The questions that come up most

Yes. I work in English as well as Italian, and a substantial part of my practice is in English.

Working in a second language is worth thinking about honestly rather than assuming it is neutral. For some people English is where they are most precise, and it makes no difference at all. For others their emotional vocabulary belongs to a first language, and English holds the material at one remove — sometimes that distance makes difficult things easier to approach at first, sometimes it flattens what they are trying to say.

Both are workable, and it is something we can look at directly rather than work around.

No. In Italy you can contact a psychologist in private practice directly: there is no requirement to go through a family doctor, and no referral letter.

If you come from a system where mental health care starts with a GP, this is one of the practical differences — you book the first session yourself, and the decision about whether to continue is made between us.

Medical assessment is a separate matter, and for symptoms that could have a physical cause it still comes first.

It lasts forty-five minutes, and it is there to understand what we are dealing with. You tell me what is happening: how long it has been going on, in which situations, what you have already tried.

I ask the questions, so arriving without a prepared account is ordinary rather than a problem.

At the end I tell you what I have understood and what I would propose — whether a course of work makes sense, of what kind, at what pace. It is also when you assess me. If you decide to continue, we book the next session; if not, it stays a single consultation.

No, and most people don't. It is common to arrive with a confused sense that something is wrong without being able to put it in order. Putting it in order is part of the work rather than a condition for starting it.

The questions I ask are concrete: when it happens, in what circumstances, what changes when it happens, what you have tried. Answering a specific question is easier than producing an account unaided.

You set the pace. If there are things you would rather come to later, they wait.

The first two or three sessions are close together: weekly, or about ten days apart. Continuity matters at the start, because the picture is still being built and long gaps disperse exactly the details the work depends on.

After that the rhythm usually widens to a session every two or three weeks. When to widen it is decided together, based on how the work is going.

The frequency can be revised at any point, in either direction.

A psychologist holds a degree in Psychology and is entered on the professional register, the Albo. A psychotherapist is a psychologist — or a doctor — who has additionally completed a recognised four-year specialisation school, and is qualified to treat psychopathological disorders. A psychiatrist is a medical doctor specialised in psychiatry and, as a doctor, prescribes medication.

The practical difference is in the instruments: psychotherapy works through conversation, psychiatry also through medication. The two can run in parallel.

I am a psychologist and psychotherapist. The titles are regulated in Italy and the register is public, so anyone can verify them.

Yes. I am registered with the Ordine degli Psicologi della Lombardia, section A, number 18949, since 2016 — the register that authorises practice as a psychologist and psychotherapist in Italy.

My training spans two countries: a degree in Psychological Sciences from the University of Milano-Bicocca, an MSc in Cognitive and Clinical Neuroscience from Maastricht University in the Netherlands, and a four-year specialisation in Cognitive-Neuropsychological Psychotherapy.

Registration is what counts legally, and it can be checked independently in the public register rather than taken on my word.

Everything said in session is covered by professional secrecy, which for a psychologist in Italy is a legal obligation as well as an ethical one: it is set out in article 622 of the Criminal Code and articles 11–15 of the professional code of conduct. It covers the content of sessions and the fact that a person is in therapy at all.

The exceptions are few and defined by law, and the main one is your own written consent. In practice: if a communication with your doctor or a psychiatrist would be useful, I propose it, and it happens only if you agree. In couples work the consent has to come from both partners.

It extends to the people around you. If a family member contacts me, what happens in session stays between us.

An individual session lasts forty-five minutes and costs €100. A couple session lasts sixty minutes and costs €130.

The fee is the same at every location — the two studios in Milan, Monza, Cernusco sul Naviglio — and the same online. It also applies to the first session, which is a full session.

The fee does not vary by subject: work on anxiety, on sexual difficulties or on relationships all cost the same.

At the end of each session. I accept cash, bank transfer or card, and a receipt is issued every time without your having to ask for it.

For online sessions payment is by bank transfer or card, and the receipt is sent by email.

