Introduction
The books by Corey (2016) and Yalom and Leszcz (2005) are dedicated to the topic of group therapy, including its theory and practice; they share similar titles. However, the authors do not agree on everything, and their positions differ when discussing “difficult” or “problem” clients. The present paper will consider the similarities and differences in the positions expressed by Corey (2016) and Yalom and Leszcz (2005) with a focus on their versions of therapeutic factors and their attitudes toward the idea of a problem client, which is supported by the latter authors but not the former one.
Therapeutic Factors
Therapeutic factors are the first thing considered by Yalom and Leszcz (2005) in their book. The authors conducted their research and compared its results to those of other studies existing at the time to demonstrate the presence of particular circumstances that appear to have an impact on the effectiveness of group therapy. From this perspective, therapeutic factors describe the continuously interacting and simultaneously occurring aspects of group therapy that result in change and improvement. Thus, according to Yalom and Leszcz (2005), the success of group therapy is determined by eleven key factors.
First, they discuss hope, important information (including possible advice), the review and correction of family issues, and the cohesion of the group, which incorporates multiple features like trust and acceptance. Furthermore, the demonstration of the fact that patients are not alone in their issues (universality) and altruism (of other members, as well as the therapist) are described as crucial by Yalom and Leszcz (2005). Then, the authors comment that therapy is used for social learning, fosters the imitation of positive behaviors of therapists and other group members, and promotes interpersonal learning in a client. Finally, Yalom and Leszcz (2005) remark on catharsis, which can be defined as a discharge of suppressed emotions, and existential elements, which include the understanding of the specifics of life and one’s place in it. Yalom and Leszcz (2005) especially emphasize the idea that the factors do not exist in isolation and that they need to interact for the positive effects of group therapy to take place.
It should be pointed out that the first version of the book by Yalom and Leszcz (2005) was published even before 2005; the authors’ research on therapeutic factors is very old. However, there exist recent studies that appear to support it or still employ the idea as a functional theoretical framework. Restek-Petrović et al. (2014) apply the concept of therapeutic factors to the therapy meant for patients with psychosis, demonstrating that their sample (57 patients) described the majority of the factors as significant. Gabel and Robb (2017) study the therapeutic factors of art therapy. Behenck, Gomes, and Heldt (2016) investigate their significance for patients with obsessive-compulsive disorder, and Behenck, Wesner, Finkler, and Heldt (2017) research their importance for patients with panic disorder. All these articles use a methodology that is similar to that of Yalom and Leszcz (2005), thus supporting their approach and the conclusions made with its help. Therefore, the idea of studying therapeutic factors based on patients’ feedback remains a viable strategy to this day.
The 2016 edition of Corey’s (2016) book may be considered another recent work that references the factors. When discussing them, Corey (2016) cites Yalom, as well as some other researchers, which suggests that Corey (2016) borrows some of Yalom’s ideas and integrates them with other research on the topic. As a result, Corey’s (2016) version is different in certain ways. Firstly, Corey (2016) specifies a different aim for the factors; here, they are meant to make the group productive during the working stage, which should take it beyond cohesion achieved during the prior stages. As a result, cohesion itself is not a part of the factors, although its elements appear in the list.
Secondly, Corey’s (2016) factors also amount to eleven items, but they are not the same as those by Yalom and Leszcz (2005). To be fair, both sets of factors include hope and catharsis; also, it can be suggested that Corey’s (2016) trust and acceptance element is related to Yalom’s cohesion. Similarly, empathy and caring together with intimacy, which are two of the factors offered by Corey (2016), are comparable to altruism and universality. An argument can also be made that cognitive restructuring is somewhat analogous to existential factors since all of them are connected to self-exploration. Confrontation and beneficial feedback suggested by Corey (2016) might be included in social learning. However, Corey’s (2016) self-disclosure, commitment to change, and freedom to experiment are probably new factors that are not matched with anything by Yalom.
Thus, Corey (2016) did not include Yalom’s family issues and behavior imitation as individual factors, and there is no particular Corey’s (2016) factor that would specify the topic of providing information to clients. Still, group leader’s interventions are mentioned throughout the list, for example, in the feedback section; therefore, it is apparent that Corey (2016) does take into account the role of the therapist and education. In general, the lists are more similar than they are different both in their aim and content. However, differences are present, and they seem to indicate distinct assessments of the group therapy features that the authors considered important.
