Arcipelago: No Man is an Island – An Experience Between the Clinical, Social and Economic Worlds

Abstract

The authors recount the birth in Turin in 2008 of the Arcipelago Group Analysis Clinical Centre, focusing on what it took to carry this experience forward over the last 16 years. Attention and reflection is  focused on how to maintain the working group, with a group-analytical outlook, while going through inevitable conflicts and ambivalences.

A vision emerges that keeps in mind three areas in dynamic balance: a clinical, an economical and a social one, in articulation with the work that takes place through the group.

Intervention

My colleague and I will talk about a ‘social enterprise’ experience, born in Turin, which had to undergo transformations over the years, from its foundation to the present day, in order to meet the social world and carry out its clinical activities.

We will talk about how we were able to experience the groups in our clinical practice and how we had to maintain them in the institution.

Arcipelago today

Arcipelago is a Centre for Applied Group Analysis. It is a cooperative. It is a reality that today involves 23 group analysts/psychotherapists, 1 administrative secretary and a few collaborators. In 2023 Arcipelago served more than 500 people (with its services);

That is, patients who have undergone individual, couple or group psychotherapy, parenting support groups, groups for refugees, supervision groups for teams of social workers, support for vulnerable groups (single mothers, former prisoners or people who have lost their homes).

The data collected in 2023 shows that on average around 600 individual treatments were carried out every month and the number of patients who underwent psychotherapy (individual, couple or group) was close to 300 people every month.

A quarter of the people, in 2023, were met not in psychotherapy but through projects to support vulnerable groups, schools, supervision and refugees. In different colors you can see various projects for the weaker groups.

Image 1 | No. individual treatment for month

Image 2 | No. patients for month

Image 3 | People in projects

The group of therapists holds team meetings every two weeks, there are two different internal supervisory meetings every two weeks , and other organisational meetings and supervisory meetings with experienced clinicians from outside Arcipelago are held throughout the year.

Recounting the experience implies unraveling the long journey we have taken, today’s photograph does not mean much if we do not observe the dynamics over time: let us leaf through the album of memories and discover how it all came about.

The Matrix

i.e. the story of how a collection of people become a group with its own life, culture and history

Image 4 | Family picture, Kandinsky, Composition No. VIII

To describe the origin of Arcipelago, let us start with an image; it is a very famous painting entitled Composition No. VIII by Vasily Kandinsky. Without going into the poetics of the artwork, the loss of meaning of the painting when divided into segments is striking. In fact, if we isolate the circle on the top left corner or the three geometric shapes (triangle, circle, square) on the bottom right corner of the painting, we irreparably lose the sense of the painting, its globality.

We have entitled it family picture because, since the very beginning, it has been the logo of the Apragi Association. Founded in Turin in 1985, Apragi stands for Association for Research and Training in Individual Group Psychotherapy and Institutional Analysis. In fact, Apragi group-analytic thought was the cradle in which the Cooperativa Arcipelago was born.

In 2006, Alma Gentinetta, an Apragi member and Alessandra Simonetto, the Apragi President, decided to take up the proposal made by Fondazione Oltre, which had  contacted Alma Gentinetta because of her esteemed membership in Coirag, (Confederation of Italian Organisations for Group Analytical Research), to which Apragi belongs. The idea, which had already been put into practice in Milan a few years earlier, consisted in setting up a centre that would provide psychological services at reduced prices. In the Turin area, this project was supported by Fondazione Paideia, which has always promoted projects and interventions in the social field.

Image 5 | Arcipelago Foundation network

As Foulkes claimed:

“Human life has always been in groups. These are always in a state of flux depending on geographical, economic historical technical and cultural conditions” (Selected papers: psychoanalysis and group analysis, 1990)

That’s how the gestation period of Arcipelago began. The first meetings between the founding members took place in Alma Gentinetta’s office, in close collaboration with the two mentioned foundations, which added entrepreneurial complexity to clinical complexity.

