Journal of critical reviews 623
ISSN- 2394-5125 Vol 7, Issue 13, 2020
THE EFFECTS OF GROUP COUNSELLING
Yusni Mohamad Yusop1
, Zaida Nor Zainudin2
, Wan Marzuki Wan Jaafar3
, Wan Norhayati Wan Othman4
, Dini Farhana Baharudin4
& Nathynie a/p Arokianathan5
12346Faculty of Educational Studies, Universiti Putra Malaysia
5Faculty Of Leadership And Management, Universiti Sains Islam Malaysia Email:*email@example.com
Received: 15.04.2020 Revised: 16.05.2020 Accepted: 11.06.2020 Abstract
Group counselling is widely known in the field of counselling. This systematic review explores on the benefits of group counselling on group members who had undergone group counselling sessions. This systematic review is conducted following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Electronic databases are used, namely Cambridge University Press, Emerald and ProQuest. Furthermore, Google Scholar website is utilised. The search term used is “Effect”, “Group Counselling” and other relevant derivations, focusing on the benefits of group counselling. Only research articles in the form of quantitative research are included. The countries of the articles in this systematic review were from various countries namely Turkey, Jordan, Netherlands, Iran and United States. 10 journal articles extracted were reviewed. Results showed positive effects of group counselling on group members based on six major aspects. Social aspect includes increase in communication skills.
Physiological aspect depicts decrease in Premenstrual Syndrome symptoms. Emotional aspect shows decrease in trait anger and anger repression. Psychological aspect depicts increase in mental health and decrease in anxiety. Cognitive aspect includes increase in knowledge and decrease in automatic thoughts. Behaviour aspect includes decrease in problematic Internet use and increase in positive attitude. In conclusion, it is proven that group counselling benefits the society in various aspects.
Key words: Effect, group counselling, quantitative, systematic review
© 2020 by Advance Scientific Research. This is an open-access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) DOI: http://dx.doi.org/10.31838/jcr.07.13.109
Population of group counselling
According to UNESCO (2018), group counselling can consist of several populations, namely children, adolescents, young adults, middle-aged people and the elderly. Children with behavioural issues, such as violence, extreme withdrawal and chronic fatigue are suggested to join group counselling.
Children have the chance to express their feelings regarding wide range of personal issues in small groups. Due to inner turmoil, children often face learning issues. Some children experience anxiety due to disturbed family relationships and broken homes. These children can receive psychological help at early ages if the group is properly structured. They are also able to deal with tasks effectively which they encounter in the future (Corey, 2012; UNESCO, 2018).
The objective of this review is to determine the effect of group counselling to clients across ages. There are different issues facing by adolesncent, adult and elderly. This paper try to identify wahat is the approach that may help those group with different issues. It is well known that adolescents require closeness, but are afraid of intimacy and frequently avoid it.
They are usually rebellious. Also, they view limits as a caring sign. They are expected to act as if they have full autonomy, but are not treated as mature adults. The issues normally faced by adolescents are conflicts of acceptance or rejection, struggles of dependence or independence, identity crises and more. Due to the stresses in this stage of life, it is normal for them to feel helpless. Hence, group counselling is effective to deal with isolation feelings because it provides them with a means to express conflicting feelings, explore self-doubts, and find out that they and their peers have similar concerns.
During group counselling, they can openly question their values and freely speak about their deepest worries. They also learn to communicate with group members and take advantage from modelling shown by the leader. Moreover, the special value of group is that it offers adolescents an opportunity to be instrumental for each other's development and change. Members are able to assist each other in gaining more self-acceptance (Corey, 2018; UNESCO, 2018).
Adults of all ages may develop various special interest groups.
For instance, there are couples, single parents, parents who have children issues, middle-ages people who change careers or continue to pursue their studies, and more. These groups provide a chance to explore methods of changing particular aspects of lives. During group counselling, college pupils of all ages face many distinct problems, such as couple relationships, career decisions, love issues, meaning of life, education plans and more (Corey, 2012; UNESCO, 2018).
