CMA Week 5 Response
Irvin Yalom’s therapeutic factors remain central to group therapy, with universality and group cohesiveness standing out as particularly influential. Universality helps members recognize their shared struggles and realize that they are not alone and subsequently overcome shame and become more open and receptive to therapy (Papastylianou & Travasaros, 2024). Studies indicate that when participants identify common experiences, they report less selfstigma and greater willingness to engage in therapy (Ferizaj et al., 2025). Even simple affirmations like “me too” or “I feel the same” can close the gap of isolation and blur the line between vulnerability and humanity (Ferizaj et al., 2025; Lee et al., 2021; Papastylianou & Travasaros, 2024).
Group cohesiveness builds upon this foundation by fostering trust and emotional safety. Cohesion in group therapy is often compared to the therapeutic alliance in individual therapy, and it strongly predicts positive outcomes (Papastylianou & Travasaros, 2024). Cohesive groups encourage risktaking, disclosure, and feedback, which deepen therapeutic work. However, cohesion can also have drawbacks. If subgroups form or certain voices dominate, marginalized members may feel excluded, which undermines the collective bond (Lee et al., 2021).
These factors are broadly applicable across outpatient, inpatient, and recovery settings, but challenges arise in diverse groups where cultural differences, communication styles, and stigma may complicate universality and cohesion (Lee et al., 2021). Therapists can use several interventions to address these barriers. For instance, connecting activities at the beginning of a session, such as icebreakers or mindfulness exercises, help members feel energized toward understanding the group’s shared goals. Additionally, screening and contracting before group formation ensures members’ goals and functioning levels align, reducing dropout and enhancing cohesion (Lee et al., 2021). Finally, constructive conflict facilitation allows disagreements to be reframed as opportunities for deeper trust and learning (Papastylianou & Travasaros, 2024).
For PMHNP students and clinicians, integrating these strategies means intentionally highlighting shared experiences to foster universality and modeling inclusivity to strengthen cohesion. Even in fastpaced or court-ordered group therapies, small relational interventions, such as validating concerns or linking cultural identity to group goals, can preserve Yalom’s vision of the groups as a space of shared humanity and healing (Ferizaj et al., 2025; Lee et al., 2021).
References
Ferizaj, D., Lalk, C., Lahmann, N., StrubeLahmann, S., & Rubel, J. (2025). Identifying Yalom’s group therapeutic factors in anonymous mental health discussions on Reddit: A mixedmethods analysis. Frontiers in Psychiatry, 16, 1503427. https://doi.org/10.3389/fpsyt.2025.1503427
Lee, E., Greenblatt, A., & Hu, R. (2021). A knowledge synthesis of crosscultural psychotherapy research: A critical review. Journal of CrossCultural Psychology, 52(6), 511532. https://doi.org/10.1177/00220221211028911
Papastylianou, A. D., & Travasaros, T. (2024). Patients’ perspective on the important therapeutic factors in integrated systemic group therapy: A phenomenological approach. International Journal of Group Psychotherapy, 74(1), 3377. https://doi.org/10.1080/00207284.2024.2303087