What is the name for the therapeutic factor of groups that comes from the forces that bind the group together?

Group therapy is often part of the treatment program prescribed to addicts, but why? It is understood that working with like-minded people can yield results, but what affect does it have on the road to recovery? Taking a look at history, we’ve seen that many prominent thinkers, including Aristotle, and French social psychologist, Gustav LeBon, have studied the benefits that social interaction can have on the individual. In fact, several psychoanalysts believed that many individual problems were social in origin. When working together, people are able to solve a common problem and find comfort in knowing that they are not alone. Dr. Irvin Yalom, author of The Theory and Practice of Group Psychotherapy, identified eleven “curative factors” that are the “primary agents of change” in a group therapy setting.

1. Instillation of hope. Seeing others cope with problems similar to yours, overcome obstacles that may be overwhelming, and achieve goals of recovery can inspire new members of the group.
2. Universality. Members of a group therapy setting find relief in the fact that they can feel understood and similar to others, rather than being an outsider among their peers.
3. Information giving. Increasing members’ knowledge and understanding about their shared illness or struggle can provide relief to individuals recovering from an addiction. Sharing ideas and information helps members understand what they are going through and allows them to help others suffering from a similar problem.
4. Altruism. Recovering addicts may feel inadequate because they have had to seek so much help for themselves. By sharing their story and helping others on their path to recovery, members of group therapy can regain their self-esteem and sense of self-worth.
5. Corrective recapitulation of the primary family. Through building healthy relationships and relying on one another, members of group therapy view their peers as a second-family and this model can redefine negative connotations the idea of a family may hold for them. Members of this group can be heard, understood and accepted here.
6. Development of social skills. Dr. Yalom states, “Social learning, or the development of basic social skills, is a therapeutic factor that occurs in all therapy groups.” Learning and practicing acceptable social skills in a group setting helps members prepare for their re-emergence in society and provides feedback about the positive and negative aspects of their behavior.
7. Imitative behavior. Therapists influence communication patterns of group members by modeling certain behaviors themselves. Research shows that over time, members begin to incorporate these positive behaviors into their own lives. Common behaviors include, empathy, nonjudgemental feedback, and positive reinforcement.
8. Interpersonal learning. We frequently characterize our lives by the relationships within them and this can aid in developing our self-esteem. Group therapy provides members with the chance to improve their ability at relating to others and gaining confidence through these healthy relationships.
9. Group cohesiveness. Group therapy provides belonging and acceptance for its members. Community and group settings fulfill basic human needs of working together with peers and creating something greater than a single unit.
10. Catharsis. Releasing conscious and unconscious feelings provides therapeutic relief. With the support of its members, group therapy provides the chance to release pent-up emotions in a safe and supportive environment.
11. Existential factors. Members are able to work together at understanding life’s uncertainties, such as life, death, grief, loss and love.

It is important to recognise that the success of individual group members is intimately linked to the group as a whole.  Effective group therapy can help clients enhance self responsibility, increase readiness for change and establish authentic support for recovery and change. There are a number of therapeutic factors that influence the efficacy of group therapy. Yalom and Leszcz (2005) have categorised a number of factors. They are listed below:

• Installation of hope
• Universality
• Imparting of information
• Altruism
• The corrective recapitulation of the primary family group
• Development of socialising techniques
• Imitative Behaviour
• Group Cohesiveness
• Catharsis
• Existential Factors

Each of the factors listed above are explained in more detail below.

Installation of hope

Hope is vital in any therapeutic setting. Hope is having faith in the present moment to cause something of benefit for the future. Thus having faith in the treatment process is an important component in building hope for change. Members of therapy groups will often find hope as they discover commonalities with each other and shift their focus on to solutions over current problems. Ultimately, it is hope that helps to keep the client in therapy (Yalon & Leszcz, 2005).

This is based on the assumption that a member can be inspired and encouraged by another member who has overcome the problems that member is still struggling with. Those at the latter stages of recovery may give hope to those at the beginning stages of their treatment. It is often the inspiration provided to group members by their peers that contributes to their motivation to persevere with therapy, which in turn results in positive treatment outcomes (Yalon & Leszcz, 2005).

