Group Analysis in Spain
Abstract
This is a review of the history of group analysis in Spain from its inception (J. Campos, J. Guimón) until the current development of training and its implementation in the public and private healthcare networks.
Key words
Spain, Group Analysis, Training, History, Clinical practice
General Introduction
The invitation to participate in this issue of Contexts is attractive, complex and difficult. In the first place because as we disseminate the project, in which many of us have been involved since 1975, this serves as an opportunity to see what has happened and even to think about where we can go. Secondly, because it requires an emotional distance on my part in order to be able to give an account which is as objective as possible, preventing my particular vision from excessively staining the facts; and also knowing that it will be impossible to satisfy or include all those who have woven the threads of this story.
The proposal is twofold: on the one hand, I am going to write about the creation of GA in Spain and on the other hand, about the early days of GA in Spain. These two aspects are paired and difficult to segregate as they inevitably overlap: if it is created, it has a beginning and if it has a beginning, it is created. It has been more than forty years of work, study, conceptual development and research and the result has been more than gratifying.
I said it was difficult. It is, when verifying some dissociation between two models of understanding Group Analysis, two philosophies that arise —perhaps inevitably— from the two basic pillars on which this conceptualization of group work is built. One of them is more socio-centric with derivations of a meta-psychological type; the other one is entirely clinical. Two souls —two goals— that determine different paths that I doubt can meet. I perceive the same in other spaces or scenarios[1].
I am going to try to describe them, although my belonging to one of them will make it difficult to define my desired goal. Such an affiliation means that I only know well those who are in it. I am sorry I couldn’t walk through the other one. In any case, my intention is not to exclude it but on the contrary and as far as possible to approach it.
Finally, I would like to thank those who have participated in the training and, at the same time, I apologize for not being able to include everyone. There are many of you who have contributed to such implementation: professionals, most of you anonymous, who work daily with individuals with serious pathologies in complex healthcare contexts and who are even resistant to group work, and in environments where it is difficult to maintain the ability to elaborate what happens in those groups.
So that readers can see the two sides, I am going to develop the two aspects in unison with the desire that readers bring them together and have a complete image of group analysis in Spain; or at least, of my perspective.
Double parenthood: J. Campos and J. Guimón.
Both Mir, P. (2010) and Elustondo, I. (2011) emphasize the importance of the introduction of psychoanalytic thought in Spain in the structuring of a significant part of the development of group psychotherapy. They agree that it was the beginning of group psychotherapies, group analysis and psycho-dramatic techniques in Spain.
Let us set ourselves in 1958 in Barcelona, nineteen years after the Spanish Civil War. A series of psychiatrists led by Dr. Sarró were encouraged to organize the 3rd World Congress of Psychotherapy. J.L. Martí-Tusquets (1976) was the secretary. J. Campos, Ruiz-Ogara and L. Montserrat also participated.
«The congress revolved around two themes: Psychotherapy and Existential Analysis. Among the special sections there was one dedicated to group psychotherapy that was chaired by S.H. Foulkes and another one dedicated to psychodrama and chaired by J.L. Moreno. Foulkes organized a symposium on group analysis in which he spoke about the training that took place in his unit at Maudsley Hospital. (…) This congress would not have been possible without the work of R. Sarró, who had contacted these relevant figures coinciding with their attendance at the 2nd World Congress of Psychiatry in Zurich and the 2nd World Congress of Group Psychotherapy that was held simultaneously in the same city.» (Mir, 2010:124)
Campos was completely seduced by Foulkes. So much so that «he decided to go to London to be trained by Foulkes in his unit at Maudsley Hospital. And it was at this moment that group analysis started in Spain, yet in a very precarious and incipient way.» (Ibid:125)
He returned to Barcelona in 1963 after completing his training, participating, on the recommendation of Foulkes, in two complementary experiences, one in individual psychoanalysis and the other one, in group analysis psychotherapy at the Postgraduate Centre of Mental Health in New York. Once in Spain he gave several lectures and
