Group Therapy and the Encounter Group
Reprinted from 4th edition (1995) of The Theory and Practice of Group Psychotherapy
Fads and fashions change in the fields of psychotherapy and personal growth. And it is difficult to overestimate the rapidity of that change. Earlier editions of this book contained a lengthy and heady chapter on encounter groups studded with extravagant predictions, my own and others, about the perdurable destiny of the entire encounter group movement.
Yet, today, preparing this fourth edition, and poking around in the cold ashes of the encounter group movement, I can't help but wonder, whether I should even discuss encounter groups at all! After all, the encounter group movement has vaporized; there are few remaining signs of encounter groups. Growth centers, university bulletin boards, underground newspapers post no encounter group offerings. I have spoken to many younger mental health professionals who ask, “What is an encounter group?” There was a time when university dormitories churned with debates about whether to permit growth institutes to conduct marathon groups for the students in the dormitory common room. Today intense debates still rage, but about environmental, multicultural, gender and sexual harassment issues - not about encounter groups!
Yet, there are several reasons the well-educated group therapist should be familiar with the history, the mechanics, and the ethos of the encounter group. First, though the encounter group movement is dead and buried, the sophisticated technology of the encounter group persists and is widely employed by groups that are very much alive. Let us examine some remnants of the encounter group movement. (1)
A 1991 large survey of small group membership sponsored by the Gallup Institute accompanied by three years of in-depth case studies and interviews reveals some astounding results: Forty percent of all Americans eighteen years of age and over are involved in “a small group that meets regularly and provides caring and support for those who participate in it.” (2) Forty percent of adults - that means seventy-five million Americans at the time of the survey were currently involved in a small group! And that breaks down to approximately three million small groups! Furthermore the majority of the participants attended a group meeting at least once weekly and had been participating for at least three years!
What kind of small groups are these? And what do they have to do with either the encounter group movement or the field of mental health? The great majority of these three million groups (approximately 1.7 million) are church sponsored groups (primarily adult Sunday school groups or bible study groups) and approximately 750 thousand of the groups are special interest groups (book discussion, hobbies, current events, sports). But still there are a half million self-help groups - groups explicitly designed to offer support for psychological discomfort - with approximately eight to ten million members. Another survey using an entirely different sampling base arrives at similar figures for self-help groups “an estimated seven and a half million adults participated in a self help group in 1992.” (3)
The activities and goals of many of the 1.7 million church-sponsored groups overlap significantly with those of self-help groups. Members in both types of groups seek and obtain similar types of help. Protocols of groups sponsored by Churches indicate they are often remarkably similar to secular support groups. Of great interest is the data on the groups' helpful aspects (or therapeutic factors). Regardless of the group's name, sponsor, and purported intent, what is considered most important by members are the interpersonal interactions of the group. For example, members of all groups rated the following items as highly important: “members giving you encouragement” (86%), “hearing other members share their views” (85%), feeling they were no longer alone,”(82%) “seeing love and caring in the group” (80%). (4)
Ostensibly members enter church and secular groups for very different reasons. The major differences, of course, center around the spiritual domain: 68% joined the church group to become more disciplined in their spiritual life (versus 15% of those in self-help groups)and 60% percent of church group members say they are on a spiritual journey (versus 37% of self-help groups). (5) Yet it is also true that individuals entered both groups with almost identical levels of anxiety, depression, guilt, personal crisis, personal problems, and preoccupation with figuring out what's important in life. (6)
Is it possible that remnants of the encounter group are to be found in these church-sponsored small groups? Many would deny that. The Church has sponsored small groups long before the encounter group movement: throughout church history small groups have formed the basis for new religious orders. But it is also true that beginning in the 1960s and 1970s traditional religious institutions as well as new religious sects (7) made much explicit use of encounter technology. Encounter group technology has had some influence in the process of the marriage encounter program sponsored primarily by Catholic and Jewish religious leaders (but also by other Christian denominations). Furthermore many of the religious growth experiences: retreats for married couples, teenagers, engaged couples, families, the divorced and the bereaved, and people desiring a self-exploratory experience employ a familiar behavioral technology: the structured exercises, the emphasis upon personal exploration, the identification and expression of feelings, and the emphasis upon genuine member intimacy are highly reminiscent of, in fact adapted from, encounter group technology.
The self-help group movement is an enormously expanding field which merits discussion because its goals in many ways are parallel to the goals of group therapy. Self-help groups exist for the explicit purpose of offering psychological support: they help members deal with a psychological problem, a physical illness, a significant external stress, or with a stigmatized status in society (for example being short, obese, gay, widowed). The deepest roots of the self-help movement are to be found not in group therapy or in the encounter movement but in a Protestant populist ethos of people helping one another. Certainly it was this tradition combined with the absence of effective medical alternatives that gave rise to Alcoholics Anonymous and to all the subsequent diverse twelve-step programs that have spun off of A.A. The great recent expansion of church sponsored small groups (and self-help groups, as well) occurred in the same decades as the burgeoning of the encounter group movement - all arising in response to the same social conditions and needs.
The contemporary self-help scene has grown extremely diverse. Many self-help groups, as I shall discuss shortly, are no longer 'pure' self-help but influenced by mental health professionals who may introduce encounter group or therapy group techniques into the procedure. Sometimes mental health professionals are so closely involved with these groups that the public often confuses group therapy and self-help groups.
How large is the self-help movement? Not an easy question since the data on many self-help groups is very sketchy. Though many of the groups place a heavy emphasis on anonymity and non-professionalism and resist formal study, some of the groups are highly visible and registered. For example, the California self-help Center had, in 1993, a database of 4600 California groups and referred about one hundred twenty callers a day to one of these groups. (8) However, the Center also recognized that there is undoubtedly a massive underground of self-help activity that remains unexamined in the professional literature. (9)
To what extent are self-help groups used for the alleviation of psychological distress? A study of help-seeking patterns in a sample of 3000 households in the mid 1980s reveals that in a given year 5.6 % sought help from a mental health professionals, 5 % from a pastoral help-giver and 5.8 % from a self-help group. In fact there is evidence that the number of individuals in self-help groups now rivals the numbers in all forms (individual and group combined) of professional psychotherapy. (10)
One might conclude that the self-help movement is operating as an alternative, competing mental health system. But the picture is more complex than that. For one thing there is an overlap in membership: individuals in self-help groups are more likely than the general public to be also involved in psychotherapy. Furthermore, several surveys of self-help groups have revealed that the non-professionally led, mutual support group rarely exists in the pure state. The great majority of self-help groups surveyed - between 70 % and 80 % - have some form of professional involvement! (11) The professional may serve as group leader, consultant, tutor, or participant-observer. Approximately 32 % of the groups were led by professional paid mental health workers, 11% by other professionals (for example teachers), “trained nonprofessionals” led 18% of the groups, and regular group members led only 36% of the groups. (12)
Self-help groups have such great visibility that it is not necessary to list their various forms. One can scarcely conceive of a type of distress, behavioral aberration or environmental misfortune for which there is not some corresponding group. The roster is far larger than the psychopathologies described in the DSM-IV (13) and includes such wide-spread groups as A. A., Recovery Inc., Compassionate Friends (for bereaved parents), smoke-enders, weight-watchers, overeaters anonymous, and such highly specific groups as: Spouses of head injury survivors, Gay alcoholics, Late-deafened adults, Adolescent deaf children of alcoholics, Moms in recovery, Senior crime victims, Circle of friends (friends of suicide victims) Parents of murdered children, Go-go stroke club, Together expecting a Miracle (adoption support).
