Fiction as Therapy

Source: NHE March/April 2019

Elaine Bousfield of ZunTold Publishing – a press specialising in fiction for children and young people – discusses ‘Fiction as Therapy’, and how it can be used as a therapeutic tool for young people.

Helping children and young people to understand themselves and their experiences is something that has long been connected with novels and poetry. Fictional stories allow for escape and exploration of the imagination, whilst equally shining a light on darker aspects. This concept is not a new one: for example, through his fantasy novels, Tolkien drew from his own experience in the trenches, illuminating these unseen worlds. Indeed, fantasy fiction was used with traumatised adolescents by Dr James Giannini, where traditional talking therapies were inaccessible with patients.

On a personal level, I can most connect with the concept of Fiction as Therapy when I think back to the loss of my father. Despite working in the sphere of mental health for over 30 years as a therapist, and developing counselling and support services for young people with XenZone over the last 20 years, the most poignant confrontation of my own emotions was through fiction. A children’s novel, in fact. ‘A Monster Calls’ by Patrick Ness encapsulated everything I had not yet processed about my loss, helping me to accept it and understand it.

In 2017 I launched ZunTold, a press committed to working with writers to develop fiction for children and young people – with therapeutic change in mind. As part of a Fiction as Therapy initiative, we are hoping to create a stable of creative resources and fiction that can be used by children and young adults, and those who work with them, as part of their learning and therapeutic support.

Drawing from the author Samuel Pollen’s own experience of anorexia at 12-years-old, the first novel in ZunTold’s Fiction as Therapy stable will be ‘The Year I Didn’t Eat.’ When I talked to Samuel about why he believes fiction’s therapeutic role is so important, he said: “Looking beyond the disease. Fiction that is relatable and doesn’t just belong to one person. Complexity and nuance. For me, these are just some of the reasons why Fiction as Therapy is so important.

“We hear stories about mental health on a daily basis. But it can be hard to see the individuals behind the numbers – different people, with different symptoms, and different situations.

“‘The Year I Didn’t Eat’ is a story that I wish I’d had when I was 12 and in the period of my illness. Reading it may have helped me to understand that I wasn’t alone and may have helped others to understand too. The act of writing was a catharsis – it helped me to look beyond my own experience and imagine it through someone else’s eyes.

“When I was anorexic, I felt utterly alone. The stories I found centred on teenage girls – I couldn’t relate to them.

“This is why I think fiction is such a powerful tool when it comes to the treatment of mental health. Fiction as Therapy will help us to feel less alone, look beyond the disease, and give us more understanding.”

The evidence around the effectiveness of bibliotherapy is mounting. Various studies into the treatment of social phobia, for example, have shown that groups with access to appropriate fiction and non-fiction can make clinically significant improvements, compared to those without it. Psychological therapist Ros Rheinberg agrees, saying:  “For those working with young people with an eating disorder, they may find using fiction as part of the work will enable their clients to access insights beyond what is discussed.

“Talking about issues and externalising them through the eyes of a fictional character may allow the therapist to work with projection. Going on a journey with a character and learning from the world the characters inhabit can allow the reader to feel the changes made and learn from them. It gives readers an agency for change, for experimentation and discovery.

“Therapists can use this in their work with children and young people, and indeed the readers themselves can access it either alongside or independently of their adult supporters.

“When I read ‘The Year I Didn’t Eat,’ the thing I was struck by is how anorexia, this complex, contradictory illness, had been rendered more understandable. Laced with humour, touching commentary, and uncompromising honesty, this book is an example of how powerful Fiction as Therapy can be.

“For anyone who knows a loved one with anorexia, this book would strike a chord. Particularly relevant today, with the increasing numbers of boys and men who are diagnosed with eating disorders, the author provides no definitive answers. There is no magical solution when it comes to recovery, but the story is essentially full of hope.

“The insight into the thoughts and feelings of a lived experience of anorexia would make this book highly relevant to health professionals working with those with eating disorders, particularly adolescents.”

In a school setting, fiction can also be an invaluable resource, and can be a great tool for encouraging and guiding peer-to-peer conversations. Mental health is being spoken about more than ever in schools, and the right books can help to steer the conversation.

Emma Suffield, school librarian of the year 2018, commented: “Raising awareness, battling prejudice, and providing support. These are all ways in which therapeutic fiction can help. For example, the LGBTQ+ section in my own school’s library is something that pupils really respond to.

“‘The Year I Didn’t Eat’ was incredibly thought-provoking for me. It shows how fiction can be a positive tool, especially when young people are exploring their own stories. Authors like Sam are so important – he is raising the profile of boys’ mental health, and by sharing his own story, he will make it easier for young people to come to terms with their own.”

The untold stories we seldom hear, if put on paper, can help us to confront and process our own emotions. When it comes to therapy and recovery, I am a firm believer in the power of fiction to help us deal with issues we find difficult to confront, and empathise with the stories of others. If you are a counsellor or a teacher and wish to discuss ideas on what we should be publishing, then do please get in touch.


Enjoying NHE? Subscribe here to receive our weekly news updates or click here to receive a copy of the magazine!


There are no comments. Why not be the first?

Add your comment


national health executive tv

more videos >

latest healthcare news

HEE announces £2m investment to increase learning disability workforce

19/07/2019HEE announces £2m investment to increase learning disability workforce

Health Education England (HEE) has confirmed that it will invest £2m in 2019/20 to boost the learning disability workforce, with an extra 2... more >
Use of partial knee replacements could save NHS £30m a year

19/07/2019Use of partial knee replacements could save NHS £30m a year

Partial knee replacements (PKR) are as good as total knee replacements (TKR), whilst being more cost effective, according to new research funded ... more >
HSIB report focuses on technology to reduce radiology risks

19/07/2019HSIB report focuses on technology to reduce radiology risks

A report published today by HSIB has showcased where technology could play a pivotal role in reducing harm caused by failures in commun... more >

681 149x260 NHE Subscribe button

the scalpel's daily blog

Urology nurses are leading the way in adoption of prostate cancer biopsy technique

11/07/2019Urology nurses are leading the way in adoption of prostate cancer biopsy technique

Jonah Rusere, Advanced Nurse Practitioner for South East London Accountable Cancer Network, outlines an opportunity for urology nurses to make a difference to prostate cancer pathways. What is TRexit and why is it great news for prostate cancer patients all over the country? Let me explain. TRexit is the name given to a national initiative for hospitals to phase out TRUS biopsies and replace them with transperineal biopsies un... more >
read more blog posts from 'the scalpel' >


How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... more > more last word articles >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

health service focus

NHS Clinical Commissioners respond to NHS Implementation Framework

28/06/2019NHS Clinical Commissioners respond to NHS Implementation Framework

The membership organisation for clinical comm... more >
Can the NHS find savings in their energy bills?

10/06/2019Can the NHS find savings in their energy bills?

As the NHS works harder than ever to meet cha... more >