When Rese Rose suddenly became very ill, a friend gave her a gift voucher for an unusual treatment called bibliotherapy. Rose says she was “deeply intrigued at what it may offer, probably because my approach to health has never been completely conventional”.
Bibliotherapy involves using literature to aid mental and emotional healing. The term comes from two Greek words: biblion, meaning book, and therapeia or healing. The term was coined in 1914 by American minister and author Samuel Crothers who described bibliotherapy as a “process in which specific literature, both fiction and non-fiction, was prescribed as medicine for a variety of ailments.”
While the term is relatively new, the benefits of bibliotherapy have been recognised for millennia. The ancient Egyptians, for example, had an inscription above the portal of the library of Pharaoh Ramses II, describing it as “the house of healing for the soul”.
Bibliotherapy was used by medical professionals like Sigmund Freud in the early 20th century. During World War I, as doctors and nurses searched for ways to help soldiers with their mental health, the idea came into its own.
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A pioneer of bibliotherapy, Helen Mary Gaskell, described the beginnings of her war library in 1918: “Surely many of us lay awake the night after the declaration of War, debating … how best we could help in the coming struggle … Into the mind of the writer came, like a flash, the necessity of providing literature for the sick and wounded.”
Recent years have seen a resurgence of interest in bibliotherapy as studies explore its benefits for common mental health conditions like depression, stress, anxiety, social phobia and addictions.
Bibliotherapy in practice
A bibliotherapy session can be done in person or via an internet app like Skype, explains Dr Zewlan Moor, a GP who started a bibliotherapy practice after experiencing its benefits herself. Byron Bay-based Moor sends her clients a pre-session questionnaire, asking about their reading tastes and what they hope to achieve from the session.
“Some people will want a specific reading list for an issue that they’re facing in life,” she says. “Other people want more breadth out of their reading and are looking for recommendations. There’s book recommendations all over the web but [bibliotherapy is] all individualised for you.”
During the session, Moor discusses things that came up in the questionnaire. “It’s a focused conversation and really drilling down on what they actually want,” she says. She also asks questions to ensure nothing more serious is going on that may require referral to another practitioner such as a psychologist or GP.
She adds that bibliotherapy isn’t just about giving clients what they want: “I check if they mind getting stretched a little bit.”
After the session, Moor sends her clients a prescription of up to 12 books. These are not limited to self-help books but often include fictional works like novels and poetry.
Moor tries to only recommend things she has read, making notes for herself at the end of each book. “The themes that are covered [in a book] will often come up and be a recommendation for multiple situations,” she explains.
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She also gets advice from librarians and trusted members of her book club. “Librarians are the best resource because they’re so well-read and they want to share. They do this type of work, anyway — they’re the original bibliotherapists. The difference between us is that I have 45 minutes and talk about confidentiality.” If desired, clients can have a follow-up session.
Moor says people seek bibliotherapy for various reasons, including relationship issues, grief or to gain deeper insight into their problems. Some people are thinking they need to slow down. “Sometimes a loved one will actually have told them that,” she says.
She adds that bibliotherapy can be ideal for people who have trouble identifying or recognising that they have mental health issues. Some people, she says, “don’t realise that they’re anxious or that … a lot of their reactions are from things that have come up in childhood or reactive in some other unhealthy ways. In general practice you get patients who really have anxiety or depression but they don’t want to consider that cause. They may be far more likely to go and get a book prescription.”
The gift of reading
Rose’s friends gifted her a session with Moor after the Brisbane-based documenter and photographer developed an autoimmune condition. Previously extremely fit, she “literally overnight became bedridden and unable to walk”.
“I was in severe pain with the slightest effort to move and completely exhausted to the point where I was sleeping 18 hours a day at one stage,” she says. “It was not only incredibly challenging physically; it was enormously overwhelming psychologically. My mental health really suffered terribly as my physicality and my brain functions continued to deteriorate.”
Rose’s friends thought bibliotherapy might help her with the debilitating psychological effects of her illness. They were right. “The session was in-depth but in a really good way,” she says. Along with establishing her medical background, lifestyle and family history, Moor explored her interests and level of competency in “not only literature and reading but also things like music and art”.
Rose has a background in practising traditional Chinese medicine and entered the session without preconceived ideas. “I’ve learnt that sometimes to go in a bit naive and just see what comes forth is good,” she says. “My health was quite poor at that time — not that I was grasping at straws but I was definitely available to any kind of alternative to using pharmaceuticals or things like that.”
When her prescription came through a week afterwards, she says, “I was so deeply touched. It was such a personal diagnosis and understanding of where I currently was. There was nothing generic about my prescription. For example, because of the reduction in my cognitive function, there was an inclusion of audiobooks.
