Book Review: Literature and Therapy: A Systemic View

Liz Burns is a family therapist and trainer. This book followed from her PhD research completed in 2003. Although short it is dense with references and backed up by extensive experience and research. It will be a valuable read for anyone working with groups, not necessarily just for family therapy, and therefore a useful addition to the reading list for group therapy training as well as for group therapists already in practice.

Burns' proposition is that literary resources may 'complement and enrich therapeutic approaches and augment the available range of personal skills and therapeutic techniques' (p113). In other words, we can expand our therapeutic repertoire by use of literature. Her case stories, which she calls vignettes, include personal development groups as well as family therapy examples. These illustrate the potential for its use as a resource in training and professional development.

I found it an accessible and enjoyable read with the two caveats that (a) I am already convinced of the value of literature as a resource in life as well as for pleasure and (b) I was familiar with most of the examples (literary novels and poems by people like Virginia Woolf, the Brontë sisters, T S Eliot, Ezra Pound) and therefore already in my comfort zone. My concern being that not everyone feels this way. I had a professional female client who described being made to read Jane Austen at school as 'traumatic'. Her reading preferences were for technical manuals of various sorts.

Burns deals with this by suggesting that the definition of literature is expanded beyond novels and poetry to encompass song, art, images, TV and film. Where clients are encouraged to bring a picture, an object, a lyric, an incident or a story they feel connected to. Any of these can, through group discussion, 'give access to an imaginative world in which new possibilities are revealed and/or generated' (p81). Burns' aim is to let clients find their own focus for discussion in a medium of their choice.

Widening the definition of literature could be stretched to the point where we are exploring whatever is important to the client, which is what we would do anyway as existential psychotherapists. My 'non-literary' client brought her tapestries and art work to our sessions, and we also explored her world through her involvement in amateur dramatics. Maybe this proves Burn's point. Literature can be a wide tent and if it works, does it matter what we call it?

Her vignettes illustrate how group members can take it in turns to describe an item of literature (an extract from a book, a poem, a play, a TV show etc) and their feelings about it. The group then discuss and expand what is offered, and she describes very well how this can support group work. Witnessing and sharing each others' engagement with the 'literature' is how, for Burns, group participants gain from the therapy. Using literature to facilitate telling their story to others, particularly where it contains difficult material, can in turn help the person understand it better themselves.

Group sharing is central to her approach. So its usefulness in one-to-one therapy is less certain, to my mind. To suggest a book to a client, which Burns describes doing in her group work, can be problematic in individual therapy. Clients can hear it as homework and feel obliged to read the book, and if they do read it, they may not like it or find it accessible, and could feel humiliated about this. I prefer to ask what the client likes doing rather than risk imposing my literary choices.

Nonetheless Burns does give an example of suggesting a book in individual therapy which turns out well. The client is caught up in recurring melodrama with unsuitable men and Burns suggests reading Wuthering Heights. Some time later the client reported having found the book annoying, with its over the top dramatic stuff. 'What nonsense! Anyway, for some reason I'm feeling a lot better about myself' (p36). So literature can both provide a mirror for current preoccupations and inspiration to change. This inspires me to take more chances with literary suggestions in future. Provocation can be effective.

Overall I found the book useful for prompting ideas for my own personal and professional development. As Burns puts it, the reading becomes part of the 'self' I use as a therapeutic tool, and learning from literature combines both head and heart (p118). She says reading and therapy are mutually illuminating. Books can give insights about client work and vice versa, and I have found this too. For example Iris Murdoch's An Accidental Man describes a way of being I've met several times in my work. Recognising this gives me a way to think about the client's situation, and I might not have recognised the truth contained in the novel had I not encountered clients who live this way.

Burns also explores how writing itself is a powerful therapeutic technique. She invokes Virginia Woolf saying she had done her own psycho-analysis by expressing deeply felt emotions, and in the process 'explained it and then laid it to rest' (p104), writing being another form of sharing.

Literature can put us in touch with what it is like to be in a particular predicament. Poetry can be especially powerful in that it can express what is hard to say in any other format, and may conjure an image that 'speaks directly to the depths of our being. Thinking…comes next' (p47). Burns uses the example of Ezra Pound's two line poem 'In a Station of the Metro': 'The apparition of these faces in the crowd; Petals on a wet, black bough.' (p46), a snapshot where the impact and its meaning will be unique for every participant. Exploration of each person's experience of existence can proceed from this along with development of empathy. As Burns says, literature is a tool for developing a fundamental social skill, to imagine and

empathise with what it is to be another person. What strikes me is how Burns makes clear that literature can reach us in a way that abstractions and theories cannot. Narrative touches the feeling as well as the thinking brain.

The book is comprehensive in its scope yet succinct in its presentation. It covers group work and individual therapy, and draws on a broad range of literature including poetry, drama, novels, song, and visual art. It also explores the therapeutic use of writing. Her research and practice base gives her considerable authority.

There is a chapter devoted to psychodynamic and systemic thinking in relation to literature work. The author is able to move flexibly between these frameworks. There is also discussion of how to use literature as a training tool for therapists, which I found particularly useful. Her case vignettes are a real strength, as they illustrate very concretely how literature can be used therapeutically.

If there is a limitation it would be that some of the more challenging philosophical and theoretical ideas could be developed further. For instance, the existential framework could be more thoroughly explored. A chapter on ethical dilemmas arising from literary work might have been useful. But these are minor points.

The book will be of interest and value to family therapists and group workers. It will also appeal to individual therapists wishing to expand their therapeutic repertoire. It offers a creative and relatively accessible way of thinking about how we can harness the power of literature and the imagination in our therapeutic work. I would recommend it to anyone engaged in therapeutic training or practice.

Diana Pringle