a way about clinical groups
2. Survival systems
3. The quaternary element
5. Group by the music
6. Large group
7. Group for pregnant women
8. Experiential group training
9. Group for insulin-treated diabetics
10. Psycho-anthrop-analytic group
11. The work-group
12. Beyond the circle
The individual-group dynamics have many implications with regard
to the professional practice and frequently they have spurred
in myself the query if I were, in my heart of hearts, more inclined
toward the individuality or rather toward the "group-world".
This doubt can appear opportune when we consider that an individual
who has reached a good internal integration has various possibilities
to animate the personal "social Self". Probably
it will be necessary an increase of the scientific research on
these aspects of the dynamic psychology. By this reason now I
make the following ask: what would it happen if from a symphonic
piece we separate the musical execution concerning every component
the orchestra? We would have some musical sounds but not the execution
a music composition. It would miss that connection among phonic
events constituting in their whole exactly a symphonic music.
Besides we can ask us: what comprehension could we have about
the Impressionism if of this artistic movement we knew
only for instance a painting by Monet? What is the contribution
that Impressionism gave to the Monet's creations?
Is a group correlated to a single member as the Impressionism
is correlated to Monet? It is possible really to mention
the individual without considering his group-dimension? Besides,
it is not still resolved the problem if the human tendency to
create couples is more associable to the individualistic dimension
- because the couple appears excluding the plurality (more tenacious
it is the union between the two individuals the couple more tends
to isolate itself from the others) - or if the couple represent
a transitional and preliminary condition for a participation to
the ampler multi-personal world.
It is sure that the third element, the minimum group, the triad
originates and develops by a dyad, that is two individuals of
opposite sex, on the almighty fantasy and aristocrat that from
the couple a new messiah (W. R. Bion) will have origin.
2. Survival systems
If we refer to the biological systems (considering expressly the
recent acquisitions about the psychosomatic medicine), undoubtedly
we discover a sort of strange dichotomy among reproductive
functions, that assure a realization to the species survival
program (by the individual survival), and biological
systems maintaining the affective binds that we have to consider
key for the realization of survival programs regarding either
the couple or the group. In fact, we discover in order to the
survival that the group and the couple both have their basis on
a same biological system that is different from the system implicated
in the reproductive program. This reproductive programs that,
at least in the multi-cellular life forms endowed with gametes,
utilizes the coupling to guarantee that two living creatures belonging
to the opposite sex can reproduce themselves and consequently
be passed down from generation to generation.
3. The quaternary element
We have designated the triad as plausible minimum group. But is
it true then?
By a geometric metaphor we experience some series difficulty to
conceive a circle situated into a triangle; it is decidedly warned
something incomplete and unbalanced: it recalls the dizziness
of the precariousness and the absence, because it misses the balance.
In fact, it is unusual and it appears difficult to imagine a central
position inside one triangular configuration; contrarily to what
happens when it is a quadrangle or a circle. It is just in the
core of the circle, in a group situation, that we can imagine
the source of the supra-individual mind (W. R. Bion)
or the focus by which it emerges a phantasmal presence
in the shape of maternal imago as illusory body holding
joining the individuals as real limbs of the group (F. Fornari).
From the psychological point of view the mother, the father and
the child, the trinity, the third included, brings us to the oedipal
dimension, and to the way for the sourcing of feelings as the
envy, the jealousy, the desire, the possession, the ambivalence
and the emotional conflict develop by the secondary process
(S. Freud) rather than by the primary process (as
it has been interpreted by M. Klein).
The family triangle is lacking in the fundamental experience of
the brotherly presence; it is devoid at least of a brother or
a sister. Only so, by the presence of the quaternary element,
it is possible to overcome the narrow oedipal microcosm and to
arrive at the complete tetragonal family-matrix and, from there,
to project toward a polyhedral world and multi-vertex, rich of
unforeseen events and of enigmas (the Sphinx metaphorically
evoked by W. R. Bion for the group) inexhaustible font
of new thought and powerfully myth-producing.
Therefore recapitulating: the individual represents the primary
element; the secondary element is the couple; the third element
is three-polar and classically it is represented by the oedipal
triangle; the fourth element is the tetragonal and multi-vertex
group dimension in its circularity.
