Healing through books: The evolution and diversification of bibliotherapy.

Full text

NATALIA TUKHARELI, MLIS, PhD
Healing Through Books:
The evolution and diversification of
bibliotherapy

Table of Contents
Abstract i
Foreword by Joseph Gold iii
Acknowledgements iv
List of Abbreviations vi
Introduction 1
Chapter I
A Historical Overview of Bibliotherapy: From
Early Records to Recent Applications 8
1. The history of bibliotherapy from early
records through the 19th century 8
2. The development of bibliotherapy in
the 20th century 12
3. Bibliotherapy in the first decade of the 21st
century to the present 20
Chapter II
Book-Reader Interaction in Bibliotherapy 27
1. Books as “silent therapists” 27
2. The psychological basis of
bibliotherapy: “identification-insight” paradigm 33
3. The book-reader interaction and the construction
of meaning in bibliotherapy 40
Chapter III
Theoretical Aspects of Bibliotherapy: Definition
and Classification 46

1. The problem of definition 46
2. Traditional types of bibliotherapy:
clinical and developmental 54
3. The development of bibliotherapy in the 21st
century and its terminological implication 56
Chapter IV
Clinical Bibliotherapy: Current Trends and
Tendencies 62
1. Self-help bibliotherapy 65
2. Types of self-help materials used in
bibliotherapy 67
3. Recent applications of self-help bibliotherapy 70
4. Bibliotherapy for depression 75
5. Supported (guided, assisted) and
unsupported bibliotherapy 82
6. Potential benefits and drawbacks
of self-help bibliotherapy 85
7. Self-help bibliotherapy within a
stepped-care model in primary care 88
8. “Books on Prescription” bibliotherapy model 90
Chapter V
Creative Bibliotherapy 97
1. Recent applications of creative bibliotherapy 100
2. Evaluation of creative bibliotherapy
schemes 105
3. Benefits and challenges of the creative
bibliotherapy approach 109
4. Creative bibliotherapy reading groups within
the framework of traditional support groups 113

Chapter VI
Bibliotherapy Programme on HIV/AIDS 117
1. HIV/AIDS in Africa and its impact on
women and children 118
2. The psychological and emotional issues
encountered by children living with HIV/AIDS 128
3. The bibliotherapy programme description 133
Bibliography 161
Index 195

i
Abstract
Bibliotherapy, as a part of expressive therapy, involves
the systematic use of books to help people cope with mental,
physical, emotional, developmental or social problems.
Together with some other similar practices, such as art therapy,
dance therapy, music therapy, and play therapy, bibliotherapy
emphasizes the idea of the healing, consoling power of art
through its various forms. The manuscript will address
bibliotherapy as a powerful way of applying literature in
everyday life. It will claim that bibliotherapy is an effective tool
in helping people to restore meaningful connections with
themselves, each other and with the world around in the times
of difficult transitions and physical, psychological, emotional
and social challenges. The conceptual framework of the study
will be built based on a thorough analysis of both theoretical
and practical aspects of bibliotherapy, such as the definition of
bibliotherapy, types of bibliotherapy, goals and objectives,
methodology, evaluation, and the benefits and challenges of
bibliotherapy. The manuscript will explore the transformative
potential of literature and the complexity of a “book-reader”
interaction as the psychological basis of bibliotherapy. After a
brief historical overview of bibliotherapy from early records
through the 20th century, the manuscript will provide a detailed
description of recent theories and practices in bibliotherapy and
identify factors contributing to its rapid development. It will
suggest practical steps towards building a connection between
literature and everyday life through the examination of the most
recent bibliotherapy projects successfully implemented within
clinical and non-clinical (creative) bibliotherapy. Special

ii
attention will be paid to a self-help bibliotherapy approach and
creative bibliotherapy schemes in the form of shared reading
groups. The manuscript will also provide an overview of the
development and implementation of the bibliotherapy
programme for people living with HIV/AIDS that the author
conducted at Nkosi’s Haven Village in Johannesburg, South
Africa.

