Week 5
The therapeutic factors
I. Yalom
Group therapy as highly effective form of psychotherapy + equal to individual Page | 1
psychotherapy in power to provide meaningful benefit
Therapeutic change: complex process that occurs through intricate interplay of
human experiences – therapeutic factors
Therapeutic experience is divided into 11 primary factors:
1. Instillation of
2. Universality 3. Imparting information
hope
5. Corrective recapitulation of 6. Development of
4. Altruism
primary family group socializing techniques
7. Imitative
8. Interpersonal learning 9. Group cohesiveness
behaviour
10. Catharsis 11. Existential factors
Although discussed separately – they are interdependent + neither occur/function
separately
ALSO – represent different parts of the change process:
o Some factors [interpersonal learning] act at level of cognition
o Others [development of socializing techniques] act at level of emotion
o Others [cohesiveness] may be preconditions for change
Therapeutic factors operate in every type of group BUT function differently in each
Important to note that therapy is complex and so it is impossible to capture a
definitive, concrete account of the experience as a whole
• Feedback from group members on which factors were most + least helpful
may also be distorted by nature of their relationship to the therapist + group
etc
Therapeutic value of groups
, Week 5
• There are also factors like the length of time in treatment, level of client’s
functioning, type of group, age + diagnosis of client + ideology of group leader
There is also a distinction between how therapists view these factors + members
view them [all from the same group]
Page | 2
Also a differentiation is the ways in which group members perceive + experience the
same event in different way
BUT clients’ reports are a rich source of information so we must not disregard what
they say
o Obtaining data through questionnaires is easy but often miss the core of
clients’ experiences
o Therapist must be able to suppress personal bias + avoid influencing client’s
responses > becomes trusted
In summary – ways of evaluating therapeutic factors:
1. Therapists’ views
2. Clients’ reports
3. Systematic research approach
Systematic research approach: most common research strategy – correlate in-
therapy variables with outcome in therapy
o By discovering which variables are significantly related to successful
outcomes > can establish reasonable base from which to begin to delineate
therapeutic factors
o PROBLEM: measurement of outcome is itself a methodological morass +
selection + measurement of in-therapy variables are equally problematic
INSTILLATION OF HOPE
Instillation + maintenance of hope is crucial in any psychotherapy
Keeps client in therapy for other therapeutic factors to take effect but faith in
treatment mode can in itself be therapeutically effective as well
High expectation of help before therapy = positive therapy outcome [also when client
+ therapist have similar expectations of treatment
Therapeutic value of groups
, Week 5
Need to increase clients’ belief + confidence in efficacy of group mode > begins
before group starts [in pregroup orientation] where therapist reinforces positive
expectations, corrects negative perceptions + powerful explanation of group’s
healing properties
Page | 3
Also important for members to observe the improvement of others [those with whom
they share common problems with] for their own improvement
Hope as flexible – redefines itself to fit in immediate parameters, becoming hope for
comfort, dignity, connection with others + minimal physical discomfort
Vitally important for therapists to believe in themselves + in efficacy of group
Self-help groups place heavy emphasis on installation of hope
Substance abuse treatment programs: commonly mobilize hope in participants by
using recovered drug addicts as group leaders > expectations raised while being
inspired
UNIVERSALITY
Many individuals enter therapy thinking they alone have certain unacceptable
problems, thoughts, impulses + fantasies > due to extreme social isolation leads to
heightened sense of uniqueness
Do not learn about others nor avail themselves of the opportunity to confide in + be
validated + accepted by others
In therapy – disconfirmation of client’s feelings of uniqueness is powerful source of
relief
They hear others with the same problems > feel more in touch with world + describe
process as “welcome to the human race” experience
Members of therapy group soon perceive their similarities to one another
Universality also plays role in individual therapy – BUT less opportunity for
consensual validation [therapists restrict degree of personal transparency]
Secrecy may be an important + isolating factor > self-disclosure is vital
Feeling of universality often fundamental step in therapy of clients burdened
with shame, stigma + self-blame
Members of homogenous groups can speak to one another with powerful
authenticity based on firsthand experience in way that therapist may not be able to
Also important to pay attention to clinical factor of universality in multicultural groups
Therapeutic value of groups
, Week 5
IMPARTING INFORMATION
DIDACTIC INSTRUCTION
Most participants at the end of successful interactional group therapy – learn a lot
about psychic functioning, the meaning of symptoms, interpersonal + group Page | 4
dynamics + process of psychotherapy > usually happens implicitly [therapist does
not express this explicitly usually]
BUT are making psychoeducation an important part of the program recently
Group environment in which learning takes place is important > ideal context is one
of partnership + collaboration rather than prescription + subordination
Psychoeducation: offers explicit instruction about nature of client’s illness + life
situation + examining clients’ misconceptions + self-defeating responses to their
illness
▪ Example page 63
Groups often setting where mindfulness + mediation-based stress reduction
approaches are taught
By applying disciplined focus, members learn to become clear, accepting + non-
judgmental observers of their thoughts + feelings + reduce stress, anxiety and
vulnerability to depression
Significant + enduring psychosocial benefits
Therapists usually use some form of anticipatory guidance for clients about to enter
process of psychotherapy groups – preparatory sessions intended to clarify
important reasons for psychological dysfunction + provide instruction in methods of
self-exploration > helps cope more effectively with the culture shock
SO didactic instruction: employed in variety of ways in group therapy:
o Transfer information
o Alter sabotaging thought patterns
o Structure the group
o Explain process of illness
Functions as initial binding force in group until other therapeutic factors
become operative
The explanation of a phenomenon is the 1st step toward its control
Therapeutic value of groups
