PROFESSIONAL COUNSELLOR - Mental Health Academy

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THE PROFESSIONAL COUNSELLOR 03 2008 Third, the individual is able to observe the problems, struggles, behaviours, interaction styles, and coping mechanisms of the others in the group. He is then able to use this information as a yardstick for comparing his own behaviours. From this a group member can assess his own abilities and disabilities and consider possibilities for personal change. Closely linked with the third advantage is the fourth, which is facilitation of the individual growth process. The support of the group can be an enhancing factor in self-exploration and introspection (Lieberman, 1990b; Posthuma & Posthuma, 1972). Feeling, caring, and respect from others “The individual is able to observe the problems, struggles, behaviours, interaction styles, and coping mechanisms of the others in the group.” can go a long way in promoting the self-confidence necessary to attempt new and different ways of behaving. The final advantage of the group format for both counselling and therapy is the obvious one of economics. Having several clients meet together with a group leader rather than meeting individually with a therapist or counsellor saves time and money (Davies & Gavin, 1994). Group Therapy and Change Yalom (1985) discusses “therapeutic factors” (originally called “curative factors”) which he says operate in all types of therapy groups, with different factors being emphasized in any given group depending on the goals and composition of the group and the approach that is being used. It is also true that in some situations clients must deal with certain factors before they can benefit from others (Bonney, Randall, & Cleveland, 1986). Other authors have identified “helping factors” (Schultz, 1993; Schwartzberg, 1993) in support groups that appear similar in many respects to Yalom’s therapeutic factors. Yalom notes that many of the factors are interdependent and that some factors represent conditions for change while others are actually mechanisms of change. Yalom’s factors have been extensively cited and investigated, including recent research that demonstrated that the levels of therapeutic factors tended to increase over the life of the group (MacNair-Semands & Lese, 2000). MacKenzie (1987) established that outcome measures evaluating the usefulness of the therapeutic factors, when taken retrospectively, differed from results obtained while members were still active in the group. Descriptions of the ten primary categories of therapeutic factors follow (Yalom, 1985). 1. Imparting of Information. The type of information imparted in groups depends on the type of group, the leader, and the members. Included may be advice, suggestions, guidance, interpretations, or didactic instruction about a certain theoretical approach such as transactional analysis or cognitive restructuring. In task groups, such as assertiveness-training, life-skills, or goal-setting, it is likely that the leader will give information and instructions to the members before commencing the activity. In using a didactic approach, one must be careful that the group does not become essentially a “class” and hence foster a dependence on the leader to “tell us what to do.” This caution is basically supported by the work of Block and Crouch (1985) who found guidance to be one of the least helpful therapeutic factors. In educational domestic violence groups for men, however, Schwartz and Waldo (1999) found that imparting information and development of socialising techniques were the most useful therapeutic techniques. Members appeared to appreciate the opportunity to learn more about their condition from both professionals and their peers. In a study with clients in a psychiatric day treatment center Falk-Kessler, Momich, and Perel (1991) found that whereas group leaders found guidance to be valuable the group members did not. 2. Installation of Hope. It is crucial that the members see the group as a helpful-hopeful treatment method. Many groups are open, so new members are being accepted as others approach discharge. This process offers the opportunity for those members who have gained and improved from the group experience to share their experiences with the newer members. If Joe can say, “When I first came into this group I was scared and didn’t think I had anything worthwhile to say, so I was pretty quiet. But now I think I talk as much as anyone,” then this can give encouragement and hope to a timid, withdrawn member that he too may be able to reach that point. Yalom (1985) actually encourages leaders to “exploit” this factor by pointing out changes and improvements members have made as a means of offering hope to others. When members are dealing with uncertainties about the future, Spencer, Davidson, and White (1997) see the development of hope as a collaborative effort. 3. Universality. Each group member is different, having his very own set of unique problems. Members often believe that no one else could possibly have problems that are as bad as theirs. However, as members begin to talk in the group 4
