Chapter 6 The Therapist: Working in the Here-and-Now, (Yalom & Leszcz, 2020) The Theory and Practice of Group Psychotherapy

the two necessary parts of the here-and-now focus

1. experiencing the here-and-now, living in the current moment.

2. process illumination— meaning examining the behavior and interactions that are occurring and their significance.

"perhaps the single most important point we make in this entire book: the here-and-now focus, to be effective, consists of two symbiotic tiers, neither of which has full therapeutic power without the other" (p. 183).

content

what is being said— the explicit words used, and the issues and message communicated.

process

focuses not on the content of what is being said, but the "how" and the "why" of what is being said. Concerns the way people communicate and interact and what that reveals about the person and their relationships with others.

process commentary

It is commentary about how and why a group member said something and what that reveals about the member and their interactions with others. creates a "self-reflective loop" (p.184) in which the group examines themselves.

asking a process question of making a process commentary statement

the therapist "need not wait until they have all the answers" prior to asking a process question. In fact, asking an initial process question, may give more clarity to the process and what is going on.

Low level of inference question: "how are each of you experiencing the meeting so far?"

more inference, "You look like you are having some reaction to this"

precise, high level of inference, "Kevin, I have a sense that you yearn for respect here in the group, and I wonder if the comment last week about you being 'thick-skinned' wasn't hurtful to you and is related to your bringing in this work dilemma" (p.193).

how process focus makes group therapy unqiue

"A process focus is the one truly unique feature of the experiential group; after all, there are many socially sanctioned activities in which one can express emotions, help others, give and receive advice, confess secrets, and discover similarities between oneself and others. But where else is it permissible, in fact encouraged, to comment, in depth, on here-and-now behavior— on the nature of the immediately current relationship between people?" (Yalom & Leszcz, 2020, p. 195)

why process commentary is taboo social behavior

outside of group, in regular life, process commentary is taboo behavior. because of : socialization anxiety, social norms, fear of retaliation, power maintenance

the therapist's tasks in the here-and-now

1. activate the here-and-now through the establishment of norms such as interpersonal feedback, emotional expression, self-monitoring, expressing the value of the group. Over time, members will value and help maintain the here-and-now experience.

2. process illumination — largely the job of the therapist. an essential job.

ahistorical appraoch

While the goal in group therapy is to establish a here-and-now focus, no group can be totally ahistorical. When examining process commentary — sometimes the therapist might make a connection to a related comment of event that happened in a past session — thereby making it part of the present here-and-now.

Also, of course group members will discuss their "personal history" and "current life situations," but "it is not that the group doesn't deal with the past; it is what is done with the past" (p. 201).

Secondary gratification

Some other benefit a group member gets from being in the group, which distracts from real therapeutic work