Though the process of the self-help group overlaps heavily with the therapy group, there are some significant differences. The self-help group makes extensive use of almost all the therapeutic factors - especially altruism, cohesiveness, universality, imitative behavior, and instillation of hope and catharsis. (14) The one important exception is the therapeutic factor of interpersonal learning which plays a far more important role in the therapy group. It is rare for a group to focus significantly and constructively on the here-and-now without the presence of a well-trained leader. In general the process of the self-help group is characterized by “less skeptical response to each other's disclosures; fewer interpretations of character, and more empathic responses when compared with group or individual therapies.” (15)
How effective are self-help groups? Though the informality of self-help groups and their absence of an institutional base makes outcome research technically difficult, there has, nonetheless, in the past decade been an explosion of interest - approximately a hundred outcome studies - for a wide diversity of self-help groups. (16) For example, studies attest to the effectiveness of several groups: A. A. for the treatment of alcoholism (17), bereavement groups for both spouses and parents (18), groups for the chronically mentally ill patients (Recovery Inc., Grow, Depressive and Manic-depressive Association) . (19)
Though the impact of encounter groups upon small groups in the Church and in the self-help movement may be disputed there is no doubt at all about the utilization of encounter group technology in the many large group awareness programs - for example, est, actualizations, and Lifespring.* These programs, which first emerged in the early 1970's, use a time-extended format which consists largely of inspirational lectures and a series of encounter group structured exercises arranged and presented in a high-tech, slickly packaged format. The large group consisting of two hundred to three hundred people is occasionally broken down into smaller groups or dyads for structured exercises. (Interested readers may consult my detailed description of the format published detail elsewhere.  ) Large numbers of people are involved. Over one million people have had est (or The Forum) training and almost two hundred thousand have attended the basic Lifespring training. (22) In addition to the large group format, Lifespring offers advanced training consisting of fifty hours of small group (twenty to thirty-five persons) meetings which differ little from the highly energized, interactional, cohesive encounter group of the 1960s and 1970s. Over 92,000 individuals have attended these Lifespring encounter groups with over 4,000 attending in 1993. (23)
The attendance of all these group phenomena combined - religious growth experiences, self-help groups, large group experiences such as Lifespring and The Forum - dwarfs the attendance enjoyed, in their heyday, by the free universities, Esalen, and other growth centers.
So, although the movement is over and an encounter group qua encounter group is hard to find, more people than ever before are having an encounter group experience.
Other reasons justify discussing encounter groups in this text. In the following chapter, I stress the importance, in the training of the group therapist, of some personal group experience. Some training programs may offer a traditional therapy group for trainees, but most sponsor some variant of an encounter group. (For the moment, I refer to all personal growth experiential groups as encounter groups, but shortly I will define terms more precisely.) Thus, many group therapists enter the field through the portals of the encounter group.
Keep in mind, too, that the contemporary therapy group, in ways that I shall discuss shortly, has been vastly influenced by the encounter group. No historical account of the development and evolution of group therapy is complete without including a description of the cross-fertilization occurring between the therapy and the encounter traditions.
Lastly, and this may seem surprising to some readers, the encounter group, or at least the tradition from which it emerged, has been responsible for developing the best, the most sophisticated, small group research technology. In comparison, group therapy research has been crude and unimaginative; much of the empirical research I have cited throughout this text has had its roots in the encounter group tradition.
So much for the justification of discussing encounter groups. Let me proceed to a definition and to a historical survey.
What Is an Encounter Group?
Encounter group is a rough, inexact generic term that encompasses a great variety of forms. Consider some of its many aliases: human relations groups, training groups, T-groups, sensitivity groups, personal growth groups, marathon groups, human potential groups, sensory awareness groups, basic encounter groups, experiential groups, and so on.
Although the nominal plumage is dazzling in its diversity, all these groups have several common denominators. The groups range in size from eight to twenty members - large enough to encourage face-to-face interaction, yet small enough to permit all members to interact. The groups are generally time-limited, often compressed into hours or days. They focus to a large extent on the here-and-now; they transcend etiquette and encourage the doffing of traditional social facades. Finally, these groups value interpersonal honesty, exploration, confrontation, heightened emotional expressiveness, and self-disclosure. The goals of a group are often vague. Occasionally they stress merely the provision of an experience - joy, entertainment, being turned on; but more often they implicitly or explicitly strive for some change —- in behavior, in attitudes, in values, in life style, in self-actualization; or in one's relationship to others, to the environment, to one's own body. The participants are not generally labeled “patients;” the experience is considered not therapy but “growth.”
ANTECEDENTS AND EVOLUTION OF THE ENCOUNTER GROUP (24)
The term encounter group for an experiential group was coined by Carl Rogers in the mid-1960s. The most common term before then was T-group (“T” for training in human relations). *
The first T-group, the ancestral experiential group, was held in 1946. The State of Connecticut had passed a Fair Employment Practices Act and asked Kurt Lewin, a prominent social psychologist, to train leaders who could deal effectively with tensions among groups and thus help to change the racial attitudes of the public. Kurt Lewin organized a workshop that consisted of small groups of ten members each. These groups were led in the traditional manner of the day; they were basically discussion groups and analyzed ‘back home’ problems presented by the group members.
Kurt Lewin always believed in ”no research without action; no action without research.”Consequently he assigned research observers to record and code the behavioral interactions of each of the small groups. During evening meetings, the group leaders and the research observers met and pooled their observations of leader, member, and group behavior. Soon some participants learned of these evening meetings and asked permission to attend. Reluctantly the staff agreed; they feared revealing their own inadequacies and were uncertain about the effects upon the members of hearing their behavior discussed openly.
Finally the members were permitted to attend and observe the evening meetings on a trial basis. Observers who have written about this experience report that the effect on both participants and staff was “electric”. (25) There was something galvanizing about witnessing an in-depth discussion of one's own behavior. Soon the format of the evening meetings was widened to permit the participants to respond to the observations, and shortly thereafter all parties were involved in the analysis and interpretation of their interaction. Before many evenings had passed, all the participants were attending the evening meetings, which were often continued for as long as three hours. There was widespread agreement that the meetings offered the participants a new and rich understanding of their own behavior.
The staff immediately realized that they had, somewhat serendipitously, discovered a powerful technique of human relations education — experiential learning. Group members learn most effectively by studying the very interactional network in which they themselves are enmeshed (By now the reader will have recognized the roots of the use of the “here-and-now” in contemporary group therapy.) They profit enormously by being confronted, in an objective manner, with on-the-spot observations of their own behavior and its effects on others; they may learn about their interpersonal styles, the responses of others to them, and about group behavior in general.
From this beginning, research has been woven into the fabric of the T-group. I refer not only to formal research but to a research attitude on the part of the leader, who collaborates with the group members in a research inquiry designed to enable participants to experience, understand, and change their behavior. This research attitude, together with the concept of the T-group as a technique of education, is essential, as I shall shortly show, in the differentiation of the T-group from the therapy group. It was a principle, however, that was gradually abandoned in the later metamorphosis of T-group to encounter group.
This laboratory was so successful that similar laboratories were held in successive years. The small discussion groups were called “basic skill training groups” (shortened in 1949 to “T-group”). By 1950, the sponsoring organization, the National Training Laboratory (N.T.L.), was established within the National Educational Association as a permanent year-round organization. The N.T.L. is still a robust organization but in its heyday during the 1960s had a network of several hundred trained leaders and held human relations laboratories for thousands of participants.
