MacNair Semands, 2011

See discussions, stats, and author profiles for this publication at: https://www.researchgate.
net/publication/42343468
Structure and Initial Validation of a Short Form of the

Therapeutic Factors Inventory
Article in International Journal of Group Psychotherapy · April 2010

DOI: 10.1521/ijgp.2010.60.2.245 · Source: PubMed
CITATIONS READS
45 883
3 authors, including:
Rebecca R. MacNair-Semands Anthony Joyce

University of North Carolina at Charlotte University of Alberta
33 PUBLICATIONS 884 CITATIONS 168 PUBLICATIONS 5,265 CITATIONS
SEE PROFILE SEE PROFILE
Some of the authors of this publication are also working on these related projects:
Ethical issues related to suicide risk assessment in group therapy View project
All content following this page was uploaded by Anthony Joyce on 22 September 2014.
The user has requested enhancement of the downloaded file.

INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 60 (2) 2010
THERAPEUTIC FACTOR INVENTORY

MACNAR-SEMANDS ET AL.
Structure and Initial Validation

of a Short Form of the
Therapeutic Factors Inventory
Rebecca R. MacNair-Semands, Ph.D.

John S. Ogrodniczuk, Ph.D
Anthony S. Joyce, Ph.D.
Abstract
This study examined the factor structure and validity of the Therapeutic Factors
Inventory-Short Form (TFI-S), a measure originally developed to assess Yalom’s
eleven conceptually derived therapeutic factors. Patients in a group-oriented day
treatment program (n= 174) completed the TFI-S and other measures to assess
concurrent and predictive validity. Four broad therapeutic factors were identified:
Instillation of Hope, Secure Emotional Expression, Awareness of Interpersonal
Impact, and Social Learning. Alpha coefficients ranged from .71 to .91. Signifi-
cant correlations between the TFI-S factors and Group Climate Questionnaire
subscales provided preliminary evidence for the concurrent validity of the TFI-
S. Significant relationships were also identified between the TFI-S factors and
improvement in symptoms, quality of life, and interpersonal distress at the end of
treatment, suggesting that the TFI-S may have predictive validity.
THERAPEUTIC FACTORS
T herapeutic factors (TFs) (Corsini & Rosenberg, 1955; Yalom,

2005) are a theoretical constellation of the curative aspects in
Rebecca R. MacNair-Semands is Senior Associate Director, Counseling Center, The Uni-

versity of North Carolina at Charlotte. John S. Ogrodniczuk is Associate Professor &
Associate Director, Psychotherapy Program, University of British Columbia. Anthony S.
Joyce is Professor, Department of Psychiatry, University of Alberta.
245
246 THERAPEUTIC FACTOR INVENTORY
group psychotherapy and are believed to operate in all types of

therapy groups. Yalom described TFs as the actual mechanisms
that promote change in group members. His well-known eleven
factors include the instillation of hope, universality, imparting
information, altruism, corrective recapitulation of the primary
family group, development of socializing techniques, imitative
behavior, interpersonal learning, group cohesiveness, cathar-
sis, and existential learning. These factors are regarded by most
group clinicians as having considerable heuristic value. Indeed,
an understanding by group leaders of the TFs is purported to
be crucial for successfully providing group interventions (Fuhri-
man & Burlingame, 1994). Nevertheless, there is ongoing and
complex debate in the literature about the existence and number
of unique TFs (Bednar & Kaul, 1994; Budman et al., 1989; John-
son et al., 2005; Kivlighan & Mullison, 1988; Lese & MacNair-
Semands, 2000).
The Interdependence of Therapeutic Factors
Yalom notes that although he discusses the TFs singly, the distinc-
tions among the factors are arbitrary and they neither occur, nor
function, separately (Yalom & Leszcz, 2005). Many authors have
argued that there is much overlap among the TFs (Fuhriman et
al., 1986; Lese & MacNair-Semands, 2000; MacNair-Semands &
Lese, 2000; Tschuschke & Dies, 1994). This suggests that a higher-
order differentiation of TFs may be useful. It has previously been
observed that group research often defines one aspect of process
in isolation, work that teaches us little about the interrelatedness
of variables (Fuhriman & Burlingame, 1994). Instead, studying
the complex and interrelated nature of factors impacting group
process may provide us with more meaningful results (Kivlighan
& Lilly, 1997; McGrath, 1997). The purported overlap among
TFs has not necessarily implied that the concepts are meaning-
less, but that some of the factors are less meaningful in isolation
and may represent facets of more global (higher-order) TFs.
Findings from research on group processes have suggested
there may be only a few global dimensions underlying the TFs
(Sexton, 1993). Some of the “common factors” that have been im-
plicated include expressed emotion (Castonguay, Pincus, Agras,
MACNAR-SEMANDS ET AL. 247
& Hines, 1998), cohesion (Budman et al., 1989; Budman et al.,

1993; Burlingame, Fuhriman, & Johnson, 2002), and therapeutic
alliance (Marziali, Munroe-Blum, & McCleary, 1997). In a study
by Johnson and her colleagues (1995), most subscales of group
climate, cohesion, alliance, and empathy questionnaires were
significantly correlated (Johnson et al., 2005). These concepts
appeared to reflect aspects of a common higher-order construct
but did not load on a common factor, suggesting that while such
constructs may be related they do not reflect a single latent di-
mension.
Along similar lines, Kivlighan, Multon, and Brossart (1996) ex-
amined critical incident reports in group using the Group Coun-
seling Helpful Impacts Scale (GCHIS), which was designed to
categorize beneficial critical incidents into TFs. Factor analysis
revealed four underlying components for the GCHIS: (1) emo-
tional awareness-insight, indicating strong affective experiences
connected with gaining awareness and insight, (2) relationship-
climate, the formation and maintenance of relationships in the
group, (3) other- versus self-focus, learning from others, and
(4) problem definition-change, solving problems, and changing
behavior. Relationship-climate and other- versus self-focus were
identified more frequently by group clients than by clients in
individual therapy, whereas the reverse was true for emotional
awareness-insight and problem definition-change.
Employing a different methodological approach that relied on
multiple sources for item generation, Dierick and Lietaer (2008)
developed an extensive questionnaire with 155 items to reveal a
hierarchical model of the structure and interconnectedness of the
therapeutic factors. Based on rating data subsequently collected
from 489 members of 78 psychotherapy and growth groups, the
complex hierarchical model includes 28 basic scales that are
organized into seven main scales associated with two higher or-
der dimensions (Relational Climate includes the main scales of
Group Cohesion, Interactional Confirmation, and Cathartic Self-
Revelation; Psychological Work includes the main scales of Self-
Insight and Progress, Observational Experiences, Getting Direc-
tives, and Interactional Confrontation). The authors provide an
argument that validity for these numerous TFs was determined
by their grounded context, empirically derived structure, impor-
tance ratings, and correlations with outcome measures. However,

the length of the questionnaire developed by Dierick and Lietaer
(2008) is likely to be a practical deterrent to many clinicians and
researchers.
Measuring Therapeutic Factors in Group Therapy
Bednar and Kaul (1994) observed that greater precision in both

the definition and measurement of group process elements is
necessary to advance the research and practice of group therapy.
Indeed, the lack of a reliable and valid scale measuring all TFs
has contributed to the minimal advancement in our understand-
ing of the TFs that operate in group therapy.
Efforts to assess TFs can generally be characterized by two ap-
proaches: the critical incident method (Kivlighan & Goldfine,
1991; Kivlighan et al., 1996; MacKenzie, 1987) and the question-
naire method (Lese & MacNair-Semands, 2000; Magen & Gla-
jchen, 1999; Reddon, Payne, & Starzyk, 1999; Yalom & Leszcz,
2005). Bloch and Crouch (1985) characterized these methods as
indirect and direct, respectively. The critical incident, or indirect,
approach asks participants to describe the most significant event
that occurred in group. Descriptions are then rated by indepen-
dent assessors who infer the nature of the TFs. Because its for-
mat is unstructured, the indirect approach biases the respondent
less than direct inquiry (Bloch & Crouch, 1985; Crouch, Bloch,
& Wanlass, 1994). Studies employing the indirect approach by
Kivlighan and colleagues (Kivlighan & Goldfine, 1991; Kivlighan
et al., 1996) have provided data illuminating the beneficial pro-
cesses of group therapy. Yet the structure of the TFs has varied
considerably across studies using the indirect approach. Some
researchers have suggested that variability in conceptual defini-
tions and operational measures have contributed to these mixed
results (Bednar & Kaul, 1994).
Yalom argues that consideration should be given to direct cli-
ent reports of their perceptions of TFs. He describes the direct
approach as a relatively untapped source of information, noting
that “after all, it is their experience, theirs alone, and the farther
we move from the clients’ experience, the more inferential are
our conclusions” (p. 3, Yalom & Leszcz, 2005). Yalom’s (1966)
Q-sort is prototypical of the direct approach, which measures fac-

tors by client responses to 60 specific statements about the group
experience. However, Freedman and Hurley (1980) found that
less than half of Yalom’s original Q-sort TF scales demonstrated
adequate internal consistency, suggesting the need for more ro-
bust direct measures of TFs.
An important issue regarding the assessment of TFs concerns
the measurement of the members’ perception of the presence of
TFs versus the rating of how helpful a certain TF was to the mem-
ber (Roy, Turcotte, Montminy, & Lindsay, 2005). Johnson and
her colleagues emphasize the importance of measuring the per-
ceived presence of the TF itself rather than ranking how helpful
a TF is in the group (Johnson et al., 2005). They argue that it
is important that questionnaires do not confound the presence
of the TF with the helpfulness of the factor. Yalom’s Q-sort, for
example, uses a 7-point Likert-type scale ranging from 1 (most
helpful to me in group) to 7 (least helpful to me in group). The
Therapeutic Factors Inventory (TFI) items ratings, in contrast,
reflect the extent to which patients agree that the factor was pres-
ent in the group.
The Therapeutic Factors Inventory
In response to the need for a unified, direct measure of all ther-

