Contents
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Intro ===
Literature and art in our time are becoming more powerful and promising means in psychotherapy, both due to their own development, the accumulation of values, experience, methods of influencing a person, and due to the greater preparedness of a modern person to perceive these values and influences with an increasingly extensive education and manner. life.
We would like in this chapter to give a general theoretical understanding and a description of the practical work of the psychotherapeutic influence of reading, which would allow each doctor to feel confident enough to carry out the treatment. Despite the small volume of our work, we would like to give the doctor a certain integral system that can be applied quite dynamically in psychotherapy under various influences. It seems that the absence of a guide to bibliotherapy justifies our desire.
Historical overview
Understanding the meaning and use of the influence of art on human health, we find throughout the history of medicine. With the spread of literature, both doctors and patients themselves begin to use reading for therapeutic purposes: to distract from difficult experiences, to obtain information, to change stereotypes of thinking, etc.
In 1915, already V. Rush recommended reading to patients. At the end of the nineteenth century. promoted the reading of Paul Ch. Dubois, A. Moll, Ot. Rosenbach. The term bibliotherapy was first used in 1916 by Samuel Mc. Chod Crothers. In 1941, the Dorlend medical dictionary already had a definition of bibliotherapy.
In the second half of our century, bibliotherapy is becoming more and more widespread in world medicine. In Russia, they used the influence of literature on patients I.E. Dyadkovsky, S.S. Korsakov, V.M. Bekhterev and others.
A remarkable phenomenon of studying and creating a system of influence of literature on the reader, which has no equal in world practice, are the works of N.A. u.e.kin (“Among the books”, etc.). Much of his work has not lost its significance to this day.
In Soviet medicine, the rise of interest in bibliotherapy can be noted in the last two decades. The fundamental works here can be considered the works of V.E. Rozhnova (the concept of emotional stress psychotherapy), I.Z. Vel’vovsky and co-workers (particularly noteworthy is the bibliography on bibliotherapy by A.M. Miller).
However, neither the theory nor the practice of bibliotherapy can be recognized as sufficiently developed. Most of the works related to bibliotherapy are works about art in general in its therapeutic application, about libraries for patients, about book service for the patient, and not about his treatment with the help of special, dosed reading … It is no coincidence that the term bibliotherapy is not mentioned even in the most respectable science .e.zhny manuals on psychotherapy, rehabilitation, psychosomatic medicine (see manuals YF Garret, Norris G. Harring, G. Klumbies, S. Kratochvil, H. Strotzka, Th. von Uexkull).
Definition of bibliotherapy. Its features
Bibliotherapy is a therapeutic effect on a patient with the help of reading, literature in order to normalize or optimize his mental, and through them the physiological and biological processes of the body. Therapeutic reading differs from reading in general in its focus on certain painfully altered (to normalize them) or normal (to balance the painful ones) mental processes, states, and personality traits. The therapeutic effect of reading is manifested in the fact that certain perceptions, associated feelings, inclinations, desires, thoughts, assimilated with the help of a book, make up for the lack of one’s own images and ideas, replace painful thoughts and feelings, or direct them along a new channel, to new ones. goals. Thus, it is possible to weaken or strengthen the impact on the feelings of the patient, in order to establish his peace of mind. The advantages of bibliotherapy are: the variety and richness of the means of influence, the strength of the impression, duration, repetition, intimacy, etc.
Psychotherapeutic processes in bibliotherapy
Bibliotherapy differs somewhat from other methods of psychotherapy in the nature of its therapeutic processes. Often the therapist has to give patients explanations about their nature, their impact. And so it is advisable to stop at them.
Conventionally, they can be divided into non-specific and specific. Non-specific processes are characterized by the breadth, universality of their impact on the whole personality and on specific disorders mainly through the whole personality, as, for example, rest, warmth, enhanced nutrition, and gymnastics act in somatic medicine. These are calmness, pleasure and joy, feelings of self-confidence, belief in one’s abilities, self-satisfaction, a sufficiently high general mental activity, constant mental development of the personality. It is not difficult to imagine the positive influence of these processes on disease states. Let us dwell on their features in bibliotherapy.
