research_topics

DB Palmer
                 A Brief Analysis of Divergent Ethical Codes within Helping Professions:

It may often be assumed, that among the differing helping professions, there exists a unity of purpose. It would be easy for many to
think that similar professions lend to similar practices. It is the opinion of this author that such commonality may exist in superficial
streams, but that the deeper waters reveal divergences of great proportions that could threaten the very connections between these
helping professions. The area of competence, primarily, with its impact upon colleague relationships, reporting colleagues, and
counselor’s relationship to society among the American Counseling Association (ACA), American Association of Pastoral Counselors
(AAPC), and the American Association of Christian Counselors (AACC) will be compared and contrasted with regard to their specific
importance to a Christian counselor, institution, or association.
Recent litigation in the areas of counselor competency and training have brought attention to the role of training institutions and
counseling organizations (Board of Curators of the University of Missouri v. Horowitz, 1978; Harris v. Blake and the Board of Trustees
of the University of Northern Colorado, 1986; Shuffer v. Trustees of California State University and Colleges, 1977). Universities have
increasingly enforced their supervision in response. A 1988 court case versus Louisiana Tech University, settled in 1994 for $1.7
million ended in part with the universities attorney saying, “We're testing a new theory. I believe that a university has an obligation not
only to the degree participants, but also to the public, (to ensure) that a person who graduates from its program is competent in the
area in which the degree is bestowed" (Custer, 1994, p. 7).
It should be no surprise to the aware student, or practitioner, of human services that the ACA Code of Ethics and Standards of
Practice (2005) only references religion or spirituality once, and merely within its anti-discrimination text (Section C. 5). It also follows
that the AAPC, an ecumenical association does not offer any specific spiritual, or religious, starting point or standard (AAPC, 1994);
and instead, intends that the practitioner will adhere to the various, and unstated, practices of the faith community with which they are
associated (Principle 1. A). What may concern the student, or practitioner, of Christian counseling is the discrepancy of ethical
standards between the “world’s largest association” (ACA, 2005) and those of the AAPC and AACC. Can an association that
promotes and practices reparative therapies for homosexuals (AACC) be in collegial associations with an organization that includes
gays, lesbians, bisexuals, and transgender individuals as specific sub-groupings? Can a gay counselor be deemed competent as a
Christian counselor or for Christian clients dealing with homosexual thoughts? Can a Christian counselor be deemed competent for
advocating adoption as an alternative to abortion?
Competence is referenced by all three codes. Where counselor competence may be of particular importance to the Christian client is
in regard to issues and values specific to the Christian faith, especially when these areas conflict with popular culture or contemporary
clinical practice. If competence is alignment with the particular association’s mission, competence is viewed through contrasting
lenses. The ACA focuses on, among other things, multiculturalism, diversity and cultural sensitivity (Mission); while the AAPC selects
to “provide and promote theologically informed, spiritually sensitive, ethically sound, and clinically competent counseling and
consultation as an extension of the ministry of faith communities”, and “respecting the theological, psychological and faith traditions,
and spiritual practices of our members and their clients” (AAPC, 2005); and the AACC desires to “help advance the central mission of
the AACC—to bring honor to Jesus Christ and promote excellence and unity in Christian counseling”, offers that “Jesus Christ—and
His revelation in the Old and New Testaments of the Bible—is the pre-eminent model for Christian counseling practice, ethics, and
caregiving activities”, and presupposes an active relationship and belief in Jesus Christ and His church (AACC, 2004).    The
standards are remarkably different for each association! If, then, counselors are to base their colleague relationships, standards for
reporting colleagues, and relationship with society at large on these differing competencies, or core values; it would follow that
discrepancies will result.
To make matters more confusing for the Christian counselor, research into the cross-over of morality, and also referred to as
spirituality, into mainstream counseling is becoming more and more prevalent and linked to effective outcomes, as noted by Whiting,
Nebeker, & Fife (2005). What is not clear is if there is a particular moral or spiritual modality that is being tested, whether several are
used, or whether the reference to morality has any established basis. Christian counselors and associations would benefit from
studies that linked these positive outcomes to Christian-specific modalities and treatment.
It is also clear that specific groups of practitioners are finding that
Meeting the American Counseling Association's ethical standard for diagnostic training has several ethical implications for counselors,
counselor educators, and supervisors… (counselors) might struggle with how to meet their ethical responsibilities in diagnosis but
(still) want to remain true to their (specific) emphases (Dougherty, Jan. 2005).
This concern is shared by other groups, wishing to remain true to their ethics, morality, and spirituality or religion, both in the areas of
professional practice and in developing client-specific treatment, as noted in the Journal of Gay and Lesbian Psychotherapy (Israel et
al., 2003). What is at issue, primarily for the purposes of this paper, is the stark contrast between the ethical codes of the established
ranks of the ACA sub-groups, as well as like-minded associations such as the American Psychological Association, the National
Association of Social Workers, and others is the apparent bias toward radical inclusive efforts to those groups who clamor the loudest
and are most deemed politically correct versus the ethical stance or the AACC in particular. Core areas of difference include the
AACC’s (2004) stance on homosexuality, end of life concerns, abortion, extra-marital relationships, the role of spirituality, and many
other issues; each can be contested by another association’s ethical understanding of competence, professional relationships,
reporting, and role of the counselor within society. As each association asserts that what they are doing meets the latest in research
and political viability, the role of an association whose values are static must stand in contrast.
It is the opinion of this author, that the areas of: competence, colleague relationships, reporting colleagues, and a counselor’s
relationship to society are inter-related. More specifically, from an ethical standpoint, the standards of the three associations are at
best complementary to each other; and at their worst, at irreconcilable odds. It is also the opinion of this author, that clashes between
these associations will continue and that the most positive course of action for the Christian counselor, or association, is to continue
to press for empirical studies into the efficacy of Christian counseling techniques, while aggressively challenging poorly conducted
research, and a large-scale redirection of mainstream Christianity toward cultural relevance and significance.

