Brief Strategic Therapy and Obsessive Compulsive Disorder. When pain borders on enjoyment

trichotillomania

Thursday 15 September 2016, thanks toOrder of Psychologists of Lombardy, we had the opportunity to attend with pleasure the first link of the webinar Review, which saw as protagonists Giorgio Nardone (Director of the Strategic Therapy Center of Arezzo) and Brief Strategic Therapy (original application of the Strategic Problem Solving Model he invented to psychotherapy). The 380 participants were able to discover what it means to strategically intervene on one of the most disabling and ever-expanding psychological disorders, so much so that it is defined by many as the "black beast of psychotherapy", or obsessive compulsive disorder.

Giorgio Nardone offers listeners a case of Trichotillomania. It is a particular variant of doc which consists in tearing off body hair, up to, in extreme cases, to remain completely bald or hairless, as happened to the young 19-year-old woman who showed up in the Arezzo studio wearing a bandana to hide the havoc she herself perpetrated.

What can induce a person to behave like this? Is it masochism or self-harming behavior? Although it may appear illogical, or rather not ordinary, in nature, a given behavior that is repeated for a period of time that goes from three to six months becomes a subtle pleasure that, indulged, turns into a necessity, therefore into a pleasure-based compulsion. Many specialists, such as those to whom the girl in question had turned, intervene either with a drug treatment, which dulls anxiety and reactivity but does not change the quality of thoughts, making the person less lucid and present, or with therapies that they often tend to search for the hypothetical causes of the problem in the past, without considering that, assuming that it is possible to identify a real and univocal triggering event, it is not enough to know it to be emancipated from it. Or, other orientations try to exploit the person's great reasoning ability to understand how things work, in order to motivate themselves to change, without however evaluating that in obsessive compulsive disorder, those who suffer from it know perfectly how it works and what they should do to get out of it. out, but he can't do it.

La Brief Strategic Therapy, introduced by Giorgio Nardone and developed in Italy and around the world together with the numerous ones Affiliated Centers directed by his collaborators / researchers, he acts in a different way. First of all, a type of diagnosis is carried out, which is defined operational, through which a problem is known while it is being solved (learning by doing), which therefore focuses on the attempts applied to solve the problem that did not work (attempted solutions ). The investigation tool is the strategic dialogue; a form of dialogue with alternative illusion questions, through which perceptions and emotions are touched even before the intellect, to then apply strategies and stratagems that follow the same logic of the disorder, causing it to collapse from within.

In this case, the release prescription, which can then be generalized to many variants of pleasure-based doc, is what in Brief Strategic Therapy we define the "ritualization of the ritual" (Nardone, Portelli, 2013) which consists in asking the person, for a period of two weeks (which is the amount of time necessary to ensure that the indications between one meeting and the other can have their maximum effect), to go in front of the mirror at any time of day and, once there, plucking for a variable amount of time, often a minute, the hairs that usually tear.

If listened to by laymen, this indication may appear bizarre and senseless, while, analyzed from a strategic process point of view, it acts on several fronts.

  • it allows the person to gain control over the disorder, having to voluntarily decide to perform the actions first hostage of the obsession, so the behavior is no longer compulsive, but voluntary;
  • it allows to postpone the execution of the ritual, having to be carried out once an hour, so the behavior is no longer acted on the request of the obsession, but on the decision of the person;
  • it creates an interval between the request of the obsession and the reaction of the individual, interrupting the perceptive-reactive sequence that characterizes the disorder;
  • from being pleasant the ritual becomes more and more unpleasant, given the obligation to carry it out regardless of the necessity of the moment, at any hour of the day.

Having become able, following the instructions of her therapist, to voluntarily perform a behavior that as obliged is no longer a source of pleasure at every hour of the day, postponing its execution to specific times, after only five meetings, the girl was able to avoid to practice the ritual, so much so that soon she no longer needed the bandana.

The ritualization of the ritual therefore allowed to act on the logic of maintaining the problem, putting the disturbance in the condition of not being able to fail to collapse, using the stratagem of "making the enemy go up to the attic and remove the ladder" (Nardone, 2003).
Return to specific readings the description of all the phases of the therapy that Giorgio Nardone illustrated in great detail in the webinar meeting which, after an hour and forty minutes, kept 340 of the initial 380 glued to the monitor, who did not fail to put the more various questions, which have allowed us to argue about many other aspects of Clinical Psychology and Psychotherapy.
Surely to be repeated, certain that the numbers, already incredible, will only meet the expectations of Giorgio Nardone, of all the staff of the Strategic Therapy Center of Arezzo and of the hundreds of currently Affiliated Studies. I thank the Order of Psychologists of Lombardy for the organization and Giorgio Nardone for his willingness to share a part of his time with us. Until next time!

Dr. Elisa Balbi (Official Psychologist-Psychotherapist of the Strategic Therapy Center)

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