No Boundaries for Disabled Teenagers
Project location: ITALY
Project start date: September 2001 - Project end date: June 2002
Project number: 2001-11
C.O.E.S ONLUS is a non-profit of social interest helping patients suffering from neuropsychic disorders. Its main objectives are:
-study and realise projects aiming at the education, rehabilitation, assistance and social reintegration of people suffering from mental handicap;
-assist and support families of disabled people through specialised personnel;
-establish relations with public and private associations having the same objectives
The project financed by the Nando Peretti Foundation intends to foster the cognitive-relational instrument of young people, with the purpose of constructing essential conditions for a better social integration and a possible future employment.
The project deals with a group of about 30 adolescents aged 11 to 18 years and will be divided as in the previous project, into the following phases:
a) COGNITIVE AND DIAGNOSTIC PROCEDURE: interviews made by the children's neuropsychiatric, psychologists and cognitive therapists with young people and aimed at neuropsychological and psychodiagnostic evaluation (also through tests). The interviews will be made when young people begin again to work.
b) FORMULATION OF PROJECTS AND RETURN OF WORKING PROGRAMMES TO FAMILIES AND YOUNG PEOPLE INVOLVED.
c) REHABILITATION PROCESS: Each adolescent will come to the Centre three times a week on overage, in the afternoon, for one-and-half hour each day. During this time, they will benefit of group or individual neuropsychological interventions-according to individualized projects -and psychotherapeutic treatments through:
1. Computer laboratories;
2. Occupational laboratories;
3. Individual or group activities with cognitive therapist;
4. Individual or group psychotherapies;
5. Individual or group expressive such as : music therapy, arts therapy, dance therapy, and theatre- laboratory.
At the same time, the following interventions will be planned:
6. family group or individuals psychologic interventions aiming at sharing and elaborating their experiences and inner difficulties, in particular those linked to the handicap of their children or brothers/sister.
7. Didactic- rehabilitative collaboration with schools attended by these young people, hrough phone contacts and meetings with the teachers.
8. Research and identification, in close contact with families, of protected suitable job or occupational situations where these young people could be inserted when our intervention has reached its end, and possible intervention of insertion.
Rehabilitation processes will be evaluated every fifteen days through team meetings in which all technical and rehabilitation personnel working at the project will take part.
d) EXPERIMENTATION ON THE TERRITORY: Young people, in small groups and helped by reference people, will experiment the skills acquired through outings on the territory aimed at the knowledge and use of public means and offices.
The project aims at achieving the following goals:
1) Enhancement of psychological, cognitive and social autonomy.
2) Establishment of cognitive and relational bases vital to foster occupational experiences and protected job insertions.
3) Identification of protected suitable occupational and/or job situation with consequent possible intervention of insertion.
4) Families will understand the different experiences in their widest meaning and parents will give value the potentialities and resources of their children.
Year 2003-2004 Project Results
Person in charge of project: Dr. Calzaretta Teodorino Carmine
Our project saw an extremely fruitful interaction between project recipients, their families and project operators with different specialisations. In the light of all this, we can draw the conclusions summarised here below.
Recipients have been the object of more and more effective rehabilitation and therapeutic interventions, carried out both at cognitive and relational, emotional and behavioural level. In fact, parental groups and reference school teachers operating in the working groups with disabled students that we organised in schools reported specific modifications of some recipients' cognitive attitudes characterised by the strengthening of learning and the improvement of specific skills together with some significant and sometimes totally unexpected changes in relational and behavioural attitudes.
Group and individual therapeutic activities worked with a positive effect on motor and cognitive deficits and strengthened self and relational identity. Recipients' complex and multi-faceted personalities, however, request interventions in the different levels mentioned above, to act on deficit areas, some of which are still unexplored.
Therefore, a continual therapeutic intervention is the necessary condition for these Camelot recipients to reach the highest expression of their potentialities, possibilities, skills and competences.
In this view, future therapeutic interventions will take into account the situations of cognitive skills and competences and motor and behavioural attitudes that are fertile field for the construction of a self-perception as adults, thus improving school and job commitments as well as emotional and relational situations, main basic conditions for a greater well-being and better quality of life.
We believe that the attention we paid to family situations has eased therapeutic tasks for our recipients who were strengthened and stimulated by the acknowledgement of their progressive cognitive, motor and behavioural achievements. A greater parental awareness of recipients' different skills as well as an improved elaboration of the anxiety deriving from such a dramatic event as the birth of a "disabled" child is enabling - in due time - the family to discover and acknowledge those resources needed to reshape family plans by realising that the "limit of handicap" can be a source of possibilities, enrichment and not only a problem.
All operators - each for his/her specific competence - have shown great evaluation, planning and implementing capabilities to carry out therapeutic interventions with recipients and their families and establish relationships with them by showing strong empathic abilities. Moreover, in group activities each member integrated his/her professional skills with those of the others and created a protection, inclusion and operation network for all. Weekly meetings of all therapeutic and rehabilitation staff-members were used to elaborate on each recipient's respondence to planning activities as well as to provide support to each operator's professional development.
The activities proposed in the Camelot project were functional to the achievement of some general and specific goals defined in the individual project worked out for each recipient.The activities carried out in this project were characterised by continuity and perseverance. We think that some individual and group therapeutic settings should be further improved to better strengthen our interventions.
