A National Survey of Bibliotherapy Practice

in Professional Counseling

Dale-Elizabeth Pehrsson

& Paula McMillen

UNLV

American Counseling Association March, 2009

Books have universal appeal and much to offer us…

› We are wired for stories

› We learn from stories

› We heal with stories

Bibliotherapy defined…

Literally… treatment through books › (Pardeck & Pardeck, 1998)

Guided reading of written materials to help the reader grow in self awareness › (Harris & Hodges, 1995)

Process of dynamic interaction between the personality of the reader and literature under the guidance of a trained helper › (Shrodes, 1950)

Levels of Bibliotherapy

DevelopmentalThe use of literature and facilitative processes by

skilled helpers to assist individuals in dealing with life transitions and normal developmental issues

ClinicalThe use of literature and facilitative processes by

skilled mental health or medical practitioners in meeting specific therapeutic goals for the purpose of assisting individuals in dealing with severe disorders and traumatic life experiences

Benefits of Bibliotherapy

Increases empathetic understanding › other cultures, viewpoints and lived experiences

Fosters appreciation of & identification › one’s own ethnic/cultural identity

Increases self-awareness & clarifies emerging values

Stimulates discussion of feelings & ideas Improves coping skills

› as alternative responses are explored Reduces negative emotions

› stress, anxiety & loneliness Enhances

› self-esteem, interpersonal skills & emotional maturity

Why this Survey?

Limited scope/scale of existing surveys

No standardized preparation, education or training in bibliotherapy

No standardized supervision or certification in bibliotherapy

Need for counselor educators to know current scope of practice by professional counselors

Previous Surveys

Atwater & Smith (1982) Smith & Burkhalter (1987) Starker (1986, 1988) Matthews & Lonsdale (1991, 1992) Quackenbush (1991) Warner (1991) Adams & Pitre (2000)

Research Methodology

Drafted project proposal and questions Consulted with OSU Survey Research

Center Refined questions Pilot tested survey Secured funding to buy ACA mailing list Sent three rounds of e-mail requests Eliminated ‘undeliverables’ and spam

filters Summarized survey responses

Research Questions

Demographics of respondents› Personal and professional

Specific bibliotherapy practices› Populations › Presenting problems› Implementation strategies› Assessment approaches› Book recommendations

20-30 Yrs10%

31-40 Yrs17%

41-50 Yrs19%

51-60 Yrs43%

61 or Older10%

Age Group of Respondents

Female

Male

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

72%

28%

BSP-ACA Demographics: Gender

ACABPS

Caucasian

Hispanic

African Amer

Asian Amer

Native Amer

Multi-Ethnic

Other

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

BPS-ACA Demographics: Ethnic Affiliation

ACABPS

25%

28%

24%

13%

7%

2% 0%

Geographic Location of Practice

Northeast U.S.Southeast U.S.Central U.S.Southwest U.S.Northwest U.S.Alaska or HawaiiInternational

Pop < 50,00028%

Pop = 50,000 - 250,00034%

Pop > 250,000

38%

Population Base of Practice

0-5 yrs 6-10 yrs 11-20 yrs 21 yrs or more

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

51.0%

19.7%

29.1%

BPS-ACA Demographics: Years in Practice

BPSACA

Associate Bachelor's Master's Doctorate Other

BPS NaN 0.007 0.755 0.199 0.043

ACA 0.002 0.047 0.69 0.22 0.005

0.05

0.15

0.25

0.35

0.45

0.55

0.65

0.75

BPS-ACA Demographics: Highest Degree Obtained

Yes

No

0.0% 10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

BSP-ACA Demographics: Holds Professional License

ACABPS

State school license

LPC LPCS LPCP LMHC RN

17.3%

63.1%

1.8% 2.7%

8.4%

1.8%

Professional Licenses Held

School cert/reg

NCC

MAC

ACS

RPT

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

31.1%

61.2%

3.8%

3.8%

2.2%

Professional Certifications/ Reg-istrations

2-7 yrs 8-12 yrs 13-18 yrs 19-25 yrs 26-40 yrs 41-60 yrs 1

61-80 yrs 81 or older

18.4%

30.5%

43.5%47.9%

63.2%

48.9%

17.1%

1.6%

With which age groups do you most commonly work? Check all that ap-

ply.

21.6%16.8%

48.6%

23.8%

3.8% 2.9% 1.6% 4.8%11.7%

In which setting(s) do you most commonly work with clients? Limit

to 3 choices.

Men

tal h

ealth

Rehab

Stud

ents

Coupl

es/fa

mili

es

Indi

vidu

als

Group

s

Oth

er0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

54.0%

10.5%

46.7% 47.9%

80.3%

31.7%

7.6%

With which client populations do you regularly work? Check all that apply.

Psych

odyn

amic

Cogni

tive

beha

vior

al

Behav

iora

l

Client

-cen

tere

d

Exist

entia

l

Family

/sys

tem

s

Solut

ion

focu

sed

Brief t

hera

py

Eclec

tic/syn

thet

ic

Oth

er

12.5%

52.7%

15.3%

29.4%

8.3%

30.4%

36.1%

21.1%23.0%

15.3%

Identify your primary therapeutic ori-entation(s).

Do you use bibliotherapy in your work with clients?

No 21%

Yes 79%

1-20% 21-40% 41-60% 61-80% 81-100%0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

With what percentage of your clients do you use Bibliotherapy?

Percentage of Clients

Perc

en

tag

e o

f R

esp

on

den

ts

5.8%

47.8%

29.0%

43.8%50.0%

3.6%

Preparation to Use Bibliotherapy

Read it myself

Peer recommendation

Book review(s)

Client recommendation

Formal evaluation tool

Intuition

Librarian recommendation

97.8%

73.2%

37.1%

42.9%

11.6%

29.0%

3.1%

How do you choose books for clients?

