motivation at last interview

**Scheme 2.** Motivation at the end of the psychodiagnostic process

motivation categories

persons), psychotic one (patients often not conscious of their diseases, with a rigid relational

The aim of the diagnostic process, and overall aim of the last interview, was to create a relationship with the patient whose objective was to become aware of the disease and to want to change. So we tried to change the situation where the specialist evaluates the patient and at the end delivers a verdict - instead we tried to build a collaborative relation with adolescent where the main objective is to give a sense to the symptoms, to verify where the adolescent

motivation at first interview

motivated indifferent contrary

Adolescent's motivation was evaluated again at the end of the diagnosis process (basing on the same elements). The result was an increase of motivated and a decrease of indifferent and contrary adolescents (scheme 2), without relevant difference regarding gender within the three categories (p=0.19). The relation between motivation and diagnosis looses statistical signifi‐ cance too (p=0.09), whereas educational level remains significant in regard to adolescent's motivation (X2=11.38 (DF4), p=0.023). This result suggests that sociocultural aspects (like educational background) influences thinking capacity more than other more constitutional factors (like gender or psychiatric disorder); moreover, it could make operators inclined to differentiate the way of approaching psychopathology in case of particular cultural conditions,

had stopped and to make the therapy to be perceived as something useful.

motivation categories

**Scheme 1.** Motivation at the beginning of the psychodiagnostic process

Percent

50

40

30

20

10

0

modalities and then mainly indifferent towards therapy).

244 Mental Disorders - Theoretical and Empirical Perspectives

Evaluation of adolescents and their family showed, among contrary subjects, high frequency of difficult relationships and conflict with parents. This aspect seems preponderant in influ‐ encing the adolescent's feeling towards the specialist and psychological space. It is as if the difficulty with the parents is expressed by the difficulty and refusal in regards to psychiatric consultation, to which the adolescent has been lead by parents rather than coming by him self. In these cases, focusing on problematic relations and working on the relationship with the parental couple in terms of separation/ individuation, seems to favour the use of psychodiag‐ nostic space as one's own rather than as something to be used to attack parents. This was shown by contrary adolescents as major capacity to thinking for them selves, to recognise personal difficulties and to accept help to sort them out. Contrary adolescents, even if more oppositional evidently, are more "malleable" than indifferent adolescents whose defences are rigid and whose emotive distance makes it difficult to establish an emphatic relationship.

A nine months follow up have permitted verification of therapeutic compliance and clinical evolution. 84% of the adolescents are compliant, 8% have dropped out and 8% have never started psychotherapy. 62% of the adolescents have improved, 34% have not varied and 4% have got worse. There are significant statistical differences both in regard to therapeutic compliance and clinical evolution: motivated and indifferent adolescents mainly follow the therapeutic suggestion at the end of the diagnostic procedure, whereas contrary do not even start therapy (p=0.006) (scheme 3). In parallel after nine months motivated get better, indif‐ ferent do not vary and contrary adolescents do not vary or get worse (p=0.000) (scheme 4). The evidence of a missed clinical improvement nine months later even if indifferent are compliant for 90%, suggests - and confirms what said before about that - the presence of stronger rigidity of personality structure and defence mechanisms and/or necessity of a longer period to get better in these subjects.

motivation categories

of subjects with not supportive families (p=0.005).

percent

100

90

80

70

60

50

40

30

20

10 0

motivated indifferent contrary

**Scheme 4.** Motivation in relation with outcome nine month by the beginning of the semiresidential treatment.

important factor in regard to efficacy of therapeutic process [20], [14], [5], [8],[3].

