Poetry Therapy: Using Words to Heal

by Barbara Trainin Blank

It’s often been said that a picture is worth a thousand words. But when the words are poetic—full of imagery, metaphors, and rhythm—they’re much more powerful.

    Biblio/poetry therapy, one of the creative arts therapies, is the use of the written word (although it may be read out loud) to bring healing and personal growth.

    According to the National Association for Poetry Therapy, a worldwide community of poets, writers, journal keepers, helping professionals, health care professionals, and others who recognize the healing power of language, poetry therapy has primitive roots. Shamans and witch doctors chanted poetry for the well-being of the tribe or individual.

    The Roman physician Soranus prescribed tragedy for his manic patients and comedy for the depressed ones—and can be called the first poetry therapist on record. Dr. Benjamin Rush, called the “Father of American Psychiatry,” used music and literature as complementary treatments. 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. The National Federation for Biblio/Poetry Therapy, incorporated in 1963, sets standards of excellence in the training and credentialing of practitioners in both fields. 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. Dr. Karl Menninger collaborated with the librarians in his hospital, because he felt they knew the patients better.

     Freud stated that it wasn’t he, but the poet, who “discovered the unconscious.”

    Poet Eli Griefer in the late 1920s started a “poemtherapy” group as a volunteer at Creedmore State Hospital. Much later, in 1959, he facilitated a poetry therapy group at Cumberland Hospital with two supervising psychiatrists, Dr. Jack J. Leedy and Dr. Sam Spector. Leedy’s efforts led to the creation of the Association for Poetry Therapy, parent of today’s Association. He also published what social work professor and poetry therapist Nick Mazza, Ph.D., calls “the first significant book on poetry therapy.”

    Compared with art therapy and music therapy, biblio/poetry therapy is a small field, with practitioners more in the hundreds than thousands, according to Mazza, Patricia V. Vance Professor of Social Work at Florida State University, author, and editor of the Journal of Poetry Therapy. “We’re the new kid on the block [in terms of an organized field]. But it’s catching up,” he says. “We have a code of ethics. 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. The expressive-creative gives a client or group the chance to write, whether it’s poetry or letters. “This is an effective way to cope with spontaneous tragedy,” he says. “There’s a lot of hard research about the health effects of writing—for example, in the writings of James Pennebaker.”

    A third usage is the symbolic-ceremonial, which is connected to the power of ritual or symbols. “If someone is struggling with a loss, that person might write a letter to the person who’s gone,” Mazza explains. “It also works with community tragedies. 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: children, the elderly, hospice and hospital patients, the homeless, and survivors of sexual assault.

    “It doesn’t work with all people and all situations,” he says. “And as Jerome Frank, the social psychologist, said, anything that has the power to heal has the power to harm. 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. With a minor in psychology, she had heard about poetry therapy and “switched gears.” Currently, she is in full-time private practice.

    “I do a lot of writing intervention in bereavement,” she says. “If a person didn’t have a chance to say good-bye, I encourage writing a letter. We also use scrapbooks of photos and memories. The first year is hard, especially around the holidays.”

    Previously, Scherlong did therapy with kids 4-21 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. The kids would write about themselves but not as themselves, which was “less threatening,” she says. “It was fiction, but all about them. Writing helps people feel less vulnerable, but not directly. It’s a third thing to focus on. Poetry is metaphorical; it doesn’t have to be literally true but can use symbolic or vague images.”

    Writing poetry or stories diminishes anxiety and reveals more than talking otherwise might, she adds, “although it’s not quite as revealing [directly] as expository writing.”

    At the end of the poetry groups, Scherlong would help clients put together a “chat book” and a performance—at which they got to read their pieces.

    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. “This can be a catalyst, especially with bereavement, since people have walked that road before,” says Scherlong. “It can decrease a sense of isolation.”

    Poetry therapy can even be effective with people not considered to be very articulate. Early in her career, Scherlong worked with developmentally disabled children who “couldn’t write but could dictate” so she could write, Scherlong recalls. Elderly people with dementia or Alzheimer’s disease can often still tell a “coherent story or fantasy” that has meaning for them, and those with or without memory loss might want to create a memoir.

    “Poetry therapy should match the cognitive and literacy level of the client and meet the person where he or she is—with an eye toward the future,” Scherlong says.

    Alma Rolfs, a clinical social worker of more than 30 years’ duration who is a long-standing member of NAPT, isn’t using poetry therapy separately with her clients. 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.

    Rolfs calls poetry therapy an “absolutely marvelous treatment modality,” combining the strengths of all the creative arts therapies in accessing uncensored material and responding on a deep level without the use of [their] words. “For many people, the words are the really awkward part of treatment,” Rolfs says. “The use of literature and creative writing allows freedom and creativity with language the clients don’t think they have the capacity for. This is both self-esteem-building and life-affirming.”

    In the classic sequence of biblio/poetry therapy, the therapist offers a piece of literature or lyric that stimulates a response and then invites the client’s own “creative act”—writing of one’s own. This can be done in individual practice or in group, although it’s usually more “spontaneous” in the former and requires more planning in a group. “It can be democratizing with groups,” Rolfs says, “in that everyone makes a contribution. It’s been remarkably effective with any of the groups I’ve worked with.”

