There are several names mentioned when studying therapeutic models in psychology, though often the models are specifically outlined for individual counseling use (Ginsberg, 2018). Throughout studies of individual psychology and prevalence of need for support, the idea of group therapy has become a more prominent type of treatment that allows individuals to share their experiences and gain insight from others, rather than developing a therapeutic bond with a singular therapist (Crits-Christoph et al., 2013). When considering therapeutic techniques in a group setting, Irvin Yalom has developed quite a name for himself for various reasons. Yalom is namely the person that wrote definitive principles for techniques in group therapy, and is well known for his works and contributions towards the psychotherapeutic process (Ginsberg, 2018). With the support of his contributions, group therapy has become extremely important in the therapeutic process, as many people are able to benefit from attending social settings and the opportunity to interact with others that relate to what they are experiencing (Ginsberg, 2018). This success of treatment has made the process of group therapy increasingly popular over the last few decades, with the increasing need for treatment as substance use disorders have become more prevalent (Crits-Christoph et al., 2013). There are several processes within group therapy that can be highlighted to attribute to the successes of the model in substance abuse treatment (Ginsberg, 2018). Yalom introduced eleven therapeutic factors to highlight specific individual experiences and explain the efficacy of group therapy.

            In developing an understanding of efficacy and effectiveness in group counseling, Yalom named eleven therapeutic factors to explain the inner workings of group therapy. The eleven factors are as follows: instillation of hope, universality, imparting information, altruism, corrective recapitulation of the primary family group, development of socializing techniques, imitative behaviors, interpersonal learning, group cohesiveness, catharsis, and existential factors (Yalom, 2013). These factors attribute to what Yalom was able to observe in facilitation and observation of group therapy, and allows for the ideology that there are developed emotional coping mechanisms through thorough explanation of each factor, or introduction of understanding differing viewpoints as therapeutic processes are not meant to be strictly the same for each individual (Ginsberg, 2018).

This leads to the introductory factor, instillation of hope. Clients often come to treatment settings feeling a lack of purpose, defeated by life and their addictions, or overwhelmed by the state their life is currently in and feel there is no possibility of reconciliation to have a “better” life (Ginsberg, 2018). When an individual is allowed to interact with others that are struggling with similar concerns, or have struggled with similar concerns and are currently in the process of recovering, he or she is able to recognize that change is possible, thus instilling hope for prospective solutions (Yalom, 2013). There are also several techniques introduced to specifically relate to those in substance abuse treatment, including visualization exercises similar to the “miracle question” in which the clients are asked to imagine a life without the preceding problem, though this is done tactfully based on the clientele (Crits-Christoph et al., 2013). For example, the constraint may have to include the importance of picturing life without the concerning substance and promoting abstinence-based recovery rather than moderation management (Crits-Christoph et al., 2013). One of the preceding problems in substance abuse treatment is the justification of use based on functionality, and the idea that one develops such a tolerance they cannot see life without use of the substance (Yalom, 2013). This delves into the idea that if a client cannot picture life without substances, he or she could begin a downward spiral of shaming and blaming self, or feeling as though he or she is a failure in recovery (Crits-Christoph et al., 2013). Though this factor is extremely successful with alternative disorders, it is apparent that in the case of substance abuse disorders instillation of hope is suggested and guided by the facilitator more closely than that of other disorders (Ginsberg, 2018).

The next introduced factor is universality, in which it is explained that while in group each individual is introduced to other individuals that are facing or have faced similar concerns in their life, and the idea of having some common ground with others becomes very comforting (Yalom, 2013). Individuals diagnosed with a substance abuse disorder often find themselves feeling severe isolation, and an unfamiliarity in the lives they have built based on the need for use and abuse of substances, even if their social environment revolves around such activities (Crits-Christoph et al., 2013). For example, one could have been raised in an environment where use and abuse of substances was routine, leading to an adult life of substance use and abuse consistently happening within one’s familial relationships and interpersonal relationships (Crits-Christoph et al., 2013). While the individual may be surrounded, the sense of feeling secondary to use and abuse of substances is prevalent in these relationships, there is a lack of connection and a sense of feeling inferior (Crits-Christoph et al., 2013). In group counseling, the members are able to share their experiences and often gain a sense of support due to the idea that others are struggling with similar issues and are willing to offer support or motivation to move past their isolation, which can motivate willingness to change (Ginsberg, 2018).

