Description
InstructionsSubmit an annotated bibliography of 5 readings (individual chapters of an edited book or separate scholarly journal articles) that contributed to your knowledge and understanding of group work. You may use articles assigned for the class, but one of the articles must be found by searching the literature. Articles that come from “online, a.k.a. the internet,” should be from scholarly journal article sources and full text only. Your articles can all be on one topic (e.g., groups for adolescents with eating disorders), or can be on five different topics of interest to you. The major requirement is that the article has to describe some example of group work and/or research about the use of groups. Articles focusing on practice with individuals only will not be accepted. In the bibliography, first cite the reference (in APA format) and then summarize the major points of the article or chapter. Second, critique the article or chapter based on the information presented. Third, discuss whether this article may be helpful to you in your work – now or in the future. Fourth, discuss how the reading apply to one of the five social work perspectives in the social work department (i.e., Black, Empowerment, Global, Strength, and Rural Perspective). There are sample bibliographies available through electronic reserves for this course.You should submit an actual photocopy or pdf of two of the five readings.Your total annotated bibliography should be no less than 6 pages, and should be typed, double-spaced, and in 12-point font. A separate Reference Page is not required, since the references will already be listed in the body of the paper.Please view the following information and samples of annotated bibliographies before beginning your assignment: https://youtu.be/O8nO9rezBNk Annotated-Bibliography—Creating Annotated Bibliographies Based on APA Style
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EDITION
The Theory and Practise of Group
IRVIN D. YALOM
with MOLYN LESZCZ
G RO U P
PS YC H O T H E RA P Y
I RV I N D. YA L O M
W I’f’ H
M O LY N L ES Z C Z
9AS lCi
Table of Contents
ALCO BY IRVIN D. YALOM
Title Page
DEDIGATION
PrefaGe
AGknowledgementc
€hapter 1 – THE THERAPEUTI€ FA€TORS
INSTILLATION OF HOPE
UNIVERSALITY
IMPARTING INFORMATION
ALTRUISM
THE €ORRE€TIVE RE€APITULATION OF THE PRIMARY
FAMILY GROUP
DEVELOPMENT OF SO€IALIZING TE€HNIQUES
IMITATIVE BEHAVIOR
€hapter 2 – INTERPERSONAL LEARNING
THE IMPORTAN€E OF INTERPERSONAL RELATIONSHIPS
THE €ORRE€TIVE EMOTIONAL EXPERIEN€E
THE GROUP AS SO€IAL MI€RO€OSM
THE SO€IAL MI€RO€OSM: A DYNAMI€ INTERA€TION
RE€OGNITION OF BEHAVIORAL PATTERNS IN THE SO€IAL
MI€RO€OSM
THE SO€IAL MI€RO€OSM—IS IT REAL?
OVERVIEW
TRANSFEREN€E AND INSIGHT
€hapter s – GROUP €OHESIVENESS
THE IMPORTAN€E OF GROUP €OHESIVENESS
ME€HANISM OF A€TION
SUMMARY
€hapter 4 – THE THERAPEUTI€ FA€TORS: AN INTEGRATION
€OMPARATIVE VALUE OF THE THERAPEUTI€ FA€TORS: THE
€LIENT’S VIEW
€OMPARATIVE VALUE OF THE THERAPEUTI€ FA€TORS:
DIFFEREN€ES BETWEEN €LIENTS’ AND …
THERAPEUTI€ FA€TORS: MODIFYING FOR€ES
€hapter 5 – THE THERAPIST: BASI€ TASKS
€REATION AND MAINTENAN€E OF THE GROUP
€ULTURE BUILDING
HOW DOES THE LEADER SHAPE NORMS?
