Journaling Exercises to Enhance your Clinical Work

Use the Power of the Pen in Your Practice

Susan Borkin

Question: I keep hearing that journaling has many benefits for clients. I like the idea, but I’m not sure where to start. How can I integrate journaling into my practice?

Answer: Perhaps the most important rule about journaling with clients is that there are no rules. Therapeutic journaling is a fluid, free-form kind of writing, with no need to worry about grammar, spelling, or punctuation. In its broadest sense, it’s any type of writing or expressive process used for the purpose of healing or psychological growth. By taking time in your sessions to have clients record their free-flowing thoughts and concerns, even for just a minute, they can explore issues they may be dealing with but find hard to verbalize, clear their minds, and have a list of things they’d like to cover with you during therapy. Also, journaling is useful for clients to do between sessions, to keep them connected to their therapeutic work and aware of changing thoughts and feelings.

Below are some suggestions for best practice. Because every client is different, it’s important for you to tailor your approach to each individual’s personal issues and comfort level.

Keep it simple. You don’t have to start with complex journaling exercises. Instead, you can suggest to your clients that they notice and write down their feelings for four days out of the week. If you want to get a bit more specific, you can invite them to attend to what they experience during the week by using the mnemonic device ATTENDD to guide their journaling process.

  • Awareness. Be aware of what’s going on for you between sessions by jotting down anything that seems to have changed or seems different in your life.

  • Tension/physical sensations. Pay attention to your body and note when you experience any tension or tightness.

  • Thoughts. Take note of any unusual or upsetting thoughts that come up and write them down. Once you write these thoughts down, does your thinking change?

  • Emotions. Pay attention to your emotions. Do you feel joyous, depressed, elated, or fearful? Are these feelings different from what you experienced in your last session?

  • Intuition. Stay conscious of anything that comes to you intuitively during the week. Do you instinctively have a better understanding or greater sense of knowing something about your relationships, your therapy, anything that’s been on your mind?

  • Dreams. As soon as you wake up in the morning, write down everything you remember about your dreams, including partial images, people, objects, and feelings.

  • Distractions. Pay attention to what, if anything, is distracting you. Is there a pattern you can discern within the distractions?

By using the ATTENDD approach and bringing journaling notes to future sessions, clients have a specific way to notice subtle changes and keep track of their progress.

Free-form writing. Free-form writing (alternatively called stream-of-consciousness writing) is simple, but not necessarily easy. Here are some ways to begin free-form writing that you can teach right in your office. Ask your clients to close their eyes and pay attention to their breathing. Suggest that they notice any tension in their body and, if so, to let it go with the next exhale. Repeat this process for a few minutes, and then ask if they’re ready to begin. If so, set a timer for 10 minutes, or if that seems too long, try seven or even five minutes. Have them write about whatever they notice, whatever they’re feeling or thinking, even if they’re thinking about not knowing what to write. The only thing they need to do is to keep writing, to keep their hand moving across the page, even if they feel they have nothing to say and come up with something like “I don’t get what I’m supposed to be doing. What’s the point of this? What if I don’t know what to write? What am I feeling? I’m feeling tired, tired down to my bones, but it’s not just physically tired. It’s like my whole being is tired, like my soul is exhausted and achy.”

For the decades that I’ve used this exercise, both personally and with clients, it never ceases to surprise me how quickly it can shift consciousness in just a few sentences. If this seems unlikely to you, try it for yourself.

Quick lists. Much like the sentence-completion exercise, writing a list quickly can tap into important preconscious or unconscious material. When I suggested that my client Elaine write a quick list answering the question “What stresses you out at work?” she scribbled down that she felt constantly interrupted, that she was underpaid, that she thought her commute was too long, and that her boss gave her the creeps. While she’d been aware of the first three responses, her last response hadn’t been processed at all, and it led to deeper investigation of this feeling in our next sessions.

Another use of quick lists is to help a client focus on goals. Jon, a second-year law student, came to see me after finding that he wasn’t happy. He felt bad because his father’s dream had long been to make Jon a partner in the family law firm. But law wasn’t turning out to be Jon’s passion. I asked him, “If you could do anything you wanted to do in the world, what would it be? What are you happiest doing?” I suggested Jon write down the answers in a quick list, just jotting things down as quickly as he thought of them. At the end of this exercise, Jon put his pen down. He’d written three notes: compose music, practice music, and perform music. He was a brilliant musician, but had grown up hearing that music was fine as a hobby, but not as a profession. He’d always known what he wanted to do, but on seeing his short, unedited list in front of him, he was finally ready to make some changes.

Don't let the appearance of simplicity deter you from integrating therapeutic journaling into your treatment plans. It can have a surprisingly profound impact on your clients. But not only your clients may benefit: take some time for yourself, and use journaling to help solve your problems, clarify your thoughts, and connect to your feelings. Find a quiet spot, and pick up a pen!

SeptemberOctober 2014 Issue Available Now
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Topic: Professional Development

Tags: consciousness | emotion | HEAL | psychotherapy | psychotherapy networker magazine | TED

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Monday, December 29, 2014 7:22:44 PM | posted by Cheap ginger pills
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Wednesday, October 22, 2014 1:16:21 PM | posted by Susan Borkin
Thanks for your post. Glad to hear about ways you journal electronically. What's also good is not only do you capture entries in the moment, but by dictating, you have a written copy as well.
Susan Borkin

Wednesday, October 22, 2014 1:11:28 PM | posted by Susan Borkin
Hanna, thanks for your comment. It's great to hear how well these journaling rituals work for you. Acknowledging gratitude begets more to be grateful for.
Susan Borkin

Sunday, October 19, 2014 6:54:20 PM | posted by Tom Blume
I miss the feel of pen on paper, but I have found for me and my clients the convenience of smart phones -- direct entry and dictation of text, recording voice, sending entries to my email -- has made it more likely that we will "write" something while the thoughts and feelings are fresh.

Friday, October 17, 2014 6:38:30 PM | posted by Hanna McDonough
I write my gratitudes every night no matter how tired I may feel.
Every morning before I get out of bed, I journal.
This way because as of these AM and PM rituals I am powered form with in all day long.
Thank you for this constant stream of wisdom.
Hanna McDonough, Psychotherapist