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Abstract

Recent developments in online support and counselling suggest that the users of chat rooms, for example, or the Samaritans' e-mail 'listening' service, have already discovered the power of writing as a self-help vehicle. Developments in computer-mediated counselling and therapy are essentially text-based and client-driven. The therapeutic use of expressive and reflective writing is not widely recognised in British counselling and therapy circles. The empirical foundations for the therapeutic uses of the literary arts are, however, well established. This review aims to map the use of 'writing therapy' by drawing together cross-disciplinary research and practitioner reports which might support the place of writing as a creative therapy in its own right, whether as an adjunct to face-to-face counselling or as a self-help tool.
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British Journal of Guidance & Counselling
ISSN: 0306-9885 (Print) 1469-3534 (Online) Journal homepage: http://www.tandfonline.com/loi/cbjg20
Mastery or mystery? Therapeutic writing: A review
of the literature
Jeannie Wright & Man Cheung Chung
To cite this article: Jeannie Wright & Man Cheung Chung (2001) Mastery or mystery?
Therapeutic writing: A review of the literature, British Journal of Guidance & Counselling, 29:3,
277-291, DOI: 10.1080/03069880120073003
To link to this article: http://dx.doi.org/10.1080/03069880120073003
Published online: 17 Jun 2010.
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ISSN 0306±9885/print/ISSN 1469 ±3534/online/01/030277±15 2001 Careers Research and Advisory Centre
DOI: 10.1080/03069880120073003
Br itish Journal of Guidance & Counselling, Vol. 29, No. 3, 2001
Mastery or mystery? Therapeutic
writing: a review of the literature
JEANNIE WRIGHT
Counselling Ser vice, University of Sheffield, Northumberland Road, Sheffield S10 2TT,
UK
MAN CHEUNG CHUNG
Department of Psychology, University of Plymouth, Drakes Circus, Plymouth PL4 8AA,
UK
AB S TR AC T Recent developments in online suppor t and counselling suggest that the users of chat
rooms, for example, or the Samar itans’ e-mail `listening’ ser vice, have already discovered the power
of wr iting as a self-help vehicle . Developments in computer-mediated counselling and therapy are
essentially text-based and client-driven. The therapeutic use of expressive and reflective writing is not
widely recognised in B ritish counselling and therapy circles. The empir ical foundations for the
therapeutic uses of the literary arts are, however, well established. This review aims to map the use of
`writing therapy’ by drawing together cross-disciplinary r esearch and practitioner reports which might
support the place of writing as a creative therapy in its own right, whether as an adjunct to face-to-face
counselling or as a self-help tool.
Introduction
Consumer demand for alternatives to the `talking cure’ , the traditional, individual,
face-to-face, 50-minute hour of counselling and psychotherapy, is indicated both by
anecdotal repor ts of the use of chat rooms and `online therapy’ and by a recent survey
initiated at the Maudsley Hospital in London (Graham et al., 2000). When asked
about their preferences for the delivery of self-help psychotherapies, 62% of
respondents wanted access to self-help therapy via paper-based formats, but 91% of
these same respondents wanted access via some form of computer system.
The reconstruction of therapeutic practice (McLeod, 1999) in the UK,
represented by online counselling or computer-mediated `writing therapy’ , has been
relatively slow and characterised by practitioner caution (BAC, 1999; Goss et al.,
1999; Parker, 1999). Reporting a number of computer treatment systems in clinical
service for the treatment of obsessive±compulsive disorder and phobic anxiety
disorders, Graham et al. (2000) conclude that `computerised delivery of cognitive±
behavioural therapy for psychiatric disorders is developing rapidly’ (p. 331).
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278 Jeannie Wright & Man Cheung Chung
The histor y of using client writing in a therapeutic setting, mostly, but not
exclusively, associated with cognitive and behavioural approaches, is long. It could be
argued that `writing therapy’ has also been restimulated by the development of
narrative approaches (McLeod, 1997) and computer-mediated methods where
keyboard and cyberspace have replaced pen and paper.
This review will aim to outline the major developments in the therapeutic use of
writing in the English language over the last 30 years with an emphasis on recent
research in the USA and Europe.
