This document discusses bibliotherapy and its use with children in hospital settings. It defines bibliotherapy as using written materials to help people gain understanding and solve problems relevant to their therapeutic needs. Reading to children is important for their development as it allows them to explore concepts and emotions in a safe way. When using bibliotherapy with hospitalized children, it is important to select age-appropriate books based on the child's development and condition. Facilitating discussion during and after reading can help children gain insight and feel normalized. Bibliotherapy should be used as part of an overall treatment plan to address children's emotional needs.

1. Krista Caballero, CCLS II, CIMI
Texas Children’s Hospital

2.  Reading to children is central to their development.
 “Books provide a safe medium for children to explore different
concepts, feelings, and attitudes while allowing them to better
understand their environment, community, and societal
expectations. Reading to children increases self-esteem, gives
comfort, and may aid children in coping with difficult
situations.”

3.  Bibliotherapy is:
 The use of written materials to gain understanding and engage
in problem solving relevant to the person’s therapeutic needs
 What is Bibliotherapy?
Central to Development
Safe Outlet to Explore Concepts and Emotions
 Why Bibliotherapy?
Communication
Stimulates Discussions and Conversations
Addresses innermost feelings
Provides Insight
Normalizes the Hospital Environment
Strengthen relationships
Healthcare Workers
Family

4.  History
 The term ‘‘bibliotherapy’’ was first used by S. M.Crothers in 1916 to describe the use
of books to help patients understand their health problems and symptoms.
 Origin
 The word is derived from the Greek words biblion (book) and oepatteid
(healing).

5.  Can address/express
compassion, criticism, tension, relief, sadness, happiness, fear, c
ourage, rage, pain, anguish, and death
 Children express their worries and fears differently than adults
 Lack of verbal skills can inhibit the ability to express feelings and
emotions
 Lack of family discussions concerning feelings
 Parents’ stress reactions

6.  Stages of Development and Literature
 When Using Reading as a Resource to Minimize the
Stress of Hospitalization, it is Necessary to Consider
Aspects of Development
 Pre-Schoolers (3-6 years) Experience a rapid development of
their vocabulary and language skills, and understand their
experience by using symbols, including language
 School-Aged Children (6-8 years) Are improving their
reading and like to know about concepts and skills
 Pre-Adolescents (8-11 years) Enjoy realistic fiction and books
that describe real life events, since they are learning to make
choices and developing personal values
 Adolescents (12-18 years) Enjoy novels and fiction, fantasy, or
even individual non-assisted readings

7.  Selection of a Book
 Criteria:
 Must not give a false sense of hope
 Must provide correct information about a presenting
problem
 Age appropriate
 Assess the Child’s Development, Coping Response, and
the Attitude of the Child’s Parents

8.  Transformation of Children’s Beliefs
 Themes
 Separation
 Escape from a Difficult Situation
 Recovery
 Small Individuals who are Important
 Control
 Rescue by a Powerful Stranger

9.  Determining a Theme
 Stage of Cognitive Development
 Stage of Personality Development
 The Impact of the Medical Condition on the Child’s Life
 The Psychological Defense Mechanism the Child Uses
 The Child’s Dominant Affectual State
 The Attitudes of the Family Members toward the Child
and the Illness

10.  Didactic
 Instructional and educational, similar to textbooks. A
didactic text can be found for nearly any topic a clinician may
wish to address with the patient-reader, including personality
conflicts, and coping with stress (eg, self-help books). The
purpose is to facilitate a direct change within the individual
through a cognitive understanding of self.
 Imaginative
 Refers to the dramatic presentation of human behavior
through fiction, poetry, drama, biography, and
autobiography.