The Analytical Psychology (C. G. Jung) have repeatedly
underlined the tall spiritual value of the mandala, the
elevated sense connected to the alchemic strain toward the squaring
of the circle and besides the deep meaning - in the dreams,
in the collective unconscious, in the art and in the architecture
- of every expression that symbolically sends again to the circle
and to the squaring of the circle or to the Uroboro,
therefore to the archetype of the Self.
Today numerous group-analytical studies (F. Di Maria, G. Lavanco,
G. Lo Verso, R. Menarini, C. Pontalti) and various experiences
as, for instance, the Itinerant Seminar on "The Symbolic
Imaginary" - that it is a group full-immersion
in the soul and in the matrix (A. Anania)
- contribute to direct our attention not only toward the individual
Self but, in penetrating way, also toward the collective
Self and toward its relational and cultural matrix, that
I have defined as Historical Self.
However by all the studies on the folkloric creations -
rites, myths, fables, stories and popular traditions - (M.
L. Von Franz; V. J. Propp), on the transpersonal (F.
Di Maria, G. Lo Verso), on the Psychology of the Self
(O. Kernberg, H. Kouht) and on the intersubjective perspective
(R. D. Stolorow), it is unanimously underlined that the
birth and the development of the Self cannot happen without
the Other and cannot exist without the intersubjective
and transpersonal world.
Therefore we have admit that what we call the first element
or the individuality, has origin only from the fourth
element, that is from the group, passing through the
preliminary assumptions: first by the couple, secondarily by the
trinitarian dimension or minimal elementary group.
Do I incline more for the individual psychotherapy or do I have
a greater propensity toward the group-work?
Probably my scientific and application approach to the group-analysis,
has subsequently strengthened in me the natural propensity toward
the groups and it has helped me to mature, in the clinical activity,
a conduction method perhaps more proper for the therapeutic needs
of the patients rather than centred on the self-exploration exigencies
typical of the experiential-group and I however warn still
today the charm of it that is since from the start of my bionian
In a previous work, I have underlined that it is possible to observe
the group, with regard to its intrinsic complexity and polyhedral
configuration, under various interpretative perspectives: "evidently
these only are as helpful landmark, models or theories that order
the same process of observation (theoretical criterions useful
to confer sense and to conceive, in the most disciplined possible
way, a lived reality that it is not abstract). Without these perspectives
and interpretative models the automatic selection of total reality
would to be precluded; the absence of models would come across
the experience of chaos or the confusion (in group it is easy
the confusion with the same observed object). Insofar we have
to accept, that every interpretation relatively to the
group constitutes a restrictive but necessary process of transformation
of the reality.
The adoption and the choice of perspectives and models by the
group-conductor are partially conscious and voluntary, for the
rest they are unconscious because they originate from the personal
disposition and from life-experience (above all a prominent value
has the psychological training).
My mind goes to the psychotherapeutic group formed by chronic
psychiatric patients, about them I have already written in "The
anxiety of the group". I remember the insistence of the
participants in carrying the plastic bag containing medicines
and prescriptions, probably because they had the need to sustain
themselves on a basic-assumption psychiatrist-dependent and to
remain anchored therefore to a dimension, for so to say, "known
and familiar"; besides the bag probably was a metaphor
in relation to their silent appeal to be "cured" also
in a group context.
The group was by me conducted on the experiential model probably
because being formed exclusively by psychiatric chronic patients,
I unconsciously was feeling it as enough hard and therefore
I was inclined to preserve me from my unconscious worry to not
be excessively involved in the serious personal problems that
the participants presented. I would not like however that how
much now I affirm can induce the reader to believe my conduction
cold and detached in a way to favour the regression in the patients
and to leave free in all their entity the basic-assumptions (Bion).
Considering the chronic phase of illness (several patients was
frankly autistic) and taking into account the difficulties of
elaboration also because their cultural level not was elevated,
probably it was useful to maintain the attention more directed
on the group in its whole rather than a conduction principally
oriented on the personal sufferings introduced by every patient.