Although it will refer to the implications for online therapy, the focus of the
review will be the underlying debate along the `mastery’ (scientific) and `mystery’
(humanities) continuum, comparing the theoretical assumptions of both para-
digms, their methodologies and their findings about the benefits of therapeutic
writing.
A continuum exists in the growing body of literature on therapeutic wr iting
between the polarities of a `scientific’ and a `humanities’ approach, or between
`mastery and mystery’ (Bakan, 1969, quoted in McLeod, 1994). On an international
basis, those practitioners and researchers who come primarily from a literary arts or
creative writing background tend to describe the `soothing and healing power of
poetr y’ (Bolton, 1999a ), for example, or `writing to provide a mechanism for
psychological insight’ (Hunt, 2000). Drawing on their experience of clinical practice
(Fuchel, 1985; Moskowitz, 1998) or of facilitating creative writing groups (Bolton,
1995, 1999a, 2000; Hunt, 2000; Hunt & Sampson, 1998) the therapeutic benefits of
writing are explored with an enthusiasm verging on the evangelical.
Those who follow a more scientific paradigm, from disciplines including
immunology, health and social psychology, seek to `master’ the phenomenon by
measuring, explaining, predicting and analysing the results of randomised, controlled
trials. Psychologist James Pennebaker and his associates have initiated studies into
the empirical foundations for writing about emotional experiences, the results of
which have been critiqued, replicated and extended in North America, Europe and
many other parts of the world (see Pennebaker & Seagal, 1999). These experiments
clearly demonstrate the benefits of `writing therapy’ for both physical and mental
health.
The increase in and demand for online suppor t and counselling (BAC, 1999)
suggest that the users of chat rooms, for example, or the Samaritans’ e-mail suppor t
service (Baughan, 2000) have already discovered and are using writing as a self-help
tool. More central to potential use rs’ concer ns and to those of practitioners,
especially those working within the pressures of a brief/time-limited model, is the
question: how can client writing enhance the psychotherapeutic process?
These practitioner/researchers give their views: `Perhaps there is no other system
of psychotherapy in which the client has so much control over the rate, depth and
intensity of his or her personal therapeutic work’ (Rasmussen &
Tomm, 1992, p. 3);
or `Writing is a kind and comparatively gentle way of facing whatever is there to be
faced.
You can trust it to pace itself to your needs and wants rather than to anyone
else, such as a therapist. It can be private until you decide to share it’ (Bolton, 1999a,
p. 12).
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Mastery or mystery? 279
Comparisons between vocal and written expression of feeling about traumatic
events have been analysed (Murray & Segal, 1994) and would suggest that there is
similar emotional processing by vocal and written expression of feeling. Bolton’s work
in `writing therapy’ encompasses f ar more than writing to disclose feelings about
specific, stressful or traumatic experiences however, and `writing therap y’ is not
narrowly defined in her publications.
Definitions of `writing therapy’
Defining `writing therapy’ is difficult Ð `. . . a useful but vague and poorly defined
technique’ , in Riordan’s (1996) summaryÐ nor is there one neat theoretical model or
set of empirical findings to guide the use of therapeutic writing. References to
parallels with other expressive and creative therapies, art, movement, drama and
music, for example, are clear but there is little systematic explanation as to why
writing therapy has not developed to the same extent.
For the purposes of this review, writing therapy is defined as client expressive and
reflective writing, whether self-generated or suggested by a therapist/researcher. Therefore,
the use of writing by the therapist about the client, such as in case notes or in farewell
letters (Ryle, 1990), is not included.
It is not intended to polarise or oversimplify the body of literature on writing
therapy by structuring the review around the scientific/humanities continuum. If
anything, as Mazza (1999) argues, both approaches are needed in order to develop
the research base and professional practice of writing therapy.
The `humanities paradigm
The National Association for Poetr y Therapy (USA) represents the most developed
of the therapies which uses creative writing. Standards and ethical guidelines are in
place in the USA for Certified Poetry Therapists and Registered Poetry Therapists
(Mazza, 1993, p. 51). Mazza (1999) extends an earlier research agenda for poetry
therapy and suggests that both quantitative and qualitative research methods are
needed at this interface of the arts and psychology.
