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An investigation of the extent and use of bibliotherapy in the lower mainland of British Columbia Yasin, Sandra Rae 1978

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AN INVESTIGATION OF THE EXTENT AND USE OF BIBLIOTHERAPY IN THE LOWER MAINLAND OF BRITISH COLUMBIA by SANDRA RAE YASIN B.A., S i r George Williams U n i v e r s i t y , 1971 * A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Department of C o u n s e l l i n g Psychology) We accept t h i s t h e s i s as conforming to the re q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA J u l y , 1978 Q Sandra Rae Y a s i n , 1978 In presenting th i s thes is in pa r t i a l fu l f i lment of the requirements for an advanced degree at the Univers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f r ee l y ava i l ab le for reference and study. I fur ther agree that permission for extensive copying of th is thes is for scho la r l y purposes may be granted by the Head of my Department or by h is representat ives . It is understood that copying or pub l i ca t ion of th is thes is for f inanc ia l gain sha l l not be allowed without my wri t ten permission. Department of The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date i i ABSTRACT This study i s an i n v e s t i g a t i o n of the extent and use of bi b l i o t h e r a p y . i n the lower mainland of B r i t i s h Columbia. B i b l i o t h e r a p y i s defined as the use of l i t e r a t u r e , e i t h e r f i c t i o n or n o n - f i c t i o n , to help people w i t h t h e i r problems. The sample c o n s i s t s of f o r t y mental h e a l t h p r a c t i t i o n e r s , randomly s e l e c t e d , f i f t e e n of whom were interviewed p e r s o n a l l y . These f i f t e e n respondents were those who used b i b l i o t h e r a p y as par t of t h e i r p r a c t i c e . A questionnaire was devised, on the b a s i s of the l i t e r a t u r e review to examine the methods and procedures of b i b l i o t h e r a p y . The tape-recorded i n t e r v i e w s were then t r a n s c r i b e d verbatim and summarized i n t o major and sub-categories. Frequencies and percentages of the r e s -ponses were recorded and tabulated. The f i n d i n g s were that most of the respondents use a s i m i l a r pro-cedure when p r e s c r i b i n g b i b l i o t h e r a p y , i . e . they are s e m i - d i r e c t i v e i n t h e i r recommendations, provide an adequate r a t i o n a l e f o r t h e i r suggestions and discuss the impact of the reading w i t h t h e i r c l i e n t s . The types of books most o f t e n employed were n o n - f i c t i o n , e i t h e r l a y psychology or s e l f - h e l p l i t e r a t u r e . The type of problem which the c l i e n t presents played a determining r o l e i n the d e c i s i o n to use b i b l i o t h e r a p y . I t was p o s s i b l e to i s o l a t e two major areas w i t h which b i b l i o t h e r a p y was most e f f e c t i v e : communication and i n t e r p e r s o n a l problems^and f a m i l y c o n f l i c t s . In c o n c l u s i o n , b i b l i o t h e r a p y has been e f f e c t i v e l y employed by the respondents i n t h i s study and i s a va l u a b l e form of psychotherapy whose wider a p p l i c a t i o n should be considered. i i i TABLE OF CONTENTS Page ABSTRACT 1 1 LIST OF TABLES i v ACKNOWLEDGEMENTS v l INTRODUCTION . . . . . . . . . . . . . . . 1 LITERATURE . . . . . . . . 7 METHOD AND PROCEDURE 33 FINDINGS . . 4'4' DISCUSSION 72 SUMMARY AND CONCLUSIONS 86 BIBLIOGRAPHY 89 APPENDIX A .96 APPENDIX B . • • • 9 8 APPENDIX C . . 1 0 0 APPENDIX D . . . 1 0 1 APPENDIX E 104 APPENDIX F 1 0 6 APPENDIX G • - HO APPENDIX H 114 APPENDIX TABLES 1 and 2. 116 APPENDIX TABLES 3 to 17 117 APPENDIX TABLE 18 131 APPENDIX I . 133 i v LIST OF TABLES Page Table 1. Do you have a w r i t t e n or formal l i s t of t i t l e s ? 45 Table 2. Have you ever discontinued use of a t i t l e ? 46 Table 3. How do you determine which t i t l e s to use?. 47 Table 4. The question about t i t l e determination: Other sources? 48 Table 5. The question about t i t l e determination: Follow-up? 49 Table 6. How f a m i l i a r are you w i t h the t i t l e s you use? 50 Table 7. What i f a c l i e n t mentions a t i t l e w i t h which you are u n f a m i l i a r ? 51 Table 8. Do you suggest that your c l i e n t s do some w r i t i n g ? 51 Table 9. How does the subject of r e a d i n g / w r i t i n g come up, and what i s the procedure? 53 Table 10. How w i l l the c l i e n t o b t a i n the t i t l e ? 55 Table 11. How long i s i t before the t i t l e i s mentioned again, and do you suggest i t again i f not followed the f i r s t time? 57 . Table 12. Which types of t i t l e s do you most f r e q u e n t l y recommend? 59 Table 1 3 r C h a r a c t e r i s t i c s of c l i e n t s w i t h whom b i b l i o t h e r a p y i s t y p i c a l l y used? 61 Table 14. What types of problems do your c l i e n t s have? 63 Table 15. What i s the combination of problem types d e a l t with? 65 Table 16. With which of the types of problems i s b i b l i o t h e r a p y most e f f e c t i v e , and what percent of your p r a c t i c e i s t h i s p a r t i c u l a r problem? 67 Page Table 17. B i b l i o t h e r a p y i s p r a c t i c e d w i t h what percent of your :\ t o t a l c l i e n t p o p u l a t i o n and w i t h what percent of men versus women i s b i b l i o t h e r a p y p r a c t i c e d ? ..............69 Table 18. How many t i t l e s do you suggest per c l i e n t ? 70 Table 19. What i s the current and past use of b i b l i o t h e r a p y as a technique? 71 v i ACKNOWLEDGEMENTS I o f f e r my thanks and a p p r e c i a t i o n to a l l those people, too numerous to name, who have c o n t r i b u t e d t h e i r encouragement and f a i t h i n my a b i l i t y to complete t h i s study. E s p e c i a l l y to those p r a c t i t i o n e r s who gave up - t h e i r precious time to p a r t i c i p a t e i n t h i s p r o j e c t , I o f f e r a : p a r t i c u l a r thank-you. Dr. Sharon Kahn, Chairman of the Thesis Committee, i s g r e a t l y ^ a p -p r e c i a t e d f o r her enthusiasm and a s s i s t a n c e as w e l l as s p e c i f i c a l l y f o r her w i l l i n g n e s s to step i n t o the r o l e at such a l a t e stage. Dr. Robert Conry, member of the Thesis Committee, who taught me what X r e a l l y means, helped me to gain enough confidence to undertake and s u s t a i n t h i s study. A l s o , to L o r i , f o r having me r e a l i z e that avoidance of the task was f a r more p a i n f u l than the doing of i t , and to Marie and Toni-Lee, f o r n u r t u r i n g me through the agony of r e - w r i t e s , I o f f e r -my solemn g r a t i t u d e . F i n a l l y , to Bob, whose guidance and support was in e s t i m a b l e during my graduate t r a i n i n g as w e l l as t h i s study, and f o r h i s e x t r a o r d i n a r y p a t i e n c e , t r u s t and l o v e , I submit my g r a t e f u l f e e l i n g s . Chapter 1 INTRODUCTION 1 Books have always been l i v i n g things to me. Some of my encounters w i t h new authors have changed my l i f e a l i t t l e . When I have been perplexed, l o o k i n g f o r something I could not de f i n e myself, a c e r t a i n book has turned up, approached me as a f r i e n d would. And between i t s covers c a r r i e d the questions and the answers I was l o o k i n g f o r . (Ullmann, 1976, p. 43) The t h e r a p e u t i c value of books, has been proclaimed f o r many years and has r e c e n t l y become the subject of research. To date, t h i s research has been g e n e r a l l y of a d e s c r i p t i v e nature, t r a c i n g the h i s t o r y and the uses of b i b l i o t h e r a p y — usi n g books as a therapeutic t o o l — i n educa-t i o n and psychology. However, w h i l e such s t u d i e s have i n v e s t i g a t e d the conceptual aspects of b i b l i o t h e r a p y , r a r e l y have i t s f u n c t i o n a l aspects been described. I t i s important to l e a r n what happens to people when they read and what they b r i n g of themselves to reading, as s e v e r a l s t u d i e s have a t -tempted to show, but to research'why reading can be ther a p e u t i c does not answer the question of how b i b l i o t h e r a p y can be e f f e c t i v e l y used i n a thera p e u t i c s e t t i n g . Therefore, the purpose of t h i s study i s to i n -v e s t i g a t e the extent and use of b i b l i o t h e r a p y , that i s , to describe who i s using t h i s t o o l , what are the procedures of t h i s technique and how they are administered. A review of the l i t e r a t u r e has revealed that researchers are i n -te r e s t e d i n documenting the implementation of b i b l i o t h e r a p y . The p r i n t -ed matter a v a i l a b l e represents many f i e l d s : medicine, psychology, s o c i a l work, h o s p i t a l administration:,- l i b r a r i e s and education. Various types of reading m a t e r i a l s have played an important r o l e i n therapeutic e f f o r t s . 2 Books — texts,- biographies, autobiographies, anthologies, novels and poetry — have a high value i n the t o t a l educative process (Zaccaria & Moses, 1968). School counsellors may use many types of educational, occupational and personal-social reading materials for informational purposes i n t h e i r work. As we l l , books are used to f o s t e r and promote mental health. They serve as media f o r helping people solve c r i t i c a l problems encountered at various developmental stages of t h e i r l i v e s . Bruno Bettelheim (1975) has written that f a i r y t ales are important f o r children's growth, since they dialogue with t h e i r fantasies, which are, i n e f f e c t , t h e i r thoughts and b e l i e f s . If deprived of f a i r y t a l e s , a c h i l d i s conceivably denied the opportunity to cope with l i f e ' s problems i n an inventive, creative way. As the t a l e begins exactly at the c h i l d -ren's emotional developmental l e v e l s , i t helps them to grow, by means of images they can comprehend. In e f f e c t , t h i s i s bibliotherapy i n p r a c t i c e , defined as the process of using various kinds of reading materials i n teaching and/or counselling f o r the r e a l i z a t i o n of psychological ob-j e c t i v e s (Zaccaria & Moses, 1968). The fundamental concept underlying bibliotherapy can be traced to early sources which assert the therapeutic r e s u l t s of reading. Most of the people who worked i n the area of bibliotherapy were l i b r a r i a n s , medical doctors and p s y c h i a t r i s t s , and most of the settings e i t h e r men-t a l or * penal ">institutions (Beatty, 1962). The objectives of b i b l i o -therapy have included the a c q u i s i t i o n of fact s and knowledge i n aid of self-understanding: s o c i a l l y , to a f f e c t a t t i t u d e s , goals and values; emotionally, to be concerned with i n s i g h t and growth; and behaviorally, to promote changes i n reaction patterns. An outstanding observation emerging from the study of l i t e r a t u r e and research i n bibliotherapy i s that "not a sing l e piece of l i t e r a t u r e 3 argues against the use of b i b l i o t h e r a p y nor does any r e s e a r c h suggest that b i b l i o t h e r a p y i s not an e f f e c t i v e way of h e l p i n g i n d i v i d u a l s " (Zaccaria & Moses, 1968, p. 98). Because of t h i s , i t i s p o s s i b l e that p r a c t i t i o n e r s who espouse mental h e a l t h goals but do not use b i b l i o -therapy are not f a m i l i a r w i t h i t or may e l e c t not to use i t because of u n c e r t a i n t y about i t s e f f e c t i v e n e s s or manner of performance. I f t h i s i s so, then there may be a.need.within the h e l p i n g p r o f e s s i o n s , f o r some s p e c i a l i z e d t r a i n i n g i n b i b l i o t h e r a p y which would i n c l u d e the dynamics of therapy coupled w i t h a strong background i n l i t e r a t u r e . In l i g h t of recent innovations i n teaching and c o u n s e l l i n g and the growing concern over mental h e a l t h , b i b l i o t h e r a p y has become an i n -c r e a s i n g l y important medium f o r h e l p i n g i n d i v i d u a l s r e a l i z e t h e i r goals (Zaccaria & Moses, 1968). From a review of the l i t e r a t u r e , Moody and Limper (1971) found that few p r a c t i t i o n e r s use t h i s technique systema-t i c a l l y . Nevertheless, i t has p o t e n t i a l , e s p e c i a l l y i f i t were to be more i n t e g r a t e d w i t h other types of t h e r a p e u t i c r e l a t i o n s h i p s . A personal r e l a t i o n s h i p - or a p s y c h o l o g i c a l r e l a t i o n -ship - i s i n v o l v e d i n every h e l p i n g r e l a t i o n s h i p , even i f the i n f o r m a t i o n i s conveyed i n an apparently im-personal manner, as through the p r i n t e d word. A w r i t e r does e s t a b l i s h a k i n d of p s y c h o l o g i c a l r e l a t i o n -ship w i t h the reader, or perhaps b e t t e r s t a t e d , the reader creates or c o n s t r u c t s some ki n d of r e l a t i o n -s h i p . (Patterson, 1974, p. 10) As the emotional and reading l i v e s of people can be interwoven, the competent and s e n s i t i v e educator and p s y c h o t h e r a p i s t , through reading guidance, can help people make b e t t e r l i f e adjustments, solve a c t u a l problems, thereby d i m i n i s h i n g pressures, or prevent p a r t i c u l a r problems from becoming u n s e t t l i n g f a c t o r s should they e v e n t u a l l y a r i s e . 4 B i b l i o t h e r a p y , the dynamic i n t e r a c t i o n between the p e r s o n a l i t y of the reader and l i t e r a t u r e , should not be o v e r s i m p l i f i e d . The f o l l o w i n g 1940's ; proclamation serves as the theme of t h i s jstudy: " b i b l i o t h e r a p y has a d e f i n i t e place i n p r a c t i c a l psychotherapy. I t s value has probably i n general been underestimated. We have found i n many cases that therapy went ahead much f a s t e r w i t h i t s use than w i t h the p a t i e n t who had done no r e a d i n g " (Appel, 1944, p. 1132). O B J E C T I V E S The general goal of t h i s study i s to investigate;'the extent and use of l i t e r a t u r e and other w r i t i n g as a t h e r a p e u t i c t o o l i n the lower mainland of B r i t i s h Columbia. The f o l l o w i n g o b j e c t i v e s have been es-t a b l i s h e d : 1. To determine whether the t h e r a p i s t has a l i s t of t i t l e s which are r o u t i n e l y r e f e r r e d to i n the p r a c t i c e of b i b l i o t h e r a p y . 2. To determine how the t h e r a p i s t decides upon which t i t l e s to use, what the sources of the t i t l e s are and what use i s made of the c l i e n t ' s responses to a p a r t i c u l a r t i t l e . 3. To determine how f a m i l i a r the t h e r a p i s t i s w i t h the m a t e r i a l s used. 4. To determine how the subject of reading books a c t u a l l y comes up w i t h -i n the t h e r a p y / c o u n s e l l i n g s e s s i o n and then what procedures are f o l -lowed once a s p e c i f i c t i t l e i s mentioned. More p r e c i s e l y , what i s i n v e s t i g a t e d i s whether t i t l e s are assigned or recommended, whether a r a t i o n a l e f o r the t i t l e choice i s provided, whether the t h e r a p i s t p r e f e r s the t i t l e to be read w i t h i n a s p e c i f i c time p e r i o d , and how the c l i e n t i s supposed to o b t a i n the chosen t i t l e . 5. To determine whether the t h e r a p i s t or the c l i e n t i s f i r s t to mention the t i t l e a gain, and how much time elapses before t h i s takes p l a c e . Further i f the book has not been read, whether the t h e r a p i s t makes another attempt at suggesting a t i t l e at some l a t e r date. 6. To determine under what reference c a t e g o r i e s the t h e r a p i s t ' s t i t l e s e l e c t i o n s can be catalogued; e.g. f i c t i o n vs. n o n - f i c t i o n . 7. To determine whether the t h e r a p i s t can provide a general d e s c r i p t i o n of the type of c l i e n t w i t h whom t h i s technique i s used most o f t e n , or what i t i s about a c l i e n t that brings a t i t l e to the t h e r a p i s t ' s mind. 8. To describe the type of problems the t h e r a p i s t ' s c l i e n t s t y p i c a l l y have, and whether the type of prob l e m r b i b l i o t h e r a p y i s most e f f e c t i v e w i t h can be i s o l a t e d , as w e l l as what p r o p o r t i o n of the t h e r a p i s t ' s p r a c t i c e i s t h i s p a r t i c u l a r -problem .-.conducive' to b i b l i o t h e r a p y . 9. To estimate the p r o p o r t i o n of the t h e r a p i s t ' s c l i e n t p o p u l a t i o n w i t h whom b i b l i o t h e r a p y i s used, i f i t could be d i s t i n g u i s h e d whether i t i s used more w i t h men or women and how many t i t l e s are normally sug-gested per c l i e n t . 10. To estimate the number of c l i e n t s undergoing b i b l i o t h e r a p y at the time of the i n t e r v i e w , and whether the t h e r a p i s t can estimate how many c l i e n t s over the past year w i t h whom b i b l i o t h e r a p y had been used. 11. To determine whether the t h e r a p i s t considers having c l i e n t s w r i t e as part of t h e i r therapy, and, i f so, whether they are d i r e c t e d i n t h e i r w r i t i n g and whether i t i s seen afterwards. I f c l i e n t s do not w r i t e , what does the t h e r a p i s t do should the c l i e n t spontaneously w r i t e and then want to share that work w i t h the t h e r a p i s t . 6 D e f i n i t i o n of Terms The f o l l o w i n g terms have been defined f o r purposes of t h i s study? a. C o u n s e l l i n g . "A process i n v o l v i n g a s p e c i a l k i n d of r e l a t i o n s h i p between a person who asks f o r help w i t h a p s y c h o l o g i c a l problem '(the."client or the p a t i e n t ) and a person who i s t r a i n e d to provide that help (the c o u n s e l l o r or the p s y c h o t h e r a p i s t ) " . (Patterson, 1973, p. x i i ) b. Respondents. Mental h e a l t h p r o f e s s i o n a l s w i t h whom a telephone and/ or a personal i n t e r v i e w was conducted. c. B i b l i o t h e r a p y . The use of l i t e r a t u r e , e i t h e r f i c t i o n or n o n - f i c t i o n , to help people w i t h t h e i r problems (Brammer & Shostrom, 1968, pp. -316 - 17). d. T i t l e s . Books, or l i t e r a t u r e , or w r i t t e n m a t e r i a l s used by the respondents i n t h e i r p r a c t i c e of b i b l i o t h e r a p y . e. B i b l i o t h e r a p i s t . A c o u n s e l l o r or psychotherapist who employs b i b l i o t h e r a p y as p a r t of the th e r a p e u t i c p r a c t i c e . Note: The words t h e r a p i s t , p r a c t i t i o n e r , c o u n s e l l o r and respondent are used as common terms throughout t h i s study. 7 Chapter I I REVIEW OF THE RELATED LITERATURE Books go out i n t o the world, t r a v e l m y s t e r i o u s l y from hand to hand, and somehow f i n d t h e i r way to the people who need them at the times when they need them. (Jong, 1971, p. 248) H i s t o r y of B i b l i o t h e r a p y The power of reading has been wi d e l y accepted f o r c e n t u r i e s , as people have looked to w r i t t e n m a t e r i a l s f o r help and r e l a x a t i o n ( A l s t o n , 1962). The research l i t e r a t u r e contains many a r t i c l e s and books t r a c i n g the development of b i b l i o t h e r a p y . In f a c t , more has been w r i t t e n on the aspect of b i b l i o t h e r a p y ' s h e r i t a g e than on almost any other aspect (Axelrod & T e t i , 1976; Beatty, 1962; Heitzmann & Heitzmann, 1975; McKinney, 1975; Moody & Limper 1971; Weingarten, 1964; Z a c c a r i a & Moses, 1968). Most authors agree that the Greeks f i r s t p o s t u l a t e d the h e a l i n g e f f e c t s of l i t e r a t u r e , drama and poetry. The idea was that the r i g h t book at the r i g h t time,can help people open the window to t h e i r world (Weissenberg, 1973). The l i b r a r y at Thebes i s s a i d to have the i n s c r i p -t i o n on i t s w a l l s 'The Healing Place of the Soul' (Axelrod & T e t i , 1976). The Greeks might not have had a word f o r b i b l i o t h e r a p y but they knew of i t s e f f e c t s . A r i s t o t l e b e l i e v e d i n the t h e r a p e u t i c value of drama be-cause i t aroused emotions w i t h i n a person that had h e a l i n g e f f e c t s . S t o r y t e l l i n g was meant to d e p i c t a c t u a l l i f e r o l e s and the l i s t e n e r , l a t e r the reader, was able to i d e n t i f y w i t h the s t o r y characters (Thrush, 1974). And poetry reading, or s i n g i n g the rhymes, had a soothing,'nour-i s h i n g e f f e c t (Leedy, 1969). P l a t o t a l k e d about changing behavior when 8 he suggested that the f i r s t s t o r i e s people ought to hear should b r i n g "the f a i r e s t lessons of v i r t u e to t h e i r e a r s " (Thrush, 1974). Therefore, the Greeks were t h i n k i n g about and using the p s y c h o l o g i c a l concepts of i d e n t i f i c a t i o n , c a t h a r s i s and behavior m o d i f i c a t i o n two thousand years ago. And, on the other s i d e of the world, L i n Yutang commented that "reading of the best k i n d always gives...understanding of l i f e and one-s e l f " (Weingarten, 1964). So, even before the i n v e n t i o n of the book as we know i t , teachers used reading m a t e r i a l s to help i n d i v i d u a l s solve t h e i r personal and adjustment problems. Shakespeare's-Hamlet a l s o supported the view that the purpose of l i t e r a t u r e and drama " i s to h o l d , as t'were, the m i r r o r up to nature" and give us glimpses of "timeless t r u t h s " about human nature ( L i c k o r i s h , 1975). I t seems that imaginative l i t e r a t u r e provides an e x t e r n a l frame of reference which permits readers to view t h e i r experiences f r e s h l y from the p e r s p e c t i v e of the detached observer. Being at once fantasy and r e a l i t y , i t permits the reader to be both p a r t i c i p a n t and s p e c t a t o r . The term b i b l i o t h e r a p y has a comparatively recent o r i g i n i n North America. I t i s g e n e r a l l y c r e d i t e d to S.M. Crothers i n an A t l a n t i c Monthly a r t i c l e i n 1916, who was .describing."a friend.'s..bibli'opathic';iristitute .(Axelrod'& T e t i , 197fr; Heitzmann & Heitzmann1975)./ However, Home (1975) gave the date at 1904, when b i b l i o t h e r a p y was f i r s t recognized as an as-pect of l i b r a r i a n s h i p . During the 1930's i n t e r e s t i n the f i e l d continued to grow. The Menningers used the term to r e f e r to the p r a c t i c e of a t r a i n e d l i b r a r i a n c o l l a b o r a t i n g w i t h p s y c h i a t r i s t s i n t h e i r c l i n i c . Dr. W i l l i a m Menninger published a paper e n t i t l e d " B i b l i o t h e r a p y " i n 1937, adding to the v i a b i l i t y of t h i s technique as a treatment (Menninger C l i n i c B u l l e t i n , 1937). Also i n 1937, E l i z a b e t h Pomeroy attempted to put the f i e l d of bibliotherapy on an empirical basis by discussing over 1500 « case reports (Heitzmann & Heitzmann, 1975). In Europe, according to Sp i t h i l l (1968), Freud wrote, in 1922, that "storytellers are valuable a l l i e s , . . . for they actually know many things between heaven and earth that our academic wisdom does not even dream of". He thus enhanced the fact that writing i s our major, permanent communication link, supplying support for Francis Bacon, who said that "reading maketh a f u l l man" and for Alfred Adler, who believed that "reading improves thinking" (Thrush, 1974). Menninger recalled how Freud was ridiculed with his notion that patients could be cured by talking with them and how French psychiatrist Pierre Janet was most interested in therapeutic reading more than 50 years ago (Menninger, 1961). The point of Spithill's a r t i c l e , "The Valuable A l l i e s " (1968), then, was to affirm that literature and psycho-logy ought to be fellow disciplines. "A psychologist discovered the adolescent" she declared, "but i t i s the novelist who defines him" (p. 879) I f i t is the counsellors' function to fosterthrough understand-ing and acceptance, the development of individuals, then they must use literature as their "a l l y " . The growth of bibliotherapy continued in the 1940's, beginning this link to psychology. Schneck (1945), working through the Menninger Clinic, produced a bibliography of 79 t i t l e s dealing exclusively with bibliotherapy for neuro-psychiatric patients and mental hospital lib r a r i e s . No c r i t i c a l evaluation was presented but several t i t l e s were noted for their greater interest. He also published (1946) a case study a r t i c l e , in which bi b l i o -therapy was used as an aid in treatment. At that time, he stated that the technique varies with physician and'patient and predicted that "with an increase in our knowledge and experience, techniques may probably be standardized, although f l e x i b i l i t y w i l l undoubtedly be necessary..." 