Writing Therapy as a Healing Tool for Sexual Violence Survivors: A Literature Review

Isabelle Parker

Submitted to the Faculty of Bennington College, Bennington, Vermont, in partial

fulfillment of the requirements for the degree of Bachelor of Arts.

June 2016

Recommended to the Faculty of Bennington College for Acceptance by:

Michael Dumanis

David Anderegg

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Isabelle Parker David Anderegg SCT Senior Seminar

Writing Therapy as a Healing Tool for Sexual Violence Survivors: A Literature Review

Abstract

In this literature review I will assess the benefits of writing therapies such as poetry

therapy, narrative therapy, and journaling for the population of sexual violence survivors. I make

comparisons of these therapies to more common trauma­focused therapies like Cognitive

Behavioral Therapy and Prolonged Exposure Therapy. I also consider what makes these writing

therapies so potentially effective, what research has been done on them, whether they would be

better standing alone or combined with other therapy and what role structure and form plays in

these therapies.

Introduction

Since 2011, the percentage of American women raped during their lifetime is 19.3%, or

around 23 million women, and the percentage of American men raped during their lifetime is

1.7%, or about 2 million men . The percentage for other sexual violence over a lifetime, 1

including being made to penetrate, sexual coercion, unwanted sexual contact and noncontact

unwanted sexual experiences is 43.9% for women, which is almost 53 million women, and

23.4% for men, which is a little over 26.5 million men (CDC, 2014). Though Americans in

recent years are more vocal about the widespread issue of rape and sexual assault than they have 2

been in decades past, sexual violence, by its very nature of being traumatic and shameful for its

1 This includes completed and attempted forced penetration, as well as completed alcohol or drug penetration. 2 The legal definitions of rape and sexual assault can be found at the Bureau of Justice Statistics website, http://www.bjs.gov/index.cfm?ty=tp&tid=317.

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survivors, is still hard to talk about. Survivors are still often met with a hostile combination of

victim­blaming, discomfort, and disbelief when trying to confide in others, which often makes

healing even harder. Self­blame­­a common theme among survivors of all types of sexual

violence­­slows the healing process as well, especially when survivors inherently blame their

fundamental character for the rape or assault rather than on their actions (Sigurvinsdottir,

Ullman, 2015). Additionally, sexual violence survivors are more likely to be diagnosed with

PTSD than survivors of other traumas, and have a higher risk of also developing depression,

anxiety and other mental health issues. These mental health issues­­especially the avoidance

component of PTSD ­­can make it even more stressful to report rape and assault to the police, on 3

top of concerns about privacy, trivialization of the crime, and occasionally, time limits on filing

reports (Walsh, Bruce, 2014). Rape and assault cases that go to trial do not fare well either,

according to RAINN only 2 out of every 100 rapists go to jail. 4

In the midst of the very real stigma that surrounds sexual violence, survivors can find it

hard to find other people to talk to about their trauma, either because they know outsiders may

not empathetically understand what they go through or because they are conscious that the

trauma of their story may be too much for another person to bear. Writing therapy, however, can

offer survivors the chance to create safe, solitary spaces for themselves on the page, to make

meaning out of their own traumatic experiences and to transfer all of their thoughts, feelings and

struggles to the page in order to begin moving forward from their past traumas. Though writing

therapy can alleviate the strain of trying to speak to those who may be unwilling to listen, as a

3 Avoidance is one of the three main components of PTSD. When survivors actively avoid any situation that might trigger them, it can limit the day­to­day activity of their lives severely. To see an outline of all the main components of PTSD­­re­experiencing, avoidance and hyperarousal­­see the national institute of mental health website: http://www.nimh.nih.gov/health/topics/post­traumatic­stress­disorder­ptsd/index.shtml 4 See the statistics and their sources at https://rainn.org/get­information/statistics/reporting­rates

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therapy it is often overlooked in favor of more popular psychotherapies (Mazza, 2003).

However, because writing therapy gives survivors a chance to heal in their own voice and on

their own terms, it is worth exploring its theory as well as the value that it may have for sexual

violence survivors, which this literature review aims to do. 5

Writing therapy is an umbrella term for therapeutic writing techniques such as poetry

therapy, journaling, and narrative therapy, all of which will be touched on in this review. In fact,

poetry therapy utilizes a model that helpfully explains the different forms writing therapy can

take. There are three components of poetry therapy. The receptive/prescriptive component

introduces written literature to a client that relates thematically to his or her struggles, the

expressive/creative component involves client writing in therapy, and the symbolic/ceremonial

component involves the use of metaphors and storytelling in writing (Mazza, 2003). Though

pre­written poetry can be used as a springboard for a client's own writing, this review will mostly

be focusing on analyzing the impact that writing, metaphors and narrative can have on a client

when used as a tool towards her own healing. This review will also be looking at the different

and varying degrees of form and structure writing therapy can have, since different methods of

writing (such as poetry and journaling) and different writing prompts may help survivors in

various ways. However, no matter what the method or structure of the writing therapy, all forms

it takes can give survivors the skills to organize and order their past experiences, express

themselves safely and in a wide range of ways, and can provide much needed catharsis. For the

survivors of a trauma as internalized and silenced as sexual violence, these potential skills and

benefits are not to be underestimated, and are well worth investigating and utilizing.

5 I define “survivors” here as anyone over the age of 13 who has survived rape, sexual assault and sexual abuse/incest.

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Are Current Psychotherapies Meeting the Needs of Survivors?

The therapies that sexual violence survivors seem to use most frequently are Cognitive

Behavioral Therapy and Prolonged Exposure therapy (Resick, Williams et al. 2012). CBT works

to expose a patient’s unhealthy thought processes and ways these thought patterns lead to low

self­esteem and self­destructive behaviors and beliefs (Castillo, 2011). Prolonged exposure

therapy, which is also often used with war veterans, works to reduce the stress of triggers and

traumatic memories by either using flooding or desensitization techniques, where the survivor is

exposed to triggering memories either all at once or repeatedly over time (National Alliance on

Mental Illness, Psychotherapy) . There have in fact been research studies that compare these 6

therapies against each other to test their effectiveness with sexual violence survivors, and the

consensus seems to be that both therapies are effective in the short term as well as in the long

term, though CBT seems to offer more of an effective and helpful strategy for survivors than PE

therapy does.

