EFFECTIVENESS OF SUPPORTIVE GROUP THERAPY ON THE SELF ESTEEM OF PATIENTS WHICH SCHIZOPHRENIA AT SOEJARWADI KLATEN MENTAL HOSPITAL: A BASIS FOR CUSTOMIZED THERAPEUTIC SUPPORTIVE THERAPY MODULE Ririn Wahyu Widayati Dosen tetap S1 Ilmu Keperawatan Universitas Respati Yogyakarta Abstract Background: Schizophrenia is a mental disorder characterized by a breakdown of thought processes and by a deficit of typical emotional responses and behavior, (Videbeck, 2008). A person with mental disorders often shows maladaptive coping responses (Shives cit Handy, 2005). People who do not have a good self-concept develop low self-esteem. Therapeutic psychiatric nursing action for a client who had a low self-esteem can either be generalist or specialist. Group psychotherapy is supportive group therapy. Supportive group is a collection of people who plan, organize and respond directly to the issues and pressures in special or adverse circumstances. The initial purpose of which is to establish support and complete the isolation of the experiences of each member (Grant-Iramu, 1997 in Hunt, 2004). Statement of the Problem: Knowing difference on the self-esteem level among schizophrenia patients after the suportive group therapy when classified according to control and experimental group. Research Method: The researcher used a quantitative research approach to the design of "quasi experimental with design". The population in this study consists of schizophrenic patients who have self-esteem poblems. The number of samples in this study, which is sixty (60) is divided into two groups: thirthy (30) for the experimental group and the other thirthy (30) for the control group. Technique samples in this study used the Non-Probability Sampling. The technique used in this study is a combination of consecutive and quota sampling technique because of the difficulty in choosing subjects. the statistical tools applied were as follows Mann Withney U Test. Results:The mean level of the schizophrenia patients in the control group after the supportive group therapy obtained the overall weighted mean of 2.68 interpreted as “minimal level” and 2.48 in the experimental group and interpreted as “moderate level”. The mean difference after the group therapy in terms of affective domain got the weighted mean of 2.51 in the control group interpreted as “moderate level” and 2.47 interpreted as “moderate level” in the experimental group. The mean level after the supportive group therapy in terms of physiologic domain got the weighted mean of 2.16 which is “moderate level” in the control group and in the experimental group the weighted mean is 1.90 interpreted as “moderate level”. The mean level after the supportive group therapy in terms of behavior got the weighted mean of 2.26 with verbal interpretation of “moderate level” in the control group and 2.18 interpreted as “moderate level” in the experimental group Conclusions: Based from the result of the findings of the study, a customized supportive group therapy module was developed for patients with low self-esteem Keywords: Schizophrenia, Low Self-Esteem, Supportive Group Therapy

INTRODUCTION Mental health is the state of feeling healthy

mental disorder (Nurdwiyanti, 2008). A person with

happy and being able to cope with life's challenges to

mental disorders often shows maladaptive coping

accept others as they are. It creates a positive attitude

responses (Shives cit Handy, 2005). Maladaptive coping

towards self and others. An estimated 50 million or 25%

responses are indications of failure to respond adaptively

of the entire population of Indonesia is experiencing

caused bylow self-esteem. Low self- esteem is a

maladaptive coping in self-concept. The concept of self is

result in patient‟s behavior as observed in increased

all thoughts, and beliefs that are individual's knowledge

adaptive behaviors.

about himself that affect relationships with others (Stuart,

Another group psychotherapy is supportive

2009). People who do not have a good self-concept

group therapy. Supportive group is a collection of people

develop low self-esteem. Low self-esteem can be

who plan, organize and respond directly to the issues and

described as negative feelings, including loss of self-

pressures in special or adverse circumstances. The initial

confidence (Stuart, 2009).

purpose of which is to establish support and complete the

Therapeutic psychiatric nursing action for a client who had a low self-esteem can either be generalist

isolation of the experiences of each member (GrantIramu, 1997 in Hunt, 2004).

or specialist. Generalist nursing actions strengthen the

Supportive therapy aimed to provide support

positive aspects of the client with the assistance of

between group members Coppersmith (1967 in Mary et

(Keliat, 2006). Clients experiencing low self-esteem need

al., 2007). The researcher, therefore, was challenged to

specialist nursing actions. Which can be assigned to

pursue this study to help patients with self-esteem

individuals, families or groups. Group therapy is usually

concerns or problems avoid becoming schizophrenic by

performed in a group activity therapy of the psychiatric

introducing supportive therapy.

hospital to deal with clients who have self-esteem

This study aimed to determine the effectiveness

concerns or problems. Psychiatric group nursing practice

of supportive group therapy on self-esteem of patients

has a positive impact in the prevention, treatment or

with schizophrenia at Soedjarwadi Klaten Mental

therapy and the recovery of a person's health. The

Hospital. Specifically it sought to answer the following;

constant use of supportive group therapy has positive 1. What is the level of self-esteem among schizophrenia patients before the supportive group therapy when grouped according to: 1.1.

