By Heather Rose Artushin, LISW-CP

People have long understood the healing power of words. In ancient Egypt, intentional words of healing were written on papyrus, then dissolved into a solution so that it could be physically ingested, like medicine. Today, a growing body of research confirms that reading and writing can be therapeutic, even reducing symptoms of anxiety and depression. Reading fiction in particular builds emotional literacy and empathy, research shows.

The International Federation for Biblio/Poetry Therapy (IFBPT) champions this approach, offering certification for social workers and other professionals interested in specializing in this creative modality. Owner of Change Your Narrative consulting and training practice, Nancy S. Scherlong, LCSW-R, CHHC, SEP, PTR/CJT-CM is a licensed clinical social worker and the current president of the IFBPT.

Scherlong discovered a passion for doing healing work with words when she was an MFA student with a background in creative writing and psychology. “I was going to do this work as a visiting artist,” Scherlong explained, “and all my friends at the time were therapists and suggested that I get a social work degree. I found that doing this work through the therapy door, for me, is a more intuitive way.”

Scherlong explains biblio/poetry therapy as the use of reading materials, like a book well-matched to a client’s circumstance, can be therapeutic with discussion or reflective writing. When it comes to poetry, Scherlong focuses on the use of metaphor. “Metaphor is another language specifically for trauma,” she said. “Sometimes people don’t have words for unspeakable things that have happened to them, and with metaphor they have privacy and a secret language to say, or not say, what they’re trying to convey. I think story is a word I use a lot, because it’s familiar.”

Nicholas Mazza Ph.D., licensed clinical social worker and Professor and Dean Emeritus at the Florida State University College of Social Work, has been involved in the practice, research, and teaching of poetry therapy for over 50 years. He is the author of Poetry Therapy; Theory and Practice, 3^rd Edition (Routledge; 2022), and president of the National Association for Poetry Therapy (NAPT).

“Poetry therapy has emerged as an independent field that is inclusive of bibliotherapy, narrative therapy, expressive writing, and journal therapy, all of which maintain their own independent field of study and practice,” Dr. Mazza explained. “Poetry and narrative can be powerful tools in promoting social justice. Poetic approaches have been and continue to be used to promote awareness of such critical problems as domestic violence, poverty, racism, sexism, and so much more. Poetry lends voice to the oppressed and can be empowering. Consider the invasion of Ukraine, gun violence, oppression, and women’s rights as just a few examples. The writing and sharing of poetry offer hope during troubled times.”

Whether social workers use books, poetry, and writing exercises with individual clients in individual therapy, with groups of nursing home residents, or patients in a hospital setting, the possibilities are endless. Sherry Reiter, PhD, LCSW, PTR-CM of The Creative “Righting” Center, has worked in private practice for over 30 years. “Bibliotherapy gets the maximum mileage out of words, powered by our own voices, fueled by our needs to be seen and heard in a meaningful way,” she said. “One of the many extraordinary moments was when my 87-year-old client held a published chapbook with all the poems she had written in therapy. It was called ‘This Is My Life’ by It’s-Never-2-Late-Productions. The author could not stop smiling and a feeling of pride and triumph overcame her feelings of helplessness and depression.”

Scherlong used this approach with children in foster care who had endured what she described as “horrific losses.” The results were powerful. “They would write letters to people no longer here, read them out loud, and write imaginary responses,” she said. “That dialogue ended up being healing.” Social workers can consider creative ways to tailor reading and writing prompts to a client’s unique situation, offering a non-threatening opportunity for expression.

In today’s post-pandemic world, the chance to heal through storytelling is something many people are discovering on their own. “As hard as the pandemic was, people have really started writing their own stories, and memoir is at an all-time high, and self-publishing is at an all-time high,” Scherlong said. “People are discovering on their own the healing power of words, and writing their stories.”

Social workers seeking more information on ways to incorporate books, poetry, and journaling into their work with clients can pursue continuing education courses in biblio/poetry therapy, seek one-on-one consultation, or pursue certification through the IFBPT. The certification process is a mentorship program, and according to Scherlong more than half of current mentors are social workers. “I think social work pairs well with expressive therapy modalities because it is already strengths-based, holistic, and affirms what’s right,” she said.

