By Carrie Gilman, LCSW 

For most of us working in the sphere of being present with individuals as they contend with their cancer, it’s clear that a significant part of our work is helping individuals make meaning out of their experiences. When I began my work in oncology, I also began training in poetry therapy. This approach to self-discovery which focuses on utilizing language, particularly metaphor and symbol, to promote greater self-awareness and reflection, has become an invaluable part of my therapeutic technique toolbox, whether I’m working with groups or individuals in the cancer care setting.  

Dr. Nicholas Mazza, a social worker and past president of the National Association for Poetry Therapy (NAPT), describes in his model of poetry therapy three major dimensions of the therapeutic intervention:  

• The first dimension is “receptive/prescriptive” (introducing literature into practice with clients). Whether in a group or with an individual client, this dimension encompasses a facilitator sharing a piece of writing for participants to respond to. In the writing workshops I facilitate at our cancer center, I rarely bring pieces that have to do with the experience of having cancer. The participants are already there because they share an experience of having a cancer diagnosis and they bring this lens to their reflection on material. As such, readings about other topics deepen the conversation by adding another layer to the conversation that can provide potential metaphor.  An example of a piece of writing I use frequently with groups and individuals is the poem “Sifter” by Naomi Shihab Nye. This poem recounts the poet’s memory of a school assignment in which she and her peers were tasked with deciding which “kitchen implement” would best describe them. Shihab Nye determines she is a sifter and, “when bad days came I would close my eyes and feel them passing/through the tiny holes./When good days came/I would try to contain them gently/the way flour remains/in the sifter until you turn the handle.” This piece never fails to provide insightful discussion as participants begin to see their cancer experience in the metaphor of commonly found objects in the kitchen. Not surprisingly, the blender has been mentioned more than once by a cancer patient to describe their current experience. This piece of writing also provides an opening to touch on mindfulness techniques such as what thoughts might be contained and others “let go.”  Another piece I frequently use that can nicely complement the mindful concept of non-judgment or the “wise mind” approach of DBT is “permission to feel it all” by Kate Bowler. The line “I need reminders that my emotions are not bad or good. They’re just information” is particularly useful and has led to the introduction of tools such as the “feelings wheel” to encourage patients to be more able to specifically name their experience (and also to write about it).  

• The second dimension is “expressive/creative” (written expression of a client’s experience). I have found that many patients I work with have been encouraged to journal but not how to journal. While some patients will respond well to writing in sentence and paragraph form, others may need permission to be creative or use other forms of creative writing. Short forms of creative writing (acrostics, lists, haiku) can be particularly useful to incorporate into individual assessments/sessions and group work as they don’t demand many words and often don’t demand much time but can be just as impactful as a lengthy journal entry. The “six-word memoir,” for instance, is a wonderful way to help patients focus on the heart of their experience. A group member from a prior writing workshop at our cancer center wrote the six-word memoir “broken woman seeks tape and glue.” This simple but profound statement helped her and others in the group to address feelings of “brokenness” related to their cancer diagnosis as well as to define what healing could look like. Short forms can be a useful tool as their structure can be appealing during a time in which many feel a loss of control and can be freeing for cancer patients as it can allow them a new way to identify and think about their needs, feelings, goals, etc.  

• The third dimension is “symbolic/ceremonial” (the use of metaphors and rituals). For those of us who have the opportunity to work with patients on an ongoing basis, the use of metaphor can be invaluable. Once a social worker has engaged in sharing a piece of writing and reflecting on it with a patient and/or assisting patients with expressing/allowing creativity into their processing, the use of metaphor can be an ongoing touchstone for both the patient and the social worker. A patient I worked with who had outlived her metastatic cancer prognosis developed through responding to a reading and writing about it her personal metaphor of describing how she was doing as her “landing pattern.” Some days were “turbulent” while others were smoother. This helped to deepen understanding of where she was physically, emotionally, and spiritually.  

As social workers, we naturally gravitate toward the use of metaphor as we listen to the lived experiences of those we work with. Recognizing and focusing on utilizing the therapeutic value of writing with patients going through cancer can be an extension of this. In my own work, I appreciate that writing techniques are so adaptable. They can stand alone as an intervention or deepen others. They can be planned for a group or used spontaneously during an individual session. I can’t think of a therapeutic approach (DBT, narrative medicine, solution focused therapy to name a few) that couldn’t be complemented by one of the therapeutic dimensions of the poetry therapy approach.  While the participants in my most recent writing workshop put pen to paper, I quickly jotted down my own six-word memoir: Through shared words, new possibilities emerge.  

If you would like to reach out to me to talk more about poetry therapy, writing ideas for patients, or particularly useful books and websites to utilize when looking for therapeutic writing sources or prompts, please feel free to email me at Carrie.Gilman@imail.org.  

For more information about training in poetry therapy, check out the NAPT website.