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Writing Can Help Us Heal from Trauma

• Deborah Siegel-Acevedo

Three prompts to get started.

Why does a writing intervention work? While it may seem counterintuitive that writing about negative experiences has a positive effect, some have posited that narrating the story of a past negative event or an ongoing anxiety “frees up” cognitive resources. Research suggests that trauma damages brain tissue, but that when people translate their emotional experience into words, they may be changing the way it is organized in the brain. This matters, both personally and professionally. In a moment still permeated with epic stress and loss, we need to call in all possible supports. So, what does this look like in practice, and how can you put this powerful tool into effect? The author offers three practices, with prompts, to get you started.

Even as we inoculate our bodies and seemingly move out of the pandemic, psychologically we are still moving through it. We owe it to ourselves — and our coworkers — to make space for processing this individual and collective trauma. A recent op-ed in the New York Times Sunday Review affirms what I, as a writer and professor of writing, have witnessed repeatedly, up close: expressive writing can heal us.

• Deborah Siegel-Acevedo is an author , TEDx speaker, and founder of Bold Voice Collaborative , an organization fostering growth, resilience, and community through storytelling for individuals and organizations. An adjunct faculty member at DePaul University’s College of Communication, her writing has appeared in venues including The Washington Post, The Guardian, and CNN.com.

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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.

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Ultimate Guide to Creative Writing Therapy (with Writing Therapy Prompts)

March 22, 2023

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Creative writing therapy, or therapeutic writing is a form of therapeutic intervention that uses writing as the tool to explore and express your thoughts, feelings and emotions. It’s also known as journal therapy – and it’s essentially the art of writing in a journal to heal yourself. 

Writing therapy can be a useful tool for people who struggle with mental health, have experienced trauma or grief, or are simply looking for a creative outlet to process their thoughts and feelings. Today we’re going to explore what creative writing therapy is, how it works, and the potential benefits of writing therapy. We’ll also share writing therapy prompts to help you get started and explore writing therapy today. 

Please keep in mind that there is no true substitute for seeing a licensed therapist, and if you feel like you could benefit from talking to someone and getting help with what you’re going through – you’re not alone! There are tons of incredible therapists out there to help you. Here at Made with Lemons we’re big advocates for therapy and if you’d like a more inside scoop to our own journey with therapy, join On Your Terms . It’s a wellness newsletter that shares a more inside look to our own wellness journey as well as tools to help you along yours. Learn more about On Your Terms here.

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What is Creative Writing Therapy?

Writing therapy, also known as therapeutic writing, is a form of creative and expressive therapy that involves writing about your personal experiences, thoughts and feelings. It can take many forms, including journaling, poetry, creative writing, letter writing, or memoirs. Writing therapy can be done individually or in a group setting. It can also be facilitated by a therapist, counselor or writing coach.

The purpose of creative writing therapy is to help you express and process your emotions in a safe and supportive environment. It’s helpful to be able to write out your thoughts and feelings that might be hard to articulate in other ways. 

You might also see therapeutic writing used to help explore issues that are difficult to discuss in traditionally talking therapy sessions. And when your therapist invites you to try writing therapy, it’s also used in conjunction with other forms of therapy, such as trauma-focused therapy, to enhance its effectiveness. 

An example of creative writing therapy could be writing a letter to a person who hurt you, and then shredding or burning the letter to release some of the hurt and anger. 

How Does Therapeutic Writing Work?

Writing therapy works by allowing individuals to express their thoughts and feelings in a way that is both private and creative. The act of writing can help you organize your thoughts and gain clarity on your emotions. Writing can also be a way to release pent-up emotions and relieve stress. 

For example, if you’re feeling stressed after a long day of work, taking a few moments to write down what’s stressing you out and allowing yourself to let it go, can help you have a calm and more relaxing evening. 

Writing therapy should be a truly non judgemental space. It’s a time to write without worrying about grammar, punctuation, or spelling. The goal here is to let words flow freely, without judgment or criticism. Creative writing therapy sessions can be structured or unstructured, and sometimes it’s helpful to use prompts or exercises to help you get started. (i.e. what in your life is bringing you the most anxiety, or writing a letter to your friend to express ___________ hurt you when they said that.)

Oftentimes we find it easier to write about our hurt, our pain and the experiences that caused that, as opposed to opening up to talk about those things. In this way, writing can be a way to explore and process complex emotions such as grief or anger in a safe and supportive environment, where no one can get hurt further by what’s being felt and expressed. 

Potential Benefits of Writing Therapy

Now let’s talk about some of the benefits of therapeutic writing. 

Improved mental health

Writing therapy can be a tool that helps you manage symptoms of depression, anxiety and other mental health conditions. You can use journaling therapy to express and process difficult emotions, which over time can lead to improved mental regulation and a better sense of control over your thoughts and feelings. 

Increased self-awareness

Creative writing therapy can help you gain a better insight into your thoughts and behaviors. By reflecting on your experiences through writing, you can start to identify patterns and gain an understanding of yourself. 

Stress relief

Therapeutic writing can be a way to relieve stress and reduce anxiety. Writing is often cathartic, allowing you to release pent-up emotions and start to feel relief from things that would otherwise feel overwhelming. 

Improved communication skills

Journal therapy can also help you improve your overall communication skills. When you practice expressing yourself through writing, you can develop more confidence to communicate more effectively in both your personal and professional relationships. In essence, writing your feelings can help you communicate them better when needed. 

Increased creativity

Lastly, creative writing therapy can also be a way to tap into your creativity and imagination. We talk a lot about your inner child around here, and journal therapy can be another helpful way you can interact with your inner child. Through writing you can explore new ideas and perspectives, leading to your own personal growth.

How to try Creative Writing Therapy Today

Now let’s talk about how you can try therapeutic writing for yourself today. These tips are going to help you get started with writing therapy from home, as a personal activity to help heal yourself. 

Set aside dedicated time for writing therapy

Like most self improvement and self care techniques, it helps to set aside a dedicated time to write regularly. We know this can be a challenging task, especially if you’re struggling with mental health issues or challenges in your life. A good place to start is to set aside a few minutes each evening to write and decompress from your day. It can be just 2 minutes before bed. Remember, therapeutic writing is a non judgemental activity, so the amount of time you dedicate isn’t important, it’s just important to show up for yourself. 

Find a quiet and comfortable space

Find a place that’s quiet and comfortable, and where you can write without interruptions. Some people find it helpful to create a writing ritual, such as lighting a candle or playing soft music to create a sense of calm and focus. Find what works for you, in a space where you can be alone for a few minutes. 

Choose a writing therapy prompt or topic

At the end of this guide we’re going to share writing therapy prompts to help you explore creative writing therapy and give you a starting point. You can also talk to your therapist to get prompts, or find some online. Prompts can be general, such as “write about what makes  you grateful or happy”, while others can be more specific, such as “write about a time that you felt overwhelmed.”

Write freely and without judgment

The most important thing about writing therapy is to write freely, without judging yourself. Allow yourself to write without worrying about grammar, punctuation or spelling. Don’t put a time limit on your writing, or feel like you have to write a certain number of words or pages. The goal here is to allow your thoughts and emotions to flow freely without any judgment at all. 

Write honestly and openly

Along with being judgment free, it’s also so important that you write honestly and openly. Writing therapy is a space for honesty and openness. This space is created for you to share your thoughts and emotions, even if they're difficult or uncomfortable to confront. Just be open to exploring them, and remember that you don’t have to share this with anyone, so it’s a space where you can be fully honest with yourself. 

Reflect on your writing

After writing, you can take a few moments to reflect on what you have written. It might even be helpful to come back to what you have written at another time, when you have a clear head or have left the emotions behind. This can help you consider the emotions and patterns that you have expressed. Doing this reflection can help you gain more insight into your thinking patterns and emotions for future sessions. 

Consider sharing your writing with a therapist or counselor

Lastly, consider sharing your writing with a therapist or counselor. They can help you process emotions and gain a deeper understanding of yourself. Sharing your writing can also help you feel less alone in your struggles and provide important validation for your experiences. 

20 Writing Therapy Prompts

• When do I feel the most like myself?
• How do I feel at this moment?
• What do I need more of in my life?
• What do I look forward to every day?
• What is a lesson that I had to learn recently?
• Based on my daily routine, where do I see myself in 5 years?
• What don’t I regret?
• What would make me happy right now?
• What has been the hardest thing to forgive myself for?
• What’s bothering me? And why?
• What do I love about myself?
• What are my priorities right now?
• What does my ideal day look like?
• What does my ideal morning look like? Evening?
• Make a list of 30 things that make you smile
• Make a gratitude list
• The words I’d like to live by are…
• I really wish others knew this about me…
• What always brings tears to my eyes?
• What do I need to get off my chest today?

Creative writing therapy can be a powerful tool for exploring and processing thoughts and emotions. When you set aside a dedicated time to write, and create a safe and supportive space for yourself, you can gain insight into your emotions and develop better tools to manage them. With practice and commitment, writing therapy can become a habit for your self care routine. 

If you’d like to build the habit of writing therapy in your own life, then we’d like to invite you to download our habit tracker. It’s super easy to use, beautifully designed and completely free. All you need is a google account to access it. Grab a copy of our habit tracker here.

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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

Bereavement

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/10.1037/0022-3514.67.6.1079
• 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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• National Coalition of Creative Arts Therapies Associations, Inc.​​ (NCCATA)

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• Mar 11, 2019

Creative Writing Prompts for Mental Health

Updated: Mar 12, 2019

There is plenty of great research proving that journaling and creative writing can improve mental, and even physical health. Writing is a powerful tool that can be used for so many things; making sense of difficult situations, identifying and understanding big emotions, easing loneliness, cultivating meaning, improving self-esteem, learning to forgive...the list goes on!

However, all writers can attest to the anxiety that a blank page can induce. It's a lot of pressure to sit down and figure out how to write something that improves your mental health. If you're not sure where to begin, skim through the following prompts and write to the prompt that speaks to you the mos

Personify your anxiety, panic, depression, or addiction. Give it a name, a voice, a physical form-human or otherwise. When your symptoms are at their worst, what is this being saying to you? What do you want to say back? (For some reason, my anxiety is an insidious green version of Mad Magazine's Spy vs. Spy pictured below. His name is Jeff).

Ten years from now, in a perfect world, who are you and what are you doing with your life?

What positive things are you doing in your life right now that you never get thanked for? How would things change if you started being appreciated for those actions?

Do you have ghosts?

Write about a time you meant to go one place, but ended up somewhere else.

Spend some time thinking about who your alter-ego might be. How does this person look/act/dress? What pieces of yourself does your alter-ego express?

Are there cycles or seasons to your life that you haven't thought about before? How do you know you are in one of these cycles/seasons?

What is terrifying?

What is awe-inspiring?

What are you f---ing mad about?

Here, at the tail end of winter in Denver and Summit County, many of us need a little boost in mood and energy to get us through to those warmer, sunnier summer months. Writing can be a great addition to your self-care practice, which is especially important during the darker, colder times of year.

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“Writing by Prescription”: Creative Writing as Therapy and Personal Development

• Open Access
• First Online: 16 December 2020

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• Leni Van Goidsenhoven 5 &
• Anneleen Masschelein 6  

Part of the book series: New Directions in Book History ((NDBH))

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This chapter investigates how-to books on creative “life writing” for therapy, transformative learning, and personal development, in short, therapeutic writing. This subgenre of writing advice is situated in two different domains with psychology and pedagogy on the one hand, and life writing and creative writing on the other hand. After a brief overview of the history of therapeutic writing, we focus on Jessica Kingsley Publishers (JKP), a leading international niche publisher in the field of neurological and cognitive differences. JKP offers a combination of popular-science books, memoirs, and self-help publications, as well as a series of how-to books on writing for therapy or personal development. By this specific grouping of genres and formats, JKP turns its readers into writers and also guides the process of writing by setting out standards for narratives about neurological illness and disability, both in content and form. Combining both textual and contextual analysis, we examine the advice oeuvres of three JKP authors, Gillie Bolton, Kate Thompson, and Celia Hunt, to see how they relate to the therapeutic and self-help ethos as well as to more literary forms of creative writing, and how they negotiate the ideas of becoming a writer through craft, therapy, and self-expression.

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The poetics of vulnerability: creative writing among young adults in treatment for psychosis in light of Ricoeur’s and Kristeva’s philosophy of language and subjectivity

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Mysteries of Creative Process: Explorations at Work and in Daily Life

• Therapeutic writing
• Life writing
• Literary advice
• Therapeutic culture
• Gillie Bolton, Celia Hunt
• Kate Thompson
• Jessica Kingsley Publishers

Introduction

In The Author is Not Dead (2008), Micheline Wandor extensively cites Gillie Bolton’s writing advice for starting authors, a six-minute freewriting exercise, as an example for what creative writing should not be:

For most creative writing teachers, the tone and content of the above is probably not at all problematic. However, this does not come from a CW textbook. It is taken from a patient’s leaflet in a GP surgery, used to help with ‘anxious’ or ‘depressed’ patients. In that context, it may be couched in the most productive way. But the fact that it is indistinguishable from CW advice, should give us all pause. This extract leads into the heart of CW methodology, which is suspended in an uncomfortable contradiction in the Romantic/therapy axis. (Wandor 2008 , pp. 118–119)

In the eyes of Wandor, and of poet and creative writing scholar Nancy Kuhl, good creative writing is about language and craft, rather than about self-expression. While this may be a legitimate therapeutic aim, it is detrimental for the field of creative writing. Creative writing for therapeutic reasons (hereafter “therapeutic writing” or TW) indiscriminately praises all creative efforts, leading to uncritical, unproductive, and overly self-referential writing. Contrary to Wandor and Kuhl, we consider TW handbooks as a subgenre of the contemporary CW handbooks selections which caters to a “niche” of illness and disability narrative writing, which is increasingly becoming part of the field of memoir writing (Couser 2012 , p. 12). At the same time, we will argue that TW handbooks can potentially reach a surprisingly broad and diverse audience of patients, aspiring writers, counselors, creative writing teachers, and qualitative researchers experimenting with new methods of “writing as inquiry” (Richardson and St. Pierre 2005 ). In the twenty-first century, in the wake of the so-called memoir boom, therapeutic writing has left the therapy room and entered the commercial sphere, as a relatively large and stable market for illness and disability narratives has developed (Rak 2013 ). While Kuhl deplores that the “connection between creativity and psychotherapy is relativist and deeply marketplace oriented” (Kuhl 2005 , p. 10), we seek to draw attention not only to the long history and diversity of TW, but also to the possibilities that it can entail.

In the present chapter, we will focus on three of the most important advice oeuvres in this field. Gillie Bolton has published widely on how every person, especially medical professionals and their patients, can benefit from expressive and exploratory writing. Kate Thompson explicitly focuses on journal writing as a therapeutic tool, and Celia Hunt is the founder of a postgraduate program in creative writing and personal development at the University of Sussex. All three authors have been published by Jessica Kingsley Publishers (JKP), a leading international publisher of professional, academic, and self-help books in the field of neurological and cognitive differences. Combining both textual and contextual analysis, we will investigate how the how-to books relate to the therapeutic and self-help ethos as well as to more literary forms of creative writing, and how they negotiate the ideas of becoming a writer, craft, therapy, and self-expression. We will argue that therapeutic writing advice serves as a formal and ideological framework which allows, guides, and also “coaxes” subjects to talk and think about the self, illness, and disability in a particular way (Van Goidsenhoven and Masschelein 2017 , p. 4). While this can be regarded as constraining, the institutional context of JKP also consistently encourages writers to become authors, and thus, against the explicit advice of its handbook authors, to make their personal writings public.

Therapeutic Writing: A Longstanding History and a Heterogeneous Field

The link between writing and health can be traced back to Antiquity, with Apollo as the god of both poetry and medicine, and with practices such as the Laments of Ancient Greece (Sijakovic 2011 ), and the supplication of the Ancient Egyptian through letter writing to the gods to heal diseases. (Williamson and Wright 2018 ). In his essay “Self Writing,” Michel Foucault shows how writing (and reading) in Greco-Roman culture was associated with meditation and how it functioned as a technique of caring for the self and of sustaining “the art of living” (Foucault 1997 , pp. 208–209). 1 Today, the popularity of creative writing as therapy and as a transformative healing purposes is associated with a society immersed in a culture of self-help, confession, and emotionalism, in which the therapeutic discourse has become a major code to express, shape, and guide self-hood (Illouz 2008 , p. 6; Gilmore 2001 ; McGee   2005 ).

In the past four decades, there has been an explosion of interest in the history and practice of creative writing for therapeutic, transformative, and healing purposes, not only from counselors, clinicians, academics, and writers, but also from researchers, who have examined its psychological, social, and emotional benefits. Thus, TW has become an academic, therapeutic, and creative field in its own right, albeit a heterogeneous one. Even those involved, as Anni Raw et al. argue, conceptualize, perceive, and interpret the practice in many different ways (Raw et al. 2012 , p. 97). 2 As a result, the terminology used to refer to therapeutic writing practices ranges from “creative (life) writing for therapeutic purposes,” to “therapeutic creative writing,” “personal expressive and explorative writing,” “expressive writing,” “programmed writing,” “controlled writing,” and so on. Likewise, the definitions may highlight different aspects: transformational and health outcomes, self-expression, or the dichotomy between creativity and craft. Therapeutic writing involves a variety of professions, sites, approaches, and goals. Workshops can be organized as one-to-one sessions, or as groups, led by a writing facilitator who can also be a professional author, a creative writing teacher, as well as a clinician, a health practitioner such as a nurse, a social worker, or therapist. TW can be embedded within another therapeutic trajectory, or it can serve as a therapy on its own. It can take place anywhere according to the maxim that “you only need pen and paper,” and the structure and principles can be adapted to specific groups: prisoners, refugees, children, psychiatric patients, etc. The approaches of TW workshops range from using narrative and psychodynamic models of counseling, to more informal and intuitive styles of practice. Participants are referred to as patients, clients, or service users. Some methods focus on writing by people with mental illnesses (e.g., depression, anxiety, schizophrenia), or somatic illnesses (e.g., asthma, rheumatoid arthritis, immunity), prioritizing either social or aesthetic outcomes, or a combination of the two. Finally, different genres can be chosen for the writing itself, such as journal writing, autobiography, poetry, song lyrics, drama, and letter writing.

Considering this diversity, it is not surprising that academic research on therapeutic writing is found in various disciplines, especially in journals devoted to the intersection between arts and health, journals focused on different forms of therapy, and journals on life writing. Broadly speaking, there are two approaches of the phenomenon: On the one hand exists the quantitative approach of experimental psychologists, who have conducted randomized controlled trials of the effectiveness of TW as a therapeutic tool while on the other hand, within more qualitative-oriented research found in educational studies (and more recently in literary and cultural studies), scholars develop a more holistic view of self-development and creativity. 3

Programmed Versus Non-restrictive Writing

A pioneer of the first type of approach is social psychologist James Pennebaker, who, along with colleagues, experimented with what they call “expressive writing” in relation to psychical and emotional health. In order to measure the effects of expressive writing, the participants’ blood pressure readings, heart rates, and self-reports of mood and physical symptoms are gathered before and after each writing session. Many variations of the Pennebaker procedure have been developed since. 4 The majority of these research projects and therapeutic set-ups work with short writing tasks that are restrictive and highly standardized, hence the term “programmed writing” (L’Abate 2004 ; Smyth 1998 ). The many attempts to systematically prove the effect of therapeutic writing and the preoccupation for quantitative outcomes are likely to go hand in hand with an effort to prove to the effectiveness of art to funding agencies or to more broadly promote its usefulness for society (Swinnen 2016 , p. 1379; Williamson and Wright 2018 ). After years of developing and conducting randomized controlled trials, internationally and across different populations, there seems to be evidence that therapeutic writing produces beneficial effects for patients, although it is not (yet?) clear why this is the case (Hustvedt 2016 , p. 101).

