The Effect of the Logotherapy-Based Group Psychological Counseling Program on Widowed Syrian Refugee Women’s Well-Being

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As of 2011, battles and civil war had broken out in Syria with the uprising called the Arab Spring; since then, many Syrians have been faced with huger and misery and have lost their most sacred rights such as the right to life. This situation in the country drove many Syrian citizens from their homes and homeland and caused them to migrate to neighboring countries. In this process, Turkey with its open door policy has been the country hosting the highest number of Syrian refugees since 2014 (Karkın & Yazıcı, 2015). According to data from the United Nations High Commissioner for Refugees [UNHCR] (2017), 2,992,567 people are seen on record as having migrated from Syria to Turkey, 46.8% of whom are women (23.6% are women between the ages of 18-59 years old). Women who’ve had to leave their place of residence due to the war face serious difficulties not just during the war such as getting arrested, loss of relatives, economic and physical hardships, and sexual violence (Disaster and Emergency Management Presidency [AFAD], 2014, p. 31). The multiple traumas experienced alongside the war have negatively impacted women’s well-being.

According to the World Health Organization (WHO), health is a state of holistic physical, mental, and social well-being. In this context, asylum seekers also experience social, cultural, and economic problems and health issues due to forced migration. Experiencing all these difficult process have increased refugees’ stress levels, and this situation in particular has caused mental health problems to emerge (Ehntholt & Yule 2006, pp. 1197–1210). Risk factors are seen that have negatively impacted asylum seekers mental health before, during, and after migrating to another country due to war. Many asylum seekers experience a number of traumas that will negatively impact their mental health such as the traumatic experiences and past losses prior to migrating as well as the difficulties encountered in the destination country after migrating (Karanfiloğlu, 2019). The pre-migration risk factors can be stated a the economic changes in the refugees’ country due to war, having insufficient conditions for education and employment, and the deterioration of political movements, social relations, and their networks (Kirmayer et al., 2011). In addition, the vast majority of asylum seekers experience or witness traumatic events such as sexual abuse (e.g., harassment, rape), physical abuse (e.g., injury, torture, murder), and emotional abuse (e.g., imprisonment, bullying) before being forced to leave their country (Nicholl & Thompson 2004). The length and difficulty of the path taken after making the decision to migrate, the difficulty experienced in refugee camps, exposure to violence, the harm done to family and social relations, and uncertainty about life form the traumatic experiences encountered upon arriving at the destination country and while fleeing. The other risk factors significantly impacting mental health after seeking asylum in a new country are uncertainty regarding asylum/refugee status, economic difficulties, loss of family and social relations, uncertainty and anxiety about the family members that stayed behind as well as unease regarding reuniting, difficulties learning the language of the country one is in, and difficulties adapting to the new country (Kirmayer et al., 2011). The performed research has stated the trauma following forced migration to have strong negative effects on asylum seekers’ stress factors (Teodorescu et al., 2012).

The symptoms of post-traumatic stress disorder are sleep problems, frequent nightmares, negative experiences constantly being uncomfortably remembered, feeling on edge due to concern about reliving the negative experience, getting suddenly startled, sudden anger, lack of future plans, alienating from others (feeling no one understands or knows what you’re going through), feeling unease when recalling negative experiences, and avoiding these situations. Symptoms are seen in many people due to negative experiences following trauma and go away on their own after a while; however, the reason these symptoms persist for months or even years in asylum seekers/refugees is due to the persistence of stress factors (Öztürk & Uluşahin 2008).

Many studies have revealed refugee communities to experience high levels of stress (CARE International [CARE], 2015). The findings revealed refugees to force girls under the age of 18 to marry at an early age due to their inability to meet their needs. Therefore, refugee women and girls are at an increased risk of exposure to being married with a foreign man through a sudden decision, to gender-based violence, and to domestic violence (International Rescue Committee [IRC], 2014). Turkey provides Syrian women and girls residing there training to prevent marriage under the age of 18. Women who are deprived of education are observed to remain silent about abuse and violence; because of this situation, family problems are unable to be detected (AFAD, 2014).