One study took the long­term approach on analyzing the benefits of these therapies by

doing follow­up research with 126 of the original 144 female rape survivors who had

participated in the original trials comparing the therapies 5­10 years ago. The survivors were

split into an intent­to­treat control group and a long­term follow up (LTFU) group that originally

had been in a trial comparing the efficacy of CBT and PE therapy. Researchers assessed whether

symptoms of self­reported PTSD, self­reported depression severity and several other comorbid

factors decreased at the intervals of pretreatment, posttreatment, 3 months prior, 9 months prior,

and LTFU. What they found was that 93.4% of the CBT participants and 91.9% of the PE

6 https://www.nami.org/Learn­More/Treatment/Psychotherapy

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participants achieved a 10­point change on the CAPS scale (Clinically administered PTSD scale)

by the LTFU period, which exhibits an improvement in the quality of life. In addition, 88.5% of

CBT participants and 88.7% of PE participants achieved a 20­point change on the CAPS scale,

which is actually a clinically significant difference. The authors of the study concluded that “the

maintenance of treatment gains throughout the follow­up period, on average 6 years, exhibited

by both [groups] is impressive, especially considering that these women continued to experience

life events that might impact their symptoms” (Resick, Williams, et al. 2012), since the

post­trauma of sexual violence can indeed last, and it is significant that these therapies stand up

to the symptoms that can endure for months or years after the initial attack(s).

A second study did a similar comparison between the therapies with female rape

survivors as well, though they maintained more of a focus on assessing the treatment of complex

PTSD. Survivors were split into a CBT group, a PE group and a wait­list control group.

According to the study, “significant assessment effects were found for all three TSI [Trauma

Symptom Inventory] factors with significant decreases in scores occurring from pre to

posttreatment, and no change from the posttreatment to follow­up assessments,” meaning that

whatever positive changes survivors had in either therapy, the positive changes were more

immediately apparent during the therapy, while they stabilized without change after the

posttreatment. This supports the first study in saying that though survivors might not continue to

gain positively from the therapies after they are over, at least those positive changes last and are

maintained for a long time (Resick, Nishith, and Griffin, 2003).

Prolonged exposure therapy provides more of a rigorous structure than Cognitive

Behavioral Therapies do: rather than change a survivor’s negative beliefs about themselves, PE

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therapy works intensively to combat a survivor’s fears, avoidance and anxiety by exposing them

both mentally (through imaginal exposure) and in daily life (in vivo exposure) repeatedly to

memories and triggers until a survivor no longer anxiously avoids these things, and any PTSD

symptoms related to these triggers and memories subside (Castillo, 2011). Though the majority

of the studies comparing PE with CBT found no significant differences between the two in how

they help heal survivors (Nishith, Resick, Griffin, 2002; Nishith, Resick, Griffin, 2010; Resick,

Williams, Suvak, Monson, Gradus, 2012; Wachen, Jimenez, Smith, et al. 2014), PE is still a very

rigorous form of therapy. Survivors may have to monitor their own anxiety throughout exposure

exercises with a subjective unit of distress (SUDS) scale on a level of 1­100, while the exercises

themselves include them repeating a story of a traumatic memory of theirs over and over again

for forty­five to sixty minutes in a session in order to desensitize themselves to the memory

(which is imaginal exposure). They also must repeatedly return to places (i.e. friends’ houses,

large crowds, certain streets) that trigger them, perhaps on a daily basis, in order to also lower

their anxiety about these places (which is in vivo exposure). While I can understand that this

therapy is helpful for lowering survivor’s trauma­related anxiety and helps make day­to­day

functioning easier (Castillo, 2011), it can be argued that many survivors would not be able to

withstand the stress of having to face the scariest parts of their traumas repeatedly. In fact, one

study that compared PE and CBT with female rape survivors found that “intensive exposures,

although effective at bringing about eventual habituation in PTSD symptoms, are more likely to

bring about an immediate increase in avoidance symptoms” (Nishith, Resick, Griffin, 2002).

Furthermore, two studies that compares PE and CBT had slightly higher dropout rates in the PE

groups than the CBT groups: 27.3% in PE over 26.8% in CBT (Nishith, Resick, Griffin, 2003)

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and 79% in PE over 69% in CBT before session four­­the exposure session in each therapy group

(Nishith, Resick, Griffin, 2002)­­respectively.

One study summed both therapies up nicely when comparing them both, by saying that

Notably, there is considerable overlap between exposure therapy and cognitive therapy for PTSD. Both approaches include similar elements, although programs may differ in how much emphasis they place on exposure versus cognitive therapy, how exposure and cognitive therapy are conducted, and even in what they label as exposure or cognitive therapy (Foa, Hembree, Cahill, et al. 2005).

While it is true that both therapies maintain different levels of trauma exposure and therapeutic

education for their clients, CBT seems to maintain more of a distance from directly dealing with

trauma than PE does, since it tackles underlying beliefs and perspectives associated with the

trauma rather than dealing directly with the trauma itself. Both therapies, especially PE, also lack

ways for a survivor to have agency over what healing means to her­­rather these therapies both

apply their own framework onto individual survivors. While this paper will explore how much

value writing therapies can hold for survivors­­whether they can stand alone as therapies or work

better as supplements, for example­­one can argue that writing therapies put more power and

flexibility into a survivor’s hands, so she can determine and define her healing process for herself

and engage with her trauma as directly or indirectly as she likes.

Poetry Therapy

In an article analyzing the general health benefits of therapeutic writing, James W.

Pennebaker­­a social psychologist who has contributed much to the expressive writing therapy

field­­has said that “the mere expression of trauma is not sufficient. Health gains appear to

require translating experience into language” (Pennebaker, 1997). It seems to be true: not only

can writing be an immensely powerful source of catharsis, but the act of putting language on

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paper also brings order, definition and meaning to messy and traumatic life experiences (Bolton,

1999). Poetry especially offers a way of organizing an experience creatively, through vivid,

heightened language, imagery and metaphors. All of these factors give agency and power to the

survivor: through the flexibility of these factors, he can use his imagination to define his

traumatic and post­traumatic experiences any way that feels true to him, while again, through

language, keeping as much or little distance from the experience as he wishes to.

Eli Griefer, a poet, lawyer and pharmacist, is commonly cited as the man who officially

got the poetry therapy movement underway. He and Jack J. Leedy, a psychiatrist, eventually

developed a poetry therapy group at Creedmore State Hospital in Queens, New York. Dr. Leedy

continued Griefer’s efforts after Griefer died in 1996, and both published numerous books on

poetry therapy in the late sixties up to the early seventies. The Association for Poetry Therapy

(APT) was founded in 1969, and became the National Association for Poetry Therapy (NAPT) in

1981­­the organization still holds annual conferences and trains therapists to become certified or

registered poetry therapists. Other important contributors to the field have been Arthur Lerner, a

poet and psychologist who founded the (now defunct) Poetry Therapy Institute in 1973; Gilbert

Schloss, who attempted to classify poems for different therapeutic settings; and Nicholas Mazza,

Ph.D, RPT, who edited NAPT’s Journal of Poetry Therapy: The Interdisciplinary Journal of

Practice, Theory, Research and Education during its debut in 1987 (Mazza, 2003; NAPT

website).