EXAMPLES OF THERAPEUTI€ GROUP NORMS
€hapter 6 – THE THERAPIST: WORKING IN THE HERE – AND – NOW
DEFINITION OF PRO€ESS
PRO€ESS FO€US: THE POWER SOUR€E OF THE GROUP
THE THERAPIST’S TASKS IN THE HERE-AND-NOW
TE€HNIQUES OF HERE-AND-NOW A€TIVATION
TE€HNIQUES OF PRO€ESS ILLUMINATION
HELPING €LIENTS ASSUME A PRO€ESS ORIENTATION
HELPING €LIENTS A€€EPT PRO€ESS-ILLUMINATING
€OMMENTS
PRO€ESS €OMMENTARY: A THEORETI€AL OVERVIEW
THE USE OF THE PAST
GROUP – AS – A – WHOLE PRO€ESS €OMMENTARY
€hapter 7 – THE THERAPIST: TRANSFEREN€E AND
TRANSPAREN€Y
TRANSFEREN€E IN THE THERAPY GROUP
THE PSY€HOTHERAPIST AND TRANSPAREN€Y
€hapter 8 – THE SELE€TION OF €LIENTS
€RITERIA FOR EX€LUSION
€RITERIA FOR IN€LUSION
AN OVERVIEW OF THE SELE€TION PRO€EDURE
SUMMARY
€hapter 9 – THE €OMPOSITION OF THERAPY GROUPS
THE PREDI€TION OF GROUP BEHAVIOR
PRIN€IPLES OF GROUP €OMPOSITION
OVERVIEW
A FINAL €AVEAT
€hapter 10 – €REATION OF THE GROUP: PLA€E, TIME, SIZE,
PREPARATION
PRELIMINARY €ONSIDERATIONS
DURATION AND FREQUEN€Y OF MEETINGS
BRIEF GROUP THERAPY
PREPARATION FOR GROUP THERAPY
€hapter 11 – IN THE BEGINNING
FORMATIVE STAGES OF THE GROUP
THE IMPA€T OF €LIENTS ON GROUP DEVELOPMENT
MEMBERSHIP PROBLEMS
€hapter 12 – THE ADVAN€ED GROUP
SUBGROUPING
€ONFLI€T IN THE THERAPY GROUP
SELF-DIS€LOSURE
TERMINATION
€hapter 1s – PROBLEM GROUP MEMBERS
THE MONOPOLIST
THE SILENT €LIENT
THE BORING €LIENT
THE HELP-REJE€TING €OMPLAINER
THE PSY€HOTI€ OR BIPOLAR €LIENT
THE €HARA€TEROLOGI€ALLY DIFFI€ULT €LIENT
€hapter 14 – THE THERAPIST: SPE€IALIZED FORMATS AND
PRO€EDURAL AIDS
€ON€URRENT INDIVIDUAL AND GROUP THERAPY
€OMBINING GROUP THERAPY AND TWELVE-STEP GROUPS
€O-THERAPISTS
THE LEADERLESS MEETING
DREAMS
AUDIOVISUAL TE€HNOLOGY
WRITTEN SUMMARIES
GROUP THERAPY RE€ORD KEEPING
STRU€TURED EXER€ISES
€hapter 15 – SPE€IALIZED THERAPY GROUPS
MODIFI€ATION OF TRADITIONAL GROUP THERAPY FOR
SPE€IALIZED €LINI€AL SITUATIONS: …
THE A€UTE INPATIENT THERAPY GROUP
GROUPS FOR THE MEDI€ALLY ILL
ADAPTATION OF €BT AND IPT TO GROUP THERAPY
SELF-HELP GROUPS AND INTERNET SUPPORT GROUPS
€hapter 16 – GROUP THERAPY: AN€ESTORS AND €OUSINS
WHAT IS AN EN€OUNTER GROUP?
