Curative Factors MOD

7/30/2019 Curative Factors MOD

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Table of Contents

1. INTRODUCTION................................................................................................................ 1

2. IMPARTING OF INFORMATION .................................................................................. 2

3. INSTILLATION OF HOPE ............................................................................................... 4

4. UNIVERSALITY ................................................................................................................. 5

5. IMITATIVE BEHAVIOUR ................................................................................................ 7

6. GROUP COHESIVENESS ................................................................................................. 8

7. INTERPERSONAL LEARNING ...................................................................................... 9

8. CATHARSIS ...................................................................................................................... 11

9. EXISTENTIAL FACTOR ................................................................................................ 12

10. ALTRUISM ...................................................................................................................... 14

11. CORRECTIVE RECAPITULATION OF THE PRIMARY FAMILY GROUP ...... 15

12. DEVELOPMENT OF SOCIALIZATION TECHNIQUES ........................................ 16

13. CONCLUSION ................................................................................................................ 17

14. REFERENCES ................................................................................................................. 18


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THE CURATIVE FACTORS 2011

S.GUTTY 1

1. INTRODUCTIONGroups are fundamental component in our social life. On a daily basis almost all

individuals need a group to function. These groups can be in form of friends, family circle,

community groups and also cultural groups. These types of groups influence a persons

behaviour and the way he perceive his environment. On the other hand individuals can also

become part of a group in order initiate and work together for a joint goal achievement.

Yaloms therapeutic factors (curative factors) are derived from extensive self-report

research with individuals following group therapy. Yalom (2005) discussed eleven categories

of curative factors which are as follows: instillation of hope, universality, imparting of

information, altruism, corrective recapitulation of the primary family group, development of

socialising techniques, imitative behaviour, interpersonal learning, group cohesiveness,

catharsis and existential factors. These factors are interdependent.

As occupational therapists or group therapist, the success depends mostly upon our

capacity to unfold and sensitively manage the dynamics of interdependent people relating to

each other in the using curative factors.


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S.GUTTY 2

2. IMPARTING OF INFORMATION

Description

Imparting of information is the giving and sharing of information. The curative factor

includes the following:

Didactic instruction, that is informative and instructive. The information is providedby the therapist. The therapist can also invite other professionals to convey important

things to the group members if the latter agree.

Direct advice is the opinion or recommendation about what could or should be doneabout a particular situation. This comes from the members of the group.

Reasons for being therapeutic

Yalom (2005, p.11) noted that information often functions as the initial binding force

in the group until other curative factors become operative. This curative factor encourages

the group to interact, share thoughts and feelings and give feedback to each other with

honesty. The therapist helps the members to increase their knowledge and understanding of a

particular problem.

The author also noted that knowledge can be comforting for the sufferers since the

explanation of the phenomenon is the first step towards control of the phenomenon. (Yalom

2005, p.11). The explicit instruction about the nature of the shared illness, such as bipolar

disorder, depression, panic disorders or alcoholism allows the clients to leave the group far

more knowledgeable about their specific conditions than when they entered. This makes them

increasingly able to help others with the same or similar problems.

Thr ee ways to facili tate Imparti ng of in formation

This curative factor can be facilitated through formal learning such as:

1. LecturesThe therapist or professionals invited by the therapist may address the group on specific

issues. Learning must take place in a warm congruent atmosphere where the patients

collaborate fully with the therapist and/or professionals and vice-versa.


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S.GUTTY 3

2. FilmsViewing an instructive film on a specific problem or condition is always helpful. In this

process the therapist must should clear any misunderstanding and help the group members to

reflect on the information they got from the video.

3. Activities such as role playTaking the example of a group consisting of alcoholics, a role play on the impact of

alcoholism on an individuals health can be done. Through the role play, the group members

will gain information on the particular issue and on completion the members should be

invited to share the information they gained.

The stage at which imparting of i nformation is facil itated

This curative factor can be facilitated in the forming phase. The group members are

given the opportunity to reflect on what they learned from the therapist, the professional or

the group members and hence at the same time trying to apply the knowledge in the group.


