HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


  • George GournasPsychiatrist, Group and Family Therapist. Athenian Institute of Anthropos
  • mirror neurons
  • empowerment
  • resilience
  • group
  • living systems
  • interpersonal neurobiology


The crisis is a social event. It is a social drama which becomes a personal drama and thus, the management of crisis can not be just a personal matter. In this paper, with the purpose of a better understanding of the complexity of such an event, we use the knowledge of the Neurosciences, of the General Systems Theory, of the Complex Systems, of The Sciences of Anthropos, of Psychology and Sociology. The Systems Approach shifts the focus from the individual, that is the focusing on his personal characteristics and his reactions, to his study as a biopsychosocial system in the context of the multiple systems of which he is a part.Τhe family, the group and the social networks are intermediateC systems that intervene the human being and the event of crisis, they absorb the vibrations, the virulence and they function as a membrane, a filter, a strainer, with flexible and permeable boundaries. At the same time they are a context of values, beliefs, possibilities, sources of support of learning and the actualization of experience. All these lead to the better understanding and facing of the crisis. In the present paper parts of therapeutic group sessions are presented, coming from a group of men and a group of women. There is reference to the value of the group for the management of crisis and to the need to redefine the role of professional mental health with special emphasis at the human relations, the sharing of the traumatic experience, the creation of supportive systems and social networks, with the aim to activate and enhance the potential of individuals and groups.

Key words:   group,living systems, interpersonal neurobiology, mirror neurons, empowerment, resilience

Neuroplasticity Relationship and Narrative

Human beings are in need of a safe environment in order to exist, grow and evolve. Humans cannot exist and be happy on their own. We are relational beings, we are social beings. In recent years we have focused on science, technology, material goods. We believed that our DNA, the genetic material we inherit, defines us. But it’s not only genetics that determine who we are. Our genes give rise to our cerebral structures, but it is the environment that shapes them. It’s what is communicated among different brains that largely shapes what is going on inside a human brain and soul. From our birth onwards the most important relationships take part in the shaping of our neurons and our neuronic circuits which in turn allow us to become aware of other humans and their feelings and through these relationships to be able to realize our own feelings and ourselves (Cozolino, 2006). Relationships shape our brains and determine the course, and some of them continue to heal our wounded selves throughout our lifetime (Badenoch, 2008). The exact map of our neurotic circuits, that is, what differentiates each one of us, is shaped through the immediate and timely interaction of our genetic material with the environment. The environment influences our brain’s development that influences our behaviour, which in turn influences our environment, and so on (Papadopoulos, 2011). The term neuroplasticity (Siegel, 1999) describes our brain’s ability to change its structure and function. The factors necessary for the promotion of neuroplasticity are: a) strong emotional bonds, b) an environment rich in stimuli, c) experience, learning through experience, d) a state of safety which is characterized by cooperation, nurture, positive reinforcement and a feeling of fairness, all factors that highlight the profound social character of the human brain. Our relationship with the environment is crucial. Secure relationships offer a base, a starting point for exploring the world but they also serve as a safe context for someone to retreat to whenever they feel threatened. The Emotional Bond is a behaviour, a biological instinct through which a child seeks out closeness and safety in his relationship with an older figure whenever it finds itself under the fear of a threat. A safe and strong connection with the authority figures constitutes a source of power and personal fulfilment (Holmes, 2009).  A safe or unsafe emotional bond is considered to be a possible predictive factor of how functional a child is going to be throughout its lifetime and of the way he/she is going to deal with future traumas. The threat of losing the sense of safety and especially the interruption of the relationship with the environment, whenever that becomes threatening, impersonal, cold and indifferent, is a serious cause of anger, aggressiveness and emotional solitude which is considered to be more dangerous for our health than smoking and doubles the possibility of heart and cardiovascular attacks (Walsh, 2006). Bowlby borrows the idea of Kurt Lewin about ‘social fields’ and applies it in antisocial behaviour: ‘good environments create good citizens, bad create bad’. As humans we form our personal identity based on what we ‘know’ and how we describe ourselves as persons. But the way in which we perceive ourselves is defined to a great extent by cultural factors, narrations, descriptions from third parties, labels, classifications, separations, exclusions. The Narrative Approach proposes the storytelling or the “re-storytelling” of human experience, the co-creation of new liberating narratives that focus on a new meaning of life. Every new narrative, every new reading is a new interpretation and a new writing. By inviting other persons as audience during the presentation of those alternative stories, we enhance their chances of survival through time and a sense of a different personal identity is created (Epston & White, 1990). By narrating and sharing our stories with other people, they help us to form a picture of who we are, our identity, how we see ourselves and the world around us. We are our stories, our narratives. The way in which each culture creates its narratives provides the same traumatic experiences with different meaning. In that way the same event can shift from shame to pride, from shade to light (Cyrulnik, 2008). Rossi (1986) states that every narration is a recreation, a reframing as much on a social level, by redefining our identity, as on a neurophysiological level, through the plasticity of the human brain. Markes (2003) in his autobiography I live in order to narrate suggests that “Life is not the one that somebody lived, but the one that somebody remembers and the way he remembers it in order to narrate it”.

