Bibliotherapy chla 17
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Reading for Resilience: bibliotherapy lights the road to recovery for mental health patients
![CHLA/ABSC 2017
Overview
• What is Bibliotherapy?
• Brief History
• Types of Bibliotherapy
• Exploring effectiveness
• Bibliotherapy @ St. Mikes
• STAR Program
• Psychiatric In-Patients
• Evaluation
Image by Robert Burdock; CC. 2.0
[https://www.flickr.com/photos/robaround/5274209090]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Bibliotherapy chla 17
- 1. CHLA/ABSC 2017 Reading for Resilience: Bibliotherapy lights the road to recovery for mental health patients Sharon Bailey1 , MI, AHIP Sandy Iverson2, MEd, MLIS, Psychotherapist Carolyn Ziegler2 , MA, MIS 1 Centre for Addiction & Mental Health, Toronto 2St. Michael’s Hospital, Toronto
- 2. CHLA/ABSC 2017 Overview • What is Bibliotherapy? • Brief History • Types of Bibliotherapy • Exploring effectiveness • Bibliotherapy @ St. Mikes • STAR Program • Psychiatric In-Patients • Evaluation Image by Robert Burdock; CC. 2.0 [https://www.flickr.com/photos/robaround/5274209090]
- 3. CHLA/ABSC 2017 Books and reading as “Medicine for the soul”
- 4. CHLA/ABSC 2017 to assist in the process of coping with life R E A D I N G
- 6. CHLA/ABSC 2017 Is it effective?
- 8. CHLA/ABSC 2017 Re-wiring our experience through reading Image Source: Front. Hum. Neurosci., 01 October 2010 | https://doi.org/10.3389/fnhu m.2010.00168
- 10. CHLA/ABSC 2017
- 11. CHLA/ABSC 2017 St. Michael’s Hospital • Inner city hospital • 5000 + staff • Trauma & critical care • Inner city health • Research
- 12. CHLA/ABSC 2017 Shared Reading Group Session Check-in Read-aloud activity Guided group discussion Closure
- 13. CHLA/ABSC 2017 Supporting Transitions and Recovery (STAR) Learning Centre The STAR Learning Centre was the first initiative of St. Michael’s Urban Angel Fund for Homeless People.
- 14. CHLA/ABSC 2017 Reading for Resilience – Working with psychiatric in-patients
- 15. CHLA/ABSC 2017 [Loneliness] [Forgiveness][Courage] [Responsibility] Participants explore their own problems through discussing themes in literature [Positive thinking] [Gratitude] [Resilience] [Love & Giving]
- 16. CHLA/ABSC 2017 Participant Evaluative Feedback I enjoyed the readings. It was a good time. I would like topics of depression and tackling challenges I am very impressed with the selection of poems and essays Thank you. Awesome! Forgiveness, gratitude and appreciation is great. I enjoyed being a part of the group. It was nice and the readings were warm. I feel at peace with much of my past. I’m lucky I have so much love in my life, both at home and here at St. Mikes. Thanks for your time. Very enjoyable topics.
- 19. CHLA/ABSC 2017
- 20. CHLA/ABSC 2017 References & Further Reading • “About | Reading Well”. Reading-well.org.uk. N.p., 2017. http://reading- well.org.uk/about • Berthoud, Ella, and Susan Elderkin. 2013. The novel cure: an A-Z of literary remedies. • Davis J. Enjoying and enduring: groups reading aloud for wellbeing. Lancet. 2009 Feb; 373:714-5. • Gold, J. Read for your life. Toronto (ON): Fitzhenry & Whiteside; 2001. • Gold, J. The story species: Our life-literature connection. Toronto (ON): Fitzhenry & Whiteside; 2003. • Hodge S, Robinson J, Davis P. Reading between the lines: The experiences of taking part in a community reading project. J Med Ethics. 2007: 33:100-104. • McCulliss, D. 2012. “Bibliotherapy: Historical and research perspectives” Journal of poetry therapy. Vol. 25. • Tukhareli N. Healing through books: The evolution and diversification of bibliotherapy. Lewiston (NY): Edwin Mellen Press; 2014.
Editor's Notes
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- At its most fundamental, bibliotherapy is “reading to assist in the process of coping with life”. It is used informally all the time: whenever we use or recommend literature of any kind to help ourselves or others prepare for, or cope with, challenges or life situations. I know the first time my daughter had to go in to hospital (nothing serious just minor surgery at the age of 3) we went to the public library and borrowed about a 100 books on going to the hospital including the classic: Curious George goes to the hospital. Bibliotherapy includes a variety of successful applications including one-on-one and group sessions run by health professionals and therapists.
