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Bibliotherapy for youth and

adolescents—School-based application
and research
a b
Debbie McCulliss & David Chamberlain
a
Greenwood Village , CO , USA
b
Community Outreach, Redditch Health Library , Alexandra
Education Centre, Alexandra Hospital , Redditch , UK
Published online: 14 Feb 2013.

To cite this article: Debbie McCulliss & David Chamberlain (2013) Bibliotherapy for youth
and adolescents—School-based application and research, Journal of Poetry Therapy: The
Interdisciplinary Journal of Practice, Theory, Research and Education, 26:1, 13-40, DOI:
10.1080/08893675.2013.764052

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 Journal of Poetry Therapy, 2013
Vol. 26, No. 1, pp. 1340, http://dx.doi.org/10.1080/08893675.2013.764052

Bibliotherapy for youth and

adolescents*School-based
application and research
Debbie McCulliss1* & David Chamberlain2
1
Greenwood Village, CO, USA, and 2Community Outreach, Redditch Health Library,
Alexandra Education Centre, Alexandra Hospital, Redditch, UK
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Bibliotherapy in the elementary, middle, and high-school classroom is used to foster healthy social and
emotional growth in children and young adults to develop insight, a deeper understanding of self,
solutions to personal problems, development of life skills, or enhanced self-image. The focus of this
article is on how bibliotherapy can be used to address students’ specific issues ranging from mild
behavioral issues to physical and psychosocial conditions. Based on an extended review of the literature
on bibliotherapy, this article may serve as a guide to readers interested in developing a bibliotherapy
program for youth and adolescents. Recommendations for research are also noted.
Keywords Adolescents; bibliotherapy; growth; literature selection; school; youth

We read to discover we are not alone

C. S. Lewis (Shadowlands)

Introduction
Historically, bibliotherapy has been defined in many ways (Russell & Shrodes, 1950;
Shepherd & Iles, 1976; Rubin, 1978). Developmental bibliotherapy for children and
youth has been defined as the use of literature to facilitate healthy social and
emotional growth or maintain normal mental health. Developmental bibliotherapy is
provided by educators who work with children and young adults. Miller (2009)
further described bibliotherapy as ‘‘the process of using books to help youth and
adolescents think about, understand, and work through social and emotional issues’’
(p. 260).
The focus of this article is on the available evidence on the use of bibliotherapy
with implications for further research. Particular attention is given to how

*Corresponding author. Debbie McCulliss, 5440 S. Grape Lane, Greenwood Village, CO 80121,
USA. Tel: 303-771-4375. Email: [email protected]
# 2013 National Association for Poetry Therapy
 14 D. McCulliss & D. Chamberlain

bibliotherapy can foster insight and a deeper understanding of self, help readers find
solutions to personal problems, develop life skills, and enhanced self-image. This is
accomplished through either (1) reading and a guided discussion of fiction (themes,
characters, and plot), or (2) using nonfiction books and related writing exercises, or
use a variety of artistic mediums. Bibliotherapy for youth and adolescents can
include different formats, self-guided reading, or in groups; and different mediums,
such as poetry, film, or art work.

Background
Pardeck (1995) proposed the goals of bibliotherapy as providing information,
insight, discussion, and solutions to problems; stimulating discussion about
problems; communicating new values and attitudes and creating an awareness that
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others have dealt with similar problems. Bibliotherapy can be described into four
distinct phases:

1. identification of the reader’s issue(s);

2. pre-reading; selection of book(s) to match the reader’s needs;
3. presentation that includes guided reading based on a carefully planned
approach;
4. follow-up on what the reader learned or gained from reading the book(s)
(Pardeck & Pardeck, 1993).

Bibliotherapy is based on classic psychotherapy principles of identification (with the

character or situation in the story), catharsis (wherein the student gains inspiration),
and insight (which leads to motivation for positive change) (Hébert & Kent, 2000;
Jalongo, 1983; Lenkowsky, 1987). Halstead (1991) referred to these stages as
‘‘recognising’’, ‘‘feeling’’ and ‘‘thinking’’ (p. 80). A fourth stage, universalization (the
recognition that we are not the only one having these problems), has also been
described (Slavson, 1950, cited in Hébert & Furner, 1997). According to Wilson
and Thornton (2007/2008) there is a fifth stage of bibliotherapy that happens after
readers add insight into their own circumstances. Projection occurs when readers
consider what this could mean for the future. Teachers can use bibliotherapy
to provide information or insight, stimulate discussion, create awareness, and
solutions to problems with their students. Biblio/Poetry Therapy The Interactive
Process: A Handbook, written by Arleen Hynes, O.S. B., who established the
first hospital-based training program in bibliotherapy in 1974 at St. Elizabeths
in Washington, D.C., and Hynes-Berry, professional writer, is considered an
authoritative book in the field of bibliotherapy (Hynes & Hynes-Berry, 1986/
1994/2012).
The aim of the practice of bibliotherapy is to elicit change in the attitude or
behavior of the reader to enhance their problem-solving skills, and hence increase
their resourcefulness. It aims to show readers that they are not alone (Harvey, 2010).
 Bibliotherapy for youth and adolescents 15

Bibliotherapy has the potential for affecting a number of changes in the reader. These
changes have been described as follows:

1. empathy;
2. positive attitudes;
3. personal and social adjustment;
4. positive self-image;
5. new interests;
6. tolerance, respect, and acceptance of others;
7. realization that there is good in all people;
8. socially accepted behaviors;
9. examination of moral values, which can result in character development
(Cornett & Cornett, 1980).
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Bibliotherapy can also induce cognitive changes in the reader, which have been
described as follows:

1. enhanced critical thinking skills;

2. perspective and universality of problems;
3. insight into human behavior and motives;
4. increased capacity for self-evaluation;
5. higher-level reasoning;
6. careful planning before taking a deliberate course of action;
7. choices and alternative solutions in problem solving (Cornett & Cornett, 1980).

