using creative writing as therapy

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Writing Therapy: Harnessing the Power of Words for Emotional Healing

Pen in hand, you hold the key to unlocking the transformative power of words, embarking on a journey of self-discovery and emotional healing through the cathartic art of writing therapy. It’s a simple yet profound act – putting pen to paper, fingers to keyboard, or stylus to screen. But in that moment, something magical happens. The floodgates of your mind open, and your innermost thoughts, feelings, and experiences pour out onto the page.

Writing therapy, also known as expressive writing or therapeutic writing, is more than just jotting down your daily activities or venting frustrations. It’s a structured approach to using the written word as a tool for emotional healing, personal growth, and mental well-being. This practice has roots that stretch back centuries, with notable figures like Marcus Aurelius and Virginia Woolf extolling the virtues of reflective writing. However, it wasn’t until the latter half of the 20th century that writing therapy began to gain recognition as a legitimate therapeutic technique.

The concept is deceptively simple: write about your deepest thoughts and feelings, particularly those related to traumatic or stressful experiences. But the effects can be profound. By externalizing our internal world, we gain perspective, process emotions, and often find unexpected insights lurking in the shadows of our psyche.

The Science Behind Writing Therapy: Unraveling the Mind’s Mysteries

You might be wondering, “How can simply writing about my feelings actually make a difference?” Well, buckle up, because the science behind writing therapy is fascinatingly robust. Numerous studies have shown that expressive writing can lead to improvements in both physical and mental health.

Let’s dive into the psychological benefits first. When we engage in Catharsis Therapy: Unleashing Emotional Release for Healing and Growth , we’re essentially giving ourselves permission to acknowledge and process our emotions. This act of emotional release can reduce stress, anxiety, and symptoms of depression. It’s like decluttering your mind – by getting those swirling thoughts and feelings out of your head and onto paper, you create mental space for clarity and healing.

But the benefits don’t stop at the psychological level. Writing therapy has also been shown to have tangible effects on our brains and bodies. Neuroimaging studies have revealed that expressive writing activates areas of the brain associated with emotional regulation and cognitive processing. It’s like giving your brain a workout, strengthening the neural pathways that help you manage stress and process difficult experiences.

One particularly intriguing study conducted by James Pennebaker, a pioneer in writing therapy research, found that participants who engaged in expressive writing about traumatic experiences showed improved immune function. They had higher antibody levels and fewer visits to the doctor compared to those who wrote about neutral topics. It’s as if the act of writing about our troubles gives our bodies permission to redirect energy from suppressing emotions to fighting off illness.

Types of Writing Therapy: A Buffet of Expressive Options

Just as there are many flavors of ice cream to suit different tastes, writing therapy comes in various forms to cater to different needs and preferences. Let’s explore some of the most popular types:

1. Journaling and diary writing: This is perhaps the most accessible form of writing therapy. It involves regularly writing about your thoughts, feelings, and experiences. Unlike the diaries of our teenage years (filled with crush confessions and friend drama), therapeutic journaling focuses on self-reflection and emotional exploration.

2. Poetry therapy: For those who find beauty in metaphor and rhythm, poetry therapy can be a powerful tool. It allows for the expression of complex emotions through creative language, often revealing insights that prose might not capture.

3. Narrative therapy: This approach involves reframing your life experiences as stories. By viewing your life as a narrative, you can identify recurring themes, challenge unhelpful plotlines, and author new, more empowering chapters.

4. Guided writing exercises: These are structured prompts or activities designed to focus your writing on specific themes or issues. They can be particularly helpful for those who struggle with where to start or what to write about.

5. Online writing therapy platforms: In our digital age, Writing Therapy Shows: Healing Through Creative Expression on Screen have gained popularity. These platforms offer a combination of guided exercises, journaling tools, and sometimes even feedback from trained therapists.

Each of these approaches offers a unique pathway to self-discovery and healing. The key is finding the type that resonates with you and your personal style of expression.

Writing Therapy Exercises: Your Emotional Toolbox

Now that we’ve covered the types of writing therapy, let’s roll up our sleeves and dive into some practical exercises you can try today. These techniques are designed to help you tap into your emotions, gain insights, and promote healing:

1. Freewriting: Set a timer for 10-15 minutes and write continuously without stopping. Don’t worry about grammar, spelling, or even making sense. The goal is to let your thoughts flow freely onto the page.

2. Gratitude journaling: Each day, write down three things you’re grateful for. This practice can shift your focus from negative experiences to positive ones, fostering a sense of well-being.

3. Unsent letters: Write a letter to someone (or even to yourself) that you don’t intend to send. This can be a powerful way to express feelings or thoughts that you might not feel comfortable sharing directly.

4. Stream of consciousness writing: Similar to freewriting, but with a focus on capturing your thoughts as they occur, no matter how random or disjointed they may seem.

5. Dialogue writing with your inner self: Create a conversation between different parts of yourself (e.g., your anxious self and your confident self). This can help you understand internal conflicts and find resolution.

Remember, there’s no “right” way to do these exercises. The goal is to express yourself freely and honestly. As you engage in these practices, you might find yourself experiencing a range of emotions. That’s perfectly normal and, in fact, a sign that the therapy is working.

Writing Therapy in Clinical Settings: When the Pen Meets the Couch

While writing therapy can be a powerful tool for self-help, it’s also increasingly being integrated into professional therapeutic settings. Many mental health professionals are recognizing the value of Emotional Release Therapy: A Powerful Approach to Healing and Wellness through writing.

In traditional psychotherapy, writing exercises can be used to complement talk therapy sessions. A therapist might assign writing tasks as “homework” between sessions, providing a way for clients to continue processing their thoughts and feelings outside of the therapy room. This can accelerate the therapeutic process and provide valuable material for discussion in subsequent sessions.

Group writing therapy sessions are another exciting application. In these settings, participants not only engage in writing exercises but also have the opportunity to share their work with others. This can foster a sense of community and provide different perspectives on shared experiences.

Cognitive-behavioral therapy (CBT), a widely used therapeutic approach, often incorporates writing assignments. These might include thought records, where clients document negative thoughts and challenge them, or behavioral logs to track patterns in mood and behavior.

Therapist-guided writing exercises can be particularly powerful. A skilled therapist can tailor writing prompts to address specific issues a client is facing, providing a structured way to explore difficult topics. They can also offer feedback and insights based on the client’s writing, helping to uncover patterns or themes that might not be immediately apparent to the writer.

Self-Directed Writing for Therapy: Becoming Your Own Healer

While professional guidance can be invaluable, one of the beautiful aspects of writing therapy is that it can be practiced independently. Creating a regular writing routine for mental health can be a powerful act of self-care. But like any new habit, it can take some time and effort to establish.

Start small – even five minutes a day can make a difference. Find a time that works for you, whether it’s first thing in the morning with your coffee, during your lunch break, or as part of your bedtime routine. The key is consistency.

Writer’s block can be a real challenge in therapeutic writing, just as it is in creative writing. If you find yourself staring at a blank page, try using prompts or themes for self-exploration. These can be as simple as “Write about a time you felt proud of yourself” or as complex as “Explore your relationship with fear.”

It’s important to strike a balance between personal writing and professional help. While writing therapy can be incredibly beneficial, it’s not a substitute for professional mental health care when needed. If you find yourself consistently struggling with difficult emotions or traumatic memories, it may be time to seek support from a trained therapist.

The Therapeutic Power of Words: Your Journey Begins

As we wrap up our exploration of writing therapy, let’s take a moment to recap the incredible benefits this practice can offer. From reducing stress and anxiety to improving physical health, from gaining clarity on complex emotions to fostering personal growth – the power of putting pen to paper (or fingers to keyboard) is truly remarkable.

Writing therapy offers a unique blend of Cathartic vs Therapeutic: Exploring Emotional Release Techniques . It provides both the cathartic release of expressing pent-up emotions and the therapeutic benefits of processing and reframing our experiences.

If you’re intrigued by the idea of writing therapy but feeling a bit overwhelmed about where to start, consider trying Pre-Therapy Journaling: Maximizing Your Mental Health Journey . This can be a gentle way to dip your toes into the world of therapeutic writing before diving in deeper.

For those who are ready to take the plunge, remember that your writing doesn’t need to be perfect. It doesn’t need to be profound or poetic (unless you want it to be). The most important thing is that it’s authentic – a true expression of your thoughts and feelings.

As you embark on your writing therapy journey, be patient with yourself. Healing and personal growth take time. Some days, the words might flow easily. Other days, it might feel like pulling teeth. Both experiences are valid and valuable parts of the process.

Consider exploring different Therapeutic Papers: Innovative Tools for Mental Health and Personal Growth to find what resonates with you. You might discover that you prefer the structure of guided exercises, or perhaps you’ll find freedom in freewriting. There’s no one-size-fits-all approach to writing therapy.

