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Relational Group Psychotherapy
of related interest
Building on Bion: Roots
Origins and Context of Bions 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 Bions Contributions

to Theory and Practice
Edited by Robert M. Lipgar and Malcolm Pines
ISBN 1 84310 711 2

Two volume set ISBN 1 84310 731 7
The Group as Therapist

Rachael Chazan
ISBN 1 85302 906 8
Dreams in Group Psychotherapy
Theory and Technique

Claudio Neri, Malcolm Pines and Robi Friedman
ISBN 1 85302 923 8
Circular Reflections
Selected Papers on Group Analysis and Psychoanalysis

Malcolm Pines
ISBN 1 85302 492 9 pb
ISBN 1 85302 493 7 hb
The Social Unconscious

Selected Papers
Earl Hopper
ISBN 1 84310 088 6
Foundations and Applications of Group Psychotherapy

A Sphere of Influence
Mark F Ettin
ISBN 1 85302 795 2
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, 6179; (2001) The therapists anxiety and resistance to group, International Journal
of Group Psychotherapy 5, 83100. Chapters 2 and 4: (1997) Entitlement and counter entitlement in group
therapy, International Journal of Group Psychotherapy 47, 459474; (1998) Entitlement and the presence of
absence, Journal of Melanie Klein and Object Relations 16, 537554; (1999a) Power and entitlement: Or, mine
versus yours, Contemporary Psychoanalysis 35, 475489; (1999c) An intersubjective approach to entitlement,
Psychoanalytic Quarterly 68, 441461. Chapter 5: (2001a) Relational levels of the containercontained in
group, Group 24, 243259; (2003a) Relational dimensions of the containercontained, 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 therapists 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 Bions theory, Contemporary Psychoanalysis 35, 629646;
(2001b) The class that would not read: Utilizing Bions affect theory in group, International Journal of Group
Psychotherapy 51, 309326. Chapter 10: (2000a) From countertransference to passion, Psychoanalytic
Quarterly 69, 93119: (2000b) Bions passion; the analysts pain, Contemporary Psychoanalysis 36,
411426: (2002) Passion in Group: Thinking about loving, hating, and knowing, International Journal of
Group Psychotherapy 52, 355372.
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 owners 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
616.89152--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 Therapists Psychology
33
Chapter 2
The Therapists Anxiety and Resistance to Group
45
Chapter 3
The Basic Conflict: To Think or Anti-think Applying

Bions 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 ContainerContained
110
Chapter 6
Containing the Adolescent Group
131
Chapter 7
Bonding in Group The Therapists 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
10
RELATIONAL GROUP PSYCHOTHERAPY
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. Bions writings are notoriously difficult to comprehend and Billow has made a significant contribution in bringing together Bions 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 Bions 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 Billows 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. Billows vivid description of his work with adolescents should give
confidence to clinicians who are working in this area. Billows 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
11
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 Bions contributions to it. I am not a group therapist, but after reading Dr. Billows 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.
Billows understanding of Bions ideas. I found his understanding remarkable.
Bions 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. Billows superb rendition of Bions 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 therapys 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
14
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 Brten (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 selfother organization (p.26). The title of
his thesis is Born with the Other in Mind (p.25). With these ideas in mind,
Sullivans (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 Fliesss (1942) term partial identification on
the therapists 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
(Bions 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 Bions ideas that the author has imported and thoughtfully applied to
his study of the group psychotherapy process. Moreover, because Bions 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 patients character that all
too frequently escape detection in individual treatment. Bion puts forward the
idea that narcissismand 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.
16
Abandon memory and desire

Bions (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 analysts 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 Magrittes 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
Bions creed.
INTRODUCTION
17
Countertransference issues in the group leader:

Containercontained
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 therapists introjective counteridentification and Grinberg (1962, 1979a, 1979b) speaks of the analysts
projective counteridentification which, to my mind, constitutes the extension
to the former of the analysts own infantile neurosis. Mason (1994) refers to
this phenomenon as folie 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).
Bions (1959, 1962) conception of containercontained 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 mothersanalysts-group leaders capacity to achieve reverie and to apply their
alpha-function2 becomes decisive as a prophylactic to avoid collusion, counter-projective counteridentification, and subsequent retaliation.
18
Ogdens (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 Bions 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,
Bions (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
19
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 Freuds (1911) notion of the distinction between
the primary and secondary processes into his notion of alpha-function
(dream-work-alpha) which paradoxically dreams ones 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.
Bions theory of thinking

The author has done such a superb job in presenting Bions 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 Freuds ideas of epistemology and with Kleins 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 Kleins 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-
20
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
Freuds 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 Freuds (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
21
Bions (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 Bions 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 Bions 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 infants (or patients) 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,
22
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, Freuds 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 (mans 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. Bions 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 analysts 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 Stanislavskis [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 Bions 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 Bions 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).
INTRODUCTION
23
Implicit in Bions 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 (Freuds 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 Bions theory of L, H, and K as basic
affects and links them to premonition. Bions basic conception of the mind
was one of affects, relationships, and being. He regarded emotions as the individuals outer defense frontier in the internal world that intercepted the
impact of Os 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 Os 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 passion8 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 infants being weaned from
the breast in so far as they impart truths, the acceptance of which promotes
growth. Winnicotts (1960) concept of the holding environment and Kohuts
(1971) idea of empathy constitute exceptions. Bion was strongly leaning this
way when he conceived of containercontained. He had come to realize, for
24
instance, that psychotic patients may have lacked what we might call a
sufficient bonding experience with their mothers who, failing to contain their
infants projective identifications, became malevolently transformed into
internalized (within the infant) obstructive objects who thereafter attacked
the infants thinking and relationships to good objects. It is my impression
that Bions concept of containercontained 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 Bions 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 ones 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 mothers 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 Bions 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
INTRODUCTION
25
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 containercontained, Bion thought of the
mother and infant as a thinking couple. Having recently reviewed Bions
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 Kleins
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 Freuds (1915) topographic theory and Kleins
26
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 Bions 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,
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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.
Brten, 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, 211227.
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 patients projective
identification. International Journal of Psycho-analysis 43, 436440.
Grinberg, L. (1979a) Projective counter-identification. In L. Epstein and A. Feiner (eds)
Countertransference. New York: Aronson.
INTRODUCTION
27
Grinberg, L. (1979b) Countertransference and projective counter-identification. Contemporary

Psychoanalysis 15, 226247.
Grotstein, J. (1978) Inner space: Its dimensions and its coordinates. International Journal of Psychoanalysis
59, 5561.
Grotstein, J. (1995) Projective identification reappraised. Contemporary Psychoanalysis 31, 479511.
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 Bions 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 deux. Psychoanalytic Quarterly
63, 641679.
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, 532536.
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 parentinfant relationship. In The Maturational Processes and
the Facilitating Environment: Studies in the Theory of Emotional Development (1965). New York:
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 Blancos (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 Bions O.
28
4.
While I basically concur with Bion about the infants 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 mothers 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 Freuds concept of the id as wish-fulfilling

constitutes the psi column on Bions (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 Bions (1970) group
theory it corresponds to the Establishment.
6.
Lacans concept of the Register of the Real closely approximates Bions 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 mothers and analysts 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, Bions 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 Therapists Psychology, orients
the reader to my relational point of view, which confers on the therapists
emotional experience a primary influence on the formation and evolution of
the group structure, culture, and process. Bions 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 Therapists 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 Bions
Theory of Thinking in the Group Context, introduces the reader to epistemological object-relations theory, and explains Bions expansion of ideas
first introduced in Experiences in Groups (1961). Bion brought a special
29
30
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 ContainerContained, presents Bions 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 containercontainer: 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. Bions formulations concerning
thinking and communication, particularly the model of the container
contained, put a most interesting perspective on understanding and treating
adolescents. Shakespeares Hamlet provides a vehicle in which to explore
themes associated with adolescent thought, fantasy, and communication.
Hamlets 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 Therapists 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 therapists
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
PREFACE
31
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
Bions 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 Bions 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 transferencecountertransference. The concept of passion advances the historical consideration of
countertransference by delimiting an independent area within the therapists
subjectivity.
CHAPTER 1
The Authority of the Group