This result is relevant because it indicates that adolescent's motivation is linked not only to therapeutic compliance but also to therapeutic efficacy. In fact the elements we considered to define motivation are significant ingredients to build an alliance relationship; this one is an

Significant, statistically only in the latter case, the result about parents' collaboration in regard to therapeutic compliance and clinical evolution: 10% of adolescents do not start multimodal treatment or drop out among supportive families, whereas the percentage becomes 30% among not supportive families. With respect to clinical evolution: nine months later there was a clinical improvement in 73% of cases with supportive families, while the improvement regarding 31%

29 30

1 702

79

29

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9 months follow up

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w orse

unvaried

better

#### motivation categories

**Scheme 3.** Motivation in relation with therapeutic compliance after nine months by the beginning of the semiresiden‐ tial treatment.

difficulties and to accept help to sort them out. Contrary adolescents, even if more oppositional evidently, are more "malleable" than indifferent adolescents whose defences are rigid and

A nine months follow up have permitted verification of therapeutic compliance and clinical evolution. 84% of the adolescents are compliant, 8% have dropped out and 8% have never started psychotherapy. 62% of the adolescents have improved, 34% have not varied and 4% have got worse. There are significant statistical differences both in regard to therapeutic compliance and clinical evolution: motivated and indifferent adolescents mainly follow the therapeutic suggestion at the end of the diagnostic procedure, whereas contrary do not even start therapy (p=0.006) (scheme 3). In parallel after nine months motivated get better, indif‐ ferent do not vary and contrary adolescents do not vary or get worse (p=0.000) (scheme 4). The evidence of a missed clinical improvement nine months later even if indifferent are compliant for 90%, suggests - and confirms what said before about that - the presence of stronger rigidity of personality structure and defence mechanisms and/or necessity of a longer period to get

43

14

43

whose emotive distance makes it difficult to establish an emphatic relationship.

<sup>10</sup> <sup>6</sup>

91 90

better in these subjects.

100

246 Mental Disorders - Theoretical and Empirical Perspectives

90

80

70

60

50

40

30

20

10 0

percent

tial treatment.

motivation categories

motivated indifferent contrary

**Scheme 3.** Motivation in relation with therapeutic compliance after nine months by the beginning of the semiresiden‐

compliance tp

drop out

regular

discontinous

**Scheme 4.** Motivation in relation with outcome nine month by the beginning of the semiresidential treatment.

This result is relevant because it indicates that adolescent's motivation is linked not only to therapeutic compliance but also to therapeutic efficacy. In fact the elements we considered to define motivation are significant ingredients to build an alliance relationship; this one is an important factor in regard to efficacy of therapeutic process [20], [14], [5], [8],[3].

Significant, statistically only in the latter case, the result about parents' collaboration in regard to therapeutic compliance and clinical evolution: 10% of adolescents do not start multimodal treatment or drop out among supportive families, whereas the percentage becomes 30% among not supportive families. With respect to clinical evolution: nine months later there was a clinical improvement in 73% of cases with supportive families, while the improvement regarding 31% of subjects with not supportive families (p=0.005).

This data seems to indicate that parental support for adolescents is more important to the efficacy of intervention than to compliance, as if adolescent's motivation was fundamental to start treatment, but then the family's support becomes significant as well to get clinically better.

tacks". His words made me remember that his mum had said that 'there are guys who are able to study and guys who aren't able to bear the burden and R should understand if he's

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After about 20 minutes someone knocked on the door, twice. I went to open it and it was R's mum who wanted to tell me she'd wait for R outside, in the car. In the meantime she was trying to look behind me to see R, at the same time, looking at me making a lot of signs with her face and her hands as if to say "is it all right with him?" I closed the door with a gentle smile and went back to my seat feeling annoyed; I looked at R with a questioning glance. He did not say anything about his mum, he did not seem ashamed or embarrassed or annoyed. He seemed to me a bit relieved instead. I asked him more about his parents: R's mum is from South Italy while his father is North Italian. They divorced when R was 6 because his father had an affair. His mum, who now is a housewife, has been living with another man for 10 years. He told me about the first time he'd met his

R said he gets on very well with both his dad and his stepfather. It seemed to me it was very important for R to tell me that everything is all right with his family. This picture (intrusive and anxious mum, close family, worry about school, not many friends) gave me the image of a little boy, even though I was listening to a tall, broad, handsome man of 18 years. I felt a sort of big gap between his physical appearance and the way in which his mum treated him plus the way in which his symptoms seemed to ask for care. R was very keen to go on with interviews (what struck me was that he spoke about finding a way to face panic attacks rather then a way to rid himself of them). We agreed to see each other

