'ALL ABOUT MY IDEAL MENTAL HEALTH SERVICE': Users, family members and experts by experience discussing a co-designed service.

INTRODUCTION: Many studies have investigated patients' understandings of how to optimise mental health services. However, only a few studies in the Italian context have involved experts by experience (EbEs), who can be ex-users, family members of ex-users or current service collaborators. Their role is crucial in implementing collaborative service quality assessment projects. METHOD: The study investigated the experience of 35 EbEs,  users, and family members who carried out a 9-month fortnightly project aimed at imagining an 'ideal service'. The facilitators of the discussion groups (two EbEs) were interviewed; written reports of each meeting were produced with relevant comments, notes and specific suggestions; and content analysis was applied. RESULTS: The most important result concerns the effectiveness of the project management method and group leadership carried out by the two EbEs. This approach allowed for complete autonomy of the work, without professional gaze or power imbalance. Also, the ideas and specific contents focused on by the two groups offer strategies to facilitate users' entry and reception in health care centres, to reduce the stigma of mental illness, to improve the centres' physical environment, to improve organisational aspects, to keep family members actively involved and to network mental health services with other territorial services. CONCLUSIONS: EbEs have proven to be key figures in ensuring equity of role in the service co-design process. This also concerns a context, the Italian one, where their role has not yet been recognised and legalised. Their contribution and ideas to improve services could be fundamental not only in mental health centres, but also in other health facilities, and could concern the entire service delivery process rather than being limited to quality assurance, according to a virtuous circle based on active participation and transformation of the role of users. PATIENT OR PUBLIC CONTRIBUTION: This work resulted from close collaboration between the two EbEs who conducted the groups, users and family members, the university, and the psychiatrist in charge of the service. All of them contributed to the research. The EbEs, researchers and psychiatrist participated in the interpretation of the data and are the co-authors of this paper.

Issues Related to the Use of Visual Social Networks and Perceived Usefulness of Social Media Literacy During the Recovery Phase: Qualitative Research Among Girls With Eating Disorders.

BACKGROUND: The patient-centered approach is essential for quality health care and patient safety. Understanding the service user's perspective on the factors maintaining the health problem is crucial for successful treatment, especially for patients who do not recognize their condition as clinically relevant or concerning. Despite the association between intensive use of visual social media and body dissatisfaction and eating disorders, little is known about the meanings users assign to posting or searching for edited photos and the strategies they use to protect themselves from digital risks. OBJECTIVE: This study aims to examine how young women recovering from eating disorders in Northern Italy perceive the health risks and potential benefits associated with visual social networks (ie, Instagram and Snapchat). The literature has found these platforms to be detrimental to online body comparisons. It also explores the perceived usefulness, willingness, and personal interest in coconstructing social media literacy programs with girls recovering from eating disorders. METHODS: A total of 30 semistructured interviews were conducted with adolescent girls aged 14-17 years at the end of their treatment for eating disorders. The following areas of research were addressed: (1) the meanings associated with the use of Instagram and Snapchat; (2) the investment in the photographic dimension and feedback; (3) the impact of visual social networks on body experiences; (4) the potential and risks perceived in their use; (5) the importance of supporting girls undergoing treatment for eating disorders in using social networks; and (6) the usefulness and willingness to co-design social network literacy programs. Content analysis was applied. RESULTS: A total of 7 main contents emerged: active or passive role in using social networks, the impact of online interactions on body image, investment in the photographic dimension, effects on self-representation, perceived risks, self-protective strategies, and potential benefits. The findings highlight a strong awareness of the processes that trigger body comparisons in the virtual context, creating insecurity and worsening the relationship with oneself. The self-protective behaviors identified are the development of critical thinking, the avoidance of sensitive content, increased control over social networking site use, and a certain skepticism toward developing antagonistic ideologies. All these topics were considered fundamental. CONCLUSIONS: The findings provide important insights for health professionals working with youth in preparing media literacy programs. These programs aim to reduce potential risks and amplify the positive effects of online resources. They underscore the importance of addressing this issue during hospitalization to develop skills and critical thinking aimed at changing small habits that perpetuate the problem in everyday life. The inherent limitations in current service practices, which may not adequately address individual needs or impact posttreatment life, must also be considered.