Asylum seekers often share nostalgic memories of their families, past lives, and children. The selective memories and dreams about their homes, country, and returning home show the soporific and therapeutic impact on refugees (Gündüz, 2011). The problems of having weak adaptation and social relations in the society to which they’ve migrated, remaining unemployed, and inability to find work cause an increase in psychological disorders and their accompanying illnesses (Teodorescu et al., 2012). While studies have shown no difference between men and women in terms of post-traumatic symptoms in terms of mental health (Türk, 2013), differences are seen in terms of coping with the problems and crises encountered.

Most refugees from the Middle East who’ve migrated to Turkey in the last two decades have been women who were abused whose spouses had passed away. Victims are often in a state of shock in the acute period following sexual and physical abuse. They are seen to feel guilt and loss of control over their lives, have difficulty performing daily activities, feel insecure, depressed, experience post-traumatic stress disorder, and attempt suicide (Buz, 2008). According to the findings obtained as a result of Düşünceli’s (2015) study, implementing psychological counseling with a logotherapy-oriented group was found effective at reducing the symptoms of post-traumatic embitterment.

Traumatic events, forced displacement, and loss of social support have been said to be able to effectively increase the number of Syrians who experience symptoms of mental illness (Hassan et al., 2016). Most refugees from the Middle East in the last two decades have been women who’ve been sexually abused or whose spouses have died. Prolonged grief disorder is one of the leading psychological disorders Syrian refugees experience (Hijazi & Weissbecker, 2015; Hassan et al., 2016). Developing a logotherapy-based group psychological counseling program has significant value for determining the well-being levels of Syrian refugee women facing traumatic grief who’ve suffered serious traumatic events, become widowed in the war, and taken refuge in Turkey due to life threatening danger. In light of this information, the problem statement of the research is “Does the logotherapy-based group psychological counseling program have an impact on the indicators of psychological functionality (PERMA areas of well-being) for widowed Syrian refugee women.

Logotherapy

Logotherapy is a theory developed by Viktor E. Frankl. The theory of logotherapy consists of concepts such as search for meaning, existential frustration, the existential vacuum, and neurogenic neurosis (Joshi et al., 2014, p. 227; Nassif et al., 2010, p. 21). Logotherapy was constructed upon Frankl’s concepts of search for meaning, which he described as the Third Viennese School of Psychotherapy. In general, logotherapy is an individual-centered phenomenological approach (Längle, 2012, p. 162).

The Philosophy of Logotherapy

According to Victor E. Frankl, logotherapy focuses on the future less retrospectively and less inwardly than psychoanalysis; namely, it focuses on the meanings the client will realize in the future. At the same time, logotherapy removes the focus from all vicious cyclical formations and feedback mechanisms in the development of neuroses. Humans as spiritual beings and life’s challenges as stepping stones to emotional and spiritual growth summarize logotherapy’s point of view (Yaniger & Shantall, 2015). The aim of logotherapy is to help individuals find purpose and meaning in life and to act positively in line with self-transcendence. The uniqueness of logotherapy comes from this.

Stating logotherapy to be based on three basic principles, Xu (2010, p. 181) stated the search for meaning as the greatest thing motivating people to be the first, life having meaning even in hopeless and difficult moments to be the second, and humans being free to find meaning in their life as the third.

The Basic Concepts of Logotherapy

As one of the basic concepts of logotherapy, the search for meaning according to Frankl expresses the self-transcendence of human existence. The reality of self-transcendence may happen by a person turning to something or someone other than themself. The more one forgets the self by dedicating themself to serving a cause or a person to love, the more human and self-realized they become. The more comprehensive the meaning, the less agreeable it is. Meaning in life is always able to change; however, it never disappears. According to Frankl, (2007, 1967a; Lewis, 2011), an individual can find meaning in life in three different ways: by creating a work or doing a job (creative values), by experiencing something or interacting with someone (experience-based values), and by developing an attitude toward inevitable suffering (attitudinal values).

As another important concept of logotherapy, the existential vacuum causes obstruction in a person’s search for meaning (Frankl, 2013). When the search for meaning regarding the self remains inconclusive, a person gets swept into an existential void (Thompson, 2012, p. 429). Existential frustration is a state anyone can experience because meaning can become obstructed by external and internal factors (Wong, 2002).