11.  Stages of Therapeutic Involvement
1. Involvement
 At this point, patients begin listening to the story and
demonstrate interest in what is happening. They get “caught
up” in the narrative
2. Identification
 Patients best identify with characters of the same age and
who are experiencing similar circumstances
3. Catharsis
 Patients are pulled further into the process of recognizing
and vicariously experiencing the character’s feelings. As the
character successfully resolves problems, patients release
emotional tension associated with their own problems

12. 4. Insight
 Patients think about what happened in the story and apply it
to their own lives. Patients begin resolving the struggles they
may be personally experiencing
5. Universalism
 Patients move beyond the egocentric trap of only seeing their
own problems and the perception that no one else
understands or shares their pain. They gain a broader
perspective of their own challenges and are able to
understand that others may have similar problems.

13.  Stages of Bibliotherapy
 Identification
 Selection
 Presentation
 Follow up

14.  Conditions to be Met
 Rapport, Trust, and Confidence to Have Been
Established
 The Patient and Child Life Specialist have Begun to
Address Goals/Interventions
 Some Preliminary Exploration of the Problem has
Occurred

15.  Reading Goals
 Creating your Own Goals
 Examples of goal
Provide a sense of pleasure and enjoyment through
humorous read-alouds
Provide normalization by facilitation of imaginative
separation from the hospital environment through pre-
occupation with read-alouds
 Program Design Aligns with Child Life Goals

16.  Entrancement During the Reading
 Strong Emotional Responses
 Show evidence of their experience in relation to their disease and
care, their acceptance and understanding. This information is
relevant to plan comprehensive and humanized care.
 Preoccupation with the Story’s Theme
 Cascades of Questions
 Testimonials
 Examples: The child’s comments and questions, such as “that
mouse is hurt just like me” and “is he scared too?” seemed to
indicate strong identification with story characters in children read
aloud to in a research study.
 In the same study, several stories which had characters who
survived a catastrophe, generated in some children hope and smiles
and questions about their own convalescence and recovery.

17.  Use of Timing
 Questioning Strategies
 Questioning strategies during and after reading should
not be judgmental; rather, the focus is on the feelings of
the main characters
 Facilitators must allow the stories themselves to shape
the questions
 For example, “In the book, Onion John, how do you think
Onion John felt when Andy was able to understand what he
said?” or “In Sam, Bangs, and Moonshine, how do you think
Sam felt when her friend and her pet were in danger?”

18.  Preview
 Question
 Predict
 Infer
 Connect
 Summarize
 Evaluate

19.  Maintain the Emotional Distance
Necessary
 Never Let a Story Become a Sermon

20.  Reflection
 Connection
 Understanding
 Interpretation

21.  What is the main idea of this story?
 Why do you think the story has the title “ ”?
 What would be another good title for the story?
 Why does a character (take a particular action)?
 What caused______to______?
 What effect did _______ have on _______?
 What character can you connect with most in the book?
 What issue in the book the most interesting? Upsetting?
Familiar? Ridiculous? Confusing?
 What are the problems the main character faces and how
are they solved?

22.  What events and people cause the main character to
change?
 What have you learned in the book that will be helpful
to you in the future?
 What do you think the author wants you to know or
learn?
 What impact has the story made on you?
 What caused….?
 Why do you think…?

23.  To Assist in Determining the Appropriateness of a
Post-Reading Activity, Ask These Questions:
 Will the activity help students connect with the story?
 Will the activity help students connect with the story?
 Will the activity help students in making conclusions
aligned with the story?
 Will the activity promote emotional growth and
healing?

24.  Use of Ipad, Ipod/Iphone, or Kindle (can use kindle
Application for the Apple Technology
 Use of YouTube:
 http://www.youtube.com/watch?v=zwwGBVa1j9A
The Next Place
 http://www.youtube.com/watch?v=Scj3A1cLVzY
You are Special
 http://www.youtube.com/watch?v=RnYW6YH_8w4
Alexander and the Horrible, No Good, Very Bad Day

25. Let’s practice!

26.  www.compassionbooks.com
 http://www.ed.gov.nl.ca/edu/k12/curriculum/docume
nts/english/biblio46/criteria_for_selecting_childrens_
literature.pdf
 http://www.apa.org/pubs/magination/index.aspx
 www.brainpop.com