The psychotherapy group,inmigrant’s camp

Introduction

The grief that is involved in stopping using your communication resources in order to interact with people from another country and place, and then rebuilding your identity based on this experience, is important. And even more so, when this is done to survive. We cannot deny that after that grief, a psychic symptomatology emerges that signals the suffering associated with the effort to establish roots, and the grief for what is lost or abandoned. I wonder if the scale of this drama hides from us other smaller dramas that flood our psychiatry and clinical psychology consultations.

Alongside all this drama, there are other minor migrations. Some are changes of residence within the same country for work, economic reasons or seeking a better and less pressured way of life. But being within the country, the ruptures that occur do not match the harshness of the migrations or, what is worse, their harshness is often not recognized; in fact, they are not considered as migrations but as a mere change of residence. But the devaluation of those movements does not nullify their consequences, since the grief associated with them is not necessarily any less.

But there are other griefs, to which I will now refer, and which mental health workers encounter constantly without giving them the attention they deserve. I am thinking about the experience of joining psychotherapy groups and psychiatric admission units.

Indeed, many of us who work with people with high levels of mental suffering encourage them to make apparently minor, but still important, migratory movements; depending on the philosophy from which we work—especially the group-analytic—we organize, assist, and share in more or less transitory migratory experiences that affect our lives and the lives of those who require our attention and concern.

I suggest that every psychotherapy group is, in reality, a new space into which its components—including the conductor—migrate temporarily, but very significantly, in order to learn to better survive among their own.

Country of origin: the family environment

Let us consider that the relational and family environment is our country of origin. From the first minute of our extrauterine life, we assimilate the messages we receive from our mother and, later, from the other members of the family: it is the only way we have to constitute ourselves as individuals and, at the same time, build our habitat. In our interaction with them, we acquire the relationship and communication guidelines that are common in this environment. They enable us to get closer to the other or to get away from him.

All relationship is communication and vice versa. The act of communicating is not confined to the information that is transmitted, but rather it puts our internal world in communion with that of others, and contains our desires to approach or distance ourselves from the other.

From the first moments of our existence—not including the intrauterine communication and the primary identification processes indicated by Burrow (2013)—what underlies the mother–child relationship is the sharing of emotions, affections and feelings. It occurs through the so-called defence mechanisms that are also communication mechanisms (Sunyer, 2020). With them we participate in the co-construction of those around us, projecting, introjecting, identifying ourselves, splitting or denying experiences, feelings and thoughts. It is a permanent co-construction. The idea of homines aperti is still there (Elias, 2010; Dalal, 2002). All of our behaviours and reactions are conditioned by others (Lewin, 1988; Sullivan, 1974; Mead, 1980; Winnicott, 1981; Freud, 1974). But we not only co-construct ourselves but also determine the position that the other occupies in relation to us; and us in relation to him. In other words, we not only participate in the construction of those around us but also in the construction of our vital spaces: this is our world, our country.

Under normal conditions there is a co-construction of the family and social world in which dissonances are tolerated and incorporated. In it we develop our own language and establish our common family and social reference points. Through the use of various communication mechanisms known to all, we build our Self, and we contribute to the formation of those around us. In this way, our identity is nourished by relational and communicative experiences; it nourishes the identities of others, and ties of interdependence are established with those who constitute the family and reference groups. There is an experience of continuity that gives coherence to the Self and the collective Self (Volkan, 2006). Our mental scheme is imbued with the characteristics of this environment, as well as other experiences that our elders provide us with: school, sports and leisure activities, friends, etc. What is common to all these contexts is the existence of people with whom we constantly interact in a process of continuous co-construction. All this constitutes the family and social culture in which we grow up and which, paraphrasing Winnicott (1981), constitute a good enough group: one that adapts sensitively to the needs of its members.

We are part of that culture. All the wealth that we have, we acquired from the relationships we have had with our family and social environment. We have modeled ourselves from the meanings that we observe in our environment, and that ride on words, looks, gestures, attitudes, silences, behaviours and reactions. This modeling constitutes us as beings in relation to other beings, through which communication and language travel. This process is not limited only to language but includes all forms of expression (verbal, corporal, attitudinal, symptomatic, emotional, etc.) through which we are connected with others.

But we are not passive beings. From birth we begin to copy first the behaviours of our mother and, later, that of those who make up our environment. In this interaction with others, we build ourselves, and we also form–give form to–those around us, establishing ties of interdependence that are binding with them. And it is precisely in this co-construction, where conflicts appear, that at times entail varying degrees of suffering. When these present unsustainable levels, our Ego does not always develop in a normogenic mode: pathogenesis appears.

