Brief history of Brief Strategic Psychotherapy

The Mental Research Institute (MRI) in Palo Alto California USA

It all started here: The Mental Research Institute (MRI) was founded in Palo Alto in September 1958 thanks to the intuitions of Donald D. Jackson, a brilliant and inventive psychiatrist, who founded an institute dedicated to the study of systemic interactional processes —that is, studies of the mutual influence, action, and reaction, in communication between people. This was a true innovation: from the study of symptoms to the study of the role of human communication in psychological distress and mental illness. D.D. Jackson collaborated with Gregory Bateson, an anthropologist, who shifted his studies from ethnology to the epistemology of communication. Cybernetics, a new multidisciplinary field, provided new tools for studying the interactive systems of which human communication is a part. They were the two leading figures who saw communication phenomena as the key to and explanation of all human behavior. In 1962, the journal "Family Process" was founded, with D.D. Jackson and J. Haley as its first editors.

At the same time, the other important schools of thought in psychology, including psychiatry, maintained, then as today, the positivist orientation of seeking the primary cause of the subsequent psychic distress. The unconscious Freudian psychic trauma is well combined with the medical model of etiology, i.e. the study of the causes of diseases according to a cause-effect logic, a concept that indicates the relationship between two phenomena (or classes of phenomena), in the case in to which the first phenomenon, called cause, is the reason for the existence of the second, called effect.

In 1967, the Brief Therapy Center was founded at the Mental Research Institute by multidisciplinary clinicians and researchers who were already collaborating with the MRI.

John Weakland, chemical engineer and student of G. Bateson, studied for 18 years, confronting directly with him the work of Milton Erickson; Richard Fisch, a New York psychiatrist who moved to MRI; Paul Watzlawick, philosopher, psychoanalytically trained psychologist, expert in language and logic; Artur Bodin, a psychologist, at that time president of the Californian section of the American Psychological Association. Among the people who worked at the MRI at that time we remember Virginia Satir psychologist, the best known American family therapist, Jules Riskin, C. Sluszki and Cloe Madanes, who was assistant to Paul Watlzawick, and many others ... The Brief Therapy Center was a project for the experimentation of innovative therapeutic techniques. The multidisciplinary nature of the MRI members made this Institute an independent organization dedicated to research, training and clinical activity. Studies from that period highlight the importance of pathogenic family relationships in the genesis of mental problems and disorders. From here begins a new way of dealing with mental problems and disorders with the patient's family.

Systemic (family) therapy became famous worldwide thanks to the studies published in the book "The Pragmatics of Human Communication" (1967) by Paul Watzlawick, JH Beavin, and DD Jackson, the bible for those who study the pragmatic, or concrete, effects of communication on people. How things are said, that is, how the person communicating creates different effects on those receiving the communication. It's everyone's experience not to feel hurt by someone who, with care, is capable of saying unpleasant things to us, but instead to react impulsively to someone who tells us something as silly as being urged on with a horn at a traffic light...

The revolution of those years was the concept of Attempted Dysfunctional Solution , developed at the Brief Therapy Center of the Mental Research Institute in Palo Alto: it refers to the tendency of people to reiterate the same attempted solutions despite their ineffectiveness. In other words, each failed attempt at a solution, if repeated over time, consolidates, rather than resolves, the initial problem; replacing the original causes and becoming the cause of the problem's persistence. It changes the way we look at psychological problems, from the search for the root cause (etiology) to the study of the process—thoughts, actions, and reactions—that maintains the dysfunction until it becomes pathological. We can elegantly describe this paradox with the words of Paul Watzlawick: "The (attempted) solution becomes the problem."

When a person has a problem, he tries and puts in place a solution, if it doesn't work he tries again until he reaches the solution. This is the most frequent case: most of us have the ability to solve on our own the thousands of big and small problems we encounter in our life path. In some cases, however, we cannot find the right solution and the attempted solution can even make the problem worse. All those who have experienced an impeding problem, such as a simple phobia - for example the fear of pigeons, of driving a car, of being locked in an elevator ... - know that understanding the cause is useless for the solution and the effort of the will does not it is enough to overcome fear. Yes, because phobia is an uncontrollable fear. A rational reference to reality is useless .. or sermons of empirical persuasion. Thus the person begins to avoid what creates the panic or to ask for help in order to deal with what they fear. Here are the attempted dysfunctional solutions that keep the problem - avoid and ask for help - which, if repeated over time, confirm and worsen the situation up to a severe psychopathological disorder.

Paul Watzlawick publishes “Change” in 1974 which illustrates the innovative clinical and therapeutic approach; this work proposes a model based on the logic of formation, persistence and problem solving and is influenced by Milton Erickson, so much so that he writes the preface. Starting from these studies, the background was formed for that psychotherapeutic method known as the strategic approach, whose main pillars were the study of human communication and trance-free hypnosis during the clinical interview.