Getting to the heart of the story, we’d like to quote the incipit of a poem “No man is an island”, by John Donne, which is also a piece of our story. In fact, Arcipelago was born out of a group matrix, i.e. from the meeting of an individual (Alma Gentinetta) who was contacted because of her belonging to a group (Coirag) and who engaged her own group, which, as a group, she thought of from the beginning (Apragi). In fact, what Foulkes advocated was made real and conscious:

…what is called ‘the mind’ consists of interactive processes between a number of closely related people.

(Selected papers: psychoanalysis and group analysis, 1990)

In fact, the group-analytical point of view has always allowed us to keep together, as much as possible, the pieces of our history and relationships while trying to keep visible the parts that make up the whole.

It was 2006 and the signs of the economic crisis that would explode in 2008 were already visible. The 2008 crisis led many states to cut public spending. The Italian National Health Service also suffered the consequences of that crisis (in Italy, all citizens are guaranteed free access to health care and equal provision of services). Already in 2006, there was an increase in waiting lists, and the farsightedness of group-analytic thinking, attentive to detecting the signals coming from the social sphere, in fact predicted the need to create a middle ground between the public and private sectors, offering psychological services at lower rates as suggested by Fondazione Oltre. At the same time, special thought was given to the young colleagues finishing the Coirag Apragi Training who, due to the continuous economic cuts, could not find an employment within the National Health Service, as they would only a few years earlier. In practical terms, thinking in a complex way means grasping the movements of the times in which one lives, putting oneself in constructive, non-ideological dialogue with the social movements, opportunities and constraints encountered along the way. With this in mind, Fondazione Oltre suggested that the most suitable legal form for the Arcipelago project would be that of a Social Cooperative.  This was an initial transformation that the encounter between group-analysis and the business world has produced.

What is a social cooperative? It is a way of doing business that has a long tradition in Piedmont and other Italian regions. Its distinctive feature is its democratic structure, i.e. each member has the right to one vote and power is not divided on the basis of capital shares held. The aim of the enterprise is mutuality, not profit: the allocation of the operating surplus, which is not called profit, is not redistributed among the shareholders but is almost entirely reinvested in the development of the cooperative itself and in strengthening the cooperative’s assets.

Image 6 | What is a Cooperative in Italy

Through the cooperative, a democratic economic vertex is attained as a way of reinterpreting social life. Being a Social Cooperative, therefore, constitutes a further element of our matrix; if we were to paraphrase Foulkes,

‘The group is a form of psychotherapy  practised by the group towards the group including the conductor‘.

So, The Social Cooperative is a form of enterprise that cares for the social practised by the Cooperative towards  the working group and the set of citizens of the afferent territory including  the Board of Directors of the Cooperative itself.

In conclusion ‘nomen omen’, Arcipelago is a complex reality immersed in a network of links, an archipelago immersed in other archipelagos: Apragi, Coirag, the colleagues who support us with their different specialties, the associations with which we collaborate and the international conferences at which the Arcipelago project is presented.

With a view to collaboration, non-competitiveness and the building of networks to support clinical activity, Arcipelago immediately made contact with professionals from different backgrounds (different disciplines and theoretical orientations) to the point of building innovative projects integrating group analysis and other approaches (e.g. Feuerstein Method, Mindfulness, EMDR, Circle of Security…)

Its presence in the territory as a social organization came about through links with other associations, public bodies and cooperatives, culminating in its membership of the Ri-Mediare Network. Indeed, a transformation that can be coherent, effective and lasting passes through a way of observing, reading and dialoguing about phenomena together with a community of thought that is much wider than the small Arcipelago group.

Please allow us to say with some pride that our matrix is a group, social and economically democratic one. Its founding characteristic is the idea of a generous generativity to protect the ‘little ones’, feeling in them the possibility of imagining and building a future; this is done through the involvement of newly trained group analysts (in line with Apragi’s original intention) up to the support of patients and the weak, the construction of projects, and arrives at the sharing of individual generativity (more than 22 children were born during these 16 years of existence of our Arcipelago cooperative!).

Image 7 | Arcipelago Logo

All this complexity was officially born on 6 March 2008 with 9 members, 2 Foundations and 3 patients . 

