The effects of psychotherapies: a study on patients' perception of results in an Italian public setting.

Enquiries centred on the perspective of users of psychiatric treatments and their families, has become an increasingly widespread method to improve the quality of treatments administered by health services. In this study, in particular, we examine the users' perception of the quality and variability of the effects of psychotherapies, the difficulties met, and the perceived help factors. The sample consists of 216 users of psychotherapy and 223 patients in psychiatric treatment with psychological support. They are outpatients, managed by the public health service. The questionnaires included closed ended, open-ended questions and scales that were previously tested on a sample of patients. The questionnaire for patients was anonymous and administered by researchers external to the medical staff. Irrespective of the diagnosis or of a concurrent pharmacological therapy, a high percentage of patients (75%), in both groups, feel improved. Improvement consist of the decrease of symptoms, a sense of feeling better, but also feeling grown up, more mature, having higher self-esteem and feeling more adequate in interpersonal relationships. This last type of result is significantly more frequent in the group of patients in psychotherapy. Besides these patients are faced with more difficulties and play more active a role while they are in treatment. The main difference between patients in psychotherapy and those in psychiatric management with psychological support is not indeed the identification of different perceived therapeutic factors, but rather the different evaluation of their relative importance. On the whole, the study seems to show that the effects of real psychotherapies include, beside an improvement of symptoms, the achievement of goals of personal growth and maturity, self-satisfaction and an increase in self-esteem, all in accordance with a conception of health as well-being and self-satisfaction rather than as absence of illness.

[Psychotherapies in psychosocial centers in Lombardia: a point of view of psychiatrists and psychologists]. / Le psicoterapie nei centri psicosociali della Lombardia: il punto di vista di psichiatri e psicologi.

OBJECTIVE: The purpose of this study is the systematic analysis of operators' points of view about psychotherapies concretely performed in the Public Psychiatric Public Services and inside the global operating mode of the assistance. SETTING: The study has involved 26 CPS selected randomly in Lombardia. The sample has been built with 73 psychiatrists and 42 psychologists. MAIN OUTCOME MEASURES: All the therapeutists involved in this research have been submitted to a question-form querying socio-anagraphic data, professional training, orientations, operating modes in their CPS, rules and objectives of their psycotherapies, observations and evaluations about psychoterapic treatments and their effects. RESULTS AND CONCLUSIONS: Psychiatrists and psycologists working in CPS, mostly the younger ones (less than 45 years old), followed a personal training in over the 70% of the cases. The prevalent orientation is the psycoanalityc one in both the categories. The most part of therapeutists deems that there has been an evolution in their way of conceiving psychiatry inside the public service. The lines at these evolutions have been mentioned explicitly in the article. Psychiatrists and psycologists, even with some concrete differences; seems to have mostly homogeneous points of view: psychiatrists have a more flexible vision of which practices can be considered as a psychotherapy, whereas psycologists are more rigorously linked to theoric reference models and to rules learnt during their training. They are both slightly favourable to the use of psychotherapies in their services, even if, as a matter of fact, they are used by just a few patients. No contrast between psycotherapy and psycopharmacology has been detected from operators' answers. These practices seem to be both considered useful and integrable.

The training of the psychiatrist in relation to the new trends in psychiatry.

One of the most important things to realize about modern Psychiatry is that many factors are involved in the pathogenesis and especially in the evolution of mental diseases. The results of epidemiological research and the development of different schools with separate specializations have shown the importance of extrasubjective factors such as family environment, social context, life events and life stressors, and therefore the need to find therapeutic strategies which are able to influence the different areas. From this wide spectrum arises the necessity for a functional integration of the different therapeutic areas in the operative context, also because of the nonhomogeneity and the frequent random choice of reference models by the operators and the mental health services. In this study we propose a training model which allows the achievement of this integration ability at an operative level, and which at the same time defines its limits.

Substance abuse and psychopathology. A diagnostic screening of Italian narcotic addicts.

This report evaluates, using DSM III, the psychopathological profile of 226 heroin users taken in at the clinical centre of "Cascina Verde" Therapeutic Community (Milan, Italy) and admitted to a psychotherapeutic, retraining, integrated, both out-and-in-patient treatment. The outcome shows that 30% of subjects are to be diagnosed according to Axis I while 61% are to be considered among Axis II personality disorders. A portion of 16% is to be referred to the "schizophrenic spectrum", 25% has histrionic, narcissistic, antisocial and borderline personality disorders and the remaining are to be referred to an extremely heterogeneous category. The report shows also data concerning Axes IV and V, always according DSM III.

Integrated psychotherapy in the project of the treatment of psychoses.

We present a model of integrated psychotherapy of schizophrenia. When we do an integrated therapy with a patient, attention must always be directed to the calibration of the interventions which constitute the therapeutic compound. This kind of calibration has to be done by a therapist with an integrative function. Experience and competence are necessary conditions, but not sufficient ones for carrying out such a function; the therapist must have also the authority which is due not only to his hierarchic role, but which has to be empathically recognized by the other therapists and the patient. The theoretical reflection has been possible only by starting from a clinical experience (the case of a young woman who in the light of the nosographical categories was considered an 'impossible patient') which allowed us to translate the clinical language into a conceptual form.

Involvement of families in group therapy of heroin addicts.

In a follow-up study of 98 heroin addicts staying in a therapeutic community for different periods of time the effectiveness of involving family members in the group therapy was investigated. In subjects who terminated the treatment programme prematurely on their own the length of abstinence was linked to the frequency of parental attendance at group therapy.

Representation of psychosomatic disturbances: metaphor and metonymy.

The purpose of this study was to explore the expressive capacities of our psychosomatic patients. We invited them to represent their illness in a drawing through the design test. Following this, we investigated 43 patients affected with bronchial asthma, 30 patients affected with refractory massive obesity and compared them with a control group of 25 'normal' subjects (medical students in a situation where stress and anxiety were strongly suspected as they were awaiting to sit for an examination in the Medical School). The two patient groups showed quite relevant differences as to their own expressive modalities in the use of metaphor and metonymy, which are considered as the graphic representation means of the illness.

Psychotherapy of the family as a measure for preventing relapses and improving the prognosis in schizophrenic patients.

The increasing interest in the relationship among psychoanalysis, linguistics and higher nervous activity (neurodynamic) is recalled. As most of the works on the therapy of the family have been based upon psychodynamic interpretations, the authors shall try to speculate on how much room this field should be given in the phenomena related to higher nervous activity. The study of Pavlov, Gantt and others on biological and social factors influencing human behaviour have been discussed in relation to the system represented by the family nucleus. Some aspects have been taken in consideration like the double bind, the perverse triangle and the formation of a scapegoat. Double bind theory and praxis is representing a paradoxical situation similar to unavoidable conditioned patterns. The behaviour of the "designed patient" may be interpreted as a tentative escape to express his disagreement to the fixed situation. What happens is a kind of abnormal conditioning which is realized through a progressive stratification of discordant learning. The final result is the disorganisation of cognitive processes. In the meantime, we observe a discordance of the activity of the first and the second signaling system because, very often, an apparent external calm is accompanied by intense cardiovascular or visceral turmoil. Every kind of communication should take care of both processes, the congnitive and the neurodynamic. The analysis of the verbal, as well as the non-verbal communication in the family setting, may be fruitfully based upon the study of the progressive significance of the cognitive-emotional dissyntony, as well as the dissyntony between the 1st and the 2nd S.S., and the transactional dissyntony implicit in the double bind. A group of 25 families of schizophrenics followed by one up to five years has been examined following the concepts above mentioned.