Palazzo Francisci Residence - General overview
THE SOUL NEEDS A PLACE (Plotinus) Palazzo Francisci Residence
This quote by Plotinus was the basis for creating the philosophy behind the first Italian public facility dedicated to the treatment of Eating Disorders, as part of the Local Health Authority (USL Umbria 1). The idea was to create a space for treatment outside the hospital environment, a space that would be neutral and impersonal, which would be distinguished and differentiated from the traditional healthcare setting and where patients would be able to receive intensive therapy accompanied by a rich and welcoming life experience. The facility is located in the city of Todi, inside Palazzo Francisci an antique residence surrounded by a park filled with centuries-old trees. A team of specialized personnel carries out an integrated program that deals intensively with the pathologies. This facility may represent either a therapeutic follow-up to a hospital stay in a protected environment or an alternative to a hospital admission.
The length of the admissions varies from 3 to 5 months.
The facility can accommodate up to 12 patients in a residential setting and 8 in a semi-residential setting.
Access to the facility
Access to the facility is set-up by the team at the suggestion of the treating physician or the territorial services or directly upon request by patients or their family members. Patients are accepted from throughout Italy. The Palazzo Francisci Residence is the only Italian residence to accept patients under the age of 14, with assistance from assigned pediatric staff members. The facility is completely open and requires patients to enroll in the program with preliminary motivational meetings and a shared and well-defined therapeutic contract to be signed by the patient, and in the case of a minor, also by the patient’s parents.
During the stay at the residence, both weekly individual encounters and group meetings with the family members of the admitted patients are held.
The use of psychotropic drugs is reduced to a minimum (also in consideration of the young ages of the patients) and in any event only in cases of clinically overt psychiatric co-morbidity.
An attentive, weekly internal medicine monitoring is guaranteed by the Department of Pediatrics with the Hospital of Todi, which is located just a short distance from the Residence.
The approach used to treat the eating disorders is an integrated type: psychoanalytic skills and cognitive-structuralist skills are used for individual psychological therapy; the aspect of nutrition is imposed according to Fairburn’s cognitive model for Bulima Nervosa and the one developed by Garner and Bemis for Anorexia; systemic-relational type family therapy is used and this is supplemented by a program that focuses a great deal of attention on the body, which we have progressively developed and expanded and has proven to be quite effective.
The Staff Employed at the Residence includes:
2 psychiatrist/ psychoterapist physicians
1 endocrinologist
1 Nutritionist
2 Nurses
4 Dieticians
3 Biologists
4 psychologists
3 philosopher
1 Dance-movement therapist
4 tutors
1 amministrative secretary
A network within the city
In addition to the activities that are more closely associated with psycho-nutritional rehabilitation, some activity centered programs have been constructed in order to allow patients to experience an enriching life that is not too different from their everyday experiences. The high quality urban and social network that is present in Todi has allowed for the construction of a network of integration and reciprocal enrichment.
Alternative medicine treatments
The ethical and scientific choice to not use psychotropic drugs throughout the course of the Eating Disorders treatment program, as well as the strongly holistic nature of the treatment, which takes all of the patient’s specific characteristics into consideration, has resulted in the development of a portion of the program, that remains closely connected to the rest, regarding integrated medicine techniques. The presence of three physicians (an endocrinologist, a physiatrist and a National Health Service physician-acupuncturist) who specialize in this type of therapy and who have constructed a series of ad hoc treatment programs for these types of disorders, guarantees the application of procedures that are scientifically correct and verifiable.
Specifically, we are applying the following methods of alternative medicine with interesting results: Meditative Techniques, Auricular Therapy, Acupuncture, and Homotoxicology.
A book on this subject has also been published: The Soul Needs a Place by S. Marucci and L. Dalla Ragione – New Techniques Edition
The Treatment of Childhood Eating Disorders
During the last decade, clinical cases of anorexia nervosa and other eating disorders have been reported more frequently in younger subjects as well; that is, in prepubescent aged subjects (from the age of eight and prior to the onset of menarche and the somatic changes that are induced by puberty).
