Systemic · 1990
Brief strategic therapy (Nardone)
Change comes about by blocking the attempted solutions that maintain the problem and generating experiences that reorganise the perceptive-reactive system.
Brief Strategic Therapy as developed by Giorgio Nardone is an evolution of the Palo Alto strategic and systemic approach, aimed at understanding and modifying how a problem works and is maintained in the present. Its central clinical unit is the perceptive-reactive system: the redundant organisation of perceptions, emotions, actions and interactions through which the person relates to themselves, to others and to the world. The therapist investigates the attempted solutions that are repeated without success and that, through feedback, end up sustaining or aggravating the problem; defines observable goals; adapts communication to the patient's logic, language and resistance; and designs manoeuvres capable of interrupting that persistence. The model combines restructurings, strategic dialogue, direct, indirect and paradoxical prescriptions, metaphors, stratagems and specific protocols built through research-intervention. Clinical knowledge is also obtained through change: the response to a manoeuvre makes it possible to verify or correct the operational hypothesis about how the problem works. The advanced evolution of the model adds an explicit phase of consolidation and reorganisation after symptomatic unblocking, with a progressive reduction of directiveness and the attribution of achievements to the person's resources in order to foster autonomy and prevent new pathogenic equilibria from being rebuilt.
Theory of change
The person changes when the attempted solutions that maintain the problem are interrupted and they live through experiences capable of reorganising their perception, emotion and action.
Core ideas
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The problem is maintained by the way one tries to solve it
A difficulty can turn into a persistent pathology when attempted solutions are repeated redundantly and produce consequences that confirm the need to go on using them. The strategic focus is on this present circle because interrupting it can modify the whole system without first requiring a single remote cause to be discovered. (Nardone & Watzlawick, 1990/1993, The Art of Change; Nardone & Portelli, 2005, Knowing Through Changing).
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The perceptive-reactive system organises the problematic reality
The person does not respond to a neutral psychological reality but to a reality constructed through regularities of perception and reaction. When these regularities become rigid, each response filters experience in such a way that it confirms the same frame; therapy introduces perturbations capable of widening the ways of perceiving and reacting. (Nardone & Barbieri, 2010, Advanced Brief Strategic Therapy; Nardone & Portelli, 2005, Knowing Through Changing).
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Knowing a problem through the solutions that change it
Intervention has an epistemological function: a manoeuvre that alters a clinical regularity provides knowledge about how that regularity was organised. For this reason therapy advances through self-correcting operational hypotheses and uses the effects of each strategy to verify, refine or abandon the previous conceptualisation. (Nardone & Portelli, 2005, Knowing Through Changing).
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The relevant diagnosis is functional and operational
The strategic formulation gives priority to describing how the problem works, under what conditions it appears and which responses maintain it. Diagnostic categories may provide clinical information, but selecting a strategy requires knowledge of the concrete perceptive-reactive logic and the attempted solutions of the case. (Nardone, Verbitz, & Milanese, 2001/2012, Las prisiones de la comida; Nardone & Portelli, 2005, Knowing Through Changing).
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The solution must fit the logic of the problem
The model rejects the automatic application of the same technique to superficially similar problems. Paradox, contradiction, belief, avoidance, control, help-seeking or pleasure-seeking call for different strategies; the manoeuvre is selected according to the structure of persistence and modified according to the response obtained. (Nardone & Portelli, 2007, Caught in the middle of a double-bind; Nardone & Barbieri, 2010, Advanced Brief Strategic Therapy).
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The experience of change can precede its understanding
A person may understand intellectually why their behaviour is dysfunctional and still be unable to modify it. The strategy first seeks to make them feel and perceive differently through a concrete experience; explanation comes afterwards to integrate the change and turn it into usable knowledge. (Nardone & Salvini, 2004/2014, El diálogo estratégico; Nardone, 1996, Brief Strategic Solution-Oriented Therapy of Phobic and Obsessive Disorders).
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Communication is part of the intervention
Asking, paraphrasing, evoking, summarising and prescribing are acts that modify the person's relationship with their problem. Language is adapted to the interlocutor's logic and style to reduce resistance and build discoveries that can be felt as their own, so the first interview can already be a complete therapeutic intervention and not merely a gathering of data. (Nardone & Salvini, 2004/2014, El diálogo estratégico).
