International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Residential intensive therapy for pathological gamblers
A three weeks treatment model
dr. Claudio Dalpiaz
Psychologist, Psychoterapist
Psy+ Onlus President
Psychiatric Community “San Girolamo” Supervisor
Progetto Orthos - South Italy Coordinator
www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
ORTHOS AT A GLANCE
INTENSIVE
RESIDENTIAL
THERAPY
RESEARCH - FOLLOW UP
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
ORTHOS > at a glance
Based on a Humanistic-Existential
approach, the project mainly relies on
Gestalt Therapy
nevertheless, it integrates psychoanalytical,
systemic, bioenergetic analysis and
cognitive-behavioral contributions
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
ORTHOS > at a glance
The intensive part of the program lasts only
three weeks in order to be compatible with
social, occupational and affective life of clients.
We provide an accurate diagnostic phase of
intake in connection with the public services of
the residential area of our clients.
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
ORTHOS > cultural background
3 months, 6 months and 1 year after intensive
care, everyone returns to our residential house
on tuscanian hills near to Siena for a follow up
weekend.
Everybody is warmly advised to attend
psychotherapy session weekly, or so, between
meetings mentioned above.
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
ORTHOS > at a glance
Orthos = Study, Research, Treatment
of Behavioral Addictions
Équipe = psychotherapists, counselors, financial
consultants, trainers, social researchers, arttherapists, cultural operators, educators, general
practitioners and specialists
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
ORTHOS > at a glance
Promotes an healthy culture of gaming
 Psychoeducation
 Responsible Gambling
Updates, trainings, specialization (Master GAP)
Promotes congresses & workshops on
gambling and on addictions in general
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Scientific Direction
Riccardo Zerbetto- Neuropsychiatrist, Psychotherapists Trainer, Scientific Director CSTG and Progetto Orthos
www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
ORTHOS SERVICES
 intensive residential group therapy at “il Noceto”:
since 2007 we had XXVII 21 days modules
 Individual counseling or psychotherapy, couple and family
therapy, provided in different cities
 Telephonic consultancy and support
 Legal consultancy for families and gamblers
 Informations on public and private services network
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
ORTHOS:
ORTHOS is the one
name attributed
to Dionysus in
classical Greece
who “stands” on his own legs
and does not depend on substances or behaviors
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
INTENSIVE
RESIDENTIAL
THERAPY
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Residential Intensive Therapy
Residentiality, in a natural environment,
far from cities and triggers:
➔Concretely as well as symbolically stops the recurrence
of compulsive and self-defeating behaviors;
➔Creates a favorable setting for auto-observation,
existential analysis and modeling;
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Residential Intensive Therapy
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Residential Intensive Therapy
The residential community Orthos is hosted in a
farm-house in the countryside of Siena, located in
the municipality of Monteroni d'Arbia. Its unique
location provides a pleasant stay to patients in a
calm and comfortable environment. The property
provides bedrooms, common areas, library and
dedicated spaces for study, therapeutic activities,
workshops of artistic expression and physical,
occupational work.
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Destinatari
soggetti che risultino sostanzialmente inseriti
nel tessuto socio-economico e che dispongano
di una rete di legami familiari
L’impostazione orientata alla responsabilizzazione dei residenti
non consentirà l’accettazione di utenti con patologie di tipo
grave, (dipendenze multiple e/o disturbi psichiatrici in acuzie)
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Structural components of therapeutic intervention
and community days timeline
Self Care
Days starts at 7.30 with personal care,
room cleaning and breakfast (before 8.30)
Silent Time
during which observe and reinforce
personal growth achievements
in terms of autonomy and non-dependence
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Self-listening and auto-observation
Everybody is invited to enjoy the possibility to stay with
himself silently for half an hour every morning, and to
face effort and fear in doing this if he has not yet
developed in life the habit of “self-listening”
horror vacui often originates
maniacal and/or anancastic acting out
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Meditation
Residential Intensive Therapy
Vipassana and Mahayana meditation, as well as guided exploration
of awareness are regularly taught and daily applied
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Vipassana and Mahayana meditation, as well as guided exploration
of awareness are regularly taught and daily applied
Meditation
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Group Counselling
Every morning, participants are
supported with group counseling
sessions related to the topic of the day
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Group Therapy
Every afternoon, a gestalt therapy
group session takes place, with
different methods and topics,
following a pre-ordered scheme
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Body Work
Body works is part of the process: through this, everyone could
identify and release rigidities and blocks that interfere with a healty
emotional expressivity
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Magical thinking
This group will provide information on less known aspects
of gambling (mathematical theories, etc.), and explore
irrationality in cognitive processes of gamblers.