According to a recent study by Irwin:
- 9% of patients with Anorexia Nervosa with a prepubescent onset are younger than 13 years of age
- 1% are less than 10 years of age
- 8% – 33%: demonstrate abnormal eating behaviors
Our intervention network is able to accept patients under 14 years of age for all levels of assistance (clinical, hospital stay, residence) since it has an elaborate program of therapy and specific rehabilitation and features assigned pediatric staff.
The program uses an approach that combines internal medicine, psychology, nutrition, family therapy and physical therapy.
We attempt to gradually reacquire natural eating patterns, through the use of assisted meals for individuals and in groups, with the objective of influencing one of the most powerful maintenance mechanisms for eating disorders, eroding nutritional control.
Moreover, special attention is paid to the parents of such young girls, who arrive at our facility exhausted by the drama of witnessing their own daughters put their lives at risk due to such severe disorders and by the pilgrimages they have made in search of help, which they are often unable to find, or which turn out to be inadequate.
Research, Prevention and the Organization of Conferences, Seminars and Courses are Part of the Center’s Activity
How to contact us:
People with eating disorders or weight issues from throughout the regional and national territories may access the services provided at the Center. Access to the various treatment levels will be determined by the therapeutic team, after an initial, multi-dimensional evaluation.
To access the Service or for additional information call direct to the following telephone number: +39 075 8943302 or write an e-mail to: dallaragione@tiscali.it
Useful addresses:
The “Palazzo Francisci” Intensive Rehabilitation Residence of Todi ETAB -USL Umbria 1 Via Cesia 65, Todi – Telephone Numbers: +39 075/8942577 - +39 075/8943302 - Fax +39 075/8943302.
For patients and/or family members that need to stay in Todi, we can recommend some facilities that were renovated for the Jubilee Celebration in 2000, located just a short distance from both the hospital and the residence, and which offer comfortable accommodations at fair prices:
Crispolti Residence - Todi - Tel. +39 075/8944827
- S. Annunziata Monastery, Via Borgo Nuovo - Todi - Tel. +39 075/8942268
- Sacro Cuore Convent - Via Cesia, 2 - Todi - Tel. +39 075/8942358
School and Eating Disorders
The Centre pays a great deal of attention to its relationship with the educational system, both in relation to its prevention program and the possibility of helping patients maintain their school attendance throughout the treatment at the facility and the hospital.
Regional Program for Scholastic Inclusion Aimed at the Patients of the Palazzo Francisci Centre.
This innovative proposal for integration with the educational system is being developed and implemented in order to allow the patients at the facility to not have to interrupt their schooling during their intense period of psycho-nutritional rehabilitation, which lasts anywhere from 3 to 5 months.
Eating Disorder Training Program for middle school and upper level school teachers
Project Coordinator: Dr. Laura Dalla Ragione - laura.dallaragione@uslumbria1.it
This program was developed from the need to provi de correct information in the timeliest manner to public school teachers, who along with parents are the subjects who have the most contact with the youth that are affected by these disorders.
New Activities at the Residence
At the Palazzo Francisci Residential Center, we have enriched our program of complex intervention techniques, which in addition to contributing to a decrease in symptoms, has also resulted in a cognitive modification of the disorder.
All of the interventions are monitored and evaluated for their efficacy and appropriateness through the administration of specific tests.
The 360° treatment that we offer aims not only to modify the underlying cognitive structure related to the eating disorder, but also do much more by reconstructing a new viewpoint for the patient regarding her life and the world in general.
Dance Therapy
Motor Activities
Expressive Activities
Mirror Therapy
Director: Dr. Sabrina Mencarelli, Psychologist - Sabr761@hotmail.com
The use of mirror therapy techniques (developed by Wilson and adapted by Laura Dalla Ragione) in the treatment of eating disorders is based on the assumption that anxiety about weight and body shape is based in the mind and cannot always be accessed and modified by cognitive-verbal restructuring techniques.