In contrast to the experimental paradigm and its “programmed writing,” a more qualitative approach focuses on so-called non-restrictive writing. The psychological discourse, with its emphasis on empirical evidence and concrete terminology, here gives way to a more humanist and ambiguous vocabulary, using words as such as “soul” (Chavis 2011 , p. 12), “inner picture” (Thompson 2011 , p. 41), “intuition” (Bolton 1999 , p. 35), and phrases like “a page full of tears” (ibid., p. 174), “speaking from the heart” (Moss 2012 , p. 247), and “the art of freefall” (Turner-Vesselago 2013 , p. 37). The research and workshops mostly stem from the idea that the aim of creativity is expression of the self. 5 The rationale follows that writing opens up a “window to the soul” and to the “personal truths” of the sufferer (in this case the person in need of therapy), as Bolton claims: “Writing offers a powerful avenue towards finding out what one thinks, feels, knows, understands, remembers” (Bolton et al. 2006 , p. 3).

Authors in this paradigm favor variable and eclectic writing experiments, indicated as a “multi-faceted” practice (Sampson 2004 , p. 17) or a “multidimensional jigsaw” (Bolton 2011 , p. 9). Workshops are explicitly client-centered and based upon a meaningful relation between client and facilitator, paying attention to imagination and creativity (Bolton, Hunt), to artistic merit in terms of the specific qualities of writing as an act and process (Sampson), and in some cases also to craft (Freely, Hustvedt). Underlying the different approaches, however, is the emphasis on the therapeutic effects of these workshops and on mental and physical well-being they afford. Whereas the experimental approach addresses an academic or specialist audience, the qualitative approaches draw broader audiences of both academics and practitioners, facilitators as well as writers. For this reason, TW advice authors commonly evolve from creating more specialist books (in terms of content) to more popular works such as handbooks. This evolution can be viewed in light of two tendencies: the professionalization of TW, and the pervasiveness of therapeutic culture.

Since the 1980s, in the Anglo-American world TW has been institutionalized by two professional organizations: The National Association for Poetry Therapy (NAPT) in the USA, and The Association for Literary Arts in Personal Development (Lapidus) in the UK. These organizations offer training programs for candidates who boast a double background in psychology (or counseling) and in literature, developing standards, guidelines, and set research agendas. Lapidus is part of the Arts Council policy on literature provision in England, and the academic Journal of Poetry Therapy , edited by Nicholas Mazza, serves as the official mouthpiece of the NAPT. In the twenty-first century, TW as a discipline entered many academic programs in both Medical Humanities 6 and in Narrative Medicine. 7

TW handbooks also fit in with what many studies have described as the “triumph” of therapeutic discourse, usually based on a psychoanalytic understanding of self and society, in the twentieth century. 8 Psychology is not just a body of knowledge produced by formal organizations and experts, and its vocabulary has widely entered into social and cultural life via multiple institutional arenas and mass media. In Saving the Modern Soul, Eva Illouz analyzes the intersections of therapy, self-help, and autobiographical discourse (Illouz 2008 , pp. 7–8). She argues that the combination of popular psychology and the cultural industries has led to the mass-production of objects, like TW handbooks. This has led to the widespread distribution of therapeutic discourse, which has shaped a new qualitative language and interpretative framework to think the self and others (ibid., p. 155). 9 In Illouz’s view, therapeutic culture is a “structure of feeling,” an inchoate, pre-ideological mental structure that is expressed in cultural objects (ibid., p. 156). The problem, according to Illouz, is that the discourse of therapeutic self-help is fundamentally sustained by a “narrative of suffering” (ibid., p. 173). Moreover, it resorts to standardized vocabulary and narrative structures which render it “highly compatible with the cultural industry because narrative pegs can be easily changed […] to renewable consumption of ‘narratives’ and ‘narrative fashions’” (ibid., p. 147).

In her study of self-help literature, Micki McGee ( 2005 ) examines how self-help, one of the most commercial forms of therapeutic discourse, is driven both by an optimistic faith in the perfectibility and capacity for continual improvement of the individual, and by a vicious circularity inherent in the very labels it creates and perpetuates. Therapeutic self-help books are presented as necessary guides to attain the intended realizations of the self, or of the desired achievements possible. While providing a (limited) comfort and improvement for the individual reader, they in fact set in motion a never-ending cycle of “work on the self,” in which suffering and victimhood come to define the self (McGee 2005 , p. 142). In what follows, we seek to draw attention to another type of cycle which may arise from the pervasiveness of therapeutic discourse, i.e., a cycle of consumption and activation, that ultimately allows new voices in the public domain and their (limited) forms of agency. In order to do this, we will take a closer look at the work of niche publisher Jessica Kingsley, that published the majority of TW handbook oeuvres in our corpus.

Jessica Kingsley Publishers: Turning Readers into Writers

Founded in 1987 with a bank loan of £5000, and with eight research books addressing an intended audience of social workers and practitioners, JKP has managed to achieve annual revenue growth for the past 30 years, and now publishes over 250 books a year. Because of their commercial success, they were able to open an office in Philadelphia (USA) in 2004, and have been collaborating with Footprint Books in Warriewood (Australia) as well. Jessica Kingsley herself retired in mid-2018, and sold the company to the multinational publishing house Hachette. Despite this change in management, the company policy remains focused on making specialized knowledge available for non-specialists, and the company still presents itself an independent niche publisher of “books that make a difference” (JKP homepage 2019 ). Although JKP is mainly known for its list on autism spectrum, the company now also plays a leading role in distributing books on neurological difference, healthcare, education, art therapies, social justice, counseling, palliative care, adoption, and parenting, with new areas including gender diversity and Chinese medicine. Across these topics, their catalog features accessible academic research alongside memoirs and handbooks, thus fostering an inclusive and non-hierarchical publishing policy.

Kingsley attributes the company’s commercial success to the combination of a focused and programmatic publishing list, her marketing background, and adherence to a clear policy. At the same time, she does not merely want to conform to the market, but rather their press seeks out new directions in order to counter psychiatric stigmas and negative associations with, for instance, neurological differences (Tivnan 2007 ). For the JKP team, it is key to keep in constant touch with several communities, and by maintaining a close relationship, JKP learns about, and integrates new debates and new voices. As Lisa Clark, editorial director at JKP, states: “Being close to communities and the subject helps with identifying emerging topics and to stay abreast of changing language used around the subject” (Headon 2019 ). This way of working contributes to the emancipatory baseline of JKP’s policy and is visible in their catalog which includes memoirs by people who are traditionally not associated with authorship, even though they report about their lives in narrative forms. In this way, experience transforms into expertise (Van Goidsenhoven and Masschelein 2017 , p. 7).

However, this emancipatory stance has its limits. Although JKP is a niche publisher, it is not an experimental house. Its goal is not only to give voice to authors/communities, but also to create a public, and to sell. This means that JKP is not only looking for existing communities, but also actively creates a community. Today it is common for publishers to invest in reading communities and the construction of a brand profile, but JKP’s efforts to build a community with a highly specific target group are striking. Readers are addressed through intimate issues articulated in a sentimental mode that nonetheless exceeds the personal, and fosters recognition and understanding. 10 What is at stake here, is a form of community where readers are invited to share their experiences in such a way that the line between reading and writing becomes profoundly blurred. On the JKP blog, for instance, author Vanessa Rogers shared her writing tips for aspiring (life writing) authors. The post was accompanied by the straightforward message that “if you’re feeling inspired feel free to send in your proposal to [email protected]” (Rogers 2013 ).

Another manner of blurring reading and writing is through the large portfolio of advice books about creative life writing and therapeutic writing that actively shape the kind of publications that JKP seeks. Finding language to discuss (or even reflect upon) neurological difference or painful events in life is generally difficult, as is writing down your life story. To lower this threshold, JKP offers advice through books about writing, both creative and therapeutic. Twenty-two writing handbooks, published between 1998 and 2016, covering genres like poetry, journal, autobiography, and creative fiction, are included in the Arts Therapies catalog, alongside books on Play Therapy, Drama therapy and Story making, Dance Therapy, Music Therapy, Art Therapy, Mental Health, and Trauma and Wellbeing, addressing professional as well as general audiences. 11 Some of the handbooks are part of a series edited by Gillie Bolton, “Writing for Therapy and Personal Development,” which is framed as “appropriate for therapeutic, healthcare, or creative writing practitioners and facilitators, and for individual writers or courses” (Bolton 2011 , back cover).

The Arts Therapies catalog is dominated by “quest narratives” and “triumph narratives” as the most popular plot structures in the context of illness and disability narratives. 12 The quest story is mostly interpreted as a story that addresses suffering directly, that urges readers to accept failure, illness, or disability, and to use them to their own advantage (Frank 1995 , p. 115). Importantly, the JKP catalog neither focuses on the medical side of the healing process, in which a physician plays the most important role, nor on so-called supercrips, a term for people with an illness or disability who “nonetheless” excel at something like sports or science. Instead, the quest narratives are used to emphasize the positive aspects of being different, to focus on coping strategies in order to overcome obstacles in the interaction between an individual and society, and to highlight the promise of attainable progress and improvement. These formats and storylines are reinforced by paratextual elements, such as the titles that frequently feature phrases like “my way through,” “transformation through,” “healing power of creative expression,” “writing routes,” “writing works,” and “creative solutions for life.” The book covers, glossy and colorful with soft-covers depicting flowers, hearts, upward-leading staircases, writing angels, notebooks, and pens, are strikingly similar to other popular CW handbooks. Their two most recent handbooks, which are more geared toward fiction, both depict drawings of old-fashioned typewriters with colorful letters flying out, suggesting that writing is not just something to do in order to feel better, but also for fun.

The publisher’s explicit foregrounding of formats like the quest and triumph narrative, both in content and in form, can be read as a negotiation with the marketplace, since these stories are more likely to become bestsellers than stories that connote stasis or chaos (Frank 1995 , p. 83). The repetition of formats creates uniformity, which, along with offering a standardized vocabulary for complex and diverse topics, are strategies commonly used by cultural intermediaries like publishers. JKP’s approach nonetheless stands out because it effectively opens up possibilities for new types of voices, who in their writings, to some degree, resist standardization (Van Goidsenhoven and Masschelein 2017 , pp. 15–16). The TW handbooks published by JKP mirror and highlight this ambivalence, and they diverge from other popular CW handbooks in that they are more focused on process than on product: The handbooks encourage subjects to write purely for themselves, not for publication, even though the context of JKP  implicitly upholds this as a possibility.

Three Therapeutic Writing Oeuvres: Gillie Bolton, Kate Thompson, and Celia Hunt

Gillie Bolton, a British consultant in therapeutic and reflective writing, works largely but not exclusively, in health care settings. She comes from a background of teaching creative writing, which she combines in her handbooks with pop-psychology and self-help, and has written eight books, five of which are advice books. All published with JKP (three monographs and two edited volumes), those advice books are currently the most popular handbooks in the field of TW, covering genres from journaling, poetry, prose, and autobiography. They are accessible, geared toward a wide audience, and aim to be both informative and practical.

Bolton’s first advice book ( 1999 ) mainly focuses on the connection between theory and practice, but it already contains exercises and practical information. The two following advice books, Writing Works (2006) and Writing Routes ( 2011 ), are co-edited with Victoria Field and Kate Thompson. They are framed as essential roadmaps, containing a huge amount of examples, among which more than seventy clients/patients who share their writings and experiences. Her two latest advice books, Write yourself (2011) and The Writer ’s Key (2014), are designed as traditional literary advice guides, written in a hands-on and directive style wherein the reader/writer is always openly addressed and every chapter ends with Write! , “a menu of suggestions and strategies” to start writing (Bolton 2014 , p. 15). The directive tone is also visible in the text design and typography. Bolton uses, for instance, many lists describing what one must do and capitals letters in order to stress rules or techniques. 13 In all her handbooks, she explicitly states that the book chapters can be read and used in any order, depending on the reader/writer’s needs. All books contain appendices in which the exercises are arranged by genre (e.g., unsent letters, AlphaPoems, Diary), by client group (e.g., cancer patients, children, or the elderly), and by theme (e.g., childhood, illness, color).

At the same time, Bolton’s exercises are also organized in a “developmental way” (Bolton 2014 , p. 15), offering several foundational exercises which are important to begin with writing. One of Bolton’s most popular foundational exercises is, for instance, a CW-based exercise called the “Six Minute Write” (Bolton 2011 , p. 33), a sort of free (intuitive) writing to overcome beginner’s blocks. While Bolton’s main focus is on creating exercises for writing workshops with therapeutic goals, the handbooks also pay attention to writing as “a way of life” (Bolton et al. 2006 , p. 230). Entire passages are devoted to the act of choosing the best place to write or even the ideal notebook or pen: “Writing materials are significant. Different equipment is likely to create different writings with very different impacts” (Bolton 2014 , p. 41). Important for Bolton is that this way of life is attainable for everyone, since everyone can write: “If you trust yourself you cannot write the wrong thing” (Bolton 1999 , p. 11). This is in line with the democratic idea of self-help, a discourse which pervades Bolton’s advice books, for instance, through the use of certain metaphors such as “the key to unlock […] the secrets” and to “open the door” to your “life solutions” (Bolton 2014 , p. 17), or finding the key to help the writer to return “to the relationship with the self in a direct and immediate way” (Bolton et al. 2006 , p. 27). Also typical for the self-help discourse is the circular quest of continual improvement and reflection. Working on the self is presented as an endless process which “goes round and round in circles – excitingly and dramatically” (Bolton 1999 , p. 87). After all, “we keep on facing life changes” (Bolton 2011 , p. 8), and “when life becomes difficult […] the wisest person to turn to is often oneself” (Bolton 2014 , p. 17). Accordingly, the writing facilitator is like a “midwife” or a “helper-on-the-way” (Bolton et al. 2006 , p. 14). who “support(s). the writers in their own personal explorations and expressions” (Bolton 1999 , p. 128).

Together with Bolton and Field, Kate Thompson is the co-editor of Writing Routes and Writing Works . Unlike Bolton, she does not come from a creative writing background, but is a psychotherapist and certified journal therapist, whose main work is clinical private practice (both online and face-to-face counseling) and supervision of other therapists. Therapeutic Journal Writing: An Introduction for Professionals (2011) is her single-authored handbook in which she develops journal writing as a therapeutic tool. Contrary to Bolton’s advice, the book only focuses on journal writing as a genre, based on a protocol trademarked by Thompson.

The first chapters of Therapeutic Journal Writing offer the theoretical background, history, and key concepts of therapeutic journal writing. 14 Once the basics are covered, the focus shifts toward the techniques and protocol, each technique being elaborated in great detail in a separate chapter, illustrated with cases and ending with a “journal prompt” to get the reader started. The techniques are presented in a progressive way from structured to freer techniques, a principle Thompson borrows from Kathleen Adams’s The Way of the Journal ( 1998 ). 15 The reason for this progressive structure is to offer enough encouragement for less-experienced practitioners and more vulnerable clients. 16 Once the entire protocol has been followed, a personal structured repertoire consisting of several techniques can be assembled and used according to the writers’ own judgments as to what methods are appropriate for different times and for different reasons.

While Thompson consistently uses the word “technique,” and emphasizes the importance of formats and structured exercises, journaling, for her, is also an undeniable creative and personal act (Thompson 2011 , p. 15). This allows her to connect the protocol of expressive writing and the open strategy of handbooks, which further advocate writing as lifestyle, symbolized by the appropriate writing implements (ibid., pp. 41, 43). She encourages her readers to personalize the exercises, and reassures them that “you cannot write the wrong thing” (ibid., p. 53). In typical self-help style, the personal dimension of writing is related to her own experiences: “At each stage of my professional journey I have used therapeutic journal writing […] with myself to monitor my own process both in my professional practice and in my life” (ibid., p. 14). In an article on JKP’s blog that offers some advice on writing for yourself and with a group, Thompson also elaborates on her personal experiences:

My own journey from childhood diary writing in the 1960s to journal therapist in the 21 st century has indeed been an almost lifelong process. This journey continues today, propelling me into the modern work of blogs and internet therapy. (Thompson 2012 )

The integration of personal experience enlivens the protocol, but it also clearly frames journal writing as a technology for monitoring the self in terms of continual improvement (change, healing, growth) and a never-ending cycle of work on the self (from childhood until the present), which can even have benefits for someone’s professional career.

JKP’s third handbook author to be discussed, Celia Hunt, is Emeritus Reader in Continuing Education (Creative Writing) at the Centre for Community Engagement at University of Sussex Here, where she has set up the Certificate in Creative Writing as well as an MA program in Creative Writing and Personal Development with an associated research program in 1996. Hunt was also a founding member and first Chair of Lapidus. At the end of the twentieth century, Hunt published two TW advice books with JKP: The Self on the Page: Theory and Practice of Creative Writing in Personal Development (1998, with Fiona Sampson) and Therapeutic Dimensions of Autobiography in Creative Writing (2000). The former is an edited volume with a triple focus of providing an overview of different TW practices, on the application between theory and practice, and on possible exploration frameworks. The second book is based on Hunt’s doctoral dissertation, and gives a account of her trajectory from a more creative writing context to a therapeutic one. This book starts with a description of her work with students enrolled in an academic Creative Writing and Personal Development course, which means that their writings were graded, and that the therapeutic benefit of writing was present “by chance rather than by design” (Hunt 2000 , p. 186), but it led her to connecting creative writing work with writing as a tool in self-therapy or psychotherapy.

Hunt is convinced that literary techniques can stimulate self-knowledge and therapeutic effects: “Fictionalizing from ourselves and finding a satisfactory form for our fictions helps us to engage more deeply with our inner life, opening up possibilities for greater insight and self-understanding” (Hunt and Sampson  1998 , p. 33). The link between creative writing and self-understanding is of course not new. Hunt consistently refers to seminal CW handbooks, like Peter Elbow’s Writing Without Teachers ( 1973 ) and Dorothea Brande’s Becoming a Writer (1981), which claim that writing appeals to one deepest self. If you want to become a writer, so Brande states, it is best to be a balanced person, and the inverse is true as well: when a writer encounters problems with writing, there will be primarily personal problems, rather than a deficit in equipment and technique (Brande 1981 , p. 33). While Brande and Elbow state that writers need to work on themselves in order to become writers, Hunt turns this around and argues that it is important to (learn to) write in order to achieve a healthy and balanced self.

Stylistically, Hunt’s advice books are dense, providing detailed descriptions of writing exercises, 17 alongside psychoanalytic explanations. Contrary to Bolton and Thompson, Hunt offers a theoretical model of therapeutic writing, based on a “Horneyan literary psychoanalytic approach,” which suggests that writing “throw(s) light on the present structure of the psyche through increasing intellectual understanding and emotional experiencing of the defenses in operation” (Hunt 2000 , p. 160). 18 This psychoanalytic background is linked to Hunt’s post-structuralist literary and narratological frameworks, signaled by narratological concepts like “implied author,” “showing,” and “telling,” and references to scholars like Roland Barthes, Norman Friedman, and Shlomith Rimmon-Kenan. This makes her books less accessible, but then again, accessibility is not her primary intention. In Hunt’s view, TW as practice is not suitable for everyone:

Writing of this kind would clearly not be appropriate for use with all patients or clients, as they would need to feel relatively at ease with the written word and preferably to have some familiarity with writing techniques. I would suggest that this approach might be particularly useful for writers who present with writer’s block, or for people who are accustomed to keeping a diary, or are more generally interested in the literary arts. (ibid., p. 181)

Unlike her fellow authors, Hunt’s focus is on enriching TW with insights from creative writing, literary theory, and psychoanalysis.

