Ergotherapy

Head of the Service:Antonio Caggioni

Ergotherapy or Occupational therapy in psychiatry promotes the recovery and maintenance of more autonomous participation in the patient’s daily and social life. This is referred to as role and occupational performance.
The occupational therapist assesses and measures the patient’s resources and deficits while performing activities with regard to psycho-affective, communicative, inter-relational, cognitive and body self-perception functions. Together with the patient, he develops an individual treatment plan by choosing specific activities appropriate to the disorder and the patient’s needs. The aim of the individual or group intervention is to improve the patient’s ability to act.

Various occupational therapy activities are planned to allow support for the different types of deficits diagnosed in patients:

  • Individual Therapy

    Description of service

    The occupational therapist, in the context of the assessment interviews, shares with each patient individual treatment goals based on the patient‘s difficulties, resources, values and interests. He also proposes a personalized treatment plan in order to achieve the established goals and to verify their achievement during individual treatment sessions.

    Listed below are some situations in which the occupational therapist offers to carry out therapeutic activities as part of individual treatment:

    • activities for specific and very acute cases (acute psychosis, dementia, acute anxiety, social phobia, etc.).
    • challenging and complicated activities that are difficult to perform in a group setting
    • daily activities with the aim of preparing a patient specifically for independent living conditions
    • activities and exercises for specific cognitive disorders
    • perceptive and sense-motor activities for psycho-somatic or/and specific sense-motor problems
    • analysis and awareness of the experience in the process of creating and doing of a patient
    • moment of reflection about the result of an activity integrating mentalization processes
    • self-assessment of one’s own capacity to act and interact, with respect to abilities and difficulties

    Therapeutic performance objectives

    By participating in the individual activity, the patient is led to achieve the following therapeutic goals:

    • to facilitate and/or improve its participation in social life
    • promote his/her autonomy in all areas of life (such as: self-care, domestic activities, leisure time, social and professional life and/or study, etc.)
    • finding concrete strategies to prevent discomfort and crisis
    • to evaluate and value oneself in a more realistic way, being aware of one’s own resources and limits in the ability to act and interact
    • to facilitate the patient in finding a balance between the various areas of life.

    The occupational therapist interweaves the above-mentioned goals with those in the psycho-affective, psycho-social, interactive, perceptual, cognitive, psycho- and sense-motor areas.

    Recipients of the service

    Suitable for all patients in the field of mental health; in particular, the individual activity is aimed at all those patients who in the initial phase cannot be included in group activities.

  • Group A-Ri-Sentirci

    Description of services

    The group entitled “A-Ri-Sentirci” is characterised by the methods based on expression, perception and interaction. The expressive method offers space for the inner representations and images of the patients which can be expressed through figurative and plastic therapeutic means on a symbolic and metaphorical level.

    This expressive dimension, stimulated through shapes and colours, anticipates the development of clearer and more structured verbal expression and helps to express oneself where it is difficult to express one’s feelings through verbal language.

    Through his own spontaneous creation, the patient is sensitised and made aware of his own self-perceptive abilities and his own experience, which can be “channelled”, contained and enhanced in a protected group setting. The creations become mediating objects (sometimes transitional) between the inner and outer world of the patient and between him, the group and the therapist.

    Therapeutic objectives

    The goal of group participation is to get patients to reflect on themselves, thus creating a basis for meta-cognitive and mentalization processes. In addition, the following objectives are set:

    • stimulate greater awareness of intra-psychic processes through outward transformations
    • find diversified and differentiated expressive alternatives
    • integrate, with greater awareness in an intra-personal dimension, the inner images and one’s own experience through creative-expressive material, stimulating “individuation processes”.
    • Develop a more defined and clearer self-image with greater self-confidence.

    Recipients of the service

    It is indicated for many post-acute patients with minimal self-reflective abilities. It is very useful in the psychosomatic field for people suffering from depression, anxiety disorders, personality disorder, eating disorders, drug addiction, other addictions and also for patients suffering from a bipolar disorder or schizophrenia not in an acute phase. The group is not indicated for patients with acute mental decompensation.

  • Kitchen Group

    Description of service

    This occupational therapy group offers a space in which patients, in a situation of discomfort, have the opportunity to “re-experiment” in the kitchen, rediscovering the dimension of culinary pleasure and nourishment, sensitising them to take food not in an impulsive way and giving particular importance to a balanced diet.
    The menus are discussed in common for the following week, as is the organisation of the various courses.

    The group allows the exchange of cultures through the enhancement of various recipes proposed by the individual participants, giving space to share culinary memories, for example through reminiscence techniques.
    During the group you cook you eat and tidy up the kitchen together.