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S.GUTTY 4

3. INSTILLATION OF HOPE

Description

Yalom (2005, p4) cites instillation of hope as crucial in all psychotherapies. Members

meet other individuals who have had similar problems to their own and have successfully

coped with the situation. This factor provides the group members with a notion that change is

possible.

Reasons for being therapeuti c

1. It increases participation.2. The group members get the willingness to attend group therapy.3. It gives emergence to hope that something good can happen.4. It helps to build confidence in the clients.5. This facilitates communication and sharing of information among the group members.6.

Three ways to facil i tate I nstil lation of Hope

1. Making the client realise that others had solved problems similar to his/hers.2. Role plays can help to give lively examples of successful recovery.3. Ex-sufferers can be made to narrate about their lives and how the change took place

for a better future.

The stage at which I nsti l lation of H ope is facil itated

Forming stage (motivates client to get involved with other members) Termination stage (at termination stage it helps the client to cope with difficult

feelings associated with the ending of the group so as to make constructive beginnings

following group life.


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S.GUTTY 5

4. UNIVERSALITY

Description

According to Yalom (2005, p6), many individuals enter therapy believing that they are

unique in wretchedness. The refutation of being isolated and unique with a particular

problem is a powerful source of relief for members. The meaning of universality to a member

of a psychotherapy group is when he/she understands that we all have problems.

Universality helps the group as a social microcosm.


1. Universality mixes with other therapeutic factors through the sessions as groupmembers become more connected with the sense of similarity.

2. This curative factor gives group members the insight that other individuals have atsome point in their lives faced similar experiences or issues.

3. Group members also find satisfaction in being listened to and by listening to others,and have a sense of belonging to the group. (Yalom, 2005).

4. Group members may feel relief by the fact that they are not alone. The sense that theirpain is not exclusive or unique and that others with similar problems are willing to

support them can be profoundly healing.

5. It helps clients move beyond their isolation, and it gives further energy to hope, whichhelps to encourage the change process.

Three ways to faci li tate Universali ty

1. In homogeneous group.Group therapy with individuals having the same problem is beneficial. This is a first

step to make them feel that they are not alone and they can share their personal

problems easily and ultimately having possible solutions.

2. Activity: Share your fearAll members in the group are asked to write about what they fear the most on a piece

of paper and put them in a box. The papers are redistributed randomly, ensuring no

one gets his/hers own writing. Some fears prove to be similar. Each member is then

asked to read aloud the anonymous secret and tell what he/she would do if it was your

fear. Some may find themselves having common fears and that they are not alone.


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S.GUTTY 6

3. Theme: The therapist can choose a specific theme that reflects on a common problem(e.g. stress). By the end of the group process, the members will find that he/she is not

alone with this particular problem.

The stage at which Universali ty is facil i tated

1. Forming stage2. Storming stage


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S.GUTTY 7

5. IMITATIVE BEHAVIOUR

Description

Members expand their personal knowledge and skills through the observation of

group members self-exploration, working through and personal development. During the

forming stage, the therapist exerts a powerful control on the communication patterns of group

members by modelling certain behaviours. For example, therapists model active listening,

giving nonjudgmental feedback, facilitating communication and interaction and offering

support. Over time, members copy these behaviours and incorporate them. Imitative

behaviour is in itself short-lived. This allows them to gain progressively more positive

feedback from others, increasing their confidence and emotional growth.


Due to imitative behaviour group members develops social skills through a modelling

process, observing and imitating the therapist and other group members. E.g. when a member

shares his/her personal feelings. Also when he/she shows concern and supports each other. It

provides an approach which helps the members to tackle problems. Therefore, it should be

facilitated so that each member can be more independent and confident.

Three ways to facil i tate Imitative behaviour

1. Activity: spinning bottle and matching characters. A bottle is spin in the middlespace by the therapist. When it stops, the bottle cap pointing the particular

member is the selected member. Therapist will give the choice of characters. The

other group members need to choose one character which suits the best to the

selected member and why.

