Counseling and psychotherapy in Italy: a profession in constant change.

This article illustrates the state of the art for mental health counseling in Italy through a historic and postmodern perspective. The context of Italian mental health counseling is complex and full of new and old premises, events, and arguments. On the one side, the way counseling has developed and is perceived in Italy results from the intersection of old cultural legacies, such as Christianity, and new challenges, such as a multicultural and multiethnic society. On the other side, the development of mental health counseling in Italy is the result of the encounter between the pragmatic, optimist U.S. counseling and the phenomenological, hermeneutic traditions of European schools. The article ends with an exploration of the potentials that may arise from an ongoing communication between US. and Italian mental health professionals.

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It is an arduous endeavor to address the topic of counseling and psychotherapy in Italy in a few pages. The subject is, in fact, so vast and full of historical, cultural, and theoretical facets that every depiction will always end up being a rough reduction. Having to come to a decision on what to write about, we chose to focus on three main areas that will help mental health counselors understand the state of the art of mental health counseling and psychotherapy in Italy. The first of these areas is the historical origins of counseling in Italy. The second section examines the complexity of the professional training and legislative system. Finally, the last part addresses the influence of central cultural values and institutions, namely the Roman Catholic Church, in pressing issues related to gender equality, cultural diversity, and minority populations. We purposely wanted to avoid the use of banal stereotypes about Italian culture or cultures, such as supposed attempts of reifying cultural differences between North and South Italy (Gemignani, 2003).

A BRIEF HISTORY OF MENTAL HEALTH COUNSELING IN ITALY

Introduction

Regardless of the field of knowledge, when presenting a categorization of things, we have to carefully consider our assumptions and intentions on this process. In fact, no classification is neutral or impartial, especially when history is considered. If we want, even briefly, to illustrate the historical facts of mental health counseling, we must address our view of that discipline (Cimino & Dazzi, 2003). In fact, placing a boundary between what falls into and what remains outside the definition of mental health counseling is often a subjective and political act (Cushman, 1995).

Interestingly enough, the word counseling does not find a precise correspondent in the Italian language (Vitelli, Galiani, Amodeo, Adamo, & Valerio, 1998). Although often used as a synonym for psychotherapy in mental health contexts, counseling has a broader meaning that includes a top-down, instead of collaborative, process of advising, which corresponds to the Italian word consulenza. As in the Anglo-Saxon world, the word counseling also is used outside therapeutic settings, such as in vocational, school, organizational, legal, or spiritual counseling. In this article, however, we focus on the most common interpretation of counseling as related to and partially synonymous with psychotherapy. In addition, we will consider mental health counseling or psychotherapy as those practices and theories that are connected to a specific professionalism regarding psychological issue or discomfort and its treatment, which prevailingly occurs through the therapeutic relationship between the client/patient and the counselor. Mental health counseling operates within historical and traditional narratives or grand narratives (Lyotard, 1979) that culturally define the extent of its possibility and agency.

The Origins

Having established a definition of psychotherapy or mental health counseling, we can positively say that in Italy the origins of psychotherapy correspond to the beginning of the psychoanalytic movement. Dr. Edoardo Weiss, born in Trieste in 1889, can be considered the precursor of mental health counseling in Italy. He was a student of Freud. After moving from Vienna to Trieste, in Northeast Italy, Weiss became the first Italian psychoanalyst. In 1932, he cofounded the Rivista Italiana di Psicoanalisi (Italian Psychoanalysis Review) with Cesare Musatti, who was born in 1897 and is considered the most influential and famous Italian psychoanalyst.

