Writing for Wellbeing

1. Introduction

Version followed: Lapidus International's published practice guidance (its "Writing for wellbeing" page, the resource "Creating a Safe Setting for Writing for Wellbeing" and its Ethical Code, which was a draft under review in 2023), together with Gillie Bolton's therapeutic creative writing method, which Lapidus cites in its safe-setting guidance. Pennebaker's expressive writing paradigm, which appears on Lapidus's recommended reading list, is included as the structured variant for writing about trauma. Where these differ, the difference is named.

What it is. Writing for wellbeing is a field of practice, not one manualised therapy. Lapidus International is a membership organisation that brings together practitioners who use the literary arts for personal development. They come from health, education, counselling, coaching, the arts, universities and charities [source: Lapidus, Writing for wellbeing; About Lapidus]. Lapidus describes the work as using language to support self-understanding, personal growth and recovery, starting from a simple prompt that opens space to write and helps people find what matters to them. It runs as workshops or groups in hospitals, cancer centres, schools, libraries, GP surgeries, care homes, community centres and outdoors. It is also combined with poetry, narrative, music, yoga, meditation, walking, counselling, nature and storytelling [source: Lapidus, Writing for wellbeing]. Bolton presents therapeutic writing as a complement to talking therapies, used either by individuals for self-help or by health professionals with patients. Her forms include journals, poetry, fiction, autobiography and writing about trauma [source: JKP page, Bolton, The Therapeutic Potential of Creative Writing].

How change is thought to happen. In this tradition, writing slows thought to the pace of the hand. That lets ideas be ordered while material that was not yet conscious surfaces [source: JKP page, reviewer summary of Bolton 1999]. Externalising experience onto the page gives the writer a new view of it [source: Lapidus, Writing for wellbeing]. Rereading and reflection then help shape memories into meaning [source: Lapidus, Creating a Safe Setting]. In a qualitative study with cancer and palliative-care patients, Bolton reported that writing helped them discover what they thought, felt and remembered, and made them more aware of issues needing attention [source: Bolton, Medical Humanities abstract]. Pennebaker's account adds that putting an emotionally important experience into words over several sessions lets the writer externalise and organise it [source: Wikipedia, Writing therapy, citing Pennebaker].

Professional frame. No regulated profession exists for writing for wellbeing. Lapidus does not state any accreditation, register or required qualification. Its directory of members who work as wellbeing practitioners says listed members "may have" a relevant qualification, and that Lapidus does not endorse or recommend them [source: Lapidus, Wellbeing Practitioners]. Members agree to an Ethical Code, can join a members' insurance scheme and can attend regional groups and training events [source: Lapidus, Ethical Code; Policies & Projects; About Lapidus]. In 2019 Lapidus produced a Practice Guidance Report, Creative Practices for Wellbeing, with the TS Eliot Foundation and the University of Chester, to support effective and safe practice [source: Lapidus, Policies & Projects; the report itself is not drawn on here, so its content is [uncertain]]. A psychotherapist who uses these methods does so within their own registration, ethics and supervision, such as BACP, UKCP or a national licence. Writing exercises become part of therapy and are covered by your therapy contract, record-keeping duties and safeguarding duties [synthesis]. Non-clinician facilitators who run Lapidus-style groups should state plainly that the group is not therapy [source: Lapidus, Writing for wellbeing]. Other countries have their own credentials, for example in poetry therapy, but they were not checked here [uncertain]. Structured trauma writing with people who have PTSD, active suicidality, psychosis or severe dissociation should be done only by a clinician trained in trauma treatment and working inside a treatment plan. Community facilitators should not do it [synthesis].

Materials and physical safety. Provide good lighting, clear directions to the venue, room to move, a stable writing surface (a table or clipboards) and seating that allows eye contact [source: Lapidus, Creating a Safe Setting]. Writing materials matter to the writer [source: Bolton 2014, p. 41, as cited in Van Goidsenhoven & Masschelein 2021]. Outdoor and walking sessions need accessibility, weather, terrain and lone-working checks [source: Lapidus, Writing for wellbeing (accessibility); remaining points synthesis]. If collage or cutting is added, remove sharp tools or supervise them in settings with self-harm risk, such as prisons, inpatient wards and some youth work [synthesis].

2. Framework

Lapidus publishes no phase model, session count or criteria for moving on [source: Lapidus pages]. What follows combines the session elements Lapidus and Bolton describe with the Pennebaker schedule. The sequence, the movement criteria and the course shapes are [synthesis] unless a source is tagged.

Phase A: Preparation and contracting (before session 1).

• Goals: clarify what kind of work this is and what each party is responsible for. Lapidus's code asks that agreements state whether the work is therapeutic, training, supervisory or personal growth, along with the costs and the practitioner's qualifications and experience [source: Lapidus, Ethical Code]. Give people advance information about the venue, what to expect and the participation guidelines. Plan, but stay flexible. Know the local support services you can signpost to [source: Lapidus, Writing for wellbeing].
• Facilitator task: try every exercise yourself before you set it, so you know its difficulties and rewards [source: Lapidus, Creating a Safe Setting].
• Clinician additions [synthesis]: screen for current crisis, suicidality, dissociation, active substance misuse, literacy or physical barriers, and whether the client lives where their writing could be found and used against them. Agree in advance where the writing will be kept and who may read it (see 4.18).

Phase B: Settling and resourcing (sessions 1–2, or the opening of each group session).

• Goals: build a protected space that feels safe enough to trust the process [source: Lapidus, Writing for wellbeing]. Agree ground rules: respect and listening; no attention to spelling, punctuation, technique or craft; boundaries; the right to say "PASS" [source: Lapidus, Creating a Safe Setting]. Use free writing to get past blocks [source: Bolton 2011, p. 33, as cited in Van Goidsenhoven & Masschelein 2021].
• Content: present-day, sensory and neutral or positive prompts.
• Move on when [synthesis]: the client writes without freezing; can stop on cue and come back to the room; can read their writing back without being flooded; and can say what they will do with the page afterwards.

Phase C: Exploratory writing (the middle of the course; most group work stays here).

