Group Analytic Contexts, Issue 77, September 2017

Newsletter – Autumn 2017 109
enough’ and when is it likely to be achieved? In Bionian terminology,
when transformation of beta-into alpha-elements occurs. The former
are thoughts without thinking, in search of a thinker. In the group,
psychotic members can be helped to transform primal psychotic
dependence on the mother (or group) into more creative and symbolic
thinking. Some of Koukis’ patients spent 8-10 years in group therapy.
If this feels long, lengthy treatment periods are not uncommon for
chronic and severe conditions (schizophrenia; psychosis; personality
disorders) within psychoanalysis and GA.
Koukis conceptualises schizophrenia in a traditional
psychoanalytic way. He cites research studies throughout his book,
asserting that depression in such patients can be treated “effectively”
in an analytic group. Considering that ‘schizophrenia’ is a
heterogenous condition, this claim is perhaps too ambitious. Whilst
the presented case of Nikos certainly makes for an interesting read,
the idea that patients with depressive symptoms cope in their transition
from the paranoid-schizoid to the depressive position in an autodestructive
way and, therefore, may benefit from a group, is perhaps
less convincing. There are many confounding factors (e.g.
medication). And as much as I would like to believe in the supremacy
of the group analytic method over cognitive behavioural therapy, I
remain sceptical.
In his chapters on dreaming in psychosis, Koukis rejects
some neuropsychological theories of hearing voices. Instead, he
favours Freud’s explanation (voices are defence mechanism; if
derogatory, they emanate from a harsh superego). Patients with
psychosis are thought to be unable to dream. However, they can
rediscover the ability to produce ‘proper’ dreams as their therapy
evolves in his heterogenous analytic group. Group analytic
phenomena (mirroring, communication, sharing experiences in freefloating
discussions in the group) foster the narration of dreams in the
dreaming group matrix. This may lead to “decompensation of patients’
super-invested pre-conscious”. In turn, a reconstitution of their ability
to dream occurs. This description is as heart-warming as it gets.
Koukis shows that patients’ ability to dream is enhanced by the dreamlike
similarity between the act of hearing voices and the dream matrix
of the group. His phenomenology and ontology of dreaming in
psychosis is most certainly unique. The interweaving of
neuropsychological studies and case presentations in his arguments
makes for an excellent read. Unfortunately, their abrupt appearance
may be disconcerting for those readers without prior knowledge of
neuropsychology.