Remember, writing therapy is just one tool in the vast toolkit of Best Self Therapy Techniques: Empowering Tools for Personal Growth and Healing . It can be used alongside other practices like meditation, exercise, or traditional talk therapy to create a holistic approach to mental wellness.

For those interested in diving deeper into the academic side of writing therapy, Therapy Papers: Essential Resources for Mental Health Professionals and Students offer a wealth of information on the latest research and techniques in this field.

As you continue on your journey of self-discovery and healing through writing, remember that every word you write is a step towards understanding yourself better. Each sentence is an opportunity for insight, each paragraph a chance for growth.

So, pick up that pen, open that notebook, or fire up that word processor. Your story is waiting to be written, and with it, a path to healing and self-discovery. Who knows? You might even find that writing becomes more than just therapy – it might become a passion, a form of self-expression that brings joy and fulfillment to your life.

In the words of the great author Anaïs Nin, “We write to taste life twice, in the moment and in retrospect.” Through writing therapy, you have the opportunity not just to taste life twice, but to savor it, to understand it more deeply, and to shape it into the story you want to live.

Your journey with writing therapy might even lead you to explore other creative therapeutic techniques, such as Guided Imagery Therapy Scripts: Powerful Tools for Mental Health and Relaxation , which can complement your writing practice beautifully.

And finally, as you delve into the depths of your psyche through writing, don’t forget the healing power of connection. Writing can be a solitary act, but sharing your journey with others – whether through a writing group, with a trusted friend, or with a therapist – can add another dimension to your healing process. After all, at its core, writing therapy is about expressing yourself, and sometimes that expression finds its fullest realization when it’s shared with others.

So, dear reader, as you close this article and open your journal, remember that you’re embarking on a journey of Love Therapy: Healing Relationships and Nurturing Emotional Connections – with yourself, with others, and with the world around you. Your words have power. Use them wisely, use them often, and watch as they transform not just the page, but your life.

References:

1. Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), 162-166.

2. Smyth, J. M., Stone, A. A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. JAMA, 281(14), 1304-1309.

3. Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338-346.

4. Lepore, S. J., & Smyth, J. M. (Eds.). (2002). The writing cure: How expressive writing promotes health and emotional well-being. American Psychological Association.

5. Bolton, G., Howlett, S., Lago, C., & Wright, J. K. (Eds.). (2004). Writing cures: An introductory handbook of writing in counselling and therapy. Routledge.

6. Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. Oxford handbook of health psychology, 417-437.

7. Thompson, K. (2004). Journal writing as a therapeutic tool. In G. Bolton, S. Howlett, C. Lago, & J. K. Wright (Eds.), Writing cures: An introductory handbook of writing in counselling and therapy (pp. 72-84). Routledge.

8. Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823-865.

9. Sloan, D. M., & Marx, B. P. (2004). Taking pen to hand: Evaluating theories underlying the written disclosure paradigm. Clinical Psychology: Science and Practice, 11(2), 121-137.

10. Kerner, E. A., & Fitzpatrick, M. R. (2007). Integrating writing into psychotherapy practice: A matrix of change processes and structural dimensions. Psychotherapy: Theory, Research, Practice, Training, 44(3), 333-346.

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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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How to Use Writing Therapy to Release Negative Emotions and Trauma

Whether it’s lyrics or journaling—expression through writing can be cathartic

Ayana is the former Associate Editor at Verywell Mind, where she aims to publish mental health content that is both engaging and of high quality.

Yolanda Renteria, LPC, is a licensed therapist, somatic practitioner, national certified counselor, adjunct faculty professor, speaker specializing in the treatment of trauma and intergenerational trauma.

Verywell / Julie Bang

• What to Know About Writing Therapy

The Major Benefits of Writing Therapy

• How to Get Started With Expressive Writing

Every Friday on  The Verywell Mind Podcast , host Minaa B., a licensed social worker, mental health educator, and author of "Owning Our Struggles," interviews experts, wellness advocates, and individuals with lived experiences about community care and its impact on mental health.

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Putting pen to paper feels a bit like an anomaly in a world obsessed with texting, tweeting, and sliding into people’s DMs. But let’s try something different. The next time you’re in your Notes app, give your thumbs a break and grab a pen and piece of paper instead. If you don’t have any paper handy, grab that Starbucks receipt and start writing whatever you were about to type. See how it feels. 

It might feel a bit awkward at first, especially if you haven’t had to physically write anything down in a long while. But as you keep writing, you may feel really engaged with the words you’re jotting down. Tapping letters on a screen isn’t the same as drawing out each letter of every word. Writing things down will inherently bond you to the words you write. And because of that, writing becomes quite powerful for the psyche . Aside from being a feel-good activity, writing can also let us process negative emotions and trauma in what turns out to be a pretty soul-cleansing experience. 

In fact, singer/songwriter and season three winner of The Voice, Cassadee Pope , seconds this. Pope, who's been in the music industry since she was 11 years old, has been pretty open about her mental health struggles—from bad breakups to the emotional impact of her parent’s divorce. Pope told Minaa B., LMSW , host of The Verywell Mind Podcast, “I needed an outlet with everything that was happening with my family. So that was really what I leaned on most, was songwriting.”

Now, you don’t have to be a gifted songwriter to reap the benefits of writing, but let's talk about why writing can be so good for your mental health. 

At a Glance

Writing can be a powerful therapeutic tool. Getting your thoughts down can help you understand them and process them more effectively than keeping them all in your head. People who use writing therapy report better overall mood and fewer depressive symptoms. If you’re struggling with a mental health condition and need to vent your frustrations—consider making a journal your new BFF.

What to Know About Writing Therapy (Write This Down)

Writing therapy (aka emotional disclosure or expressive writing) is pretty much exactly what it sounds like. It involves using writing of any kind, like creative writing, freewriting, and poetry, as a therapeutic tool. Writing therapy can be especially for those who are more withdrawn or have trouble opening up to others.

Writing therapy can be so beneficial to our mental health because it’s basically a form of venting. You know how good it feels to come home after a long day of work and go on and on about how much you dislike that one coworker for a reason you can’t even put your finger on. Or when you spill all of your dating frustrations to your bestie over the phone. It’s a nice release of stress. You can release stress in a similar way when you write, too. Just pretend that piece of paper is your therapist, closest confidante, or even yourself. 

No one else has to know whatever you choose to jot down (or rage-write about). Your journal or diary is your personal safe haven, and your innermost thoughts are safe on those pages. 

Research shows that writing about painful experiences can even improve your immune system. Getting all of your thoughts out on paper is a big stress reliever. It’s also known that trying to suppress negative emotions can be detrimental to your overall well-being, so verbal release may only help you in the long run. Another advantage of writing therapy is that it gives your emotions and thoughts some structure. For instance, my therapist knows I love writing—especially writing poetry. So, when I was dealing with a particularly traumatic time in my life, she told me that my next few homework assignments would be to write poetry about my feelings. Because poetry is a form of creative writing, I had to really think about the diction and imagery I wanted to convey in the poems.

As a result, I really had to unpack my feelings so that my poem would paint a clear picture of what I was going through. I worked on the poem each night before bed and had it ready for my next weekly session.

The next day, I hopped online to meet with my therapist and tell her I had completed my assignment. In response, she asked me to read it aloud. What?! I quickly grew nervous since I was not expecting that. But, considering she’s never led me astray, I reluctantly recited my poem. It was an emotional experience, and my voice audibly cracked a few times, but it felt really good—euphoric, even. So when Pope says that singing her lyrics is "cathartic," I completely get it. She says her singing can be a bit “disarming” because “ I’m believing every word so intensely, and I feel them so intensely.” 

So, not only does writing release some deep-seated feelings, orating them breathes life into them. There’s this particularly beautiful Chinese proverb that says: ‘I hear and I forget, I see and I remember, I write and I understand.’ Once our thoughts are written down, we can see them in front of us, through this practice they become real. Then, we can dig in and unpack what it all means to us.

Other Benefits of Writing Therapy

If you’re still not convinced about the power of writing, here are some other amazing benefits of writing to take note of (pun intended):

• Lowered blood pressure
• Reduced anxiety and depression symptoms
• Improved cognition
• Increased antibody production 
• Better overall mood

Ready to Get Started With Expressive Writing?—Here’s How

The great thing about writing is that it can be about anything you want. There are zero restrictions on what you can say. If you’ve had an upsetting experience or need to release some frustrations about daily stressors, try writing about it.

Pope talks about how she’s been using songwriting to get more authentic about her life as of late. In fact, she was kind enough to dish on the details about a new song of hers that’s set to release soon titled “Three of Us.” In this track, she details what it’s like being the “third wheel” when you’re in a relationship with someone who’s dealing with a substance use disorder : “It's about me, you, and the drugs.” In describing the lyrics, she says, “It's probably the most revealing song I've ever released.” 

Now, if you’ve already got an experience you want to write about, feel free to get started when you’re alone and in a private space. But if you don’t know where to start, here are some prompts to start flexing your writing muscles. 