    Therapeutic objectives

    The main objective of the activity is represented by the dimension of socialization since patients share an activity with the same interest, i.e. food. Moreover, the importance of interaction, distribution of roles and tasks is made explicit and valued. It is then tried to increase skills such as listening, collaboration, expression of opinions or desires, finding compromises, adapting, accepting and managing compliments or criticism, responsibility etc..
    Other objectives are the stimulation of perceptive, cognitive and sense-motor skills, the organization and planning of “executive strategies” of the activity in the kitchen: remembering the steps of the recipe and the ability to stay focused on the activity without being distracted by the interaction with others while perceiving them.
    Finally, the cooking group facilitates the patient to reach a higher level of independence in his daily activities.

    Recipients of the service

    The cooking group is indicated for almost all patients in the non-acute phase and especially for most of those with eating disorders and/or difficulties related to the perception of their bodies.

  • Open Group

    Description of service

    The open group offers a therapeutic setting in which patients share the same place in the same period of time; it takes place in a room equipped according to their needs and allows them to carry out an activity or work individually. Interaction is spontaneous and free and there is the possibility of withdrawing to a more protected place in the room, should the interactions created become too demanding for the individual patient. It is also possible, in consultation with the occupational therapist, for the patient to leave the group at any time if they no longer feel able to stay.

    Activities are chosen together with the patient in order to work on the objectives set in the initial interview: these can be structured, planned and competence-based or creative activities with a process-oriented approach and an expressive dimension.
    Within this setting it is possible that subgroups are spontaneously formed to carry out common activities or to support each other in particular moments of the project they are carrying out.

    Therapeutic objectives

    Through participation in the group activity, the patient is encouraged to a first level of rather spontaneous interaction in a setting where other people are present; a further objective is the gradual increase in being able to stay and live calmly in this context. Depending on the initial assessment interview, the occupational therapist selects and defines objectives together with the patient. These goals are related to the psycho-affective, psycho-social, interactive, perceptual, cognitive, psycho- and sensorimotor areas and facilitate the patient’s skills and independence in the various occupational areas of life (e.g. work, leisure time, social life, domestic activities, etc.).

    Recipients of the service

    The open group is indicated for all patients who have enough emotional stability to be able to stay in a setting where other people are present. It is not indicated for patients in an acute confusional state and with strong psycho-motor agitation.

  • Cognitive (-Psychiatric) Group

    Description of service

    In the cognitive (psychiatric) group, the occupational therapist offers activities mainly aimed at carrying out exercises and/or games to stimulate, recover, improve and maintain the cognitive performance of the patients. Being able to “train” one’s cognitive abilities together with other people often creates greater motivation in the individual participants: the interactive, partly playful dimension can thus become comforting. In this group, the occupational therapist creates a situation in which the patients are stimulated to exchange ideas about learning strategies, thus enabling them, both in group situations and in their individual daily lives, to adapt more readily should difficulties arise in the cognitive sphere.

    Therapeutic objectives

    Through the group activity the patient is helped to improve his cognitive abilities: the improvement of spatial-temporal orientation, of divided, selective and maintained attention, of concentration and memory, especially in the short term.

    In addition, the occupational therapist seeks to increase the ability to process information by improving skills in the areas of perceptual processing, organisation, planning, gnosis, praxis, analytical skills, logical thinking, understanding of instructions for an exercise or game, problem solving skills, flexibility to change, etc.

    All this is intended to facilitate the patient in achieving the highest level of independence and satisfaction in daily activities.

    Recipients of the service

    The group is indicated for patients with mild to moderate cognitive impairment (dementia, chronic schizophrenia, etc.).
    With a thorough evaluation, carried out by the occupational therapist, it is indicated for patients suffering from temporary limitations in their cognitive performance, related to an acute or post-acute phase of their illness (severe depression, pseudo-dementia, etc.).

    It is not suitable for patients in an acute state of confusion (in this case the occupational therapist offers individual treatment with targeted methods to improve orientation in the three domains etc.).

  • Geronto-Psychiatry Group

    Description of service

    The geronto-psychiatry group is intended for people over 65, with the intention of stimulating patients in social participation and supporting their autonomy in daily life.

    It supports the ability to live as independently as possible in serenity by promoting moments of well-being in the “here and now” trying to soothe states of anxiety and facilitating feelings of belonging.

    In a welcoming group setting, activities of common interest are offered in which people participate by sharing stories and life experiences.

    Respecting the person’s resources and difficulties, each person gives his or her own practical contribution during the activity: the activities vary from concrete work, with immediate meaning and satisfactory results (e.g. preparing a cake), to reading texts from their own generation (typical poems and songs, etc.).

    Moreover, the group offers a space for sharing concepts and themes experienced and felt in the period of old age (e.g.: theme of mourning, confrontation with illnesses etc.).

