1 A Therapistâs Guide to Using Journaling With Clients
Susan Borkin
This chapter highlights three organizing principles for therapists who want to use journaling with their clients. First, I describe therapeutic journaling and how my own origin story weaves into this narrative. Next, I look at therapeutic journaling as an adjunct to clinical practice. Finally, I address how therapeutic journaling actually works and I provide a broad overview of best practices for integrating therapeutic journaling into your work with clients.
Therapeutic Journaling
Therapeutic journaling is any type of writing or expressive process intended for personal growth or psychological healing. It is an evolving, creative, organic process with few actual rules.
The intermingling of words and feelings has been a theme in my life. As a child in middle school, I remember my class sitting on the gym floor for some kind of real or imagined misbehavior and writing on the floor with my finger to express my anger at what I felt was an unfair punishment. This early form of writing out my feelings helped me feel better. In college in the late â60s, I jotted down the phrase, âWriting as therapyâŚ??â in my personal journal.
A few years later, I had moved from the Midwest to San Francisco and joined a womenâs group. I loved it so much that for months I had no idea that it was actually a gestalt therapy group. Among other things, I experimented with using a method from gestalt therapy. I took dialogues, a conversation between two conflicted parts of the self, and wrote out dialogues between them in my journal.
When I had the opportunity to start graduate school in psychology in 1977, my committee accepted my thesis, Journal Writing as Self-Therapy. At that time, so little was known about the topic that my thesis was considered radical. Next, I took what I had been exploring and learning on my own and began teaching workshops called âJournal Writing for Personal Growth.â
As I taught, I watched workshop participants writing in Free Form, a manner of rule-less writing without stopping. I watched participants scribbling âI Wantâ lists and dialoguing with themselves and with troubled relationships in their lives. I saw faces change, little bursts of understanding, moments of insight and awareness that minutes earlier had been unconscious. I watched participants return from a Walk and Write exercise outdoors, beaming with new understanding. I witnessed personal growth and psychological healing.
Therapeutic Journaling as Adjunct to Clinical Practice
As I continued teaching workshops and working with clients in private practice, I learned that as powerful as journaling is, it is best used as an adjunct in clinical practice. Journaling is an enhancement to and not a replacement for sound clinical work and judgment. Therapists must always rely first on their experience, their skill as a clinician, their relationship to a particular client, their attention to the presenting therapeutic issue and, of course, their care for the safety of the client.
Interestingly, at times, a clientâs response to a suggested journaling exercise can also provide clinical data. For example, a clientâs excessive difficulty selecting a physical journal may speak of perfectionist standards or obsessive-compulsive disorder. Or, extreme reluctance to write may indicate an underlying trauma or perhaps performance anxiety if the trauma was related to shame or humiliation.
How Journaling Works
Journaling has much to contribute to therapeutic work. Suppressing emotions takes energy. Journaling can release stuck energy and provide a safe place to explore feelings. Traumatic memories are frequently stored in bits and pieces as disorganized pieces of a puzzle. Creating a written narrative makes a story whole, bringing these disparate pieces together. Journaling can also lead to self-reflection, which in turn may self-empower clients.
As much as you can, begin with a clear clinical picture before introducing journaling to a new client. As you create a working diagnosis, selectively choose how and when to best integrate journaling. Bringing therapeutic journaling together with solid clinical work provides a richly enhanced experience for your clients.
Even though I have stated the flexible nature of therapeutic journaling, there are nonetheless numerous guidelines, suggested methods, and best practices for integrating therapeutic journaling into your work with clients. These are available from additional sources, including from my own book on the subject, but I will provide a sampling here.
If, for example, your clientâs diagnosis falls into the category of an adjustment disorder, it can be useful to begin with a QuickList, a rapidly written unedited list to identify underlying issues. A Whatâs Bugging Me List is an example of this. Depression might be eased by Giving Depression a Voice. In issues of grief and mourning, one of the most important tasks is letting go without forgetting. I Wish I Could Tell You in either the form of a list or a letter can be repeated over time to remember oneâs loved one.
