Group Therapeutic Factors Research Articles

What do patients find most helpful in group treatment? Importance of group therapeutic factors in standardized psychological group treatments

IntroductionThere are numerous structured group psychological treatments (GPT), especially in the cognitive behavioral paradigm, which have proven effective. In these TPG, strategies, guidelines, knowledge, etc. are worked and, in many cases, homework is prescribed as an integral part of the treatment. A group context is also generated where people relate, generally with a similar culture, ages, mental health states and life problemsObjectivesElucidate which group therapeutic factors (GTF) are valued as most important by patients in their psychological improvement process. Know what our patients consider has helped them most in their GPT, whether the GTF or the content of the therapy (CT), conceptualized as the set of guidelines, knowledge, strategies, exercises and learning carried out with the therapists intrasession and with the material provided intersessionsMethods A total of 36 patients(mean age=51.04 (9.21)); 69.44% women (n=25); with main diagnoses (77.77%, n=28) of adaptive disorder, 6 patients of major depression (16.66%) and 2 unspecified anxiety disorders (5.55%) are included in GPT based on acceptance and commitment therapy (ACT) of Hayes’s (2012) for primary care patients, and on a treatment protocol developed in our clinical health psychology section (Segú et al. PaP 2023; 25 6-18) in long covid patients Patients are recruited and cared for in the collaboration program with the primary care centers (CPPC), n=22(61.11%), and 12 patients (38.89%) diagnosed with long covid in the specialized post-covid unit of internal medicine, and treated in the clinical health psychology section on the Hospital Clínic of Barcelona (HCB)Post-treatment evaluation is carried out using the GTF questionnaire, based on Yalom’s Q-short(1985), validated with 11 items, adapted to Spanish (Ribé et al. RAEN 2018; 38(134) 473-89). Patients rate from 1 to 10 how much they consider each FTG has helped them in their improvement processResultsThe relevance of the GTF are: Altruism(8.16), catharsis(7.61), cohesiveness(7.94), corrective recapitulation(6.15); socialization techniques (6.41); self-awareness of reality(6.65); imitative behavior(6.43); participated information(6.69), instill hope(6.39); interpersonal learning (7.07), universality(8.27).Regarding the other objective, 44.44%(n=16) consider the GTF more important than the content of the therapy in their improvement; 36.11%(n=13) equal importance; 13.88%(n=5) plus the CT and 2 consider that none of it has helped them (5.55%). Total importance CT(7.18/10) and GTF(7.44/10). The perceived help in their improvement process in the GPT(CT + GTF)=7.61/10.ConclusionsIn two structured group treatments, based on ACT, a greater percentage of patients value that the GTFs have helped them more in their improvement process than the CT. The GTFs considered most relevant were universality, altruism, cohesiveness and catharsis.Disclosure of InterestNone Declared

Using Neuroscience-informed Group Work with Children and Adolescents Affected by the Pandemic

ABSTRACT The COVID-19 pandemic has resulted in many types of disruptions from mild inconveniences to deaths. These disruptions have resulted in a host of stress responses among children and adolescents. Small group work is one way that helpers in schools and agencies can address developmental and diagnostic issues that arise. Neuroscience informs counselors understanding of stress responses and reactions in children and adolescents, as well as aids in generating activities and activating group therapeutic factors. This article describes the ways the neuroscience of pandemic stress and therapeutic factors can be used in group work with children and adolescents.

Preliminary Findings from a Collaborative Storytelling Program on Life Participation and Communication among Persons with Aphasia

ABSTRACT Aims The purpose of this study is to evaluate the outcomes of a remotely delivered collaborative storytelling program based on the TimeslipsTM approach in persons with aphasia (PWA). The program aims to improve social interaction, communication, and participation through a guided experience. Methods Six PWA of mild-moderate severity and of fluent and nonfluent types participated in the program twice a week for seven weeks. They collaboratively created 28 free-form stories from staged pictures. PWA were tested pre- and post-treatment on several validated outcome measures representing each of the Living with Aphasia: Framework for Outcome Measurement (A-FROM) domains. PWA self-rated on group therapeutic factors and program satisfaction scales. To assess the benefits of the program, the results were analysed for clinical significance (reliable change index) and meaningfulness for each of the outcome measures. Results Comparison between pre- and post-test scores yielded clinical significance among all participants on at least one A-FROM domain and most participants improved on communication confidence, functional communication, and overall language abilities. All participants’ ratings of perceived group therapeutic factors and satisfaction with the program were high. Conclusions The findings provide preliminary evidence for the effectiveness of a collaborative storytelling program for PWA. Such a program may have an important place in aphasia rehabilitation in improving psychosocial and communication deficits through engagement in creative arts. Large-scale studies with rigorous mixed-methods designs are needed to build on the present findings.

