Shelf Help: An Exploration of Bibliotherapy

The patient refused to speak. He wouldn’t say a word to his therapist, or to anyone else for that matter, which was why he was in therapy in the first place. After several weeks of unrelenting silence, the therapist gave the patient a poem to read—Stone by Charles Simic.

From the outside the stone is a riddle: 
No one knows how to answer it. 
Yet within, it must be cool and quiet …

I have seen sparks fly out 
When two stones are rubbed, 
So perhaps it is not dark inside after all. 

The patient read the poem to himself. Then he wrote a poem of his own: “I am like this stone. I am broken. I once was great like a mountain. But now I’m broken.” And then he began to talk.

The therapist in question was a protégé of Dr. Sherry Reiter, who tells the story with pride even though she wasn’t there to witness it.  But perhaps, as one of the pioneers in the field of poetry therapy, Reiter (pronounced “writer”) has the right to lay claim to any stories that involve the successful use of poetry in the soothing of troubled minds and healing of heavy hearts. Reiter, a doctor of social work with a masters in creative arts therapy, is one of the founding members of The National Association for Poetry Therapy. She is also the director of “The Creative Righting Center,” a ten-month poetry-therapy certification program that operates out of a high-ceilinged loft in Chelsea. Sometimes, her students call her the Poetry Doctor, although she is quick to point out that this is not because she doctors poetry.

Poetry therapy falls under the umbrella of bibliotherapy, which can be broadly defined as a type of creative arts healing that uses directed reading to help patients work through psychological, social, and developmental issues. Or to put it more simply, bibliotherapists select works of literature that contain characters, tropes, imagery, or phrases that a patient might identify with and that might help the patient feel less alone, less frightened, less conflicted.

“It’s really just the use of words, which is the lifeblood of psychotherapy,” Reiter explained before one of her monthly training workshops. She has soft grey hair and chocolate eyes, and speaks in a hushed tone that makes you feel simultaneously secure and sleepy. “You have all the psychological mechanisms of dreams: you have condensation and displacement. You have projection. But at the heart of it is imagery and poetic device. Poetic device bypasses any resistance that the person may have.”

It was an icy, grey Sunday in early March, but the Chelsea loft was warm and cozy, its walls a soft aquamarine, its floor covered in a creamy, shaggy carpet. Underneath a row of hooks that line the entrance to the loft was a long, wooden plaque painted with the words, “Transform. Shout. Jump for Joy.” One by one, Reiter’s students filed in, all of them women, all of them hoping that within poetry lies a transcendent healing power.

“Poetry is revolutionary,” said one student, a social worker and published poet named Lora Tucker. “It’s made to do transformative work … And I think it’s teaching a lot of people compassion, empathy, a sense of family and community that’s so important now. I work with teenagers, and that’s one of the things that’s very lacking: their sense of compassion and community, and also their expository reaction to things. How are they thinking? How are they feeling? Can they put in words what they’re feeling?”

March’s Creative Righting workshop was, in fact, all about giving voice to the most difficult of emotions. The title of the session was “The Hole in the Heart: Bereavement, Grief, and Loss.” Reiter passed around a thick packet of poems that deal with the process of coming to terms with the death of a loved one, poems like Linda Pastan’s The Five Stages of Grief, which snakes through the phases of denial, anger, bargaining, depression, and acceptance. The group read the poems aloud, and discussed how each one might be helpful to patients who are grieving deeply, and grieving differently.

Then, because Reiter believes that her students can only successfully administer poetry therapy once they have experienced it, she had them write and recite their own poems about people they have lost, or people they do not want to lose. When one student, Rou, read a poem about her brother, who died of AIDS many years ago, her voice wavered and her eyes filled with tears.

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 Lora Tucker, the social worker who works with troubled teenagers, has been using Reiter’s class as a means of coping with her own AIDS diagnosis. “I look at the work that I do with Sherry as a part of the work that I do on myself,” she said. “I go to the workshops, even though I don’t right now have the money to pay for the supervision hours. It’s part of my wellness.”

Tucker is an African American woman with heavy-lidded eyes and a shock of buoyant, copper hair. She chortles at her own jokes and giggles when she shows off photos of a young, very handsome soldier who has been flirting with her online and who, by Tucker’s own admission, may very well be an MTV-style catfish.

