Souls in Jeopardy: Questions and Innovations for Bibliotherapy With Fiction

Jonathan J. Detrixhe s s s

How is bibliotherapy with ction hypothesized to work, and what are the ideal conditions for treatment success? Patterns in the bibliotherapy literature are explored. Questions are posed and suggestions offered regarding the practice of bibliotherapy with ction.

s s s Authors discussing the subject of bibliotherapy commonly quote an inscription from the lintel of an ancient Greek library (Head, 2007; Riordan & Wilson, 1989; Zaccaria & Moses, 1968). The library decreed itself the healing place of the soul (Riordan & Wilson, 1989, p. 506), and by including this quote, authors hope to convey that the use of books as an aid to feeling better is not new, is ancient in fact, and if it was good enough for the Greeks, those eternal fonts of arts, letters, and wisdom in general, it should be good enough for us. However, in the intervening millennia, the study of bibliotherapy with ction has not moved much beyond this pithy invitation. Yes, in some ways it seems natural to assume that because stories and poems give people so much pleasure and peace in daily life, they should have some psychotherapeutic application as well. Yet watching basketball also gives people pleasure and peace. Why not watch basketball in therapy? Why read ction? In this article, I explore the potential of ction as a medium of therapeutic change. I examine the basic premises underlying the theory of action, raise the current shortage of empirical support for the theory as a limitation, and provide suggestions for future research. Also, I challenge three basic assumptions of the theory regarding who is considered a good candidate for bibliotherapy, what types of books should be used, and what the therapeutic goals are. Finally, I offer a set of new ideas intended to advance the knowledge and practice of bibliotherapy with ction. BIBLIOTHERAPY DEFINED The term bibliotherapy originated with Samuel Crothers in 1916 and refers to the use of books as healing tools (Pardeck, 1994). Following Crothers example, most writers on the subject keep their denitions broad, allowing
Jonathan J. Detrixhe, Department of Psychology, Long Island University. Correspondence concerning this article should be addressed to Jonathan J. Detrixhe, Department of Psychology, Long Island University, 1 University Plaza, Brooklyn, NY 11201 (e-mail: jonathan.detrixhe@gmail.com).
58 2010 by the American Counseling Association. All rights reserved.
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room for use of both ction and nonction. Bibliotherapy is helping with books (Ahmann, 1997, p. 500) or the use of assigned readings (Coleman & Ganong, 1990, p. 327). Expanding on the denition, Riordan and Wilson (1989) wrote, Bibliotherapy refers to the guided reading of written materials in gaining understanding and solving problems relevant to a persons therapeutic needs (p. 506). This denition provides a clue as to how bibliotherapy might in fact heal the soul or at least augment therapy: A book can promote understanding and help individuals solve problems when it addresses their needs for improvement. Other denitions are more restrictive, seeming to rule out the possibility of ction as a therapeutic aid: Bibliotherapy is a form of self-administered treatment in which structured materials provide means of self-improvement or help alleviate distress (Gregory, Schwer Canning, Lee, & Wise, 2004, p. 275). Are ction books structured materials? Are poems? How does a short story provide means for improved well-being? The problem seems to be that as the denitions become more specic, they make more sense for the use of nonction than of ction. MODELS OF BIBLIOTHERAPY WITH FICTION Pardeck and Pardeck (1984) might be considered advocates of the classical view of bibliotherapy with ction. They saw it working in three stages. In the rst stage, identication and projection (Pardeck & Pardeck, 1984, p. 196), clients, with a therapists guidance, come to recognize themselves in the life and problems of a character in a book. Next, in the stage called abreaction and catharsis (Pardeck & Pardeck, 1984, p. 196), clients experience an emotional release (Pardeck & Pardeck, 1984, p. 196). Little is said about this stage except that clients should respond to the story with some sort of passion. In the nal stage, insight and integration (Pardeck & Pardeck, 1984, p. 196), clients become aware that there is a problem in their life and that a solution is needed. Other authors propose four- or ve-step models of basically the same process. For example, Rudman, Gange, and Bernstein (as cited in Ahmann, 1997) offered more detail on the catharsis stage. Clients may cry or express feelings that were previously bottled up (Ahmann, 1997, p. 500). Whether this is merely an evocative moment, temporary relief from suffering, or a more technical corrective emotional experience, the authors did not say, nor does there seem to be any research devoted to the necessity or efcacy of successful completion of the catharsis stage. Pardeck (1994) later added to his theory, highlighting additional benets of bibliotherapy. Books offer an opportunity for clients to learn new values and ideas. Also, books remind clients that they are not alone in their difculties, that others share the same problems. Furthermore, if the book is well chosen, it may suggest specic solutions to those problems. Coleman and Ganong (1990) proposed some additional benets of bibliotherapy with ction, particularly direct didactic goals. Even though clients