1. Reassurance — obtaining specific, authoritative knowledge from medical literature (for example, D. Furst. “Neurotic …”), convincing the patient that his disorders are functional, typical of neurosis, not dangerous for mental and physical health (for example, sexual disorders, sometimes many people have it and usually go away on their own).
The patient can be calmed by specially selected philosophical, journalistic, fiction. In our experience, for example, it is useful for patients to read the work “Past and Thoughts” by A. Herzen, where he describes “..these early misfortunes that did not leave any bitterness in the soul, swept like spring thunderstorms, illuminating and. strengthening young life with its blows.
2. Pleasure. The patient usually feels separated from the world by his illness, and it is quite difficult for him to get satisfaction from a good novel, a humorous story, a detective story. Most often, such a patient will receive pleasure by making sure that he is also experiencing difficulties, like Nikolenka from L. Tolstoy’s Childhood, Adolescence, and Youth, and often copes with them better. He experiences joy when a rather difficult book becomes understandable and receives a fairly high mark from the doctor for this.
3. A feeling of self-confidence, faith in one’s own abilities in a patient often arises when reading biographies, autobiographies, memoirs, letters of prominent people with an interesting but difficult fate, for example, autobiographical works of L. Tolstoy («Confession», «Way of Life») , F. Dostoevsky (“Notes from the Dead House”, “A Writer’s Diary”), A. Chekhov (“Letters”), where he sees that the giants of the human spirit and thought, just like him, experienced uncertainty in some areas He has a lot in common with them. Publicistic articles (about the shortcomings and weaknesses of people), philosophical, dramatic works have a similar effect.
4. Most literary genres can cause high mental activity, which stimulates normal and protective mental and physiological processes, suppresses pathological ones, and contributes to the disappearance of traumatic experiences.
For example, let’s cite one more quote from the work “Past and Thoughts” by A. Herzen (his date with Natalya Alexandrovna), which emphasizes the strength and importance of the present in comparison with the past or future that weighs on our patients: “… such fullness was in the soul. More, less, shorter, longer, more — all this disappeared before the fullness of the present … »
The importance of mental activity for recovery can be well conveyed to the patient by the article of the literary critic L. Ozerov «Spring Feelings Flood» in the collection «Peaks». “Thunderstorm interested Tyutchev as a renewal of life, its explosive power and as a moment of revealing the essence, enlightening the meaning from within. Nature and the soul were united, this unity was not in moments of peace and silence. A thunderstorm is desirable, in a thunderstorm the inner forces of the human soul find a way out … «» In a thunderstorm, disorder, chaos, discord ultimately acquires order, order, harmony. And nature here is like a human soul, striving from discord and confrontation to come to coherence and unity. Quite often, light genres of detective, science fiction, humor activate the patient better than serious fiction that requires special effort from the patient. Facilitating the work of the patient, it is better to recommend him specific books with specific tasks such as self-diagnosis and exercise: “You must compare yourself with the main characters of the work. How is he different from you? What are you? What do your situations have in common..?”
“You must choose from this book the thoughts, aphorisms that you have used so far in your life, and those that would be more reasonable to be guided by, those that guide the majority … Compare them … Choose aphorisms that you could defend yourself in most difficult situations . Learn to turn a dramatic situation into a humorous one.”
5. The general constant mental development of the personality, stimulating the previous processes, has its own special therapeutic and preventive effect: it stimulates the integrity of the personality, the tendency to complex compensatory reactions, more creative overcoming of difficulties, spontaneity.
This development is stimulated by the tendency of the doctor to gradually move bibliotherapy from scientific literature to biographical, philosophical, and fiction. The patient thus gets used to the «skeleton» of the schema of knowledge to clothe the «body» of personal characteristics: sensations, emotions, drives. For example, introducing the patient to the classification of personality according to P. Gannushkin or A. Lazursky, we then ask to find similar types of personalities in I.S. Turgenev, A.P. Chekhov.
