Using Bibliotherapy within Play Therapy: Implications for Child Counselors

1. Using Bibliotherapy within Play Therapy: Implications for Child Counselors Dr. Dale-Elizabeth Pehrsson Nevada Play Therapy Association Fall Conference, 2007

2. All sorrows can be borne if we put them into a story or tell a story about them…(adapted from Isak Dennison)

3. Using Bibliotherapy within Play Therapy:Guidelines to Practice Dr. Dale-Elizabeth Pehrsson NCC, LCPC (Id), RPT-S, RN Department of Counselor Education UNLV

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

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

6. A rose by any other name… • Bibliocounseling • Bibliopsychology • Bookmatching • Literatherapy • Library Therapeutics • Guided Reading • BiblioGuidance • And…

7. Bibliotherapy is… • Bibliotherapy is a combination of the Greek words for therapy and books • Samuel Crothers first coined ‘Bibliotherapy’ in 1916 (Atlantic Monthly) • “Treatment through books” (Pardeck & Pardeck, 1998) • “Therapeutic use of literature” (Cohen, 1993) • “The process of dynamic interaction between the personality of the reader and literature under the guidance of a trained helper” (Shrodes, 1950)

8. Distinction found most useful is practice based • Clinical Bibliotherapy is implemented by trained helping professionals dealing with significant emotional or behavioral problems • Developmental Bibliotherapy which may be used by teachers, librarians or lay helpers to facilitate normal development and self-actualization with an essentially healthy population

9. A bit of history… Oral storytelling Written stories Plays and Theatre

10. Many cultures use story • To teach • To socialize • To entertain • To give guidance • To give joy • To give solace • To honor • To celebrate • To mourn • We are wired for story

11. “Healing place of the soul”(Inscription over the entrance to the ancient library at Thebes) • Aristotle proposed the notion of emotional catharsis • Freud acknowledged his intellectual debt to creative artists suggesting that they, not he, had first ‘discovered’ the unconscious. Freud further suggested that in the therapeutic process creative artists are “valuable allies…”

12. History Early 1800’s…movement toward the moral/humane treatment of the insane • Institutions founded and administered by the early Friends (Quaker) Societies embraced this approach • Reading became one of the most commonly used therapeutic interventions, second only to physical exercise

13. Moving to the Mid-19th Century… • Several major medical hospitals established patient libraries • Reading materials intended to: • distract their patients • connect them to the outside world during lengthy stays • engage them with positive ideas • give them hope and consolation

14. Early 1900’s • American Library Association active in establishing libraries for hospitals and other therapeutic institutions • Belief in the “value of patients’ library service as an adjunct to treatment & recovery of patients • Early standards for patients’ libraries were endorsed by the American Hospital Association and the American College of Surgeons

15. The World Wars • WWI …a major impetus for expansion of patients’ libraries in general hospitals in Britain & America • Librarians/volunteers used reading to help soldiers recover from physical & mental trauma of war • US War Service (WW II), run by ALA, boasted of library service to more than 3,981 military service points • And as far away as Siberia and China

16. Current Practice • Rubin (1978) reported 35% of Bibliotherapy articles were in library journals and 65% in psychology, education, nursing and occupational therapy • Forrest (1993-97) identified 4 major groups: psychologists (57%), librarians (20%), nurses (11%), and social workers (10%) • US regional & national surveys (1980s), found Bibliotherapy used extensively by psychologists, psychiatrists and counselors

17. Literature (1990 onward) indicates it is employed by nearly every helping profession, with all ages and with multiple populations • School Counselors (Gladding & Gladding, 1991) • Social Workers (Pardeck & Pardeck, 1998a) • Mental Health Nurses (Farkas & Yorker, 1993) • Teachers (Kramer & Smith, 1998) • Librarians (Bernstein & Rudman, 1989)