The therapeutic factors
I. Yalom
Group therapy as highly effective form of psychotherapy + equal to individual Page | 1
psychotherapy in power to provide meaningful benefit
Therapeutic change: complex process that occurs through intricate interplay of
human experiences – therapeutic factors
Therapeutic experience is divided into 11 primary factors:
1. Instillation of
2. Universality 3. Imparting information
hope
5. Corrective recapitulation of 6. Development of
4. Altruism
primary family group socializing techniques
7. Imitative
8. Interpersonal learning 9. Group cohesiveness
behaviour
10. Catharsis 11. Existential factors
Although discussed separately – they are interdependent + neither occur/function
separately
ALSO – represent different parts of the change process:
o Some factors [interpersonal learning] act at level of cognition
o Others [development of socializing techniques] act at level of emotion
o Others [cohesiveness] may be preconditions for change
Therapeutic factors operate in every type of group BUT function differently in each
Important to note that therapy is complex and so it is impossible to capture a
definitive, concrete account of the experience as a whole
• Feedback from group members on which factors were most + least helpful
may also be distorted by nature of their relationship to the therapist + group
etc
Therapeutic value of groups
, Week 5
• There are also factors like the length of time in treatment, level of client’s
functioning, type of group, age + diagnosis of client + ideology of group leader
There is also a distinction between how therapists view these factors + members
view them [all from the same group]
Page | 2
Also a differentiation is the ways in which group members perceive + experience the
same event in different way
BUT clients’ reports are a rich source of information so we must not disregard what
they say
o Obtaining data through questionnaires is easy but often miss the core of
clients’ experiences
o Therapist must be able to suppress personal bias + avoid influencing client’s
responses > becomes trusted
In summary – ways of evaluating therapeutic factors:
1. Therapists’ views
2. Clients’ reports
3. Systematic research approach
Systematic research approach: most common research strategy – correlate in-
therapy variables with outcome in therapy
o By discovering which variables are significantly related to successful
outcomes > can establish reasonable base from which to begin to delineate
therapeutic factors
o PROBLEM: measurement of outcome is itself a methodological morass +
selection + measurement of in-therapy variables are equally problematic
INSTILLATION OF HOPE
Instillation + maintenance of hope is crucial in any psychotherapy
Keeps client in therapy for other therapeutic factors to take effect but faith in
treatment mode can in itself be therapeutically effective as well
High expectation of help before therapy = positive therapy outcome [also when client
+ therapist have similar expectations of treatment
Therapeutic value of groups
, Week 5
Need to increase clients’ belief + confidence in efficacy of group mode > begins
before group starts [in pregroup orientation] where therapist reinforces positive
expectations, corrects negative perceptions + powerful explanation of group’s
healing properties
Page | 3
Also important for members to observe the improvement of others [those with whom
they share common problems with] for their own improvement
Hope as flexible – redefines itself to fit in immediate parameters, becoming hope for
comfort, dignity, connection with others + minimal physical discomfort
Vitally important for therapists to believe in themselves + in efficacy of group
Self-help groups place heavy emphasis on installation of hope
Substance abuse treatment programs: commonly mobilize hope in participants by
using recovered drug addicts as group leaders > expectations raised while being
inspired
UNIVERSALITY
Many individuals enter therapy thinking they alone have certain unacceptable
problems, thoughts, impulses + fantasies > due to extreme social isolation leads to
heightened sense of uniqueness
Do not learn about others nor avail themselves of the opportunity to confide in + be
validated + accepted by others
In therapy – disconfirmation of client’s feelings of uniqueness is powerful source of
relief
They hear others with the same problems > feel more in touch with world + describe
process as “welcome to the human race” experience
Members of therapy group soon perceive their similarities to one another
Universality also plays role in individual therapy – BUT less opportunity for
consensual validation [therapists restrict degree of personal transparency]
Secrecy may be an important + isolating factor > self-disclosure is vital
Feeling of universality often fundamental step in therapy of clients burdened
with shame, stigma + self-blame
Members of homogenous groups can speak to one another with powerful
authenticity based on firsthand experience in way that therapist may not be able to
Also important to pay attention to clinical factor of universality in multicultural groups
Therapeutic value of groups
, Week 5
IMPARTING INFORMATION
DIDACTIC INSTRUCTION
Most participants at the end of successful interactional group therapy – learn a lot
about psychic functioning, the meaning of symptoms, interpersonal + group Page | 4
dynamics + process of psychotherapy > usually happens implicitly [therapist does
not express this explicitly usually]
BUT are making psychoeducation an important part of the program recently
Group environment in which learning takes place is important > ideal context is one
of partnership + collaboration rather than prescription + subordination
Psychoeducation: offers explicit instruction about nature of client’s illness + life
situation + examining clients’ misconceptions + self-defeating responses to their
illness
▪ Example page 63
Groups often setting where mindfulness + mediation-based stress reduction
approaches are taught
By applying disciplined focus, members learn to become clear, accepting + non-
judgmental observers of their thoughts + feelings + reduce stress, anxiety and
vulnerability to depression
Significant + enduring psychosocial benefits
Therapists usually use some form of anticipatory guidance for clients about to enter
process of psychotherapy groups – preparatory sessions intended to clarify
important reasons for psychological dysfunction + provide instruction in methods of
self-exploration > helps cope more effectively with the culture shock
SO didactic instruction: employed in variety of ways in group therapy:
o Transfer information
o Alter sabotaging thought patterns
o Structure the group
o Explain process of illness
Functions as initial binding force in group until other therapeutic factors
become operative
The explanation of a phenomenon is the 1st step toward its control
Therapeutic value of groups
