Bion on Group Therapy

Why do groups of people have trouble keeping focus on tasks?

Bion postulated that people in a group are always torn between working on the overtly stated group task, and what the unconsciously assume is the real group task. Members have a conscious purpose and a collective unconscious purpose with a different agenda.

Unconscious agendas are often primitive in nature, and aim at gratifying primitive desires. Members collude in an unconscious, out-of-awareness process in which the group acts as if it is meeting for a different purpose.

What are these unconscious assumptions? Bion postulated three basic assumptions and they parallel Freud's oral, anal an oedipal primary processes:

In the dependency basic assumption, group members act as if they are helpless while the leader is omniscient. This often occurs when the group meets with a high ranking official from their company. Members unconsciously maintain that if they are patient, their leader will come forth with a miraculous solution to their problem. The group might offer up a sick member in order to test the leader. The group members do not really care about he suffering member; they are using the person to get what they all need from the leader. The members' expectations of the leader are so high that the leader has to fail. Frustration is a key emotion of such a group.

In the flight/fight basic assumption, the group meets to fight or flee from an enemy. The leader is needed to find the enemy and then lead the group into or away from battle. The individual members do not matter to anyone; if a few get trampled on in the fighting or fleeing, it is an acceptable loss. There is no room for sick or weak members. Members are anti-intellectual and anti-introspective. They have no frustration tolerance. What matters is the preservation of the group and the need to act.

Hope is the hallamrk of the pairing basic assumption. In this assumption, the group is waiting for a messiah to come and save it. (Sound like any culture you know?) It is important that this messiah NEVER come, members are waiting for redemption - they don't actually want it - that would stop them from doing what they are already doing, and they are enjoying what they are doing. Sometimes the group unconsciously sees a couple in the group as the prospective parents of the messiah. Other times, the messiah is seen as a new idea or other form of creation. Interestingly, delusions concerning messiahs are commonplace in psychosis.

Again, these assumptions mirror Freud's psychic stages, they represent the repressed disavowed wishes the people hate to admit to. This is why they stay repressed.

A basic assumption operates in all groups, according to Bion. In some instances it helps with the task at hand. The church depends on the dependency assumption as it keeps people placated and willing to toss cash in the collection plate. The military loves the fight or flight assumption, as it helps to rid people of the usual concern for life, and keeps people from questioning those in command and the oligarchy adores the paring assumption, as it keeps the masses focused on some miraculous future and away from the truth of now.

Bion does not focus merely on group think, Bion also speaks of a concept known as valency which is the individual tendency of a person towards one kind of assumption. It is possible for an individual to be at odds with the majority assumption.

Source Used:

Basics of Group Psychotherapy, Guildford Press

BINOCULAR VISION’ AND THE PRACTICE OF PSYCHOANALYSIS

Paulo Cesar Sandler, MD, MSc
São Paulo

[One thought alone occupies us; we cannot think of two things at the same time. This is lucky for us according to the world, not according to God] Pascal, Pensées, 145

