Using Bibliotherapy within Using Bibliotherapy within Play Therapy: Play Therapy:

Implications for Child Implications for Child CounselorsCounselors

Dr. Dale-Elizabeth PehrssonDr. Dale-Elizabeth Pehrsson

Nevada Play Therapy AssociationNevada Play Therapy Association

Fall Conference, 2007Fall Conference, 2007

All sorrows can be borne if we put them into a story or All sorrows can be borne if we put them into a story or tell a story about them…tell a story about them…

(adapted from Isak Dennison)(adapted from Isak Dennison)

Using Bibliotherapy Using Bibliotherapy within Play Therapy:within Play Therapy:Guidelines to PracticeGuidelines to Practice

Dr. Dale-Elizabeth Pehrsson Dr. Dale-Elizabeth Pehrsson NCC, LCPC (Id), RPT-S, RNNCC, LCPC (Id), RPT-S, RN

Department of Counselor EducationDepartment of Counselor EducationUNLVUNLV

Play TherapyPlay Therapy

The use of specific play The use of specific play interventions that are interventions that are theoretically driven and theoretically driven and facilitated by a professional facilitated by a professional mental health care giver with the mental health care giver with the deliberate intention of promoting deliberate intention of promoting healing, therapeutic growth or healing, therapeutic growth or positive behavioral changepositive behavioral change

So then… Just what ‘IS’ So then… Just what ‘IS’ Bibliotherapy?Bibliotherapy?

A rose by any other name…A rose by any other name…

Bibliocounseling Bibliocounseling Bibliopsychology Bibliopsychology Bookmatching Bookmatching Literatherapy Literatherapy Library Therapeutics Library Therapeutics Guided ReadingGuided Reading BiblioGuidanceBiblioGuidance And…And…

Bibliotherapy is…Bibliotherapy is…

Bibliotherapy is a combination of Bibliotherapy is a combination of the Greek words for therapy and the Greek words for therapy and booksbooks

Samuel Crothers first coined Samuel Crothers first coined ‘Bibliotherapy’ in 1916 ‘Bibliotherapy’ in 1916 (Atlantic (Atlantic Monthly)Monthly)

““Treatment through books” Treatment through books” (Pardeck (Pardeck & Pardeck, 1998) & Pardeck, 1998)

““Therapeutic use of literature” Therapeutic use of literature” (Cohen, 1993)(Cohen, 1993)

““The process of dynamic The process of dynamic interaction between the personality interaction between the personality of the reader and literature under of the reader and literature under the guidance of a trained helper” the guidance of a trained helper” (Shrodes, 1950)(Shrodes, 1950)

Distinction found most useful is Distinction found most useful is practice basedpractice based

Clinical BibliotherapyClinical Bibliotherapy is implemented by trained is implemented by trained helping professionals dealing with significant helping professionals dealing with significant emotional or behavioral problemsemotional or behavioral problems

Developmental BibliotherapyDevelopmental Bibliotherapy which may be used which may be used by teachers, librarians or lay helpers to facilitate by teachers, librarians or lay helpers to facilitate normal development and self-actualization with an normal development and self-actualization with an essentially healthy populationessentially healthy population

A bit of history…A bit of history…

Oral storytellingOral storytelling

Written storiesWritten stories

Plays and TheatrePlays and Theatre

Many cultures use storyMany cultures use story

To teachTo teach To socializeTo socialize To entertainTo entertain To give guidanceTo give guidance To give joyTo give joy To give solaceTo give solace To honorTo honor To celebrateTo celebrate To mournTo mourn

We are wired for storyWe are wired for story

““Healing place of the soul”Healing place of the soul”((Inscription over the entrance to the ancient library at Thebes)Inscription over the entrance to the ancient library at Thebes)

AristotleAristotle proposed the notion of proposed the notion of emotional catharsisemotional catharsis

Freud Freud acknowledged his acknowledged his intellectual debt to creative artists intellectual debt to creative artists suggesting that they, not he, had suggesting that they, not he, had first ‘discovered’ the first ‘discovered’ the unconscious. Freud further unconscious. Freud further suggested that in the therapeutic suggested that in the therapeutic process creative artists are process creative artists are “valuable allies…” “valuable allies…”

HistoryHistory Early 1800’s…movement toward the Early 1800’s…movement toward the

moral/humane treatment of the insanemoral/humane treatment of the insane

Institutions founded and administered by Institutions founded and administered by the early Friends (Quaker) Societies the early Friends (Quaker) Societies embraced this approachembraced this approach

Reading became one of the most commonly Reading became one of the most commonly used therapeutic interventions, second only used therapeutic interventions, second only to physical exerciseto physical exercise

