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Alexithymia PATHOLOGICAL AND EMPLOYMENT: THE MEDIATION OF EXPRESSION AS A TACTICAL ENGAGEMENT Educational psychology is a prerequisite for psychotherapy of William Champion and Paul Wells

alexithymia is defined (or alexithymia) a set of emotional competence and emotional deficits, revealed the inability of mentalizing, perceive, recognize and describe verbally their own and others' emotional states. It is currently regarded as a possible shortfall in the reflective function of the self. It literally means "no words for emotions"

Alexithymia The term was coined by John Nemiah and Peter Sifneos in the early seventies, to define a set of personality traits highlighted in the so-called psychosomatic patients. The name was disclosed to the first time in 1976 at the XIth European Conference on Psychosomatic Research [1].

The alexithymia is manifested in the difficulty of identifying and describing their feelings, and of distinguishing emotional states from physiological perceptions. The alexithymic subjects have great difficulty in identifying what are the reasons which led them to feel or express their emotions, and yet are unable to interpret the emotions of others. Their powers of imagination and dreams is reduced, sometimes non-existent, lack of capacity of introspection, and tend to engage in conduct complied with the media. The alexithymic subjects also tend to establish strong relations of dependency or, failing that, prefer the isolation. The alexithymia
was significantly related to many pathological conditions of dependence and craving as well as pathological is psychosomatic and psychological in nature, such as hypertension, dyspepsia, sexual dysfunction, and some anxiety disorders. The
alexithymia was associated with an insecure-avoidant attachment style, characterized by a sometimes obsessive need for attention and care.

mental processes common in subjects with alexithymic personality traits is the inability to symbolize mentalizing and emotion. The emotion is experienced by somatic (body directly and without mental processing), and cognitive interpretation, nor conceptualized in pictures mental or words that synthesize and contain. The excitement is for individuals to alexithymia, the mere physical perception, and dysregulated presymbolic, psychophysiological correlates of the emotional.

There are three characteristics considered the basis of the disorder:

• the difficulty in identifying feelings;
• the difficulty in describing the feelings of others;
• oriented thinking almost exclusively outdoors, and rarely to their own processes endopsychic.

From the perspective of psychodiagnostic are three specific tools to assess alexithymia:

the TAS-20 (Toronto Alexithymia Scale), a psychometric scale [2] [3] Self-evaluation at 20 questions (items), the projective test TAT (thematic nature Apperception Test) and the SAT9 (Objectively Scored Archetypal Test).

The proverbial difficulty of our patients reflection and self-awareness and reality, their tendency to concrete thinking and operating with no capacity for abstraction, representation and symbolization (base alexithymia and psychosomatic) deprives them of the ability to sublimate the instincts and to delay the satisfaction, prompting them to act impulsively and compulsively with disastrous consequences.

mental This feature is also behind the 'agonizing loneliness relational-dependent patients, often concurrent contributory cause of depression and suicide are not rare. A framework as complex and makes it extremely difficult to compromise the therapeutic work, and will require different approaches, which often preclude a direct approach to psychotherapy. There is thus moving in a gray area, (good metaphor for a halt to emotions) which requires the identification of new coordinates orientation and exploration. It 'important to do this to have specialized training resources and no more "naive", which are preparatory to a subsequent psychotherapy according to a' lens case and polyphasic.

One of these is the mediation effected through non-verbal means of expression, allowing the emergence of mental contents still no lexicon to be put into words in the first place to themselves and then communicated to others.

are often aphasic or content, so to speak, stammering: to name the emotion, your state of mind, recognize and share in a therapeutic process may be easier if, bypassing the defenses of the verbal code is choose to use (and here, in preparation and therapeutically, you choose the mode that make possible the employment), the use of alternative codes of expression, which can also be used in parallel to this is that the word will a return.

E 'where the use of techniques, materials, art practices can be useful.

The game of communicating without saying, even chaotic and raw expression of his inner world in those spaces that are the setting for mediation and support can help you become an emotional literacy and emotional and expressive codes more refined and finalized, of course, not necessarily in the aesthetic sense or not.

The concept of art therapy is established then the encounter of two distinct poles, and that the art of therapy (Rudolf Arnheim " For the sake of art "(1994). Art (Understanding phenomenologically, such as "... everything that people call art") is understood as material use, codes, procedures and techniques of their art practices, such as therapy care, support and report path structured and verified. The art therapy is based on nonverbal experience and makes use of rehabilitative and therapeutic potential inherent in the creative process. The creative act can bring out emotions, conflicts, problems, needs and can start the adventure of shaping of it, through creating objects of mediation, while using, as mentioned above, instruments and codes of artistic practice, not necessarily to be evaluated and treated according to a meter of aesthetics, but according to their emotional charge, whether latent or conscious, as a means of expression and are simultaneously subject of this expression, and are characterized as external objects, other than itself, but also as containers for elements of the self.