THERAPEUTIC STAY IN TARQUINIA
In May and September, the Camelot project organised two short "therapeutic stay" activities in Tarquinia, a seaside resort near Rome. The stay was organised in premises with swimming pool and a pine wood, a very favourable environment for our children. These "therapeutic stay" activities saw the participation of project staff-members and recipients. Families joined us on the last day of vacation and we had lunch together, played music and had fun together in a serene and cheerful atmosphere. It was a positive experience for all participants. Children (some of them for the first time) experienced the possibility of time for them far from home and it was a good opportunity for autonomy and independence. Families had to elaborate their separation from children and the anxiety linked to their being away; the success of this activity has made parents aware that their children can have their own life despite their problems. Project members could live a different, more intense and deeper relation with their patients. The vacation helped them to better know emotions, feelings, needs, habits, autonomies and relational approaches of their patients. Furthermore, this experience turned out to be positive also because it strengthened intra-group relations.
Federico has achieved several goals concerning his cognitive development. In fact now he uses syntax better and corrects inconsistencies. He can have a partial understanding of semantic inferences, look for details, understand the literal meaning of a sentence, detect its actors, places time, actions, internal answers and events as well as follow its sequentiality. In his graphic production, great improvement can be seen in the way he writes/draws pictures, in the proportions used and in their mechanical relations. In logic and mathematic activities, Federico still shows some deficits; whereas no change can be noted in his practical and other cognitive competences. Therefore to present date the intended goals can be considered as partially achieved. The rehabilitation programme must be continued and the therapeutic setting adjusted and aimed at learning daily events and activities.
In these months of the Camelot project, F. showed greater maturity and self-confidence. However, weaknesses still remain and require a continuation of the therapy. Federico responds in a different way when the therapist has an individual programme with him rather than when he has to work with another recipient or a group of them (for instance, in the narration activities). He sometimes proposes activities, and other times disturb them; when he works alone, in particular, he shows greater spontaneity and availability towards himself, emotions and narrations. In the group, Federico has not made many relations, but he goes along and works quite well with the other group members. In some occasions, as for instance at snack times, he still shows difficulties in coping with rules. For those who work with him, Federico's strongly positive aspect is his spontaneity and funny attitude. We could even draw him away from the main aspect that enable him to show his capabilities: football. His increased self-esteem and self-confidence (but there is still a lot to be done) has allowed him to keep off that single "topic" in which he comes off better than others. In this way, room can be created for other interests and activities. Federico seems to have found in the Camelot Project a pleasant and welcoming space, and his constant presence to our activities is a further confirmation of that.
In the light of the final analysis concerning Music Therapy, Federico seems to have positively modified his mnemonic, attention and concentration abilities as well as coordination and temporal setting and duration of events. He is positively involved in learning alternation of expressions in group activities and is developing a greater capability of listening to others. In music activities, Federico showed a great attraction towards adult world, though s some conflicts with reference to this same adult world still persist, as do his strong difficulties in complying with rules and performing a role different from that of leader. He still shows poor self-esteem and still needs to be supported, approved, protected, strengthened, feel reassured and controlled.
Occupational Laboratory Activities
Upon the evaluation carried out in the intermediate project phase, this activity turned out to be less effective and profitable to achieve the goals set for this boy. For this reason, it was deemed as therapeutically unfit and therefore abandoned.
As concerns the pleasure and recreational aspects of this activity, the boy showed an optimal interest, paid attention to the proposed goals and looked for alternative problem solving paths. We think that this approach can be the base to get motivation for future projects aimed at learning the basic tools for computer drawing and computer construction of objects.
In this activity Federico showed a greater ability to suitably react to frustration, and elder group members have surely helped him in this with their presence, since he is showing interest and awe for them. His relation making has been modified, though in difficult moments he tries to take refuge in more familiar and therefore more controlled situations. His relation with the therapist has improved, though mischievous and provocative behaviours still persist. From an emotional point of view, Federico is opening up to communication and expression of his emotions, even if not all difficulties have been solved; of course, these aspects should be strengthened.
Giorgio seems to have greater capabilities to establish and maintain a relation with his therapist, an important point of reference for him, whom he tries to get in touch with not only by using body expression approaches. Though he has recreational relations with other group members of his age, G. shows to share structured activities also when adult group members (i.e. therapists) are present. He is also more aware of his emotions, and his requests of help from adults have been modified so to strengthen his search for strategies to overcome difficulties, with a consequent decrease of evasive and contrast behaviours. Correct space associations are still a problem for him, and he still insists in finding symmetry in asymmetric positions. His strategy-making capabilities in problem solving are unchanged. However, in comparison with the start-up of therapy, his analysis of problems has changed and he tries to use all instruments provided to him. Manual activities requesting the use of both hands are still creating difficulties to him. His graphic and mental representation of objects has improved; G. has begun to use language to support his ideal representation of objects and organise its graphic implementation. He has acquired good logic and language capabilities and his verbal communication has improved. Though helped by adults, G. understands and voices logic relations of a narration, but morphologic and syntactic problems still remain. His understanding of oral narration and logic-time sequence seem to have improved. Strong deficiencies still persist in logic-mathematical areas. To achieve proposed goals, continuation of therapeutic activities is needed.
As compared to project start-up, Giorgio seems to have grown, in particular in his relations with other group members and therapists. He keeps childish attitudes, and proposes games and funny activities, but he is more tolerant towards external frustration. This situation was eased also by the fact that at the beginning his young age was reason to make fun of him in the group but with the passing of time also older boys accepted him and played with him. His hyperactivity, too, seems to diminish, and through the therapy Giorgio finds his own space, in harmony with his self and therefore more controllable; however, this is a complex process and needs constant and continuous interventions so that the boy's new discoveries can become assimilated forms of learning and behaviour. The initial improvement of his relation with his body self is fostering the acquisition of new expression and communication skills. Yet Giorgio sometimes still shows feelings of uneasiness and solitude. School comparisons through GLH confirmed his growing maturity: his increased attention and concentration times, his greater tolerance towards frustration, his improved participation in didactic activities are signs of this maturity. Giorgio participates in a narration activity of the Camelot project together with another project recipient. Giorgio showed participation for all the duration of these activities and sometimes acted as a provoker and troubler.
