Chronicity of disorder or of treatment? Individual and focused on metacognition treatments in a group psychotherapy for severe patients in a therapeutic community

Journal title QUADERNI DI PSICOTERAPIA COGNITIVA
Author/s Mirko Ficco, Ornella Nappi, Luigi Gastaldo
Publishing Year 2014 Issue 2014/35
Language Italian Pages 15 P. 22-36 File size 77 KB
DOI 10.3280/QPC2014-035002
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

In the renewal process of rehabilitation techniques in therapeutic communities, interest raised in new treatments that could evaluate clinical work with severe psychotic patients beyond their high social impairment, poor quality of life and severe symptoms, with the aim of limiting the many prejudices on chronicity. Starting a specific group psychotherapy created the need of focusing the intervention and verifying its efficacy, with special attention both on themes that emerged and the mental processes involved. The Metacognition Assessment Interview (MAI, Semerari et al., 2003) was used to identify the poorest metacognitive abilities, on which we focused our intervention during the psychotherapeutic dialogue. The central aim of our job was the therapeutic action on the individual even in a group psychotherapy. At the end of the therapy, patients showed an improved ability to report the narrative details on which the work was focused. Our observations found a positive feedback in scores for different metacognitive functions, measured before and after the therapy. Comparison of HONOS and PANNS scales seemed to report an improvement in social functioning, with unchanged or reduced symptoms. This experience confirms the possibility to go beyond therapeutic practices that are structured on a single type of chronic patient, and foresees a possible good recovery even in severe and stabilized mental suffering. This is in line with the hypothesis of an heterogeneous ability of mentalization in equal disorders.

Keywords: Psychiatric rehabilitation, psychotic patients, chronicity, metacognition, MAI (Metacognition Assessment Interview), focused treatment.

  1. Allen J.G., Fonagy P., Bateman A.W. (2010). La mentalizzazione nella pratica clinica. Milano: Raffaello Cortina.
  2. Applebaum S.A. (1973). Psychological mindedness. Work, concept, and essence, International Journal of Psychoanalysis, 54: 35-46.
  3. Baron-Cohen S., Leslie A.M., Frith U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21: 37-46. DOI: 10.1016/0010-0277(85)90022-
  4. Bateman A., Fonagy P. (2004). Psychotherapy for Borderline Personality Disorder. Oxford, UK: Oxford University Press.
  5. Carcione A., Nicolò G., Pedone R., Popolo R., Conti L. Fiore D., Procacci M., Semerari A., Dimaggio G. (2011). Metacognitive mastery dysfunctions in personality disorder psychotherapy. Psychiatry Research, 190 (1): 60-71. DOI: 10.1016/j.psychres.2010.12.03
  6. Carcione A., Nicolò G., Procacci M. (2012). Manuale di terapia cognitiva delle psicosi. Milano: FrancoAngeli.
  7. Carozza P. (2006). Principi di riabilitazione psichiatrica. Milano: FrancoAngeli.
  8. Ciompi L. (1980). Is chronic schizophrenia an artefact? Arguments and counter-arguments, Fortschritte der Neurologie-Psychiatrie, 48: 237-248. DOI: 10.1055/s-2007-100238
  9. De Girolamo G. (1996). WHO Studies on Schizophrenia: an overview of the results and their implication for the understanding of the disorder, The Psychotherapy Patient, 9 (3-4): 213-231. DOI: 10.1300/J358v09n03_1
  10. Dimaggio G., Vanheule S., Lysaker P.H., Carcione A., Nicolò G. (2009). Impaired self-reflection in psychiatric disorders among adults: a proposal for the existence of a network of semi-indipendent functions. Consciusness and Cognition, 18: 653-664. DOI: 10.1016/j.concog.2009.06.00
  11. Erikson R.C. (1975). Outcome studies in mental hospitals: a review. Psychological Bullettin, 82 (4): 519-540. DOI: 10.1037/h007689
  12. Harding C.M., Strauss J.S. (1984). Changing view about prognosis of schizophrenia, Biological Psychiatry, 19: 1597-1600.
  13. Lysaker P.H., Buck K.D. (2008). Is revovery from schizophrenia possible: an overview of concepts, evidence and clinical implications. Primary Psychiatry, 15 (6): 60-66.
  14. Lysaker P.H., Lysaker J.T. (2008). Schizophrenia and the Fate of the Self. Oxford, UK: Oxford University Press.
  15. Lysaker P.H., Buck K.D. (2010). Metacognitive capacity as a focus of individual psychotherapy in schizophrenia. In: G. Dimaggio, P.H. Lysaker, editors, Metacognition and severe adult mental disorders: from basic research to threatment. London: Routledge.
  16. Popolo R., Salvatore G., Lysaker P.H. (2012). Schizofrenia e Terapia Cognitiva. Psicopatologia, metacognizione e trattamento, Alpes Italia.
  17. Semerari A., Carcione A., Dimaggio G., Falcone M., Nicolò G., Procacci M. (2003). How to evaluate metacognitive functioning in psichotherapy? The metacognition assessment scale and its apllications. Clinical Psychology & Psychotherapy 10 (4): 238-261. DOI: 10.1002/cpp.362
  18. Semerari A., Cucchi M., Dimaggio G., Cavadini D., Carcione A., Battelli V., Nicolò G., Pedone R., Siccardi T., D’Angerio S., Ronchi P., Maffei C., Smeraldi E. (2012). The development of the Metacognition Assessment Interview: Instrument description, factor structure and reliability in a non-clinical sample. Psychiatry Research, 200: 890-895. DOI: 10.1016/j.psychres.2012.07.01
  19. Silverstein S., Bellack A.S. (2008). A scientific agenda for the concept of recovery as it apllies to schizophrenia. Clinical Psychology Review, 28 (7): 1108-24. DOI: 10.1016/j.cpr.2008.03.00
  20. Silverstein S., Spaulding W., Menditto A. (2006). Schizophrenia. New York: Hogrefe & Huber Publishing.
  21. Spivak M., Omer H. (1992). Un modello interpersonale per capire e neutralizzare i processi cronici nei pazienti psichiatrici. Rivista Sperimentale di Freniatria, CXVI, 2: 179-202.
  22. Stanghellini G., Lysaker P.H. (2007). The psychotherapy of schizophrenia through the lens of phenomenology: intersubjectivity and the search for the recovery of first- and secondperson awareness. American Journal Psychotherapy, 61 (2): 163-79.
  23. Strauss J.S. (1989). Mediating processes in schizophrenia. British Journal of Psychiatry.
  24. Supplement, 5: 22-28. Wells A. (2000). Emotional Disorders and Metacognition, Innovative cognitive therapy. New York: John Wiley & Sons.
  25. Wing J.K., Brown G.W. (1970). Institutionalism and schizophrenia, London: Cambridge University Press.
  26. Yalom I.D. (1995). The theory and practice of group psychotherapy. New York: Basic Books.
  27. Zubin J., Magaziner I., Steinhauer S.R. (1983). The metamorphosis of schizophrenia: from chronicity to vulnerability. Psychological Medicine, 13: 551-571. DOI: 10.1017/S003329170004798

Mirko Ficco, Ornella Nappi, Luigi Gastaldo, Cronicità di disturbo o di trattamento? Trattamenti individualizzati e metacognitivamente focalizzati in un gruppo psicoterapeutico con pazienti difficili in comunità residenziale in "QUADERNI DI PSICOTERAPIA COGNITIVA" 35/2014, pp 22-36, DOI: 10.3280/QPC2014-035002