The Logic of Therapeutic Change

Fitting Strategies to Pathologies

Elisa Balbi, Giorgio Nardone

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781782202264, 9780367103217
• eBook ISBN: 9780429921339
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

In 1993 the authorspublished The Art of Change: Strategic Therapy and Hypnotherapy Without Trance, a revolutionary work that introduced a series of effective clinical strategies to create therapeutic change, even in seemingly impossible cases. In his new book, the author performs another quantum leap, leading his readers to a more operative knowledge of the precise logic of therapeutic change. Most intimidating mental disorders are based on perceptions of reality that when using an ordinary 'common-sense' logic as our reading lens, look as if they are irrational, bizarre, illogical and therefore hard to understand and manage.

Chapter One

Non-ordinary logic

[…] Returning requires leaving. Stopping needs going, releasing follows holding. Since each arises from other, then speak to find silence, change to know unchanging, empty to become full.

From moment to moment, mind tricks mind and thoughts follow thinking in circles. The way out is in. The way in is out. Through is between.

Take hold of both halves and swing the doors of mind wide open or closed shut. Full mind is the same as empty mind.

—Grigg, 1988

We have no other way to grasp the external world than with our senses, from which we could receive constantly deceiving images; and even if we could see the world in a completely correct manner, we would not be able to know it.

—von Glasersfeld, 1974

Logic is nothing but the method by which man always applies his knowledge, solves problems, reaches objectives, and logic is therefore the bridge between theory and practice. Most psychotherapeutic models move from theory to practice, forgetting along the way that between theorems and direct application stands a gap that can only be filled with a logic model. Logic is what allows us to build an applicative model from theory to practice and is therefore not a pure theory above empiric observation, but something that should render to the empiric level what was fathomed at a theoretical level.

Ordinary logic is traditionally summarised by Aristotle and his followers with concepts like “true/false” or “law of excluded middle”, with the principles of “non-contradiction”, of “internal coherence” and of “congruence of logical models”. In other words, ordinary logic is our habit to discriminate between items through negation—“If it is not that, it is this. If it is that, it is not this”, through an associative recognition— “if it belongs to this category, it has the characteristics of this category”, through syllogisms—“if it belongs to this class it means that it has all the features of this class”, through the principle of non-contradiction— “if it is like that, it cannot be the opposite”, through the coherence principle—“Things must be coherent which means that they must be related by a linear connection”, through congruence—“within a system there must be a congruent relationship between its components”.

Let’s think about how many times we use negative forms like “do not”, “do not say”, simply because we are used to a type of logic in which “not” is a strong discriminant, even if using negation has been empirically demonstrated to be not only ineffective but counterproductive when we want to persuade someone about something. We continue to use this kind of logic simply because it is part of our cultural idiosyncrasies. If this works when analysing linear phenomena like cause and effect patterns, when we try to apply it to complex phenomenon, like the dynamic between the mind and the mind or, as Gregory Bateson would have suggested, between the individual mind and the collective mind, it’s no longer working because for a human being to be in contradiction is a rule, not an exception (Bateson, 2002). How many times do our emotions and our sensations lead us to do things that are not consistent with our usual behaviour? The same observation is true for congruence: so many times our reactions are not congruent with our actions.

When we speak about non-ordinary logic we can no longer refer to purely cognitive processes of rationality of choices, decisions, and actions as we would do with ordinary logic, precisely because each of us, as stated by Gödel, is a part of the system and therefore cannot control the system from within (Gödel, 1986). In our relationship with reality we tend to be linear, self-recursive just because of the experiences that we have made or the beliefs that we have constructed—and that’s the reason why no one can have pure knowledge. According to some philosophers, this would have only been possible when we were born, that is to say when we would theoretically have been a kind of “tabula rasa” or blank slate,—provided, of course, that we do not take into consideration life as an embryo. As Jung would say, we cannot underestimate the cultural idiosyncrasies that are passed on to us (Jung, 1953). The possibility of a pure knowledge of reality comes simply from the need and ability of human beings to find explanations, even reductive ones, to the phenomena in the world when they are unexplainable, and to consider them as true because of the need to be reassured. About the causal instinct, Nietzsche wrote:

