Sören Lander: Interview with Ana Quiroga, March 27, 2002.

The interview was originally part of my scientific work (as a kind of "fieldwork") during the psychotherapy training leading to certification, with a group-analytic orientation (“Psychotherapy Society” in Stockholm). The title of the thesis was: “An Argentine Operative Group Approach. The Thought World of Enrique Pichon-Rivière, Ana Quiroga, and the Pichonian Concept of the ‘Operative Group’.”

The interview takes place at the Institute of Social Psychology (Escuela de Psiquiatría Social, Dr. Pichon Riviere), which Pichon-Rivière founded in Buenos Aires in the 1960s and which Ana Quiroga took over as director after his death.

As a curiosity, it’s worth noting that we are sitting in Pichon’s old treatment room (which has been left unchanged), with well-stocked bookshelves, paintings, a couch, and a desk. Despite it being evening, the institute is bustling with people coming to or from lectures. Ana Quiroga herself is scheduled to lead a class immediately after the interview.

For clarity’s sake, some quotes not included in the original interview have been added. These quotes define concepts specific to the Pichonian terminology, using Pichon-Rivière’s own formulations from his texts. The reason I use these alongside Ana’s own words is that her thinking frequently draws directly from Pichon’s formulations when she develops her own arguments.

The Operative Group Over the Past Forty Years

The operative group (viewed as a group) focuses on the task, and its aim is to learn how to think in terms of solving difficulties that arise and are manifested within the group’s field. It is thus not about each individual group member per se—otherwise, we would be speaking of individual psychoanalysis within a group setting. But the focus is also not solely on the group itself (as in Gestalt approaches), because in every here-and-now-with-me moment of the task, one operates in two dimensions. In this way, a synthesis of all the tendencies present within the group is achieved to a certain extent.

The patient (and the event they highlight) is seen as a spokesperson for both themselves and the group’s unconscious fantasies. Since interpretations are made in two tenses (now–then) and in two different directions (vertical–horizontal), this operative technique differs from other group techniques. (Quote from El Proceso Grupal: Grupos operativos y enfermedad única [Operative Groups and the Single Illness], in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social. Buenos Aires: Ediciones Nueva Visión, 1995).

What does our technique consist of?

One could say it consists of two fundamental aspects—the explicit (manifest) and the implicit (latent). In this sense, we approach the analytic technique, which in reality aims to make the unconscious conscious or the implicit explicit. From a technical perspective, one usually starts from the explicit in order to uncover the implicit, with the goal of making the implicit explicit—this occurring in a continuous spiral motion. (Quote from El Proceso Grupal: Historia de la técnica de los grupos operativos [History of the Technique of Operative Groups], in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social. Buenos Aires: Ediciones Nueva Visión, 1995).

Sören Lander: What I am primarily interested in learning more about concerns the concept of the “operative group.” What does it look like, and has it changed?

Ana Quiroga: What aspects have changed? I think that the essential point when trying to define an "operative group" is that its focus is the task. And I understand "task" as something complex with multiple dimensions.

At certain moments, the focus may be on what's stated in the explicit contract. At other times, we work with fantasies … various forms of anxiety … transference … the relationship to the framework and to the institutional setting. I believe this is what characterizes what is essential and specific about the operative group – and that has not changed.

However, many other things have changed. One of these is the possibility of including other forms of interaction beyond verbal ones, such as something that Pichon both thought about and valued – psychodrama … working with roles and with a conflict through dramatization.

All this has developed much further than during the Pichon era. However, this does not mean that action-oriented techniques have come to dominate over the verbal ones. These are still extremely important … but sometimes one needs access to other means … a “tool” that involves other modalities, yet still maintains a coordination perspective and keeps the group task focused around the concept of task. Still, these additions do not change the fundamental nature of the operative group.

Another aspect that has changed considerably is the nature of groups themselves. The forms of “groupness” have gradually shifted over the last forty years. I have examined how these traits have changed … for instance, how “groupness” appeared among us during the period of military dictatorship, when the group had both unconscious and quite conscious significance as a refuge … since there were not many places where one could meet “the other” in a safe and confidential way, etc.

So, relationships among people were marked by this need for a safe haven. The relationships became more like primary relationships. Transference became more primitive and intense. As trainers, we worked with what essentially comes from Hernán Kesselman – “the coordinator’s feared scenes” … they were terrifying scenes. The levels of regression were very intense.

Then we realized that these scenes were deeply connected to the horrors occurring at the societal level … and that they triggered terrifying experiences and fantasies among group members. This is not something we see today.

Sören Lander: Could people talk about everything in the groups during the military dictatorship? Or did they have to self-censor to avoid putting anyone at risk?

Ana Quiroga: Two things happened. To a fairly large extent, there was confidentiality and safety. It was possible to talk. But then there were moments when this was lacking, and the relationships were marked by some mistrust.

It was hard to form groups because there was a high degree of idealization. During this and the following period, one could observe the phenomenon that Anzieu speaks of as “group illusion” … the idea that “we are all one and we are fantastic, etc.” There were ideas that the group was an object.

The idealization was strong due to anxiety, loneliness, and fear. At the time, I often thought of something René Kaës said: “one of the fantasies of being in a group is that you belong to a body that can neither break apart nor die.”

Among us, this had a very special meaning … experiencing fragmentation or death anxiety or something even worse than death … namely, to disappear … to not be able to imagine what that means – all of this was very present among people. We who worked in psychology and those who were in training were heavily persecuted.

S L: These were real events…?

A Q: Yes, something very real, made worse by the presence of armed groups. Group activities were not appreciated by those in power. So various forms of gatherings were attacked – and groups were something suspicious.

This happened during the period when we were just starting our work. Pichon lived through part of that era. He died in 1977, and this began to unfold between 1975 and 1977. That’s when we started to perceive the meanings of “groupness” … the search for a safe space … the “uterine group” as a refuge … then the contradiction between intense fear and desire … and the mobilization of regression.

During the 1980s, there was less regression in groups. There was a kind of functioning based on solidarity, etc., and people began to put words to much of what had been silenced during the previous period, in which I doubt people spoke about everything. Many never told what they had experienced … or what had happened to them personally or to their families … very difficult things.

Then came a time when there were more words and greater opportunities for communication and storytelling. Then came the 1990s – a time of fragmentation and resistance to “groupness.”

S L: As a reaction?

A Q: As a reaction or a reevaluation of what the “other” is. What is “the other”? If you think about the market’s law, it says that “the other” is a rival … this was also in the air. Society went through a period of exalted individualism … and that does not favor “groupness.” People sought groupness, but it comes at a cost … it costs a lot to accept differences … to go through a dialogue where this can be made explicit. Expressing differences (between people) is still very difficult.

That was not the case in the 1970s … people had more opportunities to meet … to discuss and to express different positions without experiencing it as a catastrophe.

S L: But was there also a desire – as a reaction – to simply forget in the 1990s … to forget what happened in the ’70s and ’80s?

A Q: Yes, that could also be the case.

S L: Perhaps it is reappearing now in what’s happening in Argentina today?

A Q: Yes, indeed, among what’s emerging now are things that could not be forgotten …

Other things also emerged in the 1990s that were more individualistic and distanced. We studied, for example, what image people on the street had about the size of a group. We found that people thought a group consisted of three … four people … but not more … if it was more, it was not a group, but a mass. So, the ability to feel something as a group was reduced … a group was seen as fewer people. In people’s ideas about the size of a group … some might consciously think a group is larger, but unconsciously that did not function as a reference.

There were also other social references to larger groups. There were moments when people referred to the family group … middle-class families, among whom we typically move in our training programs, usually consisting of 4–6 people.

In other social strata – we conducted our research on the street, not just inside the institute – groups were perceived as larger because people there live more collectively and with different relational forms and norms.

S L: In the lower classes?

A Q: Among the lowest classes, we saw a very different concept of closeness.

We tend to isolate ourselves in our homes, etc., while people from other parts of society move around and live together in different ways. But of course, there are moments when they close their doors due to conflicts or violence. They “close the situation” and won’t let us in, for example. But at other times, when there’s less conflict, they are more open to people coming and going.

S L: Do you think this “reduction” of group size had something to do with earlier repression?

A Q: Yes, and with intolerance … and with the inability to tolerate difference and the valorization of individuality. One’s peer had to be very much like oneself … very much a mirror image. It was a very narcissistic phase … and there was also great fear of “the other.”

It was like going backward for us. We had thought the most transformative processes had occurred in the 1980s because that was when people spoke a lot.

S L: Do you think the “dialectical spiral” closed at a certain stage … and that it is opening again now?

A Q: Yes, but all this also has to do with the weight of the economic models that took hold in Argentina, which implied lifestyles that came into play during the 1990s. This was a time of labor market crisis. Many people lost their jobs. And people began to be pitted against each other. Life became more difficult, and people turned inward. It was a different kind of isolation than during the dictatorship. Then, there was more solidarity.

This later kind of isolation, however, is less solidaristic and is tied to many losses … people have lost so much over the last 10 years. What has now exploded in Argentina is the rage over all that was lost. Earlier there was more of a silent pain … an enormous, costly pain … people suffered greatly in silence. Now there is more of a social explosion in this. In recent months, we’ve seen changes in group relations because people are coming closer to one another again.

What I mean is that if groups change in some way in how they function socially, then the coordinator also ends up in a different position in relation to how the group works. Not because it’s dictated or we have new rules, but it has become more difficult to work with groups today than before. It has also taken more effort for us to process our own relationship with group members – our own countertransference or transference to the groups – because we too are part of this situation. We are not outside it.

If I think about your question regarding changes in the “operative group” … then these are the things that have happened. Some technical openings have occurred by incorporating new questions. There have been important influences from the broader field of group work. But Pichon’s ideas about “groupness” still hold value, and their usefulness is confirmed in practice.

S L: ECRO (the conceptual, referential, and operative schema) as a flexible tool that opens up and is increasingly enriched?

A Q: The idea that ECRO should open this way or that way in practice led me, for instance, to begin investigating what was happening during Argentina’s societal crisis … and with people and groups. At one point, however, it seemed that the tools I had no longer worked … and that was something I had to examine further.

Among the core elements included in ECRO, we want to emphasize the concept of feedback between theory and practice. In line with the dialectical process and its model of thesis, antithesis, and synthesis, the a posteriori of one situation becomes the a priori of a new one. To the extent that one studies a dialectical process – the human relationship with their surroundings – ECRO, as a method of approach, includes a dialectical methodology. That’s why the social psychology we propose has an instrumental character that does not find solutions within a closed circle but through the ongoing enrichment of theory via its encounter with practice. The experience of a practice conceptualized through criticism and self-criticism enriches and corrects the theory through mechanisms of rectification and ratification. (Quote from “Concepto de ECRO,” upcoming edition. In: Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social. Buenos Aires: Ediciones Nueva Visión, 1995)

It was about praxis and ratification … and verification … something related to dialectical materialism – and which became even more prominent toward the end of the 20th century … an idea of thinking in a complex way and not abandoning the notion of multidimensionality, complex thinking, etc. That fits well with dialectical materialism … and if one cannot progress in this sense, then suddenly one is left without tools and cannot understand what is happening.

S L: And ECRO had closed?

A Q: Exactly. And there is nothing more disheartening when working with people than suddenly not understanding or failing to notice … that was the point I had reached.

In operative groups, so much more happens … and finding out what that is. But not even being able to get close enough to see what it is! I think that became a very important driving force to think – and think again – and again.

How does an operative group work?

S L: How does one start a session? What is the coordinator’s role at the beginning of a session?

A Q: Generally, it starts in the simplest way possible. “Hi, how are you?” etc. It’s very important for us to observe how the session opens. How do people arrive? Late, early, together, individually? What do the members manifest at this beginning? Usually, there are clues in this opening that indicate what will unfold later in the meeting.

S L: The task – when and how does an operative group decide what its task will be?

A Q: You’re asking me how one opens the session – from the perspective of the task. It depends on the task. If it’s a therapeutic group, the opening is free. Members take their places in the room. It’s time to begin the session, whatever the topic may be. The task is already “installed” in the initial contract that was established earlier.

If it’s a study group, the theme of the day is defined – assuming a lesson has already been given… and then one waits. A new theme isn’t set every day since the contract already states that the group’s task is to work with the information provided during the lessons.

The systematic analysis of oppositions (dialectical analysis) constitutes the central task of the group. Fundamentally, this analysis aims to explore the unconscious ideological infrastructure that is activated in group interaction. (Quote from El Proceso Grupal: Aportaciones a la didáctica de la psicología social, in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social, Buenos Aires: Ediciones Nueva Visión, 1995)

If it's institutional work, there has also been a prior contract, which has been made explicit. One often returns to the contract as it is gradually understood in a spiral manner until it’s integrated; until it’s understood and accepted... until a psychological contract is in place that establishes a working connection between coordinator and group members – a connection that allows one (as coordinator) to “operate”… to interpret, for example.

S L: Does the coordinator summarize the session at the end?

A Q: Regarding how to "close," it’s sometimes important to give a kind of summary of what happened and what the session was about. Sometimes, it’s better to refrain from this if the group is still processing and it’s not yet time to return anything. This is a situational criterion.

It also depends on the coordinator’s style and whether the group meets monthly… and whether a summary is necessary. If the group meets weekly, it may be useful to leave the ending open. It depends on what has occurred.

S L: In group analysis, the therapist plays a fairly passive role (at least outwardly) – it seems to me that the coordinator in the operative group is more active. Is that true?

A Q: The coordinator should not be passive in an operative group. Passivity tends to intensify regression. But the coordinator should not be excessively active either… the coordinator should be a “co-thinker”… a support and companion. This, too, relates to the group’s task since regression in a therapeutic group doesn’t mean the same as in a learning group. In any case, as a coordinator, one is neither a leader nor a task organizer.

The coordinator’s or co-thinker’s function in these group techniques is mainly to create, maintain, and promote communication, which through progressive development takes the form of a spiral where didactics, learning, communication, and effectiveness converge. (Quote from El Proceso Grupal: Técnica de los grupos operativos, in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social, Buenos Aires: Ediciones Nueva Visión, 1995)

The coordinator plays a prescribed role in the group. The role consists in helping members to think so that they can tackle the epistemological obstacle posed by fundamental forms of anxiety. (Quote from El Proceso Grupal: Estructura de una escuela destinada a psicólogos sociales, in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social, Buenos Aires: Ediciones Nueva Visión, 1995)

S L: An operative group… how many people does it consist of?

A Q: How many people do we work with in an operative group? We have a limit. If the individuals are used to working in operative groups… up to 20–21 people. And the lower limit… generally 6–7 people… maybe 5. It depends greatly on the task. If it’s a therapy group – whose task is therapy – then it’s a much smaller number… 6–7… or 8… but not more. Learning groups can have more people.

S L: In these operative groups… do members change, or is it the same group throughout?

A Q: For one year, yes. In reality, for nine months… like a pregnancy (laughs).

S L: How often do they meet?

A Q: Once a week. There may be other meetings, but then one isn’t working with group techniques. Then the members mix with each other… form other subgroups, etc. But those working within the “operative group” framework… it’s the same group for one year.

S L: I’ve never had the opportunity to see an operative group in action… but I feel I have a fairly clear theoretical picture of it. Since I constantly compare it with the group-analytic model, it’s difficult to “see” the operative group situation. There’s a coordinator in the operative group… but there can also be one or two co-coordinators, right? Can you describe how this works… or is it that when the operative group’s task is psychotherapy, there is only one coordinator?

A Q: Co-coordination is always a possibility in the operative group technique. Pichon didn’t particularly like it… he said he feared that if competition or complementarity were to arise between coordinators, it could disturb the group’s functioning.

