Journal of Psychology & Psychotherapy
Open Access

Promoting a Positive Self-Image in Elementary School Girls

Natasha Skinner^{* *}Correspondence: Natasha Skinner, School of Education, University of Alaska Fairbanks, Alaska, United States, Email:

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Introduction

A positive self-image varies by the individual. According to Lindberg, et al. [1], self-image depends on the individual’s belief in their skills, appearance and character, while body image focuses on one’s view of their physical form. A positive self, or body, image is important as it protects against mental illness, according to Norwood, et al. [2]. Since images in the media overwhelm young girls with what society believes the body should look like, it is crucial to develop school-based programs teaching girls how to separate the media’s message from their own self-image [2]. One concern in teaching young girls about media’s influence, however, is that it could result in harmful body image, which might be followed by risky actions to alter one’s body shape and weight [2].

According to Asamen, et al. [3], young girls are greatly influenced by the media, linking watching television with adolescent girls’ desire for a slim body type. Asamen, et al. [3], add that young girls’ exposure to television can manipulate their self-image and gender identity during adolescence, which is defined as being between the ages of ten and twenty by Santrock, et al. [4]. How the effect of television manifests depends on the individual. Factors influencing the effect of television include the age of an individual, their developmental period, amount of television exposure, what is viewed, and the race of the individual [3]. These factors could aid school counselors in understanding the link between the self-image of adolescent girls and society’s power to affect their self-image.

Wertheim, et al. [5], state that having a positive self-image may promote healthy mental and physical growth in young girls. When young girls lack a positive self-image, it can result in a variety of harmful issues emotionally, cognitively and behaviorally [5]. Furthermore, when adolescents do not like themselves and cannot view themselves favourably, they often need the attention of their caregivers, teachers and counselors [6]. Based on 21 studies, including at least 6,000 young girls who were ten years and older, it was found that girls who were exposed to fashion magazines were more likely to suffer from self-image issues [7].

Over time, young girls’ development is hindered by society’s portrayals of what makes women beautiful, preventing them from completely developing into functional individuals [8]. According to Wertheim, et al. [5], young girls tend to believe that a slim body would make them more content, healthier and physically appealing. In effort to achieve the beauty ideal, the adolescent girls may suffer malnutrition from choosing not to eat, which can have harmful effects on cognitive development, according to the body wise handbook [8]. As a result of not eating, the children experience hunger, which leads to irritability, lack of concentration, nausea, headaches and fatigue. The body wise handbook states that students with these symptoms are less likely to be attentive during instruction and may have difficulty accomplishing any work. Therefore, as a result of poor selfimage, the affected girls are more likely to have poor academic achievement, poor health and absenteeism.

Teen eating disorders supports the claims of Wertheim, et al. [5], and states that at least 9% of nine-year-old girls confessed to vomiting in order to lose weight [9]. Furthermore, this website indicates that 42% of young girls in second and third grade have a desire to be slim. For example, 53% of thirteen-year-old girls admit to being discontent with their bodies [9]. Other sources like the Association of Anorexia and Nervosa and Associated Disorders (ANAD) state that anorexia is the third most prevalent disease among adolescents [10]. Friedman, et al. [11], state that 51% of nine and ten-year-old girls feel happy when they diet and 53% of thirteen-year-old girls have said that they are discontent with their bodies. Moreover, these authors assert that for the age range of 11-17 some of these girls desire to lose weight.

Ferreira, school counselor at Anne Hopkins Wien elementary school in Fairbanks, Alaska (personal communication, February 16, 2010) stated that girls start to manifest issues with self-image in the fourth grade at nine-years-old, continuing through the fifth and sixth grades. In her six years as a school counselor, she expressed that her kindergarten-third grade students were oblivious to their appearances and were more accepting of one another. The discrepancy in awareness of self-image may be due to the difference perception, which depends on the social and emotional development [12].