«He tried to introduce a group approach in the psychiatric health care of the time. Thus, by taking over the Psychiatry dispensary of the Hospital Asilo de S. Juan de Dios, he implemented a comprehensive and integrated multidisciplinary care orientation. It was a pioneering care service in applying family counselling to child psychiatry and in the on-the-job training of professionals with a multidisciplinary nature. » (ibid:125)
Campos was committed to the development of group analysis, even though he did not trust regulated training insofar as it could end up prevailing over or reproducing the same patterns of control and imprisonment of the creative capacity, which is typical of the training institutes. Indeed, in 1980 he published a text criticising psychoanalytic training, pointing out that « in Psychoanalysis, epistemological ruptures are more dangerous and more severely punished than technical non-modifications » (Campos, 1980: 16), reminding us that
«if the analyst risks confronting reality and accepting that in a group what can be done is group analysis and not psychoanalysis (in the group or of the group)[2], they impose on themselves a task that will lead them to make a theoretical effort to understand what happens there and develop techniques that translate into true therapeutic results. On a personal level, what this implies is finding yourself helpless in the face of the unknown, with no other resources than those provided by your own ingenuity, your analytical attitude and the personal maturation that you may have accumulated in your years of training and from your experience as an analyst.» (ibid:17)
Paradoxically, in another text in which training is discussed, he points out that
«the four fundamental elements on which the group analytical training model is based are:
• Group personal analysis of a minimum of three years (…);
• Small group supervision based on conduction practise;
• Theoretical-practical and small group reading seminars, joint scientific sessions with members of the institute;
• Scientific sessions together with all members and adherents of the Institute.» (Campos, 1986:33)
In 1989 he published in Clinic and Group Analysis an interesting reflection on the state of group psychotherapy under the title “The group, fifty years later …”. In the article he reviews his evolution, giving an account of the beginnings of T. Burrow and the “conspiracy of silence” on his person as well as that of Schilder’s, “one of the most brilliant psychoanalysts of the Vienna group who emigrated to the United States in the early 1930s” (: 115). In this text a certain disappointment is revealed:
«the therapeutic fury and the enthusiasm for the training that I demonstrate can be explained in a young doctor recently graduated in psychoanalysis, but where did my group analysis training that I took simultaneously to avoid the side effects of the first training go? What strikes me is the inconsistency that I demonstrate: when it comes to producing theory, behind this “nobody” there is not a group or a group of groups,…» (:120)
He was absolutely dedicated to the dissemination of group analytic thought (Campos, 1986, 1988) in a land insufficiently fertilized for it. In a later text, (1999) he sings a certain farewell with sad tones when noting the serious difficulties in the creation of group projects such as, in this case, a magazine. Very possibly many factors concur in this, two of which are, in my opinion, the strong prevalence at that time of Kleinian thought, and the almost total absence of texts closer to group analytic thought or, at least, to relational psychoanalysis.
Thanks to the conversations I had with J. Campos and from what I have read about him, I gather he was not quite in favour of the formal training at regulated Institutes or Centres. I doubt if this is due to his own philosophy – possibly a rebound from the school period – or to Foulkes’ influence. I know of the wicked influences that arise in institutions and I remember the work of Kernberg (1999) in this regard. But also that of Skynner (1989), Kaes (1996) and Caudill (1966). Yet, on the other hand, I am aware that healthcare reality requires sufficiently accepted training standards so that those who work as group analysts have the credentials that accredit them. Such are, for example, those demanded by FEAP (the Spanish subsidiary of the EAP). I know that my philosophy, much closer to Guimon’s, clashed with Campos’s, a fact which perhaps deprived me of obtaining more teachings from the first —and I think the only— Spaniard trained directly by Foulkes.
Juan Campos had the support and help of two people who, in my opinion, were his personal support, one of them contributing to the conceptual development and the other one, to the practical one: Hanne Campos and Pere Mir.