- Bibliotherapy is often divided into two main approaches: clinical (sometimes referred to as prescriptive) and non-clinical (sometimes also referred to as creative, developmental or social bibliotherapy). Clinical bibliotherapy is usually defined as being practiced in clinical settings: originally in psychiatric institutions, but also hospitals, therapy offices and other clinics. It most often takes place in a structured setting and is facilitated by a counselor, therapist or other clinician to treat people experiencing emotional or behavioural problems. It most often involves strictly prescribed readings, such as might be used in a Cognitive Behavioural Therapy Group. Another form is the use of, or recommendation of, self help books by clinicians or in a clinical setting. Much of the research published on bibliotherapy involves this type of bibliotherapy. The ‘developmental’ or creative use of bibliotherapy, is the use of reading for the purpose of meeting normal ongoing life tasks and is practiced by a wide range of professionals in a wide variety of settings. This type of bibliotherapy more often utilizes literature, versus self-help texts or workbooks. There is, or can be, a great deal of overlap between the various types of bibliotherapy, especially with creative bibliotherapy techniques being used in clinical settings. The projects we have engaged in at St. Mikes utilized a creative or developmental modality but, at least in one case, were carried out in a clinical setting.
- Much of the recent research on bibliotherapy focuses on the use of self help books, either alone or as an adjunct therapy. Most of these studies have shown that self-help bibliotherapy can be quite effective in treating both adults and children with mild to moderate mental health problems and improving copying skills of individuals living with chronic and life-threatening conditions. A number of studies have focused on the use of bibliotherapy based on cognitive behavior therapy for treating mild to moderate depression and anxiety and have been shown to be quite effective… in many cases as effective as pharmaceutical interventions.
- As a psychotherapist, who was first (and still is) a librarian and avid reader, I am particularly fascinated with how the act of reading, or at least the act of reading the right book at the right time, can effect or enhance therapeutic and transformative change. As mentioned earlier, books (and reading) have long been perceived as tools for treating the soul… as having the power and potential to facilitate positive change in the lives of the reader. Reading is very effective at illiciting powerful feelings in the reader… of providing the ‘corrective emotional experience’ that therapy strives to provide. One of Canada’s foremost theorists on Bibliotherapy, a family therapist , Joseph Gold explains it something like this: Reading can help us learn and understand our own feelings, and identify the sources of our anxieties, angers, likes and dislikes. Stories can reflect for us, like a magic mirror, the veiled parts of ourselves and our lives. …Story has the power to alter our way of thinking and perceiving, and can help us to reorganize things differently. Reading other’s stories helps us to rewrite our own stories. It helps us to revise, review and add on stories, so that we can continue living our narrative in a creative and more healthy way.
- The reality in which we live and relate to others is largely created from our experiences of life. In the last few decades neurological research has supported the notion that we construct our worlds from our experiences. Brain imaging studies have shown that some of the brain regions active while reading, mirror those involved when people perform, imagine, or observe similar real-world activities. The reading brain simulates what happens in the story, using the same circuits we would use if the same things happened to us. On a neurological level there seems to be very little difference between reading an experience or having an experience. And reading provides a level of safety that the experiential world does not. Reading provides an opportunity to engage with situations and provides the safety in which to explore and reflect on the experience with emotional safety… much as one would do in the therapy office.
- As we put ourselves in the place of others we experience empathy for others, we understand the needs and desires of others, and of ourselves, as we observe and compare their experiences and responses to our own. We learn we are not alone by identifying with stories and characters and the experiences they have endured. Normalizing our troubling and wounding experiences is essential for learning to accept ourselves and come to terms with what has happened in our lives, and can help lay the groundwork for turning the tide of the possibly self destructive coping mechanisms we have unwittingly implemented. Recognizing ourselves in others provides an opportunity for us to view ourselves from another perspective… that we are a member of a group with common characteristics, which can help us let go of the heaviness of self-blame and shame that can block our path to change.
