Psychiatric Annals

experiential groups: can they enhance adaptation?

Lewis R Wolberg, MD

Abstract

2

In searching for means of enhancing adaptation, we are confronted with the problem that constructive personal change, whenever it occurs, usually is a tediously slow process, characterized by both progress and regress. Inhibiting change are many obstructive forces such as those we experience in contemporary society. Such forces arise from the international struggles for political and economic supremacy, with the wasting of lives and resources in wars and revolutions; but they are just as much a consequence of modern technology, urbanization, bureaucratization, continued population growth and mobility, and the complexity of communications. The pressures of modernization are often beyond the coping powers of the average individual, taxing even the most stable of citizens. Anxiety and alienation lead to a ceaseless search for identity and a challenging of conventional values. As a result a person's resources may be stretched to the breaking point in forcing him to make appropriate choices in the face of often irreconcilable conflict.

One way of mediating conflict is psychotherapy. But even if it were possible to supply enough psychotherapists to treat all of humanity at very low fees, most people neither need extensive psychotherapy, nor want it. They may recognize that they are not getting along as well as they might - they are not working efficiently nor taking full advantage of the joy that their life offers. But they would for the most part resist formal treatment even if it could be arranged, which, as we know, it could not since there are not enough psychotherapists available for even a tiny fraction of the persons who now seek help.

In recent years, a new measure has been introduced which is still in the experimental stage, but which is said to hold promise of catalyzing focal change in certain key areas. This measure, a form of experience-based learning, is called "sensitivity training," "the encounter group," "the T-group," "human relations training," "laboratory training," and other names, all of which we may arbitrarily lump together under the generic term "experiential groups." An experiential group is commonly a small gathering of people in which interpersonal confrontations are encouraged for the purpose of influencing attitudes and developing skills toward more productive social interactions. The process is a blend of education, social psychology, managerial techniques, and psychotherapy. The experiential group cuts across many of the behavioral sciences and has for the past few decades been involving more and more of the helping professions. Since the process is so new, its theories and methods have not been firmly codified. It does not fit into conventional molds of either education or psychotherapy, although it draws many theories and methods from both. We may say that the practices that have emerged are still questionable. Undoubtedly some of them will survive the test of time and be refined and consolidated into a body of methodologies acceptable for conventional clinical practice. At the Postgraduate Center for Mental Health in New York, we have been working with experiential groups for over ten years in our Community Services and Education Division, and we are constantly gathering data regarding their utility as well as their effectiveness.

The supposition behind experiential groups is that people in their daily lives are blocked from relating to one another at their full potential because of difficulties in communication. To a large extent these difficulties are fostered by a pervasive conscious mistrust, a fear that were they to open up to others, they would be rejected, ridiculed or hurt. To an even greater degree problems of communication are believed to be rooted in personal conflicts, many of which are on the hazy periphery…

2

In searching for means of enhancing adaptation, we are confronted with the problem that constructive personal change, whenever it occurs, usually is a tediously slow process, characterized by both progress and regress. Inhibiting change are many obstructive forces such as those we experience in contemporary society. Such forces arise from the international struggles for political and economic supremacy, with the wasting of lives and resources in wars and revolutions; but they are just as much a consequence of modern technology, urbanization, bureaucratization, continued population growth and mobility, and the complexity of communications. The pressures of modernization are often beyond the coping powers of the average individual, taxing even the most stable of citizens. Anxiety and alienation lead to a ceaseless search for identity and a challenging of conventional values. As a result a person's resources may be stretched to the breaking point in forcing him to make appropriate choices in the face of often irreconcilable conflict.

One way of mediating conflict is psychotherapy. But even if it were possible to supply enough psychotherapists to treat all of humanity at very low fees, most people neither need extensive psychotherapy, nor want it. They may recognize that they are not getting along as well as they might - they are not working efficiently nor taking full advantage of the joy that their life offers. But they would for the most part resist formal treatment even if it could be arranged, which, as we know, it could not since there are not enough psychotherapists available for even a tiny fraction of the persons who now seek help.

