Relational Group Psychotherapy: From Basic Assumptions to Passion (International Library of Group Analysis)

Relational Group Psychotherapy

of related interest Building on Bion: Roots

Origins and Context of Bion’s Contributions to Theory and Practice Edited by Robert M. Lipgar and Malcolm Pines ISBN 1 84310 710 4

International Library of Group Analysis 20

Building on Bion: Branches

Contemporary Developments and Applications of Bion’s Contributions to Theory and Practice Edited by Robert M. Lipgar and Malcolm Pines ISBN 1 84310 711 2

International Library of Group Analysis 21 Two volume set ISBN 1 84310 731 7

The Group as Therapist Rachael Chazan

ISBN 1 85302 906 8

International Library of Group Analysis 14

Dreams in Group Psychotherapy

Theory and Technique Claudio Neri, Malcolm Pines and Robi Friedman ISBN 1 85302 923 8

International Library of Group Analysis 18

Circular Reflections

Selected Papers on Group Analysis and Psychoanalysis Malcolm Pines ISBN 1 85302 492 9 pb ISBN 1 85302 493 7 hb

International Library of Group Analysis 1

The Social Unconscious Selected Papers Earl Hopper

ISBN 1 84310 088 6

International Library of Group Analysis 22

Foundations and Applications of Group Psychotherapy A Sphere of Influence Mark F Ettin ISBN 1 85302 795 2

International Library of Group Analysis 10

INTERNATIONAL LIBRARY OF GROUP ANALYSIS 26

Relational Group Psychotherapy From Basic Assumptions to Passion Richard M. Billow Foreword by Malcolm Pines With an Introduction by James S. Grotstein

Jessica Kingsley Publishers London and New York

Reworked and excerpted material from the following journal articles I authored appears in the following chapters. Chapters l and 2: (2000) ‘Self disclosure and psychoanalytic meaning: A psychoanalytic fable,’ Psychoanalytic Review 87, 61–79; (2001) ‘The therapist’s anxiety and resistance to group,’ International Journal of Group Psychotherapy 5, 83–100. Chapters 2 and 4: (1997) ‘Entitlement and counter entitlement in group therapy,’ International Journal of Group Psychotherapy 47, 459–474; (1998) ‘Entitlement and the presence of absence,’ Journal of Melanie Klein and Object Relations 16, 537–554; (1999a) ‘Power and entitlement: Or, mine versus yours,’ Contemporary Psychoanalysis 35, 475–489; (1999c) ‘An intersubjective approach to entitlement,’ Psychoanalytic Quarterly 68, 441–461. Chapter 5: (2001a) ‘Relational levels of the container–contained in group,’ Group 24, 243–259; (2003a) ‘Relational dimensions of the “container–contained”,’ Contemporary Psychoanalysis, in press. Chapter 6: (2003a) ‘The Adolescent Play: Averting the tragedy of Hamlet,’ Contemporary Psychoanalysis, in press; (2004) ‘Working relationally with adolescents in group,’ Group Analysis, in press. Chapter 7: (2003b) ‘Bonding in group: The therapist’s contribution,’ International Journal of Group Psychotherapy. Chapter 8: (2003c) ‘Rebellion in group,’ International Journal of Group Psychotherapy, in press. Chapter 9: (1999b) ‘LHK: The basis of emotion in Bion’s theory,’ Contemporary Psychoanalysis 35, 629–646; (2001b) ‘The class that would not read: Utilizing Bion’s affect theory in group,’ International Journal of Group Psychotherapy 51, 309–326. Chapter 10: (2000a) ‘From countertransference to “passion”,’ Psychoanalytic Quarterly 69, 93–119: (2000b) ‘Bion’s “passion;” the analyst’s pain,’ Contemporary Psychoanalysis 36, 411–426: (2002) ‘Passion in Group: Thinking about loving, hating, and knowing,’ International Journal of Group Psychotherapy 52, 355–372. All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London, England W1P 9HE. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. The right of Richard M. Billow to be identified as author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. First published in the United Kingdom in 2003 by Jessica Kingsley Publishers Ltd 116 Pentonville Road London N1 9JB, England and 29 West 35th Street, 10th fl. New York, NY 10001-2299, USA www.jkp.com Copyright © 2003 Richard M. Billow Library of Congress Cataloging in Publication Data

Billow, Richard M., 1943Relational group psychotherapy : from basic assumptions to passion / Richard M. Billow ; foreword by Malcolm Pines p. cm. -- (International library of group analysis ; 26) Includes bibliographical references and index. ISBN 1-84310-738-4 (alk. paper) -- ISBN 1-84310-739-2 (pbk. : alk. paper) 1. Group psychotherapy. 2. Group psychoanalysis. I. Title. II. Series. RC488 .B475 2003 616.89’152--dc21

British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN 1 84310 739 2 Paperback ISBN 1 84310 738 4 Hardback Printed and Bound in Great Britain by Athenaeum Press, Gateshead, Tyne and Wear

2002041106

To the groups that bred, fed, and led me. Most particularly, to my loving wife, Elyse, and to our children, Jennifer, David, and Brette.

Contents ACKNOWLEDGMENTS FOREWORD

9 11

Malcolm Pines, Institute of Group Analysis, London INTRODUCTION

13

James S. Grotstein, School of Medicine, UCLA PREFACE: PLAN OF THE BOOK

29

Chapter 1

The Authority of the Group Therapist’s Psychology

33

Chapter 2

The Therapist’s Anxiety and Resistance to Group

45

Chapter 3

The Basic Conflict: To Think or Anti-think – Applying Bion’s Theory of Thinking in the Group Context

69

Chapter 4

Entitled Thinking, Dream Thinking, and Group Process

89

Chapter 5

Containing and Thinking – The Three Relational Levels of the Container–Contained

110

Chapter 6

Containing the Adolescent Group

131

Chapter 7

Bonding in Group – The Therapist’s Contribution

152

Chapter 8

Rebellion in Group

172

Chapter 9

Primal Affects – Loving, Hating, and Knowing

193

Chapter 10

Primal Receptivity – The Passionate Therapist: The Passionate Group

215

BIBLIOGRAPHY

238

SUBJECT INDEX

249

AUTHOR INDEX

255

Acknowledgments It is wonderful to have a good friend, more wonderful still and rarer to have one with a brilliant mind that can understand the meaning behind an illogical thought, and provide the grammar to untwist it, a musical ear to improve its turn of phrase, a creative eye for its ideal expression, and a demanding character to insist upon its being good enough. Dr. Charles Raps has been with this project from its inception, and Relational Group Psychotherapy has benefited greatly from our many theoretical discussions and occasional arguments, from his original contributions, and from his encouragement, careful reading, and detailed editing of each draft of the manuscript. He is patient and giving beyond what I should have expected, certainly not asked for, although I asked and received with equal rapidity, and I am deeply grateful. Dr. Malcolm Pines, Editor of the International Library of Group Analysis, has been an enthusiastic reader of my writing and supporter of this project from the initial outline and plan of the book and has shepherded its publication by Jessica Kinsgley. I appreciate very much his welcoming Foreword to this volume. Dr. James Grotstein continues to be an inspiring explicator of Bion as well as one of psychoanalysis’ most creative forces. I am honored by his erudite Introduction, which represents a significant contribution in its own right. Dr. Earl Hopper perused the final manuscript and complimented me by providing a thought-provoking analysis. He also suggested some needed reorganization of material. Dr. Rosemarie Carlson read the final version to correct for theoretical inconsistencies and stylish infelicities. Drs. Michelle Berdy, Elyse Billow, Robert Mendelsohn, Joseph Newirth, Beth Raymond, and Bennett Roth, and Doris Friedman, M.S.W., have read and made helpful comments on various sections and chapters. The following editors have worked with me as I developed certain themes that first appeared in their journals: Drs. William E. Piper and Cecil Rice of the International Journal of Group Psychotherapy, Owen Renik of the Psychoanalytic Quarterly, Jay Greenberg, Donnel Stern, Ruth Imber, Sandra Beuchler, and Robert Langan of Contemporary Psychoanalysis, and Jeffrey Kleinberg of Group. Many generations of doctoral and postdoctoral students at the Gordon Derner Institute of Advanced Psychological Studies have shared my interest in Klein and Bion. They have been willing to read and think deeply, and it has been 9

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challenging to prepare lectures and engage in classroom and supervisory discussions with them. The candidates in the Adelphi Postdoctoral Group Program have been a particularly valuable resource, providing rich material from their own practices as well as participating creatively in experiential learning. Finally, I thank the inspirational sources of my thinking, and writing: the sensitive and articulate individuals I have been privileged to work with in my clinical practice and with whom I have suffered and enjoyed the group experience.

Foreword

I am very pleased to be able to present this monograph by Richard Billow in this series. In my opinion, Billow is the most able author in our field to present the theoretical and clinical thinking of Wilfred Bion. Bion’s writings are notoriously difficult to comprehend and Billow has made a significant contribution in bringing together Bion’s salient notions in a way which I am sure will be very welcome to readers. Beyond that, Billow shows how he has been able to use these seemingly abstruse notions in clinical work, in supervision and in teaching. I have immersed myself in Bion’s ideas for the past three years, whilst engaged in co-editing another monograph in this series, Building on Bion: Roots and Building in Bion: Branches, which shows the fertile application that many persons are able to make of his work. However, it is Billow’s book that brought many stimulating vignettes to life. I am glad to see that Billow has been able to make use of Foulkesian group analytic ideas and to make links between Foulkes and Bion. This applies also to his understanding of Winnicott. Psychodynamic group work with adolescents is a notoriously difficult area. Billow’s vivid description of his work with adolescents should give confidence to clinicians who are working in this area. Billow’s experience complements that already described by John Evans in an earlier book in this series, Active Analytic Group Therapy for Adolescents (1998). Malcolm Pines, Institute of Group Analysis, London

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Introduction James S. Grotstein

The author has written an erudite, profound, and extraordinarily useful text, not only on group therapy, but also on the application of Wilfred Bion’s contributions to it. I am not a group therapist, but after reading Dr. Billow’s theoretical and clinical explications, I began to wish that I had been. I do know something about the works of Wilfred Bion, however, having written about them on many occasions, and, furthermore, having been analyzed by him. From this background I believe I am in a respectable position to evaluate Dr. Billow’s understanding of Bion’s ideas. I found his understanding remarkable. Bion’s works are hard reading for most. He, like Lacan, seems to write in ‘poetics,’ that is, in the style of evocation of ideas rather than in clarification, which to him amounted to closure. His ideas open up innumerable hypertexts or asides, rarely end in closures. In my own contribution here I shall epitomize and paraphrase Dr. Billow’s superb rendition of Bion’s work. Group therapy, like individual psychotherapy, once began as a stepchild to orthodox-classical psychoanalysis but ultimately grew into its own entelechy as a unique form of treatment in its own right. ‘Relational’ group psychotherapy is the next generational distinction in group therapy’s career in which the relational component began to assume a dominant role. The term ‘relational’ presupposes that the dyad, the smallest group, is indivisible – that we can no longer speak of the patient or the therapist as an isolate. Likewise, we cannot speak of the group leader as separate from his group. Each affects the other. The casualty in this evolution is the myth of the objective analyst. Wilfred Bion, who began his career in the study of groups, reminded us that man is basically a dependent animal and that the individual is composed 13

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of internal groups and that the external group may function as a cohesive individual. It is the concept of individuality itself that seems to be in need of a post-modern, relativistic redefinition. Sperry (1969) and his colleagues, Gazzaniga and LeDoux (1978), came to a similar opinion about the need for a redefinition of individuality from their brain-laterality researches. More recently the Norwegian sociologist, Stein Bråten (1993), suggests that the infant has an inborn propensity to experience a ‘virtual other’: ‘…[T]he observer is invited to view them [infants] as one self-organizing system, not two, and yet with a differentiated self–other organization’ (p.26). The title of his thesis is ‘Born with the Other in Mind’ (p.25). With these ideas in mind, Sullivan’s (1953) notion of ‘participant observation’ as a shared faculty – shared by therapist and patient and/or group member – becomes more cogent than ever. Yet a paradox exists. For individual analysts or for group leaders (therapists) to maintain their authority and to be able to be a container for their patients, they must achieve and maintain some considerable degree of separateness from their patients. Perhaps we can reconcile the problem by suggesting that the analyst, therapist, group leader must ultimately be separate and yet at the same time allow him or herself to be vulnerable to experiencing both the emotions emanating from their patients and from their own emotional states as well. Robert Fliess’s (1942) term ‘partial identification’ on the therapist’s part fits in well here. I believe this is one of the ideas that the author is trying to get across in this work. Put another way, the classical posture of the separate, neutral, objective, and unaffected therapist must exist alongside his or her emotionally-affected counterpart. I believe that Bion (1959, 1962, 1963) makes this point clear in his formulation of the qualifications of the analyst or group leader as container of his or her patients’ anxieties. While addressing the process of group psychotherapy from many vertices (Bion’s way of stating ‘points of view’), the author organizes the chapters of the book along lines that issue from the works of Bion, whom he puts forward as one of the prophets in the contemporary relational reformation. I concur. Bion was the first post-modern, relativistic Kleinian, the one who first transcended the Cartesian boundaries that had (and still do) encased so much of classical and Kleinian thinking. In my own contribution I shall expand on some of Bion’s ideas that the author has imported and thoughtfully applied to his study of the group psychotherapy process. Moreover, because Bion’s professional career began with the study of groups, he was able more than others

INTRODUCTION

15

to bring his social awareness to bear on psychoanalytic issues, as well as the reverse once he had undergone psychoanalytic training. Thus, his model of ‘socialism’ versus ‘narcissism’ (Bion 1992). When he was able to combine his experiences treating psychotics (narcissistically asocial) with his group experiences, he was able to forge a metatheory (his term for a metapsychology) that blossomed with fascinating and revolutionary changes in our concepts of epistemology, ontology, and phenomenology. Dr. Billow has brilliantly and effectively captured them and clinically epitomized them in this present work. Having said the above, I must hasten to add another of my impressions of Bion. Though thoroughly immersed in the theory of groups and group relationships, his main thinking centered on the individual, whom he considered to constitute a group in itself. He strongly espoused his belief that man was utmostly a dependent animal and was thus certainly relational in his thinking, but, in my view, he was a ‘relational Kleinian,’ not an ‘in-kleined relationist.’ While he keenly understood the importance and powerful effects of human interaction (‘emotional turbulence’), he at the same time believed that each individual needs to feel solely responsible for his or her own responses to others. He brought this principle home to me over and over again in my analysis. Here he rigorously followed Freud and especially Klein.

Does group psychotherapy (analysis) have a place in psychoanalytic training? In Chapter 2 the author brings up a subject that I believe has considerable merit. He states: ‘Psychoanalytic institutions bar inclusion of group therapy [I would say ‘group analysis’] in their candidates’ own training analyses, or presentation of patients in combined therapy as control cases’. I heartily agree. The group experience brings out dimensions of a patient’s character that all too frequently escape detection in individual treatment. Bion puts forward the idea that ‘narcissism’and ‘socialism’ are two significant tropisms in individuals and that individual analysis is better handling the former. Received wisdom suggests that group therapy seems better in dealing with character problems, habits, and problems in interpersonal relating. At the very least group therapy and individual therapy seem to complement one another. I for one believe that group therapy or analysis – as well as group process (i.e. Tavistock groups) should be a part of institute training.

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‘Abandon memory and desire’ Bion’s (1962) mantra to ‘abandon memory and desire,’ as well as preconceptions, understanding, and all forms of sensuous experience, has now become legendary. He carried the idea as far as to exhort the analyst to treat each psychoanalytic session as if it were the first. For his rationale Bion cites the contamination that sense-derived information imparts to the analyst’s mind. My own understanding of his rationale is as follows: our senses form images within us (representations, constructions) of the object, and we subsequently fail to distinguish the object as it really is (what he calls ‘O,’ unknown and unknowable) from the internal working model we have made of it (Bion, 1965, 1970). One is reminded here of Magritte’s famous painting of a pipe with the statement, ‘This is not a pipe.’ Bion was a Platonist. He believed that the quintessence of reality resided in the ‘ideal forms’ and that the objects of perception were a falsified or diluted reality. Hence, if an analyst were to eschew memory and desire, she or he would be undergoing something like a meditative withdrawal, a process not unlike a sensory-deprivation experience, in which the internal sense organ, the one that is sensitive to internal qualities, becomes activated – as intuition into the unconscious. For Bion memory, desire, and ‘understanding’ on the part of the analyst causes the analyst to imprison the patient in a static, devitalized conception, one that is not alive or generative. Bion (personal communication) derived his idea about abandoning memory and desire (the desire, for instance of wishing to cure the patient) from a letter Freud had written to Lou Andreas Salome. I recall that, following my analytic session with him, Bion reached for a volume in the bookcase in his office, retrieved the book that contained the Freud-Salome correspondence in German, and translated it for me. To the best of my memory his translation ran something like this: ‘When conducting an analysis, it helps to cast a beam of intense darkness into the interior so that elements that have hitherto eluded detection because of the dazzling illumination can glitter all the more visibly in the darkness.’ When challenged by other analysts about his seemingly radical suggestion, he would immediately retort, ‘I am only paraphrasing Freud’ – and he was. Perhaps another way of saying the above is to think of Bion as a serious post-Cartesian thinker, one who sought to bring psychoanalysis out of its confines in the certainty of logical positivism into the new era of uncertainty, where the best we can hope for is a transient glimpse, not of the object, but of the impression the object makes upon us. That was Bion’s creed.

INTRODUCTION

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Countertransference issues in the group leader: Container–contained The author speaks of the ‘dread and fear of doing group therapy.’ We know from individual analysis that the analytic process acts like a poultice to summon bad demons from inside to the surface to be expressed – that the patient is unconsciously enjoined to regress, and from this regression to project his infantile anxieties into the analyst. Klein believed that this was an unconscious phantasy. Bion explicated that it was all too often an interpersonal fact. Now imagine a group of individuals who are undergoing a therapeutic regression. Recall also that in all therapeutic regressions such ideas as omnipotent expectations of the therapist as well as attribution of omniscience and intentionality (purpose) are attributed to him or her. She or he has become the leader who is now imprisoned by these expectations of omnipotent responsibility. When they fail, they intended to fail, the purpose being to persecute the patient or group. One also realizes that the number of individuals in the group offers a kind of leverage so that their attributions seem to undergo a geometric ratio of intensified urgency on the leader (‘emotional amplification and contagion’). Money-Kyrle (1956) speaks of the therapist’s ‘introjective counteridentification’ and Grinberg (1962, 1979a, 1979b) speaks of the analyst’s projective counteridentification which, to my mind, constitutes the extension to the former of the analyst’s own infantile neurosis. Mason (1994) refers to this phenomenon as ‘folie à deux’ or ‘mutual hypnosis.’ I myself term the realistic interpersonal process ‘projective transidentification’ to distinguish it from projective identification, which to me is only the unconscious intrapsychic phantasy (Grotstein 1995, 2002b). Bion’s (1959, 1962) conception of container–contained revolutionized Kleinian as well as classical thinking in so far as he formulated a pathway for the emergence of preverbal and nonverbal communication and for communicative impact – and designated the obligation of the receiver to withstand the emotional onslaught of the communicator long enough and patiently enough so as to enter into a state of reverie in order to apply his or her alpha-function (capacity to dream by day and by night) and thereby encode with meaning the infra-verbal communications from the communicator. The mother’sanalyst’s-group leader’s capacity to achieve reverie and to apply their alpha-function2 becomes decisive as a prophylactic to avoid collusion, counter-projective counteridentification, and subsequent retaliation.

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Ogden’s (1994) concept that the therapeutic relationship itself constitutes the ‘analytic third subject’ and his derivative concept of the ‘subjugating third subject’ is of relevance here. The subjugating third subject is a virtual subject that comprises the projective identification of the subjectivities of the analysand and analyst, and unconsciously orchestrates and subjugates both participants. One can only imagine what kind of bedlam is created when this potential monster is turned loose in a group. I have reason to believe that it is the sinister work of the subjugating third subject that causes splitting in the work group into the basic assumption sub-groupings, i.e. pairing, fight/flight, and dependency.

The caesura and the maintenance of boundaries Central to Bion’s thinking, both clinically and theoretically, is the idea of the presence of intact but flexible (not elastic) boundaries (Bion 1977). The individual and group therapist must each establish, maintain, and reinforce the existence of boundaries within his or her respective therapeutic frames. The rationale behind this is the need to protect the intactness and encourage the functioning of each domain, System Ucs. and System Cs. The boundary must be intact, as in theater, so that the play can go on. The therapist, group leader, and patients all seek consciously or unconsciously to cross the boundary because of a variety of fears, but the principal fear is that of ‘O,’ Bion’s (1965, 1970) enigmatic term for uncertainty, i.e. the Absolute Truth about Ultimate Reality,3 noumena, things-in-themselves, beta elements, ideal forms, and/or inherent preconceptions. In other words, when therapist, leader, or patient seeks to cross the boundary of the established frame, they are enacting collusion and huddling with one another in order to avoid an impact with evolving ‘O.’ Bion speaks (1977) often of the caesura, first as the semipermeable boundary between fetaldom and birth. He also speaks of a ‘contact barrier’ between systems Ucs. and Cs. that is formed and reinforced by alpha-function (dreaming). All logical thinking depends on the presence of boundaries so as to preserve the faculty of negation, which is of such quintessential importance for logical thinking. The contact barrier, on the other hand, must also be ‘selectively permeable’ to thoughts and feelings from System Ucs., thus a paradox. This selective permeability of the contact barrier must be orchestrated by a numinous intelligence that knows what to allow forth and what to disallow. That which is allowed forth constitutes revelation and epiphany,

INTRODUCTION

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ultimately the ‘selected fact,’ the revealed unconscious element that coheres into meaning the hitherto unorganized yield from the unconscious. Thus, one can envision an underlying connection that runs from the model of the caesura of birth through the contact barrier between Systems Ucs. and Cs., to boundary and frame issues in psychotherapy. Further, we realize that Bion collapsed Freud’s (1911) notion of the distinction between the primary and secondary processes into his notion of alpha-function (‘dream-work-alpha’) which paradoxically ‘dreams’ one’s emotional impact with ever evolving ‘O’ into dreams and/or unconscious phantasies as preparation for their transformation into memories and logical thoughts (Grotstein 2002a). When one considers the issues of projective transidentification in tandem with boundary issues, we can readily understand their importance for the therapist or group leader whose task it is to maintain a mind of his or her own and, while allowing him or herself to develop countertransference feelings, albeit with partial, not total, immersion or identification, she or he must ultimately remain extra-territorial to these subterranean influences – as a separate object as well as subject in his or her own right.

Bion’s theory of thinking The author has done such a superb job in presenting Bion’s theory of thinking that I shall deal with the subject only summarily here and refer the reader to the forthcoming chapters of the text. Briefly, Bion brought three main streams of experience together to formulate his theory of thinking: 1. his experience in groups where the idea of ‘protomental elements’ emerged (later to become ‘beta elements,’ ‘O,’ and/or ‘thoughts without a thinker’) (Bion 1961b); 2. his experience in treating psychotics, where he witnessed their hatred for thinking and experiencing (Bion 1967a); and 3. his training as a Kleinian psychoanalyst, where he became familiar both with Freud’s ideas of epistemology and with Klein’s ideas of projective identification and splitting (of the self and the object), the early Oedipus complex, and the paranoid-schizoid and depressive positions. He then applied Klein’s concept of projective identification (which she held was an unconscious intra-psychic phantasy) to his experience treating psychotics and arrived at the conclusion that these patients, as infants, lacked the experience of having a mother who could tolerate their normal projective identifications. This conclusion heralded the following ideas: (a) that projective identification was normal as well as abnormal (defensive); (b) that projective identifi-

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cation constituted not only an unconscious phantasy but also a normal preverbal/infra-verbal mode of interpersonal or intersubjective communication; (c) with these two previous hypotheses in place, Bion had added the dimension of adaptation (Hartmann 1939) to Kleinian thinking, which had hitherto been exclusively intra-psychic in its clinical and theoretical focus; (d) from the above hypotheses he concluded yet another: that, as the normal infant projects his/her inchoate, unprocessed emotions (later to be called beta-elements, ‘O,’ or ‘thoughts without a thinker’) into his/her mother – and she receives them as container and processor-translator,’ employing her ‘alpha-function’ while in a state of reverie – the earliest rudiments of thinking can be detected (converting or transforming beta-elements into alpha-elements). Once the infant introjects or internalizes this model of mother-as-container, she or he thereafter begins to project into his or her internal container and thereby becomes a thinker in his or her own right;4 (e) in the meanwhile Bion was establishing that the individual is fundamentally an emotional being, i.e. one who not only emotes but who needs to feel his or her emotions and to communicate them to another, i.e. the individual is fundamentally dependent on communicating with objects. Bion (1965) then made (f ) one of the most startling discoveries about thinking in the history of epistemology: that ‘thoughts without a thinker’ were primary and required the development of a mind to think them to give them meaning and to reduce (contain) the ‘emotional turbulence’ inherent within and inseparable from them; (g) in so doing, Bion united epistemology with ontology and phenomenology. Transformations in ‘O’ became his way of designating ultimate phenomenology and ontology. Once he had established a theory of thinking, he then (h) repositioned Freud’s concept of the instinctual drives (libido and the death instinct) and united them in a triumvirate with the epistemological drive as ‘L’ (love), ‘H’ (hate), and ‘K’ (knowledge), all three of which are linkages to objects, act inseparably, and give dimension to all object relations and to all thinking and feeling. He then (i) extended ‘K’ into the truth instinct (Bion 1992) and thereby transcended Freud’s (1915) conception of the unconscious, including dreaming. Bion stated that the human mind needs truth similarly to the need of the body for food. Freud, we recall, believed that the purpose of dreaming was wish-fulfillment. Bion believed that while this may be true, it was true only defensively.5 Utmostly, dreaming is the instrument of the truth instinct, according to him.

INTRODUCTION

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Bion’s (1965) (j) theory of transformations became a further extension of his epistemological metatheory. All the while he was constructing his metatheory, parenthetically, Bion, the polymath and autodidact, had been deeply immersed in varieties of mathematical theories ranging from set theory, intuitionistic mathematics (the ‘Dutch School’), infinity theory, algebraic geometry, differential and integral calculus (algebraic calculus), Cartesian coordinates, etc. Why? Bion wished to use notation symbols that were free of saturation, i.e. free of a vast penumbra of hitherto assigned associations that would collectively impair or confuse the employment of non-mathematical (ultimately unsaturated) signs. In defining transformations he listed ‘rigid-motion’ (a geometric term for self-sameness or concordance, as in the classical theory of reconstruction), projective (as in projective identification), and transformations in hallucinosis, which correspond to wish-fulfilling hallucinations proper or the superimposition of wishfulfillment images on to objects in reality. It was Bion’s extension of the theory of transformations into epistemology, however, that was to demonstrate its ultimate cogency. He conceived of transformations of beta-elements into alpha-elements in which the vehicle (carrier) of the elements would be altered (transformed) but the original truth that lay in the vehicle was able to resist transformation and thereby persevere as truth. In other words, when a beta-element was transformed into an alpha-element, it was only its ‘beta-ness’ that was transformed. The fundamental truth ‘O’ that was implicit in beta remained fundamentally true to its nature in alpha. It was Bion’s concept of (K) transformations in, of, and from ‘O,’ however, that was to impose what many have come to believe the foremost paradigm change in psychoanalytic theory and practice since Freud. First of all, he conceived of transformations from ‘O’ to ‘K’ in the instance where mother (or analyst) is able to receive the infant’s (or patient’s) ‘O’ and transform it through her alpha-function into ‘K’ (practical knowledge about the infant [or patient]. He then suggested, alternatively, that there was a rare class of individuals, geniuses or mystics in particular, who were able to be in direct contact with ‘O’ with serenity, being able not to be distracted by intermediary signs, images, or symbols, i.e. they did not need transformations from ‘O’ to ‘K.’ Transformations in ‘O’ became an act of self-transcendence into a domain that Western culture, aside from the religious mystics and Lacan6, had never conceived of. Put simply, until Bion the cosmological limits of psychoanalytic thinking were internal and external reality. Bion understood the latter,

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external reality, to be the consensual symbolic reality of ‘K,’ beyond which, as well as interpenetrating it, lay ‘O.’ Bion conceived of ‘O’ as the ‘analytic object’ in psychoanalysis, the ineffable truth that the analyst must look for – with sense, myth, and passion. In other words, Freud’s drives have been pushed to the side as ‘L,’ ‘H,’ and ‘K’ modes of relating to thoughts and objects of thought. What the analyst must look for is ‘O,’ which he equated with beta-elements, the Absolute Truth about Ultimate Reality, noumena, things-in-themselves, inherent preconceptions, ‘thoughts without a thinker,’ and godhead (man’s construction of an immanent deity to encompass the ineffability of the unknown and unknowable. With the formulation of ‘O’ psychoanalysis turned a corner and blindly peeked into the maw of uncertainty and infinity. From the group perspective, ‘O’ is the unannounced, invisible but regular and regularly felt extra member of the group. In further elaborating his concept of ‘O,’ Bion suggests (l) that we ‘learn’ knowledge but ‘become’ truth, ‘O.’ He means ‘become’ in the way that Plato meant it, i.e. ‘That which is always becoming’ (never achieving). It appears at first blush to resemble fusion, but that is not its meaning. When a patient seeks unconsciously to become his or her analyst, for example, the process entails an unconscious phantasy in which the patient projects him or herself into the analyst along with a breaching of the boundary between them. Bion’s epistemology presumes the presence of a ‘caesura’ or contact barrier of separateness not only within the individual but also between self and other. Consequently, it is only the analyst’s confidence in the intactness of his or her boundaries that allows him or her to ‘become’ the patient – because she or he is autonomous and can never really become the patient. What must happen is that the analyst, in a state of reverie, can so match up his or her own feeling state (not unlike Stanislavski’s [1936] concept of ‘method acting’) that a state of intersubjective resonance occurs. Whatever else, Bion formulated the phenomenon of intimacy as it had never been portrayed before. In retrospect it would seem that Bion’s ideas would have been better served if his first major book had been entitled Learning from Experience and Experiencing by Becoming. His discovery of transformations in ‘O’ also constituted a further journey for Bion’s journey into epistemology by boldly introducing the mystical vertex. Bion then came to think of psychoanalysis as a ‘mystical science,’ not in the sense of mystifying but in the sense of seeing through the camouflage images and symbols (constructs).

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Implicit in Bion’s epistemological considerations are such concepts as ‘binocular vision,’ ‘reversible perspective,’ and the ‘caesura’ (already discussed above). Binocular vision was his way of imposing a dual-track (Grotstein 1978) to the operations of the mind. Once again he transcended Freud by changing the focus of a direct relationship between the unconscious and consciousness (Freud’s theory) to one in which consciousness and unconsciousness are viewed as complementary but oppositional (not necessarily conflictual) partners in viewing ‘O.’ He extended this oppositional partnership to the relationship between the paranoid-schizoid and depressive positions as PS1 D, in which each had its own way of processing ‘O.’ His concept of shifting perspectives ultimately devolved into his idea of employing multiple vertices, i.e. the psychoanalytic, aesthetic, and scientific vertices. His quest was for ultimate stereoscopy. Dr. Billow clearly explicates Bion’s theory of ‘L,’ ‘H,’ and ‘K’ as basic affects and links them to premonition. Bion’s basic conception of the mind was one of affects, relationships, and being. He regarded emotions as the individual’s outer defense frontier in the internal world that intercepted the impact of ‘O’s evolutions and subjected them through ‘L,’ ‘H,’ and ‘K’ encoding along with transformation by alpha-function to change from proto-emotions to emotions that the mind could have feelings about.7 It is as if the proto-emotional frontier makes impressions of ‘O’ from its impact and processes, not ‘O’ per se, but ‘O’’s impact upon it. This idea brings forth another. ‘O’ in the first instance is indifferent or neutral circumstance. When we allow ‘O’ to impact us and do not shrink from the experience, it is as if we are allowing a transformation of our experience of ‘O’ from a neutral or indifferent external status to one where we ‘become’ ‘O’ and thereby render it personally or subjectively ours as our own experience. If the subject is not able to allow his ‘passion’8 to embrace his or her emotional experience with ‘O,’ then ‘-K’ (falsehood, lies) results, along with concomitant ‘-L’ and ‘-H.’

Bonding Dr. Billow has an evocative chapter on bonding. Psychoanalytic interpretations generally seem to recapitulate the act of the infant’s being weaned from the breast in so far as they impart truths, the acceptance of which promotes growth. Winnicott’s (1960) concept of the holding environment and Kohut’s (1971) idea of empathy constitute exceptions. Bion was strongly leaning this way when he conceived of container–contained. He had come to realize, for

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instance, that psychotic patients may have lacked what we might call a sufficient bonding experience with their mothers who, failing to contain their infant’s projective identifications, became malevolently transformed into internalized (within the infant) obstructive objects who thereafter attacked the infant’s thinking and relationships to good objects. It is my impression that Bion’s concept of container–contained closely approximates many aspects of the holding environment and is consummately empathic – but to the unconscious infant, not the conscious one that Kohut relates to.

The passionate psychoanalyst/therapist and his instruments I have referred to Bion’s unique conception of passion, a meaning he borrowed from another age in which passion meant the capacity to suffer – in the sense of being able to bear one’s experiences without outward or inward flinching. Captain Bion, the intrepid tank commander of World War I, learned about passion in battle. He realized that he had to be a model for the men under his command. The analogy to child-rearing and psychoanalysis is clear. The infant looks at the world through the veritable periscope of his or her mother’s eyes, and the patient looks to see if the analyst can bear, not only what she or he shares with (projects into) him or her but, additionally, the 9 fateful vicissitudes of his or her own life, i.e. if mother (analyst) can bear ‘O.’ Bion suggests that the analyst must abandon memory, desire, understanding, and preconceptions and be able to achieve negative capability (tolerate doubt and uncertainty) in order to create a mental space within him or herself that is optimally receptive for unconscious intuition. Another way of saying this is that Bion’s suggestions operate in a way that momentarily permits right-cerebral-hemisphere dominance, which is characterized, inter alia, by non-linear thinking and by field-dependency. Put succinctly, in a field-dependent situation, unconscious elements seek their counterpart in the external world, i.e. a depressed patient will tend to see images that exclusively match his or her depressive state. It is only a short step to make the next hypothesis. If the analyst is in this field-dependent state while listening to his or her patient, then, if she or he is able to be in a state of passion (passionate anticipation without an object) and reverie then, sooner or later, she or he will experience the arrival of the ‘selected fact’ (‘strange attractor’ in chaos theory), that which will give coherence to the randomness that was hitherto experienced, and which will be passionately suffered. Bion never said so, but it is my belief that the model he has given us closely resembles exorcism, the transfer of demonic pain from one individual to

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another. The arrival of the ‘selected fact’ seems to be a co-construction in the right-hemispheric unconscious of analyst and patient. In other words, the analyst must clear his or her mind so as to be able to be receptive to and to intuit the psychoanalytic object (the ‘O’ of the session). Bion suggests that the psychoanalytic object is detected by the evidence of sense, myth, and passion. In his writings Bion seems to be ambiguous about where the sense, myth, and passion lie, much as he is with the selected fact. Do they emerge within the patient, or do they emerge within the analyst – or both? Sense, which Bion is critical of elsewhere in terms of the senses being deceivers of intuition, in this instance seems to be the ‘sense or feeling’ of a hidden experience becoming palpable. Myth refers to the personal unconscious phantasy or phantasies that are operant with the analytic object but also refers to the collective myth that subtends it, i.e. the Oedipal myth, the Tower of Babel myth, etc. Thus, sense, myth, and passion constitute a triumvirate-tool that triangulates the analytic object. My own point of view would see the ‘analytic object’ as a subject, as the Kleinian conception of the unconscious infant or, more specifically, as the ‘ineffable subject of the unconscious’ whose task it is to be the passionate ‘existential registrar of agony,’ which mysteriously communicates its pain to the ‘phenomenal subject of consciousness’ and, failing that, to the analyst (Grotstein 2000). Returning to the concept of container–contained, Bion thought of the mother and infant as a ‘thinking couple.’ Having recently reviewed Bion’s unique contributions on dreaming, I would add the idea of the ‘dreaming couple’ (Grotstein 1978, 2000). One of the tasks that Bion adds to his suggestive repertoire of techniques is that of the analyst (mother) ‘dreaming’ the patient (infant). He believed that sanity depended, not only on truth, but also on the capacity to use alpha-function (‘dream-work-alpha’) to supply alpha-elements to restore the contact barrier between the unconscious and consciousness so that each might work effectively as separate processes in their own right. He also cautioned that the dream that the patient uses to evade truth constitutes an hallucination, and that the analyst should detect the difference. Another interesting innovation of his was his reorienting Klein’s paranoid-schizoid and depressive positions from a sequence of successions to a simultaneous dialectical interaction between them: PS1 D. In so doing, he changed the perspective of Freud’s (1915) topographic theory and Klein’s

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adherence to it from one in which there is a conflict between the unconscious and consciousness and between P-S and D, to one in which the unconscious and consciousness and P-S and D triangulate ‘O,’ which both interpenetrates them and is paradoxically extraterritorial to them. Bion also conceived of ‘alpha-function in reverse,’ a situation that occurs in psychosis when method infuses madness and things are turned topsy-turvy – with a disingenuously cunning agenda. One commonly sees the phenomenon of alpha-function in reverse in pathological organizations (‘psychic retreats’) and in the negative therapeutic reaction. The current state of world affairs also bears testimony to its pervasiveness. Dr. Billow has written a very important integrative work. He has diligently researched virtually the entirety of Bion’s contributions and skillfully applied them to the group therapy situation. In so doing, he has unwittingly presented a challenge for someone to follow with a counterpart for individual psychoanalysis. I feel the challenge stirring within me.

References Bion, W.R. (1959) ‘Attacks on linking.’ In Second Thoughts (1967). London: Heinemann. Bion, W.R. (1961a) ‘A psycho-analytic theory of thinking.’ International Journal of Psycho-analysis 43, 306–310. Bion, W.R. (1961b) Experience in Groups. London: Tavistock Publications. Bion, W.R. (1962) Learning From Experience. London: Heinemann. Bion, W.R. (1963) Elements of Psycho-analysis. London: Heinemann. Bion, W.R. (1965) Transformations. London: Heinemann. Bion, W.R. (1966) ‘Catastrophic change.’ The Bulletin of the British Psycho-Analytic Society 5. Bion, W.R. (1967a) Second Thoughts. London: Heinemann. Bion, W.R. (1967b) ‘On arrogance.’ In Second Thoughts (1967). London: Heinemann. Bion, W.R. (1970) Attention and Interpretation. London: Tavistock Publications. Bion, W.R. (1977) Two Papers: The Grid and the Caesura. Jayme Salomao (ed). Rio de Janeiro: Imago Editora Ltd. Bion, W.R. (1992) Cogitations. London: Karnac Books. Bråten, S. (1993) ‘Infant attachment and self-organization in light of this thesis: Born with the other in mind.’ In I. Gomnaes and E. Osborne (eds) Making Links: How Children Learn. Oslo: Yrkeslitteratur. Damasio, A. (1999) The Feeling of What Happens: Body and Emotion in the Making of Consciousness. New York, San Diego, London: Harcourt, Brace. Fliess, R. (1942) ‘The metapsychology of the analyst.’ Psychoanalytic Quarterly 11, 211–227. Freud, S. (1911) ‘Formulations of the two principles of mental functioning.’ Standard Edition 12 (1958). London: Hogarth Press. Freud, S. (1915) ‘The unconscious.’ Standard Edition 14 (1957). London: Hogarth Press. Gazzaniga, M.S. and LeDoux, J.E. (1978) The Integrated Mind. New York: Plenum Press. Grinberg, L. (1962) ‘On a specific aspect of counter-transference due to the patient’s projective identification.’ International Journal of Psycho-analysis 43, 436–440. Grinberg, L. (1979a) ‘Projective counter-identification.’ In L. Epstein and A. Feiner (eds) Countertransference. New York: Aronson.

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Grinberg, L. (1979b) ‘Countertransference and projective counter-identification.’ Contemporary Psychoanalysis 15, 226–247. Grotstein, J. (1978) ‘Inner space: Its dimensions and its coordinates.’ International Journal of Psychoanalysis 59, 55–61. Grotstein, J. (1995) ‘Projective identification reappraised.’ Contemporary Psychoanalysis 31, 479–511. Grotstein, J. (2000) Who is the Dreamer who Dreams the Dream: A Study of Psychic Presences. Hillsdale, NJ: The Analytic Press. Grotstein, J. (2002a) ‘Projective identification and projective trans-identification: A reassessment and proposed extension of the concept.’ Manuscript in preparation. Grotstein, J. (2002b) ‘"We are such stuff as dreams are made on" – Annotations on dreams and dreaming in Bion’s works.’ In C. Neri, M. Pines and R. Friedman (eds) Dreams in Group Psychotherapy. London: Jessica Kingsley Publishers. Hartmann, H. (1939) Ego Psychology and the Problem of Adaptation (1954). D. Rapaport (trans). New York: International Universities Press. Kohut, H. (1971) The Analysis of the Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders. New York: International Universities Press. Mason, A. (1994) ‘A psychoanalyst looks at a hypnotist: A study of folie à deux.’ Psychoanalytic Quarterly 63, 641–679. Matte Blanco, I. (1975) The Unconscious as Infinite Sets. London: Duckworth Press. Matte Blanco, I. (1981) ‘Reflecting with Bion.’ In J. S. Grotstein (ed) Do I Dare Disturb the Universe? A Memorial to Wilfred R. Bion. Beverly Hills: Caesura Press. Matte Blanco, I. (1988) Thinking, Feeling, and Being: Clinical Reflections on the Fundamental Antinomy of Human Beings. London/New York: Tavistock and Routledge. Money-Kyrle, R. (1956) ‘Normal counter-transference and some of its deviation.’ In D. Meltzer (ed) The Collected Papers of Roger Money-Kyrle. Strath Tay, Perthshire: Clunie Press. Ogden, T. (1994) Subjects of Analysis. Northvale, NJ and London: Aronson. Sperry, R.W. (1969) ‘A modified concept of consciousness.’ Psychology Review 76, 532–536. Stanislavski, C. (1936) An Actor Prepares. New York: Routledge. Sullivan, H.S. (1953) The Interpersonal Theory of Psychiatry. New York: W.W. Norton. Winnicott, D.W. (1960) ‘The theory of the parent–infant relationship.’ In The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development (1965). New York: International Universities Press.

Endnotes 1.

Bion pointed out that memory is the past tense of desire and that desire is the future tense.

2.

Alpha-function designates an unconscious form of thinking that, according to Bion, derives from being able to dream. A suggestive way of looking at it is to compare it with the ‘method acting’ techniques of Stanislavski whereby the actor sought within him or herself those inherent attributes that match up (symmetrically) with those required for the role.

3.

Bion lists ‘Absolute Truth’ and ‘Ultimate Reality’ as if they were separate. I choose to unite them in so far as I believe that they are inseparable. This perspective becomes clearer when one applies Matte Blanco’s (1975, 1981, 1988) concept of bi-logic, infinite sets, and absolute indivisibility to both the issue of Absolute Truth and Ultimate Reality. Put another way, Ultimate Reality is total chaos. Matte Blanco states that Homogeneous Indivisibility (total symmetry) characterizes the unrepressed unconscious, and I state that it designates Bion’s ‘O.’

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4.

While I basically concur with Bion about the infant’s need to project into mother, I differ with him on the origin of alpha-function (‘dream-work-alpha’). It is my belief that the latter constitutes an inherent given for the infant – from his or her Kantian repertoire as a primary category and that mother’s alpha-function is a necessary accessory to his or her own until the infant is able to think on his or her own (Grotstein 2000).

5.

Elsewhere I have hypothesized that Freud’s concept of the id as wish-fulfilling constitutes the ‘psi column’ on Bion’s (1977) grid (Grotstein 2000). The psi column is the second vertical column, the one after ‘definitory hypothesis,’ the first step in trying to define beta-elements. The ‘psi column’ is ‘saturated,’ i.e. unable to accept new information and seeks to negate anything new. In Bion’s (1970) group theory it corresponds to the Establishment.

6.

Lacan’s concept of the ‘Register of the Real’ closely approximates Bion’s ‘O.’

7.

The terms ‘affects,’ ‘emotions,’ and ‘feelings’ are used variously in the literature. I prefer the perspective that Damasio (1999) proffers: affects constitute the overall term, whereas emotions emerge as bodily experiences, and feelings as mental experiences about emotions.

8.

Bion uses ‘passion’ in the sense of ‘suffering,’ as in the passion of Christ in the crucifixion. Dr. Billow is keenly aware of this usage and explicates it beautifully in the text.

9.

Here I mean the mother’s and analyst’s ability to have the passion that can contain (bear) primal ‘O’ (uncertainty with indifference, fate) and their own personal transformation of ‘O’ (personal fate). Bion did not make a distinction between impersonal and personal ‘O;’ I do.

Preface Plan of the Book Relational Group Psychotherapy: From Basic Assumptions to Passion emerged from my efforts to integrate Klein-Bionion conceptualizations, Bion’s early group theory, and his later metapsychological formulations, with contemporary relational thinking. At the same time, I wanted to offer a clinically relevant, generative experience, similar to my own. And this meant not overloading the text with theory or clinging to a single clinical point of view. The chapters relate to and build on each other, but no rigid linearity of thinking or organization is implied. My intention is to supply grit for thinking, feeling, and doing; if pearls are to be found, they will have been co-constructed by you. A brief description of each chapter follows. Chapter 1, ‘The Authority of the Group Therapist’s Psychology,’ orients the reader to my relational point of view, which confers on the therapist’s emotional experience a primary influence on the formation and evolution of the group structure, culture, and process. Bion’s early theory of group, and his later formulations regarding the structure of thought and the role of affect, presage and add metapsychological and clinical depth to a relational or intersubjective approach. In all chapters, clinical anecdotes are included to ground theory in the realities of clinical experience, with particular reference to the psychology of the group therapist. Chapter 2, ‘The Therapist’s Anxiety and Resistance to Group,’ discusses some of the personal difficulties that the therapist must bear in accepting the position of primacy in the mental life of the group. Our knowledge, training, and experience doing and thinking about groups offers partial control of our anxiety and resistances, which continue to operate. Anxiety and resistance contribute creative as well as disruptive influences to our work. Chapter 3, ‘The Basic Conflict: To Think or Anti-think – Applying Bion’s Theory of Thinking in the Group Context,’ introduces the reader to epistemological object-relations theory, and explains Bion’s expansion of ideas first introduced in Experiences in Groups (1961). Bion brought a special 29

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meaning to ‘thinking,’ emphasizing that its function is to establish emotional awareness of self and others. While thinking satisfies a basic need, it also stimulates painful realizations. Hence, we partially hate relational consciousness, and this is never more apparent than when a group is asked to think about itself. The therapist aids a group in thinking about its defenses against thinking, which may involve anti- or minus thinking (-K), bizarreness, and hallucination. Chapter 4, ‘Entitled Thinking, Dream Thinking, and Group Process,’ calls attention to a type of narcissistic thinking and resultant interpersonal behavior prominent in the waking and sleep life of all individuals and groups. The structure, process, and contents of group therapy reveal entitlement fantasies of being able to possess thoughts and control thinkers, rather than to think thoughts with thinkers. Characteristics of entitlement may be attributed, with accuracy, to the personality of the therapist. Chapter 5, ‘Containing and Thinking – The Three Relational Levels of the Container–Contained,’ presents Bion’s complex model of symbol formation, human development, internal and external object relations, and learning from (and resisting) emotional experience. There are three relational variations of the container–container: commensal, symbiotic, and parasitic interactions. They provide a framework for listening, processing, and formulating, which can be helpful in doing, supervising, and reflecting on groups of all types. Chapter 6, ‘Containing the Adolescent Group,’ brings a relational focus to adolescent theory and group technique. Bion’s formulations concerning thinking and communication, particularly the model of the container– contained, put a most interesting perspective on understanding and treating adolescents. Shakespeare’s Hamlet provides a vehicle in which to explore themes associated with adolescent thought, fantasy, and communication. Hamlet’s words and behavior illustrate the conflictual traversing of relational levels, as they function both to further and to destroy thinking and thinkers. Chapter 7, ‘Bonding in Group – The Therapist’s Contribution,’ describes a preverbal dimension of group experience essential to the work function (W). The therapist fosters constructive bonding through posture and technique, but the therapist must be emotionally authentic. This requires understanding the interactive forces that contribute as well as conflict with the therapist’s basic need to connect to other group members. Chapter 8, ‘Rebellion in Group,’ describes various pathways of social action: defiance, secession/exile, anarchy, and revolution. Rebellion focuses

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attention on the idea of the group: its basic premises and values are at the center of the controversy, to be addressed on that level, among others. Like other group members, the therapist has rebellious feelings and thoughts, and may traverse each pathway of rebellion, taking multiple roles of defiant instigator, exiled outcast, anarchist, and revolutionary. Chapter 9, ‘Primal Affects – Loving, Hating, and Knowing,’ introduces Bion’s structural theory of primal affects. Urges to love, to hate, and to know about (L, H, and K), which operate from the beginning of life and function out of awareness, are central in constructing intersubjectivity and undergird all subsequent meaning. The theory of basic assumptions, and our understanding of groups, is supplemented by the constructs of premonition, LHK, alpha functioning, and beta elements. Chapter 10, ‘Primal Receptivity – The Passionate Therapist: The Passionate Group,’ expands on a key concept in Bion’s later writing. Passion involves primal receptivity: an intersubjective process of bearing and utilizing the primal affects to reach self-conscious emotional awareness. Passion describes the necessary and sufficient conditions for a psychotherapy group to be a work group (W). As a dialectic position of connectedness and separateness, passion transcends the basic assumptions, and transference–countertransference. The concept of passion advances the historical consideration of countertransference by delimiting an independent area within the therapist’s subjectivity.

CHAPTER 1

The Authority of the Group Therapist’s Psychology In Relational Group Psychotherapy, I put the group therapist’s experience as center of the action. The major theorists have described groups as organic entities, evolving through stages, rebounding from one defensive position to another in accordance with developmental conflicts consequent to group membership. According to their theories, successful groups depend on the therapist’s effective performance in pretherapy tasks such as patient selection, composition and preparation, and in negotiating the novice group through its formative stages of boundary formation, structuring, resistance, and goal direction. It follows that the mature group more often treats itself, coming to appreciate the therapist as a consultant rather than as the continuing mesmerizer of transference (Agazarian 1997; Ettin 1992; Foulkes and Anthony 1965). Foulkes (1964) wrote that the group therapist ‘does not step down but lets the group, in steps and stages, bring him down to earth…[the group] replaces the leader’s authority’ (p.61). Along this line of thinking, Yalom (1995) presented the maxim: ‘Unlike the individual therapist, the group therapist does not have to be the axle of therapy. In part, you are midwife to the group: you must set a therapeutic process in motion and take care not to interfere with that process by insisting on your centrality’ (p.216). While the classic contributions in theory and in descriptive phenomenology are fundaments of every group therapist’s thinking and practice, their emphasis on member-inspired dynamics seriously underplays the enduring role of the therapist, most particularly, the authority of the therapist’s evolving psychology on what occurs and does not occur in group. The basic premise of the relational approach is that psychoanalytic data are mutually generated by therapist and patients, co-determined by their conscious and unconscious organizing activities, in reciprocally interacting subjective worlds (Stolorow 1997). 33

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The therapist who subscribes to the less relational view that the group maturates away from its unconscious relationship to its leader, and therefore, away from transference, may also suppose that, as facilitator, the therapist may reach and maintain adequate self-understanding, such that one’s own subjectivity is well in control. Racker (1968) suggested that a neglected aspect of the Oedipus complex was the analyst’s wish to be master or king, not only of other people, but also of his own unconscious. Racker described how the analyst’s verbal and nonverbal behavior continues to be variable and inconsistent, professional and personal, mature and immature, healthy and neurotic, and regulated by the emotional state of the relational matrix. The analyst’s ‘internal and external dependencies, anxieties, and pathological defenses… [respond] to every event of the analytic situation’ (p.132). The best the therapist can do is to eradicate, as much as he or she can, not anxieties, resistances, wishes, and fears, but their repression. In being receptive to the infantile, primitive, and neurotic aspects of one’s own personality, the therapist may more fully experience his or her own experience, and this is, I believe, the precondition that allows the therapist to help the group members do the same. All psychoanalytic psychotherapy is grounded on Freud’s belief that the understanding of others is based on self-understanding. However, selfunderstanding is an evolving, affective process, stimulating strong and often painful emotions that influence and are influenced by others. Self-awareness remains tentative and uncertain, and is revised according to the shifting currents of present-day reality. Inspection, introspection, retrospection, the longevity and stability of a group, these factors do not vouchsafe objectivity or inoculate therapists from the tendency to rationalize who we are, how we feel, and what we are doing. The clinician’s subjectivity cannot be tamed, cured, banished, or superseded by ‘psychoanalytic purification’ (Freud 1912b) via personal individual and group therapy, or meticulousness in theory, diagnosis, and technique. Reaching, challenging, and expanding self-consciousness is an intersubjective process. The group therapist, like other group members, develops by engaging others. Growth is not always immediate, or readily visible. Some relational theorists (Chused 1992; Renik 1993; Spezzano 1996) suggest that both patient and analyst do most of their thinking unconsciously, and learn only retrospectively about what has been going on mentally, when the derivatives emerge into preconsciousness or consciousness. By that time,

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words and actions have produced enactments, and these too are learned about with the benefit of hindsight and interpersonal feedback. While the therapist’s unconscious conflicts, character structure, and misunderstandings lead to inevitable iatrogenic resistances in the group and its members, they also provide vehicles for learning and transmitting information (Boesky 2000). From this point of view, we could characterize groups as taking place through the medium of the therapist’s progressive understanding of his or her own transferences and countertransferences. The assumption here is that transferences and countertransferences do not resolve but evolve, continuing to provide a rich source of potential meaning. In my thirty-five-year experience as therapist, supervisor, and member of long-term psychoanalytic groups, I have found that mutual interest, fantasy, and emotional involvement between patients and therapist remain intense and extensive, although, of course, significant relational changes occur. Transference and countertransference do not simply diminish, given length of treatment, maturity of the group and its therapist, or modality of treatment (group alone or combined). Group therapy continues to fuel transference and countertransference feelings and fantasies, and these remain invaluable in exploring intrapsychic and intersubjective phenomena in dyadic and small and large group settings. Transference–countertransference, as a prominent element in intersubjectivity – but as we shall see, not the exclusive element – may be conceived as an ego activity (Bird 1972) that functions at varying levels of pre and post consciousness, and is subject to mutual discovery. The therapist is not a blank screen, but a quite human presence whose subjectivity the group monitors and perceives with varying accuracy. Group members form valid and mutually significant insights regarding the therapist’s personality and the complexities of their therapist’s psychology, and respond accordingly (Gill 1994). Groups generate their structure, process, and meaning from the interaction between the conscious and unconscious emotional and intellectual strivings of the group members and the group leader. Like other group members, the group therapist’s communications are intersubjectively constructed; their intent and effect remain highly subjective and no final, or even fully objective, assessment is possible. Each group conductor plays his or her own music, as well as captures a particular version of the music of others. While some notes resound forcefully, others remain faint, distant, or unheard,

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and they await their development other occasions, other players from within and without the group. The therapist remains the figure of inspiration, and the most important member of any group, no matter its focus or duration. Therapist-influenced dynamics supersede the clinician’s theoretical or technical orientation, and we sometimes achieve more, or less, in our practice than what we preach. Our amiable, sincere, and patient efforts to reach the group count for a lot, and we fumble and are forgiven for our fumbling more than we know. Well-analyzed psychoanalysts are not conflict-free, interpersonalists are not always interpersonal, relational therapists may deny their own subjectivity, and self-psychologists may fail to accept and to provide. No school of thought owns exclusive or automatic rights to empathy, or to understanding of the self and others. And, in our striving for depth, psychoanalytic or otherwise, clinicians of all theoretical persuasions may miss what is timely and most relevant. The technical focus may be intrapersonal, concentrating on the individual, transactional or interpersonal, concentrating on the subgroups and dyads, group-as-a-whole, concentrating on group dynamics (Parloff 1968), or more likely, an eclectic mix of the three approaches. The clinician’s basic patternings of subjective experience influences, often determines, not only the focus, but also the group’s depth of functioning, even the particular process and contents of the session. Whatever the therapist is attending to, he or she is also reflecting upon and revealing him or herself, influencing other members in this process. Contemplating one’s evolving mental relationship to the group, and its influence on the group, brings layers of meaning to the here-and-now clinical situation, however conceptualized. All benefit from a group therapist unequivocally involved in personal discovery and growth. I agree with Foulkes (1964) that the specific therapeutic quality of a group ‘is embodied in the conductor…he has created the group and his influence remains decisive from the beginning to the end… His insight into his own emotional involvement as a member of the group, and even his individual reactions in this capacity, should be fully acknowledged and, on occasion, may have to be voiced for the benefit of the group’ (p.160, his emphasis). The therapist who consistently and openly pursues his or her varied significance in the members’ consciousness and unconsciousness – and the members’ significance to him or her – creates a powerful group experience. Whereas the focus of this book is on the therapist’s affects, thought, and clinical behavior, and the therapist’s influence on the group, subgroup, and individual members, I appreciate that not all therapeutic change flows from

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the efforts of the therapist. A restrictive focus on the leader, or for that matter any predetermined theoretical-technical focus, neglects other important group, subgroup, and intrapersonal factors, other ways in which experience may be generated and understood. Indeed, even when therapist-inspired dynamics are conceptualized as a prevailing influence behind all group interactions, the force of these dynamics may be modulated by the nature of the group situation. The resulting transferences and countertransferences may be deflected onto the group and its members, where their diverse manifestations may be fruitfully understood and interpreted. Patients and therapists derive benefit from multiple factors of group membership and from working with other members, who provide a wide range of interpersonal options and therapeutic effects. Finally, there are cultural, ethnic, and political factors that contribute to the group’s organization, functioning, and goals (Hopper 1999).

