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What is Bibliotherapy? The simplest definition of bibliotherapy is helping with books. Katz and Watt defined it as the guided use of reading, always with a therapeutic outcome in mind. Poetry therapy and bibliotherapy are terms used synonymously to describe the intentional use of poetry and other forms of literature for healing and personal growth. Bibliotherapy may be classified as to utilization in the following manner: a. "Developmental interactive bibliotherapy" refers to the use of literature, discussion and creative writing with children in schools and hospitals, adults in growth and support groups, and older persons in senior centers and nursing homes. In these community settings, bibliotherapy is used not only to foster growth and development, but it is used as a preventive tool in mental health. b. "Clinical interactive bibliotherapy" refers to the use of literature, discussion and creative writing to promote healing and growth in psychiatric units, community mental health centers, and chemical dependency units. Other bibliotherapy related terms are the following: Literatherapy. Refers to the direct and intentional use of literary text in conjunction with psychotherapy. Bibliodiagnostics. When bibliotherapys techniques are used for assessment. Iblioprophylaxis. When bibliotherapy is used for prevention. Videotherapy. The use of film or video for therapeutic purposes.

Historical use of Bibliotherapy The ancient Greeks recognized the power of books as therapeutic tools by inscribing these words above the door at the library of Thebes: The medicine chest of the soul. They made the reading of books in their medical and health undertakings. It was Samuel Crothers, a Unitarian Minister who first coined the term bibliotherapy in 1916, who wrote in The Atlantic Monthly about a technique of bringing troubled persons together with books. By the early 1920s, Sadie Peterson Delaney, chief librarian of the United States Veterans Administration Hospital in Tuskegee, Alabama, was using books to treat the psychological and physical needs of African American war veterans.

Working as a team of social workers and psychiatrists, their purpose was to enable patients to connect - or reconnect - themselves with a broad community of ideas. Delaneys holistic practice of bibliotherapy transcended typical literary events by including hobby clubs and activities such as stamp and coin collecting and debating to awaken a patients mind. His techniques created such a buzz that she received worldwide recognition. Between 1924 and 1958, Delaney spoke at major conferences and held lectures in conjunction with psychology courses, and actively trained other librarians in the practice of bibliotherapy. In 1937, Dr. William C. Menninger, a founder of the Menninger Clinic, a prestigious group in psychiatry practice, edited a book about psychiatry that included several of his papers. In one of these papers he described the purposes of bibliotherapy, how it fit into a patients treatment plan, and how it was to be prescribed. At the Menninger Clinic, bibliotherapy was used to treat mental illness but only after the patients background, symptoms, and therapeutic needs had been evaluated. Because bibliotherapy was considered a treatment, the physician was responsible for the contents of the library and must approve the books before they [were] purchased, and for prescribing reading assignments. In 1950, Caroline Shrodes furthered the study in her dissertation, when she postulated that there is a psychological basis to bibliotherapy. According to Shrodes, the reader under the impact of imaginative literature, is subject to certain processes of adaptation or growth, which correspond to the major phases of psychotherapy: identification, projection, abreaction and catharsis, and insight. The above studies brought out the following data which pointed out the mental and psychiatric beneficial effects of bibliotherapy: First, identification and projection occur when the reader shares a problem, circumstance, or issue with the books character. Second, a reaction and catharsis occur for the reader when the character resolves a problem, circumstance, or issue. Third, insight occurs when the reader reflects on his or her situation and internalizes the characters solution. In the 1970s, Rhea Joyce Rubin added mental health specialists have conducted rigorous studies to prove bibliotherapy works. By using metaanalysis, a technique of synthesizing research results using various statistical methods, mental health specialists have determined that bibliotherapy is effective in certain circumstances. Pieter Cuijpers and Robert J. Gregory et al. performed meta-analysis to isolate the effectiveness of bibliotherapy in treating depression. Mark Floyd used meta-analysis to gage the effectiveness of bibliotherapy to assuage geriatric depression. Timothy R. Apodaca and William R. Miller conducted a meta-analysis to determine the effectiveness of bibliotherapy in treating alcohol problems. In each of these meta-analyses, bibliotherapy was found to be an effective treatment in certain instances. The above studies resulted in the following conclusions: First, it was found to be most effective with individuals whose mental health issues are minimal to moderate in severity.