In recent years, a new measure has been introduced which is still in the experimental stage, but which is said to hold promise of catalyzing focal change in certain key areas. This measure, a form of experience-based learning, is called "sensitivity training," "the encounter group," "the T-group," "human relations training," "laboratory training," and other names, all of which we may arbitrarily lump together under the generic term "experiential groups." An experiential group is commonly a small gathering of people in which interpersonal confrontations are encouraged for the purpose of influencing attitudes and developing skills toward more productive social interactions. The process is a blend of education, social psychology, managerial techniques, and psychotherapy. The experiential group cuts across many of the behavioral sciences and has for the past few decades been involving more and more of the helping professions. Since the process is so new, its theories and methods have not been firmly codified. It does not fit into conventional molds of either education or psychotherapy, although it draws many theories and methods from both. We may say that the practices that have emerged are still questionable. Undoubtedly some of them will survive the test of time and be refined and consolidated into a body of methodologies acceptable for conventional clinical practice. At the Postgraduate Center for Mental Health in New York, we have been working with experiential groups for over ten years in our Community Services and Education Division, and we are constantly gathering data regarding their utility as well as their effectiveness.

The supposition behind experiential groups is that people in their daily lives are blocked from relating to one another at their full potential because of difficulties in communication. To a large extent these difficulties are fostered by a pervasive conscious mistrust, a fear that were they to open up to others, they would be rejected, ridiculed or hurt. To an even greater degree problems of communication are believed to be rooted in personal conflicts, many of which are on the hazy periphery of awareness or are totally unconscious. Providing a permissive medium for the ventilation of one's thoughts, fears, ideas and feelings may open up hidden channels of communication. This medium may thus provide a means of testing the validity of assumptions that have prevented an individual from achieving his true potential in his work, creativeness, and relationship with others.

A quarter of a century ago this theory was tested out by the psychologist Kurt Lewin, who had been working at the Massachusetts Institute of Technology. Along with a small number of psychologists and sociologists, including Leland Bradford, Kenneth Benne and Ronald Lippit, he conducted a series of experiments at Bethel, Maine, in training groups in human relations skills. The participants were encouraged to react as spontaneously as possible - dancing, wrestling, insulting each other, saying whatever complimentary or outlandish things came to their minds, and in general being as completely uninhibited as possible. The participants, realizing that they were not being condemned or punished for their thoughts and ideas, became much more open and friendly with one another and, finally, were able to cooperate with extraordinary facility. They later reported important changes in the way they related to people in general, as well as changes in certain attitudes toward themselves.

Shortly after World War II, Carl Rogers and his associates at the University of Chicago evolved a program for the training of personal counselors to help returning veterans make a better adjustment.16 The program consisted of intensive group interactions in which the trainees met for several hours each day to work on attitudes that could be self-defeating. According to the trainees and counselors many deep and meaningful changes resulted.

The experiments were repeated by different observers in a number of varying settings with the consequence that increasing numbers of training organizations emerged. At present over 150 institutions have been developed for leadership training. The largest of these organizations is the National Training Laboratories Institute for Applied Behavioral Science, which has a staff of 500 psychiatrists, psychologists, sociologists and educators, and which is planning a $20 million university to conduct research in the field. Other organizations which have done work in leadership training are the American Management Association, the Polaroid Company, Corning Glass Works, General Foods, and American Airlines.

EXPERIENTIAL LEADERSHIP TRAINING AND INDUSTRY

A universal finding among these business groups is that the efficiency of an organization is sabotaged by inter-group rivalries, fears and hostilities among the executives that are rarely brought out in the open. Where the members who customarily work together are gathered in an experiential training group, they may, within this protected and permissive milieu, under the guidance of a good leader, be able more and more readily to communicate their prejudices and distrustful feelings to one another. Ventilation of these thoughts eventually leads to clarification and the emergence of closeness and expressive warmth that did not exist before. Inevitably, this closeness enhances communication and is said to result in personnel working better together, greatly improving the efficiency of the organization.

