Guide Using Bibliotherapy in Clinical Practice: A Guide to Self-Help Books (Contributions in Legal Studies)

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In contrast, Guydish 32 found no evidence that any of the three interventions used in his study was effective in reducing alcohol consumption. However, his work used university students rather than alcoholics seeking psychiatric help. Guydish's article scored 2 out of 17, the lowest mark on Apodaca and Miller's methodological quality table. It is therefore reasonable to conclude that the study is of insufficient quality and relevance. Results from the screening programme group showed more variable outcomes. The majority of studies showed some level of reduction in drinking with participants using bibliotherapy; in cases where drinking was not reduced, other problems were alleviated.

Participants were assigned to a group using materials prepared for MACT therapeutic reading, or a control group continuing with their existing treatment. The results were more pronounced than in Gould, Clum and Shapiro's study. Results in this RCT showed significant reductions in symptoms for the group receiving therapy compared to the wait list control group. The authors recommend further study to confirm this theory.

Febbraro 54 compared the use of bibliotherapy alone, bibliotherapy with phone contact, and phone contact alone in an RCT. The authors conclude that bibliotherapy can form an effective adjunct to psychotherapies. It was not possible to reach any conclusions as to the efficacy of bibliotherapy for other sexual dysfunctions as too little original research was available. Results differ from those reported for other disorders, finding that participants in a skills training group showed significant improvement over the bibliotherapy group. It should be noted that unlike the majority of studies, subjects were not volunteers.

As already noted, bibliotherapy may be less effective when participants are not volunteers. The research quality of the studies was from poor to moderate, and the authors argue that there needs to be more independent research, as program designers currently undertake most studies.

Preliminary findings showed symptoms were reduced in participants. However, the study should be viewed with caution: the sample size was small, and one of the authors owns intellectual property rights in the program being studied. To date there have been insufficient studies on the effectiveness of bibliotherapy in treating clinically severe conditions. The majority of authors recommend further research before definitive conclusions can be made. There is also little research in less formal bibliotherapy in the use of fiction, drama and poetry, despite papers having been published recommending their use.

Researchers aim to answer questions concerning the:. Examination of these studies shows a consistent requirement for educational and leisure facilities—and provision of services would need to consider the specialist requirements of patients and carers. Nurses also claimed to provide the information they described, however, patients did not express this as a need p.

Many spent their time pacing up and down the corridor. As part of the process of rehabilitation, residents were helped to learn about budgeting, cooking and homemaking, how to seek help, and how to enjoy leisure activities. This model places the needs of individual service users at the heart of the care planning process, prioritizing the need for understanding, emotional security and the role of education and leisure in rehabilitation.

For the past decade, hospitals have been required to record the ethnicity of all persons admitted. Provision of information was found to be poor, with patients and carers forced to seek alternative sources which were often of unreliable quality. Participants provided a comprehensive list of reasons for believing information to be a vital part of care planning p. The literature review shows that the value of using bibliotherapy and associated interventions in the treatment of mental illness is supported by the evidence.

The programme was supported by community nursing staves who were not psychiatric nursing specialists, but the implication is that bibliotherapy is part of the treatment and requires some professional support. An earlier review 3 suggested that reading therapy can be considered as an adjunct to library services, as such therapy seemed effective.

Ten years on, the conclusions are little different, but perhaps librarians need to work more closely with the health professionals to devise suitable therapeutic programmes that include bibliotherapy. Research has been hampered by the inability of researchers to mask the nature of the intervention to trial participants, due to the interactive nature of bibliotherapy, and factors such as the interaction of bibliotherapy with support from nursing contacts, for example.

Studies tend to use small sample sizes, meaning that testing to identify an effect as statistically significant is more difficult. There is also a lack of evidence relating to more serious mental illness. The need for accessible, quality information for service users and carers is strongly supported by the evidence.

The requirement for recreational materials has been a neglected area of research and requires further study, but anecdotal evidence suggests that provision of fiction and poetry would be beneficial. The question, perhaps, is the type of involvement and professional expertise required by the library staff. The project aimed to interest adults with mental health problems with the devices and designs on the old maps in the National Archives, to inspire them in the creation of a sculpture now in the grounds of the National Archives.

This was a successful project—but required considerable commitment from all the partners. There is little information available concerning library services for patients in UK facilities before the 20th century. There were no structured programmes of therapy or acknowledgements of the therapeutic value of reading.

Expansion of facilities for the mentally ill began in , before which there were few such institutions. Libraries were commonly funded by donations, with no stock selection other than the approval of donated materials. Eminent physicians and superintendents such as Benjamin Rush author of the first key psychiatric text in America promoted the benefits of library services to patients.

Samuel Woodward set aside part of his office to house a library for patients. William Rockwell helped his patients to produce their own newsletter. John Galt was instrumental in the development of bibliotherapy, and published the first essay devoted to the provision of libraries to the mentally ill. Charles Evans recommended the use of reading, encouraging patients to have free access to scientific books and materials.

James MacDonald promoted the circulation of periodicals at Bloomingdale asylum and organized the creation of a reading room.