Experimental?

2. What is the level of self-esteem among schizophrenia patients after the supportive group therapy when grouped according to: 2.1.

Control,

2.2.

Experimental?

3. Is there a significant difference on the self-esteem level among experimental schizophrenia patients before and after the suportive group therapy? 4.

Is there a significant difference on the self-esteem level 5.

Based from the findings of the study, what customized

among schizophrenia patients after the suportive group

therapeutic supportive therapy can be developed?

therapy when classified according to control and experimental group?

RESEARCH METHOD The researcher used a quantitative research approach to

5) willingness of patient to participate as respondent to be

the design of "quasi experimental with design".

a participant. The exclusion criteria are: 1) outpatients at

According to Dharma (2011), quasi experimental with

the Soedjarwadi Klaten Mental Hospital, Indonesia 2)

pretest-posttest control group design is the design of the

clients in state of crisis 3) unresponsive clients in term of

study where respondents are divided into two or more

the rules of supportive group therapy.

groups, one group was treated group while the other

In this study, the researcher utilized a self-made 1 (one)

group was a control group for comparison. Self-esteem

part questionnaire that delved on the self-esteem

was measured before and after the action of supportive

parameters consisting of 30 questions. Each item was

group therapy at Soedjarwadi Mental Hospital, Klaten

given 4 level score using Likert scale where 4 is the

Indonesia. This study also aimed to compare the self-

highest score as indicated in the following equivalent

esteem in the intervention group who received supportive

ratings and interpretation 4 ranges from 4.0- 3.28 with

group therapy with a control group who did not receive

verbal interpretation low level, 3 ranges from 3.27- 2.52

supportive group therapy thus identified the influence of

with verbal interpretation minimal level, 2 ranges from

supportive group therapy on self-esteem in patient

2.51- 1.76 with verbal interpretation moderate level, and

schizophrenia.

1 ranges from 1.75- 1.0 with verbal interpretation high

The population in this study consists of schizophrenic

level. To unfavourrable question intepretation score 4 is

patients who have self-esteem poblems. The number of

range 1.75- 1.0 with verbal interpretation high level,

samples in this study, which is sixty (60) is divided into

score 3 is range 2.51- 1.76 with verbal interpretation

two groups: thirthy (30) for the experimental group and

moderate level, score 2 is range 3.27- 2.52 with verbal

the other thirthy (30) for the control group.

interpretation minimal level, score 1 is range 4.0- 3.28

Technique samples in this study used the Non-

with verbal interpretation low level.

Probability Sampling. The technique used in this study is

Validity of an instrument (questionnaire) is determined

a combination of consecutive and quota sampling

by the correlation between the scores of each variable

technique because of the difficulty in choosing subjects.

with the total score and the questionnaire was submitted

Quota sampling is the method of selecting people

for validation to three several experts.

according to some fixed quota. This sampling technique

According Hastono (2007), the instrument is a reliable

was chosen for this study conducted at the Soedjarwadi

instrument when used several times to measure the same

Klaten Mental Hospital, Indonesia.

object would yield the same value.

The subjects chosen following the established criteria

Otherwise comply with the reliability of research

were as follows: 1) clients who were hospitalized at the

instruments when the value of Cronbach's alpha

Hospital Soedjarwadi Klaten Indonesia and diagnosed of

coefficient-the value of the alpha coefficient table is

schizophrenia.

diagnosis

0.824. Validity and reliability was done same with pilot

showing low self-esteem. 3) ability to read and write. 4)

study before the implementation proper, and was

cooperation and state of consciousness to communicate.

conducted last July.

2)

psychosocial

nursing

In answering the problems raised in the study, the

Rank Test was utilized. According Darma (2013),

statistical tools applied were as follows: for sub-problem

Wilcoxon Signed Rank Test is used to test the mean

number 1, the score of self-esteem before supportive

differences from two result with same group pre-test and

group therapy was measured by Weighted Mean; 2, the

post-test. 4, Mann Withney U Test was used to measure

score of self-esteem after supportive group therapy was

the difference in the self-esteem of the respondents to the

measured by Weighted Mean ; 3, to measure the

experimental and control groups after supportive group

difference in the self-esteem of the respondents before

therapy.

and after supportive group therapy Wilcoxon Signed

PRESENTATION, INTERPRETATION AND ANALYSIS OF DATA This results of studies of the effect of supportive

were divided into two groups the intervention group and

group therapy changes in the level of self-esteem in

the control group according to predetermined inclusion

schizophrenia clients treated in hospital for three weeks

criteria. In both groups, a pre-test and post-test were

at Soedjarwadi Klaten Mental Hospital. The of

administered. The results were analyzed and as follows

respondents consisting of 60 clients with schizophrenia

then compared.