The first one was his wife. She is a group analyst trained in London with a significant capacity to think and rethink the group phenomenon. She participated in the organization of Workshops (Castelldefels in 1980 and Cestona in1981), and attended several of the SEPTG[3] and AIPG symposia. In June 1989, J. Campos created a group in Barcelona called «Grup d’Anàlisi Barcelona » in which Hanne herself, S. Jover, P. Mir, J. Mª Ayerra (who left after a short while), M. Martínez and I. Admetlla participated. This group collaborates intensively with the SEPTG and other organizations. I believe that Hanne was a significant philosophical reference for Juan, enabling him not only to delve into his ideas but also to create new ones. An example is his text “Group theories as a context for group psychotherapy in particular and group work in general” (Campos, H. 1988) or the one published with him in 2007. I think that she and Juan were a significant conceptual, philosophical tandem.
The second person was P. Mir. Without him, a great deal of the group analytical conceptual development based on the work of Foulkes would not have been possible by those who will later be trained under the auspices of the OMIE[4] Foundation. He is not someone who likes to come to the fore, but his patient and constant work, his total discretion and, at the same time, his commitment to group analysis, make him worthy of that apparently secondary but fundamental place in the history of GA in Spain. His friendship and closeness with J. Campos and his wife, his participation in projects shared by them, turned him into this professional linked to the group and with close connections with a good part of the members of the GASI and other group associations such as the SEPTG, AIPG, and APAG[5]. He actively participates in all group analytical forums that may be held in order to be up to date with what the GA world can offer.
His dedication has allowed us to have the work of Foulkes and Pat de Maré in Spanish as well as to keep an extensive archive of information on the history of the group analysis. His efforts have made it possible for most of the 1,300 professionals who have been trained in this field to study the four books by Foulkes and an extensive work by P. De Maré in the Spanish version.
I mentioned J. Guimón[6] (Sunyer, Moneo, 2015) as the second cornerstone of this building. I believe that without his entrepreneurial capacity, most of us could not qualify as group analysts. He initiated his steps as a psychiatrist with J. Ajuriaguerra in Geneva. His training led him to the Queen’s Square Institute of Neurology in London. Later, he completed part of his training in New York connecting with the American Group Association and the Ackerman Institute. Once in Spain he connected with two psychotherapists trained at the Peña Retama Institute in Madrid, C. González and L. Yllá, whom he convinced to move to Bilbao and contribute to the training of the professionals who were there.
As the Head of the Psychiatry Service of the Basurto Hospital, he was confronted with a situation: in 1975, the Hospital did not practice psychotherapy, so he had to manage to be able to offer psychiatric and psychological care service which involved psychotherapeutic activities. To begin with, he created the Bilbao Psychotherapy Institute with Dr. L. Yllá, I. Delclaux and M. Gutiérrez. At the end of that year “the activities prior to the establishment of the Basurto Day Hospital, inaugurated the following year under the direction of J. M. Sunyer, began[7]“ (Guimón: 2010: 90). The group assistance activities were transferred to Basurto, and were enriched by the experiential seminars given by Pacho O’Donnell from Buenos Aires, W. Schindler from London and O. Silverstein and Nina Fieldsteel from NY, among others.
The interest in training health care professionals in the field of psychotherapy enabled Dr. Guimón to come into contact with J. Campos and, possibly through him, with Fernando Arroyabe[8] – a Colombian settled in England and a person closely linked to the Institute at the time. Under those circumstances and possibly after talking about it with him, Juan and Hanne Campos organized a first intensive seminar in Castelldefels (Barcelona) in 1980 under the title «Introducción al Grupoanálisis de S.H. Foulkes». Some people from Bilbao attended. This was an intensive residential workshop and was organized under the sponsorship of the Institute of Group Analysis in London (H. Campos, 2021). After the success and support of F. Arroyabe and M. Pines, another meeting was organized in 1981 in Cestona (Navarra) together with the Institute of Group Analysis in London, in which several colleagues from Bilbao also participated.
Being involved in the psychiatric reform of our country following the model proposed by Ajuriaguerra, Dr. Guimón created the conditions that enabled representatives of the Institute of Group Analysis in London to come to Bilbao to start training many of us who were interested in the group. There, Malcom Pines, Fernando Arroyabe, Ana Mª Patalán and Mario Marrone began the development first with the post-degree endorsed by the University of Basc Country (UPV) and that would later become the training endorsed by the University of Deusto as the Master’s degree in Group Analytical Psychotherapy.