Specific psychotherapeutic processes in bibliotherapy are characterized by a narrower, special focus on disorders and on the personality, mainly through any one mental process: thinking, feeling, activity. Therefore, they are simpler, more specific, easier to regulate. This is control; emotional processing; workout; conflict resolution.
1. Control over mental processes by strengthening their repetition, reproduction of details or weakening by means of analysis, pushing aside other memories and emotions can change the impact on the personality of both ordinary and neurotic experiences. Control can be divided into several levels. The first is an understanding of one’s neurotic symptoms, its subjectivity, and the impact of hetero- and autopsychogenic factors on it; the second is understanding the role of one’s own personality in the development of the disease; the third is the realization of one’s true attitudes to the most important life problems.
In all degrees of control, medical, scientific, popular science books from the field of psychiatry and medical psychology are of particular importance (D. Furst, S. Konstorum, E. Kretschmer, P. Gannushkin, A. Kempinski, V. Rozhnov and M. Rozhnova, K. Obukhovsky, K. Imelinsky and others). In the second and third degrees, modern fiction can be very important. We can, for example, recommend the works of such authors as V. Likhonosov «Melancholy — grief.» “I am always torn somewhere and imagine in advance my life there, in the Far Far Away kingdom. And my imagination is stronger than my life.” «The world appeared to me unbearably beautiful because it was invented by me.» “At our age, something can happen in a month that you can’t turn back in a lifetime.” G. Matevosyan, «The Orange Herd». “… I want to somehow start a new world war and, in the midst of its noise and smoke, quietly exterminate, finish off the remnants of the Armenians … but why don’t people with their kindness prevent all my terrible actions?” V.V. Potanin, «Pier». «So that’s the truth — in my weakness, and I do not want to throw it off, I protect it, I hide under it.» Such experiences of the heroes of the works give patients the opportunity to identify themselves with them, to understand many personal characteristics, to realize their mistakes. The literature here gives the patient the opportunity that even an experienced psychotherapist cannot give due to his workload: to thoroughly, slowly, in an intimate setting to learn, understand, learn to analyze and, therefore, control his symptoms.
2. Emotional processing. Its essence is the ability of the patient, showing personal emotions, to compare them with the emotions of other people with support and correction from the doctor. This allows the patient to learn the most optimal reactions and actions, helps to avoid too violent, weak, or perverse emotional reactions. The literature in this case makes it possible to do this with the same effect as conducting functional training, group therapy, which are more difficult to organize. For example, a middle-aged man with excessive psychasthenic decency, diligence, because of which he and his neighbors suffer, finding A.P. Chekhov, the ruthless honesty of Dr. Lvov, is convinced that often impracticality, idleness contributes to a deepening of the feeling of life, that the “unnecessary” gives more pleasure than the necessary.
3. Workout. Its essence is for the patient to try, as often as possible, to feel, desire, think, do what is difficult for him. In this way, normal mental processes are trained, strengthened and pathological ones are forced out. In bibliotherapy, this is done by “playing” dialogues in the imagination, the behavior of an alternative work compared to the characters, taking into account its own characteristics: less experience, courage, etc. This can be a “conversation” with a psychiatrist, a sexologist after reading S. Konstorum, K. Imelinsky, with such a “conversation” with a loved one, it can be a story about his failures in the spirit of the stories of M. Zoshchenko or the autobiography of V. Nushich and M. Twain.
These may be attempts, like A. Fet, to equate a single moment with eternity. “Fet .. dreamed of achieving such a sound of a word that it would be felt not as a sign of meaning, but as a sign of feeling, so that it would convey the musical mood of the soul, the state of mind.” In one of his poems «… with 15 subjects, not a single predicate!»
4. Resolution of the conflict. This is a kind of synthesis of control, emotional processing and skills obtained as a result of training — as applied to a specific life situation. After the patient reads the book, the therapist asks the patient how he thinks the author of the book or the protagonist would overcome his difficulties. The doctor can set the patient, for example, the following task: “Over the next week, you must resolve conflicts in the spirit … Try to ensure that you have enough reasons for conflicts …” Or suggest thinking about the questions: “What is the way of action … better Your his? What don’t you like about this behavior? What negative consequences have most often caused your behavior before and now? How can this behavior be improved? How would the literary heroes of V. Likhonosov, V. Potanin, Yu. Nagibina cope with these difficulties …?