apeutic factors that tapped into group members’ perceptions
of the presence of the factors in the group, Lese and MacNair-
Semands (2000) developed the Therapeutic Factors Inventory
(TFI). Therapeutic factors were defined using Yalom’s (2005)
descriptions, and items were generated based on this formula-
tion. The authors of the scale, two doctoral-level psychologists,
each had over nine years of experience leading, researching, and
studying groups. The authors independently generated items
and then critiqued and revised items based on clarity, correspon-
dence with the factor definition, and redundancy. Following this
critique, problematic items were revised or eliminated. A total
of 174 items were retained for analysis. Each scale comprised 15
to 19 items. Items were assessed along a 7-point Likert-type scale
rated from 1 (strongly disagree) to 7 (strongly agree). A few items
in each scale were reverse-coded to reduce response bias. Items
were then placed in random order. Preliminary psychometric

testing resulted in several items being omitted from the scale.
The end result was a 99-item version of the TFI (11 factors con-
sisting of 9 items each). Internal consistency of the 11 subscales
was high, with alpha coefficients ranging from .82 to .94. Fur-
thermore, test-retest reliability was high (r > .63) for all but one
of the subscales, recapitulation of the family group.
Subsequent work with the TFI found significant associations
between interpersonal problems of group members and several
of the TFI subscales (MacNair-Semands & Lese, 2000), which pro-
vided preliminary evidence for the validity of the TFI. Despite
initial indications of satisfactory psychometric properties of the
TFI, the length of the scale represented a major limitation to its
use by clinicians and researchers (Roy et al., 2005). In a review
of the state of group psychotherapy process research, Greene
(2003) noted the TFI’s reasonable psychometric properties, face
validity, and applicability to a broad range of groups. However,
he recommended conducting further studies to examine dynam-
ic relationships among theoretically important constructs. Thus,
an effort was made to develop a more efficient and user-friendly
version of the TFI.
The Therapeutic Factors Inventory-Short Form
The Therapeutic Factors Inventory-Short Form (TFI-S) is a de-

rivative of the longer TFI. MacNair and Lese (2002, unpublished
document) utilized data from the initial development of the TFI
to create the TFI-S. Specifically, items for the TFI-S were selected
based on item analyses for each of the 11 subscales. The four
items with the highest corrected item-total correlations were se-
lected for retention for the TFI-S. This resulted in a 44-item scale
(11 subscales consisting of 4 items each). The 7-point Likert-type
rating used with the TFI was retained for the TFI-S. The present
study is the first to engage in a systematic test of the psychometric
properties of the TFI-S.
Purpose of Study
The present study was conducted to evaluate the Therapeutic

Factor Inventory-Short Form (TFI-S). In particular, the primary
objective of the study was to conduct a preliminary examination

of the factor structure of the TFI-S. Given the arguments ques-
tioning the presence of 11 distinct factors and the findings of
small sets of global dimensions in previous factor analytic studies
of group process variables, we expected that the structure of the
TFI-S would reflect fewer, more global dimensions of the group
process than the 11 factors suggested by Yalom (2005).
A secondary objective was to assess the concurrent and predic-
tive validity of the TFI-S. Documenting these aspects of a scale’s
validity is important for establishing a scale’s clinical utility. In
order to assess the concurrent validity of the TFI-S, we chose to
examine its association with another measure of group process,
the Group Climate Questionnaire-Short From (GCQ-S; MacK-
enzie, 1983). The GCQ-S was chosen because it is one of the
most widely used measures of group process. On a general con-
ceptual level, the GCQ-S is a measure of broad-ranging group
phenomenon and process, and we expect that the TFI-S should
reflect somewhat similar constructs. Three key features that are
purported to be common to all therapy groups are measured by
the GCQ-S: Engagement, Avoidance, and Conflict. These scales,
respectively, reflect a cohesive environment and willingness to
participate, a reluctance of group members to take responsibility
for problems within the group, and the presence of interpersonal
friction. We expect the factors of the TFI-S to be facilitative con-
structs (i.e., factors that promote benefit from group). Thus, we
anticipated that the TFI-S factors would have a positive associa-
tion with engagement and negative association with avoidance
and conflict. In order to assess the predictive validity of the TFI-
S, we chose to examine its association with change on several out-
come measures. The outcome measures that we used--the Quality
of Life Inventory (Frisch, Cornell, & Villanueva, 1992), the Social
Adjustment Scale-Self Report (Weissman & Bothwell, 1976), the
Brief Symptom Inventory (Derogatis, 1993), and the Inventory of
Interpersonal Problems-64 (Horowitz et al., 1988)--were chosen
because they reflected different aspects of patient functioning
and are frequently used in contemporary psychotherapy research
(Strupp, Horowitz, & Lambert, 1997).
Method
Setting
The study took place in the day treatment program (DTP), one
component of the Psychodynamic Psychiatry Service of the De-
partment of Psychiatry, University of Alberta Hospital, in Ed-
monton, Alberta. The DTP is an 18-week, time-limited, intensive
milieu treatment for patients with affective and personality disor-
ders or maladaptive personality traits. It does not admit patients
with other serious mental illnesses such as schizophrenia. Treat-
ment and rehabilitation in a variety of groups constitute the total
experience of the program for all patients. The pervasive treat-
ment philosophy is psychodynamic; this orientation is bolstered
considerably by systems theory, group theory, and a modification
of ideals formulated for the administration of therapeutic com-
munities (Piper et al., 1996). Consideration of the program as
a total system that supports the application of group therapy is
central.
The treatment team consists of five therapists (from the dis-
ciplines of nursing, social work, occupational therapy, and psy-
chology), a teacher, a psychiatrist, and an administrative assistant.
The psychiatrist shares leadership of the program with the oc-
cupational therapist. The whole team meets daily from Monday
to Friday.
All patients are expected to attend all day, five days a week, for
18 weeks. The average daily census is 30 to 35 patients. Two or
three patients are admitted and a similar number are discharged
each week. The new patients enter ongoing groups within the
program. Treatment consists of a variety of small and large
groups and psychopharmacology. Groups are divided into two
broad categories: psychotherapeutic insight-oriented groups and
rehabilitative sociotherapy groups.
This study focuses on one particular group within the DTP: the
self-awareness group. This small, twice-weekly group (which typi-
cally consists of about 8 patients) occurs during the first phase
of the DTP (between weeks 1 and 6). The self-awareness group
is an introduction to insight-oriented work. The therapist gently
encourages the patients to explore perceptions of themselves and

of others, while paying particular attention to emotions that may
surface in the process. For example, a patient talking about how
a therapist reminds her of her mother might be asked to talk
about the tears that are showing as she is reminded of her past
experiences.
Participants
The sample for the present study consisted of 174 patients (65%
female) who were consecutively admitted to the DTP. A thorough
diagnostic assessment was conducted shortly after each patient
was confirmed as appropriate for the DTP. Axis I diagnoses were
determined by the computer-administered Structured Clinical In-
terview for DSM-IV (First, Spitzer, Gibbon, & Williams, 1997) and
validated by the independent clinical diagnosis assigned jointly
by the DTP therapist and psychiatrist, both of whom saw the pa-
tient for the initial program intake. Axis II personality disorder
diagnoses were determined by the Structured Clinical Interview
for DSM-IV Personality Questionnaire (SCID-II-PQ) (First, Gib-
bons, Williams, Spitzer, & Benjamin, 1998) and the Structured
Clinical Interview for DSM-IV Personality Disorders (CAS-II)
(First et al., 1997). Seventy-one percent of the patients received at
least one Axis II diagnosis. The three most prevalent personality
disorder (PD) diagnoses were Avoidant (38%), Borderline (36%),
and Obsessive-Compulsive (22%). Ninety-four percent of the sam-
ple was diagnosed with an Axis I disorder. The most prevalent
Axis I disorders were Major Depression (70%) and Dysthymia
(20%). At admission, patients had a mean age of 37.2 years (SD
= 10.7). Thirty-six percent were living with a partner, 39% were
living alone, and 25% indicated other living arrangements. Sev-
enteen percent had less than a high school education, 20% had
a high school education only, and 64% were educated beyond
high school (trades training, college, or university). Sixty-seven
percent had received psychiatric treatment in the past, and 27%
had been previously hospitalized for psychiatric difficulties. Of
the patients who provided information about ethnic background,
91% were Caucasian, and the remaining 9% were Asian, East In-
dian, First Nations, and Hispanic. The dropout rate for the study
was 37.4%.
Measures
Therapeutic Factors Inventory-Short Form. The Therapeutic Factors