Problem Clients
Chapter 13 of the book by Yalom and Leszcz (2005) is dedicated to the topic of “problem” clients. The authors point out that all group members are likely to experience issues during therapy and highlight the fact that such concerns are less the result of clients’ character and more the product of the social context in which they interact with the group. Therefore, the authors indirectly suggest not viewing members as the problem and paying attention to the various factors that can result in the difficulties exhibited by them.
The chapter describes different types of problem clients. The first one, who is termed as the monopolist by the authors, attempts to hold the attention of the group, including the leader, which results in negative experiences for all the members. The authors point out that silencing the client is not a good decision, but a discussion of such behaviors is a possible solution. The second type is the reticent client who is less likely to benefit from the group than more active members. The authors suggest that this behavior needs to be discouraged. The next type, which is the boring client, is socially awkward and prefers making safe statements instead of taking risks. The authors state that such clients bore the group as well and that this reaction needs to be analyzed and acted upon by determining how the client can be coaxed into a breakthrough. Furthermore, some clients express concerns but also reject help, and people with disorders that require relevant treatment are not offered by the group. In summary, Yalom and Leszcz (2005) discuss problematic behaviors, problematic reactions of a therapist, and problematic health conditions under the category of problem patients.
Corey (2016) is explicitly critical of the idea of “difficult” or “problem” group members. Instead, the author terms issues, including those described by Yalom and Leszcz (2005), as problem behaviors which a leader needs to deal with using various interventions. Corey (2016) does not offer a classification of problem behaviors; rather, the author suggests discussing them with an invitation to reconsider their usefulness. However, Corey (2016) contributes some direct advice on how to deal with particular challenges, which include problem behaviors (for example, the denigration of others), information deficits (both from the perspective of members and group leaders), and conflicts. The author also points out the importance of nonjudgmental ways of informing members about spotted unproductive behaviors.
In summary, both Corey (2016) and Yalom and Leszcz (2005) discuss the issues that a group leader might encounter in practice with suggestions on how to resolve them. It cannot be claimed that Yalom and Leszcz (2005) shift the blame for difficult behaviors onto the patients alone; the authors recognize the possibility of the group leader having inappropriate reactions (for instance, to a boring client) or the existence of various medical conditions that complicate the group work. However, the primary difference between the two is that Corey (2016) explicitly opposes calling patients problematic, and Yalom and Leszcz (2005) recognize that this approach can be improper but continue to use the term.
Conclusions
When discussing therapeutic factors and problem patients, Corey (2016) and Yalom and Leszcz (2005) cover more or less the same phenomena. Admittedly, they have some different perspectives on what is important for the success of a group, and Corey (2016) specifically discusses the working stage, but their factors are comparable. Similarly, their description of problems experienced by group leaders are similar, although Yalom and Leszcz (2005) aim to classify the issues associated with members, and Corey (2016) avoids that. As a result, the primary difference in their positions is that Corey (2016) recommends avoiding the terms that would label participants as problematic, focusing instead on problem behaviors.
References
- Behenck, A., Gomes, J., & Heldt, E. (2016). Patient rating of therapeutic factors and response to cognitive-behavioral group therapy in patients with obsessive-compulsive disorder. Issues in Mental Health Nursing, 37(6), 392-399. doi: 10.3109/01612840.2016.1158335
- Behenck, A., Wesner, A., Finkler, D., & Heldt, E. (2017). Contribution of group therapeutic factors to the outcome of cognitive–behavioral therapy for patients with panic disorder. Archives of Psychiatric Nursing, 31(2), 142-146. doi: 10.1016/j.apnu.2016.09.001
- Corey, G. (2016). Theory and practice of group counseling (9th ed.). Boston, MA: Cengage Learning.
- Gabel, A., & Robb, M. (2017). (Re)considering psychological constructs: A thematic synthesis defining five therapeutic factors in group art therapy. The Arts in Psychotherapy, 55, 126-135. doi: 10.1016/j.aip.2017.05.005
- Restek-Petrović, B., Bogović, A., Orešković-Krezler, N., Grah, M., Mihanović, M., & Ivezić, E. (2014). The perceived importance of Yalom’s therapeutic factors in psychodynamic group psychotherapy for patients with psychosis. Group Analysis, 47(4), 456-471. doi: 10.1177/0533316414554160
- Yalom, I., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.