EPISTEMOLOGY AND THEORY OF THE SHORT STRATEGIC THERAPY MODEL
The brief strategic approach to therapy is evidence based (Szapocznik et al., 2008) and is recognized as a best practice for some important psychopathologies. The model, formulated by Paul Watzlawick and evolved by Giorgio Nardone (Brief strategic therapy, Giorgio Nardone Model), as well as being empirically and scientifically validated (Nardone, 2015; Pietrabissa, Gibson, 2015; Nardone, Salvini, 2014; Castelnuovo et al., 2011; Watzlawick, 2007; Jackson et al. 2018) in the span of over 25 years, has led, as evidenced by the numerous publications that have sprung from it, (see annotated bibliography), to the formulation of advanced short therapy protocols, composed of innovative techniques built ad hoc to unlock the particular types of persistence of the most important psychic and behavioral pathologies.
The epistemology of reference is the constructivist-interactionist one as expressed in the collection of essays created by Paul Watzlawick in 1981, The invented reality in which the most important authors of this perspective participated: Von Förster, Ernst Von Glasersfeld, Jhon Elster etc. This is a theoretical position that distances itself from any form of determinism and reductionism, just as it emancipates itself from any strong theory that has self-immunizing constructs (Popper 1972) and which is instead based on the interaction-strategic paradigm of the Palo Alto School. This leads to opting for an "operational pragmatism" (Salvini, Nardone) where effectiveness represents the only form of truth. The theory itself is confirmed or not by the application of its operational constructs.
The research methodology will therefore also be of an empirical type, in the field and not based on the methods and criteria of an aseptic laboratory, or rather the Lewinian method of research-intervention evolved and adapted to the clinical field. The other fundamental aspect characterizing our reference theory is, as explained in detail below, the use of models of mathematical logic and linguistic predicates that go beyond classical rational logic, which does not fit the phenomena of the interaction between mind and mind, the paradoxical, contradictory dynamics and the apparently absurd beliefs, which support psychopathological perceptions and reactions.
All this makes our model of brief strategic psychotherapy completely original, right from its assumptions, an epistemological technique and the resulting operative constructs.
THE SHORT STRATEGIC PSYCHOTHERAPY MODEL
From the very first meeting with the patient, the model is geared towards change; in fact, a classic diagnosis procedure is not used, but an advanced diagnosis-intervention technique: the strategic dialogue. This protocol for conducting the first interview allows to transform, through a sequence of specific techniques (strategic questions, restructuring paraphrases, evocative formulas and the final prescriptions), into a research-intervention process that leads patient and therapist to the joint discovery of the "how "The problem works and the" how "can be solved.
On the basis of this, at the end of the first session the therapeutic indications appropriate to the presented disorder are prescribed.
At the following interview, the effects produced both by the therapeutic dialogue and by the prescriptions to be implemented will be evaluated.
Depending on the results, we proceed to the next phases of the model if these were positive, otherwise we analyze what did not work, re-adjusting the therapy based on the responses to the maneuvers applied.
The focus of a strategic brief psychotherapy is the restructuring and change of the patient's rigid perceptions that induce his pathological reactions. To achieve this, the intervention is aimed at interrupting the vicious circle between the failed solution attempts implemented by the patient that feed the disorder and its persistence sustained precisely by such counterproductive reactions. Therefore, the dysfunctional "attempted solutions" must be replaced with others capable of breaking the pathological balance and transforming them into healthy and functional ones.
Therapeutic strategies and stratagems adapted to the problematic situation and to the specific form of expression of the disorder. As already mentioned, the number of therapeutic techniques developed and formalized by Giorgio Nardone and his collaborators that cover most of the forms of pathology encountered in psychotherapy is abundant. Parallel to these strategies and stratagems, particular forms of therapeutic communication have been developed over the years, capable of circumventing the resistances to change typical of every human system, in particular "performative" communication, the language that makes you 'feel' as well as understand and 'injunctive' communication, or suggestive language to prescribe actions or thoughts that the patient would usually oppose.
This is what Paul Watzlawick called "trance-free hypnotherapy". If the therapeutic intervention produces the desired effects, they proceed to the consolidation phase through a process of redefining the changes made and the resources and abilities that the patient has shown he can put into play. All with the aim of guiding him to the conquest of complete autonomy and personal independence. For this purpose, each technique used is also elucidated in such a way that the now former patient can treasure it for his future.
METHODOLOGY OF THE AREZZO SCHOOL
The basic idea, since first research project on phobic-obsessive disorders, in 1985, was to make general models of therapy evolve towards specific intervention protocols for particular pathologies, that is, predetermined sequences of therapeutic maneuvers with heuristic and predictive power, capable of guiding the therapist to break, through particular therapeutic stratagems, of specific pathological rigidity and their restructuring in functional modalities of perception and reaction towards reality.
For the purpose of this project, not only the theoretical, applicative and research tradition of brief therapy of the Mental Research Institute of Palo Alto was used, which appeared as a criterion for the development of an evolved rather artisanal and rudimentary model, but a new rigorous methodology of research-intervention in the clinical field of an experimental empirical type, in line with the advanced research typical of physics and the most advanced applied sciences, based on the assumption that it is the "solutions that explain the problems and not the hypothetical explanations that lead to solutions ".
