by Adri Badenhorst BOccTher (UP)


The best way to find yourself is to lose yourself in the service of others.

Mahatma Gandhi


“The Western world has a “scarcity mindset” common to many of us, no matter how much we have on a material level; we believe we are not successful enough, rich enough, beautiful or thin enough.  We simply don’t have enough or are not good enough.  We become so lost in our sense of that which is lacking, low self-esteem, and non-existent self-love that we forget that each of our lives is an essential part of a greater whole and that we have many gifts to offer to the world at large.” (Walker, 2009)


In general, a negative connotation has been formed around the concept of giving, because our lives in this day and age already demand so much of us.  Therefore, often when asked to give or to get involved in some form of altruism, we automatically show resistance.  This resistance is often rooted in a fear of losing something - “When I give, I lose (out)”.  Because of this, we attempt to avoid scenarios where we would be required to observe people’s insufficiencies or inadequacies and feel obliged to give or intervene.




American group therapist Irvin Yalom discovered that the outcome of altruism is not a feeling of emptiness or of being insufficient.  It is, in fact, quite the opposite.  He even went as far as considering altruism as having curative properties for the self-esteem (Yalom, 1995).



We therefore need new insight into this misunderstood concept.  In this article, we will have a look at the hidden treasures of altruism in terms of:


• What altruism means

• The origins of altruism

• Altruism in a group therapy setting

• Practical tips and ideas

• Linking with levels of creative ability

• Conclusion



Practical tips

What altruism means


Auguste Comte, founding sociologist and philosopher of science, was the first to identify the term "altruism" (French, altruisme, from autrui: "other people", derived from Latin, alter: "other") in the 19th century.  (Anonymous (A), n.d)


From the various definitions provided for altruism, it can be concluded that it consists of two basic aspects:


(1) An empathy/concern for the welfare of others.

(2) The deed of helping/providing/acting upon the needs of others.



In essence, altruism is the opposite of selfishness.  Giving alms to the poor is considered an altruistic act in many cultures and religions.  There is, however, a difference between altruism and duty: altruism is a motivation to provide something of value to a party, while duty focuses on a moral obligation towards a specific individual (e.g. a god or king), or collective (e.g. a government).  (Anonymous (A), n.d)


Every man must decide if he will walk in the light of creative altruism or in the darkness of destructive selfishness ~ Martin Luther King


Although most definitions of altruism state two aspects, group therapist Yalom identified a third aspect of altruism often overlooked by many, but of key importance to the therapist:


(3) A feeling of usefulness in helping (Yalom, 1995).


The act of physically doing something for somebody else has a hidden “reward” in store: an inner feeling that the giver still has something to offer others; that the giver is still needed and therefore of value.  This is crucial and essential to the human psyche.


It is therefore this “receiving by giving” concept that makes altruism a practical tool which the therapist can use in the process of re-instilling self-worth in group members who often struggle with feelings of worthlessness due to various reasons e.g. their inability to cope with the demands of life, failure, broken relationships or irrational thinking.


“The very nature of the therapy, in which group members help each other (while getting help), is reciprocal. This reciprocity gives way to feelings of altruism - which in itself has the capacity to make one feel better”.  (Wikibooks, n.d)



One step back – the origins of altruism


Richard Dawkins once said: “Let us try to teach generosity and altruism, because we are born selfish”.  He might have received a standing ovation the day he uttered his wise words, but how much scientific truth does his idea hold?


According to researchers at the University of Bonn, it has already been known from previous studies on twins that altruistic behaviour is partly influenced by our genes, but their researchers have now been able to narrow it down and establish a connection between a particular gene and altruistic deeds.  (Reuter, 2010)


Specific areas of the brain have also been associated with altruism and compassion.  The Center for Compassion and Altruism Research and Education states that their brain-imaging studies have demonstrated a burst of activity in a certain area of the brain known as the nucleus accumbens when people think compassionate thoughts. (Stanford University, 2009)


In her search for the first visible signs of altruism, Jessica Sommerville, associate professor of psychology at the University of Washington, conducted a study which presented the first evidence that a basic sense of fairness and altruism appears in infancy – even in babies as young as 15 months.  Her findings show that norms of fairness and altruism are even more rapidly acquired than what was previously thought.  The results of her experiment did, however, show that early in life there are individual differences in altruism.  "It's likely that infants pick up on these norms in a nonverbal way, by observing how people treat each other”. (University of Washington, 2011)