Engagement, clinical outcomes and therapeutic process in online mindfulness for psychosis groups delivered in routine care.

ObjectivesThere is growing evidence for the benefit of mindfulness‐based interventions (MBI) for people with psychosis. However, research is yet to evaluate the clinical benefit of delivering MBI groups online. We examine engagement, clinical outcomes, participant experience and therapeutic process of delivering therapy groups online in routine clinical practice.MethodsThe study used an uncontrolled pre‐post design to examine engagement, therapeutic benefits (depression, anxiety, beliefs about voices) and group process in a 12‐session online mindfulness group for individuals with a schizophrenia spectrum diagnosis with current distressing voices. Qualitative data on participant experience of online group therapy were analysed using Thematic Analysis.Results17/21 participants (81%) completed one of three consecutively run therapy groups. For completers there were significant reductions pre‐post in depression, anxiety, beliefs about voices and voice‐related negative affect, with medium to large effect sizes. There were individuals showing reliable and clinically significant improvements in each clinical outcome, and none showing reliable or clinically significant deterioriation. Participants’ rankings of the importance of different group therapeutic factors were very similar to those observed in face‐to‐face mindfulness for psychosis groups. Qualitative analysis of participant feedback identified three themes: ‘experience of online delivery’, ‘therapeutic benefits’ and ‘feeling connected to people in the group’.ConclusionsFindings in relation to therapy engagement, clinical benefits, participant experience and group process offer encouragement that online delivery of mindfulness for psychosis groups may be a useful addition to mental health services for people with distressing voices.

Interpersonal Emotion Regulation: From Research to Group Therapy.

The concept of interpersonal emotion regulation (IER) refers to a variety of processes in which emotion regulation occurs as part of live social interactions and includes, among others, also those interpersonal interactions in which individuals turn to others to be helped or to help the others in managing emotions. Although IER may be a concept of interest in group therapy, specific theoretical insights in this field appear to be missed. In this article, we firstly provide a review of IER definitions, of classifications of IER strategies, and of IER clinical conceptualizations. Afterwards, we discuss the relevance of considering IER for group therapy, both in terms of non-specific group therapeutic factors and of group therapy techniques promoting adaptive emotion regulation, underlining the potentially relevant role of IER behaviors as intrinsically involved in group experience.

Group Therapy for Patients With Medical Illness.

This article aims to review the expanding role of group psychotherapy in the treatment of individuals with medical illnesses, an area that has expanded dramatically during the past 30 years. The fundamental principles of adaptation of group therapies for specialized clinical populations are articulated. Clarity of goals and thoughtful alignment with patient interests and needs are at the heart of building a strong therapeutic alliance and potentiate the effectiveness of group therapy. This article also discusses the conceptual underpinnings of group therapies and the ways in which group therapeutic factors gain expression with these clinical populations. This article also focuses on breast cancer, in light of its clinical prominence and the development of group therapies for individuals with the disease. These therapies address clinical concerns for women along the continuum of the disease, including familial and genetic predisposition, primary breast cancer, adaptation to illness and its treatment, metastatic disease, and dealing with mortal illness.

Therapeutic Factors in a Psychiatric Group Therapy: a Preliminary Validation of Therapeutic Factors Inventory-8, Italian Version.

