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The Strategic Clinical Model In Psychotherapy: Theoretical And Practical Profiles

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Giulio Perrotta at Marche Polytechnic University
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This work deals with the analysis of the theoretical and practical profiles of the strategic clinical model in psychotherapy, starting from the examination of the historical and evolutionary contents of this particular model, passing through the main theories and techniques used in the clinic.
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Journal of Addiction and Adolescent Behaviour
Giulio Perrotta
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The Strategic Clinical Model In Psychotherapy: Theoretical And Practical Profiles
Giulio Perrotta
Director of the Department of Criminal and Investigative Psychology UNIFEDER, Italy.
Corresponding Author: Giulio Perrotta, Director of the Department of Criminal and Investigative Psychology UNIFEDER, Italy. E-mail:
giuliosr1984@hotmail.it
Received date: January 30, 2020; Accepted date: February 02, 2020; Published date: February 06, 2020
Citation: Giulio Perrotta (2020), j Addi Adol Beh 3(1) The Strategic Clinical Model In Psychotherapy: Theoretical And Practical Profiles Doi:
10.31579-007/2688-7517/016
Copyright: ©2020 Giulio Perrotta This is an open-access article distributed under the terms of The Creative Commons. Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract:
This work deals with the analysis of the theoretical and practical profiles of the strategic clinical model in psychotherapy,
starting from the examination of the historical and evolutionary contents of this particular model, passing through the main
theories and techniques used in the clinic.
Keywords: psychotherapy; theoretical and practical profiles
1. Introduction. Historical contexts and
epistemiological profiles
The strategic model originates from the systemic psychological current,
which refers to that complex of hypotheses and researches able to
overcome the perspective centered exclusively on the individual typical
of traditional psychology. It is a current that refers to von Bertalanffy's
"general systems theory" (1901-1972) and cybernetics for the study of
psychological communication. The main authors who founded this
orientation, starting in the late 1950s, were all members of the Mental
Research Institute in Palo Alto (California, United States of America),
including the constructivists Watzlawick (1921- 2007) and Bateson
(1904-1980), with their theories on language and groups, and inspirers
with M. Erikson (1901-1980), the true father of the strategic current.
[1]
The epistemological basis [2] of the evolved model is therefore the:
1) the "radical constructivism" by von Glasersfeld and von Foerster.
It is an unconventional approach to the problem of knowledge and
knowing. It starts from the assumption that knowledge, regardless of
how it is defined, is in people's heads, and that the thinking subject
has no alternative: he can only build what he knows based on his
own experience. What we understand from experience constitutes
the only world in which we know we live. The fundamental
principles of its radical constructivism are proposed in four points: a)
knowledge is not received passively either through the senses or
through communication; b) knowledge is actively constructed by the
"knowing" subject; c) the function of knowledge is adaptive, in the
biological sense of the term, and tends towards adaptation or
"viability"; d) knowledge serves the organization of the experiential
world of the subject, not the discovery of an ontologically objective
reality. The strategic approach therefore does not present itself as an
absolute truth but as a model that offers different truths according to
the different realities, as the perceived reality depends on multiple
conditioning factors that determine a never objective reality. This is
why there is no single reality, unique, unchanging but many realities
determined by the various relationships between us and the rest of
the world. Radical constructivism is therefore interested in the
"how" we know reality and live it and less in the "why" (albeit
important to fully investigate each profile). What people call
"reality" is the result of communication between us. Reality is
therefore the result of how we communicate about what is around us.
Communication becomes a tool to organize actions, through
communication, recognizing the ways in which people build their
own reality (perceptive / reactive system) and find the resources to
reshape the dysfunctional reality and identify the parts of themselves
to be integrated. Radical constructivism teaches us how there is no
truth or one real world. Accepting that there are different versions of
reality and the world, as many as there are people, allows the
therapist to always be on the patient's side, an active builder of his
own reality, his beliefs and his values.
2) the “systems theory” by von Bertalanffy, Luhmann, Crozier,
Friedberg, Homans, Blau and Emerson. The general theory of
systems uses the mathematical concept of function (interdependence
relationship between different variables) on the basis of which it
examines the relationships that are actually established between the
different elements of the considered system. The term system refers
to a complex reality whose elements interact with each other,
according to a circularity model according to which each element
conditions the other and is in turn conditioned by it. The meaning of
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each individual element should therefore not be sought in the
element itself, but in the system of relations in which it is inserted.
The system should therefore not be understood as something that
exists in reality, but rather as a theoretical elaboration, on the basis
of which it is possible to account for certain phenomena. The
consideration of the phenomena in their reciprocal relationship
makes the systems not something static, but in constant evolution (or
involution) dynamic. It should be noted that this dynamic is
particularly present in systems in which relations with the
surrounding environment are more frequent (open systems). The
new instances that gradually arise in the environment give rise to
dynamic variations that tend to bring the whole to a situation of new
equilibrium. Since social systems are constituted on the basis of a
shared sense, the analysis of communicative processes is essential as
part of social research itself.
3) 3) the "Mental Research Institute". Starting from the studies of
Milton Erikson (1930), Weakland et al. found MRI in Palo Alto
(California), with the aim of studying the human mind. In the early
70s of the last century, Haley founded a strategic family studies
office in Washington, while Watzlawick et all. offers new lifeblood
to the Palo Alto institute, with contributions aimed at communicative
processes. In particular, each communication process between
human beings has two distinct dimensions, namely the content (what
the words say) and the relationship (what the speakers allow us to
understand, both verbally and otherwise, on the quality of
relationship between them). In 1971 the author published a text
entitled "Pragmatics of human communication": a study of
interactive models, of pathologies and paradoxes, going so far as to
claim that" neuroses, psychoses and in general forms of
psychopathology do not arise in the isolated individual, but only in
the interaction between the people who communicate, according to
the social and cultural context of reference. This theoretical
elaboration generates five axioms: a) one cannot fail to
communicate. Silence, for example, is also communication; b) each
communication has one aspect of the content and one of the
relationship, the second defines the first: as happens with the
differences that can give the tone of voice, for example, the same
word can be defined differently by different ways of relationship ; c)
the nature of a relationship depends on the punctuation of the
communication sequences between the communicants and each
influence of the communicative action and the s influenced by the
verbal and not-verbal behavior of the interlocutor; d) human beings
communicate both with the verbal (numerical) and with the non-
verbal (analogical) form, therefore the language, in "digital",
generally concerns the aspect of the content. Not-verbal modalities,
on the other hand, generally concern the relational aspect; e) all
communication exchanges are symmetric or complementary: they
are symmetric between people who have similar roles;
complementary between people who do not have the same role and /
or the same power. Between the 1980s and 1990s, other authors
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contributed: 1) De Shazer, in Milwaukee, focused on solution-
oriented strategic therapy; b) Haley (Washington), also with the
contributions of Madanes and Rabkin, focuses on strategic therapy
applied to family and group contexts; c) Fisch, Witezaele-Garcia and
Nardone are formed from Watzlawick, which focus on strategic short
techniques and on the importance of a clinical approach. [4]
4) the “modern game theory” by von Neumann and Morgenstern.