Moving to the Mid-19Moving to the Mid-19thth Century… Century… Several major medical Several major medical

hospitals established patient hospitals established patient librarieslibraries

Reading materials intended to: Reading materials intended to: distract their patientsdistract their patients connect them to the outside connect them to the outside

world during lengthy staysworld during lengthy stays engage them with positive engage them with positive

ideasideas give them hope and give them hope and

consolationconsolation

Early 1900’s Early 1900’s

American Library Association active in American Library Association active in establishing libraries for hospitals and other establishing libraries for hospitals and other therapeutic institutions therapeutic institutions

Belief in the “value of patients’ library service as Belief in the “value of patients’ library service as an adjunct to treatment & recovery of patientsan adjunct to treatment & recovery of patients

Early standards for patients’ libraries were Early standards for patients’ libraries were endorsed by the American Hospital Association endorsed by the American Hospital Association

and the American College of Surgeonsand the American College of Surgeons

The World WarsThe World Wars WWI …a major impetus for WWI …a major impetus for

expansion of patients’ libraries in expansion of patients’ libraries in general hospitals in Britain & general hospitals in Britain & America America Librarians/volunteers used reading to Librarians/volunteers used reading to

help soldiers recover from physical & help soldiers recover from physical & mental trauma of warmental trauma of war

US War Service (WW II), run by US War Service (WW II), run by ALA, boasted of library service to ALA, boasted of library service to more than 3,981 military service more than 3,981 military service points points

And as far away as Siberia and China And as far away as Siberia and China

Current Practice Current Practice

Rubin Rubin (1978)(1978) reported 35% of Bibliotherapy articles were in reported 35% of Bibliotherapy articles were in library journals and 65% in psychology, education, nursing and library journals and 65% in psychology, education, nursing and occupational therapy occupational therapy

Forrest Forrest (1993-97)(1993-97) identified 4 major groups: psychologists (57%), identified 4 major groups: psychologists (57%), librarians (20%), nurses (11%), and social workers (10%)librarians (20%), nurses (11%), and social workers (10%)

US regional & national surveys US regional & national surveys (1980s),(1980s), found Bibliotherapy used found Bibliotherapy used extensively by psychologists, psychiatrists and counselors extensively by psychologists, psychiatrists and counselors

Literature (1990 onward) indicates it is employed by Literature (1990 onward) indicates it is employed by nearly every helping profession, nearly every helping profession,

with all ages and with multiple populationswith all ages and with multiple populations

School Counselors School Counselors (Gladding & Gladding, 1991) (Gladding & Gladding, 1991)

Social Workers Social Workers (Pardeck & Pardeck, 1998a)(Pardeck & Pardeck, 1998a)

Mental Health Nurses Mental Health Nurses (Farkas & Yorker, 1993)(Farkas & Yorker, 1993)

Teachers Teachers (Kramer & Smith, 1998)(Kramer & Smith, 1998) Librarians Librarians (Bernstein & Rudman, 1989)(Bernstein & Rudman, 1989)

Range of problemsRange of problems: : aggressiveness (Shechtman, 1999, 2000)aggressiveness (Shechtman, 1999, 2000) adoption/ foster care (Pardeck, 1993; Sharkey, 1998)adoption/ foster care (Pardeck, 1993; Sharkey, 1998) diversity awareness/ valuation (Pardeck & Pardeck, 1998a; Tway, diversity awareness/ valuation (Pardeck & Pardeck, 1998a; Tway,

1989) 1989) death & dying (Meyer, 1994; Todahl, Smith, Barnes, & Pereira, death & dying (Meyer, 1994; Todahl, Smith, Barnes, & Pereira,

1998)1998) chemical dependency (Pardeck, 1991) chemical dependency (Pardeck, 1991) divorce (Early, 1993; Kramer & Smith, 1998; Meyer, 1991)divorce (Early, 1993; Kramer & Smith, 1998; Meyer, 1991) obsessive-compulsive disorder (Fritzler, Hecker, & Losee, 1997) obsessive-compulsive disorder (Fritzler, Hecker, & Losee, 1997) giftedness (Hebert, 1995)giftedness (Hebert, 1995) conflict resolution (Hodges, 1995) conflict resolution (Hodges, 1995) child abuse/ neglect (Jasmine-DeVias, 1995; Pardeck, 1990) child abuse/ neglect (Jasmine-DeVias, 1995; Pardeck, 1990) nightmares (Barclay & Whittington, 1992) nightmares (Barclay & Whittington, 1992) ethnic identity (Holman, 1996)ethnic identity (Holman, 1996) depression (Ackerson, Scogin, McKendree-Smith, & Lyman, 1998)depression (Ackerson, Scogin, McKendree-Smith, & Lyman, 1998) separation & loss (Bernstein & Rudman, 1989) separation & loss (Bernstein & Rudman, 1989) family violence (Butterworth & Fulmer, 1991) family violence (Butterworth & Fulmer, 1991) homelessness (Farkas & Yorker, 1993) homelessness (Farkas & Yorker, 1993) self-destructive behavior (Evans et al., 1999)self-destructive behavior (Evans et al., 1999)