2. Activity: Role play - Therapist writes the different characters (e.g. policeman, busdriver, and surgeon). Followed by a draw, each member will have to present

himself as the character according to his draw.

3. Question: e.g.: Can you do the same as other members in the group?

The stages at which I mitative behaviour is facil i tated

1. Forming stage2. Storming stage
http://en.wikipedia.org/wiki/Observational_learninghttp://en.wikipedia.org/wiki/Observational_learning


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S.GUTTY 8

6. GROUP COHESIVENESS

Description

Cohesiveness is a broadly defined as the result of all the forces on all members such

that they remain in the group. Members of a cohesive group feel warmth, trust and comfort

the group and a sense of belongingness. Members value the group and feel in turn that they

are valued, accepted and supported by other members. Cohesion is developed when there is

an ideal therapist client relationship. E.g. the client must be comfortable to express his

feelings. The client must be able to experience himself without threat, the therapists

unconditional positive regard and to feel and to feel an unconditional self-regard. High

cohesion is closely related to high degree of intimacy, risk taking, empathic listening and

feedback.


Belonging, acceptance, and approval are among the most important and universal of

human needs. Fitting in with our peers as children and adolescents, pledging a sorority or

fraternity as young adults, and joining a church or other social group as adults all fulfil these

basic human needs. Many people with emotional problems, however, have not experienced

success as group members. For them, group therapy may make them feel truly accepted and

valued for the first time. This can be a powerful healing factor as individuals replace their

feelings of isolation and separateness with a sense of belonging. It allows members to speak

openly of a broad array of their life concerns. Thus the group can be viewed as a social

microcosm.

Three ways to faci li tategroup cohesiveness

1. Warm up: making a big island with magazine. Therapist brings all members in theisland. Around the island there are sharks. The therapist will act as cyclones that will

take away part of the island, which is the therapist, will tear the paper. Therefore, the

group member will support each other.

2. Activity: the members make a circle by holding the hands. Therapist will try to makethem leave their other member hands. Group members work in a team with the

support of each other.

3. Activity: everyone write their secret fear in a piece of paper. Then they fold thepaper. Someone else in the group will read it and he/she will suggest ways how to


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S.GUTTY 9

overcome the fear. The other group member also comment to help the member linked

with the particular secret fear.

The stages at which group cohesiveness is facil i tated

The stage of the group where cohesiveness is facilitated are forming and storming

stage. Cohesion is not facilitated in the termination stage.

7. INTERPERSONAL LEARNING

Description

Group members achieve a greater level of self-awareness through the process of

interacting with others in the group, who give feedback on the member's behaviour and

impact on others.

There are 3 concepts which define and describe the mechanism of interpersonal learning.

i. The importance of interpersonal relationship.People need people for initial and continued survival, for socialization, for pursuit of

satisfaction. Whereas social isolation is as much a risk factor for early mortality as obvious

physical risk factors such as smoking and obesity. Thus, social connection and integration

have a positive impact on the course of serious illnesses such as cancer and AIDS.

Interpersonal distortion may occur in an interpersonal situation when one person relates to

another not on the basis of the realistic attributes of the other but on the basis of an image

existing mainly in the formers own fantasy.

ii. The corrective emotional experience.The group member is exposed under more favourable circumstances, to emotional

situations that he could not handle in the past. Therefore the member must undergo a

corrective emotional experience suitable to repair the traumatic influence of previous

experience.

iii. The group as social microcosm.Social microcosm is developed over time when the group member feel free to express

his/her feelings without restriction. The group member will interact with other members in

the same way as they interact with others in their social sphere. In the group they will create

the same interpersonal universe they have always inhabited. That is they will automatically

and inevitably begin to display their maladaptive interpersonal behaviour in the therapy

group.
http://en.wikipedia.org/wiki/Self-awarenesshttp://en.wikipedia.org/wiki/Self-awareness


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S.GUTTY 10


- It helps to develop insight in the member when he/she discovers something abouthimself/herself. (Including his/her own behaviour and motivation)

- It prevents isolation and withdrawal.- It helps understanding each other by sharing views and knowledge as well as

problems.

