Teaching coping skills in a group setting can help participants to develop needed tools and stimulate psychological growth (Lambie & Sias, 2009). Participants in group counseling also learn positive interpersonal/social skills that can be generalized beyond the hospital setting and applied in daily living (Shechtman, 2004). Cancer patients learn to adapt to novel social situations and build rapport among peers in this setting (Fineberg, Hohnson, Leiden, & Lynch, 1956; Shechtman). It has also been shown that group counseling has high efficacy in improving coping and adaptation skills (Barakat et al., 2003). This is especially helpful in this population, as individuals who have/have had cancer may have less opportunity to engage in social and peer situations which reinforce adaptive social development, due to medical needs (Barakat). This interference in the social developmental continuum can have lasting effects on the way that an individual relates to others and behaves in social situations (Bynner, 2000). Group counseling can provide a social environment in which participants can learn and develop social tools, which may be applied in other settings.

Competence in peer relationships for individuals with cancer depends on the amount and quality of social support received (Kazak, 2005). As this population tends to have less opportunity than their peers to engage in meaningful social activities (Barakat, 2003), they tend to have weak social support systems. The use of a group intervention format provides a social environment and opportunity for social interaction that may otherwise be unavailable to participants, thus impacting social competence.

Group counseling may help normalize participants' concerns, putting such fears into perspective, and decrease feelings of social isolation by providing a network of peers (DeLucia-Waack et al., 2004). Group counseling may also be less stigmatizing than individual therapy, which lends an aura of acceptability to the intervention, helping participants to feel comfortable in the initial stage of treatment (DeLucia-Waack et al., 2004). This can facilitate openness and trust between members of a group. Issues such as education, coping skills, fears of death, relapse, and loss of functioning, which may be difficult for the individual to deal with and accept on his/her own, are oftentimes shared and dealt with more readily in a group of peers who share a background and understanding of the illness (Shechtman, 2004). Medically/terminally ill individuals can benefit from this aspect of group counseling, as denial tends to be a common and medically, as well as psychologically, dangerous defense mechanism (Bloom, Stewart, Onofrio, Luce, Banks, Fobair & Morrow, 2008).

Quality of Life

Group counseling has been shown to improve patients' and survivors' of medical/terminal illness quality of life and sense of well-being (Meneses, McNees, Loerzel, Su, Zhang & Hassey,2007). Group counseling provides children and adolescents with a positive, supportive relationship with an adult (the group leader), which results in higher expectations and more trust in adult figures (Phipps, 2007). Children also report better mood, more perseverance, pride in achievement, and decreased somatic stress as contributing to a better quality of life (Phipps). Individuals with chronic medical conditions who participate in group counseling tend to have better social skills and competence, and exhibit a decrease in behavioral problems; they also report a higher level of positive affect and better mood due to group interventions (Barakat, 2003). Both parents and children report substantial benefits on satisfaction and increased quality of life post-intervention (Barrera & Schulte, 2009).

In addition to group counseling, the simple task of providing self reported quality of life measures to patients has demonstrated a positive effect upon patient-physician communication and overall patient well-being (Velikova, Keding, Harley, Cocks, Booth, & Smith, 2010). These measures ensure a continuous flow of information regarding subjective symptoms and level of functioning which increases the individual's self-awareness in a way that allows the patient to relay this information to the group leader and/or medical team. Patients who are given these measures have reported an increase in ability to build rapport and empathy, as well as higher quality interpersonal relationships, as the increased self-awareness made it easier to discuss emotional and personal issues; patients have reported a higher health related quality of life due to these measures (Velikova et al., 2010).

Group counseling provides adolescents a safe place to express feelings, discuss personal challenges, and appreciate that peers share many of their concerns, the latter being universality. Universality is an important therapeutic factor in group counseling (Yalom, 2005). Due to the high level of importance that peer relationships play in adolescence, group therapy helps individuals in learning how to build and sustain healthy relationships....

