Therapeutic Factors and Member Satisfaction in an Online Group Intervention During the COVID-19 Pandemic
Open accessAbstract
The purpose of the present study was to evaluate members’ perceptions of the therapeutic factors during a group intervention that was designed to mitigate the adverse psychological effects of the coronavirus pandemic and the imposition of restrictive measures, their satisfaction with the online format of the intervention, and how these are associated with the intervention’s outcomes. The participants (N = 44, Mage = 31.93, SD = 8.09) were Greek adults who attended a 2-week, voluntary, online group intervention. To assess the effectiveness of the intervention, 1 week before and 1 week after implementation, participants completed several questionnaires measuring their demographic characteristics, empathy, resilience, affectivity, feelings of loneliness, depression and anxiety levels, and feelings of fear regarding the outbreak. One week after the intervention, they also completed two questionnaires evaluating the therapeutic factors and their satisfaction and impressions regarding telemental health counseling. Analyses showed that the most frequently cited therapeutic factor was guidance, followed by acceptance, self-disclosure, universality, and instillation of hope. Therapeutic factors of catharsis, self-disclosure, guidance, self-understanding, vicarious learning, and therapeutic alliance correlated with elements of empathy, resilience, loneliness, positive emotions, symptoms of anxiety and depression, and fear of the coronavirus. Satisfaction with the online format of the intervention was associated to universality, elements of empathy, and symptoms of depression. More specifically, member satisfaction was negatively correlated with improvement in personal distress and depression, an unexpected finding that may be attributed to the brief duration of the present intervention. The practical value of the results for the development and implementation of online psychological interventions during a crisis is discussed. © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.
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Claims the paper makes
4 of 26 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured
- Interpretationcitation
Therapeutic alliance's negative association with fear decrease may be because emotional closeness with the facilitator causes members to worry about the facilitator's health.
“Therapeutic alliance was negatively associated with the decrease in fear of the coronavirus, as it is possible that the development of emotional closeness between the group facilitator and the members’ is likely to cause members’ concern about the facilitator’s health and well-being (Grynberg & Konrath, 2020).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Grynberg & Konrath, 2020 source
The Correlations section (p. 11) reports that greater closeness with a person undergoing pain was associated with greater empathic concern and distress, which supports the proposed link between closeness and concern for another person. The paper does not test therapeutic alliance, concern for a facilitator’s health, or changes in fear of the coronavirus; its findings also do not establish that closeness causes concern. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Findingown data
Catharsis showed a significant negative correlation with the increase in members' ability to use imagination.
“The results of the correlation analysis revealed that catharsis was significantly and negatively associated with the increase in members’ ability to use their imagination.”
Quote in the paperNot a substantial claim - Findingown data
Self-understanding showed a significant negative association with the decrease in social loneliness.
“Self-understanding was significantly and negatively associated with the increases in the expression of empathic interest in others, resilience, and the decrease in social loneliness.”
Quote in the paperNot a substantial claim - Findingown data
The final sample included 44 Greek adults (6 men, 38 women) aged 20-54 years.
“The final sample included 44 Greek adults (6 men, 38 women) from various parts of Greece aged 20–54 years (Mage = 31.93, SD = 8.09).”
Quote in the paperNot a substantial claim - Findingown data
Satisfaction with the online format showed a significant positive correlation with the increase in perspective-taking.
“Results showed that participants’ satisfaction was significantly and positively correlated with the increases in perspective-taking and fantasy, while it was negatively associated with the decreases in personal distress, and symptoms of depression (Table 4).”
Quote in the paperNot a substantial claim
- Findingown data
Guidance showed a significant negative correlation with the increase in positive emotions.
“Guidance was significantly and positively correlated with the increase in understanding of the perspectives of others, and negatively with the increase in positive emotions.”
Quote in the paperNot a substantial claim - Findingown data
Guidance showed a significant positive correlation with the increase in understanding others' perspectives.
“Guidance was significantly and positively correlated with the increase in understanding of the perspectives of others, and negatively with the increase in positive emotions.”
Quote in the paperNot a substantial claim - Findingown data
Satisfaction with the online format showed a significant positive correlation with the increase in fantasy.
“Results showed that participants’ satisfaction was significantly and positively correlated with the increases in perspective-taking and fantasy, while it was negatively associated with the decreases in personal distress, and symptoms of depression (Table 4).”
Quote in the paperNot a substantial claim - Findingown data
Self-understanding and learning through interpersonal actions were also among the most common therapeutic factors in the online intervention.
“The most common therapeutic factors in the present online intervention were guidance, acceptance, self-disclosure, universality, instillation of hope, self-understanding, and learning through interpersonal actions.”
Quote in the paperNot a substantial claim - Findingown data
Self-understanding showed a significant negative association with the increase in resilience.
“Self-understanding was significantly and negatively associated with the increases in the expression of empathic interest in others, resilience, and the decrease in social loneliness.”