10 (p. 18). This i s s i g n i f i c a n t i n that h i s p r e d i c t i o n , so confidently made, has yet to be r e a l i z e d i n 1978. He made several other c r i t i c a l observations which are s t i l l being proclaimed as valuable (Alston, 1962; Gottschalk, 1948; Lazarsfeld, 1949). These included that treatment time i s often abbreviated, and that treatment can continue during the patient's or the doctor's absence, both during and a f t e r formal contact has ended. Sudden termination i s thereby avoided. Also i n the middle 1940's, i t was accepted that a reader's i n t e r -action with the written material i s unique and not e a s i l y generalizable (Thrush, 1968). No oneuperson w i l l see the same book i n the same way. The e f f e c t s of a book are personal. F i c t i o n mobilizes imagination and c a l l s f o r t h emotion, and as such, i s demanding upon the reader. The purpose of f i c t i o n , said Kosinski (1977), i s to engage the reader i n a drama that i s much more condensed than the drama of our d a i l y l i v e s . Yet, the main ingredients remain the same: "human beings i n a state of i n t e r a c t i o n , or c o n f l i c t " (p. 56). Through t h i s process, the reader's awareness of h i s or her l i f e - as a drama - i s increased. And herein l i e s the d i f f e r e n c e . Each person l i v e s t h e i r own drama or, as Russell (1960) noted as he searched for information as to what happens to readers when they a c t u a l l y read - they go into a "shock or r e c o g n i t i o n " where the impact of the words provide fresh i n s i g h t into t h e i r l i f e and that of others. Gottschalk (1948) also t i e d l i t e r a t u r e to psychology. He defined i t as a means of psychotherapy through reading. He l i s t e d s i x functions? of prescribed reading ranging from helping patients to understand t h e i r own psychological reactions to c o n f l i c t , to stimulating them to v e r b a l i z e t h e i r problems as they discover (through reading) that t h e i r f e e l i n g s of being d i f f e r e n t do not d i f f e r from those of others. He goes on to suggest suitable patient types for bibliotherapy, s t r e s s i n g that age i s not a f a c t o r , nor i s the degree of i l l n e s s . It i s h e l p f u l i f the patient i s already i n the habit of reading and l i k e l y more b e n e f i c i a l i f the patient requests reading a book before the therapist does. Gottschalk provided some i n s t r u c t i v e hints for using bibliotherapy with c h i l d r e n and adults, s t r e s s i n g that a s i g n i f i c a n t number of interviews must occur before i t s recommendation. This allows for a f a m i l i a r i z a t i o n of s p e c i f i c problems and personal habits, so that reading does not i n t e r f e r e . Other authors agree (Darling, 1957; L i c k o r i s h , 1975; Strunk, 1972). An operational d e f i n i t i o n of bibliotherapy was beginning to emerge i n the l i t e r a t u r e . The therapist was encouraged to be thoroughly fami-l i a r with the materials i n order to be^able to discuss them and the patient's reactions to them. Gottschalk concluded h i s a r t i c l e , as did many other authors before and a f t e r him, with an extensive bibliography, t h i s one arranged according to personality disorders and age. Other use-f u l b i b liographies can be found attached to a r t i c l e s by S p i t h i l l (1968), Corman (1975), Thrush (1974), McKinney (1975), Riggs (1968), and Reid (1972). By 1946, Dr. E.B. A l l e n was suggesting how to begin a b i b l i o -therapeutic interview (Beatty, 1962), and i n 1949 two important works appeared. Lazarsfeld wrote of her experiences with f i c t i o n i n her prac-t i c e of psychotherapy. Very early, she was al e r t e d to the extent to which people read f i c t i o n to answer t h e i r own emotional problems, and was convinced that people who l i k e to read can make s t r i d e s toward d i s -covery of t h e i r r e a l selves, e s p e c i a l l y when guided by one trained i n psychological techniques. She believed that books might play an im-portant part i n the reconstructive work of psychotherapy of counselling, serving the purposes of helping the counsellor better understand the c l i e n t and helping the c l i e n t s illuminate a c r i t i c a l spot i n t h e i r own 12 behavior, through the d i s c u s s i o n of f i c t i o n a l c h a r a c t e r s . Several authors have si n c e a f f i r m e d t h i s view ( A l s t o n , 1962; Brammer & Shostrom 1968; Home, 1975). A p a r t i c u l a r l y u s e f u l technique she had was to ask c l i e n t s what books, i n t h e i r l i v e s , had e s p e c i a l l y impressed them. And she specu-l a t e d on how i n s i g h t o f t e n came from reading when the t h e r a p i s t had spent so much time on the same problem, to no a v a i l . She surmised that i t had to do w i t h t r u s t . The author o f / a l i t e r a r y work i s n e u t r a l , does not know the reader, and t h e r e f o r e the- reader does not have to r e s i s t and block any emotional responses. L a z a r s f e l d was one of the f i r s t t h e r a p i s t s to c l a i m that the r i g h t moment to attempt b i b l i o t h e r a p y must be c a r e f u l l y chosen and she has s i n c e been supported i n t h i s i dea ( A l s t o n , 1962; Strunk, 1972). D e f i n i t i o n s of B i b l i o t h e r a p y An e a r l y comprehensive work i n the f i e l d of b i b l i o t h e r a p y was the d o c t o r a l d i s s e r t a t i o n of C a r o l i n e Shrodes (1949). Her t h e o r e t i c a l and c l i n i c a l study demonstrated the use of b i b l i o t h e r a p y as a treatment met-hod i n psychotherapy. She wrote w i t h R u s s e l l (1950) on such mechanisms as i d e n t i f i c a t i o n , c a t h a r s i s and i n s i g h t i n reading. Their d e f i n i t i o n of b i b l i o t h e r a p y was that of "a process of dynamic interaction".between the p e r s o n a l i t y of the reader and l i t e r a t u r e , which may be u t i l i z e d f o r p e r s o n a l i t y adjustment or growth" (Lindeman & K l i n g , 1968-69, p. 335). Most d e f i n i t i o n s s i n c e seem to be i n agreement as to these b a s i c con-s t r u c t s . I d e n t i f i c a t i o n i s an almost u n i v e r s a l experience of readers, the idea being that through a f f i l i a t i o n w i t h a c h a r a c t e r , a person be-gins to experience therapy. Once the i d e n t i f i c a t i o n has taken p l a c e , the c a t h a r t i c e f f e c t can take hold ( D a r l i n g , 1957). The reader begins to be l e s s i s o l a t e d and f e e l l e s s d i f f e r e n t from others. This i d e n t i -f i c a t i o n then f o s t e r s a r i s e i n self-esteem and adds to the understand-i n g of l i f e (Corman, 1975). I n s i g h t i s dependent upon both i d e n t i f i c a t i o n and subsequent c a t h a r s i s , or the emotion accompanying t h i s "shock of r e c o g n i t i o n " . When readers r e a l i z e t h e i r i d e n t i f i c a t i o n w i t h the charac-t e r they are able to see the m o t i v a t i o n of t h e i r own behavior more c l e a r -l y . R e lieved of some of t h e i r own emotional t e n s i o n , they can make a more i n t e l l e c t u a l approach to t h e i r problems ( D a r l i n g , 1957). Even though A r i s t o t l e , Menninger and so many others b e l i e v e d that the person experiences r e l i e f as a r e s u l t of c a t h a r s i s , we do not yet know whether t h i s has an enduring e f f e c t or i f t a l k i n g about i t w i t h a t h e r a p i s t i s c r i t i c a l (McKinney, 1975). And people can take i n only that which they can r e l a t e to and which i s not too t h r e a t e n i n g . So, percep-t i o n becomes a p a r t i a l f u n c t i o n of one's needs, values and defenses. But almost everyone agrees w i t h Jourard (1964) that "the v i c a r i o u s ex-perience that reading or l i s t e n i n g provides us w i t h can shape our es-sence, change us, j u s t as f i r s t - h a n d experiences can" (p. 42). Years l a t e r , Shrodes continued her d e f i n i t i o n (1955), s t r e s s i n g the i n t e g r a l r e l a t i o n s h i p between the dynamics of the p e r s o n a l i t y and the nature of v i c a r i o u s experience. This i n t e r a c t i o n can provide readers w i t h increased self-awareness, an opportunity to see t h e i r problems ob-j e c t i v e l y and a f e e l i n g of belonging. Since "reading i s a f u n c t i o n of the t o t a l p e r s o n a l i t y " (Shrodes, 1955, p. 24) and the person w i l l ab-s t r a c t s e l e c t i v e l y , b i b l i o t h e r a p y can o f f e r a new frame of reference to extend awareness and e n r i c h understanding. The f i c t i o n or drama d e p i c t s experiences d i f f e r i n g only i n degree from those of the reader. A l l of t h e i r p r e d i s p o s i t i o n s , when p r o j e c t e d onto the emotions and characters 14 of the work, enable readers to have a unique p e r s p e c t i v e which may u l -t i m a t e l y a l l o w them to re-evaluate t h e i r own experiences. Or, should such v i c a r i o u s experiences be too t h r e a t e n i n g , the reader w i l l f a i l to gain i n s i g h t . However, the t h e r a p i s t w i l l see t h i s and can use t h i s i n f o r m a t i o n to b e t t e r understand and support the c l i e n t . You t h i n k your p a i n and your heartache are unprecedented i n the h i s t o r y of the world, but then you read. I t was books that taught me that the things that tormented me the most were the very things that connected me w i t h a l l the people who were a l i v e , or who had .ever been a l i v e . (James Baldwin, as c i t e d i n Corman, 1975, p. 935) In 1959, a formal d e f i n i t i o n of b i b l i o t h e r a p y was published i n the D i c t i o n a r y of Education: The use of books to i n f l u e n c e t o t a l development, a process of i n t e r a c t i o n between the reader and l i t e r a t u r e which i s used f o r p e r s o n a l i t y assessment, adjustment, growth, c l i n i c a l and mental hygiene purposes; a concept that ideas inherent i n s e l e c t e d reading m a t e r i a l s can have a therapeutic e f f e c t upon the mental or p h y s i c a l i l l s of the reader. (1959, p. 58) And i n 1961, Webster's D i c t i o n a r y defined b i b l i o t h e r a p y as "the use of s e l e c t e d m a t e r i a l s as t h e r a p e u t i c adjuvants i n medicine and p s y c h i a t r y ; a l s o , guidance i n the s o l u t i o n of personal problems through d i r e c t e d reading" (Lindeman & K l i n g , 1968-69). The s c i e n t i f i c approach was s t i l l honored, but the newer, more i n f o r m a l , l e s s m e d i c a l l y - o r i e n t e d approach was g a i n i n g support. Since 1955, the s o p h i s t i c a t i o n that b i b l i o t h e r a p y was a t t a i n i n g helped e s t a b l i s h i t as a t o o l to be used i n 'normal' s e t t i n g s i.e.,:".in schools. According to Beatty (1962),,few guides yet e x i s t e d on how to use b i b l i o t h e r a p y as treatment. 15 Methodological s t u d i e s increased i n the United States, e s p e c i a l l y i n the Veteran's A d m i n i s t r a t i o n . Many p r o j e c t s r e s u l t e d and a major annotated b i b l i o g r a p h y was produced i n 1958 (Beatty, 1962). Because of t h i s growth, c o n s t r u c t i v e c r i t i c i s m s began to appear i n the l i t e r a t u r e , w i t h gaps i n the p r a c t i c e being pointed out and recommendations being explored ( D a r l i n g , 1957). In 1960, the A s s o c i a t i o n of H o s p i t a l and I n s t i t u t i o n a l L i b r a r i e s produced a B i b l i o t h e r a p y Clearinghouse to enable the research being done f i n a l l y to be catalogued. I t was i n 1962 that the j o u r n a l L i b r a r y Trends h e l d a symposium and produced a volume of l i t e r a t u r e on the subject of b i b l i o t h e r a p y . Tews (1962) chaired a committee which devised a ques t i o n -n a i r e sent to a v a r i e t y of p r a c t i t i o n e r s , designed to construct a com-p o s i t e d e f i n i t i o n . The conc l u s i o n was that b i b l i o t h e r a p y e x i s t s when i t i s a l i b r a r y s e r v i c e i n conjunction w i t h a planned, guided and c o n t r o l l e d a c t i v i t y , performed by a s k i l l e d , t r a i n e d l i b r a r i a n i n c l o s e c o n s u l t a t i o n w i t h a medical team. F u r t h e r , i t must support any other t h e r a p e u t i c pro-gram as r e l a t e d to the needs of the p a r t i c u l a r p a t i e n t . There i s not much regard paid to the p s y c h o l o g i c a l aspects of the process i n t h i s d e f i n i t i o n ; however, i t i s i n d i c a t i v e of i t s time and the type of r e -search then being done. The d r i f t back towards the p s y c h o l o g i c a l l i n k d i d not begin again f o r s e v e r a l years. The concept of the c l i n i c a l l i b r a r i a n w i t h i n t e r p e r s o n a l r e l a t i o n s experience was then launched (Home, 1975). B i b l i o t h e r a p y i n the Educational S e t t i n g Studies i n edu c a t i o n a l s e t t i n g s began,to surface. An e a r l y study (Witty, 1952) had reported on the importance of i d e n t i f y i n g developmental needs of the reader. Thus, reading f o r developmental purposes became 16 one way of a t t a i n i n g an adjusted personality (Weingarten, 1964). In one of the few college l e v e l studies, Weingarten (1964) pointed out that the complaint heard from many at the time, that bibliotherapy was c l i n i c a l and therefore did not belong i n the schools, was a c t u a l l y inappropriate. He argued for using books simply to help people s a t i s f y needs or master tasks. Bibliotherapy began to be defined i n terms of "objectives" (Sclabassi, 1973, p. 72). Authors were concerned with mainly four points of view: i n t e l l e c t u a l , s o c i a l , emotional and behavioral. A l l the objectives were s i m i l a r i n that t h e i r aim was to promote growth and change i n a t t i t u d e s and values. Two types of l i t e r a t u r e emerged as u s e f u l : d i d a c t i c , for a more cognitive approach to understand the s e l f ; and imaginative, f o r the production of an emotional experience (Shrodes, 1960). The aim became that of helping a student achieve a "mature personality", defined by Hartley (1951) as a personality that has outside i n t e r e s t s , an ob-j e c t i v e view of i t s e l f and a u n i f y i n g philosophy of l i f e . The way i n which reading l i t e r a t u r e can help to create t h i s i s , e f f e c t i v e l y , how bibliotherapy o p e r a t e s — t h a t i s , by awakening perceptions, helping to set goals, increasing one's awareness of values and r e l i e v i n g some emotion-a l tensions. Through the 1960's then, t h i s approach was attached to b i b l i o t h e r a p y — or, as i t was sometimes c a l l e d , b i b l i o c o u n s e l l i n g (Tsimpoukis 1968)—and was applied to the educational s e t t i n g . Children were encouraged t o r t a l k f r e e l y about t h e i r fears and problems within the classroom s e t t i n g (Comer, 1959). Reading guidance was described as*, helping the p u p i l s s e l e c t books which would meet t h e i r needs or answer questions or help solve problems (Dane, 1961). Annotated references for elementary and secondary teachers were compiled and shared (Brown, 1975; Dane, 1961; Lindemann & K l i n g , 17 1968-69; Lundsteen, 1972; Spache, 1962; Weissenberg, 1973) and suggestions f o r how to use b i b l i o t h e r a p y i n the classroom s e t t i n g were provided ( C i a n c i o l o , 1965; Dane, 1961; Lindemann & K l i n g , 1968-69; Nickerson, 1975; Olsen, 1974-75). In f a c t , b i b l i o t h e r a p y was described as " i n e v i t a b l e as w e l l as u n i v e r s a l " w i t h i n the education context (Townsend, 1963, p. 121). She p o s t u l a t e d a r a t h e r novel i d e a , s t a t i n g that a problem i n reading i s a problem i n emotional adjustment and th e r e f o r e any c o r r e c t i v e work w i t h -i n the school must consider p s y c h o l o g i c a l f a c t o r s . Hoagland (1972) s t r e s -sed that b i b l i o t h e r a p y need not imply s e r i o u s maladjustment but ra t h e r i t merely r e f e r s to the a p p l i c a t i o n of e x t e r n a l help. The idea of preventive work i n the classroom grew w i t h e n t h u s i a s t i c support. I t was argued that one could make an e f f e c t i v e adjustment to a problem'when i t a r i s e s i f one had encountered i t p r e v i o u s l y , through l i t e r a t u r e ( C i a n c i o l o , 1968). C h i l d r e n can be helped to develop problem-s o l v i n g behaviors through b i b l i o t h e r a p y , as w e l l as to acquire informa-t i o n about the psychology and physiology of human behavior ( C i a n c i o l o , 1965). The teacher can act to help the c h i l d l e a r n s e l f - a c c e p t a n c e , or to accept"the past, through characters met i n books (Olsen, 1974-75). Brown (1975) a l s o encouraged the use of b i b l i o t h e r a p y i n the schools, to be used not only w i t h the r e l u c t a n t reader but i n h e l p i n g c h i l d r e n deal w i t h t h e i r minor problems. Her book ex p l a i n s her b e l i e f that b i b l i o -therapy has important a p p l i c a t i o n s beyond the c l i n i c a l s e t t i n g , i n that each person i n the audience experiences l i f e s t r e s s e s . This p l e a f o r b i b l i o t h e r a p y as prevention was aimed towards i t s p r a c t i c e w i t h i n the community as a whole. Books can help c h i l d r e n , and a l l people, under-stand that t h e i r f e e l i n g s , f o r example, of anger and shame, are n a t u r a l and that almost everyone has them. They can be used to encourage fantasy and reading f o r enjoyment and escape (Axelrod & T e t i , 1976; C i a n c i o l o , 18 1968; Dane, 1961), although Hoagland (.1972) warned that one must guard against the reader s l i p p i n g more permanently i n t o a fantasy world and, i f too much emphasis i s placed upon the t h e r a p e u t i c value of books, the pleasure i n t h e i r reading may be destroyed. This observation extends beyond the classroom and i n t o the c l i n i c a l s e t t i n g as w e l l (Moody & Limper, 1971; S c l a b a s s i , 1973). Although many of the dynamics of b i b l i o -therapy being discussed here have been devised and implemented s p e c i f i c a l l y f o r w i t h i n the educational context, most have been g e n e r a l i z e d to apply a l s o to a d u l t s and the c l i n i c a l s e t t i n g . B i b l i o t h e r a p y should be p r a c t i c e d e i t h e r w i t h groups(Olsen, 1974-75; Saper, 1967) or i n d i v i d u a l s , i n a non-threatening environment (Nickerson, 1975). P a r t i c u l a r l y , w i t h c h i l d r e n non-verbal methods such as r o l e - p l a y -i n g and a r t work are e f f e c t i v e i n dramatizing a s t o r y . What i s e s s e n t i a l i s that the reading m a t e r i a l be at the person's reading and/or l i s t e n i n g l e v e l ( C i a n c i o l o , 1968; Moses & Z a c c a r i a , 1969; Nickerson, 1975). Just as there i s reading readiness, there i s developmental task readiness ( C i a n c i o l o , 1965; Dane, 1961). Reading s p e c i a l i s t s have underscored the f a c t that c h i l d r e n read w i t h t h e i r own knowledge and set of experiences r a t h e r than merely w i t h t h e i r eyes (Olsen, 1974-75). A l s o important i s that the books s e l e c t e d must not be m o r a l i s t i c ( C i a n c i o l o , 1968; Nickerson, 1975; Olsen, 1974-75). Those who are of d i f f e r e n t socio-economic and c u l t u r a l l e v e l s w i l l a l l respond to the same value w i t h i n a book, but w i l l do so d i f f e r e n t -l y ( C i a n c i o l o , 1965; Dane, 1961). F i n a l l y , reading ought to be suggested r a t h e r than assigned, (Moses & Z a c c a r i a , 1969) and follow-up must occur (Olsen, 1974-75; Weissenberg, 1973). "In f a c t , reading f o r b i b l i o t h e r a p e u t i c purposes f a l l s short of i t s goal i f no p r o v i s i o n f o r follow-up" i s made ( C i a n c i o l o , 1968, p. 15). 