R arrived on time, brought by his stepfather who waited for him outside. R had had his hair cut and he was wearing a cap that he did not take off. He started to tell me about his last panic attack that had happened while he was reading an article about a 12 y.o. girl's death. R told me that horror films made him have panic attacks as well. I asked him what he'd felt about the girl's death and he was able to say only that he'd felt strange "how can things like that happen?" Then he told me yesterday he went to his GP who prescribed R some medication (paroxetine) for his shaking. He went on to speak about his panic attacks, how they happen, how he feels and so on, talking very fast and repeating the same things. R links them to the

R said he gets very anxious thinking about his exams. I asked him what he's scared of. He's scared of failing. What could happen if you failed an exam? R answered he wouldn't know what to do. I asked him if it's something to do with him only and he said that he's worried what others could say about him too. He was getting very anxious so I asked him what he was going to do after his graduation. He seemed relieved to change the topic and said he'd like to get a job and a house. I asked him if he would like to live with anyone; he answered it doesn't matter. I asked him about girlfriends: he has never had one and he doesn't care...now he has no time to think of this. He told me he used to speak with his mother about these things, also

fear of exams, stubbornly, as if he had to convince himself about that.

able or not; he could eventually leave university…'

mother's partner, saying that he'd liked him from the start.

next week at the same time.

**5.2. Second diagnostic session**

### **5. Romeo (R), 18 years old: Reports diagnostic interviews by interviewer's words**

### **5.1. First diagnostic session**

Yesterday R's mother (Mrs A) phoned to confirm the appointment and asked if it would be possible to speak to me before his son would. Today Mrs A arrived at the Institute on time and the secretary found her screaming asking for someone, from the balcony upstairs on the first floor. Mrs A said she couldn't find anyone immediately upon entering the building and she didn't know where to go. Mrs A asked the secretary if she could speak to me before I saw R (R was waiting into the car). The secretary said she could spend the first 10 minutes with me whilst R was present – then she went to get R.

After I had introduced myself, we entered the room together and R's mother started to speak to me about R. "R has been suffering panic attacks for 4 months, he has got very nervous, he can't sleep, he has a lot of difficulties with his exams, he needs help in facing going to university, panic attacks, girls…" Furthermore she asked for medication to help him to sleep. She was very agitated and I felt R's anxiety rising while she was speaking. After a while I asked her to leave and wait for R. Then I asked R what he thought and he replied that what his mother had said was true, and he started to tell me about his panic attacks. They started since February when he had to do his first exam. He was at home, having a shower; his heart started to beat faster, he couldn't understand what was going on and he went to his mum (who was in the kitchen) to ask for help. I wondered within myself what he was doing or thinking while having a shower. His mum suggested he drink a glass of water but it didn't work. His legs and arms started to tremble and he was not able to control them. So his mum took him to the hospital where he had a lot of tests; everything was all right medically.

The second panic attack came a month later, at home too, nobody was in. R called his dad who went home and took R to the hospital again. Then panic attacks became more frequent: until two weeks ago they were every day. During these two last weeks R has been feeling a bit better (the exams have finished). His General Practitioner (GP) did not prescribe any medication, instead he suggested R come to the Service. I asked him what he thought about that and he answered he preferred not to take medication at that moment. I asked him about University and he told me the choice to go on to study was a very important one. Before he had been working at his stepfather's shop for nearly one year. Now he has to study a lot, he has no more time for friends and recreation. His life consists of going to university then coming back home and so on again, every day. He did not look worried or sad saying this. He doesn't want to give university up "even if it causes my panic at‐

tacks". His words made me remember that his mum had said that 'there are guys who are able to study and guys who aren't able to bear the burden and R should understand if he's able or not; he could eventually leave university…'

After about 20 minutes someone knocked on the door, twice. I went to open it and it was R's mum who wanted to tell me she'd wait for R outside, in the car. In the meantime she was trying to look behind me to see R, at the same time, looking at me making a lot of signs with her face and her hands as if to say "is it all right with him?" I closed the door with a gentle smile and went back to my seat feeling annoyed; I looked at R with a questioning glance. He did not say anything about his mum, he did not seem ashamed or embarrassed or annoyed. He seemed to me a bit relieved instead. I asked him more about his parents: R's mum is from South Italy while his father is North Italian. They divorced when R was 6 because his father had an affair. His mum, who now is a housewife, has been living with another man for 10 years. He told me about the first time he'd met his mother's partner, saying that he'd liked him from the start.