In the UK, Hunt and Sampson (1998), both involved in the organising
committee of LAPIDUS (The Association for the Literary Arts in Personal
Development), define `writing’ as `what is generally called ª creative writingº , rather
than, for example report writing or clinical notes’ (p. 199). They have edited a
collection of essays which link autobiographical and expressive writing to personal
development and healing. The Self on the Page: Theor y and Practice of Creative Writing
in Personal Development is useful for its detailed accounts of current practice in a wide
range of British educational and healthcare settings. The emphasis in accounts of
research undertaken is on qualitative methods.
The section on theoretical contexts is a tentative collection of ideas, drawing on
psychoanalytic theory, linguistics, symbolic interactionism and philosophy, ancient
and moder n. The need to synthesise and to work across disciplines in the field of
writing therapy is apparent. In her most recent book, Celia Hunt (2000) adopts a
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280 Jeannie Wright & Man Cheung Chung
`Horneyan literary±psychoanalytic approach’ to cast-studies of four `highly literate,
self-reflective’ women who took part in her `Autobiography and the Imagination’
creative writing course (p. 14). Some of the exercises described, such as `life
mapping’ , will be familiar to guidance practitioners and counsellors who recall the
innovative use of `psychoeducational’ methods in the 1970s (e.g. Figler, 1979; Ivey &
Authier, 1971).
Hunt explores the complexity of her chosen theoretical model with great
tenacity, asking impor tant questions about the tension between writing as art and
writing as therapy. She points out the limitations of her approach, however, first in
not focusing on broader cultural or sociological questions of class, gender or
ethnicity.
There is certainly very little sense of the political awareness of constructivist
approaches, to be found in some contributions to the field (e.g. Bacigalupe, 1996)
where questions of social justice and user preference are addressed. Ethical
boundaries are also less than clear, as pointed out by Hunt herself:
`There are considerable risks associated with applying psychodynamic
theor y to the written and spoken words of people one is working with
without the safe-guards which would normally be built into the therapeutic
relationship’ (Hunt, 2000, p. 191).
Gillie Bolton, a poet and leading British practitioner/researcher working largely, but
not exclusively, in health care settings, also comes from a background of teaching
creative writing. Describing her theoretical model as `eclectic’ , the humanistic
tradition predominates, and specifically Rogers and Perls are cited. The methods
Bolton advocates skilfully marry a number of approaches from creative education
and therapeutic practice, for example, the boundaries of confidentiality and `self-
empowerment’ of experiential small groups, where the facilitator’ s role is not to
interpret. Bolton’s (1998a) `Writing or pills: therapeutic writing in primary care
repor ts the positive findings of a pilot project carried out under the auspices of the
Institute of General Practice at the University of Sheffield. In challenging the
British medical profession to undertake a new, creative way of working with
patients, she stresses the power of writing in a setting where patients are all too
often passive and powerless. One advantage of writing, in Bolton’s view of her
research, is that it is:
`for patients and by them rather than being done to them. Too much
medicine is diagnosis from the outside and having treatments done to the
patient’ (Bolton, 1999a, p. 5).
Bolton’s work is criticised by some for implying that in self-directed therapeutic
writing there are no risks. Conversely, as illustrated by the above and by self-report
from a range of participants in writing groups, it is this very emphasis on the potential
of therapeutic writing for self -help, prevention and self-directedness which makes it
such a viable alternative to those who choose to write, whether or not they enter
therapy.
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Mastery or mystery? 281
Some attention is paid here to the question of for whom and under what
circumstances writing is most effective. Patients to whom it was appropriate to
suggest writing therapy included those suffering from problematic life circumstances
rather than chronic depression, for example. Those it would not be useful for
included `disturbed or psychotic patients’ who, it was felt, needed more supervision
than a GP could offer. A summary of these and other findings will be considered in
more detail in the implications for practice section at the end of this paper.
