PSYCHO-ANALYTICAL RELAXATION GROUPS (SAPIR METHOD)
A TOOL FOR THE TRAINING OF CARERS


Simone COHEN-LEON
Christiane d'OLIER
(Paris)

What follows concerns  training groups for the carer-patient relation using relaxation.
We are indebted to Michel Sapir for the foundation of Psycho-analytical Relaxation, also called Variable Induction Relaxation. If it has its origins in Schultz's Autogenous Training, from the years 1955-60, it was quickly distanced from that, by the first practitioners, Freudian psycho-analysts, who were much inspired by the works of Férenczi, Winnicott, Dolto and Balint.
The purpose is not to become relaxed; relaxation is offered as a way of listening to the body and is in fact just a means, in the same sense as the couch, to enable the lowering of defences and the psychological circulation which permit analytical work.
The psycho-analyst relaxer, through his inductions, verbal, tactile or otherwise, allows the subject to begin listening to the sensations which then arise in himself, to put them into words and to relate to his story.
This requires training groups comprising around ten carers from different backgrounds, meeting regularly for thirty three sessions.
Ideally the group is conducted by a mixed couple with an observer, either qualified or in training. All three are trained psychoanalysts.
The relaxation session progresses by two stages: first, a period of relaxation introduced by verbal inductions, and followed by touching; second, a period of speaking, when each person expresses in his own rhythm, his own feelings in words. The touching and the verbal induction are variable in the course of training sessions.
The work concerns the bodily sensations, through the impact of the words and the touch of the conductors, attending to what the two processes reveal : narcissistic regression of the group, and narcissistic regression of the subject.

This is not therapy, but training, for carers who wish to question their attitude to caring, through a corporal approach and in a group.
The association relaxation and group, makes possible a relation to one's own body, within a secure setting, the group serving simultaneously as vector, support, security and induction.
The appeal to the sensorial initiates a process of regression which involves all of the senses.
So we invite the relaxers to feel what is happening in their bodies; (cénesthésique) sensations, but also, to awaken their senses: touch, smell, taste, hearing, sight. In other words, to mobilize those sensory organs that were so present in infancy, and even from the foetal stage.
"In infancy" J. MacDougall tells us,"the psyche is organized on a pre-linguistic basis" although the first transactions from mother to infant are made in "a linguistic community. . . . For human offspring, in the beginning was, not the word, but the voice. . . a voice pregnant with the corporality of the mother. . . To the mother's voice should be added all the other perceptions of the senses: smell, touch, internal and kinesthesic experiences . . . the skin-self, but also the smelling-self, breathing-self, digesting-self."
Our hypothesis is that, ever since we have had a body and sensory receptors, everything that we have experienced with this body, our history, has encoded itself in the course of time in our sensory self, by means of which we shall be able to recover the messages. In this way the approach of psychoanalytical relaxation will favour their expression through the discovery of their print. Our concern is that the bodily sensations are made perceptible, then the perceptions put into words, to be received, heard, by an other.
The sensation has a very particular meaning in the process we establish. It arises in a quite precise situation, limited in time and space, and it is, in some way, a response to an induction. It has a location just like the talk which expresses it.
 It is encoded in the transference which arises directly from the first sessions.

Concerning Touch
We have spoken of touch; indeed, with the model that we offer in RPS touching is a central feature. After giving a spoken induction, we touch the participants.
Touching is part of the model, established as such, expected by the participants, reflected upon by the leaders, and has nothing to do, with an acting out.
We are aware that this, involves undertaking a risky procedure, which requires in the analyst a constant vigilance over what unfolds, what he perceives in the relaxant, and what he perceives in his own spontaneous counter-transferential emotions.
What does this touching mean; how is it received; what is its effect?
"I felt I was trapped in an iron collar", reported Bernadette during one of our relaxation groups; she said her skin had felt to her, like "a thick crust" which could not feel anything. Then she recalled a picture of herself as a young child, plastered from chest to legs for several months.
The induction spoke of the skin thus: "the body present, enclosed in the skin which protects it . . .", followed by the touching of her legs, had brought back for her, that desperate lack of contact, between her body and the body of an other.

The hand which touches comes to question the feeling.
It is clear in Bernadette's case how the sensation of someone else's hand on her skin, re-awakened in her, the lack of that sensation at a point in her life when she would have so much needed her relation to an other to be from body to body. The verbal induction about skin had provoked rejection in Bernadette :"skin, that means nothing to me, I feel nothing", but in this context, the hand of the relaxer placed on one of her legs, this live bodily element, provokes in her, a sensation which, caught in the field of transference, gives rise to associations whilst drawing out bodily traces of memory.

This touching happens at a moment when the subject is alone in his own private space; it introduces the presence of an other into that space. It invite each person to encounter bodily sensations experienced in the past, and thus encoded somewhere inside themself.
This is why the participants are surprised to find themselves in the grip of ancient sensations:
Mireille:"I was like a baby swaddled in its bands";
Elise: "After the touching, I had the feeling of being released, like a baby who has been given the Moreau reflex".

