Less Fearful, More Active: Group Counselling
The gesture dance during the closing CBI at Nuri Bermek Primary School, Kocaeli.
Photograph by Yakut Temiroğlu-Sundur © UNICEF Turkey 2000
While the CBI proved to be successful in facilitating and accelerating a return to normalcy for most of the affected children, a number of the more severely affected, requiring additional support, were easily identified as being at risk by counsellors during the course of the sessions. These children had problems concentrating, were reluctant to take part in community games, showed a lack or an excess of initiative and, at times, a manifestly aggressive nature.
UNICEF’s approach took two paths. The first, additional to the CBI, entailed seven sessions of Group Counselling (GC) by counsellors trained and equipped with the necessary tools. Children with more severe traumatic reactions would be referred through the Guidance and Research Centres by CBI counsellors themselves. The second approach was to establish a fully functioning referral system between the Psycho-social School Project and the MOH mental health referral system. A manual developed by the CCP/Foundation for Children in War was translated into Turkish and revised. Training seminars were held in April for sixty counsellors and members of NET.
The Group Counselling Process
The main body of the course was structured in five parts for groups of six to eight children. Group Counselling addressed intrusive thoughts, distressing memories and emotions and dealt with symptoms of hyper-arousal by teaching relaxation and focusing techniques in order to dispel worries and aid concentration. Relaxation problems and sleep disorders, the symptoms of physiological arousal, were also dealt with. Thought management techniques were taught in order to counter avoidance reactions -- the cause of distracted and inattentive behaviour. The sessions involved practical instructions and activities with homework assignments designed to consolidate skills learned in the group setting. An additional two sessions involved parents in order to strengthen bonds and improve understanding of the child’s experience at home.
| Earthquake experiences | 12-16 yrs | 6-11 yrs |
|---|---|---|
| Temporary separation from both parents | 19.4 | 11.3 |
| Temporary separation from either parent | 22.6 | 21.2 |
| The child was injured | 16.1 | 5.7 |
| A loved one was injured | 48.4 | 22.1 |
| The child witnessed injury to others | 51.6 | 25.5 |
| An immediate family member died | 61.3 | 33.6 |
| A relative died | 29.9 | 18.1 |
| A friend died | 41.9 | 12.3 |
| A neighbour died | 16.1 | 12.5 |
| The child saw someone dying | 19.4 | 5.4 |
| The child saw dead bodies | 48.4 | 17.4 |
| The child saw dismembered bodies or body parts | 35.5 | 5.8 |
| The child carried or touched a dead body | 16.1 | 4.8 |
| The child thought he or she might die | 67.7 | n/a |
| Home was moderately or severely damaged | 29.1 | 59.7 |
| Belongings or property lost | 38.7 | 47.5 |
| The child saw a building collapse | 22.7 | 33.5 |
| The child was rescued from rubble | 1.9 | 3.3 |
Evaluating Group Counselling
By the end of the the pilot phase of GC in January 2001, a hundred and fifty children had been reached. A sample group was made up of two sub-samples of sixty-two adolescents of 12-17 years of age and forty-six children of 6-11 years. Each sub-group was divided so that half of the children received GC and the second, being the control group did not. Great care was taken to match the subjects in the control groups with the GC participants in terms of symptom severity, earthquake experiences and other demographic characteristics.
What Did Group Counselling Achieve?
Comparisons between GC participants’ symptoms and those of the control group showed that while the GC participants improved on all measures of post-traumatic stress, high-risk for PTSD subjects in the control group either stayed the same or became slightly worse over time. The only exception was that avoidance symptoms decreased over time in the control group. The results clearly highlighted the persistent nature of post-traumatic symptoms in highly traumatised individuals who do not receive treatment. In general, GC proved to be a highly effective intervention for the reduction of post-traumatic symptoms in adolescents, particularly those who were most affected by the earthquakes.
Conversely, this part of the programme appeared to have little or no effect on the younger children. Possibly the interventions were not sufficiently sensitive to the needs of young children or, it is equally possible that real improvements may have been achieved, but that the measures for symptom change were not as accurate as the assessors would have liked. It should be noted that assessment tools such as the Demographic Information and Earthquake Experiences Questionnaire and the PTSD and Perceived School Performance Scales were completed by parents in the case of the younger group and that as such, the data compiled was less than adequate since they tend to over/under-estimate their children’s symptoms.
Between May 2000 and June 2001, four hundred and twenty-four students and their parents had been reached through Group Counselling. The sessions are set to continue. In order to replicate the programme’s success with adolescents, it has been suggested that it would be more helpful to develop interventions which are sufficiently sensitive to the needs of younger children. Furthermore, an accurate method of collecting symptom measures from the younger children themselves would enhance evaluation and therefore improve the programmes general performance.
The fully illustrated text of Less Fearful, More Active is also available for download in print-ready pdf format. [PDF 1.25MB]
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