iii
Foreword
It is with pleasure that I write a brief introduction to this
latest addition to the multidisciplinary field of bibliotherapy.
And fitting it is that this valuable contribution to this body of
work should be authored by a librarian, Dr. Natalia Tukhareli.
Reading as a healing behaviour and a therapeutic practice found
its first formal home in libraries, where as an intentional
discipline it became part of the curriculum of Library Science.
Because librarians are very often “book people” themselves as
well as guardians and custodians of books, opponents of
censorship and champions of freedom of information, they want
to help their clients, share their enthusiasms, and guide their
fellow readers.
Bibliotherapy or healing through reading obviously
occurs even when therapy is not the primary or conscious goal
of reading. Those who love reading will reap benefits from
doing so. The fact that this affection and joy in reading can be
harnessed as a health regimen must surely be welcome news
that librarians and teachers can explain to everyone else. We
must hope that health care professionals will soon join the ranks
of those bearing this good news. As Ms. Tukhareli reminds us,
a major benefit of bibliotherapy is the low cost of delivery. And
a big part of this advantage derives from the enlisting of the
patient/reader in his/her own healing. Patients who can help to
heal themselves are much more economical to treat than non-
compliant, depressed and passive patients, who do not respond
well to being passive and poorly informed consumers.
The first few chapters of this book provide a survey that
brings us from the early days of research into bibliotherapy up

iv
to the present day. From the point of view of perspective and
context, this is extremely useful showing us not only what there
is in the research field but also providing a sense of continuity
and development. The author pays close attention to the need
for a terminology, such as “clinical” vs. “creative” to bring
some welcome order to terms that have been in the past
somewhat vague: self-help, non-fiction, instructional and
narrative to give a few examples. She introduces us to the “Get
into Reading” movement. Even more importantly she draws our
attention to variables that are revealed in the research when
attention is paid to bibliotherapy pursued in a group setting. I
am not aware of any other attempt to date that puts the would-
be student of this field so clearly in the “picture” as it were.
Ms. Tukhareli puts before us that bibliotherapy is
measured as successful when it is able to lead the reader to a
new sense of personal empowerment. When the reader feels
renewed optimism, hope and energy, and when a feeling of
increased control and agency is experienced, then many changes
become possible. Diet, activity and social interaction can
improve, and mood and energy increase.
The author of this book is not someone content to sit in
the library or the lab. In 2010, Ms. Tukhareli took herself to
South Africa to join the staff at a shelter for women, mothers
and orphans living with AIDS in order to work with the
modality of bibliotherapy, hoping that it might help to improve
the conditions that challenged these patients. It is difficult to
imagine how hopeless life must seem for many such people. In
this front-line work for patient survival the author was able to
observe many changes first-hand and every day. To her passion
for the modality, she added her compassion for her patients, and
by means of books, stories, group interactions, discussion and

v
kindness these patients changed. They grew and learned with
their readings. They felt less alone, and their hope and optimism
took hold. They expressed their gratitude and their appreciation
in profound ways. Obviously this kind of experience changes
therapists as well as patients. This book seeks to share and
expand the practice of healing through reading and talking
about the reading experience.
I am encouraged by Ms. Tukhareli’s work.
Bibliotherapy promises large returns in human well-being for a
modest investment of resources. I hope to see this work
expanded in many ways and in a wide variety of places.
Joseph Gold, PhD
Professor Emeritus
University of Waterloo

vi
“In reality, every reader is, while he is reading, the reader of
his own self. The writer’s work is merely a kind of optical
instrument which he offers to the reader to enable him to
discern what, without this book, he would perhaps never have
experienced in himself. And the recognition by the reader in his
one self of what the book says is the proof of its veracity.”
Marcel Proust
“Ideal readers do not reconstruct a story: they re-create it.
…For the ideal reader, every book reads, to a certain degree,
as an autobiography.”
Alberto Manguel

Introduction
My experience with bibliotherapy went through
different stages — from my personal experiences of the
transformative power of literature, to an academic
exploration of the art and science of bibliotherapy as a
discipline, to first-hand observations of how literature can
change the lives of a particular group of destitute people
facing a terminal illness. Something that began as a
personal interaction with literary classics, and continued as
a scholarly exploration of the theoretical grounds of
bibliotherapy, found a practical implication at the end of
the journey.
A few years ago, while browsing shelves at the
University of Toronto bookstore, I came across a book
called How Proust Can Change Your Life, by Alain de
Botton (1997). The title spoke to me immediately,
triggering emotions similar to the “joys of discovery” that
we experience at eye-opening moments. It described my
own experience with Proust’s writings, particularly their
transformational effect on my life. I remember holding the
book in my hands and having a Proustian moment of
“involuntary recollection” of a particular period from my
past. I recalled the time I lived through Proust’s novels,
applying his theory of memory and recollection to my own
experience. This emotional journey helped me not only to
revisit my past, but also to reconcile a few painful
memories, have strong moments of gratitude for all the
happy moments and, finally, to get a fresh perspective on
my life at that point. This reading experience was very
therapeutic, and it happened because of my encounter with
the “right book” at the “right time”. Proust provided me
with a tool that I would use throughout my life when
approaching different situations and challenges.
I have always believed in the consoling and
transforming power of a book. Since my childhood, I kept
expanding a narrow circle of “friends” by adding the names
of my favourite authors, such as Hans Christian Andersen,
Antoine de Saint-Exupéry, Gabriel García Márquez, Marcel

