Coordination of multifamily-groups in DSM in Lazio, Italy: history, aims and perspective Corrado Bernardi

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1 Coordination of multifamily-groups in DSM in Lazio, Italy: history, aims and perspective Corrado Bernardi Abstract Coordination allows the systematic comparison among practitioners who work with parental participated groups and operators dealing with groups and families where children pathological are present, with the aim of sensitizing the fromer to the possibility of extending the scope of its expertise in the direction of the latter. Keywords: coordination of conductors of MFGs and GPMF, admission polices, exchange, debate and mutual learninges The aim of the present paper, developed together with the representatives of the coordination of several ASLs, is to expound about how the coordination of multifamily-groups (MFGs) in DSM in Lazio is born and how and why different workers in diverse areas decided to cooperate. The essential reasons that lead to the formation of this Coordination board are: Isolation, that conductors of MFGs experimented within their own Services, where their skills were very seldom recognized and appreciated by their colleagues; Interest in disseminating a model of intervention on psychoses which includes psychotherapeutic treatment involving patients families, basing on the acknowledgment of the importance of treating families besides patients alone; Aspiration to compare different forms of clinical work in order to critically rethink treatments configuration, settings, groups construction techniques, and patients referring. During these very moments of confrontation, the coordination board learned about the clinical model of Garcia Badaracco s Multifamily Psychoanalysis. Basing on this encounter, many colleagues - who got interested travelled to Argentina to deepen their knowledge about the issue. But, before discussing the merits of the matter, it is worth noting how MFGs work strategies operate in Italy. We must briefly say that the work of Multifamily Groups as a form of clinical intervention in the treatment of severe disorders originated from the closing down of mental institutions, that is widely known, and from the resulting changes in treatment practices. Until then, in fact, the treatment of mental disorders in public 1

2 institutions was mainly focused on curing the patient, who was segregated within the institute. After the n. 180 Low, the attention was shifted outside the mental institution, towards the local mental health services. From then on, mental professionals treated patients in the social structure and within the families. That cultural and political change gave birth to new, articulated and complex answers, which must face a transformed reality. That period watched plenty of great transformations, new possibilities and research. The peculiarity of that period was in the fact that mental health operators started working in local services and specialized in different methodologies of clinical treatment (psychoanalysis, family therapy, relational and group therapy, etc.). They brought to the fore a type of on field research aiming to apply their models to public services, which were mainly used in private work. And in MFGs also, professionals found themselves working together with colleagues that used different clinical models, wishing to experiment new practices. They had a common belief: that the treatment of psychotic patients could not leave out the treatment of their families and of their family dynamics. This belief constituted the foundation stone for the first MFGs, forebears of nowadays MFGs. Clinical practice demonstrated that giving the patient an individual pharmacological answer (therapeutic and rehabilitative) was not enough. All the efforts they put in that direction, taking no account of family context, resulted ineffective due to the presence of checks in the family. Just because severe mental pathologies are not consequences of an isolated trauma that struck the patient recurrent conviction of their relatives rather it is an outcome of complex bonds and communicative cages wherein all components of the family are imprisoned. GMF conductors worked on these very multifaceted dynamics and they experimented several adjustments, with regards to groups formation and conduction techniques. We intend to highlight a transformation that is observable today, after years of work in MFGs, and is related to an increased confidence of patients and their relatives about their potentialities and resiliencies. Simultaneously to their involvement in MFGs, they experimented independent paths, which let them uncover a social role and a political participation, such that they could feel partners with clinical workers in the process leading to possible changes to be realized in the mental health services. 2

