Yalom's The Theory and Practice of Group Psychotherapy has been the standard text in the field for decades. In this completely revised and updated fifth edition, Dr. Yalom and his collaborator Dr. Molyn Leszcz expand the book to include the most recent developments in the field, drawing on nearly a decade of new research as well as their broad clinical wisdom and expertise.
New topics include: online therapy, specialized groups, ethnocultural diversity, trauma and managed care. At once scholarly and lively, this is the most up-to-date, incisive, and comprehensive text available on group psychotherapy. Get BOOK. This book written by Irvin D. Yalom and published by Basic Books which was released on 06 July with total pages We cannot guarantee that Theory and Practice of Group Psychotherapy book is available in the library, click Get Book button to download or read online books.
Join over The classic work on group psychotherapy Hailed by Jerome Frank as "the best book that exists on the subject," Irvin D. Yalom's The Theory and Practice of Group Psychotherapy has been the standard text in the field for decades. In this completely revised and updated fifth edition, Dr. Yalom and his collaborator Dr. Molyn Leszcz expand the book to include the most recent developments in the field, drawing on nearly a decade of new research as well as their broad clinical wisdom and expertise.
New topics include: online therapy, specialized groups, ethnocultural diversity, trauma and managed care. At once scholarly and lively, this is the most up-to-date, incisive, and comprehensive text available on group psychotherapy. Yalom and. Dive into this educational and entertaining work on group psychotherapy and see firsthand how it has been helping patients learn and grow for years.
Hailed by Jerome Frank as "the best book that exists on the subject," Irvin D. The classic work on group psychotherapy. The Theory and Practice of Group Psychotherapy has been the standard text in the field for decades. In this completely updated sixth edition, Dr. Yalom and Dr. Hope is flexible—it redefines itself to fit the immediate parameters, becoming hope for comfort, for dignity, for connection with others, or for minimum physical discomfort. If I happen to receive notes from recently terminated members in- forming me of their continued improvement, I make a point of sharing this with the current group.
Senior group members often assume this function by offering spontaneous testimonials to new, skeptical members. Research has shown that it is also vitally important that therapists be- lieve in themselves and in the efficacy of their group.
In my initial meetings with clients individ- ually, I share this conviction with them and attempt to imbue them with my optimism. Many of the self-help groups—for example, Compassionate Friends for bereaved parents , Men Overcoming Violence men who batter , Sur- vivors of Incest, and Mended Heart heart surgery patients —place heavy emphasis on the instillation of hope. At each meeting, members of Recovery, Inc.
One of the great strengths of Alcoholics Anonymous is the fact that the leaders are all alcoholics—living inspirations to the others. Members are inspired and expectations raised by contact with those who have trod the same path and found the way back. A similar approach is used for indi- viduals with chronic medical illnesses such as arthritis and heart disease.
These self-management groups use trained peers to encourage members to cope actively with their medical conditions. Of course, there is a core of truth to this notion, since most clients have had an un- usual constellation of severe life stresses and are periodically flooded by frightening material that has leaked from their unconscious.
To some extent this is true for all of us, but many clients, because of their extreme social isolation, have a heightened sense of uniqueness. Their interpersonal difficulties preclude the possibility of deep intimacy.
I have heard group members reveal such acts as in- cest, torture, burglary, embezzlement, murder, attempted suicide, and fantasies of an even more desperate nature. Universality 7 Nor is this form of aid limited to group therapy. Universality plays a role in individual therapy also, although in that format there is less op- portunity for consensual validation, as therapists choose to restrict their degree of personal transparency. During my own hour analysis I had a striking personal encounter with the therapeutic factor of universality.
It happened when I was in the midst of describing my extremely ambivalent feelings toward my mother. I was very much troubled by the fact that, despite my strong positive sen- timents, I was also beset with death wishes for her, as I stood to inherit part of her estate. Despite the complexity of human problems, certain common denomi- nators between individuals are clearly evident, and the members of a ther- apy group soon perceive their similarities to one another.