The T-group was only one aspect of these one to two week human relations laboratories. There were also large group and intergroup exercises and educational seminars on group theory and the transfer of learning. that is the application of in-group learning to back home situations.
At first the leaders maintained that the T-group was an educational venture in human relationships and not a psychotherapeutic one. Gradually, however, during the 1950s and 1960s, the training staff shifted from a sociological and educational emphasis to a clinical one. Rogerian and Freudian clinicians became involved with the human relations laboratory, and the language gradually grew less sociological and socio-psychological and more clinical.
Gradually, the T-group moved in the direction of ever greater emphasis on interpersonal interaction. Discussion of outside material (“there-and-then”), including “back home” current problems or past personal history, was discouraged, whereas here-and-now material was highly prized. The T-group made major technical innovations which were destined to exert much influence on the psychotherapy group. These included feedback, unfreezing, observant participation, and cognitive aids.
Feedback, a term borrowed from electrical engineering, was first applied to the behavioral sciences by Lewin (it is no accident that he was teaching at M.I.T. at the time). (26) The early trainers considered that an important flaw in society was that too little opportunity exists for individuals to obtain accurate feedback from their back home associates: bosses, fellow employees, husbands, wives, teachers, students, and so on. Feedback, which became an essential ingredient of all T-groups was found to be most effective when it stemmed from here-and-now observations, when it followed the generating event as closely as possible, and when the recipient checked it out with other group members to establish its validity and reduce perceptual distortion.
Unfreezing, also adopted from Lewinian change theory, refers to the process of disconfirming an individual's former belief system. Motivation for change must be generated before change can occur. One must be helped to re-examine many cherished assumptions about oneself and one's relations to others. The familiar must be made strange (27); thus, many common props, social conventions, status symbols, and ordinary procedural rules were eliminated from the T-group, and one's values and beliefs about oneself were challenged. This was a most uncomfortable state for group participants, a state tolerable only under certain conditions: one must experience the group as a safe refuge within which it is possible to entertain new beliefs and experiment with new behavior without fear of reprisal.
Most trainers considered observant participation as the optimal method of involvement for all group participants. Members must both participate emotionally in the group and observe themselves and the group objectively. Often this is a difficult task to master and members chafe at the trainer's attempts to subject the group to objective analysis. Yet the dual task is essential to learning; alone, either action or intellectual scrutiny yields little learning. Camus once wrote, “My greatest wish: to remain lucid in ecstasy.” (28) So, too, the T-group (and the therapy group, as well) is most effective when its members can couple cognitive appraisal with emotional experience.
Cognitive guides around which T-group participants could organize their experience were often presented in brief lecturettes by a T-group leader or another staff member. This practice adumbrated and influenced the use of cognitive aids in contemporary Psychoeducational and cognitive-behavioral group therapy approaches. One example used in early T-group work (I mention this because it still proves useful in the contemporary therapy group) is the Johari window,* a four-celled personality paradigm which clarifies the function of feedback and self-disclosure.
(see image on page 493)
Cell A, “Known to self and Known to others,” is the public area of the self; cell B, “Unknown to self and Known to others,” is the blind area; cell C, “Known to self and Unknown to others,” is the secret area; cell D, “Unknown to self and Unknown to others,” is the unconscious self. The goals of the T-group, the trainer suggests, are to increase the size of cell A by decreasing cell B (blind spots) through feedback and cell C (secret area) through self-disclosure. In traditional T-groups, cell D (the unconscious) was considered out of bounds.
The use of such cognitive aids, lectures, reading assignments, and theory sessions demonstrates that the basic allegiance of the T-group was to the classroom rather than to the consulting room. The participants were considered students; the task of the T-group was to facilitate learning for its members. Different trainers emphasized different types of learning: some focused primarily on group dynamics and helped the members to understand group development, group pressures, the leadership role, and common group tensions and obstacles; others emphasized personal learning and focused on the interpersonal style and communication of the members. These two emphases became more polarized until a formal distinction was made in laboratory planning between group process groups (which were more concerned with group properties, group functioning, and, on a larger scale, with organization development) and personal development groups. I shall pursue the evolution of the T-group most concerned with personal development, since this form of T-group most closely resembles the therapy group and has spawned the many varieties of encounter groups.
From T-Group to Encounter Group
GROUP THERAPY FOR NORMALS
In the 1950s, the N.T.L. established several regional branches, and each of the various sectors gradually developed its own T-group emphasis. It was the West Coast, and particularly Southern California, that pursued the personal development model most vigorously. A 1962 article by Southern California trainers, which presented a model of a T-group as group therapy for normals, clearly signaled the change in emphasis from group dynamics to individual dynamics, from stress on the development of interpersonal skills to a greater concern with personal growth. (30) The experiential group was still considered an instrument of education - not of therapy. However, a broader, more humanistically based definition of education was proposed: education is not, they argued, the process of acquiring interpersonal and leadership skills, not the understanding of organizational and group functioning; education is nothing less than full self-discovery, the development of one's full potential.
THE STRESSES OF NORMALITY
These group leaders worked with normal healthy members of society, indeed with individuals who by most objective standards had achieved considerable success. Yet they learned that though these members had much external success, their inner experience was one of tension, insecurity, and value conflict.
The highly competitive American culture, many behavioral scientists noted, encourages facade building. One who is considered successful by one's peers too often strives at all costs to protect one's public image. Doubts about personal adequacy are swallowed and one must maintain constant vigilance lest any uncertainty or discomfort slip through. This process is isolating and crippling since it curtails communication not only with others but with oneself. Gradually, in order to eliminate a perpetual state of self-recrimination, the successful individual comes to believe in the reality of his or her facade and attempts, through unconscious means, to ward off internal and external attacks on that self-image. Thus, a state of equilibrium is reached but at great price: considerable energy is invested in maintaining intrapersonal and interpersonal separation, energy that might otherwise be used in the service of self-actualization. Creativity and self-knowledge are sacrificed as one turns one's gaze outward in a never-ending search for peer validation. Interpersonal relationships are shallow and unrewarding; one squelches spontaneity so that one's studied facade remains unruffled; one avoids self-disclosure, and refrains from confronting others to avoid reciprocal confrontation.
THE T-GROUP AS A SOCIAL OASIS
The T-group was promulgated as a respite from the insidious stresses of our culture. It offered an oasis where many of the restrictive norms I have described were unnecessary - in fact, were not permitted. The T-group did not reward individuals for material success, hierarchical position, expertise in some specialized area or a manner of unruffled aplomb and efficiency. Instead, the T-group encouraged different values: interpersonal honesty and disclosure of self-doubts and perceived weaknesses.
Gradually individuals discovered that their pretense of self-satisfaction was not only unnecessary but an encumbrance. For years they had operated on the assumption of having to pay dearly if they let slip their facade - a cost envisioned as humiliation, rejection, and loss of social or professional status. The T-group experience challenged these assumptions and enables these people to experiment with openness and to differentiate its real costs from its pseudo costs. Obviously there are real risks in the disclosure of all one's thoughts and feelings: The realities of living, of sensible interpersonal strategy and tactics, clearly dictate the advisability of keeping some things as part of our private selves. (31) But many of the pseudo costs are exposed. Letting one's facade slip does not result in rejection; in fact, members find themselves more completely accepted on the basis of a fully disclosed self rather than on that of a false projected image. Moreover, their deep sense of isolation is assuaged, as each becomes aware of the universality of secret doubts and fears. These processes are self-reinforcing since the experience of universality encourages each to be even more self-revealing. Members who have previously regarded interpersonal relationships as automated or threatening are able to sample the inherent richness and depth of human intimacy.
