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Writing to Re-write stories and relationships. * Margarita Tarragona, Ph. D. For Peggy Penn, with gratitude and affection.

I. Introduction: In order to start thinking about the possibilities that writing opens in therapy, Id like to invite you to do one of the following exercises1: A. Write a list of some of clients that you remember fondly or B. Write a list of books that have had a strong influence on your professional development. or C. Write a list of future projects that you are excited about. _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

What was the experience of writing like? Would it have been the same to make the list in your mind? This work proposes that the written word is especially powerful, that it may trigger ideas, evoke feelings and invite telling stories and thus it can be very productive in therapeutic work. This paper presents some ideas about the use of writing to enrich therapeutic conversations. It presents evidence for the psychological and even physical benefits of writing, it describes the work of the Language and Writing Project, led by Peggy Penn at the Ackerman Institute in New York City; several ways of using therapeutic documents are presented and the last section includes some reflections of a client who wrote as part of her therapy. *This work is based on a paper presented at the 1999 Conference of the Mexican Association of Family Therapy (Asociacin Mexicana de Terapia Familiar),and published in Psicoterapia y Familia (2003) Vol. 16, No.1

II. Writing as Catharsis:the expression of deep thoughts and feelings


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Inspired by Segalove and Velick (1996)

James Pennebaker, from the University of Texas in Austin, has been researching for decades the mind-body relationship and physiological correlates of emotions. In the late 70s and early 80s he had evidence that people who talked about traumatic situations had less health problems than people who did not discuss them. Pennebaker (1997) describes his own experience with a severe depression when he was a graduate student: He did not want to go to therapy, but he began to sit down in front of his typewriter and to write between ten minutes and an hour a day. Within a week he was feeling better and he recovered from depression. This experience led him to start researching the effects of writing on health. In his book Opening Up (1997), Pennebaker describes the result of his studies: In the first study that he and his team conducted they asked 46 college students to write for 15 minutes every day during four days. They had to write in a university cubicule and they were assigned randomly to four groups. The first group was instructed to write about the most disturbing or traumatic experience of your life, expressing their deepest feelins and thoughts about it this experience, without worrying about spelling or grammar. The second group was given similar instructions, except that they were asked to write just about their feelings around the most traumatic experience in their life, without mentioning any specifics of this event. They could write about their feelings at the time of the event as well as in the present. The third group was asked to write just about the facts of the traumatic experience, without mentioning their feelings. The fourth group was a control group in which people had to write about superficial topics, such as describing in detail the room they were in, or their shoes. Researchers found that, initially, right after writing about their painful experiences, people felt sad and their mood got worse. However, when they looked at the numer of times that the research subjects had visited the university health center during the months prior to and subsequent to the study, they found that students in group 1 (those who had written about their deepest thoughts and feelings around the traumatic incident) showed a 50% decrease in visits to the clinic for illness. Intrigued by these results, the researchers designed another study to measure physiological factors. In order to asses immune function (T cells), participants had their blood drawn the day before they started writing, at the end of the last writing session and six weeks afterward. The results were fascinating: people who wrote about their deepest thoughts and feelings surrounding traumatic experiences evidenced heightened immune

function compared with those who wrote about superficial topics" (Pennebaker, 1997, p.37) This effect reached its peak during the last day of writing, but it tended to last over the six weeks. Visits to the university health centers also decreased. In addition to their results, researchers found that participants frequently told them how helpful it had been to write and how it had helped them understand and deal with things. Other studies have also revealed the beneficial effects of writing on health. Smyth et al. (1999) found that patienst with moderate or severe asthma or reumathoid arthritis who wrote about their stressful experiences showed a clinical improvement in their health four months after treatment, while patients in the control group showed no improvement. In 1991, Pennebaker and his team conducted a different study with a group of men who had been laid off from their jobs after working for the same company for most of their lives. Half of these men, the experiemnetal group, were asked to write for half an hour a day during five days, expressing their deepest thoughts and feelings about their being let go from their work. The other half was told to write about how they managed their time, and a third group did not write at all. The results were surprising: after 3 months, 27% of the men in the experiemental group had found a new job, while only 5% of the men in the time management group were employed. Months later, 53% of the people in the first group had a job, compared to 18% employement among those from the other groups. All of the men from the three groups had had the same number of job interviews. Researchers interpret these results in terms of the way these men were able to handle their anger. Pennebaker has also doccumented the benefits of writing in educational contexts. In a particularly tedious class at the University of Texas in Austin, which was not going well, the following program was implemented: at the beginning of the class there was a brief description of the main ideas in the readings and the presentations. Immediately after that, students had to write for 10 minutes without interruption, about their deepest thoughts and feelinsg on the topic Their writings were nopt graded. After writing, students participated in class discussion in a more productive and creative way. Absenteeism dropped and their grades on examinations improved dramatically. Students commented that writing forced them to assimilated ideas from different sources, as well as from their own experiences. Summarizing, Pennebaker (1991, pp.190-191) says that writing: Clears the mind Resolves traumas that interfere with our lives