That depends entirely on your policy, and it is worth establishing before you start rather than after. Some international plans reimburse out-of-network psychotherapy abroad, others cover mental health only within a defined network, and many basic policies exclude it.

The reliable way to find out is to ask your insurer in writing: whether psychotherapy with a private practitioner in Italy is covered, at what proportion, and what the documentation has to show. Insurers differ considerably on that last point.

A receipt is issued for every session in any case. If your insurer tells you what they need it to contain, tell me and I will confirm what I can provide.

Under Italian tax law, services provided by a psychologist registered with the Albo count as medical expenses and are deductible at 19% on the part exceeding the statutory threshold. The payment has to be traceable — bank transfer or card — for the deduction to apply.

This is only relevant if you file an Italian tax return. If you are not tax resident in Italy, your own country's rules govern, and they vary widely.

Either way, keep the receipts: they are the document any tax authority will ask for.

Yes. Online sessions have the same length and the same fee as those in the studio, and take place on a private platform: you need a device with a camera and somewhere you can speak without being interrupted.

For some people it is what makes starting possible at all — when anxiety makes travelling difficult, when working hours leave no margin, or when the nearest studio is still far away.

Sessions can also alternate: some in person, some online, depending on the period.

Two in Milan — Citylife, at via Buonarroti 41, and Bicocca, at piazza della Trivulziana 4/A — one in Monza at via Tolomeo 10, and one in Cernusco sul Naviglio at via Torino 24/11.

The fee is identical at all four, so the choice is practical: whichever is easiest to reach, and it can change if your commute or your hours change.

Online sessions are an alternative to all four.

Sessions can continue online while you are away, whether that is a work trip or a longer period abroad. Time zones are a practical matter and we work out what is feasible.

If you are relocating permanently, it is worth raising early rather than at the last session. Continuing across borders raises questions about which country's professional regulations apply, and that is better looked at with time than under pressure.

Either way, an ending that is planned is different from one that simply happens, and the planning is itself part of the work.

No. Shyness is a trait: it makes some situations tiring, but they still get done. Social anxiety involves avoidance, and avoidance progressively narrows the field.

The practical test is what it costs. How many things you have stopped doing, how many occasions you have let pass, how much time goes into preparing or replaying an ordinary interaction.

A shy person can have a full social life. With social anxiety the perimeter tightens, and it is usually visible only when you look back a few years.

No. The most frequent situations are ordinary ones: a phone call, lunch with colleagues, going into a shop, asking for information, eating in front of other people. Public speaking is one form, not the definition.

The mechanism is the same throughout: attention turns inward — onto your voice, your hands, how you are coming across — and that monitoring degrades the very performance it is watching.

The work is therefore about where attention goes, more than about techniques for individual situations.

Because reassurance answers a different question from the one you are asking. A test tells you what was not there at that moment; what you are asking for is certainty, and no test can supply it.

That is why the relief is short — hours, sometimes days — before the doubt reassembles and another check is needed. The search for certainty is the mechanism, not a side effect of it.

The work is on that loop: what triggers it, what feeds it, and what happens when it is interrupted.

In everyday use, yes. Hypochondria is the older word; current classifications use different names for the same pattern.

The clinical distinction is mainly about the weight of physical symptoms: in one case real symptoms are read as evidence of serious illness, in the other symptoms are mild or absent and fear predominates.

For the purposes of the work the label matters little, because the mechanism being addressed — checking, reassurance, the pursuit of certainty — is the same.

Check-ups prescribed by a doctor stay, and they are not my decision. The work concerns something else: the checking done to lower anxiety.

Searching symptoms online, repeated self-examination, asking the people around you for reassurance, booking a test you had recently — these give immediate relief and maintain the problem over time.

They are reduced gradually and by agreement, one step at a time, rather than abandoned in one decision.

Because sleep hygiene addresses the conditions rather than the mechanism. Regular hours, a dark room, no screens: these are useful premises, and for someone sleeping badly through disordered habits they work. If what is keeping you awake is anxious arousal, habits do not reach it.

