Inpatient adolescent and latency-age children's perspectives on the curative factors in group psychotherapy

Thirty-three adolescent and 11 child psychiatric inpatients were administered a downward revision of Yalom's (1970) 60-item Q-sort, which sets forth 12 putative curative factors of group, to assess patient perceptions of which factors in group therapy are most curative. The impact that age, patient level of functioning, and time in treatment had on which factors were most valued was assessed. Patient perceptions of the value of group compared to other treatment modalities were also assessed. Both child and adolescent subjects highly valued the factors of Hope, Cohesiveness, and Universality. Patients' level of functioning had limited effects on adolescents' perceptions, but did effect children's perceptions of what was most valued in group. The modest effect of time in treatment was attributed to the short duration of inpatient treatment. Implications for inpatient adolescent and child group therapy and future research are explored.Appreciation is extended to Mary Kelly, Elly Cobb, and Anna Csaky-Chase for their conceptual and editorial assistance.     

Therapeutic factors in interactional inpatient groups: Results from a Turkish sample

Therapeutic factors in an inpatient group from Turkey are presented. A total of 40 patients were seen over a period of 2 years and each patient was given Yalom's (1983) 60-item therapeutic factor list on discharge. The first four most valued therapeutic factor groups were Catharsis, Existential Factors, Cohesiveness and Hope. There were significant differences in the highly valued factors in different diagnostic groups. Patients with diagnoses of anxiety/somatization and borderline/identity problem preferred factors resembling those in many out-patient studies. The results are discussed in the light of relevant literature.     

Modifications of Yalom's interactional group therapy model as a mode of treatment for alcoholism

As a result of a review of the literature and especially Brown and Yalom's (1977) clinical report, it is suggested that the preferred mode of treatment for alcoholism is group psychotherapy. The group's ability to provide support, structure and reinforcement for abstinence make it a powerful catalyst in the recovery process. In measures of time, efficacy and recovery, group psychotherapy generally succeeds where other treatment modalities frequently fail.     

Group therapy with the multiply oppressed: Treating Latino,HIV-infected injecting drug users

The Latino community in New York City and across the country is disproportionally represented in the AIDS epidemic. This article explores the impact of multiply oppressed group membership on the psychotherapeutic group treatment of Latino, HIV-infected injecting drug users. The interaction of traditional Latino values with injecting drug user and seropositive identities is described. Clinical examples drawn from a bilingual group held in a methadone maintenance clinic in the South Bronx highlight how oppressed group memberships affect Yalom's curative factors.This article was written with the support of a Ryan White CARE Act Title I grant to Montefiore Medical Center through the City of New York, contract OHF-4165.     

The effects of different types of interpretation on outcome in group psychotherapy

Interpretations in three psychodynamic therapy groups were rated according to Yalom's typology. Results indicated that here-and-now interpretations were employed over four times as often as historical ones. Outcome results, as measured by the DSM-III-R, indicated that interpretations of a client's present patterns of behavior were most effective in changing pathology, followed by interpretations of the impact of the client's behavior on others, then by historical interpretations. Interpretations of motivation tended to make clients worse. Client session satisfaction ratings demonstrated the same pattern as the outcome results.     

Teaching group treatment in doctoral programs for counseling psychology

We surveyed the 71 doctoral programs in counseling psychology approved by the American Psychological Association to examine whether and how group counseling or therapy was taught. Responses from 31 programs listed at least one graduate course in group counseling; over half offered more than one. In most cases the introductory course was required. Analysis also indicated that introductory courses often included an in-class or an out-of-class experiential component, focused either primarily or exclusively on outpatient therapy and used Yalom's interpersonal approach. Discussion focused on the importance of courses in group interventions in doctoral programs in counseling psychology and the differences and similarities in academic training of group interventions in programs in counseling and clinical psychology.     

A comparison of curative factors in different types of group psychotherapy

The authors have constructed a Dutch version of Yalom's "Questionnaire for Curative Factors." This Dutch version has been administered to 134 participants of 22 psychotherapy groups in various psychiatric services in the Netherlands. Results concerning validity and reliability of the instrument are presented, as well as concerning the homogeneity of the hypothesized "factors." Differences between types of groups and categories of group members were tested by means of techniques of analysis of variance (ANOVA). Multiple regression analysis was applied in order to detect variables of differential qualities on one or more factors. Only the factor identification, neglected in literature on curative factors, was highly predictable.     