According to Corey (2000), the effectiveness of using a group is the fact that group members can have chance to practice the skills they learn within the group as well as in their daily interactions outside the group. In addition to that, group members can benefit from the feedback and insights they get from other members of the group and also from counselor.
Receiving positive feedback and appreciation from other group members and the leader is considered to be another important therapeutic factor in group counseling. This therapeutic factor is identified as interpersonal learning, where a group member may become aware of the strengths and limitations of their interpersonal behavior through self-observation and the observation of other group members (Yalom, 2005). Interpersonal learning may increase members hope as they find that they have something to offer other group members.

The research has shown that group counseling is effective in working with at-risk students (Zinck & Littrell, 2000) and the Center for School Counseling Outcome Research reported that improvement was observed in the self-concept of alcoholics' children through the use of group counseling interventions (Riddle, Bergin, & Douzenis, 1997). According to6Bina, Finn, and Sowle (as cited in Coleman & Baskin, 2003), improving students' sense of belonging and connectedness to the school can be accomplished through small group counseling. Bauer, Sapp and Johnson (2000) indicate that students are more likely to use the school counselor or another adult as a source of support and are less likely to drop out after they have participated in groups. Not only has research demonstrated the effectiveness of group therapy with adolescents (Coleman & Baskin, 2003; Zinck & Littrell, 2000), group intervention allows mental health services to be delivered to a greater number of individuals in an efficient manner, which is particularly important in schools or any budget strapped organization. This author hypothesizes that the benefits and therapeutic outcomes of career group counseling are to increase the hope and positive expectancies with at-risk youth roles.

Group Counseling

Yalom (2005) suggests that therapeutic change occurring in group therapy "is an enormously complex process that occurs through an intricate interplay of human experiences" that he refers to as "therapeutic factors" (p.1). One of the eleven primary therapeutic factors that Yalom (2005) discusses is the instillation of hope. Yalom's (2005) therapeutic factor, instillation of hope, fits with the common factor of hope and positive expectancy reported in outcome variance research. According to Lambert (1992) (as cited in Duncan, Miller, Wampold, Hubble, 2009), the contribution of placebo, hope, and expectancy to positive psychotherapy outcome is 15%. These effects relate to the hopeful expectations that accompany the implementation of counseling (Duncan, 2009). Worrel and Hale (2001) reported that at-risk adolescents who possessed high levels of hope were less likely to drop out of school than those with low levels of hope. It is thought that group therapists can capitalize on this factor and increase confident of clients in group efficacy by doing whatever they can. Snyder's hope theory (1994) suggests that individuals who have high in hope have the potential to face a more stressful situation vigorously, compared to low hope individuals. As the variable hope has been investigated, possessing low hope is significantly related to a number of negative outcomes, such as school failure, in comparison to individuals reporting significantly higher hope (Snyder, LaPointe, Crowson, & Early, 1998).

Guidance/psycho educational groups and counseling/interpersonal problem solving groups are the most common type of groups used in schools. Adolescents tend to be group oriented and often find support in sharing concerns among themselves (Hagborg, 1991). For middle school students, the increase in peer influence and social interaction tends to dominate. Therefore, the peer group is a natural place for adolescents to learn. Many social, emotional and developmental needs could best be met through the group counseling process (Gumaer,1986).

The majority of research, investigating which therapeutic factors clients perceive to be most helpful, has been conducted with adults. The perceptions of children's effective therapeutic factors depends on their developmental needs which are different.. Research supports group counseling as an effective treatment modality for children and adolescents. Whiston and Sexton (1998) conducted a research study using previous research on the outcomes of school counseling outcome which was published between 1988 and 1995. The review found several group treatments to be an effective counseling intervention. Children having behavioral problems were effectively treated through social skills' training program, children with learning disabilities and gifted students (Verduyn, Lord, & Forrest, 1990; Ciechalski & Schmidt, 1995). Omizo and…