Brief history of Brief Strategic Psychotherapy

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

It all starts here: The Mental Research Institute (MRI) was born in Palo Alto in September 1958 thanks to the insights of Donald D. Jackson, a brilliant and inventive psychiatrist, who founded an institute dedicated to studies on systemic interactional processes, that is, studies on the mutual influence, action and reaction, in the communication between people. A real novelty: from the study of the symptom to the study of the role of human communication in psychic distress and mental illness. DD Jackson collaborates with Gregory Bateson, an anthropologist, who moves his studies from ethnology to the epistemology of communication. Cybernetics, a new multidisciplinary subject, brings new tools to study the interactive systems of which human communication is part. They are the two leading figures who saw in the phenomena of communication the key and the explanation of all human behavior. In 1962 the “Family process” magazine was founded, of which DD Jackson and J Haley were the 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 at the Mental Research Institute the Brief Therapy Center by clinicians and multidisciplinary researchers who were already collaborating with Il 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 becomes famous all over the world thanks to the studies published in the book "The Pragmatics of Human Communication" (1967) by Paul Watzlawick, JH Beavin, DD Jackson, the bible for those who deal with effects, pragmatics, that is concrete, of communication in people. How to things are said, that is, how whoever communicates creates different effects in whoever receives the communication. It is everyone's experience not to feel hurt by those who, with attention, are able to tell us unpleasant things and instead react impulsively with those who communicate nonsense to us like being solicited with a horn at a traffic light….

The revolution of those years was the construct of Dysfunctional Solution Attempted, elaborated at the Brief Therapy Center of the Mental Research Institute in Palo Alto: it refers to the tendency of people to repeat the same attempts at solution despite being proving ineffective. In other words, every unsuccessful attempt at a solution, if repeated over time, consolidates, instead of solving, the initial problem; replacing the original causes to become itself the cause of the persistence of the problem. The way of observing the psychological problem changes, from the search for the root cause (etiology) to the study of the process - thoughts, actions and reactions - that maintains dysfunctionality until it becomes pathology. We can elegantly describe this paradox in 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 became ever closer until the joint foundation of Strategic Therapy Center of Arezzo as Research, training and psychotherapy institute, for the development and evolution of the model of the Palo Alto School towards a more advanced therapeutic technology, which fit the specific forms of psychopathology. That is, 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.

All this gave rise to what will later be the modern evolution of Brief Strategic Psychotherapy, presented to the general public in 1990 through the publication, manifesto of the evolved approach, “The art of change. Manual of strategic therapy and trance-free hypnotherapy ”, written by Giorgio Nardone and Paul Watzlawick, 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 of the Brief Strategic Psychotherapy model of Arezzo, already active since 1988, is recognized by the Ministry of Education, University and Research (MIUR) as Four-year School of Postgraduate Specialization in Brief Strategic Psychotherapy (Ministerial Decree 20.11.2000).

One of the peculiarities that distinguish brief strategic psychotherapy from traditional forms of psychotherapy is that it allows to develop interventions based on pre-established objectives and on the specific characteristics of the problem in question, rather than on rigid and preconceived theories. Furthermore, every type of pathology is conceived not as a biological disease to be cured, but as a dysfunctional equilibrium to be transformed into functional.

Another fundamental aspect of brief strategic psychotherapy is to break the specific pathological rigidity of the disorder or problem through thecorrective emotional experience. The construct, formulated by Franz Alexander in 1946, indicates that therapeutic change can only be achieved after corrective emotional experiences that concretely make the subject experience that he can cope with what he believes he is unable to do. This example gives credit to another therapeutic concept learned from the masters Paul Watzlawick and John Weakland, that of scheduled random event, or the idea that in order to effect rapid and concrete therapeutic changes, communicative maneuvers or elaborate prescriptions were necessary to create corrective experiences in the patient's life that appeared random to him while in reality they are stratagems planned by the therapist.

The solution of the problem, through brief strategic psychotherapy is therefore represented by strategies and tricks able to make the person change his own attempted dysfunctional solutions and, thanks to this, induce him to concretely experience the therapeutic change; that is, to make the patient actually modify the perception of the things that forced him to pathological reactions. In this direction it appears fundamental to differentiate, for each form of psychopathology, the logical models of the dysfunctional interaction that feed their formation and persistence, and along the same line to build models of strategic logic of the solution intervention. The effectiveness and efficiency of the therapeutic strategies and stratagems built ad hoc for the different pathologies and their replicability then led us to have an effective and empirical knowledge of the functioning of these dysfunctional balances. All this explains the apparently paradoxical statement: the solutions explain the 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 the protocols - that is, guidelines in the various phases of therapy available to the clinician for the treatment of psychopathology, demonstrate their effectiveness, efficiency and replicability. They are taught with rigor at the Quadrennial Specialization School and are continuously validated by over one hundred researchers who apply them all over the world and subject to continuous monitoring and adjustment under the direction of prof. Giorgio Nardone. The use of protocols has become the yardstick for evaluating effectiveness and efficiency psychotherapeutic interventions both in clinical practice and as an experimental tool. The validation can now also be positively confirmed as transcultural, as the various Brief Strategic Therapy Centers Nardone's model arose in the United States, Spain, Ireland, France, Belgium, Romania, Russia, Paraguay, Colombia, Mexico, Costa Rica, Argentina and Chile , confirm equivalent efficacy percentages updated to 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

So our roots are at the Mental Research Institute and at the Brief Therapy Center, but the Strategic Therapy Center of Arezzo has become the crown of a majestic tree, with an important theoretical-operational model, nourished by studies of logic, cybernetics and problem solving , definitely different from the original. From the study of the redundancies of the Attempted Dysfunctional Solutions of the MRI to the protocols studied at the CTS, supported by therapeutic stratagems suitable to unblock the patient's dysfunctional perception with reality. Furthermore, another discriminating feature with respect to MRI is the particular importance of the consolidation process of the therapeutic process: once the pathogenic balance is broken we must rebuild another functional one, developing in the patient an awareness of his own resources. The patient must feel that he has been able to free his mind from his prisons. A complex, operationally clear model: Advanced Brief Strategic Psychotherapy Nardone's model based on "operational pragmatism" (Nardone & Salvini, 2013) where effectiveness is 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

Il Strategic Problem Solving Model it is an operational method for making changes and achieving set goals even in non-clinical contexts. A new branch of empirical-operative research called Performance Science, an original synthesis of psychology, neuroscience and short-term strategic therapy that deals with enabling the performer to improve, reach and exceed the performance, be it a sportsman, an artist, a scientist or a manager, etc.

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 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: Handbook of hypnosis without trance. Milan: Ponte alle Grazie.

Watzlawick, P., Beavin, JH & Jackson, DD (1967). Pragmatics of human communication: a study on interactional patterns, pathologies and paradoxes. New York: Norton. Trad. It .: Pragmatics of human communication. Rome: Astrolabe, 1971.

Watzlawick, P., Weakland, JH & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. New York: Norton. Trad. It .: Change: Training and problem solving. Rome: Astrolabe, 1974

Watzlawick, P. & Weakland, JH (eds.) (1974). The Interactional View: Studies at the Mental Research Institute, Palo Alto, 1965-1974. New York: Norton. Trad. It .: The relational perspective: The contributions of the Mental Researc Institute in Palo Alto from 1965 to 1974. Rome: Astrolabe, 1978.

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

Weakland, JH & Ray, WA (eds.) (1995). Propagations: Thirty years of influence from the Mental Research Institute. New York: Haworth Press.

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