« The course was carried out according to two modalities: one of them was an Introduction to Group Work, scheduled every Friday afternoon in two sessions of 90 minutes during 32 weeks, and the other one included a series of seminars, each offering an 18-hour experience, the last three days of the week, four times a year.[9] Since then, the course has been held annually in a weekly format in Bilbao. For the programs that began in Barcelona and Geneva, the block format was chosen[10].
The growth of our programs created gaps in the OMIE Foundation, which lead some significant person to decide to launch, against the opinion of others, a parallel program with funds from the Basque Government. To do this, he brought British trainers from the “Institute of Group Analysis” who spoke Spanish. This brought about a serious conflict (…) In any case, that rival experiment went into a decline and eventually disappeared years later.» (Guimón, 2010:92)
Predictably, tensions also began to emerge between the London IGA and the team of trainers from Bilbao.
« At that time, the representative of the Institute of Group Analysis suggested that the program be under his direct responsibility by delegation of the training committee of European programs that had been created in London. This plan was not well received by some of the local trainers, who pressured the local committee not to accept the initiative. On that occasion, we followed the same path of “autonomy” as other training centres that had been created in Europe under the same circumstances and together we became part of the European Group Analytic Training Institution Network (E.G.A.T.I.N.). Despite the gratitude of the new European training institutes to the London organization, the desire for independence from a colonialist Britain prevailed among all of us. » (ibid: 92-3)
He participated in the creation of EGATIN, being, if I remember correctly, his first secretary[11]. Consequently, the Institute for Group Analysis of the OMIE Foundation was created. And likewise, he led the creation of the Group Analytical Psychotherapy Association[12] – not group analytical as J. Campos emphasized in his complaint, (2005: 46) – in order to enable its members to be recognized as psychotherapists by the FEAP, a subsidiary of the European Association or Psychotherapy (EAP).
Another relevant aspect of J. Guimón’s work was the development of Training Communities. As a result of the emergence of numerous training centres throughout Europe and given the difficulties of establishing weekly training patterns, these sessions were replaced by training in Blocks. Thus, «in 1990 block training began in Barcelona, unlike the one carried out in Bilbao, which, at that time, followed a weekly program». (Guimón 2004)
Following his initiative, many colleagues supported him, among them J.Mª Ayerra; J.L. López Atienza; K. Totorika; A-L. Fredenrich (in Geneva). We all contributed our efforts, desire to learn and availability in the initiatives that Guimón launched in Spain and Switzerland[13].
Next I am going to address four outstanding aspects of such initiative: training and training format, the creation of the Institute for Group Analysis, the emergence of APAG and additional training.
a) Training[14]
This training initially had the academic support of the University of the Basque Country, but later it was decided to find another institution that would allow greater agility in the management of the course and that would more easily adhere to the training criteria that followed EGATIN’s model directly. The University of Deusto (Bilbao) was the chosen institution, which with all the aid and support continues to maintain the academic recognition of the training with the “Master’s degree in Group Analytical Psychotherapy” after thirty years of continuous work and effort. In this way, all students who undergo this training earn a degree from the University of Deusto[15].
We started the training program in Bilbao under the direction of J. Mª Ayerra and the collaboration of J.L. López Atienza. In 1990, with the help of M. Casas and A. Bulbena, we planned to offer the training program also in Barcelona (with the collaboration of S. de Miguel, M. Sallés, J. Gutiérrez, C. López, among others). This led B. Trojaola, J. Grijalvo, E. González de Mendívil, E. de la Sierra, and E. Barón to run the training in Bilbao. In 2015, the Foundation accepted my proposal to provide the same training program in Madrid (with the help of M. Soler, L. Granell and M. Solano), which started in the format of awareness seminars and currently, it has same training structure as in the other locations.
The training format
The European Group Analytic Training Institutions Network (EGATIN) recommends that training cover three fundamental areas: personal group experience (240 hours), theoretical training (160 hours) and supervision (120 hours). As for block training, the minimum number must be 6 per training year. In addition, students are required to lead groups in their clinical practice.
