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Resistance, Rebellion and Refusal in Groups

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Richard M. Billow expands and develops his ideas, first presented in Relational Group Psychotherapy: From Basic Assumptions to Passion. He constructs a theoretically sophisticated, yet experience-near approach to contemporary group therapy. Building on Bion's striking theoretical realignment, replacing the polarity unconscious-conscious with infinite-finite, Billow revises traditional concepts and terms to offer a new model of relational group psychotherapy.In this book he defines the essential therapeutic task: to address the hunger for truth, an appetite stimulated by the group itself. Group members bring infinite potential into the room, but the truth that is developed and realized is bounded by the nature of their interrelationships, individual psychologies and perspectives, as well as by human limitations in processing experience to make it meaningful. How the therapist, along with group members, assess and respond to the need for truth, in the immediate clinical context, create the phenomena of resistance, rebellion, and refusal.The group therapist remains central in the action: evaluating and responding to the truth needs of the various individuals and the group itself and detecting and minimizing the impact of falsity.Using lively clinical anecdotes, Billow demonstrates how the group therapist deals with the dynamic forces of the 3 Rs, operating in four relational modes: diplomacy, integrity, sincerity, and authenticity. This volume is essential reading for individual and group psychoanalysts and psychotherapists, academics, and students of psychoanalytic theory.

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Chapter One: The group never leaves the room: The radical nature of combined psychotherapy

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CHAPTER ONE

The group never leaves the room:
The radical nature of combined
psychotherapy

I consider the combination of individual and group psychoanalytic psychotherapy to be radical, that is, foundational and primary in the mindset, stance, and identity of the committed psychotherapist. It imbues my thinking and the theory and case examples in The 3 Rs . The combined modality actualizes many of the precepts of relational psychoanalysis, a movement Mitchell (1993) proclaimed revolutionary, leading to a paradigm difference (Hoffman, 2006), and so, it is radical in that sense too.

Relational life involves a duality. The human being needs groups, and not only dyadic relationships, to secure a psychological identity, to organize and ground thinking, and to grow emotionally. But the tendency to establish organization and structure may lead to rigid customs, hierarchies of status and power, and conformity, what Bion (1970) referred to as a truth-avoiding Establishment. As I will explain in Chapter three , an effective leader wears two faces: conservator and revolutionary. He or she introduces principles and practices that normalize dyadic and group relations and provide a sense of cohesion, continuity, and regularity. Yet, to be constructive and seek the qualities of emotional truth that lead to growth, such an individual is also deconstructive, encouraging the individual and the group to question and challenge the very principles and practices that he or she asserts.

 

Chapter Two: Truth, significance, and the role of falsity

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CHAPTER TWO

Truth, significance, and the role
of falsity

By virtue of their appearance in this book, my words are granted Establishment credibility, but each reader decides if they are significant. In a similar vein, our professional credentials give us voice and professional status, however, our group members decide if what we say is true, and further, significant.

The novelist William Burroughs (1985) captured an essence of what I will be getting at in Resistance, Rebellion and Refusal in Groups: The 3 Rs: Truth is used to vitalize a statement rather than devitalize it. Truth implies more than a simple statement of fact. I dont have any whiskey, may be a fact but it is not a truth. Significant truth vitalizes the self and relationships, such as I am attempting to establish with the reader; significant truth vitalizes the group, and society at large.

Worse than being right or wrong is the failure of an interpretation to be significant (Bion, 1970, p. 79). I qualify Bions aphorism, for an interpretationlike any interventionis an intersubjective construction. Its rightness,and its significance remain subjective without a final or fully objective assessment.

 

Chapter Three: The two faces of the group therapist

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CHAPTER THREE

The two faces of the group therapist

As leader of the group, we introduce principles and practices that normalize group relations and provide a sense of continuity and regularity. To establish cohesion, we encourage bonding among members and monitor each members bond to us. Conforming to the group norms provides an important sense of identity, regularity, and security for the therapist as well as for other group members. Yet, we risk creating a conformist Establishment , becoming too comfortable in the overt and covert alliances and compromises we make with other group members our self and put off thinking about and investigating these arrangements.

There needs to be, then, dialectical tension in our functioning. In order to preserve a well-working group, or attend to the difficulties of an ineffective one, the leader must be constructive and deconstructive. As I will propose in later chapters, the leader not only responds to rebelliousness, as emphasized in traditional Freudian approaches to groups, but also, functions as rebel.

