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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 [email protected]
Dr. Paula McMillen at [email protected]
Bibliotherapy Education Project website:http://www.library.unlv.edu/faculty/research/bibliotherapy/