Poetry Therapy: Testimony on Capitol Hill
Sherry Reiter, C.S.W., PTR, RDT
This report on poetry therapy was originally submitted to the National Coalition of Arts Therapies (NCATA) for testimony on Capitol Hill. The report presents an overview of the field of poetry therapy.
DEFINITIONS
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. The term "biblio" means "books" and by extension, literature. "Therapy" is derived from the Greek word "therapeia," meaning "to serve or help medically," and suggests the concept of healing. Basically then, bibliotherapy is the use of literature to promote mental health (Hynes & Hynes-Berry, 1994). The poetic elements play a central role in heightening the emotional impact of the literature with the potential for katharsis-cleansing through the release of emotion.
The concept of katharsis was conceived by Aristotle who believed that poetry was a form of knowledge, having a positive moral effect on the psyche. The process of katharsis involved both a controlling and directing of emotions, reminiscent of William Wordsworth's lines in "Intimations of Immortality":
* This testimony was written and respectfully submitted by Sherry Reiter, President of the National Association for Poetry Therapy ('93-95), and the following members of the Advisory Committee: Samuel Gladding, Ph.D., C.P.T., Marion Goldstein, M.A., R.P.T., Kenneth Gorelick, M.D., R.P.T., Owen Heninger, M.D., R.P.T., Arleen Hynes OSB, R.P.T., Jack J. Leedy, M.D., C.P.T., Arthur Lerner, Ph.D., R.P.T., Hirsch Lazaar Silverman, Ph.D. More information about the National Association for Poetry Therapy may be attained from NAPT's Central Office, P.O. Box 551, Port Washington, NY 11050. Phone (516) 944-9791.
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A timely utterance gave that thought relief,
And I again am strong.
Imaginative literary material books; articles; stories; songs; poems; films or videos may be chosen to elicit both thoughts and feelings. The therapeutic experience is facilitated by a therapist, poet, or other professional trained in biblio/poetry therapy and may involve a one-to-one relationship, a couple, a family, or group process.
Developmental interactive bibliotherapy refers to the use of literature and creative writing with children, adults, and older persons to promote growth and development when working with healthy populations in environments such as schools, recreation centers, libraries, and nursing homes.
Clinical interactive bibliotherapy refers to the use of literature and creative writing to promote healing and growth in psychiatric units, community mental health centers, and in chemical dependency units.
Creative writing is a specific activity in which the participant's own creative writing is viewed as another avenue toward self-discovery. Different genres lend themselves to specific needs. For example, preschool and older children benefit from a technique called "mutual storytelling," in which the client and bibliotherapist tell a story together (Gardner, 1971). Junior high school kids read, write, and react enthusiastically to soap opera scenarios. Teens are especially responsive to song lyrics and may choose to write their own (Mazza, 1988). Journal writing is an excellent way to discover what has been learned over time through reflecting on personal experiences (Adams, 1990).
Life review and reminiscence have been particularly effective in helping the elderly (Reiter, 1994). A life review involves a person writing his or her autobiography using albums, letters, memoirs, and interviews in order to gather and integrate a person's life experience into a meaningful whole. Telling one's story through poems, songs, journals, or other expressions of the written word provides vital material for the therapeutic process. Finding one's own voice is a self-affirming process, often followed by greater self-understanding and new insight.
GOALS
The basic goal of therapy is to promote change, resulting in increased coping skills and adaptive functions to work through underlying conflicts. The specific goals of poetry therapy may be identified as follows:
a. to improve the capacity to respond to vivid images and concepts,
and the feelings aroused by them;
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b. to enhance self-understanding and accuracy in self-perception;
c. to increase awareness of interpersonal relationships;
d. to heighten reality orientation;
e. to develop creativity, self-expression and greater self-esteem;
f. to encourage positive thinking and creative problem-solving;
h. to strengthen communication, particularly listening and speaking skills;
i. to integrate the different aspects of the self for psychological wholeness;
j. to ventilate overpowering emotions and release tension;
k. to find new meaning through new ideas, insights, and/or information;
1. to help participants experience the liberating and nourishing qualities of beauty.
APPLICATIONS
Bibliotherapy has a broad range of application with people of all ages and is used for health, maintenance, and populations requiring treatment for a variety of illnesses and conditions. Examples of these are: those suffering from the addictions of drugs, alcohol, and eating disorders; families with problems; the frail elderly; adolescents; survivors of violence, abuse and incest; the homeless; the learning disabled; and veterans. The literature and case studies provide supporting evidence that poetry therapy is an effective and powerful tool with many different populations.
