Writing – A Powerful Tool Enabling Occupational Participation

  • Published on

  • View

  • Download

Embed Size (px)


Occupational therapy student Christine Balaba explores writing as tool to be used within occupation therapy, based on her work within acute adult mental health setting. COT Annual Conference 2010 (22-25 June 2010)


  • 1.Writing
    A Powerful Tool Enabling Occupational Participation

2. Writing group
Theory behind therapeutic writing
Therapeutic writing and OT
Model of human occupation (MOHO) as tool for a writing group
3. 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
4. Writing Group
Main Inclusion Criteria:
Clients at competence stage of the levels of occupational functioning
(De Las Heras 2003)
5. Writing Group Structure
6. 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
7. 8. Clarify and organise thoughts
(Moskowitz (2005)
Allows participants to excel
Writing as a means of
personal development
(Hunt and Sampson 2005)
Therapeutic Writing
9. 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
10. Internal connection (with self) and external connection (with others) facilitated through the use of poetry
(Hilse et al 2007)
Writing and Mental Health
11. 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
12. 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
13. Occupation focused!
Writing - opportunity for re-evaluating and planning aspects of life in an occupational dimension (Pollard 2004).
Writing and Occupational Therapy
14. Writing as occupation
Writing to reflect
Writing as means to plan occupational life
Writing to produce a piece of art
Writing and Occupational Therapy
15. Experiences and perceptions of events in order to understand how change in occupational roles takes place (Goldstein et al 2005).
Occupation focused narrative, the clients 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
16. 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
17. Model of Human Occupation
(Kielhofner 2008)
Role checklist
Guided fantasy
Story starters
Topics and tasks suggested by clients
19. Personal sense of effectiveness
Sense of achievement
Examples of topics:
Things I am good at?
Helping others
Personal Causation
20. 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
21. Persons interest to write
Writing about interests
22. Examples of topics:
Roles in my life
Being a friend
At the dinner table
23. Organise thoughts through writing
Planning on paper
Example of topics:
A day in the life of me
24. Writing
Creativity / Imagination
Examples of topics:
Favourite things
Cast away on an island
Practicing and Recognising Skills
25. Communicating to oneself and to others
Sharing the work with others
Examples of topics:
Unsent letters
Written dialogues
Communication and Social Interaction Skills
26. Tolerating
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
27. Collaborating
Intentional Relationship Model
(Taylor 2007)
Role of Therapist
28. Volition
Literacy skills
Negative association with writing
English language barrier
Varied stay on acute ward
Strong emotions
29. Model of Human Occupation Screening Tool (MOHOST)
MOHOST single observation as outcome measure after each session
(Parkinson et al 2006)
30. 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
31. Clients as facilitators
Journal writing
Establish more links with the community
New group on the female intensive care
Plans for the group
32. 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,
33. 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 lasHeras, C, Llerena, V, Kielhofner, G (2003) Remotivation process: Progressive intervention for individuals with severe volitional challenges (Version 1.0). Chicago: MOHO Clearinghouse.
34. 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.
35. 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 Users 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.
36. 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.