Second, bibliotherapy is most effective in combination with other treatments. Third, bibliotherapy is a viable option in rural areas where mental health treatment is not available or when therapy time is limited. For instance, in one study comparing treatments for panic attacks, bibliotherapy was more beneficial than minimal interventions such as phone contact with a therapist. Fourth, bibliotherapy increases the patients sense of responsibility. It works best with motivated individuals who are functioning at a higher cognitive level. However, Floyd cautions that bibliotherapy may be harmful if the client feels that the therapist is minimizing their problems by giving them a book. References Jones, Jamil. A Closer Look at Bibliotherapy. Young Adult Library Services Journal. 2006 Retrieved from http//:www. Katz, Gilda and John A. Watt, Bibliotherapy: The Use of Books in Psychiatric Treatment, Canadian Journal of Psychiatry 37, no. 3 (1992): 173. Manfreda, M. et. al. (1977). Psychiatric Nursing 10th Ed. Philadelphia: F.A. Davis Co. Shives, L.R. et. al. (2002). Basic Concepts of Psychiatric Mental Health Nursing 5th Ed. Philadelphia, USA: Lippincott Stuart, G. et. al. (2005). Principles and Practice of Psychiatric Nursing 8th Ed. Missouri, USA: Mosley, Inc. Videbeck, S. et. al. (2008). Psychiatric and Mental Health Nursing 4th Ed. Philadelphia, USA: Lippincott Williams & Wilkins

Music Therapy
What is Music Therapy? The American Music Therapy Association, Incorporated defined music therapy as the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. It is an established health service similar to occupational therapy and physical therapy and consists of using music therapeutically to address physical, psychological, cognitive and/or social functioning for patients of all ages. Because music therapy is a powerful and non-invasive medium, unique outcomes are possible. In addition to its applications in mental health, music therapy is used successfully in a variety of additional healthcare and educational settings. In mental health and psychiatric nursing, music therapy serves the purposes of maintenance and improvement of mental hygiene and fosters social integration. Music therapy activities in the clinical setting will include any or a combination of the following: 1. Listening to music (sound experience with therapeutic instruments or recorded music, and conversation) 2. Joint singing and music-making (e.g. popular songs playing with the guitar) 3. Improvisation (free or within a given framework) with easy-to-handle instruments 4. Singing of songs to learn the language 5. Rhythmic work 6. Movement to music 7. Guitar lessons in single therapy 8. Spontaneous interventions as response to a clients reaction (e.g. role play with instruments, acting out an emotional situation or an experience) How Does Music Therapy Make a Difference for Persons with Mental Health Needs? Music therapy is an efficacious and valid treatment for persons who have psychosocial, affective, cognitive and communicative needs. Research results and clinical experiences attest to the viability of music therapy even in those who are resistive to other treatment approaches. Music is a form of sensory stimulation that provokes responses due to the familiarity, predictability and feelings of security associated with it. Music therapy for clients with mental health concerns uses musical interaction as a means of communication and expression. The aim of therapy is to help individuals develop relationships and address issues they may not be able to address using words alone. Music therapy sessions include the use of active music making, music listening, and discussion.

What do Music Therapists Do? Music therapists use music strategies, both instrumental and vocal, which are designed to facilitate changes that are non-musical in nature. Music selections and certain active music making activities are modified for client preferences and individualized needs (i.e., song selection and music may vary). Music therapy programs are based on individual assessment, treatment planning, and ongoing program evaluation. Frequently functioning as members of an interdisciplinary team, music therapists implement programs with groups or individuals that display a vast continuum of needs, from reduction of anxiety to deeper self-understanding.