Often the reverse happens: the rules become another thing to do correctly, and waiting for sleep acquires a further layer of monitoring — checking the time, counting the hours left, measuring sleep quality with an app.

The work starts there: with the half hour before sleep, and with what happens during night waking.

If the insomnia is persistent, yes. Sleep disorders can have organic causes that need ruling out, and sleep apnoea in particular is common and often undiagnosed.

The daytime exhaustion it produces closely resembles that of anxious insomnia, and the two can also coexist.

A family doctor is the starting point and can advise whether a sleep clinic assessment is needed.

No. I am a psychologist and psychotherapist, not a medical doctor: medication is prescribed by your doctor or a psychiatrist.

If a course of medication is already under way, I work alongside whoever prescribed it. People often arrive after a period of using sleep aids and ask how to proceed — that too is a medical assessment, and belongs with the doctor.

The psychological work concerns the mechanism keeping you awake, and can run in parallel.

The symptoms are intense, but the response the body produces is the same one it would produce facing real danger: an alarm reaction.

That said, medical assessment comes first. A racing heart, chest pain and shortness of breath have possible organic causes, and telling them apart requires examination rather than psychological interpretation.

Once that has been done, the work concerns the loop: how an ordinary bodily sensation gets read as a danger signal, and how that reading amplifies the sensation.

The peak generally arrives within ten minutes and then the reaction subsides — the body cannot sustain that level of activation for long.

What lasts longer is different: the exhaustion in the hours afterwards, and the tension of waiting for the next one.

That waiting is often the heavier part, because it occupies the days when nothing happens, and it is usually where the work begins.

It is very unlikely. In panic, blood pressure rises, whereas fainting happens when it falls — two opposite mechanisms.

The sensation of being about to faint is nonetheless among the most common, and comes largely from hyperventilation, which produces dizziness and light-headedness without any drop in pressure.

The exception is blood and needle phobia, where the physiological response is different and fainting genuinely can occur.

No. It is the fear of being somewhere it would be difficult to leave, or difficult to be helped, if you became unwell. That is why it includes enclosed and crowded places too.

The typical situations show it clearly: the metro, queues, motorways, cinemas, lifts, going far from home alone. What they share is not openness but the availability of an exit.

The criterion is the exit, not the place.

Yes, although in most cases agoraphobia develops afterwards. The criterion is fear of the situation, not the presence of attacks.

It happens that the attacks occurred years earlier, stopped, and the avoidance remained — at which point the problem is no longer panic but the perimeter that has tightened.

It also happens that there were never full attacks, only partial symptoms sufficient to make a situation one to avoid.

No. Online sessions have the same length and the same fee as those in the studio, and for this difficulty they are often the starting point.

Beginning from home makes it possible to work on the mechanism before addressing travel, rather than having to clear the largest obstacle at the first appointment.

Moving to in-person sessions, if it makes sense, becomes part of the work itself, and is approached when there is a basis for it.

Yes. A substantial part of work on relationships is done individually, and concerns your own way of being in one: how you react, what you ask for, what you tolerate, when you withdraw.

It is also the only part you have real leverage over. The other person's behaviour can be understood, but not altered from outside.

In many cases one person changing shifts the dynamic anyway, because fixed scripts need both people to stay fixed.

Here the work is individual even when the subject is a relationship: you are the one in the room, and the work is on your side of it.

Couples therapy involves both partners in session and is a separate course of work: the object changes — the relationship as a system — and so does the setting.

They are distinct, and which one fits is decided in the first session, based on who is there and what is to be addressed.

For couples therapy, yes. What is being worked on is what happens between the two of you, and that needs to be observable as it happens.

If one of you is unwilling or unable, individual work on relationship difficulties is a real alternative rather than a fallback: the work is on your own part of the dynamic.

The reverse also happens — individual work that at some point opens onto a session together.

Sixty minutes, at €130 per session, the same in the studio and online.

It is longer than an individual session because two people are speaking, and both need room to actually do so.