As the goal of the group shifted from education, in a traditional sense, to personal change, the name of the group shifted from T-group (training in human relations) or sensitivity training group (training in interpersonal sensitivity), to one more consonant with the basic thrust of the group. Several labels were advanced: “personal growth,” “human potential,” “human development,” or “encounter groups.” “Encounter group,” which stresses the basic authentic encounter between members (and between leader and members and between the disparate parts of each member), had the most staying power and became the most popular name for the “let it all hang out” experiential group prevalent in the 1960s and 1970s.
The third force in psychology (third after Freudian analysis and Watsonian-Skinnerian behaviorism), which emphasized a holistic, humanistic concept of the person, provided impetus and form to the encounter group from yet another direction. Psychologists such as A. Maslow, G. Allport, E. Fromm, R. May, F. Perls, C. Rogers, and J. Bugenthal (and the existential philosphers behind them - Nietzsche, Sartre, Tillich, Jaspers, Heidegger, and Husserl) rebelled strongly against the mechanistic model of behaviorism, the determinism and reductionism of analytic theory. Where, they asked, is the person? Where is consciousness, will, decision, responsibility, and a recognition and concern for the basic and tragic dimensions of existence?
All of these influences resulted in groups with a much broader, and vaguer, goal - nothing less than “total enhancement of the individual.” Time in the group was set aside for reflective silence, for listening to music or poetry. Members were encouraged to give voice to their deepest concerns - to re-examine these basic life values and the discrepancies between them and their life styles, to encounter their many false selves; to explore the long-buried parts of themselves (the softer, feminine parts in the case of men, for example).
Collision with the field of psychotherapy was inevitable. T-groups claimed that they offered therapy for normals, yet also that “normality” was a sham, that everyone was a patient: the disease, a dehumanized runaway technocracy; the remedy, a return to grappling with basic problems of the human condition; and the vehicle of remedy, the experiential group. The medical model could no longer be applied to mental illness. The differentiation between mental illness and health grew as vague as the distinction between treatment and education. Encounter group leaders claimed that patienthood is ubiquitous, that therapy is too good to be limited to the sick, and that one need not be sick to get better.
The Effectiveness of the Encounter Group
In its early days the T-group was heavily researched. The social psychologists and sociologists associated with the National Training Laboratories generated an enormous amount of rigorous research into its process and outcome. Many of these studies still stand as paradigms of imaginative, sophisticated research.
The most extensive (and expensive) controlled research inquiry into the effectiveness or groups that purport to change behavior and personality, was conducted by Lieberman, Yalom, and Miles in 1973. Since I believe this research has much relevance to group therapy (I have drawn from this study often in this book), I shall describe the design and method before reporting the results. The project is complex, and I can only touch upon major features relevant to our present discussion; I refer interested, research-minded readers to Encounter Groups: First Facts, the monograph fully describing the project. (28)
We offered an experiential group as an accredited one-quarter course at Stanford University. Two hundred and ten participants (all undergraduate students, aged eighteen to twenty-two) signed up for the course and were then randomly distributed (aside from sex, race, and previous encounter group experience) to one of eighteen groups, each of which met for a total of thirty hours over a twelve-week period. Sixty-nine subjects, who were similar to the participants but who did not have a group experience, were used as a control population and completed all the outcome research instruments.
Since a major aim of the study was to investigate the effect of leader technique upon outcome, we sought to diversify leader style by employing leaders from several ideological schools. We selected experienced and expert leaders from ten such schools:
Traditional NTL (T-groups),
Encounter groups (personal growth group),
Sensory awareness groups (Esalen group),
Transactional analytic groups,
Psychoanalytically oriented experiential groups,
Encounter-tapes (leaderless) groups.
There were a total of eighteen groups. Of the 210 subjects who started in the eighteen groups, 40 (19%) dropped out before attending half the meetings, and 170 finished the thirty-hour group experience.
WHAT DID WE MEASURE?
We were most interested in an intensive examination of outcome and the relationship between outcome, leader technique, and group process variables. To evaluate outcome, an extensive psychological battery of instruments was administered to each subject three times: before beginning the group, immediately after completing it, and six months after completion.
These self-administered instruments attempted to measure any possible changes encounter groups might effect — for example, self-esteem, self-ideal discrepancy, interpersonal attitudes and behavior life values, defense mechanisms, emotional expressivity, values, friendship patterns, and major life decisions. Much third-party outcome assessment was collected - evaluations by leaders, by other group members, and by a network of each subject's personal acquaintances. The assessment outcome was strikingly similar to that of a psychotherapy project but with one important difference: since the subjects were not patients but ostensibly healthy individuals seeking growth, no assessment of target symptoms or chief complaints was made.
Leader style was studied by teams of trained raters who observed all meetings and coded all behavior of the leader, by tape recordings and by written transcripts of the meetings in which all leader statements were recorded and analyzed, and by questionnaires filled out by participants.
Process data were collected by the observers and from questionnaires filled out by participants at the end of each meeting.
RESULTS: WHAT DID WE FIND?
First, the participants' testimony was very high. At the termination of the group, the 170 subjects who completed the groups considered them “pleasant” (65 percent), “constructive” (78 percent), and “a good learning experience” (61 percent). Over 90 percent felt that encounter groups should be a regular part of the elective college curriculum. Six months later, the enthusiasm had waned, but the overall evaluation was still positive. To put it another way, at the end of the group for every one participant who viewed the experience negatively, 4.7 participants perceived it as productive; six months later, the ratio was still positive but had dropped to 2.3 to 1.
So much for testimony. What of the overall, more objective battery of assessment measures? Each participant's outcome (judged from all assessment measures) was rated and placed in one of six categories: high learner, moderate changer, unchanged, negative changer, casualty (significant, enduring, psychological decompensation which was due to being in the group), and dropout. The results for all 206 (33) experimental subjects and for the sixty-nine control subjects may be summarized in table 16.1. (Short post is at termination of group and long post is at six-month follow-up.)
(see page 500)
Table 16.1 indicates that approximately one-third of the participants at the termination of the group and at the six months follow-up had undergone moderate or considerable positive change. The control population, who were studied with the same instruments, showed much less change, either negative or positive. The encounter group, thus, clearly influenced change, but for both better and worse. Maintenance of change was high: of those who changed positively, 75 percent maintained their change for at least six months.
Put in a critical fashion, one might say that table 16.1 indicates that, of all subjects who began a thirty-hour encounter group led by an acknowledged expert, approximately two-thirds found it an unrewarding experience (either dropout, casualty, negative change, or unchanged).
Viewing the results more generously, one might put it this way. The group experience was a college course. No one expects that students who drop out will profit. Let us, therefore, eliminate the dropouts from the data. If that is done (see table 16.2), then it appears that 39 percent of all students taking a one-quarter college course underwent some significant positive personal change which persisted for at least six months — not a bad batting average for a twelve-week, thirty-hour course! (And of course this finding has significance in the contemporary movement - in managed care - toward briefer therapies)
However, even if we consider the goblet one-third full rather than two-thirds empty, it is difficult to escape the conclusion that, in this project, encounter groups did not appear to be a highly potent agent of change. Furthermore, a significant risk factor was involved: 16 (8 percent) of the 210 subjects suffered psychological injury which produced sequelae still present six months after the end of the group.
