Poetry Therapy and the Elderly:

Poetry Therapy and the Elderly: Literature Review Only

Today, an increasing number of healthcare practitioners of all types have found poetry therapy to be an effective treatment intervention with the elderly by helping them express themselves and identify inner feelings that may otherwise go unexpressed. As one clinician reports, "Poetry is a popular form of written expression used in counseling. Developmental tasks and interpersonal struggles often project the angst of the universality of life's struggles" (Thompson, 2003, p. 130). Besides the elderly, poetry therapy has also been used to good effect with children as well as with poor and oppressed populations (Furman, Langer & Anderson, 2003). Furthermore, the elderly have benefited from poetry therapy in different clinical settings, including hospices and medical facilities (Furman et al.). The beneficial effects of poetry therapy also extend to helping practitioners themselves become more empathetic and reflective (Furman et al.). In addition, poetry therapy can be used with a broad range of applications with people of all ages and is typically employed to promote health and maintenance; such techniques have also been used to good effect with individuals receiving treatment for conditions such as heart disease, cancer, and substance abuse (Thompson, 2003). According to Thompson, poetry therapy has also been found to be effective in the treatment of military veterans, adolescents, learning disabled patients, dysfunctional families, inmates undergoing rehabilitation, the physically challenged, and survivors of violence, abuse, instances of incest as well as the elderly. As this author points out, "The literature and case studies provide evidence that poetry therapy is an effective and powerful tool with many different populations" (Thompson, p. 128).

While everyone is unique and will experience poetry differently, there are some common features concerning how poetry therapy functions that can help explain its efficacy. In this regard, Bolton and Kingsley (1999) advise that, "Poetry is therapy and is part and parcel of normal development. Poetry therapy is a newcomer. Long before there were therapists there were poets, and from time immemorial man has struggled to cope with his inevitable inner turmoil" (emphasis added) (p. 103). This author also suggests that poetry therapy operates by helping to codify these conflicting emotions in ways that can help identify issues that contribute to such "inner turmoil" and make them more amenable to resolution (Bolton). For instance, Bolton emphasizes that, "Once crystallized into words, all engulfing feelings become manageable, and once challenged into explicitness, the burden of incommunicable becomes less heavy" (p. 103).

According to Thompson (2003), the terms "poetry therapy" and "bibliotherapy" are frequently used interchangeably to describe the intentional use of poetry and other types of literature to promote healing and personal growth. This clinical approach can also be divided into two types: (a) developmental interactive and (b) clinical interactive (Thompson). In this regard, Thompson notes that, "Developmental interactive bibliotherapy refers to the use of literature, discussion, and creative writing with children in schools and hospitals, with adults in growth and support groups, and with older persons in senior centers and nursing homes. In these community settings, bibliotherapy is used not only to foster growth and development, but also as a preventive tool in mental health" (Thompson, p. 128). By contrast, the term "clinical interactive bibliotherapy" is used to describe the use of discussion, literature, and creative writing techniques in an effort to promote healing and growth in psychiatric units, community mental health centers, and chemical dependency units (Thompson).

The general goals of poetry therapy include the following:

To develop accuracy and understanding in perceiving self and others.

To develop creativity, self-expression, and greater self-esteem.

To strengthen interpersonal skills and communication skills.

To ventilate overpowering emotions and release tension.

To find new meaning through new ideas, insights, and information.

To promote change and increase coping skills and adaptive functions.

The therapeutic use of poetry involves a mutual exchange comprised of three fundamental parts: (a) the literature, (b) the therapist, and - the client(s) (Thompson). According to this clinician, "The therapist selects a poem or other form of written or spoken media to serve as a catalyst and to evoke emotion, feelings, and the identification of certain themes for discussion. The interactive process helps the client to develop and grow on emotional, cognitive, and social levels. The focus on the client's reaction to the literature promotes psychological health and well-being" (Thompson, p. 129). The selection of the poem to be used in poetry therapy is also an important consideration because it will serve as the general framework in which the intervention can proceed. Therefore, therapists should select poems that are conducive to promoting a "gentle, nonthreatening atmosphere where clients feel safe and are invited to share feelings openly and honestly. The therapist chooses literature that will be effective therapeutically" (p. 129).

Over time, Hynes and Wedl (1990) report that four stages typically develop that characterize the interactive process of working with poetry and other forms of literature and the elderly:

Recognition: Clients must be able to recognize and identify with the selection.

Examination: Clients explore specific details with the assistance of the therapist.

Juxtaposition: This process explores the significant interplay between contrasts and comparisons in poetry and literature. Comparing or looking at an experience from a directly opposite point-of-view can provide an awareness that may become the basis for wise choices in attitude, behavior, and decision-making.

Application to self: Clients make the connection between the individual and the literature, and apply the new knowledge to their selves in the real world. At the end of the session, the therapist provides closure to deal with unfinished business, and help participants to integrate what has been learned. The process of reading and writing serves as a significant catalyst for self-integration (Hynes & Wedl, 1990).

The functional aspect of poetry therapy is to help codify an individual's inner thoughts, emotions and feelings in ways that help bring them out of the mind's shadow into the light of the real world where they can be acted upon (Thompson). By capturing these otherwise intangible thoughts and emotions on paper, the clinician and client alike will have a tangible focus for the therapeutic intervention (Thompson). According to this author, "Poetry therapy and bibliotherapy intentionally use of the written word to further therapeutic goals and enhance the well-being of individuals and groups through the integration of emotional, cognitive, and social aspects of self" (Thompson, p. 129). While some authorities suggest that more research needs to be conducted to provide more empirical results concerning its efficacy, Thompson emphasizes that the jury is already in one this one and poetry therapy represents a viable treatment modality: "Poetry therapy is a recognized modality employing poetry and other forms of literature to achieve therapeutic goals and personal growth. The goals are to promote understanding of the self and the individual in society, to accept and change feelings and behavior, and to enhance mental and social wellness" (Thompson, p. 129).

In those cases where the elderly may have physical problems with writing, Bolton, Field and Thompson recommend having the therapist or another designated "scribe" record the spoken poetry lines for later review and analysis. In addition, more than one elder can contribute to a "group poem" in this fashion. According to Bolton and his colleagues (2006), "Asking people to contribute lines or images whilst the facilitator scribes is a way of introducing poetry to people who may have difficulty with the physical act of writing itself. I have used this technique with the elderly. There is often a great sense of pride in a group poem which can be greater than the sum of its part" (p. 98).