Quote in the paperNot a substantial claim - Findingown data
Self-disclosure showed a significant positive correlation with the decrease in depression symptoms.
“Self-disclosure was significantly and positively correlated with the decreases in emotional loneliness, symptoms of anxiety, and depression.”
Quote in the paperSubstantial claim - Findingown data
Therapeutic alliance showed a significant positive association with the decrease in fear about the spread and effects of coronavirus.
“Finally, therapeutic alliance was significantly and positively associated with the decrease of fear about the spread and effects of the coronavirus.”
Quote in the paperSubstantial claim - Findingown data
Satisfaction with the online format showed a significant positive correlation with universality.
“Moreover, satisfaction with the online format of the intervention was significantly and positively correlated with universality (Table 3).”
Quote in the paperNot a substantial claim - Findingown data
Vicarious learning showed a significant negative association with the decrease in emotional loneliness.
“Vicarious learning was significantly and negatively associated with the decrease in emotional loneliness.”
Quote in the paperNot a substantial claim - Findingown data
Self-disclosure showed a significant positive correlation with the decrease in emotional loneliness.
“Self-disclosure was significantly and positively correlated with the decreases in emotional loneliness, symptoms of anxiety, and depression.”
Quote in the paperSubstantial claim - Findingown data
Satisfaction with the online format showed a significant negative association with the decrease in depression symptoms.
“Results showed that participants’ satisfaction was significantly and positively correlated with the increases in perspective-taking and fantasy, while it was negatively associated with the decreases in personal distress, and symptoms of depression (Table 4).”
Quote in the paperNot a substantial claim - Findingown data
Satisfaction with the online format showed a significant negative association with the decrease in personal distress.
“Results showed that participants’ satisfaction was significantly and positively correlated with the increases in perspective-taking and fantasy, while it was negatively associated with the decreases in personal distress, and symptoms of depression (Table 4).”
Quote in the paperNot a substantial claim - Findingown data
Self-disclosure showed a significant positive correlation with the decrease in anxiety symptoms.
“Self-disclosure was significantly and positively correlated with the decreases in emotional loneliness, symptoms of anxiety, and depression.”
Quote in the paperSubstantial claim - Interpretationown data
The online format did not prevent the emergence of therapeutic factors that usually appear in face-to-face groups.
“The online format of the intervention did not prevent the emergence of therapeutic factors that usually appear in face-to-face groups, showing that the processes of online groups evolve in the same way and are associated with the intervention’s outcomes.”
Quote in the paperSubstantial claim - Interpretationcitation
The therapeutic factors that emerge in telemental health groups appear to be the same as those in face-to-face groups.
“The results of the present study confirm the previous literature and show that the therapeutic factors emerging in telemental health groups appear to be the same as those that operate in face-to-face groups (Heckman et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Heckman et al., 2017 source
- Interpretationown data
Members' satisfaction with the online delivery seems to affect the intervention's outcomes.
“Ensuring that the process runs smoothly in general and towards the end of the program and the transition to self-help is essential, as members’ satisfaction with the online delivery of the intervention seems to affect its outcomes and the nature of the ongoing Covid-19 pandemic indicates long-term use of technology capabilities to support individuals.”
Quote in the paperSubstantial claim - Study design and conductnone given
The small sample reduces the generalization of results.
“Another limitation is the small sample, which reduces the generalization of results.”
Quote in the paperNot a substantial claim - Interpretationown data
Therapeutic alliance plays an important role even in an online intervention.
“Based on the results of this study, this particular factor plays an important role even in the context of an online intervention.”
Quote in the paperSubstantial claim - Interpretationcitation
The remote application of the intervention does not appear to affect the effect of therapeutic factors.
“Therefore, the effect of therapeutic factors does not appear to be affected by the remote application of the intervention (e.g., Heckman et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Heckman et al., 2017 source
- Interpretationreasoning
The group processes in telemental health group interventions follow the same principles as traditional face-to-face group interventions.
“The group processes taking place during a telemental health group intervention and the study of its process follow the same principles as those that emerge during the implementation of traditional, face-to-face, group interventions.”
Quote in the paperSubstantial claim - Interpretationcitation
Catharsis's negative association with fantasy increase may be because creating imaginary scenarios is a way to escape negative emotions, and once emotions are released, members no longer need to engage in imaginary situations.
“Creating imaginary scenarios is likely a way to escape negative emotions, such as anxiety, depression, and/or anger (Sánchez-Bernardos & Avia, 2004). During the intervention, these feelings were released within the safe environment of the group, resulting to catharsis. Once the emotions that cause discomfort were released, members probably no longer had to engage in imaginary situations.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Sánchez-Bernardos & Avia, 2004 source
- Study design and conductreasoning
The brief time span of the intervention was an inevitable limitation.
“The brief time span of the intervention was an inevitable limitation of the current study.”
Quote in the paperSubstantial claim - Study design and conductown data
The measurement scales demonstrated good internal reliability in the current study.
“Internal reliability in this study was good for all scales (α = 0.79, α = 0.69, α = 0.72, and α = 0.77 respectively).”
