Closing the wound in the belly

I only have one pair of shorts with me, and thankfully they had dried out by this morning.

The order of the day is the reviews, also called 'Balancing' - and it means hearing from everybody about their experience at the intensive week. I had been warned that it was such an important part of the whole process that it took priority over meals, bedtime, and everything else. Previous last days, we learned, had not finished until 0400 on the Saturday. At least my plane home isn't until 1635!

As is the way of things here, the first thing to do was celebrate - and that was about thanks and celebrations to everybody who had helped with the organising and conducting the groups. Numerous people were carried round the room on the shoulders of fit young men and women, to dramatic music and racous applause - ending with very heartfelt adulation of the maestro himself. Then it was the turn of the other English guests and myself to be thanked for our participation. Mine included the showing of a rather embarrassing video of last night's swimming pool incident! But the warm and genuine gratitude clearly went both ways; I expressed how I felt that I had received a gift that I would take home to England, and try to grow it there.

After a very powerful video of an orchestra playing a fugue of  'Ode to Joy' in an Italian Piazza, we had a few minutes of organisational business. Mariano explained how his retirement and ultimate death are approaching, and the work needs to be sustained beyond that. He made it very clear that the method is not him - but is the people involved in its numerous local and regional activities as well as the central organisation; it will change and develop according to them and their vision.

Various people, most of whom are here, are helping in various roles with the 'Fondazione Nuova Specie Olnus', which was formed three years ago to coordinate and promote development of the method (www.nuovaspecie.com). Economic times are hard, with

The Snail and Quadrangle logo

Mariano supporting much of the work with his own money, and all the people I have identified as 'staff' work for nothing. They did have some government support in the past – but this has disappeared in the recession. They make a small amount of money from the sale of books - and they will lose their base and space at the hospital in Foggia next year. So they are fundraising, hoping to buy and develop a farmhouse and land nearby, in which they can hold the intensive weeks. An architect has drawn up plans for outdoor group space and a building for dining and other activities - so this is one of their main hopes for the future.

In fact the reviews started with an architect, who eloquently described the way in which the surroundings affect us, and with the cycle of the seasons> Although  which I was rather enjoying. But he got a firm rebuke from the chair – as needing to talk in feelings, from the heart, rather than intellectualisations from the head. Then a succession of others took to the chairs at the front - with the usual casual agglomerations of supporters. Sometimes the encounters were aggressive, and even physically violent - with the participants being kept physically safe with vigorous restraint from those around them; in others Mariano had to work hard to generate the passion and energy - like when he spent a long time trying to get a young boy to yell 'vaffancoulo' at him.

'Tell me to FUCK OFF'

The pattern of what was happening was difficult to understand at the time – as some of the encounters seemed needlessly severe – but it was only by discussing it directly with Mariano the next day that I cottoned on. His personal manner – which comes across to sensitive English eyes as somewhat brutish and callous – is deliberately used in the context of long-term relationships with these families, with a shrewd and perceptive judgement of what they need and what they can take (widely acknowledged by the participants) – all of which is dressed up and concocted in brash Italian humour (which often left the interpreters quite lost for words – and me completely in the dark). 

It is also to do with the structure of the week – and the whole Friday event is to ‘close the wounds in the belly’ that may have been opened up during the week with care and humour. Importantly, everybody there gets the opportunity to be in the hot seat – as part of the process of assessing how everybody is, and ensuring they are not leaving without expressing their feelings. It is an important part of the rhythm of the week – with the crescendo rising to the Wednesday morning ritual, with deliberate expression of angry and negative feelings on Thursday and this to round everything off on Friday.

So this is what the whole week looked like:

	Morning	Afternoon	Evening
Sunday	0900 - 1700 Trip to Gargano National Park and the seaside		1800 - 2030 Introduction session
Monday	0930 - 1330 Dynamics	1530 – 1930 Dynamics	2030 - 0030 Birthday party
Tuesday	0930 - 1330 Dynamics	1530 – 1930 Dynamics	Music and singing round the hotel piano
Wednesday	0930 - 1330 Ritual	1530 – 1930 Theory	Music and singing round the hotel piano
Thursday	0930 - 1330 The Ring	1530 – 1930 The Ring	2100 - 0030 Last night party
Friday	0930 - 1330 Reviews	1530 – 0025 Reviews
Saturday	1000 – 1300 Debrief with Mariano and team	1635 BRI-LGW

The Ring

I don't know what the other hotel guests make of us lot - drifting around the lobby, coffee and and swimming pool - arm-in-arm, in huddles of cuddles, or randomly accosting each other for kisses - and rarely passing each other in the corridors without deliberately touching each other. All with a remarkably easy familiarity. We must look like beings from another world! If it happened in London, I am sure they would either throw us out - or call the police and have all our emails hacked...

