Models of collaboration between psychologist and family doctor: a systematic review of primary care psychology

open2noThe prevalence of psychological suffering is greater than the actual request for clinical consultation in Europe (Alonso et al., 2004). In Italy, no more than 5.5% of the population requested psychological assistance during lifetime (Miglioretti et al., 2008). There are different obstacles that prevent the access to mental health services, such as economic restrictions (Mulder et al., 2011), cultural prejudice (Kim et al., 2010), and lack of knowledge about the service providers that can answer to the patient’s psychological needs (Molinari et al., 2012). Therefore, the psychologist is often consulted as a last resort, only after everything else has failed, when problems have become severe, and thus requiring longer, more intensive, and expensive treatments. The introduction of the Primary Care Psychologist, a professional who works together with the family doctor, allows to overcome the above-mentioned problems and intercept unexpressed needs for psychological assistance. This professional role is operating in many countries since several years. In this study, current literature concerning different models of collaboration between physician and psychologist, in Europe and in Italy, was reviewed. A systematic search of Web of Science (ISI), Pubmed, Scopus, and PsychINFO was conducted using the initial search terms Primary Care Psychologist, Family Doctor, Primary Care, Collaborative Practice, and several relevant papers were identified. The review has shown the improved quality of care when mental health care is integrated into primary. Analyzing how different programs are implemented, results indicated that the more efficacious models of Primary Care Psychology are those tailored on the environment’s needs.The results of our systematic review stress the importance of the Primary Care Psychologist implementation also in Italy, to intercept unexpressed psychological needs and enhance clients’ quality of life.openFrancesca, Bianco; Enrico, BenelliBianco, Francesca; Benelli, Enric

Empirically supported emerging and marginalized psychotherapies: Integration of non-concurrent multiple baseline design and hermeneutic single case efficacy design

According to APA division 12, at least two Randomized Clinical Trials (RCT) or alternatively nine Single Case Experimental Design (SCED) are required to be recognized as Empirically Supported Treatments (EST). Multiple baseline is the most suitable SCED in psychotherapy research because the treatment effects do not reverse after conclusion and do not require withdrawal in ABAB phases. Treatment's introduction is staggered sequentially across multiple participants, which allows the researcher to demonstrate that changes occur when treatment is introduced, simulating a waiting list. Hermeneutic Single Case Efficacy Design (HSCED) ensures time series analysis as the SCED, adding also qualitative and hermeneutic analysis that allow the recognition of bidirectional linkage between outcome and process variables. Furthermore, external judges assess the quality of the studies providing a verdict of good, mixed or poor outcome. To present systematic replication of multiple non-concurrent baseline HSCED as a way to empirically support both emerging and marginalized models of psychotherapy. After a phase of assessment and the collection of a stable three-point baseline, change in a convenience sample of five patients was tracked with quantitative (PHQ9, STAI, CORE-OM, PQ) and qualitative (HAT, CI) measures. Hermeneutic analysis and judge evaluation were conducted according HSCED protocol. Quantitative data show Clinical Significant and Global Reliable Change in all patients, supported by qualitative data. Hermeneutic analysis suggests specific outcome-to-process linkage and therapeutic interventions followed by shift in weekly outcome measures, supporting and refining the theoretical predictions of the manualized Intensive Transactional Analysis Psychotherapy. Combining multiple baseline design and HSCED, it is possible to support recognition as EST of emerging and marginalized treatments, involving less resources than RCT

Hermeneutic single case efficacy design: A systematic review of published research and current standards

open4siThis article systematically reviews the methodological characteristics of Hermeneutic Single Case Efficacy Design (HSCED) studies published in peer-reviewed journals. HSCED provides researchers with a flexible and viable alternative to both between-groups and within-subject experimental designs. This article includes a description of the evolution of the methodology distinctive to HSCED; a discussion of results of HSCED studies considered within a framework of contemporary standards and guidelines for systematic case study research; a presentation of recommendations for key characteristics (e.g., diagnosis, hermeneutic analysis, adjudication procedure). Overall, the aim is provide researchers and reviewers with a resource for conducting and evaluating HSCED research. The results of a systematic review of 13 studies suggests that published HSCED research meets contemporary criteria for systematic case study research. Hermeneutic analysis and adjudication emerged as areas of HSCED practice characterized by a diversity of procedures. Although consensus exists along key dimensions of HSCED, there remains a need for further evaluation of adjudication procedures and reporting standards.openBenelli, Enrico; De Carlo, Alessandro; Biffi, Diana; Mcleod, JohnBenelli, Enrico; De Carlo, Alessandro; Biffi, Diana; Mcleod, Joh

Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

Development and Case Study Application of a Proxy-Generated Outcome Measure of Suffering for use with Clients with Illusory Mental Health

The concept of illusory mental health is described as the rationale for needing an approach for working with individuals who are unaware of their suffering and are therefore unable to describe their problems through self-report instruments. The use of a nomothetic approach using self-report or clinician-generated standardised instruments is compared with an idiographic approach for working with such individuals. A case study is used to illustrate the development and first application of a Proxy-Generated Outcome Measure (PGOM) that allows clinicians, observers and researchers to trace an individualised understanding of a client's core sufferings and changes occurring during the process of psychotherapy. A comparison with a nomothetic outcome measure is also presented

La guida interattiva INandOUT. Un modo nuovo di esplorare musei ed aree archeologiche

The Interactive Guide INandOUT, created as part of the project “Signs of pre-Roman cultures in land and landscape” and sponsored by the European Program “Culture 2000”, aims at experimenting new forms of comprehension by creating a direct link between site-visiting, excavations finds and archival research using the newest available technologies (notebooks, Tablet PCs, etc.). The Interactive Guide INandOUT answers the visitor’s need to contemplate the single work he is observing inside the site or museum and to observe it together with the entire site, at the same time. In short, it can place the visitor outside the site while still taking him through each single step of the excavations. Two goals have been achieved: first of all an informative net was created, covering vast open spaces (such as those found in archeological sites) and smaller indoor spaces (such as those found in museums), and using wireless technology (Wi-Fi, Bluetooth, GPRS, UMTS). Second, this net was filled with multi-medial contents, such as animations, movies, images, sounds and voices, in order to enhance the correspondence between inside and outside, between the single object and its original environment. The visitor’s position is identified by means of tags RFid (Radio Frequency Identification). These simple and quite “invisible” radio transmitters, spread all over the site, interact with the client-driver (the Tablet PC) given to the visitor. By receiving different specific codes the Guide recognizes where the visitor stands and sends him the most specific and contextual information. Last, but not least, the RFid system considerably reduces both operation and maintenance costs. The Tags used to activate the multi-medial information on the visitor’s Tablet PC are small, easily attached (even only using glue) and easily removed if necessary, long lasting, ideal for open and external spaces, and, most important, they need no power supply

The words of the body: psychophysiological patterns in dissociative narratives

Trauma has severe consequences on both psychological and somatic levels, even affecting the genetic expression and the cell\u2019s DNA repair ability. A key mechanism in the understanding of clinical disorders deriving from trauma is identified in dissociation, as a primitive defense against the fragmentation of the self originated by overwhelming experiences. The dysregulation of the interpersonal patterns due to the traumatic experience and its detrimental effects on the body are supported by influent neuroscientific models such as Damasio\u2019s somatic markers and Porges\u2019 polyvagal theory. On the basis of these premises, and supported by our previous empirical observations on 40 simulated clinical sessions, we will discuss the longitudinal process of a brief psychodynamic psychotherapy (16 sessions, weekly frequency) with a patient who suffered a relational trauma. The research design consists of the collection of self-report and projective tests, pre-post therapy and after each clinical session, in order to assess personality, empathy, clinical alliance and clinical progress, along with the verbatim analysis of the transcripts trough the Psychotherapy Process Q-Set and the Collaborative Interactions Scale. Furthermore, we collected simultaneous psychophysiological measures of the therapeutic dyad: skin conductance and hearth rate. Lastly, we employed a computerized analysis of non-verbal behaviors to assess synchrony in posture and gestures. These automated measures are able to highlight moments of affective concordance and discordance, allowing for a deep understanding of the mutual regulations between the patient and the therapist. Preliminary results showed that psychophysiological changes in dyadic synchrony, observed in body movements, skin conductance and hearth rate, occurred within sessions during the discussion of traumatic experiences, with levels of attunement that changed in both therapist and the patient depending on the quality of the emotional representation of the experience. These results go in the direction of understanding the relational process in trauma therapy, using an integrative language in which both clinical and neurophysiological knowledge may take advantage of each other