To this finality it was positive to limit my interpretative interventions
and to resort more frequently to the metaphors, to the discursive
plots, to the link-weavings among the various arguments that were
begun by the patients, above all when their communications appeared
notably unconnected the one from the others. Probably, only in
this way was possible to this group to live for almost two years.
A group-conduction mainly oriented on the group-analytic model
could not evidently happen without one time course and without
to go through a transitional phase rich in new experiences.
Probably I have found this infra-space by the conduction
of some group-therapeutic activities, reserved to patients hospitalised
in a psychiatric service, the reunions were twice the week through
two different settings.
5. Group by the music
The first one was a "Group by the music" - that
it substantially differed from a group of "music-therapy"
because it is not a treatment through the music but instead a
group-discussion that starts the communication from the preliminary
listening of a musical passage that is spontaneously picked out
by someone of the participants. Initially I thought opportune
to put to disposal of patients various cassettes reproducing both
classical music and songs; but, with the progress of the experience,
I understood that the sung passages (both lyric musical passages
and light music) produce in the patient much emotional tension
because frequently the contents of the songs is able to provoke
in this or in that patient (it is not necessary to underline that
generally they was acute or revolving door cases) the return to
deepest personal removed worries, from which the patients tend
to shelter themselves or tend to check by the pharmacological
therapy. The contents of songs, as known, generally propose some
life-themes rich of feeling and passion: the loneliness, the loss,
the incomprehension, the disappointment, the love, and the jealousy.
Instead, the symphonic music appears deeply cathartic, joining
and pacifying. I felt that the patients were participating, with
"religious" listening, to the "universality"
of the music that, in combination with the group context, opened
a "numinous" space particularly appropriate to the imaginative
production, to the free-associating, to the "interpretative"
The other weekly reunion happened as a normal "clinical group",
by me conduced employing the traditional therapeutic "setting".
The insertion of the group-psychotherapeutic among other routine
activities in the hospital psychiatric service, has allowed me
to verify the potentiality, underlined by numerous authors, relatively
to the therapeutic "group-setting, as efficient "holder"
relatively to the most explosive psychopathological emergences
and as "tool" useful to relieve the deep isolation-sense
of psychotic patients in need of elevated assistance; besides,
as precious tool to favour the communication, also through the
increased opportunities for every patient to be mirrored each
I cannot forget the case of a strongly aggressive "giant"
participating in the above-mentioned group as external patient.
This person, in the past repeatedly hospitalised and able to smash
with his punch the body of a car, one day he came to the group-session
after to have watched a television-film that was the story of
a man whose uncontrolled "escalation" of violent actions
was stopped only after the capture by the police. My patient told
to be shaken by the vision of the film and now he was convinced
of the necessity to put end to his outbursts of anger and to abandon,
as he said in the course of that session, the "almighty sensation
to be able to give scot-free to the own aggressiveness. From then,
really, he finished his violent behaviours and it doesn't result
me that later he was author of new aggressions. Rather than the
subject of the mentioned film, I believe, the substantial turn
in the behaviour of the patient has been caused by the participation
to the psychotherapy sessions and by the occasion to confess to
a "public co-elaborating" the internal solicitations
toward the dangerous behaviours of which he was protagonist and
in comparison to which, rather than with the fear or with the
refusal, the group had reacted with an "holding" behaviour,
more offering him an "emotional eco" and functioning
on it as "detonation box".
Useless to underline that music listen characterizing the first
part of one of two weekly group sessions and called "Group
by the music", it was useful to activate the communications
among the participants but, because the music pertains to so much
the body how much the mind, it is also a meaningful space both
to unite and to elaborate the emotional feelings and to warn the
movements of the Soul transmitting her metaphors with advantage
of those cathartic dimensions connected to the self-narration
out the ordinary world; as it is without time the maternal lullaby,
despite it has accompanied a period of our existence that is datable
only with an approximation.
To graft a something new inside an institution or a cultural context
or a territory, it is not an easy operation and it makes to live
all the difficulties alike that every pioneer has experienced.