Groups talk about the Crisis

A good way to look into the impact of the crisis on mental health, on the behavior and relationships of people, would be to listen to their stories. In the present thesis, the narratives of four women and five men from group therapy sessions are presented, as well as the manner in which they experience and connect the present crisis with their past memories and their future life quests. The therapeutic approach follows the principles of the Dialectic-Systemic Approach, utilizes analogical  communication and the living process developed by Vassiliou (1983) as enriched by his colleagues over time.

**Narratives from the women’s’ group: **

Maria :  Today my wage was decreased even more. I feel despised. I came second in the Polytechnic University entry exams and now I’m not able to make a living. I cannot ask my parents for help. I am exasperated and disappointed. I feel like all my efforts have come to nothing, that everything I have done has no value.

Gianna: You are in pain for all your generation and that pain is hard for one human being to bear. I graduated from the university in the third place yet I was unemployed for 5 months. I bore on my shoulders the pain of a whole generation end eventually I got depressed.

Rea : There is so much gloom and distress around. The only thing of value is faith in human beings. A lot of times I feel disdain. Amidst my own difficulties, I think of how my parents managed to make it. My father was a political exile. I was born in a foreign country and lived there for the first eight years of my life. My parents didn’t speak the language. I feel admiration for them. Often the doctor would give a box of cream to my mother, because she couldn’t afford to buy it herself. Today, I face my own difficulties and I say: “look, my parents managed to make it in a foreign country” and I respect them. But there was a price to pay for that, and a personal cost. As a child I would take in all their difficulties. I was under a lot of stress… I remember my mother saying that I was a very quiet child. I never complained. I would sit in a corner and cry silently. Every time I hear them telling that story, I feel pain for the child I used to be. That silent crying in the corner had a lot of fear, grievance and burden in it. A burden which I kept for myself because I didn’t want to add it to the burden they already lifted. I didn’t feel like adding to that, like some need I might have had for a little new toy. Since then, I kept that silent crying and the difficulty to express my needs. I still have the fear that if I do so, I might burden my own people… and so I keep my needs ‘silent’. Today I’m worried that this situation could affect my children’s life.

Fani : After Maria spoke I felt tears coming up my throat. I feel connected with M, R, and G. It’s the burden from the parents as well. They went through a lot of difficulties and survived. They keep saying to me: “We got tired, you shouldn’t get tired”. It hurts when you see and hear that your parents are fatigued. It’s like all their efforts went to waste…They used to hide their pain. Yesterday, my daughter who is 6 years old, told me with pride: “I didn’t cry this time mom, eh?”. I wondered what am I doing? The same? Am I blocking the expression of pain?