• Goals: externalise, find perspective and make meaning through prompts, image and metaphor, journals, letters, dialogues, poetry and fiction [source: Lapidus; Bolton, chapters 3, 6 and 7 as described on the NYU Medical Humanities page].
• Disclosure level: in groups, encourage people not to over-disclose and to keep stories at a mild or moderate level [source: Lapidus, Writing for wellbeing].
• Move on to Phase D only in individual therapy, and only when [synthesis]: Phase B criteria hold under emotionally charged prompts; distress comes down within the session; the client chooses the trauma topic; and a treatment plan includes trauma work.

Phase D: Focused emotional or trauma writing (optional; individual or clinician-led).

• Pennebaker's paradigm: in the original study, people wrote about a past trauma for 15 minutes a day over four days [source: Wikipedia, Writing therapy]. A later practitioner version uses at least 20 minutes on four consecutive days, writing continuously, privately and for oneself [source: Evans 2012, describing Pennebaker]. Name the version you use: 15 minutes is the original study, 20 minutes is Evans's description.
• Bolton's books also cover writing out trauma [source: JKP page], but the procedure is not drawn on here [uncertain].
• Move back to Phase B or C if [synthesis]: distress has not settled by the end of the session; there is dissociation, nightmares or self-harm urges between sessions; or the client cannot use the stop rule.

Phase E: Reflection, redrafting and ending.

• Goals: reread, reflect and decide what to do with the writing. Bolton treats a text as something "that must be worked upon" if it is to speak to a reader [source: Bolton 2011, p. 48, as cited in Van Goidsenhoven & Masschelein 2021]. Evans suggests a reflection a week or two after the four-day paradigm [source: Evans 2012].
• End by reviewing the body of work, agreeing what will happen to the writing, and making a plan to keep writing alone if wanted [synthesis].

Typical formats.

• One-to-one within therapy: 5–20-minute writing segments inside a 50-minute session, plus optional homework [synthesis].
• Closed groups: usually 6–12 people, 90–120 minutes, over 6–10 weeks [synthesis; Lapidus gives no figures].
• Single workshops and open drop-in groups [source: Lapidus, settings and calendar].
• Remote work by email, chat or video [source: Wikipedia, Writing therapy].

A typical session [synthesis, built from Lapidus elements]:

1. Arrival, and recap of ground rules and "PASS".
2. A warm-up free write of about six minutes.
3. One or two main prompts.
4. Each person rereads their own writing silently.
5. Optional sharing, with listening rather than critique.
6. A short reflection write.
7. A closing write and practical close (see 4.17).

3. Guiding principles

• Client-centred awareness [source: Lapidus, Writing for wellbeing]. Tell people in advance what will happen and that the group is not therapy. Plan, but follow the group. Have your signposting list ready.
• A defined, protected space [source: Lapidus]. Choose the room, its privacy, seating and timing deliberately. Bolton's image for the group is a "warm island in stormy seas" [source: Bolton 1999, as cited in Lapidus, Creating a Safe Setting].
• Confidentiality, stressed on its own [source: Lapidus, Creating a Safe Setting]. State aloud what stays in the room and what its limits are (see section 5).
• Each person is responsible for their own safety [source: Lapidus, Writing for wellbeing]. Teach the stop rule and "PASS" before the first prompt. This does not reduce your duty of care [synthesis].
• Do not over-disclose; keep stories mild to moderate in groups [source: Lapidus]. Choose prompts that invite depth through image and specific detail, not a full trauma narrative.
• Respond carefully and supportively when difficult material arises [source: Lapidus]. Slow down, acknowledge it and attend to the person before going back to the exercise.
• Process, not craft [source: Lapidus; Creating a Safe Setting]. Never correct spelling or grammar, and never comment on literary quality unless the writer asks.
• No judgement of shared writing [source: Lapidus]. Respond to what was meaningful, not whether it was good.
• Externalise to gain perspective [source: Lapidus]. Prefer techniques such as third person, letters, dialogues and metaphor that put some distance between the writer and the experience.
• Own pace [source: Lapidus; Creating a Safe Setting]. Make time limits soft, give everyone the right to stop, and keep no prompt compulsory.
• Attunement to group energy [source: Lapidus, Creating a Safe Setting]. Read the room and change prompts or timings when energy shifts.
• Space for spontaneity and reflection [source: Lapidus]. Build reflection time into every session.
• Trust and acceptance: everyone matters and will be heard [source: Lapidus]. Give each person an equal chance to share, or to pass, without being chased.
• Open to all [source: Lapidus]. Adapt for literacy, language, disability and setting (see section 5).
• The facilitator as "midwife" or helper on the way [source: Bolton et al. 2006, p. 14, as cited in Van Goidsenhoven & Masschelein 2021]. The writer owns the meaning, so ask rather than interpret.
• A relationship of trust and empathy [source: Bolton, as quoted on the NYU Medical Humanities page]. The writing rests on the therapeutic alliance.
• Self-trust: "If you trust yourself you cannot write the wrong thing" [source: Bolton 1999, p. 11, as cited in Van Goidsenhoven & Masschelein 2021]. Say early and often that there is no wrong answer.
• Writing is primarily private [source: Bolton 1999, p. 225, as cited in Van Goidsenhoven & Masschelein 2021]. Bolton held that a wider public audience is not useful for this kind of writing (p. 136, same source). Default to privacy. Treat sharing in a trusted circle as optional, and treat publication as a separate decision that needs consent.
• Try it yourself first [source: Lapidus, Creating a Safe Setting]. Do every exercise before you set it.
• Ethical practice [source: Lapidus, Ethical Code]:
  • Work with competence, support and accountability.
  • Respect human rights, dignity and diversity, and promote equal opportunity.
  • Aim to "cause no harm to any clients".
  • Make clear contracts.
  • Follow the ethical guidelines of the setting you work in, and the law where you work.
  • Look after yourself and keep up professional development so that you can "practise safely".
  • Never exploit a client financially, sexually or in any other way.
• Know what to do when someone discloses risk [source: Lapidus, Creating a Safe Setting]. Facilitators must know what to do if someone discloses information that "puts themselves or others at risk". Have a written risk and safeguarding procedure before the first session.

