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DESIGNING BIBLIOTHERAPY FOR YOGYAKARTA EARTHQUAKE
        VICTIMS WITH POSTTRAUMATIC STRESS DISORDER


                                  Yossy Suparyo




                                   ABSTRACT
      Earthquakes pose one of the most dangerous types of natural disasters due to
the power of life-threatening, unpredictable and uncontrollable nature of the
phenomena. When earthquake within 5.9 on the Richter scale shook province of
Yogyakarta (May 27, 2006) caused major damage leaving over 5,700 dead, and
tens of thousands requiring long-term assistance. In disaster moment, various
causes of psychological disturbances in trauma patients have been highlighted.
There are 10-20 percents of victims who were directly affected may suffer from
posttraumatic stress disorder (PTSD).
      Bibliotherapy is an effort useful books or reading material to assist PTSD
patient in disaster event. It is a form of supportive psychotherapy in which
carefully selected reading materials are used to assist a subject in solving personal
problems or for other therapeutic purposes. From this experience, we came to
some important conclusions. First, the bibliotherapy project that based upon a
careful selection that includes variety and aesthetic quality can open possibilities
for individual elaboration through enjoyable encounters. Second, bibliotherapy
project we undertake should consider the strengthening of nets in order to return
leadership back to those space, school and Islamic Boarding School (Pondok
pesantren) libraries, that they were intended for; and in third place, that the
bibliotherapy projects should be carried out in defined cycles, work without
assumptions, but in a continuous way and with systematic follow-ups, it should be
more open to the other’s need than to rigid planning of goals.

Keyword:
Bibliotherapy, post-traumatic stress disorder, Yogyakarta earthquake, disaster
management.




A.     Introduction
       Disasters (e.g., earthquake, floods) are traumatic events that are
experienced by many people and may result in a wide range of mental and
physical health consequences. When earthquake within 5.9 on the Richter scale
shook province of Yogyakarta (May 27, 2006) caused major damage leaving over
5,700 dead, and tens of thousands requiring long-term assistance. There are 10-20
percents of victims who were directly affected may suffer from post-traumatic
stress disorder (PTSD).1
       In one survey of US residents, 13 percent of the sample reported a lifetime
exposure to natural or human-generated disaster. In the National Comorbidity
Survey, 18.9 percent of men and 15.2 percent of women reported a lifetime
experience of a natural disaster2. Indeed, women consistently have a higher
prevalence of PTSD after disasters than men, as do persons with pre-existing and
those who have previously experienced traumatic events.3
       This project began as response to the horrifying when Yogyakarta—
especially district of Bantul and Gunung Kidul was literally destroyed.
Bewildered by the brutal devastation, we decided to go and read stories to victims
of the earthquake. Heartbreaking experiences then took place, like when mothers
confessed that their children were able to sleep better after they were told stories.
       Reading activity has an important role to play in supporting health and
well being. It empowers the individual, promotes personal development, support
self-expression and personal choice and result in creative and independent
learning4. Of course, reading, in this case is not simply the skill acquired at a
given school level. Reading that opens spaces for communication and
development goes much further than the action of deciphering the alphabet. It
exercises the imagination, provides access to information and opportunities for
relaxation, enjoyment and social interaction.5
       The using book for therapeutic purposes called bibliotheraphy. It is not
something new or recently discovered. Reading has been used for centuries to


1 Anonim, “Banyak Relawan Terkena Psikotik Akut”, Republika, Juni 14, 2006
2 Sandro Galea, Arijit Nandi and David Vlahov. The Epidemiology of Post-Traumatic Stress
Disorder after Disasters. Unpublished, 2004
3 Prapanca Hari, Modul Workshop TFT Kesehatan Mental dan Pemulihan Trauma, Yogyakarta:
Unpublished, 2006 p. 3
4 Aswadi, “Budaya Membaca”, www.pontianakpos.com. Accesed on Februari 9, 2007.
5 Umar Sidik, “Budaya Membaca dan Kemelekhurufan Masyarakat” on Firhis Vol. I No.2 July-
December 2007 p. 6
disseminate new ideas, alter old attitudes and activities, and initiate new ones.
Bibliotherapy is an extent of humanitarian side of librarianship. It recognizes the
therapeutic powers of the literature and benefits which can be derived by the
reader thereof. It is often defined as “healing through books”.6
         Branco del Libro has been applied of bibliotherapy in the Read to Live
(Leer para Vivir) Project, was an initiative in answer to tragic fooling in all of the
Vargas Sate in 1999.7 This project would carry out simultaneously three main
lines of action with children, the community’s adult, and with preschool teachers
through encounters, symposiums to establish a diagnostic of their needs,
recognize the importance of bibliotherapy in their realities, and carry out reading
promotion projects in their communities.
         Similarly with Branco de Libro, Posko Kemanusiaan Yogyakarta (PKY—
Humanitarian Center of Yogyakarta) provide an innovative therapy that utilizes
books and storytelling to help people solve problems and cope with live. The aim
of study intends to look at bibliotherapy, to show to what extent bibliotherapy can
be used in dealing with various problems encountered. The research questions will
be investigated is influence of bibliotherapy for earthquake victims with post-
traumatic stress disorder in disaster event.


    B. Posttraumatic stress disorder (PTSD)
         Earthquakes pose one of the most dangerous types of natural disasters due
to the power of life-threatening, unpredictable and uncontrollable nature of the
phenomena. Earthquakes cause such a widespread devastation that leaves
survivors at risk for injury, loss of property, homelessness and dislocation. In
addition, the lack of advance warning systems causes confusion and shock. People
find themselves         completely       unprepared   for earthquake physically     and
psychologically as well.

