Tzivia Macleod
Jennifer Tzivia MacLeod is a writer, translator, and editor living in northern Israel. Her picture books for children, most focusing on aspects of Jewish family life, have won multiple awards. This article was written as part of her work towards a Master's degree in interdisciplinary studies (MAIS) at Athabasca University. .
ABSTRACT
The practice of journaling in contemporary psychoanalysis has been adopted by a broad range of therapists since the 1960s. However, while many therapists use journaling as a component of their practice, studies promoting a unified approach to journal writing as an adjunct to psychotherapy are still woefully lacking. This article examines explanations of journaling from humanistic/existential and feminist/narrative perspectives. Given the adaptability of writing to a range of approaches, and its application by many therapists today, this article also investigates why journaling and writing components of therapy continue to be deprecated within the field, while offering recommendations for future research.
Keywords: journaling, expressive writing, meaning, intervention, psychotherapy
The use of journaling in modern psychoanalysis may have begun with feminist therapy, but it has since been adopted by a broader range of therapists. However, while many therapists use journaling as a component of their practice, studies promoting a unified approach to journal writing as an adjunct to psychotherapy are still woefully lacking. This article examines explanations of journaling from two contemporary perspectives, humanistic/existential and feminist/narrative psychotherapies, followed by a brief exploration of precursors. It then explores the literature for possible explanations of the fact that, given the adaptability of writing to a range of approaches, and its application by many therapists today, it continues to be deprecated within the field. Finally, it offers recommendations for future research.
Although this article deals with journal writing in psychotherapy, definitions of “journaling” in practice range from the basics of dates, times, moods, and triggering events to an elaborate daily practice of soul-baring, putting pen to paper with candle and baroque music in the background, as described by Metcalf and Simon (2002). There is no line demarcating where journaling begins and other writing, such as “expressive writing,” “therapeutic writing,” “scriptotherapy,” and “writing for personal development” ends. Because literature on journaling is scant, this article adopts a broad definition, encompassing most therapeutic writing created without regard for external measures such as writing quality, readability, marketability, or mechanics of grammar or spelling. This article considers only writing shared with a therapist, thus serving as an adjunct, rather than independent writing which is never discussed in therapy.
Originating with Carl Rogers in the 1950s, humanistic psychotherapy is a term sometimes used interchangeably with “person-centered” or “client-centered” therapy (Raskin, Rogers, & Witty, 2008, p. 148). This theory is founded on a concept of humans as actively self-regulating and constantly moving towards self-actualization. Humanism broke away from two major psychotherapeutic traditions of the time—psychoanalysis and behaviourism—in several significant ways. The emphasis in person-centred therapy is not on interpretation, and there is also reduced emphasis on transference. It contrasts with behaviourism in that behaviour change is not seen as the cause of inner change in the client. Both psychoanalysis and behaviourism emphasize external factors as the cause of issues that the client is confronted with in the present, and neither views the client as entirely reliable in gaining insight into their personality or problems (Yontef & Jacobs, 2008). In contrast, person-centered therapy places less emphasis on externalities such as the past, childhood, or dreams, or on behavioural triggers, and more on consistency, transparency, and authenticity on the therapist’s part expressed in part through its emphasis on unconditional positive regard.
In contemporary humanistic psychotherapies, and in existential psychotherapy, an outgrowth of this theory, journal-writing is sometimes used as part of the movement towards homework, a trend adopted from cognitive-behavioural therapies. As Canada et al. (2015) explain, “journaling is a way to extend the therapeutic enterprise between sessions and to maintain progress, develop additional insight, and reflect on the content of sessions” (p. 113). Thus, journaling is a simple and accessible tool to extend the therapy hour.
