A tribute to Vittorio Guidano

The Guidano’s approach has pointed out importance of affective and emotional aspects for development of Self and has focused subjective manner of experience rearrangement, operating in experience/explanation interface, to identify basic aspects and processes that lead to knowledge of Self and others. Continuous swinging from immediate experience and explanations of such an experience produces two levels of knowledge: “tacit” (emotional, scarcely defined and conscious) and “explicit” (rational and conscious). Individual development is characterized by a self-referring process of a more and more complex arrangement of continuous and heterogeneous flowing of external stimuli, perceived and elaborated as identity and knowledge of Self and world. Attachment patterns (concerning quality of parental expected response, intrusion, interference and control levels, and invested empathy), can produce, on one hand, early emotional control disorders, and, on the other hand, can compromise further evolution of attachment patterns during late infancy, preadolescence and adolescence, impairing affective style and ability of engaging valid couple friendships. In Guidano’s approach, any psychopathological disorder (neurotic or psychotic, with respect to one’s flexibility, abstraction and self-integration abilities) reflects a perturbation of self-organization processes, essential for one’s internal coherence maintenance, with arising of a critic phase resolved by getting a newer and more complex and adaptive equilibrium; any symptom, independently by its semeiological characteristics, must be referred to an alteration of internal balance and coherence

Pattern di attaccamento e depressione nell'età evolutiva: contributo clinico in un'ottica cognitivista sistemico-processuale

Attachment patterns and developmental depression: a clinical and process-oriented cognitive investigation. According to the systems and process-oriented cognitive theory, different significant factors are involved in development of a «self-organization of personal meaning dimension», such as constitutional factors, attachment relationships, and, most of all, a subjective manner of arranging life experiences. During adolescence, each self-organization of personal meaning dimension acquires more or less adaptive characteristics, that will be used during adulthood. Therefore, in regard to its physiological or pathological aspects, adolescent depression represents a criticai way of understanding emotional and cognitive style involved in the development of adult personality. With respect to the examined subjects, the Authors propose a classification of adolescent depression into three different forms: the first one, characterized by an uncertain and indefinite personality, which avoids any significant confrontation (external depression, corresponding to an «entangled », anxious resistent attachment); the second one, characterized by a primary sense of personal inadequacy and failure (internai depression, corresponding to a «dismissing», anxious avoiding attachment); the third one, has characteristics common to the other two forms or has atypical clinical aspects. Key words: adolescent depression, attachment, self organization of personal meaning dimension

Adolescent depression: New perspectives according to a cognitive post-rationalist approach

Vistosky H., Lieh Mak F., Lòpez-Ibor J. (Eds.

Valutazione cognitiva sistemico-processuale delle variabili di ingresso nella depressione adolescenziale

associate a differenti stili di attaccamento: una forma caratterizzata da una personalità dai confini incerti ed indefiniti, con tendenza ad evitare ogni confronto emotivamente significativo con l'altro (depressione a lettura esterna, corrispondente ad un attaccamento ansioso resistente); una forma caratterizzata da un primitivo e marcato senso di inadeguatezza e di fallimento per ogni iniziativa personale (depressione a lettura interna, corrispondente ad un attaccamento ansioso evitante); una forma mista con caratteristiche comuni alle due precedenti ma, in parte, anche atipiche. Soggetti e metodi. Sono stati valutati 185 soggetti (83 maschi e 102 femmine). Il valore diagnostico e prognostico delle modalità di trama narrativa è stato valutato in rapporto alla capacità di lettura interna o esterna, ai livelli di flessibilità, concretezza/astrazione ed integrazione del sé. Risultati e conclusioni. Le esperienze discrepanti all'origine della perturbazione critica che ha portato all'osservazione sono consistite in: conflittualità familiare, fallimenti o perdite affettive, eventi di lutto scarsamente elaborati, fallimenti scolastici e lavorativi, delusioni da parte di figure significative. Nei soggetti con depressione Tipo I, le emozioni prevalenti sono state vergogna, colpa e disperazione; nel Tipo II si sono osservate soprattutto rabbia, tristezza, disgusto, disperazione, colpa, rammarico e collera; nel tipo III-a sono emerse attivazioni emotive comuni alle due forme precedenti; nel Tipo III-b, infine, sono emerse in particolare ambivalenza, disprezzo, disgusto e colpa. Il grado di flessibilità è apparso scarso soprattutto nei soggetti con depressione Tipo II e Tipo III-a; un discreto rapporto concretezza/astrazione si è osservato in tutti i soggetti, ma in particolare in quelli con depressione Tipo III-b; il livello di complessità è apparso più basso nei soggetti con depressione Tipo I e IIIa e più elevato nei soggetti con depressione Tipo III-b; un tasso di somatizzazione particolarmente elevato, infine, ha caratterizzato le trame narrative di soggetti con depressione Tipo L PAROLE CHIAVE: adolescenza, depressione, organizzazione di significato personale, psicoterapia cognitiva. SUMMARY. Introduction. In our previous investigations, adolescent depression has been classified into three different forms: the first one, characterized by an uncertain and indefinite personality, which avoids any significant confrontation (external depression, corresponding to an "entangled", anxious resistant attachment); the second one, characterized by a primary sense of personal inadequacy and failure (internai depression, corresponding to a "dismissing", anxious avoiding attachment); the third one, has characteristics common to the other two forms or has atypical and ambivalent clinic aspects. Subjects and methods. Cognitive psychotherapy concerned 185 subjects (83 males and 102 females). Diagnostic and prognostic efficacy of such an approach was evaluated with respect to the following clinic factors: a) prevalent internai or external self lecture, b) flexibility, c) ratio: concrete/abstract thought level, and d) self integration ability. Results and discussion. Clinic onset of depression was associated to family conflicts, affective failure or loss, school or work failure, and any significant disappointment. In external depression, (Type I) main emotions were shame, guilt and despair. In internai depression (Type II), main emotions were rage, sadness, repulsion, despair, guilt, sorrow, and anger. In mixed (Type III-a) or ambivalent (Type III-b) depression emotions were common to the other two types or ambiguous, with ambivalence, contempt, repulsion, and guilt. Behavioural flexibility was lower in Type II and Type III-a. A sufficient self integration level was observed in ali subjects. Ratio: concrete/abstract thought level was generally high, especially in subjects with depression Type III-b. Cognitive complexity was lower in Type I and III-a and higher in Type III-b. Somatization was higher in Type L Cognitive psychotherapy, performed by reframing subjective negativity themes, according to the self-organization of personal meaning dirnension of each adolescent, allowed for a more adaptive and viable reading of one's own experience over time. KEY WORDS: adolescence, depression, self-organization of personal meaning dimension, cognitive psychotherapy

