Kaës' Internal Groups and Actual Groups: A Relational Perspective.

Rene Kaës (2007), an influential French psychoanalyst relatively unknown to English-speaking readers, extends the field of psychoanalytic investigation and practice to groups. Building on Klein, Anzeiu, Bion, and Lacan, Kaës presents a dual-axes theory in which early oedipal and sibling complexes structure unconscious dynamics of internal groups. According to Kaës, analytic group psychotherapy provides access to the phantasies, affects, and action tendencies contained within internal groups that would be otherwise inaccessible. While a few reference articles have appeared in the English literature, Kaës' bold assertions, core concepts, and praxis have not been subject to critical evaluation. I introduce Kaës' main ideas, demonstrate their influence on my group work, and by comparing two case examples, from his practice and mine, articulate our differences, some of which arise from different conceptions of and approaches to intersubjectivity. The discussion continues in the final section which briefly considers the nature of psychoanalytic learning and how we may employ the therapeutic group to reach this goal.

Opening Laplanche's Window: Transference-Countertransference in Psychoanalytic Group Psychotherapy.

Comparing analytic activity to a spaceship launching, Laplanche (1999, pp. 231-232) suggested that there are "windows;" opportune interpretative moments. Laplanche emphasized the enduring impact of intergenerational "enigmatic messages," such that all individuals cope with an essential "alterity" (otherness to oneself). He did not consider the countertransference implications. I propose that the analyst must also open the self-reflective window and pass through "originary situations" to prepare for intervention. In accordance with Kaes' (2007, p. 98) formulation that "the unconscious is structured like a group," I illustrate how unique windows of opportunity exist in psychoanalytic group treatment. Sharing and competing in a therapeutic space with "like me's," group members reexperience intense "horizontal" as well as "vertical" transferences, as does its leader. Clinical examples illustrate my efforts to mediate among interacting "translations" of early developmental experience-mine as well as other group members-to understand emerging psychic material.

Attention-Getting Mechanisms (AGMs): A Personal Journey.

All relationships could be described in terms of the coordinations and conflicts between competing needs for attention and the mechanisms utilized to seek this goal. In this article, I introduce the initialism AGM (Attention-getting Mechanism) to refer to an interpersonal style or particular behavior or constellation of behaviors that one adopts and displays publicly that is unhealthy, repetitively counterproductive and ultimately harmful to self and/or others. Delineated from socially- and personally- productive modes of seeking attention, self-defeating AGMs categorize across varied spectra, from subtle and seemingly inhibited, to blatant, excessive, or frankly pathological. They arise in response to trauma and psychological disturbance and, as such, are the outcome of enduring deficits in getting appropriate and sufficient attention. I record the evolution of my thinking and doing, over the course of leading two group sessions, spaced several months apart, regarding dilemmas in getting attention. The first drew me to the topic, and, unexpectedly, stimulated personal associations and remembrances, which centered on a cumulative childhood trauma organized around the term, "AGM." I approached the second session better equipped to understand the proceedings, and to connect my ideas to current diagnostic criteria, technical considerations, clinical research, and metapsychological theory.

Witnessing: The Axis of Group.

We enter the group and, to some degree make choices in what we observe and focus on, and how we participate and make our presence known. Unavoidably, and with limited control, we are thrust into a public position of witness and witnessed. Witnessing deals with the impact of embracing experience beyond observing and participating-the uncertain consequence of coming to know and becoming known. It is specifically the axis of personal growth and transformation around which a dynamically oriented group process rotates with our leadership. Discussion and two case examples illustrate its key features and the role members and therapist play in fostering this process.

Doing Our Work: Words, Deeds, and Presence.

Group leadership is an art, with relational tools of words, deeds, and presence. We aim to take our groups to creative places that they-and we ourselves-have never been before. Something needs to happen, fresh experience needs to emerge that becomes relevant to the growth of the members, including the therapist. The therapist's work is done while we are also doing something else. It entails a dual focus, or "binocular vision," directed to personal discovery, while also focused on the group's realities and growth potentials. Three case examples illustrate how the work happens to us: we evolve as a person as we do the work.

On Deconstructive Interventions.

