The Italian consensus conference on psychological therapies for anxiety and depressive disorders: findings and recommendations.

A Consensus Conference of clinicians, researchers, public health specialists and users was convened in Italy to review efficacy, effectiveness, treatment appropriateness and access to care for anxiety and depression, and to consider the role of psychological therapies. Expert opinion was sought concerning identification of people requiring psychological therapies according to levels of symptom severity matched to corresponding levels of treatment intensity, suitability of psychological therapies for subclinical anxiety or depression, definition of a minimum level of information on evidence-based psychotherapies to be provided by university medical and psychology courses, initiatives to raise awareness among potential users and decision makers on the role and effectiveness of psychological therapies in healthcare. The expert jury concluded that a number of psychological therapy models endorsed by most authoritative guidelines are supported by research showing their effectiveness at least equal to the drugs used in common mental disorders (CMDs). Such therapies are under-represented in the Italian public health system, leading many people to resort to the private sector, resulting in unacceptable wealth discrimination. The difficulty of accessing psychological treatments often entails the use of drug therapies in cases where they are not indicated. Starting from these assumptions, the experts recommended the promotion of better and timely recognition of anxiety and depressive disorders and their classification in terms of symptom intensity and functional impairment, differentiating subthreshold mood swings from clinical forms, to foster outcome studies of psychotherapies in CMDs in Italy, to introduce a stepped care model structured according to levels of intensity of treatment, based on wellbeing support strategies in nonmedical contexts for subthreshold situations, self-help, support and psychoeducation as frontline interventions in mild clinical forms, evidence-based psychotherapies in moderate and severe forms, with the option of combining psychological treatment and appropriate drug therapy in the most severe cases.

What does "brief" mean? A theoretical critique of the concept of brief therapy from a psychoanalytic viewpoint.

The concept of "brief therapy" contains internal contradictions. The techniques suggested by brief therapists are the same techniques that have been discussed historically in debates on theory of technique, both within and without psychoanalysis (e.g., the experiential factor at the center of the Freud-Ferenczi confrontation is also an important aspect of Gestalt therapy). A time limit is the only operational criterion that allows a rigorous definition of brief therapy; without this criterion it is impossible to discriminate between "brief" and simply "good" therapies (i.e., those in which patients are successfully treated in a short time). An important question is why, with a given patient, a therapist should decide, a priori, to terminate a treatment within a set time. Two clinical examples are presented, illustrating the usefulness of Eissler's concept of parameters as a heuristic framework to identify the potentially defensive nature of both "brief" and "long-term" therapy.

[Jervis and scientific research in psychoterapy: reflections on the problem of plurality of research methods]. / Jervis e la ricerca scientifica in psicoterapia: riflessioni sul problema della pluralità dei metodi di ricerca sul processo psicoterapeutico.

It is documented that psychotherapy and its scientific investigation interested Giovanni Jervis since the early 1960s. In this paper an aspect of psychotherapy research that attracted Jervis' interest is discussed. While there is more agreement on the hierarchy among the various methods of outcome research in psychotherapy, it is argued that in the field of process research the discussion on how the many process methods should relate to each other is still open. It is not clear which method is "superior" or "more useful" than others in understanding and measuring behaviour change. This problem is discussed also in its epistemological aspects, e.g., regarding the knowledge of "reality" (the patient's mind) and the eye(glasses) we have (the research methods or "lens" we use). A subdivision of the methods of psychotherapy process research into "thematic" and "structural" methods, used also for the classification of projective tests in personality psychology, is suggested.

Intentional attunement: mirror neurons and the neural underpinnings of interpersonal relations.

The neural circuits activated in a person carrying out actions, expressing emotions, and experiencing sensations are activated also, automatically via a mirror neuron system, in the observer of those actions, emotions, and sensations. It is proposed that this finding of shared activation suggests a functional mechanism of "embodied simulation" that consists of the automatic, unconscious, and noninferential simulation in the observer of actions, emotions, and sensations carried out and experienced by the observed. It is proposed also that the shared neural activation pattern and the accompanying embodied simulation constitute a fundamental biological basis for understanding another's mind. The implications of this perspective for psychoanalysis are discussed, particularly regarding unconscious communication, projective identification, attunement, empathy, autism, therapeutic action, and transference-countertransference interactions.