Process research

Yalom's therapeutic factors

Yalom's therapeutic factors have been the basis of many subsequent research studies. Of these, insight, cohesiveness, and learning from feedback are valued positively, and identification, family re-enactment, and guidance are valued less. Piper (149) points out that we do not know whether valuing certain factors is related to good outcomes. The patient's perception of what is useful has not been found to be synonymous with what was predominant in a group or what actually helped to effect change. It is at best an indirect measure.

Preparation of patients for group therapy

Salvendy(98> has offered convincing evidence that preparation through prior individual sessions is a significant factor in achieving positive results, which confirms the clinical experience of many practitioners. However, in a review of 20 controlled or comparative studies Piper and Perrault (155) found that preparation has a positive effect upon attendance but that it could not be shown to have a direct effect on outcome.

Therapist activity

Development of constructive group norms will depend on factors such as careful group composition and leadership style. Foulkes stated that in the initial stages of a group the conductor has a relatively high rate of activity but as the group develops its own resources for psychological work, there should be a decrescendo in the conductor's activity and a crescendo in the activity of the group members. (156) This has been supported by later research. Liberman wrote that, as the group develops:

The group members take over from the therapist some of his influence and shaping behaviour. Where the therapist initially is important in establishing a group culture, later some of his influence is mediated by the group members themselves.

Group process variables

Research on therapeutic factors (e.g. self-disclosure and feedback) and leadership technique indicate that members in well-established groups are engaged in many different types of psychological work. They are less group-centred and more likely to be confronting the personal distress and maladaptive interpersonal styles that brought them to treatment in the first place. Certainly these individualized issues have been apparent throughout the group's evolution, but now the therapist and group members have fashioned a supportive and coherent group system to address these deeply personal conflicts in a much more concentrated and effective mannerA58)

Therapeutic factors

In an important study of process and outcome in long-term inpatient groups, Tschuschke and Dies(159) studied five therapeutic factors: cohesiveness, self-disclosure, feedback, interpersonal learning output, and family re-enactment. The result showed that all five factors are meaningfully associated with clinical improvement and emphasized that group cohesiveness is an important ingredient for effective group process to occur. They suggested that affective integration into the group, i.e. the high and positive emotional relatedness to co-members, promotes the capacity to disclose and leads to more frequent and intense feedback from fellow patients. It appears that feedback given earlier in the group has a stronger relationship to treatment outcome. This may suggest that interpersonal feedback needs time to be assimilated and worked through before it can be utilized effectively. There are significant differences between successful and unsuccessful patients in terms of the level of group cohesion and amount of self-disclosure. The patient who discloses little and does not feel drawn to the group receives relatively little meaningful interpersonal feedback and becomes neglected. Tschuschke and Dies(159) concluded that there is:

A complex interdependency among the three therapeutic factors of cohesiveness, self-disclosure, and feedback that promotes a working through process that is also apparent in improved interpersonal patterns (interpersonal learning-output) within the group and productive and enduring intrapsychic changes in object and self-representations (family re-enactment).

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Break Free From Passive Aggression

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