Problem

No

1:

Level

of

self-esteem

among

schizophrenia patients before the supportive group therapy Table 1. Mean Level of Self-esteem among the Schizophrenic Patients who belonged on the Experimental Group before the Supportive Group Therapy in Terms of Cognitive Level of Self Esteem of Schizophrenic Patients Indicators Experimental Interpretation 2.83 Minimal Level I often lack concentration 2.83 Minimal Level I feel my creativity was reduced 2.96 Minimal Level I find it hard to make decisions 2.10 Moderate Level I am a person who easily gets offended 2.83 Minimal Level I feel confident General Weighted Mean 2.71 Minimal Level 4.0-3.28 (Low Level); 3.27-2.52 (Minimal Level); 2.51-1.76 (Moderate Level); 1.75-1.0 (High Level) Table 1 shows the mean level of experimental

concept is a foundation stone of one's personality. Self-

group according to each indicator before supportive

concept is related to anxiety, depression, problems in

group therapy in terms of cognitive. The tabulated results

relationships with others, and self-destructive behavior.

show that the self-esteem level client schizophrenia in the

The highest value of 2.96 interpreted minimal

experimental group obtained general weighted mean 2.71

value was attained in most questions reflected in Table 1.

with verbal interpretation minimal level after the

”I find it hard to make decisions”. Only the question, “I

supportive group therapy.

am a person who easily gets offended” acquired the value

Stuart (2009), explains that the concept of self-

2.10 interpreted as moderate level. This finding is

assess clients is a challenge, for nurses because the self-

supported by Stuart (2009) which states that impairment

in cognitive function results inability of schizophrenic

refers to intelligence, perception, and thought. Wiyani

patients to perform productively in work place.

(2011) explained that a person with low self-esteem is

Cognitive is a process of knowing and thinking

confronted with cognitive problems issues such as lack of

precisely, paying attention and learning to make

concentration, pessimism, and difficulty in making

decisions. According to Stuart (2009), cognitive aspect

decisions for themselves.

Table 2 Mean Level of Self-esteem among the Schizophrenic Patients who belonged Experimental Group before the Supportive Group Therapy in Terms of Affective Level of Self Esteem of Schizophrenic Patients Indicators Experimental Interpretation 2.56 Minimal Level I am optimistic 3.03 Minimal Level I often feel sad 2.90 Minimal Level I often helpless or useless 2.60 Minimal Level I feel unable to cope easily 2.53 Minimal Level I more energetic 2.50 Moderate Level I have negative feelings about myself 1.86 Moderate Level I am easy get angry 2.56 Minimal Level I easy get embarrassed General Weighted Mean 2.57 Low Level 4.0-3.28 (Low Level); 3.27-2.52 (Minimal Level); 2.51-1.76 (Moderate Level); 1.75-1.0 (High Level) The data in Table 2 above shows the mean level

affecting the brain that lead to the emergence of strange

of respondents in the experimental group per indicator in

mind, perceptions, emotions, movement and disturbed

terms of affective domain before supportive group

behavior. It is strengthened by the statement of Mugiono

therapy. The general weighted mean is classified as

(2009) which states that affective mental disorder is a

minimal level indicated by 2.57. Based on the data “I

mental disorder characterized by a disturbance of

often feel sad” occupied the highest score, 3.03

emotions so that all behavioral object investments by

interpreted as minimal level. This is supported by

colored by emotion.

Videbeck (2008), stating that schizophrenia is a disease Table 3 Mean Level of Self-esteem among the Schizophrenic Patients who belonged to Experimental Group before the Supportive Group Therapy in Terms of Physiologic Level of Self Esteem of Schizophrenic Patients Indicators Experimental Interpretation 1.90 Moderate Level I often get headaches 2.13 Moderate Level My weight dropped or weight loss 2.06 Moderate Level I have good in appatite 2.20 Moderate Level I often feel dizzy 1.76 Moderate Level I am suffering from hypertension General Weighted Mean 2.01 Moderate Level 4.0-3.28 (Low Level); 3.27-2.52 (Minimal Level); 2.51-1.76 (Moderate Level); 1.75-1.0 (High Level) The data obtained in Table 3 conclude that in

each indicator is 2.20 interpreted as moderate level from

terms of psychology average self-esteem if schizophrenia

the statement “I often feel dizzy”. This is supported by

patients who belonged to experimental group is 2.01

Mary cit Handayani (2005) which states that the

indicating moderate level. The highest score obtained in

characteristics or manifestations of low self-esteem is

loss of appetite or weight loss, excessive eating,

participating with others in a group of people, sensitivity

constipation or diarrhea, sleep disorders (insomnia),

to criticism, feeling helpless, complaining of pain and

fatigue, body not treated, confidential initiate a new

dizziness, feelings of worthlessness, hating oneself,

activity, decreased libido, changes in behavior , sadness

feeling of failure, isolation, inability to solve problems,

and anxiety, feelings of isolation, fear and anger,

strange behavior, and seeing other people better than

suppression of others, more easily become listeners from

himself.

