Anthony Pantaleno, Ph. D.
When therapists encourage their clients to journal, do we often get initial agreement followed by a blank entry? For the future poets and mystery novelists in our practices, this may come easily. Give them a blank page and they are off and running. For others, the suggestion of journaling produces an internal eye roll. And for still others, it can become an anxiety-provoking request—another assignment they fear they will fail, another opportunity to disappoint their therapist when they return the following week empty-handed.
I understand this.
Personally, I live to write. Give me a blank page and I am happy. But if you assigned me a page of basic arithmetic problems as therapy homework, I would comply—and probably get half of them wrong. My lifelong math disability would quickly be revealed.
The point is simple: what feels natural and liberating to the therapist may feel awkward, intimidating, or even exposing to the client.
So perhaps our first task is not to tell clients to journal. Perhaps it is to help them discover a way of expressing themselves that feels like their own.
The word journaling itself can sound like an assignment. A therapist hands a client an imaginary notebook and says, in effect, “Go home and write something meaningful about yourself.” That is a tall order.
Instead, we might begin with a small, specific invitation and match the activity to the client’s needs, energy, and preferred way of communicating.
Use these when a client is willing to write but becomes anxious when faced with an open-ended assignment. Keep the task brief—one to three minutes or a single sentence.
At the next session, ask what it was like to complete the prompt—not whether the client wrote something profound.
Use letter writing when a client is carrying words they have never been able to say to another person. The letter does not need to be sent. Its purpose is to give shape to an unfinished conversation.
Invite the client to decide what happens next: keep the letter, revise it, read it aloud, destroy it, or bring it to therapy.
Use nonverbal activities when the client says, “I don’t know how to explain it,” or when writing feels too direct. The goal is not artistic skill; it is externalizing an internal experience.
Ask the client to describe the image, if they wish. Do not assume that the therapist’s interpretation is the correct one.
Use music or poetry when a client naturally responds to rhythm, lyrics, or metaphor—or when ordinary description feels too limited.
These activities can help clients identify emotional states without requiring them to analyze those states immediately.
Use voice recording when a client has meaningful thoughts outside the therapy hour but does not want to write. A phone can become a private, accessible journal.
Suggest a time limit so the activity remains manageable. The client can save, delete, or bring the recording to therapy, depending on their comfort and privacy needs.
Use reflective prompts when a client has enough emotional distance to consider patterns, growth, or lessons learned. These prompts may be especially useful during transitions or near the end of treatment.
These reflections can help clients recognize strengths without forcing a falsely positive interpretation of painful experiences.
Use a shared activity when the client has created something privately but is ready to let another person see it. The therapist might invite the client to bring a drawing, poem, photograph, playlist, or written reflection to session.
Begin with curiosity: “What would you like me to notice?”
Then ask: “What was happening for you when you created this?”
The client remains the authority on the meaning of the work. The therapist’s role is to witness, ask respectful questions, and help the client decide whether the expression should remain private or be shared more widely.
The therapeutic objective is not to produce literature. It is to create a pathway between an internal experience and an external expression.
Sometimes that pathway begins with a single sentence.
The Voices From the Heart feature in this newsletter is meant to showcase artistic expression from former clients who, at some point in their treatment, managed to capture an aspect of their experience that resonated with their therapist the moment it was shared.
These are just some of the experiences that former emerging-adult clients, all over the age of eighteen, have granted me permission to share through Voices From the Heart.
Some sign our publication agreement and choose to remain anonymous. Others courageously—and vigorously—insist that their names appear alongside their work. Both choices deserve respect.
One former client was sharing pieces from her art portfolio during a therapy session when I became captivated by one of her watercolors. She seemed genuinely surprised by my reaction. What she had regarded as simply another piece of her artwork communicated something much deeper to me. That watercolor now resides in the Voices From the Heart archive.
Another former client composed music and lyrics about the loneliness of being the most hyperactive child in his elementary school. He is considering releasing that work to us for a future issue.
These experiences have taught me something important.
Journaling can be much broader than putting words into a notebook. It can become a creative and beautiful bonding experience between therapist and client. It can allow an experience that has existed privately—in a bedroom drawer, on a laptop, inside a sketchbook, in a phone, or simply inside someone’s mind—to be witnessed by another human being.
And sometimes, long after therapy has ended, that private expression may be given permission to live another life. It may become something that says to another person:
There is something profoundly moving about that transformation.
When former clients permit deeply personal expressions created during or around their therapy to move from the privacy of their lives onto a wider stage, they may perceive our interest in their work as an honor. The honor, however, is all mine.
So the next time you encourage a client to journal and receive the familiar smile, nod, and empty notebook the following week, perhaps don’t assume resistance. Maybe the notebook was simply the wrong doorway.
Ask another question: “If you didn’t have to write about it, how would you express it?”
Then offer a choice: “Would you rather write one sentence, create an image, choose a song, record a voice memo, or try something else?”
The answer may surprise both of you.
Attached to this newsletter is a link to the publication agreement for Voices From the Heart. I invite clinicians to read it and think about former clients whose creative work has remained with you—an essay, poem, drawing, painting, photograph, song, reflection, or other expression that captured something powerful about their therapeutic journey.
If you have been the recipient of such a hard-copy or digital work, and if appropriate permission can be obtained from an adult former client, we would welcome the opportunity to consider it for Voices From the Heart.
The more welcoming we make opportunities for authentic expression, the more our clients may surprise us.
And perhaps that is where journaling really begins—not with the forced assignment to fill a page, but with the experience of discovering: I have something inside me worth expressing.