Despite the intellectual enthusiasm surrounding the development of psychology, the cultural climate of the period was unfavorable toward the field: Both the powerful Catholic Church and the Fascist regime deemed psychoanalysis a threat to their authority (Colombo, 2003). Their pressure and authoritarianism silenced the just-born Rivista and repressed the spread of psychoanalysis in Italy. In 1923, the Gentile Reformation of the education system had decreed the abolition of the teaching of psychology in Italian schools and its substitution for philosophy and pedagogy of idealistic orientation. Weiss had to migrate to the United States in 1934; and, a few years later, Musatti lost his university teaching position, which he regained only after the war following the publication of his famous Trattato di Psicoanalisi (Treatise on Psychoanalysis) in 1949. Nevertheless, psychoanalysis set down the bases for Italian psychology and mental health counseling: Hereafter, it would be the point of comparison for all other forms of psychotherapy.

After the end of World War II in 1945, Italian psychology started to be increasingly open to the U.S. influences of experimental psychology as well as the interpretations and practices of mental health services. The post-war context was a time of deep societal changes in Italy. Especially in the 1950s and 1960s, the public demand for mental health counseling become increasingly strong and popular (Cancrini, 1982). In spite of this, psychology achieved an important scientific status only in the 1970s, with the simultaneous launch of the first two psychology degrees at the universities of Padua and Rome in 1971. These openings into the closed and elitist academic milieu became the doors through which other theories, and consequently other forms of clinical theory and practice, came onto the Italian scene. Since then and in just two decades, theoretical diversity in mental health counseling has flourished.

The university world fully accepted and recognized the scientific, almost exclusively in the sense of measurable, aspects of psychology, especially its cognitive dimensions. However, despite this promising start, academics kept distance from and expressed annoyance toward mental health counseling, which was deemed too unscientific. For many years, counseling and clinical psychology were present only in the medical schools of Siena and Bologna and were not part of any other university curricula. This situation created a fertile ground for the proliferation of private schools in mental health counseling, even though their standards of education and training were not regulated by strict legal controls until the Italian Republic's Law 18, No. 56, was passed in 1989. With the creation of legal standards, universities started to develop graduate training and, as we will see later, private schools had to fulfill clear legal parameters.

Besides psychoanalysis, the phenomenological approach represented the alternative and often opposite core of psychological care in Italy. Thanks to the pioneering work of Franco Basaglia, born in 1924, the anti-psychiatric movement quickly developed in Italy. (Basaglia [1968] started the neuropsychiatry clinic of Padua. Soon, however, his political and scientific views of phenomenological orientation forced him into a professional exile in Gorizia, close to Trieste, where he managed the local psychiatric hospital. After several overseas experiences--such as visiting the therapeutic community of Maxwell Jones in the United States--in 1962 he came back to Gorizia to direct, with Antonio Slavich, the first anti-institutional center for the curing of mental illness. This professional experience was the historic beginning of a deep sociopolitical movement that led to the transformation of psychiatric care and regulations in Italy.)

The anti-psychiatric movement in Italy paralleled simultaneous developments in the United Kingdom by Laing and Cooper (Laing, 1967; Laing & Cooper, 1964); in France by Foucault and Guattari (Deleuze & Guattari, 1977; Foucault, 1979); and in the United States by Thomas Szasz (1965). This movement seriously and effectively challenged the psychoanalytic assumptions and the medical model of mental illness management: It revalued the person in the social context and directly and indirectly contributed to further developing the psychotherapeutic understanding of and approach to human sufferance. The anti-psychiatric lobby in Italy was able to become a vast and popular opinion movement, which led the Italian Parliament to establish the crucial Law 180 in 1978. This law reformed the entire psychiatric system and it changed the response of Italian society to the problem of the mentally ill. In particular, Law 180 abolished a previous legislation that confined mental patients in asylums and denied them the rights entitled to other medical patients.