Elderly people may resign themselves to a useless life because they see little in their future. They frequently feel unproductive, unwanted and unneeded by society. Also, they have uncritically accepted myths regarding ageing. Normal issues during this stage are losses, poverty, rejected feelings, loneliness, social isolation and despair, among others. They need a listening ear, and be understood. When people accept them, they see it as respect. They need listening ears and not patronizing act for acceptance. Group counselling assists elderly people to challenge the myths that limit their lives.
Also, they are better able to face developmental tasks. Groups can also motivate them to find a new meaning to life (Corey, 2012; UNESCO, 2018).
Purposes of groups
There are many purposes of group counselling. Group members learn not to demand for perfection. Instead, they have self-acceptance. They also foster self-knowledge and a special self-identity development. Members learn how to trust themselves and others. Their fears for intimacy also decreases and they learn to approach those who they desire to be closer to. Their self-awareness is also increased. Group members make decisions for themselves regarding standards of living instead of meeting others’ expectations. They are aware of their decisions, and to make wise decisions. Other than becoming more sensitive to the feelings and needs of others, they seek methods of comprehending and resolving their personal issues (UNESCO, 2018).
Stages of group process
There are mainly six stages of group counselling, namely pre-
Journal of critical reviews 624 group issues, initial stage, transition stage, working stage, final
stage and post-group issues. During pre-group issues, which is formation of the group counselling, its rationale is clarified.
Planning is crucial because groups can flounder if members are not selected and prepared with care.
When announcing a group and recruiting members, the types of people joining the group is impacted by the way a group is announced. One of the best ways to recruit members is personal contact with potential members. The group leader may demonstrate with enthusiasm that the group has potential value to somebody (Corey, 2012; UNESCO, 2018).
Screening and selecting members is conducted by having pre- group interview with prospective members. The leader then chooses the members which have the same needs and goals to the established goals of the group. A half-hour interview may consist of questions such as the reason of the person joining the group (Corey, 2012; UNESCO, 2018).
After screening of members and forming a group, it is beneficial to have pre-group session with all chosen members.
This meeting may be an extended version of the individual screening process, since it is an ideal method to present fundamental information, assist members in getting to know each other, assist members to decide about committing themselves to the group or not, and more. Ground rules have to be established based on the nature of the group. For instance, members are not allowed to use verbally abusive words in the session. The rules may be in the written contract where they can sign. They have to know the leaders’
expectation of them in the group counselling (UNESCO, 2018).
During stage two, which is the initial stage, orientation and exploration occurs. Group members get acquainted. Members display socially acceptable behaviours. Group cohesion is gradual when members are willing to share their thoughts and feelings. In this stage, there is a central issue of trust versus mistrust. Members also may be passive and wait for things to occur instead of initiating. In this context, leaders have to deal with members’ questions and concerns openly. They also have to model therapeutic behaviours (Corey, 2012).
In stage three, the transition stage occurs. Members deal with resistance at this stage. Group members may have anxiety and defensiveness. For instance, they may be anxious that others see their true self and not their masked self. They may begin to recognise and deal with conflicts. Other than challenging group leaders, they may be resistant, which blocks them from exploring personal or painful matters. Leaders play a role in encouraging members to remember why they are in the group, their purpose and goal (Corey, 2012).
Stage four is the working stage, where there is cohesion and productivity in the group counselling. There is a focus of here- and-now. Members are also willing to work outside the group in order for behavioural changes to occur. The therapeutic factors occurring in this stage are trust, acceptance, empathy, intimacy, hope, freedom to experiment, cognitive restructuring, commitment to change, self-disclosure and confrontation, among others. Leaders play a role in providing systematic reinforcement which fosters cohesion and productive work (Corey, 2012).
Stage five is the final stage, where consolidation and termination occurs. In this stage, members deal with feelings, such as separation feelings among group members. Members also examine the effects of the group on themselves.
Feedbacks are given and received with open-mindedness. At this stage, members decide or plan how to use what they learned in daily life scenarios. Leaders can create aftercare plans for members to be applied in future (Corey, 2012).
Stage six is the last stage, which is postgroup issues. There are evaluation and follow-up in this stage. During this stage, they can share the obstacles they encountered along the way, moments of joy or sadness, and more. Leaders are also
suggested to conduct one-to-one follow up sessions after the group counselling ended. This shows members that leaders care for each of them. Also, leaders are able to determine the extent of each member in achieving their goals (Corey, 2012).
