Introduction 

I would like to share with you what an experience of a group is. From the October 1999 up to the June 2001, I lived this experience together with all young people carrying a mental handicap.

I wish all people like managers, families and friends who approached the mental handicap universe and/or will do approach it, could get some reflections on this matter.

Once per week, I was the conductor of this group which took place in a Rome lab with some of these young people carrying a mental handicap .

In that period this lab was the primary structure of the association called “Cartallegra Onlus” and because of a lack of funds, it was obliged to end its activities by the end of September 2001.

To begin with, I would like to explain to you all the reasons why I felt it was important to carry on this psychological/clinical work. Therefore, in the very first two paragraphs, I will provide you with

some short information on the lab and  how I decided to offer my professional contribution to it.

The next paragraphs will be respectively devoted to the group members'profile and to the psychological path we run all together. Therefore, I will also analyse the specialised literature sources as an important support of this psychological/clinical experience I described right now.

The reasons why “Cartallegra Onlus” was created 

The association “Cartallegra Onlus” was born in 1999 because of a particular need. This structure was already projected by some people. Some of them were able to provide Cartallegra with an economic support, some others were just young people with a mental handicap, their families, operators and voluntarists too.

During 1999, in a very precise period of  this project, the usual economic supports were denied.

Some of the families decided to create the association “Cartallegra Onlus” and they became responsible for the direct management of this structure so to guarantee the performance of its activities and initiatives.

The rehabilitating program of the association took its inspiration from the experience which was based on several years'activity played by the young members of the lab. The main activity was the cartotecnica[1]. I projected this program and now, I am going to show you its contents.

On this experience basis, I believed it was fundamental to allow these guys to perform further activities.

In fact, the cartotecnica had been used separately and so many guys got bored; it was repetitive and inadequate if we compare it to their need to grow and exploit their capabilities inside the lab.

Among the new proposals, the group thought it could be shaped as a room for ”meta activities”. In this area, guys could meet, know and recognize one another as what they were and what they felt

since their relationships, general and particularly rehabilitative experiences were limited to what they knew to do or what they did not know, or rather what they could learn to do or what they could not learn.

I will provide you with some examples about these concepts during the clinical treatment. Here, I simply would like to show you the project tried to satisfy both the single guys'growing needs and the ones of their working group which they constituted first, inside the lab.

Furthermore, the project aimed to meet the families'needs that witnessed the guys'expectancies towards their own daily activities in the structure.

My family is one of them. Maria Claudia is my sister and she is a girl suffering from the Free Trisomy 21, also known as the Down Syndrome. She was one of the people going to the lab and I wish to write a short paragraph on this particular experience.

I wanted to take the responsibility for the management of the group for many different reasons[2].

· The first one concerns the nature of the group; at the very beginning, it had been a listening group (an experiential one).

Later on, such sessions were alternated with psychoeducational ones. This experience never aimed at a psychotherapeutic outcome, even if, somehow, such aspects were also lived by the guys, as I will show you later on.

· The second reason was linked to my professional profile, the group education with a psychoanalytic orientation. Besides, many times in the specialised literature I read as the group is pliable when it becomes a psychological and psychotherapeutic instrument.

At that time, I really had the opportunity to use this instrument for an emotional and psychological universe, the one of the guys I wanted to help, since I knew this world better than the other ones.

At the same time, I also knew these parents and families expectancies and I tried to give a room to their needs too, as the project shows.

· The third reason is the so-called “reality reason”: it would have been very difficult to find a psychologist with a group professional education and an experience in the world of the people suffering from a mental handicap who could take the responsibility to work for the project as a voluntarist. 

Cartallegra[3] project: its activities  

In this paragraph, I am carrying a section of the Cartallegra Onlus project, concerning the new rehabilitating activities which were proposed for the lab, together with the cartotecnica.

The lab is offering the guys a room to socialize and get the capabilities so to have their lifestyles increased thanks to a cutting synergy too.

The cartotecnica has been chosen as the peculiar activity of this lab; this idea was born many years ago because of the following reasons, always valid, as well:

· The material we need is cheap and so, the guys are allowed to experience a wide range of mistakes.