Therapists Psychology
In Relational Group Psychotherapy, I put the group therapists 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
therapists 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 leaders 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 therapists thinking and practice, their
emphasis on member-inspired dynamics seriously underplays the enduring
role of the therapist, most particularly, the authority of the therapists 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
34
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 ones own subjectivity is well in control. Racker (1968) suggested that a neglected aspect of the
Oedipus complex was the analysts wish to be master or king, not only of
other people, but also of his own unconscious. Racker described how the
analysts 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 analysts
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 ones 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 Freuds 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 clinicians 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,
THE AUTHORITY OF THE GROUP THERAPISTS PSYCHOLOGY
35
words and actions have produced enactments, and these too are learned about
with the benefit of hindsight and interpersonal feedback. While the therapists 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 therapists 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.
Transferencecountertransference, 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 therapists personality and the
complexities of their therapists 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 therapists 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,
36
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 clinicians 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 clinicians basic
patternings of subjective experience influences, often determines, not only the
focus, but also the groups 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 ones 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 conductorhe 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 therapists affects, thought, and
clinical behavior, and the therapists influence on the group, subgroup, and
individual members, I appreciate that not all therapeutic change flows from
37
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 groups organization, functioning, and goals (Hopper
1999).
Appreciating Bions legacy

The chair of a recent panel of the American Psychoanalytic Association
declared, In todays 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 transferencecountertransference, 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 others communication; how we
convey our experience back, and how this communicative interplay
38
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 Bions 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. Bions
symbolic shorthand may aid the clinicians thinking about emerging as well as
dissociated thought and emotion, in oneself and in the group. Mentally
playing with Bions 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 Bions
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 Bions 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 therapists situation within the group. I emphasize throughout Bions attention to
the universal, existential conflict regarding tolerating emotional thinking, and
how this conflict plays out in ones 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
39
LHK, (loving, hating, knowing), alpha functioning and beta elements, premonitions and premonitory anxiety, and passion.
Bions condensed, epigrammatical writing style is open to multiple interpretations, which seemed to serve Bions 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.
Bions 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.165166). 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
40
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 leaders 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 leaders 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 groups characteristic modes of
functioning develop partially from coping with the leaders difficulties in
thinking, the leaders problems with learning from experience. Thus, a fourth
dual represents the leaders subjectivity, one that influences the development
of basic assumptions and their relative prominence vis--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. Bions 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 Bions, in which the
apparent abdication of leadership magnifies the leaders importance and
increases the groups 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 leaders 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,
41
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 therapists respectful silence or brief
appreciative acknowledgment in the face of an apprehensive members
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 therapists reverie, patience, and inner
security communicate something crucially important, even curative,
furthering the patients capacity to develop and tolerate emotional thoughts.
42
The variety and flexibility of the therapists activity, internal and interpersonal, exposes the qualities of the therapists care and establishes the therapists 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 therapists ever expanding understanding of the psychic reality
of the group and its members, and the therapists 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 ones 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
43
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 cant 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 clinicians memories of
what happened and beliefs about what is revealed, and the patients or
supervisees 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 Generals Warning is in order, regarding
what follows and all clinical contributions:
The clinicians 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 therapists 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-
44
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 Therapists 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).
45
46
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 analystanalysand
societyand 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 therapists access to her or his own subjective experience. The therapists
THE THERAPISTS ANXIETY AND RESISTANCE TO GROUP
47
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 paranoiagenesisthat 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 Freuds curiosity and writings
about groups and group process, group therapy remains taboo in many psy-
48
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
49
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 cant start a group. I dont have room in my office. Then I realized it wasnt
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 Im 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 cant always predict. People I least expect say no; Ive been
more successful with people I dont 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 clinicians therapeutic uniqueness. The schizoid therapist
fears invasion by patients. The depressive therapist needs to remain each
individual patients 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.
50
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. Im a follower, not a leader, she
argued, I cant think that quickly when Im 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 womans 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 Im too fragile. I dont 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]
51
Group members see the group therapist from multiple perspectives.

Previously unrevealed and undeveloped facets of the therapists 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 dont do or say, from the dcor 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 leaders position in the group, and hastens
the development of group autonomy and cohesiveness.
52
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-ODea
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 therapists 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 therapists
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
53
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 Im just a person, she exclaimed.
Ive 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 patients 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.
54
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 therapists own] hitherto defended
introjects (p.407). Therapists must cope with the groups 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 wouldnt be coherent if I had to talk. I feel like I cant 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.
55
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 dont know where my feet are.
I dont 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. Im psyched. Curtain going up, light the
lights! Im beginning next week. What should I do?
I lose interest in those patients who arent also involved in group. I think of
my groups as my family, and until patients are in a group, I dont feel we are
really engaged.
56
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.489490). 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 therapists 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
57
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 therapists 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 therapists) 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 therapists 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 analysts
long-standing patients and former and present supervisees. Much of the
group process involved fighting for the analysts 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.
58
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 ones 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 therapists 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 groups 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 therapists 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.
59
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 patients 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 therapists 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 therapists personality and behavior? How will the patient respond to the therapists group family?
When a patient enters a group, unanticipated facets of the individuals
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
60
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 patients 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 elses. The therapist
realized how he had been trapped in a complementary countertransference
(Racker 1968), becoming a superego figure representing the patients anxious
and demanding parents. The therapist learned from the group members how
better to accommodate the patients 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 dont 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
61
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 groups 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. Im 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 groups 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-
62
culties in trusting others caring for her and in accepting and valuing herself as
special.
The entitlement of leadership and power

The therapists 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 (19161917) 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 patients] 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 therapists 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
63
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 therapists 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 groups basic
assumption may work in the explosive manner Bion described, or may fizzle
into embarrassing bombast, cleverness, or navet.
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 professions 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 mans 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 patients 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 therapists theory and technique bring power, control,
and directionality to the psychotherapeutic experience, which privilege and
64
prohibit modes of patienttherapist 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 therapists importanceas an object of cathexis and dependence (Slavson 1992, p.179). The therapists 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 therapists 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 groups projections to
understand the groups 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
analysts own emotional reactions (Bion 1961, pp.148149). One must
strive to maintain an independent mind of ones own (Caper 1997), one
which both identifies and disidentifies with the groups allegiance to the basic
assumption mentality. In effect, the therapist contains the basic assumptions
65
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 leaders subjective reactions, which include to varying
degrees the leaders 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 groups, 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 Im
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 groups 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 dont 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
66
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 therapists insight, humor, and
creativity may surpass the recognition received from the therapists 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 therapists 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 therapists 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 therapists needs for growth and development, professionally and personally. The group is entitled to and benefits
from expression of the therapists 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 didnt
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see that aspect of my personality in our relationship, but I do now, thanks to

our group. Ill try to be more sensitive to my effect on you.
Clinical example: Appreciating the groups invitation for growth

The chapter concludes with this clinical example. A patient casually
commented: I like you better in group, youre more fun. You look like youre
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 peoples 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 individuals

transferences are not easily challenged by group consensus!
In response to the womans nave 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 groups 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 Bions 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 individuals 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.
69
70
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 personalitys emotional
experience either the individuals 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 Freuds 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 possibletogether with an awareness (and not an evasion) of the
emotions Iftherapy is found to have a value, I believe it will be in the
conscious experiencing ofactivity 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 mustremain
traversable. (Freud 1915b, p.204)
THE BASIC CONFLICT: TO THINK OR ANTI-THINK
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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 infants 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 kindthe 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 ones feelings, or anothers)
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 Freuds 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
introjectiveprojective 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 containercontained
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 ones 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 ones 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 Kleins epistemological instinct to Bions K

