The Theory and Practice of Group Psychotherapy (114 page)

5. If you could replace members of your group with other ideal group members, how many would you exchange (exclusive of group therapists)?

6. To what degree do you feel that you are included by the group in the group’s activities?

7. How do you feel about your participation in, and contribution to, the group work?

8. What do you feel about the length of the group meeting?

9. How do you feel about the group therapist(s)?

10. Are you ashamed of being in group therapy?

11. Compared with other therapy groups, how well would you imagine your group works together?

37
I. Falloon, “Interpersonal Variables in Behavioral Group Therapy,”
British Journal of Medical Psychology
54 (1981): 133–41.

38
J. Clark and S. Culbert, “Mutually Therapeutic Perception and Self-Awareness in a T-Group,”
Journal of Applied Behavioral Science
1 (1965): 180–94.

39
Outcome was measured by a well-validated rating scale (designed by A. Walker, R. Rablen, and C. Rogers, “Development of a Scale to Measure Process Changes in Psychotherapy,”
Journal of Clinical Psychology
16 [1960]: 79–85) that measured change in one’s ability to relate to others, to construe one’s experience, to approach one’s affective life, and to confront and cope with one’s chief problem areas. Samples of each member’s speech were independently rated on this scale by trained naive judges from taped excerpts early and late in the course of the group. Intermember relationships were measured by the Barrett-Lennard Relationship Inventory (G. Barrett-Lennard, “Dimensions of Therapist Response as Causal Factors in Therapeutic Change,”
Psychological Monographs
76, [43, Whole No. 562] [1962]), which provided a measure of how each member viewed each other member (and the therapist) in terms of “unconditional, positive regard, empathic understanding, and congruence.”

40
Lieberman, Yalom, and Miles,
Encounter Groups.

41
First, a critical incident questionnaire was used to ask each member, after each meeting, to describe the most significant event of that meeting. All events pertaining to group attraction, communion, belongingness, and so on were tabulated. Second, a cohesiveness questionnaire similar to the one described earlier (Yalom et al., “Prediction of Improvement”) was administered early and late in the course of the group.

42
J. Hurley, “Affiliativeness and Outcome in Interpersonal Groups: Member and Leader Perspectives,”
Psychotherapy
26 (1989): 520–23.

43
MacKenzie and Tschuschke, “Relatedness, Group Work, and Outcome.”

44
Budman et al., “Preliminary Findings on a New Instrument.” Although this scale is based on the assumption that cohesiveness is multidimensional, results of a well-designed study of time-limited (fifteen sessions) therapy groups in fact supported cohesiveness as a single factor. Furthermore, an attempt to distinguish cohesiveness from alliance was also unsuccessful. The authors suggest that it may be especially critical for group leaders to attempt to develop a strong working alliance between group members during the first half hour of each group. S. Budman, S. Soldz, A. Demby, M. Feldstein, T. Springer, and M. Davis, “Cohesion, Alliance, and Outcome in Group Psychotherapy,
Psychiatry
52 (1989): 339–50.

45
Marziali et al., “The Contribution of Group Cohesion.”

46
Budman et al., “Preliminary Findings on a New Instrument.”

47
D. Hope, R. Heimberg, H. Juster, and C. Turk,
Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach
(San Antonio: Psychological Corp., 2001).

48
S. Woody and R. Adesky, “Therapeutic Alliance, Group Cohesion, and Homework Compliance During Cognitive-Behavioral Group Treatment of Social Phobia,”
Behavior Therapy
33 (2002): 5–27.

49
H. Sexton, “Exploring a Psychotherapeutic Change Sequence: Relating Process to Intersessional and Posttreatment Outcome,”
Journal of Consulting and Clinical Psychology
61 (1993): 128–36.

50
K. MacKenzie, R. Dies, E. Coche, J. Rutan, and W. Stone, “An Analysis of AGPA Institute Groups,”
International Journal of Group Psychotherapy
37 (1987): 55–74.

51
V. Tschuschke and R. Dies, “Intensive Analysis of Therapeutic Factors and Outcome in Long-Term Inpatient Groups,”
International Journal of Group Psychotherapy
44 (1994): 185–208.

52
Horvath and Symonds, “Relation Between Working Alliance and Outcome.” Martin et al., “Relation of the Therapeutic Alliance with Outcome.”

53
C. Rogers, “A Theory of Therapy, Personality, and Interpersonal Relationships,” in
Psychology: A Study of a Science,
vol. 3, ed. S. Koch (New York: McGraw-Hill, 1959), 184–256.