The Therapeutic Factors Inventory: Development of a Scale

Although Yalom's (1995) framework of the therapeutic factors facilitating outcome in group has been accepted by group specialists, no empirically based instrument assesses all of these factors. The Therapeutic Factors Inventory (TFI), with 11 scales based on the therapeutic factors, has been designed to fill this gap. This article summarizes the development and preliminary reliability testing of the TFI. Each scale of the instrument demonstrated high internal consistency; however, one scale obtained unacceptably low test-retest reliability. Further validity testing is needed. Implications of these findings are discussed.     

Qualitative analysis of experiences of members of a psychoeducational assertiveness group

This study describes qualitatively a psychoeducational assertiveness intervention for 20 women's perceptions of positive and negative experiences, undertaken to identify whether therapeutic mechanisms operating in group therapy as described by Yalom might be inferred. There were 14 90-min. weekly sessions organized around educational material. Two groups were conducted with 10 university women each (M= 20.9 yr., SD= 1.9). Qualitative analysis of the 20 interviews identified five of Yalom's therapeutic mechanisms, namely, self-understanding, universality, acceptance, catharsis, and self-disclosure. The positive experiences were group cohesiveness, self-understanding, self-disclosure, positive views about the self and learning, and cognitive benefits. Self-disclosing at the early stages of group development was the most frequently reported negative experience or difficulty in the group. Although participants stated they improved interpersonal communication skills, analysis suggested the cultural context was an important mediator of assertive behavior.     

Perceptions of Turkish psychiatric inpatients about therapeutic factors of group psychotherapy

Many studies on therapeutic factors in group psychotherapy were done during the 1970s and 1980s, primarily with Western samples, The present study was carried out in a psychiatric inpatient clinic in Turkey. Using Yalom's (1975) therapeutic factor questionnaire administered at discharge, patients rated existential factor, instillation of hope and self-understanding as the most helpful factors and identification as the least helpful. There were significant differences among patients with regard to gender, age, education, comorbid personality disorder, but not with Axis I diagnosis or number of attended sessions. Patients' and psychiatrist's rating showed significant differences. Differences between this Turkish sample and those reported in common Western literature are discussed under the light of relatedness psychology, which is an important concept of cross-cultural psychology.     

Experience in Developing a Combined Activity and Verbal Group Therapy Program with Latency-Age Boys

Ten fundamental principles are outlined for the practice of brief, dynamic group therapy within a 10- to 20-session time limit. They include: group composition and screening; contracting for appropriate goals: facilitating rapid cohesiveness; stages of group development; building a work group atmosphere; leadership style; structural levels of focus; transference and countertransference considerations; the cotherapy relationship; and curative factors. This approach integrates recent formulations from the practice of short-term individual therapies as well as brief group approaches. Each brief group principle is contrasted with its long-term analytic group counterpart. Relevant research literature, historical roots, as well as other types of brief therapy groups are reviewed. The recent and experimental nature of these techniques is critically discussed.     

Therapeutic factors in two forms of inpatient group psychotherapy: Music therapy and verbal therapy

Therapeutic processes in one type of creative arts group psychotherapy, music therapy, were compared with verbal group psychotherapy. Sixty-one short-term inpatients ranked group psychotherapy curative factors and completed satisfaction ratings. Therapists rated 201 group therapy sessions— 109 music therapy and 92 verbal therapy. Statistical analysis revealed that patients highly valued both group formats. The mean curative factor rankings for both groups included cohesiveness, instillation of hope, and altruism among the most helpful factors. Therapists' ratings indicated qualitative differences between the two groups. Music therapy involved more therapeutic interaction among patients and emotional expression, whereas verbal therapy emphasized concrete problem solving.Supported in part by Biomedical Research Support Grant Program grant #S07-RR05755 from the Division of Research Resources, National Institutes of Health.     

Readiness to adaptively change under three conditions: Clinical,careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self‐rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non‐therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non‐therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.     

Leadership skills and helpful factors in self-help groups

The effects of training on leadership skills and group processes in cancer and anorexic self-help groups are investigated. Three components of the study are reported. Firstly, an observational case-study of each type, of group was conducted to investigate the nature of the leadership input. Secondly, a Self-Help Questionnaire based on Lieberman's classification of leadership skills was administered to members of eight self-help groups to compare the experiences of groups with trained and untrained leaders. Thirdly, group members completed a Helpful Factors Questionnaire based on Yalom's analysis of group processes. The observational case-study revealed significant differences between the trained and untrained leaders in that, unlike the trained leader, the untrained leader clearly dominated the group. Results from the Self-Help Questionnaire showed that trained leaders scored higher on Caring and Emotional Stimulation but lower on Attribution of Meaning. Member satisfaction, however, was similar in the two types of group. Results from the Helpful Factors Questionnaire showed that most of the helpful factors were seen similarly by the two types of group, though differences were found concerning the relative rankings of both Guidance and Altruism. It is concluded that some degree of training of group leaders could be usefully incorporated into the self-help movement.     

