His patients published their own writings in their newspaper. Although there is some disagreement, many consider bibliotherapy—interactive use of literature—a subcategory of poetry therapy. Practitioners may be credentialed as certified applied poetry facilitators, certified poetry therapists, or registered poetry therapists. Some poetry and bibliotherapists are also active in the National Coalition of Creative Arts Therapies Associations, which hosts an annual conference of all the arts therapies.
Bibliotherapy was first adopted by librarians, who saw value in the practice of selecting and using specific books helpful to psychiatric patients. Karl Menninger collaborated with the librarians in his hospital, because he felt they knew the patients better. Much later, in , he facilitated a poetry therapy group at Cumberland Hospital with two supervising psychiatrists, Dr. He also published what social work professor and poetry therapist Nick Mazza, Ph.
The journal gives us credibility. Poetry therapy is used in three major domains, he explains. The receptive-prescriptive uses preexisting poetry or literature to elicit responses. A third usage is the symbolic-ceremonial, which is connected to the power of ritual or symbols. A lot of people wrote and drew after Columbine, but it became ceremonial when they posted it. In his past private practice—now he largely does workshops and consultation—Mazza found poetry therapy is effective with many different populations: The timing is important.
We also have to ask if a person is ready for a group. Young children might be more responsive with art therapy. But I use poetry therapy a lot. It cuts across modalities—with individuals, couples, families, groups, and community. Although Nancy Scherlong became a social worker, she was a writer years ago, trained to be an English teacher and poet. We also use scrapbooks of photos and memories.
Finding the Words to Say It: The Healing Power of Poetry
The first year is hard, especially around the holidays. Previously, Scherlong did therapy with kids in a foster care facility and used writing, especially fairy tales and the force of magic. She worked with them individually and in sibling groups. Writing helps people feel less vulnerable, but not directly. In addition to the three modalities described by Mazza, she believes there is a fourth—asking clients to take existing poems and discuss what poem they would write if it were their own. Poetry therapy can even be effective with people not considered to be very articulate.
She does work it into regular psychotherapy sessions in her practice with adults and couples. However, in the past, Rolfs did poetry therapy with both in- and outpatient psychiatric patients, with the chemically addicted, postpartum women, and children, as well as training and workshops regarding poetry therapy.
Now she does more educating and training. This is both self-esteem-building and life-affirming. With individuals, she adds, you have to fit the technique to a particular type of person. Peggy Heller loved poetry and words as a child. Heller has held multiple positions in the poetry association, including president. She has applied poetry therapy in psychiatric and regular hospitals, with recently deinstitutionalized patients, and at a center for young people with dual diagnosis of mental retardation and schizophrenia.
I trained with the most severely schizophrenic people who had been hospitalized for decades. We created progress in such minute steps. She then worked in a variety of nonprofits until starting a private practice in Most of her experience has been with adults, although she did see children and teens in the early part of her career. From there I was determined to get credentialed. That's nothing unusual for Ernie. People say there's something wrong with me. In the end, she's still gone, no matter how I work it out.
I've got children now. I love my wife, but my sister… She was all of our heroes… tall with dark red hair. She drowned going after a ball. I saw her go out, and I heard her yell. When she went under, I saw her. My cancer was removed ten years ago. Between the surgeries and the chemo and the complications, it was all I could do to live day-to-day. Now it's been ten years. I'm beginning to believe I have a future. I've lost a lot of friends along the way, but we were there for each other. Then we hugged and we touched. For more on the ways in which poetry is employed as a therapeutic tool, you can refer to the following references 23 — In Chinese, the written character for poem is composed of two characters, one means word and the other means temple.
Together they mean poem. The wisdom of poetry is in the combination of the sacred and the word as illustrated by the character in Chinese. Healing is frequently thought of as taking place at the level of the individual. But if healing is viewed as a process that brings us back to wholeness, then in addition to happening within the individual patient, healing can also take place between patient and family members, between patient and the larger community of which they are a part, and even at the level of the community as a whole. In fact healing is often necessary on many of these levels simultaneously.