Sandoval, et al. [12], supports Ferreira’s claims and declares that a child who is five years old has different capabilities for processing facts and responding to situations than an adolescent. According to Santrock, et al. [4], the ages from two to seven are concurrent with the stage of preoperational functioning, when children can express themselves verbally and pictorially. Whereas at the concrete operational stage from seven to eleven, children can perform mental aspects enabling them to mentally do what they previously could do only physically. However, at the age of nine, they are in the concrete operational stage, capable of reasoning, projecting and identifying what they observe and feel.

Researchers Kater, et al. [13], assert that media instills the idea in young girls that being thin is equal to being beautiful and that anyone can attain this state. The consequence of not adapting to this ideal is ridicule [13]. Kater, et al. [13], used an elevenlesson program with 415 fourth-to-sixth grade female elementary students to address positive perceptions of their bodies and how to practice eating habits. The results showed that the young girls learned how to analyze the messages received by media, allowing them to combat eating disorders, weight concerns and other issues. As a result of these actions, the self-image, life choices and overall body perceptions of these young girls were positively affected.

This paper will begin by discussing how the media, peers, culture and parents contribute to the prevalence of poor selfimage among young girls. The literature review discusses the consequences of these aspects on the self-image of young girls, as well as what happens to young girls early on and later in life when the effects of these processes are left unquestioned. In addition, the literature review uses what young girls have to say about these processes and methods to lessen the impact of society on their self-image. The question to address is how elementary school counselors can promote positive self-image in young girls. To aid in that endeavour, an application with sample lesson plans has been developed.

Theoretical frameworks

The theoretical frameworks providing the base of literature and applications pieces are Cognitive Behavioral Therapy (CBT) and Albert Ellis’s Rational Emotive Behavioral Therapy (REBT). According to Corsini, et al. [14], CBT is a therapeutic process which involves modifying harmful thoughts or behavioral patterns and substituting them with more constructive thoughts or behaviors. The goal of CBT is to modify the misconceptions and ideas that an individual has by exploring the reasons behind the thought patterns and why they produce certain behaviors. The second framework is Albert Ellis’s perspective of Rational Emotive Behavioral Therapy (REBT). The goal of this framework is to get young girls to question their irrational beliefs about their self-image [14]. With the aid of REBT, young girls could realize their flawed belief system, enabling them to see discrepancies in their beliefs about their self-image.

Literature Review

In elementary school, when children are rapidly developing physically and mentally, they may receive impressions that follow them into adulthood [4]. Hansen, et al. [15], recounts a story about a woman named Valerie McManus, who, when she was a little girl, was very conscious of what society expected of her gender without ever questioning the rationality of these expectations. As she grew older, she grew to not accept her developing body. In order to control her appearance, McManus reduced her food intake, and it developed into an eating disorder by college. It was not until McManus took a college class on the sociology of gender that she learned how much society based the worth of women on their physical characteristics.

This understanding enabled McManus to see the power of society’s definition of beauty and just how much she had allowed these sociocultural views to define who she was [15]. Later in life, McManus sought a career where she would be able to prevent young girls from succumbing to the same sociocultural ideas. As a licensed clinical social worker, she is able to educate teenage girls in the foster system, in addition to girl scouts troops and other community non-profit groups, by hosting seminars in which she teaches them to appreciate and accept their bodies and provides healthy outlets to explore their self-image.

Many young girls do not realize that their distorted body images are driven by society’s beliefs about how their bodies should look. If the behaviors resulting from a negative self-image are not remedied early on that they can lead to low self-esteem, chemical dependency, promiscuity, self-harming behaviors, eating disorders and despondency [15]. Furthermore, a poor self-image could lead to detrimental relationship choices, mental health problems and bone diseases [15].

To either mitigate or combat the effects that society has on young girls, Hansen, et al. [15], states that parents should be the buffer between society and their daughters by limiting the time spent watching television and by encouraging them to enjoy outdoors activities and interpersonal connections. Additionally, since actions are more influential than words, parents could practice what positive body image looks like, in addition to praising their daughters on their skills.