Because of humanistic therapies’ emphasis on authenticity and mutuality in the therapist-client relationship, the writing practice can occasionally run both ways: not only from client to therapist, but also from therapist to client. Albert Ellis, for instance, who is not considered a humanistic psychotherapist, but who was nonetheless highly influenced by proto-humanists including Alfred Adler, documented a situation in 1965 wherein he lost his voice and was forced to correspond back and forth in writing with patients (Lamprecht, 2015). This forced adoption of a novel method can be seen as an early precursor to writing as a component of therapy. Existential psychotherapist and author Irvin Yalom adopted a similar practice when a series of his letters back and forth with client Ginny Elkin were published in 1974 as Every day gets a little closer: A twice-told therapy. As with so many of Yalom’s practices, this move was inspired by sheer intuition: “I could not know the precise effects of the exercise, but I felt certain the plan would release something powerful” (Yalom & Elkin, 1974, p. xviii). One insight this exercise provided for Yalom (2002) was the realization that patients are often not attuned to the therapist’s “elegant and brilliant” interpretations (p. 21), but rather the human touches such as compliments and apologies. Thus, in a wonderful demonstration of authenticity and mutual learning—a hallmark of humanistic and existential psychotherapies—the back-and-forth writing led not only to clients’ resolutions of their problems but to a deeper understanding of what clients were experiencing during therapy.
Yalom is also noteworthy for other ways in which he uses writing. For instance, he routinely recommends and practices writing as an adjunct to group therapy and follows the practice himself by dictating “detailed and impressionistic” (2002, p. 80) summaries of group sessions, including honest admissions of his own errors. He then sends them out to members between meetings to provide continuity and spark reflection. Yalom also turned to email as soon as this technology became available, communicating with clients between sessions and making himself available in ways that many therapists would not. An angry email, he mentions (p. 71), may be the “grist for the therapy mill” that is the “here-and-now” of humanistic psychotherapies. He is also quick to note when writing is not useful or appropriate, as in one case where a client was coming to sessions armed with notes and a detailed agenda, which Yalom interpreted as a distancing strategy rather than one which fosters intimacy. In another case, a woman’s handing him her “dream journal” to read on his own time “turned our relationship into something crude” (p. 55). In both these cases, Yalom rejected the written offerings of clients to some extent because he recognized them as a means of sidestepping the essential here-and-now focus. As Riordan (1996) points out, writing can be detrimental when it is “an excuse to avoid other appropriate action or as an unhealthy obsessive rumination” (p. 267). He recommends maintaining “here-and-now” type interactions around a writing practice to keep clients focused.
Yet the here-and-now focus and other aspects of humanistic psychotherapies can also undermine the adoption of journaling in therapy. Person-centered therapies sometimes eschew “homework” from the therapist in favour of actions initiated by the client, since therapist-generated work may be perceived as imposing value judgments rather than unconditional acceptance (Raskin, Rogers, & Witty, 2008). A humanistic psychotherapist will want to put the client-therapist relationship above most other considerations, and homework may be seen as detracting from the centrality of that core relationship. Finally, humanistic therapies emphasize the “human” element—the art and soul of therapy—as strongly opposed to the type of manualized approaches with which journal-writing practices are sometimes associated. Therapy, Raskin, Rogers, and Witty write, “is a unique, unpredictable encounter premised on the response of the therapist to a person who seeks help” (p.149), thus it cannot be neatly plotted into a workbook or through a writing program of any kind.
