Writing Skills Workshop

Writing Skills Workshop

This long post is primarily intended as background reading for staff of Cumbria Partnership NHS Foundation Trust (CPFT) attending a writing skills workshop on 8th May 2017. However, almost all of the content in the post should be both accessible to, and relevant to, people from outside CPFT and outside of the UK.

The workshop timings are 13:00-16:00 and the main topics in the programme are:

• Writing for wellbeing and stress management
• Reflective writing
• Elements of effective written communication

Click here if you would like to read the programme. Click here for the Powerpoint presentation, which covers the section on elements of effective written communication. Click here if you would like to see the evaluation form.

Writing for Wellbeing

Writing can help both mental and physical wellbeing. It can clarify thoughts and feelings, improve mood and positivity, bring more focus to the mind, change your perspective on things, and through all these help you manage stress. In my work as a Writing Practitioner I have found that different kinds of writing are helpful for different symptoms and problems.

When I recommend or use a particular type of writing with someone I am hoping for a specific effect, which may be short term or long term. When someone is feeling highly stressed or mentally unwell, short-term effects are needed, e.g., calming,
relaxation, bringing the attention into the present moment, increasing mental focus or respite (from voice hearing for example). Mindful writing is very useful in these circumstances. Once an individual is feeling calmer and more focussed, a writing technique such as perspective shift or positive writing can be useful to bring a new perspective on problems and even change the way we think.

My main aim in writing sessions is to inspire and encourage participants to write to help with their recovery and wellbeing. I want to inspire people to continue writing regularly after the end of the workshop(s) they attend. With this in mind, I aim to make the sessions as enjoyable and varied as I can. I use flexible writing exercises so that I can adapt them to individual needs and capability. I believe that different kinds of writing can be therapeutic for different symptoms and problems.

In developing and selecting therapeutic writing exercises I have been influenced by (i) observations of mental health patients in ward groups, i.e., what type of writing works for what symptoms; (ii) research studies on therapeutic writing; and (iii) consideration of how certain well-established therapies can be applied to therapeutic writing, in particular: Mindfulness Based Cognitive Therapy and Narrative Therapy.

Writing for Stress Management

For stress management I recommend keeping a journal in which you write: 5 minutes each per day of mindful descriptive and mindful expressive writing; plus longer, less frequent, writes using other techniques such as positive and perspective shift writing.

Therapeutic writing is a powerful box of tools that can help us cope with short-term acute stress and manage long-term stress. At times of acute stress, a short piece of mindful writing can bring calm and focus, and a daily practice of mindful writing (expressive and descriptive) is helpful in long-term stress management. Other writing techniques such as perspective shift and positive writing can help us change our thinking patterns to tackle the root causes of excessive stress.

Writing for Wellbeing and Reflective Writing Techniques

Journaling
There are many techniques and many books with ideas for writing journals. Here I describe a technique called Captured Moment developed by Kathleen Adams and described in her book Journal to the Self: Twenty Two Paths to Personal Growth (Adams, 1990). The idea is to write about a moment of your life, for example: a moment of joy, sadness, delight, anguish, exhilaration or serenity, and really bring it to life by including as much detail as you can remember about what you could see, smell, hear, taste and feel at the time. Write for 15 minutes about one of the happiest moments you can remember. Include as much detail as you can about what you could see, hear, taste, smell and feel in that moment.

Mindful writing: descriptive
I think of mindful descriptive writing as a writing meditation: choose an object, or a photograph of a beautiful place, and write to describe it in some detail. Don’t add thoughts, associations, feelings. Just write a description of the picture or object. Or, better still, notice something in the real world, perhaps the view around you or out of the window, and write to describe it. If possible include description of more than just what you see, e.g., the sound a bird is making, the smell of the flowers. I recommend this as a daily practice along with writing a journal. Example exercise (mindful writing about something in the real world): (1) Write for about 5-10 minutes to describe an object in detail – how it looks, smells and feels (this is the mindful writing bit). (2) Optional second part: write for another 5 minutes about any thoughts, memories or associations that spring to mind. This second part of the exercise is not mindful writing – so let the writing take you where it will, and write from your imagination if you wish. [10-15 minutes]. Desired effects: calming; lowering/raising psychological arousal; increasing mental focus; increasing sense of the present; teaching mindfulness; increasing appreciation of the world; decreasing focus on self/problems.