At the Postgraduate Center for Mental Health, the Director of Research, Dr. Bernard Reiss, has organized a number of programs for businesses in the United States, West Germany and Norway. An example of his approach is contained in the paper, "Experience Compression: A Technique for Facilitating Interpersonal Communication." 15 The object of his technique was to increase the "productivity of organized human effort in business . . . through the development of better executives," by helping the participants develop clearer concepts of themselves which would improve their contacts with their superiors, colleagues and subordinates. The essential methodology was role-playing under simulated business situations, involving problems normally encountered by executives. Riess states: "What is added to this role-playing technique is a kind of goldfish-bowl life since every movement of their existence for the duration of the workshop is under scrutiny by means of closed circuit TV, walkietalkies, tapped telephones and direct observation by monitors. . . . What is not imparted to the participants is the existence of action triggers, stimulus-situations designed to increase tension and to provoke psychologically significant action. By this is meant behavior which reveals either unconscious motivations, resistances or habitual maladaptive reactions." Riess sums up his results: "Having worked as an analytic psychotherapist for some two decades, I can say that the degree of self-awareness and readiness to examine behavior and motivation induced by Experience Compression outdoes anything I have been able to accomplish in a much longer time in individual therapy."

Many other models exist for working briefly with business and industrial groups, but the outstanding agreement has been that at the end of the workshop period participants insist that they have benefited and can communicate better. They express a feeling that their personal lives have been enriched. However, a word of caution is necessary before accepting such judgments at face value. As enthusiastic as their statements may be, there have been few follow-up studies attesting to the permanence of change. Before we can accept the lasting value of brief encounter group confrontations, we will have to validate change over a long period of time.

EXPERIENTIAL ENCOUNTER GROUPS AND EMOTIONAL GROWTH

When people meet in small groups to discuss problems they are having in their jobs, it is commonly observed that they project their neurotic attitudes, needs, and defenses onto each other. Indeed it soon becomes apparent that the hardships they are experiencing at work are related to the personal difficulties they are having with themselves. Indeed it is obvious that many problems credited to his work situation are the outcome of disturbed reactions the individual has had in his relationships with authority, his peers, and himself for many, many years. Some of his aberrations are residues of faulty values, excessive competitiveness, pathological dependency, devaluated self-feelings and other distortions which have pursued the person most of his life. We would not label all people who display such reactions as "abnormal." As a general rule the average person in our culture possesses certain emotional and neurotic burdens even though he is considered "normal." Why then should a person with a "normal" mild neurosis need an experiential encounter group? This is one explanation:

"In most respects we seem adjusted in our day-by-day activities. We appear to behave appropriately with regard to the demands made upon us by our families, friends, and jobs. Yet this appearance is deceptive. Internal doubts and schisms persist. As no convenient learning vehicle is typically available to the 'pseudo-healthy' person, tensions below the surface debilitate realization of potential capacities, stunt creativity, infuse hostility into a vast range of human contact, and frequently generate hampering psychosomatic problems." 24

Even the so-called healthy individual in our society has problems in adjustment which could be improved. If a technique is available that will help him to function more effectively and to improve his relationships with people, it would benefit him greatly.

Actually a constructive group experience with a small group of people who are educationally on a relatively equal level and who permit themselves to disclose their self-doubts and personal weaknesses can be most liberating to the participants. The fact that one can expose himself to others and reveal his fears and his desires of which he is ashamed, without being rejected or ridiculed, can be reassuring and strengthening. The person feels accepted for himself, with all his flaws, rather than for the pose he presents to the world. Whereas previously he may have regarded interpersonal relationships as threatening, he finds that they can embrace a sustaining richness. As communication between the members broadens, they share more and more their hidden secrets and anxieties. They begin to trust and accept themselves as they learn to trust and accept the other participants. Interpersonal confrontations, while temporarily upsetting, may even ultimately bring the individual into contact with repudiated aspects of himself.

