Peripatetic Group Therapy: Considerations

This text is based on the book Group Peripatetic Therapy: Considerations by Demétrius França. He is a doctor of psychology, works as a clinical psychologist, professor, researcher. Book that presents two interesting developments: first because it reflects on the challenges and insecurities that young psychologists and other health professionals face at the beginning of their professional lives. And secondly, because it is the first book entirely dedicated to group peripatetic therapy in Brazil.

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For those who do not know, peripatetic therapy is a mobile clinic with no fixed clinical setting . If in conventional clinical therapy we have the psychologist and his patient inside the office or institution, protected and private places. In the therapeutic follow-up we will have a patient and therapist moving on foot, by car or public transport without a fixed clinical setting , to open places such as streets, squares and shopping malls .

Peripathetic therapy began in the Psychiatric Reform in care for patients who did not adapt to conventional therapy within the office, or hospitalization in psychiatric hospitals. Over the years, this clinical practice has evolved and matured, adopting different names since psychiatric assistants, qualified friends and therapeutic follow-up, which is popularly known today. And it is in response to the evolution of this walking therapeutic practice that Demétrius proposes the adoption of peripatetic therapy. After all, if originally it was support work for psychiatrists and psychologists, today we have peripatetic therapists who exercise it autonomously and with therapeutic possibilities different from conventional psychotherapy due to the clinical setting .

Peripatetic is a Greek word that means “given to walk, especially while teaching or discussing”. It is widely used when talking about Aristotle’s peripatetic school, where the philosopher taught his students while everyone walked. In this way, the Greeks who conveyed the teaching of philosophy in this way were called walking or traveling philosophers, those who walk. Peripatetics.

The work presents a case study developed in therapeutic activity, that is, it is the result of an action research. As the main theoretical foundation, the author speaks of the group through the notion of genesis and group dynamics by Kurt Lewin and for the individual uses the phenomenon-structural psychopathology of Eugène Minkowski, a psychiatrist and phenomenologist still little known in Brazil.

The purpose of peripatetic psychotherapy groups is to guarantee their users to leave themselves through the encounter with the other and / or with the places they visit outside the institutional walls in which they remain confined, to face a world where they can be more .

Introduction

Demétrius’ experience, which he said transformed his clinical practice, is part of a day hospital, which is a partial hospitalization service. In peripatetic group therapy, the focus is not concentrated on just a central dialogue or activity, but spontaneously circulates among the participants in a diffuse and simultaneous way. In addition, it involves a series of issues and contingencies that go beyond the setting of conventional group therapies within the office and with participants in a circle, in addition to other classic features. The variables are uncontrolled, the stimuli are unprecedented, provocative and full of possibilities.

The research is also an exercise in Minkowski’s psychopathology, which has developed a diagnostic and intervention technique based on the comparison of its own psyche with that of its users. His work does not exclude conventional psychopathology, which is merely descriptive, but it criticizes the function of this perspective for therapeutic work and proposes the understanding of his patients through an intuitive and sensitive practice to the constitution of phenomena for each individual. Action research presupposes participation (and interference) of the researcher naturally, without pursuing a desired “neutrality”. The method for collecting data follows the understanding of Mailhiot (1970), who uses Kurt Lewin’s theory to propose the study of group phenomena in their entirety, as they are perceived and lived subjectively by researchers and participants. Mailhiot proposes action research as a technique that allows to use the feelings and impressions of the researcher and the participants as research data. He uses Lewin’s concept that the social field is a Gestalt, that is, even if the group is made up of individuals and subgroups, it is not reducible, because the dynamics of the constitution of these groups and subgroups are characteristic of the situation that provided them . Action research as a method was a response to attempts to reproduce social phenomena within laboratories, which provide questionable results because they came from artificial situations and which mistakenly sought concrete and absolute results for subjective subjects.

The first publication on peripatetic therapy took place in 1985, but the practice emerged in the context of psychiatric reform in the years 1969-1970 in response to demands not met by the asylum model of the time, with a hospital-centered format and long hospitalizations, which, in practice, excluded the sick people from their families and communities permanently. Interestingly, some biographies of Freud already used the term peripatetic therapy to designate sessions that took place during a walk.

Phenomenon-structural psychopathology

Minkowski’s alternative to conventional psychopathology is that the adoption of the syndrome ceases to be a grouping of symptoms and is recognized as “the expression of a profound and characteristic change of the entire human personality”. He appropriated Bergson’s concepts, considering that the most fundamental aspects of human existence are not quantifiable or measurable, in order to develop his own classifications of psychology and psychopathology.