Mindful writing: expressive
This technique involves writing to describe how you feel right now. Do not add thoughts or associations. Write non-judgementally. Write only about how you feel in this present moment. Sometimes I combine mindful expressive writing with metaphor, for example: “What kind of weather am I right now?” Example workshop exercise (body scan write): (1) Take 5 minutes to write about how you feel physically. Starting at your toes and moving up, write about how each part of you feels – hot or cold? Comfortable or uncomfortable? Tense or relaxed? Tingly? Painful? (2) Now write for 5 more minutes about how you feel emotionally and mentally right now. Desired effects: increasing mental focus; increasing sense of the present; teaching mindfulness; possibility for improving clarity of thoughts/problems.

Positive writing
For example you could write a journal each day but only write about positive things. Example workshop exercise: someone who has lost a parent who they loved and got along well with could write about a positive memory of being with them. Desired effects: motivation; encouragement; perspective; decreased negativity.

Reflective and perspective shift writing
Example workshop exercise: think about a conversation you had recently. Now imagine that you are the other person in the conversation, or perhaps an object that was there at the time – a coffee cup maybe – and write about the event or conversation again from this new point of view, in the third person. Desired effects: insight; shift of focus from self to other(s).

Fictional characters
Example workshop exercise: choose a photograph from a selection of photographs of people, preferably doing something, e.g., sitting outside a café, sleeping, reading, making something. Think about who they are, their name, what they do, who they live with and where. Write about them doing an activity. Desired effects: decreasing focus on self/problems and increasing focus on the real world and the people in it.

Freewriting
Freewriting means writing for a timed period without stopping to think, punctuate or correct your writing in any way. The idea is to just keep writing whatever comes into your head, without stopping. Example workshop exercise: in response to stimulus words (4 words, 2-3 minutes per word), write for without stopping to think, punctuate or correct your writing in any way. The idea is to just keep writing whatever comes into your head, without stopping. Desired effects: calming; lowering/raising psychological arousal; freeing up of writing/thoughts; possibility of insights.

Writing inspired by metaphors/symbols
Example workshop exercise: look at cards with symbols on, e.g., circle, triangle, square, rectangle, and write what each symbol means for you or your life at the moment. Desired effects: freeing up of writing/creativity; possibility of insights.

Handouts

Therapeutic Writing
Mindful Writing
Journals and Diaries
Freewriting
Fictional Characters
Reflective Writing
Random Input

Therapeutic Writing Research / Further Reading

Research shows that writing can have positive effects on health and wellbeing, but no-one knows how and why it works (King, 2002, p. 119). What is clear is that the beneficial effects of writing arise from the process of writing one’s thoughts. The writing that is produced – the product – is less important.

In most of the research into the benefits of creative writing, the research subjects were directed to write about negative events; the most well-known researcher undertaking studies of this nature being Pennebaker (1997). However, I rarely use a negative approach because I believe, as Laura King argues in her article ‘Gain without pain’ (2002:131), that it is not necessary to write about negative emotions or events to gain benefit from writing. People can benefit from writing that inspires happiness or joy. There is certainly a place for writing about undisclosed trauma, but repeatedly writing about negative thoughts can be counter-productive by reinforcing negative thinking.

The writing I find one of the most helpful is mindful writing, and I recommend daily mindful writing practice. The benefits of mindfulness are too well evidenced to need much mention here. Mindfulness is increasingly being incorporated into treatments for mental health for example (see Williams, Teasdale, Segal and Kabat-Zinn, 2007)

References

Adams, K. (1990) Journal to the Self: Twenty Two Paths to Personal Growth, USA: Grand Central Publishing.

King, L. (2002). Gain without pain? Expressive writing and self-regulation. In S.J. Lepore, J.M.; Smyth (eds.) (2002) The writing cure: How expressive writing promotes health and well-being. Washington DC: American Psychological Association.

Pennebaker, J.W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162-166.

Williams, M.; Teasdale, J.; Segal, Z.; Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York: The Guilford Press

Further Reading

Reflective Practice: Writing and Professional Development, by Gillie Bolton, published by Sage Publications, 2005.

Expressive Writing: Words That Heal, by J. W. Pennebaker & J. F. Evans, published by Idyll Arbor, 2014.

Words for Wellbeing: Using Creative Writing to Benefit Health and Wellbeing, edited and co-authored by Carol Ross, published by Cumbria Partnership NHS Foundation Trust, 2012.

