Reality Testing and Testing Reality in Group Treatment

ABSTRACT

This two-part contribution addresses concepts of “reality,” “reality testing,” and “testing reality,” as they apply to group treatment. Part I provided topic overview and focused on reality testing. Part II focuses on testing reality and how it promotes emergence of new or previously inhibited forms of engagement.

Whereas reality testing centers on a particular theme or object, with a goal to define and solve problems, testing reality involves approaching targets of interest without necessarily looking for or coming to definition or clarity. It is wide open, spontaneous, and unbounded, and may take the individual and group into realms that are uncomfortable and even unwanted. Engaging the group and supporting individuals in these two approaches to learning requires a well-defined therapeutic focus on process and purpose; at times, different tactics and techniques are called for.

Notes

¹ Readers of my papers will recognize some of the clinical vignettes that have been presented before. Any clinical episode illustrates myriads of clinical issues; here, I focus specifically on testing reality.

² In proposing two principles of mental functioning, Freud (1911, p. 221) conceptualized the reality principle as involving “an experimental kind of acting, requiring “restraint of motor discharge.” Because of Freud’s influential formulation, traditional psychoanalytic psychotherapy has privileged thoughts and words and classified other types of interactions as “acting out” and anti-therapeutic. Informed by advances in cognitive-developmental research (e.g., Piaget, 1954), the influx of Kleinian and Sullivanian theories and techniques, and in understanding the importance of play (Stern, 1995) and other forms of pre- and non-verbal exchanges, contemporary psychoanalysis has recognized that all communications exist in an intersubjective field of influence (Hoffman, 1991). Whereas formerly actions have been distinguished from thinking, thinking is now regarded as a form of relational action (Greenberg, 1996). Mental activity proceeds within the mind and within the environment.

³ Weiss (1950) usefully distinguished between “reality tests,” which are intellectual, rational, and conceptual, and a “reality sense,” which is emotional, intuitive, and perceptual. Reality sense is essentially unshared, private, and complete in itself; it has no need for confirmation, since its criterion is the intensity, rather than the invariants of experience.

⁴ I felt it premature to approach or interpret our interactions symbolically, for example, Peter’s attempt to “take care of the group” by protecting or rescuing a weak father or challenging a strong one. Better to share experience first and let it develop imagistically and conceptually. I invited responses—realistic or not—to my diplomatic methods, rationales, and self-presentation (Billow, 2010b). Psychic events need to become contextually and relationally relevant before they can be utilized as a potential nuclear idea (Billow, 2015).

⁵ Looking at this interaction theoretically, my verbal barrage served as a group-as-a-whole intervention. Communicating with Maggie on her wavelength, I could jam her “noise” with my own, and the group communicative node [Billow, 2016a; b] could resume operation.

Additional information

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.