54
F. Nietzsche,
Thus Spoke Zarathrusta
, trans. R. Hollingsdale (New York: Penguin Books, 1969).

55
K. Horney,
Neurosis and Human Growth
(New York: Norton, 1950), 15.

56
J. Weiss,
How Psychotherapy Works: Process and Technique
(New York: Guilford Press, 1993).

57
Rector et al., “Cognitive Change and the Therapeutic Alliance.”

58
C. Truax, “The Process of Group Therapy: Relationships Between Hypothesized Therapeutic Conditions and Intrapersonal Exploration,”
Psychological Monographs
75 (5111 [1961]).

59
A. Walker, R. Rablen, and C. Rogers, “Development of a Scale to Measure Process Changes in Psychotherapy,”
Journal of Clinical Psychology
16 (1960): 79–85.

60
Roarck and Sharah, “Factors Related to Group Cohesiveness.” Tschuschke and Dies, “Intensive Analysis.”

61
A. Bandura,
Social Foundations of Thought and Action
(Englewood Cliffs, N.J.: Prentice Hall, 1986).

62
C. Rogers, personal communication, April 1967.

63
C. Rogers, “The Process of the Basic Encounter Group,” unpublished mimeograph, Western Behavioral Science Institute, La Jolla, Calif., 1966.

64
P. Schlachet, “The Once and Future Group: Vicissitudes of Belonging,”
Group
24 (2000): 123–32.

65
I. Rubin, “The Reduction of Prejudice Through Laboratory Training,”
Journal of Applied Behavioral Science
3 (1967): 29–50. E. Fromm,
The Art of Loving
(New York: Bantam Books, 1956).

66
M. Leszcz, E. Feigenbaum, J. Sadavoy, and A. Robinson, “A Men’s Group: Psychotherapy with Elderly Males,”
International Journal of Group Psychotherapy
35 (1985): 177–96.

67
D. Miller, “The Study of Social Relationships: Situation, Identity, and Social Interaction,” in Koch,
Psychology: A Study of a Science
3 (1983): 639–737.

68
H. Sullivan,
Conceptions of Modern Psychiatry
(London: Tavistock, 1955), 22.

69
Smith et al., “Attachment to Groups.”

70
Miller, “Study of Social Relationships,” 696.

71
E. Murray, “A Content Analysis for Study in Psychotherapy,”
Psychological Monographs
70 (13 [1956]).

72
R. DeRubeis and M. Feeley, “Determinants of Change in Cognitive Therapy for Depression,”
Cognitive Therapy and Research
14 (1990): 469–80. Rounsaville et al., “The Relation Between Specific and General Dimensions.” J. Safran and L. Wallner, “The Relative Predictive Validity of Two Therapeutic Alliance Measures in Cognitive Therapy,”
Psychological Assessment
3 (1991): 188–95. Rector et al., “Cognitive Change.”

73
Weiss,
How Psychotherapy Works.
P. Fretter, W. Bucci, J. Broitman, G. Silberschatz, and J. T. Curtis, “How the Patient’s Plan Relates to the Concept of Transference,”
Psychotherapy Research
4 (1994): 58–72.

74
D. Lundgren and D. Miller, “Identity and Behavioral Change in Training Groups,”
Human Relations Training News
9 (Spring 1965).

75
Yalom et al., “Prediction of Improvement.”

76
Before beginning therapy, the patients completed a modified Jourard self-disclosure questionnaire (S. Jourard, “Self-Disclosure Patterns in British and American College Females,”
Journal of Social Psychology
54 [1961]: 315–20). Individuals who had previously disclosed much of themselves (relevant to the other group members) to close friends or to groups of individuals were destined to become popular in their groups. Hurley demonstrated, in a ten-week counseling group, that popularity was correlated with self-disclosure in the group as well as prior to group therapy (S. Hurley, “Self-Disclosure in Small Counseling Groups,” Ph.D. diss., Michigan State University, 1967).

77
Measured by the FIRO-B questionnaire (see chapter 10).

78
J. Connelly et al., “Premature Termination in Group Psychotherapy: Pretherapy and Early Therapy Predictors,”
International Journal of Group Psychotherapy
36 (1986): 145–52.

79
Ibid.

80
P. Costa and R. McCrae,
Revised NEO Personality Inventory and Five-Factor Inventory Professional Manual
(Odessa, Fla.: Psychological Assessment Services, 1992). The NEO-PI assesses five personality dimensions: extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience.