19 -There i s a cumulative e f f e c t of follow-up a c t i v i t i e s , she s a i d , i n that the l e a r n i n g s are r e i n f o r c e d . The reader should have an opportunity to explore the consequences of c e r t a i n behaviors and f e e l i n g s . Recommending the book i s , i n i t s e l f , very c r i t i c a l . Timing i s c r u c i a l and the t h e r a -p i s t must know when i t i s appropriate ( C i a n c i o l o , 1968; Lundsteen, 1972). "In recommending a book, knowing the i n d i v i d u a l i s probably more im-portant than knowing the book" (Olsen, 1974-75, p. 428). Books should center on the problem, have a r e a l i s t i c approach and have the characters be l i f e - l i k e (Cianciolo", ' 1968; Olsen, 1974-75; Shepherd & l i e s , 1976). As Lundsteen put i t , " l i t e r a t u r e can help a c h i l d to t r y on l i f e f o r s i z e " (1972, p. 511). Shrodes (1960) drew the conclusion that teachers should be aware of the dynamics of reading as to how i t a f f e c t s the reader p s y c h o l o g i c a l l y . The t h e r a p e u t i c approach to reading, she said,can be a k i n d of "preventive therapy" e i t h e r through immediate impact or as en-tertainment to be remembered f o r years. B i b l i o t h e r a p y i n the C l i n i c a l S e t t i n g In the 1970's, researchers were lamenting the "voluminous amounts of l i t e r a t u r e " e x i s t i n g on the t o p i c of b i b l i o t h e r a p y , c l a i m i n g that very l i t t l e of i t could be conceptualized or c l a s s i f i e d ( S c l a b a s s i , 1973, p. 75). Evidence was " r e p e t i t i v e and ambiguous" (p. 70), though e n t h u s i a s t i c , and promising r a t h e r than c o n c l u s i v e . In the v a r i o u s p r o f e s s i o n a l d i s -c i p l i n e s s e v e r a l people a year researched b i b l i o t h e r a p y i n d i s s e r t a t i o n s (Ranaan, 1975; McClaskey, 1970) and p i l o t s t u d i e s (House, 1977). They a l l continued to attempt to f o r m a l i z e a procedure and to devise a theory to e x p l a i n why b i b l i o t h e r a p y seemed to be an e f f e c t i v e t o o l . Perhaps 20 methodological and measurement problems have c o n t r i b u t e d to the slow growth of b i b l i o t h e r a p y as a science. Studies have been weak i n g e n e r a l i z -a b i l i t y , v a l i d i t y and r e l i a b i l i t y , u sing questionable methods ( Z a c c a r i a & Moses, 1968). However, the range of subjects w i t h which b i b l i o t h e r a p y has been used i s q u i t e wide: retarded readers (Kantrowitz, 1967), r: s t u t t e r e r s (Emerick, 1966), the learning-handicapped (Corman, 1975), weight-reduction (Hagen, 1974), sex education f o r sexual problems (McCary & Flak e , 1971), b u i l d i n g s e l f - c o n c e p t (Caffee, 1975; Edwards, 1972), and p a r t i c u l a r l y w i t h s e l f - c o n c e p t and m i n o r i t y groups (Newton, 1969). Suggestions continued to be made as to what procedure b i b l i o t h e r a p y should f o l l o w and as to what c h a r a c t e r i s t i c s the b i b l i o t h e r a p i s t should d i s p l a y . For i n s t a n c e , Strunk (1972) has made some u s e f u l proposals, extending from c o u n s e l l o r f a m i l i a r i t y w i t h the source m a t e r i a l , to being able to provide a m i l d i n t e r p r e t a t i o n of i t s meaning to the c l i e n t , to using a follow-up method appropriate to the already e x i s t i n g c o u n s e l l i n g r e l a t i o n s h i p . Reading may even be used as a homework e x e r c i s e f o r the c l i e n t . L i c k e r i s h (1975) added another dimension to be considered: the value of b i b l i o t h e r a p y to the t h e r a p i s t . Examples of such gains are: 1. teaching empathy, warmth and genuiness as suggested f o r a l l c o u n s e l l o r s by Truax and Carkhuff (1967), 2. p r o v i d i n g v i c a r i o u s experiences of s i t u a t i o n s u n l i k e l y to be met i n r e a l l i f e , 3. guiding i n the search of v a l u e s , 4. s e n s i t i z i n g to the c l i e n t s ' c o n d i t i o n , thereby becoming "ac u t e l y aware of the tragedy of unresolvable human c o n f l i c t s " (p. 106), and 5. i n c r e a s i n g communication between t h e r a p i s t and c l i e n t . L i c k e r i s h had another i n n o v a t i v e suggestion: to supply the c l i e n t w i t h " l i t e r a r y gems" (p. 108) which can be c a r r i e d at a l l times. Such "gems" are short quotations s u i t e d to the c l i e n t ' s c o n d i t i o n , taken from any 21 source and p r i n t e d on small cards f o r handy r e f e r r a l , The s i g n i f i c a n c e of the quote would be discussed before-hand and would be used as a stimu-l u s f o r t h e r a p e u t i c t h i n k i n g . Other authors a l s o wrote of the value of b i b l i o t h e r a p y to the t h e r a p i s t . Thrush (1974) s a i d that the use of the w r i t t e n word " i s probably the next best a l t e r n a t i v e " (p. 403) to d i r e c t i n t e r a c t i o n w i t h a person, i n order to c l a r i f y p o i n t s or achieve b e t t e r understanding and S p i t h i l l (1968) asked that c o u n s e l l o r s read f i c t i o n i n order to s p e c i f i c a l l y understand adolescence. Mo r r i s (1973) developed a model of how one's p e r s o n a l i t y can change through b i b l i o t h e r a p y . His a r t i c l e s t r e s s e d the importance of both the c o g n i t i v e and a f f e c t i v e con-tent of l i t e r a t u r e used i n b i b l i o t h e r a p y . The i n t e r a c t i o n of both do-mains must occur before p e r s o n a l i t y change can happen. He devised a book l i s t d i v i d e d i n t o two areas, namely those which deal w i t h emotions and experience ( i d e n t i f i c a t i o n and c a t h a r s i s ) and those which are " r a t i o n a l towards comprehension" (p. 63). According to M o r r i s , i t i s the f u n c t i o n of b i b l i o t h e r a p y to present the r e l e v a n t issues i n the l i t e r a t u r e and to act as a l i n k between the two domains. The i n d i v i d u a l subsequently experiences maximum pleasure, as the r e c o g n i t i o n and accep^-tance of the ' s e l f occurs. This t h e o r e t i c a l approach to the e f f e c t s of b i b l i o t h e r a p y has yet to be v a l i d a t e d . A suggestion that received f u r t h e r support was that of the counsel-l o r having a b i b l i o g r a p h y of l i t e r a t u r e , i n c l u d i n g m a t e r i a l s that could be made a v a i l a b l e to c l i e n t s (McKinney, 1975). His suggestion was that c o u n s e l l o r s could employ short s t o r i e s , because they are g e n e r a l l y e a s i l y compiled, q u i c k l y read and s u f f i c i e n t l y ambiguous to a l l o w the c l i e n t s to b r i n g t h e i r own experiences to bear. O'Brien and Johnson (1977) i n a workshop on b i b l i o t h e r a p y as an i n t e r v e n t i o n s t r a t e g y , a s s e r t e d that 22 t h i s technique gives the c l i e n t something to do immediately, and they have found i t most h e l p f u l with non-verbal, n o n - t r a d i t i o n a l c l i e n t s as i t can e s t a b l i s h a framework for further s e l f - e x p l o r a t i o n . While most authors were searching for ways to standardize b i b l i o -therapy, Alston (1962) had several reservations.. He pointed out that while many people are influenced by books, not everyone reads, nor are a l l deeply affected. Further, the patients' i l l n e s s e s may prevent them from d i s t i n g u i s h i n g what i s relevant. Therefore, bibliotherapy must be used with appropriate discussion, or there may occur resistances and misunderstanding. Also, a book cannot be a substitute for the r e l a t i o n -ship between two people. Gottschalk (1948), Russell and Shrodes (1950), and Brammer and Shostrom (1968) concurred on t h i s point. The book i t -s e l f must not be the sole means of therapy for the reader. F i n a l l y , Alston speculated that as long as bibliotherapy remains an adjunct tech-nique " i t may not be susceptible to standardization and precise evalua-t i o n " (p. 174). He concluded that i t s use w i l l l i k e l y remain a momentary decision dependent upon the matching of the therapist, patient, moment and book content, with the book l i k e l y being of more value than anything els e . The counsellors' f a m i l i a r i t y with the materials to be used i n bib-liotherapy continued to be stressed (Alston, 1962; Darling, 1957; McKinney, 1975). Jackson (1962) asserted that the b i b l i o t h e r a p i s t must know the book and the reader, as well as the e f f e c t s of bringing the two together. She commented that t i t l e suggestions which occur to the counsellor spon-taneously i n response to an expressed need may sometimes be the best s e l e c t i o n s . The s e l e c t i o n of books should provide a l t e r n a t i v e s from which the reader may choose. The counsellor, l i b r a r i a n or other 23 p r a c t i t i o n e r , can act as a "pharmacist!' (Gottschalk, 1948; Home, 1975) f i l l i n g the order, knowing the i n g r e d i e n t s , and t a k i n g r e s p o n s i b l i t y i n recommending the reading. The personal q u a l i t i e s r e q u i r e d f o r a b i b l i o t h e r a p i s t , as f o r any t h e r a p i s t , are: emotional s t a b i l i t y , p h y s i c a l w e l l - b e i n g , and empathic c h a r a c t e r i s t i c s and p e r s o n a l i t y . This person must have good communica-t i o n s k i l l s and b e l i e v e i n a c l i e n t ' s inherent a b i l i t y to grow and change towards s e l f - r e a l i z a t i o n (Kinney, 1962). Kinney wondered why a program of t r a i n i n g f o r b i b l i o t h e r a p i s t s d i d not yet e x i s t ( i n 1962), and subsequently b u i l t a case f o r an i n t e r d i s c i p l i n a r y , u n i v e r s i t y graduate course. However, Mahoney (1965) d i d make use of l i t e r a t u r e when teaching psychotherapy to c l i n i c a l p s y c h o l o g i s t s . He was convinced of i t s importance i n a t r a i n i n g program, because he b e l i e v e d that f i c -t i o n i s a powerful means of evoking f e e l i n g s . Thrush (1974) a l s o put f o r t h her ideas f o r the use of b i b l i o t h e r a p y as a t r a i n i n g technique f o r c o u n s e l l o r s , teachers and doctors. Her reasons were the same as those f o r using b i b l i o t h e r a p y w i t h c l i e n t s : i t can provide i n s i g h t , to solv e a t h e r a p e u t i c problem. Home (1975) wondered why no course i n b i b l i o -therapy was being o f f e r e d and was responded to by Kusterbe (1975), who informed her that at V i l l a n o v a U n i v e r s i t y , the l i b r a r y science program has a s p e c i a l l y designed course i n b i b l i o t h e r a p y . This program was i n -i t i a t e d i n 1970, yet she d i d agree that there was s t i l l much work to be done before b i b l i o t h e r a p y gains c r e d i b i l i t y . She suggested c e r t i f i c a t i o n f o r the b ' i b l i o t h e r a p i s t and s t r i c t g u i d e l i n e s f o r the s e l e c t i o n and u t i l i z a t i o n of m a t e r i a l s . An i n t e r e s t i n g and u s e f u l p r a c t i c e which i s t a k i n g hold w i t h i n the psychotherapy p r o f e s s i o n i s that of c r e a t i n g a c l i e n t ' s s t a t e of 24 readiness f o r c o u n s e l l i n g , Reading f o r inf o r m a t i o n as a p r e - c p u n s e l l i n g s t r a t e g y has been suggested by Brammer and Shostrom (1968) and they con-s i d e r t h i s , too, as b i b l i o t h e r a p y . The b e n e f i t s of using b i b l i o t h e r a p y p r i o r to c o u n s e l l i n g range from f r e e i n g time f o r more c r i t i c a l therapy to s t i m u l a t i n g i n s i g h t f u l t h i n k i n g . I t i s sometimes e a s i e r to t a l k a-bout what happened i n a book than about what has happened to the reader ( A l s t o n , 1962). A non-evaluative atmosphere must be maintained through-out the p r e - c o u n s e l l i n g approach and t h i s p a r t of the p r a c t i c e may be conducted on an i n d i v i d u a l or group b a s i s (Jackson, 1962; Moody, 1971). V a r i a t i o n s i n the Use of B i b l i o t h e r a p y Strauss (1977) has s a i d that during the Renaissance, myth was r e -placed by the novel i n l i t e r a t u r e and by the symphony i n music. There i s , i n t h i s , an i m p l i c a t i o n f o r the p r a c t i c e of b i b l i o t h e r a p y : as myths were used to convey the c u l t u r a l values of t h e i r time, so now the novel and music have that task. Two books have been produced which confirm t h i s view and which b r i n g b i b l i o t h e r a p y to the people. In the f i r s t , Stone and Smart-Stone (1966) have presented the v a r i o u s l a b e l s of the abnormal p e r s o n a l i t y i n p o r t r a i t form, drawn from the l i t e r a t u r e of the Russians, French, E n g l i s h , Germans and Americans. The examples present p s y c h o l o g i c a l d i s o r d e r s of the s t o r y characters and t h e i r r e l a t i o n s h i p s . In a sense, that these sources e x i s t , r e f l e c t s the aforementioned c u l -t u r e s ' p a r t i c u l a r pre-occupations w i t h the e x p l o r a t i o n of human behavior and m o t i v a t i o n . Further, the p s y c h o l o g i c a l impact upon the reader might be increased were the reader to know of the l i f e , s t r u g g l e s and i d e a l s of the author who created such works. "For s u r e l y every work acquires 25 more depth and meaning when viewed against the circumstances that com-p e l l e d the author to be what he was..." (Marti-Ibanez, 1976, p. 6). The second book i s the production of Landau, Landau-Epstein and Plaat-Stone (1972). Ten developmental stages of childhood are i l l u s t r a t e d v i a p e r t i n e n t s t o r y excerpts. What the authors have done i s to show that growing up and a l l i t s elements can be demonstrated by example as w e l l as by theory. Aimed at education students, the book provides a r e a l -l i f e approach to theory. "Those who teach or counsel need to b r i n g t h e i r own childhood experiences to the conscious l e v e l i n order to f u n c t i o n w i t h empathy" (p. x i v ) . B i b l i o t h e r a p y has been brought to the a t t e n t i o n of l a y people i n the magazine Psychology Today (August, 1977). The a r t i c l e was e n t i t l e d " T a l king over Death - C h i l d r e n ' s S t o r i e s that Help". A l s o , the American Personnel & Guidance A s s o c i a t i o n ' s Newsletter Gxiidepost (December, 1977) ran an advertisement f o r a guide to c h i l d r e n ' s l i t e r a t u r e about the needs and problems of youth aged 2 - 1 5 . This volume i s c a l l e d "The Bookfinder" and i s a v a i l a b l e to anyone. Axelrod and T e t i (1976) b e l i e v e d that i f the concept of b i b l i o t h e r a p y remains t r u e , then using other forms of communication media i n the same manner as books may be a s o l u t i o n to a t&lXua'ltori"- wherein the person i s l e a r n i n g - d i s a b l e d and/or emotionally d i s t u r b e d , thereby p r e c l u d i n g reading. An example of such media i s f i l m . Hence, " a u d i o - v i s u a l therapy" and the a u d i o - v i s u a l t h e r a p i s t becomes a v i a b l e a l t e r n a t i v e to the b i b l i o t h e r a p i s t , f u l l y capable of i n t e r c e p t i n g c e r t a i n problem behaviors. There i s a c o l l e g e i n F l o r i d a which o f f e r s an i n n o v a t i v e E n g l i s h course, invented by James P i t t s (1975). C a l l e d Self-Awareness Through Characters i n L i t e r a t u r e (SATChL), t h i s program i s d e l i b e r a t e , 26 p s y c h o l o g i c a l education, w i t h a developmental r a t h e r than remedial focus. This, too, i s a form of b i b l i o t h e r a p y . P i t t s recommends a non-judgemental, accepting and s e l f - d i s c l o s i n g p o s i t i o n on the p a r t of the i n s t r u c t o r i n order to f a c i l i t a t e the d i s c u s s i o n which flows from the s e l f - d i s c o v e r y each student experiences. The concept of the course i s based upon the opinion "that a l l l i t e r a t u r e deals u l t i m a t e l y w i t h the human c o n d i t i o n " ( P i t t s , 1975, p. 167). F i n a l l y , the commercial bookstands are abound w i t h s o - c a l l e d s e l f -help books. Such d o - i t - y o u r s e l f problem-solving books (Atkinson, 1974) promise growth and enhancement. Several opinions e x i s t on the e t h i c s and e f f i c a c y of such l i t e r a t u r e . A r i e t i (1977) worried about them, s t a t i n g that the p s y c h o l o g i c a l work they recommend to the reader should not be done outside of a t h e r a p i s t ' s o f f i c e . He a t t r i b u t e s t h e i r popular-i t y to the f a c t t h a t t t h e y promise something and r e q u i r e l i t t l e , i f any, previous education. Concluding that these books provide only momentary s a t i s f a c t i o n of our needs, he s a i d that they may have a ne g a t i v e , long-term e f f e c t by inducing an a t t i t u d e of complacency and u n r e a l i t y . On the other hand, D i l l e y (1978) p r a i s e d the use of s e l f - h e l p l i t e r a t u r e . He q u a l i f i e s t h i s somewhat by encouraging the reader to use such books i n conjunction w i t h the c o u n s e l l i n g process i t s e l f . He s a i d that these books have many p r a c t i c a l a p p l i c a t i o n s , v o c a t i o n a l , r e h a b i l i t a t i o n and school c o u n s e l l i n g f o r example, and sometimes can be more e f f e c t i v e than the c o u n s e l l o r . He l i s t e d s i x problem areas t y p i c a l l y d e a l t w i t h i n such books, cautioned the reader not to make the book a s u b s t i t u t e f o r c o u n s e l l i n g f o r more d i f f i c u l t problems and asserted that„there i s no b e t t e r way to get a p o i n t across than by t e l l i n g a good s t o r y . 27 I have l i t t l e doubt but that we t h e r a p i s t s have l o s t the chance to make some, p r o f e s s i o n a l fees because a pro s p e c t i v e p a t i e n t came to achieve c a t h a r s i s , i n s i g h t i n t o and compassion f o r h i m s e l f , through w r i t i n g a poem, a nov e l , a p l a y . (Jourard, 1964, p. 42) The value of w r i t i n g as a b i b l i o t h e r a p e u t i c technique has re c e i v e d l e s s a t t e n t i o n than the reading of books; nev e r t h e l e s s , w r i t i n g i s a s i g n i f i c a n t element of .bibliotherapy. E l l i s (1965) encouraged h i s p a t i e n t s to w r i t e as therapy, suggest-i n g that they make b r i e f notes of u p s e t t i n g s i t u a t i o n s , and that they keep d i a r i e s , j o u r n a l s and schedules. Burton (1965) saw w r i t t e n pro-ductions, of the c l i e n t , as adjuncts to therapy s i n c e they a l l o w f r e e -dom of expression and hence, c r e a t i v i t y and r e l e a s e . "Most c l i e n t s , p a r t i c u l a r l y s c h i z o p h r e n i c p a t i e n t s , want to be w r i t e r s " (p. 5) not f o r fame or wealth but to express t h e i r innermost being. "Who of us has not yearned to w r i t e i t a l l down" (p. 5). He concluded that t h i s need may account f o r why so much w r i t i n g i s produced, namely poems and books, by people i n the process of therapy. I t promotes t h e r a p e u t i c growth. The type of w r i t i n g that can be used f o r mental h e a l t h o b j e c t i v e s i n c l u d e s a wide range of personal documents such as autobiographies, d i a r i e s j l e t t e r s , verbatim recordings and l i t e r a r y compositions. The "p s y c h o l o g i c a l d i s t a n c e " between t h e r a p i s t and c l i e n t which can be a t -tained through w r i t i n g can enable the i n d i v i d u a l to be more f r e e to ex-p l o r e the problem (Zaccaria & Moses, 1968). This can be done i n the classroom s e t t i n g as w e l l and, i n a l l cases, the sharing of such docu-ments should occur w i t h the c o u n s e l l o r p l a c i n g no judgement upon the work, e s p e c i a l l y i f i t i s a c r e a t i v e p i e c e , accepting i t only as having meaning f o r the c l i e n t ' s growth ( M i t c h e l l & Campbell, 1972). Free-28 w r i t i n g as therapy i s something which. McKinney (1976) values h i g h l y as a supplement to c o u n s e l l i n g . He found that i n s i g h t s "or v e r b a l perceptions of a c l i e n t ' s predicament are more l i k e l y to appear i n w r i t i n g " than i n other c o u n s e l l i n g methods (p. 185). Those who do w r i t e are not, accord-:" i n g to McKinney (1976), more i n t e l l i g e n t or f l u e n t but are more s e r i o u s and r e f l e c t i v e . Poetry says what i t says i n metaphor and symbol r a t h e r than i n l i t e r a l terms, i n sound as much as i n sense, i t penetrates the p a t i e n t ' s defences and r a t i o n a l i z a t i o n s ' and permits him to experience the f e e l i n g s he i s t r y i n g to deny. The d i s c u s s i o n of poetry o f t e n turns out f o r the p a t i e n t to be the d i s c u s s i o n - and the discov e r y - of him s e l f . (Hayakawa, as c i t e d i n Leedy, 1969, p. 271) In 1959, a poetry therapy group was organized a t the Mental Hygiene C l i n i c of Cumberland H o s p i t a l i n Brooklyn, New York. Since that time, s i m i l a r groups have been e s t a b l i s h e d and the movement has spread s i g n i f i -c a n t l y . Some people can spontaneously express t h e i r emotions through verse. Poems w r i t t e n during treatment and read or r e c i t e d during a ses-s i o n may serve as a signpost f o r f u t u r e d i s c u s s i o n - something the p a t i e n t may not be yet ready to t a l k about but s t i l l wants to l e t the t h e r a p i s t know what i s to come (Harrower, 1969). Or, the poem may be a way of e l i c i t i n g a response i f read to a c l i e n t or group of c l i e n t s by the th e r a -p i s t . Those who discuss poetry i n the context of c o u n s e l l i n g s t r e s s i t s a u d i t o r y and rhythmic q u a l i t i e s and they d i s t i n q u i s h between what c l i e n t s may f i n d h e l p f u l to read, and t h e i r own c r e a t i o n s . L i c k o r i s h (1975) em-phasized that the work of the c l i e n t i s l i k e l y to be even more important than that of the greats, s i n c e i t "speaks to the p a t i e n t ' s c o n d i t i o n " 29 (p. 108) and thus evokes a response c r u c i a l to the ther a p e u t i c process. Poetry therapy has been the subject of at l e a s t one d o c t o r a l d i s s e r t a t i o n (Margolis, 1971) and Leedy i s the person most reknown i n the f i e l d . He produced a volume (1969) on the p r a c t i c e of poetry therapy, t r a c i n g i t s development, proposing a n a t i o n a l a s s o c i a t i o n of poetry t h e r a p i s t s and o f f e r i n g a c u r r i c u l u m f o r t h e i r t r a i n i n g . He st r e s s e d that the main p r i n c i p l e to f o l l o w i n the implementation of poetry therapy i s the s e l e c -t i o n of the appropriate poem f o r the i n d i v i d u a l or group. I t s mood must match that which the p a t i e n t i s ex p e r i e n c i n g , f o r example, depressed p a t i e n t s w i l l b e n e f i t from a sad or gloomy poem, thereby r e c o g n i z i n g that they are not alone. I f read aloud, the poem w i l l enable the p a t i e n t to respond more d i r e c t l y to i t s rhythms and patterns and may have a h e a l -i n g e f f e c t . P a t i e n t s may even be encouraged to memorize a poem, thereby g i v i n g themselves a sense of mastery and accomplishment. Poetry therapy, w i t h i n a group s e t t i n g , may a l s o be a c r e a t i v e experience f o r those i n the group. They may r e c i t e together, decreasing i n h i b i t i o n s and a n x i e t i e s and i n c r e a s i n g belongingness and ego-strength. Through poetry, we may share, w i t h others, a v a r i e t y of emotions and thereby e s t a b l i s h a bond of r e l a t i o n s h i p s ( H i t c h i n g s , c i t e d i n Leedy, 1969). Poetry b r i n g s emotional i n s i g h t more r e a d i l y , s a i d Greenwald ( i n Leedy, 1969), be-cause i t r e q u i r e s that the p a t i e n t do something ra t h e r than simply read or be t o l d a s t o r y . A l l forms of c r e a t i v e w r i t i n g can be ther a p e u t i c v e h i c l e s which o f f e r c l i e n t s an opportunity to turn t h e i r a t t e n t i o n inward without having to modify i t as may happen when they express themselves o r a l l y . Thus, i n w r i t i n g , r e s i s t a n c e i s lessened and f a n t a s i e s may be expressed more f r e e l y (Leedy, 1969). And, as c l i e n t s w r i t e , t a l k and re a c t to 30 t h e i r own written creations, the .materials serve as a therapeutic t o o l , which, when added to the t r a d i t i o n a l therapeutic process, enables the c l i e n t s to accelerate t h e i r healing. Conclusions In conclusion, the l i t e r a t u r e review has covered four general re-search areas: bibliotherapy and personality development, bibliotherapy i n the educational s e t t i n g (the classroom, l i b r a r y , s p e c i a l problems, counselling and guidance), bibliotherapy i n the c l i n i c a l s e t t i n g and v a r i a t i o n s i n the use of bibliotherapy. There has been some discussion of the actual process of bibliotherapy but much of the research has been de s c r i p t i v e , occasionally u t i l i z i n g case studies. P a r t i c u l a r l y i n the area of counselling, the concept of bibliotherapy has seldom appeared, apart from reviews of the l i t e r a t u r e r e l a t i n g to the general therapeutic e f f e c t s of b i l i o t h e r a p y . Only a few guidance texts mention bibliotherapy and only one of the major textbooks i n counselling mentions the term bibliotherapy (Zaccaria & Moses, 1968). Brammer and Shostrom authored that book (.1968), and i t appears to be the most thorough treatment of bibliotherapy i n the context of counselling. Therefore, although coun-s e l l i n g may occasionally use b i b l i o t h e r a p e u t i c techniques, there appears to be l i t t l e support for the use of bibliotherapy as a well-established part of the counselling process. C r i t i c s have emphasized that the research focus of bibliotherapy has been upon creating materials and bib l i o g r a p h i e s , not giving adequate information as to how bibliotherapy has been, or i s now, practiced CZaccaria & Moses, 1968). The l i t e r a t u r e has t y p i c a l l y been sparse or cloudy; investigations and books have been l i s t e d f o r numerous groups 31 and types of problems but not c l a r i f i e d - — f o r example, i n the cases of l i t e r a c y and educational l e v e l s . Even with the passage of s i x docu-mented decades, bib l i o t h e r a p y has remained elusive and i n t a n g i b l e . Bibliotherapy seems to have evolved from an " a r t " stage through "enthusiasm" towards "science" (Beatty, 1962, p. 107). It i s not r e a l l y science yet, but i t may be on i t s way. In order to speculate upon the future of bibliotherapy as an ef-f e c t i v e and accountable therapeutic t o o l , some groundwork was f i r s t r e -quired. I t was necessary to discover exactly i n what ways bibliotherapy i s used, and by whom, i n order to understand the process and to discuss possible recommendations f o r a l t e r a t i o n c o r improvement. Although the research l i t e r a t u r e has not f u l l y examined the p r a c t i c e and methodology of bibliotherapy, i t has provided some information regarding the o v e r a l l J structure under which bibliotherapy could be performed. Therefore, the purpose of the present study i s to describe, i n d e t a i l , the process of t h i s technique as i t i s currently used by p r a c t i t i o n e r s i n t h i s l o c a l e . Zaccaria and Moses (1968) have outlined 12 p r i n c i p l e s of b i b l i o -therapy, which serve as conditions for i t s p r a c t i c e . They are, as follows: 1. Understand the nature and dynamics of bibliotherapy and i n -corporate the t h e o r e t i c a l aspects of bibliotherapy into a functional theory. 