One consequence of the First World War was a dramatic increase in rates of mental illness. Drake detailed her experiences at St. Elizabeth's Hospital for the Insane in Washington, DC, describing cases where the library service helped patients in their recovery. She supervised the creation of a reading room, organized a book trolley to visit the incapacitated, and encouraged patients to undertake voluntary work in the library. Most notable were E. This growth coincided with a series of upheavals amongst the ALA committees responsible for patient libraries, resulting in their gradual decline.

Interest in bibliotherapy was at its height between the Wars, and librarians wrote many papers during this period. Schneck's literature review found familiar themes running through the majority of papers: i Bibliotherapy was generally found to be an efficacious treatment; ii Patients should be assessed as individuals with unique needs; iii Material relating to suicidal acts or thoughts should not be permitted in the library; iv Fiction was popular, but there were few subjects which did not interest patients; and v Librarians frequently employed patients to assist in the library.

In she wrote of the positive feedback she received from patients expressing their appreciation of the library service. Over the same period of time, a lack of scientific evidence had caused some misgivings regarding the validity of bibliotherapy among librarians and managers, with several critics observing that scientific measurement of effect was virtually impossible given the nature of the intervention. Schneck noted that few psychiatrists published papers on bibliotherapy, with the result that other clinicians were not inspired to research the subject.

Again, the work of librarians notably Mona Going was instrumental in arousing interest. Professional bibliotherapist Arleen McCarty Hynes published several papers on the value of bibliotherapy, and advocated formal training for practitioners to ensure optimum effectiveness. She also commented on the interest patients had in the lives of poets, and how reassured many were that writers often suffered from mental illnesses. Like Wenger, she fails to record specific examples of this. She also discusses the problem of censorship, pointing out legal aspects to be considered such as the civil rights of patients p.

Armstrong also notes that promotion of bibliotherapy is hampered by the disparate organizations and societies involved, and the lack of a structured national USA training programme. The therapeutic value of reading was noted in some accounts published in the 19th century.

Users frequently commented that they would not consider borrowing from a public library because of the stigma attached to mental illness. The library service ran events and workshops for patients, often involving staff from the public library and museum. Patients also helped operate the library as part of the health authority's work experience project. Ward rounds were made each week to enable confined patients to participate, including those in the Regional Secure Unit.

Videos and audiotapes were particularly popular on the wards. Another initiative was an outreach scheme whereby care assistants were given library materials for housebound service users. Public library and archives services have funded several regional projects aimed at providing therapeutic services for disadvantaged residents in the community, including the mentally ill. These include the Northern Ireland Reminiscence Network and a similar, earlier archive therapy project in Carmarthenshire.

Several articles in the German library literature refer to the use of bibliotherapy in psychotherapy and the role of librarians , and an integrated approach to library provision and reading groups. Different reactions were observed between the patient and control groups concerning aspects of the books discussed. The focus of the discussions often differed as well. Finance continues to be the key barrier to investment; there are no requirements for hospitals to have libraries, therefore services may be targeted when costs need to be reduced. Russell described the advanced, integrated programme of library participation in rehabilitation at the McLean Institute in Massachusetts.

Patients were assessed on arrival at the hospital and suitable therapeutic activities recommended. Information was considered key to the process, to ensure patients had an understanding of their illness. Jones's time many subjects were censored, such as horror, erotica, and medical or reference books, but it has been made illegal to censor the reading material of patients in many American States. Instead, a system of classification was used whereby contentious materials were kept together under supervision.

Evans reported on the success of a project providing computer access to patients at the Florida Mental Health Institute. However, the report is too brief to be evaluated comprehensively, and no information is provided on research methodology. It is difficult to attribute value to this article, which seems to be a biased diatribe resulting from the author's own experience of being assaulted at work. The diagnosis of mental health problems as a social construction has meant that social controls have been implemented through diagnosis and treatment of illness.

Hockey p. Specific individuals have specific experiences, causes and solutions. Such mis-diagnosis of depression and related illnesses is still present today for men and women. MIND, For example, British Afro-Caribbean women were thirteen more times likely than white women to be admitted to mental hospitals as schizophrenic. This was due to pathologising of normal behaviour as schizophrenic Hockey, p.

In addition, gaps in librarianship research indicate that women have been marginalised from research and practice, and the issues relating to the unfair treatment of women have been ignored Ilett, The above points indicate that a proposed bibliotherapy service by GWL would need to include a feminist perspective of empowering women in the mental health and reading for health field. Hicks and Maloney have made recommendations for the future development in the UK and the gaps in research point to a role for the GWL in addressing these in particular, literacy, ESOL, and gender.

The review focussed on the areas of operational sources and this showed that, for example, potential funding sources were health based. Projects of special interest to GWL are in creative bibliotherapy and sources on the process of bibliotherapy that describe how imaginative literature can change people. Clinical sources were limited to specifically targetted sources that may help GWL to include an empowering feminist perspective for their proposed bibliotherapy service.

An outline of those in the UK of general importance and the models which have a particular addition to make to the research questions for GWL. The UK will be looked at then the US. Current UK Services The two main strands of provision are the books on prescription type and the creative bibliotherapy type. Hicks, These bibliotherapy service models can be viewed by degrees or depth of service. The list below begins with the lowest degree of input, ranging to the highest.

