14: Using Expressive Writing in Play Therapy
Note: Play Therapy Across the Lifespan is created to be heard. If you are able, we strongly encourage you to listen to the audio so that you are able to appreciate the emotion and emphasis that cannot be captured by text alone. Transcripts may contain errors and differ slightly from the audio. Please check the corresponding audio before quoting it in print.
Resources and Links
Visit www.ieta.org for information on becoming a Registered Expressive Arts Therapist.
Go to www.psychologytools.com to browse prompted writing handouts.
Learn more about Teresa Prendes-Walls and her work at www.teresaprendes.com and on Instagram @mycircleart.
Teresa shared three resources with you.
Emotional Vocabulary Checklist for children and adults
Building an Emotional Vocabulary a presentation
Prologue
As we continue to shelter in place, practice social distancing and learn all about telehealth, I hope that you are staying well. This week I hit the wall. I was absolutely exhausted from learning and implementing new things while holding myself to the same expectations I had before. I know better. I teach others to know better. But this has been a really hard, long and grueling semester. I was drained after looking at a screen for all but my family interactions, and I’m an extrovert. In the midst of crisis, I didn’t have the capacity to be as self-aware. Things had to get done and they had looming deadlines.
One of the reasons that I hit the wall was because last week I didn’t do one of my most consistent self-care practices: journaling. I started a daily writing habit five years ago. I did that to provide the process goals to help me consistently write books. But, to keep me going between projects, and some days to prime the pump, I started journaling and counting that towards my word count. The whole purpose was to be able to write without restraints. It didn’t have to be good. It didn’t have to be printable. It didn’t have to be productive. I just wanted to write one word after another, and in the process train myself to write daily.
It worked. I’ve written books, but the unexpected benefit was that I processed a lot of my own thoughts and feelings through expressive writing that I didn’t even recognize as journaling until a couple of years ago. That’s our topic for today: Expressive writing.
Writing in Therapy
This is the point of the podcast where I usually offer a disclaimer and remind you of the importance of credentials and representing yourself accurately. Well, to my knowledge, there is not a national credential to become a certified or registered expressive writing therapist. There are lots of programs that will teach you how to use expressive writing therapeutically, but none with a professional organization, a journal, and an ethical code. So, this is a good time to tell you about another credential that includes expressive writing. The International Expressive Arts Therapy Association offers a credential that covers all the expressive arts we have talked about this season. You may want to consider becoming a Registered Expressive Arts Therapist, an REAT. If you want to learn more about the requirements, go to ieta.org. This podcast, however, is about play therapy and some of the ideology is different. That doesn’t mean that two can’t play together nicely, pun intended.
What Is Expressive Writing in Therapy?
Expressive writing can be just about anything that uses words. This includes narratives and prose, poetry and letters, lists, songs, free verse, sonnets, haiku, and so on. Expressive writing may cross boundaries with other expressive arts like music or art. So the words can be paired with sound or visual images.
Our cognitive behavioral friends have been using writing techniques for awhile now. Websites like psychologytools.com have hundreds of beautifully prepared worksheets and writing prompts, and students get a 50% discount after the free 7-day trial. I personally don’t like using worksheets in my sessions, but some of you do, and it might be handy to have some kid-friendly and professionally prepared handouts ready with prompts when you need them. Probably not surprising to any of you, I like fluid and flexible options when incorporating writing into therapy.
It works well for homework to give the client some space and time to get their thoughts out in a written form, but sometimes, it’s appropriate within a session, too. Be aware that most clients have had their writing evaluated in school, and that may be something to work through if you notice some resistance around using writing techniques. And this expressive art requires enough physical and cognitive development to be able to pull out thoughts and emotions through writing.
What Materials Are Needed?