Still, much caution must be exercised in the interpretation of the results. It would do violence to the data to conclude that encounter groups per se are ineffective or even dangerous. First, it is difficult to gauge the degree to which we can generalize these findings to populations other than an undergraduate college student sample. But, even more important, we must take note that these are all massed results: the data are handled as though all subjects were in one encounter group. There was no standard encounter group experience; there were eighteen different groups, each with a distinct culture, each offering a different experience, and each with very different outcomes. In some groups, almost every member underwent some positive change with no one suffering injury; in other groups, not a single member benefited, and one was fortunate to remain unchanged.
The next obvious question - and one very relevant to psychotherapy - is: Which type of leader had the best, and which the worst, results? The T-group leader, the gestalt, the T.A., the psychodrama leader, and so on? However, we soon learned that the question posed in this form was not meaningful. The behavior of the leaders when carefully rated by observers varied greatly and did not conform to our pre-group expectations. The ideological school to which a leader belonged told us little about the actual behavior of that leader. We found that the behavior of the leader of one school - for example, gestalt therapy, resembled the behavior of the other gestalt therapy leader no more closely than that of any of the other seventeen leaders. In other words, the behavior of a leader is not predictable from one's membership in a particular ideological school. Yet the effectiveness of a group was, in large part, a function of its leader's behavior.
How then to answer the question, which is the more effective leadership style? Ideological schools - what leaders say they do is of little value. What is needed is a more accurate, empirically derived, leader taxonomy. A factor analysis of a large number of leader behavior variables (rated by observers) resulted in four basic leadership functions:
Emotional stimulation (challenging, confronting, activity; intrusive modeling by personal risk-taking and high self-disclosure).
Caring (offering support, affection, praise, protection, warmth, acceptance, genuineness, concern).
Meaning attribution (explaining, clarifying, interpreting, providing a cognitive framework for change; translating feelings and experiences into ideas).
Executive function (setting limits, rules, norms, goals; managing time; pacing, stopping, interceding, suggesting procedures).
These four leadership functions had a clear and striking relationship to outcome — a finding that has considerable relevance for group therapy.Caring and meaning attribution had a linear relationship to positive outcome: the higher the caring and the higher the meaning attribution, the higher the positive outcome.
The other two functions, emotional stimulation and executive function, had a curvilinear relationship to outcome — the rule of the golden mean: too much or too little of this leader behavior resulted in lower positive outcome. For example, too little leader emotional stimulation resulted in an unenergetic, devitalized group; too much stimulation (especially with insufficient meaning attribution) resulted in a highly emotionally charged climate with the leader pressing for more emotional interaction than the members could integrate. Too little executive function - a laissez-faire style - resulted in a bewildered, floundering group; too much executive function resulted in a highly structured, authoritarian arrhythmic group, which failed to develop a sense of member autonomy or a freely flowing interactional sequence.
The most successful leader, then, was one moderate in amount of stimulation and in expression of executive function and high in caring and meaning attribution. Both caring and meaning attribution seemed necessary: neither alone was sufficient to ensure success.
These findings from encounter groups strongly corroborate the functions of the group therapist as discussed in chapter 5. Both emotional stimulation and cognitive structuring are essential. The Rogerian factors of empathy, genuineness, and unconditional positive regard thus seem incomplete; we must add the cognitive function of the leader. The research does not tell us what kind of meaning attribution is essential. Several ideological explanatory vocabularies seemed useful. What seems important is the process of explanation which, in several ways, enabled a participant to integrate his or her experience to generalize from it, and to transport it into other life situations. The importance of meaning attribution received powerful support from another source. When members were asked to report (at the end of each session) the most significant event of a meeting and the reason for its significance, we found that those members who gained from the experience were far more likely to report incidents involving cognitive integration. (Even so revered an activity as self-disclosure bore little relationship to change unless it was accompanied by intellectual insight.) The pervasiveness and strength of this finding was impressive as well as unexpected (occurring in encounter groups with a fundamental anti-intellectual ethos).
The Relationship between the Encounter Group and the Therapy Group
Having traced the development of the encounter group to the point of collision with the psychotherapy group, I shall now turn to the evolution of the therapy group in order to clarify the interchange between the two disciplines.
THE EVOLUTION OF GROUP THERAPY
The history of group therapy has been too thoroughly described in other texts to warrant repetition here. (34) A rapid sweep will reveal the basic trends. Joseph Hershey Pratt, a Boston internist, is generally acknowledged to be the father of contemporary group therapy. Pratt undertook, in 1905, the treatment of many patients with far-advanced tuberculosis. Recognizing the relationship between psychological health and the physical course of tuberculosis, Pratt undertook to treat the person rather than the disease. He designed a treatment regimen that included home visits, diary keeping by patients, and weekly meetings of a tuberculosis class of approximately twenty-five patients. At these classes, the diaries were inspected, weight gains were recorded publicly on a blackboard, and testimonials were given by successful patients. A degree of cohesiveness and mutual support developed which appeared helpful in combating the depression and isolation so common to tubercular patients.
During the 1920s and 1930s, several psychiatrists experimented with group methods. Adler employed group methods in Europe because of his awareness of the social nature of human problems and because of a desire to provide psychotherapeutic help to the working classes. (35) Lazell, in 1921, met with groups of schizophrenic patients in St. Elizabeth's Hospital in Washington, D.C., and delivered lectures on schizophrenia. (36) Marsh, a few years later, used groups for a wide range of clinical problems, including psychosis, psychoneurosis, psychophysiological disorders, and stammering. (37) He employed a variety of techniques, including such didactic methods as lectures and homework assignments as well as exercises designed to promote considerable interaction; for example, members were asked to treat one another; or all were asked to discuss such topics as one's earliest memory, ingredients of one's inferiority complex, night dreams, and daydreams. Wender used analytic group methods with hospitalized non psychotic patients in the 1930s, (38) while Burrows (39) and Schilder (40) applied these techniques to the treatment of psychoneurotic outpatients. Slavson, who worked with groups of disturbed children and young adolescents, exerted considerable influence in the field through his teaching and writing at a time when group therapy was not yet considered by most workers to be an effective therapeutic approach. (41) Moreno, who first used the term group therapy, employed group methods before 1920 but has been primarily identified with psychodrama, which he introduced into America in 1925. (42)
These tentative beginnings in the use of group therapy were vastly accelerated by the Second World War, when the many military psychiatric patients and the few trained psychiatric workers made individual therapy impractical and required more economic modes of treatment.
During the 1950s, the main thrust of group therapy was in a different direction: toward the application of group therapy in different clinical settings and for different types of clinical problems. Theoreticians - Freudian, Sullivanian, Horneyan, Rogerian - explored the application of their conceptual framework to group therapy theory and practice.
The T-group and the therapy group thus arose from different disciplines; and for many years, the two disciplines, each generating its own store of theory and technique, continued as two parallel streams of knowledge, even though some leaders straddled both fields and, in different settings, led both T-groups and therapy groups. The T-group maintained a deep commitment to research and continued to identify with the fields of social psychology, education, organizational science, and industrial management.
THERAPY GROUP AND ENCOUNTER GROUP:
The evolution of the T-group into the modern encounter group resulted in an entirely different concourse between the two fields. To speak of “group therapy for normals” and at the same time to suggest that, because of the stresses inherent in our culture, “patienthood is ubiquitous” can only lead to deep questioning about differences between the goals of encounter and therapy groups.