By communicating without restraint, the members are enabled to learn that other individuals have problems similar to and even more severe than their own. This realization enables them to relax their guards and to open up more with one another. The "encounters" in the group will probably sooner or later release underlying patterns of conflict, such as hostility toward certain members, excessive tendencies to defy and obstruct, inferiority feelings, unrealistic expectations, grandoise boastings, and other maneuvers that have little to do with the immediate group situation, but rather are manifestations of fundamental characterologic flaws. Under the guidance of a skilled group leader, the encounter group becomes a means through which the members become aware of how they are creating many of their own troubles. By talking things out they are able to correct some of their misperceptions.

Some observers would call this process psychotherapy. We are dealing here with semantics. The effects of the encounter group can be psychotherapeutic, particularly in persons who are ready for change and who already have, perhaps in previous psychotherapeutic experiences, worked through their resistances to change. But psychotherapy, in most cases, is not the achieved objective. What is accomplished is an educational realignment which challenges certain attitudes and teaches the person how to function better in certain situations. If one happens in the course of this education to change a neurotic pattern of behavior, so much the better, but it must be emphasized that psychotherapeutic groups are run differently from encounter groups. They are organized on a long-term basis and focused on neurotic symptoms and intrapsychic processes.

Even though there is some evidence that encounter group experiences may have a therapeutic effect on neurotic personality structure,12 our observations at the Postgraduate Center for Mental Health indicate that personality changes, when they do occur, are temporary, rapidly disappearing once the participant leaves the encounter group and returns to his habitual life setting. We have worked with the staffs of various institutional units, including psychiatric clinics, correctional institutions, schools, and a host of professional and non-professional organizations. Our delight at "depth" changes brought about by encounter techniques has been generally short-lived when we do follow-up studies after a reasonable time has elapsed. This fact does not depreciate what the encounter group can do for a participant, because in many instances it does alert the individual to his neurotic shortcomings and motivates him to seek psychotherapy on a more intensive level. Many of our "cured" encounter clients later ask for more thorough psychotherapeutic help, once they have an inkling of their problems.

EXPERIENTIAL SENSITIVITY GROUPS AND PROFESSIONAL TRAINING

A more substantial benefit of experiential groups is their impact on the learning process as it pertains to professional functioning. When people become aware of their personal difficulties, as has been mentioned before, and associate these with their failings in professional functioning, they may become surprisingly more efficient at work.

When future duties are related to counseling or educating people, the student may gain, as a group member, both a knowledge of interpersonal dynamics and a realization of how his own emotional problems blind him to certain aspects of human relationships, and thus interfere with proper work functioning. Group programs have become a part of education in many schools, having as their objective a widening of the students' understanding of their human and social responsibilities. There are many effective programs of this type. In medical schools, for example, the experiences at Wayne State University, the University of Southern California in Los Angeles, Tufts Medical School, and the University of Maryland have brought out the fact that traditional teaching methods are lacking in a psychological dimension essential for the proper role of the physician in the community.5,7,9,14,18,21 At the Cornell Medical School voluntary participation in group seminars was offered to freshman medical students to help the future physician become a more sensitive, empathie and self-aware individual. The reported results have been gratifying: "The program makes the student more aware of himself, of others, and of the dynamics of interpersonal exchange. With increased capacity for spontaneity and creative thinking, confidence and personal enrichment will grow and lead in turn to a strengthening of the ability to deal with personal, social, and vocational crises." 4