Whilst other types of model are operating the research period was inadequate to investigate all projects. The Self-help Library Model The most basic model consists of a stock of self-help books and whilst it is developed in conjunction with the user needs, it does not have any prescription or discussion element GP Prescriber Model The first large-scale project that is ongoing in the UK and which has had a significant influence, is the Books on Prescription BOP scheme started by Dr. There are now over 80 schemes in England, Scotland and the Channel Islands, whilst in Wales, the national adoption of the model in means that all GPs, counsellors and practitioners in mental health care are on the BOP scheme.

Frude, The scheme started by asking a group of 50 counsellors and psychologists to select books that were helpful to people with any mild to moderate mental health problems Frude, An initial list of 35 books was produced, which contains items on the following subjects: depression, social phobia; panic; anger; anxiety ;OCD; low self-esteem; eating disorders; sexual abuse; stress. The approach of these books is primarily a structured sytematic approach of exercises, diary-keeping, and self- assessment within a context of clinically effective methods.

The current book stock, including some audio books is now available in all Welsh public libraries. The booklist is successful and was published in the British Medical Journal and made freely available through the NHS. Many bibliotherapy schemes have used it.

Frude states that the future potential includes the use of other media, extending the service to physical healthcare, aspects of social care and new user categories. Children and older carers are possible new user groups. GWL sees this as a possible element of a bibliotherapy service to women. Using a self-help book can help patients to see things differently. It can help them to do things themselves … So it can help to empower patients. The GP prescribes the book, then the patient goes to the library and gets the book, either by self-serving at a named section of the library, or by approaching a member of staff to ask for the book.

The success of this scheme is huge: there is international interest, a wider range of professionals taking on the prescriber role, and it is used in diverse locations including voluntary organisations and alcohol centres. However, there is no discussion of the usefulness of the book between the GP and patient. It may be that self- help and non-fiction material may not require discussion according to some who debate what defines bibliotherapy. Comments in anecdotal evidence stated that this model in practice in some Scottish local authorities is not effective and not widely used.

In a large Glasgow library, a member of staff had never been given a book prescription since the scheme had been adopted. It was thought that a patient who had a book prescription would just go straight to the self-help section for the book. The survey of bibliotherapy providers may produce new information on this issue.

There is therefore room for improvement and extension to alternative models as shown below. The Supported Self-help Model In this model, a GP or a member of health care staff can advise clients to attend a clinic for self-help. Again, a prescription for a self-help book may be given, and this is taken to the local public library.

The improvement here is the support aspect that consists of some follow-up sessions with the person. Primary care mental health workers participate in these schemes. Future plans are to build an innovative health centre with a library within it. This will provide access to bibliotherapy and other services such as the internet, health information and a healthy food shop. This plan matches the governments recent announcement that libraries will need to provide more patient information for customers.

It is an innovative scheme and shows promise that librarians can be involved in the provision of information sources for health. The procedure is that people can be referred by health workers, or refer themselves to staff, whether trained librarians, bibliotherapists, counsellors, social workers or teachers Hicks, It can be either a one-to-one or a group setting. This model is closest to the East Ayrshire Read Yourself Well project and qualifies as a proper bibliotherapy project. This project was targetted by GWL as a contact to explore and a case study will follow this section at Chapter 4.

The Reading Group Model In this approach, emphasis is given to reading groups that people are referred to or refer themselves to these groups may have a specific client base for example, mental health users and are often associated with the local public library service. This has been an important project for GWL since its inception mainly because it is using creative bibliotherapy. It is aimed at social inclusion and encompasses the benefits of reading for enjoyment and relaxation as well as the health-related benefits for people with mild depression and anxiety.

The scheme uses bibliotherapists who work with health professionals prescribing books and library tickets. An improvement of reading skills has been noted in users and there is support for friendships, chatting to others in a relaxed atmosphere where people can discuss their health related issues Morris, Promotion of reading as a social and community activity to reduce social isolation and promote friendship has been an important element RAYS, This is strongly resonant with GWLs aims. RAYS provides both one-to-one and group sessions.

This is especially useful for those people with literacy needs or visual impairments. These are then discussed or written about. Arts projects in the health sector have shown that if creativity is stifled it has detrimental effects on our physical and mental health. It is also acknowledged that self— expression, the sharing of experiences and social interaction all contribute to happier, healthier and more confident individuals. Duffy, Get Into Reading GIR is another reading based model in Liverpool area that focuses on the enjoyment of fiction for social inclusion and an improved sense of well-being.

A volunteer aspect is particularly interesting for GWL, which has a commitment to offering women the volunteering experience. GIR groups involve reading short stories, poems or novels aloud and discussion. These groups can be in libraries, community centres or other locations. There can often be a therapeutic aspect to discussions that emerge, and the sessions certainly build confidence.

The fact that material is read aloud in an informal setting over a cup of tea makes the activity accessible to everyone whatever their educational background. Wirral Libraries, In the words of a group member: The power of the story or poem is not just for children. Our Get Into Reading project is offering a model, which I hope will be taken up nationally, of inclusive and intense reading experiences for people of all ages, abilities and educational backgrounds.

Read-aloud reading groups can help create community. This is really good. There is no pressure and you meet lots of new people. It has given me an interest after a really difficult time in my life. Wirral Libraries, It is definitely a project that is working for the benefit of Wirral citizens. Current research is accumulating evidence of the impact that public libraries have on health in their communities.