References
American Association of Christian Counselors. (2004). Code of Ethics. . Retrieved November 1, 2005, from http://www.aacc.net

American Association of Pastoral Counselors. (1994). Code of Ethics. . Retrieved November 1, 2005, from http://www.aapc.org/ethics

American Counseling Association. (2005). Code of ethics and standards of practice. Alexandria, VA: Author.

American Counseling Association. (2005). Inside ACA. . Retrieved November 1, 2005, from http://www.counseling.org/AM/template.
cfm?Section=INSIDE_ACA

Board of Curators of the University of Missouri v. Horowitz, 430 U.S. 964 (1978).

Custer, G. (1994, November). Can universities be liable for incompetent grads? APA Monitor, 25 (11), 7.

Dougherty, J. (Jan. 2005). Ethics in case conceptualization and diagnosis: Incorporating a medical model into the developmental
counseling tradition. Counseling and Values, 49(2), 132-140, 9p. Abstract retrieved Nov. 1, 2005, from EBSCO host database.

Harris v. Blake and the Board of Trustees of the University of Northern Colorado, 798 F. 2d 419 (CO. 10, 1986).

Israel, T., et al. (2003). Identifying counselor competencies for working with lesbian, gay, and bisexual clients. Journal of Gay and
Lesbian Psychotherapy, 7(4), 3-17. Abstract retrieved Nov. 4, 2005, from EBSCO host database.

Whiting, J., Nebeker, R., & Fife, S. (2005). Moral responsiveness and discontinuity in therapy: A qualitative study. Counseling &
Values, 50(1), 20-37. Abstract retrieved Nov. 3, 2005, from EBSCO host database.

Shuffer v. Trustees of California State University and Colleges, 136 Cal. Rptr. 527 (1977).

DB Palmer

                                         Stages and Therapeutic Factors in Group Psychotherapy:
                                                        Considerations for Adventure Therapy