Writing Prompts to Help You Get to Know Yourself Better

When you’re ready, get something to write with and a blank sheet of paper. Here are some prompts you can use to get started: 

• What does the perfect day look like for you? Think about the activities you’d engage in and who you would be spending your time with. Try engaging your five senses to dive deep into your imagination. 
• Write a story about the last time you were embarrassed. This time, reframe the experience into a positive one where you learn something new about yourself.
• Think about the best piece of advice you've ever received from someone. How has it helped to shape your life?
• Write a song or a poem about what it’s like to eat your favorite dessert. Consider the flavors, textures, and how you feel when you eat this specific treat. Where are you eating it? Did someone special make it for you, or did you make it yourself?
• What does self-love really mean to you? Who taught you what loving yourself looks like? What have you learned to embrace about yourself?
• If you’ve experienced a painful event, free-write about it. Don’t worry about grammar, spelling, or legibility—just write whatever comes to mind. You can even draw if that helps. 

These writing prompts should get you more comfortable with expressing your feelings. Once you make sense of your own experiences, you might be ready to share them with friends, significant others, and other people you trust. If you have a therapist or plan to start therapy, you’ll already have some material to share that you can explore in the session. 

When you connect through storytelling, you begin to strengthen your support network. Pope shared how much she leaned on her friends after a bad breakup. “ If you have community, lean into it and don't be afraid that someone's gonna judge you if you made a mistake or a bad decision, a poor decision, don't be afraid of that. It's so much more healthy to just let it out,” she says.

Pope also cautions that doing this can also reveal the people who accept you just as you are—flaws included: “ If somebody judges you or tries to make you feel bad about it, then OK, great. That one person is not a safe space for you.”

What This Means For You

If you’re uncomfortable opening up to your friends this way, that’s perfectly fine. Never feel pressured to share some uncomfortable thoughts or experiences. You can keep them to yourself in your journal or reserve them all for your therapist.

Writing is a good place to start when you want to better understand who you are and how your experiences have affected you. If you’re struggling with processing your emotions and feel that you need someone to talk to, consider seeing a mental health professional.

Mugerwa S, Holden JD. Writing therapy: a new tool for general practice? . Br J Gen Pract . 2012;62(605):661-663. doi:10.3399/bjgp12X659457

American Psychological Association. Writing to heal .

Krpan KM, Kross E, Berman MG, Deldin PJ, Askren MK, Jonides J. An everyday activity as a treatment for depression: the benefits of expressive writing for people diagnosed with major depressive disorder . J Affect Disord . 2013;150(3):1148-1151. doi:10.1016/j.jad.2013.05.065

By Ayana Underwood Ayana is the former Associate Editor at Verywell Mind, where she aims to publish mental health content that is both engaging and of high quality.

IAJW » IAJW Journal Blog » Journaling for Health & Wellness » What is Writing Therapy?

What is Writing Therapy?

What do you do?

Recently, I was sitting beside someone on an airplane (I travel a lot to facilitate workshops, speak at events, etc.) and she asked me, “what do you do?”  I responded, “I am a Writing for Wellness Coach and I teach people how to use writing to improve their health, prevent burnout, and feel more joy in their lives through creative self-expression.”

This embarked us into a conversation about how her daughter has used journaling to help her get through a really dark time in her life.  She said, “I have no idea how writing has helped her, but I can see that it has.”

I explained a bit about how expressive writing can be helpful in our lives and she was surprised to learn that there is something called “therapeutic journaling” and “writing therapy”.  This field of work is not widely known (I am always explaining to people what it is I actually do!)

I told her about the IAJW.org and how we are a learning and inspiration community for journal writers worldwide and for people who want to experience the many life and health enhancing benefits of writing in their lives.

What is writing therapy?

Writing therapy involves using the written word, self-expression, and life story for the purposes of healing and self-discovery.

There are many ways to engage in healing and personal growth through contemplative practices such as meditation, yoga, mindfulness and in this case, expressive writing.

There is well over 35 years of scientific research that proves there are many benefits that can be gained through writing about your thoughts and feelings.  Lowered blood pressure, improved immune functioning, reduced stress, greater confidence, more clarity for decision making, healing emotional wounds, improving personal relationships, cultivating personal resilience and making meaning out of life events are among the many proven benefits of expressive writing.

Learn more about writing therapy and the history of this healing and wellness practice https://en.wikipedia.org/wiki/Writing_therapy

Life Enriching Benefits of Creative Self-Expression

Beyond writing therapy, are the many life enriching benefits of creative self-expression.  Journaling is a way to cultivate joy, gratitude and self-awareness in daily life.  What we focus on grows.

Pause & Reflect

Do you write for wellness and personal growth?  What has your experience been with this healing and expressive art?  What area of  your life or health would you like to improve?  Journaling can help!

Access our free Journal Writing Gift which offers you ideas, information and inspiration for going to the page to write!

That’s really neat that writing therapy is an established form of therapy. I have found that when I’m having a difficult time, writing usually helps me clear my head and organize my ideas. I’m sure that this would be a very effective form of therapy for most people.

Please note, an earlier version of this article appeared on my prior CreativeWellnessWorks.com blog which is now integrating into the IAJW.org blog. Here’s to the healing and transformational power of writing!

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Writing Therapy: How to write therapeutically

Discover the benefits of therapeutic writing - a powerful tool for processing emotions, finding clarity, and promoting overall mental well-being.

Writing therapeutically has become an increasingly popular tool for improving mental health and wellbeing. The act of writing allows people to process emotions, gain insight, reduce stress, and work through inner conflicts and traumas. This comprehensive guide will provide an overview of therapeutic writing, explain the different techniques and approaches, and offer tips for getting started with your own therapeutic writing practice.

What is Therapeutic Writing?

Therapeutic writing, also known as expressive writing, is the process of using writing to come to terms with and heal from emotional distress. The focus is not on creating a polished piece of literature, but rather on using writing as an outlet for inner exploration and healing.

Therapeutic writing can take many forms, including journaling, autobiographical writing, letter writing, poetry, and free-form creative expression. The goal is to use the writing process to gain understanding, release pent-up emotions, work through inner conflicts, develop self-awareness, and promote overall mental well-being .

Benefits of Therapeutic Writing

Decades of research have demonstrated the wide-ranging benefits of expressive writing. Studies show that opening up on paper can help:

• Reduce stress and anxiety
• Cope with grief and trauma
• Gain insight into behaviors, thoughts, and emotions
• Clarify goals and values
• Boost self-esteem and confidence
• Improve sleep and overall physical health
• Strengthen relationships
• Process challenging life events

In essence, therapeutic writing allows people to make sense of their inner world, gain perspective, and move forward in a psychologically healthy way.

Approaches to Therapeutic Writing

There are several structured approaches to therapeutic writing that offer frameworks and prompts to guide the process:

• Journal Writing – Keeping a journal, diary, or log to record thoughts, feelings, and daily experiences. This allows you to track patterns, reflect, and gain self-awareness. Check out some writing prompts for journaling .
• Autobiographical Writing – Writing your personal history, including meaningful events, relationships, challenges, and key memories. This helps organize memories and find meaning.
• Gratitude Writing – Keeping a journal focused specifically on things you are thankful for. This cultivates optimism.
• Expressive Writing – Free-writing about traumatic, stressful, or emotional events. This allows you to process the experience.
• Letter Writing – Writing letters to yourself or to others as a way to heal relationships, grieve, or clarify thoughts. The letters do not need to be sent.
• Poetry/Creative Writing – Using poetic language and imagery to express emotions. Creating stories, metaphors, and dialogues to gain new perspectives.
• Spiritual Writing – Writing about your beliefs, values, sense of meaning, and inner wisdom. This connects you to something larger.
• Therapeutic Storytelling – Crafting your experiences into a coherent narrative. This imposes order on thoughts and events.
• Bibliotherapy – Reading therapeutic books and then journaling about how the material impacts your life.

The style of therapeutic writing you choose depends on your specific needs and what you hope to get out of the process. Many people incorporate several approaches.

Tips for Writing Therapeutically

Here are some tips for getting started with your own therapeutic writing practice:

• Set aside regular time to write – Ideally 20-30 minutes, 3-5 times per week. Treat this time as a therapy appointment with yourself.
• Find privacy and minimal distractions – Write where you can relax and focus internally. Turn off devices. Let family/roommates know you need quiet time.
• Don’t censor – Let words and emotions flow without judging yourself. The writing is just for you.
• Write naturally – Don’t worry about grammar, spelling, sentence structure. Go with stream-of-consciousness writing.
• Stick to your truth – Delve into your real thoughts, beliefs, and feelings. Avoid sugar-coating.
• Know when to stop – If emotions become too intense, take a break. You can return to the topic later.
• Reflect afterward – What insights did you gain? What emotions were released? How do you feel now compared to before?
• Re-read occasionally – Notice patterns in your thoughts, feelings, behaviors. Reflect on how you’ve grown.
• Destroy writing if preferred – If you don’t want to keep a record, immediately shred or delete.
• Consider sharing with therapist – If you have a therapist, they can help process your therapeutic writing.
• Be patient – Healing takes time. Stay motivated and let the writing support your journey.