Sociocultural influence on self-image

Wertheim, et al. [5], state that sociocultural influences drive children to believe in the importance of being beautiful and a certain standard of beauty Welch, et al. [16], studied fourth grade female students in Maryland public schools from urban, rural and suburban areas to figure out if there was a correlation between body image perception and weight status based on the Body Mass Index (BMI). They first collected information from this population, including height, weight and body image. They also wanted to determine, based on the BMI, who was at risk for being underweight and overweight. The research included 524 fourth grade public school girls: 38.6% from an urban school, 30.7% a suburban school, and 30.7% for a rural school. The students ranged in age from eight to eleven. They learned that, based on BMI, there was not a relationship between body image views and weight status [16]. Moreover, 60.6% of urban female students expressed more contentment with their body image compared with 44% of their suburban and 26.3% of their rural counterparts. Unlike rural students, urban schoolgirls desired a larger body image than both rural and suburban schoolgirls. Obese urban girls were more content with their larger figures than obese suburban or rural girls were. These authors surmised this discrepancy to be a product of these girls residing in distinct localities that espouse contrasting cultural beliefs about body image. This study reveals how early in development young girls are capable of expressing discontentment with their bodies.

In another study, Kostanski, et al. [17], focused on how being teased about physical appearance in school impacted self-esteem and young girls’ body image. These authors sampled 232 preadolescent girls in grades two to four from six public and four private schools in Melbourne, Australia and measured the height and weight of these girls, employing the BMI test, test see whether or not these students were malnourished or overweight. Kostanski, et al. [17], asked the girls if they were teased by their friends and parents about their weight and questioned them about the type of name-calling they endured. In addition, the girls were shown a figure rating scale which consisted of seven females who were rated from 1 (very thin) to 7 (obese). With this scale, the girls were asked which picture represented their current appearance and which one portrayed their preferred appearance. Kostanski, et al. [17], learned that 15.3% of their participants had been exposed to some teasing about their weight by both parents and friends. Girls who were obese had higher experiences with teasing than did those who were either normal or underweight. This study concluded that girls who did not have a normal body weight and were teased had more experiences with body image discontent. The evidence indicates that the disparaging words of both parents and friends regarding body image are very influential in the lives of young girls.

Krahnstoever-Davison, et al. [18], discuss why young girls begin having self-image concerns at the age of nine. These authors conducted a longitudinal study with 182 girls when they were the ages 5, 7 and 9. To determine the weight and body image issues of this population, these authors asked these young girls questions regarding fears of gaining weight, dietary habits, body shape, and their perceptions about being fat. Krahnstoever- Davison, et al. [18], found that from age 5 to 9 these girls had the same level of weight and body image issues, but as they got older their weight concerns increased. Those girls ages 5 to 7 who had admitted to having weight and body image issues along with dietary limitations and poor eating attitudes were more likely to diet at the age of nine.

The results of this study illustrate that young girls start dieting or having poor eating habits because they are anxious about their weight, leading them to engage in damaging behaviors such as dieting, purging, binging, and fasting [18]. This result would also explain why early dieting and weight matters result in harmful attitudes and behaviors in all young girls, as well as those who are non-overweight and overweight girls. It also shows that the issues that young girls manifest in preadolescence related to their weight, body, and dietary habits and attitudes are explanations as to why they are at risk for these same issues in later adolescence and adulthood.

Media influence on self-image

Media influence-magazines and television: Researchers Dohnt, et al. [19], show how the media contributes to the foundation and manifestation of body image. Dohnt, et al. [19], pooled 128 first to fourth grade girls from four different private schools in Adelaide, South Australia, two being single-sex and the other two being co-educational. To measure the body image of these girls, these researchers used a children’s figure rating scale, involving nine female silhouette illustrations that had appearances that varied from 1 (very slim) to 9 (very obese). The children were asked which silhouettes currently had a similar weight to them and which one had one that they would like to look like. Then, the girls were shown two pictures, one was said to be happy with her appearance while the second was not. The researchers then asked the girls which woman was similar to them, and if they were always happy or unhappy with their appearance.

To study the girls dieting awareness, Dohnt, et al. [19], used the children’s figure rating scale to ask the girls about their knowledge regarding restricting food intake as a way to control weight. During this assessment, they were shown two pictures, one of the women in the past, thinner, and one in the present, at larger size. The girls were then asked a series of questions, including why they thought the woman’s appearance had changed and what they would do if they were in the situation of both sizes.

