Self-help: the CiaoLapo model

by Claudia Ravaldi

Together with Cristina Fiore, collaborator of CiaoLapo and contact person for the association’s activities in Liguria, we talk about self-help: what is it and what is it for?

CiaoLapo since 2007 has been involved in various projects related to self-help in perinatal bereavement and in pregnancies following a loss in the network and face to face: over the years we have developed a pioneering theoretical and experiential model (the first specific groups in Italy for this type of mourning) and prototypical (we have developed a model on theoretical and experiential bases that today we are reproducing in numerous Italian realities).

Before describing our work, it is necessary to make a cultural premise: what is a self-help group (GAMA) for our society today?

The self-help group in the collective imagination is still represented as a fearsome mythological figure, halfway between the persecuting minotaur and the ravenous chimera: it is often seen as a place destined for “penitents” who carry a cumbersome pain that can only be shared by few; it is seen as a “cry” or “vent” by many uninformed people, it is portrayed in films and books as a space “parallel” to normal living, which one enters until the problem it brings is completely extinguished. At that point, only at that point can one return to society, to the former life, being careful not to name either the group or the problem that one has shared in the group.

In our culture, despite hundreds of evidence to the contrary, it is still believed today that life events and related problems are processed by filing them, removing them, distracting themselves. For some, life events are a “test” to which one should react on their own by proving to be strong. To react, therefore, to move forward, without sharing anything. Sharing in a group, for many, is a subversive and bizarre act, even dangerous: leaving the private dimension, in the face of numerous positive evidences, is mistakenly seen as a means of maintaining the problem, magnifying it, making it chronic, and is often discouraged by experts, much more oriented to using an “individual therapy” to address the issue (despite the evidence telling us that GAMA and psychological support are two distinct and often complementary areas). Finally, a large part of the population, including some insiders, including health professionals, believe that bereavement is resolved even better, faster, and more effectively with drugs.

Why spend all that time talking, when with ten drops, you can get better immediately?”

Even today, the shared word and the exchange of experiential experiences are considered a useless palliative.

Imagine how difficult it is, with a prejudice of this type, to understand the theoretical assumptions and practical implications of a self-help group. Let’s imagine for a moment how difficult the position of those who, being afraid of mourning and its derivatives, are in difficulty in front of a painful person at a time: let’s imagine their suffering in front of an army of mourners, eager to share. Pain is not seen as an object of healing, but as a persecuting object. Let’s ask ourselves again, then why the GAMA in our culture are still so poorly understood and accepted, and the Gama on mourning more than all the others.

In this curious dynamic between the supporters of the parallel world (read: go ahead and come back when you get better ) and the supporters of “you have to do it alone” (read: brace yourself and come back when you get better), Cristina Fiore and I join: joining together the professional experiences of group management (psychotherapy, psychoeducation, listening, accompaniment to parenting) we began to study, observe, deepen and then create a self-help model for parents affected by perinatal bereavement that could effectively and empathically take care of bereaved parents and affected family members, using the dynamics of self-help groups and listening groups and adapting them to the complex reality of perinatal bereavement.

In these years of study, observation and facilitation of groups, a colorful picture has emerged, full of ideas and shades that are often difficult to read and interpret. We immediately realized that between saying “I facilitate a self-help group” and doing “the facilitator of a self-help group” there is the usual abyss. As between doing and doing well. Especially when one enters a dimension of deep suffering and extreme delicacy such as that of a traumatic life experience that has a pervasive and profound impact not only on parents but also on other children.

The self-help group is often spoken of as an unlikely caravanserai in which the maddened splinters of pain wander aimlessly. Among the experts and the facilitators of groups there is the conviction that it is enough to define mute help as “the mute to passively accept any painful expression”, to occupy two hours of space to give vent to unchanged and immutable pains. This, from the point of view of CiaoLapo and its facilitators, is very far from the essence of the self-help group.

We must remember that the approach to the group, both for operators and users, is decidedly powerful. The operator finds himself immersed in a circular of experiences that present important emotional peaks and the user opens his story and welcomes the others in it, feeling understood and reabsorbed, tossed and sucked. It is not therefore a question of arranging chairs in a circle and filling a time with words in turn. Rather, it is a question of transforming through words, listening and shared space, the identity wound inflicted by mourning into an experience, certainly painful, but not destructive.

Let us then examine the technical and human aspects of the group journey and what should happen in a group that works according to the authentic model of self-help.

Mutual help is a dynamic of the human being, and has both biological and social foundations.

