Bibliotherapy pioneered as a treatment for depression

A project on Merseyside has pioneered bibliotherapy as a treatment for people with acute depression and anxiety. Now the government is taking notice

The notion that books can make you feel better goes back to the era of Plato and Aristotle, both of whom recognised their therapeutic capabilities.

Reading as clinical therapy (or “bibliotherapy” to give its popular title) is relatively new but it is backed by a growing number of mental health professionals, many of whom have seen profound changes in patients with acute depression and anxiety.

Its status was confirmed by the Department of Health’s consultation on its planned new strategy for mental health, New Horizons, which cited the Merseyside-based Get Into Reading project as an example of good practice.

Get Into Reading, part of charity the Reader Organisation, provides more than 120 weekly read-aloud groups on Merseyside in prisons, care homes, hospitals and mental health services.

The project was set up in 2001 by former university lecturer Jane Davis, founder and director of the Reader Organisation, with a £500 grant from Liverpool University.

In 2007, it was commissioned by specialist mental health and learning disability provider Mersey Care NHS Trust to deliver reading groups across its services.

Readers in residence

Groups are set up by readers in residence (or bibliotherapists) from the Reader Organisation who then train trust staff, including the chief executive and medical director, to run the groups themselves.

Part-time reader in residence Mary Weston, who has a background in counselling, runs four to five hour-long groups a week at the high-security Ashworth Hospital in Merseyside and an acute psychiatric single ward unit in Southport.

Weston, helped by a colleague with whom she job-shares, sets up groups with an occupational therapist, nurse or psychiatrist and teaches them how to run the classes over 12 hourly sessions on average.

Weston emphasises the importance of shared experience in bringing about therapeutic benefits in reading groups, including among those of her clients with severe psychiatric disorders.

“Recently, I was teaching a group for the first time,” she says. “They were all quite unwell, especially two who were particularly anxious, and the atmosphere was tense. We started reading Pardon, a short story by Carol Shields about people being stuck on a bus in bad weather. The bus wasn’t going anywhere and people began striking up conversations and singing, creating a short-term community. This got everyone talking about their own experiences on buses and trains.

“Because the model is very simple – we read a book and then discuss it – that shared experience is a bonding exercise. You’re going into a state of consciousness, almost like a meditative state, with others and it’s contagious in the group and helps people who normally can’t concentrate or focus.”

Dr David Fearnley, medical director at the trust and a consultant forensic psychiatrist at Ashworth, runs a weekly reading class at the institution. He says the experience of reading in a group can help people – even those with severe psychiatric illnesses – to build confidence and feel more connected with the world around them.

“The whole experience requires concentration and makes people reflect and think,” he says. “It’s almost like CBT (cognitive behavioural therapy), which trains people to think more positively and to look at their problems in a different light. Some one-on-one therapies can be daunting but this is a comfortable place to start and a powerful way of learning to interact and to develop communication skills.

“Getting positive feedback is also a good way to boost someone’s self-esteem. Sharing ideas about characters gets people talking about their own experiences.”

College lecturer Ita O’Keefe started using mental health services in Merseyside in 1995 due to severe depression and anxiety.

Impact on well-being

In 2008, after a particularly bad episode of depression, she began observing and interviewing service users in Get Into Reading projects on Merseyside as part of her work in training and research into mental health. It had an enormous impact on her own well-being.

“It reawakened my interest in reading and literature, which, partly from being busy and partly from being depressed I’d got out of the habit of,” says O’Keefe, who has now left the group. “It’s also been very therapeutic even though it doesn’t feel like medical intervention.

“It makes you feel normal again, because you can feel like a failure when you’ve had depression and had social services involved. Sharing experiences such as past events made me feel connected and gave me my confidence back.”

Reading groups, most of them run by local authorities, operate in Yorkshire, Essex, Lancashire, London and Salford.

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This article is published in the 15 October 2009 edition of Community Care magazine under the headline Brought to book