RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS (IN BLOCK

LETTERS)

Ms. SINTA JOSEPH

FIRST YEAR M Sc NURSING

B G S COLLEGE OF NURSING

APOLLO BGS HOSPITAL

MYSORE- 23

2NAME OF THE INSTITUTION B G S COLLEGE OF NURSING

MYSORE- 23

3. COURSE OF STUDY AND

SUBJECT

FIRST YEAR M. Sc. NURSING

MENTAL HEALTH NURSING

4. DATE OF ADMISSION 15-6-2010

5. TITLE OF THE TOPIC

EFFECTIVENESS OF COUNSELING ON IDENTITY CRISIS AMONG

ADOLESCENTS IN A SELECTED PRE-UNIVERSITY COLLEGE AT MYSORE”

INTRODUCTION

The needs of children during adolescence are

particular and acute.

They need an opportunity to develop a sense

of identity and

to maintain the sense of security that

emanates from group acceptance.- Elliot W. Eisner

Adolescence is the transitional stage of development between

childhood and full adulthood, representing the period of time during which a person is

biologically adult but emotionally not at full maturity.1 The World Health Organization

(WHO) defines adolescence as the period of life between 10 and 20 years of age2.In

terms of etymology, adolescence comes from the Latin word adolescere, which means

"to grow up" or "to grow into maturity."3 The reference to growth is nonspecific and

could conceivably apply to physiological, psychological, or social growth. It is

necessary therefore to agree on a more specific definition. Adolescence in the

sociological sense refers to the experience of passing through the unstructured and ill-

defined phase that lies between childhood and adulthood. 4 It is one of the dynamic

stages of human development . Adolescent is accompnied by dramatic physical,

cognitive, social, and psychological changes that present both opportunities and

challeges for adolescents, families, health professionals , educators and communites . 5

Erik Erikson was the first major psychological theorist

to develop the notion of an adolescent "identity crisis.6" In his view, all of the earlier

crystallizations of identity formed during childhood come into question during

adolescence with the overwhelming combination of physical changes, increased sex

drive, expanded mental abilities, and increasing and conflicting social demands."7

“I was… the loser of my class. I had absolutely no friends”

~ Neve Campbell

One of the imporatant psychological changes for this developmental stage is

the emerging importance of peer group8. Peer group is the out let of an adolescent

during transitional stage that they provide a sense of comfort ,love and acceptance.

During transitional phase, the peer group can be said as the real world providing him a

stage upon which tries out him self and others. It is in the peer group that he continues to

formulate and revise his concept of self. For all these reasons it would seem of virtual

importance to the adolescent that his peer group contain a number of friends who can

accept him and upon whom he can depend.

"Everyone who deals with teens seems to agree that the most important and toughest job

is staying in connection and conversation ... not delivering a lecture but saying what we

think." Ellen Goodman

adolescents, is a difficult time for parents and teachers and some times

coinciding needs for independence and support ,so that, this vulnerable group ofcourse

demands relentless care and meticulous attention. Here, the importance of proper

guidance and counseling arises. Counseling is such an important healing and ventilating

therapy that will enable the adolescents who are searching for a sense of identity, to

look inside themselves, rather than out side, but to find answers for unanswerable

questions, to resolve the conflicts of unresolved problems and eventually to withstand

the pressures of this contemporary world , so that a young, vibrant, energetic, and

productive new generation both physically and mentally healthy will form

6.BRIEF RESUME OF INTENDED WORK:

6.1 NEED FOR THE STUDY :

Today's generation of young people is the largest in human history.

Nearly half the world's population- more than 3 billion people-are under the age of 25.

Within the world of the young, adolescents are at a particularly formative stage. It is

surprising that, 1.2 billion adolescents between the ages of 10 and 19 are brimming

with energy and possibilities.10 United states census beauro estimates the current figure

of (2010) 6,883,900,000 of adolescents that they are preparing themselves to fly to the

world of knowledge, skills, values and opportunities and the whole world is looking

them through the eyes of expectations and hope because the soul of a nation lies at the

hands of its yong ones.When it comes to india ,population in 2010 is around(1.15

billion). It is amazing that among this our future assets represents (adolescents) 41.05%

of the total population of our country.

