Bibliotherapy

Form of psychotherapy involving reading

Bibliotherapy (also referred to as book therapy, reading therapy, poetry therapy or therapeutic storytelling) is a creative arts therapy that involves storytelling or the reading of specific texts. It uses an individual's relationship to the content of books and poetry and other written words as therapy. Bibliotherapy partially overlaps with, and is often combined with, writing therapy. Distinct from the creative arts therapy is bibliotherapy as a supportive psychotherapy, a brief self help intervention where through the reading of a chosen standard manual, emotion regulation skills are acquired through either behavioral therapy or cognitive therapy techniques. Two popular books used for this are The Feeling Good Handbook for behavioral therapy. The main advantage of this psychotherapy compared to cognitive behavioral therapy (CBT) is its cost effectiveness, although, especially for complex presentations, CBT tends to have more positive treatment outcomes. Modest evidence also exists to the symptom reduction of alcohol dependence, self harm and panic disorder. Galen, the extraordinary philosopher and physician to Marcus Aurelius of Rome, maintained a medical library in the first century A. D., used not only by himself but by the staff of the Sanctuary Asclepion, a Roman spa famous for its therapeutic waters and considered to be one of the first hospital centers in the world. As far back as 1272, the Koran was prescribed reading in the Al Mansur Hospital in Cairo as medical treatment. In the early nineteenth century, Benjamin Rush favored the use of literature in hospitals for both the "amusement and instruction of patients". By the middle of the century, Minson Galt II wrote on the uses of bibliotherapy in mental institutions, and by 1900 libraries were an important part of European psychiatric institutions. After the term bibliotherapy was coined by Samuel McChord Crothers in an August 1916 Atlantic Monthly article, it eventually found its way into the medical lexicon. During World War I, the Library War Service stationed librarians in military hospitals, where they dispensed books to patients and developed the emerging "science" of bibliotherapy with hospital physicians. When they returned from the war, they tried to implement these ideas in hospital libraries. E. Kathleen Jones, the editor of the book series Hospital Libraries, was the library administrator for the McLean Hospital in Massachusetts. This influential work was first published in 1923, and then updated in 1939, and again in 1953. Pioneer librarian Sadie Peterson Delaney used bibliotherapy in her work at the VA Hospital in Tuskegee, Alabama from 1924 to her death in 1958. Elizabeth Pomeroy, director of the Veterans Administration Library Service, published the results of her research in 1937 on the efficacy of bibliotherapy at VA hospitals. By the 1920s, there were also training programs in bibliotherapy. One of the first to offer such training was the School of Library Science at Western Reserve University followed by a program at the University of Minnesota School of Medicine. In the United Kingdom, some felt that bibliotherapy lagged behind the US and Joyce Coates, writing in the Library Association Record, felt that "the possibilities of bibliotherapy have yet to be fully explored".

Although the term "bibliotherapy" was first coined by Samuel Crothers in 1916, the use of books to change behavior and reduce distress has a long history, dating back to the Middle Ages. When applied in a therapeutic context, bibliotherapy can comprise both fictional and non fictional materials. Fictional bibliotherapy (e. g., novels, poetry) is a dynamic process, where the material is actively interpreted in light of the reader's circumstances. From a psychodynamic perspective, fictional materials are believed to be effective through the processes of identification, catharsis and insight. Through identification with a character in the story the reader gains an alternative position from which to view their own issues. By empathizing with the character the client undergoes a form of catharsis through gaining hope and releasing emotional tension, which consequently leads to insights and behavioral change. proponents claim that a therapeutic story approach has the potential to shift an out of balance behavior or situation back towards wholeness or balance. A patient might also find it easier to talk about his issues if he and the therapist can pretend that they are talking about the character's issues. Proponents suggest that the story form offers a healing medium that allows the listener to embark on an imaginative journey, rather than being lectured or directly addressed about the issue. McKenna et al. (2010) conducted a review on psychotherapies for older depressed people, which concluded that bibliotherapy is effective. The use of bibliotherapy in mental health programs, including those for substance abuse, has been shown to be beneficial to patients in the United Kingdom where it is a popular resource.

Bibliotherapy can be performed using affective treatment techniques, cognitive behavioral therapy (CBT), and visual based materials. Affective bibliotherapy relies upon fiction which can aid participants. By empathizing with a story's character, the client undergoes a form of catharsis by gaining hope and releasing emotional tension. There can also be a connection made between the circumstances in a story and the reader's own personal issues. This, consequently, leads to insights and behavioral change. Bibliotherapy using CBT relies mainly on self help books which work to correct negative behaviors by offering alternative, positive actions. Visual based materials, such as graphic novels, utilize both affective and CBT techniques.