There is also an observer in the group (usually non-participating). Their function is to capture all the material expressed verbally or preverbally in the group and thereby contribute insights that may help the coordinator lead the group. (Quote from El Proceso Grupal: Estructura de una escuela destinada a psicólogos sociales, in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social, Buenos Aires: Ediciones Nueva Visión, 1995)

I can say that co-coordination provides a learning experience in complementarity… it’s something you discover over time. I’ve used co-coordination in both therapy and learning-task groups, and it has worked well provided the relationship was well-developed and the frame of reference shared key points… though this didn’t necessarily mean it was homogeneous.

Kaës and Anzieu work in an interesting way with the theme of intertransference, both regarding the observer and the coordinator (i.e., the mutual transfer between them – Translator’s note)… and this can also apply in situations with two coordinators. I’ve also experienced coordinator rotation (in training), where one session is led by one coordinator and the next by another. It’s interesting to note what different styles evoke.

S L: I’m thinking of other forms of group therapy… group analysis, for example. Have you compared the “operative group” technique with these?

A Q: One person who has worked specifically with this is Hernán Kesselman, as well as Juan Campos. Apart from Hernán, we haven’t examined it in depth. I’ve read Foulkes, and his ideas are very interesting. His thinking is rich. It was a line of thought that was completely silenced for many years. No one here knew that there was an Englishman apart from Bion (laughs)! I came across Foulkes’ work… I was in Denmark… Copenhagen, in 1980.

First of all, I must say that Bion contributed very interesting things regarding groups… but then he left that area. Foulkes, however, continued to be interested… he died during a group session, didn’t he? And then his ideas started spreading, especially in Europe. I know that many people in Eastern Europe were also influenced by Foulkes.

But this is something that has happened quite recently, because 20–30 years ago… at least 30 years ago, this wasn’t available. It was much more limited back then.

Link, Matrix, and Depression

S L: Link … “link” is a very problematic concept to translate into Swedish. I spoke with Ángel Fiasché (Argentinian psychoanalyst – student of Pichon-Rivière – who, along with his wife Dora, was among the founders of the Gothenburg Psychotherapy Institute) about this several years ago to get a more detailed explanation in Spanish. What’s interesting, however, is that Foulkes uses a concept called matrix, and … these two concepts – “link” and “matrix” – share similarities.

A Q: Yes, there’s a lot of common ground there.

S L: Is it the case that the link in a group more or less constitutes the matrix?

A Q: I’d say rather a network of links. Initially, Pichon analyzes the link between two people, right? – but with reference to a third. In other words, there is always another person involved … and that other is not the same for you as for me.

But – I would say that the concept in Pichon’s work that most closely corresponds to Foulkes’ matrix is this network of links with its interlinkages … established through mutual internalization or mutual inner representation … along with another concept, which would be the group structure of the inner world. I believe these two aspects are very closely aligned … practically overlapping. They are conceptualized differently, but I see the central idea as very similar.

S L: The analytic group is closed off from the outside world because it is a therapeutic group. But operative groups open themselves to the environment, and this is also one of the operative group’s aims?

A Q: Yes, that’s correct.

S L: For example, I’ve imagined that what’s currently happening in Argentina – the neighborhood assemblies (Asambleas and piqueteros) … the movement of unemployed workers … who gather – may have something to do with the fact that certain individuals had experiences in operative groups and then carried these experiences into, for instance, neighborhood assemblies …

A Q: I would actually say the opposite. The operative group arises by engaging with the group phenomenon in social life.

For example, we work as an operative group with a very large organization of unemployed individuals. They asked us for help – but not to organize themselves. That is part of their struggle, and they know much more about that than we do. But they asked us for another kind of help … help that is essentially about managing suffering and enduring … about finding a space to talk about conflict-ridden family issues … for example, domestic violence, which is a major theme … teenage pregnancies … young people’s drug use.

It’s striking how drugs, in very poor and unemployed areas – and with a profound lack of life content – come to organize life. To pay for the drug – if you have no money – you must steal. So, you go out and steal, buy the drug, and … the drug ends up becoming something that organizes your life.

Gradually, one becomes aware that behind this destructive chain of events lies a horrific upbringing environment from birth … though there are always individuals who manage to get out of this in different ways. And the operative group serves the purpose here of finding other ways to imagine growing in society … for example, for people who haven’t finished school, who are semi-illiterate, or similar.

They begin to develop projects, which is important … with a sense of belonging to something. And if there is a therapeutic function in these cases, it has to do with accomplishing tasks of a social struggle … unless the task is about growing as a group and as individuals … or about being neighbors from the same community and learning to resolve conflicts among each other.

S L: Learning to think … learning to learn. That’s another concept.

A Q: One of the things that strikes me most in my work every time I work with these people is that, in reality, they are perfectly capable of thinking. They are extremely sharp. And I believe it’s the struggle their living conditions have forced them into that has made them so sharp. This applies to certain areas of their lives … women, for example, are very brave and strong, but in other respects, they are very dependent on their family situation.

The concept of learning as praxis makes it possible to formulate the process in terms of learning to learn and learning to think. This concept is of an instrumental nature and is based on a theory of thought and knowledge operating in a social context. (Quote from El Proceso Grupal: Grupo operativo y modelo dramático – Operative Group and Dramatic Model in Pichon-Rivière, E., Diccionario de términos y conceptos de psicología y psicología social, Buenos Aires: Ediciones Nueva Visión, 1995).

And the man becomes depressed. Unemployed men become depressed and stay in bed. Then they become alcoholic and – that’s where the violence begins!

These are the kinds of issues … and the opportunity exists to learn to think differently … to get out of this … for example, what it means for men to get out of bed … because they lie down and … feel defeated and just want to die. There are many suicide attempts.

The depressive response should be understood as a total behavioral pattern in situations characterized by frustration, loss, and deprivation. Its nature is consistent in terms of occurrence, structure, and function. (Quote from El Proceso Grupal: Empleo del Tofranil en psicoterapia individual y grupal – Use of Tofranil in Individual and Group Psychotherapy in Pichon-Rivière, E., Diccionario de términos y conceptos de psicología y psicología social, Buenos Aires: Ediciones Nueva Visión, 1995).

Because depression always grips the bed, doesn’t it? That’s the fundamental pathology … depression. And it appears frequently.

We speak of “a single illness” in the sense that we regard depression as the fundamental pathogenic situation. Other pathological structures – formed on the basis of stereotypical ego techniques (defense mechanisms) of the schizoid-paranoid position – are seen as failed or inadequate attempts at healing. This inadequacy (which can be seen as a disturbance in the ability to “read” reality) gives these structures their pathological character. (Quote from El Proceso Grupal: Grupos operativos y una enfermedad única – Operative Groups and the Single Illness in Pichon-Rivière, E., Diccionario de términos y conceptos de psicología y psicología social, Buenos Aires: Ediciones Nueva Visión, 1995).

The Inverted Cone and the Dialectical Spiral

S L: “The inverted cone” or “the dialectical spiral”. Are they the same thing, or are they two different concepts?

A Q: They are related, but not the same.

S L: Can you draw and describe them?

A Q (draws): This idea may seem contradictory, doesn’t it?

(Points to “the inverted cone,” where the base and the largest part represent “the explicit” and the tip and smallest part represent “the implicit.”)

It doesn’t seem to align with Freud’s thinking… he says the opposite… we see this (points to “the explicit”), and it’s here we seek to reach (points to “the implicit”).

Why does Pichon draw such a diagram? Not because he doesn’t think like Freud… there is a lot here (points to “the implicit”). But, for example, if in a group setting we are faced with a series of actions or events that are explicit… and if we then carry out an analysis that follows this path (points to the “dialectical spiral” in the diagram), we can arrive at an implicit element. If this implicit element is interpreted – a hypothesis, right? – then it can become part of the “explicit” that is found here (points to the base of the cone).

S L: Like an “emergent” or…?

A Q: Yes, exactly – the emergent has aspects here… and aspects here (points in turn to the tip and the base of the cone). I register something here… a hypothesis takes shape and I touch on something… some conflict or chain of associations. What I say – whatever it may be – might trigger a chain of associations that allows something to become explicit.

In this cone, we see a base, a tip, and the dialectical spiral.

a) The base: This is where the clear or explicit content that emerges is located.

b) The tip: The foundational situations or implicit universals.

c) The spiral represents the dialectical movement of exploration and clarification that moves from the explicit to the implicit, with the aim of making the latter explicit.

The explicit would be what we see, the manifest; starting from this, we can gradually, by following the direction of the spiral in a dialectical manner, observe and – little by little – reach the bottom of the situation we are aiming at. With this dialectical spiral, we can reach the central core where the fear of change – as resistance – is located.

What first appears in the diagram is the explicit. The implicit, on the other hand, corresponds to the zone of the unconscious. But it is by starting from the explicit and moving through a continuous spiral that one can reach the implicit. In this process, the elements involved are analyzed, and the rigid structure of the situation is examined in order to break it open and make possible a situation of progress and a new formulation. (Quote from El Proceso Grupal: Tratamiento de grupos familiares: psicoterapia colectiva / The Treatment of Family Groups: Collective Psychotherapy, in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social. Buenos Aires: Ediciones Nueva Visión, 1995.)

The diagram of the inverted cone is intended to represent, at its base, all manifest situations in the operational field, and at its tip, the fundamental universal situations that operate in latent form.

Broadly speaking, this means that our task consists in breaking down stagnant situations—whether they involve a “stuckness” in illness, in learning, or in any other area of life—and in making the situation dialectical. Thesis, antithesis, and synthesis can lead precisely to a situation of movement within the group, and to the possibility of learning without risking loss—that is, the loss can be “displaced” in the face of the opportunity for operational learning.

With this technique, the group, in any case, moves from the explicit to the implicit, so that—through this process—a new explicit can emerge. In other words, what was latent, disturbing, and conflict-laden becomes explicit. In this way, the corrective operation can indeed be represented as an inverted cone. (Quote from De próxima edición: Historia de la técnica de los grupos operativos / Forthcoming Edition: The History of the Technique of Operative Groups, in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social. Buenos Aires: Ediciones Nueva Visión, 1995.)

AQ: What we have here (points to the tip of the cone) … for Pichon, this is where the forms of anxiety are located (fear of loss and fear of attack). To me, these ideas seem strongly influenced by the English school and Melanie Klein.

The basic fears:

  1. Fear of losing the structure that has been built so far, and

  2. Fear of attack in the new situation that is about to be structured.
    (El Proceso Grupal: Tratamiento de grupos familiares: psicoterapia colectiva / The Treatment of Family Groups: Collective Psychotherapy)

The field of action for the social psychologist is the field of fears; their task is to clarify the origins and irrational nature of these fears. Ultimately, they can be reduced to two: the fear of loss and the fear of attack. (Quote from Psicología de la vida cotidiana: El Psicólogo social / The Social Psychologist, in Pichon-Rivière, E. Diccionario de términos y conceptos de psicología y psicología social. Buenos Aires: Ediciones Nueva Visión, 1995)

However, Pichon arrives at slightly different ideas … but this position of the forms of anxiety is very important as an organizing element for actions, anxieties, and fantasies (points to the tip of the cone).

These are matters that may be explicit on one level and implicit on other levels. He says that when one form of anxiety is explicit—for example, persecutory anxiety (fear of attack)—there is simultaneously a depressive situation (fear of loss) that cannot become manifest. Because Pichon believes that these forms of anxiety coexist. This is where he differs from Melanie Klein. They coexist and interact. But when one is manifest, the other is here (points again to the tip of the cone).

Pichon says that when the patient enters the treatment room and looks under the couch … he doesn’t seem particularly sad. What he’s showing is that he feels persecuted. But if we explore what he’s defending against—what does this obviously persecutory situation contain?

S L: And behind that lies the fear of loss?

A Q: Exactly. The patient is sad and troubled about this situation of loss. This is when Pichon draws his first diagram of the cone…

I’ll probably never know why Pichon chose the second model (draws the figure with the vectors: attachment/belonging, cooperation, pertinence, learning process, communication, and telé)—and I don’t think he knew either, but it worked for him.

For example, he said that when analyzing a group… he used this (the vector model) because it complicated the other one (the cone)… and he incorporated more… and these vectors are related to Kurt Lewin’s ideas. Pichon picked up ideas from various group theorists.

So here we have the theme of “attachment”... “belonging.” “Belonging” would be a level much further removed from “identification.” “Attachment” is an even more distant form of identification… more labile… weaker.

And “belonging” is this… the team and the matrix… the mutual internal representation here… and this has implications for “cooperation”… because the possibility of cooperation when there is belonging has significance for applicability.

The first vector… includes attachment to or identification with group processes. However, in these, the individual/subject retains a certain distance and does not completely merge with the group. This first moment of attachment—characteristic of what happens in all groups—later transforms into belonging, which entails a higher degree of integration into the group…

Cooperation consists of contributing—albeit silently—to the group task. It is based on differentiated roles. Through cooperation, both the interdisciplinary character of the operative group and the interaction we will later define as verticality and horizontality are manifested.

Pertinence is the name we have given to the category that involves the group focusing on how the given task can be clarified. The qualitative aspect is evaluated based on the amount of preliminary work, the group’s creativity and productivity, and whether openings are created that point toward a project.

The fifth category on our scale consists of communication—both verbal and preverbal, in the form of gestures—between members. Within this vector, we note not only the content of the message but also its appearance and sender. We call this metacommunication. When these two elements come into opposition, misunderstandings arise within the group.

The sixth vector concerns a fundamental phenomenon—learning. By bringing together the group members’ information at a certain point, the dialectical law of transformation from quantity to quality operates. A qualitative change occurs in the group—a change that can be translated as anxiety resolution, active adaptation to reality, creativity, project development, etc.

As a universal category in the group situation, the factor telé is included—defined by Professor Moreno as a negative or positive attitude toward cooperating with a particular group member. Telé creates an atmosphere that can be translated as positive or negative group transference, both in relation to the coordinator and regarding the relationships among group members themselves.

It should be emphasized that the attitude toward change constitutes the central situation of the operative group. This attitude can manifest as either an increase or a decrease in depressive or paranoid anxiety (fear of loss and fear of attack). These forms of anxiety coexist and interact in time and space. A consequence of this is that the coordinator, in their interpretation, should also include the other, underlying form of anxiety when one of these manifests in a group situation (Pichon-Rivière, E. El Proceso Grupal. Del Psicoanálisis a la Psicología Social I. Buenos Aires: Ediciones Nueva Visión, 1995).

A Q: And this is another level (points to the right side of the figure where the vectors learning process, communication, and telé are) of vectors… communication, learning… and then this idea of telé… which Pichon actually takes from Moreno but interprets simultaneously…

Pichon, as mentioned, often took ideas from other theorists and reworked them. But he did not warn his listeners, who knew nothing about this… and it became complicated. For example, I once had a discussion with him and said, “No, that’s not how it is!” “Okay,” he replied, “but it works anyway.” Because the telé concept is about perceiving something real… Pichon also includes this in his concept… that one perceives something real… and transference processes are then triggered.

See here how in this open ECRO we move with the coexistence of two theoretical frameworks that Pichon integrates in this idea that if I have a good telé toward someone, there is something real I have perceived in them, something that appeals to me, etc.—and which refers me to other connections.

Moreno says that telé appears when the transference has been worked through. Pichon says, “No, that’s not so… between transference and telé there is a permanent interaction.” This idea that a past relationship is actualized in a current relationship must have to do with telé… with transference.

S L: This thing about “pertinence”… does it have to do with the relevant…?