- Also stated in: § Measures · plain
“The scale has previously been translated and used in Greek showing good psychometric properties (Stalikas et al., 2012), and good internal validity was found in the current study (α = 0.84 for the positive and α = 0.84 for the negative affectivity scale).”
- Also stated in: § Measures · plain
“Internal validity in the current study was good for both scales (α = 0.89 and α = 0.88, respectively).”
Quote in the paperNot a substantial claim - Also stated in: § Measures · plain
- Classified as probably not a substantial claim. 16
- May combine two claims. 15
- The quote only partly states this claim. 2
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationTelemental health provision has proven useful for delivering mental health services and effective for depression, anxiety, and post-traumatic stress.
“In general, the provision of telemental health has proven its usefulness for delivering mental health services (Schuster et al., 2019; Wilson et al., 2020) and has also shown its effectiveness in treating depression, anxiety, and post-traumatic stress (García-Lizana & Muñoz-Mayorga, 2010; Rees & Maclaine, 2015; Turgoose et al., 2018).”
Quote in the paperNot a substantial claim1 of 3 sources checkedMay combine two claims.
PremisecitationTelemental health services may effectively provide relief and combat the psychological impact of restrictive measures.
“Telemental health services may be an effective way to provide relief to those affected and to combat the psychological impact of the restrictive measures (Holmes et al., 2020; Roncero et al., 2020; Zhou et al., 2020).”
Quote in the paperSubstantial claim2 of 3 sources checkedMay combine two claims.
Findingown dataGuidance was the therapeutic factor most often cited by participants, with acceptance, self-disclosure, universality, and instillation of hope next.
“Analyses showed that the most frequently cited therapeutic factor was guidance, followed by acceptance, self-disclosure, universality, and instillation of hope.”
- Also stated in: § Discussion · plain
“The most common therapeutic factors in the present online intervention were guidance, acceptance, self-disclosure, universality, instillation of hope, self-understanding, and learning through interpersonal actions.”
Quote in the paperNot a substantial claim- Also stated in: § Discussion · plain
The quote only partly states this claim.
Findingown dataSelf-understanding showed a significant negative association with the increase in empathic concern.
“Self-understanding was significantly and negatively associated with the increases in the expression of empathic interest in others, resilience, and the decrease in social loneliness.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataOne critical incident did not match any of the ten therapeutic factors and was placed in a new category called therapeutic alliance.
“One answer did not match the existing therapeutic factors and it was included in a new category, “therapeutic alliance,” to describe the emotional closeness that members feel towards the group facilitator.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenWithdrawal from the survey was allowed at any time.
“Withdrawal from the survey was allowed at any time.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenA written protocol with session content and facilitator instructions was prepared to ensure fidelity.
“A written protocol with clear descriptions of each session’s content and detailed instructions for the facilitators was prepared to ensure fidelity in implementing the intervention.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe study followed Helsinki Declaration and APA ethical guidelines.
“The present study followed all the principles of the Helsinki Declaration and the ethical guidelines of the American Psychological Association (2017).”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims. The quote only partly states this claim.
InterpretationcitationSatisfaction's positive associations with universality, perspective-taking, and fantasy and negative associations with personal distress and depression may be because satisfaction reinforces relating to others, empathy nurtures relationships, and feeling understood enhances safety and adherence.
“Satisfaction from the process is likely to reinforce the members’ effort to relate and find common ground with others in the group (Keyton, 1991; Shaw et al., 2000), creating a sense of universality. Satisfaction has also been linked to increased empathy (Greenberg et al., 2001). Empathy nurtures positive relationships, and perspective-taking and fantasy are core elements of understanding others (”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
InterpretationcitationSelf-understanding's negative associations with empathic concern, resilience, and social loneliness may be because self-focus absorbs empathy, cognitive changes cause discomfort reducing resilience, and distancing causes loneliness.
“The members’ attempt to understand themselves seems to focus on personal thoughts or feelings, absorbing them from the expression of empathy towards others (Damon & Hart, 1982). This process may lead to changes in their existing cognitive structures, causing discomfort and temporarily reducing their resilience (Beardslee, 1989). Members are likely to distance themselves from other people in their”
Quote in the paperSubstantial claim0 of 3 sources checkedClassified as probably not a substantial claim.
PremisecitationGuidance, self-disclosure, learning from interpersonal actions, universality, acceptance, self-understanding, and instillation of hope are common therapeutic factors in groups that educate members and develop skills.
“Guidance, self-disclosure, learning from interpersonal actions, universality, acceptance, self-understanding, and instillation of hope are common therapeutic factors in groups aiming at educating members regarding a psychological construct and assisting them in developing specific skills (Brouzos et al., 2015, 2020; DeLucia-Waack, 2006).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Brouzos et al., 2015, 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites DeLucia-Waack, 2006 source
Classified as probably not a substantial claim. May combine two claims.
