Paula Heimann's question and group analysis

SUMMARY

Paula Heimann asked a famous question: “Why is the patient now doing what to whom?”, and said “The answer to this question constitutes the transference interpretation”. In the individual setting, sometimes the answer is obvious, but more often it is obscure. Only a complex and painful integration in the mind of the therapist of manifest verbal and non-verbal material, with subtle countertransference feelings and the ‘atmospherics’ of the session, can point to a possible description of the unconscious internal relationship indicated by Heimann.

When this work takes place in a group setting, it is further complicated by the conscious and unconscious currents intrinsic to group interaction. Furthermore, the many patients now treated in formal group psychotherapy experience severe problems with their identity, ranging from the identity diffusion and rigidities of Personality Disorder to the fragmentation and confusion of more psychotic patients. Such additional factors must be confronted if a response, let alone an answer, can be given to Heimann's question from the group perspective. An account of a group session shows how the author considers Heimann's question in his clinical practice, and, by means of this question, approaches the application of psychoanalytic concepts to groups.