Helps acquire and remember new information. Makes problem solving easier. Free writing enhances obligatory writing. (for example, writing freely before writing a school paper or work document makes the latter easier).

For Pennebaker, one of the most important characteristics of writing is its cathartic power, that is, how it facilitates emotional expression. III. Narrative Psychology and writing: stories and identities Writing as catharsis has long been used in psychotherapy. In this section we will focus on the use of the writen word from another perspective, not so much as a means to express emotions, but as part of a process of constructing identity. During recent years there has been a movement in psychology and psychotherapy that emphasizes the importance of stories or narratives in peoples lives. (Bruner, 1990; Anderson, 1997;Gergen, 1994; Polkinghorne, 1996; White & Epston, 1989). Narrative Psychology proposes that human beings organize our life experience as a narration, that is, as a series of events that have a temporal sequence, a development and an outcome, all fraught with meaning. These life narratives not only describe or reflect our lives, but they constitute them. As Bruner (1987) has stated, we become the narratives that we construct to tell our lives. Harlene Anderson points out that narrative is more than a metaphor about story telling: "it is a reflexive, two way discursive process. It constructs our experiences and in turn it is used to understand our experiences. Language is the vehicle of this process: we use it to construct, to organize and to attribute meaning to our stories (1997, p.213) Many contemporary social scientists, like K. Gergen (1994) and R. Rorty (1979) propose that throughout our lives we are constantly revising our stories and we modify the meaning of events and of relationships. Our personal narratives are not static, but fluid, and they take place in the context of our interpersonal relationships and our linguistic exchanges with other people. Harlene Anderson has writen :The self is an on-going autobiography; or, to be more exact, it is a self-other multifaceted biography that we constantly pen and edit (1997, p.216) Many therapists influenced by narrative psychology and a social constructionist epistemology have said that therapy is a process of re-writing stories. The term

writing is generally used metaphorically, referring to the conversations that allow us to revise and possibly give new meaning to our experiences. The following section presents some examples of how writing can add to therapeutic conversations and sometimes give the term rewrite an almost literal significance. IV.Writing in therapy. This section describes the work of two groups of therapists that have given the written word an important place in their practice. It is definitely not an exhaustive overview, these are just the two that the author has had a closer contact with and whose work she is most familiar with. A. The Languaje and Writing Project at the Ackerman Institute2: Clientswritings and the emergence of new voices Peggy Penn, who is a writer, poet and a remarkable therapist, has been interested for many years in the use of writing as part of the therapeutic process. She heads a project at the Ackerman Institute for the family, in New York City, in which clients are often asked to write at different point of their therapy. Their writings can take different forms: notes, letters, diaries, essays, poetry... Clientswritings become an important part of the therapeutic conversations. They generally write at home and when they come back to the next session they read their writings out loud to the therapist and possibly to other family members who may be present. Therapists and clients talk about what the experience of writing was like, as well as the experience of hearing themselves reading what they have written. Other family members are asked about their reactions to what they have heard. This process can bring forth many interesting topics for conversation. Clients often report that when they were writing they had new ideas or they realized things, and that they felt deep and intense emotions. Reading their writing out loud many times makes these feelings even more intense and having other people witness their experience may bring a sense of validation and acceptance. Other family members many times have commented that they were not aware that their loved one though or felt what was expressed in these writings. Peggy Penn proposes that we all have many voices and, like Harlene Anderson (1997), that we are constantly engaged in internal dialogues with ourselves, as well as in interpersonal dialogues with other people. Penn uses the term voice to refer to different views of oneself in relation to others (Penn & Frankfurt, 1994. p.218)
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The author was a member of the Language and Writing Project from 1996 to 1998. Many of the ideas presented in this paper come from participating in that group. My deep thanks to Peggy Penn, Joan de Gregorio, Patricia Booth and Sallie Witte for the stimulating opportunity of working with them.

