Bibliotherapy: Benefits and Effectiveness

What Is Bibliotherapy?

Bibliotherapy is a creative arts therapy that uses literature and reading to assist individuals facing personal challenges and promote mental well-being. In this cost-effective form of therapy, books and stories are used in the therapeutic process and provide individuals with support, insight, self-awareness, understanding, guidance, or reassurance.¹ Numerous genres of literature, including fiction, nonfiction, poetry, and self-help manuals, can be used in this form of treatment.

There are two primary forms of bibliotherapy: developmental bibliotherapy and clinical bibliotherapy.

Developmental bibliotherapy

• This is primarily used for children, usually takes place in an educational setting or at home, and may involve teachers, librarians, and parents. This form of bibliotherapy aims to facilitate the child’s normal social development and provide the child with the resources and space to talk through and feel their emotions. Literature is used to educate children about feelings and behaviors and how to navigate and process them as they develop.²

Clinical bibliotherapy

• This is used as an intervention for adults who are struggling with their mental health. This form of bibliotherapy involves a trained mental health or healthcare practitioner who uses literature to stimulate discussion of complicated feelings or facilitate the resolution of significant behavioral and emotional issues.³ Despite its potential benefits, clinical bibliotherapy is rarely used alone but rather is used as an adjunct to other therapeutic interventions.⁴

What Is the History of Bibliotherapy?

The use of literature as a healing method can be traced back to ancient Greece, when libraries were considered sacred places with the ability and power to cure.⁵ However, the term “bibliotherapy” was coined by American minister and essayist Samuel McChord Crothers in 1916. Crothers proposed and explained how literature could be used to counsel those who have mental conditions.⁴ During World War I and II, bibliotherapy was used to help returning soldiers deal with emotional wounds and trauma.⁵ In 1940, bibliotherapy gained more recognition when formally defined in Dorland’s Illustrated Medical Dictionary, a popular English-language medical reference book.⁴ Since then, bibliotherapy has become a widely used therapeutic intervention.

How Bibliotherapy Works – The Therapeutic Process

Since bibliotherapy can take on many forms and take place in various settings, there is no specific method of conducting it. Bibliotherapy can be as simple as assigning an individual a book to read. However, common bibliotherapy methods include reading books and then reflecting on them, usually through discussion with a trained individual who is able to break down the client’s thoughts and feelings about the text.⁶ It can also take place in a group therapy setting with other individuals experiencing similar issues.

Various texts can be used in bibliotherapy; thus, approaches to selecting the texts are also diverse. Self-help books are usually chosen by mental health professionals who have a background in psychology or psychiatry, while fiction and poetry are generally selected by scholars of English literature, librarians, and the clients themselves.¹ Approaches to working with these different texts are also wide-ranging.¹

The therapeutic process involved in bibliotherapy can be condensed into four main steps:

1. Recognition or personal identification: The reader experiences a sense of familiarity with a theme or idea or identifies with a particular character.⁷ The latter is a central premise in developmental bibliotherapy with children.⁶
2. Examination: The reader digs deeper into the issues they relate to in the book and begins to identify and react emotionally, potentially leading to psychological catharsis.⁷
3. Juxtaposition: The reader, with the help of a therapist or other trained professional, develops a deeper understanding of and insight into how and why they relate to aspects of the text and feel the emotions evoked by the text.⁷
4. Self-application: The reader incorporates the insights gained into their own life.⁷

Potential Benefits of Bibliotherapy

Research has shown that bibliotherapy results in numerous benefits with regard to mood, behavior, and general life functioning, including the following:

• reduced depressive symptoms⁸
• strengthened prosocial behaviors in children⁹
• reduced internalizing and externalizing problems in children⁹
• improved engagement and social interaction in older adults¹⁰
• improved quality of life¹⁰
• decreased perceived stress¹¹
• improved resilience¹¹
• improved mindfulness¹¹

Additionally, studies have shown that the following conditions are improved by bibliotherapy:

• depression⁸
• anxiety¹²
• posttraumatic stress disorder (PTSD)¹²
• alcohol addiction¹³
• obsessive-compulsive disorder (OCD)¹⁴
• deliberate self-harm¹⁵
• intellectual disability in children¹⁶

Effectiveness of Bibliotherapy

Although bibliotherapy is a widely used, longstanding intervention, the research that has been conducted on its efficacy is not as strong as one would imagine. Effectiveness has been determined in specific populations; however, expanding these studies to further populations while focusing on a broader array of mental health conditions would strengthen the existing data.

Regardless of this, the studies that have focused on bibliotherapy so far display promising results, especially in cases where bibliotherapy is used as an adjunct treatment.

• In 1999, Evans et al. studied the impact of manual-assisted cognitive behavioral therapy, or MACT, which was essentially a combination of traditional cognitive behavioral therapy (CBT) and bibliotherapy, on 34 patients who had recently performed a deliberate act of self-harm. MACT effectively reduced the rate of suicidal acts and depressive symptoms.¹⁵
• In 2003, Apodaca and Miller conducted a meta-analysis of 22 studies involving self-help materials and found that bibliotherapy had a small to medium effect in reducing harmful drinking.¹³
• In 2004, a team of British researchers conducted a pilot study analyzing the effect of 12 weekly sessions of 30-minute duration with a therapist who assisted clients with obsessive compulsive disorder (OCD) in using self-help materials. This intervention resulted in improved clinical outcomes in patients with OCD.¹⁴
• In 2015, Montgomery and Maunders carried out a systematic review of multiple studies indicating that bibliotherapy improved internalizing, externalizing, and prosocial behavior in children aged 5 to 16. However, these effects were small to moderate in size.⁹
• In 2015, James et al. reviewed six studies with a combined total of 426 participants and determined that bibliotherapy was as effective as CBT.¹⁷
• In 2017, Gualano et al. conducted a systematic review of 18 randomized clinical trials. They determined that bibliotherapy was effective in reducing long-term symptoms of depression as well as potentially decreasing the need for further medication.⁸

Overall, bibliotherapy appears to be a convenient, straightforward, and cost-effective intervention. As previously mentioned, its effectiveness is increased when paired with an evidence-based psychotherapeutic intervention; however, it can still be beneficial when used independently.