THEORY
Poetry therapy is an interactive process with three essential components: the literature, the trained facilitator, and the client(s). A trained biblio/poetry therapist selects a poem or other form of written or spoken media to serve as a catalyst and evoke feeling responses for discussion. The interactive process helps the individual develop on emotional, cognitive, and social levels. The focus is on the person's reaction to the literature, never losing sight of the primary objective-the psychological health and well-being of the client. The great poet Byron once said, "Poetry is the lava of the imagination whose eruptions prevent the earthquake." When emotions such as anger and depression cannot be expressed, they may lead to symptom formation. The process of reading and writing poetry can be seen as providing an acceptable outlet for venting potentially explosive psy-
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chic forces and restoring psychological and physiological balance (Heninger, 1978). William Blake's poem reminds us of the importance of expressing feelings directly and honestly.
I told my wrath,
my wrath did end.
I was angry with my foe: I told it not,
My wrath did grow.
Poetry enables people to express what they may be unable to say in any other way. A bibliotherapy session may provide the first step in speaking about what is shameful or "unspeakable." The bibliotherapist draws upon a wide range of literature to address the "existential" concerns of individuals (i.e., mortality, loss, loneliness) (Yalom, 1985). These subjects, which are ordinarily "taboo," can be approached and examined in a bibliotherapy session.
The power of literature is derived largely from imagery or seeing with the mind's eye. Research has shown that imagery is linked with learning, relaxation techniques, life meaning and life enjoyment (Gladding, 1992). Imagery is the language of dreams and the unconscious, and as such, serves as a catalyst for bringing unconscious material into conscious awareness. Freud called the poet "the professional daydreamer," and noted the similarities between poetry and dreams (Leedy & Reiter, 1981). Dreams and poetry utilize the same psychological mechanisms-imagery, displacement and condensation. The single most powerful poetic device, in dreams as well as literature, is symbolic representation through metaphor. Dramatic plays and short stories may be chosen to help people gain control over their life situation; the reader identifies with the characters, and seeks solutions that are unique and universal (Lerner & Mahlendorf, 1991). Symbolic representation and imagery are poetic qualities that can be found in fiction, myths, fairy tales and dramatic plays, but its richest source is poetry.
Imagery teaches people how to use their creative imagination, and taps into hidden resources that can break dysfunctional patterns and promote change. The cultural authority attributed to the poem is a factor that may influence individuals to surrender some control of their thinking to the organized experience portrayed in the literature. Constricted thinking and resistance give way to involvement, sharing, and the resolution of conflict (Stainbrook, 1978). Literature is also infused with the energy of its creator, and the words of great men and women through the ages empower the reader.
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The poetry that is written or used in poetry therapy is not chosen for its literary merit, but as a tool for awareness and self-discovery. Since an essential part of self is experienced through sense perception, poetry with vivid imagery is most effective. Poetry opens the senses and their associated feelings to receiving clearer, more intense impressions and images from both the outer and the inner world (Gorelick, 1989). With the help of the facilitator and group, the participant can examine and adjust these impressions for a clearer focus.
The universal component is essential to helping people connect with others who are "in the same boat." Often the poem is experienced as "an understanding other" or a "friend" (Leedy, 1985). "I suffer," said the man. "Not you alone," said the poem.
When participants externalize feelings through writing, the literature is a black and white testament to feelings and thoughts previously without form. The externalization gives participants a sense of mastery and also allows individuals to view their feelings from an different perspective. Often people who are experiencing loss or stress are comforted by a poem or affirming thought that they can carry with them.
In addition, poetry may have layers of meaning, and its ability to conceal as well as reveal, gives participants the freedom to express themselves without being judged. The subtlety of poetry is part of its gentle appeal. By introducing a poem, the therapist suggests an agenda for the session. If the group is not ready for it, they will evade it, but because the suggestion is gentle, the resistance is also gentle. As a result, poetry therapy may be experienced as less confrontational and less threatening than other therapies, and some people in clinical settings who refuse to participate in more traditional therapies, willingly attend poetry therapy (Rossiter, 1989).
Poetry can be subtle, hold multiple messages, and at the same time be emotionally direct (Murphy, 1979). Its honesty helps people to explore difficult issues. When participants hear a group member or poet speak from the heart, they become more willing to do so themselves.
I wish he had not been
so tired
when I was born.
Alice Walker
Poetry has the unique capacity to allow the varied and even paradoxical aspects of self to be integrated into a unified expression of the heart, mind, and spirit. Contradiction is exemplified in these words by poet James Kavanaugh:
I laugh and cry with the same eyes,
Love and hate with the same heart
I feel my rage and my gentleness.