Table 4 Mean Level of Self-esteem among the Schizophrenic Patients who belonged to Experimental Group before the Supportive Group Therapy in Terms of Behavior Level of Self Esteem of Schizophrenic Patients Indicators Experimental Interpretation 2.70 Minimal Level I often humbled myself 2.20 Moderate Level I reject reality 2.40 Moderate Level I can communicate effectively which others 3.20 Minimal Level I smoke or use cigarette when in problem 1.36 High Level I always pray 2.40 Moderate Level I usually or prefer to stay at home 2.60 Minimal Level I don’t feel like going with others 1.86 Moderate Level I often follow the activities on the environment 2.56 Minimal Level I have positive feelings about one’s body 2.50 Moderate Level I am active in organization within our community 2.16 Moderate Level I am aloner 1.66 High Level I seldom talk to other General Weighted Mean 2.30 Moderate Level 4.0-3.28 (Low Level); 3.27-2.52 (Minimal Level); 2.51-1.76 (Moderate Level); 1.75-1.0 (High Level) The data on behavior shown in Table 4, lead to the

conclution

that

the

average

self-esteem

be attributed to one‟s self-concept and this feeling of

of

mood disorder low self-esteem that leads to depression. It

schizophrenia patients is 2.30 which is interpreted as

is also supported by Videbeck (2008) who posited that

moderate level. The figures show that the highest mean

schizophrenia is a psychiatric disorder and medical

of 3.20 with interpretation of minimal level is achieved in

conditions that affect the functioning of the human brain,

the statement „I smoke or use cigarette when in

affecting the normal functioning of the cognitive,

problem‟‟. Most patients feel comfortable and good with

emotional and behavioral. The depressant effect of

smoking because it makes them calm and relaxed.

nicotine contained in cigaretles cause the smokers to

According to Stuart (2009) self-destructive behavior can

release their disturbed feelings.

Problem

No:

2

Level

of

self-esteem

among

therapy

schizophrenia patients after the suportive group Table 5 Mean Level of Self-esteem among the Schizophrenic Patients who belonged to Control and Experimental Group after the Supportive Group Therapy in Terms of Cognitive Level of Self Esteem of Schizophrenic Patients Indicators Control Interpretation Experimental Interpretation I often lack concentration 2.70 Minimal Level 2.50 Moderate Level I feel my creativity was reduced 2.83 Minimal Level 2.66 Minimal Level I find it hard to make decisions 2.80 Minimal Level 2.86 Minimal Level I am a person who easily gets offended 2.33 Moderate Level 1.93 Moderate Level I feel confident 2.76 Minimal Level 2.46 Moderate Level General Weighted Mean 2.68 Minimal Level 2.48 Moderate Level 4.0-3.28 (Low Level); 3.27-2.52 (Minimal Level); 2.51-1.76 (Moderate Level); 1.75-1.0 (High Level) Table 5 shows the results of supportive group

with verbal interpretation minimal level 2.48 categorized

therapy, in terms of cognitive, from the control and

as moderate self-esteem level. The control level self-

experimental group. The mean level of self-esteem

esteem is 2.68, classified in minimal level self-esteem.

among the schizophrenic patients who belonged to the

The same opinion was expressed by Shechtman (2002),

control group is 2.68 with verbal interpretation of

cited by Wiyani, (2012) that after the supportive

minimal level, where as the mean level of experimental

treatment the patient rapidly improve in their cognitive

group is 2.48 with verbal interpretation of moderate

aspect with adaptability of life situations, build ego

level.

strength, and develop the ability to learn problem solving After the supportive group therapy, the level of

skills.

self-esteem of the experimental group change from 2.71 Table 6 Mean Level of Self-esteem among the Schizophrenic Patients who belonged to Control and Experimental Group after the Supportive Group Therapy in Terms of Affective Level of Self Esteem of Schizophrenic Patients Indicators Control Interpretation Experimental Interpretation I am optimistic 2.56 Minimal Level 2.56 Minimal Level I often feel sad 2.86 Minimal Level 2.73 Minimal Level I often helpless or useless 2.33 Moderate Level 2.80 Minimal Level I feel unable to cope easily 2.70 Minimal Level 2.46 Moderate Level I more energetic 2.53 Minimal Level 2.40 Moderate Level I have negative feelings about myself 2.53 Minimal Level 2.46 Moderate Level I am easy get angry 2.13 Moderate Level 1.86 Moderate Level I easy get embarrassed 2.46 Moderate Level 2.50 Moderate Level General Weighted Mean 2.51 Moderate Level 2.47 Moderate Level 4.0-3.28 (Low Level); 3.27-2.52 (Minimal Level); 2.51-1.76 (Moderate Level); 1.75-1.0 (High Level) Analysis in Table 6 shows the results of

schizophrenia who underwent supportive group therapy

differences in the level of self-esteem in terms ofaffective

nursing actions significantly changed when compared

aspect after the implementation of supportive group

with the control group. In the control group the mean

therapy among the control group and the experimental

value is 2.51 with verbal intepretation moderate level,

group. The reveals that the self-esteem of clients with

while the experimental group got the mean value scores

of 2.47 which is moderate level. Noted is the decrease of

can influence the person‟s feelings, attributions and

self-esteem scores of experimental group after the

ensuing behaviors of others, potentially evoking a

supportive group therapy.