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are reading ction, they can learn certain facts (Coleman & Ganong, 1990, p. 327) about their situation. The authors were particularly insistent that the content of books should match the clients situations (i.e., a child experiencing depression in a stepfamily should read about a child experiencing depression in a stepfamily). Their rationale was as follows: In reading about a character who is facing a situation similar to their own, readers may identify with the character and in so doing gain some awareness and understanding of their own motivations, thoughts, and feelings (Coleman & Ganong, 1990, p. 327). EMPIRICAL SUPPORT FOR BIBLIOTHERAPY MODELS The majority of bibliotherapy research focuses almost exclusively on the use of nonction (Riordan & Wilson, 1989; Shechtman & Nir-Shfrir, 2008). In particular, the use of prescribed reading materials in cognitive therapy has been the subject of many empirical studies (Gregory et al., 2004). In this modality, clients read books, such as David D. Burnss (1999) Feeling Good: The New Mood Therapy, that contain exercises and homework assignments designed to help them overcome negative feelings. Bibliotherapy is particularly common in cognitive therapy because the active ingredient is thought to be program content, not interaction with the therapist (Shechtman & Nir-Shfrir, 2008). In recent studies, cognitive bibliotherapy has shown signicant treatment gains for individuals with depression (Bilich, Deane, Phipps, Barisic, & Gould, 2008; Naylor, Antonuccio, Johnson, Spogen, & ODonohue, 2007), panic disorder (Carlbring, Bohmans, et al., 2006), social phobia (Carlbring, Furmark, Steczk, Ekselius, & Andersson, 2006), childhood anxiety (Lyneham & Rapee, 2006), and vaginismus (van Lankveld et al., 2006). In their meta-analysis of 29 outcome studies of cognitive bibliotherapy for depression, Gregory et al. (2004) concluded that the technique compares favorably with individual psychotherapy. Other research has shown that the results are not long lasting; Floyd et al. (2006) found that at the 2-year follow-up, individuals with depression who were treated with bibliotherapy had signicantly more symptom recurrences than did other individual therapy clients. In their review of the bibliotherapy literature, Riordan and Wilson (1989) argued that self-help nonction offers the clearest and most consistent promise (p. 507) for research into the usefulness of bibliotherapy, whereas ction and poetry remain essentially unvalidated (p. 507). Even researchers who focus on the use of ction in therapy concede that research is lacking (Shechtman & Nir-Shfrir, 2008). However, in their pithy reference to the healing properties of books, the ancient Greeks did not appear to draw a distinction between ction and nonction. It seems that belief in and impetus for using books as an adjunct to psychotherapy is partly based on the fact that many people naturally derive great personal satisfaction from reading. Nevertheless, because this phenomenon is not limited to nonction readers, some account of ctions potential role in therapy needs to be given as well. Unfortunately, thus far, the mere belief in ctions important place

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in the therapy room is held in higher esteem than the need to rigorously research the phenomenon. For example, Coleman and Ganong (1990) have a very specic view of how bibliotherapy with ction should be conducted. They have argued that the clients problems need to match those of the characters and that books must meet certain moral and aesthetic guidelines. However, although they stated that they have been using ction with clients for over a decade, they have conducted no controlled experiments to test their views. Perhaps aware of this deciency, they wrote, Unfortunately, there are no valid measures to assess gains in insight or deeper understanding (Coleman & Ganong, 1990, p. 328). Although this may have been true at the time, Castonguay and Hill (2007) have since published Insight in Psychotherapy, a guide to measuring and understanding insight. Unfortunately, the majority of important writings on bibliotherapy with ction are long on theory but short on research. Only in the work of Shechtman does bibliotherapy with ction nd a true believer and an empiricist. She has conducted at least six experiments since 1996 that include bibliotherapy with ction as an experimental condition. For example, Shechtman (2006) investigated bibliotherapy as a mutative complement to the counseling of aggressive boys. To establish her theoretical position, she began by citing research suggesting that aggressive children have affect disorders that include symptoms such as high levels of emotional arousal, low levels of empathy, and difculties in self-expression (Shechtman, 2006, p. 645). She then provided support for the idea that affect disorders are best addressed by an integrative treatment orientation (Shechtman, 2006, p. 645). Shechtman (2006) dened integrative treatment as a multistage model wherein the client (a) explores the problem, (b) gains insight, and (c) commits to change (p. 645). The treatment is integrative because the exploration and insight stages slightly favor humanistic and psychodynamic techniques, while the commitment to change stage relies on cognitive behavior methods. Participants in Shechtmans (2006) study were randomly assigned to one of three treatment conditions: integrative counseling (IC), integrative counseling plus bibliotherapy (ICB), and no counseling. Participants in the ICB condition experienced a story, poem, or lm (Shechtman, 2006, p. 646) at the beginning of their sessions. On the basis of her qualitative outcome measures, Shechtman found increased empathy and reduced aggression in participants in the IC and the ICB conditions as compared with those in the control condition. Also, participants in the ICB condition showed greater gains in empathy, insight, therapist satisfaction, and therapeutic change, plus higher stages of change, than did the participants in the IC condition. Here, we see evidence for the use of fiction in therapy. However, Shechtmans (2006) use of a story, poem, or film (p. 646) to start the ICB sessions may be viewed as a methodological shortcoming. This lack of precision in describing the specific media chosen in the study is a problem because it implies that there are no process or outcome issues