According to the researchers of Duke University Medical Centre, their results suggest that altruistic behaviour may originate from how people view the world rather than how they act in it.  "We believe that the ability to perceive other people's actions as meaningful is critical for altruism” said Dharol Tankersley, graduate student in Huettel's laboratory. (Broadfoot, 2007)


From the literature, it is evident that there are a genetic component and a “learnt behaviour” component to altruism visible even from a young age. This confirms that Richard Dawkins’s statement is therefore partially correct – we can learn to become more altruistic, although there may be a genetic predisposition to it.  The fact that we as humans are able to learn to be more altruistic is what therapists rely on within a group context.  We want to facilitate this learning in our group members in order for them to benefit from its healing power and in the end to grow into people with healthy relationships.



Altruism in a group therapy setting



Because altruism is proven to be partly genetic, certain people will have a natural tendency and ability to see other people’s needs and to act upon their needs.  However, the opposite might be true for people who did not fall into the right end of the gene pool.  Their development of altruism may even have been inhibited further by circumstances in which they did not have the opportunity to learn this skill through observing others.  Many group members have lost their trust and interest in other people due to pathology or trauma.


Whatever the case may be, the group setting provides the ideal opportunity and context for members to give and to receive from other people, for two main reasons:


1. Many psychiatric clients withdraw from other people; they feel isolated and awkward among others.  During group therapy, they feel that they are unconditionally accepted and valued as part of the group.  They feel more at ease and experience warmth and a sense of belonging.  (Fouché, 2010)  The group setting provides a context in which members have the opportunity to connect with other people and form new relationships.  This spontaneity stimulates altruism, as it is easier to give to someone familiar than to give to a stranger.  As members become comfortable and spontaneous in the group, they start to trust and will therefore be willing to risk reaching out to other people.


2. With the knowledge of the curative factors, the therapist is there to facilitate the full effect of altruism.  By just giving to someone else, the patient might miss the paradoxical curative effect altruism can have, as there might not be specific feedback from either or both the giver and the receiver through which the group members can realise the value of the “gift” given.  The therapist will therefore facilitate the necessary feedback from both parties.


Researchers confirmed the fact that the group setting is ideal for facilitating certain aspects.  They realized that it would be difficult to learn how to give if there were no one to give to, and have therefore looked into the effectiveness of therapeutic intervention and compared the individual therapy process with the group therapy process.  What they have discovered is that participating in a therapeutic venue comprising multiple therapeutic relationships produced therapeutic factors that were unique to the group format. Examples include vicarious learning, role flexibility, universality, altruism, and interpersonal learning. (American Group Psychotherapy Association, 2007)


The group is a place where members can help each other, and the experience of being able to give something to another person can lift the member's self-esteem and help develop more adaptive coping styles and interpersonal skills. (Anonymous (B), n.d)


The group setting provides an opportunity to learn not only how to give, but for some clients it is imperative to learn how to receive, as well as to develop insight into the impact it has on themselves and other people.


Members gain a boost to self-concept through extending help to other group members.

(American Group Psychotherapy Association, 2007)


There is, however, an important prerequisite before altruism can be facilitated successfully within a group setting.  When people feel distant and unsafe among other people, they feel reluctant and even anxious to reach out to them.  Therefore, before people can risk reaching out, they need the security of feeling connected to the other group members.  This feeling of connectedness is also known as cohesion.


An interesting study by psychologists at the Universities of Kent and Liverpool has revealed that laughter increases altruism towards strangers.  They concluded that laughter acts as a social lubricant that enhances a sense of group identity among strangers.  Professor van Vugt also pointed out that humans may have evolved the capacity for laughter to quickly release positive emotions in order to facilitate group bonding. (Backing, 2007)


This study can be summarized as follows:




Sense of group identity / bonding / spontaneity (COHESION)




Although their research used the “lubricant” of laughter, they identified an important aspect needed for altruism to take place spontaneously:  a sense of group identity or group bonding.  In group therapy terms: COHESION.


When feeling connected to people, group members will show spontaneity and will therefore be more comfortable to risk reaching out to others.  The group therapist should therefore lay a firm foundation of cohesion before she starts facilitating the curative factor of altruism.