As bibliotherapy rises up the national agenda, so GIR is increasingly coming into prominence. We hope to work in the coming year on a plan to integrate GIR practice into Wirral Library Service, thereby offering a national model for regeneration through reading. Watch this space!

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Current US and Canadian Projects The library services providing bibliotherapy are in general in the hospital, prison and other institutional settings. There are significant projects in the educational field and in particular, some of these focus on providing imaginative literature bibliotherapy. The following section will focus on selected projects in America. This organisation provides training to counsellors in the American Counselling Association and also to individuals.

The training is in how to evaluate literature. OSU, Their focus is on children and adolescents and as mentioned earlier, they host conferences on themes such as Gender and Culture. An evaluation tool is available for assessing books for bibliotherapy in particular with children and adolsescents and the project is keen to continue evaluating applications of bibliotherapy to specific targeted groups for clinical benefits. OSUs future aim is to Expand our investigations into the use of story telling and books in other specific diagnostic groups and clinical situations including suicide prevention, ADHD, etc.

This should help address the lack of quantitative data about benefits of bibliotherapy, especially using fiction. This was mentioned in the previous chapter and information about the operational elements of the model as applied specifically to women have significance to the GWL project. The benefits are usually life-changing for all members. Trounstine and Waxler, p. Creative writing is also used in some groups. Joseph Gold The third bibliotherapist whose work is invaluable to the field is Joseph Gold. He has been researching and writing for this field since and was the first to link neurosciences into a consideration of the value and importance of literature in education.

Gold, p. His work has developed into a resource for training therapists in how to use literature in treating their patients. He has developed applications that can be used by individuals and by groups, for example a self-assessment tool which questions your responses to reading a piece of literature. A follow-up project in response to the political climate then continued the same work. In fact, only fiction can save the world. He has contributed to the field of bibliotherapy by examining the psychological process of reading in laymans terms rather than psychotherapeutic. See chapter 5. His approach matches many of GWLs needs, such as the use of imaginative literature and the specific needs of women in bibliotherapy.

Women read more fiction. Conclusion Bibliotherapy services save money on prescribing drugs and the GPs time, but also improve the outcome for peoples lives. An approach of self-help can be empowering for people. This is based on the fact that creative arts make available a new outlet for enjoyment and a reduction of mental health problems. The reading for health approach has also become a health promotion, and a way of creating and maintaining good mental health, rather than just a response to ill-health.

GWL will be able to use useful sources above to review the more imaginative ways to treat people, in particular, women who have literacy needs, ethnic minority issues, or English as a second language. The role for public libraries, such as the development in Gwent of a family scheme, shows the promise of bibliotherapy widening its range of services throughout UK libraries. The Oregon project also began from this particular aspect of bibliophilia OSU, and Gold is evangelical about it. This organisation is keen to follow all bibliotherapy innovations and has evaluation as a core aim.

It is suited to current government strategies. The RAYS and the Get Into Reading GIR schemes show that imaginative literature and a focus on the reading act itself is the strength of libraries and librarians, and is one we should continue to show in whatever way is possible to help people to enjoy life to the full. The US projects show that clinical uses of literature and fiction- based bibliotherapy are effective along with the self-help based models.

A study of the CLTL course showed that Recidivism of the participants was well below the average rate for offenders who did not take the course. The nature of the crimes if committed became less violent. There is a need for women in particular to address their mental health by using fiction, short stories, poetry, along with creative writing and the essential discussions, the element that these practitioners deem definitive for bibliotherapy. The practical steps of providing a bibliotherapy session, with lists of the questions to be asked for individual texts, are delivered in all three of the services above.

This forms a useful resource for a toolkit for a new bibliotherapy service. The reading lists are also valuable as a guide to beginning an imaginative literature service. The focus is on people who have depression. The project matched existing local health and information strategies and policies. They assess and refer patients on to one of a possible three options: gym, walking or bibliotherapy. A range of self-help literature is made available to the patient.

This includes an information pack containing instructions for contacting the service; its aims and objectives; suggestions of useful contacts. The Library in East Ayrshire, In addition, a workbook for patients gives ideas about living your daily life such as eating and keeping a diary of habits, feelings and so on. Some user feedback has been collected. Gender Issues In the last year, statistics show that 34 men and women used the service.

Staff may believe that this relates to the fact that more women use mental health services and health services in general. However, it is an obvious need for women to obtain access to bibliotherapy as the number of women is almost three times the number of men.

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Contact was made to this group, however this had not been used as yet. The lack of response may indicate a need to choose an approach that could possibly be made by a personal visit by the bibliotherapist. This could advertise the service and perhaps develop an outreach service in the groups own setting. This could address issues of vulnerability and a feeling of safety rather than putting the onus on a vulnerable person to approach a possibly alien and new location the library. Specialised ways of approaching victims may benefit from staff training by women who have experience of working with abused women.

A gap in coverage has been identified in the bereavement stock. This service would consider using fiction, perhaps with the new developments of a young peoples service and a carers service. The fact that it was possible that some women do not like non-fiction will perhaps be taken into account for any future stock selection and devlopment of a creative bibliotherapy. The Better Neighbourhood Fund has provided some funds, and this relates to the Lifestyle Transition Fund; the library service has funded some parts by themselves.