The Current Context

As almost everywhere else, in Italy, the solitary supremacy of psychoanalysis has faded, taking out of its shadow a number of different mental health counseling schools and orientations. An often confusing consequence of the lack of a strong reference is the blurring of previously granted definitions and boundaries: In Italy, it is not easy to clearly name and differentiate counseling approaches. Despite numerous attempts for creating consensus on names and meanings of theoretical traditions of counseling, the process of identifying and labeling a school of thought implies a political act with epistemological and historical implications (Legrenzi, 1980; Marhaba & Armezzani, 1988). One may think, for example, about the innumerable clinical offshoots of psychoanalysis in Italy and their adhesion to or separation from the epistemic core and structure of psychoanalysis itself. Epistemological and political positions, and the related labeling process, have implications for the endorsement of certain schools by the already established circles of power, which in its turn influences the reputation and degree of success of the specific school, both in terms of clientele and academic acceptance.

In brief, the Italian panorama on counseling includes the major theoretical approaches usually described in the European and U.S. literature. Marhaba and Armezzani (1988) presented 25 counseling approaches related to the "most well-known representatives of Italian psychotherapy" (p. 45). Adami Rook, Ciofi, and Giannini (1998) provided another and more recent review of current Italian counseling traditions and schools of thought. A comparison of the two sources gives a quite precise idea of the mental health counseling resources and trainings that are currently predominant in Italy. Although it cannot be considered exhaustive of the Italian counseling context, the following is a list of the counseling approaches that the two texts have in common: Adler's individual psychology; bioenergetics; behaviorist and cognitive-behaviorist therapy; brief cognitive therapy; cognitive therapy; constructivist therapy; Freud's, Lacan's, and Klein's psychoanalysis; family system therapy; Gestalt psychology; humanistic psychology; hypnosis; Jung's analytic psychology; object relations; psychodrama; psychosynthesis; rational emotive therapy; and transactional analysis.

Psychosynthesis developed from the works of Assagioli (1965); family system therapy originated from the contributions of Selvini-Palazzoli, Boscolo, and Checchin (Boscolo, Cecchin, Hoffman, & Penn, 2004; Palazzoli, Cecchin, Prata, & Boscolo, 1978) and Andolfi (1977/1979). These two approaches, together with the cognitive approaches of Guidano and Liotti (Guidano, 1991; Guidano & Liotti, 1983) and the brief strategic therapy model of Nardone and Watzlavick (1990/1993, 1997/2004), are among the most original and outstanding international contributions of Italian scholars and counselors.

PROFESSIONAL TRAINING IN MENTAL HEALTH COUNSELING

Different Training Institutions

The list of training institutions that have been officially recognized by the Ministry of Education, University and Research (MIUR) is quite long and continuously changing and growing. Currently, it includes about 70 private institutes from very different theoretical backgrounds. As previously stated, it is sometimes difficult to understand the theoretical approach of a training institution just by its name or declared orientation. More often, a deep look at its curriculum and instructors is needed in order to achieve a better picture. This complexity in defining and understanding the theoretical framework that informs a specific training institution is even more marked for the "schools of specialization in psychotherapy" of the major Italian universities, in which the training programs tend to offer a diversity of orientations within their curricula. The public universities currently offering professional training in mental health counseling, within either psychology or medical departments, are Rome, on three different campuses, Padua, Bologna, Milan, Genoa, Turin, Bari, Siena, and Messina.

At first, only state universities were allowed to issue graduate degrees in mental health counseling, which are necessary to work as mental health counselors or psychologists in public institutions or in private practice. Private schools, instead, were allowed to give a generic degree that enabled only private practice. As a consequence, the demand of students interested in attending university specialization schools was so high that it could not be fulfilled by the state universities alone. The MIUR had to allow private schools to issue degrees with the same level of job access as university degrees, thereby making university and private education basically equivalent. The MIUR created a set of precise criteria and norms for private schools of specialization (see next section), putting an end to the chaos of unruly training that was lacking any control. Within Europe, the Italian legislation is considered quite restrictive in comparison to the standards of the European Certificate of Psychotherapy (van Deurzen, 2001).

