Dale-Elizabeth Pehrsson and Paula McMillen
A mutual interest in helping graduate counseling students to effectively use books as an adjunct in therapy initiated a collaboration between the co-authors that began in 1999 and has since expanded in focus. Bibliotherapy, facilitating personal development or problem resolution through books, is utilized in many helping professions; however, we found little in the literature regarding the preparation of emerging counselors for theoretically grounded, ethical use of this approach. Based on our own areas of expertise and an extensive literature review, we identified the essential criteria articulated by practitioners for evaluating materials to be used in counseling settings. Subsequently, we developed a tool that systematically walks the practitioner through the process for evaluating literature for potential use with a client. The evaluation tool became the core of the Bibliotherapy Education Project, which now includes a teaching module, a gateway to print and electronic resources on Bibliotherapy, and sponsorship of student research projects. In addition, the book evaluations, completed using our tool, are now available in a searchable database on our website.
Our project began when we wanted to introduce bibliotherapy as a therapeutic tool in the advanced Theories and Techniques course for graduate Counselor Education students. We were surprised to find no mention in the literature of formal training for graduate students and practicing professionals, although books are widely used in the helping professions. Just as with any other therapeutic intervention, we believe that ethical use of bibliotherapy within the counseling context requires education and training for professional grounding. We felt compelled to address this concern, initially focusing our efforts on the creation of a book evaluation tool. The construction of the Bibliotherapy Evaluation Tool (BET) © was based on clinical practices, literary genres, theoretical constructs and a thorough review of the literature. It has undergone multiple revisions with feedback from graduate students, teaching faculty and practicing professionals. The BET has been utilized in several teaching and research projects which have informed further refinements and added essential components to the teaching/training process (Pehrsson & McMillen, 2005). The tool began as a simple paper and pencil questionnaire that guided the user through a series of questions addressing format, subject matter, suitability, text and illustrations, diversity and cultural considerations, developmental level, context for use, population, value and therapeutic practices. The authors’ successful application for two teaching improvement grants allowed us to create a multidisciplinary team that transformed the BET from paper to electronic format and to create an accompanying web site where the BET is available to counselor educators, students, and helping professionals.
The BET is one rather detailed aspect of what has become a larger project, the Bibliotherapy Education Project (BEP: http://bibliotherapy.library.oregonstate.edu). In addition to the two primary researchers, we involved computer programmers, design specialists, graduate counseling students (masters and doctoral level), library and literacy specialists, who work together and communicate regularly to continue development of our growing research project and website. The BEP website includes the BET, which is completed online and populates a database of reviews for books evaluated for therapeutic use. Additionally, we’ve created a page with links to both print and electronic resources for finding literature, focused at the present time on children and young adults. Separate pages summarize: background information about the two principle creators, the relevant presentations and publications of the authors, and related research projects and scholarship involving Bibliotherapy. It is our hope that the website will provide counselors and other helping professionals freely shared access to standardized educational and training processes for the ethical practice of Bibliotherapy. An additional goal is the construction of a quality database of clinical materials, techniques and resources.
Our review of the literatures in medicine, mental health, education and librarianship surveyed almost sixty years with a concentration on publications written after 1990. We found that bibliotherapy has been employed by nearly every helping profession, with all age groups, in multiple populations, and with a wide range of benefits (McMillen & Pehrsson, 2004; Pehrsson & McMillen, 2005). Bibliotherapy, initially a collaboration between library and healthcare professionals, has now become widely adopted by counselors, psychologists and social workers. The United States has a long history of helping medical and mental patients with books. In the 1930’s the Menningers even wrote their own book for use with patients at the Menninger Clinic. Later, Shrodes wrote the first scholarly treatise postulating psychological mechanisms for bibliotherapy (1950). Her psychodynamic model focused on the processes of identification, catharsis and insight; this model fits best when fiction, rather than non-fiction/self-help material, is used. Shrodes argues that such literature assists in the reader’s understanding of drives and consequences; it is imaginative literature that will provide the client with an affective experience that moves them forward therapeutically (1950, p.33). The therapeutic processes of bibliotherapy are flexible enough to accommodate non-dynamic counselor orientations as well. Those who utilize more cognitive-behavioral approaches rely on non-fiction genres to facilitate cognitive changes. When used in group settings, social learning mechanisms such as feedback, modeling, practicing adaptive behaviors, and hearing alternative perspectives play a role in therapeutic growth. Bibliotherapy is an adjunct to, not a substitute for the counseling process. Shrodes and subsequent writers emphasize that individual reactions to a given work will never be identical: “For no two persons can there be an absolute equivalence of symbols, for no two people have identical psychological fields” (1950, p.85) .