As I have mentioned before, there are three components to the practice model of poetry

therapy, which are the receptive/prescriptive component, the expressive/creative component, and

the symbolic/ceremonial component. The receptive/prescriptive component brings existing

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poetry into sessions, which can serve as a useful foundation if a client identifies with what the

poem is saying, and can relate it to her own struggles after reading it. Leedy’s isoprinciple (an

idea inspired by music therapy) is also an important concept to keep in mind: it states that the

poem must match the emotional state of the client so that the client feels that she can connect

with the poem. For therapists, this means knowing the client enough to choose the right poem­­if

the poem is optimistic, yet the client is going through a lot of pain, for instance, that poem may

be invalidating and dismissive to that pain and therefore not the right tone for the client. Getting

the poem right for the client, however, can be tremendously validating since the client can read

writing that intimately and honestly resonates with her own emotions and experiences. The

therapist will usually take note of what resonates for the client and why, in order for the client to

use the poem to more deeply define her own experience (Mazza, 2003).

The receptive/prescriptive component of poetry therapy can actually fit nicely with the

expressive/creative component, since one can follow the other in session exercises. Clients can

write from an open­ended prompt, or the prompt can be inspired by a pre­existing poem (for

instance, clients can use the first line or their favorite line in a poem to start with). Either way,

the structure of these prompts can be flexible depending on what the client needs. If a client

doesn’t quite know where to start or what to write, prompts with more structure, such as

sentence stems (where every line could start with “I remember” or “when I am alone,” for

instance) can be very useful to provide some direction. If, on the other hand, clients already

know what they would like to explore, or have a lot of memories, thoughts and experiences that

need cathartic release, perhaps freewriting based on a certain theme she wants to explore or

writing in response to a question the therapist forms could be more useful (Mazza, 2003). Either

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way, poetry can structurally be quite abstract, and the metaphors and imagery that allow for this

abstraction can create protective distance from triggering aspects of trauma while also providing

creative and new ways of exploring this trauma (Kerner, Fitzpatrick, 2007). The range of

structure in the prompts can help provide a focus point for this abstract writing.

In fact, Mazza’s third component, the symbolic/ceremonial component, doesn’t seem to

be an active method of poetry therapy as much as it is a way of acknowledging the uniquely

poetic factors of this therapy, such as the value of metaphors, imagery, and the use of expressive

writing in general as tools of meaning­making. In a qualitative study done with a few survivors

of childhood violence, the participants and the researcher interviewing them worked together to

create a metaphor that aptly described their life narratives, with the results being that they were

able to make clearer sense of their pasts through the lens of that metaphor. As the researchers put

it, “the metaphors appeared to change the emotional chaos of the co­collaborators into order, and

helped these individuals make more coherent meaning of their past.” For instance, one of the

participants, who went by the name Jo, used food as a metaphor for her life story, which

involved growing up in a violent home, getting date raped at 14, enduring eating disorders and a

string of abusive relationships. She knew that some food was nourishing while others were

unhealthy. Once she cast her life through this metaphor, Jo was more easily able to see all the

ways she wasn’t nourished properly from the start, and how her unhealthy choices later on

stemmed from this trauma, further perpetuating her “taking in [of] toxins.” The metaphor

became an easy and tangible way to make sense of her life (Burton, Rehm, 2003). However,

making experiences coherent and easier to make sense of is not the only way in which metaphors

and images can be useful for survivors.

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Using metaphors and imagery to describe traumatic experiences is also a useful way to

condense those experiences, emotions and memories into a sort of tangible shorthand. For

instance, in Marge Piercy’s poem “Rape,” the first four stanzas compare rape to other horrible

traumas, but points out what makes rape (and how society reacts to it) unique. The poem begins

with “there is no difference between being raped/and being pushed down a flight of cement

steps/except that the wounds also bleed inside” (Piercy, 1982). Here, the complex point she is

trying to make comes across clearly: rape is as painful, violent and damaging as anything we

might overtly consider so (like being pushed down the stairs, or being run over by a truck, as she

also illustrates) except that in the case of rape, the psychological and emotional trauma lasts

much longer and becomes an extra layer of pain in this sort of trauma­­a concept we can easily

grasp when we imagine that the “the wounds also bleed on the inside.” Survivors who read this

poem would likely be able to understand this idea in the way it is expressed very well, and in

their own writing, survivors would be able to put their pain into an image or a metaphor in a way

that can hold all of the complexity of that pain into one idea or image, which one can’t

necessarily do as well when they verbally give voice to their trauma rather than writing it out.

Additionally, metaphors and images give survivors the benefit of gauging their own

distance from their trauma (Croom, 2014)­­if they write directly about their past assaults, for

instance, expressing that an element of that assault felt like something else gives the survivor a

way to hide that trauma behind something safer and easier to speak of, even if the way that

trauma is expressed still rings true. If the survivor uses an image (say, writing about the

attacker’s hands or smile) in his poem, even if those images may be more visceral and

immediate, they still give the survivor a more concise way to express and manage their trauma.

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Either way, images and metaphors are powerful tools not only to facilitate a deeper

understanding of sexual trauma when survivors come across them in pre­existing poems, but can

help survivors express their own traumas in safer, more manageable­­but no less powerful­­ways.

It would be useful now to return to the Pennebaker study quoted a few pages ago, in order

to look at what research generally has to say on both expressive and poetic writing in terms of

trauma. Pennebaker has argued for the cathartic value of writing (having stated that inhibiting

emotionally fraught experiences such as trauma could be a low­level stressor) and claims to

observe “both the subjective and objective markers of health and well­being” that can result from

writing about traumatic experiences. Though he writes about the positive effects of this writing

in terms of short­term changes like reduced heart rate and relaxed muscles as well as broader

changes such as positive behavioral changes after different populations in studies wrote about

emotional experiences, Pennebaker also stated that “a number of studies have failed to find

consistent effects on mood or self­reported stress” and seemed to not be able to move past a

claim that expressive writing generally reduced distress. Additionally, Pennebaker had some

conflicting points on writing specifically about trauma: though he cites studies that state that

writing and talking about trauma is more helpful than doing either for superficial topics, he also

cites a study that stated that students who wrote about college rather than traumatic experiences

thus improved their grades, suggesting that perhaps while writing about trauma is cathartic, it

may not always be the useful topic of choice for a client at the moment, perhaps depending on

the severity of their trauma and the structure of the assignment given (Pennebaker, 1997).