“I particularly liked the broad range of books that were appointed. Because of the variation in the recommendations, I was able to immerse myself in a wide range of authors and topics. Many of them I wouldn’t really have ever considered.”
While Moor prescribed some books about chronic pain and dealing with mental health issues, there were also novels, poetry and works about history and art. “She really had tapped in and pulled just what I needed — not in the way that you are given a bag of lollies but you have your vegetables as well.”
Rose says that due to the complexities of her condition she struggled a bit with getting started on the reading, but is glad she persevered. “I really found myself looking forward to being able to lose myself in whatever book I was up to. For me, it was far more enjoyable than my rehab sessions with the physio or with the neurologist.”
The results speak for themselves. “I really think these books allowed me to come out of my shell and my protective moment that I was keeping myself in,” Rose says.
“They played a huge part in improving my cognitive ability, my concentration, my memory and my general conversational skills. On days where my pain levels were literally beyond my control, I was able to anchor myself in the pages of all sorts of lives and situations. This way I could keep progressing forward, even if it was just incrementally, rather than lapsing backwards.”
Words with benefits
Rose’s results are not isolated. Bibliotherapy can be used to treat a variety of mental health issues. The Royal Australian College of General Practitioners, for example, states that “bibliotherapy can be used to treat mild to moderate depression or subthreshold depressive symptoms, as a sole or supplementary therapy”.
They describe it as a form of guided self-help, where the doctor’s role is to support and motivate the patient and help to clarify any concerns they might have. They acknowledge that bibliotherapy is cost-effective and that no serious adverse effects have been reported. They also note that, in this context, bibliotherapy has National Health and Medical Research Council Level 1 evidence — the highest level of research evidence for a treatment’s effectiveness.
A 2013 article published in the journal Clinical Psychology & Psychotherapy looked at the effectiveness of bibliotherapy in 96 young adults with subthreshold depression. They were randomised into groups having immediate treatment, delayed treatment, placebo and no treatment.
The researchers found that bibliotherapy resulted in statistically and clinically significant changes in depressive symptoms and cognition, which were maintained at follow-up. No changes in symptoms or cognition were found in the delayed treatment and no treatment groups.
The authors concluded that “bibliotherapy is an effective treatment of subthreshold depression Cognitive bibliotherapy is a potential alternative or adjunct to psychotherapy for mildly depressed adults.”
A 2003 study published in the Journal of Clinical Psychology analysed 22 studies into the effectiveness of bibliotherapy for decreasing at‐risk and harmful drinking. They found modest support for its use with problem drinkers seeking help to reduce their consumption and to a lesser extent with drinkers who are identified through screening as at risk.
Published in 2008 in the journal Brief Treatment and Crisis Intervention, another study found that bibliotherapy was helpful for social phobia and could boost the effects of cognitive behavioural therapy for this condition.
In the United Kingdom, bibliotherapy has been recognised under the National Health Service. GPs and other health professionals have a list of self-help books recommended by specialists and can issue book recommendations to children or families under their care. The recommendation is taken to the local library and the book loaned out for the recommended period.
Finding a therapist
A bibliotherapy practitioner doesn’t need to be a doctor. In fact, there are currently no restrictions on who can set themselves up as a bibliotherapist. Some bibliotherapists, like Moor, have a background in medicine or healthcare. Moor completed extra studies in mental health through an accredited medical training organisation.
Others have a keen interest in literature. Either way, it’s crucial to find a practitioner that you connect with. “It’s about getting rapport with the patient, having that trust and giving people the space to talk,” Moor says. She reinforces that bibliotherapy doesn’t just use non-fiction books addressing specific issues but also creative literature that speaks on various levels.
While that may sound strange, many of us have unknowingly used bibliotherapy throughout our lives. In books, we find inspiration, encouragement and challenges to our thinking as we become absorbed in the stories we’re reading. The simple pleasure of reading for enjoyment can be thoroughly therapeutic.
Rose says this “very subtle form of therapy” provides “an avenue to approach yourself in a different way”. The gift of bibliotherapy is “something I’ll be forever grateful for”. She loved reading as a child, and after her session “a really deep passion for reading was reignited. It’s like having access to a whole other world when you open a book up.”
It also gave her the confidence to join the book club at her local bookshop: “It’s just not something I would ever have previously done.”
For anyone considering giving it a try, Rose can’t recommend it highly enough. “Different modalities will resonate with different people at different times in their life,” she says. “This is just another level where someone might be able to find a healthier way of living their life.”
She adds that you should be willing to challenge yourself. “It’s like anything — you really only get out of it what you put into it. There’s plenty of books that you can skim through superficially and go, ‘Yeah, that was a nice novel.’ But if you take the time to detour through the history of why something has occurred or the author’s past and how they got to be writing about that specific event, it can be like this great labyrinth that you keep wandering through.”
