On the Origins of Clinical Interventions

ABSTRACT

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.

Notes

¹ In actuality, we have three adult children. I gave birth to a fourth child because apparently, even in a dream, I could not bear to part with one of our own. Likely, too, the child was the assignment itself.

² Of course, the theories and training the therapist brings to the clinical experience—age, gender, sexual, religious, political orientations, emotional maturity—also participate in the therapist’s views of clinical reality, and influence clinical actions.

³ Klein (1952) intuitively came to describe a multi-tiered, organization of the personality, in which developmentally early, pre-operational cognitive-emotional modes—the “psychotic positions”—underlie, coexist, and both contribute and interfere with higher-level mental organization. Bion (1961) extended Klein’s formulations in devising a model of social organizations as a dynamic between basic assumption and work group thinking, corresponding to the “psychotic” and “normal” levels of the individual personality. “Developmental conflicts” underlie our individual psyches, our theoretical and clinical allegiances, the structures of our groups, and of larger sociopolitical cultures (see Hopper, 2003; Menzies Lyth, 1988).

⁴ Referring to group members, Bion’s (1961, p. 161) observation applies to their leader as well: “It can always be seen that some mental activity is directed to the solution of the problems for which the individuals seek help.”

⁵ The analyst’s “internal and external dependencies, anxieties, and pathological defenses…[respond] to every event of the analytic situation” (Racker, 1998, p. 132).

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Notes on contributors

Richard M. Billow

Richard M. Billow is Clinical Psychologist, Psychoanalyst, and Director of the Group Program, Derner Institute, Adelphi University, Garden City, New York.