Therapeutic Factors in Adolescents’ Groups With and Without Movies

ABSTRACT

The study explores the therapeutic factors in two types of group interventions–-film therapy (n = 69) and affective support therapy (n = 48) for Arab adolescents (ages 13–14) in Israel. Film therapy is a relatively new method for groups, aimed at enhancing adolescents’ engagement in the process of group counseling. Six-hundred students from 11 schools were screened for the level of parent–adolescent conflict, based on a self-report measure. The 117 students who met the cutoff point constituted our sample. They were randomly divided into 12 small groups (6 in each type of intervention). A previous study reported the outcomes of these two interventions, showing equal progress in both groups (compared to control). The current study explores process variables, specifically therapeutic factors, in an attempt to enhance our understanding of those outcomes. Results indicated common therapeutic factors across both types of intervention. The factors of relationship–climate and other- versus self-focus were ranked the highest and, contrary to expectations, were significantly higher in affective support therapy than in film therapy.     

Significant treatment factors in short-term group psychotherapy

The author briefly describes an approach to short-term group psychotherapy based upon an adult developmental model. By means of a clinical case example significant treatment factors are examined. Such an approach to planned short-term group therapy may force group members to confront and deal with important existential issues.     

Focused group therapy: An integrative approach

Focused Group Therapy (FGT) was developed within a research project on treatment for burned out patients on long-term sick leave. The core of FGT is to find and formulate an individual focus expressed in behavioural terms. This focus is then worked with in the here-and-now of the group therapy. It is argued that the use of common factors in group therapy, rather than a special technique, improves the clinical work. Thesupport factor in group therapy is understood in terms of cohesion, therapeutic alliance and goal-corrected empathic attunement. Thelearning factors that are stressed are the experience of being a part of a developing group, building on similarities instead of differences, affective communication and the implicit knowledge developed in new ways of dealing with interpersonal relations. Theaction factor is considered to consist of challenging interpersonal situations corresponding to the individual focus, which are mastered in the here-and-now of the group.     

Perceptions of helpfulness and behavior in groups

Before, midway, and late in a 50-hour small group experience, 28 persons separately and subjectively appraised the helpfulness of 60 items representing Yalom's (1975) 12 curative factors of group psychotherapy. Items from the catharsis and interpersonal learning factors proved highly and increasingly helpful, despite their poor internal consistency. Item helpfulness also linked to members' ingroup behavior, as measured by peer ratings of acceptance-rejection of self and others. (Hurley, 1976). Persons more accepting of self and others regarded family reenactment items as more helpful, and advice and guidance items as less helpful, than did members who were more rejecting of self and others.     

Individual Versus Group Physical Therapy for Patients with Low Back Pain: Outcomes and Process (Therapeutic Factors)

ABSTRACT

Low back pain (LBP) is a common health problem usually treated individually, and requires costly physical therapy. Group treatment, besides being cost-effective, provides psychological support to the recovery of people who struggle with a physically disabling condition. The current study compares individual and group treatment of LBP, measuring differences in outcomes and process data (therapeutic factors). The study included 158 patients who participated in group (n = 71) and individual (n = 87) physical therapy, using a pre-post-follow-up design. Results indicated a significant improvement in all outcome measures at postintervention in both treatment settings, with no difference between them, which were sustained at follow-up. On a clinical level, a few differences were found: At postintervention, minimal clinically important improvement in perceived functioning and level of pain was greater among patients treated individually. On the other hand, at follow-up, only group participants gained additionally in perceived functioning and in fear avoidance. Therapeutic factors of other- versus self-focus and problem definition–change were more prevalent in group treatment.     

The Couch and the Circle by Hyman Spotnitz

A qualitative study explored the therapeutic elements in psychodynamic group therapy for adolescents with learning disabilities and related psychosocial problems. Four boys and four girls, diagnosed with learning disabilities, were interviewed on completion of group therapy, to obtain their subjective experiences. Therapeutic factors were identified, grouped, and found to be operative through an interpersonal process, termed mutual recognition. Mutual recognition is defined as the adolescents realizing that they saw themselves in the others and that the others saw themselves in the participants. The subcategories were trust, connection, and group issues/process. The subcategories were interactive: they contributed to, and were influenced by, mutual recognition.