A Q: … with the purposes. When we say “pertinence” we must also consider the concept of the task. But this task concept is complex because there are moments when it is relevant to bring certain group problems to the foreground… and in other moments, it is not relevant to do so. For example, working with integration is relevant at the moments when the question arises… or in the beginning. But in other moments when integration is at issue, a contradiction concerning belonging may arise. When this occurs, it is relevant to work with the group’s connections.

S L: You delve into this?

A Q: Pichon continues to seek out this toward the apex and the fundamental forms of anxiety. That was something he never changed. He used more or less the same schema for two different “entry forms.” Because you can use this schema even in individual psychoanalysis.

Pichon never stopped using individual analysis… as this couch shows (laughs and pats the couch)… sometimes he used it and sometimes he worked face to face.

Addition by Ana Quiroga sent via email November 2004 after a question I asked during a group training in Sweden. In my question, I asked Ana to clarify the meaning of the concept “emergent.”

S L: What is an emergent?

A Q: As a first attempt to approach what an emergent is, one can say that there is something observable in it. This observable is here not only of a material nature like a chair or a book. It is also so that the presence or absence of certain objects and their handling can make the emergent observable.

In the operational area, the observable in the emergent appears as something different and contradictory; as discontinuity and “break” (in relation to what has been so far). But—discontinuity in relation to what? Between the preceding, which we call the “existing”—that which has reached a certain degree of presence and has also been established with a certain hegemony within the interaction area—and something new.

When we speak of emergent, it is because something “breaks in”… something that can be a modality or a mode of expression. But an emergent is also something previously non-present, which more subtly begins to hint at or outline itself as new.

The emergent—this new quality—appears with different forms of intensity. “New quality” means, in other words, according to Enrique Pichon-Rivière, that a significant change is taking shape even though it is not yet possible to determine its extent… it constitutes a “synthesizing” and creative event. He refers here to the importance of paying attention to the sequence of the process, which consists of the different forms of connection between the preceding/existing and the new/emergent.

Let us imagine a situation that is beginning to take shape in a group integration process. The entire group experiences, in fact, always qualitatively different shifts in the integration process—but now we will try to imagine the significant “experience situation” that arises among the group members when a qualitative leap occurs in the group’s integration process…

When this our identificatory experience—different from others and a boundary that separates us from the group’s external symbolic (environment)—is “installed,” we also distinguish ourselves from the “other” that exists in the external. This event has to do with a specific moment in the mutual internalization movement… with changes in the mutual internalization process that one was engaged in.

This intensely experienced inner “presence” tends to be expressed in the form of a spatial language. The external here can consist of our everyday scenarios…but at this moment there is something contradictory between this integration process and “group presence” and all other “presence.” Other “presence” seems to threaten intimacy. One can conclude that in this integration and identification moment or “boundary moment,” the group gathering offers a maximum in terms of support, strengthening of the ego—and perhaps also of illusion.

If we in this situation are coordinators or observers, what is registerable for us—in the form of words, actions, body language, cooperation, ways of advancing the task, etc.—will be something almost obvious. Something changed!

This level of integration is different from the previous one. We will gain a sense of time, process, and that what happens is something different and, in some sense, opposite to what came before. Depending on the ongoing integration, something has transformed, and this has also been registered by the group members. Emotionally, this satisfies us. However, the direction of the task and our analytic commitment require that we be attentive to the contradictions we have noted are active within the field and that may give rise to different developmental lines.

We are here facing a significant integration emergent. But—what happened to the previous? It is not true that groups have no history. Within the field until recently, there were labile forms—“hesitations” regarding integration and approach… what happened to the initial fragmentation? Have these non-integration aspects been completely wiped out or diminished as one pole in the contradiction and turned into secondary ones?

The line we follow in the task will largely depend on whether we can “open up” these questions within ourselves. Because in the observable, which constitutes parts of the emergent, there is much to explore since these are not simple but complex facts. This new event contains contradictions. There is a multiplicity of active aspects within the group field, and these can set off different movements.

If we as social psychologists position ourselves from an understanding of complexity, movement, contradictions, and interrelations regarding phenomena, then we must both ask ourselves and ask what it is that emerges; this group—or (possibly) organizational—form that emerges is not simple but complex. Why? Because things contain both something of the old or preceding and something of the new—even if the new is now dominant.

Sören Lander: A Long South American Journey Through Time and Space…

Beginning an introduction and book review with a long quote (especially one not from the book under review) is perhaps not very common. Here, however, it serves as a way to let the reader step into the hidden context implied by the title’s “long South American journey through time and space.”

Norwegian — and generally Nordic — psychiatry, including its psychotherapeutic branch, has for several decades been oriented toward the United States. However, to understand what is happening in the field of psychotherapy and psychoanalysis today, we must broaden our horizon and take note of developments in the French-, German-, and Spanish-speaking parts of the world.

But isn’t it a bit far-fetched to take an interest in psychoanalysis in Latin America? one might ask. The answer is that countries like Argentina and Brazil are not only giants when it comes to literature, cinema, and football, but also in psychoanalysis. At least a quarter of today’s psychoanalytic literature is authored by individuals whose native language is Spanish, Portuguese, or Italian. These countries may have a shorter tradition than ours, but they’ve benefited from receiving ideas from multiple cultural spheres. In the 1960s, psychoanalysts there were reading Hartmann, Rapaport, and George Klein alongside Lacan and Bion — at a time when, in the Nordic countries, we barely even knew the latter two names. Argentine analysts have contributed in many areas, especially in child analysis and early child development, technical aspects of therapy, psychoses, and metapsychology. (1)

The situation described in the quote above primarily concerns the “cultural (and linguistic) barrier” that in various ways seems to block the inflow of ideas from parts of the world outside the Anglo-American sphere. Over the past ten years, as I’ve translated Argentine texts on psychoanalysis and psychology (particularly by the Swiss-born Argentine psychoanalyst Enrique Pichon-Rivière — one of the truly great names in Argentine psychiatry, psychoanalysis, and social psychology), I’ve repeatedly been struck by the lack of translated material from Argentina, despite its rich and sophisticated theoretical contributions, especially in the psychoanalytic field.

It was therefore a great joy, during a visit to London in December 2003, to discover a long-awaited book (for me) at Karnac’s bookshop. The title is Operative Groups. The Latin American Approach to Group Analysis (Jessica Kingsley Publishers, London and New York, 2004. International Library of Group Analysis 24). The book is written by two Mexican analysts, Juan Tubert-Oklander (born in Argentina and emigrated to Mexico in 1976) and Reyna Hernández de Tubert. With growing interest in the English-speaking world, the authors aim to introduce the concept of “operative groups,” which developed in Latin America as an independent group-analytic tradition based on the work of the aforementioned Pichon-Rivière.

The book has three main objectives:

  1. to introduce Pichon-Rivière’s concept of the “operative group” to English-speaking readers;

  2. to present the authors’ own ideas and experiences (rooted in the operative group tradition, but also influenced by the English group analyst S.H. Foulkes and his “companions”);

  3. to clearly illustrate how the operative group’s theoretical and technical concepts can be used in practical group work.

Tubert-Oklander and colleagues have made a deliberate effort to make the book accessible to English readers by building conceptual bridges between the group-analytic and operative group traditions. The authors frequently discuss similarities and differences between Pichon-Rivière’s operative groups and Foulkes’ group analysis. As an interesting aside, they note that Pichon-Rivière actually began his “group-analytic” work as early as 1938 — two years before Foulkes began his. (We often think of Foulkes as one of the “pioneers” of group analysis.)

The authors are firmly convinced that the two group traditions have much to learn from each other. So far, however, an exchange has been hindered by language barriers. Only a few of Foulkes’ works have been translated into Spanish — and some of those translations are poor. And Pichon-Rivière has not been translated into English at all. Judging by Malcolm Pines’ foreword in the book, it seems the concept of the “operative group” has nonetheless spread through various group-therapeutic circles, generating interest that has so far been difficult to satisfy through available literature:

“For many years my Latin-American colleagues in psychoanalysis and group analysis have frequently told me that in Latin America Enrique Pichon-Rivière was the great pioneer in our field, that his ‘operative groups’ – to me a mysterious concept that was never properly clarified – were closely related to Foulkes’ group-analytic groups, as were their basic idea. The few papers set out to illustrate Pichon-Rivière’s work were stimulating but insufficient, snacks rather than a substantial meal. Now we can feast on the substance of this remarkable, important book.” (2)

Regarding certain concepts and focal points, there are minor differences — probably due to the different contexts in which the two traditions emerged. Otherwise, these group-analytic schools share a common view of human beings, group processes, and group-analytic psychotherapy. In the book’s foreword, the British group analyst Malcolm Pines reflects on this relationship:

“Pichon-Rivière was a radical reformer who studied and influenced social organisations, at one time even attempting to work with a network of a whole city, Rosario. The Latin-American lifestyle of meeting in cafés late into the night with ardent discussions is in marked contrast to Foulkes’ more conventional London lifestyle. What is fascinating is the convergence of their ideas, part of the developing network of psychoanalytic and socio-psychological knowledge of the mid-twentieth century.” (2)

However, there is one key difference between these two early “pioneers” of group analysis. Pichon-Rivière consistently emphasized the “task” as the primary “organizer” of the group process. Foulkes, on the other hand, argued that there is no formal task in group-analytic psychotherapy — that any such conscious procedure would act as a form of resistance.

The book’s short concluding chapter becomes a reflection on operative groups and group analysis in relation to psychoanalysis. The authors present the idea that group analysis represents a natural development of psychoanalysis. Their reasoning is twofold: First, that the concepts of group analysis and psychoanalysis differ greatly due to their distinct experiential origins. Second, that the concepts nonetheless converge because both seek to explore hidden meanings in human behavior and experience, and both involve a particular way of listening. This line of thought culminates in the following “conclusion”:

“...perhaps, instead of being sometimes psychoanalysts and sometimes group analysts, we are just analysts, working with people in an attempt to understand them, as well as ourselves, and using whatever concepts we may find useful in this endeavour.” (2)

Enrique Pichon-Rivière – A Background Sketch

Because Pichon-Rivière’s contributions are so little known in our part of the world, I have chosen to continue this review with a relatively extensive description of the "imprint" he left—both theoretically and practically—on the Argentine psychoanalytic context. This will serve as something of an introduction to both the man and his way of thinking. Parts of this presentation are based on my introductory text about operative groups and Pichonian thought, "An Argentine Operative Group Approach: The Thought World of Enrique Pichon-Rivière, Ana Quiroga, and the Pichonian Concept of the 'Operative Group'" (7). As in the rest of this review, I will refer not only to Tubert-Oklander et al., but also to Spanish-language sources (see bibliography) that go beyond those cited in the book.

Enrique Pichon-Rivière (1907–77) was born in Geneva to French parents, who emigrated to Argentina when he was very young. He grew up in the sparsely populated northeastern part of Argentina, where the influence of the indigenous Guaraní culture was significant. He trained as a physician and psychoanalyst and became one of the major figures in Argentine psychoanalysis, group theory, and social psychology (at times, one gets the impression that it’s almost obligatory to refer to him in certain psychoanalytically inclined Argentine texts). He was also one of the founders of the APA (the Argentine Psychoanalytic Association) in the early 1940s and was for a long time an orthodox psychoanalyst with a "Kleinian" orientation.

As a result of his clinical work, Pichon-Rivière became increasingly aware of the practical limitations of psychoanalysis as an individually focused treatment method—and particularly of which people actually have access to it. He was also, in some respects, critical of certain psychoanalytic concepts, including its drive theory and its blindness to the historical-social context’s role in shaping the human being. In tandem with this, his thinking took on a more social-psychological character. These ideas, emphasizing the study of interpersonal relationships, laid the foundation for the psychiatry of the link, which Pichon-Rivière developed based on psychoanalytic postulates. The concept of the link (in which the intrasubjective "object relation" is extended into an intra- and intersubjective "link") is one of the key concepts in his theoretical framework. It represents a structure of interpersonal relationships including a subject and an object, the subject’s relation to the object and vice versa, where both parties fulfill a function within the context of a social situation. The concept also contains an implicit inner multipersonal network through the fact that we are born into a group. In Pichon’s psychosocial thinking, the individual’s (and the link’s) problems are always related to a network of inner and outer connections.

In a series of lectures in the mid-1950s, he clarified his theory of the link. Here, a shift toward group thinking also becomes increasingly apparent. He uses the concept of the internal group to highlight the social-psychological approach he believed was already hinted at in Freud’s work—even if Freud never formulated it systematically.

We understand the internal group as a collection of internalized relationships—that is, they have gone from "the external" into the internal world and are in constant interaction. They are internalized social relations that, in the Ego’s environment, reproduce ecological relations (interplay between organism and environment). (5)

The individual internalizes the people he or she has links with, the groups to which he or she belongs, the institutions he or she is part of, as well as society as a whole—its culture, values, traditions, roles, and conflicts. The concept of the link and the internal group shed light on the inner drama he believed existed in each person’s inner world—a drama which, through intersubjective interaction with others in various forms, tends to repeat itself in outer relationships (links). The question Pichon came to ask himself when faced with a patient and their issues was:

“What is it we must analyze? Where does what happens in the inner world come from, and how does it manifest in the transference link—the link to the analyst?”

It was when Pichon-Rivière reached a point in his development where he perceived that the couch and traditional psychoanalysis "locked in" the patient that he began to promote the group as a treatment form. The group, according to Pichon, has a greater ability to access and expose conflicts; it constitutes a stage—and so does the human inner world. However, he never abandoned psychoanalysis as an individual treatment method.

When Pichon-Rivière founded La Escuela de Psicología Social (today known as Escuela de Psiquiatría Social, Dr. Pichon Riviere, led by his successor Ana Quiroga) in the late 1960s, its aim—apart from serving as a forum for dialogue—was twofold: 1) to teach students how to construct a conceptual, referential, and operative schema (ECRO/CROS) as a way to systematize their thinking; and 2) to train so-called social operators (a kind of social therapist who, through their specific knowledge of working with groups, could help free society from phenomena with alienating effects). The intellectual exchange that took shape here helped Pichon overcome the epistemophilic resistance (3) (meaning an emotional barrier to approaching a particular object of knowledge) he felt—not so much against writing per se, but against giving his theory a condensed written form and having it published.

An important idea behind Pichon-Rivière’s psychosocial institute (an idea continued by Ana Quiroga) was that people with this (operative) educational experience could become agents of change in their own social environments. For that reason, his institute accepted people from all professions and social classes—even those without any prior formal education. The aim was to train a new kind of "problem solver" who could help individuals, groups, families, institutions, etc., to diagnose their own problems and investigate their "everyday life," plan corrective interventions, train their members to carry out such interventions, and evaluate them in a spiral-shaped developmental process. In this way, the interventions became a combination of research, learning, and therapy.

The particular kind of research propounded by this school is the inquiry into the hidden meanings and sources of everyday life, in order to free the social actors from their ideological subjection. In this, Pichon-Rivière’s project was not only scientific and therapeutic, but also political. From his point of view, the greater development of the individual’s personality is rooted in his participation in collective projects, and therefore requires a social change, in addition to the individual and the group change. (2)

The exploration of the obvious or everyday (the explicit)—as a more or less "royal road" to reach the most determining social relations (the implicit)—is one of the foundational aspects of Pichon-Rivière’s psychosocial thinking (cf. Freud and the dream as a royal road to the unconscious).

