Creative Healing: What Role Does Creative Writing Play in Therapy?

The field of psychotherapy is brimming with a number of therapeutic techniques designed to address patient needs. Some well known examples include: Cognitive Behavioral Therapy (CBT), Exposure Therapy, and Group Therapy. Despite the many therapeutic techniques used by professionals in the therapeutic setting, the application of creative writing as a therapeutic technique has not garnered as much attention as is warranted. While there are plenty of practices that emphasize creative expression and literary analysis–namely, journaling, art therapy, bibliotherapy, and music therapy– the act of writing through cross-genre formats such as fiction, non-fiction, and poetry deserves to be explored further specifically for its potential ability to facilitate psychological, social, and emotional well-being. Narrative writing in which the patient engages in story-telling, has been deemed an effective strategy for individuals to re-author and regain control of their life stories. Such an approach to therapy may offer patients the opportunity to separate themselves from their problems and cultivate fresh perspectives about their life experiences. This article aims to explore the ways in which creative writing may act as a therapeutic agent when implemented in a clinical setting. 

Speculations regarding the role of writing in shaping one’s health can be found earliest in Greek Mythology through the god Apollo who was believed to oversee the faculties of both poetry and medicine (Goidsenhoven and Masschelein, 2020). Such an early association between the arts and medicine may suggest that there was an early understanding of the positive capacity which artistic expression in the form of writing could lend to one’s mental and emotional healing. Another instance of creative healing exists in Buddhist practice; specifically, in the The Platform Sutra of the Sixth Patriarch–an 8th century Buddhist scripture written by the Chinese monk Huineng–when students are asked by the Fifth Patriarch or Master to write down a poetic verse that demonstrated their understanding of Enlightenment (Huineng, 2000). The writing of verses was considered to be both a meditative and healing practice that led students to advance in their journey toward enlightenment. The philosopher Michel Foucault when examining Greco-Roman culture, explains that both reading and writing functioned as meditations which contemporaries considered to be a form of self-care (Foucalt, 1997). Today, the use of creative writing spans into the therapeutic space as terms like “expressive writing”, “therapeutic writing”, and “explorative writing” have been redefining what it means to write.  Writing is no longer only accessible to a niche group of individuals, but to an entire population of individuals seeking to heal by way of pen and paper (Goidsenhoven and Masschelein, 2020). 

One of the first studies investigating the value of implementing writing in the therapeutic process was published by Pennebaker (1997). The study conducted by Pennebaker (1997) sought to determine if there were any significant physical and mental health improvements after having participants confront significant traumas by writing about them. Researchers began by assigning participants to writing groups in which they were assigned a topic everyday for three to five days that they wrote about for about thirty minutes each day. Participants were encouraged to explore their deepest thoughts about topics such as their relationships with parents, friends, partners, life experiences that have shaped them, and any other emotions that present themselves. The exercises did not place emphasis on participant’s grammatical correctness. The only rule given was to write. Pennebaker's study revealed that participants’ blood pressure, heart rates, and stress hormones decreased, while self-wellness reports increased. Despite the crying and emotional distress elicited during the writing process, Pennebaker (1997) notes that the participants’ overall self-reports improved when writing about emotionally wrenching experiences in comparison to control topics that did not trigger any emotions. 

Following early attempts to study the effects of writing on psychological health, contemporary researchers have been inspired to dive into the effectiveness of creative writing therapy on relieving patients with traumatic histories. One such study was conducted by Glass et al. (2019) on a group of 39 English-speaking adults (eighteen years or older) who self-reported having experienced trauma or significant emotional turmoil. Participants were given access to a six week expressive writing online course developed by researchers and took pre and post program questionnaires to aid in measuring changes that occur in their psycho-emotional state. The pre and post tests employed questions from the Perceived Stress Scale (PSS) and the Rumination Response Scale (RRS). The first part of the program uses writing prompts inspired by those applied in Pennebaker (1997)’s writing paradigm to guide participants into an emotionally vulnerable state in which they could freely explore deep emotions. While the second part of the course transitioned participants from the heavy emotional state to one of tranquility by use of mindfulness techniques. It’s important to note that although the course format was proposed to be educational with a mix of instruction and creative writing in the form of expressive, transactional, poetic, and mindful writing, participants were seldom graded or judged on the quality of the works they produced. After having completed the six-week program, the participants displayed increased resilience, decreased depressive symptoms, stress, and rumination. The latter study demonstrates that reaping the benefits of creative writing does not require elaborate tools, accessible versions of the study can be applied in one’s life by simply picking up a pen and piece of paper. 