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related to using books versus poems or films. Are they really the same? Indeed, this is what Shechtman seems to be suggesting. Use Goodnight Moon (Brown, 1975), or Lord of the Flies (Golding, 1954), or Terminator 2: Judgment Day (Cameron, 1991)whatever, it does not matter. Yet obviously it does because her experiment cannot be replicated if it is not known what the participants watched or read. Also, the concern extends beyond the matter of replication. Bibliotherapy with fiction is exciting to many clinicians because it brings an essential element of the humanistic perspectiveart!directly into the therapy room. To group books with films and not reveal what types of books or films are referred to is disappointing to fellow bibliotherapists. Furthermore, because the results indicate that the therapy works, Shechtman has missed an opportunity to create excitement about her method. Also, it is unfortunate that when Shechtman (2006) discussed bibliotherapy and its place in her design, she did not cite other research. She simply asserted that bibliotherapy aided in the rst two stages of integrative counseling by reducing the level of defensiveness (Shechtman, 2006, p. 645). In line with Pardeck and Pardecks (1984) view, she proposed that identifying with a character in a book allays defenses by offering an indirect way to talk about challenging issues. Clients can speak about what the character is going through and begin to see connections to their own problems, thereby gaining insight and moving toward change. Now that Shechtman has taken the rst important steps toward establishing the efcacy of bibliotherapy with ction, future research in bibliotherapy should begin at the level of the theoretical hypotheses, rather than assuming them to be true: Is identication with the characters required for therapeutic change? What happens if the client does not recognize herself or himself in the character? Is catharsis or insight the mutative factor? Moreover, understanding how a literary work helps a reader could increase the knowledge not only of bibliotherapy with ction but also of aesthetics in general and of the human experience of art. CHALLENGING ASSUMPTIONS ABOUT BIBLIOTHERAPY Although the identication, insight, problem-solving paradigm currently dominates bibliotherapy theory and research, it seems that such a complex work of art as the book could have multiple applications. In the following sections, I reconsider three basic assumptions about bibliotherapy with ction regarding who is considered a good candidate for bibliotherapy, what type of books should be used, and what the therapeutic goals are. I conclude with four suggestions for alternative therapeutic applications of bibliotherapy. Characteristics of Good Candidates for Bibliotherapy With Fiction Bibliotherapy with ction is generally viewed as an adjunct to child and adolescent rather than adult psychotherapy (Pardeck & Pardeck, 1984).

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Little reasoning is provided for this view, suggesting that the explanation is supposed to be obvious. In some sense, the kids only perspective logically ows from the theory. The idea is that bibliotherapy helps children achieve certain intrapsychic developments that adults were to have accomplished long ago, such as the ability to recognize aspects of ones self and ones problems in the life of another; to feel empathically, not only for others but also for oneself, and to react emotionally; and to problem solve by example. Although these are certainly important skills for children to learn, surely not all adults have mastered them. It also seems that bibliotherapy is considered to be limited to children because adult problems are thought to be too complex to be captured by a mere story. Novels of great psychological depth and complexity, such as Leo Tolstoys (1877/2000) Anna Karenina or Jean-Paul Sartres (1938/2007) Nausea, clearly suggest otherwise. However, on the basis of my experience, this belief that stories are for children seems to be shared by both therapists and clients. Therapists may fear that their clients will balk at reading a story as a way to better understand what they are going through, and clients may indeed resist and feel misunderstood. Surely their problems are too acute and need to be addressed in the here and now, and too deeply rooted in their own intimate history for a ctional narrative to provide any insight or relief. Reading ction with adults, many may assume, will waste valuable time and effort, plus risk infantilizing clients and minimizing their problems. Because adult clients can potentially benet from bibliotherapy, claims of these benets need to be discussed and explored. On the basis of their work with stepfamilies, Coleman and Ganong (1990) encouraged both therapists and parents to explore the same books that they recommended to child clients. They asserted that a well-written, honestly portrayed stepfamily story can be informative and instructional for adult readers (Coleman & Ganong, 1990, p. 328). Going beyond the didactic element, Coleman and Ganong (1990) added that they often used ction to sensitize (p. 328) graduate students to the problems their clients were facing. Yet what about identication and insight leading to increased self-awarenesscould an adult experience this type of personal growth through the guided reading of ction? Baudry (1990) considered the interesting example of the writer Mario Vargas Llosa, whose book The Perpetual Orgy describes his love affair with and unrequited passion (as cited in Baudry, 1990, p. 388) for the title character of Gustave Flauberts Madam Bovary. Vargas Llosa experienced neither a onetime aesthetic experience nor a single moment of identication leading to epiphany; he described instead a deep connection with a literary character leading to personal change over time. Unlike the actual people in Vargas Llosas life, Emma Bovary was always there for him. A ctional character can be brought to life indenitely merely by opening the pages of the book and stopping at the right lines (Vargas Llosa, as cited in Baudry, 1990, p. 388.) Also, Emma was emotionally constant. In contrast to the mercurial world at large, where personality, moods, desires, and wishes