Several studies support group therapy effectiveness due to the activation in patients of unique psychological mechanisms defined as non-specific therapeutic factors (Therapeutic Factors-TFs), which shape the setting and, at the same time, enhance the specific group therapeutic factors. The objectives of this study were to preliminarly validate Therapeutic Factors Inventory-8 (TFI-8) Italian version and identify group therapeutic factors. In a psychiatric residential facility, a weekly psychotherapeutic group was evaluated during 1year. One scale on group process (TFI-8, Ferrara-Group Experience Scale) and three clinical scales (Brief Symptom Inventory-53, Sheehan Disability Scale, WHO Quality of Life-Bref) were administered to participating patients. Internal consistency, Exploratory Factor Analysis (EFA), convergent validity of TFI-8 were assessed. Correlations between TFI-8 and other scale scores and selected variables were pwerformed. Our sample consisted of 64 participants. TFI-8 showed good internal consistency (Chronbach's alpha = 0.84), concurrent validity with Fe-GES (Rho = 0.42, p = 0.0008). EFA highlighted a single Factor, accounting for 92% of variance. TFI-8 was not significantly related to clinical scale scores. TFI-8 Italian version proved to be a valid and reliable tool which allowed us to identify one therapeutic factor indicating relational attraction in group therapy, composed of three dimensions: infusion of hope, cohesion and social learning.

Therapeutic Factors in Equine-Facilitated Group Psychotherapy for Women Survivors of Interpersonal Violence

This study entailed a qualitative content analysis of therapeutic factors in equine-facilitated group psychotherapy (EFGP) for women trauma survivors (n = 9). Our findings indicated that instillation of hope, self-understanding, learning from interpersonal action, guidance, and acceptance frequently appeared in group members’ narratives about their most important session events. These, as well as other group therapeutic factors, manifested in unique ways specific to the EFGP format. Clinical practice implications and new directions for future research investigations are discussed within the context of designing and delivering equine-facilitated therapy groups.

Reciprocal influence of distress and group therapeutic factors in day treatment for eating disorders: A progress and process monitoring study.

Eating disorders (EDs) are chronic mental illnesses with high levels of psychological, social, and health burden. Day treatment programs (DTP) are effective group-based partial hospital models that have been used to treat EDs for several decades. However, few studies have examined the factors associated with reduced distress in ED patients who participate in DTP groups. Related to this is whether change in distress is preceded by change in positive group processes, or vice versa. In this study, we examine the reciprocal relationship between growth of group therapeutic factors and change in distress in an ED sample. Participants were patients with an ED (n = 156) who took part in a 12-week DTP at a tertiary care hospital center. On a weekly basis, patients completed progress- and process-monitoring measures. We hypothesized: (a) positive changes in distress and in group therapeutic factors across weeks of DTP and (b) a bidirectional relationship between change in distress and group therapeutic factors. We found a significant growth of group therapeutic factors and decline in distress over the 12 weeks of DTP. We also found evidence for a reciprocal relationship between change in group therapeutic factors and change in distress. Group therapists working in DTPs for patients with EDs can enhance the benefits of treatment by focusing on group therapeutic processes, which in turn reduces distress, which then acts to enhance the ability of an individual to benefit from group interactions. (PsycINFO Database Record

The circle in dance movement therapy: A literature review

The circle represents a powerful symbol with perceived characteristics of totality, wholeness and completeness. Forming a circle is used frequently in Dance Movement Therapy (DMT), emerging on several occasions during a DMT session, especially when working with the model which originated with Marian Chace. The therapeutic factors of the circle formation are fascinating but are rarely documented. This article explores the circle as a symbol and documents the ways in which DMT works with groups, by comparing the essential elements of circle DMT with group therapeutic factors. It reviews the pertinent literature on the subject and summarizes three basic elements of working within a circle, namely, containment and holding, multi-mirroring, and physical contact through the holding of hands.

Integrating Spirituality Within Yalom's Group Therapeutic Factors: A Theoretical Framework for Use With Adolescents

Integrating Spirituality Within Yalom's Group Therapeutic Factors: A Theoretical Framework for Use With Adolescents

Delivering the Treatment so That the Therapy Occurs: Enhancing the Effectiveness of Time-Limited, Manualized Group Treatments

ABSTRACTGroup therapy has been shown to be effective for treating a variety of problems, across particular treatment approaches. However, interesting questions about how group therapy helps people persist, given that little variance in client outcomes has been found to be attributable to the particular brand of therapy or treatment protocol. At the same time, treatments that are both empirically supported and efficient are in demand. Therefore, the present article reviews research related to transtheoretical constructs that can be applied to enhance the effectiveness of any short-term, manualized group therapy treatment. Specifically, research related to group therapy effectiveness, common or therapeutic factors models, group stage development theory, key interpersonal processes, and constructs from the multicultural competency literature are reviewed. Examples of how these principles might be applied in practice to a specific therapy group are also provided.