Operative Group, Group Analysis, Change, Learning, and Worldview

The group treatment initiatives that Pichon-Rivière began in the late 1930s within a psychiatric inpatient context (at Hospicio de las Mercedes) were called operative groups. These groups were strongly influenced by Kurt Lewin's Gestalt perspective and expressed the idea that patients, caregivers, and doctors should be viewed as a unified whole. Based on this, Pichon-Rivière sought to create a more operative and constructive form of treatment work. By the late 1950s, this group-operative technique had evolved and was applied in what became known as the Rosario Experiment. The explicit goal was to carry out a community project—a social laboratory in the city of Rosario (Argentina’s third-largest city), open to anyone who wished to participate. It was an attempt to analyze an entire city through intensive interpretive work in small groups, using certain techniques and interdisciplinary didactics.

The Rosario Experiment gave rise to several new groups, which continued to engage with the city’s problems under the supervision of Pichon's institute IADES. These operative groups—whose forerunners can be traced back to Pichon’s group activities at Hospicio de las Mercedes in the 1940s—contributed to moving groups and psychoanalysts out of the clinical treatment context and into various sectors of society and culture. The experiment was later documented with the help of José Bleger, David Liberman, and Edgardo Rolla (well-known names in Argentine psychoanalysis), and published under the title Técnica de los grupos operativos (“The Technique of Operative Groups”) in Acta Neuropsiquiátrica Argentina, 6, 1960.

The most significant result of the “Rosario Experiment” was the presentation of Pichon’s operative group methodology. The foundation of this method is that a group—focused on creating a relevant conceptual, referential, and operative framework (ECRO or CROS) for itself—can reflect on its difficulties in accomplishing a particular task. Operative groups were soon introduced into teaching at medical faculties, in psychology, and other educational fields. Teachers, who often lacked pedagogical training, began to receive it by learning to manage groups, reflect on the group’s challenges with a task, and understand how an ECRO/CROS tailored to the specific group could be developed. Both the terminology and the technique were popularized during the 1960s.

According to the authors, many people have tended to view operative groups as a distinct type of group, separate from therapy groups, educational groups, etc. This, however, is incorrect. The name “operative group” actually refers to an entire view of how life in groups takes shape and how groups should best be led. Pichon-Rivière did not draw a sharp line between educational/learning processes and therapeutic processes.

The group technique we have created—in the form of so-called operative groups—derives its character from the fact that it explicitly focuses on a task. This task may concern learning, healing (which includes therapy groups), diagnosing the difficulties of a work organization, developing advertising, etc. Beneath this explicit task lies another, more implicit one, aimed at breaking down stereotypical patterns that hinder learning and communication—and that, as such, are obstacles in every development or change process.” (4)

The authors argue that the above definition is quite similar to the standard definition of group analysis found in the works of S.H. Foulkes. They illustrate with the following quote from Elizabeth T. Foulkes (The Origins and Development of Group Analysis, 1984):

Group analysis or more specifically, group-analytic psychotherapy, is an intensive form of treatment in small groups. The term group analysis also includes application of the principles both within and outside the therapeutic field. While fully based on psychoanalytic insights, it is not an application of psychoanalysis to a group but a method and technique based on the dynamics of the group. It is therapy in the group, of the group and by the group, the group providing the context in which the individual person is treated. Intra-psychic processes are seen as interacting within the mental matrix of the group as a whole.” (2)

As a didactic model, the operative group concept focuses on the factors that facilitate learning and the obstacles that hinder it. As a tool for therapy, supervision, and research, among other applications, the concept emphasizes the difference between the lived group experience and the (theoretical) group concept. Hence, the strong emphasis on the importance of praxis in shaping ECRO as a theoretical framework. A theory is not valid in itself but should always be evaluated in relation to concrete human beings and their ongoing communication with their reality/environment—something Kurt Lewin succinctly expressed in his famous statement:

“There is nothing more practical than a good theory.” (5)

One of Pichon-Rivière’s close collaborators, José Bleger, provided the following definition of an operative group in Grupos operativos en la enseñanza (1961), which Tubert-Oklander et al. consider perhaps the most concise:

“…an operative group ... is a set of people with a common goal, which they try to approach by acting as a team.” (2)

However, an operative group is not primarily defined by its goals. It is rather a perspective—a way of thinking about and acting in groups—and a set of values about what promotes better functioning and “productivity” in human groups. It concerns the kind of learning process one considers desirable, which in turn depends on the worldview (see ECRO/CROS) and values of the person choosing the form of learning. Tubert-Oklander et al. (2) emphasize that the coordinator’s main task in an operative group is not to “distribute” information, but rather, as Balint (1957) puts it, to “contribute to a limited but deep change in the personality of the group members,” thereby opening the way for new ways of thinking.

Pichon used psychoanalysis’ concepts of “manifest” and “latent” (though he called them “explicit” and “implicit”) to clarify the processes taking place within a group. So, if a group discusses how to complete its task (its “work”), this process also offers an opportunity to observe and “read between the lines” what is happening in the group—and to make the implicit explicit. The coordinator’s technique is to help clarify the “implicit” (obstacles) so the group can become aware of them and move forward in its task.

This exploratory process—from the surface toward depth—is illustrated by an inverted cone, where the spiral represents the dialectical, exploratory, and clarifying movement from the explicit (external connections) to the implicit (internal connections), with the goal of making the latter explicit. Ana Quiroga describes the line of thought:

“…if, for example, in a group context we are faced with a series of actions or events that are explicit... and if we then carry out an analysis that follows this line (she points to ‘the dialectical spiral’ in the figure), we can arrive at an implicit element. If this implicit element is interpreted—a hypothesis, right?—it can become part of the ‘explicit’ that is found here (points to the base of the cone)…

the emergent has aspects here… and aspects here (points to the tip and then the base of the cone, respectively). I register something here… a hypothesis begins to take shape and I touch on something… a conflict or chain of associations. What I say—whatever it may be—can initiate a chain of associations that allows something to become explicit.” (7)

The emerging emergents form the new explicit (which can also be referred to as the existing, as part of what Pichon-Rivière calls the basic work unit: existing–interpretation–emergent). The emergent "summarizes" the latent content that appears on the manifest level.

In this process, the coordinator should act somewhat like a co-thinker, walking alongside group members and seeking to understand their own perspective—and, when needed (if the group process gets stuck in a stereotypical loop), intervene (by pointing out the obstacles in the process of ongoing discovery) and support the kind of "reading" the group itself can carry out of the situations it experiences throughout the process. Reflecting in this way on experiences—and in turn letting those experiences correct the theory in a continuous cycle of perception–reflection–action–new perception (or, in other terms, existing–interpretation–emergent–new existing, etc.)—is what Pichon-Rivière refers to as praxis.

Pichon-Rivière’s operative technique aimed at integrating the false opposition between theoretical and practical work into a concrete praxis, understood as a perpetual coexistence of inquiry and operation, in a complementary and mutually enriching relation... this mutual regulation between theory and practice is what Pichon-Rivière calls praxis, and it takes the form of an ever-widening dialectic spiral. (2)

The dialectical spiral can be understood as an expanding process of communication and thought. The operative approach aims to help group members “learn to think” and “learn how to learn.”

The group coordinator in an operative group should support the development of a more scientific attitude among the group members by fostering a mode of group thinking that progresses from everyday thought to more scientific, exploratory thinking. Something fundamentally essential in this (which is also implicitly present in the term operative) is the idea that only action can change reality. A group that is operative is therefore centered around a task whose ultimate purpose is transformation. Within the group, members are invited to reflect together on the difficulties involved in engaging with a specific task (which can lead to change).

Pichon-Rivière later modified the inverted cone and constructed a vector model, in which the idea of the dialectical spiral remains. The purpose of this new model was to "read" the group’s processes using six different interpretive vectors. The members' participation in the group is thought to be reflected through these vectors.

"Connection" is what initially characterizes an individual’s experience in a group. It refers to a rather superficial identification with the group and its processes. "Belonging" means that individuals in the group begin to view both themselves and the others as truly part of the group, rather than—like during the connection phase—simply being there. "Cooperation" is the result of group members mutually internalizing one another. "Pertinence" means that individual members have internalized the group’s task, so that their actions become relevant to the group’s overall purpose.

Within the communication vector, the coordinator observes not only the content of various messages but also their form and sender (if these come into conflict, misunderstandings arise in the group). "Learning" refers to a qualitative transformation within the group, where members’ pieces of information in a given moment are brought together—this transformation can be equated with anxiety resolution, active adaptation to reality, creativity, "projects", etc. "Télé", finally, creates an atmosphere that can be translated as a positive or negative group transference—toward the coordinator, the task, and between group members themselves. The attitude toward change constitutes the central issue of the operative group. This attitude may manifest as either an increase or decrease in depressive anxiety (fear of losing a stable, secure situation) and paranoid anxiety (fear of being "attacked" in a new or changed situation).

There is a purpose behind the placement of the vectors in the model described above. By following the vectors from bottom to top, their meaning becomes clearer. This can be seen as a kind of "reading" of group dynamics, somewhat playfully called the "elevator game", in which one follows each side of the cone from the bottom up. If one detects a deficiency in the applicability/relevance vector—or a negative applicability/relevance (i.e., the group cannot focus on the task)—this implies a dysfunction in the vector just above it, the cooperation vector. This, in turn, suggests that regressive forces are dominating. And if there is a disruption in the cooperation vector, one must examine the next vector above: the belonging vector. If a disturbance exists there, it means that the group has not transitioned from connection to belonging (from "I" to "we"). In such cases, group members are often in "deception" situations, in which they behave as if they had made the transition from connection to belonging—when, in fact, it is a case of pseudo-belonging.

If, on the other side of the cone, one encounters a negative telé that disrupts group development to the point where relationships between members are paralyzed or disturbed, it indicates that something is not functioning properly at the next vector level, the learning vector. We must then consider what epistemophilic obstacles (emotional barriers that prevent individuals from approaching certain knowledge or learning certain things) are at play—those that hinder the group from finding new ways of relating to each other, as opposed to the stereotypical patterns they’ve previously returned to and repeated. In such a group, alternative behaviors cannot be learned, and members cannot relate to one another in new ways.

In that case, we need to move upward to the next vector. Something, in other words, is malfunctioning at the communication level, and we must attempt to identify the breakdowns and misunderstandings that are blocking communication from flowing smoothly (which also causes group members to regress and behave more immaturely). In the Pichonian model of thought, communication and learning go hand in hand, and every disturbance in the communication process inevitably leads to changes in how one learns from reality and experience—something Pichon-Rivière regarded as a foundational factor in the development of mental illness.

The Task Process: Preparatory Work, Task, and Project

As previously mentioned, the concept of the "task" plays a central role in Pichon-Rivière’s operative group approach. The function of the task is to provide an overview in relation to what emerges as problematic, pathological, etc. With this knowledge, a plan is then created with the aim of producing change. The task helps define and establish elements of the contract, the working alliance, or the framework within which the group "works." But the task is also a metaphor. In reality, no one fully knows what the task is, since what appears to be the task at the beginning of the process is no longer the same by the time the process concludes.

Ana Quiroga describes the relationship between the task, the contract, and the group connection in the following way:

The task is "installed" in the initial contract that was previously established... If it is a study group, the day's theme is set—if a lecture has already been given—and then one waits. A new theme is not set each day, since the contract states that the group's task is to work with the information provided during the lectures.

The group often returns to the contract, gradually “taking it in” in a spiral fashion until it is integrated; until it is understood and accepted... until a psychological contract exists that "installs" a functional connection between the coordinator and group members—a connection that allows the coordinator to “operate”… to interpret, for example.

In Pichon-Rivière’s operative group concept, the group task has both an explicit and an implicit dimension, the latter of which is initially only apparent to the coordinator. However, it is not possible to focus on just one of these dimensions—the group must engage in both in order to function as a working team. Sticking solely to the external (explicit) task—without engaging with the internal (implicit) one, which provides meaning—will cause the group’s activity to quickly lose momentum, leading to minimal productivity. Conversely, an internal task alone, without an external referent, becomes an empty ritual. The internal task gains meaning only in relation to an external one.

Tubert-Oklander and others make the following analogy with the functioning of the body:

The difference between the internal and the external task could perhaps be better clarified if we compared the internal task with the organism’s basal metabolism – i.e. that continuous work that our body has to carry out, just to keep on living, even when it is in repose – and the external task with the additional energy expended by our organism whenever it starts to “do something”.

In a group, the task can be described as a cycle, comprising the following stages:

1. Preparatory Work: In this stage, there is a kind of unconscious “conspiracy” aimed at preserving the status quo. This is a regressive phase marked by fragmentation, denial, omnipotence, idealization, devaluation, and primitive forms of projection and introjection.

The underlying driving forces include:

  • Confusional anxiety (fear of being overwhelmed by new knowledge),

  • Paranoid anxiety (fear of being harmed by new knowledge, habits, or relational patterns),

  • Depressive anxiety (fear of losing old knowledge, habits, or relational patterns).

These unconscious conflicts must be worked through either via spontaneous insight within the group or through interpretive interventions by the coordinator, aimed at revealing the underlying anxieties and defense mechanisms.

2. The Task Phase: This phase begins when the group is able to start working toward achieving the manifest goal. Initially, members approach this in a dissociated manner. Issues are framed in terms of absolute opposites, without acknowledging the connections between them. The discussion becomes an "either-or" dilemma, where group members are stuck between two partial insights. This is referred to as the Dilemma Phase. At this point, the group task is no longer absent (as it was during the preparatory phase), but it suffers from internal fragmentation that impedes progress. The coordinator now seeks to highlight this fragmentation and its underlying motives through interpretations, helping the group recognize the particular and complementary aspects of the opposing positions being expressed.

Learning necessarily involves giving up—though often not consciously—other ways of viewing the world, reality, or whatever it is that is felt to be lost. This gives direction to the work. Because the operative group allows for learning, it becomes just as therapeutic as if another technique had been applied. The earlier defensive strategies are abandoned, and the subject can learn new aspects of reality—of the concrete world—which revise their previous worldview.

After moving past fragmentation, the group enters the Problem Phase. Here, the group is able to address the task from multiple and varied perspectives. A new creativity emerges. Members are able to formulate the question in workable terms by using all available information and by collaborating in discussion, rather than wasting energy on sterile confrontations. The group can now:

  • Identify variables and possibilities,

  • Weigh these against their own capabilities,

  • Ultimately reach decisions that pave the way for the final phase—the Project Phase.

This is what Pichon called “the scientific method.”

3. The Project Phase: This phase begins when the group defines a new course of action based on realistic analysis and newly discovered shared interests. At this point, one cycle of group activity ends and opens the way for a new one—one that may extend beyond the boundaries of the formal sessions with the coordinator. This often occurs when the group is working in a "real-life" setting—such as a family, organization, or work team—or when the original members decide to form a permanent group.

"An apparatus for thinking reality." The conceptual, referential, and operative schema (ECRO/CROS) and Weltanschauung

Pichon-Rivière sees the individual’s (subject’s) constant dialectical interaction with the world as the only way to construct an adequate “reading” of their reality. The loss of this dialectical interplay leads to the reference framework—the way of perceiving, distinguishing, and “operating” in the world—taking on an anachronistic character, whereby the possibility of a mutually transformative interaction with the world disappears. To “close off” one’s own referents thus favors the emergence of old “ghosts” that are projected onto present social relations.

These ideas led Pichon to formulate the conceptual “tool” ECRO/CROS (ECRO = Esquema conceptual referencial y operativo; CROS = Conceptual referential operative schema), which can be seen as a flexible “thinking apparatus for thinking reality.” In this, he emphasizes both the conceptual elements (the surface structure) and the individual’s own “life journey” (the deep structure).