Bonnycastle (1996) described the central process of bibliotherapy as the formation of

a relationship with a book, with the reader changing ‘‘in some significant way as a
result of this engagement’’ (Dysart-Gale, 2007, p. 35). Reading is one way to
enhance feelings of belonging.
Through identification with characters and situations, readers are helped to feel
less isolated (Walker, 1986, p. 16). According to Joanne Bernstein (1983):

Children, through reading, realize that others share their plight . . . their
feelings are within the range of normality . . . .When children feel less isolated,
they lose some of their embarrassment about their situation. (p. 28)

Review of the literature

A literature review on bibliotherapy for ages 018 years was carried out for the dates
January 1997November 2011 utilizing MEDLINE, CINHL, PsycINFO, and
AMED databases. These are specific health databases and refer to research papers.
See Table 1. In addition the authors drew on their own experience and refer to
articles following their own research. See references.
 16 D. McCulliss & D. Chamberlain
TABLE 1. List of research articles found on health databases.

Study Type of bibliotherapy Client group Recommendations

1. Aggression/bullying
Shechtman (1999) 10 45 minute meetings using short 108-year-old boys Effective in reducing aggression and enhancing
stories, poems, films, and pictures constructive behavior
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Shechtman (2000) 10 45-minute meetings using short 551011-year-old Short-term effectiveness in reducing aggressive
stories, poems, and film followed by boys behavior. Film particular noted as meaningful.
activities 151011-year-old
girls
Gregory and Vessey (2004) 11 with school nurse using School-age children Bibliotherapy is one method that can be used to
suggested reading list successfully engage with children
Christensen (2004) Comic book Delinquent adolescents Participants were helped to recognize meditation
as an alternative course of action to fighting
through the comic book
Shechtman (2006) Counseling, counseling with 61816 boys Both counseling groups reduced aggression with
bibliotherapy and no counseling the counseling with bibliotherapy also improving
interventions compared empathy

2. Anxiety
Hébert and Furner (1997) Lesson plan for math anxiety children Gifted 1116-year-olds Suggested strategies to relieve stress.
Booklist suggested
Lyneham and Rapee (2006) Parent-led CBT self-help book with 10067-year-olds and Both interventions reduced anxiety with the
Randomized trial nine supporting therapist phone calls parents telephone support being more effective
or e-mails
Rapee et al. (2006) Parent-led CBT self-help book 267612-year-olds Parent-led CBT more effective than waiting-list
Randomized control trial compared to standard group group but not standard group treatment
treatment and wait-list group
Leong et al. (2009) Parent and clinician delivered 10714-year-old girls Parent-directed bibliotherapy may be more
Comparison programs using CBT books 17714-year-old boys efficacious over clinicians but CBT is an effective
Including 25 mothers treatment overall
and 2 fathers
Thompson (2010) Issue-related books compared to 910-year-olds Significant decrease in low anxiety levels with
general reading bibliotherapy
 Table 1 (Continued )

Study Type of bibliotherapy Client group Recommendations

3. Depression
Ackerson et al. (1998) Self-directed reading of a CBT book 30 adolescents Bibliotherapy may be an effective treatment and
(feeling good) over 4 weeks with alternative for adolescents experiencing
telephone information gathering depressive symptoms. Further research suggested
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and call for age-related material.

Stice et al. (2008) Comparisons of four interventions; 341 adolescents CB reduced risk for future depression and was
Randomized efficacy trial cognitive-behavior (CB), groups, effective in some outcomes than alternative
bibliotherapy (feeling good*self- methods. Bibliotherapy was strong in reducing
directed), and assessment only 6-month follow-up symptoms
Stice, Rohde, Seeley, and Gau Evaluating a five-step method for 341 adolescents Limited support for the hypothesized mediators
(2010a, 2010b) testing mediators on three suggesting that nonspecific factors affect
Randomized control trial interventions; CB, groups, meditational role. Suggested further research.
bibliotherapy (feeling good*self-
directed), and an assessment-only

Bibliotherapy for youth and adolescents 17

control
Stice et al. (2010a, 2010b) CB, groups, bibliotherapy, and 341 adolescents Bibliotherapy is the least-expensive method in
brochure controlled compared after 1 reducing risk of future episodes of depression
and 2 years

4. General illness and disabilities

Hippie, Comer, and Boren Suggested reading list Teenagers Recommendation of books for 20 different issues
(1997)
A booklist
Ahmann (1997) Fiction and nonfiction books Children Discussion on how books can support children
with siblings who are ill or disabled. Some book
suggestions
Manworren and Woodring Children’s books on illness, surgery, Children aged Review of current literature, discussion, and
(1998) and hospitalization 211 years recommended booklist
Felder-Puig et al. (2003) Own children’s book on ENT surgery 210-year-olds Own preparation book provided educational
benefits and helped reduce anxiety
 18 D. McCulliss & D. Chamberlain
Table 1 (Continued )

Study Type of bibliotherapy Client group Recommendations

Clough (2005) Personalized story 18-year-old girl Account of writing and using a story to prepare a
Narrative child for surgery. Some recommended books
Eppler and Carolan (2005) Biblionarrative (oral and written Children generally Describe research project of biblionarrative with
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stories) bereaved children. Process of gathering life story

of child for research and clinical purposes
Reynhout and Carter (2006) Social StoriesTM teaching tool Children with autism Rigorous systematic approach needed on future
A review and related disorders research to answer questions raised about
effectiveness in this review
Chan and O’Reilly (2008) Social StoriesTM teaching tool 25 and 6-year-old Inappropriate behavior decreased
boys with autism
Goddard (2011) Subject-related children’s books Children Discussion of the use of bibliotherapy with
children with chronic illnesses. Suggested
booklist
5. Issues with parents
Tussing and Valentine (2001) Fiction books Literature aimed at 7 books suggested for bibliotherapy
Mental illness of parents adolescents
Hames and Pedreira (2003) Subject-related books Children and Discussion on the benefits of professionals using
Incarcerated parents adolescents bibliotherapy. Suggested booklist
Nuccio (1998) Teacher read fictional book and 89-year-olds No significant self-esteem changes took place
Divorce discussion compared to placebo and between different groups. Although there was
control groups significantly improved classroom behavior
Barrett-Kruse (2000) Fiction and story telling Adolescent females Describes use of bibliotherapy for school and
Mother/daughter community counselors
Pehrsson, Allen, Folger, Fiction and nonfiction books Pre-adolescents Discussion on the benefits of counselors using
McMillem, and Lowe (2007) bibliotherapy with methods and booklist
Divorce suggested
 Table 1 (Continued )

