Write to Health: Journaling Can Enhance Psychotherapeutic Process

As a part of psychotherapy, journaling or “expressive writing” can help patients work out psychological issues safely, said psychiatrist and writer Martha Peaslee Levine, M.D., an assistant professor of pediatrics and psychiatry at the Penn State Health Milton S. Hershey Medical Center.

Speaking at APA’s 2017 Annual Meeting, Levine said writing therapy is a personal form of “confession” that has helped her patients navigate through their feelings about complex emotional experiences and traumas, and eventually come to terms with them.

Writing about emotional topics has been found to have a beneficial effect on the immune function of people with chronic diseases, according to recent research by James Pennebaker, Ph.D., at the University of Texas, Austin. His first research study on journaling, published in 1983, showed that college students who wrote about their deep feelings and traumatic experiences visited the health center doctors less often than the control group who wrote about something usual in their day, said Levine.

Pennebaker’s research has tested the idea that “failure to confide a traumatic experience is associated with psychological stress, and the stress of not confiding (inhibition) is increased by excessive rumination about the event,” he wrote.

Levine, essayist and author of two children’s books, said she found writing therapy useful for herself over the years when confronted with various life challenges. She discovered that writing a narrative helped give structure and organization to anxious feelings.

“As a writer, I have come to recognize the power of the story, the power of words. When I need to understand something that has happened in my life or a feeling I didn’t understand, the best way for me to approach it was through writing. As a psychiatrist, I have come to understand the importance of the story,” she said.

Therapeutic writing be done in therapy by individuals or in groups. Levine suggests giving patients 10 minutes (up to an hour at the most) to write on assigned topics or a topic of their choosing. As an example, she provided this prompt: “You are standing outside a door. What does the door look like?” The next prompt could be, “When you open the door, what do you find?” Levine said such prompts can help patients visualize their future and reflect on issues that might be holding them back from achieving their goals.

Clinicians might also consider assigning patients to journal on their opinions and dreams, how their family and upbringing have affected them, what personal characteristics they value, and what makes them happy and what brings them down—all part of their journey in self-discovery.

Some patients take to writing more than others, especially those who have difficulty talking during group therapy sessions yet may have a “huge conversation going on in their heads,” said Levine.

Because initial writing about trauma can trigger distress and emotional arousal, patients should be made aware that they need to continue working through the distress therapeutically and continue the writing.

When some patients expressed worry about other people seeing their written work, Levine encouraged them to set boundaries or shred the paper when they’re done.

“Sharing of writing is not as important as doing the writing,” she said. ■