The referential aspect in an ECRO/CROS points to the area of reality (the phenomenal world) under consideration and influence. That the schema refers to a specific, determined sector of reality is fundamental because no conceptual schema can encompass the entire reality. The operational criterion (or action criterion) here represents what, in other referential schemas, is called the truth criterion—i.e., what in the thought or conceptual (conceptual world) corresponds to reality.

That the schema always refers to a concrete situation and is used as a “guide for action” in the specific sector of the world where we “operate” also functions as a determinant, ensuring it is always tested against reality—which in turn fosters an attitude of self-criticism. Of importance is not only how “true” an interpretation is, but also how adequate it is in practice (i.e., timing). In an operative group, therefore, effectiveness is the only criterion that can be said to apply. One can liken it to a football team; what determines its effectiveness is whether it wins its matches. Similarly, an operative group’s effectiveness depends on what results it achieves—that is, how effectively it tackles its task.

It is the mutually transformative (dialectical) interaction with the environment that governs verification or falsification of the “reference framework” constituted by a person’s ECRO/CROS. “Discoveries” are made possible by how adequately the investigator’s conceptual schema is set in relation to the characteristics of the phenomena under investigation. Therefore, an ECRO/CROS should also be modifiable—not because it would be good or bad in itself, but because it needs to be supplemented with new knowledge. It thus functions as an open, modifiable system. Every previous experience is incorporated into the schema and forms part of the perspective influencing the interpretation of later experiences—but also vice versa, so that later experiences/knowledge change the interpretation of earlier experiences.

In an operative group, different frames of reference or worldviews necessarily clash with one another. The mere fact that other people perceive, think, and act differently than oneself, and based on different assumptions, can open the way to developing critical thinking (which includes room for unlearning, relearning, and new learning).

Concretely, this group process proceeds such that, initially, each group member has their own understanding of things (their own “code” or ECRO/CROS). What complicates the “meeting” within the group is that large parts of each member’s ECRO/CROS are unconscious. The group coordinator’s task here is to “interpret” these and help create an explicit formulation of what up to that point has been a set of implicit assumptions (personal thoughts about how things relate, which, incidentally, promotes dogmatism). Pichon-Rivière speaks of how images from the past implicitly remain as a “as if.” Tendencies to misunderstandings thus arise when each person’s personal ECRO/CROS encounters those of others. Tubert-Oklander and others emphasize that misunderstandings constitute a more serious communication failure than lack of understanding, since a person who has misunderstood actually believes they have understood—and therefore lacks reason to further investigate what is communicated to them.

The group coordinator highlights the presence of possible misunderstandings to facilitate group members’ progress in exploring each other’s referential “codes” or “schemas.” The ultimate goal is to arrive at a shared “code” that enables effective communication within the group. Thus, one of the group’s main tasks becomes building a common ECRO/CROS. In the process of constructing a shared ECRO/CROS in an operative group, the original misunderstandings can be transformed into understanding. However, this creation of a “common language” also entails a partial and temporary loss of the group members’ “individualism,” which instead is subordinated to the need to create an effective team capable of solving the group’s task (whether it is educational or more therapeutic in nature). This loss implies a sense of grief; giving up some of one’s individual distinctiveness also becomes part of the path into the group.

It should also be noted that Foulkes had similar ideas in that he stated that a group— in order to reach a satisfactory level of functioning—needs to develop a common foundation and a common language. He described this (Teaching, Study and Research, 1964) in terms similar to Pichon-Rivière’s:

“… basic differences of personality make-up … creates a further problem for every group as to whether sufficient common ground or language can be found to render full cooperation possible, while making allowances for the individual personalities involved (2).”

The Operative Learning Group and Group Operative Technique in the Supervision Situation

Unfortunately, there is no clear description in the book of how an operative group with group psychotherapy as its “task” functions. Possibly, this is one of the book’s weaknesses. However, some clues about how this proceeds can be found in the latter half of the book, which is devoted to describing how the authors concretely proceed when dealing with operative learning groups and supervision groups coordinated with group operative technique.

In its way of working, the operative learning group discusses a prepared topic while the coordinator observes the discussion and intervenes at regular intervals (in interpretive terms) to point out obstacles that block the work on the task. The coordinator strives both to identify underlying premises in the discussion and to relate these to the members’ referential schemas. The purpose is to find out the conceptual elements that a person usually (more or less unconsciously) uses to perceive, think, and act. In their interpretations, the coordinator discusses and analyzes these schemas and helps the group members develop a common ECRO/CROS so that they receive both theoretical and practical help in effectively dealing with the problem they are struggling with.

The function of the group coordinator resembles both that of a group analytic therapist—in that they seek to identify and interpret the group’s emotional conflicts in relation to the task at hand—and that of an epistemologist, in that they encourage group members to critically analyze their own theories and the assumptions underlying them.

Such an analysis requires, among other things, that members and coordinator share a common starting point or common information as a “discussion starter.” This can be done in three ways:

  • An introductory lecture is given on an agreed-upon subject, after which the group is asked to discuss it. This is the model Pichon-Rivière and his colleagues chose in the “Rosario experiment” in 1958. In this form of large group, the lecture is usually given by a teacher, and the audience is then divided into smaller discussion groups, each with a coordinator or a coordinating team.

  • The second model is usually used in smaller classes or study groups that meet regularly over a longer period. Here, all members have had the opportunity to read recommended literature in advance, and the group’s task is to discuss their reading based on the impressions it has given them. The coordinator does not answer questions or clarify difficulties encountered by group members in their reading; instead, they help them use their own resources to clarify and further discuss the material and its implications. The coordinator assumes that the group members have read the material. If this has not happened, they generally “choose” to perceive the situation as an obstacle and resistance to the task, and therefore also investigate the motives behind this and the conscious and unconscious meanings involved.

  • The model is often used in small workshops at institutions or conferences, where the starting point is a particular problem or question, usually stated in the name chosen for the workshop. The coordinator begins by reminding the group of the problem the members wish to address. Then they ask the members to share their views on the subject and to discuss their conclusions. Here, the coordinator avoids giving their own perspective on the topic so that the members have room to express their own opinions. Then the coordinator seeks to help them develop a critical analysis of underlying assumptions and “belief systems.” Only in the concluding phase of this type of group may the coordinator express their own opinion—but not as a summarizing conclusion, rather as an additional example of the various viewpoints (vertices) one can apply to the initial question and its consequences.

In the authors’ description of supervision in the group operative form, this is contrasted with the traditional normative supervision model, described as follows: supervision is conducted by an expert who arrives at diagnoses, therapeutic indications, and treatment planning; the supervisee is taught how the “correct technique” should be applied at all stages of the treatment process and is given suggestions on actions to take. The traditional supervision model is based on the assumption that there is a standard technique for practicing psychotherapy, which must be taught by a supervisor to a supervisee who learns it. The essential point here is that the supervisee learns to apply the method correctly. The operative supervision group, by contrast, emphasizes the creative aspects of clinical discussions as well as the reconstruction and critical discussion of underlying assumptions and theories. One might call this process an epistemological critique of clinical practice. Such a perspective regards every treatment as a joint “creation” of patient(s) and therapist (therapeutic team) adapted to place, moment, people, and circumstances (and thus incompatible with accepting any kind of standard technique).

In the practical application of the group operative model in a supervision situation, Tubert-Oklander and others place special emphasis on how the group’s emotional and defensive processes are dynamically influenced by the unconscious aspects of the presented material. As a supervisor, one can observe the material’s impact on each group member. Just as a patient’s emotional processes resonate in the analyst’s feelings—and vice versa—the complex unconscious exchange occurring between them resonates throughout the supervision group (including the supervisor). The group operative technique is used to create a reflective space in which the supervisee’s conceptual, referential, and operative schema (ECRO/CROS) can be reconstructed, analyzed, and questioned. The aim is to help the therapist develop their own referential schema and maintain a constantly questioning attitude towards the clinical phenomena under consideration.

Tubert-Oklander and others stress the importance that every group operative supervisor (who is engaged in “research” on the group they work with) gives back to the group everything they have learned from it and its members, so that these in turn can use, correct, or reject what the supervisor presents. The purpose of this is primarily to enable group members to further discuss with the analyst and help them revise their understanding of what has been shared. Pichon-Rivière emphasizes here the importance of “democratic leadership”:

The ideal role one can assume in group work is democratic leadership. The interplay between leader-coordinator and group takes the form of a permanent spiral in which learning and unlearning processes are connected as a unit of giving and taking (feedback).

If the members of the supervision group (with the coordinator’s help) are capable of understanding what emotional reactions, for example, a particular case description induces in them—and if they find ways to synthesize this multifaceted “image”—they will gain a much deeper and more multidimensional understanding not only of the treatment presented for supervision but also of what psychoanalysis is and could become. In supervision groups coordinated with group operative technique, the emotional reactions evoked by the case material are used to initiate reflections and theoretical understanding of what is going on both in the supervised treatment and in the supervision group itself. The ultimate goal of the group’s thought process is conceptualization and to “bring to life” previously read literature, which can now be connected to new personal experiences.

The Operative Group as a Therapeutic “Project”

When operative technique is applied to a therapeutic “project” – in which “cure” constitutes the implicit task – the group’s therapeutic function becomes apparent. As noted above, this is not explicitly addressed in the book. Therefore, the section below serves as a complementary description of a technique and a way of thinking (which I imagine the book’s authors are well familiar with) where the idea of learning plays an important role.

In Pichon-Rivière’s individual psychotherapeutic perspective, individual psychoanalysis (or psychotherapy) is seen as a learning process – a dialectical functioning system that opens and closes. The relationship that exists between therapist and patient can be described as a dialectical spiral in constant motion. In this dialectical relationship, what one (the patient) experiences and feels is translated by the other (the therapist). It involves the therapist’s re-experiencing of the patient’s experiences and the therapist’s re-translation in the form of an interpretation. This interpretation is a function of what is awakened within the therapist. The therapist acts towards the patient and vice versa. Consciously, the therapist works towards the patient through interpretations aimed at changing the shared field that the therapist and patient form (an interaction situation between two persons). Everything here should be considered as a function of the entire relationship (Gestalt) created between subject and object, between therapist and patient, between observer and observed. Every movement, attitude, etc. of the therapist acts on the patient’s unconscious and evokes changes within the shared field. These changes in turn influence back (this whole reasoning about mutual influence could be briefly seen as something like the principle of connectedness).

In the “Pichonian” group-operative perspective, the coordinator and group members (and context) together form a Gestalt that is constantly changing based on the interplay occurring. The relationship between coordinator and group members is formulated as a dialectical spiral relation in which the former inevitably is somewhat of an “active agent” and not a “pure observer.” Pichon emphasizes the interplay between Gestalt and Gestaltung (the shaping/forming process) that takes place. The Gestalt constitutes what exists, and from it emerge the emergents, which in the form of a nascent “new situation” point to a process of change in the making.

Here the emergent appears as a sign of an implicit process, i.e., as a sign of the already existing underlying process that must be made explicit. Making the implicit explicit takes place in the “structuring,” which means being a constantly open circuit. The word Gestaltung has this meaning. At the beginning of our task, the word Gestalt appeared constantly in terms of structure or function. But when the spiral nature of the continuous process was discovered, we had to give it a special meaning. Even the Gestalt psychologists themselves, including Kurt Lewin, began using the term Gestaltung, which is related to Gestalt and means “structuring”… The definition we could give the process was “structuring” – not “structure” – because of the constant motion it was in… We defined the group as a Gestalt, as is commonly said. For example, social psychologists who work focusing on the group define it as a Gestalt with a fixed and not dynamic meaning. If one says that it (i.e., Gestalt) is a Gestaltung, one transforms the process into a structuring. The process therefore happens gradually and in a determined direction; Gestaltung became the most suitable term to denote that it was a moving process in an open circuit – and not closed as Gestalt can be. (8.)

Each group member’s “inner drama” (the vertical or life history) together with the “outer drama” (the horizontal or what the group here and now has together) forms what is in motion in the group (Gestaltung). The process is partly illustrated in the description below, made by a member of an operative group:

At first, some of us in the group try tentatively to express ourselves – as if trying to speak ‘submerged under the water surface.’ The initial observations here constitute stories that suddenly seem to me ‘like from another film’… and the coordinator is on edge, searching for emergents and blindly (at least it seems so to me) directing toward whomever it may be in the group… Gradually… ‘line’ by ‘line’… language and its consequences emerge on the scene… and we sink into the ‘second act’ of the play. The confident continue to sink… those of us who hesitate continue with our ‘salsa’… and those who don’t know where they are going want to continue their journey. It is strange, but I notice that a space for feelings opens and that we begin to learn… Interpretations arise within us. We listen attentively, respectfully, and now also with pleasure. Everything we say to each other has consequences. Even when we talk about ourselves, changes appear in our feelings… sometimes fantastic changes… At first, silences occur which we quickly try to fill with ‘music’ without caring much how it ‘sounds.’ Today, however, the silences are long, expressive, and delicate. We exchange looks without fear (‘where words die, music arises’)… and we listen for the resonance of our life destinies… Suddenly the coordinator intervenes and brings out an emergent… and as if by magic, a change occurs. We are shaken… stop… fall… but then come back on our feet.” (12)

It is interesting to observe how the group, in order to perform its task (or “work”), generates a way of associating that could be called an “association chain” (the group’s way of applying “free association”?). One member says something… another says something based on this… and yet another enters the dialogue, etc., and in this way the group event moves forward. In line with the previously described interplay between the “inner group” and the “outer group” (see above section “Operative group, group analysis, change, learning, and worldview”), this process can be described as externalized thinking (group thinking). Communication becomes an externalized “thinking process” (in the outer group), while individual thinking constitutes intrapersonal communication (in the inner group). Pichon uses his concept “the inverted cone” (the dialectical spiral – see above!) to graphically illustrate the dynamic between implicit and explicit that is present here (and can be seen as an expanding thought and communication process).

By being observable on the surface, the explicit – or manifest – in the situation is at the base of the cone. The implicit – or unconscious – is placed at the tip. From the outside, one may get the impression that the explicit plays the leading role by occupying the largest space in the figure. However, the implicit here should be seen as analogous to an iceberg – the largest part is not visible. Within this cone moves the dialectical spiral, which in this context represents both individual and group process. Based on the universals (the two basic forms of anxiety – fear of loss and fear of attack) placed at the tip, the group process will gradually increasingly change in a permanent emergence of new emergents. Here, symptoms can for example be seen more as “situational emergents” (something new and original as moments of, for example, the shared Gestalt the therapist and group members form with their behaviors) rather than direct results of the individual’s (subject’s) past and something already given (the implicit is however present through the transference situation). From the same reasoning, the operative group establishes a meaningful relationship between the vertical (the individual) and the horizontal (the situation created in the meeting). When “ruptures” occur in the horizontal (group event), the different “verticalities” (individuals with their “subjectivities”) emerge.

Pichon-Rivière points out that the role of narrative in individual analytic treatment is rather played by the dramatic event in a group. Therefore, the group therapist (the group coordinator in an operative group) must, more than just listen analytically, also observe analytically and ask what is happening before their eyes in the “network of connection” that is in motion and alternately gestalted and gestalts. This “observer role” is described in a simplified “premature” form in the quote below:

(Pichon) recounts how he (in his teenage years) ... performed his first non-participatory observation – the archetype and model for how coordinators of operative groups were trained:

For example, the village women gathered once a week in our house to talk. My mother actively participated in these meetings. I had arranged a hole to see and listen through. In this way, I noted the contradictions and the events that took place in these groups. And I believe it was there that I – as a non-participating observer – gained my first knowledge of how human groups function. One could say it was teaching through the keyhole.” (9)

If Freud thus grounds classical analysis on getting the patient to observe their own fantasies in order to then tell them to the analyst, the group proceeds in the opposite way. And it is then that the group therapist must observe and interpret the group and its dialogue like a dream unfolding before their eyes. The forms the group constructs (and then more related to its productivity and what emerges) can here be described as a kind of “group text” or “writing” in an extended sense (i.e., not only something verbal) produced in the group. This “group text” has the capacity to generate further meanings. An implication of this is that the meaning which at a certain moment a certain “reading” attributes to an aspect of the group event therefore does not exhaust the productivity of this “group text.” One can here most closely compare with, for example, the “text” of a dream. The group’s “texts” are inexhaustible, and it is more about something that has no end. Rather than being a hidden substantial meaning that interpretation should reveal, the “text” tirelessly generates meanings, which in the form of different expressions are “written into” not only the said or unsaid.

