an inTeRlink feature article
11-18-01

Bibliotherapy Applications for Recreation Therapy

By Laurie Jake CTRS, CEDS
Most of us realize how therapeutic reading can be. We find ourselves entering the world described in the pages of a good book and becoming involved with the characters. We often close the cover having gained new insight and ideas. The purpose behind the use of bibliotherapy is to assist a client in overcoming the emotional turmoil related to a real-life problem by having him/her read a story on that topic. This story can then serve as a springboard for discussion and possible resolution of that dilemma. The therapist provides guidance in the resolution of personal crisis through the use of directed readings and follow-up activities.

The clients we serve are dealing with increasingly complex issues. The road to recovery and healing is not only based on what happens in a treatment group or session, but between sessions. Bibliotherapy is the clinical technique of recommending books to clients for guidance in solving their problems. Another, more precise definition is that bibliotherapy is a technique for structuring interaction between a facilitator and a participant based on mutual sharing of literature. Bibliotherapy generally appears to be more successful as an adjunctive therapy.

Many mental health professionals use popular self-help books, such as "What Color Is Your Parachute" and "The Relaxation Response" for their clients, rather than fiction or poetry, yet the use of many types of literature can have tremendous therapeutic value. There are many ways to use literature to help a client reach his/her treatment goals. Good books can alleviate feelings of alienation when readers recognize characters with feelings, thoughts and circumstances similar to their own. This can be especially therapeutic for someone who is in the process of recovery or rehabilitation from a disabling condition. Books can help clients to objectify their own experience, come to a better understanding, and move on to more positive attitudes and relationships in life.

Why Bibliotherapy?
Subjects that clients deal with can include: grief and loss, body image, social rejection, and many others. Books can reduce people's isolation, and supplement the therapy process. A client who may have decreased social skills can be given books as an addition to group therapy in order to increase their social skills. Books, such as How to Start a Conversation and Make Friends by Don Gabor, can reinforce concepts that are brought up in didactic treatment groups. The Outsiders by SE Hinton can also be used to address social skills in a much different way. Clients can react to the social challenges that the main character Ponyboy has to deal with, and then can relate their situation to that of Ponyboys. Bibliotherapy is a collaborative process between client and therapist. Recommending reading materials has become a primary treatment technique for many mental health practitioners. It is essential in today's restrictive managed care environment when length of stay is so limited, that we find ways to give more to the clients. Bibliotherapy enhances and increases the resources available to a client.

The goals of bibliotherapy can include the following:
(1) to develop an individual's self-concept
(2) to increase an individual's understanding of human behavior or motivations
(3) to foster an individual's honest self-appraisal
(4) to provide a way for a person to find interests outside of self
(5) to relieve emotional or mental pressure
(6) to show an individual that he or she is not the first or only person to encounter such a problem
(7) to show an individual that there is more than one solution to a problem
(8) to help a person discuss a problem more freely
(9) to help an individual plan a constructive course of action to solve a problem

A practitioner must decide whether an individual or a group therapy approach would be best in the particular situation. Individual therapy requires time-consuming one-on-one sessions, but some people feel freer to express themselves in a one-on-one situation. Bibliotherapy can be included in leisure education or therapeutic process type groups, directed at themes the entire group can relate to. Outpatient settings are also a good place to use bibliotherapy techniques. There are many excellent books that a client can read and then return to a session to discuss their reaction to the material. Regardless of whether the practitioner chooses the individual or group approach, the basic procedures in conducting bibliotherapy are: (1) motivate the individual or individuals with introductory activities; (2) provide time for reading the material; (3) allow time to reflect; (4) provide follow-up discussion time, using questions that will lead persons from literal recall of information through interpretation, application, analysis, synthesis, and evaluation of that information; and (5) conduct evaluation and direct the individual or individuals toward closure--this involves both evaluation by the practitioner and self-evaluation by the individual.

Which Books to choose?
Various kinds of information can be conveyed through assigned and shared reading. It is important that the CTRS is familiar with any literature that is used. Therapists should be aware of the length and complexity of the book. The book should be applicable to the problem facing the client. The client's reading ability should be known, as well as the client's emotional and chronological age must be considered. Reading stories aloud for small children can be an option to achieve similar desired results. Before undertaking bibliotherapy, a practitioner must remember that it is more than just the casual recommendation of a certain book to an individual--it is a deliberate course of action that requires careful planning.

Bibliotherapy must be handled with great delicacy, and not every practitioner possesses the personal qualifications to be a facilitator in the process. Setting out to "trigger emotional catharsis" can be a risky thing to do. It is important to be prepared to deal with the emotional issues that may result. Fictional works are good for discussion purposes because participants can talk about the characters in a book rather than about themselves. This is often less threatening for the client. Children's literature offers many good choices, one example is the classic story of the Velveteen Rabbit and the pain the rabbit experiences when becoming 'real'. Another good example, Deenie by Judy Blume has helped many children with scoliosis to cope with wearing a brace and other stressful changes to their lifestyle. This story is also helpful to address issues of body image or social rejection. Librarians are a valuable resource to identify appropriate books.

Above all, the books chosen by the practitioner should have literary merit--a poorly written novel with stereotyped characters and simplistic answers to complex questions is probably worse than not reading anything at all and can leave clients with a negative view of literature. Reading quality literature, however, can be beneficial to clients, even outside the context of bibliotherapy. A recreational therapist who really loves literature and who has a large collection of books is in a good position to conduct bibliotherapy, if he or she possesses the other necessary personal qualifications.

These points are worth thinking about when selecting literary resources, how well does the book help with:
· Fostering personal insight
· Triggering emotional catharsis
· Assisting with solving problems
· Altering the ways in which clients act
· Promoting satisfying relationships with peers
· Providing information about shared problems
· Provide a good quality recreation experience

Bibliotherapy offers the CTRS a unique way to allow clients to actively participate in treatment. Bibliotherapy is extremely individualized to each person and their situation, but it can be a useful addition to the treatment services provided by a recreational therapist.

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Doll, Beth and Doll, Carol (1997) Bibliotherapy with Young People: Librarians and Mental Health Professionals Working Together. Englewood, Colorado: Libraries Unlimited

Nola Kortner Aiex, Bibliotherapy, ERIC Clearinghouse on Reading, English, and Communication Digest #82, http://www.indiana.edu/~eric_rec/ieo/digests/d82.html

Pardeck, John T. and Jean A. Pardeck (1989). "Bibliotherapy: A Tool for Helping Preschool Children Deal with Developmental Change Related to Family Relationships." Early Child Development and Care, 47, 107-29. EJ 401 179

Bibliotherapy. Fact Sheet (1982). Urbana, IL: ERIC Clearinghouse on Reading and Communication Skills. ED 234 338, http://www.ed.gov/databases/ERIC_Digests/ed357333.html

Nancy K. Peske, Beverly West, Bibliotherapy: The Girl's Guide to Books for Every Phase of Our Lives, Dell Publishing, 2001

Wei Tu , Using Literature to Help Children Cope With Problems, ERIC Clearinghouse on Reading, English, and Communication Digest #14, EDO-CS-99-09 Dec 1999

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