2. Possess at l e a s t a general f a m i l i a r i t y with the l i t e r a t u r e to be used. 3. Bibliotherapeutic reading can be encouraged and f a c i l i t a t e d through the use of prompting techniques. 4. Readiness i s an important factor to be kept i n mind when u t i l i z i n g bibliotherapy techniques. 5. Books should be suggested rather than prescribed. 32 6. In general, reading m a t e r i a l s that are concise and to the p o i n t are more p r e f e r a b l e to lengthy pieces of l i t e r a t u r e . 7. The p r a c t i t i o n e r should be s e n s i t i v e to p h y s i c a l handicaps of the i n d i v i d u a l which may d i c t a t e the n e c e s s i t y of using s p e c i a l m a t e r i a l s . 8. B i b l i o t h e r a p y appears to be most e f f e c t i v e w i t h i n d i v i d u a l s of average and above average reading a b i l i t y . 9. Several p e r s o n a l i t y c h a r a c t e r i s t i c s of the person should be considered i n the s e l e c t i o n of m a t e r i a l to be used. 10. The reading of the l i t e r a t u r e by the i n d i v i d u a l should be accompanied and/or followed up by d i s c u s s i o n and/or coun-s e l l i n g . 11. B i b l i o t h e r a p y i s adjunct to other types of h e l p i n g r e l a t i o n -ships r a t h e r than an a l t e r n a t i v e or independent form of therapy. 12. Although b i b l i o t h e r a p y i s a u s e f u l technique, i t i s not a panacea. In t h i s i n v e s t i g a t i o n , a questionnaire was devised and used as an i n t e r v i e w schedule, w i t h the purpose of o u t l i n i n g and r e f i n i n g the a c t u a l step-by-step procedure of b i b l i o t h e r a p y . The above 12 c o n d i t i o n s d i d not serve as the foundation of t h i s research, but they are r e f l e c t e d i n the q u e s t i o n n a i r e and t h e r e f o r e comply w i t h the standards these p r i n c i p l e s demand. 33 Chapter I I I METHOD AND PROCEDURE The Sample The sample i n t h i s study c o n s i s t e d of 40 mental h e a l t h p r a c t i t i o n e r s d i v i d e d i n t o four groups: 10 s o c i a l workers, 10 p s y c h o l o g i s t s , 10 coun-s e l l o r s and 10 p s y c h i a t r i s t s . P opulation The p o p u l a t i o n sampled have t h e i r p r a c t i c e i n the lower mainland area of B r i t i s h Columbia. In order to be s e l e c t e d as par t of the sample, each p r o f e s s i o n a l had to be a current (1976) member of a p r o f e s s i o n a l a s s o c i a -t i o n , thereby being i n c l u d e d on a membership or m a i l i n g d i r e c t o r y , such as: the B r i t i s h Columbia Psychology A s s o c i a t i o n (B.C.P.A.), The College of Phy s i c i a n s and Surgeons of B r i t i s h Columbia, The B r i t i s h Columbia A s s o c i a -t i o n of S o c i a l Workers (B.C.A.S.W.), and the Canadian Guidance and Coun-s e l l i n g A s s o c i a t i o n (C.G.C.A.). Most school c o u n s e l l o r s d i d not belong to C.G.C.A. i f they were members of the B r i t i s h Columbia A s s o c i a t i o n of School Counsellors (B.C.A.S.C.). Therefore, i t was decided to i n c l u d e t h i s a s s o c i a t i o n as w e l l . Mailing/membership l i s t s were obtained from each a s s o c i a t i o n , except f o r the B.C.A.S.C. In order to o b t a i n that l i s t , i t was necessary to w r i t e a l e t t e r to the d i r e c t o r s of c o u n s e l l i n g i n each of the eleven school d i s t r i c t s , requesting the names and addresses of each c o u n s e l l o r w i t h i n the d i s t r i c t (Appendix A ). Seven of the 11 co-ordinators or d i r e c t o r s complied w i t h t h i s request, three d e c l i n e d and 34 one d i d not respond. Once each of the d i r e c t o r i e s was obtained, an i d e n t i f i c a t i o n number was assigned to each name ori the l i s t s , and a s u b - t o t a l number of names was obtained f o r each l i s t . The sample s i z e was f i x e d at 40: 10 subjects per group of professions' 1, r In order to o b t a i n a random sample, the com-puter program "RANGE" ( R u s s e l l , 1976) was employed. S i x t y randomly o r -dered numbers were generated f o r each group, from which the f i r s t 15 were se l e c t e d to r e c e i v e a l e t t e r requesting t h e i r p a r t i c i p a t i o n i n the study (Appendix B )• Therefore, 15 p r o f e s s i o n a l s from each group received a l e t t e r informing them that they had been s e l e c t e d and would s h o r t l y be contacted, by telephone, f o r an i n t e r v i e w . The f i r s t 10 people to r e s -pond to the phone contact comprised the i n t e r v i e w sample f o r each group of p r o f e s s i o n a l s . Personal Interview Sample of F i f t e e n This sample c o n s i s t e d of 15 of the o r i g i n a l 40 p r a c t i t i o n e r s who, during the telephone i n t e r v i e w , responded a f f i r m a t i v e l y to the f o l l o w i n g questions: 1) does your work i n c l u d e a c t u a l c o u n s e l l i n g or psychotherapy? 2) do you ever suggest that your c l i e n t s read or w r i t e something r e l a t e d to t h e i r problem or i s s u e ; to what extent or how o f t e n do you suggest t h i s ? The remaining 25 p r a c t i t i o n e r s were interviewed only on the t e l e -phone, and not i n a personal i n t e r v i e w . They are described i n Appendix C . These i n d i v i d u a l s e i t h e r were not doing c o u n s e l l i n g or d i d not use l i t e r a -t ure i n t h e i r c o u n s e l l i n g , and were t h e r e f o r e excluded from the study. 35 Demographic C h a r a c t e r i s t i c s of the Personal Interview Sample C o l l e c t i v e l y , there were three interviewees w i t h Medical Degrees, two w i t h PhD's, seven w i t h Masters'Degrees, and three w i t h Bachelor's Degrees: three p s y c h i a t r i s t s , four p s y c h o l o g i s t s , three c o u n s e l l o r s and f i v e s o c i a l workers. Of the 10 men and f i v e women, three maintained a part-time p r i v a t e p r a c t i c e along w i t h other d u t i e s , and were employed e i t h e r by government s e r v i c e s (9), school boards ( 3 ) , or i n d u s t r y , h o s p i t a l s and u n i v e r s i t i e s (3). With a mean of 16.4 years of c l i n i c a l experience, the median being 14 years and a median age of 46, these 15 p r o f e s s i o n a l s subscribed to three p a r t i c u l a r t h e o r e t i c a l approaches, namely E c l e c t i c (dynamic, e x i s t e n t i a l , humanistic) (11), A d l e r i a n ( 2 ) , and B e h a v i o r a l C l )• One p r a c t i t i o n e r d i d not subscribe to any p a r t i c u l a r theory of p r a c t i c e . The mean average number of c l i e n t s each t h e r a p i s t saw per day was 5.27, excluding the two t h e r a p i s t s who p e r i o d i c a l l y con-duct workshops which o f t e n c o n s i s t of 20 or more p a r t i c i p a n t s . F i f t y - , three percent of the t h e r a p i s t s had an average c l i e n t - i n t e r v i e w time of one hour, whereas approximately 13 percent see t h e i r c l i e n t s f o r one-h a l f hour. Appjf©xi|i]^ tely';. 13 percent e i t h e r conduct workshops where the time v a r i e s from three hours to an e n t i r e weekend, o r , they could not s t a t e the average l e n g t h of t h e i r i n t e r v i e w time, as t h e i r p r a c t i c e i s q u i t e u n s t r u c t u r e d . Only seven percent, or one of the 15 respondents, i n t e r v i e w s c l i e n t s f o r l e s s than 30 minutes. The respondents i n t h i s sample v a r i e d as to t h e i r f a m i l i a r i t y w i t h the p r o f e s s i o n a l l i t e r a t u r e on the t o p i c of b i b l i o t h e r a p y , as w e l l as w i t h the degree and extent of exposure to b i b l i o t h e r a p y they experienced during t h e i r formal t r a i n i n g programs. For more complete reference to t h i s , see Appendix Tables 1 and 2. 36 The Interview Interview Schedule The i n t e r v i e w schedule was developed and based upon the review of the research l i t e r a t u r e on the t o p i c of b i b l i o t h e r a p y . The schedule c o n s i s t e d of nine questions about the p r a c t i t i o n e r s ' use of b i b l i o -t h e rapeutic reading and one question about the use of c l i e n t s ' w r i t i n g . Each question covered a general area of the p r a c t i c e of b i b l i o t h e r a p y ; as w e l l there were s e v e r a l sub-questions (probes) which were contingent i n part upon responses of the interviewees to the major questions. Ques-t i o n s were open-ended. F o l l o w i n g i s a l i s t of the o b j e c t i v e s as out-l i n e d i n the i n t r o d u c t i o n as they r e l a t e to each i n t e r v i e w question. Objective 1. To determine whether the t h e r a p i s t has a l i s t of t i t l e s which are r o u t i n e l y r e f e r r e d to i n the p r a c t i c e of b i b l i o -therapy. Question 1. What are the t i t l e s you most o f t e n use i n your coun-s e l l i n g / t h e r a p y ? a) Do you have a w r i t t e n or formal l i s t ? b) Have you ever decided not to continue w i t h a t i t l e you p r e v i o u s l y used? - f o r what reason? Objective 2. To determine how the t h e r a p i s t decides upon which t i t l e s to use, what the sources of the t i t l e s are and what use i s made of the c l i e n t ' s responses to a p a r t i c u l a r t i t l e . Question 2. How do you determine which t i t l e s to use ( i . e . add to your p o s s i b l e l i s t of t i t l e s ) ? a) What are your (other) sources of t i t l e s ? eg. b i b l i o g r a p h y , book club e t c . b) What use do you make of your c l i e n t ' s responses to a p a r t i c u l a r t i t l e ? 37 Objective 3. To determine how f a m i l i a r the t h e r a p i s t i s w i t h the m a t e r i a l s used. Question 3. To what degree are you f a m i l i a r w i t h the t i t l e s you use? a) Do you read whole books, p a r t s , index etc? b) What do you do i f a c l i e n t mentions a t i t l e which you are not f a m i l i a r with? Objective 4. To determine how the subject of reading books a c t u a l l y comes up w i t h i n the t h e r a p y / c o u n s e l l i n g session and then * what procedures are followed once a s p e c i f i c t i t l e i s mentioned. More p r e c i s e l y , what i s i n v e s t i g a t e d i s whet-her t i t l e s are assigned or recommended, whether a r a t i o n a l e f o r the t i t l e choice i s provided, whether the t h e r a p i s t ..prefers"" the t i t l e be read w i t h i n a s p e c i f i c time p e r i o d , and how the c l i e n t i s supposed to o b t a i n the chosen t i t l e . Question 4. Normally, how does the subject of r e a d i n g / w r i t i n g come up i n your sessions? What i s the procedure once a s p e c i f i c t i t l e has been mentioned? a) Would you a s s i g n i t or would you recommend or suggest i t more i n passing? b) Do you give a r a t i o n a l e f o r your t i t l e suggestion? c) Do you f e e l that i t must be read w i t h i n a c e r t a i n time p e r i o d i n order to have the e f f e c t you intend? d) How do you a c t u a l l y describe what you want the c l i e n t to do regarding the t i t l e ? (homework?) -Suppose that I'nra c l i e n t and you t h i n k I might b e n e f i t from a s p e c i f i c t i t l e ; would you b r i e f l y r o l e play w i t h me and t e l l me how you'd t e l l the c l i e n t what you want? e) How w i l l your c l i e n t get the t i t l e to read? Objective 5. To determine whether the t h e r a p i s t or the c l i e n t i s f i r s t to mention the t i t l e again, and how much time elapses before t h i s takes place. Further, i f the book has not been read, whether the t h e r a p i s t makes another attempt at suggesting a t i t l e a t some l a t e r time. Question 5. How long i s i t before the t i t l e i s mentioned again? a) By whom i s i t mentioned? b) Do you suggest t h i s i . e . r e a d i n g / w r i t i n g again, i f your c l i e n t has not followed your f i r s t sug-gestion? 38 Objective 6. . To determine under what reference c a t e g o r i e s the t h e r a p i s t ' s t i t l e s e lections, can be catalogued; e.g. f i c t i o n v s . non-f i c t i o n . Question 6. I'm going to mention v a r i o u s types of t i t l e s (books) and I'd l i k e you to i n d i c a t e which type you most fr e q u e n t l y use:-- f i c t i o n vs. n o n - f i c t i o n - l a y psychology and/or s e l f - h e l p readings - biographies and autobiographies - r e l i g i o u s m a t e r i a l - poetry a) : Any. 'Other m a t e r i a l s you can think of? b) Do you p r e f e r to use an e n t i r e work or par t of one i . e . s e l e c t e d passages or perhaps magazine or news-p a p e r - a r t i c l e s ? Objective 7. To determine whether the t h e r a p i s t can provide a general d e s c r i p t i o n of the type of c l i e n t w i t h whom t h i s technique i s used most o f t e n , or what i t i s about a c l i e n t that b r i n g s a t i t l e to the t h e r a p i s t ' s mind? Question 7. What i s i t about a c l i e n t that b r i n g s a t i t l e to-your mind"? ' „•";. " . ; Objective 8. To describe the type of problems the t h e r a p i s t ' s c l i e n t s t y p i c a l l y have, and whether the type of problem b i b l i o -therapy i s most e f f e c t i v e w i t h can be i s o l a t e d , as w e l l as what p r o p o r t i o n of the t h e r a p i s t ' s p r a c t i c e i s t h i s p a r t i c u l a r problem conducive to b i b l i o t h e r a p y . Question 8. What types of problems do your c l i e n t s t y p i c a l l y have? a) For which type of problem do you f i n d t h i s tech-nique most e f f e c t i v e ? b) What p r o p o r t i o n of your t o t a l p r a c t i c e i s t h i s p a r t i c u l a r problem? Objective 9. To estimate the p r o p o r t i o n of the t h e r a p i s t ' s c l i e n t popu-l a t i o n w i t h whom b i b l i o t h e r a p y i s used, i f i t could be d i s t i n g u i s h e d whether i t i s used more w i t h men or women and how many t i t l e s are normally suggested per c l i e n t . 39 Question 9. With what p r o p o r t i o n of your c l i e n t s do you use these techniques of e i t h e r reading t i t l e s or ..having them w r i t e ? a) What i s the p r o p o r t i o n of men vs. women that you use these techniques with? b) Can you estimate how many t i t l e s you would nor-m a l l y suggest per c l i e n t : ? O bjective 10. To estimate the number of c l i e n t s undergoing b i b l i o t h e r a p y at the time of the i n t e r v i e w , and whether the t h e r a p i s t can estimate how many c l i e n t s over the past year w i t h whom b i b l i o t h e r a p y had been used. Question 10. How many c l i e n t s are you using these techniques w i t h r i g h t now and how many others can you estimate you used i t w i t h the past year? Objective 11. To determine whether the t h e r a p i s t considers having c l i e n t s w r i t e as pa r t of t h e i r therapy, and, i f so, whether they are d i r e c t e d i n t h e i r w r i t i n g and whether i t i s seen a f t e r -wards. I f c l i e n t s do not w r i t e , what does the t h e r a p i s t do should the c l i e n t spontaneously w r i t e and then want to share that work w i t h the t h e r a p i s t . Question 11. I want to d i g r e s s f o r a moment and ask you about c l i e n t ' s w r i t i n g - as opposed to reading - and then w e ' l l get back. In the research l i t e r a t u r e , the idea of usi n g m a t e r i a l w r i t t e n by the c l i e n t i s al s o considered as a therapeutic t o o l - do you, during the course of your c o u n s e l l i n g , suggest that your c l i e n t s do some w r i t i n g ? Yes - how do they know what to w r i t e ? - do you g e n e r a l l y see t h e i r work? -OR- No - have you ever considered sug-g e s t i n g t h i s ? given that you don't use w r i t i n g i n any f o r m a l i z e d way, what do you do when a c l i e n t b r i n g s you something he's done or t e l l s you about work he's w r i t t e n ? Thank you. Is there anything e l s e you'd l i k e to say which you th i n k i s r e v e l a n t here? Thank you. 40 P r e - t e s t Interview P r i o r to the completion of the i n t e r v i e w schedule, the author i n -terviewed a p r a c t i c i n g t h e r a p i s t as a t r i a l or p r e - t e s t of the i n t e r -view procedure. The experience served adequately to i l l u m i n a t e p o t e n t i a l e r r o r s and ther e f o r e precluded any f u r t h e r p r e - t e s t i n t e r v i e w s . Telephone Interview The i n t e r v i e w c o n s i s t e d of two p a r t s . The f i r s t was a b r i e f t e l e -phone i n t e r v i e w , the purpose of which was to screen the respondents i n two ways: 1) to assure that they a c t u a l l y were p r a c t i t i o n e r s and 2) to assure that they d i d , at l e a s t on occasion, recommend r e a d i n g / w r i t i n g to t h e i r c l i e n t s . The term b i b l i o t h e r a p y was not used by the i n t e r v i e w e r (the author) unless i t was mentioned by the interviewee f i r s t . Those t h e r a p i s t s who s a t i s f i e d these two requirements were then asked f o r an in-person i n t e r v i e w , expected to l a s t approximately 30 - 45 minutes and to be conducted at a time convenient to them. Appointments were sub-sequently made. Those people who d i d not meet the above c r i t e r i a were questioned f u r t h e r on the telephone to determine whether they had ever heard of the technique of b i b l i o t h e r a p y , or whether they had ever consider-ed using i t as pa r t of t h e i r p r a c t i c e . Their responses were recorded verbatim as n e a r l y as p o s s i b l e (Appendix D ). Personal Interview The second p a r t of the procedure was the personal i n t e r v i e w . A 41 consent form was presented f o r s i g n i n g , which was an agreement that tape-recording was acceptable and that c o n f i d e n t i a l i t y was to be maintained (Appendix E). Six demographic questions were asked i n the i n i t i a l stage of the i n t e r v i e w . Each i n t e r v i e w was conducted i n the interviewee's o f f i c e and l a s t e d 30 - 45 minutes. At the completion of the i n t e r v i e w , each interviewee was promised a l i s t of t i t l e s p r o v i d e d by a l l respondents Processing the Interview Schedule Interviews were tape recorded. A procedure f o r doing the content a n a l y s i s was developed, as f o l l o w s : 1 - Two of the i n t e r v i e w s were selected- using the c r i t e r i a that these two respondents provided the most complete d e s c r i p t i o n of t h e i r p r a c t i c e of b i b l i o t h e r a p y . 2 - These two i n t e r v i e w s were t r a n s c r i b e d verbatim. 3 - The t r a n s c r i p t s c o n s i s t e d of responses to each question on the i n -terview schedule. Each response was designated as a content category 4 - The remaining tapes were reviewed and t h e i r content analysed and categorized according to the designated c a t e g o r i e s . 5 - Responses which could not be categorized using the p r e v i o u s l y i d e n t i f i e d c a t e g o r i e s were then used to develop a d d i t i o n a l c a t e g o r i e s This r e s u l t e d i n approximately 200 response c a t e g o r i e s , which i s too l a r g e a number to manage. 6 - The 200 responses were transformed i n t o 96. major and sub-categories. This was done by s u b j e c t i v e l y i d e n t i f y i n g a common element across t' "several c a t e g o r i e s . For example, the o r i g i n a l response c a t e g o r i e s to the question: "What types of c l i e n t s tend to r e c e i v e b i b l i o t h e r a p y were: " v e r b a l " i . e . l e v e l of l i t e r a c y of the c l i e n t ; " c u r i o u s " i . e . w i l l i n g n e s s of the c l i e n t s to examine themselves p s y c h o l o g i c a l l y ; " m i d d l e - c l a s s " i . e . a socio-economic l e v e l a c t u a l l y a s s o c i a t e d w i t h l i t e r a c y ; "readers" i . e . the c l i e n t ' s i n t e r e s t i n reading; and "high s c h o o l " i . e . c l i e n t s who had, at l e a s t , attended high school. The common'element i n a l l of these response c a t e g o r i e s i s that these c l i e n t s are motivated to solve t h e i r problems us i n g c o g n i t i o n . The f i n a l major response category which comprised these f i v e o r i g i n a l c ategories was l a b e l l e d ' c o g n i t i v e and -motivated'. 42 7 - A frequency count was made of-the responses i n the various major categories. In most instances, the respondents' statements could not be t a l l i e d into a s i n g l e , d i s c r e t e category. In these cases, sub-categories were created to r e f l e c t this- confounding across major categories (see Table 13). For example, the respondent's statement "My c l i e n t s must be together, curious and readers...also, I must already have an established rapport...and i t w i l l also de-pend on the nature of h i s problem or goal" was placed into the f o l -lowing major categories: 'ego-strength'; 'overtly cognitive and motivated'; 'reading readiness and established rapport'; and 'nature of problem/goal'. These categories, i n combination with each other, were placed as the following sub-categories; 'A) ego-strength and B) cognitive and motivated and C) reading readiness/rapport and D) nature of problem/goal' i 43 L i m i t a t i o n s Although the i n t e r v i e w method of gathering i n f o r m a t i o n i s adaptable to v a r i o u s s i t u a t i o n s , i t may a l s o l e a d to s u b j e c t i v i t y and p o s s i b l e b i a s . The sources of such b i a s can be the eagerness of the respondent to pieas'e'y-the ."interviewer ,\ ;; a disagreement of views which may a r i s e be-tween the i n t e r v i e w e r and respondent, or the i n t e r v i e w e r may tend to seek answers which support preconceived notions about the t o p i c . In e f f e c t , the i n t e r v i e w e r may lead the respondent to answer i n a favourable manner. Important too, i s the t r a i n i n g and s k i l l of the i n t e r v i e w e r i n t h i s p r a c t i c e . The i n t e r v i e w i t s e l f i s a time-consuming e f f o r t which o f t e n l i m i t s the number of subjects and t h e r e f o r e hampers the g e n e r a l i z -a b i l i t y of r e s u l t s . In t h i s case, 40 people c o n s t i t u t e d the sample, 15 of whom provided the bulk of,, the data by p a r t i c i p a t i n g i n personal i n -terviews. The f a c t that a l l respondents r e s i d e i n one l o c a l e , namely the lower mainland of B r i t i s h Columbia, f u r t h e r l i m i t s the f a r - r e a c h i n g e f f e c t s of the f i n d i n g s . I t was apparent to the i n t e r v i e w e r that none of the respondents were i n t i m i d a t e d by the tape recorder, however, n e a r l y a l l wanted reassurance that c o n f i d e n t i a l i t y / w b u l d ' b e maintained. 