4. Intervention inventory

Lapidus publishes principles rather than a fixed set of exercises. Bolton's books contain many prompts that are not drawn on here. The items below are the techniques named in the sources. Their step-by-step procedures are [synthesis] unless tagged, and all example language is illustrative.

4.1 Safety frame and ground-rule induction

• Purpose: set up the protected space before anyone writes. Use it in the first session, and briefly at the start of every session.
• Steps:
  1. Say what the session is, and is not. A group is not therapy [source: Lapidus].
  2. Agree the ground rules: respect and listening; no attention to spelling or craft; the right to say "PASS" to sharing or questions [source: Lapidus, Creating a Safe Setting].
  3. State confidentiality and its limits [source: Lapidus; limits are synthesis].
  4. Teach the stop rule [synthesis, adapted from Pennebaker's flip-out rule, 4.14]: if writing starts to feel like too much, stop, put the pen down, look around the room, and either write about something else or simply listen.
  5. Tell people where support is available after the session [source: Lapidus, signposting].
  6. Agree what will happen to the pages (4.18).
• Example language (illustrative): "You never have to read anything out. 'Pass' is always a full answer. If a piece starts to feel too big, stop, look around, and write about what you can see from your chair instead. That's good practice, not failure."
• Watch for: people who look as if they cannot say no, or who apologise for passing. Tell them again that passing is valued. If the frame is working, people pass without explaining themselves, and nobody is pressed for more.

4.2 Six-minute free write

• Purpose: get past blocks and the inner critic, and let unplanned material surface. Use it as a warm-up, or on its own as a daily discipline [source: Bolton 2011, p. 33, as cited in Van Goidsenhoven & Masschelein 2021; Wilson-Howarth 2016, reporting Bolton's six-minute discipline].
• Steps:
  1. Paper and a pen the writer likes [source: JKP page, reviewer summary].
  2. Write whatever comes for six minutes without stopping, editing or rereading. Spelling and grammar do not matter [source: JKP page; Lapidus].
  3. If stuck, write "I don't know what to write" until something else comes [synthesis].
  4. Stop at six minutes. The writer may read it back silently or not at all, and it does not have to be shared [synthesis].
• Example language (illustrative): "Six minutes. Keep the pen moving. Nobody else will read this unless you choose to show it. If your mind goes blank, write that it's blank."
• Watch for: a free write that slides into intense material in the first sessions. Teach the writer to redirect to sensory description of the present. It is working when writing starts quickly and the writer is surprised by what came. Do not set it straight after trauma disclosure in a session; ground first [synthesis].

4.3 Prompt-based writing (the simple prompt)

• Purpose: focus attention and open a theme gently. Lapidus describes a simple prompt as creating space to write and helping people find what matters to them [source: Lapidus]. Stimulus poems have been used as prompts in Lapidus school work [source: Lapidus, Policies & Projects, Poetry & Mental Health project]. Use this as the main exercise in most sessions.
• Steps [synthesis]:
  1. Choose a prompt for the phase. Early on, use present-tense, sensory or resource prompts (an object in the room, a place where you felt at ease, a list of small pleasures). Later, use relational or memory prompts at the edge of what the person can manage.
  2. Give it in one or two sentences, or read a short published poem aloud as the stimulus. If you hand copies out, respect copyright.
  3. Set a time of 8–15 minutes and give a two-minute warning.
  4. Offer an easier alternative alongside every charged prompt.
• Example language (illustrative): "Write about a door you remember: what it looked like, what was behind it. If that doesn't take you anywhere, write about the door of this room."
• Watch for: in groups, prompts that pull straight to the worst experience, such as "your worst memory" or "the abuse". Avoid these, in line with Lapidus's mild-to-moderate guidance. It is working when writers take the prompt in their own direction.

4.4 Rereading to oneself

• Purpose: turn raw writing into reflection. This is where perspective and meaning-making happen [source: Lapidus, time for reflection; Bolton, writing helps people discover what they think and feel]. Use it after every substantial write.
• Steps [synthesis]:
  1. Read your own piece silently, at your own pace.
  2. Underline one phrase that matters, surprises you or carries energy.
  3. Optionally, write two or three lines starting from that phrase.
• Example language (illustrative): "Read it back to yourself, quietly. Mark one line that stands out. You don't need to know why."
• Watch for: the writer flinching or going blank while rereading. They may stop rereading; reading is optional. It is working when the writer notices something new in their own words.

4.5 Optional sharing and listening responses

• Purpose: be witnessed, be heard and build connection. Sharing within a trusted circle, such as family or a hospice group, can help [source: Van Goidsenhoven & Masschelein 2021, describing Bolton].
• Steps:
  1. Invite, never require, sharing [source: Lapidus, PASS].
  2. Choose the form: reading the whole piece, one line, or describing it without reading it [synthesis].
  3. Listeners respond only with what struck them or what they felt. No critique, advice, interpretation or questions about the facts of the story [source: Lapidus, no judgement; the form of response is synthesis].
  4. The facilitator thanks the reader and protects their time. Move on if the reader is becoming distressed [synthesis].
• Example language (illustrative): "Would anyone like to read, or read just a line? ... Thank you. What stayed with you from that, as a listener? Just the words or images, not advice."
• Watch for:
  • Over-disclosure in the moment.
  • Listeners rescuing or interpreting.
  • Comparing, or competing over who suffered more.
  • Anyone who has not shared feeling left out.
  Interrupt gently when a reading moves beyond the level agreed for the group, and offer one-to-one time afterwards [synthesis].

4.6 Journal writing

• Purpose: ongoing self-observation between sessions. Bolton gives practical guidelines for starting a journal [source: NYU Medical Humanities page, Bolton chapter 3]. Bolton also gives a directive example: choose a peaceful time, uninterrupted and alone, of at least 20 minutes [source: Bolton 2014, p. 33, as cited in Van Goidsenhoven & Masschelein 2021].
• Steps [synthesis beyond the above]:
  1. Agree the frequency (for example 3–5 times a week), the length (6–20 minutes), and a time and place where the writer will not be interrupted or overlooked.
  2. Give one focus per week, for example what went well, a feeling and where it sits in the body, or a conversation I wish had gone differently.
  3. Agree that the journal is private. The client decides what, if anything, to bring to session.
  4. Agree where the journal is kept (4.18).
• Example language (illustrative): "This notebook is yours. You don't have to show me any of it. If something in it feels important, you can bring a line or tell me about it."
• Watch for: a journal becoming a place for rumination (the same complaint repeated with no movement). Add a closing line such as "one thing I could do" or "what I'd say to a friend" [synthesis]. It is working when entries show some variety and reflection, and the client uses them in session.