First principle: any explanation is better than none. […] Because it is fundamentally just our desire to get rid of an unpleasant uncertainty, we are not very particular about how we get rid of it: the first interpretation that explains the unknown in familiar terms feels so good that one “accepts it as true”. (Nietzsche, 2007)

We must begin by assuming that since we are our own cognitive instrument, we are already contaminated and, in the act of knowing, we are contaminating what we know. If, as shown by Heisenberg, a scientist influences what he observes while observing it, then this is even truer for human beings in their relationship to their own reality (Heisenberg, 1971).

We are continuously “non-ordinary” and I defy anybody to find an example in his own life of an application—impossible to my point of view—of purely ordinary logic, without any ambivalence; it’s very difficult to find something that works without any underlying self-deception behind it. Let’s consider mathematics: human beings are astonished that two times two is four, five times five is twenty-five. Everything just works. Obviously, since it was designed to work. This is a sublime self-deception that, like all self-deceptions, may have a function, an operative effectiveness. Being in love is the most sublime self-deception of all.

Everything is self-deception. In Insight May Cause Blindness and Other Essays, a recently published compilation of texts selected by Paul Watzlawick, (2009) is transcribed a great conference on illusion of illusion that ends like this: “there is no illusion because everything is illusion.” Besides, we can think about Hermann Hesse and the theatre reserved for fools in his book Steppenwolf (Hesse, 1999). We cannot exit illusion. The logic of self-deception, which is an obscure phenomenon and for that reason has remained for centuries in the dungeons of linear logic, has been back on centre stage for the past thirty years. Indeed, when we began studying the relationship between the subject and his reality with more accurate methodology and epistemology, we could no longer avoid the fact that we tend to alter the reality that we perceive and that we constantly construct reality based on our self-deceptions. We have a numbers of examples for this: I get up in the morning after having slept poorly, and every minimal event becomes painful because of what I have experienced before; it’s a self-deception. I can be paranoid and think that everyone is against me, I look around me and I constantly find proof of what I believe; it’s a self-deception. I may be exalted, thinking that I am able to do extraordinary things and I convince myself of this even with the minimal incident: I stumble down the stairs and instead of falling I get back in balance—I think I am a tightrope walker. A person who does not realise that his/her partner has been unfaithful while everybody around knows is self-deceiving. Self-deception is a natural ability that protects us from all the things that can hurt us; it’s something positive but can become pathological when overused. We can think about fear, with a negative twist—in reality it’s our most primitive sensation and the healthiest we have; this physiological mechanism that, thanks to some perceptions, triggers the activations of our body that makes us better. Without fear we would do nothing. We all know that anxiety, fear’s closest equivalent in purely physiological terms, follows a curve which makes us much more efficient until it exceeds a certain level; but when it goes over a threshold we become incapable. Self-deception is therefore not something to denigrate as cognitivists would like to do and all of those whose thinking is marked by the illusion of rational control; self-deception is a gift that we must use as we cannot avoid it.

The interactional-systemic tradition has studied the logic of ambivalence in communication and has introduced the “double-bind” concept, at that time associated with the logical paradox, that is to say a message that conveys a content and its opposite. The research of Bateson, Jackson, and Weakland on the etiology of schizophrenia (1956) have stressed how a schizophrenic patient could “shape himself” as such through the redundancy of paradoxical communication within the family dynamics. Bateson, Watzlawick and others were the first to bring Bertrand Russell’s study of logical levels (Whitehead & Russell, 1910–1913), a particularly refined logic, into the fields of psychotherapy and psychology. By studying communication ambivalences and ambivalences of people’s answers, they went as far as establishing the logic of paradox, which has become one of the fundamental concepts of the traditional strategic approach. The phenomenon of paradoxical communication with one-self, with others, and with the world is the basis of the etiology of the most serious mental disorders and at the same time the structural basis of therapeutic interventions. But back then, people were still talking of paradox rather than self-deception; self-deception is actually a more basic mechanism that includes paradox, but is not limited to it. When I feel something in myself and at the same time its opposite—“I love him and I hate him”—it’s a paradox just like when I desire something that at the same time I dread. But when I think it’s fair to act a certain way and I am doing the opposite, or when I believe so much in something that all my actions are aimed at confirming my belief, or else when an idea repeated over time becomes true, precisely because of its repetition, we are no longer in the presence of paradoxes.

