A Basis in Bibliotherapy
The use of writing as a tool in the health field is not a new concept; it has roots in bibliotherapy, a form of therapy that began in the 5th century BCE. This therapy was based on the belief that literature could help people face the challenges that would arise in their daily lives, and was often used to treat melancholia (a condition of profound sadness and despair). It wasn’t until the 20th century that writing in therapy began to truly gain traction in the psychological world.[1]
Sigmund Freud, the founding father of psychoanalysis, is largely responsible for the growth of writing in therapy as a result of his 1907 presentation “Creative Writers and Day Dreaming” (which was eventually written and published). His speech bolstered the concept of writing as a therapy tool and it only continued to grow throughout the 1930s and 1940s, during which time the use of creative arts in therapy became popularized.[2] Currently, writing is one of the most commonly-used tools with patients in psychotherapy, even if it isn’t the focus of the therapy nor the core tool used.[3]
TYPES OF WRITING IN THERAPY
Writing can take several forms within a therapeutic setting. The first is free writing, which often comes in the form of journaling. When free writing, the client’s only instruction is to write what is on their mind; to put their thoughts on paper in whatever form they come in, without censoring or altering them.[4] Though this may seem basic, it’s entirely common for people to try and reject thoughts that they don’t find appealing. They often worry that, by acknowledging these thoughts, they’ll also be giving them credibility, or making them true.[5] However, repressing or denying thoughts instead of addressing them will only do more harm than good in the long run; thus, giving the client a space where they can express all of their thoughts (and easily reflect on them later) can be incredibly beneficial.
Writing poetry is another often recommended outlet, for similar reasons. It provides a creative, positive avenue for a client to express their thoughts and emotions, and helps them channel even negative feelings into something productive.[6]
Letter writing is another common tool used in therapy. Essentially, the client is tasked with writing a letter; the recipient of the letter varies. It may be to themselves, to someone in their life they have unresolved issues with, or to a concept or issue that they’ve personified for the sake of the exercise. However, the letter will never actually be sent to anyone. Its purpose is to allow the client to communicate their feelings (on a given issue or person) to themselves more than to anyone else. By writing them down and expressing them in a way that would help the other person (whether they’re real or imaginary) understand their emotions and perspective, the client can gain a better understanding of their emotions on the matter.[7]
While it does not technically include writing, storytelling can also be used with young children in therapy in a manner very similar to (or even crossing over with) play therapy. One particularly famous example involves the use of dolls. In this exercise, the therapist gives their child client one or two dolls, and instructs them to tell the therapist a story using the dolls. In theory, the story the child tells using the dolls would be reflective of their own experiences, giving the therapist insight into the child’s understanding of and perspective on what they have gone through.
DISORDERS MOST-BENEFITED
Writing is commonly used to treat PTSD, anxiety and depression.[8] For all three psychological disorders, writing is helpful because it allows the patient to externalize their mental processes and emotions in a way that is productive and generally isn’t harmful to themselves or to others. Regarding PTSD, an example of writing therapy is demonstrated in a 2013 study by Lorenz et al.; they invited 70 women who experienced childhood sexual abuse to participate in five weekly 30-minute sessions that included writing therapy. In these sessions, participants would write about their traumas and sexual schemas. Then, at three different intervals—two weeks, one month and six months (post study) they were asked to complete questionnaires centered around their PTSD symptoms, depression, and sexual functioning. Not only did participants report fewer PTSD symptoms post-treatment, but those who wrote about their sexual schemas reported experiencing less sexual dysfunction.[9]
Writing can also be beneficial in treating anxiety. In 2020, the Tabriz University of Medical Sciences in Iran performed a study in which they administered three writing therapy sessions to pregnant women. Each week, they utilized writing therapy in different ways. In the first, the women were tasked with writing about concerns they had about their pregnancy and possible solutions. In the second, they were asked to write a story about their concerns, in which they applied the solutions they had brainstormed in the previous section. Finally, in the third, participants were led through a group discussion about their previous assignments. At the end of the study, the research team concluded that the women who had participated in writing therapy had much lower anxiety levels than the control group, despite having only experienced three sessions.[10]