- Identifying with characters and situations is not the only way in which reading can be a therapeutic activity. There is also evidence that suggests that the pure enjoyment (including laughter) and escapism of reading can be extremely helpful. While running into a book (or movie for that matter) to escape our troubles is not recommended as a permanent solution to problems (especially severe mental health problems), there are definitely times when ‘rest’ is prescribed. Temporarily avoiding a problem can be a coping strategy… a way of mustering the internal resources necessary to take on dealing with the problem. Our emotional lives sometimes need rest, just as our physical bodies need rest. When a friend of mine was undergoing treatment for terminal cancer, 10 year old son was far more interested in reading fantasy literature than he was in reading books about other kids whose parents were ill. However, a year or two from later when he is more ready to process the experience of losing his mom, he may well find comfort in books with characters that have also lost a parent. Stories are a biological imperative, part of our adaptive human evolution. Stories or literature have their roots in empathy and draw our attention to our necessary connections… first oral stories, and then written stories were our first therapists and they remain extremely powerful tools for healing. Now that I’ve given you a little background on bibliotherapy and it’s possible power in helping people manage life’s challenges, I’m going to turn the podium over to Sharon who will tell you about our specific programs at St. Mikes and what we have learned from them.
- St. Mike’s is a relatively large inner city teaching hospital affiliated with the University of Toronto. We have just over 6000 staff and 780 physicians. We train over 3500 students a year. We are one of two regional trauma centres and are well known for trauma, critical care, and inner city health … especially research into social determinants of health.
- In the past 2 years, librarians at St Michael’s Hospital have been involved in read-aloud bibliotherapy programs. The structure of these types of read aloud group programs is replicated in many similar programs in the US, Canada, UK, Australia and probably many other countries around the world. Our sessions began with a check in.. Followed by (usually) one of the faciliators reading a short reading or two, followed by a group discussion about the readings. Participants are invited to share their reflections and reactions to the readings. The session would generally close by one of the facilitators reflecting on the theme and some of the points that were raised by either the readings, the discussion, or both.
- SLIDE 13: 1.5 minutes St. Michael’s first bibliotherapy program was done with the STAR Program in the Fall of 2015, and was repeated in the Fall of 2016. A bit of background… In 2014 the hospital received a gift of $10 million to the Urban Angel Fund for Homeless People which allowed St. Michael’s to develop a think-tank for homeless solutions. St. Michael’s has established a “health-solutions incubator” focused on testing new approaches to help homeless and vulnerably housed people regain their independence. The incubator’s first project, which launched in 2014, is a recovery and learning centre called Supporting Transitions and Recovery, or STAR. The STAR Program is an example of a Recovery College. It’s also Canada’s first though there are now others at Ontario Shores and the University of Montreal. The Recovery College is an educational model that was piloted in England and is now used around the world. It involves both clinicians and people with direct experience with mental health issues who work together to develop and run courses that focus on skills training and arts-based recreation to facilitate recovery, wellbeing, and social inclusion. Evaluative data from pilot projects in England and subsequent projects around the world indicated increased self-management and personal recovery outcomes for the participants. In keeping with Recovery College principles, the STAR program provides a safe and welcoming environment that helps people discover or rediscover activities that are meaningful to them. It also provides opportunities for people to develop the skills they need to secure or maintain stable housing. Members involved in program/course development and are considered participants in their recovery, not just patients. Sessions are often led by peers with lived experience. When Sandy first heard about this program, she reached out to the STAR program to propose a number of ideas, including Microsoft office training and a reading group. She had been interested in bibliotherapy for some years, and had delivered a joint presentation on the topic with Natalia Tukhereli at a conference in early 2014. Our first session, in the Fall of 2015, we offered an 8 week bibliotherapy series for STAR clients, called Book Break. Unfortunately we didn’t keep super accurate records from those sessions. What we do know is that roughly 8 people signed up and we averaged about 5-6 participants at every session. We relied upon the STAR program’s evaluation methods – surveys at the end of the program – but because attendance dropped off quite significantly for the last two sessions we weren’t able to collect much data. Anecdotally, though, we were happy that a core group of participants did come to the majority of the sessions and the engagement by the vast majority of participants was very high. People responded positively to the experience and were pleased to share their feelings and thoughts on the readings.