It’s thereafter possible to build subgroups, subclasses within the logic of self-deception. With this intent, as we will see, we have developed non-ordinary therapeutic stratagems for the majority of the most important pathologies and their respective treatment protocols. If we did not metabolise the non-ordinary logic criteria, we would not be able to apply the stratagems, even when they were prescribed to follow through direct and clear guidelines; and especially when we need to use penetrating techniques. Knowing the various non-ordinary logic criteria and the functioning of non-ordinary logic is consequently fundamental for a strategic therapist. Obviously, when a patient clearly and lucidly describes his problem and we can negotiate the solution with him, we immediately move to direct instruction and we do not need non-ordinary logic. The problem is that in my clinical experience of treating over 10,000 patients, I met perhaps ten patients of this type. It may of course be that for the past twenty years I have only met with “extreme patients”; but if we analyse the majority of these so-called pathologies, we notice that they are functioning on the basis of non-ordinary criteria. We can rarely find pathology based on ordinary logic. The paranoid, who needs to defend himself from others’ aggressiveness—who is afraid of mafia because he received a threat—uses a seemingly ordinary logic, but following his perception, whoever is waiting near his house is a mobster and he therefore cannot go out after 8pm as he is scared of being the victim of a mob attack. We are entering another logical level: a phobic obsession turns into a belief that builds the perceived reality and causes pathological reactions. As suggested by Pinel (2006), maybe “the logic is valid but the premises are false”.

To effectively intervene in these realities, we need a logic that follows their structure and that is able to reorient their direction towards a functional management—that is to say, to transform dysfunctional self-deception into functional self-deception.

Strategic logic

Oscar Wilde wrote:

To know the truth one must imagine myriad falsehoods. For what is Truth? In matters of religion, it is simply the opinion that has survived. In matters of science, it is the ultimate sensation. In matters of art, it is one’s last mood. (Wilde, 1997)

This points to the fact that, without going back too far and referring to “radical constructivism”, (von Foerster, 1981a, 1992; von Glaserfeld, 1974, 1980; von Foerster & von Glaserfeld, 2001; Watzlawick, 1981) that there is no single reality but there are as many realities as there are observers. Moreover, an observer might even, if willing to do so, perceive the same reality in different ways following the point of view he will take each time. This is what Watzlawick and I have called, in our book The Art of Change (1993), the first heresy of the strategic approach to human problems, defining the heretic as “the one who has the possibility of choice”, and heresy as what differentiates the strategic approach from most models of psychotherapy.

Therefore, each reality changes following the point of view of who is observing, and consequently leads to different reactions based on the different significance that one can give to this same reality.

In ancient Zen Buddhism, wisdom assumed by modern constructivism, one can discern two kinds of truth: the “truth of essence” and the “truth of error”. The truth of essence cannot be reached by a human during his lifetime because it comes through illumination—that is to say transcending concrete reality—as essence cannot be found in terrestrial life but rather through transcendence. Conversely, truths of error correspond to partial and instrumental truths that are built in relationship with earthly matters to increase our ability to manage them. The only option granted to human beings is precisely to improve one’s capability to invent truths of error.

As for Watzlawick (Watzlawick, Beavin, & Jackson, 1967), he speaks of first order and second order reality. The first refers to the physical properties of objects or situations, the second to the meaning we ascribe to the same objects or situations.

In other words, and borrowing the words of an old Chinese proverb, “life is a blade that hurts, but cannot hurt itself; just like the eye sees but cannot see itself.”

Most of the difficulties we face, regardless of their severity, depend not so much on the first order reality but on the meaning we give it; in other words of the second order reality.