What Can One Expect From a Music Therapist? Music therapists work with the interdisciplinary team to assess emotional well being, physical health, social functioning, communication abilities, and cognitive skills through musical responses. When individualized music experiences are designed by the music therapist to fit functional abilities and needs, responses may be immediate and readily apparent. Clients need not have a music background to benefit from music therapy.

Music Therapy Intervention Provides Opportunities to (adapted from AMTA) a. Explore personal feelings and therapeutic issues such as self-esteem or personal insight b. Make positive changes in mood and emotional states c. Have a sense of control over life through successful experiences d. Enhance awareness of self and environment e. Express oneself both verbally and non-verbally f. Develop coping and relaxation skills g. Support healthy feelings and thoughts h. Improve reality testing and problem solving skills i. Interact socially with others j. Develop independence and decision making skills k. Improve concentration and attention span l. Adopt positive forms of behavior m. Resolve conflicts leading to stronger family and peer relationships What Outcomes are Documented in Music Therapy Research? (adapted from AMTA) a. Reduced muscle tension b. Improved self-image/Increased self-esteem

c. Decreased anxiety/agitation d. Increased verbalization e. Enhanced interpersonal relationships f. Improved group cohesiveness g. Increased motivation h. Successful and safe emotional release

The following selected researches/studies provides evidence that Music Therapy is effective in the improvement of certain psychiatric conditions: Music therapy as an addition to standard care helps people with schizophrenia to improve their global state and may also improve mental state and functioning if a sufficient number of music therapy sessions are provided. Gold, C., Heldal, T.O., Dahle, T., Wigram, T. (2005). Music Therapy for Schizophrenia or Schizophrenia-like Illnesses. The Cochrane Database of Systematic Reviews, 3. Accession: 00075320-100000000-03007 PMID: 15846692 Music therapy significantly diminished patients negative symptoms, increased their ability to converse with others, reduced their social isolation, and increased their level of interest in external events. As music therapy has no side-effects and is relatively inexpensive, it merits further evaluation and wider application. Tang W, Yao X, Zheng Z. Rehabilitative effect of music therapy for residual schizophrenia: A one-month randomised controlled trial in Shanghai. British Journal of Psychiatry 1994;165(suppl. 24):38-44. PMID: 7946230 Results indicated that music has proven to be significantly effective in suppressing and combating the symptoms of psychosis. Silverman, M.J. The Influence of Music on the Symptoms of Psychosis: A Meta-Analysis. Journal of Music Therapy 2003; XL(1) 27-40. Depressed adolescents listening to music experienced a significant decrease in stress hormone (cortisol) levels, and most adolescents shifted toward left frontal EEG activation (associated with positive affect). Field, T., Martinez, A., Nawrocki, T., Pickens, J., Fox N.A., & Schanberg, S. (1998). Music shifts frontal EEG in depressed adolescents. Adolescence, 33(129), 109-116. Music therapy clients significantly improved on the Aggression/Hostility scale of Achenbachs Teachers Report Form, suggesting that group music therapy can facilitate self-expression and provide a channel for transforming frustration, anger, and aggression into the experience of creativity and self-mastery. Montello, L.M., & Coons, E.E. (1998). Effect of active versus passive group music therapy on preadolescents with emotional, learning, and behavioral disorders. Journal of Music Therapy, 35, 49-67.


American Music Therapy Association, Inc. (2010) Retrieved from http// Manfreda, M. et. al. (1977). Psychiatric Nursing 10th Ed. Philadelphia: F.A. Davis Co. Shives, L.R. et. al. (2002). Basic Concepts of Psychiatric Mental Health Nursing 5th Ed. Philadelphia, USA: Lippincott Stuart, G. et. al. (2005). Principles and Practice of Psychiatric Nursing 8th Ed. Missouri, USA: Mosley, Inc. Videbeck, S. et. al. (2008). Psychiatric and Mental Health Nursing 4th Ed. Philadelphia, USA: Lippincott Williams & Wilkins