Especially in the field of psychiatry and physical disability, in the 1990s there was a proliferation of user organizations and family members completely independent from formal services and their professional operators, if not often in open opposition. According to the members of these movements, empowerment is an issue that concerns them exclusively, which they do not intend to delegate. They do not propose a generic socio-political change, but commit themselves to an action free from professional conditioning or exploitation, in the direction of legislative adaptation, of a better definition of their needs, of an affirmation of their identity with respect to opinion or to the dominant culture, of a more adequate action to deal with their typical problems, based primarily, as far as possible, on their own self-help resources.[1]

Mutual help is recognized as an essential component of social work with groups and those involved in mutual aid, as Steinberg well puts it [2] , intervenes on personal and interpersonal needs and their activity reflects a holistic approach to social work. Therefore the group is both a system in its own right and made up of individuals which must be taken into account as such.

Mutual help is based on the assumption that people can apply and strengthen their resources by helping others while helping themselves.

“Here I am. I boarded this ship …”, writes S. a participant of the self-help group CiaoLapo (Genoa, Giannina Gaslini hospital) in the logbook[3] , and gives a good idea, in its metaphorical embarkation, of the process that it is necessary to face right from entering the group and even before: thinking of oneself willing to ask for help in the first place, and actively requesting the entrance interview, are two important steps for effective participation in a GAMA.

Steinberg defines self-help as “as well as a process … also as a result”, but in order for the result to be “translated”, mutual help must be reflected in the interaction process of the group. And for this to happen, group members must have both the ability and the opportunity to communicate and interact with each other while having the freedom to do so.

Middleman and Wood (1990) [4] , tell us that the only style of communication that really promotes this practice is what we could define as “free and unencumbered”. This style of communication should be accompanied by a climate in which a balance has been found between the need for freedom to express one’s feelings and points of view and the obligation to constantly respect those of others.

According to the Ligurian experience (groups active since 2007), the approach that best suits the facilitation of a group that has the pain of losing a child in pre- or perinatal times as its underlying theme, is the “person-centered” one. , being the Rogerian idea founded on the confidence that in every man there is an actualizing, propulsive tendency, which pushes him, if there is a facilitating ground, towards his own resilience.

I will omit here the known issues of the general trend of the self-help group, which can be found in any good manual in the sector and I will try to offer an overview of the specific GAMA CiaoLapo instead.

It seems to me correct to point out that the parent who accesses a GAMA is part of a subgroup of parents who need help and who recognize it. In a GAMA therefore not all parents are represented but a minority, which is no longer in a state of emotional freezing, at least for that necessary piece that allows you to ask for help and get help.

The methods of access to the group change in terms of sending, timing and other less frequent but equally important variables to be taken into account in order to improve the performance of the group itself.

The goal of the GAMA, to be kept in mind at every moment of the group’s life, is that the user leaves the group itself and regains a normal relationship life, in which it is no longer necessary to access self-help as a “unique place of salvation “.

The first specification that appears to the facilitator is the extreme difference that is noticed between the parent who feels he has been welcomed and the one who, on the other hand, has experienced a rejection or “mistreatment” during his hospitalization. In the first case, the access to pain is cleaner, less distrustful, more able to be contained.

Nuclear work, which revolves around bereaved parents, initially translates into a narrative that has as its subject the child who died too early and that does not ignore a framework of explanations relating to the event itself. Parents dwell on the clinical history of their child, on the birth event (whether spontaneous or following painful interruption decisions) and on the search for the causes of death, often unclear in the early days after death.

Understandably, the emotions that inhabit this part of the work have excruciating pain as their background, but peaks of anger, amazement, disbelief, resentment and love without borders and without domicile emerge from this. dignity.

Having overcome the need to present oneself and one’s history to the other members of the group, this naturally moves towards themes emerging from time to time from domestic and social experiences of this period of the life of the bereaved family: the relationship with others, the before and after, hope, planning, fear …

“I miss my daughter more and more and I always feel expecting my baby,” says G .; “I feel like I left someone outside the door,” says A .; and the suspended dimension of something unnaturally interrupted arrives, and answers are sought in this dimension.

  1. and D. respond to this tension by wishing all parents “whose children have abandoned their body, to revive their true wild self” (referring to a reading they had done together after the death of their little girl) and continue saying that only in this way, perhaps, the pain will be able to find a meaning even if it will never have an explanation.

The dilemma that arises and revolves around the “explanation”, the meaning, is pregnant with the group. Over the years, despite changing users, this nucleus imperatively returns to make itself felt in the manner and in the terms of the mourner who seeks a way in the storm of loss.

