Stories That Heal

Once upon a time in an Oregon river valley, there lived a woman named Dale-Elizabeth Pehrsson. At the big university where she was a teacher and researcher, her students called her Dr. Dale. When visitors walked into Dr. Dale’s office at the College of Education, they noticed something very important about her: She loved working with children. Toys and dolls and posters in bright colors filled every niche. Picture books filled every shelf. And her blue eyes sparkled with excitement whenever she talked about using stories to help children heal.

“In times of trauma and stress,” she would tell her visitors, “books and stories can buttress children’s self-concept, cultivating self-worth and calming the storm.”

Terra Up Close

Bibliotherapy in Kenya


It was at the bedside of a dying relative that the idea for Daphne Kagume’s doctoral dissertation took hold. As her beloved uncle succumbed to AIDS in a Kenya hospital, the OSU graduate student witnessed the heartbreaking isolation that so often afflicts AIDS patients in her native country.

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So at the turn of the millennium, the OSU associate professor for counseling education teamed up with OSU’s social science reference librarian — Associate Professor Paula McMillen — to develop literature-based tools and trainings for grad students preparing to work with troubled kids.

A paper-and-pencil questionnaire designed by Pehrsson for evaluating children’s books has evolved into the Bibliotherapy Education Project, featuring a searchable database of 600 titles. The project Web site, launched in 2003, has drawn queries from 40 states and at least half-a-dozen countries. The professors have developed workshops for mental health professionals, which they are adapting for teachers and librarians. With funding from the Association for Creativity in Counseling, a branch of the American Counseling Association, they are conducting a national study to investigate the scope and reach of bibliotherapy across the U.S. Another study exploring cultural responses in book choices aims to sharpen counselors’ sensitivities and, ultimately, to enhance the development of positive ethnic, racial or cultural identity among young clients.

“All the research I do,” says Pehrsson, “is aimed at improving counselor competency in working with children.”

Monsters To Vanquish

Long before they teamed up at OSU, both professors had discovered the therapeutic powers of the technique known as “bibliotherapy,” defined variously as “helping with books,” “guided dialogue about books” or “literature as a catalyst for growth and healing.” Pehrsson and McMillen each used bibliotherapy in their previous careers, McMillen as a clinical psychologist and Pehrsson as a pediatric nurse, play therapist and family counselor. The technique, which is used with people of all ages, is especially suited to kids. Related to other expressive techniques such as play therapy and art therapy, it gives children a psychological pathway — a backdoor of sorts — to feelings they’re not able to analyze, articulate or access directly.

Bibliotherapy — coined as a term in 1916 and established as a practice at the Menninger Clinic in the 1930s — has grown steadily in popularity among teachers, school counselors, mental-health therapists and librarians. Today, bibliotherapy is a many-headed creature. It looks quite different from setting to setting, morphing to meet client needs and practitioner expertise, spanning a continuum from “developmental” to “clinical” — from wrestling with the normal ups and downs of life, to dealing with extreme trauma or emotional disturbance. A teacher or librarian will typically use stories developmentally to address topics like starting kindergarten, fending off bullies or understanding cultural differences. Clinical interventions, on the other hand, belong strictly in the offices of trained mental health professionals.

Ironically, even as the child taps deep emotions through a fictional character — a motherless bat named Stellaluna who tries to fit in with a flock of birds, a cub named Koko Bear whose parents are divorcing, a little girl named Sara whose best friend, Rune, drowns in a lake — that character shields her from those feelings’ full impact. The story forms a “safe container,” a place to explore emotions while keeping a comfy distance from them; they are, after all, happening to Stellaluna or Koko Bear or Sara, not to the child. Couched in metaphor, wrapped in fantasy, fictive emotions can instruct, gently, through example and empathy. “Books can provide a buffer, a psychological distance or safety net for exploring issues that can elicit emotional intensity,” Pehrsson says.

Unlike a sleepy-eyed bedtime story, clinical bibliotherapy is hard work. “We’ve got worries to figure out,” Pehrsson would tell her young clients. “We’ve got monsters to vanquish!”