Inventory-Short Form (TFI-S) is a 44-item self-report question-
naire that consists of four items for each of 11 subscales. The
subscales of the TFI-S represent each of the 11 therapeutic fac-
tors as defined by Yalom (2005): instillation of hope, universal-
ity, imparting information, altruism, corrective recapitulation of
the primary family group, development of socializing techniques,
imitative behavior, interpersonal learning, group cohesiveness,
catharsis, and existential learning. Group members are asked to
rate the extent to which they agreed with statements that were
intended to reflect the presence or absence (for reversed-scored
items) of the therapeutic factors. Items on the TFI-S are rated us-
ing a 7-point Likert-type scale, ranging from 1 (strongly disagree)
to 7 (strongly agree). Examples of items from the TFI-S are: “This
group helps empower me to make a difference in my own life,” “I
feel a sense of belonging in this group,” and “By getting honest
feedback from members and facilitators, I’ve learned a lot about
my impact on other people.” Preliminary testing following the
development of the TFI-S, based on a sample of n = 73 college
student participants in counseling center groups, revealed high
internal consistency for each of the 11 subscales, with alpha coef-
ficients ranging from .78 to .93.
Group Climate Questionnaire–Short Form. In addition to the TFI-
S, we included another group process measure, the Group Cli-
mate Questionnaire–Short Form (GCQ-S; MacKenzie, 1983) in
order to assess the concurrent validity of the TFI-S. The GCQ-S is
a self-report measure designed to assess patients’ perceptions of
a group’s therapeutic environment. It contains 12 items that are
rated on a 7-point Likert-type scale, indicating extent of agree-
ment ranging from 0 (not at all) to 6 (extremely). The items are
divided into three subscales: Engagement (5 items), Avoidance
(3 items), and Conflict (4 items). Engagement is a multifaceted
dimension that reflects a cohesive environment and the willing-
ness of members to participate in the group. An example of an
item from this subscale is, “The members have felt what was hap-
pening was important and there has been a sense of participa-
tion.” Avoidance pertains to the reluctance of group members
to take responsibility for psychological change. An example of
an item from this subscale is, “The members have avoided look-
ing at important issues going on between themselves.” Conflict
suggests the presence of interpersonal friction. An example of
an item from this subscale is, “There has been friction and an-
ger between the members.” Internal consistency of the GCQ-S
subscales has been high, with alpha coefficients ranging from .88
to .94 (Kivlighan & Goldfine, 1991). The validity of the GCQ-S
has also been established in a number of studies. Ratings on the
GCQ-S have been found to differentiate different types of group
therapy (Joyce, Azim, & Morin, 1988), group therapies of vary-
ing duration (Kanas et al., 1989), and different patient samples
(Daroff, 1996).
Quality of Life Inventory. The Quality of Life Inventory (QOLI;
Frisch et al., 1992) is a self-report measure that assesses 17 areas
of life deemed potentially relevant to overall quality of life. A
subscale score is derived for each domain. Scores are computed
by multiplying the importance rating (0 = not important, 1 = im-
portant, 2 = extremely important) by the satisfaction rating (−3 =
not at all satisfied to 3 = very satisfied). A total scale score is ob-
tained by averaging all subscale scores for domains rated either
important or extremely important (domains rated not important
are excluded from the total score calculation, but these scores
are considered 0 for the subscale scores). Thus, the QOLI total
score reflects subjective well-being in life domains considered to
be of at least some importance to the individual. Examples of
items from the QOLI are: “How important is health to your hap-
piness?” and “How satisfied are you with your health?” The QOLI
has test-retest reliability of .80 to .91 and correlates with other
measures of well-being (Frisch, 1994; Frisch et al, 1992). Internal
consistency is also high (Cronbach’s alpha = .90) (Petry, Alessi, &
Hanson, 2007).
Social Adjustment Scale–Self Report. Social adjustment was as-
sessed using the self-report version of the Social Adjustment
Scale (SAS; Weissman & Bothwell, 1976). The scale consists of 54
questions covering social functioning in 7 areas: (1) as a worker
outside the home, home-worker, or student; (2) social and leisure

activities; (3) relationships with extended family; (4) marital role;
(5) parental role; (6) functioning with the family unit; and (7)
economic level. Individuals rate the extent of friction, negative
feelings, and satisfaction about the given roles using a 5-point
rating scale. Higher scores reflect poorer adjustment. A Global
Functioning score is computed by averaging item responses. Ex-
amples of items from the SAS are: “Have you had any arguments
with people at work in the last 2 weeks?” and “Have you been able
to talk about your feelings and problems with at least one friend
during the last 2 weeks?” Internal consistency for the overall ad-
justment score is moderate (α = .74) and temporal stability is good
(r = .80) across 2-week intervals (Edwards et al., 1978).
Brief Symptom Inventory. General psychiatric distress was as-
sessed using the Brief Symptom Inventory (BSI; Derogatis, 1993),
a 53-item self-report instrument covering 9 dimensions of psy-
chological symptoms. The subscales include somatization, ob-
sessive-compulsive, interpersonal sensitivity, depression, anxiety,
hostility, phobic anxiety, paranoid ideation, and psychoticism.
Participants indicate the severity of psychological symptoms on
a 5-point rating scale ranging from (0) not at all to (4) extremely
severe. The General Severity Index (GSI), a weighted frequency
score based on the mean of the ratings the subject assigns to each
symptom, is considered the single best indicator of current dis-
tress level. Examples of items from the BSI are: “How much were
you distressed by thoughts of ending your life?” and “How much
were you distressed by having to avoid certain things, places, or
activities because they frighten you?” As to reliability, Derogatis
and Melisaratos (1983) presented coefficients of internal consis-
tency of the Brief Symptom Inventory ranging from .71 to .85
and test-retest reliability ranging from .68 to .91.
Inventory of Interpersonal Problems-64. The final outcome mea-
sure was the Inventory of Interpersonal Problems–64 (IIP–64).
The 64-item IIP (Horowitz et al., 1988) is a self-report instrument
designed to assess problems in interpersonal interactions that ei-
ther are reflected by difficulties in executing particular behaviors
(“It is hard for me to …”) or difficulties in exercising restraint
(“I do … too much”). The instrument is based on interpersonal
theories of behavior that have a long tradition in personality and
social psychology (e.g., Kiesler, 1996). The IIP–64 consists of 64

items (8 subscales of 8 items each) that are rated on a 5-point scale
(0-4). The eight subscales reflect interpersonal problems charac-
terized by the following adjectives: domineering, vindictive, cold,
socially avoidant, nonassertive, exploitable, overly nurturant, and
intrusive. In addition to the subscales, the IIP–64 provides a total
score, which we used in the current study to indicate overall level
of interpersonal distress. Examples of items from the IIP–64 are:
“It is hard for me to trust other people” and “I fight with other
people too much.” The IIP–64 is one of the most widely used
instruments in psychotherapy outcome research (e.g., Strupp,
Horowitz, & Lambert, 1997), and it has strong psychometric
properties. Estimates of internal consistency range from .88 to
.89 for the total score and from .68 to .84 for the subscales. Test-
retest reliabilities are also high, ranging from .71 to .83 for the
total score and from .41 to .85 for the subscales.
Procedure
Participants in the study were admitted on a consecutive basis to

the day treatment program (DTP). After a description of the proj-
ect by the study coordinator, written informed consent was ob-
tained. At the time of their entry into the DTP, participants com-
pleted each of the four outcome measures (QOLI, SAS, BSI-18,
and IIP–64). These measures were completed once again upon
termination from the treatment program. The TFI-S and GCQ-S
were completed after the 4th week of the participants’ 18-week
stay in the program. The TFI-S and GCQ-S were distributed to
participants when they were enrolled in the self-awareness group
of the DTP. Participants were asked to provide process ratings
concerning the self-awareness group only, and not about the DTP
in general.
Approach to Analysis
Exploratory Factor Analysis. Prior to conducting factor analy-

ses of the TFI-S ratings, we considered arguments regarding the
problems associated with using item-level data (see Bernstein &
Teng, 1989). Specifically, item-level data almost never meet the
criteria of continuous distributions and multivariate normality
required for factor analytic routines. Moreover, the correlation

between any two items is affected by both their substantive (con-
tent-based) similarity and by the similarities of their statistical
distributions. Items with similar distributions tend to correlate
more strongly with one another than do items with dissimilar
distributions. Easily or commonly endorsed items tend to form
factors that are distinct from difficult or less commonly endorsed
items, even when all the items measure the same unidimensional
latent variable (Nunnaly & Bernstein, 1994, p. 318). It is recom-
mended that when items are based on ordered categories (e.g.,
Likert scales), factor analyses should be conducted the matrix of
polychoric correlations rather than using the matrix of Pearson
correlations. Polychoric correlations are based on the assumption
that the response categories are actually proxies for unobserved,
normally distributed variables. Thus, the factor analysis of a poly-
choric correlation matrix is essentially an analysis of the relations
among latent response variables that are assumed to underlie the
data and also to be continuous and normally distributed. We de-
rived a polychoric correlation matrix of the TFI-S items using the
PreLis subroutine of the LISREL software, version 8.51.
We selected principal axis (PA) factor analysis as the method
of extraction, as our interest was on the latent dimensions of the
variation the rating items shared in common versus the total
variation, which includes components associated with unique
and error variance. We also selected an oblique rotation method
(Promax) for interpretation of the resulting factors, based on our
assumption that the latent dimensions would be correlated to
some degree, rather than orthogonal. Analyses were conducted
using version 15.0 of SPSS for Windows.
Prior to the actual conduct of the PA analysis, we implemented
two recommended methods for determining the number of fac-
tors to be retained. The eigenvalue > 1 criterion tends to over-
estimate the number of relevant factors, while Cattell’s scree test
can involve a high degree of subjectivity on the part of the in-
vestigator. Velicer’s minimum average partial (MAP) test focuses
on the relative amounts of systematic and unsystematic variance
remaining in a correlation matrix after extractions of increasing
numbers of components or factors (O’Connor, 2000; Zwick &
Veliceer, 1986). Parallel analysis involves identifying the number
of components or factors that account for more variation than