feedback process to the original agent. According to

Supportive group therapy influenced not only

Bloom taxonomy of objectives, affective domain

the respondents who directly received the treatment, but

contains behaviors that emphasize aspects such as

also the third parties who observed an agent's emotion.

feelings and emotions, attitudes, appreciation, and how to

Moreover, emotions can affect larger social entities such

make adjustments. The person's behavior may be good or

as a group or a team. Emotions are a kind of message that

bad (Wiyani, 2012).

Table 7 Mean Level of Self-esteem among the Schizophrenic Patients who belonged to Control and Experimental Group after the Supportive Group Therapy in Terms of Physiologic Level of Self Esteem of Schizophrenic Patients Indicators Control Interpretation Experimental Interpretation I often get headaches 2.23 Moderate Level 1.83 Moderate Level My weight dropped or weight loss 2.20 Moderate Level 2.13 Moderate Level I have good in appatite 2.03 Moderate Level 1.90 Moderate Level I often feel dizzy 2.33 Moderate Level 1.93 Moderate Level I am suffering from hypertension 2.00 Moderate Level 1.70 High Level General Weighted Mean 2.16 Moderate Level 1.90 Moderate Level 4.0-3.28 (Low Level); 3.27-2.52 (Minimal Level); 2.51-1.76 (Moderate Level); 1.75-1.0 (High Level) Analysis in Table 7 shows the results of

of 1.90 with verbal intepretation moderate level. Both

effecting the level of self-esteem in terms of physiology

groups received mean score in moderate level after

after implementation of nursing actions supportive group

supportive group therapy. According to Stuart (2009), the

therapy in the control group and the experimental group.

physical manifestations include hypertension, and having

The data suggest which that the self-esteem of clients

a hard time sleeping. The data showed the result between

with schizophrenia who underwent supportive group

pre-test and post-test in physiological aspect as well.

therapy nursing actions significantly change when

Supportive group therapy showed effect on physiological

compared with the control group. In the control group,

improvement of the respondents evidenced by the results

the mean value is 2.16 with verbal intepretation moderate

between pre-test and post-test.

level, while the experimental group got the mean scores Table 8 Mean Level of Self-esteem among the Schizophrenic Patients who belonged to Control and Experimental Group after the Supportive Group Therapy in Terms of Behavior

Indicators I often humbled myself I reject reality I can communicate effectively which others I smoke or use cigarette when in problem I always pray

Control 2.36 2.36 2.26 2.33 1.56

Level of Self Esteem of Schizophrenic Patients Interpretation Experimental Interpretation Moderate Level 2.53 Minimal Level Moderate Level 2.06 Moderate Level Moderate Level 2.30 Moderate Level Moderate Level High Level

3.23 1.30

Minimal Level High Level

I usually or prefer to stay at home 2.43 Moderate Level 2.23 Moderate Level I don‟t feel like going with others 2.73 Minimal Level 2.46 Moderate Level I often follow the activities on the 2.23 Moderate Level 1.73 High Level environment I have positive feelings about one‟s body 2.53 Minimal Level 2.36 Moderate Level I am active in organization within our 2.40 Moderate Level 2.30 Moderate Level community I am aloner 2.03 Moderate Level 2.10 Moderate Level I seldom talk to other 1.90 Moderate Level 1.56 High Level General Weighted Mean 2.26 Moderate Level 2.18 Moderate Level 4.0-3.28 (Low Level); 3.27-2.52 (Minimal Level); 2.51-1.76 (Moderate Level); 1.75-1.0 (High Level) Analysis in Table 8 shows the results in the

when I have problems, and I am taking drugs to cope

level of self-esteem in terms of behavior after

with my problems. Stuart (2005) mention that a person

implementation of supportive group therapy in the

with low self-esteem manifests behaviors like rarely

control group and the experimental group which reveals

leaving the house, never following or joining activities

that self-esteem in clients with schizophrenia who

around him/her, likes to be alone, and very seldom talks

underwent supportive group therapy nursing actions

to other people.

significantly changed when compared with the control

Moreover Stuart and Laraira (2005) claimed

group. In the control group the mean value is 2.26 with

that the behaviors associated with low self-esteem

interpretation moderate level while the experimental

include:

group got mean scores of 2.18 which moderate level.