SUMMARY  Bion developed some observational concepts and tools that enhance the apprehension of psychic reality during an analytic session. This paper deal with one of them, ‘binocular vision’. It is examined in its philosophical (epistemological) roots and implications, as well as in its psycho-analytical roots. The synthesis made by Bion of some Locke’s, Hume’s and Kant’s contributions (on commonsense, constant conjunction and the noumenic realm, respectively) is adumbrated; also, Bion’s innovative integration of some of Freud’s and Klein’s observations of mental functioning (the theory of unconscious and the splitting processes, respectively). The paper reproduces the clear-cut definition made by Bion of the concept; and examines some philosophical and psycho-analytical implications of it. Binocular vision is seen as an useful aid to tolerate paradoxes, which seems to be a basic fact of human condition, and as a factor in the discovery and formulation of some fundamentals of psycho-analysis. Group phenomena such as the conflict between ego-centric and socio-centric tendencies of the individual, on dependence of the prevalence of death and life instincts, are reviewed, including clinical cases. Intra-session uses of binocular vision in what regards to achievement of a sense of truth and its contrasting hallucinated counterpart, the feeling of attaining ‘absolute truth’. False depression and false paranoid-schizoid position phenomena are focused, with the aid of binocular vision. Above all, a way of dealing with the analytical session profiting from the alternative of observing dream work in waking life, that is, the ability to elicit the latent content out from conscious verbal formulations uttered by the patient, is open through the use of binocular vision. It seems that binocular vision is a posture we have at our disposal to attain the psycho-analytical vertex. The study considers that it helps us not to be too mesmerized by the manifest content, by superficial psychology; that it rescues the richness of Freud’s original psycho-analysis in its most profound ethos. Is it welcome at a time when the question, ‘one psycho-analysis or many’ (Wallerstein, 1988) is on the agenda? When psycho-analysis itself seems to be at stake?

INTRODUCTION The apprehension of both mental functioning and its disturbances can be enhanced by resorting to models empirically grounded in a Kantian sense. It is their capacity for raising particular cases to a general level that lends scientific legitimacy to these models. Some of them are drawn from psychiatry while others stem from poetry and mythology in the form of powerful imagery, or from commonsense, plain discourse. Many verbally formulated models are doomed to turn into a technical jargon. As such they hamper the meaning of the author’s apprehensions by deteriorating into ‘pompous phraseologies’, ‘psychobabble’ which nourish ‘formalistic’ habits. They badly damaged poetry and mathematics, as was shown by William Wordsworth and A. N. Whitehead respectively. Precisely to avoid such after-effects, Bion formulated his models in commonsensical parlance. ‘Binocular vision’ is a model of the latter kind.

DEFINITION Although the binocular vision model pervades the whole of Bion’s work since 1944 (a group’s ‘Basic assumptions’ are binoculars), its first explicit definition dates from 1962, when it was linked to Bion’s observation of psychotics with thought disturbances (Bion, 1962b, p. 54). For example, the obese patient who sheltered a greedy, skinny inner self; or the shy, pale patient who was unable to blush sensuously. The clinical observations appeared in Cogitations . They seem to correspond with intra-session data obtained from 1959 to 1960. The clinical data suggested to Bion the need to amend – rather than reject -- a specific aspect of Freud’s theory of consciousness as a sensuous organ for the perception of psychic quality. He found that the Pleasure/Unpleasure principle and the Reality principle were to be regarded as genetically non-sequential, simultaneous events: ‘the conscious and the unconscious thus constantly produced together do function as if they were binocular therefore capable of correlation and self-regard. Because the manner of its genesis, impartial register of psychic quality of the self is precluded: the "view" of one part by the other is, as it were, ‘monocular’’ (Bion, 1962b, p. 54; my bold).... ‘The model is formed by the exercise of a capacity similar to that which is in evidence when the two eyes operate in binocular vision to correlate two views of the same object. The use in psycho-analysis of conscious and unconscious in viewing a psycho-analytical object is analogous to the use of the two eyes in ocular observation of an object sensible to sight.’ (Bion, 1962b, p. 86).... The analyst in therefore in the position of one, who, thanks to the power of "binocular" perception and consequent correlation that possession of capacity for conscious and unconscious thought confer, is able to form models and abstractions that serve in elucidating the patients inability to do the same’ (Bion, 1962b, p. 104, n. 19.2.1).