Bibliotherapy can enhance personal insight, suggest alternatives, diminish isolation, clarify values, stimulate discussion, foster empathy and nurture ethnic identity and pride, according to Pehrsson and McMillen. It can be applied, they say, to an “astounding” range of problems: Aggressiveness, adoption, addiction, grief, depression, nightmares and homelessness are just a few.

But it’s not without dangers and drawbacks. The OSU professors warn that bibliotherapy’s benefits depend heavily on the practitioner’s training and skill. While skillful story work can help kids cope with tough circumstances, a clumsy or careless venture into stories about sensitive topics — death, divorce, abuse, abandonment — can further disturb or damage a vulnerable child, they caution. Says Pehrsson: “If it’s a really scary topic and you open that book, you may be pushing something on the child they’re not ready for.” Adds McMillen, “All the things that can make bibliotherapy powerful in a positive way can make it powerful in a negative way.”

One Enchanted Story

“The right story at the right moment is an arrow to the heart. It can find and catch what is hiding inside the reader (or the listener), the secret hurt or anger or need that lies waiting, aching to be brought to the surface.”
Bruce Colville
children’s author, 1990

Bibliotherapy’s power stems from the ancient and universal enchantment of stories, the professors explain. Fairy tales, fables, myths and epic narratives have been vehicles of culture and wisdom throughout human history. “We are creatures who learn through stories,” says Pehrsson, who is clinical editor of Play Therapy magazine. “Stories, like human lives, have a beginning, a middle and an end. For children to understand and make sense of the world, a story is a very logical fit. It’s how we’re wired.”

Related to bibliotherapy is a strategy that Pehrsson calls “collaborative story writing” or “co-storying.” The therapist starts a story (“Once upon a time long, long ago, there was a…”) and the child picks up the thread. One of Pehrsson’s former clients, a little girl named Savannah, invented a character called “Savannah Horsie.” When Pehrsson suggested that “Savannah” was feeling scared or sad or worried, the child quickly and firmly corrected the therapist — “Not Savannah — Savannah Horsie!” When the feelings were safely contained within the invented character, the little girl was free to explore different scenarios and alternative endings with Pehrsson, who would pose such questions as, “What would happen if…?” Eventually, the child was able to transfer the feelings to her own life.

“I would start by reading a story aloud about a character who’s been through a similar situation — a character who models resiliency or success but also the pain and the sadness that goes along with it,” Pehrsson explains. “Over time, children would start to tell their own stories about the character. And the character would become stronger and braver.”

The theory behind this transformation was first described by bibliotherapy pioneer Caroline Shrodes in 1950. She explained the underlying dynamic — what happens in the subconscious mind — as a series of three processes: identification, catharsis and insight. First, the child recognizes his own feelings in the character. Second, his repressed or conflicted feelings begin to surface. Third, his recognition of the universality of his experience makes him feel less isolated and thus more empowered.

“Allegorical stories can bypass conscious and unconscious defenses,” Pehrsson explains.

Unfortunately, the current evidence for the effectiveness of fictional story therapy is mostly anecdotal. Although studies show therapeutic benefits for self-help books for adult mental-health problems such as anxiety and sexual dysfunction, rigorous research on using imaginative literature in clinical or school settings is still on the horizon. Several of Pehrsson’s master’s and doctoral students, under her guidance, are conducting research projects that will move the field forward, quantitatively (see sidebar). Her emerging counselor cadre is making important contributions to a scientific literature base that may validate what Pehrsson knows from experience: Stories have the power to heal.

One Response to “Stories That Heal”

  1. Odete Almeida says:

    Hi.
    I’m from Portugal and i’m doing my PH.D. in Alcalá university of Madrid. I choose to study Bibliotherapy with DDA (disoreders deficti of attention) children.
    In this moment I’m doing a revision of the literature and i’m feeling lost.
    I’ve read Daphne Kagume’s statement and I decide to ask for your help. At Portugal there’s notihng done about bibliotherapy. How can I begin? What do you advise me to do first?
    What do you suggest me to include in my doctoral dissertation:
    - revision of literature
    - children characterization
    - description of the bibliotyerapist’s plan/program
    - books selection (?)
    - conclusions

    I would to have your feedback and guidance.

    Graciously

    Odete Almeida