Welcoming summer, Just before we start packing for holidays our new issue is online. In this issue you can read about Playback Ψ team, by Lambros Giotis, where the participants share stories from their lives and a group of trained actors performs them on stage. It is a kind of interactive theater that strengthens the bonds of people belonging to a community. Also, we have an article by Konstantina Nousia for "Normal birth and VBAC technique (Vaginal Birth After Cesarean)". VBAC is a vaginal birth after a caesarean. It means having your baby vaginally when you've had at least one baby by  more

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What is the Playback Ψ team? Playback Ψ was created in 2004 as part of the Association of Dramatic Expression and Therapy "Palmos", with the purpose of educating actors in Playback Theater, a form of interactive theatre that strengthens community bonds. In playback performances, audience members share stories from their lives, and the actors, as well as the other artists (musicians, visual artists, light designers), portray them on stage through instant theatrical improvisation. The show is coordinated by a conductor (usually the group’s leader) who mediates between the tellers and the actors, proposing expressive ways of representing the stories. The whole process requires appropriate training, which lasts about 6 months and includes specific methods of theatrical improvisation, story-telling, narrative techniques and study of group dynamics. Which are the people who consist the Playback Ψ team? Team leader is Lambros Yotis, psychiatrist and drama therapist (PH.D.), trained in Playback Theatre with in Jonathan Fox and Jo Salas (Center for Playback Theater, N.Y.,) founders of the genre. His collaborators, who formed the first group in 2004 and still take part both as actors and trainers are: Dimitris Begioglou (clinical psychologist/actor), Christina Fragiadaki (dramatherapist /actor) and the actors and drama teachers Christos Theocharopoulos, Vera Lardi and Margarita Kastrinou. The group also consists of new members: Maria Maragopoulou (psychotherapist), Katerina Webster (drama teacher/ actor), Thaleia Portokaloglou (psychologist and dramatherapist), Artemis Chatjiargyriou (psychologist), Christos Kanavis (musician), Alexandros Misirliadis (musician) and Nikos Theoharopoulos (illuminator).  Is the team’s script specific? The scenario of each performance is not pre-constructed. It is "woven" by the audience in each performance and is different in each show, depending on what the audience wants to share with the help of the conductor. The thematic material of this performance may be anything: from initially simple words or phrases, everyday incidents, events from the latest news, to larger stories, comic or dramatic, or even dreams, wishes or songs that audience members decide to share. The conductor transfers this material to the actors and proposes an adequate form of theatre improvisation for the representation of each story. So every performance is different and this is an element that always makes it interesting and up to date. What is the role of audience in the performance? In each Playback performance, both actors and audience-members enter a process of exposing inner truths or their perceptions of reality and share it with other people. It is, therefore, an individual and a collective experience at the same time. Some audience-members also become tellers during the show, essentially co-creators. But even if some of them do not want to tell any story, they play an important role as active witnesses, who take on the confessions of those who come into the process of a personal narrative. When one goes into the process of telling a story, he begins a journey both in time and in his/her Self, a journey with an unpredictable end. It connects the performance’s “here and now” with the past and the possible manifestations of the future. The journey starts from the moment story-telling begins and ends with its presentation on stage by the playback group. What can the viewer get through this? Any teller exposes and rejuvenates his or her story bringing to life feelings and thoughts he or she has connected with it. At the same time, however, observing the representation of their story, tellers unlock closed doors. The images on stage and their associations often go through the barriers towards the unconscious. In a similar way, those images as well as the sharing after each story, can work for those who remain listeners, offering them a vivid theatrical experience. Besides, the artists of the group participating in the performance travel on the same wagon as the spectators. As they revive a story - with movements, words, light or color - they also make a journey between their “Self” and the “Other”; a journey equally unpredictable and revealing. At the same time, as