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Chapter 4

Curative Factors

Group therapy is effective because of the curative factors that occur during the process of the group sessions. Yalom & Leszcz (2005) identified eleven therapeutic factors, which I shall discuss in this chapter. These factors are “interdependent and neither occur nor function separately.” (Yalom & Leszcz, 2005, p. 2).

Instillation of Hope

“Not only is hope required to keep the client in therapy so that other therapeutic factors may take effect, but faith in a treatment mode can in itself be therapeutically effective.” (Yalom & Leszcz, 2005, p. 4.) Jacobs, Masson & Harvill (2009, p. 40) defined instillation of hope as “feeling hopeful about one’s life” and Conyne, Crowell & Newmeyer (2008, p. 183) defined instillation of hope as “leaders helping members to feel optimistic about the group as a place for improvement.”

When one feels hopeless, she has no energy or motivation to make changes that are necessary to improve. Through the group process, she can watch others be involved and make positive changes that result in happiness and a sense of well-being. As a result of this process, she may begin to wonder if she can improve. Through this sense of wondering, she might begin to interact and participate in the group and thus gradually a ray of hope begins to shine in her life.

Ivers & Newsome (2011, p.97) presented two ways that the leader might instill hope in the group members. One way is through recounting success stories. The leader “might describe instances in which the leader was able to see the progress that a member made while participating in the group.” The second way is “when group leaders truly believe that they can help every motivated member of their group to progress and are able to succinctly express this belief to each member, they can begin to help members obtain hope and confidence in themselves and in the group.”

Corey, Corey & Corey (2010, p. 252) pointed out that some group members feel hopeless because they are convinced that they have no control over the external circumstances of their

lives; but, by hearing other group members share success stories of assuming control over circumstances, they begin to experience a new sense of optimism that they, too, can be different.

Without hope, one will continue to function as she has in the past. It is only with hope that she can muster the courage and energy to change in productive ways. Group therapy is effective at instilling hope in group members.

Universality

“Many individuals enter therapy with the disquieting thought that they are unique in their wretchedness, that they alone have certain frightening or unacceptable problems, thoughts, impulses, and fantasies.” (Yalom & Leszcz, 2010, p. 6). This is where the factor of universality comes in. They learn that others have the same problems as they. Conyne, Crowell & Newmeyer (2008, p. 183) defined universality as “aloneness is supplanted by a sense that others in the group experience similar difficulties” and Jacobs, Masson & Harvill (2009, p. 40) defined it as “realizing others have similar concerns.” Gladding (2012, p. 31) pointed out that universality “enables group participants to identify and unify with one another.” Southern, Erford, Vernon & Davis-Gage (2010, p. 19) stated much the same.

As group members hear the struggles and concerns of other group members, they begin to recognize that others are more like them than different from them. They begin to feel more a part of the human race. They begin to feel better about themselves because they realize that they are not so bad after all. Whereas before they felt that they were struggling all alone and that no one could understand their situation, they now begin to realize that they are not struggling alone and that perhaps others can understand them, because these “others” are struggling with similar issues.

Imparting Information

According to Yalom & Leszcz (2010, p. 8) imparting information includes “didactic instruction about mental health, mental illness, and general psychodynamics given by the therapists as well as advice, suggestions, or direct guidance from either the therapist or other group members.” Jacobs, Masson & Harvill (2009, p. 40) defined imparting information as “gaining information about healthy living.”

While I find the “experiential parts” of group work more beneficial than the “talking parts”, there are times when group members are helped through something that is taught or some suggestion that is made. If one has spent her life in an unhealthy environment, there may be relevant information that she does not know and upon hearing it, a light comes on and she has insight that she needs, to make healthy changes. Correct information can mean new power for a group member.

Altruism

Yalom & Leszcz (2010, p. 13) wrote, “In therapy groups, members gain through giving, not only in receiving help as part of the reciprocal giving-receiving sequence, but also in profiting from something intrinsic to the act of giving.” They go on to state that many “are demoralized and possess a deep sense of having nothing of value to offer others. They have long considered themselves as burdens, and the experience of finding that they can be of importance to others is refreshing and boosts self-esteem.” Conyne, Crowell & Newmeyer (2008, p. 183) stated that “helping others provides personal benefits to the helper, as well as the helpee.”