Three ways to faci li tate interpersonal l earning

1. Theme: Developing self-awareness.2. Discussion: - Who want totalk about his/her problem?

- Who has undergone the same situation and wants to share?

- Who wants to suggest solution for this particular problem?

3. Activity: Story telling according to situations. (Situations can be decided by therapist

or group members).

The stages at which interpersonal learning is facil itated

- Forming stage- Norming stage- Performing stage- Storming stage


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S.GUTTY 11

8. CATHARSIS

Description

Catharsis is a Greek word meaning purging of emotions and this has a cleansing effect

on the psyche (part of the mind which is responsible for ones thoughts and feelings) of an

individual. The person feels lighter after removal of the emotions.


According to S.Freud, people often have feelings and desires which are

unaccomplished or unexpressed and these feelings are suppressed within themselves.

Suppression leads to a state where the individual feels suffocated and choked and we all have

emotional discharges throughout our life.

Emotion expression has a direct connection with hope and a sense of personal

effectiveness (Yalom; 2005,p.91). Sharing of ones feelings enables him to cope and perform

effectively in his environment and have positive outcomes in his immediate surroundings.

Through disclosure of positive emotions, a positive and serene atmosphere is created.

Expression of emotions leads to a better quality of life and is beneficial for the

physiological processes. An example is expression of emotions in HIV positive men help

them to have a higher immune system and helps them to live longer than those who do not

share their grief and troubles.

We want to facilitate this curative factor as it makes group therapy more lively and

rich experience for the group members where they can relieve themselves from inner tensions

and worries. A group without catharsis would degenerate into a sterile academic exercise.

Three ways to faci l i tate Catharsis

This curative factor can be facilitated through:

1. Certain kinds of arts e.g music and singing, painting, poem writing, sculpture. Usingart to express some of the inner most feelingsthat they have trouble expressing to the

world can be a very therapeutic experience. Painting can help children express some

of their inner feelings, whether it is joy or pain. Drawing or painting a picture to

represent how they feel can often allow these children to be able to release a lot of the

inner emotion that they feel (artsz.org).


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S.GUTTY 12

2. Writing about e.g their fears: The goal of writing therapy is to provide a catharsis forpeople, and the evidence shows that this is precisely what takes place. Writing has the

potential to facilitate growth of opinions and beliefs (Elbow, 1985).

3. Talking: Talking about how we feel is really one of the most adequate ways ofexpressing feelings. It takes courage, timing, opportunity and a good listener. We can

only talk about painful emotions when we are ready to. Grief, pain and hurt can often

render us silent and encourage us to hold our feelings within. (Mental Health

Foundation)

The stage at whi ch catharsis is facil i tated

Performing stage Termination Stage. (Catharsis is possible when close bonds and cohesiveness has

been formed in the group; hence it is facilitated in late stages.)

9. EXISTENTIAL FACTOR

Description

Existential Factors mean our presence on earth as a human being, till we are alive wemust endeavour to forge our life and assume the responsibility for our survival. It deals with

self awareness and peeping into our own selves to ensure the continuity of our life.


Existential factors are essential factors which makes us realize the person we are and

some of the factors are: responsibility, will, values, courage and spirit (we have a soul). These

are the core elements of human nature. It deals with our consciousness and our interpretation

of our world. If we are able to understand the concepts which govern us, we will understand

ourselves better.

Lessons and life experiences learnt from group sessions can eventually be applied by

each group member in their individual life.

Self realization is curative as it empowers the individual with experiences and better

insight of self which he can apply to make his condition better. Unlike S.Freuds

psychoanalytical approach (we are governed by inner sexual drives and pleasure principles),existential factors lay more emphasis on profound concerns of human conditions which are


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S.GUTTY 13

death, isolation and freedom. Awareness of these conditions can be used to decrease anxiety

in an individual. Existential factors allow us to take control of our life, enable us to forge our

destiny and lead the direction of our life by making appropriate decisions using our mind.

Though we are surrounded and supported by group members, there is a point where

we alone take major decisions of our life.

