The applications of Yalom's "Curative Factors" to psychoeducational groups.

1. Curative Factors in Psychoeducational Groups

3. Curative factors in groups is a concept developed by Irving Yalom and discussed in his books Group Psychotherapy: Theory and Practice. In different editions Yalom has made some modifications to the original factors. This presentation outlines the factors most applicable to psychoeducational groups.

4. Not all the curative factors apply equally to psychoeducational groups . The importance of the factors may change over time in a group or have greater importance in some groups than others. In this presentation the factors are rated as primary, secondary and tertiary in terms of their applicability to psychoeducational groups. This rating system is not part of Yalom’s discussion and review of the curative factors.

5. Imparting Information The “Imparting of Information” occurs when group members get useful in formation from either other group members or the facilitator. The imparting of information is not a factor Yalom identified as a psychotherapeutic process. However he stated group members felt it was very helpful to learn factual information from other group members. Primary Factor

6. Imparting Information in Psychoeducational Groups This is the primary factor and purpose for psychoeducational groups. Each group focuses on specific learner outcomes that are either new information or new skills. Primary Factor

7. Universality Most group practitioners and members state the sharing of common experiences and feelings among group members helps remove a group members’ sense of isolation, validate their experiences. Primary Factor

8. Universality in Psychoeducational Groups Having members recognize common problems and experiences is one of the building blocks of psychoeducational groups. This acceptance of a common problem helps members feel not alone in their experience and helps provide a common bond for the members. Most psychoeducational groups have a common theme centered on a universal problem confronting all the group members. Primary Factor

9. Imitative behavior Yalom and other group practitioners believe that group members can develop social skills by observing and imitating the therapist and other group members. In traditional group therapies members can observe how others managed conflict, supported one another or shared feelings. The group members then often model those same behaviors latter in or outside the group. Primary Factor

10. Imitative Behavior in Psychoeducational Groups Having group members practice and demonstrate new skills is one of the primary techniques used in psychoeducational groups. Imitative behavior is often the core of teaching any new skill. One model for psychoeducational groups, “Skill Development”, has the facilitator first demonstrating the skill, then members practicing the skill and finally selected members modeling the skill for the rest of the group. Primary Factor

11. Instillation of Hope The “Instillation of Hope” happens when group members at various stages of recovery are inspired and encouraged by other members who have overcome their problems and are more successfully managing their lives. Primary Factor

12. Instillation of Hope in Psychoeducational Groups Psychoeducational groups focus on hope and reinforce the concept that group members can successfully manage their lives. Some psychoeducational group programs have ex-group members as co-facilitators. All psychoeducational groups focus on providing new information or skills that will help the members. Primary Factor

13. Development of Socializing Techniques Traditional group psychotherapy is often viewed as a learning lab where participants have opportunities to learn and improve their social skills. The safe and supportive group environment allows members to take interpersonal risks and try new behaviors. Secondary Factor

14. Many psychoeducational groups focus on developing social skills. When that is the specific topic of a group course then the developing socializing techniques is a primary factor. For many psychoeducational groups focusing on a variety of topics such as “Getting Back into the Workforce” there is a secondary gain of developing new social skills during the group course. Secondary Factor Development of Socializing Techniques in Psychoeducational Groups

15. Secondary Factor Curative Factor: Interpersonal learning In traditional group psychotherapy there is a great emphasis on members learning more about themselves and their style of interacting with others. Much group activity is spent on members exploring their feelings and receiving feedback from others.

16. Interpersonal Learning in Psychoeducational Groups Similar to developing social skills many psychoeducational groups focus on increasing interpersonal learning. When that is the specific topic of a group course then interpersonal learning. And, similar to developing new social skills, psychoeducational groups focusing on a variety of other topics such as “Budgeting Your Money” there can be a secondary gain of interpersonal learning during the group course. Secondary Factor

17. Secondary Factor Curative Factor: Existential Factors In traditional group psychotherapy there is an emphasis on individuals taking responsibility for their behaviors and the consequences of their actions. In many instances individuals come to therapy wanting to learn how to change the world, where in reality the focus of the therapy is how to change themselves and their reactions to the word.

18. Existential Factors in Psychoeducational Groups Part of the underlying message of psychoeducational groups is that individuals are responsible for trying to manage their lives. There may be factors out of the direct control of individuals but the person is ultimately responsible for learning how to best to cope and manage their life. This does not discount the role of therapy, behavioral health professionals and even chemotherapy. But it highlights the primary role of the individual in managing their treatment and their life. Secondary Factor

19. Secondary Factor Curative Factor: Guidance Guidance is a factor that was identified in earlier research on curative factors but was later discontinued. Yalom and other practitioners argued that the facilitator often needed to be directive i n the group psychotherapy sessions. They believed it was sometimes necessary to identify members’ behaviors that w e re self-defeating and discuss options for group members.