In patients affected by Eating Disorders, the difficulty that they encounter in tolerating the levels of anxiety and negative opinion when looking at their bodies in front of a mirror is quite high and constitutes a cause for great suffering. At the same time, as in a sort of uncontrollable compulsion, by constantly looking at themselves in the mirror, patients try to find a confirmation for their reflected image, a confirmation that is always negative and painful.
It is for this reason that there are no scales or mirrors at the Residence, to provide support for a desensitization of the patient’s own image from the moment she enters the facility.
From here, the idea of introducing this technique to the therapeutic rehabilitation program which develops the patient’s ability to look at her body without judgment (Mindfulness). The work that takes place with regard to body image and the suspension of judgment occur at the same time as the mediation work, which constitutes a sort of preparation for the acceptance of ones own body scheme.
This type of therapy cannot be used with all the patients, and a careful selection must take place in order to exclude experiences of depersonalization, dysmorphobia, pre-pubescent aged girls, and severe misperceptions.
At the first encounter, at the time the mirror is introduced, patients often manifest a sense of alienation, as if they do not recognize themselves. They are generally quite agitated, and are often also confused, they use adjectives that are extremely negative when describing their bodies, which they view once again for the first time after a period of time spent inside the facility, during which time their body shapes have been modified.
During the second and third encounters they begin to become more used to the mirror, with their images and with their bodies. By this point they can autonomously describe and locate the different parts of their bodies and their anxiety will have diminished.
During the following sessions, patients are placed in front of the mirror with clothing that reveals more and more of the patient’s body while their anxiety gradually decreases. These sessions can be quite emotional for the patients, who often cry and sometimes it becomes necessary to interrupt the meeting and the role of the therapist becomes central in knowing when to slow down or move forward with the therapy.
The Theatrical Laboratory at “Palazzo Francisci”
Director: Costanza Pannacci - titubanza@hotmail.com
In patients affected by Eating Disorders, the body – in all of its aspects – is transformed into a prison and the spaces and methods available for self-expression and relating with oneself and the world become more and more limited.
In order to return to perceiving others and to reconstruct a relationship with the world, it is necessary to “face oneself”, sometimes even to stop oneself and try to step outside of one’s own situation to explore other methods, other paths, taking a step – even just one step – in another direction.
The experiences we have had with the theatrical laboratories that have been created for the patients at the Palazzo Francisci Residence have allowed us to feel – and also experience through all of our other senses – how true this is and to what extent theatre can be an extraordinary tool for creating a passage, which is sometimes just a tiny crack at the beginning – for rediscovering the worlds that exist both inside us and around us.
Dance Movement Therapy Laboratory Director: Dr. Raffaella Fasoli, Dance Movement Therapist -
ea.ra@libero.it Since 2004, the “Palazzo Francisci” Center for the Treatment of Eating Disorders has included the dance-movement-therapy laboratory directed by Dr. Raffaella Fasoli as part of its multi-disciplinary program.
From the very first encounters, the use of dance-movement-therapy, results in an obvious increase in mind-body integration for patients, as well as improved verbal communication skills regarding their own experiences and knowledge of the potential and uniqueness of their own existence.
Philosophical Consulting Activities
Director: Dr. Paola Bianchini - bianchinipaola@libero.it | Chiara De Santis desantisch@gmail.com
Philosophical consulting activities were introduced at the Palazzo Francisci facility in 2004-2005. The combination of philosophy with treatment represents a challenge, but in any case has proven to be quite fertile. And so, philosophy thereby returns to one of its original purposes, that of providing an education regarding the issue of existence.
Existence remains a function and clarifying its methods represents a reconfiguration of its own experience.
Therefore, providing clarification regarding the radical nature of suffering is a process that involves both the consultant’s own humanity of as well as that of the group participants, since it is true that behind every form of suffering, there is an issue, which is what needs to be heard.
The philosophy group meets at Palazzo Francisci on a weekly basis and the group meetings usually last about two hours. The group is directed and supervised by Dr. Paola Bianchini, a consultant-philosopher and researcher with the Department of Philosophy – Aesthetics at the University of Perugia.
