As published in The PAPPC JOURNAL

The Pennsylvania Association on Probation, Parole and Corrections

Fall 2003

Volume 63, Number Two

BETHESDA Family Systems Counseling and Self Esteem  

By Jennifer Napp, Bethesda Day Treatment Center

Self-esteem is strongly correlated with school success.  According to Canfield and Siccone (1995), self-esteem is not a measure of a person’s capabilities, but of his or her evaluation of those capacities, representing one’s satisfaction with oneself as a person.  Healthy self-esteem provides a strong foundation for learning in class.  Research has demonstrated that self-esteem is an important issue to address because of its effects on academic achievement (Glenn & Nelson, 1998); Bartz & Matthews, 2001).

Students labeled as “at risk” are those who often are already surmised to be in trouble.  Characteristics of “at riskness” are: abusing drugs, selling drugs, pregnancy, sexual activity, delinquent behavior, unlawful behavior, adjudications, truancy, dropping out of school, and fraternizing in gangs (Caram, 2001; Cooley & Goertz, 1991).  Some studies have pinpointed a number of interrelated causes of school dropout, including poor grades, absenteeism, truancy, school discipline problems, and dislike of school (Bachman, 1991), while other studies have linked dropping out to a student’s background, school achievement, and behaviors and attitudes in education (Eberhard, 1989; Goertz, Ekstrom & Rock, 1991; Swisher & Hoisch, 1992).

The search for alternative solutions to address the problem of student misbehavior has resulted in the promotion, growth, and development of alternative education programs.  Alternative schools and programs for junior and senior high school “at risk” students are increasingly popular in school districts across the country, having grown because they provide school districts an alternative to expelling or suspending at-risk students who are not succeeding in the regular classroom (Upperman, Curcio, Fortune & Underwood, 1996; Fuller & Sabatino, 1996).  Students with greater self-esteem are more likely to be successful in academics.

An intervention for a child with low self-esteem would focus on long term goals such as having the student demonstrate the ability to verbalize affirmative self-descriptive statements on a regular basis and reducing the frequency of self-disparaging or self-doubting remarks (Van Ness, 1995).  The immediate goal of a self-esteem intervention would include for the child the establishment of a close and trusting relationship with a therapist and significant others, which would be demonstrated by the open sharing of feelings.  A successful short-term objective for a student with low self-esteem would be to verbalize reasonable and attainable personal goals and to identify sources of low self-esteem and feelings of insecurity (Van Ness, 1995).

The focus of this research study was on the Bethesda Alternative Education Program, which provides individualized educational services for youth, ages 10 to 18, who have failed or been removed from public school settings.  The non-profit agency, Bethesda Day Treatment Center, Inc., served as the setting of the study and was originally established to provide intensive intervention in the community for troubled youth and court-referred juveniles with a high risk of a life of failure.  Bethesda now serves Juvenile Probation Departments and Children and Youth Agencies in over 21 counties in Pennsylvania, providing one of the most comprehensive program structures in the country, with a six-fold service menu designed for every type of need including:

1)   After School Evening Day Treatment Services consisting of 6 day a week intervention providing individual, family, and group counseling in addition to caseworker monitoring of students living at home.

2)   A state approved Alternative Education Program for those youth that have been removed from public school settings:

3)   Bethesda Family Systems Counseling developed for “High risk” families, to defuse conflict and bring about family healing;

4)   Licensed Drug and Alcohol Counseling, which provides outpatient treatment to those youth and family members who are caught in abuse patterns;

5)   Licensed Specialized Foster Care, which provides a structured secure home environment and the after school evening treatment component;

6)   Bethesda Adolescent Boys Group Home, which provides a disciplined residential environment for those clients who are inappropriate for foster care placements.

The essence of the agency’s intensive community-based approach is found in its behavioral management strategies and Bethesda Family Systems Counseling.  The behavioral management approach focuses upon keeping a client’s behavior in check, whereas the Bethesda Family Systems Counseling component focuses on core issues in healing a hurting heart.  Both systems work together, bringing a well rounded, balanced approach in dealing with the youth (Herbst, 2001).

