Imaginative Bibliotherapy for Children with Cancer

1
Imaginative Bibliotherapy for Children with
Cancer Stephen N. Maley1, Margaret M. Madeleine1,
Dale-Elizabeth Pehrsson2, Paula
McMillen2 Department of Epidemiology, School of
Public Health, University of Washington 1 Fred
Hutchinson Cancer Research Center, Seattle, WA 2
University of Nevada, Las Vegas, NV
Overview
Children with cancer often experience fear, worry
and other hardships beyond the physical suffering
of cancer and cancer treatment. In some cases,
more serious or longer lasting psychological
symptoms may develop. Bibliotherapy involves
choosing books and stories to read and then
discuss with patients as a means of addressing
some of the social and emotional needs of
patients who are favorably disposed to books and
talking about stories. Briefly, if patients can
identify with fictional characters and their
struggles, then the patients may be able to
experience cathartic emotional release and gain
insights to help face fears, worry, and other
social and emotional challenges. Underlying the
effectiveness of bibliotherapy is a caring bond
between the bibliotherapist (who may be a
professional counselor or instructed family
member) and the patient. The goal of this MPH
Practicum was to develop an understanding of the
theory and practice of bibliotherapy and to
tailor it for use with children and adolescents
with cancer.
Childhood Cancers Epidemiology and Emotional
Concerns
The most common types of childhood cancers
include leukemias (especially acute lymphoblastic
leukemia), gliomas, medulloblastomas, and solid
tumors (neuroblastomas, Wilms tumors, and
sarcomas (especially rhabdomyosarcoma and
osteosarcoma).1 Table 1 gives an overview of
common treatment stages for childhood cancers
2, as well as potential emotional concerns.
Table 1. Potential emotional concerns of children
with cancer at each stage of treatment 2
Imaginative Bibliotherapy Theory and Examples

• In imaginative bibliotherapy a counselor chooses
  a book or other literary work (fiction or poetry)
  specifically for the patient, often reads it
  aloud with the patient, and then discusses it
  afterwards to facilitate the therapeutic process.
  Bibliotherapy operates through a three stages
  3
• Identification patients recognize similarities
  between themselves and fictional characters and
  struggles.
• Catharsis patients experience emotional release
  through discussion of their own emotional
  experiences.
• Insight patients identify new ways of
  approaching challenges, including acceptance,
  sharing of emotions, and courage.

• Example Rey, M. and Rey H.A. (1966). Curious
  George Goes to the Hospital. Boston, Houghton
  Mifflin Company.
• Synopsis Curious George requires hospitalization
  after eating a puzzle piece. George visits
  radiology, the childrens ward, the playroom, and
  the operating room. During his recovery,
  Georges curiosity leads to further adventures.
  4
• Discussion Questions 5
• How do you think George felt when he had to go to
  the hospital? Was he frightened?
• How did you feel when you first came to the
  hospital? Were you afraid, too?
• Curious George brought a big red and blue ball
  along with him to the hospital. Why do you think
  he brought the ball Did you bring anything
  special from home?
• Some things in the hospital looked scary to
  George. Does anything in this hospital look
  scary to you? Which things look scariest?
• George cried when the nurse gave him a shot, and
  when he broke the hospital dishes. Do you ever
  feel like crying here in the hospital? Does
  crying help? Are you bad or naughty because you
  cry, or are you simply getting out some of your
  feelings?
• How did Curious George feel when it was time to
  go home? How do you think you will feel when it
  is time for you to go home?
• Why did Curious George have to come to the
  hospital? Why did you have to come to the
  hospital?

• Example Bemelmans, L. (1939). Madeline. New
  York, The Viking Press.
• Synopsis A fashionable Parisian schoolgirl is
  rushed to the hospital for an emergency
  appendectomy. After the surgery, she proudly
  shows her new scar to jealous schoolmates.
• Discussion Questions 5
• Madelines friends were almost like sisters to
  her because they all lived together. How did
  your sisters or brothers act when you went to the
  hospital? Do you think they were somewhat jealous
  of the attention you were receiving? How do you
  think they will act when you return?
• Some of her friends thought Madeline was a
  show-off. What do you think? How do you think
  she really felt about her scar?
• Madeline stared at a crack in the ceiling over
  her bed until she discovered that it looked like
  a rabbit. Why do you think she did that? Are
  you ever bored in the hospital? What do you do
  when you are bored?
• Why did Madeline get sick? Why did she need an
  operation? Why did you have to come to the
  hospital?

Recommendations

• Bibliotherapy can be implemented at several
  therapeutic stages following cancer diagnosis.
• Bibliotherapy is recommended in addition (not as
  a substitute) for traditional counseling.
• Tools, such as the Bibliotherapy Education
  Project 6, should be developed to facilitate
  the identification of appropriate books, as well
  as the training of counselors in bibliotherapy
  methods.
• Empirical studies, such as a randomized control
  trial, should be conducted to test the efficacy
  of bibliotherapy in conjunction with standard
  counseling.

References
1 http//www.cancer.gov/cancertopics/factsheet/S
ites-types/childhood 2 www.WebMD.com 3
Hynes, A. M. and M. Hynes-Berry (1994).
Biblio-poetry therapy, the interactive process a
handbook. St. Cloud, MN, North Star Press of St.
Cloud. 4 Manworren, R. C. and B. Woodring
(1998). "Evaluating children's literature as a
source for patient education." Pediatr Nurs
24(6) 548-53. 5 Fassler, J. (1978). Helping
Children Cope. New York, NY, Macmillan Publishing
Co., Inc. 6 http//www.library.unlv.edu/faculty/
research/bibliotherapy/
Contact maleys_at_u.washington.edu