6 Lilian Mitchell Kamalie, The Application of Bibliotherapy with Primary School Children
Living in a Violent Society. A Thesis, 2002. p. 1.
7 Paula Cadenas, “Books to Build”. This paper presented in World Library and Information
Congress: 70th IFLA General Conference and Council August 22-27, 2004 in Buenos Aires,
In the psychology literature, there is a growing awareness addressed to the
psychological squeal among children and adolescents. The effects of disasters on
children’s mental health are well established. Natural catastrophes may cause
physical, psychological and physiological stress for the survivors. Due to their
frequent occurrences, earthquakes and hurricanes are the most commonly
researched natural phenomenon. Powerful earthquakes can cause thousands of
casualties and can have long term consequences.8
         The findings of previous studies involving earthquake survivors suggest
that PTSD symptoms are common among the trauma victims. Since posttraumatic
stress disorder (PTSD) entered the psychiatric lexicon with DSM III, numerous
investigations have confirmed that exposure to life-threatening stressors often
leads to PTSD in young persons, just as in adults. In particular, child psychiatrists
and psychologists have come to appreciate the extent to which children are
exposed to traumatic situations, the severity of their acute distress, and the
potential serious long-term psychiatric squeals.9
         According Tupattinaja, posttraumatic stress disorder (PTSD) occurs in
individuals who have survived a severe or terrifying physical or emotional event.
People with PTSD may have recurrent nightmares, intrusive memories, or even
have flashbacks, where the event seems to be happening all over again. They feel
extreme distress when in circumstances that remind them of the trauma, and go to
extremes to avoid these situations. 10
         Four criteria must be satisfied to establish a DSM-IV diagnosis of PTSD in
both adults and children: (1) exposure to a PTSD magnitude stressor; (2)
subsequent re-experiencing of the event; (3) consequent avoidance or numbing of
general responsiveness; and (4) persistent increased arousal.11 Additional
symptoms include: (1) feeling numb or detached; (2) trouble sleeping; (3) feeling

Argentina.
8 Hari, Opcit. p. 9
9 Catherine D. Mcknight, Scott N. Compton, John S. March, Posttraumatic Stress Disorder, 2007
10 Josetta Maria Remila Tupattinaja, “Cemas: Normal atau Tidak Normal” in
www.library.usu.ac.id. Accesed on February 9, 2007 time 15.20 p. 10-12.
jittery or on guard; and (4) irritability. Events that can trigger PTSD include
military combat, a violent personal attack, natural disasters, tragedies (e.g., plane
crash), physical or sexual abuse during childhood, or witnessing another person’s
serious injury12.
        “Trauma” has both a medical and a psychiatric definition13. Medically,
“trauma” refers to a serious or critical bodily injury, wound, or shock. This
definition is often associated with trauma medicine practiced in emergency rooms
and represents a popular view of the term. Psychiatrically, “trauma” has assumed
a different meaning and refers to an experience that is emotionally painful,
distressful, or shocking, which often results in lasting mental and physical effects.
Psychiatric trauma, or emotional harm, is essentially a normal response to an
extreme event. It involves the creation of emotional memories about the
distressful event that are stored in structures deep within the brain. In general, it is
believed that the more direct the exposure to the traumatic event, the higher the
risk for emotional harm.


    C. Bibliotherapy
        Bibliotherapy is a combination of two Greek words, biblion meaning book
and therapeia refer to healing. In other word, bibliotherapy means is healing
through books.14 The idea of using literature to help shape the views and
behaviors of others has been around for thousands of years. The great thinker
Plato was one of the first to write about the vast possibilities of bibliotherapy and
children. Plato once said:
        …and shall we just carelessly allow children to hear any casual tale which
        may be devised by casual persons, and to those which we wish them to
        have when they are grown up? Anything received into the mind at this age
        is likely to become indelible and unalterable; and therefore it is most

11 Mcknight, Opcit. p. 243.
12 Tupattinaja, Opcit. p. 10-12.
13 U.S. Department of Health and Human Services, Terrorism and Other Public Health
Emergencies: A Reference Guide for Media, http://www.hhs.gov/emergency Accesed on October
25, 2007.
14 Paula McMillen and Dale E. Pehrsson, Bibliotherapy for Hospital Patients, 2007.
important that the tales which the young first hear should be models of
        virtuous thought.15

        Bibliotherapy is the use of reading to produce affective change and to
promote personality growth and development. It is an attempt to help young
people understand themselves and cope with problems by providing literature
relevant to their personal situations and developmental needs at appropriate
times.16 The purpose of bibliotherapy on the other hand is much more intriguing
to assist audients in overcoming the emotional turmoil related to a real-life
problem by having him or her read literature on that topic.
        Actually, the definition of bibliotherapy has become more complex.
Several professions have adopted the use bibliotherapy including psychiatry,
sociology, psychology, education, and library science. Each field interprets and
practices bibliotherapy differently. Bibliotherapy is practiced by a variety of
professions. Forrest’s review of the bibliotherapy literature from 1993-1997 found
that the authors fell into 4 main groups: psychologists (57%), librarians (20%),
nurses (11%), and social workers (10%).17
        There are two main types of bibliotherapy; clinical and developmental.18
Clinical bibliotherapy takes place in a clinical setting in the presence of a
professionally trained counselor or therapist to deal with emotional and behavioral
problems. Developmental bibliotherapy, on the other hand, takes place in more of
a classroom setting and is implemented by teachers, counselors, and school
psychologists to help children with prevention of problem or crisis.
        Bibliotherapy has numerous benefits. Among these are easy access to wide
variety of books, flexibility in application to various setting, and use with a range
of presenting problems and client. Stories can provide vicarious immersion into

15 Joshua Jachna, “Bibliotherapy: What, Why, and How” in www.eaa.ee Accesed on February 9,
2007 time 15.10 p. 1
16 Marci Oslen, Bibliotherapy: School Psychologists’ Report of Use and Efficacy. A Thesis in
Brigham Young University: Unpublished, 2006.
17 McMillen, Opcit. p.3
18 Marci Oslen, “School Psychologist: Guide for Using Bibliotherapy” in The Observer edition
another culture, offering exposure to alternative lifestyles and beliefs. Effective
use of bibliotherapy can enhance personal insight, provide information, suggest
alternatives, diminish isolation, clarify emerging value, stimulate discussion and
extend to counseling process outside of traditional setting.19 Pehrsson and
McMillen written:
        Bibliotherapy applied therapeutically to an astounding range of problems
        and issues. These include aggressiveness, adoption, addictions, family
        dissolution, clinical depression, talented and gifted children, homelessness,
        night terrors, obsessive-compulsive disorder and self-destructive
        behavior.20

        In this study, I will define bibliotherapy as an effort useful books or
reading material to assist PTSD patient in disaster event. Bibliotherapy is a form
of supportive psychotherapy in which carefully selected reading materials are
used to assist a subject in solving personal problems or for other therapeutic
purposes.
        The process of bibliotherapy include: identification, catharsis, and
insight.21 First, Identification, identification is generally defined as an adaptive
mechanism which the human being utilizes, largely unconsciously, to augment his
self-regard. It takes the form of a real or imagined affiliation of oneself with
another person, a group of persons, or with some institution, or even with a
symbol. There is usually involved admiration for the object of one’s identification,
a tendency to imitate, and a sense of loyalty and belongingness.
        Second, Catharsis, catharsis defines as a sharing of motivations, conflicts
and emotions of a book character. It is an active release of emotions, experienced
either first-hand or vicariously. It goes beyond the simple intellectual recognition
of commonalities as in identification or personification. It involves empathetic
emotional reactions similar to those that the reader imagines were felt by the


February 2006
19 Dale-Elizabeth Pehrsson and Paula McMillen, Competent Bibliotherapy: Preparing Counselors
to use Literature with Culturally Diverse Client. 2006
20 Ibid, p. 4
21 Kamalie, Opcit. P. 17-18.
book’s character. Third, Insight, insight is the power of thinking, feeling person to
look within and beneath the surface of things; it is an ability that can be
strengthened through bibliotherapy.


