Groups and I

In this article, I explain my experience and training in group work in the eight years that I worked at the Institut Pere Mata (IPM). The institution was structured following the guidelines of institutional psychotherapy. Since 1968 it was supervised by Francesc Tosquelles, a Catalan psychiatrist who had to go into exile in France at the end of the Spanish civil war. In the neighbouring country he was one of the promoters of this approach. In his youth he was trained at the Institut Pere Mata, and his mentor was Emili Mira i López. I will focus on a type of group created by him that we called “cassettes”. They were groups of professionals that met weekly for an hour and a half. These groups were recorded on cassettes and sent to Dr. Tosquelles, hence the name. In the monthly training week, there was a session in which he commented on some of them and all of us worked together on that.

I was twenty-seven years old when I started working at IPM, where Francesc Tosquelles had supervised the training for more than a decade. He came for a week every month, called the training week, in which the work with the patients was slowed down to attend the different sessions. These sessions were always group sessions. Tosquelles was a fervent defender of groups and group training, in one of his visits in which we talked about supervision he said that he only admitted to supervise in a group, refusing to carry out individual supervision. He began to come to Reus when there was a change in the management and direction. The general manager, Ramón Vilella, together with a team of young psychiatrists wanted to reform psychiatric care at the hospital. They wanted to change a ‘madhouse’ into a psychiatric hospital. They decided to look for someone to help them make the change and, advised by Ramón Sarró, a Catalan psychiatrist who was a consultant for the IPM, they decided to contact Tosquelles to guide them through the process. That was in 1967 and Tosquelles started collaborating on the project a year later. At that time Tosquelles was the director of the Saint Alban Psychiatric Hospital.

I started working at the institution in July 1983 and discovered a totally different way of working than I had imagined. Every morning there was a meeting with all the professionals, including psychiatric auxiliaries representing each pavilion and spaces of the Club (bar, shop, sports, etc.). In that meeting they shared what had happened in each of the institutional spaces since the last meeting the previous day, reflecting jointly on it and preparing the new day. Patients were talked about, focusing especially on their words, on what they said. What they said was shared in the different spaces. Patients don’t normally say the same to an auxiliary, than to the psychiatrist, psychologist or nurse. Signifiers vary and the meaning can be found by assembling all the pieces, like in a puzzle. As Tosquelles said, each one of us has some pieces, and only if we share them we can deduce a part of what the patients transmit to us. The patients also met in groups daily in each ward and in the different spaces of the Club with a trained auxiliary and a psychiatrist or psychologist attended the groups once a week. In addition, each ward held a weekly assembly led by psychiatrists or psychologists coordinators, attended by all patients and all staff on duty. There was also the general assembly of the Club.

Continuous training was an important piece in the development of the project. Wednesdays were the training day, in which we held group seminars, the institutional clinical session and the cassette groups. They were groups of eight or nine workers from all categories who were not on the same team. We met every week in the same place and at the same time for an hour and a half. The slogan was that our interventions should be brief and spontaneous and always about the patients, in a free association. We talked about situations, comments… from the patients and their families that had caught our attention. The situation could have occurred in formal spaces, such as the individual or group therapeutic framework, or informal, e.g. situations or comments heard in the bar or what someone had said to in passing, and that had caught our attention. We also talked about situations that worried us, but always in reference to our work. One member of the group acted as secretary. Their job was to take notes and record the session on a cassette that was sent to Tosquelles. The secretary spoke only to encourage everyone’s participation without giving his or her opinion or making personal comments. They opened and closed the session. At the end, altogether put a title trying to reflect what had emerged throughout the group.

Tosquelles said:

“one of the things that the secretary must observe, and for which he must intervene, is that, regardless of what is said, there must be exchange, whether they agree or not, facilitating the work or attacking. If four or five are involved, you can continue because the group is going well. There is no group dialogue if no more than three speak. In addition, it is not possible to speak only of one patient, but of several, in free association”.

The group law implied that explanations should not be sought for what was being talked about, but rather should be associated with the first case that came to mind. It was, as Tosquelles said, “to be around a table with a group, without waiting for something to be made clear, although it may be that at the end something will be clear.” At the end of each session, it would be good to leave with the feeling of not having finished, of having more things to say, in order to return to the next session. It was an endless experience of continuity. When someone was reluctant to participate in these groups, they said it was because he or she had a superego “as big as a house” – a Catalan expression that means immense – and their projections.

This type of group began when two of the then young IPM psychiatrists asked Tosquelles to hold training and supervision meetings. The first group consisted of five psychiatrists, who recorded the sessions and sent them to Tosquelles. He discussed them with them on his monthly visits to the hospital. Progressively more professionals were arriving and new groups were created. All the participants were psychiatrists at the time, but in the eighties psychologists (like me), nurses and social workers, started coming and joined the groups. The psychiatric auxiliary who coordinated groups in the pavilions, day hospitals and the Club were also offered to participate. At the end of the eighties some resistance appeared on the part of some professionals and it was agreed that they were not mandatory groups. Anyway, everyone kept attending.

What did I learn? One of the main learnings was the need for continuous training and to never take anything for granted. Tosquelles always said that who has taught him the most were the patients. We should be open to listening and observing them. Around that time, I attended my first SEPTG Symposium and one of the presentations asked the question: Who do we listen to, when we are with a patient? To that person or to the creator and followers of the theory in which we are trained? Perhaps this is why I have never followed a single approach in psychotherapy. The basis of training in IPM was psychoanalysis and the therapeutic groups followed the postulates of group analysis. I read and worked with other colleagues on the books that were in the institution’s library, there, in addition to the complete works of Freud, and books by other authors such as Melanie Klein, Lacan, Bowlby, etc. there were works by Anzieu, Foulkes, Bion, Moreno, and other group therapy theorists. In outpatient centres and also inside the hospital, it was almost mandatory to do therapy groups. When we started the day hospital activity, I was in Tarragona and most of the patients who attended were diagnosed with schizophrenia. Running groups with them, I felt that I needed to go further and I started my training in psychodrama after attending a Psychodrama Congress that was held in Barcelona. The introduction of active techniques and the work with intermediary objects in the day hospital, helped in the evolution of the patients. Another thing I learned was to work as a team, a team is like a group with a goal, traversed by the same dynamics of any group.

I left the institution in 1991, but these learnings have always been with me and I have tried never to stop investigating from the experiences of dealing with patients, families and therapy groups and persevere in continuing to learn.

Tosquelles wrote in the prologue of one of his books talking about the maternal and paternal role:“

if one can speak of good mothers, in the sense of promoting the ‘human’ growth of their child, this title should be reserved for mothers who know how to separate from their children (…).

The paternal function consists in giving a name and thus introducing the child into the symbolic system of language; It could be said, exaggerating a bit, that a ‘good father’ is the one who helps the mother to be able to deprive herself of the child, introducing him into the group”.

María Teresa Pi Ordóñez
Clinical Psychologist and Psychodramatist. I worked in Institut Pere Mata in Reus, Tortosa  and Tarragona from 1982 to 1991. Since 1992 I worked in Institut d’Assistència Sanitària (IAS) in Girona, where I was team manager in the Children and Adolescents Mental Health Outpatient Service in Gironès and Pla de l’Estany until my retirement in July 2019. Member of the College of Psychologists of Catalonia. IAGP Secretary. Past president of the Spanish Society of Group Psychotherapy and Group techniques (SEPTG). Education chair of the International Attachment Network Spain. Member of the Laboratory of attachment and human development in the University of Girona.
pimaite@telefonica.net