Yalom s Therapeutic Factors Eleven Primary Factors

1. Yalom�s Therapeutic Factors Eleven Primary Factors CP6130 Group Counseling Dr. Elizabeth Skjoldal

2. Installation of Hope The installation and maintenance of hope is essential in all psychotherapies. (Testimonies!) Patients will show unacceptable interpersonal behavior in group. Most common secrets: The deep conviction of basic in adequacy feeling that if others really knew the person they would discover his/her incompetence and see through their intellectual bluff. (Fig leaves come off and shame!) A deep sense of personal alienation. Some variety of sexual secret, often a dread of homosexual inclinations.

3. Universality Patients express great relief at discovering they are not alone & others share the same dilemmas and life experiences (We are all sinners!)

4. Imparting of Information Indirect advice giving serves a purpose. The purpose rather than the content of the advice may be beneficial since it implies & conveys interest & caring. This includes: didactic instruction, advice giving (can be used to estimate group age early on)

5. Altruism Selflessly receive through giving. Many are immersed with obsessive introspection, but meaning in life cannot be attained via deliberate self-conscious pursuit.

6. Corrective Recapitulation of Family Group Family conflict may be relived in group context. Relived correctively! Must be explored and challenged.

7. Development of Socializing Techniques Role play and deliberate alteration of social behaviors

8. Imitative behavior May be underestimated. Modeling of therapist & group members of self-disclosure and support

9. Interpersonal Learning Analogue to insight, working through transference and corrective emotional experience in individual therapy. The importance of interpersonal relationships � Treatment should be directed toward the correction of interpersonal distortions, thus enabling the person to lead a more abundant life, participate collaboratively with others, and to obtain interpersonal satisfactions in the context of realistic, mutually satisfying interpersonal relationships. �Their initial goal, relief from suffering, is modified & eventually replaced by new goals, usually interpersonal in nature�

10. Corrective Emotional Experience - In interviews after group therapy patients invariably select an incident that is highly laden emotionally & involves some other group member, rarely the therapist. The most common characteristics of these incidents were: The patient expressed strong negative affect This expression was a unique of novel experience for the patient. The feared catastrophe did not occur; no one left or died, the roof did not collapse. Reality testing ensued. The patient realized that the affect expressed was in appropriate in intensity or direction, or that prior avoidance of affect expression was irrational. The patient was enabled to interact more freely and to explore his/her interpersonal relationships more deeply.

11. The 2nd most common characteristic of these incidents is: A strong expression of affect � but a positive affect The 3rd most common characteristic of these incidents is: An incident similar to the 2nd usually involving self-disclosure, which plunged them into greater involvement with the group �Therapy is an emotional and a corrective experience, We must experience something strongly; but we must also though our faculty of reason. Understand the implications of the emotional experience.� �Group members must experience one another with as much spontaneity & honesty as possible, & they must also reflect upon that experience.�

12. Social Microcosm � Patients will begin to display their maladaptive interpersonal behavior in a group ( in a freely interactive group). There is no need for them to describe their pathology; they will sooner or later act it out before the group members eyes. If avoided then nothing else of import will be talked about.

13. Group Cohesiveness Group membership, acceptance and approval are of the utmost importance in the individual�s developmental sequence. The members of a cohesive group are accepting of one another, supportive and inclined to express and explore themselves. The group that is able to express negative feelings toward the therapist almost invariably is strengthened by the experience.

14. Catharsis Catharsis is not enough! Necessary but not sufficient. Patients who selected catharsis as main issues were in fact more likely to have a negative experience of the group. One must have catharsis plus some form of cognitive learning.

15. Existential Factors The recognition that life is at times unfair, no escape from some of life�s pain and death, recognizing that no matter how close I get to other people, I must still face life alone and learning that I must take ultimate responsibilities for the way I live my life no matter how much guidance & support I get from others.

16. Integration of Yalom�s Therapeutic Factors The ten most important items deemed important to the patients were (in order of importance: 1. Discovering & accepting previously unknown or unacceptable parts of myself 2. Being able to say what was bothering me instead of holding it in 3. Other members honestly telling me what they thought of me 4. Learning how to express my feelings 5. The group teaching me about the type of impression I make on others

17. 6. Expressing negative or positive feelings toward another member Learning that I must take ultimate responsibility for the way I live my life 8. Learning how to come across to others 9. Seeing that others could reveal embarrassing things & take other risks & benefit from it helped me do the same 10. Feeling more trustful of groups & of other people Note that seven of the first eight items represent some form of catharsis or of insight.

18. Looking at the general categories and not at the individual items, we see in rank order or importance: Interpersonal input Catharsis Cohesiveness Self-understanding Interpersonal output Existential factors Universality Installation of hope Altruism Family re-enactment Guidance Identification