Writing A Powerful Tool Enabling Occupational Participation
CHRISTINE BALABA
Writing group Theory behind therapeutic writing Therapeutic writing and OT Model of human occupation (MOHO) as tool
for a writing group Challenges
Plan
Open group available to clients across two adult acute mental health wards
Two co-facilitators (OT and activity co-ordinator)
Average: 3-6 participants Weekly: 1 hour Started: May 2005
Writing Group
Main Inclusion Criteria: Clients at competence stage of the levels of
occupational functioning
Writing Group
EXPLORATION
COMPETENCE
ACHIEVEMENT
(De Las Heras 2003)
Writing Group Structure
Warm-up (15min)
Main Writing Task (25min)
Sharing the Work (20min)
Process of personal, explorative and expressive writing
Creative, literary, or autobiographical Client is offered guidance and inspiration
and help in choosing a topic for their writing Authority and control of each piece of
writing always resides with the writer. Focus is upon the process of writing rather
than the product (Bolton and Wright 2004)
Therapeutic Writing
Clarify and organise thoughts (Moskowitz (2005)
Allows participants to excel Writing as a means of
personal development (Hunt and Sampson 2005)
Therapeutic Writing
Lack of research apparent (Bolton and Wright 2004)
Psychologist Pennebaker (1993, 1997, 1999):
demonstrates the benefits of writing therapy in reducing inhibition and improving both physical and
mental health
Therapeutic Writing
Internal connection (with self) and external connection (with others) facilitated through the use of poetry(Hilse et al 2007)
Writing and Mental Health
Communication skills and experiencing writing as a tool for self expression can be utilised outside of a writing group (Williamson 2004)
“The very act of writing tends to increase self-confidence, feelings of self worth and motivation for life“ (Bolton 2004)
A place for ward-based writing groups within recovery? (Sampson & Hart 2005)
Writing and Recovery
There is not one neat theoretical model to guide the use of therapeutic writing
(Hunt and Sampson 2005) Words are packets of communications,
meanings, ambiguities and implications (Steinberg 2004)
Therapeutic Writing
Occupation focused! Writing - opportunity for re-evaluating and
planning aspects of life in an occupational dimension (Pollard 2004).
Writing and Occupational Therapy
Writing as occupation Writing to reflect
Writing as means to plan occupational life Writing to produce a piece of art
Writing and Occupational Therapy
Experiences and perceptions of events in order to understand how change in occupational roles takes place (Goldstein et al 2005).
Occupation focused narrative, the client’s story should be viewed in terms of what needs to be done next (Hagedorn 2000).
Narrator and listener could co-create the narrative and move it forward (Pierce 2003).
Writing and Narratives
Competency Phase:
Clients will become aware of their abilities and limitations
Clients will feel they have control over unfamiliar occupational outcomes
Clients will feel positive about succeeding in unfamiliar activities
Clients will be able to meet their role responsibilities Clients will be able to structure their daily routine Clients will have skills to meet their goals Clients will be able to pursue activities within different
environments
Potential Goals of Clients
(Kielhofner 2008)
Model of Human Occupation
Volition
Habituation
Performance
Skills
Environment
• Personal Causation
• Values • Interests
• Roles • Routines
• Processing •
Communication and Interaction
• Motor Skills
• Space• Social
Environment
Volition Habituation
Performance Skills
Environment
OPHI-II OCAIRS OSA Role checklist WRI
Guided fantasy Story starters
Topics and tasks suggested by clients
Materials
Personal sense of effectiveness Sense of achievement
Examples of topics: “Things I am good at?” “Helping others”
Personal Causation
What is meaningful to the person Writing as a way of communicating to the
therapist and reflecting on their own experience
Examples of topics: “A person meaningful in your life” “My perfect day”
Values
Person’s interest to write Writing about interests
Interest
Example’s of topics: “Roles in my life” “Jobs” “Being a friend” “At the dinner table”
Roles
Organise thoughts through writing Planning on paper
Example of topics: “A day in the life of me”
Routines
Writing Creativity / Imagination Reflection Processing
Examples of topics: “Favourite things” “Cast away on an island”
Practicing and Recognising Skills
Communicating to oneself and to others Sharing the work with others
Examples of topics: “Unsent letters” “Written dialogues”
Communication and Social Interaction Skills
Tolerating Acceptance
Writing in a group setting can support the writers in their personal explorations and expressions and it can help to promote trust and a sense of community (Bolton 1999).