(Re)constructing identity following acquired brain injury: The complex journey of recovery after stroke.

INTRODUCTION: People with poststroke acquired brain injury (ABI) face a complex and often troubled identity reconstruction journey. The literature is rich with studies related to the psychological and neuropsychological components involved in rehabilitation, but it is lacking with respect to the investigation of the existential dimensions and the challenges associated with finding new senses and meanings for one's identity and future perspectives, body and interpersonal relationships. METHODS: The aim of this study is to investigate the narrative processes of identity reconstruction after brain damage. Through a qualitative approach, 30 autobiographical narratives about self, body and the relationships with others were collected and analyzed. Semistructured interviews were used for the data collection. Narrative and positioning analysis were applied. RESULTS: Four main positionings emerged: sanctioning a radical break with one's previous life; assuming a sense of salvation and compulsory as well as irreversible adaptation to the limitations associated with one's condition; feeling different and disabled; and considering new possibilities and active constructions of self-being in relationship with others. These results underline the narrative processes of construction of the injury and the identity and delineate possible resources and instruments to improve the clinical practice for health practitioners. They are also valuable for other professionals who deal with neurological services and rehabilitation, such as psychological counselling and support for persons who have experienced ABI and their families. PATIENT OR PUBLIC CONTRIBUTION: This work resulted from a close collaboration between two universities and a hospital neurological rehabilitation department in the Veneto Region (Northern Italy). Three associations of people with stroke and their families living in the same area contributed to designing the research on the basis of the needs expressed by their members with the aim to identify strategies and devices to be implemented in the public service to improve the care pathway. They also participated in the interpretation of the data.

Implications of Involuntary Psychiatric Admission: Health, Social, and Clinical Effects on Patients.

ABSTRACT: Involuntary psychiatric admission is an increasing, widespread practice adopted throughout the world; however, its legal regulation and practice are still under debate, and it is subject to criticism from the human rights point of view. Only a few studies have strictly focused on the outcomes and subsequent treatment implications of this practice. To perform a scoping review of the literature on involuntary psychiatric admission and systematize and summarize its outcomes and implications for adult psychiatric inpatients.Four overarching issues emerged from the studies: a) symptomatological repercussions, b) impacts on treatment before discharge, c) impacts on treatment after discharge, and d) implications on patients' attitudes, behavior, and functioning. The overall evidence suggested correlations between involuntary psychiatric admission and several implications: length of stay, aggressive behavior, occurrence of psychopathologies, uses of coercive measures, psychiatric service activations after discharge, emotive reactions, and quality of life. The proposal presented here is the major involvement of the patient and of all the other actors involved during the entire treatment process to promote a shift from a delegation perspective to a negotiation perspective in the management of involuntary psychiatric admission.

Becoming ex-obese: narrations about identity changes before and after the experience of the bariatric surgery.

AIMS AND OBJECTIVES: This exploratory research investigates obese patients' beliefs and expectations before and one year after bariatric surgery. Changes and resistance to change in the identity system, in the perception of the body, in relationships and in the quality of life were of particular interest. BACKGROUND: Although bariatric surgery represents a promising treatment for obesity, nevertheless, it is still under utilised. This may be because, either the intervention is not always easily accessible or because very little is known about its psychological implications. DESIGN: Open answers provided by participants were analysed through discourse analysis. METHODS: A semi-structured interview about the exchanges in self-representations through time was administered to 30 Italian women, 15 of whom were obese before surgery and 15 were ex-obese, one year after surgery. RESULTS: The research shows that those participants who have already been operated on are generally satisfied with the results obtained; however, they faced considerable difficulties in adapting their identity to their new body. Participants reported that even one year after surgery they still thought, behaved and related to others as though they were still obese, and only after a change in awareness did they become able to realise they are now ex-obese. CONCLUSIONS: This paper contributes to the understanding of the unrealistic expectations of patients before surgery compared with the real changes in their lives, as well the difficulties they still faced one year later. More studies in evaluating how bariatric patients live with this long-term condition are recommended to foster patient-centered care. RELEVANCE TO CLINICAL PRACTICE: Health professionals should also help people to face the difficulties of the postsurgery period, which are linked to the acceptance of the new body and of the new emerging self-image in relationships with others.