R said he gets on very well with both his dad and his stepfather. It seemed to me it was very important for R to tell me that everything is all right with his family. This picture (intrusive and anxious mum, close family, worry about school, not many friends) gave me the image of a little boy, even though I was listening to a tall, broad, handsome man of 18 years. I felt a sort of big gap between his physical appearance and the way in which his mum treated him plus the way in which his symptoms seemed to ask for care. R was very keen to go on with interviews (what struck me was that he spoke about finding a way to face panic attacks rather then a way to rid himself of them). We agreed to see each other next week at the same time.

### **5.2. Second diagnostic session**

This data seems to indicate that parental support for adolescents is more important to the efficacy of intervention than to compliance, as if adolescent's motivation was fundamental to start treatment, but then the family's support becomes significant as well to get clinically better.

**5. Romeo (R), 18 years old: Reports diagnostic interviews by interviewer's**

Yesterday R's mother (Mrs A) phoned to confirm the appointment and asked if it would be possible to speak to me before his son would. Today Mrs A arrived at the Institute on time and the secretary found her screaming asking for someone, from the balcony upstairs on the first floor. Mrs A said she couldn't find anyone immediately upon entering the building and she didn't know where to go. Mrs A asked the secretary if she could speak to me before I saw R (R was waiting into the car). The secretary said she could spend the first 10 minutes with me

After I had introduced myself, we entered the room together and R's mother started to speak to me about R. "R has been suffering panic attacks for 4 months, he has got very nervous, he can't sleep, he has a lot of difficulties with his exams, he needs help in facing going to university, panic attacks, girls…" Furthermore she asked for medication to help him to sleep. She was very agitated and I felt R's anxiety rising while she was speaking. After a while I asked her to leave and wait for R. Then I asked R what he thought and he replied that what his mother had said was true, and he started to tell me about his panic attacks. They started since February when he had to do his first exam. He was at home, having a shower; his heart started to beat faster, he couldn't understand what was going on and he went to his mum (who was in the kitchen) to ask for help. I wondered within myself what he was doing or thinking while having a shower. His mum suggested he drink a glass of water but it didn't work. His legs and arms started to tremble and he was not able to control them. So his mum took him to the hospital where he had a lot of tests;

The second panic attack came a month later, at home too, nobody was in. R called his dad who went home and took R to the hospital again. Then panic attacks became more frequent: until two weeks ago they were every day. During these two last weeks R has been feeling a bit better (the exams have finished). His General Practitioner (GP) did not prescribe any medication, instead he suggested R come to the Service. I asked him what he thought about that and he answered he preferred not to take medication at that moment. I asked him about University and he told me the choice to go on to study was a very important one. Before he had been working at his stepfather's shop for nearly one year. Now he has to study a lot, he has no more time for friends and recreation. His life consists of going to university then coming back home and so on again, every day. He did not look worried or sad saying this. He doesn't want to give university up "even if it causes my panic at‐

**words**

**5.1. First diagnostic session**

248 Mental Disorders - Theoretical and Empirical Perspectives

whilst R was present – then she went to get R.

everything was all right medically.

R arrived on time, brought by his stepfather who waited for him outside. R had had his hair cut and he was wearing a cap that he did not take off. He started to tell me about his last panic attack that had happened while he was reading an article about a 12 y.o. girl's death. R told me that horror films made him have panic attacks as well. I asked him what he'd felt about the girl's death and he was able to say only that he'd felt strange "how can things like that happen?" Then he told me yesterday he went to his GP who prescribed R some medication (paroxetine) for his shaking. He went on to speak about his panic attacks, how they happen, how he feels and so on, talking very fast and repeating the same things. R links them to the fear of exams, stubbornly, as if he had to convince himself about that.