the components or factors derived from random data of parallel
structure (Hayton, Allen, & Scarpello, 2004). O’Connor (2000)
provides syntax for running the MAP test and parallel analysis
with popular statistical software.
Internal consistency. Internal consistency assesses the overall re-
latedness of a set of items in a subscale. Cronbach’s alpha served
as the measure of internal consistency of each of the factors that
were retained from the exploratory factor analysis.
Initial validity analyses. A secondary objective of the study was
to conduct a preliminary examination of various aspects of the
validity of the retained factors. To examine concurrent validity,
we calculated the correlations between each of the retained fac-
tors and each of the subscales of the GCQ-S.
To examine predictive validity, we performed two sets of an-
alyses. First, we calculated the correlation between each of the
retained factors and each of the four outcome variables. Residual
change scores (pre-therapy to post-therapy) were calculated for
each of the four outcome variables. The scores represent the pa-
tients’ post-therapy status with their pre-therapy status taken into
consideration. Second, we performed four simultaneous regres-
sion analyses. In each analysis, all retained TFI-S factors were en-
tered as independent variables. The dependent variable was one
of the four outcome variables (represented as residual change
scores, as described above). The regression analyses consider the
collective and unique impact of the retained TFI-S factors, where-
as the correlation analyses consider the impact of each retained
TFI-S factor in isolation.
There is controversy in the literature regarding the impact of
group dependency, associated with the nesting of patients within
distinct groups, on the accuracy of statistical tests (e.g., Baldwin,
Murray, & Shadish, 2005). We considered the issue of whether
the individual rating data might be influenced by dependencies
associated with group membership. Dependencies associated
with distinct therapy groups did not characterize this sample
since the TFI-S ratings were obtained from a single group with
rolling membership, as opposed to several closed groups. This
does not of course rule out dependencies associated with certain
subgroupings of patients who were in the self-awareness group
at the same time, but we are not aware of methods to correct for
these nesting effects in groups with a rolling membership.
Results
Exploratory Factor Analysis
The MAP test indicated that three factors should be retained,

while the parallel analysis suggested a 5-factor solution would be
optimal. O’Connor (2000) reports that the former test tends to
underestimate, and the latter test to overestimate, the number of
factors to retain. Consequently, we decided to first examine the
4-factor solution that was identified in the PA analysis. The ratio
of subjects to variables (n/k) for the analysis was 3.97.
Table 1 displays the final 4-factor solution, including loadings
of the items and the means and standard deviations for each item.
The four factors comprised loadings (> .40 with no cross-loadings
on other factors) of 6, 7, 6, and 4 items, respectively. A repeat
of the analysis involving only these 23 retained items resulted
in 65.3% of the variance being accounted for by the items. Two
tests of sampling adequacy were conducted. The Kaiser-Meyer-
Olkin (KMO) measure of sampling adequacy and Bartlett’s test
of sphericity demonstrated that for the analysis employing all 44
items, the KMO measure = .863 and the Bartlett’s χ2(df = 946)
= 5485.44, p < .0001. For the analysis with only the 23 retained
items, the KMO = .900 and the Bartlett χ2 (df = 253) = 2735.24,
p < .0001. These results demonstrated that the rating data was
adequate for examination with the PA factor analysis.
The first factor accounted for the largest proportion of com-
mon variance (45.6%), with the remaining 3 factors accounting
for 9.3%, 5.3%, and 5.1%, respectively. The first factor (6 items)
was labeled “Instillation of Hope.” Items included “Group helps
me feel more positive about my future” and “Things seem more
hopeful since joining group.” The therapeutic dimension of uni-
versality was regarded as an important element of this factor, as
indicated by items such as, “This group helps me recognize how
much I have in common with other people.” The second factor (7
items) was labeled “Secure Emotional Expression.” Examples of
items included, “I get to vent my feelings in group” and “I can ‘let
it all out’ in my group.” The importance of the patients’ feeling of

belongingness was regarded as central to this factor, as reflected
by items such as, “I feel a sense of belonging in this group.” The
third factor (6 items) was assigned the label “Awareness of Rela-
tional Impact.” The items highlight the potential for developing
awareness about interpersonal impacts, both communicated and
received, in the group therapy environment. For example, “By get-
ting honest feedback from members and facilitators, I’ve learned
a lot about my impact on other people” and “In group I’ve really
seen the social impact my family has had on my life.” The fourth
factor (4 items) was labeled “Social Learning.” Items address the
recognition of patterns from outside relationships being played
out in group or, alternately, practicing new patterns of relating in
group for transfer to relationships in the real world. The factor
emphasizes the group environment as a “social microcosm.”
Alternative Factor Solutions
In order to be comprehensive, 3- and 5-factor solutions were also

examined and contrasted with the 4-factor solution described
above. The first factor in each of these alternate solutions com-
prised a large number of TFI-S items (20 and 15, respectively)
and, conceptually, was difficult to interpret. Similarly, the remain-
ing factors in each solution were characterized by several concep-
tually distinct items, which also posed interpretive difficulties.
The 4-factor solution was by comparison more parsimonious and
conceptually clearer, and it was therefore the solution retained
for further analysis.
Correlations Among Retained Factors
As shown in Table 2, correlations among the four factors were

moderate to high. Factor 1, Instillation of Hope, was highly cor-
related with both factors 2 and 3, but moderately correlated with
factor 4. The correlations among factors 2-4 were in the moder-
ate range. The shared variance among the four factors ranged
from 14% to 50%, thus indicating that the factors were not overly
redundant.
TABLE 1. Items and Loadings for Four Principal Axis Factors and Week 4 Descriptive Statistics
262
Principal Axis Factors

TFI-S Item (Week 4) 1 2 3 4 Mean SD
Instillation of Hope
23.Group helps me feel positive about my future. (Instillation of Hope) .97 .10 -.01 -.17 5.03 1.59
12.Things seem more hopeful since joining group. (Instillation of Hope) .97 -.06 -.15 -.09 5.20 1.54
34.This group inspires me about the future. (Instillation of Hope) .81 .12 .12 -.15 4.85 1.63
13. In group, I’ve learned that I have more similarities with others than I .76 -.29 .03 .20 5.42 1.47
would have guessed. (Universality)
32.This group helps empower me to make a difference in my own life. .59 .16 .23 -.10 5.06 1.40
(Existential Factors)
24. This group helps me recognize how much I have in common with .43 .15 .08 .28 5.16 1.40
other people. (Universality)
Secure Emotional Expression
42.I get to vent my feelings in the group. (Catharsis) -.13 .89 -.10 -.09 4.61 1.60
44.I can “let it all out” in my group. (Catharsis) -.25 .80 -.10 -.07 4.28 1.82
21.It’s okay for me to be angry in group. (Catharsis) -.25 .78 .13 -.12 5.02 1.62
41.Even though we have differences, our group feels secure to me. (Cohe- .17 .58 .04 -.08 4.94 1.51
siveness)
20.I feel a sense of belonging in this group.(Cohesiveness) .32 .56 -.13 .06 4.99 1.42
35.It touches me that people in the group are caring for each other. -.05 .54 .03 .21 4.85 1.63
(Altruism)
33.In group, the members are more alike than different from each other. .28 .40 .04 .18 4.97 1.36
(Universality)

Awareness of Relational Impact
40. By getting feedback from members and facilitators, I’ve learned a lot -.21 .05 .83 -.05 5.22 1.40
about my impact on other people. (Interpersonal Learning)
28.In group, I’ve really seen the social impact my family has had on my .15 -.18 .75 .20 5.57 1.36
life. (Recapitulation of the Family System)
29.Group has shown me the importance of other people in my life. (Inter- .36 -.10 .50 .00 5.35 1.40
personal Learning)
30. I pay attention to how others handle difficult situations in my group .23 .07 .45 .06 5.09 1.30
so I can apply these strategies in my own life. (Imitative Behavior)
43. It’s surprising, but despite needing support from my family, I’ve also .26 .20 .48 -.07 4.64 1.51
learned to be more self-sufficient. (Existential Factors)
37.I find myself thinking about my family a surprising amount in group. -.03 .06 .39 .29 5.29 1.50
(Recapitulation of the Family System)
Social Learning
17. Sometimes I notice in group that I have the same reactions or feelings -.20 .08 .01 .82 4.68 1.75
as I did with my sister, brother, or a parent in my family. (Recapitula-
tion of the Family System)
MACNAR-SEMANDS ET AL.
18. My group is kind of like a piece of the larger world I live in; I see the -.01 .18 -.01 .74 4.80 1.54
same patterns, and working them out in group helps me work them out
in my outside life. (Interpersonal Learning)
19.In group sometimes I learn by watching and later imitating what hap- -.06 -.28 .21 .64 4.10 1.61
pens. (Imitative Behavior)
2. Because I’ve got a lot in common with other group members, I’m start- .20 .02 -.20 .49 4.76 1.60
ing to think that I may have something in common with people outside
the group too. (Universality)
Note.Yalom’s therapeutic factor that each original TFI item was designated to measure is in parenthesis following the item content.
263
TABLE 2. Correlations Among Retained Factors (n = 174)