Interestingly, a number of clients will tend to have an initial belief that individual treatment will be more beneficial than group treatment. Because of this, it is vital for the group therapist to explain why group therapy is not a second best form of treatment (Sandahl & Lindgren, 2006).

Universality

It is common for individuals who enter therapy to believe that their problems are unique to them and therefore will often feel “alone” in their fears and difficulties. Group therapy helps to alleviate these feelings as clients come to learn that others are having similar experiences. This can be a powerful source of relief. Through such an experience, clients may also find a heightened sense of acceptance by other group members as they become aware of their similarities resulting in a more positive receptive attitude towards the group therapy process.

Imparting of information

Psycho-education is an important part of any therapy. This is where clients gain information about key factors surrounding the issues/disorder being faced. Group members are able to help each other by sharing information and their understanding of any issue in question.  Explanation and understanding of problem issues is an important contributing factor that can foster positive change.

Altruism

Group therapy offers the client a real opportunity to be helpful to others. Through the group therapy process, clients learn how to give and receive help in the context of establishing appropriate boundaries. Each member encouraged and guided to offer support, reassurance, suggestions and insight to others in the group. This encourages each group member to see themselves as an important part of each group member’s recovery process. The very nature of this process, in which group members help each other is reciprocal in that each member offers it while also receiving it. This reciprocity gives way to feelings of altruism which in itself is a contributing factor to a personal sense of wellbeing.

The corrective recapitulation of the primary family group

Most individuals who embark on therapeutic treatment will often have a background of highly unsatisfactory experiences with their family and, as a consequence, may experience the group members as comparable to members of their own family. Thus working through various problems a group member may have with the group therapist and/or other members can be similar to working on past unfinished business in their own family. Within the group each member can explore how childhood experiences contributed to difficulties related to their personality and current behaviours.

Development of socialising techniques

Group therapy offers each client an opportunity to develop basic social skills that may not be inherent in them. Clients learn to listen, talk to others and learn of other’s impression of them. The group setting also provides the client with great opportunities to practice new behaviours in a safe and supportive environment that allows for experimentation without the fear of failure.

Imitative Behaviour

Groups allow clients the opportunity to try on behaviours they have seen in others. They may find that these behaviours work for them as such retain them, or they may choose to discard them if they are perceived to be dysfunctional. Individuals can model the behaviour of other group members or observe and imitate the behaviour of the group therapist. In this context imitation can be used as an effective therapeutic force.

Group Cohesiveness

Being part of a group can instil a sense of belonging and cohesiveness through group decision making, sharing of intimate issues and in the pursuit of common goals. Clients, who perceive their group to be cohesive, experience more social contact with other group members, attend more sessions than other group members and consider the group to be effectively therapeutic compared to those group members who may not consider the group to be cohesive.

Cohesion facilitates members’ commitment to remain in group therapy. The higher the group cohesiveness, the more its members feel protected by the group (Mikulinger & Shaver, 2007). Cohesion is comprised of multiple alliances (e.g., member-to-member, member-to-group and member-to-therapist) that can be observed from three structural perspectives (intrapersonal, intragroup and interpersonal).

Intra-personal cohesion refers to the member’s sense of belonging, acceptance, and commitment to the group and is directly linked to client improvement (Bernard, Burlingame, Flores, Greene at al., 2008; Hornsey, Dwyer, Oei & Dingle, 2009).

Intra-group cohesion focuses on the group level features of cohesion such as attractiveness and compatibility felt by the group as a whole, mutual trust, support, caring and commitment to work as a group. This type of cohesion has been directly linked to decreased premature dropouts.
Inter-personal cohesion focuses on positive and engaging behavioural exchanges between members and has been linked to symptomatic improvements especially if present in the early stages of group sessions (Bernard, Burlingame, Flores, Greene et al., 2008).

Catharsis

Group therapy allows group members to vent, explore feelings and gain relief from intense emotion through having opportunity to express those feelings to others in the group. Sharing feelings and experiences with others in similar situations is therapeutic in its own right as it can help relieve pain, guilt and stress.

Existential Factors

While working within a group offers support and guidance, it also helps members realise that they are responsible for their own lives, action and choices and that it is ultimately the meaning and purpose they place on their own life and healing that is important.

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