In many indigenous cultures, illness is viewed as the individual falling into disharmony with the community, so that in order to heal the individual, their place in the larger order must also be restored. In many West African indigenous cultures, proverbs are told in the oral tradition of poetry. Kykosa Kajangu from the Congo has collected these proverbs and integrated them into what he terms Wisdom Poetry personal communication.
In one African tribe, when a woman is pregnant, the women of the community assemble in the forest and listen for the new child's song. When they hear it, they bring it back to the community and sing it in public. When the child is born, the song is sung again. When the child goes through ceremonial rites of puberty and marriage, it is sung again. And, when the child grows old and is dying, it is sung again. But, it is also sung when the child has broken with the community, committed a crime, or otherwise fallen out of harmony. The people tell themselves and each other who they are in the order of things, and can thereby bring themselves back into harmony with the world.
The healing concerns of palliative care do not reside only with the patients. In , during my father's terminal illness, a friend of mine contracted a nasal sinus cancer, which was thought to be benign. After several surgeries, all of which were too-little-too-late, the tumor spread into her skull and invaded her brain.
When last I left my friend Ruth Ellen, the surgery to remove the frontal bone left her with a step on her forehead. When we went out, she wore hats. Today I'll visit her in her room. The tumor is no longer benign. In her head in her eye in what now appears to be the end of her life is my life. What a relief to know all that is left is to live.
Time becomes pudding, pudding air, thick and everywhere. These are the best times of our lives, these pudding days of grace when gardens are our guide. They finally took her eye. When I arrived at the house, her daughter Molly gave me a hug.
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She'd gone slightly stiff. I walked in and looked out the back window. The garden was beautiful and overgrown, wet with new rain. I almost missed her in her chair at the table, sitting there eating avocado, sliced and laid out flat. She looked cute in her bonnet and patch. Oh carry me wind for I am air; she's gonna lose her hair I fear she's gonna lose her hair and hibiscus's blooms and hummingbirds' wings and deep dark earth held our future as we shared the last bite of avocado. Ruth Ellen rose then retired to bed. Her black cat waited under the covers after licking Ruth's plate. I read them poetry.
We all tempted fate. I am gifted too, but unrealized. I don't know if I'll write. I don't know if I can. Whenever I try, it seems distant or removed. You must start with your own spoken voice, which is alive, not distant, here and now: You remember the last bite of avocado creamy and green a friend your bonnet, the beeping IV Molly, kinked by your arm, the cat black and close— everything rich and scented with you.
This is your poetry. This is your life. I went to the house to her room. Her face looked like a pumpkin swollen red and round as a plate. Her left eye was gone.
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She didn't wear a vanity patch anymore. I kissed her on the cheek.
Finding the Words to Say It: The Healing Power of Poetry
Sometimes it scares me. I'm shedding, like wings. Sometimes I come out whole; sometimes it's an onion. Sometimes I feel it. You know me, Robert, I don't get all mystical, but something's happening. I'm shedding from the inside. It's all falling away— beliefs, relationships— all falling. It's good you've come. Dying's no big thing anymore, It's a way to go. When I sat at my friend's side while she was dying and we wrote words like snow and shed wings, I was witness and scribe.
We wrote poetry together, She and I. My father is scheduled for surgery tomorrow. They're replacing the clogged artery in his leg with a vein graft, also from his leg. The incision will run from his groin to his foot. If they don't replace the artery, the toe will turn gangrenous, and he could die from infection. If they cut off the toe, the stump may not heal from the lack of circulation, so they have to replace the artery first, and the artery in the other leg, well, that can wait for now, but it will need replacement too, if he lives.
My father called the other day. He told me a story from his childhood about a man who owned a one horse shay. The axle broke so he took it to the blacksmith to have it repaired. In it, a wife of 25 years speaks of her role as caregiver 2. I felt frozen at first.