At present, the most evident difference between university and private training is the theoretical choice. Whereas private schools make and promote a precise orientation, universities cannot officially state the same, though they do it informally. In fact, university schools have to respect a sort of theoretical polyphony (i.e., diversity of orientations), which, in our opinion, can contribute to a certain degree of epistemological and theoretical disorientation in counseling trainees. Another significant difference is that university courses are public, and the state financially supports them. Private schools, instead, support themselves through their students, which creates important differences in student fees and tuitions of various institutes. Consequently, the economic status of students influences the choice of and access to a particular training path.

Norms and Laws

The practice of psychotherapy in Italy has been recognized and regulated by the law since 1989. Article 3 of Law 18, No. 56, states the following:

1. The practice of psychotherapeutic activity is dependent on having had specific professional training that has to be acquired after gaining a degree in psychology or medicine and surgery, by means of specialized training courses at least 4 years long, which include adequate instruction and training in psychotherapy--brought into effect, on March 10,1982, according to Decree No. 162 of the President of the Republic--at specialized schools, run by universities or institutes recognized as such according to the procedures stipulated in article 3 of the above-mentioned Decree of the President of the Republic.

2. To nonmedical psychotherapists, any intervention of competence exclusive to the medical profession is prohibited.

3. Upon the consent of the patient, the psychotherapist and the treating doctor are entitled to reciprocal information. (1989, translated by the authors)

This law gives official recognition to the professional figure of the psychologist through the institution of the Board of Psychologists. At the same time, it specifies that a university degree in psychology or medicine is necessary in order for the professional to be allowed to practice mental health counseling. To allow both psychology and medicine graduates to become mental health counselors or psychologists is an obvious attempt to resolve the historic controversy between the psychiatry and psychology lobbies: The medical lobby strongly opposed the notion that a therapeutic practice could be performed by nonmedical practitioners. Nonetheless, a direct implication of this law is the recognition of a certain scientific autonomy for the practice of mental health counseling, which ends up being both akin and dissimilar to psychiatry, depending on whether it is carried out within psychology or medicine settings. Moreover, the old-fashioned controversy between medicine and psychology was lessened even more in 1999, when the Italian Health Department decreed that all specialization courses in psychiatry qualify as training schools in psychotherapy (Decree No. 32, 1999). However, at the moment, the debate on the relationship between psychiatry and psychotherapy seems to be based more on political and economical aspects than on scientific ones.

Law 18, No. 56 (1989), also transmits a clear message about the legislators' strong intention to guarantee patients or clients the adequate formation and training of counselors. In this regard, a rigorous regulation specifies the minimum requisites and standards for this training: The main points of the regulation are about (a) having an admission test for students; (b) a minimum 4-year curriculum; (c) a minimum of 2,000 hours of counseling practice, of which at least 100 must be of direct contact with clients, for each student; (d) students undergoing individual counseling; (e) a final examination; and (f) a teaching body of proven competence. A special MIUR commission constantly checks on the schools' fulfillment of those criteria.

CULTURAL EXPECTATIONS AND CRITICAL VALUES RELATED TO MENTAL HEALTH COUNSELING

In terms of social expectations of counseling, Basaglia's (1968) movement, Psichiatria Democratica (Democratic Psychiatry), deeply shifted the professional's as well as the public's opinion toward an interpretation of psychological concerns as meaningful and contextualized within the patients' personal, social, and cultural reality or realities. Psychiatric patients went from being seen as passive objects under treatment to users who actively and engagingly were part of mental health services (Vitelli et al., 1998). Putting into practice the anti-psychiatric criticism of mechanic and reductive approaches to therapy, Basaglia's movement promoted a view of patients as capable and resourceful persons (Basaglia). In Italy, this renewed social construction of the role of psychology and psychiatry was and still is backed by other influential phenomenological approaches, such as humanistic and transpersonal (Assagioli, 1965), Gestalt (Giusti & Rosa, 2002), family systems (Andolfi, 1977/1979; Palazzoli et al., 1978), and early constructivist schools, which have kept developing mainly outside the academic environment (see Armezzani, 2002, for a general discourse on no-reductionistic psychological orientations in Italy).

