group; closed groups admit no new members once
the group has begun to function. Issues of confi-
dentiality in group therapy can be important. In
explaining group arrangements and “rules” to
group members, the therapist may find it necessary
to state that, although all members should maintain
the confidentiality of the sessions, no final guaran-
tees can be offered (see the case illustration earlier in
the chapter).
The Curative Factors
The diversity of group approaches is apparent. Yet
underlying all of them are common threads that
speak to the utility of group therapy. Yalom
(1975) has specified a set of curative factors that
seems to define the essence of what these group
methods offer:
- Imparting information. Group members can
receive advice and guidance not just from the
therapist but also from other group members. - Instilling hope. Observing others who have
successfully grappled with problems helps to
instill hope—a necessary ingredient for any
successful therapy experience. - Universality. Listening to others, one discovers
that he or she has the same problems, fears, and
concerns. Knowing that one is not alone can
be highly rewarding. - Altruism. In the beginning, a group member
often feels useless and demoralized. As it
becomes apparent that one can help others in
the group, a feeling of greater self-value and
competence emerges. - Interpersonal learning. Interacting with others in
the group can teach one about interpersonal
relationships, social skills, sensitivity to others,
resolution of conflicts, and so on. - Imitative behavior. Watching and listening to
others can lead to the modeling of more useful
behaviors. Group members learn from one
another. - Corrective recapitulation of the primary family. The
group context can help clients understand and
resolve problems related to family members.
The effects of past family experiences can be
dissolved by learning that maladaptive coping
methods will not work in the present group
situation.- Catharsis. Learning how to express feelings
about others in the group in an honest, open
way builds a capacity for mutual trust and
understanding. - Group cohesiveness. Group members become a
tightly knit little group that enhances self-
esteem through group acceptance.
Does Group Therapy Work?
Reviews of the research literature assessing the effi-
cacy of group psychotherapy consistently conclude
that group treatment is more effective than no
treatment (e.g., Burlingame et al., 2004). This is
particularly true for adults and youth with diagnoses
of panic disorder, social phobia, or eating disorders
and for those treated with cognitive-behavioral
group therapy. However, group treatments do not
appear to be anymoreeffective than other forms of
psychotherapy (Burlingame et al., 2004). The major
advantage of group therapy is that it is more effi-
cient and more economical, especially the time-
limited group treatments.
In general, research on group therapy has not
advanced much beyond answering the general ques-
tion of overall effectiveness (Bednar & Kaul, 1994;
Riva & Smith, 1997). However, some believe that
evidence is mounting to showthe differential effec-
tiveness of certain group models of treatment in dif-
ferent psychological disorders (Burlingame et al.,
2004). Although theorists such as Yalom have pro-
posed a variety of“curative factors”or other variables
that may influence outcome in group treatment (e.g.,
group leadership style, the necessity of pregroup
training), relatively few studies have been conducted
that critically examine the effect of these factors. The
studies that have been completed are plagued with a
number of conceptual and methodological problems.
Clearly, more research investigating the process of
group psychotherapy and the proposed curativeGROUP THERAPY, FAMILY THERAPY, AND COUPLES THERAPY 439