The objects in the path arteterapeutico are deeply embedded in the fabric the relationship between you and Art Therapist, (it brings almost), report that provides protection and containment and, while respecting the defense mechanisms, activates the perception of emotions, memories and experiences to be developed: the setting, that set sized material, relational, affective, adjustment that define the space of therapy: a frame that has a dual function, processing on the one hand, the protection and preservation of the other. By providing a reassuring container makes it possible treatment experience, and containing but sufficiently open to what the pc. door and says of himself without saying, is skin breathing, which adapts to the body of the meeting between the play areas of the patient and the therapist, without flaking or stiffening. With the passage of time and the thickening of the game which must always be therapeutic as the skin fits more to the body, rather it is a party. The stability of the setting ( intended as "good enough space" where you can " be alone even with someone") encourages independence movements, aided by the absence of a aesthetic judgments about what is being created, scale abandonment rationality and control evident in the production, is configured as the environment that makes it possible to give and take shape. In this context, the role of the therapist (traveling companion, and visitor listener, attentive to the process as the product) is to accompany you in discovering their potential, accompanying the gradual awareness: the 'art takes the user to do as a child in the game, (the work of the therapist has as its goal to bring the patient to a state where it is unable to play in a state where it is capable of. "" You two areas of overlap game, the patient and the therapist.

Psychotherapy has to do with two people playing together. "Winnicott) malleable making the line between fantasy and reality, between subjective and objective realities, ranging from one to another. all in a space limited by the boundaries of the sheet (the media) or by color and texture of the material, as well as the boundaries of space, time, relationship of the setting in which the therapist continues to be available and mirroring what happens in the game. Game that leads to the production of objects defined in their appearance is immediately obvious from the materials they are more or less processed and processed: the object is thus perceived outside himself while dealing with a very intimate part of himself, is a bridge between the external and internal world but also, in transparency, viewing a report "good" between patient and therapist.

Art Therapy: A BRIEF HISTORY .

The 900 is the century when the art world, configured as an open space and changing the boundaries, and often experiences dense bijective relations with psychiatry, which often , born under the sign of fascination, will evolve, especially from the forties onwards, in the therapeutic sense. spreading primarily in those countries that have had major traditions of psychiatric and psychoanalytic studies: Britain, France, Germany and the United States.

The use of non-verbal language (we are here we will consider in especially those graphic-pictorial and plastic) therefore now acquired citizenship in not only psychiatric care areas. Morgenthaler's essay on Woelffli (Ein Geisteskranker als Kunstler, 1921) to the text of Prinzhorn (Bildnerei der Geisteskranken, 1922) there are many experiences, largely historicized, using the possibility of mediation practice allowed by Art.

All is not unequivocal: for instance, was easy to reproduce the pair abused "genius and madness" under the label of the 'psychopathological art ", interpreting the expressions art as corresponding to the characteristic symptoms of the various clinical syndromes. In reality (Dubuffet) "there is an art sick", as, paradoxically, there is "an art of dyspeptic or sick of the knee," but (still Dubuffet) "... can write down the movements of an immediate ... spirit ... carry things in their body and their body is better than their name, can lend a hand to those who do not, can give an idea of \u200b\u200ba tree, an idea can make a tree ".

The first groups formed in art therapy 1942 in Britain by Adrian Hill, in a sanatorium. The introduction of art activities will spread initially in hospital who welcomed war veterans and then will be common from the middle of the century. Initially, the method is an art school, but after a few years a more consciously therapeutic is-depth Jungian analyst Champernowne.

The art therapy is also being developed in France, Germany and the United States mainly in the field of psychiatric rehabilitation.