Mariano Loiacono

Speaking the unsaid

Today's groups are flagged up as specially for family conflicts - and to specifically voice things that have previously gone unsaid. This is 'The Ring' - and the analaogy with boxing or wrestling seemed to be rather relished by those who had been here before. After mopping up some unfinished business from yesterday, the stage was set. Mariano himself conducted it all, sitting on a high chair at the front of the carpet. He calls families (at least two, but sometimes four or five members) to come and sit on the carpet at his feet, and several others whom he thinks would be good to support them. The family members sit facing each other, in the blue corner and the red corner, as it were; the rest of the ring is made up by the supporters, sitting or lying on the carpet in an intimate huddle, all around the family.

Most families spend half an hour or so in the ring, although one took over two hours - and made us all late for dinner. The sequence is usually the same

1. One of the family is invited to say the things they have been unable to, to one or more of the other family members. With full physical support from those around.
2. Mariano commentates and reflects, I think in the style of 'structural family therapy' - often making extremely provocative suggestions (for example 'you three should get together and all kill yourselves')
3. The other family members respond - ideally with feelings rather than thoughts - again, with as much support as they need.
4. Mariano again intervenes
5. Any supporters wanting to speak are invited to contribute - again, more from the heart than the head (interestingly, they are usually better at this than the family at the centre).
6. Mariano summarises, and usually suggests simple structural interventions to try (for example, keep apart for a time, leave home, talk more about feelings together)

All interspersed with rather less music, dancing and light relief than on previous days.

The Celebration Cake

Not much spare time today - we didn't get to dinner till 2030, and the last night party was due to start at 2130, in the garden. The party - for an alcohol-free zone - was as wild as they come: ridiculously energetic dancing, impromptu rap bands, toasts with an enormous celebration cake (for the first ever international intensive week) and a dance tableau expertly choreographed by Anarita from London with the twelve best female dancers in the group. It finished, mush to the hotel management's disapproval, with a vote being held for who next was going to be chucked into the swimming pool. I thought I has escaped when the manager came out to ban us - but sadly, he allowed one last victim to be chosen. And guess who that was to be!

However, as a fully clothed wet dripping mess, I was able to exact a certain amount of revenge by extreme hugs with whoever I catch!

An extraordinary Italian Shamanic ritual

Interestingly, especially for Italian events, nearly everybody was on time for a 0930 start, directly after breakfast this morning. We all went up to the third floor meeting room (see the photo from the day before yesterday) to find our entrance blocked - we weren't allowed into the large group space in our usual desultory and disrespectful way.

Instead, we had to take off our shoes and leave them in the ante-room, form an orderly queue and keep quiet. Can you imagine it! One hundred and thirty people, mostly Italians, being asked to queue and stop talking...

Once the room was ready, a reception committee was formed on the other side of the door - and we were allowed in, one at a time. One of the more experienced group conductors hugged each of us, and then passed us on, by the hand, to the 'reception committee' - which was a gaggle of children just inside the door. One of the children held our hand and led us to our allotted place, with the gaggle of them accompanying each of us. Then the gaggle returned to base to bring the next person in.

Our allotted places were at the end of a large forming circle of people, all holding hands, who were gently swaying to soft Native North American chant music. The chairs has all been put to the sides, and there was a small table in the middle of the room with a bowl of water surrounded by foliage. The whole circle filled up in about half an hour, I think about 130 people; nobody said a word during this time. Some special arrangements were made to accommodate people who did not understand or could not tolerate it - one person near me, for example, needed to be held in a secure hug throughout the process by one of the group conductors. Once the group was complete, we were asked to sit or lie wherever we liked, and were given a short powerpoint presentation explaining the development of the ritual over the 38 years of the method's development. 

