Kirklees Library and Information Service have been delivering bibliotherapy for over 14 years and are widely recognised as pioneers in this field. 

What is bibliotherapy?

Bibliotherapy is the use of fiction and poetry to support and improve positive outcomes for people with mental health and wellbeing issues.

It helps to improve people’s emotional wellbeing and health in line with the NHS’ Five Ways To Wellbeing Strategy. In particular it fits with secondary level preventions/interventions by promoting opportunities for increasing coping skills, supporting people to take control of their own health and wellbeing and building resilience. 

It also helps to:

• alleviate symptoms of depression and anxiety
• increase self esteem 
• improve social skills and concentration combat isolation
• provide access to deeper thoughts and feelings and the words to express these to others.

We have produced a short 10 minute video on which some of our beneficiaries and partners comment; watching this will give a much clearer picture of what we do and how it works. 

Our bibliotherapy model

There are other models of bibliotherapy but we believe that our model works best because it is diverse and flexible. The participants are at the centre of our work so, rather than trying to bring people to literature, we use literature as a tool to enhance the wellbeing and quality of life of people. By literature I mean all kinds of fiction including chick lit, song lyrics and poetry. 

A good bibliotherapist is able to adapt the material to the audience and this necessitates having a good toolkit with lots of resources to hand. For example, I always plan my weekly session on an acute psychiatric admission ward beforehand; however sometimes, within seconds of sitting down, I can see that my plan isn’t going to work so have to change the whole thing. 

Without a variety of resources and knowledge I wouldn’t be able to do this. If the sessions were to have the same format every week I would soon lose participants; what I do has to appeal to the person who can only concentrate for 5 minutes at a time as well as the person who is well on the way to recovery and can engage for a full session. So here again is the need for flexibility of both resources and practitioner in order to be able to appeal to diverse people at different levels of wellness. Hence the bibliotherapist needs to be adaptable so that the sessions are reactive rather than prescriptive.

The link between bibliotherapy and libraries in our model is crucial. Libraries have a wealth of material and knowledge and are in community settings. They can also offer a friendly, neutral, non- clinical environment that is also integrative in its nature too - with the added bonus of being able to offer advice or point people in the right direction. Thus Kirklees libraries and the bookchat sessions that take place within them can act as a bridge from a clinical setting into a community setting. 

How do we know it works?

But how do we know it works? A simple answer would be “from the comments that participants have made either during or after a session”. 

It might be a simple answer but it is no less valid for that, especially as we do not currently use any formal evaluation process. I don’t believe the following comment, which was texted to me from a young man who had signed up to our texting project, could be any clearer in demonstrating a positive outcome:

“Hi, i just wanted to say thank you for the biblio texts, they really helped me get through my battle with anorexia,from which im fully recovered now. The quotes that particularly helped were the one about life being like a washing machine & coming out brighter & the quote from a rand about not letting the spark go out that one really helped me through tough times & now i can also see that its true. Thanks for this wonderful service.”

From this short paragraph we can see that bibliotherapy has helped this young man to change his perspective on life – which is something that is essential in tackling many mental health issues. The NHS is increasingly using patient’s stories as a valid method of evaluation so qualitative evaluation isn’t dismissed as lightly as it perhaps once was. 

Feedback from the staff is extremely helpful

Feedback from staff is also extremely helpful in evidencing the effectiveness of a session. For instance, on an acute psychiatric admission ward they had had two incidents of violence during the morning and a new admission who had to be accompanied by the police. The atmosphere on the ward was tense. However, after the session one of the nurses said, “I didn’t think you’d even get a session going today never mind have so many taking part! The ward feels really different now, much calmer. Thanks - I’m on a late shift and was dreading the evening!” 

We see from this example that the bibliotherapy session had benefitted the whole ward community, including the staff by helping to make their job easier; but without speaking to that member of staff the bibliotherapist would not have known the extent to which the session had made a difference. This is part of the reason that we insist that a member of staff participates in all our sessions in clinical settings, not only to enrich our feedback but also to highlight in advance of the session if there are any issues with the participants of which we need to be aware. 

A great deal can be learned by observing the behaviour of participants

A great deal can be learned from observing the behaviour of participants and noting any changes, particularly those that take place outside the session. One residential home manager commented that the residents carried on talking to each other long after the session had finished instead of all sitting in silence watching the television. In fact, two ladies at this home discovered through a poetry session that they had worked in the same factory and became firm friends.

Some people move on with their lives, becoming involved in new ventures or re engaging with activities that they had abandoned whilst ill.

One participant of sessions delivered on an acute admission ward said that these were the best sessions that he had had while in hospital, including the sessions with his psychiatrist. He took details of the bookchat groups in our libraries and subsequently turned up for the bookchat sessions in Huddersfield Library.

He has now found a job and is working full time, something that had seemed almost impossible for him to achieve at one stage. His health worker felt that the bookchat sessions had helped him to engage with a ‘normal’ lifestyle again.

The success of the groups can also be measured

Of course the success of the bookchat groups can also be measured by the number of participants and whether they attend regularly. This kind of data we do record – currently there are around 380 participants a month in our groups combined.

It’s also true that there is still a need for more in-depth, systematic research - something that we are currently exploring. 

I’ll finish by recounting an incident that happened to me at the Batley Alzheimers Society group. The session was about poems that pupils were often made to learn by heart in schools in the old days. One lady, who never engaged in the sessions and usually just stared blankly into space, began to recite one of the poems; by the end of the session I was just giving her the first two lines and off she went with the rest of the poem. She smiled and chatted a little about the poems and school. 

After the session her husband, who was also her main carer, came up to me and thanked me saying, “It just reminded me of who she really is underneath this illness and why I love her and am putting up with all the difficulties caused by her dementia.”  I left that session feeling something very valuable had been achieved, that the session had had a positive impact. That it had worked! 

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About the author

Julie Walker is a bibliotherapist working for Kirklees Libraries and Information Services. Julie has been working in reader development and bibliotherapy for 14 years. She is a former community psychiatric nurse and was reader-in-residence at Wakefield Prison for months.