Study Type of bibliotherapy Client group Recommendations

Hahlweg, Heinrichs, Therapist-assisted self-help booklet 69 families with Compared to control there was a significant
Kuschel, and Feldmann (2008) preschool children reduction in behavior problems. More from
Parental competence (36-year-olds) mothers than fathers
Forehand, Merchant, Long, and Comparison of two CBT-based books 52 parents of Both books helped reduce problem behavior,
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Garai (2010) (Parenting Strong-Willed Children and 36-year-old children although PSWC was more effective and better
Strong-willed children Touchpoints; 36) received by the parents

6. Social development and

self-esteem
Pardeck and Pardeck (1997) Issue-related books 48-year-olds Presents strategies and process of implementing
bibliotherapy. Suggested booklist on a range of
issues
Dunn-Snow (1997) Art therapy and bibliotherapy (stories 48-year-olds Account of art therapy and bibliotherapy used to
read to children) promote awareness of self and others

Bibliotherapy for youth and adolescents 19

Weber (1999) Interactive bibliotherapy. Comparative Gifted female No significant influence of bibliotherapy on
study adolescents gender roles. Further research suggested
Hébert and Kent (2000) Developmental bibliotherapy. Reading Gifted adolescents Descriptive account with suggested reading list.
and discussion Developmental bibliotherapy has the power to
enrich meaning and experience
Ford (2000) Reading and discussion Gifted ethnic minority General discussion on multicultural literature
adolescents and the effectiveness of bibliotherapy raising
awareness. With suggested booklist
Stringer, Reynolds, and Simpson Reading groups (literature circles) 2667-year-olds Placing a counselor into a teacher-led literature
(2003) circle did not significantly raise self-esteem of the
children
Heath, Sheen, Leavy, Young, and Reading and discussion Children Discussion on the benefits of shared reading.
Money (2005) Booklist suggested for counselors
Seung-Mcfarland (2008) Developmental bibliotherapy African American Bibliotherapy did not impact on emerging racial
including art children 57 years old identity. Findings discussed and further research
suggested
 20 D. McCulliss & D. Chamberlain
Table 1 (Continued )

Study Type of bibliotherapy Client group Recommendations

7. Specific
Fritzler, Hecker, and Losee Comparison of self-directed 91763-year-olds As a group all showed significant improvement
(1997) reading with guided
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Obsessive-compulsive disorder reading

Burns and Kondrick (1998) Reading therapy program 10 children with Parents as reading therapists appeared to help the
Reading disability reading disability children significantly
Davies and Yehieli (1998) Reading, slides, origami, discussion 1011-year-olds Description of a bibliotherapy plan
Death and grief
Amer (1999) Reading 27716-year-olds Bibliotherapy is an effective nursing tool to
Short stature and diabetes facilitate discussion
Evans et al. (1999) Comparison of three treatments 341650-year-olds Suggests manual-assisted CBT is effective and
Self-harm including manual-assisted CBT cost efficient
Randomized controlled trial
Koppenhaver et al. (2001) Reading of story tales (familiar and 6 girls Familiar story reading enhanced communication
Rett syndrome unfamiliar) 67-year-olds and skills
their mothers
Burke, Brett, and Peterson Bedtime story (related theme to issue) 427-year-olds Story helped parents address disruptive bed time
(2004) and reduce disturbance. Book format is an easy
Bed resistance and night and cost-effective tool
waking
Raingruber (2004) Writing and reading poetry Children and Using poetry in a clinical nurse setting can help
General mental adolescents children express themselves
health
Leonard, Lorch, Milich, and Parent story telling using wordless Parents of 25 children Both groups told similar-length stories and
Hagans (2009) picture books with ADHD complexity. Child retell did not differ either.
ADHD Comparison group of Story reading positive experience for both groups
parents with 39 children
(mean age 7.5)
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Table 1 (Continued )

Study Type of bibliotherapy Client group Recommendations

Bravender et al. (2010) Subject-related fiction book compared 81913-year-old girls Greater weight loss by group with subject-related
Obesity to nonsubject-related book and no book. More research suggested to include all
Randomized control trial book adolescent ages
Duncan (2010) Creation of two children’s libraries Children (27-year- Descriptive account of setting up two libraries
2 support organizations olds) with some book suggestions and discussion
(seriously ill and domestic or

Bibliotherapy for youth and adolescents 21

sexual abused children)
Harper (2011) Fiction and nonfiction books 182613-year-olds A range of increased emotional awareness
Emotional and behavioral
disorders
 22 D. McCulliss & D. Chamberlain

Inclusion/exclusion criteria
Research papers and reviews of papers examining the use of bibliotherapy with
children and adolescents were sought. The period reviewed was limited to 1997
2011 to focus the review and discussion on current practice. In addition, the aim was
to summarize the evidence of the findings to enable future practitioners to quickly
identify areas of practice that work and areas of research that requires further
investigation; hence, a table format was used to present the findings. A total of
59 papers were found in the combined literature searches, with 50 meeting the
criteria. Nine were rejected because two were available only in German, five were
related to bibliotherapy only with adults, and two were book reviews. From the
remaining papers, themes were identified and ordered accordingly.

Results of the literature search

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See Table 1. Please note that it is advised that reference is made to the full paper for a
complete view.

Identification of issues
The literature search shows a wide use of bibliotherapy over many issues from mild
behavioral issues to psychosocial conditions. This demonstrates the flexibility of
bibliotherapy in its range and application. The following highlights many of the
issues for which bibliotherapy have been used with the young. Please note that the
content below represents only some issues covered and reference should be made to
Table 1 for further specific issues.

Abuse
Many youth and adolescents today cope with chaotic and dire, life-threatening home
life circumstances such as domestic violence abuse, poverty, hunger, and child
neglect and mistreatment (Johnson, Dupuis, Musical, Hall, & Gallnick, 2002).
Traumatic home lives may lead to children acting out erratically in the school
environment. School professionals need to be vigilant in detecting and reporting
abuse issues (Haeseler, 2009, p. 115). Bibliotherapy can provide believable
characters or situations that the abused child can identify with.