The concept of the existential vacuum in logotherapy refers to a person beginning to question their life when unable to find a reason to live; the feeling of emptiness that forms in one’s psyche is the existential vacuum (Budak, 2003, p. 800). Although the existential vacuum is not a pathological phenomenon (Frankl, 1967), boredom is experienced as a feeling of stagnation and emptiness (Altıntaş & Gültekin, 2003, p. 181).

Frankl stated self-transcendence to be the greatest trait in the human search for the question of meaning. Self-transcendence reflects the human desire to turn to something or someone above or beyond the self by overcoming one’s selfishness (Yalom, 2001, pp. 688–692).

The concept of looking at oneself from afar that occurs in logotherapy is the capacity one has to be able to look at oneself from outside as humorously as possible by diminishing oneself. A sense of humor is another symbol of the human psyche, and logotherapy is one of the few therapies to make meaningful use of humor (Rice, 2005).

Having a significant position in existential philosophy, existential psychology, and logotherapy, the concept of freedom according to Frankl does not mean humans are free beings under human conditions but that they are free to take a stand in the face of these conditions. Humans make decisions to fight, yield, let circumstances decide, or ignore whether they want to or not. According to logotherapy, a person is as free as the extent to which they take responsibility for their life.

The Logotherapeutic Process

According to Frankl (2005), not every method is applicable to every client with the same success, nor is every therapist able to apply every method with equal success. In addition, logotherapy is not an approach that is usable in all types of cases (Frankl, 1967). By applying logotherapy, the aim is to accompany the client as they become aware of their own responsibilities and freedoms as well as the source of their psyche (Rice, 2005). Logotherapy’s therapeutic goals can be listed as follows (Wong, 2002, p. 20):

• To help individuals develop a deeper understanding of the causes of their complaints.
• To help individuals develop a set of positive meanings related to core values, deep-rooted beliefs, and existential interests.
• To equip individuals with skills effective toward the many needs in their lives.
• To enable social approval in order to facilitate the process of realizing meaning.

The psychological counseling process attempts to ensure a client who has problems becomes fully aware of their own existential responsibility. Clients should become aware of what, why, or to whom they are responsible (Karahan & Sardoğan, 2004, p. 145).

Well-Being

Having importance and prominence in the literature on positive psychology, the concept of well-being focuses on supporting happiness and well-being by enabling people to discover their own strengths as opposed to improving weak points or mental disorders (Seligman et al., 2005).

One of the most current and comprehensive well-being models in the literature on well-being and the one giving direction to this research is the multi-dimensional PERMA model of well-being (Seligman, 2011).

Seligman’s PERMA Model of Well-Being

Seligman (2011) explained the expression of well-being in its simplest form by developing a five-dimensional model of well-being. According to the model of well-being, PERMA is an abbreviation of positive emotions, engagement, relationships, meaning, and accomplishment and emerges as the experience of these five dimensions. According to Seligman, while a person experiencing the five dimensions at the same time is not well-being, neither does experiencing the sub-dimensions one at a time provide well-being. The PERMA model is a multidimensional theory of well-being that combines the subjective (hedonic) and psychological (eudaimonic) theories of well-being.

Butler and Kern (2016) created a measurement tool with respect to the PERMA model that can measure well-being, and Demirci et al. (2017) carried out the adaptation of this scale to Turkish, which is what this study also uses.

Positive emotions make up the first sub-dimension of the PERMA model and is related to what a person feels; subjective measurements can be made regarding this sub-dimension. Emotion such as pleasure, happiness, excitement, hope, and love have been identified in the sub-dimension of positive emotions (Fredrickson et al., 2008; Seligman, 2011). Engagement is the second sub-dimension of the PERMA model and is a subjective concept. Engagement is also expressed with the word “flow” (Khaw & Kern, 2014). Relationships is the third sub-dimension, and Seligman (2011) suggested people to be the most reliable and best antidotes in difficult times. The concept of meaning is the fourth sub-dimension of the PERMA model and is interpreted as a part of well-being. Relationships with other people add meaning and purpose to life. Meaning contributes to well-being and exists without serving any other purpose; meaning is defined and measured independently from positive emotions and engagement. The sub-dimension of accomplishment indicates how a person progresses toward goals, feels competent performing daily activities, and has a sense of achievement. Accomplishment emerges as a sustainable concept in well-being.

