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The psychotherapeutic approaches can be dynamic/non-dynamic, supportive, psychoeducational, or other types of rehabilitation. It is important to underscore that the psychodynamic approach stems from the psychoanalytic concept of understanding the developmental line of a human being, from prenatal observable phenomena and following all life phases. Primarily, this includes object relations theory, ego- and self-psychology, and attachment theory, among others. Countertransference is a key issue for the therapist/therapeutic team, who cannot remain 'untouched' by many highly specific and deeply regressive symptoms of different pathological features of patients with psychosis. These features often trigger very intense, even stormy, feelings that can cause confusion in the therapist/therapeutic team, and difficulties in controlling them. It is important that psychotherapists learn how to recognise, elaborate and make constructive use of what they have understood from their reactions and feelings. The chapter presents some images and comments from Patient, who has shown through art therapy his experiences during amniotic therapy.

In questo articolo descrivo il mondo di Anna, una giovane donna che, dopo anni di abusi sessuali aveva sviluppato una grave psicosi cronica. La paziente non parlava piu. La comunicazione terapeutica e stata possibile grazie ad uno scambio di disegni fra Anna e me. I disegni della paziente documentano da un lato gli effetti psicologici devastanti degli abusi sessuali e dall’altro le capacita generative della coppia analista paziente. Lo scambio di disegni terapeutici permette di visualizzare il superamento delle difese deliranti, la ricostruzione dell’identita mancante e altre tappe importanti nel processo di cura. I disegni illustrano la psicodinamica dell’abuso e la sua elaborazione nella creativita del transfert e del controtransfert

Il contributo di Maurizio Peciccia, stretto e originalissimo allievo di Gaetano Benedetti, ci permette di comprendere e "vedere", attraverso il ricco materiale clinico, una psicoterapia di otto anni con una paziente psicotica, condotta secondo il modello della schizofrenia di Benedetti e particolarmente con la tecnica denominata "Disegno speculare progressivo terapeutico" (Peciccia e Benedetti, 1989), derivata dallo "squiggle game" di Winnicott (1953, 1971). Essa permette di salvare una forma di comunicazione con quei pazienti la cui grave frammentazione psichica impedisce la capacita di sognare e di parlare. La tecnica consiste nel disegno a quattro mani di paziente e terapeuta e consente di "costruire", attraverso uno strumento transizionale e progressivo (cioe i disegni), i passaggi terapeutici che Benedetti ha definito come "trasformazione del Se del paziente attraverso la positivizzazione del terapeuta", "psicopatologia progressiva" e "soggetto transazionale". Quaranta disegni e brevi note cliniche illustrano in modo straordinariamente vivo questa originale visione del lavoro con i pazienti psicotici.

Viene descritta una tecnica basata sul "disegno speculare progressivo" per la terapia psicodinamica delle psicosi, sviluppata da Gaetano Benedetti (1920-2013) e Maurizio Peciccia. In questa tecnica paziente e terapeuta tracciano contemporaneamente su due diversi fogli un disegno spontaneo, e in un secondo momento entrambi completano e trasformano il disegno dell’altro. Arte-terapeuta e paziente - ripetendo i medesimi gesti della mano, sviluppandoli nel dialogo grafico - entrano nel mondo dell’altro attraverso porte inconsce condivise e si aprono a una comunicazione precedentemente nascosta, come in un sogno. Questa tecnica e diversa dallo squiggle game di Winnicott, il quale tracciava uno scarabocchio che poi il bambino trasformava "facendone qualcosa", e altre volte il bambino disegnava una forma che poi Winnicott sviluppava o completava.

We hypothesize that, in the structure of the psychotic self, there is a disintegration between the symbiotic and separate states of the self, of which the patient is painfully aware: to use a metaphor, the light in the schizophrenic self is split: at times it is only in wave form, energy (the patient is living in disintegrated symbiosis), at others it is only matter, corpuscular (the patient is living in disintegrated separation); unfortunately, the wave and the particle are unable to produce a unitary phenomenon: the light becomes two entities. Sometimes we see the psychotic living symbiotically, we feel him to be very close to us, he tells us: “I am the moon, the sun, the universe. I am you”. At other times the patient is in his separate self but, as he is split off from the symbiotic self, his separation is extreme, it is autistic solitude: “nothing exists apart from me: the sun, the moon, the universe, are meaningless shadows which I cannot distinguish …, you are light-years away from me … yo...

Introduction The awareness of one's body constitutes a basic experience of Self which modulates the individual engagement in social interactions. Indeed, Interoception Sensitivity (IS), an index of individual ability to represent one’s own internal body states, is implicated in the autonomic regulation in interpersonal context. Schizophrenia deficits in Self-experience and awareness, which frequently entail anomalies in self-other relationship, capture the ever-growing attention of researchers. Nevertheless, IS and autonomic regulation of schizophrenic patients in social context are completely new and not yet investigated aspects of Schizophrenia. Aim To investigate whether Schizophrenia could be associated with lower IS and with a dysfunctional autonomic regulation during social interaction. Methods 24 chronic schizophrenia patients, and a matched group of healthy controls, performed a Social and a Non-social task while respiratory sinus arrhythmia (an index of autonomic regulation) was measured. In the Social task participants viewed an experimenter performing a caress-like movement at different distances from their hand. In the Non-social task a metal stick was moved at the same distances from the participants’ hand. As measure of IS, a cardiac Mental Tacking Task was performed. Results Comparing to controls, Schizophrenia patients presented lower IS, absence of relation between IS and autonomic regulation, and an anomalous autonomic regulation in social and non-social contexts. Conclusions Deficits in Self-experience, associated with Schizophrenia, could be extended to patients’ sensitivity to internal bodily signals. Moreover, the observed altered autonomic regulation will be part of interpersonal interaction deficit frequently associated to Schizophrenia.

Background theory Stern’s observations of infants (Stern 1985, The Interpersonal World of the Infant, Basic Books, New York) changed the linear model of child development proposed by Mahler (early autism–symbiosis–separation) into a model of development defined as “complementary”. In the complementary model of mental development there is no longer any question when exactly our psyche, which starts out as a continuous structure, becomes discontinuous or separated from the space of the mother-environment. According to this model, symbiosis and separation are two autonomous spaces of development, which integrate one another as they develop, but remain fundamentally different. The self is joined to what is not-self and, at the same time, separated from what is not-self. Alongside a space of the self, which operates separately from the outside world, coexists another space of the self that continues to work, unconsciously, in symbiosis with the outside world.