Sustainability

or not endlessly repeating the effort

Image 8 |  Sisyphus condemned of forever rolling a boulder up a hill

One term that has conditioned the working group of Arcipelago at some point in its history has been ‘sustainability’.

The act of existence was well established, but would the cooperative walk on its own feet? Would the innovative project stand the test of time, the changes within it and the demands of the changing world? How would it manage a harmonious development that was not just growth?

The first famous definition of ‘sustainable development’ dates back to 1987:
“Sustainable development is development that enables the present generation to satisfy its needs without compromising the ability of future generations to satisfy theirs.” (Our Common Future, World Commission on Environment and Development)

A vision in the social sphere

The challenge involved in survival included some strictly clinical aspects and, from the very beginning, different visions were manifested in the working group.

On the one hand, the idea was to immediately embrace the needs of the market, which would require openness to complex services, in which the members themselves might not have the necessary skills, and as a consequence the involvement, on an emergency basis, of other colleagues without the possibility of selecting and training them. On the other hand, the need to respect the growth stages of group thinking, both in terms of competence in doing social enterprise and in enhancing the specific skills of the founders. We should not forget that most of the founding members were group analysts who had graduated a year or two before the birth of Arcipelago.

This polarization led to an unavoidable conflict that finally identified as valuable assets the working group and the time to build shared thoughts applicable to clinical practice, at the expense of immediate economic returns.

This choice created an irremediable rift with the first president at the time, a rift that resulted in his resignation.

It can happen in groups and we know that the costs of a conflict will reverberate in the future dynamics between group members and especially in the most critical moments often related to change.

In this regard, Morris Nitsun wrote:

The multiple nature of the group, due to the presence of various members, increases the possibility of dangerous fragmentation. After all, the group is not a whole: it is made up of the sum of its parts, especially in the group’s inception phase, when it is not yet an integrated unit.

(M.Nitsun,The Anti-Group: Destructive Forces in the Group and their Creative Potential,

Routledge Mental Health Classic Editions 1996)

Today we can read that moment as a movement of identity construction of the working group. If it is true that Polemos, meaning ‘conflict’ in Greek, is the father of all things (Heraclitus), it is also true that the pain generated by the afore mentioned rift went through the working group for a long time, expressing itself in various dynamics. In any case, Arcipelago survived, finding its own identity and growing while maintaining the implicit memory of that conflict.

As we write, we can see the echoes of that initial clash reverberating in the years that followed and expressing themselves as a slow group work of healing the pain that had been generated. Particularly during Manuela Serra’s presidency, care passed through dealing with the development of the working group by managing the dynamics of competition between siblings. Defining the sibling community stage in groups, Claudio Neri (1995) stated that:

In this phase, participants become aware of the elaborative potential of the group, as a community of thought within which everyone feels they ‘have a right’.

It is not possible to go back, but keeping these movements in memory and taking care of them has meant – in the subsequent history of Arcipelago – protecting the possible transformations while avoiding any possible acting-out by the group, for example through more or less violent expulsions.

The group’s care has not only passed through the management of conflicts but also through the reading of critical issues, starting with the difficult moment of the passage of the presidency during Covid, which took place online and with a series of challenges, including the use of technology in psychotherapy, both an opportunity and an aspect to be integrated with awareness, in order to continue the work of supporting patients in charge and colleagues. Arcipelago never stopped providing its services during that time, with a considerable expenditure of energy and thought.

Currently, the team has been more successful in digesting that original conflict and expanding their creativity accordingly

Beyond its destructive potential, the anti-group is an important component of group psychotherapy in that it provides a pathway to the powerful and long-standing experiences of lack, loss, disappointment and the resulting hatred, and also highlights the way in which ambivalence originates, which can be used constructively in group development.

(M.Nitsun,The Anti-Group: Destructive Forces in the Group and their Creative Potential,

Routledge Mental Health Classic Editions 1996)

During the current presidency of Anna Croni Bono, this creativity has been realised by taking care of the expansion of projects, by creating links with the outside world and by accompanying the entry of new therapists, in favour of a management of generational levels that is expected to be complex.

Transformation needs time and also retrospective readings for it to become fully embedded in the culture of the group and usable in a creative sense.