Gianna : It was the parents’ burden that you had to lift on your shoulders too. They desired the best for you. There were very high expectations and you were not aware of your own potential. That was tormenting, but it also made you stronger. I realized little by little that I should uphold certain values along with some other people whom I chose to have in my life, with whom I could share my fears, my agonies, my hopes and dreams. That is the way. I was tired of floating into fear and pain on my own. Now I feel relieved that I walk on this road together with other people.

Narratives from the men’s’ group

John : I started to get affected by the crisis, not directly but because everybody around me experienced it. I‘ve started to see everything around me as black. I’m scared about myself. I’m afraid that I won’t be able to take care of my responsibilities…one of my sons is studying in another city, the other one is attending private lessons… I’m going to find myself in a difficult position. I’m disappointed and I feel that this is not my fault.

Vassilis : I’ve always had a plan B., now I feel that this is not enough. It feels like there’s no way out, I feel disappointment, anger and fear. Up to this day, our family has been able to cope with the situation. But the uncertainty about tomorrow scares me. If you cannot cope with your responsibilities you feel like a loser. In the face of these problems everything else seems superficial, meaningless, even my psychosomatic problems seem like a joke…

Dimos : I feel the agony that other people bring. While I try to encourage people at work and their families, I feel that I have no answers to give… I’m drained by the crisis. I recently cashed in a gold sovereign I had since my wedding. I feel it’s hard. I’ve experienced a similar crisis within my family, it was hard…but this difficulty brought deaths in the family. My mother died from cancer, and later my father too, who by the way spent his whole life worrying about paying back his loan. My father never spoke about his difficulty, but he exuded stress. You could hear him sighing, you definitely felt his stress. My mother also did the same thing, without speaking, until she died. In our house, we didn’t use to talk about our difficulties, everyone experienced the crisis on their own, and me as a little kid, I felt that I should do things faster, better and more responsibly in order to avoid becoming a burden and cause more difficulty for them. Two days ago, my daughter who is 9 came and asked: “daddy, have you ever experienced a crisis? How did you cope?”. I told her that I had experienced a similar crisis but that these matters were not for her age and she should go back to her studying because that was her job…I was surprised with her question. I don’t know what to do, I try to find alternative solutions, I don’t know what else to cut back anymore… I have to redesign my reality… concerning the use of the money, not to mention the emotional part.

Kyriakos : I have my own business, I cannot cope with my obligations. I keep cutting back this or that…Now I have to fire one of my two employees… This hurts me, I can’t find the way to do it, I don’t know how to make it happen, I find it inhumane...and this has consequences for my home too. The crisis has somehow awakened my children’s consciousness—they have their own opinion now… They say ‘do you have any money today, dad?’…and then say ‘leave it, I’ll manage somehow…’ and I don’t know how they manage and what they say about it… I feel uncertainty, we all do, and this leads to nagging… I have to provide the necessary for us to get by…

Kimon:  I feel hatred for those responsible… We’re on a financial edge. We ‘re going to face a problem with the next cut down. I don’t know what else to reduce… My daughter is silent at home. But I know that they’re talking about it at school… I don’t know why she doesn’t talk about it… sometimes I think it is because she doesn’t trust her parents or in order to protect us, or to avoid making us sad. But what am I going to do when I am no longer able to offer what she wants? I feel useless…

‘’I carried on my shoulders the pain of my generation and I got depressed’

