The clinical model

BRIEF STRATEGIC THERAPY, GIORGIO NARDONE'S MODEL

The short strategic approach to therapy is evidence based (Szapocznik et al., 2008, Castelnuovo et al., 2010, Gibson et al., 2016, Lock, 2002, 2009, 2010, Nardone, Salvini, 2013, Robin et. Al., 1994, 1999) and is recognized as best practice for some important psychopathologies: obsessive compulsive disorder, binge eating, juvenile anorexia, panic attacks, family violence and antisocial behavior.
In particular the model, formulated by Paul Watzlawick and evolved by Giorgio Nardone (Brief strategic therapy, Giorgio Nardone's 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 (Nardone, Balbi, 2015).

The epistemological basis of the evolved model are radical constructivism (E. von Glasersfeld, H. von Foerster), systems theory (E. von Bertalanffy), pragmatics of communication (P. Watzlawick, Beavin, Jackson), strategic logic (J. Elster, N. Da Costa, G. Nardone) and modern game theory (J. von Neumann).

WHAT SHORT STRATEGIC PSYCHOTHERAPY IS AND HOW IT WORKS

The central operational construct is that of "attempted solution that feeds the problem"Formulated by the group of researchers of the MRI (Mental Research Institute) of Palo Alto (1974), which later evolved into that of a perceptive-reactive system by Giorgio Nardone and which identifies everything that is implemented by the person and / or by the system around the person to manage a difficulty and which, repeated over time, maintains and feeds the difficulty leading to the structuring of a real disorder.
However, the pragmatic tradition and the philosophy of stratagems as the key to strategic problem solving boast an older history. Strategies that seem modern can be traced, for example, in the persuasive art of the Sophists, in the ancient practices of Zen Buddhism and in the Chinese art of stratagems, as well as in the ancient Greek art of métis.

One of the distinctive features that distinguishes brief strategic therapy 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.

This dysfunction is supported by a self-perpetuating dynamic, not based on specific biological characteristics, nor driven by obscure impulses embedded in the unconscious, nor even as a simple result of faulty learning. Rather, it is the result of the exasperation and rigidity of adaptive strategies that transform into maladaptive ones—that is, "attempted solutions" that have proven effective for certain problematic situations, which ultimately serve to maintain and complicate the problem rather than resolve it. But precisely because they initially work, these solutions form the basis for their repeated application, until the pathology actually develops. Therefore, therapeutic intervention will consist of maneuvers capable of interrupting these counterproductive vicious cycles . For these maneuvers to be effective, they must be aimed at subverting the problem's internal logic, redirecting it toward its solution.

For this reason the strategy must, as the "game theory" teaches us, fit the internal rules of the game in progress and, as the strategic logic indicates, it must be composed of a series of tactics and techniques specifically created or adapted to lead to victory. This means analyzing a psychopathology as a problem to be solved, and not as a disease to be cured in the biological sense of the term.
Another fundamental aspect of brief strategic psychotherapy aimed at breaking the specific pathological rigidity of the disorder or problem presented is given by the construct of corrective emotional experience formulated by Franz Alexander in 1946 on the basis of an example taken by another great therapist, Balint, who narrates in one of his books, The basic Fault, like a patient of hers with a phobia of not being able to do a somersault on the ground and therefore suffering from the fear of falling or losing her balance, she recovered suddenly when one day tripping over the carpet of her study and rolling on the ground a splendid somersault getting up promptly.

The construct indicates that therapeutic change can only be achieved after corrective emotional experiences that concretely enable the subject to experience the ability to cope with 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 thus inducing them to concretely experience therapeutic change—that is, enabling the patient to effectively alter their perception of the things that were driving them into pathological reactions. In this regard, it seems 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.

This is what has been pursued since the second half of the 1980s at the Strategic Therapy Center in Arezzo, which has led to the development of specific treatment protocols for most forms of mental and behavioral disorders. The efficacy and efficiency of the therapeutic strategies and stratagems specifically tailored for different pathologies, and their replicability, have led us to gain effective and empirical knowledge of the workings of these dysfunctional balances. All this explains the seemingly paradoxical statement: solutions explain problems.

RESULTS OF EFFECTIVENESS AND EFFICIENCY OF SHORT STRATEGIC PSYCHOTHERAPY

The results show that the positive outcomes of the application of the model are attested in 88% of cases treated with even higher efficacy for phobic-obsessive disorders where it reaches 95%.
The efficiency relative to the complete recovery from the disorder (which includes three follow-up meetings) stands at an average of 7 sessions for the entire treatment. If, on the other hand, we consider the elimination of the disabling disorder, or the release of the symptoms, in the totality of the sample it was achieved within the first 4 sessions, or 2/3 months from the beginning of the therapy.
Effectiveness results of the treatment protocols:

• 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 (77% of cases)

As you can well understand, the fact that psychopathologies can be decidedly painful and persistent for years does not mean that therapy must be equally painful and prolonged . In the words of William Shakespeare, we like to remember, "there is no night that does not see the day."