Secure Awareness of
Emotional Relational Social
Expression Impact Learning
TFI-S Factor
Instillation of Hope .67* .71* .56*
Secure Emotional Expression . 56* .38*
Awareness of Relational Impact .54*
*p < .0001.
Internal Consistency of Retained Factors
The alpha coefficients were .91 (factor 1), .86 (factor 2), .82 (factor
3), and .71 (factor 4), indicating high internal consistency among
the items of each factor. In no case did the alpha coefficient in-
crease for any factor with the removal of any one of its items.
This suggests that there were no weak items on any factor.
Concurrent Validity
Each of the four factors from the TFI-S was found to be signifi-
cantly associated with the Engagement subscale from the GCQ-S
(see Table 3). As shown in Table 3, the correlations were small
to moderate, and all in the direction of a positive relationship.
Higher ratings of an engaged group climate were thus associated
with higher ratings of Instillation of Hope, Secure Emotional Ex-
pression, Awareness of Relational Impact, and Social Learning.
We also found a significant inverse association between factor 2,
Secure Emotional Expression, and the Avoidance subscale of the
GCQ-S.
Predictive Validity
Table 4 displays the descriptive statistics and pre-post compari-

sons on the outcome measures. Significant change was shown
by the patient sample on each of the outcome variables. Table 5
shows the results from the correlation analyses involving the TFI-
S factors and the measures of outcome. Three of the four TFI-S
TABLE 3. Correlations Between TFI-S Factors and GCQ-S Subscales (n = 174)

GCQ Subscale
TFI-S Factor Engagement Avoidance Conflict
Instillation of Hope .40** -.08 -.11
Secure Emotional Expression .48** -.15* -.08
Awareness of Relational Impact .36** .06 .04
Social Learning .20** .14 .06
*p < .05.**p < .0001.
factors were significantly associated with change in quality of life

following treatment. Greater Instillation of Hope, Secure Emo-
tional Expression, and Awareness of Relational Impact at week 4
of treatment was associated with improved quality of life at the
termination of the 18-week treatment program. Similarly, two of
the four TFI-S factors were significantly associated with change in
general psychiatric symptoms. Greater Instillation of Hope and
Social Learning at week 4 were associated with improvement in
psychiatric symptoms at the end of treatment. All four TFI-S fac-
tors were significantly associated with total scores on the IIP, indi-
cating that higher scores on each of the factors at week 4 were
related to improvement in interpersonal functioning at termina-
tion of treatment. None of the TFI-S factors were significantly
associated with change in social functioning.
The regression analyses showed that the four TFI-S factors col-
lectively accounted for significant variance in outcome for three
of the four indices: QOLI, R2 = .09, F(4, 116) = 2.85, p < .03; GSI,
R2 = .10, F(4, 116) = 3.16, p < .02; and IIP, R2 = .16, F(4, 118) =
5.43, p < .0001. Secure Emotional Expression emerged as a sig-
nificant, unique predictor of improvement on the QOLI, t (116)
= 2.03, p < .05. Social Learning emerged as a significant, unique
predictor of improvement on the GSI, t (116) = 1.99, p < .05. No
single TFI-S factor emerged as a significant, unique predictor of
improvement on the IIP. The factors derived from the TFI-S were
not significantly associated with change in social role functioning
as measured by the SAS.
266
TABLE 4. Outcome Measures:Descriptive Statistics and Pre-Post Comparisons

Pretreatment Posttreatment Comparison
Outcome Variable n Mean SD n Mean SD t df
QOLI Total Score 121 -0.45 1.78 121 0.66 1.88 -7.77** 120
SAS-SR Global Functioning 124 104.18 22.35 124 92.76 22.76 7.54** 123
BSI Global Severity Index 121 1.46 0.50 121 0.82 0.61 10.01** 120
IIP Overall Score 123 1.74 0.51 123 1.33 0.61 8.07** 122
Note. QOLI = Quality of Life Inventory; SAS-SR = Social Adjustment Scale – Self Report; BSI = Brief Symptom Inventory; IIP = Inventory of Interpersonal Problems.
*p < .001.
TABLE 5. Correlations Between TFI-S Factors and Outcome Indices

Outcome Variable
TFI-S Factor Quality Social Role General Interpersonal
of Life Functioning Symptoms Distress
Instillation of Hope .23* -.07 -.25* -.36**
Secure Emotional Expression .29** -.07 -.16 -.23*
Awareness of Relational .20* -.14 -.16 -.33**
Impact
Social Learning .16 -.16 -.27* -.30**
*p < .05.**p < .01.
Discussion
Our hypothesis was that the factor structure of the TFI-S would
reflect fewer global dimensions of the therapeutic process than
the 11 distinct therapeutic factors seminally conceptualized by
Yalom (Yalom & Leszcz, 2005). In line with this prediction, we
identified four broad factors that accounted for the ratings on
the TFI-S; these factors were labeled Instillation of Hope, Secure
Emotional Expression, Awareness of Relational Impact, and So-
cial Learning. The four identified factors shared only moderate
amounts of variance, indicating that they were not overly redun-
dant. We also found preliminary evidence for the concurrent va-
lidity of the four factors; each of the factors was significantly as-
sociated with Engagement on the GCQ-S, and Secure Emotional
Expression was inversely associated with the Avoidance scale on
the GCQ-S. In addition, the predictive validity of the TFI-S was
suggested by significant associations between the four TFI-S fac-
tors and changes in quality of life, psychiatric symptoms, and in-
terpersonal distress following treatment completion.
Factor Structure
The preliminary findings regarding the TFI-S factor structure

seem consistent with the assertion of other researchers that the
large number of therapeutic factors discussed in the literature
can probably be represented by a small set of underlying dimen-
sions (Sexton, 1993). For example, Fuhriman and colleagues
(1986) argued that several of the traditional TFs “nest” within
one another rather than exist independently. Corsini and Rosen-
berg (1955), in the classic study examining 300 articles on group

psychotherapy, obtained and reduced 200 items by inspection
to nine general classes. They proposed that the nine categories
“appear to reduce to three factors: an intellectual one, consisting
of universalization, intellectualization, and spectator therapy; an
emotional one, consisting of acceptance, altruism, and transfer-
ence; and an actional factor, consisting of reality testing, interac-
tion, and ventilation” (p. 409). Other authors have specifically
proposed four central factors when examining TFs. For instance,
MacKenzie (1990) proposed a factor classification that included
insight (understanding, learning input and output), support (co-
hesiveness, universality, hope, and altruism), learning from oth-
ers (identification and guidance), and self-disclosure (catharsis).
While we are not imposing a conceptual framework on the data
due to the exploratory nature intended, parallels with the pre-
viously mentioned research can be seen with the Awareness of
Relational Impact, Instillation of Hope, Social Learning, and Se-
cure Emotional Expression factors, respectively, identified for the
TFI-S. MacKenzie (1990) also added existential factors and family
reenactment.
The first factor that emerged from our factor analysis of the
TFI-S, Instillation of Hope, has a history of support as one of the
most important therapeutic factors in groups (Goldstein, 1962;
Yalom, 1966). This factor appears to represent a form of motiva-
tion (e.g., “I can get better”). Such positive expectancy is often
described as the primary factor to impart to clients during the
initial phase of therapy. Positive expectations for group therapy
and hope for personal change have continued to emerge in the
literature as crucial to the process and outcome of group treat-
ments (Cox et al., 2004; Leary & Miller, 1986; MacNair-Semands,
2002; Piper & McCallum, 1994; Yalom, 2005). Mackenzie (1987),
in line with the findings of Kivlighan and Goldfine (1991) and
Reddon and colleagues (1999), found that hope is a significant
variable for group members, particularly in the first stages of a
group. We believe there is consistency between what we identify
as instillation of hope and what Yalom describes, but the factor
emerging in the present study also incorporates the concept of
universality. It is possible that these two concepts are connect-
ed because group clients experience universality as the basis of
hope. MacKenzie (1990) proposed that both hope and universal-

ity are included in the cluster of supportive factors that promote
a sense of belongingness and acceptance early in the group. This
works in both directions, as universality promotes hope and hope
may stimulate participation. He argues that this individual par-
ticipation can then actually serve to develop ideas of universality
in the member. MacKenzie (1990) also put forth that the devel-
opment of a sense of hope carries with it a motivation to engage
in therapy, thus providing a reduction in anxiety-mediated symp-
toms that further reinforces motivation. As discussed by Yalom
(Yalom & Leszcz, 2005), the experience of hope and universal-
ity are frequently accompanied by a sense of elation regarding
group membership.
The second TFI-S factor, Secure Emotional Expression, in-
cludes items about venting emotion in group but extends further
than the traditional “catharsis,” as items regarding a sense of be-
longing in the group also loaded on this factor. Secure Emotional
Expression appears to reflect a sense of connection with fellow
group members and thus may be an indication of comfort in
group. Establishing safety in the group through this sense of be-
longing may be coupled with becoming more honest and open.
It has been argued that emotional expression and personal infor-
mation are generally shared only after some time has been spent
with the group (Toseland & Rivas, 1998). As a result, Secure Emo-
tional Expression may refer to elements of transparency that be-
come more prominent as the group progresses. Castonguay and
colleagues (1998) identified a similar concept, termed expressed
emotion, and suggested that this concept is a core common factor
in group psychotherapy. This second factor thus reflects a cen-
tral process of group member engagement. The simple fact that
the members can express emotions safely is therapeutic, but the
exercise of this process also enables new perspectives and cor-
rective experiences. Self-revelation factors, as MacKenzie (1990)
labeled them, include self-disclosure and catharsis (both from
Yalom’s classification). Further, an experience of secure emotion-
al expression, particularly for those patients who present without
such a history, should lead to significant shifts in outcome. For
example, Mackenzie argued that when a group member decides
to put distressing information into words, that member may also