Forbidden games: the construction of sexuality and sexual pleasure by BDSM 'players'.

This study aims to explore personal meanings related to the constructs 'sexuality' and 'sexual pleasure' in people who choose to write in forums and blogs about their own experience with Bondage and Discipline, dominance and submission, and Sadism and Masochism (BDSM). We carried out semi-structured online interviews with 343 people, of whom 50 (24 women and 26 men) claimed to practise or to have practised BDSM, in order to investigate participants' definitions of their sexual experiences and the construction of sexuality and sexual pleasure from their personal point of view and from the perspective of the opposite sex. Data were analysed according to Grounded Theory methodology. Questions concerning the 'normality' or the 'deviance' of participants' sexual practices were reflected in the answers of the majority of BDSM practitioners. Sexuality was construed as a 'game' with specific rules, and 'pleasure' was associated with extremely intense experiences. The relationship between the partners was considered fundamental, as it gave meaning to the sexual practice. Both dominant and dominated roles were found to be tightly linked to the possession and management of power between partners, which either confirms or reverses the social construction of traditional male and female roles.

Food safety and hygiene lessons in the primary school: implications for risk-reduction behaviors.

OBJECTIVE: This study describes an effective educational program to improve children's knowledge about characteristics of microorganisms and food contamination, and their personal hygiene behaviors. MATERIALS AND METHODS: Between November 2011 and March 2012, a health campaign, targeted at fifth-grade students of 12 public primary compulsory schools, was conceived. Participants were divided into two classes, a theoretical class and a practical class based on two different teaching approaches. To address children's knowledge and behaviors on the program topics and to monitor the effectiveness of the health campaign on changing pre-existent concepts and habits, pre- and post-intervention questionnaires were administered both to students and parents. Poisson and binomial mixed models were performed. RESULTS: Two hundred forty-nine children were enrolled. Results show an overall improvement in children's knowledge both for the practical and theoretical classes (incident risk ratios [IRRs]: 1.2, 95% confidence interval (CI) 1.1-1.2, p<0.001 and 1.1, 95% CI 1.0-1.1, p<0.001, post- versus pre-intervention). The same effect was observed for children's behavior, comparing post- versus pre-intervention for both groups (IRRs were 3.4, 95% CI 2.2-5.2, p<0.001 and 3.2 95% CI 1.9-5.5, p<0.001). CONCLUSION AND APPLICATIONS: The methodology described in this article might be usefully adopted to conduct food safety classes, contributing to the amelioration of children's awareness on food related risks and leading to significant benefit for primary prevention.

Body-Related Existential Dilemmas During Gender Transition: Research in the Italian Context.

The scientific literature shows that gender transition is effective in improving the general well-being of transgender people. However, so far, little attention has been paid to the actual role of the body concerning the existential dilemma that holds the person hostage during transition. This study investigates the relationship between the body-here considered in its concrete, experienced, imagined, and intersubjective dimensions-and gender identity. Twenty-five transgender people who live in Italy were interviewed to identify interpretive repertoires and identity positionings. Four main repertoires and positionings emerged: 1) Interpretative repertoires on the body in transition, where an enduring influence of gender binarism and biological determinants were observed; 2) Expectations regarding medically induced modifications of the body ranging from self-confidence to uncertainty; 3) Positionings toward medically induced bodily modifications, ranging from enthusiasm to resignation; and 4) Inter- and Intrapersonal positionings, where the other than self was found to act as a self-confirming resource or as a constant unpredictable and potentially threatening source of disconfirmation. Practitioners need to develop a stronger awareness of the different dimensions, meanings, and discourses surrounding bodily experience to more effectively intervene in their clinical practice with transgender people.

