Running head: THERAPEUTIC FACTORS, INTERPERSONAL LEARNING AND
Therapeutic Factors, Interpersonal Learning and Group Cohesion
Derek Sharpe
Stenberg College
Working in Groups
PSYN 203-3 (A)
Debbie McCreedy
August 20, 2013
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THERAPEUTIC FACTORS, INTERPERSONAL LEARNING AND
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Abstract
Yallom asserts that the positive impact of psychotherapy groups on its members is due to
curative factors derived from prior research as well as his own (Sherry, 1976). The factors are
interdependent and overlapping. They combine to create positive outcomes in psychotherapeutic
groups (Sherry, 1976). Yalom sees the psychotherapeutic group as a social microcosm where the
leaders provide group members with opportunities for “emotionally corrective experiences in
interpersonal learning by developing and maintaining a constructive environment including
group cohesion (Sherry, 1976, p. 1).”
THERAPEUTIC FACTORS, INTERPERSONAL LEARNING AND
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Therapeutic Factors, Interpersonal Learning and Group Cohesion
The debate about the effectiveness of Individual versus group psychotherapy remains
silent. Research demonstrates that group therapy is on par with individual therapy in the delivery
of meaningful benefits to clients (Yalom & Leszcz, 2005, Evidence, 2012). No discussion about
the effectiveness of group therapy would be complete without reference to the therapeutic factors
(Barker, 2009). The interdependent nature of the therapeutic factors means that grading their
importance is an exercise in subjectivity. Despite this, the factors of interpersonal learning and
group cohesiveness are, in the writer’s opinion, cornerstones in the delivery of meaningful
benefits to clients. This paper will briefly examine the therapeutic factors described by Yalom &
Leszcz, (2005) and describe the mechanism of action and therapeutic results of Interpersonal
Learning and Group Cohesion.
History of Yalom’s Curative Factors
In the 1970s Yalom envisioned the psychotherapeutic group as a social microcosm. This
constructive environment is maintained by the therapist and allows for emotionally corrective
experiences in interpersonal learning (Sherry, 1976). During this time Yalom identified 12
curative factors impacting the psychotherapy group. These factors were derived from his
research and the influences of other research which included over 300 articles on group therapy
(Sherry, 1976). At this early stage Yalom realized that the 12 curative factors were
interdependent and overlapping. They combined to contribute to the positive outcome of group
therapy (Sherry, 1976). This was supported by a Q-sort administered to 20 former clients who
had been in therapy for at least 17 months and who were considered successful members of
group therapy. The Q-sort was made up of items representing each of the curative factors. With
reference to helpfulness, the 60 items were sorted by group members according to their
THERAPEUTIC FACTORS, INTERPERSONAL LEARNING AND
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experience (Sherry, 1976). The results in descending order were, “Interpersonal Input, Catharsis,
Cohesiveness, Insight, Interpersonal Output, Existential Awareness, Universality, Instillation of
Hope, Altruism, Reenactment, Guidance and Identification (Sherry, 1976, p. 1)”
11 Factors
According to Yalom, (2005) the therapeutic experience is divided into 11 primary factors.
They are not definitive but derived from the best available evidence at this time and are an
effective approach to therapy (Yalom & Leszcz, 2005). More than a cursory look at these factors
is beyond the scope of this paper. However cursory the look, the role they play in positive
therapeutic change is evident.
Instillation of Hope
Yalom & Leszcz, (2005) support with studies an assertion that the instillation and
maintenance of hope is crucial to psychotherapy. The most extreme example of hope in terms of
healing might be therapies mediated entirely on faith and hope such as faith healing and placebo
studies (Yalom & Leszcz, 2005). Groups like Alcoholics Anonymous (AA) utilize and create
hope for members through testimonials of members who remain sober as a result of the program
(Yalom & Leszcz, 2005).
Universality
This is such a powerful factor with reference to groups like AA, where the recognition of
not being alone in ones addiction reduces a sense of uniqueness and isolation (Yalom & Leszcz,
2005). Members recognize that other members share similar feelings, thoughts and problems
(Evidence, 2012).
Imparting Information
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This is the education and advice given by the therapist or group members (Evidence,
2012). In recent times this is more didactic, the equivalent of psychoeducation. Ideally it takes
the form of a partnership and a working together. Subordination of the client due to his position
relative to the leader is to be avoided (Yalom & Leszcz, 2005).
