See

discussions, stats, and author profiles for this publication at:

http://www.researchgate.net/publication/226675582

Group Psychotherapy and

Existential Concerns: An
Interview with Irvin Yalom

ARTICLE in JOURNAL OF CONTEMPORARY PSYCHOTHERAPY JUNE 2005

DOI: 10.1007/s10879-005-2699-7

DOWNLOADS VIEWS

321 346

1 AUTHOR:

James C Overholser
Case Western Reserve Univ
202 PUBLICATIONS 5,251
CITATIONS

SEE PROFILE

Available from: James C Overholser

Retrieved on: 21 June 2015
Journal of Contemporary Psychotherapy, Vol. 35, No. 2, Summer 2005 (

C 2005)

DOI: 10.1007/s10879-005-2699-7

Group Psychotherapy and Existential Concerns:

An Interview with Irvin Yalom
James C. Overholser, Ph.D.

Group psychotherapy can be used to help clients deal with most forms of emotional
distress or problems with interpersonal functioning. Also, group therapy can be
useful when helping clients to confront existential concerns such as isolation or
meaning in ones life. During a recent interview, Irvin Yalom discussed a variety
of issues related to group processes and existential matters that are involved in
effective psychotherapy.
KEY WORDS: group therapy; existential; research.

Over the past 40 years, Irvin D. Yalom, MD. has been involved in psy-
chotherapy via research, writing, training, and the provision of clinical services.
Dr. Yalom is an emeritus Professor of Psychiatry at Stanford University. He has
published extensively on group psychotherapy and the exploration of existential
issues. Recently, Yalom has published works of fiction and nonfiction that explore
issues related to existentially-oriented individual psychotherapy. Most of his work
has demonstrated an integration of the scientific method and the art of psychother-
apy. He has shown that research can examine difficult psychosocial issues without
becoming overly mundane, abstract, or artificial.
Yalom has written the primary text for group psychotherapy (Yalom, 1995),
inpatient group therapy (Yalom, 1983), as well as a brief summary of the core
principles of group psychotherapy (Vinogradov & Yalom, 1989). Yalom (1995)
postulated the central curative factors that are active in psychotherapy groups.
The curative factors include the instillation of hope, self-understanding, altruism,
universality, catharsis, and various aspects of interpersonal learning. Therapists
should focus on group dynamics, and work to maximize their role as facilitator

Address correspondence to James C. Overholser, Ph.D., Department of Psychology, Case Western

Reserve University, 10900 Euclid Avenue, Cleveland OH 441067123; e-mail: overholser@case.edu.

185
0022-0116/05/0600-0185/0

C 2005 Springer Science+Business Media, Inc.
186 Overholser

and role-model (Yalom, 1966b). In addition, a focus on here-and-now processes

can be important in individual as well as group therapy (Yalom, 2002).
Psychotherapy relies on an interpersonal relationship whereby patient and
therapist are seen as fellow travelers, working to remove obstacles for effective
growth (Yalom, 2002). The therapeutic relationship that defines individual psy-
chotherapy is analogous to cohesiveness in group therapy. Cohesiveness is best
viewed as a necessary precondition for effective group therapy (Yalom, 1995).
Group therapy can be effective in many different settings for clients with
many different types of problems. Group therapy is an important and valuable
component of inpatient treatment (Leszcz, Yalom, & Norden, 1985). Group ther-
apy can even be quite helpful when working with psychotic elderly patients, build-
ing group cohesiveness, and increasing interactions among the members (Yalom
& Terrazas, 1968). Group therapy includes key aspects of interpersonal learning,
which can be useful for clients with chemical dependency problems (Matano &
Yalom, 1991). Group therapy can help addicted patients learn to manage their
anxiety (Yalom et al., 1978). For many clients, group therapy can be helpful
in cultivating strategies for managing anxiety and reducing tension. In contrast,
group therapy exercises that strive to deliberately arouse affect in the members
may have serious risks (Yalom et al., 1977). Therapists and clients should pro-
ceed with caution when groups focus on the open expression of emotions while
minimizing the importance of rational reflection (Lieberman, Yalom, & Miles,
1973).
Long-term group therapy provides many opportunities for clients to confront
important issues in their psychosocial development. Over the course of group
therapy, many clients shift their goals from symptom reduction to interpersonal
growth (Yalom, 1995). However, even short-term/time-limited therapy groups
can be useful for helping clients to confront interpersonal problems and make
preliminary changes (Yalom & Yalom, 1990).
A variety of techniques can be used to maximize traditional therapy pro-
cesses. Yalom has devised several therapy innovations that blend psychotherapy
and literature. Group members may benefit from reading the therapists written
summary of each session (Yalom, Brown, & Bloch, 1975). In a similar manner,
clients in individual therapy can gain a new perspective by reading the therapists
process notes that were written after each session (Yalom & Elkin, 1974).
A sizable minority of clients tend to drop out of therapy groups (Yalom,
1966a). Some clients do not feel compatible with the other group members (Yalom
& Rand, 1966). If clients fail to generate a sense of cohesiveness with the other
group members, they are likely to drop out fairly early in the group process (Yalom
et al., 1967b). However, group interactions can be enhanced through a preparatory
session that clarifies group therapy roles and processes (Yalom et al., 1967b).
Psychotherapy can help clients explore existential issues. Effective therapy
requires understanding the subjective experience of the client (Yalom, 1980).
Group Therapy and Existential Concerns 187