Aggression/bullying
Bullying is a pervasive problem affecting millions of students every year and it is one
of the most frequently reported discipline problems (www.youthviolence.edschool.
virginia.edu/violence-in-schools/nationalstatistics.html).
Bibliotherapy can help promote successful coping strategies in youth and
adolescents who have been affected by this often devastating experience (Gregory &
Vessey, 2004). In addition, bibliotherapy has also been used for children to gain
insight into their aggressive behavior (Shechtman, 1999, 2000, 2006).
 Bibliotherapy for youth and adolescents 23

Anxiety
Children can suffer significant distress from school or social phobias, separation
anxiety, or test anxiety. Bibliotherapy allows these children to explore their fears in a
character or situation in literature and then to relate how the fears were faced and
overcome to their own life. Cognitive behavior therapy (CBT) self-help books have
also used both parent- and clinician-led as well as issue-related fiction.

Bereavement
There is no correct way to grieve and no timetable for mourning (Broadway, 2008).
The bereaved may exhibit the following emotional grief behaviors: anger, sadness,
anxiety, denial, depression, guilt, shame, relief, mood swings, repression of feelings,
and hypersensitivity. Cognitive reactions may include limited attention span, decline
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in academic performance, confusion, memory problems, spiritual questions, and a

preoccupation with death (Broadway, 2008). Somatic reactions may include inability
to sleep, loss of appetite, nightmares, and physical complaints such as headaches or
stomach aches (Burke, 2009). Regressive behaviors including a lapse to earlier
behaviors are not uncommon.
In dealing with children, adults need to be aware of how they have been affected
by their own loss experiences of death, illness, divorce, separation due to illness or
incarceration or custody issues, relocation, family restructuring, loss of friendship or
pet, or alcoholism or substance abuse. Grief can also be complicated by factors such
as gender, culture, society, and availability of support (Burke, 2009). Branch and
Brinson (2007) provide a listing of recommended books on attachment, separation,
and loss of a loved one in their article, ‘‘Gone but not forgotten: Children’s
experiences with attachment, separation, and loss.’’
According to Malachiodi (2008) it is important to know the relationship of the
child to the person who died, how the individual died, the age of the child at the time of
the loss, how the child learned about the death, and the child’s cultural or religious
background in choosing literature for use with bereaved youth. Selected books should
provide comfort and reassurance, along with explanation and insight, and be realistic.
Fantasy literature has been found to be helpful during difficult times for gifted youth
(Burke, 2009). Guidelines for library collection managers for selecting books to help
young people manage grief and several pertinent books and web sites can be found in
the article ‘‘Dealing with Death: Books to Help Young People Cope with Grief’’ by
Marsha Broadway (2008), juvenile literature librarian, Brigham Young University.
Children can be helped to cope with loss in concrete ways. This can be accomplished
by encouraging them to draw pictures, write letters, or make a scrapbook about the person
who has died. Gifted children may be perceived as self-sufficient and smart enough to
figure out their own problems. However, due to their unique social and emotional needs,
it is gifted children who may require differential support to deal with loss, the most
(Burke, 2009). Schultz (1999) outlined developmental and emotional characteristics of
children that affect their expression, misconceptions, and facts surrounding grief and
provides book references about death for both younger and older children.
 24 D. McCulliss & D. Chamberlain

Depression
Bibliotherapy has been found to be useful in helping students experiencing mild and
moderate depression (Ackerson, Scogin, McKendree-Smith, & Lyman, 1998), those
who are in crisis (Heaton, Johnson, Ashbaker, Gstettenbauer, & Allen, 2003) and
those who cope with the mental illness of a parent (Tussing & Valentine, 2001).
Bibliotherapy may help reduce the risk for future depression onset. Methods used
tend to be using CBT self-help books rather than fictional books.

General illness and disabilities

Ten to fifteen per cent of children under the age of 18 have one or more chronic
health conditions that limit daily activities or cause disability (Callahan, Winitzer, &
Keenan, 2001; Creedy, Ludlow, Collis, & Cosgrove, 2005). Adolescents today
experience greater rates of behavioral and mental disorders than in previous decades,
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and there are increased numbers of adolescents with diabetes, cancer, chronic
inflammatory bowel disease, allergies, and obesity (Sawyer, Drew, & Duncan, 2007).
Harvey (2010) investigated the use of bibliotherapy in a regional Australian city
with adolescents who have chronic illness. In general, books were found to have
therapeutic value. One helper’s perception was that students have no time to read
anything other than school texts. They made the suggestion that those students who
have more time benefit from bibliotherapy. This concern may also indicate that the
use of books for therapeutic purposes in secondary schools is peripheral to the real
business of student life: study, meeting academic requirements, and examination.
Disabilities may include learning disabilities, behavioral disorders, or mild
mental retardation. Students with these or other disabilities can learn to become
independent and effective problem solvers through the utilization of bibliotherapy.
Using the book as a focal point, teachers can guide class discussion of the character’s
problem. Students can dialogue about the main characters’ issues and come to
understand that other people may experience the same types of problems and that a
variety of solutions are possible.

Issues with parents/guardians

Bibliotherapy can be used to cover issues to help children understand and relate to
their parents (see Table 1). This can vary from an understanding of mental health
issues to an improvement in specific relationships.

Lived through a natural disaster

Youth today are dealing with an increased sense of vulnerability to natural and
human-made disasters. It is estimated that as many as 25% of all children experience
a traumatic event by the time they are 16 years of age (Costello, Erkanli, Fairbank, &
 Bibliotherapy for youth and adolescents 25

Angold, 2002). Clinicians who study children impacted by disasters have reported
frequent physical and psychological responses associated with stress (Lovelace &
Fridell, n.d.). Webb (1999) noted that school-based interventions during and
following disasters can help children heal. Bibliotherapy provides opportunities to
think about what happened, discussion, and investigation of feelings (Lovelace &
Fridell, n.d). An annotated listing of children’s literature on disasters can be found in
the article ‘‘Helping children cope with disasters: Initiating dialogue with children’s
literature’’ which can be found at www.nssa.us/journals/2009-32-2/2009-32-2-13.
htm.