Though there seems to be a severe lack of quantitative studies on the benefits of poetry

therapy for survivors of sexual survivors, there are many qualitative articles and case studies that

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speak to the effectiveness of the therapy for rape and CSA survivors. Though poetry therapists

and psychologists like Nicholas Mazza, Geri Chavis, and James W. Pennebaker have all looked

at the intersection of sexual trauma and poetry therapy, any kind of research that looks at both

outside of their literature remains slim, though case studies and quantitative articles detailing

poetry therapy’s use for sexual violence survivors do exist. Professor Stephanie Y. Evans, for

instance, has gathered an extensive body of black poets’ work for use in poetry workshops and

also advocates for poetry workshops for black sexual violence survivors. These workshops are

necessary for healing, she says, since in addition to surviving sexual violence, “Black women

often experience an added layer of silence because of social and cultural stigmas, but silence can

be broken most effectively by activism that engages Black women’s creativity.” She also

mentions the importance of form and clear guidelines when running a poetry therapy workshop

(Evans, 2015). Poetry Facilitator Emily R. Blumenfeld writes about poetry as a tool of witness

and testimony in cases of severe trauma (Blumenfeld, 2011), and psychologist Julie. A.

Schwietert presents a telling case study of a transwoman named Kelly who underwent short­term

poetry therapy treatment as part of emergency crisis intervention shortly after her rape. The

six­week intervention helped her start to regain her sense of safety and re­identify her strengths.

Though it did not solve everything, it did “play a critical role in the restoration of her functioning

to a state that exceeded her pre­crisis functioning” in a way that she could creatively relate to.

Schwietert concludes that “crisis is a fragmenting experience, a disintegration and loss of

organization. Poetry therapy helps create a literal container where the various pieces of emotion

can be held and, eventually, put back together again” (Schwietert, 2004).

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Two other qualitative articles analyze the expressive/creative and the

receptive/prescriptive component of poetry therapy, respectively, and they discuss how these

aspects can be healing and useful and what populations they can be useful for. In the former

article, Jan L. Hitchcock and Sally Bowden­Schaible also discuss how poetry therapy can

provide a powerful alternate mode of expressing traumatic pain, saying “Given the various

ways—some...as...a result of trauma and repression—in which our experiences can become and

remain “unsayable,” poetry's capacity to open doors to new perception, articulation, and

discussion...is significant” (Hitchcock and Bowden­Schaible, 2007; Baker and Mazza, 2004).

This body of qualitative research is important for its ability to make survivors’ experiences

heard, instead of just contributing data and numbers to the cause of poetic healing. Though it

contains a great deal of information about the benefits of poetry therapy for this population, this

type of research could stand to grow. Empirical research in this area is also absolutely necessary

to validate these findings with concrete evidence of survivors’ improvements when they use

poetry therapy prompts that allow for the expression and integration of their traumas through

imagery and metaphor­­using the format of comparing this group to a neutral control writing

group or even to a group writing about trauma in prose would answer a lot of important

questions about the function of poetry specifically as a therapeutic tool.

Narrative Therapy

Narrative therapy was developed by David Epston and Michael White in the late 1970’s

and early ‘80’s (White, 2009). Though it does not specifically focus on expressive writing,

narrative therapy has enough to do with analyzing and reauthorizing survivors’ stories that it

merits attention in this paper. The most powerful aspects of narrative therapy are the ways in

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which it gives the survivor agency to be the “expert” on her own story while the therapist acts

from an “unknowing” position, and in the way narrative therapy allows survivors to step outside

of their own stories, analyze them and find room for more positive alternative stories. In these

alternative stories, survivors can find that their strengths and resources are recognized and learn

that in their problem­saturated stories (stories which focus mostly on the negative aspects of

one’s life) that “the person is not the problem, but rather that the person has a relationship to the

problem” (Sahin, McVicker, 2011). Narrative therapy allows survivors and therapists to work

together in untangling this relationship between the person and their problems while finding

space for more empowering­­and just as legitimate­­narratives.

Judith Herman describes traumatic memory as a “prenarrative,” as wordless and static in

comparison to normal memory. The role of therapy, therefore, is to provide a safe outlet for

stringing these “fragmented components of imagery and sensation” together, and to “provide the

music and words” to the stillness (Herman, 1997, p. 175, 177). However, what’s more important

than the opportunity for catharsis and self­expression that narrative therapy provides is the

opportunity for survivors to be able to see the stories they’ve always carried with them change

and expand, so that in effect, their conceptions of themselves broaden with it. In fact, the

analyzing and reworking of survivors’ stories in this context is a lot like editing a piece of

writing: when writers edit or collaborate with editors, this process gives them a chance to come

apart from the work they wrote so personally, so they can have a more impartial stance to take

stock of what weaknesses muddle the writing and what bits of strength and clarity stand out and

can be expanded upon. While I risk simplifying narrative therapy when using this metaphor, my

point does stand that the process of externalization, in both cases, gives the person a healthy

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distance from which to accept editing, growing, and changing what it is they see (Sahin,

McVicker, 2011).

After the survivor’s story is told and before he achieves distance from his problems and

the possibility of new narratives, an important component of narrative therapy and

externalization is mapping the influence of the problems that arise in the survivor’s narrative.

This step happens when therapists ask their clients how the survivors’ problems have been

affecting them, how they cope with the problems, as well as recognizing their strengths and

opening pathways for alternative stories (Sahin, McVicker, 2011). The act of analyzing and

talking through these problems could be enormously helpful for survivors of sexual violence,

many of whom carry feelings of guilt and responsibility for their assaults (Sigurvinsdottir,

Ullman, 2015). Mapping the influence of problems can give survivors a better idea of just how

much they’ve struggled under the weight of these problems and show them that the problems did

not stem from them and were not their fault. After all, “problem­saturated story has a focus that

does not allow the individual to tell any alternative story” (Sahin, McVicker, 2011) and when the

problems that are a part of that narrative can be examined and talked through, more pieces of a

survivors’ story get filled in, which may lead to them having a different and perhaps more

validating perception of themselves and what they’ve been through.