Suggested Writing Prompts

Here are some therapeutic writing prompts to spark reflection:

• The parts of myself I’ve yet to confront are…
• If my childhood self could see me now…
• The story I tell myself about why I can’t move forward is…
• What I wish I could tell my younger self is…
• The biggest misconception people have about me is…
• If I could go back in time, I would tell my past self…
• The ways in which I sell myself short are…
• The limiting belief I need to let go of is…
• The parts of my life story I try to ignore are…
• If I had one day left to live, I would…
• The times I felt most alive were when…
• The areas of my life needing more courage are…
• My vision for my ideal future self is…
• The secrets or fears I mask from the world are…
• If I had no limitations, I would…
• Right now I need to admit to myself that I feel…
• To evolve, I first need to acknowledge…
• My inner wisdom tells me…
• If my intuition could speak out loud, it would say…

You can modify prompts to target specific issues you want to work through, like grief, anger, relationships, self-esteem, etc. Let the wording elicit honesty and introspection.

Troubleshooting Challenges

Therapeutic writing can stir up intense emotions. Here’s how to navigate common challenges:

• Overwhelming feelings –  If you feel flooded, pause and use calming strategies before continuing. Speak kindly to yourself. Seek support if needed.
• Resistance – It’s normal to avoid confronting painful issues. Be patient and give yourself time. Begin with small steps.
• Lack of motivation – Connect with why therapeutic writing matters to you. Notice how you feel when you neglect it. Let go of perfectionism.
• Distractions/restlessness – Eliminate distractions ahead of time. If restlessness arises, try switching locations or free-writing about your urge to avoid.
• Writer’s block – Free-write about your internal resistance. Or, begin with stream-of-consciousness writing, a gratitude list, etc. until words flow again.
• Concern over privacy – Keep your writing in a secure place. Or, fictionalize sensitive details. The benefits outweigh the risks.
• Self-criticism – Treat yourself as you would a dear friend. Show compassion. Let your hand do the healing, not the criticizing.

If challenges persist, consider working with a writing therapist or counselor to provide support and guidance. The key is maintaining commitment to the process. Even when difficult, therapeutic writing develops self-awareness and sustains emotional growth.

Integrating Therapeutic Writing Into Your Life

To fully benefit from therapeutic writing, integrate it into your lifestyle as a form of self-care. Here are some ways to incorporate it daily:

• Keep a journal by your bed for morning pages or a reflection on dreams.
• Carry a pocket notebook for jotting feelings throughout the day.
• Take 5 minutes on lunch break to free-write.
• Debrief after challenging interactions.
• Write letters to loved ones – sending optional.
• Use writing to complement other wellness practices like meditation, yoga, art.
• Write about therapy sessions, health changes, life transitions.
• Make writing materials easily accessible at home and work.
• Write for a few minutes before bed to process the day.

By making therapeutic writing a consistent habit, you ensure its transformative powers.

Finding Supportive Resources

For those seeking additional support and guidance, many books, websites, courses, and therapists offer resources for therapeutic writing:

• Books like Writing as a Way of Healing by Louise Desalvo or The Writing Cure by Joshua Smyth. Bibliotherapy lets you learn and reflect.
• Websites like JournalTherapy.com, American Journal of Nursing, and PositivePsychology.com provide articles, prompts, and techniques.
• Classes through organizations like The Therapeutic Writing Institute teach structured writing techniques led by therapists.
• Certified writing coaches offer personalized feedback and support.
• Writing groups provide motivation, inspiration, and community.
• Therapists can help overcome resistance, unlock memories, and process writing content.

Explore resources that resonate with your needs and interests. Having support makes therapeutic writing even more empowering.

Therapeutic Writing in Action: An Example

To illustrate therapeutic writing, here is a journal entry by a woman struggling with grief over losing her mother:

Today marks one year since my mother passed away from cancer. I can’t believe how quickly and painfully the time has gone by. I took off work today because I knew I couldn’t handle trying to focus or make small talk. Instead, I’m spending the day journaling and reflecting on my mom’s life.

It’s strange to think she’s been gone for a whole year now – it feels like just yesterday we were laughing over lunch together and talking about our plans for the holidays. I miss those days terribly. I miss her voice, her hugs, her advice. There’s such an empty space now and I wish more than anything I could have her here with me.

Her final weeks in hospice care were so difficult. Seeing her waste away each day, losing her strength and eventually her ability to speak – it broke my heart. But I’m grateful I could be by her side, holding her hand and letting her know how very much she is loved. She was the strongest woman I’ve ever known and faced the end with grace and courage.

The grief comes in waves. At times I feel like I’m coping well and moving forward. Other times the pain and loneliness hit me like a crushing tidal wave. All the milestones without her – my daughter’s graduation, my promotion at work, the holidays – just reopen the wound. I know she’d want me to go on living and find joy again. But it’s so hard when I can’t make new memories with her.

I try to focus on the beautiful moments we shared over the years. The way her face would light up when I brought her fresh flowers. Our hysterical laughter while playing silly games. Teaching me how to bake her famous chocolate chip cookies. How she selflessly cared for me as a single mother. Her endless love is something I’ll carry with me forever.

I think she’d be proud of how I’ve handled this past year of firsts without her. There have been plenty of tears, but I’m still standing. Her memory motivates me to appreciate every day. To give to others. To live life to the fullest, just like she did.

I know the pain will ebb and flow. Healing is not linear. But she remains in my heart, and for that I am endlessly grateful. I miss you so much, Mom. You are with me always.  

Writing therapeutically has the power to transform lives by promoting insight, personal growth, and mental wellbeing. By regularly engaging in expressive writing practices like journaling, letter writing, and reflective poetry, individuals can better cope with trauma, reduce anxiety and stress, clarify their sense of purpose, and heal on a profound level.

While writing therapeutically, the goal is not literary perfection. The focus is on authentic self-expression that allows inner wisdom to rise to the surface. By pouring out thoughts and feelings on paper, we can gain new understanding of our deepest needs, values, emotions, and conflicts.

This comprehensive guide outlined the many structured techniques, helpful tips, and supportive resources available for those interested in unlocking the healing potential of writing. By experimenting with different therapeutic writing modalities and sticking with the practice, you’re sure to experience expanded self-awareness, a greater sense of control over your mental health, and positive growth.

The journey with therapeutic writing is an ongoing process. But the rewards in terms of inner peace, clarity, and mental well-being make it a worthwhile endeavor. As many great writers have expressed, writing has the power to not only document life, but to liberate life. May your therapeutic writing give voice to your story, heal your spirit, and renew your mental health.

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Writing Technique Across Psychotherapies—From Traditional Expressive Writing to New Positive Psychology Interventions: A Narrative Review

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• Volume 52 , pages 23–34, ( 2022 )

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Writing Therapy (WT) is defined as a process of investigation about personal thoughts and feelings using the act of writing as an instrument, with the aim of promoting self-healing and personal growth. WT has been integrated in specific psychotherapies with the aim of treating specific mental disorders (PTSD, depression, etc.). More recently, WT has been included in several Positive Interventions (PI) as a useful tool to promote psychological well-being. This narrative review was conducted by searching on scientific databases and analyzing essential studies, academic books and journal articles where writing therapy was applied. The aim of this review is to describe and summarize the use of WT across various psychotherapies, from the traditional applications as expressive writing, or guided autobiography, to the phenomenological-existential approach (Logotherapy) and, more recently, to the use of WT within Acceptance and Commitment Therapy (ACT). Finally, the novel applications of writing techniques from a positive psychology perspective will be analyzed. Accordingly, the applications of WT for promoting forgiveness, gratitude, wisdom and other positive dimensions will be illustrated. The results of this review show that WT yield therapeutic effects on symptoms and distress, but it also promotes psychological well-being. The use of writing can be a standalone treatment or it can be easily integrated as supplement in other therapeutic approaches. This review might help clinician and counsellors to apply the simple instrument of writing to promote insight, healing and well-being in clients, according to their specific clinical needs and therapeutic goals.

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Writing Therapy and the Search for Meaning: A Case History

Writing Your Way Through Feelings: Therapeutic Writing for Emotion Regulation

A review of empirical studies investigating narrative, emotion and meaning-making modes and client process markers in psychotherapy.

Avoid common mistakes on your manuscript.

Introduction

Writing therapy can be defined as the process in which the client uses writing as a means to express and reflect on oneself, whether self- generated or suggested by a therapist/researcher (Wright & Chung, 2001 ). It is characterized by the use of writing as a tool of healing and personal growth. From the first investigations of James Pennebaker (Pennebaker & Beall, 1986 ), writing therapy has shown therapeutic effects in the elaboration of traumatic events. In recent years, expressive and creative writing was found to have beneficial effects on physical and psychological health (Nicholls, 2009 ).