I have worked as an Adventure Therapy Guide and Instructor for several years and have found that some of the most powerfully
therapeutic experiences have occurred during our frequent group sessions. It is through these experiences of group therapy that I
discovered my passion for the field of Adventure Therapy. My work as a Masters degree student in Counseling Psychology has
afforded me the opportunity to get into the books, and author’s minds, that have chronicled and fashioned so much of what group
therapy has become. While many authors have written on the topic of Group Dynamics, Irvin D. Yalom’s work, “The Theory and
Practice of Group Psychotherapy” is considered a must read for many therapists, and according to Yalom (1995) was ranked one of
the ten most influential psychiatry publications of the last decade by the American Journal of Psychiatry.
It would be difficult to discuss group dynamics without addressing what are commonly referred to as the stages of group
development. When I began working with youth ten years ago, I was unfamiliar with the group process. I observed that most groups
travel through similar stages. While there is no single model, many therapists agree that certain characteristics are similar enough
for categorical explanation. These stages are usually longitudinal in nature, tracing a linear path from beginning to end. It is
important to note that like Piaget and Kohlberg’s developmental stages, I agree with Yalom, in that regression and stagnancy may
occur at any level. The stages: Initial, Transitional, Working, and Final, are widely used to describe this progression. They are so
widely used, that I have not been able to determine their origin. The amount of information that is published on group work,
leadership, psychology, etc… is vast. Nonetheless, it is important to note that no theory or model, alone, supersedes the need for
experience or competence in working with groups. Therapy deriving its course from a manual is likely going to lose the truer spirit of
the group and its members (Yalom, 1995).
In my estimation, the group stages hold true enough to form a basis for clarification of the common group stages. In the Initial Stage,
group members are generally unfamiliar with the process and the other group members. I firmly believe that this stage is a critical
one. This is where the tone is set, and the place from which the lines are drawn. The task of the group leader is to build trust,
explore ground rules, and to help members (Corey, 2000) develop goals for the sessions. In adventure therapy, I try to get as much
information out as possible, and have found that more work on this end equates to simpler and smoother continuation. This is where
I define what the program will entail. For my trek, beginning in a few days, I have made it a priority to sit down with my fellow
instructors and hash out our ground rules ahead of time to ensure that we are relatively on the same page and present a united
front. Often, there is a considerable amount of anxiety built up around being in a new group in an unfamiliar place. I try to
communicate acknowledgement of this. Many of these students are sent to treatment programs due to their own poor choices,
however this in no way equates with license for maltreatment or an implied delinquency. I have noted, concurrently, that many
students are in treatment due to reasons beyond their control. Adventure therapy is about making new choices and selecting new
horizons. During this stage, I will spend considerable effort getting to know each student and in establishing some level of trust with
them. I will count on this trust in the stage to come.
The Transitional stage, to oversimplify, is where boundaries are explored and tested. As the newness and accompanying anxiety
wears off, the group members begin to advance their search for placement in the group. I have seen this with almost every group
that I have been a part of, and I am in no way excluded from this tendency to seek out a pecking order. The task of the leader is to
identify and challenge member’s fears, hesitation, and resistance (Corey, 2000). Since we have been together for a short while, the
sessions begin to increase in potency. I will ask deeper questions and challenge members to begin taking risks. I want to see if
students will step out and test the water; meanwhile, I must maintain a vigilant awareness of emotional safety. For the leader, this
stage is a real challenge. I do not take this stage lightly and engage my fellow staff in feedback sessions with even more seriousness
and frequency than usual. While I enjoy each stage for the changes it brings, the real reward to this stage, in my belief, is in its
completion. This is the mountain that provides the view to the other side. Beyond lies wakening minds and spirits.
In the Working stage, the group has crossed over their resistance into open disclosure and exploration. The task of the leader is to
explore feelings, ideas and beliefs, and delve into experiencing issues (Corey, 2000). It is this stage that groups commonly develop
strong bonds with each other, also referred to as cohesion (a topic to be discussed in more detail). I mentioned in the previous
paragraph that this stage is a product of the conflict of the transitional stage, and as such, I look forward to the emergence of this
stage. The multi-stage model suggests a continuing developmental progression of the group. In truth, this stage is the pinnacle of
the group’s lifespan. For the leader, this stage commonly represents the ‘man, I love my job’ part of group work. This, by no means,
that the working stage is easy. Far from it! As group cohesion and trust increase, resistance is generally decreasing. The result is