Externalization also involves achieving critical distance from one’s narrative, and Miguel

M. Gonҫalves, Marlene Matos and Anita Santos give a good idea of what that process looks like:

when a survivor tells her problem­saturated story, this story contains elements of the “landscape

of action” and the “landscape of consciousness.” The landscape of action include the setting,

actors and actions of the story, and answer questions like “what happened, in what order, and

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involving whom?” The landscape of consciousness refers to how the survivor and others as

actors in this story feel, know and think about the events; and discussing this landscape means

analyzing the intentions, desires, values and beliefs of the survivor and others in the story. The

story itself can only properly be looked at from a critical distance if the therapist and survivor

look at both elements of the story: what happened and how it affected the survivors’ thoughts,

beliefs, emotions and self­esteem. Another crucial element for a survivor to be able to

successfully reflect on and expand upon her story is her ability to meta­reflect on her progress:

once unique outcomes (points in the problem­saturated narrative that make room for potential

and formerly unseen alternative narratives) start appearing in the story and the survivor and

therapist start developing more positive perspectives about the survivor’s story, she should

ideally be able to see what in herself has changed from the past to the present and how that

change occurred (M. M. Gonҫalves et al., 2009). An example of this kind of reconceptualization

(as Gonçalves et al. call it) would be if a survivor were able to acknowledge the lack of

self­esteem at the time of her rape with her desire for any kind of attention, and also see where in

her narrative she began to change, if at some point in the narrative she had begun to discern good

and bad attention from people the more she figured out who were positive and healthy influences

in her life. At the present moment of that narrative, she could be able to say that she could better

discern who to let into her life and who not to. In this example, the survivor would be able to

string the past and present together while also recognizing that this new narrative is different but

more empowering than her original, problem­saturated narrative.

Finding new narratives can happen in different ways, too: in fact, according to

Gonҫalves, Matos and Santos, there are five different innovative moments (a more expansive

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term for ‘unique outcomes’) that can occur in the process of reviewing the problem­saturated

narrative and looking for new ones: action IM’s, reflection IM’s, protest IM’s,

reconceptualization IM’s and new experience IM’s. Action and reflection IM’s are the simplest:

action IM’s mark moments in the narrative where the survivor may have acted against a problem

in her narrative, like telling someone about her rape, while reflection IM’s involve new

understandings and perspectives of the narrative that have previously not been figured out, such

as a survivor realizing that her discomfort with another friend’s affectionate physical contact ties

back to her early sexual abuse. As Gonҫalves et al. puts it, these IM’s “could facilitate

therapeutic transformation functioning as good “examples” that that change is happening.” The

three other innovative moments that can happen during narrative therapy are more complex, but

potentially facilitate more growth. Protest innovative moments can involve actions or thoughts,

however, theses actions and thoughts both protest against the problem and the problematic

people involved, which can reposition the survivor’s sense of self and can potentially make way

for more proactive progress to occur. An example of this could be a woman reflecting back on

the victim blaming that appears in her narrative after her rape, and coming to an understanding

that, after all she’s suffered the blaming isn’t fair, and that she should not have to put up with it.

Reconceptualization IM’s are moments where, as explained before, the survivor can look at her

narrative and understand what about her has changed since its beginning and how that

transformation occurred. The ability to track changes in the self is imperative; without it,

narrative therapy would be less effective. Without the ability to self­reflect and see a connected

change from past to present, the survivor would not be able to see beyond their own

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problem­saturated narrative. Lastly, there are new experience IM’s, which are critical for 7

healing and moving forward in life: survivors in this case prepare and plan for the future of their

life stories, perhaps applying newly learned skills to new experiences. All of these innovative

moments found in a survivor’s narrative therefore can lead to different kinds of growth, healing

and progress, since they all take place at different stages of the narrative and allow the survivor

to engage with her own life story with varying levels of complexity. Gonҫalves et al. even

suggest that there may even a cyclical process to discovering all of these innovative

moments­­externalization could begin with a client discovering action, reflection and/or protest

IM’s­­signs of initial change­­before moving towards reconceptualization, where they start to see

changes in themselves. Fluctuation between all the IM’s could happen several times as a way of

validating changes in the survivor before a new narrative is really secure. And lastly, the 8

function of the IM’s themselves is that they are a variety of realizations from which the new

narrative emerges­­the new narrative itself is not different from these IM’s (M. M. Gonҫalves et

al., 2009). What is important about this externalization process is that it happens naturally at the

survivor’s own pace and within his own agency: when he and his therapist examine his narrative

together, the therapist is not a conscious arbiter of these steps as he might be with CBT or

exposure therapy, but is a guide. When the survivor knows his own narrative best, it is within his

own agency to change and expand it, and only within the therapist’s power to help him see the

hidden positives and strengths of this narrative that the survivor may have been previously blind

to.

7 To learn more about what a self­defeating struggle between the problem­saturated narrative and an inability to see beyond it (or having unrealistic ideals beyond it) looks like, see p. 17­18 of “Narrative Therapy and the Nature of ‘Innovative Moments’ in the Construction of Change” by Gonçalves et al. 8 The cycle could of course happen in different orders, this is just one theorized order.

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Empirical research on narrative therapy mostly seems to study the link between narrative

therapy and its effect on mental health, rather than on any link between narrative therapy and

trauma specifically. The first of two linked studies examined short­term personality change 9

through narratives relating to mental health, and found that increases of agency in participants’

narratives led to positive increases in mental health (Adler, 2012). The second of the two studies,

done a year later, follows up these findings with a focus on sudden gains (rapid, substantial

improvements in symptoms) and whether SG’s are associated with the meaning­making process

of narrative therapy. They found that out of all eight themes they coded the narratives

for­­processing, avoidance, coherence, positive self, negative self, agency, hope and

hopelessness­­that processing and coherence (and avoidance, marginally) were higher right

before a participant’s sudden gain than in the control group, suggesting that “the process of

self­construction, not the qualities of the self­as­construction, are associated with SGs” (Adler,

Harmeling et al. 2013). In other words, the work of actually organizing one’s story and making

meaning out of it is what leads to improvements in mental health, not the personality or

circumstances of the person doing the work. While it is important to take these findings about the

importance of the narrative therapy process and its effect on agency, these studies only examined

participants’ narratives about their own therapies and not about themselves or their lives, and the

studies did not focus on trauma specifically.

However, there were several qualitative studies that did focus on the relationship between

narrative therapy and childhood sexual abuse, and these studies were usually very detailed in

discussing the benefits of the therapy for this population and the process survivors underwent.

