How to Keep a Journal to Improve Mental Health

A great way to improve mental health is by keeping a journal. A journal can help you work through feelings and resolve issues. To help further understand how journaling can help improve mental health and how to keep a journal, I have interviewed therapist Dr Karen Hoving.

Tell me a little bit about yourself.
"I hold a Ph.D. in Clinical Psychology (1996) from The Union Institute, Cincinnati, OH.

I specialized working with Children and Adults with PTSD (Post Traumatic Stress Disorder) from childhood abuse as a pre and post doc, and continued this work after I graduated. I also did a large amount of internship and residency hours testing, diagnosing, and treating individuals with AD/HD and ending up doing my Doctoral Dissertation on AD/HD.

I was trained as a Gestalt Therapist and spend a lot of time using very creative therapeutic skills with my patients. Today, I specialize in three specific areas: 1)Depression and Mood Disorders, 2)Individuals with PTSD from childhood abuse, and 3) Individuals struggling with Chronic Illness.

I am located near Denver, CO and work with patients in person and via SKYPE (a free program that you use on your computer with a webcam to see and speak to each other online) if they are out of state or unable to come to my office because of chronic pain or illness."

How can journaling improve mental health?
"I have been using journaling as a tool to work with my patients since I was in graduate school (the early 1990's) when I working with individuals with what used to be called Multiple Personality Disorder (now Dissociative Identity Disorder). I found it was a wonderful way to get the individual's "parts" to begin to dialogue with each other. As I continued working with patients with other mental health disorders I found that Journaling was extremely helpful with almost everyone I was working with, regardless of their diagnosis.

Many people come to see a therapist because they are feeling uncomfortable with some aspect of their life or behavior. Sometimes they aren't quite sure how they feel, or when they feel it. So when my patients come in for their first visit I give them a composition book.

I ask them to start writing just for a few minutes every day. I have found that this exercise assists all of my patients. For example, with patients who are cutters or have an eating disorder, such as bulimia, I ask them to journal for 7 minutes when they have the desire to cut or binge. After they write about what they are feeling if they still need to binge/cut then they can go ahead.Then I then ask them to write how they feel after they have cut or binged. Often putting off those feelings for 7 minutes and writing down the feelings they are having can help them let go of the need to binge or cut or postpone it long enough to have a better sense of why they need to do it."

"Frequently therapists understand why individuals do these behaviors but if the patients don't understand for themselves they will not get better. Journaling helps them get in contact with feelings of anger, depression, sadness and even painful memories. It gives them a safe place to let go of the hurt that they have repressed often for a lifetime."

What are some different ways that someone could journal?
"I don't give a lot of instructions on "How" to journal. What I have seen in my practice is that often my female patients and adolescent girls have an easier time journaling than my male patients (perhaps because some girls kept diaries as children). Also, the teens and tweens are used to writing down things on a blog or on Facebook they are more comfortable with writing down how they feel. But I have had a number of men who come in saying that initially they weren't comfortable with writing. Usually I tell them not to worry about it, giving them permission to let it go.I tell them if they have a dream that is interesting, or they remember things that they want to tell me the next visit to use the journal to write that down. Sometimes that simple instruction gets them used to writing their feelings and ideas down. Often when they feel there are no negative repercussions to NOT writing it frees them up and they start writing simple things about what they did in the day. Usually this leads to writing about feelings and then often the dam is released and they come in beaming showing me pages and pages of writing.

The reason I give my patients a journal is because I found out early on in my career that if I ask them to go a purchase a journal they typically "forgot" and the exercise didn't get started. So I went out and bought a stack of journals or composition books and kept them for new patients.
I explain that this is not an academic exercise, spelling doesn't count, and I won't be reading them unless they bring them in and want to share something. They won't get " in trouble" if they chose not to journal or only journal occasionally. If they don't like to write I suggest they draw or even make collages with magazine pictures to describe their feelings.