Game theory is a mathematical theory that serves to describe the
rational choices that players make when they are in a situation where
they have to interact strategically, that is, when a player can
influence the behavior / result of another player. Game theory is
based on mathematical models, a simplified representation of reality
to understand how interested parties behave based on the
information they have to develop a strategy. These analyzes allow us
to understand, and to some extent predict and condition, the
evolution of a process such as a trivial chess game or the complex
functioning of the stock market. Game theory has a distant origin
that has its roots in 1654 in a correspondence of Pascal and de
Fermat. The modern birth, however, can be traced back to the
release of the book "Theory of games and economic behavior" by
von Neumann and Morgenstern in 1944. The one who during the
twentieth century made the greatest contribution to this fascinating
theory is Nash, American mathematician, to whom the film starring
Crowe is dedicated. It is essentially a theory that attempts to define
and give a concrete explanation to the behavior of people when they
are in a situation that can lead to the division of an object of desire
or to the latter's victory by one. Before hypothesizing a situation to
understand in detail what we are talking about, we must specify
some assumptions that cannot be missing in order to apply the
theory. Those who participate in the "game" must play to win and
maximize their winnings. The situation requires a finite number of
decisions that can be taken by the participants, each decision made
has positive or negative (not-neutral) implications, the game can be
cooperative or not-cooperative. The best strategy, to be implemented
in situations such as poker, is to minimize the maximum possible
loss, everything is explained in the "minimax theorem": you need to
define and imagine the worst possible scenario.
5) the “constructivist approach” by Kelly, which develops a
psychological theory on the assumption that a person's activities are
psychologically channeled by the ways in which he anticipates
events, and these anticipations, which Kelly calls "constructs", are
verified through a behavior capable of validating or invalidating
them. From these assumptions, and from the conception (shared with
the constructivist model) of knowledge / knowledge as a subjective
construction, the Psychology of Personal Constructs is developed,
the purpose of which is to get to know the meaning and value that
people attribute to their experience, and the ways in which they
develop their knowledge and use it in subsequent experiences,
anticipating the facts. To anticipate events in a more useful way,
each person develops, with particular characteristics, a construction
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system that involves ordinal relationships between the constructs
(corollary of the organization). This means that constructs are
ordered hierarchically: those that refer to more central and nuclear
dimensions and that respond to the "why" fundamental for their
existence are placed at the top. Those that refer to concrete
dimensions and that represent the "visible manifestation" of one's
why are placed in peripheral position. [5]
The strategic logic [1] is based on these theoretical foundations. The
short strategic approach to therapy is evidence based 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 Watzlawick (Brief strategic therapy) and evolved by
Nardone (Giorgio Nardone's Model), as well as being empirically and
scientifically validated (Nardone, Gibson, Salvini, Castelnuovo) for
almost thirty years, has led, as evidenced by the numerous publications
resulting from this, 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). This model has four specific
phases: knowledge of the problem and attempted solutions, definition of
the objectives to be achieved, behavioral prescriptions and specific
techniques and strategies, conclusion of the therapy. The intervention
never exceeds twenty sessions (even if often excellent results are
obtained even with half the sessions), including the three follow-up
sessions at three, six and twelve months.
2. The main characteristics of the theoretical model
The theoretical framework of strategic psychotherapy [1] is based on
specific epistemological assumptions as highlighted so far. These
assumptions refer briefly to:
a) functioning of the human mind, understood as an organized structure
on a "system of interdependent relationships between oneself -
others - world", where man is at the center of the systemic
relationships between all the components, according to a scheme of
first (objective reality) and second (subjective) order, and no longer
linear but circular (the search for a first cause (linear logic) fails
because the phenomenon follows a logic of circular causality, and on
three levels of functioning of the mind (visual, auditory and
kinesthesic or emotional, which also includes all the other senses). In
the same way, in all human relationships we influence each other
with cybernetic and constructivist logics);
b) use by the subject of his personal "perceptive-reactive system",
understood as the set of ways in which each of us, in a subjective
way, perceives reality, attributes a certain meaning to it and reacts to
it. Through the experiences of interaction (with oneself, others, and
the context), the mind constructs the criteria and ways in which to
interpret reality, that is, its habits to perceive-react. Our reactive
perceptive system works as a filter that selects the meanings to be
given to things, as a frame that frames a phenomenon interpreting it
Copyrights@ Giulio Perrotta
in one sense or another, according to its own criteria (emotional,
motivational, logical, values and according to the states Of the
mind). The individual perceptive-reactive system is the result of
interaction with the environment and does not depend on genetic
factors.
c) elaboration, by the subject, of "attempted dysfunctional solutions" to
the problems encountered, that is what we do to solve a problem is
often exactly what keeps it or makes it worse. Subjective perceptions
and reactions to reality produce (even relatively quickly) habits of
thinking, behaving, reacting and interacting in a certain way. These
habits, once established, tend to be repeated (due to a mental
economy), even when they are no longer suitable for the situation
and even if they cause discomfort. They are then called "attempted
solutions" because they are only unsuccessful attempts to resolve.