    This makes the individual participant feel welcomed and facilitated in the elaboration of the discomfort linked to this phase of life. The proposed activities are mainly based on the following methods: “Reality Orientation Therapy” by Folsom and Taulbee, the “Reminiscence” and “Biographical Writing” (Pigorsch) and “The Re-Motivation”.

    Therapeutic objectives

    In today’s society the change in the role of the elderly person is often experienced, more or less consciously, as a loss of values and a decrease in self-esteem.
    The objective of the group is to promote the quality of life, always taking into account the specific needs and values of the geriatric patient and his subjective experience, improving and enhancing the awareness of his personal resources.
    The occupational therapy team aims to increase or maintain specific skills in activities of daily living by promoting perceptual and cognitive abilities (stimulating procedural and long-term memory, enhancing short-term memory etc.) and social skills. “Re-motivation” stimulates socialisation, listening and communication etc.

    Recipients of the service

    The group is indicated for patients in the psycho-geriatric branch who suffer from mild or medium-severe depression, difficulties in interaction (often with social withdrawal), limitations in activities of daily living, patients with polymorbidity, mild or medium-severe dementia, post-stroke conditions, Parkinson’s disease, chronic pain and/or psychosomatic illnesses, etc.

    The group is not indicated for patients with acute confusional state or severe dementia who are followed in an individual occupational therapy setting.

  • Shopping Group

    Description of service

    The spending group is indicated for patients who feel the need to “re-experiment” in activities of daily living outside the clinical and protected environment, even if they have already returned home.

    The patients, accompanied by an occupational therapist, undertake to prepare a shopping list for the occupational therapy department, to choose and propose the specific place where they wish to carry out the various planned errands (e.g. supermarket, stationery shop, tailor’s shop, post office, etc.).

    The fact of confronting the collective daily context can sometimes represent a difficulty for people suffering from a high level of anxiety: for this reason, patients accompanied in outings outside the clinic, are supported and facilitated in coping with the interactions that these contexts contain, e.g. dealing with shop assistants or dealing with various means, such as shopping carts, public transport timetables, speedometers etc..

    Therapeutic objectives

    Through the group activity the patient is helped to increase his intra- and interpersonal skills, not only in the interaction between patients in the group, but also directly with the external environment.

    The occupational therapist’s aim is to try to increase self-confidence in dealing with anxiety when in crowded places, or where complex activities have to be experienced.

    Further objectives are the stimulation of perceptual, cognitive and sense-motor skills (e.g.: the organization and planning of “executive strategies” of the shopping activity, remembering what and where to do the errands, the ability to stay focused on the shopping by managing multiple stimuli present in the context). Finally, it aims to facilitate patients in achieving the highest possible level of independence in various activities that are meaningful to them.

    The patient is therefore stimulated in the acquisition of greater confidence and competence in the management of purchases and money, creating the conditions to become autonomous in their daily errands.

    Recipients of the service

    The group is indicated for almost all patients in the non-acute phase and in particular for patients who suffer from anxiety when confronted with public places and/or when they find it difficult to manage activities in such contexts.

  • Con-Tatto Group

    Description of service

    The group entitled Con-Tatto is characterised by the method centred on perception. The proposed activities are based on the stimulation and perception of the various senses and of one’s own body. The result of the activity is not a priority, but rather the patient’s experience and its sharing with the rest of the group. Different approaches are used: the first are those centred on sensory, functional and neurophysiological stimulation that allow a concrete comparison with external stimuli, while the second are those based on expressive, free and symbolic paths in the psycho-corporeal sphere. Patients are guided in diversified perceptive processes that allow them to compare their attitudes of sensory exploration in different contexts. In addition to increasing awareness in this dimension, openness to change is stimulated, strengthening self-confidence and the ability to make choices.

    Therapeutic objectives

    Through the Con-Tatto group, the patient’s perception of the “presence” and “boundaries” of his own body is strengthened, stimulating the integration of interior images and strengthening the dimension of the Ego.

    The group also has the following objectives:

    • more intense and deeper ability to listen and awareness of the perceptive dimension in the “here and now”.
    • better understanding and ability to observe and recognise the interrelationship between internal and external perceptual stimuli
    • a greater ability to recognise the effect of perception on one’s emotional experience.

    Finally the occupational therapist can teach the patients some sense-motor activities that allow them to possess future strategies for self-empowerment.

    Recipients of the service

    The “Con-Tatto” group is indicated for almost all patients in the non-acute phase. It is very suitable for psychosomatic patients, for patients with depression, anxiety disorders, personality disorders, eating disorders and also for patients with psychotic structure. The group is not indicated for patients in acute psychotic decompensation or in an acute confusional state.