For more information on cohesion, refer to the article:  Cohesion Explored – A force to be reckoned with. (Nieuwenhuizen, 2011)



Practical tips and ideas


Although giving something or doing something physical for someone in the group can be rewarding, there are a variety of other ways in which group members can “give” to each other.  They often offer other members advice, support, feedback, insight, assurance, suggestions, compliments or comfort, but this can easily be overlooked by both the receiver and the therapist.  Sometimes group members take risks in giving something (e.g. giving advice) but don’t get any feedback on it.  Without feedback, they might miss the positive impact it had on other people and not realise that they still have something to offer.  Without feedback, they might feel unheard or unseen and might not have the willingness to give again; which is contradictory to altruism.




The therapist’s role is key in facilitating the healing power of altruism throughout the course of the group process.  The therapist therefore needs to be alert and aware of these subtle actions and make the giver and the receiver aware of their altruistic deeds in order to facilitate the benefit for both.


The following diagrams demonstrate the difference between a case where the therapist doesn’t facilitate altruism and a case where she does.



Diagram 1: Person A risked reaching out and made Person B a card.  Person B was polite and replied with a “Thank you”.  No further interaction was facilitated; therefore the altruistic effect was minimal.

Diagram 2: Person A risked reaching out and made Person B a card.  The group therapist facilitated the first aspect of altruism by asking person A to share something about the process she followed in making the card specifically for person B.  Person A elaborated about the colours she used: “When I made this card, I specifically used lots of colours because I see you as such a colourful person”.


Person B was touched by the compliment, but only replied with a polite “Thank you”.  The therapist observed appreciative non-verbal cues and asked Person B:  “You seem touched by Mrs A’s card. Tell her what impact it has had on you”.


Person B expressed her feelings and added a compliment: “It makes me feel special.  I really appreciate your attention to detail and the effort you put in.”  In return, Person A felt touched by Person B’s reply and felt appreciated.

Both Person A and Person B walked away with a feeling of worth.  Altruism was facilitated successfully.


It is therefore crucial that the therapist notices potential opportunities for altruism so that it can be facilitated effectively.  Observing non-verbal behaviour helps.


Altruism can be facilitated during all the phases of the group work process. (Fouchè, 2010)  As soon as a firm foundation of cohesion is laid, members might spontaneously start reaching out to other group members.  The therapist can also select the specific goal of facilitating altruism as part of an activity or discussion.  Here are a few ideas:


a) Giving something physical


• Making something for another group member.  Examples include any arts/crafts product like a drawing, painted plaster of Paris figure, leather article, gift box, collage, key holder, fridge magnet, bracelet, Christmas stocking, Christmas cracker, biscuits, coasters, picture frame, potpourri sachet,  pot plant, bath salts, etc.


• Writing something to other group members.  Examples include a card, letter or poem.  Ideas for themes might be: a compliment, something you appreciate or admire about the person, a message of hope or encouragement, etc.


• Selecting something for another group member which reminds you of him/her; a metaphor.  Examples include something from nature, a picture from a magazine, etc.


• Giving physical support.  Examples include doing an obstacle course, participating in a team sport like volleyball or cricket, etc.


• Reaching out to the greater community. Examples include reaching out to a children’s home or old age home.  Ideas for activities may include: making toys, organising a fun day, organising a jumble sale, presenting a play, hosting a Carols by Candle Light event, etc.





Remember: The therapist should request that the person who made the gift or selected the object describe what he/she did to make the gift special for that specific group member.  This, however, is only the first part of the process and needs to be followed up with the most important part: The therapist now asks the person who received the gift to explain what makes the gift special to him/her, to ensure that altruism will have the necessary curative impact. (Fouché, 2010)


b) Giving in words


• Giving positive feedback.  This can be facilitated as part of your activity or discussion.   Examples: Something you like, appreciate or admire about a group member; something that inspires you about the person; encouragement or messages of hope.  Questions at the end of a session can also facilitate positive verbal feedback, for example: “Who meant the most to you during the group today?” or “From whom did you learn the most today?”  Remember to ask them to explain the reason for their choice.


• Giving support/ideas/advice/suggestions.  The therapist needs to choose topics that would facilitate this aspect.  Ideas for topics may include stress or conflict management, overcoming depression, losses, relationships, etc.

Example during a group session: Mrs G shares with the group that she struggles to keep her thoughts off her deceased husband and doesn’t know how to handle it.  The therapist asks the group if anyone has ever experienced the same problem before.  Mrs W indicates that she has.  The therapist asks Mrs W whether she would be willing to share how she handled it.  Mrs W says that she started a new hobby and discovered that it took her mind off her loved one and simultaneously lifted her mood.  The therapist asks Mrs G to tell Mrs W what she thinks of her idea.  Mrs G replies with a smile and says:  “I think it may be a good idea – I actually used to enjoy doing mosaic and think that I should start again.  Thank you for the idea.”