4.7 Image and metaphor writing

• Purpose: approach feelings indirectly through image. This gives distance and new perspective, and is one of the externalising techniques [source: NYU Medical Humanities page, Bolton chapter 6; Lapidus, externalising techniques].
• Steps [synthesis]:
  1. Ask the client to describe a feeling or situation as if it were weather, an animal, a landscape, an object or a colour.
  2. Ask for sensory detail: size, texture, sound, movement.
  3. Ask: what does it need, and what happens next in the picture?
  4. Reread, and notice any shift.
• Example language (illustrative): "If this worry were a kind of weather, what would it be? Describe it as if you're standing outside in it."
• Watch for: metaphors that become literal and frightening ("it's a monster in my room"). Bring the client back to the room and shrink or contain the image, for example by putting the weather behind glass. It is working when the image changes, softens or gains a helper.

4.8 Writing dream material

• Purpose: record and explore dream images for creative writing [source: NYU Medical Humanities page, Bolton chapter 6].
• Steps [synthesis]:
  1. Keep a notebook by the bed and note fragments on waking, in the present tense.
  2. In session, choose one image and write from it, or continue the dream.
  3. The meaning belongs to the writer; do not interpret it for them.
• Example language (illustrative): "Write the dream as if it's happening now. Then, if you like, write what you'd want to happen next."
• Watch for: trauma nightmares. Do not ask the client to rewrite or continue them outside a trauma-treatment protocol you are trained in. Remember that writing them down at night can disturb sleep. It is working when dream images give the client new language for waking concerns.

4.9 Unsent letter and imagined reply

• Purpose: say what could not be said to a living or dead person, then imagine the other's reply to gain perspective [source: Wikipedia, Writing therapy]. Use it for bereavement, unfinished business and relationship conflict.
• Steps [synthesis beyond source]:
  1. Agree from the start that the letter will not be sent.
  2. Write to the person, beginning "Dear ...". Say what you want to say, what you are grateful for and what you resent.
  3. Optionally, in the same or a later session, write the reply you imagine, or the reply you wish you could receive.
  4. Reread both. Decide what to do with the letter: keep, burn, bury or file it (4.18).
• Example language (illustrative): "This letter won't be sent. You can say anything in it. Start with their name, and see what comes."
• Watch for:
  • With a perpetrator of abuse, the imagined reply can retraumatise. Offer instead a reply from a protective figure or from the writer's future self.
  • A client who wants to actually send the letter. Take that decision separately, after reflection, and consider safety and consequences.
  It is working when the writer feels some completion or relief, or is clearer about what they want.

4.10 Dialogue with an object, part or symptom

• Purpose: externalise a relationship with a substance, symptom or object. The source example is a recovering alcoholic in dialogue with a bottle [source: Wikipedia, Writing therapy]. Lapidus has run writing groups with people with drug or alcohol problems [source: Lapidus, Policies & Projects, Hooked on Words].
• Steps [synthesis]:
  1. Name the other voice, for example the bottle, the pain or the anxiety.
  2. Write a script with alternating lines, each beginning with the speaker's name.
  3. Let the other voice answer freely, including what it offers and what it costs.
  4. End with a line from the writer to the other voice that states a boundary or a wish.
• Example language (illustrative): "Write a conversation between you and the bottle. Let it speak too: what does it promise you? Finish with what you'd like to say back."
• Watch for: the object's voice becoming persuasive, for example arguing for relapse or self-harm. Cut it short, and end with the writer's own voice and a coping plan. It is working when the writer shows ambivalence more clearly and gains some distance from the urge.

4.11 Poetry writing

• Purpose: compress feeling into image and form. The line breaks and short length help contain intense material. Bolton gives guidance on beginning poetry, and poetry runs through her examples [source: NYU Medical Humanities page; JKP page].
• Steps [synthesis]:
  1. Start from a list: words from a free write, or five things seen, heard and touched.
  2. Arrange them into short lines, without worrying about rhyme or rules.
  3. Optionally, use a simple frame, for example each line beginning "I remember" or "I am from", or a short list poem.
  4. Reread the poem aloud to yourself; sharing is optional.
• Example language (illustrative): "Take three words you underlined earlier. Give each its own line, then add whatever comes next. It doesn't need to rhyme or be good."
• Watch for: perfectionism, or shame about "not being a poet". Remind the writer that craft is not the focus [source: Lapidus]. It is working when the writer feels a piece holds something they could not say in prose.

4.12 Fiction and third-person writing (externalising)

• Purpose: make distance by turning "I" into a character. Lapidus names externalising techniques that give a new perspective [source: Lapidus]. Bolton covers fiction [source: NYU Medical Humanities page; JKP page]. Use it when first-person writing floods the writer, or when they need perspective.
• Steps [synthesis]:
  1. Write the scene about "she", "he" or "they", or about a character with another name, age or setting.
  2. Optionally, write it from the point of view of a witness, such as a kind neighbour, an animal or the room itself.
  3. Optionally, give the story an ending the writer chooses.
  4. Afterwards, reflect: what did the character need, and who could have given it?
• Example language (illustrative): "Tell it as a story about someone else, a person in a book. Give them a different name. You decide how much of it is true."
• Watch for: fiction used to avoid feeling indefinitely, or a story that drifts into a detailed trauma reconstruction. Slow it down and come back to the present. It is working when the client can show compassion to the character and then to themselves.