9 This study has a section titled “Empirical Research on Narrating Change and Mental Health” which reviews more literature than I have here, but this literature, again, takes mental health broadly into account and does not focus specifically on trauma.

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One study that proposed a thorough and well­thought­out combination of narrative therapy and

internal family systems therapy for survivors of childhood sexual abuse (CSA) discussed a 10

process of finding not only what an individual’s dominant story was, but what the dominant (and

likely oppressive) story was in society that the survivor may have been struggling against. The

narrative therapy part of their process focused on finding these dominant stories, analyzing them

and then bringing the more “subjugated stories” to the fore, while the IFS therapy looked deeply

into a survivor’s internal, psychological story, contextualizing all the strong emotions and

thoughts a survivor has dealt with in the course of her life. The system as a whole worked to

honor the survivor’s story, put the survivor back in control of their stories and lives and relegate

the therapist to a non­judgemental guide who validates the survivor’s story rather than imposing

yet another oppressive dominant narrative about the survivor on them (Miller, Cardona, Hardin,

2007). Therefore, not only was this study thorough, but the system it implemented followed all

of the important tenets of narrative therapy as well: it respected narrative therapy’s safe

therapist/client power dynamics and worked to find more empowering, positive stories from the

dominant one, while also being conscious of the oppressive problem­saturated narratives our

society tells us about CSA and rape. The other study focused on CSA survivors as well, though it

had more of a straight narrative focus: it instead tracked how the “narrative sense of self”

changed after attending group therapy for CSA. Four women from the group therapy participated

10 Internal Family Systems Therapy operates on the basis that all people contain an “internal family” within them, with many parts of themselves existing beside their core self. This therapy examines these internal systems alongside external systems, like work, society, family to see how they affect the self and how these systems interact. Trauma causes these parts to polarize due to loss of safety and confidence, decentering the core self as other parts fight for leadership. One of IFS’s objectives is to analyze each of these parts and contextualize them, as well as their relationship to the trauma and the survivor’s external systems. As the research says, “This model seems especially effective for dealing with survivors of CSA because it allows the client a sense of control in the therapy room and validates the client’s often seemingly contradictory feelings and actions.” Rather than pathologizing those feelings and actions, survivors find that “seeking to understand these many parts help them find a role in the client’s life that allows [the parts] to be less burdened and more productive” (Miller, Cardona, Hardin, 2006).

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in a life­story interview, a recovery­story interview and a semi­structured interview focusing on

how these survivors’ selves evolved after therapy. Researchers found that these survivors’

narratives all had shared themes of mental distress, avoidance as a coping mechanism, feelings of

shame and guilt, low self­esteem and harboring unrealistic demands for themselves.

Externalization of their life experiences was an important factor in their healing process both in

group therapy and the resulting interviews, as well as the solidarity shown in the group therapy.

As one participant said, because she externalized her trauma, she was able to “unburden myself

of [the responsibility of the abuse]” and undo her own self­blame (Saha, Cheung Chung, Thorne,

2011), which returns back to narrative therapy’s concept of making sure survivors know they

may have a relationship to their problems but that they themselves are not the problem (Sahin,

McVicker, 2011). What is important about this study is that in not only looks at how narratives

can be useful, but, much like Pennebaker’s word­search system used on his own participants’

narratives (Pennebaker, 1997), it examined survivors’ narratives to find and address common

themes among them, which can then help us understand how to better help and address the issues

CSA survivors struggle with. In general, though there is empirical research that has been done on

the benefits of narratives and narrative therapy, there needs to be much more research of this

kind that focuses on trauma and narrative therapy specifically. However, the qualitative research

on trauma and narrative therapy is promising.

Journaling

Ira Progoff led the way for journaling from the 1960’s onward with instructional

workshops on his own journaling methods, which are still applied today (Baker, Mazza, 2004).

Journaling is a form of therapeutic prose writing that functions as a means of self­reflection and

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self­observation for people. It is very flexible in many ways­­one could write in a notebook, a

computer or phone and it can be done in any setting­­at home, in therapy, or in a public place.

Additionally, the amount of structure one can have to help them right write varies greatly: there

are countless different prompts, sentence stems and sources of inspiration that can serve as a

jumping­off point for journaling. And lastly, journaling can serve as a sanctuary; there is no right

or wrong way to write, no established wordcount, and nothing one can’t write about (Purcell,

2013; O’Keefe, 2015; Howes, 2011). A writing therapy as open­ended as journaling is useful for

survivors since it allows them to reflect on their own thoughts, feelings and healing progress

within the safety of their own writing, and if taught not to edit or self­censor their thoughts,

journaling could lead them to feel that their thoughts and feelings are validated as well as

clarified and organized (Harrell, 2011). Journaling is also different from the other writing

therapies mentioned since it can promote growth and self­knowledge between therapy sessions,

as well as accompany the sessions themselves.

Though there is not a lot of research on journaling with the specific population of sexual

violence survivors, there is a chapter on journaling in the book Surviving Sexual Violence, A

Guide to Recovery and Empowerment edited by Thema Bryant­Davis. In her chapter, Shelly P.

Harrell compiles four different methods of journaling­­free writing, flow writing, expressive

writing and integrative writing­­as well as five other supplemental journaling strategies in case

her main methods are too daunting for some survivors. Her four main methods span the range of

more unstructured journaling, such as freewriting, to more structured methods, such as

expressive writing or integrative writing. All methods are useful for different reasons:

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unstructured methods such as free writing and flow writing, where “you simply write your 11

thoughts and feelings of the moment and follow where the writing takes you” can allow a

survivor tremendous freedom to express whatever she wishes to express in the present moment

without having to feel any external judgement from others or self­blame from herself for

whatever she may be processing­­her truths can be her own. However, Harrell acknowledges that

unstructured journaling is not for everyone and that others may need more structure in order to

center their thoughts and emotions. This is where expressive writing and Harrell’s own

integrative writing come in handy, for different reasons. The expressive writing paradigm is

James W. Pennebaker’s invention, and involves writing for four consecutive days for 20­30

minutes each day about a traumatic or stressful event as well as one’s thoughts and feelings on it,

although it does not have to be about the same thing every day, or even about sexual violence at

all, as long as it is still a stressful event of some kind (Harrell, 2011). This exercise could be a

good way for survivors, who know they are ready to open up about a certain experience, to do so

for a limited amount of time in a safe environment. This expressive writing paradigm could

therefore be a tamer alternative to exposure therapy, where survivors could face a traumatic

experience without feeling too overwhelmed or not ready, while also knowing that experience

would be safely contained in the writing. The other journaling method that Harrell suggests is

one she established: integrative writing. This method is the most highly structured and is useful

as a sort of self­initiated crisis intervention for “when you are feeling overwhelming emotions,

when your mind is racing, or when you feel you are about to lose control.” The structure of this

is broken up into three parts­­release, recognize and reset­­and is meant to help someone in crisis

11 Flow writing is like freewriting, except that the writer writes after an image or metaphor comes to them in meditation.

