SECTION III: Group process: moving towards K

Editor’s note

Successful group meetings, according to Billow, are ones where leader and members engage in the pursuit of significant psychological truths. These can be historical reconstructions, here-and-now interpersonal realizations, or even common existential anxieties. No matter. To an extent, it is less about the garden than it is about the gardening, more about the open-ended pursuit of knowledge (K.) than its attainment. But how do groups come to possess the necessary blend of patience, creativity, and rigor that allow growth to occur? And how can deep convictions be challenged and modified without reflexive dismissal of the other, or masochistic submission? The four chapters in this section deal with group processes and leader interventions that address these questions and facilitate behaviors and felt experiences likely to increase cooperation, creative problem-solving, and psychological-mindedness.

Chapter 8 focuses on bonding, the feeling of connectedness necessary for any meaningful learning to occur. For group members to be moved by fellow members or by the leader, they need to be sufficiently confident of their benevolent intentions, integrity, and trustworthiness; they need to feel like the other is doing something with them rather than to them (Benjamin, 1990). In discussing—and illustrating—his technical approach to bonding, Billow provides an alternative to the contemporary relational focus on recognition, rupture, and repair (e.g., Benjamin, 1990) or the self-psychological/ Winnicottian emphasis on accommodation and holding (e.g., Bach, 2016). Instead, he suggests using one’s subjectivity creatively and benevolently, while accessing a range of communicative tools. These include, but are not limited to, the use of humor, explicitly supportive comments, and blunt challenges. The chapter also highlights two common obstacles to bonding: misdiagnosing (and pathologizing) patients’ legitimate bonding needs and overlooking our own need to feel bonded with our patients or supervisees. Once these pitfalls are identified, bonding needs are met, and anxieties worked through, members and leaders feel safer to explore new ways of being and thinking.

One of the harder things to do in a group therapy session is to identify, and expand upon, the most significant common threads. Such threads are relevant to many if not all of the participants, link members to each other, and deepen the group’s discourse. Expanding on Bion’s (1963) notion of a

“psychoanalytic object,” Billow defines a new term the “nuclear idea”1—an event, a theme, or a metaphor with the potential to address two questions: (1) What is at the center or heart of current group process? and (2) What has the potential to generate or release the most psychic energy? The nuclear idea may be explicitly acknowledged by the group or its leader (as in the ‘checkpoints’ example) or implicitly discussed (as in the ‘two groups’ example); it can alleviate tensions, acknowledge them, or generate new ones. Ideally, it is down-to-earth and experience near. To aid therapists (and groups) in identifying nuclear ideas, Billow suggests tuning in to what is fresh, affectively charged, and unexpected. In line with Pines’s (1985) important distinction, it promotes coherence rather than merely cohesiveness.

Stated simply, group cohesiveness implies a degree of closeness between members and a general positive attitude towards the group-as-a-whole. However, groups can unite around a mutual enemy, or admiration for a sports team, and this does not necessarily provide therapeutic benefits. Coherence implies a unity that is based on a shared logic or higher order organization. In the therapy group, this is achieved despite (or perhaps owing to) the other’s separateness, and through an agreement to keep learning about, and from, each other. This brings us to the next chapter, which describes the tension between two types of learning: about one’s internal world and its correspondence with the external world as seen by others (reality testing), and about the creative/experimental options one has of who to become (testing reality).

Reality testing, which Freud (1917b, p. 233) classified as “one of the major institutions of the ego,” continues to be an essential aspect of group work, regardless of stage. In relaying the importance of reality testing to me. Billow contended that a large reason why patients stay in treatment is that they trust the accuracy—and clinical relevance—of their therapists’ reality-oriented interventions. Like any good explanatory system, reality testing reduces the level of unexpectedness of events: it helps us better understand ourselves (our psychic reality) as well as others (our external reality). Within the group context, therapists promote reality testing by encouraging honest feedback, providing it themselves, and titrating the amount of “reality” different members are given based on (the therapist’s assessment of) their ability to tolerate others’ perspectives.

In contrast, testing reality is geared towards trying out new ways of being: a conflict-averse member may try to express dissatisfaction, an overly critical member—express empathy, and a member used to being at the center of the action—be silent. Therapists too can test reality, and their groups benefit from their willingness to improvise and take emotional risks. Of note, testing reality does not have to be behavioral and can also include new ways of being internally. By definition, it is experimental and novel, likely to move into uncharted territory. It reduces our ability to predict how others will respond to us or how we will feel at any given junction. As the chapter illustrates, the leader’s role in advancing testing reality is to encourage members to go “as deep as they feel comfortable” and protect them from some of the dangers they may encounter on their psychological and interpersonal voyages.

Concluding this section is a chapter that returns to the central role of the leader in moving the group towards K. The four modes of relational engagement—diplomacy, integrity, sincerity, and authenticity—inform interventions as well as an overall leadership stance that both directs and models truth-seeking. Diplomacy is defined in the Oxford Dictionary (2018) as “the art of dealing with people in a sensitive and tactful way.” In Billow’s use of it, diplomacy does not necessitate being gentle or conflict-avoidant. Rather, it entails titrating the amount of truth that the leader believes the group can tolerate by leaning on status and authority. Examples include protecting a new or vulnerable member from scapegoating, averting the discussion away from a sensitive topic when the session is about to end, or disturbing stale alliances.

To act with integrity (etymologically meaning “whole”), the leader must reject sainthood and asceticism as ideals, and sometimes be willing to “sin” (Orwell, 1946/1981). As the case vignettes show, the leader is neither devoid of self-interest nor attempts to hide it. This can be freeing for members since, as many of us know, being in the presence of saints can be quite oppressive.

Sincerity and authenticity, as modes of engagement, are both used colloquially, often interchangeably, to describe a congruence between what’s inside of us and what we present to the world. Here, Billow links sincerity to the either/or, idealization/demonizing stance of the Kleinian paranoid-schizoid position, and authenticity to the more mature, able-to-tolerate-ambivalence stance of the depressive position. Therapeutically, we can appreciate sincerity’s importance via its less charitable opposites, hypocrisy, and dishonesty. To feel cared for, members need to trust the leader’s communications despite his or her financial (and narcissistic) self-interest. Beyond words, sincerity is conveyed in tone, facial gestures, and actions over time.

I end this note with a few words on Billow’s Kleinian slant on authenticity, which has yet to be sufficiently incorporated into our clinical theorizing. The distinction between our “true selves” and the “masks” we wear is, he avers, a false dichotomy. Our feelings, intense, and real as they may seem are not facts, and we are not just pretending when we occupy social roles. To use a rather trivial example from my personal life, when my four-year-old son refuses to do anything I say and gleefully splashes bath water on my dry clothes, I get thoroughly frustrated and count the minutes until he goes to bed. But being authentic means not reducing myself to this narrow version of an impatient father by holding in mind my love for him, the pride I have in myself as a caring father, and the sadness about the fleetingness of his adorable/infuriating four-year-oldness. To live authentically, we need to struggle with the tension between who we are and who we want to be, with being less dissociated, owning our projections, and being less reactive to others’. Though it is always a work in progress, our groups generally reward us for our efforts.


1 An expanded exploration of the nuclear idea can be found in Billow (2015).

Chapter 8


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