Appreciating Bion’s legacy The chair of a recent panel of the American Psychoanalytic Association declared, ‘In today’s world countertransference is God’ (Friedman 1997). Racker has been called the prophet of this God. Relational psychoanalysis does not represent a single theory or a consistent metapsychology, however, and has underpinnings in philosophy (Frie and Reis 2001). There are many prophets, including Hegel, Freud, Ferenzci, Sullivan, Winnicott, Fairbairn, Kohut, and Klein. Relationally oriented social constructivists, communication and systems theorists, and our English group analytic colleagues, claim forbears in George Herbert Mead, Norbert Elias, and Foulkes. In Relational Group Psychotherapy, I put forth Bion as another prophet in the contemporary relational reformation, for he too anticipated our current interest in intersubjectivity, perspectivism, and co-constructionism. His thinking extended past transference–countertransference, to postulates regarding the earliest and most basic elements of the human psychological experience. In Experiences in Groups, many of the important metapsychological constructs and clinical themes that Bion was to establish appear embryonically. His later writings attempted to systematize psychoanalytic theory and practice, based on an intersubjective theory of thinking, with particular reference to the social group. Bion conceptualized the psychoanalytic process as a dynamic field of mutual influence and interaction. He drew attention to how we hear and think about the other’s communication; how we convey our experience back, and how this communicative interplay

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influences the participants and the immediate future of the relationship. I join the ranks of a number of contributors (Gordon 1994; Grinberg 1985; James 1984; Nitsun 1996; Resnik 1985; Schermer 1985; Stiers 1995) who have utilized advantageously Bion’s post-Experiences in Groups constructs to enrich our understanding of groups, and the practice of group therapy. Bion presented his concepts in a manner that could be difficult for the reader, and the scope of his thinking is not immediately or easily accessible. As he developed his own metapsychology, he often did not delineate when and how he was challenging or modifying the grand metapsychologies of Freud and Klein. He also introduced the Grid and a series of alphabetical and mathematical symbols. His intentions included offering a shorthand for his relational epistemology, to make his ideas manageable, flexible, and practical for the working clinician. Bion (1967a) admonished the analyst to eschew ‘memory and desire,’ to participate within each hour with a minimum of intellectual and emotional assumptions. However, he also advocated intellectual exercises, introspective squiggle games played with signs and symbols rather than lines. Bion’s symbolic shorthand may aid the clinician’s thinking about emerging as well as dissociated thought and emotion, in oneself and in the group. Mentally playing with Bion’s metapsychological constructs provides an antidote for such leader- or therapist-based hazards as complacency, intellectual rigidity, and countertransference immersion, and heightens intersubjective awareness of ongoing group process. I will present means of using certain of Bion’s abstruse terms and symbols as tools, ways of thinking, processing, and formulating that can be helpful in leading, supervising, or reflecting on groups of all types. These tools are also helpful in framing how group members and group leaders interact at preverbal levels. Many of Bion’s ideas concerning intersubjectivity and clinical interaction are not well known; they are dispersed among his major works, and were never fully developed and integrated. In Relational Group Psychotherapy, certain Bionian formulations are extended and applied to the group and to the therapist’s situation within the group. I emphasize throughout Bion’s attention to the universal, existential conflict regarding tolerating emotional thinking, and how this conflict plays out in one’s relationship to oneself and others. Chapters 3, 4, 5, 6, 9, and 10 are involved specifically with Bionian metapsychology. These chapters introduce the reader to the special meaning Bion brings to the term ‘thinking,’ and to the concepts of the container– contained (commensal, symbiotic, and parasitic relations), primal affects, or

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LHK, (loving, hating, knowing), alpha functioning and beta elements, premonitions and premonitory anxiety, and passion. Bion’s condensed, epigrammatical writing style is open to multiple interpretations, which seemed to serve Bion’s purpose: his work may be played with and utilized by others in developing their own ideas. In disembedding and extrapolating from his important ideas, and applying them to group theory and my clinical work, I sometimes reach implications at variance with how Bion probably understood his own formulations, more in keeping with contemporary relational assumptions, and reflecting my personality and temperament. Bion’s group theory hinges on the description and workings of the basic assumption group, as it operates in conjunction with and opposition to the work group. As many readers of this volume already know, ‘basic assumptions’ refer to three types or constellations of primitive object relations, fantasies, and affects, which individuals come to project and act out in social settings. In the basic assumption group, the members collude to avoid open-mindedness, because it could be painful. Basic assumptions are accompanied by characteristic patterns of defense that are utilized to evade intrapsychic and interpersonal tensions associated with emotional learning and productive work group activity (W). The basic assumptions are dependency (baD), fight/flight (baF/F), and pairing (baP). In dependency, the members are preoccupied with seeking ministrations from, or ministrating to, the leader. In fight/flight, the members mass against an enemy, within or outside of the group; or, members may maneuver to ignore or avoid underlying hostilities. In pairing, the group fastens on two members, one of whom may be the therapist, and they become the focus of group activity. Bion (1961) described basic assumptions as ‘duals,’ or ‘reciprocals of each other’ and not ‘distinct states of mind’ (pp.165–166). While one basic assumption is prominent, all three remain operative (as well as the work group function). For example, from one point of view the group can be shown to be expressing anxiety around giving up dependency, but from another, patterns of flight are evident, and these can be hidden behind the obvious pairing of two members. We may appreciate how the clinical task of assigning relative importance among the assumptions remains problematic. But from still another point of view – the one adopted in Relational Group Psychotherapy – a still larger clinical problem remains. According to Bion, basic assumptions represent an inevitable response to any leader who displays a

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‘questioning attitude.’ A leader stimulates a group to think, and the members react by shifting – slowly or quite frequently over the life of group – from one to another of the basic assumptions. However, as group therapists, we feel intersubjective tensions that relate to our own emotions, thoughts, and fantasies, activated by social participation, and representing the currency and history of our own intrapsychic and interpersonal struggles. The dynamic factor involving the group leader’s psychology is always prominent and influential, and often apparent to group members although not always articulated consciously or publicly. We must acknowledge that groups unify, collude, and project, not only to avoid thinking, as Bion emphasized, but also because they react to, and attempt to protect themselves and the work group from, the leader’s unavoidable vulnerability to, and inevitable participation in, basic assumptions. Many of the clinical examples in Relational Group Psychotherapy (and in other group texts, for that matter) could illustrate how a group’s characteristic modes of functioning develop partially from coping with the leader’s difficulties in thinking, the leader’s problems with learning from experience. Thus, a fourth ‘dual’ represents the leader’s subjectivity, one that influences the development of basic assumptions and their relative prominence vis-à-vis work group activity. In Relational Group Psychotherapy, I describe how basic assumptions, along with many other of the defining characteristics of group life, are co-created, maintained, and worked through intersubjectively. Bion’s early theory of group, and his later formulations regarding the structure of thought and the role of affect, presage and add metapsychological and clinical depth to my intersubjective approach. It remains for others to decide whether my formulations and applications represent a significant departure from his ideas and clinical intentions. Certainly, my style of intervention differs from Bion’s, in which the apparent abdication of leadership magnifies the leader’s importance and increases the group’s anxiety and reliance on basic assumptions. I believe that it is important to interact spontaneously and maintain a down-to-earth manner. After all, as therapists, we want this type of verbal behavior from our patients. The inexpressive leader may become an artifact that calls attention to itself. The infrequency of this type of leader’s interventions augments their strength and tendency to sound oracular. It is quite possible that the technique of minimalist intervention derives from the classical model of psychoanalysis,

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in which interpretations are reserved to associative blocks connected to transference (Halton 1999). I value the interpretative mode in group as well as in individual analysis, but do not limit myself to group-as-a-whole interventions, as did Bion. To be effective, group-as-a-whole interpretations should be made sparingly, couched in conversational language, and without sounding or being definitive. For example: ‘Everyone seems very careful tonight. Why so scared?’ Or ‘A number of you have talked about forestalling; it seems to be a theme, afraid of moving forward in your lives. At the same time, I take it as progress, the opposite of forestalling, to grapple with these difficulties here.’ We keep in mind that ‘an interpretation does not become a “group interpretation” because it is given in the form “we,” “all of us,” “the group this” or “the group that.” Neither does it become an individual interpretation because it is directed to and concerned with any particular individual’ (Foulkes 1964, p.163). An interpretation directed to the group may not be experienced as applying to all the members, and certainly, no therapist can be certain that the interpretation does apply to all, or reaches each member equally or in the same spirit. And on the other hand, interventions directed to an individual or subgroup are witnessed by the group at large, and are reflected upon and integrated by the entire membership to varying degrees. It is quite possible and often beneficial to make genetic or transference interpretations focused on an individual, and this can be done without disturbing here-and-now, member-to-member, and whole-group processes, or fostering a basic assumption. I believe that there are no clear demarcations between interpretation and other forms of interventions. A group therapist’s respectful silence or brief appreciative acknowledgment in the face of an apprehensive member’s challenge may be a powerful, even decisive interpretation. Conversely, verbal formulations that reach into the realm of unconscious phenomena, involving constellations of fantasy, desire, anxiety, character, and defense, rightly may be valued for their effort and concern as much as for their acuity and depth. As do most contemporary therapists, I give more emphasis than Bion did to patients’ developmental and ongoing needs, and accept the legitimacy of patients’ desire for noninterpretative activity involved in symbolic play and certain other forms of enactments. Of course, it was Bion who taught us about nonverbal containment: how the therapist’s reverie, patience, and inner security communicate something crucially important, even curative, furthering the patients’ capacity to develop and tolerate emotional thoughts.

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The variety and flexibility of the therapist’s activity, internal and interpersonal, exposes the qualities of the therapist’s care and establishes the therapist’s authenticity. Moreover, through his or her behavior, the group therapist defines the working group culture: how group relationships and experiences are to be regarded, and the depth to which seemingly unremarkable narratives and exchanges may be considered. A curious, empathic, and emotionally responsive leader secures an environment in which more can be said and examined, and thereby averts unnecessarily provoking anxiety and exaggerating basic assumption defenses. Bion emphasized that insight is a relational process that, while reducing suffering, produces anxiety and pain for all group members, including the therapist. A caring, receptive manner alone cannot overcome the resistance to hear, think about, and emotionally integrate other persons’ points of view. While almost immediate among some individuals, some of the time, empathy remains a hard won, precarious achievement, requiring a hovering, strategic, and interventionist therapeutic presence. Ultimately, what holds a group together is the therapist’s ever expanding understanding of the psychic reality of the group and its members, and the therapist’s success in interesting others in reaching and deepening such understanding, however painful and unwelcome. The achievement represents ‘passion.’

A disclaimer Using myself among others, as example, I will describe how the group therapist attempts to realize and respond to the divergent and evolving dynamics of group, while striving to understand how one’s own personality and therapeutic presence influence what one experiences, and fosters in the group. The clinical anecdotes, from my work as group therapist, supervisor of group therapy, case conference consultant, and group member, most often describe difficult situations that might have been understood and handled quite differently and more successfully by others, or by myself with the benefit of hindsight. I trust that they will illuminate the theoretical issues involved in the various chapters by grounding these issues, without implying that my reality represents clinical actuality, the only version of what took place. The following exchange with a group therapist in supervision lucidly calls attention to the wide latitude in the perceptions of a shared experience. I had written a paper (Billow 1997) that presented case material involving this supervisee and her group, the supervisee and me, her supervisor, and the

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parallel processes between clinical situations. I gave her a draft of the manuscript. She reported positive feelings, but also anger. Was this a document or a docudrama? she asked, referring to that low art form that is neither documentary nor drama, neither truth nor fiction. ‘My patient did not say that,’ she complained regarding one detailed exchange. Referring to another: ‘You got that patient down right, but not my part.’ She insisted that some of the comments I reported making in supervision I had not in fact made. Maybe I thought I made them but I did not, and of some of the comments I had made, she claimed I did not say them nearly as well as I did on the written page. Why can’t I be as clear when I am with her! Finally, she commented that in supervision I always seem so sure of myself, I do not seem to be uptight about patients or about issues that arise between us in supervision. But in the paper, I share my doubts and insecurities. Who is the real me, how honest am I with her, how do I really work in therapy? I should clarify that her anger was in the context of a friendly relationship in which we both felt safe to express a variety of feelings toward each other and our work. I appreciated her remarks, not the least for dramatically demonstrating to me the distance that may exist between the clinician’s memories of what happened and beliefs about what is revealed, and the patient’s or supervisee’s memories and beliefs. Where is fact, where is fable? Bion (1975) spoke to this issue when he wrote, in evaluating presentations by other analysts: ‘You are not obliged to say whether you regard the scientific papers as works of fiction or not. But you can form some opinion of the kind of fiction that those particular analysts write, or the kind of reality which they describe’ (p.185). My self-reports give some idea of how I think and feel while doing group psychotherapy and supervision, how I think I think and feel, and how I would like others, such as the reader, to believe I think and feel. Perhaps a disclaimer or ‘Surgeon General’s Warning’ is in order, regarding what follows and all clinical contributions: The clinician’s communications contain aspects of infantile as well as dissociated inner experience. Gross distortions due to commissions and omissions are to be expected, involving conscious and unconscious censorship, relating to the therapist’s emotional, cognitive, and psycholinguistic limitations, shame and guilt, fear of embarrassment, humiliation and ostracism, fear of the unknown, and fear of loss of livelihood. In clinical reports, any similarity to persons living or dead depends on the narrative talents of the reporter and the imaginative talents of the receiver. Your con-

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struction and deconstruction of meaning may be unstable, subject to further processing by waking and dream thoughts, and may be deleterious to the health of preformed opinions.

The case material in Relational Group Psychotherapy reveals my evolving emotional experience, including my emotional resistance to emotional experience. My words, at their best, will, I hope, convey what Ezra Pound defined as the successful poetic image: ‘That which presents an intellectual and emotional complex in an instant of time’ (cited in Wellek and Warren 1956, p.18). By ‘image,’ Pound did not mean specifically a pictorial representation, but a captured moment of truth making, a potent verbal formulation that seeks to evoke an emotionally meaningful response. What follows may be understood as evocations of my intellectual and emotional experiences at particular instances of time. They do not represent, of course, the complex experiences themselves, or the only experiences that I and the other participants were having. My intention is to invite an object relationship, that is, to activate mental links with the reader. As in any human communication, meaning is an emotional experience, which remains ambiguous, unfinished and evolving; its success at conveying truth is incomplete.

CHAPTER 2

The Therapist’s Anxiety and Resistance to Group In this chapter, I will discuss some of the personal difficulties that the therapist must bear in accepting the position of primacy in the mental life of the group. Our knowledge, training, and experience doing and thinking about groups, offers some control of our anxiety and resistances, although these personal variables remain continual, their genesis only partially knowable, and they contribute creative as well as disruptive influences to our work. For therapists relatively comfortable in individual psychotherapy, new anxieties and fears are raised when they contemplate doing groups. Even for experienced group therapists, forming a new group, considering placing an individual within an existing group, or responding to the real and imagined emotional reconfigurations when members are added or replaced, may stimulate difficult feelings. Relative to individual therapy, the intersubjective field in group therapy is larger and more complex by orders of magnitude.

Anxiety raised by conflicting guidelines When contemplating whether to start a therapy group, the individual practitioner has to consider certain basic questions. These include: ‘Whom do I put into the group?’ ‘Who benefits and how should a group be constructed.’ ‘How would group treatment influence and possibly impinge on the patients’ individual work with me, and my work with the patients?’ Experienced and neophyte therapists seek comfort in definitive procedures, but our classic readings and texts offer conflicting theoretical rationales and technical recommendations. Empirical data do not offer guidelines on how most effectively to select group patients; even ‘risky clients sometimes surprise us’ (Piper 1994, p.107).

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Stein (1992), adhering to a traditional psychoanalytic model, did not advise group therapy for individuals capable of undergoing psychoanalytic psychotherapy. Groups were for out-of-touch patients with rigid character structures or for those who need to defend against and dilute overly intense, primitive transferences to the therapist. By contrast, Grotjahn (1993) and also Ormont (1992) advocated group therapy as ‘the basic model of treatment, the primary therapy’ (p.53). The question of ‘group or no group?’ became ‘which group?’ The selection of members hinged on composition variables, such as age, presenting symptoms, and diagnosis, and on setting (e.g. private practice, clinic, or hospital). In some cases, combining individual and group therapy is the treatment of choice, but others may benefit from individual or group therapy rather than a combination with the same therapist. According to Grotjahn (1993, p.4), analytic group experience dissipates and ‘does not invite any regressive transference neuroses’ to the individual therapist, but to the ‘group family’ (see also Kauff 1993; Stein 1992). In sharp disagreement, Kernberg (1977) observed intense transferences to the group therapist, as did Ethan (1978), Ormont (1992) and Yalom (1995). Kernberg (1976) advised against combining group and individual therapy, because the combination leads to hidden and unanalyzable split transferences to the same therapist. If one does, he recommends that combined treatment should be carried out with two different therapists, who also communicate with each other. But this recommendation does not eliminate the problem of interacting transferences between the two communicating therapists, further complicated by their respective relationships to the patients. Anxiety, transference, and resistance are basic and continual in the therapist, as well as patient and group. For the group therapist not to acknowledge and grapple with his or her emotionality promulgates what Racker (1968) described as the ‘myth of “analyst without anxiety or anger.”’ He saw this myth as a ‘great danger,’ a remnant of the traumatogenic ‘patriarchal order,’ an expression of ‘social inequality in the analyst–analysand society…and the need for social reform’ (Racker 1968, p.132). Psychoanalytic purification (Freud 1912b), resulting in ideal equanimity, detachment, and clinical objectivity, is impossibility. The core elements of classical psychoanalysis – neutrality, abstinence, and anonymity – may contribute to maintaining the static, ‘hierarchical arrangement of power and privilege in the psychoanalytic situation’ (Gerson 1996, p.626), constraining the therapist’s access to her or his own subjective experience. The therapist’s

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‘irreducible subjectivity’ (Renik 1995) cannot be eliminated; and this is not even a desirable goal. All therapists would do well to follow Grotjahn (1993) who routinely analyzes ‘the resistance to joining the group – in the patient and in me’ (p.58).

Anxieties and resistances of training institutions The decision to establish a new professional identity as a group therapist arouses apprehension, which may be understood and modified by study and group experience supported by training institutions. However, powerful institutional resistances and injunctions exist regarding groups that may contribute to rather than lessen the distress of the novice group therapist. Writing at the same time as Racker, Jaques (1955) described ‘how much institutions are used by individual members to reinforce individual mechanisms of defence against anxiety and in particular against recurrence of the early paranoid and depressive anxieties’ (p.478). In a critique of psychoanalytic education, Kernberg (2000) acknowledged the ‘regressive idealizations and split-off paranoiagenesis…that haunt psychoanalytic institutions’ (p.113). Kernberg recognized the striking avoidance of studying the essential literature of small and large groups. He did not go so far as to suggest structured and ongoing group experience among his proposals to address the authoritarian pathology in these oligarchic and parochial training organizations (Kirsner 2000). Bion (1961) held that the capacity to participate in group was ‘possible only to individuals with years of training and a capacity for experience that has permitted them to develop mentally’ (p.143). While stressing the importance of individual analytic work, and mileage doing groups, he did not seem to advocate personal group therapy in the training of the analyst or group therapist. Foulkes (1964), in contrast, trained group analytic therapists. Individual psychotherapy was indispensable, but not enough. Group therapists needed special gifts, ‘years of hard study, penetrating experience [group implied], before they may qualify and provided also they have proved to possess a sufficient degree of personal integration to stand up to the emotional storms and havocs they have to live through’ (p.99). Psychoanalytic institutions bar inclusion of group therapy in their candidates’ own training analyses, or presentation of patients in combined therapy as control cases. Few institutions, if any, even offer theoretical or clinical seminars in group therapy. We see that despite Freud’s curiosity and writings about groups and group process, group therapy remains taboo in many psy-

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choanalytic circles. Indeed, most psychoanalysts seem not particularly interested in group therapy, a contributing factor being the attitudes promulgated by their training institutes. They seem unaware of and resist attending group therapy conferences, and supply a languishing membership in the group therapy division of the otherwise thriving Division 39 (Psychoanalysis) of the American Psychological Association. Finally, the group therapy literature remains mostly segregated from mainstream psychoanalytic journals. Being an optimist, I expect that it is only a matter of time for the recently liberated, democratized relational psychoanalyst to recognize that group therapy is a wonderful equalizer and helps keep the analyst honest, humble, and on his or her toes with colleagues and patients. An ongoing process group should be an important segment of pre- and postdoctoral level training experiences. Large, median, and small group experience could enliven and personalize the often dry and repetitious conferences of the national and international psychoanalytic and psychotherapy associations. In sum, whereas the group therapist often considers and even prefers combined individual and group treatment, the typical individual practitioner surely does not. The concept of the individual in a group has been insufficiently incorporated into important subdisciplines of psychotherapy theory, training, and practice, and there are institutional resistances to be overcome.

Dread and fear of doing group therapy Symbolically, all therapy is an act of aggression, interfering, challenging, and undermining patients’ beliefs, values, and relationships, and perhaps even their sense of themselves. The possibility of group therapy introduces new ways in which the therapist aggresses on existing and potential members. I suggest that in being introduced to the idea of group, every patient, unconsciously and often consciously, feels the therapist is abandoning, exiling, and hating him or her by encroaching on their exclusive relationship and exposing them to others. The therapist also feels this to be so, and suffers from depressive anxiety and guilt. In addition, like the patient, the therapist suffers abandonment and persecutory anxieties and fears exposure. In starting a group or adding a member to an existing group, the therapist disturbs and destabilizes the meaning of preexisting relationships. The members must tolerate absence and loss of meaning, leaving a mental space to receive new experience. In breaking down existing meaning as well as confronting what is unknown and confusing, the therapist raises his or her own

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anxieties and accompanying feelings of persecution and depression. Thus, in the very effort to foster growth and development, the therapist aggresses against the self and other. The group – and not the nature of learning – comes to represent the source of danger. Therefore, the therapist hates and dreads the group and its members for subjecting him or her to the very group he or she has longed for and is creating.

Expressions of resistance to group Consider these remarks from candidates and recent graduates of psychoanalytic institutes, some of whom had contemplated or begun doing group therapy. I can’t start a group. I don’t have room in my office. Then I realized it wasn’t my office, but my life I was concerned about. Do I want to add this worry to my busy existence? I am imagining the first meeting, afraid I am not up to it, afraid I would not be in the clinical moment. I am worried I’m not ready for the big time. Not ready to live life, jump into the life of group. I feel anxious when asking patients to join my new group and I feel bad if they say no. I take it personally, and I also question my clinical judgment. I feel remiss. I can’t always predict. People I least expect say no; I’ve been more successful with people I don’t care about.

Many clinicians practicing individual therapy forthrightly acknowledge that they abjure group therapy for personal, not theoretical, reasons. Koenig and Lindner (1994) have described characterological issues in therapists that express resistance to group. The narcissistic therapist fears that an active group will undermine the clinician’s therapeutic uniqueness. The schizoid therapist fears invasion by patients. The depressive therapist needs to remain each individual patient’s universal supplier. The compulsive therapist fears a group would spread unconstructive attitudes and behavioral modes and must control how things should be done. The hysterical therapist fears being overwhelmed and controlled. Supervision, individual and particularly group therapy may aid the conflicted and ambivalent therapist in making a transition into becoming a group practitioner.

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Clinical examples of resistance to group 1. A gifted clinician, characterologically quiet and reserved, insisted that she did not have the personality to run a group. ‘I’m a follower, not a leader,’ she argued, ‘I can’t think that quickly when I’m under pressure.’ I do not believe ‘leading,’ meaning quickly responding, to be a requirement for the job of group therapist. A quiet, reflective leader who takes her time can be quite effective in containing anxiety and encouraging the evolutionary process of learning. In supervision we explored this woman’s history. We discovered many professional situations in which she led others quite capably. She also valued her own experience as a patient in group therapy, in which she actively participated. However, she adamantly maintained her belief that, as a group therapist, she would flee mentally, and retreat to the passivity and paranoid-depressive loss of confidence which she characterized as her position in her family of origin and which continued in certain social situations. She regretted not feeling able at this time to offer her patients what she considered a valuable option. 2. Preoccupied with his recently initiated group, a supervisee had difficulty containing his anxieties between sessions. He worried about each patient – was he or she sufficiently satisfied and not unduly disturbed by the process – and whether the group would stay together. He tended to be quiet in group, but steered patients in their individual hours to discuss group experience, and made constant reference to the group. I suggested that the therapist was projecting his own insecurity and fear regarding group participation on to the members. Our subsequent discussions alerted him to characterological obsessive defenses around his ‘need to know.’ He revealed difficulty in tolerating uncertainty. What really took place in group and how each member felt about it preoccupied his thoughts. We agreed he should more actively participate in the group process and connect with his patients there, and not use individual sessions to bolster his unrealistic fantasies and his striving for clinical certainty.

Fear of exposure I should be in a group and do a group, but I’m too fragile. I don’t think I could take it. So many eyes staring at me, no place to hide, even to think. Everyone would notice when I make a mistake. [Remarks from an experienced psychoanalyst, and psychoanalytic supervisor and faculty member]

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Group members see the group therapist from multiple perspectives. Previously unrevealed and undeveloped facets of the therapist’s professional and subjective self, including values, beliefs, character issues, unconscious wishes, feelings, and fantasies, are put into group play. The therapist may feel that, relative to individual therapy, he or she has less control and knowledge of how and what is being revealed. But self-disclosure is inevitable and continuous in any human interaction, certainly in individual as well as group psychoanalytic therapy. Greenson (1967) observed that, even in a classical psychoanalysis, ‘everything we do or say, or don’t do or say, from the décor of our office, the magazines in the waiting room, the way we open the door, greet the patient, make interpretations, keep silent, and end the hour, reveals something about our real self and not only our professional self ’ (p.91). An important question to consider is how the group therapist discloses (e.g. the verbal, paraverbal, and nonverbal manifestations), as well as what, when and why. Not only is self-disclosure unavoidable, but also the lines between its various forms – such as intentional or unintentional – are ambiguous and fluctuating. Vocal (and nonvocal) behaviors may range from spontaneous exclamation to measured revelation, from those that are seemingly consciously determined to those unconsciously enacted. Pragmatic meaning, that is, paralinguistic signification revealed by subtleties in timing, tone, and cadence, may contradict what is verbally spoken (Chused 1991; McLaughlin 1991). When the group therapist utilizes him or herself in an open, spontaneous manner, the therapist may be producing more obvious disclosures, or different types of disclosures, than those that are also inevitable in traditional individual or group technique. In moments when the group therapist is purposefully transparent, one may be consciously as well as unconsciously avoiding, and yet also inadvertently conveying other aspects of personal experience (Frank 1997; Greenberg 1995). Some group therapists gradually and purposefully reveal aspects of themselves, in an attempt to model for the patients as well as to propel patients to deal more realistically with the nature and basis of their beliefs. Yalom (1995) conceived the group therapist as busy in the early stages of group life with the development of the social system, while in later stages, he or she productively relates more personally and interactively with each individual. From this point of view, the expansion of self-disclosure facilitates greater openness among members, decentralizes the leader’s position in the group, and hastens the development of group autonomy and cohesiveness.

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A number of contemporary writers of differing psychoanalytic persuasions have argued that because the therapist cannot help being self-disclosing, why not consider the opportunity to make explicit that which reveals oneself to be emotionally involved with the patient? The contemporary group therapist may consider disclosing autobiographical material, as well as explicitly refer to the emotional experience with the patient, as in countertransference disclosure. Reports in the psychoanalytic literature include revelations of confusion, distraction, tears (Ehrenberg 1995); annoyance, dislike, envy, and murderous hatred (Jacobs 1991; Searles 1979; Winnicott 1949); humor and sarcasm (Bader 1995; Greenson 1967); sexual imagery, fantasy, and feelings (Davies 1994; Marcus 1997); error and its origin in unconscious countertransference (Jacobs 1991; Little 1951); day and sleep dreams about the patient (Marcus 1997; Wilner 1996); caring actions, such as borrowing a videotape and offering personal feedback (Hoffman 1996); touching and being touched physically (McLaughlin 1995); and various feelings expressed through acting-out behaviors, including (symbolic) sexual abuse (Frawley-O’Dea 1997) and lying to the patient (Gerson 1996). Analysts have talked to patients about their life crises and issues relating to their own character and identity; included here are the therapist’s illness (Pizer 1997), impending death (Morrison 1997), late pregnancy loss (Gerson 1994), race (Leary 1997), sexual orientation (Blechner 1996), weight difficulties (Burka 1996), and childlessness (Leibowitz 1996). While non-disclosure ‘makes the analyst into a mystery, and paves the way for regarding the analyst as an omniscient sphinx whose way cannot be known and whose authority, therefore, cannot be questioned’ (Renik 1995, p.482), the converse, that disclosure dissipates fantasies of the therapist’s omniscience, is not necessarily true. Bion (1961) prefigured the contemporary movement to share ‘inner experience’ (Jacobs 1991), disclosing certain thoughts and feelings in some of his interventions. For example: ‘It becomes clear to me that I am, in some sense, the focus of attention in the group. Furthermore, I am aware of feeling uneasily that I am expected to do something. At this point I confide my anxieties to the group, remarking that, however mistaken my attitude might be, I feel just this’ (p.30). But at the same time, Bion maintained a sphinx-like, nontransparent persona that stimulated his groups’ transference fantasies and irrational reaction tendencies. The group therapist must consider many factors in including deliberate self-disclosure within his or her theory and technique. How is self-disclosure

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possible and appropriate, and what kinds of self-disclosure are constructive? In attempting to systematize self-disclosure, one risks moving from authenticity to manipulation. In sum, self-exposure is inevitable in any modality of therapy, and volitional self-disclosure should not suggest that the therapist is fully aware or certain of his or her motivation, meanings, and effect. The rule for the group therapist seeking guidelines is that there are no hard and fast rules. One issue to consider is whether taking or avoiding the opportunity for self-disclosure serves to open or close things up, a question that may be answered only retrospectively, and even then without certainty that another way may not have been better (Aron 1996; Greenberg 1995).

Clinical anecdote involving exposure A young analyst reported in supervision that she felt ‘unmasked’ when one of her patients in combined treatment saw her in a restaurant with her husband and preschool children. ‘Now she knows I’m just a person,’ she exclaimed. ‘I’ve lost my specialness.’ I thought that if the patient saw her as special, as indeed she might, it was because of her personal qualities, not in spite of them. I advocated an investigation, preferably in the next session, which was group. Gathering her courage, the supervisee took an opportunity to inquire about the chance meeting. The patient, also a young woman, admitted feeling awed by what she discovered in the unexpected encounter. The patient’s fantasy was confirmed: her therapist was a well-rounded human being with a career and a family. The woman wished such a reality for herself. Ironically, until their discussion, both parties had felt a loss of confidence, whereas afterwards, they both felt enhanced. The patient seemed relieved of some of her suppressed feelings of inferiority by simply expressing them in the accepting group context. For her part, the therapist also experienced self-assurance from being seen, literally, as herself. She felt less dependent on an imaginary mask of anonymity and other ‘extrinsic’ (Gill 1994) features of psychoanalytic psychotherapy that she had relied on to give her the status to practice her profession.

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Emotional amplification and contagion in group Groups amplify emotional reactions, as laughter increases in a full movie house when compared to a relatively empty one (Koenig and Lindner 1994). Bion (1961) referred to this combustible process of emotional contagion as valency, describing a rapid formation of group uniformity of thought, feelings, and interactional behavior. Valency contributes to the power of group therapy to induce, stimulate, and intensify countertransference, as the group comes to represent a collection with a singular mind and personality. Valency or amplification may increase in frequency and intensity particularly as the group becomes structurally homogenous, regresses deeply, acts out, or becomes polarized. The group, vulnerable to emotional contagion, may influence the therapist who unconsciously provokes or colludes with the very process that is threatening to group life (Kauff 1993). The intersubjective pressure is either to join the group via overidentification or rigidly to oppose it. Roth (1980) described anxieties regarding over- or counter-identification with a group, and how the leader may fear being overwhelmed by collective group phenomena. The therapist may be tempted ‘to control or evacuate parts of the group in an attempt to ward off the painful task of analyzing [the therapist’s own] hitherto defended introjects’ (p.407). Therapists must cope with the group’s and their own intense feelings, including anger, rage, guilt, and neediness. They must also cope with the fear of losing ego boundaries, and even of being crazy.

Testimonies of fear of craziness I asked candidates in the Derner Postdoctoral Group Program whether they ever felt crazy from their groups. The responses were, in this order: [From a male candidate] I was having trouble with my first group. Two of the four women dropped out, and I felt responsible for bringing in a female member who would stick, although the group seemed okay either way. I had this dream the night before introducing a new woman: My [male] supervisor, the men in the group, and I were holding hands, in a circle. I think I felt I was falling apart and I needed the other men to keep me together. I sometimes get scared that people will fight with each other, so scared that I feel I wouldn’t be coherent if I had to talk. I feel like I can’t focus or process. I hear ‘fix it’ in my head, but I have no idea what to do. I drive myself so crazy that the room spins around.

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My mind can go blank, yet I will feel a painful imploding inside it. I can get up after a difficult session so uncoordinated I don’t know where my feet are. I don’t feel crazy, but feel that the group will think I am crazy, and I get scared after I make interpretive leaps. If they challenged me, what would I say? I can feel like a maniac, not a normal human being, that I pushed people too hard and exposed them. I criticize myself for wanting too much from them, for them, and then worry all week, sick with dread.

These feelings and fantasies were easily accessed by the candidates, which I considered to be evidence of their clinical maturity and sophistication. Interventions are often as difficult for clinicians to offer, as for patients or groups to receive, and sometimes we feel that we are mean or crazy for making them. Bion (1965) held that emotional acceptance of an interpretation includes the sense of being or becoming that aspect of the self to which attention has been drawn. This acceptance may entail violent feelings of madness, murderousness, and guilt. Such catastrophic feelings of becoming the person of the interpretation are also to be experienced by the analyst, who must become ‘reconciled to the feeling that we are on the verge of a breakdown, or some kind of mental disaster’ (1975, p.206).

Idealization of group treatment Therapists may defend against, and compensate their dread and fear of groups by idealizing this form of treatment and certain patients who participate enthusiastically in it. Consider, for example, these comments from postdoctoral supervisees: I am looking forward to it [initiating a first group] – like my high school graduation or [doctoral] orals, tremendously excited, nervous, like I was starting a new phase in my life. I’m psyched. Curtain going up, light the lights! I’m beginning next week. What should I do? I lose interest in those patients who aren’t also involved in group. I think of my groups as my family, and until patients are in a group, I don’t feel we are really engaged.

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I get angry and feel rejected when a patient refuses my invitation to join one of my groups. I told my patient that if he did not at least try group for three months, I would not see him.

In these examples, the clinicians betray difficulty in containing and acknowledging personal anxiety and ambivalence. They may have prematurely introduced the group option to unprepared patients or insisted on converting all patients to group patients. The therapists have not sufficiently analyzed their patients’ resistances (including compliance), or their own.

Fear of and allegiance to the basic assumptions From the first moment in its life, a group begins to unify around a predominant basic assumption, through which members express a group mentality that contributes to a group culture. The therapist is perceived and treated as antagonistic by that element of the group mentality that resists learning by experience. To the extent that the group is dominated by one of the basic assumptions, the therapist is fought against or eluded (fight/flight culture), unduly depended upon (dependency culture), or symbolically replaced by a pair or subgroup (pairing culture). Grotstein (1995) stated that individual therapy, like ‘any couple relationship constitutes a group entity as well as a dyad, and is subject to the laws of group formation and the inevitable development of basic assumption resistances’ (pp.489–490). Basic assumptions contain ‘features that correspond so closely with extremely primitive part objects that sooner or later psychotic anxiety, pertaining to these primitive relationships, is released’ (Bion 1961, p.189). The therapist’s countertransferences to patients and to the group reflect anxieties associated with basic assumptions, and resistance to analyzing such anxieties and these countertransferences may determine criteria for group selection or deselection. For example, a therapist resists placing a competitive, outspoken individual in group, thereby avoiding power issues. In consequence, the basic assumption of fight/flight may remain unexplored in the patient, the group, and particularly, in the countertransference. When therapists resist confronting and working through internally the predominating basic assumption, they become susceptible to engulfment by and absorption into the cohering group mentality. Resulting countertransference enactments serve to foster a static, emotionally inhibited basic

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assumption group culture. For example, a therapist reacts with exaggerated fear of personal or group destruction when a group or member first attempts to introduce aggression or flight themes (baF/F). Or, when members are competing relentlessly for the therapist’s ministrations, the therapist feels coerced to supply individual psychotherapy (baD). A third example occurs when group members form a subgroup or take turns to identify and treat other members’ (including the therapist’s) psychological problems. The therapist impotently joins the silent majority as a rotating leadership goes about ‘curing’ targeted members (baP). Under the guise of clinical choice and leadership style, the therapist may act out character pathology congruent with a particular basic assumption. For instance, leading homogenous groups composed of antisocial individuals may attract therapists with rebellious character structures and unresolved conflicts with authority, or conversely, therapists with rigid superegos (baF/F). A characterologically impulsive therapist may enjoy the immediacy and action of short-term crisis groups and miss opportunities for introspection, intimacy, and extended work (baF/F). A therapist may be overly supportive and encourage patients to relate to each other similarly (baD). A therapist may terminate unwanted patients from individual therapy, rationalizing that they would benefit from connecting to others in group (baP). The therapist’s adoption of a basic assumption mentality may cause the group to carry out therapeutic functions that rightly belong to the leader, such as recruiting new members or maintaining boundaries (ba/D). The therapist may symbolically abandon frustrating patients to be ‘killed or cured’ by group (baF/F), rather than protect difficult individuals from premature group confrontation. Additionally, the therapist may bask in a dependency or pairing group culture and resist analyzing the idealizing and sexualizing transferences.

Clinical examples: The therapist promotes basic assumptions 1. A well-respected senior clinician encouraged students at several analytic institutes to participate in one of his supervisory groups. A female analyst entered, only to find a harem of adoring women, including the analyst’s long-standing patients and former and present supervisees. Much of the group process involved fighting for the analyst’s attention. He passively satisfied his underlying hunger for idealization and had no motivation to offer the intellectual and emotional depth he provided in the analytic institutes.

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The unexplored pairing fantasy would be that he, the Divine Presence, would miraculously impregnate in each of his disciples a new Messiah. 2. A clinician referred to group as one’s ‘real family,’ meaning an ideal family in which she herself would be idealized. She regularly scheduled double sessions for several of her groups during holidays, even pressuring them to have annual or biannual holiday weekend marathons at her country home. (The members were to stay in nearby motels without socializing.) When members reported that their mates complained, the therapist suggested that the mates were jealous that they were not in one of her groups, and advised that they should appear for consultation. Her dominating and controlling personality contributed to group formation and cohesion around dependency, but stifled the members’ independent thought and behavior.

Anxiety stimulated by a new member The fluctuations and reconfigurations in group process and membership influence the therapist’s self/object, self/group representations. Each person represents an influence of immigration on the group culture, actual and imagined. A new member often stimulates the group’s reevaluation of itself. Who are we, what are we about? The new member awakens dormant group issues and activates dormant conflicts, for example, dependency, sexual and/or sibling rivalry (Brown 1998; Rabin 1989), and competition for special attention. A new member often stimulates exit fantasies. Therefore, the therapist may hesitate unnecessarily in bringing a novice to a sophisticated group or a problematic patient to a cohering group. ‘I resent having to start over again,’ a member complains, perhaps echoing the therapist’s unstated feelings as well. ‘Perhaps this is a good time for me to terminate, I have a replacement,’ a second member adds. Yet, a new member is more than a new, or repeat, set of problems. He or she is a fresh perspective who is valuable for the leader and group. A new member represents aspects of the group leader, as the baby represents aspects of parents. Whereas there may be no such thing as an ugly baby to its parents, therapists may be considerably less charitable in their feelings towards patients they are considering for group. The therapist may be proud of and wish to show off an attractive or status patient, or to hide one who is neither.

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Countertransference may involve anxiety in losing the exclusive and familiar individual therapeutic relationship, anticipatory fear in exposing the patient to group, and relief or disappointment in the patient’s consent. The anxious therapist may unnecessarily shepherd a patient through the inclusion and absorption phase, behaving like ‘an over-careful parent who discusses all possibilities with the patient [or with the group], as a mother would with a child going on a long trip when she thinks he cannot tackle possible difficulties’ (Koenig and Lindner 1994, p.123). When the patient integrates into the group, the therapist may feel suddenly useless, like the parent no longer needed by the child. In addition, in attempting to be fair and neutral to the entire group, the therapist may blot out intimacies already established with the patient from individual work. The therapist can also feel anxious about introducing the group to the new patient and exposing the therapist’s ‘other’ professional life. The beginning group therapist may be adopting and modifying a group persona, one that is more, or less, distant, dramatic, or active than the analytic self of individual work. How will the patient respond to the difference in the therapist’s personality and behavior? How will the patient respond to the therapist’s ‘group family?’ When a patient enters a group, unanticipated facets of the individual’s personality are revealed, and unpredictable group interactions occur. Countertransference surprise and readjustment are continual and inevitable.

Clinical examples: The new member and countertransference 1. The new member stimulates countertransference. ‘You treated me as a stranger in group,’ a patient complained after her first group session. Indeed, the therapist felt protective of other members and did not want to betray them by acknowledging her prior and intense relationship with the new group member. In supervision, the therapist associated to her experiences as a mother, not wanting to betray her older children by being too excited by the new baby whom she came to know in the privacy of the maternity ward. 2. The new member stimulates recognition of preexisting countertransference. A therapist hesitated to place in group a schizoid male patient who, though sufficiently intelligent, steadfastly remained concrete or silent in individual sessions. How could the therapist expose this frustrating and inglorious person to the group, and this lively, interacting group to this person? The therapist was surprised when the man revealed a charming, puppy-dog quality

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to the group, which quickly adopted him and stimulated his active participation. Subsequent individual sessions revealed that the patient felt that the therapist, like the patient’s parents, always wanted more from him than he could give them. In group, the patient did not feel forced to reveal himself because the members enjoyed whatever he did. He could participate according to his wishes and wants, rather than somebody else’s. The therapist realized how he had been trapped in a complementary countertransference (Racker 1968), becoming a superego figure representing the patient’s anxious and demanding parents. The therapist learned from the group members how better to accommodate the patient’s authentic need to be appreciated and enjoyed.

The anxiety of entitlement This brings us to the topic of entitlement, the wish to be and fear of being special, which is an important element in the transference and countertransference, and a topic developed further in Chapter 4. Whereas at one time entitlement was considered primarily a manifestation of a pathological insistence on being an ‘exception’ to reality (Freud 1916), contemporary psychoanalysts have recognized that the sense of entitlement represents a basic human need to feel loved, and to be recognized and affirmed (Billow 1997, 1998, 1999a, 1999c; Dorn 1988; Kriegman 1988). When one feels thwarted in having these needs met, pathological attitudes of excessive as well as restricted entitlement may arise. Both the group therapist and the members are vulnerable to exhibiting variants of these unrealistic attitudes and resulting behaviors. Phenomena of entitlement may be subtle and ambiguous, with levels of normal, restricted and excessive entitlement interacting with and camouflaging each other. For example, excessive entitlement may hide behind overt humility, just as an inflated posture may hide underlying feelings of low self-esteem.

Clinical examples of entitlement 1. After several years of introspective vacillation, a therapist committed to forming an inaugural group, only to find his patients resisting. ‘I don’t want to share you,’ a chorus of patients exclaimed, each in their individual sessions. This exceedingly conscientious therapist realized that, in his diligence, he had covertly transmitted a fantasy of specialness. Each patient was exceptional, his

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favorite child, and he was the most important figure in each life. He had to work through, and help his patients work through, mutual attitudes of exaggerated entitlement before constructing a group. Even then, the early stages of the group were marked by intense, underlying competitiveness among the members, with many premature dropouts. 2. A supervisee found that in doing couples work, females looked to her to come to their side, but males felt castrated when she did so. She felt boxed in and adopted an unauthentic professional neutrality to defend against being overwhelmed by what she experienced as an emotional tug-of-war. How could she consider initiating a group, where these polarizations would happen? For her to proceed comfortably, she needed to understand more about her own restricted attitudes regarding her entitlements. She was susceptible to gender-based projective identifications and felt pressured to behave in certain ways. To function with ease, she had to trust her right to join either – or neither – side of a polarized group, as she found it appropriate. 3. A therapist, and recent member of one of my ongoing groups, hesitantly announced that she was commencing her own therapy group. She had resisted raising the subject to our group, since this would call attention to her special status as both a patient and a clinician. She believed the members would criticize and attack her, as they had done in previous sessions, for intellectualizing and for inflating herself by playing the therapist. Instead, the group encouraged her to continue to describe her new project and her concerns about their reactions. The members admired her courage in taking on a new role in her career and in broaching her fear of the group’s reactions to her. She hesitantly explained that she was terribly nervous in starting the group. She felt that way now, imagining us criticizing her for doing what she wanted, and for not doing it well. ‘I’m not a good group patient yet; how could I be a good group therapist?’ She felt that her individual patients were similarly disapproving of her efforts, and that they too would react negatively to her performance in group. In response to the group’s questioning, she acknowledged that her patients were for the most part pleased with her, interested, and quite excited by the prospect of group. But, she said, she could only think about and trust their criticisms, stated and anticipated. She minimized her patients’ warmth and encouragement, as she had minimized the many positive responses she had received since joining our group. We agreed that leading her own group, along with participating in ours, could contribute to working through diffi-

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culties in trusting others’ caring for her and in accepting and valuing herself as special.

The entitlement of leadership and power The therapist’s attitudes toward entitlement are put into play around such issues as assertion of power to establish and care for the group and its members, to feel a part of a group, and to feel and act separate from other group members. The therapist may struggle with both personal issues and technical decisions regarding power, monitoring memory and desire, zealous affects, and resulting impingements. Nevertheless, the therapist must feel entitled to influence individual psychotherapy patients to join a group, or else not maintain a group practice. He or she must believe that what is special and caring in individual therapy will not be lost in a group. Rather, the therapist must convey the conviction that groups, and the individuals who form them, are valuable resources for the patient in reaching therapeutic goals. Indeed, each member, each session, and each group is special, evolving in unique ways, in precious moments of time that cannot be replaced or recaptured. Analytic writers have identified the exercise of therapeutic power as the agent of change. Freud (1916–1917) wrote that: if the patient is to fight his way through the normal conflict which we have uncovered from him in the analysis, he is in need of a powerful stimulus which will influence his decision in the sense we desire, leading to recovery.

Freud went on to state that the powerful stimulus is not intellectual insight, but ‘simply and solely his [the patient’s] relationship to the doctor’ (p.445). According to Modell (1976), the analyst implicitly must possess ‘some powerful qualities so that change may be affected merely by being in his presence’ (p.494). Bion (1966) advised that the individual or group therapist must function with ‘the impact of an explosive force on a preexisting framework’ (p.37). In these quotations, the endorsement of power seems to be collapsed into the idea of effectiveness. There may not be a clear distinction between the two. There are, of course, many different ways to be powerful and many different ways to be effective, and the group therapist’s use of power is not always therapeutically effective. When group therapists describe what they do in clinical situations, different and even contrary approaches often are interesting and

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seem moving and powerful. And yet, it is not easy to delineate which elements in the interaction caused the experience to be therapeutically effective. The same words at different moments, or spoken by different group therapists, may vary in fostering the positive therapeutic relationship that Freud saw as leading to change. The therapist’s presence may create the empathic Kohutian mirror in one group, but may seem too mild in another, or too seductive in a third. An intervention calling attention to a group’s basic assumption may work in the explosive manner Bion described, or may fizzle into embarrassing bombast, cleverness, or naïveté. Whereas the group therapist needs to be powerful, no therapist feels powerful consistently. Working with individuals and with groups, I carry a feeling of powerlessness, even when I also feel powerful. Measuring therapeutic progress may be difficult, and there are no good measures of therapeutic skill. When group members stay year after year, I consider the possibility that I have wielded little effective power and much powerlessness. When an individual ‘gets better,’ I assume it is something he or she did in conjunction with the group experience, and which may or not relate to my efforts. Similarly, when one feels worse or leaves, I assume it relates only partially to my personal or professional limitations, and also relates to the larger question of our profession’s effectiveness. And, complicating matters further, the group therapist must deal with the reality that consensus on therapeutic power may not be apparent or immediate. A group member complained, ‘What you say may be true, but it is not helping. Nothing is changing!’ He seemed to be saying that I was powerless. I felt the sting of public humiliation in the man’s assertion of my therapeutic ineffectiveness. I evaluated my momentary pain as receiving something new from the patient, even representing success rather than failure on the power dimension. I suggested that something must have been changing for him to express himself with such force and directness. He assented dubiously, but with what I took to be a hint of self-satisfaction that I confess was similar to my own. Here the group seemed to have produced a powerful effect and, despite the patient’s initial protestations, a consensus between us as well. The group therapist draws on professional entitlements to predetermine, define, and enforce many of the essentials within the therapy, including boundary functions such as time, place, seating, duration of the session, and fee. In addition, the therapist’s theory and technique bring power, control, and directionality to the psychotherapeutic experience, which privilege and

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prohibit modes of patient–therapist interactions (Hoffman 1996; McLaughlin 1996). Symbolically, the group legitimizes and entitles the leader to lead and the members to be a part of the group (Alford 1995). ‘Patients come to group because of the therapist’s importance…as an object of cathexis and dependence’ (Slavson 1992, p.179). The therapist’s ambivalence regarding being special may interfere with the capacity to function creatively (Safan-Gerard 1997). To initiate and facilitate the analytic process, ‘a group seems to be more dependent on the therapist than is the case in individual treatment’ (Grotjahn 1993, p.29). The therapist stands in the center of the group process and must accept power and leadership, whether or not he or she likes such a position.

Accepting and utilizing countertransference Over three decades ago, Bieber (1971) declared, ‘if the therapist is undefensive in a group setting, he will not be perceived in a dramatically different light [from how he is perceived in individual therapy]’ (p.157). However, we now accept the reality that no therapist is truly undefensive. Experienced group therapists, like experienced actors, do not lose their stage fright. Therapists continually struggle with anxiety and resistance. It is often true that the anxieties and resistances of the group members reflect the therapist’s own. Therapists adjust and integrate different subjective self-states; these are dependent on the real and imagined, present and historical, relationship with the groups and their members. As with any countertransference signals, anxiety and resistance can be used to further psychoanalytic meaning, if not actedout or succumbed to. Sometimes one does succumb, however, and learns retrospectively about enactments, by reviewing countertransference, and listening ever more closely. Bion (1961) described how groups unify around a basic assumption and how the therapist may absorb or contain the group’s projections to understand the group’s emotional struggles. Indeed, the strongest source for interpretations lay not in the observed facts in the group, ‘but in the subjective reactions of the analyst… In group treatment many interpretations, and among them the most important, have to be made on the strength of the analyst’s own emotional reactions’ (Bion 1961, pp.148–149). One must strive to maintain an independent ‘mind of one’s own’ (Caper 1997), one which both identifies and disidentifies with the group’s allegiance to the basic assumption mentality. In effect, the therapist contains the basic assumptions

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to the extent that he or she internally acknowledges and deals with ‘subjective reactions,’ the unavoidable countertransference anxieties, resistances, fantasies, and affects that are in the very fabric of intersubjective experience. Groups unify and not only project, as Bion emphasized, but also protect themselves from the leader’s ‘subjective reactions,’ which include to varying degrees the leader’s unavoidable vulnerability to, and inevitable participation in, basic assumptions. Groups test and challenge the therapist ’s countertransferences, and monitor his or her resistances (Rosenthal 1994), for example, distortions, prejudices, favoritisms, and reaction tendencies. The contemporary therapist listens to the group voice, when it is faint and hesitant, or harsh and exaggerated, without assuming that it necessarily or solely represents the group’s, rather than his or her own, adoption of basic assumptions. The therapist no longer operates with confidence that patients’ evaluations are inaccurate or primarily reflect transference distortions (Gill 1994; Hoffman 1983). Patients have protested or affirmed certain behaviors and personality traits that they attribute to me in the group and that they found different from their experience in individual treatment. The beginning group therapist may dread such feedback, hearing an indictment rather than an invitation to explore previously resisted or undeveloped aspects of the transference, and quite probably, of the countertransference, and of the intersubjective process.

Clinical anecdotes: Working with countertransference 1. A resistant and repetitive patient, new to group, commented to me ‘I’m afraid of you in group. You seem impatient with me.’ The group seemed silently to concur. I first considered that his perception of my impatience related to my wish to protect him from the group’s anger and lack of interest (baF/F). But because the patient and his defenses were new to group, and they seemed interested and not annoyed, I concluded that I had been projecting my negative feelings about him onto the group, and acting them out. 2. A relatively new patient, a successful middle-aged career woman, felt she should ‘take her medicine’ and respond positively to my invitation to join a group. She was convinced that she would have trouble. ‘People don’t really like me, they respect me.’ She associated to her senior high school year, when she had been voted ‘Most Likely to Succeed.’ She longed to be ‘Most Popular,’ but was treated as far too serious, and not ‘really pretty,’ meaning socially attractive. I realized that I had the same mix of feelings toward her as had her

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classmates from so long ago, and that I had projected these feelings onto each of the several potential groups to which I had mentally assigned her. Her acknowledgment of her fears and vulnerability not only gave me important insight into her personality and conflicts, but also alerted me to these heretofore vague countertransference feelings. I now felt more compassion for this woman, and confident that I could facilitate her group placement and help her expand her range of interpersonal options.

Accepting the invitation for personal growth A well functioning psychotherapy group provides a culture of appreciation, caring, and personal growth, for the therapist and patients alike. Genuinely positive feelings develop toward the therapist, who becomes and is treated as special. The appreciation and love of the therapist’s insight, humor, and creativity may surpass the recognition received from the therapist’s family of origin. Therapists may feel anxious, guilty, and not worthy of their patients’ love and gratitude, mistakenly identifying such feelings as defenses against envy, or attributing them to positive transference or excessive idealization. The group is special too, and while it stimulates the therapist’s envy (Alonso and Rutan 1996), it also stimulates loving gratitude. Individual members display strengths of character, patience, insight, and empathic skills, characteristics in which the therapist sometimes feels personally lacking. The group and its members provide self object stabilizing functions, educate the therapist, and modify the therapist’s anxieties, impulses and reactions. Being human, the therapist sometimes distorts and projects personal attractions and repulsions onto others in the group, or finds an element particularly difficult to understand. Group members, not necessarily having the same difficulties, may at times have the greater wisdom. Therapist and patients use group productively, not just pathologically, to satisfy unresolved developmental needs. These include needs for attention, recognition, affect regulation, emotional nurturing, support, and guidance. The group stimulates and satisfies the therapist’s needs for growth and development, professionally and personally. The group is entitled to and benefits from expression of the therapist’s gratitude. I freely acknowledge to members that their group can reach them in ways that I cannot, or have not, and refer often to their contributions in improving my work, as well as personal qualities. For example, in group, ‘You put this much better than I did, thanks for translating me into English’ or, in individual or group treatment, ‘I didn’t

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see that aspect of my personality in our relationship, but I do now, thanks to our group. I’ll try to be more sensitive to my effect on you.’

