Academic journal article British Journal of Occupational Therapy

Using Writing as Therapy: Finding Identity

Academic journal article British Journal of Occupational Therapy

Using Writing as Therapy: Finding Identity

Article excerpt

Statement of context

This case study was one of 12 client stories from qualitative doctoral research (Cooper 2008, Cooper 2013). The purpose of this practice analysis is to show how Linda (pseudonym), a mental health service user diagnosed with schizophrenia and depression, was able to regain a sense of occupational identity. Working with the author/therapist in a Using Writing as Therapy (UWaT) group, she utilized eight containers that UWaT provides (containers [c] 1-8, see Table 1).

Writing as a therapy

Research has shown that Pennebaker's (1997) writing model is found to improve the immune system and reduce ruminative thought (Frattoroli 2006). The model follows a 3-day, 20-minute unstructured free-writing format without therapist intervention. UWaT (Cooper 2008, Cooper 2013) is a manualized, structured course of six 90-minute sessions of writing tasks with a therapist, through which to explore story and narratives.

The development of the UWaT course was informed by Bruner's (1986) basic components of story: the narrative; the version told; and plot--events as related in sequence. In occupational therapy, narratives provide an in-depth description of the client's volition, habituation, and performance (Kielhofner 2002) that convey personal meaning through occupation (Creek 2008). The UWaT course utilizes Winnicott's (1971) core text describing the safe 'potential space' (p41) (the group or therapeutic space) in which to play with the 'transitional object' (p43) and be nurtured (the therapist role). In UWaT the page becomes a complex transitional object or personal possession from which important communications (words) are held and shared; one that extends from the writer's inner thought to the outer reality (the therapist and group).

Ethical approval was given for a previous study from which this case study material is drawn (Cooper 2008, Cooper 2013) that highlighted outcomes where clients regained a positive sense of self, made cognitive changes, and re-engaged with activity.

Critical reflection on practice


'Linda', categorized as a 'revolving door client' due to constant re-admissions, presented as a depressed woman of intelligence with low self-esteem. She did not identify an occupational narrative other than her role of mother to her two children: one an adult, the other a teenager. Her long-term coping mechanism of using illicit drugs and alcohol was linked to the development of a diagnosis of schizophrenia, resulting in ongoing paranoia and depression.

Linda had been sexually abused from childhood by her father and others. In later years, the pattern of abuse continued within her adult relationships. She wrote poetry in order to 'feel better' but did not consider herself a poet or writer per se. She was selected to join a UWaT group of four people due to her interest in writing, her potential for insight, and her desire to participate to 'sort herself out'.

Linda's story

Session one: Names

Linda was ready for the first session; historically, she had a reputation for non-attendance and being late. She presented as nervous and agitated, noticeably lacking in self-care; the only female amongst three males.

All sessions begin by writing the date and grading mood (see Table 2). Linda graded herself as 6/10 and her artistic handwriting denoted her creative sense of play on the page. She was asked to write two lists of names; her concentration was poor at first and she mixed the lists of names together indicating that her thoughts (c1) were confused but as words (c3) were utilized--the page (c2) became a creative place to gain control and set her thoughts in order.

Progressively, Linda's concentration became focused and intense. 'DAD' on Linda's list, the only name to have been written in capital letters, was scored through with several bold lines and two crosses. For Linda, the scoring through of the name was a liberating experience and generated discussion that enhanced personal sharing and openness in the group (c5). …

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