Thursday, July 07, 2016

Poetry Therapy Roots and guide (link)

What are the Roots of Poetry Therapy?

Poetry Therapy may be traced back to primitive man, who used religious rites in which shamans and witchdoctors chanted poetry for the well-being of the tribe or individual.
[17]  As far back as the fourth millennium B.C.E. in ancient Egypt, words were written on papyrus and then dissolved into a solution so that the words could be physically ingested by the patient to take effect.[18]  The Greeks are credited as being one of the earliest people to conceive the importance of words and feelings to both poetry and healing.[19]  Thus, it is not surprising that Apollo was the dual god of poetry and medicine, since medicine and the arts were entwined.[20]  However, the first Poetry Therapist on record was a Roman physician Soranus(98-138 AD), who in the first century A.D., prescribed tragedy for his manic patients and comedy for those who were depressed.[21]

For many centuries the link between poetry and medicine remained obscure.
[22]  As far back as 1751, Pennsylvania Hospital, the first hospital in the United States, employed many ancillary treatments for their mental patients, including reading, writing and publishing of their writings.[23]  However, it was Dr. Benjamin Rush, called the "Father of American Psychiatry"[24], who was the first American to introduce music and poetry as a form of therapy in the early 1800’s.[25]   Poemwriting became an activity of the patients, who published their work in The Illuminator, the hospital’s newspaper.[26]

In 1928, Eli Greifer, an inspired poet and lawyer and pharmacist by profession, began a campaign to show the healing power of poetry.
[27]  Griefer offered poetic prescriptions to people filling their drug prescriptions.[28]  Griefer believed that memorization of poems was useful for a process of healing he called ‘psychosurgery.’[29]  In the 1950's Griefer started a "poemtherapy" group at Creedmoor State Hospital in New York, where he volunteered his time.[30]  By 1959, Greifer expanded his poetry therapy group to Cumberland Hospital where he collaborated with two supervising psychiatrists, Dr. Jack L. Leedy and Dr. Sam Spector.   The overwhelming success of Griefer’s poetry therapy groups prompted Griefer to write Principles of Poetry Therapy in 1963.[31]  Although Griefer died in 1966, he played a key role in the development of what we now call "Poetry Therapy,” and is credited for giving poetry therapy its name.[32]

Dr. Jack. L. Leedy continued Griefer’s work and published
Poetry Therapy: The Use of Poetry in the Treatment of Emotional Disorder in 1969.[33]  Leedy’s book, which includes essays by many of the early pioneers in the field, is considered the first definitive book on poetry therapy.[34]  About this time, more and more professionals in the medical field began to use poetry integrated with group process.[35]   While Dr. Leedy continued his work at Cumberland Hospital, “Ann White [worked] with the Nassau County Recreation Department and developed an experimental project that brought the therapeutic benefits of poetry to hospitals, rehabilitation centers, and schools for special children.[36]  At the same time, Gilbert Schloss PhD conducted psychotherapy sessions with individuals and groups at the Institute for Sociotherapy in New York.[37]  In 1969, Leedy, White and Schloss collaborated to create the Association for Poetry Therapy (APT).[38]  Shortly thereafter, the APT developed a set of standards for certification in the field of poetry therapy.[39]

In the early 1970’s, many medical professionals developed training institutes for poetry therapy.
[40]  Among them was Arthur Lerner, Ph.D. of Los Angeles who founded the Poetry Therapy Institute in the 1970’s on the west coast and in 1978 authored Poetry in the Therapeutic Experience.[41]  Arleen Hynes, a librarian at St. Elizabeth’s Hospital in Washington D.C. established the Bibliotherapy Roundtable and Morris Morrison founded the American Academy of Poetry Therapy in Austin, Texas.[42]  While each institute conferred its own training certificates, uniform requirements for poetry therapists had not been established.[43]   Consequently, in 1980, a meeting was called to bring together those active in the field working all over the country to formulate guidelines for training and certification in poetry therapy.[44]  Those in attendance unanimously decided the APT would become the National Association for Poetry Therapy, a national non-profit association.[45]   They also developed the National Federation for Biblio/Poetry Therapy whose intended purpose was realized in 2002, when it became the certifying body for trained poetry therapists.[46]  NAPT is now the official membership organization representing poetry therapists.         How Does Poetry Therapy Work?