Patients with depression can also benefit from writing therapy. In a 2014 study published in Cognitive Therapy and Research, two groups of undergraduate students were gathered and given separate tasks. The first was asked to engage in non-emotional writing (i.e., writing that does not focus on complicated emotions or traumatizing experiences). The second was asked to participate in emotional writing, with a special focus on emotional acceptance of traumatic experiences. At the end of the study, those who had engaged in emotional writing saw a reduction in their depressive symptoms, while those who had conducted non-emotional writing saw no change.[11]
Writing can also be used to treat issues that are not fully-fledged psychological disorders. When a person is looking to improve their self-esteem, process bereavement, find perspective or avoid relapses, their mental health provider may recommend incorporating writing into their treatment plan.[12] Writing is also frequently used with patients who have terminal or life-threatening illnesses. In addition to providing clients with an outlet for the undoubtedly complex, intense emotions they have about their condition, Murray (2002) notes that writing about one’s emotions and stress has been shown to improve immune functioning.[13]
ADDITIONAL BENEFITS OF WRITING THERAPY
There are numerous benefits to writing in therapy, including physical benefits. In addition to increasing immune function (though the exact explanation as to how has not yet been discovered),[14] Moy (2017) notes that writing has also been shown to lessen stress, lower blood pressure and can even improve liver function.[15]
The benefits of writing extend beyond physical advantages. Students who engage in writing therapy often experience an improvement in their grades, likely in part because writing also strengthens a person’s memory (both in the sense of making them more apt to remember specific information and by improving their recall abilities). Writing also generally results in decreased symptoms of depression and reduced emotional distress, which can result in fewer missed days of work or school compared to those who don’t utilize writing therapy.[16]
Further, writing is a versatile tool that can be used in a variety of therapies, in one form or another. It also requires few resources, making it easily and readily available to clients.
LIMITATIONS
There are few disadvantages to writing therapy. Some patients will benefit with writing therapy more than others and some forms of writing will prove to be more effective than others, based on the individual. Therefore, it’s important to utilize different forms of writing until the one with greatest efficacy is determined.
The biggest points of contention among psychologists regarding writing include: the discussion of venting vs. healing; and the risk of retraumatizing patients. Depending on the manner in which writing is utilized, a mental health provider may ask the patient to write about a traumatic experience that they endured. In doing so, the patient must, to some degree, relive the experience, and some psychologists worry that the process of reliving the trauma will only do the patient more harm than good.[17] Others argue that avoiding acknowledgment of the trauma is the real danger, and while the process of reliving the experience may be difficult or painful in the moment, the long-term relief will be worth the short-term struggle.[18]
If you’re interested in pursuing writing in therapy and exploring the psychological benefits of this modality, please reach out to a licensed mental health professional to discuss options and plan a course of action.
Contributed by: Jordan Rich
Editor: Jennifer (Ghahari) Smith, Ph.D.
1 Moy, J.D. (2017). Reading and writing one’s way to wellness: The history of bibliotherapy and scriptotherapy. New Directions in Literature and Medicine Studies, 15-30. https://doi.org/10.1057/978-1-137-51988-7_2
2 Ibid.
3 Exploring Your Mind. (2018). Writing as a Therapeutic Tool. https://exploringyourmind.com/writing-therapeutic-tool/
4 Tartakovsky, M. (2015). The Power of Writing: 3 Types of Therapeutic Writing. Psych Central. https://psychcentral.com/blog/the-power-of-writing-3-types-of-therapeutic-writing#1
5 Ibid.
6 Ibid.
7 Ibid.
8 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
9 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
10 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
11 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
12 Exploring Your Mind (2018)
13 Murray, B. (2002). Writing to Heal. Monitor on Psychology, 33(6), 54.
https://www.apa.org/monitor/jun02/writing
14 Ibid.
15 Moy (2017)
16 Ibid.
17 Capozzi, B. (2021). The Benefits and Drawbacks of Therapeutic Writing. Step Up for Mental Health.
https://www.stepupformentalhealth.org/benefits-and-drawbacks-of-therapeutic-writing/
18 Ibid.