- In the summer 2016 we revised that program for the in-patient unit. The inpatient mental health unit has 33 beds, including acute care. There are two peer support workers who work on the unit part time. (and also with STAR). The information specialist who liaises with the Psychiatry department was asked by one of the psychiatrists if she was interested in setting up an inpatient book club on the unit with topics around resilience and recovery. The peer support workers already had a number of suggestions for books, however the book club model didn’t seem like a good fit for a patients whose average length of stay was 21 days. While the IS had a lot of interest in the project, she knew that she did not have the necessarily qualifications to lead a therapeutic book club so she asked Sandy for advice…. We met with the psychiatrist and two peer support workers and proposed a modified six week program based on/similar to the Book Break that would be led by Sandy, co-facilitated by CZ, and attended by a peer support worker. (at the same time, we developed a recovery-oriented book collection for the unit as well) Each session would include a range of readings – poetry, short fiction, quotes, excerpts from autobiographies, magazine articles. We ran a 6 week program in the summer for the in-patients and repeated it in the autumn of 2016. Working with the in patient group was different in that we did not have the same participants each week as the average length of stay is just 21 days. Some participants did come to multiple sessions but no one came to all sessions. In addition to changing the series to 6 weeks, we also added a session topic: Lived experience with readings from people who have lived with mental health challenges and/or homelessness. This topic, although more potentially challenging was very well recevied by participants. The in-patient group sessions were also shortened to one hour and it was uncommon that all participants would stay for the entire hour. We also simplified the evaluation form to 7 quick questions and gave people two versions of the eval form to choose from… one utilizing smiley faces for the likert scale and one using words.. The most popular series was the 1st round of Book Break and the 1st round of Reading for Resilience. In the 1st round of Reading for Resilience we had a total of 25 participants, and we collected 17 evaluation forms. The biggest group we had was 8 and the smallest was 2. The 2nd round was more sparesly attended and a couple of sessions were cancelled because no one on the ward that week was interested or available. Attendance is extremely variable depending on the clients on the unit that week and what else was going on. Attention received internally about the bibliotherapy program… In Touch and Intranet.
- Based on the principles of non-clinical (developmental, creative, social) bibliotherapy, the program involved small groups of participants in a read aloud group. Themes, thought to be relevant to the targeted client group, were selected, and compilations of reading materials were developed to address those themes. With each iteration of the program, the themes and readings presented were altered as we solicited input from facilitators, participants, and peer support workers. The reading materials were selected from a broad variety of both fiction and nonfiction texts, including short stories, novels, poetry, biographies, autobiographies, self-help books, academic manuscripts, and journal and magazine articles. Our program, was originally based largely on a program that Natalia Tukhereli had developed entitled “Read to Connect”. In turn the “Read to Connect” program was based on a model often attributed to the Reader organization in the UK’s “Get into Reading Program”. This model is a shared reading model. The principal feature of this approach is that it is a read-aloud activity in a group setting. Unlike book clubs or other modes of bibliotherapy, where members may read outside the group and come together to discuss the readings, in this model all of the reading activity takes place in the group. Copies of the texts are provided to participants so that those who wish to follow along can do so, those who wish to do some of the reading aloud might volunteer to do so (and this did happen in our groups), and maybe most importantly, so that participants can take the readings with them after the session. Describe a typical session including: Librarian role Peer support workers role Who were the participants (in general terms) numbers of participants Handouts – reading selections Therapist training advantage ? Participants listen to readings chosen to provoke discussion on various themes. For many people, it is safer and easier to explore their own problems through discussing literature. Use of fiction non fiction and poetry. Read aloud by facilitators. Discuss themes and which ones worked and which ones didn’t. Include info from peer support workers feedback. (see slide 17) Sharon’s collection and choosing materials co-creating collections etc.
- In total we collected 26 completed evaluation forms. People were very generous with there evaluations. Generally they found that: Group leaders were well organized everyone in the group had the change to speak if they wanted to Difficult topics and discussion were handled well by the leaders the handouts from the group were useful the content of the group was relevant to their situation And That it was worth their time and effort to take part in todays group. The one question on the evaluation form that frequently did not resonate with them was: I feel more hopeful about my future as a result of todays group