D.     The    Designing        Bibliotherapy   for   Earthquake     Victims     with
       Posttraumatic Stress Disorder
       After each natural disaster a comprehensive treatment protocol is needed
for volunteers of healthcare personnel of the disaster zone. In this study we
analysis the application of bibliotherapy to victims who are suffering the effects of
posttraumatic stress disorder (PTSD) on disaster event—earthquake—in district of
Bantul, Yogyakarta, especially in trauma healing project areas of Posko
Kemanusiaan Yogyakarta. We create trauma healing project in sub-district of
Pleret, Jetis, and Piyungan.

       Early trauma studies had methodological limitations because of their small
sample size, use of different instrument, different time lags, lack of probability
samples and control groups. But, we believe in disaster moment, various causes of
psychological disturbances in trauma patients have been highlighted. These
include pain, sudden and unexpected nature of events and the procedures and
interventions recruited to resuscitate and stabilize the patients. The patients react
to these stressors by various defense mechanisms such as conversion withdrawal,
denial, regression, pain, anxiety, adjustment disorder symptoms and depression.
Some of them develop delirium or even more severe problems like pain disorder
or post-traumatic stress disorder.22

       Reactions to trauma may appear immediately after the traumatic event or
days and even weeks later. Loss of trust in adults and fear of the event occurring
again are responses seen in many children and adolescents who have been
exposed to traumatic events. Other reactions vary according to age23:


22 Hartosujono. Kesehatan Mental pada Anak Pasca Gempa. A paper presented in Workshop
Kesehatan Mental dan Pemulihan Trauma, Aliansi Jogja Recovery. Unpublished, 2006.
23 Ibid. p.7-8
1. For children 5 years of age and younger, typical reactions can include a
      fear of being separated from the parent, crying, whimpering, screaming,
      immobility    and/or    aimless     motion,   trembling,   frightened   facial
      expressions, and excessive clinging. Parents may also notice children
      returning to behaviors exhibited at earlier ages (these are called regressive
      behaviors), such as thumb-sucking, bedwetting, and fear of darkness.
      Children in this age bracket tend to be strongly affected by the parents’
      reactions to the traumatic event.

   2. Children 6–11 years old may show extreme withdrawal, disruptive
      behavior, and/or inability to pay attention. Regressive behaviors,
      nightmares, sleep problems, irrational fears, irritability, refusal to attend
      school, outbursts of anger, and fighting are also common in traumatized
      children of this age. Also, the child may complain of stomachaches or
      other bodily symptoms that have no medical basis. Schoolwork often
      suffers. Depression, anxiety, feelings of guilt, and emotional numbing or
      “flatness” is often present as well.

   3. Adolescents 12–17 years old may exhibit responses similar to those of
      adults, including flashbacks, nightmares, emotional numbing, avoidance of
      any reminders of the traumatic event, depression, substance abuse,
      problems with peers, and antisocial behavior. Also common are
      withdrawal and isolation, physical complaints, suicidal thoughts, school
      avoidance, academic decline, sleep disturbances, and confusion. The
      adolescent may feel extreme guilt over his or her failure to prevent injury
      or loss of life and may harbor revenge fantasies that interfere with
      recovery from the trauma.



      Bibliotherapy can deal with emotional, as well as developmental needs of
individuals. Literature provided to earthquake victims with PTSD is more
intended to educate them than to address their emotional needs. Yet it seems
reasonable to conclude that people still experience many of the same fears,
confusion, embarrassments, sense of lost control and increased vulnerability that
they did in years past. Most of those who use fictional literature still draw on the
original psycho-dynamically oriented models of how bibliotherapy works.
Readers are encouraged to identify with significant characters in the story, to
experience emotional catharsis as the story characters express themselves, and
then to gain some insight into themselves and their situations.

         Theses activities produced rich moment of sharing and learning. We
selected and donated book collection for different areas district of Bantul. At first
time, we suspected that we were giving something more than mere entertainment
or a way to escape from reality. According to specialists we were engaged in a
therapeutic practice, something that some people nowadays call bibliotherapy.
Also, local institution like Islamic Boarding School (Pondok Pesantren), Youth
Moslem Association (Ikatan Remaja Masjid), and local traditional leader have
most contributes that they is mainly stakeholder in this project.

         Prapanca Hari attempted to understand the therapeutic mechanisms from
the reader’s perspective24. He used a well-functioning, non-clinical population
who believed that reading had helped them through difficult situations in their
lives. The participants selected their own reading materials that ranged from
poetry and fiction to motivational and self-help literature. Identification with the
characters and/or situations in the selected literature was acknowledged by
virtually all readers as the key to experiencing positive effects, regardless of the
literary genre. The findings certainly seem to corroborate bibliotherapy with
patients to be “diversion, education, and therapeutic”.25

        Warner provides a straightforward explanation of how bibliotherapy works
in theory26. The underlying idea of bibliotherapy is that a person dealing with
specific problem—e.g. traumatic or phobia—might be helped by reading a piece


24 Yossy Suparyo, 2007. Aplikasi Bilioterapi untuk Klien Penderita Gangguan Kecemasan di
Kantor Psikolog Prapanca Hari dan Rekan Yogyakarta. A paper: Unpublished .
25 Ibid 45-46.
26 Jackson, Opcit. p. 3.
of fiction in which a character is dealing with a similar problem. Proponents of
use of bibliotherapy explain the process in this way. First, a reader forms a bond
with the character facing a problem similar to reader’s own. Second, the character
deals with the problem, most times successfully, sometimes not. Third, in a
vicarious sense, the reader does the same and experiences the accompanying rise
of self-esteem gained from successfully coping with the problem. If the character
fails to handle the problem successfully, the reader can come away from the story
having tried one approach and seeing the outcome without suffering the negative
consequences. The reader is then able to reflect on personal circumstances and
practice the behaviors that now seem to stand the best chance of success.27
         Transference of bibliotherapy in this project focuses on five basic
procedures that can be used with a single individual or a group.28 There are:

1.       Motivate. Motivate is introductory activities, such as games and role plays
         can help motivate client to participate.