The training requirements are met in the three locations with the only difference that while Barcelona and Madrid offer 8 weekend training blocks, Bilbao offers 10; although the number of teaching hours is similar in the three programs, amounting to 600 hours of classroom training. Furthermore, in the three locations the small group experience (between 6 and 8 experiences per weekend) is complemented by large group experiences. And if the prevailing philosophy in all three is that of a “group analytical psychotherapeutic-pedagogical community in a multi-group format[16]“, it is possibly more clearly so in Barcelona and Madrid. In all three locations, there is a “border person”, who is a professional outside the training experience and who attends as an observer for a whole weekend, subsequently contributing their experience and highlighting some blind spots within the training program.
b) Additional training
In Bilbao, during the first years of training, there were cycles of large group experiences led by J. Mª Ayerra. They involved series of 9 large groups that were held over three days. A large number of professionals attended and the debates were extremely intense, mainly addressing social issues that permeated the daily life of those of us who lived in the Basque Country. Something similar was organized in Barcelona; however, it was only held twice.
In Barcelona we also set up group spaces called «ongoing training» for those people who wish to have a specific conceptual space and take advantage of the synergy of the training course at the same time. They consist of four weekend meetings coinciding with the Master’s program and participating in the large group with the rest of the students who are being trained.
c) Group Analysis Institute
Created by Dr. Guimón within the OMIE Foundation while at the same time EGATIN was organized, it has not had much activity beyond the organization of training courses and various group meetings among those of us who are dedicated to it. After a parenthesis with no participation, their European network membership was reactivated in 2010, becoming part of the Egatin Committee for a few years. Currently, the president of the Institute is Dr. Manuel Mateos.
The underlying idea is the certification of the group analyst status as well as promoting the exchange of professional experiences, the organization of meeting and conceptual discussion venues, the organization of sequential seminars for conceptual deepening and establishing ties with other European Institutes through EGATIN.
d) Association of Group Analytical Psychotherapy (APAG)
In 1987, in order to offer legal coverage to those who were trained in the group setting, those of us who made up the then called “teaching committee” considered Dr. Guimón’s proposal appropriate. The proposal involved the creation of a professional association. Its creation and launch in an Inaugural Congress in which more than 100 people participated coincided with the visit of several EGATIN members to Bilbao. Such entity was admitted as a member of the Spanish Federation of Psychotherapy Associations (FEAP), a subsidiary of the EAP. Belonging to the association requires certain training standards that coincide with those of EGATIN and the EAP. At national level, there is a catalogue of psychotherapists of various orientations, among which there is group analysis.
Consequences of the training
It is not difficult to deduce the impact of group analytical training in psychiatric care in Spain. Right from the start, in 1976 the HD of the Basurto Hospital was inaugurated, opting from the outset for a group format. Shortly after, the Uribe Kosta Mental Health Consortium was created, first led by J.Mª Ayerra, and later by J.L. López Atienza, and it has been serving the population of Guetxo with group programs (especially in its Day Hospital for adults and children) until today. The hospital prioritizes large groups with psychotic patients and the developments of multi-family groups. (García Badaracco 1990, 2000)
As a result of these two initiatives, group meetings were initially promoted between the Basurto and Uribe Kosta teams, to which other HDs from the rest of the Basque Country were later added. It actually was the embryo to annually organize a State Conference of Hospitals and Day Care Centres. Representatives of a good part of DH and DCC from all over the national territory attended these group meetings. Even a book was published after the 5th Symposium.
Today the presence of group psychotherapy is a reality in a large part of the psychiatric assistance facilities throughout Spain. To a large extent this is due to the fact that 93% of the students are clinical psychologists or psychiatrists, 4% are nurses, a scant 1.5% is social workers, and the rest are pedagogues or sociologists. 95% work in psychiatric-psychological care centres (psychiatric hospitals, day care centres and hospitals, psychiatric clinics, drug addiction centres, psychiatric residences, etc.) while the remaining 5% are either in private clinics or in some school or social centre.
This does not mean that group analytic reading is limited to the psychotherapeutic field: Children Psychiatric Centers (Torres (2020), Farrés (2020); Hospital Day Centers (Soler, 2020; Agudo, 2020; Atienza, 2020); Personality disorders (Baños, 2020); Drugs (Hijosa, 2020), Psychiatric Units (Martínez 2020). Other initiatives inspired by these developments are known to apply to administrative (Fernández, R., 2020); Gutiérrez, J., (2020), Academic (Sunyer, 2020), Prison (Torrents, O., 2020), social and other areas.