Psychotherapy can help clients deal with fundamental concerns, such as free-
dom/responsibility, isolation, death, and the meaning of ones life (Yalom,
1980).
Group therapy has been found helpful for patients who were diagnosed with
metastatic breast cancer (Spiegel, Bloom, & Yalom, 1981). Group sessions help the
members discuss ways to maximize the quality of their remaining time, demystify
death, and clarify their meaning of life (Spiegel & Yalom, 1978). Most group
members benefit from the process of helping each other and express their fears in
an open and supportive atmosphere (Yalom & Greaves, 1977). Weekly meetings
help the members to reduce their emotional distress and improve their coping
styles (Spiegel, Bloom, & Yalom, 1981).
Psychotherapy can help most patients confront the issue of responsibility
for their own life, problems, and improvement (Yalom, 1974). Group therapy can
be somewhat beneficial for clients who are dealing with the death of a spouse
(Lieberman & Yalom, 1992). Clients can seek personal growth, even when strug-
gling through the process of bereavement (Yalom & Lieberman, 1991). The group
leader can facilitate a dialogue about identity, responsibility, and growth that pro-
motes a natural process of self-exploration (Yalom & Vinogradov, 1988). Many
clients can find a sense of purpose in life via creative works and acts of altruism
(Yalom, 1982). As seen in detailed case studies (Yalom, 1989), meaning in life
can be a natural byproduct of living a life engaged with others and committed to
a purpose.
Recently, Irvin D. Yalom (IDY) was interviewed by James C. Overholser
(JCO). Their dialogue explored a variety of issues focused on group therapy and
existential issues. The interview has been transcribed below.

JCO: I feel that your list of curative factors in group therapy has been quite
influential. In your own work, when leading groups, which one of the
curative factors have you found to be most helpful?
IDY: The therapeutic factor is a very good structure for neophytes coming into
the field and is a very good way to organize the data so they can get a
good feel for it, but theyre not very conscious in my mind as I work in
groups. Like all very experienced therapists I work very intuitivelyboth
in individual and group therapy. But I would say the therapeutic factor I
invest in the most is interpersonal learning, which is a very broad-based
factor which encompasses all the changes that people will undergo in their
interpersonal relationships. I believe this is the real pay-dirt of therapy.
My group therapy approach is very interpersonally based. Other factors are
obviously essential, for example, group cohesiveness. Certainly youve got
to have a cohesive group and youve got to help people get feedback and
learn what theyre doing interpersonally.
188 Overholser