Eventi di scompenso ed evoluzione dei temi di negatività in adolescenti depressi sottoposti a psicoterapia cognitiva

RIASSUNTO. Introduzione. In un'ottica cognitivista sistemico-processuale, a partire dai fattori costituzionali, la relazione di attaccamento, la modalità soggettiva di riferire a sé gli.eventi esperienziali, contribuiscono alla formazione della personalità e di una specifica organizzazione di significato personale. Metodo. Un accordo con precedenti lavori sono state distinte tre diverse forme di depressione adolescenziale, associate a differenti stili di attaccamento: una forma caratterizzata da una personalità dai confini incerti ed indefiniti, con tendenza ad evitare ogni confronto emotivamente significativo con l'altro; una forma caratterizzata da un primitivo e marcato senso di inadeguatezza e di fallimento per ogni iniziativa personale; una forma mista con caratteristiche comuni alle due precedenti ma, in parte, anche atipiche. Risultati. La psicoterapia cognitiva, condotta su una casistica di 151soggetti, di cui 69 di sesso maschile e 82 di sesso femminile, ha consentito di mettere a fuoco nel Tipo I eventi perturbanti caratterizzati da disconferme in ambito familiare, affettivo, scolastico o lavorativo, nel Tipo II eventi perturbanti caratterizzati da un senso soggettivo di ulteriore perdita, abbandono, sconfitta, nel Tipo 111eventi di perdita più vari, talora caratterizzati da un senso ambivalente di sé. Conclusioni. La psicoterapia, ha consentito di spostare la percezione della negatività personale da aspetti di sé vissuti come oggettivi ed immutabili, a modalità soggettive di ordinare l'esperienza, attribuendole significati di disconferma (depressione di Tipo I), di non valore personale (depressione di Tipo II), di disconferma/ non valore (depressione di Tipo III-a, forme miste), di imperfezione (depressione di Tipo III-b, forme con ambivalenza). PAROLE CHIAVE: adolescenza, depressione, organizzazione di significato personale, psicoterapia cognitiva. SUMMARY. Introduction. According to the systems and process-oriented cognitive theory, different significant factors are involved in the development of a "self-organization of personal meaning dimension", such as constitutional factors, attachment relationships, and, a subjective manner of arranging life experiences. Methodology. According to our previous investigations, adolescent depression has been classified into three different forms: the first one, characterized by an uncertain and indefinite personality, which avoids any significant confrontation (external depression, corresponding to an "entangled", anxious resistant attachment); the second one, characterized by a primary sense of personal inadequacy and failure (internai depression, corresponding to a "dismissing", anxious avoiding attachment); the third one, has characteristics common to the other two forms or has atypical clinical aspects. Results. Cognitive psychotherapy, concerning the 151subjects treated (69 males and 82 females), pointed out the following perturbing events: a) more marked feelings of family, affective, school, or work devaluation (Type I depression), b) further feelings of subjective negativity, abandonment or loss (Type II depression), c) more various feelings of personal inadequacy, sometimes centered on an ambivalent sense of themselves. Cognitive psychotherapy, performed by reframing subjective negativity themes, according to the self-organization of personal meaning dimension of each adolescent, allowed for a more adaptive and viable reading of one's own experience over tirne. Conclusion. In therapy, feelings of self-negativity (perceived as abjective and unchanging aspects of the Self) were focused as subjective patterns in organizing experiences, giving them the following values: a) not being appreciated by significant other's opinions (Type I depression), b) mantaining an internai self-devaluation (Type II depression), c) associating feelings of being scarcely appreciated with internai self-devaluation (Type I1I-a depression, mixed patterns), or d) esteeming themselves as guiltily imperfect (Type III-b depression, ambivalent patterns). KEY WORDS: adolescent depression, attachment, cognitive psychotherapy, self-organization