· The ended products take a short time.

· The products are sold at a low price.

· The instruments and the equipments are simple, safe and consequently, they can be directly used by the guys themselves.

The products are the guys'result who have worked in this employing area; these products want to be original and of quality, since they have to be sold.

The leading guide of each activity is freely chosen by the guys: this activity makes them the main actors , they are active and take part much more than possible into the whole cycle of performance (starting from the idea of the product to do, up to the buying of the necessary materials and the final production).

According to this attitude, each activity will also be the opportunity to strengthen each member's autonomy. The forseen activity, plus the concerning psycho-pedagogic targets are the following ones:

· Every month, the guys will go out together with an operator so to buy all the material they need.

Goal: to know the territory, the means of transportation, the established path, the use of money.

· The cartotecnica activity, every morning. Goal: the guys can get the adequate capabilities and develop a feeling of identity as capable and producing human beings.

· The theatrical activity, once per week. Goal: to increase the communication, the emotional expression, the creativity.

· Kitchen activities, once per week; guys are employed in every single step: they decide the menu, the shopping list, the shopping, the cooking, they prepare the table, they have their meal all together. Goal: the guys can get the appropriate kitchen capabilities as well as the use of money, so to develop a feeling of identity as capable and producing human beings.

· Gardening activities, half a morning per week. Goal: the guys can get the adequate capabilities and develop a feeling of identity as capable and producing human beings.

· Yoga activities, one hour per week. Goal: to increase the psychophysical integration.

· A listening group with the psychologist, forty minutes per week. Goal: to make the mutual communication among the guys easier, to assure them they have an area of “meta activities” and reflection both on the personal emotional experiences and on the activities performed in the lab.

On demand, once per fortnight, there is a listening room for the guys'[4] parents and families too.

· Commercial activities in an open market, at least, once a year. Goal: to develop the feeling of the working social value and get the right capabilities concerning the use of money. 

The guys[5] 

When the very first year of the group started, members knew one another, since, as I already explained, they were taking part into the Cartallegra structure.

Many of them were suffering from the Down Syndrome and they had already participated all together in the group activities of the Associazione Italiana Persone Down  (Italian Association of Down People).

These activities have the target to make all members independent so they can get their operative targets concerning every day life, so they can reach a local territory, they can use the public means of transportation, they know how to buy and use money.

Therefore, they are group experiences which are rather different from the experience I was going to offer to the guys. Anyway, I want to remind you that both on these experiences basis and on the work we performed in the lab during the last few years, a sort of communication level among the group's members had been already developed. As the project showed, what I wished it could be reached in  the group was to make the development of a further knowledge plus communication levels among the guys easier, and in great harmony with the affective needs and the growing period they were just living.

Because of a lack of space, I will introduce you the guys in a very short paragraph, even if this does not allow me to show you their complete personalities.

However, in this way, the reverse of the medal is the reader will easily take care to the the guys'life and interactive aspects which have been underlined by the group itself and that are going to be followed in the next paragraph.

Here we are with the guys at the beginning of the group, as I saw and knew them at that time and as they had been introduced to me by the lab operators.

Maria Claudia is 21 years old and as I already wrote, she is suffering from the Down Syndrome. She looks like younger, she can tell just a few words but she can understand much more than that, emotional meanings included. Her contribution to the cartotecnica lab activity is limited to a pair of steps as the cutting and sticking of the material.

Marco is suffering from the Down Syndrome and he is 25 years old. He speaks in a very comprehensive way, he is able to build a whole cartotecnica product.

However, the lab operators complain Marco has some strange behaving attitudes: for examples,

when he goes to the bathroom, he is used to get undressed, when he gets nervous he does not want to work and he is even capable of being rather spiteful towards the other guys or the lab operators and voluntarists.

His family was one among the families who were totally convinced that the cartotecnica activity was not only absolutely boring for Marco, but it was also increasing his tendency to repeat.

