Chapter 5: Therapist

Basic TasksThe Theory and

Practice of Group Psychotherapy

Irvin Yalom, Ph.D

Basic Tasks

• 1. Creation and maintenance of the group

• 2. Culture Building• 3. Activation and illumination

of the here-and-now

Basic Tasks

• Creation and Maintenance of the Group– Transitional object ????– You need to create a physical

entity– Occasionally, you may need to

focus on not meeting everyone’s needs.

Basic Tasks• Culture Building

– Shaping the energy/dynamics into a therapeutic social system.

– The group that is the agent of change.• They set the therapeutic factors in motion.

– The group therapist functions far more indirectly, than individual therapist in which the clinician is the agent of change.

– Like the game of chess, therapist sets up the situation.

Basic Tasks• In this process it is important to

demonstrate– Capacity for empathy and caring

(Rogers, 1957 & Traux & Carkhuff,1967)• In Lieberman, Yalom & Miles (1973) work

with encounter groups, they found that the member’s perception of the leader as genuinely concerned and caring was the most important factor.

• It contributes to the culture of a safe place.• Self Reflection in order to manage adverse

reactions to the group.

Dimensions of the Leader’s Role

As per Brabender, Fallon, & Smolar (2004);

– Directive vs.. Nondirective

– Transparency vs.. Opaqueness

– Group as a whole/subgroup/interpersonal/individual

– Past/resent/Future

– Inside/Outside the group

– Content/ Process– Understanding/

Corrective Emotional experience

– Confrontation/exploration vs. support

8 dimensions

Dimensions of the Leader’s Role

As per Brabender, Fallon, & Smolar (2004);– Directive vs. Nondirective

• Self explanatory• Nondirective allows for the members to take on

greater responsibility– Focus on each other instead of the leader as the

transitional object– Allows leader to see their “natural” (supposedly)

form of relating

• Directive– Efficient use of time– Insures greater participation by more members– Keeps group on track but possibly influencing too

much

Dimensions of the Leader’s Role

As per Brabender, Fallon, & Smolar (2004);

– Transparency vs. Opaqueness• The extent the leader shares information

about themselves• What might you expect if a therapist is

completely transparent?No boundaries

Loss of the dual role of a leader

Dimensions of the Leader’s Role

As per Brabender, Fallon, & Smolar (2004);• What if the leader isn’t transparent at all?

• Therefore, Judicious self disclosure– Know the intent and its dynamic influence

Unsafe place

Cold

Little spontaneous interaction

Dimensions of the Leader’s Role

As per Brabender, Fallon, & Smolar (2004);– Group as a

whole/subgroup/interpersonal/individual• Represents the different layers or degree

upon which a leader can intervene• Group level focus – members responding to

the same stimuli• Subgroup level focus - two members form

alliances and explore the differences or focus on conflict resolutions between subgroups

• Individual level focus – the group is directed to examine one’s member’s issues

Dimensions of the Leader’s Role

As per Brabender, Fallon, & Smolar (2004);– Past/present/Future

• as related to the group’s life

– Inside/Outside the group• Now this one can combine with the above

to create a matrix

– Content/ Process • The communication dynamics between

members• NOTE: As you focus on the process of an

individual, he/she may feel more vulnerable because you are often addressing more unconscious material

Dimensions of the Leader’s Role

As per Brabender, Fallon, & Smolar (2004);– Understanding/ Corrective Emotional

experience• Increase understanding via providing

insight which suggests that there is a conflict to be addressed

• Or provide the basic foundation that they may have not had in their previous relationships a corrective experience suggesting that there is a lack of something

– Confrontation/exploration vs. support• Raise the level of emotional stimulation• Or consolidate the gains acquired through

support

Basic Tasks

• Construction of Norms– Constructed via from expectations for

their group and from the explicit and implicit directions of the leader

– If member’s expectations are not firm, then the leader has even more opportunity to design a group culture.

– The leader cannot not influence norms.– What one does not do is often as

important as what one does do.

Basic Tasks– Norms are shaped both the

expectations of the members and by behavior of the therapist.

The leader shape norms via:The technical expert roleThe model setting participant

-The technical expert understands the dynamics and is able to explain to the group and reinforce appropriately.Page 113 good examples

Basic Tasks

E.G. asking members to mention their opinions on each other’s comments.

Hence, this role includes significant social reinforcement – persuasion.

Among certain theoretical frameworks or clinicians, this is a controversial issue.

Consider this, that it tends to be inevitable that a clinician’s overt and covert responses act as a reward-punishment.

Basic Tasks• The model setting participant

– Bandura has demonstrated in studies that individuals may be influenced to engage in more adaptive or less adaptive behaviors through observing and assuming the therapist’s behavior.

– A clinician model the difference of their a self esteem and public esteem. Therefore, they demonstrate how the integrity of their self esteem is not threatened but rather can be improved.

– Appropriate disclosure can also be modeled. Sometimes pts don’t understand how to moderate such behavior.

– The therapist models honest with appropriate restraint.

Basic Tasks

• A leader that presents a infallible doesn’t allow for members to present their flaws and encourages a norm of being always being right.

• NOTE: A patient issue with you may related to his/her past but may have some validity to it in your reality. In other words, check its validity within and through ???______ validation.

• For example: an overly cautious leader may lead to a guarded and lifeless group. How does this work in the individual therapy format.

• A clinician’s transparency relates to the amount of a clinician’s disclosure.

Basic Tasks

• Therapeutic Norms– Self Monitoring group

• They are the main event instead of waiting on you

Self DisclosureThere is a subjective aspect of disclosure.What you consider superficial may be profound to another.The other issue is when to disclose – avoiding premature.Vertical vs. horizontal disclosure (metadisclosure)

Basic Tasks

– Be aware not to have a pt punished for disclosure.

– Procedural norms•The patterns of behavior in the

group may not be appropriate. (i.e. An appropriate one is checking in at the beginning but inappropriate one would be to continue the session in a sequential method.)