20. Guidance in Psychoeducational Groups In psychoeducational groups the facilitator is also part instructor and teacher. In that role of teacher the facilitator gives clear feedback to members on their behaviors. The facilitator often models behaviors and certainly gives corrective feedback to members on their performance. Secondary Factor

21. Tertiary Factor Curative Factor: Cohesiveness Cohesiveness is defined as a phase of group development when members feel trust, acceptance and belonging within he group. For Yalom and other group psychotherapists cohesiveness is the primary therapeutic factor that is the base for all the other factors. In order for the group process to work and personal development to occur the individual needs to be in a cohesive group.

22. Cohesiveness in Psychoeducational Groups Cohesiveness is an important factor in psychoeducational groups because it provides a psychologically safe environment where members are willing to take risks and try new behaviors. However attaining cohesiveness is not a goal or focus of psychoeducational groups. Members can learn new information and skills in the absence of cohesiveness. If the outcome of the psychoeducational group course has an interpersonal focus then cohesiveness becomes a primary factor. Tertiary Factor

23. Tertiary Factor Catharsis Catharsis is often described as an intense expression of emotion leading to a sense of relief. In group psychotherapy catharsis occurs when a member is able to express their feelings or “tell their story” to the rest of the group and feels a sense of support and acceptance.

24. Catharsis in Psychoeducational Groups Catharsis is not often identified as a component of psychoeducational groups. Inevitably, there are time when members will feel overwhelmed and need to experience this “catharsis”. When a member does have a cathartic moment the facilitator needs to assist the member, mobilize group support and process the event. Tertiary Factor

25. Corrective recapitulation of the primary family experience In traditional group therapy members often relate to the therapists and other members as parents and siblings. This transference of emotions is often used by the therapists to help members understand how the member’s relations with family members impact on the member’s current relationships. The group therapist’s discussion of those themes can help group members learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships Tertiary Factor

26. The corrective recapitulation of the primary family group is rarely a topic or issue for psychoeducational groups. There may be times when members express forms of transference to the therapists or other group members. If the transference interferes with the learning then the behavior needs to be addressed. The interpretation of the behavior and direct discussion of the transference is an issue for therapy more than psychoeducational groups. Corrective Recapitulation of the Primary Family Experience in Psychoeducational Groups

27. The curative factors discussed in this presentation can be very useful to psychoeducational group facilitators. These curative factors should be consciously integrated into the design of psychoeducational group courses. During the ongoing delivery of the psychoeducational group sessions there will also be opportunities for the facilitator to capitalize on the various factors such as universality, instillation of hope or other factors.

28. He always wants all the attention from the facilitator and does not want to share. Maybe I am not as alone in my problems as I think. That seems to be an interesting way to handle that situation maybe it will work for me. Look at how well George has done, I can do that next time someone pressures me . O.K. These are the four things to remember when I go for my interview. Maybe the facilitator is right and counting to five will help cool things. Universality Catharsis Interpersonal Learning Cohesion Family Hope Modeling Guidance Imparting Information Imitative Behavior Socializing Techniques Match Member Statement to Factor Curative Factor

29. I guess I needed to say that to everyone and feel better now. Maybe I do come across a little too hard on others. This might be a chance to try something different.. Universality Catharsis Interpersonal Learning Cohesion Family Hope Modeling Guidance Imparting Information Imitative Behavior Socializing Techniques Match Member Statement to Factor Curative Factor It feels good coming someplace where I feel people accept me for who I am. This not interrupting others when they talk is tougher than it sounds. Some of these other people have had it worse than me and they are getting better.

30. He always wants all the attention from the facilitator and does not want to share. Maybe I am not as alone in my problems as I think. That seems to be an interesting way to handle that situation maybe it will work for me. Look at how well George has done, I can do that next time someone pressures me . O.K. These are the four things to remember when I go for my interview. Maybe the facilitator is right and counting to five will help cool things. Universality Family Modeling Guidance Imparting Information Imitative Behavior Match Member Statement to Factor Curative Factor

31. I guess I needed to say that to everyone and feel better now. Maybe I do come across a little too hard on others. This might be a chance to try something different.. Catharsis Interpersonal Learning Cohesion Hope Socializing Techniques Match Member Statement to Factor Curative Factor It feels good coming someplace where I feel people accept me for who I am. This not interrupting others when they talk is tougher than it sounds. Some of these other people have had it worse than me and they are getting better.

32. The curative factors discussed in this presentation can provide a positive psychological environment for helping members learn how to successfully manage their lives. Psychoeducational group facilitators will greatly enhance their skills by a thorough reading of Irving Yalom’s book Group Psychotherapy: Theory and Practice .