BackgroundIndividuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS). Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use. Therefore, alternative short-term treatments, less complex than long-term psychodynamic psychotherapies but specifically oriented to BPD core problems, need to be developed to reduce MHS overuse. This study aimed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to Supervised Team Management (STM) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD. Effectiveness was evaluated 6 times along a two-year follow-up.MethodsThirty-five outpatients who met inclusion criteria were randomly assigned to two treatment groups (STM = 17; SB-APP = 18) and then compared. Clinical Global Impression (CGI) and CGI-modified (CGI-M) for BPD, Global Assessment of Functioning (GAF), State-Trait Anger Expression Inventory (STAXI), and Symptom Checklist-90 Revised (SCL-90-R) were administered at T1, T3, T6, T12, T18 and T24. At T12 the Working Alliance Inventory-Short Form (WAI-S) was also completed. At the one-year follow-up, SB-APP group did not receive any additional individual psychological support. MHS team was specifically trained in BPD treatment and had regular supervisions.ResultsAll patients improved on CGI, GAF, and STAXI scores after 6 and 12 months, independently of treatment received. SB-APP group showed better outcome on impulsivity, suicide attempts, chronic feelings of emptiness, and disturbed relationships. We found a good stabilization at the one year follow-up, even after the interruption of brief psychotherapy in the SB-APP group.ConclusionsAlthough STM for BPD applied to heavy MHS users was effective in reducing symptoms and improving their global functioning, adding a time-limited and focused psychotherapy was found to achieve a better outcome. In particular, focusing treatment on patients' personality with a specific psychotherapeutic approach (i.e. SB-APP) seemed to be more effective than STM alone.Trial RegistrationClinicalTrials.gov: NCT1356069

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Little information is available on the use of brief psychotherapy among subjects with generalised anxiety disorder (GAD) within community mental health services. This study compared results among subjects treated with brief Adlerian psychodynamic psychotherapy (B-APP), those treated with medication (MED), or those who experienced combined treatment (COM). Symptomatology and occupational functioning were assessed using the Hamilton Anxiety and Depression scales (HAM-A; HAM-D), Clinical Global Impression (CGI), and Social and Occupational Functioning Assessment Scale (SOFAS) at intake (T1) and at 3, 6, and 12 months later (T3, T6, T12). The study sample included 87 patients with GAD (B-APP 34; MED 33; COM 20), and an ANOVA was applied for analysing repeated measures while controlling for personality disorder. After 6 months, CGI, HAM-A, HAM-D, and SOFAS scores significantly improved independently from the type of treatment. Subjects with personality disorders treated with B-APP exhibited superior results to those treated using other methods only in SOFAS scores at T6. These results were generally maintained at T12. Remission rates among subjects (HAM-A scores <7) varied between 55% (MED) and 74% (B-APP) at T6 and between 63% (MED) and 78% (COM) at T12; no significant differences appeared between the three treatment groups. A logistic regression model predicted anxiety remission only by CGI at T1. This paper discusses these results in relation to the use of brief psychotherapy within community mental health services.

Luego de considerar algunos aspectos centrales de la ética profesional en la psicología, este trabajo describe la elaboración colectiva de la Declaración Universal de Principios Éticos Para Psicólogas y Psicólogos en 2008 y algunos efectos posteriores en ámbitos profesionales y de formación de la psicología. El objetivo de la misma es servir de guía para la revisión de códigos de ética de psicología o la elaboración de códigos nuevos, presentando 4 principios generales y sus valores éticos asociados, a partir de los cuales cada país o región puede construir sus propias normas de conducta profesional, social, histórica y culturalmente situadas. Se analiza la similitud de los principios de la Declaración con los establecidos en los principales códigos de ética de psicología de Sudamérica. Finalmente, se presentan las 2 primeras experiencias concretas de aplicación de este documento, una de ellas en el ámbito profesional y otra, más novedosa aún, en el ámbito de la formación en psicología.Palabras clave: psicología, ética, códigos, profesión, formación After considering some key professional ethics issues in psychology, this paper analyzes the collective development of the Universal Declaration of Ethical Principles for Psychologists in 2008, and its further effects on professional and training settings. Its goal is to serve as a guide for reviewing ethics codes in psychology or for the development of new codes, considering 4 general principles and their associated ethical values. Based on those principles, each country or region will be able to develop its own professional ethical standards, in a socially, historically, and culturally situated way. The similarity between the principles pointed out in this declaration and those included in the main South American psychology ethics codes is also considered. Finally, the first 2 experiences in the application of this document's guidelines are presented, one within a professional setting and a more novel one developed for training in psychology.

