The Theory and Practice of Group Psychotherapy (116 page)

13
S Freeman and J. Hurley, “Perceptions of Helpfulness and Behavior in Groups,”
Group
4 (1980): 51–58. M. Rohrbaugh and B. Bartels, “Participants’ Perceptions of ‘Curative Factors’ in Therapy and Growth Groups,”
Small Group Behavior
6 (1975): 430–56. B. Corder, L. Whiteside, and T. Haizlip, “A Study of Curative Factors in Group Psychotherapy with Adolescents,”
International Journal of Group Psychotherapy
31 (1981): 345–54. P. Sullivan and S. Sawilowsky, “Yalom Factor Research: Threats to Internal Validity,” presented at the American Group Psychotherapy Convention, San Diego, Calif., February 1993. M. Stone, C. Lewis, and A. Beck, “The Structure of Yalom’s Curative Factor Scale,” presented at the American Psychological Association Convention, Washington, D.C., 1992.

14
The number in each of the seven piles thus approaches a normal distribution curve and facilitates statistical assessment. For more about the Q-sort technique, see J. Block,
The Q-Sort Method in Personality Assessment and Psychiatric Research
(Springfield, Ill.: Charles C. Thomas, 1961).

15
Freedman and Hurley (“Perceptions of Helpfulness”) studied twenty-eight subjects in three fifty-hour sensitivity-training groups. Seven of the ten items selected as most helpful by these subjects were among the ten I listed. The subjects in Freedman and Hurley’s study placed three new items (21, 23, and 24 in
table 4.1
) into the top ten. These items are all interpersonal output items, and it is entirely consistent that members of a sensitivity group that explicitly focused on modifying interpersonal behavior should value these items. B. Corder, L. Whiteside, and T. Haizlip (“A Study of Curative Factors in Group Psychotherapy”) studied sixteen adolescents from four different groups in different clinical settings, both outpatient and inpatient. The youths did not highly value the adults’ top ranked item (insight), but their next four highest items were identical to those the adults had chosen. Overall, they valued the therapeutic factors of universality and cohesiveness more highly than did adults. R. Marcovitz and J. Smith (“Patients’ Perceptions of Curative Factors in Short-Term Group Psychotherapy,”
International Journal of Group Psychotherapy
33 [1983]: 21–37) studied thirty high-functioning inpatients who attended group psychotherapy in a psychiatric hospital. Only three of the top ten items in their study corresponded to our results, but their method was different: they asked patients to rate items from 1 to 60, rather than the Q-sort technique of sorting into piles from most helpful to least helpful. Their subjects’ top selected item was item 60
(Ultimately taking responsibility for my own life)
. When condensed into the rankings of overall therapeutic factors, their results were quite similar to ours, with five of the top six factors the same; their subjects ranked altruism third, notably higher than the outpatient sample did. M. Rohrbaugh and B. Bartels (“Participants’ Perceptions of ‘Curative Factors’”) studied seventy-two individuals in both psychiatric settings and growth groups. Their results were also consistent with our original Q-sort study: interpersonal learning (both input and output), catharsis, cohesiveness, and insight were the most valued factors, and guidance, family reenactment, and identification were least valued.