PHILOSOPHICAL ORIGINS Bion was able to integrate seemingly different but in fact mutually complementing philosophical achievements from Locke, Hume and Kant (Sandler, 1997b). ‘Binocular’ refers to obtaining a discrete image through the constant conjunction (Hume, 1748) of two images by the two human eyes or two sets of lenses, along a longitudinal imaginary axis. The revival and improvement of Aristotle’s concept of ‘commonsense’ (Locke, 1690) allowed for the establishment of a fundamental epistemological method of apprehension of reality, brought to psycho-analysis by Freud and Bion. It is constructed from pairs, or counterpoints. For example, in a dark room one has the tactile impression of fur. A second sense, hearing, informs us that a ‘meow’ is present too (Bion, 1959, p. 10). The overall perception, and consequently the apprehension of reality is enhanced. This reality to be apprehended is beyond the spectrum covered by the human sensa apparatus; it is the realm of noumena (Kant, 1781) - or psychic reality, latent contents in Freud’s terms, the psycho-analytic realm (Freud, 1900)

PSYCHO-ANALYTICAL ROOTS In an innovative way Bion integrated Klein’s observations on splitting processes into Freud’s theory of the unconscious, specifically concerning their effect in the area of perception (both analyst’s and analysand’s) and of thinking. He disclosed what was already prefigured by Freud himself: the coexistence of the conscious with the unconscious through a dynamic functional in-between, the ‘contact barrier’ .

SOME IMPLICATIONS  The model is an epistemological tool to be used in the psycho-analytical session. It provides a way for enlightening previously existent, but hitherto unobserved clinical facts. Whether it is a concept or a personal way of dealing with clinical matters is open to debate. In my experience it sheds light on some general epistemological issues, to the extent that it can constitute a step forward from what is called ‘dialectics’ in philosophy. Rather than dealing with a pair of competing opposites, under the aegis of Death instincts, it elucidates by operating with a creative couple, taking into account the product of the antithetical pair: Oedipus (Sandler, 1997b). Regarding ‘correlation and self-regard’, ‘binocular vision’ is an unattainable ideal mode of functioning that makes allowances for neither conscious or unconscious predominance. ‘Monocular’, in contrast, refers to the ‘view’ that one system, either conscious or unconscious, ‘holds’ of the other. ‘Binocular’ thus applies to integration, while ‘monocular’ refers to splitting in cognitive processes (the realm of perception) as well as in thought processes. In clinical practice this model helps to elicit the latent content from the unfolding conscious material, not unlike a musical counterpoint. By way of correlation and contrast it highlights the patient’s inability to bring to bear his/her own binocular vision. The model generated further clarifications of notions which had been lurking in Freud’s original insights: nothing can be conscious without having been unconscious (Bion, 1959c, p. 71; 1962b, p. 8). Any analytic session displays a dream-like nature, so far unobserved; through binocular vision the analyst may ‘dream the session’ (Bion, 1959a, 1959b, p. 38, 39, 43). The patient’s consciously verbalized material is akin to the manifest dream content, and can be dealt with as such.

I suppose that ‘binocular vision’ helps the analyst to tolerate paradoxes without rushing into an attempt at solving them (Sandler, 1997b). In the psychic reality it expresses a basic fact of human life as it is: the fundamental ‘supremely creative couple’ (Klein, 1932; Money-Kyrle, 1968). A baby is ‘monocularly’ hungry, a breast provides a ‘second view’. A good (or bad) breast is the experiential binocular outcome of a matching non-sensuous pair, i.e. mother-baby. Binocular vision provides two points of view susceptible to be integrated, through commonsense, into a kind of ‘son’ or ‘daughter’. This is a transient act dependent on the data then available; a living process, bound to develop. A bad breast can be seen as the former ‘binocular outcome’ of the matching of a mouth and a nipple. Now it is the ‘monocular’ component on standby, waiting to be matched with yet another counterpoint provided by a further experience. The ‘former bad breast’ can turn into a good breast; or lead to a more integrated view, in a ceaseless cycle of matching pairs. The marriage of two points of view produces a third, that is neither the first nor the second creates something new – and thus, unknown. This can be observed in all areas of human activity: the formation of thought processes; the mother-baby relationship; the creative sexual couple; the perception of reality; the marriage between an artist and his/her media, a psycho-analyst and his/her patient’s conscious/unconscious material. The unknown, new ‘product’ of the binocular vision is respectively: the apprehension of thoughts without a thinker, maternal love for a son or a daughter, ‘percepts’ of facts; a work of art; na insight in an analytical session and so on. This insight is the product of the meeting of the person with him/herself: an elementary ‘two-ness’, the internal basic group.