Contribution of Group Therapeutic Factors to the Outcome of Cognitive–Behavioral Therapy for Patients with Panic Disorder

BackgroundInvestigating the contribution of therapeutic factors arising from the collective nature or group therapy to treat mental disorders may help therapists maximize the outcome of therapy. Studies about the role of therapeutic factors in cognitive–behavioral group therapy (CBGT) for panic disorder (PD) patients are still scarce. ObjectivesTo identify the therapeutic factors rated as the most useful by patients during CBGT. Also, we aimed to investigate the relationship between patient rating of therapeutic factors and specific stages of CBGT. DesignNon-controlled clinical trial. MethodsA 12-session CBGT protocol was set up, covering psychoeducation, techniques for anxiety coping, cognitive restructuring, interoceptive and naturalistic exposure, and live exposure to avoidant behavior. PD symptom severity was assessed before and after the CBGT protocol. Yalom's Curative Factors Questionnaire was self-administered at the end of each session to evaluate the 12 therapeutic factors. ResultsThe sample consisted of 16 patients, who produced 192 assessments of therapeutic factors. Severity of symptoms improved at the end of CBGT, with a large effect size (>1.0). Different ratings were attributed to therapeutic factors at different phases of CBGT. Seven factors were rated as significantly helpful: altruism, interpersonal learning/input, guidance, identification, family reenactment, self-understanding, and existential factors. ConclusionsTherapeutic factors are dynamic and interdependent. Therefore, recognizing the impact of these factors during CBGT may potentially contribute to a better understanding of the therapeutic process.

Change Factors in Group Therapy: Development and Validation of a Questionnaire

While the efficacy of group therapy is sufficiently confirmed, there is a research gap concerning relevant therapeutic processes. Particularly, there is a dearth of integrative instruments that assess a broad spectrum of group therapeutic change factors. Hence, the aim of the current investigation was the validation of the newly developed "Scale for the assessment of therapeutic processes in group therapy (FEPiG)" based on Grawe's general psychotherapy and Yalom's conception of change factors in group therapy. 303 Patients (110 outpatients, 193 inpatients) participated in the study and completed the FEPiG as well as established measures concerning group processes. The outpatients additionally received established questionnaires concerning clinical symptomatology and filled out all instruments at the beginning and end of treatment. Factor analysis demonstrated an excellent factor structure of the FEPiG, which corresponded to the theoretically predicted subscales. Internal consistencies of the FEPiG were good to excellent and correlated with established process measures, which indicated convergent validity. While the FEPiG change factors subscales at the beginning of therapy were not correlated with outcome, associations between increases in change factors across the course of therapy and symptom reduction could be demonstrated.

Patient Rating of Therapeutic Factors and Response to Cognitive-Behavioral Group Therapy in Patients with Obsessive-Compulsive Disorder

Group therapy involves complex mechanisms that rely on certain therapeutic factors to promote improvement. The objective of this study was to assess patient rating of therapeutic factors during cognitive-behavioral group therapy (CBGT) and to investigate the correlation between patient rating and outcome of CBGT for the treatment of obsessive-compulsive disorder (OCD). In the present clinical trial, 15 patients participated in a 12-session CBGT protocol. Severity of symptoms was assessed before and after CBGT with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression (CGI), Hamilton Anxiety Scale (HAM-A), and Beck Depression Inventory (BDI). Yalom's Curative Factors Questionnaire was administered at the end of each session for patient rating of the usefulness of 12 therapeutic factors to treat OCD. There was a significant interaction between improvement in obsessive-compulsive symptoms and patient rating of altruism, universality, interpersonal learning input and output, family re-enactment, self-understanding, and existential factors over time. The results show that group therapeutic factors positively influence the response to CBGT in OCD patients.

