Therapeutic Factors, Interpersonal Learning and Group Cohesion
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Therapeutic Factors, Interpersonal Learning and Group Cohesion
Working in Groups
PSYN 203-3 (A)
August 20, 2013
Abstract Yallom asserts that the positive impact of psychotherapy groups on its members is due to curative factors derived from prior research as well as his own (Sherry, 1976). The factors are interdependent and overlapping. They combine to create positive outcomes in psychotherapeutic groups (Sherry, 1976). Yalom sees the psychotherapeutic group as a social microcosm where the leaders provide group members with opportunities for “emotionally corrective experiences in interpersonal learning by developing and maintaining a constructive environment including group cohesion (Sherry, 1976, p. 1).”
Therapeutic Factors, Interpersonal Learning and Group Cohesion The debate about the effectiveness of Individual versus group psychotherapy remains silent. Research demonstrates that group therapy is on par with individual therapy in the delivery of meaningful benefits to clients (Yalom & Leszcz, 2005, Evidence, 2012). No discussion about the effectiveness of group therapy would be complete without reference to the therapeutic factors (Barker, 2009). The interdependent nature of the therapeutic factors means that grading their importance is an exercise in subjectivity. Despite this, the factors of interpersonal learning and group cohesiveness are, in the writer’s opinion, cornerstones in the delivery of meaningful benefits to clients. This paper will briefly examine the therapeutic factors described by Yalom & Leszcz, (2005) and describe the mechanism of action and therapeutic results of Interpersonal Learning and Group Cohesion.
History of Yalom’s Curative Factors
In the 1970s Yalom envisioned the psychotherapeutic group as a social microcosm. This constructive environment is maintained by the therapist and allows for emotionally corrective experiences in interpersonal learning (Sherry, 1976). During this time Yalom identified 12 curative factors impacting the psychotherapy group. These factors were derived from his research and the influences of other research which included over 300 articles on group therapy (Sherry, 1976). At this early stage Yalom realized that the 12 curative factors were interdependent and overlapping. They combined to contribute to the positive outcome of group therapy (Sherry, 1976). This was supported by a Q-sort administered to 20 former clients who had been in therapy for at least 17 months and who were considered successful members of group therapy. The Q-sort was made up of items representing each of the curative factors. With reference to helpfulness, the 60 items were sorted by group members according to their experience (Sherry, 1976). The results in descending order were, “Interpersonal Input, Catharsis, Cohesiveness, Insight, Interpersonal Output, Existential Awareness, Universality, Instillation of Hope, Altruism, Reenactment, Guidance and Identification (Sherry, 1976, p. 1)”
According to Yalom, (2005) the therapeutic experience is divided into 11 primary factors. They are not definitive but derived from the best available evidence at this time and are an effective approach to therapy (Yalom & Leszcz, 2005). More than a cursory look at these factors is beyond the scope of this paper. However cursory the look, the role they play in positive therapeutic change is evident.
Instillation of Hope
Yalom & Leszcz, (2005) support with studies an assertion that the instillation and maintenance of hope is crucial to psychotherapy. The most extreme example of hope in terms of healing might be therapies mediated entirely on faith and hope such as faith healing and placebo studies (Yalom & Leszcz, 2005). Groups like Alcoholics Anonymous (AA) utilize and create hope for members through testimonials of members who remain sober as a result of the program (Yalom & Leszcz, 2005).
This is such a powerful factor with reference to groups like AA, where the recognition of not being alone in ones addiction reduces a sense of uniqueness and isolation (Yalom & Leszcz, 2005). Members recognize that other members share similar feelings, thoughts and problems (Evidence, 2012).
This is the education and advice given by the therapist or group members (Evidence, 2012). In recent times this is more didactic, the equivalent of psychoeducation. Ideally it takes the form of a partnership and a working together. Subordination of the client due to his position relative to the leader is to be avoided (Yalom & Leszcz, 2005).