But ,a study was conducted by National Institute of Mental Health and

neurosciences , indicates that one in five children have some sort of mental, behavioral,

or emotional problem, and that one in ten may have a serious emotional problems in

India. Recent Indian research studies also reveal that 10-74% of indian adolescents are

suffering from some sort of emotional problems , Taking all these children and teens,

who is struggling with emotional and behavioral problems, a mere 30% receive any sort

of intervention or treatment11The other 70% simply struggle through the pain of mental

illness or emotional turmoil. Emotional Problems about 20% of parents were somewhat

or very concerned that their child might be suffering from serious emotional problems.

However, it is a fact that adolesents is such a critical period that they

have undergone stress and strains such as emotional conflicts, physical changes,

searching for identity, these all together constitues such a big burden for them and it

makes this stage such a crucial period in every ones life that any other stage of life does

not have. Numerous studies have shown that problems due to identity crisis leads them

to behavioral problems such as suicide and anti-social behavior

Though every age has problems, the adolescent period is especially difficult

for boys and girls to cope with and this is mainly because of two reasons.The foremost

reason is that the problems and needs of adolescents were not met and solved by

parents and teachers ,as a result many adolescents are struggling to coping with

problems alone. The second reason for this is that adolescents want to feel and express

that they are independent, and they demand maximum freedom,but the parents and

teachers treat them as if small children and they try to restrict their freedom

The problems of adolescents include physical, mental, emotional, and

sexual. Sudden body changes will put the adolescents in pressure .The unspecified

physical changes will sometimes lead to behavioral abnormalities .The main emotional

problems includes anxiety ,depression, identity crisis, frustration, low selfesteem,lack of

confidence , loneliness10. The parents often feel neglected and are often worried about

child’s behavior and many times they feel that they lost the control over their children.

The problems initiated in the home extent in to the school and the child may develop

problems which includes absenteeism., lack of interest in studying ,coping, laziness and

other behavioral problems and these all things together will give a big burden to the

teacher

Whenever we go to a new place we want to know about the details of that place. In

that case a guide can help us to move smoothly around that place and help us in

solving our problems. Adolescence is a phase which makes a person enter into a new

world and they are in the same stage they have difficulty in relationships11 — dealing

with parents, peers and teachers— physical problems, and face bullying and ragging

issues. Problems affect them at the psychological, emotional and physical levels, and

it is then that the question of ‘what’s the purpose of living’ pops up in their mind,”.

Proper guidance and counseling is quite essential inorder to channelize the emotions

of adolescents in the direct way. Counseling will help the adolescents a better

understanding of themselves, and their goals and values .and it helps to develop skills

for improve relationships. Counseling again helps the adolescents find resolutions to

their problems .Moreover it helps to learn new ways to cope with stress and

anxiety .Counseling is crucial in adolescent so that it will enable adolescents to

manage grief, anxiety, depression and it will improve communication and listening

skills .Counseling will help the adolescents in such a way that it will change the old

behavior patterns and developing new ones.

Taking everything in to consideration, the problems due to identity crisis is

inevitable in every teen’s life .The parents and teachers should help the students to

cope-with the crisis due to identity. Certainely, through guidance and counseling

services adolescents can be helped to solve the problems.To be more precise, counseling

will enable the teens to identify themselves,will provide deep insights ,make adjustment

to the dramatic physical and emotional changes and eventually mould an individual who

is emotionally strong and stable .Personal and social identity is the sense of self. It is the

answer to our quest for who am I, our values, beliefs Seeking an identity means locating

one’s place in the social setup. Identiy also refers to one’s skills and attributes as a

person. At this juncture, counseling enables an adolescent to resolve the conflicts and

find answers to his questions hence,find an identity in the society,

The researcher during her community postings and personal

experience found that in homes there are teenagers who are struggling to cope with the

problems due to identity crisis. Parents and teachers are also in a conflict situation that

they are facing difficulties to handle their problamatic teens wisley. so the researcher

felt the need to help the teenagers to cope with the problems of identity crisis and their

by reducing their emotional conflicts and hence help them to maintain an identity in the

society.Thus the researcher selected this topic for this research.