PremisecitationPrior work found that the intervention increased empathy, resilience, and positive feelings and decreased fear, negative feelings, loneliness, anxiety, and depression.
“In general, the intervention was effective in promoting the participants’ strengths and ameliorating their psychological distress (Brouzos et al., 2021a, 2021b). Members of the intervention group experienced an increase in empathy, resilience, and positive feelings, while reporting a decrease in fear about the pandemic outbreak, negative feelings, loneliness, anxiety, and depression (Brouzos et al”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Brouzos et al., 2021a, 2021b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe emergence of therapeutic factors depends on the group type.
“The emergence of therapeutic factors depends on the group type (DeLucia-Waack, 2006; Kivlighan & Holmes, 2004).”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationBloch et al. proposed a taxonomy of ten therapeutic factors.
“Bloch et al. (1979) proposed a new taxonomy of therapeutic factors, using the critical incidents methodology.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bloch et al., 1979 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThree experienced facilitators implemented the intervention after training and received regular supervision.
“Three experienced female facilitators (SV, BVC, TC) implemented the intervention after appropriate training and received regular supervision by the first author throughout the program.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationVicarious learning's negative relationship with emotional loneliness decrease may be because loneliness does not hinder vicarious learning, as lonely individuals' attention to social information remains unaffected or enhanced.
“Loneliness does not seem to hinder vicarious learning. In fact, previous findings show that the attention and perception of social information and cues remain unaffected or enhanced in lonely individuals (Gardner et al., 2005).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Gardner et al., 2005 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataParticipation was voluntary and required electronic consent after full information.
“The participation in the intervention was voluntary and required their electronic consent, after they were fully informed about its purpose and content.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationTherapeutic factors are an important process element that facilitates group members' personal growth.
“Research shows that therapeutic factors are an important element of the process that facilitates group members’ personal growth (Kivlighan & Arseneau, 2009).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kivlighan & Arseneau, 2009 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenNo specialized telemental health software ensuring confidentiality of personal data was available in Greece.
“Unfortunately, there is currently no specialized telemental health software or other relative software that could ensure the confidentiality of personal data available in Greece.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThere were no dropouts or missing data, and no participant missed any group session.
“There were no dropouts or missing data during the study and no participant missed any of his group’s sessions.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationSelf-disclosure's positive correlation with decreases in emotional loneliness, anxiety, and depression may be because sharing personal experiences reduces emotional loneliness and revealing troubling experiences in a supportive group reduces symptoms.
“In line with previous findings (Leung, 2002), group members seem to feel less emotionally lonely as they share with others personal experiences that they may be ashamed of or reluctant to reveal. Revealing troubling intimate experiences and stories within the group’s familiar, confidential, and supportive context may reduce members’ symptoms of anxiety and depression (Kahn & Garrison, 2009).”
Quote in the paperSubstantial claim0 of 2 sources checkedClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataTwo independent raters classified answers, reaching 100% agreement on ten participants and 91% initial agreement on the rest, with disagreements resolved to full consensus.
“Specifically, the two independent raters first classified ten arbitrary participants’ answers together until they had reached 100% agreement. Then, they independently rated the remaining answers, reaching an initial 91% agreement in their ratings. Disagreements were discussed until full consensus was reached.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe evaluation of therapeutic factors at a single point at the end and the evaluation of only one group process variable were limitations.
“The two main limitations of the present study include the evaluation of therapeutic factors at a single point in time at the end of the intervention and the evaluation of only one group process variable.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The use and effectiveness of telemental health services for the psychological effects of COVID-19 had not been evaluated before this study.
“However, the use and effectiveness of telemental health services in combating the psychological effects of the outbreak of the COVID-19 pandemic has not been evaluated so far.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Correlation direction for therapeutic alliance and fear conflicts
MajorOne passage says therapeutic alliance was positively associated with decreased fear of coronavirus, while another passage says it was negatively associated with the decrease in fear. Those directions cannot both be correct.
“Finally, therapeutic alliance was significantly and positively associated with the decrease of fear about the spread and effects of the coronavirus.”
“Therapeutic alliance was negatively associated with the decrease in fear of the coronavirus, as it is possible that the development of emotional closeness between the group facilitator and the members’ is likely to cause members’ concern about the facilitator’s health and well-being (Grynberg & Konrath, 2020).”
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“Yalom was one of the first to develop a classification of 11 therapeutic factors that emerge during group psychotherapy and lead to therapeutic change (Shechtman, 2003; Yalom & Leszcz, 2005).”
BackgroundIntensive Analysis of Therapeutic Factors and Outcome in Long-Term Inpatient Groups
Tschuschke, V., & Dies, R. R. (1994) · International Journal of Group Psychotherapy · doi:10.1080/00207284.1994.11490742 · Cited by 143 · cited 1× · see citing works
“The questionnaire includes four seven-item subscales answered on a 5-point Likert scale and has demonstrated good psychometric properties in Greek (e.g., Tsitsas, 2009).”
