Lucio Sibilia
Ho studiato, lavorato come clinico e ricercatore (facendo ricerca scientifica in Italia!), ho insegnato alla Sapienza, ho fondato associazioni scientifico-professionali e formato terapeuti, ho pubblicato articoli e libri e curato pazienti.
less
Related Authors
InterestsView All (68)
Uploads
Papers by Lucio Sibilia
I casi sono stati scelti tra quelli presentati dagli allievi per l’esame finale di diploma in psicoterapia. Il libro presenta quindi un interesse diretto per tutti i colleghi in formazione che stanno per prepararsi a questo importante passaggio.
La selezione dei casi, tuttavia, copre un’ampia gamma di disturbi e, pur con la vivacità della narrazione soggettiva, mantiene l’accuratezza del resoconto clinico. Per questo, anche lo psicoterapeuta esperto può trovare numerosi spunti di interesse in questo libro.
Infine il linguaggio scevro da tecnicismi rende la lettura agevole anche al profano che voglia soltanto curiosare o esplorare dall’interno la psicoterapia cognitivo-comportamentale.
L'esistenza di peggioramenti nei pazienti in psicoterapia, fenomeno noto da tempo come "deterioramento", può essere studiato come effetto di errori di condotta terapeutica a diversi livelli, oppure di carenze intrinseche alle procedure, se l'errore in psicoterapia è concepito come lo scarto obiettivi-risultati, cioè l'errore procedurale. Data sia la diffusione degli errori, per la dimostrata fallibilità della mente umana, che la loro fertilità, si può definire uno sbaglio quello di scotomizzarli o sottovalutarli. È possibile vedere nei fallimenti la conseguenza di uno o più sbagli rilevanti o sistematici, laddove un fallimento grave e persistente potrebbe essere indicato come "catastrofe". Inoltre, il dubbio di poter essere in errore è motore di apprendimento cognitivo, ovvero di nuova conoscenza. Ciò è possibile qualora si accetti e quindi si cerchi l'errore, si cerchi di controllarne le fonti, si costruiscano ipotesi alternative, si esplorino nuove modalità o vie per raggiungere un risultato desiderato o si riconoscano gli effetti di errori “fortunati”. A livello metodologico, si può mostrare come il controllo delle fonti di errore sia alla base dello stesso metodo sperimentale. Questo processo ricorsivo di problem solving può descrivere sia l'interazione terapeutica, sia l'iter procedurale in psicoterapia cognitivo-comportamentale, nella pratica clinica e nella ricerca.
Parole chiave: errori, psicoterapia, problem solving, metodo scientifico
Abstract.
Errors in psychotherapy are conceivable as mismatches between goals and outcomes. So, the reality of worsening in patients during psychotherapy, a fact known as "deterioration", can be studied as an effect of therapeutic errors at different levels or as deficiencies inherent to used procedures. Given both the diffusion of errors, as examples of the demonstrated fallibility of the human mind, and their fertility, to underestimate or scotomize them can be defined as a mistake. We can see as failures are resulting from one or more major or systematic mistakes, whereas a serious and persistent failure might be referred to as "catastrophe". Furthermore, the doubt to be wrong is a propeller of cognitive learning, or new knowledge. This is possible if we accept the error and then try to look for its sources, if alternative hypotheses are built, and if we will explore new modes or ways to achieve a desired result or otherwise recognize the effects of "lucky" errors. At a methodological level, we can show how the control of sources of error is the basis of the experimental method itself of science. This recursive process of problem solving can describe both the therapeutic interaction, and the formal procedures in cognitive-behavioral psychotherapy in clinical practice and research.
Key words: errors, psychoterapy, problem solving, scientific method
issues, from obesity to drug
abuse, have shown that selfmanagement
abilities can be fostered
by methods such as self-monitoring,
by use of cognitive-social learning
principles. On this basis, we have
started a programme with patients
admitted to University of Rome La
Sapienza, with a diagnosis of alcohol
abuse. The programme aims at
maintaining total or partial abstinence
in participants by teaching and
fostering self-monitoring and selfmanagement
abilities with minimum
use of professional time. The
programme is assessed with a
controlled randomised design
spanning 1 year.