The Model was thus established on the basis of the criteria of:
- Effectiveness: the ability of the intervention to achieve the set goals. In our case, the extinction of the ailments presented by the patient;
- Efficiency: the ability to produce results in a reasonably short time. In our case, a therapy must give results of improvements from the first sessions and must lead to the solution of the problem within 3-6 months. After all, as the research literature indicates that 50% of the disorders can be resolved within 10 sessions, 25% of the disorders can be brought to extinction with a therapy that does not exceed the duration of 25 sessions. Only the remaining 25% of cases require more prolonged therapy over time. (MA Hubble, BL Duncan, SD Miller, "The Heart and Soul of Change“, American Psychological Association, Washington, 1999);
- Replicability: the property of a therapeutic technique that it can be applied to different people who have the same type of disorder;
- Predictivity: for each single therapeutic maneuver the effects must be predicted in order to correct the unwanted ones during the therapeutic process.
- Transmissibility: the characteristic of a model that it can be learned and applied by different people, that is what makes a therapeutic technique a teaching subject for psychotherapy.
In addition to this, non-ordinary formulations were taken from mathematical logic, capable of using self-deception, belief, paradox and contradiction, as structural elements of rigorously constructed Logical models (Newton Da Costa, Nardone).
In other words, through the contribution of formal logic, creative therapeutic stratagems, based on non-ordinary logic, could become formalized tools within intervention models that proved effective and replicable.
All this has led to safeguarding both creativity and systematicity in the development of therapeutic strategies. This work, of empirical study for the constitution of therapeutic sequences applied to thousands of cases, over the span of over 25 years, has led, as evidenced by the numerous publications that have emerged, (see annotated bibliography), to the formulation of evolved protocols of brief therapy, composed of innovative techniques built ad hoc to unlock the particular types of persistence of the most important psychic and behavioral pathologies.
These treatment protocols have proved capable of resolving some relevant forms of pathologies, such as obsessive and compulsive phobic disorders and eating disorders, with a higher rate of effectiveness and efficiency than any other psychotherapy. (Nardone-Watzlawick 1997, Nardone-Watzlawick 2005, Castelnuovo et. Al 2011. Nardone, Ranieri Brook 2011, Nardone-Salvini 2013).
Lastly, the laborious research-intervention in the clinical field also led to new assumptions regarding both the structure of Problem Solving procedures and the characteristics of therapeutic communication, in their development phase by phase, from the first steps to the conclusion of the therapy. Another fundamental characteristic of the brief strategic therapy model is that, in line with the strategic logic (specialized branch of mathematical logic), the therapeutic intervention is constituted not on the theory assumed upstream by the therapist but on the basis of the objective to be achieved. and the characteristics of the problem to be solved.
Therefore the starting assumption is the renunciation of any normative-prescriptive theory, including the systemic theory from which in some respects the brief therapy is derived. It is believed, in fact, that any theory assumed a priori functions in any case as an “implicit” judgment (Salvini, 1991) or as a misleading prejudice for the development of effective solutions. On the contrary, fitting the intervention to the prerogatives of the problem and to the objective to be achieved leads to the construction of a well-focused strategy which will then have to “self-correct” in its interaction with the problem. In other words, the strategy adapts tactic after tactic to the responses deriving from the interventions implemented: as in the game of chess, we proceed with an opening followed by moves that follow one another on the basis of the opponent's game.
If the opponent's strategy, that is the way the disturbance persists, appears among the well-known ones, a formalized sequence of checkmate can be attempted in a few moves, that is a specific treatment protocol. The measurement of the effects, in this case, will not only be between the beginning and the end of the therapy, but will be aimed at each single phase of the therapeutic process, since, as in a rigorous mathematical model, the possible responses to each individual are hypothesized. maneuver, which are then verified, through empirical-experimental practice. This methodology leads to reducing these response possibilities to a maximum of 2 or 3 for each single intervention, thus allowing the subsequent move to be constructed for each of these response variants. Then, we proceed with a process measurement of the effects and predictive value of each individual maneuver and not just of the entire therapeutic process.
RIGOR BUT NOT RIGIDITY
"Rigor alone is death by asphyxiation but creativity alone is madness"
Everything stated in the previous paragraph is valid for the study of the structure of the intervention and for its constitutive logic, another discourse must be made, however, for the adaptation of the intervention to every single person, family and socio-cultural context. Since in this regard, every control and "predictive" criterion jumps. As Milton Erickson already stated, in fact, each individual has unique and unrepeatable characteristics, just as his interaction with himself, others and the world always represents something original.
Consequently, every human interaction, even the therapeutic one, turns out to be unique and unrepeatable, within which it is up to the therapist to adapt his own logic and language to that of the patient, thus proceeding in the investigation of characteristics of the problem to be solved, up to the detection of its specific persistence mode. Once the peculiarities of the persistence of the problem have been identified, he will be able to use the problem solving logic that appears most suitable, following the model described above in its constitution and application, but formulating every single maneuver adapting it to the logic and language of the patient. In this way, in reality, the therapeutic intervention maintains its ability to adapt to the singularities of each new person and situation, while also maintaining strategic rigor at the level of the intervention structure.
To make this important concept even clearer, it is good to underline that what can be prefixed is the strategy, at the intervention structure level, which adapts to the structure of the problem and its persistence; what always changes is the therapeutic interaction, the relationship with the patient and the type of communication used. Therefore, even when a specific treatment protocol is adopted, as in the case of phobic-obsessive disorders and the variants of eating disorders, each maneuver is always different but always remains the same, since this changes in its communicative explication and in its adaptation to the person, but the same maneuver remains at the level of the strategic problem solving procedure. As the ancient strategic wisdom shows us “always change to stay the same”.