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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

2.
Recommended to the Faculty of Bennington College for Acceptance by:
Michael Dumanis
David Anderegg
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3. 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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4. 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
3

5. 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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6. 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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7. 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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8. 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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9. 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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10. 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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11. 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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12. 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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13. 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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14. 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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15. 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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16. 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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17. 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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18. 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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19. 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
18

20. 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
19

21. 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.
20

22. 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 self­​as​­construction, 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.
21

23. 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).
22

24. 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
23

25. 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:
24

26. 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

27. 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,
26

28. 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
27

29. 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,
28

30. 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
29

31. 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

32. 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.
31

33. 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

34. 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

35. 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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