In December of 1987, the Bethesda Alternative Education Program was added to the existing menu of interventions out of the need to provide alternative educational services to students in the state where the agency is located.  The Bethesda Alternative Education Program is currently available to any child of elementary or secondary reading level.  It specializes in treating the needs of students with educational problems such as chronic absenteeism, persistent disregard for school authority, persistent violation of school policy and procedure, violent acts directed toward staff or other students, use of controlled substances on school property, serious misconduct in the classroom, and severe behavioral problems. 

Bethesda’s Alternative Education Program offers a low staff to student ratio of 1:5.  The learning environment is structured in such a way that students have constant supervision.  Caseworkers are trained to address behavioral difficulties and underlying emotional needs of the troubled youth. Other interesting aspects of the program are a “no suspension, no expulsion policy,” which is supported by staff being sent to search and rescue students who fail to report to school.  Students are referred to the Alternative Education Program for as few as 30 days or as long as the entire academic year. 

The experimental treatment consisted of eight weeks of an effective group counseling-based intervention called Bethesda Family Systems Counseling provided to students on a once-a-week basis.  The intervention is based in counseling which seeks to establish healthy relationships by focusing on four steps to emotional healing.  The steps are identified as follows: (1) admission and grieving, (2) confrontation and disclosure, (3) forgiveness and reconciliation, and (4) restoration and healing (Herbst, 2001).

Participants

All students who participated in the study were enrolled in two of the alternative education programs operated by Bethesda.  The center’s learning environment is designed to ensure that its’ students are both well supported and well supervised.  Students have constant supervision and access to caseworkers trained to deal with both the behavioral and emotional needs of the troubled youth.

The control group was established at one center and consisted of 25 students, three of whom were female.  The experimental group was located at the other center and consisted of 24 students, one of who was female.  The age range of students in both the control and experimental groups was 13 through 18.  The control group consisted of 22 Caucasian students, 2 African American students, and 1 student of Puerto Rican descent classified as Hispanic.  The experimental group consisted of 18 Caucasian students, 5 African American students, and 1 student who was unsure about his ethnicity due to no parental involvement in his life. 

Treatment

The experimental treatment consisted of eight weeks of counseling provided to students in weekly sessions.  The counseling is based on building healthy relationships and has Four Steps to Emotional Healing (Herbst, 2001).  The first step is known as admission and grieving.  During this stage, the student must become truthful about feeling the pain from being offended even if it occurred years ago.  Often the offender is one of the most important people in the life of the student and therefore the hurt is intensified.  Admission and grieving allow the student to be validated for his or her pain. 

The second step to emotional healing is known as confrontation and disclosure.  At this stage, the student is ready to confront his or her hurtful past and the offender who contributed to it.  A series of assignments are given to students, which take the form of letters.  The letters are required even if the offender is deceased or unknown to the student.  The opportunity to confront the offender provides the student with vindication from the shame and blame  that he or she may feel.   The confrontation takes place in a formal setting and often brings a powerful release of grieving, bringing the student closer to the place of healing and victory. 

The third step is known as forgiveness and reconciliation.  It requires a purposeful decision to let go of the pain and bitterness that once controlled the student.  At this stage, each student is required to count the cost of forgiveness by giving up a perceived right of vengeance.  The fourth step is known as restoration and healing.  Having completed the three previous steps to emotional healing, the student has progressed to a point of readiness to be reconnected with his or her past and emotions.  He or she experiences both emotional and relational healing.  This journey allows him or her to rebuild relationships with family and the community (Herbst, 2001).

Instrumentation & Procedure

The Coopersmith Self-Esteem Inventory was used in a pre-test and post-test manner.  The Coopersmith Self-Esteem Inventory contains a total of 58 questions; 26 of them applied to a “general” sub-scale, 8 to a “social self” sub-scale, 8 to a “home and parents” sub-scale, and 8 to a “school and academic” sub-scale.  All students were asked to complete the inventory to determine their levels of self-esteem prior to the intervention.  Experimental center students received weekly counseling for a period of approximately two months, after which time they were re-administered the Coopersmith Self-Esteem Inventory.  The control center students were also re-administered the Coopersmith Self-Esteem Inventory at this time to allow for comparison of gains across the two groups.   The effectiveness of the intervention was measured by differences between members and nonmembers of the counseling groups as demonstrated by an increase in post-test scores.