Narrative therapy developed as an outgrowth of feminist therapy in the late 1980s and early 1990s. As Lee (1997) described, narrative therapy emerged from the observation that women actively create meaning in their own lives, often with devastating effect, through “stories or self-narratives framed by dominant misogynous cultural meta-narratives” (p. 1). Narrative therapy was an attempt to reframe harmful self-narratives. It revolves around the core concept of narrative, defined by Peterkin and Prettyman (2009), citing Aristotle, as “a representation of a causally connected sequence of events with a beginning, middle and end” (p. 80). In addition, Lee writes that the “stories we refer to both shape the interactional context and are shaped by it” (p. 1). While other therapies privilege either internal or external forces to shape emotions and actions, narrative therapy privileges the “meaning system” (p. 1) as a whole to create the discourse of self-perception. The goal of narrative therapy is meaning-making—creating a consistent self and reconciling personal life with dominant social discourses. The idea behind narrative therapy is that a given order of events does not have an inherent meaning in itself, any more than the shape of the letters “CAT” has some inherent meaning. The letters “CAT” become understood as a furry creature which purrs only within an English-speaking cultural framework. In a different social and cultural construct, the word could have a completely different meaning altogether. The role of the therapist is to guide individuals towards awareness of the meanings, actively influencing a client within his or her context. For instance, an individual may have a clear picture of how married people should behave, or what success in business should look like, but that individual’s personal narrative may not be consistent with those dominant discourses, and in that conflict lies the root of psychological problems.
Narrative psychotherapy differs from humanist psychotherapies in that it does not, as Weedon writes, “presuppose an essence at the heart of the individual which is unique, fixed and coherent and which makes her what she is” (cited in Lee, 1997, p. 4). Instead, narrative psychotherapy sees the self as “plural, plurivocal, and as a product of culture” (p. 4). The role of the therapist is to “attempt to facilitate trust and intimacy rather than dependency and fear, to make meaning in their lives based on the stories they live” (Ricks et al., 2014, p. 100). In therapy, clients arrange the events of their lives in particular sequences. Narrative therapy is thought to promote healing by allowing clients to reframe their own life story, changing the meaning and significance of past and present events with an awareness that they are dynamically creating their own future. Various terms for this process are used throughout the literature, including “re-storying” and “re-authoring,” and “meaning reconstruction.” Writing techniques, including journaling, are thus one of many methods through which participants “externalize,” which is key to narrative therapy in any form (Keeling & Bermudez, 2006, p. 405). Externalization allows clearer focus on a problem as distinct from the person him- or herself. Indeed, separating person from problem to better understand the dimensions of the problem is an essential aspect of narrative therapy.
One of the important ways that the concept of narrative has been studied is in connection with rape and other sexual traumas inflicted on women. Pulverman et al. (2017) do not mention the term “narrative,” but refer to “sexual self-schemas” (p. 181) in a way that closely parallels the idea of a personal story which clashes with dominant narratives, in this case, narratives of abuse and domination. Self-schema, for the authors, is a “cognitive generalization” (p. 181) about the self, almost like a lens which distorts the story of an individual’s life. A situation of sexual abuse may be ideally suited to writing therapies since it allows women “to control the pace and intensity of the treatment sessions” (p. 181). They speculate that this is because “writing may alter maladaptive self-schemas” (p. 182). They also demonstrated an increase in long-term meaning-making, perhaps signalling an emergence of positive narratives following creative writing tasks, “suggesting that continuing expressive writing exercises past the initial five treatment sessions may confer additional benefit” (p. 186). Their study clearly demonstrates the power of repairing narrative to initiate healing after trauma.
Modern psychotherapies are not entirely novel in their suggestion that writing is a useful way to create new narratives and re-imagine the life course of a person in crisis. One major precursor for journaling in psychoanalysis began in the 1960s with Ira Progoff. Trained by Carl Jung, Progoff founded Holistic Depth Psychology, a philosophy he laid out over several books, but which lacked practical implementation until he added the Intensive Journal Method in 1963. The core of Progoff’s theory was twofold: that individuals can transcend rational awareness and that societies shape the consciousness of those within them (Gestwicki, 2001). Progoff was one of the first therapists for whom clients’ journaling practices let them mirror “the elusive images, thoughts, hunches, intuitions, and feelings that came to persons from the deeper levels of their understanding” (p. 57). Progoff died in 1998, but to this day, his organization, Dialogue House, continues to promote his Intensive Journal program for self-development.