be enacting a decision to take issues seriously.
The third factor, Awareness of Relational Impact, encompasses
an awareness of both communicated and received interpersonal
messages. This factor appears to include the traditional concept
that Yalom labeled “interpersonal learning,” but also incorpo-
rates items about understanding how the member’s family system
may have contributed to interpersonal patterns and dynamics.
Awareness of Relational Impact, then, may indicate recognition
that the member is part of a social fabric and how one’s behav-
iors affects others in this broader fabric and, in turn, can be af-
fected by others’ behaviors. It is suggestive of the initiation of
a cognitive transformation that may occur when group clients
either bring an issue from outside of group and work on it in
the group, or move from working on an issue inside the group
to shifting a dynamic outside of group. Awareness of Relational
Impact is somewhat broader than Yalom’s interpersonal learn-
ing factor, which has a limited focus on the dynamics within the
group. Additionally, Awareness of Relational Impact appears to
be similar to the factor Kivlighan and colleagues (1996) labeled
“emotional awareness-insight,” which refers to a connection be-
tween affective experiences and cognitive factors associated with
gaining insight. Fuhriman and colleagues (1986) also included
insight as one of their four central factors in the group coun-
seling process, reflecting an incorporation of new information
realized in therapy together with knowledge of the self. Thus,
our third factor is a learning factor that reflects the process of
insight. Insight is often described as a complex concept with mul-
tidimensional implications, including two potential processes: one
that reflects understanding of the patient about his/her own psy-
chological process and the other interpersonal, referring to the
understanding of the nature of the relationships with the others
(Bloch, Crouch, & Reibstein, 1981). Awareness of Relational Im-
pact represents the internal components and states of mind that
may later be revealed in interpersonal actions (MacKenzie, 1990).
It encompasses much of what Yalom associated with “interper-
sonal input, such as modeling, vicarious learning, guidance, and
education.
The fourth factor, Social Learning, is also a learning factor,

emphasizing the skills acquired in the social microcosm of the
group environment. Through behavioral processes, such as ac-
tively watching and imitating others, recognizing how one is simi-
lar to others outside of group, and learning how to express and
communicate thoughts and feelings, group members learn more
effective strategies for social interactions. Essentially, this factor
represents the generalization of the learning occurring in the
group to the patients’ outside lives. High scores on the Social
Learning factor may suggest that the member is moving from in-
sight to behaving differently in an environment (i.e., a cognition
to behavior transition). While this transition to action is consid-
ered the most difficult to reach, leaders can provide interactional
opportunities in the group for the members to learn such role
flexibility (MacKenzie, 1990).
Concurrent Validity
Regarding the concurrent validity of the TFI-S, we found mean-

ingful relationships between the TFI-S factors and the Engage-
ment subscale of the GCQ-S (MacKenzie, 1983). The Engagement
scale of the GCQ-S reflects a positive working atmosphere, cap-
turing aspects of group cohesion and working alliance with the
group. Higher ratings of an engaged group climate in our study
were associated with higher ratings of Instillation of Hope, Se-
cure Emotional Expression, Awareness of Relational Impact, and
Social Learning. Engagement in group indicates the emergence
of working behaviors such as self-disclosure and group member
attempts to understand the meaning of behavior (MacKenzie,
1983; Ogrodniczuk & Piper, 2003). Furthermore, it is suggested
that tactful confrontation and challenging of other members in
an engaged group climate promote social learning. Thus, our
finding that being more fully engaged in the group therapy pro-
cess was related to the perceived presence of social learning and
the other three therapeutic factors is consistent with the existing
literature.
The second concurrent validity finding was the inverse rela-

tionship between Secure Emotional Expression and the Avoid-
ance subscale of the GCQ. One possible explanation for this re-
lationship is that the more patients perceived a group climate
characterized by an avoidance of important issues, the less secure
they felt in expressing their feelings. In the beginning of a group,
members are often insecure about expressing emotions. If the
members do not confront the avoidance, there will be little dis-
closure of important feelings and the group will likely suffer. Al-
ternatively, it is possible that this finding indicates that the more
insecure the members are about expressing their emotions, the
more the group climate will be characterized by avoidance be-
haviors. When members are insecure and reluctant to address
personal issues, they also are often hesitant to address issues that
develop in the group (Ogrodniczuk & Piper, 2003).
Predictive Validity
The associations between the TFI-S factors and treatment out-

come provide preliminary support for the predictive validity of
the TFI-S. The findings revealed that three of the four identi-
fied TFs (Instillation of Hope, Secure Emotional Expression, and
Awareness of Relational Impact) were associated with improved
quality of life at the end of the 18-week treatment program. All
four factors were also predictive of improvement in interpersonal
distress. It is possible that early in the group, the shared percep-
tion of these broad TFs promoted risk-taking among the patients.
Taking risks is a part of a reinforcing cycle (Tschuschke & Dies,
1994), creating therapeutic processes that contribute to positive
treatment outcome. Furthermore, Instillation of Hope and So-
cial Learning were significantly associated with improvement in
symptom distress. The hope that the therapy group would lead to
self-improvement and the belief that one was learning about his/
her impact on other people through the group experience might
help alleviate some of the distress that originally propelled the
patient to seek treatment.
Although these TFI-S factors were related to changes in psy-
chological symptoms, interpersonal distress, and quality of life,
they were unrelated to changes in social functioning. It is pos-
sible that the TFI-S factors were more relevant to changes in the
quality of a member’s interpersonal relationships, as measured
by the IIP, than to changes in a member’s performance in specific
social roles, such as employment, as measured by the SAS. Shifts
in specific tasks associated with, for example, partner or parent-
ing roles may take longer for the group member to make follow-
ing group therapy and require continued learning with feedback
from others. The regression findings provide further evidence
suggesting that specific TFI-S factors are associated with change
on QOL and symptoms, and that all four factors may be perti-
nent to change on interpersonal distress. However, these findings
need to receive replication to have confidence in the predictive
strength of the factors.
Overall, the present results are consistent with previous re-
search that demonstrated connections between therapeutic fac-
tors and outcomes (Johnson et al., 2005; Lieberman, Yalom, &
Miles, 1973; Ogrodniczuk & Piper, 2003; Tschuschke & Dies,
1994). MacKenzie and Tschuschke (1993) found that members
who reported higher levels of cohesiveness, acceptance and sup-
port in group experienced greater symptomatic improvement.
Interpersonal definitions of cohesion that focus on interactions
between group members have also been linked to symptomatic
improvement, particularly when they occur in the early phases of
group sessions (Budman et al., 1989). MacKenzie (1983) and Kiv-
lighan and Tarrant (2001) additionally suggested that the group
climate, particularly group engagement, has an important influ-
ence on the outcome of treatment.
Whereas the four factors found in this study represent com-
ponents of the group process, by no means do they capture all
phenomena occurring in therapy groups. While not intending
to be fully comprehensive of all group processes, we want to ac-
knowledge that other features of group process that are in the
literature are not represented by our factors. For instance, John-
son and colleagues (2005) put forth a classification of three fac-
tors: negative relationship factors, positive bonding, and positive
working relationships. Using Yalom’s TF framework, negative re-
lationship factors and other concepts (e.g., conflict) were clearly
not included. Thus, the derived dimensions using Yalom’s clas-
sification are self-limiting from a clinical-theoretical perspective.
Strengths and Limitations of the Study
There are a number of strengths associated with the present study.

We used a large sample of patients with complex clinical diagno-
ses who were engaged in an intensive group therapy program.
We made an effort to be thorough by examining factor structure,
internal consistency, concurrent validity, and predictive validity
in order to more fully develop the new scale and derive meaning
from the results. Current best practices were adhered to in the
application of factor analytic principles. We implemented both
Velicer’s MAP test and parallel analysis (O’Connor, 2000) to de-
termine the number of factors to be retained, and we then used
the matrix of polychoric correlations in the factor analysis, fol-
lowing recommendations for analyzing latent response variables
that are assumed to be continuous and based on ordered catego-
ries.
It is also important to be cognizant of several limitations of the
present study. First, since the ratio of subjects to variables for the
factor analysis was 3.97 rather than the more common standard
of five, the results of the PA analysis must be regarded as prelim-
inary and in need of replication. Because the factor analysis was
exploratory with no pre-set conceptual framework and did not
have the ideal number of subjects per variable, the results are
potentially sample-specific. Second, we are aware of the possibil-
ity for dependencies in the data and distortions of the statistical
tests related to the subgrouping of patients. Third, the results of
the present study may also be limited by the fact that the therapy
group we studied was psychodynamically oriented, provided in
the context of a day treatment program, and offered to patients
with significant personality pathology. Fourth, ratings were com-
pleted at the end of the self-awareness group with instructions to
rate this specific group, but we want to acknowledge that patient
experiences might be influenced by other treatments in the pro-
gram.
The factor structure of the TFI-S, which was originally de-
signed to tap into Yalom’s 11 factors, does not support using the
TFI-S for this purpose. Instead, based on the factor analysis, it
appears that the TFI-S is a measure of a smaller number of broad-
er constructs that perhaps subsume some of Yalom’s 11 factors.
Further research would be needed to test this hypothesis more

