Children's Books for Use in Bibliotherapy

Anna Tielsch Goddard, MSN, RN, CPNP-PC

Disclosures

J Pediatr Health Care. 2011;25(11):57-61. 

In This Article

Abstract and Introduction

Introduction

Reading to children is central to their development. Books provide a safe medium for children to explore different concepts, feelings, and attitudes while allowing them to better understand their environment, community, and societal expectations. Reading to children increases self-esteem, gives comfort, and may aid children in coping with difficult situations.

Communication of a medical diagnosis to children can elicit questions and further discussion, especially in children with chronic diseases. Explaining the possibility of a life-threatening condition to an ill child, as well as the nature of his or her diagnosis, is a difficult task for trained clinicians, and it often evokes fear and anxiety in parents (Last & Veldhuizen, 1996). Grief, loss, and death cause emotional distress and psychological trauma that often leads to depression and anxiety (Briggs & Pehrsson, 2008).

Bibliotherapy-that is, the use of written materials to gain understanding and engage in problem solving relevant to the person's therapeutic needs-has been explored as a successful method in communicating illness to pediatric patients (Marrs, 1995, Thibault, 2004). The term "bibliotherapy" was first used by S. M. Crothers in 1916 to describe the use of books to help patients understand their health problems and symptoms. Briggs and Pehrsson (2008) reported that librarians in the 1930s compiled lists of books to assist clients with concerns similar to the bibliotherapy lists used today. Thibault (2004) emphasizes that the key to bibliotherapy is using the story as a way to begin a discussion of issues and should be used as a substitute for dealing with problems.

For bibliotherapy to be successful, the child first needs to identify with the characters in the story who are coping with similar issues (Gregory and Vessey, 2004, Thibault, 2004). The reader then must become emotionally involved in the story and finally have insight or a realization that the characters in the book worked through solutions to their problems. The child then may begin to understand that his or her issues can be solved using a similar solution (Gregory & Vessey; Thibault, 2004, Tu, 1999).

Children who receive open information about their diagnosis and prognosis at the initial stage of their disease show significantly less anxiety and depression (Last & Veldhuizen, 1996). The use of literature as a medium for children to cope with their problems helps them recognize that they are not alone as they relate to the story discussion (Tu, 1999). Children's books allow children to share their feelings and can provide an opening to discuss other difficult topics such as a chronic illness in a family member, a friend, or themselves (Kurkjian & Livingston, 2005).

Books also provide structured communication between two individuals, which is particularly helpful when dealing with difficult subject matter. Bibliotherapy has been used to open communication between children, parents, and teachers (Amer, 1999, Gregory and Vessey, 2004). The use of bibliotherapy in clinical domains has increased in recent years in order to promote therapeutic gain (Amer, 1999, Gregory and Vessey, 2004, Mazza, 2003, Pehrsson et al., 2007). Narratives outside the child's individual situation provide story lines that aid in the understanding of his or her own personal feelings and help children realize that they are not alone in their situation (Heath et al., 2005, Pehrsson et al., 2007). With the correctly chosen book, story characters can provide an exemplar to guide the patient through distress or challenges (Pehrsson et al., 2007).

Research also has shown that the use of story characters as models for the patient can foster self-efficacy and coping skills (Early, 1993, Jasmine-DeVias, 1995). Gregory and Vessey (2004) explored the use of children's books as a successful intervention strategy for school nurses to help students with bullying. They found that through the use of bibliotherapy, children began to communicate their own experience with bullying and have been able to develop coping strategies to deal with teasing and harassment (Gregory & Vessey, 2004).

Before speaking with children about their illness, the parents or caregivers should prepare themselves and approach the subject slowly and cautiously so as not to overwhelm the child. Books need to be carefully matched to the child's various problems and developmental level so the child can identify with the fictional character and follow the events of the storyline (Kurkjian & Livingston, 2005); this ultimately will emotionally involve the child in the story (Gregory & Vessey, 2004). The child then will be able to express his or her feelings under safe conditions and through the characters. Insight occurs when the readers become aware that their problems are not entirely unique and can be solved or addressed as they were in the book (Gregory & Vessey, 2004).

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