Through the mediation of play and recreational activities, Giorgio was successful in partly widening his relation-making possibilities also with older boys, though sometimes he still showed a weakness that made him behave as troublemaker as he did at the beginning. In Music Therapy activities, G. put to the test his compliance with rules, with moments of listening and expression, with the playing of different roles that allowed him to create room to express his inner aspects.
His collaboration and proposal making have improved, whereas his desire of support and strengthening and his non perception of danger have remained unchanged. Though with difficulty, G. Has started to acknowledge the authority of adults and to increase his mnemonic, attention and concentration abilities as well as coordination and temporal setting and duration of events. To achieve proposed goals, continuation of therapeutic activities is needed.
Unlike the initial phase of this activity, G. has shown a clear "worsening" as concerns relation and behavioural aspects as well as attention and participation. It is as the recreational aspect no longer played a mediation role for a more specific theatre therapy activity. However, it seems that the fact of working in a group could have been the element hampering G.'s growth process more than the activity itself. It is therefore important to see whether an individual setting could help to get more effectiveness.
During his experience in this laboratory, G. has calmly reached the proposed goals and has improved his concentration and autonomy, as well as his attempts of good relations with the group and the therapist. The activities proposed were characterised by play and recreational elements and set the basis for future activities aimed at reaching higher computer acquisitions and strengthening G's communication skills.
Though in the last months Mirko has been often absent due to illnesses, he has however achieved a positive result both in individual meetings in which Berebzon's music therapy has been used and in group meeting in which we also had a fruitful use of global language therapies.
His good relation with his therapist, characterised by deep affection, trust and confidence, has allowed Mirko - who is blind - to trust in the therapist and the latter could work on building a space that the patient could in turn recognise. Since the first meetings, M. has "come out" of the deadlock of spatial orientation and has recognised the setting. In this activity, Mirko has shown a really unusual memory as well as creativeness and musicality which derived from a special learning. As far as his production is concerned, he showed since the beginning a great skill; in fact he seems to possess techniques and a remarkably sense of rhythm in the use of some instruments. In this therapy, mainly carried out without verbal interactions, Mirko explored his vocal abilities, expressed great satisfaction at every discovery and involved the therapist in sessions of improvisations. In fact he produced a plethora of interesting compositions, recorded by using the voice in many different ways, from whispering to shouting, from an attractive tone to a popular one, from a text with a meaning to musical pungs. In group intervention, he overcame his initial difficulties since the others could recognise him from an affective point of view. Thanks to the therapists, Mirko has slowly understood the group situation and learned, for instance, how to act in the group at first by some almost isolated sallies and then by showing some self-assertion and assuming an open approach and availability to cope with the different situations. Due to the peculiar life and cognitive condition of this patient, the therapy and rehabilitation proposed by this activity must be continued.
Play and Recreational Activities
This was a profitable intervention for Mirko. The sharing of specific group situations allowed him to improve his relation-making and communication, which were strongly affected by his handicap, blindness. Mirko has therefore come out of his strong isolation and let the other group members touch him, get closer to him, and help him. In this way, he could establish a very intense emotional relation with some of them.
A more punctual and accurate evaluation was possible only after months of work on the patient's relationship skills. This evaluation showed the frequency and relative swinging of intensity of his contrast and aggressive behaviours, probably caused by inner emotions and drives. We therefore tried to realise a hypostimulating therapeutic setting in which the therapist adopted controlling and guiding attitudes. His understanding is affected, whereas his semantic level seems to be acceptable. Logic-linguistic aspects show a fair-to-serious compromising, whereas his verbal reasoning shows a total deficit. His reading and writing skills are strongly affected. Due the seriousness of his case, future and time-lasting interventions must have an individual setting aiming at the absolutely necessary understanding and distinction of events, actions and inner reactions. And it is also necessary and extremely important to make Andrea become part of a small group led by a therapist for future interventions aiming at the acquisition of a greater awareness of his emotional conditions.
After a phase of extreme difficulty in the patient-therapist relation, we are now living through a new phase of collaboration and involvement. Andrea proposed activities and showed creativeness and sometimes came to meetings with some stuff he had chosen to carry out activities. The psychologic intervention is not limited to the time spent with therapist in the specific setting, but is extended to the whole afternoon: in compliance with rules, in the relations with other patients, in the moments in which a greater self-control is requested. A. often has aggressive and provoking attitudes that can be defined as "compulsive" and represent a good base to work on and make him express his inner feelings and his uneasiness. He still has difficulty in verbal language and other communication methods and his actions are still the only way for him to express his specific needs. Andrea set up a relation only with some other patients of his same age, and normally prefers to have a relation with people older than him and with adults. Among those of his same age, Andrea often created difficult situations, first of all because of his low tolerance to frustration. Moreover, he still copes with the rules of a specific context with difficulty. We had a positive result on the decreasing of body contacts (hugs, kisses, etc...), which had created problems at the beginning of project.In individual meetings Andrea talked a lot about his family and himself, and did not show too much difficulty in sharing his experiences with others. A. cannot generalize his behaviours: each small achievement in a specific context cannot be applied to other situations, and must be sought and found again. His swinging behaviours and moods made him an extremely difficult boy and therefore future therapeutic interventions must focus on different aspects and strengthen and consolidate the small achievements realised up to now.
