[Therapist's reactions on the treatment of suicidal patients]. / Reattività inadeguata del terapeuta nei confronti del paziente a rischio suicidario.

In the present study, we describe fourteen therapists' reactions (Avoidance, Rejection, Suicidal collusion, Over-involvement, Overprotection, Loss of patients' responsibilities, Loss of therapists' responsibilities, Reaction to the feeling of being exploited, Creation of dependency, Manipolatory acting out, Feeling of undergoing an iniquity, Patients psychopathology inflation, Therapists' psychopathology inflation, Suicidal Burnout Syndrome), based on emotions, behaviors and cognitivity, toward patients with suicidal risk. These responses can interfere with a correct assessment and management of suicidal risk in psychiatric patients. The purpose of the present clinical study was to improve therapist's professional skills through the recognition and management of his own responses to suicidal patients.

[Psychopathology and risk of homicide committed by a patient with schizophrenia]. / Sulla psicopatologia e sulla valutazione del rischio dell'omicidio compiuto dal paziente con disturbo schizofrenico.

We describe, thirteen psychopathologic dynamics based on defense mechanism and primary process thinking, that could determined an homicide committed by a patient with schizophrenia. The purpose of this study is to allow: a) to improve diagnosis of the homicidal act; b) to emphasize psychopathological elements which can be treated by specific forensic psychotherapy; c) to prevent an homicidal recidivism through evaluation of risk passing to the homicidal act.

[The countertransference of the therapist towards the patient with mental disorder and violent behavior]. / La controtraslazione del terapeuta verso il paziente con disturbo mentale e comportamento violento.

We described thirteen typologies of the therapist countertransference toward the patient with mental disorder and violent behavior. The purpose of this study is to improve: a) the ability of the therapist to mentalize emotions without any passing to the act; b) the recognition of the patient transference; c) the recognition of the countertransference related to mental disorder and violent behavior.

[Clinical interview in psychiatric difficult situations]. / Il colloquio in situazioni psichiatriche di crisi.

There are here described a number of basic principles underlying an effective clinical interview in psychiatric difficult situations (violent or suicidal patients, victims of serious physical and psychological damages, authors of inadequate or anti-social requests to the therapist). The aim of the present study is to provide the psychiatric operator with useful skills for the optimal management of the interview in difficult situations both at diagnostically and therapeutically level. The methodology was based on examination of the literature and personal experience of the authors. The authors highlighted 18 working hypothesis that may represent beneficial instruments in situations of difficult psychiatric interview. Further studies will deepen under the clinical, actuarial and statistical validity the principles covered in various clinical and crisis situations with difficulty to the interview, in relation also to specific types of patients for a more updated training of the operators in the field of mental health.

[Suicidal contagion and collusion between therapist and patient]. / Il contagio e la collusione suicidaria tra terapeuta e paziente.

The purpose of the present study is to point out suicidal contagion and suicidal collusion describing clinical cases, to improve professional skills in suicidal risk evaluation and management. In suicide contagion we described three typologies of contagion between therapist and patient: 1) suicide contagion of the environment on the therapist and on the patient; 2) suicide contagion of the therapist on the patient; 3) suicide contagion of the patient on the therapist. We described also four typologies of suicidal collusion with specific kind of patients: 1) with patient suffering of physical illness; 2) with patient suffering of a serious mental illness; 3) with manipulative patients; 4) with patient who is aggressive toward himself and toward other people. In conclusion we pointed out the importance of an adequate recognizement and management of suicidal contagion and collusion to decrease patient suicidal risk.