4.13 Autobiographical and life writing

• Purpose: construct a coherent life story, and record life history in illness, ageing and bereavement. Bolton covers autobiography [source: JKP page]. Lapidus names people drawn to autobiography or biography, and people going through crises such as bereavement, serious illness or divorce [source: Lapidus].
• Steps [synthesis]:
  1. Make a timeline or chapter list of the life, with a title for each chapter.
  2. Choose one chapter at a time, starting with safe or resourced periods.
  3. Write specific scenes (one place, one day) rather than summaries.
  4. Include "what I learned" or "what I'd tell my younger self" pieces.
  5. Decide who, if anyone, will read the life story; for family legacy projects in palliative care, see 4.18.
• Example language (illustrative): "Let's map the chapters of your life on one page. Which one would you like to start with? It doesn't have to be the earliest, or the hardest."
• Watch for: a chronological approach that drags the writer into a traumatic period too early. Let them skip chapters and come back later. It is working when the client gains a sense of continuity and authorship.

4.14 Expressive writing (Pennebaker paradigm)

• Purpose: structured, private writing about the writer's deepest thoughts and feelings on an emotionally important or traumatic experience. Use it in individual work, with clients who are stable and who choose to do it.
• Versions:
  • Original study: 15 minutes a day on four days, about a past trauma [source: Wikipedia, Writing therapy].
  • Evans's practitioner description: at least 20 minutes a day on four consecutive days [source: Evans 2012].
• Steps [source: Evans 2012, describing Pennebaker; wording here is paraphrased]:
  1. Choose a topic that is extremely personal and important to you. It need not be the worst trauma; smaller conflicts and stressors also count.
  2. Write continuously, ignoring spelling and grammar. If you run out of words, repeat what you wrote or draw a line.
  3. Write only for yourself. This is not a letter, and you may plan to destroy the writing.
  4. Apply the flip-out rule: if writing about something feels as if it will "push you over the edge", stop.
  5. Expect to feel sad or low afterwards, especially on the first day or so. This usually passes within an hour or two.
  6. A week or two later, reflect on what you notice.
• Clinician additions [synthesis]:
  • Schedule the writing at a time that is followed by 30–60 minutes of low demand, not just before work or driving.
  • Agree a coping plan and contact route in advance.
  • Review in the next session how the client felt during and after each day.
  • Allow the topic to change between days.
• Example language (illustrative): "Over four days you'll write privately about something that really matters to you. If any memory feels like too much, stop; that's part of the method. Many people feel a bit low for an hour or so afterwards, so plan something gentle for after you write."
• Watch for:
  • Distress that lasts beyond a few hours.
  • Intrusions, nightmares, dissociation, or self-harm urges between days.
  If any of these appear, stop the protocol and return to stabilisation. Reported benefits are mixed. Some people feel negative emotions straight after writing, and some trials found no difference from control conditions [source: Wikipedia, Writing therapy]. Monitor rather than assume benefit.

4.15 Graded trauma writing within therapy

• Purpose: give a trauma-trained clinician a way to pace written disclosure [synthesis throughout; Lapidus and Bolton procedures are not drawn on here, and Bolton's "writing out trauma" chapter is [uncertain]].
• Steps:
  1. Map the material together on a graded list, from "easy to write about" to "not yet".
  2. Start at the edge: the time just before or after the event, the setting, or a safe person who was present.
  3. Use distancing forms first: third person, past tense, metaphor (4.7), or writing about the event from the present ("Today when I think of that summer ...").
  4. Set a short time box (5–10 minutes) in session, with the clinician present.
  5. Rate distress at the start and end of each piece on a simple scale the client chooses.
  6. Always finish with a resource write and a closing (4.17).
  7. Move one step up the list only when the last step ended with distress back near baseline within the session.
• Example language (illustrative): "Let's not go to the middle of it today. Write only about the street outside, the way it looked that evening, and stop there."
• Watch for:
  • Rising arousal: faster pen, shaking, a flat voice, staring.
  • Switching into present-tense "I am there" writing without choosing to.
  If you see these, stop, ground the client, and drop back a step.
• Contraindications [synthesis]: acute crisis, active suicidality, psychosis, severe dissociation, ongoing danger such as living with an abuser, and early bereavement where the client does not want to write.

4.16 Reflection writing and redrafting

• Purpose: move from raw expression to perspective. Bolton treats a text as something that must be worked upon to communicate [source: Bolton 2011, p. 48, as cited in Van Goidsenhoven & Masschelein 2021]. Lapidus builds reflection into every session [source: Lapidus]. Evans suggests reflecting a week or two later [source: Evans 2012].
• Steps [synthesis]:
  1. After rereading (4.4), write a short reflection: "Reading this, I notice ..." or "What I didn't know I knew ...".
  2. In a later session, the client may redraft a piece: cut it, shape it, change its point of view, or give it a title.
  3. Compare the drafts and discuss what changed in the telling and in the person.
• Example language (illustrative): "Read your piece from last week. Is there anything you'd change now? Changing it is allowed; so is leaving it as it is."
• Watch for: redrafting turning into a hunt for perfection or self-criticism. Keep the focus on meaning, not quality. It is working when later drafts show more perspective, compassion or agency.

4.17 Closing and grounding sequence

• Purpose: leave the material on the page and bring the person back to the present before they leave. Use it at the end of every session, and after any distressing piece [synthesis; Lapidus gives no closing procedure].
• Steps:
  1. Leave 10–15 minutes for closing in every session (20 after trauma writing).
  2. Write a closing piece of 2–3 minutes in the present tense, with a sensory, resource or next-hours focus. For example: "Right now I can see ...", "Something that steadied me today ...", "Tonight I will ...".
  3. Decide what to do with the page now: fold it, close the notebook, put it in an envelope or folder, or leave it with the therapist (4.18).
  4. Check in with each person, using a word or a 0–10 rating.
  5. Give practical next steps: who to contact, the signposting list, and a reminder that low mood afterwards often passes within an hour or two [source: Evans 2012].
  6. In groups, close with a round of one word or one line each, and keep the right to pass.
• Example language (illustrative): "Before we finish, write three lines about this room and what you're going to do in the next hour. Then close your notebook; it can stay closed until you choose to open it."
• Watch for: anyone still flooded, dissociated or numb. Do not let them leave until you have grounded them and checked how they are getting home (see section 5). It is working when people leave settled and can say how they will look after themselves.