44 CHAPTER IV •FINDINGS The r e s u l t s of t h i s study are presented i n the sequence i n which the questions were asked during the personal i n t e r v i e w w i t h the 15 p r a c t i t i o n e r s . The f i r s t item or o b j e c t i v e was to determine which t i t l e s (books) are most o f t e n used by the respondents i n t h e i r p r a c t i c e of b i b l i o t h e r a p y and whether they have compiled a w r i t t e n l i s t of these t i t -l e s . The frequency and percent i n each category of response can be seen i n Table 1. The f i r s t column contains the major and sub-categories of response; i n subsequent t a b l e s , t h i s column w i l l be headed by the word 'categories'. The next column contains the frequencies of the sub-category responses; to be l i s t e d as 'f (sub)'. The next column contains the frequencies of the major c a t e g o r i e s ; to be l i s t e d as 'f (major)'. The f i n a l column contains the percentages of the major c a t e g o r i e s , to be l i s t e d as '% (major)'. In a l l t a b l e s , the frequencies of the sub-c a t e g o r i e s ' t o t a l the frequency of the major category. F u r t h e r , n e i t h e r category- i-major or s u b — i s mutually e x c l u s i v e . F i n a l l y , percentages w i l l be used i n a l l of the t a b l e s although the sample s i z e i s comparatively s m a l l . 45 Table 1. Frequency of response to the question: Do you have a written or formal l i s t of tit l e s ? (N=15) Major categories and Sub-categories of response frequency of sub-category frequency of major category % per major category A) Yes, a written l i s t - yes, only and C) recall rather than refer to l i s t B) No written l i s t - no, only and C) recall t i t l e s spontaneously C) Recall t i t l e s spontaneously rather than refer to a l i s t 4 2 40.00 60.00 46.67 Forty percent of the therapists responded that they have a formal or written l i s t of t i t l e s which they have compiled for their use, some of these so complete that they are divided into categories or problem areas. Of the 60 percent who stated they did not have a written l i s t , five said that they recall their t i t l e s spontaneously, or, that t i t l e s just"pop into their minds" as required. Two of those who have a l i s t also rely on recall rather than refer to their l i s t s . Therefore almost half, or a total of 46.67 percent of those interviewed stated that they spontaneously recall t i t l e suggestions rather than refer to a l i s t . Table 2 gives the distribution of those who have or have not ever decided to discontinue the use of a t i t l e they had previously been using in their practice. 46 Table 2. Frequency of response to the question: Have you ever discontinued use of a t i t l e ? (N=14) Categories f (major) ) Z (major) A) Yes 4 28.57 B) No 10 71.43 Those respondents who have discontinued use of a t i t l e have done so either because the t i t l e had a judgemental tone (n=2) or a complicated format (n=2). Fully 71.43 percent—ten of the 14 respondents—said they had not discontinued using a t i t l e , other than for updating pur-poses . The next question deals with the subject of t i t l e determination and how the respondents acquire their t i t l e s . A tabulation of the re-sponses can be seen in Table 3. Table 3. Frequency of response to the question: How do you determine which t i t l e s to use? (N=15) Categories f (sub) f (major) % (major) A) I read i t myself 13 86.67 - I read i t myself, only 3 and B) c l i e n t mentions i t 4 and C) according to 4 problem and C), D) other 1 and B), C), D) 1 B) C l i e n t mentions i t 6 40.00 - c l i e n t mentions i t , only 1 c) According to problem 7 46.67 - according to problem, 1 only D) Other 2 13.33 The most c o n s i s t e n t response to t h i s question i s that the t h e r a p i s t , when determining which t i t l e s to recommend to c l i e n t s , must f i r s t read the t i t l e (86.67%). However, only three of the 15 used t h i s as t h e i r s o l e t i t l e determinent, whereas four combined t h i s c r i t e r i o n w i t h the idea that the c l i e n t ' s p a r t i c u l a r problem plays an important r o l e i n deter-mining which t i t l e to use. Furth e r , although a t o t a l of s i x t h e r a p i s t s stated that the f a c t that the c l i e n t ' s mention of a t i t l e w i l l determine t h e i r use of i t , o n ly one considered t h i s f a c t o r as the s o l e determinent w h i l e f i v e used t h i s c r i t e r i o n i n combination w i t h others. The category "other" c o n s i s t s of responses regarding the t h e o r e t i c a l l e v e l of the t i t l e (n=2). The second p a r t of the question concerning t i t l e determination i s described i n Table 4, which r e v e a l s the v a r i e t y of sources which the respondents use to acquire t h e i r t i t l e s . Table 4. Frequency of response to the question about t i t l e d etermination: / Other Sources: (N=15) Categories f (sub) f (major) % (major) A) P r o f e s s i o n a l l i t e r a t u r e 3 20.00 and B) m a i l i n g l i s t s 1 -and C) browsing 1 and B), C), D) d e l i b e r a t e search 1 B) M a i l i n g l i s t s - m a i l i n g l i s t s , only 1 5 33.33 and D) 2 C) Browsing 4 26.67 and D) 3 D) D e l i b e r a t e Search - d e l i b e r a t e search, only 6 12 80.00 Eighty percent of the respondents d e l i b e r a t e l y search f o r t h e i r t i t l e s , e i t h e r l o o k i n g i n l i b r a r i e s , t a k i n g courses and workshops or con-s u l t i n g w i t h colleagues. Only s i x of these 12 t h e r a p i s t s depend s o l e l y upon t h i s method, whereas another s i x search w h i l e c a s u a l l y browsing, reading p r o f e s s i o n a l l i t e r a t u r e , or by j o i n i n g book club m a i l i n g l i s t s . The l a s t segment of question two has to do w i t h the follow-up 49 procedure the respondents employ once a t i t l e has been mentioned. These data are presented i n Table 5. Table 5. Frequency of response to the question about t i t l e determination: Follow-up: (N=15) Categories f (sub) f (major) % (major) A) D e l i b e r a t e and s p e c i f i c - d e l i b e r a t e and s p e c i f i c , only 9 11 73.33 and B) c a s u a l , n o n - s p e c i f i c 1 and C) no follow-up 1 B) Casual, n o n - s p e c i f i c - c a s u a l , n o n - s p e c i f i c only 3 5 33.33 and C ) 1 C) None (workshop s e t t i n g ) 2 13.33 Eleven t h e r a p i s t s s t a t e d that they do d e l i b e r a t e and s p e c i f i c follow-up, nine of whom do so e x c l u s i v e l y . F u r t h e r , two of the t h e r a p i s t s occasion-a l l y do workshops, and i n these cases they do no follow-up work at a l l ; however, when i n non-workshop s e t t i n g s , one of these p r e f e r s a more casual follow-up p r a c t i c e whereas the other a more d e l i b e r a t e follow-up. Question three of the i n t e r v i e w concerns the respondents' degree of f a m i l i a r i t y w i t h the t i t l e s they use. 50 Table 6. Frequency of response to the question: How f a m i l i a r are you w i t h the t i t l e s you use? (N=14) Categories f (major) % (major) A) Read each completely , 12 85.67 B) Read each i n p a r t 2 14.33 I t can be seen i n Table 6, that more than 85 percent of the t h e r a p i s t s who use b i b l i o t h e r a p y s t a t e d that they are completely f a m i l i a r w i t h each book or w r i t t e n m a t e r i a l they present to a c l i e n t . These s a i d " I wouldn't recommend anything v^,I jhaven't read myself", ; as opposed to 14.33 percent who s a i d that they read only s e l e c t e d passages or the index of the book they suggest. And, as can be seen i n Table 7, c l i e n t s mention a t i t l e w i t h which the t h e r a p i s t i s not f a m i l i a r each w i l l d i s -cuss how i t i n t e r e s t s the c l i e n t ; e i g h t of the 14 w i l l do t h i s as w e l l as have the c l i e n t b r i n g i n the work and w i l l read i t themselves, where-as three of the 14 may read i t and three do not consider reading what the c l i e n t may b r i n g i n to the s e s s i o n . 51 Table 7. Frequency of response to the question: What i f a c l i e n t mentions a t i t l e with which you are unfamiliar? (N=14) Categories f (sub) f (major) % (major) A) W i l l discuss how i t i n t e r e s t s 14 100 them - discuss i t , only 3 and B) may read i t 3 and C) w i l l read i t 8 The idea of using the c l i e n t ' s w r i t i n g i s also considered as a thera-peutic t o o l . Table 8. Frequency of response to the question: Do you suggest that your c l i e n t s do some writing? (N=15) Categories ' f (major) % (major) A) Yes, suggest they write 8 53.33 B) Dire c t what they write 8 53.33 C) Yes, w i l l see what they write 8 53.33 D) No, do not suggest they write 7 46.67-E) Yes, w i l l see what they write and comment i f requested. 7 46.67 Table 8 reveals that over 53 percent (8 of 15), of the respondents r e -commend w r i t i n g to t h e i r c l i e n t s . A l l eight not only suggest w r i t i n g , but also direct what is to be written and w i l l always read the produced work. The remaining seven (46.67%) who do not suggest writing have con-sidered i t and would be willing to look at whatever their clients have produced and be willing to discuss i t with them as well. How the respondents actually perform their practice of bibliotherapy i s the objective of question four. As can be seen in Table 9, although a l l 15 of the respondents described their procedure of bibliotherapy as commencing with their bringing up the subject, usually saying "read this...", four of these said that i t may occur that their client brings up the subject f i r s t , and that this was acceptable. 53 Table 9. Frequency of response to the question: How does the subject of r e a d i n g / w r i t i n g come up, and what i s the procedure? (N=15) Categories f (sub) f (major) % (major) A) Therapist b r i n g s up the 15 100 subject - t h e r a p i s t , only 11 and B) c l i e n t brings i t up 4 B) C l i e n t b r ings up the subject 4 26.67 C) Assign r e a d i n g / w r i t i n g 9 60.00 - a s s i g n i t , only 3 and D) recommend i t 6 D) Recommend r e a d i n g / w r i t i n g 12 80.00 - recommend i t , only 6 -----: l R a t i o n a l e : E) - i s provided 13 86.67 F) - i s not provided 2 13.33 T i m e - l i m i t : G) - yes 10 66.67 H) - no 5 33.33 R e f e r r a l : I) - s p e c i f i c 10 66.67 J) - cas u a l 5 33.33 Nine of them, or 60 percent, d i r e c t l y a s s i g n reading or w r i t i n g , o f t e n g i v i n g i t as a homework assignment, and of these n i n e , s i x combine t h e i r d i r e c t i o n w i t h another more c a s u a l l y put suggestion that t h e i r c l i e n t s may read or w r i t e something, whereas another s i x use t h i s i n f o r m a l approach exclusively. Nearly a l l (86.67%) prefer to provide a rationale as to why they are suggesting the client read/write and what they might expect to get out of the exercise; and a l i t t l e more than half (66.67%) prefer that the work be done within a certain time period, usually by the next interview or two, in order to have the effect they intend. Again, 66.67 percent are very specific as they describe to the client what i t i s they want: i.e., the therapists take time to point out what might be gained and state that some discussion w i l l follow at a later time. Only five of the 15 respondents believed that such a detailed ex-planation was not necessary. The book to be read by the client may be obtained in a variety of ways, as can be seen in Table 10. Table 10. 55 Frequency of response to the question about procedure: How w i l l the c l i e n t o b t a i n the t i t l e ? (N=15) Categories f (sub) f (major) % (major) (r A) Obtains book through purchase B) Obtains book through l i b r a r y C) Obtains book by-'borrowing from t h e r a p i s t - borrowing, only D) . Obtains book as g i f t from t h e r a p i s t E) Obtains photocopy handouts from t h e r a p i s t 7 46.67 11 73.33 12 80.00 4 26.67 7 46.67 The combination of ways the c l i e n t s are advised to o b t a i n the books: - through purchase, l i b r a r y , borrowed from t h e r a p i s t and as g i f t from t h e r a p i s t - through purchase, l i b r a r y borrowed from t h e r a p i s t and handouts from t h e r a p i s t - through purchase, l i b r a r y and as g i f t from t h e r a p i s t - through purchase and l i b r a r y - through l i b r a r y , borrowed from t h e r a p i s t and as g i f t from t h e r a p i s t - through l i b r a r y , borrowed from t h e r a p i s t and handouts from t h e r a p i s t - through borrowed from t h e r a p i s t , as g i f t from t h e r a p i s t and hand-outs from t h e r a p i s t 2 1 Most t h e r a p i s t s , 80 percent, w i l l lend the book and/or suggest other means of o b t a i n i n g i t . Only three of these 12 thought that the book should or could be obtained only when l e n t by them. Eleven of the 15 (73.33%) mentioned that c l i e n t s could o b t a i n books from the l i b r a r y as w e l l as from the t h e r a p i s t or by buying i t themselves. No one s a i d that the only way a c l i e n t could get the book would be to buy i t , whereas four or 26.67 percent of the t h e r a p i s t s are i n the hab i t of g i v i n g books to t h e i r c l i e n t s as g i f t s . The next item deals w i t h the length of time which may elapse before the t i t l e i s mentioned again, by whom i t i s mentioned, and whether or not the t h e r a p i s t w i l l pursue the t o p i c i f i t were not followed the f i r s t time. 57 Table 11. Frequency of response to the question: How long i s i t before the t i t l e i s mentioned again? -and-Do you suggest i t again i f not followed the f i r s t time? (N=15) Categories f (sub) f (major) % (major) ''J When: A) - mentioned at next interview B) - other interviews By Whom: C) - either therapist or client D) - therapist f i r s t E) - client f i r s t 12 3 80.00 20.00 40.00 40.00 20.00 F) Therapist w i l l suggest reading/ writing a second time - w i l l suggest i t , only 4 and I) w i l l ask why i t was 3 not done the f i r s t time G) Therapist w i l l not suggest i t again - w i l l not suggest i t , only 3 and I) 1 H) Therapist may suggest i t again - may suggest i t , only 1 and I) 3 I) Therapist w i l l ask why reading/ writing was not done the f i r s t time 46.67 26.67 26.67 46.67 58 As i n d i c a t e d i n Table 11,,80 percent of the t h e r a p i s t s p r e f e r r e d that the t i t l e be brought up at the next i n t e r v i e w , and n e a r l y h a l f of these s t a t e d that i t d i d not matter whether they or the c l i e n t mentioned i t f i r s t . A-nother 40 percent p r e f e r r e d that the t h e r a p i s t b r i n g i t up f i r s t — a g a i n , at the next i n t e r v i e w . I f f o r some reason t h e i r suggestion" has not been followed, 46.67 percent of the t h e r a p i s t s w i l l be curious as to why and w i l l say so to t h e i r c l i e n t s . Approximately h a l f (7 of 15) w i l l suggest that the c l i e n t read/write again, perhaps a month l a t e r , whereas four more s a i d that they are unsure whether they would pursue the subject again (the m a j o r i t y of t h e s e — t h r e e — s t i l l curious as to what caused the c l i e n t not to do so the f i r s t time) and four s a i d they d e f i n i t e l y would not suggest r e a d i n g / w r i t i n g again once i t had not been picked up the f i r s t time. The o b j e c t i v e of question s i x i s to describe the v a r i o u s types of m a t e r i a l s to which the respondents most f r e q u e n t l y r e f e r t h e i r c l i e n t s . Although a l l 15 of the t h e r a p i s t s s t a t e d that they use n o n - f i c t i o n types of reading, f i v e of them combine t h i s w i t h t h e i r use of f i c t i o n , as w e l l . Table 12. 59 Frequency of response to the question: Which types of t i t l e s do you most frequently recommend? (N=15) Categories f (sub) f (major) % (major) A) Fiction 5 33.33 B) Non-fiction 15 100 - non-fiction, only , 10 and A) above 5 c) Lay-psychology (self-help) 13 86.67 D) Vocational (job-search) 5 33.33 information E) Autobiographies and biographies 8 53.55 F) Religious 7 46.67 G) Poetry 5 33.33 H) Other: e.g. humor, philosophy 12 80.00 I) Reprints (magazines, newspaper) 13 86.67 J) Information pamphlets: e.g. 11 73.33 health care K) Entire work 11 73.33 - entire work, only 5 and L) selected passage 6 L) Selected passage 10 66.67 - selected passage, only 4 As can be seen in Table 12,"the majority (86.67%) recommended lay-psychology or self-help literature to the clients, with autobiographies and biographies a close second (53.33%), and religious material in third place (46.67%). The "other" category, which was substantial (80%), con-sisted of such materials as philosophy, humor, science f i c t i o n , texts and records, f i l m and t e l e v i s i o n . Over 86 percent of t h e r a p i s t s employ r e p r i n t s of newspaper and magazine a r t i c l e s which they give to t h e i r c l i e n t s , and n e a r l y as many (73.33%) a l s o hand out a v a r i e t y of i n f o r -mation p a m p h l e t s — f o r example, h e a l t h care and job-search t i p s . Approximately 73 percent of the respondents s a i d i t was important that the c l i e n t read the e n t i r e work suggested. Of these 11 t h e r a p i s t s , more than h a l f (6) a l t e r n a t e the former w i t h a suggestion that a s e l e c t -ed passage or a chapter or two would be s u f f i c i e n t under c e r t a i n circum-stances; i . e . , a book may co n t a i n only one p e r t i n e n t s e c t i o n , whereas the bulk of the book may be l e s s r e l e v a n t or c r i t i c a l at a p a r t i c u l a r time. Question seven i s designed to di s c o v e r what types of c l i e n t s tend to r e c e i v e b i b l i o t h e r a p y as a treatment mode. The data i n Table 13 i n -d i c a t e that most of these c l i e n t s are c o g n i t i v e l y - o r i e n t e d and motivated. 61 Table 13. Frequency of response to the question: C h a r a c t e r i s t i c s of c l i e n t s w i t h whom b i b l i o t h e r a p y i s t y p i c a l l y used? (N=15) Categories f (sub) f (major) % \ (major A) Ego strength 2 13.3.3 and B) c o g n i t i v e and motivated 1 and B), C) reading readiness/rapport, D) nature of problem/ goal 1 B) Over t l y c o g n i t i v e and motivated - c o g n i t i v e and motivated, only 12 3 80.00 and C) 3 and D) 2 and C), D) 2 C) Reading readiness and e s t a b l i s h e d rapport - readiness, only 9 1 60.00 and D) 2 D) Nature of problem/goal as re l e v a n t as c h a r a c t e r i s t i c s of c l i e n t 7 46.67 Although only three of the 12 respondents who s t a t e d t h i s look f o r such c h a r a c t e r i s t i c s as t h e i r s o l e determinants when d e c i d i n g to employ b i b -l i o t h e r a p y , nine others look f o r other elements, such as ego strength and reading readiness. S i x t y percent of the t h e r a p i s t s l i n k being able to d i s c e r n reading readiness w i t h the establishment of rapport. These 62 s a i d that they must already have a formed r e l a t i o n s h i p as a b a s i s f o r the i n t u i t i o n (or hunch) that the c l i e n t w i l l read i f _ i t i s suggested to them. And, about h a l f (46.47%) of the 15 respondents s a i d that the nature of the goal or problem of the i n d i v i d u a l plays as l a r g e a p a r t as t h e i r i n -d i v i d u a l c h a r a c t e r i s t i c s i n determining whether or not to use b i b l i o -t herapeutic techniques. Question ei g h t f u r t h e r describes the c l i e n t s who are candidates f o r b i b l i o t h e r a p y . Beyond t h e i r personal c h a r a c t e r i s t i c s , i t was important to know what types of problems they tended i n i t i a l l y to p r e s e n t , f o r c o u n s e l l i n g , and to i s o l a t e the types of problems w i t h which b i b l i o t h e r a p y was most e f f e c t i v e . 63 Table 14. Frequency of response to the question: What types of problems do your clients have? (N=15) Categories f (sub) f (major) % (major) A) Communication and/or inter- 10 66.67 personal (social) relation-ship , including - poor self concept 2 - lack of assertion s k i l l s 5 - shyness 2 - career confusion 1 B) Family conflict, including 11 73.33 - marital and sexual 7 d i f f i c u l t i e s - child management 4 C) Personal habits and be- 7 46.67 haviors, including - obesity 1 - alcoholism 4 - smoking 1 - stress 1 D) Depression and anxiety 2 13.33 E) Educational (school 4 26.67 setting), including - vocational 1 - peer relations 1 - family interaction 2 The therapists interviewed had clients with a variety of problem types. According to Table 14, the most common type (73.33%) was family conflict, including marital and sexual d i f f i c u l t i e s as well as problems with child management. The second type of problem was that of inter-personal relations and communication troubles (66.67%), of which the most consistently presented issue was that of a lack of assertion s k i l l s . Just under half of the therapists (46.67%) see clients who complain of problems w i t h t h e i r personal h a b i t s and behaviors, most frequent among these being a l c o h o l i s m . Four of the 15 respondents work w i t h i n the e d u c a t i o n a l s e t -t i n g and break down the types of problems they encounter i n t o v o c a t i o n a l , peer r e l a t i o n s and f a m i l y i n t e r a c t i o n . Table 15 r e v e a l s that n e a r l y a l l of the p r a c t i t i o n e r s see more than one problem type c l i e n t . For example, those who mainly see c l i e n t s w i t h communication problems (n=10) f i n d that these people o f t e n have f a m i l y c o n f l i c t as w e l l . 65 Table 15. Frequency of response to the question about problem types: What i s the combination of problem types dealt with? (N=15) Categories f (sub) f (major) % (major) A) Communication and/or inter- 10 66.67 personal - communication and/or 2 interpersonal, only and B) family conflict 4 and E) educational 1 and B), C) personal habits 1 and B), D) depression 1 and B), C), D) 1 B) Family conflict 11 73.33 and C) 2 and E) educational 1 and C), E) 1 c) Personal habits and behaviors 7 46.67 - habits, only 2 D) Depression and anxiety 3 13.33 E) Educational (school settings) 4 26.67 - educational, only 1 Further, Table 15 indicates that those who see clients with primar-i l y family conflicts (n=ll) observed that personal habit and educational problems are intertwined with the family conflicts, whereas those who work only within the educational setting stated that they did not deal with clientsA depressions and anxieties at a l l . In Table 16, i t can be seen again that most c l i e n t s present them-selves w i t h more than one problem type. F o r t y percent of the t h e r a p i s t s st a t e d that they had the most success w i t h b i b l i o t h e r a p y i n cases of communication and i n t e r p e r s o n a l problems; however only two worked ex-c l u s i v e l y w i t h t h i s problem type. Another two worked w i t h c l i e n t s who had f a m i l y c o n f l i c t problems as w e l l , one worked w i t h f a m i l y and be-h a v i o r problems and one w i t h f a m i l y and depression d i f f i c u l t i e s . However, a l l s i x found t h e i r highest b i b l i o t h e r a p e u t i c success w i t h communication problems. 