At the Postgraduate Center we have employed experiential groups as an essential, even indispensable, part of the training of various professionals, including teachers, teaching supervisors, principals, school superintendents, guidance counselors, school aides, special educators (drug education, sex education), attendance teachers, correctional officers, police officers, psychiatrists, nurses, social workers, psychologists, speech pathologists, paraprofessional workers, vocational rehabilitation workers, and clergymen. Our experience has on the whole been gratifying. We have observed changes in attitudes, and follow-up evaluation studies over an extended period have shown that the educational gains have continued and have made for greater efficiency in work roles. Many professionals testify that their personal lives have also been enriched. For example, the following are excerpts from students in our program for the S.T.M. degree in Pastoral Counseling. This program of training is carried out in conjunction with the New York Theological Seminary, the Union Theological Seminary and other seminaries for the training in counseling of ministers, priests and rabbis. In their work, clergymen must possess skills that enable them to understand the dynamics of their parishes and the realities of their communities. The ability to relate in small groups to clergymen of faiths other than their own not only enhances understanding of those who have different religious beliefs, but it widens the participants' insights into themselves and their own problems.*

One must mention at this point that the leader of the experiential group is the key factor for success. All of our leaders are trained psychoanalysts who have gone through, in addition to postgraduate analytic training, a training course in Community Consultation under the auspices of our Community Service and Education Division. An inexperienced and untrained leader would not have the skills to deal with many of the explosive reactions that can develop. We also feel that the group experience should best be extended over a period of at least one year in order to integrate the new learnings and to implement changes in behavior. During the period of group experience, it is important that the student be working actively at his profession so that he may be able to alter patterns, feelings and attitudes.

UNTOWARD REACTIONS

It must not be assumed that experiential groups are without their problems, nor that they are universally applicable.6,13 Many persons manage to function, in the face of serious emotional instabilities, with defenses of detachment and isolation. Exposing such persons to confrontations in a group may be highly disturbing emotionally. Borderline psychotic problems may be deepened into an open break with reality. An individual may, despite the permissiveness of the group, be unable to take criticism, and may if he is in a power position in an organization become recriminatory toward a subordinate in his experiential group who exposed his weaknesses or who he feels has insulted him. Fortunately, in the hands of qualified, trained leaders such untoward incidents are rare. For example, the National Training Laboratories have published figures that indicate that emotional disturbances have developed in only nine people among 30,000 persons who have taken part in programs. It has bean said that these figures are better than the breakdowns that occur among people exposed to an average movie or concert. Ross et al. have reported a survey of all psychiatrists in a metropolitan area where many sensitivity groups were going on.17 They discovered that less than one percent of all participants become psychologically disturbed when exposed to a wide assortment of group procedures. Seashore also states that approximately one percent of participants suffer serious stress and mental disturbance, and practically all cases are limited to persons with a history of prior emotional disturbances.20 On the other hand, there is evidence that in some group situations the percentages of untoward reactions are considerably higher.

It is certainly wise to err on the side of caution. Amateurs should definitely not try to organize or run encounter groups. Most of the bad consequences reported are the product of leaders who have not received the proper training or who themselves have personal problems they are not able to resolve. Insatiable power drives, grandiosity, and excessive hostility are among such problems.

We find example after example of groups that have been organized by nonprofessional people who employ a host of unorthodox and untested tactics from shouting contests, to nude marathons, to silent-blindfolded touching siestas. We may reasonably doubt the efficacy of such maneuvers in spite of the positive anecdotal testimonies that are offered.10·6 Since the field is so new, there are no generally approved and accepted tactics. In the main, wild acting-out methods, while seemingly dramatic, are less effective than verbal interaction with role playing. Under the guidance of good leaders, many participants have achieved competence in important interpersonal situations, have enhanced their self-awareness, and have evolved leadership skills.

Since the experiential groups stimulate a great deal of stress, it would seem expethent to screen all potential members. Few guidelines for screening are available although some attempts have been made to formulate general principles.23 The best screening device is a competent leader who can interfere when a potentially upsetting reaction threatens to break out in a psychotic or pre-psychotic member, and who can consult individually with this member and administer the proper psychotherapy. A leader ideally should have training in psychotherapy in order to be able to make a proper diagnosis and to supply the essential help.

