The use and effectiveness of psychodinamic psychotherapy in childhood and adolescence were object of contest in scientific research until the Seventies of the last century. In spite of this question, the latest literature reports that there is a lack of empirical evaluation about psychodynamic psychotherapy techniques and use. This could be explained considering that a standardization of this method, as for example in the pharmacological-therapy studies, that are so frequently compared with psychotherapy in several studies (i.e. Target e Fonagy, 2004), is quite difficult to act, considering the specificity of therapeutic relationship in psychodinamic psychotherapy technique (i.e. Brusa, 1994) The newest results of two reviews published in 2005 and 2008 suggest that at the moment psychodinamic psychotherapy has more efficacy in spite of no therapy or other therapies, and underline that a long-term psychodinamic psychotherapy (LTPP) achieves better outcomes that a short term-one (Leichsenring, 2005; Leichsenring et al., 2008). The aim of this project was to consider the use and effectiveness of time-limited psychodynamic psychotherapy in a sample of inpatients from a child and adolescent public mental health clinic, and to compare two group of patients treated by an individual LTPP and usual-care treatment respectively. All patients and parents receive a semi structural interview for diagnosis according to the DSM IV-TR criteria (KSADS); to evaluate changes in behavior and global functioning, the operators filled out the Children Global Assessment Scale (C-GAS), than the parents were asked to fill out the Child Behavior Checklist (CBCL), used to obtain standardized reports of children' behavior, considering social and relational capacities and behavior and psychological problems, at the start of study (T0), at the end of therapy (1 year, T1) and 6 months later (follow up, T2). Starting from 2005 66 subjects were enrolled, between age from 4 to 17 years old, with DSM IV-TR diagnosis of Psychotic Disorder, Personality Disorder and Depressive Disorder and without individual psychodynamic psychotherapy ongoing yet. 33 patients composed the experimental group, mean age 11,3 years old (DS=3,1); control group is constituted by 33 patients, mean age 11,2 years old (DS=4,1). The patients were all collocated in a general waiting list, and assigned to the groups according with therapists' availability; patients' assignment used also clinical criteria, so it wasn't totally blinded, according with ethical matters. The experimental group was treated by LTPP once a week for 1 year (44 sessions in total); the control group instead received usual-care treatments, focused on rehabilitation and symptoms’ resolution, in the territorial Operative Unit of Neuropsychiatric Clinic of S. Gerardo Hospital. The data gained at T1 show higher social and relational competencies and a symptoms’ reduction in subjects treated by LTPP, considering both their own characteristics at T0, and the control group ones, too, as it can see at the scores filled out by therapists at C-GAS and parents at CBCL questionnaires. Psychodynamic psychotherapy shows also at K-SADS interview to be able to get a global symptoms’ reduction from T0 to T1, specially in patients with diagnosis of Depressive Disorders and Personality Disorders, according to literature and American Psychiatric Association’s guidelines, that indicate this therapy as the preferential for these patients. The preliminary outcomes at follow up show the persistence of the benefits of psychotherapy both considering relational and symptomatological aspects, that can't be observed in control group. A peculiarity of LTPP was also observed: the data collected at T2 show a further increase of scores in patients treated by LTPP, in particular at C-GAS. Subjects belonged to experimental group in fact achieved at T2 a not pathological score (>70), the control group instead remained in the pathological one. These improvements are reported in literature as "sleeping effects", and are typical of LTPP, that can offer better useful psychological resources and abilities also after the end of therapy.

(2009). Efficacia della psicoterapia psicodinamica in un servizio di neuropsichiatria per l'infanzia e l'adolescenza. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2009).

Efficacia della psicoterapia psicodinamica in un servizio di neuropsichiatria per l'infanzia e l'adolescenza

MASERATI, ELISA
2009-12-17

Abstract

The use and effectiveness of psychodinamic psychotherapy in childhood and adolescence were object of contest in scientific research until the Seventies of the last century. In spite of this question, the latest literature reports that there is a lack of empirical evaluation about psychodynamic psychotherapy techniques and use. This could be explained considering that a standardization of this method, as for example in the pharmacological-therapy studies, that are so frequently compared with psychotherapy in several studies (i.e. Target e Fonagy, 2004), is quite difficult to act, considering the specificity of therapeutic relationship in psychodinamic psychotherapy technique (i.e. Brusa, 1994) The newest results of two reviews published in 2005 and 2008 suggest that at the moment psychodinamic psychotherapy has more efficacy in spite of no therapy or other therapies, and underline that a long-term psychodinamic psychotherapy (LTPP) achieves better outcomes that a short term-one (Leichsenring, 2005; Leichsenring et al., 2008). The aim of this project was to consider the use and effectiveness of time-limited psychodynamic psychotherapy in a sample of inpatients from a child and adolescent public mental health clinic, and to compare two group of patients treated by an individual LTPP and usual-care treatment respectively. All patients and parents receive a semi structural interview for diagnosis according to the DSM IV-TR criteria (KSADS); to evaluate changes in behavior and global functioning, the operators filled out the Children Global Assessment Scale (C-GAS), than the parents were asked to fill out the Child Behavior Checklist (CBCL), used to obtain standardized reports of children' behavior, considering social and relational capacities and behavior and psychological problems, at the start of study (T0), at the end of therapy (1 year, T1) and 6 months later (follow up, T2). Starting from 2005 66 subjects were enrolled, between age from 4 to 17 years old, with DSM IV-TR diagnosis of Psychotic Disorder, Personality Disorder and Depressive Disorder and without individual psychodynamic psychotherapy ongoing yet. 33 patients composed the experimental group, mean age 11,3 years old (DS=3,1); control group is constituted by 33 patients, mean age 11,2 years old (DS=4,1). The patients were all collocated in a general waiting list, and assigned to the groups according with therapists' availability; patients' assignment used also clinical criteria, so it wasn't totally blinded, according with ethical matters. The experimental group was treated by LTPP once a week for 1 year (44 sessions in total); the control group instead received usual-care treatments, focused on rehabilitation and symptoms’ resolution, in the territorial Operative Unit of Neuropsychiatric Clinic of S. Gerardo Hospital. The data gained at T1 show higher social and relational competencies and a symptoms’ reduction in subjects treated by LTPP, considering both their own characteristics at T0, and the control group ones, too, as it can see at the scores filled out by therapists at C-GAS and parents at CBCL questionnaires. Psychodynamic psychotherapy shows also at K-SADS interview to be able to get a global symptoms’ reduction from T0 to T1, specially in patients with diagnosis of Depressive Disorders and Personality Disorders, according to literature and American Psychiatric Association’s guidelines, that indicate this therapy as the preferential for these patients. The preliminary outcomes at follow up show the persistence of the benefits of psychotherapy both considering relational and symptomatological aspects, that can't be observed in control group. A peculiarity of LTPP was also observed: the data collected at T2 show a further increase of scores in patients treated by LTPP, in particular at C-GAS. Subjects belonged to experimental group in fact achieved at T2 a not pathological score (>70), the control group instead remained in the pathological one. These improvements are reported in literature as "sleeping effects", and are typical of LTPP, that can offer better useful psychological resources and abilities also after the end of therapy.
NERI, FRANCESCA
Psychodynamic psychotherapy, effectiveness, child, adolescent, mental health
MED/39 - NEUROPSICHIATRIA INFANTILE
Italian
Scuola di Dottorato in Scienze Mediche Sperimentali e Cliniche
NEUROSCIENZE - 17R
22
2008/2009
(2009). Efficacia della psicoterapia psicodinamica in un servizio di neuropsichiatria per l'infanzia e l'adolescenza. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2009).
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/7655
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