Our brief characterization of three important TW advice authors and their oeuvres provides insight into the diversity and eclecticism of TW as a field, even in a commercial context such as JKP. Authors connect different traditions and framework, ranging from psychoanalysis, psychology, literary theory, and self-help, to underpin their theory and methods. Despite their diversity, however, they share a strong focus on writing as a process, rather than as product. For Hunt, writing-as-art and writing-as-therapy are not mutually exclusive (Hunt 2000 , p. 185), but they are qualitatively different. Writing a story for therapeutic purposes is first and foremost done to gain more insight in one’s own feelings. It is only by reworking these first drafts, that communication with the writer within can be achieved. Writing to create a literary product is, therefore, a long and laborious work, which is not for everyone. Likewise, Bolton agrees that a text is a construction that must be worked upon in order to achieve a product capable of communicating effectively with the reader/listener (Bolton 2011 , p. 48). The process is what counts, Bolton states, because patients will not benefit from the idea that they are creating a form of art as soon as they pick up a pen. On the contrary, therapeutic writing is primarily a private practice (Bolton 1999 , p. 225; Thompson 2011 , p. 52).

Still, sharing therapeutic writing with a known, trusted, and intimate audience might have some benefits. A group anthology of shareable, redrafted writings, which can be given to family or friends, can provide a wonderful affirmation. Likewise, an informal reading to the rest of the patients and staff in a hospice day-unit, for instance, can be a heart-warming occasion as well. But Hunt, as well as Thompson and Bolton, are adamant that this is not the same as publishing these writings: “A sense that these booklets should reach a wider public, or that writings could be published nationally, is NOT useful for this kind of writing” (Bolton 1999 , p. 136). This brings us to the heart of the paradox that we outlined earlier: the fact that TW advice occupies such a prominent part of JKP’s catalog and community-building strategy nonetheless reinforces the idea that therapeutic writings are a legitimate genre after all. After all, in JKP’s vision, patients/readers can become authors and/or therapists, and can even achieve star status within this field, as the example of “autie-biographical” author Donna Williams, illustrated (see Van Goidsenhoven and Masschelein 2017 ).

Moreover, as Wandor pointed out in the quote at the beginning of this chapter, the popularity of TW has led to a curious reversal in which TW advice has become increasingly indistinguishable from CW. This is not only due to the low quality of CW handbooks, as Wandor suggests, but also to the rising prominence of autobiographical and non-fictional creative forms as legitimate points of entry into the literary field, wherein we see literary advice manuals closely following these new trends. 19 Unlike Wandor and Kuhl, we do not propose that this phenomenon is in itself is deplorable. If we do see a tendency toward uniformity and standardization in narrative patterns at the commercial end of the offer of illness narratives, we also observe that the genre itself is developing and diversifying, bringing new voices to the fore, which greatly diverge from the previous self-help discourse, in the direction of activism, crip theory, or more experimental forms of creative non-fiction, rooted not only in autobiographical forms of writing, but also in artistic and qualitative research practices. 20

For this reason, it is valuable to draw attention to other feedback loops, apart from those of the self-help discourse that has become to intertwined with therapeutic discourse: Relations between reading and writing, between writing and research, between different domains of writing as a strategy of inquiry, survival and emancipation, and the market. Therefore, as Illouz puts it, when looking at TW handbooks, it is important to momentarily suspend judgment, in order “to understand how they have come to be what they are and why, in being what they are, they accomplish things for people” (Illouz 2008 , p. 4).

“Self Writing” is part of a series of studies of “the arts of oneself,” or “the aesthetics of existence and the government of oneself and of others in Greco-Roman culture” (Foucault 1997 , p. 207). Foucault examines how hypomnemata (a kind of individual notebook serving memory aids) and correspondence (letter writing) helped subjects to deal with emotions (e.g., anger, envy, gossip, flatter) or to overcome difficult circumstance (e.g., grief, exile, ruin, disgrace) (ibid., pp. 209–210). In Foucault’s account, writing and drafting raw material helps the writer to shape her life.

Several scholars have voiced the need for a general conceptual framework to ground therapeutic writing (Nicolls 2009 ; Hunt and Sampson 1998 ; Sampson 2004 ). There are a few valuable attempts to give an overview of the research literature across disciplines (Wright and Chung 2001 ; Williamson and Wright 2018 ), and to unravel the plethora of different terms and interpretative frameworks (Clift et al. 2009 ; Cox et al. 2010 ; Raw et al. 2012 ).

In their overview of the field, Wright and Chung ( 2001 ) speak of a continuum between a “mastery” and a “mystery” approach. Swinnen ( 2016 ) also makes a distinction between two types of publications, where one type is more interested in psychology, methodology, and measuring impact, while the other type is more interested in experiences and creativity.

Smyth et al. ( 1999 ) directed a similar study, but with a focus on journal writing and physiological symptomatology. Ryle ( 2004 ) and Prasko et al. ( 2009 ) conducted studies about journal and letter writing in the context of Cognitive Analytic Therapy and Cognitive Behavioral Therapy.

Depending on the framework in which the concept is used, “creativity” can denote a product, process, or a skill. Often, authors differentiate between Creativity with a capital C, the exceptional achievements of artists, scientists, and “small c creativity,” i.e., psychological skills rooted in everyday activities. In the field of therapeutic writing, creativity is interpreted as part of psychological growth, and the effects of engaging in creative practices are understood as beneficial for one’s quality of life and well-being (Swinnen  2019 , pp. 1–2).

Medical Humanities focuses on what the arts and humanities can offer to health care and medicine, not only in terms of improving medical education, but also by offering insight into human experiences of illness, disability, and medical interventions (Bleakley 2015 , pp. 12-59, Evans 2002 ; Brody 2011 ). Through a range of creative, arts-based interventions, they aim to affirm personhood and redress the biomedical focus on deficit and loss.

Narrative Medicine, a term introduced by M. D. Rita Charon, is defined as “a clinical intervention based on a specific communicative competence a fundamental tool to acquire, comprehend and integrate the different points of view of all the participants having a role in the illness experience” (Fioretti et al. 2016 , p. 8). Narrative Medicine is mainly involved in re-orienting medical education. In order to improve the narrative skills of physicians, Narrative Medicine draws on methods such as close reading of literature and reflective writing, based on the assumption that literary competence can improve empathy (Charon 2001 , p. 1897).

See Moskowitz ( 2001 ), Furedi ( 2003 ), Madsen ( 2014 ) and Wright ( 2011 ). Wright ( 2011 ) and Eva Illouz ( 2008 ) try to avoid the overemphasis of the pernicious effects of therapeutic culture, in order to provide a more nuanced explanation of the triumph of therapeutic culture.

The therapeutic discourse and its objects (like TW handbooks) are imbued with the Western notion of “healing.” For a more nuanced, critical and vexed claim of “healing” in the context of illness and disability, we like to refer to Eli Clare’s Brilliant Imperfection: Grappling with Cure ( 2017 ), a “writing mosaic” (xv) in which he uses his own experiences, multibranched pattern of histories and ideas and critical analysis to explore the many meanings of “cure,” “healing” and “fixed bodyminds.”

This community-building based on intimate issues and sentimental rhetoric adds up to what Lauren Berlant in The Female Complaint has called “intimate publics” of readers/consumers, i.e., a sense of community “constituted by strangers who consume common texts and things” (Berlant 2008 , p. viii), in which they participate in diverse forms of suffering and fantasies of transcendence.

This is the online classification on the JKP website. The printed catalog of 2019 is slightly different in terms of categorization.

In fact, the entire JKP catalog is dominated by quest narratives, but in some sub-catalogs, like that of autism, the quest is supplemented by the triumph narrative. A triumph plot implies a happy ending and achieving an idea of “normality” (Couser 2001 , pp. 79–80).

Lists are made out of directive assignments as: “Choose a peaceful time with at least 20 minutes UNINTERPUTED, and ALONE” (Bolton 2014 , p. 33).

Thompson even refers to James Pennebaker’s work, an exponent of the experimental paradigm (Thompson 2011 , pp. 26–27).

Examples of structured (and thus safe and controlled) techniques are, for instance, prompts for overcoming the first blank page (e.g., answering question, completing sentences, making a dialogue with the notebook), making lists, drawing a mind map, making acrostics and alpha poems. Examples of freer techniques are journal dialogues (i.e., imagined dialogues with the journal itself, or with other people, an illness, or an object), unsent letters (writing a letter to someone or something), and changing perspective (rewriting the narrative from another viewpoint or character).

The latter group receives markedly more attention than in other advice books. Thompson mentions for instance “working with (people with) low levels of literacy,” or “working with people who are unable to write” (Thompson 2011 , pp. 192–193).

For instance: Overcoming the Block by Freewriting (Hunt 2000 , p. 20), The Words to Say it: Dramatizing Real Events using Dialogue (ibid., p. 29), and Melody of Two Voices: Creating a Fictional First-Person Narrative (ibid., p. 31).

The importance of Karen Horney’s psychoanalytic theory is motivated by an emphasis on the present, seeking to explain psychic phenomena in terms of their function within the present character structure, whereas classical Freudian theory is diachronic, explaining the present in terms of the past (Hunt 2000 , pp. 64, 159). Hunt’s later work (which is not published with JKP) focuses more on a bodily felt-sense approach, based on neurophysiological, psychodynamic, and cognitive models of the self (Hunt 2006 , 2010 ).

In McGurl’s chronology of the influence of creative writing on postwar American phase, the phase subsumed under the maxim “Find your own voice!” occurs more or less in the 1970s and 1980s and is concomitant to the rise of identity politics (McGurl 2009 , Chapter 4).

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Leni Van Goidsenhoven has received funding from the European Research Council (ERC). under the European Union’s Horizon 2020 research and innovation program (grant agreement No. 804881).

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Session 1: Introduction – What is therapeutic and reflective writing and how can it be used? This session will introduce you to the genre, the course and to one another through a series of practical assignments, readings and writing exercises.

Session 2: Journal Writing – What are journals and how can they be used creatively and therapeutically? We will explore this question and how to use expressive writing effectively through a series of tutor-led writing exercises and reflections.

Session 3: Biblio-Poetry Therapy – The practice of biblio-poetry therapy includes reading and responding to texts as a way of exploring our lives. This session will introduce some of the theory of biblio-poetry therapy and how it has developed into a distinct practice, and explore a number of classic poetry therapy texts and exercises.

Session 4: Writing Your Self – We will focus on how the material of our personal experience can be transformed into fiction, drama and memoir. We will look at how shaping expressive writing into something more formal can increase a sense of mastery and enable transformation.

Session 5: Reflective Writing and Practice – We’ll consider what we mean by reflective writing and its relationship with reflective practice and other forms of therapeutic writing for educational or professional development as well as transformation in our personal lives.

Session 6: Writing, Metaphor and Coaching – Metaphor has the power to transform our thinking through coaching and writing. You will be invited to engage in a series of exercises and reflections using a range of methods including the ‘clean language’ coaching model.

Session 7: Writing in Groups – We will focus on therapeutic writing in groups and how it offers such a rich and nuanced opportunity for personal growth. We will explore the reasons for this through some key texts and theories. There will be opportunities to discuss facilitation skills as well as the process of being in writing groups.

Session 8: Creating Your Future – We will draw the course to a close with some final writing and reflections on your personal writing journeys and individual portfolios. We’ll look at the many ways you can take your learning and reflective-writing experience forward.

At the end of the course, you will be well prepared to move onto our follow-on course  Running Writing Workshops .

Join our alumni community 

After your course finishes, you can join our online alumni community – a friendly group of writers supporting each other as they continue to explore and develop their writing. There’s no cost for this. It’s easy to access via the online classroom, where you can:

• Revisit all your course materials, including tutor notes, feedback, videos, podcasts and forum posts
• Rejoin your classmates, and continue working together in a private space
• Meet alumni from other courses to find beta-readers and share work on our critiquing forum
• Network with other writers working in your genre or area of interest
• Take part in regular ‘sit and write’ Zoom sessions, to push forward with your work-in progress
• Join our monthly live alumni events with our expert tutors and industry guests, including agents, editors, publishers, competition and festival organisers, and prizewinning writers.

Taking things further If you’d like to continue on to another Professional Writing Academy course,  please get in touch  for more details.

Meet your course team

Healing with Words

More about Anne Taylor

Poetry Therapy Pioneer

More about Victoria Field

Kate McBarron

Kate is a writer, editor and writing for wellbeing practitioner & researcher. She is passionate about words and their ability to enhance our daily lives, from relaxation to self-discovery and workplace wellness.

Kate is cofounder of  WritingForLife.co.uk  and founder of  WriteToRelax.com .

More about Kate McBarron

Start your journey

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(Including taxes)

The course has been remarkably good value for money. It has provided loads of resources and many new book suggestions. I have loved the assignments, every single one, and loved the brain-buzz I’ve felt at the end. It has been a sweet learning curve discovering new lives, new careers and new ways of writing.

Find out about our payment plans and get in touch.

Course Alumni

Meet our writers.

Laura Steen

I kept hearing stories about the efficacy of writing for well-being schemes and the enrichment they can provide for prisoners and those with mental health difficulties — the type of people I would one day like to work with. Over these eight weeks, I found myself learning and writing in ways that were completely unfamiliar to me, yet allowed me to process and make sense of my experiences more effectively than I ever had through talking.

More about Therapeutic & Reflective Writing

Creative writing can help preserve our mental health

Introduction to Therapeutic and Reflective Writing tutor Anne Taylor explains how writing can preserve our wellbeing.

Poetry can change your life

PWA course director Victoria Field interviews William Sieghart about his poetry prescriptions and the ability of poetry to renew the human spirit.

My journey into therapeutic writing

English teacher Laura Steen embarked on our Therapeutic Writing course with one goal in mind: to find wellbeing through writing. Here is her journey.

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"Writing by Prescription": Creative Writing as Therapy and Personal Development

2020, Writing Manuals for the Masses

This chapter investigates how-to books on creative “life writing” for therapy, transformative learning, and personal development, in short, therapeutic writing. This subgenre of writing advice is situated in two different domains with psychology and pedagogy on the one hand, and life writing and creative writing on the other hand. After a brief overview of the history of therapeutic writing, we focus on Jessica Kingsley Publishers (JKP), a leading international niche publisher in the field of neurological and cognitive differences. JKP offers a combination of popular-science books, memoirs, and self-help publications, as well as a series of how-to books on writing for therapy or personal development. By this specific grouping of genres and formats, JKP turns its readers into writers and also guides the process of writing by setting out standards for narratives about neurological illness and disability, both in content and form. Combining both textual and contextual analysis, we examine the advice oeuvres of three JKP authors, Gillie Bolton, Kate Thompson, and Celia Hunt, to see how they relate to the therapeutic and self-help ethos as well as to more literary forms of creative writing, and how they negotiate the ideas of becoming a writer through craft, therapy, and self-expression.

Related Papers

Global Media Journal

Katie Sutherland

This article examines two exemplar texts, both memoirs written by mothers about their sons, and discusses the altruistic motivation for using self-reflexive writing techniques in narrative representations of illness and disability. Through an analysis of texts by authors Rachel Adams (2013) and Anne Deveson (1991), the article explores the pros and cons of vulnerable writing about oneself and others, including the author's own children and family. Much is at stake for Adams and Deveson as they write about deeply personal experiences and feelings, and in doing so share the lived experience of disability (Down syndrome) and mental illness (schizophrenia) and broader issues around parenting, difference and identity. It is proposed that researching and writing with reflexivity not only allows writers to better understand themselves, but also opens the door to reader empathy, creating a sense of connection for readers. Furthermore, the examined texts by Adams and Deveson illustrate how vulnerable writing can be a form of advocacy as the authors promote a greater understanding of the ethnographic subject matter by pushing against assumptions, breaking down stereotypes and making the personal, political.

The Journal of Multimodal Rhetorics

Millie Hizer, PhD

Journal of Poetry Therapy

Claire Williamson

G. Thomas Couser

Disability memoir writing, and especially disability autobiography, is one of the most high-profile forms of disability narrative, frequently reaching wide audiences. Typically, disability positions are marginalized positions, where identity (especially medical identity) has been the product of outside examination and classification. In life writing, disability autobiographers work from this initial position of pre-inscription and seek to destigmatize their conditions, responding to wider cultural misrepresentations about the nature of a life lived with disability. This chapter will explore a variety of life writing narratives, covering physical, cognitive and learning disabilities, intersecting with chronic illness, and written by friends/family members as well as those who are themselves disabled. It will introduce readers to the methods through which disability life writers assume the subject position in the process of reclaiming their own narratives, a form of autoethnography that revises generic ideas about what life and memoir writing are, and will reveal this to be a political as well as an aesthetic act, a process of speaking for as well as speaking about the experience of a disability life. It will have specific foci – on the body, questions of metaphor, the paradigm of self representation, and the complex questions surrounding ‘collaboration’ or co-authored stories – as they are narrativized in texts. It will collect these under the umbrella idea of signification and assert that a major product of disability of life writing is the emphasis on the presence and significance of people with disabilities, acknowledged both as skilled writers and in the wider context of society.

Zarine Roodt

This article comprises a review of writing as therapy, a therapy practised by the client heror himself as a means of achieving equilibrium on a psychological level the self on the page1. In this sense it focuses on the therapeutic value of autobiographical writing which is inherently a communication act. It underscores a substantial body of research which validates the notion that individuals can bring about physical and psychological change by writing about traumatic experiences. Writing in this manner vents the emotions associated with trauma, enables the individual to gain distance and insight, and could ultimately lead to the integration of such experiences and emotions. Therefore, it should be understood that writing in this way is a form of “selfhelp” therapy. However, some measure of support is advised for the individual wishing to practise writing as a form of personal therapy. In its treatment of the therapeutic value of writing, this article spans two broad themes: first, ...

Kathleen M . Quinlan

ABSTRACT This reflective piece suggests three phases from therapeutic writing to full-fledged poetry to an audience's reading and discussion, illustrated with specific examples and commentary. The author, a social scientist, an adult educator and a published poet, begins with the role of writing in her own processing of the painful experience of a family member's severe mental illness and suicide, showing us her earliest therapeutic writing. She then illuminates a second phase, in which she gives us an inside look at the rewriting process that led to two poems suitable for public display. She considers how the resulting poems might be used for both therapeutic and educational purposes, offering discussion prompts and questions related to the poems.

