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When the pandemic struck, in March 2020, Anne Boulton was already feeling overwhelmed. She was pursuing a PhD at Laurentian University, which meant teaching in the English department and spending her days at home reviewing readings on literature and psychoanalysis for her thesis. But personal issues were bubbling just below the surface. “When COVID happened,” she says, “suddenly you were faced with your own isolation.” She wanted to better address the strain she was dealing with.
Boulton contacted Hoi Cheu, her supervisor at Laurentian. Besides teaching literary theory, Cheu is a trained marriage and family therapist: he has drawn on his experience in both areas to offer therapeutic support, on and off, for about thirty years. He also trained in bibliotherapy, using his dual background in psychology and literary studies to recommend specific texts for people coping with life challenges from loneliness to mental illness.
Bibliotherapy is premised on the idea that books can be healing tools. It can occur in individual or group settings, though the main distinction is between clinical bibliotherapy, where texts, including fiction and nonfiction, are recommended by a clinical therapist, and nonclinical bibliotherapy, as practised by a facilitator such as a librarian. Though not a stand-alone clinical practice in Canada, clinical bibliotherapy is a method used by professionals who already have certification in counselling, therapy, and clinical therapy and want to help patients seeking an additional outlet. Nonclinical bibliotherapy can’t replace professional help for patients with mental illnesses; instead, it is often used in conjunction with other forms of clinical therapy.
Cheu, based in Sudbury, Ontario, first learned of bibliotherapy during his undergraduate degree, when he came across English professor Joseph Gold’s Read For Your Life, which outlines the benefits of bibliotherapy. In fact, the British-born Gold is widely credited with bringing bibliotherapy to Canada. Cheu began working under Gold during his master’s at the University of Waterloo and later wrote his PhD thesis on James Joyce and the art of Zen, applying principles of Buddhism to his analysis of the Irish writer’s works. He eventually became Gold’s assistant, joining him in sessions with clients in his private practice. Books, Cheu says, provide a safely cocooned space inside which people can unearth painful and sometimes repressed feelings.
When Cheu and Boulton logged on to their first virtual session, Cheu started taking notes on Boulton’s needs. “What literary character do you most identify with?” he asked her. She responded with Anna Karenina. She related to the Leo Tolstoy heroine’s strength of spirit. Like the Russian socialite, Boulton was comfortable asking for what she wanted even when she had repeatedly been discouraged by those around her. From this first session, Cheu started to build out her reading list. There was Kaye Gibbons’s Ellen Foster, a novel about a young heroine’s tumultuous childhood in the American South. And there was Nikolai Leskov’s “Lady Macbeth of Mtsensk,” a short story about a young woman seeking to escape a stifling marriage to an older man. Being a good student of English literature, Boulton dove into the texts with vigour.
Though the first known use of the term bibliotherapy appeared in a satirical essay published in a 1916 issue of The Atlantic Monthly, the idea of offering reading material to those in mental distress dates back to eighteenth-century asylums. By the early twentieth century, librarians in US hospitals were even considered therapists. American military libraries also prescribed books to soldiers suffering from trauma after the First World War. These programs were eventually expanded to other hospitals and libraries.
The growing interest in the field of psychotherapy in the 1930s led to research on bibliotherapy. Throughout the 1960s and 1970s, several books were published on the subject. And, as mental health treatment expanded, bibliotherapy gained broader appeal, according to Bibliotherapy: A Critical History.
Proponents of bibliotherapy firmly believe in the potential of literature to provide people the language to help them make sense of their experiences. Fiction does this especially well by nudging readers to substitute their sense of self for that of a character. Enveloped in the perspective of another person, the reader can ponder their choices with a greater degree of objectivity.
The case for bibliotherapy is further bolstered by developments in cognitive science, which indicate a range of benefits. Research suggests that regular readers are likely less stressed and more empathetic. One study by Yale University even suggested that reading books could help people live longer. Critics of bibliotherapy, on the other hand, say that fiction falls short as a method for dealing with real-life challenges and that the practice assumes its patients have access to education and an understanding of the way metaphor and literary motifs work. Some also consider it an overly utilitarian view of literature as a means of self-improvement instead of an outlet for pure enjoyment.
In practice, bibliotherapy varies greatly in form. The clinical approach involves a therapist working with patients to build a tailored reading list, which can be accompanied by writing prompts. In recent years, The School of Life, a UK-based company focused on personal development, has popularized the reading-list approach in its nonclinical sessions. Nonclinical formats have been used in diverse contexts, from prison programs to hospitals. In these, a facilitator poses questions about the readings, and participants are encouraged to reflect on the stories as they relate to their own lives.