METHOD
A typical session would consist of the following steps:
I. Introduction
The poetry therapist creates a gentle, non-threatening atmosphere where people feel safe and are able to share feelings openly and honestly. The group agrees to respect any confidential issues that are brought up. A warm-up consisting of a word game, word associations, a song, or other verbal introduction is used to "break the ice" so everyone feels comfortable.
II. The Body of the Session
The facilitator suggests a creative writing theme, or uses creative writing that has already been published to help participants to explore feelings, thoughts, ideas and personal issues. Choosing literature that will be effective therapeutically requires forethought and sensitivity. Although there are no fixed rules regarding the method for selecting material, there are some basic guidelines:
1) The facilitator uses universal material to foster identification. Psychiatrist Dr. Jack Leedy suggests that the catalyst poem be chosen according to the isoprinciple, matching the feeling tone of the poem to the client's mood to aid in the identification process.
2) The facilitator avoids confusing, hopeless, and depressing material that offers no resolution or insights into coping with negative feelings. Even if a poem's last few lines are uplifting, if the bulk of material is negative, the mood of the client may plummet with counter-therapeutic results.
3) The facilitator chooses poems in which the metaphoric content
builds upon and integrates images clearly and consistently. This leads to clear, cohesive thinking on the part of the listener (Goldstein, 1992).
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4) The facilitator avoids literary material that glorifies homicide, suicide, or that denigrates parental figures or G-d (Leedy, 1985).
In addition to choosing the genre or form of literature, the poetry therapist will pay special attention to the content of the material and its relevance to the participants. The developmental level, cultural make-up, literacy level, circumstance and emotional fragility of the participants will be assessed prior to making a literary selection. If the bibliotherapist is working in a clinical or institutional setting, it is important to know the personal history and diagnosis of each participant. This familiarity will alert the bibliotherapist to sensitive issues and the individual goals in the participant's treatment plan.
Ideally, each participant is given a copy of the chosen literature, so that the words can be taken in visually while being heard. Reading the material silently is not enough; a poem must be read word for word in order that rhythm, rhyme, assonance and alliteration be appreciated (Silverman, 1988). Poetry therapy can be used effectively with any population regardless of formal education or reading ability. Because the literature is read aloud, participation is not hampered by illiteracy or physical disabilities.
Reading poetry aloud builds group cohesion, is ego-boosting, and enables patients to respond to the rhythm of the poem. The closer the rhythm of the poem is to the human heartbeat, the more calming its effect. Therefore, the rhythm of a poem is a factor that should not be overlooked.
Four stages can be identified in the interactive process (Hynes & Wedl, 1990):
a) Recognition
To begin with, participants must be able to recognize and identify with the selection.
b) Examination
During this phase, participants explore specific details with the assistance of a bibliotherapist. Through questions and open dialogue, the group explores the significance of their reactions.
c) Juxtaposition
This is a process that explores the significant interplay between contrasts and comparisons. For example, Robert Frost's poem "The Road Not Taken" is about coming to a fork in the road and the difficult dilemma of having to make a choice. In juxtaposition, two reactions are placed side by side.
Reaction #1: "If I had to choose between two roads, I'd take a road I've been down before. At least then I'd know what to expect. Security is important to me."
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Reaction #2: "If I had to choose a road, I'd just flip a coin and take my chances. Adventure is important to me."
Looking at an experience from a directly opposite view can provide an awareness that may become the basis for wise choices in attitude and behavior.
d) Application to the Self
The bibliotherapist encourages feelings to emerge and become integrated with cognitive concepts and deeper self-understanding. "Now I understand why I was able to leave home and succeed; my parents believed in me," or "Now I understand why I have difficulty making decisions; I lack confidence." It is important for the client to see the connection between the individual and the literature, and to apply the new knowledge to his/her own self in the real world.
III. Closure
At the end of the session, the facilitator will help provide closure. Factors to consider include: the length of the session, the degree of self-disclosure and group unity, and the degree of tension encountered during the workshop. Closure provides a time for "winding down" and "tying up loose ends." The facilitator can use closure to:
1. Ask the group what relevancy the workshop had to everyday life;
2. Summarize some of the key points;
3. Take care of "unfinished business;"
4. Help participants reestablish defenses;
5. Conclude in a positive and mutually affirming way.
Psychotherapist Irwin Yalom has defined eleven therapeutic factors that clients relate to a successful outcome in group therapy, all of which are evident in a bibliotherapy group (Goldstein, 1989). These factors include cohesion, universality, addressing existential fears, developing social skills, altruism and imparting information. All factors combine to achieve the goals of interpersonal learning, catharsis, and perhaps most important of all-the instillation of hope. Bibliotherapy builds community and offers opportunities for what Yalom calls the "corrective recapitulation of the primary family group."