MethodA Method for the Study of Therapeutic Factors in Group Psychotherapy
Bloch, S., Reibstein, J., Crouch, E., Holroyd, P., & Themen, J. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.3.257 · Cited by 131 · cited 3× · see citing works
“The Critical Incident Questionnaire (CIQ; Bloch et al., 1979) includes an open-ended question that taps directly into each member’s perspective regarding what makes the group effective by assessing the therapeutic factors that emerge during the sessions (Lese & MacNairSemands, 2000; MacKenzie, 1987).”
BackgroundMethodInfluentialEmpathy, group norms and children's ethnic attitudes
Nesdale, D., Griffith, J., Durkin, K., & Maass, A. (2005) · Journal of Applied Developmental Psychology · doi:10.1016/j.appdev.2005.08.003 · Cited by 126 · see citing works
The Therapeutic Factors Inventory: Development of a Scale
Lese, K. P., & Macnair-Semands, R. R. (2000) · Group · doi:10.1023/a:1026616626780 · Cited by 122 · see citing works
Telemedicine for Depression: A Systematic Review
García-Lizana, F., & Muñoz-Mayorga, I. (2010) · Perspectives in Psychiatric Care · doi:10.1111/j.1744-6163.2010.00247.x · Cited by 120 · cited 1× · see citing works
“…health has proven its usefulness for delivering mental health services (Schuster et al., 2019; Wilson et al., 2020) and has also shown its effectiveness in treating depression, anxiety, and post-traumatic stress (García-Lizana & Muñoz-Mayorga, 2010; Rees & Maclaine, 2015; Turgoose et al., 2018).”
BackgroundA Systematic Review of Videoconference‐Delivered Psychological Treatment for Anxiety Disorders
Rees, C. S., & Maclaine, E. (2015) · Australian Psychologist · doi:10.1111/ap.12122 · Cited by 115 · see citing works
Greenberg, L. S., Elliott, R., Watson, J. C., & Bohart, A. C. (2001) · Psychotherapy: Theory, Research, Practice, Training · doi:10.1037/0033-3204.38.4.380 · Cited by 106 · see citing works
Clients' perspectives on therapy termination
Knox, S., Adrians, N., Everson, E., Hess, S. A., Hill, C. E., & Crook‐Lyon, R. E. (2011) · Psychotherapy Research · doi:10.1080/10503307.2010.534509 · Cited by 100 · see citing works
Leading Psychoeducational Groups for Children and Adolescents
DeLucia-Waack, J. (2006) · doi:10.4135/9781452204291 · Cited by 93 · cited 2× · see citing works
“…interpersonal actions, universality, acceptance, self-understanding, and instillation of hope are common therapeutic factors in groups aiming at educating members regarding a psychological construct and assisting them in developing specific skills (Brouzos et al., 2015, 2020; DeLucia-Waack, 2006).”
BackgroundGroup Alliance and Cohesion as Predictors of Drug and Alcohol Abuse Treatment Outcomes
Gillaspy, J. A., Wright, A., Campbell, C., Stokes, S. L., & Adinoff, B. H. (2002) · Psychotherapy Research · doi:10.1093/ptr/12.2.213 · Cited by 89 · cited 1× · see citing works
“The therapeutic alliance is an important element of the group process and refers to the therapeutic relationship developed between the facilitator and the group members (Gillaspy et al., 2002).”
BackgroundTherapeutic factors in group psychotherapy: A contemporary view
MacKenzie, K. R. (1987) · Group · doi:10.1007/bf01456798 · Cited by 71 · see citing works
Roncero, C., García-Ullán, L., de la Iglesia-Larrad, J. I., Martín, C., Andrés, P., Ojeda, A., González-Parra, D., Pérez, J., Fombellida, C., Álvarez-Navares, A., et al. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113252 · Cited by 71 · cited 1× · see citing works
“Creating imaginary scenarios is likely a way to escape negative emotions, such as anxiety, depression, and/or anger (Sánchez-Bernardos & Avia, 2004).”
BackgroundAlliance as a Mediator of Expectancy Effects in Short-Term Group Psychotherapy.
Abouguendia, M., Joyce, A. S., Piper, W. E., & Ogrodniczuk, J. S. (2004) · Group Dynamics Theory Research and Practice · doi:10.1037/1089-2699.8.1.3 · Cited by 70 · see citing works
Therapeutic factors and outcomes in group and individual therapy of aggressive boys.
Shechtman, Z. (2003) · Group Dynamics Theory Research and Practice · doi:10.1037/1089-2699.7.3.225 · Cited by 60 · cited 1× · see citing works
“Yalom was one of the first to develop a classification of 11 therapeutic factors that emerge during group psychotherapy and lead to therapeutic change (Shechtman, 2003; Yalom & Leszcz, 2005).”
BackgroundLoneliness: A multidimensional experience.
