Group Analysis – the road to mind and social freedom in Poland
At the outset, I need to express my gratitude to Jurek Pawlik, whose memories in the book Pawlik. J (2021) Znaczenie Ośrodka Psychoterapii “Rasztów” dla rozwoju psychoterapii i psychoanalizy w Polsce. Kobylińska – Dehe E., Prot – Klinger K. (2021) Jak Feniks z popiołów? Odradzanie się psychoanalizy w powojennej i dzisiejszej Polsce. (p.117 – 143) recently published in Poland allow me to recreate and quote how it was with the group analysis in our country. Jurek is one of the pioneers, thanks to whom this method is developing rapidly. He is also a great friend.
When group analysis was introduced in Poland in the 1960s, psychiatry’s biological approach was dominant. For ideological reasons (socialism prevailing in our lands at that time), psychoanalysis as an example of science and individualistic bourgeois thinking was not supported. While access to foreign literature was becoming more accessible, there was still a shortage of trained psychoanalysts or group analysts to teach others.
In 1963, the Center was established in the village of Rasztów. He combined psychoanalytical thinking about the sources of emotional disorders with the social (state) health service requirements. Apparently, it was not easy to convince the officials in the Ministry of Health that it is possible and worth organizing a ward with 24/7 patient stay without drugs and the constant presence of a doctor on duty, nurses, and orderlies. The psychotherapist on duty was entirely responsible for the ward, and it could have been both a doctor and a psychologist. Moreover, the Center did not have direct communication, e.g., bus, train station, or the nearby town. The distance of 6 kilometers from the railway station to the department was covered in winter by sleigh and a horse-drawn carriage or wagon in summer.
The assumed simplicity of living and premises conditions did not encourage patients to derive a secondary profit from the treatment. They had to do all the cleaning activities themselves. Initially, the psychotherapy in the Center lasted eight and then ten weeks, carried out in the system of a 24-hour stay of the patient. The group operating in the semi-open system consisted of 15-20 patients. Staff limited to the minimum and active participation of the therapist (he came for two-day shifts) in all activities, including physical work with patients in the garden or in the forest, making them the cheapest therapeutic system in Poland. Patients staying at the Center formed a therapeutic community, the framework of which was determined by the regulations adopted by everyone and strictly adhered to. The therapy program assumed constant and active participation of each patient in all group activities: four-hour physical work in the field or garden, three-hour daily group psychotherapy (two sessions of one and a half hours), evening program, and in the work of the local government. Neurotic symptoms were not reduced with drugs (they were administered in exceptional cases), and they were not a reason to release the patient from any activities.
Patients from all over Poland aged 18 to 50 with a diagnosis of neurosis were referred for treatment at the Center by doctors, most often psychiatrists. Patients addicted to alcohol or drugs and people with clear self-destructive and psychopathic tendencies were not admitted. After the stay, the patients were invited to several meetings of the post-Rashtov group, which was to help them return to their daily activities and duties and to family life.
Initially, the therapeutic system was based on the new psychoanalytic, interpersonal concept of neurotic disorders and on the model of functioning of small groups. However, a comprehensive system of short-term, analytically oriented group psychotherapy was created with time. In those years, this system was undoubtedly something new and bold, both in the way of thinking about the program of treating neurotic patients in psychiatric hospitals and day wards and the practical implementation of this program. Its most important elements were:
- A thorough diagnosis and preparation of the patient for short-term intensive group psychotherapy, where reliance on DSM was insufficient. The concept of a problem diagnosis was created according to the idea of dr. Jan Malewski on the current conflict and its childhood counterpart.
- Intensification of the psychotherapy process. The therapy material consisted of verbal or non-verbal messages, as in outpatient groups, and the entire behavior of the patient and his experiences in contact with others taking place “here and now.” The assumption was such that every patient, by engaging in community life, sooner or later would repeat his fundamental difficulties in life, which led him to treatment. It was about getting a new, corrective emotional experience.
- Social aspects of psychotherapy, such as the role of the experienced therapist as a natural person rather than as a transference object, or meetings with the family, are aimed mainly at preparing them for changes in patients during psychotherapy.
The team of the Center in Rasztów introduced psychodrama methods to therapeutic practice in Poland. In group, short-term treatment carried out in Rasztów, the idea was to study the behavior of the patient in the group, help him understand and reject those aspects of his behavior that make it difficult for him to enter into a positive relationship with others, as well as work out ways with him that create such opportunities. The team was building something new and exciting while having a hostile medical environment outside. This experience can be called analytical through and through, for example, because of the development and factual knowledge about oneself that was achieved by two groups: patients and therapists conducting them.
A critical moment was establishing cooperation with psychoanalysts and group analysts from Heidelberg. In 1983, Werner Knauss and his later wife Adelheid Miller visited Warsaw. It was a tough time in Poland. This visit became a significant impulse to train with German colleagues. The cooperation, which finally began in 1985, lasted 15 years.
In 1992, due to many socio-political changes in the country, a decision was made to leave Rasztów and establish the Warsaw Center for Analytical Psychotherapy, where it was possible to continue the previously developed ideas regarding analytical short-term group psychotherapy. At the same time, the “Rasztów” Group Analysis training facility was founded and soon became a member of EGATIN. Today, it is developing dynamically, has more and more students, members, certified psychotherapists, and the method is widely recognized both in the state health service and in private practice.
It is worth remembering that in those days in Poland, the study group’s goal was in stark contradiction to the purposes of the political system of the time. The analytical group leads, like psychoanalysis itself, to inner freedom and the ability to accept the truth about oneself and the environment.
And here, you can move on to the challenges we face today. Our older colleagues have developed a method to combine different perspectives instead of divisions:
- More and more patients in our country benefit from psychotherapy at the clinical level. As a result, people willing to work in the analytical field, who we would not accept earlier due to their diagnosis, come forward. Currently, there are groups for psychotic patients, whether people with more profound personality disorders or with a diagnosis of the autism spectrum are included. This means that the method has to be slightly modified while the substantive background remains the same. And this is a test for current therapeutic work.
- On the social level, on the other hand, the issues of freedom and the ability to accept the truth about oneself and the environment now seem particularly important in Poland, due to the totalitarian tendencies introduced by the freely elected government by our society, or to events taking place on the border with Belarus, where human rights are violated in front of everyone’ eyes because of political reasons. Therefore, group-analytical thinking, performed locally in small groups, is essential to freedom of group mind. This is the first step to offer hope of liberty globally.
References
Pawlik. J (2021) Znaczenie Ośrodka Psychoterapii “Rasztów” dla rozwoju psychoterapii i psychoanalizy w Polsce. Kobylińska – Dehe E., Prot – Klinger K. (2021) Jak Feniks z popiołów? Odradzanie się psychoanalizy w powojennej i dzisiejszej Polsce.