Non-specific and specific bibliotherapy
Non-specific bibliotherapy can be singled out if psychotherapy mainly uses non-specific therapeutic processes of calm, pleasure, confidence, satisfaction, high activity, general development of the personality, without individualizing bibliotherapy either in the nosological or in the personal aspect. This is expedient with sufficient intensity of other types of psychotherapy applied to this patient, with supportive psychotherapy, with overloads of the doctor, with a high general level of development of the patient, who is able to independently find the most promising areas of work with literature.
Usually, non-specific bibliotherapy includes a certain, well-known to the psychotherapist, a small list of books (or only some chapters of them) of medical, psychological, special literature, fairly simple, guaranteeing a clear, easy understanding and the absence of iatrogenic. Such, for example, as D. Furst, «Neurotic»; E. Kretschmer, «On Hysteria»; A. Lazursky, «Classification of Personalities»; K. Lorenz, «The Ring of King Solomon»; I. Kon, «Sociology of Personality»; S. Schnabl, «Intimate Behavior». From the works of fiction and journalism, it is the selection of «classics» that is desirable, books that have been time-tested by several generations of readers. Indicative here L.N. Tolstoy, his experience of life, tested by the mistakes of Tolstoyism, non-resistances. A.P. Chekhov, his humanism, gentleness, kindness, which had such an impact on many generations of intelligent people and powerless in influencing the philistines and fanatics.
In journalism — Ch. Aitmatov with articles like «Find Your Destiny» (in the book «In collaboration with land and water»), in critical literature we recommend «Critical Handbook, 100 Years of Russian Criticism»; in the humorous — M. Twain, J. Hasek; in science fiction — R. Bradbury, A. Asimov, E. Russell, A. and B. Strugatsky, R. Sheckley; in the detective — D. Hammett, J. Simenon.
For greater effectiveness of the impact, with non-specific bibliotherapy, it is possible to recommend patients to summarize the books and chapters they have read, to write summaries for “improved” versions of books and chapters in accordance with the wishes of the patient himself.
Over time, NBT, as the patient becomes involved in it, may require less and less time and activity of the therapist. It is often enough to just express your approval or recommend to the patient to turn his attention to the next area of literature. If necessary, NBT turns into supportive psychotherapy or becomes an integral part of the process of self-education, self-re-education, self-development.
Specific bibliotherapy is characterized by its focus on specific processes (control, emotional processing, training, conflict resolution), on specific disorders, personality traits, and difficulties. It is distinguished by great intensity, great guidance from the psychotherapist.
In practice, this is done by selecting the literature that is most relevant to the patient in accordance with his symptoms, difficulties, disorders, goals, personal characteristics, literature that stimulates, for example, mainly awareness of the nature of the disorders, the causes of the difficulties that caused the disorders, etc. The patient is usually instructed before reading what requires his special attention, what can be omitted, what from what has been read will need to be compared with his own experience, what should be immediately checked in practice. After reading, a control survey is conducted in the spirit: “What was especially interesting to know? What’s the use? What caused doubts? Fears? How will these titles help you cope with difficulties? What is not clear? How can I help?»
In SBT, scientific medical, psychological, special and aphoristic literature is more often used.
Literature in terms of bibliotherapy
Perceptions, feelings, interests, possibilities of a healthy and sick person are very different. Practice shows that for therapeutic literature, the following are especially important: the relationship of the work with the current state and problems of the patient, the availability of specific knowledge, facts that allow one to find the essence, cause of phenomena, and be independent of authorities. It is necessary to have brief precise formulations for various life situations that create a real idea of how the world should be, with the identification of contradictions between ideals and reality. Literature should teach the reader to set a goal and find ways to achieve it.
We consider it possible to offer an approximate list of literary genres, arranged according to their importance for bibliotherapy, and give them brief characteristics.