These traditions of psychology that we have included under the phenomenological umbrella contrast with well-established psychopathological approaches to mental health practice, such as psychoanalysis, behaviorism, and, in general, medical models, creating the same philosophical and pragmatic split that is commonly seen in most Western national, academic, and private systems of mental health care. In Italy, the ability to construe counseling as a discipline that seeks clients' collaboration instead of their passivity led to broadening counseling interpretations from pathology to potentials and from deficits to growing edges. Nonetheless, reductionistic and positivist approaches such as traditional psychoanalysis, behaviorism, and psychiatry remain main forces in the realm of Italian mental health counseling.

Counseling often receives both positive and negative social judgments: It is sometimes seen as something that clients should keep secret, while at other times it is a topic of everyday conversation. Demographic and personal variables--such as age, cultural level, urbanization, and previous exposure to psychotherapy--can be good predictors of the social construction and acceptance of counseling. However, in Italy, as in the rest of Europe, "psychotherapy has become more and more integrated into the daily environment of the average citizen today, no longer reserved exclusively for the sick and the 'crazy!' It exists in an intermediate zone, a crosswalk between medical, psychological and social spheres" (Ginger, 2003, p. 136).

CULTURAL ASPECTS AND CHALLENGES RELATED TO THE CATHOLIC CHURCH

The Two Main Positions of the Church

Needless to say, the Roman Catholic Church has had a deep influence on Italian society. In regard to counseling and the construction of mental problems, the Church may be seen as covering at least two main and often contrasting roles. The first is the paternalistic role of humanitarian assistance, solidarity, and charity that has indeed helped a number of needy people. In this regard, the Church places the dignity of the person in the midst of its social policy by taking care of underrepresented, marginalized, and capitalistically idle groups, such as the elderly, illegal immigrants, individuals with severe handicaps, and prisoners, whom the public health system too often neglects. In addition, almost all Italian private schools are Catholic and the Church deals with the practical as well as spiritual issues of loss: Catholic priests are commonly present in hospitals and they preside at the overwhelming majority of funerals.

The second role played by the Vatican is more subtle and involves the prompting or transmission of certain cultural values to the general population, including moralistic assumptions on the definition of sin. As this topic is so vast that it would need a separate article, we decided to address just three aspects of the Catholic influence that we consider particularly important and relevant to mental health counseling: blame and sacrifice; the role of women within the Church; and the Church's position on lesbian, gay, bisexual, and transgender (LGBT) individuals.

Blame and sacrifice. In the Catholic Church, the individual carries the ultimate responsibility for his or her actions in front of God. On the one hand, this belief gives responsibility and a certain degree of freedom to the human being, who is free to negotiate with God his or her meaning-making processes (e.g., justifications). On the other hand, however, the person is seen as ultimately responsible and, eventually, will be individually blamed for his or her sins. People generally are invited to blame themselves as individuals instead of looking at power structures, self-fulfilling prophecies, and shared responsibilities that may have played a critical role in determining the person's behavior (McNamee & Gergen, 1999). This Catholic interpretation is in contrast with postmodern and constructionist views on shared and relational responsibility, which look for answers, explanations, and actions both in the personal realm of the client and in the enlarged linguistic community of social meanings, structures, and norms (Anderson, 1997; Foucault, 1980; Gergen, 1991). As a consequence, Catholic perspectives contribute to the creation of conservative and rigid views of the origins and meanings of mental health concerns.

In this scenario, the priest plays the role of the intermediary who can show the right path toward liberation from sin and, implicitly, from eternal suffering. Sacrifice often accompanies the individual's relationship with God and the process of liberation. In this context, the person usually is invited to accept the status quo of passive sufferance, instead of engaging in social action. Often, church members are encouraged to follow the religious leader's advice about relating to God, seen as the final rationale, responsible for everything, instead of engaging in an empowering battle to change the social world.

