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Paper

A psycho-educational treatment project for ill-treated and/or abused adolescents

abstract

Purpose. This paper concerns the exposition, the description of advancement and the assessment of a project presented and managed by 4 psychotherapists working for ApSa onlus[1].

The aim of this project is to interrupt the ill-treatment chain by offering psycho-social interventions oriented towards the support of psychical working on trauma and the resumption of a more integrated developmental process in these adolescents.

With adolescents' ill-treatment and abuse we refer to an extended meaning of this concept, in which trauma corresponds to a condition of severely inadequate parental cares that compromise the developmental process of these adolescents. Usually, this type of adolescents corresponds to adolescents who don't recognize spontaneously their need to be cured, so they can only be cured indirectly, by using treatment programs which work on their relational and social context. In this perspective it is necessary for clinicians, social and educational operators to work strictly together.

Many authors and our clinical experience showed these adolescents, if not treated, can reproduce the psychopathology of their parents or of their family context.

Method. Our project is aimed at carring out free psycho-educational treatments, shaped on each adolescent's needs, putting a time-limit sufficiently extended to be significant and effectual. Users/clients are 10 adolescents (6 males and 4 females), 14 to 18 years old (for some of them there could be an administrative extension of the tutelage until 21). They were chosen through an indication of the Town Council Social Services and most of them were involved in Juvenile Court measures. Some of them lived with their families,others lived in some public institutions. The project also aims at working with these children's families, when there are the conditions to do so. The project consists of the following steps:

  • clinical assessment;
  • planning a personal rehabilitation program;
  • monitoring the program's advancement.

It is necessary for educational and social professionals to be supported when there are difficulties in their relations with the adolescents by an adequate clinical team-work. Adolescents often test and challenge their adult interlocutors, thus communicating something they themselves don't know and cannot directly express with their own words.

In this perspective, we planned to help professionals that directly work with adolescents (psychotherapists, educational and social professionals) to improve their own competence in offering holding and support. We carried out this purpose by providing them with a specifically devoted supervision, which starts from considering these professionals as parts of a group involved in a complex relational network.

This psycho-educational integrated approach proved to be effective in helping he adolescents integrate their impulses and improving their relational and social behaviour. They seemed to use their relational experience with their professionals as an alternative relational pattern, compared with those they had introjected in their traumatic stories.

We built an evaluation schedule in order to get, in a synthetic but significant way, a psychopathologic assessment of the adolescent at the beginning, a six-months monitoring, a final assessment. The schedule works with a 4-areas scoring, necessary to get and describe the main elements and their variations: symptomatology, cognitive skills, impulses control, relational behaviour.

Key findings. At the moment, no adolescents reached the End Point of their own clinical plan, but none of them has interrupted the treatment yet.

  • All adolescents showed clinical improvements within 6 to 12 months, in comparison with the beginning score;
  • We consider these improvements related more to the stability and the preciseness of our co-operation work with the professionals and with adolescents' families than to the total score every adolescent got in the evaluation schedule at the beginning;
  • The areas in which we found a constant and more significant improvement are those of cognitive and relational behaviour;
  • We consider these two areas as strictly interrelated. Somehow we expected to find such a relation between the two improvements (cognitive and relational), because we think that the interest adolescents show in themselves, in their relation with their key adults and in the clinical program could be regarded as the consequence of the interest they had experienced.

Recommendations. From our experience we can draw the following conclusions and recommendations:

Politicians should not cut down the financial support for children's services. In this field, present savings tend to become more expensive in the future, thus leading to the increase of disturbed social behaviours and severe psychiatric pathologies;

It's important to assess adolescents and their main relations correctly, an effectual psycho-educational program and a significant, constant and reliable support on their relations network. "Empasses" could be frequent and severe, every overcoming could become a fundamental stage.

It's important to achieve a deeper comprehension of the psychopathologic functioning of this kind of adolescents to pay attention to every kind of feedback following the care program stages, in order to achieve a better comprehension of group dynamic events when working with the adolescent's relations network.

Evaluation schedule

evaluation
schedule

presentation

6

months

12

months

18

months

end point

psychiatric symptomatology

behavioural disorders

cognitive performance ability

relational behaviour

 

 

 

 

 

total score

 

 

 

 

 

Psychiatric symptomatology:

  • neurotic (i.e. performance anxiety, depression (not severe), obsessive-compulsive symptoms, phobia) scores from 1 to 3;
  • psychosomatic or mood disorders (either isolated or associated with the previous ones) scores from 4 to 6;
  • psychotic (schizophrenia series) scores from 7 to 9.
  • Behavioural disorders:
  • sporadic disorders, self-harm or not, scores from 1 to 3;
  • frequent or chronic self harm disorders, sporadic self or hetero-injuring disorders, scores from 4 to 6;
  • self or hetero-injuring disorders, scores from 7 to 9.
  • Cognitive performance ability (starting and carrying-on school or job tasks):
  • normality or not severe difficulties (difficulties which are not requesting any supporting interventions) scores from 1 to 3;
  • difficulties which request supporting interventions, without task interruption, scores from 4 to 6;
  • difficulties which request supporting interventions, with the risk of task interruption, scores from 7 to 9.
  • Relational behaviour:
  • interpersonal meaningful relations, normal or weakly disturbed, with adults (relatives and/or professionals) and/or other adolescents, scores from 1 to 3;
  • interpersonal meaningful relations disturbed by impulsive, aggressive, seductive or escaping behaviour which requests adults' interventions, scores from 4 to 6;
  • severe lack of interpersonal meaningful relations, scores from 7 to 9.

Key references

Codignola, F., a cura di (2001). Una cornice per la crescita. Milano: Franco Angeli.

Fraiberg, S. (1999). Il sostegno allo sviluppo. Milano: Cortina.

Gesuè, A. (2001). La supervisione di operatori che si occupano di adolescenti gravi: il vertice dell'etica. Quaderni di psicoterapia infantile. Milano: Borla.

Contacts: Angela Gesuè, ApSA onlus, piazza XXIV Maggio 7, Milano, E-mail: apsa.onlus@gmail.com, Phone 0258102520.

 


[1], ApSa onlus: Associazione per lo studio dell'Adolescenza, Milano. The project involves the local Social Services (Milan), and it is financed by Fondazione Cariplo - Bando Minori Soli 2005 - through a two-years contribution (2006-2008).

 

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