thoroughly.
Further studies are needed to replicate the present findings
with other kinds of group approaches, settings other than partial
hospitalization programs, and different patient populations. The
next stage in the scale’s development requires confirmation of its
factor structure and further establishment of various aspects of its
validity. This includes examining aspects of convergent, discrimi-
nant, and predictive validity. To this end, we are currently collect-
ing data in a multi-site study involving many outpatient groups
that serve different patient populations and ascribe to various
theoretical orientations. This initiative is being supported by the
Group Psychotherapy Foundation. Concerning the assessment of
factor structure, we will evaluate the fit of two alternate models,
one reflecting the four factors identified in this study and the
second specifying a higher-order structural model (i.e., the four
factors as facets of a more global, second-order “working group”
factor). To help establish the discriminant validity of the TFI-S,
we will also examine the associations between the TFI-S factor
scores and social desirability scale scores in order to determine
whether a tendency to provide socially desirable responses is re-
lated to endorsements of the presence of therapeutic factors in
group psychotherapy. We are also monitoring patient outcomes
in order to continue assessing the predictive validity of the TFI-
S. Additional future work that we intend on conducting with the
TFI-S concerns examining its association with other constructs
such as alliance and cohesion.
Conclusion
The practice of group psychotherapy is often guided by the as-

sumption that 11 distinct therapeutic factors operate in psycho-
therapy groups. We believe that this assumption should be exam-
ined more closely as evidence for fewer, more global therapeutic
factors emerges. The present study provides preliminary support
for the TFI-S, which measures four broad therapeutic factors. Al-
though this line of research is in the initial stages of development
with the present exploratory factor analysis, the TFI-S appears
to be a concise measure that may provide an efficient way for re-
searchers and clinicians to monitor group members’ perceptions

of the therapeutic process. Group therapists often informally
monitor the therapy process, adjusting group interventions in ac-
cordance with leader perceptions. However, data has shown that
formally tracking certain group processes can provide great bene-
fit because clinicians have difficulty making accurate assessments
(Hannan et al., 2005). Hannan and colleagues argue that repeat-
ed monitoring of the therapy process using patients’ perceptions
may create an opportunity for therapy realignment, the next step
in evidence-based treatment. The CORE Battery-Revised (Burl-
ingame et al., 2006) has recently been released for this purpose
and provides a variety of patient outcome and group process in-
struments for clinicians to use. The TFI-S could be considered as
an additional instrument to use for such therapy realignment if
future work can confirm its structure and validity.
References
Baldwin, S.A., Murray, D.M., & Shadish, W.R. (2005). Empirically sup-
ported treatments or Type I errors? Problems with the analysis of
data from group-administered treatments. Journal of Consulting and
Clinical Psychology, 73, 924-935.
Bednar, R. L., & Kaul, T. J. (1994). Experiential group research: Can
the cannon fire? In S. L. Garfield & A. E. Bergin (Eds.), Handbook of
Psychotherapy and Behavior Change (pp. 631-663). New York: Wiley.
Bernstein, I. H., & Teng, G. (1989). Factoring items and factoring sca-
les are different: Spurious evidence for multidimensionality due to
item categorization. Psychological Bulletin, 105, 467-477.
Bloch, S., & Crouch, E. (1985). Therapeutic Factors in Group Psychothera-
py. Oxford: Oxford University Press.
Bloch, S., Crouch, E., & Reibstein, J. (1981). Therapeutic factors in
group psychotherapy: A review. Archives of General Psychiatry, 38,
519-526.
Budman, S. H., Soldz, S., Demby, A., Davis, M., & Merry, J. (1993).
What is cohesiveness? An empirical examination. Small Group Re-
search, 24, 199-216.
Budman, S. H., Soldz, S., Demby, A., Feldstein, M., Springer, T., & Da-
vis, M. S. (1989). Cohesion, alliance, and outcome in group psycho-
therapy. Psychiatry, 52, 339-350.
Burlingame, G.M., Fuhriman, A., & Johnson, J. (2004). Process and

outcome in group counseling and group psychotherapy. In J.L.
DeLucia-Waack, D.A. Gerrity, C.R. Kalodner, & M.T. Riva (Eds.),
Handbook of Group Counseling and Psychotherapy (pp. 49-61). Thou-
sand Oaks, CA: Sage.
Burlingame, G. M., Fuhriman, A., & Johnson, J. E. (2002). Cohesion in
group psychotherapy. In J.C. Norcross (Ed), Psychotherapy Relation-
ships That Work: Therapist Contributions and Responsiveness to Patient
(pp. 71-88). New York: Oxford University Press.
Burlingame, G., Strauss, B., Joyce, A., MacNair-Semands, R., MacKen-
zie, R., Ogrodniczuk, J., & Taylor, S. (2006). American Group Psycho-
therapy Association’s CORE Battery – Revised. New York: American
Group Psychotherapy Association.
Castonguay, L. G., Pincus, A. L., Agras, W. S., & Hines, C. E. (1998).
The role of emotion in group cognitive-behavioral therapy for bin-
ge eating disorder: When things have to feel worse before they get
better. Psychotherapy Research, 8, 225-238.
Corsini, P., & Rosenberg, B. (1955). Mechanisms of group psychothera-
py: Processes and dynamics. Journal of Abnormal and Social Psycholo-
gy, 51, 406-411.
Cox, J. C., Burlingame, G. M., Davies, D. R., Gleave, R., Barlow, S., &
Johnson, J. (Feb. 2004). The Group Selection Questionnaire: Further
Refinements in Group Member Selection. Paper presented at the 61st
annual conference of the American Group Psychotherapy Associa-
tion, New York, New York.
Crouch, E. C., Bloch, S., & Wanlass, J. (1994). Therapeutic factors: In-
terpersonal and intrapersonal mechanisms. In A. Fuhriman & G.
Burlingame (Eds.), Handbook of Group Psychotherapy (pp. 269-315).
New York: Wiley.
Daroff, R. B. (1996). Group climate in an open-ended cancer support
group. Group, 20, 313-322.
Derogatis, L. R. (1993). Brief Symptom Inventory: Administration, Scoring,
and Procedures Manual. Minneapolis, MN: National Computer Sy-
stems.
Derogatis, L.R., & Melisaratos, N. (1983). The Brief Symptom Invento-
ry: An introductory report. Psychological Medicine, 13, 595-605.
Dierick, P. & Lietaer, G. (2008). Client perception of therapeutic factors
in group psychotherapy and growth groups: An empirically based
hierarchical model. International Journal of Group Psychotherapy, 58,
203-230.
Edwards, D. W., Yarvis, R. M., Mueller, D. P., Zingale, H. C., & Wagman,
W. J. (1978). Test-taking and the stability of adjustment scales: Can
we assess patient deterioration? Evaluation Quarterly, 2, 275–291.
First, M. B., Gibbon, M., Williams, J. B. W., Spitzer, R. L., & Benja-
min, L. S. (1998). Computer-Assisted SCID-II. Toronto, Ontario: Multi-
Health Systems.
First, M. B., Spitzer, R. L, Gibbon, M., & Williams, J. B. W. (1997). Struc-
tured Clinical Interview for DSM-IV Personality Disorders. Washington,
DC: American Psychiatric Press.
Freedman, S. M., & Hurley, J. R. (1980). Perceptions of helpfulness and
behavior in groups. Group, 4, 51-58.
Frisch, M. B. (1994). Quality of Life Inventory. Minneapolis, MN: Pearson
Assessments.
Frisch, M. B., Cornell, J., & Villanueva, M. (1992). Clinical validation of
the Quality of Life Inventory: A measure of life satisfaction for use
in treatment planning and outcome assessment. Psychological Assess-
ment, 4, 92-101.
Fuhriman, A., & Burlingame, G. M. (1994). Measuring small group pro-
cess: A methodological application of chaos theory. Small Group
Research, 25, 502-519.
Fuhriman, A., Drescher, S., Hanson, E., Henrie, R., & Rybicki, W. (1986).
Refining the measurement of curativeness: An empirical approach.
Small Group Behavior, 17, 186-201.
Goldstein, A. P. (1962). Therapist-Patient Expectancies in Psychotherapy.
New York: Pergamon.
Greene, L. (2003). The state of group psychotherapy process research.
International Journal of Group Psychotherapy, 53, 130-134.
Hannan, C., Lambert, M., Harmon, C, Nielsen, S. L., Smart, D. W.,
Shimokawa, K., & Sutton, S. (2005). A lab test and algorithms for
identifying clients at risk for treatment failure. Journal of Clinical
Psychology, 61, 1-9.
Hayton, J. C., Allen, D. G., & Scarpello, V. (2004). Factor retention de-
cisions in exploratory factor analysis: A tutorial of parallel analysis.
Organizational Research Methods, 7, 191-205.
Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureno, G., &Villasenor,
V. S. (1988). Inventory of Interpersonal Problems: Psychometric
properties and clinical applications. Journal of Consulting and Clini-
cal Psychology, 56, 885-892.
Johnson, J. E., Burlingame, G. M., Olsen, J. A., Davies, D. R., & Glea-
ve, R. L. (2005). Group climate, cohesion, alliance, and empathy in
group psychotherapy: Multilevel structural equation models. Jour-
nal of Counseling Psychology, 52, 310-321.
Joyce, A. S., Azim, H. F. A., & Morin, H. (1988). Brief crisis group psy-
chotherapy versus the initial sessions of long-term group psychothe-
rapy: An exploratory comparison. Group, 12, 3-19.
Kanas, N., Stewart, P., Deri, J., Ketter, T., & Haney, K. (1989). Group
process in short-term outpatient therapy groups for schizophrenics.
Group, 13, 67-73.
Kiesler, D. J. (1996). Contemporary Interpersonal Theory and Research. New
York: Wiley.
Kivlighan, D. M., & Goldfine, D. C. (1991). Endorsement of therapeu-
tic factors as a function of stage of group development and parti-
cipant interpersonal attitudes. Journal of Counseling Psychology, 38,
150-158.
Kivlighan, D. M., & Lilly, R. L. (1997). Developmental changes in group
climate as they relate to therapeutic gain. Group Dynamics: Theory,
Research, & Practice, 1, 208-221.
Kivlighan, D. M., & Mullison, D. (1988). Participants’ perception of
therapeutic factors in group counseling: The role of interpersonal
style and stage of group development. Small Group Behavior, 19,
452-468.
Kivlighan, D. M., Multon, K. D., & Brossart, D. F. (1996). Helpful im-
pacts in group counselling: Development of a multidimensional ra-
ting system. Journal of Counseling Psychology, 43, 347-355.
Kivlighan, D. M., & Tarrant, J. M. (2001). Does group climate mediate
the group leadership-group outcome relationship? A test of Yalom’s
hypotheses about leadership priorities. Group Dynamics, 5, 220-234.
Leary, M. R. & Miller, R. S. (1986). Social Psychology and Dysfunctional
Behavior: Origins, Diagnosis, and Treatment. New York: Springer-Ver-
lag.
Lese, K. P., & MacNair-Semands, R. R. (2000). The Therapeutic Factors
Inventory: Development of a scale. Group, 24, 303–317.
Lieberman, M. A., Yalom, I. D., & Miles, M. B. (1973). Encounter Groups:
First Facts. New York: Basic Books.
MacKenzie, K.R. (1983). The clinical application of a group measure. In
R.R. Dies & K.R. MacKenzie (Eds.), Advances in Group Psychotherapy:
Integrating Research and Practice (pp. 159–170). New York: Internatio-
nal Universities Press.
MacKenzie , K. R. (1987). Therapeutic factors in group psychotherapy:
A contemporary view. Group, 11, 26-34.
MacKenzie, K. R. (1990). Introduction to Time-Limited Group Psychotherapy
(1st ed.). Washington, DC: American Psychiatric Press.
MacKenzie, K. R., & Tschuschke, V. (1993). Relatedness, group work,
and outcome in long-term inpatient psychotherapy groups. Journal
of Psychotherapy Practice and Research, 2, 147-156.
MacNair-Semands, R. R. (2002). Predicting attendance and expectati-
ons for group therapy. Group Dynamics: Theory, Research, and Prac-
tice, 6, 219-228.
MacNair-Semands, R. R., & Lese, K. P. (2000). Interpersonal problems