Obesity
The fat girl is typically never a main character and rarely talks about her life and her
feelings and her dreams, according to Susan Vaught, author of Big Fat Manifesto.
Often she is the sidekick, sexless and hungry. The fat boy is sloppy, grotesque, and
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lonely; sometimes he’s the funny man (Nolfi, 2011, p. 55). Affirming literature for
young readers, who are overweight, includes literature with positive, authentic, and
interesting characters, honest portrayals of diverse characters, and less obesity-
phobia and sizeism (Nolfi, 2011).

Obsessive-compulsive disorder
Two to three out of every 1000 students, ages 515, are affected by obsessive-
compulsive disorder (OCD) (Heyman et al., 2001), making OCD the fourth most
common psychiatric disorder among American youth (Sloman, Gallant, & Storch,
2007).
Students with OCD have difficulty concentrating on schoolwork, completing
homework, meeting deadlines such as arriving at school on time, making decisions,
transitioning from one activity to the next, and completing tasks requiring visual-
spatial skills. Thus, they often perform below their potential on such academic tasks
as reading and computation (Adams, 2004; Starcke, Tuschen-Caffier, Markowitsch,
& Brand, 2010; Tomb & Hunter, 2004). In addition, these students often struggle
with maintaining friendships.
Leininger, Dyches, Prater, Heath, and Bascom (2010) identified and evaluated
numerous OCD books (5 picture books and 12 chapter books). Ten books (two
picture books, three novels, four autobiographies, and one self-help book) published
between 1999 and 2008 were selected for recommendation for quality of text and
illustrations and presenting realistic, dynamic characters in a positive manner (see
Table 1).

Sexuality
The sexual orientation of gay and lesbian as well as transsexual teens is oftentimes
devalued in curriculum, extracurricular activities, and student services. Gay and
lesbian teens could benefit from seeing their concerns reflected in the literary
 26 D. McCulliss & D. Chamberlain

selections or textbooks used in their school classes. Educators can use bibliotherapy
to penetrate any barrier of silence, creating a more supportive school climate (Vare &
Norton, 2004).

Selection of literature for bibliotherapy

Because of the range of issues and applications of bibliotherapy there are an equal
number of ways to select literature. However, careful consideration of the topic, its
target audience, and the outcome desired will begin to narrow the process.
Consideration must also be made to the medium. The literature used in the articles
in Table 1 range from specific CBT self-help books on depression to self-written
stories. However, issue-related fiction tends to be the preferred medium.
When considering books many articles deal with selection criteria. Goddard
(2011) suggests the following:
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1. motivating and challenging experiences;

2. suitability to age, ability, and maturity;
3. elicits response;
4. range of literacy structures;
5. proper use of language;
6. broadens understanding of diversity;
7. develops sensitivity and understanding.

Factors including age and cognitive ability and needs related to the situation must
be taken into account when considering bibliotherapy (Morgan & Roberts, 2010).
It is also important to understand their social/emotional, medical and family
challenges. Maich and Kean (2004) suggested answering the following questions
based on the findings by Carlson (2001) and Cartledge and Kiarie (2001) in
choosing literature: (a) Is the story simple, clear, brief, nonrepetitious, and
believable? (b) Is it at an appropriate reading level and developmental level?
(c) Does the story fit with relevant feelings, needs, interests, and goal? (d) Does it
demonstrate cultural diversity, gender inclusivity, and sensitivity to aggression? and
(e) Do characters show coping skills, and does the problem show resolution?
(Maich & Kean, 2004, p. 7).
Iaquinta and Hipsky (2006) proposed the following checklist to evaluate
children’s literature with characters who have disabilities:

1. depicts children with disabilities in leadership and action role;

2. conveys a story that is realistic, empathetic, and sensitive to the child with the
disability and thereby encourages a positive attitude; enables the child with the
disability to resolve the problem; and conveys the same story line if the main
character did not have a disability;
3. encourages positive value judgments;
4. generates balance in the relationships between children with disabilities and
their nondisabled peers;
 Bibliotherapy for youth and adolescents 27

5. promotes a child with a disability as a positive role-model for nondisabled peers;

6. contains layers of meaning;
7. avoids loaded words.

Most authors suggest that teachers discuss with their students recommended books,
concerns, and sensitive issues and to display books and posters to encourage youth
and adolescents to voice their concerns, ask about reading material, and choose
helpful books. The child’s needs and desires must be met sympathetically and the
child must not be forced to share feelings or situations they may be uncomfortable
with (Abduallah, 2002; Joshua & DiMenna, 2000).

Presentation of bibliotherapy
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In the classroom
Contemporary teachers are challenged by a wide range of social, emotional, and
economic issues (including self-identity, independence, and self-worth issues) at all grade
levels. Issues that students may find themselves dealing with include physical or sexual
abuse, poverty, health issues, prejudice, alcohol, or illicit drug use, grief, depression,
unwanted pregnancy, learning or physical disabilities, or risky behavior issues (Shaw &
Asianian, n.d.). Other issues may involve parental mental illness or death, divorce,
suicide, illiteracy, gangs, adoption, or violence. In the United States, immigration is
unprecedented in its diversity of ethnicity, class, and countries of origin, making
application of traditional techniques of intervening limited. Bibliotherapy brings a less
traditional, but effective means of opening up communication with a diverse population.
Schools are inundated with increasing numbers of students who may have socio-
emotional difficulties. This trend is confirmed by current statistics on youth suicide,
arrests, and suspension from and violence in the schools. Children all over the world
have lived through the Sept 11 attacks, the panic over the anthrax mailings, the hunt
for terrorists in Afghanistan, elevated homeland security threat levels, the war in
Iraq, the tsunami disaster, and Hurricanes Katrina and Rita (Rycik, 2006).
Exposing students to bibliotherapy can enhance the probability of their success
both academically and socially as well as fostering resilience. To meet a range of
student needs or build on students’ strengths, teachers may assign their students to
read and engage in discussion on literature that is based on quality and relevance.
Students can then write a new story or rewrite the story based on new choices or a
different outcome or ending, compare decisions made by the characters and
decisions they would have made, or write their reflections in their journal.
Problem-solving through literature can be an effective intervention. Teachers, in
collaboration with school counselors, librarians, and administrators, can evaluate
student writings and note personal, academic, social, and behavior areas that need to
be addressed. Why would a teacher choose to use bibliotherapy with their students?
Nine potential reasons have been proposed for the use of bibliotherapy (Aiex, 1993)
including the following:
 28 D. McCulliss & D. Chamberlain

1. showing an individual that he or she is not the first or only person to encounter
such a problem;
2. showing an individual that there is more than one solution to a problem;
3. helping a person discuss a problem more freely;
4. helping an individual plan a constructive course of action to solve a problem;
5. developing an individual’s self-concept;
6. relieving emotional or mental pressure;
7. fostering an individual’s honest self-appraisal;
8. providing a way for a person to find interests outside of self; and
9. increasing the individual’s understanding of human behavior or motivations.