As things went worse for his body there was a kind of condensation— like distilling our future into a very tiny space. Everything became condensed into moments of closeness. I became a better person. Sometimes I wanted to sleep. Sometimes I wanted to hide. I was envious of people. The humor we shared wasn't about jokes.
It was about being silly. You can't be silly with just anyone. It's a real loss. I knew the minute he died. It was like he shrunk into his body. The soul may linger for a while, But it didn't linger in that body. What was left was left in our hearts, not in the bed. I came up with this amazing idea That everything now is surreal, And the surreal is the new reality. I just thought of something wonderful. No matter how long we were together, There was always more. I wrote a poem. Here are a few lines. Nothing of love is ever lost. You take each other in. The poetry and brain cancer project also produced poetry that presented a different sort of perspective.
The first question most brain cancer patients ask is, How long do I have to live? I'll tell you how to Figure it out. First, think of a number. Now, this is where it gets a little tricky … Add the number of your surviving relatives Immediate family only please. Divide by your estimated percentage hair loss. Subtract one quarter of the number of seizures per month.
Multiply by the amount of times you cry. Divide by the amount of times you want to cry. Add the number of people in your email support group. Add twice the number of medications taken daily. There you have it. An accurate and realistic assessment of your life expectancy. We call it median mortality. In a soon-to-be published paper, Jack Coulehan and Patrick Clary, Journal of Palliative Medicine in press write about the need for professionals who work in palliative care to be able to process their own experience, specifically using poetry.
John Fox writes of this need amongst hospice care givers to find their own voices in the work they do 23 , Gregory Gross discusses the need to deconstruct death from his Scientific Medicalization to a more poetic remystification of the process of dying The Man With a Hole in His Face 31 by Jack Coulehan is a dramatic example of a physician trying to come to grips with his own reactions to the reality of this patient. He has the lower part, a crescent of face on the right, and an eye that sits precipitously beside the moist hole where the rest of his face was.
The hole is stuffed with curls of gauze. His nurse comes before dawn, at the moment the eye fears for its balance, and fills the wound, sculpting a tortured landscape of pack ice. The man's eye does not close because any blink is death, nor does the eye rest in mine when I ask the questions he is weary of answering. While I wait here quietly in arctic waste, the pack ice cracks with terrifying songs and over the moist hole where the rest of his face was, he rises.
Introduction
This man is the man in the moon. Most of the experimental evidence as to the efficacy of Poetry Therapy comes through the literature on expressive writing. The seminal researcher in the field of the therapeutic uses of expressive writing is James Pennebaker 32 , Pennebaker has shown that the use of expressive writing for as little as 15 min over 4 days has positive health effects as measured by visits to physicians and a diminution of symptom complaints.
His original work deals with the use of expressive writing to heal wounds from traumatic stressful events. Pennebaker's argument and the evidence for the efficacy of expressive writing is well stated in his most recent book Writing to Heal: In it he summarizes his argument for the therapeutic effects of expressive writing on the immune system 34 ; medical health markers with asthma, cancer, and arthritis patients 35 ; and decreased physiological stress indicators in the form of lower muscle tension, drops in perspiration levels, and lower blood pressure and heart rate levels.
Findings from numerous experiments have suggested that writing exercises can give a whole array of health benefits including reductions in emotional and physical health complaints 37 , 41 , 42 , and enhanced social relationships and role functioning On the other hand not all investigators have found positive effects using writing, and not all people who wrote showed positive benefits Some writers have shown skepticism How Expressive Writing Promotes Health and Well-Being 34 , which is the most comprehensive review to date on the research into the efficacy of expressive writing.
It presents cutting edge theory and research, and points students and scientist to new avenues of investigation. It also presents how clinicians are beginning to translate basic research into practical applications. The book is divided into four sections: Overall, the research on poetry therapy in general and expressive writing in particular is promising.
I hope you've enjoyed the ride. If you've gotten this far, you've certainly had some kind of experience. You may or may not understand it, but ask yourself whether you have a better sense of being in the dialogue on illness, death and dying. How do you already use your capacities for poetic expression in working through these questions? If on the other hand, you just skipped directly to this conclusion, here's something for you too. What I want is not words But where words come from The space within breath That calls out our tongue.
