Translation: Eliza Voriadaki
Everything is born of an inflection (or deviation), namely an unexpected and unpredictable movement of matter (Lucretius 2nd century BC). If all of individual particles fell under their weight in a vacuum and instraight lines, like raindrops, nothing would have ever existed. Inflection is the source of free will in the life of all intelligent beings, humans and animals. For if all movements were a long defined chain, there wouldn’t be any possibility of freedom and one cause would succeed the other, “as determined by fate”... Instead, we grasp our free will from the hands of fate... (S. Greenblatt).
Approaching “Memories and Reflections: Stories of Systemic Psychotherapy” through the eyes of Lucretius, we are able to see the Family Therapy Unit (FTU) emerging as one of these “inflections” within the Psychiatric Hospital of Attica service, but also in general, within the Mental Health Services of the NHS of Greece: “A high level service of high differentiation in the context of the public domain, which provides a specialized treatment to individuals and families dealing with a wide range of problems.
A “public psychotherapy” for families with severe or urgent problems, that come with a registered social dimension (N. Marketos). While studying “Memories and Reflections” I often realized some of my own inflections, since when I was asked to be one of the presenters of the book, I was not aware that this preparation would be a parallel journey of “memories and reflections” for me, as I acknowledged my own experiences and parts of my course.
While preparing for this presentation I had in mind the words of my teacher, G. Vasileiou, who at the end of each therapy would ask “what have you learned today?...” and if you had nothing to say, he would shake his head and say, “Then neither has the family learned anything”. It was his unique way of placing you into the therapeutic system, not as an observer but as a member who participates with respect and responsibility and is co-evolving through the therapeutic process. Thus, in the questions that one would pose while studying a book for presentation, “What does this book have to offer? What will its contribution be?” I asked myself: “What do I have to learn from studying “Memories and Reflections” that describes so vividly the 24-year service of the Family Therapy Unit?” A second question that was raised was how to approach a book that includes the work and experience of 19 colleagues involved in its writing, a book that presents the 24 years of life of a pioneer unit, which was able to create a “crack” within the public mental health system and shine, 24 years now,... as the lyrics of Leonard Cohen say: "...there is a crack, a crack in everything, that's how the light gets in..."
In the chapter “Instead of a Preface: What remains? What has changed?” K. Charalabaki mentions that “...what remains are the deep human values of authenticity, sincerity, modesty, the genuine care for people under therapy... and the co-occurrence through a collective effort to keep some principles” and continues, “...an anniversary is the historical reminder of the fact that a system remained alive and open and did not sink into the underground streams of entropy...”, therefore defining the FTU as an open living system and referring to the epistemology of human being systems (HBS).
In many articles presented in this book, there is also a diffuse reference to systemic concepts, systemic epistemology and the theory of HBS, as the title of this book “Stories of Systemic Psychotherapy” foretells, such as: “synthetic systemic experiential” program, “holistic approach”, “goal oriented therapy”, “learning through action and apprenticeship”, “development of perspective relating to education andtherapy”, “systemic training”, “learning experiences earned into the group”, “the concept of the polyphonic self”, “of cosmopolitanism, migration, transnationality, multimodality, multinational family, digital revolution”. “The observation of group processes, the observation of the three stages in the life circle of training groups” have led me to approach the FTU, in its 24-year function, as it emerges through this book “Memories and Reflections”, through the principles of Dialectic Systemic Approach, as they have been developed by George and Vaso Vassiliou and their collaborators. I tried to see the application of theory into practice and through the course and evolution in time, of a living human system such as the one encountered in the FTU, following Systemic principles, like the ones mentioned in Yvonne’s Agazarian “Systemic centered Group Therapy”.
In accordance to this theory, the Living Human Systems (LHS) define a hierarchy of isomorphic systems which are: self-organizing, self-correcting and goal directed.
a. Systems organize energy, based on their ability to distinguish and compile differences. Through this process the LHS survive, develop and transform. The organization of energy defines the function of the system, its ability to produce work or particularly its ability to work to achieve its objectives.
b. Systems are self-correcting. They remain “stable”, constantly changing in the context of a world, which changes through reception, inclusion and integration of information. Conflicting (noisy) communications make them unstable. Systems re-gain their stability though the resolution of conflicts, either by cutting off some of the differences that disrupt the existing situation (defenses, forces against change) or by taking time to contain the conflict, until they are able to integrate the differences. Systems survive due to their ability to approach and resolve problems that appear on their way to a goal.
c. Systems are directed toward specific goals. Within all LHS there are primary and secondary goals. The primary goals of a system are survival, evolution and transformation and these are the goals that constitute the primary driving force in all groups. The secondary goals are the predetermined tasks or the apparent goals situated by the system, the tasks of solving the problems set by the environment. All secondary goals can only be achieved when aligned with the primary systemic goals. These primary goals of survival, evolution and transformation are achieved through a process of distinguishing and integration of differences.