It started with an Ethiopian Catholic priest, who ran it as a semi-religious event with a strong Christian and Catholic structure, metaphor and iconography. Later in the group's history (I suspect when the Ethiopian priest died), there was a Zen Buddhist influence with the ritual (which marks the mid-way point of the intensive week event) being based on Buddhist practice and ritual. More recently, it has changed to have a Native North American Shamanic structure, content and process. We were informed that there were no satisfactorily respectful terms for 'Native North American' in existence, which did not suggest its brutal colonisation. So the 'Dancing People' was used, with an explanation based on the shape of the American continents: North America being the male dancer, South America being the pregnant female dancer, and Middle America being where they were holding hands.

As the four elements were evoked in the description of the ritual to come, the auspiciousness of the morning's windy weather was acknowledged and we were all invited to dip our hands into the ceremonial bowl of fresh water and wipe our faces with it. I presume the earth was represented by the hard floor on which we sat, with the fire being the extreme emotions that were to come.

"Dancing on the edge of chaos"

Once everybody had dipped their hands in the water, the main part of the ritual began. We were asked to close our eyes and gently move around he room, to soft 'Dancing People' music. Bumping into people was part of it, and we were to acknowledge them with a short caress or touch, then move on. This must have lasted ten or fifteen minutes before we were asked to remain in contact with whom we bumped into (or move on to choose another person if not happy with our first contact) and start with a deep, long, intensive hug. This is all still with our eyes closed. We were then taken through a routine to slowly explore and caress the whole body of the other person. It started with the head and shoulders, and arms and back. We were then led to the chest and asked to ignore the sexual significance of it, and continue the same process of appreciating and cherishing the other person's physical body through touch and caress - often quite hard, as well as softly. Then we were encouraged to move to the bottom, legs and feet, and finally to the whole person - before being asked to move on again, our eyes shut all the time. I do not know who she was, and never will.

Once everybody was moving again we went through several stages of an intense crescendo – all still with our eyes shut (though that wasn’t absolutely possible in the later stages!). First we were to walk in small circles, and then to choose a direction and move that way whoever got in our way with determination that that was ‘our chosen direction’. Then to change direction, and keep repeating it.

During this time the gentle music faded out and the drumming started. It gradually became faster, louder and more frenzied as our movements become more forceful and determined. The final instruction was to dance as if nobody was watching (and indeed, if all were following their instructions, nobody was watching!) - and be absolutely free to do whatever movements you wanted. 

When I thought that the drumming couldn’t get any more extreme, it did. And then again, and again. We were also now being implored to vocalise - first our names, which soon became increasingly primitive, loud and elemental. I lost my sense of time, and was only limited by my middle aged cardio-respiratory system and general unfitness. But after I don’t know how long, it did stop – and everybody collapsed onto the floor in sweaty heaps – mostly connected to others by minor or major physical contact, with quiet Dancing People’s chants and pipe music playing. After another indeterminate time, the music faded away and we were slowly coaxed back to Wednesday morning in a third floor conference room, somewhere in Italy.

The ritual was the prelude to the ‘transitions’ – where people who were chosen and judged ready by the group conductors – were then invited to undergo the 'transition' process. Closely aided and supported by the group conductors and numerous others, they were led into an extreme emotional state, and then, after the extreme regression, swaddled and slowly supported back to a normal level of consciousness. Two happened in the time we had – both extremely moving and painful to witness – but it would feel disrespectful for me to describe them in any more detail here. Suffice to say that they were very different.

Then another marvellous Italian pranzo (lunch).

Ingredients of a turbo-charged TC

The further into the week I get, the more this magical mystery tour surprises me. And being a grumpy old psychiatrist who usually thinks he has ‘seen it all’ in therapeutic communities, I thought I was pretty immune to surprises in therapy groups!

It would take a book - or an anthropology PhD to capture the whole of this event, so I'm going to try just identifying a few themes and bullet point lists today. So here goes.