25

work through current thoughts and emotions safely. During the “release” section, the writer is

meant to write out a detailed catharsis of whatever he or she is experiencing at the moment, in

whatever way makes sense to them, until the intensity of the emotion lessens. Afterwards, the

“recognize” section acts as a space for the writer to try to understand and contextualize the

meaning of these emotions­­the writer can write about where these emotions are coming from,

how they might help or hurt, or how they relate to different aspects of a writer’s identity, and so

on. The reset section, lastly, is meant to bring these last two sections together, in a kind of

condensed format of narrative therapy: the writer is supposed to string together a reset narrative

of this emotional crisis, incorporating the last two sections, what the emotions are and what they

mean, into this narrative. This effectively gives the writer a chance to step back and make sense

of the organized trajectory of their experience (Harrell, 2011). Though most of the other

journaling methods are less intense than integrative writing, it is crucial that survivors (and

anyone prone to emotional crisis) have an emergency coping strategy that can safely redirect

them from more harmful coping methods, if needed. Though there may not be other research

done on journaling and sexual violence survivors, Harrell has compiled a useful list of different

journaling methods that are sensitive to survivors’ needs and to the struggles with self­blame,

silence, and shame that they may face.

Other research on journaling generally seems to just assess its therapeutic benefits,

though there are many studies done with populations other than sexual violence survivors, such

as studies done on journaling for veterans, therapists in training and those with mental illness.

However, one literature review that very thoroughly categorizes all types of therapeutic writing

does assess its benefits for survivors of sexual violence. The researchers here drew up a small,

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four­pane matrix with a continuum of affective/emotional and cognitive/constructivist types of

writing therapies on the horizontal axis and a continuum of concrete/structured and

abstract/unstructured types of writing therapies on the vertical axis. Different writing methods

such as poetry, journaling, storytelling, autobiography and memoir are plotted onto the matrix

depending on where they fit under the different spectrums. Under a “survivors of severe trauma”

section, the article discusses female survivors of intimate partner violence and CSA survivors.

Both groups underwent trials that split them either into groups following Pennebaker’s

expressive writing paradigm or control groups writing about their daily schedules or time

management. For survivors of partner violence, both the emotional content of the expressive

writing and the structure of the control writing seemed useful:

For the women who were most depressed, entering the change process through emotional aspects may have prompted reframing of their emotional memories to became more coherent, organized, and possibly safer thereby allowing the depression to lift (Smyth & Helm, 2003). The cognitive daily planning task had no impact on the memories, but the structure of the task may have facilitated a sense of control in the lives of these women that allowed them to experience less pain (Kerner, Fitzpatrick, 2007).

This finding brings up a good point I mention earlier, that in order for therapeutic writing to be

beneficial, the chance for emotional catharsis and expression of agency must go hand in hand

with some structure, even if the structure is provided in a simple prompt or in the

instructions­­otherwise it is harder to contain or make meaning of one’s emotional catharsis.

However, Kerner and Fitzpatrick raise a good point about structure when they discuss the similar

trial done with CSA survivors: though the control group’s physical and psychological symptoms

decreased, the expressive writing group had increases in physical symptoms and depressive

symptoms. Though their trial lasted for a mere two days, which undoubtedly contributed to this

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increase in symptoms (the survivors of partner abuse, by contrast, had four weeks to write), it

still led Kerner and Fitzpatrick to an important realization: “when the traumas are more severe,

more time may be necessary to process the emotional material.” There is, therefore, an important

relationship between trauma and writing structure, both time­wise and method­wise. Kerner and

Fitzpatrick also emphasize that while more abstract writing techniques like poetry therapy can be

helpful in finding alternate ways of understanding one’s struggles that may not appear otherwise

in conventional therapy, that more structured techniques like journaling or expressive writing are

helpful for giving survivors a way to organize, narrate and make sense of their very chaotic and

fragmented experiences (Kerner, Fitzpatrick, 2007).

Another article, which also examines many different writing therapies under the term of

“scriptotherapy” (an umbrella term for therapeutic writing techniques), also briefly mentions

writing therapy’s relationship with trauma and has its own review of empirical research of

scriptotherapy’s benefits. The empirical research section not only lists studies that show positive

psychological and physical benefits of different therapeutic writing techniques for a few different

populations, but also importantly counters these benefits in the last article, noting that positive

effects may not occur if the emotional expression achieved in the writing is not also integrated

and reviewed with a therapist or counselor afterwards. This article also says of journaling that it

“brings the conscious self more into flow with the unconscious self” as a grounding mechanism

for figuring out what one is feeling and thinking at the moment. Riordan also cites a study that

reported the benefits of journaling for CSA survivors, which was not only useful for the

recording of thoughts and feelings in between sessions, but, as other studies have mentioned,

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helpful for uncovering painful memories that might not necessarily be disclosed in talk therapy,

but could then be worked through (Riordan, 1996).

Though there seem to be more articles that aim to discuss journaling alongside other

writing therapies, there was one empirical study that tested Pennebaker’s expressive writing

paradigm on “clinically distressed” outpatient psychotherapy clients, rather than on neurotypical,

healthy clients, as so many other studies have done writing therapy research on. The research

found that those in the expressive therapy group­­who wrote about the most stressful experiences

of their lives for twenty minutes in two weekly sessions­­talked more about their writing with

therapists and gained greater insight into their issues than did the control group­­which wrote

about their plans for the rest of the day (Graf, Gaudiano, Geller, 2007). Given that both groups

were given the choice to either discuss their writing with their therapists or not and that there was

a 100% retention rate as well signals that many people seem attracted to the idea of being given

the chance to work what distresses and perhaps even traumatizes them out on paper: perhaps it is

the promise of privacy in doing so or the opportunity for a contained form of catharsis that made

this exercise so appealing to the 44 out of 71 clients who were approached about the study.

Overall, while there is a lack of research on journaling with the specific population of

sexual violence survivors, what we do know about journaling’s format can be very promising for

survivors: it is simpler than poetry therapy and a little more solitary than narrative therapy.