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ebb and ow, Emma remained the same. Vargas Llosa was considering suicide, but reading about Emmas self-poisoning and agonizing death (and also, one imagines, her husband Charless distraught reaction) helped him control those thoughts. Each time [Vargas Llosa] found consolation and a sense of proportion, a revulsion against chaos, a taste for life in those heart-rending pages. The ctional suffering neutralized the suffering he was experiencing in real life (Baudry, 1990, p. 388). Vargas Llosa is perhaps an extreme example of adult bibliotherapy in action. His own unique attributesa passion for reading, a writers sensitivity to proseallowed him to connect with the ctional Emma on a level approaching a real human relationship. Yet Vargas Llosa is not unique in having his life saved or forever altered by the act of reading. A dear friend with depression told me that the subtly humorous and grimly existential poems of Fernando Pessoa have often staved off his thoughts of suicide. If Pessoa can do it, I can do it, he said. Im not so bad off as he. Personally, during periods of anxiety or fear, I recall the opening paragraph of Norman Mailers (1948/2000) The Naked and the Dead, the character John Gradys courage in Cormac McCarthys (1993) All the Pretty Horses, or other examples of heroism in literature. Although research is required, I hope that Vargas Llosas case and the aforementioned examples suggest the removal of the healing power of books from the kids-only realm. Surely adults are not immune to the kind of catharsis and identication hypothesized by Pardeck and Pardeck (1984). Also, even if experienced on a smaller scale than Vargas Llosas relationship with Emma Bovary, psychic interaction with literary characters offers a host of benets to adult clients, including identication leading to personal change, familiarity with emotional constancy, and strength by example. In addition, it should be noted that according to the bibliotherapy literature, not all children are considered good candidates for bibliotherapy with ction (Lindeman & Kling, as cited in Pardeck & Pardeck, 1984). Children with severe emotional, adjustment, or developmental problems are seen as less likely to benet from directed reading than are those with more minor or basic (Lindeman & Kling, as cited in Pardeck & Pardeck, 1984, p. 195) problems. At rst glance, this seems to make sense. Reading is both a mental and a physical activity. It requires a certain maturity of cognitive processing as well as the ability to sit still for a period of time. If either of these conditions is not met, the child is unlikely to benet, and other treatments (e.g., movement therapy, art therapy) may be indicated. To help satisfy the cognitive requirements, one should ensure that the book matches the childs reading level; otherwise, frustration will result (Pardeck & Pardeck, 1984). However, it still seems that illiteracy or learning disabilities need not preclude bibliotherapy. A child could be read to, as long as the storys content matched the childs level of comprehension. Also, the intellectual challenge posed by understanding a story might promote development. Finally, a child who cannot sit still might be encouraged to do so if the story was particularly interesting.