Bolton points out that `poetry and medicine have gone hand in hand since
Apollo was the god of both’ (Bolton, 1999b, p. 119). Certainly the poetr y and `stor y’
columns in the British Medical Journal and Journal of the American Medical Association
are enriching and could be welcome additions to some of the currently somewhat arid
counselling and therapy journals published in the UK.
Drawing from her extensive experience of running workshops with small groups
of women (Bolton, 1999b), and citing examples from modern poetry written by
women, including Sylvia Plath and Anne Sexton, the particular persistence of the
savage inner critic in women is addressed. Bolton (1995) compares writing as therapy
to other expressive therapies: `Like art therapy it offers direct access to a client’s
creativity’ (Milner, 1971, p. 216).
Although there are similarities between Bolton’s methods and those of the
Pennebaker paradigm, such as instructing the client/group in `writing without
thinking’ , a clear divergence emerges here. Practitioners and researchers from the
cognitive±behavioural/`scientific’ end of the continuum, for whom client creativity
and imagination are variables to be reduced if possible, underestimate this most
important aspect of `writing therapy’.
Bolton’s (1999a) The Therapeutic Potential of Creative Writing: Wr iting Myself
conveys a passion for writing and a range of experience of working with groups who
repor t its physical and psychological benefits. One reviewer called it `a bubbling
cauldron of a book’ , conveying the sense of wanting to rush out and follow the
author’ s enthusiasm to try out some of the ideas and exercises. Although Bolton’ s
ideas and practical examples of ways to begin writing are equally powerful for
individual use, it is perhaps the descriptions of group work, many from group
participants themselves, which stand out. The harnessing of the expression of
hitherto undisclosed emotion and private insights in writing, together with the
potential for support and challenge in well-facilitated small groups create results
which are difficult to define or explain. Bolton herself, rather than explaining,
recommends experiential methods for both potential users of writing therapy and for
practitioner/researchers. Could this process be measured, analysed, predicted?
Bolton (1999a) refers to Pennebaker and other leading representatives of the
scientific paradigm, whose findings on the beneficial effects of writing support her
own. In her critique, she points out that Pennebaker and his associates are working
from a different model and contests their assumptions about the self. Her own view
is:
`People are composed of a stewpot of beliefs, understandings, memories,
terrors and hopes. Different elements bubble up at different times, wanting
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282 Jeannie Wright & Man Cheung Chung
and needing to be attended to. Dealing with these in an appropriate way
then and there will lead to a more balanced and happy individual. But there
are no r ight or wrong elements’ (Bolton, 1999a, p. 200).
Bolton is not a neutral obser ver. Her stance draws on a long tradition of the
therapeutic use of human creativity in general and writing in particular: `. . . poems
are a hotline to our hearts, and we forget this emotional power at our per il’ (Motion,
2000).
The possibility of synthesis
Family and systemic therapy has been a fruitful area for therapeutic writing and
demonstrates the potential for synthesis of science and humanities or `mastery’ and
`mystery’ . Bacigalupe (1996), practising in an American family therapy and
community mental health context, emphasises, like Bolton, the client-centredness of
writing with and by the client rather than wr iting about or to the client. The
implications and relevance of client writing for working cross culturally are also
highlighted. Bacigalupe also links the participatory basis of writing therapy with the
power imbalance within any helping relationship.
By writing about particular problem areas, the client becomes expert on their
own material, thus challenging the boundaries between what White and Epston
(1990) call `exper t knowledge’ and `local knowledge’ . This is particularly crucial
when the social status of the client is inherently subject to discrimination and
oppression.
`The question of writing in therapy is also relevant to discussions about
issues of social justice in therapy contexts (e.g. therapists working with
minority families.) Work in a community health clinic can challenge
therapists with questions about gender inequalities, institutionalised racism,
evolving ethnic and cultural values and class ism’ (Bacigalupe, 1996,
p. 362).
Writing in this context is empowering and inclusive. Examples given from family
therapy in Australia and the USA include instances where adolescents and children
are encouraged to write about their experience of foster care, for example, and
present that writing to the `experts’ on the panel of professionals who hold the power
to make decisions over their lives.