The secrets prove to be startlingly similar, with a couple of major themes predominating. Next in frequency is a deep sense of interpersonal alienation—that, despite appearances, one really does not, or cannot, care for or love another person. The third most frequent cate- gory is some variety of sexual secret. These chief concerns of nonclients are qualitatively the same in individuals seeking professional help. Almost invariably, our clients experience deep concern about their sense of worth and their ability to relate to others.
With rare exceptions, patients express great relief at discovering that they are not alone, that others share the same dilemmas and life experiences. Each member is then asked to read the secret aloud and reveal how he or she would feel if harboring such a secret.
This method usually proves to be a valuable demonstration of uni- versality, empathy, and the ability of others to understand. Members in such groups can encounter others who have suffered similar violations as children, who were not responsible for what happened to them, and who have also suffered deep feelings of shame, guilt, rage, and uncleanness.
For instance, I once supervised a thirty-five-year-old therapist who was leading a group of depressed men in their seventies and eighties. At one point a seventy-seven-year-old man who had recently lost his wife expressed suicidal thoughts.
The therapist hesitated, fearing that anything he might say would come across as naive. Then a ninety-one-year-old group member spoke up and described how he had lost his wife of sixty years, had plunged into a suicidal despair, and had ultimately recovered and returned to life.
That statement resonated deeply and was not easily dismissed. In multicultural groups, therapists may need to pay particular attention to the clinical factor of universality.
Cultural minorities in a predomi- nantly Caucasian group may feel excluded because of different cultural attitudes toward disclosure, interaction, and affective expression. Thera- pists must help the group move past a focus on concrete cultural differ- ences to transcultural—that is, universal—responses to human situations and tragedies.
Mental health professionals are often sorely lack- ing in knowledge of the cultural facts of life required to work effectively with culturally diverse members. As clients perceive their similarity to others and share their deepest concerns, they benefit further from the accompanying catharsis and from their ultimate acceptance by other members see chapter 3 on group cohesiveness. Didactic Instruction Most participants, at the conclusion of successful interactional group therapy, have learned a great deal about psychic functioning, the meaning of symptoms, interpersonal and group dynamics, and the process of psy- chotherapy.
Generally, the educational process is implicit; most group therapists do not offer explicit didactic instruction in interactional group therapy. Over the past decade, however, many group therapy approaches have made formal instruction, or psychoeducation, an important part of the program.
Although there is no formal professional guidance, the conduct of the meetings has been highly structured by Dr. Low; parts of his textbook, Mental Health Through Will Training,28 are read aloud and discussed at every meeting. Many other self-help groups strongly emphasize the imparting of in- formation.
The ideal context is one of partnership and collaboration, rather than prescription and subordination. The therapists dis- cuss the benign nature of panic attacks and offer instruction first on how to bring on a mild attack and then on how to prevent it.
They provide de- tailed instruction on proper breathing techniques and progressive muscu- lar relaxation. Groups are often the setting in which new mindfulness- and medita- tion-based stress reduction approaches are taught.
By applying disciplined focus, members learn to become clear, accepting, and nonjudgmental ob- servers of their thoughts and feelings and to reduce stress, anxiety, and vulnerability to depression. They may also advise members about methods of informing others of their condition and fash- ioning a less guilt-provoking lifestyle. Leaders of bereavement groups may provide information about the natural cycle of bereavement to help members realize that there is a se- quence of pain through which they are progressing and there will be a natural, almost inevitable, lessening of their distress as they move through the stages of this sequence.
Leaders may help clients anticipate, for exam- ple, the acute anguish they will feel with each significant date holidays, anniversaries, and birthdays during the first year of bereavement. Psy- choeducational groups for women with primary breast cancer provide members with information about their illness, treatment options, and fu- ture risks as well as recommendations for a healthier lifestyle. Evaluation of the outcome of these groups shows that participants demonstrate sig- nificant and enduring psychosocial benefits.
