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Bibliotherapy: A proposed treatment for children coping with divorce

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Anya Stekoll
Abstract:
Divorce has become an increasingly common experience for families in the United States. Psychological literature has found divorce can have a variety of psychological impact on children. This dissertation explores the current literature on divorce trends in the United States, and the specific types of psychological impact divorce can have on children, and the existing treatment interventions for children coping with divorce. Specifically, this project highlights the clinical efficacy of bibliotherapy as being a valuable intervention for improving symptoms associated with children coping with divorce. Ideas for future literature exploring the use of bibliotherapy as an intervention for children coping with divorce are discussed. Lastly, this project introduces a toolkit designed for clinicians who want to use bibliotherapy in their work with children who are coping with divorce. The toolkit includes easy to reference clinical information on the psychological impact children coping with divorce can experience. There is also general information on bibliotherapy, including definitions and stages of treatment. Additional components of the toolkit include structured clinical vignettes with a break down of specific sessions, a list of book recommendations, and a glossary of terms in child friendly language.

TABLE OF CONTENTS

Page

DE DICATION

................................ ................................ ................................ ..................

iv

ACKNOWLEDGME NTS

................................ ................................ ................................

v

CHAPTER

I. INTRODUCTION

................................ ................................ ................................ .........

1

II. LITERATURE REVIEW

................................ ................................ .............................

5

Divorce Prevalence

................................ ................................ ................................ ...........

5

Cultural Issues

................................ ................................ ................................ .............

5

Psychological Impact of Divorce on Children

................................ ................................ ..

8

Cross Cultural Impact

................................ ................................ ................................ ..

8

Social Impact

................................ ................................ ................................ ...............

10

Academic Impact

................................ ................................ ................................ .........

11

Internalizing S ymptoms

................................ ................................ ...............................

13

Externalizing Behaviors

................................ ................................ ...............................

15

Interventions for Children Coping with Divorce

................................ ..............................

16

School Based Interventions ................................ ................................ ..........................

18

Bibliotherapy ................................ ................................ ................................ .....................

21

History of Bibliotherapy

................................ ................................ ..............................

21

Bibliotherapy Defined

................................ ................................ ................................ ..

21

Populations That Have Used Bibliotherapy

................................ ................................ .

22

Limitations

................................ ................................ ................................ ...................

26

Bibliotherapy for Children Coping With Divorce

................................ .......................

27

Bibliotherapy Compared to Other Treatments

................................ .............................

28

III. METHOD

................................ ................................ ................................ ...................

30

Toolkit Development

................................ ................................ ................................ ........

33

Vignette Development

................................ ................................ ................................ ......

35

vii

Book Recommendation Development

................................ ................................ ..............

35

IV. RESULTS

................................ ................................ ................................ ...................

37

V. DISCUSSION

................................ ................................ ................................ ..............

39

REFERENCES

................................ ................................ ................................ .................

41

APPENDICES

................................ ................................ ................................ ..................

48

A.Bibliotherapy Toolkit for Children Coping With Divorce ................................ ............

48

B. Toolkit Feedback Questions for Expert Clinicians

................................ .....................

68

1

CHAPTER I

INTRODUCTION

Divorce has become an increasingly pervasive issue in the United States with 43 - 50% of first marriages ending in divorce (U.S. Census Bureau, 2004). Over the decades rates have steadily increased despite changes to divorce laws in the 1990‟s (Kreider & Simmons, 2003). Given the prevalence of divorce, affecting ne arly half of families in the United States, many children are impacted by divorce each year. In fact, issues stemming from separation or divorce can often become problematic enough in a family or classroom setting for a child to be referred to see a psycho logist. There can be both short term and long - term effects for children of divorce. Though every child handles divorce differently, statistically, they are more likely to have increased anxiety around abandonment, (Hetherington, 1989) as well as social and

academic difficulties (Pehrsson, Allen, Folger, McMillen, Lowe, 2007). Children can present with internalizing or externalizing behaviors when managing their parents‟ divorce, both can be distressful and disruptive for the child and family (Lansford, Malo ne, Castellino, Dodge, Pettit, & Bates, 2006). Not only are the acute symptoms of distress from divorce important to consider when working with this population, but it is also important to note that research supports the notion that principles of developme ntal psychopathology are related to divorce and young children (Leon, 2003). A negative experience, such as divorce, can result in immediate negative outcomes for a child that overtime have the potential to change coping style or self - concept, this in turn

can potentially influence later adaptation (Leon, 2003).