If we add to that the personal burden and the burden of the older generation, the agony of our friends and our fellow human beings, then depression is a possible human reaction. Depression is not a personal drama and its treatment cannot be just a personal affair. Humans are in need of other humans to share their experiences. The group serves as an antidote to loneliness and the decay that characterizes our times, providing instead the sharing of experience, the relationship with others and the shared human values. Eighteen months after the 9/11 attack on the twin towers in New York, a relevant study showed that 60% of people with a traumatic experience had rebounded from crisis. Those people found themselves connected with each other, turned to others in search of emotional support and utilized the cooperation, the rules and the norms of the community as well as the services designed for their support. They dealt more effectively with the traumatic event and they came out of it stronger, functional and creative, in contrast to the other 40% who were found to display serious psychological problems that led to chronic stress situations (Walsh, 2009). Epidemiological studies of the World Health Organization showed that one out of two people have undergone or would go through some serious psychotraumatic event, and one in four would experience at least two such events in their lifetime (due to war, violence, rape, etc.) (Cylunik, 2001).

**Mirror Neurons and Group **

Depression and related disorders stem from humans’ inability to achieve good relationships with others (Buchele, 2012). According to the latest views, humans relate to each other through their mirror neurons, that constitute a possible neurophysiological unit of the brain. A result of their function is the understanding of others, the recognition of their goals and intentions. Mirror neurons respond to a lot of stimuli, non-verbal, social and relate to emotional, cognitive and mnemonic centres. They constitute basic features of our social and emotional intelligence (Cozolino, 2010). ‘Mirroring’ (Sermer, 2010) means the capacity to compare reactions, to imitate and learn from the other, and constitutes a basic factor for group functioning. It is more than obvious that what is important in the educational-learning procedure is not what the parent, teacher or the professional-specialist says but who they are and how they behave (Senge, 2008). It seems that social learning is partly based on the capacity to recognize similarities and identification, which are both functions accomplished by mirror neurons, are utilised inside the group process and constitute a part of our nature that is valuable for our survival and evolution. The reflective systems and the neuronic networks constitute the biological basis for the relationships inside the group. The group as a ‘whole’ can partly be a result of the collective activity of the mirror neurons of the persons involved in the group. In that sense the group as a ‘whole’ constitutes a ‘reflective space’, a space where our brain is organized not on the basis of a reflective cycle, observable by stimuli-reaction, but on the basis of relations charged with meanings and interaction characteristics. Through the mirror neurons empathy precedes the understanding of the other, the emotional tone of every group or other meeting emerges before speech and before the group’s matters are articulated. The synchronization between group members emerges as a relationship that comes with recognizing the self inside the other and the other inside the self. In a functional group the members feel that they can communicate their feelings, their intentions and their goals. This group cohesion is a by-product of the function of mirror neurons; it has a profound educational function in terms of learning and social behaviour, because members feel less lonely inside their problems, they feel more connected, more attuned with others, more prepared to cooperate and fight for common goals.