When people come to therapy they may be having negative internal monologues. In the Language and Writing Project (LWP) the therapist can inquire about this internal voice and about other voices that the client may have that could answer the monologic one and transform the monologue into a dialogue. As Penn and Frankfurt (1994) point out, changes in our internal dialogues may make a difference in our conversations with others. Much contemporary thought in Psychology and in the social sciences (for example, social constructionism, postmodern criticism, narrative psychology) has emphasized that we are not monolithic selves, or finished products, but that we have many facets and many voices and that we are constantly constructing our identities. We create who we are in our dialogues with other people and with ourselves. The stories that give meaning and a sense of coherence to our livespersonal narratives or personal stories- have become the focus of many contemporary approaches to therapy. Penn et al. (1994) have found that including clientswritings in therapy hastens the discovery of new voicesand, thus, the creation of new narratives(p.219) One of the central ideas in the work of the LWP is opening up space for dialogue. Therapists try to develop a true dialogue with each of their clients, they try to understand their situations and experiences as well as they can and they are attentive to the different descriptions of the events in their lives. I think it is important to stress that conversation and dialogue are the central elements of the work. When I first joined the LWP I think I expected clients to be constantly, that perhaps the LWP would could be spotted in the waiting room by the pens and legal pads they would be carrying with them at all times.That was not the case. Sessions were normal sessions in which clients and therapists mostly talked . Writing was introduced sparingly, when it seemed appropriate. Clients were not pressured into writing. Writing was never a substitute for talking in therapy, it was a way of complementing and adding to therapeutic conversations The idea of writing can be suggested at different times in therapy, depending on the situation. When clients do decide to experiment and write something, this often marks and important point in the therapy, where powerful feelings are accessed and new ideas, descriptions and voices may emerge. Penn and Frankfurt offer several moving examples of materials written by clients (1994, 1999) B) Documents that strengthen alternative stories: writing in Narrative Therapy White and Epston (1993) talk about a text analogy as a particularly helpful metaphor to understand human experience. They point out that social scientists began to take an interest in this analogy when they realized that even if a behavior does no longer exist in the present, the meaning attributed to it persists through time. This enabled the interaction of persons to be considered as the

interaction of readers around particular texts. This analogy also made it possible to conceive of the evolution of lives and relationships in terms of the reading and writing of texts, insofar as every new reading of a text is a new interpretation of it, and thus a different writing of it (p.18) Michael White and David Epston, strongly influence by Foucault and the poststructuralism, have been very interested in issues of knowledge and power and their effects on peoples lives. They are keenly aware of dominant discourses and practices in the mental health field. They stress that much of what is written about people contains very limited and negative descriptions, often written in a language of pathology (for example, case reports and records). They argue that since these powerful documents can seriously restrict peoples definitions of themselves, it can be very useful to write counterdocuments that challenge the latter and offer other descriptions of the persons involved. These documents can strengthen the alternative stories that emerge during therapeutic conversations and contradict the dominant story with which the client arrived in therapy. Writing in Narrative Therapy is generally done by the therapist, though sometimes it is done jointly with the client. White & Epston (1993) use many kinds of documents in their therapeutic work.Throughout the therapeutic process they may write letters, notes, declarations, letters of reccomendation, invitations and diplomas or certificates that give recognition to clientsachievements and knowledge. Writings such as notes or letters sent to the clients between sessions may help maintain the therapeutic dialogue open during this time, possibly prolonging the effect of the session. For many wonderful and detailed examples of the documents writen by narrative therapists, see White & Epston (1993), Freedman & Combs (1999) and Epston (1989). V. In sum, why write in therapy?

