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Writing in Healthcare Settings; bibliotherapist or community writer? Fiona Place discusses the role of writing groups in mental healthcare.

Writing in Healthcare Settings; bibliotherapist or community writer? Fiona Place discusses the role of writing groups in mental healthcare.

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Published by Fiona Place
Literature in health: creating spaces for change
Today there is an increasing interest in the benefits of using art in the field of health-care. This interest is to be welcomed and applauded - the work done by artists within health settings has for too long been dismissed as merely discretionary, or worse still, upsetting. This increased appeal, however, is also creating divisions. Divisions between those who see themselves primarily as artists and those who see themselves primarily as therapists.
These divisions are not simply academic. With health organisations increasingly looking to employ artists and the recent introduction of two Masters Degrees in Art Therapy a formal re-structuring
of the whole field is taking place. Issues such as the registration of art therapists and the arrangements to be made regarding sources of funding will affect everyone. Questions such as: How
should art be used? By whom should it be used? And what training should they have? Will need to be addressed. In the case of literature, Fiona Place addresses these issues.
Literature in health: creating spaces for change
Today there is an increasing interest in the benefits of using art in the field of health-care. This interest is to be welcomed and applauded - the work done by artists within health settings has for too long been dismissed as merely discretionary, or worse still, upsetting. This increased appeal, however, is also creating divisions. Divisions between those who see themselves primarily as artists and those who see themselves primarily as therapists.
These divisions are not simply academic. With health organisations increasingly looking to employ artists and the recent introduction of two Masters Degrees in Art Therapy a formal re-structuring
of the whole field is taking place. Issues such as the registration of art therapists and the arrangements to be made regarding sources of funding will affect everyone. Questions such as: How
should art be used? By whom should it be used? And what training should they have? Will need to be addressed. In the case of literature, Fiona Place addresses these issues.

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Published by: Fiona Place on Jun 08, 2009
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02/03/2013

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Bibliotherapist or Community Writer?
Fiona Place (Australia Council funded Writer-in-Residence) examines the useof literature in therapeutic settings
Paper presented at the First National Conference/Workshop
‘The Arts in Health’
Toowoomba Nov 4-6, 1994
Literature in health: creating spaces for change
Today there is an increasing interest in the benefits of using art in the field of health-care. This in-terest is to be welcomed and applauded - the work done by artists within health settings has fortoo long been dismissed as merely discretionary, or worse still, upsetting. This increased appeal,however, is also creating divisions. Divisions between those who see themselves primarily as art-ists and those who see themselves primarily as therapists.These divisions are not simply academic. With health organisations increasingly looking to employartists and the recent introduction of two Masters Degrees in Art Therapy a formal re-structuringof the whole field is taking place. Issues such as the registration of art therapists and the arrange-ments to be made regarding sources of funding will affect everyone. Questions such as: Howshould art be used? By whom should it be used? And what training should they have? Will need to be addressed.In the case of literature there is a need for writers to address the issues. Should literature be in-cluded within the field of art therapy, it may become increasingly difficult for writers who do notwish to use literature from within an art therapy framework to be recognised and employed bypublic health-care institutions and organisations.Health-care policy-makers need to be made aware that if art is to provide creative and innovativespaces for change, the structures set in place for its use also need to be broad and diverse. It istherefore crucial there is wide consultation to ensure that artists are not excluded from this debate.Entry points for artists who choose to work within health settings need to be established. The useof art and literature must remain open to artists.With this in mind it would seem appropriate to review the current situation, especially in its rela-tionship to literature. For although the art therapy paradigm makes many valid and importantcontributions to the ways in which literature is thought about and used within health settings, it isnot the sole approach. Other approaches need to be acknowledged. We must work to ensure thatthe perspectives from writers who choose to work within health settings primarily as writers formpart of our foundations for future growth.
The current situation
In the United States the use of literature within health settings is well established. There, an ap-proach known as bibliotherapy, has been developed. This approach combines the knowledges of 
 
