The clinical model

THE BRIEF STRATEGIC THERAPY, GIORGIO NARDONE’S MODEL

The brief strategic approach to therapy is evidence-based (Szapocznik et al, 2008) and it is recognised as best practice in relation to some major psychopathologies. The model, formulated by Paul Watzlawick and developed by Giorgio Nardone (Brief strategic therapy, Giorgio Nardone’s Model), has been empirically and scientifically validated (Nardone, 2015Pietrabissa, Gibson, 2015Nardone, Salvini, 2014Castelnuovo et al. 2011Watzlawick, 2007) and it was registered as original invention at the World Intellectual Property Organization (WIPO) and it is a registered trademark.
The epistemological bases of this advanced 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).

The central operational construct is “the attempted solution feeds the problem” formulated by the MRI’s (Mental Research Institute) researchers in Palo Alto (1974) and later evolved into the construct of perceptive-reactive system developed by Giorgio Nardone. It identifies everything that is implemented by the person and/or around the person in order to manage a problem and, when repeated over time, it maintains and feeds the problem and leads to the structuring of a real disorder.
However, the pragmatic tradition and the philosophy of stratagems as a key to strategic problem solving have a much more ancient history. For example, strategies that still seem modern can be found in the persuasive arts of the Sophists, in the ancient practices of Zen Buddhism, in the Chinese Arts of Stratagems, as well as in the ancient Greek art of Metis.

One of the peculiarities that distinguish brief strategic therapy from more traditional forms of psychotherapy is that it allows therapists to develop interventions based on pre-established objectives and on specific characteristics of the problem, rather than on rigid preconceived theories. Moreover, every type of pathology is conceived not as a biological disease to cure, but as a dysfunctional equilibrium that needs to be converted in a functional one.

This dysfunctionality is supported by a self-feeding dynamic, and not by specific biological characteristics, nor it is pushed by unconscious drives nested in the unconscious and neither it is a simple result of incorrect learning. A dysfunctionality is the effect of the exasperation and hardening of adaptive strategies that become maladaptive, that is, “attempted solutions” proven effective in certain problematic situations, which become what keeps and complicates the problem rather than solve it. But precisely because they initially work, these solutions form the basis of their repeated application up to the proper construction of a pathology. Therefore, the therapeutic intervention consists of manoeuvres capable to interrupt these counter-productive vicious circles. In order for these manoeuvres to be effective, they must aim at subverting the internal logic of the problem and direct it towards its solution.

For this reason, as suggested by the “game theory”, the strategy must fit the rules of the ongoing game. Moreover, as indicated by strategic logic, it must be composed of a series of tactics and techniques which are specifically created or adapted to lead to victory. This means that a pathology needs to be analysed as a problem to solve, and not as a disease to be cured in the biological sense of the term.

Another central element of brief strategic therapy, aiming at breaking the specific pathological rigidity of the disorder or the problem presented, is the construct of corrective emotional experience. This construct was formulated by Franz Alexander in 1946 and based on an example taken from another great therapist, Balint. In one of his books, The basic Fault, Balint writes that one of his patients with a phobia of not being able to do somersaults, and for this reason affected by the fear of falling or losing her balance, had a sudden recovery when one day she stumbled into the carpet of his studio, did a splendid somersault by rolling on the ground, and picked herself up immediately.

The construct indicates that therapeutic change can take place only after corrective emotional experiences that allow subjects to concretely experience that they can cope with what they believe they are not capable of doing. This example gives credit to another therapeutic concept learned from the masters Paul Watzlawick and John Weakland, the planned random event — the idea that, in order to obtain concrete and quick changes, communicative manoeuvres or elaborated prescriptions are necessary, so as to create corrective experiences in patients’ life which appear random to them but that are actually stratagems planned by the therapist.

Therefore, the solution to a problem through brief strategic therapy is represented by strategies and stratagems that can make people change their own attempted dysfunctional solutions, and thanks to this, lead them to concretely experience a therapeutic change, that is, make sure that the patient actually modifies the perception of things that forced him to pathological reactions. In this context, it appears crucial to differentiate, for every form of psychopathology, the logic models of dysfunctional interaction that feed their formation and persistence, and along the same lines, to build models of strategic logic for corrective interventions.

This is what has been brought forward since the second half of the 1980s at the Centro di Terapia Strategica of Arezzo and which led to realise specific treatment protocols for most of psychological and behavioural disorders. The effectiveness and efficiency of the therapeutic strategies and stratagems that were built “ad hoc” for the various pathologies and their replicability led us to have an actual and empirical knowledge of the functioning of these dysfunctional balances. All this explains the seemingly paradoxical statement: the solutions explain the problems.


EFFECTIVENESS AND EFFICIENCY RESULTS OF BRIEF STRATEGIC THERAPY

The results indicate that 88% of cases treated with this model had a positive outcome. Phobic-obsessive disorders showed an even higher efficacy (95%).
The efficiency concerning the complete recovery from a disorder (which includes three follow-up meetings) indicates an average length of seven sessions for the entire treatment. However, if we consider the elimination of the crippling disorder — that is, the unblocking of the symptomatology, this was achieved within the first 4 sessions in the totality of the sample, which means 2/3 months after the beginning of the therapy.

Efficacy of treatment protocols:

  • Phobic and anxiety disorders (95% of cases)
  • Obsessive and obsessive-compulsive disorders (89% of cases)
  • Eating disorders (83% of cases)
  • Sexual dysfunctions (91% of cases)
  • Mood disorders (82% of cases)
  • Childhood and adolescence disorders (82% of cases)
  • Internet addiction disorders (80% of cases)
  • Presumed psychosis, borderline and personality disorders (77% of the cases)

How it can be well understood, although some pathologies could have been persisting and a source of suffering for years, the therapy is not necessarily just as painful and lasting for a long time. In that regard, we like to remember William Shakespeare’s words: “there is no night that does not find the day”.

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