The Theory and Practice of Group Psychotherapy Read Online Free PDF Page B

as a cornerstone of therapeutic effectiveness. Change both at the behavioral level and at the deeper level of internalized images of past relationships does not occur primarily through interpretation and insight but through meaningful here-and-now relational experience that disconfirms the client’s pathogenic beliefs. 36 When such discomfirmation occurs, change can be dramatic: clients express more emotion, recall more personally relevant and formative experiences, and show evidence of more boldness and a greater sense of self. 37
    These basic principles—the importance of the emotional experience in therapy and the client’s discovery, through reality testing, of the inappropriateness of his or her interpersonal reactions—are as crucial in group therapy as in individual therapy, and possibly more so because the group setting offers far more opportunities for the generation of corrective emotional experiences. In the individual setting, the corrective emotional experience, valuable as it is, may be harder to come by, because the client-therapist relationship is more insular and the client is more able to dispute the spontaneity, scope, and authenticity of that relationship. (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 emotional atmosphere.) 38
    No such simulation is necessary in the therapy group, which contains many built-in tensions—tensions whose roots reach deep into primeval layers: sibling rivalry, competition for leaders’/parents’ attention, the struggle for dominance and status, sexual tensions, parataxic distortions, and differences in social class, education, and values among the members. 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. Although “critical incident” is not synonymous with therapeutic factor, the two are not unrelated, and much may be learned from an examination of single important events. 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 described by Frank and Ascher) 39 involves a sudden expression of strong dislike 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.
2. This expression was a unique or novel experience for the client.
3. The client had always dreaded the expression of anger. Yet no catastrophe ensued: no one left or died; the roof did not collapse.
4. Reality testing ensued. The client realized either that the anger expressed was inappropriate in intensity or direction or that prior avoidance of affect expression had been irrational. The client may or may not have gained some insight, that is, learned the reasons accounting either for the inappropriate affect or for the prior avoidance of affect experience or expression.
5. The client was enabled to interact more freely and to explore interpersonal relationships more deeply.
    Thus, when I see two group members in conflict with one another, I