While most clients are unlikely to identify low self-esteem as the presenting issue, it is almost always present in some way. Positive psychology offers both a Strengths Introduction and Three Good Things. In a Strengths Introduction, a client is asked to write a story, introducing herself via her strengths. In Three Good Things, a client is asked to write down three good things that happened each day for at least a week. In what I think of as Three Good Things Plus, a client is additionally asked to identify her part in creating these positive experiences. The addition of the causative piece makes this exercise additionally powerful.
How journaling is introduced to a client can significantly affect the results. I have found it best to emphasize the positive benefits to the client. For example, I frequently ask a new client to write a brief autobiographical statement at the beginning of our work together. There are several advantages to this approach. Writing about your history stimulates memories and events. As I review a clientâs autobiography, I look for patterns, the structure of the family system and coping mechanisms my client has used. I also explain to a client that this written information is cost-effective in that it will save hours of interview time. Indirectly, too, this written assignment can help a client become engaged with the therapeutic work and feel responsible for his or her own progress.
Similarly, giving a client between-session assignments is a useful way to keep the therapy coherent and moving forward. One such tool I created is ATTENDD, a mnemonic device for tracking thoughts, feelings, and distractions. Another is W.R.I.T.E., for becoming aware of and shifting belief systems (for details on both tools, see Tips for Helping Professionals next).
There will be occasions when a client is reluctant or resistant to journaling. This may be a clinical issue to explore or it may be something more basic. For example, dyslexic clients may find writing too challenging. Clients with a known or unknown learning or processing disability may also be reluctant to write. Journaling is simply not for everyone. Work with your client and yourself to find creative alternatives.
5 Tips for Helping Professionals
- ATTENDDâTry this mnemonic to help clients organize responses to their experience, particularly between sessions. Ask them to pay attention to:
Awareness (Have you noticed any changes in yourself?)
Tension/Physical sensations (Are you feeling any tension in your body? Where?)
Thoughts (Has your thinking changed in any way?)
Emotions (Are you feeling happy, sad, angry, relieved? Do you feel elated, joyous, fearful, depressed?)
iNtuition (Do you feel differently about your inner sense of âknowing?â)
Dreams (What are you noticing in your dreams?)
Distractions (What has been distracting you lately?)
- W.R.I.T.E. can be useful when working with clients on their beliefs.
WâWhat are your current beliefs?
RâWhich beliefs are no longer working for you and need to be released?
IâIdentify memories, search for beliefs from family, friends, and teachers
TâTransform into new beliefs (note: especially useful with EMDR)
EâEmpowering new beliefs; how would you like to live with new beliefs
- If the client wants to share what they have written, thatâs absolutely fine. However, therapeutic journaling does not require the therapist to see, read, or know what the client has written. The therapeutic value for the client is in the writing itself. This is an excellent point to use when explaining the method to clients.
- I can practically guarantee you that if you do your own journaling work, you will feel much more at ease when presenting journaling to your clients. Therapist, heal thyself.
- Lighten up. There is very little about journaling that is right or wrong. Explore, experiment, and enjoy!
5 Tips for Clients and Journal Keepers
- QuickLists. To answer a question or brainstorm ideas, quickly make a list without editing. This rapid-fire list-making may be in the form of kernel sentences, short phrases, or even a question. For example, âWhat are five things I can do right now to improve my health?â Or, âIf I found myself with a completely open day, I would âŚâ.
- PenVisioning combines both positive and negative visualizations. Move back and forth between a positive visualization and a visualization in which something goes wrong, taking notes after each picture. Move back and forth between these two pictures until you feel relief or clarity on how to proceed with your positive visualization.
- Feeling sluggish with your daily journaling? Get outside, walk and breathe some fresh air. Sit down and try writing again.
- There will be times when no matter what you do, your journaling will feel stuck. Try shaking things up a bit. Write with your nondominant hand.
- Write four or five nouns in different colors on...