The Theory and Practice of Group Psychotherapy (115 page)

97
Castonguay et al., “The Role of Emotion.”

98
J. Frank, “Some Values of Conflict in Therapeutic Groups,”
Group Psychotherapy
8 (1955): 142–151.

99
I. Yalom
The Schopenhauer Cure
, (New York: HarperCollins, 2005) 175ff.

100
A study by Pepitone and Reichling offers experimental corroboration. Paid college students were divided into thirteen high-cohesion and thirteen low-cohesion laboratory task groups. Cohesion was created in the usual experimental manner: members of high-cohesion groups were told before their first meeting that their group had been composed of individuals who had been carefully matched from psychological questionnaires to ensure maximum compatibility. The members of low-cohesion groups were given the opposite treatment and were told the matching was unsuccessful and they would probably not get along well together. The groups, while waiting for the experiment to begin, were systematically insulted by a member of the research team. After he had left, the members of the high-cohesive groups were significantly more able to express open and intense hostility about the authority figure (A. Pepitone and G. Reichling, “Group Cohesiveness and the Expression of Hostility,”
Human Relations
8 [1955]: 327–37).

101
S. Schiedlinger, “On Scapegoating in Group Psychotherapy,”
International Journal of Group Psychotherapy
32 (1982): 131–43.

102
T. Postmes, R. Spears, and S. Cihangir, “Quality of Decision Making and Group Norms,”
Journal of Personality and Social Psychology
80 (2001): 918–30.

103
I. Janis,
Groupthink: Psychological Studies of Policy Decisions and Fiascoes,
2d ed. (Boston: Houghton Muffin, 1982), 9.

104
Postmes et al., “Quality of Decision Making.”

105
G. Hodson and R. Sorrentino, “Groupthink and Uncertainty Orientation: Personality Differences in Reactivity to the Group Situation,”
Group Dynamics: Theory, Research, and Practice
1 (1997): 144–55.

106
These findings are strongly correlative—that is, cohesion and the reported group variables increase together at the same time. Although this does not establish a clear causeand-effect relationship, it underscores the important relationship between cohesion and a large number of desired outcomes. Research on the therapeutic alliance in individual psychotherapy is relevant: there is a strong, enduring positive relationship between therapeutic alliance and outcome. This is a genuine finding; it is not an artifact of clients who endorse therapy strongly because of early change in their target symptoms. See Martin et al., “Relation of the Therapeutic Alliance with Outcome.”

107
A. Goldstein, K. Heller, and L. Sechrest,
Psychotherapy and the Psychology of Behavior Change
(New York: Wiley, 1966).

108
Cartwright and Zander, “Group Cohesiveness: Introduction,” in
Group Dynamics,
69–74.

109
K. Back, “Influence Through Social Communication,”
Journal of Abnormal Social Psychology
46 (1951): 398–405.

110
G. Rasmussen and A. Zander, “Group Membership and Self-Evaluation,”
Human Relations
7 (1954): 239–51.

111
S. Seashore, “Group Cohesiveness in the Industrial Work Group,” Monograph, Ann Arbor, Mich., Institute for Social Research, 1954.

112
Rasmussen and Zander, “Group Membership and Self-Evaluation.” Goldstein et al.,
Psychology of Behavior Change,
329.

113
R. Kirschner, R. Dies, and R. Brown, “Effects of Experiential Manipulation of Self-Disclosure on Group Cohesiveness,”
Journal of Consulting and Clinical Psychology
46 (1978): 1171–77.

114
S. Schachter, “Deviation, Rejection, and Communication,”
Journal of Abnormal Social Psychology
46 (1951): 190–207. A. Zander and A. Havelin, “Social Comparison and Intergroup Attraction,” cited in Cartwright and Zander,
Group Dynamics
, 94. A. Rich, “An Experimental Study of the Nature of Communication to a Deviate in High and Low Cohesive Groups,”
Dissertation Abstracts
29 (1968): 1976.

115
Goldstein et al.,
Psychology of Behavior Change.
Schachter, “Deviation, Rejection, and Communication.” These findings stem from experimentally composed groups and situations. As an illustration of the methodology used in these studies, consider an experiment by Schachter, who organized groups of paid volunteers to discuss a social problem—the correctional treatment of a juvenile delinquent with a long history of recidivism. In the manner described previously, several groups of low and high cohesiveness were formed, and paid confederates were introduced into each group who deliberately assumed an extreme position on the topic under discussion. The content of the discussion, sociometric data, and other postgroup questionnaires were analyzed to determine, for example, the intensity of the efforts to influence the deviant and the degree of rejection of the deviant.