Participants, enrolled with specific
criteria, represent about 25% of all
alcoholics arriving at our service. All
participants receive standard medical
treatment as day hospital patients in
the first 2 weeks. Those in the
treatment group are given the choice
of aiming for abstinence or for
controlled drinking and sign a
contract. Thereafter, they are trained
to observe their own drinking
behaviour, as well as the emotional,
cognitive, and environmental contingencies
that control it. After
discharge, the participants in the
control group attend routine aftercare,
whereas those in the treatment group
are required to maintain the scheduled
assignments, including monthly
structured telephone contacts, for the
next 12 months.
Motivation to pursue the selfmanagement
tasks is stimulated and
maintained in the monthly interviews
with staff psychologists. Initial results
on the first 60 participants are
striking; total abstinence days and
drop-out rates differ significantly
between groups. At 1 year, 47% of
treatment-group participants continue
to attend, compared with only 17% in
the control groups. Results are also
expected in self-efficacy and
psychopathology scores, but already
we think that increase in perceived personal control of drinking behaviour
is a better strategy than standard
medical treatment.
well, together with smoking habits, were assessed during a survey on a sample of adult subjects. Sample comprised 200 men and women of mean age of 36,9 years, enrolled in the waiting rooms of family physicians. Data about the actual degree of pollution in the same areas (in Sardinia, Italy) were also gathered by local health authorities. Areas were classified on the basis of the degree of pollution (high, moderate, low).
We posited the following hypotheses: a) there is a weak positive relationship between the rate of smokers and environmental pollution, as well as between the rate of smokers and perception of the quality of air, and b) there
is a significant inverse relationship between rate of smokers and coherent (subjective/objective) assessment, both in high and in low pollution areas. As expected, the quality of air was significantly perceived as worse in the more polluted areas (p=.008; Fisher's exact test). The correlation was however not
complete as a number of subjects had an optimistic bias: positive appraisals of air in more polluted areas were more frequent in smokers (p=.018), thus confirming hypothesis b. This interaction effect of subjective perception with actual pollution is discussed as far as regards health promotion interventions.
I casi sono stati scelti tra quelli presentati dagli allievi per l’esame finale di diploma in psicoterapia. Il libro presenta quindi un interesse diretto per tutti i colleghi in formazione che stanno per prepararsi a questo importante passaggio.
La selezione dei casi, tuttavia, copre un’ampia gamma di disturbi e, pur con la vivacità della narrazione soggettiva, mantiene l’accuratezza del resoconto clinico. Per questo, anche lo psicoterapeuta esperto può trovare numerosi spunti di interesse in questo libro.
Infine il linguaggio scevro da tecnicismi rende la lettura agevole anche al profano che voglia soltanto curiosare o esplorare dall’interno la psicoterapia cognitivo-comportamentale.
L'esistenza di peggioramenti nei pazienti in psicoterapia, fenomeno noto da tempo come "deterioramento", può essere studiato come effetto di errori di condotta terapeutica a diversi livelli, oppure di carenze intrinseche alle procedure, se l'errore in psicoterapia è concepito come lo scarto obiettivi-risultati, cioè l'errore procedurale. Data sia la diffusione degli errori, per la dimostrata fallibilità della mente umana, che la loro fertilità, si può definire uno sbaglio quello di scotomizzarli o sottovalutarli. È possibile vedere nei fallimenti la conseguenza di uno o più sbagli rilevanti o sistematici, laddove un fallimento grave e persistente potrebbe essere indicato come "catastrofe". Inoltre, il dubbio di poter essere in errore è motore di apprendimento cognitivo, ovvero di nuova conoscenza. Ciò è possibile qualora si accetti e quindi si cerchi l'errore, si cerchi di controllarne le fonti, si costruiscano ipotesi alternative, si esplorino nuove modalità o vie per raggiungere un risultato desiderato o si riconoscano gli effetti di errori “fortunati”. A livello metodologico, si può mostrare come il controllo delle fonti di errore sia alla base dello stesso metodo sperimentale. Questo processo ricorsivo di problem solving può descrivere sia l'interazione terapeutica, sia l'iter procedurale in psicoterapia cognitivo-comportamentale, nella pratica clinica e nella ricerca.
