The instillation and the maintaining of hope is one of the most important factors in any type of psychotherapy (Yalom 2005). Yalom (2005) notes that hope is needed to keep the patient going to therapy in order for the other factors to take place, and "faith in treatment mode can in itself be therapeutically effective" (2005). Yalom (2005) compares the importance of the instillation of hope to the efficacy of faith healing and placebo treatment in order to show just how powerful it can be. When a therapist uses this knowledge to their advantage, increasing patients' belief and confidence in the efficacy of the group therapy, great results can take place for the patient.
Yalom (2005) states in group therapy, there are individuals -- often who have the same problem -- at different points in their healing or recovery process; however, Yalom, attests that when individuals can watch others grow and learn, it is hopeful for their own recovery. This is where the "installation of hope" (2005) comes from. Thinking of group such as Alcoholics Anonymous or other types of support groups, watching others struggle and grow and learning from more "senior" level members can offer hope to new and perhaps skeptical individuals who aren't yet filled with hope.
Alcoholics Anonymous is the fact that the leaders are all ex-alcoholics -- living inspirations to the others. Similarly, substance-abuse treatment programs commonly mobilize hope in patients by using recovered drug addicts as group leaders. Members are inspired and expectations raised by contact with those who have trod the same path and found the way back (Yalom 2005).
The emphasis of the approach, on a somewhat detached leader who serves as a "conductor" of the group and limits its participation only to group-as-a-whole interpretations has ended in the abandonment of the Tavistock approach for group psychotherapy (Yalom 2005). When leaders are people who have "trod the same path" (2005), for example, they are making themselves out to be role models -- they are playing the role of survivor and thus instilling hope into the more skeptical or struggling members of the group.
Yalom focused on the importance of group cohesiveness, which he saw as the attraction between group members. He believed that groups should meet twice a week in order stay on top of the group situation but without overwhelming the individuals. He thought that a group of seven members was a perfect number, with fewer people if the group is a shorter session or more members if the group is a longer session. He believed that the group should interact face-to-face, sitting around a table or in a circle with the middle space empty. He thought that group members had two basic tasks at hand: the assigned task and the social interactions to complete the task.
Yalom believed that groups go through a sort of honeymoon period in the beginning of their meetings, and then followed by disenchantment, eventually leading to cohesiveness as a group. "Early provocateurs" (Yalom 2005) challenge the group leader and then leave. He notes that approximately ten to thirty-percent of the members of a psychotherapy group leave altogether by the twentieth session. There are also certain subgroups that can form alliances, threatening the cohesiveness of the group as a whole. An example of this would be a love affair or even a very special friendship that is formed between two group members, making other people in the group feel left out. Yalom also believed that conflict wasn't necessarily a bad thing in a psychotherapy group setting. In fact, he believed that conflict could encourage passion and growth in individuals. If one member is acting out rather aggressively, it can bring other individuals together,...
Yalom (2005) notes that at the end of group therapy, people often talk about how important it was to hear the others in the group -- that it was a key element in their own therapeutic process. When new members of group therapy come in, perhaps skeptical of the whole process, older members are often very important in keeping those people coming back to the group -- as they are sort of witnesses to the efficacy of group therapy success.
Keyton and Beck (2009) note that relational communication if often neglected in group interaction research and their study focuses on the need for a "refocusing" on group communication. Effective group communication can transform a group, helping it move through different phases of its development. Yalom's (2005) third therapeutic factor, imparting information, is a good example of this. He notes that many self-help groups emphasize the imparting of information aspect (groups such as Adult Survivors of Incest, Parents Anonymous, Gamblers Anonymous, Make Today Count, Parents Without Partners, and Mended Hearts). Communication can also come in the form of inviting leaders in to talk to the group and give information that can perhaps help to quell any irrational fears that individuals may be having. This can be especially true in groups such as HIV / AIDS groups where people need real information -- medical information about what is happening to their bodies, etc. While it is also important for the group to talk about the emotions that go along with the illness, knowing what to expect is also a very important part of coping with fears. Another example, according to Yalom (2005) would be for groups of young women who are experiencing pregnancy for the first time.
Yalom (2005) notes that unlike more didactic instruction that can come from a therapist, direct advice from members in a group occurs without exception in every single therapy group. Different people in the group respond in different ways to advice from others. Yalom (2005) asserts that he can estimate the age of a group by listening to the types of advice given. That aside, he states that advice-giving or seeking is a very important clue in the clarification of interpersonal pathology (2005).
Both Bion and Yalom have shaped the way that we think about group therapy and the dynamics that go along with it. Both of their theories of group behavior in small group settings has gone on to stimulate more conversation on the topic. Yalom's (2005) "therapeutic factors" have been found to operation in all types of group interactional settings. They have come to be representative of particular mechanisms of change that work in different types of groups. Likewise, Bion's three basic assumptions of groups has become a universal aspect of human psychology.
