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of related interest
Building on Bion: Roots
Origins and Context of Bion’s Contributions to Theory and Practice
Edited by Robert M. Lipgar and Malcolm Pines
ISBN 1 84310 710 4
International Library of Group Analysis 20
Building on Bion: Branches
Contemporary Developments and Applications of Bion’s Contributions
to Theory and Practice
Edited by Robert M. Lipgar and Malcolm Pines
ISBN 1 84310 711 2
International Library of Group Analysis 21
Two volume set ISBN 1 84310 731 7
The Group as Therapist
Rachael Chazan
ISBN 1 85302 906 8
International Library of Group Analysis 14
Dreams in Group Psychotherapy
Theory and Technique
Claudio Neri, Malcolm Pines and Robi Friedman
ISBN 1 85302 923 8
International Library of Group Analysis 18
Circular Reflections
Selected Papers on Group Analysis and Psychoanalysis
Malcolm Pines
ISBN 1 85302 492 9 pb
ISBN 1 85302 493 7 hb
International Library of Group Analysis 1
The Social Unconscious
Selected Papers
Earl Hopper
ISBN 1 84310 088 6
International Library of Group Analysis 22
Foundations and Applications of Group Psychotherapy
A Sphere of Influence
Mark F Ettin
ISBN 1 85302 795 2
International Library of Group Analysis 10
INTERNATIONAL LIBRARY OF GROUP ANALYSIS 26
Relational Group Psychotherapy
From Basic Assumptions to Passion
Richard M. Billow
Foreword by Malcolm Pines
With an Introduction by James S. Grotstein
Jessica Kingsley Publishers
London and New York
Reworked and excerpted material from the following journal articles I authored appears in the following
chapters. Chapters l and 2: (2000) ‘Self disclosure and psychoanalytic meaning: A psychoanalytic fable,’
Psychoanalytic Review 87, 61–79; (2001) ‘The therapist’s anxiety and resistance to group,’ International Journal
of Group Psychotherapy 5, 83–100. Chapters 2 and 4: (1997) ‘Entitlement and counter entitlement in group
therapy,’ International Journal of Group Psychotherapy 47, 459–474; (1998) ‘Entitlement and the presence of
absence,’ Journal of Melanie Klein and Object Relations 16, 537–554; (1999a) ‘Power and entitlement: Or, mine
versus yours,’ Contemporary Psychoanalysis 35, 475–489; (1999c) ‘An intersubjective approach to entitlement,’
Psychoanalytic Quarterly 68, 441–461. Chapter 5: (2001a) ‘Relational levels of the container–contained in
group,’ Group 24, 243–259; (2003a) ‘Relational dimensions of the “container–contained”,’ Contemporary
Psychoanalysis, in press. Chapter 6: (2003a) ‘The Adolescent Play: Averting the tragedy of Hamlet,’
Contemporary Psychoanalysis, in press; (2004) ‘Working relationally with adolescents in group,’ Group Analysis,
in press. Chapter 7: (2003b) ‘Bonding in group: The therapist’s contribution,’ International Journal of Group
Psychotherapy. Chapter 8: (2003c) ‘Rebellion in group,’ International Journal of Group Psychotherapy, in press.
Chapter 9: (1999b) ‘LHK: The basis of emotion in Bion’s theory,’ Contemporary Psychoanalysis 35, 629–646;
(2001b) ‘The class that would not read: Utilizing Bion’s affect theory in group,’ International Journal of Group
Psychotherapy 51, 309–326. Chapter 10: (2000a) ‘From countertransference to “passion”,’ Psychoanalytic
Quarterly 69, 93–119: (2000b) ‘Bion’s “passion;” the analyst’s pain,’ Contemporary Psychoanalysis 36,
411–426: (2002) ‘Passion in Group: Thinking about loving, hating, and knowing,’ International Journal of
Group Psychotherapy 52, 355–372.
All rights reserved. No part of this publication may be reproduced in any material form (including
photocopying or storing it in any medium by electronic means and whether or not transiently or
incidentally to some other use of this publication) without the written permission of the copyright owner
except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the
terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London,
England W1P 9HE. Applications for the copyright owner’s written permission to reproduce any part of this
publication should be addressed to the publisher.
Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim
for damages and criminal prosecution.
The right of Richard M. Billow to be identified as author of this work has been asserted by him in
accordance with the Copyright, Designs and Patents Act 1988.
First published in the United Kingdom in 2003
by Jessica Kingsley Publishers Ltd
116 Pentonville Road
London N1 9JB, England
and
29 West 35th Street, 10th fl.
New York, NY 10001-2299, USA
www.jkp.com
Copyright © 2003 Richard M. Billow
Library of Congress Cataloging in Publication Data
Billow, Richard M., 1943-
Relational group psychotherapy : from basic assumptions to passion / Richard M. Billow
; foreword by Malcolm Pines
p. cm. -- (International library of group analysis ; 26)
Includes bibliographical references and index.