R said he gets very anxious thinking about his exams. I asked him what he's scared of. He's scared of failing. What could happen if you failed an exam? R answered he wouldn't know what to do. I asked him if it's something to do with him only and he said that he's worried what others could say about him too. He was getting very anxious so I asked him what he was going to do after his graduation. He seemed relieved to change the topic and said he'd like to get a job and a house. I asked him if he would like to live with anyone; he answered it doesn't matter. I asked him about girlfriends: he has never had one and he doesn't care...now he has no time to think of this. He told me he used to speak with his mother about these things, also because she asks him a lot...even if it is not so easy and a bit embarrassing too, he added. I wondered whether he wouldn't find easier to talk to his father about things like this, "between men"…R looked a bit thoughtful then said that yes, probably it'd be easier.

fear anymore; he has not had panic attacks since he managed to talk about it. I asked what his mum had said. She had told R he shouldn't have worried, that's normal, besides the same had happened to his father years ago (!). The mother told him she thought it might be something to do with sex and now he has told her she feels better. R told me he should have spoken before. I commented he'd probably needed a period in order to understand and to face a lot of feelings that had been coming out, not always easy to deal with. He agreed and repeated he had felt really ashamed and guilty. In particular, he had been scared of what his mum could have thought about him. I took up that it was difficult to say such personal things to his mum, especially now that he's growing up, and that growing up could be also be something to feel guilty about. He agreed and said it had been very important to speak to his dad before…

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We spoke a bit about girls; R got a bit anxious and it seemed to me he wanted to censor the topic. He repeated he's very well, he wants to go on with University, he's able to go out again and so on. I felt he was censoring interviewing as well so I asked him openly what he had thought about continuing to come here. He seemed relieved by my question and answered that he felt he had received the help he needed and that he was very grateful. I proposed to him to take some time to think about that and to see each other next week again…he seemed more agitated and in trouble, then he repeated his thanks for the help he has received and that he preferred to stop there, because he was really OK and he did

I took up his anxiety (probably linked to sexuality and body) and his fear in facing it: I told him I thought it would be important for him to have a deeper look inside; I also said that, looking at his anxious state, I could feel that perhaps it was too much for him at that moment and that it was important and right to respect his feelings of being scared by those thoughts and emotions. So I reassured R about the possibility of finding someone to help him here, if

Six months later, R came and ask for psychotherapy. He was chosen a male therapist for him.

Results of this study suggest that it is possible to work on adolescent's motivation using relational instruments. Data from follow up indicates the importance of preparing the adolescent and his family, since during the diagnosis process, for treatment with the object of fair compliance and clinical evolution. With regard to that this paper suggests that an im‐ provement of interviews, specifically used to discuss therapeutic referral, could be methodo‐ logically useful to improve motivation. In conclusion the motivation influences both compliance and clinical evolution, so it is important to pay attention to motivation since the start of the diagnosis process. This study moreover suggests that it is important to work with

because he's a man.

not need help anymore.

We said goodbye each other.

**6. Conclusions**

and when he decides to ask for further help.

The compliance has been good from the beginning.

What about friends? He has a few good friends, but now he has no time anymore to go out with them. I asked R what his mum would think about him going to live on his own. R said that it would be difficult for her to accept, but she knows it'll happen one day. He told me he gets on very well with his mum, she's very supportive and that's been very important for R. I asked R if anyone else in his family was suffering panic attacks. He, looking as if he had been discovered of some secret, answered that his mum had had panic attacks too, when she was the same age as R. According to this she used to tell him not to worry because "panic attacks are going to stop spontaneously". He did not look very sure about this. His voice and way of talking made me ask him whether he's worried about his mum. "Yes" he said "because she's worried about me". I took up it looks like a sort of vicious circle and R agreed but he did not add anything else.

R likes music very much; he can play the piano (he had studied in a music school for some years). His dream is to become a musician…I took up he had chosen quite a different subject (computers) and R said it was because after you qualify you can get a job easier.

Towards the end of the session I asked him how he felt and he said with a smile he's feeling much better, he needs to talk to somebody about himself and what's happening "I should have come before". I thought he had been saying only a little of the whole and the way in which he used to speak about his panic attacks (using the most of our sessions talking about them) seemed to me a sort of defense for avoiding different topics or for not telling me something deeper.