There are two categories of expressive writing: digital and physical. You can also combine them. Let’s begin with traditional physical writing. You’ll need something to write on and something to write with. So, the first basic supply would be paper, maybe of different textures, weights, colors and sizes. You could use individual pieces of paper or a bound version, like a journal or notebook. It doesn’t require anything fancy, and some people have trouble with the idea of “messing up” an elegant journal, so start simply. If you like the idea of a having a board to write on, then a chalkboard, dry erase board, or a wall with special paint means it is always ready to use. Baby wipes do a great job of fully erasing dry erase markers and preserving confidentiality. Next, you need writing implements. Pencils, mechanical pencils, colored pencils, ballpoint pens, gel pens, Sharpies, colorful markers, chalk, dry erase markers, and others offer options. Pencil is smudgeable and erasable, and pens are more permanent so whichever your client chooses might lend itself to different expression.
If you or your client has access to technology, then writing can also be done digitally. It requires a laptop, computer, or device. Digital may be more convenient, private and password protected, so some clients may prefer it. Others, however, like the organic feel of a pen in their hand and the ability to write words that can wind across the page. There are plenty of advocates for both, but I tend to let the client decide.
A couple of other things you might want to use are books and magnetic words. Have a thesaurus and a rhyming dictionary (both are available online, too) can help selecting just the right word. Magnetic words can be arranged into descriptive sentences, telling lists, or interesting groups.
To Prompt or Not To Prompt?
There are literally thousands of writing prompts out there ranging from a simple, “How do you feel right now?” to “If your feeling drove off in a car right now, describe what kind of car it would be?”
I liked that prompt so much, I decided to write about it. Here’s what I wrote:
“My car would be one of those old station wagons with wood paneling, and it would have two flat tires as it sits empty in the driveway. It’s a family vehicle, a kid-hauler, but it’s feeling old and tired with years of beloved service. Family matters a lot to me, but working at home, I’m frustrated because I keep hearing myself asking the kids to be quiet when I’m on Zoom calls. They and my husband just want to be with me. I just want some time to myself when no one needs me. I generally have better boundaries, but with these flat tires, I’m kind of stuck right now.”
Wow! I put some things in there I didn’t even realize that I was feeling, like being stuck. I knew I was tired and frustrated in my third week of remote work, but as I listen to sweet giggles downstairs while the children practice their tumbling skills, I also feel left out of the fun. Hmmm. That’s the power of expressive writing.
For homework, some older clients would like a few journal prompts to write about between sessions. Sometimes, though, unstructured and uncensored free association writing is helpful. For me, my morning journaling is whatever it needs to be that day: venting, processing an event, planning my day, or lots of capital letters and exclamation points.
So you might prompt if you have a specific purpose for the writing. But, you might not prompt if the purpose is to allow the writing to flow. Is the goal of the technique about an outcome or the process. Outcome goals lend themselves better to prompts, but process goals are better unprompted.
Writing Across the Lifespan
So, how do you adapt writing with clients across the lifespan?
Children
Children that are young enough to hold a pencil, but too young to write letters, might pretend to write. They could also “read” you what they have written. In child-centered play therapy, the client has the tools available, but how and if they use them is up to the client.
As children develop writing skills and the ability to verbalize ideas, you could serve as a scribe, writing down what the client says. This helps with shame around misspellings or other writing insecurities, but feeling unconditional positive regard as they write imperfectly can be powerful, too.
As children hone their fine motor skills, language skills, and grammar, they can do the writing. Keep any prompts age appropriate, and remember that this can feel like a school assignment, so those who struggle at school may not like it, while those who have competence around school and writing may find it very helpful.
Adolescents
Adolescents are exploring who they are, but often in comparison to others. Writing provides a nice method for internal searching. Writing techniques can be logical and sequential, such as creating lists of attributes, timelines, or outlines. But they can also be creative and imaginative, such as drawing a word, creating lyrical poetry, or fictional alternative-world descriptions. Intentionally breaking the rules of writing can be an interesting way to explore freedom. Letter writing to a person who is experiencing what they are might be a way to embrace what they have learned.