Currently, clinicians have moved from a distress-oriented approach to an educational approach, where writing is used to build personal identity and meaning through the use of autobiographical writing (Hunt, 2010 ). In this vein, autobiographical writing is becoming a widespread technique, which allows people to recall their life path and to better understand the present situation (McAdams, 2008 ). Moreover, it is observed that individuals often tend to report significant life events (positive or negative) in personal journals (Van Deurzen, 2012 ). Keeping a journal is a way of writing spontaneously: it can be considered a sort of logbook where thoughts, ideas, reflections, self-evaluation and self -assurances are recorded in a private way. Journaling is different from therapeutic writing the writer does not receive specific instructions on the contents and methodologies to be followed when writing, as it happens in therapeutic writing. Nowadays journaling can be done also through online blogs and social network (Facebook). In doing so, a private and spontaneous journal can be shared publically.

Writing techniques are often implemented into talking therapies, since both processes (talking and writing) favor the organization, acceptance and the integration of memories in the process of self-understanding (Lyubomirsky et al., 2006 ). However, expressive writing has been found to be beneficial also as a “stand alone” technique for the treatment of depressive, anxious and post-traumatic stress disorder symptoms (Reinhold et al., 2018 ). In a recent study, it was found that enhanced expressive writing (i.e., writing with scheduled contacts with a therapist) was as effective as traditional psychotherapy for the treatment of traumatized patients. Expressive writing without additional talking with a therapist was found to be only slightly inferior. Authors concluded that expressive writing could provide a useful tool to promote mental health with only a minimal contact with therapist (Gerger et al., 2021 ). Another recent investigation (Allen et al., 2020 ) highlighted that the beneficial effect of writing techniques may be moderated by individual differences, such as personality trait and dysfunctional attitude (i.e., high level of trait anxiety, avoidance and social inhibition). In these cases, therapeutic writing may be even more beneficial since it avoids the interactions with the therapist or other clients.

This article aims to illustrate and summarize the main psychotherapeutic interventions where writing therapy plays an important role in the healing process. For instance, a common application is the use of a diary in standard Cognitive Behavioral Therapy for promoting patients’ self observation (Butler et al., 2006 ). Similarly, other traditional psychotherapies use writing in their therapeutic process: from the pivotal application of writing to understand and overcome traumatic experiences, to the phenomenological-existential approach where writing has the function of giving meaning to events and of clarifying life goals (King, 2001 ), to Acceptance and Commitment Therapy, where writing facilitates the process of thought-defusion (Hayes, 2004 ). This review will also address the novel applications of writing technique to new a psychotherapeutic context: positive psychotherapy where the tool of writing is employed in many effective techniques (i.e. writing gratitude or forgiveness letters). Smyth ( 1998 ) reviewed 13 case-controlled writing therapy studies that showed the positive influence of writing techniques on psychological well-being. The benefits produced in writing activity (self regulation, clarifying life goals, gaining insight, finding meaning, getting a different point of view) can be described under the rubric of psychological and emotional well-being. In accordance with Fredrickson’s Broaden and Build Theory of Positive Emotions ( 2004 ), writing may foster positive emotions since putting feelings and thoughts into words widens scope of attention, opens up to different points of view and allows the mind to be more flexible (King, 2001 ).

Finally, we will describe and explore new contexts where writing activities currently take place: the web and social networks. We will underline important clinical implications for these new applications of writing activities.

Traditional Applications of Writing Techniques

Clinical applications of writing therapy include the method of expressive writing created by Pennebaker (Pennebaker & Beall, 1986 ); the autobiography; and the use of a diary in traditional Cognitive Behavioral Therapy as described in the following sections.

James Pennebaker: The Paradigm of Expressive Writing

James Pennebaker was the first researcher that studied therapeutic effects of writing. He developed a method called expressive writing, which consists of putting feelings and thoughts into written words in order to cope with traumatic events or situations that yield distress (Pennebaker & Chung, 2007 ). In the first writing project, Pennebaker and Beall ( 1986 ) asked fifty college students to write for fifteen minutes per day for four consecutive days. They were randomly instructed to write about traumatic topics or non-emotional topics. Results showed that writing about traumatic events was associated with fewer visits to the health center and improvements in physical and mental health. The experiment was repeated several times with different samples: with people who suffered from physical illnesses, such as arthritis and asthma, and from mental pathologies such as depression (Gortner et al., 2006 ). Individuals with different educational levels or writing skills were examined, but these variables were not found to be significant. At first, studies investigated only traumatic events, but later research expanded the focus to general emotional events or specific experiences (Pennebaker & Evans, 2014 ).

According to Pennebaker, what makes writing therapeutic is that the writer openly acknowledges and accepts their emotions, they become able to give voice to his/her blocked feelings and to construct a meaningful story.

Other therapeutic ingredients of expressive writing concern (1) the ability to make causal links among life events and (2) the increased introspective capacity. The former may be favored through the use of causality terms such as “because”, “cause”, “effect”; the latter through the use of insight words (“consider”, “know” etc.). These emotional and cognitive processes were analyzed through a computerized program (Pennebaker et al., 2015 ) and outcomes showed that the more patients used causation words, the more benefits they derived from the activity. Similarly, using certain causal terms expresses the level of cognitive elaboration of the event achieved by the patient and may indicate that the emotional experience has been analyzed and integrated (Pennebaker et al., 2003 ). Thus, the benefits of writing stem from the activity of making sense of an emotional event, the acquisition of insight about the event, the organization and integration of the upheaval in one’s life path.

Moreover, expressive writing allows a change in the way patients narrate life events. Many studies have highlighted that writing in first or third person alters the emotional tone of the narration (Seih et al., 2011 ). It is common for people who have experienced a severe traumatic event to initially narrate it in the third person and only later, once the elaboration and integration processes have set into motion, are they able to narrate their experience in the first person. This phenomenon occurs because third person narration allows the writer to feel safer and more detached from the experience, while first person perspective reminds them that they were the protagonist of the trauma. While writing using the third person can be easier in the wake of a traumatic event, writing in first person has been demonstrated to be more effective in the elaboration process (Slatcher & Pennebaker, 2006 ).

Another issue examined by Pennebaker and Evans ( 2014 ) concerns the difference between writing and talking about a trauma. In expressive writing, an important element consists of feeling completely honest and free to write anything, in a safe and private context without necessarily share the content with a listener or the therapist. Conversely, talking about trauma implies the presence of a listener, and the crucial aspect lies in the listener’s capability to comprehend and accept the patient’s narrative. Moreover, the interactions with a therapist could be particularly stressful for individuals with high levels of social inhibitions and trait anxiety (Allen et al., 2020 ).

Writing Techniques for Addressing Trauma

Writing is considered a therapeutic strategy to cope with life adversities thanks to the positive effects of putting feelings and thoughts into words. There are various writing techniques used as therapeutic strategies to cope with a trauma which are described in Table 1 .

What the aforementioned writing therapies all have in common is a theoretical underpinning: the act of writing as a means to modify one’s life story and reframe elements which survivors want to change. Creating stories and thinking of ways to alter them may emphasize on one hand the possibility of a real change to occur, and on the other, the active role of the individual in their own life (Sandstrom & Cramer, 2003 ). In this way, writing can be also defined as a process of resilience: putting negative feelings into words can spark the search for solutions, with the consequence of having a positive attitude towards life challenges and promoting personal growth.

Besides the numerous positive effects of writing, there can be situations in which writing does not work, or when it can actually cause negative side effects. An example of said situation is when an individual has to deal with issues that arise intense painful emotions. In this case, writing can cause crying, very low mood, or even a breakdown (Pennebaker & Chung, 2007 ). This may occur because analyzing a traumatic experience may trigger a process of cognitive rumination, which is considered a specific symptom of PTSD (Pennebaker & Evans, 2014 ).

In conclusion, the paradigm of expressive writing is frequently used in patients who have had distressing experiences. Writing about traumatic experiences can help to elaborate negative emotions connected to the upheaval, to construct a narrative of the event, and to give it a meaning. However when client’s levels of distress are very intense and/or they are maintained by cognitive rumination, it is not advisable to undergo a writing exercise.

McAdams: The Use of Autobiography in the Construction of Self-identity

Writing therapy has also been shown to have benefits in constructing self-identity (Cooper, 2014 ). An important pioneer of this method, Dan McAdams, developed a life story model of identity, which postulates that individuals create and tell evolving life narratives as a means to provide their lives with purpose and integrity (McAdams, 2008 ). Identity is an internalized story that is composed by many narrative elements such as setting, plot, character(s) and theme(s). In fact, human lives develop in time and space, they include a protagonist and many other characters, and they are shaped by various themes. Narrative identities allow one to reenact the past, become aware of the present and have a future perspective. Individuals construct stories to make sense of their existence, and these stories function to conciliate who they are, were and might be according to their self-conception and social identity. Biography, for example, is a written history of a person’s life; it deals with the reconstruction of a personal story in which salient events are selected and told. The therapeutic power of biographies entails the act of selection of worthy events that characterize a person’s life (Lichter et al., 1993 ).