Transsexual parenthood and new role assumptions.

This study explores the parental role of transsexuals and compares this to common assumptions about transsexuality and parentage. We conducted semi-structured interviews with 14 male-to-female transsexuals and 14 men, half parents and half non-parents, in order to explore four thematic areas: self-representation of the parental role, the description of the transsexual as a parent, the common representations of transsexuals as a parent, and male and female parental stereotypes. We conducted thematic and lexical analyses of the interviews using Taltac2 software. The results indicate that social representations of transsexuality and parenthood have a strong influence on processes of self-representation. Transsexual parents accurately understood conventional male and female parental prototypes and saw themselves as competent, responsible parents. They constructed their role based on affection toward the child rather than on the complementary role of their wives. In contrast, men's descriptions of transsexual parental roles were simpler and the descriptions of their parental role coincided with their personal experiences. These results suggest that the transsexual journey toward parenthood involves a high degree of re-adjustment, because their parental role does not coincide with a conventional one.

Caring for People with Rare Diseases: A Systematic Review of the Challenges of, and Strategies for Dealing with, COVID-19.

The COVID-19 pandemic took a toll on everyone's lives, and patients with rare diseases (RDs) had to pay an even higher price. In this systematic review, we explored the impact of the COVID-19 pandemic on individuals with RDs from a psychological perspective. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we retrieved articles from the Google Scholar, Scopus, and PubMed databases focusing on 'COVID-19,' 'psychology,' and 'rare diseases.' Seventeen primary articles were identified (mainly from continental Europe). The results revealed the psychological effects of the pandemic on rare disease patients, including increased anxiety, stress, and depressive moods. This review also highlighted the increased vulnerability and reduced quality of life of rare disease patients during the pandemic, as well as the importance of telecare and psychological support as critical interventions for improving their well-being. There is an urgent need for multidisciplinary research and stronger healthcare systems to meet the unique challenges of rare disease patients, who represent 3.5-5.9% of the global population.

Grounding co-writing: An analysis of the theoretical basis of a new approach in mental health care.

This contribution aims to highlight the theoretical and epistemological premises of the co-writing experience, a practice where a clinician and a patient are mutually engaged in jointly or collaboratively writing a narrative related to the patient's experience. Unlike a typical set of therapeutic techniques, co-writing is based on sharing perspectives and meanings about the experience of crisis, recovery, and the therapeutic process. The paper identifies and briefly describes four non-clinical epistemological paradigms on which it is grounded: ethnography, values-based practice, narrative care, and phenomenology. Although they differ in several ways, at the same time, they seem to share some common features that the paper investigates and comments. For clinicians, nurses, researchers and Mental Health Service managers, attention to the users and to the improvement of their active roles represents not only a strategy for the empowerment of results, but also the access door to a different perspective which relies on a renewed conceptualization of the mental disease nature that may lead to overcoming the epistemic asymmetry between the 'expert' and the 'other' in favor of intersubjective dialogue.

Is falling in love within the mental health system a problem? How to turn it into a chance for the care relationship.