Theatre Therapy was for Andrea a setting in which, according with and depending on his specific mood of the day and swinging behaviour, he could experiment some learning linked to rules shaping the relation, as for instance respect for the setting (he does not show destructive behaviours against the environment or furnishings), respect for things belonging to others and interaction (also physical interaction) in due way and context. Over time, his attitude to "showing off" has been a good motivation to the narration of events he reported and expressed. His achievements in this activity, however, depend on his mood and cannot be generalized outside the theatre therapy setting. For this reason, and also in the light of the strong motivation he shows in this activity, the continuation of theatre therapy is deemed as necessary to strengthen the proposed goals.
Working Activities Laboratory
Although he showed attention and emotional participation in activities, in time A. expressed intolerance and implemented contrast and aggressive attitudes that made impossible to continue the activities.
The evaluation carried out in the intermediate project phase stressed the boy's great creativeness and expression skills, and therefore his participation in music therapy activities was decided. In music activities, A. showed to be able to have a real music dialogue with the therapist using both music instruments and his voice. He has also evidenced a great sense of rhythm and a remarkable bent for inventing stories and songs, also ironic ones. Though one must always take in mind Andrea's precarious emotional condition, it must however be underlined that during the therapy he showed some tolerance to activities and the time they requested. Andrea is deeply interested in music therapy activities and therefore we think it necessary to continue this activity in order to implement cognitive and behavioural goals whose achievement is of vital importance for the rehabilitation progress of this patient.
The most evident aspect of Martina is a significant emotional growth. She seems to better face and solve daily problems, asks for help from others and can express what she feels. She seems to face even frustration in a more mature way. Her cognitive situation still shows great difficulties, especially in school tests, grammar tests and understanding of logic relations in a narration. To this end, she should follow a cognitive therapy in small group to strengthen what she has learned. However, her verbal reasoning and logical-linguistic integration seem to have improved.
Martina sees psychologic support meetings as a personal and private space in which she can share emotions and narrations belonging to her adolescence. Her relation with the therapist has certainly had a positive contribution, since Martina could share womanliness problems with the therapist, often identifying herself with the therapist.The meetings often dealt with topics such as falling in love or expressing love, attention for one's body and daily changes. Her desire to perceive herself as "woman" and a beautiful one was welcomed and even stimulated when she showed fear and shame. M. shows a greater maturity and an improved expression of her emotions through less childish attitudes. In her relation with other group member and therapists, too, she showed a more open and free approach. Proposed goals have not been fully achieved yet, which means that a longer and continuous therapy is probably necessary. Self-confidence and self-reliance in her skills must still be improved, and this was also confirmed in meetings with school teachers. She still has problems in separation-individuation processes.
In these months, a series of meetings were held with her parents to support their role and relation with their daughter. These were intense meetings both for the parents and the therapist. Focus was given to the following aspects:
q The adolescent's relation with her parents and the different problems of this phase (social relations, falling in love, womanliness, growing up, trust, etc.);
§ Accept her diversity;
§ Work on pain and fears linked to her "limits"
Though levels reached with her families are good ones, this intervention must be continued.
The final evaluation shows that M. has improved her self-confidence, better follows her desires and can express herself sometimes even with determination. Her body language can better express her womanliness, through the way she moves, walks, dances or dresses. Sometimes M. can be more direct and strategic in planning a series of actions and behaviours aiming at reaching her goals. Other times she is collaborative and makes proposals and follows proposed solicitations and activities, often showing a quantitatively greater commitment; in fact her perseverance, concentration and attention have increased, especially as concerns more motivating activities, such as, for instance, dance. M. has improved her verbal and body communication to better express her inner feelings about a specific situation and shows a greater awareness and perception of her body. An improvement has also been noted in her relation with her body. Though difficulties remain, M. has modified her attention time and precision in carrying out therapeutic tasks. She still needs support from adults, especially other women, to which she now demands woman complicity.
As concern this activity, we can say that M. has visibly improved her "quality" of group participation and the effectiveness of her communications and relations. This seems to be a consequence of her increased self-esteem, confidence and assertive skills, as well as a greater use of suitable strategies for conflict solving. She is more self-centred, collaborates and participates more. She tends to establish relations with non-aggressive group member and with the therapists. She has recently tried to establish women complicity with other group girls of her same age. How much this social, communication and relationship improvement can affect her cognitive setting - which is her worst part- still remain to be assessed.
In dance therapy activities, M. seems to have reached an improved self-esteem and conflict and anxiety management. Attention is still a problem for her, as her relational performances and conflict between growing up and remaining in childhood. In the light of the strong motivation she shows for dance, we deem it necessary to continue this therapy so to give her cognitive stimuli in deficit areas.
Occupational Laboratory Activities
M. came to the first meetings showing emotional refusal and a deep lack of self-esteem. This led to a therapy with strongly emotional and creative group activities, and specific drawing and expression materials were used. She progressively removed her refusals about her privacy, first through narration and then through the production of manufacts. The possibility of comparison with other group members allowed her to become more receptive. She showed a greater knowledge of her womanly aspects and a greater attention for her body. hese improvements have reached a good point but not full achievement, and therefore we plan a continuation of therapy in order to reach proposed goals.
The final evaluation shows the persistence of semantic and lexical deficiencies. In particular, the narration of her experiences - though motivating - is not adequate to her age and not true-to-life. Alessia has enormous difficulties in giving up aspects of adulthood and her emotional growth has slightly improved. Facing such a compromised clinical situation, therapy must necessarily be continued.