Linking with levels of Creative Ability


The theory of creative ability was developed by Vona du Toit, a key figure in the development of occupational therapy in South Africa, who was renowned internationally, to meet this demand. The theory provides a theoretical framework to evaluate a patient’s occupational performance according to skills he/she has attained in the personal, social, work and recreational occupational performance areas.  It also provides guidelines for treatment by identifying treatment requiring emphasis, principles to ensure effective therapy, expected performance of the patient, and criteria for grading. (Crouch & Alers, 1997)


Each of the levels of creative ability will be discussed briefly in terms of group work and altruism.


1. Self-differentiation

During this stage, patients are more open to social contact, but have no concept of social norms.  They start recognising certain people as familiar and others as unfamiliar.

The focus of groups should assist members in developing awareness of the environment and other people.  There will be little interaction between group members, but they should be encouraged to make contact with others.  Activities should be concrete and simple. (Crouch & Alers, 1997)

Although members in this phase might not experience the full effect of altruism yet, as their thought patterns are concrete, they can  “give” something to other members when making contact, for example sharing eye contact or shaking hands.  However, the emphasis is on making contact with the other person, and therefore altruism is not facilitated.


2. Self-presentation

On this level, members start developing the basic components of self-concept; they have a sense of belonging to a group; they start interacting with others in a basic, fundamental and even superficial way; and they try to explore the ability to influence the environment.

Treatment should focus on practising both verbal and non-verbal social skills in order to explore the effect they have on other people.  Activities should still be concrete and should allow exploration.  (Crouch & Alers, 1997)  Once again, true altruism is not appropriate for this level, but the therapist can request the group members to make something concrete for each other in the group and then give it to them.


3. Passive participation

Group members become more goal-directed and show interest in the totality and purpose of activities, but are not yet able to initiate these independently.  Ideals and morals start to develop and more refined emotions such as regret, sympathy, and loyalty are evident.  The group members will tend to experiment with their own behaviour by following what others do.  They can discuss a wide range of subjects, although they might demonstrate a reluctance to initiate conversation.  They like to be involved with a group, but not to be singled out to give an individual opinion or suggestion.

The objectives for treatment include making members aware of- and learning- or experimenting with skills that make them acceptable to society.  They still need to be shown practically through the use of examples.  They should be encouraged to participate in activities and discussions.  Occupational group therapy can be presented at this stage, as altruism can play an important role and members discover how they can have an impact upon others.


4. Imitative participation

During this stage, members should be able to comply with norms set by society for socially acceptable behaviour.  Members will, however, tend to do what is asked of them - no more and no less.  They are able to form more mature relationships now, but tend to function better in familiar settings.

This patient’s concept of self is still low and can therefore benefit from the positive effect of altruism.  The discovery of how he/she can have a positive impact on others will increase self-worth and spontaneity, and help him/her to form more mature relationships.


5. Active participation

This level is directed towards improving or changing aspects of activities or behaviour where the individual has identified a problem.  The patient does, however, still lack sensitivity to the needs of others.  (Crouch & Alers, 1997)

Altruism can be facilitated effectively on this level.  Group members enjoy the sense of belonging, although their motivations might still be egocentric.  They can therefore be effectively made aware of their actions and altruistic deeds and how these affect others.






Yalom truly discovered a jewel when he investigated the curative properties of altruism. Understanding the working and curative power of altruism can contribute significantly to the therapist’s repertoire of tools which he/she can use for effective group therapy.  This tool can be versatile and cost-effective and has the ability to deliver rewarding results in terms of the group process as well as the group members individually.



On a group level, a firm foundation of cohesion paves the way for altruism to take place.  When it does take place, group members feel more connected to each other and it therefore strengthens the cohesion of the group.


On a personal level, successful altruism gives members a sense of worth which in turn will make them feel more confident to reach out to other members again.


It is therefore essential that group therapists continually practise their skills in facilitating altruism in their group in order to be as effective as possible and to benefit from the curative capacity of altruism.  It can greatly contribute to the success of the process.


People think that heroes are born, not made; that they can’t be heroes.  The fact is that most heroes are ordinary people.  It’s the heroic act that is extraordinary ~ Philip Zimbardo.



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