productivity, destructiveness, disruptions in relatedness,

criticims

of

self

or

others,

decreased

The behavioral aspects in this study delved on

exaggerrated sense of self-importance, feelings of

behaviors associated with low self-esteem. Behavioral

inadequacy, guilt, irritability or exessive anger, negative

aspects of self-esteem are manifested in such behaviors

feelings about one‟s body, perceived role strain,

as assertiveness, resilience, being decisive and respectful

pessimistic view of life, physical complaints or physical

of others. Thus, self-esteem is difficult to define because

manifestations including abuse of various substances

of these multiple dimensions. In addition, although self-

such as alcohol, drugs, tobacco or food. For McCallum

esteem is generally stable, it can fluctuate from time to

(1999) cited in Shechtman (2002), supportive group

time. According to Robert Reasoner (2011) cited by

therapy can rapidly increase the adaptive capacity of the

Wiyani (2012), there are six statements included in this

patient's life situation, building ego strength, and ability

aspect: I criticize myself and others, I often humbled

to learn problem solving skills.

myself, I vilify myself, I reject reality, I drink alcohol Problem No 3: Significant Difference in the Self Esteem Level of the Experimental Schizophrenia

Patients before and After the Supportive Group Therapy

Table 9 Significant Difference in the Self Esteem Level of the Experimental Schizophrenia Patients before and After the Supportive Group Therapy Variables Before the SGT After the SGT

Sig

Interpretation

Decision

0.000

Significant

Null hypothesis rejected

Above table illustrates the mean ratings on the

However, in other aspects also scores the

level of self-esteem, which were gathered among the

decreased. Activities provided encouraged schizophrenia

schizophrenic patients before and after the supportive

patients to be more active in expressing their thoughts

group therapy. The researcher utilized a non-parametric

and feelings from previous events and be mutually

statistics which is the Wilcoxon Signed Ranks Test to

supportive and helpful to solve the problems that exist

depict significant difference before and after between the

between the friend‟s group therapy. Since majority of

two variables. Test finding elicit a P value of 0.000,

patients in the treatment of schizophrenia in a mental

which is significantly different at 0.01 level, which

hospital have little time to convey their feelings

therefore rejects the null hypothesis. Taken collectively,

individually, in the implementation of supportive group

the mean ratings indicate before is 2.39, while after is

therapy they were given a special opportunity and time

2.26. The decrease, therefore, on the level of self-esteem

complete the process. Relatives and families were

after the supportive group therapy, made significant

involved in presenting problems solving problems which

indication that indeed supportive group therapy helped

helped build together, confidence, feel more useful, not

the schizophrenia respondents to reduce their level of

easily angered, more relaxed, happy and more active in

self-esteem. Mean ratings given after the supportive

the activities designed for treatment.

group therapy indicate an increased level of self-esteem

Low self-esteem in clients with schizophrenia

that establishes a strong indication of the relevance of the

may occur due to precipitation of predisposing factors

supportive group therapy among schizophrenic patients.

and stressors in his life. Predisposing factors are all

This allows the patients to be more focused despite their

factors that exist or occur in an individual's life span and

limitations to concentrate brought about by their

can increase the risk of mental disorders in these

condition.

individuals. Factors predisposing to low self-esteem can

Furthermore,

supportive

group

therapy

somehow improve their optimism, leading to slight

be

biological,

psychological

and

socio-cultural.

physiologic improvement cognitive, affective, behavioral

Biological factors may include damage to the frontal

psychology in schizophrenic patients and overall,

lobe, temporal lobe (Townsend, 2004), limbic system

supportive therapy group also boosted self-esteem in

(Kaplan, 2004) and hypothalamus (Stuart, 2009).

patients. Among the questions, the cognitive scores

Psychological factors may arise from parenting

decreased, where the average scores of patients who

parent‟s wrong and individual failures in performing its

initially had moderate levels of self-esteem decreased to

role and function (Stuart, 2009), while the socio-cultural

low levels.

factors derived from socioeconomic status clients and grow client environment (Hawari, 2001).

Schizophrenic patients with low self-esteem can

learn how to develop and

maintain satisfactory

do supportive therapy group. Group therapy is a form of

relationships while they themselves destroy maladaptive

psychotherapy in which the individuals in a small group

behavior (Fortinesh & Patricia, 2004).

regularly meets with a therapist. The goal of this therapy

It is also dictated by Stuart (2009), in which the

is to help the personal and emotional growth as well as

activity group therapy can increase self-confidence and

members of the group helps them solve their problems,

self-esteem of patients as well as help facilitate patients

meet challenges and achieve their life goals. Individuals

in expressing his feelings, Purba (2008) likewise that the

learn with and from other group members, as well as

therapeutic group activity can also help patients resolve

better understand their patterns of thought and behavior

issues through group therapy.

that they can defend themselves in life. Group members Problem No 4: Significant Difference in the Self-Esteem Level of the Schizophrenic Patients who belonged to

Experimental and Control Supportive Group Therapy

Groups

after

the

Table 10 Significant Difference in the Self Esteem Level of the Schizophrenic Patients who belonged to Experimental and Control Groups after the Supportive Group Therapy Variables Sig Interpretation Decision Experimental Group after SGT 0.000 Significant Null hypothesis rejected Control Group after SGT In determining the effect of supportive group imbalances and their behavioral responses, given various therapy the researcher made used of the Mann Whitney U

medical and paramedical interventions. Generally, the

test to measure independent samples who were

availability of this treatment approach allow increase

experimentally and not experimentally manipulated or

focus and reduce distress brought about by different

did not receive the intervention. Data revealed P value of

psychological disturbances. The interventions, through a

0.000, which showed significant difference at 0.01 level

guided procedure, gave relevance to the development of

between the control and experimental groups. The result

the patients social welfare.

therefore affirmed the rejection of the null hypothesis.