JCO: I think that many graduate students find the list of curative factors to be quite
helpful. I would like to hear some of your thoughts about running groups
and how to do it well. When you think about group therapy today, is there
any curative factor that you think would be useful to add to the original list?
IDY: No, but it is very possible that other therapists leading groups might come
up with a whole different way to slice it. I dont think these things are set
in concrete. These factors were the result of personal brainstorming and
brainstorming with students originally back in 1968 when I started writing
my book and thought about these therapeutic factors. No, I cant think of
another one. While Ive been preparing the 5th edition, Ive been thinking
of things to add and other ways to do it, and I cant think of another way to
slice it thats more useful.
JCO: Im concerned that the current state of the field is shifting, and group
therapy is moving from expressive therapy groups to brief, highly structured
educational groups. Do you think we can integrate these different styles?
IDY: Im very concerned about these directions. It would seem to me that with
the economic crunch thats going on, with the emphasis on less expensive
therapies, that the stage was set for group therapy. It could be a magnificent
opportunity, but it hasnt worked out that way. The HMOs are using a
tremendous numbers of groups, but theyre using them extremely poorly and
patients are not being prepared in any way for groups. The great bulk of these
groups are psycho-educational. Theres a role for psycho-education and
cognitive-behavioral approaches, but I feel that too many of the therapists
today are leading groups that arent really using the strongest feature of the
groups, the work in the here-and-now, which is the real power source of the
small group. I led a workshop not too long ago in Palo Alto in a large medical
clinic and there were about 15 therapists there each leading several groups a
week. However when they described the groups they were leading, it seemed
to me that, out of about 60 groups, only 4 or 5 of them were therapy groups
that really worked on interactions, which is the heart of group therapy. A
lot of the others were psycho-educational groups, teaching groups, which
have some value, but lack the real power to make some substantial enduring
change in the life of the client. So yes, I have a lot of concern about whats
happening as groups get briefer and more structured. I think about the old,
silly joke about the farmer who was teaching his horse to be able to eat less
and less and less fodder, but then he was terribly disappointed because just
about the time he had gotten the horse to the point where he was eating
nothing at all, the darn critter died on him. In a sense, thats what I feel can
happen in group therapy. You cut it briefer and briefer until you cut out the
whole heart of it and theres nothing really living in it.
JCO: I am concerned about the second wave as well. It seems to me that a lot of
these changes in group therapy started because of the financial limitations,
Group Therapy and Existential Concerns 189

but now Im concerned that the new generation of therapists will see this
is the proper way that group therapy is done, in a short-term educational
format, and is becomes the only way that most people know how to do
group therapy.
IDY: Exactly. Furthermore, even therapists who plan on leading a manualized
group still need an education in dynamic group therapy so as to be able to
understand and deal with any unforeseen incidents that may arise.
JCO: It was some of these issues that prompted our dialogue today. I hope to find
some insight and wisdom to push ahead and help the next generation of
therapists really learn the value and the style of good therapy groups. You
talked earlier about working by intuition. The new generation of therapists
doesnt have your years of experience. Is there any advice that you could
give them?
IDY: I gave a workshop in San Francisco 4 days ago, there were about 500 people,
most of them younger people who seemed very interested, and were very
responsive to what I had to say about groups, so I think there is an aching to
learn about that. Maybe theres a reversal in the pendulum. Earlier today I
got a call from the chief resident at Stanford telling me his list of 18 residents
who are hoping to have some work with me, maybe in a supervisory group or
something like that. Thats a very new trend. A few years ago, the residents
had no interest at all in psychotherapy, because of the tremendous emphasis
on biological issues in psychiatry and psychopharmacology. Maybe there
will be a swinging back of the pendulum. To me always the most effective
way to teach group therapy is to provide the students an opportunity to be
involved in some kind of personal group experience. If they are in a group
experience where theres a focus on the here-and-now, and theres a good
leader working on interactions, its an experience they will never forget and
they will look for ways to make use of that in their practice. Students really
have to be in some type of group experience, and they can also participate
as observers of ongoing group therapy.
JCO: How much do you think that to become a good group leader, the qualities
come from training in technical skills, or it just comes from the person of
the therapist?
IDY: Well, thats a very central question and an old question. Carl Rogers used
to say we really should spend more time selecting rather than training
therapists. In my many years of teaching, I work with beginning students
in their first months of training and you already see that there is some
natural talent of openness and engagement that is evident in these students.
With training in the content of the field, they can become good therapists.
Some students dont have that quality at all, and its going to take many
years of training for them to get to where the other people were when they
started their training program. There certainly are some people who are
190 Overholser