Didactic instruction has thus been employed in a variety of fashions in group therapy: to transfer information, to alter sabotaging thought pat- terns, to structure the group, to explain the process of illness. Often such instruction functions as the initial binding force in the group, until other therapeutic factors become operative.
In part, however, explanation and clarification function as effective therapeutic agents in their own right. Human beings have always abhorred uncertainty and through the ages have sought to order the universe by providing explanations, primarily re- ligious or scientific.
The explanation of a phenomenon is the first step to- ward its control. If a volcanic eruption is caused by a displeased god, then at least there is hope of pleasing the god.
Frieda Fromm-Reichman underscores the role of uncertainty in pro- ducing anxiety. Confronting traumatic anxieties with active coping for instance, engaging in life, speaking openly, and providing mutual support , as op- posed to withdrawing in demoralized avoidance, is enormously helpful. Didactic instruction, through its provision of structure and explanation, has intrinsic value and deserves a place in our repertoire of therapeutic instruments see chapter 5. Direct Advice Unlike explicit didactic instruction from the therapist, direct advice from the members occurs without exception in every therapy group.
In other words, advice-giving may reflect a resistance to more intimate engagement in which the group members attempt to manage re- lationships rather than to connect.
Although advice-giving is common in early interactional group therapy, it is rare that specific advice will directly benefit any client. Indirectly, however, advice-giving serves a purpose; the process of giving it, rather than the content of the advice, may be benefi- cial, implying and conveying, as it does, mutual interest and caring.
Advice-giving or advice-seeking behavior is often an important clue in the elucidation of interpersonal pathology. Others soak up advice with an unquenchable thirst, yet never rec- iprocate to others who are equally needy. Some group members are so in- tent on preserving a high-status role in the group or a facade of cool self-sufficiency that they never ask directly for help; some are so anxious to please that they never ask for anything for themselves; some are exces- sively effusive in their gratitude; others never acknowledge the gift but take it home, like a bone, to gnaw on privately.
Other types of more structured groups that do not focus on member interaction make explicit and effective use of direct suggestions and guid- ance. For example, behavior-shaping groups, hospital discharge planning and transition groups, life skills groups, communicational skills groups, Recovery, Inc. One communicational skills group for clients who have chronic psychiatric illnesses reports excellent results with a structured group pro- gram that includes focused feedback, videotape playback, and problem- solving projects.
Is some advice better than others? Researchers who studied a behavior- shaping group of male sex offenders noted that advice was common and was useful to different members to different extents. The same information presented in an intellectualized and detached manner is far less valuable. In the center of the table rested an enormous pot of stew, more than enough for everyone. Yet no one ate. The rabbi saw that their suffering was indeed ter- rible and bowed his head in compassion.
Yet there was gaiety in the air; everyone appeared well nourished, plump, and exuberant. The rabbi could not understand and looked to the Lord. You see, the people in this room have learned to feed each other! Many psychiatric patients beginning therapy are demoralized and possess a deep sense of having nothing of value to offer others.
They have long considered themselves as burdens, and the experience of finding that they can be of importance to others is refresh- ing and boosts self-esteem. Group therapy is unique in being the only therapy that offers clients the opportunity to be of benefit to others. It also encourages role versatility, requiring clients to shift between roles of help receivers and help providers. Yalom, Momma and the Mean- ing of Life [New York: Basic Books, ] had been involved with me from the beginning in conceptualizing and organizing this group see also chapter Her parable proved to be pre- scient, since many members were to benefit from the therapeutic factor of altruism.
They offer support, reassurance, suggestions, insight; they share similar problems with one another. Not infrequently group members will accept observations from another member far more readily than from the group therapist. For many clients, the therapist re- mains the paid professional; the other members represent the real world and can be counted on for spontaneous and truthful reactions and feed- back.
