Academic journal article American Journal of Psychotherapy

Programmed Writing and Therapy with Symbiotically Enmeshed Patients

Academic journal article American Journal of Psychotherapy

Programmed Writing and Therapy with Symbiotically Enmeshed Patients

Article excerpt

This paper illustrates how programmed writing lessons from a codependency workbook can be used in conjunction with traditional verbal psychotherapy. Each patient in the series was involved in a symbiotically enmeshed relationship. Special benefits gained from the combination of programmed writing lessons with traditional psychotherapy were enumerated.

The status and popularity of using writing for or in conjunction with traditional psychotherapy has increased substantially in recent years.1"3 The most widespead use of writing has been in single-shot ad hoc purposes, or to log behavior.4-9 The use of diaries and/or journals has been encouraged and engaged in by Baker.10 Birren and Hedlund n advocated the use of both autobiography and journals. The marital diary of Robert and Clara Schumann offers to therapists valuable insights.12 More recent empirical evidence has pointed to the use of writing to improve immune-system functions,13 an original finding reported by Pennebaker and his coworkers.14

A classification of writing to enable us to determine which type of writing could be helpful for specific problems or personalities is needed.3 Furthermore, writing is a precursor to the use of personal computers and interactive media to reach patients in their homes or in public libraries. Hence, writing can be classified according to five overlapping dimensions: (1) degree of structure, ranging from open-ended, as in diaries and journal ("Write whatever comes into your mind."), to focused, as in autobiographies or specific clinical conditions ("Write about your depression for 30 minutes every other day."), to guided ("Answer in writing questions I have written after reading your autobiography."), to programmed, as in workbooks ("Please complete the first lesson in a series of eight lessons about depression."), as illustrated in this paper; (2) degree of specificity, ranging from very general ("Write about the meaning of existence.") to very specific ("Count how many times you use the pronoun 'you' in writing to your partner."); (3) focus, ranging from prescriptive, as in the example given earlier, to cathartic ("Write down every time you feel like crying and what you feel like crying about"); (4) content, ranging from traumatic ("Write about all the painful and stressful events that you have experienced in your life.") to trivial ("Write about all of the clothes, furniture, and objects in your room."); (5) level of abstraction, ranging from very abstract to very concrete, a dimension overlapping with specificity.

The purpose of this paper is to illustrate specifically how programmed writing can be added synergistically to conventional verbal therapy to deal with issues and problems that would take a great deal of the therapist's time and energy. Furthermore, through programmed writing certain issues may be dealt at home with greater efficiency than in the therapist's office. Behaviorally, programmed writing would allow to generalize more explicitly and specifically the influence of the therapist. Programmed writing, by definition, consists of materials (workbooks) made up by a sequence of lessons linked by a topic (program), assigned to patients (individuals, couples, families) to be completed systematically outside the therapy session at prearranged, preset times. This approach is used as a way to keep patients centered between sessions and to assume personal responsibility for change. It is a way for them to experience self-mastery and self-knowledge, by getting feelings and thoughts out in the open, sharing them with a partner or family friends and, later on, with the therapist. Programmed writing lessons, therefore, are often used as a springboard for further discussions, evaluations, and corrective feedback by the therapist. Programmed writing is an approach that complements and supplements in-session, face-to-face psychotherapy experiences, but it can become an alternative way of helping patients who cannot be seen directly in weekly, face-to-face sessions for economic (too expensive to be seen weekly but willing to come once a month with in-between written assignments) or logistic (inmates in prison) reasons. …

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