Pathogenic developments are relational responses not appropriate to the environment in which one develops; attempts at maladaptive adaptation that, when they exceed the capacity of the family and social system to contain them, give rise to pathology. They are also attempts to model those around us to our convenience and need, because all communication threatens that desire. And this, whether we like it or not, happens from the first minute of, at least, our extrauterine existence. We call the modeling effort, power (Elias, 1994; Castells, 2009; Sunyer, 2010, 2018). We all exercise a certain amount of power over others, and we suffer what our environment does to us.

When, for professional reasons, we enter their homes—their castles, their country—we are usually surprised by the great differences that we observe in relation to the characteristics to which we are accustomed. We easily detect that there is no unanimity or interpretation or meanings of the events that occur among those who constitute them. Though speaking the same language, their reference patterns—those that allow assigning relational meanings—are not shared. It is as if different languages emerged under it; and, therefore, very different interpretations of the same event, experience, feeling or emotion. These variations are in line with personal convenience and interests, leading them to generate responses which continue modeling the environment to our desire; not including the more or less invisible complicities and loyalties (Boszormenyi-Nagy and Spark, 1983) that determine the psychic development of the group members.

Normology

In such situations, as the ones I referred to above, those who are part of a therapy group interpret in a similar way the set of signs that constitute the communicative expression. The matrix that is created comes from a communicated history. In it, the different configurations of individuals that make it up tie agreements and disagreements into a framework of mutual respect; they have been negotiated, renegotiated and woven into common guidelines that are shareable—though not necessarily shared—by its members. The either subtle or abysmal interpretative differences fall within the range of respect, affection and complicity in which the components of that group move and relate (for example, the family member). The differences determine not only the place in which each member of the group stands with respect to the others, but in which the others place him. The phenomena of identification and projection do not reach the intensity of projective identification or introjection. The ability to think is maintained, so that the elaboration of differences allows the acceptance of its members and their personal circumstances. When the possibility of thinking succumbs to emotion, all possibility of thinking is automatically paralyzed, leading to confrontation and madness.

The dynamic constellation of interdependencies establishes a structure that keeps its members linked beyond their differences. It is a dynamic structure. The psychic membranes, which differentiate one member from the other, support levels of fluctuation and permeability that do not unbalance the system of forces that occur between them. Thus, the logical divergences that appear, the differences of criteria, of attitudes, behaviours, interpretations, etc., can oscillate, drawing diverse normogenic relational constellations, determined by the forces of power. The balances resulting from one over the other, and the fluctuations that occur over the years, fall within a bearable, sustainable, non-threatening variability; and the possibility of elaborating emotions persists. The matrix, there, is containing and sustaining. And their attachments, safe (Bowlby, 1998).

If power is the capacity that every individual has to modify or influence something in the psychic structure of the other, each member of the group feels that they have a place where they are welcomed, accompanied, supported and contained by others. And you can do the same with those around you. The modifications that occur in individuals, and in their relationships, fall within sustainable parameters that do not threaten either individual or collective development.

When this is not the case, we enter psychopathology.

Psychopathology

When the context—the family, the country—does not include the means of transmitting what one experiences, feels, thinks or perceives, it is necessary to find some other way to make oneself heard or to gain the understanding of others. These are situations in which attachments to reference persons become insecure, anxious, avoidant or disorganized (Bowlby, 1986). One desperately seeks to modify something of the environment and those who constitute it in order to be able to feel within the group nest. Their symptoms are nothing more than a more or less desperate way of communicating, trying to become or stay in the group; but their very characteristics do not facilitate the creation of communication bridges. The absence or the inadequacy of the responses activates the experience of isolation, reactivating the use of the symptoms. The psychic membrane does not serve as containment, activating the extremes that Hopper (Hopper, 1997, 2011) pointed out in his fourth basic assumption: failure to communicate and isolation from the other, or fusion and diffusion in him.

