Positive Psychology and Curative

Community Groups: Life Satisfaction,

Depression, and Group Therapeutic Factors
Paula McWhirter
Julie Nelson
University of Oklahoma
Michael Waldo
New Mexico State University

Yalom’s therapeutic factors are examined in the context of small quilt-making

groups, revealing the presence of predominant curative factors. Additional results
reveal positive well-being reported among group participants through higher life
levels of satisfaction and lower levels of depression. Results of this preliminary
research provide initial support for encouraging participation in community-based
groups for individuals suffering from depression or among those seeking to improve
life satisfaction, given the demonstrated presence of therapeutic factors and the
potential to advance specific therapeutic goals.

Keywords: art therapy; community groups; positive psychology; therapeutic

factors

Group therapy is a highly effective form of psychotherapy that is at

least equal to individual psychotherapy in its power to provide mean-
ingful benefit (Yalom & Leszcz, 2005). Crucial aspects of the process
of change occur through an intricate interplay of human experiences
which Yalom refers to as therapeutic factors. These factors include:
instillation of hope, universality, imparting information, altruism, the
corrective recapitulation of the primary family group, socializing tech-
niques, imitative behavior, interpersonal learning, group cohesiveness,
catharsis, and existential factors. Therapeutic factors can help guide
the therapist’s selection of strategies to shape the group experience and
to maximize its potency with different clients in a variety of settings.

Manuscript submitted January 28, 2014; final revision accepted August 8, 2014.
Paula McWhirter, Ph.D., is an associate professor in the Department of Educational
Psychology at the University of Oklahoma. Julie Nelson, Ph.D., is now a psychol-
ogist at the Oklahoma City VA Medical Center. Michael Waldo, Ph.D., is a profes-
sor in the Department of Counseling and Educational Psychology at New Mexico
State University. Correspondence concerning this article should be addressed to
Julie Nelson, Department of Veterans Affairs, Oklahoma City VA Medical Center,
AMHC 3G-121, 921 Northeast 13th Street, Oklahoma City, OK 73104. E-mail:
julienelson4418@yahoo.com

THE JOURNAL FOR SPECIALISTS IN GROUP WORK, Vol. 39 No. 4, December 2014, 366–380
DOI: 10.1080/01933922.2014.955384
© 2014 ASGW
366
 McWhirter et al./CURATIVE COMMUNITY GROUPS 367

Specific therapeutic factors are found to be of relative importance

within different therapeutic groups. For example, factors found to
be helpful to patients on an alcohol in-patient unit include existen-
tial factors, self-understanding, cohesiveness, and catharsis (Ogilvie,
Blair, & Paul, 1995), while factors most important to one group of
cancer patients were instillation of hope, catharsis, imparting informa-
tion, existential factors, and group cohesiveness (Wang & Ming, 2006).
McLeod and Ryan (1993) studied the therapeutic factors experienced
by members of an out-patient therapy group for older women. They
compared their results with four other studies and found that four
studies listed catharsis and self-understanding as helpful therapeutic
factors. Three of the studies found universality and group cohesiveness
to be most helpful. McLeod and Ryan’s study results were unique in
that their results alone found existential awareness to be one of the
top five most helpful therapeutic factors in their out-patient therapy
group. They attribute this in part to the psychological reality of aging,
loss, and death that may be present among their target population of
older adult women (McLeod & Ryan, 1993).
Yalom suggests that psychotherapy is currently focused on increas-
ing clients’ positive emotional and conceptual expression of self, having
outgrown its previously singular emphasis on simply decreasing patho-
logical symptomatology (Yalom, 2005). Some of the tenets of positive
psychology include cultivating as much of a concern and interest in
building the best things in life as in repairing the worst; as con-
cerned with making the lives of normal people fulfilling as with healing
pathology (Seligman & Marshak, 2004). A group therapy approach
that encourages members to create and inhabit a powerful and caring
environment is a potent approach to these contemporary goals.
Based on a positive psychology approach to group therapy, it may be
of benefit to explore and utilize Yalom’s therapeutic factors in naturally
occurring community-based groups, such as quilt-making groups.