In these months of work, Alessia's difficulties in expressing her true self have become more evident. Problems still persist in her analysis of intra and extra psychic reality. Her reference models are still television stereotypes or creations of her imagination. For this reason, Alessia swings from immature and childish behaviours to adult thoughts she imitates or has heard about. Adolescence topics could be dealt with only at times: school, friends and real interests. If we analyse all this from a psychodynamic perspective, we can say that mechanisms of protection concerning mind splitting are predominant in Alessia.However, she was mostly collaborative and participated in meetings, though in the last period her physical problems (backaches, headaches and stomach aches) affected her activities. In the last meetings she showed greater openness towards other group members, and this led to a returned love. Positive actions were carried out also at school, where teachers were dubious about her promotion to the subsequent year. She passed up, since her failure would have had negative consequences. The relation established with Alessia's family, and her mother in particular, was very important, since her mother found a point of reference in the therapists to elaborate her anxiety and pain. In the light of what above, to give greater psychologic balance to Alessia, individual therapy must be continued and her mother must be supported.
The cognitive therapy was affected by Giovanna's worsened psychopathological situation caused by epileptic crises. It was however possible to notice a slight and inconstant improvement of abilities and narration of self through writing. She still has great problems as concerns her mnemonic setting, due to her serious pathology. A time-lasting therapeutic setting aiming at maintaining acquired abilities and supporting memory is of vital importance.
In the light of G.'s complex psycho-physic-pathologic setting, just a partial achievement of goals aiming at a greater harmony and smoothness of movements, sense of rhythm, attention, listening and relationship was possible. G. seems to need long time to consolidate some specific achievements and her attention is too week and variable. It is therefore necessary a long and focused therapy free of diversions to reach the proposed goals.
Despite her difficulties in focusing attention and her reduced time of attention due to her recently worsened pathology, G. participates with involvement in this activity. Her relationship with therapist and group member is adequate and sometimes she exaggerates and becomes intrusive and wearying. In this activity G. seems to distinguish different emotional situations and express them in an appropriate way through different modalities. From a motor point of view, she seems rather hampered in her movements. This therapy must be continued for the following reasons: 1. reach an understanding of space and time; 2. improve movements; 3. improve relationship and compliance with rules.
Giovanna shows collaboration and makes proposals in this activity and often gets cheerfully involved in proposals made by therapists. She shows affection to therapists, as well as a need for protection and support especially in her moments of confusion. Though her difficulty of listening to others remains, she was able, in a minimum way, to understand herself and understand the experience of therapy, especially when the setting was free of too many stimuli and in tune with her childish need of fun and play. Verbal and body reactions became more and more fit to the context and showed a greater awareness of her own body. Perhaps the greatest difficulty was G.'s problem in seeing-listening to others since she is very self-focused and often tries to prevail over others. Her partially stereotyped attitudes seem to hamper the therapy. Her complex personhood requires an even more systematic and lasting intervention.
Occupational Laboratory Activities
Since the first meetings G. showed full awareness of her condition and brought it in the activities. A first approach centred on self-portrait enabled her to talk at length and of her free will about the accident she suffered. We inserted G. in a play setting for our therapy and also planned activities in which she could express topics typical to her age and therefore we often organised figurative representations of love stories and fairy tales. Due to her week attention and focusing, a constant therapy focused on specific goals is still necessary.
Due to her complex pathological situation, a specific psychologic support was impossible. This part of the rehabilitation therapy was implemented through wider and diversified methods: use of group activities in which the therapist played a role as relationship facilitator, activities in which the patient found her place and actively, often autonomously, demanded. Flavia needs a continued psychologic support since isolation seems to be a strongly possible risk for her.
This activity was characterised by a progressive welcoming of the therapeutic experience. The therapist has adjusted his times with those of the patient and this allowed the patient to learn specific setting elements and relationship methods. During the therapy, a slow but progressive improvement of verbal abilities has been noted; Flavia is now more focused on an active verbal request of something or someone. These small inputs make us feel optimist and think that Flavia could make a rehabilitation aimed at strengthening emotional, relationship and cognitive aspects.
Flavia seems to have benefited from this therapy and, though in a discontinuous way, rather improved her relationship. She is certainly more serene in her relationship with therapists and other group members, towards whom she was able to express preferences and liking. Her initial inhibition has laboriously given way to an excellent relationship with her therapist and also a good welcoming of therapeutic proposal. Despite her serious clinical picture demanding a continuation of therapy, F. seemed to verbally express herself with extreme spontaneity: words, sentences and names of other patients are providing F. with an essential dialogue tool for a good relationship with our project.
As suggested by the evaluation carried out in the intermediate project phase, Michele confirmed his excellent understanding and problem solving skill, his brilliant cognitive performances and his good creativeness. His positive approach is highly important not only for the strengthening of his self-esteem but also for the motivation he brings in the group. Behavioural aspects linked to his hyperactivity problems are unchanged.
Occupational Laboratory Activities
Michele showed high technical and expression skills. Despite his serious behavioural disorder, he has shown self-control, also because he felt satisfied by the activities, since his ideas were always implemented by the whole group and this gave him reasons for self-esteem. M. is able to bring in the setting his emotional experiences, also as stories to be represented. He bents for an equal-to-equal relationship with the therapist, though he understand the limits imposed by their different roles. In the light of his high abilities, we think that the continuation of therapy could make him reach an even higher expression of his skills.
Music Therapy and Theatre Therapy
The evaluations of these two therapies led us to draw only one report. M. has shaped for himself a leading role in the activities: he is the acknowledged leader and his ideas and enthusiasm have spread to the whole setting. Michele collaborates and makes proposals, and feels immediately enthusiast about proposals and activities made by therapists. His commitment is qualitatively and quantitatively impeccable. He intensely expresses his feelings, emotions and desires and often shows incapacity to cope with rhythms and variations imposed by the setting. In fact, his respect of rules and time of others shows a deficit. He acknowledges authority to significant adults and often shows his gratitude and happiness for these people by hugging them or getting closer to them or just eyeing them. M. shows great problems in keeping his attention focused. His serious behavioural disorder requires a protracted therapy aimed at distributing the patient's cognitive, emotional and relationship energies in a more suitable way.