Ruth Salter

The pieces in The Healing Art of Writing bring together caregivers and patients who share a passion for writing about the mysterious forces of illness and recovery. A belief shared among all contributors is that being cured of a disease is not the same as being healed, and that writing poetry and prose brings us to a place of healing. Our subject is the body, our medical experiences widely diverse; our goal is to express through literature what happens when a physical or mental anguish disrupts our lives. Copyright Information: Copyright 2011 by the article author(s). This work is made available under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs4.0 license, http:// creativecommons.org/licenses/by-nc-nd/4.0/ Perspectives in Medical Humanities

American, British and Canadian Studies Journal

Rebecca Pert

A host of recent studiesii have shown that creative acts such as writing have significant psychological, social, and emotional benefits. In the past few decades many healthcare settings have implemented creative writing groups as a complement to more traditional medical interventions for a wide variety of illnesses. However, the relative novelty of creative writing therapy, coupled with its conflicting artistic and medical aims, may mean that a writer who is considering leading such a group might be unclear as to what her role entails: whether she is primarily a teacher, mentor, or therapist; how much control she should exert over the patients’ creative output; the type of feedback, if any, she should give, and how to respond to upsetting or disturbing writing. This paper explores how various experts, from both artistic and medical backgrounds, have theorised what constitutes best practice in creative writing therapy, focussing specifically on the treatment of mental illness. The pa...

NIHR Health Technology Assessment Programme

Victoria Field

Long-term health conditions (chronic illness) can reduce the quality of people’s daily lives and can be costly to the health service. It has been suggested that when patients write about their experiences, this can have positive effects on patients’ lives and the health service. We refer to this type of writing as writing therapy. The aim of this study was to see if people with long-term health conditions benefit from writing therapy. We undertook a thorough search for scientific studies that tested writing therapy in people diagnosed with any long-term condition (LTC). We looked at whether or not writing therapy helped the individuals in the study, if the study was conducted properly, how the writing therapy might produce benefits and if it could lower health service costs. We found that most of the available evidence looked at writing done by individuals on their own and focused on writing about distressing events. Overall, there was very little evidence that this type of writing therapy had benefits for people with LTCs. A few studies looked at another type of writing therapy, which was done mainly in groups, was led by a leader and which we called facilitated writing. People with LTCs appeared to get some benefits from this type of writing, but much more research needs to be done to see how useful it is. Overall, studies were unclear on how writing therapy might work to produce health benefits or if it reduced health-care spending.

Teaching Life Writing Text. Ed. Miriam Fuchs and Craig Howes. New York: MLA, 2008. 350-58.

In this short essay, I explain why we might think of personal narratives of illness and disability as "quality-of-life writing": because they furnish testimony that one can have a satisfying quality of life despite impairment and illness. Granted, such narratives need to be carefully taught, but they should be required reading in medical schools.

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Cover Story

Writing to heal

By helping people manage and learn from negative experiences, writing strengthens their immune systems as well as their minds.

By BRIDGET MURRAY

Monitor Staff

June 2002, Vol 33, No. 6

Print version: page 54

Writing is no stranger to therapy. For years, practitioners have used logs, questionnaires, journals and other writing forms to help people heal from stresses and traumas.

Now, new research suggests expressive writing may also offer physical benefits to people battling terminal or life-threatening diseases. Studies by those in the forefront of this research--psychologists James Pennebaker, PhD, of the University of Texas at Austin, and Joshua Smyth, PhD, of Syracuse University--suggest that writing about emotions and stress can boost immune functioning in patients with such illnesses as HIV/AIDS, asthma and arthritis.

Skeptics argue that other factors, such as changes in social support, or simply time, could instead be the real health aids. But an intensive research review by Smyth, published in 1998 in the Journal of Consulting and Clinical Psychology (Vol. 66, No. 1), suggests that writing does make a difference, though the degree of difference depends on the population being studied and the form that writing takes.

Researchers are only beginning to get at how and why writing may benefit the immune system, and why some people appear to benefit more than others. There is emerging agreement, however, that the key to writing's effectiveness is in the way people use it to interpret their experiences, right down to the words they choose. Venting emotions alone--whether through writing or talking--is not enough to relieve stress, and thereby improve health, Smyth emphasizes. To tap writing's healing power, people must use it to better understand and learn from their emotions, he says.

In all likelihood, the enlightenment that can occur through such writing compares with the benefits of verbal guided exploration in psychodynamic psychotherapies, notes Pennebaker. He notes, for example, that talking into a tape recorder has also shown positive health effects. The curative mechanism appears to be relief of the stress that exacerbates disease, researchers believe.

Health benefits

A groundbreaking study of writing's physical effects appeared in the Journal of the American Medical Association (Vol. 281, No. 14) three years ago. In the study, led by Smyth, 107 asthma and rheumatoid arthritis patients wrote for 20 minutes on each of three consecutive days--71 of them about the most stressful event of their lives and the rest about the emotionally neutral subject of their daily plans.

Four months after the writing exercise, 70 patients in the stressful-writing group showed improvement on objective, clinical evaluations compared with 37 of the control patients. In addition, those who wrote about stress improved more, and deteriorated less, than controls for both diseases. "So writing helped patients get better, and also kept them from getting worse," says Smyth.

In a more recent study, presented in a conference paper and submitted for publication, Pennebaker, Keith Petrie, PhD, and others at the University of Auckland in New Zealand found a similar pattern among HIV/AIDS patients. The researchers asked 37 patients in four 30-minute sessions to write about negative life experiences or about their daily schedules. Afterward, patients who wrote about life experiences measured higher on CD4 lymphocyte counts--a gauge of immune functioning--than did controls, though the boost to CD4 lymphocytes had disappeared three months later.

Regardless, the fact that they at first showed improved immune functioning suggests that it reduced their stress through a release of HIV-related anxiety, says Pennebaker. "By writing, you put some structure and organization to those anxious feelings," he explains. "It helps you to get past them."

Other research by Pennebaker indicates that suppressing negative, trauma-related thoughts compromises immune functioning, and that those who write visit the doctor less often. Also, Petrie's colleague Roger Booth, PhD, has linked writing with a stronger antibody response to the Hepatitis B vaccine.

Writing right

Not everyone agrees, though, that the mere act of writing is necessarily beneficial. In fact, initial writing about trauma triggers distress and physical and emotional arousal, researchers have found. And not all people will work through that distress therapeutically or through continued writing, says psychologist Helen Marlo, PhD, of Notre Dame de Namur University and a private practitioner in Burlingame, Calif. In past research, she found that, contrary to Pennebaker's results, writing about negative and positive life events produced no physical health benefits in undergraduate students.

"I get concerned that if people just write about traumatic events, they get raw and opened up and aren't able to work through it on their own," says Marlo. Her study did not, however, provide evidence that writing poses any long-term risk to people.

But there is evidence that the nature of a person's writing is key to its health effects, notes health psychology researcher Susan Lutgendorf, PhD, of the University of Iowa. An intensive journaling study (in press, Annals of Behavioral Medicine ) she conducted recently with her doctoral student Phil Ullrich suggests that people who relive upsetting events without focusing on meaning report poorer health than those who derive meaning from the writing. They even fare worse than people who write about neutral events. Also, those who focus on meaning develop greater awareness of positive aspects of a stressful event.

"You need focused thought as well as emotions," says Lutgendorf. "An individual needs to find meaning in a traumatic memory as well as to feel the related emotions to reap positive benefits from the writing exercise."

In explaining this phenomenon, Pennebaker draws a parallel with therapy. "People who talk about things over and over in the same ways aren't getting any better," he says. "There has to be growth or change in the way they view their experiences."

Evidence of a changed perspective can be found in the language people use, Pennebaker has found. For example, the more they use such cause-and-effect words as "because," "realize" and "understand," the more they appear to benefit.

Pennebaker also acknowledges that some personality types likely respond better to writing than others. Tentative evidence suggests that more reticent people benefit most. A host of other individual differences--including handling of stress, ability to self-regulate and interpersonal relations--also mediate writing's effectiveness.

A place in practice?

After all, writing's power to heal lies not in pen and paper, but in the mind of the writer, say a number of psychologists who use it with their patients. That's where clinicians come in, helping clients tap that healing power, they say. Private practitioner Marlo, for example, employs writing cautiously--using it only with patients who take to it, and closely integrating it into the therapeutic process.

"The cornerstone of therapy is engagement in the therapeutic relationship that addresses the individual's process--especially the intrapersonal, interpersonal, affective and symbolic dimensions of experience," says Marlo.

Another practitioner, Judith Ruskay Rabinor, PhD, author of "A Starving Madness: Tales of Hunger, Hope and Healing in Psychotherapy" (Gurze Books, 2002), has her patients explore their anxieties in writings between sessions, e-mailing her as the anxiety strikes them. Rabinor offers feedback on their writing and helps them track progress in their thinking.

Though more studies are needed, many behavioral researchers believe such approaches could also work with treating chronically ill people. "Writing is another potential tool in the armatorium of the clinical professional," says Smyth.

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50+ Best Therapeutic Journal Writing Prompts for Mental Health

Share because you Care!

Journal therapy involves the therapeutic use of a journaling practice to bring about awareness and improve mental health. The biggest difference in therapeutic journaling from just keeping a personal journal is therapeutic journaling focuses more on thoughts, feelings, and insights.

By being intentional about your writing, you can identify areas where you are struggling and start implementing change, whether you struggle with mental health conditions such as anxiety, depression, or even just the use of cognitive distortions .

The therapeutic benefits of keeping a mental health journal can be endless.

Here are 7 therapeutic benefits of keeping a mental health journal [affiliate].

As well as 53 journal prompts that will help get you started, so you hopefully do not find yourself staring at a blank page trying to figure out where to start.

Mental clarity through journaling

Especially as we get older, time tends to fly right past us. And sometimes, it feels like it is flying by so quickly that we barely get a chance to process it. Before the next barrage of thoughts and feelings show up. And this is where journaling can come in. 

Journaling helps us slow down for a few minutes to get some clarity in our lives. Because sometimes, we find ourselves trapped in patterns of thoughts and behaviors that do not make much sense to us. At least at the time. By keeping a journal, we can get some clarity in our lives and identify those thoughts, feelings, and patterns. 

That without journaling, we might not have been able to identify. With journaling, we can get a different perspective on our thoughts, feelings, and behaviors and a chance to learn from them. What inspires and motivates us. And what we shy away from out of discomfort or fear. 

Journaling offers the opportunity to observe our lives from a third-party perspective and track our decision-making processes and the consequences of those decisions. So hopefully, over time, we can make new or better decisions.     

Patterns in thoughts and feelings

Do you ever find yourself engaging in patterns of thoughts and feelings? While journaling helps us build a stronger connection with our thoughts and feelings. By offering a space where you can write openly and honestly. And helps us to sort through why we are thinking and feeling how we are thinking and feeling. 

So, while the pages of your journal give you the space to write openly and honestly, it should not become the place where you spiral into hopeless despair, sometimes also referred to as the rabbit hole. 

Finding self-love through positive self-talk – ­­­­­­­­­­­­­­­­­­­Internal Dialogue that keeps you Stuck

Instead, the purpose of a journal should be a place where you can reflect on the patterns that emerge. And either uncover where they are coming from or form a plan to address or challenge those thoughts and feelings moving forward.    

How you talk to yourself about yourself (the inner critic)

We all experience internal thoughts and have some form of internal dialogue. Some people have a fairly healthy internal dialogue, and for others, they have an unhealthy internal dialogue. Some folks are pretty aware of their internal dialogue, and others are not. Whether you are fairly aware or unaware, journaling can help you gain better awareness. 

17 Common Cognitive Distortions

The way we talk to ourselves influences our levels of happiness and success. But, unfortunately, it also influences our levels of unhappiness and lack of success. Your internal dialogue can be your greatest enemy or your most powerful ally, depending on how you use it. You can’t control every thought that comes into your head because we have automatic thoughts. These are the thoughts that come unbidden and suddenly pop up. However, you can control your second thought and all of the thoughts that come after it. 

11 Powerful Growth Mindset Journal Prompts (Limiting Beliefs & Inner Critic)

Journaling can be the space that you need to record your automatic thoughts. This can help you create an awareness of how you talk to yourself and even the tones you talk to yourself. 

Journaling can also be a safe space where you can begin to make changes in your internal dialogue and tone. At the very least, you can begin to recognize when you have an unhelpful automatic thought and begin to change how you are thinking consciously. 

Journaling creates the space and opportunity to intentionally change how you think by getting those thoughts on paper. It offers you the distance and the perspective that you need to look at these thoughts, written by your own hand and in your own words. 

Self-talk is far too powerful to be lazy with. And with journaling, you can perhaps gain the awareness that you need to consciously take control over how you talk to yourself about yourself.       

Helps you visualize the changes you want to make

Journaling provides an outlet and helps you visualize where you want to go. One of the many benefits of journaling is it gives you an outlet for your thoughts and emotions. In addition, journaling provides you with space where you can express yourself honestly. 

You can begin to break down the things you are struggling with into smaller pieces that feel less overwhelming; journaling offers an efficient solution, problem-solving.

By reading over previous journal entries, you may begin to see a pattern emerge. This pattern can be a great way to discover where you need to implement changes, even if they are just little things or small new habits that create change.    

Your small wins, insight, and inspiration

As a mental health therapist, I see folks struggle with this all the time. I have folks that come to me each week with a laundry list of all the things that didn’t go right since the previous week. This then becomes a self-fulfilling prophecy. 

If you are walking around with an unhealthy internal dialogue and are only acknowledging (consciously or unconsciously) the negatives in your life, you are almost setting things up to guarantee a fail. But, on the other hand, when you focus exclusively on the negatives, it becomes a way to support your hypothesis and internal dialogue. 

So if your hypothesis and internal dialogue are “I’m a failure,” and all of your focus is on the things that are not going right or going well. There is almost a satisfaction in finding evidence to support your hypothesis and internal dialogue. 

Dangers of Perfectionism vs. Excellence (Overwhelming Anxiety vs. Healthy Striving)

Because out of all the things in life that we cannot control, at least you feel that you can control this. The hypothesis and internal dialogue of “I’m a failure” becomes the one area of your life you feel you can control. 

But by journaling about your small wins, insights, and moments of inspiration, you can begin to challenge your hypothesis and internal dialogue. By focusing on the wins, insights, and inspirations, you begin to shift your negative mood states and cognitions. By making this shift, you can begin to move towards whatever your goals or aspirations are.         

Self-reflection a new perspective

Through journaling, you can begin to do some self-reflective work. You can identify your beliefs, morals, and values. And you can also begin to identify your limiting beliefs too. So often, our “I can’t… because I’m not…” statements that we say to ourselves keep us stuck. 

By using a journal as a space for self-reflection, you can begin to discover where your beliefs, morals, and values, as well as your limiting beliefs, come from. We often inherit these things from our primary caregivers, and they are passed down through the generations. And through journaling, you can begin to discover where you have learned these things, especially when it comes to the limiting beliefs that we so often want to change. 

And it is through moments of self-reflection, we can gain the perspectives that we need to decide if we want to change something that we have held onto. So through the act of journaling, you can begin to recognize the themes that are coming up for you. And through journaling, you can reflect on what you want to change to have the life you want to have.   

101 Self-Care Journaling Prompts for better Mental Health.

Your personal growth

Have you ever stopped and looked at your life and wondered how you got to where you are? Life happens so quickly that we rarely get the opportunity to stop and reflect on our life. We rarely stop to contemplate how far we have come. So often feel like we are chasing (a potentially unknown) destination, and we don’t know how we have gotten here. And journaling gives us an amazing gift. It tracks your personal growth and the decisions that have led you to where you are now. 

But what if you are at a destination you don’t want to be at or remain at longer than necessary? This is another gift that journaling offers you. The opportunity to look back at your decisions and make new different decisions. It makes me think of a fairly common saying.  You don’t know what you don’t know. 

And if you find yourself in a part of your life and don’t know how you have gotten there, this is where journaling can come in handy. Whether you have entries that you can refer back to, or if you’re starting with journaling, you can begin to discover and document the things that you didn’t know. 

How to Love Yourself: 27 Self-Love tips from a Therapist

Human beings, for the most part, are pleasure-seeking creatures. Therefore, we tend to avoid things that cause us pain or discomfort or what we think will cause increased pain or discomfort. 

So we choose the lesser of the two. But sometimes, to experience personal growth, we have to lean into the discomfort. And sometimes, we have to read and reread our stories to find those opportunities for personal growth.     

Here is a list of 56 journaling prompts for therapeutic journaling. I have broken down this list of journal prompts into categories to help get you started.

10 Therapeutic journaling prompts for a bad day

• Describe your day and what about it is bothering you. What were you thinking and feeling?
• What are some helpful things to tell yourself on difficult days?
• Did you have any negative thoughts today, and how can you reframe them to be more helpful?
• Make a list of things that you are grateful for.
• If a day like today happens again, what are some helpful ways for you to get through it? If you can control it, what do you need to do differently? And if you can’t control it, how can you begin to accept it?
• Reflect on the last time you had a bad day. What were some helpful things that you said or did to get through it?
• Make a list of self-care ideas you can do when struggling.
• Research and write about managing anxious thoughts when you have them.
• What are three important things that you can remind yourself of when you struggle with negative emotions?
• What have past experiences taught you about your resiliency? And what can this experience teach you moving forward?

28 Therapeutic journaling prompts for self-reflection

• How can you encourage yourself to get out of your comfort zone?
• What are some things that you need to remind yourself of when you are having a hard time shifting your mindset?
• If you could travel back in time, what would you tell your teenage self that would help you now?
• What are 3 things that your best friends would say that you do well? And what are 3 things that your best friends would say that you struggle with? What do you need to do to begin to work on those things?
• If you were to have a perfect day, what would you be thinking and feeling? And how do your thoughts and feelings influence your day?
• What new habits or daily routine can you implement to empower you?
• Are there boundaries that you need to set with yourself or others, and if so, what is the first thing that you need to do?
• How do you set boundaries and avoid absorbing other people’s stuff?
• How do you know when you are nearing burnout, and what mental health issues do you experience?
• What does your authentic self look like?
• How do you remind yourself that you are enough even when you have a tough time or a difficult experience?
• What are 3-5 things that you need in that present moment when you are struggling?
• What new opportunities have come out of the challenges that you have faced?
• How do you calm your anxiety when you are experiencing difficult times?
• When you get on social media, what is it that you are looking for and why?
• What is your personal definition of success? And do you have any limiting beliefs that are holding you back?
• What are your priorities for next year? And are you actively or passively working towards them?
• Write about a failure you have experienced. How did you experience it emotionally? What did you say to yourself as you were experiencing it? And what do you want to remind yourself the next time you experience failure?
• What are some good things about experiencing failure?
• Make a list of all of the things you would like to say ‘NO,’ too. How many of these things are you currently doing?
• Make a list of all of the things you would like to say ‘YES,’ too. How many of these things are you currently doing?
• What personal goal am I working towards? And how will I know when I get there?
• If I wrote a letter to my younger self, what would it say?
• What if you wrote a letter of forgiveness to yourself? What would it say?
• A defining moment in my life was…
• If you were guaranteed success, what would you be doing? And how can you begin to work towards it?
• If you were guaranteed that today was the perfect time to do something, what would you do?
• What does unconditional love look like for you?

18 Therapeutic journaling prompts for self-care

• What have you done lately for yourself, even if they are just a few small things? And if you haven’t, what are a few small things you could start doing?
• When you take the time to care for yourself, what mental health benefits do you experience?
• What does your self-care routine look like now, and are there any changes you need to make? If so, what are they?
• When you think about your morning routine, what is one thing that you would like to adjust that would help you take better care of yourself?
• Are there any adjustments you would like to make to your evening routine to take better care of yourself? And if so, what adjustments would you make?
• When I’m swamped, how can I find 10 minutes for myself? And what is something I can do during that time?
• What are some things I can do to prioritize my physical health, and how can I implement them?
• After a long day, the kindest thing that I can do for myself is…
• If you were to make a self-care box, what kinds of things would you add to it and why?
• How well have you been taking care of yourself the last couple of years? Are there things you need to keep doing, and are there things you need to change?
• Research some new ideas to implement into your self-care routine if you feel stuck.
• What acts of self-care truly make me happy, and how can I add more of these into my day?
• Am I sacrificing personal needs to make others happy, and what are those sacrifices?
• How do I advocate for myself? And what is at least 1 healthy thing that I can do to advocate for myself?
• What is my own experience around forgiveness?
• What do I need most to heal right now from a difficult situation?
• If you were to give yourself the best compliment ever, what would it be and why?
• What is your favorite memory? And how can you make more memories like this moving forward?