Women’s Therapeutic and Community Support Groups

Research suggests that group psychotherapy is effective in general

for treatment of older adults suffering from a variety of disorders
(Payne & Marcus, 2008). Various studies have been conducted on group
therapy experience in relation to women’s midlife challenges (Alonso &
Schermer, 2008), depression (Laitinen, Ettorre, & Sutton, 2007; Lara
et al., 2004; Stacciarini, O’Keefe, & Mathews, 2007) anxiety (McLeod &
Ryan, 1993), cancer survival (Cunningham et al., 1998; Wang & Ming,
2006), substance abuse (Ogilvie et al., 1995), disability (Seligman &
Marshak, 2004) and divorce related issues (Oygard, 2001). In terms of
women’s support groups specifically, a small subgroup of women with
368 THE JOURNAL FOR SPECIALISTS IN GROUP WORK/December 2014

metastatic breast cancer who attended outside support groups survived

significantly longer than those who did not (Cunningham et al., 1998).

Psychological and social benefits of textile arts groups. Textile arts

groups, such as quilting groups, constitute a thriving example of a
naturally occurring community-based group. An estimated 21 million
people, predominantly women (99%), engage in quilt making in the
United States, spending $3.58 billion dollars annually on quilting fab-
rics, notions, and books (“Quilting in AmericaTM 2010 Survey,” 2010).
Participating in quilt making within the context of small groups pro-
vides opportunity for: self-expression (Cerny, Eicher, & DeLong, 1993;
Reynolds & Prior, 2003;); meaningful relationships, sharing, communi-
cating, and nurturing (Schofield-Tomschin & Littrell, 2001); leadership
and learning (Dickie, 2003); mental/ emotional relaxation through dis-
traction and escape (Reynolds, 2000); physical relaxation (Reynolds,
2000); increased self-esteem through mastery/ competence (Reynolds,
2000); enhanced perceived control (Reynolds, Vivat, & Prior, 2007);
and meaningful work resulting in increased activity and energizing
thought (Reynolds, 2000).
It has been suggested that gender-role socialization orients women
toward leisure activities that involve relationships, sharing, communi-
cating, and nurturing (Schofield-Tomschin & Littrell, 2001). Perhaps
because textile art activity has been a predominantly female activ-
ity, these characteristics are particularly salient in textile hand craft
guilds (Schofield-Tomschin & Littrell, 2001). According to previous
studies, these very types of leisure activities contribute overall to suc-
cessful aging. Scholars have associated autonomy, self-worth, directed
learning, generativity, and the development of the self during social
interactions as key components to successful aging (Fisher, 1995).
Textile art guilds in general have been shown to incorporate these
components (Johnson & Wilson, 2005). By providing unique avenues
for intergenerational interaction, structure, participation in learning
and teaching activities (Dickie, 2003), and a sense of purpose, the
textile art guild is thought to contribute to women’s healthy aging
(Schofield-Tomschin & Littrell, 2001). In addition, involvement in tex-
tile art has been found to contribute to successful aging through
an enhanced sense of competence and worth, and through encourag-
ing relationships, communication, and caring (Schofield-Tomschin &
Littrell, 2001).

Depression. Compared with men, women are twice as likely to suf-

fer from clinical depression (Nolen-Hoeksema, 2001). Two constructs
linked to gender differences in depression include: ruminative cognitive
 McWhirter et al./CURATIVE COMMUNITY GROUPS 369

style (Nolen-Hoeksema, 2001) and maladaptive interpersonal depen-

dency (neediness) versus healthy interpersonal dependency (connect-
edness; McBride & Bagby, 2006). Involvement in needle craft activities
may counter these constructs by occupying the mind in ways that
decrease ruminative tendencies and by fostering relationships that
can lead to a perceived increase in connectedness with others. In a
study among residents in a nursing home, following 10 weeks of
an increase in pleasant events behaviors that included doing hand-
work such as needlecrafts, the majority of participants (80%) showed
decreased depression compared with a control group (Meeks & Depp,
2003).
Another way of looking at the effects of quilt making on depres-
sion has to do with the intense focus required by the task. The intense
focus of one’s attention on a seemingly innocuous task has been shown
in some studies to decrease stress perception (Dandeneau, Baldwin,
Baccus, Sakellaropoulo, & Pruessner, 2007). Furthermore, a seem-
ingly innocuous task that specifically directs one’s attention away
from perceived threat can help intercept the cascade of psychological
and neuro-endocrinological stress response (Dandeneau et al., 2007).
Quilt making could be employed as a response-focused coping strat-
egy offering emotional suppression or escape. It may also serve as
an antecedent-focused cognitive strategy by offering a choice for sit-
uation selection or automatic attention deployment that could alter
threat perception early in the primary appraisal stage before the
stress response is triggered. Some studies have demonstrated that
antecedent-focused strategies are associated with increased well-being
and improved interpersonal functioning (Gross, 2002).