Overall, group counselling can be categorised into various populations, has many meaningful purposes and has systematic stages and process which occurs in group counselling sessions.
METHODOLOGY Search strategy
This systematic review is conducted following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Electronic databases are used, namely Cambridge University Press, Emerald and ProQuest.
Furthermore, Google Scholar website is used. The search term used is “Effect”, “Group Counselling” and other relevant derivations. The flow diagram is depicted in Figure 1.
Figure 1. Flow diagram for selection review of studies on the effects of group counselling to the clients.
All articles from various journals are from January 2013 to October 2018, which is at most five years back. Only research articles in the form of quantitative research are included in this systematic review. Moreover, articles only in English language are used. Subject area related to counselling is included, which are Psychology, Social science and Arts and humanities. The countries of the articles in this systematic review are from various countries such as Turkey, Jordan, Netherlands, Iran and United States. The inclusion criteria is depicted in Table 1.
Journal of critical reviews 625 Table 1: Inclusion Criteria Of The Systematic Review
Studies of qualitative research are excluded. Also, reviews, book chapters and books are excluded. Subject areas which are irrelevant to this area is excluded, namely Business, management and accounting, and Economics, econometrics and finance. The inclusion criteria is depicted in Table 2.
Table 2: Exclusion Criteria Of The Systematic Review
The flow of the systematic review (Figure 1) started with initial search using the terms group counselling, effectiveness, approach, and effects. The search was followed by including the year of publication, population, article type, and subject area as shown in Figure 1. There were 1993 papers found related to the key terms in the search. Only 1234 of the papers were published from year 2010 to 2019. The retrieved papers were screened based on their titles and abstracts. 653 of the papers were selected due to the subject area in psychology, social science and art and humanities. Articles then narrowed down to 34 which included approach and effects of group counselling. Besides, this review excluded articles from medicine, business, management and accounting, economics and finance, engineering, and health professions. The articles from books were also excluded. Finally, 10 out of 16 literatures were selected from different journal sources.
FINDINGS AND DISCUSSION
Findings were tabulated based on six major aspects. Social aspect includes increase in communication skills. Physiological aspect depicts decrease in Premenstrual Syndrome symptoms.
Emotional aspect shows decrease in trait anger and anger repression. Psychological aspect depicts increase in mental health and decrease in anxiety. Cognitive aspect includes increase in knowledge and decrease in automatic thoughts.
Behaviour aspect includes decrease in problematic Internet use and increase in positive attitude.
SOCIAL ASPECT Communication skills
According to Erden (2015), there are mean differences between pre-and post-test scores for communication skills of mothers. When comparison between pre and post-test scores were made, it is found that mothers’ communication skills increased.
Premenstrual Syndrome symptoms
According to Khodakarami, Babakhani, Masoumi and Farhadian (2017), the intervention group, as compared to the control group, experiences significant decrease in the syndrome severity after consultation sessions (P<0.001). The outcome of this research and other similar studies revealed
that group counselling has a significant role in decreasing the severity of Premenstrual Syndrome (PMS) symptoms. After the intervention, the range of the intensity of the symptoms in the test group was like this before the intervention: 38.3%
moderate and 61.7% severe, which decreased to 36.7% mild, 46.4% moderate, and 16.7% severe. This proved the efficacy of the implemented intervention. The finding is in line with Dastyar, Safarzadeh, Moharer & Navidian (2018) indicated that group assertiveness counselling had a positive effect on the marital satisfaction of female students.
Trait anger and anger repression
According to Üzar-Özçetin and Hiçdurmaz (2017), after counselling, the trait anger scores and anger repression scores of the counselling group were significantly lower, when compared with the pre-counselling and control group scores.
There is a significant difference in the anger control scores of the counselling group with time after the group counselling.
This shows that post-counselling anger control score of the counselling group was statistically higher than its pre-coun- selling score. As compared to the control group, the counselling group had higher levels of anger control and repression scores and lower trait anger scores after the counselling. Participants mentioned an improved awareness about their anger symptoms and mechanisms, and resourcefulness relevant to their anger management skills.