ANTE€EDENTS AND EVOLUTION OF THE EN€OUNTER
GROUP
GROUP THERAPY FOR NORMALS
THE EFFE€TIVENESS OF THE EN€OUNTER GROUP
THE RELATIONSHIP BETWEEN THE EN€OUNTER GROUP
AND THE THERAPY GROUP
€hapter 17 – TRAINING THE GROUP THERAPIST
OBSERVATION OF EXPERIEN€ED €LINI€IANS
SUPERVISION
A GROUP EXPERIEN€E FOR TRAINEES
PERSONAL PSY€HOTHERAPY
SUMMARY
BEYOND TE€HNIQUE
Appendix – Information and Guidelines for Participation in Group Therapy
Notec
Index
Copyright Page
ALSO BY IRVIN D. YALOM
Exictential PCYGHOTHERAPY
Every Day Getc a Little Clocer: A TWIGE-Told Therapy
(with Ginny Elkin)
ENGOUNTER Groupc: Firct FAGTC
(with Morton A. Lieberman and Matthew B. Miles)
Inpatient Group PCYGHOTHERAPY
CONGICE Guide to Group
PCYGHOTHERAPY (with Sophia
Vinogradov)
Love’c EXEGUTIONER
When NIETZCGHE
Wept Lying on the
COUGH
Momma and the Meaning of Life
The Gift of Therapy
The CGHOPENHAUER Cure
ALSO BY MOLYN LESZ€Z
Treating the Elderly with
PCYGHOTHERAPY: The CGOPE for Change in
Later Life (with Joel Sadavoy)
To the memory of my mother and father, RUTH YALOM and BENJAMIN
YALOM
To the memory of my mother and father, €LARA LESZ€Z and SAUL
LESZ€Z
PrefaGe to the Fifth Edition
For this fifth edition of The Theory and PRAGTIGE of PCYGHOTHERAPY I have
had the good fortune of having Molyn Leszcz as my collaborator.
Dr. Leszcz, whom I first met in 1980 when he spent a yearlong
fellowship in group therapy with me at Stanford University, has been a
major contributor to research and clinical innovation in group therapy.
For the past twelve years, he has directed one of the largest group
therapy training programs in the world in the Department of Psychiatry
at the University of Toronto, where he is an associate professor. His
broad knowledge of contemporary group practice and his exhaustive
review of the research and clinical literature were invaluable to the
preparation of this volume. We worked diligently, like co-therapists, to
make this edition a seamless integration of new and old material.
Although for stylistic integrity we opted to retain the first-person singular
in this text, behind the “I” there is always a collaborative “we.”
Our task in this new edition was to incorporate the many new changes in
the field and to jettison outmoded ideas and methods. But we had a
dilemma: What if some of the changes in the field do not represent
advances but, instead, retrogression? What if marketplace considerations
demanding quicker, cheaper, more efficient methods act against the best
interests of the client? And what if “efficiency” is but a euphemism for
shedding clients from the fiscal rolls as quickly as possible? And what if
these diverse market factors force therapists to offer less than they are
capable of offering their clients?
If these suppositions are true, then the requirements of this revision
become far more complex because we have a dual task: not only to present
current methods and prepare student therapists for the contemporary
workplace, but also to preserve the accumulated wisdom and techniques of
our field even if some young therapists will not have immediate
opportunities to apply them.
Since group therapy was first introduced in the 1940s, it has undergone a
series of adaptations to meet the changing face of clinical practice. As new
clinical syndromes, settings, and theoretical approaches have emerged, so
have corresponding variants of group therapy. The multiplicity of forms is
so evident today that it makes more sense to speak of “group therapies”
than of “group therapy.” Groups for panic disorder, groups for acute and
chronic depression, groups to prevent depression relapse, groups for eating
disorders, medical support groups for patients with cancer, HIV/AIDS,
rheumatoid arthritis, multiple sclerosis, irritable bowel syndrome, obesity,
myocardial infarction, paraplegia, diabetic blindness, renal failure, bone
marrow transplant, Parkinson’s, groups for healthy men and women who
carry genetic mutations that predispose them to develop cancer, groups for
victims of sexual abuse, for the confused elderly and for their caregivers,
for clients with obsessive-compulsive disorder, first-episode schizophrenia,
for chronic schizophrenia, for adult children of alcoholics, for parents of
sexually abused children, for male batterers, for self-mutilators, for the
divorced, for the bereaved, for disturbed families, for married couples—all
of these, and many more, are forms of group therapy.