Young Adults
Young adults are usually familiar with writing and may have tested out journaling already. They may have been required to write reflective papers or taken a creative writing class. For some, getting around the rules and expectations they learned from these experiences may be important. Therapeutic writing emphasizes expression. Academic writing is about conveying information in an orderly, readable way. Expressive writing may be messy and lack order, but that is okay.
Older Adults
With older adults, they can write to something abstract. Write a letter to your wellness… or your disease. They may appreciate writing as a way to record and pass on the wisdom of their experience. Some may appreciate the puzzle of fitting phrases into a specific form, such as a haiku or a sonnet. Writing techniques can include checklist reminders, affirmations, and quote collections, too.
Interview with Teresa Prendes-Walls
Transcript not available.
Research Segment with Rachel Sellers
Expressive writing can be used as a tool in therapy regardless of theoretical orientation. Today, I’m going to discuss an article published by the American Psychological Association in 2014-- this article will be linked in the show notes for your reference. The researchers use examples from an open trial of exposure-based cognitive therapy for depression to discuss how EW can be used to both promote and track therapeutic change.
First, they review the literature. EW has been used in various kinds of treatment modalities, such as TF-CBT, CPT, and narrative therapy, which all have empirical support. Research has consistently documented a positive association between writing about emotional/stressful experiences and both physical and mental health. Research also supports that EW is correlated with fewer doctor’s visits, improved immune functioning, reduced blood pressure, improved mood, reduction in depressive symptom and rumination, and fewer posttraumatic intrusion and avoidance symptoms. There are, however, only a handful of RCT’s specifically looking at EW in therapy, but they do have promising results. For example, in TF-CBT including the trauma narrative is more effective at reducing children’s fear and general anxiety related to the trauma than TF-CBT delivered without this component.
The researchers also talk about how EW can be used to promote change and track treatment progress. It promotes self-monitoring and encourages reflection which may lead to greater insight. It also promotes exposure and processing, which is an important predictor of therapeutic gains. EW can be used as a way for therapists to provide quick check-ins with their clients. EW can also provide ongoing monitoring of the therapeutic alliance, readiness for change, and social support-- all of which are associated with positive therapy outcomes.
EW won’t be a good fit for every client. Research indicates that EW may lead to worse emotional outcomes for those with a tendency to ruminate or search for meaning. It’s also important to note that in all the RCT’s studying EW, the samples have been predominantly White, which raises the question about the effectiveness of EW with multicultural populations.
But from what we can tell, EW can be an effective therapeutic intervention, and the authors conclude with a few considerations for implementing it. They suggest that therapists adjust EW instructions as needed to meet the needs of their own clients. They also encourage therapists to be collaborative with clients in the implementation of EW. This might look like working together with the client to decide when and how to use it based on the client’s needs and level of comfortability. Lastly, they encourage therapists to monitor client reactions on a continuous basis and be willing to adjust as needed.
Conclusion
That wraps up today’s show… and Season 2. When I planned this out, I had no idea how disrupted things would be in March and April here in Nashville during the COVID 19 pandemic, but even with all that, now you know why I was so excited about this season. I have enjoyed the opportunity to take seven episodes to talk about seven different expressive arts. I truly hope the information, ideas and techniques help you do what you do better… help the hurting.
We’re going to take a break between seasons, but make sure you have subscribed because we’ve got Season 3 in the works, and you don’t want to miss it. If you found this season helpful, would you please take a minute to leave a short review to help others find us?
Try this today: Try mood mapping with magnetic words. Make sure to have a magnetic white board and some markers handy. Visit ieta.org for information on becoming a Registered Expressive Arts Therapistand psychologytools.com to browse some prompted writing handouts for children, adolescents and adults.
Thank you to our Expressive Writing Technique guest, Teresa Prendes-Walls. You can learn more about her work at teresaprendes.com and on Instagram @mycircleart.