NARCISISM AND SOCIAL-ISM The relationships between individual and group are clarified by binocular vision, which is, according to Bion, a practical tool that indicates what the prevalent impulsive drive is in the personality. He describes it (Bion, undated, circa 1960, in Cogitations, pp. 105 and 122; 1965, p. 80) as being in the guise of two tendencies, ‘one ego-centric, the other socio-centric’. It allowed to address hitherto unanswered questions. For example: why does a paranoid individual lust for external approval? Why does social-istic behaviour such as found in soldiers, social reformers, young idealists, often a cover for self-hate? Bion points out that if a narcissistic (ego-centric) tendency is operating, a second one, social-istic (socio-centric) ‘must go together’ with it (Bion, 1960, p. 122). ‘If one group of impulses is dominated by narcissistic trends, then the remaining impulses will be dominated by social-istic trends’. That has nothing to do with love of the self. In malignant narcissism hate impulses are also narcissistic -- the death instinct’s cathexis is deflected against the ego with its whole strength.. Therefore, love of the group also need not be social-istic either. This individual’s vicissitudes of instincts imply a ‘dangerous problem to solve in the operation of aggressive impulses, which, thanks to this bi-polarity, may impose on him the need to fight for his group with the essential possibility of his death, while it also imposes on him the need for action in the interests of his survival’ (Bion, 1960, p. 106). It can lead to the splitting, the weakening, and even the destruction of the ego. ‘If the love impulses are narcissistic at any time, then the hate impulses are social-istic, i.e. directed towards the group...if the hate is directed against an individual as a part of narcissistic tendency, the group will be loved socialistically’. This development can be destructive of the group as well of the individual when it is claimed by political leaders who advertise themselves as group-loving people. This particular conflict is likely to be most intense in the so-called latency period and, most painfully, in adolescence. A loving pair may steer its hate impulses social-istically.

TRUTH BINOCULAR; ABSOLUTE MONOCULAR A sense of truth is achieved with realisation that the object that is loved and the object that is hated are one and the same object (Bion, 1962a, p. 119). When the object is seen as either loved or hated, it is perceived "monocularly". Binocular vision, in contrast, allows for perception of the whole object. The inception of the depressive position is contingent on a perceptual process: the exercising of binocular vision. b-elements are the manifestations, in the area of (lack of) thought, of feelings of contact with absolute truth. They are also felt as concrete objects, as things in themselves. In stark contrast, binocular vision provides the sense of truth, which is itself has a binocular quality. In a patient with a predominantly psychotic personality ‘there are only b-elements, which cannot be made unconscious, there can be no repression, suppression, or learning. This creates the impression that the patient is incapable of discrimination. He cannot be unaware of any single sensory stimulus; yet such hypersensitivity is not contact with reality’ (Bion, 1962, p. 8; my bold). The ‘impression’ ensues from the highly emotionally charged environment that the patients creates. In a certain sense, the patient tries to make projective identifications of his inability to exercise binocular vision. That impression may be swallowed as truth by a professional who is unable to bring to bear his own binocular vision. This may throw the entire analysis into the realm of superficial psychology, of what is known and conscious. When conscious claims, self-evaluations, and statements made by the patient are taken at face value, it can lead to collusion, shared hallucination, and blindness to underlying, latent contents. Dreams seem to demand binocular vision in order to realize their nature as a ‘composè’, made of manifest content and latent content. Does binocular vision allows us to get hold of the psycho-analytic vertex as well as the profoundness of Psycho-Analysis? Which, like beauty, is more than skin deep.