In the institutions, the roles playing and the mechanisms of power
it is true they can often hinder the most innovative realizations,
in particular when they are initiatives driven by workers occupying
positions "hierarchically" subordinated, but other times
it is possible to verify the opposite case that is the realizations
come only by the personal will of who is to the apex of the responsibilities.
This is my story, so citing my experience, despite the invitation
more times turned toward many collaborators to start group works,
I remained for a long time, in my department, the only operator
conducting group-psychotherapeutic activity.
The small group knows the disillusion in the larger group.
6. Large group
With the purpose to spread the familiarity about the groups and
to involve the entire staff in the group therapeutic activity,
I started a "large group" formed by all the people
that were for the moment in the department: hospitalised persons
and coincidentally them relatives, patient in day-hospital and
naturally the entire staff including the nurses and the assistants.
This setting facilitates the collective involvement, therefore
the expansion of the communication level and the intensification
of the "network" besides, paradoxically, a greater intimacy
at level of the subgroups. The disadvantages in comparison to
the small therapeutic group, by my opinion, are perceptible above
all on the psychodynamic plain because the large group can intensify
in the participants the unconscious worry of fragmentation, regression
and individual loss of identity; reason why above all defensive
projective processes are mobilized, in more archaic and thick
form. But more the collective worries raise about the chaos and
the confusion so more the single ones are solicited toward the
unconscious activation of some psychic functions that allows the
logical reorganization and toward some emotional processes that
contribute to consolidate the affective attachment bind. In my
experience, the large group is above all characterized by the
number of speeches finalised to rationalize the collective experience,
by the wealth of communications in the form of "metaphors"
and of "parables" regarding the personal life, at least
by the tendency to multiply the "intimate" subgroups.
In a precedent work I signed that it is possible to see generally
in every group, but perhaps in form more evident in the experiential
group and in the large group, the presence of the so-called "collective
illusory phenomena" or of "psychotic behavioural models"
or of "typical dream-elements (absence of negation, a part
for the whole and vice versa, condensation, absence of space-storm
Since every individual participates in the group to the purpose
to be able to work better as integrated and interactive person,
seeing that the group determines depersonalisation and dreamlike
phenomena, the speeches of every participant can be read as an
effort to resolve the dreamlike flowing in the group, or better
as the final consequence of two opposite movements that is between
the tendency of the dreamlike to emerge and the contemporary necessity
to check it to maintain an adherent way to the reality principle.
7. Group for pregnant women
The dreamlike, as perhaps it is natural, emerged in all its sovereignty,
in the good and in the evil, in the "Group for pregnant
women" by me conducted in general hospital for about
one year and that remains, as it regards me, an exceptional experience
on which I will want to return as soon it will be possible
The pregnancy is a natural event, but in the imaginary collective
it maintain some magic value. The dreams of the pregnant women
underline the ambivalent feelings that accompany the pregnancy:
the waiting, the hope, the love, the devotion, the sense of completeness,
the procreativity, but also the limitation of liberty, the physical
transformation, the discomforts, the worry about the possible
damaging the little being in the womb, the anxiety for the birth,
the pains and the fear not to give the child to the light or that
he won't be born healthy and the fear that he can bring the death
to his mother.
The physically enlarged body hides the delicate, sometimes fragile,
psychological dimension of a woman in "interesting"
condition: the kaleidoscopic to variegate of the day-dreams is
accompanied to a continuous need of external support, for which
the transpersonal dimension plays a notable role both at the ethnic-anthropological
level (and archetypical) that at the "trans-familiar"
level. The attitudes of her husband and of her mother have a fundamental
Has impressed me the deep need to exchange the experiences lived
by the women participant to the group in a different context from
the banal ordinary thinking and the customary communications that
surround the "expectants" and, besides, their great
need, despite the pride for "empty" womb, to psychologically
be tiled in their gravid going. Probably it was by them
primarily important to traverse the period of the pregnancy accompanied
by a "good" "combined object" rather than
by the alone "good" mother". It can be true that,
in my experience, the maternal-female element was symbolically
represented by the group in its entirety, while the fatherly-masculine
element, reverberating routinely in the figure of the husband,
was symbolically represented by me as "conductor".
