The Theory and Practice of Group Psychotherapy

By Irvin D. Yalom | Go to book overview

CHAPTER 4
The Therapeutic Factors:
An Integration

The inquiry into the therapeutic factors in group therapy began with the rationale that the delineation of these factors would lead to the development of systematic guidelines for the tactics and strategy of the therapist. The compendium of therapeutic factors presented in chapter 1 is, I believe, comprehensive but is not yet in a form that has great clinical applicability. For one thing, the factors have, for the sake of clarity, been considered as separate entities when in fact they are intricately interdependent.

I have taken the therapy process apart to examine it and am now obliged to put it back together again. One question I will consider in this chapter is: How do the therapeutic factors operate when they are viewed not separately but as part of a dynamic process? A second issue to be considered is the comparative potency of the therapeutic factors. Obviously, not all are of equal value. However, an absolute rank-ordering of therapeutic factors is not possible. Many contingencies must be considered. The importance of various therapeutic factors depends upon the type of group therapy practiced. Groups with differing clinical populations and therapeutic goals (for example, ongoing outpatient groups, brief therapy groups, inpatient groups, partial hospitalization groups, eating disorders groups, panic disorders groups) may emphasize different clusters of therapeutic factors. Some therapeutic factors are important at one stage of a group, whereas others predominate at another. Even within the same group, different patients benefit from different therapeutic factors; patients may relate to the pool of group therapeutic resources as to a cafeteria: depending upon their needs, their social skills, their character structure, they select their menu of therapeutic factors.

Lastly, some factors are not always independent mechanisms of change but

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