Deconstructive interventions challenge the group, thought, and language itself. They are common and frequent. When we say, "stay in the room," redirect attention to a disregarded or unnoticed interaction, symbolic or real, play with words and metaphors, or even raise a quizzical eyebrow, we are making a deconstructive intervention.I distinguish among three types of deconstruction and show their relevance to our work via clinical anecdotes. Transformative deconstructions seek to dismantle one set of conventions to supplement or supplant with another to create new meaning. Reflective deconstructions mine for and analyze alternative meanings of any set of communicative conventions. Diversity deconstructions direct attention to social and political meanings-and consequences-of specific narratives, based on power relations and status, as pertaining to gender, sexual orientation, age, race, or ethnicity.

On the Origins of Clinical Interventions.

I use my own experience in responding to Dr. Shay's assignment to illustrate key relational principles. Clinical data resides in an intersubjective field in which the therapist's psychology-including its irrational and preverbal elements such as those that appear in a dream-provides entry points and remains prominent in understanding and intervening. A troubling dream clarified my emotional reactions to the assignment, which progressed from resentment, mental isolation, and refusal to guilt, curiosity, and concern. The dream had purpose to reconnect me to my commitment to the Special Issue. I could fulfill Dr. Shay's assignment of addressing the evolution of my thinking. I then felt free to offer a relational path through this difficult, if imaginary, group.

Reality Testing and Testing Reality in Group Treatment.

This two-part contribution addresses concepts of "reality," "reality testing," and "testing reality," as they apply to group treatment. Part I provided topic overview and focused on reality testing. Part II focuses on testing reality and how it promotes emergence of new or previously inhibited forms of engagement.Whereas reality testing centers on a particular theme or object, with a goal to define and solve problems, testing reality involves approaching targets of interest without necessarily looking for or coming to definition or clarity. It is wide open, spontaneous, and unbounded, and may take the individual and group into realms that are uncomfortable and even unwanted. Engaging the group and supporting individuals in these two approaches to learning requires a well-defined therapeutic focus on process and purpose; at times, different tactics and techniques are called for.

Psychic Nodules and Therapeutic Impasses: Three Case Studies.

I introduce the term "nodule" to call attention to a particular type of irruption into the individual and collective's psychology. Something happens that punctures ongoing communicative flow, hijacking the individual and group focus. Personal associations and group discourse do not integrate usefully, furthering self-reflection and group work. Rather, a nodule crystallizes: an amalgamation of preoccupying affects and feelings, fantasies, reality statements and suppositions, bodily states, actions, and action-tendencies.When primarily affecting the individual, nodules become interpersonally consequential: they create therapeutic impasse and may lead to confusion, disorganization, and anarchy in the group and larger social spheres. In this article, I report on the combined individual-group treatment of three individuals struggling with intense and repetitive irruptions, and their impact on their respective groups.

Reality Testing and Testing Reality in Group Treatment Part I: Reality and Reality Testing.

This two-part contribution addresses reality, reality testing, and testing reality-how we think about and may technically approach these concepts. Part I provides a topic overview and focuses on reality testing. Part II (in an upcoming issue) focuses on testing reality and how it promotes emergence of new or previously inhibited forms of engagement.Reality testing and testing reality represent two fundamental, reciprocal manifestations of the drive to know and of tasks of learning: approaching problems and solving them. While testing reality involves approaching reality without necessarily looking for or coming to definition or clarity, reality testing centers on a particular theme or object. It evolves towards organization and rationality, with a goal to define and solve problems-or to avoid them.Engaging the group and supporting individuals in these two types of approaches to learning requires a well-defined therapeutic focus on process and purpose; at times, different tactics and techniques are appropriate.

The Therapist Dissociates: Psychic Nodules and Group Process.

I introduce the term nodule to call attention to the effects of a particular type of irruption into the therapist's psychology, leading to dissociation. A preoccupying state of mind emerges that muffles, mutes, or blots outs other internal and external channels of communications. The therapist's associations do not integrate usefully, furthering self-reflection and contributing to productive leadership. Rather, a nodule crystallizes as the therapist becomes preoccupied with an amalgamation of affects and feelings, fantasies, reality statements and suppositions, bodily states, actions, and actions-tendencies. I focus on the influence of psychic nodules on me, as a commandeered subject, and their effects on the communicative matrices (nodes) of three groups I led.

Sense and clinical sensibility.

I call attention to the metapsychology of sense, and the role sense plays-phenomenologically and symbolically-in the life of the clinician and the group. Each group member asserts influence in taking a role as the perceiver and the perceived, the senser and the sensed. We reach for sense, for without sense reference, we cannot grasp or even talk about psychic reality. It serves as sign and symbol, as metaphor, analogy, illustration, and model. Sense fixes experience yet may fixate experience and interfere with developing abstract thoughts. Clinical vignettes illustrate how the leader may utilize his or her particular clinical sensibility to reach the group and focus attention, to link sense to psychic qualities: to the personality of the members, the group culture and process, and the live clinical interaction.