According to the NAPT, the definition of Poetry Therapy is the intentional use of the written and spoken word to facilitate healing, growth and transformation. The NAPT has been in existence since It's predecessor was The National Association for Bibliotherapy. Twenty-five percent of the members are mental health providers psychologists, social workers, family counselors, etc. Please refer to the web site for details.
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National Center for Biotechnology Information , U. Evid Based Complement Alternat Med. Author information Article notes Copyright and License information Disclaimer. For reprints and all correspondence: Published by Oxford University Press. This article has been cited by other articles in PMC. Abstract My purpose in this paper is to help you experience for yourself the potential of poetry to heal by feeling its power through your own voice. Introduction My purpose in this paper is to help you experience for yourself the potential of poetry to heal by experiencing the power of poetry through your own voice.
Poetry as a Natural Healing Practice Many people have an intuitive sense that voice in general and poetry in particular can be healing. One patient reported his dilemma following brain surgery to remove his cancer, I felt I lost my edge and then I lost my place but the tragedy is I have so much to say. Amazing Change We can go through amazing changes when we are faced with knowing we have limited time.
Poetry and Therapy In my private practice of family psychiatry, I often ask whether my patients do any writing and for what purpose. Eileen Eileen has breast cancer. Being the Stone I want to be the stone and tell how she held me in the palm of her hand rolled me between her fingers slipped me into her mouth tasted my salt tumbled me around.
MeFather I rose in his wake. What Waiting Is We sit on the bench in the hospital corridor next to the cafeteria, and we wait. The Family Plot I dig the earth with my hands, claw stones with my nails, sift ash through my fingers— bone and tooth fragments burned out by morning spread on the ground. A Note On Healing In Chinese, the written character for poem is composed of two characters, one means word and the other means temple.
Poetry and Palliative Care The healing concerns of palliative care do not reside only with the patients. The Proof in the Pudding When last I left my friend Ruth Ellen, the surgery to remove the frontal bone left her with a step on her forehead. The i in Poetry When I sat at my friend's side while she was dying and we wrote words like snow and shed wings, I was witness and scribe.
Cherish My father is scheduled for surgery tomorrow. The Legacy I felt frozen at first. Median Mortality The first question most brain cancer patients ask is, How long do I have to live? The Man With a Hole in His Face He has the lower part, a crescent of face on the right, and an eye that sits precipitously beside the moist hole where the rest of his face was.
The Experimental Evidence Most of the experimental evidence as to the efficacy of Poetry Therapy comes through the literature on expressive writing. In Conclusion I hope you've enjoyed the ride. Afterword What I want is not words But where words come from The space within breath That calls out our tongue.
The National Association for Poetry Therapy According to the NAPT, the definition of Poetry Therapy is the intentional use of the written and spoken word to facilitate healing, growth and transformation. Open in a separate window. II — New York: New Directions Books; Asphodel, That Greeny Flower. The Art of the Brain: Writing for Your Life. North Atlantic Books; Entering the Ghost River. Hand to Hand; Texas Tech University Press; Last Leg Publishing; Passion and Shadow, the Lights of Brain Cancer.
Contemporary Poems for Health and Healing. Poems about the Lives of Patients and Doctors. Belli A, Coulehan J. University of Iowa Press; A Doctor's Black Bag of Poetry. The Poetry of Healing: What the Body Told. Duke University Press; Journal to the Self. Finding What You Didn't Lose: The Healing Art of Poem-Making. Poetry Therapy Theory and Practice. The National Association for Poetry Therapy web site www. Chavis G, Weisberger L, editors. Poetry Therapy for Life's Journey.
North Star Press of St. Poems of Strength and Solice. National Association for Poetry Therapy Foundation; Mending the Troubled Mind. The Vanguard Press; Journal of Poetry Therapy.