harder conversations, deeper searching for answers, and the truth to why some members have come. These confessions, for lack
of a better word, can be extremely emotional. It is not uncommon to swing the gamut of emotion within a session, ending in tears and
hugs for all. By no means, however, does this stage (nor any other) necessarily consist of any set actions of facets. The stages will
likely have no clear demarcation between the next, may wander back and forth between each other, and may not exist at all. It is
important to remember that research has had great difficulty finding conclusive evidence of any particular order or existence of a set
stage or stages (Yalom, 1995).
(note: I will discuss the Final Stage in the conclusion)
Yalom outlined several key areas that may better define the benefits of group therapy. I find his eleven primary factors interesting in
that I have experienced and interpreted these factors to have existed in the groups that I work with. The negative stigmatization that
students or patients often adopt is, in my opinion, commonly due to several core beliefs of inadequacy. The instillation of hope,
Yalom’s first therapeutic factor, attends to this feeling of inadequacy in that it offers the student hope for progress. I agree with
Yalom in that hope is probably required to keep the patient in treatment. How many ‘runners’ have run because they genuinely
believed that the program was helping them in ways that they could not have. I dare say, probably none. Yalom also referred to
faith in the leader and treatment mode, which I press in the initial stages of each program. I agree with Yalom, in that, I can help
every motivated student that is willing to work; and I will reinforce this by saying things such as, “ I have great confidence that if you
apply yourself and get into this, you will learn and grow more than you thought you could” and also, “I am here to be a listener and to
work through any issues you want to deal with”. I think that this approach allows, even the skeptical and resistant students, to file this
invitation away for future reference. This is where I plant the seeds and begin to cultivate hope.
The pregroup orientation that Yalom (1995) refers to is also beneficial in my work as a way to define boundaries and set the tone for
the rest of the trek. From the beginning I will reinforce positive behavior and ignore or address negative behavior. A real benefit to
programs that offer rolling admission into established groups is that the new students can see those that have come before them.
The leader may share a considerable amount of information in the orientation, but it is through seeing senior members who are
displaying the positive learning through their actions and words that inspires, likely, a deeper sense of hope.
During the Initial stage of the group, I find that many of the interpersonal and intrapersonal anxiety is due to a sense of loneliness or
isolation. Corey (2000) noted in the video, “Evolution of a Group“, that many patients feel isolated during this stage. Yalom’s
second therapeutic factor, Universality, attends to this idea. I do not know the feelings and thoughts that accompany new students
as they enter my treks. I have asked, but I wonder how genuine the answers are, judging from the body language and hesitation
occurring after the question. Yalom (1995) notes that, “many patients enter with the disquieting thought that they are unique in their
wretchedness, that they alone have certain frightening or unacceptable problems, thoughts, impulses, and fantasies.” I would
generally agree, adding that in my experience, many students do not readily, or ever in a few cases, admit to having anything wrong.
Far from it, they believe that their issues are no different than those of anyone else. I think the discrepancy here may be attributed
to the manner in which these two groups come to be in group therapy, whether self-referred or mandated.
The issue of universality in adventure therapy can be very important. Take for instance a student who has been sexually abused.
S/he may have very mixed feelings surrounding the event. In a few cases, I have known students that thought maybe they deserved
to be abused. Interestingly, after hearing the painfully tragic story of another student who also was unsure of similar self-blame, the
student was now able to see that they both shared the same unfounded self-blaming thoughts. This consensual validation, or
knowledge of another’s similar feelings and experiences (Yalom, 1995) often grants further awareness towards universality.
Imparting information, wherein the student is offered educational information, advice, or other counsel from the leader or group is
often the least effective means of effecting change (Yalom, 1995). I have found that imparting information is of benefit when
discussing medical or other physically based issues, particularly in assisting the student in grasping a fuller understanding of the
nitty-gritty details of relevance. I took particular notice of using direct advice, not so much to the content; but rather, the process of
providing advice may imply an interpersonal interest and caring. Also relevant to my work are the use of systematic, operationalized
instructions, or alternative suggestions rather than the use of direct suggestion. (Yalom, 1995) For example, instead of offering a
packaged answer to a problem, I choose to assist in active problem solving.
Altruism is of great benefit to many students. The opportunity to give back to something, or more importantly to someone, is often
noted as having very powerful therapeutic value (Yalom, 1995). As students enter my groups, there are usually members that do not
think that they have anything to offer anyone, and in turn, often act as if they don’t need anything from anyone else. Yalom
