Irving Yalom's Therapeutic Factors of Group Therapy

Prenatal and Perinatal group process is built on some of the same theoretical principles as conventional group therapy, such as group configuration, creating and maintaining group safety, transference and counter transference. Some of the differences and similarities in conventional groups and pre-and perinatal groups are highlighted and summarized here.

Conventional groups are generally groups of adults who meet with a therapist for the purpose of personal growth. Groups may have a focus, such as loss, a particular disorder or simply to experience improvement in social skills or managing everyday life. Most conventional groups are guided by a therapist but the real work is among the members mutual interactions. Gestalt-oriented groups are a noted exception in that the therapist facilitates one-on-one work with the support of the group. A pre-and perinatal group is similar to a Gestalt group in that the therapist works one-on-one with an individual with group support. A pre-and perinatal group brings together people who want to make changes in their current lives, just as in conventional groups. The focus of the pre-and perinatal group, however, is the exploration of earliest experiences and core imprints.

To begin, let's look at the factors of group psychotherapy that Irving Yalom (1995) calls therapeutic factors and see how they apply to the pre- and perinatal group therapy process.

1. Instillation of Hope. Members of conventional groups often find hope as they discover commonalties and focus on solutions to current problems. The pre-and perinatal group seems to take this to another level as clients explore their earliest experiences and re-experience, re-pattern and reprogram at visceral and cellular levels. Because we create beliefs and make decisions about ourselves and our world at such an early stage of development, we often feel hopeless and helpless, just as we did in the very early experiences. (McCarty, 2002) We may feel stuck, hopeless that things will ever change, that help will ever come and helpless to change things ourselves. These feelings are from the more primal centers of the brain that do not know time and sequence. Therefore, when familiar unpleasant sensations emerge, the feeling of hopelessness often arises. Within the somatically-oriented group context, there are more opportunities for what Allan Schore (1994) calls right brain to right brain synchronization, which can help move one from despair to hope. Like conventional groups, in a pre-and perinatal group, clients get a sense that they are not alone, others have had similar experiences and "lived through them". They often find a role model for a certain aspect of their process that gives them hope. Because much of the pre-and perinatal work has a somatic focus, they also begin to experience in their bodies that they are not stuck, hopeless or helpless as they (literally) move through their process and discover and utilize their internal resources. Hope also naturally comes as we move from external support to self-support in a healthy way.

2. Universality. Many people believe their situations are unique and they feel alone in their fears and fantasies. Conventional group therapy helps dispel this as clients learn that others are having similar experiences. Pre-and perinatal group therapy is often able to create an experience of universality and add a deeper level. Because our earliest experiences are before we have a sense of separateness or a sense of self - we are merged with our environment - we imagine we are alone. In a pre-and perinatal group, we can understand the roots of our early beliefs and how universal they are. From an adult perspective, we have an opportunity to witness the little one who created these self-defeating, albeit survival, self-beliefs and change them.

3. Imparting of Information. In many conventional groups clients garner information about their malady and their recovery within the group setting. In pre-and perinatal groups, most of the imparting of information is implicit and experiential. It is body based, a kind of "learning from the inside out." Because knowledge of the pre-and perinatal period is fairly new to most people, some information is given through brief explanation, experiencing and witnessing of various processes. Information is also given in service of orienting and creating safety. ''

4. Altruism. In the pre-and perinatal group, each member becomes a vital part of every member's process. It is a good opportunity to learn appropriate helping and giving as well as appropriate boundaries.

5. The corrective recapitulation of the primary family group. Probably more pronounced and articulated than any other type of group, the pre-and perinatal group embodies various aspects of one's family of origin. It is also a corrective, or positive experience of belonging, supporting and receiving support, of seeing and being seen, of claiming one's turn and supporting others to have their turn. Small behaviors such as orienting, attention, mirroring, and slowing the pace help this process, as well.

6. Development of socializing techniques.' Yalom states that groups are a place you can be with others, listen, and talk to others. A pre-and perinatal group also encourages clients to become aware of and hold boundaries, take risks in styles and modes of communication as well as learn to give and receive safe and appropriate touch.

7. Imitative behavior. Yalom believes that groups allow one to try behaviors they have witnessed in others with the thought, "maybe it will also work for me". We know that babies learn by imitation. In the pre-and perinatal group, the pace is such that small movements, behaviors, innuendoes, things that might otherwise be missed can be made conscious, experienced and integrated into one's life.

8. Interpersonal learning. Yalom says that interpersonal learning is a major curative factor. We learn that life doesn't always unfold as expected, that others are dealing with similar issues and we see other options for behavior. A pre-and perinatal group is definitely an interpersonal learning experience. I would add that the pre-and perinatal group is also an intrapersonal learning experience. We understand the origin of current maladaptive behaviors and life long patterns. We also discover our wants and needs and we learn to formulate and work with an intention. This is much more than cognitive learning. We connect with and follow sensation and learn from moving our bodies, just as we did as infants. One of the most important learnings is to come from an impulse inside the body, inside the self. This is a powerful intrapersonal learning that often leads to transformation of unwanted patterns and behaviors.

9. Group cohesiveness. Yalom states that being with a group once a week may instill a capacity of being with a group. Certainly a pre-and perinatal group instills a sense of belonging, of group decision-making and cohesiveness. This can easily transfer to groups in the context of daily life.

10. Catharsis. Yalom writes about the client being able to vent and explore feelings and gain relief from having expressed them. I would add the importance of connected catharsis, not just emotional expression for the sake of catharsis. This is explored in more detail below.