Writing therapy

Writing thehas been conducted in the US, especially in recent years. The earliest and most important work was directed by James W. Pennebaker, a psychology professor who became deeply interested in the physical and mental benefits of self disclosure. The basic writing paradigm, as introduced by Pennebaker and now widely employed in expressive writing experiments, involves participants writing about traumatic or emotional experiences for 3–5 sessions, often over consecutive days, for 15–20 minutes per session. Typical writing instructions include:

For the next 4 days, I would like you to write your very deepest thoughts and feelings about the most traumatic experience of your entire life or an extremely important emotional issue that has affected you and your life. In your writing, I’d like you to really let go and explore your deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends or relatives; to your past, your present or your future; or to who you have been, who you would like to be or who you are now. You may write about the same general issues or experiences on all days of writing or about different topics each day. All of your writing will be completely confidential.

Don’t worry about spelling, grammar or sentence structure. The only rule is that once you begin writing, you continue until the time is up.

Although many report being upset by the writing experience, they also find it valuable and meaningful. Control participants are asked to write as objectively and factually as possible about neutral topics (i.e. a particular room or their plans for the day), without revealing their emotions or opinions.

In Pennebaker's original experiments, a group of students were asked to write about their own traumatic experiences for 20 minutes, on three consecutive days. Serving as a control group were an equal number of students asked to write about trivial matters. The results showed that, firstly, the amount of undisclosed trauma in the life of the average American student was surprisingly high. Secondly, there was a marked difference between the two groups in terms of the impact of the writing exercise. In those who had written of trivial matters, there was no change either in their physical or mental health. In contrast, those who had written about traumatic experiences showed a marked strengthening of their immune system, decreased visits to the doctor and significant increases in psychological well-being. These findings were measured using physiological markers (long term serum measures, antibody levels, cell activity, enzyme levels, muscular activity, etc.), behavioural markers and self-report (distress, depression, etc.).

Reception and criticism of Pennebaker's theories

Pennebaker's experiments, begun over twenty years ago, have been widely replicated and validated. Following on from Pennebaker's original work, there has been a renewed interest in the therapeutic value of abreaction. This was first discussed by Josef Breuer and Freud in Studies on Hysteria but not much explored since. At the heart of Pennebaker’s theory is the idea that actively inhibiting thoughts and feelings about traumatic events requires effort, serves as a cumulative stressor on the body, and is associated with increased physiological activity, obsessive thinking or ruminating about the event, and longer-term disease. However, as Baikie and Wilhelm note, the theory has intuitive appeal but mixed empirical support:

Studies have shown that expressive writing results in significant improvements in various biochemical markers of physical and immune functioning (Pennebaker et al, 1988; Esterling et al, 1994; Petrie et al, 1995; Booth et al, 1997). This suggests that written disclosure may reduce the physiological stress on the body caused by inhibition, although it does not necessarily mean that disinhibition is the causal mechanism underlying these biological effects. On the other hand, participants writing about previously undisclosed traumas showed no differences in health outcomes from those writing about previously disclosed traumas (Greenberg & Stone, 1992) and participants writing about imaginary traumas that they had not actually experienced, and therefore could not have inhibited, also demonstrated significant improvements in physical health (Greenberg et al, 1996). Therefore, although inhibition may play a part, the observed benefits of writing are not entirely due to reductions in inhibition.

Other theories related to writing therapy

An additional line of enquiry, which has particular bearing on the difference between talking and writing, derives from Robert Ornstein's studies into the bicameral structure of the brain. While noting that what follows should be considered "wildly hypothetical", L'Abate, quoting Ornstein, postulates that:

One could argue (...) that talk and writing differ in relative cerebral dominance. (...) if language is more related to the right hemisphere, then writing may be more related to the left hemisphere. If this is the case, then writing might use or even stimulate parts of the brain that are not stimulated by talking.

The role of the distance therapies

With the accessibility provided by the Internet, the reach of the 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.

This requires the services of a counsellor 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.

Writing therapy via the Internet

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). 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 "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. With e-therapy, space is eliminated and time expanded. Overall it considerably reduces the amount of therapeutic input, as well as the speed and pressure that therapists habitually have to work under.

Ironically, 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.

Journaling

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. Moreover, as Kathleen Adams notes, 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". As one person describes it: "Quite what happens when near-obsessive ruminations, which frequently take place in the small hours of the night, are committed to paper is difficult to describe. It does feel as if the trap door of a mental treadmill has been opened to allow persecutory thoughts to escape. Though the accompanying feelings may persist for a time, the thoughts begin to integrate or dissipate or reach some constructive resolution."

Poetry

Pulitzer Prize for Poetry finalist Bruce Weigl, a veteran of the Vietnam War, has discussed the therapeutic benefits of writing, especially when combined with other forms of therapy, for people coming to terms with traumatic experiences such as war. According to Weigl, "What it helps you do is externalize things, give a shape to it. And that’s what Denise Levertov kept telling me is that, Look, you control it now. It doesn’t control you anymore. You own it now."

See also

• Reflective writing
• Self-Concealment
• Self-disclosure

References

• Baikie, Karen A. and Wilhelm, Kay. "Emotional and physical health benefits of expressive writing." Advances in Psychiatric Treatment 11 (2005): 338-346.
• Field, Nathan. "The Therapeutic Action of Writing in Self-Disclosure and Self-Expression".
• Graybeal, A., Sexton, J.D. & Pennebaker, J.W. "The Role of Story-Making in Disclosure Writing: The Psychometrics of Narrative ".
• Harwood, T. Mark and L'Abate, Luciano. "Distance Writing: Helping without Seeing Participants." Self-Help in Mental Health: A Critical Review. London: Springer, 2010.
• L'Abate, Luciano. Distance Writing and Computer-Assisted Interventions in Psychiatry and Mental Health. Westport: Ablex Publishing, 2001.
• Pennebaker, James W. "Writing About Emotional Experiences as a Therapeutic Process". Psychological Science 8.3 (May 1997): 162-166.

External links

• Structured Journal Template based web application for structured journaling focused on achieving specific goals.