When psychotherapy encounters chronicity: Challenges and possible remedies

Journal title RIVISTA SPERIMENTALE DI FRENIATRIA
Author/s Lorenzo Burti
Publishing Year 2018 Issue 2018/3 Language English
Pages 20 P. 97-116 File size 1854 KB
DOI 10.3280/RSF2018-003006
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.

Chronicity occurs in psychotherapy, as in any other type of health care profession. In psychotherapy, more than in the biomedical field, it is widely influenced by the model framework employed to define and diagnose it, i.e. whether it is considered to be a process which is irreversible, fatal or, at the very least unfavorable, or a situation of dynamic imbalance which can always be changed for the better, in full or in part. It can be ascribed to the characteristics of the individual suffering from a mental disorder or a personality disorder. Or, it can be attributed to environmental conditions, acute traumatic events, or long-term distress either internal or external. It may also be secondary to the modalities of therapy itself: too short or too long, or conducted with incompetence. Then again, it may depend on an iatrogenic diagnosis, blind to the effects of the treatment setting itself, as frequently occurs in the public sector. It may be due to the excessive reliance on the naïve belief that the individual, once re-established psychologically thanks to psychotherapy, is permanently equipped with the necessary and sufficient tools to live a full and happy life. In many cases, the real difficulties are insurmountable even for a person who is absolutely solid and tough, let alone for someone who has suffered for a long time, being overwhelmed by adversities. Various perspectives are exposed in the text with clinical vignettes and quotations from the works of various authors who practiced different psychotherapeutic approaches, ranging from individual to institutional psychotherapy.

Keywords: Psychotherapy, chronicity, individual, environment, idiopathic, iatrogenic