Patients with schizophrenia typically have a

Specific mean ratings depicts that experimental group

negative self-concept, one of which is low self-esteem.

obtained a mean of 2.26, while the control group

Self-esteem is one of the components of the self-concept.

garnered an average mean of 2.43, which evidently

Self-esteem is a personal assessment of the results

showed decrease level among those who underwent the

achieved by analyzing how much behavioral conformity

supportive group therapy session compared to those who

to the ideal self (Stuart, 2009). Self-esteem is a feeling

were not experimentally manipulated, indicative of

that is formed by individuals about the value and

progress of the patient‟s self-esteem, which is relevant in

preciousness of themselves, or how a person's self-

their treatment regimen.

respect. Self-esteem refers to an individual self-

helped

The promising increase in the self-esteem

evaluation, in which self-concept is a broader term to

the

describe the self-description as a whole.

patients

to

cope

with

psychological

Low self-esteem is a normal human emotion, but it can be meaningful clinically pathological behavior

client as well as the positive things that can be trained to use the client (Keliat & Akemat, 2005).

when interrupt day-to-day, to be pervasive and appears

Specialist nursing actions done when clients are

with other diseases. 3) Social and cultural factors; social,

already getting generalist nursing actions have not

economic status greatly affects the occurrence of low

experienced an increase in self-esteem. Specialist nursing

self-esteem. In everyday life the child growth and

actions include supportive group therapy is a form of

development in three places, namely at home (family), in

therapy has the main objective to provide aid to

schools (educational institutions) and in the social

individuals, by eliminating or reducing their suffering.

community

Social

Supportive group is a collection of people who plan,

conditions in each of these places will interact with each

organize and respond directly to the issues and pressures

other and affect the appearance of low self-esteem.

those special or adverse circumstances. The initial

environment

(Hawari,

2001).

Predisposing factors experienced throughout the

purpose of this group is established to provide support

client will lead to low self-esteem after the stressor

and complete the isolation of the experience of each

precipitation that comes from within yourself or from

member (Grant-Iramu, 1997 in Hunt, 2004).

outside, such as role strain, role conflict, role unclear,

The results showed that a supportive group

redundant roles, developmental transitions, role transition

therapy can increase self-esteem intervention group after

situations and role transition healthy-sick. Precipitation

the post-test. The average price of self-group post

stressor is a stimulus that can be changes, threats and

intervention at 2.26 of the test is the average price of self-

needs of the individual, require excessive energy and

pre-test that was 2.39. This suggests that a supportive

issuing a form of tension and stress (Cohen, 2000 in

group therapy can provide opportunities for group

Stuart, 2009). The trigger has been experienced in a long

members to convey the problem as well as provide input

time by the client. Eventually the client loses the ability

and solutions or opinions on the problems experienced by

to cope with the triggers.

members of the group supportive therapy in Soedjarwadi

Generalist

nursing

actions

performed

by

Klaten Mental Hospital. It can be concluded that in this

identifying the capabilities and positive aspects which are

supportive group therapy research has a positive effect on

owned by the client. The therapist then helps the client

increasing self-esteem and psychosocial functioning of

with low self-esteem to train owned by the positive

patients with schizophrenia.

aspects so that clients feel that they are still useful and

This is because the therapy group provides

beneficial to others. Therapists also praised the positive

emotional support from people who have had similar

skills that serve to increase the client's self-esteem

experiences and can use the experience of others in the

(Keliat, et al., 2006). Other generalist nursing action is

group as an example. Feeling of being part of a group, to

therapeutic group activities. A therapeutic group activity

understand and know the other members of the group, to

for clients of low self-esteem is also very supportive of

give and receive emotional strength as well as improving

the healing process of the client. Activity therapy group

the condition of an excess of group therapy when

also aims to identify the positive things that exist on the

compared with other therapies (Van der Ven, 2011). It is also likely to be excess supportive group therapy as

specialist nursing action when compared with generalist

social withdrawal to improve the psycho-physical

nursing actions, so that when the provision of nursing

condition, 2) suportive therapy in the form of confession

actions nursing generalist followed by action specialist,

and ventilation, guidance, reassurance and environmental

in this case is supportive group therapy, performed on

manipulation is effectively used to restore emotional

clients with low self-esteem will give effect better on the

balance of the child tunalaras type of social withdrawal

client as shown in the results of this study.