Final Thoughts

While therapeutic journaling has many benefits and is a positive way to help improve your emotional state. It may not be beneficial to process through traumatic experiences or significant mental illness on your own. And would be best used in conjunction with seeing a licensed mental health professional.

If you’re interested in starting therapy and would like to do it from the comfort of your own home, then take a look at Online-Therapy.com , and if you use my link [affiliate link].  You’ll receive a 20% discount on your first month  at no additional cost to you.

I have been affiliated with online therapy platforms for over a year now and have had the privilege to work with a lot of folks on various life struggles. That without the ease of online platforms might not have ever reached out for help.

So if you’re struggling and feel that therapy would be helpful, then I encourage you to give it a try. Because who knows where you might be in a few months down the road. And I’m guessing if you’re reading this article it’s because you’re not where you want to be.

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Expressive Arts Therapy: 15 Creative Activities and Techniques

It is especially well suited to clients who lack the ability to articulate their inner world with words alone. These clients can use the many forms of creative arts to express themselves.

In this article, we will discuss expressive arts therapy by explaining the interventions used and the difference between expressive arts therapy and creative arts therapies. You will be introduced to expressive arts therapy techniques and ideas for your psychotherapy and counseling sessions, both with individual adults and groups.

The article will also introduce training programs and degrees in expressive arts therapy and present a brief review of some of the best books on the subject.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with detailed insight into Positive CBT and give you the tools to apply it in your therapy or coaching.

This Article Contains:

What is expressive arts therapy, expressive arts therapy vs creative arts therapy, 12 techniques and ideas for your sessions, 3 activities for adults and groups, training in expressive arts therapy, top 14 courses, programs, and degrees, 3 best books about expressive arts therapy, helpful positivepsychology.com resources, a take-home message.

Expressive arts therapy incorporates elements of all forms of creative expression into a multimodal expressive form of integrative psychotherapy (Knill et al., 2005).

Expressive arts therapists are proficient in interpreting creative expression, rather than arts practitioners who have trained in a specific form of therapy.

In expressive arts therapy, each client is encouraged to use multiple forms of creative expression to articulate their inner world, including drawing and painting, photography, sculptures using a range of materials from clay to paper mâché, music, drama and role-play , poetry, prose, and dance and movement.

Expressive arts therapy focuses on four major therapeutic modalities:

• Imagination
• Active participation
• Mind–body connection

Human beings have used expressive arts as healing modalities since ancient times (Malchiodi, 2020). Expressive arts therapists facilitate multimodal creative expression, sometimes in one session, usually non-directively.

In other words, the therapist provides the materials, equipment, and media required to facilitate a client’s creative expression during the therapy session.

Dr. Cathy Malchiodi is a psychologist and expressive arts therapist who explains the four core healing practices when using expressive arts to work with trauma: movement, sound, storytelling through image, and silence through contemplative and self-regulatory practices.

Expressive arts therapy involves a multimodal integration of varied elements of the creative arts therapies into psychotherapy and counseling.

Creative arts therapies include art therapy, dance therapy , music therapy , drama therapy , and writing therapy . Creative arts therapists tend to be expert arts practitioners in one specific area who have gone on to train in a specific type of creative arts therapy (Stuckey & Nobel, 2010).

For example, a painter who has graduated with a fine art degree may then complete graduate training in art therapy to practice as an art therapist, or a professional performer may train as a dance or drama therapist.

However, expressive arts therapists are not expert arts practitioners. Rather, they are proficient in the skilled use of expressive arts as an integrative intervention in psychotherapy (Knill et al., 2005).

1. Drawing and painting

Intuitive drawing and painting with pastels, chalks, acrylics, and watercolors can be useful for expressing emotions, mood states, or relational dynamics that are difficult to express in words (Laws & Conway, 2019; Stuckey & Nobel, 2010; Trevisani et al., 2010).

Take a look at the video under the next item for an example of an intuitive drawing session.

2. Sculpting

Clay sculpting during a session can be very therapeutic, as clay is moldable and remoldable. Clay can take a lot of impact, and sculpting can be used to represent abstract inner states, a self-image, and other people (Vaartio-Rajalin et al., 2020). It can then be stretched, pummeled, and flattened as a means of expressing emotions.

In the video below, expressive arts therapist Natalie Rogers uses the two techniques mentioned during a therapy session with the same client.

Mask making using a range of materials such as tissue paper, clay, or paper mâché can be a powerful tool for expressing the many different roles people play in different relationships and life situations (Jones, 1996).

It can also express personal strengths. In this article , art therapists Gioia Chilton and Rebecca Wilkinson describe how they use mask making while working with people in addiction recovery.

4. Movement

Movement can be a powerful form of self-expression to connect to the wisdom of the body and its innate healing capacity. This may include dance, but not necessarily.

Movement can relieve stress and can be a powerful tool for self-regulation (Jones, 1996). In the video below, somatic psychologist and dance/movement therapist Dr. Jennifer Tantia explains how she used movement to transform her client’s anxiety into a sense of agency.

Expressive journal writing can combine words, drawings, sketches, collages, or photos to represent emotions, thoughts, events, memories, aspirations, strengths, and other inner experiences.

The journal provides a safe place for a client to express their authentic voice and practice honest self-expression (Knill & Atkins, 2020).

It can help clients clarify thoughts and feelings and forge a deeper connection to their needs, aspirations, and goals. This activity can also be continued between sessions as an adjunct to therapy then discussed during sessions. In this article , expressive arts therapist Shelley Klammer explains the wider benefits of expressive journaling.

Poetry writing is a central technique in expressive arts therapy that aims to mobilize artistic language, symbolism, and poesy as the source of creative expression. Clients can be encouraged to write expressively but also share poems written by others that have moved them.

The video below is the trailer for the book Poetry in Expressive Arts: Supporting Resilience Through Poetic Writing  by Margo Fuchs Knill and Sally Atkins (2020) and presents examples of poetry written as therapy.

7. Role-play

We all play many roles in our lives – at work, in social situations, and in our relationships.

Drama therapy is a safe method for exploring these roles in a nonthreatening way (Jones, 1996). Masks and puppets can also be used to explore roles and express difficult feelings rather than participating in active role-play if a client is uncomfortable expressing themselves directly.

This drama therapy intervention enables clients to explore roles they dislike, roles they aspire to play in the future, and current roles they’d like to expand. Role-play may be used in interventions designed to enhance self-awareness, strengthen a sense of identity, and enhance relationships.

Collage can be used to make emotionally expressive images using cut-outs, photos, paints, and felt pens. The key to this exercise is working quickly and spontaneously, as free of internal verbal commentary as possible.

The expressive collage-making exercise by expressive arts therapist Shelley Klammer in the video below is designed to enhance self-acceptance.

9. Self-portraiture

Self-portraiture using a range of materials can be very cathartic, and a series of self-portraits can reflect how a client sees themselves changing over time. These can be made by drawing, painting, mask making, sculpture, photography, or mixed media using a combination of these materials.

10. Photography

Photography used in a therapeutic context is often called photo therapy or therapeutic photography (Gibson, 2018).

Photo therapy can enhance clients’ appreciation of their environment and what they love about their daily life. It can also be used to journal the healing process after trauma or loss.

In the TED Talk below, How Photography Saved My Life , Bryce Evans explains how therapeutic photography helped him recover from depression and anxiety.

11. Mandala making or coloring

Mandala making or coloring can be a wonderfully meditative exercise for emotional expression, centering, and self-soothing.

Mandala derives from the Sanskrit word for “circle,” and in Eastern religious traditions, mandalas are often used as an aid to contemplation and meditation.

To make a mandala from scratch, the client needs to draw a circle (perhaps tracing around a circular object or using a compass) and then fill the circle in with spontaneous patterns and colors.

Alternatively, mandala coloring books such as 150 Mandalas: An Adult Coloring Book With 150 Beautiful Mandalas in Various Styles for Stress Relief and Relaxation can be used to relieve stress and for self-soothing purposes (Koo et al., 2020).

12. Filmmaking

Filmmaking is another powerful expressive art form that is now available to most of us, given we can all make videos with our smartphones and edit them with various low-cost or free video-editing apps online.

This video trailer for the book Video and Filmmaking as Psychotherapy (Cohen et al., 2016) gives a taste of how filmmaking is being used in psychotherapy with veterans to treat post-traumatic stress disorder.

All the techniques above are used in expressive arts therapy in conjunction with person-centered, psychodynamic, cognitive-behavioral, and mindfulness-based approaches to maximize and integrate psychological healing.

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We share three activities with which to get started.

1. Mindful painting for stress relief

For this activity, you will need drawing pencils, ink pens, felt pens, colored pencils, pastels, chalks, crayons, acrylic and/or water paints, and brushes. This activity can be conducted with an individual or in a group.

The activity involves intuitively drawing or painting abstract representations of the things that stress your clients in response to the prompt ‘pressure.’ The idea is for clients to express how pressure makes them feel by making marks on the paper without judgment, rather than holding them in their bodies.

This exercise should begin with a brief mindful breathing exercise for each participant to relax and register their stress levels. Then, encourage them to make marks with colors that represent their feelings and draw and paint their problems away.

This video by Mindful Creative Muse for World Mental Health Day explains the process in more detail.

2. Guided imagery with music into a safe place

This activity can be conducted with individuals or in a group and was devised by music therapist Paula Higgins. For this activity, you will need space for clients to sit or lie down, yoga mats or cushions for them to lie on, and a device that can play music either using the video below or your own source.

The activity uses relaxation, guided imagery , music, and the mindfulness of breathing to create a sense of safety and stability. It could be particularly helpful for clients who are grieving, experiencing stress or anxiety, or in recovery from addiction.

You can download the transcript by clicking on the three dots on the right-hand side under the video and then clicking “open transcript.” You can copy and paste the transcript from the text box on the right. Adapt it for your session.

3. Mindful photography as phototherapy

This activity is again suitable for individuals or a group and involves slowing down through mindfully looking at photos to relieve stress through appreciation. Ruth Davey, the founder/director of Look Again has made a short video to give a taste of mindful photography and its benefits.

For this activity, each participant will need access to a digital camera of some sort. A mobile phone camera is more than adequate. Access to nature in either a garden or park is also preferable (Atkins & Snyder, 2017), as it’s much easier to slow down in nature than in a busy urban setting.

Participants benefit by relaxing, becoming more present, and through an enhanced sense of creativity and flow.

The International Expressive Arts Therapy Association has a searchable list of training programs. The following are some of the top courses available, from certificates to diplomas and degrees up to PhD.

Some are offered purely remotely, some are hybrid courses that combine a residential component with online learning, and some are campus based. Most of the training programs are currently based in the United States. There is also one training institute in Europe and one in Hong Kong, with new trainings emerging all the time.

The best place to get started with expressive arts, is by learning more about it. Have a look at the following selection of courses, spread out over the globe.

1. Expressive Arts Florida Institute

The following courses range from an introductory online program to a series of campus-based master’s degrees in expressive arts therapy in conjunction with other approaches, such as coaching, conflict resolution, and peacebuilding.

• Creative Wisdom – Introductory Online Training in Expressive Arts
• Certificate Training Program in Intermodal Expressive Arts
• Master of Arts Degrees in Expressive Arts Therapy; Expressive Arts Coaching and Consulting; and Conflict Transformation and Peacebuilding (offered in conjunction with the European Graduate School, Switzerland).

2. Lesley University, Cambridge, MA, United States

Lesley University has a range of on-campus courses available from undergraduate to graduate certifications and a doctoral program.

• BA in Expressive Therapies
• Certificate of Advanced Graduate Study in Expressive Therapies
• Graduate Certificate in Expressive Therapies Studies for mental health professionals
• PhD in Expressive Therapies – low residency

3. Appalachian State University, Boone, NC, United States

• Degree in Clinical Mental Health Counseling with a Concentration in Expressive Arts Therapy
• Graduate Certificate in Expressive Arts Therapy

4. The European Graduate School (EGS), Saas-Fee, Switzerland

The courses listed below and other programs at EGS are the only expressive arts therapies training options currently available in Europe.

They offer hybrid study options that comprise a residential component on campus in Switzerland with other studies conducted at a university in your home country. Programs include the following:

• Continuing Education CAS Expressive Arts Practice
• Certificate of Advanced Graduate Study in Expressive Arts
• MA degrees in the fields of expressive arts therapy
• Doctoral program

5. The University of Hong Kong, Centre of Behavioral Health, Hong Kong

This graduate degree program with a duration of two years full time or three years part time at Hong Kong University is the only one available in Asia.

• Master of Expressive Arts Therapy

These books are highly recommended and created by experts in the field.

1. Principles and Practice of Expressive Arts Therapy: Toward a Therapeutic Aesthetics – Paolo J. Knill, Stephen K. Levine, and Ellen G. Levine

This book begins by describing the philosophical foundations of expressive arts therapies in poiesis (creating by making) as an antidote to mind–body dualism and modern alienation as the root cause of many mental health problems.

This book will really appeal to practicing psychotherapists who want to understand how to incorporate expressive arts techniques into their existing approach.

Find the book on Amazon .

2. Nature-Based Expressive Arts Therapy – Sally Atkins and Melia Snyder

This book is also aimed at practicing therapists and helping professionals with an interest in expressive arts and ecotherapy.

This book explains how environmentally aware creative expression can be used to heal the relationship between human beings and nature that can exacerbate and even cause mental health problems from an ecotherapy perspective.

3. Trauma and Expressive Arts Therapy: Brain, Body, and Imagination in the Healing Process – Cathy A. Malchiodi

This book is specifically aimed at therapists and helping professionals who work with trauma.

Malchiodi explains the neuroscience of trauma and how expressive arts can reprogram the nervous system through holistic acts of creative expression, by helping to process traumatic experiences that often evade language.

PositivePsychology.com has free resources that can help you introduce expressive arts interventions into your practice.

Try our Self-Love Journal worksheet, which provides 10 journal prompts for those clients needing to cultivate self-compassion.

Alternatively, try our Mapping Emotions worksheet, which uses visualization and color to enhance emotional awareness.

Our Positive Psychology Toolkit© also contains numerous expressive arts therapy tools, including Rewriting the Narrative With Humor, a tool for promoting emotional wellbeing and resilience using writing therapy to reframe a narrative about an embarrassing event with humor.

Also in the Toolkit is Drawing Grief,  an expressive arts tool that aims to help bereaved clients explore their thoughts and feelings about their loss through drawing.

If you’re looking for more science-based ways to help others through CBT, this collection contains 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

Some pre-linguistic symptoms from trauma, grief, addiction, and anxiety may be inaccessible to conventional language processing. New neural pathways can be built through creative expression, which is a much more potent approach than talking.

Expressive arts therapy is an intervention that can help heal the body and mind, with ancient roots in ritual, music, song, art, poetry, dance, and drama across all cultures.

And although this approach is relatively new to Western psychotherapy, it is growing in relevance as our understanding of the functioning of the brain and nervous system explains why expressive arts therapy can be so effective.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

• Atkins, S., & Snyder, M. (2017). Nature-based expressive arts therapy: Integrating the expressive arts and ecotherapy . Jessica Kingsley.
• Cohen, J. L., Johnson, J. L., & Orr, P. (2016). Video and filmmaking as psychotherapy: Research and practice . Routledge.
• Gibson, N. (2018). Therapeutic photography: Enhancing self-esteem, self-efficacy and resilience . Jessica Kingsley.
• Jones, P. (1996). Drama as therapy: Theatre as living . Routledge.
• Knill, M. F. & Atkins, S. (2020). Poetry in expressive arts: Supporting resilience through poetic writing . Jessica Kingsley.
• Knill, P. J., Levine, E. G., & Levine, S. K. (2005). Principles and practice of expressive arts therapy: Toward a therapeutic aesthetics . Jessica Kingsley.
• Koo, M., Chen, H. P., & Yeh, Y. C. (2020). Coloring activities for anxiety reduction and mood improvement in Taiwanese community-dwelling older adults: A randomized controlled study. Evidence-Based Complementary and Alternative Medicine, 2020 , 6964737.
• Laws, K. R., & Conway, W. (2019). Do adjunctive art therapies reduce symptomatology in schizophrenia? A meta-analysis. World Journal of Psychiatry , 9 (8),107–120.
• Malchiodi, C. A. (2020). Trauma and expressive arts therapy: Brain, body, and imagination in the healing process . Guilford Press.
• Stuckey, H. L. & Nobel, J. (2010). The connection between art, healing and public health: A review of current literature. American Journal of Public Health , 100 (2), 254–263.
• Trevisani, F., Casadio, R., Romagnoli, F., Zamagni, M. P., Francesconi, C., Tromellini, A., Di Micoli, A., Frigerio, M., Farinelli, G., & Bernardi, M. (2010). Art in the hospital: Its impact on the feelings and emotional state of patients admitted to an internal medicine unit. The Journal of Alternative and Complementary Medicine , 16 (8), 853–859.
• Vaartio-Rajalin, H., Santamäki-Fischer, R., Jokisalo, P., & Fagerström, L. (2020). Art making and expressive art therapy in adult health and nursing care: A scoping review. International Journal of Nursing Science , 8 (1),102–119.

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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).

Monday, June 3, 2024 (Group accepts new members after start date.)

Begin registration process now .

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The Role of Creative Writing in Therapy

I decided at the start of the year to practice what I preach in my role as a counsellor – to explore creativity as an enhancement to wellbeing – and joined a local creative writing group. There I penned my first piece of creative writing since leaving school. Our homework assignment from the group was for us to choose a memory from our childhood and write 2500 words.

I chose a memory at 11 years old, of my best friend choosing to go out with a girl one Saturday afternoon instead of playing with me. And in the writing of it, I found myself exploring themes of trust, the loss of innocence, betrayal and how when you’re 11 years old everything can quickly return to normal and life carry on. I realised when I read this out to the group the following week that what I’d ended up writing was not just a recollection, but more of a dissection of the things I was unable to voice at the time. This turned an autobiographical piece into a powerful drama that could give airtime and perspective at last to my feelings.  Its rawness and vulnerability resonated deeply with the group, and from that beginning, I have gone right back to my adoption and written so far 50,000 words on the theme, ‘Days, events and people that have shaped my life.’ I’ve written quite forensically and as accurately as I can recall, helped particularly as far as my childhood was concerned by a wealth of family photos taken by my father, a talented photographer.

How often do we take the opportunity that’s there for all of us to dwell on the significant times in our lives? Even those of us who have had extensive therapy – and I’ve had 100 hours – didn’t spend that much time on this, and certainly not this amount of words. I have acquired a new thread of insight now that runs through my life. It’s been possible for me to understand now why I changed from innocent to worldly, or idealistic to materialistic, or from atheism to searching for a spirituality that fits me. Not from a developmental theoretical framework that I have learnt about, but from a highly specific personal journey. 