            Poetry therapy group facilitators use many different kinds of media and exercises to aid their clients in overcoming their problems.  The different kinds of activities facilitators employ can be broken down into three main components:
[47] 1) the receptive/prescriptive component involving the introduction of literature into therapy, 2) the expressive/creative component involving the use of client writing in therapy, and 3) the symbolic/ceremonial component involving the use of metaphors, rituals, and storytelling.  All three components “have the potential to address the cognitive, affective and behavioral domains of human experience”[48] and can be collectively used to develop an effective poetry therapy seminar or session.

               The receptive prescriptive component typically involves reading a pre-existing poem to an individual or group and inviting reactions for discussion.  The poem introduced to the group should be connected with the pre-determined theme of the session or connected with the dialogue or content of the session.
[49]  The poem should serve as a vehicle for group members to talk about ideals, goals and emotions.[50]  The discussion following the poem should be focused on what the poem means to the reader and whether there was is any line or overall theme of the poem that strikes the reader as their own.[51]  If the poem is to be read aloud to the group, copies should be distributed to group members for visual reference.

            The selection of the proper poem or song is essential to effective poetry therapy.
[52]  Poetry therapists dealing with young adults often prefer to use popular song lyrics or an audio version of a song to elicit reactions from the group.[53]  Open-ended songs and poems can assist the client with self-awareness.  Encouraging clients to bring their own poems and songs they found to be helpful allows group members to share their feelings with the group.[54]  Facilitators can ask clients about particular works they enjoyed or identified with in order to provide the facilitator with “fruitful clinical information and self-understanding for the client.”[55]

            The expressive/creative component involves the use of creative writing (poems, stories, diaries) to aid the client in expressing emotion and gaining a sense of order and concreteness.
[56]  A variety of creative writing techniques are used, from free-writing exercises to structured poems to sentence stems.[57]  Some poetry therapy scholars suggest journal writing can be a useful tool for clients to express thoughts and feelings in a personal way.[58]  Keeping a journal allows clients to keep their feelings confidential in the event they are not ready to share among a group.  Journals can involve creative techniques, from keeping an open record of thoughts to a highly structured log of events and feelings.  Regardless of the creative techniques employed by the group facilitator, creative writing exercises should provide some element of control and expressiveness to the client.[59]

The symbolic/ceremonial component involves the use of metaphors, rituals, and storytelling in therapy.  Metaphors both in preexisting literature and creative writing are often used in therapeutic capacities to help clients express and understand the connection between internal conflict and external reality.
[60]  In its most basic form, “a metaphor is something that stands for something else”; metaphors may stand for emotions, actions and beliefs.[61]  Rituals are also often used in poetry therapy groups to meet the particular needs of clients.  For example, writing Christmas cards, giving a eulogy or writing a letter to a loved one may allow individuals to “recognize [the present and] past, let go and move on.[62]  Using ritual exercises within a poetry therapy group serves dual purposes, “to validate an occurrence and promote change.”[63]  Finally, storytelling exercises aid group members in sharing their experiences and receiving support.[64]  Storytelling is an essential part of everyday life; people tell stories all the time by remembering what they experience and telling other people what they remember in the form of a story.  Human memory itself is story-based.[65]  Most people find it a lot easier to remember what other people have said if they tell it as a story and we learn from these stories, as others learn from the stories we tell.[66]  Externalizing problems through narrative storytelling is central to functioning and resolving conflict.[67] What Happens in a Typical Poetry Therapy Session?