Abstract. Sequential Brief-Adlerian Psychodynamic Psychotherapy (SB-APP) is a timelimited (40 weekly sessions) psychotherapy for a wide range of psychic disorders, delivered in sequential and repeatable module (in each module a different therapist is involved). Its specific features in the treatment of Borderline Personality Disorder (BPD) are presented, concerning setting, technique and therapist's emotional attitude. Four Personality Functioning Levels (PFLs) are focused, in order to provide targeted interventions for more homogeneous subsets of BPD patients. PFLs are assessed by evaluating symptoms, quality of interpersonal relationships, overall social behaviours, cognitive and emotional patterns, and defense mechanisms. Two clinical vignettes describe how SB-APP strategies vary according to patient's PFLs, also with respect to the predetermined treatment end. Preliminary reports of SB-APP effectiveness in the treatment of BPD are summarized and discussed.

As the world becomes globalized, psychologists more frequently encounter ethical dilemmas based on differences in worldviews. Enlightened globalization may lead to greater harmony, while unilateral globalization by dominant cultures will not. This chapter presents practical examples for psychologists of culture-based ethical dilemmas around such themes as respect, competency, professional boundaries, the status of women, the law, and social justice. Today, psychologists and counselors may come from different cultures, train in different countries, and practice with a diversity of clients and in a diversity of locations. When cultural beliefs appear to clash with ethical rules of conduct, ethical decision making must focus on the well-being of clients individually and collectively. Respect and caring for clients takes priority over Western concepts of rule-compliance. The vignettes of ethical dilemmas illustrate some of the complexities of working across cultures. Psychologists are urged to support an enlightened globalization.

BackgroundSymptoms description is often not enough to provide clinicians with guidelines for treatments and patients’ clinical history does not represent an exhaustive source of data. Psychopathological dysfunctions are known to relate to the core disturbances that underlie different forms of psychopathology so the identification of such dysfunctions could be helpful for treatments. Some tools are available although highly complex and lengthy. This study aimed to provide clinicians with an easy-to-administer instrument able to capture different levels of impairment in psychopathological functioning, namely the Psychopathological Functioning Levels – Rating Scale (PFL-RS).MethodsThe Psychopathological Functioning Level - Research and Training Committee (PFL-RTC) has been established in Turin since 2002 including psychiatrists and clinical psychologists with extensive clinical and research experience. Our research was grounded on the Qualitative Research Criteria (QRC) 1-7 and conducted with subsequent steps in order to identify those core psychopathological dysfunctions to be rated by this tool.ResultsFrom 2002 until 2014, 316 outpatients were administered the clinical interview on at least two different occasions. Diagnoses were mixed and included: Schizophrenic and Psychotic Disorders, Depressive Disorders, Anxiety Disorders, Obsessive-Compulsive Disorder, Post- Traumatic Stress Disorder, Somatic Symptoms Disorders, Eating Disorders and Personality Disorders. Focus groups were conducted to identify those psychopathological dysfunctions which needed to be rated, according to two Phenomenological Selection Criteria (PhSC) and four Etiopathogenetic Selection Criteria (EtSC). As a result, five dysfunctional areas emerged: Identity (ID); Comprehension (CO); Negative Emotions (NE); Action-Regulation (AR); Social Skills (SS). After checking such dimensions for consistency with the existing instruments, 7 levels of severity were identified for each area. Finally, a provisional Italian schedule of Psychopathological Functioning Levels – Rating Scale (PFL-RS) was obtained and checked for semantic comprehension and then administered gathering preliminary data.ConclusionsPsychopathological dysfunctions underlying mental disorders have been recognized in the present study with the PFL-RS. This instrument seems promising to inform in a specific way treatments strategies and goals, specifically concerning psychotherapy. Notwithstanding, further research is needed in order to confirm validity, sensitivity and reliability of this instrument.

The better the personality functioning in schizophrenic patients the better seems to be the response to treatment, with regard to symptoms as well as rehabilitation. Personality assessment might be useful for the individualisation of therapies, even within the context of a standardised program.