Krista Caballero, CCLS II, CIMI

Texas Children’s Hospital

Books at the Bedside: Literature Coming Alive to

Enhance Interventions

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.”

Why Bibliotherapy?

Bibliotherapy is: The use of written materials to gain understanding and

engage in problem solving relevant to the person’s therapeutic needs

What is Bibliotherapy?Central to DevelopmentSafe Outlet to Explore Concepts and Emotions

Why Bibliotherapy?Communication

Stimulates Discussions and ConversationsAddresses innermost feelings

Provides InsightNormalizes the Hospital EnvironmentStrengthen relationships

Healthcare WorkersFamily

Determining a Need for Bibliotherapy

History 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.

Origin The word is derived from the Greek words biblion (book) and

oepatteid (healing).

Bibliotherapy’s Roots

Can address/express compassion, criticism, tension, relief, sadness, happiness, fear, courage, rage, pain, anguish, and death

Children express their worries and fears differently than adults

Lack of verbal skills can inhibit the ability to express feelings and emotions

Lack of family discussions concerning feelings

Parents’ stress reactions

Why Bibliotherapy and Child Life?

Stages of Development and LiteratureWhen Using Reading as a Resource to Minimize the

Stress of Hospitalization, it is Necessary to Consider Aspects of DevelopmentPre-Schoolers (3-6 years) Experience a rapid development

of their vocabulary and language skills, and understand their experience by using symbols, including language

School-Aged Children (6-8 years) Are improving their reading and like to know about concepts and skills

Pre-Adolescents (8-11 years) Enjoy realistic fiction and books that describe real life events, since they are learning to make choices and developing personal values

Adolescents (12-18 years) Enjoy novels and fiction, fantasy, or even individual non-assisted readings

Books and Development

Selection of a BookCriteria:

Must not give a false sense of hopeMust provide correct information about a

presenting problemAge appropriate

Assess the Child’s Development, Coping Response, and the Attitude of the Child’s Parents

Books and Development

Transformation of Children’s BeliefsThemes

SeparationEscape from a Difficult SituationRecoverySmall Individuals who are ImportantControl Rescue by a Powerful Stranger

Conventions and Themes

Determining a Theme Stage of Cognitive DevelopmentStage of Personality DevelopmentThe Impact of the Medical Condition on the

Child’s LifeThe Psychological Defense Mechanism the

Child UsesThe Child’s Dominant Affectual StateThe Attitudes of the Family Members toward

the Child and the Illness

Conventions and Themes

DidacticInstructional and educational, similar to textbooks.

A didactic text can be found for nearly any topic a clinician may wish to address with the patient-reader, including personality conflicts, and coping with stress (eg, self-help books). The purpose is to facilitate a direct change within the individual through a cognitive understanding of self.

ImaginativeRefers to the dramatic presentation of human

behavior through fiction, poetry, drama, biography, and autobiography.

Types of Text

Stages of Therapeutic Involvement1. Involvement

At this point, patients begin listening to the story and demonstrate interest in what is happening. They get “caught up” in the narrative

2. IdentificationPatients best identify with characters of the same age

and who are experiencing similar circumstances

3. CatharsisPatients are pulled further into the process of

recognizing and vicariously experiencing the character’s feelings. As the character successfully resolves problems, patients release emotional tension associated with their own problems

Facilitating a Read Aloud

4. InsightPatients think about what happened in the story

and apply it to their own lives. Patients begin resolving the struggles they may be personally experiencing

5. UniversalismPatients move beyond the egocentric trap of only

seeing their own problems and the perception that no one else understands or shares their pain. They gain a broader perspective of their own challenges and are able to understand that others may have similar problems.

Facilitating a Read Aloud

Stages of BibliotherapyIdentificationSelectionPresentationFollow up

Facilitating a Read Aloud

Conditions to be MetRapport, Trust, and Confidence to Have Been

EstablishedThe Patient and Child Life Specialist have

Begun to Address Goals/InterventionsSome Preliminary Exploration of the Problem

has Occurred

Facilitating a Read Aloud

Reading GoalsCreating your Own Goals

Examples of goalProvide a sense of pleasure and enjoyment

through humorous read-aloudsProvide normalization by facilitation of

imaginative separation from the hospital environment through pre-occupation with read-alouds

Program Design Aligns with Child Life Goals

Facilitating a Read Aloud

Entrancement During the ReadingStrong Emotional Responses

Show evidence of their experience in relation to their disease and care, their acceptance and understanding. This information is relevant to plan comprehensive and humanized care.

Preoccupation with the Story’s ThemeCascades of QuestionsTestimonials

Examples: The child’s comments and questions, such as “that mouse is hurt just like me” and “is he scared too?” seemed to indicate strong identification with story characters in children read aloud to in a research study.

In the same study, several stories which had characters who survived a catastrophe, generated in some children hope and smiles and questions about their own convalescence and recovery.

Reactions to Literature

Use of TimingQuestioning Strategies

Questioning strategies during and after reading should not be judgmental; rather, the focus is on the feelings of the main characters

Facilitators must allow the stories themselves to shape the questions For example, “In the book, Onion John, how do you

think Onion John felt when Andy was able to understand what he said?” or “In Sam, Bangs, and Moonshine, how do you think Sam felt when her friend and her pet were in danger?”

Components that Determine Success

PreviewQuestionPredictInferConnectSummarizeEvaluate

Questioning Strategies

Maintain the Emotional Distance Necessary

Never Let a Story Become a Sermon

Cardinal Rules of Bibliotherapy

ReflectionConnectionUnderstandingInterpretation

Types of Questions

What is the main idea of this story?Why do you think the story has the title “ ”?What would be another good title for the story? Why does a character (take a particular action)?What caused______to______?What effect did _______ have on _______?What character can you connect with most in the

book?What issue in the book the most interesting?

Upsetting? Familiar? Ridiculous? Confusing?What are the problems the main character faces and

how are they solved?

Examples of Questions

What events and people cause the main character to change?

What have you learned in the book that will be helpful to you in the future?

What do you think the author wants you to know or learn?

What impact has the story made on you?What caused….?Why do you think…?

Examples of Questions

To Assist in Determining the Appropriateness of a Post-Reading Activity, Ask These Questions:Will the activity help students connect with the

story?Will the activity help students connect with the

story?Will the activity help students in making

conclusions aligned with the story? Will the activity promote emotional growth and

healing?

Follow Up Activities

Use of Ipad, Ipod/Iphone, or Kindle (can use kindle Application for the Apple Technology

Use of YouTube: http://www.youtube.com/watch?v=zwwGBVa1j9A

The Next Place http://www.youtube.com/watch?v=Scj3A1cLVzY

You are Special http://www.youtube.com/watch?v=RnYW6YH_8w4

Alexander and the Horrible, No Good, Very Bad Day

Incorporating Technology

Let’s practice!

Activity

www.compassionbooks.comhttp://

www.ed.gov.nl.ca/edu/k12/curriculum/documents/english/biblio46/criteria_for_selecting_childrens_literature.pdf

http://www.apa.org/pubs/magination/index.aspx

www.brainpop.com

Resources