They are redundant, that is, they tend to repeat and extend to
contexts other than those in which they were built. Two examples of
an attempted 'avoidance' solution. First: in the case of panic attacks,
the attempted solution to avoid the panic site reinforces the belief
that some places are dangerous. Thus avoidance extends to other
places or different situations, becoming an 'attempted' solution,
increasingly pervasive and thus building an increasingly disabling
problem. Second example: in a couple the attempted solution of
'avoiding conflicts' leads to a constant fear of making mistakes, to do
/ speak less and less and to a progressive closure. This is then
interpreted as a danger to be feared (and therefore to a greater fear of
making a mistake) or as a failure (and therefore will produce forced
attempts to interact, smiles and phrases that are not spontaneous and
credible) or a resignation not to communicate, or yet a continuous
suspicion towards the other and a greater closure. These solutions,
therefore, in their dysfunctional redundancy, instead of promoting
the extinction of the problems, preserve and aggravate them.
d) use by the subject of his personal "perceptive-reactive system",
understood as the set of ways in which each of us, in a subjective
way, perceives reality, attributes a certain meaning to it and reacts to
it. Through the experiences of interaction (with oneself, others, and
the context), the mind constructs the criteria and ways in which to
interpret reality, that is, its habits to perceive-react. Our reactive
perceptive system works as a filter that selects the meanings to be
given to things, as a frame that frames a phenomenon interpreting it
in one sense or another, according to its own criteria (emotional,
motivational, logical, values and according to the states Of the
mind). The individual perceptive-reactive system is the result of
interaction with the environment and does not depend on genetic
factors.
e) elaboration, by the subject, of "attempted dysfunctional solutions" to
the problems encountered, that is what we do to solve a problem is
often exactly what keeps it or makes it worse. Subjective perceptions
and reactions to reality produce (even relatively quickly) habits of
thinking, behaving, reacting and interacting in a certain way. These
habits, once established, tend to be repeated (due to a mental
economy), even when they are no longer suitable for the situation
and even if they cause discomfort. They are then called "attempted.
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solutions" because they are only unsuccessful attempts to resolve.
f) They are redundant, that is, they tend to repeat and extend to
contexts other than those in which they were built. Two examples of
an attempted 'avoidance' solution. First: in the case of panic attacks,
the attempted solution to avoid the panic site reinforces the belief
that some places are dangerous. Thus avoidance extends to other
places or different situations, becoming an 'attempted' solution,
increasingly pervasive and thus building an increasingly disabling
problem. Second example: in a couple the attempted solution of
'avoiding conflicts' leads to a constant fear of making mistakes, to do
/ speak less and less and to a progressive closure. This is then
interpreted as a danger to be feared (and therefore to a greater fear of
making a mistake) or as a failure (and therefore will produce forced
attempts to interact, smiles and phrases that are not spontaneous and
credible) or a resignation not to communicate, or yet a continuous
suspicion towards the other and a greater closure. These solutions,
therefore, in their dysfunctional redundancy, instead of promoting
the extinction of the problems, preserve and aggravate them.
With these premises, it is clear that strategic therapeutic therapy is aimed
at the solution that opens the lock, not seeking so much the "why" but
the "how", since strategic interventions act to produce changes not on
people themselves but on their way to interact with each other and the
perceived reality and in order to therefore achieve a change of
perspective and the change of maladaptive behavior into one more
functional to the well-being of the subject, strategic psychotherapy, in
line with the epistemological model of radical constructivism, starts
from the belief that to change a problematic situation, one must first
change the action and then the thinking, or rather the observation point
or 'frame' of reality. So we certainly do not want to deny the influence of
thought and cognition on acting but it is argued that change must pass
first from the phase of concrete experience and by itself become
cognitive baggage. Only through the preliminary experimentation of a
corrective emotional experience (Alexander) can changes in the
dysfunctional perceptive-reactive system be produced, which must then
be strengthened and maintained over time with learning and made
evident in the evaluation of the subject. The strategic intervention is
therefore structured on the methodological principle of “Research-
action” or “Research-intervention”, theorized by the psychologist Lewin
in 1946, which, by connecting theory and practice, derives from the
functional knowledge of a problem starting from modified attempts to
modify with specific interventions the problem itself: this perspective is
based on the conception for which it is the solution that explains the
problem and not the other way around. [1]
Other peculiarities of the strategic model are; the "brevity of the therapy"
(based on the problem encountered, it is possible to complete the course
even in one session, in other cases instead in 6-8 sessions it is the best
option); the "the exact identification of the objectives to be achieved"
(what we are trying to achieve to break the dysfunctionality that
supports the cause of suffering); the "suppression of the belief that the
pathological state is irreversible or serious" (through the use of a series
of techniques aimed at making the patient live corrective emotional
experiences intended as experiences that nullify the rigidity of the
theoretical position previously assumed by the patient towards the his
state of health); the use of "specific targeted protocols" for the
management and treatment of certain morbid pathological conditions
(there are over forty fo them, for example for the panic attack, capable
of solving the problem in 85-90% of cases, but also for and phobias,
disorders food, sexual, mood and addictions). [1]
3. The main techniques used in the clinic
There are several techniques that are now part of the strategic therapist's
clinical background. So far we have understood that the three pillarsof
strategic psychotherapy are certainly communication, relationship and
specific techniques. [1]
In particular, among the most incisive and functional techniques [3]:
1) the guided fantasy. It is a technique aimed at "structuring an
imaginary topic between the subject and the operator, in which one
tries to reach a point from which the person can observe, directly or
as an allegory, the knots of emotional conflict. The topic of fantasies
will be developed by both: the therapist stimulates, encourages,
persuades without forcing the person, seated and with their eyes
closed, to recount the actions that develop in his inner world;
2) the direct, indirect and paradoxical prescriptions. The "direct
prescriptions" are clear indications of actions to be performed. For
example, a parent who constantly motivates the child to study,
producing refusal in him, may be instructed to temporarily stop his
vain efforts, so that the child reduces his or her refusal attitude. Or,
to those who suffer from problems of an anxious nature, and who
constantly talk about his problem without realizing that by doing this
he feeds his anxieties, one can ask to limit communications on the
problem, in order to avoid his attempted dysfunctional solution. Of
course, it is clear how these types of prescriptions can be used