Method

This study uses a quasi-experimental design which examines the relationship between widowed Syrian women’s well-being with the logotherapy-based group psychological counseling program in which the participants voluntarily participated. The study takes widowed Syrian women and the logotherapy-based group psychological counseling program as the independent variables and well-being as the dependent variable. The individuals observed during the research are subjected to an experimental intervention, and the use of a control group is not required as the attempt is to determine the individuals’ status before and after the intervention.

Study Group

The study group is formed from 12 widowed Syrian women residing in Istanbul’s Arnavutköy District. While identifying the study group of the research, an announcement was made by reaching out to the people in the universe through a non-governmental organization located in Arnavutköy. Afterword, the purpose of the program was explained to the women who wanted to participate voluntarily, 12 of whom were invited to the study.

Twelve female participants have been included in the research. The participants’ ages are seen to vary between 24-39 years. When looking at the participants’ educational status, four were seen to have literacy skills, four are primary school graduates, two are high school graduates, and two are university graduates. Of the participants, seven stated not working at any paid job, while five stated having a paid job. When looking at the distribution of professions, six participants are seen to have none, one is a graphic designer, two are cleaning staff, and three work in field of textiles. All participants stated their current income level to be low; five stated their income level before losing their spouse had been high, while five stated it been at a medium level. Of the participants, one stated having lost their spouse one year earlier, two lost their spouse two years prior, six became widows three years prior, two were widowed four year prior, and one became a widow five years prior. All but one participant had had arranged marriages, with their ages at the time of marriage ranging between 13 and 20 years old.

Of the participants in the study group, two have one child, three have three children, three have four children, and four have five children. The time the participants have been residing in Turkey varies between one and five years. In regard to receiving social support, six participants stated they were on their own and received no social support, two have support from friends, three have support from siblings, and one has family support. Of the participants, 10 are seen to receive no psychological support. When looking at information regarding their health status, nine participants are seen to have a chronic illness.

Data Collection Tools

Sociodemographic Information Form

The demographic information form consists of 15 questions aimed at evaluating the participants’ sociodemographic characteristics. The questions involve topics related to age, education level, employment status, income level, number of children, age at marriage, type of marriage, social support, chronic illness, and psychological support. Written informed consent was obtained from the women who participated in the logotherapy-based group psychological counseling program.

PERMA Profiler (5-Dimensional Well-Being Scale)

Developed by Butler and Kern (2015, 2016), the PERMA Profiler aims to conceptualize and measure Seligman’s five dimensions of well-being (i.e., positive emotions, engagement, relationship, meaning, and accomplishment. Demirci et al. (2017) adapted the PERMA Profiler to Turkish. PERMA is an acronym for the first letters of the sub-dimensions of the model (i.e., Positive emotion, Engagement, Relationship, Meaning, and Accomplishment). The PERMA Profiler’s Cronbach alpha of reliability is 0.91; it includes 15 items, eight filler items, and five sub-dimensions. Cronbach’s alpha of reliability for the positive emotions sub-scale is 0.81. Items 5, 10, and 22 involve the sub-dimension of positive emotions. Cronbach’s alpha for the engagement sub-scale is 0.61. Items 3, 11, and 21 involve the sub-dimension of engagement. Cronbach’s alpha for the relationship sub-scale is 0.61. Items 6, 15, and 19 involve the sub-dimension of relationship. Cronbach’s alpha for the meaning sub-scale is 0.77. Items 1, 9, and 17 involve the sub-dimension of meaning. Cronbach’s alpha for the accomplishment sub-scale is 0.70. Items 2, 8, and 16 involve the sub-dimension of accomplishment. Items 7, 12, 14, and 20 are reverse scored. Each sub-dimension has three questions. Although each sub-scale can be defined and measured separately, none of them express well-being on their own; each sub-scale contributes to well-being. Scores are obtained by taking the average score for each sub-dimension, and these five sub-dimensions are reported using the dashboard approach. Overall well-being is calculated by averaging the scores from the sub-dimensions of positive emotions, engagement, relationship, meaning, and accomplishment.