It is 1985 when Paul Watzlawick, John Weakland, and Giorgio Nardone, who arrived in Palo Alto as a philosopher of science, began to develop innovative techniques for the intervention on an area of ​​pathology little explored by the traditional model of MRI.

An important study that starts from clinical practice on phobic and obsessive disorders that leads to the definition of the epistemological-theoretical prerogatives, that is, the study of methods to achieve this knowledge and related applications to intervene. The research method, the logic of strategic problem solving and the strategies of therapeutic communication are outlined.

They begin to formulate, in a completely original way, the Brief Strategic Therapy model, distinguishing it from other forms of brief systemic psychotherapy, from Ericksonian hypnosis and from cognitive-behavioral models.

In 1987, the collaboration between Giorgio Nardone and Paul Watzlawick grew increasingly close, culminating in the joint founding of the Strategic Therapy Center in Arezzo , an institute for research, training, and psychotherapy . This center was designed to develop and evolve the Palo Alto School model toward a more advanced therapeutic technology tailored to specific forms of psychopathology. This meant moving from a general model to specific techniques.

In 2000, during an international conference, Paul Watzlawick stated that the Palo Alto school moved to Arezzo, precisely by virtue of the fact that, while there, researches, applications and results were flourishing. at the original site, the MRI, every type of research and evolutionary application of the model was running out.

This all paved the way for what would later become the modern evolution of Brief Strategic Psychotherapy, introduced to the general public in 1990 through the publication, a manifesto of the advanced approach, "The Art of Change: A Manual of Strategic Therapy and Hypnotherapy Without Trance," written by Giorgio Nardone and Paul Watzlawick, and translated into over twenty languages ​​with hundreds of different editions.

 

 

The Strategic Therapy Center of Arezzo: the team of researchers, clinical research, and the School of Specialization

The training school for the Brief Strategic Psychotherapy model in Arezzo, active since 1988, is recognized by the Ministry of Education, University and Research (MIUR) as a four-year postgraduate specialization school in Brief Strategic Psychotherapy (ministerial decree 20.11.2000).

One of the distinctive features that distinguishes brief strategic psychotherapy from traditional forms of psychotherapy is that it allows for the development of interventions based on pre-established objectives and the specific characteristics of the problem at hand, rather than on rigid and pre-established theories. Furthermore, each type of pathology is conceived not as a biological disease to be cured, but rather as a dysfunctional balance to be transformed into a functional one.

Another fundamental aspect of brief strategic psychotherapy is breaking down the specific pathological rigidity of the disorder or problem through corrective emotional experiences . This construct, formulated by Franz Alexander in 1946, suggests that therapeutic change can only be achieved after corrective emotional experiences that concretely enable the patient to confront what they believe they are incapable of doing. This example reflects another therapeutic concept learned from the masters Paul Watzlawick and John Weakland, that of the planned chance event , or the idea that to effect rapid and concrete therapeutic changes, communication maneuvers or elaborate prescriptions are necessary to create corrective experiences in the patient's life that appear random but are actually stratagems planned by the therapist.

The solution to the problem, through brief strategic psychotherapy, therefore consists of strategies and stratagems capable of changing the patient's dysfunctional attempted solutions and, as a result, inducing them to concretely experience therapeutic change; that is, by enabling the patient to effectively alter their perception of the things that were causing them to react pathologically. In this regard, it appears essential to differentiate, for each form of psychopathology, the logical models of dysfunctional interaction that fuel their formation and persistence, and along the same lines, to construct strategic logical models of resolution intervention. The efficacy and efficiency of therapeutic strategies and stratagems tailored specifically for different pathologies, and their replicability, have led us to gain effective and empirical knowledge of the functioning of these dysfunctional balances. All this explains the seemingly paradoxical statement: solutions explain problems.

In 2003 the first results of the protocols were published, which are a set of specific rules and procedures for intervening and communicating in the different classes of psychopathological problem. Thus, the efficacy and efficiency of treatment for the different forms of psychopathology elaborated and applied in the previous decade on a total of 3484 patients are brought to the scientific attention. Results: 86% of cases resolved with an average of 9 sessions. Thinking about efficacy and efficiency in the psychotherapeutic field is still difficult to combine with the different models of intervention!

 

The "operational pragmatism" of the CTS: effectiveness is the only form of truth.