6.2 Review of Literature

i. Studies related to identity crisis among adolescents

ii. Studies related to effectiveness of counseling on adolescents

A co- relational study was conducted by Indian Statistical Institute at Kolkatha to

determine the ego-identity status and it relationship with self-esteem .The sample of the

study consists of 650 college students from different districts of West Bengal

namely,Murshidabad, Birbhum and Kolkata.. Due to some missing information and

outliers, the final sample size was 590, out of which there were three 53 male and 237

female students. The age range of the students varied from eighteen to twenty two years

with a mean age of 18.82 years. Rosenberg self esteem scale was used for the

assessment of self-esteem. The study also wants to see whether gender and location

(rural, urban) has significant effect on identity status of late adolescents. The results of

the study revealed that those having high identity achievement status have high self-

esteem, especially in the areas of occupation and ideological belief for religion. On the

other hand, adolescents who are in crisis and not made commitment have low self-

esteem. The analysis also indicated that ego-identity status of students differed with

respect to gender and rural-urban location. This study contributed to adolescent

literature by exploring identity status and self-esteem in Indian adolescents with

emphasis to those living in West Bengal12.

A study was conducted to determine the process of ego identity formation in late

adolescents. The purpose of this study was to examine the internal process of identity

formation in late adolescence in relation to the psychosocial identity crisis from the

viewpoint of the individual-group conflict. A sample of 252 University students were

classified into one of three types, depending on two phases of the individual-group

conflict: (a) whether or not the conflict has been experienced; and (b) if so, whether or

not the conflict had already been solved. The traits of each type were subsequently

determined by examining the individual's awareness of their relationship with the group

and their sense of identity. The main results of the study: indicates that (a) the

experiencing of the individual-group conflict was closely related to the unsettling of the

sense of identity. (b) Men tended to resolve the conflicts better compared to women13.

A study was conducted on the emotional problems of school children in JJM medical

college Davangere Karnataka .The study is based on the need that emotional problems

in school children may result in low level of scholastic performance.. Screening tools

,self assessment tools ,and observation tools were used based on parental or teachers'

observation.. The sample of the study consists of 218 school children and they were

selected through multistage random sampling. The study was conducted in three stages.

In the first stage, all the students were administered six-item version of GHQ to screen

for emotional problems. Raven's Progressive Matrices was administered to evaluate IQ.

In the second stage, parents assessed their child's behavior using CPMS. In the third

stage, all students were subjected or detailed clinical work-up. 22students dropped out

of the study for various reasons. Finally there were 283 as the sample. To detect

emotional problems in the sample, GHQ was administered to students, CPMS was

administered to parents of the children. Tools used are Six-item version of GHQ and

Child Psychopathology Measurement Schedule CPMS were considered as cases.. The

results of the study after detailed assessment, indicates that the psychiatric diagnoses

were prescribed according to DSM-IIIR criteria Out of two eighteen students, one

thirty one were positive on GHQ and ninety eight students were positive on CPMS.

Students who were positive on both scores were only sixty seven. When these one sixty

eight students who were positive on GHQ and/or CPMS were subjected to detailed

clinical assessment, one thirty five cases were clinically positive for emotional

problems. In addition among the fifty cases, which were negative on screening

instruments, seventeen cases were positive on clinical interview after clinical interview,

out of one thirty one positive cases on GHQ, one seventeen were true positive cases and

fourteen were false positive cases. Out of the eighty seven negative cases, thirty five

were false negative cases14.

A five –wave longitudinal study was conducted to determine the

identity formation in adolescence and the study is conducted in 923 samples early to

middle adolescents (50.7% boys; 49.3% girls) and 390 middle to late adolescents

(43.3% boys and 56.7% girls)and the main aim was to provide a comprehensive view

on change and stability in identity formation from ages 12-20.Seveal types of change

and stability (i.e., mean-level change, rank-order stability, and profile similarity) were

assessed for three dimensions of identity formation (i.e., commitment, in-depth

exploration, and reconsideration), using adolescent self-report questionnaires. Results

revealed changes in identity dimensions towards maturity, indicated by a decreasing

tendency for reconsideration, increasingly more in-depth exploration, and increasingly

more stable identity dimension profiles.. Overall, girls were more mature with regard to

identity formation in early adolescence, but boys had caught up with them by late

adolescence. Taken together, findings indicate that adolescent identity formation is

guided by progressive changes in the way adolescents deal with commitments, rather

than by changes in the commitments themselves15 .