Klein had challenged Freuds 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 childrens 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,
75
context. It is the mental region particularly that is disturbed when material,

but not psychological provisions, are offered in infancy.
Klein had called Bions 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 Freuds 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 Schrebers 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 Freuds 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,
76
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 wifes treatment of him, and pulled for
emotional ransom, that is, our sympathy and consolation. He replicated in
group the relentlessness that stimulated his wifes impatience and anger.
In a moderately intense form, the goal might be to make the object suffer a
victimvictimizer 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 analysts, 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 partin somebody elses phantasybeing 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
couldnt 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 groups accommodating compassion renewed Sarahs sorrow, and her
sorrow, the groups 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 groups
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 elses fantasy of how I was to behave.
I had received the dreamers 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 Bions (1970) pithy statement that the pre-verbal matter the
78
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 didnt want to, and dreamt about it by being forced to
wear a red dress. Gails 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 didnt love his marriage because he
was forced to do what he didnt 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
79
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 Sarahs 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 dont
hear so well! I dont 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
Sarahs 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 groups 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 didnt 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 patients 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
patients 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. Im afraid to say it, but I even cursed at her.
David thought I was right, but he didnt 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 groups 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 its their fault. Your world is out of Picasso. Everything is disjointed and
doesnt 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 dont really get people, but were
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 dont 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 groups 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 members assertion that she did not like me right
now. She responded with a relieved smile: Oh, I thought you said that you
didnt like me. Its okay if I dont 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: Im dreaming, this couldnt be
real, My eyes are deceiving me! I dont 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 members 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 analysts 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 individuals consciousness and unconsciousness, and of groups
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 didnt 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 dont want to read her signals,
if she doesnt 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 dont want to think about that.
Mike, a new member, marveled: I cant 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. Im just
beginning to think the way people do here, but I find it doesnt 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 dont 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 wasnt 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
Bobs 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 didnt like how he felt
and couldnt 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 cant 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 Im 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 wasnt sure what she was getting out of it. Marge, unexpectedly
brave, said that Lela wasnt putting anything into it. Lela agreed, but insisted
that what the men were talking about didnt 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 didnt 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 werent 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 wasnt
changing, but not what was.
Lela dryly acknowledged that we all sounded like her husband, who had
the same complaints. He says I dont appreciate how much he is trying, and
that I accuse him of not relating, but it is I who doesnt relate to him.
Ann said that she had the same husband. My husband is right, I dont
want to relate to somebody who isnt relating to me. But Im not being
impatient and critical now. Im here, Im 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, its no sale.
Lela got teary and frustrated with herself. I cant do it right. If I speak Im
too negative, and if I dont speak I get accused of being withdrawn. I dont
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 mothers
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 womens silence, which I felt hadnt been explored. Did they think
the silence had an effect on the three members who were participating?
Of course, Lela responded, impatiently, they didnt 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 didnt 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 doesnt
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 Marges 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
leaders 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 ones 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 Bobs 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 groups role in
inducing and supporting his budding emotional self-consciousness. Bob
resonated with Mikes 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 womens 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
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experience repeatedly confronts the thinker with awareness of ones 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 ones 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 Kleins 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
ENTITLED THINKING, DREAM THINKING, AND GROUP PROCESS
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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 possessorpossessed, masterslave, sagefool, 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 lifes 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
ones 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 therapists counterentitlement

Shakespeares Richard III, whom Freud (1916) considered the embodiment
of pathological entitlement, took particular pleasure in the interactional
process of taking over Annes 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 ones 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 Richards
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 therapists 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 groups reaction, while having a defensive aspect, also may
be a thoughtful criticism of the therapists 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 therapists 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 ones diagnostic and technical orientation, as well as of
countertransference, on what is perceived to be pathological entitlement, and
the group therapists 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 groups 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 patients 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 therapists 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 supervisees 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 youre saying Im 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 therapists 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 ones
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 years 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 familys 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 persons problems, she was met with confusion, protestation, or silence.
She took the groups reactions as a communication that she was being
premature in her interventions, and would become inactive.
The therapists reference to Frankenstein reminded me of Freuds (1916)
evocation of Richard III. Freud formulated that in Shakespeares drama, the
protagonists 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 Freuds 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 therapists boundaries, consideration of the therapists
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
therapists technique and rejecting of her groups 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 lifes 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 groups. 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 groups rising indignation: Im
beginning to get angry. Are you happy now? Why do you want to find
trouble? We support each other and dont attack like people do on the
outside. The group agreed that something had gotten into the therapist; she
seemed bossy and not agreeable. One members challenge to the groups
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 dont like it.
We may note a pattern that often eventuates in analyzing entitlement. The
therapists critical assertions regarding the groups entitlements were met with
escalating counter-assertions regarding the therapists 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 groups ambivalent
feelings and the fantasies behind them. But a psychological dialogue had
begun, although often in an intimidating vocabulary of the groups indignation and initial condemnation. A propitious moment occurred when the
group monster relieved itself of its head. With the encouragement of the
therapists skillful interventions, the members dethroned Ralph. He now
resides on the couch with the others.
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The therapists vulnerability to entitlement

Many aspects of the therapeutic relationship suggest the group therapists 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 therapists 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 therapists primary experience is of the patient or
group malignantly not caring about or understanding clinical ministrations,
and perversely blocking the therapists efforts to love and to be loved. This
was indeed the situation that Freud (1916) described. The exception was the
individual unresponsive to the analysts 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 patients 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 analysts 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 therapists 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 therapists involvement with and preference for his or her own
inner objects would limit his or her availability to the patient, and also limit
the patients availability to the therapist. Hence, the therapists 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 therapists 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 therapists 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 clinicians tendencies to entitled thinking
may play a significant role in assessing whether a members 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 members 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 individuals
and groups 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 groups, 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 youre the exalted leader. Were 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
dont take up too much space; if you talk one week, you shouldnt talk too
much the next; everybody judges me, although I dont 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 dont 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. Sarahs 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
Sarahs 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 dont feel comfortable when youre 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 wasnt her mother and even if she were, tough!
It wasnt Catherines fault that her mother married her father, and it wasnt
Catherines 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 Sarahs anger in the prior session, my banquet-hall office to Mollys
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 Mollys 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
groups 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 Mollys dream, I inquired skeptically: If Im 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, thats why I have to be
careful not to get you angry. We have to perform for you, so youll like us.
Im afraid youll 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
ones 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 isnt 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.
Annas 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
Annas 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, Im 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. Wasnt 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 Annas 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 Annas
indignant reactivity, which mercifully she seemed to have discarded. One
member said, I dont think Anna is evil. How could you say that. Another:
Youre chastising us. You want us to stand on your white line. Were not
standing on what you said was Annas. When a member exclaimed: Were 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. Were not bad, an individual had
exclaimed, signifying the groups 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! Hes
starting again. Youre 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 dont like it when you call us names. Ill never
forget some of the things youve said to me. I hate it when youre sarcastic. I
like it when he makes fun, except when it is directed at me, then it hurts.
Was the group, caught in Annas projective identifications, dreaming me
up? I felt like the sorcerers apprentice, in Disneys 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 groups 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 groups
anxiety, manifested in the paranoid submissiveness to Anna, but that I had
camouflaged my envy of Annas 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
Annas progress, without a hint that she was or remained a fearsome character.
I guess Im 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 Annas 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 groups 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 groups 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 patients 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 clinicians
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 therapists, 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-
107
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 therapists 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 therapists 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 Annas 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 patients
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 therapists 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 therapists mental evasiveness.
Thus, analyzing or not analyzing may variously signify the clinicians
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 therapists 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 therapists 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 ContainerContained
The concept of containing has captured the psychoanalytic imagination,
becoming an idiom in the contemporary clinicians 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 containercontained 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 anothers
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 therapists subjectivity.
Let us take as a starting point Bions statement that the human
animalcannot find fulfillment outside a group and cannot satisfy any
emotional drive without expression of its social component (1967a, p.118).
The cornerstone of Bions 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
containercontained:
The individual cannot contain the impulses proper to a pair and the pair
cannot contain the impulses proper to a group. The psycho-analytic
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CONTAINING AND THINKING THE THREE RELATIONAL LEVELS
111
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.1516)
This compressed passage pertains specifically to the inherent problems in