4.18 Containment, privacy and storage of written material

• Purpose: protect the writer, and anyone named in the writing, from exposure. Writing is primarily private [source: Bolton 1999, as cited in Van Goidsenhoven & Masschelein 2021]. People may plan to destroy their writing, or store it safely or shred it if they fear others will read it [source: Evans 2012]. Confidentiality is essential [source: Lapidus].
• Steps [synthesis unless tagged]:
  1. Ownership: agree at the start that the writing belongs to the writer, and that copying, photographing or quoting it needs their consent.
  2. Where it lives: the client's notebook stays with the client by default. For clients who live in an unsafe home (domestic abuse, controlling family, shared care settings, prisons), offer to keep notebooks in a locked cabinet at the service. Alternatively, write on loose sheets that are destroyed at the end of the session.
  3. Clinical records: treat any copy or excerpt you keep as part of the clinical record, under your data-protection and records duties (for example UK GDPR). Do not keep it on a personal phone or in a personal cloud.
  4. Digital writing: use password-protected devices. Watch for documents that auto-sync to shared family accounts. Check email, chat and browser history when writing remotely (4.20).
  5. Destruction rituals: shredding, burning (only where fire is safe and permitted) or tearing up can be a deliberate ending, but agree it in advance so the client does not later regret losing the writing.
  6. Group anthologies, exhibitions and publication: get separate written consent for each piece, offer anonymity and pseudonyms, remove identifying details of third parties, and allow withdrawal up to an agreed date. Bolton considered that a wider public is not useful for this kind of writing [source: Bolton 1999, p. 136, as cited in Van Goidsenhoven & Masschelein 2021]. Make publication a separate later decision, never an aim of the work.
• Example language (illustrative): "Where will this notebook live this week? Is there anyone at home who might read it? If so, we can keep it here or use loose pages."
• Watch for: fear of discovery limiting what the client writes, and third parties identifiable in pieces that might be shared.

4.19 Writing in groups

• Purpose: offer mutual witness and community. Bolton describes groups in prisons, hospices, dementia care and mental health services, and groups for health professionals [source: JKP page; NYU Medical Humanities page, chapter 9]. Lapidus projects have included:
  • children in long-stay hospital care
  • women with chronic pelvic pain
  • self-harming prisoners
  • trainee counsellors and hospice counsellors
  • people with drug or alcohol problems
  • unemployed people with mental health problems
  • patients at a family practice
  [source: Lapidus, Policies & Projects].
• Steps [synthesis using Lapidus elements]:
  1. Recruit with clear advance information [source: Lapidus].
  2. Brief screening call.
  3. Ground rules (4.1).
  4. Warm-up (4.2), then the main prompt (4.3), reread (4.4) and optional sharing (4.5).
  5. Reflection (4.16) and closing (4.17).
  6. Use a co-facilitator, or arrange an on-call clinician, for groups with clinical populations.
  7. Debrief and get supervision after each session.
• Example language (illustrative): "In this group we write, and then anyone who wishes reads. We listen without fixing."
• Watch for: see section 5 on group-specific problems.

4.20 Remote, online and combined formats

• Purpose: improve access. Writing therapy is delivered by email (asynchronous, within an agreed timeframe), chat and video [source: Wikipedia, Writing therapy]. Lapidus also lists combined forms: writing with nature, walking, yoga, meditation, music or storytelling, and outdoor sessions [source: Lapidus].
• Steps [synthesis]:
  1. Agree response times and say plainly that email is not monitored in a crisis. Give crisis numbers.
  2. Check where the client is and who else is present at the start of every live session.
  3. Agree what happens if the connection drops during distress (you call back by phone).
  4. For outdoor or walking writing, check accessibility, toilets, weather and the route in advance, and choose a place where writing can be private.
• Example language (illustrative): "Before we start: are you somewhere private? If we get cut off, I'll ring you straight away on your mobile."
• Watch for:
  • Online disinhibition: clients may disclose more by email than face to face [source: Wikipedia, Writing therapy]. Respond to heavy emails with care and pace, and arrange a live check-in.
  • Difficulty finding a private space at home, and tiredness [source: Wikipedia, Writing therapy].

5. Handling problems

The Lapidus pages give principles but no specific protocols for distress, closing, after-care, privacy, online work or access [source: Lapidus, Creating a Safe Setting; the page itself says so on each topic]. The guidance below is therefore mostly [synthesis] from general clinical practice. Source-based points are tagged.

5.1 Pacing of trauma disclosure

• Disclosing too fast in a group (someone starts reading or telling a detailed trauma account):
  • Interrupt gently, warmly and early.
  • Thank them, say that what they are carrying sounds important, and offer to talk one-to-one after the session.
  • Move the group on with a grounding prompt.
  • Lapidus asks practitioners to encourage people not to over-disclose and to keep stories mild to moderate, and to respond carefully when difficult material arises [source: Lapidus].
  • Illustrative wording: "I'm going to pause you there, because this matters and deserves more time and care than we can give it in the group. Can we talk at the break?"
  • Afterwards, check on the person and on the listeners. Hearing trauma material can unsettle other members [synthesis].
• Disclosing too fast in individual therapy:
  • Use the graded list (4.15).
  • Change the form to third person, metaphor or past tense.
  • Shorten the time box.
  • Let the client write only headings or a single word for parts that are "not yet".
  • Remind them that writing less is allowed [synthesis].
• The urge to write it all at once at home:
  • Agree a home-writing rule: no trauma writing outside sessions until the stop rule and closing have worked reliably in session [synthesis].
  • If the client uses Pennebaker-style writing at home, keep the four-day structure, the flip-out rule and the after-care plan [source: Evans 2012, describing Pennebaker].
• Signs of going too fast [synthesis]:
  • Writing turns into present-tense reliving.
  • Handwriting changes sharply, or the client stops writing mid-word and stares.
  • Breathing changes, the client goes numb, or they lose track of time.
  • Nightmares, intrusions or self-harm urges appear after sessions.
  Response: stop, ground, and drop back a stage (Framework, Phase D to Phase B or C).