Members gain an important boost to self concept by extending help to other group members (Evidence, 2012). Feeling needed is important, yet the concept is not always grasped by new group members. Often new members feel the blind cannot lead the blind. When they have transcended themselves they are able to be absorbed in the helping of others (Yalom & Leszcz, 2005). The Corrective Recapitulation of the Primary Family Group
This factor is dynamic because of the influence and reinforced conditioning of the family of origin in our lives (Whitefield, 1987). Therefore, any opportunity to reenact critical family dynamics with group members in a corrective manner is a powerful factor in therapeutic change (Evidence, 2012). The important point here is, that the familial conflicts are not just relived but they are “relived correctly (Yalom & Leszcz, 2005, p. 16).” Development of Socializing Techniques
The development of basic social skills seems obvious but for some members they are lacking or have been stunted. In many cases they enter adulthood with childhood survival behaviours that do not work in an adult world (Whitefield, 1987). A simple manifestation might be an inability to make eye contact while conversing that has undermined social relationships (Yalom & Leszcz, 2005). The group provides members with an environment that fosters adaptive and effective communication (Evidence, 2012). Imitative Behaviour
Members grow skills and gain personal knowledge by observing group member’s self-exploration, working through and personal development (Evidence, 2012). The great therapeutic impact of this factor is “finding out what we are not, is progress towards finding out what we are (Yalom & Leszcz, 2005, p. 18).”
In general, interpersonal learning occurs within the group because many points of view reality test the person’s assumptions, attitudes and beliefs (Barker, 2009). An example would be of the member who shows much caring for others but little self care, perhaps trivializing his needs. This triviality is picked up by the group. The member comes to understand that trivializing his needs is a big problem in his life (Yalom & Leszcz, 2005). This pattern of relating outside the group is reenacted and repeated within it (Barker, 2009).
Interpersonal learning is broad and complex (Yalom & Leszcz, 2005). Perhaps this is why it plays such a pivotal role in therapeutic change. Its broadness might best be represented by a comparison to individual therapy. 3 important factors, insight dealing with transference and the corrective emotional experience are analogous to the group therapy factor of interpersonal learning (Yalom & Leszcz, 2005). The complexity of interpersonal learning is that it must be understood in the context of 3 concepts. Firstly, is the Importance of Interpersonal Relationships, secondly, is The Corrective Emotional Experience, and thirdly, is The Group as a Social Microcosm (Yalom & Leszcz, 2005). The Importance of Interpersonal Relationships
From studies of human evolution to Harry Stack Sullivan’s interpersonal theory of psychiatry, our personalities are the result of approval and interactions with the significant people in our lives (Yalom & Leszcz, 2005). Therefore our concept of self is at the mercy of those significant interactions or relationships (Yalom & Leszcz, 2005). More powerfully put, our self regard is based on the reflected appraisals of others and when those appraisals are consistently and negatively false, it leads us to parataxic distortions or transference (Yalom & Leszcz, 2005). These false perceptions perpetuate throughout life, and manifest as projections such as incorrectly perceiving one to be harsh and rejecting (Yalom & Leszcz, 2005). It gets worse. This projection evolves into behaviours and mannerism that will cause others to become harsh and rejecting, a self fulfilling prophecy. Yalom & Leszcz, (2005) further assert that these behaviours are modifiable through consensual validation (the opinions of others) which is exactly what happens in group. So powerful is this concept that Stack Sullivan, cited in Yalom & Leszcz, (2005) further asserts that the treatment for mental illness should focus on maladaptive interpersonal behaviour because, in many cases, it is from this perspective that mental illness is defined. “Accordingly, psychiatric treatment should be directed toward the correction of interpersonal distortions (Yalom & Leszcz, 2005, p. 23). Group members exposed to consensual validation will often replace their initial goal to relieve suffering with an interpersonal goal.
