Group Psychotherapy of Psychosis through Dreams
English summary of Chapter 2 of the book Dreams in Group Analysis by Koukis, A.E. (2004). Publisher: Savalas, Greece
Introductory remarks
The group-analytic process, in that it touches the extremes of the “psychotic” process at many points, can reveal the psychotic dream clearly in terms of both its phenomenology (manifest or latent content) and its deeper ontological substance (emotional experience). The psychotic dream in turn, as it accompanies and expresses the group’s course of development can, in some strange way, provide an image and an interpretation of this course.
Thus, from the beginning, a kind of “malignant mirroring” is established between the group-analytic process and the psychotic dream. This mirroring, to the degree that it is gradually normalised through the satisfactory evolution of the group-analytic process, provides an opportunity for the psychotic dream to access deeper emotional experience and can in some cases lend it many of the features of the neurotic dream.
The psychotic dream, as it is manifested in the group-analytic group, seems to follow and approximately to express the latter’s three stages as described by Foulkes and Anthony and at the same time, on a deeper level, to correspond to them, i.e. the sadistic-oral stage, the paranoid-schizoid position and the depressive position (Klein, Bion).
The term “phase” or “stage” should of course be regarded as totally schematic, given that the evolution of the psychotic dream, and indeed of the group itself, follows more of a spiral than a linear course, since it is a course that, notwithstanding its progressive direction, contains many regressions.
On the contrary, what seems to be certain here is that the psychotic dream, like the neurotic dream, usually presents itself just before or after the group breaks up for the holidays, since this is usually the moment when some of the beta-elements tend to become transformed into alpha-elements, the moment that access to deeper emotional experience has begun to be achieved. In other words, it appears at the moment of transition from one phase to the next, condensing elements of both.
First phase: The sadistic-oral stage
The first phase of the psychotic dream and the group process alike contains the harshest form of many of those elements that, according to Klein and Bion, characterise the sadistic-oral stage in the development of a personality.
Under these conditions any possibility the psychotic has of being mirrored in either his dreams or his thought, and as a result of reproducing the primal scene even in fragmentary form, breaks down entirely. The psychotic might be said to “float” in the maternal body or in the group that represents it; thus he identifies either with the absolutely impotent embryo that is stifled by this body or with the positive omnipotence (penis) of the latter in such a way that the mirror (maternal eye) is shattered and the primal scene – in its primitive form as “sensual experience” – is either not reproduced at all (as happens with most dreams in this phase, which can be described, according to Bion, as “hallucinatory”) or surfaces, in the sense that it is still contained in the maternal body, i.e. in the form of the primary fantasy of the “mother with the penis” (phallic mother), which happens in some dreams at this phase that again, with Bion, we would call “psychotic”.
These dreams do not result from the mirroring of a subject or from a benign primal split; they merely preserve a kind of false self-mirroring that comes from an absolutely narcissistic identification with the maternal body, which is why they are unable in turn to acquire any representationality through the group.
Second phase: the paranoid-schizoid position
The second phase of the psychotic dream and the group process simultaneously includes, in different forms and variations, many of those elements that are characteristic of the paranoid-schizoid position. This position is known to be governed by a dynamic that stems largely from the split which appears to have been achieved for the first time between the subject and the object, and from the sense of persecution felt by the subject from both the “good” and the “bad” object.
The psychotic dream at this phase denotes the existence of a split between the subject and object or, to be more precise, between his infant self and the maternal body (breast). By virtue of the split, as denoted again by the dreams in this phase, the mirroring of the subject in the maternal object begins to be achieved for the first time in the sense that the former, which has ceased to be fully absorbed by the latter, can see itself in the rudimentarily symbolic, although still physical, dimension of the latter as a part object. This already constitutes an adequate screen, so that the subject can be mirrored (represented) on it through his dream. It is a dream which, while retaining its physical dimension, also has a primary mental (symbolic, representational) character which at this phase, reflects the subject within the context of a narcissistic symmetry against a background that remains more or less persecuting: this body or penis that persecutes me in order to kill (devour) me is ultimately my own body-penis. Thus the subject can proceed to a first ideogram of the primal scene, i.e. to an early Oedipal stage.
Third phase: The depressive position
The third phase of the psychotic dream and the group process is based on many of those elements that constitute the depressive position. This happens in such a way that both the dream and the group as a whole, to which the dream is submitted and through which it is largely derived, gradually take on the features that prepare for the neurotic phenomenology of the dream process, even though not completely, and in a form that remains fluid.
In the psychotic dream of this phase, as in the neurotic dream, the screen – i.e. the imaginary container on which dream actions (part of one’s self) are projected – has become much clearer, more stable and spacious. At the same time, these actions no longer unfold in the non-space-time dimension that characterises the psychotic dreams of the first phase, or in a space-time that remains fleeting and unstable, like that which distinguishes dreams in the second phase, but rather in a space-time whose outlines have become fairly clear and discernible. The screen (imaginary container) is thus transformed into something higher and more effective: a theatre stage or symbolic container.
In one sense, the psychotic dream has now begun to take on the first distinct features of groupishness. This should be attributed mainly to the fact that the subject, since he has already achieved an adequate primary split, can now represent the maternal object (screen/stage) better through a representation/screen rather than a representation in itself, and at the same time he can be represented through it (mirroring).
The mirroring of the subject is also illuminated by the presence of a father who is no longer in one form or the other, either an extension of the maternal body (penis or archaic, real, imaginary and symbolic father of the early Oedipal stage) or a pre-Oedipal father, but a signifier at least in the first version, i.e. the Name-of-the-Father (the Oedipal real, imaginary and symbolic father according to Lacan).
By extension, paternal intercourse (primal scene), even though it still takes place in the “darkness” inside the maternal body, can now be represented in such a way as to connote acceptance of the symbolic death of the parents with greater representational clarity and symbolism.
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