Evaluation The following statistics were results of a recent evaluation of the first year of the scheme. Vallance, A large evaluation has been started and will be completed by Paisley University this year. This will be of great interest to the field as there has been little evaluation done Hicks, It is a major piece of research that will evaluate the users responses to bibliotherapy.

It will also compare participants experiences of this and other projects. Future developments An extension to young people is being considered, as well as a carers service. The use of discussion as an essential element of bibliotherapy will then be reviewed. The psychological process Reading imaginative literature in general terms evokes an emotion from your past and you respond in the same way as you would in the real experience. The process of reading increases the chance of cognitive change because thinking of new possibilities via fiction or poetry can alter the ways we think and perceive.

It influences our identity and is based on experiences of feelings, emotions, thoughts, and images that become conscious when we use reading to explore ourselves Gold, For Gold, reading fiction is political in the sense that it is an act of independence using your own imagination to see the world. He opposes the academic approach to studying literature, which traditionally has cut out the feeling response and developed a dry, critical method of reading. It also ignored the value of the fiction novel. His approach empowers women to become their own therapist through bibliotherapy and his career as a therapist has proved that everyone has built their own story.

Gold, , p. This can provide catharsis from repressed fears and memories. Can this be experienced by reading non-fiction? For Gunn, the experience of that transitive moment is related to a philosophical approach to life, and the atom of delight is available in all experiences.

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Gold relates this moment of experience to the Buddhist concept of insight seeing reality as it truly is Gold, , p. Whether these experiences are separated or divided by the categories of fiction and non-fiction, fantasy and reality is irrelevant, and maybe due to this elusive paradox at the root of the reading process: Literature, being at once a fantasy and a realistic portrayal of human behaviour, permits the reader, paradoxically, both an illusion of psychic distance and immediacy of experience Shrodes, , p.

Paradox is found often in the bibliotherapy literature, such as in the CLTL programme, Reading allows us to get inside and outside of ourselves — addresses the paradox of self-absorption and low self-esteem Trounstine and Waxler, , p. The apparent contradiction of the encounter in fiction with a character is that the reader sees both the universal aspect of all people and simultaneously, the particular woman in the story.

The interaction and counteraction between the personality of the reader and literature is the psychological process of bibliotherapy. Shrodes, , p. Her framework for this change process used psychotherapeutic theories of Gestalt, molar theory, field theory, and Freudian psychoanalysis to explain the dynamics of the aesthetic experience based upon personality theory and psychoanalysis Shrodes, , p. In brief, Gestalt states that the whole is greater than the sum of its parts, like the novel, which is cumulative and climactic Shrodes, , p.

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Molar behaviour theory states that changes in one part of the personality are direct results of changes elsewhere. Field theory indicates that the symbolization of words and meaning in the mind triggers responses, and that the literature being read becomes a psychological field for the person Shrodes, , p. Freudian psychoanalysis uses the concepts of projection, identification, abreaction, introjection and transference that can describe the reading process.

His views are necessarily cross-disciplinary and he uses general systems theory as well as personal construct theory for his explanations. The root of his theory is that literature is not only good for you but is essential for personal growth, coping in crises, and using the imagination.

The act of reading, and especially of reading narrative fiction, does two things for the reader which are crucial to personal development. The first is the activation of the pre-frontal cortex of the brain and the temporal lobes where some of the major language control centers are located. These sites are connected to many others to form a web activity that creates thought. The second important function of reading literature is to assist in building personal identity in narrative form.

Catharsis or relief at the recognition of fears or behavioural habits from childhood releases person to a new sky-view to see their lives anew. The use of fiction versus non-fiction Fiction is better than non-fiction because it is more than conceptualization; it is a direct experience Shrodes, , p. Non-fiction reading may be different because it contains only information and this involves the reader in a thinking-only process - no feelings are accessed.

This has been asserted by Gold as a merely cognitive process, but not affective so that no feeling is involved. These will involve the persons belief system, which is their own story. By literature we mean something that makes us part of the story we are reading, or discussing with others. Trounstine and Waxler, , p. However, in some cases, non-fiction may be the only suitable remedial reading for a patient. Nor would I confine my reading suggestions to fictions.

When a life- narrative is broken patients may find it very difficult to enter a narrative. This is often explained as a problem with concentration. In fact it is entirely possible that people do best with fiction when their own life narrative is proceeding well. For instance I have found that reading about grief processes as described by Therese Rando is very helpful to patients feeling lost and confused by the emotions and circumstances of grief.

Gold, Is narrative required in order to engage the psychological process outlined above? In the case of bereavement it seems unnecessary. This honest appraisal seems to contradict his earlier position that fiction therapy is bibliotherapy. However, it shows an extension to that particularly difficult area of the human experience, death and bereavement. These points may benefit from further research. Some bibliotherapists have stated that knowledge about symptoms may make it easier to verbalize problems and give patients the courage to do so. On the other hand, the dangers of using some medical literature if the text is too advanced make it possible that symptoms become worse if the patient is anxious, insecure or depressed.