psychology and literature. It focuses on the therapeutic aspects of the reading and writing processand has been developed mainly by health and welfare librarians within the American Library As-sociation.Bibliotherapy regards literature as a therapeutic tool which can be used to encourage and fosterinsight as well as serve as a useful aid in assisting people to develop skills in problem solving. Lit-erature in this context is seen as a catalyst for therapy. This use of literature has led to bibliothera-pists working more like psychotherapists or psychologists rather than writers. According to biblio-therapist Arleen Hynes (1980) bibliotherapists can be further divided into two groups: clinical bib-liotherapists and developmental bibliotherapists. ‘Clinical bibliotherapists are those who use litera-ture as a tool with the mentally ill who have a contract for therapy.’ While ‘developmental biblio-therapists are those who use feeling responses to literature to stimulate the growth of normal indi-viduals from children to the elderly.’In the United Kingdom the field is still at the fledging stage, with librarians and to a lesser extentwriters and other allied health professionals developing ideas. The term reading therapy, ratherthan bibliotherapy, is currently being used and covers a wide range of activities using library re-sources within therapeutic contexts. According to Mary Howie (1988) reading therapy can be de-fined as: ‘the use of literature and/or audiøvisual materials, by a trained worker, to facilitate atherapeutic activity, usually a guided discussion, which promotes personal growth for the partici-pant(s).’ Here too, literature is seen as a catalyst, as a tool for the promotion of psychological in-sight.In Australia the field is not as established as it is in the United States. Here the use of literature has been pioneered by writers and allied health professionals, rather than librarians. As a result therehas been little comparison or connection made between the work in Australia and that of biblio-therapists in the United States or reading therapists in the United Kingdom.The area is presently under-resourced, under-valued and yet to be formally recognised. It is notincluded as a specialisation within the current Master of Arts Therapy programs and is not repre-sented within existing professional organisations for art therapists. Amongst writers, however,many of whom have worked within health settings under the auspices of the Writer-in-Community Program funded by the Literature Board of the Australia Council; there is much dis-cussion of the term therapy. Many see a need to resist the work they do being labelled bibliother-apy, writing therapy or reading therapy because they believe the term therapy limits the way inwhich literature is thought about and used within therapeutic communities.There are signs, though, that a similar approach to that taken in the United States is emerging. Theproposed curriculum for an Arts in Health Post-Graduate Program in Queensland views art fromthe health-care paradigm. The course, to be offered to artists and health workers alike, describesart as a therapeutic tool and treatment option. Discussion centres on the need for health workersand artists to be trained from a health-care/therapy-based perspective. While this emphasis is nodoubt driven by genuine concerns regarding patients/clients welfare it is also due, in part, to the‘therapy-bias’ present in institutions and to the current financial arrangements in which anythingthat is not labelled as ‘therapy’ will find it difficult to attract funding from already stretched health budgets.But what are the effects on the processes of reading and writing if literature is regarded as a thera-peutic instrument? And can it automatically be assumed that a therapy-based perspective will bemost helpful?Problems with the health-care/therapy-based perspectiveThe use of literature as a tool for therapy has the potential to create several problems.Firstly, an approach which sees itself primarily as therapy introduces a therapeutic structure inwhich there are often defined roles - therapist and patient/client. While the adoption of thisframework can be helpful, adverse effects such as role rigidity may reinforce the identity of the
 
participant as patient. Writing therapy may come to be viewed as just another variant of psycho-therapy. Or worse still, one more institutional demand.Secondly, an approach to literature which sees its primary function as a means of reaching feelings,treats literature as though it is neutral; a knowable and transparent tool. This approach fails to ad-dress the complex relationship between reader and text and is unable to provide participants withthe space to develop the necessary skills to question and deconstruct texts: to question the implicitvalues encoded in every text, including their own narratives.Thirdly, an approach which focuses on a text’s ability to suggest solutions or ways of dealing withproblems runs the risk of using literature to merely teach certain values. And not create the spacefor the patient/client to explore and choose their own values.Fourthly, an approach which uses literature to offer psychotherapeutic interpretations may, if toorigidly applied, pre-form the desired response regardless of need. If psychotherapists are encour-aged not to interpret excessively or wildly the same needs to be said for a therapist using litera-ture. It can be disturbing and anxiety-provoking to patients to have their needs and feelings brought to their attention before they are ready. A focus on a psychological reading of the text andthe feeling responses of the participants runs the risk of blocking the reflective space available toparticipants and limiting discussion to the psychological paradigm.This appropriation and psychologising of art is, therefore, to be strongly resisted. The moment artis institutionalised and administered from a health-care perspective it will lose its ‘otherness’ andpotency to effect change.
Other approaches
Artists working within health-care settings often employ models from outside the health-careparadigm. They do this for many reasons. Many perceive a need to remain ‘from the outside’ if they are to offer those in a therapeutic community a cultural experience. And to de-medicalise thespace in which they find themselves, must work against the dominant health-care paradigm whichviews people as patients. Their choice of model will depend on many factors; the needs of thecommunity, their own particular skills, the length of the residency and the particular constraintspresent within the community. Models may also emphasise different priorities and be influenced by a variety of theories including; communication, literary, feminist, oral history, community art,and cultural development.
So how does this work out in practice?
The following account is based on my experiences as Writer-in-Residence at the Psychiatry Unit,Prince Henry Hospital. This residency was funded by the Writer-in-Community Program/ Litera-ture Board of the Australia Council and it was during this time I faced many of the issues I haveoutlined. My residency, although supported by various senior medical staff, was seen by the hospi-tal administration as belonging to the ‘too difficult basket’. They were wary of my coming in as awriter and keen to make sure I did not conduct what could be construed as therapy. On the otherhand, as time went by and they saw that what I was doing was therapeutic they were thrilled tohave me there. And when my contract expiry date loomed were more than happy for it to be ex-tended, but only if the Literature Board of the Australia Council was willing to continue to providefunding.The model I chose to work with was a ‘participatory model’. This meant that patients would not beregarded as patients attending a writing group but rather, as participants engaged in writing andreading groups that would, as far as possible, be directed by their needs. This decision took intoaccount the shortness of my residency and the necessity to work slowly and gently against themany resistances to my working as a writer in a psychiatric setting.It was important to provide participants with access to an activity that was not therapy-based andthat would allow them to find their own voice. I also believed there should be a strong culturalcomponent to the residency and set up a library of contemporary Australian literature in my office.

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