Altruism
Members gain an important boost to self concept by extending help to other group
members (Evidence, 2012). Feeling needed is important, yet the concept is not always grasped
by new group members. Often new members feel the blind cannot lead the blind. When they
have transcended themselves they are able to be absorbed in the helping of others (Yalom &
Leszcz, 2005).
The Corrective Recapitulation of the Primary Family Group
This factor is dynamic because of the influence and reinforced conditioning of the family
of origin in our lives (Whitefield, 1987). Therefore, any opportunity to reenact critical family
dynamics with group members in a corrective manner is a powerful factor in therapeutic change
(Evidence, 2012). The important point here is, that the familial conflicts are not just relived but
they are “relived correctly (Yalom & Leszcz, 2005, p. 16).”
Development of Socializing Techniques
The development of basic social skills seems obvious but for some members they are
lacking or have been stunted. In many cases they enter adulthood with childhood survival
behaviours that do not work in an adult world (Whitefield, 1987). A simple manifestation might
be an inability to make eye contact while conversing that has undermined social relationships
(Yalom & Leszcz, 2005). The group provides members with an environment that fosters
THERAPEUTIC FACTORS, INTERPERSONAL LEARNING AND
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adaptive and effective communication (Evidence, 2012).
Imitative Behaviour
Members grow skills and gain personal knowledge by observing group member’s selfexploration, working through and personal development (Evidence, 2012). The great therapeutic
impact of this factor is “finding out what we are not, is progress towards finding out what we are
(Yalom & Leszcz, 2005, p. 18).”
Interpersonal Learning
In general, interpersonal learning occurs within the group because many points of view
reality test the person’s assumptions, attitudes and beliefs (Barker, 2009). An example would be
of the member who shows much caring for others but little self care, perhaps trivializing his
needs. This triviality is picked up by the group. The member comes to understand that
trivializing his needs is a big problem in his life (Yalom & Leszcz, 2005). This pattern of
relating outside the group is reenacted and repeated within it (Barker, 2009).
Interpersonal learning is broad and complex (Yalom & Leszcz, 2005). Perhaps this is
why it plays such a pivotal role in therapeutic change. Its broadness might best be represented
by a comparison to individual therapy. 3 important factors, insight dealing with transference and
the corrective emotional experience are analogous to the group therapy factor of interpersonal
learning (Yalom & Leszcz, 2005). The complexity of interpersonal learning is that it must be
understood in the context of 3 concepts. Firstly, is the Importance of Interpersonal Relationships,
secondly, is The Corrective Emotional Experience, and thirdly, is The Group as a Social
Microcosm (Yalom & Leszcz, 2005).
The Importance of Interpersonal Relationships
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From studies of human evolution to Harry Stack Sullivan’s interpersonal theory of
psychiatry, our personalities are the result of approval and interactions with the significant
people in our lives (Yalom & Leszcz, 2005). Therefore our concept of self is at the mercy of
those significant interactions or relationships (Yalom & Leszcz, 2005). More powerfully put, our
self regard is based on the reflected appraisals of others and when those appraisals are
consistently and negatively false, it leads us to parataxic distortions or transference (Yalom &
Leszcz, 2005). These false perceptions perpetuate throughout life, and manifest as projections
such as incorrectly perceiving one to be harsh and rejecting (Yalom & Leszcz, 2005). It gets
worse. This projection evolves into behaviours and mannerism that will cause others to become
harsh and rejecting, a self fulfilling prophecy. Yalom & Leszcz, (2005) further assert that these
behaviours are modifiable through consensual validation (the opinions of others) which is
exactly what happens in group. So powerful is this concept that Stack Sullivan, cited in Yalom
& Leszcz, (2005) further asserts that the treatment for mental illness should focus on
maladaptive interpersonal behaviour because, in many cases, it is from this perspective that
mental illness is defined. “Accordingly, psychiatric treatment should be directed toward the
correction of interpersonal distortions (Yalom & Leszcz, 2005, p. 23). Group members exposed
to consensual validation will often replace their initial goal to relieve suffering with an
interpersonal goal.
Our social needs are necessary and powerful. Our sense of self is conducted from the
reflected appraisals of significant others. Negative reflective appraisal results in disturbed
interpersonal distortions and negative projections throughout are life. Consensual validation in
group therapy provides the opportunity to correct these distortions.