116
A. Fuerher and C. Keys, “Group Development in Self-Help Groups for College Students,”
Small Group Behavior
19 (1988): 325–41.

CHAPTER 4

1
B. Brown, T. Hedinger, G. Mieling, “A Homogeneous Group Approach to Social Skills Training for Individuals with Learning Disabilities,”
Journal for Specialists in Group Work
20 (1995): 98–107. D. Randall, “Curative Factor Rankings for Female Incest Survivor Groups: A Summary of Three Studies,”
Journal of Specialists in Group Work
20 (1995): 232–39. K. Card and L. Schmider, “Group Work with Members Who Have Hearing Impairments,”
Journal for Specialists in Group Work
20 (1995): 83–90. K. Kobak, A. Rock, and J. Greist, “Group Behavior Therapy for Obsessive-Compulsive Disorder,”
Journal of Specialists in Group Work
20 (1995): 26–32. G. Price, P. Dinas, C. Dunn, and C. Winterowd, “Group Work with Clients Experiencing Grieving: Moving from Theory to Practice,”
Journal of Specialists in Group Work
20 (1995): 159–67. J. DeLucia-Waack, “Multiculturalism Is Inherent in All Group Work,”
Journal for Specialists in Group Work
21 (1996): 218–23. J. McLeod and A. Ryan, “Therapeutic Factors Experienced by Members of an Outpatient Therapy Group for Older Women,”
British Journal of Guidance and Counseling
21 (1993): 64–72. I. Johnson, T. Torres, V. Coleman, and M. Smith, “Issues and Strategies in Leading Culturally Diverse Counseling Groups,”
Journal for Specialists in Group Work
20 (1995): 143–50. S. Bloch and E. Crouch,
Therapeutic Factors in Group Psychotherapy
(New York: Oxford University Press, 1985). E. Crouch, S. Bloch, and J. Wanless, “Therapeutic Factors: Intrapersonal and Interpersonal Mechanisms,” in
Handbook of Group Psychotherapy,
ed. A. Fuhriman and G. Burlingame (New York: Wiley, 1994): 269–312. R. Rugel, “Addictions Treatment in Groups: A Review of Therapeutic Factors,”
Small Group Research
22 (1991): 475–91. W. Fawcett Hill, “Further Consideration of Therapeutic Mechanisms in Group Therapy,”
Small Group Behavior
6 (1975): 421–29. A. Fuhriman and T. Butler, “Curative Factors in Group Therapy: A Review of the Recent Literature,”
Small Group Behavior
14 (1983): 131–42. K. MacKenzie, “Therapeutic Factors in Group Psychotherapy: A Contemporary View,”
Group
11 (1987): 26–34. S. Bloch, R. Crouch, and J. Reibstein, “Therapeutic Factors in Group Psychotherapy,”
Archives of General Psychiatry
38 (1981): 519–26.

2
An alternative method of assessing therapeutic factors is the “critical incident” approach used by my colleagues and me in a large encounter group study (M. Lieberman, I. Yalom, and M. Miles,
Encounter Groups: First Facts
[New York: Basic Books, 1973]) and by Bloch and Crouch
(Therapeutic Factors in Group Psychotherapy)
. In this method, clients are asked to recall the most critical event of the therapy session, and the responses are then coded by trained raters into appropriate categories. The following are examples of studies using critical incident methodology:R. Cabral, J. Best, and A. Paton, “Patients’ and Observers’ Assessments of Process and Outcome in Group Therapy: A Follow-up Study,”
American Journal of Psychiatry
132 (1975): 1052–54. R. Cabral and A. Paton, “Evaluation of Group Therapy: Correlations Between Clients’ and Observers’ Assessments,”
British Journal of Psychiatry
126 (1975): 475–77. S. Bloch and J. Reibstein, “Perceptions by Patients and Therapists of Therapeutic Factors in Group Psychotherapy,”
British Journal of Psychiatry
137 (1980): 274–78. D. Kivlighan and D. Mullison, “Participants’ Perception of Therapeutic Factors in Group Counseling: The Role of Interpersonal Style and Stage of Group Development,”
Small Group Behavior
19 (1988): 452–68. D. Kivlighan and D. Goldfine, “Endorsement of Therapeutic Factors as a Function of Stage of Group Development and Participant Interpersonal Attitudes,”
Journal of Counseling Psychology
38 (1991): 150–58. G. Mushet, G. Whalan, and R. Power, “In-patients’ Views of the Helpful Aspects of Group Psychotherapy: Impact of Therapeutic Style and Treatment Setting,”
British Journal of Medical Psychology
62 (1989): 135–41.