almost phobic about being in groups and it takes years to overcome that.
For people who are medically trained and have that authoritarian medical
model behind them, it means relinquishing a little bit of that power and
stature, and being more transparent and egalitarian may be threatening to
many.
JCO: What are your thoughts on how the push for medications has been changing
the field of therapy, changing our views of treatment, and changing the
financial structure of the field?
IDY: I find it deplorable. Deplorable and at the same time exciting because
there are certain conditions for which medication is quite wonderful, but
the overuse of medication and the dispensing of it for many issues and
symptoms that could better be dealt with in therapy is really deplorable.
Certainly, research is demonstrating that psychotherapy is, for many people,
equally advantageous, and psychotherapy plus medication is always more
effective than medication alone.
JCO: Let me switch and ask you a few questions about existential therapy. Cur-
rently there is a major push for treatment manuals to guide the therapy that
we do. Do you think it will ever be possible to try to structure an existential
therapy along treatment manual guidelines?
IDY: They seem incongruous and exceedingly incompatible because if you think
of the real heart of an existential approach the way that I do it, so much of it
rests on foundations of genuineness and spontaneity, and when you speak
of a method which is designed to squeeze out spontaneity, then obviously
there is a looming insoluble paradox. How can you have a manual to make
people be spontaneous and genuine in their work with patients? So, no, I
dont think so and I always feel manual-driven therapy is anathema to an
existential approach or any human approach in therapy.
JCO: I think youve been getting at this, but let me ask directly. I have had a
difficult time in learning and applying existential therapy. It seems to me
that most writers describe several general areas that need to be addressed,
but dont describe much about what you do in order to deal with the issues.
Do you think that in order to be effective, existential therapy has to be spon-
taneous and idiographic and, therefore we can never capture the treatment
strategies in more detail?
IDY: Well, I tell you what my own approach has been. I want to make it quite
clear, when I talk about existential therapy I never think of it as some kind
of a free-standing approach akin to other schools like cognitive-behavioral.
I always think of it as having sensibilities to existential issues that have
to be grafted onto or added onto a well-trained, well-rounded, dynamic
psychotherapist. These are issues that are salient for some patients more
than others or some stage of therapy, at least for the content area but from
the process area it doesnt tell you a lot about how you relate to patients. So
I finally decided I could do the best teaching about this by giving countless
Group Therapy and Existential Concerns 191

illustrations. I write examples of how one does this through case histories
that were written in a literary style and capture interest but give people a
flavor that they could then begin to improvise in their own voice, in their
own style, how they might look at and get comfortable with dealing with
these more existential issues.
JCO: Well, let me pick up a piece of what you said. Do you think it would be
fair to say the field could be advanced by looking at cognitive-behavioral
therapy of existential issues?
IDY: Well, I dont know how. Ill have to think about that. I have some patients
right now in therapy who are extremely panicked about death and they
have a lot of death anxiety, are awakened by thoughts about death in the
middle of the night. I think I implicitly invoke a lot of these techniques,
I talk to them about that, I try to look at it, dissect it, I try to have them
less sensitized by speaking about it quite openly and freely. I try to talk
about what parts of death are most frightening to them. I try to do some
history about what their contact with death is, where these ideas come from,
I try to de-catastrophize some of the issues about that, but, and I think this
is essential, I do this from a vantage point of having established a caring,
strong, open therapeutic alliance which is grounded in the idea that the
client and I are fellow travelers.
JCO: It seems to me that existential therapy helps clients to address major life
issues but sometimes it is difficult to do in a short-term therapy setting.
IDY: Yes, I agree with that. In my own practice Ive rarely worked with really
brief therapy in that way. Ive done research and work with some short-term
grief groups but generally the patients I see individually Ive always seen
several months to three years. Right now, I usually have a contract with
patients for about one year when I start.
JCO: What type of client do you think is ideal for an existential approach?
IDY: There are some patients who are dealing overtly and explicitly with existen-
tial issues, such as concerns about death, isolation, meaning of life, freedom
and life-altering decisions and so they come specifically for those issues.
But when I think of what it means in terms of how you relate to patients,
they do have to have a certain willingness and ability to be close to others,
to be intimate, to ally themselves to be in a very intimate conversation, to
be aware of and be able to recognize their feelings on these issues. I cant
be really specific because I see patients who come in with so many different
issues over the years. I worry a little bit that were thinking of existential
issue as a certain kind of therapy that you apply to a certain kind of patient,
and that has never been what I conceptualize it as. Im a journeyman psy-
chotherapist and I strive to have a sensibility to existential issues when they
arise.
JCO: So if existential issues are part of what brings a client into your office, then
youre more than ready to explore and discuss them.
192 Overholser