In North America in the '40s we began to talk about Art Therapy: The pioneer in this field are Margaret Naumburg and Edith Kramer. The Naumburg , close derivation of psychotherapy, has a vision very close to that of Freud and considers the patient's artistic product as a tool to access his unconscious contents to be used in therapy as a material interpret and thereby also contributing to insight and resolution of internal conflicts. The artistic expression of the patient view and is therefore only used as a diagnostic tool. Art, therefore, as a tool for therapy, not art as therapy.
Edith Kramer (1958), however, moves from a 'completely different perspective and focuses on the creative process , considered in itself a therapeutic tool. The artistic expression of the patient is not seen only as a means for the expression of unconscious conflicts, but as an instrument for the resolution and as a resource for personal growth and development. Art, therefore, as therapy, with the shift of attention from the artistic product as a material to interpret the creative process itself, which, using symbols and metaphors, involving the person in activities that involve a commitment and kinesthetic sensory is proposed as a means to identify and express their emotions, and to understand and resolve their difficulties. The Kramer traces his interest in the value of art in times of severe stress in the late '30s, when he taught art to children of displaced refugees from Nazi Germany to Prague, a school founded by the artist Friedl Dicker- Brandeis, then deported to Terezin. Dicker-Brandeis, not surprisingly, was formed with Itten at the Bauhaus, it seems not so casual attention to the interface between the creative process of Kramer and that monument to the creative process that, in purely pedagogical and artistic context, is the "Theory the size and shape "of Paul Klee, who was also a teacher at the Bauhaus in those years.

In France in the 50s during the World Congress of Psychiatry will start to talk about research on the psychopathology of expression and open the first workshop in some hospitals of Paris. Shortly before, in 1947 - another moment of high tangency between psychiatry and art of 900 - Jean Dubuffet founded the Compagnie de l'Art Brut ", confirming the interest in artistic production by people outside the cultural conditioning and social, which dated from 1923 (remember, Prinzhorn published his text in 1922) and that, in addition to the protean artistic work of Dubuffet, gave rise to the spectacular collection of works by "irregular", now housed at the Hotel du super Beaulieu in Lausanne.

In Italy the interest for art asylum, even in the service of theoretical systems misleading, however, was cultivated by Cesare Lombroso in early 900. Pioneering work is then made between the years 50 and 60 to the asylum St. John's Tomb Verona, where he will open an art studio in 1957, and where a young Vittorino Andreoli "discover" Zinelli Carlo, now considered one of the most significant Italian exponents of art brut. Experience delll'atelier Tinaia of Florence, near the asylum of San Salvi is part of the movement that will culminate in the experience dell'antipsichiatria basagliana and the coming into force of Law 180, which marks the transition from the structures mental hospitals to a full rehabilitation in the area. The experiences in this new field can enhance the creative experience of its ability to activate processes of renewal even in the most severe psychotic forms. Gaetano Benedetti in his work with schizophrenic patients clearly expresses how creativity is to be considered a human resource of great value were able to restructure itself in the fragmented and discontinuous.

The relationship between psychoanalysis and expressive therapy .

the second half of the twentieth century art therapy or expressive therapy, is a technique of psychological treatment for mental disorders whose application is open to sensory and perceptual contexts that allow free communication words. It shares with the process of artistic communication content of the unconscious, repressed and removed at the same time, expressed in metaphorical or symbolic language, essentially by analogy. This phenomenon, beyond the possibilities of communication that acts on the sensory and perceptual level, is used in psychoanalysis to the analysis of unconscious contents whose expression is facilitated by the spontaneity and impulsiveness of the vehicle as it happens in dreams, free association, in Proceedings lost age. (Freud)

Beyond aesthetic concerns of the then art therapy is focussing on the expression of the unconscious by an impulse that fast and then extra work psychotherapeutic dynamic or psychoanalytic analysis through verbalization. The expression and representation becomes a metaphor for the symbolic analogy assumes that it may be subjected to the processes of insigth. Psychotherapy it concludes with the verbal elaboration and the realization of unconscious contents subject to removal by the release waves of repressed objects, while the Art therapy is a cathartic resolution of psychic objects repressed or removed.

's interest in psychology, psychiatry and psychoanalysis to art coming from far away or Sigmund Freud in 1905-1907 in the two essays "Wit and its relations with the unconscious and the imagination and the poet expressed his thoughts concerning the connection between the child's gaming experience and the process of imagination in adult life.

Ernst Kris, psychoanalyst and scholar of aesthetics and art history, in his book Psychoanalytic Explorations in Art "(1952), referring to Freud's essay on wit, consider the sublimation of an important route for the understanding of artistic, but giving it a broader function than the defensive one in which psychoanalysis Classic had relegated. His interest is mainly aimed at

grotesque distortion, which results from a kind of functional pleasure of mastery, the ability to control fear and anxiety. According to Kris, the difference between the artist and the neurotic is that the former has the ability to make a regression in the service of the ego, a regression that controlled and reversible, while the second is in the throes of uncontrollable dynamics.

E 'in the field of child psychoanalysis the game, the creativity and imagination buy specific relevance as intermediate between the conscious and unconscious processes: Anna Freud introduces the technique of drawing, while Melanie Klein explores the method of spontaneous play.