5.2 Overwhelm or dissociation during writing

Steps [synthesis]:

1. Stop the exercise for that person, or for the group if needed.
2. Orient them: name, date, place; feet on the floor; five things they can see.
3. Lower your voice and slow your pace.
4. Put the page face down, or have the client move it away from them.
5. Offer water.
6. Once they are oriented, offer a present-tense sensory write (4.17).
7. Do not ask them to read the piece aloud.
8. In groups, a co-facilitator stays with the person while the session goes on. If you work alone, set the group a gentle solo write while you attend to the person.

5.3 Distress after writing, and how to close

• Expect it and plan for it. Many people feel sad or low after expressive writing, especially at first, and this usually fades within an hour or two [source: Evans 2012]. Some people feel negative emotions straight after writing [source: Wikipedia, Writing therapy].
• Before anyone leaves: run the closing sequence (4.17) and a check-in rating.
• If a person rates 7 or more out of 10, or seems numb or flat [synthesis]:
  1. Keep them with you for 10–20 minutes.
  2. Ground them.
  3. Ask how they are getting home and who will be around this evening.
  4. Make a short coping plan: what they will do, who they can call, and crisis contacts.
  5. Agree a follow-up contact within 24–48 hours.
• Homework writing:
  • Ask the client not to write charged material late at night, alone after alcohol, or just before driving or caring duties.
  • Ask them to plan a pleasant, low-demand activity for afterwards.
  • Give them a written closing routine to use at home.
• If distress lasts longer than a day, or symptoms increase: suspend emotional writing, review the plan, and consider referral or a change of treatment.

5.4 Risk disclosed in writing (suicide, self-harm, harm to others, abuse)

• Lapidus requires facilitators to know what to do if someone discloses information that "puts themselves or others at risk" [source: Lapidus, Creating a Safe Setting]. It plans to develop training in this area [source: same].
• Read writing that is handed to you on the day you receive it, or say plainly that you will not read it [synthesis].
• Treat a statement in writing as you would a spoken disclosure. Raise it with the person privately, carry out your standard suicide and self-harm risk assessment, and follow your service's safeguarding procedure [synthesis].
• Where self-harm risk exists, discuss safe storage and removal of means as part of safety planning [synthesis].
• State the limits of confidentiality in the ground rules, so that a disclosure in writing does not feel like a betrayal when you act on it [synthesis].
• For a non-clinician facilitator: know the escalation route before the first session, such as a named clinician on the ward, a prison safer-custody officer or a designated safeguarding lead in a school [synthesis].

5.5 Children and young people

• Lapidus has run projects with children in long-stay hospital care, and with teenagers in schools alongside Samaritans and The Poetry Society [source: Lapidus, Policies & Projects].
• Follow the safeguarding procedures of the school, hospital or service, and your national mandatory-reporting duties. Explain the limits of confidentiality in words the child understands before they write [synthesis].
• Consent and involvement [synthesis]:
  • Get parental or carer consent as the setting requires, and the child's own assent.
  • Agree with the young person what, if anything, carers will see.
  • Do not show a child's private writing to parents without the child's agreement, unless there is a safeguarding need.
• Adaptations [synthesis]:
  • Use shorter writes, and more play with words: lists, acrostics, collaborative poems.
  • Allow drawing beside the writing.
  • Make it clear there is no marking, which helps keep the work separate from schoolwork and grades.
• Do not treat a child's story, poem or image as evidence of abuse or disorder. Respond to what a child says directly, following safeguarding procedure, and leave investigation to the agencies responsible [synthesis].

5.6 Privacy problems

• Writing found or read at home:
  • Assess the client's safety first. In domestic abuse, discovery can increase danger.
  • Move to in-session-only writing or storage at the service (4.18).
  • Agree neutral cover stories or labels if helpful [synthesis].
• Group member repeats someone's story outside the group:
  • Raise it in the group.
  • Restate confidentiality as essential [source: Lapidus, confidentiality].
  • Take the matter up with the member privately.
• Requests to publish or exhibit: follow the consent steps in 4.18. Be cautious when the writer is in crisis, is a minor, or names identifiable third parties [synthesis].
• Records requests: writing kept by the service is likely to fall within subject-access and disclosure rules. Tell clients this before you store anything [synthesis].

5.7 Access barriers

• Lapidus calls for sessions open to all, a physical environment that meets participants' needs including outdoors, and no focus on spelling, grammar or craft [source: Lapidus; Creating a Safe Setting].
• Adaptations for literacy, dyslexia or limited schooling [synthesis]:
  • Offer to scribe for them.
  • Offer voice recording or speech-to-text.
  • Accept lists, single words, or drawing alongside words.
  • Read prompts aloud.
  • Avoid asking anyone to read aloud.
• Adaptations for visual or motor impairment [synthesis]:
  • Large print and bold-line paper.
  • Thick pens or grips.
  • Typing or dictation.
  • Extra time.
• Language [synthesis]:
  • Invite writing in the person's first or preferred language, including mixing languages.
  • Do not ask for translations.
  • Use an interpreter only for instructions and spoken sharing, with confidentiality agreed.
• Dementia, palliative care and fatigue [synthesis; Bolton's groups in these settings are noted on the JKP page, but procedures are not drawn on here]:
  • Use shorter sessions.
  • Write collaboratively, with the facilitator scribing a group poem.
  • Use sensory prompts.
  • Agree consent to keep or share the writing while the person has capacity.
• Cost and venue: Lapidus lists libraries, GP surgeries and community centres as settings [source: Lapidus]. Choose venues that are step-free, on public transport routes and free or low-cost [synthesis].

5.8 Stuck clients, the blank page and "I can't write"

• Often caused by shame about school, fear of judgement or perfectionism.
• Steps:
  1. Restate that craft does not matter and there is no wrong way [source: Lapidus; Bolton 1999, p. 11, as cited in Van Goidsenhoven & Masschelein 2021].
  2. Shrink the task: three words, a list of five, or one sentence.
  3. Use concrete objects as prompts.
  4. Offer to scribe what they say.
  5. Model by writing alongside them. Lapidus asks facilitators to try exercises themselves first [source: Lapidus, Creating a Safe Setting].
• Illustrative wording: "Just a list: five things in your kitchen. That's all."