Therapeutic Journal Writing: An Introduction for Professionals (Writing for Therapy or Personal Development), by Kate Thompson, published by Jessica Kingsley, 2010.

Article

This is a link to the article I had accepted by Mental Health Practice: Final Version. For copyright reasons I cannot share the actual version as published by the journal but this is the final version I had accepted by them.

Article in Mental Health Practice

I had a pleasant surprise at work yesterday when I opened a big brown envelope and found the April issue of Mental Health Practice inside, because the front cover has the words “Therapeutic Writing” emblazoned across it and, on pages 33-38, it has an article by me about my psychiatric ward writing groups.

Here’s a link to the abstract on the journal website: click here. Unfortunately the full text of the article is not free to download, but I believe I will be able to post an edited version of it on here as long as it isn’t exactly as published by Mental Health Practice.

Expressive Writing: Counseling and Healthcare [book]

The latest in a series of books on expressive writing has recently been published and I’m delighted to say that it contains a chapter from me. The publisher is R&L Education, and the book editors are Kathleen Adams (who is also the series editor) and Kate Thompson. The chapters cover a range of topics by a wonderful selection of people with experience of using expressive writing in different settings. My chapter is about the therapeutic writing I do in mental health units in Cumbria.

It’s a great book for anyone working  in therapeutic writing. If you are interested, here’s a link to more information on the book on the publisher’s website: https://rowman.com/ISBN/9781475807721.

At the moment the UK Amazon site only has the hardback (£48.65) and Kindle (£22.75) editions. However, the paperback edition is available on the Book Depository (£23.95) – click here, and on Amazon.com ($29.46) – click here.

Best wishes, Carol.

Writing projects update

At last I can tell you a bit more about one of my writing projects. The chapter I was commissioned to write last year was for an American book on expressive writing in counseling and healthcare edited by Kathleen Adams and Kate Thompson. The book, which is one in a series, is due to be published in September and I’ve just pre-ordered a copy on Amazon. Here’s a link to the book on the publisher’s website: https://rowman.com/ISBN/9781475807721

And last week, after several years of trying to get around to it, I submitted an article on therapeutic writing in acute psychiatry to the British journal Mental Health Practice. Wish me luck on getting it accepted please!

Meanwhile, the HTA monograph I contributed to on therapeutic writing in long term conditions is due out this Autumn I hope.

It’s all very exciting!

Best wishes, Carol.

One hour creative therapeutic writing workshop

This post is based on a handout I produced for a one-hour workshop for Adult Learner’s Week:

Workshop exercise 1: Freewriting

Freewriting means writing for a timed period without stopping to think, punctuate or correct your writing in any way. The idea is to just keep writing whatever comes into your head, without stopping. If you stop and don’t know what to write next, just write: “I don’t know what to write” a few times and more thoughts will come.

The workshop exercise: one by one for each of a set of 5 words, do some freewriting for 2-3 minutes per word. The words are: castle, house, cottage, garden, door. [10-15 minutes]

Workshop exercise 2: Fictional characters

Choose a piece of fabric. [Note: I have a selection of fabric squares for group participants to choose from. You might get your inspiration for this exercises in a shop that sells fabrics on the roll, or a charity shop.] Imagine who might own something made of the fabric, for example, an item of clothing, curtains, a tablecloth, a cushion. Write about the person, and write about them wearing or using whatever the thing is that is made of the fabric. [15-20 minutes]

Workshop exercise 3: Mindful descriptive writing

The workshop exercise (mindful writing about something in the real world): (1) Write for about 5-10 minutes to describe an object in detail – how it looks, smells and feels (this is the mindful writing bit). You could choose a favourite ornament, a piece of fruit, a tree – whatever catches your eye. (2) Optional second part: write for another 5 minutes about any thoughts, memories or associations that spring to mind. This second part of the exercise is not mindful writing – so let the writing take you where it will, and write from your imagination if you wish. [10-15 minutes]

This workshop provides a taster of three types of writing that can be therapeutic in different ways.

10-week plan for a ward writing group

A few weeks ago I decided to create a rolling 10-week plan for my writing groups. As this is working pretty well so far, I thought I would share it with you.

Link to plan: Ten week plan for ward writing group

The first column in the plan indicates the week number within the plan. Week 1 is the first week of the first 10-week course, but when I get to week 11, week 1 will actually be week 11 (counting from the beginning).