8. Experiential group training
The possibility to experiment as "to stay alone in presence
of the mother", could be an extremely synthetic metaphor
for the Experiential group training by me conducted for
about three years and reserved to university students of a school
of specialization in psychiatry; this training work has again
approached me to the bionian conduction model.
Despite some more or less indirect therapeutic needs periodically
emerged among the students, I have thought essential to avoid
the toning from a experiencing itself group to a psychotherapeutic
group. As it is comprehensible it is necessary to avoid both to
transgress in comparison to the model and to put together in a
same group, to purpose therapeutic, people that are daily together
for other reasons. The difficulty relative to conduct a group
whose members belong all to the same institution would be become
insurmountable by the transformation from an experiential in a
therapeutic group setting. In this case the dark wings of the
perversion would have altered the unanimously recognized atypical
context characterizing this training group and the "good"
mother would have been submerged by the intrusion of the "narcissistic
For many years, in the territorial department, I conduced a "Group-analytical
psychotherapy" in which I had inserted some people by
me a long time individually treated and besides some other patients
that had begun with me a psychotherapy foreseeing weekly one individual
session and one group session.
Evidently it was a group, from the clinical point of view, for
so to say soft, because the participants were outpatients
without serious psychopathological disorders. For some of them
it can be affirmed that they have definitely overcome the neurotic
troubles for which they had begun the individual psychotherapeutic
treatment and despite this they felt the need to keep on enjoying
of a context that facilitates the psychological elaboration.
Not unproblematic was to accept by every person the entry in the
group. The initial perplexities towards the group-psychotherapy
are justified by social-cultural reasons as the insufficient open-mindedness
in a territory that only after various years is above all receptive
to the individual psychotherapy. On the purely psychological plan,
we have to consider the intervention of some comprehensible factors
as the fears about the privacy and the intimate; these matters
can arouse in a number of people a lot of perplexities to the
idea to expose some individual problems in presence of a public
even if this is constituted by a narrow number of people tormented
by similar problems. The other factors can be connected to the
imagination of an exclusive therapeutic relationship with the
psychotherapist, to the jealousy towards other patients and to
the emotional feelings linked to the oedipal conflict. At a level
more deep we have to also consider the unconscious competition
inside the individual between family and group. By my experience,
I can affirm that more the person is enmeshed in critical familiar
dynamics more will have various resistances to the participation
to a group; evidently, the "internally introjected pathological
family" is to consider as a group self-defence operating
in the, so-called "designed", family person a destruction
of every alternative experience that would be able to diminish
inside that individual the value of the same family. With one
patient of mine, a young woman which painfully lived the particular
and complicated interlacement of paradoxical situations stratified
in her family, I had to wait more than three years before she
decided (or before this was allowed her by the "subjective
internal family") her entry in the therapeutic group; by
this she had an express and tangible benefit.
9. Group for insulin-treated diabetics
One of the most interesting was the "Group for insulin-treated
diabetics", by me conducted in general hospital in collaboration
with a colleague, specialist in diabetic, illnesses who actively
intervened in the group for furnishing to the participants, when
this was in demand, various explanations about the diet or other
specialist matters connected to the diabetes and, beside giving
some suggestions about how to proceed relatively to the insulin-therapy.
The beginning of the insulin injection-therapy represents for
these patients one of the most delicate moments during their life:
this intensifies theirs sensation of a damage coming from the
inside of the body linked to the hyperglycaemia and to the hormonal
pancreatic alterations; more all this opens a life perspective
as endless slavery to the syringes, to the glycaemia extemporaneous
controls and to the exasperating verification of an alternate
welfare-discomfort state in relationship to the assumptions of
food, to the habits of life, to the existential events.
The delicate interlacements - inherent to dynamics as oral voracity-frustration,
food-transgression guilt, dependence-independence, together with
the substantial not-acceptance of the illness and the negative
myths by the entourage produced about the diabetic disease - they
permeate the psychological life of the insulin-treated
patient. From these factors, beside the other individual elements
connected to the personality, it originates the enormous need
to communicate, to receive support, to attenuate the difference-feelings,
to develop with the specialist in diabetic illnesses a constant
relationship and to recover the trust and the hope in itself and
in the life.