Similarly, this message of passivity is often implicit in clients' perception of their mental health concerns. Despite the empowering benefit of being socially proactive, the client's first attempt to deal with psychological concerns often begins with seeking the support of religious figures. Although this step can provide some initial assistance, the underlying implication of the prospected solution often carries the same message of personal blame, sacrifice, and passivity that is embedded in the Catholic view of psychological issues. Clients frequently expect counseling to be a reductionistic, patriarchal, and paternalistic service, in which they will be provided some quick, and disempowering, formula that will fix the problem without necessarily solving it.

Gender issues. The patriarchal orientation that still characterizes Italian society can be seen as another critical influence of the Roman Catholic Church. The Church is a very male-oriented institution in which women have been marginalized and relegated to powerlessness (Wijngaards, 2001). Women "are not permitted to hold priestly offices, because they are believed not to appropriately represent the maleness of Jesus Christ" (Chrisler & Hemstreet, 1995, p. 122) or because they are a "constant source of temptation and sin" (O'Connor & Drury, 1999, p. 62). This support of a patriarchal organization is particularly dangerous if put in relation to the alarming growth rate of domestic violence in Europe (World Health Organization, 2002), which can be seen as "a reflection of historically unequal power relations between men and women, the result of the institution of patriarchy, a system based on the idea of a natural inferiority of women and a biological supremacy of men" (Ramonet, 2004).

In different contexts, other authors also have underscored the risks of patriarchy for Western societies (Amnesty International, 2004; Gelli, 2002; hooks, 2003; Siegel, Choldin, & Orost, 1995), and the Vatican cannot be seen as the only cultural institution holding responsibility for the epidemic diffusion of patriarchy. Nonetheless, the Church consistently links gender roles and power differentials to absolutistic discourse on nature, thereby suggesting the unchangeable and necessary character of the present. In this regard, a recent Vatican document addressed to the bishops about the "Collaboration of Men and Women in the Church and in the World" (Congregation for the Doctrine of the Faith, 2004) argues against "historically conditioned models of femininity" (chap. 16) by stating Mary's "dispositions of listening, welcoming, humility, faithfulness, praise and waiting.... Women in fact live these traits with particular intensity and naturalness" (chap. 16).

Although gender egalitarian access is constitutionally granted in Italy, there are still striking numeric differences between men's and women's presence in positions of political, economical, and social power. For instance, the 2003 report of the European Commission on the social situation in the European Union states that, in 2001, Italy was the European country with the smallest percentage of female representatives in the European Parliament (10%). By the same token, in 2003, the Italian Parliament was composed of less than 9% of women. In the field of counseling, although more women than men obtain undergraduate and graduate university degrees in psychology, more men actually end up working as professionals in private practice or in academia. Without any doubt, women in Italy face bigger challenges than men in their access to positions of responsibility and power. The Italian Constitution and the Parliamentary Commission for Equal Opportunities provide at least legal protection that, nonetheless, often lacks empowering implementations in women's everyday lives.

LGBT. The Roman Church has always been hostile to same-sex unions, which are seen as "a deplorable distortion of what should be a communion of love and life between a man and a woman in a reciprocal gift open to life" (John Paul II, 1999, chap. 23). Same-gender sexuality is believed to "impede the person's acquisition of sexual maturity" (Sacred Congregation for Catholic Education, n.d., chap. 101). Accordingly, the Vatican intensely lobbied the Italian and European Parliament against any

legislative attempts to make the family and de facto unions equivalent, including homosexual unions (it is good to keep in mind that their juridical recognition is the first step toward their equivalency). Members of parliament should be reminded about their grave responsibility to oppose them. for lawmakers, and in particular Catholic members of parliaments, should not favor this type of legislation with their vote because it is contrary to the common good and the truth about man and thus truly unjust. (Pontifical Council for the Family, 2000, chap. 16)