The plan for most weeks has 3 writing exercises described. The exceptions being weeks 7 and 8, which are about published poetry.

I have briefly described the writing exercises in the Core Exercise column and indicated some variations for both less and more able/well participants in another column.

The Resources column lists what I plan to bring along to each session for writing inspiration – prompt words, pictures, objects, and so on.

The plan initially covers 10 weeks but it is intended to then restart for weeks 11-20, and again for weeks 21-30, etc. For each new start of the plan I will choose different photos, poems, objects, etc. The numbers in brackets indicate resources choices that I plan to use in later weeks, i.e., (1) is for weeks 1-10, (2) is for weeks 11-20, (3) is for weeks 21-30, and so on.

Feel free to use the plan, and to reblog this if you wish, and do let me know if you find it useful, or want to share any of your writing exercises or session plans, or just have any comments you want to make.

North Country Bus

Rosie the 1946 Leyland Tiger visited Carleton Clinic recently for Dementia Awareness Week and inspired my next couple of writing groups.

This lovely north country bus parked up outside the Ruskin Unit at Carleton Clinic as part of a Dementia Awareness Open Afternoon on Monday 18^th May. I sat in the bus for an hour or so handing out old fashioned sweets, and talking to the patients who climbed aboard for a quick trip down memory lane, and to the carers and ward staff who accompanied them. There was an eclectic collection of nostalgia items laid out on Rosie’s back seats: bus tickets, a ticket machine, a bus driver’s hat, a travelling gentleman’s grooming case, assorted hats, trinkets and jewellery, cigarette cards, and much more. I had made a small pile of postcards of Rosie and as people boarded the bus I asked them where they would like to go on Rosie if they could go anywhere at all that they wanted. I wrote their answers on the postcards and gave them to the ward at the end. Where people wanted to go varied from “Carlisle” to “home” to “Cornwall” to “the mill near Shap” to “Brazil”! A few people took away a postcard as a souvenir.

The postcards of Rosie went down very well in my next few Carleton Clinic writing groups. In the Hadrian Unit, which is an adult mental health ward, everyone wrote on the back of their postcard and we all wrote something quite different. The brief was that we could go to any place and time in Rosie, with any people we wanted. An 18-year-old young man who loves motocross wrote that he would adapt Rosie to accommodate two motorbikes in the back and then he and his friend would go travelling on with their bikes, sleeping and cooking on the bus. A middle-aged female patient wrote that she would adapt Rosie to be like a campervan to take on holiday with her family. I wrote that I would go back in time on Rosie with my sister and my son and visit my Mum and Dad when they were younger and stronger, and when my Dad could walk (he became left-side paralysed because of a stroke last year).

In the older people’s ward, one patient did not write about Rosie at all, or even about a journey. He wrote instead about his own early life. However, he wrote clearly and lucidly, and he read the piece of writing aloud to the group. This was a good achievement given that he is often confused and delusional. Another patient wrote on her Rosie postcard a message to her dear friend, who happens to be called Rose.

Relating a writing exercise for a group to a recent event can, I find, help to engage participants with the exercise. And once their interest has been caught, a simple thing like a postcard of an old country bus can spark inspiration in people of widely varying age and differing symptoms. The key factors for this exercise were to engage participants’ interest in the postcard exercise by first telling them about the visit of Rosie to Carleton Clinic; and then give them instructions that were sufficiently clear for someone with memory problems to cope with, but at the same time flexible enough to give freedom of choice to the more imaginative and able participants.

Thinking about Rosie the north country bus has reminded me about Jake Thackray and his lovely song “Country Bus”. If you have not come across singer-songwriter Jake Thackray (1938-2002) then please do have a listen to some of his songs, which are mainly witty tales of rural Yorkshire. Being from Yorkshire myself, I am somewhat biased in favour of his lovely Yorkshire baritone voice. I was lucky enough to see him in concert twice and even chatted to him briefly in the interval. In my opinion – to use a phrase I stole from Jake himself – he was “head, shoulders and knees” above any other comic singer I know of – living or dead.

Lyrics to Jake Thackray’s “Country Bus” and Jake singing the song.

The ten year itch?

I stayed for ten years in my last job, so should my boss be worried that today is my tenth anniversary with the Cumbria Partnership NHS Foundation Trust (CPFT)? Have I got itchy feet? No, I have not (no need to worry Rob).