Describing a systemic innovation which Terperger Rasmussen, a Danish
psychiatrist and psychotherapist, initiated in 1979, Rasmussen and Tomm (1992)
outline a `long brief therapy’ , the core of which is `respect for the client’s self-
directedness’ (p. 18).
Pragmatism, and not wanting to succumb to pressures to abandon his interest in
psychotherapy in favour of prescribing medication, was largely Rasmussen’ s original
motivation for using writing with non-psychotic patients. His approach to guided
letter writing emerged in response to the time pressures of the Danish health care
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Mastery or mystery? 283
system and long train journeys incur red by his practice between urban and rural
areas. Letters from patients could be read on the train!
Within a time-limited model,
Rasmussen encourages and supports his clients’ existing resources, including their
autonomy and creativity, thus mirroring the `empowerment and self-healing’, which
is the focus of Bolton’ s work with groups. `In this method, clients are coached to
search out and find what they need the most and will do so if the therapist doesn’ t
interfere too much’ (p. 18).
Tomm has applied Rasmussen’s approach in psychiatry in Canada, and outlines
his clinical findings. There is no evidence of systematic evaluation.
The scientific paradigm
If science is the art of the soluble, then Pennebaker and other empiricists have failed.
Four leading American researchers (Esterling et al., 1999) admit that `despite the
beneficial effects of writing, it is not entirely clear why it is effective in bringing about
such striking physical health and behavior ch ange’ (p. 84).
The beneficial effects of written emotional expression are, however, clearly and
precisely recorded and have been subjected to meta-analysis (Smyth, 1998). One
decision on how to categorise this wide-ranging body of work for the purposes of this
review could have been chronological and geographic, showing the development of
randomised controlled trials, internationally, over a 15-year period and across
populations. Instead, to illustrate the wealth of research outcomes within the
Pennebaker paradigm, the work of the leaders of the field in the USA and of those in
the Amsterdam Writing Project will be highlighted.
Reviews of core research on written emotional expression and health (Esterling
et al., 1999; Pennebaker, 1993) and `meta-analytic reviews’ of the written emotional
expression literature (Smyth, 1998) suggest various benefits, including physiological
functioning, e.g. impact on the immune system (see Esterling et al., 1990, 1994;
Greenhalgh, 1999; Pennebaker et al., 1988; Smyth et al., 1999).
Some potential disadvantages of therapeutic writing are also considered, such as
short-term negative mood related to long-ter m improvements in self-reported
psychological well-being (see Pennebaker, 1990, 1993, 1995).
Theoretical models to explain the benefits described are less confident. The
cognitive±behavioural paradigm predominates, suggesting, for example, that emo-
tionally expressive writing facilitates cognitive processing of traumatic memory,
which leads to affective and physiological change (Pennebaker et al., 1990).
The links between boosting the immune system and emotional disclosure in
writing (Esterling, 1990, 1994) suggest that the therapeutic uses of the literary arts
are on a firm psychobiological foundation (Lowe, 2000).
Specific chronic illnesses, for example, have been the subject of RCTs using
writing about stressful experiences as a `nonpharmacological’ treatment. Smyth et al.
(1999), researching the effects of writing with patients with asthma or rheumatoid
arthritis, concluded that clinically relevant changes were found in those who had
written about stressful life experiences. Headlines such as `The pen is more powerful
than the p ill’ have drawn popular attention to the efficacy of writing. The economic
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284 Jeannie Wright & Man Cheung Chung
implications for such a low-tech, low-cost intervention are discussed in the
literature.
Similarly, the potential for health care `at a distance’ was recognised before the
widespread development of `telehealth’ via the Internet. LAbate (1991, 1992,
1999a,b), a family therapist working in the USA, has contributed significantly to the
literature on the use of writing, specifically with distance and programmed writing
materials, which can be used preventively or in computer-assisted training (L’ Abate
& Baggett, 1997). Known for his humorous suggestion that counsellors should be
advised to tell their clients they must write, `unless they 1. like you a lot, 2.have plenty
of money, 3. have excellent insurance, and 4. want to stay in therapy for ever!’