2

Given the above stated scope of the problem and potential serious consequences of divorce on children, interventions have been created to assist children of divorce. These interventions range from social support and therapy, to community and school based interventions. Support from extended family, caregivers and teachers help bolster social and cognitive skills for children of divorce (Leon, 2003). These environmental supports can make a large diff erence in the prognosis of a child of divorce. In addition to environmental supports, therapeutic interventions used by clinicians can have a great impact on a child‟s ability to cope and understand their parents‟ divorce.

Therapeutic interventions used by

clinicians working with children of divorce include: non - directive play therapy, directive play therapy, individual therapy, group therapy, cognitive therapy, behavioral therapy and bibliotherapy. Using an eclectic approach, a therapist can individualize treatment plans to meet the needs of clients presenting with different issues. Among the different therapies used with children, bibliotherapy is a particularly versatile therapy and can be used with children across cultures (Freitag & Ottens, 1999). This dissertation includes a thorough review of literature of current therapies and the benefits of bibliotherapy comparing and contrasting it to the other treatments used with children of divorce.

Given the wide range of children affected by divorce and the p sychological impacts there is a need for multiple resources to help them. Bibliotherapy has been referred to as a neglected resource (Freitag & Ottens, 1999) and with more exposure and research, clinicians can become better informed about what this therapy

has to offer children exp eriencing distress as they deal with

t heir parents‟ divorce. There are several definitions of bibliotherapy, however, the primary focus of this paper will be concerned

3

with this definition: the therapeutic use of books as a means

to provide emotional growth and change by giving alternate perspectives and ideas for thoughts, feelings, and behaviors

(Heath et al., 2005).

Bibliotherapy is

a potentially valuable treatment for children of divorce because it can address specific issues that children of divorce present, such as social and academic difficulties (Leon, 2003) as well as internalizing and externalizing symptoms such as anxiety, depression, and aggression (Lansford, Malone, Castellino, Dodge, Pettit, & Bates, 2006). Though lit erature

supports that clinicians use bibliotherapy in their practices (Adams & Pitre, 2000), it is unclear exactly how widespread bibliotherapy is used and with what populations.

The purpose of this dissertation is to explore the existing literature on th e uses of bibliotherapy and it‟s effectiveness with children of divorce. I have investigated the specific needs of children of divorce and the issues they present when coming to therapy. I have also consulted the literature to explore the appropriateness a nd effectiveness of bibliotherapy for this population. Lastly, I have looked at cultural components of bibliotherapy being used across populations and its generalizability, as well as other issues that are important to take into consideration.

The dissert ation is a comprehensive literature review, a compilation of existing literature on the use of bibliotherapy for children of divorce. The primary focus is on the key issues children of divorce face and how the main components of bibliotherapy can address t hese issues. Additionally, as I explore existing literature specific to bibliotherapy, I note areas that are lacking and suggest topics of focus for future research. Lastly, I hope clinicians will be able to utilize the information provided in this dissert ation, and become well - informed and knowledgeable about the clinical utility of

4

bibliotherapy and its implications for use with children of divorce. To augment the value of this dissertation for clinical purposes, I have created a clinicians toolkit. I hop e clinicians will refer to this source of information, should they decide they want to incorporate bibliotherapy in their practice.

5

CHAPTER II

LITERATURE REVIEW

Divorce Prevalence

Divorce has become common in the United States with currently 41% of first

marriages ending in divorce. These statistics increase up to 60 - 73% when looking at second and third marriages. Many children are impacted by parental divorce, with 40% of couples who divorce having children ( “ Divorce

statistics” ,

n. d. ). Nationally, 60% of people under poverty guidelines are divorced women and children suggesting financial vulnerability and potentially less access to services for many children in divorced homes ( Melamed , n. d. ).