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Resistance guides the strategy
Resistance provides information about how therapeutic influence should be built. Collaboration, inability to act, open opposition and non-ordinary rigidity call for different styles; the therapist seeks to use the existing response as a force for change, avoiding confrontations that reinforce the very equilibrium they aim to modify. (Nardone & Portelli, 2005, Knowing Through Changing).
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Protocols combine rigour and flexibility
Research-intervention made it possible to formulate specific sequences for recurrent clinical configurations, but a strategic protocol remains self-correcting: it prescribes a logic and an order of manoeuvres, while communication, dosage and subsequent steps are adjusted to the effects of each intervention. Clinical reproducibility depends on this combination of structure and adaptation. (Nardone & Watzlawick, 1999, Terapia breve: filosofía y arte; Nardone & Barbieri, 2010, Advanced Brief Strategic Therapy).
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Non-ordinary logics make it possible to intervene in problems resistant to linear reasoning
Some configurations simultaneously maintain incompatible demands, sequential contradictions or self-confirming beliefs. In these cases, insisting on a rational correction can strengthen the defence; the strategy uses paradox, contradiction or an intervention compatible with the belief to open up an experience that reorganises the system. (Nardone & Portelli, 2007, Caught in the middle of a double-bind).
Influences
- Strategic therapy (Haley)
- Palo Alto school / MRI
- Brief therapy (MRI)
- Ericksonian hypnosis
- Constructivism
Key references
- Nardone, G., & Watzlawick, P. (1990/1993). The Art of Change: Strategic Therapy and Hypnotherapy Without Trance. San Francisco: Jossey-Bass.
- Nardone, G., & Watzlawick, P. (1990/1992). El arte del cambio: Manual de terapia estratégica e hipnoterapia sin trance. Barcelona: Herder.
- Nardone, G., & Watzlawick, P. (1999). Terapia breve: filosofía y arte. Barcelona: Herder.
- Nardone, G., & Portelli, C. (2005). Knowing Through Changing: The Evolution of Brief Strategic Therapy. Crown House Publishing.
- Nardone, G., & Salvini, A. (2004/2014). El diálogo estratégico: Comunicar persuadiendo: técnicas para conseguir el cambio. Barcelona: Herder.
- Nardone, G. (1995/2012). Miedo, pánico, fobias. Barcelona: Herder.
- Nardone, G. (1996). Brief Strategic Solution-Oriented Therapy of Phobic and Obsessive Disorders. Northvale, NJ: Jason Aronson.
- Nardone, G. (1998/2012). Psicosoluciones: Cómo resolver rápidamente problemas humanos complicados. Barcelona: Herder.
- Nardone, G., Verbitz, T., & Milanese, R. (2001/2012). Las prisiones de la comida: Vomiting, anorexia, bulimia. Barcelona: Herder.
- Nardone, G., & Balbi, E. (2012). Solcare il mare all'insaputa del cielo. Ponte alle Grazie.
- Nardone, G., & Portelli, C. (2013/2015). Obsesiones, compulsiones, manías: Entenderlas y superarlas en tiempo breve. Barcelona: Herder.
- Nardone, G., & Barbieri, R. B. (2010). Advanced Brief Strategic Therapy: An overview of interventions with eating disorders to exemplify how theory and practice work. European Journal of Psychotherapy & Counselling, 12(2), 113–127. https://doi.org/10.1080/13642537.2010.482743.
- Nardone, G., & Portelli, C. (2007). Caught in the middle of a double-bind: the application of non-ordinary logic to therapy. Kybernetes, 36(7/8), 926–931. https://doi.org/10.1108/03684920710777432.
- Pietrabissa, G., Manzoni, G. M., Ceccarini, M., & Castelnuovo, G. (2014). A Brief Strategic Therapy protocol for Binge Eating Disorder. Procedia - Social and Behavioral Sciences, 113, 8–15. https://doi.org/10.1016/j.sbspro.2014.01.005.
- Pietrabissa, G., Manzoni, G. M., Gibson, P., Boardman, D., Gori, A., & Castelnuovo, G. (2016). Brief strategic therapy for obsessive-compulsive disorder: a clinical and research protocol of a one-group observational study. BMJ Open, 6, e009118. https://doi.org/10.1136/bmjopen-2015-009118.
- Proietti, L., Aguglia, A., Amerio, A., Costanza, A., Fesce, F., Magnani, L., Serafini, G., & Amore, M. (2022). The efficacy of brief strategic therapy in treating obsessive-compulsive disorder: a case series. Acta Biomedica, 93(Suppl 1), e2022271. https://doi.org/10.23750/abm.v93iS1.13064.