Both analytical research of Freud and Bergler and
Laduceur cognitive findings, have highlighted the
importance of "magical thinking" in the structuring of
gambling behaviors.
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Self Narration
Writing about self has been proven as useful to implement in the
context of rehabilitation processes. Infancy, adolescence and adult
life are chapters of the novel that all of this dramatic stories deserve.
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Creative Play
no money involved
competence, and possibly no alea
strong idea of socialization / cooperation
ancient traditions of games
games that facilitate auto-observation in context
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
action / dramatization
music, poetry, theatre, dance, voice, …
Art
Therapy
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
artistic expressive production
drawing, watercolour, painting, clay, photography, …
Art Therapy
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Art Therapy
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
emotional catharsis actions
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Life project
Progressively, during the three weeks of treatment,
we support a work of analysis, restructuration and
reprogramming of different aspects of personal life.
We have to redesign a more reliable
libidinal investment portfolio ;-)
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Readings and psychoeducation
Every day, we focus on different topics which are usually discussed
even during the evenings, from a clinical or a cultural point of view.
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
CRITICAL AREAS
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
LOSS OF CONTROL ON IMPULSES
•
•
•
•
OUT OF BALANCE LOCUS OF CONTROL
ACTING OUT
INABILITY TO DELAY SATISFACTION OF NEEDS OD DESIRES
LACK OF LIMITS
PROBLEMATIC SELF-ESTEEM
•
•
•
•
LACK OF SELF-ESTEEM
MASOCHISM
COMPENSATIVE EGO IPERTROPHY
UNREALISTIC AMBITION
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
DISSOCIATION
•
•
LIES. LYING TO ONE’S SELF
OUT OF TIME AND SPACE DURING “GAMBLE BINGES”
POOR REALITY AWARENESS
•
•
•
•
•
MAGICAL TOUGHT
CARELESSNESS
PLUTOMANIA
DEREALIZATION
VIRTUALIZATION OF COMPETITION
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
ORAL DISPOSITION
•
•
•
RELAZIONI OGGETTUALI E NON INTERSOGGETTIVE
NARCISSISM
EDIPICAL CONSTELLATION
• OVERPROTECTIVE MOTHER
• ABSENT OR AUTHORITARIAN FATHER
CHILDISH FIXATION
•
•
PUER AETERNUS
PETER PAN SYNDROME
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
LACK OF AD-GRESSIVE ATTITUDE
•
TENDENCY TO REPLACE REALITY WITH VIRTUALITY
ANHEDONIA
•
•
•
•
•
•
BOREDOM
DESPAIR
SUICIDAL IDEATIONA
POOR PLANNING ABILITIES
WITHDRAWAL
(OPPOSITE IS IPERCOMPENSATION VIA NOVELTY SEEKING
BEHAVIOR)
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
IMAGINAL POVERTY
• WEAKNESSES OF VALUES / ARCHETYPAL CONSTELLATION
AFFECTIVE DISREGULATION
• INADEQUATE INTIMATE RELATIONSHIP / ALEXITHYMIA
LACK OF LIFE PROJECT
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Working with families
L’esperienza sino ad ora maturata insegna che tale lavoro, in
parallelo, riveste una importanza ineludibile e strutturale.
Si richiede quindi, che sia nella fase di intake, che residenziale
che infine dell’accompagnamento, i familiari maggiormente
legati al soggetto problematico partecipino ad incontri di
verifica sulle dinamiche in atto nell’ottica di un progressivo
superamento degli aspetti comunicativi disfunzionali.
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
OUTCOME
RICERCA – FOLLOW UP
-----------------FOLLOW UP
150 patients, 1 year or + since the end of treatment
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
This paper reports outcomes of the first five years of
experimentation in a residential treatment program for
pathological gamblers.