Developing the nuclear idea: concept, technique, and process.

I introduce an approach to group that has remained undeveloped in the literature, but represents an essence of relationally oriented group psychotherapy. Evolving from the verbalizations and enactments through which the group symbolizes and becomes known-a nuclear idea takes shape. It emerges from the nucleus of the group process: co-created from intersubjective forces and locations that cannot be fully specified, yet may be possible to observe, name, and utilize clinically. Groups organize themselves by developing nuclear ideas, with the therapist's active participation. They are vehicles through which a group comes to think about its thinking: not only what it thinks, but also how it thinks, or chooses not to think, and when and why. Developing the nuclear idea provides a framework for how the therapist-and the group itself-goes about the task of containing. With its emphasis on meaning and the development of meaning as transformational, the concept of the nuclear idea supplements the whole group, interpersonal, and intrapsychic lenses through which the therapist comes to understand group experience and base interventions. Clinical vignettes illustrate how the therapist may develop nuclear ideas thematically, conceptualize further, and negotiate meaning with the co-participation of other group members.

The invited presenter: outrageousness and outrage.

I describe aspects of a multimodal presentation sponsored by a professional organization of group psychotherapists, entailing lecture and discussion, a small demonstration or fishbowl group, and a large group experience. As the invited presenter, I was being counted on to attract attendees, to stimulate and maintain their interest, and to draw enthusiasm to the host organization and its future conferences. This required, in short order, promoting cohesion, establishing norms, and creating a safe enough culture to embrace challenge, to take risks, to learn, and to seek help. Events occurring in both the larger and smaller groups were to be utilized for the benefit of the individuals and the groups themselves, to make the experience interesting and sufficiently compelling, to teach the basic principles promised by the conference's theme, and to demonstrate technique. Dysfunction or negative consequences were to be avoided. My mode of leadership was perceived by some as positive if not outrageous, but for others it just provoked outrage. Perhaps such reactions are to be expected whenever a leader challenges a group to experience and think in new ways. I tried to utilize the ensuring controversy to illustrate the conference's topic: loving, hating, and curiosity-group processes of resistance, rebellion, and refusal.

On inveiglement.

Inveiglement is a mode of interpersonal influence and control that has particular relevance to group, organizational, and political life. In inveiglement, a person or group is diverted from knowing, believing, or thinking about an idea or a perception that exists mentally, or that could be generated. In the former situation, inveiglement may be conceived of as induced dissociation; in the latter, an impingement on the capacity to think and generate thoughts. In both situations, the individual or group becomes mentally bound by the parameters imposed by the other, constricting freedom to think and behave independently. I describe four subtypes: toxic, neurotic, communal, and presentational inveiglement, and provide clinical illustrations from group psychotherapy.

On scrutiny: a nuclear idea.

Scrutiny has been investigated in ethnology, political philosophy, social and aesthetic criticism, in empirical developmental research, and in this paper, as a nuclear idea. I describe a series of group psychotherapy sessions in which each member's mental relationship to the prospect or experience of scrutinizing or being scrutinized became a prominent and productive theme in the group, and was treated psychoanalytically.

It's all about "me" (behold the leader).

The group beholds its leader: a looming figure of fantasy, an emerging figure of reality. Psychic patterns that play out in group cohesion, culture, conflicts, and process are rooted in interaction with this combined object. I describe a two-day conference on relational group psychotherapy. An assemblage had beheld "me," a visitor with gifts of knowledge, initially welcomed with collective expectation. Rivalrous and acquisitive desire (Girard, 2004) set group process in motion, involving scapegoating and open conflict, but also, self discovery and mutual appreciation. Confronted with "me," the representative, messenger, even embodiment of truth, the group had to deal with feelings, fantasies, and thoughts that were "not nice." There were moments of fear for the safety and survival of our group, yet I did not comprehend the extent to which envy, in tooth and nail, with devouring hunger tore into every aspect of our mentalities. Under its catabolic force, I was captured and I could not articulate to myself the sense of what it was, until the group shifted and released me from envy's intersubjective captivity. In group, whatever is being talked about-whoever is reacting to whom or to what-the group's focal conflict, predominating basic assumption, developmental level or stage, its regressions and progressions, dyadic interactions, subgroupings, and so forth, I now assume that on one level, it is all about "me."