- Readings and themes We have some feedback to share from conversations with the peer support workers They expressed a uniform desire for more readings by people with lived experience of over-coming adversity, addictions, and so on. They had some doubts about particular themes, namely gratitude, compassion and forgiveness. Such readings may result in people feeling a degree of inadequacy. Perhaps they’re not ready or shouldn’t have to be ready or even work towards gratitude. Or compassion. And particularly forgiveness. That said, everyone’s different and the themes and selections cannot be everything to everyone. People’s reactions to certain readings will vary by necessity. Perhaps they’re bored. Maybe they’re intimidated. Worse, maybe they’re triggered. This further another reason why it’s important to work in collaboration with therapists, or others with counselling experience such as peer support workers, social workers, and so on. Self-reflection We also took the time to reflect on the role we as librarians have in the Reading for Resilience course and bibliotherapy with vulnerable populations in general. By virtue of the name, bibliotherapy can be seen as an intervention even if the population has a range of conditions. So: Is there a possibility of harm? What level of responsibility and accountability – liability, really – do we have as librarians? These are difficult questions to answer without asking some more basic ones, first: If we don’t have credentials in the healthcare profession, why do we think we should be involved in what could be seen as an intervention with a vulnerable population? What as librarians do we bring to this initiative? Are there assumptions we make about our role and our value in this intervention? And what’s the degree of involvement? For instance, should we be in the sessions or should our role at co-creating the themes and readings after which healthcare professionals and peer support workers take over as co-facilitators? Going forward… The selections for a body of work can be iterative and rely on feedback in the sessions and after. But what we know is that the idea of ‘suitability’ cannot be prescriptive: the goal is to establish trust and rapport, ultimately to create and sustain a welcoming environment. With that in mind, here are some ideas we have: Introducing more challenging readings, by whatever definition, be it content, length or style, should maybe be delayed until participants have a greater trust Consider not being co-facilitators, limit our role to readings selections Revisit the idea of readings: consider song lyrics, spoken word poetry from YouTube. Consider new themes – instead of compassion, self-compassion. Maybe a theme of humour or coping Irrespective of theme, integrate readings by authors with lived experience into every week. Take out longer readings or break them into smaller sections. Consider a book club version where it’s a reading per week, not a bunch of readings. No readings work for all people… another reason why it’s important to work in collaboration with therapists, or others with counselling experience such as peer support workers, social workers, etc. How to choose readings not only by theme… but by suitablity to develop rapore; trust; relationship…. Comfort Introducing more challenging readings because of either content or style should maybe be delayed until participants have a greater trust. COMMENT – could we add a small piece about future plans? E.g. interviews with peer support workers, review/revise content, peer-support worker-led while we work on readings selections? Considering adding song lyrics. Considers new themes – self-compassion, humor and coping. Want to integrate lived experience readings into every week. Take out longer readings or break them into smaller sections. There’s also interest in STAR in running a more traditional book club.
- A note on material selection… because we always get this question. Carolyn says: As an audience member, I’d be interested in what material we used. Could we use some images of the sources we used? (I can locate these). I don’t think we need a list or readings but a general idea (haikus, short stories, etc, and example or two). If you want to cut more, I’d cut the section below until you get to “Bibliotherapy for others” DEPENDS ON YOUR INTENT: Bibliotherapy FOR YOURSELF: Reading materials may include fiction, poetry, biographies, autobiographies, memoirs, folk stories, children’s stories, self-help books and manuals, and journal and magazine articles. Read what makes YOU feel good… There are books (Novel Cure being one) and websites (LitTherapy being one.. But there are others) Self help: reading-well.org.uk public libraries in the UK. runs the books on prescription program in the UK – all books have been clinically reviewed. Consulting with a librarian – who has special skills in finding materials and/or a literature expert is highly recommended. Bibliotherapy FOR OTHERS: Compiling applicable themes and reading lists for a particular group of people is an art and a science ….add more here? Selecting high quality materials, with some attention to cultural sensitivities, will often transcend differences.
- Close with examples of readings: Examples of readings. Things that have happened to me that have generated more sympathy than depression Having tinnitus. Scalding my hand on an oven, and having to have my hand in a strange ointment-filled glove for a week. Accidentally setting my leg on fire. Losing a job. Breaking a toe. Being in debt. Having a river flood our nice new house, causing ten thousand pounds’ worth of damage. Bad Amazon reviews. Getting the norovirus. Having to be circumcised when I was eleven. Lower back pain. Having a blackboard fall on me. Irritable bowel syndrome. Being a street away from a terrorist attack. Eczemza. Living in Hull in January. Relationship break-ups. Working in a cabage-packing warehouse. Working in media sales (okay, that came close). Consuming a poisoned prawn. Three-day migraines From: Haig, M. Reasons to stay alive. First Canadian Edition. Toronto: Harper Collins; 2016. P. 123-124. From the book jacket: “Reasons to stay alive is a moving, optimistic account of how Matt Haig triumphed over an illness that almost destroyed him and an accessible, life-affirming guide to helping yourself –and others- through mental illness.” Wild Geese – Mary Oliver You do not have to be good. You do not have to walk on your knees For a hundred miles through the desert, repenting. You only have to let the soft animal of your body love what it loves. Tell me about your despair, yours, and I will tell you mine. Meanwhile the world goes on. Meanwhile the sun and the clear pebbles of the rain are moving across the landscapes, over the prairies and the deep trees, the mountains and the rivers. Meanwhile the wild geese, high in the clean blue air, are heading home again. Whoever you are, no matter how lonely, the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting -- over and over announcing your place in the family of things.