Biomedical subjects

Giancarlo Dimaggio

Publications and source records attributed to Giancarlo Dimaggio.

7 recordsLinked to original sources

PubMed2007

Psychotherapy in light of internal multiplicity.

The view that the self has multiple parts and that these appear in people seeking psychotherapy--and people conducting psychotherapy--is shared by clinicians of various orientations and supported by psychological research. It is useful for clinicians to think of patients as multifaceted and pay attention to the changes between facets that occur during therapy. They can thus help hidden parts to surface, facilitate dialogue between parts not in contact with each other, and convince excessively dominant or oppressive parts to make room for other adaptive facets. The authors contributing to this issue of Journal of Clinical Psychology: In Session describe, from their different theoretical perspectives, how they deal with patients' and therapists' inner multiplicity in clinical practice.

Communication↗

PubMed2007

Reaching the covert, fragile side of patients: the case of narcissistic personality disorder.

A multifaceted self allows selection of those sides that are most suited to a situation and an interpersonal context, thus improving adaptation. Patients suffering from personality disorders display a limited range of self-aspects, and their relationships are stereotyped and maladaptive. Another problem is that some of these sides scarcely reach consciousness and usually remain in the background. In the case of narcissistic personality disorder (NPD) the self-part that is fragile is unlikely to reach consciousness, so that people suffering from this disorder are impervious and detached. We present a case of a psychotherapist working with a woman suffering from NPD by facilitating the emergence of the fragile part of her self, hidden by angry and scornful characters. We demonstrate, moreover, how reaching such a self-part is associated with an improvement in the patient's interpersonal relationships outside the consulting room.

Adult↗

PubMed2006

Toward a model of self pathology underlying personality disorders: narratives, metacognition, interpersonal cycles and decision-making processes.

If we want to explain the links between the various and heterogeneous elements--symptoms, dysfunctional forms of behavior and poor social functioning--making up personality disorders, we need model a self pathology that portrays dysfunctions, the links among them, and how their interactions maintain disorders over time. In our view, the most likely elements of self pathology are: a. problematic contents (thoughts and emotions)--experienced subjectively as states of mind and organized in the form of narratives; b. shortfalls in the ability, termed meta-cognition, to reflect on mental states, both of oneself and of others; c. pathogenic interpersonal schemas; and d. maladaptive decision-making processes. These elements get altered in the various personality disorders and interact to form typical pathological organizations. This article seeks to describe a model of self pathology in personality disorders and discuss its current scientific status based on a literature review that spans several disciplines. The model is illustrated with an example of how the pathogenic elements can interact to form personality disorder. Lastly, the limitations and advantages of the model are discussed.

Defense Mechanisms↗

PubMed2005

Impoverished dialogical relationship patterns in paranoid personality disorder.

In the opinion of many experts, the self is made up of numerous different, independent facets interacting with each other in an ongoing inner dialogue. The meaning of events depends on the form this dialogue takes. The hypothesis we discuss in this article is that patients suffering from paranoid personality disorder (PPD) present impoverished dialogical relationship patterns. By this we mean that: a) The characters operating on their mental stage are few and repetitive. The character identified as self is insufficient-inadequate or diffident-mistrusting-hostile. The characters embodied by other persons are hostile, humiliating, and threatening. b) The inner dialogue the characters set up is stereotyped and always has the same outcome--the inadequate part of self feels under attack by a hostile other. This pattern has an influence on patients' behaviour and the course of psychotherapy. Our discussion of this hypothesis will be based on an analysis of extracts from diaries written by a patient with PPD during therapy. We shall give a number of strategies as to how a therapist may avoid patient drop-outs and provide effective treatment.

Adult↗

PubMed2005

Metarepresentative functions in borderline personality disorder.

Many authors consider that patients suffering from Borderline Personality Disorder (BPD) are hampered in their ability to metarepresent, which is the correct ascribing of states of mind to oneself and to others and the reflecting thereon. Although the ability to mentalize is generally described as being uniform, various authors pinpoint problems which appear to be of a diverse psychological nature. Some describe difficulties in identifying emotions or a shortfall in their regulation, others identify a lack of integration between representations of self and those of others, and yet others focus on the failure to distinguish between fantasy and reality. In the present research all sessions during the first year of therapy of four patients suffering from BPD were tape-recorded and transcribed, and then analyzed using the Metacognition Assessment Scale (MAS), which is designed for the evaluation of the ability to metarepresent in clinical reports. The results support the hypothesis that there is a metarepresentation impairment in BPD but that it is more selective than was thought until now. In particular, such patients maintain their ability to identify internal states, whereas they are impaired in the integration of representations of self and others and in the differentiation between fantasy and reality.

Adult↗

PubMed2004

A model of narrative development: implications for understanding psychopathology and guiding therapy.

Story-telling is one of the psyche's basic functions. All of us organize our experience in the form of narratives in order to give meaning to events, make forecasts about how situations will evolve, guide our actions in relationships and make our self-experience coherent. Here we present a theoretical model which starts out from the hypothesis that, when they are created, the narratives we continuously relate to ourselves and others do not have a pre-existing form. We propose a model for understanding the way each organizational level is formed in the mind, and works and interacts with other levels; and what psychological disorders could affect it, ranging from the basic, where there are simple aggregates of mental images, to the more complex, where there are true and proper stories, in which the characters of the internal scenario interact with each other. According to our model, it is possible to hypothesize the existence of: (1) a pre-narrative level, and (2) a proto-narrative level, followed by three extended narrative levels: (3) a procedural unconscious narrative level, (4) a conscious propositional narrative level, and (5) a verbal interactive narrative level. Our hypothesis is based on: (1) a review of various theories from different fields of research; and (2) illustrative clinical material obtained by recording psychotherapy sessions with severely personality-disordered patients.

Conscience↗

PubMed2003

Dialogical relationships in impoverished narratives: from theory to clinical practice.

Individuals are guided in their actions in the world by a set of narratives portraying them in their relations with others. The narratives contain representations of self, of the world, of the various characters with which individuals interact and of the forms of relationship that they foresee establishing. Within the narratives the various characters, each from the position of an independent author, negotiate the meaning of events. A narrative can be altered either as regards its contents or its form. In this article, we describe impoverished narratives. These are lacking in various elements-descriptions of a narrator's inner state, of others' points of view, of the action scenario and of what goes on between the characters-and concentrate repetitively on only one or a few themes. With such features, individuals are hampered in their actions in the world. A therapist listening to a patient relating impoverished narratives finds it difficult to grasp what the problems are and what steps need to be taken. As a result, it takes longer or is not possible for each to become attuned with the other and to put together an agreed treatment programme. We illustrate this narrative deficit with a psychotherapy case study and hypothesize about the way a therapist ought to operate in order to tackle the deficit.

Adolescent↗