الفهرس 
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Abstract
Summary group therapy is a form of psychotherapy that can be used to help clients deal with most forms of emotional distress or problems with interpersonal functioning (Overholser, 2005). In many studies group therapy was found to significantly reduce depression and increase self-esteem (McDermut et al., 2001; Andersen & Rasmussen., 2017).
The Four-Step Integrative Model is a relatively newly designed model for conducting work in psychotherapy groups. This model was born in the ongoing groups at Minia University Hospital in the 2000’s. Starting with needs which are basic and part of our ”Fetra,” ascending to wants to meet these needs, then working in rights to fulfill these needs, and finally decisions to fulfill these needs responsibly (Saleh, 2018).
Happiness has been seen as the highest good and ultimate incentive for human behavior by philosophers across history (Diener, 1984). Happiness may be seen of as the true objective of psychological practice, and also a major issue and a good topic for psychology (Abdel-Khalek, 2006). The concept that unhappiness may be a source of dysfunction is well-known and as ancient as psychology itself (Gruber et al., 2011). Studies have shown that happiness correlates in a positive way with life quality, satisfaction with life, and positive mood which are all psychological health dimensions (Medvedev & Landhuis, 2018).
Self-esteem” appears to rank among the first 3 researched variables in social and personality psychology (Eromo & Levy, 2017). In psychologist Abraham Maslow’s hierarchy of needs, which presents self-esteem as one of the essential human drives, the desire for self-esteem plays a significant role. Because it anticipates specific outcomes, such as happiness, self-esteem is a desirable psychological construct. (Baumeister et al., 2003).
The research team wanted to explore the effect of The Four-Step Integrative Model for group Psychotherapy on self-esteem and sense of happiness of both clients and trainees attending group psychotherapy so the major research question was ”Does the Four-step Integrative Model for group Psychotherapy have an effect on self-esteem and sense of happiness of clients and trainees?”
During the research process, this question grew to involve a set of minor questions:
1. Is there a difference in the effect of The Four-step Integrative Model for group Psychotherapy on clients and trainees?
2.To what extent does the Four-step Integrative Model for group Psychotherapy affect both self-esteem and sense of happiness?
3. Is there is a correlation between changes in self-esteem and sense of happiness?
The tools used in this study to measure happiness and self-esteem were respectively; the Oxford Happiness Questionnaire (Argyle & Hills, 2002) and the Rosenberg Self-esteem Scale (Morris Rosenberg, 1965).
The studied therapy group was Minia Adult Female Psychotherapy Group. This group was held regularly at Minia Neurology and Psychiatry Department every 2 weeks for one year (from April, 2019 to April, 2020). Clients who participated in the group were adults, with a minimum degree of education (at least can read and write) and carry heterogeneous diagnoses. Clients in active psychotic or manic episodes participated after remission of active symptoms. Clients were recruited through announcements on social media, outpatient clinics at Minya University and outpatient clinics of staff members at Neurology and psychiatry departement. They were interviewed at Minia University Hospital by emeritus professor Refaat Mahfouz and other staff members to determine their eligibility to attend the group. Clients signed a printed contract stating the basic rules of the group and taking their consent to participate in research purposes.
Each client was interviewed separately by the candidate of this thesis, to apply the scales which were applied three times at the beginning, middle and end of the group (April 2019, October 2019, April 2020).
The results and discussion of the current study were displayed on four domains. The first domain was socio-demographic data of both the clients and trainee group. Followed by displaying the results of the Oxford Happiness Questionnaire. Thirdly displaying the results of Rosenberg Self Esteem Scale. Lastly the Correlation between measurement of happiness and self-esteem in both groups.
I-Socio-demographic data of both the clients and trainee group:
There was statistically significant difference between both groups as regard the gender difference as all the clients were females whereas coincidentally all trainees were males. Also there was significant difference between the two groups regarding the age range as 90% of the trainees were in the age range from 25 to 35 whereas the clients were in an age range from 18 to 45 year. Lastly there was statistically significant difference regarding the educational level as all trainees were postgraduate students, whereas clients were at different educational levels.
II-As regard Oxford Happiness Questionnaire:
In the clients group:
As regard the overall score of the OHQ in the clients study group, there was a statistically significant difference between the overall score during and after (P value= 0.01) and also between before and after (P value= 0.002).
As regard details of the OHQ, there was a statistically significant change in only 2 out of 29 domains in the comparison between before and during group psychotherapy and between during and after group psychotherapy. However, when comparing between before and after group psychotherapy, there was a statistically significant change in 10 domains out of 29.
In the trainees group:
As regard the overall score of the OHQ in the trainees study group there was no statistically significant difference between the results before, during or after group psychotherapy.
As regard details of the OHQ, there was a statistically significant change in only 2 out of 29 domains in the comparison between before and during and comparison between before and after group psychotherapy and in one domain between during and after group psychotherapy.
Regarding the comparison between clients and trainees group:
There was a statistically significant difference between them before (baseline) the group therapy (P value=0.01).
III- As regard Rosenberg Self-esteem Scale:
In the clients group:
As regard the overall score of the RSES in the clients study group, there was a statistically significant difference between the score before and during (P value= 0.001) and also between before and after (P value= 0.002).
As regard the details of the Rosenberg Self-Esteem Scale, there was a statistically significant change in 7 out of 10 domains in the comparison between before and during and comparison between before and after group psychotherapy and in no domains when comparing between during and after group psychotherapy.
In the Trainees group:
As regard the overall score of the RSES in trainees study group, there was no statistically significant difference between the results before, during or after group psychotherapy.
As regard details of the Rosenberg Self-Esteem Scale, there was a statistically significant change in only one domain when comparing between before and during the group psychotherapy and there was no statistically significant change in any domain when comparing before and after group and when comparing during and after.
Regarding the comparison between clients and trainees:
As regard the overall score of RSES , by comparing between doctors and clients study group before , during and after group therapy; there was a statistically significant difference between them before (baseline) the group therapy (P value= <0.001).
IV-As Regard Correlation between happiness and self-esteem:
Our study has found a strong correlation between the measurement of happiness by the OHQ and the measurement of self-esteem by the RSES (P value <0.001*).
Conclusions
1-The Four-step Integrative Model for group Psychotherapy has a role in inducing happiness and increasing self-esteem in clients.
2-The baseline difference between level of happiness and self-esteem between clients and trainees disappear with the ending of group therapy.
3-The trainees’ apparent resistance to change obscures their benefit from group psychotherapy.
4-There is a strong correlation between self-esteem and happiness.
Recommendations
I-Recommendations regarding clinical work:
1-group psychotherapy using the Four-step Integrative Model is an effective modality of treatment that is recommended to be spread all over Egypt and the world.
2-The Oxford Happiness Questionnaire and the Rosenberg Self-esteem scale in their Arabic translated versions could be used in assessing change in clients attending group psychotherapy after conducting relevant validity and reliability studies.
3-Happiness and self-esteem seem to be intermingled and correlated to each other. It is recommended to view and study different psychotherapeutic approaches from this perspective.
4-Trainees may need more effort or more group duration in order to express their real need to change in a therapeutic direction.
II-Recommendations regarding further research:
1-Studying the effect of the Four-step Model on different aspects of mental health and illness (suicidal patients, control of anger and aggression, control of impulsivity).
2-Comparing the effect of the Four-step Model on happiness and self-esteem with the effect of other modalities of psychotherapy.
3-Giving more attention to studying the effect of group psychotherapy on the trainees.
4-Studying the effect of the Four-step Model on both sexes and other age groups as children, adolescents or geriatric.