81
C. Anderson, O. John, D. Keltner, and A. Kring, “Who Attains Social Status? Effects of Personality and Physical Attractiveness in Social Groups,”
Journal of Personality and Social Psychology
81 (2001): 116–32.

82
R. Depue, “A Neurobiological Framework for the Structure of Personality and Emotion: Implications for Personality Disorders,” in
Major Theories of Personality Disorders,
ed. J. Clarkin and M. Lenzenweger (New York: Guilford Press, 1996), 342–90.

83
Lieberman, Yalom, and Miles,
Encounter Groups.

84
G. Homans,
The Human Group
(New York: Harcourt, Brace, 1950).

85
Anderson et al., “Who Attains Social Status?”

86
Yalom et al., “Prediction of Improvement.” I. Yalom, “A Study of Group Therapy Drop-Outs,”
Archives of General Psychiatry
14 (1966): 393–414.

87
E. Nash et al., “Some Factors Related to Patients Remaining in Group Psychotherapy,”
International Journal of Group Psychotherapy
7 (1957): 264–75.

88
Yalom, “A Study of Group Therapy Drop-Outs.”

89
I. Yalom and K. Rand, “Compatibility and Cohesiveness in Therapy Groups,”
Archives of General Psychiatry
13 (1966): 267–76. P. Sagi, D. Olmstead, and F. Atalsek, “Predicting Maintenance of Membership in Small Groups,”
Journal of Abnormal Social Psychology
51 (1955): 308–11. In this study of twenty-three college student organizations, a significant correlation was noted between attendance and group cohesiveness. Yalom and Rand, “Compatibility and Cohesiveness.” This study of cohesiveness, among forty members of five therapy groups found that the members who experienced little cohesion terminated within the first twelve meetings. Yalom et al., “Prediction of Improvement.” J. Connelly et al., “Premature Termination.” This study of sixty-six clients revealed that the twenty-two dropouts had less cohesiveness—they were less engaged, they perceived the group as less compatible and less supportive, and they were viewed less positively by other members. H. Roback and M. Smith, “Patient Attrition in Dynamically Oriented Treatment Groups,”
American Journal of Psychiatry
144 (1987): 165–77. Dropouts in this study reported that they felt less mutual understanding within the group. H. Roback, “Adverse Outcomes in Group Psychotherapy: Risk Factors, Prevention, and Research Directions,”
Journal of Psychotherapy Practice and Research
9 (2000): 113–22.

90
Lieberman, Yalom, and Miles,
Encounter Groups.

91
I. Yalom, J. Tinklenberg, and M. Gilula, “Curative Factors in Group Therapy,” unpublished study, Department of Psychiatry, Stanford University, 1968.

92
Braaten, “The Different Patterns of Group Climate.” K. MacKenzie, “Time-Limited Theory and Technique,” in
Group Therapy in Clinical Practice,
ed. A. Alonso and H. Swiller (Washington, D.C.: American Psychiatric Press, 1993).

93
M. Sherif et al.,
Intergroup Conflict and Cooperation: The Robbers’ Cave Experiment
(Norman: University of Oklahoma Book Exchange, 1961).

94
R. Baumeister and M. Leary, “The Need to Belong: Desire for Interpersonal attachments as a Fundamental Human Motivation,”
Psychology Bulletin
117 (1995): 497–529.

95
P. Evanson and R. Bednar, “Effects of Specific Cognitive and Behavioral Structure on Early Group Behavior and Atmosphere,”
Journal of Counseling Psychology
77 (1978): 258–62. F. Lee and R. Bednar, “Effects of Group Structure and Risk-Taking Disposition on Group Behavior, Attitudes, and Atmosphere,”
Journal of Counseling Psychology
24 (1977): 191–99. J. Stokes, “Toward an Understanding of Cohesion in Personal Change Groups,”
International Journal of Group Psychotherapy
33 (1983): 449–67.

96
A. Cota, C. Evans, K. Dion, L. Kilik, and R. Longman, “The Structure of Group Cohesion,”
Personality and Social Psychology Bulletin
21 (1995): 572–80. N. Evans and P. Jarvis, “Group Cohesion: A Review and Evaluation,”
Small Group Behavior
11 (1980): 357–70. S. Budge, “Group Cohesiveness Reexamined,”
Group
5 (1981): 10–18. Bednar and Kaul, “Experiential Group Research.” 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): 269–317.