almost exclusively with very collaborative people, that is, who want
and can put into practice what is required. Or they can be used in
advanced stages of therapy, when the problem is now almost totally
solved and the person must be asked to do certain tasks useful for
maintaining the results achieved. "Indirect prescriptions" are instead
the kind of injunctions of behavior that mask their true goal: the
patient is prescribed to do something that will (also) produce an
effect different from what he explicitly expected. For those who
suffer from panic attacks, for example, it may be prescribed to keep
a diary of their attacks, to be filled in at the exact moment of the
onset of each of them, so that they can be monitored: the secondary
purpose, however, will be to move the attention of the person on a
simple but demanding task, so that he avoids monitoring his own
bodily functions instead. To a man who thought himself incapable of
crossing the street, Erickson absently asked to do him a favor: since
he was in a wheelchair, he asked him to post a letter for him in the
nearby box. To do so, the man did not realize that he crossed the
road twice except when he returned from Erickson. This produced a
first emotional corrective change experience. Watzlawick spoke
about "planned random events": the therapist prescribes the patient
to make an apparently neutral action (post a letter) which will
produce an apparently random effect (being able to cross the street)
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produce an apparently random effect (being able to cross the street)
with therapeutic effects. These types of prescriptions are very useful
for circumventing resistance, especially where this is given by limits
related to self-perceptions. Finally we come to the "paradoxical
prescription" or, in a more clinical sense, the prescription of the
symptom which, as Watzlawick, Weakland and Fisch claim "is
undoubtedly the most effective and elegant form we know of solving
problems". The problems, therefore, also include (but not only) the
symptomatic conditions. In this sense, the paradoxical prescription,
already studied by the psychoanalyst Frankl (1960), requires to ask
the person (or to put them in conditions) to implement exactly the
behavior they want to be freed: in this way the voluntary execution
cancels it the aspect of unstoppable spontaneity, putting it under
conscious control and quickly canceling its presence. Among the
well-known and most used examples of paradoxical prescriptions, it
is possible to think of the patient victim of obsessive thoughts who
are asked, in certain specifically agreed spaces, to think voluntarily
precisely about those thoughts; or, to a sleepless person who cannot
sleep, it can be indicated that he remains awake at all costs to
perform an unpleasant task, such as waxing the parquet; a boy
tormented by the fear of being blamed is asked to intentionally
ridicule himself several times with simple and naive actions. The
strength of the paradoxical prescriptions is such that almost always
the problem is released in a few sessions and begins to reduce its
intensity and frequency, until it disappears. Of course, all
prescriptions must be tailored, contextualized to the patient's reality
and adapted to his situation.
3) The use of strategic dialogue (logical and analog/emotional),
consisting of metaphors, paradoxes, empathize with your demon,
strategic questions (with the answer limited to only two possible
options), restructuring paraphrase (reformulating the patient's
responses to postpone the outcome of his reworking process, to
ensure the best reconstruction, even with suggestive evocations,
further circumventing the resistance to change), emphasis or
devalutazion of specific events, logbooks and constructive
manipulations, aimed at helping the patient to re-elaborate his
interpretation of reality better and more centrally. Furthermore,
using irony as a communication technique is often functional to
relieve tension and help the patient and relax in a difficult moment.
Again, borrowing from the Gestalt school, the empty chair technique
can be effective in releasing internal emotional tensions and facing a
person or situation that determines anxiety and emotional tensions.
4) Hypnosis. It is a psychosomatic phenomenon that can be caused by a
suggestion due to an image or sound that the subject perceives
intensely. Hypnotism has ancient historical roots, since the times of
the Chinese, Egyptians, Indians, Jews, Greeks and Romans and is a
theme transversal to many psychological currents that use this
therapeutic tool. The modern historical epochs can be summarized in
these three periods: a) "mystical": with Paracelsus (1490-1541), in
1530, a great scholar of astrology and occultism. The 17th century
will bring the Enlightenment with it; b) "magnetic": with Mesmer
(1734-1815), hypnosis passes from the esoteric world to the
scientific (psycho-physiological) world; however, however, his
beliefs about "animal magnetism" and man's powers through the use
of his hands will place him in antithesis with the scientific system of
the time. He came to understand the influence of the Moon on the
tides and on the female menstruation (which follows a lunar cycle),
but his idea of healing hysterical blindness will make him a heretic,
cut short by the Academy of France for his "suggestive
manipulation" ; c) "psychological": with Braid (1785-1860), in the
eighteenth century, Mesmer's theories were revised, becoming from
"animal magnetism" to "hypnosis or neuro-hypnotism", showing that
the phenomenon was only a suggestibility , due to the result between
the concentration on one point and a predominant psychic cause (so-
called monoideism), far from the fluid of which Mesmer spoke.
Subsequent studies will lead to the demonstration that to reach the
hypnotic state it will be enough just to imagine a point in one's mind
and not necessarily to focus it materially, passing in fact from the
concept of "suggestibility" to "suggestion". Prof. Bernheim (1837-
1919) and Liébeault (1823-1904) were great supporters of hypnotic
techniques (from the Nancy School), and considered hypnosis as a
psychological phenomenon consisting of a state of activated and
increased suggestibility; Charcot (1825-1893) (of the Salpétriére
School) also approached hypnosis but only in 1878. For the latter,
hypnosis was an instrument of experimental investigation and not a
therapeutic technique for a disease that was at the time classified as
"hysteria"; therefore, it was usable only with these subjects and not
with all of them, as the antagonists of his school claimed. Again,
Janet (1859-1947) laid the theoretical foundations for the studies of
Freud and Jung, arguing that hypnosis was nothing more than a form
of "dissociation", or a momentary transformation of an individual's
mental state, artificially induced by another person is sufficient to
cause dissociation; therefore, a sleepwalking influence determined
by the relationship between hypnotist and hypnotized. For S. Freud
(1856-1939), he preferred the theory of the interpretation of dreams
and free associations to the physiological state of hypnosis. For him,
hypnosis was a regressive state maintained by the archaic
relationship with the hypnotist, according to a pattern of credulity
and dependence on the latter; Ferenczi was of the same thesis. In
Russia, Pavlov (1849-1936), starting from the idea of regression,
came to define the physiological concept of "hypnosis" or "hypnotic
somnolence" as a process of widespread cortical inhibition with
some sensitive points where it is possible to intervene through
suggestion. Again, Hull (1884-1952) studied hypnosis according to
the behaviorist approach, claiming that it was a state of generalized
hyper-suggestibility. Still in this current, one of the leading experts
was M. Erikson (1902-1980), father of the short strategic
psychotherapeutic approach and modern user of hypnosis, not
exclusively linked to the treatment of mental problems and neurosis.
