Writing therapy

Writing therapy is a form of expressive therapy that uses the act of writing and processing the written word as therapy. Writing therapy posits that writing one's feelings gradually eases pain and strengthens the immune system. Writing therapeutically can take place individually or in a group and it can be administered in person with a therapist or remotely through mailing or the Internet.

The field of writing therapy includes many practitioners in a variety of settings. The therapy is usually administered by a therapist or counsellor. Several interventions exist on-line, writing group leaders work in hospitals with patients dealing with their mental and physical illnesses and in university departments aiding student self-awareness and self-development. When administered at a distance it is useful for those who prefer to remain personally anonymous and are not ready to disclose their most private thoughts and anxieties in a face to face situation.

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

Research into the therapeutic action of writing
By far the greater part of the research into writing therapy has been conducted in the US, especially in recent years. The earliest and most important work was directed by James Pennebaker, a psychology professor who became deeply interested in the physical and mental benefits of self disclosure.

In Pennebaker’s original experiments one group of his students was directed to write for 20 minutes on three consecutive days on the worst traumas of their lives, while an equal number was  asked to write of trivial matters. Firstly, the amount of undisclosed trauma in the life of the average American student was surprisingly high. And secondly, there was a marked difference between these two groups of students. In those who had written of trivial matters there was no change either in their physical or mental health whereas those who had done these brief trauma-recall exercises showed a marked strengthening of their immune system, decreased visits to the doctor and significant   increases in pychological 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).

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.

An additional line of enquiry that has particular bearing on the difference between talking and writing derives from Robert Ornstein’s studies (The Right Mind:1997)  into the bicameral structure of the brain. L’Abate postulates that:

''‘One could argue, for instance, 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.’'' (L’Abate: 2004)

The role of the Distance Therapies
With the accessibility provided by the Internet the reach of the writing therapies has grown beyond all recognition. It has become possible for a client and therapist anywhere in the world to work together, 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’.

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; that is, messages are passed between therapist and client within an agreed time frame, say 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 etherapy 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 practised form of self-help through writing is that of keeping a personal journal (as distinct from a diary of weekly 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. 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.