ISBN 1-84310-738-4 (alk. paper) -- ISBN 1-84310-739-2 (pbk. : alk. paper)
1. Group psychotherapy. 2. Group psychoanalysis. I. Title. II. Series.
RC488 .B475 2003
616.89’152--dc21
2002041106
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
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 9
FOREWORD 11
Malcolm Pines, Institute of Group Analysis, London
INTRODUCTION 13
James S. Grotstein, School of Medicine, UCLA
PREFACE: PLAN OF THE BOOK 29
Chapter 1 The Authority of the Group Therapist’s Psychology 33
Chapter 2 The Therapist’s Anxiety and Resistance to Group 45
Chapter 3 The Basic Conflict: To Think or Anti-think – Applying
Bion’s Theory of Thinking in the Group Context 69
Chapter 4 Entitled Thinking, Dream Thinking,
and Group Process 89
Chapter 5 Containing and Thinking – The Three Relational
Levels of the Container–Contained 110
Chapter 6 Containing the Adolescent Group 131
Chapter 7 Bonding in Group – The Therapist’s Contribution 152
Chapter 8 Rebellion in Group 172
Chapter 9 Primal Affects – Loving, Hating, and Knowing 193
Chapter 10 Primal Receptivity – The Passionate Therapist:
The Passionate Group 215
BIBLIOGRAPHY 238
SUBJECT INDEX 249
AUTHOR INDEX 255
Acknowledgments
It is wonderful to have a good friend, more wonderful still and rarer to have one
with a brilliant mind that can understand the meaning behind an illogical
thought, and provide the grammar to untwist it, a musical ear to improve its turn
of phrase, a creative eye for its ideal expression, and a demanding character to
insist upon its being good enough. Dr. Charles Raps has been with this project
from its inception, and Relational Group Psychotherapy has benefited greatly from
our many theoretical discussions and occasional arguments, from his original
contributions, and from his encouragement, careful reading, and detailed editing
of each draft of the manuscript. He is patient and giving beyond what I should
have expected, certainly not asked for, although I asked and received with equal
rapidity, and I am deeply grateful.
Dr. Malcolm Pines, Editor of the International Library of Group Analysis, has
been an enthusiastic reader of my writing and supporter of this project from the
initial outline and plan of the book and has shepherded its publication by Jessica
Kinsgley. I appreciate very much his welcoming Foreword to this volume. Dr.
James Grotstein continues to be an inspiring explicator of Bion as well as one of
psychoanalysis’ most creative forces. I am honored by his erudite Introduction,
which represents a significant contribution in its own right. Dr. Earl Hopper
perused the final manuscript and complimented me by providing a
thought-provoking analysis. He also suggested some needed reorganization of
material. Dr. Rosemarie Carlson read the final version to correct for theoretical
inconsistencies and stylish infelicities.
Drs. Michelle Berdy, Elyse Billow, Robert Mendelsohn, Joseph Newirth,
Beth Raymond, and Bennett Roth, and Doris Friedman, M.S.W., have read and
made helpful comments on various sections and chapters. The following editors
have worked with me as I developed certain themes that first appeared in their
journals: Drs. William E. Piper and Cecil Rice of the International Journal of Group
Psychotherapy, Owen Renik of the Psychoanalytic Quarterly, Jay Greenberg, Donnel
Stern, Ruth Imber, Sandra Beuchler, and Robert Langan of Contemporary Psycho-
analysis, 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 discus-
sions with them. The candidates in the Adelphi Postdoctoral Group Program
have been a particularly valuable resource, providing rich material from their
own practices as well as participating creatively in experiential learning. Finally, I
thank the inspirational sources of my thinking, and writing: the sensitive and
articulate individuals I have been privileged to work with in my clinical practice
and with whom I have suffered and enjoyed the group experience.
Foreword
I am very pleased to be able to present this monograph by Richard Billow in
this series. In my opinion, Billow is the most able author in our field to present
the theoretical and clinical thinking of Wilfred Bion. Bion’s writings are noto-
riously difficult to comprehend and Billow has made a significant contribu-
tion in bringing together Bion’s salient notions in a way which I am sure will
be very welcome to readers. Beyond that, Billow shows how he has been able
to use these seemingly abstruse notions in clinical work, in supervision and in
teaching. I have immersed myself in Bion’s ideas for the past three years,
whilst engaged in co-editing another monograph in this series, Building on
Bion: Roots and Building in Bion: Branches, which shows the fertile application
that many persons are able to make of his work. However, it is Billow’s book
that brought many stimulating vignettes to life.