Treatment

The researcher obtained the quantitative data for examining the effectiveness of the program in the research were obtained by implementing the PERMA Profiler and demographic information form. The participants were given detailed information about the scales and their implementation. The pretest was applied prior to the implementation. The logotherapy group program was conducted upon the experimental group over 12 weeks. The research (a logo-therapist) conducted the sessions. The first week involved introductions and discussed the program objectives and mourning processes. In the second week, meanings were discovered in the grieving process. The third week focused on meanings in life. In the fourth week, the widows shared photos of their deceased husbands and discussed the responsibilities of life. In the fifth week, a meaning-focused autobiography was created. In the sixth week, letters were written saying goodbye to the deceased, and they mentioned the hardships they’ve experienced. In the seventh week, parallel goals were set in line with existential goals. In the eighth session, an evaluation was made about the program, and the implementation was concluded with a farewell activity. The posttest was administered after the implementation, and the follow-up test was administered three months after the end of the program.

The Logotherapy Group Program

The research implemented the Logotherapy-Based Group Psychological Counseling Program for Widowed Syrian Refugee Women, which consisted of eight sessions approximately 120 minutes in length. One session was held and completed each week. Simultaneous interpretation was provided during the group sessions. The researcher prepared the logotherapy-based group counseling program by considering the principles and techniques of meaning-focused therapy, also known as logotherapy. A large volume of resources were consulted while forming the theoretical framework of the logotherapy-based group psychological counseling program and planning the session activities, which were created by taking into account the principles of the practice (Hutzell & Jerkins, 1990; Fabry & Perry, 2014; Altınay, 2009; Haditabar et al., 2013; Julom & Guzmán, 2013; Kang et al., 2009; Van Deurzen (2012); Shoakazemi et al., 2012; Van Deurzen & Adams (2016); Voltan Acar, 2004; Erkan et al., 2012; Erkan & Kaya, 2009; Smead-Morganett, 2013; Erkan & Kaya, 2007; Erkan, 2000).

The logotherapy-based group psychological counseling program has been prepared for widowed women in line with the objectives, and expert opinions were obtained by consulting with experts who conduct logotherapy efforts in the field.

Table 1. The Logotherapy-Based Group Psychological Counseling Program Sessions

Data Analysis

The data collected toward finding answers to the sub-problems within the framework of the general purpose stated in the research were saved onto a computer. The package program IBM SPSS was used for analyzing the data. The data obtained from the personal information form and the PERMA Profiler were entered in the program SPSS. The Friedman test was applied in order to test whether a significant difference exists between the ingroup measurement scores from the PERMA Profiler (i.e., pretest, posttest, and follow-up test) in the experimental group. If a significant difference occurs between the ingroup measurement scores according to the Friedman test results, the Wilcoxon signed-rank test gets applied to determine the measurements between which this significance difference has occurred.

Findings

Experimental Group Descriptive Statistics

Table 2 presents the demographic information pertaining to the participant group.

Table 2. Participants’ Demographic Characteristics

Intra-Group Comparisons

The Friedman test was applied for the purpose of testing whether or not a significant difference exists between the ingroup measurement scores on the PERMA Profiler (pretest, posttest, and follow-up test) in the experimental group. If a significant difference exists among the ingroup measurement scores according to the Friedman test results, the Wilcoxon signed-rank test will be applied to determine the measurements between which this significant difference has occurred.

Table 3. Friedman Analysis Results for Determining Whether Differences Exist Among the Pretest, Posttest, and Follow-up Test Scores for the Sub-Dimension of Positive Emotions on the Experimental Group PERMA Profiler

As shown in Table 3, a statistically significant difference has been identified among the experimental group’s pretest, posttest, and follow-up test scores for the sub-dimension of positive emotions (x² = 21,83; p < .05). Table 4 presents the results from the Wilcoxon signed-rank test that was applied to determine which measurements were significantly different.

Table 4. Wilcoxon Signed-Rank Test Results Regarding the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Positive Emotions on the Experimental Group PERMA Profiler

As shown in Table 4, statistically significant differences are seen in the sub-dimension of positive emotions for the experimental group’s pretest and posttest scores (z = -3.06; p < .05), posttest and follow-up test scores (z = -2.06, p < .05), and pretest and follow-up test scores (z = -3.07, p < .05). Accordingly, the experimental group’s scores are significantly higher on the posttest compared to the pretest scores, on the follow-up test compared to the posttest, and on the follow-up test compared to the pretest.