In the same way, the autobiography can be an instrument to create a written life story. The first therapeutic effect is the possibility to define a sense of identity through autobiographical narratives by the identification of significant personal changes and by giving meaning to them. According to Bruner ( 2004 ) writing an autobiography allows the clients to recognize themselves as the authors of their experiences (sense of personal agency).

Another therapeutic ingredient of autobiography is the process of conferring stability to autobiographical memories: people often misremember details of events over time or are influenced by distortion mechanisms (McAdams, 2008 ). Autobiography is useful not only to code every event of self-story, but also it is beneficial for integrating different experiences and for analyzing the life trail, highlighting both continuity and changes. McAdams studied the use of autobiography in life changes, by employing a written procedure, the “Guided Autobiography” (McAdams et al., 2006 ). This is a therapeutic technique aimed at investigating the relationship between the continuity of story themes and personality changes. In the span of ten two-hour sessions, which take place once a week, participants are asked to think and describe the most important events of their life, referring to a specific life theme (i.e. family, money, work, health, spirituality, death, aspirations). Reker et al. ( 2014 ) underlined that Guided Autobiography is an effective method to enable participants to understand and appreciate their life stories, which also increases optimism and self-esteem. In conclusion, Mc Adams technique of guided autobiography entails different therapeutic ingredients: it allows to connect life events and personal memories, and to underscore the process of continuity among them. At the same time, significant life changes are emphasized, and the individual can improve the sense of agency in understanding his/her role as a protagonist of his/her life. Thus, guided autobiography could enhance personal well-being and meaning in life.

The Use of the Diary in CBT

Considering that Cognitive-Behavioral Therapy (CBT) works on thinking patterns, maladaptive thoughts and dysfunctional behaviors (Butler et al., 2006 ), the diary is a very useful instrument of self-observation. It entails a written exercise in which the client is asked to take note of when and where a stressful situation occurs, the automatic thoughts it elicits, the connected emotions and the consequent behavior. This technique was developed by Aaron Beck at the early stages of cognitive therapy for anxiety and depression (Beck, 1979 ). In writing this diary the writers learn to pay attention to their functioning and acquires self-awareness about their problematic issues (King & Boswell, 2019 ). According to traditional CBT method, the therapeutic ingredients of writing the structured diary consist of helping clients to increase their awareness of automatic thoughts and beliefs, which are influencing their emotions and behaviors. The diary then allows the processes of cognitive restructuring, where negative, automatic thoughts are analyzed and modified in order to achieve a more realistic attitude toward life events and problematic situations (Beck, 1979 ). Thus, writing techniques within CBT consist of keeping a structured diary, which is supervised by the therapists along the various phases of the therapeutic process. The diary in CBT is specifically aimed at addressing symptoms and distress, but it can also trigger cognitive changes, maturation and improved self-awareness at the end of the clinical work (Butler et al., 2006 ).

Existential Approaches: The Bridge Between Clinical Psychology and Positive Psychology

Logotherapy.

Logotherapy is a specific strategy within phenomenological-existential therapies. It relies on a therapeutic paradigm created by Viktor Frankl (Frankl, 1969 ) and based on existential issues. Logotherapy is an entirely word-based treatment. Its tenets assume that life always has meaning, even in the most adverse circumstances and that people always strive to find a personal meaning in their existence (assumption of will to meaning). From this perspective, a journal can be considered a place where people find a meaning in life-threatening events and transform implicit and negative experiences into expressive and positive ones. In fact, Logotherapy emphasizes the importance of words in creating a meaning and, in this case, writing techniques are particularly appropriated to this task. The client is asked to narrate adverse life events using words and sentences that help him/her to acquire a sense of meaning and acceptance.

In phenomenological-existentialist psychotherapies, writing assignments are used to increase clients’ awareness of their limitations and to create an opportunity to reflect on both life and death (Yalom, 1980 ). Specifically, in the exercise of Writing your Epitaph, the client is encouraged to think and write what people would say in their memory. This task aims at clarifying personal values and at committing to them. This allows the identification of the direction individuals want to give to theirs life and to verify if they really are acting towards those goals. The main difference between logotherapy and guided autobiography relies on the philosophical framework used in existential approach, which is not present in Mc Adams paradigm. Furthermore, in logotherapy the narrative topic might be narrowed to a specific traumatic event, not necessarily involving all personal biography. The therapeutic ingredients of logotherapy, thus, concern the increase in life meaning and the possibility of reframing and processing existential issues as death, evil and trauma in individual’s life experiences.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) focuses on the acceptance of unchangeable things and on the integration of different interventions (including strategies of mindfulness) with the aim of increasing psychological flexibility and promoting an active attitude towards problematic matters (Hayes, 2004 ). ACT is based on a rigorous cognitive analysis, the Relational Frame Theory (Reese, 2013 ). This theoretical frame posits that language and cognition allow humans to have the ability to learn to relate events under arbitrary contextual control. This framework particularly analyzes paradoxes, metaphors, stories, exercises, behavioral tasks, and experiential processes (Hayes, 2004 ). This approach has studied a particular mechanism called “Thought Defusion” (Hayes, 2004 ) which deals with the ability to distance one’s self from problematic thoughts. Frequently, individuals cannot see problems because they are “fused” with them. The defusion techniques allow the individual to distance themselves from problems and see them from a more detached perspective (i.e., the helicopter perspective exercise). In this way, patients have the possibility to identify a problematic issue, accept it and find a manner to live with it, which can decrease the level of suffering (Hayes, 2004 ). Thus, the act of writing can be considered as a way to keep distance from one’s own thoughts and feelings in order to be able to modify the behaviors and life choices according to one’s values and priorities.

The first part of this article identifies how the traditional use of writing techniques has been analyzed within different forms of psychotherapy. The subsequent part of this review will describe the application of similar writing techniques within the framework of positive psychology. In particular, the use of expressive writing, journaling or other structured writing techniques will be described as ways to promote personal well-being, personal growth, gratitude and positive emotions in general.

Positive Psychotherapy

Unlike the traditional deficit-oriented approach to psychotherapy, Positive Psychotherapy aims at considering with a similar standing, symptoms and strengths (Rashid & Seligman, 2018 ).

Positive Psychotherapy uses writing techniques in various moments of the therapeutic process (see Table  2 ). For instance, at the beginning of the therapy clients are invited to write a personal presentation in positive terms. This exercise is called “ Positive Introduction” (Rashid, 2015 ). The importance of this exercise lies in the fact that while writing a self-presentation clients highlight their positive characteristics and qualities and they may also recall and describe a particular episode when these strengths were manifested. This initial writing assignment, thus, may foster patients’ self-esteem and self-awareness of positive personal characteristics. In the middle phase of the positive psychotherapy, therapists can suggest the “ Positive Appraisal” activity to their clients. This consists of thinking and writing down resentments, bad memories and negative events which have occurred in their past and that still affect their life. Clients are asked to reframe these past negative events and to search for possible positive consequences in terms of meaning or personal development. The final phase of therapy focuses on exploring and training the individual’s strengths. The exercises proposed in this phase include writing assignments such as “ Gift of Time” and “ Positive legacy”, where the therapist asks clients to write how they would be remembered by significant others and future generations. “ Positive Legacy” is focused on the positive connotations of writing and often it is associated with planning a “gift of time activity” that puts these positive characteristics into practice (Rashid, 2015 ). This technique entails similarities with logotherapy and ACT epitaph exercise, but in PPT the client is guided to emphasize positive aspects of their life and personal qualities, and there is no mention to relational frame theory as in ACT.

Furthermore, Positive Psychotherapy entails also specific writing techniques devoted to the promotion of specific positive emotions, such as gratitude, forgiveness and wisdom, as described below.

Gratitude is a feeling of appreciation for people or events, which is triggered by the perception of having obtained something beneficial from someone or something (it can be also an impersonal source, such as God or Nature) (Rashid & Seligman, 2018 ). Written exercises of gratitude can be divided into Gratitude Letter, Gratitude Journaling and “ Good versus Bad Memories” .

Gratitude Letter consists of writing and delivering a gratitude letter to a person that the client has never sincerely thanked. This intervention aims at strengthening the client’s relationships and enhancing their social well-being (Lambert et al., 2010 ). In Gratitude Journaling, clients are asked to write three good things which have happened to them during the day (Rashid, 2015 ).

Many studies showed that thinking about memories of gratitude in a written form promotes well-being and increases positive mood because writing allows one to give shape to positive experiences (Toepfer et al., 2012 ; Wong et al., 2018 ). In fact, in gratitude writings individuals are more likely to express positive feelings and have high level of insight, making gratitude letters or journaling a powerful tool to produce not only well-being, but also health improvements (Jans-Beken et al., 2020 ).