IDY: Thats right. And when people talk about deep foundational issues having
to do with the human condition, I will readily plunge into those. But I have a
certain style of relating to patients which draws from an existential idea of a
certain kind of egalitarian role. Were all in this human condition together. I
think of patients and myself as fellow travelers. I dont see myself working
with people, where they are the afflicted and I am the healer, but we all
have these issues together, so I tend to be fairly transparent and open with
patients rather than keeping a kind of aloofness or distance from them. In
other words existential therapy is not only concerned with content but even
more so with process, that is, the relationship between client and therapist.
JCO: How often have you seen clients who seem focused on what could be
considered trivial issues, and if you could help them shift their focus onto
more major life areas, then theyre able to let the trivial problems disappear?
IDY: Well I think thats a very common instance. You know, when people are
talking about things that I sense are trivial and are far away from deeper
concerns, I always will plunge deeper. Of course, when youre faced with
really pressing real life issues like mortality or youre facing death and youre
diagnosed with a fatal illness, all of these trivial issues will drop away. That
was one of my experiences working for many years with people who had
cancer and led groups of patients with cancer for about 10 years. Ive always
found these people begin to trivialize the trivia in life or reprioritize their
values and their needs, and they began to look at the deeper issues in life.
The trivial matters have lost their importance to them. If I can move patients
into that position by taking a look at those aspects of the human condition,
I consider that very good work.
JCO: In terms of being transparent, how have you seen the interplay between your
personal life and your professional life as a therapist?
IDY: As time has gone by, I tend to be much more open with myself than I was
originally. Maybe its because I did so much group therapy at the beginning
of my career, and if youre going to be a good group therapist, you tend to
be much more open with yourself and more disclosing. You cant use your
professional title in the group and yet call people by their first name with
everyone else in the group. You want the group to be engaged and informal
and so you start being on a first name basis with patients, you tend not to
play the expert. Ive read in many, many different places about how one
tends to be more self-disclosing. I did that with observers a lot. I invite the
patients to observe our post-group rehash with my students and observers,
and be quick to acknowledge errors that I made. I used to write summaries
of group meetings and mail them out to patients. I did that for thousands of
meetings where I was very open with what I was trying to do and whether I
said something I was sorry I had said or these types of things. I learned to be
more self-disclosing than people who strictly provided individual therapy.
Group Therapy and Existential Concerns 193

Then, I began to apply it more and more to my individual therapy. I think

you may find that all dedicated therapists, as they go through their career
and are not unduly hamstrung by orthodoxy, will become more human,
more transparent in their clinical work. This is the result of the growing
wisdom in their lives.
JCO: As you look at your views of therapy and how they have evolved over the
years do you think if you somehow went back in time and met yourself in
1970 that youd say, hey, change this, do this differently.?
IDY: I think I would, but I dont know if I would have been ready for my own
advice. My feeling is that Im a much, much better therapist than I was many
years ago, and thats one of the marvelous things about our field. I think, for
example, in the field of surgery, people coming out of their training were
trained in all sorts of new microsurgical techniques that people in practice
for a long period of time dont know at all, and you need to be retrained or
retooled for that. But I think with a therapist, you really do get wiser, better
and more comfortable with yourself, able to use yourself better. So I feel
Im a much better therapist. I can do things that I couldnt do before and use
my own person and self, feel more comfortable with myself working with
patients.
JCO: I guess thats what Im trying to clarify and objectify. I am hoping to find
advice that I can share with my graduate students. I hope to find words
of wisdom they might learn now and help them become better therapists
now and not have to wait for the years of experience. But that may not be
possible?
IDY: Well, you know, this very question youre asking was the question I was
trying to address in this book that I wrote recently, The Gift of Therapy.
I was writing about things like acknowledging your errors and letting your
patients matter to you, and creating a new therapy for each patient. That
question that youre asking was really the driving question that caused me
to write that book. So thats how I chose the particular areas that I talked
about in that book, and a lot of them had to do with the in-betweenness
of the patient and the therapist and how you were as a person, how you
revealed yourself, how you connected yourself with the patient.
JCO: As you look back over the many things that youve written and the many
contributions youve made to the field, what would you like to say is the
real mark that you have left, the real contribution that you have made to the
field of psychotherapy?
IDY: Well, lets see, thats a difficult question for me to answer. Primarily I con-
sider myself a very good story-teller and a good writer, and thats where my
energy really is. What Ive done in the therapeutic field is try to humanize it
more, try to make people more aware of the whole existential dimension, try
to be pluralistic in ones approaches and beliefs, trying to avoid orthodoxy.
194 Overholser