 

Chapter Four: Introducing the 3 Rs of relational group psychotherapy

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CHAPTER FOUR

Introducing the 3 Rs of relational
group psychotherapy

All men by nature desire to know.

Aristotle, Metaphysics

I am met with hostility and live in such isolation that one might suppose that I had discovered the greatest truths.

Freud, from a letter of March 13, 1896;
in Laplanche & Pontalis, 1973, p. 397

Configuring the 3 Rs

I was assigned an afternoons workshop at a regional group therapy conference. The topic was Formulating the Unformulated. I had anticipated that the attendees might want me to lead an experiential group, and then use the data to discuss ideas developed in Relational Group Psychotherapy: From Basic Assumptions to Passion. However, the challenges that arose and the relationships that developed within the group impacted on me and opened up a line of thought thatin calling attention to dynamics of rebellion and refusal prompted what was for me a new understanding of resistance .

I describe a painful emotional juncture, not unique to me, I am sure. The situation is this: The group therapist or leader has gone too far, feels he or she has gone too far, or has been accused of going too far. The offended group member generates a network of sympathy and support, and attention turns antagonistically to the leader. Questions are raised regarding the leaders mental and emotional balance, principles and practices, personality, psychodynamics, and motivation.

 

Chapter Five: Resistance

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CHAPTER FIVE

Resistance

I have introduced my ambition in Chapter four : to distinguish between various clinical phenomena, usually subsumed under the umbrella term resistance . Freud (1900a) emphasized the wide reach of this concept: whatever interrupts the progress of the analytic work is a resistance (p. 517). In this broadest sense, resistance remains a foundation concept in psychoanalysis and psychodynamic group therapy (Rosenthal, 1994).

To some extent, psychoanalytic psychotherapists agree with Freud, who held that all progress in psychotherapeutic technique hinges on the increasingly accurate evaluation of resistance (Laplanche & Pontalis, 1973, p. 395). As our techniques have evolved, so too has our understanding of resistance and our relative comfort with its manifestations.

Freuds mythological model of resistance

The clinical phenomenon of resistance came to light by Freuds technical innovation in the treatment of neurosis with patients not amenable to hypnosis. Freud urged that they produce memories of what had originally occasioned their symptoms. Some patients said they knew nothing, while others produced obscure recollections that they could not pursue further.

 

Chapter Six: Rebellion

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CHAPTER SIX

Rebellion

We turn to the topic of rebellionwhen a faction rebels, how the group and leader respond to the conflict, and how the conflict is resolved. I presented the essence of my ideas in Chapter eight of Relational Group Psychotherapy, and I rely, with some modifications, on that text. The illustrative clinical examples and accompanying discussions are new. I also clarify and emphasize the distinctions between anarchy and the other pathways of rebellion: defiance , secession/exile , and revolution .

Groups are not tranquil, as they are composed of individuals with different needs, wants, and goals. Disagreement over principles and values, the direction of the group, and the modus operandi of the leader, are to be expected, and these dynamicsamong others that relate more specifically to the intra- and inter-psychic relationships among individualsstructure the groups formation, motivate its membership, and drive its process.

I describe different 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 unappealing, or even futilea judgment that depends on the state of mind of the rebel as well as on the groups authenticity (see Chapter eight, this volume ): its genuine receptivity to discussion and change. The rebelling faction feels that to participate in the principles and practices of the current or proposed direction of group interaction would require unacceptable submission. The values represented by rebellion may be presented as intellectually, morally, emotionally, or pragmatically unassailableabsolutenot subject to extended disagreement, negotiation, or repudiation. As rebellion arises, there may seem no route available for successful compromise.

 

Chapter Seven: Refusal

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CHAPTER SEVEN

Refusal

As explained in earlier chapters, all efforts to delay, modify, or counter forward movement of psychotherapeutic work traditionally have been captured under the umbrella term of resistance . In distinguishing a category of refusal , I aim to signify divergent processes and strategies of reaching, sharing, or rejecting mental content in the social setting. More narrowly defined, resistance refers to the dynamics and defenses that block nonconscious-to-conscious processing, and there is always symbolization. As explained in Chapter five , working through of resistance entails embracing vague and partially unformulated aspects of internal experience and gradually articulating these elements, to make them comprehensible to self and other.