Briggs, , p. Reading can change you by naming life even at its worst moments, and thus releasing us from fear of the unknown and unnamed Irwin, which indicates that possibility. These texts may show the results of catharsis and insight depending on the person. They begin to understand that fiction is often based on truth and memoir often involves imagination. The crossing of lines of definition is a feature of the subject and process of bibliotherapy, which is perhaps just a qualitative comment on the nature of human reading and psychology.

The importance of the discussion element The question of whether a true bibliotherapeutic experience is possible without the discussion element will be reviewed. Brown states: the post-discussion between patient and therapist is of the utmost importance and adds :… Reading, without active, critical participation and application can hardly be expected to have any significant effect Another opinion states that: Unless such a relationship is somewhere in the background, whole libraries of books will be of no avail.

Alston, , p. This cannot be over-emphasised- the assignment of reading materials is not bibliotherapy and If no discussion, reading can become a barrier to therapy. The need for the discussion element is explained as a need to communicate so that we can find out what we think. The work done in CLTL and the other bibliotherapy services mentioned above show repeatedly the benefits of discussion, especially in a group setting for the offenders. It is certainly a desired element and without discussion, the person is participating only in self-help.

This method is part of the group system of reading theme-based texts, in particular those with scenes of cruelty and punishment. In some women-only groups a male judge has been present and vice versa. This presents a challenging situation, which is all the more effective for people who wish to reduce their length of probation.

The impetus for change is extremely high in these people and their success is evident from evaluations. The programme has had over 4, students in the last twelve years and now has one in the UK. Of these, only 1 person was involved in violent crime Trounstine and Waxler, , p. However, the novel can itself provide feedback to assure the person that they are being heard and that their inner personal story is valid and is expressed.

The process requires us to ask ourselves probing questions on the feelings experienced while reading a text. Every response is equally valid and there are no correct answers. This is relevant to the GWL approach to creative writing and bibliotherapy, as the aim is for every participant to be expressive. GWL may benefit from the CLTL process and ethos: Discussion helps build literacy and it is where students find their own voices, as well as diverse ways of seeing the world. The reading lists and reader response questionnaires are useful for GWL Scoping group members to use as a basis for their development of a tailored practice of bibliotherapy for their users.

To sum up the debate: o Discussion is desired and considered essential by many bibliotherapists. Conclusion Alternative views on the process of bibliotherapy indicate the rich creativity possible within the field. The fact that it is a resurgent and growing field is reflected in the blurring of boundaries. The diverse range of ways to explore the human mind is appropriate to our human nature. The wish to study background theory on the psychological process was a research question from the GWL Bibliotherapy Scoping group and has been answered by research into the literature.

A suggestion that there are degrees of the fullness of the model operated has been made. Ideally, at the top of the scale is a full discussion to explore the literature read with skilled leaders. The providers questionnaire was designed to request information on operational details and management of a bibliotherapy service. The results will be used to help plan and set up a similar project.

The aim of the user survey was to ask if users wish a bibliotherapy service and if so, what form and content is preferred. The providers questionnaire is in Appendix 1 and the user survey questionnaire is in Appendix 2. There were 34 questions and 7 responses in total and these have been collated to show any quantitative and qualitative data on the operational features of a bibliotherapy service.

Whilst this represents a low response, some limited comments can be made. A complete sheet of all responses is at Appendix 3. As these were too lengthy to present on a spreadsheet, they will be presented here. Comments and suggestions made by the providers are at the end of each part of the questionnaire, with a conclusion at the end of the section.

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Methods - need for a variety of methods to engage clients e. Summary Only 1 current provider out of 7 used imaginative literature and all returns used self-help literature. Only one provider recommended using a mixture of imaginative and self-help literature, preferring imaginative. Two replies recommended using one type, and self-help was the preferred type for three respondents.

All self-help BOP type schemes used a reading list. Health Services — 5 replies b. GPs — 4 replies c. Other organisations — 1 reply. These replies have been collated into the following table. One exception — the creative service, had various sources of referral: Self-referral, friends and relatives, library staff, community groups and organisations.

This was delivered to both mixed-gender and women-only groups. There were no gender issues recorded from the replies. The time spent on one-to-one sessions varied from 9 hours a week to 5 minutes per person. Asked for a breakdown of budgets in terms of the following categories: the replies are shown in Appendix 4.

Two libraries were funded by the NHS for books Funding if scheme extends beyond mental health; Long term funding; alone. There is a large variance between these and it may require further research to pinpoint actual costs. No budget was needed for rooms and there are no staff costs for the BOP schemes.

The initial sources of funding for the creative service may be helpful for the GWL. This is an important aspect to account for so that potential users can be made aware of a service. Part f. The comments are: o Interested health workers- a key worker to pave the way to NHS staff o Funding o Commitment o Funding if scheme extends beyond mental health o Long term funding 6.

They are then collected by NHS staff. A waiting list can build up; at present there are three titles we need more copies of. Key individuals with influence are essential. A small scale project that works is better. Also be aware that the books will be borrowed by people that do not have the prescription. Three issues to each prescription is average. Do not promise anything you cannot deliver, e. We tend to tailor sessions to fit in with the requirements of clients.

A diverse range of workers. We all came form quite different backgrounds, social work, teaching and writer, artist and librarian. All passionate about reading and have read widely- very important! Summary Every positive suggestion can be considered by new projects as guidance. In particular, the responses by the creative service will be highly beneficial to the GWL project. The suggestion of ensuring that a Partnership Agreement is in place with the local health partner is useful to ensure that all stakeholders are clear about their role.