Approaching the FTU as an open living system we can recognize as its characteristics the self-organization, the self- correction and the goal-direction:
- Self-organization: Every system, every group is built and organized upon a goal. The family therapy unit was born of a new concept, by two psychiatrists of the Psychiatric Hospital of Attica, Fotis Kotsidas and Katia Charalabaki, through the vision of psychiatric reformation, on the basis of their common education in systemic psychotherapy, their common interest in practicing family and couple therapy outside of the asylum. “An experiment . One of the first in the history of the NHS of Greece”, as it is referred to.
They started based upon:
a. the principles of “not taking money under the table, not taking a bribe, ignoring the word “nepotism” and denying commercialization... trying to keep the authentic care for people under therapy and thehuman values”.
b. “the co-occurrence upon the maintenance of a few principles” and
c. a theoretical systemic background, with “nuggets” by the first teachers G. and V. Vassiliou, which may have led, later on, to radical revisions (K.C). “A not very easy task...” (S. Kalantzi, Principle of PHA).
- Self correction: As characteristically mentioned under the title “What has changed?...” “The theory we had been taught has been modified in depth, through our rich experience”, with changes concerning:
a. the education, e.g. making it, in time, more experiential, “...blending theory with personal experience, personal development of trainers and trainees and connecting it with the professional identity for all kinds of mental health professionals”.
b. in therapy, changing the way of intervention e.g. “…from the one-way mirror to a more human, more supportive way, transitioning to more “self-revealing” roles for the therapists, living the difficult experience of co-evolution of trainers and trainees” and
c. the cooperation with other units, as we shall see, addressing and resolving problems with the “Primitive Mother” the PHA.
- Goal-direction (briefly mentioning):
a. “the public psychotherapy”, individual, couple and family therapy, at the level of public institutions, responding to severe or urgent problems with registered social dimension and offering the opportunity of free access”.
b. “the public education” for mental health professionals, primarily working in the public sector, cultivating trainees’ personal development, deeper social consciousness, responsibility and professional skills, in the work of supporting vulnerable individuals and families and
c. “the introduction of systemic principles and practices” into the community mental health services, enabling change from restrictive biomedical views and interventions to a holistic approach (N. Marketos). As mentioned, the primary goals of a system are survival, evolution and transformation, goals that are simultaneously the stages of development of groups and living systems. Each group has to manage some developmental challenges in each of these stages:
a. Survival related are authority issues,
b. Evolutionary are proximity and cooperation issues
c. Transformational are issues concerning function and work, in a novel and different way
The survival stage constitutes one of the main, primary goals but also the first stage of development of a system. Issues that arise in this stage of survival are issues of authority: Authority issues are considered by psychoanalysts as a negative transference or as inhibitory forces according to Y. Agazarian. The dynamics of authority issues are the key dynamics of the changing process in all human systems, from simple to complex. These issues result from conflicts considering the assignment and assumption of authority and are characterized, as a stage, by the presence of defenses on these issues. The challenge a human has to face in front of change, is to manage the frustration he experiences in a world that is not what he has imagined, but a world revealing itself through the existing reality. These frustrations are painful experiences, they create intense emotional reactions and every human employs his own defenses to manage them:
Flight: from the reality of the here and now, by returning to previous roles, ideas, perceptions and perspectives. Passing from flight to fight and the fight can be expressed by anger and fury, by creating roles of power, enforcement and conflict, through the rise of differences, by projecting and creating roles, like the scapegoat. The emerging matters focus on persons of authority and common reactions include complaints of dissatisfaction against the leader, who is considered the source of frustration.
Through this prospect we can also approach the reactions of trainees, as they are described not as specific characteristics of people, but as characteristics of the dynamics, which correspond to the specific stage of evolution of the group, transferring focus from the individual to the system. For instance, “... trainees, at first, appeared to be less dedicated to new ideas and more skeptical.” (Flight) A few examples are mentioned “as the turning point”. “...one of our groups, at the transition stage to the third year of education, was involved in an authority fight about the 5 euro which were attributable to the coffee during the semester”.
So, after the first exciting years of life in our education center, we started to deal more seriously with the evolution of our views on training. We set and discussed several questions or goals regarding the philosophy of the Unit, the training and the therapeutic team. At this point, we can observe the openness of the system of the FTU, in listening and making use of the crisis for the development of perspectives and the redefinition of several issues about organization and function of the Unit. This “turning point” led to “learning through experience and careful observation of the group processes, the relations of the group as a whole and between each of the members, the internal processes of the group... the observation of the stages in the life cycle of training groups”, as it is described.
In the initial stage there is the group of “the good students”.
In the second stage there are triangulation processes. Conformation of roles and alliances take place within the group and trust in the group is tested. Adolescent “riots” against the educational framework.