Manuela is 30 years old, she is suffering from the same syndrome too. The verbal language level is good and her contribution to the cartotecnica is complete. Her hip has a problem which prevents her from having a rapid deambulation, although she is independent with every single movement of her body.

Giuseppe is 23 years old, he suffers from the Down Syndrome as well. For many aspects, he could be compared to Maria Claudia, in the lab: he looks like delicate and shy, he does not speak so much, he understands the simple verbal language only, he is not able to finish a whole cartotecnica product.

Valentina is 25 years old. She speaks, but since her birth, she has been carrying a cognitive disorder not well identified, together with some problems of interaction.

Sometimes, she withdraws into the drawing activities or reading ones of magazines she usually carries from home, and she denies her contribution to the lab activity, even if she could give it.

Alessio is the oldest boy in the group, he is 33 years old. He is very fat and tall, he has been carrying a mental handicap since his birth. He is not always possible to understand what he says but he understands what operators and voluntarists tell him.

Flavio is affected by the Down Syndrome and he is 29 years old. He does not speak and he does not allow anybody to touch him, his glance is dark, he is fat. The operators tell us in the past he had spoken. It seems he understands what he has been told. He partially contributes to the cartotecnica activity.

Beatrice is 29 years old, she suffers from the Down Syndrome. Among all the girls in the lab, she is the one who dresses more stylish and as a woman. She knows how to work the cartotecnica very well, she speaks fast, without a perfect words spelling. It is not always easy to understand what she says. She has a very high verbal comprehension level in the group: it is one among the highest levels.

The group: the resume' of a psychological path 

The first session (October, the 4^th, 1999)

Some days before, I was told a sentence by Alessio, and when I went to the lab, I presumed that some of the guys had been informed on the group news.

The day of the first session, just when I got to the lab, I found that pretty all the guys were well working in the cartotecnica hall.

I invited all the members to follow me in the near hall for the group. Beatrice was absent and because of a physiotherapy at her knee, she  was not present for the first four sessions. Valentina did not want to take part into the group and she carried on her work.

Manuela, Marco and Flavio were late.

When I got in, I immediately moved the table which was in the middle of the room and I put the chairs around, in a circle. The guys went in, and I sat down on a chair and them, around, they sat on the remaining ones.

I introduced my proposal to the guys: “This is Raffaella Girelli, I am a psychologist and Maria Claudia is my sister, as some of you already know. This is a group. In this lab you have lots of activities: the cartotecnica, the theatre, the cooking, the yoga…on Mondays we can have the group, if you like. Here we can speak of whatever you want, how you feel in the group and among you, everybody. You can tell me how you feel happy and how sad, you can tell me about your happiness and sorrow.”

Alessio immediately struck me because his intervention was opportune and even appropriate, and he soon affirmed that his mother had died. I asked him when it had happened and he informed me that a lot of time had spent.

I  tried to give him something comfortable in comparison with this first heavy new content, and I added: “I imagine this had been a big pain for you, but you can always remember how much your mother loved you and this is always with you.”

He apparently agreed. I involved the group saying that Alessio had told us something very important. Manuela followed him saying that her father had died and even her first dog and after, her second dog had died, as well, and a friend of her who attended the church had died too.

More or less, I repeated the same things I said to Alessio, and saying that me, too, I knew his friend had died, a guy I knew, and that I was really sad about his death. Manuela rapidly assented, and with decision. When Flavio and Marco arrived, I repeated who I am, what we did in the group and I shortly resumed what Alessio and Manuela had given to the group just a few moments before.

I often looked to my sister: she seemingly smiled and winked. I begun to say what Maria Claudia had done during the summer and I asked the guys what they did[6]. They answered me one by one and, above all, Manuela apparently took part into the conversation, she seemed  vivacious and she also tried to involve Maria Claudia.

Since the beginning of the session, Giuseppe had been eating some pizza and he had continuously said first his liver, and after his forehead had been feeling bad. In the first case, I said maybe the pizza he had been eating was too much, in the second one, I invited my sister to give him a caress, just to encourage him.