Thus he developed a form of hypnotherapy called "Ericksonian
hypnosis", which would allow communication with the patient's
unconscious. This type of hypnosis, very similar to a normal
conversation, which often can also use metaphors and a persuasive
dreams or perceptions of half-sleep), relaxation of the muscles,
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experiences some trance signs when hearing the story or listening to
the therapist's words, he is in the necessary conditions to intervene.
Erickson, like Bateson, believed that everyone had their own self-
built reality, and that entering into and changing the patient's
perceptions (by speaking with the unconscious) was the only way to
change it. The therapist must therefore adapt to the patient, the
central pivot of the therapy and feeder of the disorder. The purpose
of psychotherapy is in fact to allow the patient to regain possession
of his own subjective resources, consciousness (such as light
"simple" hallucinations - generally sounds or colors - similar to
down, possible trance period amnesia, analgesia, mild sleepwalking,
etc. In this way, the therapist can suggest ways of solution to the
unconscious, circumventing the resistances and the repression that
consciousness would oppose to change. If the patient between sleep
and waking. This is visible when the patient has trance indicators:
half-open or closed eyes, slight states of altered breathing slowed
and poetic language, induces, relaxing the patient, a sort of hypnotic
trance in the subject, that is, a state halfway working on the present
and not on the past; hypnosis is a re-educational technique that does
not represent the source of healing that induces a psychosomatic
condition of impaired consciousness, while the trance state instead
allows you to more easily deconstruct dysfunctional behaviors, with
the fundamental collaboration of the patient. Electrophysiological
studies have recently shown that two areas of the limbic system are
involved in the hypnotic state, i.e. the hippocampus (maintenance)
and the amygdala (awakening).
4. Conclusions
Although the strategic method was already known four thousand
years ago in China and two thousand and five hundred years ago in
Ancient Greece, the strategic model applied in psychology finds
paternity thanks to the studies of M. Erikson, who reorganizes the
concepts and gives him educational dignity. Dozens of authors after
him contributed to the dissemination of strategic knowledge and
despite various economic speculations on specific theories and
approaches, more aimed at the resolving goal of the individual
problem narrated by the patient and not taking care of it in its
entirety, this model (together with cognitive-behavioral and
dynamic) it has obtained scientific validity for years, so much so that
it can take advantage of over forty specific clinical protocols for the
major psychopathologies, including mood disorders, phobias, panic
attacks, sexual disorders, disorders sleep, post-traumatic stress
disorder and obsessive-compulsive disorder. A very recent evolution
of the short strategic model is given by the "single session therapy"
by Talmon, Hoyt and Rosenbaum: a method that on the one hand
manages, by itself, to lead to success in a large series of cases; on the
other hand, by integrating it within its own reference model (whether
it is psychotherapy or psychological counseling), it allows you to
maximize its effectiveness. In fact, this means that many people
experience the effects of a short therapy: in a few sessions, often
even in one, they manage to achieve the goal they had set
themselves.
In the future, greater attention is always expected towards this model
that could totally revolutionize the way of doing psychotherapy, while
being careful not to focus too much on the immediate goal, leaving out
the definitive functional change. [1] [2]
References
1. Perrotta G., Psicologia generale. Luxco ed., I ed., 2019.
2. Perrotta G., Psicologia dinamica. Luxco ed., I ed., 2019.
3. Perrotta G., Psicologia clinica. Luxco ed., I ed., 2019.
4. Nardone G. & Portelli C., Cambiare per conoscere, TEA ed., 2015.
5. Perrotta G., The reality plan and the subjective construction of one's
perception: the strategic theoretical model among sensations,
perceptions, defence mechanisms, needs, personal constructs, beliefs
system, social influences and systematic errors. Journal of Clinical
Research and Reports. J Clinical Research and Reports: 1(1), 9
pages, doi: 10.31579/JCRR/2019/001, December 2019.
Auctores Publishing – Volume 3(1)-019 www.auctoresonline.org
ISSN: 2688-7517 Page 6 of 6
... The fifth phase of the research focused on the administration of the couple psychotherapy cycle (a strategic approach) [16][17][18][19], amounting to 4 sessions, weekly lasting 30 minutes each, to rework the data obtained from PLS-Q1 and reinforce any deficiencies. L'approccio strategico è stato preferito ad altri approcci psicoterapeutici in quanto coniuga in sé tecniche, strategie e manovre anche di natura cognitivo-comportamentale [20,21], costruttivista [22,23], umanistica [24,25] e psicodinamica [26,27], ed è la forma che meglio si adatta al campione di popolazione selezionato. ...
... (www.preprints.org) | NOT PEER-REVIEWED | Posted: 8 February 2024 doi:10.20944/preprints202402.0460.v116 ...