Our program has been applied to pathological
gamblers and is going to be extended, with
appropriate adaptations, to other behavioural
addictions (internet addiction, eating disorder,
compulsive sex, compulsive buying disorder, etc.).
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
150 subjects (136 males)
and 14 females
Females
9%
Males
91%
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Assessment tools
(South Oaks Gambling Screen: Lesieur e Blume, 1987; adatt. di Guerreschi e Gander)
screening della
e
(Barratt Impulsiveness Scale-11, Patton et al., 1995; adatt. It.di Fossati et
al.)
misurazione dell’
(Dissociative Experiences Scale – Revised: Carlson, Putnam, 1993; adatt. It. di Schimmenti)
misurazione delle
(Toronto Alexithymia Scale, Bagby, Taylor, Parker, 1994, adatt. It. di Bressi et al.)
misurazione
e
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Education
University
8%
Primary
0% 3%
Middle School
38%
High School
51%
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Marital status
Single
Married
Divorced
Partner
Widow
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Debts with …
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
comorbidity
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
BIS-11 (Barratt Impulsiveness Scale-11, Patton et al., 1995; adatt.
italiano di Fossati et al.), per la misurazione dell’impulsività;
BIS-11
Media
ds
75,53
8,35
Elevated impulsivity
Average italian population = 64,11
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Significant impulsivity
Potential affective dysregulation
Subclinical dissociative symptoms
Average
ds
BIS-11
73,72
10,36
TAS-20
56,74
12,18
DES-II
18,43
11,62
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Orthos PROJECT
outcomes
Elaborazione dei dati a cura di
Prof. Vincenzo Caretti - Adriano Schimmenti, PhD
Università Kore di Palermo ed Enna
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
+ + + effects
of significant amplitude
1 or + years after treatment
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
SOGS (pathological gambling symptoms)
average of 9,04 points reduction on SOGS
Media SOGS T0 intake = 13,15; DS=3,23
Media SOGS T1 1 year or + after treatment = 4,11, DS = 3,68
Very elevated level of significance
in pathological gambling symptoms reduction
In 85% of sample, after 1 year or +, we do not find
clinically relevant symptoms anymore
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
SOGS (pathological gambling symptoms)
16
14
13,6
12
10
8
6
3,5
4
2
0
Media SOGS Ingresso
Media Follow Up
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
GAF (global assessment of functioning)
Average increase of general mental well-being
and global functioning of 18,34 points:
Media VGF T0 (intake)= 55,06 DS=8,84
Media VGF T1 (1 year or + from treatment)= 73,41 DS = 10,76
important improvement of overall mental health even at 1 year or
more from treatment
globally improved subjects = + than 95%
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
GAF (global assessment of functioning)
73,81
80
70
60
55,06
50
40
30
20
10
0
Media VGF Ingresso
Media VGF Follow Up
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Orthos Project effectiveness:
➔Important reduction of GD symptoms (SOGS):
d di Cohen 4.20; effect size = 0,90
➔ Global functioning improvement (GAF):
d di Cohen 4,02; effect size = 0,89
effect sizes greater than 0,80 are considered as
clinically highly relevant effects (Cohen, 1988)
in medical and psychological research
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
International Conference on Pathological
Gambling and Behavioral Addictions
Warsaw, 25-26 november 2014
Italian Journal of Addiction
Among various publications presenting Orthos methodology:
Vol.2 No. 3-4, 21012 - Italian Italian Journal of Addiction
by the Ministry of Health and the Department for Drug Policies
"Research on Orthos outcomes: a residential
intensive psychotherapy program for gamblers”
Riccardo Zerbetto, Adriano Schimmenti, Daniela Poli, Vincenzo Caretti
available in complete form on
www.dpascientificcommunity.it
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
So, quit gambling and
Stop compulsive gambling and bet on relationships
dr. Claudio Dalpiaz - Psychologist, Psychotherapist – Psy+ Onlus President – Progetto Orthos Area South Coordinator – www.orthos.biz
Thanks for Your attention !!!
www.orthos.biz
Claudio Dalpiaz
+39 3470568333
info@claudiodalpiaz.it
Roma - Italia