The Theory and Practice of Group Psychotherapy (139 page)

x

One is reminded of the farmer who attempted to train his horse to do with smaller and smaller amounts of food, but eventually lamented, “Just as I had taught it to manage with no food at all, the darn critter went and died on me.”

y

It is for this very reason that I decided to write a group therapy novel,
The Schopenhauer Cure
(New York: HarperCollins, 2005), in which I attempt to offer an honest portrayal of the effective therapy group in action.

z

The limits of confidentiality in group therapy is an area that has not been broadly explored in the professional literature, but rare reports do surface of comembers being called to testify in criminal or civil proceedings. One questionnaire survey of 100 experienced group therapists noted that over half of the respondents experienced some minor confidentiality breach.

aa

The transtheoretical model of change postulates that individuals advance through five phases in the change process. Therapy will be more effective if it is congruent with the client’s particular state of change readiness. The stages are precontemplation, contemplation, preparation, action, and maintenance.

ab

In a classic paper on scapegoating, Scheidlinger recalls the Biblical origins of the scapegoat. One goat is the bearer of all the people’s sins and is banished from the community. A second goat is the bearer of all the positive features of the people and is sacrificed on the altar. To be a scapegoat of either sort bodes poorly for one’s survival (S. Scheidlinger, “Presidential Address: On Scapegoating in Group Psychotherapy,”
International Journal of Group Psychotherapy
32 (1982): 131–43).

ac

This is the same Ginny with whom I coauthored a book about our psychotherapy:
Every Day Gets a Little Closer: A Twice-Told Therapy
(New York: Basic Books, 1975; reissued 1992).

ad

Therapist countertransference is always a source of valuable data about the client, never more so than with provocative clients whose behavior challenges our therapeutic effectiveness. Group leaders should determine their role in the joint construction of the problem client’s difficulties. Any therapist reaction or behavior that deviates from one’s baseline signals that interpersonal pulls are being generated. Therapists must take care to examine their feelings before responding. Together, these perspectives inform and balance the therapist’s use of empathic processing, confrontation and feedback.

ae

Moos and I demonstrated, for example, that medical students assigned for the first time to a psychiatric ward regarded the psychotic patients as extremely dangerous, frightening, unpredictable, and dissimilar to themselves. At the end of the five-week assignment, their attitudes had undergone considerable change: the students were less frightened of their patients and realized that psychotic individuals were just confused, deeply anguished human beings, more like themselves than they had previously thought.

af

In Evelyn Waugh’s
Brideshead Revisited
(Boston: Little, Brown, 1945), the protagonist is counseled that if he is not circumspect, he will have to devote a considerable part of his second year at college to get rid of undesirable friends he has made during his first year.

ag

I learned a great deal about psychotherapy from this experiment. For one thing, it brought home to me the
Rashomon
nature of the therapeutic venture (see chapter 4). The client and I had extraordinarily different perspectives of the hours we shared. All my marvelous interpretations? She had never even heard them! Instead, Ginny heard, and valued, very different parts of the therapy hour: the deeply human exchanges; the fleeting supportive, accepting glances; the brief moments of real intimacy. The exchange of summaries also provided interesting instruction about psychotherapy, and I used the summaries in my teaching. Years later the client and I decided to write a prologue and an afterword and publish the summaries as a book. (
Every Day Gets a Little Closer.
New York: Basic Books, 1974.)

ah

Higher-level clients are the more verbal clients who are motivated to work in therapy and whose attention span permits them to attend an entire meeting. Elsewhere I describe a group design for lower-functioning, more regressed clients (Yalom,
Inpatient Group Psychotherapy,
313–35).

ai

We can think of coping as
the means
and adaptation as
the end.
Maximizing adaptation generally improves quality of life. One may categorize the medical groups according to their basic coping emphasis:

1. Emotion-based coping—social support, emotional ventilation

2. Problem-based coping—active cognitive and behavioral strategies, psychoeducation, stress reduction techniques

3. Meaning-based coping—increasing existential awareness, realigning life priorities

aj

For a full description of the first group led for cancer patients, see my story “Travels with Paula” in
Momma and the Meaning of Life
(New York: HarperCollins, 1999, 15–53).

ak

The authors of a large meta-analysis concluded that although problems with addictions respond well to self-help groups, clients with medical problems in such groups do not demonstrate objective benefits commensurate with how highly the participants value the groups.

al

The American Counseling Association has issued specific ethics guidelines for online therapists (American Counseling Association, “Ethical Standards for Internet Online Counseling” [1999]; available at
www.counseling.org
). Other organizations, such as the American Psychological Association, have not yet distinguished online from face-to-face care. It is certain that the future will see new statements from licensing bodies and professional organizations addressing this area.

am

This is not to say that the encounter ethos suddenly vanished. Many aspects of the encounter movement linger. For one thing, it was transformed and commercialized in the large group awareness training enterprises like est and Lifespring (versions of which are still viable in various parts of the world) and is much in evidence in such programs as the widespread Judeo-Christian National Marriage Encounter programs.

Copyright © 2005 by Irvin Yalom and Molyn Leszcz

Published by Basic Books,
A Member of the Perseus Books Group

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Library of Congress Cataloging-in-Publication Data

Yalom, Irvin D., 1931–

The theory and practice of group psychotherapy / Irvin D. Yalom with

Molyn Leszcz.—5th ed. p. cm.

Includes bibliographical references and index.

eISBN : 978-0-465-01291-6

1. Group psychotherapy. I. Leszcz, Molyn, 1952–II. Title.

RC488.Y3 2005

616.89’152—dc22

2005000056

/