67 Table 16. Frequency of response to the questions: With which of the types of problems i s b i b l i o t h e r a p y most e f f e c t i v e ? -and-What percent of your p r a c t i c e i s t h i s p a r t i c u l a r problem? (N=15) Categories f (sub) f (major) % (major) average % of p r a c t i c e A) Communication and/ or i n t e r p e r s o n a l r e l a t i o n s h i p s - A) only 2 and B) f a m i l y 2 and B), C) b e h a v i o r a l 1 and B), D) depression 1 B) Family c o n f l i c t and A) 2 and C) 2 and A ) , C), D) 1 C) Personal h a b i t s and behaviors D) Depression and anx i e t y E) Educational (school s e t t i n g s ) - E) only (peer 1 r e l a t i o n s ) and A) and B) and B), C) 1 1 1 0 4 40.00 33.33 26.67 62.50 38.40 26.25 Five other therapists (of the 15) found themselves most successful with family conflict problems, although they too saw more than one prob-lem type per client. Two of these were most effective with family con-f l i c t problems that were combined with communication d i f f i c u l t i e s (where-as two others had the opposite results with the same combination of prob-lem types), and two others f e l t themselves to be similarly effective with behavioral problems as well. None of the therapists f e l t particularly successful with bibliotherapy when working with the problem types of per-sonal habits or depression'. It seems that bibliotherapy as a sole tech-nique is not as effective with these two types of problems as compared to the others isolated in this study: communication, family and education. Most of those who work in the schools did not deal exclusively with school-related problems, except for one counsellor. However, a l l four who work within the educational setting f e l t the most success with such educational problem types; i.e., peer and family relations, even though these may be presented in combination with the other types; i.e., personal habits or communication problems. Finally, the 40 percent of those therapists who.found bibliotherapy most effective with the clients who have communication problems stated that over 62 percent of the cases consisted of this particular problem type. This means that for more than half of their practice they are counselling people who have communication and/or interpersonal relation-ship issues. And, those who stated that they are most successful with bibliotherapy and family conflicts spend over 38 percent of their prac-tice in such treatment. For those who work within the schools, 26 per-cent of their practice i s spent with students who have .peer and family relations problems. These percentages: 62.50%; 38.40%; and 26.25%; were 69 derived by averaging across the individual therapists per problem type. The last question of the interview investigated two points, namely the .portion of ^ clients Jwith. whom the 'respondents use bibTio therapy, and Sfex bias in prescribing bibliotherapy. An estimation was also made of the number of t i t l e s per client usually suggested, as well as the number of clients both currently and most recently receiving such treatment. Table 17. Frequency of response to the questions: Bibliotherapy i s practiced with what percent of your total client population? -and-With what percent of men versus women is bibliotherapy practiced? (N=15) f (major) % (major 3 7 1 4 20.00 46.67 6.67 26.67 Categories A) Less than 10 percent B) 10-30 percent C) 50-75 percent D) 90-100 percent E) No sexual differentiation, 10 66.67 although more female clients F) No sexual differentiation, 5 33.33 although more male clients As Table 17 reveals, nearly half of the respondents (7 of 15) stated that they practice bibliotherapy (having their clients either read or write) with 10-30 percent of their clients, and four of the 15 (26.67%) 70 p r a c t i c e bibliotherapy with nearly a l l of t h e i r c l i e n t s (90-100%). It was found that a l l of the therapists use t h i s technique with men and women equally, although 66.67 percent see a large majority of women c l i e n t s . As can be seen i n Table 18, the most common number of t i t l e s or books that therapists recommend per c l i e n t i s one or two (66.67%). How-ever, two of the therapists stated that they w i l l suggest more than f i v e t i t l e s to any one c l i e n t over the course of treatment. Table 18. Frequency of response to the question: How many t i t l e s do you suggest per c l i e n t ? (N=15) Categories 1 .. f (major) % (major) G) 1-2 t i t l e s 10 66.67 H) 3-4 t i t l e s 3 20.00 I) more than 5 2 13.33 The information i n Table 19 shows that over 26 percent of the thera-p i s t s stated that at the time of the interview they were using b i b l i o -therapy with 1-2 of thei r c l i e n t s whereas 20 percent were using i t with 3-4 and another 20 percent with 11 or more c l i e n t s . 71 Table 19. Frequency of response to the question: What i s the current and past use of bibliotherapy as a technique? (N=15) Categories f (major) % (major) A) Currently: 1-2 clients clients clients clients clients clients 4 3 1 3 1 3 26.67 20.00 6.67 20.00 6.67 20.00 3-4 5-10 11+ a l l no B) In the past year: less than 10 clients 11-20 clients 21-30 clients 31-40 clients 41+ clients do not know 2 2 3 2 3 3 13.33 13.33 20.00 13.33 20.00 20.00 Another 20 percent however, were not using i t at a l l , at the time; and one therapist was using i t with a l l of his clients, generally i n work-shop settings. When estimating how many clients had received b i b l i o -therapy-over the past year, 20 percent of the respondents said 21-30 clients, another 20 percent said more than 41 clients, and another 20 percent could not estimate. The remaining therapists estimated their past year's practice of bibliotherapy from less than 10 clients up to approximately 40 clients. Chapter V Di s c u s s i o n A w r i t t e n or formal l i s t of t i t l e s used by the respondents i n t h e i r p r a c t i c e of b i b l i o t h e r a p y was f i r s t requested. I t was considered that i f a w r i t t e n l i s t had been created and maintained, then t h i s could be an i n d i c a t i o n that the t h e r a p i s t would be up-to-date, f a m i l i a r w i t h m a t e r i a l s and p o s s i b l y had categorized them f o r easy reference. The purpose of having such a l i s t was the t h e r a p i s t s ' thorough knowledge of the t i t l e s used. The f i n d i n g s were that n e a r l y h a l f of the t h e r a p i s t s d i d have w r i t t e n l i s t s of t i t l e s . However, most of them d i d not r e f e r to t h e i r l i s t s , but r a t h e r r e l i e d upon t h e i r memory when suggesting t i t l e s . Over 46 percent s t a t e d that they spontaneously r e c a l l e d t h e i r t i t l e s e l e c t i o n s , and t h i s i n c l u d e d s e v e r a l who s a i d that they d i d not keep compiled l i s t s . Many of the respondents were i n the h a b i t of gla n c i n g a t t h e i r book-shelves w h i l e t h i n k i n g of suggesting a t i t l e to a c l i e n t . This means that the m a j o r i t y of t h e r a p i s t s do not consider m a i n t a i n i n g a l i s t of t i t l e s as a measure of t h e i r f a m i l i a r i t y w i t h them, but r a t h e r they r e l y upon t h e i r c o n t i n u a l use of these t i t l e s . The question as to whether the respondents have discontinued use of c e r t a i n t i t l e s w i l l be d i s -cussed l a t e r i n t h i s chapter. The next question d e a l t w i t h how the respondents determined which t i t l e s or books to use. Over h a l f s t a t e d that they found popular l i t e r a -t u r e — i . e . , current pocket-books—most a c c e s s i b l e to them and t h e i r c l i e n t s . F u r t h e r , n e a r l y a l l b e l i e v e d that i t was mandatory that they read the work before ever recommending i t to a c l i e n t . This f i n d i n g i s encouraging and r e a s s u r i n g , s i n c e i t i s g e n e r a l l y accepted that one must 73 not refer a client to a source which one has not read oneself. Should referral without prior reading be done by a therapist, clients could find that they are reading something that is at least inappropriate and con-fusing, at worst. Nor could a fu l l y meaningful discussion follow the reading should the therapist be unaware of what i t contains. Hence, the exercise might be lost, 1 or, at least, greatly diminished in value for the client. According to the results of this question, two of the 15 respon-dents did not consider the criterion of having read i t themselves as a determinant in t i t l e selection. Rather, other c r i t e r i a , play important roles in t i t l e determination. For instance, i f the client mentions a particular book f i r s t , close to half of the therapists w i l l respond favorably and employ that t i t l e in bibliotherapy with that client. The client, in this case, may even bring the book in to the session, show i t to' the' therapist and w i l l l i k e l y ask that i t be read. Also, nearly half of the respondents stated that the particular problem or goal of the client was important in their t i t l e determination. They said that, in fact, i t was not only the client but the problem alone which might trigger a t i t l e in their minds. However, only one of those who cited this criterion relied upon i t solely. The over-whelming majority of those interviewed claimed a combination of the various c r i t e r i a men-tioned as their methods of t i t l e determination. The actual sources of their t i t l e s were also investigated. Where did'respondents find their titles? More than two-thirds deliberately search for suitable t i t l e s to use. They spend a lot of their time consciously looking for materials; they attend courses, confer with colleagues, v i s i t the library and bookstore. Most of these also read book 74 club l i s t s , professional literature and just browse alot in their quest for t i t l e s . The last part^of question two studied the follow-up style of the respondents. A crucial part of the practice of bibliotherapy i s the follow-up discussion, after the client has responded to the therapist by reading the book. The method of follow-up the majority of respondents employed was that of deliberate, specific discussion. They preferred to use the reading of a t i t l e as a basis for discussion, seeking to il l u s t r a t e a relevant point or set up a programme for behavior-change. In a l l these cases, follow-up was meant to determine how the client had. understood the message of the book. This result i s noteworthy in that i t shows that bibliotherapy i s being practiced ;effecxlyely~-with respect to follow-up, by the majority of respondents. In fact, a l l 15 respon-dents stated that some form of follow-up was important; however, three of these believed that a more casual follow-up was acceptable and two work mainly within a workshop setting, thereby not having any opportunity for follow-up. This is s t i l l acceptable, particularly because the tone of such workshops tends to be didactic, with the books f u l l y described before they are recommended. Another objective of the interview was to discover how familiar the respondents are with the material they use for bibliotherapy. People vary in their practice of reading books; some read each page in se-quence, others skim over certain chapters and others only look at the index or preface and perhaps the last chapter. Sometimes, one might read a book review and consider that one i s familiar enough with i t s contents to refer to i t , and even recommend i t , to another. However, as mentioned earlier, complete familiarity with a t i t l e i s more preferable to any other degree of f a m i l i a r i t y . A l a r g e m a j o r i t y of the respondents agreed that they must have read the e n t i r e work p r i o r to using i t i n t h e i r p r a c t i c e . A couple of t h e r a p i s t s s t a t e d that having read the book, at l e a s t i n p a r t , would be s u f f i c i e n t f o r t h e i r use of i t . This i s a l e s s d e s i r e a b l e p r a c t i c e . F u r t h e r , should the c l i e n t mention a t i t l e w i t h which the t h e r a p i s t i s u n f a m i l i a r , a l l respondents s t a t e d that they w i l l show i n t e r e s t i n the book. Again, a l l were w i l l i n g to discus s how the book i n t e r e s t s the c l i e n t , w h i l e over h a l f may have the book brought i n by the c l i e n t and w i l l a c t u a l l y read i t themselves i n order to b e t t e r understand and t a l k about i t . Several others s t a t e d they might consider reading such a t i t l e . O v e r a l l , the degree of i n v o l v e -ment and i n t e r e s t revealed through these f i n d i n g s i n d i c a t e s that these t h e r a p i s t s are p r a c t i c i n g t h i s component of b i b l i o t h e r a p y w i t h d i l i g e n c e . The methods and procedures of the p r a c t i c e of b i b l i o t h e r a p y are v a r i a b l e and yet c r i t i c a l to i t s e f f e c t i v e n e s s . The general s t y l e of the t h e r a p i s t w i l l a f f e c t the manner i n which b i b l i o t h e r a p y i s per-formed. F i r s t to be considered i n t h i s segment of the i n t e r v i e w was who brought up the subject of r e a d i n g / w r i t i n g . A l l of the respondents s t a t e d that b i b l i o t h e r a p y was f i r s t mentioned by them. " U s u a l l y " , they s a i d , "we ( c l i e n t and t h e r a p i s t ) w i l l be d i s c u s s i n g a problem, and I w i l l t h i n k of a r e l e v a n t book f o r them to look a t " . More than h a l f are d i r e c t i v e , i n that they w i l l a s s i g n the book to be read, o f t e n as a homework assignment. However, only , three.respondents use t h i s approach e x c l u s i v e l y . The remaining are l e s s d i r e c t i v e and tend more towards recommending t i t l e s to be read. This f i n d i n g i n d i c a t e s that the t h e r a -p i s t s interviewed are f l e x i b l e , that they tend towards a n o n - d i r e c t i v e approach when suggesting a t i t l e but that they w i l l a l s o a s s i g n a reading according to the s i t u a t i o n . I d e a l l y , a c a s u a l recommendation would be p r e f e r a b l e to a h i g h l y s t r u c t u r e d or demanding one i n order f o r the c l i e n t to f e e l most motivated and l e a s t pressured to perform or please the t h e r a p i s t . However, t h i s method i s not always e s s e n t i a l , e s p e c i a l l y i f the other recommendation procedures are presented i n an e f f e c t i v e way. For i n s t a n c e , i t i s important that the t h e r a p i s t provide a r a t i o n -a l e f o r why the p a r t i c u l a r t i t l e i s being suggested. The m a j o r i t y of respondents d i d present " t h i s . - In d e s c r i b i n g t h e i r purpose or what the c l i e n t might look f o r and expect from the book, the t h e r a p i s t s prepare the c l i e n t f o r the experience, thereby reducing the a n x i e t y o r . i n s e c u r i t y about what i s "supposed" to be done. Furt h e r , a greater num-b e r ,thought ! that i t was important that the book be read (or d i a r y or l o g be w r i t t e n ) w i t h i n a c e r t a i n time p e r i o d i n order to have the maxi-mum, p o s i t i v e e f f e c t . U s u a l l y , t h i s t i m e - l i m i t was the next i n t e r v i e w , approximately one week l a t e r . These t h e r a p i s t s s t a t e d that i f the book was not read, or at l e a s t begun by then, i t l i k e l y would not be read at a l l . The remaining respondents d i d not agree that a t i m e - l i m i t was c r i t i c a l to the e f f e c t i v e n e s s of the technique. Their b e l i e f was that the c l i e n t s should read (or w r i t e ) only when they f e l t comfortable and that i t simply might not be convenient i n the short amount of time us-u a l l y a l l o t t e d . Both of these p o i n t s of view have substance and the r u l e of thumb seems to be one w i t h which the. t h e r a p i s t s themselves are most comfortable, according to t h e i r s t y l e s of p r a c t i c e . C e r t a i n l y i f the assignment i s to be considered as homework, a t i m e - l i m i t seems r e a -sonable i n that i t w i l l provide one measure of whether the e x e r c i s e i s working. Otherwise, a l e s s r i g i d format may be j u s t as acceptable i n the o v e r a l l p r a c t i c e of b i b l i o t h e r a p y . The f o l l o w i n g i s a sample of the v a r i o u s ways the t h e r a p i s t s have of i n t r o d u c i n g the subject of reading to the c l i e n t s . Important to note i s whether or not mention i s made of f u t u r e follow-up d i s c u s s i o n . Therapist number 2: " I have a book I'd l i k e you to read and then I'd l i k e to d i s c u s s i t w i t h you...please take note of what you l i k e or agree w i t h as w e l l as what you don't agree w i t h or understand...". Therapist number 1: " I ' . l l say, 'Read t h i s ' , and w i l l be very s p e c i f i c i n t e l l i n g them whether they should read i t f o r homework or not - I ' l l t e l l them that I ' l l want t h e i r r e a c t i o n s . . . " ; Therapist number 12:" ' I read t h i s and found i t h e l p f u l ; i f you want t o , O.K., arid, i f not, O.K. too'. I won't follow-up and see i f they' ve read i t other than i n passing...". Therapist number 14: " 'Have you read 'X'? W e l l , I and others have found i t u s e f u l ' . I'd show them a copy i f I had i t and ask them to get one and read i t . . . " . T herapist number 4: "With enthusiasm, I'd say 'I t h i n k y o u ' l l f i n d t h i s i n t e r e s t i n g ; these are a few things which p e r t a i n to your s i t u a t i o n ' . . . " . F i n a l l y , i n f o r m a t i o n was obtained as to how the c l i e n t s are to ac-quir e the t i t l e to be read. T h e r e a r e a v a r i e t y of ways, the m a j o r i t y of which are by borrowing i t from the t h e r a p i s t or from the l i b r a r y . Both of these appear to be s u c c e s s f u l , although the l a t t e r puts more -re^sp'phsibiii|yfupon the c l i e n t . Nearly h a l f of the t h e r a p i s t s w i l l ad-v i s e t h e i r c l i e n t s to buy the books, although, a few of them w i l l give t h e i r books as g i f t s to t h e i r c l i e n t s . In c o n c l u s i o n , the respondents use a combination of the aforementioned means of g e t t i n g the t i t l e s to t h e i r c l i e n t s . The next o b j e c t i v e was to l e a r n how much time elapsed before the subject was brought up again, and by whom t h i s was done. Most of the respondents s t a t e d that the next i n t e r v i e w was u s u a l l y the time that the book (or w r i t i n g ) was mentioned, u s u a l l y as an opening to the 78 s e s s i o n , and approximately h a l f of these were the f i r s t to b r i n g the matter up, p a r t i c u l a r l y i f i t had been a homework assignment. By i n i t i a t i n g the d i s c u s s i o n , these t h e r a p i s t s continue to e s t a b l i s h t h e i r d i r e c t i o n of the procedure, whereas the s l i g h t l y smaller number who stated that e i t h e r they or t h e i r c l i e n t s could mention i t f i r s t were demonstrating more of a f l e x i b l e or adaptable manner. I n t e r e s t i n g l y , l e s s than one-quarter s a i d that they waited f o r the c l i e n t to b r i n g up the t i t l e . These t h e r a p i s t s gave t h e i r c l i e n t s t o t a l r e s p o n s i b l i t y f o r any f u r t h e r conversation about the t i t l e . Should the suggestion not be follo w e d , about h a l f of the t h e r a p i s t s would enquire about the reason f o r not doing so. Several s a i d that they would assume that the t i t l e had not been i n t e r e s t i n g enough, and cl o s e to h a l f would suggest reading/ w r i t i n g a second time, u s u a l l y w i t h i n a month. This f i n d i n g i n d i c a t e s that not a long time elapses before the subject of b i b l i o t h e r a p y i s again mentioned, whether or not another recommendation i s a c t u a l l y made . by the t h e r a p i s t . About one-quarter s a i d that they might suggest a t i t l e again, depending mainly upon the q u a l i t y of t h e i r r e l a t i o n s h i p w i t h the c l i e n t ; . a n d another quarter responded that they would not make any f u r t h e r suggestions, concluding that t h e i r c l i e n t was not i n t e r e s t e d i n r e a d i n g / w r i t i n g at a l l . The f o l l o w i n g i s a d e s c r i p t i o n of the types of t i t l e s most frequent-l y used. F i c t i o n d i d not play as s i g n i f i c a n t a r o l e i n the l i s t as d i d n o n - f i c t i o n . This r e s u l t i s s u r p r i s i n g , given the frequency of f i c t i o n a l l i s t i n g s i n b i b l i o g r a p h i e s presented i n the research l i t e r a t u r e . A l l of the t h e r a p i s t s recommend n o n - f i c t i o n , whereas only a small p r o p o r t i o n of them a l s o use f i c t i o n a l works. The l a r g e s t category of n o n - f i c t i o n was l a y psychology or s e l f - h e l p l i t e r a t u r e . This i s mainly due to i t s p o p u l a r i t y , r e a d a b i l i t y , and a c c e s s i b i l i t y . As more examples of sources were discovered, the "other" category grew, c o n s i s t i n g of t e x t s , p h i l o -sophy, humor, science f i c t i o n and records, f i l m and t e l e v i s i o n . Another notable category was r e l i g i o u s m a t e r i a l . Although a l l of those who work w i t h i n the educational s e t t i n g s a i d that i t was against the law f o r them to suggest such reading, more than h a l f of the remaining r e s -pondents d i d s t a t e that they o c c a s i o n a l l y r e f e r to r e l i g i o u s m a t e r i a l , u s u a l l y f o r " i n s p i r a t i o n a l purposes". Further, both magazine and newspaper a r t i c l e r e p r i n t s as w e l l as informati o n pamphlets are widely employed and handed-out to c l i e n t s , making the v a r i e t y of works u t i l i z e d g e n e r a l l y r i c h and s t i m u l a t i n g . S l i g h t l y more t h e r a p i s t s p r e f e r to have t h e i r c l i e n t s read the e n t i r e work presented to them r a t h e r than a s e l e c t e d passage or chapter, which i n d i c a t e s that e i t h e r mode i s acceptable. This may be a p r a c t i -c a l s o l u t i o n f o r t h e r a p i s t s , p a r t i c u l a r l y when they have a c e r t a i n book which may have only one or two p a r t s r e l e v a n t to a c l i e n t ' s s i t u a t i o n . The f i n a l three questions on the i n t e r v i e w schedule described the c l i e n t s and t h e i r problems r a t h e r than the respondent's p a r t i c u l a r p r a c t i c e of b i b l i o t h e r a p y . Question seven was an attempt to describe the t y p i c a l c l i e n t with'whom the t h e r a p i s t tended to use b i b l i o t h e r a p y . However, as o r i g i n a l l y phrased, the item (question) was i n e f f e c t i v e i n e l i c i t i n g the response. Therapists responded, most o f t e n , that there was no such t h i n g as a t y p i c a l c l i e n t . Hence, the i n t e r v i e w e r f u r t h e r developed the question, as f o l l o w s : "what i s i t about a c l i e n t that w i l l t r i g g e r a t i t l e i n your mind?" The responses to t h i s were more d e s c r i p t i v e and more r e a d i l y given by the t h e r a p i s t s . Several r e p l i e d that they w i l l recommend reading to any c l i e n t , r e g a r d l e s s of .