Clinical example: Appreciating the group’s invitation for growth The chapter concludes with this clinical example. A patient casually commented: ‘I like you better in group, you’re more fun. You look like you’re enjoying yourself.’ I first assessed internally whether I was enjoying myself too much, employing manic or flight defenses in group, or too little in her individual treatment, employing masochistic or dependency defenses. I then explored the question of dual therapeutic identity. Did everyone experience me as different in group than individual therapy, and different in the same ‘fun’ way? I had asked similar questions at various times before, in other groups, and found that the members’ responses often led to interesting and quite divergent views of who I was and how I behaved. This occasion was no different. For, while several members concurred that I was fun in group, but not different from individual treatment, another member, relatively new to my practice, insisted I was hardly present in either modality. From her point of view, I rarely spoke at all. When I did speak, it was not to each individual, but to the group at large. She was satisfied with me, however, because she did not want a therapist ‘in her face.’ Her perception stunned many of the group members, me included, for I actively and frequently pursued her in both therapies, engaging her personally as well as supporting her often-confrontational connections to other members. As she was often in people’s faces, she apparently needed me to be different. Were we a couple, and whom did we represent in her transference? In short order, the group was introduced to her passive and withdrawn husband and father, both represented by me. Her outspoken group behavior revealed how she had conducted herself, earlier in her life as a rebellious daughter to a volatile mother, and presently as a wife, very much like her explosive mother. While she readily agreed with these interpretations, her view of me remained unshaken. ‘Are we having fun yet?’ I asked, in an attempt to extend our one-on-one conversation and demonstrate the reality of a dyadically present and not absent me. She enjoyed the question. However, it now became ‘evident,’ to her but not to any other group member, that I had skillfully turned the discussion back to the group. She had heard the ‘we’ as referring to the entire group, and not to the two of us. I could not shake off her image of me as

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another cop-out male who refused to pair with her. An individual’s transferences are not easily challenged by group consensus! In response to the woman’s naïve but revealing self-presentation, a subgroup of old-timers came up with three stages regarding the two treatment modalities. In the initial stage, after joining the group, they found two different therapists in me, one much less trustworthy in group, but certainly present and ‘out there.’ An intermediary stage involved feeling that they were two different patients, relatively secure in the individual therapy, and much less trusting of the group and of themselves in the group. At a third stage, where they were now, they reported having complementary therapies, each raising important issues and offering unique opportunities. Members who had not been in individual treatment now revealed feelings of jealousy, disparity, and curiosity. Some members, having ‘graduated from individual,’ voiced longing, while others voiced relief. As I listened to the group’s discussion, I introspectively reviewed my own changing sense of identity. Even as I have matured and become more consistent, nonetheless my sense of myself often changes in the group versus the individual context. I began also to experience and review the historical variations in my sense of myself, and in my sense of my own membership in group versus individual therapy. I thought about the group cultures that we had created and modified over time. Traces of past pleasure, pain, sadness, and gratitude – these were my emotional realizations of the group and its evolving, reconfiguring membership, which has contributed so much to my personal growth.

CHAPTER 3

The Basic Conflict: To Think or Anti-think Applying Bion’s Theory of Thinking in the Group Context Early in his writing career, Bion considered the frame of the group, the emotional and mental position of the members contained within it, and the role of the leader. Later, he delved more deeply into the frame of the individual, the position of the individual’s inner world, the social matrix, and the role of the analyst. As a group leader and analyst, he wished to understand ‘anything from a grunt to an elaborate contribution’ (Bion 1997, p.10). He intended ‘to make it possible to discuss something, or to talk about it, or to think about it, before knowing what it is’ (1997, p.10). The contemporary psychoanalyst follows Bion in assuming that an important level of intrapsychic and interpersonal communication takes place on a preverbal level in which thinking and feeling remain partially undeveloped, verbally unarticulated, and segregated from each other (Chused 1992; Renik 1993; Spezzano 1996; Stolorow, Atwood, and Brandchaft 1994). Bion emphasized that emotional meaning evolves over time, and that the process of coming to know and communicate experience is frustrating and involves tolerating pain and uncertainty. A basic conflict exists within the self, and within the group and its members, involving tensions between motives to tolerate, develop, and integrate thought and feeling, and motives to relieve frustration. To be released ‘from the bondage of inarticulation’ (Bion 1970, p.15), the individual must decide to endure the process of thinking.

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Thinking Bion brought a relational meaning to ‘thinking,’ emphasizing that its aim is emotional awareness of self and others. Thinking does not denote merely mentation, intellection, or cognition. Thinking is the process of establishing a ‘mental relationship with a personality – and of that personality’s emotional experience – either the individual’s own or that of another person’ (Bion 1962, p.53). Freud (1918) had formulated the goal of analytic treatment to extend to the patient this type of emotional thinking: ‘knowledge of unconscious, repressed impulses existing in him, and, for that purpose, to uncover the resistances that oppose this extension of his knowledge about himself ’ (p.159). Anticipating relational theory (e.g. Benjamin 1990; Carruthers and Smith 1996; Damon and Hart 1982; Fonagy and Target 1998; Mitchell 2000), Bion thus broadened Freud’s interest in self-consciousness to include affective awareness of other selves, and of the internal and external relations between self and others. Quite early he called attention to that which we might call, in contemporary jargon, relational consciousness-raising, in his writing on psychoanalytic group psychotherapy: ‘I believe that intellectual activity of a high order is possible…together with an awareness (and not an evasion) of the emotions… If…therapy is found to have a value, I believe it will be in the conscious experiencing of…activity of this kind’ (Bion 1961, p.175, my emphasis). Foulkes (1964) described a similar process of translation, which involves ‘the raising of communication from the inarticulate and autistic expression by the symptom to the recognition of underlying conflict and problems which can be conveyed, shared and discussed in everyday language’ (p.69). When our inner reactions, our vague feelings, precursory thoughts, and elusive fantasies about self and others, are captured and verbally represented, and not evaded, we may begin to think about them in a more conscious and unconscious manner. Relational-consciousness generates meaning; it is itself an emotional experience, and it influences unconscious thought. As Freud (1915b) conceived, ‘the Ucs. is alive and capable of development’ (p.190). Mental activity moves in two opposite directions: either it starts from the instincts and passes through the system Ucs. to conscious thought activity; or, beginning with an instigation from outside, it passes through the system Cs. and Pcs. till it reaches the Ucs… The second path must…remain traversable’. (Freud 1915b, p.204)

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The unconscious is not passive, merely receiving and eventually rebroadcasting repressed mental contents. Rather, unconscious thinking contributes an essential primitive, arational dimension to our transformations of experience. The systems conscious and unconscious together provide a ‘binocular’ or correlative perspective on emotions as they emerge, and on reality as it is experienced (Bion 1962, p.53; see also Matte Blanco 1988). The heightened level of consciousness and unconsciousness that I am describing requires a certain level of maturity and self-control. The original function of verbal thought, to provide restraint for motor discharge, has to be deflected ‘to the tasks of self knowledge for which it is ill-suited and for the purpose of which it has to undergo drastic changes’ (Bion 1962, p.57). Thinking is ‘embryonic even in the adult and has yet to be developed fully by the race’ (1962, p.85). Hence our biological need to understand emotional experience strains our current evolutionary limitation.

The basic conflict Like Freud and Klein, Bion postulated basic underlying emotional conflicts within the individual that, while contributing to intrapsychic and interpersonal difficulties, could also stimulate symbol and cultural development, the constructive group participation involved in talking, thinking, and knowing. Freud mythologized an antagonism between the pleasure and reality principles, and between the life and death instinct. Klein narrated a dynamic interplay between love and hate, and envy and reparative gratitude. Bion described, additionally, a deep tension between a basic need for knowledge of emotional experience, and the limited human capacity to bear it. There is a need for awareness of an emotional experience, similar to the need for an awareness of concrete objects that is achieved through the sense impressions, because lack of such awareness implies a deprivation of truth and truth seems to be essential for psychic health. The effect on the personality of such deprivation is analogous to the effect of physical starvation on the physique. (1962, p.56)

The human being needs to feel and think about emotional food for thought. However, meaningful emotional experience does not arise primarily from material experience, that is, with the milk itself, but from the source of the milk and the infant’s relationship to it. To satisfy the ‘need for awareness of an emotional experience,’ the developing individual must first depend on others

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to make sense of experience. Early in development, reality cannot be apprehended and constructed without others. Even for those whose reality sense has matured, frequent social validation remains necessary. The need to understand oneself and others – and its satisfaction – develops in a relational context. Indeed, our very ability to think depends in part on ‘the social capacity of the individual. This development, of great importance in group dynamics, has received virtually no attention; its absence would make even scientific communication impossible’ (Bion 1962, p.185). One motive to congregate in groups is to feel safe, and safety may depend on validating our thinking. In psychoanalytic group psychotherapy, other human beings help make manageable the need to understand and communicate that which we cannot or do not want to feel and understand alone. But, at the same time, there is an aspect of each of us that hates relational consciousness, and this aspect is never more apparent than when a group is asked to think about itself. ‘The group, as being the object of the inquiry, itself arouses fears of an extremely primitive kind…the group is therefore perturbed by fears, and mechanisms for dealing with them, that are characteristic of the paranoid-schizoid position’ (Bion 1961, p.162). Thinking necessarily activates primitive, turbulent emotions, and reinstates powerful early anxieties involving separation and loss, and fear of new and unknown experience. Absence of needed objects (including objects of knowledge such as the complexities of one’s feelings, or another’s) stimulates thinking to the extent to which one tolerates frustration. All objects that are needed are bad objects because they tantalize. They are needed because they are not possessed in fact; if they were possessed there would be no lack… [Thoughts] are bad, needed objects to be got rid of because they are bad. They can be got rid of either by evasion or modification. The problem is solved by evacuation if the personality is dominated by the impulse to evade frustration and by thinking the objects if the personality is dominated by the impulse to modify the frustration. (Bion 1962, p.84)

Thinking hurts. The human being suffers from needing something painful. But fearful of pain, even the strongest sometimes evades what he or she needs, and often chooses instead ways of avoiding thinking.

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The painful nature of thinking Freud (1911a), in Formulations Regarding the Two Principles in Mental Functioning, considered the problem of pain in relation to thinking. The failure of primitive repression or of hallucinatory gratification to dissolve unpleasant aspects of external reality leads to the development of thought and thinking functions. As trial internal action, thought contains but only partially modifies pain, rather than discharging it. Freud conceived of fantasy as the mode of thought activity subordinated to pleasure and not dependent on reality or real objects. Psychotics, borderline individuals, and to some extent all of us, continue to evade pain by evading thinking, by living in fantasy, or by discharging mental stimuli through impulsive behavior. Melanie Klein and her co-workers (Heimann 1952; Isaacs 1952) added to Freud’s formulations. Thinking is painful because it must deal with the unpleasant aspects of internal as well as external reality, those pertaining to the dynamics of the paranoid and depressive position. Klein emphasized that when thinking would be too painfully anxiety provoking, psychotics, neurotics, and ‘normals’ may evade thinking by hallucination, repression, and also by three other basic defenses. These are withdrawal of the introjective–projective processes that underlie thinking; splitting of the self, the object, the mental apparatus and its functions; and projective identification, through which the self disowns split-off elements and places in another (or in a dissociated part of the self ) that which upon consideration would lead to mental pain. These basic defenses may be put to constructive use, as for example, when in therapy the child uses projective identification to put aspects of its conflicts in the physical objects and actions of play, and gradually comes to understand what is represented. Similarly, individuals may verbally and interactionally enact intrapsychic and interpersonal struggles with other group members, and come to understand symbolic levels of meaning. Bion held that thinking inherently involves an exchange of painful, primitive feelings. This exchange involves a recapitulation of the earlier development shifts from paranoid-schizoid to depressive positions into moment-to-moment processes of oscillation between disintegration and reintegration, which Bion (1962) symbolized as PS1 D. As patterns of painful emotional-cognitive experience, PS1 D oscillations participate in all other learning experiences (in complex arrangements with container–contained processes, see Chapter 5, and with the processing of basic affects, see Chapters 9 and 10, on LHK and passion).

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Creative mental activity is not characterized solely by the incremental build-up of manageable experience. Thinking is inherently painful in that it involves intense episodes of emotional turbulence. Learning involves partial disintegration of what is known until a state of ignorance is regained, and meaninglessness and confusion is tolerated. Hard-won new understanding brings its own frustrations, for one has greater clarity about vast areas of the unknown. In striving for a mental attitude of openness, one must give up orienting memory and deprive oneself of the desire to possess knowledge. Words and facts may constrict the thinker to conventional ways of knowing ‘about’ experience, and prevent him or her from freshly experiencing experience. If experience is food for thought, one becomes what one eats and no longer is what one was. Thinking changes one’s identity, and hence also disorients and reorients the thinker to past, present, and future. The person who bears to think and to learn risks ever-greater separation from established, conventional relations with others, as well as with one’s previous ideas. Freud and Klein emphasized that self-knowledge brings forth the primacy of self-integration over repression and splitting; hence self-knowledge brings inner peace and social harmony. Bion emphasized that integration entails also the capacity and the courage for even greater levels of emotional turbulence, existential risk, and personal and social disharmony.

From Klein’s ‘epistemological instinct’ to Bion’s ‘K’ Klein had challenged Freud’s formulations by positing fantasy as an essential mode of thinking about, dealing with, and not evading reality, its painful as well as pleasurable aspects. She considered fantasy to be a mental operation that accompanied and was expressed in conscious and unconscious thinking such as that involved in children’s play and adult creativity, as well as expressed in pathological thinking and defenses against thinking (see also Chapter 6). Bion came to understand that primitive fantasy and other precursory forms of mental activity were important in infancy (and perhaps prenatally), as they expressed a drive to use experience for thinking. As we saw in a previous section of this chapter, Bion compared the hunger for thought content to satisfy the mental organ to the physiological hunger for food to satisfy the stomach. While both sources of hunger are rooted in instinctual need, their aims and objects are located within a psychological, initially maternal,

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context. It is the mental region particularly that is disturbed when material, but not psychological provisions, are offered in infancy. Klein had called Bion’s attention to the ‘epistemolophilic instinct,’ the urge to know, an urge which motivated and expressed a range of realistic and imaginative thought, and which at times required the active presence of other human beings. The importance of this basic drive, which he notated as K, led Bion to revise Freud’s dual instinct theory, and to place the drives within the context of object relations (see Chapter 9, on LHK).

Anti-thinking or minus K In analyzing Schreber’s autobiography, Freud (1911a) concluded ‘paranoia resolves once more into their elements the products of the condensations and identifications which are effected in the unconscious’ (p.49). Freud explained the ‘decomposition’ of mental products in psychotic states as resulting from the withdrawal of psychic energies (cathexes) from reality concerns. When Bion (1967a) turned his attention to the treatment of schizophrenic and borderline individuals, he articulated a ‘psychotic part of a personality,’ which functions actively as well as passively. This part of the personality hates reality, thought, and thinking, and attacks the mental linking processes by which we come to know and integrate our thoughts and feelings. One is not necessarily clinically psychotic when evincing this aspect of personality, of course. Rather that to the extent that one evades or perversely transforms thinking, each personality develops primitive or psychotic subselves, ‘twins’ (Bion 1967b) of our normal personality. To a greater or lesser extent, each of us – and each group in which we participate – hates reality, since it leads to unavoidable pain and anxiety, and hence hates thinking, thinkers, and thought that leads to reality. Bion (1967a) relegated Freud’s definition of the aim of Thanatos to the description of the psychotic part: ‘to undo connections and so to destroy things’ (Freud 1938, p.194). In effect, Bion construed ‘things’ as ‘mental things,’ or meaning. Hence, an element in the personality seeks to evade, forestall, halt, or destroy meaning, expressing the antipode to thinking (K), anti-thinking (- K). In this situation of minus K, that which is activated may persist without adequate mental transformation. Additionally, the individual or group may halt or even reverse the developmental process in which experience emerges into awareness and comes to be understood. Activated thoughts, feelings, and fantasies may be experienced as dangerous, even bizarre, and consequently,

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are denied, dissociated, and projected, where they may be attacked or otherwise controlled (see Chapter 8, section on attacks on links).

Hating thinking Kernberg (1991) usefully delineated levels of the psychopathology of hatred that suggest the extent to which the psychotic part of the personality is influential. In a mild form, the goal is to dominate and control the object, rather than to respond thoughtfully to the interpersonal situation. This occurred in one of my psychotherapy groups, when a member, Sydney, monopolized group process, complaining about his wife’s treatment of him, and pulled for emotional ransom, that is, our sympathy and consolation. He replicated in group the relentlessness that stimulated his wife’s impatience and anger. In a moderately intense form, the goal might be to make the object suffer a victim–victimizer relationship. For example, Sydney accused members who challenged him of being ‘hard-nosed.’ He was easily hurt, and drew attention towards how something was said, and away from its meaning. Feeling like a victim, Sydney tried to victimize others by inducing in them a sense of guilt and failure. In its extreme form, the goal involves a massive devaluation of the hated object and symbolic destruction of all thinkers, which, by extension, includes the self. A sad example involves Myra, a woman who entered group after being widowed at age thirty-eight. She had been a submissive, repressed wife, and came to realize after a few years of cooperative group effort that she had been extremely lonely in her marriage, as she had been in her childhood. She now felt explosive anger toward her parents and her deceased husband, and increasingly indulged in rebellious out-of-group behavior involving nightclub life, often with promiscuous sex, alcohol, and drug use. The group had been her ‘friend,’ she told us, but she was reevaluating us and deciding that we represented a moralistic and conventional point of view to which she could no longer subscribe. To the extent to which we challenged her to think about what she was doing and why, or merely advised her to slow down, we joined the ranks of id-suppressing, enslaving objects of her past life, which included her former self. She hated her past life, hated thinking about it, and came to hate the thought-provoking group and she self-destructed her participation in it.

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The role of excessive projective identification Bion developed the influential idea that psychotherapy patients and groups attempt to control thinking, particularly the analyst’s, by excessive projective identification, reinforced by gestural, paraverbal (e.g. tone and cadence), and verbal behaviors. The analyst may lose the ability to have the ‘moral freedom’ (Racker 1968) to think anything, and may instead feel trapped and ‘manipulated so as to be playing a part…in somebody else’s phantasy…being a particular kind of person in a particular emotional situation’ (Bion 1961, p.149). Likely, the analyst also feels that he or she is not functioning therapeutically. The analyst must ‘shake oneself out of the numbing feeling,’ to be able to think about and make meaning out of otherwise thought-destroying interactions (Bion 1961, p.149).

Clinical example: The dream of the red dress Sarah recounted a troubling dream: ‘I was back at my wedding. I remember my husband, my in-laws, and a lot of people. I thought I was having a good time, and then I noticed that I was wearing a red dress. I hate red dresses and I couldn’t understand why I had to wear a red dress at my own wedding, and why I was wearing it. I woke up very upset.’ Sarah told the dream with a palpable sense of hurt and confusion. But then her emotional status changed markedly, and she seemed no longer the perplexed and pained dreamer, but an assured dream interpreter. She described contributory weekend residues, dramatically detailing the pressures she felt from her husband and his parents to do what she did not want to do. The group’s accommodating compassion renewed Sarah’s sorrow, and her sorrow, the group’s sympathetic warmth. After awhile, I found the group process uninviting, yet felt pressured to continue to share in it. Given that I cared for Sarah and her situation, I first questioned my unanticipated desire to shuck off and rebel against the group’s warmth, and why I felt external pressure to be warm. I reasoned that like Sarah, at her dream wedding, I was feeling pressured to wear a therapeutic mantle – sympathy – not to my taste. Thus, I had the sense of being inside someone else’s fantasy of how I was to behave. I had received the dreamer’s projective identification, its force intensified by group resonance. I had to defy its numbing influence to accept the legitimacy of my therapeutic work I believed I should do. I took encouragement from Bion’s (1970) pithy statement that ‘the pre-verbal matter the

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psycho-analyst must discuss is certain to be an illustration of the difficulty in communication that he himself is experiencing’ (p.15). I said: ‘Everyone seems familiar with the difficulty in doing what one wants to do. This seems to be what Sarah was dreaming about, a difficulty that must exist in our group as well. Could we talk about it?’ A member, Gail, reminded us that during the last session Sarah had been angry with her, finding it effortful and tiresome to ‘read’ her. Perhaps she had read Gail when she didn’t want to, and dreamt about it by being forced to wear a ‘red’ dress. Gail’s attempt to relate the dream to the group process seemed obligatory and overly abstract, and seemed to turn the group away from her and from the further exploration of my request for associations to the group. A divorced man, Peter, volunteered that the dream made him think of his wedding. He loved his wedding, but he didn’t love his marriage because he was forced to do what he didn’t want to. Josh amusingly described his wedding where he did just what he wanted to do. There was an extended and increasingly animated talk of weddings, and then finally, the group turned back to the dreamer. How was Sarah feeling? they asked – and Sarah repeated and expanded on her sorrowful difficulties at home. We were back where we started! The members were doing just what I did not want them to do. I brought to the members’ attention that, since they were ignoring my question and me, they must not want to do what I wanted, but they did not want to think, much less to talk about it. Peter insisted that he respected and listened to me. He was getting ready to think about the question. ‘What question?’ Josh asked, professing not to have heard it. ‘I enjoy reliving my wedding, more than living my marriage!’ Gail reminded us that she had complied and had responded as I had asked but, as usual in her life, no one seemed interested in what she had to say. Was she boring? I said that if she merely complied she was not doing what she or I wanted. This would be boring, even to herself. Sarah became indignant. I was attending to everyone but her, and she was alone and abandoned, just like in the dream. No wonder she ends up doing what she does not want to do. She might as well just shut up and not participate. I protested affably that I was not ignoring her, but being ignored. I was thinking about her dream and encouraging the group to do likewise. But the group wanted either to give sympathy, or to party together. Sarah thought sympathy would be a good idea, but that since this was obviously beyond my emotional capabilities and against my principles, she might as well do what I

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wanted. I wondered why thinking was doing what I wanted, and not what all of us wanted. Peter acknowledged sheepishly that he would rather party first, and think later. Much later! When away from group he often ‘shelved’ us, as he once did with his schoolbooks, and indulged in doing what he knew he should not do, with the excuse that he would buckle down later. He was now approaching forty years old, he added sorrowfully, and maybe later should be now. Mike, who had not spoken, said that when a woman becomes upset, he does not think about what he wants to do, but often becomes panicked, and thinks what he should do to take care of her. ‘I was thinking of Sarah’s unhappiness, and not of your question.’ Another woman, Joan, said that she could not do what she wanted to do because all the men preferred taking care of Sarah! Her jealousy was greeted with good-natured groans, for it was quite familiar to the members. Josh, who had professed not to hear my question, volunteered: ‘I guess this is why I don’t hear so well! I don’t want to be controlled by you, Joan, or Sarah, or you Richard, or anyone.’ Sarah listened to these responses, and although she attempted to maintain a haughty defiance, an understanding smile broke through in my direction. The group was doing what I wanted them to do, and I believe profited from exposing, understanding, and overcoming their resistances to think. CASE DISCUSSION

Sarah’s verbal report and accompanying paraverbal and nonverbal behaviors formed a subtle yet forceful combination of distress and influence, and exemplified excessive projective identification. One effect was to stimulate a group of nonthinking cohorts. Individuals personified nonthinking in different ways. For instance, Gail became intellectually compliant, and did not think for herself. Peter ‘shelved’ his thinking. Josh professed not to hear and hence, without input, he would not be stimulated cognitively. Joan discharged her jealous thoughts through histrionic verbal behaviors. And finally, Sarah maintained her attitudes of inconsolable hurt and righteous indignation. Thus, mind-numbing sympathy, panic-based caretaking, and mental evasion epitomized group process. I had defined my job as bringing meaning to the situation, which meant revealing and exploring the group’s efforts at nonthinking and no meaning. I quickly became the receptacle of bad object projections, ‘being a particular kind of person in a particular emotional situation,’ ‘forcing’ the dreamer and

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the members projectively identified with her to do what they did not want to do, that is, to think self-consciously, and they did just the opposite. Eventually, individuals began to think about not thinking, and why and how they had done so. They made personally meaningful their contributions to a thought-resistant group subculture – the injustice-collecting, compliance, panic, reactivity, and habitual avoidance – their very difficulties necessitating psychotherapeutic treatment.

Thinking as dangerous and bizarre Bion related the Oedipus myth (also, other myths including the Garden of Eden and the Tower of Babel) to a pervasive unconscious fantasy that links thinking and verbal communication to loss and destruction of good objects. In the myth, the Sphinx is a bizarre object, with the head of a woman and the body of a lion. She is unnatural, but also fiercely antinatural, using her mind to destroy others. She incites interest and curiosity, tantalizing Oedipus with a riddle regarding the nature of the human being. (What walks on four legs, then two legs, then three legs?) Unlike all who preceded him, Oedipus solves the riddle and seems to survive the challenge. The Sphinx responds furiously, fragmenting her own mind and self into bits. But Oedipus’ experience with this bizarre object damages his relational consciousness. The tragedy unfolds as he loses the ability to think about and recognize himself and others until it is too late. Actions taken by the therapist or another member to provoke consciousness – which often involves uncovering areas of intrapsychic and interpersonal disturbance and conflict – may become confused or conflated with actions taken perversely to provoke or create turmoil. Unlike the monstrous Sphinx, where thought was an explosive object with tragic consequences, in group, thought can be explosive with therapeutic outcome. A group member complained facetiously: ‘I didn’t want to come back; you guys are destroying me, taking away my hero, my Dad.’

Clinical examples: Therapist as bizarre object 1. A man established a habit of breaking into the group process to ask me questions, such as ‘What do you think, Rich?’ ‘What would you do?’ ‘You think so?’ At the end of a session he would launch into a topic he felt pressing and needing resolution. He insisted that I was being unfair and arrogant if I ended the session on time, particularly if I did not first say something to help

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him along until the next session. At first, other group members, while taken aback, also found him charming and they were curious whether and how I would answer him. They soon tired of his behavior, and joined in my efforts to call attention to his conduct and his possible underlying motivations. But these interventions only gave him a headache, and he often departed with another unanswered question: ‘Is therapy making things worse?’ The patient’s demanding need-to-know was actually -K, since it served to frustrate his innate capacity to function psychoanalytically and impeded his growth and development. He experienced thinking as a distracting symptom, an intolerable ache to understand and to be understood. The cause of the patient’s pain was, in part, the unavoidably frustrating nature of reaching insight, which he did not want to tolerate. Because I subjected him to the reality of the learning process, rather than solving (or dissolving) the necessity of learning, I became personified as a spitefully withholding analyst, one who had no good reason to hurt him. ‘Come on Richard, be human,’ he would taunt me. From his perspective, he had no choice but to rebel against the bizarre outbursts of my capricious will. 2. A new member presented herself in an abstruse, unrelated manner. She tended to analyze other members, and could not bring in spontaneous, much less irrational feelings. She shortly exasperated some of the members, who developed a range of hostile responses from rage to disregard. Their reactions initially served a valuable function of informing her how she could alienate her husband and children, and she was grateful and vowed to work on her difficulties. However, progress was quite slow, and I began interceding more frequently, in an effort to move her along and avoid unnecessary frustration and pain. It took a while to realize that she was responding quite negatively to my interventions, for she would smile and struggle to get to the point. I took it as a sign of progress when she began to protest that when I asked her how she felt, or made an interpretation, she found me to be critical, even purposefully humiliating. She reported my interventions, and soon my very presence made it difficult for her to think. ‘You change from Dr. Jekyll to Mr. Hyde!’ The group supported both of us in this situation, encouraging her to express these feelings, but also defending my curiosity as therapeutic and caring. The deepening group work, supplemented with occasional individual sessions, did not dissipate the force of her feeling interrogated, microscopically cross-examined, even tortured, by the mere expression of my interest. ‘You need to be controlled,’ she laughed, but also meant what she said. For

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several years I was constrained to look and listen sympathetically, and even in silence, I could be perceived as critical and disapproving.

Clinical example: Dream segment of group members as bizarre objects Sydney, the group member discussed above in the section on hating thinking, reported the following: ‘I have to tell the group this weird dream: Josette and David are sitting where they are now, across from me on the couch, and I have a violent argument with Josette. I’m afraid to say it, but I even cursed at her. David thought I was right, but he didn’t support me, and I was very hurt. Josette and David looked very strange; their heads and bodies were tilted away from each other, very much to the sides, as if they were pretzels.’ The dream replicated a familiar group dynamic that had played out the previous session. Sydney provoked Josette, setting off an escalating verbal battle, from which she finally withdrew. Typically, Sydney felt hurt and puzzled by the group’s lack of support. The visual dimension of the dream was new, however, and stimulated a range of interesting associations from other members: ‘You bend people in group out of shape, and then you react like it’s their fault.’ ‘Your world is out of Picasso. Everything is disjointed and doesn’t quite fit together, yet it is also kind of familiar, but it still is very unsettling to you.’ ‘You see other people as strangely tilting away from each other, and from you, twisted and brittle. You don’t really get people, but we’re really available; even Josette and David care and would bend for you if you would act different.’ ‘You have to become more flexible, think what you are doing; you don’t have to turn yourself or anybody else into a pretzel.’ Sydney did not offer his own associations to his dream, or take up and carry further the thoughts of other members. I had the sense that he felt bizarre in constructing the dream, and the relief was in dispersing its contents into the group and receiving positive attention in its place. Advancing his self/other consciousness was not a motivating or rewarding aspect of the experience. Possibly, Sydney misunderstood the group’s very insistence that he should think, rather than merely get assistance, as demanding, unempathic, and bizarre.

Transformations in hallucinosis Freud (1920) observed that ‘most of the unpleasure we experience is perceptual unpleasure’ (p.11). To momentarily avoid unpleasure, individuals may exhibit ‘transformations in hallucinosis’ (Bion 1965). The receptive

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apparatus, rather than receive and integrate unpleasant reality, may also work ‘in reverse,’ to disperse, eject, and misperceive reality. Other group members, particularly the therapist, serve as the basis for visual, auditory, olfactory, or tactile distortions, illusions, negative or positive hallucinations. For instance, when the therapist unsuspectingly turns away, or registers blankness or lack of interest, bodily and facial movements may convince the member of having been perceived as wrong, stupid, and bad. The individual then may relate to the group with a baffling attenuation of self-confidence and trust. Such ephemeral, imagistic interactions may have enduring negative consequences, unless brought forth, articulated, and worked through. Hallucinatory transformations are common and frequent, particularly in moments of stress, such as during interludes of intense transference or countertransference. Transformations may be subtle and difficult for the clinician to appraise, and since they may be transitory, simultaneous with normal perceptual processes, they may evade recognition. For example, I fortuitously pursued a group member’s assertion that she did not like me right now. She responded with a relieved smile: ‘Oh, I thought you said that you didn’t like me. It’s okay if I don’t like you. Now I like you.’ The exchange became a salutary model, as the woman realized that she often did not like people because she quite literally perceived them as not liking her. She resolved, in her words, ‘to take a second look.’ I consider whether group members are describing phenomenological and not metaphoric experience when they report: ‘I’m dreaming, this couldn’t be real,’ ‘My eyes are deceiving me!’ ‘I don’t believe my ears!’ ‘This feels strange!’ and ‘My memory is playing tricks on me!’ ‘Did you say that, or am I imagining it?’ ‘When you moved that way, I saw you getting ready to hit me.’ Just like immune responses, which can cause more pain and damage than the disease that they are trying to relieve, transformations in hallucinosis, like other defense maneuvers designed to evade unpleasure, can become more painful than the dreaded thought. Hallucinations may become quite disagreeable to the perceiver, and also to the receiver. The therapist may become anxious or confused in response to a member’s defensive anxiety and hallucinatory transformations of the relationship. In terms of countertransference, when uncertain or insecure, the group therapist may rigidly draw upon theory, and upon hallucinatory relationships with authority figures that represent theory (see Chapter 4, on entitled thinking). Grossman (1995) described an underlying hallucinatory level of mentation, connected to the analyst’s professional identification and affilia-

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tion: ‘The fact that theory (along with related ideas about technique) is psychologically related to authorities who represent it gives it a status analogous to shared daydreams’ (p.889). Like other group members, I am liable to misperceive or mishear, and I am comfortable asking an individual to repeat him or herself, to ascertain whether I experienced momentary hallucination. I find it useful on occasions to disclose my misperceptions for mutual analysis, or utilize them interpretively. For instance, when a patient took an unaccustomed seat in group, I was visually surprised to discover him occupying more of a physical space than my image of him suggested. I interpreted his action as his resolve to become a larger presence. At different times, I may ask individual members or even an entire group, whether they are angry, confused, anxious, happy, or unhappy with me, ‘or am I just hallucinating?’

Thinking and non-thinking in group life One measure of the vitality of the individual and the group is success in stimulating and supporting thinking and accepting interventions regarding anti-thinking. Thinking and anti-thinking describe psychological dimensions of the individual’s consciousness and unconsciousness, and of group’s structure, culture, and process. In the following description of a group session, I apply this seminal concept of the basic ambivalence about emotional thinking.

Case example: Working through anti-thinking, bizarreness, and hallucination A group with five members present began with Bob reporting a confusing incident with his wife. Newly pregnant, she told him at a restaurant to please remove the potato chips from her plate, as they were making her nauseous. This suddenly and perplexedly reminded him of his bossy ex-wife. Then she exclaimed: ‘I didn’t get the pickle I ordered!’ Should he have gotten the pickle for her? She was perfectly able to ask the waiter for a pickle, but if she wanted him to do it, she should have asked directly. He wondered if he had been overly picky, as if talking to his bossy mother as well as ex-wife. He knew he got angry too easily, and he hated that he was slipping into his old ways. Marge empathized with Bob: ‘Maybe you don’t want to read her signals, if she doesn’t read yours.’ She added that she used to feel deprived in her marriage when her husband would not read her signals, since she easily antici-

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pated and accommodated his needs. Bob pressed her: ‘Used to?’ Marge said, ‘Okay, I still feel deprived but I don’t want to think about that.’ Mike, a new member, marveled: ‘I can’t believe how you [Bob] think about relationships. I would have just gotten my wife the pickle, not thinking about what she was doing, how I was feeling, and what I wanted to do. I’m just beginning to think the way people do here, but I find it doesn’t last all week, and I need the shot that group provides.’ Bob thanked Mike for the feedback. He explained: ‘First you think in group, then you take group with you, and then you start thinking that way in your outside life. But when you don’t want to think, you can just put the group out of your mind and go back to business as usual.’ Marge reassured Mike that she was not that far ahead of him. Bob just showed how she still avoided thinking about what troubled her, and preferred to deny problems and put them in the past. Her thoughts remained with Bob: maybe his new wife wasn’t up to his level, and he needed to give her time to relate to him, and to herself. Or was she talking about her husband, and not Bob’s wife, letting him off the hook? Mike returned to the subject of how people in group explored relationships with each other, and also were able to explore their own minds. He reflected that he must have spent much of his life out of it, not looking too closely at how he felt, and maybe that was because he didn’t like how he felt and couldn’t do anything about it. His parents were very controlling, loving but controlling. As he elaborated on his parents, a vocal flatness, now familiar to the group, began to assert itself in his communication. With a new sense of self-awareness, Mike stopped: ‘I feel dead-ended. I can’t think any more about the subject. This is usually when I sound dead and people accuse me of not expressing any feelings. I better stop while I’m ahead.’ The other members present, Ann and Lela, had remained quiet, and I asked them about it. Lela claimed that she could not get involved in group tonight. She wasn’t sure what she was getting out of it. Marge, unexpectedly brave, said that Lela wasn’t putting anything into it. Lela agreed, but insisted that what the men were talking about didn’t apply to her. She was pretty certain about what was going on in her own mind. She was worried for Bob, and hoped his new marriage would work out, but what else could she say? The group had warned him not to rush into marriage, and she didn’t want to be an ‘I told you so.’ Ann echoed Lela, claiming that she also wanted the best for both men. She hoped that Mike would catch on soon and begin to get it, because the

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group certainly had drawn his attention to how he repeated himself and remained out of it. Bob objected, pointing out that Mike had been different in this very session. Marge then continued: Lela and Ann could say plenty if they put their minds to it. She had spoken up, and had gotten something back from Bob that she would have to think about and bring into her marriage. She felt abandoned by both women; they weren’t appreciating what she was doing, or what Mike and Bob were doing. I offered that Lela and Ann seemed to have a purpose in not participating. They were quick to notice what wasn’t changing, but not what was. Lela dryly acknowledged that we all sounded like her husband, who had the same complaints. ‘He says I don’t appreciate how much he is trying, and that I accuse him of not relating, but it is I who doesn’t relate to him.’ Ann said that she had the same husband. ‘My husband is right, I don’t want to relate to somebody who isn’t relating to me. But I’m not being impatient and critical now. I’m here, I’m listening, and I can see that Mike is really trying.’ Mike turned to the two women: ‘Ann has an open mind, I have a chance, but with you, Lela, it’s “no sale.”’ Lela got teary and frustrated with herself. ‘I can’t do it right. If I speak I’m too negative, and if I don’t speak I get accused of being withdrawn. I don’t mean “accused;” there I go again.’ I suggested that Lela was struggling with a critical mindset that was difficult to change. ‘I know, I know,’ she smiled, wearily, ‘it is my mother’s mindset. I never felt I was doing anything right.’ ‘You were no sale,’ I reflected, then returned to the question of the purpose of the two women’s silence, which I felt hadn’t been explored. Did they think the silence had an effect on the three members who were participating? ‘Of course,’ Lela responded, impatiently, ‘they didn’t like it. I know that, they told me. There I go again, being hostile and negative.’ Mike said that when they were quiet, it made him feel bad about himself and he didn’t feel encouraged to talk. Bob said that he could get very angry with Lela, and give up and withdraw. He still does that at home, but doesn’t want to do that here. Marge continued the theme of feeling hurt and abandoned, and deeply affected, again asked why the women would want to treat her that way, just when she was being different? While Lela and Ann did not directly answer Marge’s question, they respected the feedback, taking note of the effects of their behavior on the group.

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CASE DISCUSSION

The movement and contra-movement of the group and of the individual members and their subgroups may be understood through reference to the conflict regarding emotional thinking. To review briefly. The nonpsychotic part of the personality carries out the thinking. In therapy, this element acknowledges self and other, and struggles with the emotional realizations that follow from introspection and interpretations. Similarly, the work group (W) recognizes and carries out the verbal activity involved in the need to develop mentally, and copes with feedback and other forms of group activity. The W group remains interested in reality and emotionally processes the group leader’s interpretations. A caveat is in order: a ‘pure’ W group becomes hyper rational and sterile, and needs the input of primitive emotion and thought. The psychotic part of the personality defends against significance by attacking the mental linking processes by which we come to know and integrate our thoughts and feelings. Similarly, the basic assumption level represents that aspect of group life wherein individuals preclude, evacuate, or suppress developing thought and feeling, and collude to defeat making meaning and meaning-makers. Bob first articulated the intrapsychic conflict between thinking and anti-thinking, describing his difficulty maintaining reality-based thought and behavior in relation to his new wife. Who was his new wife, and how should he think about her? Relational thinking includes recognizing and utilizing transformations emanating from the psychotic parts of one’s personality. Bob grasped that he was capable of calling up illusion/hallucination of his ex-wife and mother that affected his thinking, and utilized his self-report to reclaim a reality relationship to his own mind. Marge realistically thought about Bob’s marriage, but retreated to illusion when considering hers. Bob playfully confronted her mental evasiveness when he quoted her: ‘Used to?’ He brought to her mind her current and not merely past feelings of marital deprivation, to which Marge frankly admitted. Here we see a mutually receptive, thought-advancing W subgroup in action. Mike joined this subgroup, appreciating the entire group’s role in inducing and supporting his budding emotional self-consciousness. Bob resonated with Mike’s need for group, conceding that he diminished thinking by avoiding thought of the group. Marge expanded on the theme of not wanting to think in group, such that she might forestall dealing with the unpleasant but ongoing realities of her marriage.

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Mike demonstrated progress in relational consciousness, as he reflected on how other group members use their minds. He abstracted from the here-and-now, to put forth a personally meaningful hypothesis of the there-and-then that connected his previous mental inactivity to painful childhood experiences of powerlessness. He monitored the vitality of these thoughts, noting the effects of his communications on other members (‘This is usually when I sound dead’). Ann and Lela personified the anti-thinking dimension of individual and group life, which seeks to a ‘superiority in potency of UN-learning’ (Bion 1962, p.98, his capitalization). Their loud silences sought to ‘undo connections and so to destroy things.’ As Marge stated, Lela was not putting any thought into her experience. She was however, putting in anti-thought, and like Ann, ‘minus-ing’ the reality of the productive group work. In effect, the two women were demonstrating the very anti-thinking characteristics they had projected into the others. The mind-controlling ‘mindset’ of the psychotic part strives to make others believe that, in thinking, they are not thinking, never doing anything right (see Chapter 4, on entitled thoughtcontrol). As a bizarre combined object, Lela-Ann dispensed negative hallucination, hurt, and abandonment, discouraging talk and relatedness, at those very moments when individuals were being different, thinking, and thinking about thinking. In terms of the theory of basic assumptions, Lela and Ann formed a fight/flight subgroup (baF/F). The W group – Foulkes’ ‘group matrix’ – tolerated identifying, thinking about, and learning from the women’s efforts to sabotage the reality of the members’ progress. Thus, the movement and contra-movement of the group, in which the conflict between thinking and anti-thinking, between the sophisticated and the primitive, was played out intrapsychically and also between individuals and subgroups, ultimately benefited all the members. As in the previous example involving the dream of a red dress, a group or subgroup colludes to avoid emotional thinking, but in deciding to think, each member articulately represents himself and his relationships with others.

CHAPTER 4

Entitled Thinking, Dream Thinking, and Group Process Nothing hurts like absence. Absence signifies the ‘no thing,’ an anxious thought, and a space for thought, confronting member and therapist alike with the conflict over thinking described in Chapter 3. Let us review developmental postulates and hypothetical sequences. First confronted with the painful experience of missing, such as in missing a needed good breast, the infant hallucinates a good breast. When hallucination fails to provide adequate gratification, the infant does not initially organize this experience as an absent good breast, but the infant experiences pain in the form of a hallucinatory ‘bad breast present.’ To reduce the pain, the infant may attempt to reinstitute the fantasy of a good breast present, or it may choose to evacuate the experience by muting, numbing or otherwise closing off sensory, affective and cognitive processes. The dawning moment of the realization of ‘no breast’ or ‘no thing’ is the beginning of object permanence. Object permanence involves recognizing absence of the object – the object exists but is elsewhere – and thus tolerating absence as an idea. The capacity to achieve negative realization is a crucial cognitive and emotional milestone. ‘Missing’ is not a bad breast present, but an idea of an absent good breast. ‘Something is missing’ is, then, the first abstract thought, the first foray into meaning-making and the discovery of truth. The reality of separation is tolerated and is named, or titled. What follows from this thought is the possibility of other abstract thoughts. The individual develops a maturing ‘capacity to be alone’ (Winnicott 1958), to think about experience. The external world, and eventually the internal world, begin to exist as a not known, a space to be mentally discovered and explored (Boris 1994; Eigen 1995a, 1995b). Thus, absence provides the opportunity for meaning. But making meaning – the process of discovery as the individual thinks through 89

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experience – repeatedly confronts the thinker with awareness of one’s powerlessness in controlling the realities of separation, and of ambivalence toward those from whom one is separate. The self faces the essential aloneness and temporality of the human condition, the limits of knowing, of being special, and of having one’s wants and needs met. In suffering meaning, the self is susceptible to experiencing the no breast, signifying absence, as the bad breast of unsignified pain. In these circumstances, even mature individuals may seek relief through the path of hallucination and illusion. As reviewed in Chapter 3, Bion described a psychotic part of the personality implied in Klein’s writings. This immature or narcissistic aspect of the self defends against full participation in the meaning-making process, and instead cultivates defenses to forestall, evade, distort, or attack thinking and thinkers. This chapter calls attention to entitlement, a type of narcissistic thinking and resultant interpersonal behavior prominent in the mental life of individuals and groups. Pained by absence, nonpossession, and nonbeing, the entitled individual, subgroup, or group lives out the fantasy of being able to possess as concrete objects thoughts and thinkers, rather than to think thoughts with thinkers. Entitlement essentially involves then, possessing the ‘right’ to choose how, if, and when to think, combined with the right to pass judgment on what the others are allowed to think. Stemming from the word ‘title,’ entitlement has its roots in the context of rank, as in giving someone a title and special rights over others, and in the context of a right to a possession, as in having a title to a property. Entitlement may be inhibited as well as exaggerated. In inhibited entitlement, the individual, subgroup, or group may feel without rights to think, feel, and express an independent point of view, or powerless to assert these rights, in a world of powerful, possessive others. Like exaggerated entitlement, inhibited entitlement avoids absence by maintaining a mental attitude of presence, but the location of presence remains in others. The right not to think and generate fresh meaning is disguised, played out in depression, self-effacement, passivity, and social and mental withdrawal. Still, an interpersonal element of influence and control persists in the subtle expectations and demands of those who overtly renounce independent thought and behavior and suffer quietly. In entitlement, ideas, memories, and feelings are conscripted and possessed on an ‘as need’ basis, mentally manipulated as though they were material possessions, rather than considered denotations of psychological objects, the latter referring to tentative and changeable objects of and for

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thought. In exaggerated entitlement, these inner and outer concretized mental objects are hoarded and utilized by the mental apparatus as the infant once utilized hallucinations, to supply what is missing, and dispersed when they fail to satisfy (Coen 1988; Ladan 1992; Shabad 1993; Stark 1994). In inhibited entitlement, the individual, subgroup, or group forcibly or willingly submits to such treatment, in effect, playing a reciprocal part in an intersubjective fantasy of possessor–possessed, master–slave, sage–fool, and so forth. Entitlement involves, then, intrapsychic and interpersonal maneuvers that work to define, reify, and control feelings, ideas, morality, and certain behaviors. Freud (1921) called attention to this entitled process when he described how individuals and groups might unify under the standard of an ideal, with a cost of impairment of intellectual functioning. Freud (1930) observed that groups give rise to ‘a narcissism of minor differences,’ in which the group attacks that which falls outside it. By entitling their own group as ideal, and projecting hate and badness outward, group members feel compensated for the wrongs they suffer and the sacrifices they must endure within their own unit.

Adaptive aspects of entitlement The omnipotent bending or even subverting of reality may serve adaptive functions. The utilization of entitled thinking may protect the individual from fear, anxiety, or despair. By protecting the individual from an initial, overwhelming shock, gradual acceptance of unavoidable pain may be allowed. Entitled thinking may foster healthy optimism, rather than pessimism. A sense of being special, and an exception from life’s harsh realities, makes the impossible, possible, the improbable, probable. It contributes to the joy of fantasy, potentially to problem solving, and to creativity in general. The capacity to gratify entitlements based on partly irrational but not essentially pathological fantasies and desires motivates assertive behavior, bestowing aliveness and zest for living. Entitled thinking, while irrational, may also serve healthy and normal functions, and has its place in each stage of individual and group development. What may be pathological in one stage may be appropriate in another. A socialization process in which one continues to feel special, meaning loved, accepted, and understood, assists in establishing a ‘balanced feeling between one’s own needs and the slowly dawning realization of the desires and rights as defined by others’ (Dorn 1988, p.25). The confident toddler, child, or adult

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continues to express many needs and wants, but with an ever greater appreciation of the reality of the separate existence of others who have equal rights to feel, think, express, and expect.

The perception of the group therapist’s counterentitlement Shakespeare’s Richard III, whom Freud (1916) considered the embodiment of pathological entitlement, took particular pleasure in the interactional process of taking over Anne’s mind, not in seducing Anne herself, whom he promptly discarded upon marrying. Richard revels: ‘Ha! Hath she forgot already that brave prince,/Edward, her lord, whom I some three months since,/Stabbed… Upon my life, she finds…/Myself to be a marvellous proper [i.e. handsome] man’ (Richard III, Act I, Scene ii). An unfortunate fate of seduction and abandonment may await the group therapist whose mind and actions are overwhelmed by group members’ exaggerated and inhibited entitlements, or one’s own. It may seem to be a curious imaginative stretch to place the empathically inclined, dedicated group therapist in the clinical domain of such characters as the villainous Richard III, and to place patients in the role of Richard’s victims. I contend that group members (and supervisees, as in the example below) frequently make this unconscious association, experiencing their therapists as grasping for power and mental control, insisting on their way, and seeking revenge when thwarted or feeling constrained. This assessment of the group therapist’s thinking and unconscious, or even conscious, motivations may press upon members’ awareness precisely when the therapist approaches their entitlements. It is a given that the therapist and patient each have a view of what constitutes legitimate – or illegitimate – entitlements to certain ways of thinking and behaving. But neither view is necessarily invalid, or even transference dominated. Thus, the members’ or entire group’s reaction, while having a defensive aspect, also may be a thoughtful criticism of the therapist’s technical as well as personal contributions to the interactions. This understanding differs from traditional conceptualizations about entitlement, which emphasize narcissistic thinking and relational configurations of the patient, while neglecting the therapist’s dynamics and contribution to the interaction. To remind the reader, the basic premise of the relational approach is that clinical data are mutually generated, co-determined by the organizing activities of all participants in the reciprocally interacting subjective worlds of the group. Hence, it is important to consider contributing

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subjective factors of the group therapist, such as authoritarian and regressive tendencies, the bias of one’s diagnostic and technical orientation, as well as of countertransference, on what is perceived to be pathological entitlement, and the group therapist’s level of tolerance for perceived entitled thinking and behaviors in others. In some instances, there can be a conflict between values concerning entitlement, quite apart from transference and countertransference per se. Clarifying the difference in values may sometimes relieve impasses and stalemates in treatment or in supervision.

Clinical example: Entitlement controversy in supervision I discovered that a new supervisee, in her expressed desire to be fair and considerate of her group’s wishes, functioned as a bookkeeper-therapist. In addition to telephoning insurance companies and advocating for her patients, and filling out their many forms, she had developed an intricate system of exclusion of payment of fees. Each member was entitled to three weeks’ vacation plus no charge for legitimate absences, including illness, last-minute childcare, open school night, and so forth. This accord also necessitated extensive phone contact, as each patient’s monthly absences had to be discussed and accounted for. On questioning the therapist, I found that her arrangement bothered me but not her, and I wondered to myself what she was getting out of the bargain. Later, in attempting to return a telephone call from the therapist, I reached her answering machine, which conveyed an urgency regarding when and where she could be reached. The message ended with: ‘I will make every effort to return your call within the next two hours, and certainly within twenty-four hours.’ It seemed that the therapist bargained to establish an elaborate and quite defined relationship with each patient, who was to be treated as very special. Whereas the therapist’s manifest motives involved accommodation, in my opinion, they were directed, perhaps unconsciously, to preoccupy and control her mind and the minds of her patients. I could rarely break into the supervisee’s thinking, which I often found to be rigid and out of touch with the realities of sensible clinical practice. I suspected that she found my thinking equally untrustworthy, and for this reason, attempted to numb my mind by presenting her work in such detail that I had difficulty concentrating. I developed a fantasy that she was in supervision to supervise me, which I utilized by directly asking her for guidance. I said I felt not particularly useful to her; could she define an area of dialogue where my input would be of some value?

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She seemed taken aback, perhaps wounded by my request, which made me feel that I had gone too far. Was it what I said or my delivery? I wondered to myself. But then, she laughed, ‘I guess you’re saying I’m not letting you in.’ We entered on our first genuine discussion – a moment of mutual recognition – in which she acknowledged her fear of me, of what I valued in a group therapy, and of my taking her over and controlling her way of doing group.

Interacting dynamics of power, entitlement, and counterentitlement The group therapist’s appropriate expressions of power, to which he or she is legitimately entitled by the nature of the psychotherapeutic situation, are not always easily segregated from the irrational entitlements that relate to one’s anxieties in bearing feelings of power as well as of powerlessness (see Chapter 2). Freud (1916) himself implied a symmetry between patient and analyst when he candidly acknowledged the universality of entitlement: ‘We all demand reparation for early wounds to our narcissism, our self-love’ (p.315). When asserting professional prerogatives, as in intervening in the individual work to suggest group, analyzing resistances to group, making group interpretations, or remaining silent, the analyst may be influenced both by a realistic consideration of technique and by irrational attitudes of restricted and exaggerated entitlement.

Extended case example: ‘Monstrous’ entitlement Ralph, a member who quickly established himself as ‘co-leader’ of a group of a year’s duration, regularly brought from the waiting room a red chair, which he placed directly across from the therapist. His self-described ‘bad back’ made him an exception from the other members who sat on a semicircular beige sectional sofa. Like Ralph, other members had special problems that demanded sympathy rather than insight. One woman talked considerably about her family’s medical ailments; another obsessed about finding a mate; a third, recently remarried, remained unreassuringly ‘depressed.’ A fourth missed sessions when ‘too upset’ by her husband, but the group cooperatively brought her up to date. The fifth referred frequently to his ‘private psychoanalysis,’ a tantalizing but ignored reference to his special relationship with the therapist. Two silent members had special excuses: a graduate student professed excessive youth, whereas an isolated man claimed social inexperience.

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The therapist, bringing this situation to my supervision, felt unable to assert her influence. She felt she had created a Frankenstein monster: a twelve-step selfhelp program rather than a psychoanalytic therapy group. When the therapist tentatively attempted a discussion of a person, rather than of a person’s problems, she was met with confusion, protestation, or silence. She took the group’s reactions as a communication that she was being premature in her interventions, and would become inactive. The therapist’s reference to Frankenstein reminded me of Freud’s (1916) evocation of Richard III. Freud formulated that in Shakespeare’s drama, the protagonist’s physical deformity motivated and provided the rationalization for his monstrous behavior. He took compensation in following the pleasure rather than the reality principle in thought and behavior, irrespective of the negative consequences to himself as well as others. Jacobson (1959), in elaborating on Freud’s study, emphasized that Richard III, and individuals like him, in striving to be an exception, pursue a ‘revengeful wish for power’ (p.138), linked to ‘archaic, narcissistic destructive’ strivings (p.137). For Richard, his goal was the kingdom, symbolically, the paternal penis, and on a deeper level, maternal love and acceptance. I had the sense that each member, no matter how unhappy and masochistic, secretly strove to be king. Like Ralph, the ‘co-leader’ with the bad back, each was deformed with special problems that excused the necessity of responsive psychological functioning. I hypothesized that traumatic early experiences of psychic damage, rejection, and victimization were likewise left unsymbolized in language, leading to the symptomatic special problems which, like all symptoms, hide, displace, and discharge anxiety. The members collusively took turns being exceptions, compensating for underlying feelings of impotence with exaggerated entitlement claims. My technique of supervision is to invite, when appropriate and without trespassing on the therapist’s boundaries, consideration of the therapist’s countertransference, and of the supervisory relationship (Gediman and Wolkenfeld 1980; Lester and Robertson 1995). The therapist reported going crazy sitting in the group. Thoughts of murdering Ralph provided scant consolation for excruciating feelings of frustration. She also felt guilty for such reactions, and wondered about her professional competence and psychological balance. I commiserated and, with some irony, said that the group had become her ‘special problem.’ She seemed victimized by the members and did not exercise her professional entitlement to lead the group. She listened intently to what I

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had to say, but seemed unrelieved. Perhaps she was merely uncomfortable with group process, she wondered. She protested, apologetically, that my formulations seemed harsh and judgmental. She felt protective of her patients, and wanted me to help her help them. Because we were involved in supervision, and not in therapy, where I would have greater access to unconscious processes, I generally acceded to her manifest wish, and would work with her on patient and group dynamics, rather than on what might be transpiring dynamically in the supervision. I acknowledged that it was quite possible that I was unduly critical of the therapist’s technique and rejecting of her group’s level of development. Did I need her to conform to my ideas? I wondered to myself. Whereas I like to believe I democratically raise pragmatic possibilities, it is likely that I also convey autocratic expectations. In time we understood that our relational patterns had parallels in group. Although the members portrayed themselves as needy and helpless, each maintained preemptive power. Having special problems had distinct advantages over solving them. The exaggerated sense of being life’s victims camouflaged and provided the rationalization for an entitled refusal to think psychologically (see Chapter 3). Similarly, in the supervisory relationship, the troubled therapist, ostensibly the ‘needy’ one lacking in knowledge, attempted to control how we were to relate to each other. Unlike what occurred in her group, however, we struggled to put some of our uncomfortable experience with each other into words. I suggested that were she to encourage this type of interaction, she might find the group more interesting to her. ‘Why should the group have to be interesting to the therapist?’ she challenged. My comment revealed her suspicion that I believed groups existed solely for the narcissistic pleasure of the therapist. Her response seemed literal and moralistic, a state of mind quite similar to her group’s. I asked what I might be unleashing should she ever feel free to express what interested her. She suspected a ‘powerful monster’ existed inside her who wanted the group to function according to her image. Perhaps worse than having these feelings, I suggested, was evading knowledge about them. Maybe everyone has such a monster inside. She said she wished she could be more accepting of her monster, as I seemed to be of mine. I suggested that she did not believe anyone could accept even knowing about her monster, not herself, not me, certainly not the group.

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She had difficulty tolerating certain entitled feelings and fantasies and initially had attributed them to me. As she became confident in reflecting on the idea of entitlement, mine, and then her own, she began to foster a similar analysis in group. She reported with a combination of delight and anxiety that when she stayed steadfast in her interventions, the group accused her of personality deficits of dominance, selfcenteredness, and hypercriticality, similar to what she suspected in me. Ralph had initiated the expression of the group’s rising indignation: ‘I’m beginning to get angry. Are you happy now? Why do you want to find trouble? We support each other and don’t attack like people do on the outside.’ The group agreed that something had gotten into the therapist; she seemed bossy and not agreeable. One member’s challenge to the group’s moral condemnation brought unintended but relieving laughter: ‘This is her group, and she has the right to tell us what to do, even when we don’t like it.’ We may note a pattern that often eventuates in analyzing entitlement. The therapist’s critical assertions regarding the group’s entitlements were met with escalating counter-assertions regarding the therapist’s personality. Although accusatory and partially in the service of discharging tension, they were not necessarily inaccurate. The therapist was ‘happy’ to unfold the troubling anger that had been suppressed in group. The supervisory experience had ‘gotten into’ the therapist. Finally, she had expressed a ‘right’ to opine what her group should do. It would not be easy to resolve with certainty when her interventions represented a legitimate entitlement to professional power, a demand to be obeyed, or both. But the goal here is tolerating uncertainty regarding entitlement, and not ignoring or submitting passively to it. Left undisturbed, entitlement may grow into a Frankenstein monster. With patience and skill, one may lure entitlement into a meaningful dialogue, mitigating its destructive power, redirecting it towards constructive aims. From my point of view, the therapist needed to go further in asserting therapeutic power, sustaining the exploration of the group’s ambivalent feelings and the fantasies behind them. But a psychological dialogue had begun, although often in an intimidating vocabulary of the group’s indignation and initial condemnation. A propitious moment occurred when the group monster relieved itself of its ‘head.’ With the encouragement of the therapist’s skillful interventions, the members dethroned Ralph. He now resides on the couch with the others.