Life satisfaction. Individuals use a judgment process to evaluate

life satisfaction that involves a unique assessment of self-imposed
standards (Shin & Johnson, 1978). If current conditions match
the individual’s standards, then the person reports high life sat-
isfaction. Engagement in an interesting activity can induce flow
(Csikszentmihalyi, 1997). Flow is characterized by intense absorption
in an activity, during which time seems to stop and feelings sus-
pend. Engaging in activities that induce the experience of flow strongly
predicts higher subjective reports of life satisfaction and well-being
(Cantor & Blanton, 1996; Csikszentmihalyi, 1997; Diener, Lucas, &
Oishi, 2002). It is common for quilters to describe a state of flow when
they speak of the activity of quilt making (Nelson, 2012), which offers
an escape and a distraction from worrisome thoughts.
This limited research reveals the benefits of participation in textile
art activities; however, to our knowledge, no published research specif-
ically relates to the psychosocial benefits of quilt making in the context
370 THE JOURNAL FOR SPECIALISTS IN GROUP WORK/December 2014

of small groups. These quilt-making groups provide the opportunity

for participants to experience the combined effects of an intentional
and focused activity in a small group environment that may be con-
ducive to curative change. In this study, we explore the extent to
which participation in small quilt groups affects participant subjec-
tive well-being as assessed through high levels of life satisfaction and
low levels of depression. Furthermore, we seek to identify the extent
to which Yalom’s therapeutic factors exist in these naturally occurring
community-based groups.

METHOD

Participants

Group members were recruited through announcements at local

quilt guild meetings and quilting classes. Once initial contacts were
made with willing participants, the use of snowball sampling was
employed. Snowball sampling makes use of community knowledge
about those who have skills or information in particular areas or are
a part of a specific identified population (Creswell, 2007). Each quilt-
ing group member was asked to complete a survey packet and to give
a survey packet survey packet to an individual of the same gender
and of similar age whom they knew was not involved in quilt mak-
ing. This group served as the matched control condition. The survey
packet for the matched control group was identical to the quilt-making
group except that it did not contain the Critical Incident Questionnaire
(CIQ). The CIQ was specific to quilt group members in order to
assess for Yalom’s therapeutic group factors present in quilt making
groups.

Participants in the quilt-making group condition. The final sample

of participants in the small quilt-making group condition consisted of
60 women from a variety of small quilt-making groups located in the
Midwestern United States. The ages of the participants ranged from
39 to 81 years old with an average age of 62. All quilting group member
participants identified as Caucasian.
The participants’ length of experience with quilt making repre-
sented a continuum. The shortest period that an informant had been
involved in quilt making was one year, in contrast to the longest period
of over 75 years with an average among the quilters of 21.48 years
of quilting experience. The quilt group memberships varied from
3 members for the smallest to 24 members for the largest with an
average of 12 members per group. The groups met on a regular basis,
ranging from once a week to once a month. The meetings consisted of
 McWhirter et al./CURATIVE COMMUNITY GROUPS 371

members’ gathering for 2 to 4 hr to engage in quilt-making activities

together in a shared space.
Group members reported that teaching and learning of new tech-
niques was a regular part of their meeting. Other regularly planned
small group activities included: sharing of food or a meal, working on
individual projects, working together on one large shared project, travel
or planned outings, “show and tell” related to quilting projects, and
sharing of personal stories and events that are not quilting related.

Participants in the matched control condition. Participants in the

matched control condition consisted of 41 women living in the
Midwestern United States. The ages of the participants ranged from
18 to 83 years with an average age of 41. All control group participants
identified as Caucasian except one African American and one Native
American.