Reported BenefitsReported Benefits Increasing self-awareness Increasing self-awareness Clarification of emerging valuesClarification of emerging values Development of one’s ethnic/cultural Development of one’s ethnic/cultural

identityidentity Greater empathic understanding of others Greater empathic understanding of others Increased appreciation of different Increased appreciation of different

cultures, viewpoints and lived experiences cultures, viewpoints and lived experiences Coping skills can be improved as Coping skills can be improved as

alternative responses to problems alternative responses to problems Negative emotions such as stress, anxiety Negative emotions such as stress, anxiety

and loneliness can be reducedand loneliness can be reduced Self-esteem, interpersonal skills and Self-esteem, interpersonal skills and

emotional maturity are often emotional maturity are often

Hypothesized Therapeutic MechanismsHypothesized Therapeutic Mechanisms

Shrodes Shrodes (1950),(1950), utilized a utilized a psychodynamic modelpsychodynamic model, , which focused on which focused on identificationidentification (or universalization), (or universalization), catharsiscatharsis (or abreaction) and (or abreaction) and insightinsight (and (and integration) as the key steps for therapeutic benefitintegration) as the key steps for therapeutic benefit

Others have since added Others have since added action action (application)(application)

Many writers since then have relied on these same Many writers since then have relied on these same

constructs.This model is more typically applied when constructs.This model is more typically applied when fiction is used than when non-fiction/ self-help books fiction is used than when non-fiction/ self-help books are the tools; then the model is often a cognitive-are the tools; then the model is often a cognitive-behavioral one behavioral one

Laura Cohen’s (1994) Laura Cohen’s (1994) …from the reader’s perspective …from the reader’s perspective

Well-functioning, non-clinical adult population who believed Well-functioning, non-clinical adult population who believed reading helped them through situations such as depression, reading helped them through situations such as depression, miscarriage, alcoholism, grief and physical illnesses miscarriage, alcoholism, grief and physical illnesses

Participants selected materials ranging from Participants selected materials ranging from poetry - fiction - motivational - self-help poetry - fiction - motivational - self-help

IdentificationIdentification with the character/situation in selected literature with the character/situation in selected literature was acknowledged by virtually all readers as key to experiencing was acknowledged by virtually all readers as key to experiencing positive effects from reading, regardless of genre positive effects from reading, regardless of genre

OtherOther benefits described by readers validated emotional, dynamic benefits described by readers validated emotional, dynamic and cognitive modelsand cognitive models

Emotional BenefitsEmotional Benefits

Relieving feelings of isolation by learning that others shared their Relieving feelings of isolation by learning that others shared their experience (universalization) experience (universalization)

Gaining comfort or reassurance Gaining comfort or reassurance Finding hope from hearing how others had dealt with similar situations Finding hope from hearing how others had dealt with similar situations

in a positive fashion (an expectation for a good outcome) in a positive fashion (an expectation for a good outcome) Being motivated to act differently Being motivated to act differently

Temporary escape from pressing problemsTemporary escape from pressing problemsEmotional release or relief (catharsis) Emotional release or relief (catharsis)

Cognitive Benefits Cognitive Benefits

Increasing understanding of their feelings Increasing understanding of their feelings and ideas (insight and integration)and ideas (insight and integration)

Gaining knowledge such as facts, Gaining knowledge such as facts, information, advice or recommendations information, advice or recommendations which helped them make decisions and which helped them make decisions and talk effectively with gatekeepers such as talk effectively with gatekeepers such as health care providershealth care providers

Cautionary AdviceCautionary Advice Zaccaria and Moses Zaccaria and Moses (1968)(1968) “is not a “is not a

panacea… neither can it be used with all panacea… neither can it be used with all individuals”individuals”

Shrodes Shrodes (1950)(1950)…“For no two persons can …“For no two persons can there be an absolute equivalence of there be an absolute equivalence of symbols, for no two people have symbols, for no two people have identical psychological fields” identical psychological fields” (p.85)(p.85)