Being gay in Italy is not easy. Social discrimination and stigmatization are common daily experiences for non-heterosexual individuals, who understandably are more likely to suffer psychological distress in relation to the frequent lack of social acceptance and integration. It is often extremely difficult to live a LGBT lifestyle successfully. "These difficulties are not necessarily due to homosexuality as such, but are the results of both society's and the Church's attitude to the homosexual" (McNeill, 1993, p. 202). This concern is particularly vivid for non-heterosexuals who believe in and practice Catholicism (Haldeman, 1996). Although in the United States, non-hetero-sexual Catholics created associations such as Dignity, an LGBT Catholic Church, in Italy the movement is still not strong and coordinated enough to effectively organize its own religious congregation.

Worrying enough, professional mental health counselors often own homophobic constructs (Capozzi & Lingiardi, 2003). Although more research on the topic is much needed, Capozzi and Lingiardi found homophobic and anti-homosexual biases among members of Freudian institutes of psychotherapy. These negative biases should be addressed in a process of reflexive exploration that is, indeed, necessary for the multicultural development of mental health professionals. In fact, despite the Vatican and quasi-racist political parties, such as the influential Lega Nord, Italian society is becoming increasingly diverse in its family and lifestyle standards, as shown by the increased number of domestic partners (i.e., de facto couples living under common law), separations, and divorces (National Institute of Statistics, 2002).

An Important Religious Background in Need of an Internal Dialogue

We have highlighted two main positions within the Church that are relevant to mental health counseling. The first of these two positions is socially engaged in the care and dignity of the person, in a sort of Catholic neo-humanism. This branch of the Church is socially proactive in favor of the most disadvantaged groups and entails a certain political liberalism that finds a strong voice in pacifist movements, volunteers' groups, and humanitarian organizations (e.g., Caritas), as well as in the daily work of single, goodhearted religious people who are usually far from high political or ecclesiastic spheres. The other side of the complex and politicized Catholic world is the theological and contemplative realm that is, instead, devoted to a set religious orthodoxy, moral values, and behavioral standards. The two branches often appear far from each other and act discordantly. Due to the wide influence of this institution, the role of the Vatican on mental health counseling would surely benefit from an open and public dialogue between the contemplative and the socially active forms of Catholicism. This dialogue would promote the development of reflexivity and awareness within the Church as well as in the Italian population, allowing the exploration of important constructions, meaningful dilemmas, and unsolved antinomies within the delicate contexts that we have identified.

CONCLUDING REMARKS ON FUTURE ISSUES AND DEVELOPMENTS

In Search of an Identity for Mental Health Counseling in Italy

Italian counseling or psychotherapy is facing major transitions toward its own definition. The reasons for the still impelling need to define and regulate the therapy field may be partially found in the recency of the professional legislation, the opposition and conservationism of influential institutions, and the slowness of the European Union, the European Association for Psychotherapy, and the European Association for Counseling to reach an agreement on minimum standards of and requirements for professional mobility. In addition, the almost frozen situation of the Italian university system, which is a victim of suicidal political and power games among its own members and professors, does not allow for innovative contributions from external researchers and scholars. Italian universities rarely attract foreign scholars or graduate students in the humanities and social studies. In addition, the brain-drain phenomenon often deprives the university of its best candidates and researchers (Association of Italian Ph.D. Holders and Students, 2001). As a matter of fact, the research on counseling and psychotherapy is basically absent and heavily dependent on North American contributions.

A shakeup might come from the very polemic reform of the university system, which was just lately implemented and is still too recent to be assessed for its effects. Nonetheless, the university reform does not seem to keep up with its promise to create a modern and competitive university system. By cutting research funds even more and by increasing faculty teaching loads, the reform runs the risk of killing the already agonizing university research on counseling-related topics. In addition, the reform does not address the critical issues of nepotism in faculty recruiting. Sadly enough, the biggest promise for the Italian university system seems to come from outside Italy: The European Union has been working on setting new and open standards for academic and research norms, development, and support.