Special medical literature is of paramount importance in bibliotherapy, as it is able to give the patient knowledge that is especially important for him to stimulate the psychotherapeutic processes of calming, controlling, etc. In addition, the authority inspired by this literature most often puts it at the head of other genres. Therefore, it is desirable that in the bibliotherapeutic receptarium this literature be represented by sufficiently numerous works. The primacy here, of course, should belong to psychotherapeutic, psychiatric literature without discrimination of manuals in other medical disciplines. The main objectives of this literature are: to provide knowledge sufficient for a correct, optimistic orientation, to eliminate misconceptions about the disease, to orient in the process of overcoming existing disorders, to stimulate the general activity of the patient, etc.
Special scientific literature has features and tasks similar to medical literature. The only difference is that when communicating with her, patients tend to classify themselves as people who need more psychological, scientific help than medical. This helps patients to better understand their normal psychology, to stimulate normal psychological processes.
Popular science literature can perform the same functions as the first two genres, but for less prepared readers, giving the most general idea of very complex areas of knowledge.
Philosophical literature helps the patient to get a more integral, versatile idea of himself, other people, the world as a whole. Understand the inevitability of a difference and a certain conflict between the external, real world and the internal subjective, between what can be, should be and what is. This understanding brings calm, satisfaction, directs the activity of patients. In addition to a part of philosophical literature, a part of literary criticism, journalism, the history of literature, and the history of philosophy should also be attributed to such literature.
Biographical and autobiographical literature, describing bright personalities, their outstanding achievements and life difficulties, helps the patient to understand himself, his difficulties faster and better, to find a lot in common with the thoughts and destinies of outstanding people. Often it acts more strongly than fiction, simply because it describes real facts and events. Our experience proves that short, vivid biographies (50-70 pages) are more effective, with the exception of biographies of the most prominent people with difficult life positions, such as L. Tolstoy, F. Dostoevsky, M. Gandhi. Non-fiction, due to its factual nature and reduced mitigating factor of artistic creation, affects many readers very strongly.
Classical Russian literature has enormous potential for the most diverse impact and, therefore, is notable for the complexity of its practical application. Often one has to limit oneself to small, little-known works, avoiding the most popular ones, given that they have already been read before, studied at school and certain associations are associated with them that have to be overcome.
In contrast to the traditional, school approach to the author and his themes in the works of I. Goncharov, for example, patients are more attracted by the charm of a quiet, lazy contemplation of life, so contrasting with the bustling, intense life of the patient himself. Patients like the simplicity of life forms, their completeness, stability, balance. It is these tendencies of the patient that can be used in bibliotherapy. Modern non-cultural fiction is necessary for those patients who are alien to classical literature. Particularly useful literature is problematic, critical, pointing out to the patient his mistakes, delusions and helping to overcome them.
Critical literature and journalism give general ideas about writers, works, help to better understand them, discover new content, connect literature with current events in personal and social life. Journalism, for example, often compares ideals with reality. Critical literature is characterized by clarity, visibility of attitudes towards phenomena, thanks to which it helps to choose not only the appropriate, but also the best literature; helps to perceive phenomena more correctly, eliminating the dependence of other people’s authorities.
In our practice, we give preference to classical literary criticism and journalism, which have stood the test of time, proved their insight and therefore have a strong influence even on very distrustful, confused people, such as our patients.
It is appropriate to use modern literary criticism of such authors as Ch. Aitmatov, Yu. Nagibin, L. Ozerov, V. Rozov, V. Soloukhin and others.
Humorous and satirical literature is especially successful in teaching patients a broader, objective view of themselves and other people, as well as a kind of psychological defense. The essence of humor is the discovery of funny sides in any phenomena, even unpleasant ones, and their transformation. Humor allows patients to express themselves more freely in difficult situations of the most varied nature. Can teach techniques for better communication, for example, half-jokingly expressing requests, thereby avoiding the feeling of embarrassment at refusal, giving the opportunity to play a trick on oneself and thereby strengthen the confidence of others, etc.
Aphoristic literature contains the clearest images, refined ideas, often paradoxical, contradictory, dialectical, but always perfect in their completeness, categoricalness. Such literature is often easily assimilated and used by patients even with noticeable mental disorders, it helps to bring order to mental activity, dynamics, if there is a lack of it. Reading this literature, the patient gets used to being more calm about extremes, contradictions, and various life cataclysms.
