The use of writing in psychotherapy is relatively new and may have meager empirical support. A rationale for the use of writing in psychotherapy is given in terms of splitting therapeutic skills into relationship and structuring skills. Writing is one application of structuring skills to increase the therapist's influence outside of the office and into the home or workplace. There are at least four different degrees of writing possible according to structure: open, focused, guided, and programmed. Examples from the available literature are given. Even though, its impact on therapeutic outcome has yet to be fully realized beyond the experience of few clinicians. Pennebacker's research contribution in the use of writing is highlighted to support its use in psychotherapy. He found that students who wrote on traumatic topics for 20 minutes a day for four days showed improved physiological reactions and fewer physical symptoms at three-month follow-up than students who wrote about trivial topics.