Survivors have the safe space to observe whatever growth, change, emotion or thought they see

within themselves so that they can stay present and grounded within themselves. Additionally,

journaling can have many different kinds of formats and structures that can guide the survivor to

any kind of specific exploration (for instance, Harrell lists a few techniques such as writing lists

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of what one might want to say to their abuser or reasons why one might avoid commitment in

relationships. More positive suggestions include “springboard writing” where one freewrites

from any sudden inspiration from a quote, sentence stem, song lyric, movie or book; and writing

about one positive thing that has happened to the writer in the last 24 hours, as a reminder that

positive moments do occur in life (Harrell, 2011)). More importantly, journaling can be an

excellent way to keep one’s personal growth and progress moving in between therapy

sessions­­some research even claims that journaling could shorten the amount of time it takes for

a client to make sudden gains in therapy (Graf, Gaudiano, Geller, 2007). In general, though the

potential of journaling is promising, more qualitative and quantitative research needs to catch up

with this potential.

Conclusion

Poetry therapy, narrative therapy and journaling all have potential to help sexual violence

survivors process their traumas in quite different ways. Poetry therapy holds numerous

possibilities for survivors to interact with their traumatic memories and the ways in which it

affects them through a safe distance of imagery and metaphor, and to say what seems

unspeakable in normal prose. Narrative therapy uses the benefits of structure and organization to

its full advantage, and helps survivors reauthor their own stories, so that they can find a new and

equally as valid narrative that gets them to think about themselves and what they’ve been

through in a newer, more empowering light. And journaling acts as a container and sanctuary for

any sort of internal self­evaluation and observation that needs to be processed, and can be

adapted to help a survivor focus on any topic of self­exploration. All of these therapies still have

untapped potential, and research has a ways to go to catch up with the writing therapists and

30

psychologists such as Pennebaker, Chavis, and Mazza who have made their life’s work in the

field of writing therapy. Though the research on all writing therapy seems to generally point in a

positive direction, certain kinds of research are lagging, as well as all research for sexual

violence survivors specifically. It is true that qualitative research has shone some light on how

helpful therapies like poetry and narrative therapy can be for survivors, though quantitative

research for survivors in any writing therapy area (save for studies on Pennebaker’s expressive

writing technique) has yet to back up the findings of qualitative research with hard evidence.

Using the common research format of comparing a main writing therapy group for journaling or

poetry therapy with a neutral writing control group that writes emotionlessly about their day

could be very easy to do if researchers could come up with writing therapy prompts that not only

focus on past trauma but take cohesive ordering or an element of organized self­reflection into

account, in order to avoid formless catharsis. Additionally, only one study took the differences of

survivors who had experienced childhood sexual abuse and those who did not into account, and

found that though “the child sexual abuse patients improved as much as the non­child sexual

abuse patients” because of the writing assignments, that the former group had a much more

complex array of symptoms to deal with. This is important to consider when thinking about how

much structure and what kind of writing therapy assignment to give to someone with more of a

severe traumatic history such as CSA (Resick, Nishith, Griffin, 2003). More research studies

taking the differences between these two populations into account and assessing which

population might find a certain type of writing therapy useful would be very important work to

undertake.

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Save for narrative therapy, which is a comprehensive enough of a therapy to stand alone,

poetry therapy and journaling would make for very good adjuncts to more mainstream therapies

like CBT. As some research has already shown (Graf, Gaudino, Geller, 2007; Riordan, 1996),

poetry therapy could unearth realizations survivors have about themselves or their pasts that

would have developed slower in therapy without poetry, as could journaling for the accessibility

it has in between sessions. These writing therapies would also work better with a therapist since

the therapist could help guide and contextualize the writings of the survivor in a more

comprehensive way than the survivor herself might be able to do alone.

What has made poetry therapy, narrative therapy and journaling so different from

therapies like CBT and PE therapy in general is that being able to write or tell one’s story gives

the survivor more agency over his healing process than therapies that impose a pre­formed

structure onto the individual survivor necessarily might. When a survivor gets a chance to write

or narrate her own experiences, she can go at her own pace, and only has to speak or write about

whatever she is ready for (Bolton, 1999). Narrative therapy also sets up a helpful dynamic here,

where the therapist is an “unknowing” guide for the survivor rather than someone who already

thinks they might know best for the client. PE therapy, in contrast, seems to have a rigorous

agenda in mind for a survivor when it comes to techniques like flooding or in vivo exposure,

which survivors must keep up for long periods of time with no real recourse from it or source of

containment for their interactions with their past trauma. It is also important to keep in mind that

there have been slightly higher dropout rates for participants in PE groups during trials (Nishith,

Resick, Griffin, 2002, 2003; Resick, Williams et al. 2012) than there necessarily has been for

participants of expressive writing trials (Graf, Gaudiano, Geller, 2007; Adler, Franklin, 2012).

32

This may be due to the idea that writing might give participants a sense of agency, choice and

privacy where PE therapy does not, so it therefore seems more appealing. In general, the freedom

that writing therapy gives should also encourage psychologists to think about the restrictions of

other types of therapies.

Structure matters as well as the type of writing therapy; writing cathartically with no

direction may give the writer some sense of release, but does not contribute to any growth or

change in one’s sense of self. Research like Kerner’s and Fitzpatrick’s has shown potential for

where future research could go (Kerner, Fitzpatrick, 2007), since the more we start mapping

where different writing therapies fit on the spectrum of structure (as well as on the

emotional/cognitive spectrum) the closer we will be at fitting different therapies with different

population’s specific needs. Though writing therapists like Mazza have a good idea of what

kinds of structures suit certain kinds of people (Mazza, 2003, p. 20­22, 25­26), information like

that could have important implications for treatment if it was more widely researched.

Though we cannot afford to make blanket assumptions about what kinds of interventions

survivors need depending on the severity of their trauma­­and though not everyone prefers to

write­­the fact that there are so many signs that point to writing therapy’s potential in the

quantitative and qualitative research we do have is so important. Our society is entering more of

an open climate where it is more and more acceptable for survivors to speak out about their

experiences and injustices (though we still have a long way to go as a society for male

survivors). However, this slowly shifting climate does not change the fact that social backlash

and the criminal justice response to people speaking out is still ugly, and speaking out still takes

monumental amounts of bravery. Survivors should know that they don’t have to speak out and be

33

at the mercy of others’ reactions if they have a safe space to process their traumas on paper, by

themselves. With writing and creating narratives, survivors can define their own healing process;

go at their own pace; and write what they need to write, unapologetically.

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