far as the artistic aspect is concerned, they are constantly using their creative aura and their techniques, as the challenge of instant improvisation requires spiritual, mental and physical readiness and constant awakening of inspiration. Still, a playback performance clearly has a social and political dimension. It gives space to stories of people under oppression and voice to stories that cannot be heard easily (stories of people in social minorities, people with disabilities or diversity). Where do these performances take place? The “Playback Ψ” theatre group is open to anyone who wants to share stories from their lives. For this reason, performances have taken place in theatres all over Greece and abroad; in educational programs for adults and children; in psychiatric hospitals; in rehabilitation centers; in prisons; in scientific events; conferences and festivals. Moreover, the team's training venue, "Palmos", hosts, in addition to professional actors, anyone who is genuinely interested in learning this genre and using it in theatre, psychotherapy, education or social sensitization. The training programs end up each year with a series of performances at "Palmos", the studio of the group (3 Kleisthenous st., Kotzia Square, Athens). More information at www.therapy-playback.gr, palmos6@wordpress.com. Does the result of the Playback Ψ team really relate to performance or psychotherapy? Playback is a special kind of theatre that gives voice to any individual on the sidelines, oppressed or labeled as “different”, and at the same time to any voice considered as “improper” or “unusual” in each one of us; it allows those voices that choke through the everyday "must" to be heard. It proposes a way of coexistence through mutual respect and truth. Each person's story is celebrated through its stage representation and becomes the story of all of us. This does not mean that someone is in psychotherapy just by participating in a performance. However, playback performances have a “curative” value. In both considerations of the term “cure”: liberation and acceptance.
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Pregnancy and childbirth are milestones for a woman’s life. Every woman in labour gets to be reborn in another role, that of a mother. The way in which each woman will experience her transition to maternity affects herself, her baby, her family and the society as a whole. The imprint of entering maternity is for many women a happy moment of fulfilment and empowerment. However, there are mother for whom birth is experienced in a traumatic way and feelings of anxiety, confusion and fear emerge. According to studies, the chance of developing postpartum negative emotions is more common in women who have had a cesarean section. One out of ten women show postpartum depression, while about one in ten have clinical symptoms of post traumatic stress disorder (PTSD). These percentages are largely related to the extent of interventions that have been used during labour, whether it was vaginal or c section. The psychological trauma in childbirth is correlated with the feeling of loss of control over her body and human/reproductive rights, as well as the loss of her physical autonomy. Also, the way the new mother is treated by both health professionals as well as her family on this journey, plays a very important role. Based on the above, it is clear that a natural, non-interventional delivery is more likely to create a positive imprint to the mother, translated into feelings of strength, fulfilment and the ability to cope with the challenges of her new role in a more pleasant and enjoyable way. Studies show, that the couple that has participated in birth educational projects is more likely to experience their childbirth in a positive way and accept only the necessary interventions, if any. The choice of a vaginal birth after cesarean is an important step for many women in order to experience their birth as a positive event, something that might did not happen in their first child. VBAC is a method that requires the least possible interventions, while patience and knowledge are the key words for both the mother and the health professionals at its side, which increase the likelihood of a successful outcome. Beyond the undoubted benefits of natural birth for both the mother and the child, the psychological benefit should not be neglected. This benefit seems, according to studies, to empower the mother and add to her good mental health and well- being. Finally, it is important to know that in all European countries the midwife led care model is accessible to every mother. The midwife led care model during pregnancy and childbirth contributes to higher levels of satisfaction from the couple and at the same time reduces the likelihood of unnecessary interventions, which, unfortunately are very common in our country.
