This is a draft of the Preface but is in continual revision

Janus Group Guide

Philip K Springer, MD

Shelby Havens, ARNP DNP

Preface

5/24/15

      Throughout most of my adult life I have been in professions that were centered on helping others. I have been a family physician with a practice based in Southern Mississippi. And, for ten years I worked with Head Start children as part of my regular medical practice.  In retrospect, I recall how many politically astute people bitterly fought the Head Start Program. And, concurrently, I believe that programs such as Head Start helped prevent many of the incarcerations of the inmates I treated in the Florida State Prison System.In..1960 I left my family practice and enrolled in the Residency Program in the Department of  Psychiatry at the University of Florida.  Following the completion of my residency requirements, I became an Assistant Professor in the Department of Psychiatry.   In this position, I was heavily involved in the training of medical students, psychiatric residents, nurses and a broad cross section of other mental health professionals as well.  During the last ten years of my professional life I served as a staff psychiatrist in the State of Florida prison system.

     I learned a great amount of information and gained extensive and valuable experience from service in each of these venues.  That knowledge and experience served as the primary objective in writing this paper (book).  More specifically, I am especially interested in describing the development of a treatment modality which my colleagues and I designed for use in psychiatric and other environments.    It is known as The Supportive Person Group Process (SPGP) and my interest in the Process can be traced back to my days at the University of Florida.  

While performing my training and administrative duties in the Department of Psychiatry, I became very interested in group dynamics and began to develop a program we identified as Supportive Person Group Psychotherapy (SPGP) The book you are reading was inspired by a desire to write about what is and has been happening in my life from a personal and professional perspective.   I say desire because I am not a writer of experience.  I am a recovering alcoholic, a father, a widower, a retired psychiatrist, and former country doctor. When I look for answers to important questions about life ’ s meaning, I am looking for something from the heart.  When I say to myself “ written from the heart ” it is with humility and compassion and a strong sense of urgency inasmuch as I am reaching an octogenarian mindset, but this does not imply any form of frenzy but rather a firm sense of urgency about what I need to do to make it on this planet for a few more years.   As for now, it is with considerable excitement that I bring to light SPGP as a method of therapy that I had let lie fallow for many years.  

However, we are now ready to bring this group process forward.  That is, I recognize that there are stimulating new developments in understanding how the brain works.   As psychiatry falls apart right under our eyes, a broader and deeper effort to nurture our mental health therapies is finding it ’ s way through a bottom-up process in a multitude of self-help groups.  With this supportive person group process (SPGP) we hope to shed some light on how people communicate with their feelings as well as with what they say.   It is acknowledged that many people today are feeling overwhelmed and in search of new methods for dealing with mental health problems.  There are several books just out looking at dyadic relationships, or the power of two, as a method for dealing with the problem of being overwhelmed. Dyadic relationships are simply an attempt to work effectively as a pair rather than as a single individual.  These supporting personal group processes are just that kind of effort.  With one person supporting another in a group session they find that they need to develop techniques for being supportive rather than simply meddling in the partner's affairs.  So what began in the 1970s as an effort to deal with mental health workers and others in a busy psychiatric service has become available to us to use as a learning tool for becoming more effective in dyadic relationships.

There are many ways to explain bottom up processing, but for the purpose of understanding how the process works in group situations, the evidence is clear that emotions are activated more strongly in bottom up processing than top down processing. Lofty and often incomprehensible statements come from top down processing such as psychological theories from single theorists, such as Freud. But bottom up processing come from a deeper emotional level and is strongly felt rather than simply thought about and easily discarded. Bottom up processing is more democratic than top down processing.

         At present, science is expanding our knowledge about how the brain functions.   Through neuroimaging, we are also becoming more aware of simple techniques in human interaction, which can improve our lives by being involved in   quiet conversation or in groups such as AA. We now have the tools to watch the human brain in action through the miracle of functional magnetic brain imaging (fMRI). Science and technology have made it possible for us to follow emotions and thinking as they travel through the brain. However, the real test is how we sense what is going on in each other through the magic of just being close and intimate. We can get 20 hugs and know how it feels and, at present, we can also find, through an fMRI, which the brain lights up in response to these feelings of appreciation and affection.  One of the most startling recent findings is that the aging brain can set up new areas to store memory in the right-brain even while the memory area in the left-brain has gone into decay and disuse.  There are many mysteries that lie ahead that can be illustrated by the fMRI. However, this brief discussion is not focused on technology, but rather, on  human interaction at a very elemental level.   It is also important to note that the discussion presented in this chapter is focused on group processes and not necessarily on group therapy only.  There is an intelligence in groups which is at first difficult to see and which can never be seen unless you actually participate in a group.   Our thoughts are communicated not simply by words but we are finding that through the medium of the fMRI that these thoughts can be transmitted from person to person without so much as a word being uttered.  Thoughts can be read without words. It is possible that we humans can be aware of someone silently standing behind us.