referenced Viktor Frankl, a mind that I greatly admire, as saying, “that a sense of life meaning ensues but cannot be deliberately
pursued: it is always a derivative phenomenon that materializes when we have transcended ourselves, when we have forgotten
ourselves and become absorbed in someone (or something) outside ourselves” (Yalom, 1995). Native American cultures, and some
primitive cultures according to Yalom (1995), may give a troubled person the task of preparing a feast or performing another such
service for the tribe (band, village, group, etc). I have often used this intervention with adventure therapy groups, and find there are
many positive outcomes. First, the troubled person is able to focus on an external goal. Second, the group is, hopefully, thankful
and commending of the service; concurrently, this allows each member to see that the troubled person is useful and has invested in
each of them. Third, but certainly not the last benefit, is that the troubled person can now reflect on the positive feedback, has a
concrete example of how s/he is appreciated and useful, and has accomplished a beneficial goal.
The corrective recapitulation of the primary family group is often of considerable concern to adventure therapy leaders and our
students. I have, once, worked with a student whose family life, considering both the student and family’s health, I considered to be
stable, trusting, and compatible to a smooth return. Once. Many traditional groups are co-led by female and male leaders in a
deliberate effort to simulate the parental configuration as closely as possible (Yalom, 1995). Many adventure therapy programs also
follow this model. I find that this is highly effective, allowing the male in female groups to become fictional boyfriend, dad, grandpa,
brother, teacher, and other characters as transference evolves over time. This person can be a bridge towards reengaging those
characters in the student’s life back home and in the future. I find role-playing of value in some cases, and will also incorporate less
structured scenarios like, “how is this like (home), or is it?” This is a great place to challenge fixed roles and explore new ones
(Yalom, 1995).
Students in adventure therapy programs have opportunity to incorporate the behaviors modeled by the other members and leaders.
As the trek evolves, it is assumed (and generally true) that students will gain new social techniques. Throughout the trek, I will model
differing and static methods of behaving and responding. Many of these models will be incorporated into the student’s ‘tool bag’. By
trek end, it is not uncommon for several students to have considerable skill in processing information, expressing accurate empathy,
and in suspending judgment. These social techniques will certainly be of benefit in the future. (Yalom, 1995).
Yalom lists Imitative Behavior as another therapeutic factor, and I think deserves clarification here from the social techniques listed
above. The freedom to try new behaviors within a relatively safe environment is bound to be extremely informative to the student.
These behaviors, in contrast to social techniques, are modeled by senior members of the group and leaders; and, are then tried on
like an outfit to determine a fit. Imitative behavior generally plays more of a role early on in treatment as members in the Initial and
Transitional stages attempt to incorporate and act on the behaviors of others within the group. I find this factor of great benefit in
adventure therapy and will openly suggest that students try new behaviors to see if they are effective. This process will likely have
solid therapeutic impact, as finding out what we are not is progress toward finding out what we are (Yalom, 1995).
Interpersonal Learning is such a broad and encapsulating category, that it could certainly be the source of numerous texts. Within
adventure therapy, I would venture that this is commonly the factor that people, within and without the industry, use to encapsulate
and define the process and reason that adventure therapy works. The opportunity to set up a new learning environment that is
centered on addressing issues is central to group therapy.
The phrase, social microcosm, references that any group, given enough time, will recreate a social sphere (within the group) that
approximates their external social sphere. In short, the group environment will eventually approximate the group members’ natural
settings. This is of great benefit to group leaders, as there is little need for students or clients to describe or give a detailed history
of their pathology. The pathology will surface on its own for all to see. This concept, social microcosm, is of critical importance and
is a keystone in the foundation of group therapy. It is common for a group member(s) to claim indifference or detachment to the rest
of the group. Indifference generally conceals a deep-rooted sense of low self-worth; and interestingly, a strong sense of concern for
the group. This tendency to be greatly affected by the group is so strong that it affects even society’s more stereotypically hardened
criminals (Yalom, 1995).
Group cohesiveness is another of Yalom’s therapeutic factors. Cohesion is both difficult to quantify and inextricable to positive
outcomes (Yalom, 1995). Cohesion, like many of the therapeutic factors, overlaps other dimensions. It involves both the group
dynamic, the synergistic quality of the members and the individual’s attraction to the group (Yalom, 1995). Not only does cohesion
result from multiple dimensions, it also crosses over into and within other factors. It is difficult to separate the positive effects of
universality, imitative behaviors, and cohesion (for example). On trek, I rely on these multi-faceted combinations for my personal