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The therapist’s vulnerability to entitlement Many aspects of the therapeutic relationship suggest the group therapist’s vulnerability to irrational entitlement. Traditionally, he or she is the special one with exceptional power and moral authority. As Michels (1988) has emphasized, the asymmetric nature of the therapeutic situation tends to promulgate the therapist’s rights over the patients’. ‘Both metaphorically and actually the therapist sits in the most comfortable seat, controls the time and place of meeting, receives payment, and is protected from discomfort’ (p.55). Michels took for granted that the therapist sits in the seat of the expert and is legitimately entitled to protection from discomfort. I have been suggesting the opposite. The therapist is affected by irrational emotional involvement (Renik 1996), anxiety, defensiveness, and discomfiting ignorance, all of which may contribute to as well as interfere with successful group treatment. At times, the therapist may be unwilling or unable to tolerate not being special, feeling his or her expertise rejected or ineffective. An anxiety situation may evolve in which the therapist’s primary experience is of the patient or group malignantly not caring about or understanding clinical ministrations, and perversely blocking the therapist’s efforts to love and to be loved. This was indeed the situation that Freud (1916) described. The ‘exception’ was the individual unresponsive to the analyst’s insights, ‘one of the components of love’ (p.312). Freud did not consider that the clinician, feeling unjustly deprived of love and narcissistically wounded, may respond to the patient’s perceived entitlements by drawing upon entitled attitudes of his or her own. Instead of mentally processing subjective pain, the therapist may resort to entitled signification, i.e. formulaic thinking, illusion, and fixed patterns of clinical behavior. Schwaber (1996, p.10), discussing the analyst’s predilection to draw upon theory when vulnerable or uncertain, made reference to an apposite quotation from Bertrand Russell: ‘[T]here is a tendency to use ‘truth’ with a big T in the grand sense, as something noble and splendid and worthy of adoration. This gets people into a frame of mind in which they become unable to think’ (Russell 1927, p.265). Rather than think, the group therapist may maintain an adoring relationship to ‘Truth.’ The therapist’s inner objects, the teachers, supervisors, and therapists who have contributed to his or her expertise and sense of professional self, may personify Truth.

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The group therapist’s involvement with and preference for his or her own inner objects would limit his or her availability to the patient, and also limit the patient’s availability to the therapist. Hence, the therapist’s tendency towards entitled thinking would contribute to his or her own pain, to the sense of abandonment, guilt, and persecution which, we have decided, are aspects of the therapist’s relationship to the separateness of the group members and the group. An authentic clinical experience entails the group therapist thinking thoughts about non-material others. Individuals cannot be captured, only momentarily contained in the therapist’s here-and-now formulations. Entitled signification spares the group therapist from the experience of thinking about the ‘no thing’ other. Any idea or set of ideas may be treated as if it were an object, an immutable fact, possessed, held on to and adored, or hated and rejected, rather than treated as a ‘no thing,’ an idea named, from which, by disengagement, may lead to further thought and creative work. The group therapist manifests entitled thinking and signification when the group members’ independent thoughts and feelings are translated into fixated ideas of transference, defense, and basic assumptions. For instance, a therapist who attends exclusively to transference or whole-group dynamics may fail to relate authentically to the members, or to appreciate the reality-based dimensions of the patients’ response to the therapist and to each other. The clinician’s tendencies to entitled thinking may play a significant role in assessing whether a member’s perceived entitlements are appropriate or inappropriate, intractable or workable, and contribute to the negative therapeutic reaction often reported in the literature on the difficult group patient. In the following two case examples, a member’s dream provides an impetus to advance group process, analyze individual and intragroup transferences, and confront entitled thought processes and attitudes in the group members, including the therapist. I use myself as an example of a clinician who initially believed he was behaving in a balanced, professional manner, inferring and analyzing entitled thinking apparent in the individual’s and group’s fantasies, symbolism and behavior. In response to these efforts, others revealed that they believed that I, and not necessarily they, harbored unconstructive entitlements. I tried to understand and reevaluate the emotional as well as theoretical basis of my decision-making, to identify my own tendencies towards entitlement influencing my clinical reality, and

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distinguish my thinking and feeling from my perception of the group’s, and to appreciate the mutual impact of our interaction.

Two case examples: Entitled thinking, dream thinking, and group process Case 1: Being ‘at home’ in group Session 1. Catherine, a member of a group of five years’ duration, commented early in one session that she did not feel ‘at home.’ Individual sessions were special because she felt free to be herself. George reported an opposite feeling. He feared acting ‘at home’ in group would mean behaving like a ‘selfish pig,’ putting his feet up on the furniture, eating junk food and making a mess. Another woman turned to me: ‘Do most people feel comfortable in your groups?’ The question implied that she too did not feel comfortable, and at this point I joined the growing ranks of uncomfortable members. For I regularly enjoyed the group and was taken aback by the ostensible dissatisfaction among some of the members. Also, I found unsettling the reference to groups as my possessions, and I inquired whether others agreed that this group was ‘mine.’ Many did agree: ‘I call it “the group,” but it is your group.’ ‘It is my group, but it is your group because you’re the exalted leader.’ ‘We’re spokes in the wheel, but it is your wheel.’ ‘And what kind of wheel is it?’ I asked. Previously unarticulated beliefs about the group culture emerged: not a place for light stuff, humor, play, or good news, which should be talked about before or after the sessions; one has to maintain an image; the spotlight is hot and harsh, and you have to be strong enough to take it without feeling stupid, and you might feel stupid the next time; get what you need in group and get out of the focus as soon as possible; other people may have a greater need, so don’t take up too much space; if you talk one week, you shouldn’t talk too much the next; everybody judges me, although I don’t judge anybody else. The participants moved away from group experience to exploration of their histories in families of origin. No one described a comfortable childhood; rather, many members related feelings of childhood anxiety and inhibition, and humiliation from parents when in the center of attention. At one point I involved Molly, who typically remained withdrawn. She immediately began to cry, explaining that her eyelid had swelled the day before and it was red and sore. ‘My eye is so ugly I don’t want anyone looking at me.’ People consoled her as she began to cry, reassuring her that her

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difficulty was hardly noticeable. Then Sarah turned angrily to me, declaring that Molly was interfering with the group process and taking unfair attention by making everyone feel sorry for her. Now everyone felt uncomfortable. Sarah’s self-righteous anger cowed the group, although indeed she was making a valid observation. I attempted to reengage the members without taking sides or becoming a peacemaker. I professed surprise that no one besides Sarah was angry at someone for breaking the rule about taking too much attention. I playfully stated that, as everyone was silent, Molly was not alone in fearing exposing an ugly I (‘ugly eye’). My comments seemed to free members to acknowledge fears of self-exposure, and then to explore their modes of seeking reparation from others by getting attention. Kevin admitted that like Molly, he tried to send ‘come and find me’ messages to group, but that he would be afraid to attract Sarah’s temper to himself. Sarah said she had to remain angry and vigilant, or else she would be ignored everywhere. George, who often was accused of rambling and remaining unfocused, said that he enjoyed being piggish in group, making a mess when he spoke and taking in all that negative attention. Molly had become quiet again, and Catherine returned to her theme that initiated the work of the session: ‘I don’t feel comfortable when you’re so involved with your hurts. I feel manipulated into being sympathetic.’ Molly began to swell up and I became alert to the probability of another round of tears and recrimination. But Catherine continued, reassuring Molly that this was her problem of taking care of everyone but herself. She needed to separate and not worry so much. Molly wasn’t her mother and even if she were, tough! It wasn’t Catherine’s fault that her mother married her father, and it wasn’t Catherine’s responsibility to make Molly happy, although she would like to. Whoops, was she doing it again? The next session. Molly began: ‘Before I lose my courage, I want to tell a dream. There was an office room, empty, dark, no windows, broken furniture, and a pillow by the wall. I entered the room, feeling very alone and scared, and sat by the pillow. Richard comes in, there is a bright glow of light. I get up and then the other group members enter the room and we start talking. The room had become a large banquet hall, with shiny wooden floors, and huge windows, which overlooked a cliff, with waves pounding below. We are all sitting around a table feasting on healthy fruits and veggies. And oh, the windows are open and sheer curtains are billowing in the breeze.’

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In responding to the dream, the members related my destroyed office to fear of Sarah’s anger in the prior session, my banquet-hall office to Molly’s wish to be fed, and the bright flow of light and the ‘billowing’ (a reference to my surname) curtain to my ‘sheer’ presence. I was Molly’s maternal provider as well as romantic protector. In the previous session, the members described themselves as spokes in my wheel. Now I was the bright light. Had I unintentionally been attaching members to me, rather than ‘bridging’ (Ormont 1992) members to each other? Could I not withstand absence and the uncertainties of human connectedness? I had worked with each member individually and indeed, members were connected in special ways to me and I to them. Was I insisting on being the most special, a light that blinded members from attributing ‘my group’s’ harshly judgmental qualities to me? Was I like the jealous primal father Freud (1913) described in Totem and Taboo, keeping the woman all to myself ? To foster the consideration of my possible contribution to the destructive havoc described in Molly’s dream, I inquired skeptically: ‘If I’m so powerful and protective, why are people afraid?’ The answers to the question revealed fantasies of a therapist whose patients existed to please him: ‘You are so powerful, that’s why I have to be careful not to get you angry.’ ‘We have to perform for you, so you’ll like us.’ ‘I’m afraid you’ll stop caring for me.’ ‘You know so much, you could make me look like a fool any time you wanted.’ ‘Are you going to punish us for saying these bad things about you?’ Far from my identity as the light, I materialized as a seductive, vengeful perpetrator of the culture of ever-looming humiliation and abandonment. I stood for all the self-centered parents who preferred to extract rather than give special attention. The members had feared exposing the ugly truth of these realizations, and their hurt and anger. The havoc that Molly imagined existing in my absence was inspired by my presence. The members could not live without me or with me. Deprived of needed psychological attention, members developed pathological modes of self-exposure and assertion, for example, by being helpless and hopeless (Molly), self-righteously rageful (Sarah), ‘piggish,’ and so on. Reflecting on my own anxieties and possible entitled thinking and behavior deprived me of the illusory comfort that goes along with the certainty that one’s therapeutic efforts are effective. The group and I did not come to immediate or full understanding of the ongoing dynamics of exaggerated and inhibited entitlement, or of our relative contributions to the intersubjective

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entitlement matrix. To reach certainty would be illusory, and simply another manifestation of entitled signification. However, I can report that these free-flowing discussions produced insight, diminished resistances, and increased bonding among members (see Chapter 7), including member– therapist relationships.

Case 2: Ambiguity in distinguishing transference illusions from countertransference projections Anna, a professional actress, reported to a group of eight years’ duration the difficulty her husband and family suffer when she volunteers for an arduous, but enjoyable, series of special Christmas theatrical performances. Should she accept an offer? She is getting older and will not have many more years. A person playfully commented: ‘You never seemed to care about your husband or his feelings before.’ Anna laughed. ‘I know, this isn’t me talking, but “Anita,” my evil twin.’ Another member advised Anna to acknowledge how difficult her holiday schedule is for all of them. They could decide as a family. Anna found this and succeeding remarks helpful and, without a pause, reported a dream. In the dream, Anna was supervising a group of nine or ten schoolchildren who are supposed to stand on a white line. (There are ten group members.) It was not apparent how the dream related to her current concerns, and she added no associations, instead looking expectantly toward the members. I had the impression that she had completed a magnificent performance and anticipated adoring appreciation. Instead of applause, however, one by one members came forth with supportive, if stilted, dream interpretations. The comments neglected what I experienced to be the salient element, her entitlement to control the mind and behavior of others. Anna’s mother was a schoolteacher and an authoritarian at home who demanded obedience. Anna felt her husband to be like her mother in her marriage, and felt me to be like her mother in group. She felt victim, not victimizer. I often attempted to show her how she played out both identifications and that she, not I, was like her controlling mother. I then took my interpretive turn, proposing that the group was living out Anna’s dream in obediently standing on the white line of therapeutic niceness. The members supplied the well-behaved interpretations I was supposed to provide. From my perspective, the group had consumed projective identifica-

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tions of Anna the victim, and adhered to the command of Anna the schoolteacher: ‘Behave and stay in your place.’ Anna often chafed angrily at my attempts at unraveling her complex of identifications and rebelliousness regarding controlling figures, and would insist that I was demonstrating only my similarity to her critical mother. But this exchange ended differently. Rather than becoming wounded and indignant, Anna turned to me with a playful smile: ‘You mean, I’m being bad again.’ I smiled back: ‘I guess so.’ ‘My evil twin, Anita,’ she continued. I commented that I thought Anita was the one who expressed interest in the thoughts and feelings of others. Wasn’t I talking to Anita now? Because this person seemed interested in what I had to say. I thought the group would feel relieved and encouraged, as I did. I had concluded that Anna’s initial presentation regarding her holiday schedule and dream, although expressed in articulate language, was a method of enacting influence and control so as to receive special attention. She signaled a shift to self-reflective processes in the Anna/Anita metaphor. The healing process was signaled in her willingness to express her split self-representations in language and to think about the response from another, even if not entirely agreeable to her. I was surprised when other individuals retrieved the flag of Anna’s indignant reactivity, which mercifully she seemed to have discarded. One member said, ‘I don’t think Anna is evil. How could you say that.’ Another: ‘You’re chastising us. You want us to stand on your white line. We’re not standing on what you said was Anna’s.’ When a member exclaimed: ‘We’re not bad, and I resent being told I sound like a therapist,’ I could not resist humor: ‘That is worse than being evil!’ I was attempting to reassure members that I could withstand aggressive attacks and also, I was offering an opportunity to evaluate me in a fairer, more realistic manner. The members had disregarded reality in attributing to me, rather than to Anna herself, the references to evil and bad. ‘We’re not bad,’ an individual had exclaimed, signifying the group’s identification with victimized Anna and implying I had accused them, which I had not. Several members clarified who actually said evil and bad, which I understood as a return to reality and my revival as a positive figure. I now felt confident to inquire why people were protecting Anna, who seemed not to need protection. My remark freed members of lingering protective feelings toward me, however: ‘Oh! He’s starting again.’ ‘You’re supposed to be sympathetic and not attacking!’

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Why were members defending the old Anna and resisting change? Apparently, some individuals wanted to use the occasion of therapeutic progress to express, with conspicuous enjoyment, my deleterious effects on them, past and present. ‘I don’t like it when you call us names.’ ‘I’ll never forget some of the things you’ve said to me.’ ‘I hate it when you’re sarcastic.’ ‘I like it when he makes fun, except when it is directed at me, then it hurts.’ Was the group, caught in Anna’s projective identifications, dreaming me up? I felt like the sorcerer’s apprentice, in Disney’s movie, Fantasia, pursued by splitting and multiplying persecuting brooms with their murderous buckets full of water. I was drowning in guilt. More and more Annas in the group, each one demanding me to behave and get in line. The dissonance remained between my sense of myself as a courageous leader, and the group’s sense of me as a combined sadistic dictator-misbehaving child. I had to consider that perhaps I had been dreaming that I was good and not a bad analyst (Epstein 1987). Had I grasped onto a moralistic theory of what the group needed, that is, the truth according to me? That would mean that my motivation had been not to name the group’s anxiety, manifested in the paranoid submissiveness to Anna, but that I had camouflaged my envy of Anna’s special attention, and my wish to dominate and control her, along with the other members of the group. I responded with: ‘The messenger has been chastised. But what of my message concerning your feelings towards Anna?’ This invited a discussion of Anna’s progress, without a hint that she was or remained a fearsome character. ‘I guess I’m cured then, huh?’ she volunteered. Her playful sarcasm confirmed that we understood that she was not cured totally. Anna alone seemed comfortable with my message of her ambivalent attachment to her exaggerated entitlement, that is, that she was both Anna and Anita. Following her lead, a subgroup of members timorously acknowledged that in the past they had taken special care in what they said to her, and how they said it. I attempted to explore current fear: ‘People are stuck in Anna’s dream.’ I was concerned that my intervention, rather than reveal unacknowledged group process, would set off a new round of resentful accusations. Did I need to have members fulfill the analytic dictum, ‘put it into words?’ I might have better appreciated the group’s ebb and flow, the slow working through. Again, I suspected myself of counter entitlement, that I was putting in their faces my exceptional prescience, demanding stroking, and compensation for the group’s mistreatment. But then, an interlude of silence, which I took to be reparative, convinced me that the group finally appreciated my

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interventions. It also occurred to me that my perception might be wish, a hallucinatory daydream of my own, and not fact. The reality is not certain. By placating Anna and challenging me, the group forestalled her need for retaliation. I was a safer, if not stronger, target than she. According to this version, rather than my protecting the group, the members had been protecting me from her, and also protecting me from the reality that I was less powerful than I thought, and less powerful than they wished. DISCUSSION OF THE TWO CASES

Traditionally, the patient’s images and dream images of the therapist have been presumed to include mainly transference projections and distortions, such as those involved in basic assumptions. We see in two cases, however, how the patients’ group dreams as well as ongoing group verbalizations, convey valid and important information regarding the reality of the clinician’s presence and its effect on the therapeutic process. It was useful and important to subject my ‘motivations and dynamics to scrutiny and so…[permit] a reciprocal process of growth and learning’ (Skynner 1984, p.216, his emphasis). In these two case examples, I sought to introduce ambiguity, to bring to group attention the interaction between the different perceptions of and reactions to entitlement. Together we evaluated how the expressions of control and domination might be the therapist’s, the patients’, at times jointly created ‘at the interface of reciprocally interacting subjectivities’ (Stolorow and Atwood 1992, p.1). The groups and I often disagree on the positive or negative quality of entitlement, and on its location, in them or in me. I cannot conclude my formulations are correct, and the groups’ are not. Moreover, who is correct or more correct is less important and therapeutically useful than the open-ended discussion. Clinical certainty or objective truth remains a ‘no thing.’ Pathological entitlement involves not tolerating ambiguity and genuine differences in feeling and point of view, combined with the right to control what other people must think about. In promoting the understanding of all types of entitlement, normal, inhibited and exaggerated, the clinician modifies entitled thinking and behavior, by thinking about them. Notice that when analyzing entitlement, individuals are often more than willing to turn attention from themselves to their therapist, who may become a focus of intense, often discomfiting mutual scrutiny. Self-evaluation is par-

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ticularly difficult in those moments when addressing others’ perceived entitlements. People feel entitled to their entitlement, and frequently feel defensive when it is challenged. As a mechanism of defense, entitlement may be protectively maintained, denied, or disowned, and also projected to make the leader feel entitled. In addition to projecting, group members also may make accurate forays into the therapist’s patterns of entitled signification, as revealed in his or her interpretive theories, techniques, and personality. Thus, group members may function as bad-objects-present for projecting entitlement and for stirring up the therapist’s pathologically entitled inner objects. The therapist may relive his or her personal history of subjugation to, rebellion against, and identification with mind-controlling figures. At these times, the therapist may move from productive thinking to illusion and hallucination, and come to feel guilty as charged, an embodiment of what is negative in human entitlement. Thus, at his or her own entitlement set point, when the process gets too painful, the clinician may lose a capacity to tolerate ambiguity as well as negative self-representations. He or she may insist that, like the students in Anna’s dream, the bad get in line and become good. The therapist may subvert temporarily the constructive but personally painful group process, contributing to troublesome entitlement while attempting to analyze it.

The therapy of entitlement: Two theories of entitlement, and common sense The therapist cannot always be sure when interventions constitute effective therapy, and to what extent they may escalate a battle between entitlements. In the clinical literature, there are two differing standpoints on treating entitled thinking and behavior, involving frustration versus gratification of the patient (Blechner 1987). The first perspective utilizes the interpretive technique originally promulgated by Freud (1916), in which the therapist maintains traditional psychoanalytic boundaries and analyzes the dynamic genetic roots of entitlement. Michels (1988), for example, advised ‘not to placate or mollify the patient by gratifications that grow out of a desire to dilute the patient’s resentment and disappointment or bribe him into pseudo compliance…[the therapist must interpret] resistances to expressing, or even experiencing, the frustration of the treatment’ (p.56). The second perspective utilizes the accommodative technique, exemplified by Winnicott and Kohut. Viewing entitlement as expressions of need, the therapist adopts a holding environment such that the underlying desire, aim

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and object of entitlement may be discovered and experienced without subjecting the patient to excessive frustrations involved in interpretive activity (Bromberg 1986). In practice, each clinician finds his or her own compromise between interpretation and accommodation, a compromise, I submit, partially predetermined by subjective factors in the therapist and hence influenced by the therapist’s tendencies towards and reactions against various forms of entitlement. Additionally, the therapist may avail him or herself of common sense. Bion (1970) called attention to a process whereby we sharpen our view of reality by considering contrasting modes of experience, such as love and hate, or presence and absence, and he named it common sense. In treating perceived entitlement, the analyst needs to tolerate a creative tension, even antagonism, which results from maintaining in thought two conflicting treatment potentials. Each approach provides its own legitimate rationales. But each provides as well material for entitled thinking and behavior, represented by premature certainty, hallucination, and compensatory enactments. To counter feelings of submissiveness in the face of what is experienced as the patients’ anti-representational attitudes, the clinician may intrude upon the group members’ psychic readiness, thoughtlessly disregarding intersubjective reality. Alternatively, in submitting to pressures for accommodation, the group therapist may collude in circumventing reality and creating an illusion of peaceful coexistence (Ladan 1992). The therapist thereby reinforces concealed dyadic bonds to individual members (Halton 1999). Not analyzing entitled thought and behavior may be a narcissistic defense rather than a necessary technique, indicating the group therapist’s mental evasiveness. Thus, analyzing or not analyzing may variously signify the clinician’s defenses against thinking, in particular, defenses against thinking about entitlement. The group therapist may achieve greater freedom to participate in a lively, appreciative, even humorous manner, when he or she owns personal entitlements as part of the ongoing action. This entails the group therapist accepting that, like other members, he or she needs to feel and to be treated as special, and that when threatened, characteristic defense patterns are likely to emerge in the interaction. The group members may quite accurately perceive aspects of the therapist’s psychology of entitlement, and may use and abuse such knowledge in the group process. At times, the positive trajectory of the work may seem to dissolve in a heated exchange of views regarding perceived entitlement. This dialogue may be expressed in a reactive vocabulary of unac-

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knowledged entitlement: denial, protest, rationalization, indignation, recrimination, appeasement, hallucination, accommodation, even interpretation (Case example 2). At the same time, these different expressions of entitlement and reactions against perceived entitlement may become constructive building blocks in the working, mutually empathic group. Progress is more likely to occur when the group therapist openly acknowledges subjective and interactive aspects of entitlement as they emerge and are discovered in the ongoing clinical work. As always, when the therapist is receptive to the group members’ view of reality, and is able to be relatively non-defensive and non-authoritarian, interpretive activity is more likely to be respected and integrated into the psychoanalytic work. The goal is, of course, to get beyond labeling, judging, submitting, rebelling, and retaliating, to the experience of mutual recognition. The therapist’s attempt to understand the experience of his or her entitlement with the group, and to put the experience into words, may inspire the participants to do the same (Case example 1). As the group learns to confront the intersubjective realities of entitlement, each participant may realize each person possesses entitlements, and that his or her entitlements are not more special.

CHAPTER 5

Containing and Thinking The Three Relational Levels of the Container–Contained The concept of containing has captured the psychoanalytic imagination, becoming an idiom in the contemporary clinician’s language of intersubjectivity, perspectivism, and co-constructionism. In this chapter, I lay emphasis on containing as a reciprocal interaction, involving the contained as well as container. The container–contained is a complex model which describes processes of human development, internal and external object relations, affect integration, symbol formation, group functioning, and learning from (and resisting) emotional experience. The model draws attention to how we hear and think about another’s communication, how we convey our experience back, and how this communicative interplay impacts the participants and the immediate future of the relationship. Referring as it does to wide-ranging psychosocial processes, the model calls for a versatile group technique employing diverse expressions of the group therapist’s subjectivity. Let us take as a starting point Bion’s statement that ‘the human animal…cannot find fulfillment outside a group and cannot satisfy any emotional drive without expression of its social component’ (1967a, p.118). The cornerstone of Bion’s theory of individual and group development is that, while thinking is a primary emotional drive, it matures in the context of social communication. He formulated an essential relationship among thinking, emotional development, and socialization in terms of the container–contained: The individual cannot contain the impulses proper to a pair and the pair cannot contain the impulses proper to a group. The psycho-analytic 110

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problem is the problem of growth and its harmonious resolution in the relationship between the container and the contained, repeated in individual, pair, and finally group (intra and extra psychically). (Bion 1970, pp.15–16)

This compressed passage pertains specifically to the inherent problems in human communication and the importance of others in supporting the individual’s drive to think about emotions and make them meaningful. To grow and mature the individual needs communicative containment by self, pair and group. The container–contained represents the transformatory process of the mind reaching emotional awareness. It is a model of ‘an emotional realization associated with learning’ (Bion 1962, p.93).

The container–contained in development Presaging current developmental theorists (e.g. Beebe, Lachmann and Jaffe 1997; Emde 1990; Seligman 1999; Stern 1995), Bion stressed the central role of relationships in the origin and maintenance of reflective thought. As a Kleinian, Bion accepted that introjective–projective exchanges (see Heimann 1952) formed the basis of the infant’s relationship to the mother, and continued to inform all relationships. The infant’s symbolic ‘sojourn in the breast’ (Bion 1962, p.183) first makes manageable the individual’s basic drives or needs, placing them – and their satisfaction – in the relational context. Thus, in human development, container–contained processes initially are symbiotic. The normally empathic mother gathers in (introjects), deciphers, and communicates back to the infant aspects of its affective and perceptual experience beyond its current emotional and cognitive capabilities. In effect, the mother communicates to the infant aspects of her own experience of the infant’s communicated experience. In Bion’s terminology (see also Chapters 3, 9, and 10 in this book), the infant projects undigested raw experience (beta elements), such as a fear of dying, into a receptive mother. Via the empathic, receptive process of reverie, she applies her own conscious and unconscious thought (alpha process) to the situation, divesting the infant’s experience of its disintegrating impact, and returns experience in a form (alpha elements) manageable for the infant to think about. By containing the infant’s primitive affective and perceptual reactions, and interesting the infant in them, the receptive (m)other fosters the development of a ‘normal’ part of the infant’s personality that concerns itself with psychic quality.

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To an increasing degree, the infant becomes able to contain affects and perceptions while in the mother’s absence, transforming them into images and rudimentary prototypes of sophisticated thought. These internal containers develop that which previously split off and/or projected. In other words, symbols and thoughts now serve to transform preverbal emotional experience, a function once provided primarily by others. The developing child gradually comes to tolerate and process its own emotional experience, developing a rudimentary consciousness of self and other. The child has formed a model of the thinking couple. Independent thinking has begun, as commensal relations are established between one’s own mind and the minds of others. However, as we know, psychic development and functioning do not at all times proceed smoothly. Thinking and relating may easily regress to the dependent level of symbiotic communicating. More pathological is the parasitic variation, in which blockages develop between the container and contained. Because of traumatic early failures in infant–caretaker relationships, the individual (or the traumatized part of the personality) comes to experience containing and being contained as untrustworthy, painful, and dangerous. When parasitic dynamics prevail, the container–contained represents a hostile and destructive process. Thinking – and thinkers – must be avoided or attacked. Bion’s (1970) definitions of commensal, symbiotic and parasitic communications are not saturated. When one thinks about them, they may develop in unexpected ways, which was Bion’s intention. Symbiotic relations may or may not lead to growth, and parasitic relations do not preclude growth, with proper clinical technique. Also, both parents in a loving relationship contribute to the child’s relational development: ‘There is absolutely no substitute for parents who have a loving relation with each other. No amount of talk or theory is going to take the place of parents who love each other. That seems to put something over to the child which is – to use some more long words – infra-verbal, preverbal’ (Bion 1975, p.128).

Container–contained: A model of intersubjective thinking The concept of container–contained describes relationships that are dynamic and fluctuating, cognitively multilevel, and interpersonally multidimensional. We come to learn about and represent intersubjective experience at various developmental levels of thought, from pre-concrete to abstract. The pattern of relationships may be modeled on vague interioceptive memories of

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mouth–breast relations or on dyadic, triadic, and group relationships. The pattern exists in the commitment to abstract religious, aesthetic, and scientific principles, which still represent object relations pertaining to one’s place in the family, society, and universe. ‘From such relatively simple beginnings the …[container–contained] abstracts successively more complex hypotheses and finally whole systems of hypotheses which are known as scientific deductive systems’ (Bion 1962, p.94). We may see how a nesting process is involved, for the container at one level of symbolic transformation may serve as the contained at another. On the level of the structure of thought, the symbol itself serves as the object or container of the individual’s unformulated ideas and emotions, which are the contained. On the level of self, the individual serves as the container of one’s mentality. On the interpersonal level, the pair, group, and political-cultural context serve as container, while the public expressions of the individual – symbols, emotions, thoughts, self-presentation, and action – are the contained. The nesting process must remain emotionally flexible, mobile and reversible. Like the empathic mother on whom the experience of being contained is based, the container must retain the capacity to remain integrated, while penetrable with fresh emotion. As mother to infant, the container and the contained are transformed in relationship to each other. The mother cannot function effectively as a rigid mold in which the infant’s emotional and intellectual projections are made to conform. The container gets shaped and reshaped with pressure from within and without. ‘On the replacement of one emotion…by another emotion…does the capacity for re-formation, and therefore, receptivity, [of the container] depend’ (Bion 1962, p.93). To develop emotions and learn from experience, one must exercise a social capacity and interact reciprocally with the containing minds of other human beings. The social container of the other (eventually, including the parental pair, family, and cultural groups) actively participates in making emotions and thoughts meaningful. While container–contained relationships pertain to characteristics of feeling, thinking, and interpersonal behavior, such relationships may require solitary activity, as involved in certain forms of creativity, or listening to music, reading, skill building, and so forth. Relatively remote individuals may contribute to and benefit from their social systems, while many extraverts produce noise and dissonance and remain inadequately educated by their

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interaction with others. (Bion even suggested that the most vocal members of his groups were the most disturbed.) Other people symbolically are always in our thoughts; however, the thinker does not necessarily benefit, and may be thwarted or even harmed by the participation of others. But at the same time, our need for others remains. The individual, impelled to think, is not always a sufficient container of his or her own developing thoughts. At critical phases, the child and adult require substantial interactive relationships on both the symbiotic and commensal levels to develop thoughts realistically. When the social network fails in these containing functions, the internally derived, container–contained, symbol and meaning, becomes endangered. In more extreme instances, emotional thinking loses its relationship (the ‘links’) to reality and to constructive social interaction, and becomes narcissistic and not sufficiently interpersonal. Even in relatively healthy individuals, container–contained relationships have the potential to become parasitic, destructive to the self and the groups in which one participates. To summarize, K, the drive to seek knowledge and to understand emotional experience, develops within the individual’s socio-psychological matrix. An individual’s impaired relational functioning within the group-container negatively affects K, such that one develops a pathological relationship to one’s own thought processes (the container–contained). Of course, the arrows of influence in the container–contained relationship point in both directions: internal K pathology is affected by, but also influences pathological social relationships.

The group therapist’s containing functions Bion began formulating the model of the container–contained in working with groups. He discovered that a type of countertransference emerged from taking in the members’ projective identifications, such that the therapist feels ‘a sense of being a particular kind of person in a particular emotional situation’ (1961, p.141). Although painful to absorb internally and also make sense of, the group therapist’s subjective reactions could be utilized to process information about the group and its members, and could serve as a basis for interpretation. Containing is primarily transformative, that is, interpretive, even when nonverbal (see Chapter 7, on bonding). Using primary process – the capacity to free-associate, imagine and dream – and secondary processes, the analyst gathers and deciphers the patients’ and group’s unformulated experience. The

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therapist makes the thought and emotion tolerable, gradually representing (re-presenting) them to the members in the forms of words, silence, and nonverbal and paraverbal behaviors. Containing is a two-way communicative process. The infant quickly becomes a container, receiving and intuitively interpreting the mother’s thoughts and feelings, only some of which she herself may understand. An analogous process exists in the consultation room. Caper (1997) wrote of ‘the patient’s use of his intuition and perceptiveness to assess trends and forces in the analyst’s personality, including some of which the analyst may be unconscious’ (p.267). Containing depends on the emotional capabilities of the leader and of the members in their interaction. However, while remaining receptive and joining the group as a member, the therapist, particularly, also must assert a separate point of view. Containing commits the therapist to, but also removes him or her from, the intermediate, transitional, or ‘analytic third’ of self and other (Bolognini 1997; Fonagy and Target 1996; Ogden 1994, 1997). As an intrapsychic event, as well as an intersubjective construction, containing evokes subjectivity. Emotional participation is individualistic and specific to the intersubjective context. Different therapists respond to different elements of a group’s communications, and certain messages are easier to process than others. One leader may respond quite differently from another in similar circumstances, differently on one occasion from another, and differently to one patient or group from another. The container is not a telephone receiver, to utilize Freud’s (1912a) metaphor. The group therapist filters through a personalistic lens, and in representing and participating in container–contained interactions, the therapist participates with unique individuality (see also Chapter 10).

Extended case example In the following extended clinical example, I utilize the model of the container–contained and the three relational variations to describe aspects of my thinking and clinical behavior, while supervising an analyst, Dr. A, as we worked to understand her patients, her psychotherapy group, and our relationship. THE CLINICAL PROBLEM AS PRESENTED

‘I’m pissed at Mary. She’s threatening to quit group. What should I do? I’m seeing her tomorrow. Hi, how are you?’ The speaker, Dr. A, had been in

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supervision for eleven months. We knew each other well, since I participated as a faculty member in two of Dr. A’s lengthy training experiences. Dr. A had graduated from our psychoanalytic institute and now was completing our program of psychoanalytic group therapy. Mary was a patient of Dr. A in a weekly group and also in twice-weekly individual psychoanalytic sessions. In a recent group session, John had confronted Mary, which led to a heated exchange. In Dr. A’s opinion, Mary gave as good as she got, but Mary felt hurt and withdrew for the rest of the session. She missed the next group, after leaving a message on the therapist’s answering machine that she had to attend a church function which was much more important. In the intervening individual session, Mary reported: ‘I have another church meeting to go to on group night. Besides, I’m thinking of leaving group. The church treats me better.’ Although the patient had questioned the value of group and had threatened to terminate on other occasions during the past five years, this was the first time she had upped the ante by actually missing a session, and she seemed intent on missing another one. Dr. A had remained neutral and, in her words, ‘above the fray,’ during the altercation between the members, which was but briefly responded to by others. In the individual session, the analyst had explored the patient’s associations, which were rather concretely linked to her state of affairs in group. She had reminded the patient that they had been here before, cautioned against precipitate behavior, and encouraged her to deal with her anger and hurt in the group. These interventions and subsequent interpretations had failed to influence the patient. And now Dr. A would have to report Mary’s absence to the other group members. She feared being blamed for not intervening between the two members in a timely or adequate fashion. She would lose face and have more damage to control. Other patients would want to leave, the group would disband, and her individual analytic practice would be in shambles. Dr. A had, of course, attempted to withhold these anxious feelings and fantasies in her individual work, and not direct them at her patients. I listened sympathetically and made a few theoretical remarks to establish that we saw the clinical situation similarly and that perhaps, in time, the patient might too. As far as I was aware, my prominent emotional state was one of interest and unfulfilled curiosity. I did not believe I was particularly useful. I had no urgent desire to be useful. I now knew some ‘facts’ of the clinical exchanges among analyst, patient, and group. But I did not have a good sense of what the clinician was really saying emotionally, and what the patient and group were hearing. I was not

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sure what the analyst was asking for when she said, ‘What should I do?,’ what she needed, and what I was willing and able to give. From my point of view, the necessity was to think: to learn about ourselves, our relationship, and of course to learn about the patient, other members of her group, and the ongoing individual and group psychotherapy processes. We had not directly addressed the analyst’s presenting problem, which involved some disturbance in the container–contained. It seemed apparent that the disturbance existed on many levels: in Dr. A, in Mary, in their relationship, and in Mary and Dr. A’s relationship to the group. Most likely, the disturbance existed in Dr. A’s relationship to me. Dr. A’s opening comments, that she was pissed at Mary and what should she do about Mary’s threat to leave group, and her anticipation of blame and abandonment, actually provided a wealth of emotional data. The analyst’s communications had many levels of unarticulated emotional meaning and released in me feelings of my own. Some of my feelings I understood immediately and intuitively and could extrapolate to the clinical situation. For other levels of emotional meaning to emerge, I needed time and mutual participation in the supervisory sessions. Further levels of meaning have emerged in writing this chapter. In making sense of my experience of being with Dr. A, I thought it helpful to consider our dialogue from the vantage point of Bion’s framework of commensal, symbiotic, and parasitic relations. In this way, we could address the nesting of clinical situations: supervision, group, and individual therapy. In calling attention to my own developing feelings, and how they influenced my thinking about our relationship and get played out in the supervision, we could consider some technical options available to the analyst. I carried out this exercise and review with the supervisee. For didactic purposes, I presented the material to the supervisee and now to the reader, in the order commensal, symbiotic, parasitic. I emphasize that all three relational levels happen at once, and the therapist has to attend mentally to all three levels at once. COMMENSAL RELATIONS

In commensal relationships, ‘two objects share a third to the advantage of all three.’ The participants create and share the ‘analytic third’ (Ogden 1994), the dialogic emotional relationship that becomes the primary subject of group interest. Projective identification operates, but the primary containers are symbols, and the boundaries are flexible. Emotions are valued for their

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informative function, and the participants strive to find words to contain and communicate emotion, such that the words may be thought about and shared in group. Language functions as a container, used to organize and explain conscious and unconscious emotional experience, and language also exists as the contained, a mode of experience. Merleau-Ponty (1964, p.88) captured this process when he wrote: ‘My spoken words surprise me and teach me my thoughts.’ A vital part of group experience involves sharing, absorbing, and gradually coming to understand what members mean by what they say. Language, the individual, and the entire group function as dynamic containers, enlarging the capacity to bear and learn from experience. The individual tests internal and external reality by thinking emotional thoughts privately, and also experimenting publicly with language, roles and action. He or she benefits from introspection as well as from social feedback. In the group, each relatively independent human being takes responsibility for meaning-making, while remaining receptive to the contribution of the others’ feelings and thoughts. The therapist nurtures commensal relations by utilizing language and silence to cultivate a group that values curiosity and verbal communication. The leader demonstrates that he or she is intellectually responsive, and accurately understands and fosters understanding of individual and group psychology. The therapist’s interventions may stimulate pain and anxiety, informing members of that which needs to be thought about consciously and unconsciously, and articulated in the group’s verbal behavior. Finally, the therapist conveys the reality that he or she is not all-knowing but human, and consequently, also must live through unavoidably confusing and emotionally disturbing intervals of group life, and needs and benefits from the containing by other group members. COMMENSAL RELATING IN THE SUPERVISORY DIALOGUE

Assuming that we were in, or could easily shift to, commensal relating, I treated as evocative metaphor and as unexplored fantasy the supervisee’s description of her internal state (‘pissed’), her entreaty (‘What should I do?’), and her anticipation of blame and group dissolution. I did not respond symbiotically, such as by trying to be reassuring, or even ‘helpful.’ Calling attention to our relationship instead, I agreed, sardonically, that we ought to ‘do’ something to relieve the analyst’s state of mind. And, to underline how unhelpful I was at ‘doing,’ I noted that nothing the analyst did with her

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patient – neither her interpretations nor her entreaties – or I was doing with her, accomplished this goal. Dr. A responded indirectly to my rueful comments by reminding us that the group had heated up since she had been in supervision, and she liked the liveliness. But she did not like feeling that emotions were getting out of control. She was referring to her patient and to the fighting in group, but also communicating that she did not like feeling that her emotions were getting out of control. I wondered playfully whether she ever felt her supervisor was out of control and whether, at present, she even liked him. She smiled conspiratorially. ‘I know you want me to be very ‘bad,’ and my patients to be bad too.’ And then, quite seriously: ‘My mother didn’t tolerate anybody being out of control, and when I feel I might be, I freeze up with anxiety and fear, and try to ‘get it right’ by being very good. This is how my mother wanted me to be.’ The ironic use of the words, ‘bad’ and ‘good,’ as well as her tone, signaled that Dr. A was in a less anxious but more painful state of mind, one more firmly committed to the process (the alpha process) of valuing and reevaluating emotions. She was thinking, exercising and putting into words rather than freezing emotions. She was containing their vague and then articulated representations in the multidimensional, multirelational contexts of past and present, self and other, self-consciously experiencing her mental relationship with a personality: her own, my own, her patients’, her parents’. She was applying K to minus K: thinking about how she stopped thinking in certain clinical crises and impasses (see Chapter 3). In freezing, Dr. A had attempted to suppress and deny her sense of internal badness, that is, her own bad feelings, fantasies, and thoughts, and possibility of bad behavior. By volunteering and not freezing these aspects of her subjectivity, she offered us emotional ideas. These we could develop commensally within the supervisee–supervisor relationship and apply to a nesting of clinical and personal situations. Our relationship existed as a shared, dynamic structure, growing in emotional flexibility and abstraction while remaining linked to our ongoing, lived-out present, and was thus commensal. If she were to ‘do’ what the supervision hopefully modeled, she would have to find her own way to establish the commensal pattern of relationships. The patient, Mary, had threatened to terminate group but not individual work. This suggested an unanalyzed split in the patient’s mind between a bad group therapist and a good analyst. The split also existed in the therapist’s mind, but

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she was attempting to address the split in the supervision. Did other members find their group therapist to be bad, and how and why bad? These investigative questions are emotional ideas that may be presented to the patient and group, to be contained for mutual consideration. But to present difficult ideas to others, the analyst must first be willing to think and feel about them. That is, to maintain commensal relations, the clinician must be in and not above the fray. Containing – putting into words transformations of the patient’s conflictual feelings, thoughts, and fantasies – brings to the fore aspects of the history and current state of the analyst’s own conflicts. In this example, by sharing painful inner experience, the supervise was willing to be in the fray with me. To meet her commensally as the clinical supervisor, I also had to be in the fray. This meant achieving (relative) comfort about my badness with the supervisee. With this accomplished, I could then help the supervisee become more comfortable containing the idea of ‘badness,’ hers, mine, her patients’, such that she could think about and share the idea within her clinical practice. Commensally-based relations are characterized by this important dimension of self-analysis, a willingness to feel, think about, and if appropriate, put into the dialogue that which otherwise would not be shared openly but suppressed or acted out. Often, relational difficulties ascribed to a patient, or group, may reside in the personality of the therapist. Such techniques as silence, waiting for the patient’s or group’s readiness, benevolent ‘holding,’ developmentally ‘upward’ interpretations, may be prompted by therapist-inspired dynamics of reaction formation and avoidance of the personally primitive and ‘not nice.’ There are times, of course, when the patient or group is not ready or not willing to tolerate the internal and interpersonal processes of feeling, thinking, and sharing conflictual experience, or allow the therapist to do so. In contrast, words are valued as vehicles to express need and to have needs met. This brings us to the symbiotic dimension of the container–contained. SYMBIOTIC RELATIONS

In symbiotic relations, ‘one depends on another to mutual advantage.’ Symbiotic interactions are characterized by projective identifications that evoke enactments in which one individual comes to feel contained by another. Language is employed for irrational or pre-rational uses, via mechanisms of introjection and projection, for interpersonal connection and not valued primarily for their semantic content. For example, a patient may store (i.e.

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introject), the analyst’s words, deriving a sense of connection and comfort from the very act of being spoken to. The individual also may discharge (i.e. project), affectual need through the release of words, successfully establishing contact and influence via vocal intonation and emphasis, verbal repetition, and so forth. Mature dialogue, in which semantic meaning participates fully, rests on the relational bed of such pre-articulate, projective–introjective exchanges. These exchanges are ‘emotionally rewarding…[establishing] a sense of being in contact…a primitive form of communication that provides a foundation on which, ultimately, verbal communication depends’(Bion 1967, p.92). Symbiotic need reflects a self-state in which separation of self from object, and image from referent, is felt as incomplete. The self remains concretely in contact with the emotional symbol and the emotionally signified; the symbol and signified are also partially identified or fused with each other. Thus, emerging emotions are closely linked to their words, and words closely linked to deeds, and all of these – feelings, words, and action – are designed to seek and evoke contact from a containing other. To maintain empathic contact, the group therapist must invite and protect such communications without making demands on members to be consistent, intellectually articulate, or morally ‘correct.’ At times, the therapist must protect a member from encroachments by other members, safeguarding the member’s entitlements to express feelings and thoughts that might arouse, in other circumstances, a retaliatory response. Thus, the clinician models receptivity to projective identifications by maintaining an active presence that is responsive to the expressed and unexpressed emotional needs of group members. While ‘doing’ in commensal relating involves two (or more) individuals sharing thought, in symbiotic relating, doing involves empathically taking in and understanding that which not every member feels willing or able to develop into thought. Interventions must be delivered and experienced benevolently, their essential purpose being to establish ‘contact’ with an area of the projector’s personality that has insufficiently mastered selfcontainment. A sense of patience, timing, and tact are particularly important in establishing and maintaining contact on this relational level (see Chapter 7, on bonding). Once intrapsychic and interpersonal containment is established or reestablished, individuals more easily may receive and reciprocate commensal communications.

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We may appreciate how containing on the symbiotic level requires far more than passive holding, in which the therapist construes the task as supplying warmth and security until other members indicate readiness for commensal dialogue. Symbiotic processing requires the group therapist to think actively about and to respond strategically to intense emotional reactions that are ambiguously communicated, and which evoke one’s own counter-reactions that also must be understood. Psychoanalytic theory and technique, emphasizing the value of insight, regards developmentally-later commensal communications as a higher stage of development, and preferable. However, symbiotic communications remain the reassuring foundation on which the more sophisticated commensal communications develop. And symbiotic communications continue to function as an important source of data and responsive interaction in all human relations. SYMBIOTIC RELATIONS IN THE SUPERVISORY DIALOGUE

The patient, Mary, felt ‘badness’ emerging in her relationships in the group and alerted the therapist by her words and behavior. At the same time, she dreaded naming the experience or articulating and exploring its meaning. Mary’s provocative words and behavior served as projectile containers of partially formulated experience. They were efforts at communication and attempts to evoke from the therapist a containing response. This involved Dr. A in containing badness and making it less bad, initially, simply by communicating back a thoughtful acceptance. Dr. A, perhaps to a lesser degree than Mary, had difficulty containing ‘badness,’ accepting and thinking about bad feelings, without external support. And parallel to the patient, the analyst was signaling the clinical other (me) to do something about these feelings; making them less bad, such that Dr. A could accept and think about them herself. To think commensally, and to help the other move from a symbiotic to commensal level, the receiver needs to be in contact with goodness and badness, while maintaining the love of one’s own inner objects. From this position of inner security, the receiver can more easily evaluate that which the other is projecting, and also, what the other dreads to project and therefore to reveal. In the clinical situation under discussion, the supervisee’s identifications with and transferences to an unloving mother (really, to her mother’s unloving superego) made this task of evaluation difficult. Indeed, it was not clear how anxious the patient was, how serious were her threats, or what she needed from her therapist or group to foster a

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dialogue. To think about these clinical issues, the analyst would have to place herself in the transferential–countertransferential vortex of the total situation, momentarily becoming the patient with bad feelings as well as the patient’s bad object. She would have to engage her own basic affects in the process of understanding, allowing these affects to develop into fantasies, thoughts, wishes, and fears that could appear to the mature mind to be primitive, immoral, unprofessional – ‘not nice’ (see Chapter 9). Dr. A had not done this, but responded ‘analytically.’ From this point of view, the analyst’s analytic attitudes, her neutrality, limit setting, admonitions to return to group, insight-oriented interventions, and so forth, served as actions taken to relieve the analyst’s anxiety about ‘badness,’ to avoid thinking about badness, and not to contain the patient’s. In the supervisory session, I served as the symbiotic other who welcomed basic affects, including what was not nice, particularly about me. Symbolically, I took in her piss, accepting with good humor, caring, and commensally-based understanding, her sense of badness about the whole clinical situation, consisting of her patient, the group, herself, and me. Unburdening and placing in me to develop, modify, and return what she could not emotionally process by herself, she could resume thinking. ‘I haven’t let Mary play out her anger, the way you’re doing with me,’ Dr. A volunteered, ‘but I think I’m ready to now. I’ll bite the bullet. We’ll see what will happen.’ I had confidence that she would return to the individual and group work communicating an increased tolerance for emotional experience. PARASITIC RELATIONS

In parasitic relations, ‘one depends on another to produce a third, which is destructive of all three.’ Containing or being contained is experienced as threatening, untrustworthy, and must be deflected or subverted. The goal of communication is to evade, even to destroy, meaning and meaningful emotional exchanges. The very act of thinking may be hated as a process that confuses and leads to pain (Chapter 3). Therefore, commensal dialogue is dangerous, since it stimulates thought and leads to meaning. Symbiotic relatedness may be experienced as inauthentic and entrapping; the individual experiences anxiety and little reliable pleasure in empathic contact with self or other. Parasitic communications may be provocatively direct, as well as subtle and not immediately identifiable. For example, the individual may utilize projective identifications to ‘numb’ (Bion 1961, p.149) or confuse the

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receiver’s thought processes. Or, by withdrawing projective identifications, the individual attempts to ‘starve’ the other emotionally. Green (2000, p.20) comments that ‘speech addressed to another person is based on a cycle of established, mutual excitations…instinctual excitation recathects the circuit of speech, enriching its flow, preventing it from drying up.’ As basic affects are withdrawn, speech may remain intellectually informed, as in cliché or formulaic responses, but becomes lifeless and stultifying. When an individual or group is operating predominantly from basic assumptions, the communications fall into the symbiotic or parasitic category: ‘Instead of developing language as a method of thought, the group uses an existing language as a mode of action. The ‘language’ of the basic-assumption group lacks the precision and scope that is conferred by a capacity for the formation and use of symbols: this aid to development is therefore missing, and stimuli that would ordinarily promote development have no effect’ (Bion 1961, p.186). However, individuals who communicate parasitically may retain a capacity to reflect on such behavior and may respond positively to feedback from the therapist and other members. As Steiner (1994) emphasized, even a patient who hates ‘the whole idea of being understood…needs the analyst to register what is happening and to have his situation and his predicament recognized’ (p.132). In the face of parasitic attacks, the analyst needs a container for his or her own stimulated affects. The therapeutic frame (Langs 1978) of regulated availability, one’s knowledge and training, the clinician’s legitimate entitlement to assert limits, all may provide this essential function. Particularly important is the analyst’s capacity to tolerate hating and being hated, while sustaining benevolence towards the patient and curiosity regarding the interaction. By maintaining a non-retaliatory ‘disrespect’ (Caper 1997) for therapy-destructive behavior, as well as a caring understanding, in time the therapist and the group may disarm parasitic communicators and cultivate longed-for but distrusted symbiotic and commensal relatedness. Group members may decide (unconsciously as much as consciously) to be contained within therapeutic parameters, or they may continue to attempt to challenge or destroy them. At times, individuals or the entire group may decide to do both (see Chapter 6, on the adolescent group), and it is left to the therapist to describe how and why the conflict between thinking and anti-thinking, containing and anti-containing, is being played out.

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PARASITIC RELATIONS IN THE SUPERVISORY DIALOGUE

Formal, semantic, and paraverbal aspects of the patient’s communications illustrate parasitic attacks on commensal and symbiotic links. Mary’s use of telephone answering machine and physical absence from the group removed communication from its appropriate time and place, obstructing opportunity for commensal dialogue. Her abandonment threats and withdrawal of positive emotion disturbed trust and security, the symbiotic basis of relationships. Parallel parasitic relational processes occurred in the supervision. Both patient and supervisee were ‘pissed.’ ‘What should I do?’ Dr. A implored of me. Like the patient’s, her words, on this relational level, were delivered not primarily to communicate and mutually develop feeling, but to relieve feeling by provoking potentially destructive interaction. Analytic lore insists that we do not tell our patients what to do, or our supervisees either. The supervisee was relieving herself by pissing on the analytic process and me. I felt an unpleasant something come my way which, initially, I did not understand. For a moment, I did not like Dr. A. I report my emotional situation not to record negative countertransference, but to suggest its relevance in the development of my thinking. In allowing myself this vague, bad feeling, I trusted its value in developing my thoughts. And indeed, I soon realized that the badness I felt was a pressure to do something that I could not or did not want to do. This realization brought personal relevance to my situation with the supervisee, and to hers with Mary and group. I did not like what Dr. A was doing. Dr. A did not like what Mary was doing. The patient did not like what her therapist (and the group) was doing. Each of us felt bad and felt the other as bad and not in control. Each of us felt violated and untrusting, and pressured to take non-analytic action. Like Dr. A in relation to Mary, I first had to admit and not freeze my bad feelings, fantasies, and thoughts. To think about our difficulty in thinking, I had to achieve a ‘decrease of inhibition but also a decrease of the impulse to inhibit’ (Bion 1970, p.129). That is, I had to feel Dr. A’s attacks on the thinking process and on me, and feel and think about my emotional reactions to these attacks, without mindlessly complying, withdrawing, or retaliating. Indeed, I wanted to comply with Dr. A’s demand for me to tell her what to do. I wanted to resist and become sarcastic, or quiet and passive-aggressive. I wanted to blind her with brilliant insights regarding her behavior toward me.

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I had felt -K, which I applied to understand rather than to participate in the parasitic process. I had contained the pressure of Dr. A’s attacks on my thinking and on our work, bearing my own unavoidable anxiety and mental pain. Now I could participate with the inner security and relaxed attention appropriate to empathic work. As far as I was aware, I achieved an internal state without active desire. I felt no precipitate need for her to care for me or to interpret the situation before us. As I have reported, I simply suggested that the analyst thought I was out of control and that she did not like me, and I waited to see how she would respond. There was no need to rush to action by confronting her, or offering a complex clinical formulation, or telling her what to do and how to do it. My thinking, contained in my spontaneous response, reflected a nesting of multiple clinical and personal relationships, only some of which I recognized consciously. Containing, that is, preserving and communicating an emotionally balanced state of mind, protects the therapeutic frame and invites the patient or supervisee to participate within it. I wondered whether Mary and the group might accept this invitation from Dr. A. NEW PROBLEMS PRESENTED IN THE NEXT SUPERVISORY SESSION

A week had passed, and new problems regarding the group had emerged in the mind of the supervisee. A woman opened the session by reporting that she might take a series of sailing lessons on group night. She would be missed, other members responded. An idea from previous sessions recirculated: the group could get together at a singles’ bar. But what of Dr. A’s reaction? She once had been quite firm about the rule of no after-group fraternizing. Now she claimed to be willing to discuss anything. The members were not convinced. A debate ensued over the merits of what the group assumed to be the therapist’s position, and why she seemed to be changing it. The discussion then turned to other topics. But Dr. A dreaded what she had heard and to some extent ‘froze’ for the rest of the session. ‘The group was lively,’ she reported, ‘but I wasn’t.’ I wondered if some carry-over existed from the incident with Mary and the male member. ‘Oh that resolved itself, Mary is back and in fact she defended me!’ Another woman and not Mary threatened to disturb commensal and symbiotic relating. This member expressed the universal and omnipresent conflict over thinking versus non-thinking, the latter thematically developed in the group’s tacit blessing of a member’s ‘sailing away,’ and in the wish for a boundary-violating meeting in a singles’ bar.

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The nestings of clinical problems represented by the container–contained had reemerged, although some of the emotional particulars had reconfigured with different participants. In the therapist’s mind, somebody was being ‘bad’ and out of control, and the therapist feared rejection and group dissolution. There were not-nice feelings, and doings, calls to action, asserting mental pressure on Dr. A’s relationship to individual patients and group, on herself, and on me. Dr. A had experienced parasitic attacks on her containing functions. She heard that the group would rather meet without her, go sailing and drinking, and that she was a stick-in-the-mud, inconsistent, certainly a bad group therapist. I thought she had an opportunity for a commensal exchange of ideas, both in the supervision and in her individual and group work. From my point of view, which I offered, her hearing had been wonderfully enhanced by the proverbial ‘third ear’ (Reik 1948) of analytic reverie. She could share her ‘hearing,’ utilizing her own consciousness (and unconsciousness) to aid the group in awareness of theirs. And then, to raise our relational self-consciousness, I brought up that which had remained unsaid but not unfelt: I had a role in mobilizing her problems. In previous supervisory sessions, I had suggested that Dr. A consider modifying her tendency to make rules and offer moral strictures, and to let the group struggle with these issues and verbalize their fantasies regarding their leader. Now the group was doing just that. One fantasy was for me to solve Dr. A’s problems, but that would have stifled her growth, and her patients’. In analytic work, problems endure, and the therapist, along with the patients, must suffer them.

