Psychotherapeutic treatment outcome of a female filicide patient

Abstract

A case of double filicide of both her children admitted to a forensic psychiatric facility is described. According to the CARE guidelines (for CAse REports), a full description of the patient, clinical and diagnostic scenarios, the crime, psychotherapy treatment, and changes in psychopathological functioning and clinical outcome are outlined. The patient's psychopathological functioning and clinical outcome were assessed during treatment with the MMPI-2 test: 6 months after filicide (T0), after 2 years of psychotherapy treatment (T1), and prior to discharge/after 5 1/2 years of psychotherapy treatment (T2). The psychotherapeutic pathway was characterized by a supportive and expressive intervention, guiding the revision of the patient's own experiences and of those around her, the revisitation of thoughts from alternative points of view, increasing mentalization and integration capabilities of personality, and external aspects of reality. Over the course of detention, assessments of psychopathological functioning highlighted a decrease in impulsivity and perceived conflict with family members, a decreased tendency to externalize responsibilities, an adequate perception of reality, and dysthymia (rather than depression revealed at treatment initiation). The patient was discharged to a community psychiatric facility, and clinical outcomes were maintained at 12 months post-discharge. Psychotherapy, together with pharmacological treatment, encouraged and enabled the patient to develop insights into the link between her illness and filicide, reduce her externalization of personal behavioral responsibility, and improve her perception of interfamily relational conflict. The patient gradually acquired a greater acceptance of her grief.

Keywords: Italian forensic facilities; MMPI‐2; filicide; motherhood psychopathology; psychotherapy; psychotherapy outcomes.