Refusal , in contrast, involves a willful nonparticipation in discovering or learning about psychic material, with a goal often of suspending or blocking some mental activity. It is predicated on the sense or anticipation that something is or might go awry. The phenomenology of refusal manifests by opposition, noncompliance, and emotional, mental, or social withdrawal. What I am identifying as refusal most often has been understood as a specific, intense form or strategy of resistance, blocking psychotherapeutic process and progress. However, as we shall see, there are instances and domains where refusal may be adaptive.

 

Chapter Eight: The four modes of therapeutic interaction

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CHAPTER EIGHT

The four modes of therapeutic interaction

Managing truth

I refer again to Emily Dickinsons poem: Tell the truth, but tell it slant . The truth must dazzle gradually, or every man be blind, which expresses our limited capacity to tolerate truth and its effects. As emphasized throughout the 3 Rs : individuals and groups of all sizes need and long for truth, which is necessary for security and growth. But, significant truth is often anxiety arousing, and not easy to reach, contain, and communicate. And, even when benevolently offered and welcomed, truth may hurt, mislead, or obstruct.

Freud (1920g) considered the analyst the arbiter of truth. The therapeutic task was to reveal the repressed: discover the unconscious material that was concealed from the patient, put it together, and, at the right moment, communicate it to him (1920, p. 18). I have suggested that, to the extent to which the therapist is expert, it is in pursuing a search for emotionally meaningful truth: evaluating and responding to the truth needs of the various individuals and the group itself and detecting and minimizing the impact of falsity.

 

Appendix I: Basic concepts: Relational group psychotherapy

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APPENDIX I

Basic concepts: Relational group
psychotherapy

1. States of mind: Intrapsychic-interpersonal-transpersonal
    (group level)

Kleinian theory postulates two basic states of mind, the psychotic or primitive, and the neurotic or normal. The former consists of two positions (plus the enduring manic defenses against both positions ) that inform our emotional outlook: paranoid-schizoid and depressive . The positions must be tolerated and processed, informing and vitalizing the learning and growing self/group with pre-rational levels of feeling and thought. Similarly, Bion described two states of mind in a vital group that must interact the basic assumption and work group mentalities. The work group needs the bas to learn from experience. The therapist fosters primitive-sophisticated interactions via bonding, confronting, and interpreting ( container-contained ).

Bions three types of basic assumptions associate with psychotic position s and manic defenses (and to LHK , see below).

a. BaF/F The fight/flight assumption refers to the paranoid-schizoid outlook in which others are experienced as potentially dangerous.

 

Appendix II: Basic concepts: Resistance, rebellion and refusal

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APPENDIX II

Basic concepts: Resistance, rebellion
and refusal

Basic premises

The development of the individual and the growth of the group occur through mentation: the generation, pursuit, and articulation of truth that is appropriate and legitimate to its human context.

The dynamic conflict: truth-falsity, rather than consciousness-nonconsciousness. Group organization and activity conceptualized as a series of moves and countermoves to express, redirect, modify, or block the search for emotional truth.

Traditionally, all efforts to counter psychotherapeutic work have been captured under the umbrella term, resistance . However, the assumptions, methods, and goals of therapeutic work may be challenged metapsychologically, philosophically, ethically, pragmatically, and politically. Hence, rebellion and refusal .

Resistance , rebellion and refusal may not signify maladjustment or pathology, or antagonism to all emotional thinking and manners of pursuing it, but rather, to the particular approach or purpose of the endeavor, which may be experienced and evaluated as false.

 

Appendix III: Basic concepts: Diplomacy, integrity, sincerity, and authenticity

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APPENDIX III

Basic concepts: Diplomacy, integrity,
sincerity, and authenticity

Basic premises

The development of the individual and the growth of the group occur through mentation: the generation, pursuit, and articulation of emotional truth that is appropriate and legitimate to its social context.

Group organization and activity may be conceptualized as a series of moves and countermoves to express, redirect, modify, or block the search for emotional truth. Hence resistance , rebellion and refusal : the 3 Rs.

Diplomacy , integrity , sincerity , and authenticity are modes of relatinghow the group therapist uses self to build relationships, establish cohesion, foster process, generate meaning, and respond to challenges and impasses. They describe the leader in interaction: how he or she approaches emotional truth. Passion exists in the mode of authenticity.

All interventions may be captured under these overlapping rubrics, which are exhaustive but nonexclusive, and are influenced by intersubjective group processes. They supply conceptual references for the interactional stance one has adopted, allowing the therapist to be more aware of what he or she is doing, and why.

 

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