LIBRI DI PAOLO MIGONE

Real efficacy of antidepressant drugs in psychiatric practice - Kirsch et al. (2002) studied all 47 randomized clinical trials (RCT) submitted by pharmaceutical companies to the U.S. Food and Drug Administration (FDA) for approval of the six most prescribed Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants. The mean difference between drug and placebo was less than 2 points on the 21-item (62- point) Hamilton Depression Scale (which is the version used in many of the these RTCs). This superiority to placebo, although statistically significant, was not clinically significant. Furthermore, 57% of the trials funded by the pharmaceutical industry failed to show a significant difference between drug and placebo. Most of these negative data were not published and were accessible only thanks to the Freedom of Information Act. Also other studies confirming this research (Whittington et al., 2004; Moncrieff & Hardy, 2007; Turner et al., 2008) are presented. These data are discussed in light of the wider problem of the roles of interpersonal relationship in psychiatric practice.

KEY WORDS: antidepressants drugs, Selective Serotonin Reuptake Inhibitors (SSRI), placebo, Kirsch, Randomized Clinical Trials (RCT)]

An overview on the main dimensional models of personality - After an introduction on the dimensional approach in personality diagnosis and on its use as an attempt at solving some of the problems of categorical diagnoses (such as those of DSM-III and DSM-IV), the main dimensional models of personality are presented, namely: 16 PF Questionnaire by Cattell, Eysenck Personality Inventory (EPI), Five-Factor Model (FFM) by Costa & McCrae (Big Five), Temperament and Character Inventory (TCI) by Cloninger, Schedule for Nondaptive and Adaptive Personality (SNAP) by Clark, Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP-BQ) by Livesley, Structural Analysis of Social Behavior (SASB) by Benjamin, the "fundamental polarity (anaclitic and introjective) of personality" by Blatt, Shedler-Westen Assessment Procedure (SWAP). Finally, advantages and disadvantages of dimensional models are discussed, with particular emphasis on borderline disorder.

key words: personality, dimensional models, categorical model, borderline, diagnosis

Interpretation and psychoanalytic frame: the contribution of Enzo Codignola - Enzo Codignola’s book The True and the False. Essay on the Logical Structure of Psychoanalytic Interpretation (Turin: Boringhieri, 1977) originated from discussions among colleagues of Psicoterapia e Scienze Umane since 1962, and can be considered one of the most important Italian contributions on the theory of psychoanalytic interpretation. It was translated in German in 1986 with a preface by Paul Parin, and in English in 1987 with an introduction by Paolo Migone. Here part of Migone’s introduction to the English edition (with the summary of the book), and two interventions (by Alessandro Ancona and Marianna Bolko) that introduced a panel on this book and appeared in issue no. 2, 1979, of Psicoterapia e Scienze Umane, are reprinted. Codignola’s conceptualization on the strict link between interpretation and frame of the psychoanalytic situation is discussed.

KEY WORDS: Enzo Codignola, interpretation, psychoanalytic frame, theory of psychoanalytic technique, parameter of technique

A dialogue on the difference between psychoanalysis and psychoanalytic psychotherapy - Paolo Migone discusses with Otto F. Kernberg and André Green on the difference between psychoanalysis and psychoanalytic psychotherapy. Migone, in agreement with Merton M. Gill’s conception of 1984, argues that there is not a real difference, but a continuum of techniques differentiated according to specific clinical situations and patients’ defensive structures, following the implications of ego psychology that were clear already in the 1940s and 1950s. Kernberg partly agrees, but he emphasizes the need of differentiating three psychoanalytically framed techniques (psychoanalysis proper, psychoanalytic [or expressive] psychotherapy, and supportive psychotherapy) mostly in order to perform empirical research on their efficacy. Green discusses in depth this problem within the context of the history of Freud’s theory of technique, and, among other things, shows how the original idea of Freud’s technique (couch, free associations, etc.) was derived from his model of dream work.

KEY WORDS: difference between psychoanalysis and psychoanalytic psychotherapy, expressive psychotherapy, supportive psychotherapy, Merton M. Gill, dream model

Psychotherapy and "scientific" research - Some problems of the relationship between psychotherapy and scientific research are examined. The following aspects are discussed: the theory of demarcation between science and non-science, the problem of replicability, "hard" and "soft" sciences, complexity and chaos theory, the levels of probability and indeterminacy, the inductive-deductive circle, abduction, etc. Clinical material is presented in order to exemplify the issues under discussion. Some of the problems met by empirical research in psychotherapy (for example the manualization of psychotherapy techniques) are described, and the phases of the history of psychotherapy research movement are summarized. (This intervention is a discussion of the paper by the physicist Ferdinando Bersani "Replicability in science: Myth or reality?". Psicoterapia e Scienze Umane, 2009, XLIII, 1: 59-76). [KEY WORDS: science, psychotherapy research, epistemology, replicability, psychoanalytic research]

A kind of malpractice in psychiatry: ignoring of the interpersonal relationship A kind of psychiatric practice, defined as a form of malpractice and centered only on the prescription of medication, is described and critically discussed. This kind of psychiatric practice is considered to be antiscientific because it ignores research data that show evidence of the importance of the interpersonal relationship with the patient for therapeutic outcome. Two brief clinical cases are reported as examples of this form of malpractice, and research data on the cost-effectiveness of psychotherapy of personality disorders are reported. Finally, some historical and sociological considerations that can explain the diffusion of such psychiatric practice, mostly based on the sole prescription of medication, are discussed. [KEY WORDS: psychiatric practice, malpractice, patient-therapistrelationship, psychotherapy, psychiatric medication]

Finalmente un testo che affronta i limiti dei modelli, delle teorie, delle tecniche e dei modi di fare psicoterapia e che tratta con efficacia i paradossi e le contraddizioni dell’insegnamento della psicoterapia. Da Pontalti a Migone, i protagonisti della psicoterapia italiana si interrogano sul presente e sul futuro con una prospettiva “laica” e non di parte, grazie all’esperienza realizzata nella loro professione di clinici, di docenti e di supervisori.

Viene presentato il Psychodynamic Diagnostic Manual (PDM), pubblicato nel 2006 da cinque organizzazioni psicoanalitiche: l’American Psychoanalytic Association, l’International Psychoanalytic Association, la Division 39 (Psychoanalysis) dell’American Psychological Association, l’American Academy of Psychoanalysis and Dynamic Psychiatry, e il National Membership Committee on Psychoanalysis in Clinical Social Work. Il PDM include un sistema multisassiale basato su tre assi: asse P (la Personalità, in cui ciascun disturbo ha tre livelli di gravità: sana, nevrotica e borderline), asse M (il funzionamento Mentale), e asse S (i Sintomi, in cui viene enfatizzata la esperienza soggettiva). La classificazione dell’infanzia e dell’adolescenza mantiene lo stesso sistema multiassiale ma in un altro ordine (M, P, S), mentre quella dell’età neonatale e della prima infanzia è strutturata in modo diverso dato che segue il modello ICDL-DMIC di Stanley Greenspan.