But beneath Tucker’s smiles, there is sadness. She refers to her AIDS diagnosis as “my 9/11,” and though she has written poems about many different subjects, she was unable to write a single stanza about her illness for fifteen years. But then Tucker joined Reiter’s poetry therapy certification course, and felt an instant connection with Reiter and the other members of the Creative Righting group. Now, she is comfortable opening up about the fear and loneliness that have plagued her life since that summer’s day in 1997, when an ex-boyfriend called and told her she needed to take an HIV test.

“Poetry for me has always been the means in which I can have a voice,” Tucker told me, when we met at a Park Slope Diner several weeks after the Creative Righting workshop. She reached into her bag and pulled out a plastic folder, stuffed with her own work, and with poems that Reiter has handed out during different sessions. Tucker began to recite a poem that she wrote during one of Reiter’s class exercises:

Know my name as you continue

Utter the sounds that make it so

Your lips say to the air

That you’ll make me,

You’ll let me go …

Fill your soul with what once was mine

And utter my sounds

Remember my name.

“We all live to die, but I had a reality that I could have died sooner,” Tucker said, folding the page and slipping it back into her folder. “There’s still the fact that things might not go right, and things could turn around on me that quickly. Some people have the luxury of not having to worry about impending doom.”

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 That literature can be used for therapeutic purposes is not a new idea. As far back as the fourth century BCE, Aristotle was writing about the cathartic effect of dramatic poetry. Two 19th century American physicians independently noted that guided reading produced positive outcomes in the treatment of the mentally ill, and in the aftermath of WWI, librarians were recruited to carefully curate libraries at veterans’ hospitals because doctors believed that books were beneficial to soldiers’ psychological recovery. The term “bibliotherapy” appears to have been coined in 1916 by a preacher named Samuel M. Crothers, who wrote an article in the Atlantic Monthly about using books to help “troubled” individuals.

But the notion of bibliotherapy as a clinical discipline that can be taught in universities and carried out by certified professionals is relatively recent. When Reiter took a course in poetry therapy at the New School in the 1970s, not many psychotherapists had heard of the field, and poetry therapy was nowhere to be found in the majority of psychotherapy degree programs. Along with her fellow co-founders of the National Poetry Therapy Association, Reiter spent many years pitching poetry therapy to universities around the country. Now Hofstra University, Union Institute, Vermont College, and an organization devoted to “poetic medicine” offer certification courses in poetry therapy.

Though she likes to recount the story of her protégé’s breakthrough with the selectively mute patient, Reiter has plenty of success stories of her own. During recent session with a woman who was stricken by acute bouts of anxiety after the death of her husband, Reiter decided to try out a “bereavement ritual” inspired by a Thich Nhat Hahn poem that deals in assertive expressions of the self:

I asked the leaf whether it was frightened because it was autumn and the other leaves were falling …

I worked hard to help nourish the tree, and now much of me is in the tree.

I am not limited by this form.

I am also the whole tree.

“OK,” Reiter said to her patient. “I would like you to fill this in: ‘I am sorry that…’ ‘I feel bad that…’” And then, suddenly, the woman burst into tears. She confessed that she had once engaged in a brief, loveless affair while her husband was still alive. He had died without ever knowing of her infidelity, and until that point, she had been unable to bring herself to speak of the affair, unable to forgive herself for what she had done.

While bibliotherapy has come of age in recent years, it is not recognized by the broader mental health community. Talk therapy as a whole is, in fact, on the decline, with an increasing number of psychiatrists prescribing psychotropic medications instead of the therapist’s couch. Bibliotherapy also hasn’t been extensively studied, making it difficult for the field to gain acceptance within a medical culture that places overwhelming value on hard evidence and scientific facts.

“There’s a lot of emphasis now on empirical data,” said Jessica Greenbaum, a social worker who uses poems in group therapy sessions, but does not refer to herself as a “poetry therapist” because she is not certified in the field. “How do we empirically know bibliotherapy does help? That’s why that stuff might not be in the first tier of journals—my guess is there really aren’t empiric studies that can prove that.”