Proust, Rainer Maria Rilke, Leo Tolstoy, Fyodor
Dostoevsky, Jorge Luis Borges, Federico García Lorca,
Boris Pasternak, Vladimir Nabokov, and many other
beautiful minds and spirits. By calling them friends, I
acknowledged my deep connection with the writers, who
not only influenced my intellectual, emotional, and spiritual
development, but also were with me in times of joy and
hardship. Like good friends, each of these writers left an
imprint on my mind and soul. Throughout my life, I had a
few very powerful moments of interaction with their books,
while recreating narrative worlds and building intellectual
and emotional connections with the authors and characters.
Those moments often had a strong impact on my life, to the
extent that they helped me live through challenging
situations and open new perspectives and opportunities for
myself.
As a scholar with broad interests in the humanities,
I was keen to explore the transformational power of art and
literature. My engagement with bibliotherapy started as an
academic journey into a new discipline aimed at
investigating the therapeutic potential of books and reading.
During my recent involvement in library studies, a
scholarly exploration of the theoretical aspects of
bibliotherapy turned into a search for practical ways of
applying the therapeutic power of books to everyday life,
particularly in a public library setting. Finally, life brought
me to the point where I had an opportunity to apply my
newly acquired knowledge of bibliotherapy to the library
project I conducted in Johannesburg, South Africa.
In 2010, I spent three months at Nkosi’s Haven
Village, an NGO serving people living with HIV/AIDS, in
Johannesburg. During my stay and volunteer work at
Nkosi’s Haven, I established a library for the residents of
the shelter and conducted a few educational and
recreational programmes for children and adults, including
an innovative bibliotherapy programme on HIV/AIDS. The
bibliotherapy programme aimed to reach out and break the
isolation of people living with HIV/AIDS, to increase their

awareness about the disease and to improve their well-
being. The African Journal that I maintained during the
three months I spent in South Africa documented powerful
moments of interaction with literature that I observed in the
Nkosi’s Haven library.
When observing the consoling power of a book in
action, I was struck by the realisation that a common
expression, “books as a shelter”, was more than an
elaborate metaphor: Books not only console and help
people to escape, books expand worlds, which was
especially beneficial because, in most cases, the children at
Nkosi’s Haven were trapped in their physical and
emotional problems; books educate and provide a sense of
belonging; and, finally, they give pleasure. I asked a six-
year-old boy who demonstrated a particular passion for
reading, “What do you feel when you read?” He replied, “I
feel happy.”
Later on, the interview data collected through the
Wall of Happiness project that I conducted with young
residents of Nkosi’s Haven revealed that approximately 38
per cent of the children (18 out of 48) mentioned books,
reading and the library among the things that made them
feel happy. Although I realise that books cannot protect the
children at Nkosi’s Haven from the reality from which, in
the majority of cases, there is “no escape to a happy
ending”, I believe that they can help to build the coping
skills the children need to survive in this harsh reality.
Motivated by the success of the bibliotherapy
programme on HIV/AIDS, I decided to address a variety of
other “living problems” through bibliotherapy to serve the
needs of individuals and diverse groups of people within
the Canadian community. In September 2011, I founded
Read to Connect, a non-profit organisation in Toronto,
Ontario, to provide creative bibliotherapy services to
individuals and groups undergoing the effects of life crises
and transitions. My experience working with people of
different ages and cultural and social backgrounds has
proven that creative bibliotherapy in the form of a read-

