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Expressive Writing Exercises for Children with Cancer

by Nancy Morgan, MA

Photo by Cancer Type

Children with cancer often must forego their favorite activities to meet the demands of doctor appointments and treatment. They find themselves coping with body image changes and reduced energy. A lot of the fun of being a kid is put on hold, and that can produce strong feelings that need to be addressed. Expressive writing – recording thoughts and feelings about cancer or other personal issues – can be an acces­sible and inexpensive emotional outlet for children. Research suggests that expressive writing may produce a num­ber of health benefits through cognitive processing that leads to relaxation and other physiological improvements.

Art therapy is frequently used to assist children with self-expression and communication, as art making is a familiar and comfortable outlet for most children. Writing also broad­ens a child’s range of expression, bringing words into play to articulate feelings in greater detail. Expressive writing offers children a way to connect with other kids, a tool for communicating with their families and medical teams, a private way to explore feelings, and the opportunity to establish a lifelong practice of managing emotional expression.

After a day of treatment and conversations with doctors, a child may relish writing about his favorite hero or a place she likes to visit.

Author of Article photo

Nancy Morgan

Children may associate writing with schoolwork, which is subject to criticism, but expressive writing should be fun and free from judgment. A child’s writing is a true reflection of who he is and how he feels. When children open their hearts, praise and encouragement is the best response.

Writing Topics
Writing can begin with a daily check in: How am I feel­ing? What am I thinking about right now? What is special or different about today? Topics should be self-affirming and universal without probing into concerns about cancer or any other problems. Children should be encour­aged to choose a response that reflects their current emotional state. They may want to confront, defer, or redirect their thoughts and feelings through writing. After a day of treatment and conversa­tions with doctors, a child may relish writing about his favorite hero or a place she likes to visit. Being in charge of the writing content can help a child feel more in control of his or her life.

Here are some topics that encourage expressive writing:

bullet There’s more to me than what you see. Children with cancer may fear that others see them only as a sick person. This exercise invites children to describe all their interests, activities, and aptitudes, allowing them to re- claim their multidimensional selves. They are the same person they were before the cancer diagnosis, and this gives them a chance to affirm who they really are.

bullet Once I was/Now I am/Someday I will be … Children live in the present but well remember when they were younger. This exercise helps them imagine a future beyond cancer.

bulletWhat I want to tell you … Some­times children are reluctant to say something to a friend, parent, or doctor. This exercise allows them to describe what they truly think and feel. This cathartic practice may lead to more open communication or may simply allow them to vent about a topic they are apprehensive to address openly.

bullet In the process of losing something, I found something I didn’t expect. Cancer can feel like it’s all about deficits, but often new perspectives, relationships, and experiences emerge that make life more enjoyable. Ac­knowledging that lost and found go hand in hand can bring reassurance and anticipation of new experiences to come.

Writing Privately vs. Group Sharing
Private writing enables children to express whatever they wish without fear of criticism. Group sharing helps children connect and discover that others have had similar experiences, thoughts, and feelings. It can help them feel less alone. Both have value, and both should be included in a writing session. As a writing group grows in trust, often the need for privacy diminishes.

Most importantly, be sure the writing experience is fun, safe, and empower­ing. Group writing sessions should have ground rules to establish an envi­ronment of respect, mutual support, and confidentiality. This isn’t about identifying great writers; it’s about celebrating a child’s courage to express his or her true feelings.

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Nancy Morgan is a writing clinician and director of the Arts and Humanities program at Lombardi Comprehensive Cancer Center at Georgetown University in Washington, DC.

This article was published in Coping® with Cancer magazine, May/June 2013.