Folklore, fairy tale literature introduces people to the worldview of the people. During the centuries of oral existence, folklore works have undergone a special selection. Only those that were accepted by the majority and that satisfied the basic mental needs of people were passed on to the new generation. By affirming ideals, goodness, truth, justice, simplicity, folklore can stimulate non-specific psychotherapeutic processes of patients. In more specific therapy, it can be used when working with children to understand their main difficulties, problems, to improve contact with parents, etc.
Science fiction literature is different from any other in going beyond the boundaries of the familiar, characteristic of the disease, which is frightening and at the same time necessary for many patients. Bringing to extremes some of the properties of a person, situations, relationships, fantastic literature allows you to better understand and accept the extremes of your sensations, feelings, inclinations, stimulates the patient’s productive activity.
Detective, adventure literature occupies a very significant place in bibliotherapy due to a number of its features. This is, perhaps, first of all, popularity, intelligibility. In the detective story, many everyday life phenomena, which usually remain in the shadows, are condensed and highlighted. The patient is the same victim; for him, many ordinary phenomena condense in the same way. The following features are favorable for bibliotherapy: great attention to negative feelings, training of intuition, mystery as a way of knowing reality, or even the obligation of the reader to suspect everyone, exposing the romantic understanding of life, morality, decency, demonstrating that dirt and self-interest often hide behind a beautiful facade. It encourages the reader to courage, risk, resourcefulness. All this applies, of course, only to good, classic detective literature. As a detective, you can also use memoirs published in the sixties by the Military Publishing House on intelligence during the first and second world wars.
It is effective in diagnosis, obsessive-compulsive disorder, psychopathy, and some psychoses.
Dramaturgy can have a particularly strong influence on some patients, due to the greater concentration of action and visibility. When reading a play, it is often easier for the patient to identify with the character than when reading a novel. The play often teaches the patient better about dialogue, the rules of communication. Dramatic material can play the role of a medical theater. The play leaves the patient more freedom for independent creativity. Dramaturgy can be used for self-behavioral therapy, functional training in the family.
Pedagogical literature can be used along with special scientific literature — in the aspects of training, correction, formation and development of various qualities, skills, overcoming specific difficulties.
Legal literature enables the patient to understand the causes of many types of wrong behavior, both his own and those around him; assess the degree of harmfulness of deviant behavior.
It is most effectively used in behavioral therapy, the treatment of neurotic developments.
Narrow professional literature can provide very foamy material due to the ability to transfer the experience of high professionalism into practical psychology, everyday situations. A fairly striking example of such an impact on the patient is the practical application of the “Diplomatic Ceremonial and Protocol” by J. Wood and J. Serre, in some everyday situations and relationships, the study of the meaning, value of certain elements of the ceremonial.
Other random literature. Sometimes in the process of diagnosing in books that made a particularly strong impression on the patient for one reason or another, related to the world of the patient’s hobbies, through which it is possible to influence him especially effectively. Usually we offer the patient to re-read them, focusing on aspects, in the opinion of the psychotherapist, relevant to the patient because of his morbid condition.
BT technique and bibliotherapeutic formulation
The methodology of bibliotherapy can be divided into several stages.
1. Self-preparation of a psychotherapist. It includes the compilation of one’s own bibliotherapeutic recipe, i.e. lists of references and special acquaintance with books from a therapeutic point of view. To begin with, there should be only a few genres, for example: medical literature, scientific, modern Russian fiction (2-5 titles each). Only with time is it recommended to expand the recipe by genre and number of books. It is necessary to draw up brief annotations for yourself with extracts, both for individual sections (chapters) and for individual books, for individual authors, in which the most important, vivid topics, thoughts, problems of chapters, works, personal characteristics of the authors are recorded. In the beginning, this will help the novice bibliotherapist to draw the patient’s attention to the relevant texts. And later, when the formulation expands over the years, the annotations will improve the orientation of the therapist himself in all the richness of psychotherapeutic agents. It is highly desirable to have all or most of the books used in bibliotherapy in one’s own library and in the library of the psychotherapy room in order to lend them to patients who are unable to independently find this book due to various circumstances. This problem can be solved by photocopying. This greatly facilitates the work, especially when urgent and energetic action is required. Moreover, one can underline in one’s «library pharmacy» books, make notes in the margins, which facilitates orientation, focuses the attention of both the psychotherapist and the patient.