Above all, therapists should be…Above all, therapists should be… well acquainted with content of materialswell acquainted with content of materials they intend to recommend or use they intend to recommend or use

More cautionsMore cautions Helpers must beHelpers must be familiar enough with familiar enough with

reader/listener/client(s)reader/listener/client(s), to anticipate their state of , to anticipate their state of readiness and reading of materialsreadiness and reading of materials

Helpers must be Helpers must be sensitive to cultural, ethnic and sensitive to cultural, ethnic and religious messagesreligious messages in material in material

Helpers should ensure that Helpers should ensure that factual materialfactual material is is accurateaccurate and up to dateand up to date

Helpers should utilize stories with Helpers should utilize stories with characterscharacters and and situations situations similar enoughsimilar enough to facilitate some level of to facilitate some level of identification identification increase empathy and understanding for those from increase empathy and understanding for those from

different backgroundsdifferent backgrounds to provide needed distance from painful emotionsto provide needed distance from painful emotions

Play Therapy and BibliotherapyPlay Therapy and Bibliotherapy Very Adlerian (Individual Psychology) with specific Very Adlerian (Individual Psychology) with specific

credit for adapting this construct for Play Therapy credit for adapting this construct for Play Therapy (Kottman, 2002)(Kottman, 2002)

Establishing a therapeutic relationshipEstablishing a therapeutic relationship Exploring client and family lifestyleExploring client and family lifestyle Promoting insightPromoting insight Re-educating and Re-orientating (Jackson, 2001)Re-educating and Re-orientating (Jackson, 2001)

Also… Cognitive Behavioral ParadigmAlso… Cognitive Behavioral Paradigm As well as Solution FocusedAs well as Solution Focused And adapts well to Brief Therapy Models…And adapts well to Brief Therapy Models…

Final Caution…Final Caution…

Don’t confuse teaching reading and using Don’t confuse teaching reading and using books in therapy…books in therapy…

The goals and processes are very differentThe goals and processes are very different

Confusing the processes could have negative Confusing the processes could have negative outcomes and disrupt the client and play outcomes and disrupt the client and play therapist relationshiptherapist relationship

(Pehrsson & Pehrsson, 2006)(Pehrsson & Pehrsson, 2006)

Bibliotherapy InterventionsBibliotherapy Interventions

So many choices… so little time…So many choices… so little time…

1.1. Recommend a book for self reading (older clients)Recommend a book for self reading (older clients)

2.2. Reading to or along with the client in a session (also Filial)Reading to or along with the client in a session (also Filial)

3.3. Reading and reacting to the readings with playReading and reacting to the readings with play

4.4. Reading to a group of clients in group play therapyReading to a group of clients in group play therapy

5.5. Reading and writing and journalingReading and writing and journaling

6.6. Reading for information (CBT)Reading for information (CBT)

7.7. Story starters or discussion startersStory starters or discussion starters

8.8. Reading and reacting with art, poetry, dramaReading and reacting with art, poetry, drama

9.9. Reading and books in guidanceReading and books in guidance

10.10. And so many more…And so many more…

Categories for Therapist Categories for Therapist EvaluationEvaluation

General InfoGeneral Info General Format and General Format and

StructureStructure Subject MatterSubject Matter Reading Level and Reading Level and

SuitabilitySuitability Book LengthBook Length Text and PicturesText and Pictures

Developmental levelDevelopmental level Diversity FactorsDiversity Factors Usage:Usage:

ContextContext Environment Environment Situation Situation

Therapeutic UseTherapeutic Use Overall ImpressionOverall Impression

General Format and StructureGeneral Format and Structure

Play Therapist gets the “Gestalt” of the bookPlay Therapist gets the “Gestalt” of the book

More from an overview perspective More from an overview perspective

If it is a fictional book, assess factors such as If it is a fictional book, assess factors such as plot cohesiveness, character development, plot cohesiveness, character development, universality of the story line, and general universality of the story line, and general quality of the textquality of the text

Subject MatterSubject Matter

Therapist identifies major themes. Therapist identifies major themes. Whether fiction or non-fiction there is usually a subject Whether fiction or non-fiction there is usually a subject

(or multiple subjects) addressed within the material(or multiple subjects) addressed within the material

Therapist also assesses factors such as relevance of Therapist also assesses factors such as relevance of material, interest level, and writing style to material, interest level, and writing style to determine general “reader-subject fit”determine general “reader-subject fit”

A guiding question should be A guiding question should be ““is this book a good match for the client?”is this book a good match for the client?”

