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Paper

Working with the operators to cure deprived adolescents. The relations network clinical setting as an effectual therapeutical means working in complex psycho-social environments

abstract

Background. The relations network clinical setting (from now on mentioned as Rncs) is a therapeutic tool developed in order to manage the treatment of children and adolescents belonging to complex and problematical psycho-social contexts.

Our patients are under the care of social services, most of them are involved in Juvenile Court measures and live in educational or therapeutic institutions. They are children and adolescents coming from severely deprived families, which are representative of the well-known ill-treatment "trans-generational chain". They are the unconscious spokesmen of a sort of paradigm of incurability, bound to play the failure of every project or hypothesis of real change.

Method. Our methodology of clinical intervention derives from our long experience of supervising and coaching multi-professional èquipes of social or private health services. It is based on the hypothesis of a significant connection between relational dynamics inside the micro-group of psycho-social professionals involved in the care of a single case and the mental functioning of deprived children and adolescents.

We started by considering how the inner world of these young patients seems to be subject to a massive fragmentation and dispersion. First of all, these people are deprived of the possibility to build-up a meaningful and integrated self-image. Their external reality is often the desolate mirror of this lack of psychic integration. The only available option for these young people is represented by the pathological circle of repetition compulsion. In this way they realize, step by step, their individual and social expected failure.

With these adolescents, a psychotherapeutic intervention based on a "one-to-one" therapeutic relation with the adolescent is necessary but, most of times, it appears impracticable. This is due to many reasons, related either to the specificity of their mental functioning or to circumstances of the external reality.

Our clinical approach offers the possibility to "displace" the cure process from the therapeutic relation with the adolescent to the relational dynamics inside the micro-group of psycho-social professionals, and this can improve the therapeutic effectiveness.

Rncs is not an alternative to a psychotherapeutic treatment for the adolescent. When there are the conditions for starting an individual treatment or when a psychotherapeutic treatment has already been set up, psychotherapists can be included in the Rncs micro-group, as a receiver of parts of the projections that the adolescent makes and "distributes" to the micro-group.

Rncs does not interfere with the psychotherapeutic setting, whose limits and contents are respected. It is an intervention which works for elaborating and integrating the split parts: the point is to exclude none of them from the process.

The psychotherapist that leads Rncs sessions is neither a supervisor nor a leader of the activities of the professionals in the micro-group. She/he has no hierarchic function, plays exclusively a clinic function, which is oriented towards integrating dynamics that distinguish the mental functioning of deprived adolescents and their relational context. In our clinical approach, the micro-group of the psycho-social professionals is considered as a treatment context because it works as an accessible "mirror" of such integrating dynamics. We work with professionals to elaborate "partial images" that mark their perception of the adolescent they take care of. These images constitute a whole of the projections of adolescents' split parts made over their professionals' groups. These splitting and projective dynamics are the active source of difficulties that professionals experience when trying to build-up and share an integrated, complex, "three-dimensional" image of the adolescent.

The Rncs therapeutic effects work on two levels: at a first stage, to promote processes of integration of the partial and splitted images of the adolescents inside the micro-group. Within the relation between professionals and the adolescent (second level), these integrating processes tend to generate new pre-conditions that lead to new meanings in the relation and stimulate the professionals towards behaviours that show an increased cure effectiveness: "talking actions", "enactments", etc. Generally, professionals seem to experience interest and care in their relation with the adolescent when such relation had previously appeared "stuck" and deserted.

Key findings. It is a decade since we have been experimenting Rncs. In order to get a deeper knowledge of its functioning and effectiveness, we used mainly evaluation questionnaires and, when available, follow-up data. At the moment we are building-up and experimenting a specific evaluation tool, aimed at focusing the markers related with the two levels of the therapeutic effectiveness, in other words: the Rncs Evaluation Schedule.

Observed behaviour Schedule - (to be filled before and after the Rncs)

A

Aggressive behaviour

 

a1

auto-aggressive acts

4 3 2 1 0

a2

hetero-aggressive behaviour

4 3 2 1 0

a3

deviate behaviour

4 3 2 1 0

 

average index A*

 

B

Depressive-manic behaviour

 

b1

social retreat

4 3 2 1 0

b2

manic behaviour

4 3 2 1 0

 

average index B*

 

C

Thinking disorders

 

c1

disgnosia

4 3 2 1 0

c2

disprassia

4 3 2 1 0

c3

discronia

4 3 2 1 0

c4

discontinuity in carrying out personal school or working program

4 3 2 1 0

 

average index C*

 

*average index is the arithmetic mean of the sub-scores (i.e.: average index A is the arithmetic mean of a1,a2,a3).

Rncs evaluation schedule (to be given to every professional at the end of the intervention)

1

In your opinion, how much did Rncs contribute to make you feel helped in your difficulties while working with this adolescent?

1 2 3 4 5

2

How much did Rncs sessions help you and your colleagues in working together as a group to build up effectual interventions?

1 2 3 4 5

3

How much is been reached by Rncs sessions your aim to increase your knowledge about the adolescent you're working with?

1 2 3 4 5

4

How much did your participation at Rncs sessions contribute in increasing your ability to recognize and elaborate your emotional reactions when working with this adolescent?

1 2 3 4 5

5

How much did your personal image of this case get extended and enriched by Rncs intervention?

1 2 3 4 5

6

How much has your capability - that in cooperating with other professionals involved in this case after the Rncs - increased?

1 2 3 4 5

7

How much did the organization of Rncs sessions help you in reaching your aims with this case?

1 2 3 4 5

8

How much did you feel participating and involved with the other professionals working together on this case?

1 2 3 4 5

Contacts: Francesca Codignola, SPI/IPA Milano, p.zza S. Agostino 22, Milano, E-mail:francesca.codignola@libero.it, Phone 02 4699854.

 

 

 

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