Occupational therapy student Christine Balaba explores writing as tool to be used within occupation therapy, based on her work within acute adult mental health setting. COT Annual Conference 2010 (22-25 June 2010)

1. Writing A Powerful Tool Enabling Occupational Participation CHRISTINE BALABA

2. Writing group Theory behind therapeutic writing Therapeutic writing and OT Model of human occupation (MOHO) as tool for a writing group Challenges Plan

3. Open group available to clients across two adult acute mental health wards Two co-facilitators (OT and activity co-ordinator) Average: 3-6 participants Weekly: 1 hour Started: May 2005 Writing Group

4. Writing Group Main Inclusion Criteria: Clients at competence stage of the levels of occupational functioning ACHIEVEMENT COMPETENCE EXPLORATION (De Las Heras 2003)

5. Writing Group Structure

6. Process of personal, explorative and expressive writing Creative, literary, or autobiographical Client is offered guidance and inspiration and help in choosing a topic for their writing Authority and control of each piece of writing always resides with the writer. Focus is upon the process of writing rather than the product (Bolton and Wright 2004) Therapeutic Writing

8. Clarify and organise thoughts (Moskowitz (2005) Allows participants to excel Writing as a means of personal development (Hunt and Sampson 2005) Therapeutic Writing

9. Lack of research apparent (Bolton and Wright 2004) Psychologist Pennebaker(1993, 1997, 1999): demonstrates the benefits of writing therapy in reducing inhibition and improving both physical and mental health Therapeutic Writing

10. Internal connection (with self) and external connection (with others) facilitated through the use of poetry (Hilse et al 2007) Writing and Mental Health

11. Communication skills and experiencing writing as a tool for self expression can be utilised outside of a writing group (Williamson 2004) “The very act of writing tends to increase self-confidence, feelings of self worth and motivation for life“ (Bolton 2004) A place for ward-based writing groups within recovery? (Sampson & Hart 2005) Writing and Recovery

12. There is not one neat theoretical model to guide the use of therapeutic writing (Hunt and Sampson 2005) Words are packets of communications, meanings, ambiguities and implications (Steinberg 2004) Therapeutic Writing

13. Occupation focused! Writing - opportunity for re-evaluating and planning aspects of life in an occupational dimension (Pollard 2004). Writing and Occupational Therapy

14. Writing as occupation Writing to reflect Writing as means to plan occupational life Writing to produce a piece of art Writing and Occupational Therapy

15. Experiences and perceptions of events in order to understand how change in occupational roles takes place (Goldstein et al 2005). Occupation focused narrative, the client’s story should be viewed in terms of what needs to be done next (Hagedorn 2000). Narrator and listener could co-create the narrative and move it forward (Pierce 2003). Writing and Narratives

16. Competency Phase: Clients will become aware of their abilities and limitations Clients will feel they have control over unfamiliar occupational outcomes Clients will feel positive about succeeding in unfamiliar activities Clients will be able to meet their role responsibilities Clients will be able to structure their daily routine Clients will have skills to meet their goals Clients will be able to pursue activities within different environments Potential Goals of Clients

17. Model of Human Occupation (Kielhofner 2008)

18. OPHI-II OCAIRS OSA Role checklist WRI Guided fantasy Story starters Topics and tasks suggested by clients Materials

19. Personal sense of effectiveness Sense of achievement Examples of topics: “Things I am good at?” “Helping others” Personal Causation

20. What is meaningful to the person Writing as a way of communicating to the therapist and reflecting on their own experience Examples of topics: “A person meaningful in your life” “My perfect day” Values

21. Person’s interest to write Writing about interests Interest

22. Example’s of topics: “Roles in my life” “Jobs” “Being a friend” “At the dinner table” Roles

23. Organise thoughts through writing Planning on paper Example of topics: “A day in the life of me” Routines

24. Writing Creativity / Imagination Reflection Processing Examples of topics: “Favourite things” “Cast away on an island” Practicing and Recognising Skills

25. Communicating to oneself and to others Sharing the work with others Examples of topics: “Unsent letters” “Written dialogues” Communication and Social Interaction Skills