It may be that further guidance is required by librarians on how to build successful partnerships with health professionals. Also, the potential pitfalls to avoid are useful, such as who is the right person in the NHS to contact if setting up a service. Informal feedback from customers and professionals. The large number of issues per prescription 3 to 1 suggests that people are facing issues of stress and are trying to find ways of coping on their own.

The first six months are being evaluated now, but we can see that there is a demand and a need for the service. The demand for books outstrips the referrals from GPs. We do not even have any anecdotal evidence to indicate this, and this may be unlikely as people tend to be embarrassed about talking about any kind of illness, especially in a public place like a library.

Summary Evaluations were completed by 5 projects, which is crucial for public libraries to gain evidence and performance indicators. It is also essential for the Library and Information Science community to gain evidence of the effectiveness of bibliotherapy in order to secure future bibliotherapy projects funding.

Account Options

It is heartening to see that even in a new service that has only been running for 6 months, that there is a demand and a need from the public. There are few creative bibliotherapy services. This is a positive step in embracing diversity, and such developments will be interesting to GWL, as they have a new BME development worker who will be involved in this way. This need for materials in many languages is urgent in Glasgow in particular, due to the fact that it is one of the main dispersal areas for asylum seekers and refugees.

For example, one provider commented that there are difficulties in dealing with multiple and diverse partners in the NHS. This indicates a need for guidance to librarians to pinpoint influential personnel in the NHS who can ensure that schemes are used. Whilst the creative scheme uses both self-help and fiction, BOP schemes prefer to use only one type. This seems contradictory, however, it relates to the discussion element as definitive of any bibliotherapy service. The survey left it up to the practitioner to decide whether a chat whilst issuing a book on prescription counted as one-to-one service.

There is a potential cause for concern in the recommendation of books by GPs and health professionals to librarians. The skills of evaluating literature are our professional skills and it is noted that in the US, bibliotherapy evaluation tools are used to aid therapists in evaluating books. Whilst these may be mainly imaginative, even the self-help books require further, deeper evaluation, as mentioned by the GWL Scoping group wishing to assess the benefits of, for example patient information leaflets for women with complex needs. Cross-disciplinary training and further collaboration should be recommended for future development.

No gender issues were recorded, due to the replies coming from mainly BOP schemes with only 1 creative service, which is already evidently providing a gender-sensitive service by its mix of women-only groups and other types of group settings. The returns showed that the services are well-used and appreciated by customers. The increased usage figures are beneficial to public libraries.

If the staff think it is embarrassing, then they may be less likely to be open to a discussion with the customer. A total of 22 replies were received from a sample of staff, volunteers and users. This included two targeted groups in the library: the Book Group and the Writing group. They were sent the questionnaire by email. This section is arranged as follows: Demographics; Bibliotherapy service; Content of service; Conclusion. This was broken down into categories of use as shown below.

Some respondents chose more than one topic, all chose at least one. Where more than one user chose a topic , this is shown on the table, otherwise only one chose it. The number of responses for each topic is shown by the following chart: Bibliotherapy topics 10 10 Confidence 6 Moving Home Loneliness 16 5 Depression Overcoming difficulties 12 Learning new skills 11 Changes in your life 16 Other — see list Fig.

Associated Data

Most would prefer fortnightly sessions, or monthly. Wilkes, Frances. The inner world choice The new diary. Suicide - a special scar. Walker, Alice. The third life of Doyle, Sir Arthur Conan. The rainbow journey. Berne, Eric. The games people play. The highly sensitive person. Wilson, Ken. Spectre of consciousness Winterson, J. Coelho, Paul. Veronica decides to Women who run with wolves. Sebold Alice, The lovely Bones. Feminist approach to counselling.

Toxic shame. Comments made are presented in full at Appendix 6. Selected comments are as follows. I would also hope it would be fun considering some of the topics that might be discussed! If this could be transferred to the bibliotherapy service, I would have everything I could ask for! This is a definite affirmation of the project. The preferred type of text is a mix of both non-fiction and fiction, which confirms the practical experience gained by the current creative bibliotherapy projects in UK and the US.

The majority also preferred the group-leadership to be by BOTH a librarian and a counsellor, with the librarian as the favoured choice. This confirms the current practice of using writing as a technique in creative models in the UK and US. The case study will use the interviews and the scoping group report to analyse the approach to a bibliotherapy service by GWL. The interviews will show the theoretical and practical approaches by staff in this unique service.

Interviews with staff The full text of the staff interviews can be found at Appendix 5. I would say also, rather controversially perhaps that dedicated bibliotherapy work should be done with men, and young men in particular, to attempt to unravel the crisis in masculinity that is clearly needed to address the levels of violence that we are seeing. That would be something! This connects to the result that the US projects have found when bibliotherapy creates a community and can change behaviour of offenders Trounstine and Waxler, 2.

Adele Patrick, Lifelong Learning and Creative Development Manager An open question on the relation of bibliotherapy to the job role produced these selected comments: I think it would be the most appropriate service within the organisation to refer women who raised issues that were beyond particular projects provision to deliver. So if someone could help them understand the book,… all literacy learners are very very different and for some, it would be easy — a goal. This interview highlights the potential difficulties of designing bibliotherapy for literacy learners.

