Group Therapy- Irvin Yalom's Therapeutic Factors
Dr. Irvin Yalom’s eleven Therapeutic Factors have had a great impact on group therapy facilitators. His Therapeutic Factors are useful for group therapists to gain a better understanding of the group therapy process and the elements that help create a cohesive and
Yalom believes that his eleven Therapeutic Factors (sometimes referred to as Yalom’s Curative Factors) can significantly help facilitate change within individuals in the group therapy setting. Yalom (2005) says,
I suggest that therapeutic change is an enormously complex process that occurs through an intricate interplay of human experiences, which I will refer to as ‘therapeutic factors.’ There is considerable advantage in approaching the complex through the simple, the total phenomenon through its basic component processes.
Kivlighan and Kivlighan (2004) note that Yalom saw the group leaders role as the “creation of the therapeutic group climate.” They quote Yalom (1995) stating, “If it is the group members who, in their interaction, set in motion the many therapeutic factors, then it is the group therapist’s task to create a culture maximally conductive to effective to group interaction.” This is in contrast to individual therapy where the therapist is directly therapeutic by giving the clients support, feedback, and making interpretations. Group therapists are more facilitative than individual therapists who are directly therapeutic. Yalom’s eleven Therapeutic Factors he created are: Instillation of hope, universality, imparting information, altruism, the corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis and existential factors. Each serve their own unique purpose and facilitate psychological change in ways that individual therapy cannot.
A first Therapeutic Factor is the instillation of hope, meaning that a group facilitator should help a client feel optimistic about the group therapy experience- that change and resolution are possible. If a client feels hopeful and has faith that the treatment of group therapy can help their individual healing, then the other Therapeutic Factors can take effect. Clients must first see that the therapist passionately believes in the therapeutic process. Similarly, when clients witness other group members transforming themselves during the process of group therapy, they become hopeful that this type of therapy can work for them as well.
Another Therapeutic Factor is universality, which helps a client know that they are not alone and isolated with unique psychological issues. Simply being in a group therapy setting, amongst individuals who have similar issues to your own, can be healing in itself. Yalom (2005) states that “no one is unique, there is no human deed or thought that is fully outside the experience of other people.” Many individuals suffer with their issues in silence, feeling alone, afraid and shameful. When group members are accepted by other members despite their supposed weaknesses, feelings of shame and isolation begin to fall away. Also, knowing that there is a universality of human experience and emotion can provide a sense of connection, and in turn, great healing.
Yalom’s next factor is the imparting of information, which can also be known as psychoeducating clients. Group therapists may give instructions, advice and/or suggestions to client. Yalom (2005) says that “didactic instruction is used to transfer information, alter sabotaging thought patterns and explain the process of illness… Direct advice which provides systematic, operationalized instruction or a series of alternative suggestions on how to reach a goal is most effective.” A therapist can be direct with their clients and educate them on their mental illnesses and ineffective thought patterns, providing them with a sense of reality checking. Also, information can be imparted the therapist sharing how effective group therapy can be for the psychological transformation of individuals.
Altruism, meaning, the act of giving without expecting anything in return, is another of Yalom’s Therapeutic Factors. If a client is given to by others, they can understand that people find them to be of value and importance. Similarly, if a client gives to another client, they can see that they have something of importance to give. Yalom (2005) notes that we receive through the act of giving and not expecting anything in return. Also, by giving without expecting anything in return, we become absorbed in someone outside of ourselves, thus allowing us to have space from our own issues. Like Yalom, Adler believed that “to transcend interpersonal interaction [is] to develop the feeling of being part of a larger social community. Adler suggested this to be the most important of all social attitudes, as it inhibits egocentrism while promoting social interest (Mosak, 2000).” Group therapy is fitting venue to practice altruism, as clients express such vulnerable parts of themselves, which can inspire other group members to support them freely.
A next Therapeutic Factor is the corrective recapitulation of the primary family group. Yalom says that the majority of psychotherapy clients had unsatisfactory experiences in their first, and most important group- their primary family. The group therapy setting can give clients a chance to correctively relive early family conflicts, and relationships that inhibited growth. Yalom says,
The therapy group resembles a family in many aspects: there are authority/parental figures, peer/sibling figures, deep personal revelations, strong emotions, and deep intimacy as well as hostile, competitive feelings…. Members will interact with leaders and other members in modes reminiscent of the way they once interacted with parents and siblings.
The group therapy setting is a safe place to work out unfinished business with family members from childhood. This is because old family issues will often resurface in the group setting, and problems can be worked through with therapists and other group members, serving as corrective emotional experiences.