(L’Abate, 1992, p. 48), he has also been a major figure in the `mastery/mystery’
debate. He questions traditional modes of family psychotherapeutic practice and
advocates new techniques, including writing, that do not rely on therapist±patient
talk.
His early writing (L’Abate, 1991) shows a controlling, `therapist as expert’
ethos:
`Although self-administered by patients, completed assignments are scruti-
nised by the therapist who then provides cor rective feedback. These
assignments are used as a springboard for further discussion and exploration
in therapy. Generalisations, distortions, deletions and other errors in
thinking are pointed out by the therapist and worked through’ (p. 90).
Later accounts (Jordan & L’ Abate, 1995, 1999) also emphasise the need for `constant
correction’ by the therapist as `crucial’ .
Offering a critique of and advancing Pennebaker’s early work on writing about
traumatic experiences, Lange, Schoutrop and colleagues in the Amsterdam Writing
Project have used qualitative studies to highlight effective and ineffective ways of
writing about trauma. Referring to learning theory as the foundation of the model,
Lange (1994, 1996) describes the benefits of `ritualised wr iting’ and especially letter
writing, in reprocessing traumatic events. The methods are directive and involve the
therapist giving `precise instructions’ to the patient about `subject matter, the manner
of writing, frequency, the amount of time spent and loc ation’ (Lange, 1996, p. 376).
Working in family therapy, Lange demonstrates through cast-studies how writing, `a
powerful and ª friendlyº tech nique’ (1994 p. 381), results in self-confrontation
leading to cognitive reappraisal.
In subsequent studies (Schoutrop et al., 1997a,b; Van Zuuren et al., 1999 ) the
psychologists/researchers inspect the writing in a more open and reflective way. Rather
than
`searching for a direct relation between writing therapy and an outcome measure’
(Van Zuuren et al., 1999 p. 364) the group aims to study an overview of positive and
negative textual features to identify elements in the writing which are indicative of
effective or ineffective writing.
They also exemplify a less prescriptive style:
`the finding that some participants deviated successfully from their
assignment could be transformed into the instruction that deviation is
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Mastery or mystery? 285
permitted if the participant considers this useful. Clients might even be
offered several types of instructions, in order to be able to choose which type
will work best for them’ (p. 377).
A greater degree of client self-directedness is implied.
Conclusions
This review maps how the literature across the continuum has shown that expressive
writing can, under some circumstances, improve physical and psychological health.
In spite of academic and popular exposure, however, on neither side of the Atlantic
is writing `part of the mainstream psychotherapeutic armamentarium’ (Esterling et
al., 1999, p. 94). The emergence of online counselling and therapy may change
that.
Meaningful comparisons in terms of theor y, methodologies and findings
between the work of researchers and practitioners of such diversity are fraught. The
difference between humanistic and cognitive±behavioural psychology, for instance,
or between randomised, controlled trials and self-report within cast-studies is the
subject of controversy in volumes of theoretical and methodological discourse in the
social sciences and psychotherapy and would not be an appropriate focus here.
Even where a similar research aim is taken, using similar methodologies, such as
investigations into written emotional expression and its effects on post-traumatic
stress, variables are impossible to reduce entirely. When similar sample groups of
participants are used, for example, a variety of outcome measures have been applied:
physiological measures (including immune function), general health measures (e.g.
somatic complaints and health centre visits), and psychological measures (cognitive,
affective and behavioural effects). Although positive results have been repor ted for all
these domains (e.g. Esterling et al., 1994; Lange, 1994; Pennebaker & Beall, 1986),
definitive comparisons are difficult to draw because of variables in follow -up periods,
diagnosis of the degree of the initial traumatic experience, or the amount of words
actually written. Smyth (1998) takes the medical model to extremes, referring to the
amount of writing done as the `dose. It is this very reductionism which the
researcher/practitioners from the humanities end of the continuum tend to eschew.
Yet, the concomitant criticism of their research, as merely `anecdotal’ , persists.
Unsurprisingly, there is little sense of reflexivity in the accounts of the `scientific’
experiments, a quality which is, on the other hand, one of the strengths of the
`humanities’ approach, in which the voices of participants also have a central
place.