In a group, the touching is thus the point at which the leaders approach an individual, attend to him, and then leave him to go to an other. Being chosen, being left, being selected or not. Anne, while waiting for the leaders to make a move, thought that they would forget about her.
The touching identifies the individual within the group; effectively, if our words are addressed to everyone (though each person receives them personally), our touching is addressed to each person individually.

"When you were leaning over me," Madeleine verbalized, "I smelt your perfume; it is not the same perfume as my mother's, but I fond myself back, very small in my bed, when my mother came to hug me in the morning before leaving  for  work; I kept the smell of her perfume until the alarm clock sounded." Enfolded in this perfume comfort blanket, Madeleine had to wait for the alarm, get up alone and go to have her breakfast at the neighbour's.

It is through the channel of transference that the affective situation is able to show and express itself. It was not the smell of her mother's perfume which carried Madeleine back to her little child's bed wrapped in her mother's perfume; that perfume was suggested by a smell which, borne by the transference, produced that effect.
We are truly at the level of the symbolic and the touching is simply a question of interrogating the body.

Concerning Speaking
If this procedure appeals readily to the sensations, these will not mean so much without words. Words are what enable connections to be made, what give meaning to the senses. This is the point at which we leaders are closest to the classic position of the psycho-analyst, listening to the words of each person and assisting by our interventions in the search for the meaning of what has been experienced.
We ask the participants to stay as close as possible to what they have just experienced in their bodies. It is a creative time, during which what has been felt as "a sensation of coldness" or "a meaningless gargoyle" is to become a door opening onto a forgotten world.

There is what has been felt and the representation which the relaxant has been able to construct out of what has happened for him in his body. This representation, say Monique Meyer and François Reverchon* has its origin, associatively in the body feelings, in the flooding of the sensory stimuli (interior and exterior) whether or not recognized at the conscious level.

What to talk about, what not to talk about? To whom is this talking addressed?
The making of this choice has a meaning.
"I had some vague images, I  don't know what I'm going to say about them to make sense of them. I've had some images that I don't want to talk about, here" – it's too private? "Yes, that's it, and then it's like nothing, it can't be shared, not comprehensible", says Lise.

We are not here dealing with the classical psychoanalytic treatment which the fundamental rule of saying everything that comes to consciousness. During the times of silence, each person is by himself, amongst the others, listening to his own sensations, from which he knows that he will have to recover something. So he will take the time to formulate, to try to find words for what has surfaced inside himself, in his body, he will judge what he can communicate, what will be understandable by the analysts, but also by the group.
If the persons addressed by the words, are most often the three psychoanalysts: the two leaders, who can react to these words, and the observer, who writes down everything that is said, to keep it in memory, the group will also allow lateral transferences between the participants, which we shall also note.

In the course of the sessions, we see quickly emerging sensations and their colours, symbols of pleasure, displeasure, affects, differing between one participant and another and from moment to moment. Manifestations of father and mother figures, make their appearance. We are the place of projections and projective identifications.


In the Group
The group will play a role, sometimes as brake, sometimes as facilitator. We discover in this time of verbal exchange the known group phenomena (Kaes) which play their habitual role:
The containing role for example for Sylvain:"This group gives me confidence, I feel safer here with the others around me . . . I think that without the group, being touched by your hands, would have been unbearable".
It is a group matter how the space is shared out, the positioning of the mattresses either in dormitory-style rows, or in a star, randomly etc. . . next to the door, beside so and so . . .
Where will each one settle, beside whom, away from who else? And what will he be able to do about it?
Claire to her neighbour: "I heard loud breathing beside me, I felt as though you were choking and I was not able to relax." Or again Claude: "Lying down with the others beside me, I found myself back, in boarding school; there were even prefects!"

We note also the games of projection/identification which can be primary, encouraged by the passivity of relaxation, or secondary, supported by the signifiers which come from an other.

This oscillation between the singular which goes through the body and the plural which embodies the group characterises our work and confirms our commitment to balance, in the sense of working at the peak, at the margin, at the limit, a path which enables the emergence of unconscious processes.
What is essential, is that out of a regression in ones own body, a fantasy arises, which can join in, or be supported by particular group movements, or be registered in a significant personal chain.
In this quite specific model, the group joins in the quest of each person on his individual journey, through what his body is saying.

But is this not a game of chance? This is stressed by J.P. Lehmann, in his article from a book on relaxation groups, published by Dunod in 1985: "Paradoxes of Psychoanalytical Relaxation in Groups". On page 23 he quotes René Kaes in his work of 1976 on the psychic group device: "For the group to become a body, makes each individual body a partial object, it denies ones own contingent and limited body  . . ." and further, "The group becomes a body through the denial of this singular body".
J.P. Lehmann goes further in saying: "Thus there arises a major (aporia) which we cannot ignore. It can be expressed in this way: as for the regressive process proper to relaxation, is it not in danger of being lost in the narcissistic regression of the group?"