R's mother phoned to the service saying that R wasn't very well so he could not come today. He'd phone when he was better. The secretary who answered the phone, told her we would send a new appointment anyway and R's mum said not to do that because R would phone when he felt ready to ask for another appointment.

It was phoned for another appointment.

### **5.3. Third diagnostic session**

R arrived on time, he looked anxious as usual, but smiling. As soon as he sat down he started to say that he feels much better. I asked him what had happened (I was referring to last missed interview) and R told me he had managed to confide in his father about something he had been keeping to himself and that had been really hard to bear. He added it had been easier to speak between men and his father had supported and reassured him, so now he feels really well. Furthermore the day after he had spoken with his dad he managed to speak to his mum as well "so now it's all sorted out". He told me when the first panic attack came he was masturbating under the shower. He felt he had damaged his body, he felt really ashamed and scared at the same time. Until now he has been feeling that something wrong had happened to him, he's been fearing he couldn't masturbate anymore, he's been fearing about what might happen with girls…. Now the truth has come out he feels really better. It's all over. He has no fear anymore; he has not had panic attacks since he managed to talk about it. I asked what his mum had said. She had told R he shouldn't have worried, that's normal, besides the same had happened to his father years ago (!). The mother told him she thought it might be something to do with sex and now he has told her she feels better. R told me he should have spoken before. I commented he'd probably needed a period in order to understand and to face a lot of feelings that had been coming out, not always easy to deal with. He agreed and repeated he had felt really ashamed and guilty. In particular, he had been scared of what his mum could have thought about him. I took up that it was difficult to say such personal things to his mum, especially now that he's growing up, and that growing up could be also be something to feel guilty about. He agreed and said it had been very important to speak to his dad before… because he's a man.

We spoke a bit about girls; R got a bit anxious and it seemed to me he wanted to censor the topic. He repeated he's very well, he wants to go on with University, he's able to go out again and so on. I felt he was censoring interviewing as well so I asked him openly what he had thought about continuing to come here. He seemed relieved by my question and answered that he felt he had received the help he needed and that he was very grateful. I proposed to him to take some time to think about that and to see each other next week again…he seemed more agitated and in trouble, then he repeated his thanks for the help he has received and that he preferred to stop there, because he was really OK and he did not need help anymore.

I took up his anxiety (probably linked to sexuality and body) and his fear in facing it: I told him I thought it would be important for him to have a deeper look inside; I also said that, looking at his anxious state, I could feel that perhaps it was too much for him at that moment and that it was important and right to respect his feelings of being scared by those thoughts and emotions. So I reassured R about the possibility of finding someone to help him here, if and when he decides to ask for further help.

We said goodbye each other.

Six months later, R came and ask for psychotherapy. He was chosen a male therapist for him. The compliance has been good from the beginning.

### **6. Conclusions**

because she asks him a lot...even if it is not so easy and a bit embarrassing too, he added. I wondered whether he wouldn't find easier to talk to his father about things like this, "between

What about friends? He has a few good friends, but now he has no time anymore to go out with them. I asked R what his mum would think about him going to live on his own. R said that it would be difficult for her to accept, but she knows it'll happen one day. He told me he gets on very well with his mum, she's very supportive and that's been very important for R. I asked R if anyone else in his family was suffering panic attacks. He, looking as if he had been discovered of some secret, answered that his mum had had panic attacks too, when she was the same age as R. According to this she used to tell him not to worry because "panic attacks are going to stop spontaneously". He did not look very sure about this. His voice and way of talking made me ask him whether he's worried about his mum. "Yes" he said "because she's worried about me". I took up it looks like a sort of vicious circle and R agreed but he did not

R likes music very much; he can play the piano (he had studied in a music school for some years). His dream is to become a musician…I took up he had chosen quite a different subject

Towards the end of the session I asked him how he felt and he said with a smile he's feeling much better, he needs to talk to somebody about himself and what's happening "I should have come before". I thought he had been saying only a little of the whole and the way in which he used to speak about his panic attacks (using the most of our sessions talking about them) seemed to me a sort of defense for avoiding different topics or for not telling me something

R's mother phoned to the service saying that R wasn't very well so he could not come today. He'd phone when he was better. The secretary who answered the phone, told her we would send a new appointment anyway and R's mum said not to do that because R would phone