Cultur al Issues

Divorce rates vary among age, race and ethnic backgrounds. In general, African Americans have slightly higher rates of divorce compared to Caucasian Americans, however, African and Caucasian Americans‟ divorce rates are higher than those of popul ations from other backgrounds including Latino and Asian heritage ( Clarke, 1995 ). Specifically, the National Survey of Family Growth found that after the first 15 years of marriage 42% of Caucasian and Latino marriages end in divorce while 55% of African A mericans do

(Amato, 2010). These numbers indicate the possibility that cultural views of marriage and family may explain the differences in divorce rates among people from different races and cultures. Within the Latino groups divorce rates vary for instan ce Cubans and Puerto Ricans are more likely to divorce than Mexican Americans and Central Americans (Amato, 2010).

6

As previously mentioned, research suggests certain populations may be more vulnerable to divorce than others. In thinking about the specific

issues that contribute to increased vulnerability of divorce with African American families, we must consider the historical, economic, structural, and cultural factors that play a role (Amato, 2010.) These factors are complex, and future research is ne eded to clarify the specifics in how exactly these issues increase vulnerability (Amato, 2010.) Additionally, contextual factors such as immigration status play a role in certain populations being more vulnerable to divorce. Research has found Mexican Amer icans born outside of the United States have significantly lower divorce rates than their counterparts born in the United States (Amato, 2010.) Again, historical, economic and structural factors along with cultural values explain these differences in rates

of divorce however, research has yet to further define how marriages are specifically affected.

As men and women age, they are less likely to divorce. Couples married in the 20 - 24 age range have the highest rates of divorce ( “Divorce statistics”, n. d. ).

Level of education is another strong indicator of risk for divorce. While couples with college educations tend to have more stable marriages, couples with less education tend to have higher divorce rates (Amato, 2010). In addition to cultural aspects, ag e at time of marriage, and level of education, research has found other factors as increasing level of risk for divorce. Among these factors include unemployment, living with a partner prior to marriage, having child out of wedlock, blending a family, bein g in a second or higher order marriage, and growing up in a household without two continuously married parents (Amato, 2010). It is important to note, though these factors may be predictors of divorce, they are not causes of divorce (Amato, 2010).

7

Aside from often causing distress and disruption for children, the economic consequences of divorce in government expenditures is significant and must be taken into consideration when looking at the overall impact divorce has not only on individual families but society as a whole. Costs vary depending on states, however in 2001 the 9,735 divorces that occurred in the state of Utah cost the state and federal government roughly $300 million dollars. (Schramm, 2006). Divorce is estimated to cost the United States ro ughly 33.3 billion dollars annually (Schramm, 2006). These costs to state and federal governments are based on a variety of adjustments for individuals managing divorce. The adult factors contributing raising government costs include increased use of food stamps, public housing, and increased bankruptcies (Whitehead & Popenoe, 2004) while children coping with divorce can increase government costs with factors such as juvenile delinquency (Whitehead & Popenoe, 2004).

Given the multiple factors contributing to divorce costs and the cultural considerations discussed regarding divorce rates, bibliotherapy is a cost effective, successful treatment intervention and will be further discussed in the Bibliotherapy

portion of this dissertation. In using any treatment

intervention it is essential to understand the variations of how children and families cope with divorce across cultures. Understanding these differences is crucial in developing and using culturally appropriate therapeutic interventions. For instance, in

the context of using bibliotherapy, when choosing a book to use therapeutically with a client from a diverse background, it is important to consider how the divorce is handled in the story and if it is aligned with the family‟s cultural values. Given cul tural variations, specific therapeutic interventions may be more culturally appropriate to use with certain populations than others. In these

8

instances certain treatment interventions (for example: bibliotherapy) may not be the culturally ideal treatment, or may need to be modified to agree with cultural values.