STEFANO C .
As already stressed in the intermediate evaluation, his psychopathological and behavioural conditions do not allow him to bear a structured therapeutic setting. In the light of some changes and greater emotional and relationship availability of this boy, future projects of cognitive therapeutic training will perhaps be possible.
The patient is interested in these activities and in the knowledge allowing him to use the computer as a means for global communication. Although difficulties remain, he is extremely motivated in this activity and is successful in his relationship with the therapist and the group. Despite his great potential and intuition, S. is not able to reach the proposed goals due to his behavioural problems. Greater focusing of attention and problem solving abilities were developed by using a fun and play approach to computer activities.
Play and recreational activities
A greater welcoming of relationship can be noted in this therapy, as shown by some activities and the therapeutic stay in Tarquinia, during which S. expressed deep emotions coming from his inner world. He still alternates participation and elusiveness, with subsequent provoking, aggressive and contrasting attitudes. His serious psychopathological and behavioural disorders make uncertain his presence in the Camelot project, though motivations to group participation seem to be emerging. The "strengthening" role played by his mother is very important for the continuation of therapy.
Motivated and interested, this patient has successfully achieved the initial goals, so that his present level of knowledge will allow him to reach higher goals in future therapies. He showed to have good basic knowledge of this activity and be strongly motivated in learning didactics. The training followed allowed him to face word processing with a certain mastery and to achieve a good project approach in realizing and developing web pages. continuation of this activity is desirable since the patient could use his present knowledge to develop animations and realise computer objects. Aldo has also shown to have good skills in establishing relationships with the therapist and group members of his same age.
Unlike what emerged in the intermediate evaluation, this time the therapy was not functional for the patient. In fact A. could not immerse himself in the therapeutic situation, nor could he establish significant relations with other group members. Despite a greater welcoming and communication towards the reference therapist, he completely confined himself in relations with those of his same age. The proposed activities and their therapeutic goals seem not to have raised interests in the patient.
Occupational Laboratory Activities
The final phase of our project confirmed what emerged in the intermediate evaluation about the abilities and motivation of this patient, which remained constantly positive. A. was given a co-leading role in the activities and this produced an increased self-esteem, on one hand, and a greater welcoming of group members on the other hand, since A. often played the role of elder companion. This role playing could lead A. to express himself verbally in a more realistic and adequate way, and not just in provocative ways as it was in the past. It is desirable to continue this therapy, also in view of school achievements, since he is following a course as graphic designer and this activity could be extremely important for him.
The patient explicitly refused this therapy and no activity whatsoever was possible.
In recent months, music therapy activities showed the patient's difficulties in expressing his emotions through this therapy. His difficulties concerned the welcoming of proposed stimuli and their sharing with the group. His involvement in activities could be possible only in case of practical activities and in situations in which A. could express his desire of being "assistant therapist".
Jacopo's individual training was strongly and negatively hampered by his continuous absences due to his frequent epileptic crises threatening his cognitive, behavioural and physical condition. Only through the newspaper project - in which J. shows interest and motivation - could we strengthen practical language and writing skills and his self-esteem. Because of the importance of this experience, we think necessary to continue this therapy.
During the whole project, Jacopo worked out his individual psychologic space by looking for reference people and expressing his reality in less structured settings. The topics he proposed concerned his relationship with his parents and his identity and adolescence problems. During the project Jacopo did not change his behavioural strategies: his actions and relationship with others remain seductive, charming and even contact-oriented (also physical contact). He still needs time to accept and work out his disorders. His epilepsy hampers his growing up and maturity. In the final phase of project, J. showed a worsening also due to his frequent epileptic crises threatening his psycho-physical health and causing a slowing down in cognitive and learning skills. He recovered very slowly. As far as the above mentioned aspects are concerned, the therapy included individual as well as parental meetings. The latter were very intense and also significant, even if reasons of conflict between parents remained unchanged. Both the boy and his family need to continue the therapy.
This activity was strongly affected by the boy's precarious health. For this reason, the patient followed the therapy in a discontinued way and his anxiety grew. Despite this, in time we noticed that his behaviour had changed towards a greater collaboration and proposal making. Though affected by a clear anxiety about his performances and difficulty in following therapeutic stimuli, J. has shown participation, commitment and adequacy to proposed stimuli. More and more, his verbal and body behaviours expressed his inner feelings. He was more aware of his body and showed an increased ability in remembering events.
This activity was strongly affected by the boy's precarious health, which even worsened in recent months. Despite this, his presence to meetings was rather regular. He showed greater availability towards group members and some minimal availability towards the therapy. However, strong defensive attitudes remained. Jacopo still suffer from motor problems, mainly due to his pathology and the use of it as an alibi not to carry out his tasks in a more active way.
Occupational Laboratory Activities
J. used this therapeutic setting to establish relationship with the therapist and not to test his practical skills. His relationship with the therapist was characterised by intense emotional and affective verbal production. therefore it was difficult for the therapist to make J. react to the specific stimuli of this activity and for this reason the proposed goals delineated in the intermediate project phase have not been achieved. This activity was a further possibility for J. to establish significant relationships.
Due to his discontinued presence for serious family reasons, goals aimed at improving his written, practical and symbolic skills as well as his narration and vocabulary skills were not so much implemented. In the light of the patient's complex cognitive situation, it is necessary to continue this therapy and hope in his presence and continuity in the activities.