Benefits of Bibliotherapy
Bibliotherapy has numerous benefits; among these are easy access to a wide variety of books, flexibility in application to various settings, and use with a range of presenting problems and clients. Stories can provide vicarious immersion into another culture, offering exposure to alternative lifestyles and beliefs. Some studies find multicultural literature leads to an increased appreciation of different cultures, viewpoints and lived experiences. Conversely, literature can enhance development of one’s own ethnic/cultural identity. Effective use of bibliotherapy can enhance personal insight, provide information, suggest alternatives, diminish isolation, clarify emerging values, stimulate discussion and extend the counseling process outside of traditional settings. A more complete review of the literature on beneficial therapeutic outcomes is found in Pehrsson and McMillen (2005).
Similarly, a review of
the literature in medicine, mental health and education finds Bibliotherapy
applied therapeutically to an astounding range of problems and issues.
These include: aggressiveness, adoption, addictions, family dissolution,
cultural awareness and ethic identity, grief and loss, physical abuse
and domestic trauma, dispute resolution, clinical depression, talented
and gifted children, homelessness, night terrors, obsessive-compulsive
disorder and self-destructive behavior. (See Pehrsson
Certification and Training
Physicians and librarians were the pioneers in the practice of bibliotherapy. The qualifications of physicians were not questioned; however, the credentials of librarians were hotly debated. From 1920 through 1960, efforts were made to enhance librarian training in hospital organization, biology, and human development processes, to better prepare them to work with patients (McMillen & Pehrsson, 2004). Programs were created at library schools, ranging from intensive summers sessions to five-year programs. The impetus for training in this type of librarianship has diminished, perhaps because, as Schlenther suggests, fields covered are too diverse or the practices so multi-faceted (1999).
Other counseling approaches utilizing creative arts, such as Dance, Music, Art, and Play Therapies, have established minimal requirements for practitioners. Early efforts for standardized preparation for bibliotherapists were not sustained. Today, the National Association of Poetry Therapy provides training and supervision guidelines, and offers certification and registration, for individuals who practice Poetry and Bibliotherapy. Poetry Therapists include the use of bibliotherapy with other therapeutic modalities involving literature such as poetry, storytelling, journal writing; consequently, Bibliotherapy does not stand alone in the training process, but is a sub-discipline under the main focus of using poetry in therapy. The similarities in terms of goals and hypothesized therapeutic mechanisms for the expressive therapies seem to outweigh differences between the specific modalities. Most of these expressive therapies rely on psychodynamically oriented theories to explain therapeutic benefits, as do bibliotherapists who use imaginative and fictional materials. Creative and express arts counselors receive graduate training and supervised practice in a modality before they are considered by their peers to be sufficiently qualified for independent practice, and continuing education is required to maintain credentials. Bibliotherapy merits its own set of training and practice standards with similar continuing education as a strong recommendation. (See association websites in the References for specific credentialing information.)
Cultural Benefits and Focus
One of the major benefits of culturally appropriate bibliotherapy can be the increased appreciation for one’s own culture and customs and greater identification with and pride in one’s own ethnic/cultural membership. Literature reflecting culture, lifestyle, or ethnicity can serve as a mirror and acknowledgement; publication connotes a certain legitimacy and value. How invisible must people feel when they are not reflected, or not reflected fully and accurately in media? The exclusive reliance on electronic media (e.g., television) would do little to foster positive self-identification for members of many underrepresented groups, nor accurately portray these groups to others. Conversely, quality multicultural literature provides increased appreciation for groups, beliefs, customs and lifestyles different from one’s own. If young people are exposed to literature portraying only a dominant culture, it is easy to assume that this is the way to look, think, speak and behave; they might conclude difference is less valuable.