He stretched towards Maria Claudia with satisfaction. During the session, Marco got up to give me a kiss on my cheek, I received it with pleasure but then, I specified again we were there to speak.

Soon after Giuseppe, Marco intervened by saying that he had an headache since the night before he had gone to bed late ,and he said once, he had had an headache when he had seen me going with my sister to the lab.

I felt I had to give something back to the group because of these “sudden diseases”: I thought they were such treatments demands, as the group wanted to suggest me that there, there were several damages, as if it were a group with a little illness.

I said that, sometimes, we have some illness which is not in a very precise area of our body as in those cases, but, anyway, we feel bad because it is inside us (I pointed the hearth) and that in the group, they could speak about it.

In that very moment, Marco begun to list some “strange” behaviours of the other group's members.

For example, he said Giuseppe usually winked his eyes, Flavio usually hanged his tongue out, Maria Claudia gnashed her teeth. I said it was true, all of us, we had different problems. Marco said we had to speak about problems and solve them. He said this by looking and smiling to me with an ironic attitude.

I asked him if he was tricking me, he said “no”. Therefore, I said to the group Marco was offering an agreement to everybody: to speak about our problems to solve them all together. Marco assented with a light expression; he said to Flavio he wanted to be pardoned by him because of what he had said before (meaning that Flavio usually hangs his tongue out). I asked if everybody agreed on Marco's offer and everybody smiled saying “ok”.

Even Flavio who did not say anything nodded, and he seemingly understood.

I said good-by to everybody and since we all accepted Marco's agreement, we would had seen the following week

When I got out I met Valentina, she smiled to me and I asked her if, by the following time, she would had liked to participate into the group session and she said “yes”.

The group during its two years

The first year our path begun on the idea of “meeting an agreement”, after Marco's offer, an idea everybody could understand.

I already listed some group's main important targets which were:

· To grow means to be more independent in the every-day life.

· To communicate does not necessarily mean to know how to speak.

· The group can help us to express feelings and emotions.

The group allowed each of the guys to find their own area, according to the group's capabilities and times. Each of the three issues had been  pointed out with a great evidence by a guy rather than another one, but it had involved everybody. In the second year of the group, I introduced the guided reading of some materials on every-day life operations, from the observation of the guys and their families, to the watching of a videotape on the issues of feelings[7]. There had always been a discussion on the issues which had been faced by the group after these materials had been examined (psychoeducational sessions).

In general, all the materials which had been proposed had also offered a starting point to face the autonomy issue and the one of the emotional growth. This was a logical consequence of the fact that the year before, these guys had freely communicated in the group and they had learnt to accept one another more than ever. In  the first meeting, Marco had listed some little problems which had not been ignored. On the contrary, for many times I had underlined these behaviours during the group; I had considered them as expressions and ways to communicate that guys used, and I even tried to transmit to the guys they could have an acceptable image of themselves, an image which could be accepted by the whole group.

During the last few months, each of them had revealed the development of  a group membership feeling, even those who did not speak: in fact, these guys showed their feeling going to the hall we usually met, and seating down around the table (Maria Claudia) or signing up the future meetings with the group (Alessio) in the lab planning, or speaking about it at home and with enthusiasm (Valentina) or also by a direct and personal expression in the group. On this subject, I am going to report a short passage of a session where Manuela was the speaker of the group.

With a reference to the group, Manuela suddenly said: “All for one”. I asked what she meant. She answered to me just laughing and saying: ”The round table”. Then, I said that the King Artù and the knights'round table was round and everybody seated around as we would have usually done after…..she answered “yes” and she laughed, I asked her if the same went  for the group and she answered “yes”.

Neri (1998) detected the stage of the brothers'community without a mental handicap in adults of small groups with an analytic orientation. Starting from this stage, the group was shaped as a collective subject, which is capable of thinking and of an emotional elaboration. Here, it is probably not very opportune to apply the reading categories of the group phenomena which had been produced by the observation of a very different clinical context.

However, I was absolutely convinced the group really existed, because of Manuela's images of all for one and the one of the round table. The group had its own voice and thought and this would have supported its members'voices and thoughts too.