Yalom states that the development of socializing techniques is an important Therapeutic Factor that occurs in the group therapy setting. Yalom says that “social learning the development of basic social skills- is a therapeutic factor that operates in all therapy groups…” Therapy groups help clients obtain sophisticated social skills, as they learn how to process emotions, resolve their conflicts with others, to be helpful, less judgmental of others and more empathetic. These deeper social skills are indirectly learned by getting feedback from other group members and from group leaders. These skills, when taken out into the world at large, can help clients greatly with in their relationships with others.
Yalom’s Therapeutic Factor of imitative behavior says that those in group therapy will try out parts of the therapist’s and other member’s behavior to see what fits them well. When clients experiment with the behavior of others, they find out who they are, and who they are not. “Clients during individual psychotherapy may, in time, sit, walk, talk and even think like their therapists. There is considerable evidence that group therapists influence the communicational patterns in their groups by modeling certain behaviors, for example, self disclosure or support…” Much like the development of socializing techniques, imitating the behavior of the therapist and other group members can teach clients great skills that can be used in their lives outside of therapy.
A next Therapeutic Factor is interpersonal learning, meaning that interpersonal relationships are highly important, they are ground for experiencing corrective emotional experiences, and the group is a social microcosm of the members’ external lives. Yalom says,
From whatever perspective we study human society- whether we scan humanity’s broad evolutionary history or scrutinize the development of the single individual- we are at all times obliged to consider the human being in the matrix of his or her interpersonal relationships. There is convincing data from the study of nonhuman primates, primitive human cultures, and contemporary society that human beings have always lived in groups that have been characterized by intense and persistent relationships among members and that the need to belong is powerful, fundamental, and pervasive motivation. Interpersonal relatedness has clearly been adaptive in an evolutionary sense: without deep, positive, reciprocal interpersonal bonds, neither individual nor species survival would have been possible (Yalom, 2005).
As humans, we are interdependent on each other in many ways for our species survival. Yalom notes that no one can transcend the need for human contact, as it is in our evolutionary make-up. Members experience corrective emotional experiences in group by expressing their emotions to other group members and taking these risks in a supportive and emotionally intelligent environment. These types of corrective emotional experiences help individuals interact with each other more deeply and honestly.
Group cohesiveness, another Therapeutic Factor, allows members to feel the warmth and comfort of being part of a group. They feel like they belong somewhere, they value the group and feel valued by the other members, they feel unconditionally accepted and supported by the group members. Yalom states that for the other Therapeutic Factors to function at the optimal levels, a strong group cohesiveness must be present. Marmarosh, Holtz and Schottenbauer (2005) say,
In his theory, Yalom (1995) described cohesiveness as the primary curative group factor in group therapy, arguing that it facilitated greater collective self-esteem, hope for the self, and well-being. He described cohesiveness as the ‘necessary precondition for effective therapy,’ and he argued that the experience of being in cohesive group enabled group members to engage in the necessary self-disclosure and the personal exploration that is the hallmark of effective therapy.
If group members feel connected to one another and there is a group cohesion, then they will try harder to influence other group members, be more open to be influenced by other members, be more willing to listen to other members, be more accepting, feel a greater sense of security, a relief from tension in the group and will self-disclose more.
Catharsis is a Therapeutic Factor that occurs when an individual can express their deep emotional feelings and experience a release and healing. Merely having a conscious awareness of repressed feelings and experiences allows for their release. If there is a strong level of cohesiveness in a group, the support of others members can help facilitate a powerful cathartic experience for a member having an intense emotional release. It can also be cathartic for other group members to witness someone having an intense emotional experience, as they can relate to it and grow by sitting with them in their emotional release.
A last Therapeutic Factor is existential factors, or the ability to simply be with others as part of a group. Existentialism is a psychological and philosophical theory that recognizes that life can be unfair and unjust at times, that there is no escape from pain, that no matter how close we get to other individuals we are ultimately alone, and that there is no escape from the inevitability of death. When an individual can face the basic issues of life and death, they can life more fully and honestly in the here and now, not being caught up in trivialities. Also, individuals must take complete responsibility for how they live their lives, no matter how much guidance or support they receive from others. In a study done on older women (McLeod & Ryan, 1993), existential awareness was seen as the most important Therapeutic Factor by members of the group. This may be because the basic issues of human life, such as death and isolation, become more important as we age and get closer to our individual deaths.
In conclusion, Yalom’s Therapeutic Factors in group therapy present clients with many diverse ways to facilitate change in their individual lives. Group therapy offers many forms of interpersonal learning and growth that cannot exist in individual therapy, and thus it can be an important adjunct or substitute for those struggling with various psychological issues.