Three ways to facil itate Existential F actor

1. Talking and discussion: at the end of a discussion, the members can be askedwhat you will take home today from todays session? Time is given to reflect on

the question and enable them to talk about it.

2. Existential factor mostly come unplanned and we will facilitate it when someoneshares a bad experience of his life and through discussion by allowing the

members to reflect on it.

3. Activity: Viewing a movie dealing with tragedy. At the end of the movie, thetherapist can ask questions about the tragedy or injustice that the main character

has undergone. Then, the members may give solutions to the problem by finding

alternative ways to cope with conflicting situations. This activity can make the

members realise or find ways to cope with real life situations.

The stage at which Existential F actors is facil i tated

Storming phase as at this stage there are more debates, sharing of conflicts andinterpersonal learning.

Termination Stage: after the closure, the members will be made to realize that thegroup is over and that they have to take responsibility of their life.


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S.GUTTY 14

10. ALTRUISM

Definition

It is the opportunity to help others through advice, support, suggestions and helping

others to get a better insight about themselves. The clients gain something through giving to

others.


Generally, client with mental disability often view themselves as burdens for their

family. They feel useless and have the feeling of worthlessness, that is, they feel they have

nothing more to offer to other people. These people usually lose confident in themselves and

have low self- esteem.

However, during Group Therapy, they are given the chance to be helpful to others by

different means. They can provide support, reassurance, suggestions and insight to other

members of the group. They feel very useful and their self- esteem is boosted. They gain

something through giving.

It also encourages and facilitates role versatility as clients shift between roles of help

receivers and help providers. But sometime members of the group refuse help from others as

they think that the other members are in the same situation as them so they are not really the

ones who will be able to help them and give them advice. At the end of the group session

however, some of the members really appreciate the fact that other people can understand

them and they feel less depressed about their condition. They start to accept their friends

advice and support and also give them some advice when required.

Three ways to facil i tate Al trui sm in a group therapy

1. Through activities during which the members of the group must give feedbacks aboutother members

2. Through questions which the therapists can ask, for example, how will you react ifyou were in the place of Mr. X? or what will you do if you were place in the same

situation as Mr. Y?

3. Activity: Each member makes a beautiful card, writing an encouraging sentence aboutlife. Then all members exchange their cards among themselves according to a draw

made by the therapist.


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S.GUTTY 15

The stage at which Altruism is facil i tated

- The forming phase as it will help to build more cohesion among the group members,they will be able to form a bond and maintain it.

- It can also be facilitated in the storming stage where members of the group canprovide feedbacks or suggestions and advice to members in the group who have a

conflict.

11. CORRECTIVE RECAPITULATION OF THE PRIMARY

FAMILY GROUP

DefinitionThe group therapy resembles a small family where the members shared experiences

together which are kept private and confidential. Some of them consider the other members

as parents and some as siblings. The leaders are more view as parents by the other members.

Sometimes the Group therapy is carried out with a male and a female therapy team projecting

some parental features in the Group therapy. The members experience transference during

the group therapy which provides them the opportunity to relearn and clarify distortions they

used to have in their primary family.


The members of the group tend to have the same personality they usually have in their

primary family. If they use to have the full attention of the parents at home, they will tend to

behave same towards the group leaders. Therefore they should adapt to the fact that they

cannot be the only one the therapist will focus on during the group therapy like it used to be

in individualized therapy process. During the group process these members are able toexpress their feeling when they are not given the full attention of the leaders therefore helping

them to have better insight about themselves and also through feedbacks from other members

as well. Thus familial conflicts are relived correctively.


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S.GUTTY 16

Three ways to faci li tatecorrective recapitulation of the primary family

group in a group therapy

1. It can be facilitated through activities like roleplay.2. It can also happen by asking questions like which person you appreciate the most in

the group? or which personality in the group reminds you someone close to you?

3. Drawing. However, in this session, one member decides everything for anothermember: the colour of the paper, what he must draw, its size and amongst all.