The psychoanalytic problem of growth The problems described in the clinical example do not relate merely to deficiencies in the group therapist and her supervisor, the multiple transferences–countertransferences, and to individual and group resistances, but to the psychoanalytic problem cited earlier: ‘the problem of growth and its harmonious resolution in the relationship between the container and the contained, repeated in individual, pair, and finally group.’ To learn by experience, our basic and primitive feelings and thoughts must be claimed: contained within the relational context, made mentally available and, eventually, linguistically expressible. Bion (1961) found ‘the problem of the leader seems always to be how to mobilize emotions…without endangering the sophisticated structure’ (p.78).

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An interpretation should be at the level in the ‘genetic spectrum [where] it belongs (primitive communication or sophisticated)’ (Bion 1970, p.5). But it is not always easy for the clinician to know when and how to do this. For shifts along the genetic spectrum, from lower to higher level of mental organization – from not thinking to thinking, from concrete thinking to abstract thinking – operate quickly and subtly in all of us, not only our patients. The uses to which a communication is put are critical to understanding meaning, and meaning is often offered ambiguously and ambivalently. Moreover, the communicative intent and effect of any exchange remains highly subjective, influenced by the intersubjective context and subject to further reflection. In any therapeutic interaction, it is likely there are the three relational variations, commensal, symbiotic, and parasitic. Individuals communicate on many relational levels at once and the same communication may be utilized to reach conflicting goals. Group members, including therapists, may use words commensally to convey ‘truth.’ But truth may serve a parasitic as well as a representative function, to put up barriers and eviscerate relatedness. Conversely, verbal evasiveness, even manifest falsity, may signify anxiety, distrust, conflict and need, and hence supply meaning and a relational orientation to the sensitive listener. As we are well aware, therapists use factors other than the content of the patients’ verbalizations as guides to interpretation and therapeutic activity. For example, negative transferences and character pathology may be inferred from paralinguistic phenomena such as timing, tone, and cadence, which form a critical part of patients’ full communication. Likewise, the patterns, commensal, symbiotic, and parasitic, provide a level of metacommunicative information that is of a higher order of importance than literal content. I assume that the interest in understanding is basic and desired at the very time it is denied and hated. An individual is of many minds, and thinks about experience even when attacking the emotional links to understanding it. And while the therapist strives to function primarily on the commensal level, he or she must respond with patience and creativity to the reality that the other may wish to communicate predominantly on another relational level. Also, we must keep in mind that we share the human limitation in containing emotional experience, and must rely on our patients (as well as on others) to further that which we cannot or do not want to feel and understand alone. All of us need and fear containing, and scrutinize our environment for suitable objects, human and nonhuman (see Mitrani 1996; Tustin 1990). In interpersonal situations such as individual or group psychotherapy or supervi-

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sion, all the participants register how and whether our emotions are being contained and our success at containing those of others. Such mental activity most often takes place without conscious awareness, and is communicated by subtle changes in our own relatedness. And thus the intersubjective process evolves, as ongoing and shifting self–other evaluations mutually influence decisions to participate commensally, symbiotically, and parasitically.

Relational theory and the model of the container–contained Bion’s epigenetic epistemology, utilizing the model of the container– contained, brings metapsychological clarity and clinical structure to the prevalent relational view of the mental apparatus as a dynamic open system. According to this formulation, the mind is structured on a dissociative– integrative continuum that reconfigures itself according to the evocative potential of the current interpersonal moment. Interactive, autonomous suborganizations of internalized self and object representations move in and out of consciousness. Meaning originates in preverbal, affectively dominated, relational scenarios and expectancies, while the dynamics and structure of meaning creation continue through all stages of the life cycle. New meaning emerges from the discovery of isolated, split-off, or undeveloped aspects of the self linked to recurring, developmentally early, emotional experience (Davies 1999; also Aron 1996; Bromberg 1996; Hoffman 1994; Mitchell 1993, 2000). Container–contained relationships refer to such suborganizations of the personality. The three relational versions dynamically pattern experience in varying psychosocial contexts. Later suborganizations nest, within their permeable and expanding structures, developmentally earlier relational patterns. The model of the container–contained addresses what have seemed to be conflicting metapsychologies between individual and group or social psychologies. Within this model, all meaning-making requires container– contained processes. These processes are nested. The individual psychologies look at the inner rings of the nestings. The social psychologies talk of the individual being shaped by the culture. In terms of the outer rings, that is true as well. The container–contained approximates Foulkes’ (1964) goal of finding ‘a method and a theory which would do away with pseudo problems such as biological versus cultural, somatogenic versus psychogenic, individual versus group, reality versus fantasy’ (p.7). Indeed, similarly to Foulkes’ group-

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analytic theory, the epistemological framework presented in this chapter, and throughout Relational Group Psychotherapy ‘considers that all psychodynamics are originally multipersonal, at the very least two-personal, refer ultimately to the group (tribe, family, community, species), are thus primarily group phenomena’ (Foulkes 1964, p.17). The container–contained is a complex model which describes processes of human development, internal and external object relations, affect integration, symbol formation, individual, dyadic, and group functioning, and learning from (and resisting) emotional experience. The evocative model and its three relational variations are extremely useful in understanding the shifting and ambiguous realities of human communication. They aid the group therapist in the complex task of formulating therapeutic activity that is responsive to the need for meaning at different relational levels.

CHAPTER 6

Containing the Adolescent Group In this chapter, we will discover how the three relational levels of the container–contained get played out in adolescent group psychotherapy. The model of the container–contained offers a most interesting relational perspective on understanding and treating adolescents, a perspective which is enriched by the notion of play. Each of the three relational levels, commensal, symbiotic, parasitic, represents a particular attitude towards thinking and thinkers, and each level represents a different mode of play. When being curious, seeking knowledge, or learning, the adolescent relates commensally, playing with mental elements and their verbal representations. When symbiotic, he or she requires others to play with, to work through defenses against thinking and playing. In the parasitical level, the adolescent plays pathologically, that is, he or she withdraws from or subverts playing and other players. Adolescence may be considered a drama that first takes shape in the adolescent’s mind. As dramatist and actor in his or her own drama, the adolescent wishes and needs to involve an audience. The outside world provides the communicative context to rehearse and perhaps rewrite this drama. In group treatment, the adolescent often enlists other members to ‘play’ the therapist, to test, challenge, and ultimately to discover the clinician’s personal and therapeutic mettle. The question arises of how best the therapist may ‘play it.’ The task is to contain the adolescent’s ambivalent, often confrontational communications with playful utilization of the therapist’s own subjectivity.

Normal and pathological play related to the Klein-Bion theory of thinking Melanie Klein showed that play is meaningful, and serious. Individuals who do not play or play constructively have severe inhibitions and disturbances in thinking and in their relations to others (Klein 1929, 1930, 1961). Klein’s 131

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analyses of children demonstrated how the child’s verbal and nonverbal behaviors might be conceived of as forms of normal, inhibited and pathological play. Further, she showed how play – and resistance to play – reflected unconscious fantasy. For the child to play, the child had to fantasize, and therefore successful play marked the child’s freedom in playful thinking and progress in working through mental conflict. Play then is characterized by freedom for action. This freedom is primarily for mental action, and behavioral action secondarily, because play – as a container – establishes a particular meaning context for the behaviors. Thus, play establishes a zone of safety in which it is possible to process explosive or potentially destructive meanings in a constructive manner. Klein demonstrated how play allows others to get to know the child and the child to get to know itself: what the child thinks about and struggles to understand. At times, the adolescent child must rely on a therapist to learn to trust play, so as to be able to fantasize within boundaries and rules, and make sense to oneself and others. The affiliation with the playful therapist becomes a means of mental recovery and growth. Throughout the life cycle, other individuals remain essential to nurture the play of the mind, to preserve the thinker, and to foster emotional growth. A playful mind develops and maturates in the social communicative context, a context that stimulates and reflects primary relational fantasies involving the container–contained. The containing therapist fosters play by maintaining a presence that encourages, empathically receives, and enactively and semantically interprets these relational projections, fantasies, and thoughts, in a playfully serious group context.

The relational crisis of adolescence in terms of the container–contained In many ways, it is society’s and the group’s failure to deal with adolescence that reveals the face of adolescence to us. (Vanier 2001, p.584)

In every developmental stage, new equilibria between symbiotic and commensal relations is negotiated. In adolescence, with the participation of the milieus of family–school–community (see Bloch 1995), there is a push in thought and in action that involves tolerating uncertainty, the breaking of emotional and conceptual links to a dependable, known reality. Prior to adolescence, concepts of reality and moral behavior are clear and defined. The

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child sees the adult world through the absolutist point of view of concrete operations (Piaget 1969). The advent in adolescence of the achievement of abstract and relativistic thinking, Piaget’s stage of formal operations, brings new impetus and power to K, the drive for knowledge. The adolescent has achieved a greater capacity to play with his or her mind, and the minds of others. He or she may shift, permutate, combine or reverse point of view, leaping mental boundaries from one view of reality to another, from reality to fantasy, morality to immorality, narcissism to mutual recognition and concern. Feelings may be experienced and thought about in a more complex manner, closer to reality, and the individual is more capable of acting on them. Perhaps a special pain of adolescence is that thoughts inspire action and the adolescent, for the first time, is capable of adult agency. The potential for aggressive thoughts to reap destructive consequences may be actualized. So maturing thinking imparts greater moment to the adolescent play, but this is a painfully mixed blessing: ‘for there is nothing either good or bad, but thinking makes it so…,’ laments Hamlet (Hamlet, II, ii, 255–257), whom we may consider as an archetype of late-adolescence. The adolescent, in the midst of a process of biological disruption, growth and repair (Laufer and Laufer 1984), may be far from ready to deal with the painful emotional realizations that accrue from the play of a maturing mind thinking. To think long, hard or deeply about what could be felt, and what could be done about what is felt, stimulates strong emotions, and defenses against thinking about them. Few desire to sustain formal operations when such potential anxiety is involved. Indeed, at any stage of development the human being needs meaning, but cannot tolerate too much of it. When the psychosocial environment inadequately supports burgeoning commensal relatedness, the adolescent may regress and fixate at the symbiotic level. Here the adolescent waits, in need of a trustworthy audience to nurture thoughts and therein consolidate readiness for independent action. A less auspicious outcome may eventuate when, increasingly frustrated, envious and hating the ‘Establishment,’ the adolescent becomes mired in parasitic internal and external relations. Such is the unfolding tragedy of Hamlet.

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Hamlet: To think and not to think The customary answers given the child…damage his genuine instinct of research and as a rule deal the first blow, too, at his confidence in his parents…he usually begins to mistrust grown-up people, and to keep his most intimate interests secret. (Freud 1907, pp.135–136)

Shakespeare’s works, especially Hamlet, have provided rich material for psychoanalytic literary analysis (e.g., Freud 1900; Friedman and Jones 1963; Jacobson 1989; Jones 1949). For our purposes, Shakespeare’s protagonist will carry forth our consideration of the adolescent crisis. Hamlet’s behaviors, especially his speeches, illustrate the conflictual traversing of relational levels; he both participates in and destroys thinking and thinkers, playing and players. Hamlet was haunted with dream thoughts, ghostly, dissociated realizations concerning his parents, and was afraid to trust and act on his convictions. Perhaps all adolescents are in danger of prematurely recognizing the disconcerting qualities of parents and the adult world. Adolescents are not quite prepared ‘to be,’ rather than ‘not to be.’ No longer unquestioningly loyal to adults, they are not sufficiently experienced or solidified in their identities to trust their consciousness and unconsciousness to guide their behavior. Hamlet epitomizes the adolescent who remains ambivalent regarding the K function and its consequences. He or she is motivated to know and not to know, to express and to deny the human need to be understood and to understand others. To accomplish contradictory goals of thinking and not thinking, the adolescent may shift rapidly among the three levels of relatedness and use and misuse communication with great variety. In studying Hamlet’s discourse, we may appreciate how Hamlet’s words function as verbal and nonverbal symbolic conveyance, constructive and destructive evocative public behavior, assertive reality testing and self-justified acting-out. On each polarity, we may find commensal, symbiotic, and parasitic communication. In the beginning of the drama, we meet a petulant Hamlet, unhappily ensconced in his newly configured family, his thoughts only partially articulated, and irresolute in behavior. He speaks first in word play: a sarcastic aside in response to Claudius (the king), who has referred to him as ‘son.’ Hamlet responds: ‘A little more than kin and less than kind’ (I, ii, 64–65). Not hearing his actual words, but catching their emotional drift, Claudius reproves his nephew-stepson for depressive rumination. ‘How is it that the clouds still hang on you’? (66). Hamlet responds ‘Not so, my lord; I am too much i’ the

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sun’ (67–68). Hamlet’s multiple meaning, referring to the star, to the king (symbolized as the sun), with homonymic denial of a third meaning (i.e. ‘son’), provides an example of the use of language simultaneously to communicate and confuse, to provoke and undermine a dialogue. In using ambiguous word play, Hamlet ambivalently attempts to make and destroy links to his untrustworthy family that he can neither depend upon nor separate from. He can neither think clearly about nor suppress his dawning realizations. In the soliloquy that follows, Hamlet describes the suffering he endures, not only because of the deeply troubling turn of family events, but also because of his resultant communicative isolation. He is constrained in developing the social component of K. He is particularly haunted by his negative thoughts and feelings about the social context, yet needs the social context to develop them sufficiently so as to prepare for constructive action. His mother’s incestuous marriage has damaged communicative trust, such that he dares not use others constructively: ‘How weary, stale, flat, and unprofitable/Seem to me all the uses of this world! /…But break, my heart, for I must hold my tongue!’ (I, ii, 133–134, 158). Throughout the play, Shakespeare dramatizes Hamlet’s ambivalence as symptomatic of a conflict between his need to suppress and to develop his painful emotions in a social dialogue. In comparing himself to one of the professional actors, Hamlet laments: What would he Had he the motive and the cue for passion That I have? He would drown the stage with tears, And cleave the general ear with horrid speech; Make mad the guilty, and appal the free; Confound the ignorant, and amaze, indeed, The very faculties of eyes and ears. Yet I…can say nothing… (II, ii, 586–595)

Although Hamlet often denies or disguises his longing to speak sanely and meaningfully, it echoes throughout, and is sadly mourned in his final words: ‘The rest is silence’ (V, ii, 368). Hamlet does not trust the Establishment, which he fears is parasitic: You would play upon me; you would seem to know my stops; you would pluck out the heart of my mystery; you would sound me from my lowest

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note to the top of my compass – and there is much music, excellent voice, in this little organ – yet cannot you make it speak.’ (III, ii, 379–385)

Hamlet devises a strategy of provocative enactment to test the authenticity of adults: ‘The plays the thing/Wherein I’ll catch the conscience of the King’ (III, i, 905–906). He produces a play about family treachery. But at his own peril, he begins to transform his life into a stage play, casting himself in the role of the crazy adolescent, putting ‘an antic disposition on’ (I, v, 172). Under the protective cover of play, Hamlet attempts to ‘catch’ who the adults really are, embroiling the adults such that they are forced, as players, to reveal themselves: ‘Players cannot keep counsel; they’ll tell all’ (III, ii, 151–152). Hamlet’s K need motivates his participation in the uncertain drama of the adults. He strives to find direction and certainty through creating dramas of his own. His tragedy is set into motion when he fails to follow the advice he offers to the professional actors: ‘Suit the action to the word,/The word to the action’ (III, ii, 19–20). Hamlet performs with increasing abandon of reason and caring, as in his celebration of his impulsive and thoughtless aggression misdirected at Polonious: ‘Rashly/And praised be rashness for it, let us know, /Our indiscretion sometime serves us well’ (V, ii, 6–8). When Laertes attempts to hold him accountable (for the death of Polonious, his father), Hamlet excuses his behavior, declaring himself a victim of his own mindlessness. And when he’s not himself does wrong Laertes, Then Hamlet does it not, Hamlet denies it. Who does it, then? His madness. If ’t be so, Hamlet is of the faction that is wronged, His madness is poor Hamlet’s enemy. (V, ii, 246–250)

Playing crazy and crazy play have become confused and confounded. His K function grossly impaired, Hamlet has become his own enemy. He is now desperately embroiled in an alienated, parasitic world which demands that he be cured, exiled, or killed off. This is often the demand of parents who, in their anger and desperation, bring their adolescents to our offices.

Containing the disturbed adolescent: Comedy and symbiosis Often by the time the therapist gets to see the adolescent, the family is staging a tragedy. Familial relations have become treacherously parasitic. Ambivalently partaking in social life, adolescents may risk acting, feeling, or even

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becoming crazy. What is necessary is a massive collaborative rewriting of a developing tragedy into a potential for comedy. I mean by ‘comedy’ the dictionary definition: ‘a dramatic work in which the central motif is the triumph over adverse circumstance, resulting in a successful or happy conclusion’ (Stern 1973; see also Schafer 1976). Serious comedic play – rather than tragedy – necessitates authentic adult presence in the adolescent child’s life. Before genuine separation and individuation from parents are possible, alienated adolescents first need to reconnect positively to their families or find a transitional replacement in the therapist and group. I remain vigilant to the dangers of segregating an adolescent’s therapy from parental involvement, and monitor the quality of parental relationships to the adolescent, to me, and to the therapy, whether or not I have direct contact with the parents (Frankel 1998; Malekoff 1997). Often an alliance with parents involves establishing a sense of our being one big family, in which I serve as the symbolic and at times actual leader, carrying out important maternal and paternal containing functions, including providing sanctuary, emotional nurturance, and guidance for all the members. To effect change, then, the therapist writes his or her role, entering the drama and becoming a central player in the adolescent’s actual as well as mental life. The therapist’s dramatic presence (his or her ‘comedic skills’) is in the service of creating a productive symbiosis, and contributes to the triumph over adverse circumstances. Therapeutic participation does not always require actual or equal contact with all members of the social network. Successful treatment may involve the adolescent in individual and/or group therapy without the family. One or both parents may enter their own individual and group therapies, independently of the course of an adolescent’s therapy. Most effective but not always possible is some form of combined treatment, involving adolescent, family, and if necessary, school intervention.

Waiting room family therapy Certainly, good can happen when people play together. And to play comedically, the therapist may consider broadening the definition of what constitutes a good hour, or even what constitutes the hour. I am not ceremonial about where and how to institute meaningful communication, except that I attempt to function within the confines of the allotted therapy hour, which begins when I greet people in the waiting room, and ends on time. I avoid the telephone whenever possible, without being unduly rude or rejecting.

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In the early stages of treatment, the waiting room may provide a unique social context in which to contain and detoxify parasitic family relations, and to begin setting up the idea of a constructive family group. Many parents are willing to volunteer their children, but dread themselves crossing the threshold from the waiting room to the therapy room, and they make sure that nothing positive is accomplished when they do. The idea of therapy implies something about themselves that is unacceptable, such as guilt, blame, shame, responsibility, craziness, saneness, hatefulness or lovingness. The same parents may communicate with meaning outside the area of formal consultation, to express pain and anxiety, to complain and provide other forms of information about themselves and their child. Similarly, the adolescent, relatively sensate in the waiting room, turns to wood upon entering, en famille, the therapy chamber. Surprisingly, these same individuals could desire my meeting with their parents, even when they themselves refused to attend family appointments. Confidentiality is not at issue, but privacy and self-protection are (see also Malekoff 1997). People fear the treatment room because they know that it is a place to feel and to think. With the therapist’s encouragement, the waiting room may become the first and only safe place, a transformative container making possible symbiotic relatedness and commensal communication. And thus the therapist involves the troubled family, as long as it is not called ‘therapy.’ On more than one occasion, I have been greeted with a parent’s angry report regarding the offspring: ‘He did it again!’ A constructive response is problematic, since neutrality and disinterest may rightfully alienate the adult, while sympathetic inquiry may not be strategic in terms of relating further to the adolescent who may feel betrayed by the therapist’s alliance with other adults. Adolescents tend not to tell their therapist what they did again, yet sometimes what they did is quite serious and we need to know. The more serious, the less likely the adolescent will report; and the more serious, the less likely there exists an alliance among adolescent, parents and therapist. The optimal therapeutic play here takes place in the symbiotic field: nurture the informants while establishing positive contact with the informed upon. A playfully admiring rejoinder to the offspring such as: ‘It worked, you got them angry! What did you do this time?’ may give the adolescent a sense of satisfaction. At the same time, the question may elicit the needed information and relieve the parent. With everyone temporarily pleased, perhaps the

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family will be game to accept an invitation to discuss the situation further in the office.

The play within the play: Adolescent group therapy Psychoanalytically oriented group therapy is an under-utilized treatment modality that may be particularly effective with poorly communicating, resistant or otherwise socially alienated adolescents (Azima and Richmond 1989; Evans 1998; Malekoff 1997). I differentiate this form of treatment from didactic, activity, or theme focused adolescent group.

Clinical examples 1. A COMMENSAL GROUP OF POOR COMMUNICATORS

Two young adolescents introduced me to the practice of adolescent group treatment. Robert was an impulse-disordered thirteen-year-old with enuresis. Lucy, also recently turned thirteen, was socially inappropriate, with a mild thought disorder possibly due to organicity. These two immature teenagers found each other in my waiting room during the intermission between their respective appointments. They ostensibly were attracted to the boy’s portable video game which, seemingly glued to his hand, had been an impediment to our making contact. These isolated youngsters could play together, whereas individually, they had much difficulty communicating within the time and space boundaries of the waiting room or therapy office. They asked if they could take a portion of their individual sessions and share them, we three. Their parents looked at me expectantly, as if I had heard such requests before and knew how to respond. Perhaps not to lose face with the adults, as much as not to disappoint their children, I assented. Several months were spent calmly as they played together without much talk or wish for my inclusion, except to protest the close of their shared time. They wanted to know if I treated other kids and wanted them to join us for longer sessions. Again I assented, adding Steve, an inhibited and semi-mute schizoid boy with an uncertain sexual orientation and Toni, a twelve-year-old girl adopting crass behaviors. I extended the length of the session to one and one half hours. The video game, a form of isolating parasitic play in individual treatment, had been utilized to establish symbiotic communication in the small group, and was now discarded. The members used the time to talk. We called our time group therapy.

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I emphasize that the group functioned primarily on a commensal level, in which language was a prime vehicle for learning from the group experience, even though an audio transcript of any particular session could be characterized by surface and mundane dialogue, interruptions and discontinuities between speakers and between thoughts, concrete and evasive thinking, and reflexive compliance with, or rebellion against, the leader’s directives. However, from the group’s inception, the members actualized their strong desire to get to know each other by thinking and shared verbal communication, putting into words a variety of basic feelings and thoughts about each other’s psychologies. These communications expressed and elaborated enjoyment, admiration, curiosity, fantasy, empathy, insight, impatience, annoyance, and criticism. While I found I had to lead the group actively, I also followed the group’s lead, mentally groping for and experimenting with strategies to address awkward silences and rambling monologues, and to encourage intellectual and emotional momentum. A seeming casual interchange could be quite promising psychoanalytically, if allowed to remain casual and pursued with a light touch. I describe two sessions, several months apart, in the group’s third year. (A) FIRST SEGMENT

Lucy: Robert:

Toni:

Robert: Steve: Toni: Robert: Ellie: Robert:

[to Robert] Whenever we talk about fathers, you get fidgety and shifty. You drive me crazy. [while hitting his feet against the under railing of the chair and rocking himself ] My mother didn’t like him [Robert’s deceased father] anyway. There he goes again, the kid [Lucy] is right. You make me jumpy when you do that. Stop it. Do you drive them crazy at home? [embarrassed, looking towards Ellie, a shy younger girl new to group] Will not [stop kicking chair], you’re jumpy too. I wish my father would die. [to Ellie] He really means that. [to Ellie] My father just dropped dead, he wasn’t living with us. How old were you? I don’t remember, maybe ten.

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You don’t remember, what a retard!

Robert:

I ain’t so good in math, or in anything else! Did you see Married with Children [television show]? Al Bundy [the father] is so cool. Lucy: It’s crazy that show, my parents say it’s not proper for us kids to watch it. An animated discussion followed about the show and different episodes. At one point I tried to guide the conversation back to psychological issues. ‘Before, Robert said Al [Bundy] reminded him of his dad, but he didn’t get a chance to tell us how. What about for the rest of you? Is Al like your dads?’ The room got quiet and I felt awkward, that I had crashed a party for teenagers and definitely did not belong. Lucy: I like Kelly [the sexually provocative daughter], when I get to see her. She’s very pretty. [Toni rolled her eyes and met Robert’s. They laughed conspiratorially but did not otherwise put Lucy down.] Robert: She hot. Steve: [unconvincingly] For sure. Toni: [to Lucy] Why don’t you let your parents know that you are old enough to see what you want? Lucy: I like other shows too… A spirited debate over the merits of various television programs and the tastes of the members consumed the remainder of the session. I was impressed with the members’ achievements in the session, but certainly not with my own therapeutic efforts. I took consolation with the thought that further interventions on my part would have been overload and reflected impatience with the process. After all, the group had gone further than ever before in exploring Robert’s impulse-driven character pathology, its thought-disturbing effect on others (‘You drive me crazy’), and its relationship to his traumatic loss and consequent partial amnesia (‘I don’t remember’). Steve had begun to talk, putting in words his hatred of his father rather than muting all his emotions. Lucy received useful positive and negative feedback. She effectively initiated the psychological discussion of Robert (‘Whenever we talk of fathers, you get fidgety and shifty’), was praised for her mature thinking (‘The kid is right’), and encouraged to use verbal communication at home to reach age-appropriate social goals (‘Why don’t you let your parents

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know that you are old enough to see what you want?’). Finally, the group carried out important initiating functions with the new member, Ellie. Their verbal and nonverbal welcoming behaviors encouraged bonding (see Chapter 7), the symbiotic level that establishes and maintains preverbal feelings of trust and connectedness. (B) SEVERAL MONTHS LATER

Robert:

You know, I was talking with my mom and my [older] brother and his wife. And we’re talking about family and my uncles who I never see cause no one likes them, except me, they’re cool. And then I say to my mom: ‘You know, I just realized it; you’re not raising me, Dr. Billow is!’ My mother doesn’t do anything without seeing Dr. Billow; she even asked him if I should get an allowance, and how much. [Robert turns to me with a big smile.] Lucy: Did you get it? How much? Toni: [exasperated] It doesn’t matter. Robert: My mother will call him or come in to see him whenever she has a decision to make about me. Like whether I should be punished for screwing up in school, or anything. Therapist: So how are we doing? Robert: [beaming] Pretty good. Therapist: How’s that, only ‘pretty good?’ Robert: Well, I don’t hate myself anymore and I get along better with my mom she don’t hate me anymore either. Lucy: Your mom hated you? My mom and I do lots of things together. She comes here to see Dr. Billow too, when she has to, with my dad, although she thinks he wants our money and my dad can’t afford it. Sorry Dr. Billow, that’s not what I think. Therapist: What do you think? Am I raising you too? Steve: [interrupting] My parents don’t have any idea what I think of them. Toni: Steve has raised up from the dead. [Steve smiles wanly and resumes his frozen stance.]

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Lucy:

Toni: Robert: Lucy:

Robert: Lucy: Robert: Toni:

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I think you want all us kids to grow up and be happy. My father tries to make us happy too; my mother tells me how hard he works, with two jobs, and she has two jobs. Your parents have four jobs and Dr. Billow takes all their money. [smiling] Yeah. [to Lucy] Are you worth it? I don’t think so. Only kidding. [seeming not to understand the sarcasm, and repeating a fact wellknown to the group] I’m adopted; they knew it would cost dough to have me but they wanted me. I’m all they got. They hadda buy you? Gyp, gyp! I’m going to smack you one in the kisser. Ooo, I’m so worried. [to Lucy] I’ll do it for you.

The playful sparring dissipated sufficiently for me to turn to Ellie, who had remained in my mind an uncommitted new member. Therapist: Ellie: Toni: Robert: Ellie:

Robert: Toni:

How do you like being in group? I like coming. It’s interesting. Are we interesting specimens? Freaks. Why did you come to group? My mother joined Dr. Billow’s other group, that’s how come I came here. She doesn’t like it that much but she says she wants to be a good model for me, so I don’t leave this group. She can’t afford to see Dr. Billow by herself. Yeah but why did she want you to come? Stop pressing her, she isn’t ready to tell us. She’s like Steve, she’s like another Steve.

DISCUSSION

We may see in this segment how various themes, psychologies, and interrelationships were being developed and explored, the particular focus being on the containing qualities of the leader and the nature of the members’ relationship to him. Rather than interpret, I had worked within the metaphor (Ekstein 1966) of my ‘raising’ Robert, and expanded its application to all group

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members. I utilized the verbal communication to create ‘play space’ (Pizer 1996; Winnicott 1971), to explore transference–countertransference in the shared medium of language and reflective thought. Playing with Robert’s perhaps literally intended communication stimulated the adolescents’ incipient reflective processes (Fonagy and Target 1998), as the group came to symbolize and put into words a pressing reality of the here-and-now situation: was I friend or foe? This crucial question of the paranoid position (Grotstein 2000) was not resolved conclusively. I had become a central player in the lives of the members and their families. Still controversial and thought-provoking was whether my containing influence was parasitic or growth producing: were the members and their internal and external objects enriched or impoverished by their being ‘raised’ by me? In terms of countertransference, I had to make sure I remained on friendly terms with myself. I had to process irrational feelings of guilt for raising other people’s children, and reassert my own sense of moral worth for being paid to do so. 2. TRAVERSING RELATIONAL LEVELS IN WORKING WITH DIFFICULT ADOLESCENTS.

This example describes my efforts at containing the intense, primitive and incipiently violent transference communications occurring in a group of borderline, acting-out, and antisocial adolescents, ages fifteen to nineteen. While all of these individuals were in various forms of crisis, many of them could not, or would not, see me individually. I often could only surmise what was actually occurring in their chaotic lives, until informed by an irate parent, school, police or hospital personnel. The membership of the group varied from seven to ten and was in constant flux. Some adolescents were in attendance for three or four years; in fact, three members (Toni, Robert, and Steve, now seventeen years old) had been in the early adolescent group described above. Others remained short-term, such as during a school year, while still others had their attendance interrupted by brief incarcerations, or stays in out-of-town treatment programs. Although broadly similar in diagnosis and severity of intrapsychic and interpersonal difficulty, the adolescents differed greatly in their ability to socialize and to verbalize. The verbally agile became the leaders in challenging me, and they could easily recruit new as well as less skillful members away from the task of constructively discussing intrapsychic and interpersonal difficulties.

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(A) OPENING OF A SESSION

Toni:

What are you looking at, you dumb, four-eyed bastard [I wore eyeglasses]? Steve: I was thinking this week, he [therapist] deserves to be cut up in little pieces and thrown down the toilet. Therapist: What did I do this week? Silence Therapist: I guess you missed me, and you’re giving me the same treatment I gave you all week: silence. I don’t make it easy for you and you’re not going to make it easy for me. Toni: Shut up! Steve: What did he do this week? He was born. Robert: No hatched, in a test-tube. Tanya: He’s one of ‘them.’ Robert: He probably beat his kids. Toni: No sex with his wife. Sam: He gets drunk as soon as he leaves here – probably, stoned. Robert: He’s stoned already. Sam: So am I. Steve: What a pervert. Toni: You’re the pervert, Steve. Steve: And proud of it. Tanya: I know he’s [therapist] a pervert. Robert: We ought to cut off his nuts. Toni: What nuts? He’s a dickless wonder. Robert: Get the magnifying glass and the tweezers. I understood the group members to be evacuating anger, but also, communicating their need to be reassured that I was not inhuman, unbalanced, or ‘small.’ I had to reestablish in their minds that I was alive and fully equipped to cope with and not be destroyed by or withdraw from their manifest hostility. At some point, I might verbalize with sarcasm my appreciation for the group’s interest, professing to be complimented by its preoccupation with my sexual

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life, such that it was. Or I declared: ‘Same old, same old – boring, very, very boring.’ The members’ use of forceful projective identification and enactment within the group replicated, in therapeutically modified form, the parasitic acting-out that defined much of their lives. The group’s obscene language and repetitive put-downs, to some extent symbolic and playful, threatened to become cliché, utilized to establish no-meaning. In responding to their verbalizations as ‘boring,’ I was calling attention to the conventionality in their use of obscene language, and its numbing repetition – ensuring that neither speaker nor listener would be surprised by language, nor stimulated to think. My task was to be a container with firm boundaries that could be traversed, but not violated or destroyed. I had to be alert to, tolerate, and also confront the convergence and amplification of primitive emotionality, fantasy, and behavioral potential, represented by the group’s split transference, in which I was both the defiled and longed-for object. Thus I attempted to interpret their loud chorus of obscenity but most importantly, show them that I was not drowned or drowned out by it. To be sure, the adolescents’ verbal and nonverbal gambits had potentially lethal elements and thus were the negative of play, its pathological twin. There are no collaborators in negative play, only witting or unwitting co-conspirators and victims. The therapist’s task is to avoid being conscripted or defeated. The situation must be transformed from parasitic acting-out, to playful acting and, when possible, to meaningful verbal communication. In productive group phases the members, satisfied that I remained ‘complimented,’ that is, unrattled by their introductory volleys, proceeded with some success to share important events in their lives. I was allowed to participate, even praised for interventions and interpretations which were, in fact, most often simple but emotionally honest and direct, and which at other times would be derided. For instance: ‘Steve is the angriest person in group, that’s why he’s the most quiet. He doesn’t want to kill us.’ Or, ‘Toni puts up a good tough front, but she’s a mush inside. She just wants to be loved, let’s face it. She’s a big phony.’ Toni (smiling): ‘That’s why he gets my parents’ big bucks.’ At recurrent intervals, often lasting for months, the members remained devoted to verbally attacking and ostensibly ignoring me. The group cohered as a recalcitrant fight/flight culture. I was cast variously as eunuch, pervert, stupid, clumsy, clown, pariah, villain, evil monster, and so forth. As the group outcast I was a central player. Symbolically, I stood for each of them: their lives outside the office described my life inside it, and I often told them so. I also

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stood for every hated and feared adult. Like the King in Hamlet, I was portrayed in a play-within-a-play, and my reactions were closely scrutinized. Would I replicate or be different from the vindictive superego figures of the adolescents’ internal and external worlds? To contain highly aggressive individuals, the therapist may need to draw from his or her own reservoir of aggression and hatred (Searles 1979; Winnicott 1949). In an aggressive group, the therapist’s balanced and reasonable utilization of power may reassure the members that the therapist has not been taken in and therefore killed. The therapist’s forceful display of potency may be communicated through maintaining appropriate distance, setting limits, verbalizing values, and expressing non-punitive disapproval. To calm the unreasonable ‘bully’ element in acting-out adolescents (Adler and Myerson 1973; Azima and Richmond 1989), the therapist may need to play with, even personify, a healthier version of the bully idea. Eventually, the therapist may be represented in the adolescents’ psyches not as a bully, but as a powerful person who is fair, reasonable, and responsible, but who can be tough and incisive when necessary. My availability, regularity, and limited toleration and not total acceptance of the members’ behaviors, provided the frame and the absorbing container, the symbiotic medium in which a verbally constructive group could cohere. Additionally, I did not renounce verbal communication and the potential for commensal relations. I continued to challenge and interpret individual and group resistances, defenses, and the wide range of conflicting feelings, thoughts, and fantasies underlying the manifest antagonism. The adolescents could decide (unconsciously as much as consciously) to continue to harass me, or they could work with me. Mostly, they did both. In many sessions, my pursuit of constructive communication necessitated carrying out lengthy verbal duels with the members. While spiritedly attacking my interventions, the adolescents at the same time openly enjoyed them, particularly when couched in humor and irony and sprinkled with my own obscenities. (B) MIDDLE OF A SESSION

Therapist: [responding to group disarray] Hey, I notice that you guys claim to hate your parents, but just when we start talking about them, all this bullshit commotion starts, and you drown out anything critical we might say. You claim that you’re here to waste their money, but you’re really here to protect your parents from me.

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[Loud groaning and cursing.] Therapist: I notice that this group can’t take two weeks in a row when people are being emotional. Last week Robert was talking about how pissed he was at his mother for attacking his dad, and Lisa was very depressed about her boyfriend being sent away. This week I’m getting all your shit, attacked for getting you into feelings. So the secret is that you hotshots are really scared. Robert: Fuck you. Therapist: Very clever. Now I know that you can take it and really think about what I’m saying. Duh. Toni: Billow’s right, you’re not very clever. Robert: Fuck you too. Steve: Fuck you. Therapist: What is this, a ‘fuck you’ contest? Whoever says ‘fuck you’ the most wins? [laughter] Robert: Yeah, a ‘fuck you’ contest. Therapist: [to group] I think that’s what your whole life is about. A ‘fuck you’ contest with adults and the ‘straight’ kids. [Group discourse shifts as members begin talking realistically about their anger towards parents and some of the ‘jerks’ at school.] To varying degrees, the members’ use of pathological projective identification and parasitic enactments was detoxified by my absorbing – as well as confronting and interpreting – the group’s verbal and nonverbal communications. To be experienced as a benevolent container, I attempted to establish a delicate balance between acceptance and confrontation and interpretation of the adolescents’ projections. One goal was to establish a mental boundary that demarcated aggressive fantasy and play, as used and supported in group, from realistically destructive behaviors carried outside of group, which I challenged, often with the endorsement of other members. Interestingly and to a considerable extent, the group members themselves were able to establish and maintain the conceptual boundaries between aggressive wishes and destructive behaviors. The adolescents valued the health and sanity of their cohorts, which they linked to group membership, and they had no interest in encouraging out-of-group behaviors that risked attendance. The adolescents carried certain tasks of limit-setting, such as

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invoking awareness in new attendees about our rules, regulations, and customs. I had to do little to enforce boundaries regarding attendance, confidentiality, or extra-group contact. I usually found it unproductive to pursue reluctant or resistant individuals. Prospective group candidates quickly committed themselves, or left after several sessions. In contrast to their performance in public or private school, truancy, even lateness, among members was practically non-existent. Some adolescents attended ‘high,’ but not consistently, and I did not find drug taking or exchanging to be prevalent. And despite the derogation of the group and its leader, adolescents referred their friends and requested that they be allowed to attend as guests. At various times a subgroup would coalesce and socialize outside of the sessions, by attending a member’s party, meeting at a rock concert, or a beach outing in the summer. The get-togethers were mentioned casually and spontaneously, and shared in the group as a source of interest rather than exclusion. ‘You ought to come next time.’ And although many of the members were sexually promiscuous, sexual contact mostly was avoided. On several occasions, however, clandestine sexual favors were exchanged involving one of the girls (Toni). These were not talked about in group, however, and I was informed only much later in individual sessions in which the conscripted males complained about her predatory behaviors! The often chaotic and hostile play of the group was nested within a benevolent play of healing container–contained relationships. The group supported emotional development by giving its members the sense of bondedness, of belonging and being important to each other, to me, and to their families that sponsored the treatment. For many of the adolescents, the group thus served important symbiotic and commensal functions, reconnecting them to a stable, trustworthy, and knowable external and internal world. I believe the group was instrumental in their surviving the difficult high school years.

Transmission of the adolescent group process to my peer supervisory group I was fortunate to attend a peer supervisory group during this period. My peers had intense and divided reactions to my reports, and some became quite heated, interrupting each other with strong reservations. They questioned whether I was appropriate and in control. What purpose did the license I gave these disturbed adolescents serve? Was I responsible and sufficiently thoughtful? The contents of their attack, as well as the disarray of these

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sessions, mirrored the adolescent group. I was inappropriate (‘pervert’) and mindless (‘dumb’) and further, my ‘performance’ was inadequate (‘dickless’). Like the entire adolescent therapy group, a fight/flight subgroup relieved anxiety by banding together and attacking me. In their acting-in, the adolescents ambivalently provided an invitation to be contained, which I accepted but with ambivalences and counter-resistances of my own that I must have conveyed to my peer group. During one extended period, the adolescent members attended stoned, turned their chairs away from me, and read hot rod and rock magazines. To cope with what I experienced as omnipresent threats of group and personal dissolution, I isolated myself within my own brand of adolescent superiority towards both the peer and adolescent groups, as well as towards the parents and other authorities who, unlike me, could not understand adolescents or their roles in inspiring their adolescents’ difficulties. I also covertly identified with the adolescents’ arrogant anti-authoritarianism and manic bravado. When allowed entry into their circle, I felt like a special adult indeed, a talented (and brave) therapist. Whereas I am not proud of the concreteness of my feelings, and the enactments which I surely participated in, I suggest that my willingness to engage in, and eventually to understand and partially work through my intense reactions – with the support of my peer group – contributed to the relative stability and durability of the adolescent group.

Conclusion: Play and the group therapist’s containing functions The consensus of literary critics of Hamlet has been that the tragedy results from the protagonist’s inability to escape ruminative thought and so he is trapped in destructive inaction until it is too late. The task of adolescence, achieved via adolescent play, is to prepare the player for adult thinking and behavior with all its consequences. Thus, the maxim, ‘The battle of Waterloo was won on the playing fields of Eton.’ In this chapter we have considered how multiple aspects of relational experience get ‘played out’ in adolescent group psychotherapy, often at the same time. Indeed, the adolescent may exhibit constructive and destructive play, using similar means to reach opposite goals simultaneously. More than one young ward of my therapy has spent hours happily cursing me, describing my utter uselessness as a therapist, man, and human being. I have responded according to my assumption that their parasitism, that is, the manifest hostility, was merely a disguised expression of the social component of the K

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impulse. On the symbiotic level, their words were exploratory missiles, exploding harmlessly to test the depth of my patience and non-retaliatory love. On the commensal level, their words made public thoughts and feelings, hitherto hidden from the self and audience of other. Communications that could and should not be contained internally were shared, developed and expressed in sane if not polite language. Perhaps God created adolescents to keep adults honest, and to alert us when we are not. Like Hamlet, adolescents, perhaps wisely, are suspicious of adults and hence suspect the therapist’s authenticity. They are often less interested in what the therapist says, than in who the therapist is. After all, an adult’s words lose much of their value if the adult does not stand with them. And thus, adolescents team up and act out to ‘catch the conscience’ of their group therapist, to learn something about him or her. The therapist’s self-presentation is often more significant than the semantics of the therapist’s words. The group therapist’s willingness to negotiate his or her way into caring, lively, and flexible container–contained relationships informs the adolescent members who the therapist is. Sometimes our adolescents are correct in challenging us to ‘relax,’ or to ‘get real.’ If we therapists are not real, we are not really containing; rather, we are acting out. Technical interventions, such as interpretation, confrontation, holding, mirroring, enacting, and limit setting, may be experienced as the group therapist’s playing at being a therapist, rather than genuinely being one. How the therapist negotiates ambiguity and ambivalence, resistance and acting out, hinges on his or her facility and willingness to play and to think about play. A group therapist who cannot play has difficulty in containing and being contained, in creative thinking and relating to the individual members and the entire group on all three relational levels. The therapist’s appreciation and encouragement of playfulness may determine whether the group plays constructively, and thereby benefits from therapy. In every hour, the therapist must actualize his or her own capacity to play, and not be dependent on the manifest initiative or response of the adolescent patient, the family or group. Play is an integral part of mature thought, and the individual needs to think. A deficit in playfulness alerts us that the troubled adolescent is in acute K need. The therapist must playfully sabotage the resistance and move the relationship, via mutual play, from parasitic to symbiotic and commensal container–contained relations. All it takes is the group therapist’s curiosity, understanding, creativity, capacity to sustain challenge, abuse and defeat, and infinite patience.

CHAPTER 7

Bonding in Group The Therapist’s Contribution When we therapists speak, our purpose is to establish meaning. But sometimes our groups hear the words, yet the group members are left untouched. Seemingly correct interpretations and timing may not be sufficient, and that the group is too resistant may be a poor explanation. Our words, rather than connecting with the group, make the members feel that we are unreachable. We attempt to address this failure in contact, most often by using more words. In this chapter I will emphasize how our words and nonverbal behavior must do double duty: as well as convey semantic meaning, they must establish and maintain a preverbal feeling of bonding. I will differentiate bonding from related concepts such as empathy, identification, group cohesion, and therapeutic and group alliance. I will review the concept in terms of Bionion theory, calling attention to progressive and regressive forces in bonding and their respective influences on phases of group life. The therapist works actively to secure and maintain bonding, and this involves being in touch with one’s own bonding needs and anxieties. The influence of the therapist’s evolving psychology in advancing constructive bonding remains at the forefront of our clinical investigation

Bonding described I conceive of bonding as a basic feeling of connectedness to other human beings, which the individual needs to establish and maintain. Bonding is thus an ongoing aspect of intersubjective experience, a type of mental relationship to oneself and others. As a mode of interpersonal behavior, bonding utilizes verbal and nonverbal communication primarily to establish a feeling of connection between individuals. The affective experience involves a feeling 152

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of mutual communication, in which the individuals feel satisfactorily recognized, cared for, and understood.

Bonding expresses the basic relational need to love and to overcome aggressive feelings Freud (1921) suggested that bonding to form groups is based on an inborn need to love and to be in harmony with others: ‘A group is clearly held together by a power of some kind: and to what power could this feat be better ascribed than to Eros, which holds together everything in the world’ (p.92). Scheidlinger (1964) described a ‘universal need to belong, to establish a state of psychological unity with others, [which] represents a covert wish for restoring an earliest state of unconflicted well-being inherent in the exclusive union with mother’ (p.218). Guntrip (1961) saw in this sense of unity ‘the basis of all kinds of feelings of oneness in both personal and communal living’ (p.362). Internalizing a mode of establishing bonding with others represents a critical developmental accomplishment. Grotstein (2000) characterized the infant’s psychic tasks, with the other’s help: to sort out early terrors, fantasies and anxieties, ‘to mythify them, to conquer them, and to mitigate their danger through a bonding alliance with mother (and father)’ (p.474, my emphasis). Bonding also has roots in working through the conflicts over hatred and aggression, dealing internally, and secondarily, externally, with the inevitable frustrations that involve other people. Freud (1921) reasoned that individuals initially grouped and formed member-to-member bonds out of necessity, as a means of coping with envy, ruthless sexuality, societal aggression and competition – ambivalence towards peers as well as authority figures. In Kleinian terms, a secure sense of bondedness represents achieving the depressive position, in which others are recognized and preserved as loved objects. Personal guilt is accepted and utilized to repair the harm we wish to do and may actually have done to others.

Bonding and identification Bonding is related conceptually to identification, the psychological mechanism that has been hypothesized both as a fundamental process, basic to the organization of the personality, and as the unifying principle of groups (Freud 1921; Redl 1942). The term overlaps conceptualizations of internalization,

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introjective and projective identification, internalized object relations, object tie (cathexis), and transference (Meissner 1981; Schafer 1968). Freud (1921) maintained that identification was the earliest form of affective bond with another person. He understood identification as based on incorporative mechanisms. Individuals introject aspects of those they love into their egos, who now become their ego ideals. In groups, members consequently identify with each other based on their shared love of the (introjected) leader. But the process of identification may be centrifugal, an outgoing process, as well as centripetal, an ingoing process. In the former, the movement is from the ego to the object, whereas in the latter the movement is reversed (De Board 1978; Laplanche and Pontalis 1973). Melanie Klein (1955) believed Freud ‘was aware of identification by projection, although he did not differentiate it by means of a special term from identification by introjection’ (p.145). For example, Freud (1921) wrote, ‘when we are in love a considerable amount of narcissistic libido overflows onto the object’ (p.74). Janis (1963) defined group identification as ‘a set of preconscious and unconscious attitudes which incline each member to apperceive the group as an extension of himself…and to adhere to the group standards’ (p.227). Identifications may be established to the leader, other members, and the entire group, as well as to their symbolic representations (Scheidlinger 1964). Identification may be highly regressive and pathological and lead to mob behavior, dictatorship, and psychotic depersonalization; it may be progressive and adaptive, fostering empathic receptivity, democracy, and inner solidarity (Erikson 1959). However, the sense of identity, individual as well as collective (group identity), is not identical to bonding. In the psychoanalytic literature, identification is conceived primarily and defined as an unconscious mechanism, and not as a category of behavior (Grinberg 1990). Identification is a relatively permanent internalization of an object representation. Once established in the psyche it becomes an aspect of the superego or ego. Bonding may be understood as a cognitive-affective state that precedes and prepares the way for the complex process of identification. Like identification, bonding refers to an intrapsychic state, but it may describe a mode of behavioral interaction, and also, bonding may be quite conscious. Whereas true identification denotes a deep and lasting connectedness, bonding expresses and evokes feelings and thoughts that may be momentary or short-lived, and intense or merely marginal. For example, when attending a

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sporting event or a concert, individuals vary greatly in the intensity and longevity of bonding to each other and to the performers. Furthermore, an individual may maintain identification without feeling or behaving bonded. One may have established identifications with one’s university, religion, and ethnic group, but no longer feel emotionally connected. In a change of circumstance, such as an alumni reunion, religious holiday, or ethnic strife, the bonding feeling may or may not emerge with intensity. Finally, even after identifications are well established, bonding may remain an ongoing source of comfort and inspiration. Bonding establishes a sense of safety and it counters paranoid and depressive anxieties. On her last day, a twenty-year group veteran reported: ‘I carry the group around in my head and talk to it. Whenever I’m sad, or scared or unsure, I tell you and think of what you would say to me and I straighten up. I don’t think there is even half a day that goes by without me thinking of the group. I’ve been here a long time and I was looking forward to leaving, to the free time. I still am, but now I can’t believe it and am anxious. But I will keep you with me.’ Whereas the group had provided significant identifications, it also retained a mental presence – a ‘group self/object’ – to which the individual was productively bonded (Fried 1973; Kohut 1976).

Case example: From bonding to identification Frank was an argumentative, opinionated, and self-centered individual, charming but also quick to anger and oppressively dominating. He entered individual therapy as a conciliatory gesture to his wife, who had discovered his extramarital affair and threatened divorce. He accepted dubiously the referral from his wife’s psychoanalyst, for he wondered whether it was her years in therapy, rather than anything he might have done, that had made her angry, depressed, and confused and spurred his involvement with another woman. It took my considerable efforts to get across to Frank the idea that he was not an ideal partner, in a marriage, business, or therapeutic relationship. I was not diplomatic, but blunt and challenging, which he respected since we seemed to talk the same language and not be personally offended by each other. But his wife remained offended, and notified him that she was contacting a lawyer and he had better make other living arrangements. He cried, begged and pleaded, and promised to try harder in therapy. He

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increased individual sessions and, after a period of intense resistance, joined one of my long-standing analytic groups. I was quite surprised that when introduced to group, Frank revealed a hesitant and inhibited personality. With encouragement, he briefly reported on his marital predicament but otherwise revealed little in words or behavior. Equally unexpected, and unknown to other members, was his immediate bond to the group, which became a focal point of his week and of our individual work. He looked forward to the group meetings, discussed them with his wife, and inspired her to join her own group. Frank’s individual sessions often were marked by his attempts to involve me in discussions of various group interactions, which I resisted despite his vigorous protests. For example: ‘Hey, I’m new to this game [i.e. the group] and I don’t know each of the members’ stories. Why can’t you fill me in? Come on.’ He accused me of being narrow-minded and controlling: ‘Not everything relates to the unconscious, my parents, and what you like to call transference. I want to know because I want to know. You’re creating the obstacles.’ I suggested that he take up our difficulties in the group: ‘Let’s discuss the obstacles to learning the game in the game.’ He claimed that I was really being unfair, putting him in the awkward position of slowing down the group process, and he refused to do that. He spurned my reassurances of being able to attend to his needs and the group’s. He would in time work out any difficulties with group in group, he insisted. When invited by a group member to participate, he shyly declined. Frank’s passive fascination with group life continued and, risking exposing his ire to other members, I began to make interpretive hypotheses. I suggested that Frank had trouble understanding the group process because this involved identifying with democratic individuals. His life had been about competition and domination. In individual work, I called notice to his identifications with a dictatorial, narcissistic mother, also a source of his anger and ambivalence toward women. Uncharacteristically, Frank did not challenge these formulations or spar with me. He took seriously his difficulty in truly understanding other individuals and allowing them to understand him (see Benjamin 1988, 1990, on mutual recognition). He began struggling with the deep maternal identification that interfered with his resolve to become a ‘good citizen.’ The group experience provided a wake up call for this middle-aged man. Frank became more thoughtful and self-reflective in his interpersonal experi-

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ences, and attributed it, rightfully so, to his connection to the group. I emphasize that Frank’s bonding to the members occurred first and primarily in his own mind and was not played out interactionally. Only very gradually – after several years – has he built up new identifications such that he can participate in the empathic give and take of group life.

Bonding in Bionian theory: Progressive and regressive forces in bonding Although bonding interactions often involve words, their import lies at the preverbal, non-rational use of verbal thinking and communication. In Experiences in Group Bion (1961) stressed, ‘verbal exchange is a function of the work group. The more the group corresponds with the basic-assumption group the less it makes any rational use of verbal communication’ (p.185). Hence, according to Bion’s early group theory, bonding needs and anxieties, exaggerated and magnified in the group’s relationship to the leader, contribute to basic assumptions, and thereby to regressive group phenomena and resistant phases of group life. Indeed, the therapist remains mindful of how a group may be utilizing basic assumptions to maintain bonding, at the expense of work group functioning. In the dependency group culture, for example, bonding needs, feelings, and fantasies typically and repetitively get played out with demands for attention from the leader. A group may bond by massing among themselves, rallying against the leader or outside force (fight/flight culture), or by overtly ignoring the leader and pairing (pairing culture). Thus bonding may serve as a collusive group resistance, utilized collectively to evade verbal thinking and making meaning. Over time, Bion’s ideas relevant to bonding became more detailed and elaborated. In Second Thoughts, Bion described how irrational or prerational uses of language are employed, via mechanisms of introjection and projection, for interpersonal connection and not necessarily or primarily as a resistance to connection. For example, a patient may store (i.e. introject) the therapist’s words, deriving a sense of connection and comfort from the very act of being spoken to. The individual also may discharge (i.e. project) affectual need through the release of words, successfully establishing contact and influence via vocal intonation and emphasis, verbal repetition, and so forth. The semantic meaning of the exchanges is of secondary significance. Mature dialogue, in which semantic meaning is primary, rests on the relational bed of such prearticulate, projective–introjective exchanges. These

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exchanges are ‘emotionally rewarding…[establishing] a sense of being in contact…a primitive form of communication that provides a foundation on which, ultimately, verbal communication depends’ (Bion 1967a, p.92). Thus, quite in keeping with contemporary developmental theory (Beebe, Lachmann and Jaffe 1997; Emde 1990; Seligman 1999; Stern 1995), Bion gave bonding a central role in the origin and maintenance of reflective thought. Container–contained relationships (see Chapters 5 and 6) initially are symbiotic, based on infant–mother, benevolent projective–introjective exchanges. The normally empathic mother gathers in (introjects), deciphers, and communicates back to the infant aspects of its psychic experience beyond its current cognitive and emotional capabilities. To an increasing degree, as the infant becomes securely bonded to mother and others, it is able to contain its own psychic qualities. Bonding is thus a critical variable to Bion. Mature communication presupposes bonding, which is necessary for the development of commensal container–contained relationships. Even in a group situation in which basic assumptions prevail and bonding is used to blunt new thoughts, bonding may serve constructive purposes, such as to allow for fantasies and anxieties to be expressed, tolerated and gradually processed.

Bonding and group cohesion Group cohesion, which includes the element of a basic bond or uniting force (Piper et al. 1983), has been used to refer to different aspects or levels of group experience, including mutual goal orientation, acceptance and affiliation among members, attractiveness of and identification with the group, and cooperative engagement. While group cohesion rests on such local factors, it arises partially as an epiphenomenon of the local factors. The term might usefully be reserved as a macro concept, that is, to describe an attribute of a group and not of individuals. Bonding describes a process that occurs between an individual and another or others. Although group cohesion is often assumed to be equivalent to therapeutic alliance (Yalom 1995), only the latter has been linked empirically to the therapist’s leadership qualities and to therapeutic progress (Marziali, Munroe-Blum and McLeary 1997; but see also Dies 1994, who found intermember bonding often to be more important than member–therapist bonds in facilitating change). A cohesive group may exist without a true therapeutic alliance, as in an entrenched basic assumption group. However, without group cohesion, it would be difficult if not impossible for ongoing

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psychoanalytic work to occur. Group cohesion would seem to be a necessary but not sufficient condition for productive group therapy. Group cohesion aggregates from combinations of member-to-member, member-to-subgroup, member-to-entire group, and member-to-therapist bonds. While the dynamics of member–therapist bonding may be subtle and unacknowledged, they primarily determine the other bonding matrices and the ongoing group process. The entire group monitors and attends to each member’s affective bond with the therapist; severe disruption of a member-to-therapist bond calls attention to itself and necessarily becomes a focal point of the group work.

Clinical example: A failed attempt to repair a member–therapist bond in a cohesive group Marie, a patient in joint individual–group treatment, had become convinced that her therapist, in supervision with me, was cold and uncaring. Against the remonstrations from therapist and group, Marie terminated individual treatment. Now, several months later, the group was hearing similar news from a male patient: Robert reported his decision to terminate individual work, but also indicated the therapist’s approval. His announcement met a round of congratulations, which Marie protested vigorously: ‘You complained about my quitting individual therapy; why not him?’ The members tolerantly explained the difference in Robert’s and Marie’s respective therapeutic alliances. Marie began to cry: ‘You people really care about me!’ Warm and reassuring exchanges followed. However, Marie did not openly acknowledge the therapist, who felt rebuffed and remained silent. At this juncture in her reportage, the therapist-supervisee exclaimed indignantly: ‘I’m usually comfortable with anger from my patients. I’ve encouraged Marie and she expresses lots of anger. Why isn’t she over it?’ I felt jarred, and it took a moment for me to turn my attention to the person of the therapist and to her question. I had been engrossed in her evocative description of the session and was still developing my feelings and also enjoying them. It felt emotionally rewarding to remain mentally in contact with the caring group, and unpleasantly disruptive to connect to the therapist’s question. In thinking about my negative reaction, I realized that I was experiencing the therapist as invasive and not receptive in her curiosity. Like Marie, I did not want to respond to her. She was not empathically connecting to the very experience she was describing so well or to me, and I wanted her to connect.