Difficulties in writing a gratitude letter relate to the interpersonal nature of this task, because being grateful towards someone entails being dependent on that person and, in turn, this can invoke a sense of vulnerability that makes the writer feel not at ease (Kaczmarek et al., 2015 ). In this way, the psychological costs of writing a gratitude letter are greater than expressing it in a private journal. Another important element of difference pertains the delivery of the letter as the gratitude journal has a personal use, while the letter is written to be delivered to someone. The main risk of writing a letter to someone refers to the possibility of not being accepted or feeling judged by the reader. For this reason, recently, positive therapists may ask their clients to write the letter, without necessarily have it delivered to the recipient. Thus, the benefits associated with a gratitude letter exercise are not necessarily connected with the act of delivery, but are placed in the writing itself (Rash et al., 2011 ).

In addition to gratitude letter and journal, Good versus Bad Memories is a writing activity which has the therapeutic effect of helping clients to understand how anger, bitterness and other depressive symptoms may influence clients’ life and how they can stop these processes by focusing on positive memories and experiences (Rashid & Seligman, 2018 ).

These three writing activities on gratitude are useful in order to emphasize good things that usually are taken for granted. Furthermore, they may downregulate the impact of negative emotions or negative experience in life. (Lyubomirsky & Layous, 2013 ).

Forgiveness

Forgiveness implies a situation of offense where a person makes the choice of letting go of anger and of searching for a compassionate attitude towards the transgressor (Thoresen et al., 2008 ).

Evidence shows that writing about an interpersonal conflict can decrease the level of negative effects in relational conflicts (Gordon et al., 2004 ). The act of writing a forgiveness letter includes a cognitive processing that promotes emotional regulation, the expression of affect and gaining insight. Positive Psychotherapy uses forgiveness exercises in order to transform feelings of anger and bitterness into neutral or positive emotions (Rashid, 2015 ). For example, clients are asked to write a letter where they describe an experience of offence with related feelings and then the promise to forgive the guilty person. McCullough et al. ( 2006 ) found that victims of interpersonal transgressions could became more forgiving toward their transgressors when they were asked to write about possible beneficial effect of the transgression, compared with victims who wrote about traumatic or neutral topics. Thus, the positive narrative approach may facilitate forgiveness and help victims to overcome traumatic interpersonal issues.

As for gratitude letters, the delivery of forgiveness letters is a crucial issue, because the act of showing forgiveness can influence the process of forgiveness itself. In some cases, as highlighted in Gordon and collaborators’ study ( 2004 ) about marital conflicts, writing and delivering a letter is helpful to reduce relational tension and the consequent conflicts, but in other situations where forgiveness remains an intra-personal process, sharing it can be more harmful than beneficial. This may occur particularly when the relationship between victims and transgressors is particularly problematic (or even abusive) and reconciliation is not possible, or not recommendable (Gordon et al., 2004 ).

Forgiveness writing is also helpful in the promotion of self-forgiveness. Jacinto and Edwards ( 2011 ) describe a case where the exercise of writing a letter was used in the therapeutic process of self-forgiveness. The act of writing helped the client to trigger self-empathy and consequentially to let go of negative beliefs about herself.

In conclusions, the therapeutic ingredients of these writing assignments (gratitude and forgiveness letters) concern both an intra-personal dimension (the promotion of self-esteem, self-awareness and a sense of meaning in life) and an interpersonal dimension (the promotion of empathy, compassion, and a sense of connectedness with others). They both constitute the pillars of well-being and positive psychological functioning (Lyubomirsky & Layous, 2013 ).

Wisdom is a complex ability composed of cognitive and emotional competences, such as perspective-taking, thinking with a long-term perspective, empathy, perception and acceptance of emotions (Staudinger, 2008 ). Collecting narratives of wisdom may be connected with autobiographical memory (McAdams, 2008 ). Glück and collaborators ( 2005 ) conducted a study where participants had to write a 15 line paragraph describing all the situations where they did, thought or said something wise; then they had to select a situation from them where they had been wise. This writing task was followed by an interview in which the “wise situations” were discussed. Writing about autobiographical memory kindles the development of strengths related to wisdom, such as acceptance and forgiveness of others, taking different perspectives, being honest and responsible and making compromises.

The promotion of wisdom can be done also using specific narrative structures, such as the one of storytelling and fairytales. The employment of fairytales with adults was found to promote the development of feelings of wisdom (Ruini, 2014 ; Ruini & Ottolini, 2014 ). Fairytales, in fact, enable a process that allows one to reformulate problems in narrative terms, using a specific narrative plot. It consists of three main steps: (1) the identification of an initial stressful event; (2) the journey of the protagonist, with tests and adversities to face; (3) the final positive resolution (happy ending) (Masoni, 2019 ). Furthermore, Ruini and Ottolini ( 2014 ) showed the effectiveness of using fairytales in patients who had to cope with life transitions: to read and then to re-write a fairytale is a way to symbolize one’s own life and clarify moral and existential issues. In this particular narrative technique, the patients are asked to write a fairytale that well symbolizes their life, with a happy ending; the fairytale created is then read and discussed in the session. In many cases, the stories contain narrative issues and characters’ attitudes that evidence patients’ real difficulties. For example, the protagonist can be very passive in the story or not well characterized. The clinician helps the patient to re-write the fairytale making corrections that allow the patient to clarify dysfunctional elements and consequently to construct a new and more positive story. Creating a happy ending can be a way to express patients’ desires about their future and to let them imagine how they can be satisfied with their life. Through the exercise of writing a structured fiction story, patients can analyze their life situations in a more detached way, view problems from a different perspective and become aware of their values and attitude. This emotional detachment is similar to the process of cognitive defusion in ACT, but in this case, there is no mention to the relational frame theory, and the act of writing the fairytales may promote another positive dimension: creativity (Ruini et al., 2020 ).

Writing can be considered as a coping strategy aimed at finding solutions which in turn can spark hope in desperate situations. In line with the expressive writing approach (Pennebaker & Evans, 2014 ), writing about traumatic or particularly painful situations, may promote feelings of hope because it allows to go beyond suffering and to reach positive perspectives.

Positive psychotherapy entails specific written exercises that focus on strengthening hope. Among these, we can find Writing about Best Possible Selves, where possible selves are personal representation of goals, connected with what people desire for their future. This writing exercise aims to improve self regulation because it allows clients to clarify and restructure priorities and acquire insight on one’s own motivations and values (Loveday et al., 2018 ; Sheldon & Lyubomirsky, 2006 ). Other potential benefits of writing “best possible selves” are the possibility of integrating life experiences, identifying the meaningful ones, and gaining a sense of control (Lyubomirsky & Layous, 2013 ). These benefits have also been confirmed in King’s ( 2001 ) study where participants were invited to write for four days (20 min per day) a narrative description of their best possible future selves. Outcomes showed that, compared to writing about other topics, the act of thinking and describing oneself as best as possible increased positive mood and decreased distress five months later.

Another technique to foster hope is the Blessing journal/Three Good Things in which patients keep a journal where they write three good things every night and the reason why they think those things have happened. The objective is not only to identify positive happenings, but also to search for the causes and underline the active role of the subject in provoking them. The sense of personal agency in fact, is considered a component of hope (Snyder et al., 2000 ). Snyder’ hope therapy (Snyder et al., 2002 ) entails the specific use of “hope narratives” where clients are guided in a process of writing past experiences where they were able to achieve significant personal goals (hope reminding exercise). In the subsequent phase of hope therapy, clients are asked to write specific narrative where they focus on future goals to be achieved and they develop specific path to reach them (hope building techniques).

In conclusion, the traditional use of writing techniques within psychotherapies has been included also in the positive psychology perspective. However, positive psychotherapy and other positive interventions have changed the focus of the writing exercises from negative/traumatic experiences to positive ones (Lyubomirsky et al., 2006 ). The therapeutic process may be the same, but the focus is shifted from symptoms to well-being. The positive psychology approach promotes writing exercises on gratitude, hope, forgiveness, and positive descriptions of oneself with the intention of improving clients’ well-being. At the same time, these exercises may help them to process also negative emotions and traumatic events (McCullough et al., 2006 ). Conversely, in traditional psychotherapies (as described in the first part of this article) writing techniques are specifically aimed at overcoming negative events and psychological symptoms. As a byproduct, they may also favor patients’ recovery, well-being and meaning in life, but this was not their main therapeutic purpose.

New Applications: Writing on the Web

The final part of this review deals with other recent modifications of writing approaches that entail the use of internet and other digital technologies. In recent years the act of journaling and keeping a diary has been often replaced with writing in blogs or on social networks such as Facebook, Twitter or Instagram. On these platforms users may create personal profiles that reflect their sense of identity or positive introduction. User profiles also include the narration of their meaningful experiences via photos, videos or boards. In this section we will describe these phenomena and their relation with the psychotherapy process, underlying both the positive and negative features.

