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 peculiarities that distinguish brief strategic therapy 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.
This dysfunctionality is supported by a dynamic that feeds itself, and not on the basis of certain biological characteristics, nor driven by obscure impulses nested in the unconscious and not even as a simple result of wrong learning, but as an effect of exasperation and the stiffening of strategies adaptive that turn into maladaptive, or "attempted solutions" proved effective with respect to certain problematic situations, which are converted into what maintains and complicates the problem rather than solving it. But precisely because they work at the beginning, these solutions constitute the foundation of the repeated application, up to the actual construction of the pathology. Therefore the therapeutic intervention will be represented by maneuvers capable of stop such counterproductive vicious circles. For these maneuvers to be effective, they must be aimed at subverting the logic inside the problem by reorienting it towards 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 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 Jhon 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.
This is what has been carried out since the second half of the XNUMXs at the Strategic Therapy Center in Arezzo and which has led to the creation specific treatment protocols for most forms of psychic and behavioral disorders. 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.
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 can be understood, the fact that psychopathologies can be decidedly suffered and persisted for years does not mean that the therapy must be equally painful and prolonged over time . In the words of William Shakespeare we like to remember, “there is no night that does not see the day”.