As a matter of fact, economics also exists in care work

With the chairmanship, taken on in the running by Alice Mulasso, other issues of vital importance to the cooperative arose because they were of an economic nature.

In 2011, Arcipelago counted 12 therapists and 161 patients, but had to come to terms with certain facts. The number of available rooms did not allow for economic sustainability; the administrative tasks (up to that point managed by a colleague) required specific professionalism. Above all, following to a lack of control, a significant financial shortfall was discovered due to services that were never collected.

Arcipelago demanded a transformation from its members that passed through concrete actions, but in the group’s digestion this meant specific care in introducing new models and above all in accepting the delegation of administrative aspects, a very delicate step since we know how they also include the therapist-patient relationship and have to do with the clinic. In this process, as in many others later, the board’s set-up as a pre-thinking mind and antenna capable of grasping the wider movements of the organization was important.

Here come the sun: the clinic

The number of patients was growing steadily but the Centre for Applied Group Analysis was not offering any group therapy sessions!

In the founding and methodological matrix of Arcipelago, and even before that of Apragi, there is no equivalence between being a group analyst and ‘doing groups’; on the contrary, the care of institutional, environmental and social aspects even in the dimension of individual treatment are constitutive of our recognition as group analysts.

Yet, each of the therapists retained the idea of opening therapy groups.

Having more than 100 patients in a therapy centre means having a good chance of organizing group therapy paths, yet for a long time Arcipelago had only one group, which was established in 2010. Gradually and not without difficulty, new therapy groups were opened.

The team worked for a long time to understand what resistance – in an apparent cohesion – led us to avoid this transition.

Issues such as:

Trust, “will you be good at taking care of the patient?”,

Fear of judgement, “will you recognise me as adequate enough to deal with the patient?”,

Need for delegation, “is this patient my patient or else an “Archipelago” patient?”,

Sense of inadequacy, “Will I be capable of leading groups?”

Despite the fact that the supervision reported on the idea that “group psychotherapy is indicated where psychotherapy is indicated” (Foulkes, 1964), it is likely that the working group found in the resistance to change a form of protection for the individuality of its members. Setting up groups could mean questioning conquered orientations and adaptations. In the case of a new social enterprise and of therapists who were not yet so experienced with groups, these achievements were still precarious and achieved with difficulty.

Allowing a group to make groups was a transformation; transformations are not always innovations, but deal with the possibility of starting blocked processes.

Return journey

between Transformations, Actions and Care

Image 9 | Turbin

This brings our gaze to Archipelago as it is today.

According to Correale,

“the field is a slow deposit of affective relations, of ideational, representational and emotional events. This deposit enriches and at the same time burdens the life of the group, it constitutes a memory, largely unconscious, partly propulsive, partly inhibiting and blocking“. (1992).

To date, Arcipelago is a space that retains characteristics of group-analytic care of the self, as a clinically based working group, and of the outside world as a world made up of social and economic aspects. In its history, it has introduced new group therapists, new young colleagues, into the team, but the elaboration of some critical knots has allowed the construction of a trans-generational and trans-personal matrix that, for example, today allows the construction of new groups and young colleagues allow themselves to lead them.

There are currently eight ongoing therapy groups, the longest running group started in 2011. Some groups have flourished and ended over time.

Term groups were conducted on specific projects and users, others integrated with other techniques.

Returning to sustainability, we know that the original definition (1987) envisions a system that integrates economic, social and environmental sustainability. This seems very similar to what Foulkes stated well before, saying that

“we cannot isolate biological, social, cultural and economic factors from one another. Mental life is an expression of all these forces seen both horizontally, i.e. in the strictly present reality, and vertically in relation to the legacy of the past.” (1975, Group Analytic Psychotherapy)

Based on our experience as group analysts in Arcipelago, it would seem that in order to give birth to and develop a social enterprise there is a need to look at all these aspects.

Today, as we approach our task with more awareness and experience, we are observing the paths that the social sphere proposes with an eye to grasping their meaning. For example, the idea of opening a psychotherapy centre today where psychotherapy sessions are offered at a reduced price is no longer an innovative idea as it was in Italy in 2006. In fact, it seems to be more in line with neo-liberal thinking, far from a management and maintenance of social phenomena and their reading according to an analytical vertex. How can we avoid slipping into a flattening that privileges one dimension (the economic one) at the expense of the others (social and clinical)?