The clinical settings of group therapy are also diverse: a rapid turnover
group for chronically or acutely psychotic patients on a stark hospital ward
is group therapy, and so are groups for imprisoned sex offenders, groups for
residents of a shelter for battered women, and open-ended groups of
relatively well functioning individuals with neurotic or personality
disorders meeting in the well-appointed private office of a psychotherapist.
And the technical approaches are bewilderingly different: cognitivebehavioral, psychoeducational, interpersonal, gestalt, supportive-expressive,
psychoanalytic, dynamic-interactional, psychodrama—all of these, and
many more, are used in group therapy.
This family gathering of group therapies is swollen even more by
the presence of distant cousins to therapy groups entering the
room: experiential classroom training groups (or process groups)
and the numerous self-help (or mutual support) groups like Alcoholics
Anonymous and other twelve-step recovery groups, Adult Survivors of
Incest, Sex Addicts Anonymous, Parents of Murdered €hildren,
Overeaters Anonymous, and Recovery, Inc. Although these groups are
not formal therapy groups, they are very often THERAPEUTIG and
straddle the blurred borders between personal growth, support,
education, and therapy (see chapter 16 for a detailed discussion of
this topic). And we must also
consider the youngest, most rambunctious, and most unpredictable of the
cousins: the Internet support groups, offered in a rainbow of flavors.
How, then, to write a single book that addresses all these
group therapies? The strategy I chose thirty-five years ago when I wrote
the first edition of this book seems sound to me still. My first step was to
separate “front” from “core” in each of the group therapies. The front
consists of the trappings, the form, the techniques, the specialized
language, and the aura surrounding each of the ideological schools; the
GORe consists of those aspects of the experience that are intrinsic to the
therapeutic process—that is, the bare-boned MEGHANICMC of GHANGE.
If you disregard the “front” and consider only the actual mechanisms of
effecting change in the client, you will find that the change mechanisms are
limited in number and are remarkably similar across groups. Therapy
groups with similar goals that appear wildly different in external form may
rely on identical mechanisms of change.
In the first two editions of this book, caught up in the positivistic zeitgeist
surrounding the developing psychotherapies, I referred to these mechanisms
of change as “curative factors.” Educated and humbled by the passing
years, I know now that the harvest of psychotherapy is not GURe—surely,
in our field, that is an illusion—but instead change or growth. Hence,
yielding to the dictates of reality, I now refer to the mechanisms of
change as “therapeutic factors” rather than “curative factors.”
The therapeutic factors constitute the central organizing principle of this
book. I begin with a detailed discussion of eleven therapeutic factors and
then describe a psychotherapeutic approach that is based on them.
But which types of groups to discuss? The array of group
therapies is now so vast that it is impossible for a text to address
each type of group separately. How then to proceed? I have chosen in
this book to center my discussion around a prototypic type of group
therapy and then to offer a cet of PRINGIplec that will enable the therapict to
modify thic fundamental group model to fit any CPEGIALIZED GLINIGAL
cituation.
The prototypical model is the intensive, heterogeneously composed
outpatient psychotherapy group, meeting for at least several months, with
the ambitious goals of both symptomatic relief and personality change.
Why focus on this particular form of group therapy when the contemporary
therapy scene, driven by economic factors, is dominated by another type of
group—a homogeneous, symptom-oriented group that meets for briefer
periods and has more limited goals?
The answer is that long-term group therapy has been around for
many decades and has accumulated a vast body of knowledge from both
empirical research and thoughtful clinical observation. Earlier I
alluded to contemporary therapists not often having the clinical
opportunities to do their best work; I believe that the prototypical
group we describe in this book is the setting in which therapists can
offer maximum benefit to their clients. It is an intensive, ambitious
form of therapy that demands much from both client and therapist.
The therapeutic strategies and techniques required to lead such a group
are sophisticated and complex. However, ONGE ctudentc macter them and
underctand how to modify them to fit CPEGIALIZED therapy cituationc, they
will be in a pocition to fachion a group therapy that will be EFFEGTIVE for
any GLINIGAL population in any cetting. Trainees should aspire to be
creative and compassionate therapists with conceptual depth, not
laborers with little vision and less morale. Managed care emphatically
views group therapy as the treatment modality of the future. Group
therapists must be as prepared as possible for this opportunity.