R arrived on time, he looked anxious as usual, but smiling. As soon as he sat down he started to say that he feels much better. I asked him what had happened (I was referring to last missed interview) and R told me he had managed to confide in his father about something he had been keeping to himself and that had been really hard to bear. He added it had been easier to speak between men and his father had supported and reassured him, so now he feels really well. Furthermore the day after he had spoken with his dad he managed to speak to his mum as well "so now it's all sorted out". He told me when the first panic attack came he was masturbating under the shower. He felt he had damaged his body, he felt really ashamed and scared at the same time. Until now he has been feeling that something wrong had happened to him, he's been fearing he couldn't masturbate anymore, he's been fearing about what might happen with girls…. Now the truth has come out he feels really better. It's all over. He has no

(computers) and R said it was because after you qualify you can get a job easier.

when he felt ready to ask for another appointment.

It was phoned for another appointment.

250 Mental Disorders - Theoretical and Empirical Perspectives

**5.3. Third diagnostic session**

men"…R looked a bit thoughtful then said that yes, probably it'd be easier.

add anything else.

deeper.

Results of this study suggest that it is possible to work on adolescent's motivation using relational instruments. Data from follow up indicates the importance of preparing the adolescent and his family, since during the diagnosis process, for treatment with the object of fair compliance and clinical evolution. With regard to that this paper suggests that an im‐ provement of interviews, specifically used to discuss therapeutic referral, could be methodo‐ logically useful to improve motivation. In conclusion the motivation influences both compliance and clinical evolution, so it is important to pay attention to motivation since the start of the diagnosis process. This study moreover suggests that it is important to work with adolescent's parents too to obtain effective results from the treatment. If we consider that a missed therapy opportunity for psychological disease during the developmental age could become a psychiatric disease in adult age [6], [27], then what mentioned before gains the meaning of prevention too.

[9] Gatta, M, & Giovanatto, C. Condini A. L'attività clinica in un servizio di psicopatologia dell'adolescenza: studio longitudinale ed epidemiologico di una casistica ambulator‐

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[10] Gatta, M, Giovanatto, C, Salviato, C, Testa, P, Acconcia, C, & Condini, A. La relazione di alleanza con l'adolescente: centralità della motivazione. Giornale Italiano di psico‐

[11] Gatta, M, Spoto, A, Testa, P, Svanellini, L, Lai, J, Salis, M, De Sauma, M, & Battistella, P. A. Adolescent's insight within the working alliance: A bridge between diagnostic and psychotherapeutic processes. Adolescent Health, Medicine and Therapeutics

[12] Gatta, M, Spoto, A, Svanellini, L, Lai, J, Testa, C. P, & Battistella, P. A. Alliance with patient and collaboration with parents throughout the psychotherapeutic process with children and adolescents: a pilot study. Giornale Italiano di Psicopatologia (2012). ,

[13] Hintikka, U, Laukkanen, E, Marttunen, M, & Lehtonen, J. Good working alliance and psychotherapy are associated with positive changes in cognitive performance among

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[19] Laufer et al(1997). Adolescent breakdown and beyond. London: Karnac Books; 1997 [20] Luborsky, L. The therapeutic alliance measures as predictors of future benefits of psychotherapy. Paper presented at the annual meeting of the Society for psychotherapy

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tologia, Milano: Masson; (1998). cap. 21, , 505-523.

### **Author details**

Gatta Michela1 , Testa C. Paolo2 , Del Col Lara2 , Spoto Andrea3 , Dal Zotto Lara1 , De Sauma Maxim4 and Battistella Pier Antonio1

1 Woman and Child Department-University of Padua, Italy

2 Neuropsychiatric Unit of Child and Adolescent - ULSS Padua, Italy

3 Department of General Psychology- University of Padua, Italy

4 Brent Centre For Young People, London, UK

### **References**


[9] Gatta, M, & Giovanatto, C. Condini A. L'attività clinica in un servizio di psicopatologia dell'adolescenza: studio longitudinale ed epidemiologico di una casistica ambulator‐ iale. Giornale It. Psicopat. Psichiatria Inf. Adolesc. (2003). X(2): 107-120.

adolescent's parents too to obtain effective results from the treatment. If we consider that a missed therapy opportunity for psychological disease during the developmental age could become a psychiatric disease in adult age [6], [27], then what mentioned before gains the

, Spoto Andrea3

[1] Achenbach, T. M, & Rescorla, L. A. Manual for ASEBA School-Age Forms and Profiles.