WHAT IS KNOWN ABOUT THE SUBJECT?: In the context of health and social care, situations at the limit or beyond the role of the professional, such as falling in love and physical attraction between a client and a nurse, are very common events. In residential contexts, the construction of the professional relationship is made more complex than in other care contexts since sharing daily life, routine, constant contact and isolation contribute to making relationships more intense from an emotional point of view. Moreover, the same elements that promote the therapeutic process (interpersonal closeness, self-disclosure, trust) are also sources of role ambivalence and possible emotional misunderstandings. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: In contrast to what is usually proposed in the literature for the management of similar situations, such as supervision by experts external to the team, this paper proposes a strategy of supervision between peers (called in literature "intervision") and of taking charge of the situation by the entire team and the group of service users. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The story here presented offers a key example that may be of interest not only to residential centres for substance users but also to all residential mental health communities. It shows not only that one can fall in love, but that this event can generate new opportunities for the therapeutic pathway. The risks associated with not addressing these situations are discussed. These include the restriction of the feeling of falling in love within the canons of error; the attribution of what happened to personal characteristics and the assumption of guilt for such occurrences. ABSTRACT: INTRODUCTION: The care pathway within a mental health service can create situations of strong emotional impact, including physical attraction and falling in love. This may evolve in moments of impasse for the staff and sometimes compromise the success of therapeutic treatment. AIM/QUESTION: This article offers some evidence about how intervene in a situation such as a client falling in love with a nurse, avoiding transforming it into a problem. The fear of the nurse, maybe already inclined to blame themselves for what has happened, when he/she asks for supervision, is to feel judged also by the supervisor. This story teaches that to refer to figures from outside the team, as would usually be the case with supervision, may be replaced by enhancing the role composition already available in the residential community as a resource. METHOD: The story was listened and enhanced thankyou to an exchange between M. and the community manager. From the analysis of the narratives co-produced by M., the former substance user, and the community manager, the elements that made it possible to transform a feeling of falling in love into an interaction of extended trust emerged. RESULTS AND DISCUSSION: The non-judgmental and confidential context, but above all the training in interpersonal exchange, facilitated the client sharing very intimate and private experiences, which are usually hidden or denied. This made it possible to make the community responsible for the individual's experiences and to overcome the role impasse and the related identity dilemma. IMPLICATIONS FOR PRACTICE: Neither nurses nor clients should be held accountable or blamed when these episodes occur. The strongest resource is sharing in the group and putting one's own experiences into play. Following the M. story, a targeted confrontation between team members and clients is an accessible and effective resource to respond to situations of strong emotional impact, falling in love being just one example; however, it can be effectively activated only through a collective taking charge of the individual's difficulties has already been implemented.

Mental health practitioners' narratives about gender transition and the role of diagnosis: A qualitative study in the Italian context.

In many European Countries, a diagnosis is needed to access the gender transition process, which has sparked debate about whether gender variance should be equated with a psychodiagnosis. This study explores mental health practitioners' perspectives about the implications of using the diagnosis for gatekeeping purposes. Semi-structured interviews were conducted with 11 Italian mental health specialists. The personal positions and interpretative repertoires emerging from the interviews centred on three thematic areas: the diagnosis, the practitioner's role, and the clinical relationship. In relation to the development of health promotion policies, findings underscore the importance of exercising reflexivity, adhering to theory and national and/or international guidelines, and analysing people's needs to ensure that the clinical setting is an affirmative space, especially for non-binary people.

What is therapeutic? Analysis of the narratives available on the websites of Italian addiction rehab centres to present the therapeutic programme.

In recent years, the use of the adjective "therapeutic" has expanded to encompass a great variety of experiences, blurring the line between what is effectively therapeutic and what is not. Proceeding from the idea that a word's meaning is linked to its use in a particular linguistic game, we will analyse the etymons "therapy" and "psychotherapy" and the change in their meanings over time. This background will guide us in the qualitative analysis of the so-called "therapeutic activities" available on the websites of 14 Italian therapeutic communities for treating addiction. Four main master narratives emerge from our investigation. These are characterised by biomedical assumptions, pedagogical principles, religious precepts, and moral values, respectively. Activities are considered therapeutic per se rather than based on theoretical assumptions regarding change. In the light of our results, the adjective "therapeutic" has become a domain of common sense, which poses the threat of undue reification of the linguistic game that expresses it.