2.       Reading time. Participants provided sufficient time to read through the
         reading material.

3.       Incubation. Allow audients time to ponder over what they have just read.

4.       Follow-up. The main aspect of the follow-up procedure is participating in
         a discussion. This will allow the participants to share perspectives and
         insights, and obtain ideas from other participant as well. Follow-up
         discussion can also help participant to realize how they can apply this
         knowledge in their own lives.

5.       Evaluate. Individual self-evaluation, as well as group and practitioner
         evaluation may be conducted. This allows the participant who participated
         in bibliotherapy to have a solid conclusion on what the experience has
         meant to them.




27 Ibid p.5
The main portion of the bibliotherapy lesson is the application of the book
to anxiety disorder problem. This is done by using follow-up activities after
reading and sharing the book. There are a vast variety of activities that can be
done with the group depending on the problem and how the facilitator wants the
audients to realize how their problem relates to the book.

         The following are a few examples that can be used: First, creative writing:
audients can create a diary for a character in the story, write a letter from one
character to another or from the audients to one character in the book, write how
to resolve the story in a different way, write a poem to stimulate audients’
thinking about themselves, or analyze the decisions of the characters.

         Second, art activities: Draw a map to illustrate story events, create a
collage from magazine photos, draw pictures of events in the story, construct
puppets of story characters, or make a mobile to represent events. Third,
Discussion and Role-Playing: Audients participate in a roundtable discussion
about the decision of a character in the story, role-play events in the story, discuss
strong and weak points of a character in the book that the students can identify
with, or discuss how the outcome of the story could be changed and how
alternative behaviors of the characters would affect this change.


E.       Conclusion
         From this study, we came to some important conclusions. The
bibliotherapy project that based upon a careful selection that includes variety and
aesthetic quality can open possibilities for individual elaboration through
enjoyable encounters. Afterward bibliotherapy project we undertake should
consider the strengthening of nets in order to return leadership back to those
space, school or Islamic Boarding School (Pondok Pesantren) library, that they
were intended for; and the bibliotherapy projects should be carried out in defined
cycles, work without assumptions, but in a continuous way and with systematic
follow-ups, it should be more open to the other’s need than to rigid planning of

28 Hari, Opcit. p.5
goals.
         For recommended, there are two factors one must be aware of the order for
bibliotherapy    to   be   most   effective.   These   factors   are   developmental
appropriateness, accuracy of content and effectiveness of style, and strategies for
presentation. Development appropriateness simply means keeping the age and
developmental level of the audients in mind when using a book. Different
concerns are often associated with the age and developmental level of the
audients. Accuracy of content and effectiveness of style refers to choosing a book
that is realistic and does not take “fairy tale” view of the problem. This does not
mean the book cannot be fictional; instead, it must mirror reality. In other words,
having animals as characters in the book is fine so long as the situation and
outcomes are realistic. Wallahualam bish showab.
BIBLIOGRAPHY


American Psychiatric Association, Let’s Talk Facts About Anxiety Disorders,
        www.healthyminds.org/multimedia/anxietydisorders. pdf. Accesed on
        October 11, 2007 time 10.00.

Anonim, “Banyak Relawan Terkena Psikotik Akut”, on Republika, Juni 14, 2006.

Aswadi, “Budaya Membaca” on www.pontianakpos.com. Accesed on February 9,
        2007 time 10.00.

Cadenas, Paula. 2004. “Books to Build”. Presented on World Library and
        Information Congress: 70th IFLA General Conference and Council 22-
        27 August 2004 in Buenos Aires, Argentina. In www.ifla.org February 9,
        2007 time 15.30

Galea, Sandro, Arijit Nandi and David Vlahov. The Epidemiology of Post-
        Traumatic Stress Disorder after Disasters. Unpublished, 2004

Gauntz, Mary, “The Graham Model of Biblio-supervision: A Multiple baseline
        Analysis,” www.ir.library.oregonstate.edu. Accesed on February 9, 2007
        time 15.45

Gottschack, Louis A, “Bibliotherapy as an Adjunvant in Psychotherapy,”
        www.ajp.psychiatryonline.org/cgi/reprint/104/10/ 632.pdf. Accesed on
        February 9, 2007 time 16.00

Hari, Prapanca, Modul Workshop TFT Kesehatan Mental dan Pemulihan Trauma
         Juny 22 2006. Unpublished.

Hartosujono, Kesehatan Mental pada Anak Pasca Gempa. A paper presented in
         Workshop Kesehatan Mental dan Pemulihan Trauma, Aliansi Jogja
         Recovery 2006. Unpublished

Jachna, Joshua, “Bibliotherapy: What, Why, and How,” www.eaa.ee. Accesed on
         February 9, 2007 time 15.10

Jackson, Shelley A. 2001. “Using Bibliotherapy with Client in The Journal of
         Individual Psychology Vol. 57, Issue 3, Fall 2001.

Kamalie, Lilian Mitchell, “The Application of Bibliotherapy with Primary School
        Children Living in a Violent Society,” www.uwc.ac.za. Accesed on
        February 9, 2007 time 15.00

Mcknight, Catherine D., etc, Posttraumatic Stress Disorder. Digital Published:
        2007.
McMillen, Paula and Dale-Elizabeth Pehrsson, “Bibliotherapy for Hospital
        Patients,” www.ir.library.oregonstate.edu/dspace/ bitstream/1957/438/
        1/JHL703McMillenRevisedJul30.doc. Accesed on October 19, 2007 time
        10.00

Oslen, Marci. “School Psychologist: Guide for Using Bibliotherapy” in The
        Observer edition February 2006

Marci Oslen, Bibliotherapy: School Psychologists’ Report of Use and Efficacy. A
        Thesis in Brigham Young University: Unpublished: 2006.