It is therefore obvious that when we are called to intervene in a situation, whether it’s a difficulty or a disabling problem, we cannot remain in the first order reality but we must necessarily deal with second order reality. I am more precisely referring to what we have defined as a “perceptive–reactive system”, which designates the redundant modality through which a given individual perceives and consequently reacts to his own reality in relationship with himself, with others, and with the world (Weakland, Fisch, Watzlawick & Bodin, 1977; Nardone & Watzlawick, 1993; Nardone, 1991).

This concept is, in my opinion, fundamental as, once we’ve abandoned the positivistic and deterministic illusion of having an objective knowledge of reality, it allows us to create a functional intervention to a given situation. This intervention will not be based on an a priori theory—which is unfortunately often the case in our field—but rather on the objectives to be reached. Kant has already said that “we can know a priori of things only what we ourselves put into them” (Kant, 1999).

These considerations are translated in operative terms by applying a research method called “action-research” that enables the development of specific treatment protocols for both clinical and organisational contexts. This particular experimental methodology is based on the assumption that, if we want to know how a problem is functioning, we need to introduce change. Kurt Lewin (1946), in the field of social psychology, has defined action-research as the methodology that studies phenomena in the field by empirically and experimentally altering events and by observing the effects created by these changes. How a person, a system, or an organisation will answer to these changes will reveal to us the previous functioning of the phenomenon itself. In other words, we know a problem through its solution, and therefore it is not the type of problem that tells us what is the ideal solution—which would be “to know in order to change”—but rather the type of solution that explains how the problem is working—which is “to change in order to know”.

With the concept of “operative awareness”, von Glasersfeld (1980) precisely referred to this kind of constructivist knowledge that allows us to adapt, in the most functional way possible, to what we perceive as specific problems, thanks to the development of strategies based on the objectives that we set and their progressive evolution with the evolution of these realities. Therefore, the only way we have to really succeed in identifying how a given problem works is to seek to solve it by actively intervening. Knowing by changing is a concept highlighted by systems theory (von Bertalanffy, 1956, 1962) and cybernetics, which represents their evolution (Wiener, 1967, 1975; von Foerster, 1981a, 1981b) with the identification of the concept of feedback that characterises the system’s answers to a change, answers that inevitably influence the system itself. That is to say, A influences B, which influences C, which influences D which, in turn, returns to A, producing thereby a circular system in which each element influences and is in turn influenced by the other elements of the system.

Based on what has been said (Nardone & Salvini, 2007), it is possible to go beyond the hypothetical-deductive logic in favour of a constitutive-deductive one in the process of building strategies so that the solution fits the problem and not the other way round.

The methodology of knowing through changing also implies that a solution that is proven to be valid and effective, if repeated on a large sample of patients with the same type of problem, reveals the functioning of the problem itself in terms of what maintains and feeds it. When a solution is obtained, the strategies that produced the change allow us to discover how the problem functions and, at the same time, the newly gained knowledge from the interventions helps to develop the necessary adjustments. This way, the intervention model cannot but be self-correcting, that is to say adjustable at any time, as it is based on the effects obtained during the process of change. We thus have a concrete strategic model of the solution. This is, in my opinion, something extremely important because the ability of the model to self-correct ensures that it avoids the not-so-unusual error of persevering in implementing solutions that do not solve anything. Moreover, when we persevere in applying them, these dysfunctional attempted solutions (AS = 0) often exacerbate the problem for which they were conceived, as they are in no way adapted to its structure and are only coherent with the theoretical-operative model adopted. What is even more important is that the ability to correct what may not work is not just about the end of the process, which is what we can call a summative evaluation, namely the measuring of the results in terms of effectiveness/efficiency. The formative evaluation w...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• ABOUT THE AUTHORS
• FOREWORD
• CHAPTER ONE Non-ordinary logic
• CHAPTER TWO Self-deceptions and interactions
• CHAPTER THREE Change
• CHAPTER FOUR Change and performative language
• CHAPTER FIVE Learning
• CHAPTER SIX The logics of ambivalence
• CHAPTER SEVEN Operational concepts, therapeutic stratagems
• CHAPTER EIGHT Therapeutic stratagems: clinical examples
• REFERENCES
• INDEX