence-based results, has come from both insurance companies and government agencies. Hence the decline in long-term intensive psychoanalysis and the rise of much briefer forms, such as cognitive therapy.

Via the Internet[edit]

Currently, the most widely used mode of Internet writing therapy is via e-mail (see analytic psychotherapist Nathan Field's paper "The Therapeutic Action of Writing in Self-Disclosure and Self-Expression").[42] It is asynchronous; i.e. messages are passed between therapist and client within an agreed time frame (for instance, one week), but at any time within that week. Where both parties remain anonymous the client benefits from the online disinhibition effect; that is to say, feels freer to disclose memories, thoughts, and feelings that they might withhold in a face-to-face situation. Both client and therapist have time for reflecting on the past and recapturing forgotten memories, time for privately processing their reactions and giving thought to their own responses.[43] With e-therapy, space is eliminated, and time is expanded. Overall, it considerably reduces the amount of therapeutic input, as well as the speed and pressure that therapists habitually have to work under.


The anonymity and invisibility provides a therapeutic environment that comes much closer than classical analysis to Freud's ideal of the "analytic blank screen". Sitting behind the patient on the couch still leaves room for a multitude of clues to the analyst's individuality; e-therapy provides almost none. Whether distance and reciprocal anonymity reduces or increases the level of transference has yet to be investigated.


In a 2016 randomized controlled trial, expressive writing was tested against direction to an online support group for individuals with anxiety and depression. No difference between the groups was found. Both groups showed a moderate improvement over time but of a magnitude comparable to what one would expect to see over the time period concerned without intervention.[44]

Self-concealment

Self-disclosure

Reflective writing

The oldest and most widely practiced form of self-help through writing is that of keeping a personal journal or diary—as distinct from a diary or calendar of daily appointments—in which the writer records their most meaningful thoughts and feelings. One individual benefit is that the act of writing puts a powerful brake on the torment of endlessly repeating troubled thoughts to which everyone is prone. Kathleen Adams states that through the act of journal writing, the writer is also able to "literally [read] his or her own mind" and thus "to perceive experiences more clearly and thus feels a relief of tension".[45]

Poetry[edit]

Poetry has been a very powerful form of writing for many and there are beneficial factors that correspond with writing and reading poetry. Alicia Ostriker explains how personal experience and memories, whether traumatic or repressed, can be tackled by the person through the artistic ability of writing and facing these emotions that have been neglected in order to release and ease a writer's pain.[46] Robert Baden elaborates how poetry allows a wide range of emotions to be portrayed to describe the feeling or what the writer had felt within their experience to later allow others to engage and relate to their work.[47] Baden expands this concept with the idea that no emotion is too grand or too small for poetry, which allows others to engage with the healing experience. Baden also points out that for there to be an act of healing and release between the emotions that have been held within the conscience, the writer must recognize that there must be a strong enough need to be vulnerable and willing to be able to confront these emotions and trust that the audience will then be able to relate and potentially make others want to use this written release within their own lives.[47] Vasiliki Antzoulis believes that writers should be vulnerable because ignorance should never be the course of action when experiencing all kinds of emotions. Without the ability to talk about what the writer is experiencing, it becomes more difficult to understand what each of these emotions represents and how they affect the writer's current views of life.[48]


Dale M. Bauer provides insight that poetry has the power to allow people to be able to talk about inner suffering without judgment and rather gain the ability to have others be able to compare and connect with the writer's experience. Bauer goes on to say that these experiences, no matter if they are good or bad, correspond with the human experience. Being able to have others relate to them allows the writer to feel supported and reflect on what has been shared and what they have obtained with this release and be able to begin healing.[49] Veteran Writer, Liam Corley, healed significantly from his trauma through the means of poetry. By sharing this method with fellow veterans and examining its positive impacts, Corley’s research indicates the concise nature and inherent significance of poetry works greatly for self-healing. This is because poetry fulfills the crucial need for self-expression and assists in providing a voice to those who have felt silenced.[50] James W. Pennebaker has discovered that "writing about trauma allows writers to externalize an event, thereby detaching themselves from the experience" (Writing to Heal 98). Pennebaker argues that once the writer can free themselves from what has been weighing them down, they are then able to begin healing and decide whether they are going to learn from the experience, or if it is something that has been long overdue for a release. Benjamin Batzer recognized that only the writer knows what they have gone through, so the first steps into healing and coping with what life has given, we must first be able to talk about these experiences to take back the power and decide the next point of action.[51]

Medical humanities

Graphic medicine

Narrative criticism

Storytelling

Narration

Slow medicine

Health humanities

Reflective writing