Instruments

Demographic questionnaire. A demographic survey was employed to

collect data describing the participants by age and gender. Each partic-
ipant was also asked to estimate the number of hours per week spent
in social contact with people, and if they belong to a small group of any
kind. Specific questions were asked about the small group experience
such as the particular activities performed at the meetings, the number
of meetings per year and the duration of the meetings.

The Critical Incident Questionnaire (CIQ). The CIQ (Bloch,

Reibstein, Crouch, Holroyd, & Themen, 1979) was employed to assess
the therapeutic factors that group members experience while partici-
pating in small quilt group meetings. The questionnaire asks partici-
pants to write a response to the following questions, modified with the
addition of the words, “quilt making”: “What event, incident, or inter-
action ever occurred in your small quilt-making group that was most
helpful to you? Describe what happened, the feelings you experienced,
and how the event was helpful to you. Generally please list the reasons
that you participate in this small group.” Participants’ completed CIQs
were sent to a research affiliate who had experience reviewing group
members’ responses on the CIQ and identifying the primary therapeu-
tic factors evident in their responses. The affiliate conducted an initial
review of a subset of CIQs. He conducted a second review of the same
CIQs blind to the earlier ratings. He achieved a rate–rerate agree-
ment of 94% exact matches. The affiliate went on to rate the entire
sample, and rerate the entire sample blind to the earlier ratings. The
rate–rerate agreement on the entire sample was 85%. When there was
372 THE JOURNAL FOR SPECIALISTS IN GROUP WORK/December 2014

disagreement between the initial and subsequent ratings, a third rat-

ing was performed, and the third rating was used in data analysis. CIQ
ratings for assessing participants’ experience of therapeutic factors in
groups have been demonstrated to be reliable and valid in previous
studies, including high reliability ratings (assessed through interrater
agreement), which have averaged above 90% across studies (Kivlighan
& Goldfine, 1991; Waldo, Kerne, & Kerne, 2007; Wheeler, O’Malley,
Waldo, Murphy, & Blanck, 1992).

The Satisfaction with Life Scale (SWLS). Satisfaction with life was
assessed by the five-item SWLS (Diener, Emmons, Larsen, & Griffin,
1985), which assesses respondents’ current satisfaction with their life
in general. It consists of five questions (e.g., “In most ways my life
is close to my ideal”) which are rated on a 7-point Likert-type scale
(1 = stongly disagree, 7 = strongly agree) giving a possible range of
SWLS scores from 5–35. A score of 30–35 is considered very high.
Respondents who score in this range feel that life is enjoyable and
believe that the major domains of life are going well. Individuals who
score in the range of 5–9 are usually extremely dissatisfied with their
current life. Validation studies have shown that the SWLS comprises
a single factor and possesses high internal consistency (.87) and high
test–retest reliability (r = .82; Diener et al., 1985).

The Major (ICD–10) Depression Inventory (MDI). The MDI is a self-

rating inventory developed to measure DSM–IV and ICD–10 diagnoses
of major (moderate to severe) depression by the patients’ self-reported
symptoms. The MDI items cover the ICD–10 symptoms of depression
and the DSM–IV major depression symptoms with diagnostic sensitiv-
ity and specificity (Olsen, Jensen, Noerholm, Martiny, & Bech, 2003).
The questionnaire is brief and can be scored diagnostically by the
DSM–IV and ICD–10 algorithms as well as by its simple total score.
Higher scores indicate a deeper level of depression. Validation studies
have shown that the MDI comprises a single factor (Olsen et al., 2003)
and possesses adequate internal consistency ranging from .82–.92
(Bech, Rasmussen, Olsen, Noerholm, & Abildgaard, 2001; Olsen et al.,
2003).
Procedure

Survey packets were distributed to small quilting group members

who were asked to then distribute an identical survey packet to
non-quilters of similar age. The non-quilter participants served as
the matched control group. Packets contained consent and contact
information along with a postage paid envelope. Return of the survey
served as participant consent.
 McWhirter et al./CURATIVE COMMUNITY GROUPS 373

A total of 190 Packets (n = 190) were distributed and 101 were

returned (N = 101) indicating a response rate of 53%. Once received,
surveys were divided into quilt group participant responses and
matched control group participants. All data were entered into SPSS
for analysis except the Critical Incident Questionnaires (CIQ) that
were completed only by the quilt making participants and were for-
warded to an expert rater for further evaluation and scoring using a
rate–rerate procedure.
Independent samples t-tests were conducted to compare the cogni-
tive measure of subjective well-being (Satisfaction with Life Scale) and
the affective measure of subjective well-being (The Major Depression
Inventory) scores for women in small quilting groups and women not
involved in small quilting groups.