“Perrotta Love Stability Questionnaire” (PLS-Q1): Development and Regulation of a Psychometric Instrument to Investigate Couple Relationship Stability in Healthy and Psychopathologically Affected Individuals
Preprint
Full-text available
  • Feb 2024
Background. On the subject of couple relationships, the literature pays attention to clinical, socio-anthropological profiles and psychological issues related to the capacity to love, empathy, satisfaction and happiness; however, there is a lack of a psychometric tool that can address the issue of couple stability in a structured and organized manner from an emotional-affective perspective. Objectives. To develop and adjust a psychometric tool that can be efficient and effective in solving the analysis of a coefficient of couple relational stability. Materials and Methods. Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests. Results. In CGa, those who scored more than 20% differential at PLS-Q1 were 58/118 (69%), while in CGb they were 118/118 (100%). In therapy, in the CGa, the resolved cases were 58/58 (100%), while in the CGb, the resolved cases were 110/118 (93%). At the clinical interview, it was found that the 8/118 (7%) "resistant" patients had, according to the PICI-3 model, a diagnosis of borderline personality disorder (5/8, 63%), histrionic-narcissistic (2/8, 25%), and bipolar (1/8, 12%), and thus by their nature not very prone to therapeutic adherence. Conclusions. Perrotta Love Stability Questionnaire (PLS-Q1) is a psychometric tool that offers therapists the opportunity to explore the topic of couple relationship stability, helping them to better focus on patients' vulnerable emotional positions to construct the most appropriate and targeted clinical intervention
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... The obsessive traits among these patients, both in the primary hypothesis (OCD as a primary disorder) and secondary hypothesis (OCD as a secondary disorder), impact them negatively, fostering those anxiogenic and anxious processes capable of decreasing or eliminating libido, before and/or during intercourse, effectively preventing the conclusion of female intercourse. There is a profound difference between obsessive-compulsive disorder and simple obsessive traits (which are only a part of OCD), but this research has shown precisely that the clinical focus should be on the management of obsessive traits, regardless of the diagnosis status, and the literature suggests that cognitive-behavioral and strategic approaches are among the most effective [44,45]. Thus, the statistical data obtained show that there are no statistically significant differences (p > 0.05) and, therefore, there is no statistical evidence (i.e., significance) that the two groups ("OCD_pure"-"OCD_comb"), relative to the outcome of the matrix, are different. ...
Secondary Female Anorgasmia in Patients with Obsessive Traits: A Study
Article
Full-text available
  • Oct 2024
Background: In the literature, female anorgasmia (AO) is closely related to obsessive–compulsive disorder (OCD), but no publication has explored the role of individual obsessive traits that may also be typical of other disorders, assuming that repetitive thoughts and compulsions must necessarily correspond to an obsessive-type neurotic profile. It is worth investigating and assessing the specific weight of other morbid conditions involved, beyond OCD. Materials and Methods: This study was conducted during 2022–2023 by selecting 208 Italian clinical patients from private databases. They submitted to individual clinical interviews and two psychometric questionnaires (Perrotta Integrative Clinical Interviews 3, PICI-3-TA, and Perrotta Individual Sexual Matrix Questionnaire, PSM-Q). Results: Among the 208 patients (M: 39.05 years), divided into subgroups by age and obsessive symptomatology, no significant differences were found between the subgroups in the comparisons of the data obtained from the administration of the PSM-Q. Conclusions: This study confirms that it is not OCD that correlates with OA but obsessive traits, which are also common to other psychopathological disorders, such as bipolar disorder, borderline disorder, manic, and psychotic disorders and, therefore, in psychotherapy, it is necessary to intervene with a clinical approach that has in mind the patient’s psychopathological personality picture and the causes that originated or reinforced OA.
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... The use of the PCOP protocol and the PCOP-Q1 questionnaire is strongly recommended in the clinical setting, as their technical input concretely helps the therapist [71][72] in fostering the effectiveness of psychotherapeutic intervention and patients in improving their degree of acceptance by improving their quality of life. ...
Clinical application of the “Perrotta-Guerrieri Psychological Care for Ostomy Patients” (PCOP) protocol and integrated questionnaire on adult ostomy patients
Article
Full-text available
  • Apr 2024
Background. Much attention is paid in the literature to the psychological profiles associated with ostomies, but until 2022 there was a lack of a psychoclinic instrument that was able to investigate all 9 individual subjective functions possibly impaired by the ostomate condition and the degree of impairment. For this reason, "Perrotta-Guerrieri Psychological Care for Ostomy Patients" (PCOP) was developed for all clinical phases, in 45 items with an L1-5 response scale, for the study of quality of life in the ostomized patient, which was also able to offer from the therapist a holistic understanding of the problem in all its phases (pre-operative, operative, postoperative, follow-up), integrating a patient-specific clinical intervention protocol. Materials and Methods. Clinical interview and battery of psychometric questionnaires. Results. Of 58 patients (M: 57.3 years), divided into two groups (CG and Cg) of equal distribution, the group in which the protocol was applied (CG) achieved quantifiable benefits to the extent of 50-75% individually and 97% in the total group. Conclusions. PCOP is a psychoclinical tool that can offer therapists the opportunity to explore the issue of patient quality of life and best focus on the most appropriate and targeted clinical intervention.
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... The fifth phase of the research focused on the administration of the couple psychotherapy cycle (a strategic approach) [16][17][18][19], amounting to 4 sessions, weekly lasting 30 minutes each, to rework the data obtained from PLS-Q1 and reinforce any deficiencies. The strategic approach has been preferred over other psychotherapeutic approaches because it combines within itself techniques, strategies, and maneuvers that are also cognitive-behavioral [20][21], constructivist [22][23], humanistic [24][25], and psychodynamic [26][27] in nature, and it is the form that best fits the selected population sample. ...
“Perrotta Love Stability Questionnaire” (PLS-Q1): development and regulation of a psychometric instrument to investigate couple relationship stability in healthy and psychopathologically affected individuals
Article
Full-text available
  • Feb 2024
Background: On the subject of couple relationships, the literature pays attention to clinical, socio-anthropological profiles and psychological issues related to the capacity to love, empathy, satisfaction and happiness; however, there is a lack of a psychometric tool that can address the issue of couple stability in a structured and organized manner from an emotional-affective perspective. Objectives. To develop and adjust a psychometric tool that can be efficient and effective in solving the analysis of a coefficient of couple relational stability. Materials and Methods: Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests. Results: In CGa, those who scored more than 20% differential at PLS-Q1 were 58/118 (69%), while in CGb they were 118/118 (100%). In therapy, in the CGa, the resolved cases were 58/58 (100%), while in the CGb, the resolved cases were 110/118 (93%). At the clinical interview, it was found that the 8/118 (7%) "resistant" patients had, according to the PICI-3 model, a diagnosis of borderline personality disorder (5/8, 63%), histrionic-narcissistic (2/8, 25%), and bipolar (1/8, 12%), and thus by their nature not very prone to therapeutic adherence. Conclusions: Perrotta Love Stability Questionnaire (PLS-Q1) is a psychometric tool that offers therapists the opportunity to explore the topic of couple relationship stability, helping them to better focus on patients' vulnerable emotional positions to construct the most appropriate and targeted clinical intervention.