Kivlighan, D.M. & Kivlighan, M.C. (2004). Counselor intentions in individual and group treatment. Journal of Counseling Psychology, 51(3), 347-353.
Marmarosh, C., Holtz, A., & Schottenbauer, M. (2005). Group cohesiveness, group
self-esteem, group-derived hope, and the well-being of group therapy members.
Group Dynamics: Theory, Research and Practice, 9(1), 32-44.
McLoed, J. & Ryan, A. (1993). Therapeutic factors experienced by members of an
out-patient therapy group for older women. British Journal of Guidance &
Counseling, 21(1), 64-72.
Mosak, H.H. (2000). Adlerian psychotherapy. In R. J. Corsini & D. Wedding, (Eds.),
Current psychotherapies. Itasca, IL: F.E. Peacock Publishers, Inc.
Yalom, I.D. (2005). The Theory and Practice of Group Psychotherapy: 5th Edition.
New York: Basic Books.
The Social (Interpersonal) Learning Style
If you have a strong social style, you communicate well with people, both verbally and non-verbally. People listen to you or come to you for advice, and you are sensitive to their motivations, feelings or moods. You listen well and understand other's views. You may enjoy mentoring or counseling others.You typically prefer learning in groups or classes, or you like to spend much one-on-one time with a teacher or an instructor. You heighten your learning by bouncing your thoughts off other people and listening to how they respond. You prefer to work through issues, ideas and problems with a group. You thoroughly enjoy working with a 'clicking' or synergistic group of people.
You prefer to stay around after class and talk with others. You prefer social activities, rather than doing your own thing. You typically like games that involve other people, such as card games and board games. The same applies to team sports such as football or soccer, basketball, baseball, volleyball, baseball and hockey.
Common pursuits and phrasesSome examples of pursuits that people with a strong social style may follow include counseling, teaching, training and coaching, sales, politics, human resources, and others.
As with people with the logical style, you are more likely to use phrases that reflect your dominant style out of physical, aural and visual styles. Here are some other phrases you may also use:
- Let's work together on this.
- We can work it out.
- Tell me what you are thinking.
- Help me understand this.
- Let's pull some people together to discuss.
- Let's explore our options.
Learning and techniques
- If you are a social learner, aim to work with others as much as possible. Try to study with a class. If this is not available then consider forming your own study group with others at a similar level. They don't have to be from the same school or class. If you like, introduce them to some of the techniques from this book. It may be easier for you to try some of the Memletic Techniques in a social setting, and work with the feedback from others.
- Role-playing is a technique that works well with others, whether its one on one or with a group of people. For example, in aviation training, role-play the aerodrome area. Have people walking around in 'circuits' making the right radio calls with the tower co-ordinating everyone. Another example might be to role-play with one person being the instructor and the other being the student.
- Work on some of your associations and visualizations with other people. Make sure they understand the principles of what you are doing though, otherwise you may get some interesting responses! Others often have different perspectives and creative styles, and so the group may come up with more varied and imaginative associations compared to the ones you might create yourself.
- Rather than reciting assertions to yourself, try sharing your key assertions with others. By doing so, you are almost signing a social contract that your assertion is what you do. This strengthens your assertions.
- Share your reviews, review checklists and 'perfect performance' scripts with those in your group as well. By listening to how others solve their issues, you may get further ideas on how to solve your own issues. Try sharing the work of creating a 'perfect performance' script. Each person writes the script for the areas they want to work on the most, and then the group brings all the scripts together.
- Mind maps and systems diagrams are great to work on in class. Have one person be the appointed drawer, while the rest of the class works through material and suggests ideas. The group may have varied views on how to represent some ideas, however this is a positive part of learning in groups. If you can't agree on something, just take a copy of what the group has worked on and add your own thoughts. Often there is no right answer for everyone, so agree to disagree!
- Working in groups to practice behaviors or procedures help you understand how to deal with variations. Seeing the mistakes or errors that others make can help you avoid them later. As well, the errors you make are helpful to others! Whether it's via role-playing, a simulator or other technique doesn't matter too much. Be imaginative. Two chairs in the middle of a classroom to simulate an aircraft cockpit can be just as good as computer simulation and the real activity.
- Lastly, if you are working in groups it may help to have everyone do the learning styles questionnaire. This may help everyone understand why each person has different viewpoints. It can also help with assigning activities to people. Individuals may volunteer for activities based on either the styles they currently have, or the styles they want to learn. Remember the classroom is a risk-free environment. It's often safer to experiment, try out new techniques and make mistakes in the classroom than in the real activity.