I’ve had insight into the triggers that those significant ‘days, events and people’ have had on my own development, and why out of all the possible ‘days, events and people’ only thirty or so over the course of my life have been sufficiently significant to influence it. Why them and not others? Why is my memory so clear in sometimes forensic detail about those days, and yet most have flown by with little or no recollection? Why did my life turn on single moments, and then no significant change for relatively long periods of time? 

I’ve made some obvious choices in marriage, divorce, births and parental deaths. But I’ve also selected other events that might not have affected anyone else’s life in anything in the way they have influenced mine – my walk to school, a general election, first real young love, first festival, a particular house I lived in as a student, my first afternoon at work …

I’ve also resolved not to offer my writing to anyone else other than possibly my immediate family, in order to not be swayed into making my life seem more glamorous, less shameful, and more virtuous than it really was. Indeed if no-one ever read it, it would have been a hugely worthwhile achievement in itself, and I think that’s what sets it apart from any ambitions to be an erstwhile published author.  In not setting out to be published it’s freed me to write as honestly as I can recall, and to also introduce my own self-awareness now into events in the past. Neither have I sought to have my particular memories validated by for instance my sister, since I know our experiences of growing up were very different despite the efforts by our parents to raise us as equally as they felt able. 

But perhaps the most significant and entirely unexpected outcome has been that I now have a desire to write a novel, something I’ve fantasised about for years but felt completely inadequate to know where to even begin. And in doing so I’ve laid to rest a comment made on the last piece of creative writing I produced by a teacher when I was 13.  His words, ‘you’ll never make a writer’ now raise a smile of (slightly vengeful) glee when I recall them.

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The poetics of vulnerability: creative writing among young adults in treatment for psychosis in light of Ricoeur’s and Kristeva’s philosophy of language and subjectivity

Oddgeir synnes.

1 Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway

Kristin Lie Romm

2 Institute of Clinical Medicine, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, Oslo, Norway

3 Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway

Hilde Bondevik

4 Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway

Associated Data

Because of the written informed consent, the data are not available to other researchers.

There is a growing interest in the application of creative writing in the treatment of mental illness. Nonpharmacological approaches have shown that access to poetic, creative language can allow for the verbalisation of illness experiences, as well as for self-expressions that can include other facets of the subject outside of the disease. In particular, creative writing in a safe group context has proven to be of particular importance. In this article, we present a pilot on a creative writing group for young adults in treatment for psychosis. We set the texts and experiences from the writing group in dialogue with Paul Ricoeur’s and Julia Kristeva’s philosophies on poetic language as meaning making and part of subject formation. The focus is on language as materiality and potentiality and on the patient’s inherent linguistic resources as founded in a group dynamic. As a whole, the project seeks to give an increased theoretical and empirical understanding of the potentiality of language and creativity for healing experiences, participation and meaning-making processes among vulnerable people. Furthermore, a practice founded in poetic language might critically address both the general and biomedical understanding of the subject and disease.

Introduction

‘For all miracles are powerless to prevent the expression of ideas in writing; the occasional attempt to paralyze my fingers, though making writing somewhat difficult, does not prevent it, and attempts at disturbing my thoughts are easily overcome by putting them down in writing during which one has a great deal of time to collect one’s thoughts’.

Daniel Paul Schreber 1903

At the beginning of the last century, the distinguished judge Daniel Paul Schreber used writing to make sense of and tell his story. He suffered from delusions and voice hearing and felt mentally and physically ‘tortured’ by what he called ‘miracles’. Even so, he was able to write one of the world’s most famous books about psychotic experiences to regain his liberty from the asylum where he was confined. Beyond a doubt, Schreber used writing and music as a means to bring order and peace to his mind. He developed a belief in his own powers by being able to confer important matters to the outside world.

Over the past few decades, there has been growing interest in creative arts therapy and other psychotherapies in the treatment of mental illness. Music, visual art and theatre have moved from an activity of meaningful occupation of time to being recognised as a therapeutic tool. Art therapy is mostly used as an adjunct to medication, but user organisations have also advocated for more alternatives when adverse effects or a lack of effect makes medication intolerable (Hanevik et al. 2013 ). Creative and expressive writing includes personal journaling, poetry, fiction and autobiographic memoirs, and this form of writing has been acknowledged as a therapeutic tool for people suffering from severe mental illness (Chiang et al. 2019 ; King et al. 2013 ; Stuckey and Nobel 2010 ). Access to poetic, creative language may allow for the verbalisation of illness experiences, as well as self-expressions that can include other facets of the subject that rest outside of the disease. Creative writing in a safe group context allows for peer-to-peer support, and this might be especially important for people with severe mental health challenges. Even though it could be provided as individual therapy, group sessions have been recommended to optimise outcomes (Bundesen and Rosenbaum 2020 ; Hanevik et al. 2013 ).

In the current paper, we present a pilot project on a creative writing group for young adults with psychosis; here, we look into written texts and excerpts from interviews with the participants. To illuminate the potential of creative writing in this group, we analyse the project in light of two philosophers’ work on poetic language. Paul Ricoeur’s long-standing work on poetics of being ( 1950 , 2008b ) underscores how poetic language is central for providing new understandings of ourselves as capable beings in the world. According to Ricoeur, our subjectivity depends on language and symbols; thus, self-understanding requires interpretation through available linguistic resources. Additionally, an important premise for our work is Julia Kristeva’s ( 1974 ) dynamic understanding of the subject and the idea that treatment cannot be approached by looking at patients ‘as objects under treatment’ but only as ‘emerging subjects’. Her understanding of the ‘semiotic’ as fundamental for meaning making and symbolisation is discussed in relation to the selected texts. As a whole, the project seeks to give an increased theoretical, as well as empirical, understanding of the potentiality of language and creativity for healing experiences, participation and meaning-making processes among vulnerable people, as well as to critically address the biomedical understanding of the subject and disease.

More specifically, in light of Ricoeur’s and Kristeva’s perspectives, the aim of the article is to investigate the following: How can poetic language be a resource for young adults in treatment for psychosis through participation in a safe and supportive creative writing group?

Psychosis among young adults and the need for nonpharmacological interventions

Being psychotic is one of the most distressing and debilitating conditions a person can experience. A psychotic episode is often characterised by symptoms such as hallucinations, thought disorder, delusions or change in feelings and emotions, and it is followed by both intrapersonal and interpersonal distress (Griffiths et al. 2019 ). Psychotic disorders often start in late adolescents/early adulthood. This is an age marked by a demand for increased independence, acceptance of friends, separation from parents and where school results are a yardstick for success. A person who develops psychosis will often experience difficulties in several of these areas, and loneliness among this population is common (Lim et al. 2018 ). They may feel more dependent on their parents again, feel alienated from their friends, feel stigma and shame and may experience cognitive difficulties related to the disorder. The high degree of misinformation about the prognosis associated with these conditions, especially with schizophrenia, tends to underestimate the chances for recovery and adds to the burden. It is easy to lose hope even though the vast majority will either recover or be able to live meaningful lives, even with some symptoms persisting (Lally et al. 2017 ).

However, since the 1990s, there has been a move towards a more recovery-oriented approach towards treatment, where the importance of personal resources and meaning has been emphasised (Chester et al. 2016 ; Lysaker et al. 2018 ; Slade et al. 2014 ). Recovery is not only about reducing psychotic symptoms: the ability to experience connectedness, hope, identity, meaning of life and empowerment has been highlighted as well (Slade et al. 2014 ). Furthermore, there has been an increased focus on personal recovery as opposed to clinical recovery: ‘the development of new meaning and purpose in one’s life, as one grows beyond the catastrophic effects of mental illness’ versus remission in symptoms and functional improvement (Anthony 1993 ; Van Eck et al. 2017 ). Acquiring hope and self-confidence and overcoming symptoms and stigma through mobilising resources are important for personal recovery.

To promote recovery, the use of strength-based interventions has been highlighted. Previous research has defined 24 character strengths, among them creativity, persistence, social intelligence and hope (Linley et al. 2007 ). Creative writing bridges into art therapy, where creative activity has been found to improve mental health, satisfaction with care, social and cognitive functioning and overall well-being in different patient populations, even though the results of its effectiveness have been mixed (Chiang et al. 2019 ). The varied outcomes may be attributed to a range of reasons, but high-quality qualitative papers indicate that both therapists and clients find it meaningful, beneficial and acceptable (Attard and Larking 2016 ).

Previous research on creative writing in (mental) health care

Research on writing among different patient groups has been diverse in terms of these studies’ methodologies. One direction that has received much attention is James Pennebaker’s research on expressive writing , where over several individual writing sessions various groups of patients have been asked to write about traumatic life events for 20 to 30 min. Expressive writing is a nonliterary intervention, with no emphasis on genre or literary techniques. The vast amount of research on expressive writing has shown various positive effects through, for example, fewer doctor visits, reduced self-reported illness and better management of the disease (Pennebaker 1997 , 2000 , 2010 ).

Although expressive writing is a clearly defined method that has been researched extensively, creative writing is a much less defined practice, covering various forms of literary writing such as poetry, fiction and storytelling, both in groups and on an individual basis (Costa and Abreu 2018 ; Gillam 2018 ). Costa and Abreu ( 2018 ) call for greater clarity with a consistent conceptualisation for the application of creative writing in clinical settings; they conclude that at the moment, there are no ‘established ways of assessing qualitatively or quantitatively the therapeutic benefits of creative writing’ ( 2018 , p. 83).

One tradition under the umbrella of creative writing is poetry therapy, which is defined as ‘the use of the written or spoken word to further therapeutic goals and enhance the well-being of individuals, families, couples, or groups […] poetry therapy promotes growth and healing through expressive writing activities and through the reading and facilitated discussion of literary material’ (National Association for Poetry Therapy n.d.). The benefits of poetry therapy involve increased self- and interpersonal awareness, validation of voice and increased capacity for capturing and redescribing the significant life events. According to Kenneth Gorelick, a seminal figure in poetry therapy, the goal of poetry therapy is to provide opportunities to describe loss, but also to find a language that can fulfil hope ( 2005 ). This short presentation of poetry therapy is a characteristic example of the open-ended nature of the various practices that are in use. This understanding of poetry therapy could easily be applied to several other practices lumped under the umbrella of creative writing. Another example is McArdle and Byrt’s ( 2001 ) definition of expressive writing in mental health as ‘the use of writing to enable people with mental health problems to enjoy and express themselves, develop creativity and empowerment, affirm identity and give voice to views and experience’ (p. 517). Even though the latter use the term ‘expressive writing’, it is clear that they differ from Pennebaker’s highly structured and individual approach and are more related to how poetry therapy presents itself. The lack of a homogeneous practice in creative writing makes it difficult to compare outcomes across studies (Costa and Abreu 2018 ).

In recent years, mental health care has seen an increased interest in art therapeutic directions, such as visual arts (Crawford et al. 2012 ; Green 1987 ), music (Yang et al. 1998 ; Ulrich et al. 2007 ) and variants of creative writing (Houlding and Holland 1988 ; McArdle and Byrt 2001 ; Shafi 2010 ). However, there are only a few studies on the use of creative writing in severe mental illness. Houlding and Holland ( 1988 ) report that participants in a creative writing group among people with severe mental difficulties found that group affiliation allowed for greater contact and less isolation. In addition, writing provided opportunities to express their overwhelming emotions. This has been supported by McAardle and Byrt ( 2001 ) and Shafi ( 2010 ), who argue that creative writing can help express oneself and control thoughts and hallucinations. Several case reports also describe how writing can be markers on the road to recovery (Hankir et al. 2012 ; Kar and Barreto 2018 ). These findings are in line with the preliminary results from the Danish research programme ‘Rewritalize—creative writing groups as part of psychiatric treatment’, which is an interdisciplinary project that has applied a mixed method design and consists of one art practice part and one research part (Bundesen and Rosenbaum 2020 ). Their findings highlight how creative writing in a group setting in psychiatric treatment can have several positive psychological effects, such as symbolic meaning making, mentalising and the enhancement of interpersonal abilities.

Some studies have explored frameworks that propose theoretical links between creative writing and recovery from severe mental illness. King et al. ( 2013 ) outline three different theoretical perspectives to investigate frameworks for creative writing as part of a recovery process: (1) the relationship between the narrative and the emergence of identity, (2) writing as a means to reconstitute a void in the internal symbolic order of the person and (3) creative writing as a form of cognitive remediation. These perspectives might be especially valuable for people who suffer from psychosis with self-disturbances and identity problems (Sass et al. 2018 ) and/or cognitive impairment (Karr and Singh 2019 ). Both self-disturbance, which is a phenomenon of disruption or diminishing of a person’s sense of minimal (or basic) self, and cognitive impairment are considered to be major challenges (Sheffield et al. 2018 ). A related approach comes from Bundesen and Rosenbaum ( 2020 ), who combine theoretical perspectives from psychoanalysis, literary theory, and phenomenology to explore creative writing’s potential healing processes.

An interesting additional aspect that is argued for by King et al. ( 2013 ) and Bundesen and Rosenbaum ( 2020 ) is the importance of focusing on literary writing techniques for therapeutic value, emphasising both the importance of learning from a writer, not a health professional, and writing as a skill for expressing oneself.

The current project was designed as an exploratory study where we wanted to gain more insights into the processes and experiences of a group with young adults living with psychosis that were given the opportunity to participate in the writing of creative texts in a safe and supportive group environment.

Theoretical perspectives

The theoretical perspectives applied in the current article are based on two philosophers who argue for the centrality of poetic language in the formation of human experiences and subjectivity. For both Ricoeur and Kristeva, poetic language is a vital resource for agency, self-understanding and self-experience. Through poetic language and linguistic repertoires in culture, the self can find new ways of being. We argue that a look at the aspects of Ricoeur’s and Kristeva’s theories will give an increased understanding of what can be at stake when working with creative writing among vulnerable patients.

Paul Ricoeur and the poetics of human existence

Throughout his philosophy, Paul Ricoeur has been concerned with how human existence always is situated between the voluntary and involuntary, between nature and culture and between the given and the chosen: ‘Living is already having been born, in a condition we have not chosen, a situation in which we find ourselves, a quarter of the universe in which we may feel we have been thrown and are wandering, lost. And yet it is against this background that we can begin, that is to say, give a new course to things …’ (Ricoeur 2008a , p. 211). As human beings, we are part of nature and vulnerable to diseases, to death and to other people’s actions, while at the same time, we have a capability conditioned by the abilities of a body situated in a particular context. For Ricoeur, human existence is given in language and conditioned by the culture we are a part of. We can never have direct access to ourselves; the self can only be seized indirectly through an interpretation of itself through the available linguistic and symbolic resources found in one’s culture: myths, stories, different beliefs and discursive repertoires.

Although the linguistic repertoire of a culture can always be interpreted as limiting, Ricoeur wants to show how ‘human language is inventive despite the objective limits and codes which govern it…’ (Ricoeur, in Valdés 1991b , p. 465). In particular, Ricoeur has been occupied with how poetic language as poiesis , as productive work, opens up possibilities for how we understand ourselves in the world. 1 This perspective is apparent in the works of Ricoeur that investigate what he terms semantic innovation , where the creative language tools of metaphor ( 2008b ) and narrative ( 1992 ) are central for how we come to orient ourselves in the world through an indirect hermeneutics, by interpretation on the level of the sentence (metaphor) and through the plot (narrative).

For Ricoeur, literature and poetic language demonstrate man’s capability in the way it ‘preserves the width, the breadth of language’ (Ricoeur, in Valdés 1991a , p. 448) by its plurivocity. As such, it is the opposite of the language of science and technology, which aims at an instrumentalisation of language as a striving for language and reality to be one. Poetic language, on the other hand, implies potentiality and possibilities, not as correspondence but as a redescription of the world: ‘Is it not the function of poetry to establish another world—another world that corresponds to other possibilities of existence, to possibilities that would be most deeply our own?’ (Ricoeur 2008b , p. 270–271). As such, Ricoeur sees poetic images closer to a verb than a portrait, something that opens the world to a potential ‘as if’. Poetic images as verbs thus ‘reveal our being-in the-world while […] being also “our work” as a manifestation of human possibilities’ (Helenius 2013 , p. 63). Poetic images are thereby productive for human potentiality and understanding, or in Ricoeur’s words, can open for a poetics of being ( une ‘poétique’ de l’être ) ( 1950 ).

An important factor in how poetic language opens up such perspectives of potentialities is what Ricoeur terms the ‘hermeneutical function of distanciation’ of the text ( 1981 ). When a discourse becomes a text, it frees itself from the writer and the author’s intention, opening itself up for infinite readings and possibilities for the reader: ‘For what must be interpreted in a text is a proposed world which I could inhabit and wherein I could project one of my ownmost possibilities’ ( 1981 , p. 142). However, this proposed world that the poetic discourse opens up for is not something to be found as a hidden intention behind the text but is found in front of it through the act of the subject’s interpretation: ‘to understand is to understand oneself in front of the text […] of exposing ourselves to the text and receiving from it an enlarged self…’ ( 1981 , p. 143). Thus, Ricoeur’s understanding of the subject is that it is always in the process of becoming through the mediating encounters of the texts in the culture. It is a creative interpretive act that might open up new realities and possibilities for the self.

Ricoeur’s philosophy provides a perspective on the prerequisites for meaning making that can involve a liberating creative process, one that may potentially be important for persons with a severe psychiatric disorder. For instance, one important point for Ricoeur is how the confrontation between the individual and different discourses can enable or hinder language and action. In the extension of this, the literary language through poetry and narrative becomes central for a potential therapeutic function in that this becomes a language that can imply a cleansing (katharsis) within the practice of working through—narrative and literature have the potential to reinterpret one’s life. Although one is never the author of one’s existence, one can be an author of its meaning, as Ricoeur writes ( 1992 ). On the other hand, poetic language can also imply a way for the wounded and marginalised to find a voice, as well as a release of human potential: ‘…through this recovery of the capacity of language to create and re-create, we discover reality itself in the process of being created […] Language in the making celebrates reality in the making’ (Ricoeur, in Valdés 1991a , p. 462).

Another aspect of Ricoeur’s philosophy that might be of particular relevance for this specific writing group of young adults with psychosis is the emphasis of understanding as something that happens in front of the text . An important part of the writing group is the freedom attached to the knowledge that it is the meaning of the text, not necessarily the author’s intention, that is in focus. This is one advantage of a poetic discourse; it involves possible worlds that do not necessarily reveal the inner world of the writer. In Ricoeur’s argument, poetic language opens this perspective in a double movement: ‘…one way of revealing is also one way of making more obscure’ (Ricoeur, in Valdés 1991a , p. 460). We believe this is of the utmost importance when we are working with creative writing among vulnerable patients. Poetic language can open up possible worlds for both the writer and reader.

Julia Kristeva’s theory of language

The French psychoanalyst and philosopher Julia Kristeva, best known for her linguistic writings and her dynamic understanding of the subject, has throughout her career had a special interest in combining psychoanalytic theory with language and literature. In our study, we are especially inspired by Kristeva’s understanding of the ‘semiotic’ as fundamental for meaning making and symbolisation and her exploration of the possibilities that exist in the poetic language related to mental illness and psychosis.