Summary Comment

Hopefully, Tubert-Oklander’s book will contribute to increased knowledge about an Argentine group tradition that is largely unknown in Europe and the Anglo-Saxon world (to which one is sometimes tempted to suspect that at least Sweden belongs) — but also partly in its own country, as the following quote shows:

In the twenty-five years that have passed since his death, he has been largely forgotten in the world of psychoanalysis. Even though his name still rings a bell for young psychoanalysts, his works are rarely read or quoted in psychoanalytic papers. His books on groups and social psychology are ignored by many analytic group therapists, even though they are mandatory reading for those with a social bent (2).

One of Pichon’s goals was to “democratize psychoanalysis” — hence the title of his collected works Del psicoanálisis a la psicología social (6). Tubert-Oklander and others, however, argue that he was mistaken in this regard and that his work meant something more.

His work is really a breakthrough in psychoanalytic theory and practice. It is a major contribution towards the development of a new paradigm of the human being that we so sorely need (2).

Both Pichon-Rivière and Foulkes — as clinical psychiatrists and psychoanalysts — created an opening towards sociology, philosophy, and other disciplines. This allowed them to enrich the vision they had as psychoanalysts of constructing an ECRO/CROS (conceptual, referential, and operative scheme) with the possibility to create understanding and explanation of human group behavior. Possibly, this openness was also something shared by both pioneers (11).

Pichon-Rivière also moved simultaneously in several fields — psychiatry, psychoanalysis, art, journalism. One might even go so far as to say that Pichon-Rivière belongs to the group of avant-garde intellectuals in Argentina from the early last century onward — alongside names like Borges, Roberto Arlt, Cortázar, etc. (authors who were part of the Latin American literary boom known as “magical realism”).

At times, when reading his texts, one gets the feeling that it is only now, at the turn of the twentieth to the twenty-first century, that contemporary times have caught up with Pichon-Rivière in his interdisciplinary thinking, which in many ways can be described as a tendency to allow interfering creative aspects to arise in both theory and practice (something which, according to psychoanalyst Marie Langer, created a certain unease and disorientation among his psychoanalyst colleagues).

Pichon moves from one group to another... he makes certain groups appear within others, he turns oligophrenics into football players, caregivers of the ill, opens therapeutic “rooms” within educational institutions while at the same time seeing therapy as a learning process (9).

In South and Central America, Pichon-Rivière has “given rise to” Morenians, Freudians, Kleinians, Lacanians, systemic thinkers, Gestalt therapists, analytic psychodramatists, etc.; not only professional practitioners from various currents within dynamic psychology, but also representatives of disciplines covering the most diverse societal areas: education, work, recreation, health, etc. (11).

Some group therapists active in Argentina — more faithful to the traditional way of educating only doctors and psychologists as group therapists and counselors — have tended to distance themselves from the revolutionary project Pichon-Rivière initiated (and which has now been continued by Ana Quiroga). Tubert-Oklander and others’ view is that Pichon-Rivière’s concepts and techniques definitely deserve attention even if one does not share the implicit political ideas and goals he had. A prominent Argentine group therapist, Ana María Fernández (10), reflects on whether Pichon-Rivière might be better characterized as “someone who strays outside the institutional” rather than as a “groupologist.” Regarding his group contributions, however, she emphasizes the importance of not just stereotypically repeating what he came up with, but developing it further.

It should be added that the name Enrique Pichon-Rivière previously — as far as I know — has only appeared in Swedish-language texts by the well-informed Svein Haugsgjerd (including in his Den nya psykiatrin):

Pichon-Rivière is known for the psychotherapeutic work he conducted with psychotic patients in the 1940s and for applying psychoanalysis in group and milieu therapy, among other things by establishing an institute for social psychology (1).

However, he is not entirely unknown in Sweden. For those who have come into closer contact with the Gothenburg Psychotherapy Institute, the name is familiar because this institute, since its start in the 1970s, has maintained close contact with the Argentine branch of psychoanalysis, especially with “disciples” of Pichon-Rivière.

Bibliography

(1) Haugsgjerd, S. The New Psychiatry: Background and Development. Stockholm: Prisma, 1988.

(2) Tubert-Oklander, J. & Hernández de Tubert, R. Operative Groups. The Latin American Approach to Group Analysis. Jessica Kingsley Publishers. London and New York, 2004. International Library of Group Analysis 24.

(3) Actualidad Psicológica. Dialogue with Ana Quiroga. Pichon-Rivière Between Social Psychology, the Learning Process, and Lacan. (Interview with Ana Quiroga. Pichon-Rivière between social psychology, learning process, and Lacan). No. 133, June 1987.

(4) Pichon-Rivière, E. The Group Process. From Psychoanalysis to Social Psychology I. Buenos Aires: Ediciones Nueva Visión, 1995.

(5) Zito Lema, V. Conversations with Enrique Pichon-Rivière. On Art and Madness. Buenos Aires: Timerman Editores, 1976.

(6) Pichon-Rivière, E. The Group Process. From Psychoanalysis to Social Psychology I. Buenos Aires: Ediciones Nueva Visión, 1995 / Psychiatry. A New Problematic. From Psychoanalysis to Social Psychology II. Buenos Aires: Ediciones Nueva Visión, 1983 / The Creative Process. From Psychoanalysis to Social Psychology III. Buenos Aires: Ediciones Nueva Visión, 1982.

(7) Lander, S. An Argentine Operative Group Approach. Enrique Pichon-Rivière’s World of Thought, Ana Quiroga and the Pichonian Concept of “Operative Group”. Thesis for the licensure-based psychotherapy training with a group analytic orientation, Psychotherapy Society, Stockholm, 2003.

(8) Pichon-Rivière, E. Dictionary of Terms and Concepts in Psychology and Social Psychology. Buenos Aires: Ediciones Nueva Visión, 1995.

(9) Manero Brito, R. The “Madnesses” of Pichon-Rivière. (Pichon-Rivière’s ‘Idiosyncrasies’). Internet: Group Library. (Website www.campogrupal.com)

(10) Pavlovsky, E. & De Brasi, J. C. (Editors). The Group. Becomings. (Ana Fernández: The Group Device). Stories. Buenos Aires: Galerna – Búsqueda de Ayllu, 2000.

(11) Kesselman, H. Operative Psychotherapy I. Chronicles of a Psycho-Argonaut. Buenos Aires: Editorial Lumen-Humanitas, 1998.

(12) Hermosilla Ríos, J. Language and Emotions from the 3rd Meeting on Fields of Intervention in Operative Groups, Santiago, Chile, 1997.


José Bleger: Psychology of the Conduct.

Foreword

In the chaotic landscape of current psychology, a large number of schools and sub-schools, methods and techniques, currents and ideologies coexist in an isolated and opposing manner. The whole presents the appearance of a true dispersion, without order, without connection, without meaning, and without communication.

This book aims to fill, to some extent, this lack of coherence and unity by presenting a sort of map or project for a general psychology of behavior. It collects, reflects, or develops the conviction that the different schools or currents have contributed fragmented knowledge of a single, unified whole, and that when each of them has believed it saw the whole in its segment, they have given rise to erroneous, distorted, or exaggerated theories. Despite this process (or thanks to it), each school or current reflects part of the reality, which must be rediscovered and re-established in the original unity and totality. The different schools or currents have taken distinct structures or fragments of the same process, but segmentation and the forgetting of the process and the total and concrete context led each of them to believe they captured the entirety in their segment. Thus, the solution to many problems lies solely in reframing them.

This dispersion of the object is compounded by the fragmentation and dispersion of the very process of knowledge and research in moments that are isolated and which have been constituted as methods on their own.

What the schools, methods, and fields of psychology fragmented and scattered, disarticulated and formalized, must be recovered. This task is not an eclecticism that seeks to resolve contradictions but, on the contrary, it accepts and confronts the contradictions because they belong to the reality of the phenomena and their respective dialectical movement. A large part of the task at hand consists of dissolving false antitheses, transforming the irreducible antinomies into what they actually are: moments of a single, unique process. The barriers between schools are no longer fixed and are collapsing. This book seeks to contribute to this, so that a framework for psychology can be built free from arbitrary, strict, and dogmatic divisions and limits.

I am not entirely sure that I have avoided the danger of wavering between a simplified presentation of some topics and a deepening of others. Of course, the main goal is to rethink psychology as the fundamental task of the psychologist. It is not just about learning or teaching psychology; it is about thinking psychologically. Here, I try to apply my conviction that books are not meant to be read, but to be thought through.


Chapter I: Psychology and the Human Being

1. Approach to Psychology

It is very difficult to precisely define what psychology is, just as it is to exactly delineate the object of any science. Definitions are always included at the beginning of books and are only fully understood at the end, when one has a comprehensive perspective of the subject. In an attempt to resolve or avoid the narrowness of definitions, it has been said of another scientific field (sociology) that it is what sociologists do. If we transplant this formula to psychology, we gain nothing, because, in addition to being a truism or tautology, psychological disciplines have not yet fully established their ground, as a practical activity or profession, in the same way that sociology has. In sociology, as various authors have described, practice preceded theoretical systematization and began as a parascience, whereas in psychology, theory and philosophical speculation preceded practice and still, to a large extent, replace it; as Boring said, psychology came first, psychologists came later.

Psychology arrived very late in structuring itself as a scientific field. Like all sciences, it gradually separated from philosophy, although it maintained very close ties with it. The term "psychology" dates back to the 16th century, but it was still very rarely used in the 18th century; it was adopted by Kant and then became more widespread. Comte did not specifically include it in his classification of the sciences, and even today, psychology faces many resistances and doubts. Both idealization and contempt represent real obstacles to its development.

Scientific knowledge increases our real power over things, but diminishes and injures our fantasy and magical omnipotence. Freud pointed out that there are three discoveries that have most damaged our narcissism: first, that our planet is not the center of the universe, but one of many, with no special position; second, that we are not the kings of creation, but products of the evolution of animal species; and third, in chronological order, that we are not entirely rational beings, but that much of our conduct is unknown to us in terms of its motivations. The study of things in the heavens and on earth has not been done without effort or anxiety, but these are compounded when studying the human being himself. Therefore, the sciences of man arrived late and are still in a formative period.

The natural sciences also had to overcome strong resistances in their time, similar to those that currently arise for the sciences of man, especially psychology and sociology. But this resistance is even greater as it approaches and includes the human being itself. Physics and chemistry, as Fenichel observes, overcame resistance before biology, and biology before anatomy and physiology. These, in turn, before psychology. It is not so long ago that anatomists and pathologists were severely prohibited from dissecting corpses. Surely, this development does not solely have its causes in the evolution of psychological resistances or in a pure progress in the domain of ideas, but it is equally true that this resistance acts independently and very intensely at certain moments. The development of science is closely linked to the development of human society and its technical needs, or, in other words, to the need for the species' survival. So far, all scientific progress has propelled the factors of social change, which, of course, clash with all social forces that tend to preserve a given social configuration. In this way, scientific and philosophical advancements and setbacks are linked to complex historical processes of class interests in conflict.

2. Psychology and its Object of Study

Strictly speaking about human beings, and based on everything we’ve discussed so far, we can say that psychology studies humans. However, this does not exactly define or delimit its area of operation, because many other sciences also focus on humans as their object of study (history, anthropology, philosophy, sociology, etc.).

If, in this sense, psychology shares an object of study with many other disciplines, the identity and respective boundaries of each can only be established in two ways: either by considering that each discipline examines a part of the object for its study, or by recognizing that each discipline exclusively and uniquely focuses on a specific aspect of the same phenomenon, an exclusive focus corresponding to a group, class, or level of the object's qualities. We believe that, in general terms, the first criterion has prevailed in the history of psychology, while the second is the one we will develop here, and it should not be confused with the position that only explains and admits the existence of "different points of view" for the same event or quality.

Among the scientific disciplines, we can recognize a group characterized by having a specific object of study that belongs entirely to it: living beings are studied by biology, and the stars by astronomy. Another group is defined and initially configured by the use of a research instrument: microbiology, spectroscopy, ultramicroscopy, etc. Another group of sciences studies different aspects of the same object: chemistry and physics study the same objects, but they differ in how they approach them, corresponding to two distinct, real aspects or qualities of the same object. A table, a muscle, can be studied both by physics and chemistry. This is not meant to be a classification of the sciences, but rather a framework to help orient us in positioning psychology. Furthermore, these delimitations are only valid to a certain extent because phenomena, in reality, overlap, continue, or occur simultaneously.

With regard to psychology, we can say that it studies human beings, but it does so from a particular angle or perspective, one that attends to a specific plane of their organization as living beings. Psychology is not the only discipline that studies humans, and therefore shares its object with other sciences. Attempts to find a specific and exclusive object for each science are closely related to metaphysical assumptions about studying entities or substances. These fallacies have historically led psychology to define its object of study as the soul, consciousness, mind, or psyche, forgetting that these are abstract entities that replace concrete phenomena. With such definitions, the object of study is not clearly delimited; rather, it leads to a complicated mythology from which modern psychological currents have not entirely freed themselves. These definitions structure a verbalist psychology, or else a contradiction arises between the concrete phenomena studied and their respective theoretical formulations.

There is no such thing as a soul, psyche, mind, or consciousness; there are, however, psychological or mental phenomena, but the attribute should not be transformed into a subject or substance.

For all these reasons, it seems important to begin with the statement that psychology studies, or should study, real and concrete human beings. We know that the framing of a problem implies a limitation of the answers to it; as Socrates said, the one who answers a question is not the one who responds, but the one who formulates it. If psychology studies humans, there is always an implicit conception of the human being within it. Even within psychology, which is defined as the study of the mind or the soul, there is a conception of the human being that the human has of themselves at a particular historical moment. These assumptions are not mere speculations that arise from a purely contemplative attitude; they are always linked to the cultural and social characteristics of each era. Each historical-social organization has an image of itself.

We are interested in starting from a scientific conception of the human being, to which psychology itself has already contributed, and—fundamentally—oppose some fallacies with which traditional psychology has historically been constructed, but which still persist, to some extent, even in contemporary psychology.

3. The Myth of the Natural Man

In this type of conception, the existence of a state or original essence of the human being is postulated, one that has been corrupted or distorted by the influence of civilization. In contrast to what is socially acquired, which constitutes the artificial, the natural state of man is sustained as the genuine or ideal. From this, it has sometimes been inferred that the correct path is the "return to nature," a return to the original, natural state, discarding or setting aside everything culturally acquired and conditioned in the human being.

The religious tradition of this hypothesis is evident, even though it has been supported by non-religious authors. Nowadays, it holds historical value, but it is not uncommon to find it as part of the theoretical position or referential framework of some psychological developments.