Reading Level and SuitabilityReading Level and Suitability Therapists are not reading specialists yet it is important to Therapists are not reading specialists yet it is important to

evaluate material regarding reading level and suitabilityevaluate material regarding reading level and suitability

Some materials identify reading or age level, some do not. So Some materials identify reading or age level, some do not. So it is up to the helper to make their “best guess” as to the it is up to the helper to make their “best guess” as to the appropriateness appropriateness (consult a teacher or librarian)(consult a teacher or librarian)

Another consideration… how will material be applied. If the Another consideration… how will material be applied. If the clinician is reading to the client, it matters less if the level is clinician is reading to the client, it matters less if the level is an exact client skill match an exact client skill match

Rhyming and other stylistic devices may influence how the Rhyming and other stylistic devices may influence how the helper chooses to use the materialhelper chooses to use the material

Book LengthBook Length

Book length is directly correlated to treatment Book length is directly correlated to treatment interventionintervention

Therapists consider how long will it take to read through Therapists consider how long will it take to read through or use material or use material

Clinicians look at book format and lengthClinicians look at book format and length Counselors decide how the text will be utilizedCounselors decide how the text will be utilized

Session to session? (Usually with older children)Session to session? (Usually with older children) Home reading? Family Reading? Home reading? Family Reading? One time read?One time read?

Individual client characteristics also influence how long it Individual client characteristics also influence how long it will take to use a book and in what mannerwill take to use a book and in what manner

Text and PicturesText and Pictures

Evaluate print (text) and illustrations Evaluate print (text) and illustrations Check congruence and mood created by the combination of Check congruence and mood created by the combination of

print and picturesprint and pictures Age appropriate ArtAge appropriate Art Political Appropriate ArtPolitical Appropriate Art Culturally respectful IllustrationsCulturally respectful Illustrations EngagingEngaging Counselor looks at quantity and qualityCounselor looks at quantity and quality

Once an intervention strategy is identified, then ask…Once an intervention strategy is identified, then ask…

Will this text create a positive therapeutic effect for this Will this text create a positive therapeutic effect for this particular client?”particular client?”

Developmental LevelDevelopmental Level Consider clients from a holistic perspective, Consider clients from a holistic perspective,

age, age, diagnosis, diagnosis, presenting concern,presenting concern, family issues, family issues, cultural aspects,cultural aspects, language language and grade and grade

Look at therapeutic readiness/stage of counseling Look at therapeutic readiness/stage of counseling Evaluate fit/match of text, character, subject matter Evaluate fit/match of text, character, subject matter Assess appropriateness of text’s usage with populations Assess appropriateness of text’s usage with populations

who may be at multiple developmental levelswho may be at multiple developmental levels

Diversity FactorsDiversity Factors

Assess material from the vantage point of Assess material from the vantage point of diversity, community, religion, race, ethnicity diversity, community, religion, race, ethnicity and cultureand culture

Respectful presentation, culturally appropriate, Respectful presentation, culturally appropriate, world view expansive and match client needsworld view expansive and match client needs

Ensure that sEnsure that stereotypingtereotyping does not exist does not exist Examine relevancy and current nature Examine relevancy and current nature Authentic authors and illustrators Authentic authors and illustrators Check administrative & political impactCheck administrative & political impact

Use:Use:Context, Environment, SituationContext, Environment, Situation

Assess environment/situation for material useAssess environment/situation for material use Consider settingConsider setting

Home/FilialHome/Filial HealthcareHealthcare Mental health /ClinicMental health /Clinic School/education School/education Social servicesSocial services Private PracticePrivate Practice

Consider client populationConsider client population

Therapeutic Use:Therapeutic Use: Consider how the text will usedConsider how the text will used

Consider treatment intervention and application of text:Consider treatment intervention and application of text: Choral readingChoral reading Reading to the client or the group Reading to the client or the group Reading with the client/family Reading with the client/family Reading and reactingReading and reacting

Art, writing, story telling, play and dramaArt, writing, story telling, play and drama

Consider impact on client growth, the question Consider impact on client growth, the question ““What will this do for the therapeutic movement of my What will this do for the therapeutic movement of my

client?”client?”

Questions and commentsQuestions and comments

‘‘Dr. Dale’Dr. Dale’Dale-Elizabeth Pehrsson Dale-Elizabeth Pehrsson dale.pehrsson@unlv.edudale.pehrsson@unlv.edu

Be sure to check out the Be sure to check out the evaluation tool and other evaluation tool and other resources on the various resources on the various pages of The Bibliotherapy pages of The Bibliotherapy Education Project website:Education Project website:http://bibliotherapy.library.oregonstate.edu

Thank YouThank You