View
... The present research work drew from the materials used in the writing of the second edition of the Perrotta Human Emotions Model (PHEM-2) [32] and the theorizations of the Strategic Short and Integrated Approach [33][34][35][36][37] very specifi c areas. This is a consistent test with good validity that has been effective in any culture. ...
The Emotional Intelligence (E.I.) and “Perrotta Human Emotions - Questionnaire - 1” (PHE-Q-1): Development, regulation and validation of a new psychometric instrument
Article
Full-text available
  • Oct 2023
Background: Based on the Perrotta Human Emotions Model (PHEM-2), a psychometric tool was modeled that could help the therapist gain a deep understanding of the patient's emotional capacity, and thus his emotional intelligence, also concerning follow-up and achievements during the psychotherapeutic course. Aim: To check whether the PHEM-2 can be structured into a psychometric tool that assesses the subject's emotional intelligence to calibrate the most appropriate psychotherapeutic intervention for the specific case. Methods: Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests. Results: The PHE-Q-1 demonstrated its clinical usefulness during psychotherapy sessions to improve the patient's emotional capacity and confirmed its validity relative to statistical comparison, reporting an R = 0.999 and p ≤ 0.001. Conclusion: The validity of PHE-Q-1 in investigating the emotional component of human intelligence and its clinical utility concerning one's level of cognitive-emotional dissonance and PHEM-2, during psychotherapeutic encounters conducted according to the brief or otherwise integrated strategic approach, is confirmed.
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... To assess the clinical usefulness of PHEM-2 to the previous version, the same symptom severity rating scale (subjective rating on a 0-10 scale, scaling technique [10,11]) was administered during the penta-cycle of therapeutic sessions by the same therapist who had carried out the same intervention in the clinical group in which PHEM-1 was used. The fi ve sessions, both during the application of PHEM-1 and PHEM-2, were conducted according to the short strategic approach therapeutic modality [12][13][14][15][16] and supplemented by cognitive-behavioural and dynamic correctives [17][18][19][20][21][22][23][24]. ...
The "Human Emotions" and the new "Perrotta Human Emotions Model" (PHEM-2): Structural and functional updates to the first model
Article
Full-text available
  • Sep 2023
Background: The first version of the Perrotta Human Emotions Model (PHEM) responded to the need for better structuring, in a functional framework, of emotions and sentiments, giving the proper role to anxiety, according to a neurobiological perspective, in a strategic scheme, but needs structural and functional corrections. Methods: Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests. Results: Statistical comparison of data obtained by administering PHEM-1 versus data obtained by administering PHEM-2 reported an R = 0.999, with p = ≤0.001, as is the case when testing clinical utility by assessing it using MMPI-2-RF and PICI-2. Conclusion: This research confirms the clinical usefulness of administering the PHEM-2, compared with the previous version, during psychotherapeutic encounters conducted according to the brief or otherwise integrated strategic approach.
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... In fact, all etiological hypotheses underlying hypersexuality confirm this reasoning: (a) neurological syndromes [7,8,10,13,16,20,23,[30][31][32][33][34], such as Klüver-Bucy syndrome (consisting of a bilateral lesion of the amygdala), typical and atypical dementias with temporo-frontal involvement, Pick's dementia, Kleine-Levin syndrome (or recurrent hypersomnia), autism, and attention-deficit/hyperactivity disorder (ADHD); (b) psychiatric forms [9,11,12,21,24,25,27,[35][36][37][38][39], such as bipolar disorder and borderline disorder (in their euphoric/sub-euphoric components typical of manic and/or hypomanic), sub-obsessive forms, sexually oriented behavioural addictions, and high-functioning personality disorders, such as covert-type narcissism; (c) traumas of the encephalon [40], in the regions used for rationality and impulse control (temporofrontal and limbic system in general); (d) implications arising from the use of excitatory drugs (such as methamphetamine, cocaine, synthetic drugs, and hallucinatory drugs) and from the therapeutic use of certain drugs, such as the use of L-dopa and prolactin inhibitors in Parkinson's dementia (indeed, dopaminergic drugs have been shown to influence conscious processing of rewarding stimuli and are associated with impulsive-compulsive behaviours, such as hypersexuality, by going on to activate the nucleus accumbens and dorsal anterior cingulate when shown subliminal sexual stimuli), anabolic drugs, and testosterone and other sex hormone products [17]. It is precisely in the presence, therefore, of the fulfilment of generally accepted diagnostic criteria, out of any other physiological condition (albeit deviating from the statistical mean of the reference population) that the diagnosis of sexual conduct dysfunction due to hypersexuality is reached, resulting in the evaluation of a multidisciplinary therapeutic approach considering individual and/or group psychotherapy, mainly of cognitive-behavioural or constructivist-strategic approach (to correct reinforcers and coping strategies, work on one's emotions, motivational recovery and metacognitive functions), and psychopharmacological treatment based on symptomatology, with anxiolytics, antidepressants, mood stabilisers, and antipsychotics [15,18,19,41] ( Table 2). ...
The Concept of "Hypersexuality" in the Boundary between Physiological and Pathological Sexuality
Article
Full-text available
Introduction: The concept of hypersexuality belongs to modern parlance, according to a predominantly clinical meaning, and is understood as a psychological and behavioural alteration as a result of which sexually motivated stimuli are sought in inappropriate ways and often experienced in a way that is not completely satisfactory. Methods: Literature up to February 2023 was reviewed, with 25 searches selected. Results: Forty-two articles were included in the review. Conclusion: Hypersexuality is a potentially clinically relevant condition consisting of one or more dysfunctional and pathological behaviours of one's sexual sphere and graded according to the severity of impairment of subjective acting out; for this reason, the Perrotta Hypersexuality Global Spectrum of Gradation (PH-GSS) is suggested, which distinguishes high-functioning forms (pro-active and dynamic hypersexuality) from those of attenuated and corrupted functioning (dysfunctional and pathological hypersexuality of grades I and II). Future research is hoped to address the practical needs of this condition, such as the exact etiopathology, the role of oxytocin in dopaminergic hypotheses (and its ability to attenuate the symptomatology suffered by the patient in terms of manic drive), the best structural and functional personality framing of the subject, and the appropriate therapy to pursue.