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Selecting Books and Understanding Goals for Bibliotherapy For Coleman and Ganong (1990), the issue of book selection is simple. The narrative and characters should reect as accurately as possible the readers situation in order to promote learning and identication. Also, on the basis of their experience, Coleman and Ganong (1990) believed that it is best for books to be set in modern times, to be realistic (p. 328), not to offend the religious beliefs or values of the reader, to have literary merit (p. 328), to be clear and brief, and to offer specic solutions to specic problems (p. 328). The precision of their list of qualications for books is perhaps a step in the right direction as far as research in this area is concerned, because it narrows the eld of possible active ingredients coming from the books themselves. Yet there is something frustrating about the strictness of their list, perhaps because of the way the rules attempt to force certain responses from clients. Sure, readers may identify with the characters, but what choice do they have? With too many rules, readinga cognitive and emotional, or in other words, soulful experiencebecomes a didactic exercise. Clients might as well attend a psychoeducational class on their diagnosis. Also, it seems possible that the process of identicationthe effort to connect with the charactermay be an essential component of the bibliotherapy experience. If the character is exactly the same as the reader, identication may happen as a matter of course rather than through a series of psychic steps that promote a type of awakening. So, rather than reading books wherein the characters problems are similar and the solutions obvious, clients may benet from having their imaginations kindled, their viewpoints challenged, their life choices questioned but not resolved. This is, after all, what book lovers love about booksthe journey in their mind. Clearly, the issue of book selection is necessarily tied to the therapeutic goals. For example, in their guidelines for selecting books, Coleman and Ganong (1990) prescribed not only clear-cut endings but also positive ones that set good examples. They believed that it was equally important that characters are shown making good decisions. If a character is initially led astray, he should eventually be shown choosing the correct path. Here, the goal is to teach. However, books have far greater powers. For example, if the reader has the capacity to be thoughtful and engage in a discussion with the therapist, ctive characters who make poor decisions and fail in their goals might have certain uses. In coping with dissonance, the reader may be encouraged to think beyond the bounds of personal experience and struggle with more universal issues. Also, a directive, sermonic approach entails certain risks. In his discussion of analytic treatment with children, Caspary (1993) wrote, When adults comment directly on childrens experience and motives, children, especially young children, tend to see adults as criticizing and directing rather than promoting self-understanding (p. 208). It is reasonable to assume that this caveat also applies to adult clients in the context of bibliotherapy. Because

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adults may believe that their problems cannot be adequately captured by a ctional story, a facile resolution may conrm their fears. Thus, the didacticism implied by Coleman and Ganongs (1990) insistence on happy endings risks telling readers what to do and criticizing them if they disagree. In addition to teaching values and problem-solving techniques, bibliotherapy should also include identication as an essential goal, according to Coleman and Ganong (1990). Thus, they insisted that the story match as closely as possible the life of the client. In Casparys (1993) conception of child therapy, however, insight is of relatively minor importance compared with relational factors (p. 208). If so, the specic content of the reading material becomes less important than the opportunities for interaction provided by the literature. This reduces the importance of identication with characters, and the task of reading becomes a relational stimulant for the client. According to Brandell (1988), the therapist seeks to create a climate of trust and to establish a meaningful affective tie with the child (p. 249). Struggling together over the meaning of a book or the choices a character makes could help establish such a tie. In fact, it seems that matching the story to the clients life risks oversimplifying the process and reducing the range of discussion. Even in their classic view of bibliotherapy, Pardeck and Pardeck (1984) saw the utility of not matching too closely or wrapping up too neatly. Books, they wrote, can still be useful even if they have vague endings, not always pleasant, which can lead to much open-ended discussion between the child and the helper concerning alternative solutions to the problem (Pardeck & Pardeck, 1984, p. 198). So, are identication and insight really the ideal goals of bibliotherapy? Clearly, they are for many of the authors discussed so far. Nevertheless, identication presents its own set of challenges. First, the process of identifying requires recognition by readers that there are indeed similarities between themselves and ctional characters. This ability to perceive the personal and subjective in anothers circumstance is not a psychological given; indeed, failure to empathize or connect with others may be an original source of clients problems. Also, as Pardeck and Pardeck (1984) suggested, even if clients recognize themselves in a character, intellectualization rather than insight may occur. For example, clients may invent their own personalized message, such as everyone makes mistakes or that would never happen to me since I would do such and such. The process of identication and projection may therefore only serve to relieve the child of any responsibility for the resolution of the problem (Pardeck & Pardeck, 1984, p. 202). Conversely, clients overidentication with characters may occur. Mark David Chapman, John Lennons assassin, famously identied with Holden Cauleld from J. D. Salingers (1951/2001) novel The Catcher in the Rye. Nevertheless, it seems that a rebellious young person could benet from a discussion of Caulelds experience, or an individual who is suicidal nd deep meaning in the poems of Sylvia Plath (e.g., Plath, 2008), who took her