The third mentioned factor is imparting information, or the idea that one exchanges information in a group setting that is personal and tends to be meant as motivational sharing. One can share their current struggles, and in congruence clients from the group will then impart information to motivate the client, discuss coping mechanisms they used previously, or offer advice and encouragement to instill positivity towards change and avoid feelings of hopelessness, which can also cause regression in treatment (Crits-Christoph et al., 2013). Shared success in group work can implement more success, or motivation to succeed in recovery (Yalom, 2013).

The fourth mentioned factor is altruism, which is attributed to the idea that humans desire to help other humans in a time of need. While substance abuse disorders often present a sense of isolation, in turn this can contribute to a lack of regard for others (Crits-Christoph et al., 2013). This includes focusing on one’s own concerns and not reaching out to others for help, especially those that are willing and able to help. An example of this would be an individual struggling with opioid addiction and currently has a seemingly great support system available of family members that do not have a substance abuse disorder and virtually no experience with use of substances in general (Yalom, 2013). While an outsider perspective may question the recovering individual’s feeling of isolation, altruism works as an explanation and solution for such ideologies. Group therapy is meant to offer group members an opportunity to seek assistance or insight in addition to reciprocate received assistance and insight (Crits-Christoph et al., 2013). A group facilitator would praise group members in these instances, and promote a sense of motivation through remaining in support of each other (Ginsberg, 2018). This creates a sense of purpose within the group, and facilitates positive changes to self-esteem and self-efficacy which were previously diminished prior to beginning group therapy.

The fifth concept is named as corrective recapitulation of the primary family group. Ni which a client is able to relate to other group members as if they were family members they have struggled with in the past (Crits-Christoph et al., 2013). While this is seen as a projection, often this is beneficial to the learning process of how to cope in these difficult relationship dynamics (Crits-Christoph et al., 2013). The clients can develop mechanisms to avoid dysfunctional patterns of behavior and interactions, in addition to healing as a surrogate family for the time being in group (Crits-Christoph et al., 2013). This is beneficial in comparison with individual therapy as the focus is not specifically directed, but rather spread throughout the group systematics and allows for multiple interactions rather than just one therapist-client relationship, without the prevalence of mimicking those interactions with family members other than with role playing, a technique often used in individual counseling to have the same effect (Yalom, 2013).

The sixth concept defined by Yalom is development of socializing techniques, in which the facilitator needs to emphasize the group experience of teaching basic social skills, and delving beyond the social constructs of self in relation to those that use and abuse substances (Crits-Christoph et al., 2013). Similarly, one is made aware of the learned behaviors developed in substance use, and can foster more meaningful interpersonal relationships with fellow group members based on this commonality, and need for re-learning socialization techniques. This leads into the seventh concept, defined as imitative behavior. The client is able to imitate the facilitator’s behavior, or even behaviors of other group members that are further along in their recovery process than others (Crits-Christoph et al., 2013). The clients are able to view modeling of responses to difficult situations and dealing with emotions without utilizing coping mechanisms that are trying to be avoided, including drug use or outbursts of explosive anger (Yalom, 2013). This is extremely important when rolling admission to the group, and allowing new group members to join when some of the group members have been participating for some time. This sways the dynamic to mimic the mock-family aspect, in which the facilitator is seen as a “parental figure”, and the clients are in turn asked to develop coping mechanisms and gain a sense of self in regards to recovery (Crits-Christoph et al., 2013).