26. Tolerating Acceptance Writing in a group setting can support the writers in their personal explorations and expressions and it can help to promote trust and a sense of community (Bolton 1999). Social Environment

27. Collaborating Advocating Empathizing Encouraging Instructing Problem-solving Intentional Relationship Model (Taylor 2007) Role of Therapist

28. Volition Literacy skills Negative association with writing English language barrier Varied stay on acute ward Strong emotions Challenges

29. Model of Human Occupation Screening Tool (MOHOST) MOHOST single observation as outcome measure after each session (Parkinson et al 2006) Evaluation

30. More recent research is needed into the therapeutic effectiveness of writing More research in particular for the use of writing groups and writing in general within occupational therapy Future implications

31. Clients as facilitators Journal writing Establish more links with the community New group on the female intensive care Plans for the group

32. “I must write it all out, at any cost. Writing is thinking. It is more than living, for it is being conscious of living.” (Anne Lindbergh, Writer and aviation pioneer, 1906-2001).

33. Bolton, G & Wright, J (2004) Conclusions and looking forward. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 228-231. Bolton, G (1999) The Therapeutic Potential of Creative Writing. Writing Myself. London & Philadelphia: Jessica Kingsley Publishers. Bolton, G (2004) Introduction: writing cures. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 1-5. De lasHeras, C, Llerena, V, Kielhofner, G (2003) Remotivation process: Progressive intervention for individuals with severe volitional challenges (Version 1.0). Chicago: MOHO Clearinghouse. References

34. Goldstein, K. (2004) Occupational narratives and the therapeutic process. Australian Occupational Therapy Journal, 51, 119-124. Hagedorn, R (2000) Tools for practice in occupational therapy. A structured approach to core skills and processes. Edinburgh: Churchill Livingstone. Hilse, C, Griffiths, S, Corr, S (2007) The impact of participating in a poetry workshop. British Journal of Occupational Therapy. 70,10, 431-438. Hunt, C & Sampson, F (2005) Introduction. IN Hunt, C & Sampson, F (ed.) The self on the page. Theory and practice of creative writing in personal development. London: Jessica Kingsley Publishers, 9-18. Kielhofner, G (2008) Model of Human Occupation. Theory and Application. Baltimore: Lippincott Williams & Wilkins. References

35. Lindbergh, A (1974) Locked Rooms and Open Doors. Diaries and Letters of Anne Morrow Lindbergh, 1933-1935. Washington: Harvest Books. Parkinson, S, Forsyth, K, Kielhofner, G (2006) A User’s Manual for the Model of Human Occupation Screening Tool (MOHOST). London: UK Centre for outcomes, research and education. Pennebaker, J & Seagal, J (1999) Forming a story: the health benefits of narrative. Journal of Clinical Psychology, 55,10, 239-245. Pennebaker, J (1993) Putting stress into words: health, linguistic, and therapeutic implications. Behavioral Research Therapy, 31, 539-548. Pennebaker, J (1997) Writing about emotional experiences as a therapeutic process, Psychological Science, 8,3, 162-166. Pierce, D (2003) Occupation by design. Building therapeutic power. Philadelphia: F.A. Davis Company. Pollard, N (2004) Notes Towards a Therapeutic Use for Creative Writing in Occupational Therapy. Chapter 10. In Sampson, F (ed.) Creative Writing in Health and Social Care. London & New York: Jessica Kingsley Publishers, 189-206. References

36. Tailor, R (2007) The intentional relationship model: occupational therapy and the therapeutic use of self. Chicago: F.A. Davies. Steinberg, D (2004) From archetype to impressions; the magic of words. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 44-55. Williamson, C (2004) On the road to recovery: writing as a therapy for people in recovery from addiction. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 123-129. Wright, J (2004) The passion of science, the precision of poetry: therapeutic writing – a review of the literature. IN Bolton, G, Howlett, S, Lago, C, Wright, J (ed.) Writing cures. An introductory handbook of writing in counselling and therapy. London/New York: Routledge Taylor & Francis Group, 7-17. References