The child is also present in an interrupted design thought “I think how you would have been when you grew up, the first day of school, your first kiss” says S. and “when I look at my nephew I see my A., they would have looked a lot alike” he adds. another mom; and C. “talking about what I am feeling has given me the opportunity to give the right dignity to my children so that they do not get lost in the oblivion of time”.

What dimension does the group open up beyond that of sharing?

I believe I can affirm that it is a real transformative process in which the starting dimension, death, cannot be changed in any of its parts; the work that sees the painful person engaged, as long as he engages in this, is the dynamic with which he approaches loss, modeling it as an integral part of himself, in the double form of despair but also of love that exists and resists, even to death, and which has the dignity of existence.

“It is as if a very strong athlete, who has won many prizes, the day before the race, finds himself without the use of his legs”, says S. “over time he will learn to do other things, perhaps even to rejoice in the victories of others. while remaining aware that his legs are no longer there “; and A. adds “not just any race, the most important race of his life”.

Since the group is open, another situation that we find ourselves observing is the recalibration every time a new user is welcomed; parents are subjected to the enormous effort to reopen themselves to pain but somehow receive the restitution of their own healing power in exchange; what better actualizing trend?

And the facilitator?

The helper, as a catalyst of the movement of maturation, clarification, learning (Carkhuff and Berenson, 1976) [5] , conditions that distinguish a helping relationship, understands that the effort and responsibility of the research is all of the helpee. of the road that suits you best.

Reposition yourself in a place where the helping relationship is really freedom tool [ 6] to ensure that the person has favorable conditions for growth around him and can again draw on his own autonomy, dignity and self-esteem, is a titanic undertaking that involves the operator in a game of anchors in which often more than protected he feels nailed.

According to the classic Rogerian model, the helping relationship brings the client to the thresholds of action, helping him to understand himself, to explore his own experiences, behaviors, emotions; to have a clear picture of the choices regarding possible personal changes.

However, we can find ourselves in front of someone who lives with the potential for judgment and understanding momentarily clouded and compromised and who draws on the help tool to try to recover them.

In 1942 Carl Rogers in “Counseling and Psychotherapy” emphasizes that no one occupies a better position than the subject himself to know what his problems are and that the focus should be on how to integrate one’s experiences whatever it is.

In the event that the client, and it often happens when a consultation relating to a bereavement is requested, is frozen in his pain, the operator experiences a frustrating experience of helplessness and sometimes uselessness and here arises the great risk of forced intervention. , to unlock that time that becomes unbearable even for the helper.

While going beyond the strictly Rogerian model in which empathy, acceptance and congruence are necessary and sufficient conditions to produce a therapeutic change of the personality; and embracing a model of broader consideration of intervention such as the one proposed by Carkhuff and Berenson, where the helper skills also include comparison and self-openness, the emphasis of the helping relationship continues to be on the customer, as a capable person of activations necessary for the integration and development of one’s actualizing tendency, and therefore more generally on the whole group.

The operator to whom the impact with the freezing pain creates a problem also becomes a subject in crisis; the helpee’s way of dealing with pain displaces him and makes him insecure and frustrated. Activation with respect to a forcing of the process is therefore nothing more than a response to one’s own disturbance, to a discomfort in staying.

The skills required of the helper in the helping relationship, both one to one and as a facilitator of a group, underline that the technical meaning of centering on the person is a necessary condition for effective facilitation.

Shifting the attention towards the help process as such could allow the operator to get out of the frustrating discomfort of pausing in the pain of others while maintaining an attitude of open, non-directive, non-judgmental interest, with a genuine intention of understanding the other. in the meaning that the situation has for him and with a constant effort to remain objective and to control what happens in the relationship itself.

The effort that had been shifted, in the person-centered approach, from the responsibility of the helper to the involvement of the client as the only competent subject with respect to his discomfort, is now loaded into the constant and careful control of the relationship-system as a tool for growth .

[1] Bruno Bortoli, Fabio Folgheraiter: “Social Work”, vol 2, n 2, September 2002 (pp 273-281), Ed. Erickson Study Center

[2] DM Steinberg, Self-help, ”Erickson

[3] Notebook that the participants of the group exchange where it is possible to write down stories, thoughts, poems, songs, memories, images …

[4] Middleman R. and Wood GG, Skills for direct practice in social work, New York, Columbia University Press

[5] Carkhuff RR and Berenson B. (1976), Teaching as treatment. An introduction to counseling and psychotherapy, Amhrest, Human Resource Development Press, Inc.

[6] Giordani B. (1977), The helping relationship according to the address of Carl Rogers, Brescia, La Scuola-Antonianum.

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