Lecture: Group Analysis and Business. Dream or Reality?

Alfonso D'Auria

Abstract: The lecture will deal with a business project (a dream), organized with a group-analytic point of view, for the creation of a national network (in Italy) of Psychologists and Psychotherapists, who offer a private service of basic psychology, psychotherapy and group workshops of personal growth (prevention and psychological well-being). The internal organizational structure will be analyzed, which has the group as its basic unit. Finally, the focus will be placed on the concept of responsibility (individual, group and institutional), a fundamental element for the realization and development of the project.

PREMISE

The project that is presented is the result of an idea that had a gestation of some years before coming to light. The project began to be implemented in the spring of 2021, while in November 2021 we (me and my colleague and friend Rosanna Nastro, a psychologist and psychoanalyst) founded the company MIND THE GROUP and we “launched” the portal and, from January 2022, we “turned on the engines of the boat” and started to “navigate”. What is reported in this presentation is a first analysis of a complex process, a project that turns out to be an experimentation, in continuous development and change, in slow and constant acceleration. It is a trial and error process, with learning phases and structure changes.

As suggested by my Irish colleague Sheena Eustace, who read my speech before the presentation, I think it is important to add some information on the context in which this project was born so as to better understand its meaning.

The Italian community of psychologists is the largest in Europe. According to the latest official data from our National Order of Psychologists, in 2020 there were 117,762 psychologists enrolled, of which about half specialized in psychotherapy. Also from the data we have from our professional institutions, we should be just over a quarter of European psychologists (to date approximately 400,000 psychologists). Most Italian psychologists work in the private sector, while only a small number of the community work in public facilities, and most of them have retired in recent years. Only a few public competitions exams have been made for new hires in public structures, due to lack of funds to invest in health, which over the years has suffered heavy economic cuts from the various governments.

I hope that these data provided will be sufficient to give an idea of ​​how the community of Italian psychologists works mainly in the private sector, in which there is a high level of competition and competitiveness to “be able to work”, to “survive”, doing the work as a psychologist and psychotherapist. The dream, the project, which is presented here therefore arises from a need, a need for “survival”, as well as from a pure desire to create a network and a national community. I will add just one last element that also concerns the “competitiveness between theoretical models”; in Italy, to date, according to official data from MIUR (Ministry of Education, University and Research), 390 psychotherapy training institutes are active throughout the country.

THE PROJECT

(STRUCTURE)

MISSION (THE DREAM)

Create and organize a National Network of Psychologists and Psychotherapists who offer a PRIVATE service of Basic Psychology (Primary Care Psychology).

WHAT IS BASIC PSYCHOLOGY?

The concept of basic psychology and basic psychologist has been discussed for some time, in particular in 1978, during the International Conference of Primary Care, the need for collaboration between the figure of the General Practitioner and that of the Psychologist was expressed, for the preventive and curative protection of each individual.

Since that moment, in Italy, various experiments have been launched, both in the institutional sphere and in an associative and private form, in addition, various legislative proposals have been formulated aimed at regulating the figure of the psychologist in the territory, defined as Primary Care Psychologist or “Basic Psychologist”.

The proposals formulated up to now place the project focus on the close cooperation between the psychologist and the general practitioner and in particular on the request for psychological help expressed directly or indirectly by the patients of the general practitioner.

OUR VISION

According to our Vision, by Basic Psychology we mean the area of ​​clinical psychology that deals with the reception of the first request for psychological help by the citizen.

Our idea of ​​a Basic Psychologist, in the private practice, is not to include the psychologist in the general practice doctor’s office but to promote the autonomy of the psychologist and his function of welcoming the first citizen’s request for psychological help.

In particular, according to our vision, the Basic Psychologist is a psychologist enrolled in the Register of Psychologists, who is responsible for accepting the first request for help and counseling that comes from a person, a couple or a family.

PSYCHOLOGY AND THE WEB

More and more often, citizens independently seek a psychologist through the web and social networks and once the professional has been identified, they contact him in order to arrange a live psychological consultation at the professional’s office or online through a video consultation.

Our “Basic Psychologist in the private practice” project is to select, train and coordinate psychologists and psychotherapists, freelancers, who choose to organize themselves as a team and who want to work in the field of basic psychology as specified above.

The Psicologo di Base® portal https://www.psicologodibase.com/ selects its Psychologists and Psychotherapists, according to professional and experience criteria.

THE GROUP

The psychologists and psychotherapists who are part of the Basic Psychologist Portal cooperate for a common educational and professional growth, to guarantee a high level of quality of the psychological service offered to people.