In this type of postulation, it is implied that the natural man is good and has qualities that are lost or disturbed by the influence of social organization. Thus, an image of this ideal human being has been constructed, or it has been supposed to exist in cultures or populations of primitive organization. The development of culture, therefore, gives a superficial varnish to the human being, but beneath this lies their original nature, which in this way is unchangeable and fixed, and can be rediscovered or placed again in the foreground.

In this regard, authors as diverse as Rousseau, Klages, and Lessing held similar positions. In the seventeenth century, Hobbes, Spinoza, and Locke postulated a "natural state" prior to civilization, implying that the latter was artificial and conventional. For Rousseau, the arts and sciences had led to the decay of the essentially good primitive being, which had been corrupted by cultural influence, distancing itself from its direct and healthy relationship with nature and its original goodness. Culture was something artificial, and because it was unnatural, it caused the decline of the human being. More recently, Klages argued for an opposition between soul and spirit; the former is in direct and immediate relation with nature, while spirit is the rational sphere, the logical force that progressively destroys the former. Lessing also developed a "naturalism" as the authentic source of life, distorted by the actions of men.

In the theory of the "natural man," there are two different elements that must be recognized, as correctly established by Bidney: on one hand, the assumption of an original prehistoric natural state, from which the current human being has emerged, and—on the other hand—a universal present state, by which the human being, in all places and at all times, is the same. In the latter case, it is not a past genetic condition, but rather a universal condition of the human being that persists as such beneath cultural modifications, which are thus merely superficial.

We now know that there is no such thing as the "natural man," and that this theory is an extension, in the scientific field, of a religious fantasy that assumes the human being was created in a "pure" form by the hands of God, only to later suffer a decadence or "fall" into sin and guilt. The theory of the natural man is not an isolated postulation, but is part of a broader conception that considers the world as invariable and fixed, and that, in addition to the natural man, also postulates a natural justice, a natural right, etc. In other words, it is part of an ideology.

Anthropological research has demonstrated, incontrovertibly, that individuals in primitive cultures are not natural beings either, and that their personality is functionally correlated with the overall structure of their respective social organization, which is also not simple and straightforward, but highly complex.

We know that man is a historical product; he transforms nature, and in that process, he creates culture and transforms his own nature. With humans comes a new way of adapting: the ability to create new environmental conditions by transforming the natural environment, and this process can be carried out, in part, by anticipating the results and objectives. The human being himself is also a product of historical development and becomes a new nature: the human one.

4. The Isolated Man

This is another deeply rooted assumption in our culture and, therefore, in our scientific theories. It is assumed that the human being is originally and primitively—both as a species and as an individual—an isolated, non-social being, who gradually assimilates the necessity of relating to other individuals. Thus, one problem posed for psychology was how human beings establish relationships with one another. To address this, hypotheses were put forward—such as that of a gregarious instinct or a special energy, libido.

This abstraction is closely related to the previous one, that of the natural man, and both overlook the fact that a human is only such insofar as they are social, and that even the high degree of individuality reflected in this postulate is also a social product. In summary, it can be said that even the isolated man often considered by psychology is a social product, and this theory, often referred to as the "Robinson Crusoe theory," has no valid foundation.

The problem, in fact, is currently framed in entirely reversed terms; it is no longer a matter of understanding how isolated individuals become social beings, but rather how members of a culture and eminently social beings become isolated men. Even from the perspective of their biological development, beginning with intrauterine life, the human being exists in intense and profound interconnection with the life of other human beings, in a true symbiotic relationship. Research now focuses on the complex process of acculturation by which the human being transitions from this undivided, primitively undifferentiated state to the condition of an individual and person.

5. The Abstract Man

This is one of the most serious conceptual and methodological errors in the field of psychology, stemming from the corresponding philosophical error. It consists of studying the human being as if they were determined and isolated from the real, historical, and present situations in which their life unfolds, their personality is formed, and all kinds of relationships are established.

As a result, the more abstract the human being being studied is, the more identical all of their characteristics become, and the more fixed, eternal, and immutable the categories elaborated for them are. Abstraction leads to both the concept of the isolated man and the natural man, discarding social and cultural variants as non-essential additions to the human being, which are seen as merely superimposed or even subverting an original nature. This has led to erroneous generalizations and conclusions, to sterile concepts and notions, and to a mythology of psychological entities.

Moreover, as Foucault expresses, "when it comes to humans, abstraction is not just an intellectual error," because it transcends as an ideology, not only in the scientific field but also in the political and social spheres, as an instrument of domination and control.

In contrast, modern psychology tends to consider all psychological phenomena as derived from specific relationships and concrete interactions of the human being, as a social being, with the real situations of their life. This is the aspect that, even with various inconsistencies and errors, has been incorporated into psychology with the rise of the various schools of the past fifty or sixty years, and this is the most serious deficit of traditional psychology. In traditional psychology, the human being is studied in general; perception and memory, for example, are treated as entities in themselves, not as the human being who perceives or remembers, nor as that which is perceived or remembered, in a specific social and economic structure, at this moment, and in this situation.

This process of abstraction, realism, and formalism in traditional psychology and the innovative role of modern psychological currents have been skillfully analyzed by Politzer, to whom we refer the interested reader.

6. Individual-Society

This is a false antinomy that still deeply permeates psychology, as well as other scientific fields. It assumes that the individual is limited, distorted, or coerced by the social organization. It is closely related to the conception of the isolated man, as it assumes that, to achieve the benefits of social life, human beings have had to and still must sacrifice the satisfaction of individual tendencies, which are considered incompatible with social norms and the cultural organization in general.

These assumptions tend to obscure the irrational element of social organization, attributing it to a primitive animal organization of the human being that still exists in each one of us, thus superficially saving a deep contradiction inherent in the social structure itself. This structure is complex and contradictory, and such contradictions are reflected in the human being, both socially and individually considered. The aim is to "save" society in its present organization by considering the human being as bad and animal-like, attributing to them all the misalignments of our organization. This is the opposite of the myth of the natural man, in which the human being is good and society is bad. Thus, at some point, this latter thesis was supported as a social critique and as a progressive and renovative tendency.

If we take the case of delinquency, war, or prostitution, the schema proposed by this individual-society antinomy views them as resulting from primitive, instinctive, or animal impulses that still exist in all individuals and that, at a given moment, surpass the barriers of cultural control and repression. The problem actually lies in the fact that the same society that represses and prohibits delinquency, prostitution, and rejects wars, also paradoxically holds within it—the causal elements of these issues—in the form of irrational social components that are not controlled.

There is a permanent and close relationship between the individual and society, and only by understanding one can we truly understand the other. As human beings, we depend greatly on nature, our peers, and social organization to satisfy our needs.

7. Innate-Acquired

This antinomy has been the focus of research and debate for a long time and is closely related to other antinomies, such as nature-society, inheritance-learning, etc.

All these contradictions are shaped by formalism and a lack of understanding of the dialectical process. However, this does not occur only as an intellectual or ideological process but also reflects the struggle between "fixism" and progressive social currents. All those positions and forces striving to maintain the idea of a fixed, unchangeable nature and society, created once and for all, aligned themselves with theories that postulated the innate, while those advocating for the improvement and progress of social organization emphasized learning, acquisition, change, and development.

8. The Human Being

In contrast to the metaphysical dualisms that still permeate all of our scientific knowledge, the dialectical conception tends to consider the unity and interdependence of all phenomena, seeing all antitheses as phases or moments of a process. Thus, discussions and investigations that isolate the human being or treat abstractly a part of their manifestations—without connection to nature or their social environment—lose relevance. The human being can then be characterized by the following:

a) Their condition of belonging to a very peculiar nature: the human one. Since the Renaissance, humans have understood that they are part of nature, but much later did they accept that they also form part of a very distinct and particular nature. Their social condition gradually structures an integrated synthesis of nature and society, where the latter is not a superficial factor that modifies transient or non-essential characteristics of the human being, but rather profoundly and substantially changes the original state of being natural, in the sense that humans depend significantly, if not entirely, on nature.

b) Their condition of being concrete, meaning that they belong to a specific culture, social class, ethnic group, or religion, and this belonging is not accidental or random, but it is integral to their being and personality. Consciousness and attention should not be studied abstractly but rather the concrete behavior of a particular individual or group in specific conditions and at a given moment.

c) Their condition of being social, meaning that a human being is only a human because they incorporate and organize experiences with other individuals. The entire set of social relationships is what defines the human being in their personality.

d) Their condition of being historical, both individually and socially, as a product of a development in which new potentialities emerge that are not fixed and immutable once and for all. This high degree of development depends on a complex organization of living matter and reflects the social structure in the broadest sense.

e) Because the environment of the human being is a social one, from which fundamental stimuli arise for the organization of psychological qualities.

f) Because the human being cannot be understood purely by reflection; the knowledge that is acquired is, in turn, socially conditioned.

g) Because the human being is the only living being who can think of themselves as an object, use thought, conceive universal symbols, create language, foresee and plan actions, and use tools and techniques that modify their own nature. Even while being part of nature, the human being can, to a certain extent, be independent of it. All of this is closely linked to their unique ability—unlike any other animal—to produce their means of subsistence.

h) That the production of those means of subsistence creates the fundamental matrix of all human relationships.

Bibliography

Complete references for the citations in each chapter can be found in the general bibliography at the end of the book.

Brown, J. A. C.; Buber, M.; Cassirer, E.; Dujovne, L.; Engels, F. (e); Favez Boutonier (a); Foucault, M.; Goldstein, K. (a, b); Groethuysen, B.; Kardiner, A.; Marx, C. (a, b); Marx, C, and Engels, F. (a); Merleau Ponty, M. (b); Plejanov, J.; Politzer, G. (a); Rosenthal, M.

Enrique Pichon-Rivière: A theory of prevention approach within the family group.


From an integrative perspective of the "person in situation," and from an interdisciplinary approach, we cannot address the issue of prevention without trying to locate it in its proper context. Mental health, which is previously defined and implicit in this type of approach, is not an absolute value for us, and it can be evaluated in terms of the quality of social behavior.

This behavior, its operability, or its deterioration, is closely linked to socio-economic and family factors, which intervene or determine, either positively or negatively, an active adaptation to reality, where the individual engages with the environment in a creative and modifying relationship.

From this perspective, the central issue is not the methodology of prevention but rather the strategies for changing the socio-economic structure from which mental illness emerges. The patient is the spokesperson for the conflicts and tensions of their immediate group, the family. But, it is also for this reason that the patient is the symbol and the repository of the alienated aspects of their social structure, a spokesperson for insecurity and the climate of uncertainty. To cure them is to assign them a new role, that of agent of change, and for us to transform ourselves into elements of change as well.

It is important to note, from a perspective focused on prevention techniques, the instrumental and operational nature of the family group as the support of the social organization, the primary unit of interaction, which is established based on an interplay of differentiated roles.

Its structural nature arises from the necessary interdependence of the roles corresponding to the basic triangular situation: father, mother, and child, emerging from the functional and biological relationships and differences. This basic and universal triangular situation, with its potential cultural variables, determines the model that family interrelations will follow.

The mentioned structural nature of the family group allows us to approach it as a unit of analysis, in the sense that we can engage with it as a diagnostic, prognostic, therapeutic, and prophylactic unit.

As a basic unit of interaction, the family appears as the socializing instrument, within which the individual acquires their identity, their individual position within the interactional network. The functionality and mobility of this position will indicate the degree and nature of adaptation within that group context, of which each individual is the spokesperson.

When, within this structure, which acts as a vehicle for cultural norms, mediating between the individual and reality through relational ties, illness emerges as a new quality in the interaction process, we understand this deviant behavior as an anomaly that affects the entire structure in its intra-systemic or inter-systemic process of interrelation.

The illness is the emerging quality, a new quality that refers us, as investigators, to an implicit, underlying situation, shaped by a particular modality of group interaction, which at that moment becomes alienating. The patient is the spokesperson through which the pathological situation manifests itself, affecting the whole structure.

That is, the spokesperson (patient) is the vehicle through which the implicit process causing the illness begins to manifest.

We can affirm that any implicit process manifests itself through the appearance, within the observation field, of a new quality in that field, which we call emerging, and which refers us, as investigators, to an implicit occurrence, or in other words, to an order of underlying facts, subjected to a constant process of structuring and de-structuring.

In a previous work, we stated that madness is the expression of our inability to endure and process a certain amount of suffering. When a neurosis or psychosis emerges within the family group, we discover that a certain degree of insecurity had previously settled within that group, rendering it impotent.

This dynamically means that a member of the family group assumes a new role, becoming the spokesperson and repository of the group's anxiety. They take on the pathological aspects of the situation in an interactional process of assigning and assuming roles, involving both the individual recipient and the ones assigning them. The stereotype forms when the projection of pathological aspects arising from this insecurity is massive.

The individual becomes paralyzed, fails to process such intense anxiety, and becomes ill (at which point there is a shift from the quantitative to the qualitative).

From this moment on, the cycle of forming a pathological security mechanism is completed, triggered by increased tensions, which consists of the massive deposition, followed by the segregation of the repository due to the dangerousness of the deposited contents.

The interplay of roles is characterized in this situation by its rigidity and immobility, no longer governed by a law of complementarity but by a principle of supplementarity. That is, once the interactional process has established a stereotyped and repetitive pattern, an entire feedback system is put at the service of that pattern.

As a prevention strategy for the emergence of pathological situations within the family group, we will propose some clarification techniques aimed at reinforcing aspects of mobility and operability within the group. Our goal is to create an adaptive and creative security device that enables the group to face the situations of change that generate insecurity.

As approaches, we will follow the proposals in our inverted cone scheme, where we categorize the modes of interaction observed in any task group within the vectors of belonging, cooperation, pertinence, communication, learning, and tele. The operational group and the family group are susceptible to the same definition: a set of people gathered by constant time and space and articulated by their mutual internal representation, who implicitly or explicitly propose a task, which constitutes their purpose. In this case, within the family group, we will add kinship ties to the constants of time and space. The family group's task is, as previously stated, the socialization of the individual, providing a framework and foundation for achieving active adaptation to reality, in which both the individual and the environment undergo a permanent dialectical interplay.

This model can provide a reference framework for the operator, whether they work in what is generally understood as primary, secondary, or tertiary prevention.

The clarification and operational handling of the vectors of belonging, cooperation, pertinence, communication, learning, and tele will allow the group unit to address the anxieties triggered by the situations of change that any family group necessarily goes through.

Among these situations, we are particularly interested in highlighting two critical ones: adolescence, marked by the transition from the child's role to the adult's role, and entering old age, characterized in our family structure by the loss of operational roles. We see that in both cases, there are significant alterations in the process of assigning and assuming roles within the family group.

We understand belonging as the feeling of being part of a group, identifying with the events and vicissitudes of that group. Through belonging, group members visualize each other as such, feel the other members included in their internal world, and internalize them. Through this belonging, they can count on each other and plan the group's task, including them. Belonging allows the establishment of the group's identity and the individual's identity as part of the group. For Sartre, any group that does not reflect, as an act, upon itself runs the risk of falling into what he calls "seriality." The individual who sees themselves as a member of a group, as belonging, acquires an identity, a basic reference that allows them to situate themselves and develop strategies for change. However, optimal belonging, like the other vectors of approach, is not "given," as consanguinity ties might be, but acquired, something achieved by the group as such.

Through belonging, cooperation, and mainly pertinence, in which communication, learning, and tele play a role, the group reaches totalization in the sense of becoming in its process, in its task, in its work as a group.