This issue must have further research in order to produce an effective design. Anecdotal evidence from other staff: A good topic [of reading and discussion in bibliotherapy] brings back memories. Everyone could do. Brilliant even for ESOL learners. Bibliotherapy scoping meetings In the three-month research period, there were four scoping meetings. The members of theis group are: the lifelong learning and creative development manager, the librarian, and two counsellors.

Two of these were brief meetings on the specific topic of the International Arts, Film and Media Mental Health Festival event planned for October The aim of the initial meetings was defining the framework of thinking for the proposed bibliotherapy service. We looked at the perceived differences between the models and definitions inherited from earlier approaches to bibliotherapy. An interesting suggestion is that bibliotherapy can be an art AND a science, it does not need to conform to the traditionally separate concepts. The proposal was made that there can be imaginative self-help sources.

If there are none published, then it is possible that we may wish to produce our own, perhaps in conjunction with the user groups who actually use this material. This innovative approach with the readers writing their own materials indicates the current management ethos in the GWL. Worrell, The service can then be designed and delivered with the content decided by user consultation. GWL can explore the contribution to and experience of the librarys service by the user survey. This implies a definate commitment to a bibliotherapy service. Writing our own material if this is required.

The dissertation can begin this aspect by collecting any reading lists or suggestions that practitioners make. The research questions on the requirements for the management and content of a bibliotherapy service have been partly answered by the results of the provider survey. In particular, the creative model has supplied concrete ideas for the content of a service. One outcome of the provider survey was to identify key items to have in place before starting, and these are long-term funding, commitment and key health personnel for a health-oriented service.

The desired elements of staff that are passionate about reading and a flexibility of approach in order to tailor a service to users are already present in GWL ethos and practice. The user survey shows that a majority of users desire a creative bibliotherapy service with the following elements: Both fiction and non-fiction books; group setting; women-only group; both a librarian and a counsellor to lead groups; creative writing as an element of groups; a theme to bibliotherapy services. The GWL case study shows that commitment is not only to user consultation but, in fact, to a user-led service.

Their unique collection is composed entirely of donations. Bibliotherapy…would be an excellent way of developing the collection, driven by the interests of a diverse constituency of users, which again reflects the history of a user-led collection approach. See Case Study GWL There is agreement with this approach in terms of bibliotherapy session content in bibliotherapy projects in the UK: Current practice in the RAYS project is to always consult readers on the choices for a reading group text to share. The diversity of the activities which RAYS uses to engage non-library users is impressive and ultimately empowering for their readers, as it is the readers who are consulted about the selection of texts.

Duffy, This academic approach is outdated for most library users today and due to the social inclusion needs, perhaps it is time to ask the readers to develop us, in order to ensure that librarians provide culturally-unbiassed services which are accessible to all levels of literacy. Gold believes that fiction reading is more of a practical everyday tool than an analytic study of structure, character and so on.

This does not allow for the necessary feeling response that we need as human beings. Arts in Hospital, p. There is a strong commitment to, and love of literature in the GWL staff and users. The disenfranchised criminals who are participants in this innovate scheme are evidently changed by their course, and they can begin to form a community in their bibliotherapy group, then go out and join the world as an active citizen.

This resonates with the GWL staff comment that women can gain a sense of well-being from a bibliotherapy service, and the ripples effect of this will influence the children, the neighbourhood, and ultimately, the nation. The project took books to the homeless people and formed storytelling corners and reading groups everywhere they could.

The power of literature is immense. Gold has worked as a therapist and gives many examples of the individuals who have changed by it. The process involved in the act of reading has been researched in chapter 5. At this point, what literature adds are ethics, philosophy and values in the persons experience. The complex needs in the GWL user groups involves issues such as bereavement and violence, which will benefit from the imaginative literature approach as outlined by Gold. The national strategy leaders of bibliotherapy in the UK could co-ordinate similar ground-breaking research in the UK, or disseminate such research results.

The growth of creative bibliotherapy is dependant on funding. The research has produced a little background information about likely health funding strands in mental health in Scotland. Recommendations It is recommended that bibliotherapy should be addressed nationally, perhaps by the GIR in Liverpool. However, this is in England and Wales and Scotland must look to developing its own strategy. It is recommended that the gaps identified by the audit last year are addressed. It is important to collaborate across the library and information science LIS field in order to avoid duplication of effort.

The recent announcement that the government wishes public libraries to take a role in the provision of patient information reinforces this need It is also recommended that training library staff in bibliotherapy techniques is developed. As is the National Year of Reading, this may be an opportunity to facilitate innovative schemes as envisioned by the GWL bibliotherapy service. In Rubin, J. Bibliotherapy sourcebook. London, Phoenix Oryx Press. Anderson, L.

Self-help books for depression: how can practitioners and patients make the right choice? British Journal of General Practice Arts in Hospital, Blawarthill Hospital, Art in Hospital. Barber, J. Psychological Medicine. Brown, E. Bibliotherapy and its widening applications.

NJ, Scarecrow Press. Cadenas, P. Books to build. Chamberlain, D. Information prescriptions: a broad perspective.