human communication and the importance of others in supporting the individuals drive to think about emotions and make them meaningful. To grow
and mature the individual needs communicative containment by self, pair and
group. The containercontained 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 containercontained 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 introjectiveprojective exchanges (see Heimann
1952) formed the basis of the infants relationship to the mother, and
continued to inform all relationships. The infants symbolic sojourn in the
breast (Bion 1962, p.183) first makes manageable the individuals basic
drives or needs, placing them and their satisfaction in the relational
context.
Thus, in human development, containercontained 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
infants communicated experience. In Bions 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 infants experience of
its disintegrating impact, and returns experience in a form (alpha elements)
manageable for the infant to think about. By containing the infants primitive
affective and perceptual reactions, and interesting the infant in them, the
receptive (m)other fosters the development of a normal part of the infants
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 mothers 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 ones 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 infantcaretaker 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 containercontained
represents a hostile and destructive process. Thinking and thinkers must
be avoided or attacked.
Bions (1970) definitions of commensal, symbiotic and parasitic communications are not saturated. When one thinks about them, they may develop in
unexpected ways, which was Bions 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 childs 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).
Containercontained: A model of intersubjective thinking

The concept of containercontained 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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mouthbreast 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 ones place in
the family, society, and universe. From such relatively simple beginnings the
[containercontained] 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 individuals unformulated ideas and emotions, which are the
contained. On the level of self, the individual serves as the container of ones
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 infants
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 emotionby another emotiondoes 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 containercontained 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, containercontained, 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, containercontained 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 individuals socio-psychological
matrix. An individuals impaired relational functioning within the
group-container negatively affects K, such that one develops a pathological
relationship to ones own thought processes (the containercontained). Of
course, the arrows of influence in the containercontained relationship point
in both directions: internal K pathology is affected by, but also influences
pathological social relationships.
The group therapists containing functions

Bion began formulating the model of the containercontained 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 therapists 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 groups 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 mothers
thoughts and feelings, only some of which she herself may understand. An
analogous process exists in the consultation room. Caper (1997) wrote of the
patients use of his intuition and perceptiveness to assess trends and forces in
the analysts 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 groups 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 Freuds (1912a) metaphor. The group therapist
filters through a personalistic lens, and in representing and participating in
containercontained 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
containercontained 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
Im pissed at Mary. Shes threatening to quit group. What should I do? Im

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. As 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. As 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 therapists 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, Im 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 patients 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 Marys 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 analysts presenting problem, which
involved some disturbance in the containercontained. It seemed apparent
that the disturbance existed on many levels: in Dr. A, in Mary, in their relationship, and in Mary and Dr. As relationship to the group. Most likely, the disturbance existed in Dr. As relationship to me.
Dr. As opening comments, that she was pissed at Mary and what should
she do about Marys threat to leave group, and her anticipation of blame and
abandonment, actually provided a wealth of emotional data. The analysts
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 Bions 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 therapists interventions may stimulate pain and anxiety,
informing members of that which needs to be thought about consciously and
unconsciously, and articulated in the groups 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 supervisees
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 analysts 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 didnt 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 superviseesupervisor 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 patients mind between a bad group
therapist and a good analyst. The split also existed in the therapists 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
patients conflictual feelings, thoughts, and fantasies brings to the fore
aspects of the history and current state of the analysts 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 patients or groups 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 containercontained.
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 analysts 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, projectiveintrojective exchanges.
These exchanges are emotionally rewarding[establishing] a sense of being
in contacta 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
members 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 projectors 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 ones 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.
Marys 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 ones 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 supervisees identifications with and transferences to an unloving mother (really, to her mothers
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 transferentialcountertransferential vortex of the total situation,
momentarily becoming the patient with bad feelings as well as the patients
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 analysts analytic
attitudes, her neutrality, limit setting, admonitions to return to group,
insight-oriented interventions, and so forth, served as actions taken to relieve
the analysts anxiety about badness, to avoid thinking about badness, and
not to contain the patients.
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 havent let Mary play out her anger, the way youre doing with me, Dr.
A volunteered, but I think Im ready to now. Ill bite the bullet. Well 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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receivers 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 excitationsinstinctual 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 clich 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 understoodneeds 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, ones knowledge and training, the clinicians legitimate entitlement to assert limits, all may provide this essential function. Particularly
important is the analysts 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 patients communications

illustrate parasitic attacks on commensal and symbiotic links. Marys 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 patients, 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. As 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. As 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. As 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. As 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 therapists 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 wasnt.
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 groups tacit blessing of a members 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 containercontained

had reemerged, although some of the emotional particulars had reconfigured
with different participants. In the therapists 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. As 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. As 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
transferencescountertransferences, 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 emotionswithout 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-
129
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 selfother evaluations mutually influence
decisions to participate commensally, symbiotically, and parasitically.
Relational theory and the model of the containercontained

Bions 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).
Containercontained 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 containercontained 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 containercontained 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 containercontained 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
containercontained get played out in adolescent group psychotherapy. The
model of the containercontained 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 adolescents 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 clinicians personal and therapeutic mettle. The question arises of how best the therapist may play it. The
task is to contain the adolescents ambivalent, often confrontational communications with playful utilization of the therapists 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). Kleins
131
132
analyses of children demonstrated how the childs 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 childs 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
containercontained. 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

containercontained
In many ways, it is societys and the groups 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 familyschoolcommunity (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
CONTAINING THE ADOLESCENT GROUP
133
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, Piagets 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, 255257), 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.
134
Hamlet: To think and not to think

The customary answers given the childdamage his genuine instinct of
research and as a rule deal the first blow, too, at his confidence in his
parentshe usually begins to mistrust grown-up people, and to keep his
most intimate interests secret. (Freud 1907, pp.135136)
Shakespeares 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, Shakespeares protagonist will
carry forth our consideration of the adolescent crisis. Hamlets 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 Hamlets discourse, we
may appreciate how Hamlets 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, 6465). 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
135
sun (6768). Hamlets 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 mothers 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, 133134, 158).
Throughout the play, Shakespeare dramatizes Hamlets 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 Ican say nothing (II, ii, 586595)
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
136
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, 379385)
Hamlet devises a strategy of provocative enactment to test the authenticity of

adults: The plays the thing/Wherein Ill catch the conscience of the King
(III, i, 905906). 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; theyll tell all (III, ii, 151152).
Hamlets 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, 1920). 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, 68).
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 hes 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 Hamlets enemy. (V, ii, 246250)
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
137
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 childs 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 adolescents
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 adolescents actual as well as
mental life. The therapists 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 adolescents 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 therapists 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 parents 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 therapists 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
139
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 boys 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 leaders directives.
However, from the groups 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
others 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 groups
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 groups 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 didnt like him [Roberts 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], youre jumpy too.
I wish my father would die.
[to Ellie] He really means that.
[to Ellie] My father just dropped dead, he wasnt living with us.
How old were you?
I dont remember, maybe ten.
Toni:
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You dont remember, what a retard!
Robert:
I aint so good in math, or in anything else! Did you see Married