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From my supervisory point of view, the problem was not in the patient’s unintegrated anger, but in the therapist’s difficulty in understanding and responding to Marie’s bonding needs, and to mine. The group had intuited Marie’s overt anger as an articulation of hurt and longing, and they responded with reassuring contact. The members had called attention to her difficulties in bonding with the therapist, and encouraged Marie to deal with the therapist directly. While Marie continued overtly to rebuff the therapist, she did not rebuff the group in which the therapist played a prominent part. It seemed reasonable to suggest that Marie was indirectly communicating her need for the therapist to express caring, despite Marie’s overtly hostile presentation. I realized that the therapist had difficulty hearing the patient on the symbiotic level of bonding need and I, identifying with the patient and perhaps being similarly treated, wished to withdraw. I had to tolerate the disintegration–reintegration of my caring feelings – my bond with the supervisee – before I could adequately think about her difficulties in caring. For an important moment, the supervisee had become ‘my Marie,’ a mental image of one who indirectly and angrily expressed her own caring, longings and hurts. Only after my compassion and desire for contact with the therapist returned, could I with confidence offer the complexity of my own emotional response to further the therapist’s understanding of hers. Like Marie, the therapist could not process emotionally that which she understood intellectually: when one feels hurt, it is difficult to seek and offer the love that one wants and needs. Even when the individual is dominated by feelings of hatred, ‘over all is the sense of obstructed love’ (Bion 1967a, p.83). When an individual feels in contact symbiotically, he or she can more easily work through an otherwise overly intense emotional reaction, to reach an emotionally balanced and verbally articulated response. Marie’s interaction with the group showed that she did not need encouragement to express anger – she did that most efficiently – but to feel love and to communicate in a direct and positive manner her need for love. While she said to group, ‘You people really care about me,’ I heard an implied meaning: ‘I really care about you, and I can now think about it, for I feel your caring for me.’ I suggested that she gently encourage Marie to consider that ‘you people care’ could include ‘me,’ the therapist. The words could be effective only if put forth as an authentic bonding gesture. With therapeutic communications on the symbiotic level, the words implicitly carry the promise of positive feelings.

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The conveyance of benevolence must be constant and precedent over any other meaning in the communication. Sometimes, as in this example, the group is able to carry forth this therapeutic imperative when the therapist cannot. The therapist must ‘be available, and bear witness as long and as often as it is required. This may seem an impossible task, a counsel of perfection, since one’s limitations as a group analyst become obvious… Fortunately, there resides in the group wisdom and strength, often when these are temporarily absent in the therapist’ (Hearst 1981, p.31). In supervision, the therapist courageously attempted to deal with and overcome her difficulties with Marie. She understood how the group maintained a relaxed and spontaneous symbiotic connection to Marie, which the therapist learned from and struggled to achieve. But the intense negative transference–countertransference overwhelmed the therapist’s current emotional capabilities. She could not bond sufficiently to the patient, and Marie eventually terminated. From a whole-group perspective, Marie’s departure can be seen as a sacrifice so that the group could proceed to other meaningful therapeutic work.

Bonding may exist without a true therapeutic alliance When an individual patient joins a group, the therapist often serves as the initial and transitional bonding figure. Freud (1921) maintained that libidinal ties to the leader bind individuals. Yalom (1995) emphasized that the therapist functions as the primary unifying force. But this may not always be so. In some circumstances, an individual may bond first or primarily to other group members, while the therapist remains a distant and distrusted figure. Scheidlinger (1974) and others (Durkin 1964; Foulkes 1964; Grotjahn 1993; Money-Kyrle 1950; Slater 1966) have made reference to the ‘mother-group,’ a regressive perception of the group entity, which occurs during the early phase of group formation, to be supplanted by real object ties among the members including the therapist, and transferences to them. In any group alliance, there is an element of bonding, although if the activity is simple, the bond does not have to be strong and deep. In a psychotherapy group, bonding may exist without a true working alliance, in that a patient may feel connected to the therapist and be a member of a cohesive group, while going through a lengthy period of challenging the task, frame or rules, even when evading treatment.

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Clinical example: Bonding with a treatment-resistant group member Sheila regularly entered ten or fifteen minutes after the group commenced, with an apologetic flourish and the same unassailable alibi: the boss made her stay late. She insisted that while the boss was an accommodating man, business was business and there was nothing he, she or anybody could do about it. Sheila also telephoned the therapist frequently, alerting her to frequent work emergencies that entailed a still later arrival. The therapist’s attempts to enlist the group in dealing with Sheila’s resistances fell into a mindless vacuum: what did they think/feel about Sheila’s tardiness; her excuses? Similarly unsuccessful were the therapist’s efforts at group-as-a-whole interpretations: Sheila was expressing unacknowledged group dynamics of resistance, anger, entitlement, and attention seeking. These clinical interventions backfired, for the members responded with a superior tone that made the therapist feel she was losing control of her group. ‘You don’t get it,’ the group informed their therapist. ‘Sheila has a difficult work situation, and not everyone can rearrange their lives to meet your group schedule.’ ‘Sure, we don’t like being interrupted, and we miss Sheila when she can’t be on time. But we can accept it.’ ‘It’s always nice to see Sheila when she arrives.’ But the group leader did not feel nice. She remained anxious and expectant, greeting Sheila’s tardy arrival with a sarcastic comment or a nonverbal expression of pique. The therapist feared that unless Sheila changed her behavior, her own anger would chase the patient away, or worse, alienate the entire group. There were then two clinical problems: one involved the patient and her difficulties in establishing a working or therapeutic alliance; the other involved the therapist’s reaction, which interfered with her bonding to the patient. I asked the therapist why she could not tolerate Sheila’s behavior, since the rest of the group could. The therapist sardonically replied that the group members had not read the psychotherapy texts that we faculty had assigned in her training. She could not simply ignore a member’s persistent acting-out, she reminded me. I agreed, and shared my conviction that no one, not even Sheila, was ignoring her actions but that different meanings were being assigned to them. Clearly, the therapist valued the meanings offered by the texts, supervisors, and institutions of our profession, which would indicate that Sheila’s actions disrespected the time boundaries of group, semantic communication, and verbal insight. But the therapist was disrespecting the meanings

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important to Sheila and broadcast by her behavior. Shelia meant to have her words and behaviors accepted at face value and not have them interpreted. In essence, she valued words for their capacity to evoke interaction: to garner attention and reassurance that she was different from the other individuals and special (see Chapter 4, on entitlement). Whether the patient could be on time or at least tolerate verbal exploration of her behavior, and therefore accommodate to a working alliance as defined by the therapist and our profession was one pressing issue. But another was whether the therapist could in good conscience accommodate to the needs that Sheila felt were pressing and quite meaningful. An accommodation had to be reached, for the risk was a loss of the remaining positive connection between them. ‘Say more. If you could show me how to do it, I would do it.’ The therapist’s enthusiastic and immediate acceptance of an as yet untendered treatment plan suggested that I had become (if I were not already) one of the texts that, not surprisingly, a novice group therapist may rely upon. I accepted without comment or criticism the presenter’s response, which I understood as an expression of her own bonding needs. That is, I did not take her words literally; I did not assume that she would or could exactly reproduce my words or suggested behavior. In serving as a different kind of text to which she could bond, perhaps I could aid her bonding to the patient. I advised that, rather than ignore or criticize Sheila’s behavior, the therapist should call positive attention to it. At the beginning of the next group, even before Sheila’s arrival, the therapist was to announce that she had retired from the job as group truant officer. She was off Sheila’s case! When Shelia arrived, the therapist was to replace the usual disappointed silence or questioning glance with a welcoming greeting. Someone most likely would explain to Sheila the therapist’s change in attitude, at which time the therapist could connect directly to Sheila, and convey relief in revising the relationship. Something like: ‘It’s great not to have to bug you. I feel better already.’ I stressed that these interventions be applied only if offered authentically. The therapist had to recover and communicate a caring for the patient and an inner freedom (Symington 1983) to be with her and to enjoy her, uncontaminated by judgmental anger or a need to do the ‘right’ thing. There would be time to help Sheila and the group understand Sheila’s experience of being in the world: the thoughts, feelings, fantasies and behaviors she was expressing and evoking – positively and negatively – in others.

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I hypothesized that the members valued the cohesiveness of their group, which was threatened by the growing rift between patient and therapist. As in the previous example involving Marie, the group attended to the bonding needs of a resistant group member in an effort to cement a therapeutic alliance. It seemed likely that once patient and therapist were confidently bonded, other members would be released from carrying forth this aspect of the therapy. Eventually, another member and not the therapist would apply a questioning attitude, or become perturbed by Sheila’s behavior and its effect on the group.

Bonding as therapeutic technique I have emphasized throughout this chapter how the therapist often must take an active role in establishing and maintaining member-to-therapist bonding. The concept of bonding also refers then to a therapeutic posture or technique, utilized to establish a positive transference and therapeutic alliance. In the context of individual therapy, Mitchell (1993) wrote that most clinicians ‘try at times to bend the treatment to the person… I believe it most commonly entails a responsible and realistic effort to find a way to engage the patient, to reach him, to make him feel connected enough, secure enough, to participate in an analytic inquiry into his experience and difficulties in living’ (p.177). In the group context, Foulkes and Anthony (1957) termed the ‘supportive’ factor, and Scheidlinger (1964) the ‘experiential,’ both referring to the therapist’s fostering a climate of permissiveness, acceptance, and belonging. Yalom (1995) stressed that ‘underlying all consideration of technique must be a consistent, positive relationship between therapist and patient. The basic posture of the therapist to a patient must be one of concern, acceptance, genuineness, empathy’ (p.106). But this therapeutic posture, Yalom clarified, does not preclude confronting the patient, showing irritation and frustration, even suggesting that a highly resistant individual consider leaving the group. The therapist’s bonding involves not only affection, concern and affect attunement, but evidence of the capacity to hold in mind the emotional state of the other (Fonagy and Target 1998). Freud (1913) wrote of a similar ego process: ‘Everyone possesses in his unconscious mental activity an apparatus which enables him to interpret other people’s reactions, that is, to undo the distortion which other people have imposed on the expression of their feelings’ (p.15). Modell (1985) suggested that empathy also involves theory that allows us to know our patients’ minds and their feelings that they themselves may not know.

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To empathically accept the group’s bonding wishes and needs, and to understand them and not be provoked into premature action, requires a capacity for what Balint (1965) called ‘primary love’ and Searles (1979) referred to as ‘therapeutic symbiosis.’ The receiver must be able to move into and out of states of self/object dedifferentiation (Rayner 1991), to think non-rationally, on the primary-process level of ‘reverie’ (Ogden 1997b), ‘illusion’ (Winnicott 1969), symmetrization or ‘homogenization’ (Matte Blanco 1988). Bion (1963) conceptualized the empathic process as containing the patient’s and group’s projective identifications and making meaning from them. Winnicott (1971) developed the related concept of holding and playing with the patient’s communications, rather than verbally interpreting them. Sandler (1976) introduced the idea of the therapist being ‘role responsive,’ varying behavior according to the role the patient needs the therapist to play, while keeping to the essentials of the therapy. To establish and maintain a culture of bonding, the therapist must accommodate to the individual member’s contact needs, longings, and fears, without mindlessly submitting to or prematurely interpreting them. Accommodations may be subtle, communicated by bodily and tonal responses as much as by overt action or actual dialogue, and may be directed toward unexpressed rather than expressed wishes. The group therapist must differentiate between expressions of genuine needs for contact and regressive exaggerations or defensive minimization of needs, and between fantasies involved in bonding wishes (Scheidlinger 1974) and pathologically entitled actions employed to gratify such wishes. In many instances, the dynamics and behavior of entitlement may be fruitfully – if not always immediately – interpreted (see Chapter 4).

Clinical example: Working actively to secure and maintain bonding Ella often utilized individual and couples therapy to discharge what she experienced as uncontrollable rage at her husband. She insisted that she needed to tell me in great emotional detail about his invidious behavior, and seemed relieved afterwards. We came to agree that it was important for her to talk about her feelings and come to a greater understanding, not simply to ventilate them for relief. As our alliance progressed, we had increasing although inconsistent success in calling attention to her predilection for emotional outbursts. In time, we began to analyze her explosive character and understand its relationship to her internal and external objects.

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Ella expressed interest in joining one of my groups. While we agreed that she could potentially benefit from the experience, I had a serious question to consider: how would the group feel and respond to her still frequent and unpredictable outbursts? She was impressed with this question and made some further progress in modifying her behavior. To ensure her successful entry into group, we made a ‘deal.’ She would not rage in group or monopolize by discussing her husband, and if she did, I would remind her in group of our agreement. I knew that she would not entirely adhere to our arrangement, but I valued its symbolic message. The ‘real deal’ was that I could be trusted to remain connected to her and to her need for containment. If she could not contain her primitive emotionality, I would. After a honeymoon phase of group participation in which she became an active and valued member, she began to display the other side of her personality. She could not keep herself from betraying her preoccupation with her husband, and became indignant when the group interrupted, or offered opinions that varied from her own. Her outbursts and treatment of the group made certain members, males particularly, increasingly sympathetic to her husband. And not unexpectedly one man, Eli, with his own marital difficulties came to embody the negative attributes of her husband, and Ella displayed a mounting wrath towards him. This ignited retaliation: ‘Just listen.’ ‘No, you just listen.’ Both Ella and her sparring partner, Eli, wanted to be listened to. Each of them acted out the bonding wish to broadcast thoughts and feeling and have them contained by a receptive other. They both exhibited difficulties in maintaining internal boundaries of self-control, while insisting on exoneration and protection. The group tried to provide a commensal-level containing function, verbally sharing their feelings of fright, frustration and anger at one or both participants, while maintaining bonding in the expression of sympathetic thought. On some occasions I forcefully declared and enforced a truce. I asserted that when Ella ‘cooled off,’ we could help her be angry at Eli without danger and loss of control. As for Eli, he would have to learn how to receive anger without becoming unduly provoked. During this process, which took half a year to resolve, Ella often turned a modified form of rage on me. When she threatened, ‘I almost didn’t come back after last week,’ I accepted her communications with a rueful smile. ‘But you’re stuck with me, and I’m stuck with you!’ When she complained, ‘I hate therapy now,’ I commiserated. ‘And you particularly hate the therapist!’

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As a non-retaliatory, symbiotic container, I served as a lightning rod for excessive and projected aggression, caring for and protecting everyone including Eli, her male focal point, and the group as a whole. When I assessed the situation as less intense, I encouraged commensal-level, verbal exploration. Both Ella and Eli had found a replica of the container-refusing mate (and parent), and we explored their respective transferences. Other members derived benefit from experiencing and discussing the effects of an intemperate or violent parent or sibling, whom both patients came to represent. My maintaining a hovering presence provided a reassuring, containing medium in which the pair could learn to co-exist and, eventually, to work together with genuine fondness. However, I am not suggesting that I was or was experienced as always benevolent, even-handed or effective. During this lengthy period I was often accused of falling for Ella’s histrionics, overprotecting her and neglecting the rights of others to defend against her abuse. Or I was sexist and aggressive myself, and gave Eli far too much positive attention and leeway. Other group members, in their individual sessions, would question my clinical judgment: why did I ruin the group by putting Ella there? She was paranoid and scary. Eli was stubborn and undermining. One of them should go. I played favorites, preferring the pair to my less colorful patients. I was not sufficiently firm with either of them and this indicated that I too was afraid of them. There was truth to think about in these assertions. In retrospect, there were occasions when I erred by doing too much, when I should have encouraged or allowed the group to struggle. Also, when stymied or intimidated, I resisted doing enough. I learned from others, and silently and openly appreciated the group members when they came forth with courage, creativity and aplomb. The symbiotic communicator’s reliance on projective identification reflects a stage in development in which separation of self from object, and image from referent is incomplete. The self remains concretely linked to the emotional symbol and the emotionally signified; the symbol and signified are also partially identified or fused with each other. Thus the emotional thought is closely linked to the word, and word and thought closely linked to the deed. In this example, Ella experienced her anger as a concrete ‘thing’ that could be evacuated in tone and language. Her verbal behavior served as an action to carry away the unbearable emotion. Eli remained ‘bad’ until he could contain the emotion – by listening as Ella wanted. This meant responding benevo-

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lently, irrespective of the verbal content. Eli was unable to carry out this task of containing, for he took Ella’s accusations literally and sought to argue his position. Ella’s frustration and anger added unbearable weight to his own. It became my job to be the transforming container of anger, providing a cooling, detoxifying medium. In time, often with the group’s contributions, I could represent their emotional relationship in tolerated verbal thought. And both listened.

Bonding is ubiquitous in transference–countertransference ‘Bonding, attachment, affect attunement, and mind reflectivity are but a few of the innumerable, valuable contributions that have begun to change the way we feel about the relationship of the infantile aspect of the analysand and his or her relationship to the analyst’ (Grotstein 1999, p.191). From the relational point of view, we appreciate that the group therapist also has a complex of bonding needs and anxieties that are brought to the work. Like other group members, the therapist longs to contain and to be contained, to be connected and in relationship. The bonding feeling is infantile, in the sense that it is basic. And, to the extent to which the therapist does not feel and understand his or her own basic relational needs, but defends against or acts them out, he or she is handicapped in establishing and maintaining bonding, or allowing the patient or group to shift from a preoccupation with bonding to other types of interactions.

Clinical example: Acknowledging and enjoying bonding The following was presented at a case conference seminar. Rachel, an analysand, had willingly accepted her analyst’s invitation to a newly formed group. But now several months later, she declared to him in an individual session her intention to give the group three more sessions before terminating. Patient and analyst agreed that the group had quickly and positively come together, and there was meaningful interaction among members. All seemed to be benefiting from the treatment. Did Rachel not feel this to be so? he inquired. Rachel replied that indeed, she already had learned from and enjoyed the experience but: ‘I just like individual much better; I get your full attention.’ I asked the analyst/novice group therapist if he gave Rachel his full attention in group. He reported that he had purposefully minimized his involvement with her. She was a very attractive young woman, and he feared

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attending to her would betray his other female patients, as well as unfairly dominate the males. Everyone would be upset by his behavior and would want to leave group. It became apparent that the therapist was anxious not only about giving Rachel special attention, but also about receiving special attention from any of the members, particularly from Rachel. He had encouraged and responded well to the intense interactions among the members, concentrating on intrapsychic, interpersonal and group dynamics, but not on himself. The therapist’s relationship with each individual patient – the essential factor for sustaining and advancing therapeutic work (Marziali et al. 1997) – had not been sufficiently acknowledged and addressed (see Chapter 2). Showing interest in Rachel would call attention to the therapist. Other members would monitor and react in unpredictable ways to his bonding, and move him into uncharted territory. Certainly, a new dimension would be added to his group, and the challenge interested him. I believe the class noticed, as I did, his unverbalized appreciation for my offering a stimulus for his professional and personal growth. In parallel process to what was imagined for the therapist’s group, a display of intimacy between group member and leader took emotional center stage. I enjoyed the bond with the presenter while appreciating that inevitably, conflicting emotions were being stirred up in his classmates that would become an aspect of the group dynamics of our seminar. I also was quite comfortable with the likelihood that in his mind I was going to remain part of the action in both the current class session and in his forthcoming group, most likely, the center of his attention. The presenter reported in a subsequent class meeting that he was finding it much easier to look at, talk to and respond to Rachel. He was no longer pretending, to himself as much as to the others, that he was not involved in an intimate, therapeutic relationship with Rachel, one that was special to both of them. He became acutely aware that other patients and not only Rachel were vying for his attention (disapprobation as well as approbation). Rachel was just one of many who wished to be acknowledged and to have the therapist enjoy the bonding relationship. With the realization that he was and would remain a center of attention, the crisis with Rachel resolved itself. He found that in relating to Rachel easily and naturally, she did not demand or require special consideration, and she became a secure and active participant in the group. Notice that it would have been hurtful and inaccurate to interpret Rachel’s determination to leave group as a pathologically entitled need for special

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attention. Indeed, on considering the total situation of the transference–countertransference, we could say that Rachel’s dissatisfaction was a sensitive response to the therapist’s withdrawal of bonding. Her resistance to group signaled a legitimate need for the analyst to make an authentic relational gesture. The clinician must listen closely to his or her own communications as well as to those of the patients or supervisees. They subtly express the clinician’s dynamics, bonding needs and resistances that are personal and historical, as well as in response to the particular interactional matrix.

Bonding is not always interpreted Traditional psychoanalytic theory and technique has emphasized insight-oriented interaction, and valued verbal communication as the mature stage of development. However, contemporary psychoanalysis has reassessed the traditional opposition between transference and countertransference, unconsciousness and consciousness, and enactment and insight-oriented understanding (Aron 1996; Billow 2000c; Greenberg 1996; Hoffman 1994; McLaughlin 1991; Racker 1968; Seligman 1998; Stolorow 1997). Each of the five cases discussed in this chapter required the therapist to understand and respond enactively to group members’ bonding needs and fantasies that were expressed, but not necessarily semantically represented and which might have been vigorously resisted or even denied if verbally articulated. In the first case example, Frank protested when I encouraged him to talk about his growing bond to the group, as if his verbal acknowledgment of caring would shame him. In the second example, the bitterly resentful Marie longed to bond with a therapist who could contain and detoxify her anger, but she resisted admitting her longings. The therapist needed to follow the group’s lead in pursuing Marie; the members’ words were concrete reassurances of caring. In the third case, the late-arriving Sheila could not challenge her boss or process challenge from her group therapist. Her need for support and attention took precedence over negotiating boundary relations (and violations) on the job or in the group, or even talking about such negotiations. In the fourth, the entire group needed to feel that I could maintain bonding in the face of Ella and Eli’s aggression, such that the group could proceed relatively undisturbed. And finally, in the fifth example, Rachel’s inclination to withdraw from group was a meaningful response to her therapist’s emotional withdrawal. The therapist’s behavioral correction was essential; his words alone, not sufficiently meaningful. In each case, I

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monitored parallel process and attempted to maintain a mutually constructive bonding experience with the patient or supervisee, one that I did not necessarily call attention to or verbally articulate. Indeed, the impact of the therapist’s words derives not only from their lexical meaning but also from their paralinguistic signification, revealed in the ‘music’ of timing, tone, and cadence (Knoblauch 2000). The lines between various levels of a communication, such as affective and semantic meaning, or symbiotic and commensal interactions, are ambiguous and fluctuating and may function in useful tension with each other. We must keep in mind that all communications, even those promoting insight, have overt and subtle performative features. The language scholar Kenneth Burke (1966) referred to words as acts of ‘rhetorical entitlement’ (p.361). Words sonically communicate felt need, and exert pressure on the receiver to potentiate meaning and to respond empathically. Rather than merely to further semantic or insight-oriented understanding, all speakers use words to define experience and prefigure response (Crocker 1977). The group therapist’s words (and silences) are particularly powerful. They often define the emotional atmosphere of the room and allow for bonding wishes and anxieties to be expressed, bonding needs to be secured, and bonding resistances and fixations to be worked through. As the members bond and the group coheres, multiple peer- and therapist-based identifications solidify and, at the same time, members begin to differentiate from each other and define themselves.

Conclusion I have put forth a concept of bonding as an intersubjective process that embodies universal, ongoing emotional needs and wishes. While referring back to infancy and to introjective–projective exchanges, bonding remains a basic, preverbal mode of coming to know about and communicate intersubjective experience, and may be a progressive development in the individual member and group. Bonding is an important source of data and empathic interaction in all human relations. We monitor how connected we feel toward other people, and their connectedness to us. Such mental activity often takes place without conscious awareness, and subtle changes in our feelings of bondedness are communicated in behaviors, words, and silences. Dynamics of bonding are continuous and inevitable; they are a source of anxiety and comfort, resistance and growth, despair and inspiration.

CHAPTER 8

Rebellion in Group Psychotherapy groups are not tranquil, as they are composed of individuals with different needs, wants, and goals. Disagreement, conflict, vying for influence and control are to be expected in any group – small, large, international – and these dynamics structure the group’s formation, and drive its growth, be the development evolutionary, reactionary, or revolutionary. In this chapter, we consider the topic of rebellion – when a faction rebels, how the group responds to the conflict, and how the conflict is resolved. In groups, the best and worst in human nature are elicited: revolt may occur against either potential. I will describe various pathways of rebellion, differentiated by their processes and outcomes: defiance, secession/exile, anarchy, or revolution. Rebellion denotes a strategy adopted by a faction, when other avenues of influence seem futile or unattractive, a judgment that depends on the group’s genuine receptivity to discussion and change, and equally, on the state of mind of the rebel. The rebelling faction feels that to participate in the principles and practices of the current or purposed direction of group interaction would require an intolerable submission. The values represented by rebellion are felt as intellectually unassailable and morally absolute, not subject to extended disagreement, negotiation, or repudiation. The intellectual and moral justifications for protest and noncompliance are compelling. As rebellion arises, there seems no route available where compromise is possible. While rebellion represents an individual’s mental attitude toward a group, it is useful to think of group process, and rebellion as an attempt to move the group in a different direction. Rebellion is a strategy of social action: to overthrow the group’s status quo, or adamantly to oppose its revision. Greenson (1967) maintained that the concept of resistance implies a rebellion against psychoanalytic principles and procedures, thereby linking rebellion to dynamics of transference and pathology. Others have written of the negative therapeutic reaction, and patients who are ‘difficult,’ in large part, 172

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because of their rebellious enactments (Roth, Stone and Kibel 1990). Relational psychoanalysis has challenged such assumptions of clinical authority and certainty, and has reassessed traditional oppositions, as between transference and countertransference, and resistance and legitimate challenge (see Chapter 4, on entitlement, for example). More to the point, resisting, expressing a vexing self or even deviating from the existing group culture does not necessarily constitute rebellion in the sense that I will use the term. As we know, resistant or difficult individuals may spend years challenging the opinions of the group therapist or other members, while regularly attending and finding benefit in the treatment. Others may feel bonded, yet disobey the task, frame or rules, and even may dodge treatment (Chapter 7, on bonding). Neither situation necessarily represents a true rebellion, since the members are not motivated to address or influence the group’s principles or mode of operation. Quite the contrary, they may enjoy the group as constituted and have no wish for change, despite their protests and difficulties in living within it. When rebellion takes place in the psychotherapy group, the ideas and feelings that are expressed and the behaviors that are enacted are not presented as psychodynamic phenomena to be studied, interpreted, and possibly modified and worked through. Rebellion focuses attention on the idea of the group: what kind of group is this and is it acceptable to me? The basic premises and values of the group are at the center of the controversy, to be addressed on that level. Psychodynamic issues underlying the clash may be analyzed in due course, if the group successfully contains the rebellion. A conflict of therapeutic assumptions and values leading to rebellion may exist quite apart from unconscious processes or transference and countertransference per se, and may represent legitimate differences in points of view. What one individual or faction feels as indispensable for proper group functioning may feel antagonistic to another’s sense of security, well being, or purpose. Exposing and discussing the difference in perspectives, and what are believed to be incongruities in underlying or basic values, may sometimes relieve impasses and forestall crises and premature terminations. Rebellions are inevitable and not always resolvable, however, and not every outcome is or can be a positive experience for the participants. For as rebellion intensifies, a danger exists of polarization between protest and its opposition, as one or both sides substitute a coercive moral attitude for the democratic discussion of ideas. Members talk not to negotiate their differences, but to discharge anger, mete out punishment, and extinguish

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dissension. Loud silences, indignant facial expressions, condescending sighs, and other forms of exasperated paraverbal and nonverbal behavior may be as effective as words in arousing members and determining group process. Argumentation shifts to incitement, recruitment, and subterfuge, from discourse to attack. The group risks emotional warfare and dissolution, and its members are exposed to traumatic injury, even symbolic murder.

Rebellion and group process The general idea of rebellion has figured prominently in the major theories of group formation and process. Freud (1913, 1921) utilized myth to describe how groups, in the aftermath of rebellion against the primal father, massed under a leader, establishing principles and practices that normalized relations among individuals. In Freudian group theory, a tension exists between adaptive compliance and constructive rebellion. Dependence on the authority of the leader and on the group normative status quo provides a sense of identity and security from belonging in shared identifications and ideals. However, submissive groups and compliant individuals lack creativity, which is stimulated by independent thought and freedom of expression. Large governing bodies such as nations, political or professional organizations, tend to stabilize their own power structures, utility, and ideologies, producing authoritarian societies (Foucault 1978; Marcuse 1955). The conformist citizens defend against their underlying aggressive reactions by developing rigid personalities and anti-libidinal, sexist, and moralistic attitudes. Undoing repressive defenses – regaining desire and instinctual vitality – involves disentangling oneself from blind allegiance to the assumptions and values of one’s class and culture (Hopper 1999; Lacan 1977; Reich 1962). Whereas rebellion foremost involves achieving mental freedom from the ‘other,’ thought must link to behavior. Establishing an authentic self may necessitate commitment to rebellious social and political action (Sartre 1956). Nevertheless, significant danger exists when traditional values, represented by the ‘paternal order,’ are overthrown. Rebellion may lead to personal and social anarchy: the corrosion of family and societal authority, failure of sexual and social commitment, over-dependence on external sources for gratification, and abandonment of moral leadership (Lasch 1978). Thus, rebellion may work for or against the establishment of a healthy self and society. Closer to our theme, group theorists have expanded on Freudian theory by calling attention to therapist as symbolic mother as well as father (Durkin

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1964; Foulkes 1964; Scheidlinger 1974; Slater 1966). As parent figure of either or combined gender, the therapist must balance closeness and distance in relating to the members, since rebellion against the leader is a significant factor in group formation and process. If the therapist is too remote, aggressive feelings or defenses against such feelings become disproportionate, and the members and group remain undeveloped. If the therapist is too friendly, ‘then no rebellion is necessary and, consequently, any banding together within the group takes longer and feels somewhat incomplete. Independence cannot be granted by Authority, but must be wrested from it’ (Vella 1999, p.17). Widening his attention from the role of the leader to consider Freud’s (1921) formulation regarding the role of instincts, Bion posited an inherent conflict in the individual between narcissism and groupishness. ‘This bi-polarity of the instincts refers to their operation as elements in the fulfilment of the individual’s life as an individual, and as elements in his life as a social or, as Aristotle would describe it, as a ‘political animal’’ (Bion 1992, p.105). The individual needs groups for a sense of vitality, and one cannot develop fully without group participation. Yet one remains ‘at war’ with oneself for one’s very groupishness, for there are narcissistic needs that one wishes to express and satisfy anonymously via the basic assumptions. Group process is characterized by dynamics of submission and rebellion. However, the object of antagonism may be the self with its contradictory motivations to be narcissistic or cooperative, the group entity or other members, particularly the therapist. The member must come to appreciate this existential situation, without believing he or she can fully resolve it. Dialogic opposition of the developmentally early and mature, of narcissism and socialism, of primitive and sophisticated thinking, of basic assumption and work group activity, provides harmony as well as disharmony, the opportunity for growth and development as well as for chaos and destruction. In the individual and in the group, while each mode of being may rebel against the other, each needs the other for a creative, full life (Matte Blanco 1988). Bion’s thinking has influenced subsequent writing on group theory (e.g. Bennis and Shepard 1956; Gordon 1994; Grinberg 1985; Hinshelwood 1994; James 1984; Neri 1998; Pines 1994; Resnik 1985; Roth 1990; and Schermer 1985, 1994). Agazarian (1997), to give one prominent example, described phases of group life that include inevitable rebellions. In the first phase, a group may be defensively dependent, stereotypic and conforming or

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actively defiant; in either variation, the members coalesce around creating deviant roles to serve as containers for projectively identified aggression. After the group has survived a ‘barometric event’ (Bennis and Shepard 1956), which involves seduction, devaluation or a symbolic coup d’état, and when defenses are sufficiently undone and frustration is contained, the group may move away from authority and dependency preoccupations, to phases involved with intimacy and self-affirmation. Nitsun (1996) defined an ‘anti-group’ construct, describing conscious and unconscious destructive attitudes and impulses manifest in most, if not all groups. He lists three sources: underlying fear, anxiety, and distrust of group process; frustration of narcissistic needs, such that the group is experienced as neglectful, depriving, and humiliating; and overabundance of aggression among members, expressed directly in hostile confrontation or indirectly in envy and rivalry, such that the group is experienced as unsafe. When recognized and contained satisfactorily, the conflict between group and anti-group forces is generative and strengthening, illuminating the paradoxical nature of human life. The latent, or repressed, anti-group thus becomes a dialectical aspect of the ‘foundation matrix,’ Foulkes’ term for the potential of group process to correct each member’s disruptive, anti-social and destructively rebellious characteristics. In a constructive group, members ‘reinforce each other’s normal reactions and wear down each other’s neurotic reactions…collectively they constitute the very norm from which, individually, they deviate’ (Foulkes 1983, p.29). Hopper (2001) proposed a fourth basic assumption, incohesion, associated with a very early ‘autistic-contiguous’ developmental position (Ogden 1991). Hopper argued that predominant incohesive defenses, involving contactshunning aggregation, and merger-hunger massification, play out in rebellious but ultimately constructive interactions between therapist and group members. Finally, Cohen and Schermer (2002) described the ‘moral order’ of the group, referring to its norms, values, beliefs and ambience, and which supplies a context for each member’s group self and the group’s collective conscience and ego ideal. Upheavals may occur with entry of a new member, disruptions initiated by a difficult patient, impasse, or initial or terminal phases of group formation. Rebellions are against the leader, although this may not always be apparent. For instance, a rebelling member may become a scapegoat, representing a displacement of projected feelings of disappointment and betrayal

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by the leader who does not live up to their group’s expectations, or the dissident member may become the temporary leader.

Pathways of rebellion: From dissent to defiance, secession/exile, revolution, anarchy The discussion now turns to the pathways of rebellion. When antagonists cannot resolve or live with dissent, rebellion takes various action pathways: defiance, secession/exile, anarchy, or revolution. I describe each pathway with illustrative incidents from my group therapy practice or peer group experience.

Defiance Defiance represents a type of palpable and continual or phasic pressure exerted against ongoing group process and content. The group has become issue focused, and progressive development is problematic without frank acknowledgment and some attempt at resolution. Defiance would seem to be the initial mode of rebellion, from which other pathways branch out. But defiance is a pathway in itself, since dissension may be sufficiently resolved as to circumvent traversing rebellion’s more radical pathways. In terms of group theory, as summarized above, defiance represents an organic feature of group formation and development. One constructive aspect is to test the safety of protest, and hence, defiance may actually represent increasing trust in the therapist and faith in group process. A defiant member communicates important feelings, although they may be acted out rather than verbally expressed. Defiance signals the group of distress, and the need for attention and dialogue. It alerts the therapist to possible changes in the group system and in the emotional lives of individual members. In a destructive vein, by rigidly and repetitively demarcating what is acceptable and not acceptable, a defiant member or faction may produce static and repetitive group process, leading to impasse. Defiance may be friendly as well as hostile, overt as well as subtle and not easily or quickly identifiable. In any conflict, negotiation is more likely and deleterious consequences avoided when underlying issues are brought openly into the group. Therefore, when defiance is covert, the therapist must decode its signs and identify its subterranean effects before another action pathway is preferred.

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In the following case example illustrating defiance, I belatedly came to identify a defiant member and her effect on the group. The clinical incident is described further in the following section on secession/exile.

Case example: A defiant member provokes acting-out In one long-term psychotherapy group, members uncharacteristically began arriving late and absences increased. I waited for the group itself to observe this change. When it did not, I called attention to this lack of consciousness regarding the sudden latenesses and absences. I wondered whether we were facing a problem that was unspoken but not unthought about. The responses remained concrete: I received apologies for lateness and excuses for absences, and the next two sessions were marked by promptness and a return to almost full attendance. On the third session, Rita, a forceful group participant, returned from a business trip. I could hear only her voice, which ceased as I opened the door to an unusually quiet waiting room. My welcome seemed to suppress further an already subdued assemblage, and I became tense and anxious as the members entered my office. Apprehension lingered. My inquiry only increased the general dysphoria. Finally, a member urged Rita to talk. With trepidation, she shared her disapproval of certain of my therapeutic beliefs and practices. She had referred Carl, her romantic partner, to another of my groups several years previously, but without satisfaction. From what she had gathered from interrogating Carl and from observing her own group, I counseled against auxiliary treatments, specifically self-help books, organizations such as Alcoholics Anonymous and particularly, psychoactive medication. I realized from the ensuing discussion that the group had known of Rita’s mounting frustration and anger. She had used the waiting room to foment defiance, and the waiting room had become a threatening place to be avoided – hence the lateness. But to varying degrees, the members sympathized with her difficulties and responded to her anger by entering into pre- and post-group discussions about the literature on self-help, the value of mood stabilizing drugs, and the possible benefit of a psychiatric consultation for Carl. Unbeknownst to me, the group was struggling with conflicting allegiances. Facing the prospect of a drawn out conflict between two highly valued individuals – this explained the increased absences. Defiance had been covert but conspicuous, expressed in the persistent acting out and the members’ refusal to acknowledge such behavior, much less talk about its causes. The factors spurring rebellion had to be brought front

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and center. My guiding principles, imagined or real, and the extent to which they controlled others, had to be discussed openly, in conjunction with exploration of my relationship to the rebellious member, and the group’s reaction to our conflict.

Secession/exile In this pathway of rebellion, a rupture between one or more individuals and the main group threatens reciprocal allegiances and attachments. When the contentious faction withdraws or is ejected from membership, the rebellion is suspended or quelled. Controversial issues may remain unresolved and continue to impact the group. But now, with the absence of opposing viewpoints, there are fewer occasions of open debate and exchange. Dynamics of projection and scapegoating may be prominent. When a defiant member secedes, the possibility remains that the group unconsciously maneuvered the individual into exile. The excluded, like the repressed, may haunt the group’s consciousness with guilt and painful memories, and impede its future. Secession or exile represents failure on all sides – a breakdown in communication has occurred. Dissension has not been expressed in an acceptable manner, or the leader or entire group has not been able to address and accommodate the conflict. However, in human relations, including psychotherapy groups, serious misalliances may be unavoidable, and failure should not be a surprise. Deselection from membership may be the most workable solution. It solves otherwise irreconcilable differences, as when factions represent two opposing ideas of the group task, thus allowing the group to move on to other issues. If a group truly is unsafe and not capable of significant modification, secession is the choice pathway. Similarly, when an individual or faction uses the group to harm self or other, leadership requires temporarily or permanently segregating the offending membership. Of course, there are situations when separation is a beneficial outcome of growth and development. The interests of certain members and of the main group simply may come to diverge, and bridging an increasing gulf may not be the best use of available resources. A group may have served and outlived its purpose for certain individuals and termination may represent a constructive choice, more painful than continued membership, but opening up possibilities for needs and wishes to be better met in other settings. A group also benefits from the individual’s termination process, mourning its graduates and initiating new members.

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The clinical incident introduced above, in which Rita expressed dissatisfaction with my mode of treatment of her mate, Carl, serves as an example of an impasse leading to secession.

Case example: The defiant member secedes In any form of couple’s treatment, the partners may use their common therapist to aggravate each other, as well as band together to trounce a therapy. I believed that Rita and Carl were unconsciously colluding to accomplish these goals. Carl used alcohol to spite the bossy Rita and resisted dealing with both his Rita and drinking problems. For his mate, in ‘supervising’ Carl’s group psychotherapy rather than maintaining open communication in her own group, the therapy-savvy Rita evaded dealing with factors in her own personality that made for difficult relationships. To share my beliefs about the couple’s mutual resistances, or otherwise shift focus away from me would have been premature and self-protective. And too, I thought it fruitless to explain myself to a group quite familiar with my practices. Rita and I did have different beliefs about what constituted effective therapy and I wanted to give her beliefs, and her beliefs about my beliefs, a full airing. To the extent that Rita spoke for and acted out suppressed rebellious feelings of others, these members now could speak for themselves. Some members offered a round of contentious questioning, criticism, and self-justification, while others defended my work and decision-making. Some members found me insensitive to Rita’s problems with Carl, while others reviewed how I had helped Rita deal with male relationships in group. There was some agreement that I did not encourage medication for members or their families. A counter-argument was offered: ‘Just because we talk about psychological issues doesn’t mean that Richard is against medication.’ Use of the waiting room was justified and also disparaged. ‘Since we do psychological work in group, the waiting room provides the sole opportunity to offer advice and take care of issues that did not interest Richard.’ ‘That’s a copout.’ Contrary to my intention, the debate did not generate a dialogue with Rita. Rather, the support that she received fed her all-too-familiar indignation, blaming, and externalization of conflicts, which turned the group’s focus to her psychology and away from issues of my leadership. She became increasingly impatient with her group as well as Carl’s for the lack of attention to legitimate reality issues behind her suffering: Carl’s drinking and bad behavior, my apparent lack of interest. In point of fact, Carl had begun to

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consider in his group the reality that he might be alcoholic although he, and not I, opposed Alcoholics Anonymous or a psychiatric consultation. Rita announced that she was thinking of terminating. She did not engage the group in her thought processes however, and members were left pleading against an inevitable announcement, which finally arrived. I cautiously offered that Rita’s obdurate, ‘go it alone’ attitude replicated relational patterns of disillusionment with parents and a series of romantic partners. She was in danger of prematurely closing off relations with me, the entire group, and her own mind. She agreed with the formulation and those that followed from myself as well as other members that related to her transferences, both positive and negative, and her controlling attitudes. This reminded her how she had benefited from the group and from my ‘psychological approach.’ Perhaps she still would benefit, and Carl too, but she held to her belief that another type of therapy would be of greater immediate assistance. Shortly thereafter, Rita terminated. Carl also left his group and from what I have gathered, joined and benefited from Alcoholics Anonymous. Rita eventually resumed individual therapy with another practioner. The rebellion, quelled by secession, powerfully affected subsequent group process. In retrospect, I believe the episode and its outcome traumatized the members, to the extent of making it more rather than less difficult for them to confront or challenge what they believed to be my psychoanalytic presumptions and biases. For several years, the topic of my attitudes regarding auxiliary treatment was brought up most gingerly. The memory of the insurgence seemed painful and the valued member was deeply missed. No one wanted to reignite rebellion, but eventually we began to address what seemed to have stimulated it. Members revived the critical incident; they discussed unresolved feelings towards Rita and straightforwardly brought up opinions about my attitudes and prejudices. Several other members came to have issues involving psychoactive medication for themselves or their loved ones and found me different, more encouraging of a discussion, open to psychiatric consultation and respectful of their own decision-making. Had I changed? they wondered. I cannot answer definitively. It is likely that I have clarified my presentation by stating more forcefully my underlying views regarding auxiliary treatments, which remain cautious but receptive.

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Anarchy In Experiences in Groups, Bion brought forth the seminal idea that all individuals resist tolerating and thinking about painful aspects of psychic reality and band with others to rebel against this type of experience, via basic assumption defenses. In his later writings Bion (1962, 1963, 1970) described how, for some individuals, an unconscious urge to hate and destroy that which stimulates painful psychic awareness predominates over constructive motives to think. He introduced the interrelated concepts of anti-thinking, or minus K, attacks on links, and parasitic container–contained relationships, all of which involve using one’s mind to invalidate emotional and mental relationships, intrapsychic and interpersonal (see Chapters 3, 5, and 9, particularly). To the extent trust is lost in the regulating principles of intrapsychic and interpersonal life, the individual becomes perpetrator and victim of anarchy. In a psychotherapy group, a consequence of effective work is emotional disturbance and a breakdown of core defenses. Anarchically inclined group members do not commit to this type of productive and necessary breakdown. In an effort to wall off turbulent experience they project disturbance outward, where it is attacked or otherwise controlled. These individuals promote crises of miscommunication, misunderstanding, and confusion – stimulating the very anarchy they fearfully and unsuccessfully defend against. Actions taken by the therapist or another member to provoke thought – which often involves uncovering areas of intrapsychic and interpersonal disturbance and conflict – become confused or conflated with actions taken perversely to provoke or create disturbance and conflict. Group members remain in danger of stepping over a line in which their therapeutically appropriate and expectable behaviors are perceived as deliberately sadistic and immoral. And once this line is crossed, the anarchic member must challenge, condemn, and vanquish that which the group stands for and perpetuates. This includes not only the principles and craft of group psychotherapy, but also the sanity, decency, and caring of the group and its members. Anarchists are extremely destructive representatives of the flight/fight assumption and are not committed members of a ‘loyal opposition.’ To withstand assaults on all that the therapist believes, the therapist must maintain faith in the goodness of the group endeavor. The therapist’s inner security and emotional clarity serve to protect the group from the invalidating effects of anarchy, preserving the members’ capacity for therapeutic relationships.

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Case example: An anarchic member As the group arranged itself prior to commencing a meeting, a member, Tony, slapped on my desk the bill I had handed him the prior session. ‘This isn’t mine, I’m not paying it. You better give it to him!’ We had not witnessed Tony’s anger, for he had been a shy and hesitant member, relatively new to group and to my practice. The group seemed frozen in fear and confusion. All eyes were on me. On examining the bill, I saw that I had substituted another letter for the initial of his first name. ‘Well,’ Tony demanded, ‘Who is he? Or rather, who am I to you?’ I had no immediate answer to his first question and I felt words would be inadequate to answer his second question. I said: ‘I’m sorry to have hurt you.’ ‘That’s not good enough – you tell us to explore our feelings. A slip means something.’ Another member interjected: ‘What does the it mean to you, Tony?’ Tony turned to the woman who had spoken, but addressed her with the name of another woman in the group. The room erupted in relieved laughter, and Tony became quite flushed. I felt it would be unfair to resolve the group interaction by placing the onus on Tony. He had taken a chance expressing feelings, and that should be respected. ‘I don’t want to get off the hook,’ I said. ‘Let’s explore the Freudian slips in order of their appearance.’ Tony easily regained his anger, and again insisted that I explain myself. I said that I had no explanation other than to acknowledge that I was not a good bill-writer, and confessed that I often scrawled bills out while occupied with other matters. But I would think about what I had done, and would let the group know if I discovered more about my error. ‘Does this mean we should go on?’ he asked, becoming fearful, as if I was insisting on closing up the incident. ‘Not at all, I’m sure other people have reactions and they might want to join in.’ Several members commented on the intensity of Tony’s feelings, complimenting his courage in expressing them. He acknowledged that there was an historical dimension to his protest, since he felt easily overlooked and not important in his family. But he soon returned to lambasting me, who ought to know better. While members supported his exploring his angry reaction to my error, they had difficulty understanding its duration or intensity. They declared that I was a caring therapist and reported incidents from individual and group therapy that supported their view. They attested to my continual interest in Tony, who most often declined my initiatives. Even now, they reasoned with Tony, I was not reacting defensively but inviting his expression of anger.

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A member, George, broke into the discussion saying that he was suffocating from the moment of Tony’s outburst until now. ‘I want to jump out the window. Nothing that Richard or anyone else can say will make you feel better. Richard said “I’m sorry, very sorry. I didn’t want to hurt you. Please forgive me.”’ Tony responded with a new burst of anger: ‘No, Richard didn’t speak to me the way you are. If he had, maybe I wouldn’t be so angry.’ There was disagreement about what I said and how I said it. Some individuals suggested that I could have expressed more remorse, while others felt I had expressed myself adequately given the nature of the offense. I turned to George and acknowledged: ‘I didn’t communicate with Tony with the depth of feeling you are conveying because I don’t feel it. [To Tony] I feel bad for hurting you, but not as bad as George feels for you.’ Tony felt vindicated by my confession and tried to impress upon the group my lack of compassion. Others heard my communication differently, and suggested that I was compassionate by responding authentically to him and not pretending to feel something I did not. They appreciated that I seemed neither intimidated nor vengeful. George elaborated: ‘I feel too bad, too guilty. If I were you [Richard] I would cut off my finger, my hand, to prove to Tony that I care, or else I would want to beat the crap out of him. I like the way you responded. I can’t stand it when my wife or kids accuse me of something I didn’t do. It doesn’t matter if I’m right or wrong, I just want it to be over and will make it happen, no matter the cost to me. I feel with them like I do now. I have a clutching in my chest and I can hardly breathe. When someone I love accuses me of something, I feel wrong even if I’m not guilty.’ Other members participated meaningfully and personally but it was difficult to engage Tony, to gauge his interest in the discussion, and to assess whether he had modified his stance. Even when I inquired, I could not tell whether he was linking to us and to his own mind, or whether he had shifted pathways of rebellion: from defiant confrontation to guilt-inducing threats of emotional secession, and finally to a state of unexpressed anarchy. The next group meeting began with several members checking in with Tony. How did he feel after the prior session and did he need more time today? He thanked them matter-of-factly and gave no indication of wishing to continue. He avoided eye contact with me. I said that I had something to add. I began by saying that I did not try to think too much about the session. Tony broke into my unfinished account, reanimated with a mild version of the scorn of the last session: ‘I’m not surprised.’ I continued: ‘I did not think too

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much about the session because I felt I would not get anywhere by narrowing my concentration. I truly believed I had no other explanation for my slip. But sometime during the week I realized that the substituted initial stood for the adult son of a close friend and colleague. Intentional self-disclosure was not a technique I usually employed (Billow 2000c). However, Tony had demanded that I consider my primary mental and emotional assumptions: what was the meaning of my slip, and who he was to me. In responding, I thought I could accommodate to his demand, and at the same time cement and explore our relationship and advance group process. With some anxiety, I waited to discover where my remarks would take us. The group paused expectantly for Tony’s response. He seemed mildly pleased, but expressed little curiosity or interest in my continuing to relate my mentality to him or in relating to me. Other members were touched and reiterated that I had thought about Tony, and encouraged him to respond. Tony blandly paraphrased my explanation without registering its emotional significance. Instead, he brought forth the topic of the underlying moral nature of the group: is the group uncomfortable with his anger, do they want him to put it away because they can’t handle it? Is he to behave himself and pretend not to notice how people treat him? A characteristic pattern of self-righteous sureness was emerging: he was beginning to define, categorize, and condemn the group’s basic disposition and mode of functioning. The group remained unperturbed, confirming its receptivity to Tony’s anger, while not supporting his mode of thinking. ‘Can’t you see that people are interested in you and your anger, but that you don’t seem interested?’ ‘You have a chip on your shoulder.’ ‘I thought about you all week, I was very interested. Richard was too, look what he came up with.’ Tony stonewalled these comments. I had the impression from his crestfallen expression that he mistook the group’s vocal reactions as reprimands: ‘Tony, are you hearing that members think you shouldn’t be expressing your anger?’ I asked. ‘That seems clear,’ he answered in bitter affirmation. While he agreed with my words, he actually misinterpreted their intonation and the vastly different meaning supplied by it. That is, I put forth that he experienced the member’s responses as condemnation, but he heard confirmation that the members were condemning him, rather than that they were not. This suggested that his attacks on others extended to attacks on his own mentality and its linking capacities. He had misheard, misperceived, and misunderstood the genuine care and good feeling offered. For the moment, nothing I or

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anybody else said succeeded in reestablishing contact with Tony. We had become unreliable and our words corrupt. We survived this initial crisis but similar incidents occurred. When he felt slighted, the moral fiber of the offender became suspect, such that Tony could not believe any testimony that contradicted his own version of reality. To give one more example, he became convinced that several people had absolutely no interest in him, whereas he was friendly and compassionate to all group members. When one of the offending members spoke to him, he remembered who said what and when it was said. But when he spoke, these members would attribute his remarks to another person or would ignore the comments, but then would respond to someone else who said the same thing. And I failed to notice how he was being treated, or perhaps I did not care, or I thought living in this chaos was the proper method to run a group. It was difficult to assess Tony’s progress. At certain times, when he reported feeling cut off, unsafe, or confused, I actually felt encouraged because he seemed to be communicating his feeling and thoughts, and thinking about the responses he received from others. That is, I assumed he was becoming involved with psychic and not actual reality. But, in an interval between sessions and not consequent to a particular event, he left a message on my answering machine: ‘Hi, this is Tony. I can’t continue in your kind of group, it makes no sense. I’m not coming back.’ For Tony, the group, and not his own mind was the source of anarchy, and he had escaped its danger. In retrospect, I understand that Tony could not process, or rather, would not process, the true meaning of my countertransference slip, which was evidence of my positive, rather than negative or nonexistent thoughts about him. To find the group, me particularly, as authentic and truly interested in him, was a revolutionary experience that he had to block, even destroy. The very idea of my empathy seemed to fuel a bitter hopelessness that failures in self/object relationships could be talked about, much less corrected. In the previous example Rita’s rebellion was not anarchic, because there was a particular intellectual focus to her intransigence. The point of manifest contention was her belief about self-help groups and medication versus mine, as she understood them to be. With Tony, his underlying rage and resultant attacks on mental links served to sever a shared reality on which to structure our conflict. Disagreements were too vague and inchoate to be discussed in a manner that would bring us closer or further apart. Members had become frustrated and irritated with Tony’s repetitious protests, and while they

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greeted his departure with compassion and sorrow, they were ready to move on.

Revolution In revolution, the premises of the rebelling faction come to overpower and dominate the group, propelling a new phase. Revolutionary transformation may not always be immediate or obvious, or result from a single or dramatic event. Only in retrospect might the speed and significance of cultural change become apparent. For example, the introduction of the computer is said to have revolutionized communication. Freud is asserted to have had a revolutionary influence on twentieth century thought and relational thinking, a similar impact on psychoanalysis (Mitchell 1988), although not every psychoanalyst would concur. At its prospect, revolution is frightening and so provokes resistance. Individuals, psychotherapy and other small groups, as well as large groups such as psychoanalytic, political, or religious organizations, may regress to psychotic-like levels when presented with genuinely new and radical ideas (Bion 1970; Jaques 1955; Kernberg 2000). The disruption and disorganization may feel or appear to be ‘catastrophic,’ and the group may rigidify paranoiagenic defenses or seem to fall apart in anarchy. Indeed, temporary or more permanent loss of familiar mental boundaries and established interpersonal alliances may be part of the growth process. Revolution may arise organically as part of the group’s development, or be imported into the group such as by new membership. Some members may decline to participate in the revolution, choosing instead another action pathway: defiance, secession or self-exile, or counter-revolution. The effect of Melanie Klein’s ideas in London was to divide the group of psychoanalysts into schisms. Each subgroup was intellectually creative but exclusionary and personally wounding to members of other factions. Thus, revolutions may have elements that are reactionary as well as progressive, fascistic as well as democratic. Revolution may muffle as well as stimulate spontaneity and variety. In its extreme negative form, revolution leads to group dissolution or anarchy. Fromm (1963) described a ‘revolutionary character,’ which involves reaching a high level of personal development and represents a worthy goal of any form of rebellion.

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Someone who is identified with humanity, and therefore transcends the narrow limits of his own society and who is able therefore to criticize his or any other society… He is able to look at his environment with the open eyes of a man who is awake and who finds the criteria of judging the accidental and that which is not accidental according to the norms which are in and for the human race. (p.111)

As Hopper (1999) emphasized, such an individual – therapist as well as patient – would apply Marx’s revolutionary idea that we must try not only to understand social reality but also make it better.

Clinical example: From a case-centered to process-centered peer supervision group At the end of my postdoctoral training in psychoanalysis, a subgroup of candidates formed a case-centered peer supervisory group. Freud (1912b) promulgated this paradigm amongst his students (referred to as ‘technical seminars’) their purpose being to discuss psychoanalytic theory and technique. In a short time however, the candidate group’s activity widened from exclusive concentration on the report of a psychoanalytic session, to include increasing expression of frank feelings and associations set off by the reporter. Not surprisingly, there were intense reactions to these developments, although initially they were not discussed openly but suppressed and acted-out. Some members became quiet and it became difficult to muster a full roster of volunteers for case presentations. The members fostering interaction spurred dialogue about these group happenings, but the case-focused members did not greet these occasions warmly. They reminded the group that its purpose was to learn about patients and not carry out group therapy. Counter-arguments were presented. Parallel processes existed between the cases under consideration and the here-and-now group experience, and these represented crucial emotional configurations that needed to be explored. Besides, as clinicians how could they ignore emotional manifestations in the room and carry on increasingly dry and defensive intellectual discussions? The group was becoming ‘as if,’ inauthentic. The increasingly heated exchanges firmed up attitudes and boundaries, creating a schism. Some members insisted on the case-centered model. Others promoted a dual-focus supervisory paradigm, which included consideration

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of group process and its relationship to the case and presenter (Billow and Mendelsohn 1987). The case-study bloc felt sacrificed to the extent to which the group wanted to study itself, and the dual-focus bloc became disgruntled to the extent to which the group avoided study of itself. In the registration of opposing views concerning the purpose and goals of its current and future direction, the group had turned attention to itself and to the personalities of its members. A revolutionary shift was under way, transforming the group from a strictly case-presentation to a dual-focus format. But in the transition it suffered the loss of several members, who could not abide the new order. Others have written how a similar revolutionary course of a leaderless group of professional therapists may destroy the group, as the members scatter in the face of increased group scrutiny (Brandes and Todd 1972; Isacharoff and Hunt 1977). The original technical seminar, Freud’s famous ‘Wednesday Evening Society,’ broke up after becoming exceedingly emotional (in Rutan and Stone 2001).