Because most readers of this book are clinicians, the text is intended to
have immediate clinical relevance. I also believe, however, that it is
imperative for clinicians to remain conversant with the world of research.
Even if therapictc do not perconally engage in recearGH, they muct
know how to evaluate the recearGH of otherc. Accordingly, the text relies
heavily on relevant clinical, social, and psychological research.
While searching through library stacks during the writing of early
editions of this book, I often found myself browsing in antiquated
psychiatric texts. How unsettling it is to realize that the devotees of such
therapy endeavors as hydrotherapy, rest cures, lobotomy, and insulin coma
were obviously clinicians of high intelligence, dedication, and integrity. The
same may be said of earlier generations of therapists who advocated
venesection, starvation, purgation, and trephination. Their texts are as well
written, their optimism as unbridled, and their reported results as impressive
as those of contemporary practitioners.
Quection: why have other health-care fields left treatment of
psychological disturbance so far behind? Ancwer: because they have
applied the principles of the scientific method. Without a rigorous research
base, the psychotherapists of today who are enthusiastic about current
treatments are tragically similar to the hydrotherapists and lobotomists of
yesteryear. As long as we do not test basic principles and treatment
outcomes with scientific rigor, our field remains at the mercy of passing
fads and fashions. Therefore, whenever possible, the approach presented in
this text is based on rigorous, relevant research, and attention is called to
areas in which further research seems especially necessary and feasible.
Some areas (for example, preparation for group therapy and the reasons for
group dropouts) have been widely and competently studied, while other
areas (for example, “working through” or countertransference) have only
recently been touched by research. Naturally, this distribution of research
emphasis is reflected in the text: some chapters may appear, to clinicians, to
stress research too heavily, while other chapters may appear, to researchminded colleagues, to lack rigor.
Let us not expect more of psychotherapy research than it can deliver. Will
the findings of psychotherapy research affect a rapid major change in
therapy practice? Probably not. Why? “Resistance” is one reason. €omplex
systems of therapy with adherents who have spent many years in training
and apprenticeship and cling stubbornly to tradition will change slowly and
only in the face of very substantial evidence. Furthermore, front-line
therapists faced with suffering clients obviously cannot wait for science.
Also, keep in mind the economics of research. The marketplace controls the
focus of research. When managed-care economics dictated a massive swing
to brief, symptom-oriented therapy, reports from a multitude of well-funded
research projects on brief therapy began to appear in the literature. At the
same time, the bottom dropped out of funding sources for research on
longer-term therapy, despite a strong clinical consensus about the
importance of such research. In time we expect that this trend will be
reversed and that more investigation of the effectiveness of psychotherapy
in the real world of practice will be undertaken to supplement the
knowledge accruing from randomized controlled trials of brief therapy.
Another consideration is that, unlike in the physical sciences, many aspects
of psychotherapy inherently defy quantification. Psychotherapy is both art
and science; research findings may ultimately shape the broad contours of
practice, but the human encounter at the center of therapy will always be a
deeply subjective, nonquantifiable experience.
One of the most important underlying assumptions in this text is that
interpersonal interaction within the here-and-now is crucial to effective
group therapy. The truly potent therapy group first provides an arena in
which clients can interact freely with others, then helps them identify and
understand what goes wrong in their interactions, and ultimately enables
them to change those maladaptive patterns. We believe that groups based
colely on other assumptions, such as psychoeducational or cognitivebehavioral principles, fail to reap the full therapeutic harvest. Each of these
forms of group therapy can be made even more effective by incorporating
an awareness of interpersonal process.