    With individuals, she adds, you have to fit the technique to a particular type of person. A very intellectually “defended” person may be less responsive in therapy, but a poem may be able to cut through that defense,” she says. “If a poem can cut through, that can be very effective. It’s especially useful in cutting through the sense of inadequacy or intellectual defense.”

    Peggy Heller loved poetry and words as a child. For 16 years, she worked as a tutor/teacher for Stanley Kaplan Educational Services. She had studied speech pathology in college, then trained in biblio/poetry therapy and became a mental health professional. 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. One poem she found to be “sure fire,” even with developmentally disabled kids, is Eve Miriam’s “How To Eat a Poem,” dealing with metaphorical meaning.

    “I used children’s stories the kids could relate to and held up pictures, the way we do with kids in the library,” says Heller, who more recently has been in private practice. “The key is that even minimally verbal people can pay attention even in the moment, and there’s value in it. I trained with the most severely schizophrenic people who had been hospitalized for decades. We created progress in such minute steps.”

    Biblio/poetry therapy can also be effective with older people, who find life review and communication of their values meaningful, she adds. It can help poets and writers during “blank” periods, as well.

    An MSW, Phyllis Klein moved to California to work with an outpatient mental health clinic. She then worked in a variety of nonprofits until starting a private practice in 1990. Most of her experience has been with adults, although she did see children and teens in the early part of her career.

    “I got interested in poetry therapy the way many people do,” she says. “I found myself writing for my own healing and then learned there was a modality that promoted this kind of work professionally. From there I was determined to get credentialed. I had never really studied creative writing or fine arts, so I was unsullied in terms of writing straight from the heart—which is the basic credo of poetry therapy. Poetry therapy is so effective in helping people find and develop their ‘voice.’ ”

    Currently, Klein is working primarily with individuals but also runs groups when there’s interest. Sometimes she brings in a poem for someone, and sometimes she and the client read poems together. They may bring in their own writing or write during the sessions.

    “I have used poetry as a way to help with a grief process, and when this is done collaboratively, it can become a long lasting bond between me and the client,” says Klein, who has written about poetry therapy and its healing power. “Sometimes people keep a journal but don’t bring it in, which is fine. Each person has his own healing path—sometimes to share and sometimes to keep things private.”

    What is important in all settings is that there is no critiquing or editing, Klein points out, so that safety is created and meaningful self-expression can occur. “No arts therapy should make people feel their stuff isn’t good enough. It’s all from the heart and in the moment,” she adds. “People already have an inner critic.”

    Sherry Reiter, who holds an MSW and Ph.D. in social work, had a social worker father and a reading teacher mother. She also had a passion for literature at an early age. “Books were my great love, even at age five,” Reiter says. “Later, writing became a way of claiming my voice. I also loved the theater and was entranced by story, symbol, and creative imagination.”

    Reiter was only 17 when she experienced the power of poetry while volunteering to facilitate writing workshops at a senior center. Twelve senior citizens, 65 through 95, sat in a circle. She asked each person to write a list of word associations to a few selected words and then work on creating a poem or story from those lists.

    Even then, Reiter realized there was something at work beyond creative writing—what she now calls “a sharing of rich emotions and a powerful release of feelings” in the writing circle. Later on, Reiter worked part time as a drama specialist for the New York City Department of Aging as she pursued acting, but she felt more and more drawn to social work.

    She has since worked with children, teens, adults of all ages, “normal” neurotics, psychiatric populations, and individuals with addiction, HIV, cancer, disability, and terminal illness. In the 1970s, she observed Jack Leedy’s practice, in which he gave patients methadone only after they gave him a poem. Reiter taught poetry therapy with Leedy at the New School of Social Research and continues to teach at Hofstra University.

    Reiter wrote Writing Away the Demons: Stories of Creative Coping Through Transformative Writing, which illustrates writing as a tool of psychological survival. The men and women whose stories are featured were able to use their journals instead of reacting with the more usual stress responses of fight, flight, or freeze, she says.

    Reiter is also director of the Creative “Righting” Center, a poetry therapy training center for helping professionals. The title refers to the ability for writing to help us balance or center ourselves. “Writing can be a way of straightening out emotional knots, a way of achieving balance in our lives so that a sense of well-being emerges,” Reiter wrote on her Web site. “When we read, we benefit from poetic medicine.”

    Poetic devices, particularly metaphor, give the writer the freedom to be specific and concrete or as abstract as desired. It’s been called the “79-cent therapist,” because all a patient or client needs is paper and pen. It doesn’t require special materials and a special space. Writing can be done anywhere.

For Your Information

National Federation for Biblio/Poetry Therapy—http://www.nfbpt.com

National Association for Poetry Therapy—http://www.poetrytherapy.org

Nick Mazza—nfmazza@fsu.edu —editor of Journal for Poetry Therapy

Creative Righting—http://users.erols.com/sreiter/

Women's Therapy Services (Phyllis Klein)—http://www.womenstherapyservices.com/articles.html

Barbara Trainin Blank is a freelance writer in Harrisburg, PA.