As far as the guys' managing of some emotions was concerned, operators told me that during the first year of the group, Marco had calmed down a lot and he had also reduced his provocative behaviours. Many times, during the sessions, Marco had spoken about his quarrels with Flavio.

Usually they quarrelled because Marco did not want to accept that Flavio did not want to be touched. During one of this sessions, meaning that one of the first year, before Easter holidays' interval, something happened as I show you.

Marco told Flavio had got angry with him during the morning and so, Flavio had struck Marco with his fist, at the family house they were coming from.

Flavio was silent. Manuela asked to Flavio if it was true. Flavio never answered but everybody felt it was true. I told Flavio that if he had got angry, he should have told us the reason why, and if he kept his fist closed, he could not make Marco understand the reason of his anger and Marco got angry, anyway. Since I knew Marco used to tease and touch Flavio, as in that very moment, I told Marco that he should not provoke Flavio. I kept saying to Flavio that many times, in the group, Marco had told he loved him, and all of us, we knew it. Flavio smiled and made a peace gesture to Marco. Marco made the same and then, he did it to me, telling me thank you. Me, I made the peace gesture as well, then also towards Flavio, and starting from Manuela's initiative, everybody made the same gesture one another. Thereafter, we wished a good Easter everybody and we said bye bye.

I thought it was pretty extraordinary Flavio had given his hand to Marco, since he was usually not so favourable to the physical touching. From that moment onwards, he took such kind of initiatives, particularly towards the group's members who did not speak, as Maria Claudia (for example, just helping her to have her seat). I did not believe something magic had happened during that session.

With the time passing by, an atmosphere of affection had been simply created. This feeling had provided Flavio with a great freedom and Marco had renounced the provocation of affective reactions by the other ones. I can tell Marco had learnt to ask them in the group and in the lab. He had also showed he could accept  other ways to offer these answers, for example the smile from those members who did not know how to communicate (Giuseppe, Maria Claudia).

Therefore, the common denominator for the group's members during their path was the opportunity to keep in touch with new ways of expression and new ways to establish human relations.

These new human relations abilities found  a good response by the group, or by a single member, or by myself, every time. Concerning this issue, I would like to cite what C. Neri wrote on the “animation”[8] process (1998, p.122): “Another effect that the group has in establishing a positive relationship with the group, certain aspects of the patients'personalities, which have always been present but hitherto have been silent and unexpressed, come to life and acquire depth and intensity.”

As I will show you as a conclusion of this work, I believe the animation process had been the basic experience of the transformation path of the guys during the group. 

A look on the literature sources 

The international literature largely confirms the group could be an efficient instrument of intervention both for the adolescents and the young adults. Even if we limit this research to the analytic oriented contributions only, they are a lot. The authors have pointed out the different  evolution tasks that the adolescent has to face and all of them are strictly related to the difficult transformation process of this life cycle. Anyway, the same authors have found the group is the main instrument to support the adolescent.

Among the several english contributions, I want to suggest you the following ones: Cramer Azima and Richmond (1988, 1989) Tuttman (1991) MacLennan and Dies (1993) Rachman (1995) Kymissis and Halperin (1996).

In Italy too, the psychological and psychotherapeutic intervention groups for adolescents have their own tradition, also if it is less solid.

The text by Lo Verso and Raia (1998) has a chapter specifically devoted to a review on the italian articles which have been devoted to these experiences.

Besides, the experiential group has been adopted by schools to prevent the guys from the disease and the abandon of the group (cfr. M. Bernabei, R. Girelli and C. Neri 1999).

To underline an applicative example in the psychiatric departments for adolescents, I remember the group experience Bosi, Benvenuti, Gallo, Jozia and Caratelli proposed (2000, p.180)[9], where the group performs “either as an object self-reflected, or as an object self-ideal and full of omnipotence, and either as an object self-twinning[10] […whereas, there p.178] The serious disease is essentially characterized by a lack of continuity, a fragmentation, a lack of integrity, continuity and vitality, of a fundamental  function of substance we define as The Self”.