From this perspective, it is gratifying to note that forty-five years later, the seed that both J. Campos and J. Guimón planted continues to bear fruit. In the vast majority of Spanish regions there are significant group analytical developments.
The path is directed towards a conceptual deepening and a greater dissemination of the group-analytically oriented healthcare activities that all these students are carrying out and those who may continue to come. Likewise, the creation of spaces for sharing experiences such as those organized by both the Foundation’s IGA and the association (APAG) can enhance the shared creation of projects and developments, such as sharing conceptual developments that allow us to understand the homines aperti (Elias, 2010 ) more completely.
I think that both J. Campos and J. Guimón can be satisfied.
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Torrents, O. (2020). El grupo multifamiliar en prisión. En J.M. Sunyer (Coord.). Experiencias Grupoanalíticas. Aportaciones desde la práctica. Madrid: viveLibro
Torres, R.; Font, A. (2020). La experiencia del vínculo en un espacio familiar psicoterapéutico para niños de 24 a 36 meses de edad. En J.M. Sunyer (Coord.). Experiencias Grupoanalíticas. Aportaciones desde la práctica. Madrid: viveLibro
Ylla, L. (2010). Retazos de mi visión del desarrollo del psicoanálisis, la psicoterapia analítica y la psicoterapia de grupo en España. Teoría y practica grupoanalítica. 1(0):31-48
Notes
[1] I am grateful to P. Mir for the comments that he has made me and that have contributed to making what I say more closely match the reality shared by many
[2] The excerpt from the passage is mine.
[3] Sociedad Española de Psicoterapia y Técnicas de Grupo (Spanish Society of Psychotherapy and Group Thecniques)
[4] Fundación Vasca para la Investigación en Salud Mental / Osasun Mentalaren Ikerketarako Ezarkundea (Basc Foundation for research in Mental Health)
[5] Asociación de Psicoterapia Analítica Grupal (Group Analytic Psychotherapy Association)
[6] I have always considered him my professional employer. I will always be grateful to him for his support, since without him I don’t think that today I would be in the place I occupy professionally.
[7] The first H.D of Spain was founded by prof. A. Acosta, at the Hospital de la Cruz Roja in Madrid. This was the second in a General Hospital
[8] F. Arroyabe with whom I had a good friendship, gave me in 1979 the text of Kreeger, L. (1995) that I keep with all my affection. It has been very useful to me over the years.
[9] We did not have “group analysis” texts. Instead, they gave us a little book – Spheres of Group Analysis, edited by T.E. Lear -, whose articles were translated by some of the students.
[10] The London Institute of Group Analysis decided to delegate responsibility for the course to J. Guimón. The decision was made during the annual meeting of the Society for Group Analysis in April 1982, and both the Introductory Course to Group Work and the sequential seminars were initially certified jointly by the Institute of Group Analysis in London and the Department of Psychiatry of the Faculty of Medicine of the University of the Basque Country.
[11] I had the opportunity to witness the signing of the founding act in Heidelberg, where L. Yllá and I accompanied Dr. Guimón.
[12] I participated in the choice of the name, being the only one who advocated calling it the Association of Group-Analytical Psychotherapy. But there was a lot of discussion and such a specific name was not wanted. Finally, group Analytical Psychotherapy was chosen —with Jungian reminiscences— which seemed more open to the participation of professionals of all psychoanalytically inspired orientations.
[13] I was actively involved with Anne-Lise in the organization of this course. It was an excellent experience.
[14] I think I must mention B. Campos, the secretary of the Foundation whose complete dedication to its projects is an invaluable support to group training.
[15] It is the only Spanish University that offers it and the longest and most stable Master’s degree in Spain.
[16] Paraphrasing the idea of J. García Badaracco of “psychoanalytic therapeutic community of multifamily structure” (1990)
J.M. Sunyer
josemiguelsunyer@gmail.com