Psychological Impact of Divorce on Children

At this point the literature is inconclusive about the true psychological impact divorce has on the well being of children (Amato & Keith, 1991) but there

is strong evidence to suggest children can be affected socially, academically, and in internalizing and externalizing ways both in the short and long term. Additionally, the negative impacts divorce can potentially have on children have been found to occu r across cultures.

Among the

other

psychological issues children coping with divorce can present with an increased sensitivity to peer ridicule, self - blame, fear of abandonment, avoidance, and an irrational hope of parental reunification. The psychological

impact of young children coping with divorce

often manifests as irrational beliefs, anxiety, and/or depression (DeLucia - Waack & Gelman, 2007). Additionally, social and academic difficulties are often present with children experiencing parental divorce and

depending on the child, behaviors manifested from these symptoms are either internalized or externalized.

Cross Cultural Impact

Psychological impacts of divorce on children seem to be universal across cultures. In China children of divorce were found to be more susceptible to mental illness, problem behaviors, specific personality traits (both introversive and extroversive) negative self - cognitions, lower academic performance, and higher instances of crime rate and suicidal ideation (Xiaosong, G., Xiaojie , Z., & Xiangkui, Z, 2007). Though these findings suggest divorce can increase suicidal ideation in Chinese youth, an alternative study conducted in

9

China found divorce was not a contributing risk factor in youth suicide attempts (Wan & Leung, 2010). Wan a nd Leung explored the following factors: history of physical abuse, parental divorce/separation, family relationship, psychological diagnosis, environmental stressors, and presence of suicidal ideation as being risk factors in adolescent suicide attempts a nd found parental divorce and separation

were

not risk factors contributing to youth suicide attempts in Hong Kong (Wan & Leung, 2010), Though Wan and Leung found divorce and separation did not increase risk in youth suicide attempts, the findings from Xia osong, Xiaojie, and Xiangkui suggest further research is needed to confirm what impact parental divorce has on suicidal ideation and attempts in Chinese youth.

A study conducted in Norway had similar findings to the Xiaosong, Xiaojie, Xiangkui study in Ch ina. This Norwegian study measured the prevalence of bullying and aggressive behavior among adolescents and found that both bullied students and students exhibiting aggressive behavior had significantly higher scores in the youth self - report scales, higher

depressive symptoms scores, and more often had divorced parents than noninvolved students (Undheim & Sund, 2010).

Taking these cultural considerations into account when creating the book recommendation list for the toolkit, I discovered an evident dearth

of books published through Magination Press with characters from culturally diverse backgrounds. Some of the books written for younger children had animals such as bears and dinosaurs as the characters, which could be open to cultural interpretation howev er, all of the books published though Magination Press written for older children were lacking characters from culturally diverse backgrounds. Given the universality of psychological impact on

10

children coping with divorce across cultures, it is vital stor ies with characters from diverse backgrounds are created and accessible to clinicians to use in treatment.

Social Impact

According to the literature, age and gender play a factor in a child‟s risk of experiencing social issues after parental divorce. Kli ewer and Sandler examined 117 school - age children of divorce, administering the Children‟s Coping Strategies Checklist to the children, as well as the Revised Social Maturity Scale for Children and the Children‟s Depression Inventory given to their teacher s. The assessment given to the children measured active coping, avoidance, distraction, and support seeking. The assessments given to teachers measured social competence, emotional expressiveness, passive coping, physical release of emotions, active coping , and depressive symptoms. According to Kliewer and Sandler‟s findings, older children and girls tend to be more socially competent and able to cope amidst divorce. The authors did not provide a reason to account for the age and gender differences. Interes tingly, children whose

teachers identified them as having strong social competence and coping skills did not disclose having these skills in their self - report assessments. This may mean the child‟s internal experience was quite different than what the teac hers‟ were observing or they may have low self - esteem and be selling themselves short. Additionally, children with avoidant coping styles, who isolated and were not deemed “socially competent” had higher levels of depressive symptoms (Kliewer & Sandler, 19 93). The findings of this study are important in considering possible developmental and gender differences in how children cope with divorce. In thinking about bibliotherapy this may mean tailoring books to younger, older, female or male children.