From vertical to horizontal learning

Our era is characterized by an individuality that differentiates the person’s behaviour from the public space, leading to the disrupted society of intimacy-privacy, as Senet (1999) describes it. On the political level this differentiation leads to the breaking down of the notion of public life, to the extreme psychological conditions of separation and alienation. People feel safe when they can predict and verify their expectations, and when this is threatened the instinctive need for self-protection emerges. The biology of reaction in the face of danger shows that at these moments we are less capable of functioning creatively, and that we react with fight or flight behaviours or “freeze” and stand still. (Ferguson, 2006). In the present essay, fight is seen not as a reaction but rather as an action in the face of crisis. It is about the skills, the relationships and the values we have to utilize and develop, as citizens and professionals, not only in order to survive but also in order to bounce back from the traumatic experience more functional and more creative, on the basis of the notion of resilience (Walsh, 2006). Living systems like humans and their social systems are characterized by a hierarchical organization (Vassiliou, 1983). In the traditional setting there was a sequence of interconnected levels of organization. In the old days, in times of difficulty or need, people went where there was care, sharing; there were social relationships, the family, the neighbourhood, the square, the coffee shop, the teacher and the church. Today that relationships have collapsed, people go in the best of cases from the family to the psychologist. When this social cohesion is abolished, a malfunction emerges on a biological, social or psychological level. However, this is not idealizing the past. Time does not turn back. But there is a need, amidst the crisis, to regain those social structures necessary for the sense of continuity, human warmth and safety. We should built, as professionals and as citizens, along with others, our own “squares”, our own “communities”, our own networks where there would be space to express fear, shame, mistakes, insecurities, needs; and through sharing and exchanging, learning and support would emerge. We could create what is mentioned as “communities” of people who learn through the sharing of “experience”, where people, professionals or not, learn from the experiences of others, from sharing the knowledge, and that leads to the expression of a wider and collective wisdom that can bring about change through personal change. We’re talking about the passage from “vertical learning” to “horizontal learning”. We’re social beings who create themselves inside relationships, and not persons who create themselves on their own. A relevant article (Taffel, 2012) talks about the sense of inadequacy, alienation and the sense of disdain for the parent in today’s society, especially in a period of crisis, and describes the creation of support groups for parents through which they are able to build collaborative relationships, and the wisdom available from the experienced professional (Flore, 2012). A relevant study showed that the economic crisis has a substantial psychological effect on families, couples and individuals. It was found that 56% of unemployed persons with children believe that ‘the life of their children has changed in some degree as a consequence of their unemployment’, whereas 48% of unemployed persons reported ‘more conflicts or disagreements than usual with family and friends’. Another study showed that a person who has lost his job has an 83% higher probability of developing an illness related to stress, like diabetes, arthritis or other psychiatric problems (Solomon et al., 2011). A positive relationship has been observed between economic recession and men’s fatality rates. A relevant research mentioned in the same article (Economou et al., 2008) shows an important interconnection between percentages of unemployment and 5-6 causes of death — specifically, ischemic heart disease, trachea cancer, lung cancer, malignant neoplasia, manslaughter, suicides and suicidal behaviours. Moreover, it is suggested that a vertical rise of depressive disorders and suicides is expected in the United Kingdom, 3 times more psychotic episodes, double the incidence of alcohol abuse and double or triple that of depressive episodes (Giotakos, 2010). There is nothing more important than the feeling that one is not alone on this struggle. When someone listens to the ‘same’ stories from other people, calmness is regained and the voice becomes stronger. Humans grow up, evolve and mature through sharing experiences, by utilizing the difference, by gaining recognition; they have the right to make mistakes, the right to experiment, to risk, to explore the new and consequently explore the different. We need to look at our differences, whatever they may be, as strengths rather than obstacles.