safety when working with potentially aggressive group members, emotional safety within members of the group, and for overall
continuation of a sometime unpleasant confrontation or parent-letter. With group cohesion, I am more likely to share of myself, to
offer warmer regard, and to invite deeper conversation among members.
I’ve often heard that when angry, you should try throwing a banana, taking a run, or hitting a punching bag. This idea of catharsis,
getting it out of you system, is the oldest of medical and psychological treatments (Yalom, 1995). The value of cathartic exercises is
not as powerful alone as when paired with other therapeutic factors. How long could a group sit together while everyone just ‘got
things off their chests’? I presume, not long. Yalom noted that catharsis is particularly valuable as groups develop into more
advanced stages. An early gripe session is noted less valuable to participants than a deep-felt burden that is finally unloaded
amongst friends. The same is true in adventure therapy, in my experience. When new groups form, there is a tendency to place
blame of numerous outside elements. There is little interpersonal learning going on, that I can see, except for general agreement
that many of us have been ‘screwed-over’ by somebody. The power of catharsis is in its relationship to the other therapeutic factors
(Yalom, 1995).
When quantifying the numerous factors that patients found to be seminal in their progress in group therapy, Yalom noted that the
previous factors presented rather clear categories for analysis. What was left unaccounted for were several factors that presented
outside of the clear categories that I spoke of previously. These factors were deemed to important to be left out of his text, and
represent what he calls, Existential Factors. Five statements stand out as differentially significant:
1.        “Recognizing that life is at times unfair and unjust.
2.        Recognizing that ultimately there is no escape from some of life’s pain or from death.
3.        Recognizing that no matter how close I get to other people, I must still face life alone.
4.        Facing the basic issues of my life and death, and thus living my life more honestly and being less caught up in trivialities.
5.        Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I receive
from others. “
(Yalom 1995, p.88)
These issues are commonly addressed in advanced groups that I have worked with. I am consistently surprised at the depth of
conversation that I am offered to take part in with advanced student groups. Acknowledge of these existential factors amongst
students represents, to me, a powerfully successful trek; and likely will continue to shape all of our lives afterwards. I know that these
statements have greatly impacted my own life.
“Being aware of one’s self-creation (our control over our own decisions) in the authentic state of mindfulness of being (as opposed to
Martin Heidegger’s forgetfulness of being) provides one with the power to change. Thus the therapist must pay special attention to
the factors that transport a person from the everyday to the authentic modes of existing (How can I reframe this situation, or call
attention to new ideas?). One cannot affect such a shift merely by bearing down (not by trying harder, merely), by gritting one’s
teeth. But there are certain jolting experiences (wake-up calls) that effectively transport one into the mindfulness-of-being state”
(Yalom 1995, p.94).
Unfortunately, existential factors have received little/no role in psychotherapy, according to Yalom, and there is no discrete school,
training institute, or accepted body of theory and techniques. Interestingly, according to a 1983 survey (certainly outdated) over 16
percent of American therapists identified themselves as existentially oriented (Yalom, 1995). I have no doubt that number is larger
today.
In the Final stage, the group (or an individual) is preparing to move out and into the unknown. This can be a time of jubilation for my
students as they reflect on their accomplishments. Quite often, it is a time of new anxieties and fear of the unknown. I have often
heard students ask if they ‘have to’ go home. The same is true with regards to traditional groups. The group has become a home, a
safe place (generally) where the participant could receive the support, feedback, and sense of community that may have been
lacking. In other instances, it represents the first time a person may have opened up to a group. The task of the leader is to review
what has been learned and facilitate action towards the next steps in life (Corey, 2000). What will come next? Many successful
participants will have lasting memories of the group and may even use the group as a kind of filter through which they view future
choices, thoughts, and actions (i.e. what would the group think about this?) (Yalom, 1995). As a leader, I have formed valuable
partnerships with my co-leaders and students. This time of graduation is powerful for me, but how much more powerful for the
student who has taken the chance to open up and see the world anew for the first time. Ultimately, this stage represents the
responsibility to take responsibility for the next steps in life. I think Yalom says it well by saying, “it has been a place of anguish,
conflict, fear, and also great beauty: some of life’s truest and most poignant moments occur in the small and yet limitless microcosm
of the therapy group” (Yalom, 1995).

References Cited:

Corey, G. (2000). Evolution of a Group: Student Video and Workbook. Belmont,         CA: Wadsworth Publishing Co.

Yalom, I.D. (1995). The Theory and Practice of Group Psychotherapy, 4th Ed..         NY: Basic Books