Expressive writing

James Hawkins, Holistic doctor; integrative psychotherapist

Published in JHH17.1 – Stories in medicine

My background trainings are in medicine, psychotherapy and meditation. For many years I worked through a small charity I set up in Edinburgh. Back in the 1980s I was on the working party that launched the BHMA. I now work primarily as an integrative psychotherapist. For many years I’ve been interested in therapeutic applications of writing and the importance of narrative. The Good knowledge section of my Good Medicine website contains a number of free information sheets about different approaches to therapeutic writing as well as much other information.

Doctor and psychotherapist James Hawkins summarises for patients the use and benefits of expressive writing. Research suggests that people who keep a trauma secret are more likely to have a variety of health problems, possibly because holding back powerful emotions, thoughts, and behaviours, causes a long-term, low level of stress that disturbs autonomic and immune function. Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, presumably by lowering internal stress, restoring perspective and a sense of control. Improved under-standing and integration of experiences, and reduced feelings of isolation may also play a part.

The greatest discovery of my generation is that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives.

William James

What is expressive writing?

Expressive writing is the best known and most widely researched approach to using writing as a form of self-help. Expressive writing has been shown to be a surprisingly powerful way of coping with past traumas, current life stresses and worrying future events. Typically one writes for 15 to 30 minutes about anything one feels particularly upset about. It is often helpful to write about things that one has mostly kept to oneself. If one writes about the topic on several occasions the emotions are gradually processed. This working through can benefit our health both psychologically and physically.

When writing ‘expressively’ don’t think too much about what words you’re going to use. Don’t worry about style or spelling or how the writing would sound if read out. It’s sometimes helpful to start by simply describing what happened chronologically, keeping the writing matter of fact and historical. Wait a day or more, then write again about what happened, but this time describe as deeply and honestly as you can what you thought and felt during the time you were experiencing these events. Finally after another day or more, write deeply, personally and selfreflectively about your current feelings and thoughts when you look back on these events. How do you feel you and your life have been affected? What can you learn from it all? Is there anything at all positive that’s come from it? What, if anything, do you want to do about it now?

Feel free to be creative. Try writing about the feelings you experience in your body. Sometimes, if what you are writing about involves someone else, it is useful to frame the writing as a letter to them (whether they are alive or dead). You can imagine and write their reply as well. The writing though is to help you, so it is usually best not to post these letters. Writing knowing that someone else may read what you have written tends to affect what and how you write, so think twice before showing it to anyone else. It’s fine to destroy what you have written. It is the process of writing itself that is therapeutic.

When is it most useful to use expressive writing?

  • If you have had difficult or traumatic experiences – currently, in the past, or potentially in the future – expressive writing may well help you. This is particularly so if you find that you worry or ruminate a lot, or if you tend to avoid things that might trigger off feelings about your difficulties
  • Expressive writing is also likely to help if you are facing current stresses or you are muddled over some issue. You may have thoughts and emotions churning around inside, but you’re not necessarily clear what it is you want or what you should be doing about your situation. Expressive writing is likely to help you understand better.

How does expressive writing help?

Expressive writing can help us in a number of ways. These include reducing internal, chronic stress; helping us to understand and integrate what has happened; giving us a sense of perspective and control which helps us to move on with our lives; and maybe too allowing us to speak more freely to others about what has happened:

  • Expressive writing is also likely to help if you are facing current stresses or you are muddled over some issue. You may have thoughts and emotions churning around inside, but you’re not necessarily clear what it is you want or what you should be doing about your situation. Expressive writing is likely to help you understand better.
  • Expressive writing helps us to understand and integrate what has happened. The act of putting thoughts and feelings into words is surprisingly powerful. Our minds move so quickly that it is often hard to follow a train of thought right through to a clear conclusion. We may well be left with a mound of disorganised reactions which continue to churn inside. Speaking or writing slows us down and keeps us on a particular aspect of what we are facing. Confronting and expressing our deepest thoughts and feelings about a situation helps us to assimilate and learn from what has happened.
  • Expressive writing gives us perspective and a sense of control. By using expressive writing on a series of occasions, how we see and feel about an event or
    problem gradually changes. Less relevant aspects tend to drop away and the important learnings are highlighted. The problem becomes more manageable and we gain perspective and a greater sense of control. This allows us to work through what has happened and move on with our lives.
  • Feeling less overwhelmed and having a clearer sense of perspective can allow us more easily to speak with others about what has happened. Whether we want to do this or not will depend on us and on who is available. It can however sometimes be very helpful in reducing feelings of isolation.

Expressive writing is likely to be most useful if it digs deep. It is not meant to be a chance to daydream about revenge or other fantasies. It aims to explore our deepest thoughts and feelings in a self-reflective, questioning, open way. If you have a tendency to put yourself down or see things very negatively, be careful that you don’t fall into this pattern when you are using expressive writing. Ask yourself what you can learn from all that has happened. How can the outer
situation be improved? Maybe it is changes in your inner psychological state that are now more important? How could you view what has happened in a way that doesn’t hurt you so much? What small or bigger steps can you take to move forward in your life? Expressive writing is a self-help method. It supplements
rather than replaces the value of talking to others. If you don’t find it is sorting out the situation you are facing, do please consider getting other help. This might involve talking to friends, particularly if they are likely to be accepting and non-judgemental. This may be hard for them however if they feel awkward with emotions or are involved in some way in what you are talking about. Professional help from your doctor or some other therapist may also be very useful.

For more details on the health benefits of writing and selfdisclosure in general, see: J.W. Pennebaker Writing to Heal, New Harbinger (2004) and Louise DeSalvo Writing as a Way of Healing, The Women’s Press (1999).