I am glad to see that Billow has been able to make use of Foulkesian group
analytic ideas and to make links between Foulkes and Bion. This applies also
to his understanding of Winnicott.
Psychodynamic group work with adolescents is a notoriously difficult
area. Billow’s vivid description of his work with adolescents should give
confidence to clinicians who are working in this area. Billow’s experience
complements that already described by John Evans in an earlier book in this
series, Active Analytic Group Therapy for Adolescents (1998).
Malcolm Pines, Institute of Group Analysis, London
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 Bion’s con-
tributions to it. I am not a group therapist, but after reading Dr. Billow’s theo-
retical and clinical explications, I began to wish that I had been. I do know
something about the works of Wilfred Bion, however, having written about
them on many occasions, and, furthermore, having been analyzed by him.
From this background I believe I am in a respectable position to evaluate Dr.
Billow’s understanding of Bion’s ideas. I found his understanding remarkable.
Bion’s works are hard reading for most. He, like Lacan, seems to write in
‘poetics,’ that is, in the style of evocation of ideas rather than in clarification,
which to him amounted to closure. His ideas open up innumerable hypertexts
or asides, rarely end in closures. In my own contribution here I shall epitomize
and paraphrase Dr. Billow’s superb rendition of Bion’s work.
Group therapy, like individual psychotherapy, once began as a stepchild to
orthodox-classical psychoanalysis but ultimately grew into its own entelechy
as a unique form of treatment in its own right. ‘Relational’ group psycho-
therapy is the next generational distinction in group therapy’s career in which
the relational component began to assume a dominant role. The term ‘rela-
tional’ 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 RELATIONAL GROUP PSYCHOTHERAPY
of internal groups and that the external group may function as a cohesive
individual. It is the concept of individuality itself that seems to be in need of a
post-modern, relativistic redefinition. Sperry (1969) and his colleagues,
Gazzaniga and LeDoux (1978), came to a similar opinion about the need for a
redefinition of individuality from their brain-laterality researches. More
recently the Norwegian sociologist, Stein Bråten (1993), suggests that the
infant has an inborn propensity to experience a ‘virtual other’: ‘…[T]he
observer is invited to view them [infants] as one self-organizing system, not
two, and yet with a differentiated self–other organization’ (p.26). The title of
his thesis is ‘Born with the Other in Mind’ (p.25). With these ideas in mind,
Sullivan’s (1953) notion of ‘participant observation’ as a shared faculty –
shared by therapist and patient and/or group member – becomes more
cogent than ever.
Yet a paradox exists. For individual analysts or for group leaders
(therapists) to maintain their authority and to be able to be a container for
their patients, they must achieve and maintain some considerable degree of
separateness from their patients. Perhaps we can reconcile the problem by
suggesting that the analyst, therapist, group leader must ultimately be separate
and yet at the same time allow him or herself to be vulnerable to experiencing
both the emotions emanating from their patients and from their own
emotional states as well. Robert Fliess’s (1942) term ‘partial identification’ on
the therapist’s part fits in well here. I believe this is one of the ideas that the
author is trying to get across in this work. Put another way, the classical
posture of the separate, neutral, objective, and unaffected therapist must exist
alongside his or her emotionally-affected counterpart. I believe that Bion
(1959, 1962, 1963) makes this point clear in his formulation of the qualifica-
tions of the analyst or group leader as container of his or her patients’
anxieties.
While addressing the process of group psychotherapy from many vertices
(Bion’s way of stating ‘points of view’), the author organizes the chapters of
the book along lines that issue from the works of Bion, whom he puts forward
as one of the prophets in the contemporary relational reformation. I concur.
Bion was the first post-modern, relativistic Kleinian, the one who first tran-
scended the Cartesian boundaries that had (and still do) encased so much of
classical and Kleinian thinking. In my own contribution I shall expand on
some of Bion’s ideas that the author has imported and thoughtfully applied to
his study of the group psychotherapy process. Moreover, because Bion’s pro-
fessional 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 expe-
riences, 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 rela-
tionships, 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 pre-
sentation of patients in combined therapy as control cases’. I heartily agree.
The group experience brings out dimensions of a patient’s character that all
too frequently escape detection in individual treatment. Bion puts forward the
idea that ‘narcissism’and ‘socialism’ are two significant tropisms in individuals
and that individual analysis is better handling the former. Received wisdom
suggests that group therapy seems better in dealing with character problems,
habits, and problems in interpersonal relating. At the very least group therapy
and individual therapy seem to complement one another. I for one believe that
group therapy or analysis – as well as group process (i.e. Tavistock groups)
should be a part of institute training.
