A marathon of marathons

When I started training as a group analyst, we occasionally had 'marathon' groups, which were generally three hours long - although I think some of the wackier Californian 60s group therapies (long before my time) may have been longer.

But this is about therapy groups that each last four hours, and of which the intensive programme includes two of them every day for a week - a total of ten four hour groups (plus the two and a half hour introduction). Now that's what I call a marathon!

The set-up

• comfortable medium-sized hotel in San Giovanni Rotundo, Puglia (2 hours drive from Bari airport)
• large air-conditioned conference room on the top floor
• chairs set out in six layers of wide horseshoe, with four or five chairs at the front
• projector and powerful sound system linked to online music and videos, some simple musical instruments - including five African drums, a guitar and an accordion
• Large blue and gold patterned rug between the chairs at the front, and the rows facing them

Who is here?

• ~130 service users with their families, mostly parents and offspring - but also some couples.
• Many small children, running around playing and lying on the carpet
• Although no diagnoses are made or discussed, it is clear that the group includes people with
• chronic and sometimes severe psychosis
• opiate and alcohol addictions
• bereavement
• family enmeshment and marital disharmony
• troubled children - probably diagnosable ODD and ADHD
• autistic spectrum disorder (including severe autism)
• Down’s
• complex emotional disorders / personality disorder
• depression and anxiety
• obsessions and rituals
• stress and adjustment reactions
• the overall diagnosis is 'DISAGGIO DIFFUSO'
• about six staff who conduct the groups, and many active helpers who have been through the process themselves
• myself and another British guest
• a live interpreter (sitting amongst us – with wifi and headphones system)

What happens?

• Two large groups per day, each lasting four hours (or more). As is usually the case in Italy, timing is somewhat flexible: music plays from before the prescribed staring time until most members have wandered in, and the group facilitators start calling for order about a quarter of an hour after the official time.
• People volunteer or are called, one a time, to be the central person – more the ‘centre of attention’ than ‘protagonist’ (as in psychodrama)
• The discussion with them is closely conducted by some or all of the three conductors, sometimes with other helpers, and occasionally with others from the participants. It is all done with hand-held microphones through the (quite loud) sound system.
• This time at the front usually lasts about 10-30 minutes for each of them.
• There is a progression of what is talked about throughout the day, somewhat based on the three ‘codes’:
• the factual telling of biographical stories (~rational-symbolic code)
• followed by more emotional ones (~analogic code)
• then, before lunch, the ‘immersion’
• after lunch, peoples’ reactions to what they heard in the morning, to explore ‘common ground’
• then gathering of themes from everybody who chooses to contribute, based on the morning’s stories and emotions
• choosing of the single predominant theme for the day
• and reflections from all who wish about that theme
• finishing with ‘theory’ - mostly from the three facilitators – based on the chosen theme, the narratives and feeling discussed during the day, disclosure of their own stories, and using diagrams of ‘the method’
• Before the ‘immersion’ process, the general pattern is the same for each participant: say – feel – touch. In ‘say’ the narrative is given, with questioning by the facilitators, including a considerable amount of hand-holding, caressing, stroking to give physical support (~bio-organic code).
• The aim is to get to the person’s feelings – ‘feel’ (sometimes the questioning and physical actions to get there can seem quite harsh).
• The feelings themselves are explored to a variable amount, but the ending is always a crescendo of ‘touch’ – often with the facilitators calling for some or many other participants to hug (individual or group), cuddle, lie down with, stroke, caress, sit on the lap of, or some other continuing physical contact, usually on the carpet – with the children, helpers, others feeling vulnerable, and sometimes the facilitators themselves.
• Often suitable music is chosen, and everybody invited to dance. This includes lullabys, Italian ballads, loud pop and rock, and the ‘vaffanculo’ (fuck you) song - which was extremely popular!
• This process often triggers an emotional reaction in others (exactly what group analysts call 'resonance'), who are then invited to the front to go through the same process, or who are quietly supported by people nearby or who come across the room when they see the need for help. The group conductors are only occasionally involved in this themselves.
• There is movement of people nearly all the time, including coming and going. The whole event is extensively photographed and continually videoed and audio-taped for the archive.
• An exception to this is the ‘immersion’ for which several people, who have already described their narratives, have chosen to explore the emotions in more depth. It is often described by people as an important part of their 'transition'. For this, the lights are dimmed, and everybody is asked to respect the situation by turning phones off, not coming or going, and being quiet.

My first questions:

1.    The charismatic leadership, of Mariano Loiacano with a relentless positive transference: is – and can the MaS method ever be - more than just him?
This was somewhat answered for the next two days' four hour groups, which were conducted by three women on Monday (Cindy, Graziana and Dina) and two women and a man (Sandra, Nicola (?) and Silvio) on Tuesday without him being there at all.

2.    Ethics of such extensive physical contact: it was well acknowledged in the workshop that southern Italians are much more comfortable with physical contact than those from the north – and this is even more extreme when compared to northern Europe. Although in Mariano’s introductory session, he emphasised that the touch is non-sexual – to northern European eyes, it doesn’t always look like that!

3.    This is a large group therapy (which clearly gives some immediate relief and catharsis for people’s distress) - but if its benefit is to be worthwhile, long-term improvements will need to be demonstrated. Several case studies and individual accounts gave testament to this, although it is not clear whether Bob Johnson’s call for systematic use of the GHQ questionnaire, four years ago, has been taken any further. A more interesting qualitative question – much on my mind – is what it is that it shares with group analytic approaches (a turbo-charged group matrix?), with TCs (utterly flattened hierarchy and a powerful experience of emotional containment), and with positive environments more generally (relationally designed, planned and executed; informality - such as the children running around, music and other features to enrich the space)?

More later…