The Corrective Emotional Experience
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The corrective emotional experience is important because “contemporary
psychotherapies view it as a cornerstone of therapeutic effectiveness (Yalom & Leszcz, 2005, p.
27).” In group, it is the exposure of the member to emotional situations from his past that he was
unable to deal with in a healthy way. The difference is that the experience takes place in the here
and now under conditions that are more favorable (Yalom & Leszcz, 2005). To help the
member, he must undergo this corrective experience to repair the corrosive residue of the
traumatic experience. The important point here is that awareness, insight and interpretation are
not sufficient. It is the relational experience in the here and now that will challenge the client’s
pathogenic beliefs (Yalom & Leszcz, 2005). When beliefs and behaviours are disconfirmed
through experience change will occur (Yalom & Leszcz, 2005). Compared to individual therapy
where only the therapist creates scenarios from the clients past, group therapy offers greater
opportunities because of the numerous dynamic tensions that exist between the different
members jockeying for status and dominance including all their parataxic distortions (Yalom &
Leszcz, 2005). Tension between members provides opportunities to recognize inappropriate
interpersonal feelings and behaviours as well as the inappropriateness of avoiding interpersonal
behaviour. The result is the ability for individuals to interact with others more deeply. It is true,
therapy in and of itself is an emotional and corrective experience (Yalom & Leszcz, 2005).
The Group as a Social Microcosm
The social microcosm exists within the group. It is experienced; it provides information
and then the opportunity to work in the here and now with member’s issues (Yalom & Leszcz,
2005). As the group grows, a comfort level is reached and people will behave within the group as
they do in their social environment (Bender, 2000). Their reasons for being in group will be
exposed as each member’s interpersonal style will reveal itself during interaction with group
THERAPEUTIC FACTORS, INTERPERSONAL LEARNING AND
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members (Bender, 2000). “Each member brings into the group the whole sociocultural context
in which he or she lives (Bender, 2000, p. 303).” People are in therapy to learn and to make
change. Interacting with others in the therapeutic social microcosm known as group is an
immediate and effective way to learn about the self. This is a process of healing and the key is a
shift in focus from what is being said to how and why it is being said (Yalom & Leszcz, 2005).
Yalom & Leszcz, (2005) makes a strong point with regards to the effect of the social microcosm
within group therapy with its emphasis on feed back, “is a particularly effective treatment for
individuals with character pathology (p.32).”
Group Cohesiveness
According to Yalom & Leszcz, (2005) studies show that groups with high levels of
cohesiveness have better outcomes. Cohesiveness is a potent therapeutic factor in its own right
as well as being a precondition for other therapeutic factors to operate effectively. Group
cohesiveness might best be described as being the same as the therapeutic relationship in
individual therapy. It is a therapeutic group relationship that garners the same client growth
potential. Members of a cohesive group will feel warmth and comfort and a sense of belonging.
Members generate cohesion through the creation of durable relationships in group. The
importance of this and the impact on members can be understood in the context of human
development particularly adolescence where feeling acceptance and approval from groups is self
actualizing (Myers, 2010). This point may still be understated without commenting that for
some members, therapy may be their first positive group experience.
Belonging to the group provides self esteem and “meets members dependency needs
…that fosters responsibility and autonomy (Yalom & Leszcz, 2005, p. 75). Under these
conditions of acceptance and understanding members are prepared to express and explore
THERAPEUTIC FACTORS, INTERPERSONAL LEARNING AND
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themselves (Yalom & Leszcz, 2005). Cohesiveness is necessary for self disclosure, risk taking
and constructive expression of conflicts within the group. This is necessary for successful group
therapy (Yalom & Leszcz, 2005).
Yallom asserts that therapeutic factors exist and are necessary for successful outcomes in
group therapy. The curative factors do not act independently but are interdependent and overlap.
They combine to create positive outcomes in psychotherapeutic groups (Sherry, 1976). This
paper briefly described the therapeutic factors presented by Yalom & Leszcz, (2005) with a
focus on the mechanism of action and therapeutic results of Interpersonal Learning and Group
Cohesiveness.
THERAPEUTIC FACTORS, INTERPERSONAL LEARNING AND
References
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