<',-. c h a r a c t e r i s t i c s . This seemed to r e f l e c t the general view that b i b l i o -therapy appears to take place almost whenever the t h e r a p i s t i s book-o r i e n t e d and g e n e r a l l y only a f t e r an ongoing r e l a t i o n s h i p has been es-t a b l i s h e d . A common response was: " I seldom recommend reading i n the f i r s t s e s s i o n " . This r e s u l t f i t s w i t h the research l i t e r a t u r e , which c o n s i s t e n t l y s t r e s s e d that knowing the c l i e n t i s as important as know-ing the problem or knowing the t i t l e . However, most c l i e n t s who do r e c e i v e b i b l i o t h e r a p y seem to have s e v e r a l c h a r a c t e r i s t i c s i n common. These are: they are o v e r t l y c o g n i t i v e , c u r i o u s , v e r b a l , and h i g h l y motivated; they have a s u b s t a n t i a l amount of ego-strength or acknow-ledged ( i f not accepted) self-image; and they have a l a r g e degree of reading readiness. As one respondent put i t , they are o f t e n "approach-i n g m i d d l e - c l a s s values". A l l of the respondents agreed that t h e i r c l i e n t s w i t h whom they p r a c t i c e d b i b l i o t h e r a p y had some of the above c h a r a c t e r i s t i c s , and almost h a l f of them a l s o s t a t e d that the natures of the c l i e n t s ' problems or goals were as r e l e v a n t as t h e i r personal c h a r a c t e r i s t i c s i n d e s c r i b i n g them. The con c l u s i o n from these f i n d i n g s i s that the t h e r a p i s t s p r e f e r that c l i e n t s be able to read w e l l . None of them suggested that t h e i r c l i e n t s could be read to or helped w i t h t h e i r reading (or w r i t i n g ) . For example, some groups could be formed w i t h the purpose of coaching c l i e n t s i n reading, w r i t i n g and compre-hension, or t h e r a p i s t s could r e f e r some c l i e n t s f o r p r e l i m i n a r y r e -medial work. I f some t h e r a p i s t s were w i l l i n g to help the c l i e n t s w i t h reading (or w r i t i n g ) , b i b l i o t h e r a p y could then be used w i t h a l a r g e r number of c l i e n t s i n t h i s l o c a l e . During the p r e - t e s t i n t e r v i e w , p a r t of the p r a c t i t i o n e r ' s response to t h i s question was, " I would not recommend reading to a c l i e n t whom I thought was already too i n t r o s p e c t i v e . Since reading i s a s o l i t a r y ex-perience, t h i s may not be h e l p f u l f o r a c e r t a i n i n d i v i d u a l " . Consider-i n g t h i s to be a c o n t r o v e r s i a l response, the w r i t e r decided to i n c l u d e i t as p a r t of the i n t e r v i e w schedule. I t was used w i t h only h a l f of the respondents and t h e r e f o r e the r e s u l t s are not to be considered as part of the study; however, they are as f o l l o w s : Only one person a-greed w i t h the statement, four disagreed and three p a r t i a l l y agreed, confirming that i n t e l l e c t u a l i s m (reading) o f t e n leads to avoidance of the i s s u e . This a d d i t i o n a l question was put c o n s i s t e n t l y as a probe only when the t h e r a p i s t s were p a r t i c u l a r l y unclear as to what charac^ t e r i s t i c s of c l i e n t s t r i g g e r e d t h e i r use of b i b l i o t h e r a p y . As w e l l as to describe the personal c h a r a c t e r i s t i c s of c l i e n t s who r e c e i v e b i b l i o t h e r a p y , the purpose of t h i s study was a l s o to c a t e g o r i z e t h e i r problems. I f c l i e n t s problems could be c l a s s i f i e d as to which were most s u c c e s s f u l l y d e a l t w i t h by b i b l i o t h e r a p e u t i c methods perhaps a formula or o u t l i n e could be created d e s c r i b i n g type of prob-lem i n reference to type of t i t l e and subsequently t e s t e d and measured f o r e f f e c t i v e n e s s . The breakdown of these problem types was i n t o f i v e general areas: communications and/or i n t e r - p e r s o n a l r e l a t i o n s h i p d i f -f i c u l t i e s , f a m i l y c o n f l i c t s , personal h a b i t s and behavior problems, depression and a n x i e t y , and s c h o o l - r e l a t e d i s s u e s . Each problem i n -cluded s e v e r a l sub-headings, more f u l l y discussed i n the f i n d i n g s chap-t e r ; however, b r i e f examples of them are as f o l l o w s : l a c k of a s s e r t i o n s k i l l s , m a r i t a l and sexual d i f f i c u l t i e s , o b e s i t y , a l c o h o l i s m and peer r e l a t i o n s . A l l t h e r a p i s t s saw a combination of problem types. However i t was not d i f f i c u l t f o r them to i s o l a t e w i t h which type of problems t h e i r b i b l i o t h e r a p y p r a c t i c e was most e f f e c t i v e . Nearly h a l f of the respondents found that b i b l i o t h e r a p y was the most e f f e c t i v e treatment f o r problems of communication and i n t e r - p e r s o n a l r e l a t i o n s as w e l l as f a m i l y c o n f l i c t . The t h e r a p i s t s who t r e a t c l i e n t s who s u f f e r personal behavior problems and depression s t a t e d that these problems cannot be as e f f e c t i v e l y t r e a t e d by b i b l i o t h e r a p e u t i c methods as can the a f o r e -mentioned problem types. Those who work e x c l u s i v e l y i n schools s a i d that they have t h e i r most success w i t h b i b l i o t h e r a p y and f a m i l y or peer r e l a t i o n s . None st a t e d that they work w i t h students who complain of depression and a n x i e t y . Therefore, these f i n d i n g s i n d i c a t e that s e v e r a l of the problems which t h e r a p i s t s encounter can be e f f e c t i v e l y d e a l t w i t h i n b i b l i o t h e r a p y and, of those i s o l a t e d , communication and i n t e r p e r s o n a l r e l a t i o n s d i f f i c u l t i e s are the most s u c c e s s f u l l y t r e a t e d . I t remains f o r f u r t h e r i n v e s t i g a t o r s to f i n d which t i t l e i s best s u i t e d to a par-t i c u l a r problem type; however, a l i s t of t i t l e s which the respondents do employ i s a v a i l a b l e i n Appendix F . The f i n a l question concerning a d e s c r i p t i o n of the c l i e n t s revealed that there was no sexual d i f f e r e n t i a t i o n i n the t h e r a p i s t s ' p r e s c r i p t i o n of b i b l i o t h e r a p y . Women and men were expected e q u a l l y to respond (or not respond) to the suggestion that they read (or w r i t e ) . However, women do make up the bulk of the c l i e n t p o p u l a t i o n . As w e l l , the major-i t y of respondents s t a t e d that 10 - 30 percent of t h e i r p r a c t i c e was s p e c i f i c a l l y b i b l i o t h e r a p y . This percentage i s not l a r g e , i n view of the f a c t t h a t only 15 of the sample of 40 p r a c t i t i o n e r s (approximately o n e - t h i r d ) , were engaged i n b i b l i o t h e r a p y p r a c t i c e . Nevertheless, over one-quarter of the 15 who employ b i b l i o t h e r a p y s t a t e d that they do so w i t h the m a j o r i t y of t h e i r c l i e n t p o p u l a t i o n . The f i n a l concern i n t h i s i n v e s t i g a t i o n was the use of the c l i e n t s ' w r i t t e n productions as p a r t of b i b l i o t h e r a p y . More than h a l f of the respondents do recommend that t h e i r c l i e n t s w r i t e something r e l a t e d to t h e i r problem. This f i n d i n g i s s u r p r i s i n g c o n s i d e r i n g the f a c t that t h i s technique was seldom mentioned i n the l i t e r a t u r e review. Just as ' s i g n i f i c a n t i s the ".fact that the seven t h e r a p i s t s who do not suggest w r i t i n g to t h e i r c l i e n t s are w i l l i n g to see whatever the c l i e n t s have done on t h e i r own and comment upon i t i f requested. This procedure i s acceptable as b i b l i o t h e r a p y , s i n c e the mere d i s c u s s i o n and sharing of such work i s enough to s t i m u l a t e more w r i t i n g and s a t i s f y the c l i e n t s ' needs to express themselves i n that way. E a r l i e r i n t h i s d i s c u s s i o n , reference was made to the question r e -garding the t h e r a p i s t s ' d e c i s i o n to d i s c o n t i n u e use of a t i t l e . The f i n d i n g s were that most respondents d i d not stop using a t i t l e other than to update t h e i r l i s t of t i t l e s . The t h e r a p i s t s o c c a s i o n a l l y d i s -carded a s e l e c t i o n i f i t were out of f a s h i o n . However, four t h e r a p i s t s d i d have negative experiences w i t h s e v e r a l books, s t a t i n g that they had to d i s c a r d them because they were e i t h e r too judgemental or too confusing f o r the c l i e n t s to grasp. In summary, the m a j o r i t y of respondents i n t h i s study d i d not main-t a i n a l i s t of the books they use i n b i b l i o t h e r a p y , but r a t h e r r e l i e d upon t h e i r spontaneous r e c a l l . Nearly a l l b e l i e v e d that i t i s mandatory f o r the t h e r a p i s t to read the book before recommending i t . Most ther a -p i s t s d i d follow-up i n a d e l i b e r a t e and s p e c i f i c manner, always w i t h the purpose of determining how the c l i e n t nad-understood the message of the book. As w e l l , the respondents a l l took the i n i t i a t i v e to b r i n g up the subject of reading to the c l i e n t , and most maintained a f l e x i b l e and s e m i - d i r e c t i v e approach when making t h e i r recommendations. A l l 84 agreed that i t is important to provide the client with a rationale as to why the suggestion to read has been made and again, most preferred to have a time-limit within which the client ought to have begun to read. Finally, non-fiction t i t l e s constituted the major category of books employed in bibliotherapy. Such t i t l e s can be classified as lay psycho-logy and/or self-help literature. The clients who receive bibliotherapy tend to be highly motivated, verbal and cognitively-oriented and the problems with which bibliotherapy appears to be most effective are those of communication and interpersonal relationships. A post-hoc analysis was done to compare the various practitioners' responses to some of the interview questions. Overall, the data i n -dicate that psychiatrists perform bibliotherapy in a more deliberate manner than do the psychologists, counsellors and social workers. There may be several reasons for this: the psychiatrists interviewed may have had more training in bibliotherapy or may work within an en-vironment which is more' conducive to such a treatment method. For instance, they usually have fewer time-pressures than do social workers or school counsellors and also their client populations are often more select. Or i t could also be that bibliotherapy as practiced by psychiat-r i s t s , has less place within the settings where counsellors and social workers traditionally" work and further research may show that i t must be practiced differently according to setting. However, i t is interesting to note that historically, bibliotherapy has had a secure place within the educational context. For a breakdownof how each group responded to the questions, see Appendix Tables 3 to 17. 85 The i n f o r m a t i o n contained i n t h i s study should prove h e l p f u l to other i n v e s t i g a t o r s of b i b l i o t h e r a p y . Some recommendations f o r f u r t h e r study are: 1. I n v e s t i g a t e the extent'and use of b i b l i o t h e r a p y among l i b r a r i a n s i n t h i s l o c a l e and compare the r e s u l t s w i t h those of t h i s study. 2. Develop a b i b l i o t h e r a p y b i b l i o g r a p h y s p e c i f i c a l l y f o r v o c a t i o n a l c o u n s e l l i n g . P a r t i c u l a r l y , i n schools one would present books i n which the characters work at r e a l i s t i c and v a r i e d j o b s , pre-s c r i b e the reading, design a follow-up and measure any change i n i n t e r e s t and a t t i t u d e . , 3. Develop and assess a course of study or t r a i n i n g i n b i b l i o t h e r a p y at the u n i v e r s i t y l e v e l . 4. I n v e s t i g a t e remedial b i b l i o t h e r a p y i n the schools, whether and how i t i s being p r a c t i c e d , w i t h whom and w i t h what income; f i n d our whether i t prevents c r i s e s and/or helps c h i l d r e n cope w i t h t h e i r developmental d i f f i c u l t i e s . 5. Study the e f f e c t s of s p e c i f i c books upon c e r t a i n types of c l i e n t s ; i n e f f e c t , attempt to match a book to a problem type. 6. Develop a method of measuring behavior change e f f e c t e d by some form of b i b l i o t h e r a p y . 7. Study the r e l a t i o n s h i p between an i n d i v i d u a l ' s reading back-ground and p e r s o n a l i t y adjustment. 8. I n v e s t i g a t e whether the v o l u n t a r y reading h a b i t s of d i f f e r e n t p e r s o n a l i t y types vary by type. 9. Study any d i f f e r e n c e i n the e f f e c t i v e n e s s of having the read-i n g assigned versus suggested by the t h e r a p i s t p r a c t i c i n g b i b l i o t h e r a p y . 10. Compare the degree of e f f e c t i v e n e s s of b i b l i o t h e r a p y when the c l i e n t must purchase the m a t e r i a l or borrow i t from the l i b -r a r y versus have i t loaned by the"*therapist. 11. Develop a p r e - c o u n s e l l i n g questionnaire to determine the c l i e n t ' s readiness f o r b i b l i o t h e r a p y as par t of the t h e r a -p e u t i c experience. 12. I n v e s t i g a t e whether t h e r a p i s t s would s e l e c t , from a v a r i e t y of t i t l e s , the same books f o r the same problem types of c l i e n t s . Chapter VI Summary and Conclusions Many people can quote examples of personal i n s i g h t s which have been mediated by something they have read i n l i t e r a t u r e . B i b l i o t h e r a p y has been defined and discussed i n t h i s study as a therapeutic t o o l used by mental h e a l t h p r o f e s s i o n a l s i n the lower mainland of B r i t i s h Columbia. The in f o r m a t i o n was gathered by means of i n t e r v i e w i n g 40 p r a c t i t i o n e r s as to t h e i r f a m i l i a r i t y w i t h and use of b i b l i o t h e r a p y . F i f t e e n of the 40 who a c t u a l l y p r a c t i c e d b i b l i o t h e r a p y comprised the sample who r e -ceived a personal i n t e r v i e w , thereby p r o v i d i n g the bulk of the data obtained. The f i n d i n g s have i n d i c a t e d that some form of s t a n d a r d i z a t i o n of method of a p p l i c a t i o n i s p o s s i b l e . Most of the t h e r a p i s t s were very f a m i l i a r w i t h the books which they p r e s c r i b e to t h e i r c l i e n t s . They have read them a l l and have ob-tained them p u r p o s e f u l l y , u s u a l l y by j o i n i n g book club reading l i s t s , c o n f e r r i n g w i t h colleagues and searching i n bookstores. Each t h e r a p i s t b e l i e v e d that follow-up d i s c u s s i o n was mandatory, once the c l i e n t had read the work, although they v a r i e d as to the method of f o l l o w - u p — e i t h e r d e l i b e r a t e and s p e c i f i c or c a s u a l . Further, most t h e r a p i s t s were s e m i - d i r e c t i v e when recommending the t i t l e s (books), tending to b r i n g the matter up f i r s t and then, during the next couple of s e s s i o n s , checking on whether the c l i e n t had done the "homework". When g i v i n g the i n s t r u c t i o n s to read, a l l respondents provided an adequate r a t i o n a l e f o r the suggestion and e i t h e r l e n t the book or advised the c l i e n t where the book could be borrowed or purchased. The types of books most o f t e n employed were n o n - f i c t i o n , e i t h e r l a y psychology or s e l f - h e l p readings, 87 although r e l i g i o u s m a t e r i a l s a l s o played a s i g n i f i c a n t r o l e i n t i t l e s e l e c t i o n . More than h a l f of the p r a c t i t i o n e r s recommended that t h e i r c l i e n t s do some w r i t i n g , both c r e a t i v e as w e l l as s t r u c t u r e d record -keeping. This i s considered b i b l i o t h e r a p y as w e l l , p a r t i c u l a r l y when the work i s subsequently discussed by the c l i e n t and the t h e r a p i s t . According to the respondents, the c l i e n t s who r e c e i v e b i b l i o t h e r a p y tend to be c o g n i t i v e and well-motivated. However, t h e i r type of prob-lem plays an almost equal r o l e i n determining whether or not they r e -ceive b i b l i o t h e r a p y . Although c l i e n t s tend to have a combination of presenting problems, i t has been p o s s i b l e to i s o l a t e two major areas w i t h which b i b l i o t h e r a p y seems to be the most e f f e c t i v e : communication and i n t e r p e r s o n a l r e l a t i o n s h i p problems and f a m i l y c o n f l i c t s . This f i n d i n g has been confirmed both i n the c l i n i c a l and the e d u c a t i o n a l s e t -t i n g . By comparison, the problems of a n x i e t y , depression and personal h a b i t s were f a r l e s s s u c c e s s f u l l y d e a l t with'by b i b l i o t h e r a p e u t i c methods. While the m a j o r i t y of p r a c t i t i o n e r s i n t h i s study do not employ b i b l i o t h e r a p y , those who do consider i t to be a v i a b l e t h e r a p e u t i c tech-nique. I t may be used i n a d i v e r s i t y of ways and by a v a r i e t y of mental h e a l t h workers. Those i n t h i s study use b i b l i o t h e r a p y e f f e c t i v e l y , w i t h people of a l l ages and almost any l i f e - s i t u a t i o n . Defined as the dynamic i n t e r a c t i o n between the p e r s o n a l i t y of the reader and l i t e r a t u r e , b i b l i o t h e r a p y i s based upon a humanistic conception of l i f e i n that i t e n v i s i o n s the i n d i v i d u a l as a unique and purposive being s t r i v i n g f o r growth. I t i s a l s o an expression of an e d u c a t i o n a l stance which focuses upon both academic l e a r n i n g and p s y c h o l o g i c a l m a t u r i t y . This study suggests that b i b l i o t h e r a p y i s a v a l u a b l e form of t r e a t -ment whose wider a p p l i c a t i o n ought to be s e r i o u s l y considered. I t helps to place the cl ient and the therapist at a relationship level where they can communicate person to person, as opposed to helper to helpee. If the success of psychotherapy rests upon whether or not true communication can occur between the therapist and c l ient , then bibliotherapy can actually add another dimension. As some of the verbal and psychological barriers are broken down, bibliotherapy fac i l i ta tes the c l ient 's a b i l i t y to com-prehend and react to what is being read and the therapist's s k i l l in recognizing and conveying the attitude change which i s inevitable. The art of the bibliotherapist l i e s in the capacity to guide the reader to-wards an examination of the problem as well as to help the person to express any insights thereby achieved. Therefore, bibliotherapy has an important role to play in the realm of psychotherapy. 89 BIBLIOGRAPHY 90 Alston, E.F. Bibliotherapy and psychotherapy. Library Trends, 1962, 11_ (2), 159 - 76. Appel, K. Psychiatric Therapy. In J. Hunt, Personality arid behavior  disorders (Vol. II). New York: Ronald Press, 1944. A r i e t i , S. 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D i s s e r t a t i o n A b s t r a c t s , 1968, 29_ (9 - A ) , 29G0 - 01. Reid, V. Reading -ladders f o r human r e l a t i o n s (5th ed.). Washington, D.C.: American C o u n c i l on Education, 1972. Riggs, C.W. B i b l i o t h e r a p y - An annotated b i b l i o g r a p h y . Newark, Delaware: I n t e r n a t i o n a l Reading A s s o c i a t i o n , 1968, 1971. R u s s e l l , D.H. Co n t r i b u t i o n s of reading to personal development. Teachers  College Record, 1960, 6,1, 435 - 42. R u s s e l l , D.H., & Shrodes, C. C o n t r i b u t i o n s of research i n b i b l i o t h e r a p y to the language - a r t s program, I & I I . School Review, 1950, 58, 335 -42, 411 - 20. R u s s e l l , R. U.B.C. RANGE: A Program f o r Determining Random Samples. Vancouver, U n i v e r s i t y of B r i t i s h Columbia: Mimeographed, 1976. Saper, M.B. B i b l i o t h e r a p y as an adjunct to group psychotherapy (Doctoral d i s s e r t a t i o n , U n i v e r s i t y of M i s s o u r i , Columbia, 1967). D i s s e r t a t i o n A b s t r a c t s , 1968, 28^  (10 - B), 4302. Schneck, J.M. A b i b l i o g r a p h y on b i b l i o t h e r a p y and l i b r a r i e s i n mental h o s p i t a l s . B u l l e t i n of the Merininger C l i n i c , 1945, 9_ ( 5 ) , 170 - 74. Schneck, J.M. B i b l i o t h e r a p y f o r n e u r o p s y c h i a t r y p a t i e n t s . B u l l e t i n of  the Menninger C l i n i c , 1946, 10 ( 1 ) , 18 - 25. S c l a b a s s i , S.H. L i t e r a t u r e as a ther a p e u t i c t o o l - A review of the l i t e r a t u r e on b i b l i o t h e r a p y . American J o u r n a l of Psychotherapy, 1973, 27 (1), 70 - 77. Shepherd, T., & l i e s , L. What i s b i b l i o t h e r a p y . Language A r t s , 1976, 53, 569 - 71. Shrodes, C. B i b l i o t h e r a p y . The Reading Teacher, 1955, 9_ ( 1 ) , 24 - 29. Shrodes, C. B i b l i o t h e r a p y : An a p p l i c a t i o n of psyc h o a n a l y t i c theory. American Image, 1960, 17: 312. Spache, G.D. Good reading' f o r poor readers. Champaign, 111.: Garrard Press, 1962. S p i t h i l l , A'.C. The v a l u a b l e a l l i e s . The Personnel and Guidance J o u r n a l , 1968, 46, 889 - 93. Stone, A.A., & Smart-Stone, S. (Eds.). The abnormal p e r s o n a l i t y through  l i t e r a t u r e . New Jersey: P r e n t i c e - H a l l , Inc., 1966. 95 Strauss, L, Interview and d i s c u s s i o n about myths and music. C.B.C. Radio, December, 1977. Strunk, J r . , 0. B i b l i o t h e r a p y r e v i s i t e d . J o u r n a l of R e l i g i o n arid Health, 1972, 11 (3), 218 - 28. Tews, R.M. The questionnaire on b i b l i o t h e r a p y . Library Trends, 1962, 11 (2), 217 - 27. Thrush, R.S. L i t e r a t u r e as a s o c i o c u l t u r a l encounter. In F a r w e l l , Gamsky & Mathieu - Coughlan (Eds.), The Counsellors Handbook. New York: I n t e x t , 1974, 402 - 15. Townsend, A. What research says to the reading teacher: Books as Therapy. The Readjrig Teacher, 1963, 17, 121 - 22. Truax, C.B., & Carkhuff, R.R. Toward e f f e c t i v e c o u n s e l l i n g and psycho- therapy: T r a i n i n g arid p r a c t i c e . Chicago: Aldine" P u b l i s h i n g Co., 1967. Tsimpoukis, C.J. B i b l i o c o u n s e l l i n g : Theory and research i m p l i c a t i o n s f o r and a p p l i c a t i o n s i n c o u n s e l l i n g and guidance (Doctoral d i s s e r t a t i o n , The U n i v e r s i t y of Wisconsin, 1968). D i s s e r t a t i o n A b s t r a c t s , 1968, 2_9 (3 - A), 799 - 800. Weingarten, S. Boundaries of reading i n s a t i s f y i n g ' n e e d s . Education, 1964, 84, 480 - 89. Weissenberg, F. The f o u r t h R i n reading. The Reading Teacher, 1973, 598 - 601. Whipple, J r . , CM. The e f f e c t of short term classroom b i b l i o t h e r a p y on the p e r s o n a l i t y and academic achievement of reformatory inmate students (Doctoral d i s s e r t a t i o n , The U n i v e r s i t y of Oklahoma, 1968). D i s s e r t a t i o n  A b s t r a c t s , 1968, 2_9 (6 - B), 2214. Witty, P. Reading to meet emotional needs. Elementary E n g l i s h , 1952, 29, 75 - 84. Zac c a r i a , J.S., & Moses, H.A. F a c i l i t a t i n g human development through  reading: The use of b i b l i o t h e r a p y i n teaching and c o u n s e l l i n g . Champaign, 111.: Stipes P u b l i s h i n g Co., 1968. 96 APPENDIX A / 97 THE UNIVERSITY OF BRITISH COLUMBIA 2075 VVESBROOK MALL VANCOUVER, B.C., CANADA V6T 1W5 FACULTY OI- EDUCATION Dear My purpose in this letter is to introduce myself, and then, to make a re-quest. My name is Sandra Yasin and, while employed at Vancouver Community College, Langara, I am also completing a Masters Thesis in Counselling Psychology at U.B.C. I am researching the extent and use of literature and other writings as a therapeutic tool. I propose to do this by develop-ing an interview schedule and then personally interviewing a sample of persons engaged in counselling and psychotherapy in Vancouver. In order to select this sample randomly, I require as complete a l i s t of names as possible. Hence, my request; I would like you to provide me with a l i s t of your association members and/or your mailing l i s t ( i f possible, within the Vancouver area). These members w i l l then be contacted and asked for their co-operation in this study. I am also making this request of other associations, namely the B.C. Psychological Association and B.C. Association of Social Workers and thank you, in advance, for your co-operation, too. Sincerely yours, Sandra Yasin, Counsellor 98 APPENDIX B 99 THE UNIVERSITY OF BRITISH COLUMBIA 2075 WESBROOK MALL VANCOUVER, B.C., CANADA V6T 1W5 FACULTY OF EDUCATION Dear This l e t t e r i s to inform you of a research p r o j e c t which I am conducting f o r a Masters Thesis, and to ask you f o r your co-operation. The research p r o j e c t i s an i n v e s t i g a t i o n of the use of w r i t t e n m a t e r i a l s i n c o u n s e l l i n g and psychotherapy. A random sample of people i n the h e l p i n g p r o f e s s i o n s has been drawn to be interviewed. I am w r i t i n g to a l l of the people s e l e c t e d i n t h i s sample, i n order to n o t i f y them that I w i l l be phoning f o r a b r i e f i n t e r v i e w and to ask f o r t h e i r p a r t i c i p a t i o n . Your name i s one of those i n c l u d e d i n t h i s sample, and I w i l l contact you e a r l y i n J u l y . Thank you f o r your a t t e n t i o n , and I hope that you w i l l be able to j o i n i n t h i s research, as I b e l i e v e the outcome can be of b e n e f i t to our p r o f e s s i o n s . S i n c e r e l y yours, Sandra Ya s i n , Counsellor, C o u n s e l l i n g Department, Vancouver Community Co l l e g e , Langara, Vancouver, B.C. 100 Appendix '£. Frequency of response to the questions: 1. Do you ever suggest that your c l i e n t read or w r i t e something r e l a t e d to t h e i r problem? 