A study was conducted on the prevalence and incremental validity of identity problem

symptoms among high school students .The study examines the

expression ,prevalence ,and incremental validity of identity problem in adolescents .A

sample of 140 high school students aged between 15-18 selected for measuring the

identity problem

symptoms and was comprised of 98 females and 39 males (three individuals failed to

report their gender) 62 were Seniors, 54 were Juniors, eighteen were Sophomores, three

were Freshmen, and three did not report their grade. In terms of ethnicity, 78.6% of

participants were Euro-American, 5% were African-American, 3.6%were Hispanic-

American, 1.4% were Asian-American, 0.7% were Native-American, 2.1%were of

mixed or other ethnic backgrounds, and 8.6% chose not to report their racial/ethnic back

groundThe result of the study shows that 14.3% have DSM IV criteria for identity

problems Based on the IDS responses, 7.9% of the sample would meet DSM III-R

criteria for Identity Disorder. A Chi-square analysis determined that the difference in

diagnostic rates. For the less stringent requirements of DSMIV criteria for

Identity Problem, 14.3% would meet. Females had a significantly

higher rate(18.4%) than males (5.1%), X2 = 3.92, p\.05. In regard to

identity status, 18.6% of the sample was in diffusion, 30.7% were in

foreclosure, 30% were in moratorium,. Chi-square analyses revealed

no significant sex differences in status16. Identity problem symptoms predicted

psychological symptom scores beyond identity status, and identity status accounted for

substantially less variance in psychological symptom severity when controlling for

identity problem symptoms16.

.A Study was conducted among adolescents to determine the existential anxiety in

adolescents in association with psychological symptoms and identity.The aim of this

study was to examine the phenomenon of existential anxiety in a sample of adolescents.

A Sample of one thirty nine students studying in nine to-twelve grades was participated

in the study. Results indicated that existential anxiety concerns have a theoretically

consistent factor structure, are common among adolescents, and are associated with

psychological symptoms, as well as identity issues. Results are discussed with regard to

the importance of existential concerns in the lives of youth and the need for additional

therapeutic interventions17

A study was conducted at Florida state in America to determine the Erikson's theory

that adolescent identity exploration is associated with a variety of symptoms, such as

fluctuations in ego strength, mood swings, rebelliousness, and heightened physical

complaints. The Identity exploration was correlated with twenty three major clinical

scales and the fourteen Frequently Scored Scales of the MMPI.The items in the factor

suggested a pattern consistent with Erikson's theory of adolescent crisis, and was labeled

the Identity Exploration Crisis (IEC) factor. The sample of the study consisted of eighty

two academically superior high school students (43 males; 39 females) between fourteen

and seventeen years of age who had completed their junior year.. The instruments used

were the Minnesota Multiphasic Personality Inventory (MMPI) and the Ego-Identity

Interview (Grotevant & Cooper, 1981).. Separate adolescent norms were not available

for the Frequency Scored Scales. The Ego-Identity Interview (Grotevant & Cooper,

1981) was based on Marcia's (1964) operationalization of Erikson's theory (1968)

regarding adolescence as a time of increased exploration and commitment. Each subject

scheduled approximately two hours with the researchers. The paper-and-pencil

measures were completed first, followed by the interview..The results of the study is

related with exploration and with commitment. Only one of the scales correlated with

commitment. In contrast, ten of the twenty three scales were significantly correlated

with exploration at the .05 level or better. 1

A study was conducted for the exploration of identity and curiosity and also with

anxiety and depression. To explain these mixed findings, the four-dimensional identity

formation model was used and the study was extended using data from two late

adolescent samples of seven hundred and thrirty . A fifth dimension, labeled ruminative

(or maladaptive) exploration, was added as a complement to two forms of reflective (or

adaptive) exploration already included in the model (i.e., exploration in breadth and

exploration in depth). Results indicated that ruminative exploration was positively

related to distress and to self-rumination. The two forms of reflective exploration, by

contrast, were unrelated to well-being and positively to self-reflection. Ruminative and

reflective exploration also helped to distinguish between two types of less adaptive

identities (i.e., Ruminative Moratorium and Diffused Diffusion) in a six-cluster solution

that also contained adaptive types of identity19.