The rhythm of sessions is set together, as in individual work.

No, and it would not be my role. The task is to make visible what happens between you, rather than to establish who is right.

In practice that means both of you get the same space, and attention shifts from the content of arguments to the way they unfold: who starts, who withdraws, at what point the conversation changes direction.

People who arrive hoping for an adjudicator are usually surprised, but that shift is what makes the work possible.

Yes, if you have not had one. Erectile difficulties, loss of desire and pain during sex all have possible organic causes, which a doctor needs to rule out before or alongside psychological work.

Causes can also be mixed: an organic component and a psychological one feeding each other, where performance anxiety maintains something that began for another reason.

Medical assessment therefore does not postpone the psychological work — the two often proceed together.

No. What is needed is the clinical information required to understand the mechanism — when it happens, in what circumstances, for how long — rather than an account.

The pace is whatever is sustainable, and I ask the questions: answering a precise question is different from having to find the words unaided.

Reticence is the norm in this area rather than the exception, and it does not obstruct the work.

Not necessarily. Much of the work is individual and concerns your own functioning.

In some cases a session together is useful — for instance when the difficulty has organised itself around the couple and changed how the two of you approach each other. It is assessed rather than assumed.

Where it makes sense, it is discussed in advance: it is a proposal, and the decision stays yours.

No, although they share a number of symptoms. Burnout is tied to a context — usually work — and tends to vary with it, whereas depression affects every area of life.

The signal that often orients things is what happens on holiday: if a week away from work loosens something, the picture looks more like burnout.

Distinguishing them is part of the initial assessment, not least because they can overlap: prolonged burnout can develop further.

It may be, and "just" is doing a great deal of work in that question. Moving country removes, all at once, the things that ordinarily absorb stress: the language you think in, the people who know your history, and the small competences that made daily life automatic.

Some of that settles with time, and settling is the usual course. What is worth looking at is when it does not — when months pass and the tiredness, the irritability or the sense of being permanently slightly outside have not shifted, or when the difficulty has begun to narrow what you do.

The point is not whether the label fits, but whether the thing is still moving.

If there are persistent physical symptoms, yes. Chronic fatigue, sleep disturbance and gastrointestinal symptoms have possible organic causes that need ruling out.

Thyroid conditions, anaemia and deficiencies produce a picture of exhaustion closely resembling stress-related depletion.

A family doctor is the reference point for deciding which investigations are needed.

That is not a question I answer. It is a decision about someone's life, and depends on constraints — financial, family, career — that only the person concerned knows.

What the work in session is for is making that decision with clarity instead of through exhaustion, which is the difference between a choice and a capitulation.

It often turns out that once the picture is clearer the decision changes shape: not leaving, but changing something within what is already there.

Not in the first session, and not necessarily in detail. We start from how you are now: what happens day to day, what has changed, what you avoid.

The account comes when there is a basis for holding it, and building that basis is part of the work rather than a prerequisite for it.

Telling too early can reactivate without processing, which is one reason the pace is set together.

Elapsed time does not determine whether something has been processed. An event from twenty years ago can remain live, and a recent one can settle by itself.

Many people come years later, often because something recent has reactivated what had stayed still: a change, a loss, a situation that resembles the first.

Having got to it late is not a clinical problem. It is the norm.

Yes. The severity of the event is not the criterion — what counts is the effect it had, and that depends on age, on context, and on whether anyone was there at the time.

Cumulative forms are often the hardest to recognise from the inside: nothing individually large, but a prolonged climate — being dismissed, unpredictability, neglect — that leaves no single episode to recount.

Precisely because the episode is missing, many people arrive convinced they have no claim on the subject.

No. My training is in Cognitive-Neuropsychological Psychotherapy, and that is the approach I work with.

If you are specifically looking for EMDR, the first session serves that purpose too: establishing whether what I offer matches what you are looking for, and pointing you elsewhere if it does not.

That holds generally rather than only for EMDR — whether the request and the method match is one of the things the first session is for.