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own life. The implication here is that books are complicated and peoples reactions to them even more so. Insisting on identication (just the right amount) and insight (just the right kind) imposes a simplicity on a process that is anything but. ALTERNATIVE THERAPEUTIC APPLICATIONS OF BIBLIOTHERAPY WITH FICTION Books as Alliance Builders Therapists very likely use this alliance-building technique in bibliotherapy without recognizing it as such. If a client mentions a book and the therapist admits having read and enjoyed it, a connection is made. The depth of the connection is to some degree in the therapists hands, depending on the level of disclosure she or he is willing to make. Books can become the focal point of a kind of private club. A client who feels passionately about the high-seas adventure novels of Patrick OBrian is likely to experience an instant and deep afnity with a therapist who has also mastered those same thousands of densely written pages. Whether this sort of connection violates neutrality, interferes with transference, or risks sending the therapy in an intellectual as opposed to experience-near direction are important issues to consider. However, it seems that because the goal of expressive therapy is unfettered verbal communication, uniting with a client over a jointly favored expression mode seems potentially benecial. By the same token, disagreeing with a client over the quality of a book could stress or harm the alliance. An OBrian fan who learns that rather than bother with the book his therapist just saw the movie is likely to be disappointed. Yet a rupture of this sort might also serve a purpose because the therapist is now in the position to ask, What does it mean to you that we disagree about this book? When asked by clients if I have seen this movie or read this book, I am reluctant to immediately disclose. I am rst interested in how clients might summarize the plot and which elements they pick out as special. A female teenage client was particularly excited by George Orwells (1950) 1984. Her description of the narrative focused on the totalitarian states efforts to crush the main character Winston Smiths spirit and her perception of Smith as a loser for conforming in the end. This led to a discussion of the clients self-described nonconformity, a series of behaviors that took many costly forms, including cutting, overspending on clothing, and having unprotected sex. To engage fully in the discussion and invite the client to identify more fully with Smiths predicament, I felt the need to draw her attention to certain concepts in the book, such as thoughtcrime, Thought Police, and Cult of Personality. In so doing, I necessarily disclosed having read the book. The clients delight when I rst said thoughtcrime seemed obvious, and I felt our connection deepen. However, my supervisor raised an interesting question: Did I mention thoughtcrime to deepen and

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broaden the discussion or to seem cool and on the level to a young, hip client? The answer is probably both. Also, I may have wanted to show off my knowledge of books and to make sure the client knew that I was just as well-versed in literature as she. In retrospect, the clients feelings about my having read 1984 should have been explored in more detail. An opportunity for an in-the-moment discussion of the relationship presented itself, but I was too quick to assume that the client was pleased by our shared experience of Orwell. Perhaps she felt she was bringing something special to the therapy, and my previous experience of the book made her offering seem more ordinary. Clearly, the issue of discussing books with clients is complicated, but as an opportunity for elaborating transference and expanding the alliance, it seems exceedingly rich. Books as Keys to the Unconscious For bibliotherapists such as Coleman and Ganong (1990), the goal of bibliotherapy is clear. The reader must recognize that she or he and the protagonist share the same problems and that those problems can be solved in certain appropriate ways. There is no room in such a method for the clients unconscious experience, and by prescribing books that closely match the clients life, Coleman and Ganong effectively limited projection, association, and fantasy. As a result, they converted bibliotherapy with ction into a didactic endeavor similar to bibliotherapy with nonction. This is unfortunate because bibliotherapy with ction offers its own unique possibilities for healing, particularly the opportunity to explore the clients unconscious. Kundera (1986/2003) dened a novelist as one who pursues truth by seeking to unite reality and fantasy (p. 82). A therapist could be similarly dened. Thus, using ction books of almost any type is likely to aid the therapeutic endeavor, as long as the content in some way catches the clients interest. As the material is discussed, the therapist can encourage the client to associate to the material or fantasize, perhaps about what she or he would have done in the characters circumstances. Such reections of unconscious material can then be explored in order to hypothesize about the hidden meaning of the clients thoughts, feelings, and behavior. The goal here is similar to Pardeck and Pardecks (1984) classic view of bibliotherapy, only the route taken is different. Whether by directly identifying with the character or freely associating to story content, both methods seek to promote insight. However, eliciting unconscious material permits a broader scope in the inquiry and, thus, an opportunity for deeper awakening. If insight is gained by identifying with a character, the extent of the readers experience may be restricted to I too have these problems. If clients associate to a variety of story content, the full breadth of their experience becomes the goal of the analysis and they are invited to identify with themselves. The book itself plays a smaller role in this technique, becoming more of a springboard into association and process.