According to Kristeva, every theory of language depends on a specific understanding of the subject. As she understands it, the subject is permanently ‘in process’ [subject-en-procès], always in a process of becoming; by nature, it is in motion (‘From One Identity to Another’) ( 1984b ). In La Révolution du langage poétique ( Revolution in Poetic Language ) ( 1974 ), which was her doctoral thesis and also was her breakthrough, Kristeva describes that language appears as a polyphonic mosaic of transformed quotes in an intertextuality where the language is social and takes the form of dialogue (Bakhtin) as a result of the interaction between the individual and the environment. Language is dialogical also in the sense of being a divided signifying process, a production of meaning that seems to be an interaction between what Kristeva calls the semiotic and symbolic . Language itself consists of these two irreducible elements; they are linked together and could not be seen as dichotomous contradictions. With these concepts or processes, Kristeva also links the soul and body, the psyche and body and nature and culture in a dynamic way.

As speaking and writing subjects, we are also bodily beings whose bodily desires and energies—the semiotic —are in opposition in some way to the linguistic order—the symbolic (here, the semiotic as a kind of parallel to Freud’s unconscious). The semiotic, for its part, is further associated with rhythms, tones and movements, while the symbolic is associated with grammar and structure.

In this context, ‘normality’ is a sort of balancing act between the semiotic and symbolic, between the bodily and the linguistic, understood as the order, while ‘pathology’ may be seen as a loss of balance resulting in a fall to one side or another in this signifying process, either completely into the semiotic (and meaningless) or into the symbolic (and strictly legal) ( 1974 ).

Kristeva has also addressed several symptom dimensions and afflictions in her writings, such as depression, melancholy and hysteria, any of which may include psychotic elements. In Revolution in Poetic Language and later in Black Sun—Depression and Melancholy ( 1989 ), she looks at what it is in art and literature that may heal mental illness and distress.

As Kristeva understands it, depression is thought to be a form of denial of linguistic meaning, loss of meaning, loss of connections and relationships, loss of interest in the environment and, ultimately, loss of contact with bodily reality. This is where poetic language , according to Kristeva, as one signifying practice , can act as a reactivation of the semiotic, thus helping counteract an oppressive symbolic order, as well as strengthening the constructive dimensions in the language of the dissolving and destructive in a one-sided semiotic process.

Depression is anything but creativity. It is a loss of language and affiliation. However, the insanity, despair and turmoil—when strengthened by the semiotic—can be like dark matter that stimulates creativity. The melancholic temperament’s experiences of loss and absence can create the need to restore meaning and find a balanced language for these experiences to progress and move forward.

In our context, it is also interesting to note that in recent years, Kristeva, together with psychiatrist and Professor Marie Rose Moro, have explored the pathological and healing powers of cultures more concretely in the seminar on ‘Need to Believe’ (Kristeva 2011 ). This seminar is aimed at various professionals in the health sector who deal with cross-culture discontent among adolescents (Kristeva et al. 2018 ). Likewise, in ‘Interpréter le mal radical’ ( 2016 ), Kristeva refers to the case of Souad, a teenage girl from a Muslim family who suffered from severe anorexia and, subsequently, became more radicalised. Through psychotherapy with a multicultural team and writing and theatre workshop, including reading Arabic poetry translated into French, Souad gradually started to re-establish ties to the world and to her own body (Kristeva et al. 2018 ).

Taking Kristeva’s theory of the subject and signification, here understood as a production of meaning related to poetic language, we ask: Can Kristeva’s early writing on the semiotic and symbolic, and the concept of the polyphonic ( polyloge ), the diversity of rationality and of language contribute to our understanding of how language might maintain and strenghten life-giving and positive aspects of existence?

Further, is it outside of the institutionalised dialogue that the healing therapeutic potentials exist, opportunities for the ill subject to enable some of their intrinsic linguistic and bodily resources to create new meaning and affiliation, new life-giving connections and greater interest in the surroundings related to the subject?

Held together, the theories of Ricoeur and Kristeva bring a ‘poetic ethics’ or an ‘ethics of linguistics’ ( 1984a ) to our project: by stressing how the subject is relational and discursively constituted, this highlights the need for an awareness of the potentials that creative language might bring the individual, both as a writer and as a reader/listener.

Methodology

The participants were recruited from a department for in- and out-patient treatment for early psychosis at Oslo University Hospital. All participants had experienced periods with psychotic symptoms. The department is designed to provide a coherent treatment offer for a maximum of five years after a first episode of psychosis for people aged 18–30 years. When entering the service, most patients experience a moderate or high level of impairment because of psychotic symptoms. The project aimed to recruit people who were interested in writing in a natural setting, and it was stressed that this was an offer on the side and not to be counted as a part of their treatment; our programme did not interfere with their treatment as usual. We did not collect demographic data or data from hospital records and stressed that we were not interested in that part of their story unless they had something they wanted to share with the group. We held an open door, and seven persons participated during the course, while five participants became a core group and followed the course on a more permanent basis. These five produced the material for the present paper, and we have renamed them in the following way: three men (David, Gordon, Nick) and two women (Cindy and Joni).

The writing practice

The group met once a week for 2 h each time. Initially, six to eight meetings were planned, but the course was expanded to 12 meetings after requests from the participants. The project took place in the hospital area but not in the department responsible for their treatment. Here, we aimed to use a more neutral space.

The group was facilitated by the three authors of the present article; the first and last author led the group activities, while the second author was there as a participating observer and as a health professional if a difficult situation related to their psychological well-being should arise during the sessions. The first author is a literary scholar working in health humanities who has worked with creative writing for many years in different health settings, such as cancer care, dementia care and palliative care. The second author is a psychiatrist with extensive experience in working with young adults and psychosis. She was also the link to the participants’ therapists and worked at the setting where the group took place. The last author is a scholar in medical humanities with an extensive experience on research on literary representations of illness.

The protocol was influenced by the philosophies of Kristeva and Ricoeur together with traditions in creative writing that emphasise fantasy, perspective taking and literary techniques, both from outside of clinical contexts (Goldberg 2005 ; Koch 1999 ) and inside of clinical contexts (Herman 2017 ) and in illness and loss (Gubar 2016 ; Orr 2002 ). Thus, the project was founded on theory and practices, as well as our own background from previous work that underscore creative writing as a potential for (self)discovery, joy, therapy and relation building.

Being a particularly vulnerable group, the group leaders spent significant time outlining the pedagogy of the group: this was meant to be a creative and supportive community where the emphasis would always be on what the participants achieved. By reading published poetry and prose, as well as reading the products of the participants, the group session would be devoted to looking for the potential and linguistic creativity displayed in the various texts, looking for metaphors, details, original expressions, contrasts and so forth. Thus, the learning of literary techniques was located in the participants’ own texts, as well as in other relevant literature that was read during sessions. The method of learning from each other’s texts, as well as from what the participants achieved, was pinpointed as especially important during the recruitment phase and the initial sessions. We also saw the need for repeating the method regularly during the sessions to lessen the fear of failure among some participants. Another important methodological aspect of the group was the highlighting of the difference between the author and their texts. Following Ricoeur, we stressed how texts are always linguistic constructions that do not necessarily mirror the participants’ inner self as correspondence. In the groups, the focus was to be on the text and the textual self, not on the author’s life, situation or intentions.

The first meeting consisted of an outline of the method and a presentation round of the group leaders and participants. We then read a poem and had a short conversation of its content and the way the poem was written. It was important that the participants experienced writing and mastering right from the start. The first writing exercise was based on a reading of a few opening paragraphs of Charles Bukowski’s novel Ham on Rye, which is a depiction of a childhood memory with visual details seen from a young boy’s perspective. We then asked the participants to write for 10 min, taking a good childhood memory as a starting point and focusing on the sensual details of the place they were and what happened there. Again, we stressed the importance of the process, of play and of trying to write with no pressure on the end result. The participants were asked to read aloud their texts, and the two group leaders commented on each text, underlining what we deemed as literary qualities and linguistic details in the texts. Through this first reading, the participants got to know the pedagogical method: we as leaders would comment on the various texts but never criticise them. We would comment on what we found interesting, what we liked and, in particular, highlight various ‘literary’ techniques that were (un)consciously employed in the texts, thereby encouraging and developing the participants’ attention towards their own texts and the reading of each other texts. The participants could also comment on each other but never in a critical way. After the round, we read a poem by the Norwegian poet Helge Torvund. We ended the session by giving them ‘homework’. They were asked to use the word ‘trust’, which was one of the words in the poem of Torvund, as a prompt and write something for the next session. We stressed that ‘homework’ was said humorously/tongue-in-cheek and that it was an opportunity, not an obligation, and that they also could write in response to other things than to this prompt too and in whichever genre they preferred.

At the very end, we had a short feedback session where the participants commented on how they had experienced being part of the group. The group session lasted approximately 2 h.

Each group meeting had a similar structure. We started by recapturing the last session, emphasising the literary technique or aspect that was in focus, before reading a poem or a short literary text and talking about the content and literary qualities. We then had a 10 min writing exercise dedicated to a literary technique, genre or a specific theme followed by a round of reading with comments. After a short break, we then read the texts that (some of) the participants had written as a home exercise, and we always ended with feedback on the session.

The highlights of the sessions were the writing exercises and the following discussions about the texts. In addition to writing using the senses, the writing tasks during the sessions consisted of various exercises that emphasised, for example, ‘fantasy’ (writing about yourself at an age that is decided by the roll of two dices), creating suspense by writing flash fiction of six words, writing dialogues, making abstract feelings specific through the use of certain metaphors and similes, writing from different perspectives or writing in different literary genres like short stories and poems (including haiku). The tasks in between meetings were always specific but open-ended writing prompts where the participants could decide for themselves what and how they wanted to write. Examples were ‘trust’, ‘what we are searching for’, ‘my heart’, ‘standing in the rain’, ‘what I would not change in my life’ and ‘write from the perspective of a dog, a tree or the universe’. At the last meeting, the participants wrote meta-texts about writing.

Empirical material

The writing group resulted in around 100 texts consisting of poems, narrational fragments and some short stories. In addition, the three group leaders wrote field notes after the group sessions. Some weeks after the group had finished, qualitative interviews were conducted with the five participants. The interviews lasted between 15 and 48 min. All interviews were tape recorded and transcribed verbatim.

The analysis does not aim to give a representative presentation of the material as a whole but rather a reading of some significant texts that can illuminate particular aspects of how poetic language can be a resource. In the analysis, we have been inspired by Maggie MacLure’s concept of ‘wonder’ in qualitative research: ‘During the process of coding, some things gradually grow, or glow, into greater significance than others, and become the preoccupations around which thought and writing cluster’ (MacLure 2013a , p. 175). Furthermore, she writes how these things, be they, for example, a fragment, an anecdote or facial expression ‘…exert a kind of fascination, and have a capacity to animate further thought’ ( 2013b , p. 228). The analysis consisted of all three authors doing a close reading of the different texts that were produced during the groups, looking for the poetic qualities in each one, as well as the contents. What guided our reading was precisely looking for wonder , of texts that either said something original or profound about the resources of poetic language or creative writing or texts that had become important in the reading and reception in the group setting. In addition to analysing the texts, the impact of the poems for the authors in the poetry group was analysed in light of the field notes from these group settings and the semistructured interviews with the participants. Hence, the interviews were primarily used as supportive data to enrich the analysis of the texts and their potential meanings. The analysis is supplemented by the theoretical perspective in the discussion.

The project was evaluated by the Regional Ethical Committee (REK), who found it to be outside their scope, and it was approved by the data protection officer at Oslo University Hospital. Only people who were able to give written informed consent were invited to participate.

In the case of symptom exacerbation, we were in contact with each participant’s clinician and gave weekly feedback on how the course was moving along, and KLR followed up any signs of emotional strain that seemed to occur during sessions, both during sessions and in consultation afterwards, when needed.

There seems to be little risk associated with creative writing, and this is explained by the decisive emphasis on the participant’s freedom to decide what to write for the open assignments. However, a negative element is highlighted by Gallagher and Cole ( 2011 ), who show that writing in different genres for some patients with psychosis problems caused them to be less able to distinguish between reality and imagination.

Findings: poetic practice as relatedness

We will answer the research question, ‘How can poetic language be a resource for young adults in treatment for psychosis through participation in a safe and supportive creative writing group?’ by presenting a few emblematic texts from the writing group supported by glimpses and snapshots from the group sessions, as well as from interviews with the participants.

Because the texts are grounded in poetic and productive language, the texts are naturally more or less open ended, lending themselves to different interpretations. Here, we are attempting to present one possible reading among several, emphasising poetic language as a resource . We do this by presenting texts under four headings that are grounded in our close reading of the material: (1) writing as playful and reflective (co-)creation, (2) writing as a ‘long table’, (3) writing as individual discovery and (4 ) writing as mystery.

Writing as playful and reflective (co-)creation

‘Writing as playful and reflective (co-)creation’ highlights how the writing group became a room for discovery, sharing and play among the participants in the production and sharing of the texts. A fitting example is the group poems that were made at one of the meetings when we worked on making abstract feelings concrete through metaphor and similes by asking questions such as ‘what kind of landscape/sound/animal can represent the feeling of, for example, happiness, anger, fear.’ The participants worked spontaneously on visualising feelings by suggesting metaphors that were written on a flip chart. The metaphors suggested by the participants became group poems of various feelings, read aloud on the spot right after the last metaphor was added. The following poem was produced within a few minutes from responses from the participants regarding the feeling ‘unrest’:

Unrest Unrest is A rabbit A beaver that hides

Unrest is A desert A quiet room A kitchen knife Both sharp and blunt

Unrest feels like Dizziness, nausea A storm that never stops Trust that has been shattered

Unrest tastes bitter

Unrest sounds like a screech

Unrest is the sound of constant talking When you cannot participate

This poem illuminates several aspects of poetic language as a resource, both as linguistic and creative expression and as a lyric manifestation in the group, the latter aspect underscoring how the poem established a dialogue by bringing the different voices of the group together. One of the participants exclaimed after the reading and discussion of the poem that it had created a reflection room in the group by opening up different ways of looking at emotions, of seeing how metaphors and similes could visualise feelings that were otherwise unacknowledged, unarticulated or mute. Another aspect of the poem was how the participants got glimpses into each other’s meaning making, which is highlighted by how one participant explained how the disturbing noises of people talking outside the meeting room ended up as the last stanza of the poem. The fact that this was a familiar sound in the group (as the hall room outside the room was an open space with a coffee machine) impressed the other participants in how the participant created an evocative metaphor of unrest out of the familiar. Furthermore, one of the other participants also found this stanza to be a vivid metaphor of psychosis. The poem highlights the reflexive aspects that became an integral part of the group. As observed during the sessions, and also expressed in the interviews, the participants acknowledged how the reading and comments from the group leaders and the other participants, made them see different aspects and qualities in their own and in others’ writing. It sparked a process where the participants learned more about creative writing.

The poem above also underscores how the creative process of writing, exchange and reflection in the group was connected to playfulness . At its best, the creative writing group was a room where they could play with words, expressions, images and literary techniques in short designated writing exercises. In particular, the writing exercises like the one above were liberating. They took little effort and time and promoted spontaneity. Other times, we wrote flash fiction (six word stories) and haiku poems and put them on the flip chart. Characteristically, these short exercises on the flip chart were there for all to see and discuss, creating a lot of joy and laughter in the group that was based on the sharing and improvisation but also in response to other literary examples.

Writing as a ‘long table’

A prerequisite for the above category is the need for the participants to feel safe and comfortable in the group. This is highlighted in David’s text about the group, which was written at the last group meeting:

The long table Testing, testing. Are you on, yes? Yes. Ok let’s roll. What do you think? No, wait, I can’t ask. Or can I. No. I can’t sit here and interview myself. And ask myself? How has it been? Well, I know fucking well myself that. It. Has ... wait, wait. Okay, I have got a good one here ... how do you feel? Well for me it has been a long table ... Long table? Well, in therapy there is a sofa and a chair and a fucking discreet notebook ... and an ink cartridge of a pen. On a course, there may be benches, but here it is a long table. Like in Harry Potter. Hogwarts. Narnia. What do you mean? I just mean that the reason I was able to write here and failed it at school was because ... there is no square box. Not a fucking war. We flee from the neglect of the family and go to [name of the hospital] and write ... Narnia / [hospital] / Hogwarts. And sorry Kristin, Hilde and Oddgeir. You are lovely. But ... our heads rule, we own this. But the course then? That’s the answer. The course proved. We all have something in common. We are alright together.

Several aspects of the importance of the group environment can be found in this text. The title ‘The Long Table’ alludes to the magic world of Harry Potter and how this implies a different logic than the sofa, chair and notebook in therapy sessions and the benches and the square box at school. In the interview, David explained how the writing group became a haven outside of the pressure of society. The importance of the group as a safe space was highlighted by all participants. In the case of David, he was very sensitive to pressure and expectations, being an ‘extreme perfectionist’, as he expressed. David needed to know that he could withdraw from writing exercises and bring other texts that he had prepared in advance instead if he did not manage to write something during the group session. However, because of this freedom, David experienced that he flourished as a writer: in the interview, he claimed that he had written more than ever because of the course. The metaphor of ‘the long table’ also implies equality among the participants themselves and among the participants and the group leaders. For David, it was crucial that the group was a community of writers . At the same time, he also stressed in the interview how critical it was that he was met as a fellow human being. Repeatedly during the group sessions, he underlined, ‘We are more than our diagnosis!’ In a similar vein, Nick expressed in the interview how he found the group to be a ‘sanctuary’ (‘fristed’) and stated, ‘I have felt free, and have felt more like a real person […] I have not thought of myself as a patient during these meetings. And that is something I immediately do when I walk out that door’. Joni expressed how she felt freer in the group; she experienced that there was space, also for the parts that normally do not fit. The group became a space where she could be calm and get some rest. In addition, Gordon pointed out that it felt liberating that the focus was on the texts and not on him and his situation. He underlined how he experienced that the group supported each other and that he had always looked forward to going there. Cindy said how the group had made her get to know the other participants, something that had not happened before, despite several of them being together for extended periods during treatment: ‘We didn’t have any common interest before we found one in the writing’. The experiences from the group, seen together with the participants’ expressions, underline how the writing group as a supportive and free space can release the potential for writing as well as (therapeutic) community.

The overall impression from the texts, the observations done in the group and in the interviews is that the group was experienced as a safe and inclusive space. At the same time, sitting together at the ‘long table’ is a fragile and precarious space that can easily be shattered or put at risk. At one of the meetings, a writing prompt was introduced that asked the participants to write about a particular smell. For one of the participants, this became a too difficult exercise because it brought forth traumatic memories, and the participant ended up leaving the room. This episode underscores how crucial it was to have a health professional attending. On this occasion, the psychiatrist went after the participant and talked about the experience. It ended with the participant coming back to the group after a short while, and the group and the leaders were able to have a conversation around what had happened. It was then decided to give another prompt that became ‘the easiest thing is …’. This episode was referred to in several of the interviews where the participants stressed how important it was that the group leaders be flexible and attentive to what happened in a potentially fragile group setting.

Writing as personal discovery

Although the previous two sections have underscored the importance of the group setting as a supportive and creative space, this section emphasises how writing can involve a discovery of resources, thoughts and reflections in the writer. As Nick wrote in one of his texts:

I like to write. Writing gives me an overview of thoughts, as well as a way of expressing myself. I don't like to read. Unless I have written it myself. Writing is an art that takes time to learn and something you can never master. When you write, time stands still. Being part of the writing group has been a privilege. I feel that I get better when I have written for a while. Writing is a way of leaving something valuable.