Pehrrson, Dale and Paula McMillen, “Bibliotherapy: A Collaborative Project for
         Training    Counseling     Student    to    Evaluate     Literature,”
         www.osulibrary.oregonstate.edu. Accesed on February 9, 2007 time
         15.00

Suparyo, Yossy, Aplikasi Bilioterapi untuk Klien Penderita Gangguan
        Kecemasan di Kantor Psikolog Prapanca Hari dan Rekan Yogyakarta.
        A Graduate Thesis, Unpublished: 2007

Tupattinaja, Josetta Maria Remila, “Cemas: Normal atau Tidak Normal” in
         www.library.usu.ac.id. Accesed on February 9, 2007 time 15.20

U.S. Department of Health and Human Services. “Terrorism and Other Public
        Health    Emergencies:    A    Reference    Guide     for    Media,
        http://www.hhs.gov/emergency Accesed on October 25, 2007 time 10.00
Yossy Suparyo, student of Library and Information Science Dept, State Islamic
University Sunan Kalijaga Yogyakarta and Mechanical Engineering Dept.
Yogyakarta State Univerity. Activists of Posko Kemanusiaan Yogyakarta and
Library and Information Studies Center (LISC).

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Designing Bibliotherapy for PTSD

  • 1. DESIGNING BIBLIOTHERAPY FOR YOGYAKARTA EARTHQUAKE VICTIMS WITH POSTTRAUMATIC STRESS DISORDER Yossy Suparyo ABSTRACT Earthquakes pose one of the most dangerous types of natural disasters due to the power of life-threatening, unpredictable and uncontrollable nature of the phenomena. When earthquake within 5.9 on the Richter scale shook province of Yogyakarta (May 27, 2006) caused major damage leaving over 5,700 dead, and tens of thousands requiring long-term assistance. In disaster moment, various causes of psychological disturbances in trauma patients have been highlighted. There are 10-20 percents of victims who were directly affected may suffer from posttraumatic stress disorder (PTSD). Bibliotherapy is an effort useful books or reading material to assist PTSD patient in disaster event. It is a form of supportive psychotherapy in which carefully selected reading materials are used to assist a subject in solving personal problems or for other therapeutic purposes. From this experience, we came to some important conclusions. First, the bibliotherapy project that based upon a careful selection that includes variety and aesthetic quality can open possibilities for individual elaboration through enjoyable encounters. Second, bibliotherapy project we undertake should consider the strengthening of nets in order to return leadership back to those space, school and Islamic Boarding School (Pondok pesantren) libraries, that they were intended for; and in third place, that the bibliotherapy projects should be carried out in defined cycles, work without assumptions, but in a continuous way and with systematic follow-ups, it should be more open to the other’s need than to rigid planning of goals. Keyword: Bibliotherapy, post-traumatic stress disorder, Yogyakarta earthquake, disaster management. A. Introduction Disasters (e.g., earthquake, floods) are traumatic events that are experienced by many people and may result in a wide range of mental and physical health consequences. When earthquake within 5.9 on the Richter scale shook province of Yogyakarta (May 27, 2006) caused major damage leaving over
  • 2. 5,700 dead, and tens of thousands requiring long-term assistance. There are 10-20 percents of victims who were directly affected may suffer from post-traumatic stress disorder (PTSD).1 In one survey of US residents, 13 percent of the sample reported a lifetime exposure to natural or human-generated disaster. In the National Comorbidity Survey, 18.9 percent of men and 15.2 percent of women reported a lifetime experience of a natural disaster2. Indeed, women consistently have a higher prevalence of PTSD after disasters than men, as do persons with pre-existing and those who have previously experienced traumatic events.3 This project began as response to the horrifying when Yogyakarta— especially district of Bantul and Gunung Kidul was literally destroyed. Bewildered by the brutal devastation, we decided to go and read stories to victims of the earthquake. Heartbreaking experiences then took place, like when mothers confessed that their children were able to sleep better after they were told stories. Reading activity has an important role to play in supporting health and well being. It empowers the individual, promotes personal development, support self-expression and personal choice and result in creative and independent learning4. Of course, reading, in this case is not simply the skill acquired at a given school level. Reading that opens spaces for communication and development goes much further than the action of deciphering the alphabet. It exercises the imagination, provides access to information and opportunities for relaxation, enjoyment and social interaction.5 The using book for therapeutic purposes called bibliotheraphy. It is not something new or recently discovered. Reading has been used for centuries to 1 Anonim, “Banyak Relawan Terkena Psikotik Akut”, Republika, Juni 14, 2006 2 Sandro Galea, Arijit Nandi and David Vlahov. The Epidemiology of Post-Traumatic Stress Disorder after Disasters. Unpublished, 2004 3 Prapanca Hari, Modul Workshop TFT Kesehatan Mental dan Pemulihan Trauma, Yogyakarta: Unpublished, 2006 p. 3 4 Aswadi, “Budaya Membaca”, www.pontianakpos.com. Accesed on Februari 9, 2007. 5 Umar Sidik, “Budaya Membaca dan Kemelekhurufan Masyarakat” on Firhis Vol. I No.2 July- December 2007 p. 6
  • 3. disseminate new ideas, alter old attitudes and activities, and initiate new ones. Bibliotherapy is an extent of humanitarian side of librarianship. It recognizes the therapeutic powers of the literature and benefits which can be derived by the reader thereof. It is often defined as “healing through books”.6 Branco del Libro has been applied of bibliotherapy in the Read to Live (Leer para Vivir) Project, was an initiative in answer to tragic fooling in all of the Vargas Sate in 1999.7 This project would carry out simultaneously three main lines of action with children, the community’s adult, and with preschool teachers through encounters, symposiums to establish a diagnostic of their needs, recognize the importance of bibliotherapy in their realities, and carry out reading promotion projects in their communities. Similarly with Branco de Libro, Posko Kemanusiaan Yogyakarta (PKY— Humanitarian Center of Yogyakarta) provide an innovative therapy that utilizes books and storytelling to help people solve problems and cope with live. The aim of study intends to look at bibliotherapy, to show to what extent bibliotherapy can be used in dealing with various problems encountered. The research questions will be investigated is influence of bibliotherapy for earthquake victims with post- traumatic stress disorder in disaster event. B. Posttraumatic stress disorder (PTSD) Earthquakes pose one of the most dangerous types of natural disasters due to the power of life-threatening, unpredictable and uncontrollable nature of the phenomena. Earthquakes cause such a widespread devastation that leaves survivors at risk for injury, loss of property, homelessness and dislocation. In addition, the lack of advance warning systems causes confusion and shock. People find themselves completely unprepared for earthquake physically and psychologically as well. 6 Lilian Mitchell Kamalie, The Application of Bibliotherapy with Primary School Children Living in a Violent Society. A Thesis, 2002. p. 1. 7 Paula Cadenas, “Books to Build”. This paper presented in World Library and Information Congress: 70th IFLA General Conference and Council August 22-27, 2004 in Buenos Aires,