Once the literature is chosen, the prepared lesson plan is implemented. In the
classroom, the group approach is more advantageous than an individual approach for
many reasons: it is less time consuming, more natural, and it allows youth and
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adolescents to share common experiences and experience less anxiety. Students feel a
sense of belonging and security, and everyone is able to develop different
perspectives and new understandings of the problem (Aiex, 2006).
Teachers are encouraged to listen carefully to what each student has to say.
Regardless of whether the facilitator chooses the group or individual approach, the
process of conducting bibliotherapy is the same. The length of time scheduled for
each session largely depends on the attention span of the group members and how
familiar participants have become with and involved in the bibliotherapeutic process
(Hynes & Hynes-Berry, 1994/2012, p. 140).
Books and discussions of books have the potential to not only build cultural bridges,
but also widen one’s horizons (Langer, 1995a, 1995b, 1995c). Personal responses and
critical discussion are best promoted through a literacy-enriched environment and
written, dramatic, or artistic activities that allow self-exploration (Graff, 2009).
Specific questions can be asked by an adult to help children explore a story and
its characters and how they relate to the reader:

. Are you like any of the story’s characters?

. Do any of the characters remind you of someone?
. Who would you like to be in the story?
. Is there anything you would like to change about the story?
. How would you change the characters, what happened, or how the story ended?
. What is your favorite part of the story?
. Did anything in the story ever happen to you?
. What do you think will happen to the characters in this story tomorrow, in a few
weeks, or a year from now?

Students can be given the opportunity to evaluate credible interpretation and

recognize that various authors provide different points of view in their text on the
same topic (McCall, 2010, p. 153). In addition to discussion, critical thinking, role-
playing, reflection, and problem-solving stimulation could be additional activities to
reinforce content learned.
 Bibliotherapy for youth and adolescents 29

Different mediums and formats

Within the research, there are many different ways in which bibliotherapy has been
delivered, from controlled clinical studies to poetry writing. Bibliotherapy has been
used by teachers, therapists, clinicians, nurses, parents, and children. The format
range includes books (specific self-help, picture books, fiction, and nonfiction), art
therapy, origami, films, slide shows, comic books, and writing. Bibliotherapy is
extremely flexible and can be used successfully in a variety of settings.
Bibliotherapy addresses the academic and emotional needs of youth and
adolescents through poetry, graphic novels, and Internet-based video games and
user-guides. Research heralds the necessity of literary diversity, choice, and personal
engagement for the positive development of youth’s relationships with reading and
testifies to the evolving nature of literacy (Graff, 2009). Picture books stimulate
children’s thinking and promote understanding in addition to providing pleasure for
young children (Walker, 1986). They come in many shapes, sizes, reading levels, and
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topics, and can engage readers, present complex ideas, help readers visualize events,
and teach valuable lessons (Anglada, n.d). Examples include Sumi’s First Day of
School Ever (2003).
CBT techniques have also been utilized to guide students through a process of
understanding and coping with mental health issues (Leong, Cobham, de Groot, &
McDermott, 2009; Lyneham & Rapee, 2006). This format is more clinically led and
tends to be part of a timed process. Consequently, the research is more quantitative
and can incorporate comparisons between different approaches (Stice, Rohde,
Seeley, & Gau, 2008).
Social Stories are a particularly useful tool for teaching social skills to children
with autism and related disabilities (Wallin, 2004). Lynch and Simpson (2005)
defined Social Stories as ‘‘a written narrative that specifically tells how to negotiate a
problem situation’’ (p. 32). These stories include descriptive, perspective, affirma-
tive, and directive sentence types. The goal is to increase understanding of social
situations, enabling one to demonstrate appropriate behaviors, reactions, and
responses (Hanley-Hochdorfer, Bray, Kehle, & Elinoff, 2010, p. 485). Topics
include hygiene, emotions, and being polite to name a few. Social Stories have been
found to support relationship building, develop early literacy skills, and strengthen a
child’s self-awareness, self-control, and self-esteem.
Literature circles are small student-led discussion groups in which group
members have selected the same book or article to read, participated/contributed
in discussion, and share highlights of the discussion with their entire class. Teachers
may ask students to complete various roles that include connector (one who makes
connections between the reading and their own lives, the world, or other readings
and texts), questioner (one who lists important questions about the text to use during
the discussion), passage master (one who locates sections of the text that are most
interesting, important, and puzzling that the group should look back on), vocabulary
enricher (one who identifies important, interesting, puzzling, or unfamiliar words
that group members need to understand), and illustrator (one who creates a picture,
diagram, or flowchart related to the reading that may be directly related to the text or
 30 D. McCulliss & D. Chamberlain

something the text reminded the person of) (Daniels, 2002, p. 103). Literature
circles encourage authentic student-led discussion and interactions rather than the
more common, teacher-centered question-and-answer exchanges (McCall, 2010).
Film (videotherapy) can also be used as bibliotherapy. The process and the goals
are the same with videotherapy as with bibliotherapy, whereby the teacher and
students discuss themes and characters in the story and relate them to the students’
own lives. Films are particularly appropriate to use with adolescents, especially those
with reading problems and limited language skills. Adolescents who do not like to
read typically enjoy watching films (Dole & McMahan, 2005). An example of film
used in bibliotherapy is ‘‘My Girl’’ (Zieff & Elehwany, 1991). This film can serve as a
medium through which significant family changes can be addressed as a young girl
shows frustration and confusion when her widowed father decides to remarry. In a
different film of the same name (Grazer, Friendly, Gold, Caracciolo, & Zieff, 1998),
a little girl puts her best friend’s eyeglasses on him in the casket so that he will be able
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to see after he is buried (Webb, 2005).