With the progress of the sessions, I have warned that for these
diabetic persons the group, whose participants were young for
the most part, was acquiring an increasing importance. If going
on with aforesaid experiences, it will succeed in showing, as
firmly I believe, that it will be possible in the majority of
the cases to discover a meaningful correlation between stress
and diabetes, we will have a further contribution about the difficult
understanding of the mind-body relationship. More, if we will
contemporarily succeed in developing in these patients a superior
insight or a greater aptitude to a sort of "self-reverie"
about the personal somato-psychic events, we will probably have
helped these patients to partly arrest the evolution of their
illness since still today it is not possible to consider a potential
10. Psycho-anthrop-analytic group
Finally I have to mention the "Itinerant Seminar"
on "The Symbolic Imaginary", whose beginning goes
back to 1995, because at the present time it perhaps is the most
fascinating group dimension that I know. The "Immaginario
Simbolico" is an original group model, by me conceived,
it proceeds by "free associations" here and now
beginning from a visiting a much historically and/or culturally,
besides natural (that is not on purpose constructed), suggestive
place and spontaneously self-developing according to a "working
in progress" method; in fact any introductory relationship
or any preconceived stimulus is programmed if not the magic
of the place. More, the "Immaginario Simbolico"
allows the achievement of psychological dimensions relating to
archetypal profundities therefore it can be also considered as
an original psycho-anthrop-analytic training. So actually
the Itinerant Seminar is the most original and advanced
research finalized to understand the human individual and
collective complexity, because, interconnecting each other
the today's culture to the cultural matrix of historical Self,
it realizes a trans-cultural and trans-generational
"short-circuit", or rather between onto-psycho-genesis
Evidently it is not difficult to realize what test can represent
also for a yet experienced psychotherapist the conduction of a
so extremely psychodynamic group as the "Itinerant Seminar"
on "The Symbolic Imaginary".
Now, as in the beginning of this dissertation, I can return to
ask me: am I essentially individualist or inevitably am I group-oriented?
The answer is partially traceable probably in the argumentations
with which I ended an old article regarding the therapeutic groups:
other types of group situation came to my mind; similar to
those meeting and reunions among friends or acquaintances ordinarily
observable in the public places or in the parties or in the living
rooms. Reunions in which it is totally neglected to question and
to discuss about the interpersonal life "in itself";
in order to understand and to improve the quality of social life;
at least relatively to the quality of affiliation-group life.
11. The work-group
Apparently I have forgotten to talk about another type of group
which characterizes the "institutional field": the working
group, the équipe, matters on which not a long time
it is concentrate a certain part of the research within the mental
health. Simply, I have not wanted to speak of it! Because it is
necessary to find new équipe formulas, I think,
in relation to the public sanitary service.
In one historical period, as the actual global philosophy proposes,
characterized by "budgetary" and "corporate"
matters, the mental health reorganization in many little unities
- more limited in the number of operators and more and more mono-professional
(and perhaps more corporatists), besides presumably, as soon as
possible in full competition among them - it seems extremely far
the great project of the public Territorial Mental Health Service,
previous conceived as unitary and locally global coordinated activity
promoting the psychic welfare by the cooperation among various
professionals, functionally integrating the relief work of the
various sub-departments. Within the institutional field it is
fundamental the research on the "work-group".
Are they still worth for the oligo-professional groups the great
valid metaphors for the large équipe: the orchestra
or better the chessboard, in which every piece has only
one possibility of movement and a characteristic functional dynamism
still? Or will we have to find a new something?
12. Beyond the circle
It is probable to discover that the not-large operational unities
are able to experience a greater possibility to reach a "good
group spirit", if they doesn't have an excessive vision-narrowness.
So really the fourth element - it is the Soul of
the polis and of every its new foundation - will be the
factor promoting the birth of new ideas, of new solutions, of
new metaphors! The human current doesn't know arrests. It stops
a moment, adapts itself, learns from the experience and starts
walking again: "by the circle", beyond the
circle, so the humanity likewise Promethean stretched!