The Group is the central element of our Project:

  • Territorial Team Group (face-to-face and online): The group that forms a territorial center of the national network of psychologists who are part of the project. The group can consist of a maximum of 5 psychologists for a territorial area. By territorial area we consider a territory that includes a population of about 100.000 inhabitants. The proportion is 1 psychologist for every 20.000 inhabitants. The group is organized with a single telephone number, for the management of incoming requests at the territorial center. By territorial center it is not meant that all psychologists work in the same professional office, but that they have their offices in the same territorial area. There can also be territorial centers with only one colleague, to which other colleagues can be added later.
  • InterVision Group (online) with group analyst / group psychoanalyst conductor. The group, on a monthly basis, is made up of a maximum of 10 psychologists of the project. The conductor is not one of the clinicians who receive patients from the portal (no conflict of interest and different “position” in the project compared to the participants). We currently have 5 active InterVision groups. The 5 psychologists of a territorial team group are divided into 5 different InterVision groups, so that they can compare themselves with colleagues from other centers in the national territory. It is a group in which all the colleagues of the project “must” participate. A group-analytic Supervision group has not been defined, as there are some similarities and differences regarding the setting, but above all regarding the “non-centrality” of the theoretical model in clinical practice and to overcome resistance to the idea of ​​”Supervision”, in terms of “dependence on the conductor” and promoting the “equal” comparison. They are essential elements in the group-analytic supervision setting, but of not obvious and implicit understanding for those who are not of the model and have no particular experience with groups.

The function required of the Supervisor / Conductor is to “help the group” to:

  • structure itself as an autonomous InterVision group;
  • manage dynamics deriving from the basic assumptions;
  • function as a “work group” (Bion).

The focus of the conductor / supervisor should remain primarily on the structure and process of the group, leaving the content (clinical material / organizational aspects / psychotherapeutic model) in the background. That is, it is important that the autonomy of the group is favored in the management of the emerged content (focus on the first interviews with patients deriving from the Basic Psychologist portal). Obviously, if there is a need, it is good to be able to help individual colleagues to manage particularly complex and delicate situations.

  • Large Group / Plenary (online), on a monthly basis, in which all project colleagues can participate (voluntarily). Technicians do not participate, but communication and marketing psychologists can participate. It started as a plenary with mainly bi-directional communications, updates and questions about the project (a sort of question time). A couple of times, on the other hand, we moved much more like a free discussion. The goal is to shift organizational issues into email communications and the Facebook group and to increasingly promote functioning as an experiential large group, which obviously has the main focus on the project as a whole.
  • Closed (i.e. non-public) Facebook Group (online) reserved for project participants. The aim of the group is to have a stable and instant container through which to communicate, confront and reflect together on the organizational, clinical and planning aspects with all the colleagues of the portal. The group works a bit like the GASi forum, but is less dispersive, less anonymous, has many more features (differentiate the type and function of posts, such as polls, advice, questions and answers, events, live videos, reels, guides …).

WHY A DREAM?

Because it is a structure that is based on a “weak” bond. A “new” experiment, halfway between associations and the purely entrepreneurial.

BOND-RELATIONS

Psychologists who decide to join the portal are mainly driven by the need to work as freelancers (receive contacts and new patients in consultation and psychotherapy). Only a few manage to identify from the outset the value of being part of a network of colleagues at a national level in the clinical setting, with the possibility of participating in InterVision groups and large groups.

Initially, the work focused on satisfying this primary need. In a second phase (after about 4 months) work began on the feeling of belonging by stimulating communication and comparison links with the plenaries, large groups, InterVision groups and then the Facebook group.

The bond with the project recalls the therapeutic group or experiential groups with recognized leadership. It oscillates between autonomy / freedom / isolation and interdependence / cooperation / part of a community. It is a bond that oscillates and balances between these two sides. Just as in a therapeutic group, there is an asymmetry between participants and psychotherapist, so it is also between the CEO of the company and the participants in the project. Same rights and duties as participants (apart from some exceptions). It is not a “purely” democratic group, from the point of view of the structure, but leaves ample space for dialogue and consultation on the structural organization and process, as it is for a therapeutic group.

DEVELOPMENT AT 6 MONTHS

We have opened 18 centers in 7 regions and 8 Italian cities (Rome, Milan, Turin, Monza, Cagliari, Lecce, Caserta and Pescara), for a total of 38 psychologists and psychotherapists. The acquisition process is very slow and requires a large financial investment for advertising. The difficulty of joining is linked to the initial economic investment, compared to competitors who give the opportunity to join for free.