Rebellion of the therapist While on the one hand the therapist is a primary agent in fostering a sense of continuity, cohesion, and regularity, he or she is also a powerful agent of change. The group therapist symbolically, linguistically, and behaviorally traverses each action pathway of rebellion, taking multiple roles of defiant instigator, anarchist, revolutionary, and exiled outcast. Bion (1966) challenged the therapist to function with ‘the impact of an explosive force on a preexisting framework,’ the goal being that the group ‘should thrive or disintegrate but not be indifferent’ (p.37). This involves provoking mental disruption, even momentary anarchy, as the members are dislodged from the state of basic assumptive ‘groupishness’ that all participants, including the therapist, reflexively settle into (Caper 1999). The ‘putting into words’ process is a most important act of rebellion. Ogden (1997a) asserted that the therapist’s words should ‘upset (unsettle, decenter, disturb, perturb) the given’ (p.12). The therapist’s language should aspire to a ‘particular form of evocative, sometimes maddening, almost always disturbing vagueness’ (p.11). Whereas Ogden did not concentrate specifically on the countertransference or other aspects of subjectivity, I suggest that what the therapist says and how it is said must disturb the therapist’s own preconceptions, represent personal risk and open the way for self-discovery.

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To avoid sounding omniscient or oracular and to encourage feedback, the therapist needs to maintain a vernacular and playful manner, just as we want our patients to behave: group therapy serves as an effective equalizer. Sharing our thinking and not merely interpreting (Aron 1996), that is, responding to challenges to our thought with dialogue, helps keep therapists honest, humble and on our toes with patients and colleagues.

Case example: The therapist rebels I introduced without prior announcement a new patient into group the week after Daniel, a respected and long-standing member, completed his termination. I felt that the exigencies of the prospective member, and the maturity of the group to deal with my challenge of the usual norms and procedures, outweighed blind allegiance to customary technique. As I expected, the reaction was negative: ‘I figured you would do something like this.’ ‘The body isn’t even cold!’ ‘Is this a message to us: “You can be replaced?”’ ‘I wanted to mourn Daniel’s termination, now I have to be concerned with relating to the new member.’ Connections were made to experiences of tactlessness, disenfranchisement, and neglect from people who should know better. After the period of initial protest, followed by serious transference work, the discussion turned to the reality of my behavior. Various members expressed curiosity about my psychology and how it affected my decision-making: what was I thinking or was I even thinking? Do I care for the members enough to mourn? Was this an experiment to see how the group would react, and do I use similar therapeutic techniques in other groups? Perhaps I felt pressure to be helpful to a new patient and that clouded my judgment. Hiding behind a traditional analytic blank screen would have been inauthentic, yet becoming transparent and immediately sharing my reasoning would have felt like mindless submission to the group will. Further, a meaningful exploration of feelings and opinions was taking place. I replied that while I found the questions fair, I was not yet prepared to answer them. When several members complained I was copping out, others came to rescue me. A member appreciated that I could take the group’s anger without collapsing or retaliating. A second testified how I went out of my way for her by scheduling an early morning appointment. A third advised that we could avoid similar conflict if I announced a new member’s impending arrival, particularly if it occurred during an intense group period. That would be the best

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way, a fourth concurred, since it mirrored the process of bringing a new baby into the family. I felt exiled. The members were creating an idealized version of me, banishing their prior anxieties about my anti-therapeutic tendencies. Their unconscious efforts would stifle rebellion, such that we could settle comfortably into a dependency culture. I countered: ‘The group is taking care of me, now if only I would behave myself and act like a “professional.”’ But if I did behave, meaning conforming to rather than rebelling against group ritual, I would be depriving the members, including me, of growth producing intersubjective conflict brought into play by unpredictable experience. Indeed, the emotional and intellectual depth of the session confirmed my belief that routine discussions of the feasibility and timing of the entry of prospective members would not be a good policy: it would foster denial about the limits of democracy and the reality of the therapist’s authority. Nonetheless, rebelliousness for its own sake is sterile, and there is as little sense in defying ritual to provoke discord as in maintaining ritual for harmony. I wished to do neither. A year later another patient in my practice pressed for group membership, and this seemed the right group. I delayed because several members were involved in an intense termination phase. As often happens, these members pushed back their departure dates and now I felt unsure of how to proceed. I wanted to protect the process of members who were still terminating, yet could not hold in indefinite abeyance my commitment to the prospective member. I said that without wishing to convey a false sense of democracy, I needed guidance regarding whether to make room for a new member during this period in which several individuals were terminating. What did the group think? Unexpectedly, the discussion regarding the prospective member was brief and welcoming even by the departing members. Of more concern was my sudden willingness to collaborate. Had the group influenced me to change my technique? Was I going to announce and share decision-making when other new members might join? Some people liked the idea that I would share my thinking and consider their input, while others felt threatened. Was I maturing or aging? Was I becoming more considerate or no longer able to make up my own mind? Thus, while there are advantages to the traditional technique of preparing a group for a new member, there are advantages to rebelling against this tradition. Being surprised by and having to deal with a new member had been

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positive for this group, and some members were feeling deprived by the forewarning. There was truth in the maxim: ‘Be careful of what you wish for, it may come true.’ The group members took the space and time to think about what they really wanted from leadership.

Conclusion: The uncertain status of the therapist’s rebellion The therapist’s rebellion can be an expression of genuine, if not immediately apparent, empathy. It provides a caring focus of attention such that a group may examine its wishes, rather than have them either come true magically on demand or merely be dismissed. But therapists have destructive as well as constructive rebellious tendencies, independent of group phase or similar behaviors from other members. We feel intersubjective tensions that relate not only to transferences–countertransferences, but also from our own conflict between needing and desiring to think, and rebelling against the painful thinking processes and against the group that activates it (Chapter 3). In each of the case examples, I attempted to make public the efforts to rebel against therapeutic work as I defined the work to be. At the same time, my normative assumptions, therapeutic principles, personality, and human limitations influenced how I dealt with others’ rebellion and how I myself rebelled.

CHAPTER 9

Primal Affects Loving, Hating, and Knowing In Chapters 9 and 10 we consider Bion’s structural theory of affect, and apply the theory to group process and the psychology of the members. Chapter 9, on primal affects, differentiates Bion’s theory from those of Freud and Klein. In giving emphasis to the primacy of thinking, Bion posited three instincts underlying our drives, and their expression as basic or primal affects. These affects, which operate from the beginning of life and function outside of awareness, are central in constructing intersubjectivity and undergird all subsequent meaning. Primal affects alert the self to its need for human contact: for nurture, comfort, tension relief, protection from danger, and mental stimulation (Grinberg 1990; Grotstein 1999). Rather than primarily motivating drive discharge, instinctual experience motivates the search for other objects. Understanding the central role of the primal affects aids the clinician in making inferences about group members, the entire group, and the leader’s relationships to them. To preview this volume’s conclusion, Chapter 10 explores how primal affects, when tolerated and brought into awareness as feelings and emotional thoughts, allow for an integrated intersubjective sensibility that Bion referred to as passion. Defining affect, feeling, and emotion can be difficult and the terms are often used interchangeably or inconsistently in psychoanalytic writing (Rayner 1991). In Relational Group Psychotherapy, ‘affect’ refers to the most basic component of emotional experience. Affects may be thought of as based on instinctual energy (Laplanche and Pontalis 1973), drives, or constitutional factors. They are prearticulate and not directly within mental awareness. feeling refers to experience of the self and body sensations as they first verge on awareness. While we often assume a feeling exists in close correspondence to an underlying (hypothetical) affect or drive, this is not always so, since a 193

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feeling may represent an amalgam of contrary and antagonistic affect-driven motive forces. Finally, emotion refers to relatively sophisticated complexes of feelings, which have reached awareness, are becoming understood, and may be communicated as thoughts.

LHK: Bion’s relational revision of instinct theory Freud (1933) referred to the theory of the instincts as ‘our mythology. Instincts are mythical entities, magnificent in their indefiniteness’ (p.95). Bion too appreciated the role of myth and metaphor in describing experience and in building a metapsychology. Both theorists considered instincts as underlying regulating principles, without a one-to-one correspondence between these hypothetical entities and subjective experience. As Freud (1915a) qualified: ‘The attitudes of love and hate cannot be made use of for the relations of instincts to their objects, but are reserved for the relations of the total ego to objects’ (p.137, his emphases). Freud did not formulate a central theory of affect and did not consider affects to be primary in the organization and functioning of the psyche. Implicit in Klein’s writing is the notion that the human being thinks about the world through its primal affects. She described how the infant mentally divides the world into love and hate via mechanisms of splitting, projection and introjection (Klein 1952; Heimann 1952). What is loved is good, what is hated is bad, and thus originates judgments of emotional, moral, and aesthetic value. Bion turned attention to a third dimension: very early on, the baby begins to study what is happening. For the baby is curious to know, and values its curiosity and those who stimulate and respond to it. Bion (1963) offered an alphabetic shorthand for what he considered to be these most basic levels of mental organization. L refers to loving and being loved, H to hating and being hated, and K to coming to know and to being known. The assumption of a cognitive or curiosity motive particularly sensitive to the interpersonal environment thus modified Freud’s postulation of two basic instincts or drives, Eros and Thanatos. Freud (1905) had acknowledged the ‘instinct for knowledge or research’ (p.194) and related it to ‘obtaining mastery’ and to scopophilia (voyeurism). He did not, however, consider the curiosity motive as among the ‘elementary instinctual components’ that is, as an indispensable component of the infant’s basic constitutional equipment. Freud dated its onset to ‘at about the same time as the sexual life of children reaches its first peak, between the ages of three and five’ (p.194). Freud (1938) characterized the aims of Eros and Thanatos as, respectively, ‘to bind together’

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and ‘to undo connections and so destroy things’ (p.148). For Bion, these aims were represented by plus and minus. Bion added a relational structure, L, H, and K, to the two aims first posited by Freud. Plus K is the type of emotional thinking that links or meaningfully integrates the affects and so represents the aim of Eros. A relationally disturbed, psychotic part of the personality, rather than aggression or an aggressive instinct itself, is minus, and represents the aim of Thanatos. L, H, and K are minus affect links when they remain extreme and unrelated to the emotional realities of other individuals. The essential distinction is not between love and hate, but between plus and minus. Any affect may further or hinder emotional links. For example, when two group members discuss mutual resentments openly and nondefensively and thus improve their relationship such that they each derive more satisfaction, this is +H. If in idealization love is used to avoid thinking critically and knowing more about interpersonal reality, this is -L. In one final example, obsessional attention to detail, while seeming to gather information, actually interferes with learning. This of course is -K. Loving and being loved and hating and being hated supply important information; they are crucial dimensions of constructing a complex emotional experience, creating meaning, and relating to the self and others. Love and sexuality (L) and hatred and aggression (H) are self and species protective responses, when modified or fused with each other, as Freud held, but only when also linked to K. The concept of K allows us to differentiate conceptually adaptive assertion of will from maladaptive destructiveness. For Freud and Klein, the difference lay in the intensity of aggressive drive-discharge and the amount of ‘binding’ or fusion with sexual libido. For example, according to Freud (1938) healthy aggression, which is seen in the mature sexual act, is dependent on the ‘proportions of the fusion between the instincts’ (p.149). But the sexual act, even when successful physiologically, may be meaningful, meaningless, or perverse. Thus, we may understand that whereas L and H are self-contained, K achieves overarching status. For K represents not only a general curiosity drive, but also the content of K can involve L and H. Further, K is necessary to derive emotional meaning from L and H, as well as from K itself. It is the quality of one’s thinking about emotions – the movement of K over the fields L, H and K – that virtually defines the quality of one’s humanness, by rendering personal action comprehensible to oneself and others.

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K, in balance with L and H, form ‘three facets of a unitary, isomorphic life instinct, whose function is to keep us alive as individuals and as a group’ (Grotstein 2000, p.473, his emphases). L, H and K express what Bion (1961) referred to as our ‘inalienable inheritance as a group animal’ (p.91) and indeed his structural theory is quite applicable to the study of groups. For the human being does not outgrow sorting meaning on the basis of these inherent emotional categories. These primal affects supply personal information about our relationship to the environment, to our own mind and body, and to other psychic objects. L, H, and K are the foundation of our awareness as to who and where we are; how we feel about others and ourselves; and how (we think) others feel about us.

LHK foreshadowed in Bion’s theory of basic assumptions Like other Kleinians writing at the time (e.g. Isaacs 1952; Segal 1957; Sharpe 1940), Bion was interested in the earliest development of symbol formation. Bion (1961) coined the term, proto-mental, to refer to a hypothetical, undifferentiated level of experience on the border of the psychical and physical. Consisting of bodily sensations, imagery, rudimentary feelings and primitive thoughts, the proto-mental state may be best studied in the group. Indeed, proto-mental phenomena form the underlying basis of basic assumptions. In the proto-mental system there exist prototypes of the three basic assumptions, each of which exists as a function of the individual’s membership of the group, each existing as a whole… Only at a different level, at a level where the events emerge as psychological phenomena, does there appear to be possible a differentiation of the components of each basic assumption, and on this level we can talk about feelings of fear or security or depression or sex. (Bion 1961, p.101)

The basic assumptions instantaneously link members of a group and one group to all others. They express coexisting, primitive states of mind, the Kleinian positions, which displace and interact with each other, as well as with higher levels of cognitive-emotional organization. Each basic assumption contains features that correspond so closely with extremely primitive part objects that sooner or later psychotic anxiety, appertaining to these primitive relationships, is released. These anxieties, and the mechanisms peculiar to them, have been already displayed in psycho-analysis by Melanie Klein. (Bion 1961, p.189)

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Considering basic assumptions in light of the later theory, we see that each basic assumption represents an attempt to cope with a primal affect that predominates in a corresponding Kleinian position. In the fight/flight state of mind, paranoid-schizoid anxieties, hatred, and aggression (later described as H, plus and minus) predominate. In the dependency state of mind, intense, immature idealized love (L), accompanied by melancholic worry and guilt, become central. Finally, in the pairing state, exaggerated curiosity (K) preoccupies the members. Manic hope spurs a foreclosed mental system, shielding the individual from pain.

The later theory: Premonitions, beta elements and alpha function LHK exist first as premonitions Bion’s later theory refines his concepts of proto-mental experience and basic assumptions, through the introduction of the constructs of the premonition, alpha functioning, and beta elements. Drawing on Platonic and Kantian epistemology, Bion posited that some preconceptual knowledge of our basic feelings and emotional needs exists from birth (and perhaps prenatally), in the form of premonitions. Premonitions are expressions of the drives of L, H and K, released by experience, to inform the individual’s thinking. They need to be considered in the group: ‘To what I have already said about emotional drives I add a reminder that the analyst’s concern is with the premonitory aspects of these drives… The determining factors in even intimate manifestations of sex or aggression may lie outside the personality and within the group’ (Bion 1963, p.86). Premonitions arouse premonitory anxiety, a dawning awareness of L, H and K, ‘the determining factors’ underlying the manifest emotionality expressed by the individual and group. Even when dreaded and painful, premonitory anxiety must be suffered for it signals the release of the basic affects, activating in the immediacy of here-and-now experience. I qualify that premonitory anxiety relates not to any vague or unformulated affectual arousal, of which the human being is capable of an infinite variety. Rather, the anxiety refers to dawning awareness of particular, hypothetical affects that are activated but defended against. LHK thus exist as anxiety-laden potentials or premonitions. Until these potentials cohere into represented feelings, they are not available to participate in meaning-making. The

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group member remains deprived of the necessary emotional information to make adequate ‘mental sense’ and understand ongoing experience. Interestingly, Freud (1926) also hypothesized the existence of preexistent structures of ideational and emotional experience. He defined affects as ‘reproductions of very early, perhaps even pre-individual, experiences of vital importance’ and compared them to ‘universal, typical and innate hysterical attacks’ (p.133). Humans bring inborn intellectual and emotional categories to their experience. They anticipate events and put their own cognitive-emotional or subjective stance on the event into a personal experience (Grotstein 1999). The supposition of inherent preconceptions, which prepares the self for categorically organizing proto-mental experience, is Bion’s equivalence to Piaget, Lorenz and Tinbergen’s concepts of innate schemata and innate releasing mechanisms, and of Jung’s archetypes. Learning theorists have introduced the similar notion of species-specific preparedness. To return, Bion had postulated substrata of protomental contents – premonitions and beta elements – that need to be transformed so they can become thoughts. Bion called this necessary process the alpha-function. Alpha functioning organizes into conscious and unconscious thoughts disparate and chaotic eruptions of ‘raw’ or unmediated proto-mental experience so that they may be felt and thought about as feelings and ideas. The ongoing transformation of beta into alpha elements provides consciousness and unconsciousness with symbols, nameable affects in the form of feelings and emotional thoughts of increasing complexity that may be expressed in fantasy, dreams, art, science, mathematics, etc. Alpha function serves to link individuals to themselves and others and thus extends relational awareness (see also Chapter 3, on Bion’s theory of thinking). Perhaps some phenomenological considerations will persuade the reader that these concepts are not needlessly abstruse and hypothetical, but describe mental reality and functioning. As therapists, we sometimes have the experience of being spoken to, and although our minds do not feel empty (and indeed there may be a sensation of mental pressure), we have no words with which to respond. Sometime later, the realization occurs: ‘I could or should have said such and such.’ Earlier our minds were full of beta elements that could not yet be thought. After alpha functioning, meanings became clearer, thoughts evolved, and words were available. In summary, in terms of the later theory, L, H and K are premonitions – preexistent affects that supply categories for emotional experience. They may

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present themselves as beta elements, and must cross a threshold via alpha functioning, to be thought about and so named, symbolized, and meaningfully developed. To the extent that a work group exists (W), members apply alpha functioning to LHK, thereby bringing personal, emotional meaning to their experiences.

Primal affects are often ‘not nice’ Psychoanalysts, beginning with Freud, have been concerned with subjective experience involving affect and idea. Freud (1915b) had argued that only ideas relating to emotions could be repressed and made unconscious. Ideas continued to exist after repression as ‘actual structures in the system Ucs’ (p.178). As to emotions however ‘all that corresponds in that system [unconsciousness] to unconscious affects is a potential beginning which is prevented from developing’ (p.178). Although Bion did not refer explicitly to Freud’s formulations, he considered it essential for one’s basic, underlying affects to be developed and linked to inner and outer reality. However, as these primal affects emerge into awareness, they often cause anxiety. (Indeed, if they are real and valuable in the therapy situation, they should be felt as threatening and dreaded as they emerge.) For they conflict with the wish to see oneself – and to be seen by others – as mature, in control, moral in thought as well as in deed. They are judged to be ‘not nice,’ too needy, too sexual, aggressive, too primitive. The group member may become afraid to think further about what is beginning to be felt, particularly in the public setting. The therapist also may ignore these nascent feelings in him or herself and, judging them to be unprofessional, rationalize them away. In either situation, the affects are disavowed and remain unformulated, ‘a potential beginning which is prevented from developing.’ Donnel Stern (1989) aptly described aspects of this process in working with individual patients. ‘Disturbing glimmers of meaning are terminated before they reach the level of articulation at which they would be explicitly meaningful. The corresponding conscious experience may be vagueness, confusion, boredom or complacency, and the absence of curiosity about the other…or a conviction of one’s rightness’ (p.12). In the setting of group, thoughts may be uttered or emotions may be expressed, but they are without deep personal meaning. The therapist, like the patient, needs to tolerate and respect not nice feelings. ‘Often those feelings that might prove most instrumental to our work

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are not so evident. They may lurk in a sense of disquietude or in thoughts that we are not proud of when we first encounter them. It takes time and work to uncover such feelings’ (Ormont 1992). In all individuals, ‘two different categories of mental activity’ coexist, and it is the ‘painful bringing together of the primitive and the sophisticated that is the essence of the developmental conflict’ (Bion 1961, p.159). To develop mentally, we must accept the contribution of our primal affects and tolerate the necessarily anxiety-producing process that leads to the growth of emotionally meaningful thoughts.

Suffering L, H and K Psychoanalytic treatment is not about eliminating pain and anxiety, but rather, transforming the experience, to enlarge the capacity to ‘suffer’ meaning. To avoid unnecessary pain by meaningfully utilizing one’s emotional life, the individual and group must develop a capacity for openness to the development of a full range of emotions that are not observable. The full range involves the derivatives of L, H and K, emotional potentials that have been anxiously disowned and ‘prevented from developing.’ To illustrate the value of suffering the meaning-making process, compare the mourning experience to the clinical syndrome of depression. The depressed person is preoccupied with evident sadness, but stultifies and deteriorates mentally. The self and its objects, rather than being utilized for their capacity to generate thought, are worn down and rejected. This mindset applies particularly to the departed one who is introjected, only to be killed off rather than truly cared for (Freud 1917). Intrapsychic and interpersonal growth and development are foreclosed, along with the emotions themselves. The mourner, by contrast, endures the sense of persecution and depression that accompanies symbolically representing and integrating the painful drives emerging in the context of separation and loss. Thus, with premonitory anxiety, a warning of impending guilt, a mourner may experience premonitions of anger (H) toward the departed loved one. Also provoking guilt is the incipient revival of love toward oneself, and the wish to persevere (L). Integration alternates with disintegration as repressed, suppressed or dissociated anxiety-laden feelings toward the self and other cohere, evoke attention and curiosity (K). Memories of the departed one may arouse sudden happiness which then recedes, followed by confusion, frightening premonitions of catastrophe (Eigen 1993), anger, and renewed realization of loss and sorrow.

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The mourner suffers, binding together through mental representation – conscious as well as unconscious thoughts, fantasies, and narratives – ambivalent and painful primal affects. Others remain appreciated and utilized in the mourning process. In alpha functioning, symbolizing and representing primitive, even psychotic-like emotional experience, the mourner deepens meaningful psychic ties to the lost object, now regained internally. In the realm of K, the individual has considered existential and moral themes, life, death, and transience, and by implication, how best to live. Thus the mourner returns, enhanced and with gratitude, to the world of living (Klein 1935, 1940).

Clinical examples: Premonitory anxiety and halting of L, H and K 1. A distinguished and rather intellectualized woman, also the most elderly member of a long-standing group, volunteered that she divided the therapy into good sessions in which she understood and could empathize with others, and bad sessions in which she became ‘out of it.’ In these latter sessions, she would lose the focus, did not catch on the way others did, and felt bad for and about herself. ‘And then I worry that you [the group therapist] are going to ask me what I am feeling, and I don’t know what I am feeling. I am feeling nothing. I get so frustrated and angry at myself. The group is so important to me, I look forward to it all week.’ Her pain produced sympathy, but little interaction. I suggested that although she might feel that the group was important to her, she did not seem to be important to the group, given their lack of emotional response. The members strenuously protested my intervention and described their admiration for her. At this point in her work, she understood that their very admiration was an aspect of the problem. ‘All my life people have put me on a pedestal. Now they ‘admire’ me for being in therapy ‘at my advanced age.’ But I feel they don’t really know me and don’t want to.’ I replied that she might be right, perhaps people would not want to know her, but that we could not test this idea until she exposed who she really is. The group could not know her until she accessed and expressed her feelings. As long as she remained elevated, that is, above her feelings and idealized by others, she could not participate in the emotional give-and-take of group life. It was my conception that she decided to close off her emotional thinking, becoming ‘out of it’ whenever prompted and made anxious by group experience. In not thinking about her premonitions, i.e. her precursory emotional thoughts, and connecting them to the other individuals in her

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group, she could remain ‘admirable,’ but not otherwise meaningful to herself or others. I encouraged her to consider that she might have strong feelings towards the group (including me) for insufficiently caring, but that she did not want to think about them and relate them to us. She tentatively began to express hurt (L) and angry feelings (H), without undoing her immediate suffering via an intellectual retreat into elaborate explanations and qualifications. She expected the targeted group members to return anger with anger or to feel guilty for hurting her. But no one had these reactions. One member remained unimpressed, and this made her cry with frustration. Others cheered her on, defending her and accepting with genuine delight her nascent efforts at challenge and confrontation (L). Eventually her thoughts began to express a new level of relational meaning, personal and interpersonal, relevant to her growth and to the growth of others (K). Thus she began to think, which for her meant to become less intellectualized and more emotionally spontaneous, and gradually she stopped complaining of being out of it. 2. A forty-year-old physician entered treatment to address professional and family difficulties. He felt he was stultifying in his career and was short-tempered and often mentally absent at home. He reported that he became a doctor because ‘My parents thought it would be a good idea. Nothing really appealed to me. I didn’t know what I wanted to be when I grew up. I’m still waiting.’ A crisis erupted when his troubled, late-adolescent son had a paranoid outburst, ending in a physical fight with his father and placement in a psychiatric hospital. In retelling the event in group, the father broke into tears. ‘At first I felt numb. I began to have all sorts of worries, and then they stopped. I don’t know what I was feeling, maybe guilt for hitting my son. I hate to think of him feeling so bad, maybe sorry for myself and where I am in my life. I spend a lot of time living numb, or spring into anger, like a cold-blooded animal. I get too angry and don’t know what to do about it. I wish you [the therapist] would be like a hospital psychiatrist, medicate me and tell me what to do.’ The patient experienced bursts of unintegrated affects of love or of hate (L or H), but at this point in his life he seemed unable to understand himself (K). His emotions were all there, however, awaiting his attempts to develop them. Without their mental development, he felt numb or cold-blooded, less than human. He remained emotionally immature and cognitively handicapped in coping with human relations of a non-medical nature.

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His parents’ message had been that his family was special. He complied by being a well-behaved child and adolescent, a star in the classroom and on the playing fields. In treatment he soon realized that he had maintained an idealized version of his family, and that actually there were prominent marital and family tensions that he had camouflaged by not thinking, channeling his mentality into performance and achievement. Now he understood his obvious and painful lack of satisfaction in all his achievements, and why he often had been sad and anxious even during his supposedly happy childhood. Indeed he remembered consciously refusing to respond to certain inner urgings that had to do with ambivalent and rebellious feelings and thoughts towards the parent whom he had adored and obeyed. These urgings, premonitions of primal affects, he had refused to think about, really to ‘feel about.’ The price of his repudiation had been an inner sense of fear, foreboding, and guilt. Something bad was inside him, which he feared could and would break out, harming those he loved. He wondered whether the report of his physical outburst and what he called his ‘ramblings’ were scaring and upsetting the other members. Indeed they were, but none wanted him to stop. For the group was getting to know him, understanding the dynamics behind his ‘good group citizen’ front and his previous avoidance of emotionality. He began to think, rather than engaging in mere mentation, with which this ruminative man had expertise. He was becoming psychologically minded. He now could tolerate suffering premonitory anxiety, such that he could feel and think about his love and hate, and became curious about where his thoughts would take him. He became sufficiently confident in his emotional thinking (really, his capacity for alpha functioning) to display a more experimental, less conformist commitment to reality. His vague, haunting moodiness dissipated, as he established what he described as an unfamiliar type of self-control. He could feel unpleasing feelings without numbing himself and becoming passive and compliant, or springing into impulsive action that could be scary to others. The group lived through painful moments of his emotional realizations. The progressive trust in us, as well as in his growing capacity to generate and communicate emotional meaning, formed the basis of much improved, at times joyful, intrapsychic and interpersonal functioning.

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‘Dis-ease’ in group: Minus L, H and K A group may seem amplified with intense feelings, yet it fails to progress emotionally. The group’s ‘dis-ease’ (Bion’s pun, 1961) may be diagnosed by suppression and evasion of basic affects. ‘The tension thus produced appears to the individual as an intensification of emotion…[while the individual] feels as if his intellectual capacity were being reduced’ (Bion 1961, pp.174–175; see also pp.102–103). The exaggerated intensity of the group’s emotional life puts the member in conflict with the part of the self that seeks to retain individuality and remain mature and in control. This is a typical pattern when thinking is avoided: one of the basic affects gets intensified while the others are suppressed. Unwanted or uncontainable feelings, derived from the basic affect associated with predominating basic assumption, may be acted out and are also deposited anonymously into the group mentality. Thus Bion (1961) defined group mentality as ‘the pool to which the anonymous contributions are made, and through which the impulses and desires [i.e. emotions] implicit in these contributions are gratified’ (p.50). The primal affect (and its derivatives) may seem contagious, as it becomes projectively identified with the group therapist, other members, or the ‘group will’ and comes to participate in the fantasies, thoughts and felt feelings of the group. Expressed in later Bionion theory: the primal affect energizing the basic assumption remains a beta element. It is not transformed by alpha functioning (thinking) to be useful to construct emotional thoughts. In groups, the individual feels pressured by various eruptions of L, H or K, proto-mentalized emotional experience. These affect-based beta elements are activated but not caused by group membership, although they may be experienced as arising from sources outside the self (that is, from the group). The individual’s state of mind loses its distinctiveness as it becomes ‘saturated’ with primal affects that do not develop from their premonitory states of incoherence to integrate emotionally. Thus when not developed, primal affects L, H, K are minus, in terms of advancing learning. The individual, rather than informed of the personal meaning of experience, becomes misinformed. In this group situation, the affects have become activated as premonitions but they are not realized, that is, they remain unmentalized as articulated symbols, nameable feelings, and thoughts. Instead, primal affects are suppressed and denied, dissociated and projected, and acted out. What is felt is exaggerated: minus L, H and K misinform by their very intensity. Therefore, in clinical practice, when an emotion is obvious, it is usually painfully obvious (Bion 1963). To restate this

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point: to the extent that the group is immersed in a basic assumption mentality, primal affects continue to function as concrete entities, therefore as beta elements. If these are not submitted to alpha functioning, the process is minus. But with alpha functioning, the primal affects are transformed into thoughts, and thereby made into plus.

Clinical examples: Minus emotions and beta elements 1. Two women reacted similarly whenever strong quarrels occurred in group. One woman reported that she felt that the participants were about to rise from their chairs and hit each other. ‘The fighting scares me and makes me freeze,’ she reported. The other woman silently avoided contact, lowering her head and sinking into herself. When I addressed her posture, she acknowledged fright and also angry disapproval: the fighting was unproductive, reproducing the social turmoil, warring, and terrorism existing in society at large. Both participants remembered childhood experiences of verbal abuse and consequent feelings of endangerment and isolation. Nevertheless, they could not take their thinking further than seeing in the present situation disturbingly concrete repetitions of their pasts. Dramatic or intense vocalizations of anger and aggression were experienced as dangerous things-in-themselves, beta elements of H, made minus because they were not being thought about. Words were used not to convey complex feelings, but to hurt and control others. Silence and physical and mental withdrawal became pervasive defenses developed in their childhoods. It was difficult for the women to recognize that the angry members simultaneously cared for each other (H and L) and that, in heated discourse, members remained in control, self-consciously exposing and educating the group about aspects of themselves (K). 2. A man spent several years in group sparring and disagreeing with other members, me particularly, all done with apparent good humor and a subtle smile. The group experienced him as hostile, resistant, and obstructive and often told him so. He responded to their confrontations with unbroken ease and his characteristic challenge and denial, which served to exasperate the members all the more. In investigating this man’s understanding of the group’s reaction, we discovered that he experienced attacks as ministrations. ‘It means people care for me,’ he insisted, and that was all. Attentive words and behaviors, no matter how seemingly hostile, were loving beta elements, things-in-themselves (-L). He resisted thinking about the more complex

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reality of the group’s affective response or the disruptive effects of his behavior on the group’s emotional life, and could not understand why people accused him of being stubborn, even mean. 3. A woman registered that a male group member was not responding to her. He denied ignoring her, she pursued the dialogue, he briefly protested and then they both became silent. I inquired. The man acknowledged that when he felt pressured he dug in his heels. The woman reported: ‘I feel it in the pit of my stomach, a combination of fear of abandonment and anger, and I worry that I will be inappropriate. So I keep my mouth shut, just like he is doing. I do the same thing with my husband, when he stonewalls me. I usually don’t realize what I’m feeling. It is like it never happened and I leave group feeling bad in my stomach and I don’t know why. Sometimes I don’t even feel the pit, until later, and I don’t even relate it to group.’ The woman experienced her disavowed needs to be loved, to be angry and to let others know her feelings, as painfully concrete abdominal sensations (-L, -H, -K). As beta elements, her primal affects were not transformed into mental elements (alpha elements) that could inform her relational thinking and influence her social functioning.

The leader utilizes his or her own primal affects In any stage of treatment, the patient and group may display little tolerance for increasing the range of primitive emotional experiences. ‘The problem of the leader seems always to be how to mobilize emotions associated with the basic assumptions without endangering the sophisticated structure that appears to secure to the individual his freedom to be an individual while remaining a member of the group’ (Bion 1961, p.78). The group leader’s task is not to eliminate the group’s irrationality, but rather to make available for meaning basic assumptions, primal affects and attendant primitive fantasies and defenses. ‘The deep psychotic levels should be demonstrated, though it may involve temporarily an apparent increase in the “illness” of the group’ (Bion 1961, p.165). To accomplish this goal, the therapist may reveal aspects of unformulated feelings, thoughts and fantasies that are connected to the suppressed basic assumptions. In this situation, the group leader applies his or her own alpha functioning to connect to the group members, such that they may utilize their own consciousness (and unconsciousness). Bion (1962) thought it technically effective for the analyst to appreciate the complexity of the patient’s emotional experience of the session, but limit

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the description to the interplay among the primal affects. The analyst’s task was to choose a dominant or ‘key’ affect of the session, one that also imported a key to the value of the other emotional components. This choice provides a lens to help the therapist best understand the emotional functioning in the room. Earlier Bion (1961) had advised the group leader to be aware of the prominent basic assumption: ‘Work-group function is always in evidence with one, and only one, basic assumption’ (p.154). Bion (1962) attached ‘great importance to the choice of L, H, or K’ (p.46). He appreciated that the choice did not represent a record of the emotional experience of the session itself, but to the best of the analyst’s beliefs, a ‘true reflection of his feelings’ (p.45). While the leader must utilize his or her primal affects in reaching understanding, interpretations are not to be utilized to convey countertransference, i.e. ‘as a vehicle for transmission of some aspect of L or H’ (Bion l965, p.61). Although the leader has chosen a predominant affect of the session, the leader maintains his or her own communications in K, which must be exercised with patience and restraint. The leader must rein in ‘memory and desire,’ the urge to know and to apply knowledge, particularly when the urge involves an intolerance of not knowing. There should be no ‘irritable reaching after fact and reason’ (Keats, in Bion 1970, p.125; see also Bion 1967c). Finally, while the leader must communicate in K, he or she must understand that group members may receive and respond to the communication under the sway of L or H, plus or minus.

The case of the class that would not read All groups, not only psychotherapy groups, stimulate primal and unformed affects. In my view, every group member continuously is being challenged by his or her own affectively based mental processes, as well as by pressures emanating from other members. The group leader cannot evade the ‘developmental conflict,’ a conflict essentially between thinking and not thinking (see Chapter 3). The group leader internally faces decisions whether to tolerate affects in self and other, to think about emerging feelings and finally, to develop and share emotional thoughts with others. This example of a teacher (myself ) and students, illustrates how group process may be conceptualized in terms of the metapsychological constructs LHK (plus and minus), beta elements, and alpha functioning. I attempted to identify the prominent basic assumptions and affects, as well as recognize when primal affects were being denied mental access. This involved considering my primal affects and their

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influence on my thinking and nonthinking about what was occurring and not occurring in the group.

An impasse in K At the beginning of a sixth session in an eight-week postdoctoral seminar on applying Bion’s theories to group, a candidate drew my attention to something which should have been obvious: the class consistently reported difficulty securing the texts. And despite the fuss made over the unavailability of some of the readings, little effort was made to share the texts that were available, such as by reproducing them. He put it bluntly: most people were not reading and didn’t want to. (I had sent a course description, along with a reading list, to the twelve students during the summer, two months before the course was to begin.) I was surprised by the feedback regarding the class majority’s renunciation of reading, since the students seemed to enjoy and respond to the lectures, easily and appropriately applying technical Bionion concepts when discussing the accompanying case presentations. The presenter at this time was an articulate woman who organized her case around a countertransference problem: her ambivalence about being the center of attention, both as leader of her psychotherapy group, and as the class presenter. I myself had been following my syllabus, rereading the basic texts, preparing new lectures and relating them to the case, the presenter, and the class interaction. The data from the classroom had suggested that the students were in an L mode, coping with the basic assumption dependency (BaD), in which Bion and myself were taken in as good objects. There were also paranoid-schizoid (H) derived themes, including envy and fear of envy of the presenter’s role as center of attention, competition for the presenter’s attention and instances of intra-class conflict (BaF/F). I expected that at some point in the class there would be, additionally, challenges and destruction of certain of Bion’s ideas and conclusions, my interpretations of Bion and their application in the supervision. I also had been alert for pairing (BaP) phenomena, as when the class passively took in the intercourse between the presenter and me. When this situation occurred, it was easy to encourage work group formation by ‘bridging’ (Ormont 1992) to the noninteractive students and bringing forth their thoughts and feelings. Thus I felt I had a good idea of the resistances against thinking and the W group. These included the alternations among the three basic assumptions, the anxieties and defenses of the Kleinian positions

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and the influence of L, H and K. I had assumed we were functioning in the key of K, and that the other primal affects were alternating and sufficiently integrating to provide an emotional dimension to intellectual experience. A candidate had come forth with a different idea: that we were functioning in the key of K minus. He displayed a questioning attitude, backed up with a keen observation of group process, the group’s undiscussed resistance to reading. The effect was to explode the preexisting structure of the group (particularly my beliefs about the group), done with warmth and without a suggestion of violence. This describes the role of the mystic, a group leader with a disturbing, even revolutionary idea. Apparently, it was long overdue for me to display this type of leadership. At this crucial class juncture, we would destruct or grow.

Eliciting primal affects and their derivatives in feeling, thought and fantasy I felt I had to lead, for the class fell into an unproductive, guilty silence. It was as if I had caught them in the act of being a group, as described by Bion: ‘quite opposed to the idea that they are met for the purpose of doing work, and [who] indeed react as if some important principle would be infringed if they were to work’ (1961, p.84). But I had been a member of this group (whether also its leader was yet to be determined), and I was not ready to renounce my role in producing resistances to learning. When Bion (1961) wrote that the therapist should consider the ‘dual’ of any given emotional situation (see, for example, pp.165–166), he did not give the weight we now do to this concept: the dual to the group’s transference is the leader’s countertransference (see Chapter 10, section on Bion’s concept of countertransference). In attempting to elicit split-off and suppressed group emotions, perhaps I could discover, develop and integrate my own. I acknowledged my surprise and confusion about my ignorance, commenting that we all might benefit by exploring the situation before us, rather than prematurely accepting or assigning blame. A man broke the class silence by volunteering that he hated getting the readings early in the summer, when he was just beginning to go to the beach with his family and relax. Another person disagreed, appreciating the early mailing of the syllabus. A debate ensued on the timing of the mailing of the readings, until the man who raised the issue became impatient. He had not pursued the reading list – and would not have whenever delivered – because in his experience, several professors in our psychoanalytic postdoctoral program (which he and many of his current classmates had recently completed) had mailed long lists. He

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had bought the expensive books and they had remained unread and undiscussed in class. The reference to these other professors brought a conspiratorial meeting of eyes and shared laughter and groans. I understood that the group had taken a mental journey into their respective memories, hallucinating their previous professors. Who were they? I inquired. After a brief hesitation, two names were proffered, erudite men who had the unfortunate but well-earned reputation of being dry and intellectual. The class reassured me (and themselves) that I was nothing like those professors. I had taught all these students before and they ‘liked’ me. ‘We still like you,’ several students insisted, and returned the conversation to the question of the readings. Were there too many readings, and were we moving too fast? I said whether there were too many or too few it hardly mattered, since the problem remained that most of the class did not have the readings, and were making little effort to receive them. I had to take this personally, and assumed that there existed a ‘twin’ (Bion 1967b) of ‘liked me,’ an ‘unliked me,’ a combination of the rigid, unavailable personalities of the two professors whose names had been brought forth. After all, the class had not discussed with me their difficulties in how I had structured and was pursuing the course, even though the ‘liked me’ was perceived as flexible and accessible. After some amused disagreement with this interpretation, a woman volunteered that the course and male instructor were not as ‘warm’ as the earlier course in the evening’s sequence, a group process course run by a female colleague. The mention of her name brought a round of appreciating smiles. I understood and communicated the idea that now the group was hallucinating her presence to convey the feeling of love for her and her course and hatred of me and mine. A class member reminded us that my course was also a theory course, and not primarily a process course. Perhaps to dissipate lingering guilt feelings for thoughts of hating me, several members initiated a dispirited discussion of gender differences. Women tended to be receptive and responsive; men tended to be provocative and challenging. It really wasn’t a question of ‘better,’ just of ‘different.’ A dull debate on teaching styles strengthened my belief that the female professor had become the receptive ‘liked me’ and that indeed I was an intrusive ‘unliked me.’ And then with five minutes remaining, another member volunteered that she had found it unnecessary to read the materials since I summarized Experi-

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ences expertly. At first this sounded like a compliment and a resurrection, but she went on and explained that my very expertise took away her motivation. Additionally, she did not appreciate my ‘rushing’ ahead to other Bion readings and concepts, which she found useless in terms of understanding group process. Finally, she found the case presentation to be vague and without merit, and went on to describe its failings. After a moment’s stunned silence, the presenter had the aplomb to respond. She said that at least she was in ‘good company’ (meaning me). The timing of the woman’s criticisms, as much as the criticisms themselves, made her angry. There really was not much of an opportunity to check out other people’s feelings, or to respond to her own. The first woman said that she had no idea of the time, and that she had felt free to share feelings. After all, I had invited the frank discussion. There was some criticism and then defense of the critic. The presenter was also defended. I said that we would have a chance to return to the issues concerning the two women next week, and that I appreciated the opportunity to talk about our difficulties in learning, and to discuss further what I took to be my responsibilities in causing them.

Reassessing key emotional dimensions: Aspects of my inner experience To be informed of the students’ displeasure was shocking and humiliating, but curious and interesting too. How could I be so wrong when it had felt so right? I thought of my enthusiasm for Bion and my unalloyed satisfaction with the syllabus, the progress of the course, and myself. If my satisfied view represented an ideal of a good W group, the idea of a bad twin or dual had insinuated itself into the group process, and into my mind. I had to face the emotional reality that an unacknowledged fight/flight group culture existed in our class, one that needed to be released from its ‘bondage of inarticulation’ (Bion 1970, p.15). By tolerating this anxiety-producing, new perspective, perhaps I could help us begin ‘to discuss something or to talk about it, or to think about it, before knowing what it is’ (Bion 1997, p.10). This entailed bringing out the class’s hitherto unarticulated, ‘not nice’ feelings, thoughts, fantasies, and behaviors (mine included), and our tolerating their personal consequences. Thus I had encouraged the students to report how they had experienced and responded to my symbolic as well as actual presence. I treated the mailings, the lectures, case presentation, and references to other professors and courses as ‘good’ or ‘bad’ split transference

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representations. It was for this reason that I had pursued the students’ articulation of associations to the other professors, having them name the rigid, intellectualized men (the ‘unliked me’), and describe without apology their preference for the receptive woman (the ‘liked me’). The students’ resistance openly to acknowledge their negative feelings about me exemplified the group mentality. ‘The emotional state proper to a basic assumption is not wholly pleasurable…the individual, supported by the group, tries to keep the goodness of the group isolated from its badness’ (Bion 1961, p.93). The group had developed and now revealed a pattern of misinforming the leader (and each other) of their true feelings. In utilizing splitting and primitive denial, the class could avoid developing and articulating in verbal language and thought their own premonitory hatred of Bion and of the teacher. Their dread of H prevented them from integrating this emotion with their love (L) and interest in me and what I had to offer (K). This formulation is not to blame the class, but to define a problem: me. In the history of pedagogy, their teachers have driven more students crazy than vice versa. The class was pseudo-compliant. ‘As if ’ behaviors and avoidance of the reading (and of what they did not like in me) were inauthentic, but legitimate communications. I had to consider my difficulties in understanding them, and why these communications occurred. A group culture emerges from the conflict between the members’ striving to remain individuals and their need to remain connected to the group, that is, as a dialectic between rational individuals and a primitive group mentality. I suggest that the group mentality involves a defensive group response to the real as well as imagined difficulties of the leader, expressed in the latter’s arrogance (-K), aggression (-H), and emotional deprivation (-L). There is ample evidence in Experiences of Bion’s unintegrated aggression, as expressed in his contempt, sarcasm and derision of ‘neurotics.’ Bion apparently did not appreciate that the members of his groups probably cohered to defend against his intimidating persona, for instance, imposing physical presence, reputation, oracular and at times arrogant style, and emotional distance. Therapists contribute to the enactments that are prevalent in any group culture. Group leaders co-create and shape the group mentality and the resulting group culture by how they cope with their own basic affects. I had believed that I had been expressing my ideas in an integrated key of K. Apparently, I had developed and expressed my intellectual strivings and my emotional needs. To the extent to which I had not understood and responded

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to my students at their level of intellectual conflict and emotional need, I had been communicating in an unintegrated key of -K. I imagined how frightening it could be for students to challenge constructively a professor narcissistically ensconced in his own group (BaP) with the rather inaccessible Bion. A manic teacher could easily make a class feel out of touch with itself, persecuted and depressed. They required a teacher with a consistent and reliably available normal part of a personality, one able to help develop and understand the positive and minus derivatives of primary feelings of love, hatred and curiosity (LHK), legitimate emotional responses to difficult intellectual material. To fulfill the group’s need, a mystic had come forth to expose me to my countertransference, to address the mania in my own refusal to experience the class’s ambivalence, acted out by their failure to read. Authentic learning by experience requires some integration of H with L and K. In our class, the basic affect of H had been dreaded by student and teacher alike, and split off from mutual awareness. Hatred, disguised as love and curiosity (the students’ pseudo-compliance and my gullibility), served to confuse and misinform and hence was its negative (-H). As a primal emotion, -H functioned and remained an unevolved thing-in-itself, a beta element to be evacuated, only useful for acting-out. When projected beta elements are introjected and dominate thoughts, which became my state of mind, they contribute to hallucination and delusion. I had quite willingly hallucinated a satisfied class, and had projected my delusion into our classroom. The class colluded with my delusion, until we were disturbed by the student who had assumed mystic leadership. Confronting the impasse to learning gave me the opportunity to help the class and myself understand the emotional reality that had been transformed by hallucination and dissociatively acted out.

The following weeks There were three class members, particularly, who I felt needed to be responded to in the following week. In assuming the mystic role, the male student presumably had stirred up the class’s guilt and envy, and isolated himself from the group. His class members – knowing a great deal about his personal psychology – humorously suggested that the best revenge was to offer him admiration and gratitude, which indeed, he found difficult to accept. His unrealistic rejection of leadership served to reunite him with his class.

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There was also the relationship between the two women, the presenter and her critic. I agreed with the presenter that she had been in my company, but disagreed that it had been good company. Her presentation suffered from being paired with mine. I, not she, was the center of the critic’s attention and of the group’s hostility, and she was caught in the crossfire. This interpretation did not seem fully to satisfy either participant, which I took to be a positive sign. I was not in class to mollify unduly the students’ conflicts, but to make their conflicts available to think about and work on in the context of our theory course. They could continue to address intra-group dynamics in the process group run by the female professor. A new member took over the role of presenter. I made it my business to reproduce several Bion papers and distributed them, along with a reprint of my paper on LHK (Billow 1999a). I cannot say how many members of the class read the material, but I took my concern as my problem, and not necessarily theirs. Apparently I continued to find it difficult to tolerate class members having, to paraphrase Caper’s (1997) apt phrase, minds of their own. Their minds contained objects of interest different from mine; their minds had their own trajectories of development. I remained disappointed that the class was not more turned on by the metapsychological Bion. I questioned whether they were sufficiently intellectually educated, and was mildly plagued by my role in any didactic shortfall. But quite positively the class, myself included, worked with Bionion concepts, not only as intellectual exercises, but emotionally. I found that when I expressed interest in (without undue self-blame) my contribution to the class’s difficulties in studying Bion, others were interested in their contribution too. When the group became able to hate me (and Bion) openly, we functioned as a productive work group, learning how basic affects both contribute to and interfere with our need to think and make meaning.

CHAPTER 10

Primal Receptivity The Passionate Therapist: the Passionate Group This final chapter extends the subject matter of Chapter 9, which dealt with Loving, Hating, and Knowing, the basic or primal affect categories of emotional experience. Chapter 10 integrates many of the themes of Relational Group Psychotherapy, calling attention to the interacting influences of the group therapist’s evolving subjectivity, the feeling and thinking of the members, and group process and development.

Sense, myths and passion Psychoanalysts study ‘psychoanalytic objects.’ These are mental objects, thoughts, and iteratively, thoughts about thoughts. Psychoanalytic objects may consist of any mental phenomenon that captures attention and thus may be felt, fantasized and thought about, on conscious and unconscious levels. Included then are such objects as a psychoanalytic interchange, a memory, a group, or a personality, such as a patient or oneself. Feelings, fantasies, and thoughts may themselves become psychoanalytic objects, of course. Psychoanalytic objects are capable of being investigated, according to Bion, because they possess three elements: sense, myth, and passion. The element of sense refers to something discernible and socially available, such that the participants can be reasonably certain that they are hearing, seeing, and talking about a similar experience. Additionally, there is a quality of sensation to mental activity: the thinker first experiences thoughts as a perception. When there is not sufficient sense, we seek to find it. For instance, in describing various clinical interactions in this book, I have attempted to convey the sense of how words were spoken and how the partic215

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ipants and I experienced them on a feeling level, not merely semantically. A fantasy or a dream, like a poem, needs to convey sense, while retaining its ineffable qualities (Ogden 1997a). Myths express personal narratives, the explicit and implicit theories that individuals, groups, and societies bring to organize and understand the human experience. Unconscious and symbolic thinking, as involved in dreams and metaphors, express myth. Clinicians often use literary myths to describe psychological themes and their influence on internal and external object relations. For instance, Freud used the Oedipus myth of the killing of the father to describe the psychology of group thinking and behavior, how individuals play out relational fantasies involving authority figures, by massing in groups and societies. The clinical formulations in Chapter 3 evoked the Sphinx myth to describe universal fantasies and fears involving thinking and consequent dangers of knowledge and verbal communication. Passion involves a presence of emotion and receptivity to emotion in the thinker’s mental life. Bion (1963) defined passion ambiguously and not in complete correspondence with its commonplace meaning: ‘the component derived from L, H, and K. I mean the term to represent an emotion experienced with intensity and warmth though without any suggestion of violence’ (pp.12–13). Whereas Bion refers here to passion as a ‘component,’ and elsewhere as an ‘element,’ the term ‘process’ better conveys his meaning. Passion is an ongoing process of developing, integrating and utilizing one’s basic and important affects. Passion describes a representational, transformational, mental process. It is not necessarily a mode of interaction. Rather, passion is an intrasubjective or internal process that takes place within an intersubjective, group context. ‘Passion is evidence that two minds are linked’ (Bion 1963, p.13). Linkage may be in one direction, however, and not complementary. And although stimulated by sense experience, passion is an epiphenomenon, and not purely physical or primarily dependent on the senses. For instance, two minds may be linked intimately when they are separated by time and space, just as one may link one’s mind to that of Shakespeare or Mozart or Freud. An individual may relate passionately to an inanimate or abstract object as well, since disciplines such as science and mathematics evidence the existence of other minds. ‘No individual, however isolated in time and space, should be regarded as outside a group or lacking in active manifestations of group psychology’ (Bion 1961, p.169). As introduced in Chapter 9, basic or primal affects, L, H and K, are to be understood as instinctual or constitutional affect potentials, released by

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experience. They are the underlying categorical invariants that members bring to each and every group encounter, especially to one’s thinking within the encounter. Briefly to summarize that chapter, LHK may first intrude as premonitions, emerging into consciousness with vague awareness and dread. Primal affects may be experienced as ‘not nice,’ irrational, primitive, and amoral, and rather than tolerated, they may be projected into the group setting and denied. L, H and K participate in the basic assumptions. Indeed I have suggested that each basic assumption represents an attempt to cope with a predominant primal affect. To think creatively, and not to become or remain enmeshed in basic assumptions, the individual must suffer and not evade the evolution of these affects. As the group member applies him or herself to the group situation, a fresh coherence and integration of LHK may be reached and sustained. This achievement represents passion. Etymologically, passion draws on its Latin derivation, meaning suffering or submission. To develop personal meaning from experience the affect ensemble, LHK, must be claimed. But constructing meaning requires a bi-directional process in which one endures the breakdown of meaning, tolerating the mourning process, the painful separation from pre-established emotional attitudes towards self and other. Passion arises then in a context of absence and uncertainty, in which one submits to and suffers through the disorganizing, even frightening sensations accompanying paranoid-schizoid and depressive phenomena. Enduring not knowing, the activated but not fully coherent mentalization of feeling, can be an aspect of the process of passion too. In passion, a balance exists between spontaneity and self-awareness. The fullness of experience is not diminished by too much, or too little, emotion or cognition. Hence passion integrates emotional sense into experience. Further, passion involves feelings about feelings, or ‘metafeelings,’ contributing to and revealing one’s philosophical value system (Maizels 1996). Passion reveals and expresses the cultural and moral myths individuals bring to experience. Perhaps because of this important quality of passion as informative of meta-experience, Bion conceptualized passion as belonging to a higher or more sophisticated level of thought than sense or myth and which encompasses both. Passion is placed on the scientific deductive level of thought – the hallowed row G of Bion’s Grid. Meltzer (1978) found the placement of passion on the Grid to be ‘mysterious.’ At the same time, he acknowledged ‘the study of Bion’s concept of passion could lead to a new approach to

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problems of creativity’ (p.70). Passion and creativity both entail integrating elements of primal experience, in the service of generating socially valuable communications. Passion infuses the basic affects with warmth, and its attainment represents a deep level of meaning in intimate relations (Meltzer 1978). But unavoidably, passion disturbs conventional notions of intimacy. While passion offers new possibilities and new beginnings, established links to other group members, as well as to oneself, are altered in often unexpected ways. This emotional process – the breakups and breakdowns of what is known and subjectively felt – may feel catastrophic. And rightfully, for there are consequences that cannot be foreseen or necessarily desired. Passion may bring forth an unpredictable ‘change of heart’ (Maizels 1996), fresh and not necessarily pleasurable attitudes, feelings, and inclinations to self and others. To review this section briefly and to preview the next one, sense, myth, and passion represent distinct dimensions of meaningful thought. Sense concerns both the phenomenology of the thinking and the possibility of its public validation. Myth provides the content and personal and cultural context for thought. We may understand that sense and myth arise from an investment and associative use made by the thinker and refer to specific categorical domains. One can begin to explore and understand any object with sense or myth. Yet to be more fully understood and placed in its here-and-now relational frame, passion is necessary. Passion involves a more general mental activity, superordinate to sense and myth, which encompasses and integrates an affective categorical domain. As we shall see, passion describes a self-conscious relationship a thinker has to his or her own mental life.

From basic assumptions to passion: Expanding emotional self-consciousness In his early work Bion (1961) wrote about the three basic assumptions, and the goal was to learn about and get beyond the confines of basic assumptions to become a work group (W). He introduced the concept of passion in his later writings, and it becomes clear that passion is a key concept. Passion describes the necessary and sufficient condition for a psychotherapy group to function as a work group, since it represents the achievement of self-conscious emotional awareness. As detailed in Chapter 3, on thinking, Freud (1918) had formulated the goal of analytic treatment to extend to the patient’s self-conscious emotional

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knowledge: ‘to bring to the patient knowledge of unconscious, repressed impulses existing in him, and, for that purpose, to uncover the resistances that oppose this extension of his knowledge about himself’ (p.159). Bion (1961) valued the same goal in the functional psychotherapy group: ‘intellectual activity of a high order…together with an awareness (and not an evasion) of the emotions… [If] therapy is found to have a value, I believe it will be in the conscious experiencing of…activity of this kind’ (p.175, emphasis added). To reach passion, group members must tolerate fresh feelings of loving, hating, and wanting to know to combine and fuel fresh emotional realizations. These realizations evolve as they are unconsciously symbolized as well as consciously represented; they are co-constructed, deconstructed, and reconstructed, privately and publicly in the group. Passion represents the ideal of thinking: an optimal level of personal meaning from LHK is achieved and utilized in emotional participation. It would not be possible for a group to function at the level of passion at all times. The group may cycle through the various basic assumptions, but as it understands them via development of the primal affects, it reaches a passionate level of functioning. Overt displays of affects, as in confrontation, ventilation, or abreaction, are not the essence or evidence of passion. Indeed, a group without passion may seem lively or lifeless. Group members may feel powerful affects but communicate them thoughtlessly. The exaggerated intensity or amplification of the group’s affective life subtracts from (‘minuses’) the capacity for self-consciousness, making it more difficult for the members to remain in contact with their minds and thus to experience their experience. Group members, threatened (as well as thrilled) by the concreteness of experienced reality, are often misled and misinformed. Individuals conclude that they – and others – have become too dependent (-L), dangerous (-H) or invasively sexual (-K). To the extent to which basic affects are not identified, developed, and integrated into awareness, they contribute to the group mentality, i.e. the group’s lack of mentality. However, groups of all sorts – and not only psychotherapy groups (see Chapter 9) – achieve passion. Their pacing and modes of expression may vary significantly. Feelings may not immediately or clearly reveal themselves, and interludes of individual and group affective intensity are not necessarily more emotionally significant than times of quiet reflection. Silence as well as spoken language may serve as a medium in which affects are being developed and brought into awareness, privately at first and eventually publicly. A member might say: ‘When we were quiet, I was feeling…’ or ‘I was trying to

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understand this silence, what we are feeling anxious about, reviewing in my mind what was going on last week…’ Passionate groups use language in various ways at different moments. In one of my psychotherapy groups, some of the members frequently make use of exaggerated verbal communication and tone, as in ‘I’d like to strangle you right now; ‘or ‘[one member, humorously to another] We should stop obsessing about our relationship; either wrestle or just have sex.’ The group understands the communications as symbolic not literal representation. The provocative language evokes thought, and contributes to the evolution and expansion of consciousness (and unconsciousness) of emotional meaning. In another group, not any less passionate, similar words would seem violent and frighten the members, inhibiting affects and the desire to think about them. This group has maintained the more conventional vocabulary of LHK: ‘I really didn’t like when you’ (H); or ‘I was wondering…’ (K), and so forth. To further self and group consciousness, the group therapist needs to identify and help the group deal with a prominent basic assumption and a ‘key’ affect (see Chapter 9). Mobilizing passion involves a still larger task: aiding the group in engaging all primal affects, and fostering their integration with each other and with meaningful, ongoing group experience. While one affect is prominent, ‘the others must be present’ (Bion 1965, p.69), and these too must be demonstrated. ‘Meaning, or its lack…must be regarded as functions of L, H and K links of the self with the self ’ (Bion 1965, pp.73–74). The therapist’s moderated emotional curiosity may productively intensify the group’s motivation for self-consciousness. The therapist interventions in the key of K engender ‘the emotional state of awareness of an emotional state’ (Bion 1965, p.34), hence they energize the group’s K of LHK.