Yoga and Meditation in the treatment of eating desorders
Director: Dr. Tiziana Terzo - Kinesiologist- tiziana.terzo@outlook.it
The use of Yoga and meditation in the Eating Disorders field, can make the difference, working on the inner part of the subject, as well as other activities that show themselves as an expressive / perceptive input and that increase awareness in the patient ( Roff , C., 2014).The term Yoga refers to ascetic and meditative practices used as a means of realization and spiritual salvation. Millennial disciplines that involve body, posture, breath and spirit. The correct practice is possible when body and psyche are not split, the glue is the energy, the channel is the breathing, is a universe that touches the person in its depths, leading towards the unity and union with oneself. Yoga involves learning to know and to listen to oneself, to evaluate if and how to consider one's limits and possibilities, to let oneself go to the wisdom of body and breath.
Hata Yoga, in particular, is the current best known type of Yoga, and also the most widely used for the Eating Disorders treatment. Hata Yoga with Kundalini, Raja, Laya and Mantra Yoga, it is part of the Tantric Yoga current, that current that exploits the senses to reach inner realization.
Hata Yoga origins go back to the writing of the first Tantra - the classical texts of Hindu thought in which the practices and rules of conduct are included to reach the liberation, but its true systematization is due to the mystical Gorakhnath, lived between the 11th and 12th centuries, founder of Yoga type focused mainly on psycho-physical practices. In his texts is theorized that through practice the fusion between the individual self and the universal self can be stimulated, the ultimate goal of Yoga.
The discipline proposed by Hatha Yoga goes through a series of physical poses (asanas), respiratory exercises ( Pranayama ) and meditation techniques. Hatha Yoga is Yoga type that more than any other acts on a physical plane, bringing a beneficial effect in respect to the column. It also improves the elasticity and strength of muscles and tendons, bone density, as well as the ability to listen to the body in general. At the same time, the attention dedicated to breathing helps to give greater vigor and a general state of health to the all body.
In addition to physical nature benefits, Hatha Yoga also has a positive influence on the psychic level, favoring deep states of relaxation and concentration. Exercises and asanas work at the level of thin energies to unblock those energy stagnations that underlie the main physical and mental illnesses.
Moreover, according to the complex system of energetic physiology developed by the Hindu tradition, the assumption of positions taught by Hatha Yoga would also affect the well-being of the internal organs of the body, the regulation of the endocrine glands and the nervous system, thus contributing to create the premises for general psycho-physical health.
Vipassana meditation
Vipassana in the ancient Indian language Pali means "Seeing things in depth, as they really are", "right knowledge", "intuition", "understanding". It is one of the most ancient meditation techniques of India, it is universal and practicable by everyone. It was in fact rediscovered and taught by Siddhatta Gotama the Buddha more than 2500 years ago as a universal method to get out of all kinds of suffering. Vipassana is a practical technique of self-observation, a scientific method that leads to the gradual purification of the mind. This technique is also called insight meditation, because it intends to develop the maximum awareness of all the sensory and mental stimuli, so that its real nature can be grasped. The body and the mind are the field in which it is possible to discover, with a careful vision, the truth.
The theoretical foundations of vipassana can be found in the Great Discourse on the Foundations of Mindfulness, according to which technology foresees the following moments:
- Body Contemplation: breath, positions, actions, parts of the body, elements
- Sensations Contemplation
- Mind Contemplation
- Mental objects Contemplation: obstacles, mental formations, consciousness. Reference to the six internal bases and the six external bases of the senses (eyes, ears, nose, tongue, body and mind, and corresponding external realities). Reference to the seven factors of awakening (mental presence, investigation of phenomena, awakening of energy, joy, serenity, concentration and equanimity).
The protocol of Yoga and meditation specific for the treatment of eating disorders and body image used in Palazzo Francisci Clinic and Nido delle Rondini of Todi is composed of sessions in which patients are accompanied by the operator towards a greater awareness of the body and its needs through:- The use of simple but effective "asanas" ( Yoga positions)
- Complete breathing (thoracic and abdominal)
- Guided meditation
- Identification of needs, objectives and tools for physical, mental and emotional well-being.