  • 4. In the psychology literature, there is a growing awareness addressed to the psychological squeal among children and adolescents. The effects of disasters on children’s mental health are well established. Natural catastrophes may cause physical, psychological and physiological stress for the survivors. Due to their frequent occurrences, earthquakes and hurricanes are the most commonly researched natural phenomenon. Powerful earthquakes can cause thousands of casualties and can have long term consequences.8 The findings of previous studies involving earthquake survivors suggest that PTSD symptoms are common among the trauma victims. Since posttraumatic stress disorder (PTSD) entered the psychiatric lexicon with DSM III, numerous investigations have confirmed that exposure to life-threatening stressors often leads to PTSD in young persons, just as in adults. In particular, child psychiatrists and psychologists have come to appreciate the extent to which children are exposed to traumatic situations, the severity of their acute distress, and the potential serious long-term psychiatric squeals.9 According Tupattinaja, posttraumatic stress disorder (PTSD) occurs in individuals who have survived a severe or terrifying physical or emotional event. People with PTSD may have recurrent nightmares, intrusive memories, or even have flashbacks, where the event seems to be happening all over again. They feel extreme distress when in circumstances that remind them of the trauma, and go to extremes to avoid these situations. 10 Four criteria must be satisfied to establish a DSM-IV diagnosis of PTSD in both adults and children: (1) exposure to a PTSD magnitude stressor; (2) subsequent re-experiencing of the event; (3) consequent avoidance or numbing of general responsiveness; and (4) persistent increased arousal.11 Additional symptoms include: (1) feeling numb or detached; (2) trouble sleeping; (3) feeling Argentina. 8 Hari, Opcit. p. 9 9 Catherine D. Mcknight, Scott N. Compton, John S. March, Posttraumatic Stress Disorder, 2007 10 Josetta Maria Remila Tupattinaja, “Cemas: Normal atau Tidak Normal” in www.library.usu.ac.id. Accesed on February 9, 2007 time 15.20 p. 10-12.
  • 5. jittery or on guard; and (4) irritability. Events that can trigger PTSD include military combat, a violent personal attack, natural disasters, tragedies (e.g., plane crash), physical or sexual abuse during childhood, or witnessing another person’s serious injury12. “Trauma” has both a medical and a psychiatric definition13. Medically, “trauma” refers to a serious or critical bodily injury, wound, or shock. This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. Psychiatrically, “trauma” has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects. Psychiatric trauma, or emotional harm, is essentially a normal response to an extreme event. It involves the creation of emotional memories about the distressful event that are stored in structures deep within the brain. In general, it is believed that the more direct the exposure to the traumatic event, the higher the risk for emotional harm. C. Bibliotherapy Bibliotherapy is a combination of two Greek words, biblion meaning book and therapeia refer to healing. In other word, bibliotherapy means is healing through books.14 The idea of using literature to help shape the views and behaviors of others has been around for thousands of years. The great thinker Plato was one of the first to write about the vast possibilities of bibliotherapy and children. Plato once said: …and shall we just carelessly allow children to hear any casual tale which may be devised by casual persons, and to those which we wish them to have when they are grown up? Anything received into the mind at this age is likely to become indelible and unalterable; and therefore it is most 11 Mcknight, Opcit. p. 243. 12 Tupattinaja, Opcit. p. 10-12. 13 U.S. Department of Health and Human Services, Terrorism and Other Public Health Emergencies: A Reference Guide for Media, http://www.hhs.gov/emergency Accesed on October 25, 2007. 14 Paula McMillen and Dale E. Pehrsson, Bibliotherapy for Hospital Patients, 2007.
  • 6. important that the tales which the young first hear should be models of virtuous thought.15 Bibliotherapy is the use of reading to produce affective change and to promote personality growth and development. It is an attempt to help young people understand themselves and cope with problems by providing literature relevant to their personal situations and developmental needs at appropriate times.16 The purpose of bibliotherapy on the other hand is much more intriguing to assist audients in overcoming the emotional turmoil related to a real-life problem by having him or her read literature on that topic. Actually, the definition of bibliotherapy has become more complex. Several professions have adopted the use bibliotherapy including psychiatry, sociology, psychology, education, and library science. Each field interprets and practices bibliotherapy differently. Bibliotherapy is practiced by a variety of professions. Forrest’s review of the bibliotherapy literature from 1993-1997 found that the authors fell into 4 main groups: psychologists (57%), librarians (20%), nurses (11%), and social workers (10%).17 There are two main types of bibliotherapy; clinical and developmental.18 Clinical bibliotherapy takes place in a clinical setting in the presence of a professionally trained counselor or therapist to deal with emotional and behavioral problems. Developmental bibliotherapy, on the other hand, takes place in more of a classroom setting and is implemented by teachers, counselors, and school psychologists to help children with prevention of problem or crisis. Bibliotherapy has numerous benefits. Among these are easy access to wide variety of books, flexibility in application to various setting, and use with a range of presenting problems and client. Stories can provide vicarious immersion into 15 Joshua Jachna, “Bibliotherapy: What, Why, and How” in www.eaa.ee Accesed on February 9, 2007 time 15.10 p. 1 16 Marci Oslen, Bibliotherapy: School Psychologists’ Report of Use and Efficacy. A Thesis in Brigham Young University: Unpublished, 2006. 17 McMillen, Opcit. p.3 18 Marci Oslen, “School Psychologist: Guide for Using Bibliotherapy” in The Observer edition