Studies related to effectiveness of counseling on adolescents

A comparative study was done to determine the effectiveness of counseling on

adolescents as they become adults , this study compares rates of mental health

counseling use between adolescents and young adults, examines characteristics and

predictors of counseling use for young adults, and identifies reasons for foregone care

among those with mental health needs in young adulthood..The sample of the study

includes 10817 members and from the national longitudinal study of adolescent health

and secondary data analysis was conducted .Data were derived from an initial survey

collected in 1995 (mean age, 15.8 years) and a follow-up survey collected 7 years later

(mean age, 21.5 years).The results of the study shows that young adults reported

significantly lower rates of counseling use compared with adolescents.The adolescets

are using more mental health counseling but the rate of this decreses as they grow in to

the stage of adulthood20

A study was conducted to examine the effectiveness of counseling on

adolescent crisis who are at the beginning of treatement and are assessed after a period

of 12 months inorder to evaluate the relative diagnostic and therapeutic validity of

counseling .The sample of the study included 153 split university students who are

having adolescent crisis .Among this 90 of them treated by counseling annd 63 served as

controls .The study sample was split in 7significantly different subgroups Fordiagnosis,

Hampstead index and Diagnosticand Statistica lManualof Mental Disorders Fourth

Edition (DSM-IV) multiaxial evaluation were used, allowing a wider insight into

personal functioning.The results of the study indicates that the counseling-treated

examinees had better personality functioning after 12 months,and concluded

that ,Counseling is a valuable therapeutic and diagnostic tool for adolescent crisis21

A study was conducted to determine the effectiveness of psychological or emotional

counseling among suicidal adolescents for the prevention of suicidal rate among

adolescence. This study used data from Wave 1 of the National Longitudinal Study of

Adolescent Health, which involved a household-based interview with a nationally

representative sample of 15 483 adolescents from grades 7 to 12 of these, 2482

adolescents were classified as suicidal, as indicated by an affirmative response to the

question that during the past 12 months, , the study asked the following questions such

as What proportion receives psychological or emotional counseling, and What are the

sources of this counseling, What factors are associated with receipt of such counseling.

The results of the study indicates that Less than one third (28%) of suicidal adolescents

received psychological or emotional counseling. The most common sources of care

were private doctors' offices (37%) and schools (34%). Factors associated with receipt

of counseling in the past 12 months included age, race, degree of suicidal, depression

status, and having had a physical examination during the same period. Only one third of

those who report suicidal ideation and behavior receive psychological or emotional

counseling. .The findings suggest that many of those at risk of harming themselves do

not receive professional help.. Counseling services have an important role to play in

suicide prevention, and a variety of sources of care need to be available. Although

counseling services are vital, a range of other strategies is necessary to reduce the youth

suicide rate.21

6.3 STATEMENT OF THE PROBLEM

AN EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF

COUNSELING ON IDENTITY CRISIS AMONG ADOLESCENTS IN A SELECTED

PRE-UNIVERSITY COLLEGE AT MYSORE

6.4 OBJECTIVES

1. To detemine the identity crisis among adolesents

2. To find the effectiveness of counseling on identity crisis among adolescents

3. To find out the association between identity crisis and selected demographic

variables

6.5 OPERATIONAL DEFINITION

1. Effectiveness.-it refers to what extent the counseling session helps the adolescents in

facing and coping with the problems due to identity crisis

2 Identity crisis - distress and disorientation (especially in adolescence) resulting from

conflicting pressures and uncertainty about one's self and one's role in society(web

definition)

Identity crisis-In this study identity crisis refers to both internal and external conflicts

experienced by the adolescents about oneself during the period of transition in order to

maintain identity in the society

3. Adolescents – In this study adolescents refers to group of students between the age

group of sixteen to seventeen

4.counseling -Counseling helps with problems in living through an interaction

With a trained professional.