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A nal note on matching story material to client experience: Attempting to control literary content and thus client reaction is a battle no one can win. Baudry (1990) wrote, A novel, being the creation of its author, is all make-believe in its ordering and unfolding, even if the novel is based on some actual event (p. 374). This implies that although matching tries to insert nonction into ction, the attempt necessarily fails because the story remains ctive. The reader must make interpretations to understand the characters behavior, interpretations that necessarily express the readers own unique worldview. Also, because life can never be adequately captured in a reected artistic image (Baudry, 1990, p. 374), any attempt to do so risks reductionism. When reading a story that is similar to their own, clients may experience a certain validation, a cognition such as, Yes, this too happened to me. Still, what can be more deleterious is that if the storys structure is too simple, clients may feel that their problems are poorly expressed or too easily overcome, and thus mocked. Books as Fantasy Stimulants Although books may be a route to insight via the unconscious, remember that Caspary (1993) argued that insight is not necessarily the primary goal of therapy with children. Spitz (1989) emphasized the potential for therapeutic gains in validating and privileging [childrens] inner worlds of fantasy (p. 354). Children, especially those on inpatient units, may spend a lot of time alone with their thoughts. The therapist who reads with children can experience rsthand how they think and what form and quality their fantasies tend to assume. Spitz (1989) described a therapist reading with a client as being like a violinist translating the notes of a score into audible sound and whose accuracy, interpretive skill, enthusiasm, timing and contact with the listener affect the reception of the music (p. 354). By reading and fantasizing in the presence of their therapist, clients may experience a different way of coping with fantasy, a new method for sitting with, playing with, and ultimately controlling potentially frightening thoughts. The story and the fantasies it inspires become like transitional space, that special world for play and exploration that is exciting yet safe because it exists outside both the individual and reality (Winnicott, as cited in Caspary, 1993). Here, play itself becomes the goal, an essential period of practice before identifying, taking responsibility, or problem solving can effectively occur. Books as an Emotion Engine Reisenzein (1983) cited studies of emotion in which an individuals awareness of the emotional content of an experience is accentuated or wholly accounted for by a stimulus that is not present in the experience. For example, running on a treadmill in situation A can heighten sexual arousal in situation

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B, or the enjoyment of music is predicated by exposure to either positively or negatively valenced emotional material. So imagine reading a story that is exciting or otherwise emotionally provocative with a client. It seems that the feelings generated by the story might ow naturally into the therapy process. Emotional resistancefor example, Schafers (1983) terror and Teybers (1999) shame and guiltmight in this way be overcome, if only temporarily. A problem with this argument is the looseness of it. Watching a basketball game, listening to jazz, or dancing with a client, all might recommend themselves as exciting stimuli to overcome the resistance doldrums. Yet surely decorum, neutrality, and professional scruples dictate otherwise. Social custom grants books an intellectual weight that makes their place in therapy more appropriate than other assorted forms of entertainment. Finally, for Oatley and Johnson-Laird (1987), most emotions of interest to humans occur in the course of our relations with others (p. 41). This view seems controversial. The increased technological focus of recent years may have promoted a more solitary lifestyle for humans wherein the emotions of interest are more typically kindled by various media formats. Advertisements for the video game platform Sony Playstation 2 emphasized the systems advanced central processing unit called The Emotion Engine (Levy, 2000). The goal was to entice buyers who were excited by the idea of experiencing strong emotions in private. If primary emotional states are becoming a more intrapersonal phenomenon, an initial interface with their therapist through the middle ground of a book might be a way of adapting clients to a more interpersonal process. Books offer the possibility of not only exciting clients but also comforting them, easing their passage down the road from solitary experiences of limited emotion to more potent encounters with the therapist. REFERENCES
Ahmann, E. (1997). Books for siblings of children having illness or disability. Pediatric Nursing, 23, 500503. Baudry, F. (1990). Character in ction and ction in character. Psychoanalytic Quarterly, 59, 370397. Bilich, L. L., Deane, F. P., Phipps, A. B., Barisic, M., & Gould, G. (2008). Effectiveness of bibliotherapy self-help for depression with varying levels of telephone helpline support. Clinical Psychology and Psychotherapy, 15, 6174. Brandell, J. R. (1988). Narrative and historical truth in child psychotherapy. Psychoanalytic Psychology, 5, 241257. Brown, M. W. (1975). Goodnight moon. New York, NY: HarperCollins. Burns, D. D. (1999). Feeling good: The new mood therapy (Rev. ed.). New York, NY: HarperPaperbacks. Cameron, J. (Writer/Director/Producer). (1991). Terminator 2: Judgment day [Motion picture]. United States: TriStar Pictures. Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B. E., Ekselius, L., & Andersson, G. (2006). Remote treatment of panic disorder: A randomized trial of Internet-based cognitive behavior therapy supplemented with telephone calls. American Journal of Psychiatry, 163, 21192125. doi:10.1176/appi.ajp.163.12.2119