In recent times, Arcipelago has been undergoing new transformations that seek to integrate the three poles of our discourse, the clinical with the social and the economic, in a continuous and recursive dialogue between what is observed and what can be put in place as actions and care of the social and the working group:

• the exponential growth of therapy requests has not, by choice, turned into an exponential growth of therapists: what cooperative, i.e. mutual aid and social support, is possible when there are too many of them? What real project sharing would be possible if the number of colleagues grew too big? Do we want to become, or have we become, an organization? We try to maintain a focus on qualitative and not incremental growth; new thoughts have arisen on reception and responsibility towards those who ask for help, for example with the planning and testing of a Triage since 2022.
• Italy is a borderland with respect to the unregulated arrivals of foreigners who want to reach Europe to escape political, economic and environmental crises; these phenomena have questioned our presence in the clinical and social field and have allowed the construction of cooperative support projects and foundations for foreigners (with emergency psychology interventions), up to the most recent initiatives in support of Ukrainian refugees, in connection with other approaches (mindfulness and EMDR) and guaranteeing a free service;
• we have observed new patients who are not always, or at least not immediately, willing to begin a thorough and lengthy therapeutic process, yet with needs and discomforts expressed in requests for help; we are trying to integrate through projects this new type of users and our ability to set up, lead and create groups; this was recently turned into action: opening another location to have a larger room, capable of accommodating medium-sized groups. The opening of the second location entailed an economic investment, which implies taking into account a risk, that is, a business risk. Transformation also means taking such risks in order to invest in projects our cooperative believes in.
• During the COVID period onwards, we thought of projects with a focus on more social issues; these projects were named: ‘Under the same sky’. What makes all of this possible is the economic sustainability, which has been achieved for some time now: designing freely and financing projects to protect the fragile needs of the users is a luxury won with a long-term vision.

Conclusions

Speaking of Arcipelago, we had the opportunity to think again about the paths, more or less conscious, of our working group: it is indeed a very good opportunity, because it allows us to observe dynamics again, to look at the founding myths and to weave a thread on the future.

Hopefully the story will provoke reflection on how to ‘survive’ in groups and build pathways in society that will last.

Sisyphus endlessy repeats the effort; he repeats his toil that is, in fact, his punishment.

In contrast with the image of Sisyphus, we would like to offer the image of a wind turbin, which retains within itself individual aspects, in its individual helixes, and group aspects, as it functions with a set of helixes.

The dynamics of this turbin-group of ours is what interests us: we know that it can be generative as well as destructive or inconclusive, like a child game; helix-group will probably alternate between different moments of functioning, like Bion said.

We imagine that group work, not just dynamics, is what we expect to channel energy in a non-repetitive and stereotypical way.

Let us imagine, therefore, that it is possible to build teams that keep social needs in mind, teams that are capable of action and thought. We know that, in a non-idealized way, this construction is continuous, time-consuming, and includes some blank transitions that need to be re-mediated.

Confirming what we have said so far, those listening can imagine that the voices reading this intervention are many more than the two you are hearing: we have constructed, thought about and reread this paper in a working group set-up and it has once again been an opportunity for reflection for Arcipelago, APRAGI and hopefully also for you.

That is why we thank those who wrote this speech with us, working with us in Archipelago and sharing ideas in view of this Summer School.

Maniela Serra, Psychologist, Group Analyst in private practice in Turin (Italy). Full Member GASi. Member Management Committee of APRAGI – Italian Association of Group Analysis  and COIRAG. Past President and Member Management Committee of Arcipelago – Clinical Center of Group Analysis in Turin.

Marco Chiantore, Psychologist, Group Analyst in private practice in Turin (Italy). Full Member GASi. Member of APRAGI – Italian Association of Group Analysis  and COIRAG. Vice-President and Member Management Committee of Arcipelago – Clinical  Center of Group Analysis  in Turin.