Common Therapeutic Factors in Bereavement Groups

Group therapy remains a popular treatment format for individuals experiencing bereavement. Although many innovative group treatments for grief are being developed, common therapeutic factors can also contribute to outcomes. The author integrates research on group therapy processes and treatment for grief, and examines evidence regarding group therapeutic factors that may influence bereavement group outcomes. Specifically, research on therapeutic factors related to sharing and support, interpersonal learning, and meaning-making is highlighted where it has relevance to bereavement groups. Potential research examining the interactions of these processes, their effects on group functioning and outcomes, and the moderators of these effects are discussed.

Positive Psychology and Curative Community Groups: Life Satisfaction, Depression, and Group Therapeutic Factors

Yalom’s therapeutic factors are examined in the context of small quilt-making groups, revealing the presence of predominant curative factors. Additional results reveal positive well-being reported among group participants through higher life levels of satisfaction and lower levels of depression. Results of this preliminary research provide initial support for encouraging participation in community-based groups for individuals suffering from depression or among those seeking to improve life satisfaction, given the demonstrated presence of therapeutic factors and the potential to advance specific therapeutic goals.

Attachment and group psychotherapy: Introduction to a special section.

The application of attachment theory to adult psychotherapy represents a growing area of research and practice. Despite the conceptual overlap between group therapeutic factors, attachment theory, and therapeutic tasks as outlined by Bowlby (1988), there is little research on attachment functioning in group therapy. Hence, there remain substantial questions about the role of attachment theory in understanding group therapy processes and outcomes. The three studies in this special section advance the research in some of these important areas, including showing that positive changes in self-reported attachment insecurity among clients persist long after group therapy ends; attachment anxiety affects the level and rate of interpersonal learning in groups; and change in attachment to the therapy group has an impact on longer term change in individual group members' attachment. Each article also examines the impact of these attachment concepts on treatment outcomes. Numerous areas remain to be explored when it comes to the implications of attachment theory for understanding and conducting group therapy, including the conceptual and practical overlap between attachment concepts such as security and exploration with group therapeutic factors such as cohesion and interpersonal learning. The articles in this special section begin to address some of these issues related to attachment theory and its implications for group therapists.

Group psychotherapy in women with a history of sexual abuse: what did they find helpful?

To define the effects of group psychotherapy in women with a history of sexual abuse, to find possible predictors for dropout and treatment outcome rates and to find which therapeutic factors of group psychotherapy are perceived by group members to be most helpful. Sexual abuse of women is a global concern and causes many psychiatric and psychological sequelae. Group psychotherapy is one of the preferred treatment modalities. Prospective cohort study. Forty-seven women with a history of childhood and/or adulthood sexual abuse were recruited for weekly 12-session group psychotherapy. Subjects were given the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Clinician Administered Post-traumatic Stress Disorder Scale, the Dissociative Experiences Scale, the Childhood Trauma Questionnaire and the Group Therapeutic Factors Questionnaire. Re-evaluations were made after the 6th and 12th session and also at a six-month follow-up session. Group psychotherapy significantly reduced participants' levels of depression (screening/12th session mean scores, 22.45/11.10), anxiety (15.45/4.32) and symptoms of post-traumatic stress disorder (42.27/9.32), and this decline became statistically significant at the 6th session and tended to persist at the six-month follow-up. Higher levels of dissociative symptoms at baseline were associated with less response to treatment, but higher levels of attendance at group sessions. Group members rated existential factors (41.40 ± 12.39), cohesiveness (37.42 ± 8.32) and universalism (37.56 ± 7.11) as the most helpful therapeutic factors. Group psychotherapy was significantly effective in reducing levels of depression, anxiety and posttraumatic stress disorder symptoms in this sample of women. Dissociation had a significant effect on both treatment outcome and treatment adherence. For this sample of women, group psychotherapy was most helpful for reducing feelings of stigma, isolation and shame. Group psychotherapy can be used as a preferred treatment method for women from different cultural backgrounds with a history of sexual abuse.

Ethnic Identity and Social‐Cognitive Maturity in a Multicultural Group Experience

This study examined a multicultural group experience on students' (N= 94) ethnic identity development and social‐cognitive maturity. Although no differences were identified between treatment and comparison group participants, group therapeutic factors scores were predictive of ethnic identity development and social‐cognitive maturity. Implications for counselor educators and future research are discussed.