[2] American Psychiatric AssociationDiagnostic and statistical Manual for Mental Disor‐

[3] Barber, J. P, et al. Therapeutic alliance as predictor of outcome in treatment of cocaine

[4] Bronstein, C, & Flanders, S. The development of a therapeutic space in a first contact

[5] Castonguay, L. G, et al. Predicting the effect of cognitive therapy for depression: a study

[6] Ferdinand, R. F, & Verhulst, F. C. Psychopathology from adolescence into young adulthood: an 8 years follow up study. Am J Psychiatry (1995). , 152(11), 1586-1594.

[7] Frieswyk, S. H, et al. Therapeutic Alliance: its place as a process and outcome variable in dynamic psychotherapy research. J Cons Clin Psychol (1986). , 54(1), 32-38.

[8] Gaston, L, et al. Alliance, technique and their interactions in predicting outcome of behavioural, cognitive and brief dynamic therapy. Psychotherapy Research (1998). , 8,

Burlington: University of Vermont, Research Center for Children; (2001).

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of unique and common factors. Cons Clin Psychol (1996). , 64, 497-504.

, Dal Zotto Lara1

,

, Del Col Lara2

and Battistella Pier Antonio1

2 Neuropsychiatric Unit of Child and Adolescent - ULSS Padua, Italy

dependence. Psychotherapy Research (1999). , 9, 54-73.

3 Department of General Psychology- University of Padua, Italy

1 Woman and Child Department-University of Padua, Italy

meaning of prevention too.

252 Mental Disorders - Theoretical and Empirical Perspectives

, Testa C. Paolo2

4 Brent Centre For Young People, London, UK

**Author details**

De Sauma Maxim4

Gatta Michela1

**References**

190-209.


[24] Marmar, C. R, & Gaston, L. Manual for the California Psychotherapy Alliance Scale-CALPAS. Unpublished Manuscript, S.Francisco: Department of Psychiatry, University of California; (1988).

**Chapter 11**

**Parent-Child Attachment, Parental Depression, and**

Lawrence T. Lam

**1. Introduction**

http://dx.doi.org/10.5772/51170

Additional information is available at the end of the chapter

**Perception of Child Behavioural/Emotional Problems**

The issue of whether parents who have experienced symptoms of psychopathology, particu‐ larly depression, would be able to provide an accurate report on the behavioural/emotional problems of their children has long been raised. [1] It has been suggested that parental de‐ pression plays an important role in their perception of their children's behavioural. [2-7] The early review by Breslau (1988) on the available studies in 1988 found that there was no evi‐ dence for any distortion of child behavioural problems using depressed mothers as inform‐ ants. [1] However, more recent studies have found a positive relationship between parental depression, particularly maternal depression, and report of increased behavioural/emotional problems of their children. For example, in the study by Fergussen et al. on the effect of ma‐ ternal depression on their ratings of children behaviour found a significant association be‐ tween their depression and children's conduct disorder and attention deficit behaviour. [3] A recent study by Hall et al. also found that depressive symptoms in mothers contributed significantly to the perception of both internalising and externalising problems of their chil‐

Parent-child relationships, particularly attachment or connectedness between the parent and child, have been reported to have an effect on the behavioural and emotional health of chil‐ dren and adolescents. [8-9] In terms of the parent-child relationship and parental perception of their children's behavioural and emotional problems, it has been noted that few studies have been conducted. [5] The study by Kolko et al. found that low parental acceptance of the child was significantly associated with the difference between parents' and teachers' percep‐ tion of children's externalising but not internalising behaviour. [10] Another study by Mos‐ ley et al. also found that better parent-child relationships in terms of increased involvement also related to a decrease of parental perception on both internalising and externalising be‐

> © 2013 Lam; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

dren when they were asked to report on their children's behaviour [7].