Considerable encounter group-therapy group traffic began to occur in the 1960s. Many mental health professionals participated in some form of encounter group during their training and subsequently led encounter groups and/or applied encounter techniques to their psychotherapeutic endeavors. Encounter group leaders, on the other hand, felt strongly that their group participants had had a therapeutic experience and that there was in reality no difference between personal growth and psychotherapy (between “mind expansion” and “head shrinking”). Furthermore, it became evident that there was much overlap between the population seeking psychotherapy and that seeking encounter experiences. Thus, many encounter group leaders concluded they were practicing psychotherapy - indeed, a more rapid and effective type of psychotherapy - and advertised their services accordingly.
The response of the traditional mental health field to this perceived encroachment was one of great concern. Psychotherapists were alarmed at the recklessness of the new groups and at possible risks to participants. They were equally concerned about ethical issues: the lack of clinical training of the encounter group leaders; the advertising that suggested that months, even years of therapy could be condensed into a single, intensive weekend; the lack of responsibility of many of the leaders. Polarization increased and soon in many communities, the mental health professionals launched campaigns urging their local governments to pass legislation to regulate encounter group practice and to hold leaders legally responsible for untoward effects.
In part, the vigorous response of the mental health profession was an irrational reaction to what it perceived as an invasion of territory. In part, however, the response was appropriate to certain excesses in some factions of the encounter field. These excesses issued from a crash-program mentality, successful in such ventures as space exploration and industrialization, but resulting in a reductio ad absurdum in human relations ventures. If something is good, more is better. If self-disclosure is good in groups, then total, immediate, indiscriminate disclosure in the nude must be better. If involvement is good, then prolonged, continuous, marathon involvement must be better. If expression of feeling is good, then hitting, touching, feeling, kissing, and fornicating must be better. If a group experience is good, then it is good for everyone - in all stages of the life cycle, in all life situations. These excesses were often offensive to the public taste and could, as research has indicated, be dangerous to some participants.
Before excessive polarization occurred, there was, during the 1960s and 1970s, constructive interchange between the group therapy and the sensitivity training fields. Clinical researchers learned a great deal from the T-group research methodology; T-groups were commonly used in the training of group therapists (43) and in the treatment program of chronically hospitalized patients; (44) some clinicians referred their individual therapy patients to a T-group for opening-up (just as, in the 1980s, some clinicians referred their patients to est or Lifespring (45)); and finally, some T-group techniques were adopted by clinicians, resulting in a gradual shift in the practice of group therapy. For example, the increased emphasis on the here-and-now, the concept of feedback, greater leader transparency, the use of group structured exercises (both verbal and nonverbal), and the time-extended meeting, have, in part, been the legacy of the T-group to group therapy.
THERAPY GROUP AND ENCOUNTER GROUP:
SHARED PROPERTIES AND CONCERNS
Starting from their widely different points of origin, the encounter group and the therapy group converged to the point where many observers wondered whether there were any intrinsic differences between them.
Development of the Individual's Positive Potential
The traditions from which each type of group work have derived have undergone considerable evolution, which has resulted in a major shift in group goals, theory, and technology. Human relations education, as I have indicated, changed its emphasis from the acquisition of specific theory and interpersonal skills to the encounter group goals of total enhancement of the individual.
The field of psychotherapy underwent a gradual evolution from a model of personality development based on the transmutations of the individual's libidinal and aggressive energies to the current emphasis on ego psychology. Many theorists have posited the existence of an additional positively valenced drive which must perforce be allowed to unfold rather than be inhibited or sublimated; thus, Hendrick's instinct to master, (46) Berlyne's exploratory drive, (47) Horney's self-realization, (48) White's effectance motivation, (49) Hartmann's neutralized energy, (50) Angyal's self-determination, (51) and Goldstein's, Rogers's, and Maslow's self-actualization. (52) Thus, the development of the individual entails more than the inhibition or sublimation of potentially destructive instinctual forces. One must, in addition, fulfill one's creative potential; and the efforts of the therapist are best directed toward this goal. Horney states that the task of the therapist should be to help remove obstructions; given favorable circumstances, one will realize one's own potential, just as an acorn will develop into an oak. (53) Similarly, Rogers refers to the therapist as a facilitator.
A closely related trend in psychotherapy, beginning with Fromm, Reichmann, and Erickson, has been the strategy of building on the patient's strengths. Psychotherapists have come to appreciate, for example, that individuals may encounter great discomfort at certain junctures in the life cycle, not because of poor ego strength but because there have been inadequate opportunities for the learning relevant to that life stage to occur; psychotherapy may be directed toward the facilitation of this learning. This shift in therapy orientation has brought the group therapist and the T-group leader closer together. The T-group leader has always espoused the goal of acquisition of competence and believed that the reinforcement of strengths is no less vital than the correction of deficiencies.
Hoped-for changes occurring in the individual as a result of T-group experience closely parallel (despite differences in language) the changes that group therapists wish to see in their patients. For example, one T-group outcome study investigated the following fifteen variables: sending communication, receiving communication, relational facility, risk taking, increased interdependence, functional flexibility, self-control, awareness of behavior, sensitivity to group process, sensitivity to others, acceptance of others, tolerance of new information, confidence, comfort, and insight into self. (54) The Lieberman, Yalom, and Miles outcome criteria for their encounter group project also closely resembled psychotherapy outcome criteria, with the single obvious exception of target symptoms (chief complaints). (55)
Encounter group and therapy group composition grew more similar over the years. Psychotherapists no longer worked only with individuals with major mental health problems; they began treating ever more fairly well-integrated individuals with minor problems in living. Conversely, many patients came to regard the encounter groups, especially the weekend marathon variety, as crash psychotherapy programs. Lieberman and Gardner studied participants of several growth centers and reported that 81 percent had had psychotherapy in the past or were currently in the therapy. (56) Moreover, using the criteria of amount of stress, symptomatology, and reasons for seeking help, they found that 70 percent closely resembled new patients applying for help at psychiatric outpatient clinics.
THERAPY GROUP AND ENCOUNTER GROUP:
SIMILAR LEARNING ENVIRONMENTS
The Lieberman, Yalom, Miles encounter group project suggested that not only do encounter groups and therapy groups resemble each other in form but that similar rules of learning and change apply to both approaches. When the outcome (on both group and individual level) was correlated with the course of events during the life of a group, several conclusions emerged that have obvious relevance to the process of change in therapy group. For example, the study concluded that if encounter groups are to be effective vehicles of personal change, several basic encounter group maxims need to be reformulated in the following ways:
1. Feelings not thought should be altered to feelings, only with thought.
2. Let it all hang out is best revised to let more of it hang out than usual, if it feels right in the group, and if you can give some thought to what it means. In this study, self-disclosure, emotional expressiveness (of either positive or negative feelings), was not in itself sufficient for change.
3. Getting out the anger is essential to getting out the anger may be okay, but keeping it out there steadily is not. Excessive expression of anger was counterproductive: it was not associated with a high level of learning, and it generally increased risk.
4. There is no group, only persons to group processes make a difference in learning, whether or not the leader pays attention to them. Learning was strongly influenced by such group properties as cohesiveness, climate, norms, and the group role occupied by a particular member.
5. High yield requires high risk to the risk in encounter groups is considerable and unrelated to positive gain. The high-risk groups, those that produced many casualties, did not at the same time produce high learners. The productive groups were safe ones. The high-yield, high-risk group is, according to our study, a myth.
6. You may not know what you've learned now, but when you put it all together . . . to bloom now, don't count on later. It is often thought that individuals may be shaken up (unfrozen) during a group experience but that later, after the group is over, they integrate their experience in it and come out stronger than ever. In our projects, individuals who had a negative outcome at the termination of the group never moved to the positive side of the ledger when studied six months later.