  1. Bola JR, Mosher LR. At issue: predicting drug-free treatment response in acute psychosis from the Soteria project. Schizophrenia Bulletin 2002; 28: 559-75. Discussion 583-8.
  2. Bateson G, Jackson DD, Haley J, Weakland J. Toward a theory of schizophrenia. Behavioral Science 1956; 1: 251-4.
  3. Watzlawick P, Weakland JH, Fisch R. Change: principles of problem formation and problem resolution. New York: Norton; 1974.
  4. Selvini MP, Boscolo L, Cecchin G, Prata G. Hypothesizing—circularity—neutrality: three guidelines for the conductor of the session. Family Process 1980; 19: 3-12.
  5. Burti L, Berti L, Canova E, Fornari M, Pavani D. An Approach to interdisciplinary mental health work in South-Verona, Italy. In K Yeager, D Cutler, D Svendsen, GM Sills, Eds, Modern community mental health: an interdisciplinary approach, Ch. 6, pp. 84-97. New York: Oxford University Press; 2013.
  6. Mosher LR, Burti L. Community mental health: a practical guide. New York: Norton; 1994.
  7. Gigantesco A, Miglio R, Santone G, de Girolamo G, Bracco R, Morosini P, et al. Process of care in general hospital psychiatric units: national survey in Italy. Australian and New Zealand Journal of Psychiatry 2007; 41: 509-18
  8. Siani R, Siciliani O, Burti L. Strategie di psicoterapia e riabilitazione: gli psicotici e il servizio psichiatrico. Milano: Feltrinelli; 1990.
  9. Cirillo S, Selvini M, Sorrentino AM. La terapia familiare nei servizi psichiatrici. Milano: Raffaello Cortina; 2002.
  10. Burti L. Attualità di Goffman: quanto contribuisce alla carriera morale di malato mentale la psichiatria di comunità italiana contemporanea. Psicoterapia e Scienze Umane 2017; 51: 211-46. DOI: 10.3280/PU2017-002003
  11. World Health Organization. How to use the ICF: A practical manual for using the International Classification of Functioning, Disability and Health (ICF). Exposure draft for comment. WHO: Geneva; 2013.
  12. Spivak M, Homer H. Un modello interpersonale per capire e neutralizzare i processi cronici nei pazienti psichiatrici. Rivista Sperimentale di Freniatria 1992; 116: 179-202.
  13. Ghaemi SN. The rise and fall of the biopsychosocial model. British Journal of Psychiatry 2009; 195: 3-4.
  14. Pilgrim D. The biopsychosocial model in Anglo-American psychiatry: past, present and future? Journal of Mental Health 2002; 11: 585–94 DOI: 10.1080/0963823002002393
  15. Pilgrim D, Rogers A. The troubled relationship between psychiatry and sociology. International Journal of Social Psychiatry 2005; 51: 228-41. DOI: 10.1177/002076400505698
  16. Bolton D. Should mental disorders be regarded as brain disorders? 21st century mental health sciences and implications for research and training. World Psychiatry 2013; 12: 24-5.
  17. Rapoport J, Giedd J, Gogtay N. Neurodevelopmental model of schizophrenia: update 2012. Molecular Psychiatry 2012; 17: 1228-38.
  18. Goffman E. Asylums: Essays on the social situation of mental patients and other inmates. New York: Anchor Books; 1961 (trad. it.: Asylums. Le istituzioni totali: i meccanismi dell’esclusione e della violenza. Torino: Einaudi; 1968).
  19. Dell’Osso L, Gesi C, Massimetti E, Cremone IM, Barbuti M, Maccariello G, et al. Adult autism subthreshold spectrum (AdAS Spectrum): validation of a questionnaire investigating subthreshold autism spectrum. Comprehensive Psychiatry 2017; 73: 61-83. Doi.org/10.1016/j.comppsych.2016.11.001.
  20. Fink M, Taylor MA. The catatonia syndrome: forgotten but not gone. Archives of General Psychiatry 2009; 66: 1173-7.
  21. Bauer SM, Schanda H, Karakula H, Olajossy-Hilkesberger L, Rudaleviciene P, Okribelashvili N, et al. Culture and the prevalence of hallucinations in schizophrenia. Comprehensive Psychiatry 2011; 52: 319-25.
  22. Barton R. Institutional neurosis. Bristol: Wright, 1959.
  23. Linehan MM. Dialectical behavior therapy for borderline personality disorder. Bulletin of the Menninger Clinic 1987; 51: 261-76.
  24. Mosher LR, Hendrix V. Through madness to deliverance. Bloomington, IN: Xlibris; 2004.
  25. Knekt P, Virtala E, Härkänen T, Vaarama M, Lehtonen J, Lindfors O. The outcome of short- and long-term psychotherapy 10 years after start of treatment. Psychological Medicine 2016; 46: 1175-88. DOI: 10.1017/S0033291715002718
  26. Leichsenring F, Rabung S. Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. British Journal of Psychiatry 2011; 199: 15-22.
  27. Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J et al. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomized controlled trial. Health Technology Assessment 2017; 21: 1-94.
  28. Cuijpers P. Are all psychotherapies equally effective in the treatment of adult depression? The lack of statistical power of comparative outcome studies. Evidence-Based Mental Health 2016; 19: 39-42.
  29. Wampold BE. How important are the common factors in psychotherapy? An update. World Psychiatry. 2015; 14: 270-7.
  30. Haley J. Uncommon therapy: the psychiatric techniques of Milton Erickson, M.D. New York: Norton; 1973.
  31. Erickson MH. Teaching seminar with Milton H. Erickson, M.D. New York: Brunner/Mazel; 1980
  32. Freud S. Analysis terminable and interminable. International Journal of Psychoanalysis 1937; 18: 373-405.
  33. Blum HP. Analysis terminable and interminable: a half century retrospective. International Journal of Psychoanalysis 1987; 68: 37-47.
  34. Chronic. (adj) In Webster’s third new international dictionary of the English language unabridged. Springfield, MA: Merriam; 1976.
  35. Bateson G. Mind and nature: a necessary unit. New York: Dutton; 1979.

Lorenzo Burti, When psychotherapy encounters chronicity: Challenges and possible remedies in "RIVISTA SPERIMENTALE DI FRENIATRIA" 3/2018, pp 97-116, DOI: 10.3280/RSF2018-003006