It is amazing to witness a group member who is demoralized and feeling worthless to say or do something that benefits another group member and then to come alive. Her entire demeanor changes as she begins to recognize that she can benefit someone else. The theory of cognitive

dissonance predicts that we have positive feelings toward someone we help as a result of helping them. Thus the dynamic of altruism brings the group closer together as they help one another.

The Corrective Recapitulation of the Primary Family Group

Yalom & Leszcz (2010, p. 16) pointed out that it is important that early familial conflicts are not only relived but that they are relived in a way that brings healing and growth. Jacobs, Masson & Harvill (2009, p. 40) stated that this is an “opportunity to experience dynamics similar to early childhood experiences.” Conyne, Crowell & Newmeyer (2008, p. 183) put it this way: “Group provides members with positive opportunity to correct negative family experience.”

Many people come from dysfunctional families (in some sense, I suppose we all do!); therefore, we have issues from our childhood that need to be faced and resolved so that we can function more healthily in the here-and-now. I find it most useful to bring these into the present and discuss how they affect the group member now, rather than going back into the past. At times I use family sculpting as a way to get in touch with this. I’ll ask the group member to choose members of the group to represent the members of her family of origin and to arrange these individuals in a way that will demonstrate the dynamics of her family of origin. We can then discuss how this dynamic affects how she relates to people in her life today.

Development of Socializing Techniques

Yalom & Leszcz (2010, p. 17) pointed out a number of different social skills that can be learned in a group setting. These include: learning to make eye contact, learning social habits that help produce healthy relationships, learning how to avoid isolation and loneliness and learning to reduce the discrepancy between intent and actual impact on others. Southern, Erford, Vernon & Davis-Gage (2010, p. 19) stated that “Group work allows members to give and receive personal feedback that facilitates learning about the desirability of one’s behavior.”

Perhaps most of us lack some types of social skills. In the world, we are not likely to receive feedback, letting us know what our social deficits are. In a therapy group, where the group members trust one another and have the best interest of the members at heart, one group member can inform another group member of some behavior that creates a negative response from others and then the group can assist this group member in changing the unwanted behavior.

Imitative Behavior

Group members might model a certain behavior of the therapist or another group member. They may continue to use this behavior or they may throw it off, realizing that it doesn’t “fit” them. Modeling by the leader might be “purposely demonstrating behaviors and ways of being in the group with the intent of helping group members see new ways or possibilities of ways to achieve their goals. Modeling is often implicit.” (Geroski & Kraus, 2010, p. 174).

As stated by Geroski & Kraus, modeling is often implicit but it can also be explicit. For example, if a group member is struggling with what to do in a certain situation, I might ask the individual to choose the group member whom she believes could best handle this situation and then I’ll ask the chosen group member to role play the situation and demonstrate how she would handle it. Other group members might volunteer to act out other possible solutions and the group member can choose the behavior that she believes she can use most successfully.

Interpersonal Learning

Jacobs, Masson & Harvill (2009, p. 40) defined interpersonal learning as “learning to interact with others.” Interpersonal learning involves members learning through the self- disclosure of other group members, experimenting with what they learn and receiving feedback from fellow group members about their new behaviors (Conyne, Crowell & Newmeyer, 2008, p. 183). Yalom & Leszcz (2005, pp. 19-52) included an entire chapter on interpersonal learning.

They point out that interpersonal learning involves three components - the importance of interpersonal relationships, the corrective emotional experience and the group as a social microcosm. Corey, Corey & Corey (2010, p. 139) stated, “A unique value of groups is the opportunity they provide for interpersonal learning.” They continued by stating, “Members learn a great deal about how they function interpersonally in their world by looking at their patterns in the group sessions.”

Ivers & Newsome (2011, pp. 95-97) discussed specific interpersonal skills that are important to learn in the group process if the group members do not already possess these skills. They state, “Even if the group leader possesses exceptional interpersonal skills, the group may have difficulty coming together and ultimately may struggle to grow and progress if members are lacking in these skills. Therefore, it is important that the group leader teach group members basic interpersonal skills.” The skills that they consider essential are active listening, empathy, genuineness and respect.