In 1978, Progoff laid out his vision for adapting journaling to a therapist’s philosophy and method of practice. In what seems a natural precursor of narrative therapy, Progoff (1978) explains that the first task of the therapist is to position the person in crisis “in the perspective of their whole life…along the path of their life history between their past and their future, so that they can discover for themselves the next valid steps in their lives” (p. 316). Progoff’s work also closely predicts narrative therapy when he mentions that a problem or crisis occurs “when people… have lost, perhaps temporarily, the perspective of their life because of the transition in which they find themselves” (p. 316). Regaining perspective, for Progoff, is essential to correcting emotional disturbance. Another way of putting this, as Janesick (1999) writes, is that “journal writing is ultimately a way of getting feedback from ourselves, and in so doing, it enables us to experience in a full and open-ended way, the movement of our lives as a whole and the meaning that follows from reflecting on that movement” (p. 508). A more contemporary term for “the movement of our lives” is, of course, story or narrative.
While Progoff offers numerous suggestions for writing practices which may have therapeutic benefit, he cautions that “the mere fact of continuously writing entries, as is done in the keeping of a diary, is not sufficient in itself to bring about deep changes in a person’s life” (Hiemstra, 2002). Research on therapeutic writing has explored this through the use of meaningful writing tasks (describing a stressful event) compared with control writing tasks (describing a neutral topic like the weather) (Horneffer & Chan, 2009). While some writing may be therapeutic, only certain writing is believed to offer direct benefit. Research has still not determined which types of writing are most beneficial.
The debate over the practical application of writing as therapy, which has been ongoing since Progoff’s time, is most likely the reason that journaling and therapeutic writing have foundered to this day, unrecognized and even deprecated as “artsy” or “soft” by mainstream psychotherapists. This deprecation persists despite a wide range of applications in which writing has proven an excellent adjunct to mainstream psychotherapies.
Journaling as a component of therapy has a wide range of applications. A list of contemporary applications of journaling and other writing therapies would be very long, and would include abuse survivors, healthcare providers, terminally ill cancer patients, mental illness, PTSD, war, incarcerated women, and many more. Studies often do not attempt to formulate a complete explanation for how or why writing works therapeutically. In discussing applications of journaling in veterans’ courts, Canada et al. (2015) draws on a traditional psychoanalytic model in which feelings are inhibited or repressed. Repression, the authors explain, leads to disease, both mental and physical. By releasing inhibitions and suppressed material, individuals free themselves and experience greater mental and, consequently, physical health. The authors even extend this Freudian-sounding model to explain why certain populations are more likely to benefit from journal writing: “Stigmatized populations, such as those involved in the criminal justice system, may be more likely to suppress their feelings because of perceived pressure to behave or think in accordance with social expectations” (p. 114). More stigma equals more repression, therefore, more room for writing to free people from their own inhibitions. Yet studies have failed to yield much evidence for this view (Peterkin & Prettyman, 2009).
Canada et al.’s (2015) reading of how journaling works is very common, yet it runs counter to both the humanistic and feminist traditions, which have helped bring writing into the mainstream. As Raskin, Rogers, and Witty (2008) write, the classic psychotherapeutic view generates a paradox, namely, that feelings can be “both existent (coming from the past) and yet nonexistent until symbolized in awareness (felt for the first time when expressed)” (p. 168). Humanistic psychotherapies have responded by asserting that experience is contextual and that the self is continuously and subjectively reconstructed, an assertion that readily meshes with narrative therapy. Indeed, Raskin, Rogers, and Witty write that one of the goals of congruence in humanistic psychotherapy is for “therapeutic attitudes [to] combine into a gestalt as the therapist attends to the narrative of the client” (p. 182, emphasis added). During therapy, the therapist must verify his or her understanding of the client’s story until both content and meaning of that client’s narrative are grasped.