Another stumbling block in the way of bibliotherapy becoming a mainstream clinical discipline might be the fact that some “bibliotherapists” aren’t actually therapists at all. During her workshop, Reiter noted with some displeasure that bibliotherapy is “often used by people who may not have training.” While Reiter’s students receive that training, not all of her them are mental health professionals; among the social workers and psychologists who made up the bulk of the class were a middle school literacy coordinator and a writer by profession. Many fiction “therapists” have no certification whatsoever; they are often writers, who will dole out personalized reading recommendations for a fee.

“You can’t call yourself a dentist if you’re not a dentist,” Greenbaum noted during a phone interview. “I feel like people use poems the way they want. Unlike dentistry, which is considered a science, they just decide it’s their thing to use with a title like ‘therapist.’”

She paused for a moment, and then said: “Sometimes I wonder who needs the legitimacy. Who’s calling for it? Is it because people need grant money? Otherwise, do we really care?”

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Susan Elderkin has counseled clients through career crises, bad boyfriends, and deep depression. A succession of grieving parents recently sought out her services, looking for help in coping with the death of a child. Elderkin refers to herself as a “bibliotherapist,” but she is not a mental health professional; she is a novelist, the British author of Sunset Over Chocolate Mountains and Voice. 

“The best education a person can have to be a bibliotherapist is to be a huge reader,” Elderkin said during a phone interview. “We’re very obsessed with having scientific validation for things, and yet there’s been a sense of books as a quiet place to commune with your soul since the time of the Greeks.”

Elderkin studied English Literature at Cambridge, where she and a friend named Ella Berthound would playfully recommend books to one another when hearts got broken, or studies became stressful. In 2008, they took their idea for a bibliotherapy service to the School of Life, a London-based “social enterprise” that seeks to guide clients through various feelings of malaise with the help of courses like “How to Spend Time Alone,” “Have Better Conversations,” and “Getting Better At Online Dating.”

Elderkin and Berthound’s program was one of the first to apply fiction-based bibliotherapy to adults, and it quickly became one of the more popular services that the School of Life offers—so popular, in fact, that Elderkin and Berthound recently wrote a book on bibliotherapy called The Novel Cure. (Bibliotherapists, perhaps unsurprisingly, like puns).

The duo doesn’t see the sort of difficult patients that social workers like Reiter must contend with in their practice; clients of the School of Life’s bibliotherapy program are willing to be helped, and happy to pay the 130-odd dollars that Elderkin and Berthound charge for each consultation. Emily Hunt, a London-dwelling American expat, got in touch with the School of Life when she decided to take advantage of unused vacation days, and had some time on her hands to work through a personalized list of reading recommendations. Because Hunt is having a difficult time adjusting to life across the pond, Berthound recommended—among other things—several novels that are steeped in a rich and vibrant London. “The way that she was essentially prescribing books to either further my thinking or fill a gap in my thinking, or, honestly, to entertain or distract, was pretty spot on for what I was looking for,” Hunt said. “It was really helpful”

While Berthound continues to work from London, Elderkin is now based in New Haven, Connecticut. Her method of counseling is relatively simple; she asks her clients—either by e-mail, or phone, or in-person—about books they have loved, books they have hated, issues they are facing, and what they hope to get out of the therapy session. Then she will write up her “prescription,” as she calls it: a list of books that will teach her clients a lesson, that will inspire them to make a change in their life, that will help them feel less alone. Her approach can get a little cutesy; Elderkin refers to her online consultation forum as a “surgery,” and to books as “remedies.” The Novel Cure even goes so far as to provide recommendations for ailments like constipation, suggesting that those afflicted turn to Shantaram by Gregory David Roberts(“Read it for its lovely list of soft fruits that may loosen your small intestines like a lexical laxative.”)

But many of Elderkin’s private consultations are no joking matter. For grief-stricken parents, she has recommended The Year of Magical Thinking by Joan Didion, and To the Wedding by John Berger, both of which deal with the death of a loved one. She has suggested that clients overcome with apathy read James M. Cain’s The Postman Always Rings Twice because “it has a really lovely, rousing rhythm … and it just ups the energy in your body.” Somewhat surprisingly, her prescription for those suffering from depression is a dose of gloomy novels like The Bell Jar by Sylvia Plath. “We spoke to a lot of people with serious depression, and they said that when it’s really bad, you need books that show it like it is, that don’t jolly you out of it.”