Case example 1: Mobilizing passion in group While in individual treatment, Lois developed and with difficulty revealed a transference with explicitly erotic feelings and fantasies. Upon joining one of my groups, she began to have sexual dreams towards the other men. She felt she was neglecting me and being disloyal, and she became worried that I might be hurt and would lose interest in her. We made considerable analytic progress with these transference anxieties, while also working through some of her resistances to letting the group in on the libidinal aspects of her mental life. In time, she could share these dreams, and they stimulated the first group discussions of sexual feeling and fantasy.

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After a few months, Lois confessed in an individual hour that I was again her primary object of affection. Now she was concerned that the other men would be hurt. As in previous individual sessions, we considered the symbolic dimensions of her sexual feelings, and related them to her anxieties and fears regarding their effects on the men in her life, past and present. Again she responded to my encouragement to share her feelings in group. Several men reported having sensed Lois’ shift in affections. They remained unperturbed by her romantic reversal, and pursued the discussion regarding her interest in me. The women, in contrast, became increasingly impatient, and they decided that my lack of intervention signified my tacit approval of Lois’ romantic preoccupations. ‘Why do we take group time to talk about Lois’ crush on you?’ ‘What does this have to do with why I’m in group?’ ‘You like her talking about you because it feeds your ego.’ ‘I’m not the kind of a person who has to fall in love with my analyst to be cured. That’s only in psychology books.’ An opportunity existed to explore primal affects, unarticulated or denied sexual feelings (L), envy, jealousy, and rivalry (H), and to reveal incipient transference meaning (K). I agreed that my ego was fed but, I protested playfully, still not well enough fed. I claimed to have read the same psychology books. Every woman had to fall in love with her analyst to get cured, and I said I assumed they all had fallen for me. Margo, the woman who had first referred to the psychology books, challenged this view: ‘Am I the only woman who doesn’t have a crush on the therapist?’ Margo’s indignant denial of sexual feelings had the untoward effect of eroding her gender-based support. She protested too much, the other women asserted. ‘He’s fun to play with in my mind, the other guys too.’ ‘I have sex with Rich all the time, should I feel embarrassed?’ I thought that the other women’s verbalizations of sexual feelings and fantasies represented, partially, efforts to repair Margo’s difficulties in maintaining the symbolic playfulness that is characteristic of commensal communications (see Chapter 5). Their confessions were K-based, attempts to present ideas that would motivate Margo’s curiosity, to encourage her to think metaphorically rather than concretely. The women had attended to Margo’s thinking problems, and I felt confident that she would participate in the exploration of transference and group process. Focusing on the men, I inquired whether they found my method of cure satisfactory. They responded with emotional ideas involving voyeuristic, and homo- and heterosexual wishes and fantasies. ‘Go ahead, I

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like to watch.’ ‘I’ll take sloppy seconds.’ ‘You take yours now, I’m learning from you. I’ll get mine later.’ ‘What about me Rich? I’m in love with you too.’ ‘Can we do threesomes?’ ‘When did our group become x-rated? I must have missed a week, but won’t miss again!’ The group’s verbal play served to release and articulate feelings and thoughts related to different developmental levels of psychic experience, e.g. involving primal scene sexuality, curiosity, and gender identification and differentiation. The group’s seemingly loose exchanges, including my own, while spontaneous and expressing basic feeling and fantasy, were also purposive. The exchanges represented ‘quasiassociations to a common context…based on the common ground of unconscious instinctive understanding of each other’ (Foulkes and Anthony 1965, p.29). In the playful exploration of Oedipal and pre-Oedipal LHK-based structures of experience – by means of self-disclosure, metaphor, enactment, irony, and confrontation – a group culture of passion had emerged.

The therapist’s passion Like many contemporary psychoanalytic thinkers, Bion saw the human being as developing and existing in a relational context. Thus his comment: ‘An emotional experience cannot be conceived of in isolation from a relationship’ (1962, p.42). As emotions link us to others, it follows that the process of integrating the group therapist’s emotions – passion – connects him or her to the group and its members. In calling forth primal affects in the therapist, passion vitalizes, providing an essential primitive element in the evolution of the group therapist’s sophisticated mental processes that are involved in the formation of an interpretation. Passion establishes and invigorates the links within and between the analyst’s internal and external object-relational worlds, thereby nourishing the capacity to communicate to patients with warmth and without excessive (‘violent’) emotional intensification. The analyst maintains the depressive position, in that ambivalent feelings are acknowledged and conjoined in the process of thinking. Alternations between depressive and paranoid-schizoid experiencing are tolerated as well. For the moment the mind is integrating; its emotional parts are linking with each, and also are linking to the object (e.g. the group member’s mind). The analyst achieves heightened awareness of the self, the other, and their affective links.

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Bion (1963) cautioned that ‘passion must be clearly distinguished from counter-transference, the latter being evidence of repression’ (p.13). But he did not fully establish the basis for this discrimination.

Distinguishing countertransference from passion Bion, like others influenced by Klein (Heimann 1950; Little 1951; Racker 1968; Winnicott 1949), modified the classical view of countertransference as an emotional problem of the clinician, necessarily representing the clinician’s conflicts and resistances, and an impediment to treatment. Countertransference was also the vehicle by which the clinician could come to understand and interpret the patient’s emotions, conflicts, and resistances, expressed in fantasies, affects, and behaviors encompassing projective identification. ‘The analyst feels he is being manipulated so as to be playing a part, no matter how difficult to recognize, in somebody else’s phantasy…the ability to shake oneself out of the numbing feeling of reality that is concomitant of this state is the prime requisite of the analyst’ (1961, p.149). Countertransference represents an opportunity, an emotional problem to be solved, provided the analyst can achieve the psychological separation to think his or her own thoughts. Bion (1975) later returned to the traditional use of the term, defining an unconscious transference relationship of analyst to patient, to distinguish a phase and a type of emotional response that may precede what is optimal, that is, from passion. As he developed a theory of symbolic transformation, Bion described particular self-reflective processes the clinician may utilize to ‘shake out’ his or her numb reality to regain a receptive, reflective subjectivity prerequisite to passion. Particularly important are his concepts of R, containing, reverie, negative capability and catastrophic change. R: POWERS OF DEDUCTION

R, the operation of reasoning, represents ‘a function that is intended to serve the passions…by leading to their dominance in the world of reality’ (Bion 1963, p.4). Earlier, I have defined passion as a balance among mental components. R is one component, leading to the toleration of stimulation. R serves alpha functioning, for instance by deducing that which is conspicuous by its absence (including beta elements). The group therapist considers questions such as: what denied feelings might be contributing to my (and/or the others’) anxiety, symptom, hallucination, etc? What am I and other group members feeling, fearing feeling, dreading not feeling?

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For example, a therapist feeling intense attunement with a group may reason that he or she has become enmeshed within a dependency culture (baD), and that there are disruptive feelings that are not being felt. The therapist may search and find the repressed or dissociated emotional moments of fear, fragmentation, and aloneness, as well as security, joy, and communion, that should be a part of every group session. CONTAINING

Chapter 5, on the container–contained, explicated how symbols and thoughts, since they establish emotional meaning and thus contain anxiety, serve a function once provided by the mother. When a member or the entire group cannot develop emotional meaning, the therapist must provide the containing function. The receptive therapist strives to discover, often by self-examination, the existence of unarticulated emotional experiences that are subtly communicated (‘projected’). Even if the patient or group functions in a refusal mode and withdraws, the group therapist may come to understand and bring meaning to this situation by making inferences (R) and utilizing ‘reverie.’ REVERIE

Reverie demands ‘irrational emotional involvement,’ to use Renik’s (1996) felicitous phrase. Freud (1913) wrote of a similar ego process: ‘Everyone possesses in his unconscious mental activity an apparatus which enables him to interpret other people’s reactions, that is, to undo the distortions which other people have imposed on the expression of their feelings’ (p.159). In reverie, the receiving individual utilizes dream-like and irrational aspects of his or her mind in order to understand and further develop the unformulated thoughts and feelings of another, and of their own. Reverie is a necessary condition for intuition, empathy, and passion. NEGATIVE CAPABILITY

The poet Keats’ term ‘negative capability’ describes an essential activity required to reach passion. The therapist must ignore coherence so that he is confronted by the incoherence and experiences incomprehension of what is presented to him. His own analysis should have made it possible for him to tolerate this emotional experience although it involves feelings of doubt and perhaps even persecution. This state must

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endure, possibly for a short period, but probably longer, until a new coherence emerges. (Bion 1965, p.102)

Negative capability, the negation of ‘memory or desire,’ provides an essential mental space in which unarticulated expressions of primal affects, LHK, may emerge and cohere during the free association process. The inevitable patterns of transference–countertransference bring the known: familiar pain, familiar pleasure. To go beyond these patterns to reach passion, the therapist must develop the capacity to transform the group and its members into ‘no things,’ unknown mental objects, to be emotionally discovered and rediscovered within each session (see Chapters 3 and 4, on the theory of thinking). This involves the capacity to break up and break down what we feel and what we know about what we feel, to be open to fresh, personally meaningful representations of group experience via LHK. CATASTROPHIC CHANGE

Bion’s advocacy of negative capability extended Freud’s directive of evenly suspended attention and free association. Freud (1912b) did not describe the emotional effects on the therapist, however, which may include momentary or longer lasting feelings of catastrophe. In voiding or ‘unsaturating’ the mind of the ‘known,’ the therapist initiates a critically sensitive process of emotional growth. The process necessarily includes feelings of catastrophe, for old meaning must crumble before new meaning is built. Insight is not achieved solely by the incremental buildup of manageable experience. Each session lays open premonitions of catastrophe, as the group therapist copes with turbulent feelings of love, hate, and curiosity, of emotional confusion, self-doubt, persecution, and depression. We must become ‘reconciled to the feeling that we are on the verge of a breakdown, or some kind of mental disaster’ (Bion 1975, p.206). These momentary, highly intense, mini-breakdowns are co-created and redoubled in force by mutual anxiety and dread aroused by the group situation (see Chapter 2). The therapist must take pains to deduce and integrate what is behind these breakdowns: basic affects and reactions to them.

Passion requires primal receptivity In countertransference, inner objects have been stimulated, and the mental struggle is to understand the inner object and its relationship to the object in the real world. Understanding the emotional derivatives set off by

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countertransference may be considered a way station on the road to passion. However, to the extent to which the ‘new editions’ (Freud 1912a) of past emotional responses are not worked through (and it is always a considerable extent) the here-and-now discovery is impeded. At the way station of countertransference, the therapist may become stalled, emotionally directed towards separating self from other, the present from the past, and external reality from internal fantasy. Fresh releases of L, H and K are not engaging a receiving mind. Rather, the primal affects become entangled in the emotional derivatives, and defenses against derivatives, of past object relationships. Inhibitory responses render the situation static, or primal affects may be discharged in enactments. The understanding and working through of countertransference involve being receptive to the derivatives of repression. Passion involves being receptive to the derivatives of primal affects, LHK. Therefore, a suitable term to describe the metapsychology of passion is primal receptivity. The therapist’s struggle with inner objects is worked through sufficiently, such that a thinking mind is available to greet and formulate relational experience freshly, through the affect-based, prelinguistic knowledge categories of L, H and K. The group therapist is able to separate from internal and external objects to think about the group and its members as contemporaneous, versatile, affect-provoking, mental objects. To a significant degree, he or she has achieved the mental clarity and ‘moral freedom’ (Racker 1968) to feel, if not say, anything. Passion involves, then, an intense awareness of thinking, most particularly, of thinking about L, H and K. Chapter 9 elucidated how psychoanalytic treatment is not about cure, but about transforming pain into the richer capacity to ‘suffer’ meaning. This entails aiding the group’s tolerating the emergence of the full range of primal affects, LHK, and the concomitant persecution, depression, anxiety, and dread. However, often our group members come to treatment to be relieved of pain, and they initially may display little toleration for increasing the range of felt feelings, or for understanding and integrating them. It is often left to the therapist to suffer mental pain, and to think about the basic affects that may lie behind it. In fact, we learn about our patients through their pain. Such pain is indirectly communicated, particularly by projective identification, encouraged by the analyst’s tendencies toward introjective identification. The therapist feels the primal affects of those aspects of group life to which attention is drawn. In effect, the group therapist ‘becomes’ one of the persons of the interpretation (Bion 1965, p.164). At the same time, the

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therapist feels the horror and resistance to that very becoming, and is liable to reject the part of him or herself motivated to think about, much less make, the interpretation. Grotstein (1995) suggested ‘the analyst’s actual trial suffering of the patient’s pains as his or her own is the transference, from the patient to the analyst’ (p.483, Grotstein’s emphasis). I am suggesting that the group therapist’s suffering also involves primal receptivity, tolerating the painful emergence of one’s own basic affects and attendant fantasies and thoughts. These arise as a consequence of thinking and represent a different order of emotional experience than our struggle with transference–countertransference. The concept of passion advances the historical consideration of countertransference by delimiting an independent area within the therapist’s subjectivity. When first recognized by Freud, countertransference was seen as a distortion to be avoided. The only way to avoid this therapeutic error was to be perfectly analyzed. Later contributors recognized that perfectly analyzed was impossible, and so countertransference could not be avoided. Theorists then began considering countertransference in a broad sense, encompassing all the therapist’s emotional reactions to patients and useful as a source of information about them. In contemporary relational theory, transference– countertransference is understood as a dynamic, intersubjective process inherent in all therapeutic relationships. To briefly restate the difference between concepts, in all countertransference the therapist is wrestling with his or her own stimulated inner objects. In functioning with passion, the therapist utilizes a mental zone – a category of thinking and thinking about thinking – preexistent and separate from these inner objects. This is not to suggest that the therapist can ever function without countertransference. Passion does not exist in a pure state, but in an alternating relationship with countertransference. By being open and utilizing the primary affect categories of emotional thinking, the therapist may connect and separate from his or her inner objects, connect and separate from the group and its members. Passion represents a dialectical process of connectedness and separateness, and hence the passionate therapist partakes in but also transcends the basic assumptions, and transference–countertransference. Our emotional readiness, what I have called primal receptivity, allows integrating moments of passionate conviction. We strive to participate passionately and aid our group members in doing so. However, we cannot with

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certainty fully resolve the nature of our emotional participation or evaluate its effect on self and others. And tomorrow we may be uncertain whether today’s passion was not yesterday’s enactment. Passion may appear clear in theory, but it is an optimal mode of functioning to which the group therapist can but aspire.

The therapist’s passion furthers the group’s passion The therapist’s passion may serve as a central organizer of meaning and impetus for passion in group process. To summarize the above, the group therapist feels tensions that relate not only to complementary and concordant transferences and countertransferences (Racker 1968), but also to one’s own primal affects, L, H and K, activated by social participation. These affects provide links to the therapist’s mind and also to other minds that are thinking (and not thinking). In each and every session, the therapist needs selfconsciously to experience love, hate, and curiosity regarding his or her own evolving emotional experiences with the group and its members. In leading groups, I attempt to monitor my primal affects. How loving and empathic do I feel? How frustrated, impatient, angry, or hateful do I feel? How interested am I in myself and in the group? Where is my L, my H, my K and how am I utilizing these affects to link up with the patients and with the group as a whole? Thinking about my affects brings self-awareness to the therapeutic reality of the group, as I experience and re-experience it. These thoughts develop into inferences about the emotional thoughts of others and organize my clinical activity. In the following clinical example, I record the evolution of my passion and its effects on the group: how my primal affects contributed to my beliefs about and subsequent behavior pertaining to what the group members (myself included) were feeling, fearing feeling, dreading not feeling, not communicating, and communicating by miscommunicating.

Case example 2: My passion – the group’s passion As a meeting began, I took note that Lori, a long-standing member, and Peggy, a younger woman several months new to group, were avoiding each other. Their nonverbal communication seemed not to be noticed by anyone else, and I wondered whether I was reading more into the situation than was there. Several individuals took turns talking about personal issues and again I felt out of sync with the members. They were open and sincere, and their

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concerns serious and worthy of care. Everyone but me seemed interested in what was emerging in the session. I felt increasingly impatient with a group that I respected and enjoyed, and sufficiently alarmed by my own intolerance to explore the possibility that I might be unduly preoccupied with personal or countertransference issues out of my awareness. I also monitored the group and attempted to link my unformulated anxiety with a reality outside of myself. I judged the members to be offering opinions about feelings, but not offering feelings. Therefore, they were not emotionally linking to each other, although carrying out perfectly reasonable exchanges. The only evidence of unreasonable emotion was my own discomfort with the current group situation and with myself for a not nice reaction. Before too long, individual members began to drift away from an increasingly desultory conversation. It became obvious that the group had become intellectualized and without vitality, typical of a basic assumption culture. The growth-producing developmental struggle between the primitive and sophisticated dimensions of individual and group functioning was not apparent. Basic affects of caring, anger, and interest seemed noticeably absent. Therefore, it was unlikely that the group’s awareness was being advanced. Why were the members starving themselves of emotional experience? I felt uncomfortable. Perhaps I was carrying the group’s deprivation, made worse by its disavowal. My best hypothesis was that the majority group had disregarded the hostile interaction of the Lori and Peggy subgroup, which also retreated. In an attempt to stamp out not nice hating, all feelings were being suppressed. To spare us unproductive pain, therapeutic action required attending to what I assumed to be the undeveloped angry feelings in the room, calling attention to the neglected Lori–Peggy relationship, and the majority’s behavior towards it. A fight/flight culture had developed; the prominent affect of H needed to be contained, that is identified, made tolerable, explored, and learned about in the here and now. I said that unexpressed friction seemed to be in the room, and I wondered why we couldn’t talk about it. I turned first to the two women and then to the group at large, with a quizzical expression that suggested, ‘What gives?’ The intervention sufficiently mobilized Lori and Peggy to talk to each other. Each claimed that she had said hello, and had been ignored. Each claimed that the other had been unfriendly since Peggy’s introduction to group. Lori said she had felt open to Peggy, but was rebuffed. Peggy acknowledged that she had come to resent Lori, whom she characterized as relating everything to herself,

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as did Peggy’s egocentric older sister. Lori informed her, that is what people are supposed to do in group. She had been a caretaker of her younger sibs, and was a caretaker in her marriage. She did not want that role in group, she declared. Peggy replied that she could understand how Lori might feel that way, but not everything she said or did related to Lori. Besides, she could handle herself and certainly did not trust Lori for caretaking. Peggy advised Lori not to take her last remark personally, since trust was an issue for her. She asked for and received a truce. Angry feelings had been represented in words (H), a mutual emotional experience thought about (consciously and unconsciously) (K), and caring feelings reemerged (L). Passion was in process, but only on the level of the two-member subgroup. The group culture had shifted to pairing. The majority group had created a couple by remaining impassively curious but not otherwise participating (-K). I commented that the group seemed interested but otherwise unaffected by the exchange between the two women but that I doubted this to be true. Liza commented that she was watching herself with her sister, but was she Lori or Peggy? She would love to remain close to her sister without feeling so angry and guilty. Not that she felt angry toward the two women, she qualified. Joan questioned whether the group had been sufficiently welcoming; if she had done more Lori wouldn’t feel so responsible for Peggy. Frank said that Joan ought to give up her role as ‘Welcome Wagon’ hostess, the two women were taking care of themselves. Joan looked unsurely to them, neither of whom seemed interested in responding. She associated to how she felt caught in the middle when her mother fought with others. Other members readily developed the theme of feuding relationships with mates, sibs, parents, and in-laws. I remained dubious, annoyed, and dissatisfied with the group and with myself, for I took the pleasant conversation of unpleasant memories as an escape from the tense group process. The group had shifted to dependency. I had served as an emotional generator and now resented the group, as if they had caused my taking a directive stance regarding discussing angry feelings. I felt guilty for mentally blaming the members for complying, something that clearly was my responsibility. I recognized also how quickly I blamed myself – and blamed myself for blaming myself – and made a note to monitor any blaming tone in my relationship to the group. I was once more entangled with a derivative of hating, and again assumed that I was holding this basic affect that the group could not sufficiently develop.

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Frank’s next comment released a floodgate of hostility, which supported my hypothesis regarding the group’s inhibition of H. He complained that the group was getting dull and that Lori and Peggy needed to fight again, to get things moving. Liza sharply advised Frank to stop hiding under their skirts and do his own fighting. Frank said he was not going to be baited. An apprehensive silence emerged and after some time Marjorie, who had been voiceless, turned to me and said: ‘It’s clear that we need your help. Help!’ I said that it was not clear to me the group needed my help and if it was clear to others, perhaps they could explain why this was so. I was being difficult and purposefully unhelpful, Marjorie complained. Frank defended me, saying that I was like him in refusing to be baited. Lori agreed with Marjorie; she realized that she had not initially engaged Peggy because she felt unprotected. I was like her passive father and Peggy, not only like her demanding sister, but also like her hostile mother. Peggy, deflecting Lori’s commentary, reported how close she felt to me because I was not like her father. Frank felt that Peggy was rubbing our well established therapeutic relationship in Lori’s nose. Liza felt that Frank was again stirring up the women, that he was more hostile than either of the women, and that he reminded her of her father. The group was developing a series of emotional hypotheses involving all the affects, with H key. I was no longer the solitary container of a tense (but projected) emotional situation. I could more easily relax and float my attention (Freud 1912b), so as to be available and responsive to fresh releases of my own primal affects. But just when the group seemed to be most passionate, no fresh feelings of my own seemed to be developing. I seemed to be tuned in, feeling receptive to the heated communications, thinking about the unfolding individual psychologies and the patternings of group formation and reformation, and monitoring derivatives of countertransference, as I could understand them. What was most curious was my absence of affective engagement in the very group process I had worked diligently to reveal. I again felt not nice, disloyal to the members, and doubtful about my personality functioning. It took a moment to decide to think about my emotional isolation. Perhaps this was what Bion was describing in connecting containing to negative capability and catastrophe. I sensed within myself a vague pining for contact, which seemed to contradict the very reality of the group process. After all, the members were not neglecting me, but talking to and about me. I continued to think about the contradiction, valuing rather

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than pushing away the thoughts, fantasies, and feelings of longing (L). A simple idea cohered, one that felt concrete, but which suddenly and powerfully reorganized my understanding of the group process: I was not a vital presence in the minds of the members, although a pivot of conversation. Both the group and I were missing ‘me.’ The members dispersed their anxiety through emotional discharge as evidenced in the verbal sparring (-H). I said: ‘While people seem to be enjoying fighting with each other, I think you’re depressed and struggling for me.’ The room became very quiet and I was concerned that members mistook my interpretation, offered in the major key of L (minor key of K), as a condemnation (H). I investigated this hypothesis by asking whether exposing the desire for love and attention made people anxious, as if the need was not nice. The question did not beg for an answer, and none was offered, but it served its purpose of freeing members to think their feelings. Frank responded first: ‘I guess my motto tonight has been “make war, not love.” I want your attention too and I didn’t like Lori and Peggy vying for you.’ Lori blushed, then turned to Frank: ‘That’s fair. I do feel threatened with Peggy’s arrival. She’s young and smart. And pretty. I don’t know much else about her, or what kind of other therapy she has with Richard.’ Peggy broke in, and with a slightly victorious smirk, turned to Lori and said: ‘You’re still not looking at me.’ A man who had been quiet praised Peggy’s liveliness. Ralph informed him that Peggy was being competitive and hurtful. Peggy: ‘That’s fair too. Sorry, Lori. I’m a fighter, now you know. Maybe I’m not sure you [the therapist] are so different from my father. My parents were divorced, and he never had much time for me. I’m sorry for breaking in on you, Lori, or maybe I’m not.’ Lori looked at me plaintively. She too was a fighter, and could very easily hold off Peggy’s renewed challenge for my interest and sustain a verbal dialogue. But she chose a form of nonverbal communication that proved to be the right choice to achieve her goal of bringing attention to herself. Ralph [to Lori]: ‘Don’t get hopeless and withdrawn, we’re here for you, [to Peggy] and for you too.’ Frank: ‘Lori, you’re really angry and hurt. You want Richard to pursue you, and he has, but not all the time.’ Lori disagreed, and turned to me with a pout: ‘I’m being hurt by Peggy and you don’t protect me. She can say and do whatever she wants. I have to let you know when I’m in trouble, and you should know without my having to tell you.’ She did not elaborate on what she experienced as her needs and my

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emotional shortcomings. This aspect of our relationship and its transferential roots were quite familiar to the group, and raised no fresh feelings of compassion, anger, or curiosity. She was demanding an expression of caring interest; I accommodated by meeting her gaze with warmth and respect (see Chapter 7, on bonding). A verbal response was unnecessary. But other members did speak up, and they continued to develop and personalize the question of my emotional relatedness which was, after all, the unarticulated concern expressed in the tension between Lori and Peggy. L: How deeply did I care? Did I put down patients with colleagues, with my wife? H: Was it worse [i.e. more hateful] to be disparaged or ignored? K: Perhaps it was good to be talked about, for that required thinking about the group, and it was apparent that I did think about my work and remembered what was important about the members. The need to have a leader for help with human emotions – a leader with available emotions of his own – was being experienced self-consciously, thought and felt about with passion. DISCUSSION OF CASE 2

This example of group process illustrates how the therapist’s thinking about LHK may evolve during a session. Lori and Peggy expressed a complex of unverbalized affects, which the group initially ignored. To mobilize group process, I had to go through an uncertain progression that required tolerating evolution of my feeling and non-feeling. Passion requires this confusing and often painful sequence, for meaning develops over time. As Freud (1912b) counseled the analyst: ‘It must not be forgotten that the things one hears are for the most part things whose meaning is only recognized later on’ (p.112). To be passionate as therapists we need to feel, tolerate, and communicate the experience of uncertainty, of not knowing, but at the same time, of trusting our evolving feelings. On the one hand, we must know in our guts the particular conflicts and basic assumptions the members and we ourselves are struggling with. But on the other, we must separate sufficiently to remain open to fresh releases of our primal affects and attendant thoughts and fantasies. My interventions were double-edged, reflecting my commitment to what I believed was a predominant affect. Contrariwise, the interventions also reflected in varying degrees my uncertainty of where the group was and where it needed to go. I first came to feel and believe that the group was struggling with angry feelings and defenses against them. I assessed the unspoken dialogue of the two women and of the group to be in a key of H. My initial intervention, an

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unverbalized ‘What gives?’ was the first step in a series of knowledge prodding interventions, including silence. In reviewing the group’s experience and mine, while continuing to be involved in the ongoing process, I came to a different conclusion. My experience of longing for L seemed more accurately and deeply to reflect what the subgroup and group were leaving undeveloped. Still I was not sure the group was in fight/flight, when it seemed in W-group harmony, and later, that the fight/flight interactions served to disguise vital dependency dynamics. I could not count on other group members or on any objective source for validation. ‘We can never know what happens in the analytic session… We can only speak of what the analyst or patient feels happens, his emotional experience’ (Bion 1965, p.35, his emphasis). I had to do the best I could to speak from LHK, the categories of my emotional experience, while accepting that it was impossible to be fully aware or sure of what I was feeling or why. Some of my feelings had to do primarily with the individual members and their projected object relations, benign as well as pathological. These were relatively easy to understand and to interpret. Some were personal to me and my object relations, including those participating in my ‘infantile neurosis’ aroused by the patients’ multiple transferences and by the intersubjective group situation itself. These were my responsibility to know about, analyze, and not act out. Finally, some feelings evolved from the suffering of my own passion: from thinking and not thinking about the ongoing emotional situation. Ideally, these are the feelings that the group therapist attempts to integrate and make available, in silences as well as in verbal interventions. Such passionate suffering reflected emotional enactments of specific constellations of transference–countertransference, and my attempts to understand them in the moment and retrospectively. At moments I was Lori, I was Peggy, and I was with the members who sided with each of them and against the other. I was with those who sided with me and those who sided against me. I monitored my wishes to join or submit to what I experienced as sadism, and to retaliate against its perpetrators. While I dreaded becoming embroiled in these feelings, I feared removing myself and losing emotional access to group process. Other members were the persons of my interventions and so was I. But I was also not the person of the interventions. I was the person assessing whether the interventions were fair, appropriate, neither too blunt nor intellectualized, and assessing their effects on the members and their associations, and on my associations and me. While the group was in my thoughts and contributed to my countertransference and my potential for enactment, I also had

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other thoughts, and moments wherein I tried to free myself of any particular thoughts or feelings. I tried mentally to let go. I strove not to feel and not to heal. I attempted to wean myself from any ‘irritable reaching after’ the group and its members. I had to bear being with the group and its members and bear being without them. I understood that my desire to connect to others reflected in part my difficulties in tolerating, in my separateness, the intensity and confusion of my own feelings. My realization of the uncertainty of emotional knowledge, and of the essential separation between human beings who are working to achieve such knowledge, also contributed its share of mental pain. In removing myself from the proverbial frying pan of ‘memory and desire,’ I had to tolerate the fire of isolation. I became less caught up with what other group members were saying or reporting feeling, trusting my premonitions as they surfaced and evolved as representing aspects of the group interaction that had the greatest personal meaning to me. Had I become out-of-touch and arrogant too, or was I expressing an evolving, independent point of view? In my mind, I was fostering ‘catastrophic change’ and there could be no going back. There was, paradoxically, relief in my passion, relief in tolerating the evolution of emotional meaning. For my feeling of ‘becoming’ one, and several, of the group members was only part of the story. My pain and confusion, my very isolation, contributed to the feeling that I was not the person of the interpretation. I was a person feeling feelings and making sense of them as best I could. In being myself, I felt professionally disciplined. We cannot be sure of all the factors that drove the group’s process, or of the accuracy of my evaluations of the interactional dynamics I have described, or even of the reality of my passion. The therapist cannot neatly separate self from other, transference from countertransference, and countertransference from passion. Emotional reality is not a concrete, unchanging something from which truth can be derived with certainty or finality, but an ever-incomplete process of becoming. The therapist who tolerates passion disturbs the fixed patterning of transference–countertransference, establishing and leaving behind fresh and often painful configurations of object relations and emotional ideas, many times in each group session. The multilayered process of working and reworking the experience of one’s primal affects, absenting oneself from, while also being in, the clinical moment, is often painful, and bearing pain contributes to the exhausting discovery process of thoughtful group work. Tolerating and

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trusting the gut knowledge which arises partially from the primitive or irrational part of oneself is never easy. Meaninglessness and confusion are part of the relational process, along with the foreboding that the emotional emergent (L, H and K) will be dreaded and resisted by patient and therapist alike. The temptation not to struggle may be intense, but also may be appreciated as part of the conflictual experience. Enduring this discovery process, by turns an evolution and de-evolution, and not evading or modifying it, is the goal and the ideal. But at the same time, our urge to know about emotional experience may be enjoyed and not only suffered, as we live through the meaning-making process with other group members. Bion (1970) wrote in the final pages of his last major work ‘the idea that is nourished by love develops from matrix to function in Language of Achievement, from which it can be transformed into achievement’ (p.127). I take Bion to mean that the therapist’s need for, and love (L) of, psychoanalytic thinking (K) increases the tolerance for the hated frustration and suffering (H) that is necessarily part of the process. The group therapist’s functioning ‘analytic libido’ – alert for and embracing manifestations of LHK – moves the group beyond basic assumptions, beyond transference–countertransference and inspires all group members to take chances, creating passion from their emotions.

Conclusion: The passionate group therapist leads a passionate group Bion was fond of saying how all analysts are ‘bad’ analysts with a ‘good’ analyst trying to get out (he included himself ). Therapists do a ‘bad job’ (Bion 1979) not primarily because we lack requisite skill, but because we suffer human limitations. Most particularly we fear the unknown, in ourselves as much as in our patients, and are averse to embracing unconscious as well as conscious emotional knowledge. Dreading the emergence of our primal affects, we resist and foreclose the evolution and the consequence of discovery. In making this unconscious decision, we do not reach passion, and we are more likely to respond with the intensified emotions and reactive enactments typical of countertransference. Indeed we all resonate with McLaughlin’s (1991) declaration: ‘enactments are my expectable lot’ (p.613). Relational theory has increased our appreciation of how we may make good out of bad, the unexpectable out of the expectable, by understanding and utilizing transference–countertransference and the resulting enactments as the inevitable background for the

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emergence of new forms of engagement and experience (Billow 2000c, 2001a; Davies 1999; Hoffman 1992; Mitchell 1993). However, understanding enactments and working through countertransference, although inherent and useful aspects of the therapeutic process (Renik 1993), need not be celebrated as the final road to the discovery of the unconscious or the dissociated. Passion would seem to be the next process in discovery, in knowing and guiding learning, informing the group therapist’s self-consciousness. Ideally, passion may shift the balance from ‘bad analysis’ to ‘good analysis,’ in our individual and group work. Realistically, therapists, being human, are not capable of living up consistently to that which is ideal. We remain susceptible to the universal, existential conflict between the need to work over emotional experience and the desire to avoid pain. And herein lies a source of ambivalence towards our patients, no matter how else we feel about them and whatever the status of the transference–countertransference. In broadcasting their emotional experience, our patients connect us to other minds and therefore arouse the therapist’s primal affects and motivate passion. We hate our group members when they are being ‘bad patients,’ depriving us of emotional experience and aiding and abetting the element in our personality that resists passion. We hate – as well as love – our group members for being ‘good patients,’ stimulating our ‘not nice’ feelings, inspiring passion, potentiating our growth and development. In my assessment, my clinical work reported in Relational Group Psychotherapy fluctuated between countertransference and passion, between resisting and integrating primal affects in my emotional participation. Learning from both countertransference and passion, and learning to differentiate one from the other, these became growth experiences. The group therapist must continually work through his or her painful emotional experience to achieve passion. The discovery process is communicated to the group and appears in our interventions. Therapeutic passion does not require a particular style of group leadership, activity level or technique. I submit that the group therapist’s decision to feel, develop, and integrate LHK into passion is an essential aspect of what he or she offers during every genuinely alive clinical moment and hence the group therapist’s passion is central whether or not the therapist shares explicitly subjective feelings and thoughts. Group members intuitively perceive their therapist’s passion. They assess and appreciate their therapist’s toleration for loving and being loved, for hating and being hated, for knowing and coming to be known. They are invited by our passion to take chances, to develop and reveal their own.

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emotion, defining 194 feeling, defining 193–194 group culture, and affects Active Analytic Group Therapy of leader 212–213 for Adolescents (Evans) 11 H, integration of 211–214 adolescent groups instinct theory, Bion’s bonding, as symbiotic relational revision of relating 141–142 193–194 communicating, in intersubjective sensibility, as commensal group passion 193 139–144 K, and minus K disturbance, containing communication parental involvement 208–209, 212–213 137 key emotional dimensions, therapist, participation reassessing 211–213 of 137 leader’s utilization of tragedy, turning to 206–207 comedy 136–137 LHK relational structure, waiting room family addition of 194, 195 therapy 137–138 as life instinct of individual Hamlet archetype, and and group 196 thinking 30, 133–136 meaning, suffering of leader, containing qualities 200–203 of 143–144 as ‘not nice’ 199–200, see also play, adolescent; 211–212 relational levels, plus and minus, and aims of traversing Eros and Thanatos affects, primal (LHK) 194–195 all groups challenged by proto–mental contents 207, 219 alpha functioning central role of 193 197, 198–199 cognitive or curiosity inherent motive, assumption of preconceptions, 194–195 theories of 198 defining 193 premonitory anxiety dis–ease in groups, and 197–198, minus LHK 201–203 alpha-functioning, status of and relationships primal affects not between 195–196 transformed by tolerating anxiety provoked 204–205 by 199–200, 211–212 group mentality, see also basic assumptions; uncontainable thinking feelings deposited aggression, therapy as act of into 204 48–49 minus emotions, and alpha–functioning beta elements ‘alpha–function in reverse’ 205–206 26 eliciting 209–211 dream-work-alpha 19

Subject Index

249

method acting 27n2 primal affects not transformed by 204–205 and proto–mental contents 197, 198–199 and theory of transformations 17, 20–22, 25, 111–112 American Psychological Association 48 analytic third subject, role of 18, 118 anti–thinking anarchy 181–182 minus K 75–76, 84–88, 119 see also thinking anxiety, of therapist conflicting guidelines individual and group therapy, combination of 46 members, selection of 45–46 objective analyst, myth of 46–47 countertransference and new members 58–60 working with 64–66 emotional amplification, and contagion 54–55 exposure, fear of 50–53 group persona, reconciling with analytic self of individual work 59 group therapy, dread and fear of doing characterological issues 49 preexisting relationships, destabilization of 48–49 resistance, to group 49, 50

250

RELATIONAL GROUP PSYCHOTHERAPY

group treatment, idealization of 55–56 personal growth, accepting the invitation for 66–68 training institutions, attitudes of 47–48 see also basic assumptions; entitlement anxiety ‘badness’, of therapist 119–120, 122–123, 125 basic assumptions and bonding 157 and countertransference containment of 64–65 resistance to 56–57 dependency 39, 56–57, 197, 208, 230 fight/flight 56–57, 88, 146, 150, 157, 182, 197, 208, 211–212, 229, 234 group leader’s participation in 39–40 mentality, adoption of 57–58 and minus LHK 204–205 pairing 39, 56–57, 197, 208, 230 parasitic relations 124 and passion 218–222 and primal affects 196–197, 206–207 proto–mental state 196–197 resistance to/adoption of 56, 57 theory of 31 versus work groups 39 beta elements 19, 20 hallucination, and introjection of 213 transformation of (see alpha–functioning) see also affects, primal bizarre objects, and thinking as dangerous 80–82 bonding

aggression, overcoming 153 as basic relational need to love 153 and container–contained 23–24, 158 description of 152–153 as developmental accomplishment 153 and empathy 164–165 and group cohesion 158–161, 159–161 and identification 153–157 progressive and regressive forces in 157–158 reflective thought, pre–verbal foundations of 30, 157–158 and sense of safety 155 as symbiotic relating 141–142, 160–161, 167–168 and therapeutic alliance, absence of 161–164 as therapeutic technique accommodations, versus interpretation 165 empathy 164–165 securing and maintaining bonding 165–168 in transference–countertrasference 168–170 verbal articulation of, and resistance to 170–171 boundaries ceasura and maintenance of 18–19, 22 intact, need for 18 and projective transidentification 19, 22 relational levels, traversing 148–149 Systems Ucs. and Systems Cs., contact barrier between 18–19

Building on Bion: Branches (Pines) 11 Building on Bion: Roots (Pines) 11 case material, and fact/fiction issues 43–44 commensal relations see relational levels; therapist, containing function of container–contained adolescence, relational crisis of 132–133 bonding 23–24 emotional development, thinking and socialization, relationship between 110–111 growth, psychoanalytic problem of communication, on many relational levels at once 128–129 interpretation, positioning in ‘genetic spectrum’ 127–128 metacommunicative information, importance of 128 and human development 111–112 intersubjective thinking emotional flexibility 113 mulitdimensionality 112–113 social network, function of 113–114 language 118 as reciprocal interaction 110 see also alpha–functioning; countertransference; relational

SUBJECT INDEX

theory; therapist, reciprocal learning process containing 106 function of Richard III (Shakespeare), countertransference as embodiment of 92, bonding 168–170 95 and container–contained and rights over thinking 90 model 17–18 and self–evaluation containment of 64–65 106–107 as ‘dual’ to group therapist’s vulneralbility to transference 209–212 98–100, 103, 163 and entitlement 95–96 transference and as God 37 countertransference, hallucinosis, distinguishing between transformations in 103–106 83–84 universality of 94 and intersubjectivity 35–36 value conflicts over 92–93 and passion 223–228, entitlement anxiety (therapist) 234–237 clinical examples of 59–62 resistance to 56–57 leadership and power and transference, 62–64 distinguishing between epistemological metatheory 103–106 (Bion) 21 working with 64–66, 114 Eros and Thanatos (Freud) 194–195 dependency see under basic exorcism 24–25 assumptions Experiences in Groups (Bion) depressive and 29, 37–38, 157, 181 paranoid–schizoid oppositions see PS–D fight/flight see under basic assumptions entitlement Formulations Regarding the Two absence, and suffering of Principles in Mental separation 89–90 Functioning (Freud) 73 adaptive aspects of 91–92 Foulkesian group analytic controversy over, in ideas 11 supervision 93–97 Frankenstein monster, creation counterentitlement and of 95 entitlement, dynamics of Freud–Salome correspondence 94–97, 100–103 16 differences of opinion, tolerating 106–107 gratitude, appreciating 66 entitled signification, Grid (Bion) 38, 217 resorting to 98–99, 103 exaggerated 90–91, 94, 95 hallucination hallucinosis, healthy functions of 91–92 transformations in inhibited 90, 91 82–88 interpretative versus and introjection of beta accommadative elements 213 techniques for treating 107–109

251

and suffering of separation 89–90 Hamlet archetype, and thinking 30, 133–136, 150 hating (H) see affects, primal idealization transferences, resistance to 57–58 identity, and bonding 154 individual, as group in itself 14, 15 individuality, redefinition of 13–14 instinct theory, Bion’s relational revision of 193–194 intersubjectivity container–contained as model of 112–114, 119, 127 and countertransference 35–36 and passion 193, 216–217 and self–understanding 34 see also bonding knowing (K) see affects, primal language of basic assumption group 124 as container 118 paralinguistic significations, power of 170–171 in symbiotic relations 120–121 use of, and achievement of passion 219–220 LHK see affects, primal; passion loving (L) see affects, primal mathematical theories, and use of notational symbols 21, 38 medication, use of 180–181 memory and desire, eschewing of 16, 38, 207, 235

252

method acting, and alpha–function 27n2 mourning, and LHK 200–201

RELATIONAL GROUP PSYCHOTHERAPY

thinking, intense awareness of 226 transference–countertr ansference, partaking in and narcissism transcending 227 versus groupishness 175 as informative of versus socialism 15 meta–experience see also entitlement 217–218 negative capability 224–225 and intimacy 218 see also memory and desire, as intrasubjective process in eschewing intersubjective context 216–217 O language, and achievement fear of 18 of 219–220 and theory of meaning of 216 transformations 20–23, mobilizing in a group 25–26, 111–112 220–222, 228–236 object permanence, and myths 216, 218 abstract thought 89 psychoanalytic objects, objective analyst, myth of 13, elements of 215–218 14, 46–47 sense 215–216, 218 Oedipus myth 34, 80, 216 therapist, instruments of passionate pairing see under basic ‘alpha–function in assumptions reverse’ 26 paranoid–schizoid and dreaming couple, idea depressive oppositions see of 25 PS–D field–dependence, parasitic relations see relational receptivity and levels; therapist, containing arrival of ‘selected function of fact’ 24–25 passion (Bion’s concept of ) PS–D oppositions, and as achievement of processing of O self–conscious 23, 25–26 awareness 218–219 sense/myth/passion affects, integration of triumverate 25 216–217, 219, 228 uncertainty, tolerating as capacity to suffer 24 233–234 countertransference, personal growth, accepting distinguishing from the invitation for 66–68 ‘bad’ and ‘good’ Platonist, Bion as 16, 22 analysis 236–237 play, adolescent R, using concepts of adult thought, preparation 223–225 for 150 suffering meaning as integral part of mature 226–227, thought 133, 151 234–236 normal and pathological therapist, human 131–132 limitations of 236

parasitic, to establish symbiotic communication 131, 139 relational levels, shifting between 150–151 therapist’s capacity to play, actualizing 151 power and entitlement, dynamics of 62–64, 94–97 and powerlessness 94 pre–verbal communication 19–20, 30, 69, 157–158 see also alpha–functioning primal affects see affects, primal projective identification and projective transidentification 19, 22 in symbiotic relations 120–121 and theory of thinking 19–20, 73, 77–80, 88 using and withdrawing 123–124 protomental elements see beta elements PS–D (paranoid–schizoid and depressive) oppositions and emotional–cognitive oscillations 73 and processing of O 23, 25–26 psi–column, and id as wish–fulfilling 28n5 psychotic thinking 75, 76, 87 rebellion and adaptive compliance, tension between 174 anarchy 174, 181–186 anti–group forces 176 authoritarianism, undoing repressive defenses against 174 defiance 177, 178 incohesion 176

SUBJECT INDEX

‘moral order’, of group 176 narcissism versus groupishness 175 parent figure, therapist as 174–175 polarization 173–174 rebellion as inevitable phase of group life 175–176 resistance 172–173 revolution 187–189 secession/exile 179, 180–181 social action, pathways of 30–31, 172 of therapist 189–192 value conflicts 173 relational levels commensal relating, and poor communicators 139–144 container–contained model nesting processes 113, 119, 127, 129 psychodynamics, as group phenomena 129–130 relational levels 30, 110–130 suborganizations of personality, and relational levels 129 and human development commensal relations, establishment of 112 parasitic variation, development of 112 symbiotic, container–contain ed processes as 111–112 traversing aggression and hatred, drawing on own 147

bondedness, sense of 149 boundaries, maintaining 148–149 constructive communication, pursuit of 147–148 emotional realizations, dealing with painful 133 fight/flight culture, group as 146, 150 and Hamlet archetype 134–136 peer supervisory group, transmission of group process to 149–150 in play 146, 150–151 regression to symbiotic and parasitic levels 133 reluctant individuals, not pursuing 149 subgroup, activities of 149 violent transference communications, containing 144–147 see also therapist, containing function of relational theory Bion’s contribution 37–38 and role of therapist 33–34 resistances, of therapist see anxiety, of therapist reverie state, and theory of transformations 17, 20–22, 25, 111–112 Second Thoughts (Bion) 157 self–disclosure and analyst as omniscient sphinx 52

253

employing 185 forms of 51 inevitability of 50–51 intentional 51–52 no hard and fast rules for 53 subjugating third subject, role of 18, 118 symbiotic relations see relational levels; therapist, containing function of symbolic shorthand, use of 38 therapist, authority of psychology of authenticity 42 group–as–a–whole interventions 41 interpretation, and other interventions 41 member–inspired dynamics 33 minimalist intervention technique 40–41 ‘passion’, achievement of 42 relational approach, and role of therapist 33–34 self–understanding, and intersubjectivity 34 therapist–influenced dynamics 36–37 transference–countertransfe rence, evolution and mutual understanding of 35–36 working group culture, defining 42 therapist, containing function of commensal relations 117–118 in supervisory dialogue 118–120 symbiotic relations as foundation for 122 communicative process as two–way 115

254

RELATIONAL GROUP PSYCHOTHERAPY

countertransference, utilization of 114 parasitic relations basic assumptions, operating from 124 hating and being hated, tolerating 124 projective identifications, using and withdrawing 123–124 in supervisory dialogue 125–127 therapeutic frame, as container 124, 126 thinking, hatred of 123 problem as presented 115–117 qualities, of therapist 115, 143–144 separate point of view, maintaining 115 symbiotic relations language and 120–121 in supervisory dialogue 122–123 therapist, active presence of 121–122 transformative, containing as 114–115 thinking (Bion’s theory of ) anti–thinking (minus K) 75–76, 84–88, 119 Bion’s special meaning of 38–39 as dangerous and bizarre 80–82, 84–88 emotional conflict 71–72, 87 epistemological drive 20, 21, 74–75 fantasy, role of 73, 74–75

hallucinosis, transformations in 82–88 hatred of 76 K, extension as truth instinct 20 learning to endure process of 69 meaning, as relational 30, 70, 72 painful nature of 73–74 projective identification as normal pre–verbal mode 19–20 role of excessive 77–80, 88 relational consciousness and development of unconscious thought 70–71 partial hating of 30, 72 transformations, theory of 17, 20–23, 25–26, 111–112 Totem and Taboo (Freud) 102 training institutions 15, 47–48 transference and bonding 168–170 idealization, resistance to 57–58 see also countertransference truth instinct 20 uncertainty, tolerating 233–234 valency (amplification) 54 ‘virtual other’, infant’s experience of (Bråten) 14 writings, difficulty of Bion’s 11, 13, 38–39

Author Index Adler, G., 147 Agazarian, Y.M., 33, 175 Alford, C.F., 64 Alonso, A., 66 Anthony, E.J., 33, 222 Aron L., 53, 129, 170, 189 Atwood, G.E., 69, 106 Azima, F.J.C., 139, 147 Bader, M., 52 Balint, M., 165 Beebe, B., 111, 158 Benjamin, J., 70, 156 Bennis, W.T., 175, 176 Bieber, T.B., 64 Billow, R.M., 13, 15, 23, 26, 42, 60, 170, 185, 188, 214, 237 Bion, W.R., 17, 18, 19, 20, 21, 38, 39, 43, 54, 55, 56, 62, 64, 69, 70, 71, 72, 73, 75, 77, 82, 88, 108, 110-111, 112, 113, 114, 121, 123, 124, 125, 128, 158, 160, 165, 181, 187, 189, 194, 196, 197, 199, 200, 204, 206, 207, 209, 210, 217, 218, 219, 222, 223, 224-225, 226, 234, 236 Bird, B., 35 Blechner, M.J., 52, 107 Bloch, H.S., 132 Boesky, D., 35 Bologini, S., 115 Boris, H., 89 Brandchaft, B., 69 Brandes, N.S., 189 Bråten, S., 14 Bromberg, P., 108, 129 Brown, D., 58 Burka, K., 52 Burke, K., 171 Caper, R., 64, 115, 124, 189, 214 Carruthers, P., 70

Chused, J., 34, 51, 69 Coen, S.J., 91 Cohen, B., 176 Crocker, J., 171 Damasio, A., 28n7 Damon, W., 70 Davies, J., 52, 129, 237 De Board, R., 154 Dorn, R.M., 60, 91 Durkin, H.E., 161, 174 Ehrenberg, D.B., 52 Eigen, M., 89, 200 Ekstein, R., 143 Elias, N., 37 Emde, R., 111, 158 Epstein, L., 105 Erikson, E., 154 Ethan, S., 46 Ettin, M., 33 Evans, J., 11, 139 Fliess, R., 14 Fonagy, P., 70, 115, 144, 164 Foucault, M., 174 Foulkes, S.H., 33, 36, 37, 41, 47, 70, 129-130, 161, 164, 175, 176, 222 Frank, K., 51 Frankel, J.B., 137 Frawley-O’Dea, M.G., 52 Freud, S., 16, 19, 20, 23, 25, 34, 46, 60, 62, 70, 71, 74, 75, 82, 91, 94, 95, 98, 102, 107, 115, 134, 153, 154, 161, 174, 175, 187, 188, 194, 198, 199, 200, 218-219, 224, 225, 226, 231, 233 Frie, R., 37 Fried, E., 155 Friedman, N., 37, 134 Fromm, E., 187-188 Gazzaniga, M.S., 14 Gediman, H.K., 95 Gerson, B., 46, 52 Gill, M.M., 35, 53, 65 Gordon, J., 38, 175

255

Green, A., 124 Greenberg, J., 51, 53, 170 Greenson, R., 51, 52, 172 Grinberg, L., 17, 38, 154, 175, 193 Grossman, W.I., 83-84 Grotjahn, M., 46, 47, 64, 161 Grotstein, J., 17, 19, 25, 28n4, 28n5, 56, 144, 153, 168, 193, 196, 198, 227 Guntrip, H., 153 Halton, M., 41, 108 Hart, D., 70 Hartmann, H., 20 Hearst, L., 161 Heimann, P., 73, 194, 223 Hinshelwood, R.D., 175 Hoffman, I.Z., 52, 64, 65, 129, 170, 237 Hopper, E., 37, 174, 176, 188 Hunt, W., 189 Isaacs, S., 73, 196 Isacharoff, A., 189 Jacobs, T., 52 Jacobson, D., 95, 134 Jaffe, J., 158 James, D.C., 38, 175 Janis, I., 154 Jaques, E., 47, 187 Jones, E., 134 Jones, R., 134 Kauff, P., 46, 54 Keats, J., 224 Kernberg, O., 46, 47, 76, 187 Kibel, H., 173 Kirsner, D., 47 Klein, M., 19-20, 25-26, 71, 73, 74-75, 111, 131-132, 153, 154, 187, 194, 196-197, 201 Knoblauch, S., 171 Koenig, K., 49, 54, 59 Kohut, H., 23, 24, 107, 155 Kriegman, G., 60

256

RELATIONAL GROUP PSYCHOTHERAPY

Lacan, J., 21, 174 Lachman, F., 111, 158 Ladan, A., 91, 108 Langs, R., 124 Laplanche, J., 154, 193 Laufer, M., 133 Laufer, M.E., 133 Leary, K., 52 LeDoux, J.E., 14 Leibowitz, L., 52 Lester, E.P., 95 Lindner, W.V. Little, M., 52, 223 Lorenz, K., 198 Maizels, N., 217, 218 Malekoff, A., 137, 138, 139 Marcus, D., 52 Marcuse, H., 174 Marziali, E., 158, 169 Mason, A., 17 Matte Blanco, I., 28n3, 71, 165, 175 McLaughlin, 51, 52, 64, 170, 236 McLeary, L., 158 Mead, G.H., 37 Meissner, W.W., 154 Meltzer, D., 217, 218 Mendelsohn, R., 188 Merleau-Ponty, M., 118 Michels, R., 98, 107 Mitchell, S., 70, 129, 164, 187, 237 Mitrani, J.L., 128 Modell, A.H., 62 Money-Kyrle, R., 17, 161 Morrison, A.L., 52 Munroe-Blum, H., 158 Myerson, P., 147 Neri, C., 175 Nitsun, M., 38, 176 Ogden, T., 18, 115, 118, 165, 176, 189, 216 Ormont, L.R., 46, 102, 200, 208

Parloff, M., 36 Piaget, J., 133, 198 Pines, M., 11, 175 Piper, W.E., 45, 158 Pizer, B., 52 Pizer, S.A., 143 Pontalis, J.-B., 154 Pound, E., 44 Rabin, H., 58 Racker, H., 3, 34, 46, 60, 77, 170, 223, 226, 228 Rayner, E., 165, 193 Redl, F., 153 Reich, W., 174 Reik, T., 127 Reis, B., 37 Renik, O., 34, 47, 52, 69, 98, 224, 237 Resnik, S., 38, 175 Richmond, L.H., 139 Robertson, B.M., 95 Rosenthal, L., 65 Roth, B., 54, 173, 175 Russell, B., 98 Rutan, J.S., 66, 189 Safan-Gerard, D., 64 Salome, L.A., 16 Sandler, J., 165 Sartre, J.-P., 174 Schafer, R., 137, 154 Scheidlinger, S., 153, 161, 164, 165, 175 Schermer, V., 38, 175, 176 Schwaber, E., 98 Searles, H., 52, 147, 165 Segal, H., 196 Seligman, S., 111, 158, 170 Shabad, P., 91 Shakespeare, W., 92 Sharpe, E., 196 Shepard, H.A., 175, 176 Skynner, A.C., 106 Slater, P.E., 161, 175 Slavson, S.R., 64 Smith, P.K., 70 Sperry, R.W., 13-14 Spezzano, C., 34, 69 Stanislavski, C., 22, 27n2

Stark, M., 91 Stein, A., 46 Steiner, J., 124 Stern, D.B., 111, 137, 158, 199 Stiers, M.J., 38 Stolorow, R.D., 33, 69, 106, 170 Stone, W., 173, 189 Sullivan, H.S., 14 Symington, N., 163 Target, M., 70, 164 Todd, W.E., 189 Tustin, F., 128 Vanier, A., 132 Vella, N., 175 Warren, A., 44 Wellek, R., 44 Wilner, W., 52 Winnicott, D.W., 11, 23, 52, 90, 107, 143, 147, 165, 223 Wolkenfeld, F., 95 Yalom, I., 33, 46, 51, 158, 161, 164