Writing activity has been recently modified by the use of the web and by the influence of technological instruments. In fact, social networking sites constitute a technological tool for self-revelation which gives the opportunity to share experiences and impressions through writing as they can create a permanent record of one’s actions or thoughts (Sauter, 2013 ). In social-networks the personal home page is both a space of identity construction and of self presentation towards the rest of the world (Sorapure, 2003 ). In particular, Facebook can also be considered an online autobiographical instrument that codes and keeps track of events of in one’s life.

In this way, unlike traditional handwriting, writing on the web implicates a social function rather than a private one. Sharing, in fact, is a fundamental component of self-writing on the web.

Additionally, the presence of clinicians in social networks is a relevant factor: some therapists can use social networks as an extra instrument to give support or be available for patients. Taylor et al. ( 2010 ) observed that the client–psychotherapist relationship can be influenced by the presence of the psychologist on the Internet. Many psychotherapists create a web site where clients can find their professional activities and services. Other psychologists let clients contact them via e-mail or instant messaging when they need help (Manfrida et al., 2017 ). For example, “Talkspace” is a web platform which offers online therapy through messaging with a licensed therapist. Hull and Mahan ( 2017 ) studied the effectiveness of Talkspace’s text-based therapy and showed the beneficial effects that text therapy had on symptom reduction and improvement in psychological well-being. The study participants also reported high levels of satisfaction with the treatment.

Moreover, Sloan et al. ( 2015 ) have studied the efficacy of a structured writing therapy conducted via internet: “Interapy”. It consists of a protocol of 10 writing sessions, held twice a week, in which patients who suffered from post-traumatic stress disorder had to write about the traumatic event focusing on cognitive reappraisal and sharing details with someone close. A trained therapist then gave feedback on every written online narrative.

Recently Botella et al. ( 2017 ) presented a new instrument, which utilizes digital technology and virtual reality via web in a framework of positive interventions. They named it “Book of Life” and it consists of a personal digital diary composed of various chapters in which some narrative exercises are proposed. Participants may also include multimedia contents (i.e. pictures, videos, music) about a specific topic, in order to create a final positive autobiographical narrative. The therapeutic aim of the Book of Life is to foster positive emotions and the use of personal psychological resources. The results of clinical trials where the Book of Life was applied were particularly effective with older adults and cancer patients.

In conclusion, writing on the web involves different types of interventions. These techniques appeared to be particularly useful during the lockdown due to the Covid-19 pandemic. The use of online platforms and the possibility to contact therapists via mail or social network allowed the delivery of mental health treatments during a global stressful experience (González-Robles et al., 2021 ). Future investigations are needed to explore how writing in websites and social networks may influence the development and the delivery of psychological therapies, both the traditional and the positive ones.

Conclusions

Considering the various and different applications, writing therapy constitutes a very adaptable technique to be used as a standalone treatment or as a supplement of other therapies. WT may provide beneficial effects on symptoms and also on psychological well-being. In fact, the act of writing showed great potential in the promotion of personal strengths, resilience and post-traumatic growth (Sandstrom & Cramer, 2003 ). Moreover, writing techniques can be considered a tool of continuity from the traditional approaches to the new psychotherapy contexts, such as positive psychology and the employment of digital technologies in psychotherapeutic settings.

In general, although it is common sense to think that psychotherapy is for the majority orally communicated, the act of writing provides many benefits in psychotherapeutic sessions as well as in clients’ daily life. Writing makes thoughts more real and transforms mental states in something concrete as feelings, whereas thoughts and reflections expressed orally can easily disappear when the psychotherapy session ends. Moreover, writing therapy may be particularly effective for individuals with high levels of interpersonal avoidance or social inhibition, since they have a therapeutic tool for managing their difficult emotions, without the burden of a direct interaction with the therapist (Allen et al., 2020 ).

However, some caution is needed also when applying writing techniques within psychological interventions. First, the use of writing technique may give thoughts more emphasis and power, specifically when writing negative thoughts or feelings. In this case, the act of writing may increase cognitive rumination (Pennebaker & Evans, 2014 ). The same potentially negative effect of writing thoughts and life experiences may apply also to positive issues. Lyubomirsky et al. ( 2006 ) found that individuals who were asked to write about their happiest moments experienced reduced well-being. The author suggested that the analytic nature of writing about positive events may be counterproductive as opposed to the unorganized process of simply thinking about them.

Another possible side effect of writing techniques (both documented for traditional psychotherapies and positive interventions) is the sense of shame that can be triggered when someone else reads the writing. This could imply a resistance to the act of putting down negative thoughts or the worsening of worries because of the excessive interpersonal exposure (Pennebaker & Evans, 2014 ). In these cases, it is recommended that the use of writing may remain confidential, or it may be accompanied by specific psychological support, so that negative emotions can be discussed with the therapist.

Similar issues of shame and embarrassment have been found to occur when writing and delivering gratitude letters: some studies (Boehm et al., 2011 ; Layous et al., 2013 ; Shin et al., 2020 ) underlined the specific influence of cultural issues: in collectivist cultures (vs individualistic ones) expressing gratitude resulted less effective on well-being because of the sense of indebtedness and embarrassment it can provoke. In fact, the sense of self-improvement and personal agency, which were emphasized in writing assignments, increased life satisfaction only in Western individuals. Conversely, collectivist cultures consider self-focus and individual goals in a less positive way, since they may interfere with the need of the group. Thus, when working with clients belonging to collectivistic cultures, clinicians should use caution in prescribing writing assignments (such as gratitude and forgiveness letters) that can interfere with clients’ relationships within the community they belong to. However, the beneficial effect of writing can be preserved, if the delivery of the letter is not mandatory (Lyubomirsky et al., 2006 ; Pennebaker & Evans, 2014 ).

In conclusions, this review of the literature briefly described writing techniques within psychological therapies, that encompass several different methodologies and specific exercises, ranging from unstructured journaling to personal autobiography, to recalling specific memories associated with positive and/or negative experiences, to writing fairytales, short stories, or letters of forgiveness and gratitude, etc. All these methodologies could be easily implemented in many psychotherapeutic approaches, from the traditional CBT, logotherapy and existential therapies to novel approaches, such as positive interventions. Although some authors found certain potential side effects of writing techniques on the emotional well-being of patients (Lyubomirsky et al., 2006 ), a large body of literature confirmed their beneficial effects, which amplify and prolong the therapeutic effect of the talking therapy with the clinicians. Importantly, adding writing techniques to talking therapies was found to reduce the length of treatment and improve access to psychological therapies (Gerger et al., 2021 ; Pennebaker, 2018 ). The integration of writing techniques within traditional talking therapies or new positive interventions could be easily done also using technological devices, such as app, emails, on line journals or social networks (Botella et al., 2017 ) which could be more appealing for younger patients. The technological tools of communication are changing the role of therapists, who more often use on line resources to support their clinical work. Furthermore, the pandemic due to the Covid 19 and the need to implement telepsychology and distant mental health interventions make the integration of writing techniques particularly appropriate in these settings.

A final recommendation concerns the selection of writing exercises and the timing to prescribe them during the therapeutic process. Different writing activities could yield different effects according to patients’ clinical status and emotional balance. Certain activities could be used to deal with specific clinical problems, such as overcoming traumatic events or personal transgressions, and should be prescribed when the patient complains some of these issues. Other writing activities, on the other hand, have an unspecified theme, (i.e., guided autobiography, or writing your own epitaph) and they appear to be more appropriate for promoting personal growth, personal awareness and existential well-being. These activities may be well suited for the concluding part of the psychological treatment, independently of patient’s initial symptoms and problems. Research on positive interventions (Lyubomirsky & Layous, 2013 ) documented the need to consider the extent to which the therapeutic activity matches an individual’s preference and characteristics (i.e., “person × intervention fit”) in order to maximize the beneficial effect of the intervention on happiness and well-being. Similarly, Joseph ( 2015 ) suggested that therapists should follow their clients preference and should co-create with them a specific treatment agenda, unique for that client, instead of referring to a set of pre-determined list of activities (in this case writing assignments). This would be a more flexible and creative therapeutic approach, in line with a positive clinical psychology perspective (Ruini, 2017 ). However, only further clinical research should test and verify the most effective approach in prescribing writing assignments during the course of psychological interventions.

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The Authors express their gratitude to Dr. Lorenzo Angiolucci for his contribution in the process of writing and revising this manuscript.

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Ruini, C., Mortara, C.C. Writing Technique Across Psychotherapies—From Traditional Expressive Writing to New Positive Psychology Interventions: A Narrative Review. J Contemp Psychother 52 , 23–34 (2022). https://doi.org/10.1007/s10879-021-09520-9

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Accepted : 06 September 2021

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DOI : https://doi.org/10.1007/s10879-021-09520-9

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