Unfortunately, there is a reduced number of experiential groups or typically psychotherapeutic ones with young people suffering from a mental handicap.

Particularly, McCormack and Sinason (1997, pp. 186-187)[11] denounced the health structures because of the gap existing between the interventions on those people who suffered from a mental retardation and those who did not:” There is a strict separation between the operators who have a traditional mental health formation, that is with an experience of a psychodinamic or cognitive individual, family and group therapy, and people who have the emotional capability of having relationships with people suffering from a mental handicap, even if they have not been formed in this area. This cordon sanitaire has been largely spread by the fact that children, adolescents and adults suffering from a serious and deep mental handicap have been denied to have feelings […] also if today this wrong theory is being doubted.”.

The same authors are convinced about the similarity between the “normal” adolescent group process and the adolescents carrying an handicap, whose difference is linked to the performing times only (there, p.196)[12]: “The process strictly follows the one of other groups if we do not consider the group material's content […] However, every single step is longer because of the real cognitive lacks of patients and their difficulty with the thinking  process.”. The two authors end their article by stating that  both children and adults suffering from a mental handicap can exploit the group intervention. Their reference is the psychoanalytically oriented model, as the group experiences which have been described in the specialised literature refer to. In this case, it seems to me their contribution is largely relevant. In fact, for a too long time the traditional psychoanalysis has considered that the people carrying an handicap have a too “poor” inner world to be treated with a psychotherapeutic intervention

Among italian contributions, it is largely known that Levi expressed his belief in the mental disease in children who have a serious difficulty to learn.

It is possible to observe that this disease is not strictly linked to the mental retardation but to less important aspects of the same disease as the social shame, the difficulty to develop a rather adequate feeling of self-esteem.

From  this point of view, if we compare the group to other therapeutic instruments, what comes out is that the group carries the advantage of intervene at different levels: of relationships, of cognition, of affection. Stoppa, Mascellani, Tartari and Giorgi (2000, p.680)[13] point out the efficiency of this intervention for children who have a learning disease, since in this setting they can perform some learning experiences of collaboration, where:” The group interaction […] becomes a common use of individual experiences which can produce changes in how the person conceives the Self; through the identifications in the group, the single person is accepted beyond his own abilities […] the inadequacy, difference and loneliness conditions are newly elaborated.”. 

Conclusions 

Before I took part to the group, the guys I described in this article had spent much of their time in the lab to build objects of coloured paper cartoons. Finally, this activity had allowed these guys to develop either the adequate technical abilities and even an independent producing capability. However, these guys had not really known one another and they also had not developed a rather sufficient experience in the personal interaction's capability that D. Goleman (1995) defined as the emotional intelligence; this happened also if the guys had joined an adolescence life dimension or rather a pretty young adults' one.

To me, and since I am Maria Claudia sister, this interacting capability could allow a quality increase in the lives of guys, their strictly considered intellectual level excluded. So, my first hypothesis concerned the efficiency of the group as a room-instrument of development for the emotional intelligence of the guys carrying a mental handicap.

If I consider this group experience and even if I had a positive verification of both the guys' behaviour and psychological welfare, I do not give you any conclusion. However, some reflections I here reported concerning the transformation path the group had verified are confirmed by the specialised literature as you can read.

Besides, I could sum up the main phenomena on all had happened during these two years in the group, by suggesting the “animation” process C. Neri (1998) found out which was particularly effective as I already pointed out in this article. It is the process by which the person succeeds in experimenting and integrating some authentical parts of the Self, which would be rather unexpressed and no lived. This process takes place by the intensive affective participation in the group life and even by the meeting-confrontation with some ways of thinking, very different from those of one's family and environment. I believe the group has just represented this opportunity for the guys of Cartallegra. This should contribute to overcome some resistances, which are partly alive, so to offer some psychological or psychotherapeutic intervention to all the people suffering from a mental handicap; I wish there won't be only an interest towards the cognitive learning paths, as it is literary known by everybody.

Translated by Benedetta Breveglieri

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