Storytelling with children is something many parents do regularly. In collabora-
tive story-telling or ‘‘co-storying,’’ youth can be encouraged to explore different
scenarios and alternative endings. According to Pehrsson, ‘‘Allegorical stories can
bypass conscious and unconscious defences’’ (Sherman, 2007).
Writing poetry and events such as the National youth slam poetry competition is
inspiring for the lovers of language, words, and stories. Koch’s (1970) first book,
Wishes, Lies and Dreams: Teaching Children to Write Poetry, continues to be a valuable
asset in the bibliotherapists’ toolbox. Poetry writing lesson plans written by Anthony
Wilson, lecturer, poet, writing tutor, can be found at The Poetry Trust, The Poetry
Archive, and the Poetry Society. Morag Styles, Professor of Children’s Poetry, has
taught poetry for 40 years and has published more than two dozen anthologies for
youth readers with the mission to widen their knowledge of international poetry. She
is currently engaged on a Caribbean Poetry Project linked with the online Poetry
Archive and the University of West Indies (http://caribeanpoetry.educ.cam.ac.uk).
The periodical Scholastic Magazines contain condensed plays, current television
offerings, some poetry, and short stories designed for classroom use. Brod Bagert’s
poems are written in the voice of a child, for children to read out loud to perform.
Most of them are about how kids really feel (www.poetryalive.com/resoures/student_
resources/poetry_research.html). ‘‘Fooling with Words’’ with Bill Moyers (www.pbs.
org/wnet/foolingwithwords/poet.html) also provides a teacher’s guide.

Follow-up
The follow-up stage can include interactive dialogue and/or a problem-solving/
reinforcement/response activity such as commenting on illustrations or main
characters, creative writing (writing a solution to a problem situation, writing an
opinion about a certain viewpoint, or writing a letter to a character), art projects
(sketching, painting, drawing, or creating a collage from pictures from a magazine to
create a pictorial essay), or drama (role-playing, puppetry, or pantomiming)
(Pardeck & Pardeck, 1993; Forgan, 2002). Activities are based on the age level of
 Bibliotherapy for youth and adolescents 31

the child and what the child needs to take from the story. No matter what activity the
teacher chooses, the child needs to be able to identify their problem with the story
and express the identification through the activity (McNamee & DeChiara, 1996).
Examples of how various professionals have used bibliotherapy include the
following:
Dale-Elizabeth Pehrsson, pediatric nurse, play therapist, family counselor,
professor, and clinical editor of Play Therapy magazine, and Paula McMillen, clinical
psychologist, professor, are committed to improve counselor competency in working
with children.
Mary Tinucci, MSW, LICSW, a Minnesota Public School social worker and
founder of The Poetry Lab for youth, created an innovative way to work with urban
youth through group work, writing, poetry, and spoken word poetry. The lab now
includes the therapeutic use of additional creative and experiential modalities such as
photography and visual art. More information can be found at www.thelabspps.com.
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Trisha Whitney (1999), elementary school teacher, author of Kids Like Us: Using
Persona Dolls in the Classroom, a how-to guide for teachers who have never used the
dolls before, uses persona dolls to teach diversity and build classroom tolerance.
Babette Brown (2001) wrote Combating Discrimination: Persona Dolls in Action.
Michael Dissen, Peace Corp Volunteer, held a ‘‘HIV Education through
Literacy’’ class in May 2010 in Ha Sefako, Africa. Peace Corp staff and volunteers
partnered up with the Ministry of Education to facilitate a workshop to train 36
teachers from 12 schools to use roughly 70 children’s books that have an HIV, sexual
health, self-esteem, decision-making, and gender equality focus (2010). In email
correspondence dated November 27, 2011, Dissen writes:

After the workshop we were able to keep in touch with some teachers through
follow-up visits and other library/sexual health related workshops. Many of
the teachers used the books as a read-aloud in their classrooms. They did not
feel comfortable discussing sex and HIV with their students. Some books
were well illustrated story books, while others were educational and more like
a mini-textbook. Each of the schools that attended the workshop either had a
library or were in the process of applying for a school library. I also worked on
that project and the teachers were trained to use the books in their schools.

The kids used the books as a reading book and as a resource to learn more
about HIV. Lesotho has the world’s third highest HIV rate, but it isn’t
discussed often. Sexual health is hardly discussed, so the students found the
books helpful as they were transitioning from childhood to young adults.

The teachers worked in mixed school groups to create lessons to take back to
their schools. So each school had around 70 books and lessons to help them
introduce the books to the their colleagues and students. We also had well
known and respected groups come and teach about HIV through educational
games. We realized that not all teachers knew about HIV well enough to teach
about it. If I was able to do this project again, I would do it earlier in my Peace
 32 D. McCulliss & D. Chamberlain

Corps service. I had the opportunity to visit many of the schools, but some
were not accessible during parts of the year. I would have also held the
workshop twice with the same teachers. We trained students from across the
area we lived 3 different times during our service and it worked well. We were
able to build on what they knew, needed to know, and wanted to know. It
would have been nice to meet the needs of the teachers in this way.

In the UK, The Reader Organisation http://thereader.org.uk/ is a charity and social

enterprise that works to bring about social change by sharing great literature with
people of all ages, from all backgrounds and with all abilities.

The work we do is driven by a love for great literature and a strong belief that
shared reading is a deeply powerful activity that can significantly enrich and
improve lives, and the communities we live in. We work to transform the ways
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in which people view literature and get them utilising it in their everyday lives.
We work to dramatically change society’s collective approach to reading 
making literature accessible, available, emotionally rewarding, and fun.