Looking back over the course of therapy, almost all group members credit other members as having been important in their improvement.
Sometimes they cite their explicit support and advice, sometimes their simply having been present and allowing their fellow members to grow as a result of a facilitative, sustaining relationship.
Through the experience of altruism, group members learn firsthand that they have obligations to those from whom they wish to receive care. An interaction between two group members is illustrative. Derek, a chronically anxious and isolated man in his forties who had recently joined the group, exasperated the other members by consistently dismiss- ing their feedback and concern.
In response, Kathy, a thirty-five-year-old woman with chronic depression and substance abuse problems, shared with him a pivotal lesson in her own group experience. For months she had rebuffed the concern others offered because she felt she did not merit it.
Later, after others informed her that her rebuffs were hurtful to them, she made a conscious decision to be more receptive to gifts offered her and soon observed, to her surprise, that she began to feel much better.
In other words, she benefited not only from the support received but also in her ability to help others feel they had something of value to offer. She hoped that Derek could consider those possibilities for himself. Altruism is a venerable therapeutic factor in other systems of healing. In primitive cultures, for example, a troubled person is often given the task of preparing a feast or performing some type of service for the community. People need to feel they are needed and useful.
It is commonplace for alcoholics to continue their AA contacts for years after achieving complete sobriety; many members have related their cautionary story of downfall and subsequent reclamation at least a thousand times and continually enjoy the satisfaction of offering help to others.
Neophyte group members do not at first appreciate the healing impact of other members. Many clients who complain of meaninglessness are immersed in a morbid self-absorption, which takes the form of obsessive introspection or a teeth-gritting effort to actualize oneself. I agree with Victor Frankl that a sense of life meaning ensues but cannot be deliberately pursued: life meaning is always a derivative phenomenon that materializes when we have transcended ourselves, when we have forgotten ourselves and become absorbed in someone or something outside ourselves.
In fact, therapy groups are often led by a male and female therapy team in a deliberate effort to simulate the parental configuration as closely as possi- ble. Once the initial discomfort is overcome, it is inevitable that, sooner or later, the members will interact with leaders and other members in modes reminiscent of the way they once interacted with parents and siblings.
In one of my groups, Betty, a member who had been silently pouting for a couple of meetings, bemoaned the fact that she was not in one-to-one therapy.
She claimed she was inhibited because she knew the group could not satisfy her needs. She knew she could speak freely of her- self in a private conversation with the therapist or with any one of the members. When pressed, Betty expressed her irritation that others were favored over her in the group.
For example, the group had recently wel- comed another member who had returned from a vacation, whereas her return from a vacation went largely unnoticed by the group. Furthermore, another group member was praised for offering an important interpreta- tion to a member, whereas she had made a similar statement weeks ago that had gone unnoticed.
For some time, too, she had noticed her growing resentment at sharing the group time; she was impatient while waiting for the floor and irritated whenever attention was shifted away from her. Was Betty right? Was group therapy the wrong treatment for her? Ab- solutely not! These very criticisms—which had roots stretching down into her early relationships with her siblings—did not constitute valid objec- tions to group therapy.
Quite the contrary: the group format was particu- larly valuable for her, since it allowed her envy and her craving for attention to surface. What is important, though, is not only that early familial conflicts are relived but that they are relived correctively.
Reexposure without repair only makes a bad situation worse. Growth-inhibiting relationship pat- terns must not be permitted to freeze into the rigid, impenetrable system that characterizes many family structures. Instead, fixed roles must be constantly explored and challenged, and ground rules that encourage the investigation of relationships and the testing of new behavior must be es- tablished. For many group members, then, working out problems with therapists and other members is also working through unfinished business from long ago.
How explicit the working in the past need be is a complex and controversial issue, which I will address in chapter 5. Group members may be asked to role-play approaching a prospective employer or asking someone out on a date. In other groups, social learning is more indirect. Members of dynamic therapy groups, which have ground rules encouraging open feedback, may obtain considerable information about maladaptive social behavior.