To evaluate the self-esteem levels of the participants, Dohnt, et al. [19], used the global self-worth scale of the self-perception profile for children. This tool involves six items measuring how children view themselves, such as if the child is content with their present appearance. To test peers influences on self-image, three areas of their weight were evaluated: Peer body dissatisfaction, peer discussions, and imitation. With this test, the children’s figure rating scale was used to determine how girls viewed their peers’ body satisfaction. This population was asked to select a current and model body type for their peers, and it was observed that the girls chose a body type for their peers that mirrored their own unhappiness. The participants were also asked if, when they were with their friends, did they discuss the appearance of musical icons and of their friends [19]. Then, they were asked if they wanted to copy the appearances of their friends and musical icons. For this evaluation, the students were shown a picture of a group of girls and were asked if the girls in the picture would cause the students to alter their appearance. Additionally, they were asked if they or their friends would ever want to look like the women on television and magazines.

Finally, the participants were asked a series of questions about their exposure to media and its influence [19]. First, regarding television, they were asked to name a show they liked. Next, they were given a list of 12 known children’s television shows and at least two music video programs. With this list, they were asked how often they viewed any of the various programs. When it came to the subject of magazines, they were shown at least 20 periodicals that included both children and women’s magazines like Disney’s adventures and vogue. From here, they were asked how often they viewed these types of magazines. The list of 12 television programs and 22 magazines were evaluated together to determine how much they emphasized beauty and being thin.

Dohnt, et al. [19], results illustrated that the desire to be slim varied within the group. At least 48.4% of the girls wanted to be larger, while 46.7% of the girls in first-grade supported the thin ideal. Regarding appearance issues, 45% of the girls said they were content with their body image and 48% stated that they were mostly content with their appearance. Because the girls in this population had an understanding of dieting, it was easy to determine that at least 36% of them shown the sample figure said that her increase in weight was a result of poor eating habits and 43% suggested some healthy eating practices. Dohnt, et al. [19], created the sample figure to determine dieting consciousness.

Within the group of girls, there was minimal discussion relation to pop stars, their friends, clothes and imitating friends and famous people [19]. Only 6.3% discussed pop stars, 5.5% their friends, 7.0% clothes, 3.1% imitating famous people and 1.6% emulated their friends. Of this population, 83.6% viewed television often. The most viewed shows were The Simpsons (child program), saddle club (child program) and Lizzie McGuire (child program), which all had an appearance rating of 1, suggesting that these shows emphasized some aspect of appearance. The appearance rating (i.e., 0, 1, 2) indicates how much each television show or periodical emphasizes appearance and the slim ideal. A 0 means the television shows or magazines did not give any significance to appearance or the slim ideal, a 1 rating means that both television show and magazine puts some importance on appearance and the slim ideal, and the number 2 means there is a great significance of appearance and the slim ideal [19]. Of the group, 35% of girls said they look at magazines often and 34% said they viewed them occasionally. The researchers suggest that when young girls are exposed to women magazines (i.e., vogue or women’s weekly) and non-children’s programming (i.e., soap operas) they are conscious of their appearance and of ways to change it [19].

Thomsen, et al. [20], researched 502 high school female students who ranged in age from 15-18, between their sophomore and senior years, to assess the relationship between reading women’s beauty and fashion magazines and the use of dieting methods to control weight. First, Thomsen, et al. [20], asked these female students how often they read women’s fashion and beauty magazines. Next, the students were asked if they ever tried to control their weight by limiting their daily caloric intake to 1,200 calories or less and if they ingested laxatives, vomited or skipped meals. Other questions included how often they were concerned about their weight and/or engaged in exercises that lasted for two hours or more. From their study, these authors learned that at least 98% of this population read women’s fashion and beauty magazines once in a year, that 78.5% read these magazines once a month, and 59.2% read them two or more times a month [20].