Table 5. Friedman Analysis Results for Determining Whether Differences Exist Among the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Engagement from the Experimental Group PERMA Profiler

As seen in Table 5, a statistically significant difference has been identified between the experimental group’s pretest, posttest, and follow-up test scores for the sub-dimension of engagement (x² = 20.14; p < .05). Table 6 presents the results from the Wilcoxon signed-rank test applied to identify the measurements between which a significant difference is found.

Table 6. Wilcoxon Signed-Rank Test Results Regarding the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Engagement on the Experimental Group PERMA Profiler

As seen in Table 6, statistically significant differences are seen between the experimental group’s scores for the sub-dimension of engagement between the pretest and posttest (z = -3.07; p < .05) and between the pretest and follow-up test (z = -3.07, p < .05). Accordingly, both the experimental group’s posttest scores and follow-up test scores are significantly higher than their pretest scores. In addition, no significant difference was determined between the posttest and follow-up test scores for the sub-dimension of engagement (z = -0.264, p > .05).

Table 7. Friedman Analysis Results for Determining Whether Differences Exist Among the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Relationship from the Experimental Group PERMA Profiler

As seen in Table 7, statistically significant differences have been determined to exist between the experimental group’s pretest, posttest, and follow-up test scores for the sub-dimension of relationship (x² = 20.35; p < .05). Table 8 presents the results from the Wilcoxon signed-rank test applied to identify the measures between which significant differences are found.

Table 8. Wilcoxon Signed-Rank Test Results Regarding the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Relationship on the Experimental Group PERMA Profiler

As seen in Table 8, statistically significant differences have been found for the experimental group’s scores from the sub-dimension of relationship between the pretest and posttest (z = -3.06; p < .05), posttest and follow-up test (z = -2.14, p < .05), and pretest and follow-up test (z = -3.07, p < .05). Accordingly, the experimental group’s scores are significantly higher for the posttest compared to the pretest, for the follow-up test compared to the posttest, and for the follow-up test compared to the pretest.

Table 9. Friedman Analysis Results for Determining Whether Differences Exist Among the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Meaning from the Experimental Group PERMA Profiler

As seen in Table 9, a significant difference has been identified in the experimental group’s pretest, posttest, and follow-up test scores for the sub-dimension of meaning (x² = 19.64; p < .05). Table 10 presents the results from the Wilcoxon signed-rank test applied to determine the measures between which significant difference are found.

Table 10. Wilcoxon Signed-Rank Test Results Regarding the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Meaning on the Experimental Group PERMA Profiler

Table 10 shows significant differences to exist in the experimental group’s scores for the sub-dimension of meaning between the pretest and posttest (z = -3.07; p < .05) and between the pretest and follow-up test (z = -3.07, p < .05). Accordingly, the experimental group’s scores for the sub-dimension of meaning are significantly higher on the posttest and follow-up test compared to the pretest. In addition, no statistically significant difference was detected between the posttest and follow-up test scores for the sub-dimension of meaning (z = -0.141, p > .05).

Table 11. Friedman Analysis Results for Determining Whether Differences Exist Among the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Accomplishment from the Experimental Group PERMA Profiler

As seen in Table 11, a statistically significant difference has been found among the experimental group’s pretest, posttest, and follow-up test scores for the sub-dimension of accomplishment (x² = 20.57; p < .05). Table 12 presents the results from the Wilcoxon signed-rank test applied to identify the measurements between which significant differences are found.

Table 12. Wilcoxon Signed-Rank Test Results Regarding the Pretest, Posttest, and Follow-Up Test Scores for the Sub-Dimension of Accomplishment on the Experimental Group PERMA Profiler

As seen in Table 12, significant differences are seen to exist between the experimental group’s scores for the sub-dimension of accomplishment between the pretest and posttest (z = -3.07; p < .05) and between the pretest and follow-up test (z = -3.07, p < .05). Accordingly, the experimental group’s scores for the sub-dimension of accomplishment are significantly higher for the posttest and follow-up test compared to the pretest. In addition, no statistically significant difference is found for the sub-dimension of accomplishment between the posttest and follow-up test scores (z = -0.106, p > .05).