The secret to my contentment has been in finding the right combination of two parallel careers – having discovered many years ago that working full time in one post does not suit me. There are many part-time workers in the NHS and I have been fortunate enough to work part time for all my 23 years in NHS clinical audit. Which has freed me up to regularly exchange my clinical audit hat for at least one other type of headgear. I am beginning to sound like The Cat in the Hat!

For well over a decade my parallel career was in scientific publishing: writing abstracts, proof reading, copy-editing, indexing, and so on. This was a reasonably interesting combination for me, but not quite perfect. Then in 2005 two things happened: my son inspired me to re-visit creative writing; and I started work at a mental health and learning disabilities Trust (the CPFT). Those two steps set me on a writing ramble that has lasted ten years so far.

When I started writing for pleasure again I discovered, as many before me have, that writing is good for you. So I began reading about therapeutic writing, did some training, joined Lapidus, and started to wonder whether I might be able to do some writing work in our mental health wards. My therapeutic writing career breakthrough came in 2009 when I saw a poster for the CPFT’s very own Dragons Den. I bid for and won funding to lead a “Year of Writing” project. And as part of the “Year of Writing” I started my first weekly writing group in a psychiatric ward.

My combination career is now made up of a part-time, permanent post in clinical audit, and sessionally paid work leading weekly therapeutic writing groups in four psychiatric wards. A combination career may not be for everyone, but it has worked for me for more than twenty years. It is definitely a good option to consider if you feel the need to retain financial security, but at the same time yearn to pursue a new career in an intellectually stimulating (but notoriously low paid) field such as writing.

For those who are interested here are some milestones of the last ten years:

2005            started writing fiction and poetry again (after twenty five years)
2005            joined CPFT
2007-08        Introduction to Counselling Certificate
2008            Introduction to Mindfulness training
2009            achieved Certificate in Creative Writing (Lancaster University)
2009            two poems published in “Pinhole Camera 3” (University of Cumbria)
2009-10        in-house Psychological Skills training (levels one and two)
2009            led my first writing workshop
2010-11        led the CPFT “Year of Writing” project
2010            started therapeutic writing in a mental health ward
2011            organized the “Writing in Healthcare Conference”
2011            started this blog
2011            started weekly therapeutic writing group in Psychiatric Intensive Care Unit
2011            Ty Newydd Writing in Health and Social Care course
2012            published the “Words for Wellbeing” book
2012            started weekly therapeutic writing group in 3^rd mental health unit
2013            won a prize in the poetry installation “Beneath the Boughs”
2013            joined the STyLUS project team
2014            story published online by “Page and Spine”
2014            commissioned to write a chapter in a forthcoming expressive writing book
2015            started weekly therapeutic writing group in 4^th mental health unit

The Art of the Essay

If you had asked me a month ago whether I was interested in writing essays, or even reading them, my answer would have been a fairly emphatic no. This is because until then my only experience of essays were the sort one has to write as assignments on academic courses. That being said, I do remember enjoying writing one particular essay. It was while I was studying for my biochemistry degree, and I think the topic was something along the lines of: “Those who communicate discoveries to the people are as important as those who may discover them. Discuss in scientific terms.” In hindsight I think the reason I enjoyed that particular essay was because it was entirely my own creation – there was no requirement to impart knowledge to the reader.

In our last workshop, my creative writing tutor (Brindley Hallam Dennis aka Mike Smith) showed the group a volume containing the 2013 winners of the William Hazlitt Essay Prize. As I flicked through the attractively bound volume, one essay caught my attention. I only had time to read the first few lines of “The art of waiting” by Belle Boggs (Boggs 2013). But I later read and enjoyed the whole essay, plus an article or two on the art of essay writing (especially Walker 2013), and was persuaded to have a go at essay writing myself.

So at tomorrow’s workshop, where I would usually take along a piece of short fiction to read aloud, to be discussed by Mike and the group, this time I will be taking my first attempt at a literary (as opposed to academic) essay.

Brindley Hallam Dennis blogs here: https://bhdandme.wordpress.com/

Boggs, Belle (2013). The art of waiting. In: William Hazlitt Essay Prize 2013 – The Winners. Notting Hill Editions, 2013. Retrieved 31/05/2015 from: http://www.nottinghilleditions.com/uploads/essaywinners/NHEessayBOGGS.pdf

Walker, Cameron (2013). The Art of the Essay. Retrieved 31/05/2015 from: http://www.theopennotebook.com/2013/06/25/the-art-of-the-essay/