ABSTRACT

In this chapter I will argue that, just as helplessness is at the heart of the human condition, the fear of annihilation in the context of the traumatogenic process is the distinguishing characteristic of `dif®cult' patients. In my practice as a psychoanalyst and group analyst I tend to see all my patients individually and then to bring them into one of my twice-weekly groups. I see them individually for varying periods of time, but eventually, after a lengthy transition, during which they are in both individual and group treatment, they will be in group treatment only. Groups help the group analyst with troublesome countertransference responses, which are typical of work with our most dif®cult patients, precisely because countertransference responses make understanding them dif®cult (Gans and Alonso 1998; Alonson and Rutan 1990; Caligor et al. 1993; Kauff 1991). Provided that the group analyst is prepared to listen to and learn from the group, he can usually ®nd support and insight from them. However, it is uniquely important that through their enactment of the constraints of group basic assumptions, dif®cult patients are likely to repeat their traumatic life experiences and to `tell' the group about their key problems and symptoms. Containing and compassionate understanding of these processes can be used in the service of psychotherapy. It is especially important to work with `Incohesion', which I regard as the fourth basic assumption in the unconscious life of groups. In making this argument I will draw on work that is both old and novel in its implications for the study of personality, for the study of groups, and for clinical work in groups and dyads: my own studies of the social unconscious, and of traumatic experience in the unconscious life of groups (Hopper 2003a, 2003b).