Table 13. Results from the Friedman Analysis Performed for Determining Whether a Difference Exists Among the Experimental Group’s Pretest, Posttest, and Follow-Up Test Scores for General Well-Being on the PERMA Profiler

As seen in Table 13, a statistically significant difference has been found among the experimental group’s pretest, posttest, and follow-up test scores for general well-being (x² = 19.48; p < .05). Table 14 presents the results from the Wilcoxon signed-rank test applied to determine the measurements between which significant differences are found.

Table 14. Wilcoxon Signed-Rank Test Results Regarding the Experimental Groups’ Pretest, Posttest, and Follow-Up Test Scores for General Well-Being from the PERMA Profiler

As seen in Table 14, statistically significant differences exist for the experimental group’s general well-being scores between the pretest and posttest (z = -3.06; p < .05) and between the pretest and follow-up test (z = -3.06; p < .05). Accordingly, the experimental group’s scores for general well-being are seen to be significantly higher for the posttest and follow-up test compared to the pretest. In addition, no statistically significant difference was found between the well-being scores for the posttest and follow-up test (z = -1.48; p > .05).

Discussion

When looking at the findings for the sub-dimensions of well-being from the PERMA Profiler, a significant difference is seen to be present in the experimental group participants in terms of their levels of positive emotions. This difference was found to be permanent and significantly higher in the follow-up test made two months after completing the implementation. The most important effect from the widowed Syrian refugee women who participated in the study having low scores for the sub-dimension of positive emotions on the pretest was that they had lost their spouse in the war. Arslantaş et al. (2010) research on inpatients reported married individuals to have higher levels of hope compared to single, widowed, and divorced individuals. In the literature, the symptoms of post-traumatic stress disorder and depression refugee and displaced women experienced were observed to have decreased at the end of psychosocial group programs applied to them (Dybdahl & Pasagic, 2000; Nicholson & Kay 1999). The research findings from the current study can be stated to indicate the impacts of the logotherapy-based group psychological counseling program on positive emotions. Many studies show logotherapy to provide effective and sustainable results toward positive affectivity. Mohabbat-Bahar et al. (2015) examined the effect of anxiety on female breast cancer patients in their logotherapy-focused study. Their study’s results concluded the logotherapy-focused counselor to have significantly reduced the anxiety levels of the women with breast cancer.

In terms of the engagement levels of the participants in the experimental group, a significant difference was seen to exist between the pretest and posttest scores, with no significant difference between the posttest and follow-up test scores. Engagement is expressed as a subjective concept with the word “flow”. When one is not in a flow, they have no idea how they feel or what to think when they are overwhelmed. The symptoms of post-traumatic stress disorder and depression women experience have been observed in the literature to decrease at the end of psychosocial group programs applied to refugee and displaced women (Dybdahl & Pasagic, 2000; Nicholson & Kay, 1999). Group intervention programs for asylum-seeking and refugee women help them stay in the flow by helping them focus on their feelings, thoughts, and behaviors.

In terms of PERMA’s sub-dimension of relationship, a significant difference exists for the experimental group participants; their scores were found to be significantly higher in the follow-up measurement made two months after the implementation finished. For the Syrian refugee women participating in the research, what had prevented them from establishing relationships with the society in which they live were the death of their spouses, their not knowing the language, and financial insufficiency. The women who participated in the logotherapy intervention program encountered many difficulties upon choosing to come to Turkey since the border. Some of these difficulties involve negative behaviors such as abuse and fraud. Women who feel insecure due to the absence of their spouse have difficulty establishing relationships with their social environment.

The research findings show a significant increase to have been observed in the participants in the experimental group in terms of their levels of meaning, a sub-dimension from the PERMA Profiler regarding well-being. However, no significant difference was observed for this sub-dimension between the posttest and the follow-up test held implemented two months after completing the intervention. The research showed the pretest levels for the sub-dimension of meaning to be low at the beginning of the group process for the Syrian refugee women who’d faced many difficulties and traumatic situations before, during, and after the war. Their level of meaning increased significantly during the logotherapy program. When looking at the results of logotherapy-based practices in the literature, Haditabar et al. (2013) concluded the logotherapy-focused program to have played a role in improving the quality of life for female students. Southwick et al (2006) applied an experimental logotherapy treatment study and presented their observational results about people with war-related post-traumatic stress disorder having developed positive meanings about life, having increased their acceptance levels regarding themselves and their symptoms, and having gained positive perspectives. The research findings from the present study can be stated to indicate the logotherapy-oriented group psychological counseling program to have impacts upon meaning.

