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April 2017
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BIBLIOTHERAPY: FROM BOOKS TO HEALTH



Although the term bibliotherapy is often used a lot in a somewhat simple way to describe the reading of books, professionals often recommend it in order to help patients improve a problem. However, this method of help is actually an effective and scientific set of special, interactive support techniques for one’s health which is used successfully all around the world. It is based on relationships of help intertwined with the support of reading books, or parts of written texts, as well as other appropriate material, which is chosen depending on the specific aims that the patient wants to fulfil.

Bibliotherapy is an interactive process

Undoubtedly, the history of bibliotherapy is rooted in the simple reading of texts which were sometimes able to produce spontaneous benefits, thanks to their ability to provoke reflections and positive emotional reactions which motivated, informed or even taught the reader/listener strategies for dealing with problems.
Initially, the term bibliotherapy was used to define attempts to prescribe books deemed capable to support personal growth and resolve problems, a method essentially consisting of experimental forms of reading abbreviated passages or entire books deemed capable of activating self-help within the patient.
Reading therapy, as a form of support for one's health, was initially used in an official way in many American hospital departments (psychiatry, oncology, etcetera) and books rich in material were deemed capable of stimulating intellectual life and lifting the spirits of patients, especially those of long-term patients who were prescribed novels, poems or even adventure stories and books about travelling as they were considered to be rich in emotional stimuli and able to bring the patients out of their beds for a few hours. Soon enough, using reading as a way to support one's health was used in other fields too, such as schools, psychology and medical centres and even in spiritual help contexts.
The fundamental part of the definition of bibliotherapy, as it is currently conceived and used by various professionals from all over the world and in its structure as a systematic method of help, was the result of the observation of different reactions that people had when they addressed their emotions or reflected on the text.
The assumption of the existence of unquestionable therapeutic powers that certain texts possess is now somewhat in crisis and this has led on to emphasising how the therapist-reader relationship is a method which can be used to guide the reader towards the meanings and emotional experiences deemed useful for encouraging change and healing.
Bibliotherapy experiences have also led on to identifying effective criteria for choosing the prescribed literature in relation to individual aspects (psychological, educational and social aspects) which the patient wants to stimulate, as well as developing methods to accompany the reading and facilitate discussion, something which must follow the reading in an effective bibliotherapeutic environment.

Today, the image, methods and the most effective ways to achieve the aims one sets for oneself have been defined by bibliotherapy (also known as book therapy), by means of the course undertaken to achieve progressive changes. Therefore, if one intends to use bibliotherapy as a means of therapy, and not as an object of pleasure or culture, it must be formulated as an interactive process which, starting with literature, aims to stimulate reflections and personal change so as to help one's physical, psychological and social health.

More precisely, it is possible to clarify the essential characteristics that an effective bibliotherapy course must have by referring to the approaches of the world’s most noted experts who have used this method for years.

Essential aspects of bibliotherapy

1. Bibliotherapy must be formulated as an interactive process that involves sharing and discussing (either in advance or during the session) internal feelings (thoughts and emotions), which are the results of reading a text (or a similar activity carried out with a similar stimulus) chosen by a professional, who is an expert in bibliotherapy and in the field in which he/she works.

2. Bibliotherapy can be used in both clinical cases as well as educational cases since, in both cases, and in order to be considered therapeutic, the work remains focused on the relationship with one's health, even if occasionally the acceptation can be used in both a wider and stricter sense.
3. The results of an effective bibliotherapy course must bring about measurable improvements, even if only small, to the patient’s personal well-being and these improvements can consist of taking on new values, experiences or psychological or social habits that are good for one's health in more than one way.
4. The reading material used in bibliotherapy, in cases where the focus is not on culture, should be chosen without any prejudgement regarding the quality: the choice is actually about the possibility of improving one's health through communication centred around the processes and subjective realities of the text, and not its content (a particularly important criterion that must be met if the bibliotherapist is also a teacher).
5. A bibliotherapy course can be carried out in pairs or in a group context, as long as the participants’ needs are similar and the objectives are shared and can be achieved by means of this shared treatment.
6. In order for bibliotherapy to be effective, the course must include a primary or predominant use of the interactive reading method, rather than just including it in a small part of the course (for example, prescribing reading in a psychotherapy course is not deemed to be bibliotherapy, nor is using a reading-writing method inserted into a course which focuses on techniques which are not based on reading as the regular starting point of therapy sessions).
7. The effectiveness of bibliotherapy, as many experiences have shown, does not depend on using purely therapeutic material (which, in effect, does not actually exist), but rather on the conductor’s ability to choose material which answers the participants’ needs and resources in such a way as to deal with any possible resistance or disagreement, by guiding the perspectives and emotions of the participants towards a comparison, which does not necessarily have to coincide with what has been read, but rather with an internal and subjective transformation of a theme that is essential for well-being.