Parole chiave: errori, psicoterapia, problem solving, metodo scientifico
Abstract.
Errors in psychotherapy are conceivable as mismatches between goals and outcomes. So, the reality of worsening in patients during psychotherapy, a fact known as "deterioration", can be studied as an effect of therapeutic errors at different levels or as deficiencies inherent to used procedures. Given both the diffusion of errors, as examples of the demonstrated fallibility of the human mind, and their fertility, to underestimate or scotomize them can be defined as a mistake. We can see as failures are resulting from one or more major or systematic mistakes, whereas a serious and persistent failure might be referred to as "catastrophe". Furthermore, the doubt to be wrong is a propeller of cognitive learning, or new knowledge. This is possible if we accept the error and then try to look for its sources, if alternative hypotheses are built, and if we will explore new modes or ways to achieve a desired result or otherwise recognize the effects of "lucky" errors. At a methodological level, we can show how the control of sources of error is the basis of the experimental method itself of science. This recursive process of problem solving can describe both the therapeutic interaction, and the formal procedures in cognitive-behavioral psychotherapy in clinical practice and research.
Key words: errors, psychoterapy, problem solving, scientific method
issues, from obesity to drug
abuse, have shown that selfmanagement
abilities can be fostered
by methods such as self-monitoring,
by use of cognitive-social learning
principles. On this basis, we have
started a programme with patients
admitted to University of Rome La
Sapienza, with a diagnosis of alcohol
abuse. The programme aims at
maintaining total or partial abstinence
in participants by teaching and
fostering self-monitoring and selfmanagement
abilities with minimum
use of professional time. The
programme is assessed with a
controlled randomised design
spanning 1 year.
Participants, enrolled with specific
criteria, represent about 25% of all
alcoholics arriving at our service. All
participants receive standard medical
treatment as day hospital patients in
the first 2 weeks. Those in the
treatment group are given the choice
of aiming for abstinence or for
controlled drinking and sign a
contract. Thereafter, they are trained
to observe their own drinking
behaviour, as well as the emotional,
cognitive, and environmental contingencies
that control it. After
discharge, the participants in the
control group attend routine aftercare,
whereas those in the treatment group
are required to maintain the scheduled
assignments, including monthly
structured telephone contacts, for the
next 12 months.
Motivation to pursue the selfmanagement
tasks is stimulated and
maintained in the monthly interviews
with staff psychologists. Initial results
on the first 60 participants are
striking; total abstinence days and
drop-out rates differ significantly
between groups. At 1 year, 47% of
treatment-group participants continue
to attend, compared with only 17% in
the control groups. Results are also
expected in self-efficacy and
psychopathology scores, but already
we think that increase in perceived personal control of drinking behaviour
is a better strategy than standard
medical treatment.
well, together with smoking habits, were assessed during a survey on a sample of adult subjects. Sample comprised 200 men and women of mean age of 36,9 years, enrolled in the waiting rooms of family physicians. Data about the actual degree of pollution in the same areas (in Sardinia, Italy) were also gathered by local health authorities. Areas were classified on the basis of the degree of pollution (high, moderate, low).
We posited the following hypotheses: a) there is a weak positive relationship between the rate of smokers and environmental pollution, as well as between the rate of smokers and perception of the quality of air, and b) there
is a significant inverse relationship between rate of smokers and coherent (subjective/objective) assessment, both in high and in low pollution areas. As expected, the quality of air was significantly perceived as worse in the more polluted areas (p=.008; Fisher's exact test). The correlation was however not
complete as a number of subjects had an optimistic bias: positive appraisals of air in more polluted areas were more frequent in smokers (p=.018), thus confirming hypothesis b. This interaction effect of subjective perception with actual pollution is discussed as far as regards health promotion interventions.