I think it is very important to emphasize that writing is not a technique, but one more way to enrich and expand therapeutic conversations. I do not see writing as an intervention, inidicated a priori, such as: in case of mourning, have client write a letter; if there is marital conflict, have clients draft a contract; when impressed by resources, write a note I think that from a collaborative perspective, a piece of writing can be a springboard for conversation, an invitation for new dialogues. As with any element of a conversation, the opportunity to write can emerge if it is relevant for the client and apropriate in a specific therapeutic context and a particular relationship. As Penn and Frankfurt (1994) have eloquently stated, writing can become a participant text, which I undestand to mean that it becomes part of the conversation and part of the therapeutic relationship. There are many reasons why incorporating writing to therapy may be useful, at an individual level, in interpersonal relationships and for the therapeutic process itself. In my opinion, these are some of them: Writing, at an individual level: Concentrates attention Can make stories more coherent May clarify our ideas and positions Can promote a state of flow (Csikszentmihalyi,1997)3 Invites use to carefully examine the words we use Oftentimes allows us to access intense feelings and thoughts Writing may surprise us when we discover ideas, images or metaphors that we didnt know we had. Reading or re-reading our words allow us to see ourselves from a different perspective. Allows our different voices to manifest themselves.

Writing, at an interpersonal level: Allows other people to take a peek into our heads and our hearts.
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A state of optimal experience that it is often described as a sense of effortless action. It tends to occur when peoples skills are fully involved with appropriate levels of challenge, and the activity provides immediate feedback (Csikszentmihalyi,1997, pp-29-31) .

Writing from someone elses perspective may help us walk in their shoes for a moment. Listening to what others have written as if they were me lets us see how they perceive us. May promote listening in a person who would generally not hear us in an everyday verbal interaction. Can re-establish inner dialogues with people who are no longer with us or with whom we have no contact.

Writing, in the therapeutic process: Invites the emergence of different voives or facets of the client Enriches therapeutic conversations "Re-inagurates" feelings that may have been absent (Penn, 1998) Allows us to revise different versions of our personal and relational stories Writing has many cultural connotations that associate it with important, meaningful events Written documents can create a tangible account of the therapeutic process, useful for the clients and for research purposes.

VI. A first person account: one clients experiences with writing in therapy The following section presents some comments about writing in therapy, offered by a client. Olga4 came to eight therapy sessions with the author. In these sessions there were six other therapists5 who worked as a reflecting team (Andersen, 1990). The interviews were done in the context of a course on writing and therapy, so Olga knew that at times it might be suggested that she write
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Olga is a pseudonim. The members of the team were Ana Ma. Hernndez , Adriana Segovia, Fanny Sonabend, Patsy Stilman, Luchi Weissman and Martha Wilburn. I tahnk them all for they valuable participation in this process.

something. Not only did she agree, but she constantly surprised us with her expressiveness, her creativity and the beauty of her writings. Six months after we finished our sessions, Olga was interviewed about her experience in therapy. These are some of her comments: When we asked what she thought was most helpful about therapy, she exclaimed " The team! For me it was like leaving with eight gifts after each sessionit was as if each one of them (members of the team) gave me a different colored ribbon, something to hold on to, a path to take From what Olga says, the voices of the team members remained with her after the sessions and even months later: "At first I was worried thinking of how I would be able to remember so many things, but then I realized that I did remember. Even today I remember things they told me for example "like when Adriana asked me if I was important for the business or if the business was important for meor Luchi, who had gone through a situation similar to mine with my son, or when Ana Mara told me that every love is the next to the last love " Olga is a woman about 50 years old, who came to see us because of a dermatological problem that did not respond to medical treatments and because she felt that she had to work on some family issues. In one of the sessions she was talking about the problem of the skin of her hands and it was suggested that she might write a letter to them6. Olga tells us about the efefcts of this letter: "When I wrote to my hands I realized that I was disconected from what my hands felt: if they felt irritated by detergent, or if they hurt, I didnt notice it. When I wrote them I began to take better care of myself, now I want to take care of my hands, my skin, every cell of my body and it has worked because I am much better!" Olga was born and lived in Eastern Europe during her youth and came to Mexico about 25 years ago. In one session she told us of the severe economic hardships she had to endure as a child and she later shared her great sadness about the death of her parents and her pain for not having been able to be with them at that time. We talked about the possibility of her writing to her parents.
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Many thanks to Elena Ferndez,of Grupo Campos Elseos, for suggesting this exercise and for participating in the follow up interviews.