Rokach, A., & Heather, B. B. (1997) · Cited by 59 · see citing works
Brouzos, A., Vassilopoulos, S. P., Baourda, V. C., Tassi, C., Stavrou, V., Moschou, K., & Brouzou, K. O. (2021) · Current Psychology · doi:10.1007/s12144-021-01613-x · Cited by 56 · see citing works
Self-citationEvaluating Individual Group Member Satisfaction as a Situational Variable
Keyton, J. (1991) · Small Group Research · doi:10.1177/1046496491222004 · Cited by 55 · cited 1× · see citing works
“Satisfaction from the process is likely to reinforce the members’ effort to relate and find common ground with others in the group (Keyton, 1991; Shaw et al., 2000), creating a sense of universality.”
BackgroundThe role of affect in knowledge transfer.
Levin, D. Z., Kurtzberg, T. R., Phillips, K. W., & Lount, R. B. (2010) · Group Dynamics Theory Research and Practice · doi:10.1037/a0017317 · Cited by 49 · see citing works
The Importance of Therapeutic Factors: A Typology of Therapeutic Factors Studies
Kivlighan, D. M., & Holmes, S. E. (2004) · Handbook of Group Counseling and Psychotherapy · doi:10.4135/9781452229683.n2 · Cited by 42 · see citing works
Personality correlates of fantasy proneness among adolescents
Sánchez-Bernardos, M. L., & Avia, M. D. (2004) · Personality and Individual Differences · doi:10.1016/j.paid.2003.11.015 · Cited by 41 · see citing works
Shechtman, Z., & Katz, E. (2007) · Group Dynamics Theory Research and Practice · doi:10.1037/1089-2699.11.2.117 · Cited by 39 · see citing works
Dierick, P., & Lietaer, G. (2008) · International Journal of Group Psychotherapy · doi:10.1521/ijgp.2008.58.2.203 · Cited by 39 · cited 2× · see citing works
“However, Dierick and Lietaer (2008) have included feeling confidence in the group therapist, an important aspect of therapeutic alliance, as one of their therapeutic factors.”
BackgroundClients' feelings during termination of psychodynamically oriented psychotherapy
Roe, D., Dekel, R., Harel, G., Fennig, S., & Fennig, S. (2006) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2006.70.1.68 · Cited by 37 · see citing works
Grynberg, D., & Konrath, S. (2020) · Acta Psychologica · doi:10.1016/j.actpsy.2020.103175 · Cited by 36 · cited 1× · see citing works
“…alliance was negatively associated with the decrease in fear of the coronavirus, as it is possible that the development of emotional closeness between the group facilitator and the members’ is likely to cause members’ concern about the facilitator’s health and well-being (Grynberg & Konrath, 2020).”
BackgroundSchuster, R., Kalthoff, I., Walther, A., Köhldorfer, L., Partinger, E., Berger, T., & Laireiter, A.-R. (2019) · Journal of Medical Internet Research · doi:10.2196/11860 · Cited by 25 · see citing works
Behenck, A. D. S., Viana, A. C. W., Finkler, D. C., & Heldt, E. (2016) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2016.09.001 · Cited by 22 · cited 1× · see citing works
“Altruism, interpersonal learning, guidance, and self-understanding seem to play an important role in patients with panic disorder (Behenck et al., 2017).”
BackgroundHeckman, T. G., Heckman, B. D., Anderson, T., Bianco, J. A., Sutton, M., & Lovejoy, T. I. (2017) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1989 · Cited by 18 · see citing works
How does group process research inform leaders of counseling and psychotherapy groups?
Shechtman, Z. (2007) · Group Dynamics Theory Research and Practice · doi:10.1037/1089-2699.11.4.293 · Cited by 17 · cited 3× · see citing works
“Process research refers to the identification and evaluation of the variables that emerge during the therapeutic process and affect its effectiveness (Brouzos et al., 2015, 2020; Shechtman, 2007).”
BackgroundTherapeutic Factors of Cognitive Behavioral Group Treatment for Social Phobia
Choi, Y. H., & Park, K.-H. (2006) · Journal of Korean Medical Science · doi:10.3346/jkms.2006.21.2.333 · Cited by 16 · cited 1× · see citing works
“In particular, interpersonal learning, guidance, and universality might be helpful in treating social phobia (Choi & Park, 2006).”
BackgroundWilson, A., Moretto, N., Langbecker, D., & Snoswell, C. L. (2020) · Value in Health Regional Issues · doi:10.1016/j.vhri.2019.07.007 · Cited by 15 · see citing works
A typology of critical incidents in intergroup dialogue groups.
Kivlighan, D. M., & Arseneau, J. R. (2009) · Group Dynamics Theory Research and Practice · doi:10.1037/a0014757 · Cited by 14 · cited 2× · see citing works
“Research shows that therapeutic factors are an important element of the process that facilitates group members’ personal growth (Kivlighan & Arseneau, 2009).”