EXPERIENTIAL GROUPS AND INTERNATIONAL UNDERSTANDING

Can a group experience enhance one's ability to understand people from different cultures? In some of the Postgraduate Center's professional groups, we have had as participant fellows students from Japan, India, Spain, Turkey, the Philippines, Taiwan, Mexico, Argentina, Brazil, Colombia, Greece, Israel, Egypt, Syria, Italy, Holland, Sweden, Norway, and a number of other countries. The experience has universally been an enlightening one in working through shock reactions from exposure to persons with different accents, values, colors, religions, cultural idiosyncrasies, and political philosophies.

The format, leadership style, technical operations and stated goals will differ from one group to the next. But under the guidance of a sensitive, trained leader, a number of remarkably similar processes emerge in the different groups. Essentially, the group leader provides a climate where free expression is encouraged. Often due to the relative lack of structure and the strangeness of the experience, there is bewilderment, irritation, and disappointment. The members grope about for ways of relating to each other in the face of the prejudices, fears, suspicions and stereotyped ideas about people who belong to a strange or offensive culture. They tentatively explore the limits of expressiveness with many of their customary facades and defenses. Not meeting anticipated rebuffs and punishments for openness of communication - indeed, receiving approval - their ability to come forth with suppressed and repressed feelings and attitudes becomes enhanced. A milieu of trust and warmth begins to envelop the group and to facilitate communication. Members accept the problems, differences and foibles of the other members less critically. They soon realize that they have many more areas in common than they had imagined existed at the start. They ultimately experience feelings of warmth, compassion, understanding, and admiration, displacing negative feelings that had existed. These feelings may generalize to include people of the countries or groups to which the foreign members belong.

Because of the need to make adjustments to new situations and to demands imposed in working with persons from other cultures, a group experience can be an essential preparatory measure. For example, many of the volunteers for the Peace Corps found that although they were making satisfactory adjustments in their usual work and social roles in their own countries, going into different cultures imposed on them new challenges with which it was difficult to cope. Such difficulties led to the organization of "human relations training groups" as an educational medium for persons who engaged in overseas work. The Human Resources Research Office undertook to explore the existing knowledge and experience in the area of human relations training to determine its relevance for preparing personnel for overseas assignments. The overall impression from this research is that such training can constructively shape attitudes and interpersonal orientations in unicultural settings "when used with foresight by experienced trainers." 8,22,2

Reiss describes how attitude change among hostile cultures can occur as a result of bettered communication in an experiential group.15 About working with a multi-national group of affiliates of a corporation, he writes:

"As was to be expected, relationships and communication were initially affected by national attitudes and anti-German biases. This was particularly true of the Dutch, Belgian and French participants vis-a-vis their German and Italian colleagues. Indeed, one Hollander refused to eat with his German associates because of his experiences in a concentration camp. During the first three days of the program, he was totally uncommunicative and developed a series of splitting headaches which took him out of many exercises. Upon confrontation with this and with several hours of individual work, this person was able to verbalize in front of the group his resentment, hostility and self-contempt for his association with former captors and torturers. This discussion precipitated much conversation about bias, personal responsibility for atrocities and the guilt that some of the Germans felt in discussing the years of Nazism. Ventilation of feelings changed the atmosphere of the workshop and increased the amount of interpersonal relationship, both visibly and in terms of expressed reactions. Similar, but not as intense exposures of feelings were experienced between Italian, Austrian and German participants."

Another experience in a group from the United States and the Soviet Union was described by Norman Cousins in 1962 in the Saturday Review:

"For seven days, while the Cuban crisis was at its height, some two dozen prominent citizens from the United States and the Soviet Union met in a paneled trustees' room of a New England preparatory school. They were taking part in an experiment to determine whether it is possible for knowledgeable people from both countries to talk about the explosive issues between their nations without having their meeting go up in a shower of sparks.