Mutual Learning from Overseas

It is worth mentioning that Italian researchers are almost obliged to use the English language for internationally, and even nationally, acclaimed studies. This requirement creates a gap between the English-fluent younger generation and older academics, who often read but do not write in English. Most scholars publish their works in Italian, and they are very seldom translated into English. So, while the Italian academic context is strongly influenced by the English-speaking world, the reverse does not occur. The language gap prevents counselors who do not read Italian from knowing and learning from the quality work of Italian scholars. In particular, the philosophical and epistemological depth of Italian reflection on therapy is, indeed, one of the most outstanding aspects of clinical practice and study in Italy. Most Italian counselors share a general awareness that topics such as interpretation, truth, assessment, intervention, culture, clinical setting, and well-being can be explored and deepened only through the careful interweaving of clinical and epistemological research and practice (Ceruti & Lo Verso, 1998). Such dedication to philosophical elaborations ensures theoretical coherence, originality, and creativity, as well as an overall consciousness of what therapists do and what happens in counseling. Counseling is never a neutral activity: As Basaglia (1968) and Foucault (1980) warned, the act of addressing mental health issues carries deep epistemological, social, and cultural implications for what the world is and how life can and, more or less implicitly, should be lived.

As is clear from this article, Italian mental health counselors are, perhaps, less optimistic and pragmatic but often more theoretically complex and interdisciplinary than their U.S. counterparts. In both contexts, the general need for the exploration of epistemological complexities of counseling calls for a certain cultural reflexivity. From Italy, U.S. counselors could learn the general rejection of point-to-point causal simplifications, which is too often imposed by powerful insurance companies in search of easy and clear answers. In their turn, Italian counselors would benefit from the diffused social attention and, above all, the pragmatic conceptualizations and actions toward cultural and ethnic issues that are usually present among U.S. counselors and training programs.

Within a geographical area that is slightly larger than the U.S. state of Arizona, historical and cultural differences reflect centuries of conquests, invasions, and transitions. From North to South, regional dialects, languages, and cultures are palpable instances of a number of foreign influences, varying from the whole Mediterranean area to the Balkans to German-speaking countries (Maiden & Parry, 1997). To a certain extent, Italy is a complex web, and sometimes a maze, of multi-ethnicities and identities. This array of diversity within its borders should encourage Italian counselors to develop their professional sensitivity on the struggles of current immigrants. As typical North European and U.S. multicultural policies are difficult to apply to the Italian context (Grillo & Pratt, 2002), the response to cultural and multicultural transitions will have to be tailored to the Italian milieu of mental health care. Although, on the one hand, counselors need to reflect on their cultural bases and the implications of their practice, on the other hand, the need for self-reflection and reflexivity should prompt an often uncomfortable examination of the past of Italy as a country of emigration.

The rapid changes in Italian society, in light of an increasing immigration, do and will represent fascinating challenges and potentials for the Italian system of mental health counseling and psychotherapeutic care and training. These opportunities for change will have to be informed by deep processes of reflexivity on Italian cultural values and norms if therapists want to be genuine interlocutors with the Italian multicultural and postmodern society. In the current scenario of social change, mental health workers need to becoming increasingly sensitive and open to the critical exploration of their own standpoints and assumptions and to the need of minority and diverse groups to be heard, understood, and empowered.

The authors wish to thank the guest editors, reviewers, Yolanda Hernandez-Albujar, and Rom Brafman for their comments on earlier versions of this article.

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Marco Gemignani is with the Department of Psychology, University of Florida, Gainesville. E-mail: [e-mail] or [e-mail]. Massimo Giliberto is with the Institute of Constructivist Psychology, Padova, Italy.