with Children [television show]? Al Bundy [the father] is so cool.
Lucy:
Its crazy that show, my parents say its 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 didnt 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. Shes very pretty. [Toni rolled her eyes and met Roberts.
They laughed conspiratorially but did not otherwise put Lucy down.]
Robert:
She hot.
Steve:
[unconvincingly] For sure.
Toni:
[to Lucy] Why dont 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 Roberts 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 dont 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 dont 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 were talking about family and my uncles
who I never see cause no one likes them, except me, theyre
cool. And then I say to my mom: You know, I just realized it;
youre not raising me, Dr. Billow is! My mother doesnt 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 doesnt 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: Hows that, only pretty good?
Robert:
Well, I dont hate myself anymore and I get along better with
my mom she dont 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 cant
afford it. Sorry Dr. Billow, thats not what I think.
Therapist: What do you think? Am I raising you too?
Steve:
[interrupting] My parents dont have any idea what I think of
them.
Toni:
Steve has raised up from the dead. [Steve smiles wanly and resumes
his frozen stance.]
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 dont think so. Only
kidding.
[seeming not to understand the sarcasm, and repeating a fact wellknown to the group] Im adopted; they knew it would cost dough
to have me but they wanted me. Im all they got.
They hadda buy you? Gyp, gyp!
Im going to smack you one in the kisser.
Ooo, Im so worried.
[to Lucy] Ill 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. Its interesting.
Are we interesting specimens?
Freaks. Why did you come to group?
My mother joined Dr. Billows other group, thats how come I
came here. She doesnt like it that much but she says she wants
to be a good model for me, so I dont leave this group. She cant
afford to see Dr. Billow by herself.
Yeah but why did she want you to come?
Stop pressing her, she isnt ready to tell us. Shes like Steve,
shes 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 transferencecountertransference in the
shared medium of language and reflective thought. Playing with Roberts
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 peoples
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.
145
(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 youre giving me the same
treatment I gave you all week: silence. I dont make it easy for
you and youre 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:
Hes 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:
Hes stoned already.
Sam:
So am I.
Steve:
What a pervert.
Toni:
Youre the pervert, Steve.
Steve:
And proud of it.
Tanya:
I know hes [therapist] a pervert.
Robert:
We ought to cut off his nuts.
Toni:
What nuts? Hes 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 groups
interest, professing to be complimented by its preoccupation with my sexual
146
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 groups obscene language and
repetitive put-downs, to some extent symbolic and playful, threatened to
become clich, 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 groups 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 therapists
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, thats
why hes the most quiet. He doesnt want to kill us. Or, Toni puts up a good
tough front, but shes a mush inside. She just wants to be loved, lets face it.
Shes a big phony. Toni (smiling): Thats 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 therapists balanced and
reasonable utilization of power may reassure the members that the therapist
has not been taken in and therefore killed. The therapists 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 youre here to waste their
money, but youre really here to protect your parents from me.
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[Loud groaning and cursing.]

Therapist: I notice that this group cant 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 Im 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 Im saying. Duh.
Toni:
Billows right, youre 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 thats 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 groups 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
149
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 members 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 containercontained 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 therapists containing

functions
The consensus of literary critics of Hamlet has been that the tragedy results
from the protagonists 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 therapists authenticity. They are often less
interested in what the therapist says, than in who the therapist is. After all, an
adults 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 therapists
self-presentation is often more significant than the semantics of the therapists
words. The group therapists willingness to negotiate his or her way into
caring, lively, and flexible containercontained 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 therapists 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 therapists 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
containercontained relations. All it takes is the group therapists curiosity,
understanding, creativity, capacity to sustain challenge, abuse and defeat, and
infinite patience.
CHAPTER 7
Bonding in Group
The Therapists 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 ones own bonding needs and anxieties. The
influence of the therapists 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
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BONDING IN GROUP THE THERAPISTS CONTRIBUTION
153
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
infants psychic tasks, with the others 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 himselfand 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 ones
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 Im sad, or scared or unsure, I tell you and think
of what you would say to me and I straighten up. I dont think there is even
half a day that goes by without me thinking of the group. Ive been here a long
time and I was looking forward to leaving, to the free time. I still am, but now I
cant 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 wifes 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.
Franks 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, Im new to this game [i.e. the group] and
I dont know each of the members stories. Why cant 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. Youre creating the obstacles.
I suggested that he take up our difficulties in the group: Lets 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 groups. 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.
Franks 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 Franks 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 Bions early group theory, bonding needs and anxieties, exaggerated and magnified in the groups 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, Bions 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 therapists
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, projectiveintrojective exchanges. These
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exchanges are emotionally rewarding[establishing] a sense of being in

contacta 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.
Containercontained relationships (see Chapters 5 and 6) initially are
symbiotic, based on infantmother, benevolent projectiveintrojective 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
containercontained 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
therapists 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 membertherapist
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 membertherapist 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
members 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 membertherapist bond in a

cohesive group
Marie, a patient in joint individualgroup 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 therapists 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 Roberts and Maries 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: Im usually comfortable with anger from my patients. Ive
encouraged Marie and she expresses lots of anger. Why isnt 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
therapists 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 patients
unintegrated anger, but in the therapists difficulty in understanding and
responding to Maries bonding needs, and to mine.
The group had intuited Maries 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 Maries 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 disintegrationreintegration 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 therapists 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. Maries 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 ones 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
transferencecountertransference overwhelmed the therapists current
emotional capabilities. She could not bond sufficiently to the patient, and
Marie eventually terminated. From a whole-group perspective, Maries
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 therapists attempts to enlist the group in dealing with Sheilas
resistances fell into a mindless vacuum: what did they think/feel about
Sheilas tardiness; her excuses? Similarly unsuccessful were the therapists
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 dont 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 dont like being interrupted, and we miss
Sheila when she cant be on time. But we can accept it. Its always nice to see
Sheila when she arrives.
But the group leader did not feel nice. She remained anxious and
expectant, greeting Sheilas 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 therapists reaction, which interfered with her
bonding to the patient.
I asked the therapist why she could not tolerate Sheilas 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 members 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 Sheilas
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 therapists 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 presenters 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 Sheilas behavior, the
therapist should call positive attention to it. At the beginning of the next
group, even before Sheilas arrival, the therapist was to announce that she had
retired from the job as group truant officer. She was off Sheilas 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 therapists change in attitude, at which time the therapist
could connect directly to Sheila, and convey relief in revising the relationship.
Something like: Its 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 Sheilas 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 Sheilas 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
therapists 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 therapists 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 peoples 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 groups 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 patients and groups projective identifications and making
meaning from them. Winnicott (1971) developed the related concept of
holding and playing with the patients 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 members 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 didnt come back after last week, I accepted her communications with a rueful smile. But youre stuck with me, and Im 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 Ellas 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 communicators 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 Ellas accusations literally and sought to argue his
position. Ellas 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 groups contributions, I
could represent their emotional relationship in tolerated verbal thought. And
both listened.
Bonding is ubiquitous in transferencecountertransference

