Group Therapy Dynamics: Bion and Yalom Compared

Introduction to Group Norms and Cohesion

By the very nature of culture and humanity, humans are group animals — they thrive in groups, coalesce into groups, and indeed the very process of moving from hunter-gatherer societies to cities was itself a form of group behavior. This essay first examines group normative behavior, intergroup communication, and leadership, and then considers the way in which group behaviors influence individuation and specific responses to a group's culture.

Group norms are defined as a set of internal rules followed by group members in order to increase the overall efficiency of the group's activity. These norms typically govern members' behavior toward one another, toward their hierarchical superiors, and toward outsiders, as well as their approach and attitude toward the work they are expected to perform. Norms determine the way in which groups solve problems, make decisions, and carry out their work. They influence interactions between members and between the group and its facilitator. Norms also reflect the group's culture of shared values (Berry, 2007; Characteristics of a Group — Group Composition, 2007).

A group's cohesive nature is determined by its members' ability to coexist and complement one another in order to form a balanced and harmonious whole. To achieve this, group leaders need to consider three major elements: interpersonal relationships, structural relationships, and organizational relationships. Beyond these three, group leaders must also account for two additional forces that influence unity: the size of the team and the technology used within the group. The size of the group directly influences cohesion because it critically impacts communication between members. The greater the number of members, the harder it is for them to properly convey their messages and ensure they are clearly understood. In moving from transmitter to receiver, information may be distorted or even lost, thereby impairing the function of the group (Witte and Davis, 1996).

Overview of Wilfred Bion's Group Theory

This is the very nature and foundation of group psychotherapy, in which one or more trained therapists treat a small group of clients together. It is typically characterized in general terms as cognitive behavioral therapy or interpersonal therapy, but is often applied to the psychodynamic process in which change is developed by exploring and examining interpersonal relationships within the group. Through this process, the group finds similarities and differences and is able to articulate feelings more readily within the safety of the group — knowing that other individuals are experiencing similar discomfort (Montgomery, 2002). There is clear academic evidence for the efficacy of group therapy, particularly for depression, abuse issues, and traumatic stress. There is less evidence for its use as a key factor in recovery for other psychological issues, such as borderline personality disorders, sociopathic issues, or schizophrenia (McDermut, 2001; Kanas, 2006). There are, however, dozens of variations on group dynamic therapy, each with varying degrees of theory, practice, special methods, interventions, and focus. This essay focuses on two of those approaches as they relate to group dynamics: the Tavistock-based method of Wilfred Bion and Irvin Yalom's classic text, The Theory and Practice of Group Psychotherapy.

Wilfred Bion (1897–1979) was a British psychoanalyst who pioneered the study of group dynamics. His theories developed out of his work with a group of pioneering doctors tasked with treating psychological issues among returning British soldiers after World War II. This work gave rise to the Tavistock Group, and his research into what we would now term Post-Traumatic Stress Disorder formed the basis of his 1961 book, Experiences in Groups. That book went on to influence fields beyond psychotherapy and became popular with the encounter group movements of the 1960s (Symington and Symington, 1996, pp. 2–13).

Bion departed from traditional Freudianism with his theory of mind, which rests on two underlying assumptions: (1) truth for the individual will emerge through mental growth, and (2) the individual's mind grows through exposure to truth. Thus, the foundation for mental development and actualization is a process in which truth is continually being uncovered. For Bion, truth is the personal understanding of emotional experience. In his model of development, the individual is continually evolving through emotional experiences that translate into thought and truth about how that individual perceives the world. Everything is centered on the individual outside of the analytic hour, and on the processes that occur during that time. Within the therapeutic session, there should be engagement without memory, desire, or predetermined outcome. Outside the analytic hour, the process for growth and the uncovering of truth takes place (Bion, 2004, intro, pp. 5–6).

Bion's basic assumptions about the role of group processes revolve around his categorization of group types and the assumptions underlying each type. The first is the Work Group — the aspect of group functioning that focuses on the group's primary task, or the reason the group was formed in the first place. The second is the Basic Assumption Group, which describes the tacit assumptions underlying the group's behavior. Within these two group types, Bion identifies three basic assumptions: dependency, fight-flight, and pairing (Flores, 1997, pp. 541–543).

Overview of Irvin Yalom's Existential Approach

In dependency, the group attempts to protect itself and its more vulnerable members. This can result in passive-aggressive behavior, ignoring the group leader, or acting in ways that make it extremely difficult for the leader to elicit responses. In fight-flight, the group takes on an active, almost defensive character — protecting itself at all costs through either aggression or retreat (avoidance). When a group adopts pairing, individual members pair up to carry on the group's work through their own interaction; the other members are relieved because the focus shifts away from them, yet they are still able to participate vicariously. While it is natural for a group to adopt one of these assumptions, doing so diminishes the group's overall efficacy. The task of the therapist is to identify which assumption is being enacted and to respond accordingly, so that the group's forward momentum is not disrupted (Sutherland, 2000).

Irvin Yalom (1931–) is a medical doctor, author of fiction and non-fiction, a widely quoted psychotherapist, and Professor Emeritus of Psychiatry at Stanford University. After graduating from Boston University School of Medicine, he completed his internship at Mount Sinai in New York and at Johns Hopkins Hospital in Baltimore, then spent two years at an Army hospital in Honolulu, where he began forming his basic theories about groups and group dynamics. He began his academic career at Stanford in 1963, and it was there that he developed the experiences he had while working with soldiers returning from Vietnam into his model of group and existential psychotherapy (Yalom, 2008).

Yalom's central belief is that inner conflict within the individual arises primarily from that individual's own confrontation with what might be called the "natural laws" of existence. These "givens" are freedom and slavery, life and death, isolation, and meaninglessness. These four major concerns form the framework through which the therapist conceptualizes a client's problem and develops a course of treatment. Yalom's theory of mind holds that although humans are by nature individuals — fundamentally alone — we continually long to be connected to others. We want to find meaning in our lives, yet must ultimately come to realize that we cannot depend on outside stimuli, or other people, for our own validation. We must recognize, understand, and accept that we are fundamentally alone throughout our lives. The typical result of this realization is a degree of anxiety arising from the knowledge that our validation must come from within. It is the degree to which we choose to accept this truth and move forward that determines our psychological health. The task of the therapist is therefore to help the individual face the truth about their own individuality and find an appropriate plan for dealing with the doubt and discomfort that often arises from recognizing one's essential aloneness (Yalom, Existential Psychotherapy, 1980, pp. 1–44).

To his credit, Yalom continued to revise his work on group therapy in combination with existentialism. As he notes, when group therapy was introduced in the 1940s it was novel. Now there are groups for nearly everything — panic, arthritis, MS, cancer, abuse, and more. In addition, the clinical settings for these groups are extraordinarily diverse and require a different approach than traditional settings demand. Moving beyond his earlier notion of cure, Yalom now believes that the task of group therapy is to harness reality — to cause change and growth that constitutes a positive step for the individual. Whether in formal group therapy or simply as a person seeking self-actualization, the ideal is a fluid evolution that treats change as a therapeutic factor, almost a tonic, and moves through the things that cause pain, anguish, or an inability to actualize (Yalom and Leszcz, 2005, p. xiii).