Data Analysis and Results

Data were analyzed using an analysis of covariance (ANCOVA) procedure with treatment as the independent variable, the designated post-test score as the dependent variable, and the corresponding pre-test score as the covariate.  Members of the experimental group were found to show significantly greater gains in scores on the social-self sub-scale (F=3.31, p=o.039) and on the home/parents sub-scale (F=6.15, p=0.009) in comparison to members of the control group.  There were no significant differences between the post-test scores of the experimental and control groups on the general self-esteem sub-scale (F=1.53, p=0.112) and the school/academics sub-scale (F=.106, p=0.373) when the effects of pre-test scores were factored out.

Discussion

Bethesda Family Systems Counseling as an intervention appears to be effective in increasing an adolescent’s self-esteem in two areas, (a) self-esteem in relation to home and family, and (b) self-esteem in relation to how one sees oneself socially.  This study provides evidence in support of the treatment validity of the group counseling used by Bethesda.  The stated objective of the treatment is improved relationships and resultant emotional well-being.  Non-significant findings in the areas of general self-esteem and academic self-esteem are not surprising when one considers that the treatment was designed to address the more social and interpersonal aspects rather than the global and academic.  These results provide support for interventions for adolescents based on the restoration or development of healthy relationships based in effective communication strategies.  Whether these self-esteem gains lead further to improved academic performance or decrease the potential for dropping out of school is left unanswered at this time.  Further studies to establish a relationship between treatments such as this and the successful completion of high school will be needed.  As a result of such encouraging results, Bethesda Family Systems Counseling is now being taught in every Bethesda Alternative Education Program once a week for the duration of the school year.  Students are indicating that not only is it helping them with forming healthy relationships and open communications, it is also aiding them in anger dissolution.

References

Bachman, J., (1991).  Dropouts, school. In R. M. Lerner, A.C. Peterson, & J. Brooks-Gunn (Eds.), Encyclopedia of Adolescents,  (Vol. 1, A-L, pp. 254-255). New York & London: Garland

Bartz, D., Matthews, G., (2001). Enhancing students’ social and psychological development, The Education Digest, 66 (7), pp. 33-6.

Canfield, J. and Siccone, F. (1995). 101 Ways to Develop Student Self-Esteem and Responsibility. Boston: Allyn and Bacon.

Caram, C. (2001). The best kept secret in at-risk education.  Kappa Delta Pi Record,

Coley, R., & Goertz, M., (1991). At risk youth, state policies. In R.M. Lerner, A.C. Paterson, & J. Brooks-Gunn (Eds.), Encyclopedia of Adolescents, (Vol 1, A-L, pp. 65-68). New York & London: Garland.

Eberhard, C. (1989). American Indian education: A study of dropouts, 1980-1987. Journal of American Indian Education, 21 (1), pp. 32-40.

Fuller, G., & Sabatino, D. (1996). Who attends alternative high schools?  The High School Journal, 79 (4,) pp 293-297.

Glenn, H.S. and Nelson, J. (1988). Raising self-reliant children in a self-indulgent world: Seven building blocks for developing capable young people. Rocklin, CA: Prima.

Goertz, M., Ekstrom, R., & Rock, D. (1991). In R.M. Lerner, A.C. Paterson, & J. Brooks-Gunn (Eds.), Encyclopedia of Adolescents, (Vol. 1, A-L, pp. 250-253). New York & London: Garland.

Bethesda Day Treatment Center, Inc., (2001). Bethesda Family Systems Blueprint Manual.

Swisher, K., & Hoisch, M., (1992). Dropping out among American Indians and Alaska Natives: A review of studies. Journal of American Indian Education, 31 (2), pp 3-23.

Upperman, J., Curcio, J., Fortune, J., & Underwood, K. (1996). Options for everyone. American School Board Journal, 183 (1), pp 31-35.

Van Ness, R. (1995). Raising Self-esteem of Learners. Bloomington, IN: Phi Delta Kappa International.  

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