aloud reading group works, and that it is needed. It has also
shown the possibility of integrating this particular
bibliotherapy model into the conceptual and practical
framework of “support groups” that have recently been
well recognised by service providers and the general
public.
Why did I decide to write this book? It has been
almost 100 years since the term bibliotherapy was
introduced to describe the practice of using literary
materials to address mental health issues. Since then, the
literature has provided numerous evidence-based and
anecdotal stories of bibliotherapy applications that were
developed with therapeutic, educational, and recreational
purposes and implemented in both clinical and non-clinical
sectors. While psychiatrists and counsellors share their
positive experiences of using fiction and self-help materials
in their private practices, public librarians report on the
success of “Book on Prescription” schemes, and facilitators
of creative bibliotherapy reading groups in community
settings describe their benefits for diverse populations.
Behind these academic reports and anecdotal stories are
real people who were helped during difficult times in their
lives.
On the other hand, throughout the history of
bibliotherapy as a discipline, the discourse has been filled
with discussions revolving around a few controversial
topics, such as the problem of definition and confusion
around terminology, the lack of evidence-based research
and ethical concerns about practicing bibliotherapy beyond
a medical field. I have to admit that my initial exploration
of the theoretical grounds of bibliotherapy left me with
many unanswered questions and doubts. However, my
personal and professional experience of the therapeutic
power of books, which added more successful stories of
how “books can change one’s life”, motivated me to
advocate for the further development and promotion of
bibliotherapy to overcome barriers on its way to those who
can benefit from creative interaction with books.

Within this context, the goal of this book is to dispel
concerns around bibliotherapy and justify its practice by
providing solid evidence of the effectiveness of
bibliotherapy in addressing health-related and “living
problems” of individuals within a variety of clinical and
community settings. The book will provide a
comprehensive overview of current theories and practices
in bibliotherapy in order to identify trends in the
development of the field in the 21st century, and examine
how they fit into the broader picture of recent tendencies in
the healthcare and social sectors. The book will suggest
practical steps towards building a connection between
literature and everyday life through the examination of the
most recent bibliotherapy schemes run within two
bibliotherapy models, clinical bibliotherapy and creative
bibliotherapy. It will highlight the benefits and challenges
of each particular model and describe different
bibliotherapy schemes developed and implemented within
each model.
The particular emphasis of the book is on reading
groups based on the principles of creative bibliotherapy. I
will argue that a reading group based on the creative
bibliotherapy approach provides a safe and inspirational
venue for self-exploration and social relationships.
Emotional interaction with literary texts, enhanced by the
unifying power of a reading group discussion, can have a
transformational effect on individuals involved in this
activity. The book aims to promote creative bibliotherapy
to different groups of stakeholders, including health
professionals, librarians, educators and service providers in
the social sector. It will suggest that a shared reading group
be viewed as a specific type of support group that involves
the systematic use of texts and guided discussion around
them to assist individuals in dealing with “life problems”.
The book will provide a starting point for an investigation
of the practical ways in which creative bibliotherapy can be
integrated into the framework of support groups.

The conceptual framework of the study is built on a
thorough analysis of the theoretical and practical aspects of
bibliotherapy, such as the definition of bibliotherapy, the
types of bibliotherapy, its goals and objectives,
methodology, and evaluation. Chapter 1 will provide a brief
historical overview of bibliotherapy from early records of
guided reading to current bibliotherapeutic practices in
North America and the United Kingdom. Chapter 2 will
explore the transformative potential of literature and the
complexity of a book-reader interaction as the
psychological basis of bibliotherapy. Chapter 3 will address
the problem of the definition of bibliotherapy and describe
its classification. Chapters 4 and 5 will provide an
extensive overview of contemporary bibliotherapy schemes
developed and implemented within clinical and creative
(non-clinical) bibliotherapy. The last chapter will provide
an overview of the development, implementation, and
evaluation of the bibliotherapy programme for people
living with HIV/AIDS that I conducted at Nkosi’s Haven
Village, Johannesburg, South Africa, in 2010.
In conclusion, I hope that bibliotherapy, as the
intentional use of the therapeutic potential of literature in a
variety of clinical and creative schemes, will be widely
recognised as a simple, accessible, and cost-effective way
of addressing a variety of physical, emotional,
psychological and social issues. I envision that self-help
bibliotherapy will become an effective method of health
education and promotion, enabling individuals to increase
control over their health and well-being. I also hope that
creative bibliotherapy, in the form of a shared reading
group, will be recognised as an approach that holds great
promise in helping individuals to better cope with the
difficulties and challenges caused by the instability of
modern life. My experience shows that creative
bibliotherapy is an effective tool in helping people to
restore meaningful connections with themselves, with
others, and with the world around them in times of difficult

transitions and physical, psychological, emotional and
social challenges.