In the '60s and '70s art therapy practice is influenced by the psychoanalytic contribution of Donald W. Winnicott, in his book Playing and Reality (1971) considers the psychotherapeutic relationship as a game experience where children and adults handle things combine words. In this experience, the analyst is not a spectator, but is immersed in the game: the technique scribble child and therapist intervened to turn on the same design. E 'in its penetration of the experiences that you can see the intermediate zone that Winnicott calls "transitional space" where the boundaries of psychological processes and transitional pre-made blend, play, create and allow the imagination to break down barriers between inside and outside and between me and not me.

Another great psychoanalyst Marion Milner, has focused on artistic mediation of psychotherapy emphasizing a strong need in terms of artistic fusion with matter and a transient loss of differentiation between self and object.

Neuroscience and expressive activities: access to implicit memory.

As stated by LeDoux (1996), "emotional feelings resulting from the fact that we become aware of an emotional brain system. The states of the brain and the body's responses are the fundamental facts of emotion, and conscious feelings are just decorations, icing on the cake emotional. "

The implicit memory is an area of \u200b\u200bthe mind to nature and preverbal presymbolic, mostly dating from the first two years of life, then to a developmental stage where they are not yet mature nervous structures needed to run the explicit memory, autobiographical narrative in itself-and as such accessible to consciousness and verbalized. In fact, the explicit memory depends on the hippocampus and the temporal cortical areas and basal-frontal structures just not active enough in the early stages of life. In these phases, but other structures, especially the posterior cortex temporo-parietal-occipital - particularly the right hemisphere - and even then the amygdala, are already fully active, and determine Therefore, the almost exclusive archive of the most fundamental experiences in a "format" is not accessible to consciousness, not recorded and is characterized by intense emotional senses.

this evidence comes from the idea that mental activity later, more adult, with a strong predominance logical and thoughtful, you are unknowingly forced to rework a reservoir of experiences that will escape it, because it is stored in a size motor, sensory and emotional way that only the concomitant non-reflective, non-verbal, artistic, expressive hand can "collect". Indeed, non-reflective mode automatically tend to collect and channel this kind of experiences, offering the "translation" closer to them, namely that non-fiction, enclosed in "sets" perceptual-affective global and non-sequential.

Certainly it would then still a "translation" infidel, because the contents of implicit memory, as constitutionally inaccessible, would be almost virtual. But how would these non-reflective experiences the only outlet really suitable, because it is made of the same processes and the same "language", ie processes and languages \u200b\u200bcommingled psychophysical nature, that strong bodily-affective connotation. .

This ability to "think outside the reflective", consisting in directly nell'attingere mental areas that are home to the experiences and memories of non-thinkable, then allow to pass through these "tracks" in an attempt to "reinscrizione" in a format defined itself motor, sensory and emotional level. This would allow reinscrizione thinkability sensory-emotional, a kind of consciousness and subliminal nature of synesthesia, which - as it is, however, cognition and consciousness - may lead to the overcoming of trauma, conflict or other emotional knots. These would otherwise never be stored in a format which is not subject to the psyche and therefore tends to invade and continue to undermine it.

The organization of a workshop of expressive activities in the clinic of addictions.

funds for a clinical use of TA. constant can be traced in the attention to the dynamics of relationships and the development of freedom of expression with its share of unpredictability. The choice of a report conducted by a specific code, such as graphics-plastic allows people to do that is to saturate therapeutic value only if placed in perspective intervention integrated with other professionals.

A design, for example, as a team, is significant for understanding the inner world of a patient, as the minutes of an interview. This product is the fact that in a context that has always consciously therapeutic features or preparatory to a therapy that can go hand in hand (but not always and not necessarily!) Connotations to even play. This is not relegated to pure entertainment or to carry on drawing skills or plastics, which are not necessary and that, sometimes, where present, are only a further defense;

specific tools of analysis and evaluation of art therapy that can be made available to the team are the diary of the laboratory, the folder art therapy and the final report. The directory of art therapy
analyzes the most significant artifacts produced by each user in terms of space usage, color, stretch, contents of the report with the setting (materials, art therapy and group). The final report is drawn up at the end of art therapy treatment program and summarized what has emerged during the tour, assesses the effectiveness and, above all, means any open issues. It is clear that we need to contextualize these instruments with a view of engagement and preparatory to a more general therapeutic course, never forgetting that the main objective of the activity is to contribute to the observation and diagnosis of users: observation of creative materials can, in turn, through the development of hypotheses, fantasy, reverie, to stimulate the creativity of the team itself

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