Based on the frequency of these students reading beauty and fashion magazines, Thomsen, et al. [20], found that 11.4% said they used laxatives or other weight control methods and 14.5% reported using pills to suppress their appetites. Additionally, 51% said they skipped two meals per day, 8.8% indicated they forced themselves to vomit, and 52.2% admitted they limited how many calories they ingested per day by 1,200 or less. The results of this study showed that adolescent females who engage in practices that put their wellbeing in jeopardy are likely to manifest such eating disorders as bulimia and anorexia, as well as extreme weight and appetite control practices like ingesting laxatives, skipping meals, and vomiting. This study also provides evidence that the consequences of media exposure focused on beauty may result in the development of poor self-image and practicing poor dietary habits.

Media influence-videos and books: The following studies focus on media influence in belittling the self-image of young girls through pictures and verbal messages. For example, when a young girl lives in an environment which encourages a body type unlike that of her own, the likely outcome is that she will be susceptible to embracing this belief and become unhappy with her body. Wertheim, et al. [5], emphasize that research has been done on adolescent girls which shows how their exposure to the media’s beliefs about beauty predicts their unhappiness with their body.

The following study by Herbozo, et al. [21], is an example of how books and videos may instill children with body image issues. Herbozo, et al. [21], began their study by analyzing the content of body image-related ideas in children’s books and videos. The children’s books and videos they selected for their study included popular titles such as, Rapunzel, Eloise and Miss Spider’s new car, and for the video side, Aladdin, Sleeping Beauty and Pocahontas, all of which dealt with slimness, attractiveness, body type and size, strength and obesity. Overall, their study consisted of 20 children’s books and 25 children’s videos for children ages 4-8.

Herbozo, et al. [21], learned that these media associated positive traits, such as being sociable, generous, happy and prosperous, as characteristics of the slim-figured characters. The negative traits, which were being wicked, unattractive, unsociable and mean, were given to characters who did not fit the slim ideal.

The results showed each of the children’s videos had at least 8.7 body related messages and children’s books had 2.8. For instance, both Cinderella and The little mermaid videos had fourteen body-related messages, while Rapunzel had nine and where the wild things are books had five body-related messages. At least 72% of the videos and 7.5% of the books stressed physical appearance. Also, 60% of the videos illustrated a character’s affections for another being based on their appearance. This study also found 72% of the videos and 10% of the books place an emphasis on the characters who had body types with appealing traits. The media used in this study also showed that 60% of the videos illustrate female thinness and 32% show males as muscular.Additionally, 64% of the children’s videos and 20% of the books associate obesity with negative qualities [21].

Herbozo, et al. [21], research showed that beauty in media is equal to slimness, and only those who are slim, and therefore beautiful, are happy, successful and outgoing.

Beauty, then, becomes the most valuable requirement for females. Herbozo, et al. [21], research elucidates that more studies should be done to determine the full extent of the media’s influence in encouraging body image issues in young girls and reinforcing beliefs in them about their bodies that realistically they cannot achieve.

Media influence-barbie dolls: Dittmar, et al. [22], discuss Barbie dolls as a type of media which impacts children earlier than the age of nine. The researchers did a study with 162 girls who ranged in age from five to eight, coming from six primary schools in the East Sussex County of Southern England. Dittmar, et al. [22], wanted to study what affects the Barbie’s ultrathin image and the larger, size-16, Emme doll have on the body image of young girls ages five to eight. According to this article, the Emme doll was developed by the American Dietetic Association to stimulate a positive body image in young girls.

Dittmar, et al. [22], exposed the girls to images of Barbie and Emme dolls doing everyday things like shopping, trying on clothes and buying groceries. To assess how the girls were affected by these images, they were given a questionnaire that measured their body image. The questionnaire consisted of questions activities pertaining to their body esteem and body shape contentment, including if the girls liked their weight, if their peers liked their appearance and if they were satisfied with their looks.