In contrast with the oversimplified repression-based view of Canada et al. (2015), a more sophisticated understanding is reflected by Peterkin and Prettyman (2009) who believe “the ability to construct well-organised and meaningful narratives is an important skill for successfully coping with life stressors and trauma, enabling individuals to create coherent stories from fractured memories and to facilitate cognitive processing of traumatic events” (p. 80, emphasis added). Their study evaluates the use of therapeutic writing in a population of HIV-positive individuals, and differentiates between narrative, simple description of events, and “emplotment,” which describes a deliberate placing of events in sequence, relative to the story’s beginning, middle, and end, to “construct . . . interpretations and communicate meaning” (p. 83). Their study quotes several participants describing the benefits of writing as compared with traditional therapy:
Progoff (1978) and Peterkin and Prettyman (2009) advocate not simply for the act of writing, but for creating “good stories” through “narrative competence” (p. 83). This client feedback suggests writing can complement traditional therapy in resolving narrative disconnects.
Kerner and Fitzpatrick (2007) offer another sophisticated analysis of the relationship between writing and psychotherapy through a matrix-based framework keying different types of writing tasks to therapist orientations in order to “help therapists make informed choices about how to incorporate writing into their practices” (p. 333). This aligns with the claim presented by Peterkin and Prettyman (2009) that “The success of such a diverse range of writing tasks suggests that the specific structure of writing tasks cannot fully explain the source of writing’s benefit” (p. 82). Kerner and Fitzpatrick’s assertion is that writing as therapy can work in a wide range of applications and populations, even though it is not yet well-defined theoretically.
Given Progoff’s work as far back as the 1960s, along with the fact that writing is clearly being used widely in applications bordering on the psychotherapeutic, it is reasonable to ask why journal writing and other expressive writing are not a more mainstream part of contemporary therapeutic practice. It seems as if journal writing has been and continues to be deprecated within the field. As Riordan (1996) suggests, "In much of [the] literature, scriptotherapy [his own term] seems to be used most frequently with highly charged client issues and clinically ill populations. This may represent a literature bias that could mask the more routine use of the technique in counselling with developmental clients that would be less likely to reach publication" (p. 264). From this oblique reference, it seems possible that some therapists use writing routinely but in a covert way. Given the fact that therapeutic writing is so widespread, it is worth asking why it is not taught as a significant and useful adjunct to psychotherapy in a wide range of populations. This section addresses six potential reasons why this could be the case.
Few of those practicing and studying writing as therapy understand what it actually entails. The lack of definition breaks down into two areas: how to implement it as an intervention in practice, and the population that would be most likely to benefit. Therapists are probably justified in their suspicions of a practice which makes broad and sweeping claims for benefits without claiming to be more effective in a particular situation or population. As the hosts of one popular medical-history podcast like to say, “Cure-alls cure nothing” (McElroy, 2016). Are journaling and therapeutic writing presented as a cure-all?
The practice of journal writing is so poorly defined in the present climate that it lacks a single unifying name. Writers and researchers use different terms at will with little consistency. How should writing be introduced into and practiced within the therapeutic relationship? How often and for how long should clients journal for optimum benefits? Even these most basic questions have few good answers. As Kerner and Fitzpatrick acknowledge, “There is… little consensus about the mechanisms that make writing beneficial for clients” (p. 333). These are serious flaws which must be addressed in future research.
Imagine a drug which has no single, agreed-upon name or dose. No two pharmacists can agree on exactly how it works or who should take it. A responsible physician would likely be hesitant to prescribe the drug. Yet lack of agreement aside, it is true that often, once a drug is on the market for one condition, physicians also prescribe it “off-label” for uses that differ from how the drug was originally intended. In the same way, writing—which has proven valuable again and again—cannot be discredited simply because its proponents lack unity.