To give these remarks their due, we must indeed make it clear, that the particular spatial arrangement of these groups, will reinstate an aspect of the individual: at the first meeting, we ask the participants to introduce themselves, then, each one lies down on a mattress which he arranges as he likes in the room and the trio of leaders is seated on chairs. No instruction is given about this.
Next, the leaders take over, accompanying each person in his relaxing, and if the spoken induction is addressed to everyone, it is received individually. But it is above all the individual who is totally attended to in the touching, this body to body with one of the leaders, which engenders then, in the talking time moments, which are clearly transferential: "I don't know who touched me, the man or the woman". "I thought you had forgotten me". "Why did you touch me so quickly?" "Do you touch everyone in that way?". . .

In the course of these groups, we remain virtually, a clinic of sensoriality and its expression in words. The contributions of the leaders, during the time of verbal exchange, even if they issue from elements of the group dynamic, remain within the field of relaxation and the individual thought processes of the participants.

The model proposed, its framework and regularity, enables this personal experience in the group, to become a fundamental experience in the training course offered.

Psychoanalytical Relaxation, a resource for training
Relaxation, with its questioning of the body, in its relation to the word, and in body-to-body has rapidly seemed to us, a suitable tool for the training of carers in the carer/patient relation and has been the basis of our groups for over 50 years. Its transmission as a method of psychotherapeutic care, also proceeds via an initial period in groups to personal considerations.

In the chapter on training, which I wrote from 1975 in our first book, called "Relaxation: its psychoanalytic approach", I began with this observation: "When one says of a girl that she is formed, that means that from now, she can give birth".
Is it up to us now, to give birth to beings who can take over from us? I would suggest the two points that I have already mentioned above.
training by relaxation, which addresses all carers, and aims to modify the relational approach to their patients, by means of a personal change of their relation to their own body.
training in relaxation, which, more than the transmission of knowledge, is imparting an experience of acquiring a specific approach to a patient in psychotherapy through bodily mediation.

This brings us to asking the difficult question: These so-called training groups, are they therapeutic groups? This arises with every kind of training group. But, it is clear that these personal groups, conducted in the same fashion, as groups of patients, can only become formative, in as far as they touch in the carer, very deep places in their personality; at the same time, these are relatively short-term groups, and are responding, to an initial request, from the carer for training. Of course, there can be no precise answer, and each one will use this group in his own way, as in all the other psychoanalytic training by group mediation.
However, the specifics of bodily mediation, will introduce here, a particular dimension of great value.
Thus, I remember a nurse, lying down in a group, who, towards the end of the induction, said she was very afraid of the leader coming to touch her. And she associated this, with the fact that she had never imagined the fear that a patient might feel in bed, waiting for a carer from whom he didn't know what to expect. She said that infact, she feared he would crush her hand, expressing a possible aggression. From this, there followed the recall of many childhood memories.
Over the years, our requirements for training, have constructed the form of a course, which has now taken on a very clear plan. The candidate will find himself offered, at a first stage, after an introductory interview with one of the members of the association, who will become his supervisor and will not have him in his group, participation in a personal group, which will act as a common basis for the two aspects of the training by and for . . .
Monthly groups of eight to ten persons in 35 sessions, which proceed as we have described, led by a pair of psychoanalyst relaxers and an observer.
At the end of the group, the candidate will have an interview with his supervisor and will be able eventually to continue the course, if he has an analytical qualification (not required to participate in the first stages of the training).
Final stage of this first module, common basis, a day workshop three months after end of group, called "day of perspectives".
The second module is that of training as psychotherapist by psychoanalytical relaxation, Sapir model.
This is only offered to carers already engaged in a psychoanalytical process and having completed the first module.
Then the third module is that of training of trainers, offered to those who have completed the first two modules and who wish to become members of our team of leaders of training groups.
So much for the practical aspect of things.

Finally a word about the use of relaxation, in the form of sensitivity training seminars, on the care/patient relation, in Balint method. In this case there is a very brief use of two sessions of one hour, with groups of a dozen carers, where the sessions proceed, in the way that we have described fully. Although in all the rest of the seminar, the case presented about a patient, allows a certain distance, even if it is handled by working much on counter-transference, in the relaxation groups, by contrast the carer is directly involved with his own body.
We have discovered frequently that, even this minimal approach, changed the way of speaking of the carer, in further presentation of cases.

As to conclude
We wish to insist on the originality of this approach which, although groupal, favours   the individual, by a work on sensoriality, through a regression induced both by the group and by the relaxation method.
We consider that its importance for the training of carers, in their relationship with patients, is based on the fact that it allows them to put words on counter-transferential body reactions, until then remained unknown to them but perfectly felt by the patient.