THE PROFESSIONAL COUNSELLOR 03 2008 and as the “bad” problems are shared, members come to experience a join-the-club feeling. As members listen to disclosures made by other clients, they sense a similarity of concerns and issues. This helps them put their problems into perspective and tends to alleviate feelings of aloneness, which dissolves the feeling of “I am the only one.” In a study of three self-help groups, Lieberman (1983) reports that universality – the feeling of being with others who share the same problems – was the experience the members valued most. By losing their feelings of uniqueness, members came to perceive their thoughts and feelings not as aberrant and unusual but as quite common among those with similar problems. While dispelling feelings of isolation is therapeutic in itself, it also facilitates a feeling of unity among the members that is the very foundation for a successful group. 4. Altruism. One of the basic premises of therapeutic groups is that the members will help each other. The trust and cohesion that evolve in groups supply fertile ground for patients to give feedback, reassurance, suggestions, and support to one another. Because many individuals who are members of counselling or therapy groups suffer from low self-esteem, this process of being able to help others can be a very egostrengthening experience. It is often the group members, rather than the leader, who offer support and caring and point out one another’s strengths and assets. 5. Family Reenactment. Although other researchers Block, Crouch, & Reibstein, 1981; MacDevitt & Sanislow, 1987) have found family reenactment to be one of the least helpful factors, Yalom (1985) recognised the familial aspects of a therapeutic group as being useful. Many patients will have had unsatisfactory, if not “Because many individuals who are members of counselling or therapy groups suffer from low self-esteem, this process of being able to help others can be a very egostrengthening experience.” traumatic, family experiences. Reporting on a study involving a group of incest victims, Bonney, Randall, and Cleveland (1986) found that members placed a heavy emphasis on gaining genetic insight through self-understanding and family reenactment. As well as gaining understanding of the past, being in a group gives members the opportunity to experience what can be felt as a caring family environment. Within the group “family” they can discuss and perhaps resolve issues from their primary family such as parent-child conflicts and sibling rivalries. Borrowing from their professional colleagues, the psychodramatists, group leaders often use role-playing in their groups to re-create family situations so that members can learn new ways of relating and interacting with their own families. 6. Development of Socialising Techniques. The assessment and development of social skills has long been of interest to counsellors and therapists alike. Social skills are prerequisites for most people to function adequately in their life roles. Most of our clients, however, experience difficulties in one if not several of their life roles and their problems can, in part, be attributed to poor social skills. The process of feedback, mentioned earlier, affords the opportunity to learn about one’s maladaptive social behaviour. For individuals that lack close personal relationships in their lives, the group is often the first time they have had the opportunity to give and receive personal feedback. Role-playing, a technique often used in groups, can be used successfully both in increasing awareness of and in teaching social skills. 7. Imitative Behaviour. In any group each participant has the opportunity to observe, at close hand and in an interactive manner, the behaviours of all the other participants. Through such observations they become aware of which behaviours evoke positive and negative responses from the other members. By imitating or “trying on” these behaviours, they too can evoke such responses. Behaviours that receive a positive reaction from others are usually repeated and hence new learning can occur. Some members may imitate certain behaviours of the leaders or other members only to later discard them, deciding the “fit” is not comfortable. This too is learning. Of course there can also be the member who imitates the “bad” person in the group in order to receive the same degree of attention, even if it is negative attention. 8. Interpersonal Learning. No one goes through life alone. Rudestam (1982) says, “Life is primarily a social event” (p. 6). A person may feel lonely and alienated or be considered a loner, but the demands of daily existence, be they work or play, tend to involve relating to others. Because a group is considered a miniature society (Rudestam, 1982), or a microcosm of reality (Ormont, 1992), it presents similar demands. Initially members of a group or a new member in 5
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PROFESSIONAL COUNSELLOR - Mental Health Academy

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