Minkowski is quite pragmatic in his work and does not propose a definition or norm for psychotherapy. After all, the therapeutic event can occur from what appeared to be a simple conversation and we are not always very clear when this process started or when it was completed. In this perspective, the element that causes the therapeutic result may be unknown given the complexity of human relationships, being necessarily connected to explanations associated with the intuitive and irrational. It does not exclude nor does it minimize the need for professional training on the contrary, because the therapeutic and psychopathological work must necessarily be built from an individual and personal experience.

Peripathetic therapy

The experience of everyday life, outside the inpatient institution, can be therapeutic in itself for these users. Everyday life can offer more creative alternatives to an experience that was once punished by isolation and the agony of existing. The healing of the subject who had previously been isolated by severe psychological suffering must occur precisely in the social, that is, outside the institutional scope (Coelho, 2008).

One of the peculiarities of the TA clinic is in the setting of its differentiated frame from the classic clinic clinic. Because it is a clinic that takes place in everyday life in the city, the “consulting room” is constituted in public spaces. AT can happen either at home, on buses or in cinemas. It is the particularity of each place that will define the session rules. It is said by this particularity of the TA that the setting of this work is mobile. (p. 66, 2007)

Peripathetic group therapy

In the tour group, everyone must participate in the proposed activity, which takes place outside the hospital. Everyone is free to make suggestions, give their opinion on someone else’s suggestion, vote on their favorite suggestion. On the walk, one can have ice cream, the other enjoy the exhibition, the other sit, but everyone should go out together (GIOSO et al., 2005).

The street as a therapeutic setting

All psychotherapies presuppose a therapeutic setting. Generally the office is a private and protected place where those involved can relax and communicate without risk of exposure or interruption. The offices have characteristic variations in the arrangement of furniture and decoration related to the approach of the professional who performs the services. A psychoanalyst will probably have a couch. The group psychotherapy settings also have their peculiarities related to the theory and, generally, we will have the participants in a circle (at least part of the session), so that everyone can see each other. But what about the setting of the therapeutic companion’s practice?

Peripathetic therapy occurs “outside”. External even to the definition of rules, institution and space, it can be exercised even within a private space of a house or institution, but with a different perspective. Being offered on the streets, in the squares, museums, etc. A priori, every place and every time can be the time for the practice of the therapeutic companion.

The participants

The team consists of therapists, nursing assistants and psychiatrists. Within the total of 80 users, the author marked the diversity of diagnoses, age and gender, which demonstrates a very inclusive and plural work.

Final considerations

Demétrius presents interesting accounts of his experiences during the research. For example, with Içá (fictitious name):

“We invited everyone to go out and got together outside the clinic. While the group was forming, Içá approached me and said he wanted a hug, but then he ran his hand over my ass. (…) At the beginning of the treatment, she did not speak and was limited to making animal sounds, such as dogs and cats.

“In conventional clinical practice, this invasion of the therapist’s body would not be allowed, or would not be possible. From the perspective of peripatetic therapy, this event integrates the therapeutic process both in the process of understanding and diagnosing the patient and in the psychotherapeutic management of this body content.

In another very interesting situation, the same Iça claims not to be able to pay for the bus that cost 2 reais presenting a note of 20 reais. Convinced by Demétrius to pay for the bus, she takes 2 reais from the change and offers it to the exchanger asking for the 20 reais back. The absurd situation became comical with laughter on the part of the exchanger illustrates Iça’s very specific relationship with money and her difficulties not only in understanding how the use of money works, but also in giving up her resources. From that event on the bus that would not occur either in a day hospital or in a conventional office, it was again possible for the therapist to increase his understanding of his patient and discuss this subject from a psychotherapeutic perspective.

As illustrated in these two examples of others present in the book Peripatetic Group Therapy: considerations, the author presents a very different perspective on the role of the psychologist, who does not need to be limited to the office or the walls of the institutions.

I believe that many colleagues and students do not even come into contact with this type of theory and practice within the psychology degree. The book offers a great opportunity to think “outside the box” and to discover new forms of psychotherapy.

Many of you must imagine that working with groups can be difficult. Even more so with people with severe mental disorders, such as schizophrenia and bipolar disorder, in uncontrolled public environments, such as streets, parks, cinemas, shopping malls. I imagined the same thing.

This makes it even more interesting to follow the author’s reports, who, unlike an analyst who coldly observes the events, reveals his human side, his own difficulties in acting in this type of practice, and how he dealt with it.

The author explains very well the theory that underlies group peripatetic therapy, addressing, among other important points, the psychology of group dynamics and the phenomenon-structural psychopathology of Minkowski. From a phenomenological perspective and the performance of an action research, where the author really immerses himself in the relationships with the subjects, the experiences are told in a unique way.

It is a good opportunity to think about psychology beyond the walls of institutions, extrapolating the training at a university and the “containment of bodies” in psychiatric hospitals.

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