08704 - Clinical Methodology

Learning outcomes

At the end of the course the student will be able to:

-  use psychological consultation fundamentals;

-  recognise emotional, cognitive and communicative aspects of clinical relationship;

-  assess context of couple, family and social relationships;

-  assess the patient in a biopsychosocial perspective.

The student will be encouraged to take an aware and critical attitude towards the subject.

Course contents

1. THEORY AND TECHNIQUE OF PSYCHOLOGICAL CONSULTATION

• Main concepts (definition of clinical consultation; theoretical models; validity and reliability; diagnosis, clinical evaluation and therapy)
• Consultation elements (context; setting; verbal and non-verbal communication; emotive, cognitive and relational aspects; clinical consultation in infancy and adolescence)
• The development of the consultation (preliminaries; beginning; central phase; conclusion)

2. THE PSYCHODYNAMIC PERSPECTIVE

• Clinical relationship as knowledge field
• Defence and resistance mechanisms
• Transference and countertransference
• Analysis of dreams
• Assessment of personality structure
• Diagnostic formulation in a psychodynamic perspective: the Psychodynamic Diagnostic Manual (PDM)
• Symptoms as symbolic expression of an unconscious conflict
• Interpretation
• The work of the clinical psychologist: the interpretation- psychological help continuum.
• The therapeutic alliance
• Efficacy of psychotherapy (Efficacy, Effectiveness, Efficiency)

3. THE ATTACHMENT PERSPECTIVE

• Concept of attachment and its theoretical assumptions
• The influence of cognitivism
• Attachment relationships characteristics (proximity seeking, separation protest, secure base effect)
• Maternal deprivation, separation, loss and mourning
• Internal Working Models and attachment styles
• Attachment in infancy and adult age: Mary Ainsworth and Mary Main
• Dynamic-Maturational Model (DMM) by Patricia M. Crittenden
• Assessment of attachment in life span (Strange Situation, CARE-Index, assessment of attachment in infancy and adolescence, Adult Attachment Interview, self-report questionnaires)
• The concept of psychological trauma
• Resolution and psychopathology of trauma and loss
• The clinical assessment and treatment of trauma and loss experiences

4. ASSESSING THE TRAUMA

• Danger and adaptation.
• The concept of psychological trauma.
• Adaptive meaning of despair.
• Resolution and psychopathology of trauma and loss: dissociation and Post-Traumatic Stress Disorder (PTSD).
• Clinical evaluation and treatment of trauma and loss

4. MENTALIZATION AND CLINICAL RELATIONSHIP

• The concepts of mentalization and reflective function
• Mentalization, attachment and emotive regulation
• Mentalization and reflective function assessment
• Lack of mentalization and emotion disregulation (False Self; Pensée Opératoire, Alexithymia)
• The significance of aggressive behaviours and of addict disorders taking account of attachment and mentalization concepts
• The influence of attachment and mentalization on clinical relationship
• The treatment of the patient with lack of mentalization: countertransfer aspects and therapeutic strategies
• Attachment and mentalization based treatments

5. THE SYSTEMIC PERSPECTIVE

• General System Theory
• Linear and circular causality
• Cybernetics and feedback
• Gregory Bateson and the Double Bind Theory
• Palo Alto School and Mental Research Institute
• Relational and pragmatic aspects of human communication (axioms of communication, meta-communication and context, punctuation of sequences of communication, analogical and digital communication, symmetric and complementary interaction, reactions to communication, pathological communication)
• The limits of the reductionist paradigm and of the biomedical model
• The biopsychosocial model
• The analogical assessment of suffering: the PRISM method
• Diagnostic formulation in a biopsychosocial perspective

6. FAMILY RELATIOSHIPS

• The relevance of family relationships in Clinical Psychology
• Family life cycle
• Couple relationship and parental functions in life span
• Attachment, secure base and reflective function in the family
• Assessment of dyadic and triadic relationships
• Assessment of mentalization in psychotherapy: the Reflective Function in the Family (RFF) and Mentalization Assessment in Psychotherapy (MAP)
• Psychosomatic families
• The family therapy setting
• Different significance of questions (linear, circular, strategic, reflective)
• The genogram
• Systemic perspective in family therapy (Paul Watzlawick and the strategic-systemic model, Don D. Jackson and the restrictive families. Mara Selvini Palazzoli and the Milanese model, Salvador Minuchin and the structural model)

Readings/Bibliography

Course bibliography

Books:

• Baldoni F. (2010): La prospettiva psicosomatica. Dalla teoria alla pratica clinica. Il Mulino, Bologna (chapters 1 and from 5 to 10, in particular).
• Gabbard G.O. (2013): Psichiatria psicodinamica (Quinta edizione basata sul DSM-5). Raffaello Cortina, Milano, 2015 (to p. 182).