CONCLUSION
The process of reading and writing, encouraged by the sensitive guidance of professionals trained in bibliotherapy, acts as a significant catalyst
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for self-integration. Poetry joins the realms of sensation, feeling, thought and spirit. The different aspects of self meet in a place where all things gather as one. This integration becomes possible by language that is particular and specific (Fox, 1992). The words of a sixth century Japanese poet, Izumi Shikibu, express this beautifully:
at dawn
Solitary, mid-sky
I knew myself completely;
no part left out.
Although bibliotherapy in the United States may be traced back to the 1840's when Benjamin Rush introduced reading and writing into a Pennsylvania hospital, the practice of bibliotherapy is very different today. Whereas then the reading and writing was primarily a self-directed, recreational task, today the National Association for Poetry Therapy (NAPT) confers professional credentials to bibliopoetry therapists who have met its rigorous standards. The poetry therapist today is a professional who is wellgrounded in both psychology and literature, as well as group dynamics. NAPT maintains a registry of biblio/poetry therapy practitioners in educational, medical, geriatric, therapeutic and community settings. The poetry therapist of the 1990's is a valuable professional whose work is applicable to many different and difficult-to-treat persons who do not always respond to conventional therapy.
REFERENCES
Adams, K. (1990). Journal to the Self: Twenty-two paths to personal growth. New York: Warner Books.
Fox, J. (1992). The healing pulse of poetry: The life-giving power of your own words. The Quest, 65-70
Gardner, R. A. (1971). Therapeutic communication with children: The mutual storytelling technique in child psychotherapy,v. New York: Aronson.
Gladding, S. T (1992). Counseling as an art: The creative arts in counseling Alexandria, Va.: American Association for Counseling and Development.
Goldstein, M. (1992). The use of poetry in therapy. Camer Foundation Medical Education, Letter 173.
Goldstein, M. (1989). Poetry and therapeutic factors in group therapy. Journal of Poetry Therapy, 2, 231-241.
Gorelick, K. (1988). Poetry On the Final Common Pathway of the Psychotherapies: Private Self, Social Self, Self-in-the-World. Journal of Poetry Therapy, 3, 5-17.
Henmger, O. E. (1978). Poetry therapy in private practice. In A. Lerner (Ed.), Poetry in the therapeutic experience (pp. 56-62). New York: Pergamon Press.
Hynes, A. M., & Wedl, L. C. (July 1990). Bibliotherapy: An interactive process in counseling older persons. Journal of Mental Health Counseling, 12, 288-302.
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Hynes, A. M., & Hynes-Berry, M. (1994). Biblio/poetry therapy: The interactive process-A handbook St. Cloud. MN: North Star Press.
Leedy, J. J. (1985). Poetry as healer: Mending the troubled mind New York: Vanguard.
Leedy, J. J., & Reiter, S. (1981). Poetry in drama therapy. In G. Schattner & R. Courtney (Eds.) Drama in therapy: Vol. 2 (pp. 221-240). New York: Drama Book Specialists.
Lerner, A. (1984). Bibliotherapy. In R. J. Corsini, (Ed.), Encyclopedia of psychology: Vol. 1 (pp. 640-649). New York: Wiley & Sons, Inc.
Lerner, A. & Mahlendorf, U.R. (Eds.). (1991). Life guidance through literature. Chicago, IL: American Library Association.
Mazza, N. (1988). Poetry and popular music as adjunctive psychotherapy techniques. In P A. Keller & S. R. Heyman (Eds.), Innovations in clinical practice: A sourcebook Vol. 7 (pp. 485-494). Sarasota, FL: Resource Exchange, Inc.
Murphy, J. M. (1979). The therapeutic use of poetry. Current Psychiatric Therapies: Vol. 18, J. Masserman, Md. (Ed.). New York: Grune and Stratton, Inc.
Reiter, S. (1994). Enhancing the quality of life for the frail elderly: Rx: the poetic prescription. Journal of Long-Term Home Health Care, 13.
Rossiter, C., Brown, R., & Gladding, S. T (1990). A new criterion for selecting poems for use in poetry therapy. Journal of Poetry Therapy, 4, 5-11.
Silverman, H. (1988). The creative patient: The use of poetry in psychotherapy. The psychotherapy patient. 4, 111-122.
Stainbrook, E. (1978). Poetry and behavior in the psychotherapeutic experience. In A. Lerner (Ed.), Poetry in the therapeutic experience (pp. 1-10). New York: Pergamon Press.
Yalom, I. D. (1985). The theory and practice of group psychotherapy. New York: Basic Books.
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