BackgroundBrouzos, A., Vassilopoulos, S. P., Romosiou, V., Stavrou, V., Tassi, C., Baourda, V. C., & Brouzou, K. O. (2021) · The Journal of Positive Psychology · doi:10.1080/17439760.2021.1975161 · Cited by 14 · see citing works
Self-citationBrouzos, A., Vassilopoulos, S. P., & Baourda, V. C. (2015) · The Journal for Specialists in Group Work · doi:10.1080/01933922.2015.1017065 · Cited by 13 · see citing works
Self-citationIntegrating Mindfulness into a Routine Schedule: The Role of Mobile-Health Mindfulness Applications
van Emmerik, A., Keijzer, R., & Schoenmakers, T. M. (2020) · Springer eBooks · doi:10.1007/978-3-030-30892-6_15 · Cited by 9 · see citing works
A typology of critical incidents in intergroup dialogue: Perspectives of facilitators-in-training.
Frantell, K. A., Miles, J. R., Muller, J. T., & Robinson, L. M. (2018) · Group Dynamics: Theory, Research, and Practice · doi:10.1037/gdn0000088 · Cited by 8 · see citing works
The Impact of Therapeutic Factors on Locus of Control of Addicts in Therapeutic Communities
Amram, Y., & Benbenishty, R. (2014) · Journal of Groups in Addiction & Recovery · doi:10.1080/1556035x.2014.967576 · Cited by 8 · cited 2× · see citing works
“Also, higher endorsement of therapeutic factors from the initial stage of therapy leads to improved therapeutic results for patients with substance abuse problems (Amram & Benbenishty, 2014).”
BackgroundSchuster, R., Berger, T., & Laireiter, A. (2019) · doi:10.7892/boris.120835 · Cited by 8 · see citing works
Brouzos, A., Vassilopoulos, S. P., Stavrou, V., & Baourda, V. C. (2020) · The European Journal of Counselling Psychology · doi:10.5964/ejcop.v8i1.143 · Cited by 8 · see citing works
Self-citationThe Interpersonal Reactivity Index (IRI) scale in Greek patients with dementia.
Parthimos, T. P., Rankin, K. P., Lykou, E., Kamtsadeli, V., Tsinia, N., Hatzopoulou, M., Chatziantoniou, E., Papatriantafyllou, O., Miller, B. L., Papanikolaou, A., et al. (2019) · Dialogues in Clinical Neuroscience & Mental Health · doi:10.26386/obrela.v2i1.105 · Cited by 1 · cited 1× · see citing works
“…health has proven its usefulness for delivering mental health services (Schuster et al., 2019; Wilson et al., 2020) and has also shown its effectiveness in treating depression, anxiety, and post-traumatic stress (García-Lizana & Muñoz-Mayorga, 2010; Rees & Maclaine, 2015; Turgoose et al., 2018).”
Background
Flagged first, then by citations
5 of the 74 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- Mufiqoh, A., Sugiharto, D. Y. P., & Anni, C. T. (2018). The effectiveness of group guidance with film media to improve students’ empathy and social interaction. Jurnal Bimbingan Konseling, 7(2), 96–100. https://doi.org/10.15294/jubk.v7i2.24390 · DOI
- Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). Basic Books/Hachette Book Group.
- Zervou, S. (2018). Investigation of the correlation between feelings of loneliness with resilience and forgiveness in inpatients with psychiatric symptoms [Master’s thesis, Hellenic Open University]. https://apothesis.eap.gr/handle/repo/37941
Cited by
Sorted by citations
‘Isolated together’: online group treatments during the COVID-19 pandemic. A systematic review
Margherita, G., Muzii, B., Caffieri, A., Francia, A. D., & Somma, B. (2022) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2022.639 · Cited by 21 · see citing works
“Only 2 studies assessed dimensions related to therapeutic factors (Brouzos et al., 2021c; Lecomte et al., 2020).”
BackgroundResultInfluentialPastore, O. L., & Fortier, M. (2023) · Health Promotion International · doi:10.1093/heapro/daad107 · Cited by 20 · see citing works
Wang, A., Wu, F., Lin, C., et al. (2023) · Nurse Education in Practice · doi:10.1016/j.nepr.2023.103598 · Cited by 15 · see citing works
“(Brouzos et al., 2021; Zhang et al., 2021) Some students proposed that online and offline approaches should be combined, which requires future work to modify the program and find a balance between online and offline approaches in our future implementations.”
BackgroundEffectiveness of a web-based group intervention for internet addiction in university students
Brouzos, A., Papadopoulou, A., & Baourda, V. C. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.115883 · Cited by 11 · see citing works
Self-citationFajnerová, I., Hejtmánek, L., Sedlák, M., Jablonská, M., Francová, A., & Stopková, P. (2024) · Journal of Medical Internet Research · doi:10.2196/60441 · Cited by 10 · see citing works
“Therapeutic factors and group processes in online groups appear, thus far, to be the same as those in traditional group interventions [41,42].”
Mechanism of online emotional support accompany group for stress: The role of social support
Zhang, Y., Huang, H.-L., Tang, D., Lu, X., Fan, F., & Pan, J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1047364 · Cited by 13 · see citing works
“Therefore, the project team designed a single-session Online Emotional Support Accompany Group (OESAG) according to the intervention goals and methods of previous researchers (Deng, 2010; Brouzos et al., 2021a; Lu et al., 2022a).”