2. Orientation in the possibilities of bibliotherapy and its genres. Produced during the examination of the patient. During a routine clinical examination, we usually ask additional questions such as: “Name 5 favorite books. What books have made the biggest impression on you in your life? Why? Which have had the greatest influence on you? What helped? Why? Which authors, in your opinion, are most similar to you?
3. With sufficient orientation in the diagnosis, the patient’s personal characteristics, the nature of the difficulties and the prospects of certain genres of BT, when drawing up a psychotherapeutic treatment plan, it is recommended for each patient to compile a list of references with a small and large «clip of books» in reserve, even if we are not sure whether bibliotherapy apply.
Such a system allows, without additional efforts, to connect to the treatment of BT, when the insufficiency of the methods already applied is found out. In the beginning, informational medical books are usually planned that support racpsychotherapy, books of non-specific, and then specific bibliotherapy.
4. The introduction can be quite scientific in the same way as it was done at the beginning of our chapter.
5. Reading system. Usually, as our experience shows, it is advisable to start BT with medical, scientific, psychological literature. The authority of medicine and any science in patients is very high and the impact of science as a system of knowledge is very significant, especially if the book deals with symptoms and topics relevant to the patient and immediately brings a significant effect. This makes it much easier for other genres to reach the patient.
This is followed by books explaining the role of personality and individual mental processes in illness and recovery: Gannushkin, Lazursky, Obukhovsky. Then, later, books are connected that introduce ways to overcome the disease: S.I. Konstorum, guide to psychotherapy (under the editorship of V.E. Rozhnov), K.I. Platonov.
Expanding and deepening the impact on the patient, we turn to the socio-psychological literature. Later — fiction, the world of desires, human ideals, the world of art, which generalize into a system what science studies as fragmented, desirable, especially in the field of a person’s personal life.
Literary criticism, criticism, journalism are often a necessary corrector of the «idealism» of patients, showing the difference between the real and the desirable, the world of nature, patterns and the world of ideals, freeing them from inappropriate ideals, outdated authorities, replacing them with new ones, teaching critical thinking, courage, creative aggression.
Philosophical literature is often included in bibliotherapy, giving the patient a broader view of a person from the outside, in a distraction from the topic of the day, more holistically and in perspective. It calms, optimizes perception, evaluation, reaction.
Further, other genres of literature are connected, depending on the characteristics of the case. Concluding the topic of choosing books for bibliotherapy, it must be emphasized that for therapeutic literature it is especially important that books carry as many facts as possible, even if they are scientific and philosophical books. It is better if examples will stand before theories. It is advisable to stick to dynamic books, this predisposes the patient to the expectation of certain changes in the future. It is desirable to assign the first place in bibliotherapy to the latest literature, the latest word in science. The exception is fiction, literary criticism, philosophy, for which the test of time is important.
6. Techniques for directing attention, discussion, interpretation. Usually, reading is guided by those impressions, conclusions, decisions, behaviors that, in the doctor’s opinion, should evoke first, second, etc. For example. “I want you to pay special attention to the structure of your needs, the difficulties and tensions that arise in satisfying them, especially the need for emotional contact …” “Think about the possibilities of satisfying your needs …”
A non-directive method of guidance is also possible. “Read recommended books. We’ll talk about what will make a special impression on you, turn out to be especially interesting, new, useful for you later … What do you think, what would the main character of the book do in your place? .. And the author himself? .. »
7. Bibliotherapy as an auxiliary and main method of therapy. In the first case, separate books well known to the therapist are used to enhance the effect of one or another method of psychotherapy, to stimulate non-specific therapeutic processes.