            According to Sherry Reiter, former president of the National Association for Poetry Therapy (1993-1995), the typical poetry therapy session consists of the following steps: 1) the introduction, 2) the body of the session, and 3) closure.  Each step will be discussed below.  However, please note there is not a norm for a poetry therapy session as exercises and group goals will vary according to group dynamics and makeup.

Each poetry therapy group session should being with an introduction where ground-rules are set and where group members agree to respect confidential issues that may arise.
[68]  The beginning of a new session arouses many new feelings and anxieties in participants and facilitators alike.[69]  Thus, 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.[70]  Further, warm-activities serve to build confidence in group member’s abilities, warm the ink in the pen and get group members’ minds thinking, imaginations working and emotions flowing.[71]

In 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.”
[72]  Facilitators should choose literature that will be effective therapeutically and should be cautious in introducing works that may be counterproductive to group process.  Although there are no fixed rules regarding the method for selecting material, there are some basic guidelines.[73]

Poetry therapists should pay special attention to the content of the material and its relevance to the participants.
[74]  The group dynamics, group goals and group members’ individual abilities should be assessed prior to making a literary selection.  Generally, facilitators should choose poems and songs that elicit emotional associations with the work and foster connections with fellow group members.[75]  Each participant should be given a copy of the chosen literature, so that the words can be taken in visually while being heard; a poem must be read word for word in order that rhythm, rhyme, assonance and alliteration be appreciated.[76]  Reading poetry aloud builds group cohesion, and enables patients to respond to the rhythm of the poem.  Subsequent to the reading of the work, the poetry therapist should engage the group in a discussion regarding the mood, theme, what the work represents for respective group members and what connections if any group members made with the work.[77]

The reading and reflection of a literary selection should be a group interactive process.  Four stages can be identified in the interactive process:

Recognition - To begin with, participants must be able to recognize and identify with the selection;

Examination - During this phase, participants explore specific details with the assistance of a [poetry therapist]. Through questions and open dialogue, the group explores the significance of their reactions;

Juxtaposition - This is a process that explores the significant interplay between contrasts and comparisons. . . 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;

Application to the Self - The [poetry therapist] encourages feelings to emerge and become integrated with cognitive concepts and deeper self-understanding. . . 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.[79]

In working through all four stages, it is important for the poetry therapist to establish an atmosphere that promotes member participation so as to build trust and cohesion amongst the group.  Group collaboration maximizes communication abilities and establishes a beneficial culture of productivity for all participants.

At the end of the session, the facilitator should 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.”
[80] Closure provides a time for a recapitulation of lessons learned and experiences shared throughout the session.  Further, closure may be used to highlight the relevance of the workshop to everyday life, summarize some of the key points, address unanswered questions and conclude in a positive and mutually affirming way.[81] The Poetry Therapy Seminar             My goal in creating the poetry therapy seminar guide is to make therapeutic writing techniques more accessible to able facilitators who may want to try and lead a poetry therapy seminar.  While the National Association for Poetry Therapy has outlined rigorous standards for certification and registration in poetry therapy, I believe therapeutic writing techniques should not solely be left in the hands of professionals.  Keeping diaries, writing stories and reading poems are activities that almost everyone has done at one point in their life.  The universality of such activities makes therapeutic writing a familiar and useful tool in helping people overcome their battles. 

            By creating the
Poetry Therapy Seminar Guide: conquering adversity through verse, I want to give group facilitators the means to run an organized and effective poetry therapy seminar.  Though certain realms of mental illness should be left to trained professionals, the struggles of everyday Americans such as depression and substance abuse[82] can be eased through therapeutic writing and poetry therapy.  Thus, my aim is to create a poetry therapy seminar that can be used for numerous ailments and across a variety of groups.