I emphasize how to use your self in therapy, how to focus on the here and
now. I think Ive spent a lot of energy focusing on the here-and-now, both in
group therapy and also in my individual therapy. I never go through an in-
dividual hour without some kind of focus about whats happening between
me and the patient. Thats something that I try to teach every one of my
students.
JCO: You mention being a good storyteller. Ive found metaphors and analogies
can be very useful in therapy. Do you have any favorite story or metaphor
that you bring in and share with clients?
IDY: Well I think I probably do that a great deal. In The Gift of Therapy, I
wrote a short section about looking through the patients window and told
the story about how important it is to get yourself into the experiential world
of the other and see that. Im very frequently drawing on certain kinds of
metaphors or favorite statements. Quite recently I was with a patient who
was terribly ashamed of certain kinds of impulses and behavior. Nietzsche
said that to grow wise we have to listen to the wild dogs barking in our
cellars. Thats a nice phrase, the idea that you have to listen to the wild
impulses inside yourself and grow wise from really knowing that theyre
there and heeding them. I like the idea that Im human and nothing human
is alien to me which tells us something about how we have to get into the
patients world and begin to recognize that their own impulses and their
behavior, there are some pieces of that in ourselves.
JCO: Is there anything that you would feel comfortable saying about the field
of psychotherapy that the reader of the interview might say that really
surprised me?
IDY: No, I dont think that Im saying anything really surprising in terms of the
whole body of writing that I have done about this. This is what I really try to
do in my work and I think Im quite honest with my approaches and try to
be very open with myself. I hope the young therapists will begin to undergo
a good deal of personal therapy, begin to be more comfortable with himself,
begin to use him or herself in the work with therapy. I think thats the most
useful thing we can offer patients.
JCO: As you focus more on writing novels, have you kept active with therapy?
IDY: Im still practicing. I see patients about 12 hours a week, and its very much
a part of my life. I miss doing groups. I cant tell you how many times I
work with individual patients and I think Oh I wish I could put this person
into one of my groups. I refer a lot of my patients to therapy groups of
colleagues. So I miss that part. But doing psychotherapy is a very central part
of my life and I look forward to it. I dont think Id ever want to stop being
a therapist. I draw so much pleasure from being able to offer something to
people. I cant imagine retiring from therapy. I want to practice as long as I
can. I spend every afternoon doing therapy.
Group Therapy and Existential Concerns 195

JCO: When I have run groups, I think that I have felt most successful as a group
leader when the group members interact with each other and attribute their
gains to each other. Do you think its important for a group leader to stay
invisible like that?
IDY: I agree with you very much. A major part of my work is to try to build
that system, build a group, and I have to do it a lot by personal modeling.
Even by your own personal example, it will teach them how to take risks.
Try to shape therapeutic norms so that the group is really tremendously
interactive. In a mature group, if members leave, they want to have new
members in the group because they know how much the interaction with
one another is important. If group members dont welcome a new member,
its usually a sign the group is still at an early level, where they still have
some mistaken assumption that their help is going to come from the number
of minutes of attention they have with the therapist and thats not at all the
case, of course. I always tell people that the goal of therapy in this group
is to learn as much as you can about your relationship with every single
member of that group, me as well, and every other member of that group,
and the group is varied enough that they will be able to generalize it in
important ways to their outside life. I will often say things to the patient
like therapy is not really life per se, but its a dress rehearsal for life. A
therapy group is not a place where you form lasting interpersonal relation-
ships, but its a place where you learn how to do this in your own social
world.
JCO: I think thats a very helpful way of shaping their views and helping them
look at the group process. I am afraid it might be lacking from a lot of the
current education-based groups.
IDY: Yes, I couldnt agree more with that.
JCO: A lot of times I will see a shy, soft-spoken graduate student whos a bit
fearful of becoming a group leader or learning how to do groups. Do you
have any thoughts or advice for a student like that?
IDY: Yeah, I think that really the best advice I can give that person is for him to
have a personal group experience. I know that a lot of institutions will offer
some brief experience of a group for the students, and maybe even better
for him to be in some kind of independent group outside of the university,
is the very best preparation for being in a group.
JCO: A lot of the groups I see are open enrollment, where the membership in any
group session may change from week to week. Do you think that we can
foster cohesion in a situation like that?
IDY: Well, its really hard. Stable attendance is tremendously important for on-
going outpatient groups. I really focus on that so much in early meetings
and on my preparation for groups. If you have a group which is by its
very structure in places is going to have a rapid turnover, then you have to
196 Overholser

lead it in a different way. In an inpatient setting, especially now with rapid

turnover, you never have the same group meeting for more than one day,
maybe two or three days, but theres always new people coming in and out
when the hospital stay is a matter of days, so you have to lead the groups in
different ways.
JCO: I see we are out of time, so let me thank you for sharing your words of
wisdom.