Although Nick enjoyed being part of the group, he explained in the interview how he preferred to write alone and how he always had the writing prompts in the back of his head. Nick made lyrics before he started in the group, but he said that his writing had become better because he felt that the group had made it easier to write more freely. In the text above, Nick expresses how writing for him is a way of understanding his thoughts, an expression of himself and as representing a possible legacy. David explained that he had written more than ever after attending the writing group. (David had also written before the group). Although he sometimes struggled to write during the short, designated writing exercises in the group, he always brought texts into the group, and he explained in the interview how the writing helped him clear his thoughts. Gordon underlined how the writing both involved a learning of writing in different styles and a way of learning a bit more about himself, not least that he now dares to be a bit more open in his writing. As he elaborated in the interview: ‘Other things come to mind when I write: nice things, bad things, but not the least honest things. I am honest when I write. It’s a bit unfiltered somehow. I am honest when I talk too, certainly, but I believe I hold more back. That’s why writing is great’.

Another text that thematises writing as personal discovery is the following poem by Cindy:

Writing is for me

Like a song I’ve never sung

Like a bee I’ve never been stung by

Like a thread, I cannot sew Writing makes me new

Cindy’s poem touches on several aspects of her writing that she also underlined in the interview. While the other participants had written before the group, Cindy said that she had learned to like to write, something she had never experienced before (like a song I’ve never sung) and something that also involved a discovery (writing makes me new). In the interview, Cindy elaborated on how she never had liked writing at school and that she had regarded herself as one who could not write. Now, she described writing as a way of ‘making sculptures with words’, and she found significance and depth in her language during creative writing. From first having negative experiences of writing, Cindy now found herself writing everywhere, at the bus or whenever she had time.

In the previous section (the long table), we saw how the group represented a ‘safe space’ and ‘sanctuary’ that might imply a therapeutic community. We would also like to highlight how writing as personal discovery might involve therapeutic aspects. Cindy claimed in the interview that her writing shifted the focus from thoughts of the illness to other aspects. Gordon reflected on how the writing might be therapeutic because he experienced that he had developed a broader understanding of the other group members as well of himself. In one of his texts on writing, he dwelled on how writing can involve a form of working through: ‘It is good to write, even if it sometimes involves bad things. It is anyway good to get it on paper, then everything becomes a little bit different’. David most clearly stressed that he saw writing as therapy and claimed that he has felt better through writing. David was also the one who most explicitly wrote about mental illness in several of his texts. However, not all participants thought writing was therapeutic. Nick, who in the quoted text above wrote, ‘I feel that I get better when I have written for a while’, stated in the interview that he did not think of the writing group as therapy: ‘It is something completely different’. Joni also claimed that the writing group was something else; it was not therapy but ‘a room within a room’, as she said in the interview.

Writing as mystery

Writing as something ‘completely different’ or a ‘room within a room’ underlines how the writing group experience contained aspects that was not easy to pinpoint; there were elements that the participants had difficulties explaining but that were still a vital part of the writing experience. Cindy reflected on this in the interview when she pondered how writing ‘…might not reveal much, but can still affect the reader, through what it contains from the writer herself’. In addition, Nick hinted to the fact that writing may involve ‘…an unknown element… that is difficult to put your finger on’. In a similar vein Joni mentioned how the texts and their reception can hint to things that are not necessarily explicitly mentioned in the text: ‘For me it (the writing group) was like a white room that could contain multitudes. Also, things that are not easy to put in words’. A textual example by Joni can perhaps illuminate this, a poem that might or might not contain expressions of mental illness:

Do I hear or do I not hear The voices do not exist They are mirrors of the love I did not receive from you These are my twisted memories That I cannot turn back To the light

Another salient example of writing as mystery can be the ending of a poem Joni wrote in one of the last meeting to the writing prompt ‘What writing means for you’:

Falling leaves on paper In my mercury mind Words linger

‘Falling leaves on paper/In my mercury mind/ Words linger’. These lines might be a fitting example of this category, emphasising writing through metaphor that eludes elaboration. Another text is Gordon’s poem titled ‘The Writing Room’, where he ends the poem on what writing means for him with the following stanza:

These words Therefore How they are And become What they Want to say

Discussion: a poetics of vulnerability?

In the analysis, we asked how poetic language can be a resource for young adults living with psychosis through participation in a safe and supportive creative writing group. In the results, we have outlined how a selection of texts, together with extracts from the interviews from the participants, have underscored that poetic language can indeed be a resource for the participants. In the following, we highlight some of the above findings in light of our theoretical framework and previous research.

Ricoeur’s philosophy underscores the productive work of poetic language and metaphor (Ricoeur  2008b , Valdés  1991a ) and how this might offer perspectives of how we understand and orient ourselves in the world. The practice of creative writing gave access to a poetic and productive language in the group and among the participants. One example is how the exercise of feelings and metaphor gave way to a reflexive room in the group, opening up nuanced understandings of language and the potential in the participants themselves and among the group members. The experiences of this exercise underscore the cocreative aspect of both the writing and the subsequent exchanging of perspective and reflection in the reception of the poem. The latter is accentuated by how the participants saw themselves and each other in a different light through the poem, underscoring Ricoeur’s point that poetic language can open for an understanding of the subject ‘in front of the text’ ( 1981 ) by proposing a world we can inhabit. In Ricoeur’s existential hermeneutics, this involves the possibility of an enlarged self through available creative discourses, something we believe hints at the experiences that became part of the group.

Furthermore, when Ricoeur argues that poetic images must be seen as verbs —as potential redescriptions of the world—we find it fruitful to see this in relation to other aspects of what an expressive, poetic language opened up for in the group. We saw how the participants found new resources in themselves through creative writing, like when Cindy discovered that she actually could write and that she liked it. In addition, a creative language opened up new ways of knowing oneself, as well as knowing others. As Cindy explained, she was surprised by how the writing group made the members get to know each other. Despite the fact that they had been together for longer periods during treatment, this was the first time they engaged with each other, realising that they had something in common. Another example is Gordon’s experiences of how things became different when he put them in writing, as well as learning more about himself and the others through writing and talking about the texts. Kristeva’s emphasis on poetic language as dialogic also underscores this central aspect of what we found in the texts and among the participants. A practice of creative writing potentially involves a dialogue with oneself and with the texts produced in the group, as well as among the members in the writing group.

We also look at how Kristeva’s argument that poetic language can counteract an oppressive symbolic order might point to aspects of the writing group. Here, we consider David’s words about how he found therapy to be ‘a sofa and a chair and a fucking discreet notebook’ held together with his need for being treated as more than his diagnosis. We can also look at Nick’s claim that he had felt more like a real person in the group. We believe that these experiences are closely related to how poetic language and the process of writing, as well as the reception of the texts, do something. They open a way out of a fixed understanding of the group members as patients with mental illness towards potentiality and agency. After one of the group sessions, the second author remarked on how the participants’ linguistic expressions were met with genuine curiosity and appreciation and were taken seriously by the group leaders and the other participants. Nothing written or expressed was deemed wrong or awkward. The experience of mastery in the practice of creative writing and reception hints at a different symbolic order than what the participants were used to in meetings with the health care system and maybe the school system before that. For instance, in the example where Nick expressed how he had never thought about the fact that he was a patient when he was part of the group.

Furthermore, Kristeva argues for how mental illness, when strengthened by the semiotic, can be a resource, a type of dark matter for creativity. All three authors of the current article were astonished by the creativity and linguistic originality that were present in the group, more than we have experienced in similar creative writing groups among cancer patients. David seemed to agree with this when he concluded in his text ‘The long table’:‘our heads rule, we own this’. MacCabe et al. ( 2018 ) has explored the association between studying a creative subject at high school or university and later mental disorder, finding that people studying artistic subjects at university are at higher increased risk of developing a severe mental disorder. MacCabe et al. ( 2018 ) point to two putative reasons for this: evolutionary genetics and psychological explanations. The first has regained attention because of a recent demonstration of an association between polygenic risk scores for schizophrenia and bipolar disorder with membership in artistic societies or creative professions (Power et al. 2015 ). The latter points to cognitive styles that may be associated with both creativity and psychosis, such as divergent thinking patterns (Folley and Park 2005 ; Gibson et al. 2009 ). If this is the case, creative writing and other forms of art therapy may be especially suited for people with severe mental health problems. This should be investigated further.

Another important finding from this work that we would like to reflect on is how poetic language opens up nuanced understandings of potentiality and agency through play and wonder. This is part of what Ricoeur ( 1976 ) terms the ‘surplus of meaning’, underscoring how poetic language can never be seen as a duplication of the world; instead, it must be seen as a metamorphosis. In particular, this is apparent in what we have highlighted under the findings as ‘writing as mystery’, an opening towards linguistic creative expressions that hint at depths that cannot be exhausted. The texts are open to the self and the world in a way that is genuinely poetic and productive, where both experiences from illness and other aspects of life can be put in writing without being dissected or defined.

Our experiences from this pilot underline that a creative writing group can be a valuable practice for young adults who have experienced psychosis. Although the research on creative writing in mental illness and psychosis is still in its infancy, our findings correspond with previous research that highlights creative writing as part of a recovery process in how it involves symbolisation and self-expression (see, e.g., Houlding and Holand 1988 ; Kar and Barreto 2018 ; Shafi 2010 ; Bundesen and Rosenbaum 2020 ). Researchers draw attention to how an emphasis on literary technique and processes opens for cognitive remediation (King et al. 2013 ) and an opening towards processing outside of the subject (Bundesen and Rosenbaum 2020 ). Moreover, the importance of the group as a place for positive affirmation and group affiliation is also found in our pilot and has been highlighted by others (e.g., Houlding and Holland 1988 ; King et al. 2013 ; Bundesen and Rosenbaum 2020 ).

A creative writing group might not be for everyone. It is essential that this stay a voluntary offer, but it should not preclude patients who have never written before or who are in different phases of treatment. We experienced that participants were in different phases, and we also saw them evolve and get better through the course. Our experience is that there was great support in the group, even though the participants were a mixture of in- and out-patients in the same group. Some had written before, and some had joined the course more out of boredom and were pleasantly surprised. In line with King et al. ( 2013 ) and Bundesen and Rosenbaum ( 2020 ), we stress the importance of literary competence in the arranging of creative writing groups. The importance of learning and listening to each other’s texts as literary expressions was vital for group development and the experiences of the group members. Furthermore, we would like to emphasise the need for flexibility in how the participants could be free to withdraw from writing assignments in the group or bring texts outside of the writing prompts.

Closing reflections

We would like to end this discussion by once again highlighting Kristeva’s ‘ethics of linguistics’ ( 1984a ) and Ricoeur’s ‘poetics of being’ ( 1950 ) as a contribution to understanding the potential of poetic language in mental health care. As we have seen in the writing group, the practice of creative writing can give affordances to subjects in movement and subjects in becoming in a safe group environment. As a creative community, and by being in dialogue with cultural and literary resources in the culture, poetic language can be part of a recovery process where the subject can find a voice, hope and connectedness. An opening towards creative language, as we have seen in the texts and in the expressions of our participants, can truly be poetic in the way that it creates, rediscovers and enchants the world. Thus, poetic language might open towards relatedness to oneself, to the group and to the world.

Acknowledgements

We would like to thank the participants in the group for sharing their experiences and texts with us. We also would like to thank Birgit Bundesen, Bent Rosenbaum and colleagues in the ‘Re-writalize-project’ for their fruitful discussions of creative writing and mental health.

Not applicable.

Data availability

Compliance with ethical standards.

All authors declare that they have no conflict of interest.

1 It must be noted that when Ricoeur is using the term ‘poetic language’, this is not only related to poetry but also to fictional narratives and also other creative linguistic genres such as personal narrations, which are influenced by fictional narratives.

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Contributor Information

Oddgeir Synnes, Email: [email protected] .

Kristin Lie Romm, Email: [email protected] .

Hilde Bondevik, Email: [email protected] .

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Writing Creatively to Make Sense of the Times We Live In

Journalist katrin schumann talks about why she writes fiction..

Updated July 12, 2024 | Reviewed by Davia Sills

• Studies show that the act of all kinds of writing hones our reflective abilities.
• Creative writing stretches our imagination, increases emotional resilience, and alleviates stress.
• Writers of nonfiction examine complex issues that are relevant to our times.
• Novelists examine the issues using characters as a vehicle for empathy.

Studies show that the act of writing hones our reflective abilities, stretches our imagination , increases emotional resilience , and alleviates stress . In my conversation with journalist-turned-novelist Katrin Schumann, we discuss how creative writing, in particular, is a worthy pursuit to understand the issues of our time. Schumann is the author of the nonfiction books Mothers Need Time Outs Too and The Secret Life of Middle Children, as well as the novels The Forgotten Hours and This Terrible Beauty .

You’re a trained journalist and the author of nonfiction books. Why, in the last few years, have you focused on writing fiction?

Writing nonfiction has been a way for me to examine complex issues that are relevant to our times, including psychological ones, but I’ve found that in recent years, I’ve been drawn to fiction because it allows me to get closer to the subject. In exploring thorny issues like loyalty and trust or co-dependency , I’m able to do more of a deep dive in fiction. The form allows me to sit with the complexities, to live in the gray areas with my characters.

I can’t always do this with nonfiction, where I’m approaching the topic from a specific angle, seeking solutions. In fiction, I have space to explore nuances that fascinate and confuse me and try to make sense of the inevitable contradictions. It’s messier and more delicate than nonfiction. For me, this feels more true to the human experience.

All writing involves deep reflection. Do you find the act of writing fiction to be a different kind of therapy?

Yes. Spending years creating characters and situations that grapple with serious, real-world problems lets me explore my own difficult experiences. For instance, I’d been wrestling with the aftermath of dealing with a narcissist when I started writing my first novel. By fictionalizing those challenges, I was able to find the courage to linger in the dark areas, examining them from all angles in order to find where the light might get in.

I discovered greater empathy and resilience in myself while also being able to acknowledge the trauma I’d been through. It’s using my imagination, combined with researching some very real and current psychological challenges, that ultimately feels most powerful to me and an effective way to reach readers.

How does fictionalizing the story give you more latitude or depth in exploring topics? You write about things like self-reliance and depression, and I’m wondering why not just write articles about it.

I write to figure out my own issues and to learn, but also to share. For me, fiction writing makes me work harder and go deeper. I’m trying to change people’s minds and hearts in subtler ways. I’m reflecting on experiences I’ve had, wrestling with what they mean, and how we can all learn from them and come out the better for it.

Yet, I don’t want to be prescriptive; I want people to draw their own conclusions. I research deeply about whatever topic I’m tackling.

To write my last novel, I studied the history of neuropsychology, dissecting studies on substance abuse . I conducted interviews. For all my books, I gather and study facts and figures, but with novels, I take that a step further. I put those facts and figures into play with my imagined characters to explore what happens. I imbue the impersonal with empathy and allow readers to try to figure out how they feel about how the characters contend with the issue. This approach leads me to meaningful personal discoveries while also taking the reader along on the emotional journey.

How do you decide whether to approach a topic in a nonfiction book or in a novel?

The more I’m personally involved with the topic, the more I want to explore it in fictional form. Ironically, for fiction, I feel like I should have an even better understanding of some of these psychological challenges than if I were covering them through straight nonfiction reportage. I first have to understand the topic and its history so my story is not only realistic but feels authentic.

I want readers to trust me, which means I have to be thorough. It’s my aim to take them on a ride that’s compelling as well as informative. And I love learning something new when I’m immersed in researching and writing fiction.

If writing fiction is about wrestling with your own demons, why not simply journal?

Journaling is, without question, a beneficial reflective activity. Yet what differentiates this kind of work from journaling about our problems or writing blog posts is that novelists are committing more time and energy to the deep dive on a specific topic. My last novel took almost three years to write, and during that time, I was reading everything I could get my hands on about the topic in order to distill it so that readers might find it relevant to their own lives.

At that stage, it’s not really about me anymore; it’s about the human condition. And in the end, that’s what readers relate to, I think. It’s what makes them call their friends and say, “I just finished this great book. You’ve got to read it.”

More about Katrin Schumann 's work

Lynne Griffin, R.N., M.Ed. , researches family life and is a novelist.

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Palouse Writers Guild

Books & Brews 2024

Join us to celebrate the successes of our local writers! Books & Brews is FREE, family-friendly, and open to the public. This event is an opportunity for the public to meet and greet local authors in a festive book fair atmosphere. Moscow Alehouse is our beverage provider. In addition to …

Call for Authors

The Palouse Writers Guild is hosting its 5th Annual Books & Brews event on Saturday, June 22, 2024. At this free, family-friendly event, authors can meet with the public and autograph their books. The event will be held at the 1912 Center, in Moscow, Idaho and will run from 4 …

2024 Writing Contests

It’s writing contest time! You spoke, we listened. This year there will be two categories for short stories: novice and general entry. Anyone who has been published (yes, even self-published) goes in the general entry category. The novice category is limited to those writers who have never been published in …

2023 Contest Winners

We are pleased to announce the winners of the 2023 Palouse Writers Guild contests. Congratulations to all the winners and thank you to all who participated! Short Story Contest 1st Place The Void by Cora Irelan (Moscow, ID) Runner-up Now You See Me by James Foster (Potlatch, ID)   First …

2023 Books & Brews

Join us to celebrate the successes of our local writers! Books & Brews is FREE, family-friendly, and open to the public. This event is an opportunity for the public to meet and greet local authors in a festive book fair atmosphere. Moscow Brewing Company is the beverage provider and non-alcoholic …

2023 Palouse Writers Festival

The Palouse Writers Guild is pleased to present the line-up for our 4th Annual Palouse Writers Festival and Books & Brews events. Date: Saturday, June 17, 2023 Location:1912 Center, 412 East Third St., Moscow, ID 83843 Workshops What Teens Want: Exploring YA Fiction Time: 11:30 AM (75 min session) Location: Reception …

The Palouse Writers Guild is hosting its 4th Annual Books & Brews event on Saturday, June 17, 2023. At this free, family-friendly event, authors can meet with the public and autograph their books. The event will be held at the 1912 Center, in Moscow, Idaho and will run from 5 …

2023 Writing Contests

It’s writing contest time! Anyone may enter the first chapter contest, but the short story contest is limited to novice writers who have never been published before. Information for both contests is below. Submission guidelines are the same for both contests. Multiple submissions are allowed and can be mailed in …

NaNoWriMo 2022

Great news WriMos and Rebels–NaNoWriMo is back! After two years of being sequestered at home, writing alone, NaNoWriMo has returned to hosting in-person write-ins and the Palouse Writers Guild is encouraging local writers to connect and share. For those community members not familiar with the program, NaNoWriMo is the acronym …

NaNo Prep 101

Have you ever longed to write a novel? Well, now’s the time! NaNoWriMo is short for National Novel Writing Month. Founded in 1999 with just 21 participants, this novel writing movement has grown to nearly a million writers annually. During the month of November, participants are encouraged to write an …

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Department of English

M.f.a. creative writing.

English Department

Physical Address: 200 Brink Hall

Mailing Address: English Department University of Idaho 875 Perimeter Drive MS 1102 Moscow, Idaho 83844-1102

Phone: 208-885-6156

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M.F.A. Faculty

Leah hampton, assistant professor.

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Michael McGriff

Associate professor.

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Scott Slovic

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Alexandra Teague

Associate chair and professor of english; co-director, mfa in creative writing; co-director, women's gender & sexuality studies.

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Retired Faculty

Distinguished professor emerita.

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Ron McFarland

Professor emeritus.

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Daniel Orozco

Associate professor emeritus.

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Joy Passanante

Professor emerita.

Robert Wrigley

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