The pathway to the community and the redefinition of roles

Today, more than ever, there is a need for a more holistic way of perception and thought. Today’s social reality and the emerging needs pose a series of problems concerning the redesigning of work and intervention of the mental health professional as well as the redefinition of his role. The role of the mental health professional, in a society in crisis, requires a shift from the safety of the office, the private practice, the public place, to actions inside the community, the place where problems and human needs emerge. It requires the shift from the role of ‘the specialist’, who has power and knowledge, to the role of the coordinator-member of a group, who should go beyond theories, techniques and professional skills and needs to broaden out his personal capacities in order to act as a sensitive index and be able to feel how things happen in the world, and also to observe how things happen inside him and around him. Being ‘Human’ beyond the role constitutes, in parallel with the theory and the techniques, a vital part in the formation of the role of a mental health professional. The role of group coordinator is one of a catalyst-regulator of the group process with the skills of humanity, psychosocial maturity and the authenticity of his values (Vasileiou, 1973). According to the contemporary views (Flores, 2010) it’s not so much the techniques or the approaches adopted by the group coordinator that influence the successful outcome of the group but rather the creation of a proper climate that fosters neuroplasticity and neurogenesis. Theory and techniques are not factors of change—but relationships are. Techniques matter a lot less than the human need for cooperation, sharing, acceptance and the feeling of “belonging”; as a member of the Prevention Centre said about his role: “I need to be able to ‘dance’ with my colleagues and their groups. I don’t know everything but I know that all humans have rhythm and are potential ‘dancers’, and this is a basis for my work’’. It’s important to recognize that the number one problem inside the crisis is contempt, alienation and separation, and participating in a group forms a need with an objective through sharing, exchange and positive feedback, through the activation of self-leading capabilities, self-esteem, self-realization and autonomy for each human being. The narratives of experiences form the personal identity and the way in which humans perceive themselves and the world around them. The narratives and discussions transform the neuronal pathways and enhance the synapses, especially when they are important and take place in a safe, emotionally arousing environment with strong emotional bonds (Flores, 2010). The creation of small communities, which can also be of some help for social coherence, requires collective effort, collective conscience, positive reinforcement, the right to hope and the expectation of the new. The expression, the sharing of experience, the formation of emotionally safe bonds, the sense of continuity when facing uncertainty and fear constitute factors similar to those of the Emotional Bond and are based on human relationships and on the principle of ‘’keeping our hearts close and our opinions separate’’, in the words of the teacher for life G. Vassiliou. We need more than ever the horizontal relationships, the relationships between us, the sharing of experience, the wisdom of a functional group both in a professional and personal level. Just because “there is no river that can run higher than its headwaters’’, the group coordinator needs to be a member of the group, and by following the principle of co-development of living systems (Wheatley, 2003) to be able to learn, co-develop and differentiate himself inside the groups in which he participates and the groups with which he is in contact. The mental health professional, as a group coordinator, is expected to function as a catalyst for the group process, leading the passage from vertical to horizontal learning, where members take responsibility for their training, and go beyond the common belief that the expert ‘knows’ and instructs those who ‘don’t know’. The group can decide on the matters and needs that concern its members, by utilizing, as a living system, the ability of self-organization, self-correction and direction towards the target: its ability to survive, to develop, self-transform and evolve (Agazarian, 2004). The group constitutes an empowerment framework, as one can define the expression of strength, knowledge and experience that human beings hide inside them. The role of the group coordinator is to protect the group from its subversive tendencies which can be found in every group. It’s also to offer information, guidance and training on the basic processes that create a functional group, a living system, capable of bringing to surface the wisdom that only humans can develop, as group members, in relations of interdependence, interconnection and mutual giving (Vassiliou, 1987). To contribute to a functional organization that will help in the mirroring, the sharing of experience, impersonation, echoing, empathy, energetic listening, the ability of group members to encapsulate their thoughts and learn to function as group members, by utilizing the ability of human brain’s plasticity and the data that neurosciences offer. It is the therapist’s job to mirror the group dynamics, the emergence of the process on a meta-level, in order for collective knowledge to become a personal experience over time, part of a coherent relationship network that nurtures the sense of participating and belonging. By means of this process the objective is for group members to become active agents for learning and gradually phase out the role of the therapist. There is a need for us as professionals to go beyond theories and techniques, which up to this point constituted our professional power, and broaden our personal capabilities to observe what is taking place inside us, what is happening in our own professional communities and in the communities of the people around us.

**Conclusion       **

The pain of crisis is common to everybody, but the way we experience it is unique. The expression and the emotional management of this pain depend on the resilience that the social and cultural environment can offer (Cyrulnik, 2010). The participation of people in groups, in relationship networks, the emotional and social support, the crossing from vertical to horizontal learning enhance the strength of individuals and groups and give a different meaning and  a different angle to crisis and its management. We would like to close by quoting G. Seferis from his speech during the Nobel Price ceremony (1963): “In this world that keeps getting narrower, each one of us needs everybody else’’.


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Read the next article:

ARTICLE 4/ ISSUE 2, April 2013

Hypotheses are dialogues: sharing hypotheses with clients

Paolo Bertrando, Psychiatrist and Family Therapist, school Centro Milanese di Therapia della Famiglia, Milano, Piazza S. Agostino 24, 20123, Milano, Italy, Teresa Arcelloni
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