This point needs emphasis: It has great relevance for the future of clinical
practice. The advent of managed care will ultimately result in increased use
of therapy groups. But, in their quest for efficiency, brevity,
and accountability, managed-care decision makers may make the
mistake of decreeing that some distinct orientations (brief,
cognitive-behavioral, symptom-focused) are more desirable because their
approach encompasses a series of steps consistent with other efficient
medical approaches: the setting of explicit, limited goals; the
measuring of goal attainment at regular, frequent intervals; a highly
specific treatment plan; and a replicable, uniform, manual-driven,
highly structured therapy with a precise protocol for each session. But do
not mistake the APPEARANGE of efficiency for true effectiveness.
In this text we discuss, in depth, the extent and nature of the interactional
focus and its potency in bringing about significant character and
interpersonal change. The INTERAGTIONAL FOGUC ic the engine of group
therapy, and therapists who are able to harness it are much better equipped
to do all forms of group therapy, even if the group model does not
emphasize or acknowledge the centrality of interaction.
Initially I was not eager to undertake the considerable task of revising
this text. The theoretical foundations and technical approach to group
therapy described in the fourth edition remain sound and useful. But a book
in an evolving field is bound to age sooner than later, and the last edition
was losing some of its currency. Not only did it contain dated or
anachronistic allusions, but also the field has changed. Managed care has
settled in by now, DSM-IV has undergone a text revision (DSM-IV-TR),
and a decade of clinical and research literature needed to be reviewed and
assimilated into the text. Furthermore, new types of groups have sprung up
and others have faded away. €ognitive-behavioral, psychoeducational, and
problem-specific brief therapy groups are becoming more common, so in
this revision we have made a special effort throughout to address the
particular issues germane to these groups.
The first four chapters of this text discuss eleven therapeutic factors.
€hapter 1 covers instillation of hope, universality, imparting information,
altruism, the corrective recapitulation of the primary family group, the
development of socializing techniques, and imitative behavior. €hapters 2
and s present the more complex and powerful factors of interpersonal
learning and cohesiveness. Recent advances in our understanding of
interpersonal theory and the therapeutic alliance that can strengthen
therapist effectiveness have influenced our approach to these two chapters.
€hapter 4 discusses catharsis and existential factors and then attempts a
synthesis by addressing the comparative importance and the
interdependence of all eleven therapeutic factors.
The next two chapters address the work of the therapist. €hapter 5
discusses the tasks of the group therapist—especially those germane to
shaping a therapeutic group culture and harnessing the group interaction for
therapeutic benefit. €hapter 6 describes how the therapist must first activate
the here-and-now (that is, plunge the group into its own experience) and
then illuminate the meaning of the here-and-now experience. In this edition
we deemphasize certain models that rely on the elucidation of group-as-awhole dynamics (for example, the Tavistock approach)—models that have
since proven ineffective in the therapy process. (Some omitted material that
may still interest some readers will remain available at www.yalom.com.)
While chapters 5 and 6 address what the therapist must do, chapter 7
addresses how the therapist must be. It explicates the therapist’s role and the
therapist’s use of self by focusing on two fundamental issues: transference
and transparency. In previous editions, I felt compelled to encourage
therapist restraint: Many therapists were still so influenced by the encounter
group movement that they, too frequently and too extensively, “let it all
hang out.” Times have changed; more conservative forces have taken hold,
and now we feel compelled to discourage therapists from practicing too
defensively. Many contemporary therapists, threatened by the
encroachment of the legal profession into the field (a result of the
irresponsibility and
misconduct of some therapists, coupled with a reckless and greedy
malpractice industry), have grown too cautious and impersonal. Hence we
give much attention to the use of the therapist’s self in psychotherapy.
€hapters 8 through 14 present a chronological view of the therapy group
and emphasize group phenomena and techniques that are relevant to each
stage. €hapters 8 and 9, on client selection and group composition, include
new research data on group therapy attendance, dropouts, and outcomes.
€hapter 10, which describes the practical realities of beginning a group,
includes a lengthy new section on brief group therapy, presents much new
research on the preparation of the client for group therapy. The appendix
contains a document to distribute to new members to help prepare them for
their work in the therapy group.
€hapter 11 addresses the early stages of the therapy group and includes
new material on dealing with the therapy dropout. €hapter 12 deals with
phenomena encountered in the mature phase of the group therapy work:
subgrouping, conflict, self-disclosure, and termination.
