How therapeutic writing can help improve mental health
Not only is writing enjoyable, but it can be an amazing therapeutic tool. Therapeutic writing practitioner Carol Ross joined students from our Therapeutic and Reflective Writing online course to discuss how she developed the techniques she uses in her workshops, how writing can benefit patients, and how to get involved in the field.
Q – Hi Carol, thanks for joining us. Firstly, can I ask how you came to appreciate the value of therapeutic writing?
Carol Ross – Thanks for inviting me! I started out because of my son. He was about seven years old, and wanted both of us to write stories during half-term. Through doing this, I quickly realised that writing reduced my stress levels. Then, I started to do creative writing courses, and at the same time read books about therapeutic writing. Also, in 2005 I started working for a mental health NHS trust, and subsequently became more interested in mental health and illnesses.
Q – I very much enjoyed your chapter in Expressive Writing: Counseling and Healthcare, where you talk about mindful and positive writing, and its use with psychiatric patients. Are these approaches you have developed yourself?
CR – I can’t say that I invented those approaches myself, but I have developed ‘mindful writing’ and ‘positive writing’ as ways of working. I was influenced partly by the work of an American researcher called Laura King. Where practicable, I select types of writing based on the symptoms and diagnoses of mental health patients in my ward writing groups. For example, I find that ‘perspective shift writing’ can be beneficial for individuals with a personality disorder, that people with schizophrenia often respond well to exercises involving symbolism or metaphor, and that with some people who are so depressed that they are completely negative thinking, creative writing and poetry are often the best approach to take.
Q – What inspired you to work in mental health?
CR – On my infrequent visits to our mental health wards I felt there was something missing for the patients, especially in the evenings and at weekends. I felt that writing could really help patients, and help in very different ways to traditional medicinal treatment.
I had heard from clinicians that there was nothing for patients to do in the evenings and at weekends except watch television. I thought that if I could inspire some people to start writing, they would write outside of the sessions, and benefit from writing as an activity as well as gaining therapeutic benefits from expressing their thoughts.
Q – How do you evaluate the benefits of your work with in-patients?
CR – Many patients give me feedback without me asking. For patients who are well enough, I ask them to fill in an evaluation form. I’ve used several different variations, mainly ones that I have developed myself. Increasingly, I also get unsolicited feedback and discussions about patients from clinicians.
Q – How do you gauge the level of difficulty of writing for your patients?
CR – Because the groups I work with are very mixed in terms of education, severity of symptoms, etc., I use very flexible exercises most of the time. For example, with a selection of photographs of people as writing inspiration I could get a patient who is confused or distressed to briefly describe what they see in each of the photos. This descriptive writing is very calming, and quite similar to mindful writing.
With another patient who is less unwell, I might get them to choose a photo of a person and make up their character – to write about the person as if they were a friend, or choose a photo of a landscape and imagine themselves in it.
I have been reading poetry with some old ladies who have Alzheimer’s, and it has been a wonderful experience for all of us. Many older people learned poems by heart when they were young, and they can still remember them when prompted.
Q – What’s been the most rewarding aspect of working with patients in the wards? Have there been any unexpected breakthroughs, or things that have surprised you?
CR – The surprising aspects have been when someone who has been silent and withdrawn on the ward comes to the group, writes something beautiful – perhaps a positive memory – and reads it aloud to the group, joining with the discussion. Sometimes people I would not expect to be interested at all participate fully, and then say afterwards how much they got from it.
Q – That must be so rewarding to see the benefit it’s had on the individual.
CR – Absolutely. It’s also very rewarding when a patient comes to a group every week for months. I can build up a relationship with them, and try different types of writing to help them. For example, it’s great when I write with someone in Psychiatric Intensive Care when they are very unwell and their writing is confused or fantastical, and as the weeks progress I see them getting gradually better and see that reflected in their writing.
In acute mental health I’ve noticed that the benefits to patients are more varied than in community groups, eg, some withdrawn people have found a sense of companionship in sharing thoughts with others in a safe space and then mixed better with other patients outside the group; some people have had moments of insight about themselves and their relationships; and others have experienced respite from their demons, a feeling of calm, or more clarity in their thoughts.
Q – Do you have to build in any ‘safety guidelines’, as it were? I’m thinking along the lines of how people’s feedback is managed, and if you encounter any inappropriate responses.
CR – I am fortunate to work mostly in relatively safe spaces. So, if someone is upset in a session, which can happen, there are always staff on hand if I need extra support. As far as sharing work goes, people only share their writing if they want to. Sometimes there is great anger or hurt expressed, but I have found that the other group members are almost always supportive of each other. I have rarely experienced inappropriate content in writing or responses.
Q – Do you work with other client groups, and do you think that writing benefits everyone?
CR – I don’t necessarily think that writing would benefit everyone, simply because some people have a strong preference for other activities such as painting. I have worked with mixed groups, and used similar writing approaches. With community groups I make the exercises more challenging and thought-provoking.
Q – I was recently asked to share poems in a care home for individuals with mental health needs, and I’ve been encouraged by your writing and thoughts!
CR – I have been reading poetry with some old ladies who have Alzheimer’s, and it has been a wonderful experience for all of us. Many older people learned poems by heart when they were young, and they can still remember them when prompted. I also often use poetry in the working age adult ward, eg, I might bring along two similarly themed poems for us to read and then we discuss them, and then select one poem to use as writing inspiration.
Q – Do you have any advice to offer to people who would like to start a therapeutic writing group?
CR – If you decide to start a group in a mental health ward, you have to be very flexible in the exercises you choose to allow the participants choice and to cater for different abilities and symptoms. Be prepared to change the plan at a moment’s notice. I recommend that you write with the group — be part of the group not a leader or a teacher.
I definitely think there must be scope for more writing facilitators, in more wards. If this is something you’d like to get involved in, I would approach the lead occupational therapist for the NHS trust in question, or the ward manager or occupational therapist for the individual ward. Also, NHS trusts generally have a database of staff on zero hours contracts. That database is called the ‘bank’ and the staff included in it are called ‘bank staff’. Each member of bank staff has a pay grade attached to their role in the bank database. If you’re able to get yourself onto the bank, it’s a good way to get paid sessionally.
Q – To become part of the bank, do you need accredited qualifications?
CR – You don’t need specific qualifications to be a bank writing practitioner in the NHS. All you need to do is convince the NHS trust in question that you have the skills you need and can handle the environment of an acute mental ward. This might mean doing a few weeks of unpaid work to begin with, but I’d say it’s definitely worth it!
Q – Thanks, Carol, this has been really useful.
CR – You’re most welcome! I’m happy to be able to spread some information, and hopefully help people in their careers. Thank you!