RESULTS

Critical Incident Questionnaire

The results of predominant therapeutic factors are presented in
Table 1. Expert raters identified the presence of one or more ther-
apeutic group factors within each of the quilting group participant
responses. Among the three predominant factors, the most prevalent
of Yalom’s therapeutic factors found in the women’s small quilting
group was Group Cohesiveness, which was identified as predominant
among 49.5% of group members’ responses. This was followed by
Altruism, identified as predominant among 16.34%. Development of
Socializing Techniques was the third most prevalent factor, identified
among 10.46%.

Table 1 Percentages of Predominant Therapeutic Factors in Women’s Small

Quilting Groups

Cohesion 39.21%
Altruism 16.34%
Socializing techniques 10.46%
Information 9.15%
Catharsis 7.19%
Modeling 6.54%
Family re-enactment 5.22%
Existential 2.61%
Hope 1.96%
Interpersonal learning 1.31%
Universality 0.00%
374 THE JOURNAL FOR SPECIALISTS IN GROUP WORK/December 2014

Group cohesiveness refers to the individual members’ sense of

belongingness. “Members of a cohesive group feel warmth and com-
fort in the group and a sense of belongingness; they value the group
and feel in turn that they are valued, accepted, and supported by other
members” (Yalom & Leszcz, 2005, p. 55). According to one study par-
ticipant, “There is support at every turn whether it be in my sewing,
my personal life such as death in the family, or just not feeling well.
I’m asked how I’m doing and it’s not just conversation. They each are
truly interested.” Another quilter shares that she is “at home” with the
women in her group “in a way that I wasn’t anywhere else.”
Altruism was the second most prevalent factor. It refers to the
opportunity to be of benefit to others through the offering of support,
reassurance, suggestions, and insight within the group as they share
similar problems with one another. An example of altruism present in
one group is given in the following words of a participant, “We have
one member of our small quilting group whose husband is desperately
ill with cancer, and one lady whose mate died of cancer a few years
ago. We have provided food, recipes, pillows, prayers, extra phone calls,
shoulders, information, and resources.” Quilting group members are
also known for extending the benefits of their work to the community
as evidenced in the words of this respondent, “It makes me feel great
to be part of an organization that makes quilts for infants in crisis
situations.”
Development of socializing techniques was the third most prevalent
factor. Group interactions provide an opportunity for members to learn
about discrepancies between their intention and their actual impact on
others. They may learn how to be responsive to others, acquire meth-
ods of conflict resolution and become less likely to be judgmental and
more capable of experiencing and expressing accurate empathy (Yalom
& Leszcz, 2005). One participant shared her social experience in the
following words, “We learned each other’s skills and weaknesses . . . we
encouraged each other and became closer friends because of the shared
time and interaction. We seemed to become more tolerant of each other
as we learned more about the other’s lives.”

Independent samples t-test. An independent samples t-test was con-

ducted to compare the MDI scores for Quilting Group Participants and
Non-Quilting Group Participants. There was a significant difference in
scores for Quilters (M = 8.83, SD = 7.03) and Non-Quilters (M = 13.37,
SD = 12.26); F(1,101) = 2.14, p = .04, eta2 = .04. The range of MDI
scores among all participants was 43 to 0 with high scores representing
deeper levels of depression.
An independent samples t-test was conducted to compare the
SWLS scores for Quilting Group Participants and Non-Quilting Group
 McWhirter et al./CURATIVE COMMUNITY GROUPS 375

Participants. There was a significant difference in scores for Quilters

(M = 27.27, SD = 5.39) and Non-Quilters (M = 24.27, SD = 6.99);
F(1,101) = 2.32, p = .04, eta2 = .05. The range of SWLS scores among
all participants was 10 to 35 with higher scores indicating a higher
level of life satisfaction.

