Bibliotherapy is defined as "The use of books selected on the basis of content in a planned reading program designed to facilitate the recovery of patients suffering from mental illness or emotional disturbance,” according to the online dictionary for the American Library Association.
Typically bibliotherapy has a few different aims and seeks to help the client grow and develop by learning empathy and insight. The client ideally identifies with a character in the book which allows for learning from everything the character experiences including experiencing psychological catharsis and personal development. This learning is then cemented through discussion with the therapist either individually or in a group setting.
The development of bibliotherapy
Bibliotherapy has been used in some form or another for many years. In its official capacity, the Association of Hospital and Institution Libraries, then a division of the American Library Association, first issued information about bibliotherapy in 1965. However, bibliotherapy and poetry as therapy have been used as far back as ancient Rome with records dating back to 100 AD showing a Roman physician, Soranus, as the first poetry therapist in recorded history. He prescribed tragedy for manic patients and comedy for depressed patients as a way to help balance mood.
In 1751, Pennsylvania Hospital was the first official hospital in the U.S. Patients with mental illness were routinely prescribed a form of bibliotherapy by reading and writing. Additionally, they published patient work in a newspaper called The Illuminator.
The first introduction to the American Psychiatric Association was by Jacob Moreno in 1932. He founded psychodrama and used literature as part of his work as well, calling it “psychopoetry.”
This area rapidly developed, culminating in the 1969 development of standards of credentialing and the growth of training institutes in the 1970s.
The National Association for Poetry Therapy (NAPT) was established as a non-profit organization in 1980, soon followed by the incorporation of the National Association for Biblio/Poetry Therapy in 1983. In 2002 the National Federation for Biblio/Poetry Therapy (formerly the NAPT Credentialing Committee) was established as totally independent of NAPT which eventually became the International Federation for Biblio/Poetry Therapy (IFBPT).
Today the use of writing and reading for everything from personal development to specific clinical applications in mental health is prolific and highly publicized.
The setting of bibliotherapy may vary as there are different types of the therapy in practice.
Developmental bibliotherapy is typically in educational or recreational settings, to help children or adults address common life challenges such as bullying or life choices. These may be facilitated by a librarian with special training or an individual with a Bachelor’s degree and special training who is not yet a therapist.
Clinical or therapeutic bibliotherapy is the use of books, poetry, and/or writing in a professional therapy context to treat a diagnosed disorder or to mitigate symptoms and impacts of disorders. This may occur in an individual or group therapy setting or in some instances, may occur without a therapist directly involved with the individual.
Typically, if bibliotherapy work is done with a therapist, then it is not done as a sole treatment modality. Bibliotherapy work may be done in conjunction with cognitive behavioral, psychodynamic, or family therapy. Because it is typically inexpensive then it is especially beneficial for patients who may be short on time or funding. Therapists may be able to have less frequent sessions with the patient only at certain intervals of time to discuss and process a large amount of work that the patient does outside sessions.
Therapy stages and techniques
Similar to other therapies, the initial session(s) will be dedicated to the therapist gaining an understanding of the client’s strengths and areas of need. Then the bibliotherapist will begin to recommend resources based on the client’s needs and the modality they are using.
For example, if the modality is CBT then the therapist may recommend a book that discusses the integration of the evidenced based principles in life accompanied by a workbook. If the therapy modality is focused on trauma, then the therapist may recommend non-fiction or fictional books where the lead character has been through similar events as the client.
Outside of session, the client will read the book or complete the workbook as required and then at the next session the work done while outside of session will be the focus of initial conversation. This conversation will then shift to applications within the client’s life such as their personal history, coping skills, cathartic insights, or any other applicable factor.
Ideally, the choice of reading material would begin to shift towards the client choosing the material as they gain insight and move towards maintenance or termination phase. Transferring the power from therapist over to client to turn this skill from a therapy treatment tool into a lifetime training resource.
Many therapists who use bibliotherapy report that the practice increases patient engagement and commitment to the therapeutic process. Almost all therapy modalities report on the importance of the client working between sessions in order to make the most improvement and this is required by bibliotherapy.
Bibliotherapy requires a high level of work between sessions due to the expectations, therefore progress can be made at a more rapid rate. Individuals learn to identify character emotions and develop empathy skills, they can learn improved problem solving skills, and improve aspects of life like social behavior and cultural identity.
Several meta-analyses have found bibliotherapy to be helpful in the treatment of both mental and physical health struggles. Additionally, they have found that bibliotherapy can help reduce the impact of stigma on treatment. Bibliotherapy is effective for both children and adults as long as recommendations are made at the appropriate reading and developmental level.
Bibliotherapy does require a significant amount of time and energy outside of the therapy room on both the part of the client and the therapist. Therapists must ensure that books are reviewed carefully prior to recommendation and that they are current, relevant, and credible. Books should also be culturally respectful and inclusive in order to be ethically acceptable to most individuals. This can be a hefty task if the therapist doesn’t read extensively on their own or come into providing therapy with a love of reading.
Additionally, many individuals now either struggle with reading or just don’t like it. This can be a source of anxiety for them if they have a learning disorder or dyslexia, or can be a source of for them if they have a learning disorder or dyslexia, or can be a source of resistance if they have negative feelings about reading in general. This can be assuaged somewhat by supplementing with audio books or books with a lower reading level or movies which may be accessed through teletherapy. However, this highlights the importance of a thorough intake process before simply assigning books.
Bibliotherapy and insurance coding
Bibliotherapy doesn’t currently have a specific CPT code for use. However, since books and related progress could be considered similar to other ‘tools’ that therapists use, like games, then some therapists bill under regular coding 90837/34/32. This is most appropriate with therapists that use bibliotherapy as an aspect of talk therapy.
At the same time, other professionals use code 90899 Other Psychiatric Services or Procedures- to report psychiatric services or procedures that do not have a specific code. In the notes, therapists should indicate information referring to specific techniques used and the client's response to the treatment.
Some specific insurance companies do have their own billing codes to designate alternative therapies, including art therapy, equine therapy and others. Always consult information received upon credentialing with specific insurance boards for best billing practices.
Training to be a Bibliotherapist
A certified poetry therapist (CPT) and registered poetry therapist (PTR) are licensed professionals who have the training required to work independently with clients. The CPT and PTR can work in clinics, hospitals, and similar institutions, as well as with mentally healthy populations for improvement purposes.
Some therapists may complete training in biblio/poetry therapy while in their graduate program, while others complete needed training after graduation. However, all CPT or PTR professionals must have a therapy license conferred before receiving those designations. If a professional completed requirements prior to obtaining their full licensure they are designated a certified applied poetry facilitator (CAPF). The CAPF can work with individuals considered mentally healthy on their own in places such as libraries, schools, and rec facilities and may work in mental health facilities under the supervision of a licensed professional.
Training occurs under a Certified Mentor (CM) through the International Federation for Biblio/Poetry Therapy. All training must be completed under the guidance of the CM and approved by the credentialing committee of the IFBPT.
If you are interested in becoming a CPT or PTR, you should first obtain the Training Guide available on the IFBPT website which enumerates the various components of the training program, documentation, and a list of approved mentors.
An easy to read breakdown of which credential to pursue is also available at the IFBPT site, which can help you determine which credential is most appropriate for your needs.
Literature resources for those looking to help children deal with large tragedies on a community or national scale can be found here, an ERIC digest.
The International Federation for Biblio/Poetry Therapy has a wide variety of resources and information available on its website. Their site also includes helpful tips on training and getting credentialed properly.
To find a credentialed professional near you check the IFBPT directory.
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