What emerges from studying the process and outcomes of such diverse lines of
enquiry as Smyth’s (1998 ) RCTs and Bolton et al.s (2000) single case-study is the
powerful sense of commonality. For some people, in some circumstances, expressive
writing is beneficial, with or without the added value of a therapeutic relationship.
The narrative approach also emerges as an underlying link. Referring to White and
Epston’ s (1990) innovative work in family therapy, Hunt (2000) is making similar
points about autobiographical narrations, for example, to those of Kuhnlein (1999)
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286 Jeannie Wright & Man Cheung Chung
and McLeod (1997) and to Pennebaker and Seagal (1999), though all would start
from very different theoretical perspectives.
Most often identified with cognitive±behavioural orientations and with cognitive
analytic therapy (Ryle, 1983, 1990), there would seem to be a place for `writing
therapy’ amongst the expressive therapies across all theoretical orientations. As
Bolton (1999a) puts it, `poetr y or story making is therapy for both the body and soul’
(p. 27).
And one of the reasons writing therapy needs the `scientific’ approach is that the
`creative hunches’ of advocates from the `humanities’ body of research are
strengthened by corroborative evidence from the other end of the continuum:
`Thus scientific methodology is seen for what it truly isÐ a way of preventing
me from deceiving myself in regard to my creatively informed hunches
which have developed out of the relationship between me and my material’
(Rogers, 1955, p. 275).
Implications for practice
The simplicity of the way in which writing therapy works, if not the precise
mechanism, is expressed humbly, after a dense analysis of randomised controlled
trials, as follows: `Many people, perhaps most, are able to guide their own therapy.
Writing itself is a powerful therapeutic t echnique’ (Esterling et al., 1999, p. 94).
The implications of these findings for online therapy, where writing is the major
therapeutic vehicle, are complex. A review of the `literature’ , mostly electronic if it is
not to be out of date before it is word processed, let alone published, is the subject
of another paper which would raise some interesting issues about the move from
pencil or pen to keyboard and expressive writing.
An analysis comparing typing and writing longhand in terms of disclosure of
negative emotions, for example (Brewin & Lennard, 1999), may seem trivial
compared to the controversy surrounding the existence and viability of the
therapeutic relationship online, but the implications for practice are urgently in need
of more systematic application.
Similarly, Pennebaker’s work and others, previously cited (see also Cameron &
Nicholls, 1998; Bastien & Jacobs, 1974) in which students have been the participants
in the majority of randomised controlled trials, needs to be widely applied by
practitioners in educational settings. The evidence that writing about stressful or
traumatic experiences results in health and other benefits, including improved
academic performance (Pennebaker & Francis, 1996), is clear, whether or not we can
explain the mechanism that produces that benefit. Writing therapy is cost-effective
and would provide students with a self-help vehicle which some have clearly already
discovered via the Inter net and e-mail lists.
There are, however, indications, other than those already mentioned, that
writing therapy is not always appropriate or beneficial. When the client’s experience
is pre-verbal, for instance, other expressive therapies would be preferred. When
writing is associated with strong negative experiences, such as being criticised at
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Mastery or mystery? 287
school, clients are unlikely to want to try writing therapy. One such client, to whom
letter writing had been `rotten fish’ (Lange, 1996), said, `I don’t want to read or write
about my experienc es’ . Dyslexia has been another clear contraindication.
In addition, the initial negative mood and short-term psychological pain
resulting from writing about traumatic events (Esterling et al., 1999) may be
intolerable for some unsupported writers (i.e. online). The importance of creating a
safe space is thoroughly addressed in the Pennebaker paradigm and also in Bolton’s
accounts of working with small groups.
Table 1 outlines some of the circumstances in which `writing therapy’ has been
beneficial and some examples of supporting evidence.
The caution of the therapeutic profession is not matched by that of their
potential clients, or by the people using chat rooms and other forms of writing
TABLE 1. Circumstances in which `writing ther apy’ has been beneficial
Supporting evidence
Time-limited, focused, br ief therapy Ð some of
the detail can be dealt with outside the therapy
room, on paper and in pri vate;
Advantages of `economy and complexity’, e.g.