THERAPY GROUPS AND ENCOUNTER GROUPS: DIFFERENCES
Because there are similarities between encounter and therapy groups, we must not make the mistake of equating the two. There are, I believe, fundamental differences.
The encounter group differs from the therapy group in size, duration, and physical setting. Generally, it consists of ten to sixteen members who may be total strangers or who may be associates at work. Sometimes the encounter group meets as part of a larger residential human relations laboratory lasting one to two weeks. The group, in this setting, usually meets in two- to three-hour sessions once or twice a day. The members usually spend the entire day with one another, and the encounter group atmosphere spills over into other activities. Often encounter groups meet, like therapy groups, in shorter sessions spaced over a longer period. Almost always, however, the encounter group's life spans a shorter time.
Unlike the therapy group, the encounter group's ethos is one of informality and pleasure. The physical surroundings are often like a resort, and more consideration is given to the pursuit of fun.
The Role of Leader
Generally there is a far greater gap between leader and members in a therapy group than in an encounter group - a result of both the leader's behavior and the characteristics of the members. Although encounter group members may overvalue their leader, generally they see him or her more realistically than do psychiatric patients. Encounter group members, partially because of their greater self-esteem and also because of their greater opportunity to socialize between meetings with the leader, perceive the leader as similar to themselves, except insofar as the leader has superior skill and knowledge in a specialized area. The leader earns prestige as a result of his or her contributions. Eventually, the leader begins to participate in a manner similar to the other members and in time assumes full membership in the group, although his or her technical expertise continues to be employed and appreciated.
Part of the encounter group leader's task is to transmit not only knowledge but also skills; the leader expects the group members to learn methods of diagnosing and resolving interpersonal problems. Often the leader explicitly behaves as a teacher - for example, by explicating some point of theory or by introducing some group exercise, verbal or nonverbal, as an experiment for the group to study. It is not unusual for encounter group members to seek further human relations education and subsequently to become leaders themselves. (Occasionally this practice has had unfortunate repercussions since some members with much zeal but without the necessary background have considered one or two experiences as a group member sufficient training for them to undertake a new career as a group leader.)
Group therapists are viewed far more unrealistically by their group members (see chapter 7). In part, the therapist's deliberately enigmatic and mystifying behavior generates this distortion. The therapist has entirely different rules of conduct from the other members in the group; is rarely transparent or self-disclosing, and too often reveals only a professional front. It is a rare therapist who socializes or even drinks coffee with group members. In part, however, the distortion resides within the patients and springs from their hope for an omniscient figure who will intercede in their behalf. They do not view the therapist merely as an individual similar to themselves aside from specialized professional skills; for better or for worse, they attribute to the therapist the archetypal abilities and powers of the healer.
Although, as the group proceeds, the therapist's role may change to be more like a member's, it is never that of a full group member: the therapist almost never presents personal problems in living to the group; the therapist's statements and actions continue to be perceived as powerful and sagacious regardless of their content. Furthermore, the therapist is not concerned with teaching his or her skills to the group members; rarely does a therapy group member use the group experience to start out on a career as a group therapist.
Beyond the Common Social Malady
Most of the fundamental differences between encounter groups and therapy groups derive from difference in composition. Although much overlapping may occur, the encounter group is generally composed of well-functioning individuals who seek greater competence and growth; whereas the therapy group has a population of individuals who often cannot cope with minor everyday stress without discomfort; they seek relief from anxiety, depression, or a sterile and ungratifying intrapersonal and interpersonal existence. Earlier in this chapter, I referred to the tensions inherent in our competitive culture, that to a greater or lesser degree affect all of us. However - and this point is often overlooked by clinically untrained encounter group leaders (as well as by large group awareness trainers)psychiatric patients have, in addition, a set of far more pressing concerns. The common social malady is woven into the fabric of their personality but is not synonymous with their psychopathology: they have an additional, and deeper, basis for alienation and dysphoria.
Orientation to Learning
One of the basic tasks of the encounter group - the acquisition of interpersonal competence - requires a degree of interpersonal skill that most psychiatric patients do not possess. Encounter group leaders ordinarily make certain assumptions about their group members: they must be able to send and receive communications about their own and other members' behavior with a minimum of distortion; they must, if they are to convey accurate information and be receptive to feedback, have a relatively high degree of self-awareness and self-acceptance. Furthermore, participants must desire interpersonal change. They must be well intentioned and constructive in their relationships with the other members and must believe in a fundamental constructive attitude on the part of the others if a cohesive, mutually trusting group is to form. The members must be willing, after receiving feedback, to question previously cherished beliefs about themselves (unfreezing), to experiment with new attitudes and behavior, and to transfer their learning to their back home life.
These intrapersonal and interpersonal prerequisites, which most encounter group leaders take for granted in their group members, are the very attributes sorely deficient in the typical psychiatric patient, who generally has lower self-esteem and self-awareness. The stated group goals of increased interpersonal competence are often perceived as incompatible with their personal goals of relief from suffering, Their initial response to others is often based on distrust rather than trust, and, most important of all, their ability to question their belief system and to risk new forms of behavior is severely impaired. In fact, the inability to learn from new experience is central to the basic problem of the neurotic. To illustrate with a classic example, consider Anna Freud's study of Patrick, who during the London blitz in 1943 was separated from his parents and developed an obsessive-compulsive neurosis. In the evacuation center, he stood alone in a corner and chanted continuously, Mother will come and put on my overcoat and my leggings, she will zip my zipper, she will put on my pixie hat, and so on. (57) Consequently, Patrick, unlike the other children, could not avail himself of the learning opportunities in the center. He remained isolated from the other adults and children and formed no other relationships that could have relieved his fear and permitted him to continue to grow and to develop social skills. The frozen compulsive behavior did provide some solace for Patrick by preventing panic but so tied up his energy that he could not appraise the situation and take new, adaptive action.
Not only does the neurotic defense preclude testing and resolution of the core conflict, but it characteristically generalizes to include an ever-widening sphere of the individual's life space. Generalization may occur directly or indirectly. It may operate directly, as in traumatic or war neuroses in which the feared situation takes an increasingly broader definition. For example, a phobia once confined to a specific form of moving vehicle may generalize to apply to all forms of transportation. Indirectly, individuals suffer since, as with little Patrick, the inhibition prevents them from exploring their physical and interpersonal environment and developing their potential. A vicious circle arises since maladaptive interpersonal techniques beget further stress and may preclude the formation of gratifying relationships.
The important point is that individuals with neurotic defenses are frozen into a closed position; they are not open for learning, and they are generally searching not for growth but for safety. Argyris puts it nicely in differentiating a survival orientation from a competence orientation. (58) The more competence-oriented, the more receptive and flexible an individual is. One becomes an open system and, in the interpersonal area, is able to use one's experience to develop greater interpersonal competence. On the other hand, the survival-oriented individual is more concerned with self-protection. Through the use of defense mechanisms, one withdraws from, distorts, or attacks the environment.