DISCUSSION

This study reveals potential mental health benefits associated with

participation in small-group quilting. Results suggest that quilt group
study participants evaluate their lives more positively compared to
the matched control group. Depression scores were significantly lower
and satisfaction with life scores were significantly higher for quilters
than for the matched control group. These findings support the notion
that quilt making may mediate depression by occupying the mind in
ways that decrease ruminative tendencies (Nolen-Hoeksema, 2001).
Furthermore, quilting in small groups fosters relationships that can
lead to a perceived increase in social connection (Nolen-Hoeksema,
2001). From the perspective of stress response, participation in group
needle work activity provides mental and emotional relaxation through
distraction and escape as well as physical relaxation (Reynolds, 2000).
In addition to the benefits of social connectedness, intense focus of
one’s attention on the task of quilt making decreases stress percep-
tion (Dandeneau et al., 2007). Taken together, results suggest that
quilt making serves as an avenue for behavioral activation helpful in
decreasing depressive affect (Meeks & Depp, 2003).
A review of concepts relevant to positive psychology seems perti-
nent in terms of contextualizing study findings revealing lower rates
of depression and higher life satisfaction among those involved in quilt
groups. According to process/activity theories of happiness, engage-
ment in an activity of interest can induce flow, characterized by intense
mental absorption where there is an optimal balance between skill and
challenge. Higher life satisfaction and well-being are reported among
those who engage in activities that induce flow (Cantor & Blanton,
1996; Csikszentmihalyi, 1997; Diener et al., 2002). Small quilting
groups may create the conditions that allow members to experience
flow, thus explaining participants’ lower rates of depression and higher
life satisfaction.
Previous research suggests that participating in needle work activ-
ity within the context of small groups provides opportunity for
meaningful relationships, sharing, communicating, and nurturing
(Schofield-Tomschin & Littrell, 2001). Perhaps this social support
accounts for some of the differences between the two groups in this
study. It is interesting to note that the match control group reported
376 THE JOURNAL FOR SPECIALISTS IN GROUP WORK/December 2014

an overall higher number of hours spent with people per week than
did the quilters, yet depression and life satisfaction scores were still
significantly different in favor of the quilt group members. Drawing on
the concept of flow inducing process, it is possible that the added ele-
ment of a creative flow inducing activity along with therapeutic social
interaction can lead to an increase in favorable cognitive judgment of
life satisfaction and fulfillment (high SWLS scores) and a decrease in
negative affective evaluation of experience (lower MDI scores).

Therapeutic Group Factors

In addition to demonstrating increased well-being among small-

group quilters, this study is the first to explore the presence of
therapeutic group factors (Yalom & Leszcz, 2005) in small quilt-making
groups. Group Cohesion, Altruism, and Socializing Techniques were
the most prevalent factors found in the women’s small quilting group.
Importantly, group cohesiveness is a prerequisite for the function of
other therapeutic factors (Yalom & Leszcz, 2005). Groups with a
greater sense of solidarity value the group more highly and will have a
higher rate of participation, attendance, and mutual support (Yalom &
Leszcz, 2005).
Group cohesion, altruism, and socializing techniques are curative
factors that create a climate for healing and growth to occur within
small groups (Yalom & Leszcz, 2005). As participant reflections sug-
gest, the combination of these factors may help to create an atmosphere
conducive to positive emotional content. Interestingly, from a positive
psychology perspective, expression of positive emotion has been shown
to have lasting effects on psychological well-being (Fredrickson, 2003).
For example, exposure to positive emotion in lab settings resulted
in decreased anxiety arousal among research participants, including
decreased symptoms of physiological arousal, and improved cogni-
tive changes, such as broader attention, enhanced verbal fluency, and
increased openness to information (Fredrickson, 2003; Fredrickson &
Levenson, 1998). Based on these preliminary study findings, future
research might focus on the presence of positive emotion that may
result from participant experiences of Yalom’s factors, particularly
group cohesion, altruism, and socializing techniques. Critical connec-
tions may exist among specific group therapeutic factors and positive
emotion, which ultimately may serve to enhance long-term psychologi-
cal well-being among group members.