18. Range of problems: • aggressiveness (Shechtman, 1999, 2000) • adoption/ foster care (Pardeck, 1993; Sharkey, 1998) • diversity awareness/ valuation (Pardeck & Pardeck, 1998a; Tway, 1989) • death & dying (Meyer, 1994; Todahl, Smith, Barnes, & Pereira, 1998) • chemical dependency (Pardeck, 1991) • divorce (Early, 1993; Kramer & Smith, 1998; Meyer, 1991) • obsessive-compulsive disorder (Fritzler, Hecker, & Losee, 1997) • giftedness (Hebert, 1995) • conflict resolution (Hodges, 1995) • child abuse/ neglect (Jasmine-DeVias, 1995; Pardeck, 1990) • nightmares (Barclay & Whittington, 1992) • ethnic identity (Holman, 1996) • depression (Ackerson, Scogin, McKendree-Smith, & Lyman, 1998) • separation & loss (Bernstein & Rudman, 1989) • family violence (Butterworth & Fulmer, 1991) • homelessness (Farkas & Yorker, 1993) • self-destructive behavior (Evans et al., 1999)

19. Reported Benefits • Increasing self-awareness • Clarification of emerging values • Development of one’s ethnic/cultural identity • Greater empathic understanding of others • Increased appreciation of different cultures, viewpoints and lived experiences • Coping skills can be improved as alternative responses to problems • Negative emotions such as stress, anxiety and loneliness can be reduced • Self-esteem, interpersonal skills and emotional maturity are often

20. Hypothesized Therapeutic Mechanisms • Shrodes (1950), utilized a psychodynamic model, which focused on identification (or universalization), catharsis (or abreaction) and insight (and integration) as the key steps for therapeutic benefit • Others have since added action (application) • Many writers since then have relied on these same constructs.This model is more typically applied when fiction is used than when non-fiction/ self-help books are the tools; then the model is often a cognitive-behavioral one

21. Laura Cohen’s (1994) …from the reader’s perspective • Well-functioning, non-clinical adult population who believed reading helped them through situations such as depression, miscarriage, alcoholism, grief and physical illnesses • Participants selected materials ranging from • poetry - fiction - motivational - self-help • Identification with the character/situation in selected literature was acknowledged by virtually all readers as key to experiencing positive effects from reading, regardless of genre • Otherbenefits described by readers validated emotional, dynamic and cognitive models

22. Emotional Benefits Relieving feelings of isolation by learning that others shared their experience (universalization) Gaining comfort or reassurance Finding hope from hearing how others had dealt with similar situations in a positive fashion (an expectation for a good outcome) Being motivated to act differently Temporary escape from pressing problems Emotional release or relief (catharsis)

23. Cognitive Benefits • Increasing understanding of their feelings and ideas (insight and integration) • Gaining knowledge such as facts, information, advice or recommendations which helped them make decisions and talk effectively with gatekeepers such as health care providers

24. Cautionary Advice • Zaccaria and Moses (1968) “is not a panacea… neither can it be used with all individuals” • Shrodes (1950)…“For no two persons can there be an absolute equivalence of symbols, for no two people have identical psychological fields” (p.85) • Above all, therapists should be… • well acquainted with content of materialsthey intend to recommend or use

25. More cautions • Helpers must be familiar enough with reader/listener/client(s), to anticipate their state of readiness and reading of materials • Helpers must be sensitive to cultural, ethnic and religious messages in material • Helpers should ensure that factual material is accurate and up to date • Helpers should utilize stories with characters and situations similar enough to facilitate some level of identification • increase empathy and understanding for those from different backgrounds • to provide needed distance from painful emotions

26. Play Therapy and Bibliotherapy • Very Adlerian (Individual Psychology) with specific credit for adapting this construct for Play Therapy (Kottman, 2002) • Establishing a therapeutic relationship • Exploring client and family lifestyle • Promoting insight • Re-educating and Re-orientating (Jackson, 2001) • Also… Cognitive Behavioral Paradigm • As well as Solution Focused • And adapts well to Brief Therapy Models…