In this study Counseling refers to the essential helping and ventilating therapy

which helps the adolescent students to cope with the problems due to identity

Crisis

6.6 VARIABLES

Independent variable- In this study counseling is refers to as the independent

variable

Dependent variable- In this study problems faced by the adolescents due to

identity crisis is termed as independent variables

Extraneous variable-Extraneous variables includes demographic variables such

as age, sex

6.7ASSUMPTIONS

The researcher assumes that ,

Adolescents are facing problems due to identity crisis

The adolescents will participate in the counseling sessions and it will help the

adolescents to overcome the problems due to identity crisis

6.7 DELIMITATIONS

The study is delimited to Adolescents

Between 16-17 years of age.

Have the problem of identity crisis

Available at the time of the study.

6.8 HYPOTHESIS

At 0.05 level of significance.

H1: The mean post-test scores on identity crisis of the adolescents attending the

counseling will be significantly lower than the mean pre-test scores.

H2 : There will be significant relationship between identity crisis and selected

demographic variables.

7. MATERIALS AND METHODS:

7.1 Source of data:

The data will be collected from adolescents aged between 16-17years in selected pre

university college at Mysore

7.1.1Research Design:

The study design selected for this study is one group pre-test and post-test design.

7.1.1Settings

The study will be conducted in a selected pre-university college at Mysore.

7.1.2 Population:

All adolescents aged between 16 -17 years studying in a selected pre-university

college at Mysore.

7.2 METHOD OF DATA COLLECTION:

7.2.1 Sampling Procedure:

This research study will adopt purposive sampling for selecting samples. Out

of the total population defined those who will meet the inclusion criteria will be selected

for the study.

7.2.2 Sampling Size:

Thirty adolescents will be selected for the sample by purposive sampling.

7.2.3 Inclusion Criteria for Sampling:

The study will include the pre-university college students

Aged between 16-17years and are willing participate in the study

Identified with the problems of identity crisis

Those who are present at the time of the study.

7.2.4 Exclusion Criteria for Sampling:

The study will exclude the adolescents

Those who do not give consent to participate in the study.

Those who do not expose identity crisis

7.2.5 Instrument Used:

The following tool will be developed by the researcher using review of literature

and consultation with subject experts:

The structured questionnaire for assessing the identity crisis related problems among

adolescents during transitional phase.

7.2.6 Data Collection Method

.Consent is obtained from pre-university college authority followed by the consent of

samples is obtained. The data collection technique adopted in the study is structured

questionnaire on identity crisis among adolescents .Pre-test is done to screen the

adolescents with problems due to identity crisis.,. followed by counseling is given and

post –test is done to assess the effectiveness of counseling .Confidentiality is

maintained through out the study

7.2.7 Data Analysis Plan:

The data obtained would be analyzed using both descriptive and inferential

statistics. The analysis will be done on the basis of objectives and hypothesis stated. The

significance of pre-test and post-test scores would be tested using ‘t’ test, at 0.05 level of

significance.5Chisquare test is used to find out the association between the variables.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION ON INTERVENTION

TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

IF SO PLEASE DESCRIBE BRIEFLY:

Yes, the study requires providing a counseling on identity crisis among adolescents in a

selected pre-university college at Mysore

4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION

IN CASE OF 7.3:

Yes, Ethical clearance has been obtained from concerned authority and the consent will

obtained from the samples during data collection

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8 Signature of candidate

9 Remarks of guide

10 Name and designation of (in block letters)

10.1 Guide MRS. RAJULA ASIR

ASST. PROFESSOR

DEPT. OF MENTAL HEALTH NURSING

BGS COLLEGE OF NURSING

KUVEMPUNAGAR, MYSORE.

Signature

Co-guide (if any)

Signature

11 Head of department MRS. RAJULA ASIR

ASST. PROFESSOR

DEPT. OF MENTAL HEALTH NURSING

BGS COLLEGE OF NURSING

KUVEMPUNAGAR, MYSORE.

Signature