FUNDAMENTALS OF PSYCHO-ANALYSIS: PARADOXES TO BE BINOCULARLY TOLERATED, NOT RESOLVED Without dwelling in each item, there follows a listing of fundamental concepts of psycho-analysis whose fuller realization may be helped by the use of binocular vision. They are antithetical pairs that compose human truths and the most basic principles of mental functioning hitherto known, the framework of psychic reality. Perhaps Freud’s binocular vision was a factor in their formulation: I. conscious and its transient, constantly evolving relationship with the unconscious; II. the Pleasure/unpleasure principle and the Reality principle (Freud, 1910, 1920); III. the concurrence of particular cases with generalizations which is the task of any scientific discipline, with the aid of myths as ‘fact-finding tools’, primitive forms of exercising of binocular vision by a group counterpart of dream processes (Bion, c. 1960, p. 226-228; 1963, p. 66) ; IV. The Life instincts and Death instincts as two sides of the same unknown ‘coin’ (‘O’); V. PSó D, functioning in tandem. VI. the observation that the breast is created by the baby while at the same time it was already there (Winnicott, 1969).

DEVELOPMENTS Binocular vision seems to have furnished a basis for some researchers. André Green (1986) has expanded the positivistic view of mental phenomena binocularly with perceptions of the ‘negative’, whose implications are far reaching and still not wholly explored. In the same vein, James Grotstein’s developed a ‘dual-track’ approach to psycho-analysis. Grotstein (1981, 1997) further expanded it with his more recent incursions into the realm of transcendence vis-a-vis immanence (which coincides with my own research, made previously and independently; Sandler, 1997).

CLINICAL EXAMPLES Narcissismó Social-ism can be illustrated by the example of a patient who saw that she could obtain favours and business clients by flattering her boss. She played musical instruments at his parties; she cooked for him; she would play the ‘humble’ role. In due her efforts paid off. However, her financial gain implied abandoning her own ethical code and losing self-respect to a point of no-return, with increasing suspicion on other people, hostility, lack of gratitude and contempt toward real friends, bad temper, arrogance, unhappiness and sour ideas. Another example is that of the physician who fixed the broken hand of a criminal who the proceeded to use it to steal the physician’s wallet and fountain pen, a cherished gift from his deceased father.

The splitting of love and hate The splitting of love and hate which is originated by violence of feelings that clouds the perception that both (love and hate) are inseparable, is made visible through the exercising of binocular vision. Hate is the more primitive form of love hitherto known. If the patient overtly displays love, one should look for underlying hate, and vice-versa. A patient declaring ‘I do not want to come to analysis anymore’; also means ‘I need to return’ – a feared or denied sense of loving dependence.

Another patient was confronted with his aggression, both at home with his wife and in the session with the analyst. He quickly took concrete external measures to evade genuine depression; during the session he displayed a false compliance; outside it he swiftly got to buy some gifts to the wife and to the analyst. He displayed a ‘false depressive position’ tainted with persecutory colours. Similarly, a ‘false paranoid-schizoid position’ can be observed in patients who try to originate and manipulate the analyst’s persecutory feelings in order to evade their true self. For example, a patient who resorts to judgements of right and wrong accuses the analyst of judging him when his aggression is elicited. The analysis may focus both on super-egoic features and on the apparently paranoid, persecutory feature. This permits for rational knowledge of psycho-analysis, but precludes insight. At stake is another hidden feature, one that requires observation: the manipulative, guilt-inducing attempts of false persecution.