PSYCHOLOGICAL ASPECT Mental health components
According to Talebi, Nooripour and Taghizadeh (2013), comparison of the results of tests on the pre-test and post-test revealed that group counselling based on cognitive- behavioural significantly improve mental health components students in the experimental group as compared to the control group. When comparing experimental and control groups, there is a significant difference in mean levels of mental health disorders, social interaction and amount of physical and psychological symptoms. The impact of group counselling approach based on cognitive-behavioural and mental health is in good stability during time. This findings supported by Abbasi, Mahmoodi & Ziapour (2017) that group counselling support psychological weel-being among divorce women.
According to Odacı and Çelik (2017), the difference between the mean pre- and post-test life satisfaction levels scores for the study and control groups is significant to a .05 level.
Reality therapy-based group counselling significantly increases levels of life satisfaction among college students.
Psychological and satisfaction outcomes
According to Otten, Birnie, Ranchor, van Tintelen and van Langen (2015), after counselling, median Personal Perceived Control (PPC) and State and Trait Anxiety Inventory (STAI) scores displayed significantly higher control and lower anxiety. Patients reported they were contented with the counsellors. Most of the participants stated that they would participate in a group counselling session again if genetic counselling would be necessary (87.7%), and would suggest it to their family members (81.4%).
According to Abood and Abu-Melhim (2015), REBT was more effective in decreasing the level of anxiety for English learners as compared to the absence of using remedial program for members of the controlled group. Statistical analysis depicted a statistically significant difference between the experimental group and the controlled group (α= 0.05). Since REBT affects students' knowledge and thinking behaviour trends, it is very impactful in group therapy as a means to decrease foreign language anxiety. Foreign language learner's anxiety feelings increased if REBT was not used especially in the beginning stages, when comparison between using or not using REBT as a treatment program was conducted.
Journal of critical reviews 626 According to Rouzbeh, Namadian, Shakibazadeh, Hasani and
Rouzbeh (2017), as compared to the control group, mean scores of anxiety (p = .036), body dissatisfaction (p = .002), cancer fatalism belief (p ≤ .0001), and self-efficacy (p ≤ .0001) were improved in the intervention group. Between the experimental group and control group prior to intervention, there was no significant difference found between the intervention and control groups for demographic or outcome variables at baseline. After the intervention, the mean anxiety- level scores among participants in the intervention group decreased from 15.40 (SD = 10.82) at the baseline to 9.85 (SD
= 7.10). In contrast, the mean anxiety level scores in the control group did not alter during the research. The dissatisfaction of body score was also improved from 24.85 (SD = 2.82) at baseline to 28.25 (SD = 2.82). The cancer fatalism score was 61.95 (SD = 8.98) in the intervention group at baseline and plunged to 48.15 (SD = 11.82). The self-efficacy score was increased from 29.15 (SD = 6.88) in the intervention group at baseline to 45.25 (SD = 3.83). The covariance analysis depicted that the group counselling with problem-solving approach was positively impactful and improved the variables of anxiety (f = 15.316; p ≤ .0001), body dissatisfaction (f = 16.978; p ≤ .0001), cancer fatalism (f = 23.608; p ≤ .0001), and self-efficacy (f = 46.503; p ≤.0001). In addition, group counselling can reduce the stress and anxiety of the family of primiparous mothers too which identified by Alaem, Almasi, &
COGNITIVE ASPECT Automatic thoughts
According to Erden (2015), there are mean differences between pre-and post-test scores for automatic thoughts of mothers. When comparison between pre and post-test scores were made, it is found that mothers’ automatic thoughts reduced. Results revealed that mothers’ automatic thoughts significantly plunged after the group counselling and the effect of application is continuous. This review is consistent with Azar, Majid, Ali & Mahmood (2012) stated that group counselling helped group members restructuring on mental by making a specified change in depest thoughts, feelings and action. The study used REBT Approach in helping parents of exceptional children.