experience a lost of self-awareness, 3) takes behavior that

On the implementation schedule of the study

subjects maintain positive behavior, 4) parents need to be

group activity therapy performed on a scheduled basis

involved in the therapeutic process as observers psycho-

and evaluated by researchers in order to encourage

physical development of the subject. Another study of

patients to be more motivated to perform routine

Rochdiat (2011), the title is effect of generalist and

activities. Meetings conducted more routinely assist

nursing measures supportive group therapy against

patients in improving their ability to control and convey

changes on the client self-esteem Diabetes Mellitus.

feelings. Evaluation at the beginning of each meeting

Result of the sudy is general and supportive group

conducted by researchers always begins with positive

therapy had statistically significant more affected to

reinforcement of what has been done so as to encourage

diabetes mellitus patients‟s self-esteem than general

the patient to do so in accordance with what has been

therapy. According Wiyani (2012), Measuring Respati

taught. Evaluation is also important to help researchers

Yogyakarta University students‟ self-esteem through

determine the extent of the patient's ability to perform

supportive group therapy: A framework development the

activities that are already trained and to know what needs

result of this study showed significant differences

to be fixed.

between pre-intervention and post-intervention. Hence,

Research on group therapy specialist nursing

supportive group therapy is proven to be of significant

action that is supportive group therapy is the study of

value in addressing the needs of students with low self-

Purwandari (2009), a study titled supportive therapy

esteem. This research was rejecting by Hidayati (2012) in

services for children tunalaras type of social withdrawal

his study entitled effect of supportive group therapy to

aims to determine the effectiveness of supportive therapy

ability

services as an effort to improve the psycho-physical

schizophrenia. The results showed no significant

condition of children tunalaras type of social withdrawal.

differences in the ability of clients to overcome violent

The results showed: 1) supportive therapy is effective

behavior before and after the supportive group therapy.

overcome

violence

behavior

in

client

enough to use as a service for children tunalaras type of

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Hastono, S.P. (2007). Modul analisis data kesehatan. Jakarta: FKM – Universitas Indonesia (tidak dipublikasikan).

Hawari, D. (2001). Pendekatan holistik pada gangguan jiwa skizoprenia. Jakarta: FKUI. Kaplan, H.I., Sadock, B.J., & Grebb, J.A. (2004). Sinopsis psikiatri (edisi ketujuh). Jakarta: Binarupa Aksara. Keliat & Akemat. (2005). Keperawatan jiwa aktivitas kelompok, Jakarta : EGC.

terapi

Keliat & tim. (2006). Modul model praktek keperawatan profesional jiwa (MPKP) jiwa. Jakarta : WHOFIK UI Maramis, W.F. (2006). Catatan ilmu kedokteran jiwa. Surabaya: Airlangga Universitas Press. Maryam, S & Tim. (2007). Kebutuhan dasar manusia: berdasarkan hierarki maslow dan penerapannya dalam keperawatan. Jakarta: Semesta Media. Purba, J. M, dkk. 2008. Asuhan Keperawatan pada Pasien dengan MasalahPsikososial dan Gangguan Jiwa. Medan: Usu Press. Sabri, L & Hastono, S.P. (2006). Statistik kesehatan. Jakarta: PT Rajagrafindo Perkasa. Stuart. (2009). Principles and practice of psychiatric nursing (9th edition). St Louis: Mosby. Townsend, C.M. (2005). Essentials of psychiatric mental health nursing (3rd ed). Philadelphia: F.A. Davis Company.

Videbeck, (2008). Psychiatric Mental Health Nursing. Fourth Edition. Philippines: Lippincott William & Wilkins. Journals Hidayati, N.O. (2012). Pengaruh emotional freedom technique terhadap peningkatan harga diri narapidana perempuan di lembaga pemasyarakatan kelas II A bogor. Tesis. FIK UI (Tidak dipublikasikan). Purwandari. (2009). Supportive Therapy Services Pada Anak Tunalaras Tipe Sosial Withdrawal. Tesis. FIK UI Rochdiat, Wahyu.(2011). Pengaruh Tindakan Keperawatan Generalis dan Terapi Kelompok Suportif Terhadap Perubahan Harga Diri Klien Diabetes Melitus di RS Panembahan Senopati Bantu. Tesis. FIK UI Wiyani, 2012. Research Measuring The Self-Esteem Through Supportive Group Therapy: A Framework Development. Thesis. Concordia College Websites Hunt. (2004). A resource kit for self help/ support groups for people affeccted by an eating disorder.. http://www.medhelp.org/njgroups/ VolunteerGuide.pdf. September 12. 2013 Mugiono (2009). Mengenal Gangguan Jiwa pada Lansia.rehsos.kemsos.go.id. September 16 2013 Van der Ven, N. (2011). Psychososial group intervention in diabetes care. September 11 2013. http://spectrum.diabetesjournals.org

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