Self-attributed feelings offer an opportunity for using binocular vision. If something is true, it does not demand overt manifestation, explanation or proof. A patient had the habit of ‘self-analysing’, saying ‘I am depressed’, ‘I am anxious’, ‘I feel guilty’, ‘I am hateful’, ‘I love’. The emotional experience of real suffering, which is different from merely feeling it, is an interpretation of the analyst, as a way of helping the patient to achieve insight. The situation brought forth by binocular vision usually proves to have a different nature as far as the consciously uttered claim is concerned. The patient expresses an invitation to freeze in a monocular view, as if manifest content statements were absolute truth. A person says he ‘feels depressed’; the underlying basic emotion can be hate; or fear. Conversely, hate may underlie overt manifestations of love. This is the case with erotic transference. Displaying her hostility, a patient says ‘Your fees are too high while she was only paying half the current rate. Yet she did possess adequate financial resources and so she felt guilty. She was trying to expel her love instincts and the pain involved in paying more, something that she could not see clearly due to her inability to use her own binocular capacity. The verbal affirmation mirrored the denial and splitting; a real, non-audible, contrapuntal voice said, ‘I want to pay more’.

Another patient reported two dreams: 1) His wife is pregnant, but she loses the foetus before its sex is known. 2) He is dealing with some envelopes relating to a public auction. He has forgotten what his company’s bid was. He suddenly remembers that the amount is printed in the stamps on the envelopes. But the stamps slowly turn illegible. He decides to write the disappearing amount of the bid on a piece of paper, but the paper rejects the ink. He replaces the paper, but now the pen does not function. He suspends the reporting if his dreams. Surreptitiously; some extraneous fact ‘has come to his mind’. He feels puzzled by a thought that has nothing to do with the dreams; he remembers that his little son had refused to play with a model truck and hand had fallen asleep without even touching the toy. I think that this patient can use his binocular vision, even if somewhat unwillingly, when he remembers and verbalizes something that apparently ‘has nothing to do’ with previous material, that cannot be rationally linked to it. In this case, the dreams matched with his son’s behaviour, display an inner truth: his difficulties to get in touch with himself. Binocular vision helps him to express it (the baby that does not survive, which means life itself, and cannot be known; the envelope that cannot be sent because its content is lacking; the boy that cannot play). Monocular ideas are avoided by not clinging to the manifest content – the dream has actually nothing to do with his wife as a concrete entity.

A patient was married to a woman who had an adolescent, drug-addicted daughter from an earlier marriage. She had left home in a rage one year earlier and led an errant life from then on. Occasionally she would return, wanting to stay there for some days. Once she tried to flatter the patient, saying ‘I like you’. He spotted the lie and said, ‘I am sorry but I cannot say the same’. In the session he laments: ‘I did not seize the opportunity. I should have said to her, "both of us are lying"’. As soon as he said this to me, he realized that he had been sincere with her, which had been a manifestation of respect and love. Also, the very expression, ‘I am sorry’ betrayed his true feelings for her. His binocular vision allowed him to see the truth. A last clinical vignette, perhaps quite familiar to any practising analyst: a patient utters, ‘I dreamt of an atomic bomb’. If the analyst takes this at face value, as a thing-in-itself, he will interpret that the dream as relating to the patient’s aggression, hostility or hate. If the analyst follows Freud’s guidelines for interpreting dreams, he will wait for free associations – these will provide him with a counterpoint, a second sense to compare with the first sense, i.e. the patient’s utterance. Thus binocular commonsense comes about. A pattern slowly emerges, as in Charcot’s famous counselling that so impressed Freud: the patient says that he ‘loves mushrooms’ and ‘his grandfather says that mushrooms are the stuff of life – see how they multiply’. In -fact, the patient displays a Life instinct manifestation. The pictorialized - dreamt - imagery may depict the primitive fusion of love and hate, or perhaps a confused state. The use of binocular action prevents a clinical mistake.

Is binocular vision a posture we have at our disposal to attain the psycho-analytical vertex, to the extent that it helps us not to be too mesmerized by the manifest content, by superficial psychology? It rescues the richness of Freud’s original psycho-analysis in its most profound ethos. It should be welcome at a time when the question, ‘one psycho-analysis or many’ (Wallerstein, 1988) is on the agenda, when psycho-analysis itself seems to be at stake.

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