In the case of bibliotherapy as the main method, a rather massive system of reading with a certain sequence is usually outlined, even if the goals of therapy are relatively limited. It is proposed to see their authors behind the works. More attention is paid to biographical, ideological, philosophical literature.
Bibliotherapy for specific nosological units, syndromes, conditions.
Like any type of psychotherapy, bibliotherapy has its own characteristics for different disorders. As an example of such features, let us dwell on the treatment of neurasthenia, psychosomatic disorders, psychosis, help in life’s difficulties.
Neurasthenia (asthenic, hypochondriacal, subdepressive syndromes) usually requires bibliotherapy in cases where it is characterized by a protracted, recurrent course, if it is complicated by hypochondria, affective disorders, life difficulties or personality traits: sensitivity, emotional lability, suspiciousness, anxiety.
By explaining to the patient his illness, the true meaning of the symptoms, the role of personality and life difficulties in the onset and course of the disease, bibliotherapy relieves excessive tension, fears, hypochondria, and creates a strong motivation for the patient to adhere to certain doctor’s recommendations.
Psychosomatic diseases are treated like neuroses. Greater emphasis at the very beginning of the disease is placed on clarifying the symptoms, reducing the patient’s hypochondria, tension, and teaching more optimal behavior. Here, the corresponding chapters from the books of K.I. Platonov, guides to psychotherapy (under the editorship of V.E. Rozhnov).
The treatment of psychoses, especially specific ones, is certainly one of the most difficult areas of activity. It usually begins at the end of the acute period of the disease, when the patient himself begins to think about what happened to him and ask questions.
Special medical, scientific, psychological literature helps the patient to better understand the meaning of the symptoms of the disease, to treat them more critically, stimulates psychotherapeutic processes. Special fiction helps to realize the boundaries of one’s personality, strengthen them, and maintain an appropriate distance between the inner life and the outer world.
The peculiarities of bibliotherapy in psychosis is that the doctor often has to choose the literature for the patient himself and dose it, taking into account the needs of the patient, misunderstanding after a recent exacerbation, the possibility of iatrogeny.
The main directions of interpretation can be seen from the following questions most often asked by us to patients: What is the general impression of the book (text)?.. What made you happy?.. What alerted you?.. What can you learn in this book to overcome your distortions of perceptions?.. Feelings? … Thoughts? Why? How is it better to dose them yourself, with the help of relatives, a doctor?.. What benefit can be derived from the temporary distortion of mental activity? less and less often?.. How much does the disease depend on external factors, and how much on your character?.. What else would you like to read about?..
Life difficulties should often be the main object of influence of the psychotherapist, since it is they that cause overstrain, exacerbation, decompensation, and pathological reactions. Examples of such difficulties may be: excessive employment, lack of a sufficient number of friends and acquaintances who can provide support, inability to communicate, excessive demands on oneself and others, etc.
Most often, these difficulties have a fairly pronounced personal character, and we begin BT by familiarizing the patient with the strengths and weaknesses of his personality according to P. Gannushkin or A. Lazursky. We learn to rely mainly on our strengths of personality.
Later, to teach the technique of overcoming difficulties, we connect pedagogical literature, dramaturgy (K. Stanislavsky, J. Anouil), aphoristic, helping, for example, to find the right word, the right thought, to avoid an unpleasant topic.
Completion of a bibliotherapy course, as in all areas of psychotherapy, is a rather important stage, especially since it often sums up all previous psychotherapy. Often, in various types of psychotherapy, we encounter pronounced subjective and objective deterioration caused in patients by the fear of being left without support, the inability of patients to quickly reorient themselves, etc. In bibliotherapy, in our opinion, the most optimal variant of ending therapy “without ending” is possible: transition from reading for treatment to reading for development. We recommend that they continue reading “to consolidate the results of treatment”, “for mental gymnastics”, “for mental hardening”, “mental development”, etc. We usually focus on fiction, journalistic and philosophical literature. We often emphatically recommend an independent choice of books, based on what made a special impression on the patient in the process of bibliotherapy. Sometimes we help him in his choice, introducing him to our large list, making recommendations or not giving them.