For individuals lacking intimate rela- tionships, the group often represents the first opportunity for accurate in- terpersonal feedback. Many lament their inexplicable loneliness: group therapy provides a rich opportunity for members to learn how they con- tribute to their own isolation and loneliness. But, as I will show in chapter 3, these gains are more than fringe benefits; they are often instrumental in the ini- tial phases of therapeutic change. They permit the clients to understand that there is a huge discrepancy between their intent and their actual im- pact on others.
These skills cannot but help to serve these clients well in future social interac- tions, and they constitute the cornerstones of emotional intelligence. This may be particularly potent in homogeneous groups that focus on shared problems—for example, a cognitive-behavior group that teaches psychotic patients strategies to reduce the intensity of auditory hallucinations. Bandura, who has long claimed that social learning cannot be adequately explained on the basis of direct reinforce- ment, has experimentally demonstrated that imitation is an effective ther- apeutic force.
This process may have solid therapeutic impact; finding out what we are not is progress toward finding out what we are. It is the group therapy analogue of important therapeutic factors in individual therapy such as insight, working through the trans- ference, and the corrective emotional experience. But it also represents processes unique to the group setting that unfold only as a result of spe- cific work on the part of the therapist.
To define the concept of interper- sonal learning and to describe the mechanism whereby it mediates therapeutic change in the individual, I first need to discuss three other concepts: 1. The importance of interpersonal relationships 2. The corrective emotional experience 3. There is convincing data from the study of nonhuman primates, primitive human cultures, and contemporary society that human beings have always lived in groups that have been characterized by intense and persistent relation- ships among members and that the need to belong is a powerful, funda- mental, and pervasive motivation.
If the separation is prolonged, the consequences for the infant will be profound. There exists a mother-infant pair. No more fiendish punishment could be devised, were such a thing physically possible, than that one should be turned loose in society and remain absolutely unnoticed by all the members thereof. There is, for example, persuasive evidence that the rate for virtually every major cause of death is significantly higher for the lonely, the single, the divorced, and the widowed.
For one thing, his language is often obscure though there are excellent ren- derings of his work into plain English ;13 for another, his work has so per- vaded contemporary psychotherapeutic thought that his original writings seem overly familiar or obvious.
Although a comprehensive discussion of inter- personal theory is beyond the scope of this book, I will describe a few key concepts here. Sullivan contends that the personality is almost entirely the product of interaction with other significant human beings. The need to be closely related to others is as basic as any biological need and is, in the light of the prolonged period of helpless infancy, equally necessary to sur- vival.
The developing child, in the quest for security, tends to cultivate and to emphasize those traits and aspects of the self that meet with approval and to squelch or deny those that meet with disapproval. Eventually the individual develops a concept of the self based on these perceived ap- praisals of significant others. The self may be said to be made up of reflected appraisals.
If these were chiefly derogatory, as in the case of an unwanted child who was never loved, of a child who has fallen into the hands of foster parents who have no real interest in him as a child; as I say, if the self-dynamism is made up of experience which is chiefly derogatory, it will facilitate hostile, dis- paraging appraisals of other people and it will entertain disparaging and hostile appraisals of itself.
Grunebaum and Solomon, in their study of adolescents, have stressed that satisfying peer relationships and self-esteem are inseparable concepts. Although parataxic distortion is similar to the concept of transference, it differs in two important ways. I will generally use the two terms interchangeably; despite the imputed dif- ference in origins, transference and parataxic distortion may be consid- ered operationally identical.
Furthermore, many therapists today use the term transference to refer to all interpersonal distortions rather than con- fining its use to the client-therapist relationship see chapter 7.