The next mentioned factor is interpersonal learning, in which as mentioned previously, group therapy provides an opportunity to mimic, practice, and role play interpersonal relationships. This allows for a sense of honesty in oneself and with others, which can often be the first opportunity of true honesty in an interpersonal relationship for clients in substance abuse treatment (Crits-Christoph et al., 2013). This allows for a shift towards change, and development that change in interpersonal relationships can be possible to develop more positive relationships with others, which is often lost on individuals in substance abuse counseling when beginning treatment (Yalom, 2013). This leads to group cohesiveness, in which one is able to develop a sense of belonging within oneself, and in regards to the rest of the group. For example, it is seen that when developing through all of these therapeutic factors, and applying techniques to develop interpersonal relationships and respond in difficult situations, it is apparent that one is able to feel a sense of stability and safety within the group and develop further in their desired change (Ginsberg, 2018). The sense of self in relation to belonging with others is often a comforting phenomenon that many in substance abuse treatment have not previously felt, and would not be able to develop as quickly in individual counseling models. One is often able to gain insights from interactions with others, or are able to develop a sense of understanding for conscious efforts to change behavior and practicing behaviors in group (Crits-Christoph et al., 2013). These realizations can enhance an understanding for the change that is taking place for an individual, thus highlighting motivation to continue change. These realizations of change can often spark releases of intense emotion that are associated with pre-existing traumas and psychological detriments (Crits-Christoph et al., 2013). The goal of group therapy is to promote a safe environment for members to share their inner-workings, regardless of the prospective outcome because positive and appropriate feedback is enforced. Catharsis is meant to be required, and act as a release for members of the group to safely express without fear of judgement in order to prevent possible relapse from past psychological wounds being revisited (Yalom, 2013). The idea behind this is to promote expression, and acknowledge with acceptance in order to promote group therapy as an agent of change (Crits-Christoph et al., 2013). This leads to the final mentioned factor as existential factors, which attributes to issues such as loss or death that come up within group and the ideology that one is in control of his or her own life, and must accept the happenings around them as learning processes. This is particularly relevant to substance abuse treatment because it promotes an idea of accountability, and practicing the learned behaviors from group in situations of heightened or unexpected emotions without allowing one to blame surrounding factors or not take accountability for oneself (Crits-Christoph et al., 2013). This can be attributed to the previously mentioned learned factors in group therapy, and the application of these factors to life outside the group.

Concluding Thoughts

            Irvin Yalom spent the bulk of his career developing therapeutic understanding of group therapy, and is known for his accuracy and observance of the innerworkings of group technique (Yalom, 2013). Yalom highlighted eleven therapeutic factors in relation to group therapy, to outline the efficacy and purpose of facilitator technique within the groups. While applicable in varying situations, the eleven factors are especially helpful in the substance abuse field in order for one to develop a sense of need for recovery, and mimic interpersonal relationships to develop a sense of life without substance abuse (Ginsberg, 2018). While each of the eleven therapeutic factors are important as individual techniques, it is important to highlight the necessity to implement each factor as a unit with the entirety of the proposed factors rather than cherry-picking to best fit the needs of one’s specific group (Crits-Christoph et al., 2013). Facilitators are meant to act as the agent of change in one’s recovery, and with that comes a great deal of responsibility to promote self-efficacy in the most self-proclaimed powerless individuals, given that substance abuse disorders develop extreme feelings of worthlessness and isolation (Crits-Christoph et al., 2013). Yalom’s eleven therapeutic factors are vital in development of group therapy for individuals diagnosed with substance abuse disorders, and often can be seen as the best treatment course for many presenting with substance use concerns (Yalom, 2013).

References

Crits-Christoph, P., Johnson, J. E., Connolly Gibbons, M. B., & Gallop, R. (2013). Process predictors of the outcome of group drug counseling. Journal of Consulting and Clinical Psychology, 81(1), 23–34. https://doi.org/10.1037/a0030101

Ginsberg, R. (2018). Group therapy and support in addiction treatment. Oxford Medicine Online. https://doi.org/10.1093/med/9780190275334.003.0028

Yalom, V. J. (2013). Recruiting, selecting, and preparing patients for Interpersonal Group psychotherapy. Psychologists' Desk Reference, 357–361. https://doi.org/10.1093/med:psych/9780199845491.003.0074