Our social needs are necessary and powerful. Our sense of self is conducted from the reflected appraisals of significant others. Negative reflective appraisal results in disturbed interpersonal distortions and negative projections throughout are life. Consensual validation in group therapy provides the opportunity to correct these distortions. The Corrective Emotional Experience
The corrective emotional experience is important because “contemporary psychotherapies view it as a cornerstone of therapeutic effectiveness (Yalom & Leszcz, 2005, p. 27).” In group, it is the exposure of the member to emotional situations from his past that he was unable to deal with in a healthy way. The difference is that the experience takes place in the here and now under conditions that are more favorable (Yalom & Leszcz, 2005). To help the member, he must undergo this corrective experience to repair the corrosive residue of the traumatic experience. The important point here is that awareness, insight and interpretation are not sufficient. It is the relational experience in the here and now that will challenge the client’s pathogenic beliefs (Yalom & Leszcz, 2005). When beliefs and behaviours are disconfirmed through experience change will occur (Yalom & Leszcz, 2005). Compared to individual therapy where only the therapist creates scenarios from the clients past, group therapy offers greater opportunities because of the numerous dynamic tensions that exist between the different members jockeying for status and dominance including all their parataxic distortions (Yalom & Leszcz, 2005). Tension between members provides opportunities to recognize inappropriate interpersonal feelings and behaviours as well as the inappropriateness of avoiding interpersonal behaviour. The result is the ability for individuals to interact with others more deeply. It is true, therapy in and of itself is an emotional and corrective experience (Yalom & Leszcz, 2005).
The Group as a Social Microcosm
The social microcosm exists within the group. It is experienced; it provides information and then the opportunity to work in the here and now with member’s issues (Yalom & Leszcz, 2005). As the group grows, a comfort level is reached and people will behave within the group as they do in their social environment (Bender, 2000). Their reasons for being in group will be exposed as each member’s interpersonal style will reveal itself during interaction with group members (Bender, 2000). “Each member brings into the group the whole sociocultural context in which he or she lives (Bender, 2000, p. 303).” People are in therapy to learn and to make change. Interacting with others in the therapeutic social microcosm known as group is an immediate and effective way to learn about the self. This is a process of healing and the key is a shift in focus from what is being said to how and why it is being said (Yalom & Leszcz, 2005). Yalom & Leszcz, (2005) makes a strong point with regards to the effect of the social microcosm within group therapy with its emphasis on feed back, “is a particularly effective treatment for individuals with character pathology (p.32).”
According to Yalom & Leszcz, (2005) studies show that groups with high levels of cohesiveness have better outcomes. Cohesiveness is a potent therapeutic factor in its own right as well as being a precondition for other therapeutic factors to operate effectively. Group cohesiveness might best be described as being the same as the therapeutic relationship in individual therapy. It is a therapeutic group relationship that garners the same client growth potential. Members of a cohesive group will feel warmth and comfort and a sense of belonging. Members generate cohesion through the creation of durable relationships in group. The importance of this and the impact on members can be understood in the context of human development particularly adolescence where feeling acceptance and approval from groups is self actualizing (Myers, 2010). This point may still be understated without commenting that for some members, therapy may be their first positive group experience.
Belonging to the group provides self esteem and “meets members dependency needs …that fosters responsibility and autonomy (Yalom & Leszcz, 2005, p. 75). Under these conditions of acceptance and understanding members are prepared to express and explore themselves (Yalom & Leszcz, 2005). Cohesiveness is necessary for self disclosure, risk taking and constructive expression of conflicts within the group. This is necessary for successful group therapy (Yalom & Leszcz, 2005).
Yallom asserts that therapeutic factors exist and are necessary for successful outcomes in group therapy. The curative factors do not act independently but are interdependent and overlap. They combine to create positive outcomes in psychotherapeutic groups (Sherry, 1976). This paper briefly described the therapeutic factors presented by Yalom & Leszcz, (2005) with a focus on the mechanism of action and therapeutic results of Interpersonal Learning and Group Cohesiveness.
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