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 analysts 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 therapists 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 therapists 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 Rachels
determination to leave group as a pathologically entitled need for special
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attention. Indeed, on considering the total situation of the transferencecountertransference, we could say that Rachels dissatisfaction was a
sensitive response to the therapists 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 clinicians
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 groups 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 Elis aggression, such that the group could
proceed relatively undisturbed. And finally, in the fifth example, Rachels
inclination to withdraw from group was a meaningful response to her therapists emotional withdrawal. The therapists 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 therapists 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 therapists 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 introjectiveprojective 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 groups 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 groups
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 individuals 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 groups 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,
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REBELLION IN GROUP
173
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 groups 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 anothers 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
174
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 ones 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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175
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 Freuds
(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 individuals 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 ones 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).
Bions 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
176
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 dtat, 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 members disruptive, anti-social and
destructively rebellious characteristics. In a constructive group, members
reinforce each others normal reactions and wear down each others neurotic
reactionscollectively 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 members group self and the groups 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
REBELLION IN GROUP
177
by the leader who does not live up to their groups 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 rebellions 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 Ritas
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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179
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 groups
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 groups 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 individuals 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 couples 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 Carls
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 couples 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 Ritas 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 doesnt 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. Thats 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 groups focus
to her psychology and away from issues of my leadership. She became increasingly impatient with her group as well as Carls for the lack of attention to
legitimate reality issues behind her suffering: Carls 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 Ritas 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 containercontained relationships, all of
which involve using ones 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 therapists 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 isnt
mine, Im not paying it. You better give it to him! We had not witnessed Tonys
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: Im sorry to have
hurt you.
Thats 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 dont want to get off the hook, I said. Lets 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, Im sure other people have
reactions and they might want to join in. Several members commented on the
intensity of Tonys 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 Tonys 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 Im sorry, very sorry. I didnt want to hurt you. Please
forgive me. Tony responded with a new burst of anger: No, Richard didnt
speak to me the way you are. If he had, maybe I wouldnt 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 didnt communicate with Tony with the depth
of feeling you are conveying because I dont 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 cant stand it
when my wife or kids accuse me of something I didnt do. It doesnt matter if
Im 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 Im 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: Im 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 Tonys 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 cant 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 groups basic disposition
and mode of functioning.
The group remained unperturbed, confirming its receptivity to Tonys
anger, while not supporting his mode of thinking. Cant you see that people
are interested in you and your anger, but that you dont 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 groups vocal reactions as reprimands:
Tony, are you hearing that members think you shouldnt 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 members 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 Tonys 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 cant continue in your kind of
group, it makes no sense. Im 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 Ritas 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 Tonys 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 groups 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 Kleins 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 Marxs 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 groups 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, Freuds 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 therapists words should upset (unsettle,
decenter, disturb, perturb) the given (p.12). The therapists 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 therapists own preconceptions, represent personal risk and open the way for self-discovery.
190
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
isnt even cold! Is this a message to us: You can be replaced? I wanted to
mourn Daniels 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 groups 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 members impending arrival, particularly if it occurred during an intense group period. That would be the best
REBELLION IN GROUP
191
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 therapists
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
192
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 therapists rebellion

The therapists 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
transferencescountertransferences, 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 Bions structural theory of affect, and apply
the theory to group process and the psychology of the members. Chapter 9,
on primal affects, differentiates Bions 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
leaders relationships to them. To preview this volumes 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
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194
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: Bions 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 Kleins 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 Freuds 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 infants 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
PRIMAL AFFECTS LOVING, HATING, AND KNOWING
195
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 ones thinking about emotions the movement of K over the fields
L, H and K that virtually defines the quality of ones 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 Bions 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 individuals 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
Bions 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 individuals thinking. They need to
be considered in the group: To what I have already said about emotional
drives I add a reminder that the analysts 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
Bions equivalence to Piaget, Lorenz and Tinbergens concepts of innate
schemata and innate releasing mechanisms, and of Jungs 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 Bions 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 Freuds formulations, he
considered it essential for ones 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
otheror a conviction of ones 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 ones 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 dont 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 dont really know me and dont 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 didnt know what I wanted to be when I
grew up. Im 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 dont 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 dont 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 groups dis-ease (Bions 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.174175; see
also pp.102103). The exaggerated intensity of the groups 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 individuals 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 mans understanding of the
groups 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 groups affective response or the disruptive effects of his

behavior on the groups 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 dont
realize what Im feeling. It is like it never happened and I leave group feeling
bad in my stomach and I dont know why. Sometimes I dont even feel the pit,
until later, and I dont 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 leaders task is not to eliminate the groups 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 patients emotional experience of the session, but limit
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the description to the interplay among the primal affects. The analysts 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 analysts 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 Bions 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 didnt 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 majoritys 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 presenters role as
center of attention, competition for the presenters 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 Bions 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 groups 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.165166), he did not give
the weight we now do to this concept: the dual to the groups transference is
the leaders countertransference (see Chapter 10, section on Bions 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 evenings 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 wasnt 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 moments 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 womans criticisms, as much as the criticisms themselves, made
her angry. There really was not much of an opportunity to check out other
peoples 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 classs 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 pleasurablethe 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 latters
arrogance (-K), aggression (-H), and emotional deprivation (-L).
There is ample evidence in Experiences of Bions 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 groups need, a mystic had come forth to
expose me to my countertransference, to address the mania in my own refusal
to experience the classs 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 classs 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.
214
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 critics attention and
of the groups 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 Capers (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 classs
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 therapists 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
216
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
thinkers 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.1213). 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 ones
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 ones 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
PRIMAL RECEPTIVITY THE PASSIONATE THERAPIST: THE PASSIONATE GROUP
217
experience. They are the underlying categorical invariants that members

bring to each and every group encounter, especially to ones 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 ones 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 Bions Grid. Meltzer (1978) found the placement of
passion on the Grid to be mysterious. At the same time, he acknowledged
the study of Bions concept of passion could lead to a new approach to
218
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 patients self-conscious emotional
219
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 ordertogether 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 ofactivity 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 groups 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 groups 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
220
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 Id 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 didnt 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 lackmust be regarded as
functions of L, H and K links of the self with the self (Bion 1965, pp.7374).
The therapists moderated emotional curiosity may productively intensify
the groups 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 groups 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.
221
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 Im in
group? You like her talking about you because it feeds your ego. Im not the
kind of a person who has to fall in love with my analyst to be cured. Thats
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
doesnt have a crush on the therapist?
Margos indignant denial of sexual feelings had the untoward effect of
eroding her gender-based support. She protested too much, the other women
asserted. Hes 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 womens verbalizations of sexual feelings and
fantasies represented, partially, efforts to repair Margos 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 Margos curiosity, to encourage her to think metaphorically rather than concretely.
The women had attended to Margos 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
222
like to watch. Ill take sloppy seconds. You take yours now, Im learning
from you. Ill get mine later. What about me Rich? Im in love with you too.
Can we do threesomes? When did our group become x-rated? I must have
missed a week, but wont miss again!
The groups 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 groups seemingly loose exchanges, including my own,
while spontaneous and expressing basic feeling and fantasy, were also
purposive. The exchanges represented quasiassociations to a common
contextbased 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 therapists 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 therapists 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 therapists sophisticated mental processes that are involved in the
formation of an interpretation.
Passion establishes and invigorates the links within and between the
analysts 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 members 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 clinicians
conflicts and resistances, and an impediment to treatment. Countertransference was also the vehicle by which the clinician could come to
understand and interpret the patients 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 elses phantasythe
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 passionsby 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 containercontained, 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 Reniks (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 peoples 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 transferencecountertransference 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
Bions advocacy of negative capability extended Freuds 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 therapists 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 groups 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 analysts 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 analysts actual trial suffering of the
patients pains as his or her own is the transference, from the patient to the
analyst (p.483, Grotsteins emphasis). I am suggesting that the group
therapists suffering also involves primal receptivity, tolerating the painful
emergence of ones 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 transferencecountertransference.
The concept of passion advances the historical consideration of countertransference by delimiting an independent area within the therapists 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 therapists 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 transferencecountertransference.
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 todays
passion was not yesterdays enactment. Passion may appear clear in theory,
but it is an optimal mode of functioning to which the group therapist can but
aspire.
The therapists passion furthers the groups passion