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Theoretical issues and Practice: a humanistic approach According to Piaget a newborn has no self-awareness, its world is defined as a flow of non-symbolized and non-differentiated experiences of the ‘here and now’. It perceives no space or time, it does not feel to be a distinguished creature from her significant ones, it does not know the sense of “I” or “me”. So, during the first months it starts slowly and after many repetitions to know better the environment and to recognize the first symbols, the first recordings.    SYMBOLIZATION Symbolization is a mental process that makes experience become present in consciousness. The images and experiences of the outer world are represented in the child’s mind with mental symbols which incorporate drawings, meanings and feelings.  Thus, the child learns what is the exact meaning of the mothers embrace, the kiss, or  the danger to fall down, when it tries to stand up. Many of these symbols will constitute elements of the self (Rogers, 1951). The child ‘chooses’ among all its experiences the significant ones for symbolization, the ones which will help to make further steps in the fields of its interest. The environment will play a decisive role in the creation and development of the perceptual field which leads to the creation of self, while the nature has already played a decisive role in the creation of the organism. The part of the lived experiences which includes the capacities, the preferences, the judgments and the feelings in its various activities and its interpersonal relationships, together with everything concerning its theories of life. form the self-concept, the self, the ‘I’.   DIFFERENTIATION On the other hand differentiation is a mental process,   which enlarges the symbol’s meaning after a new elaboration. When the child puts its fingers on the burning hobs of the oven, it usually believes that these hobs will always burn its hands. Then, the mother explains that the hobs become hot when one turns on the knob. The concept “it hurts there” is now differentiated and replaced by the concept “hurting depends on the knob”.   EMBODIMENT The embodiment of each experience, the recording of each symbol in the body, will be created through a psychobiological route, which involves creation of new synapses, changes on blood flow, genes expression as well as epigenetic mechanisms. As mentioned, symbols can include image, sound, taste, smell and touch and will be developed from a combination of selective attention and inattention (Harrison, 1978).  Phenomenology gives a fundamental role to the body that is considered as the cradle of experience, the cot for a genuine embodied self. For Husserl (1999) the body is a locus of distinctive sorts of sensations, that can only be felt firsthand by the embodied experiencer concerned. Accurate symbolization and differentiation are crucial for the child’s and the adult’s health. To be specific:   OBJECT CONSTANCY Margaret Mahler names ‘object constancy’ the mental ability to maintain accurate symbolization of the positive mental image of the ‘significant other. This means, that a positive image of the parent will provide to the child the model of admiration, approval, acknowledgement, encouragement, soothing, and boundaries (Mahler et al 1975).   In a secure parent-infant relationship the above mentioned functions will be repeated again and again.  So, the image of the parent will be slowly embodied in the child after the separation and individuation phase, which starts after the fifth month of age and continues until the end of the second year of life. The internalization of this parental image, the embodiment of this object will continue through subsequent repetitions during the childhood and adolescence. Accordingly, in adulthood ‘object constancy’ will respectively offer, self-admiration, self-approval, self-encouragement, self-soothing and self-control, even when the adult faces stressful situations. Object constancy can apply to people and relationships or to objects. Consequently this kind of parental approach permits the formation of a healthy self-concept and self-confidence. Deficiencies in positive internalization could possibly lead in adulthood, to a lack of object constancy, a sense of difficulty to perceive people as trustworthy and reliable, which lead to insecurity and low self-esteem issues (Engler, 2006)  John Bowlby (1988) in his attachment theory is not far from this idea, since  insecure attachment is preceded by parent’s anxiety and is followed by child’s anxiety, so personal development is retarded  (Campbell, 2000)   IN PSYCHOBIOLOGICAL TERMS At birth (the right) amygdala, a small, almond like, brain construct, is activated and provides rapid fear responses and face recognition, thereby conferring protection. However, if fear is dominating the infant’s life, amygdala develops hyperactivity, resulting in an imbalance of the autonomic system, and inhibits the development of higher cortical systems that are designed to manage fear at a more deliberate way.  Namely, the growth and differentiation of new neurons and synapses in hippocampus, anterior cingulate area, orbitofrontal cortex and other basal forebrain areas is vital for stress management, learning, memory, and higher thinking. But, when fear dominates the child’s personality the amygdala’s hyper function inhibits the growth of these areas. Then insecure attachment and/or traumatic experiences are more probable to occur (Montgomery, 2013) .  According to Porges (2001, 2009) the social engagement system (gaze, extraction of human voice, facial expression, head gesture and prosody) which is designed to facilitate interpersonal approach and relationships is activated “only when defensive circuits are inhibited” Insecure attachments in general are affected by lower right brain functioning, such as the problematic capacity to compare past and present or the inability to carefully consider alternative behavioral choices and change.   