€hapter 1s, on problem members in group therapy, adds new material to
reflect advances in interpersonal theory. It discusses the contributions of
intersubjectivity, attachment theory, and self psychology. €hapter 14
discusses specialized techniques of the therapist, including concurrent
individual and group therapy (both combined and conjoint), co-therapy,
leaderless meetings, dreams, videotaping, and structured exercises, the use
of the written summary in group therapy, and the integration of group
therapy and twelve-step programs.
€hapter 15, on specialized therapy groups, addresses the many new
groups that have emerged to deal with specific clinical syndromes or
clinical situations. It presents the critically important principles used to
modify traditional group therapy technique in order to design a group to
meet the needs of other specialized clinical situations and populations, and
describes the adaptation of cognitive-behavioral and interpersonal therapy
to groups. These principles are illustrated by in-depth discussions of various
groups, such as the acute psychiatric inpatient group and groups for the
medically ill (with a detailed illustration of a group for patients with
cancer). €hapter 15 also discusses self-help groups and the youngest
member of the group therapy family—the Internet support group.
€hapter 16, on the encounter group, presented the single greatest
challenge for this revision. Because the encounter group qua encounter
group has faded from contemporary culture, we considered omitting the
chapter entirely. However, several factors argue against an early burial: the
important role played by the encounter movement groups in developing
research technology and the use of encounter groups (also known as process
groups, T-groups (for “training”), or experiential training groups) in group
psychotherapy education. Our compromise was to shorten the chapter
considerably and to make the entire fourth edition chapter available at
www.yalom.com for readers who are interested in the history and evolution
of the encounter movement.
€hapter 17, on the training of group therapists, includes new approaches
to the supervision process and on the use of process groups in the
educational curriculum.
During the four years of preparing this revision I was also engaged
in writing a novel, The CGHOPENHAUER Cure, which may serve as a
companion volume to this text: It is set in a therapy group and illustrates
many of the principles of group process and therapist technique offered
in this text. Hence, at several points in this fifth edition, I refer the reader
to particular pages in The CGHOPENHAUER Cure that offer fictionalized
portrayals of therapist techniques.
Excessively overweight volumes tend to gravitate to the “reference book”
shelves. To avoid that fate we have resisted lengthening this text. The
addition of much new material has mandated the painful task of cutting
older sections and citations. (I left my writing desk daily with fingers
stained by the blood of many condemned passages.) To increase readability,
we consigned almost all details and critiques of research method to
footnotes or to notes at the end of the book. The review of the last ten years
of group therapy literature has been exhaustive.
Most chapters contain 50–100 new references. In several
locations throughout the book, we have placed a dagger ( † ) to
indicate that corroborative observations or data exist for suggested
current readings for students interested in that particular area. Thic
lict of referENGEC and cuggected readingc hac been PLAGED on my webcite,
www.yalom.Gom.
AGknowledgmentc
(Irvin Yalom)
I am grateful to Stanford University for providing the academic freedom,
library facilities, and administrative staff necessary to accomplish this work.
To a masterful mentor, Jerome Frank (who died just before the publication
of this edition), my thanks for having introduced me to group therapy and
for having offered a model of integrity, curiosity, and dedication. Several
have assisted in this revision: Stephanie Brown, Ph.D. (on twelve-step
groups), Morton Lieberman, Ph.D. (on Internet groups), Ruthellen
Josselson, Ph.D. (on group-as-a-whole interventions), David Spiegel (on
medical groups), and my son Ben Yalom, who edited several chapters.
(Molyn Leszcz)
I am grateful to the University of Toronto Department of Psychiatry for
its support in this project. Toronto colleagues who have made comments on
drafts of this edition and facilitated its completion include Joel Sadavoy,
M.D., Don Wasylenki, M.D., Danny Silver, M.D., Paula Ravitz, M.D.,
Zindel Segal, Ph.D., Paul Westlind, M.D., Ellen Margolese, M.D., Jan
Malat, M.D., and Jon Hunter, M.D. Liz Konigshaus handled the painstaking
task of word-processing, with enormous efficiency and unyielding good
nature. Benjamin, Talia, and Noah Leszcz, my children, and Bonny Leszcz,
my wife, contributed insight and encouragement throughout.
