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Using picture books in therapy with children.

There are so many wonderful picture books that can be incorporated into therapy. Many children enjoy books and the experience of being read to can often feel nurturing. Books also have a normalising value: their existence implies that other children have experienced similar difficulties and helps the child to feel less alone in their experience. What follows are some tips for using books well in therapy.

Choosing the right book is essential when using books in therapy. You need a book that fits from a developmental point of view, that resonates with the child’s experiences and that provides consistent messages to those you have been providing in therapy. Knowing the book well is essential in this regard and for this reason I often suggest that clinicians have a handful of books they use rather than a whole bookshelf they know less well.

Sometimes therapeutic picture books cover a whole range of materials and can be quite detailed. As therapists we need to consider what we need to focus on with the child at the time, being mindful that there is only so much they can take in at one time. Slowing down and really exploring the section or point that you see as most relevant to the child is essential. This might mean spending considerably more time on one or two pages or even not reading the book in its entirety. It also enables us to come back to different parts of the book later in therapy if this is appropriate and if the child is interested in doing so.

At times children will define the focus for you. For example, if you are using a book to explore worries in the assessment stage noticing what a child focuses on can tell you a lot about the content of their worry and how they experience this. As therapy draws to an end and you are wrapping up with children you might read a book and encourage them to notice what fits with their own story or reflecting on any of the strategies in the book they’ve found particularly helpful.

Checking in with children repeatedly as we read is essential. Providing lots of time for children to reflect and notice whether or not they experience something similar not only provides a wealth of clinical information but also ensures that the child is able to relate to the book. Slowing down, providing examples, and encouraging the child to reflect on any similar experiences they might have had allows us to personalise this.

A book is a great starting point for therapeutic play. Enacting parts of the book or using it as a base for a craft activities allows children to engage with the material covered in the book in a really active way. It allows them to better integrate what they have learnt from the book and supports them to generalise this to their day to day life. Figures, puppets and animals all provide ways of making the story more real and exploring a part of the story in play provides another important opportunity for repetition, thereby supporting a child’s learning. Children may be happy to simply act out the story using toys and having toys that link with the story is often appealing and creates another chance for conversation. Karen Treisman for example has a lovely set of workbooks with associated stuffed toys.

If you are looking for further ideas however you could try introducing a character who has a similar experience to the one featured in the book and asking the child to think about what the character in the book might say to this new character. Alternatively you can try suggesting that you turn the story into a movie or a play and use toys to act it out, videoing it while you do so. Using dress ups and props can also be lots of fun. You can have the child dress up as a character from the book and encouraging the child when they are dressed up to think about a few things the character might say or do.

Making something from a book is one of the easiest ways of bringing it to life for children and has the advantage of allowing them to take it home. Being able to take something home symbolises the taking of the learning from the therapy room into their day to day life and provides opportunities for repetition and sharing the learning with the family. While it is not always practical to let a child take a book home taking home something they have created often works really well. Many books include something that you can readily make using materials you are likely to have in your clinic room. For example, The Huge Bag of Worries, is a wonderful book that lends itself well to creating a big bag of worries. Use a paper bag and have the child draw some worries to put in it, naming their worries as they do so. Visiting Feelings, another favourite book of mine, provides an opportunity to create a door out of cardboard and talk with children about what feelings might be visiting them. The narrative also explores the size, colour and shape of different feelings so having a child mould their different feelings from coloured dough can work well too.

Picture books can be a terrific resource for therapy with children. As with all activities and materials we use however, we need to keep the individual child in mind and use books in a purposeful manner, being conscious of the learning styles and providing opportunities for repetition and generalisation.

Dr Fiona Zandt
Clinical Psychologist

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