By giving them permission to do anything they want with their journal, and not having to "show" it to me I find this allows them to get really creative. Usually within a few weeks they are bringing their journals in either because I have given them a homework assignment and they have done it in their journal or they have had a dream that they wrote about in their journal. Sometimes people want me to hear what they wrote especially if they have had an "ah ha" moment."

What are some tips you can give for keeping a journal?
"As for tips for keeping a journal I think that my basic suggestion is, "anything goes." I suggest that they try to write just a little bit every day. Initially I will tell them if they are stuck to just write one sentence before they go to bed, such as, "Today I felt or did ______." If they can't go any further, no worries. I suggest they write things that they might tell a friend, or want to tell me but it isn't our appointment day. If they are having marital issues this is a great way to start writing about things that they feel angry about, instead of downloading on their spouse or partner.

As I mentioned earlier, there are no rules. They can write or draw what they are thinking or feeling. They can write about dreams, notes to me if they are having flashbacks so they don't forget. Often a few days after a patient has seen me they might remember something that they had wanted to tell me but sometimes the session goes in a different direction, or they forget to mention some feelings or a dream. With the journal they begin writing down things that they remember, memories, feelings, dreams, symptoms they are having. This is not only incredibly beneficial to the patient but also helpful to the therapist. If my patient brings in their journal every session, even if they don't read anything to me, if something comes up they can refer to it. If I recommend a book or an exercise that I would like them to try they can write it down in their journal so they have everything in one place.

The main issue many clients have is they are afraid that someone (a parent, spouse, partner) will discover their journal and their inner most feelings and thoughts. Often we work on a way to hide their journal so no one inadvertently "finds" it. One suggestion is if the patient is the one to change the sheets and make their bed, to hide the journal between the box spring and mattress. Some of my male clients keep their journals at work or in the glove compartment in their car if they are sure no one will go through it. With adolescents I explain to their patients that this is an exercise that I am asking them to do for me. I explain that if the Tween or Teen feels that their parent or sib may read their feelings they won't work on the exercise and then won't get better. Often Mom or Dad will at this time admit that they do "snoop" and we discuss (always in front of the child) ways to deter the desire to know "everything" about their child . Usually if I promise that if their child is getting into something concerning that all of us will have a session and the child and I will tell them what is going on, it helps Mom and Dad to relax knowing that an adult is aware of what is going on. This helps them to feel that they aren't completely out of the loop. This also helps the child feel that their private thoughts are safe but another adult will be monitoring them in case things in their life are getting out of control. I always, of course, explain to the child and the parents the reasons why confidentiality would be broken . This usually helps Mom and Dad to promise to back off, and the child to promise to work on the exercise. It is a win-win situation. Everyone feels safe. Mom and Dad know I am watching, and the child knows that Mom and Dad won't be snooping. If Mom and Dad find it and are tempted to read it I suggest they give it to their child and let them know that, hopefully, they didn't "peak." Usually I can get the parents to promise not to look for it or read it. They want their teens and tweens to get better. Trust is the first step in that process.But as soon as they discover the journal we all meet to discuss what happened, how everyone feels, and if anyone broke the agreement.

Obviously, Journaling is specifically beneficial in the areas that I specialize in: Mood Disorders (so they can write down their emotional pain and feelings of sadness), PTSD (to write down flashbacks, any memories of abuse, feelings of the betrayal they experienced, and any anxiety, fear, anger or sadness they are experiencing as they begin working with me, and Chronic Illness (the anger of their body taking over, any physical pain they experience, feelings of being isolated that are caused from being trapped inside their body or their room - watching the rest of the world traveling past them, issues with feeling unheard by their medical team). But clearly, there are a multitude of mental health issues that can be assisted by journaling as a first step in feeling more in control and emotionally healthier."

Thank you Dr. Hoving for doing the interview on how to keep a journal and improve mental health. For more information on Dr. Hoving or her work you can check out her website on www.drkahoving.com.

Recommended Readings:
Post Traumatic Stress: Questions & Answers
Reducing Unemployment Stress
How to Reduce Stress Simply