Treating Psychiatric and Psycho Affective Disorders in Adolescence

Project location: ITALY, Rome
Project start date: June 2012 - Project end date: May 2013
Project number: 2012-032
Beneficiary: Centro Italiano di Solidarietà

TIMELINE OF THE PRESENT ACTIVITY REPORT: From  10/07/2012  to  31/05/2013

The goal of this project was to offer differentiated paths of treatment of psychiatric problems, through the identification, assessment and early taking in charge of cases at risk of comorbidity. In particular, the mission of the service has been redefined taking into consideration the treatment of situations in which the discomfort is associated with psychopathological behaviour of self-injury and self-injuring, whose incidence in the adolescent population presenting psychiatric problems reaches dramatic percentages and, unfortunately, constantly growing.
The intervention aimed at preventing the "risk factors" and to enhance "protective factors" and to develop coping skills and resilience of the young people. The overall objective of the program was, therefore, to avoid the accentuation or stabilization of psychopathological disorder and conduct of cutting through a series of interventions and activities to reactivate an evolutionary process which was stopped or at risk of interruption. Specific objectives were:

• Creation of a cozy space;
• Test of an integrated intervention model;
• Support to families
• Reduction / elimination of elf-harm behaviours;
• Promotion of psycho-social skills;
• Stimuli to social, scholastic and working inclusion
• Provision of early diagnosis

- Detailed description of the activities implemented and of the methodologies applied
The therapeutic-educational project is highly individualized and customized for each user and it is essentially based on four criteria: reception/welcoming, relationship, structure of space-time, restitution of meaning.
I) Welcoming/reception service as an alternative way to simply "taking charge". The selection of a cozy and not institutionalizing space, where they can feel "at home". It is where to (re) activate the adaptive evolutionary resources of the users, to tackle the crisis by relying on the healthy aspects of personality;
II) The structure of space-time. The space allows the user to experience a "place" of dynamic and affective movements, it represents a kind of container from which it is possible to regain the value - representative, emotional and relational - of "being and doing together with others." Structuring time-space and its flexibility are essential for the establishment of a setting within which it is possible for the user to experience normalization and socialization.
III) The relationship between peers and with operators is the fundamental therapeutic tool: it allows not only the re-acquisition of social skills but, more importantly it strengthens the motivation to "sociality" in a general sense, offering the possibility to experiment as "person" in a protected environment where the emotional dimension unequivocally linked to any experience becomes convertible and processable.
IV) The return of the sense / meaning offers the possibility of "meaningful" experience, that is, to give it a content and a form. This criterion allows users' reactivation of those mental functions, normally caught and compromised by the disorder, such as categorization and thought processes and dynamics that affect individuals and the group, returning to the same group, while at the individual level allows the understanding, development and management of the same symptoms.
On these general criteria (Sollami et others. 2005) was built the methodological framework of the service, as an expression of an experiential process constantly in search of therapeutic alternatives, evidence of clinical efficacy and methodology. The multimodal intervention proposed by the service acts simultaneously on the many aspects of the person everyday: psychological (emotional, cognitive and behavioural), relational, bodily skills.
The intervention than featuring therapeutic aspects, in fact, has an important social and educational component that is essential for the type of user in question. Participation in the management of everyday life of the service, the opportunity to explore their creativity and manual skills through laboratory activities, the development of the ability to make better use of or acquire the necessary tools to face the working world, are all important elements that constitute the ' aspect of psycho-social intervention.
A. Therapeutic activities
• Welcoming interviews,
• Interviews of support: It provides the user, in agreement or in conjunction with any other therapeutic referents, a space of narrative for the development of personal and emotional problems;
• Family interviews: The work plan is developed for parents through individual, family and / or couple;
• Encounter Groups: The group has a duration of half an hour and takes place on a weekly basis.
• Groups based on the technique of mindfulness:. The group based on the above technique has a duration of one hour and takes place at two-monthly basis.
• Psycho diagnostic multidimensional evaluation.
• Psychiatric Counselling: where necessary,.
• Psycho-physical activities: Yoga, it is a discipline that we have to get in touch with our resources and learn how to cultivate them.

B. Educational activities
• Educational activities (orientation, school support, computer literacy course): Inside the service, according to the age of the user, is offered an individual path and educational guidance and / or training.
• Creativity Workshops (music, art, ceramics, video-photo)
• Sports activity: In the course of treatment and rehabilitation is also used sport.

- Results obtained ( final)
Since May 2012 the Eco Service offered:
• activities of individual psychological counselling: n ° 603 hours
• Counselling and guidance aimed at families: n ° 120 hours
• psychodiagnostic examination including investigation of cognitive and personality ': n ° 147 hours
• psychiatric Counselling: n ° 80 hours
• psycho-physical activities (yoga): n ° 240 hours
• Group meeting: No. 30 hours
• support and educational guidance: n ° 560 hours
• Laboratories artistic and cultural (music, ceramics, creativity): 151 hours

In addition, ECO has maintained an active network of collaborations estimated at No. 80 contacts distributed among the network of services inside the CeIS (welcome; Institute of the family; Service Gulliver; Public schools; Service Mentor; Therapeutic Communities) and Public Institutions (SERT , DSM; Asl; Service Maternal and Child; Municipalities, Schools, Health)
Number of people supported:
• First contact: n° 105 of which
• Taken in charge: n° 41
• Families supported: n° 38
• 6 schools were contacted

- Final remark
A contextual reading of the phenomenon of cutting and its link with psychiatric illness, today leads CeIS to believe that the proposal for differentiated interventions that have been designed on the person, is the only way therapeutically viable. This is the proposal of a way of understanding the intervention as a tool that, starting from the homogenizing factor of suffering, trying to make room for the distinctive feature that each brings with it and value it. This applies to the principle on which Eco bases its intervention.
"Self-mutilation redefines the boundaries of the body, differentiating itself from the others. The blood flowing from the wounds proof that within the body there is life. The stimulation of the skin through self-mutilation helps to rebuild the shattered self-perception, possibly recreating a tactile experience that, at least for anyone who is injured, is pleasant and comforting "(Raine, 1982). The cutting is used to manage painful and intense emotional states such as shame, anxiety, aggression, empty and self-regulate emotions.
CeIS thinks of Eco as a "second skin" that can try to "contain" all that and makes it expressible through "others" channels, such as verbal, proprioceptive, psicobodily channels. It, allows you to establish new links between the body and the mind, the inside and the outside, the I and the Other. This is a goal that is pursued shortening the distance with respect to the world of the youths: it is for this reason that Eco has adopted a model that could be called "counselling", open, dialogical, plural of dynamism instead of something fixed and set.


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