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Structuring the process helps at the early stage of the group to decrease the premature drop-out (Morran, Stockton, & Whittingham, 2004; Nitza, 2014), by providing realistic information before therapy started, about what the intervention will be like, information among assessment and progress, duration and recovery expectations off positive and negative courses of change are important, which develop security to build the framework (Swift, Greenberg, Whipple, & Kominiak, 2012), this benefits to find individual motivations and needs to formulate group goals (Shechtman, Vogel, & Maman, 2010).
The members will have similar problems to be useful to each other, with the ability to communicate and interrelate (Kenny, Mannetti, Pierro, Livi, & Kashy, 2002). Not all individuals are prepared to join group-therapy; individuals with attachment-avoidant type personality could not be appropriate (Shechtman, et al., 2004; 2006). Context creates boundaries and built up rules for structure, consistency, and predictability. Therapists in group-therapy remained central for alliance at all periods, but for cohesion just in the intermediate stage (Bakali, Wilberg, Hagtvet, &Lorentzen, 2010).
The leader influences will decline as group member communication progresses. Nevertheless, cohesion must be understood as an individual level (Taube-Schiff, Suvak, Antony, Bieling, & McCabe, 2007), groups with solid cohesion are more predictable to have robust attendance, participation, and mutual support, with a significant connotation of the client’s outcome improvements and decrease psychological symptoms (Lorentzen, Sexton, & Høglend, 2004).
Identification is one main dynamic, where members will interiorise aspects of the therapist’s behaviour, values, and vision as a mirror, which would create alternative choices to archive their goals. This value defines and gives the overall flow of the group.
Supporting the idea of values and uniqueness of each member promotes their responsibility for the quality of the group. The group experiences partake the group’s energy to facilitate the likelihood of share and work together in a safe environment. Therapist work in the interest of each member but in the group context. The process transgresses all members adjusting them individually (Foulkes, 1973). Transference and counter-transference conceal the distortion and complexity of interrelationships (parent–child relationships and sibling dynamics) which affects the relationship between therapist and members and within-group members. The effectiveness of group therapy takes carefully and constantly these dynamics to analyse individual engagements (Moser, Jones, Zaorski, Mirsalimi, & Luchner, 2005). Transference usually reacted more frequently in the group that in individual therapy (Mullan, 1955). If members had the feeling of been listened or understood, and trust by the therapist and by the other’s members facilitate to express feelings that they were unconscious or will retain them to themselves, dealing with what is really happening within the group; the here and now boosts to look what and how occurs, by naming and expressing their feelings on how has affected them; will bring the opportunity to observe on their own experienced group life and give meaning from the therapeutic process as a mediator of creating new strategies.
The group will move to different phases of inclusion leading group-as-a-whole phenomena, which will have a predisposition of caring group standards (Connors, & Caple, 2005). Nonetheless, individualism is preserved in some amount to give an equilibrium of the demands but also adjusted to the social context (Herbert-Read, et al., 2013). The members are very close tangled in the life of the group, members might have been part of the conflict, compelling decisions, and resolutions, which fluctuated by experiencing; gratification, exasperation, eager, tedious, painful or happiness. By moving too fast into actions, techniques, or painful experiences and emotions, participants are at risk of becoming overwhelmed, susceptible to quit prematurely, to minimise this, is important monitoring treatment outcomes regularly, Swift, et al., (2012) propose to use outcome measures, that clinicians can detect which members are not progressing or failing before they decide to finish treatment. A positive opportunity to evaluate the group is continually engaging the group as a co-worker to transfer the member’s experiences in the group and reflect what they are taking from the group. At the end of the session is also important to contextualise the session, and notice if there are some unfinished issue that can go on agenda for the next meeting to bridge safety outside life (Benson, 2009).
There are therapeutic elements that provide the success of treatment called the therapeutic factors, which can be defined as a sequence of unique elements that bring change in symptoms, behaviour, and personality, Yalom (1970, 1975) labelled 12-factors , this has been the subject of several studies, findings showed that the perceived importance of therapeutic factors is empirically inconsistent with respect to the patients’ inclinations and the different phases of treatment (Ahmed, Abolmagd, Rakhawy, Erfan, & Mamdouh, 2010; Garcia-Cabeza & Gonzalez de Chavez, 2009; Vlastelica, Pavlovic, & Urlic, 2003). Pan and Lin, (2004) highlighted the problems in recognizing, describing, and distinguishing the therapeutic factors, the identification on the effect of therapist and client outcome, the therapeutics influences variables, the reliance and validity on self-report and inadequate measurements. Nonetheless, criticism has been base on the lack of reliable and valid measures of psychotherapist competence reflected in the quality of treatments replicated on the inconsistent data (Fairburn and Cooper, 2011, Muse and McManus, 2013; Perepletchikova and Kazdin, (2007). Brown, et al., (2013) suggested the importance of given adequate training and supervision to ensure therapist competence. Leach, et al., (2008) offered a hierarchical, multi-component model of in-group identification within two dimensions; the group-level self-definition (i.e., individual self-stereotyping, in-group homogeneity) and the self-investment (solidarity, satisfaction, and centrality) to be a central factor of the group and inter-group dynamics, which let to analyses of individual experiences and response to a specific group and intergroup contexts, this measure has high-reliability validity (Postmes, Haslam, & Jans, 2013; Souza, Lima, Maia, Fontenele, & Lins, 2019) to become more useful in future research.
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