Bibliotherapy and bibliotherapists around the world

As can be seen in countries where bibliotherapy has already been in use for some years, the therapist is a conductor whose function is to facilitate experiences related to the text so as to accompany the person (or group) in carrying out single steps which will be useful for improving one or more individual aspects, which are necessary in order for the patient(s) to feel better. In this sense, the progress must be taken into consideration by the conductor via monitoring stages, which take into account the responses shown during the course, any possible assessments with specific instruments for measuring the state of the patients’ health and what is being treated.
A bibliotherapist’s training includes a wealth of specific knowledge, methods and conduct techniques, including those that have been shown to be the most effective in treatment courses carried out all over the world, in addition to specific, professional training with regards to the objectives the participants intend on achieving.
Therefore, by combining specific skills with objectives related to the profession, four broad categories of bibliotherapists and, consequently, four types of bibliotherapy treatment courses, can be identified which are all very different from one another and which have been implemented in various countries.

Psychotherapy bibliotherapists use interactive bibliotherapy methods in order to fulfil goals concerning improving and/or curing mental disorders by working on pathological aspects during the bibliotherapy course. In this case, bibliotherapy is better defined as ‘psychotherapeutic bibliotherapy’.
Medical bibliotherapists (not psychotherapists) often use bibliotherapy in order to fulfil traditional health education goals, the aims of which are to have the patients improve bad habits which are responsible for numerous health problems (which the therapist is an expert in).
Psychology bibliotherapists (not psychotherapists) use bibliotherapy for prevention and psychological diagnosis means, as well as for habilitation and rehabilitation activities and as a means of support in the psychological field. In this case, bibliotherapy is better defined as biblio-psychology, psychological bibliotherapy or psychobibliotherapy.
Educational bibliotherapists use bibliotherapy methods to promote education and healthy development, setting achievable goals according to their treatment fields, such as courses in pedagogical, artistic, motor, cultural, social and recreational fields, which, depending on the type of professional who conducts the treatment, allow patients to experience bibliotherapeutic counselling, developmental literature or even bibliotherapeutic guidance.

Bibliotherapeutic material

In bibliotherapy it is possible, according to the needs related to the objectives which the patient has set him/herself, to use material from various different sources which, as previously stated, does not have to have significant literary content, but rather must possess a certain ‘power’ related to the ability to stimulate positive reflections regarding one’s health.
It has generally been observed that such therapeutic potential is related to certain characteristics which allow us to distinguish what is ‘good bibliotherapeutic material’. More precisely, the quality of such material is related to the presence of one or more thematic dimensions and one or more stylistic dimensions, some of which are listed below. Thematic indicators generally appear to be better predictors of effectiveness, compared to the stylistic ones.

THEMATIC INDICATORS OF A GOOD QUALITY TEXT OR OTHER BIBLIOTHERAPEUTIC MATERIAL
1. the text/material is about universal experiences;
2. the material has a particular way and effect to deal with a common theme;
3. the text/material is comprehensible and free from obscure meanings;
4. the literary material deals with a subject with a certain positivity, whilst addressing, but not belittling, certain ‘strong’ subjects.

STYLISTIC INDICATORS OF A GOOD QUALITY TEXT OR OTHER BIBLIOTHERAPEUTIC MATERIAL

1. the text/material has a continual rhythm that encourages reading and attention;
2. the literary material has the ability to stimulate the five senses through imagination;
3. the literary material uses clear vocabulary and vocabulary which is relevant to the reader/listeners;
4. the length of the material/text is just right so that all the activities planned for a particular session can be completed, without losing the participants attention.

Depending on the techniques employed, the stimulating material used in bibliotherapy can include:
• parts of books (rarely entire books, but if so they are read over the course of a few sessions);
• short stories;
• quotes;
• song lyrics;
• poems or parts of poems (this then becomes poetry therapy or biblio-poem therapy);
• newspaper articles or articles from scientific magazines (this then becomes journal therapy);
• fairytales (this then becomes fairytale therapy);
• parts of scripts (used in theatre therapy or biblio-drama);
• videos (commercials, music videos, short films, selected scenes).

The activities possible in bibliotherapy

With regards to the material and the conductor’s specific and professional training, different ways to carry out these therapy sessions have been experimented with and they involve activities carried out according to bibliotherapeutic regulations and the aims of the treatment, such as:
• reading in silence, out loud or all together;
• having a guided discussion;
• dramatisation;
• creative writing;
• bodily expression and dance;
• video projections;
• listening to music and sounds;
• drawing activities;
• manipulation of materials and objects;
• psycho-corporal awareness techniques.

Each activity used alongside bibliotherapy is used together with objectives and technical requirements and these allow for reflection on the theme and the emotions experienced after reading, so as to guide the participants towards a positive, personal change.
Furthermore, it must be remembered that the difference between bibliotherapy and guided reading methods, or advice from self-help manuals, is the initial monitoring of the participant’s needs, an assessment of observed improvements during the course of the responses to literary stimuli (done with specific check lists) and a final check of any positive changes achieved.


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