The therapists 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 ones own
primal affects, L, H and K, activated by social participation. These affects
provide links to the therapists 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 groups 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 groups awareness was being advanced.
Why were the members starving themselves of emotional experience?
I felt uncomfortable. Perhaps I was carrying the groups 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 LoriPeggy relationship, and the
majoritys 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 couldnt 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 Peggys 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 Peggys 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 wouldnt 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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Franks next comment released a floodgate of hostility, which supported

my hypothesis regarding the groups 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: Its 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
Loris 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 Loris 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 youre
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 didnt like Lori and Peggy vying for you.
Lori blushed, then turned to Frank: Thats fair. I do feel threatened with
Peggys arrival. Shes young and smart. And pretty. I dont 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: Youre still
not looking at me.
A man who had been quiet praised Peggys liveliness. Ralph informed
him that Peggy was being competitive and hurtful. Peggy: Thats fair too.
Sorry, Lori. Im a fighter, now you know. Maybe Im not sure you [the
therapist] are so different from my father. My parents were divorced, and he
never had much time for me. Im sorry for breaking in on you, Lori, or maybe
Im not.
Lori looked at me plaintively. She too was a fighter, and could very easily
hold off Peggys 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]: Dont get hopeless and withdrawn, were here for you, [to Peggy] and
for you too. Frank: Lori, youre 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: Im being hurt by Peggy
and you dont protect me. She can say and do whatever she wants. I have to let
you know when Im 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 therapists 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 groups
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 transferencecountertransference, 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 groups 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 transferencecountertransference, 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 ones 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 therapists 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
therapists functioning analytic libido alert for and embracing manifestations of LHK moves the group beyond basic assumptions, beyond transferencecountertransference 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 McLaughlins (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 transferencecountertransference and the resulting enactments as the inevitable background for the
237
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 therapists 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 transferencecountertransference. In
broadcasting their emotional experience, our patients connect us to other
minds and therefore arouse the therapists 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 therapists 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 therapists passion is
central whether or not the therapist shares explicitly subjective feelings and
thoughts.
Group members intuitively perceive their therapists passion. They assess
and appreciate their therapists 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 193194
group culture, and affects
Active Analytic Group Therapy
of leader 212213
for Adolescents (Evans) 11
H, integration of 211214
adolescent groups
instinct theory, Bions
bonding, as symbiotic
relational revision of
relating 141142
193194
communicating, in
intersubjective sensibility, as
commensal group
passion 193
139144
K, and minus K
disturbance, containing
communication
parental involvement
208209, 212213
137
key emotional dimensions,
therapist, participation
reassessing 211213
of 137
leaders utilization of
tragedy, turning to
206207
comedy 136137
LHK relational structure,
waiting room family
addition of 194, 195
therapy 137138
as life instinct of individual
Hamlet archetype, and
and group 196
thinking 30, 133136
meaning, suffering of
leader, containing qualities
200203
of 143144
as not nice 199200,
see also play, adolescent;
211212
relational levels,
plus and minus, and aims of
traversing
Eros and Thanatos
affects, primal (LHK)
194195
all groups challenged by
protomental contents
207, 219
alpha functioning
central role of 193
197, 198199
cognitive or curiosity
inherent
motive, assumption of
preconceptions,
194195
theories of 198
defining 193
premonitory anxiety
disease in groups, and
197198,
minus LHK
201203
alpha-functioning,
status of and relationships
primal affects not
between 195196
transformed by
tolerating anxiety provoked
204205
by 199200, 211212
group mentality,
see also basic assumptions;
uncontainable
thinking
feelings deposited aggression, therapy as act of
into 204
4849
minus emotions, and
alphafunctioning
beta elements
alphafunction in reverse
205206
26
eliciting 209211
dream-work-alpha 19
Subject Index
249
method acting 27n2

primal affects not
transformed by
204205
and protomental contents
197, 198199
and theory of
transformations 17,
2022, 25, 111112
American Psychological
Association 48
analytic third subject, role of
18, 118
antithinking
anarchy 181182
minus K 7576, 8488,
119
see also thinking
anxiety, of therapist
conflicting guidelines
individual and group
therapy,
combination of
46
members, selection of
4546
objective analyst, myth
of 4647
countertransference
and new members
5860
working with 6466
emotional amplification,
and contagion 5455
exposure, fear of 5053
group persona, reconciling
with analytic self of
individual
work 59
group therapy, dread and
fear of doing
characterological
issues 49
preexisting
relationships,
destabilization of
4849
resistance, to group
49, 50
250
group treatment,
idealization of 5556
personal growth, accepting
the invitation for 6668
training institutions,
attitudes of 4748
see also basic assumptions;
entitlement anxiety
badness, of therapist
119120, 122123, 125
basic assumptions
and bonding 157
and countertransference
containment of 6465
resistance to 5657
dependency 39, 5657,
197, 208, 230
fight/flight 5657, 88,
146, 150, 157, 182,
197, 208, 211212,
229, 234
group leaders participation
in 3940
mentality, adoption of
5758
and minus LHK 204205
pairing 39, 5657, 197,
208, 230
parasitic relations 124
and passion 218222
and primal affects
196197, 206207
protomental state
196197
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
alphafunctioning)
see also affects, primal
bizarre objects, and thinking
as dangerous 8082
bonding
aggression, overcoming
153
as basic relational need to
love 153
and containercontained
2324, 158
description of 152153
as developmental
accomplishment 153
and empathy 164165
and group cohesion
158161, 159161
and identification 153157
progressive and regressive
forces in 157158
reflective thought,
preverbal foundations
of 30, 157158
and sense of safety 155
as symbiotic relating
141142, 160161,
167168
and therapeutic alliance,
absence of 161164
as therapeutic technique
accommodations,
versus
interpretation 165
empathy 164165
securing and
maintaining
bonding 165168
in transferencecountertrasference 168170
verbal articulation of, and
resistance to 170171
boundaries
ceasura and maintenance of
1819, 22
intact, need for 18
and projective
transidentification 19,
22
relational levels, traversing
148149
Systems Ucs. and Systems
Cs., contact barrier
between 1819
Building on Bion: Branches

(Pines) 11
Building on Bion: Roots (Pines)
11
case material, and fact/fiction
issues 4344
commensal relations see
relational levels; therapist,
containing function of
containercontained
adolescence, relational crisis
of 132133
bonding 2324
emotional development,
thinking and
socialization,
relationship between
110111
growth, psychoanalytic
problem of
communication, on
many relational
levels at once
128129
interpretation,
positioning in
genetic spectrum
127128
metacommunicative
information,
importance of 128
and human development
111112
intersubjective thinking
emotional flexibility
113
mulitdimensionality
112113
social network,
function of
113114
language 118
as reciprocal interaction
110
see also
alphafunctioning;
countertransference; relational
SUBJECT INDEX
theory; therapist,
reciprocal learning process
containing
106
function of
Richard III (Shakespeare),
countertransference
as embodiment of 92,
bonding 168170
95
and containercontained
and rights over thinking 90
model 1718
and selfevaluation
containment of 6465
106107
as dual to group
therapists vulneralbility to
transference 209212
98100, 103, 163
and entitlement 9596
transference and
as God 37
countertransference,
hallucinosis,
distinguishing between
transformations in
103106
8384
universality of 94
and intersubjectivity 3536
value conflicts over 9293
and passion 223228,
entitlement anxiety (therapist)
234237
clinical examples of 5962
resistance to 5657
leadership and power
and transference,
6264
distinguishing between epistemological metatheory
103106
(Bion) 21
working with 6466, 114 Eros and Thanatos (Freud)
194195
dependency see under basic
exorcism 2425
assumptions
Experiences in Groups (Bion)
depressive and
29, 3738, 157, 181
paranoidschizoid
oppositions see PSD
fight/flight see under basic
assumptions
entitlement
Formulations Regarding the Two
absence, and suffering of
Principles in Mental
separation 8990
Functioning (Freud) 73
adaptive aspects of 9192
Foulkesian group analytic
controversy over, in
ideas 11
supervision 9397
Frankenstein monster, creation
counterentitlement and
of 95
entitlement, dynamics of FreudSalome correspondence
9497, 100103
16
differences of opinion,
tolerating 106107
gratitude, appreciating 66
entitled signification,
Grid (Bion) 38, 217
resorting to 9899, 103
exaggerated 9091, 94, 95 hallucination
hallucinosis,
healthy functions of 9192
transformations in
inhibited 90, 91
8288
interpretative versus
and introjection of beta
accommadative
elements 213
techniques for treating
107109
251
and suffering of separation