According to Gammon, Otto, Wick, Borowski and Allyse (2017), in terms of prenatal testing and screening knowledge, participants knew before the group counselling session that first and second trimester screening emphasized at Trisomy 21. Session participants depicted more understanding of the limitations of first and second trimester screening, specifically conditions that are not screened. In particular, more participants knew that first and second trimester screening is unable to screen for deafness (p < 0.0001), cleft palette (p <
0.0001), cystic fibrosis (p = 0.0002), autism (p = 0.008), or the broad category of Bany genetic condition (p = 0.001) after the session than prior. The majority (88.7%) trusted that first and second trimester screening could screen for trisomy 13 although fewer participants mentioned they were not sure after the session if first or second trimester screening screened for trisomy 13, and there was only a 5.2% increase in those choosing the correct answer. A similar trend in responses happened regarding the ability of first and second trimester screenings to screen for neural tube defects. After the session, significantly more patients had knowledge that chemical markers in maternal serum (p = 0.0004) were assessed in first and second trimester screening, not the baby’s DNA (p < 0.0001). Significantly more patients had the knowledge that first and second trimester screening is unable to provide a definitive result (p = 0.0006). After the session, while the amount of participants who understood that first and second trimester serum screening does not look at cell- free DNA increased significantly, most of the participants (56.8%) still believed that cell-free DNA was analysed. Before the genetic counselling, many participants knew that cfDNA screening can screen for Trisomy 21, Trisomy 13, and Trisomy 18. During the counselling session, participants learned that
cfDNA screening is unable to screen for neural tube defects (p
= 0.01), deafness (p = 0.001), cleft palette (p < 0.0001), cystic fibrosis (p = 0.003), autism (p = 0.007), or any genetic condition (p = 0.004). After the session, significantly more participants picked the correct answer. After the session, significantly more participants knew that cfDNA screening is unable to provide a definitive outcome for a given condition (p
< 0.0001). After the session, there was also a significant increase in the participants’ number who knew that cfDNA screening assess placental DNA (p < 0.0001); in contrast, 38.9% of participants still thought cfDNA screening did not assess placental DNA. Also, before and after the session, most of the participants believed that cfDNA screening looked at maternal DNA, foetal DNA, and chemical markers in the mother’s blood. After the session, significantly more patients knew that an amniocentesis or CVS is able to provide a result for a given condition with a high certainty level (p = 0.0001).
Moreover, more patients knew that CVS assessed placental DNA (p < 0.0001). However, while fewer patients were not sure after the session as to whether an amniocentesis assessed placental DNA (p < 0.0001), the number of participants picking Byes and the number of participants picking Bno increased, revealing continued confusion.
According to Soltani, Majidi, Shobeiri, Parsa and Roshanaei (2017), 98.6% of the case group and 100% of control group had low-to-moderate level of knowledge about perinatal cares before the intervention. The level of knowledge of the control group did not change after the intervention (P = 0.567).
Another research found that group counselling enhance the knowledge a,ong maritak couple. Ziapour, Mahmoodi, Dehghan, Mehdi, Hoseini, Azami & Rezaei (2017) indicated that group counselling based on acceptance and commitment approach could increase marital adjustment of couples when their have gain and share as many information, knowledge and experience among group members.
BEHAVIOUR ASPECT Problematic Behaviour
Group counselling could help clients with problematic behaviour. According to Odacı and Çelik (2017), the addiction of internet can be reduced when there is a significant differences between the mean pre- and post-test problematic internet usage scores for the study and control groups is significant to a .05 level. Using Reality therapy-based group counselling significantly decreases the problematic internet use level among college students. While Mark D & Raymond (2010) did a research on alcohol abused identified that group counselling helped the group members who are alchohol abused, reduced the alchohol intake. This study applied the REBT Approach in the group session.
According to Soltani, Majidi, Shobeiri, Parsa and Roshanaei (2017), 86.1% of case group and 81.9% of control group had a positive attitude to join perinatal cares for their wives and none of them had a poor attitude in this regard before the intervention. However, positive attitude level in the case group increased after the intervention (95.8%), and there was a significant difference before and after the intervention. In different research, group counselling helps group members to enhance the positive attitudes especially in control weight. Liu, Wen & Jia (2017) indicated that group based therapeutic programme can protect women with overweight from an increase in overall self esteem, personal value, slimming, oral inhibition and perceived control of emotions and feelings and a decrease in overeating. Group counseling also help to restructured a positive attitude. Mohammad Nasir, Samsiah, Aslina, Amelia, Ahmad Jazimin, Muhammad, Noraini, Faizura &
Mohd Noor (2015) helped adolescents group towards the resilient of drug abuse risk.