The development of protocols —i.e., guidelines for the various phases of therapy available to clinicians for the treatment of psychopathology—demonstrates their effectiveness, efficiency, and replicability. They are rigorously taught at the Four-Year Specialization School and are continuously validated by over one hundred researchers who apply them worldwide. They are subject to ongoing monitoring and adjustment under the direction of Professor Giorgio Nardone. The use of protocols has become the benchmark for evaluating the efficacy and efficiency of psychotherapeutic interventions, both in clinical practice and as a tool for experimentation. This validation can now be confirmed positively across cultures, as the various Nardone Model Brief Strategic Therapy Centers established in the United States, Spain, Ireland, France, Belgium, Romania, Russia, Paraguay, Colombia, Mexico, Costa Rica, Argentina, and Chile confirm equivalent efficacy rates as of 2018:

• Phobic and anxiety disorders (95% of cases)
• Obsessive and Obsessive Compulsive Disorders (89% of cases)
• Eating disorders (83% of cases)
• Sexual dysfunction (91% of cases)
• Mood disorders (82% of cases)
• Disorders of childhood and adolescence (82% of cases)
• Internet addiction disorders (80% of cases)
• Presumed psychosis, borderline and personality disorder compensation (77% of cases)

All patients are invited to follow a rigorous follow-up, i.e. scheduled checks for one year from the end of therapy, in order to consolidate the change as well as provide us with concrete data for research.

 

The roots are not the crown

Thus, our roots are in the Mental Research Institute and the Brief Therapy Center, but the Strategic Therapy Center in Arezzo has become the crown of a majestic tree, with a significant theoretical-operational model, informed by studies in logic, cybernetics, and problem solving, decidedly different from the original. From the study of the redundancies of the MRI's Attempted Dysfunctional Solutions to the protocols developed at the CTS, supported by therapeutic strategies designed to unblock the patient's dysfunctional perception of reality. Furthermore, another distinguishing feature compared to the MRI is the particular emphasis on the consolidation process of the therapeutic process: once the pathogenic equilibrium is broken, we must rebuild a functional one, developing in the patient an awareness of their own resources. The patient must feel they have been able to free their mind from its prisons. A complex, operationally clear model: Nardone's Advanced Strategic Brief Psychotherapy model based on “operational pragmatism” (Nardone & Salvini, 2013) where effectiveness represents the only form of truth.

Research is our guide and our guardian: a free, open, ethical activity of continuous experimentation, which aims to develop and share knowledge by marrying the rigor to create a psychological technology. The numerous clinical publications of the director of the CTS, prof. G, Nardone and the researchers of the CTS, have brought contributions to the scientific community together with a commitment to dissemination.

The Science of Performance

The Strategic Problem Solving Model is an operational method for implementing change and achieving pre-established objectives, even in non-clinical contexts. A new branch of empirical-operational research called Performance Science has recently been systematically developed , an original synthesis of psychology, neuroscience, and brief strategic therapy that focuses on enabling performers—be they athletes, artists, scientists, managers, and others—to improve, achieve, and even surpass their performance.

There are many schools and centers in Italy and in the world that define themselves as Brief Strategic Therapy but which at the moment have not brought about epistemologically significant evolutions in both research and clinical practice and have remained anchored to what we can define prehistory, of the prestigious Mental Research Institute which no longer exists. The young tree not watered with ideas has died out precisely due to a lack of brilliant minds, research and evolution.

 

Emanuela Muriana, psychotherapist

Official researcher and lecturer at the Strategic Therapy Center

 

Bibliography:

Nardone, G. (2009). Pocket-Sized Strategic Problem Solving : The Art of Finding Solutions to Unsolvable Problems. Ponte alle Grazie: Milan.

Nardone, G. & Salvini A. (2013). International Dictionary of Psychotherapy . Milan: Garzanti.

Nardone, G. & Watzlawick, P. (1990). The Art of Change : A Manual of Trance-Free Hypnosis. Milan: Ponte alle Grazie.

Watzlawick, P., Beavin, J. H. & Jackson, D. D. (1967). Pragmatics of human communication: a study on interactional patterns, pathologies and paradoxes . New York: Norton. Italian translation: Pragmatics of human communication . Rome: Astrolabe, 1971.

Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. New York: Norton. It. trans.: Change: Problem Formation and Resolution . Rome: Astrolabio, 1974

Watzlawick, P. & Weakland, J. H. (eds.) (1974). The interactional view: Studies at the Mental Research Institute, Palo Alto, 1965–1974 . New York: Norton. It. trans.: The relational view: Contributions at the Mental Research Institute, Palo Alto, 1965–1974 . Rome: Astrolabio, 1978.

Watzlawick, P. (1977). Die Möglichkeit des Andersseins: Zur Technick der therapeutischen Kommunikation . Bern: Verlag Hans Huber. Italian translation: The language of change: elements of therapeutic communication . Milan: Feltrinelli, 1980.

Weakland, J. H. & Ray, W. A. ​​(eds.) (1995). Propagations: Thirty years of influence from the Mental Research Institute . New York: Haworth Press.

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