Finding a voice: revisiting the history of therapeutic writing

Abstract

We review the history of therapeutic writing, focusing on the role of narrative competence and the use of writing therapy for stress, trauma and coping with chronic illness. After providing a historical overview of the evidence for writing's positive effects on health and the hypothesised mechanisms underlying this effect, we ask whether narrative competence can explain and improve writing's benefit. Narrative competence is defined across two dimensions: (1) Emplotment, or the ability to construct and comprehend goal-oriented connections among temporally situated events; and (2) Meaning, or the ability to understand and communicate contextual interpretations of ambiguous story structures. We suggest that the ability to construct well-organised and meaningful narratives is an important skill for successfully coping with life stressors and trauma, enabling individuals to create coherent stories from fractured memories and to facilitate cognitive processing of traumatic events. Given the positive effect of narrative competence on psycho-physical health, there is a need to broaden medical use of narrative competence therapies beyond the current interventions aimed at fostering empathy among healthcare providers, to include therapies for the patients themselves. Toward this end, we briefly explore one clinical model currently offered by Dr Allan Peterkin and colleagues at Mount Sinai Hospital providing group Narrative Competence Psychotherapy (NCP) for individuals living with HIV.

Empowering patients of a mental rehabilitation center in a low-resource context: a Moroccan experience as a case study

“…Writing helped patients to find a voice, to find their voice, and to develop a coherent, well-organized, meaningful narration resulting in “therapeutic emplotment”23 and “clinical meaning” 24. Besides triggering these cognitive mechanisms, writing also exerted emotive effects and, at least in some patients, helped to reach valued, fulfilling moments, enabling them to express all their potential.…”

“…In particular, they were asked and instructed to write about a topic of their choice, not necessarily based on their clinical and personal story. A “humanities paradigm”17–19 was preferred to a “scientific paradigm”20–24 which, as in a randomized controlled trial, makes use of controls and implies highly standardized, structured writing sessions. We privileged, instead, more unstructured, open-ended, and exploratory sessions.…”

Therapeutic acts of witness: why writing poetry and prose has never been just for patients

“…As discussed in this issue by Peterkin and Prettyman,3 the ability to construct well-organised and meaningful narratives is an important skill for coping with life stressors. Stories of birth, courtship, survival and illness help make sense of these events, both good and bad.…”

“…Those who have been diagnosed as having serious illnesses are sometimes moved to record their experiences as a way to make sense of them and to impose some feeling of order or control. Such writing may be shared with a therapist or support group, as discussed by Peterkin and Prettyman,3 or may be published for wider distribution so these experiences can be shared with readers outside the therapeutic circle. Recent examples document the experience of polio, stroke, cancer, Parkinson disease (written by a physician about his experiences) and even lobotomy 6 7 8 9 10.…”

Picasso, professionalism and plastic surgery: why privileging the patient’s perspective is a moral imperative

“…Her conclusion, that medical soaps “provide a programme of bipedagogical instruction in that they negotiate and disseminate current notions of how to live one’s life and look after one’s body properly”, raises interesting questions about how, given the socially, politically, historically and culturally constructed nature of the medical gaze, the patient’s perspective on what it means to live their life can possibly regain primacy. If Allan Peterkin and Adrienne Prettyman’s4 review, in this issue ( see page ), of the history of therapeutic writing is to be believed, Momma Boone would have been well served by being given the opportunity to write about her experiences.…”