More than anything, viewing our work with people through the lens of storytelling can be a humbling, inspiring experience as a social worker. “I see their story before I see their problem,” Scherlong shared. “Stories can always be changed, by writing a new ending, or revising the middle, or shifting an arc of a narrative. It’s an affirmative process for people.”

Learn more by visiting the IFBPT website at https://ifbpt.org/ and the NAPT website at https://poetrytherapy.org/

The National Institute of Mental Health defines specific phobia as an intense, irrational fear that poses little or no actual danger. Approximately seven to nine percent  of the United States population experience specific phobias. Glossophobia, or fear of public speaking, affects up to 75 percent of the population. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not identify glossophobia as a specific phobia, but its prevalence makes finding treatment for those who suffer from it important. Exposure therapy and cognitive behavioral therapy are evidence based practices that mental health counselors use to treat phobias.

I wonder if comedian Jerry Seinfeld knew a thing or two about glossophobia. In his 1998 stand-up comedy special “I’m Telling You for the Last Time,” Jerry quipped that “I saw a thing actually, a study that said speaking in front of a crowd is considered the number one fear of the average person. I found that amazing. Number two was death. Death is number two?? This means to the average person, if you have to go to a funeral, you would rather be in the casket than doing the eulogy.” The crowd fell into laughter, noting a deeper truth that fear can be a more debilitating force than actual loss of life.

I’m a mere therapist, but if I could share one piece of life advice with anyone, it would be this: Take an improv class. I’m not suggesting that improv is a cure for depression or anxiety, or any mental health concern. But I do think there is therapeutic value in being part of a community that welcomes you with open arms. There’s an undeniable dopamine rush that comes from being playful with your scene partner and developing interesting characters. And it’s really nice to have something to look forward to each week.

In thinking about the connection between improv and therapy, I reflected on how I incorporate elements of improv philosophy into my therapy sessions. There is a shared idea that it’s ok to be vulnerable and experience an array of emotions. Both disciplines aim for presence of mind and spirit. And, improv teachers and therapists cultivate an environment of support, empathy, validation, and a space to improve skills. These values of being present, slowing down, and leaning into uncertain territory creates a feeling of “we’re in it together.”

I can speak to therapeutic concepts, but I’m not an improv expert. To understand how improv teachers think about the relationship between therapy and improv, I sat down with my veteran improv teachers, Rick Andrews, and Louis Kornfeld of the Magnet Theater. In crafting this article, I got their feedback on how improv classes and therapy sessions have similar beginning and middle stages. I explain how the ‘yes, and’ principle of improv resembles the social work tenant of “meeting the clients where they are at.” And, I offer a unique way of comparing the therapeutic approach of Internal Family Systems (IFS) to character work in long form improv. I hope this piece can compel anyone to take an improv class, not because it’s my passion, but because I do think that it provides healthy life lessons that anyone would be interested in learning about.

I also owe Rick and Louis a huge debt of gratitude for helping to make this story robust. They are great teachers who listen carefully and provide both practical and abstract explanations of the improv art form. I am a better improviser and scene partner because of them. They deserve a cut in my hourly rate, as I prescribe an improv class at the end of each session.

Beginning stages of therapy: therapists build rapport and help clients feel emotionally vulnerable

The therapeutic alliance, or the relationship between therapist and client, is the biggest predictor of success in psychotherapy. Researchers use complex words like misalignment, epistemic authority, alliance assessment, affective bond, pantheoretical change variable, and secure patient attachment style to address a very simple question: How much do you trust your therapist? The quality of the therapist-client relationship hinges on the therapist’s ability to ensure safety, so that clients can feel comfortable discussing vulnerable and potentially shameful areas of their lives.

There is no one method to achieve a successful therapeutic alliance, but certainly the rapport, or reciprocity, curiosity, openness, and positive attitude between therapist and client can influence a clients’ willingness to engage. My personal goal in the first few sessions is to ensure safety and trust. It doesn’t matter how knowledgeable I am in a particular subject: what matters is that my clients perceive me to be genuine and to have their best interest in mind.