8990
Hamlet archetype, and
thinking 30, 133136,
150
hating (H) see affects, primal
idealization transferences,
resistance to 5758
identity, and bonding 154
individual, as group in itself
14, 15
individuality, redefinition of
1314
instinct theory, Bions
relational revision of
193194
intersubjectivity
containercontained as
model of 112114,
119, 127
and countertransference
3536
and passion 193, 216217
and selfunderstanding 34
see also bonding
knowing (K) see affects, primal
language
of basic assumption group
124
as container 118
paralinguistic significations,
power of 170171
in symbiotic relations
120121
use of, and achievement of
passion 219220
LHK see affects, primal;
passion
loving (L) see affects, primal
mathematical theories, and use
of notational symbols 21,
38
medication, use of 180181
memory and desire,
eschewing of 16, 38, 207,
235
252
method acting, and

alphafunction 27n2
mourning, and LHK
200201
thinking, intense
awareness of 226
transferencecountertr
ansference,
partaking in and
narcissism
transcending 227
versus groupishness 175
as informative of
versus socialism 15
metaexperience
see also entitlement
217218
negative capability 224225
and intimacy 218
see also memory and desire,
as intrasubjective process in
eschewing
intersubjective context
216217
O
language, and achievement
fear of 18
of 219220
and theory of
meaning of 216
transformations 2023,
mobilizing in a group
2526, 111112
220222, 228236
object permanence, and
myths 216, 218
abstract thought 89
psychoanalytic objects,
objective analyst, myth of 13,
elements of 215218
14, 4647
sense 215216, 218
Oedipus myth 34, 80, 216
therapist, instruments of
passionate
pairing see under basic
alphafunction in
assumptions
reverse 26
paranoidschizoid and
dreaming couple, idea
depressive oppositions see
of 25
PSD
fielddependence,
parasitic relations see relational
receptivity and
levels; therapist, containing
arrival of selected
function of
fact 2425
passion (Bions concept of )
PSD oppositions, and
as achievement of
processing of O
selfconscious
23, 2526
awareness 218219
sense/myth/passion
affects, integration of
triumverate 25
216217, 219, 228
uncertainty, tolerating
as capacity to suffer 24
233234
personal growth, accepting
distinguishing from
the invitation for 6668
bad and good
Platonist, Bion as 16, 22
analysis 236237
play, adolescent
R, using concepts of
adult thought, preparation
223225
for 150
suffering meaning
as integral part of mature
226227,
thought 133, 151
234236
normal and pathological
therapist, human
131132
limitations of 236
parasitic, to establish
symbiotic
communication 131,
139
relational levels, shifting
between 150151
therapists capacity to play,
actualizing 151
power
and entitlement, dynamics
of 6264, 9497
and powerlessness 94
preverbal communication
1920, 30, 69, 157158
see also alphafunctioning
primal affects see affects,
primal
projective identification
and projective
transidentification 19,
22
in symbiotic relations
120121
and theory of thinking
1920, 73, 7780, 88
using and withdrawing
123124
protomental elements see beta
elements
PSD (paranoidschizoid and
depressive) oppositions
and emotionalcognitive
oscillations 73
and processing of O 23,
2526
psicolumn, and id as
wishfulfilling 28n5
psychotic thinking 75, 76, 87
rebellion
and adaptive compliance,
tension between 174
anarchy 174, 181186
antigroup 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
174175
polarization 173174
rebellion as inevitable
phase of group life
175176
resistance 172173
revolution 187189
secession/exile 179,
180181
social action, pathways of
3031, 172
of therapist 189192
value conflicts 173
relational levels
commensal relating, and
poor communicators
139144
containercontained model
nesting processes 113,
119, 127, 129
psychodynamics, as
group phenomena
129130
relational levels 30,
110130
suborganizations of
personality, and
relational levels
129
and human development
commensal relations,
establishment of
112
parasitic variation,
development of
112
symbiotic,
containercontain
ed processes as
111112
traversing
aggression and hatred,
drawing on own
147
bondedness, sense of
149
boundaries,
maintaining
148149
constructive
communication,
pursuit of
147148
emotional realizations,
dealing with
painful 133
fight/flight culture,
group as 146, 150
and Hamlet archetype
134136
peer supervisory
group,
transmission of
group process to
149150
in play 146, 150151
regression to
symbiotic and
parasitic levels
133
reluctant individuals,
not pursuing 149
subgroup, activities of
149
violent transference
communications,
containing
144147
see also therapist, containing
function of
relational theory
Bions contribution 3738
and role of therapist 3334
resistances, of therapist see
anxiety, of therapist
reverie state, and theory of
transformations 17,
2022, 25, 111112
Second Thoughts (Bion) 157
selfdisclosure
and analyst as omniscient
sphinx 52
253
employing 185
forms of 51
inevitability of 5051
intentional 5152
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
groupasawhole
interventions 41
interpretation, and other
interventions 41
memberinspired dynamics
33
minimalist intervention
technique 4041
passion, achievement of
42
relational approach, and
role of therapist 3334
selfunderstanding, and
intersubjectivity 34
therapistinfluenced
dynamics 3637
transferencecountertransfe
rence, evolution and
mutual understanding
of 3536
working group culture,
defining 42
therapist, containing function
of
commensal relations
117118
in supervisory
dialogue 118120
symbiotic relations as
foundation for
122
communicative process as
twoway 115
254
utilization of 114
parasitic relations
basic assumptions,
operating from
124
hating and being
hated, tolerating
124
projective
identifications,
using and
withdrawing
123124
in supervisory
dialogue 125127
therapeutic frame, as
container 124,
126
thinking, hatred of
123
problem as presented
115117
qualities, of therapist 115,
143144
separate point of view,
maintaining 115
symbiotic relations
language and
120121
in supervisory
dialogue 122123
therapist, active
presence of
121122
transformative, containing
as 114115
thinking (Bions theory of )
antithinking (minus K)
7576, 8488, 119
Bions special meaning of
3839
as dangerous and bizarre
8082, 8488
emotional conflict 7172,
87
epistemological drive 20,
21, 7475
fantasy, role of 73, 7475
hallucinosis,
transformations in
8288
hatred of 76
K, extension as truth
instinct 20
learning to endure process
of 69
meaning, as relational 30,
70, 72
painful nature of 7374
projective identification
as normal preverbal
mode 1920
role of excessive
7780, 88
relational consciousness
and development of
unconscious
thought 7071
partial hating of 30,
72
transformations, theory of
17, 2023, 2526,
111112
Totem and Taboo (Freud) 102
training institutions 15,
4748
transference
and bonding 168170
idealization, resistance to
5758
see also countertransference
truth instinct 20
uncertainty, tolerating
233234
valency (amplification) 54
virtual other, infants
experience of (Brten) 14
writings, difficulty of Bions
11, 13, 3839
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
Brten, 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-ODea, 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
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

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Relational Group Psychotherapy

Origins and Context of Bions Contributions to Theory and Practice

International Library of Group Analysis 20

Building on Bion: Branches

Contemporary Developments and Applications of Bions Contributions

International Library of Group Analysis 21

The Group as Therapist

ISBN 1 85302 906 8

International Library of Group Analysis 14

Dreams in Group Psychotherapy

Theory and Technique

International Library of Group Analysis 18

Selected Papers on Group Analysis and Psychoanalysis

International Library of Group Analysis 1

The Social Unconscious

ISBN 1 84310 088 6

International Library of Group Analysis 22

Foundations and Applications of Group Psychotherapy

International Library of Group Analysis 10

INTERNATIONAL LIBRARY OF GROUP ANALYSIS 26

Relational Group Psychotherapy

Jessica Kingsley Publishers

British Library Cataloguing in Publication Data

To the groups that bred, fed, and led me.

Malcolm Pines, Institute of Group Analysis, London

James S. Grotstein, School of Medicine, UCLA

The Authority of the Group Therapists Psychology

The Therapists Anxiety and Resistance to Group

The Basic Conflict: To Think or Anti-think Applying

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Primal Affects Loving, Hating, and Knowing

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I am very pleased to be able to present this monograph by Richard Billow in

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