Dittmar, et al. [22], results showed that these girls were unaffected by the Emme dolls, but that the Barbie dolls had a strong impact. The girls ages five and a half to seven and a half who were exposed to the Barbie dolls had lower body esteem and a stronger desire to be slim, while those who were ages seven and a half to eight and a half did not This suggests that the earlier young girls are exposed to dolls expressing an unachievable ideal of slimness, the more likely they are to develop eating disorders, poor body image and weight control issues. Additionally, Dittmar, et al. [22], learned that Barbie is a cultural icon and that about 99% of girls ages three to ten in the United States own a doll. Since fantasy and play are a means of socialization for young children, the girls may consciously and unconsciously adopt the ideas and values projected by Barbie about beauty.

Interventions

REBT and CBT can be used to make young girls aware of the discrepancies in their beliefs about self-image created by media and sociocultural influences and enable them to define their own belief system. Corsini, et al. [14], say that REBT could be used to challenge faulty a belief in an individual’s, while CBT may be used to modify a thought pattern, aiding in creating positive behaviors. Much of the research on REBT and CBT focuses on effectiveness with adults, but there are aspects of these theories that can be used with younger girls. For example, interventions could be implemented prior to the development of irrational thought patterns to firmly put in place effective thought patterns.

Cognitive Behavioral Therapy (CBT)

Mountford, et al. [23], employ CBT in treating eating disorders in conjunction with imagery, which is used to help adjust the restrictive-thinking models permeating some eating disorders.

The individuals studied use words like “gremlin”, “the thin”, “my anorexia” and “me” to picture their eating disorders. To illustrate the use of imagery and CBT with eating disorders, Mountford, et al. [23], present a case example of a woman aged twenty-two named patient L, who was a student being treated for her fouryear battle with bulimia and anorexia. Before patient L started this treatment, she had a body mass index which shifted between 17 and 20, depending on the level of her bulimia when her treatment began, patient L binged four times a week, limited her food intake, vomited sometimes, and exercised 10 hours a week. Patient L also admitted to sometimes manifesting self-harming behaviors, suicidal thoughts, and depression. During this study, the researchers started her on traditional CBT, which involved challenging the thinking patterns that she had concerning her eating, weight, and shape, as well as confronting her mood issues and impulsiveness. Her treatment also involved her drawing pictures of her anorexia to show what it looked like to her at various stages of treatment.

Told to keep a diary, patient L maintained a record of her anorexia and her negative thinking patterns [23]. Toward the end of her treatment, patient L began to view her anorexia as powerless. In the end, the use of imagery with CBT proved to aid patient L by changing her thought patterns regarding her weight, image and shape which had previously led to her developing the eating disorder. When Mountford, et al. [23], followed up with her after six months, they learned that patient L had maintained her progress. Even though patient L was past adolescence during the time of the study, she is an example that the use of CBT to treat eating disorders can be effective if it is structured to suit the individual.

Locks, et al. [24], discuss how CBT may be utilized, along with family therapy, with children with eating disorders, specifically anorexia nervosa. The researchers found that research done in Maudsley hospital in London demonstrated children could benefit from family-based representations of therapy since they live and have a prolonged reliance on their family members.

The Family-Based Treatment (FBT) would include client issues dealing with healthy weight maintenance. The methods of therapy employed in FBT do not vary according to the age of the client; however language is modified depending on development. FBT has three phases which take 6-12 months. The sessions in FBT are 1 hour, and the treatments for this therapy can be found in a manualized format. Locks, et al. [24], state that in phase 1 FBT helps parents to find beneficial ways to reestablish their child’s weight.

To facilitate this process, a family meal is taken with the therapist to provide a chance to examine the family’s behavior with eating and to aid the parents in improving the child’s eating habits [24]. The therapist also seeks to help the parents create a united front in order to better treat the symptoms causing the child’s self-starvation. If there are any siblings in the family, attempts are made to include the siblings in the process. Additionally, the therapist allows the parents to decide the best method for weight restoration. When the child starts to gain weight, phase 2 of treatment begins where the child may begin to take control of his or her eating. The final phase of this treatment involves decreasing the meals that are observed by the parents so that the child can be self-reliant in food situations outside the family.