16
M. Weiner, “Genetic Versus Interpersonal Insight,”
International Journal of Group Psychotherapy
24 (1974): 230–37. Rohrbaugh and Bartels, “Participants’ Perceptions.” T. Butler and A. Fuhriman, “Patient Perspective on the Curative Process: A Comparison of Day Treatment and Outpatient Psychotherapy Groups,”
Small Group Behavior
11 (1980): 371–88. T. Butler and A. Fuhriman, “Level of Functioning and Length of Time in Treatment: Variables Influencing Patients’ Therapeutic Experience in Group Therapy,”
International Journal of Group Psychotherapy
33 (1983): 489–504. L. Long and C. Cope, “Curative Factors in a Male Felony Offender Group,”
Small Group Behavior
11 (1980): 389–98. Kivlighan and Mullison, “Participants’ Perception of Therapeutic Factors.” S. Colijn, E. Hoencamp, H. Snijders, M. Van Der Spek, and H. Duivenvoorden, “A Comparison of Curative Factors in Different Types of Group Psychotherapy,”
International Journal of Group Psychotherapy
41 (1991): 365–78. V. Brabender, E. Albrecht, J. Sillitti, J. Cooper, and E. Kramer, “A Study of Curative Factors in Short-Term Group Therapy,”
Hospital and Community Psychiatry
34 (1993): 643–44. M. Hobbs, S. Birtchnall, A. Harte, and H. Lacey, “Therapeutic Factors in Short-Term Group Therapy for Women with Bulimia,”
International Journal of Eating Disorders
8 (1989): 623–33. R. Kapur, K. Miller, and G. Mitchell, “Therapeutic Factors Within Inpatient and Outpatient Psychotherapy Groups,”
British Journal of Psychiatry
152 (1988): 229–33. I. Wheeler, K. O’Malley, M. Waldo, and J. Murphy, “Participants’ Perception of Therapeutic Factors in Groups for Incest Survivors,”
Journal for Specialists in Group Work
17 (1992): 89–95. Many of these studies (and the personal-growth therapeutic factor studies and inpatient group studies discussed later) do not use the sixty-item Q-sort but use instead an abbreviated instrument based on it. Generally, the instrument consists of twelve statements, each describing one of the therapeutic factors, which patients are asked to rank-order. Some studies use the critical incident method described in note 2. In the Lieberman, Yalom, and Miles encounter group study
(Encounter Groups)
, the most important factors involved expression of a feeling (both positive and negative) to another person, attainment of insight, vicarious therapy, and responding with strong positive and/or negative feelings. In the Bloch and Reibstein study (“Perceptions by Patients and Therapists”), the most valued factors were self-understanding, self-disclosure (which includes some elements of catharsis and interpersonal learning on other tests), and learning from interpersonal actions. Although the structure of the categories is different, the findings of these projects are consistent with the studies of the therapeutic factor in the abbreviated Q-sort.

17
Lieberman, Yalom, and Miles,
Encounter Groups
. S. Freedman and J. Hurley, “Maslow’s Needs: Individuals’ Perceptions of Helpful Factors in Growth Groups,”
Small Group Behavior
10 (1979): 355–67. Freedman and Hurley, “Perceptions of Helpfulness.” Kivlighan and Goldfine, “Endorsement of Therapeutic Factors.”

18
MacKenzie, “Therapeutic Factors in Group Psychotherapy.”

19
Stone et al., “The Structure of Yalom’s Curative Factor Scale.”

20
S. Holmes and D. Kivlighan, “Comparison of Therapeutic Factors in Group and Individual Treatment Process,”
Journal of Counseling Psychology
47 (2000): 478–84.

21
A. Fuhriman and G. Burlingame, “Consistency of Matter: A Comparison Analysis of Individual and Group Process Variables,”
Counseling Psychologist
18 (1990): 6–63. Holmes and Kivlighan, “Comparison of Therapeutic Factors.”

22
J. Breuer and S. Freud,
Studies on Hysteria
(New York: Basic Books, 2000).

23
Lieberman, Yalom, and Miles,
Encounter Groups.

24
Bloch and Crouch suggest “purifying” the factor of catharsis. They separate out the acquisition of the skill of being emotionally expressive and include it in another therapeutic factor, “learning from interpersonal action.” Furthermore, they split off the expression of bothersome ideas into a separate category, “self-disclosure.” Cleared of these, catharsis is left with only “emotional release,” which I think has the advantage of greater consistency yet becomes separated from any clinical reality, since emotional expression in the group cannot help but have far-reaching interpersonal ramifications. See Crouch, Bloch and Wauless, “Therapeutic Factors: Intrapersonal and Interpersonal Mechanisms.”

25
Freedman and Hurley, “Perceptions of Helpfulness.”

26
M. McCallum, W. Piper, and H. Morin, “Affect and Outcome in Short-Term Group Therapy for Loss,”
International Journal of Group Psychotherapy
43 (1993): 303–19.

27
A. Stanton et al., “Emotionally Expressive Coping Predicts Psychological and Physical Adjustment to Breast Cancer,”
Journal of Consulting and Clinical Psychology
68 (2000): 875–72.

28
J. Bower, M. Kemeny, S. Taylor, and J. Fahey, “Cognitive Processing, Discovery of Meaning, CD4 Decline, and AIDS-Related Mortality Among Bereaved HIV-Seropositive Men,”
Journal of Consulting and Clinical Psychology
66 (1998): 979–86.

29
Rohrbaugh and Bartels, “Participants’ Perceptions.”

30
J. Flowers and C. Booraem, “The Frequency and Effect on Outcome of Different Types of Interpretation in Psychodynamic and Cognitive-Behavioral Group Psychotherapy,”
International Journal of Group Psychotherapy
40: 203–14.