The groups usually run for oneone-and-half hours*the facilitator starts reading a
short story and stops at intervals along the way to discuss the text (includes a
personal response). The facilitator will offer the story to members, i.e., to take turns
in reading but this is voluntary. Then there is a tea-and-biscuit break (very
important!) and the session ends with a couple of poems usually picking out a
theme from the short story. Group members do not have any pre-reading to do or
need to have any literary background. Although the reader would not necessarily use
the term ‘‘bibliotherapy’’ to describe what they do, mainly because they do not want
to scare people off by using labels, it uses bibliotherapeutic principles.
They have worked with many different groups including children and
adolescents.
A report is available from http://www.liv.ac.uk/health-inequalities/Research/
web_version_therapeutic_benefits_of_reading_final_report_Mar.pdf.

Positive and negative effects of bibliotherapy

The major benefits of bibliotherapy have been described as self-expression,
examination of one’s own thoughts and feelings in relation to self and others,
and revelation of new solutions to problems. James Britton (1993) described this
in his writings as ‘‘We read ourselves—and when we see ourselves in literature—
straddling or perhaps balancing the roles of ‘‘spectator and participant’’’’ (Britton,
1982), we engage the reflective process. Corr (2003) also wrote in relation to
youth that bibliotherapy serves to ‘‘bring . . . a child or adolescent indirectly to
the edge of sensitive issues, possibly too threatening or painful to face directly’’
(p. 338).
 Bibliotherapy for youth and adolescents 33

Some youth and adolescents do not enjoy reading or have difficulty reading. As a
result, the child may project their own motives into the character with the result of
reinforcing the situation they are enduring, thereby receiving negative results. Some
participants may be defensive and unwilling to discuss their problems because they
feel uncomfortable with the situation.

Limitations of bibliotherapy
Limitations of bibliotherapy include the following. What is the readiness of the child?
Is the child of an age where they can comprehend the reading or be emotionally
ready to benefit from the literature? The nature and degree of the issue must
determine the most pertinent literature selected, and the availability of quality
materials, the therapist’s training, skill, and experience are critical. A high level of
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reading ability is needed from some self-help books.

Strategies for teachers and educators

While bibliotherapy, by its nature, is not a precise science, many have learned this as
a behavioral technique as developed. To follow are many of the ‘‘lessons learned’’
during the implementation of bibliotherapy.

. Teacher collaboration with other school professionals, such as the school

counselor, psychologist, or librarian.
. Establish a diverse collection.
. Read books before assigning them to students. Do not rely on a summary or review
posted on the web. Be prepared to recommend more than one book or different
types of books.
. Provide an audiobook to a child you cannot read or does not like to read.
. Develop a list of talking points that you can use to help stimulate discussion about
the story.
. To keep a student’s attention and focus it may be helpful to draw from one or two
pages that are pertinent to the problem rather than the whole book.
. Stop reading periodically to ask questions.
. Keep in mind that not all students may benefit from or be able to watch films. If
movies are used, preview movies in entirety and assess it for appropriateness
(Eppler, Olsen, & Hidano, 2010).
. Educators must be aware of a reader’s reactions, especially those that might
create self-imposed barriers, rather than the response to the assigned literature.
. Encourage feedback.
. If a particular student encounters a problem that is more severe, seek out other
resources.
. Consider forming a literature circle.
 34 D. McCulliss & D. Chamberlain

Research recommendations
Several comprehensive reviews of literature written on the effectiveness of bib-
liotherapy found the following to be most consistently improved: (a) level of
assertiveness, (b) attitude, (c) level of anxiety and text anxiety, (d) mood, and (e)
appropriate behavior. Young adult advocates need to pave the way for well-written
stories with educational importance, to reveal a world beyond stereotypes.
Areas of suggested future research include the following:

1. studies with overweight and obese adolescents to determine if the novel is

effective for healthy life-style promotion (Bravender, Russel, Chung, &
Armstrong, 2010);
2. studies with autistic children in inclusive settings targeting appropriate class-
room behaviors and analysis of the effects of different intervention components
(Chan & O’Reilly, 2008);
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3. studies to test long-term effectiveness, ways of increasing the effects of cognitive

behavior prevention programs, and barriers that will hamper wide-scale
implementation (Stice et al., 2008);
4. well-controlled studies to support the use of Social Stories, in isolation and used
in conjunction with different interventions (instructional methods), to increase
social and communication skills in a school setting (Hanley-Hochdorfer et al.,
2010). Increased teacher involvement, with classroom teachers playing a role in
the design and implementation of Social Stories studies is another target for
research (DiGennaro, Martens, & Kleinmann, 2007).
5. evaluation of different methods for treating depression (Cuijpers, Donker,
van Straten, Li, & Andersson, 2010);
6. influence of bibliotherapy on gender roles (Weber, 1999);
7. influence of bibliotherapy on ethnic identity (Seung-McFarland, 2008).

There will always remain a need for rigorous, empirical studies on the effectiveness of
bibliotherapy with juvenile literature. Further investigation of bibliotherapy and
journal writing and the effectiveness of bibliotherapy as an intervention with
bereaved children and adolescents are recommended. Authors are encouraged to
publish additional accurate accounts and stories about OCD, particularly for high-
school males and lower-elementary females (Leininger et al., 2010). In addition, any
literature published adds to the public domain and can guide clinicians, teachers,
and children to gain a greater awareness and insight into their cultural surroundings,
as well as providing an evidence-based treatment for some clinical conditions.

Summary
Bibliotherapy has been widely used in many different applications and in many
different formats for a large range of issues. Research has shown that bibliotherapy is
a successful tool to help nurture understanding and empathy for children and
adolescents.
 Bibliotherapy for youth and adolescents 35

This article may guide readers through the process of creating a bibliotherapy
group, looking at both psychological and practical issues and directing the reader to
research and book lists that have been successfully used.
Several authors have created recommended booklists on topics that include
sexuality, emotional issues, identity, puberty, and self-esteem, and social and
multicultural issues. See Table 1 for research that recommended books for
bibliotherapy use with youth and adolescents.

Every reader finds himself.

The writer’s work is merely a kind of optical instrument that makes it possible for
the reader to discern what, without this book, he would perhaps never have seen in
himself.
Marcel Proust
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Sidebar: The right story at the right moment is an arrow to the heart. It can find and
catch what is hiding inside the reader (or the listener), the secret hurt or anger or
need that lies waiting, aching to be brought to the surface. – Bruce Colville children’s
author, 1990.

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