Rational Emotive Behavior Therapy (REBT) Dahir, et al. [25], assert that REBT is utilized by school counselors who believe that awareness influences emotions whether or not they are positive, neutral, negative or assorted. With REBT, school counselors use methods like instruction and challenging to teach students on the freedom of emotion. Additionally, students would practice role-play, bibliotherapy, and journal writing, and homework assignments as part of the counseling procedure. REBT also includes learning new methods of thinking, behaving and feeling and aids the student to manage the course of their life [25]. Unlike other approaches, REBT is more practical with older children and adolescents who are mature and intellectually capable to distinguish reality from fictional thought processing. Even though REBT seems to be more used with older children and adolescents, there are some aspects of it that can be employed with elementary school children.

Ellis, et al. [3], discuss the use of REBT in developing confidence in a young person through a series of steps. First, they suggest that when children express confident behavior it should be promoted by telling them that what they have done thus far took conviction to accomplish and to look at how they took a chance at accomplishing something that was difficult. Second, Ellis, et al. [3], says that teaching methods that stimulate confidence can also teach children self-acceptance. They say that this could be accomplished by teaching them to list their positive traits. In addition to listing their positive traits, they could also list the not so appealing traits in order to recognize and appreciate their faults and choose, if they cause harm, to improve themselves. By understanding their positive traits, children can be taught that their traits do not disappear when something goes awry.

Both Cognitive Behavioral Therapy (CBT) and a Rational Emotive Behavioral Therapy (REBT) could be used to approach young girls in second and third grades and focus on challenging and changing their thinking patterns in order to produce behaviors that encourage them to be conscious of both the harmful and helpful aspects of self-image. CBT makes young girls aware of the faults in their ideas about their self-image and gets them to define their own self-image. REBT has its drawbacks in that it is more appropriate for older children and adolescents, but it can teach young girls to list positive traits about themselves, encouraging self-confidence.

Program examples

This section will review research regarding programs created to help elementary age students to develop a positive self-image and provide step-by-step directions for teachers or counselors. Most are focused on older elementary grades, but they can help set the foundation for programs focused on younger children.

Kater, et al. [13], tested 183 girls, ranging in age from nine to thirteen, attending four public schools and one private school in urban and rural parts of Minnesota. The program, called “Healthy body image: Teaching kids to eat and love their bodies too,” focuses on the individuals’ perceptions of their body image, their biases about their size, what influences their views, their level of self-esteem concerning their body and the ideas that society imbues them with. The eleven-lesson program is taught to children through games, experiential activities and anecdotes. In the lessons, Kater, et al. [13], educate the young girls regarding the basics about their body size, shape and weight and teach them about how much their bodies will fluctuate during puberty, the factors that heredity plays in their development, healthy ways to manage their weight, and the adverse effects of dieting and starvation. The goal of these lessons is to get these children to realize the drawbacks of unhealthy weight and shape habits, and to learn to accept their body, as is, despite messages from media.

Kater, et al. [13], showed the young girls what foods could satiate their appetite, types of physical activities that could make them more productive, role models that mesh with how people truly look, and how to be attentive to the many facets of their being. This study found that the older females (older in an age group of nine to thirteen) scored higher on the awareness of healthy and unhealthy food choices than the younger females. The older females also had a higher level of awareness concerning media messages than the younger, more susceptible females. The studies of Kater, et al. [13], show that when young girls are in the later years of their elementary education they are more aware of the effects that the media’s misleading messages have on their selfimage, and they have healthy ways of approaching it.

Unlike other preadolescent health programs, the body wise handbook (U.S. DHHS) is part of a Girl Power! Campaign by the U.S. Department of Health and Human Services (U.S. DHHS) intended to support and implement optimist standards and health actions among girls nine to fourteen and spread the message about the harmful effects eating disorders have on preadolescents [8]. The body wise program was created to give school employees, and anyone who works with students age’s nine to twelve, data and support that will help to develop backgrounds, strategies and plans which would prevent disordered eating [8]. The goal is to recognize which youths have risk behaviors related to eating disorders, lower the risk factors that subscribe to the creation of the eating disorders, add to the aspects that protect the youth and prevent new eating disorders from developing. The body wise handbook is a four-part packet discussing eating disorders and how school employees may aid students. Silverstein, et al. [26], state that multiple schools have been attempting to increase awareness of the dangers of eating disorders in young people. According to Silverstein, et al. [26], schools encourage this awareness by promoting a video called Self-Image: The fantasy, the reality, which was used by the PBS television broadcast for teenagers on in the mix, which is a program that tackles the issue of America’s fixation with body image. The video investigates America’s fixation with body image, which drives teens to diet, use steroids, and encourages them to have disordered eating and low self-esteem.