Chapter 1
THE THERAPEUTI€ FA€TORS
Does group therapy help clients? Indeed it does. A persuasive body of
outcome research has demonstrated unequivocally that group therapy is a
highly effective form of psychotherapy and that it is at least equal to
1
individual psychotherapy in its power to provide meaningful benefit.
How does group therapy help clients? A naive question, perhaps. But if
we can answer it with some measure of precision and certainty, we will
have at our disposal a central organizing principle with which to approach
the most vexing and controversial problems of psychotherapy. Once
identified, the crucial aspects of the process of change will constitute a
rational basis for the therapist’s selection of tactics and strategies to shape
the group experience to maximize its potency with different clients and in
different settings.
I suggest that therapeutic change is an enormously complex process that
occurs through an intricate interplay of human experiences, which I will
refer to as “therapeutic factors.” There is considerable advantage in
approaching the complex through the simple, the total phenomenon through
its basic component processes. Accordingly, I begin by describing and
discussing these elemental factors.
From my perspective, natural lines of cleavage divide the therapeutic
experience into eleven primary factors:
1. Instillation of hope
2. Universality
s. Imparting information
4. Altruism
5. The corrective recapitulation of the primary family group
6. Development of socializing techniques
7. Imitative behavior
8. Interpersonal learning
9. Group cohesiveness
10. €atharsis
11. Existential factors
In the rest of this chapter, I discuss the first seven factors. I consider
interpersonal learning and group cohesiveness so important and complex
that I have treated them separately, in the next two chapters. Existential
factors are discussed in chapter 4, where they are best understood in the
context of other material presented there. €atharsis is intricately interwoven
with other therapeutic factors and will also be discussed in chapter 4.
The distinctions among these factors are arbitrary. Although I discuss
them singly, they are interdependent and neither occur nor function
separately. Moreover, these factors may represent different parts of the
change process: some factors (for example, self-understanding) act at the
level of cognition; some (for example, development of socializing
techniques) act at the level of behavioral change; some (for example,
catharsis) act at the level of emotion; and some (for example, cohesiveness)
may be more accurately described as preconditions for change.† Although
the same therapeutic factors operate in every type of therapy group, their
interplay and differential importance can vary widely from group to group.
Furthermore, because of individual differences, participants in the same
group benefit from widely different clusters of therapeutic factors.†
Keeping in mind that the therapeutic factors are arbitrary constructs, we
can view them as providing a cognitive map for the student-reader. This
grouping of the therapeutic factors is not set in concrete; other clinicians
and researchers have arrived at a different, and also arbitrary, clusters of
2
factors. No explanatory system can encompass all of therapy. At its core,
the therapy process is infinitely complex, and there is no end to the number
of pathways through the experience. (I will discuss all of these issues more
fully in chapter 4.)
The inventory of therapeutic factors I propose issues from my clinical
experience, from the experience of other therapists, from the views of the
successfully treated group patient, and from relevant systematic research.
None of these sources is beyond doubt, however; neither group members
nor group leaders are entirely objective, and our research methodology is
often crude and inapplicable.
From the group therapists we obtain a variegated and internally
inconsistent inventory of therapeutic factors (see chapter 4). Therapists, by
no means disinterested or unbiased observers, have invested considerable
time and energy in mastering a certain therapeutic approach. Their answers
will be determined largely by their particular school of conviction. Even
among therapists who share the same ideology and speak the same
language, there may be no consensus about the reasons clients improve. In
research on encounter groups, my colleagues and I learned that many
successful group leaders attributed their success to factors that were
irrelevant to the therapy process: for example, the hot-seat technique, or
nonverbal exercises, or the direct impact of a therapist’s own person (see
s
chapter 16). But that does not surprise us. The history of psychotherapy
abounds in healers who wer