Therapy with Mario was discontinued due to his absences for serious family reasons. However, the Camelot project offered him the possibility of widening his social, cognitive and emotional "views" through interaction with other group members and therapists. Experiment his skills among people of his same age was for him a way to foster rule compliance and establish interpersonal relations. His social and family context does not offer him many positive inputs to his growth and psychophysical and relational development. Unlike the initial phase, Mario showed more availability towards group members and therapists. His provocations and/or aggressions to other group members diminished; he accepted the activities proposed by therapists and participated in his own way and according to his possibilities. Mario still needs time to grow up and strengthen his personal autonomies. His greatest difficulty is the expression of his emotions and the narration of his feelings, both very complex goals to work on. Our vacation in Tarquinia was a positive experience for him, though he suffered from being separated by his family. However, he showed good adaptability and activity sharing with other group members.
This therapy was the start-up of a work on socialization, real emotional expression and communication free from some television stereotypes that he constantly follows and cherishes. His confidence in group members and therapist allowed him to "unveil" many potentialities of creativeness that must be encouraged and consolidated in a possible and needed future therapy.
This therapy was characterised by the patient's clear motivation to share and actively participate in activities and his strong desire to lead and decide about experiences, as well as give expression to his inner aspects. He cheerfully participates in activities and acknowledges the therapist as the authoritative person that can support, take care and sometimes pamper him. The patient shows gratitude and affection both verbally and not verbally, for instance by asking to do those activities symbolically closer to a pampering relationship. As the therapy progressed, M. showed more attention, mnemonic and listening skills for music and verbal productions. Despite his absences, he has begun to learn some correspondences between inner emotional conditions and their external music, body and verbal expressions.It must be evidenced that M. is positively testing himself in organising event sequence, duration and quality and is able to protract pauses and silence and experiment lower volumes and slower rhythms. Seen the effectiveness of the proposed therapy, its continuation is of fundamental importance.
Occupational Laboratory Activities
As already stressed in the intermediate evaluation, the patient's strong phobic attitude towards some elements of this activity made impossible to meet the goals fixed at the beginning. However, this laboratory made it possible for the patient to widen his relationship skills.
This activity made it possible for the patient to live physical contact not as destructuring elements but as possible integration of relationship aspects that were of fundamental importance for him. In time C. experienced the joy of working in a group, sought physical contact and also made affective selections. Though with great difficulty, because of his deep inhibition, C. seems to begin to recognise and express his feelings and differentiate rhythms and different emotions. Moreover, he showed an ability of "being inside" events and focus on them with the right emotional intensity. In the light of these small yet huge achievements reached during these months, we deem it necessary to continue and deepen this intervention.
C. experienced this group activity with enthusiasm and curiosity. Group therapy seems to fit better than individual for him. During the therapy, the patient made proposals and collaborated, by showing attention and interest in the proposals made by other group members and enriching them with personal inputs.C. can share the proposed experiences both verbally and physically, and cherishes some music expressions such as singing and dancing; his enthusiasm was so enthralling that the other group members constantly called for him. He acknowledges authority to therapists and reacts adequately to proposed inputs. He is having a stronger and stronger success in achieving awareness of relations between some of his inner emotional conditions and their external expression. This experience is so important that the continuation of therapy is strongly desirable.
Occupational Laboratory Activities
We used the experience of "colours" and some articles such as hats, cloth, masks etc. and this gave the patient the possibility to get closer and closer - though with difficulty - to practical activities. In fact C. progressively abandoned some of his phobic rituals of behaviours and could experience the "hic and nunc". In his relationship, qualitative and quantitative changes could be noted in communication, and he could communicate personal and even deep aspects to others and even critically analyse the activities. Oue to the therapeutic value of this practical laboratory, it is of fundamental importance to continue this experience.
His complex behaviour did not allow for a structured specific cognitive activity. The activity of our "newspaper" has replaced this therapy in achieving cognitive goals. The strong interest he showed towards this activity allowed his to express his cognitive abilities as well as strengthen his learning strategies, for which a continuation of this activity seems of vital importance.
The patient showed great interest in this activity and confirmed his basic and advanced knowledge on this topic. He achieved his goals in an excellent way. A. makes proposals and feels at ease in the group. The school curriculum he followed in this period can enable him to have a complete -though basic- skill to realise and develop web pages and use Office Automation tools. His wish of becoming graphic designer and frequent the High School makes necessary to continue this therapy.
After a serious initial difficulty (as reported also in the intermediate evaluation) A. has become progressively more available and participated and accepted proposed inputs. His aggressive behaviours diminished. A deep intolerance towards authoritative adults remains and makes it very difficult to establish a relationship with Andrea. In fact he continuously requires adjustments of therapy spaces with his approaching - departing attempts and expresses a deep need of being accepted and limited in his appearances/disappearances. This acceptance is important for the patient to carry out activities and therefore perceive himself as sufficiently stable and compliant at the same time. In time A. showed his preference for male adults, to whom he shows his collaboration, affection and proposals. He is progressively prolonging his attention, focus and mnemonic skills.
This activity was characterised by a deep relationship conflict between the therapist and the patient. This difficulty led to a progressive discontinuity of patient and made it impossible to reach the goals set at the beginning. It seems that the patient has some difficulties in this using and benefiting from this type of intervention.
Occupational Laboratory Activities
The patient showed a relationship uneasiness that decreased in time. His greater knowledge of therapist and inputs allowed him to participate in the activities. His complex behaviour expressed in his conflictual presence made it impossible to achieve the needed continuity to make change possible. Despite this, his relationship with therapist seems to have been positively changed and some motivations for this activity seem to have been found.