When someone lives isolated within their relationship with those around them, panic takes over. I do not doubt the incidence of genetic factors, but they are not the only ones that are present. There are also relational ones. You know better than I how communication abnormalities or distortions are present in all mental disorders. Their intensities and modalities define the various symptomatological pictures. Sometimes such moments appear in adolescence, or after a major illness or accident. Also in times of maturation or evolutionary crisis in a couple or in an institution. These are moments in which the psychic membrane—that is, the set of aspects of the Self that allows and modulates the intensity and valence of interdependencies with others—loses its mediating capacity with the environment, either becoming rigid (which will tend to isolate ) or diluted (merged to some extent with the environment)

As these communicative patterns become internalized, language—that is, the ability of every individual to communicate with others— loses its adaptive and environmental modeling value. Symptomatology directly expresses that enormous difficulty of being with and among others; because the ability to elaborate the experiences that arise from the relationship has been reduced or even canceled. This is confirmed by the diagnosis, which it is nothing other than the official status that explains that what happens to the patient corresponds to a social label.

What is a group from this perspective?

One patient told me that she felt better with me in the online sessions because she was in her castle and I was in mine.

The metaphor is significant because when a patient visits a professional’s practice, he or she enters his or her castle with his or her rules and guidelines. This reminds me that each of us belongs to a family group, more or less extensive, which is still, metaphorically, their country. There, each has their norms, operating guidelines and each lives within the matrix of relationships in which, in their own way, each one has, or tries to have, their place.

When patients join a therapy group, they metaphorically go into another country. Each is an immigrant. There, they must unlearn many aspects that come from their environment, in order to learn those that they will establish together with their companions for that group: a new country, a new culture. From the beginning there is a complex negotiating task, at the base of which, we find fears of being ‘shaped’ by the other, fearing the loss of personal identity (Nitsun, 1996). Even the very possibility of abandoning a certain diagnosis, of becoming a happy person in relationships with others, is frightening enough to activate introjective or projective identifications and, hence, aggressiveness. This also hides the individual desire to model others according to their ‘cultural’ patterns and their interests or conveniences that, in a way, have led to psychopathological developments. This aspect collides with the need to feel part of the group, to integrate into a new network of interdependencies. The struggle between how much I accept being modeled and how much I manage to model determines communication difficulties, all communication difficulties.

A new culture is created in the group (Bion, 1976) totally different from that of its affective reference group. Communication is something else. It comes from what that same group creates. The embodiment of the transference is still the updating of the family patterns on the group, which also affect the professionals, and are present in the determination of their degree of reliability (Granell, 2011). All that new culture must be learned. Every group develops a matrix of interpersonal relationships in which communication and what is communicated intertwine in a way that gives rise to a singular space. A field to debate and clarify meanings that emerge in the interrelation of its members. A field in which the trust, security, acceptance and understanding necessary to enable a rebirth of the Self of each of its components must grow. A territory that, in general, is quite different from that of its ‘land of origin’.

What are you coming to this new country for?

To live an experience of acceptance, tolerance and care different from those they have had in their family. But that is unknown. The usual thing is that, given their own relational characteristics, there is an important contamination of the object of study (Sunyer, 2020): the relational characteristics learned and integrated from early childhood in their families (countries) of origin are reflected.

The conductor has one objective: to facilitate the construction of a relational space in which each patient feels it is their own. This means the development of normogenic relationships that ensure that each one is well received and welcomed, where they can talk about absolutely everything. A place—a country—in which the capacities of tolerance to the diversity of each ‘inhabitant’ are increased, and the possibilities of thinking about what happens to them in the relationships they establish between them are enhanced. And all this in an institutional and social framework that also determines the working conditions in the group.

Such conditions facilitate the development of a different reality regarding the relationships and communications that occur in their countries of origin, which offers a maternal image without the characteristics of the real mother. An object that the patient can love, interpose, expel, reject again and take up again, while not allowing him to inflict harm or harm himself (Soler, 2020). That implies addressing the obstacles and relational skills that occur in coexistence within the group framework amongst everyone, including their conductors. The commitment to move towards the greatest horizontality possible, addressing the elements that endanger group work (Nitsun, 1996), both because of what is cooked in it, and because of what it derives from—the organizational, structural and social aspects (Sunyer, 1997; Nitsun, 1998a, 1998b) in which the group develops.

The group is a country, in which communication—not language—is put to the service of understanding and accepting the other, accompanying the members in the discovery of personal aspects that were suspended, and facilitating, if possible, a reunion with their family group. The redevelopment of each of its members supposes, on occasions, the support and even the use of resources from other psychological orientations that facilitate the communication (Nitsun, 2014); as well as the use of creativity and other instruments within our reach with a single purpose (Agudo, 2020; Baños, 2020): that the participation for the time required in this group will represent a significant experience for everyone.

Something not very far from what we have tried to share these three days with each other; even if it is in a virtual way.

Thank you very much.