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Carlbring, P., Furmark, T., Steczk, J., Ekselius, L., & Andersson, G. (2006). An open study of Internet-based bibliotherapy with minimal therapist contact via email for social phobia. Clinical Psychologist, 10, 3038. Caspary, A. C. (1993). Aspects of therapeutic action in child analytic treatment. Psychoanalytic Psychology, 10, 207220. Castonguay, L. G., & Hill, C. E. (2007). Insight in psychotherapy. Washington, DC: American Psychological Association. Coleman, M., & Ganong, L. H. (1990). The uses of juvenile ction and self-help with stepfamilies. Journal of Counseling & Development, 68, 327331. Floyd, M., Rohen, N., Shackelford, J. A. M., Hubbard, K. L., Parnell, M. B., Scogin, F., & Coates, A. (2006). Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults. Behavior Modication, 30, 281294. doi:10.1177/0145445503261176 Golding, W. (1954). Lord of the ies. London, United Kingdom: Faber & Faber. Gregory, R. J., Schwer Canning, S., Lee, T. W., & Wise, J. C. (2004). Cognitive bibliotherapy for depression: A meta-analysis. Professional Psychology: Research and Practice, 35, 275280. Head, C. A. (2007). Bibliotherapy: The use of fantasy novels in child and adolescent psychotherapy. Unpublished manuscript, Department of Psychology, Long Island University, Brooklyn, NY. Kundera, M. (2003). The art of the novel (L. Asher, Trans.). New York, NY: HarperCollins. (Original work published 1986) Levy, S. (2000, March 6). Here comes Playstation 2. Newsweek, 135, 5460. Lyneham, H. J., & Rapee, R. M. (2006). Evaluation of therapist-support parent-implemented CBT for anxiety disorders in rural children. Behavior Research and Therapy, 44, 12871300. Mailer, N. (2000). The naked and the dead: 50th anniversary edition. New York, NY: Picador. (Original work published 1948) McCarthy, C. (1993). All the pretty horses (The border trilogy, Book 1). New York, NY: Vintage/ Anchor Books. Naylor, E. V., Antonuccio, D. O., Johnson, G., Spogen, D., & ODonohue, W. (2007). A pilot study investigating behavioral prescriptions for depression. Journal of Clinical Psychology in Medical Settings, 14, 152159. Oatley, K., & Johnson-Laird, P. N. (1987). Towards a cognitive theory of emotions. Cognition and Emotion, 1, 2950. Orwell, G. (1950). 1984 (Reissue). New York, NY: Penguin. Pardeck, J. T. (1994). Using literature to help adolescents cope with problems. Adolescence, 29, 421427. Pardeck, J. T., & Pardeck, J. A. (1984). Treating abused children through bibliotherapy. Early Child Development and Care, 16, 195204. Plath, S. (2008). The collected poems (T. Hughes, Ed.). New York, NY: HarperCollins. Reisenzein, R. (1983). The Schachter theory of emotion: Two decades later. Psychological Bulletin, 94, 239264. Riordan, R. J., & Wilson, L. S. (1989). Bibliotherapy: Does it work? Journal of Counseling and Development, 67, 506508. Salinger, J. D. (2001). The catcher in the rye. New York, NY: Back Bay Books. (Original work published 1951) Sartre, J.-P. (2007). Nausea (L. Alexander, Trans.). New York, NY: New Directions. (Original work published 1938) Schafer, R. (1983). The analytic attitude. New York, NY: Basic Books. Shechtman, Z. (2006). The contribution of bibliotherapy to the counseling of aggressive boys. Psychotherapy Research, 16, 645651. Shechtman, Z., & Nir-Shfrir, R. (2008). The effect of affective bibliotherapy on clients functioning in group therapy. International Journal of Group Psychotherapy, 58, 103117. Spitz, E. H. (1989). Primary art objects: Psychoanalytic reections on picturebooks for children. Psychoanalytic Study of the Child, 44, 351368. Teyber, E. (1999). Interpersonal processes in psychotherapy: A relational approach (4th ed.). Pacic Grove, CA: Brooks/Cole.

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Tolstoy, L. (2000). Anna Karenina (C. Garnett, Trans., L. J. Kent & N. Berberova, Eds.). New York, NY: Modern Library. (Original work published 1877) van Lankveld, J. J. D. M., ter Kuile, M. M., de Groot, H. E., Melles, R., Nefs, J., & Zandbergen, M. (2006). Cognitive-behavior therapy for women with lifelong vaginismus: A randomized waiting-list controlled trial of efcacy. Journal of Consulting and Clinical Psychology, 74, 168178. Zaccaria, J. S., & Moses, H. A. (1968). Facilitating human development through reading: The use of bibliotherapy in teaching and counseling. Champaign, IL: Stipes.

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