Writing For Therapy: What to Know About Therapeutic Journaling

Journaling is one self-care method counselors can recommend to their clients. Clients can use this tool on their own and incorporate these entries into a therapy session.

Counselors refer to journaling in therapy as writing therapy, journal therapy or expressive art therapy.

Clients can write in a paper journal, type into a phone, an online entry or a word document. It doesn’t matter where the writing is taking place, as long as the client takes the time to explore their inner thoughts, feelings, and motivations. Journaling allows clients to observe themselves; write about the future, past, and present; express what happened and how they felt; and share their goals, hopes, and dreams.

Is Journal Writing Right for Every Client?

When you consider expressive writing exercises for your clients, note their diagnosis. Writing is a tool that works well with those who are emotionally expressive but is not recommended for those who have difficulty understanding, describing, or expressing emotions. According to Niles et al. (2013): 

“Expressive writing produced anxiety improvement in participants relatively high on emotional expressiveness, whereas participants low on expressiveness showed increases in anxiety following expressive writing. The control group evidenced no change in anxiety regardless of emotional expressiveness. These findings suggest that for people who already tend to manage emotions through expression, expressive writing may be particularly beneficial in reducing anxiety.” 

There is no right or wrong way to express oneself and some clients may associate writing with English or grammar class—a place where they once were critiqued and felt judged. Counselors can remind clients that journaling in therapy is used for self-expression. Therapeutic writing is not about writing quality; it is about the process of getting the thoughts and feelings in your head onto the page. 

Other clients may not resonate with the written word. They may feel more comfortable talking than writing. This is why it is important to discuss with your client about any new technique or treatment you bring into the session room and honor their preferences and comfort level.

Bringing the Journal into a Therapy Session

When clients bring their journal writing into a therapeutic session, they can give highlights of what they have written, a synopsis, or the entire entry. Each time your client comes to a session to share their written words, tell them how much you appreciate it. It is an honor to witness a person’s deepest inner thoughts. Remind your client how much courage it takes to connect to the deepest part of themselves and trust to share this piece with you.

Used over time, journal writing shows clients how their relationships affect them, their responses to others, and how they may be giving their power away. The significance is not about the events written about but more about the meaning made out of these events. The therapeutic work involves how the client relates to these events or people. Listen for their interpretation and perception. In counseling, you can use cognitive therapy with faulty thinking, generate options for future responses, teach assertiveness skills and encourage self-care methods, including setting boundaries.

When a client uses journaling as a part of therapy, the counselor needs to assess the effectiveness of this type of treatment. Are the client’s symptoms improving or are the client’s symptoms worsening through this method? Periodic assessments will be needed to determine effectiveness and symptom management. If the client’s mental health decompensates, the counselor will need to consider other treatment methods.

Types of Therapeutic Writing to Explore

Writing About Therapy – Clients can write about their responses to their last therapy session. In their journal, they can record what they would like to discuss in the next therapy session, how they feel about the process of therapy, and even their impressions of their therapist. 

These types of insights can enrich the current work you do with your clients. When you hear negative feedback, listen and acknowledge the client’s experience.

Letter Writing – A journal can be used to write letters. These letters can process relational conflicts or heal unfinished business between the client and a deceased loved one. Letters that are written for those who are living are not meant to be sent. Rather, these exercises are used to release repressed emotions. 

Another method of letter writing can be through a dialogue in which one letter is written to a person and then the client answers the letter as if they were that person.

Daily Entries – Writing is not only creative but also therapeutic. Journaling can be cathartic by releasing pent-up feelings such as anger, depression, fear, guilt, jealousy, regret, resentment, sadness, shock, and yearning. Clients can record their symptoms in between sessions. The pages of the journal act as a container for these powerful emotions and help clients relieve and manage stress.

Free Writing – In an entry, encourage your clients to write whatever comes to their minds without censoring it. This type of free association can be expressed through bullet points, short sentences, or complete paragraphs.

Prompts – Clients who are not as comfortable writing may prefer a prompted method to elicit responses. Journals can be purchased or the counselor can design fill-in-the-blanks or a question format for clients to complete.

Mixed Arts Journal – Journaling can include drawings, pictures, and words. Some clients may feel more comfortable drawing a feeling or using pictures rather than writing a story or using words. Others may enjoy drawing shapes with words or phrases inside.

