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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1. INTRODUCTION
Groups 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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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 provided by 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 done about 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.

Three ways to facilitate Imparting of information

This curative factor can be facilitated through formal learning such as: 1. Lectures The 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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2. Films Viewing 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 play Taking 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 information is facilitated

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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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 therapeutic

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 facilitate Instillation 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 Instillation of Hope is facilitated

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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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.

Reasons for being therapeutic

1. Universality mixes with other therapeutic factors through the sessions as group members become more connected with the sense of similarity. 2. This curative factor gives group members the insight that other individuals have at some 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 their pain 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, which helps to encourage the change process.

Three ways to facilitate Universality

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 fear All 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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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 Universality is facilitated

1. Forming stage 2. Storming stage

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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.

Reasons for being therapeutic

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 facilitate Imitative behaviour

1. Activity: spinning bottle and matching characters. A bottle is spin in the middle space 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, bus driver, 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 Imitative behaviour is facilitated

1. Forming stage 2. Storming stage

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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.

Reasons for being therapeutic

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 facilitate group cohesiveness

1. Warm up: making a big island with magazine. Therapist brings all members in the island. 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 make them 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 the paper. Someone else in the group will read it and he/she will suggest ways how to

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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 facilitated

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.

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Reasons for being therapeutic
It helps to develop insight in the member when he/she discovers something about himself/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 facilitate interpersonal learning

1. Theme: Developing self-awareness. 2. Discussion: - Who want to talk 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 facilitated

Forming stage Norming stage Performing stage Storming stage

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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.

Reasons for being therapeutic

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 facilitate Catharsis

This curative factor can be facilitated through: 1. Certain kinds of arts e.g music and singing, painting, poem writing, sculpture. Using art to express some of the inner most feelings that 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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2. Writing about e.g their fears: The goal of writing therapy is to provide a catharsis for people, 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 of expressing 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 which catharsis is facilitated

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 we must 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.

Reasons for being therapeutic

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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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 facilitate Existential Factor

1. Talking and discussion: at the end of a discussion, the members can be asked what 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 someone shares 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, the therapist 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 Factors is facilitated

Storming phase as at this stage there are more debates, sharing of conflicts and interpersonal learning. Termination Stage: after the closure, the members will be made to realize that the group is over and that they have to take responsibility of their life.

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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.

Reasons for being therapeutic

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 facilitate Altruism in a group therapy

1. Through activities during which the members of the group must give feedbacks about other members 2. Through questions which the therapists can ask, for example, how will you react if you 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 about life. Then all members exchange their cards among themselves according to a draw made by the therapist.

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The stage at which Altruism is facilitated
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 can provide feedbacks or suggestions and advice to members in the group who have a conflict.

11. CORRECTIVE RECAPITULATION OF THE PRIMARY FAMILY GROUP

Definition
The 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.

Reasons for being therapeutic

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 to express 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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Three ways to facilitate corrective recapitulation of the primary family group in a group therapy
1. It can be facilitated through activities like role play. 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 another member: the colour of the paper, what he must draw, its size and amongst all.

The stage at which it is facilitated

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 role- play. 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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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 role- play where the members are ask to do a scene in front of other group members 2. Through activities where feedbacks are asked from other group members on any members of the group

The stages at which it is facilitated

In 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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14. REFERENCES
1. Anon. [online] Available from: http://www.artsz.org/. Date accessed: 18th February 2011

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 a Group Setting[online]. Available: http://www.addictioninfo.org/articles/691/2/TimeLimited-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/talkingtherapies/. Date accessed: 18th February 2011

5. RESTIVO-LEVITT, A., ca. 1985. An Examination of Alcoholics Anonymous: The Open 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.

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