2. I f you suggest i t , why not more r e g u l a r l y or w i t h other purposes? -0R-3. I f you do/not suggest i t , have you ever considered i t ? (N=25) f f f f S o c i a l Workers'^ ^ Psychologists'' P s y c h i a t r i s t s Counsellors (N=5) (N=5) (N=7) (N=8) Question 1. -FTyes - no ;3 ,2 3 2 4 3 2 6 Question 2. - " I t r a r e l y comes up" e./2 - "One must be c a u t i o u s " -- "People j u s t don't 1 read" 1 3 Other Question 3. - yes 1 - no '5l 101 Appendix D. Selected Comments from the Respondents to the Telephone Interview Respondent #19 s t a t e d that she o f t e n suggests that c l i e n t s w r i t e i n terms of p r i o r i z i n g t h e i r needs or d e s i r e s to help c l a r i f y them - as w e l l as to teach them how to budget. On the other hand, she b e l i e v e d that " i t could be dangerous" to send people to the l i b r a r y to read, s i n c e they could p i c k up "the jargon and then argue w i t h you". Respondent #20 works w i t h c h i l d r e n i n the schools and b e l i e v e d that they are, as such, " l e a r n i n g d i s a b l e d . . . t h e r e f o r e , p r e s c r i b i n g reading to them would be u s e l e s s " . Respondent #21 . b e l i e v e d that b i b l i o t h e r a p y could be an important t o o l and was eager to l e a r n more about i t , expressing i n t e r e s t i n r e -c e i v i n g the r e s u l t s of t h i s study. He concluded that he would l i k e t r a i n i n g i n the use of b i b l i o t h e r a p y before he would employ i t . Respondent #22 > a l s o discussed some t r a i n i n g i n b i b l i o t h e r a p y and added that " i t s not the book i t s e l f , but the w r i t e r , who makes an im-p r e s s i o n upon the reader". Respondent #25 was i n favor of using pamphlets and b u l l e t i n s f o r i n f o r m a t i o n a l purposes, but f e l t that w r i t t e n m a t e r i a l d i d not belong i n a c o u n s e l l i n g s e s s i o n s i n c e i t ' s meant to be "a v e r b a l i n t e r a c t i o n " . Respondent #26 f e l t that b i b l i o t h e r a p y would be a u s e f u l t o o l i n s i t u a t i o n s where a student was "having d i f f i c u l t y i n o r g a n i z i n g h i m s e l f or i n b u i l d i n g a s e l f - c o n c e p t " and that a d o s s i e r of t i t l e s would be handy. Respondent #27 warned that one must look " c a r e f u l l y a t the motives 102 of the c o u n s e l l o r i n ever suggesting that a student read something par-t i c u l a r to h i s s i t u a t i o n , s i n c e i t might r e i n f o r c e , one way or another, h i s home s i t u a t i o n " . Respondent #31 b e l i e v e d that the p r a c t i c e of b i b l i o t h e r a p y "would r e q u i r e a l o t of work beforehand on the p a r t of the c o u n s e l l o r " . Respondent #33 was not included i n the o r i g i n a l sample of 40 because he i s no longer p r a c t i c i n g , nevertheless b e l i e v e d s t r o n g l y i n both read-in g and w r i t i n g "as a way to get some p a t i e n t s s t a r t e d " and concluded that the author "was on to a good t h i n g " . Respondent #34 had h i s c l i e n t s keep s e v e r a l forms of w r i t t e n r e -cords but r a r e l y suggested reading, s i n c e books could be " m i s i n t e r p r e t e d " . He s t a t e d that an i n t e r v i e w w i t h the author "was not needed" because h i s use of b i b l i o t h e r a p y was only an occasional?one and that he "didn't have time f o r i t , i n general". Respondent #35 a c t u a l l y used to p r a c t i c e b i b l i o t h e r a p y but had found i t " u n s a t i s f a c t o r y " and concluded that i t might be most u s e f u l w i t h "the educated, more normal u n i v e r s i t y crowd". Respondent #37 f e l t that c l i e n t s could "confuse themselves through i d e n t i f y i n g and i n t e l l e c t u a l i z i n g " . He s t r e s s e d that one must be care-f u l that the book " w i l l not harm the p a t i e n t " . Several respondents s t a t e d that they were book o r i e n t e d and would recommend reading should the subject arise.and i f they could f i n d r e -levant m a t e r i a l . Respondent #40 s t a t e d that he d i d o c c a s i o n a l l y recommend reading, however he was extremely " s e l e c t i v e " . He would not consent to be i n -terviewed, c i t i n g time c o n s t r a i n t s . F i n a l l y , those respondents who d i d o c c a s i o n a l l y suggest to c l i e n t s that they read, most o f t e n recommend a book f o l l o w i n g the model of Tr a n s a c t i o n a l A n a l y s i s - the most common of which was I'm Ok - You'  Ok by Thomas H a r r i s , M.D. ) 104 APPENDIX E CONSENT FORM: 105 I agree to p a r t i c i p a t e i n Sandra Yasin's research p r o j e c t f o r her Masters Thesis. I understand that she w i l l tape record our i n t e r v i e w , which w i l l be c o n f i d e n t i a l and w i l l be used i n a study, the subject of which i s an i n v e s t i g a t i o n of the use of w r i t t e n m a t e r i a l s i n the course of my coun-s e l l i n g or psychotherapy. SIGNED: DATE: 106 APPENDIX F LIST OF TITLES I Books A u s t i n , S. & Phelps, M. "The A s s e r t i v e Woman" Bach, G. "Crea t i v e Aggression" Bach, G. "The Intimate Enemy" B e l l i v e a u , F. "Understanding Human Sexual Inadequacy" Berne, E. "Games People P l a y " Boston i Women's Health C o l l e c t i v e "Our Bodies, Our Selve Cammer, L. "Up From Depression" Comfort, A. "The Joy of Sex" Cork, M. "Alcoholism And The Family" Craven, M. " I Heard The Owl C a l l My Name" Dobson, J . "Dare To D i s c i p l i n e " Dyer, W. "Your Erroneous Zones" Eichenlaub, G. "Marriage A r t " E l l i s , A. "A Guide To R a t i o n a l L i v i n g " F r a n k l , V. "Man's Search For Meaning" F r a n k l , V. "The Doctor And The Soul" Fromm, E. "The A r t Of Loving" Gardner, R.A. "Boys And G i r l s About Divorce" G e t c h e l l , R. " A l i c e Doesn't L i v e Here Anymore" Gi n o t t , H. "Between Parent And Adolescent" G i n o t t , H. "Between Parent and C h i l d " Gordon, T. "Parent E f f e c t i v e n e s s T r a i n i n g " Greenberg, J . " I Never Promised You A Rose Garden" H a r r i s , T. "I'm-Ok, You're Ok" Hunt, M.M. "The World Of The Formerly M a r r i e d " James, M. & Jongeward, D. "Born To Win" Jourard, S. "The Transparent S e l f " Kesey, K. "One Flew Over the Cuckoo's Nest" K o e s t l e r , A. "Roots Of Coincidence" LeCron, L.M. "Self-hypnotism" Lindner, R.M. "The F i f t y - M i n u t e Hour" Masters, W.H. & Johnson, V.E. "Human Sexual Inadequacy" Maultsby, M.C. "Help Y o u r s e l f To Happiness" Ney, P. "How To Raise A Family For Fun And P r o f i t " P a tterson, G. " L i v i n g With C h i l d r e n " P e r l s , F. " G e s t a l t Therapy Verbatim" (1st three chapters) Roberts, J . "The Education Of Oversoul Seven" Rubin, T. "The Angry Book" S a r f a t t i , J . , Wolfe F., Toben, B. "Space, Time And Beyond" S a t i r , V. "Peoplemaking" Sheehey, G. "Passages" Smith, M. "When I Say No, I F e e l G u i l t y " Steinbeck, G. "The Grapes Of Wrath" S t e i n e r , C. "Games A l c o h o l i c s P l a y " S t u a r t , R. "Fat Chance In A Slim World" Thurber, J . "Fables For Our Time" Tournier, P. "Learning To Grow Old" T r o b r i c h , W. "Love T h y s e l f " Voeks, V. "On Becoming An Educated Person" White, E.B. "Lives In Progress" White, B. "The F i r s t Three Years" I I Magazines Handouts on VD; Alc o h o l i s m ; P a r e n t i n g ; Health "Human Behavior" "McCall's" "Psychology Today" "Readers' D i g e s t " "Saturday Evening Post" "Time" I I I T e l e v i s i o n & Records Educational Cable 9 Mario Thomas, "Free To Be, You And Me" "Man A l i v e " C.B.C. "The F i f t h Estate C.B.C. . 110 APPENDIX G QUESTIONNAIRE What are the t i t l e s you most o f t e n use i n your counselling/therapy? a) Do you have a w r i t t e n or formal l i s t ? b) Have you ever decided not to continue w i t h a t i t l e you p r e v i o u s l y used? - f o r what reason? How do you determine which t i t l e s to use ( i . e . add to your p o s s i b l e l i s t of t i t l e s ) ? a) What are your (other) sources of t i t l e s ? eg. b i b l i o g r a p h y , book club e t c . b) What use do you make of your c l i e n t s ' responses to a p a r t i c u l a r t i t l e ? To what degree are you f a m i l i a r w i t h the t i t l e s you use? a) Do you read whole books, p a r t s , index etc? b) What do you do i f a c l i e n t mentions a t i t l e which you are not f a m i l i a r with? Normally, how does the subject of r e a d i n g / w r i t i n g come up i n your sessions? - What i s the procedure once a s p e c i f i c t i t l e has been mentioned? a) Would you a s s i g n i t or would you recommend or suggest i t more i n passing? b) Do you give a r a t i o n a l e f o r your t i t l e suggestion? c) Do you f e e l that i t must be read w i t h i n a c e r t a i n time p e r i o d i n order to have the e f f e c t you intend? d) How do you a c t u a l l y describe what you want the . c l i e n t to do r e -garding the t i t l e ? (homework?) - Suppose that I'm a c l i e n t and you th i n k I might b e n e f i t from a s p e c i f i c t i t l e ; would you b r i e f l y r o l e play w i t h me and t e l l me how you'd t e l l the c l i e n t what you want? How long i s i t before the t i t l e i s mentioned again? a) By whom i s i t mentioned? b) Do you suggest t h i s i . e . r e a d i n g / w r i t i n g again, i f your c l i e n t has not followed your f i r s t suggestion? 112 6. I'm going to mention v a r i o u s types of t i t l e s (books) and I'd l i k e you to i n d i c a t e which type you most f r e q u e n t l y use:-- f i c t i o n vs. n o n - f i c t i o n - l a y psychology and/or s e l f - h e l p readings - biographies and autobiographies - r e l i g i o u s m a t e r i a l - poetry a) Any other m a t e r i a l s you can th i n k of? b) Do you p r e f e r to use an e n t i r e work or part of one i . e . s e l e c t e d passages or perhaps magazine or' newspaper a r t i c l e s ? 7. What i s i t about a c l i e n t that b r i n g s a t i t l e to your mind? 8. What types of problems do your c l i e n t s t y p i c a l l y have? a) For which type of problem do you f i n d t h i s technique most e f f e c t i v e ? b) What p r o p o r t i o n of your t o t a l p r a c t i c e i s t h i s p a r t i c u l a r problem? 9. With what p r o p o r t i o n of your c l i e n t s do you use these techniques of e i t h e r reading t i t l e s or having them w r i t e ? a) What i s the p r o p o r t i o n of men v s . women that you use these techniques with? b) Can you estimate how many t i t l e s you would normally suggest per c l i e n t ? 10. How many c l i e n t s are you using these techniques w i t h r i g h t now and how many others can you estimate you used i t w i t h the past year? 11. I want to di g r e s s f o r a moment and ask you about c l i e n t ' s w r i t i n g -as opposed to reading - and then w e ' l l get back. In the research l i t e r a t u r e , the idea of using m a t e r i a l w r i t t e n by the c l i e n t i s a l s o considered as a ther a p e u t i c t o o l - do you, during the course of your c o u n s e l l i n g , suggest that your c l i e n t s do some w r i t i n g ? Yes - how do they know what to w r i t e ? - do you g e n e r a l l y see t h e i r work? -OR-113 No - have you ever considered suggesting t h i s ? - given that you don't use w r i t i n g i n any for m a l i z e d way, what do you do when a c l i e n t b r ings you something he's done or t e l l s you about work he's w r i t t e n ? Thank you. Is there anything e l s e you'd l i k e to say which you th i n k i s r e l e v a n t here? Thank you. 114 APPENDIX H 115 Name: Sex: Just before we begin, there are two things I'd l i k e to do. F i r s t l y , I'd l i k e to ask that you s i g n t h i s form. I t s t a t e s that you agree to be interviewed by me and that I may tape record as w e l l . As you probably know, t h i s i s simply a f o r m a l i t y that the U n i v e r s i t y p r e f e r s . Thank you. And, second, there are some demographic questions I'd l i k e you to respond t o : 1. What i s your most recent p r o f e s s i o n a l degree, when was i t obtained, from where and by what department. A l s o , i n what year were you born? 2. The i n s t i t u t i o n you are employed w i t h i s - (or self-employed) and the t i t l e of your occupation. How many years of experience i n t o t a l ? 3. What t h e o r e t i c a l approach would you say you subscribe to?. 4. In your t r a i n i n g program, were you exposed to the use of t h i s technique of using w r i t t e n m a t e r i a l s as a therapeutic t o o l ? I f so, to what extent? 5. How f a m i l i a r are you w i t h the p r o f e s s i o n a l l i t e r a t u r e on the use of w r i t i n g / r e a d i n g i n c o u n s e l l i n g or psychotherapy?- not at a l l - a l i t t l e - a l o t . 6. Would you b r i e f l y describe your c l i e n t e l e f o r me, i . e . ages, income status e t c . What types of "presenting problems" i . e . p e r s o n a l , v o c a t i o n a l or social?. Do you or could you ever c l a s s i f y them as prevention (neurotic) v s . remediation ( p s y c h o t i c , developmental)?,, F i n a l l y , what i s the number of c l i e n t s you normally see per day, and the average l e n g t h of i n t e r v i e w time?*. 116 Appendix Table 1. Frequency of response to the question: To what extent were you exposed to the use of b i b l i o t h e r a p y during your t r a i n i n g program? (N=15) Categories f (major) % (major) A) Extensive exposure B) I n d i r e c t exposure C) No exposure 6.67 46.67 46.67 Appendix Table 2. Frequency of response to the question: How f a m i l i a r are you w i t h the p r o f e s s i o n a l l i t e r a t u r e on the use of b i b l i o t h e r a p y i n psychotherapy? (N=15) Categories f (major) % (major) A) Very f a m i l i a r B) Moderately f a m i l i a r C) Not at a l l f a m i l i a r 2 7 6 13.33 46.67 40.00 APPENDIX TABLES 3 TO 17 POST HOC ANALYSIS 118 A f i n d i n g of the postx-hoc a n a l y s i s i s that the p s y c h i a t r i s t s and p s y c h o l o g i s t s i n t h i s study p r a c t i c e d b i b l i o t h e r a p y i n a more d e l i b e r a t e and methodical manner as compared to the c o u n s e l l o r s and s o c i a l workers interviewed. Therefore, i n summary, the p s y c h o l o g i s t s more o f t e n main-tained a l i s t to which they r e f e r f o r t h e i r t i t l e s e l e c t i o n s . They a l -so, used the l a r g e s t v a r i e t y of methods f o r determining which t i t l e s to employ. The p s y c h i a t r i s t s had the greatest means of sources f o r t h e i r t i t l e s e l e c t i o n s whereas p s y c h o l o g i s t s and s o c i a l workers performed the best follow-up procedures, being both s p e c i f i c and c a s u a l about the d i s -cussions which would f o l l o w the reading done by the c l i e n t . A l l of the respondents would read each book completely before recommending i t , how-ever, only the s o c i a l workers would consider reading the book i n p a r t as p r o v i d i n g s u f f i c i e n t f a m i l i a r i t y w i t h i t . The p s y c h i a t r i s t s and co u n s e l l o r s e q u a l l y considered the c l i e n t s ' w r i t i n g as p a r t of the b i b l i o t h e r a p e u t i c process. Although the s o c i a l workers were more open to having e i t h e r the c l i e n t or themselves as the i n i t i a t o r of b i b l i o t h e r a p y , the p s y c h i a t r i s t s had the best o v e r a l l procedure once the subj e c t of reading had been r a i s e d . They had the l a r g e s t v a r i e t y of means whereby the c l i e n t s could o b t a i n the books and tended to be more d i r e c t i v e i n t h e i r approach. Only the p s y c h i a t r i s t s and p s y c h o l o g i s t s appeared to consider having t h e i r c l i e n t s purchase books, whereas c o u n s e l l o r s seemed u n w i l l i n g to give a book as a g i f t to a student. Further, the c o u n s e l l o r s p r e f e r r e d to b r i n g up the subject of reading again a t the next i n t e r v i e w , w h i l e the psycholo-g i s t s were more f l e x i b l e and l i k e l y to suggest reading at a l a t e r date, should the f i r s t suggestion not be followed by the c l i e n t . The p s y c h i a t r i s t s were best able to describe t h e i r c l i e n t s , c i t i n g a v a r i e t y of c h a r a c t e r i s t i c s . F u r t h e r , t h e i r p r a c t i c e c o n s i s t e d of the l a r g e s t v a r i e t y of c l i e n t problem types. The p s y c h o l o g i s t s spent the l a r g e s t p r o p o r t i o n of t h e i r p r a c t i c e i n b i b l i o t h e r a p y and estimated, e q u a l l y w i t h the p s y c h i a t r i s t s , the number of t h e i r c l i e n t s who had received b i b l i o t h e r a p y i n the past year. F i n a l l y , the c o u n s e l l o r s and p s y c h o l o g i s t s used more t i t l e s per c l i e n t than the other two groups In the f o l l o w i n g t a b l e s , i t was p o s s i b l e f o r the respondents to r e p l y i n more than one way. Therefore, the sum of the frequencies w i t h i n a column does not always equal the number of cases i n the cor-responding category. Appendix Table 3. 120 Frequency of response to the q u e s t i o n : Do you have a w r i t t e n l i s t of t i t l e s ? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) Yes 2' 1 3 B) No 3 2 1 Appendix Table 4. Frequency of response to the question: How do you determine which t i t l e s to use? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) CN=4) (N=3) A) I read i t myself 4 2 4 B) C l i e n t mentions i t 3 1 2 C) According to 1 2 2 problem D) Other 1 - 1 121 Appendix Table 5, Frequency of response to the question about t i t l e determination: What are your sources of t i t l e s ? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) P r o f e s s i o n a l l i t e r a t u r e B) M a i l i n g l i s t s 2 C) Browsing 1 D) D e l i b e r a t e search 4 Appendix Table 6. Frequency of response to the question about t i t l e determination: What i s your follow-up procedure? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (.\=5) ( N = 3 ) ( N = 4 ) (N=3) A) D e l i b e r a t e search 4 B) Casual and non- 2 s p e c i f i c C) None (workshop s e t t i n g ) 122 Appendix Table 7. Frequency of response to the question: How familiar are you with the t i t l e s you use? Categories f f f f Social Workers Psychiatrists Psychologists Counsellors (N=5) (N=3) (N=4) (N=3) A) Read each 3 3 3 3 completely B) Read each 2 -in part Appendix Table 8. Frequency of response.to the question: Do you suggest that your clients do some writing? Categories f f f f Social Workers Psychiatrists Psychologists Counsellors (N=5) (N=3) (N=4) (N*ej , A) Yes, suggest they write 2 B) Direct what they write C) Yes, w i l l see what they write D) No, do not suggest 3 they write 123 Appendix Table 9. Frequency of response to the question: How does the subject of r e a d i n g / w r i t i n g come up? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) Therapist brings 5 up the subject B) C l i e n t b r ings 2 up the subject C) Assign i t 2 D) Recommend i t 4 E) R a t i o n a l e i s 5 provided F) Time l i m i t 3 G) S p e c i f i c r e f e r r a l 2 3 2 2 2 3 1 4 4 2 3 Appendix Table 10. 124 Frequency of response to the question: How w i l l the. c l i e n t o b t a i n the book? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) Obtains book through purchase B) Obtains book through l i b r a r y C) Obtains book by borrowing from t h e r a p i s t D) Obtains book as g i f t from t h e r a p i s t E) Obtains photocopy 2 handouts from t h e r a p i s t Appendix Table 11. Frequency of response to the question: How many t i t l e s do you suggest per c l i e n t ? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) 1-2 t i t l e s 4 3 2 1 B) 3-4 t i t l e s 1 - 1 1 C) more than 5 - - 1 1 125 Appendix Table 12. Frequency of response to the questions: How long i s i t before the t i t l e i s mentioned again? -and-Do you suggest i t again i f not followed the f i r s t time? Categories A) When: next i n t e r v i e w f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) - (N=3) (N=4) (N=3) B) Other i n t e r v i e w s 1 C) By whom: e i t h e r 2 t h e r a p i s t or c l i e n t D) Therapist f i r s t 2 E) C l i e n t f i r s t 1 F) Therapist w i l l 2 suggest i t a second time G) Therapist w i l l 3 not suggest i t again H) Therapist may suggest i t again 1 3 1 - - 1 2 1 1 126 Appendix Table 13. Frequency of response to the question: C h a r a c t e r i s t i c s of c l i e n t s w i t h whom b i b l i o t h e r a p y i s t y p i c a l l y used? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) Ego str e n g t h 1 B) O v e r t l y c o g n i t i v e 5 and motivated 1 3 C) Reading readiness and e s t a b l i s h e d rapport D) Nature of problem/ goal as r e l e v a n t as c h a r a c t e r i s t i c s of c l i e n t 127 Appendix Table 14. Frequency of response to the question: What types of problems do your c l i e n t s have? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) Communication and/or i n t e r -personal r e l a t i o n s h i p B) Family c o n f l i c t 4 C) Personal h a b i t s 2 and behavior 2 2 2 1 D) Depression and a n x i e t y E) Educational 1 3 128 Appendix Table 15. Frequency of response to the question about problem types: With which i s b i b l i o t h e r a p y most e f f e c t i v e ? Categories f f f f ' S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) Communication and/ 2 2 2 or i n t e r p e r s o n a l r e l a t i o n s h i p B) Family c o n f l i c t 2 1 2 C) Personal h a b i t s - - -and behavior D) Depression and _ _ _ a n x i e t y E) Educational 1 3 129 Appendix Table 16. Frequency of response to the questions: B i b l i o t h e r a p y i s p r a c t i c e d w i t h what percent of your t o t a l c l i e n t population? -and-With what percent of men versus women i s b i b l i o t h e r a p y p r a c t i c e d ? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) Less than 10 percent B) 10-30 percent C) 50-75 percent D) 90-100 percent E) No sexual d i f f e r e n t i a t i o n , although more female c l i e n t s F) No sexual d i f f e r e n t i a t i o n , although more male c l i e n t s 130 Appendix Table 17, Frequency of response to the question: What i s your current and past use of b i b l i o t h e r a p y ? Categories f f f f S o c i a l Workers P s y c h i a t r i s t s P s y c h o l o g i s t s Counsellors (N=5) (N=3) (N=4) (N=3) A) C u r r e n t l y : I - 2 c l i e n t s 2 3-4 c l i e n t s 2 5-10 c l i e n t s 11+ c l i e n t s a l l no 1 B) In the past year: Less than 10 1 c l i e n t s I I - 20 c l i e n t s 1 21-30 c l i e n t s 1 31-40 c l i e n t s 41+ c l i e n t s do not know 2 1 .1 1 1 1 1 Appendix Table 18. Frequency of response to the question: Describe your c l i e n t e l e according to age, income st a t u s and pre s e n t i n g problems. (N=15) Categories f (sub) f (major) % (major) I "AGE A) Young a d u l t and a d u l t B) Adolescent - adolescent, only and A) 4 4 12 8 80.00 53.33 i i : : SEX A) Predominately men B) Predominately women C) Men and women e q u a l l y 4 10 1 26.67 66.67 6.67 I I I INCOME STATUS A) S o c i a l a s s i s t a n c e - s o c i a l a s s i s t a n c e , only and, B) middle c l a s s and, C) upper c l a s s and, B), C) B) Middle c l a s s - middle c l a s s , only C) Upper c l a s s - upper c l a s s , only 3 2 1 2 53.33 40.00 33.33 132 IV PRESENTING PROBLEMS A) In t e r p e r s o n a l and s o c i a l 15 100. - i n t e r p e r s o n a l and s o c i a l , •-• '. f only and, B) v o c a t i o n a l 8 C) Prevention i s p o s s i b l e 14 93.33 but not common i n treatment D) Remediation i s the bulk of treatment. 15 100. 133 APPENDIX I Respondents' Added Comments "- I would l i k e a b o o k - l i s t f o r p r o f e s s i o n a l s to use". " - B i b l i o t h e r a p y i s l i k e medication; i t acts as a l i n k between the c l i e n t and t h e r a p i s t " . "- I j u s t used b i b l i o t h e r a p y and had not r e a l l y thought about what I was a c t u a l l y doing". "- Some l i t e r a t u r e i s m u s i c a l " . "- A l l media are h e l p f u l and u s e f u l i n b i b l i o t h e r a p y " . 

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