Individuals are neither all open or all closed; they may be closed in specific areas and open in others. Nor, as I have stated, are all therapy group members more closed than all encounter group members. Consider for a moment the vast scope and diversity of the group therapies: it is possible, for example, that the affluent members of an analytic group in Manhattan may be as integrated and congruent as the members of an average encounter group. The label, “patient,” is often purely arbitrary and a consequence of a request for help, not of a need for help. Generally, however, the therapy group is composed of individuals who are oriented toward survival rather than competence and who therefore cannot readily take advantage of the interpersonal learning opportunities of the group. Therapy group members cannot easily follow the simple encounter group mandate to be open, honest, and trusting when they are experiencing profound feelings of suspicion, fear, distrust, anger, and self-hatred. A great deal of work must be done to overcome these maladaptive interpersonal stances so that patients can begin to participate constructively in the group. Jerome Frank came close to the heart of the matter when he said that therapy groups are as much or more concerned with helping patients to unlearn old patterns as they are with helping them to learn new ones. (59)
DIFFERENCES: EARLY AND LATE DIFFERENCES
The therapy group, then, differs from the encounter group early and late. It differs early by beginning more painfully and laboriously. Encounter group members may begin a group with trepidation; they face an unknown situation in which they will be asked to expose themselves and to take risks. Nevertheless, they are generally backed up by relatively high self-esteem and a reservoir of professional and interpersonal success. Psychiatric patients, on the other hand, begin a therapy group with dread and suspicion. Self-disclosure is infinitely more threatening in the face of a belief in one's basic worthlessness and badness. The pace is slower; the group must deal with one vexing interpersonal problem after another. The encounter group, after all, does not often have to face the problem of an angry paranoid patient, or a suicidal depressive one, or a denying patient who attributes all difficulties in living to a spouse, or the unstable borderline patient, or the easily discouraged members who constantly threaten to leave the group. The therapist, unlike the encounter group leader, must constantly modulate the amount of confrontation, self-disclosure, and tension the group can tolerate.
The therapy group differs later by having a different termination point for each member. Unlike the encounter group, which invariably ends as a unit and generally at a predetermined time, the therapy group (or at least the open therapy group) continues for each member until his or her goals have been reached. In fact, as Frank points out, one reason that the therapy group is so threatening is that its task, broad personal modification, has scarcely any limit; and, furthermore, there is no restriction about what can and, perhaps, must be discussed. (60) Often in an encounter group, it is enough for the members to recognize and surmount a problem area; not so in the therapy group, in which problem areas must be explored in depth for each of the members involved.
For example, in a twelve-session encounter group of mental health professionals which I once led, the members (who were also my students) experienced great difficulty in their relationship to me. They felt frightened and inhibited by me, vied for my attention, addressed a preponderance of their comments to me, overvalued the wisdom of my remarks, and harbored unrealistic expectations of me. I responded to this issue by helping the group members recognize their behavior, their distortions, and unrealistic expectations. I then helped them appreciate the effects of their unrealistic and dependent attitudes toward me on the course of the group and called their attention to the implications of this phenomenon on their future role as group therapists. Next, we discussed some of the members' feelings toward the more dependent members of the group: for example, how it felt to have someone ostensibly talk to you but at the same time gaze fixedly at the leader. Once these tasks were accomplished, I felt that it was important that the group move past this block and proceed to focus on other facets of the group experience, for it was abundantly clear that the group could spend all of its remaining sessions attempting to resolve fully its struggle with the issue of leadership and authority. I helped to turn the group's attention to other current but untouched group issues - for example, the members' feelings about three silent and seemingly uninvolved members, the hierarchy of dominance in the group, and the general issue of intermember competition and competence, always a specter looming large in encounter groups of mental health workers.
In a therapy group, I would approach the same issue in a different fashion with different objectives in mind. I would encourage the patients especially conflicted in this area to discuss in depth their feelings and fantasies toward me. Rather than consider ways in which to help the group move on, I would help plunge them into the issue so that each member might understand his or her overt behavior toward me, as well as avoided behavior and the fantasized calamitous effects of such behavior. Although I would, by a degree of transparency, assist the members in their reality testing, I would attempt to modulate the timing of this behavior so as to allow the formation and full exploration of their feelings toward me. (See chapter 7 for a detailed discussion of this issue.) The goal of clarifying other facets of group dynamics is, of course, irrelevant for the therapy group; the only reason for changing the focus of the group is that the current issue is no longer the most fertile one for the therapeutic work: either the group has pursued the areas as far as possible at a particular time, or some other more immediate issue has arisen in the group.
To summarize, the basic intrinsic difference between the encounter group and the therapy group arises from differences in their composition (and thereby their goals). As a general rule, psychiatric patients have different goals, more deeply disrupted intrapersonal and interpersonal relations, and a different (closed, survival-based) orientation to learning. These factors result in process and procedural differences both in the early stages and in the late working-through stages of the group.
1.I am much indebted to my close friend and colleague, Morton Lieberman, for his careful reading of the section on Religious and self-help groups and for his many helpful suggestions.2.R. Wuthnow, Sharing the Journey (New York: Free Press, 1994).3.M. Lieberman and L. Snowden, “Problems in Assessing Prevalence and Membership Characteristic of Self Help Participants,” Journal of Applied Behavioral Science29(1993):166–80.4.Ibid p. 259.5.Ibid p. 1206.Ibid p 121.7.B. Kilbourne and J. Richardson, “Psychotherapy and New Religions in a Pluralistic Society,” American Psychologist 39(1984):237–51.8.G. Goodman and M. Jacobs, “The Self-Help, Mutual-Support Group,” in A. Fuhriman, and G. Burlingame, eds., Handbook of Group Psychotherapy (New York: Wiley, 1994).9.Ibid.10.M. Lieberman, “Self-help Groups in Psychiatry,” in American Psychiatric Association Annual Review vol 5, A. Frances, H. Hales, eds., (Washington, D.C.: American Psychiatric Association Press, 1986).11.Goodman and Jacobs, “The Self-Help, Mutual-Support Group” .R. Toseland and L. Hacker, “Self-help Groups and Professional Involvement,” Social Work 27(1982):341–47.12.Goodman and Jacobs, “The Self-Help, Mutual-Support Group” .13.Ibid.14.A recent still unpublished study by a Turkish colleague comparing the therapeutic factors of A.A. and a professional therapy group (n=44 patients) revealed that interpersonal learning input and output were ranked significantly higher by the therapy group while universality, cohesiveness, and instillation of hope were chosen by the A.A. members. (Cem Atbasoglu, Ankara, Turkey. Personal communication, February 1994)15.Ibid.16.M. Lieberman, Personal Communication, February 1994.17.M. Lieberman, “Self -help Groups and Psychiatry,” in The American Psychiatric Association Annual Review of Psychiatry A. Frances and R. Hales, eds., vol. V, (Washington, D.C.: American Psychiatric Press, Inc., 1986) pp. 744–60.18.M. Lieberman, “Self-help Groups,” in Comprehensive Group Psychotherapy H. Kaplan and B. Sadock, eds., (Baltimore: Williams and Wilkins, 1993) pp. 300–01.M. Lieberman and L. Borman, Self-help Groups for Coping with Crisis (San Francisco: Jossey-Bass, 1979).C. Marmor, et al., “A Controlled Trial of Brief Psychotherapy and Mutual Help Group Treatment of Conjugal Bereavement,” American Journal of Psychiatry 145(1988):203.M. Lieberman and L. Videka-Sherman, “The Impact of Self-help Groups on the Mental Health of Widows and Widowers,” American Journal of Orthopsychiatry 56(1986):435.19.M. Galanter, “Zealous Self-help Groups as Adjuncts to Psychiatric Treatment: A Study of Recover Inc.,” American Journal. of Psychiatry 145(1988):1248–53.N. Raiff, “Self-help Participation and the Quality of Life,” Prevention in Human Services1(1982):78–9.D. 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