In common with other therapies:

TYPE OF THERAPY	OBSERVATIONS
TC	Very flat hierarchy, tolerance of extreme disturbance, emotional containment, everything done in groups, different planned and timetabled groups, rapid change of group mood, includes social and meal time together, staff cohesiveness, emphasis on personal responsibility, strong on belongingness, peer support outside community time, powerful but flexible group-held rituals. Deliberate playfulness and fun. All staff have been through the programme themselves (addiction TCs only)
Psychodrama	Protagonist, role of conductors (3 at once), warm-up, action, sharing. Often with planning and preparation of who the protagonists are to be. Deliberate playfulness and fun.
Primal Scream*	Produces deep states of regression, cathartic release, and physical (bodily) containment afterwards.
Group Analysis	Matrix, resonance, large group process (though not explicit)
Transactional Analysis (TA) – Cathexis model	Reparenting with much physical holding
Gestalt	Empty chair work
Reichian / body*	Primacy of mind-body relationship; touch +++
Dance*	Much time is taken up with dancing – from gentle rocking (often with others) and swaying while holding hands in circles - to folk dancing - to wild expressive ‘let it all hang out’ bopping. Nobody forced to participate, but the substantial majority do.
Music*	Often used for warm-up, and frequently chosen ad-hoc to represent dynamic material or for group mood regulation – everything from lullabys and ambient spiritual songs to heavy rock and punk. Also singing, guitar and accordion from group members, and use of five African drums for particular intense emotional episodes
Existential	Unconditional positive regard; genuineness; openness to whatever emerges
Psychoanalysis – Freudian/Neo-Freudian	Oedipal dynamics (though not explicit)
Kleinian	Primitive infantile states (though not explicit)
Jungian	Archetypes, collective unconscious, primordial human codes, ritual, spirituality, numinosity, mysticism
Bion	Nameless dread and containment of primitive and primordial emotional states (though not explicit)
Winnicott	Holding, good enough parenting, infantile limits; playfulness
Kohut and ego-psychology	Relationship with self
Systemic Family (Milan)	Whole families involved, all ages; reframing; usually sees the ‘index problem’ as shared; long period between sessions
Structural Family (Minuchin)	Paradoxical injunctions; recommendations of structural family change; long period between sessions; deliberate playfulness and fun
Brief Focal  Therapy (Davanloo)	Forceful interventions intended to produce strong emotional reactions
Provocative*	Forceful conductors: can become confrontational and aggressive
Cathartic*	Profound emotional expression encouraged and prized
Positive Environment	Extremely warm and accepting, non-judgemental relationships expected of all
Open Dialogue	Whole family seen together; network of support; no secrets and extensive openness
Soteria*	Approach to medication and diagnosis peer support
Hearing Voices network	Normalisation of psychotic experience
Eastern / Tao / Chinese	Balance; clearing blockage and restoring flow; valuing negative as well as positive
DBT	Zen attitude; non-judgemental
MBT	Continuous thinking about, and responding to, the emotional state of others in the group
CBT	Very little!
* I have little direct experience or theoretical training in these approaches – so my observations are very speculative!

In common with NO other therapies (that I have encountered, at least):

·        Amount of touching, holding, hugging, caressing, stroking, hand-holding, lying together – between everybody present

·        All staff are unpaid

·        The groups are free to participants (with donations welcome)

·        Extensive incorporation of music and dance

·        Shamanic rituals

·        Theoretical framework – ‘codes’, ‘tree of life’, ‘communitometer’, ‘quadrangle’, ‘pyramid’

·        Clinical sequence of ‘ancestor tales’, ‘communications’, ‘immersion’, ‘common ground’

·        All as part of desired ‘transition’ (which seems closer to what we would describe as ‘transformative change’)

In keeping with contemporary critique of mainstream mental health services:

·        Total avoidance of diagnosis

·        Aim to reduce use of medication, especially long-term neuroleptics

·        No stigma

·        Centrality of TRUST and HOPE

·        Not ‘superficial’

·        Has a clear spiritual, numinous and transcendental quality

·        Based on personal narratives

Probably unacceptable in modern mainstream mental services:

·        Risk (need I say more!!)

·        Informed consent probably impossible to obtain (nobody could explain the experience enough to prepare somebody for it)

·        Boundaries unclear

·        Non-professionalisation and lack of institutional backing

·        Economic model

·        Un-standardisable

·        Extreme spontaneity in the groups

·        Necessarily chaotic/complex/emergent processes (including the development of the method itself)

·        Lack of the right sort of evidence…

Enough for tonight. Major ritual tomorrow!