Following Sartre's view of the group as an act, as something that constitutes itself permanently as a group, we must consider the fundamental role that internal dialectic plays in establishing the constitutive relationships of the group. This is why we have emphasized in this definition the fact that the group is a set of people articulated by their mutual internal representation. This representation follows the characteristics of the dramatic model. The internal dialectic is the dialectic of the internal group whose chronicle – always following the mentioned model – is unconscious fantasy. Through this dialectic, each member achieves a totalization, a synthesis, that constitutes the group as a group. Put in Sartrean terms, this internal and external dialectic leads the group to transcend seriality, understood as dispersion.

The task, the group's sense, and the mutual internal representation made in relation to the task constitute the group as a group. The task is the group's march towards its goal; it is a becoming and a dialectical doing towards an end, a praxis, and a trajectory.

In a family group, cooperation is based on differential roles. We emphasize the heterogeneity that roles within the family must exhibit. This heterogeneity is supported by the biological and functional differences on which a family structure must be configured. The family, as we have said, thus becomes the realm of learning biological roles and social functions.

Only through heterogeneity can we achieve the complementarity needed in an operational group, that is, in a group capable of instrumental and situational achievements.

A clarification of the group's communication networks, along with addressing family mysteries and analyzing ideologies, will allow, along with the adjustment between internal images and external reality, the resolution of misunderstandings, thus creating the appropriate climate for the family task.

Bibliography Sartre, J.P., Critique of Dialectical Reason, Losada, Buenos Aires, 1963
Lapassade, G., Institutions, Groups, and Organizations, Gauthier-Vilars, Paris, 1968.
Pichon-Rivière, E., "Family Groups: An Operational Approach," in this volume.
__,"Praxis and Psychiatry," ibid.
__,"Use of Tofranil in Individual and Group Psychotherapy," ibid.





Enrique Pichon-Rivière: Corporal Schema.

Notes by Dr. Fernando Taragno

In Schilder's definition, Pichon-Riviére introduces a new dimension, the time factor: "The body schema is the four-dimensional image that each one of us has of ourselves." He conceives it as a social structure, configuring notions of space and time that govern many aspects of our relationships with others.

He considers the divisions established between mind, body, and the external world as formal separations, as phenomenological areas or dimensions of the self or person. He describes three areas: Area 1 (the mind), Area 2 (the body), and Area 3 (the external world). This division is purely formal, as everything that happens in the mind, body, or world is related to common basic situations across all of them. In other words, both neurotic and psychotic structures can be expressed in the mind, body, or external world. Nothing that happens in a specific area is not experienced by the entirety of the person. This three-dimensional schema is a phenomenological designation, a way to place different categories of good and bad objects in various areas.

He attempts to conceive this schema as a unity in constant function, where the totality is included, expressed through an outward behavior that is visible and called objective behavior, and through an internal behavior, the emotional life through the body, in a constant relationship with the object. Of the three areas, Area 2 (the body) is the most "scotomized" for the self, where the objects projected there are less recognized, as well as the connection and unconscious fantasy accompanying it.

This mind-body division, which has emerged as a result of one of the most primitive defense mechanisms (Scott), serves to separate the mind from the body, creating two "bags," if you will, to place the first introjected objects, both good and bad, so that they don’t mix and contaminate.

The child conceives his body and mind as a unit. In the progressive postnatal integration of his body schema, Pichon-Riviére introduces a new concept: these integrations occur around a prenatal axis that he calls the proto-body schema, which is made up of interoceptive, proprioceptive, etc., stimuli originating during fetal life. In progressive structuring, the body schema in a child develops particular characteristics based on oral, anal, or genital primacies. The interplay of projections occurs through these openings and primarily concerning problems of distance. For example, in hallucinations, we can see a pathology of space related to the body schema.

According to his theory of the unitary conception of neuroses, psychoses, characteropathies, and psychosomatic diseases, he establishes that the main difference between them lies in the area of expression of conflicts, whether in the mind, in the mental representation of the body, or in the mental representation of the external world. Always keeping in mind that the totality of the person is engaged, though one structure predominates.

The bond with the object is not only established with the psyche but also expressed through the body. Thought is manifested through the mind, but the entire organism is involved in the situation.

The basic psychotic anxieties underlying the different neurotic, psychotic, characteropathic, perverse, and psychosomatic structures are the same in all of them. They are depressive and paranoid anxieties, which shape the depressive and schizoparanoid positions. In the first position, the relationship is with a total object, both good and bad at the same time, before which the person experiences the feeling of ambivalence. In the schizoparanoid position, the objects are partial, divided into good and bad, creating what Pichon-Riviére has called "divalence," meaning the simultaneity of opposing partial feelings.

According to the technique used for controlling and managing these internalized partial objects, different nosographic pictures will be configured. It can be said that the basis of all mental pathology lies in the schizoparanoid position. When the partial bad or persecutor object is projected in Area 2 (the body), we have hypochondria. The persecution is experienced in the body. This is where the self feels the threat, the danger of death. It is posed as an alienation localized within the body schema. Madness is confined to the body or part of it; it has a particular meaning; the symptom appears in a specific situation, with a particular connection and an unconscious fantasy. This notion of the relationship with a persecuting object within the mental representation of the body is fundamental. The hypochondriac becomes megalomaniac by identifying with the internalized good partial object within his mind, feeling omnipotent when he manages to control his persecutors internalized in his body, control which he establishes through his mind. It can be said that he is a patient who specializes in controlling his persecutors by putting them inside his body.

In the internalization of this bad and persecuting object, a division and dispersion of the object throughout the body occur initially, resulting in generalized suffering. The fragmentation of the object is a mechanism aimed at making it easier to control the parts, it’s a "divide and conquer" approach, as M. Klein would say.

In the vast majority of cases, internalization occurs orally, within the digestive system, later spreading to other organs. As for the choice of organ within which the hypochondriacal situation is established, it falls on the one that, due to a previously learned "profession," has greater control within the limited space of the reference organ.

The hypochondriac often chooses a hypochondriacal woman who has failed to control her own persecutors. He projects his own sick organs, including the persecutors, onto her body. This externalization of his sick organs allows the hypochondriac to observe and control them from the outside. It’s what Pichon-Riviére calls externalized hypochondria. She, in turn, has chosen him because she feels he is capable of controlling her own persecutors, control in which she feels she has failed. Together, they form an inseparable pair.

In conversion hysteria, the basic situation is hypochondria. In pure hypochondria, which doesn’t actually exist, the inclusion of the bad object occurs without provoking any reaction from the organ in which it is included. When the organ reacts with its own functions, with the purpose of managing the persecuting object included within it, we find the phenomenon of conversion. For example, in hysterical paralysis, which is the prototype of neuroses that take part of the body schema and eliminate it from the rest, the self deposits the conflictual situation in a paralyzed limb, isolating it from the rest of the self through the mechanisms of division and repression.

Persecution in the body is not "psychologically" experienced because the body-mind division mechanism is permanently active. At the same time, a part of the body is isolated and its content repressed, giving rise to the feeling described by Charcot as "la belle indifférence."

The reason why conflicts are presented in the body dimension brings forth the issue of the choice of expression area, which would be related to the individual history, hereditary factors, and dispositional characteristics of each subject.

The hysterical symptom is situational because it includes a specific object relationship, which occurs in the body dimension, with that object being administered, controlled, expelled, etc., meaning it undergoes all the vicissitudes of objects, but within the mental representation of the body. In the body, defensive techniques are more limited, as they are confined to the specific functions of each organ.

The concept of conversion implicitly includes a dualism, i.e., the conversion of one system into another, or from something that belongs to it. This is why Pichon-Riviére thinks the word is beginning to be troublesome. Because if one considers that what happens in the body is relational, a specific way of approaching the object within a total situation with a particular fantasy, conversion disappears. This term complicates the total understanding of the phenomenon, the organic symptom. On the other hand, the concept of situational relationship, connection, or visceral behavior facilitates it.

Conversion hysteria can be divided into two groups, depending on the system that intervenes in the control of internalized persecutor objects. On one hand, we have true conversion hysteria, where control is carried out through the central nervous system, in the neuromuscular and sensory system, such as in paralysis, blindness, convulsions, etc. On the other hand, there are so-called psychosomatic diseases, where control is established through the autonomic or neurovegetative system, expressing itself in the visceral field. Psychosomatic disease must be understood, in relational terms, as the establishment of a particular bond with a given object, within the body schema, with the functions of the organ regressing to earlier stages, where certain types of bonds predominated. This regression in organ functions creates a mismatch in the total economy, leading to the disease (Pichon-Riviére). The regression is towards the dispositional point, which is the developmental moment when certain types of visceral behavior were organized, achieving at a given point the control of anxieties.

During the phenomenon of regression, this does not only occur in the sense that objects are deposited in the body, but the organ itself also undergoes regression regarding its functions. For example, the stomach of an ulcer patient is a stomach that has regressed to its infantile stage, as the rhythm of hunger and satisfaction is similar to that of that period. The painful hunger of the ulcer patient is equivalent to the painful hunger of the infant. Here, the regression of functions to a specific stage and particular connections can be seen, with the totality of the person returning to a type of behavior that was operative in defending against anxiety.

The illness would arise from the conflict between the regression of an organ to a more primitive function and the persistence of the rest of the body at a more adult level. This would explain the pathology specific to the organ and the influence of the organ on the total economy. According to Pichon-Riviére, the organ that becomes ill is not the weakest, as it has been considered so far, but rather the strongest, the most resistant. Because the chosen organ is the place where the ego is most entrenched, where there is the most communication between it and the functions of the organ in question. The choice is made for the organ that already knows the task. Thus, the ulcer patient has long been thinking and acting with their stomach, trying to control the pursuing objects that determine their paranoid anxieties.

From a dispositional perspective, the chosen organ is the one that, at a given moment, has tended to establish a defense from there.

In the phenomenon of conversion, the relationship with the internal object is not explicitly stated, but it is implied, although not visible. What is visible are the defensive mechanisms that cause all the symptoms of conversion, either through the central nervous system, the peripheral nervous system, or the neurovegetative system. These are different levels of expression of behaviors through the body.

The subject configures a psychosomatic illness at a given moment with the purpose of "escaping" from psychosis (Pichon-Riviére). From a social perspective, it has the great advantage that this illness does not appear in the category of alienation. The subject suffering from it is considered a body patient and not recognized as a mental patient.

We should consider it as a pattern of repetitive behavior expressed through the body. A pattern that includes both the organ and the object, its connection, and the unconscious fantasy in totality. There is always an alternation between a bodily expression and a mental expression, and quite frequently the succession of psychosomatic conditions with psychotic episodes.

It can be said that children who have been overprotected in a situation of illness in a particular organ tend to escape from the mental situation and develop a psychosomatic illness. Meanwhile, children who have suffered from a situation of bodily neglect tend to develop mental elaboration. Repeating a situation of bodily neglect is much more dangerous for them, so they try to elaborate the situation through the mind. Among these three nosographic pictures—hypochondria, conversion hysteria, and psychosomatic illness—only phenomenological differences exist, having instead a common dynamic unity.

The phantom limb highlights a serious disturbance of the bodily schema. It is of particular interest because it poses the problem of alienation in the body. It is characterized by the compensatory illusion of the amputation on an amputated limb. It occurs in an unconscious, conflicted, and situational context. It appears in some cases, and specifically in front of certain people, with specific unconscious content. The phantom, by occupying a spatial position, that empty space from the stump, raises the problem of externalization, in the same way as in visual or auditory hallucinations, for example. The essential mechanism is the division of the bodily schema, followed by repression. It appears mainly in narcissistic structures, where internal relationships in the bodily domain are fundamental. The illusion of the amputee is a mechanism for recovering the object through the phantom limb (Pichon-Riviére). Thus, we find: 1) a narcissistic structure; 2) the loss of the limb; 3) the depression following the loss of the object included in that part of the body, and 4) the recovery or establishment of the lost bond through a hallucinatory mechanism. The reintroduction of the object occurs through the stump, a displaced oral route. The phantom detaches itself from the rest of the body through the mechanism of division.

In any kind of hallucination—whether visual, auditory, etc.—the problem of externalization is posed. There is an alteration of the bodily schema in the sense that a part of oneself is placed outside, through the mechanism of division and projection. It is the situation of one divided into two, and one of those parts placed outside and later perceived as though it belongs to someone else. This occurs during waking in hallucinatory delusions, where, for example, the voice heard from outside is produced by the extension of the bodily schema, which has been divided and functions by creating a situation of two.

The "influence apparatus is, ultimately, a part of the body itself that has been placed outside through the projection mechanism. It then appears as the representation of the own penis or sexual organs projected into the outside world.

In depersonalization, the bodily schema is massively compromised. It can involve both the sphere of the mind and the body. The first symptom of a hypochondriacal delusion evolving into a Cotard delusion is the estrangement from the body. It appears before the specular vision as different. In Cotard syndrome, the first situation that occurs is the internalization of the persecutor in the body, configuring hypochondria. It then denies the incorporated object, including the organ where it has been included, expressing, for example, that they have no stomach, heart, etc. Finally, they rationalize the reason for not having that organ by constructing the delusion of denial.

Anosognosia is the failure to perceive a zone of the bodily schema, whether altered or not, functionally and organically, for example, in the case of hysterical paralysis, blindness, etc. Here we find the mechanism of denial through the bodily schema.

Negative external autoscopy is the failure to perceive one’s own specular image in the mirror, i.e., not perceiving the image reflected in the mirror. Positive autoscopy occurs when the subject sees their double outside, in any place, as if in front of the mirror.

In the phenomenon of levitation, sudden sensations of lightness occur, with alterations in body weight and consistency. It is the expression of a manic bond in the bodily area (Pichon-Riviére).

In epilepsy, sudden alterations of the bodily schema occur, with paroxysmal character being the most typical element. These disturbances are very frequent and should be systematically searched for.

During the application of biological treatments, very frequent and significant changes to the body schema occur. Upon awakening from an insulin coma, alterations can even reach experiences of metamorphosis (Pichon-Riviére). The same occurs with the administration of mescaline and LSD-25. Electroshock, electronarcosis, etc., also cause changes in the body image, as does prolonged sleep application.

Space is comprised of three areas: mind, body, and external world, functioning with a given time and situation, the dynamic origin of which is constituted by the bond, a functional structure that includes the subject, the object, and a two-way communication that can suffer disturbances specific to each neurosis, psychosis, characteropathy, perversion, and the so-called psychosomatic phenomena.



Summary:

Schilder defines the body image as "the three-dimensional mental representation that each of us has of ourselves." This image is constructed based on multiple sensations that dynamically integrate into a Gestalt of the body. It is a structure in constant disintegration and restructuring. Libido plays a fundamental role. He describes the space of the ego, the objective space, and the space of the id, where affections bring objects closer or push them away. There is also the body space and the external space.

Scott suggests that the mind-body division arises from an early defense mechanism aimed at resolving specific anxieties. The phenomenon of the bodily surface is fundamental for establishing the domain of the self and the non-self.

Pichon-Riviére describes three phenomenological areas of the self or person: mind, body, and the external world. The integration of the schema is based on a prenatal proto-body schema. According to his theory of the unitary conception of neuroses, psychoses, character disorders, and psychosomatic diseases, he establishes that the main difference between them is the area of conflict expression. When these conflicts are expressed in the body (Area 2), and depending on the technique used to control the internalized pursuing objects, we have hypochondria, conversion hysteria, and the so-called psychosomatic diseases. The control is established, respectively, through the mind, the central nervous system (expressed in the muscular and sensory territories), and the neurovegetative system (expressed in the visceral field). The organ that becomes ill is the strongest, not the site of least resistance.

The author proposes the designation of the self-schema as a conceptual, referential, and operational schema that includes the three dimensions: mind, body, and the external world, functioning with a given time and link that includes the subject, the object, and their communication.

Acta Neuropsiquiátrica Argentina, 1959.