Thompson (2011) writes, "Some professional groups may be sceptical about the therapeutic benefits of journal writing because it has not been subject to much empirical testing or the subject of randomized controlled trials" (p. 52). She has a point, and the truth is that much research to date has taken place in a setting so artificial that it would be foolish to extrapolate its results to a general population. Much research is based on brief studies conducted in an artificial environment where "therapeutic" tasks (writing about positive or negative experiences, or about life goals) are pitted against "neutral" tasks (control tasks like writing about the weather). A suspicious number of these study participants are students, leading any therapist to wonder about how readily results could be extrapolated to the population at large. Some studies of writing as therapy also seem to undermine their own legitimacy, such as one study which tested a "micro-dose" of writing, proving that even two minutes could have psychological benefits (Burton & King, 2008). Studies like these highlight how little is known about how exactly therapeutic writing should be applied for optimal psychological wellbeing.
Riordan (1996) raises this potential objection in his historical overview of writing therapies. Though he cites 18th-century physician Benjamin Rush as having used a form of journaling to reduce tension in patients, he also notes that "[d]evelopmental use of scriptotherapy [i.e., that aimed at self-improvement] is more obvious in commercial workbooks on career and other life skills development" (p. 264). These workbooks, as he describes them, are psychoeducational tools “which provide stimulus statements requiring the reader to respond in writing” (p. 265). Workbooks are available for couples, single parents, and other specific demographics. However, he shares the caution expressed by L’Abate, that “corrective feedback” to the individual is absolutely necessary, or else the effort is “bound to fail” (cited on p. 265). Riordan offers no further explanation or examination of the dimensions of this anticipated failure.
This leaves the reader wondering whether, in an era of managed care and cutbacks, a writing program which can be purchased in workbook form might directly threaten the role of the psychotherapist. Kerner and Fitzpatrick (2007) state that “When writing has been compared to psychotherapy, writing about traumatic events was found to be as useful as therapy in promoting clients’ positive emotions, cognitions, and behaviors” (p. 334). It is possible that psychotherapists are simply not willing to take the risk that their clients will attempt this comparison for themselves. If a therapist can be replaced by a workbook (or if a client believes this) it is easy to imagine a certain amount of resistance to this practice on the therapist’s part.
Howes (2011) undoubtedly speaks from experience when he ventures to share colleagues’ belief that “journaling smacks of CBT - they fear token economies and thought logs are soon to follow” (para. 18). They are more likely to roll their eyes, he writes, than leap to adopt writing therapies. This skepticism may also stem from concern for the therapist’s role. If a writing practice is scripted or formulaic, does the client need a therapist at all? Riordan (1996) counters that “counselor and client… need a close partnership in prescribing therapeutic writing because the tool can be complex, requires sound counselor direction, and needs mutual enthusiasm for greatest effect” (p. 268), though this assertion as well is not backed up with strong evidence.
Howes nonetheless urges peers to take writing seriously, in part by describing its success as an adjunct to psychodynamic psychotherapies. He cautions against using it with clients in analysis, writing that “They already do plenty of introspection, and yes, journaling might get in the way” (para. 20). Yet for weekly clients, he writes that “If you journal in the interim, there's more chance for growth between sessions” (para. 21). This approach leaves plenty of room for client-therapist authenticity. As Stone (1998) adds, journaling is not a quick fix. Rather, “journaling introduces a ‘quiet time,’ a period for reflection where thought can prevail over expedient action so that people find sense and meaning in the issues of life” (p. 536). This emphasis on contemplation and insight may reassure therapists who fear that journaling is too readily manualized.
Not every client loves writing or takes to it naturally. Narrative therapy cannot force all clients into the same mode of treatment, but rather should emphasize using clients’ creativity to externalize problems and reconstruct narratives. Many reluctant writers find that writing taps into something fundamental within themselves, to great psychological benefit. Kerner and Fitzpatrick (2007) actually suggest that writing offers advantages over other art-as-therapy adjuncts: “writing was found to encourage a greater decrease in psychological symptoms, especially for individuals who had higher baseline levels of psychological distress” (p. 334). Though poorly understood, writing seems to offer something other modalities do not.