There are many benefits of group counselling in terms of using theories such as REBT, cognitive-behaviour, Reality Therapy, and as a general group counselling. According to Odacı and
Journal of critical reviews 627 Çelik (2017), findings of their research revealed that reality
therapy based group counselling significantly plunges problematic internet usage levels among college students and increases their life satisfaction levels. For Abood and Abu- Melhim (2015), the application of REBT as a group therapy program to decrease anxiety is a very effective tool in assisting foreign language learners to overcome their fear of learning a foreign language. REBT helps to extinguishing the anxiety and fear connected with foreign language learning in general and English learning in particular by effectively decreasing sensitivity towards learning English as a foreign language and decreasing the fear and anxiety connected with the language learning process. Talebi, Nooripour and Taghizadeh (2013) concluded that group counselling based on cognitive- behavioural on mental health in gifted pupils was effective in experimental group when compared with control group.
Moreover, it increases aspects of general health, namely depression aspect, anxiety aspect, social interaction disorder and physical symptoms. This type of counselling can be applied as an effective and efficient intervention for psychotherapy and counselling.
According to Gammon, Otto, Wick, Borowski and Allyse (2017), group genetic information sessions combined with abbreviated genetic counselling did not alter women’s minds about their screening or testing choices. However, women made more informed choices and had more confidence in their choices. Group counselling sessions is a possible alternative.
However, it must be conducted with care and attention. Group information sessions is able to reduce the barriers of time, limited staff, familiarity with details of specific screening choices, and help to improve patient knowledge and confidence. In order to educate and assist patients in making informed choices regarding their prenatal screening and testing options, group prenatal genetic information sessions conducted by genetic counsellors are an efficient method.
Otten, Birnie, Ranchor, van Tintelen and van Langen (2015) stated that group genetic counselling in cardiogenetics is a feasible, accessible, and psychologically effective method of counselling huge numbers of symptomatic cardiomyopathy patients. According to Khodakarami, Babakhani, Masoumi and Farhadian (2017), group counselling has a significant role in decreasing the severity of PMS symptoms. Hence, it is more reliable to validate the effect of this counselling on the treatment of PMS syndrome.
Erden (2015) mentioned that participation in group counselling program caused decrease in negative automatic thoughts and increase in communication skills. Hence, it facilitates to decrease their parental stress, and to increase realistic and healthy perceptions about adolescent feelings, thoughts and behaviours. The differences in this research depicted the importance of these types of program. With the development of such programs, it is crucial to see that the participants will both save their psychological mental health and have healthy relationships with their children. In this sense, the new and practical researches are thought to be in the preventive, protective and developer characteristics.
According to Soltani, Majidi, Shobeiri, Parsa and Roshanaei (2017), there is effect of educational interventions to increase the knowledge and attitudes of men as one of the largest encouragers of maternal and child health. Hence, specific attention should be provided to consulting and training men in the perinatal care field. In the study conducted by Üzar- Özçetin and Hiçdurmaz (2017), structured group counselling improved the students’ anger management skills. Moreover the study of Somayeh, Tayebe, Katayoun, Fatemeh, Ahmad &
Mahin (2018) identified that group counselling helped mothers learn and apply better the problem-solving skill in their life, leading to their enhanced marital satisfaction. Hence, such programs should be integrated into the services prepared for nursing students.
In conclusion, group counselling is proven to be effective for clients. Group counselling reduce anxiety levels, decrease automatic thoughts, increase communication skills, increase readiness for decision making, increase knowledge, decrease Premenstrual Syndrome symptoms, decrease problematic Internet use, increase life satisfaction, increase control, increase self-efficacy, increase attitude, increase mental health components such as social interaction, and decrease trait anger and anger repression. Counsellors should conduct more group counselling in order to benefit clients in their societies to achieve better overall mental health.
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