3
K. Lese, R. McNair-Semands, “The Therapeutic Factor Inventory Development of a Scale,”
Group
24 (2000): 303–17.

4
R. Bednar and T. Kaul, “Experiential Group Research: Can the Canon Fire?” in
Handbook of Psychotherapy and Behavioral Change: An Empirical Analysis,
4th ed., ed. S. Garfield and A. Bergin (New York: Wiley, 1994): 631–63.

5
H. Roback, “Experimental Comparison of Outcome in Insight and Non-Insight-Oriented Therapy Groups,”
Journal of Consulting Psychology
38 (1972): 411–17. J. Lomont et al., “Group Assertion Training and Group Insight Therapies,”
Psychological Reports
25 (1969): 463–70. S. Abramowitz and C. Abramowitz, “Psychological-Mindedness and Benefit from Insight-Oriented Group Therapy,”
Archives of General Psychiatry
30 (1974): 610–15. S. Abramowitz and C. Jackson, “Comparative Effectiveness of There-and-Then Versus Here-and-Now Therapist Interpretations in Group Psychotherapy,”
Journal of Counseling Psychology
21 (1974): 288–94.

6
W. Piper, A. Joyce, M. McCallum, and H. Azim, “Interpretive and Supportive Forms of Psychotherapy and Patient Personality Variables,”
Journal of Consulting and Clinical Psychology
66 (1998): 558–67. R. Wing and R. Jeffery, “Benefits of Recruiting Participants with Friends and Increasing Social Support for Weight Loss and Maintenance,”
Journal of Consulting and Clinical Psychology
67 (1999): 132–38.

7
B. Berzon, C. Pious, and R. Parson, “The Therapeutic Event in Group Psychotherapy: A Study of Subjective Reports by Group Members,”
Journal of Individual Psychology
19 (1963): 204–12. H. Dickoff and M. Lakin, “Patients’ Views of Group Psychotherapy: Retrospections and Interpretations,”
International Journal of Group Psychotherapy
13 (1963): 61–73.

8
J. Reddon, L. Payne, and K. Starzyk, “Therapeutic Factors in Group Treatment Evaluated by Sex Offenders: A Consumers Report,”
Journal of Offender Rehabilitation
28 (1999): 91–101. A. Nerenberg, “The Value of Group Psychotherapy for Sexual Addicts,”
Sexual Addiction and Compulsivity
7 (2000): 197–200). R. Morgan and C. Winterowd, “Interpersonal Process-Oriented Group Psychotherapy with Offender Populations,”
International Journal of Offender Therapy and Comparative Criminology
46 (2002): 466–82.

9
K. Lese and R. McNair-Semands, “The Therapeutic Factors Inventory: Development of a Scale,”
Group
24 (2000): 303–17. I. Yalom, J. Tinklenberg, and M. Gilula, “Curative Factors in Group Therapy,” unpublished study, Department of Psychiatry, Stanford University, 1968.

10
Spurred by the large data pool of the NIMH Treatment of Depression Collaborative Research Program, individual psychotherapy researchers have used a method similar to the Q-sort discussed in detail in this chapter: they developed a 100-item scale, the Psychotherapy Process Q Set (PQS), which is completed by trained raters evaluating session recordings at sessions 4 and 12 of a sixteen-session treatment. The PQS evaluates the therapy, therapist, and therapy relationship on a range of process criteria. Analysis of the 100 items produces a core of therapeutic factors. Successful therapies, both interpersonal therapy and cognitive-behavioral therapy, were similar in that in both treatments created a relationship in which clients developed a positive sense of self and very strong positive regard for their therapist (J. Ablon and E. Jones, “Psychotherapy Process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program,”
Journal of Consulting and Clinical Psychology
67 (1999): 64–75). Lese and McNair-Semands (“The Therapeutic Factors Inventory”) developed the group therapy Therapeutic Factors Inventory (TFI), a self-report instrument. The TFI, which builds on the original therapeutic factor Q-sort, demonstrates promise as a research tool with empirically acceptable levels of internal consistency and test-retest reliability.

11
Yalom et al., “Curative Factors in Group Therapy.”

12
There were four checks to ensure that our sample was a successfully treated one: (1) the therapists’ evaluation; (2) length of treatment (previous research in the same clinic demonstrated that group members who remained in therapy for that length of time had an extremely high rate of improvement [I. Yalom et al., “Prediction of Improvement in Group Therapy,”
Archives of General Psychiatry
17 (1967): 158–68]); (3) the investigators’ independent interview ratings of improvement on a 13-point scale in four areas: symptoms, functioning, interpersonal relationships, and self-concept; and (4) the members’ self-rating on the same scale.