Therefore, while considering clients’ limitations, therapists should not let perceived limitations, from stereotypes and preconceptions, obscure the client’s potential to benefit. Studies have shown that numerous factors have, in fact, not been an obstacle to writing in therapy, including low socioeconomic status, education level, incarceration, disability, terminal illness, minority and immigrant status, and many others. Not every client does write, but many clients can write and could benefit from a journaling practice, even if it does not come naturally.
In discussing journaling in a therapy practice, Stone (1998) takes an individual psychology perspective, emphasizing process rather than content, and empowering the client’s choice of what to disclose in journal form. He views therapists as “guides and fellow travellers,” and cautions—echoing Yalom—that “the therapist needs to journal as well, or it will be ineffective. How can you recommend journaling to clients if you don't journal yourself?” (p. 536). This recommendation will likely resonate with some therapists while repelling others.
It is possible that in anticipating clients’ dislike of journaling, some therapists are projecting their own dislike of the idea. For therapists who do not write regularly, writing may be a dreaded practice, hearkening back to college days: late nights, papers, deadlines, and stress. And there is the possibility as well that individuals practicing psychotherapy, known for over a century as “the talking cure,” simply cannot see the appeal of transforming spoken word into written form and vice versa. Riordan (1996) points to a further potential objection of a therapist to putting journaling into practice: “little exists to guide counsellors in using scriptotherapy” (p. 267). He attempts to offer practical guidelines for practice, yet does not adequately cite his recommendations or offer alternatives for other types of therapeutic approaches.
What is the best way to combine journaling or other expressive writing with traditional therapy? The answer to this question is not yet clear, but given the tremendous benefits throughout the literature on journaling, and expressive/therapeutic writing, it seems clear that the topic merits further study and engagement by professionals in the field. Yet the dimensions of future research are also still unclear. Kerner and Fitzpatrick (2007) offer concrete suggestions, such as that future research concentrate on testing writing as an adjunct to therapy along the matrix/axes described in their article, “mov[ing] future research toward a sharper focus on the benefits of writing” (p. 344). However, the types of investigations they recommend require knowledge of various writing therapies, along dimensions ranging from little structure to more structure, and from therapist-imposed to client-initiated. These types of investigations are poorly suited to the setup and funding available for research, since they are intended to take place with an existing therapeutic relationship, and their presentation of all these dimensions can make the practice seem unwieldy for therapists simply interested in incorporating writing as an adjunct.
What is clear is that writing has not disappeared as a component of therapy, despite some evidence of deprecation within the field. However, as with any type of treatment, writing will likely offer greater yields as it becomes better understood. A good example of a study which combines current research with constructive recommendations for therapists is that of Pulverman et al. (2017). They offer practical guidelines for therapists based on the authors’ observation of writing and the use of “self-schema” in 138 women with a history of childhood sexual abuse. Following their discussion of the study and observed effects of expressive writing treatment, they offer suggested guidelines for practitioners working with this population in practice. They recommend, for instance, observing changes in women’s narratives over time, suggesting that “when abused women are asked to engage in expressive writing about their sexuality, they first choose to focus on the abuse and their family and development, and later on existential ideas of reflection, questioning, and growth” (p. 187). Therapists using journaling to serve this population might observe the progression of narrative development during therapy, perhaps noting a shift, for instance, from themes of abuse and family security to broader existentialist themes. However, the authors likely lose most casual readers at their recommendation of specialized software to process clients’ writing samples and track progress, as this would demand an investment in software, training, and time that many therapists would be reluctant to pursue.
Future studies will, like this one, demand sensitivity to the practice of writing as well as the nature of the content generated by participants. Therapists must be trained in what to look out for, noting the types of language clients use to describe themselves as important clues to psychological transitions. Further, research must be targeted towards addressing the six significant objections listed above in order to legitimize the use of journaling as an adjunct to therapy.. This can only be accomplished by creating studies within the general population, and through experimental situations which, rather than taking place in a sterile laboratory environment with strangers, actually integrate journaling or other forms of writing within the intimate setting of trust in which most forms of psychotherapy function at their best.
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