Therapeutic Factors in Groups

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A group is a representation of the family and community to which individuals belong. Issues that emerge in a group often have origins in past and present family and community relationships. Often the dynamics of interpersonal relationships are not on a conscious level of awareness. For many, the group experience will offer the initial experience of personal insight into their relationships with others. Within the format of the group, a process occurs that is not possible in individual counselling. There are more people to relate to in a group and common issues of the human condition emerge that facilitate exploration of personal issues. Yalom proposed 11 primary factors that he viewed as being the basis of the therapeutic experience of group work: instillation of hope, universality, imparting of information, altruism, the corrective recapitulation of a family group, development of socializing techniques, imitative behaviour, interpersonal learning, group cohesiveness, catharsis, and existential factors (1995: 1).

Individuals attending a grief group have the opportunity to experience many of the above-mentioned influences. Instillation of hope occurs as members observe positive changes in each other and anticipate forward movement in their own process of bereavement. As they take risks to fully experience the pain of grief, they come to understand that the pain will not further destroy them; rather, the pain becomes a healing element. The universality of some of the common aspects of grief promotes a bonding and a sense that one is not alone in grief. However, although grief is the common denominator, initially individual differences will need attention. Members may not be experiencing the same type of death, nor the same issues. Even within a family, no two family members will have the same grief experience. The relationship each person has had with the deceased has been different, and the various perspectives discussed in Chapters 1, 2, and 3 will influence each person's grief process in a different manner. In the early, acute period of grief an individual will not feel connected to others. They believe that their grief is more painful than anyone else's, and they do not want to be compared to another's grief experience. From a philosophical perspective, one must face this aloneness, meaninglessness, and despair in isolation before one can connect with others in the universal aspects of grief. There seems to be a sense of readiness to connect with others and be part of a group six to eight weeks following a death. Before this time there are pervasive feelings of unreality, numbness, and a general desire to turn inward in one's grief. To experience a universality that promotes cohesion and a sense of belonging takes time and willingness on the part of members to risk joining with others. Many express reluctance at self-disclosure because they have believed that others would not view their issues as valid or important. Many individuals remain lonely in their grief because they believe their needs to be petty or selfish.

Early on members need to know if their individual needs will be met in a group where they view themselves as being different from others, even though they are there for similar reasons. From the first session the group is structured to foster an atmosphere and environment that assures members that their needs will be met. The promotion of universality and cohesiveness in the sessions builds hope. Those in grief together begin to rely on each other; they can begin to hope for diminished pain and new futures. They begin to learn from each other and realize that mourning will not be forever.

Members know from the first session who will be in the group. This facilitates the process of building trust and cohesiveness. As this process occurs, members begin to support each other and experience further healing from their efforts of altruism. They begin to understand that their grief is lessened by helping others in similar circumstances.

As mentioned above, members want to know if their needs will be met in this group. All have come from some type of family group, with positive and negative experiences. Many have been told by family members that they should 'get on' with their lives, or that their grief is a sign of weakness. The support group has the potential to be a corrective recapitulation of a family. Members will find someone in the group who reminds them of a family member. Thus an event that occurred many years ago within someone's family can still be experienced, cognitively and emotionally, in present time. Through the power of the experience of the group, members can address past experiences, rethink and cognitively correct them, and understand their influence on the present experiences. Connections will be made, and members may see that they are reacting to a present situation that has components which represent something in the past. Opportunities are present to practice new behaviours that can be used in real-life settings. Generally speaking, a group has the potential to become a therapeutic community, offering opportunities for support, self-exploration, insight, behaviour change, and the development of new socializing techniques. Bereaved members often express the fact that they no longer hear from old friends, or that they feel that people are avoiding them because of their grief. Within a group setting, members accept and support each other in their grief, and move together to develop new skills for socialization. One support group had four widowers, who had been totally dependent upon their wives to provide their social life. After the third session, one of the men suggested that they all meet for dinner each week before the group. He said that he had never done anything like this before, but if women could have their hen parties, men could have their rooster parties.

Groups set the stage for imitative behaviour. Members will observe how others try to cope with their grief and imitate each other's efforts. This is especially true when one comes in and reports that the pain of grief did not defeat him/her this week, and that a way had been found to cope with it. In the course of a several-session group, most members will adopt aspects of each others' ways of behaving. This illustrates interpersonal learning; that is, the group learns from each other, not just from the counsellor. Those in pain are often the best teachers for each other, as they have acutely known the experience of grief. Basic information for surviving and coping is shared on a weekly basis. This type of interpersonal learning cannot take place in individual counselling.

Group cohesiveness is one of the most therapeutic factors in a bereavement support group. Members whose worlds have been made less rich after the death of a loved one need cohesion or a sense of belonging. They all enter a group feeling shattered and bereft. The trappings of pretense and the wearing of masks are usually not part of a group experiencing deep grief. The outer layers of human defenses are cut through quicker and a sense of cohesiveness and trust is more readily built. Activities, such as sharing pictures and stories about the deceased person, promote the goals of cohesiveness. Catharsis in a group that fosters a healthy expression of emotions is an integral factor, and one that needs little facilitation. Counsellors may have to state up front that sharing tears together is encouraged, and that it is a way to build inter- and intrapersonal strength.

Lastly, consideration is given to Yalom's existential factors brought to the surface by grief. As discussed in Chapter 1, existential anxieties are part of the philosophical perspective in the loss experience. Sharing common feelings of a deep sense of aloneness and questioning the meaning of life set the stage for feelings of cohesiveness, and direct the process towards integration of the experience of loss and eventual rebuilding and resolution.

To illustrate the emotional connection among group members, the following letter reveals the personal experience of one member:

My Dear Friends,

Tonight is our last session together as a group but I hope it's not our last time together as friends. When I first came here, and for about the first four weeks, I thought I couldn't possibly continue the grief sessions, but for some unknown reason to me, I continued to come back, and now I am very sorry to see it end.

You have all reached out to me and touched my life, and through our mutual grief, we have come to know one another, and to care for one another.You have tried to help me understand the whys and have tried to show me reasons why I must go on and somehow, someday, perhaps be able to build a new and meaningful life for myself.

I will never forget your kindness and your love, our coffee breaks after the meetings, and your allowing me to share my dear and precious son with all of you. I know that if I never see some of you again on this earth, there will come a time when we shall be together with our loved ones and with each other on the other side of the mountain.

(43-year-old bereaved mother)

Following is an illustration of a semi-structured adult support group which capitalizes on Yalom's (1995) therapeutic factors.

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