and the perception of therapeutic factors in group therapy. Small
Group Behavior, 31, 158-174.
Magen, R., & Glajchen, M. (1999). Cancer support groups: Client outco-
me and the context of group process. Research on Social Work Prac-
tice, 9, 541-554.
Marziali, E., Munroe-Blum, H., & McCleary, H. (1997). The contri-
bution of group cohesion and group alliance to the outcome of
group psychotherapy. International Journal of Group Psychotherapy,
47, 475-497.
McGrath, J. E. (1997). Small group research, that once and future field:
An interpretation of the past with an eye to the future. Group Dyna-
mics: Theory, Research, Practice, 1, 7-27.
Nunnaly, J., & Bernstein, I. (1994). Psychometric Theory. New York: Mc-
Graw-Hill.
O’Connor, B. P. (2000). SPSS and SAS programs for determining
the number of components using parallel analysis and Velicer’s
MAP test. Behavior Research Methods, Instruments, & Computers, 32,
396-402.
Ogrodniczuk, J. S., & Piper, W. E. (2003). The effect of group climate on
outcome in two forms of short-term group therapy. Group Dynamics:
Theory, Research, and Practice, 7, 64-76.
Petry, N. M., Alessi, S. M., & Hanson, T. (2007). Contingency manage-
ment improves abstinence and quality of life in cocaine abusers.
Journal of Consulting and Clinical Psychology, 75, 307-315.
Piper, W. E., & McCallum, M. (1994). Selection of patients for group
interventions. In H. S. Bernard & K. R. MacKenzie (Eds.), Basics of
group psychotherapy (pp. 1-34). New York: Guilford.
Piper, W. E., Rosie, J. S., Joyce, A. S., & Azim, H. F. A. (1996). Time-
Limited Day Treatment for Personality Disorders: Integration of Research
and Practice in a Group Program. Washington, DC: American Psycho-
logical Association.
Reddon, J. R., Payne, L. R., & Starzyk, K. B. (1999). Therapeutic factors
in group treatment evaluated by sex offenders: A consumers’ re-
port. Journal of Offender Rehabilitation, 28, 91-101.
Roy, V., Turcotte, D., Montminy, L., & Lindsay, J. (2005). Therapeutic
factors at the beginning of the intervention process in groups for
men who batter. Small Group Research, 36, 106-133.
Sexton, H. (1993). Exploring a psychotherapeutic change sequence: Re-
lating process to intersessional and posttreatment outcome. Journal
of Consulting and Clinical Psychology, 61, 128-136.
Strupp, H.H., Horowitz, L.M., & Lambert, M.J. (1997). Measuring Pati-
ent Changes. Washington, DC: American Psychological Association.
Toseland, R. W., & Rivas, R. F. (1998). An Introduction to Groupwork (3rd

ed.). Needham Heights, MA: Allyn & Bacon.
Tschuschke, V., & Dies, R. R. (1994). Intensive analysis of therapeutic
factors and outcome in long-term inpatient groups. International
Journal of Group Psychotherapy, 44, 185-208.
Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment
by patient self-report. Archives of General Psychiatry, 33, 1111-1115.
Yalom, I. D. (1966). A study of group therapy dropouts. Archives of Gene-
ral Psychiatry, 14, 393-414.
Yalom, I., & Leszcz, M. (2005). Theory and Practice of Group Psychotherapy
(5th ed.). New York: Basic Books.
Zwick, W. R., & Velicer, W. F. (1986). Comparison of five rules for deter-
mining the number of components to retain. Psychological Bulletin,
99, 432-442.
Rebecca R. MacNair-Semands Received: June 4, 2008

Counseling Center Final draft: December 17, 2008
The University of North Carolina Accepted: December 17, 2008
at Charlotte
9201 University City Blvd.
Charlotte, NC 28223-0001
Email: RRMACNAI@uncc.edu.
View publication stats

MacNair Semands, 2011

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

MacNair Semands, 2011

Uploaded by

Copyright:

Available Formats

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

Structure and Initial Validation of a Short Form of the

Article in International Journal of Group Psychotherapy · April 2010

Rebecca R. MacNair-Semands Anthony Joyce

SEE PROFILE SEE PROFILE

The user has requested enhancement of the downloaded file.

THERAPEUTIC FACTOR INVENTORY

Structure and Initial Validation

Rebecca R. MacNair-Semands, Ph.D.

T herapeutic factors (TFs) (Corsini & Rosenberg, 1955; Yalom,

Rebecca R. MacNair-Semands is Senior Associate Director, Counseling Center, The Uni-

group psychotherapy and are believed to operate in all types of

The Interdependence of Therapeutic Factors

& Hines, 1998), cohesion (Budman et al., 1989; Budman et al.,

tance ratings, and correlations with outcome measures. However,

Measuring Therapeutic Factors in Group Therapy

Bednar and Kaul (1994) observed that greater precision in both

Q-sort is prototypical of the direct approach, which measures fac-

The Therapeutic Factors Inventory

In response to the need for a unified, direct measure of all ther-

were then placed in random order. Preliminary psychometric

The Therapeutic Factors Inventory-Short Form

The Therapeutic Factors Inventory-Short Form (TFI-S) is a de-

The present study was conducted to evaluate the Therapeutic

objective of the study was to conduct a preliminary examination

encourages the patients to explore perceptions of themselves and

Therapeutic Factors Inventory-Short Form. The Therapeutic Factors

outside the home, home-worker, or student; (2) social and leisure

social psychology (e.g., Kiesler, 1996). The IIP–64 consists of 64

Participants in the study were admitted on a consecutive basis to

Exploratory Factor Analysis. Prior to conducting factor analy-

required for factor analytic routines. Moreover, the correlation

of components or factors that account for more variation than

Exploratory Factor Analysis

The MAP test indicated that three factors should be retained,

it all out’ in my group.” The importance of the patients’ feeling of

Alternative Factor Solutions

In order to be comprehensive, 3- and 5-factor solutions were also

Correlations Among Retained Factors

As shown in Table 2, correlations among the four factors were

Principal Axis Factors

TABLE 2. Correlations Among Retained Factors (n = 174)

Internal Consistency of Retained Factors

Table 4 displays the descriptive statistics and pre-post compari-

TABLE 3. Correlations Between TFI-S Factors and GCQ-S Subscales (n = 174)

factors were significantly associated with change in quality of life

TABLE 4. Outcome Measures:Descriptive Statistics and Pre-Post Comparisons

TABLE 5. Correlations Between TFI-S Factors and Outcome Indices

The preliminary findings regarding the TFI-S factor structure

berg (1955), in the classic study examining 300 articles on group

hope. MacKenzie (1990) proposed that both hope and universal-

to put distressing information into words, that member may also

The fourth factor, Social Learning, is also a learning factor,

Regarding the concurrent validity of the TFI-S, we found mean-

The second concurrent validity finding was the inverse rela-

The associations between the TFI-S factors and treatment out-

Strengths and Limitations of the Study

There are a number of strengths associated with the present study.

Further research would be needed to test this hypothesis more

The practice of group psychotherapy is often guided by the as-

searchers and clinicians to monitor group members’ perceptions

Burlingame, G.M., Fuhriman, A., & Johnson, J. (2004). Process and

MacNair-Semands, R. R., & Lese, K. P. (2000). Interpersonal problems

Toseland, R. W., & Rivas, R. F. (1998). An Introduction to Groupwork (3rd