Improv class begins with warm up games to get people back into their bodies and connected to fellow improvisers

An improv class is all about being vulnerable and establishing trust between improvisers. Kornfeld starts his classes with warm-up games that shift attention away from “linear, left brain, analytic ego-based thinking” to “musical, holistic, playing-the-room style of thinking.” My nature is already emotional, creative, and right-brain-centered, but I understand his point – we come here to be less individualistic and more communal. This way of thinking might help people let their guard down. And for me, warm-up games are a wonderful way to clown around with my improv friends.

Warm-up games offer ways to feel connected in a disconnected world. I think about warm-up games like “pass the face” or “bunny, bunny,” and I recognize that the outside world is just that: we’re now in a cozy new environment of friends who want to play with each other. And I can’t help but wonder if I approach my clients with the same level of curiosity, openness, and cheerful outlook that is representative of a warmup game.

Kornfeld isn’t a therapist, but we think the same way: we want people to feel comfortable being themselves. Therapists cultivate an environment where clients can release themselves from emotional pain. I doubt that Kornfeld wants his improvisers to use warm-up games as a substitute for therapy, but it’s possible that we both provide a space for release. We both want people to be OK with feeling a bit exposed – and connected.

Middle stages of therapy: therapists use different modalities to treat symptoms and monitor for signs of progress

The bulk of therapeutic work involves the specific therapeutic approach that matches the clients’ needs and therapists’ expertise. I use a mix of psychodynamic therapy, solution-focused brief therapy, cognitive behavioral therapy, and acceptance and commitment therapy to inform my eclectic therapeutic style. I am trained in EMDR, a treatment used to reprocess traumatic experiences with the brain’s own adaptive network channels. After completing EMDR, something traumatic will not carry any emotional weight. For instance, the emotional pain of a traumatic experience might be replaced by an emotion, memory, or thought that doesn’t typically carry a strong emotional reaction. This treatment offers hope for people who suffer from lingering effects of trauma, like anxiety or irrational thoughts that the event might re-occur.

In addition to evidence-based practices, I also provide homework, recommend podcasts, and use music to connect with my clients (I often whip out my guitar and ask my clients to write a song with me). But truthfully, the middle stages are the meat and potatoes of therapeutic work. It’s where clients can make significant progress in reaching their goals. And it’s this steady rhythm that is effective in their progress, which, to me, is the ability to manage symptoms in the moment, and an awareness of how to use tools to mitigate symptoms should they arise in the future.

Improv students learn different improv styles, crave less external validation, and feel less compelled to hold onto their performance

Improv students learn different types of improvs (short form, long form, the Harold, etc.), and the Magnet Theater is a great place to take classes. Kornfeld teaches the style of the class and mentions that “you’re not judging the behavior but offering feedback on how that behavior more usefully accomplishes the goal that we’re set out to embrace or pulls you away from it.” As students progress, they develop flexible thinking patterns, crave less external validation, and feel less compelled to hold onto their performance.

Kornfeld describes progress as a “lack of fogginess, a slow and steady presence in the process, and a warmth and tenderness towards the characters that improvers create.” This gentle way of teaching is comforting, especially when being on stage can feel intimidating. The lack of judgment or criticism, and the emphasis on growth is helpful, especially when understanding that progress is not linear. Kornfeld, in his way, provides tools to succeed (via learning the style of the class), and a space for reflection through feedback after each scene. Often, I feel like I’m listening to a college professor when I’m in improv class with Kornfeld. But it’s worth connecting the dots and seeing that the progression, and progress, looks the same, even if the skills and type of support are different.

The concepts of “Yes, and” (improv) and “Meeting the client where they are at” (clinical social work/therapy) are one and the same, with slight differences

Teacher with students during an improv class at a performing arts school.

There’s a term in clinical social work called “meeting the clients where they’re at.” It’s the idea that we validate a clients’ beliefs, experience, and emotions as their reality, without judging or dismissing it. It doesn’t necessarily mean that we personally agree with behavior (I would never condone heroin use, for instance), but I would acknowledge that this is the reality for my client, and I validate whatever emotions they might be experiencing. The lack of judgment can encourage clients to change their behavior, as therapy  offers a space for reflection and consideration of how a particular behavior can be harmful (after an overdose, for instance, a client may need a safe space to explore that incident without interference or advice from a therapist).