Social Environment
Collaborating Advocating Empathizing Encouraging Instructing Problem-solving
Intentional Relationship Model (Taylor 2007)
Role of Therapist
Volition Literacy skills Negative association with writing English language barrier Varied stay on acute ward Strong emotions
Challenges
Model of Human Occupation Screening Tool (MOHOST)
MOHOST single observation as outcome measure after each session
(Parkinson et al 2006)
Evaluation
More recent research is needed into the therapeutic effectiveness of writing
More research in particular for the use of writing groups and writing in general within occupational therapy
Future implications
Clients as facilitators Journal writing Establish more links with the community
New group on the female intensive care
Plans for the group
“I must write it all out, at any cost. Writing is thinking. It is more than living, for it is being conscious of living.”
(Anne Lindbergh, Writer and aviation pioneer, 1906-2001).
Bolton, G & Wright, J (2004) Conclusions and looking forward. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 228-231.
Bolton, G (1999) The Therapeutic Potential of Creative Writing. Writing Myself. London & Philadelphia: Jessica Kingsley Publishers.
Bolton, G (2004) Introduction: writing cures. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 1-5.
De las Heras, C, Llerena, V, Kielhofner, G (2003) Remotivation process: Progressive intervention for individuals with severe volitional challenges (Version 1.0). Chicago: MOHO Clearinghouse.
References
Goldstein, K. (2004) Occupational narratives and the therapeutic process. Australian Occupational Therapy Journal, 51, 119-124.
Hagedorn, R (2000) Tools for practice in occupational therapy. A structured approach to core skills and processes. Edinburgh: Churchill Livingstone.
Hilse, C, Griffiths, S, Corr, S (2007) The impact of participating in a poetry workshop. British Journal of Occupational Therapy. 70,10, 431-438.
Hunt, C & Sampson, F (2005) Introduction. IN Hunt, C & Sampson, F (ed.) The self on the page. Theory and practice of creative writing in personal development. London: Jessica Kingsley Publishers, 9-18.
Kielhofner, G (2008) Model of Human Occupation. Theory and Application. Baltimore: Lippincott Williams & Wilkins.
References
Lindbergh, A (1974) Locked Rooms and Open Doors. Diaries and Letters of Anne Morrow Lindbergh, 1933-1935. Washington: Harvest Books.
Parkinson, S, Forsyth, K, Kielhofner, G (2006) A User’s Manual for the Model of Human Occupation Screening Tool (MOHOST). London: UK Centre for outcomes, research and education.
Pennebaker, J & Seagal, J (1999) Forming a story: the health benefits of narrative. Journal of Clinical Psychology, 55,10, 239-245.
Pennebaker, J (1993) Putting stress into words: health, linguistic, and therapeutic implications. Behavioral Research Therapy, 31, 539-548.
Pennebaker, J (1997) Writing about emotional experiences as a therapeutic process, Psychological Science, 8,3, 162-166.
Pierce, D (2003) Occupation by design. Building therapeutic power. Philadelphia: F.A. Davis Company.
Pollard, N (2004) Notes Towards a Therapeutic Use for Creative Writing in Occupational Therapy. Chapter 10. In Sampson, F (ed.) Creative Writing in Health and Social Care. London & New York: Jessica Kingsley Publishers, 189-206.
References
Tailor, R (2007) The intentional relationship model: occupational therapy and the therapeutic use of self. Chicago: F.A. Davies.
Steinberg, D (2004) From archetype to impressions; the magic of words. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 44-55.
Williamson, C (2004) On the road to recovery: writing as a therapy for people in recovery from addiction. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 123-129.
Wright, J (2004) The passion of science, the precision of poetry: therapeutic writing – a review of the literature. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 7-17.
References