5.9 Resistance and non-adherence to home writing

• Ask what gets in the way: time, privacy, fear of what will come up, or the format [synthesis].
• Responses [synthesis]:
  • Cut the task down to six minutes, or to a weekly rather than daily practice.
  • Move writing into the session.
  • Change the medium, for example phone notes or loose sheets that are destroyed afterwards.
  • Treat avoidance as information. It may mean the pace is too fast (5.1).
• Do not insist that the client brings writing in. The client decides what to bring [synthesis, consistent with Bolton's view of writing as private].

5.10 Ruptures

• The client feels judged, or that the therapist reacted badly to a piece:
  • Name it and own your part.
  • Restate that writing is not evaluated [source: Lapidus, no judgement].
  • Ask what response would have helped [synthesis].
• The client feels exposed after sharing:
  • Acknowledge the courage it took.
  • Check whether the level of sharing was more than they wanted.
  • Agree in advance how much they will share next time [synthesis].
• The therapist interprets a piece and the client feels misread:
  • Go back to the facilitator's role as "midwife": the meaning belongs to the writer [source: Bolton et al. 2006, as cited in Van Goidsenhoven & Masschelein 2021].
  • Ask, don't tell, from then on [synthesis].

5.11 Group-specific difficulties [synthesis]

• A dominant sharer: set a time limit or a number of lines for readings, and invite others first.
• Cross-talk, advice or critique: restate the listening-only response rule (4.5).
• Distress spreading through the group: shift to a grounding or resource prompt, and slow the session down.
• Competition over who suffered most: acknowledge everyone, and steer back to each person's own writing.
• A mixed group with different needs: balance individual needs with participation, as Lapidus's ground rules require [source: Lapidus, Creating a Safe Setting]. Refer people who need more than the group can hold to individual support.

5.12 Facilitator impact and supervision

• Lapidus asks members to look after their own health and wellbeing, keep developing professionally to practise safely, and regularly monitor and reflect on their work [source: Lapidus, Ethical Code].
• In practice [synthesis]:
  • Get regular supervision that covers both the clinical and the creative aspects.
  • Keep reflective writing of your own.
  • Limit how much trauma material you read between sessions.
  • Debrief with your co-facilitator after each group.

5.13 What is uncertain

• Lapidus's revised Ethical Code was to be confirmed in December 2023. Supplementary guidelines for wellbeing practitioners were targeted for June 2024 [source: Lapidus, Review of the Lapidus code]. Whether either has been published, and what it contains, was not confirmed [uncertain].
• The 2019 Creative Practices for Wellbeing Practice Guidance Report is not drawn on here [uncertain].
• Bolton's detailed exercises are not drawn on in full, from The Therapeutic Potential of Creative Writing (1999), from Write Yourself (cited as 2011 and 2014 in the secondary source) or from her trauma chapter. Kate Thompson's journal-therapy methods were not checked either. The descriptions above rely on secondary summaries [uncertain].
• Lapidus's founding date and founders were not verified [uncertain].
• The publication details of Bolton et al. (2006) were not verified [uncertain].
• Session counts, group sizes and the criteria for moving between phases are [synthesis].

Sources

Sources

• Writing for wellbeing (Lapidus International). Definition, settings, essential features of good practice, recommended reading.
• Creating a Safe Setting for Writing for Wellbeing (Lapidus International). Physical setting, ground rules, "PASS", pacing, risk disclosure; cites Bolton 1999.
• Lapidus Ethical Code. Ten-point code, marked as under review.
• Review of the Lapidus code. Draft revision, 2023 timeline, supplementary guidelines planned.
• Policies & Projects (Lapidus International). Practice Guidance Report (2019), Spreading the Word pilots, Poetry & Mental Health project.
• About Lapidus International. Membership, governance, LIRIC journal.
• Wellbeing Practitioners directory (Lapidus International). No stated criteria; no endorsement.
• The Therapeutic Potential of Creative Writing, publisher page (Jessica Kingsley Publishers). Description, reviewer summaries including six-minute writing.
• The Therapeutic Potential of Creative Writing: Writing Myself, annotation (NYU Literature, Arts and Medicine Database). Chapter overview.
• "Writing is a way of saying things I can't say": therapeutic creative writing with people with cancer, abstract (Bolton, Medical Humanities). Abstract only.
• Van Goidsenhoven & Masschelein, "Writing by Prescription": Creative Writing as Therapy and Personal Development (KU Leuven repository). Chapter in Writing Manuals for the Masses (Springer, 2021); cites Bolton 1999, 2011, 2014 and Bolton et al. 2006.
• Expressive Writing (Evans, Psychology Today, Write Yourself Well blog, 2012). Pennebaker paradigm instructions, flip-out rule, after-effects, privacy.
• Writing therapy (Wikipedia). Secondary: Pennebaker's original study, unsent letters, object dialogue, online formats, mixed findings.
• Reflective Writing (Wilson-Howarth blog, January 2016). Secondary: account of a Bolton workshop and her six-minute daily discipline.

Further reading (not drawn on; seen only as cited by the pages above)

• Bolton, G. (1999). The Therapeutic Potential of Creative Writing: Writing Myself. Jessica Kingsley Publishers.
• Bolton, G. (2011; also cited as 2014). Write Yourself [uncertain: full title and editions not verified].
• Bolton, G. et al. (2006) [uncertain: title not verified], as cited in Van Goidsenhoven & Masschelein 2021.
• Bolton, G., Howlett, S., Lago, C. & Wright, J.K. (eds) (2004). Writing Cures: An Introductory Handbook of Writing in Counselling and Therapy. Brunner-Routledge (Lapidus recommended reading).
• Chavis, G.G. (2011). Poetry and Story Therapy: The Healing Power of Creative Expression. Jessica Kingsley Publishers (Lapidus recommended reading).
• DeSalvo, L. (1999). Writing as a Way of Healing. Harper (Lapidus recommended reading).
• Pennebaker, J.W. & Smyth, J.M. (2016). Opening Up by Writing It Down (3rd ed.). Guilford Press (Lapidus recommended reading).
• Lapidus International, TS Eliot Foundation & University of Chester (2019). Creative Practices for Wellbeing: Practice Guidance Report [uncertain].