Dream Journals – Some clients find dream interpretation insightful to their growth. The client can be instructed to write down the dream content, feelings associated with the dream and upon awakening. 

In session, the dreams can be discussed for symbolism and interpretation. It can also be helpful to notice any recurring themes or patterns. Some theories for dream analysis are Jungian or Freudian (psychoanalysis).

Poetry and Other Writings – Clients may find they can express themselves through writing a poem or a short story. The National Association of Poetry Therapy (2022) describes poetry therapy as: 

“…the use of language, symbol, and story in therapeutic, educational, growth, and community-building capacities. It relies upon the use of poems, stories, song lyrics, imagery, and metaphor to facilitate personal growth, healing, and greater self-awareness. Bibliotherapy, narrative, journal writing, metaphor, storytelling, and ritual are all within the realm of poetry therapy.”

The Benefits of Writing for Therapeutic Clients

Increases self-awareness – The practice of writing encourages clients to slow down and pay attention to what is going on in their inner life. As they connect within the forgotten parts of themselves, they discover healing and hope. By acknowledging the emotional hurts, clients decrease anxiety and depression. This inner reflection allows clients to learn to respond rather than react to their impulses and emotions. For trauma clients, it can be helpful to track symptoms and triggers.

As a client maintains a journal, they can look at previous entries and notice certain patterns in their life. These may appear as ongoing issues or conflicts, which can be addressed in therapy and your client may find his or her own solution for their long-standing problem. 

Beaumont (2019) states: 

“Reflective practice and expressive writing requires and fosters awareness and observation skills. Through writing, those mindfulness skills create what I would call, a ‘readiness for possibility.’ As does expression through images, expressive writing involves a process of readying ourselves to see, to be receptive to what we are experiencing and becoming. It is true that writing requires a creative leap, but in trusting the process, we discover and create our most authentic selves”. 

Serves as positive reinforcement – A client can utilize a journal to write about all they have accomplished in a day. For a client with depression, this can be the act of getting dressed, taking a shower, or eating three meals a day. 

Clients can also focus on what they have in their life by listing what they are grateful for. This can include a list of supportive people and other areas they enjoy health in. 

Lastly, a journal can increase self-esteem, when a client notes their positive attributes. It can be helpful to direct your client to review these lists when they are having a tough day. This act helps clients to acknowledge themselves.

Helps with processing grief – Journaling helps process complicated feelings that accompany the loss of a loved one. In the beginning stages of grief, it is exhausting and requires a lot of energy. Clients can write down ways to set boundaries and institute self-care. In the middle stages, clients may want to write more about their loved ones and think about how they want to memorialize them. 

Later on, clients can focus on the meaning they make out of this loss. Writing can increase their newfound self-awareness, process feelings, and create a new reality. Some clients who grieve may want to keep their journal private to ensure they have a safe place to vent about the specific difficulties they face. As the counselor, it is important to respect how much the client wishes to share in session.

Increases client self-reliance – Some clients develop a dependency upon the counselor. In the beginning of counseling, clients learn what are healthy behaviors and responses. It is the counselor’s job to encourage the client to also look to their own higher wisdom. When a client learns to listen within, it decreases the tendency to look toward the counselor for all of the answers. Clients can learn to trust themselves and their decisions.

Lisa Hutchison, LMHC

Lisa Hutchison, LMHC

Writer & Contributing Expert

Lisa Hutchison, LMHC, is a licensed mental health counselor for the Commonwealth of Massachusetts. She works for professionals who want to treat and prevent compassion fatigue. With over 20 years of psychotherapy experience, she helps her clients assert themselves, set boundaries, and increase their coping skills. Her specialty is decreasing stress, anxiety, and depression while increasing realistic methods of self-care for those who help others. Ms. Hutchison’s psychological advice has been featured in Reader’s Digest and the Huffington Post. Her articles have been published in numerous magazines, including Grief Digest and Today’s Caregiver.

Lisa is the bestselling author of I Fill My Cup: A Journal for Compassionate Helpers and a faculty member writer for NetCE. Her latest continuing education unit publication is “Setting Ethical Limits for Caring and Competent Professionals.” She has taught creative writing in colleges and presented on boundaries for the compassionate helper; the use of expressive art to heal grief, anxiety, and depression; inspirational and motivational topics; and creative writing techniques.