The goal of this article is to observe how communicative processes intervene in constructing and maintaining given self-narratives. Proceeding from the idea that the Self is, rst of all, narration, we shall scrutinise the topic of identity permanence and change in our linguistic system by exploring the con gurations of reality produced by the use of a speci c morpheme: the “ex”. After considering some differences about the intricate relationship between language, mind and reality, we tried to enter the etym and the meanings linked to the use of this linguistic particle. Making use of Wittgenstein’s proposed method called “perspicuous representation” we examined the implicit meanings it assumes in different usage contexts such as daily language and self-narratives provided by prisoners asked about their image of the “ex-prisoner”. The analysis revealed a substantial ambiguity between the identity change and its nega- tion since the use of the pre x “ex” seemed to con rm and at the same time deny the meaning of the noun accompanying it. The use of the pre x can also prevent the re-positioning of the persons with respect to their past. These ndings may contribute to the understanding of the need for a change in linguistic direction. Our conceptu- alisations of identity cannot be divorced from the linguistic devices used to express them. Major implications for daily language and for the study of clinical and deviant phenomena have been considered

Accessible Summary What is known on the subject The first access to a mental health service is sometimes marked by aggressive behaviours and anger. Forced hospitalization is frequently an occasion for resistance and hostility to the service, which should not be mistaken for psychotic symptoms. If this situation is not dealt with effectively, it can jeopardize the quality of the relationship with staff and compliance with the treatment programme. What the paper adds to existing knowledge The narrator presents his experience in undergoing voluntary psychiatric treatment, casting light on nurses’ good and bad practices: those that increased resistance, and those that helped de‐escalate the uncontrolled reaction at the time of access, as well as during the recovery period. What are the implications for mental health nursing Practitioners should be able to put in place listening techniques and ways of personalizing the relationship with the patient. When such measures become part of the patient's meaning system, the vicious circle of misunderstood anger that creates more anger may be interrupted and the patient can invest in relationships of trust. Abstract Aggression is often a reason for psychiatric hospitalization and may lead to prolonged hospital stays, and at worst to compulsory treatments. The relationship between mental illness and aggressive behaviour is a source for debate in the literature, while research data suggest that violent behaviour is impacted not only by the mental state of the patient, but also by environmental and relational conditions, hence the importance of an increased awareness of operating methods on the part of psychiatric staff. Alex's story is an effective mirror for rethinking staff conduct and offers many practical suggestions for understanding a patient’s point of view in critical episodes and for deescalating relational tension.

Accessible Summary What is known on the subject? It is well known that psychotropic drugs, besides having beneficial effects, may become a source of addiction. Drug therapy involving methadone is traditionally considered an essential medicine in the treatment for heroin dependence since it significantly reduces drug injecting and death rates associated with opioid dependence. What the paper adds to existing knowledge? This paper investigates a paradoxical situation: the use of methadone therapy to maintain a condition of addiction rather than to overcome it. The story is told jointly by the head of a rehab centre and a young man who has developed a methadone addiction and kept it hidden for years from the operators of the addiction centre, who supplied him with the substance. What are the implications for mental‐health nursing? The young man's story offers a key example which can be of interest not only for addiction centres but also for all mental‐health services that supply drugs as therapy. This study examines what happens when a person taken over by a service pursues goals that are in contrast to the service mission. Specific communication strategies have to be implemented to update and negotiate goals in continuity with the personal live project of the service user. This story is a warning to not rely on consolidated operational practices, ignoring the investigation of personal meanings and aims of those who experience them. Abstract IntroductionMental health services typically follow standardized intervention protocols and systematic operating practices. Aim/QuestionThis paper explores what happens when a service relies exclusively on fixed practices rather than on the negotiation of objectives and the differentiation of procedures according to the needs of the user. MethodThe analysis of the narratives produced in first person by Oliver, a former substance user, emphasizes the need of constructing a therapeutic plan in close cooperation, promoting an user active role and strengthening his affiliation in the change process. Results and DiscussionIn this specific case, the involvement of the user meant the identification of the peculiar meanings he attributed to the “substance of use,” which paradoxically coincided with the “therapeutic substance” (methadone). Implications for PracticeOliver's story is an effective mirror for rethinking staff conduct when it assumes that the drug is therapeutic in itself, regardless of the way the person experiences and means it, it also offers a description of the interactive ways in which the relationship between a young person and service staff proved to be effectively therapeutic.

Accessible Summary What is known about the subject? In the context of health and social care, situations at the limit or beyond the role of the professional, such as falling in love and physical attraction between a client and a nurse, are very common events. In residential contexts, the construction of the professional relationship is made more complex than in other care contexts since sharing daily life, routine, constant contact and isolation contribute to making relationships more intense from an emotional point of view. Moreover, the same elements that promote the therapeutic process (interpersonal closeness, self‐disclosure, trust) are also sources of role ambivalence and possible emotional misunderstandings. What does the paper add to existing knowledge? In contrast to what is usually proposed in the literature for the management of similar situations, such as supervision by experts external to the team, this paper proposes a strategy of supervision between peers (called in literature “intervision”) and of taking charge of the situation by the entire team and the group of service users. What are the implications for mental health nursing? The story here presented offers a key example that may be of interest not only to residential centres for substance users but also to all residential mental health communities. It shows not only that one can fall in love, but that this event can generate new opportunities for the therapeutic pathway. The risks associated with not addressing these situations are discussed. These include the restriction of the feeling of falling in love within the canons of error; the attribution of what happened to personal characteristics and the assumption of guilt for such occurrences. Abstract Introduction The care pathway within a mental health service can create situations of strong emotional impact, including physical attraction and falling in love. This may evolve in moments of impasse for the staff and sometimes compromise the success of therapeutic treatment. Aim/Question This article offers some evidence about how intervene in a situation such as a client falling in love with a nurse, avoiding transforming it into a problem. The fear of the nurse, maybe already inclined to blame themselves for what has happened, when he/she asks for supervision, is to feel judged also by the supervisor. This story teaches that to refer to figures from outside the team, as would usually be the case with supervision, may be replaced by enhancing the role composition already available in the residential community as a resource. Method The story was listened and enhanced thankyou to an exchange between M. and the community manager. From the analysis of the narratives co‐produced by M., the former substance user, and the community manager, the elements that made it possible to transform a feeling of falling in love into an interaction of extended trust emerged. Results and Discussion The non‐judgmental and confidential context, but above all the training in interpersonal exchange, facilit...

In recent years, the use of the adjective “therapeutic” has expanded to encompass a great variety of experiences, blurring the line between what is effectively therapeutic and what is not. Proceeding from the idea that a word’s meaning is linked to its use in a particular linguistic game, we will analyse the etymons “therapy” and “psychotherapy” and the change in their meanings over time. This background will guide us in the qualitative analysis of the so-called “therapeutic activities” available on the websites of 14 Italian therapeutic communities for treating addiction. Four main master narratives emerge from our investigation. These are characterised by biomedical assumptions, pedagogical principles, religious precepts, and moral values, respectively. Activities are considered therapeutic per se rather than based on theoretical assumptions regarding change. In the light of our results, the adjective “therapeutic” has become a domain of common sense, which poses the threat of undue reification of the linguistic game that expresses it.