  • 7. another culture, offering exposure to alternative lifestyles and beliefs. Effective use of bibliotherapy can enhance personal insight, provide information, suggest alternatives, diminish isolation, clarify emerging value, stimulate discussion and extend to counseling process outside of traditional setting.19 Pehrsson and McMillen written: Bibliotherapy applied therapeutically to an astounding range of problems and issues. These include aggressiveness, adoption, addictions, family dissolution, clinical depression, talented and gifted children, homelessness, night terrors, obsessive-compulsive disorder and self-destructive behavior.20 In this study, I will define bibliotherapy as an effort useful books or reading material to assist PTSD patient in disaster event. Bibliotherapy is a form of supportive psychotherapy in which carefully selected reading materials are used to assist a subject in solving personal problems or for other therapeutic purposes. The process of bibliotherapy include: identification, catharsis, and insight.21 First, Identification, identification is generally defined as an adaptive mechanism which the human being utilizes, largely unconsciously, to augment his self-regard. It takes the form of a real or imagined affiliation of oneself with another person, a group of persons, or with some institution, or even with a symbol. There is usually involved admiration for the object of one’s identification, a tendency to imitate, and a sense of loyalty and belongingness. Second, Catharsis, catharsis defines as a sharing of motivations, conflicts and emotions of a book character. It is an active release of emotions, experienced either first-hand or vicariously. It goes beyond the simple intellectual recognition of commonalities as in identification or personification. It involves empathetic emotional reactions similar to those that the reader imagines were felt by the February 2006 19 Dale-Elizabeth Pehrsson and Paula McMillen, Competent Bibliotherapy: Preparing Counselors to use Literature with Culturally Diverse Client. 2006 20 Ibid, p. 4 21 Kamalie, Opcit. P. 17-18.
  • 8. book’s character. Third, Insight, insight is the power of thinking, feeling person to look within and beneath the surface of things; it is an ability that can be strengthened through bibliotherapy. D. The Designing Bibliotherapy for Earthquake Victims with Posttraumatic Stress Disorder After each natural disaster a comprehensive treatment protocol is needed for volunteers of healthcare personnel of the disaster zone. In this study we analysis the application of bibliotherapy to victims who are suffering the effects of posttraumatic stress disorder (PTSD) on disaster event—earthquake—in district of Bantul, Yogyakarta, especially in trauma healing project areas of Posko Kemanusiaan Yogyakarta. We create trauma healing project in sub-district of Pleret, Jetis, and Piyungan. Early trauma studies had methodological limitations because of their small sample size, use of different instrument, different time lags, lack of probability samples and control groups. But, we believe in disaster moment, various causes of psychological disturbances in trauma patients have been highlighted. These include pain, sudden and unexpected nature of events and the procedures and interventions recruited to resuscitate and stabilize the patients. The patients react to these stressors by various defense mechanisms such as conversion withdrawal, denial, regression, pain, anxiety, adjustment disorder symptoms and depression. Some of them develop delirium or even more severe problems like pain disorder or post-traumatic stress disorder.22 Reactions to trauma may appear immediately after the traumatic event or days and even weeks later. Loss of trust in adults and fear of the event occurring again are responses seen in many children and adolescents who have been exposed to traumatic events. Other reactions vary according to age23: 22 Hartosujono. Kesehatan Mental pada Anak Pasca Gempa. A paper presented in Workshop Kesehatan Mental dan Pemulihan Trauma, Aliansi Jogja Recovery. Unpublished, 2006. 23 Ibid. p.7-8
  • 9. 1. For children 5 years of age and younger, typical reactions can include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions, and excessive clinging. Parents may also notice children returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear of darkness. Children in this age bracket tend to be strongly affected by the parents’ reactions to the traumatic event. 2. Children 6–11 years old may show extreme withdrawal, disruptive behavior, and/or inability to pay attention. Regressive behaviors, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger, and fighting are also common in traumatized children of this age. Also, the child may complain of stomachaches or other bodily symptoms that have no medical basis. Schoolwork often suffers. Depression, anxiety, feelings of guilt, and emotional numbing or “flatness” is often present as well. 3. Adolescents 12–17 years old may exhibit responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of any reminders of the traumatic event, depression, substance abuse, problems with peers, and antisocial behavior. Also common are withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances, and confusion. The adolescent may feel extreme guilt over his or her failure to prevent injury or loss of life and may harbor revenge fantasies that interfere with recovery from the trauma. Bibliotherapy can deal with emotional, as well as developmental needs of individuals. Literature provided to earthquake victims with PTSD is more intended to educate them than to address their emotional needs. Yet it seems reasonable to conclude that people still experience many of the same fears,
  • 10. confusion, embarrassments, sense of lost control and increased vulnerability that they did in years past. Most of those who use fictional literature still draw on the original psycho-dynamically oriented models of how bibliotherapy works. Readers are encouraged to identify with significant characters in the story, to experience emotional catharsis as the story characters express themselves, and then to gain some insight into themselves and their situations. Theses activities produced rich moment of sharing and learning. We selected and donated book collection for different areas district of Bantul. At first time, we suspected that we were giving something more than mere entertainment or a way to escape from reality. According to specialists we were engaged in a therapeutic practice, something that some people nowadays call bibliotherapy. Also, local institution like Islamic Boarding School (Pondok Pesantren), Youth Moslem Association (Ikatan Remaja Masjid), and local traditional leader have most contributes that they is mainly stakeholder in this project. Prapanca Hari attempted to understand the therapeutic mechanisms from the reader’s perspective24. He used a well-functioning, non-clinical population who believed that reading had helped them through difficult situations in their lives. The participants selected their own reading materials that ranged from poetry and fiction to motivational and self-help literature. Identification with the characters and/or situations in the selected literature was acknowledged by virtually all readers as the key to experiencing positive effects, regardless of the literary genre. The findings certainly seem to corroborate bibliotherapy with patients to be “diversion, education, and therapeutic”.25 Warner provides a straightforward explanation of how bibliotherapy works in theory26. The underlying idea of bibliotherapy is that a person dealing with specific problem—e.g. traumatic or phobia—might be helped by reading a piece 24 Yossy Suparyo, 2007. Aplikasi Bilioterapi untuk Klien Penderita Gangguan Kecemasan di Kantor Psikolog Prapanca Hari dan Rekan Yogyakarta. A paper: Unpublished . 25 Ibid 45-46. 26 Jackson, Opcit. p. 3.