The advantages of this protocol, known for years in the United States, have also been tested in Italy, thanks to the study started in 2016 and currently underway at Todi's multidisciplinary care centers "Palazzo Francisci" and "Nido delle Rondini", run by Dr. Laura Dalla Ragione. After months of practice and analysis, it has been possible to record highly positive results in patients demonstrated by the administration of pre and post-treatmenttests .
Bibliographic References :
Judith Balk , MD , MPH, Melissa Gluck , MD, Lisa Bernardo, PhD , Janet Catov , PhD . (2009). The Effect of Yoga on Markers of Bone Turnover in Osteopenic Women : a Pilot Study . International Jo urnal of Yoga Therapy - No. 19
Michalsen A1, Grossman P, Acil A, Langhorst J, Lüdtke R, Esch T, Stefano GB, Dobos GJ. (2005). Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program . Med Sci Monit . Dec; 11 (12 ): CR 555-561. Epub 2005 Nov 24
Lavey , Roberta; Sherman , Tom; Mueser , Kim T .; Osborne, Donna D .; Currier , Melinda; Wolfe , Rosemarie . (2005). The Effects of Yoga on Mood in Psychiatric Inpatients . Psychiatric Rehabilitat ion Journal, Vol 28 (4), 399-402
Jennifer J. Daubenmier . (2005). The Relationship of Yoga, Body Awareness, Responsiveness and Body to Self-Objectification and Disordered Eating . Psychology of Women Quarte rly June , vol. 29 no. 2 207-219
Robin Boudette, Ph.D. (2006). Yoga in the treatment of Disordered Eating and Body image Disturbance . Journal for Treatment and Preventi on of Eating Disorders , 14: 1-4.
Jennifer E. McMahon . (2014). The Use of Yoga
in Eating Disorder Treatment: Practitioners ' Perspectives . St. Catherine University
Rocío Guardiola Wanden-Berghe , Javier Sanz-Valero & Carmina Wanden-Berghe . (2010). The Application of Mindfulness to Eating Disorders Treatment: A Systematic Review . 2 0 Dec. eating Disorders Journal
Jessalyn Klein, BA, Catherine Cook-Cott, PhD . (2013). The Effects of Yoga on Eating Disorder Symptoms and Correlates : A Review . International Journ al of Yoga Therapy - No. 23 (2)
PatriciaG. Byrn . PCOM Physician Assistant Studies Student Scholarship . (2013). Is Yoga an Effective Management Strategy for Disordered Eating ? A selective evidence-based Review . Philadelphia College of Osteopathic Medicine. Paper 132
T. RainCarei, Ph.D., Amber L. Fyfe-Johnson, ND, Cora C. Breuner, MD, MPH, and Margaret A. Brown, Ph.D. (2010). Randomized Controlled Clinical Trial of Yoga in the Treatment of Eating Disorders . Journal of Adolescent Health 46 (2010) 346-351
Pandora’s House
An apartment available for experiencing independent living after the critical period of intensive treatment at the Palazzo Francisci of Todi Center for the Treatment of Eating Disorders. This is the most recent novelty that has been made available in this Umbrian city by ETAB (La Consolazione Ente Tuderte di Assistenza e Benefizenza). In 2007, an agreement between ETAB and the association "Mi fido di te", which is comprised of the parents of the youth who are undergoing or have undergone treatment in Todi, resulted in the availability of one of the most beautiful apartments in this Umbrian city, located in San Fortunato and managed by the parents’ association.
There are four beds available as well as a kitchen, a common area and a large terrace that faces the Church of San Fortunato. All of this is located inside the city centre, making it easy to move about on foot.
The apartment is occupied by patients who are already in a stage of improvement or who come there to spend shorter times at the centre. However, Pandora’s House is also intended to be used by patient’s family members: mothers and fathers of the youngest patients, between the ages of 11 and 12, often choose to stay here.
The apartment was given the name "Pandora’s House", in remembrance of the Greek myth of those human beings who were afflicted by a variety of illnesses, but always managed to keep hope alive.
Visit the website of the Family Members’ Association, Mi fido di te