GENES EXPRESSION Furthermore, it seems that in stressful environments, the expression of genes is inhibited or transformed through epigenetic modification, in order to protect from painful experiences.  Namely, in highly stressful situations, the production of the brain derived neurotropic factor in the hippocampus and cortex, shows important reduction, followed by reduced production of neurons and synapses, thus hindering memorization, learning and higher thinking! And it seems that this can be transferred to the next generation, to our child’s children!!    GROUPS FOR PARENTAL SKILLS   So stress is an important factor for the development of the child. Now, let’s put these concepts in terms of parents groups: Parents enter primarily in a preparatory ten hour workshop on empathic communication and choose whether they want to continue or not.  At the start of a parents’ group, the facilitators work empathically and respectfully to each parent’s anxious experience. As known, through the work of Creswell (2007) empathy reduces the amygdala activation thus reducing stress. The parents group is also empathic to each parent’s experience without criticism or solution proposals. So, the body language and faces of the participants reflect security to the speaker. Then, topics discussed include criticism, yelling and  punishment, and their influence on autonomy, collaboration, creativity etc. (Gordon, 1980).    THREE MAIN AREAS However three are the main areas of discussion and work, in our parental skills groups: Experiential learning, targeting to the acquirement of empathic listening skills which are fundamental for parenting. So: one member listens to the experience of another then the group members are working the emotional context of the experience then the facilitators are deepening the personal meanings through reflection and conceptualization in order to enhance further active experimentation and resilience of the previously stressed parent (Kolb, 1982). The parents expectations are also elaborated at this point.  Finally peer education  exercises are performed (Rogers, 1983). Modeling of behavior and behavior proposals are also discussed. A second main topic is the work on the child’s self-esteem. Experiential learning on descriptive praise and it’s distinction from evaluative praise are cornerstones on this issue.  Carol Dweck (2006) proposes the terms ‘fixed mindset’ (‘look smart at all costs’) and growth mindset (‘learn at all costs’) in order to show the huge difference that exists in the outcome between praising the process and the effort instead of praising the result.  So, the acquirement of these special skills helps the parent to work efficiently on the child’s self-esteem and on the creation of a secure concept of self. This happens through mirror neurons  (Rizzolati, 1999) and the embodiment of the parent’s friendly face, thus allowing  children to be resilient in frustrating circumstances. A third topic is dedicated to boundaries and consequences, which gradually create  the secure framework for experiential learning of the child’s self-control. Special work is done with parents, on body language and prosody of the statements, since boundaries need to be set using a calm and secure parental figure. Stress and anger undermine their effort, as well as the child’s health. Parents learn to respond with a constantly calm manner when their child shows distress reactions. In such a climate the first recordings of their neural circuits will be created in a basis of security and confidence. Such a manner can make the child believe that its existence is important and that parents care, even though its demand cannot be fulfilled. This way, after many repetitions, the child learns to sooth itself, and to be resilient in stressful situations.   DISCUSSED TOPICS AND ‘OBJECT CONSTANCY  In terms of ‘object constancy’ (Mahler, 1975) and embodiment the three above mentioned topics, are as follows:  • empathic understanding to the parents experience offers relaxation to the parent. Then the parent will maybe (hopefully) have more time for soothing and approval to their child,  • descriptive praise skills offers  admiration, while  • boundaries and consequences skills help in order to control the child. Our parental skills programme comprises 80 - 90 hours of experiential learning.   ON PREVENTION According to Cambridge dictionary : Prevention is  the act of stopping something from happening or of stopping someone from doing something. In our case it is the act of maintaining the child’s health, or to stop the appearance of a series of syndromes, i.e. pain syndromes, premenstrual tension, fatigue syndromes, codependences, obesity or anorexia, metabolic syndrome, hypertension, autoimmunity, allergy, anxiety, insomnia, depression, severe chronic diseases (Chrousos at al. 2009).   So prevention comes through therapeutic modulation of the parent’s emotional state, which subsequently will be reflected on the parent-child relationship and results in the child’s autonomic system regulation. A child with good autonomic balance, will be able to surmount most of life’s challenges. Moreover, as far as the pedagogical process is concerned the embodiment of experiences is fundamental for reflective learning and a child’s relationship with the parent or tutor.   So when we talk about disease and health, let’s remember that in the majority of cases it’s not about nature and chromosomes, it’s about embodiment and it’s about parents and … their parents!   Thank you!
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