In the third stage the cycle is successfully completed ... “A Shakespearian period, where the existential question, “To be, or not to be?” predominates”, as K. Charalabaki writes.
We can see all these group development stages as three concentric circles, with survival in the center, development and transformation following in the external circles, with each circle containing and being contained within others, through relationships of interdependence, interrelation and transaction, that characterize the relations of OLS. Through the survival stage we can recognize the unfolding of elements, that belong to the next stages, those of evolution and transformation.
In the Evolution stage, issues of Intimacy and Cooperation arise, which are key factors in the development of the system.
The evolution of the Unit is evident through its education project, Briefly Mentioned. The Unit started in 1995, accepting 15 applications for participation in education. Now it accepts 240 applications, in order to select 20-21 people per year. The same number of people have participated in the supervision team, after completing the education. We should mention the collaborations of the Unit with
a. the Psychology Program of the Athens School of Philosophy, by practical exercise of its students
b. the therapist’s supervision team of the “Doxiadis” Unit
c. the therapist’s supervision of the detoxification team of Elaionas Thebes detention facility
d. the practical training of students, in the Specialty of Psychiatric Health Nursing of the PHA.
Moreover, since 1994 the Unit has organized 13 workshops with a wide range of topics and important guest speakers, such as Mony Elkaim, Jacques Pluymaekers, Jaakko Seikkula, Chris Dare, Huan-Luis Linares, John Shotter, Sotiris Manolopoulos and Maria Borcsa.
In order for a system to remain alive, it has to be open to relationships of interdependence, interrelation and interchange with the environment, with the human society, with other facilities, needs, problems and concerns, which keep it in touch with all that is most alive in the society. Without this contact with these aspects of the society, it would face the danger of being closed to the reality of its own world, office, center, leeway and prejudice, without “deviations”, serving the theories away from the principal, basic goals. That is why the opening of the Unit in other scientific and professional contexts is so important and that is what, among other things, makes it an open, living system.
The evolution of the Unit in the context of therapy: The number of sessions, from 144, in 1996, has reached 1971 in the 20 year period since, with an increase in the proportion of men by 10%. Over these years, the unit has received 5023 phone calls and 3504 visits, noting that whilst the frequency of appointments has changed, the type of family problems has changed too, being more complex and complicated and so the staff has increased (Ioanna Anagnostopoulou) and the relationship with the wider context has changed.
As it emerges from the workers’ descriptions, “in a difficult time for the institutions in the crisis, the Unit stood up in time, while evolving as a “structured family”, despite the effects of the crisis on the system”, the Unit shows that it stands out and, “seems to work in balance, having a “routine” through its experience that makes me feel safe” (Helle Wagner). We see therefore, through the description of the Unit’s operation, that alongside the evolution coexist elements of stability, continuity and smooth functioning, elements of survival, along with the emergence of concerns, questions and differentiation, as presented by many of the Unit’s associates, through a polyphony, whose value comes to show D. Sakkas, in his work “Exploiting the myth of Iphigenia in experiential education” and the new reality described by Maria Borcsa in “Virtual Relations and Globalized Families”: The Genogram Interview “on global developments regarding the growing number of transnational families and the expansion of information and communication technologies in the family and the therapy field”, leading us to the third stage of development of the OPS, in the stage of transformation.
The stage of Transformation, the third stage in the development of the team. Transformation means: “I am through what I am becoming”. It is the unknown, which will not be known before it is transformed. The transformation signifies the transition to the new task-target of the system and it is the primary source of continuous development, evolution and maturity.
At this stage, the completion, the integration of goals becomes an issue that is achieved through inner cognition and awareness that the system has acquired for itself and its relation to the environment. M. Borcsa suggests such a transformation in “Memories and Reflections” by saying: “Therapists and educators need to react to these changes by providing new ideas and new methods, as globalization is incorporated into family and marital relationships...” , a suggestion embraced by K. Charalabaki when she characterizes the FTU as an open system and wants “this anniversary to be a moment that unites, cheers and creates new expectations for the future...” meaning the Unit to remain in the future as an open, living system in progress.
In closing, to the question, “What have I gained?” studying “Memories and Reflections”: Throughout this stage, I had the feeling that I was observing the theory rising through the course of the FTU. I witnessed the emergence of a living system, watching it self-organizing, self-correcting, having direction and goal. I saw it surviving in time, evolving and transforming. I observed the “theory becoming practice and experience and experience enriching the theory”. I felt what Walter Benjamin has mentioned: “The force of a country road is different if you walk it through on foot or by airplane”. I felt at many times while reading “Memories and Reflections” like I was getting off the airplane of theory and was walking on foot down the road of practice, application, a road filled with experiences of people, trainers and trainees. I transformed, through my own personal experiences and reflections, from an observer of processes to a fellow-walker on this 24-year journey of the Unit.
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