3 The coordination The Coordination is born on the month of March Since the beginning, it had an important flywheel effect in promoting Multifamily Groups work in the ASLs where they were not present and, over time, it witnessed an ever larger participation of workers than in the original group. Its aims Supporting the launch of new MFGs It stimulated the participation of still inexperienced colleagues in groups that started long before, just to promote their learning of directing techniques. Conductors appraisal between their peers The coordination symbolized and still represents a capacious container in which different souls co-existed right from the start: in a certain sense it worked as an open multifamily group itself, so that it continuously faced the experience of receiving new participants, accepting and appreciating all the differences, which were considered as strengths. The function of the coordination appears, thus, to correspond to the capacity of reception and holding differences and distinctions in the several clinical models. This function allows a constant process of exchange, confrontation and sharing, in an intense and innovative spirit that participants appreciate as an adjunct value. Listening got immediate attention and a great variety of different treatment practices emerged from diverse theoretical frameworks and clinical contexts in which they operated. Integrate GMF work into mental health services A consideration emerged in the Coordination: that non-integrated and split clinical practices are present in services today. In this context, MFGs can represent a new model of treatment, aimed to contrast both chronicity of mental health problem and the chronicity of the cure (i.e. the repetitiveness of the treatment practices proposed in the services, which is now mainly based on medications and rehabilitation and that not always contemplate psychotherapy). For these reasons, Coordination played an important role: it supported, gave a voice to, recognized and confirmed MFGs conductors work who could more convincingly bring their clinical practices into the services in which they already operated. Thanks to MFGs coordination they could also uphold the importance of a group-multifamily intervention within individual therapeutic paths. 3

4 Also because, as we always stated, MFG work does not foreclose the possibility of using other clinical practices but it can integrate psychotherapy (individual and/or family), pharmacological treatment and rehabilitation, strengthening their effectiveness. We believe that this change in local services can be possible only if referring to a multifaceted model of the mind, as an integration of different models in operators mind and in services is present. Developing and supporting intervention practices and cultural framework to be able to address families and patients needs. Thus, realizing family interventions, not only involving patients, has been a precise objective right from the first sessions. Periodically mapping MFGs in Lazio We realized and regularly updated a map of MFGs that worked in DSMs in Lazio area. Participating in events and congresses The Coordination participated with some papers in AILAS congress on May 2006 and to IAGP congress on August 2009; it organized a workshop titled: A achievable change. Multifamily group treatment in mental health services on April 2009, which witnessed a considerable participation of professional workers, families and clients. Conductors training The Coordination stimulated and encouraged the reciprocal exchange of clinical practices. Some of the conductors could participate in MFG groups directed by other colleagues in other DSMs. As discussed above, this undoubtedly promoted the birth of MFGs where not present and, besides, an improvement of conductors knowhow. We Can Why working in coordination is so motivating? Because the work of thirty-year dozens of operators is producing the belief that it is possible to capitalize on the current crisis of the services to go towards the recognition of effective clinical practices. When accomplished, at least in part, these goals through the work of several years, we have moved to new objectives, in perspective. And then, the Perspectives that Coordination is endorsing with regards to some issues Crisis of the Services Considering the continuous and unstoppable depletion of operators from services, the Coordination carried out a reflection about the "after us". We are thinking about who will continue those activities, in what ways and with which resources. Services operators get older, and retire without replacements. What young people 4

5 will be in charge? In seeking answers to these questions, we must consider other situations and contexts in which to work with MFG, thus going beyond the Department of Mental Health. Pathways to care How the psychotic patient s management works in services? And how MFG can be achieved, involving patients family? The way the patient is referred to another service and how and if this process constitutes an issue, is considered within the therapeutic project. Visibility and recognition The current information system of registration of interventions used in the DSMs does not provide for a specific check-list to register the intervention of the MFG. As this causes a loss of visibility of this particular form of treatment, the conductors are forced to record this activity generically as group interventions. Therefore, we are proposing a change in this regard. Disseminating MFGs culture We intend to ask for a meeting with ASL in Lazio directors in the next future, in the aim to promote shared initiatives which could disseminate the knowledge of MFGs practices in mental health services. We also plan to formulate a paper to be presented to institutions (Region, Municipality, Consult committees) and we aim to organize events involving mental health operators, clients, families, DSMs and Lazio Region. References García Badaracco, J. (2000). Psicoanalisis multifamiliar. Los otros en nosotros y el descubrimiento del sí mismo. Buenos Aires: Ed. Paidós. Corrado Bernardi: Psychiatrist, Psychotherapist. He worked in the mental health department ASL RME where he was responsible for the functional unit Departmental Multifamiliari Groups. Teacher of the Center for Studies of Family Therapy from 1984 and Director of the I.P.R.( Institute of Relational Psychotherapy) one of the seats of the Center for Studies of Family Therapy. Founding member of the Italian Laboratory of multifamiliar Psychoanalisis cobern@libero.it 5