When the non-sharing of therapeutic goals becomes the problem: The story of a consumer and his addiction to methadone.

WHAT IS KNOWN ON THE SUBJECT?: It is well known that psychotropic drugs, besides having beneficial effects, may become a source of addiction. Drug therapy involving methadone is traditionally considered an essential medicine in the treatment for heroin dependence since it significantly reduces drug injecting and death rates associated with opioid dependence. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper investigates a paradoxical situation: the use of methadone therapy to maintain a condition of addiction rather than to overcome it. The story is told jointly by the head of a rehab centre and a young man who has developed a methadone addiction and kept it hidden for years from the operators of the addiction centre, who supplied him with the substance. WHAT ARE THE IMPLICATIONS FOR MENTAL-HEALTH NURSING?: The young man's story offers a key example which can be of interest not only for addiction centres but also for all mental-health services that supply drugs as therapy. This study examines what happens when a person taken over by a service pursues goals that are in contrast to the service mission. Specific communication strategies have to be implemented to update and negotiate goals in continuity with the personal live project of the service user. This story is a warning to not rely on consolidated operational practices, ignoring the investigation of personal meanings and aims of those who experience them. ABSTRACT: Introduction Mental health services typically follow standardized intervention protocols and systematic operating practices. Aim/Question This paper explores what happens when a service relies exclusively on fixed practices rather than on the negotiation of objectives and the differentiation of procedures according to the needs of the user. Method The analysis of the narratives produced in first person by Oliver, a former substance user, emphasizes the need of constructing a therapeutic plan in close cooperation, promoting an user active role and strengthening his affiliation in the change process. Results and Discussion In this specific case, the involvement of the user meant the identification of the peculiar meanings he attributed to the "substance of use," which paradoxically coincided with the "therapeutic substance" (methadone). Implications for Practice Oliver's story is an effective mirror for rethinking staff conduct when it assumes that the drug is therapeutic in itself, regardless of the way the person experiences and means it, it also offers a description of the interactive ways in which the relationship between a young person and service staff proved to be effectively therapeutic.

It's the way you treat me that makes me angry, it's not a question of madness: Good and bad practice in dealing with violence in the mental health services.

WHAT IS KNOWN ON THE SUBJECT: The first access to a mental health service is sometimes marked by aggressive behaviours and anger. Forced hospitalization is frequently an occasion for resistance and hostility to the service, which should not be mistaken for psychotic symptoms. If this situation is not dealt with effectively, it can jeopardize the quality of the relationship with staff and compliance with the treatment programme. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: The narrator presents his experience in undergoing voluntary psychiatric treatment, casting light on nurses' good and bad practices: those that increased resistance, and those that helped de-escalate the uncontrolled reaction at the time of access, as well as during the recovery period. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING: Practitioners should be able to put in place listening techniques and ways of personalizing the relationship with the patient. When such measures become part of the patient's meaning system, the vicious circle of misunderstood anger that creates more anger may be interrupted and the patient can invest in relationships of trust. ABSTRACT: Aggression is often a reason for psychiatric hospitalization and may lead to prolonged hospital stays, and at worst to compulsory treatments. The relationship between mental illness and aggressive behaviour is a source for debate in the literature, while research data suggest that violent behaviour is impacted not only by the mental state of the patient, but also by environmental and relational conditions, hence the importance of an increased awareness of operating methods on the part of psychiatric staff. Alex's story is an effective mirror for rethinking staff conduct and offers many practical suggestions for understanding a patient's point of view in critical episodes and for deescalating relational tension.

The Impact of Relational and Organizational-Environmental Aspects in Hospital Blood Collection: Clinical and Health Indications and New Training Needs.