To overcome resistances, there must be a strong need / desire to work as psychologists and psychotherapists but also need an ability to recognize the potential of the project, which still stimulates many ambivalences in relation to the umpteenth attempt to establish service in the institutional sphere. In July there was the first renewal of the contracts (every 6 months) and about 10 colleagues left the project, for main economic reasons of investment (ROI-return on  investment and increase of the membership fee) and for lack of structure of a sufficient feeling of belonging and adherence to the mission, which translates into “not bearing part of the RESPONSIBILITIES and risk” that the project requires.

PROCESS

  • Strong tendency to dependency;
  • Psychologists are focused on the concrete need rather than the potential to be part of a network;
  • Need of time to structure a feeling of belonging;
  • Conflict between autonomy and cooperation;
  • Difficulty in sharing the mission (the dream) and in “firing” the desire;
  • Difficulty accepting risk and responsibility.

DREAM AND RESPONSIBILITY

The questions we asked ourselves and tried to answer are:

  • Who is responsible for making the dream come true?
  • Where is the responsibility positioned, is it something individual intrapsychic or is it something of the group?
  • How much is it linked to the concept of power?
  • Where does this power fit? In leadership or in the group?

We believe that, as happens within an analytical group, responsibility and power are widespread and interconnected at the group level.

For the realization and development of the project, it is essential that a relationship of trust is structured with the leadership and with the other members of the project, in all groups of the structure.

We obviously start from a condition of aggregation to aim for cooperation and therefore at a group cohesion at different levels and in different groups.

All this is associated with the feeling of belonging to the project, the sharing of the mission and the professional identification with the Brand.

Hence, the responsibility lies with the individual and the group as a whole, including its leader.

FUNCTION AND RESPONSIBILITY OF LEADERSHIP

In the initial phase of the project it is essential to be aware that there is a leader (the CEO, Chief Executive Officer, or in Italian AD, Delegate Administrator) who has a position of vertical power both from a structural point of view (corporate setting) and in terms of relational “imprinting”, as he is the one who conceived, structured and presented the project and who “selected ”all the colleagues who joined the network.

The selection interviews were mostly done individually. This created a bond between two and created an expectation of reference and primary communication with the leader rather than with the group. A fragmentation of bonds, mainly of two, which has structured an aggregate of colleagues mainly referred to leadership and who do not yet communicate with each other.

The function of the CEO is to “direct” the project and colleagues towards achieving the mission. There is a direction to follow, an aim to pursue but, to achieve it, it is not possible to do it as if you were a company with “employees”, that is, paid to work.

In our case, the psychologist colleagues pay to be part of the project (not the company) and, theoretically, to follow the indications, the guidelines given by the leader (CEO) and the rules defined in the contract.

Initially the relationship is of an “employee” type, despite the contractual link keeping them in a “free” professional condition. This creates a conflict regarding the responsibility in carrying out the project. Colleagues are mainly interested in their individual professional needs and not those of the company and the national group / network (the project).

The leader’s great effort is to maintain a position of leadership and responsibility (including legal) in giving the “direction” of the work, but at the same time it must inevitably be to activate a process of withdrawing into the background and detecting and entrusting the individual colleagues and groups with their responsibilities.

To achieve this, it is inevitable to stimulate an “horizontal” and circular communication between the colleagues of the project, which creates emotional-professional bonds and a feeling of belonging to a community with a project, a mission, a common dream.

To achieve this goal, the concept of “trust” is fundamental, on both sides.

Just as the leader must win the trust of every single colleague of the project, at the same time he must trust every single colleague and the groups he has structured by promoting their “autonomy” of functioning.

CONCLUSION

To conclude, we at MIND THE GROUP mean by “dream” an ideal idea that, on a “potential” level, can be transformed into a real project. To do this it is necessary to exercise “power” with “responsibility”, but the responsibility of the leader and of the company is not enough, it is necessary that each fellow psychologist of the project feels partly “responsible” for the realization of the project, and therefore of the dream.

Therefore, the realization of the project can only succeed if the dream becomes shared, only if the colleagues of the project take on the responsibility of dreaming together and sharing the risks associated with failure.

[1] Alfonso D’Auria, Psychologist, Psychoanalytic Psychotherapist, Group Analyst, Private Practice in Rome (Italy), Full Member of GASI (Group Analytic Society international), Full Member of IL CERCHIO – Italian Association of Group Analysis, Full Member of COIRAG (Italian Confederation of Organizations for Analytic Research on Groups), Professor at SRBA (Roman Analytic Balint School). Mail: alfonsodauria@gmail.com , mobile: +39 347 91 99 463