The gains achieved in cognitive bibliotherapy illustrate that the most important element in cognitive bibliotherapy is content of the program and not the individual interactions with a therapist. Bibliotherapy using CBT have been empirically tested the most and directed CBT appears to be the most prevalent methodology in the literature. The selection of CBT books is important since there are many on the market that purport to help. Pardeck's analysis on choosing books is quite instructive and much of his criteria mirror what librarians teach in information literacy. These include the authority of the author on the topic, the type of empirical support offered for treatment claims, the existence of studies testing its clinical efficacy, and a comparative review of other books.

There is not as much research on using fiction in bibliotherapy when compared to cognitive self help books. The recent work of Shechtman has been important in investigating the use of affective literature for bibliotherapy. In her work on counseling with aggressive boys, Shechtman discusses the deficits these children exhibit and describes affect disorders with symptoms of emotional arousal, low levels of empathy, and difficulties in self expression. Using integrative treatment whereby the patient explores the problem, gains insight, and commits to change, Shechtman found that using affective bibliotherapy techniques achieved therapeutic change while indicating gains in empathy and insight.

In the simplest sense, graphic novels are long form comic books, usually 100 pages or more in length. The application of graphic novels in this context will allow people struggling with literacy to have better access to materials. Dozens of graphic novels have been published over the last decade that address public health topics, such as depression, drug abuse, and PTSD. Public health based comic books originated in the 1940s. The earliest public health comics averaged around twelve pages and were aimed at preventive instruction for children. Over the last fifteen years, however, the genre has evolved and public health graphic novels and are now commonly 150 pages long and focus more on adult struggles with physical or mental illness. This change has gotten the attention of medical professionals who gather and evaluate these materials. Currently, a group of physicians, professors, artists, and bioethicists run the website Graphic Medicine and hosts an annual conference to discuss the use of graphic novels and comic books in health. There is a wide range of research that indicates graphic novels are an effective tool for people struggling with literacy and communication problems. They also have been shown to be effective with populations that have trouble with traditional literacy instruction. Resistance to learning can take many forms, some of which can be seen in populations involved with the criminal justice system. Graphic novels are most often used to entice the group referred to as "reluctant readers", people who have abandoned reading for pleasure. While this group may be literate in the basic sense, research shows that people who read for pleasure continuously improve vocabulary and language skills, skills that can help people rehabilitate after incarceration. Research shows graphic novels are of use to students with traditional learning disabilities, like dyslexia and also have been shown to be effective when used in a bibliotherapeutic context to assist people with mental illness in explaining their own struggles to others. Graphic novels have also been described by professionals in the field as especially apt for portraying the struggles associated with mental illness.

Bibliotherapy has been studied by Jennie Bolitho (2011) in relationship to libraries, health and social connection for the elderly. Bolitho set up a pilot reading program where she read the text aloud to a group of participants at a local aged care hostel. (She described "being read to as part of the nurturing experience".) Her evaluation at the end of the 12 week program described all responses as positive and participants commented that they "look forward to the group as it made them think for themselves and gave them something to think about aside from their ailments and the monotony of the day" (p. 90).

Bibliotherapy has not been vastly researched to ensure that it will be successful for all students. It has many drawbacks, which include unavailable literature on certain topics that students may be struggling with, many students not being ready to face their issues and read, and students and parents defensively implementing the therapy. The resistance of using bibliotherapy is based on a lack of assertiveness, negative attitudes, anxiety, depression, sexual dysfunctions, and negative behaviors. The major issue that lies behind bibliotherapy is the lack of research that has been conducted on this therapy device. Advantages of bibliotherapy include teaching students to solve problems, help students cope with teasing, name calling, mockery, fears, sexuality changes, anxiety, and death. Many therapeutic stories are written for specific individual needs, but practitioners have also used them to build psychological resilience when groups and communities face challenges. For example, therapeutic storytelling can play a role in creating inclusive classroom and work communities. Therapeutic stories are also sometimes referred to as "healing stories". In the US, the National Storytelling Network has a special interest group called the Healing Story Alliance.

There are steps that make bibliotherapy a more effective solution for dealing with the issues that a student may be facing, including developing support, trust, and confidence with the student with an issue, identifying other school personnel that could aid in implementing the therapy, seeking support from the student's parents or guardians, defining the issue that the student is facing and why the teacher wants to help solve it, creating goals that may help the student overcome the issue, researching books that may help with the specific problem, introducing the book to all the people that will be involved, incorporating reading activities, and evaluating the effects and successes that the book may have had on the student.