Read it myself

Peer recommendation

Book review

Client recommendation

Formal evaluation tool

Intuition

Librarian recommendation

74.4%

8.5%

4.0%

4.9%

2.2%

4.0%

0.4%

Most Valuable Way to Choose Materials for Bibliotherapy Use with Clients

2 - 7 yrs 8 - 12 yrs

13 - 18 yrs

19 - 25 yrs

26 - 40 yrs

41- 60 yrs

61 - 80 yrs

81 or older

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Percentage of Clients with Whom Use Bib-liotherapy: Age Groups

NA 1-20% 21-40% 41-60% 61-80% 81-100%

Significant Findings for Age Groups: 67% of counselors report they use

bibliotherapy (BT) with 19-25 year old clients more than 20% of the time

71% of counselors report they use BT with 26-40 year old clients more than 20% of the time

69% of counselors report they use BT with 41-60 year old clients more than 20% of the time

Only 20% of our sample reported working with the 2-7 year old & 81 or older age groups so BT usage was accordingly low

Acade

mic is

sues

Caree

r iss

ues

Subs

tanc

e ab

use

Grief &

loss

Social

/life

ski

lls

Trau

ma

Family

/cou

ples

Rehab

ilita

tion

Clinical

dia

gnos

es0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Percentage of Clients with Whom Use Bib-liotherapy: Issues

N/A 1-20% 21-40% 41-60% 61-80% 81-100%

Significant Findings for Issues:

Counselors report using BT with more than 20% of their clients for the following categories of presenting issues:› Grief and loss› Social/life skills› Trauma (abuse, catastrophic events)› Family & couples’ issues› Clinical diagnoses (depression, anxiety,

etc.)

Assig

n in

depe

nden

t rea

ding

Read

to o

r with

clie

nt(s)

Guida

nce

or cla

ssro

om re

adin

g

Group

ther

apy

read

ing

Readi

ng w

ith a

rt a

citiv

ity

Readi

ng w

ith w

ritin

g ac

tivity

Readi

ng w

ith d

ram

a ac

tivity

Client

read

s to

cou

nsel

or0.0%

10.0%20.0%30.0%40.0%50.0%60.0%70.0%

What percentage of your bibliotherapy in-terventions involve the following activities?

N/A 1-20% 21-40% 41-60% 61-80% 81-100%

Significant Findings for Activities:

Most frequently used activities were › Reading combined with writing activity› Assigning independent reading› Reading to or with the client

Least used activities included› Use in classrooms or guidance units› Group therapy readings› Reading accompanied by art or drama

activity

Pict

ure

book

s

Poet

ry

Easy

read

ers

Fictio

n

Non

-fict

ion

Self-

help

Wor

kboo

k

Audio

book

s

Info

rmat

iona

l pam

phle

t0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Percentage of Bibliotherapy Materials by Category

0-20%21-40%41-60%61-80%81-100%

Significant findings for Materials:

Most commonly used materials for BT were:› Self-help materials or readings› Workbooks› Informational pamphlets

Least used materials were :› Poetry› Audio books› Fiction› Picture books

Client reports improvement

Progress toward treatment goals

Clinical assessment checklist

Other

78.4%

83.8%

14.4%

6.3%

How Assess Effectiveness of Bib-liotherapy?

Research Limitations

Getting a viable sample from e-mailing list Self-selected respondents Those who selected out of survey Possible social desirability response bias Some possibilities of duplicate reporting

within questions (“Other” category) Difficult to assess actual preparation that

individuals obtained

Survey Surprises Limited use of imaginative

literatures (e.g., poetry, picture books, fiction)

Limited intervention approaches (e.g., few use with classroom guidance)

Some populations/ issues not targeted (e.g., academic issues, children & elders)

Few rely on librarians as source of recommendations!

Conclusions

Based on the populations served (adults aged 19-60 years) and the therapeutic orientations (cognitive behavioral, 53%, & solution-focused, 36%) of our sample, it is not surprising that the predominantly used materials are non-fiction (self-help, workbooks, informational pamphlets).

We believe that fiction & imaginative literature are not adequately recognized or used.

More to do….

Target practitioners who use creative interventions for comparative survey data

Association for Creativity in Mental Health American School Counselor Association Association for Play Therapy Association of Poetry Therapy

Enhance the evaluation components in Bibliotherapy Evaluation Tool for

Non-fiction Informational Self-help books Manualized treatment texts

Implications for Counselor Educators

Counselors do use bibliotherapy as a part of their professional practices

Their preparation takes place to a large degree as part of academic course work or at workshops

Many are self taught

Counselors in training need grounded preparation because this is a common set of therapeutic interventions

Specific bibliotherapy education unit embedded within curriculum that includes:› Historical practices of bibliotherapy› Research on effectiveness of bibliotherapy› Client assessment and treatment planning› Intervention options and strategies› How to analyze and select appropriate literature› How to assess client progress› Ethical considerations and practice cautions› How to find therapeutically relevant resources—

including calling on the expertise & resources of local libraries (children and adult librarians)

› Emphasize the value of imaginative literature & picture books for bibliotherapeutic applications

Recommendations for Counselor Preparation

Thank you!

For questions or future communication contact either:

Dr. Dale-Elizabeth Pehrsson at dale.pehrsson@unlv.edu

Dr. Paula McMillen at paula.mcmillen@unlv.edu

Bibliotherapy Education Project website:http://www.library.unlv.edu/faculty/research/bibliotherapy/