27. Final Caution… • Don’t confuse teaching reading and using books in therapy… • The goals and processes are very different • Confusing the processes could have negative outcomes and disrupt the client and play therapist relationship • (Pehrsson & Pehrsson, 2006)

28. Bibliotherapy Interventions • So many choices… so little time…

29. Recommend a book for self reading (older clients) • Reading to or along with the client in a session (also Filial) • Reading and reacting to the readings with play • Reading to a group of clients in group play therapy • Reading and writing and journaling • Reading for information (CBT) • Story starters or discussion starters • Reading and reacting with art, poetry, drama • Reading and books in guidance • And so many more…

30. General Info General Format and Structure Subject Matter Reading Level and Suitability Book Length Text and Pictures Developmental level Diversity Factors Usage: Context Environment Situation Therapeutic Use Overall Impression Categories for Therapist Evaluation

31. General Format and Structure • Play Therapist gets the “Gestalt” of the book • More from an overview perspective • If it is a fictional book, assess factors such as plot cohesiveness, character development, universality of the story line, and general quality of the text

32. Subject Matter • Therapist identifies major themes. • Whether fiction or non-fiction there is usually a subject (or multiple subjects) addressed within the material • Therapist also assesses factors such as relevance of material, interest level, and writing style to determine general “reader-subject fit” • A guiding question should be • “is this book a good match for the client?”

33. Reading Level and Suitability • Therapists are not reading specialists yet it is important to evaluate material regarding reading level and suitability • 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 appropriateness • (consult a teacher or librarian) • Another consideration… how will material be applied. If the clinician is reading to the client, it matters less if the level is an exact client skill match • Rhyming and other stylistic devices may influence how the helper chooses to use the material

34. Book Length • Book length is directly correlated to treatment intervention • Therapists consider how long will it take to read through or use material • Clinicians look at book format and length • Counselors decide how the text will be utilized • Session to session? (Usually with older children) • Home reading? Family Reading? • One time read? • Individual client characteristics also influence how long it will take to use a book and in what manner

35. Text and Pictures • Evaluate print (text) and illustrations • Check congruence and mood created by the combination of print and pictures • Age appropriate Art • Political Appropriate Art • Culturally respectful Illustrations • Engaging • Counselor looks at quantity and quality • Once an intervention strategy is identified, then ask… Will this text create a positive therapeutic effect for this particular client?”

36. Developmental Level • Consider clients from a holistic perspective, • age, • diagnosis, • presenting concern, • family issues, • cultural aspects, • language • and grade • Look at therapeutic readiness/stage of counseling • Evaluate fit/match of text, character, subject matter • Assess appropriateness of text’s usage with populations who may be at multiple developmental levels

37. Diversity Factors • Assess material from the vantage point of diversity, community, religion, race, ethnicity and culture • Respectful presentation, culturally appropriate, world view expansive and match client needs • Ensure that stereotyping does not exist • Examine relevancy and current nature • Authentic authors and illustrators • Check administrative & political impact

38. Use:Context, Environment, Situation • Assess environment/situation for material use • Consider setting • Home/Filial • Healthcare • Mental health /Clinic • School/education • Social services • Private Practice • Consider client population

39. Therapeutic Use: • Consider how the text will used • Consider treatment intervention and application of text: • Choral reading • Reading to the client or the group • Reading with the client/family • Reading and reacting • Art, writing, story telling, play and drama • Consider impact on client growth, the question “What will this do for the therapeutic movement of my client?”

40. Questions and comments

41. ‘Dr. Dale’Dale-Elizabeth Pehrsson dale.pehrsson@unlv.edu Be sure to check out the evaluation tool and other resources on the various pages of The Bibliotherapy Education Project website: http://bibliotherapy.library.oregonstate.edu Thank You