Take the tedium out of patient journaling

When it comes to the recovering person's practice of keeping a journal, a New Jersey medical director insists that less is definitively more.

Indra Cidambi, MD, medical director for the Center for Network Therapy's detox and partial hospitalization services, says the common tendency to chronicle all of a day's activities in a journal actually proves counterproductive for the patient. The person usually can't sustain that amount of daily writing for very long, Cidambi says. Moreover, family members or others might gain access to the journal and see detailed entries they shouldn't be privy to.

With nearly all of Cidambi's patients having engaged in the traditional form of journaling, she attempts to steer them toward a much simpler method—a shorthand version that she says takes only a couple of minutes before bedtime each night but can be considerably more productive.

Her patients follow a five-column format in their notebook, first listing the date of their entry and then answering these questions:

• What bothers you?

• How are you feeling?

• What action did you take?

• What action(s) do you plan to take?

Sometimes a one-word note will suffice for a particular response, but Cidambi says that as soon as the person looks back on that day's text, the problems he was facing and the feelings that accompanied them will resurface. The exercise seeks to assist individuals in being able to apply the tools that they are learning in therapy, before they encounter a trigger that might lead to a slip or a relapse.

Even if the person has done nothing that day in response to what was bothering her, the exercise of identifying what should be done later can offer temporary relief before bed, assisting in the recovering person's sleep. “Most of the patients have difficulty sleeping, and often that's because something is bothering them before bed,” Cidambi says.

Dealing with emotions

The treatment patient often will convey being afraid to experience emotions, Cidambi says. A simple method of journaling offers a non-threatening forum for one's feelings, and a convenient way to look for patterns in one's interactions over a period of time. It may help uncover how unresolved issues from past days contributed to emotional outbursts or other unwanted behaviors later.

Cidambi even has to be ready for the occasions in which her own interaction with a patient may have caused the unrest. Patients generally become more comfortable talking about not only the emotions that surface in their interactions with loved ones, but in those with their clinicians as well.

“The feelings are unique to everybody,” Cidambi says. “You can't tell me I'm wrong if I feel angry, for example. The problem comes in how you express your feelings.”

Cidambi says she often will bring up the journaling in therapy, and some patients will choose to share what they have written. Even if they don't, the experience, conducted in a simpler fashion than traditional journal, is meaningful to patients, she says. She refers to an exhaustive accounting of the day's events in a journal as a “useless” exercise.

She adds that she is more eager than most physicians to tap into the power of therapy, as well as the 12 Steps. “The 12 Steps are important, whether you're an addict or not,” Cidambi says. “When you hurt somebody, you need to make amends. When you're stuck in traffic, you need to realize that you're powerless.”