Addition ally, given the findings regarding

11

children who experience high levels of depressive symptoms tending to have more avoidant coping styles and having social difficulties, it may be helpful for children to promote social interactions and build social skills by assigning books with these themes.

Sun and Li conducted a longitudinal study looking at social well - being and academic performance comparing adolescents whose parents inevitably divorce to adolescents whose parents remain married. With regards to socia l well being, Sun and Li discovered a U - shaped pattern with adolescents whose parents divorced. That is, these adolescents experienced a decline in social well - being as their parents divorced however, ultimately improved as they adjusted to their family‟s divorce. These findings indicate a adolescent‟s may have a more developed ability to adjust socially after coping with divorce compared to younger children‟s social adjustment.

Academic Impact

Literature suggests a divorce occurring in middle school or h igh school is more likely to affect a child‟s academic performance

(Lansford et al., 2006). A possible reason for this is may be related to the divorce occurring when grading standards become more stringent in middle school and high school (Lansford et al , 2006). Lansford et al. conducted a longitudinal study on 194 families, interviewing their mothers the summer before children started kindergarten and each subsequent year through 10 th

grade. Each year the mothers were asked if they had divorced or separa ted in the past 12 months, and children‟s teachers completed the Teacher Report Form of the Child Behavior Checklist for children in Kindergarten through 8 th

grade. This study found that older children coping with divorce have a higher risk of academic dif ficulties (Lansford et al., 2006). The rationale presented for this finding suggested family conflict coinciding with grade

12

level‟s increased standards, coupled with declines in parental support, and less parental monitoring could account for the decline i n academic performance (Lansford et al., 2006).

Lansford et al.‟s findings suggest that different interventions be targeted for different symptoms depending on a child‟s age when a divorce occurs. For instance, interventions for adolescent children of div orce should be focused more on academic mentoring or tutoring (i.e. academic achievement) rather than social, internalizing, or externalizing behaviors, since low academic performance is more common among adolescent children of divorce (Lansford et al., 20 06.) Lansford et al‟s findings are congruent with a study Sun and Li conducted that looked at longitudinal social and academic differences in adolescents coping with divorce compared to adolescents with continuously married parents. They found that adolesc ents whose parents got divorced had lower test scores 1 year before the divorce, 1 year after the divorce, and 3 years after the divorce compared to adolescents whose parents remained married (Sun and Li, 2002). Lansford et al. suggest that changes in pare nts‟ behavior such as lack of general parental support and less parental monitoring post divorce may contribute to trends in poor academic performance.

In contrast to lowered academic performance, both internalizing and externalizing problems were more li kely to occur when parental divorce was initiated at a younger age for the child. Reasons for this may be related to the child being less able to realistically assess the causes and consequences of the divorce, feel anxiety around abandonment, blame themse lves, and be less able to use outside resources (Lansford et al, 2006). Taking into consideration a child‟s age at the time of their parents‟ divorce and the

13

differences in symptoms children can experience, treatment interventions should look different dep ending on the age of the child they are designed for. In terms of bibliotherapy, books should be tailored to children of specific ages. When creating the toolkit for clinicians, the books recommendations chosen for older children generally focus on social

issues and academic performance while the books for younger children tend to focus on problems around guilt and anxiety.

Internalizing Symptoms

The literature suggests there are multiple factors that may increase a child‟s likelihood of developing intern alized problems when experiencing parental divorce (Simons, Lin, Gordon, Conger & Lorenz, 1999). Specifically, age and gender are two factors that can determine the likelihood of with what particular types of symptoms a child may present. More specifically , the literature supports that the younger a child is when their parents divorce, the more likely they are at risk for internalizing problems such as anxiety and depression rather than other problems, such as, poor academic achievement (Lansford et al., 20 06). Younger children are often unable to assess the cause of their parents‟ divorce, as a result, some of the internalized symptoms they can experience include increased levels of anxiety with regard to abandonment and blaming themselves for the demise of

their parents‟ marriage (Hetherington, 1989). Another common occurrence in young children experiencing parental divorce is the presence of irrational beliefs, such as, causing the parents to divorce or the belief their parents will reunite (DeLucia - Waack & Gellman, 2007).