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... And it is precisely in the presence, therefore, of the fulfilment of generally accepted diagnostic criteria, out of any other physiological condition (albeit deviating from the statistical mean of the reference population) that the diagnosis of sexual conduct dysfunction due to hypersexuality is reached, resulting in the evaluation of a multidisciplinary therapeutic approach considering individual and/or group psychotherapy, mainly of cognitive-behavioural or constructivist-strategic approach (to correct reinforcers and coping strategies, work on one's emotions, motivational recovery and metacognitive functions), and psychopharmacological treatment based on symptomatology, with anxiolytics, antidepressants, mood stabilizers and antipsychotics. [35][36][37][38] ...
The Concept of “Hypersexuality” in the Boundary Between Physiological and Pathological Sexuality
Preprint
Full-text available
  • Apr 2023
Introduction: The concept of hypersexuality belongs to modern parlance, according to a predominantly clinical meaning, understood as a psychological and behavioural alteration as a result of which sexually motivated stimuli are sought in inappropriate ways, often experienced in a way that is not completely satisfactory. Methods: Literature up to February 2023 was reviewed. Results: Forty-two articles were included in the review. Conclusion: Hypersexuality is a potentially clinically relevant condition, consisting of one or more dysfunctional and pathological behaviours of one's sexual sphere and graded according to the severity of impairment of subjective acting out; for this reason, the Perrotta Hypersexuality Global Scale (PH-GS) is suggested, which distinguishes high-functioning forms (pro-active and dynamic hypersexuality) from those of attenuated and corrupted functioning (dysfunctional and pathological hypersexuality of grade I and II). Future research is hoped to address the practical needs of this condition, such as the exact etiopathology, the role of oxytocin in dopaminergic hypotheses (and its ability to attenuate the symptomatology suffered by the patient in terms of manic drive), the best structural and functional personality framing of the subject, and the appropriate therapy to pursue.
View
The new Dysfunctional Personality Model of the Dramatic Matrix (DPM-DM) and the Psychotic Matrix (DPM-PM): “Dramatic Personality Disorder” (DPD) and “Psychotic Personality Disorder” (PPD)
Article
Full-text available
  • Nov 2024
According to the PICI model, there are six personality disorders in the neurotic area (anxious, phobic, obsessive, somatic, avoidant, and manic), and the diagnosis of psychopathological disorder is determined based on the persistence of certain dysfunctional traits present in the personality framework. Based on clinical experience and through the application of the IPM/PICI, Deca, PDM, PHEM and PPP-DNA models, it was found that all disorders in the neurotic area had anxiety traits in common and that symptoms of the six different disorders were often present in comorbidity. This assumption led to the hypothesis of a different and better way to group them into one all-encompassing category: "Neurotic Personality Disorder" (NPD). Based on this construct, it is suggested to perform the same nosographic operations for the other personality disorders, grouping 7 personality disorders (bipolar, depressive, borderline, histrionic, narcissistic, antisocial, psychopathic) from the psychopathological area related to Cluster B of DSM-5-TR and PICI-3 into "Dramatic Personality Disorder" (DPD) and 4 other personality disorders (delusional, paranoid, dissociative, schizophrenic spectrum) from the psychopathological area related to Cluster A of DSM-5-TR and Cluster C of PICI-3 into "Psychotic Personality Disorder" (PPD). This paper aims to suggest their use to facilitate psychopathological framing.
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Psychopathological investigation of the personality of "psychic mediums": Clinical evidence
Article
Full-text available
  • Mar 2023
Background: In popular culture, the medium is a subject of seemingly controversial psychic abilities, as he or she seems to be able to communicate telepathically and physically with the various spirit entities present on the astral plane, i.e., a plane parallel to the physical one that can interact with it. In the literature, such assumptions rise to mere speculation, the result of superstition and personal beliefs, using the abilities of mental manipulation; however, some research has challenged these beliefs. Objectives: To demonstrate whether the personality profile of the psychic mediums analyzed exhibits pathological personality traits and whether such is sufficient to confirm a clinical diagnosis. Materials and methods: Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests. Results: The totality of the clinical group (CG) is found to be pathological, with at least 5 dysfunctional traits, and a corollary of secondary traits reinforcing the primary condition; the pathological differential from the control group (Cg) is +70.7%. At the individual sexual matrix questionnaires, just over 1/4 of the CG show a dysfunctional tendency to sexual behavior with a differential from the Cg of +42.8%. Slightly more than one-fifth of the CG also exhibit affective dependence, with a pathological differential with the Cg of +17%, while the CG sample concerning ego defense mechanisms exhibits the pathological totality of the sample, with a differential for the Cg of +45.7%. Conclusion: This research confirms the psychopathological nature of the personality profiles of mediums, with a higher prevalence of delusional, dissociative, and narcissistic disorders of the overt type, although these results do not prove the fraudulent nature of the mediumistic activity boasted by the subjects, and therefore what has been obtained should be read more generally, subjecting psychic mediums (in mediumistic activity) to technical instrumentation (electroencephalogram, functional magnetic resonance imaging and signal potential and audio-video) in the future to verify the outcomes.
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The Reality Plan and the Subjective Construction of One's Perception: The Strategic Theoretical Model among Sensations, Perceptions, Defence Mechanisms, Needs, Personal Constructs, Beliefs System, Social Influences and Systematic Errors
Article
Full-text available
  • Dec 2019
The strategic theoretical model is mainly based on the patient's perceptive-reactive system and its functioning profiles, putting the typical nosographic descriptions of DSM-V in the background-in clinical practice. This methodological choice is aimed at favouring a more integrated and general approach, enhancing the particular individual components, typical of the patient, far from an excessively rigid approachable only to cage the patient in a scheme that does not value all the nuances of his clinical symptomatology. This model is then integrated with other theories able to fully explain the subjective nature of reality and the re-elaboration of it in a perceptive key.
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Cambiare per conoscere
  • Jan 2015
  • G Nardone
  • C Portelli
Nardone G. & Portelli C., Cambiare per conoscere, TEA ed., 2015.