  • 11. of fiction in which a character is dealing with a similar problem. Proponents of use of bibliotherapy explain the process in this way. First, a reader forms a bond with the character facing a problem similar to reader’s own. Second, the character deals with the problem, most times successfully, sometimes not. Third, in a vicarious sense, the reader does the same and experiences the accompanying rise of self-esteem gained from successfully coping with the problem. If the character fails to handle the problem successfully, the reader can come away from the story having tried one approach and seeing the outcome without suffering the negative consequences. The reader is then able to reflect on personal circumstances and practice the behaviors that now seem to stand the best chance of success.27 Transference of bibliotherapy in this project focuses on five basic procedures that can be used with a single individual or a group.28 There are: 1. Motivate. Motivate is introductory activities, such as games and role plays can help motivate client to participate. 2. Reading time. Participants provided sufficient time to read through the reading material. 3. Incubation. Allow audients time to ponder over what they have just read. 4. Follow-up. The main aspect of the follow-up procedure is participating in a discussion. This will allow the participants to share perspectives and insights, and obtain ideas from other participant as well. Follow-up discussion can also help participant to realize how they can apply this knowledge in their own lives. 5. Evaluate. Individual self-evaluation, as well as group and practitioner evaluation may be conducted. This allows the participant who participated in bibliotherapy to have a solid conclusion on what the experience has meant to them. 27 Ibid p.5
  • 12. The main portion of the bibliotherapy lesson is the application of the book to anxiety disorder problem. This is done by using follow-up activities after reading and sharing the book. There are a vast variety of activities that can be done with the group depending on the problem and how the facilitator wants the audients to realize how their problem relates to the book. The following are a few examples that can be used: First, creative writing: audients can create a diary for a character in the story, write a letter from one character to another or from the audients to one character in the book, write how to resolve the story in a different way, write a poem to stimulate audients’ thinking about themselves, or analyze the decisions of the characters. Second, art activities: Draw a map to illustrate story events, create a collage from magazine photos, draw pictures of events in the story, construct puppets of story characters, or make a mobile to represent events. Third, Discussion and Role-Playing: Audients participate in a roundtable discussion about the decision of a character in the story, role-play events in the story, discuss strong and weak points of a character in the book that the students can identify with, or discuss how the outcome of the story could be changed and how alternative behaviors of the characters would affect this change. E. Conclusion From this study, we came to some important conclusions. The bibliotherapy project that based upon a careful selection that includes variety and aesthetic quality can open possibilities for individual elaboration through enjoyable encounters. Afterward bibliotherapy project we undertake should consider the strengthening of nets in order to return leadership back to those space, school or Islamic Boarding School (Pondok Pesantren) library, that they were intended for; and the bibliotherapy projects should be carried out in defined cycles, work without assumptions, but in a continuous way and with systematic follow-ups, it should be more open to the other’s need than to rigid planning of 28 Hari, Opcit. p.5
  • 13. goals. For recommended, there are two factors one must be aware of the order for bibliotherapy to be most effective. These factors are developmental appropriateness, accuracy of content and effectiveness of style, and strategies for presentation. Development appropriateness simply means keeping the age and developmental level of the audients in mind when using a book. Different concerns are often associated with the age and developmental level of the audients. Accuracy of content and effectiveness of style refers to choosing a book that is realistic and does not take “fairy tale” view of the problem. This does not mean the book cannot be fictional; instead, it must mirror reality. In other words, having animals as characters in the book is fine so long as the situation and outcomes are realistic. Wallahualam bish showab.
  • 14. BIBLIOGRAPHY American Psychiatric Association, Let’s Talk Facts About Anxiety Disorders, www.healthyminds.org/multimedia/anxietydisorders. pdf. Accesed on October 11, 2007 time 10.00. Anonim, “Banyak Relawan Terkena Psikotik Akut”, on Republika, Juni 14, 2006. Aswadi, “Budaya Membaca” on www.pontianakpos.com. Accesed on February 9, 2007 time 10.00. Cadenas, Paula. 2004. “Books to Build”. Presented on World Library and Information Congress: 70th IFLA General Conference and Council 22- 27 August 2004 in Buenos Aires, Argentina. In www.ifla.org February 9, 2007 time 15.30 Galea, Sandro, Arijit Nandi and David Vlahov. The Epidemiology of Post- Traumatic Stress Disorder after Disasters. Unpublished, 2004 Gauntz, Mary, “The Graham Model of Biblio-supervision: A Multiple baseline Analysis,” www.ir.library.oregonstate.edu. Accesed on February 9, 2007 time 15.45 Gottschack, Louis A, “Bibliotherapy as an Adjunvant in Psychotherapy,” www.ajp.psychiatryonline.org/cgi/reprint/104/10/ 632.pdf. Accesed on February 9, 2007 time 16.00 Hari, Prapanca, Modul Workshop TFT Kesehatan Mental dan Pemulihan Trauma Juny 22 2006. Unpublished. Hartosujono, Kesehatan Mental pada Anak Pasca Gempa. A paper presented in Workshop Kesehatan Mental dan Pemulihan Trauma, Aliansi Jogja Recovery 2006. Unpublished Jachna, Joshua, “Bibliotherapy: What, Why, and How,” www.eaa.ee. Accesed on February 9, 2007 time 15.10 Jackson, Shelley A. 2001. “Using Bibliotherapy with Client in The Journal of Individual Psychology Vol. 57, Issue 3, Fall 2001. Kamalie, Lilian Mitchell, “The Application of Bibliotherapy with Primary School Children Living in a Violent Society,” www.uwc.ac.za. Accesed on February 9, 2007 time 15.00 Mcknight, Catherine D., etc, Posttraumatic Stress Disorder. Digital Published: 2007.
  • 15. McMillen, Paula and Dale-Elizabeth Pehrsson, “Bibliotherapy for Hospital Patients,” www.ir.library.oregonstate.edu/dspace/ bitstream/1957/438/ 1/JHL703McMillenRevisedJul30.doc. Accesed on October 19, 2007 time 10.00 Oslen, Marci. “School Psychologist: Guide for Using Bibliotherapy” in The Observer edition February 2006 Marci Oslen, Bibliotherapy: School Psychologists’ Report of Use and Efficacy. A Thesis in Brigham Young University: Unpublished: 2006. Pehrrson, Dale and Paula McMillen, “Bibliotherapy: A Collaborative Project for Training Counseling Student to Evaluate Literature,” www.osulibrary.oregonstate.edu. Accesed on February 9, 2007 time 15.00 Suparyo, Yossy, Aplikasi Bilioterapi untuk Klien Penderita Gangguan Kecemasan di Kantor Psikolog Prapanca Hari dan Rekan Yogyakarta. A Graduate Thesis, Unpublished: 2007 Tupattinaja, Josetta Maria Remila, “Cemas: Normal atau Tidak Normal” in www.library.usu.ac.id. Accesed on February 9, 2007 time 15.20 U.S. Department of Health and Human Services. “Terrorism and Other Public Health Emergencies: A Reference Guide for Media, http://www.hhs.gov/emergency Accesed on October 25, 2007 time 10.00
  • 16. Yossy Suparyo, student of Library and Information Science Dept, State Islamic University Sunan Kalijaga Yogyakarta and Mechanical Engineering Dept. Yogyakarta State Univerity. Activists of Posko Kemanusiaan Yogyakarta and Library and Information Studies Center (LISC).