“Yes, and” is similar, but differs in some ways. Improv emphasizes paying close attention and listening to what your scene partner is saying, which is similar to the way therapists listen very closely to their clients. But the “yes, and” rule involves listening and acknowledging that what your scene partner is saying is true, but not necessarily agreeing or going with it. There’s overlap with improvisation in that both therapists and improvisers have tools, make room for nuance, and go with whatever the client, or improviser, brings into the room. I might have a master’s degree and advanced training, and improvisers might have taken advanced improv classes, but both disciplines recognize that we might have to disregard our plan if a client or improviser comes in presenting in a way that wasn’t what we expected.

It’s possible that therapists and improvisers agree to be the reality of their clients and scene partners. And, therapists will refrain from outwardly making judgements about their clients choices, as improvisers do with their scene partners. But the main difference is that therapists try to suggest alternatives and use therapeutic modalities to improve their clients’ realities, whereas improvisers simply use improv skills to respond to their scene partners’ choices. Improvisers don’t become too invested in offering therapeutic support to their scene partners, but rather respond to the scene and make it interesting (or funny) for the purpose of a performance. This gray zone, or ability to see shades of gray, is what blurs the line for me, when I’m in an improv scene. I tend to develop relationships that often appear sincere and deep (as a therapist, I always want to “help” my improviser out), but that’s not the same for everyone. My fellow improvisers may try out a character or accent – and this ability to try something new and bold makes improv especially exciting to perform and to watch.

Kornfeld says that for him, “yes, and ” is the idea of building something unique, together. “Whatever comes up,” he says, “I fold into the scene. It doesn’t mean I agree with it, it’s part of what’s true for the people of the scene, of the reality of the scene. And adding it means I just kind of digest it and metabolize it. I respond to it. I let it in on an emotional level and let myself care about it.” Kornfeld loves metaphors (as do I), and I think he’s saying that we all add something unique to a scene – and that reality is free of judgment or bias – a place for emotional security.

Internal family systems is a therapeutic approach that bears resemblance to improv’s character work of bringing character parts back second or third beats

Internal family systems (IFS) is a therapeutic modality where the therapist identifies different parts of a person and identifies ways in which those parts have served or harmed an individual. In IFS work, therapists have clients talk to the different parts of themselves and see what those parts need. If a client engages in a maladaptive part, a therapist might reflect on how that part has protected an individual. Binge-eating, a maladaptive coping mechanism, might be thanked for shielding someone from unbearable emotional pain. The therapist will teach a client to have a conversation with binge-eating, and ask it kindly to let it go, as the behavior longer serves the client. This type of work can be emotionally draining and appear scary or even impossible for a client who has years’ worth of engaging in that part as a coping mechanism. The gentle conversation helps to acknowledge that we’re saying goodbye to the behavior, not the part of a client trying to protect themselves. In doing this performative role play, we get creative, and hopefully take a fraught emotional conversation and make it a little more bearable.

The performative nature of scene work in improv offers a similar approach to a part, or trait, of an improviser’s chosen character. An overly confident high school football star might have an embarrassing stutter. A friendly server might have a crush on her patrons. And a quirky therapist might have a knack for incorporating improv into her sessions! The idea is this: find something interesting about your character, positive or negative, and bring it back into the second or third scenes. In long form improv, there’s usually three or four “beats,” or sets of scenes where improvisers use those oftentimes humorous aspects of a character’s personality to publicize it up, exaggerate it.

Final Thoughts

I think that in writing this piece I took quite some time to flush out ideas. As a therapist, I enjoy working with people, helping, and solving problems, together. I did much of the same improv classes. I also think it’s a great tool and outlet for fun. Whenever I come back from an improv class, my spirits are lighter. I hope that in explaining some of these concepts, I could help therapists incorporate some elements of improv into sessions, and for those doing improv, and in therapy themselves, see this connection. Laughter is the best medicine.

Marisa Markowitz (she/her) is a licensed psychotherapist practicing in New York. Marisa specializes in EMDR, CBT, DBT, other evidence based modalities. Her area of expertise is addiction, with a focus on technology misuse.

Disclaimer: The National Association of Social Workers invites members to share their expertise and experiences through Member Voices. This blog was prepared by Marisa Markowitz in her personal capacity and does not necessarily reflect the view of the National Association of Social Workers.