Therapy

Distance Writing

A field of words ripe for mental health research

Posted August 31, 2012

Like many writing clinicians I am excited when I find current research that supports writing to heal practices, so imagine my delight when Luciano L'Abate asked me to write a foreword for his recent work with co-editor Laura Sweeney. Research on Writing Approaches for Mental Health comes at an historic juncture in the development of effective ways to use writing to treat and foster mental health. Calling out for studies to examine writing to heal practices, L'Abate and Sweeney explain that research is essential to document what works especially as mental health treatment options are offered online. Their quest is for a research-based approach that capitalizes on the unique capabilities of digital communication.

Anecdotal or Experimental

While professional resource catalogues and general bookstores, both online and in our neighborhoods, offer dozens of titles touting the benefits of writing therapy, few offer more than anecdotal evidence for the efficacious features of this practice. On the one hand are a few older important works like James Pennebaker’s, Opening Up: The Healing Power of Expressing Emotions (1990) and on the other hand are numerous contemporary works like, Elizabeth Maynard Schaefer’s, Writing through the Darkness: Easing Your Depression with Paper and Pen (2008). Pennebaker’s work provides a research base upon which to ground practice and generate new theory. Schaefer’s work, part memoir and part self-help guide, provides an insider’s story of managing depression. The former reports research; the latter reports anecdotes. It can certainly be argued that both works have a place, but they illustrate a gap in the literature that continues as some mental health treatment options move online.

For nearly a decade now the Internet has made it possible to deliver a cornucopia of mental health services, but many practices remain unexamined. Many of these services mimic face-to-face therapy and follow traditional processes common in conversational or talk therapy. Some offer therapy through writing in chat rooms, a synchronous atmosphere, and some offer email, a more asynchronous setting, with potential for reflection. From a research perspective, with proper care to protect clients, both chat rooms and email offer a researchable base in that the texts can be saved from session to session and indeed over the whole history of a treatment. A field of words ripe for research exists here and the research findings can help inform better choices for both clients and practitioners.

Best Practices

While echoing some of the major findings of Best Practices in Online Therapy from authors, Jo-Anne M. Abbott, Britt Klein, and Lisa Ciechomski, L’Abate and Sweeney describe a broader range of therapeutic writing than what is found in online therapeutic writing, and they make their own recommendation for distance writing. After looking at research in automatic writing, expressive writing, autobiographies, diaries, bibliotherapy, and poetry, L’Abate and Sweeney assert why distance writing may be the preferred method of help and healing as more mental health practitioners move online.

L’Abate and Sweeney claim that no matter how popular a treatment writing is now or may become, it will not serve the professional community and clients or fulfill its promising potential as well as it could until its research base is alive, healthy, and robust in the literature of the disciplines. The discipline demands that healthcare workers such as psychologists, therapists, and counselors become reflective practitioners. How does writing therapy work and under what conditions? How does writing therapy compare with traditional therapies? How can writing therapy be standardized or modified as prescribed by client needs. Are there writing therapies supported by studies that can be duplicated?

Reflective Practitioners

If each mental healthcare professional were part of a network documenting interactions with clients, but honoring privacy requirements, a rich database would grow quickly. From these records of reflective practitioners, a richer description and deeper understanding of writing-to-heal theory will emerge providing models of practice. I am delighted that Research on Writing Approaches for Mental Health encourages its readers to expect more rigor and discipline from those who suggest writing is an effective tool for treating mental health challenges.

My vision for future wellness practice includes writing as a mental health modality and extends beyond that application to other health challenges as well. Wellness and writing connections is a braided column. One braid suggests expressive and programmed writing as effective methods for individuals. Another braid suggests a curriculum for training professionals who will include writing as a significant treatment modality. Joining the first two braids is one that suggests program guidelines for individuals who work in institutional settings like hospital wellness programs, cancer treatment clinics, trauma centers, prisons, counseling offices, schools, and universities.

Whatever your current wellness and writing practice, much remains to do. I agree with L/Abate and Sweeney that therapeutic writing needs more rigorous science, what Pennebaker calls the “big science, big medicine” approach applied to large samples of people with differing diagnoses. I agree. I would also like to emphasize that a significant contribution to the science of writing-to-heal can come from individuals and professionals in settings large and small if they engage in reflective practices, carefully documenting their processes and results.

References:

Abbott, J-A, M., Klein, B., & Ciochomski, L (2008). Best practices in online therapy. Journal of Technology in Human Services, 26, 360-375.

Pennebaker, J. (1990) Opening up: the healing power of expressing emotions. New York: The Guilford Press.

Pennebaker, J. W. & C. Chung. (2010) Expressive writing, emotional upheavals and health. In wellness & writing connections: writing for mental, physical, and spiritual health. (2010) J.F. Evans, (Ed.) Enumclaw, WA: Idyll Arbor, Inc.

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