Articles and books' chapters (download from Web course site):

• Baldoni F., Baldaro B. e Ravasini C. (1994): Il colloquio clinico. In: Trombini G. (a cura di): Introduzione alla clinica psicologica. Zanichelli, Bologna, pp.103-126.
• Baldoni, F. (2013). La funzione adattiva della disperazione nel fallimento delle strategie di attaccamento: una prospettiva Dinamico-Maturativa. In V. Caretti, G. Craparo, A. Schimmenti (Eds.) Memorie traumatiche e mentalizzazione. Teoria, ricerca e clinica. Astrolabio, Roma, pp. 215-236.
• Baldoni, F. (2014) La regolazione psicosomatica delle emozioni. Mentalizzazione e utilizzo di regolatori esterni. Pneireview, 2, pp. 4-22.
• Baldoni, F. (2015). L'efficacia della psicoterapia nel trattamento dei disturbi psichici. La mente che cura, 1, pp. 17-20.

Optional readings for depth

• AA.VV. (2006): PDM. Manuale Diagnostico Psicodinamico. Raffaello Cortina, Milano, 2008.
• Allen J.G., Fonagy P. (a cura di) (2006): La mentalizzazione. Psicopatologia e trattamento, Bologna, Il Mulino, 2008.
• Allen J.G., Fonagy P., Bateman A.W. (2008): La mentalizzazione nella pratica clinica. Raffaello Cortina, Milano, 2010.
• Baldoni F. (2007): Modelli operativi interni e relazioni di attaccamento in preadolescenza. In: Crocetti G., Agosta R. (a cura di): Preadolescenza. Il bambino caduto dalle fiabe. Teoria della clinica e prassi psicoterapeutica. Pendragon, Bologna, pp. 54-77.
• Baldoni F. (2013): Psicoterapia e attaccamento. Il paradigma dell'attaccamento nella pratica clinica. In: Lazzari D. (a cura di). Psicoterapia: effetti integrati, efficacia e costi-benefici. Tecniche Nuove, Milano, pp. 106-140.
• Baldoni, F. (2015) Aggressività, attaccamento e mentalizzazione. Contrappunto, 51-52, pp. 9-44.
• Baldoni, F. & Landi, G. (2015) La funzione del padre nel periodo perinatale. Attaccamento, adattamento e psicopatologia. Quaderno di Psicoterapia del Bambino e dell'Adolescente, 41, pp. 73-96.
• Bertrando P., Toffanetti D. (2000): Storia della terapia familiare. Raffaello Cortina, Milano.
• Caretti V., Craparo G., Schimmenti A. (a cura di) (2013): Memorie traumatiche e mentalizzazione. Teoria, ricerca e clinica. Astrolabio, Roma.
• Caretti V., Ragonese N., Crisafi C. (a cura di) (2013): La depressione perinatale. Aspetti clinici e di ricerca sulla genitorialità a rischio. Fioriti, Roma.
• Cena L., Imbasciati A., Baldoni F. (a cura di) (2010): La relazione genitore-bambino. Dalla psicoanalisi infantile alle nuove prospettive evoluzionistiche dell'attaccamento. Springer-Verlag, Milano.
• Cena L., Imbasciati A., Baldoni F. (a cura di) (2012): Prendersi cura dei bambini e dei loro genitori. La ricerca clinica per l'intervento. Springer-Verlag, Milano.
• Fava G.A., Grandi S., Rafanelli C. (a cura di) (2010): Terapia psicologica. Centro Scientifico Editore, Torino.
• Gabbard G.O. (2010): Introduzione alla psicoterapia psicodinamica (Seconda edizione). Raffaello Cortina, Milano, 2011.
• Holmes, J. (1993): La teoria dell'attaccamento. John Bowlby e la sua scuola. Raffaello Cortina, Milano, 1994.
• Jurist E.L., Slade A., Bergner S. (a cura di) (2010): Da mente a mente: infant research, neuroscienze e psicoanalisi. Raffaello Cortina, Milano.
• Levy, R.A., Ablon, J.S., & Kächele, H (2012). La psicoterapia psicodinamica basata sulla ricerca. Raffaello Cortina, Milano, 2015.
• Lingiardi V., Madeddu F. (2002): I meccanismi di difesa. Teoria, valutazione e clinica. Raffaello Cortina, Milano.
• McWilliams N. (1999): Il caso clinico. Dal colloquio alla diagnosi. Raffaello Cortina, 2002.
• McWilliams N. (2004): Psicoterapia psicoanalitica. Raffaello Cortina, Milano, 2006.
• Renik O. (2006): Psicoanalisi pratica per terapeuti e pazienti. Raffaello Cortina, Milano, 2007.
• ·van der Horst F.C.P. (2011): John Bowlby. Dalla psicoanalisi all'etologia. Raffaello Cortina, Milano, 2012.
• Wallin D.J. (2007): Psicoterapia e teoria dell'attaccamento. Il Mulino, Bologna, 2009.
• Watzlawick, P., Beavin, J. H. e Jackson, D. (1967): Pragmatica della comunicazione umana. Studio dei modelli interattivi, delle patologie e dei paradossi. Astrolabio, Roma, 1971.

Teaching methods

Teaching will be done in a historical framework with references to daily life and clinical practice.

Use will be made of role playing methods, slides, videotapes and further reading suggested.

The teaching material (schedules, figures, articles and bibliographies) will be available on Internet at the course end.

Assessment methods

The final examination involves a written test based on three open questions in 60 minutes.

Teaching tools

Overhead projector, PC, Power Point, videotapes.

Office hours

See the website of Franco Baldoni