The transference distortions emerge from a set of deeply stored memo- ries of early interactional experiences. Interpersonal that is, parataxic distortions tend to be self-perpetuat- ing. For example, an individual with a derogatory, debased self-image may, through selective inattention or projection, incorrectly perceive an- other to be harsh and rejecting. Moreover, the process compounds itself because that individual may then gradually develop mannerisms and be- havioral traits—for example, servility, defensive antagonism, or conde- scension—that eventually will cause others to become, in reality, harsh and rejecting.
In other words, causality in relationships is circular and not linear. Consensual validation is a par- ticularly important concept in group therapy. Maladaptive interpersonal behavior can be further defined by its rigidity, extremism, distortion, circularity, and its seeming inescapability.
Improving interpersonal communication is the focus of a range of par- ent and child group psychotherapy interventions that address childhood conduct disorders and antisocial behavior.
These ideas—that therapy is broadly interpersonal, both in its goals and in its means—are exceedingly germane to group therapy. That does not mean that all, or even most, clients entering group therapy ask explic- itly for help in their interpersonal relationships. Yet I have observed that the therapeutic goals of clients often undergo a shift after a number of ses- sions.
Their initial goal, relief of suffering, is modified and eventually re- placed by new goals, usually interpersonal in nature. For example, goals may change from wanting relief from anxiety or depression to wanting to learn to communicate with others, to be more trusting and honest with others, to learn to love. It is important in the thinking of the therapist as well. Therapists cannot, for example, treat depression per se: depression offers no effective therapeu- tic handhold, no rationale for examining interpersonal relationships, which, as I hope to demonstrate, is the key to the therapeutic power of the therapy group.
It is necessary, first, to translate depression into interper- sonal terms and then to treat the underlying interpersonal pathology. Thus, the therapist translates depression into its interpersonal issues—for example, passive dependency, isolation, obsequiousness, inability to ex- press anger, hypersensitivity to separation—and then addresses those in- terpersonal issues in therapy.
This interpersonal and relational focus is a defining strength of group therapy. The theory of interpersonal relationships has become so much an inte- gral part of the fabric of psychiatric thought that it needs no further un- derscoring. People need people—for initial and continued survival, for socialization, for the pursuit of satisfaction. No one—not the dying, not the outcast, not the mighty—transcends the need for human contact.
During my many years of leading groups of individuals who all had some advanced form of cancer,32 I was repeatedly struck by the realization that, in the face of death, we dread not so much nonbeing or nothingness but the accompanying utter loneliness.
Dying patients may be haunted by interpersonal concerns—about being abandoned, for example, even shunned, by the world of the living. One woman, for example, had planned to give a large evening social function and learned that very morning that her cancer, heretofore believed contained, had metastasized. She kept the information secret and gave the party, all the while dwelling on the horrible thought that the pain from her disease would eventually grow so unbearable that she would become less human and, finally, unac- ceptable to others.
The isolation of the dying is often double-edged. Patients themselves often avoid those they most cherish, fearing that they will drag their fam- ily and friends into the quagmire of their despair. Thus they avoid morbid talk, develop an airy, cheery facade, and keep their fears to themselves. The patient is always informed covertly that he or she is dying by the de- meanor, by the shrinking away, of the living.
They make the mistake of concluding that, after all, there is noth- ing more they can do. What the patient needs is to make contact, to be able to touch others, to voice concerns openly, to be reminded that he or she is not only apart from but also a part of. Psychotherapeutic ap- proaches are beginning to address these specific concerns of the termi- nally ill—their fear of isolation and their desire to retain dignity within their relationships. The outcasts, too, have compelling social needs.
I once had an experience in a prison that provided me with a forceful reminder of the ubiquitous nature of this human need. An untrained psychiatric techni- cian consulted me about his therapy group, composed of twelve inmates. The members of the group were all hardened recidivists, whose offenses ranged from aggressive sexual violation of a minor to murder.
The group, he complained, was sluggish and persisted in focusing on extraneous, ex- tragroup material. I agreed to observe his group and suggested that first he obtain some sociometric information by asking each member privately to rank-order everyone in the group for general popularity.
