Free The Theory and Practice of Group Psychotherapy by Irvin D. Yalom, Molyn Leszcz Page B

occurs, the client appreciates that some feared calamity, which had hitherto prevented such behavior, has been irrational and can be disconfirmed; the change in behavior has not resulted in such calamities as death, destruction, abandonment, derision, or engulfment.
X. The social microcosm concept is bidirectional: not only does outside behavior become manifest in the group, but behavior learned in the group is eventually carried over into the client’s social environment, and alterations appear in clients’ interpersonal behavior outside the group.
XI. Gradually an adaptive spiral is set in motion, at first inside and then outside the group. As a client’s interpersonal distortions diminish, his or her ability to form rewarding relationships is enhanced. Social anxiety decreases; self-esteem rises; the need for self-concealment diminishes. Behavior change is an essential component of effective group therapy, as even small changes elicit positive responses from others, who show more approval and acceptance of the client, which further increases self-esteem and encourages further change. 49 Eventually the adaptive spiral achieves such autonomy and efficacy that professional therapy is no longer necessary.
    Each of the steps of this sequence requires different and specific facilitation by the therapist. At various points, for example, the therapist must offer specific feedback, encourage self-observation, clarify the concept of responsibility, exhort the client into risk taking, disconfirm fantasized calamitous consequences, reinforce the transfer of learning, and so on. Each of these tasks and techniques will be fully discussed in chapters 5 and 6.

    TRANSFERENCE AND INSIGHT
    Before concluding the examination of interpersonal learning as a mediator of change, I wish to call attention to two concepts that deserve further discussion. Transference and insight play too central a role in most formulations of the therapeutic process to be passed over lightly. I rely heavily on both of these concepts in my therapeutic work and do not mean to slight them. What I have done in this chapter is to embed them both into the factor of interpersonal learning.
    Transference is a specific form of interpersonal perceptual distortion. In individual psychotherapy, the recognition and the working through of this distortion is of paramount importance. In group therapy, working through interpersonal distortions is, as we have seen, of no less importance; however, the range and variety of distortions are considerably greater. Working through the transference—that is, the distortion in the relationship to the therapist—now becomes only one of a series of distortions to be examined in the therapy process.
    For many clients, perhaps for the majority, it is the most important relationship to work through, because the therapist is the personification of parental images, of teachers, of authority, of established tradition, of incorporated values. But most clients are also conflicted in other interpersonal domains: for example, power, assertiveness, anger, competitiveness with peers, intimacy, sexuality, generosity, greed, envy.
    Considerable research emphasizes the importance many group members place on working through relationships with other members rather than with the leader. 50 To take one example, a team of researchers asked members, in a twelve-month follow-up of a short-term crisis group, to indicate the source of the help each had received. Forty-two percent felt that the group members and not the therapist had been helpful, and 28 percent responded that both had been helpful. Only 5 percent said that the therapist alone was a major contributor to change. 51
    This body of research has important implications for the technique of the group therapist: rather than focusing exclusively on the client-therapist relationship, therapists must facilitate the development and working-through of interactions among members. I will have much more to say