According to Gallop, et al. [27], the cool connections program guides children through common life-skills in order to build selfconfidence. The program, which uses CBT methods, included about 150 children, ages nine to fourteen, and taught them to regulate their emotional state, build emotional flexibility and learn problem-solving skills over 10 lessons. It also involves building support network through socialization. This article is evidence of how effective CBT is at targeting behaviors children manifested as a result of anxiety provoking situations resulting from poor self-image.

Application

The literature is a testament to the importance of self-image in young girls and the consequences on their development when this aspect is not dealt with accordingly. Since the creation of self-image occurs when these individuals are vulnerable, it has the ability to impede their developmental processes. Therefore, an application should be in place to build their confidence and create their own understanding of beauty. Physical appearance is not the only significant aspect of self-image, any qualities and talents that they possess are just as important.

This group has been developed to target second and third grade female students. Following recommendations from the American School Counselor Association (ASCA), school counselors could collaborate and plan with the parents, teachers and staff of the school to ensure that young girls are adequately informed of this issue, and that all parties involved are clear about what it takes for students of this age to flourish and focus on their studies [28].

Stallard, et al. [29], employment of CBT is an example of this application’s goal to make young girls aware of how external forces influence their self-view and to help the girls create their own self-image. This way they are able to develop awareness in regard to their own beauty that reflects more of who they are as individuals. The application could also utilize Kendall, et al. [30], and work by promoting self-awareness in young girls and how their self-image makes them feel. Understanding their selfimage and how it is developed would reduce anxiety provoking behaviors. With this knowledge, the young girls would have control over their thoughts and emotions and could learn other important aspects to themselves outside physical beauty.

Next Choate, et al. [31], advises that once young girls learn what to expect during puberty, they can become aware of the harms of gender stereotyping. This part of the application segues into teaching individual classes of females in grades second to third about how to develop an appreciation for the many types of beauty. The application would start with reading children’s books that teach the reader about accepting themselves just the way they are. The following lesson plans are intended to aid development of self-image and to find role models who enable the children to express what they like about themselves. At the end of the application, they would describe what is important to them, what they appreciate, what ideas and symbols they care about and what activities they like to do. The goal of this application is for young girls to get to a point where they are cognitively aware of what the media communicates about beauty and be able to take it apart and dispute the unrealistic aspects about it.

Discussion and Conclusion

During adolescence, young girl’s experience many bodily changes and are oftentimes at their most sensitive and vulnerable when it comes to their bodies. Statistics and literature illustrate the importance of self-image in the development of young girls and how often young girls have issues, such as mental illness, selfharming behaviors and eating disorders, caused by self-image. The literature also shows what happens to young girls in later adolescence and thereafter if there is no intervention.

Although this paper discusses other sociocultural factors that can contribute to the perpetuation of young girls negative self-image, the literature shows that the media, as insidious and present as it is, has the strongest impact because it is easily able to propagate its influence through magazines, television, advertisements, and even dolls.

The media’s many facets of communication are ripe with images and messages targeting and creating insecurities in young girls by telling them they will not be happy unless they achieve a certain look or behavior. That self-image issue occur in adolescent girls as young as the age of nine years old indicates that there is still time for school counselors at this level to intervene with guidance lessons teaching them how to seek what beauty is within themselves. In the end, the goal would be to take a page by encouraging them to challenge their negative beliefs about their self-image and those beliefs and images projected by the media, so that in time they could be happy with, and accept, who they are and not wish to look like someone that does not embody them.

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