Group Cohesiveness

Yalom & Leszcz (2005, p. 54) noted that group cohesion involves the group members’ relationship to the therapist, to individual group members and to the group as a whole. They continue by pointing out that “Group cohesiveness is not only a potent therapeutic force in its own right. It is a precondition for other therapeutic factors to function optimally.” (p. 55). Fall, McMahon & Hays (2011, p. 122) stated, “Cohesion is the beneficial outcome of the group members struggling to know one another and find their collective place in the group matrix.” Corey, Corey & Corey (2010, p. 250) gave the characteristics of a cohesive group which include: a climate of support, bonding, sharing of experiences, mutuality within the group, the togetherness that unites members, a sense of belonging, warmth and closeness and caring and acceptance. Hays, Milliken & Chang (2010, p. 181) wrote, “Group cohesion involves strong interpersonal bonds among members and yet decreased dependence on one another for support. Members from cohesive groups have more genuine interactions and can provide constructive feedback regarding self, the group, and other members.” Geroski & Kraus (2010, p. 71) pointed out, “Group cohesion develops from healthy interpersonal relationships among group members and when members have a sense of commonality in connection to the purpose of the group. That is, when members are clear about why they are in a particular group and when they feel purposefully connected to the content of the group, they are likely to feel a sense of belonging. When members feel like they belong in the group, they are more likely to feel safe enough to take some risks in order to grow.”

Catharsis

Southern, Erford, Vernon & Davis-Gage (2010, p. 19) defined catharsis as “the expression of strong and often hidden emotions by an individual. Catharsis is characterized primarily by a sense of freeing oneself. Instead of masking one’s true feelings, group work provides a forum for releasing tension and venting about whatever a member has kept inside.”

Corey, Corey & Corey (2010, p. 255) defined catharsis as the physical and emotional release experienced when one expresses “stored-up pain and other unexpressed feelings.” Concerning catharsis, they write, “Although it is often healing, catharsis by itself is limited in terms of producing long-lasting changes. Members need to learn how to make sense of their catharsis, and one way of doing so is by putting words to those intense emotions and attempting to understand how they influence and control their everyday behavior.”

Many times I have observed group members vent pent-up feelings and after a highly emotional experience, they have confessed that this is the first time they have ever told anyone

about this experience, even though it may have occurred years ago. Sue had been raped by an older cousin as a young girl and had never told anyone. After weeping uncontrollably, unable to speak, she was able to calm herself enough to share this experience with the group. The group helped her process this and decide what she needed to do. After discussing this and making her decision, she appeared to be a different person. Prior to this cathartic experience, she looked sullen and defeated. After the experience, her face glowed and she looked lighter. I have witnessed group members, through catharsis, relieving themselves of chronic pain in their backs, neck and stomach. I have also witnessed group members who suffered from migraine headaches, curing themselves through catharsis. This can be a powerfully healing experience, but as has already been said, the experience must be processed to produce lasting results.

Existential Factors

The existential factors relate to “our confrontation with the human condition - a confrontation that informs us of the harsh existential facts of life: our mortality, our freedom and responsibility for constructing our own life design, our isolation from being thrown alone into existence, and our search for life meaning despite being unfortunate enough to be thrown into a universe without intrinsic meaning.” (Yalom & Leszcz, 2005, p. 98).

I find these factors coming into play when a group member has faced a crisis in her life such as the death of someone close to her; the loss of something significant to her such as a job, her possessions, or her reputation; or a divorce. These losses may force her to face her mortality or what her life means. Sometimes these also occur as the result of a group member facing an important decision that will change her life and she struggles with what decision to make. These factors are difficult to work through and take time and thoughtfulness. They should never be taken lightly or rushed through.

All of these factors are important and some play a more important role early in the group process while others become more important later in the group sessions. It is important for the therapist to be aware of these factors and when they are occurring in the group sessions.

Questions to Ponder

1. As you reflect on the curative factors discussed in this chapter, which factor do you think will be most beneficial for you and which will be least beneficial for you? Why?