MethodEvaluation of virtual caregiver support groups for young-onset dementia family caregivers
Climans, R., Berall, A., Santiago, A., Gardner, S. L., Margles, D., & Shnall, A. (2022) · Social Work With Groups · doi:10.1080/01609513.2022.2148038 · Cited by 6 · see citing works
“(Brouzos et al., 2021).”
Human Rights Group Intervention in Primary School
Stavrou, V., Brouzos, A., Vassilopoulos, S. P., et al. (2022) · The International Journal of Children s Rights · doi:10.1163/15718182-30030008 · Cited by 5 · see citing works
Self-citationIs Online Group Therapy as Effective as Face-to-face Group Therapy? A Mixed Methods Study
Zhang, J., Hu, H., Wu, D., Nie, Y., & Lin, X. (2024) · Clinical Social Work Journal · doi:10.1007/s10615-024-00933-2 · Cited by 4 · see citing works
“For example, a higher level of disclosure of personal information and emotions in online groups compared to f2f groups provides opportunities for group members to be more open and genuine, thereby relieving anxiety and depression symptoms (Brouzos et al., 2021 ; Rogers et al., 2009).”
Evaluating the impact of human rights education on the adjustment of Greek primary school students
Stavrou, V., Brouzos, A., Vassilopoulos, S. P., & Koutras, V. (2023) · International Journal of Psychology · doi:10.1002/ijop.12937 · Cited by 3 · see citing works
Self-citationTassi, C., & Brouzos, A. (2025) · International Journal of Applied Positive Psychology · doi:10.1007/s41042-025-00244-y · Cited by 1 · see citing works
“One notable exception is the work by Brouzos et al. ( 2021), who examined a positive psychology-based online group intervention for adults dur-1 ing the COVID-19 pandemic.”
Self-citationΜπρούζος, Α. (2022) · Θέματα Επιστημών Αγωγής · doi:10.12681/thea.30191
Tett, R. P., Goodman, T. M., Devlin, N., Rigby, E., & Martínez, R. N. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.4768560
Palli, A. (2025) · European Family Therapy Association series · doi:10.1007/978-3-031-92225-1_13
Helpful factors of group cognitive behavioral therapy in overweight and obese college students
Zhao, Z., Zhang, Y., & Zhao, D. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1585765
Online therapeutic groups: integrative literature review (2012-2022)
Costa, S. S. D., & Santeiro, T. V. (2025) · Psico-USF · doi:10.1590/1413-8271202530e281807
Harmsen, C. R. W., Cordeiro, K., Rependa, S. L., Baranowsky, A., & Muller, R. T. (2026) · International Journal of Group Psychotherapy · doi:10.1080/00207284.2025.2602009
“This is in contrast with one study, which found that greater satisfaction was negatively associated with symptom change, such that greater satisfaction did not predict significant reductions in anxiety or depression symptoms (Brouzos et al., 2021).”
InfluentialCaydı, S., Batmaz, S., & Erdil, İ. E. G. (2026) · Current Psychology · doi:10.1007/s12144-026-09083-9 · Cited by 1 · see citing works
“Some participants may have found the group format less comfortable than individual sessions, and the online setting might have reduced the sense of personal connection (Brouzos et al., 2021 ).”
Moments of Change in Group Psychotherapy: Exploring Therapeutic Factors and Relational Processes
Chelios, K., & Vlachos, I. (2026) · Behavioral Sciences · doi:10.3390/bs16081418
“Interpersonal learning and imparting information emerged in participants’ accounts of receiving feedback, recognizing relational patterns, and gaining new perspectives, paral-leling research on insight and relational change in group therapy (Joyce et al., 2011; Brouzos et al., 2021).”
- Authors
- Brouzos, A., Vassilopoulos, S. P., Stavrou, V., Baourda, V. C., Tassi, C., & Brouzou, K. O.
- Affiliations
- University of Ioannina (GR)
- University of Patras (GR)
- Heinrich Heine University Düsseldorf (DE)
- Corresponding author
- Stavrou, Vaia
- ORCID
- Venue
- Journal of Technology in Behavioral Science
- Published
- 2021-09-26
- Volume
- 6
- Issue
- 4
- Pages
- 609-619
- ISSN
- 2366-5963 (ISSN-L)
- PMC
- PMC8475888
- OpenAlex
- W3203143202
- Semantic Scholar
- 89f905c9ef1819f199e9ff994d889e025ef593b3
- Cited by
- 19
- References
- 74
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 4
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Technology in Behavioral Science (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- therapeutic factors, online group intervention, COVID-19 pandemic, member satisfaction, telemental health, psychological distress, depression, anxiety, loneliness, resilience, empathy, acceptance, self-disclosure, universality, guidance, fear of coronavirus, crisis intervention
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