This study deals with people who underwent a blood test and consequently suffered a fainting episode in the past. This phenomenon affects many people and if not adequately dealt with, it can lead to a perception of the blood test as a serious and traumatic event, which could limit its use as a preventive diagnostic tool. These experiences have been explored by research mainly on the basis of the physiological mechanisms involved in fainting, with a few studies considering the actual lived experience related to the blood test. This study explored how this experience is lived and managed, capturing aspects that could facilitate blood tests and the procedures associated with them, thus it focused on people with vasovagal syncope and was articulated through the semi-structured interview methodology. Among the significant results is the importance of the relational aspects implemented by health staff, the differing organisation of the blood test procedure, the need to make the hospital environment less aseptic and more humanistic, effective actions to counter the anxieties relating to the administration of the blood test and the importance of including the blood test with an inter-disciplinarity perspective.

Illness Experiences and Attitudes towards Medication in Online Communities for People with Fibromyalgia.

Fibromyalgia is a chronic disabling syndrome, and the legitimacy of its diagnosis is still debated. Internet and online communities may become a relevant resource for affected people. This present study aims to understand the role of online communities relating to fibromyalgia syndrome (FMS) patients' illness experiences and their attitudes towards medication. A qualitative content analysis based on the grounded theory approach was conducted on 19 conversations from an online forum, and 14 online interviews. Illness experience, lack of reference points, online communities, personal role and attitude towards medication were the five categories identified, with the search for recognition as the core category. The study highlighted that online communities represent a resource that allows users to express and share their needs, especially in terms of legitimacy and recognition.

The Effectiveness of Psychoeducational Support Groups for Women With Breast Cancer and Their Caregivers: A Mixed Methods Study.

Background: Previous studies on the effectiveness of psychological interventions in oncology mainly used quantitative measures and no study was conducted with regard to both caregivers and patients. Aim: This study evaluates the effectiveness of psychoeducational support groups, both for women with breast cancer, and for their informal caregivers through the use of quantitative and qualitative measures. Methods: A longitudinal design was used comparing two psychoeducational support groups with other two groups in a standard care control condition. Participants were 28 women with a diagnosis of breast cancer in the care of a hospital in Northern Italy, and 21 family caregivers. The quantitative data were collected by Cognitive Behavioral Assessment for Outcome Evaluation (CBA-OE) and the qualitative data through the use of semi-structured interviews. Results: The statistical analysis showed a significant change attributable to the psychological intervention that proves the effectiveness of such an intervention in the patients' and caregivers' group. The qualitative analysis allowed us to interpret the behavioral and psychological profile emerging from CBA-OE, by considering the subjective experience of the treatment groups. The group experience offered affective, relational and informative support, and allowed participants to create a network and to feel understood and reassured. Conclusion: The results suggest the usefulness of psychoeducational support groups for women with breast cancer and for their caregivers. The value of this kind of intervention is not only at an individual level but also at a systems level, and family involvement ensures the best positive outcomes.

Self-writing as a tool for change: the effectiveness of a psychotherapy using diary.

There is an abundance of literature investigating the relationship between self-writing and well-being in cases of trauma or life-changing events, but no such research has assessed the value of keeping a daily diary in promoting small changes, describing an individual's identity in its slow, but realistic evolution. This study examined how the use of diary as a narration tool contributed to improving a patient's awareness of his personal emotions and feelings during a course of psychotherapy. It investigated the changes occurring in the prevailing writing style of a 200-page diary written by a patient suffering from hypochondria over a period of two and a half years. Sentences relating to the need for change, to the self, to suffering and to the function attributed to the self-writing activity were analyzed on the basis of specific criteria deriving from dialogical self theory, which conceptualizes ways to adopt new identity positions during the course of change. Respondent validation identified a good correspondence between the findings of the textual analysis and the writer's own point of view. Results showed an improvement in awareness of moods and feelings. Identity positions became more integrated and writing more enjoyable. These findings demonstrate the potential of innovative use of diary writing as a longitudinal tool for consolidating strategies for change and as an additional means for assessing psychotherapy efficacy. Writing a diary proved effective both in supporting the patient's personal reflections and changes and in making it easier for him to share his thoughts with the therapist.