REFERENCES

Leszcz, M., Yalom, I. D., & Norden, M. (1985). The value of inpatient group psychotherapy: Patients
perceptions. International Journal of Group Psychotherapy, 35, 411433.
Lieberman, M., & Yalom, I. D. (1992). Brief group psychotherapy for the spousally bereaved: A
controlled study. International Journal of Group Psychotherapy, 42, 117132.
Lieberman, M., Yalom, Y., & Miles, M. (1973). Encounter groups: First facts. New York: Basic Books.
Matano, R., & Yalom, I. D. (1991). Approaches to chemical dependency: Chemical dependency
and interactive group therapy: A synthesis. International Journal of Group Psychotherapy, 41,
269293.
Spiegel, D., Bloom, J., & Yalom, I. (1981). Group support for patients with metastatic cancer: A
randomized prospective outcome study. Archives of General Psychiatry, 38, 527533.
Spiegel, D., & Yalom, I. (1978). A support group for dying patients. International Journal of Group
Psychotherapy, 28, 233245.
Vinogradov, S., & Yalom, I. D. (1989). Concise guide to group psychotherapy. Washington, DC:
American Psychiatric Press.
Yalom, I. D. (1966a). A study of group therapy dropouts. Archives of General Psychiatry, 14, 393414.
Yalom, I. D. (1966b). Problems of neophyte group therapists. International Journal of Social Psychi-
atry, 12, 5259.
Yalom, I. D. (1974). Existential factors in group therapy. Journal of the National Association of Private
Psychiatric Hospitals, 6, 2735.
Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books.
Yalom, I. D. (1982). The terrestrial meanings of life. International Forum for Logotherapy, 5,
92102.
Yalom, I. D. (1983). Inpatient group psychotherapy. New York: Basic Books.
Yalom, I. D. (1989). Loves executioner and other tales of psychotherapy. New York: Basic Books.
Yalom, I. D. (1995). The theory and practice of group psychotherapy (4th ed.). New York: Basic
Books.
Yalom, I. D. (2002). The gift of therapy. New York: Harper Collins.
Yalom, I. D., Bloch, S., Bond, G., Zimmerman, E., & Qualls, B. (1978). Alcoholics in interactional
group therapy: An outcome study. Archives of General Psychiatry, 35, 419425.
Yalom, I. D., Bond, G., Bloch, S., Zimmerman, E., & Friedman, L. (1977). The impact of a weekend
group experience on individual therapy. Archives of General Psychiatry, 34, 399415.
Yalom, I. D., Brown, S., & Bloch, S. (1975). The written summary as a group psychotherapy technique.
Archives of General Psychiatry, 32, 605613.
Yalom, I., & Elkin, G. (1974). Every day gets a little closer: A twice-told therapy. New York: Basic
Books.
Yalom, I. D., & Greaves, C. (1977). Group therapy with the terminally ill. American Journal of
Psychiatry, 134, 396400.
Yalom, I. D., Houts, P., Newell, G., & Rand, K. (1967a). Preparation of patients for group therapy:
A controlled study. Archives of General Psychiatry, 17, 416427.
Yalom, I. D., Houts, P., Zimerberg, S., & Rand, K. (1967b). Prediction of improvement in group
therapy: An exploratory study. Archives of General Psychiatry, 17, 159168.
Yalom, I. D., & Lieberman, M. (1991). Bereavement and heightened existential awareness. Psychiatry,
54, 334345.
Group Therapy and Existential Concerns 197

Yalom, I. D., & Rand, K. (1966). Compatibility and cohesiveness in therapy groups. Archives of
General Psychiatry, 15, 267275.
Yalom, I. D., & Terrazas, F. (1968). Group therapy for psychotic elderly patients. American Journal
of Nursing, 68, 16901694.
Yalom, I. D., & Vinogradov, S. (1988). Bereavement groups: Techniques and themes. International
Journal of Group Psychotherapy, 38, 419446.
Yalom, V. J., & Yalom, I. (1990). Brief interactive group psychotherapy. Psychiatric Annals, 20,
362367.