Ryle, 1983, p. 365; Rasmussen & Tomm, 1992
With people who have a self-directed tendency
to write Ð journals, diaries, letters Ð and who
have found the process of writing, especially
autobiographical wri ting, cathartic and
clarifying;
Examples from literature throughout history
and as analysed in Hunt, 2000; Hunt &
Sampson, 199 8
With people who are, or perceive themselves to
be, powerless;
Bacigalupe, 1996; case material in Wright,
1999, 2000
With people who are not usin g their first
language in the face-to-face therapy Ð they are
able to use their fir st language or a mixture of
both first and host language;
Wright, 1999
With people who, for cultural or other reasons,
are silenced by shame or other i nhibiting
emotions and feel unable to speak;
Bass & Davis, 1988; Bolton, 1 999b
With people who are in i nner turmoil and n eed
to `unpack the mind’ , externalise and organise
their thoughts and feelings;
Bolton et al., 2000; L’ Abate, 1992; Riordan,
1996
With people who nee d to disclose and exorcise
a particular mem ory of stressful or traumatic
experience;
Pennebaker paradigm reviewed in Smyth, 1998;
Esterling et al., 1999; Amsterdam Writing
Project summarised in Van Zuuren, 1999
With people at particul ar stages of life
associated with experiencing strong feelings,
e.g. adolescence, or with the d ying and those in
hospice care.
Bolton, 1998b
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288 Jeannie Wright & Man Cheung Chung
therapy who would not classify themselves as `patients’ or `clients’. It has been
suggested, for example, that writing may be more effective for males (Smyth, 1998),
who have, traditionally, been underrepresented in statistical analyses of the use of
face-to-face counselling ser vices.
`Above all, writing may provide an alternative for m of preventive therapy
that can be valuable for individuals who otherwise would not enter therapy’
(Esterling et al., 1999, p. 92).
It is based on this evidence that one of us has introduced `writing therapy’ with a
range of clients in time-limited, workplace counselling. A simple sheet of instructions,
emphasising the need to silence the `inner critic’ by `writing without thinking’ and
without concern for spelling, syntax, neatness and other memories of academic red
pens is useful but most important is the potential for clients to come up with their
own ideas. One secretary, for example, who had been to assertiveness classes but was
still struggling to work with an overbearing manager, started to write what she called
`SCREAM SHEETS’ . In an evaluation questionnaire, she wrote, `It helped me to
vent anger/frustration and allowed me to communicate much more effectively once I
actually spoke to that person’ .
Another, an academic with a tendency to intellectualise about his feelings but
who agreed to the suggestion of keeping an emotional diary, wrote that `It helped me
raise cer tain fears/emotions that I was reluctant to admit/confro nt’. A feeling named
is a feeling tamed.
Human communication was revolutionised by the invention of writing. Now
another revolution has resulted in communication via the Internet. So chat rooms
thrive. Lear ning from both the creative writers and from the scientists of self-
disclosure, another valuable vehicle for self-exploration and change is developing.
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Psychotherapy research is still dominated by the drug metaphor, based-in analogy to medical treatment-on the natural science paradigm. Yet this scientific metamodel has its limitations in explaining the complex developments occurring within and after the therapeutic process. Once psychotherapy is understood as a social interaction conveying different aspects of knowledge (concerning behavior as well as self-related experiences and interpretations), you must shift to models and research questions based on the social sciences. In this article, I present the results of a study based on autobiographical narratives of discharged clients of the same psychotherapy ward. We show that new experiences from psychotherapy are integrated, and thereby assimilated, into the previous person schemas. The potential for this integration contributes decisively to the long-term effect of psychotherapy. By using the methods of "social scientific hermeneutics" and ideal typification, we reconstructed the transformation of psychotherapeutic knowledge into four typical structures. These types differ in several respects: (a) their systems of autobiographical construction, i.e., complex metaschemas which develop during a lifetime, (b) their subjective concepts about emotional disorders and about psychotherapy, and (c) their future orientations.