"Perhaps the most interesting development of the experiment was that, paradoxically, the delegates drew closer together on the personal level even as the issues that separated them grew more intense. The international crisis deepened and the debates at the conference table were correspondingly sharper, but the personal rapport mounted from day to day. Whether this was because the participants were becoming increasingly aware subconsciously of their underlying membership in a human commonwealth, or whether, as they came to know one another, they yielded to the magnetic puH of human gravity, it is difficult to say. One thing, however, is certain: By the end of the week there was no awkwardness or strain in raising any question, however severe, or in venturing a response, however pointed. It was possible to be forthright without being caustic, impassioned without being abusive, severe without being cutting. You could disagree and still retain your respect for the person you were disagreeing with. Just in the process of working and living together, those at the conference had been able to transcend what until then had been their purely national identities and were recognizing the implicit existence of a human agenda for their deliberations."

LEWIS R. WOLBERG, M.D.

LEWIS R. WOLBERG, M.D.

BIBLIOGRAPHY

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4. Cadden, J. J.. Flach, F. F., Blakeslee. S. and Charlton, R. Growth in medical students through group process. Am. J. Psychiatr. 726(19691. 862-868.

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6. Crawshaw, R. How sensitive is sensitivity training? Am. J. Psychiat. 126 (1969). 868873.

7. Derbyshire. R. I. Small groups: A technique for teaching patient-physician interaction. Read at the 124th annual meeting of the American Psychiatric Association. Boston. Mass.. May 13-1 7. 1968.

8. Foster. R. J. and Danielian. J An Analysis of Human Relations Training and Its Implications for Overseas Performance. Technical Report 66-16; George Wash. Univ., Human Resources Research Office, Aug. 1966.

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14. Pollack, S. and Manning, P. On experience teaching the doctor-patient relationship tp first year medical students. J. Med. Educ. 42 (1967), 770-774.

15. Riess, B. F. Experience compression, a technique for facilitating interpersonal communication. Int. Mental Health Research Newsletter 7:1, 1966.

16. Rogers, C. Carl Rogers on Encounter Groups. New York: Harper and Row, 1970.

17. Ross, W. D., Kligfield, M. and Whitman, R. M. Psychiatrists, patients and sensitivity groups. Presented at the 1 23rd annual meeting of the American Psychiatric Assoc, San Francisco, Calif, May 1 1-15, 1970.

18. Rubenstein, B. and Levitt, M. An approach to humanism in a medical setting: The preceptor program at the Wayne State Univ. School of Medicine, Amer. J. Orthopsychiat. 36(1966), 153-159.

19. Schein, E. H. and Bennis, W. G. Personal and Organizational Change Through Group Methods. New York: John Wiley and Sons, 1967.

20. Seashore, C. Personal growth through intensive group experiences. In: Science and Psychoanalysis. Techniques of Therapy (Ed. Masserman, J.) New York: Grune & Stratton, 1971.89-99.

21 . Sequin, C. A. Groups in medical education. J. Med. Educ. 40(1 965), 281-285.

22. Stewart, E. C. Danielian, J. and Foster. R. J. Simulating intercultural communication through role-playing. Technical Report 69-7; George Wash. Univ.. Human Resources Research Office. May 1 969.

23. Stone, W. N. and Tieger. M. E. Screening for T groups: the myth of healthy candidates. Am. J. Psychiat. 727(1971), 1 1 .

24. Wechsler, I. R., Messarik, F., and Tannenbaum, R. The self in process: a sensitivity training emphasis. In: Issues in Training. I. R. Wechsler and E. H. Schein, Eds. Wash., D.C., National Education Association, National Training Laboratories, 1 962, pp. 33-46.

25. Yalom, I. D. and Lieberman, M. A. A Study of encounter group casualties. Arch, of Gen. Psychiatry 25 (1 97 1 ), 1 6-30.

10.3928/0048-5713-19720301-07

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