Issues in Assessing Therapeutic Factors

There are no known quantitative measures to assess the breadth

and depth of therapeutic group factors. Therefore, although other
 McWhirter et al./CURATIVE COMMUNITY GROUPS 377

therapeutic group factors clearly were represented within a partici-

pant response, only a single factor, the most salient factor as identified
by expert coders, was reported as predominant for each participant.
The CIQ identifies the presence of Yalom’s therapeutic group factors
and provides a rank order of the predominant factors. For example,
Group Cohesion may be the primary therapeutic factor in a participant
response, yet the respondent may also give answers that reflect sev-
eral other factors. These other factors are not reflected in the study
results. In the current study, Universality did not appear as a predom-
inant factor in any of the participant’s answers and was, therefore, not
reported in our results; however, evidence of Universality appeared in
five participant answers but not as the predominant factor.
Furthermore, ratings of intensity and depth of experience related
to therapeutic factors are not addressed when the focus is limited to
rating predominant therapeutic factors. In the current study, Family
Re-enactment ranked only seventh as a predominant response; how-
ever, when it was present, its impact may have been considered by
participants to be profound as illustrated by the following statement,
“We moved here from the East coast. . . . It was hard. I felt like I had
lost my identity. . . . Finally I met some of the members of the quilt-
ing group and before I knew it I had been welcomed in. It really saved
me. The members of this group are as close to me as family.” When
asked to list reasons that she participates in a quilt group, one partic-
ipant responded “You become like family. You take care of each other.”
Selecting one therapeutic factor per response helps control for sample
size and independent data collection but it also limits the results. These
limitations reflect a current need within the field in terms of measuring
the presence of therapeutic group factors.
In terms of methodological study limitations, use of a non-equivalent
(not randomly assigned) control group in this study precludes drawing
definitive conclusions about the impact of participating in a quilting
group because it allows alternative explanations for the differences
between quilt group members and others. For example, it is possi-
ble that a variable that was not measured (e.g., lack of disposable
income or lack of free time) caused people in the control group to
be more depressed, less satisfied with life, and less likely to partici-
pate in a quilting group. Similarly, being more depressed may have
caused control group members to refrain from participation in quilting
groups.

Implications for Intervention and Research

Trends identified in this study suggest that further research on

therapeutic factors present in other naturally existing community
groups may be warranted. Exploration of therapeutic factors present in
378 THE JOURNAL FOR SPECIALISTS IN GROUP WORK/December 2014

traditional therapy groups might be compared and contrasted with nat-

urally occurring groups present in the community. It may be possible to
utilize curative aspects of these naturally occurring community groups
to further specific individual counseling goals associated with group
therapeutic factors, for example, increasing social learning or facili-
tating feelings of belonging and hope. Additionally since quilting is
popular across ethnicity and culture as is evidenced by the high levels
of attendance at International Quilting Events (Houston International
Quilt Festival and Paducah Kentucky Quilt Festival), research focus-
ing on specific populations of quilt makers may be beneficial in the
facilitation of curative factors that can translate easily in multicultural
settings. Also it may prove advantageous to examine each therapeutic
factor separately to learn more about how each is created and fostered
in various community groups. Insights may help therapeutic group
leaders facilitate specific therapeutic factors when warranted. Finally,
future research employing randomly assigned experimental and con-
trol groups could help answer the question of whether quilting groups
cause participants to be less depressed and more satisfied with their
lives.
Ultimately, from a positive psychology perspective, study findings
provide a rationale to health care professionals and community service
personnel to discuss and encourage creative lifestyle pursuits, such as
quilting. These activities may be particularly important for individu-
als suffering from depression or seeking to improve life satisfaction.
Involvement in small group quilt making is readily adaptive to special
populations (such as clients who are managing chronic illness, disabil-
ity, or incarceration) in ways that fit particular constraints and ability
(Reynolds & Prior, 2003; Terichow, 2007). Findings may be considered
in light of managed care’s quest for brevity and uniformly structured
time-limited therapy. If effective, health care professionals might more
aptly consider prescribing participation in a creative social group such
as a small quilting group, given demonstrated therapeutic factors and
potential to advance specific therapeutic goals.

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