Cognitive Therapy As reported in the intermediate evaluation, we confirm a good level of learning and autonomy in proposing and carrying out a task. The patient knows how to use a computer in a functional way. His graphic and symbolic skills are remarkable and in group activities and topic selection he shows perfect harmony with goals and times as well as model behaviour. Greater cognitive and learning achievement can be reached through a continuation of this therapy. Music Therapy
Davide seems to have established a good relationship with other group members and an increased involvement in proposed activities. He has shown more collaboration and has expressed more adequately and with greater confidence his emotions and moods through his voice and movements. However, his inhibitions remain high and make unsteady his emotional involvement. His attention and focus have increased, as have his expression of his inner feelings and emotions. The continuation of therapy is fundamental to strengthen and consolidate Davide's emotional status.
D's positive changes mainly concern sociality and relationship. He is clearly more available to others and to contact with group members and operators. He seems to be more active: he is the first to say hello, makes questions, and asks about the activities scheduled for the day. He gets involved and is quite always the first to perform activities and achieve his tasks in a very creative way. His sense of shame and fear has changed. The results achieved to date make it important to continue this activity so that D. could better consolidate his psychodynamic aspects.
Occupational Laboratory Activities
In technical activities Davide has shown stereotypes and schematism, whereas in the relationship his problems of contact diminished over time and gave way to a greater availability towards others. He was not motivated, and this activity was used almost exclusively for relationship purposes.
As stressed in the intermediate evaluation, Simone seems deeply interested and collaborative and seems to have reached good results in writing and text ideation and drafting and therefore in focusing on significant elements of a text. Text planning, revision, self-correction and cause and effect logics requested an important effort. In group activities, the patient maintained model behaviour and an active participation. Achieved results request the continuation of cognitive therapy.
Simone showed great interest in proposed activities and deeply participated in this experience. Despite he requested approval for his behaviours, nevertheless he was able to express genuineness without inhibitions and with a playful approach. He respect reference therapists and acknowledges their authority. S. can nevertheless claim autonomy for himself and this protects his point of view. He has progressively protracted his attention, focus and mnemonic skills. Though with some difficulty, he can express his inner feelings and emotions both verbally and through analogies.
As reported in the intermediate evaluation, Theatre Therapy in large group is very difficult for S. In fact the patient seemed to be bewildered, absent, not performant, not interested and not committed in the search for new expression channels and topics. Also his ability of emotion management and expression seemed to stop, especially when a new patient became a member of the group and took its leadership. This therapy should be proposed to Simone in a small group.
Occupational Laboratory Activities
Simone is generally really talented in arts, but his attention and participation diminished progressively especially in recent months. He is not fit for a large group, probably because the anxiety of others does not help him in keeping focused and motivated.
Therefore an individual therapy was attempted, and S. could reach some practical and expression results. These latter make us think that a continuation of the therapy would be positive for him.
The group therapy for parents of children following the Camelot project has been a positive and interesting experience, first of all for the parents who took part in it, but also for our therapists.
All meetings were characterised by a lively and intense participation, which we interpreted as a strong need of parents to share their experience with others: pain, joy, fear. In so doing, parents could find themselves and form a closely-knit and solid group.
As we also wrote in the intermediate evaluation, the main topics dealt with concerned:
v Isolation of children and families in school and social contexts;
v Quality of communication between parents and children;
v Educational strategies to implement as concerns behavioural problems of children;
v Fears and anxieties of parents for autonomy of their children;
v Understanding difficulties in accepting disabilities and abilities;
v The genuineness of children's feelings;
v Issues concerning conflicts in separated parental couples;
v The delicate relation between being a couple and being parents;
The persistence of some topics is due to the fact that often parents stress those problems that create greater difficulties to them in their relation with their disabled child.
In the last months, the list of these topics included also:
v the cage metaphor, as isolation, uneasiness and fear for disabled children and families;
v Sex, falling in love and love in disabled people;
v Concerns on school curricula and future choices for these children;
v Vacation in Tarquinia: experience of independence and autonomy.
At the end of this series of meetings, a final meeting was held to carry out an evaluation of the group and its usefulness and to set up goals for future projects that could be closer to parents' needs.
In the final meeting, the following topics were analysed:
Concern about the continuation of the Camelot project;
Concern and anxiety for the future of children;
The positive outcome of our meetings focused on parents;
The usefulness of mutual help and group experience.
We have also used two tools:
1. An individual questionnaire
It is a questionnaire to find the factors of group effectiveness in parental support. This questionnaire was tested and adjusted in a study carried out to verify efficacy factors in self-aid groups ( Francescato D, Tomai M., Foddis A., I fattori di efficacia nei gruppi di auto-aiuto, in Psicologia della Salute, n.2, 2002). It is formed by 18 items, to which scores are given according to a Likert scale (Very likely, Likely, not likely, not at all); the aim is the detection of those factors that foster most changes in the participants in a support group.
2 - A narration experience
This is a free tool. Participants received a series of inputs to be followed or not; this exercise can be made with a partner or individually. The aim is that of pushing parents to narrate their experience in the group, so to understand the effectiveness of work carried out. In this way, the therapists can monitor and evaluate group experience and modify and improve some questionnaire aspects on the basis of what parents reported.
The results of these activities are under assessment and will be sent as soon as possible. The parental group has also participated in theatre therapy, music therapy, occupational laboratory meetings, dance therapy and creative writing with the project therapists. Parents found this experience interesting and expressed curiosity and amusement after an initial uneasiness and difficulty. This possibility of meeting and experiencing the same activities carried out by their children was an opportunity to exchange experiences in a creative environment. As concerns psychological support to families, we carried out monthly meetings with six families. In most cases, these meetings strengthened the role of parents and relationships and communication within the family; in 1 case, they increased the problems in parental relationship and in family situations. It must also be said that a final meeting was held with therapists and families, in which all families received sufficient information on the progress and achievements of their children's social educational and rehabilitation project.