This document is a distillation of our thoughts and discussions over the past year. Here we aim to set out the conditions necessary for creative writing sessions to be delivered and received effectively in healthcare settings. We hope that this document will provoke discussion and further contributions from all interested parties to the evolution of this vital and exciting field of work.
The use of writing as a healing tool has long been recognised in the United States but in the UK the written word is the only major art form which does not have a specific therapeutic training. Yet all over Britain, creative writing tutors are engaging with the medical profession and social services to provide groups, courses and individual sessions within the healthcare remit. As things stand in 2004, the inclusion of writers in healthcare is unregulated and the requirements of the healthcare provider and the writer are not clearly defined. Both writers and healthcare providers need to establish mutual understanding by sharing more information about their work to the other, both need to understand their responsibility to the other, therefore enabling the full benefit of writing to be received by the clients involved. As more and more writing tutors find themselves in situations where the therapeutic value of the work is a clear component, some guidelines for both writers and healthcare providers are necessary.
With any art form used in healthcare, care must always be taken to ensure that the non-therapeutic practice of that creative activity - as a skill to be learned and enjoyed for its own sake - is continued. However, writing workshops intended for educational and recreational purposes in healthcare settings will still experience a therapeutic content, whether this aim is explicit or not. Many writers who choose to teach their craft are not well-equipped to deal with clients who may be experiencing, for instance, depression, mental or physical illness, bereavement or the after-shocks of trauma. Many writers will not have experienced these states themselves and therefore know little about them. For others, their own experiences may be recent or unhealed and the possible emotional content of the work they find themselves engaged with in a healthcare setting may prove to be deeply distressing. Writers are not trained to understand projection or transference, yet these will still arise, creating confusion and even illness in the writers if they do not understand these processes or have no access to appropriate supervision.
Creative writing has a powerful therapeutic value. The use of an emotional-responsive tool such as poetry requires responsibility; real harm can be done by its clumsy use. Encouraging a client to write from their experience or imagination can unleash very deeply held feeling. Whilst this is the therapeutic value of creative writing, the client may need to be skilfully supported to move forward from a position of pain and distress. A writer who has no knowledge of therapeutic interventions may be unable to assist a client either to face raw and difficult emotions or to integrate them into the whole self.
It is often difficult for the medical profession to integrate writers into the healthcare environment. They do not always have enough information about what the writer’s requirements are and how these should be met. The writer may be viewed as an extra visitor, an impediment to routine, or even someone who makes a client ‘worse’ by allowing them freedom of expression.
With the rise of interest in writing in healthcare and the recognition of its beneficial qualities, the time is ripe for guidelines which provide the best possible working practice in this field.
What is required of the Writer in Healthcare?
Respect and recognition within the healthcare organisation enables the creative-therapeutic work to flourish in a positive environment. The Writer-Facilitator needs to feel part of the unit and connected with staff. For this there needs to be
Both the Provider and the Writer-Facilitator must be committed to appropriate ongoing evaluation in order to contribute to the positive evolution of the work and assess how it is being received. The outline for how evaluation is to be carried out should be discussed at the outset of a project and reviewed periodically.
As a guideline in 2004, half day £100 minimum, whole day £200 minimum; to include contact time, preparation and travel time. Significant travel expenses paid in addition. Space for administrative work associated with the sessions should be provided.
It should be clear to participants what they are being offered in a creative writing session. Information about the session may be in written or spoken form, and will include details of matters such as confidentiality, number of sessions and how to contact the facilitator.
Record-keeping should be agreed in advance between the healthcare provider and the facilitator as necessary and appropriate records kept in a safe location. Participants should be made aware of how records are managed.
The Healthcare provider should:
The use of image and metaphor places ‘creative writing therapy’ close to art therapy, and many lessons may be learned from that discipline.
At the root of the training for art therapy lies the ‘therapeutic triangle’ between therapist, client and the art. This could also be the case in creative writing therapy, where the written word would take the place of the visual work.
To practise as an art therapist requires a degree in art. It would seem necessary for those who were engaging with therapeutic writing to also be proven writers. Writers who see themselves as professional, like artists, bring to the therapy session a very deep knowledge of their craft and a different world-view to those who chose non-artistic professions such as healthcare. Since childhood, the writer's life will have been informed by the world of imagination, by creative thought and deed and by observance of the world in which they live. They understand the working of the imagination and the uses of metaphor; they have a clear grasp of form and a broad knowledge of many different kinds of creative writing which they can draw upon very quickly. They are able to express themselves in the medium of words and assist others both emotionally and technically, to do the same. A capacity to empathically enter a shared imaginative space with a client may in itself have healing potential.
In art therapy, many different models are in use, ranging from Gestalt to Freudian. Some art therapists see themselves as closer to psychologist than artist; many practise analytically, some practise transpersonal therapy. An awareness of projection, transference and counter-transference, a knowledge of the effects of trauma in infancy, or later abuse, and a working knowledge of mental illness all form a practical basic training.
But therapeutic writing – or whatever it may be called – may not need such a psychologically oriented approach as Art Therapy. In the American Poetry/Biblio Therapy model, emphasis is placed on the selection of material, careful supervision and a structured approach, although at least basic counselling skills and some kind of qualification as a writer are required before training.
It would seem that the current situation, where unprepared writers go to work with unprepared providers is in need of some regulation, education and clarity. Whilst we do not suggest that all writing in healthcare must become writing therapy, we strongly recommend that all writers in healthcare must have attended at least a basic counselling course and are provided with adequate supervision. We would also suggest that a document outlining the required commitment of providers and writers should be in NHS and Social Services circulation. Alongside this, the future of writing in healthcare should hold the option of a recognised ‘therapy of literature’, validated by an academic body and accepted by the NHS and Social Services, the priority being that the healing potential of words can be safely accessed by those who need it, at whatever level.
Rose Flint, Fiona Hamilton, Claire Williamson 2004
COPYRIGHT OF THIS DOCUMENT RESIDES WITH THE AUTHORS. NO REPRODUCTION, COPY OR TRANSMISSION MAY BE MADE WITHOUT WRITTEN PERMISSION