During my stint as an assistant professor in the Department of Psychiatry at the University of Florida (1976-83) I had to  provide inpatient clinical experiences to the medical students and residents.   The question that kept nagging me and the other members of the Staff was how can we educate and/or treat this menagerie of groups we had on our Service.  In addition to patients. on any given day. our Unit often included  faculty members, psychiatric residents, nurses and medical students as well as  a host of other mental health professionals .  This diverse collection was a considerable challenge to the Staff. We had to find ways to communicate what we knew about both personal and group therapies.  

During my psychiatric residency one of my colleagues kept urging me to attend the summer sessions of the National Training Labs located in Bethel, Maine.  I eventually went to the Lab meetings and the result was a total conviction that group processes and group therapies will be our ultimate pathway to mental and spiritual health.   Many of the ideas presented in this guide have evolved through my experience at the National Labs.

    In the 1960’s a considerable amount of psychiatric and training was committed to educating future psychiatrists so that they could become psychoanalysts in the tradition of Freud.  We are now in a different era, an era that is devoted to promulgating new diagnoses and new medications to combat the assumed new diagnoses.  Since the 1960’s we have moved abruptly from discovering and nurturing the patient’s individual positive personality features to stamping out, in cookie cutter fashion, a diagnosis based on a checklist and yielding a convenient (to the drug companies) a medication treatment.

     (Drawing of the double circle group)

Using a large single circle to begin with I found that the medical students were prone to put the patients in an awkward position of having to defend themselves. Part of this was the awkwardness of the questioning employed by medical students, which I think must have come out of their experience of watching Perry Mason on television. So eventually I put all of the staff and students in an outer circle behind the patients and the patients were placed in an inner circle with the group leader, generally myself.  With this simple beginning, SPGP was instituted in 1978. A great deal has changed since then so I will present the basis for the changes as well as the rationale for SPGP.

The word supportive requires some clarification. Generally, the failure in this process is seen as a one-person meddling in another persons business.  However,  I found while working with the Staff of  the Florida School for the Deaf and Blind that a staff member who knew the child well could be very supportive.  Being supportive is very delicate process and the teachers and counselors at the School were amazingly adept at being supportive.   But they became supportive through an understanding of the sensitivity of the deaf child and the understanding that the deaf child was willing to be supported if the counselor knew them, as they understood their own self.

    In this short book I will bring to your attention both the mystery of the interaction between people at a very elemental level and a method of exploring human interaction with a simple technique within a particular style of group process. This done by use of the group configuration by moving the circles inward and outward and also by moving the individuals of the group inward and outward providing perspective to each participant. The mystery is provided by the manner in which the flow of energy among the participants creates a balance for the group and smoothes the jagged egos of each individual. With this supportive person group process (SPGP) we hope to shed some light on how people communicate with their feelings as well as with what they say and perhaps become as astute as some of our dogs. Many people today are feeling overwhelmed. It is obvious that many divorces stem from expectations of each other in the marriage is simply are beyond our reach. We are also seeing our young people back away from society because they feel overwhelmed.  Should we now look toward new methods for dealing with this problem? There are several books just out looking at dyadic relationships, or the power of two, as a method for dealing with the problem of being

Using a large single circle to begin with I found that, particularly, the medical students were prone to put the patients in an awkward position of having to defend themselves. Part of this was the awkwardness of the questioning employed by medical students, which I think must have come out of their experience of watching Perry Mason on television. So eventually I put all of the staff and students outer circle behind the patient's and the patients had the inner circle with the group leader, generally myself. With this simple beginning Supportive Person Group Psychotherapy (SPGP) happened in 1978. A great deal has changed since then so I will present the basis for the changes as well as the rationale for SPGP.

   The word supportive requires some clarification. Generally, the failure in this process is seen as a one-person meddling in another persons business. But I found while working in the Florida School for the Deaf and Blind with the staff and the student in a conference setting that a staff member who knew the child well could be very supportive but not interfere with what the youngster wanted to say or do in the future. Being supportive is very delicate process and these teachers and counselors at Florida School for the Deaf and Blind were amazingly adept at being supportive. But they became supportive through an understanding of the sensitivity of the deaf child and the understanding that the deaf child was willing to be supported if the counselor knew them, as they understood their own self.

In this short book I will bring to your attention both the mystery of the interaction between people at a very elemental level and a method of exploring human interaction with a simple technique within a particular style of group process. This done by use of the group configuration by moving the circles inward and outward and also by moving the individuals of the group inward and outward providing perspective to each participant. The mystery is provided by the manner in which the flow of energy among the participants creates a balance for the group and smoothes the jagged egos of each individual.   With this supportive person group process (SPGP) we hope to shed some light on how people communicate with their feelings as well as with what they say and perhaps become as astute as some of our dogs. Many people today are feeling overwhelmed. It is obvious that many divorces stem from expectations of each other in the marriage is simply are beyond our reach. We are also seeing our young people back away from society because they feel overwhelmed. Should we now look toward new methods for dealing with this problem? There are several books just out looking at dyadic relationships, or the power of two, as a method for dealing with the problem of being

to know about their job. But that is the way of the World; is it not the one we often desire.