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She came back with a very moving letter, full of joyful memories and with surprising conclusions. Olga says: "The greatest thing was writing to my parents I recovered my parents, I got back their love. I had not lost it, it was there, but writing them was like finding them again, like closing a circle with them and now I feel that I take them with me all the time " Throughout therapy Olga did other writing exercises. For example, after a session in which we talked about the dilemmas that she faced being from another culture and living in Mexico and her feeling of not being from here nor there, she made two lists: a list of things that she learned in her homeland that would always be a part of her, and a list of things that she learned in Mexico that she has chosen to make a part of her. These led to an animated conversation the next session and to her feeling less divided. After the end of an important couple relationship she wrote a letter saying goodbye to her partner, which she reported to be very helpful. She also wrote letters to her children. When we interviewed her six months after therapy, Olga said many interesting things about what we may think of as changes in her internal and external dialogues: "Something funny has happened to me: I dont write much, but now I talk a lot with myself. I talk to myself a lot. I say: Olga, be careful, or Olga this or that" "I used to curse a lot. I said many bad words and when I learned to write7 I realized that you have to chose words carefullynow-it is a curious thingI hardly ever say curse words "I was not very affectionate with my children, at least not with words. Now I tell them things like my love, sweetheart, honey maybe it was because it seemed strange to me to say loving words in a language that was not mine. Now I think that it doesnt matter in what language you say it, the important thing is to say it. " Interestingly, by writing, Olga also reconnected with the writings of others: "I have re-encountered my readings, I have taken out my books again, I have re-read some of them " Olga reports positive changes in her relationships with other people and with herself. She tells us: "Now I love myself more"
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Shes referring to when she learned to write in therapy

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"I am a different woman, I am a renewed woman." "Even though I am going through difficult times, I feel strong, I feel good" " I am being able to solve many situations that had been pending for a long time" "I have always had good relationships with my friends, but I feel that now they are closer." During our last session we gave Olga a diploma. In it, she and the team members wrote down all the things for which they thought Olga deserved recognition. Among other things, it was said that she was like the Phoenix, because she had resurged many times despite adversity. Months later Olga says something about her diploma: "When I feel bad I go back to my diploma and I feel much better. We made it together and that was very important to me (it says) adaptability, intelligence, hard working, being re-born, the Phoenix in the top part of it we wrote that I am important and that is very important to me When asked how this is helpful to her, she replies: Because it reminds me of who I am Having a written register of the teams words, as well as of her own words, allows Olga to go back to them when she wants to: "Sometimes I take out my notebook where I have everything that I wrote and what the team gave me and I read it again To close, we asked Olga if she wanted to say something to therapists who might be hearing about this work. She said: "I did not imagine that work such as this could be done, something so constructive, please keep on doing it I want to thank Olga for her generosity and willingness to share her experiences with others. As Harlene Anderson frequently says: our clients are our best teachers.

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References: Andersen, T. (1991). El equipo reflexivo. Dilogos y dilogos sobre los dilogos. Barcelona: Gedisa. 1994. Anderson, H. (1997). Conversation, language, and possibilities. A postmodern approach to therapy. Nueva York: Basic Books. Bruner, J. (1990) Acts of Meaning. Cambridge, Harvard University Press. Bruner, J. (1987) Life as Narrative. Social Research. 54(1) 11-32. Csikszentmihalyi, (1997) Finding Flow. New York, Basic Books. Epston, D. (1989) Collected Papers. Adelaide, Dulwich Centre Publications. Freedman, J. & Combs, G. (1996) Narrative Therapy: the Social Construction of Preferred Realities. New York. W.W. Norton & Co. Gergen, K. (1994) Realities and Relationships. Cambridge, Mass. Harvard University Press. Penn, P. & Frankfurt, M.(1994) Creating a Participant Text: Writing, Multiple Voices, Narrative Multiplicity. Family Process, Vol.33, No.3 Penn, P. & Frankfurt, M. (1998) Client Voices and Relational Aesthetics: A Correspondence. Journal of Systemic Therapies. Vol. 17, No.4, Winter 1998. Pennebaker, J. (1990) Opening Up. New York, Guilford Press. Polkinghorne,D. (1988) Narrative Knowing and the Human Sciences. Albany. SUNY Press. Rorty, R. (1979) Philosophy and the mirror of nature. Princeton, NJ. Princeton University Press. Segalove & Velick (1996) List Yourself. Andrews and McMeel, Kansas City Smyth, J.;Stone, A.; Hurewitz, A. y kaell, A. (1999) Effects of Writing about Stressful Experiences on Symptom Reduction in Patients with Athsma or Rheumatoid Arthritis. JAMA, 1999;281:1304-1309. White, M. & Epston, D. (1989) Literate Means to Therapeutic Ends. Adelaide, South Australia.Dulwich Centre Publications.

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