A number of studies have reported tremendous success with the use of creative writing to alleviate psycho-emotional problems, prompting individuals to wonder why it is that writing works. Several theories have been proposed by researchers. For one, researchers believe that theoretically, expressive writing allows for individuals to leave negative experiences and resounding insights on paper, emboldening them to release the stress reflected in the central-nervous system associated with the harboring of such negative emotions (Pennebaker, 1997). The same researcher suggests that individuals who hold onto these negative emotions without releasing them through either written or verbal communication methods, tend to have more long-term health related problems. Another theory considered that creating a story–as is done in fiction writing– may facilitate a space where the individual can see themselves reflected on paper and are better capable of obtaining insight on their own emotions about a past event or experience (Goidsenhoven and Masschelein, 2020). Another researcher claims that creative writing therapy is novel in its ability to encourage the individual to write down events in an organizational order – such that previously unstructured emotions now have a beginning and a resolution (Ayodeji and Bates, 2023). Though, the latter research stresses that writing programs like the one implemented in the study can be used both in and outside of therapeutic practice. For survivors of rape or suicide or other traumatic experiences, it can be challenging to discuss experiences alongside a therapeutic provider, so creative writing can act as both a therapeutic technique and facilitator of communication between the therapist and patient. 

Group therapy is a widespread therapeutic practice used to provide support and address specific mental health concerns. What does the implementation of creative writing therapy look like in the group therapy space? Researchers Lauer and Goldfield (1970) documented the mental states of patients after asking them to participate in creative writing groups facilitated by a clinician. The sample included a majority of psychotic patients with depressive or character disorders. It was vital to create an environment that exhibited warmth and psychological safety in an effort to help patients lower their defenses and de-intellectualize the space. A combination of poetry therapy and expressive therapy was used in practice and the clinicians established that overtime, participants felt more relaxed and free to express a wider range of emotions in their writing. Further, sharing their creative works in a group setting enabled discussion and cultivated a supportive as well as an educational environment. Psychotherapeutic professionals also noted being able to obtain a broad view of their patient’s psychodynamic state. Moreover, other writers express the importance of group therapy by asserting that verbally reading out their works in front of an “audience” closes the negative feedback loop –negative actions in response and in attempt to cope with negative thoughts–, particularly because receiving constructive criticism may lead an individual to change their behavior in order to avoid repeating negative behaviors (Goidsenhoven and Masschelein, 2020). 

There are a growing number of resources for individuals who desire to engage in and professionals who want to practice therapeutic creative writing. Specifically, in the United States, The National Association for Poetry Therapy (NAPT) was established in the 1980s to train professionals such as social workers, therapists, and psychologists (Goidsenhoven and Masschelein, 2020). Individuals may also find tools in literature and media which promote the daily use of writing as a form of therapy. In Louise DeSalvo’s Writing As A Way of Healing, the college English professor asserts that writing lets individuals sit with emotions “without becoming overwhelmed by them” (p.106). Even so, additional questions should be asked regarding the use of poetry therapy on its own as some of the studies reviewed use creative writing therapy in conjunction with other therapeutic practices. 

As the field of creative writing therapy continues to grow, one should keep in mind that writing is not a luxury to be enjoyed by only a subset of individuals, it is accessible to those of any cultural background, language, and skill level. The only rules for participation in this psychotherapeutic movement are an open-mind and willingness to share one’s uniquely exceptional story, whether it be with a group of individuals or on a piece of paper.