Cho’s (2008) experimental study examined the effect of the logo-autobiography intervention program on the meaning in life and mental health of people with alcoholic spouses. As a result of Cho’s study applied to an experimental group, a significant increase was observed in the meaning and purpose in life levels for the experimental group compared to the control group, and a significant decrease was observed in the experimental group’s levels for the sub-dimensions of somatization, interpersonal irritability, depression, and anger/hostility compared to the control group. The increases in the levels of meaning, positive emotions, and relationship in the present study are consistent with Cho’s research findings.

In terms of the research’s levels for the sub-dimension of accomplishment with respect to the participants in the experimental group, a significant increase occurred that is seen to be significantly high between the posttest and pretest and between the pretest and follow-up test. The sense of failure and inadequacy the Syrian women felt at the beginning of the group intervention changed positively upon continuing the program. Most of the women who participated in the study were observed to have felt unsuccessful due to their low education level; as a result, they worried that they would be unable to raise their children well. In the literature, Seligman (2002) stated educational status to however not directly affect well-being; social status instead increases well-being indirectly (e.g., increased income levels).

A significant increase is found in terms of the general well-being levels when comparing the experimental group participants’ pretest, posttest, and follow-up scores. While the intragroup comparison showed significant difference between the pretest and posttest and between the pretest and follow-up test, no significant difference was found between the posttest and follow-up test. When looking at the literature, Chakhssi et al.’s (2018) study found positive psychology intervention programs to have low significant effects on well-being and depression levels, moderate effects on anxiety levels, and no significant effect on stress levels. When looking at the impacts on general well-being in the current study, this is consistent with the absence of a significant difference in the level of well-being between the posttest and follow-up test. The negative impacts of traumatic experiences on mental health and well-being before and during migration have been said to make coping with traumatic experiences post-migration difficult for individuals (Li et al., 2016). In the literature, Tinghög et al.’s (2017) study on Syrian refugees living in Sweden stated traumatic experiences after migration to be associated with anxiety, depression, and post-traumatic stress disorder. Another study by Özen and Cerit (2018) examined the traumatic experiences of Syrians as research carried out over Syrians who’d migrated to Turkey due to the war and who work in relief organizations. According to their research findings, they found a significant positive relationship to exist between their scores for depression and for post-traumatic stress disorder. The literature shows Syrian refugees’ levels of depression, post-traumatic stress disorder, and anxiety to have been examined. The present study observed the participants during the group program to have experienced many positive emotions and memories despite the war, death, migration, and losses. Research on well-being is important as one of the most basic concepts of the positive psychology literature.

What was shared during the group process in the research revealed the Syrian women to have difficult living conditions, their opinions to have not been taken into consideration during the marriage process, and to have accepted early marriage as part of their culture. When observing the number of children they have at the same time as their current living conditions, these difficulties are high. Problems can be said to have been experienced regarding family planning. Of the women participating in the logotherapy group intervention program, seven have no job, and five work in non-qualified jobs. Syrian women with low economic status were learned to receive help from NGOs. Undoubtedly, this situation negatively affects well-being levels. In the literature, the well-being levels for individuals with no job were found to be significantly lower compared to those who have a profession, according to Kilit’s (2019) research.

As a result, this research has shed light on the literature based on the application to widowed Syrian refugee women as well as its effectiveness on their well-being levels. Adapting the logotherapy-based group psychological counseling program to female groups from different culture may be beneficial. Testing the program’s effectiveness is recommended by applying it to women in disadvantaged groups by taking into account the war, migration, and traumatic process. The expression of meaning that logotherapy gains is considered to be able to benefit researchers when considering Turkey. In this context, the recommendation is made to carry out studies in various fields to test the effectiveness of logotherapy in Turkey.