The seminar uses a mixture of: (1) receptive/prescriptive exercises, (2) expressive/creative exercises and (3) symbolic/ceremonial exercises (as discussed in the
How Does Poetry Therapy Work? section above).   The overall format is based on a combination of a seven week/session format developed by Nicholas Mazza,[83] Ph.D., R.P.T. (Registered Poetry Therapist) and the typical poetry therapy session as outlined by Sherry Reiter, C.S.W, R.P.T., R.D.T (Registered Drama Therapist), in her testimony on Capitol Hill regarding poetry therapy.  The seven week format takes into account time limits of participants and participants’ limited goals.  Because session participants will likely be those who have other commitments (work, school, etc.), goals will be more limited than sessions attended strictly by those with serious mental disorders.  Mazza suggests that seven weeks serves as an adequate time frame for brief therapy, but that “time could be used as a treatment variable consistent with other student responsibilities.”[84]  My hope is that activities within the seven week program can be duplicated in the event a facilitator finds them successful (if a seminar needs to be lengthened) or eliminated in the event they are counterproductive (if a seminar needs to be shortened).

The poetry therapy seminar schedule and activities should be set-up as follows.  The group should convene for one session a week, for seven weeks.  The group facilitator should ideally allow at least 2 hours for each session.  Each session follows an identical structure: the session begins with 1) a
warm-up activity, 2) followed by a reflection activity and 3) concludes with a group activity.   

Warm-up activities consist of different forms and methods of creative writing to get group members’ minds thinking, imaginations working and emotions flowing.  As aforementioned, the beginning of a new poetry therapy seminar can be a nerve-wracking experience for participants and facilitators.  Warm-up activities reduce anxieties, encourage group members to participate and bolster confidence.  Most warm-up activities are relatively light and do not require enormous amounts of creativity to complete.  Consequently, group members begin to feel confident in their abilities.  However, as the sessions progress, and group members become more advanced, warm-up activities get increasingly challenging.  After completing the warm-up activity, the facilitator should lead a focused discussion about the exercise and what group members should have learned upon completion of the activity.

Following the warm-up activity is the reflection activity.  Reflection activities employ pre-existing poems or pop music to be used by the group leader to facilitate discussion.  Poems and songs can elicit emotional connections with the narrator or with fellow group members through discussion.
[85]  Also, songs and poems allow group members to see how emotions may be expressed from different points of view and likewise how different points of view can be expressed in identical ways.[86]  The poem/song may be introduced into the session to parallel the conversations or subject matter of the week or may be introduced to allow group members to make an emotional identification with the poem.  Copies of the poem should be passed out to each group member for visual reference.  Facilitators may also choose to use two or more poems or songs for a compare and contrast activity.  Following the reading, the facilitator should lead a discussion focusing on what the poem means to the readers and which lines strike them as significant.  Facilitators may also ask the group how they would change the poem if they were the author.  The back of the guide contains an appendix containing discussion questions for reflection activities.  A list of the twenty-two poems most often used in practice and song suggestions for reflection activities are also included.

Each session concludes with a group activity.  Group activities are comprised of collaborative poems, whereby the group creates a poem with each member having the opportunity to contribute lines.  The facilitator should provide a theme for the poem to direct group members’ thinking.  Upon completion of the collaborative poem, the group should create an appropriate title for the work.  Copies of the collaborative poem should be disseminated to the group and may be used for discussion following the activity or at the beginning of the next session.  The benefits to group activities are numerous; collaborative poems are useful in creating group cohesiveness, maximizing communication abilities and interpersonal skills and establishing a culture of productivity.
[87]  Further, collaborative poems give encouragement to group members who at first may have a hard time completing poems by themselves.[88]     

Each week/session is broken into its own color-coded section.  Every session starts with a goal sheet to be used by the facilitator for outlining goals for the upcoming session.  As different groups will have different goals, the goal sheets are blank.  Facilitators are to determine goals for the group according to the group’s needs and progress.  Though pre-determined goals would make the seminar more user friendly, they also limit the seminar’s applicability to numerous ailments.  Thus, goals will vary according to the particular disorders the seminar intends to address.