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On a warm day in early May, five girls sat at desks that had been squished into a semi-circle in a math classroom on the sixth floor of the Casita Maria Center for Arts and Education. The tinkling music of an ice cream truck trickled in through open windows, and the late-afternoon sun splashed across colorful posters that broke down the steps of solving a quadratic function. But for now, math wasn’t on the agenda. Instead, the girls had gathered together to read poems under the guidance of the school’s literacy coordinator, Erienne Rojas.

The Casita Maria Center is a middle and high school in the South Bronx that places special emphasis on the arts. It is a colorful, vibrant place; students laugh as they lean against the bright yellow doors of the school, they toss balls around in the gym, they give their teachers hugs. But like any school where adolescents and teenagers roam the halls, Casita Maria has had its fair share of problems.

Teachers and administrators have been worrying for some time that many of the pre-teen girls seem confused by the physiological changes that are taking over their bodies. There are issues of bullying, low self-esteem, and fighting within and between different cliques. Some of the girls have started self-mutilating. One way that the school is trying to combat these problems is through a “girl empowerment workshop” for twelve and thirteen year olds, which uses poetry to help students identify and validate their emotions, thoughts, and fears.

Rojas, who is one of Sherry Reiter’s students, is the creator and facilitator of the workshop.  “I want the kids to experiment with poetry in a different way that they’re not used to, which is on a personal level,” she said. “I feel poetry reflects their stream of consciousness. They’re reading fiction and mostly informational texts with the curriculum. It’s that block passage that just shuts them out, they lose interest. Poetry is sparse.”

Erienne Rojas

Erienne Rojas

Every week, Rojas picks one poem that relates to a specific topic: puberty, stress, friends, academics, parental conflict. She will have the girls read the poem, talk about its main tropes, and identify phrases that speak to them. The workshop is not a counseling session; the therapeutic aspect lies in the identification of emotions that are difficult for the girls to express. “They don’t really know how to talk about themselves,” Rojas explained. “For me, the biggest goal here is self-awareness: get them to the point where they are aware what’s going on emotionally, socially, and physically as well.”

The topic of the first workshop in May was “transition,” specifically the transition from childhood to adolescence. Rojas handed out copies of a poem called “Hanging Fire” by Audre Lorde, which is told from the perspective of a fourteen-year-old girl:

I am fourteen

and my skin has betrayed me   

the boy I cannot live without   

still sucks his thumb

in secret

how come my knees are

always so ashy

what if I die

before morning

and momma’s in the bedroom  

with the door closed.

“In this poem, we have to ask the question: does the speaker really mean what she says?” Rojas told the students. “Is her mom really behind a door? Or is it that people just don’t understand her so she feels like the door is closed?”

“I thought maybe her mom won’t be able to see what’s happening to her,” said one of the students, a tall girl named Maria.

“Excellent point,” Rojas said with a nod. “Sometimes people can’t see outside of themselves, right? Maybe mom is there, but doesn’t see you, that you’re changing. How many of us can relate to that?”

All of the students raised their hands.

Perhaps unsurprisingly, the speaker’s faltering self-esteem was an issue that resonated with the group. As the girls combed through the stanzas of the poem, noting the speaker’s discomfort with her ashy knees and changing skin, they began to open up about the challenges they are facing as their bodies change and their relationships become more complex. They expressed concerns about getting braces. They spoke about the insecurity they feel when other girls in the school tell them they aren’t pretty. One student, Amelia, told the group that she had wanted to try out for a talent show, but had been discouraged from doing so by a cousin. “She laughed at me,” Amelia said. “She was like, ‘You’re not going to be able to do that.’ She put me down, so that’s why I didn’t do it.”

Before she dismissed the group, Rojas asked the girls if they enjoyed reading “Hanging Fire.” “I felt like it spoke to me,” said a student named Jessica. “I could relate to it in a lot of different ways. There are some other poems, where I can read it, and I can see how someone might feel. Maybe I can take into consideration their feelings sometimes.” Another student noted that reading poetry makes her feel “relieved” because the poems that Rojas has given them “relate to people.”

And really, that’s all Rojas wants: to help her students feel a little less confused and a little less alone during a difficult time in their lives. She watched with a smile as the girls skipped out of the classroom, chatting with one another as they headed into the warm, spring sun, each one holding a poem in her hand.