In addition to age being a factor in the likelihood of a child developing internalized symptoms, gender of a child has also been found to be related to the

14

likelihood a child can develop internalized symptoms. Simons et al. (1999) intervi ewed 407 families involved in the Iowa Single Parent Project and Iowa Youth and Families Project. The families were visited twice in their homes, completed questionnaires and had behavioral exchanges videotaped that were later coded. Each family had either

male or female seventh - grade students. The authors found three factors that can increase risk for boys developing internalized problems. These factors include: pre - divorce parental conflict, mother‟s depression, and low quality parenting by mother. They a ttributed to depression in girls being a result the mother having depression, and in turn, having lowered parenting quality. Another finding from this study was girls having an increased risk of antisocial behavior when post divorce conflict occurred in th e family. The authors suggest antisocial behavior may be a way of expressing emotional distress caused by parental conflict. Also, parental fighting and extreme conflict may serve as model behavior for the child (Simons et al, 1999). Though boys seemed to be greater affected by parenting quality and girls by conflict between parents, this study suggests the overall psychological impact of divorce can impair a parents functioning which in turn can create depression in children of both genders.

Somatic compla ints can co - occur with children experiencing internalized issues such as depression and anxiety. In 1999 Pedro - Carroll, Sutton, and Wyman conducted a preventative intervention named Children of Divorce Intervention Program (CODIP) for school - age children o f divorce. The CODIP used group support and social competence enhancement in their 12 - session intervention with 102 kindergarten and first - grade students. In addition to the CODIP, measures used by teachers and parents included Teacher - Child Rating Scale, Parent Evaluation Form, Children‟s Family Adjustment

15

Scale, State - Trait Anxiety Inventory for Children, and a parent interview. The children were followed for two years after the intervention and parents were interviewed to determine the program‟s effects overtime. The child‟s emotional adaptation was the primary effect being measured. The program was helpful because children who were involved in the intervention showed significantly greater gains of emotional adaptation (Pedro - Carroll, Sutton & Wyman, 1999 ). This study found children of divorce visited the school nurse more frequently with vague and generalized complaints compared to a group of children who were enrolled in a program intervention. It is possible these physical complaints children were repor ting to nurses were manifestations of internalized disorders stemming from parental divorce, such as anxiety or depression.

Externalizing Behaviors

As previously mentioned, there is an increased risk of poor academic achievement for adolescent children o f divorce. Externalizing behaviors are also a risk, the literature suggests increased levels of substance use and antisocial behavior being present with this age group as well (Neher & Short, 1998). Neher and Short conducted a study of 136 sixth and sevent h grade students from two public schools. The students and their parents completed separate questionnaires. This questionnaire measured for at substance using friends and family members, coping behaviors, social skills, antisocial behavior, and substance u se. From the questionnaires, the authors found children of divorced parents disclosed more substance use and antisocial behavior than did the children of married parents reported (Neher & Short, 1998). Neher and Short suggest the increased substance use an d antisocial behavior being related by children of divorce was a result of them having more substance using friends and less coping and social skills. The authors also

Full document contains 78 pages
Abstract: Divorce has become an increasingly common experience for families in the United States. Psychological literature has found divorce can have a variety of psychological impact on children. This dissertation explores the current literature on divorce trends in the United States, and the specific types of psychological impact divorce can have on children, and the existing treatment interventions for children coping with divorce. Specifically, this project highlights the clinical efficacy of bibliotherapy as being a valuable intervention for improving symptoms associated with children coping with divorce. Ideas for future literature exploring the use of bibliotherapy as an intervention for children coping with divorce are discussed. Lastly, this project introduces a toolkit designed for clinicians who want to use bibliotherapy in their work with children who are coping with divorce. The toolkit includes easy to reference clinical information on the psychological impact children coping with divorce can experience. There is also general information on bibliotherapy, including definitions and stages of treatment. Additional components of the toolkit include structured clinical vignettes with a break down of specific sessions, a list of book recommendations, and a glossary of terms in child friendly language.