The stage at which i t is facil i tated

During the storming stage after the members had known each other, during which the

members would be working through their conflicts in the group. They will be able to express

themselves more easily and they would have a better understanding of themselves and

members of the group.

12. DEVELOPMENT OF SOCIALIZATION TECHNIQUES

Definition

It deals mainly with social learning, which is the therapeutic factor that operates in all

therapy groups. However, the way the social skills are taught depends on the type of group

therapy involved. For example; when dealing with adolescents they can be asked to do a

roleplay how they will ask someone out on a date. Therefore these social skills required for

this is taught during the roleplay.

In other groups social learning is not direct, for examples; in dynamic therapy groups,

the members learn about their maladaptive social behaviours through feedbacks from others

in the group process, for e.g., their body language.

Reasons for being therapeutic:

Sometimes clients are able to realize that they are lonely in life due to their lack of

social skills. They are able to modify these factors that hinder the development of

socialization techniques after receiving feedbacks from others in the group.

At the end of the group therapy sessions, some members of the group are able to

develop extremely good social skills, they are able to deal with their conflicts and are more


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S.GUTTY 17

understanding towards other and do not try to judge them but develop a sense of empathy for

these people.

How to facilitate this curative factor in a group therapy?

1. Through roleplay where the members are ask to do a scene in front of other groupmembers

2. Through activities where feedbacks are asked from other group members on anymembers of the group

The stages at which it is facil i tatedIn the norming and performing phase, after the conflict, the members will be more

close together as they had gone through the storm all together. It will be easier for the

members to accept these feedbacks from other members of the group.

13. CONCLUSION

The eleven curative factors elaborated in this assignment are mechanisms leading to a

change in clients life. All the curative factors must not necessarily be present at once in a

group therapy session. The therapist should facilitate the curative factors for therapeutic

benefits.

It should be noted that cohesion is the most important curative factor and the first one

that has to be built in a group therapy session. However, it should be remembered not to

facilitate this curative factor at the terminating stage.

Other curative factors are also important equally, and should be facilitated

appropriately and accordingly, depending on the group and the way the therapist want the

group to progress.


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S.GUTTY 18

14. REFERENCES

1. Anon. [online] Available from: http://www.artsz.org/. Date accessed: 18th February2011

2. Anon., 2011.Encyclopedia of Mental Health [online]. Available from:http://www.minddisorders.com/Flu-Inv/Group-therapy.html. Last accessed 2nd

March 2011

3. Anon., 2011. Time-Limited Group Therapy: Use of Psychodrama Techniques in aGroup Setting[online]. Available: http://www.addictioninfo.org/articles/691/2/Time-

Limited-Group-Therapy/Page2.html. Last accessed 27th January 2011.

4. Mental Health Foundation: Talking therapies[online], Available from:http://www.mentalhealth.org.uk/help-information/mental-health-a-z/T/talking-

therapies/. Date accessed: 18th February 2011

5. RESTIVO-LEVITT, A., ca. 1985.An Examination of Alcoholics Anonymous: TheOpen Speaker Meeting and Yaloms 11 Curative Factors[online]. Available:

http://www.angelfire.com/journal2/njca/Adrian.html. Last accessed 6th February

2011.

6. SCOTT, L., 2010. Writing as therapy [online] Available from:http://ezinearticles.com/?Writing-as-Therapy&id=322640 Date accessed: 18th

February 2011

7. YALOM, I.D & LESZCZ, M., 2005. The Theory & Practice of group Psychotherapy,5th edition. New York: Basic Books.
http://www.artsz.org/http://www.minddisorders.com/Flu-Inv/Group-therapy.htmlhttp://www.mentalhealth.org.uk/help-information/mental-health-a-z/T/talking-therapies/http://www.mentalhealth.org.uk/help-information/mental-health-a-z/T/talking-therapies/http://www.mentalhealth.org.uk/help-information/mental-health-a-z/T/talking-therapies/http://www.mentalhealth.org.uk/help-information/mental-health-a-z/T/talking-therapies/http://www.minddisorders.com/Flu-Inv/Group-therapy.htmlhttp://www.artsz.org/

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