I had hoped that the discussion of this task would induce the group to turn its atten- tion upon itself. Although we had planned to discuss these results before the next group session, unexpected circumstances forced us to cancel our presession consultation. During the next group meeting, the therapist, enthusiastic but profes- sionally inexperienced and insensitive to interpersonal needs, announced that he would read aloud the results of the popularity poll. Hearing this, the group members grew agitated and fearful.
They made it clear that they did not wish to know the results. Several members spoke so vehe- mently of the devastating possibility that they might appear at the bottom of the list that the therapist quickly and permanently abandoned his plan of reading the list aloud. I suggested an alternative plan for the next meeting: each member would indicate whose vote he cared about most and then explain his choice. Nevertheless, the group shifted to an interac- tional level and developed a degree of tension, involvement, and exhilara- tion previously unknown.
These men had received the ultimate message of rejection from society at large: they were imprisoned, segregated, and explicitly labeled as outcasts. To the casual observer, they seemed hard- ened, indifferent to the subtleties of interpersonal approval and disap- proval.
Yet they cared, and cared deeply. The need for acceptance by and interaction with others is no different among people at the opposite pole of human fortunes—those who occupy the ultimate realms of power, renown, or wealth.
I once worked with an enormously wealthy client for three years. The major issues revolved about the wedge that money created between herself and others. Did anyone value her for herself rather than her money? Was she continually being ex- ploited by others? To whom could she complain of the burdens of a ninety- million-dollar fortune? The secret of her wealth kept her isolated from others.
And gifts! How could she possibly give appropriate gifts without having others feel either disappointed or awed? There is no need to belabor the point; the loneliness of the very privileged is common knowledge. Loneliness is, incidentally, not irrelevant to the group therapist; in chapter 7, I will discuss the loneliness inherent in the role of group leader.
Every group therapist has, I am sure, encountered group members who profess indifference to or detachment from the group. My ex- perience has been that if I can keep such clients in the group long enough, their wishes for contact inevitably surface. They are concerned at a very deep level about the group.
One member who maintained her indifferent posture for many months was once invited to ask the group her secret question, the one question she would like most of all to place before the group. Moreover, this engagement with other members is often long-lived; I have known many clients who think and dream about the group members months, even years, after the group has ended. In short, people do not feel indifferent toward others in their group for long.
And clients do not quit the therapy group because of boredom. Be- lieve scorn, contempt, fear, discouragement, shame, panic, hatred! Believe any of these! But never believe indifference! Let us now turn to the corrective emotional experience, the second of the three concepts nec- essary to understand the therapeutic factor of interpersonal learning.
The patient, in order to be helped, must undergo a cor- rective emotional experience suitable to repair the traumatic influence of previous experience. I believe Alexander was aware of that, because at one point he suggested that the analyst may have to be an actor, may have to play a role in order to create the desired emo- tional atmosphere. But the evocation and expression of raw affect is not sufficient: it has to be transformed into a corrective emotional experience.
For that to occur two conditions are required: 1 the members must experience the group as sufficiently safe and supportive so that these tensions may be openly expressed; 2 there must be sufficient engagement and honest feedback to permit effective reality testing. Over many years of clinical work, I have made it a practice to interview clients after they have completed group therapy. I always inquire about some critical incident, a turning point, or the most helpful single event in therapy.
My clients almost invariably cite an incident that is highly laden emotionally and involves some other group member, rarely the therapist. The most common type of incident my clients report as did clients de- scribed by Frank and Ascher 39 involves a sudden expression of strong dis- like or anger toward another member. In each instance, communication was maintained, the storm was weathered, and the client experienced a sense of liberation from inner restraints as well as an enhanced ability to explore more deeply his or her interpersonal relationships.
The important characteristics of such critical incidents were: 1. The client expressed strong negative affect. This expression was a unique or novel experience for the client.
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