Bibliotherapy has also been put forward as a potential way to help manage social ills from stress to isolation—states that have been particularly pervasive during COVID-19. At the start of the pandemic, online book groups—such as the popular Tolstoy Together, initiated by novelist Yiyun Li—sprang up to help participants collectively sort through feelings that they would otherwise have had to address alone. Despite the demonstrated benefits of reading—many backed by scientific evidence—bibliotherapy remains relatively niche in Canada.
Cheu’s clients are often friends who approach him in distress. His consultation process, he says, is never as simple as asking clients to identify their problem and handing them a stack of books. “Rather,” he explains, “it’s a complex process to integrate stories into people’s everyday lives.” Each introductory session starts with Cheu asking a client to tell him their story and, sometimes, what type of books they are drawn to. From there, Cheu identifies literature that may resonate with the individual.
The books Cheu prescribes are as diverse as his clientele. For young people experiencing grief, he suggests Bridge to Terabithia, a novel about two children who create a magical land that allows them to escape a personal tragedy. For people dealing with indecision, he recommends “Eveline,” a short story by James Joyce about a young woman who plans to leave Dublin with her lover and is forced to decide whether to abandon her family. Cheu prompts clients by asking them, “If you were Eveline, what would you do?” Turning the question on the reader, he says, uses the story to ease them into sharing more about themselves. “That is how you allow the discussion to move away from a very personal direct confrontation to an imaginary alternative,” he says, “which allows them to imagine a different life for themselves.” Literature essentially helps clients be seen without being exposed.
While bibliotherapy has yet to be broadly embraced here, its popularity is on the rise. Cheu says he is not aware of any formal licensing organization for bibliotherapy, since it’s not taught as a stand-alone practice, but that programs for clinicians do exist outside of Canada. In other words, those seeking to become bibliotherapists in clinical settings have to go abroad to earn their certification. Some organizations, such as the International Federation for Biblio/Poetry Therapy, offer certificates and formal guidelines for the practice. The IFBPT requires that participants learn the theory and techniques behind bibliotherapy and that they complete courses in psychology and literature.
While a handful of certified clinical bibliotherapists are currently operating in Canada, the practice is far more widespread in places like the UK, where a national charity, The Reader, is overseeing a nationwide program to promote nonclinical bibliotherapy through “shared reading.” But it’s not for everyone—including those who have limited appetites for reading at all, whether for enjoyment or learning. A 2020 BookNet Canada survey of 748 Canadians indicated a slight uptick in those who were interested in doing more reading during the pandemic. That is a positive sign, but enjoying books, according to Cheu, is not a prerequisite for success in bibliotherapy. A successful session depends on the individual’s simple willingness to engage and self-reflect.
Despite bibliotherapy’s lower profile in Canada, a growing body of research points fairly clearly to its potential. University of Toronto cognitive psychologist Keith Oatley and York University psychologist Raymond Mar have explored the role fiction can play for people seeking to enhance their social skills or mental well-being. In 2011, Mar found an overlap in the brain networks used to understand stories and those used to infer the mental states of other people. His findings suggest that literature—fiction in particular—can ignite the parts of the brain that process how others think and feel. The hope, then, is that, if bibliotherapy can trigger those reactions, it can help us better understand others and improve our lives.
In regular therapy, you’re looking at yourself. It can be really hard. It’s too vulnerable.
Boulton ended her treatment after five sessions with Cheu, but she credits those sessions with validating her relationship to reading. She sees certain books as “old friends” she can return to and finds comfort in rereading them.
Boulton says bibliotherapy came naturally to her as it melded the languages of literary analysis and psychoanalysis. “Because I understand motif and symbolism,” she says, “I was able to access some of the ideas and awareness [around bibliotherapy] quickly.” Her sessions led her to share observations about stories that felt adjacent to her—only to realize how entangled they were with her own reality. As she started reading and talking to Cheu, she also found that the stories illuminated clear parallels in her life. However, the reading was only part of the process—she describes it as “starting points for conversations,” prompts that led her to ponder new perspectives.
She has recommended bibliotherapy to several people since her sessions with Cheu. “I liked it better than traditional therapy,” she says. Ultimately, it provided a path to confront her issues. “In regular therapy, you’re looking at yourself. It can be really hard. It’s too vulnerable. It’s too naked. Whereas, when relying on literature, it’s a gentler way of processing the more painful things.”