    One of the paradoxes of serving others is that the serving person loses energy and the person being served gains energy. In my opinion the better the process of serving the more drain at the end of the day these serving person experiences. I believe that this is why many people hold back on offering their full attention and energy in the serving role. Intuitively they know what can happen at the end of the day. They feel extraordinarily drained when they have done a good job. We may have avoided serving I just went through the motions idea of the day they might feel my brain did all. So this is a real problem for each person who is trying to do their best and serving others.   One way that one can counteract this problem is to provide methods for energizing those serving. A frequent group process involving the serving one's can be a remarkable rejuvenating force. There are many companies and even institutions that practice this method of rejuvenation using a variety of group methods. In 1947 the T group was developed for this very purpose. We will be discussing in detail the Supportive Person Group Process (SPGP) in this guide.

     Before getting too deeply into the issue of supportive person group it is very important that we at least try to grasp the difference between content of the group and process of the group. Specifically content would be that it contains 12 or 16 members, for instance, arranged in a circular fashion made up of people about particular discipline etc. The process is more difficult to understand what essentially is an unseen moving, often complex interaction between members. For instance in baseball there is a very complex interaction process that goes on between the area of second base and first base. The content can be the first baseman, the second baseman, or the shortstop most commonly but what they go through in order to complete the double play is a process. Some of this can be so rapid that it is difficult to see how it actually happened. When a mother is attempting to make contact with a new infant she is participating in a process that cannot be readily seen. However it is easy enough to see that there is a mother and a baby in the same place doing something but we do not always know exactly what they are doing.

    There is also urgency about how the flow of information is leaning toward the top down rather than from the bottom up. Someone say that I am a hopeless whom may prove politically out of sync but time will tell. My OPTMISM is based on my I recall during my ten years of working with Head Start children in Mississippi as a part of my regular practice. I also recall how bitterly many politically astute people fought against the Head Start program. The Head Start program was and still is an enormous benefit to the developing child. I argue that more similar activity would have prevented many incarcerations of inmates that I treated in Florida State prison and Union Correctional Institution. Short-term thinking generally wins political battles.

     We now live in a system, which is based on economics and extremely short term thinking and planning. If we were to stop and think for a moment our world system could be based on raising healthy human beings. We fail over and over again to spend money on the very young and turn around and spend it on fantastic war and dreadful prison costs. If one thinks of costs in four-year segments it remains seemingly intelligent to stick with the economics but if one thinks in terms of the lifespan of a human being then we are on the wrong track.

Yet another story leads me to bring up the matter of personality. My wife and I brought 7 children into the world with such strikingly diverse personalities that I believe that current personality theory must be reviewed in detail. I ask a very simple question concerning personality but the answer requires a detailed explanation. The question is: would it not be preferable that we approach mental illness treatment from a strengthening of personality approach rather than from a diagnosis of pathology approach? The personality is the humans ’ immune system and as time ravages on within chronic mental illness, the personality is gradually eroded and misshapen. The patient ’ s pathology is not the fulcrum. The discovery of balance and inner strength within the individual demands our reverent attention. I say reverent because we as humans through centuries of trial and error have gradually developed a soul. We find that this soul development is somehow crucial to the survival of our planet, as we know it. Perhaps the soul is the seat of what we are all about and once damaged we can become tools of the state.

During my stint as an assistant professor in the Department of Psychiatry at the  University of Florida (1976-83) I had to  provide inpatient clinical experience to the medical students and residents in  psychiatry.    However, this was a considerable challenge to the Staff  because there were so many students and residents as well as the patient's who needed to learn as much as possible about  psychotherapy.  The question that kept nagging the Staff was how could we educate and\or treat the menagerie of groups we had on our Service.  In addition to patients on any given day our Unit often included faculty members, psychiatric residents, nurses, medical students as well as a host of other mental health professionals.  Our high priorities included a desire to provide an inpatient clinical experience to those who functioned on our Unit.  However,  this was a considerable challenge because there were so many different professional groups. The ideas presented in this guide have evolved through my experience in National Training Labs and as such emphasize the enhancement and enrichment of the personality in contrast to waging war on mental illness.

    Dyadic relationships are simply an attempt to work effectively as a pair rather than as a single individual. These supporting personnel group process is just that kind of effort. With the person supporting another in the group session they find I need to develop techniques for being supportive rather than simply meddling in the partner's affairs. So what began in the 1970s as an effort to deal with medical students and a busy psychiatric service is now become available to us to use as a learning tool for becoming more effective in the dyadic relationship