31
A. Maslow, “The Need to Know and the Fear of Knowing,”
Journal of General Psychology
68 (1963): 111–25.

32
J. Weiss,
How Psychotherapy Works: Process and Technique
(New York: Guilford Press, 1993).

33
A. Maslow,
Motivation and Personality
(New York: Harper, 1954).

34
D. Hellerstein, R. Rosenthal, H. Pinsker, L. Samstag, J. Muran, and A. Winston, “A Randomized Prospective Study Comparing Supportive and Dynamic Therapies: Outcome and Alliance,”
Journal of Psychotherapy Practice and Research
7 (1998): 261–71.

35
Maslow, “The Need to Know.”

36
R. White, “Motivation Reconsidered: The Concept of Competence,”
Psychological Review
66 (1959): 297–333.

37
Dibner exposed forty psychiatric patients to a psychiatric interview after dividing them into two experimental conditions. Half were prepared for the interview and given cues about how they should, in a general way, conduct themselves; the other half were given no such cues (a high-ambiguity situation). During the interview, the subjects in the high-ambiguity situation experienced far greater anxiety as measured by subjective, objective, and physiological techniques (A. Dibner, “Ambiguity and Anxiety,”
Journal of Abnormal Social Psychology
56 [1958]: 165–74).

38
L. Postman and J. Brunner, “Perception Under Stress,”
Psychological Review
55 (1948): 314–23.

39
S. Korchin et al., “Experience of Perceptual Distortion as a Source of Anxiety,”
Archives of Neurology and Psychiatry
80 (1958): 98–113.

40
Maslow, “The Need to Know.”

41
B. McEwen, “Protective and Damaging Effects of Stress Mediators,”
New England Journal of Medicine
38 (1998): 171–79. B. McEwen and T. Seeman, “Protective and Damaging Effects of Mediators of Stress: Elaborating and Testing the Concepts of Allostasis and Allostatic Load,”
Annals of the New York Academy of Sciences
896 (1999): 30–47.

42
F. Fawzy, N. Fawzy, and J. Wheeler, “A Post-Hoc Comparison of the Efficiency of a Psychoeducational Intervention for Melanoma Patients Delivered in Group Versus Individual Formats: An Analysis of Data from Two Studies,”
Psycho-Oncology
5 (1996): 81–89. K. Lorig et al., “Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status While Reducing Hospitalization: A Randomized Trial,”
Medical Care
37 (1999): 5–14.

43
F. Wright, “Being Seen, Moved, Disrupted, and Reconfigured: Group Leadership from a Relational Perspective,”
International Journal of Group Psychotherapy
54 (2004): 235–50.

44
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. D. Rosenthal, “Changes in Some Moral Values Following Psychotherapy,”
Journal of Consulting Psychology
19 (1955): 431–36.

45
Colijn et al., “A Comparison of Curative Factors.”

46
D. Randall, “Curative Factor Ratings for Female Incest Survivor Groups: A Summary of Three Studies,”
Journal for Specialists in Group Work
20 (1995): 232–39.

47
Reddon et al., “Therapeutic Factors in Group Treatment.

48
M. Leszcz, I. Yalom, and M. Norden, “The Value of Inpatient Group Psychotherapy and Therapeutic Process: Patients’ Perceptions,”
International Journal of Group Psychotherapy
35 (1985): 331–54. R. Rugal and D. Barry, “Overcoming Denial Through the Group,”
Small Group Research
21 (1990): 45–58. G. Steinfeld and J. Mabli, “Perceived Curative Factors in Group Therapy by Residents of a Therapeutic Community,”
Criminal Justice and Behavior
1 (1974): 278–88. Butler and Fuhriman, “Patient Perspective on the Curative Process.” J. Schaffer and S. Dreyer, “Staff and Inpatient Perceptions of Change Mechanisms in Group Psychotherapy,”
American Journal of Psychiatry
139 (1982): 127–28. Kapur et al., “Therapeutic Factors Within Inpatient and Outpatient Psychotherapy Groups.” J. MacDevitt and C. Sanislow, “Curative Factors in Offenders’ Groups,”
Small Group Behavior
18 (1987): 72–81.

49
M. Leszcz and P. Goodwin, “The Rationale and Foundations of Group Psychotherapy for Women with Metastatic Breast Cancer,”
International Journal of Group Psychotherapy
48 (1998): 245–74. M. Greenstein and W. Breitbart, “Cancer and the Experience of Meaning: A Group Psychotherapy Program for People with Cancer,”
American Journal of Psychotherapy
54 (2000): 486–500. D. Spiegel and C. Classen,
Group Therapy for Cancer Patients
(New York: Basic Books, 2000).