No individual is the definitive representative of culture; likewise, no single work of literature adequately represents a culture. This perspective is an essential part of using multicultural bibliotherapy appropriately. It is vital to discuss cultural stereotypes in literature, even with works that are written by members of non-dominant groups. There is ongoing debate in the field of literature regarding authenticity. Can someone, who is not a member of a cultural, ethnic, or lifestyle group, accurately write about that group? Do ‘outsiders’ have the right to speak for others, especially if they haven’t lived their lives and confronted their daily issues? Clients may have strong reactions to a dominant culture person claiming the authority to speak for them. Counselors should be sensitive to how authors represent the culture or group in question, as well as to client reactions to that portrayal.
To access the Bibliotherapy
Evaluation Tool, users register as a reviewer by providing basic demographic
information. Measures have been taken to insure the confidentiality of
the reviewer’s identity and names only appear on the review if desired
by the reviewer. Once a reviewer is registered and creates a review, their
password protects the review from alteration by others. Reviewers, using
a book of their choosing, follow a guided questioning process to evaluate
the book from a clinical perspective, filling in the online form. Some
information is factual; other questions require critical analysis or subjective
opinion. Once the form is completed, researchers check the data and, if
appropriate post it to the publicly accessible database. Research has
indicated that reviewers who evaluate two or three books become more comfortable
with and knowledgeable about evaluating potential therapeutic material
This paper reviewed the inception and development of the Bibliotherapy Education Project, which included a discussion of the development of the Bibliotherapy Evaluation Tool. Also provided were an overview of the history, benefits, uses, and therapeutic mechanisms of bibliotherapy. As with other expressive and creative arts therapies, there is a need for consistent and rigorous preparation of emerging and practicing helping professionals who want to ethically and appropriately use bibliotherapy. We emphasized the necessity for bibliotherapists working with clients that are not a part of the dominant culture to understand the issues around multicultural literature. Finally, we summarized the process for using the BET and its training value. The Bibliotherapy Education Project is part of the authors’ ongoing efforts to advocate for theoretically grounded and culturally competent practice, and to facilitate access to tools and resources that support that goal.
American Art Therapy Association, Inc., (n.d.). Retrieved Aug. 03, 2005, from American Art Therapy Association, Inc. Web site: http://www.arttherapy.org/.
American Dance Therapy Association, (n.d.). Retrieved Aug. 03, 2005, from American Dance Therapy Association Web site: http://www.adta.org/.
American Music Therapy Association, Inc., (2004). Retrieved Aug. 03, 2005, from American Music Therapy Association: Music Therapy Makes a Difference Web site: http://www.musictherapy.org.
Association for Play Therapy, Inc., (2005). Retrieved Aug. 03, 2005, from Association for Play Therapy, Inc. Web site: http://www.a4pt.org.
Bernstein, J. E., & Rudman, M. K. (1989). Books to help children cope with separation and loss: An annotated bibliography. Volume 3. New York: R.R. Bowker.
Pehrsson, D.E., & McMillen, P. (2005). A bibliotherapy evaluation tool: Grounding counselors in the therapeutic use of literature. The Arts in Psychotherapy, 32 (1), 47-59.
McMillen, P.S. and Pehrsson, D.E. (2004). Specialty of the house: Bibliotherapy for hospital patients. Journal of Hospital Librarianship, 4 (1), 73-82 (invited article).
National Association for Poetry Therapy, (2005). Retrieved Aug. 03, 2005, from National Association for Poetry Therapy Web site: http://www.poetrytherapy.org/.
National Expressive Therapy Association, (n.d.). Retrieved Aug. 03, 2005, from www.expressivetherapy.com Web site: http://www.expressivetherapy.com/.
Schlenther, E. (1999). Using reading therapy with children. Health Libraries Review, 16(1), 29-37.
Shrodes C. (1950). Bibliotherapy: A theoretical and clinical-experimental study [dissertation]. Berkeley (CA): University of California.