I have studied this topic in depth since I have been trying to develop specific intervention for each of the psychopathologies I have dealt with most. The type of therapeutic intervention is different for each semantic, and for the related diseases, precisely because people with different dominant semantic build the relationship with the therapist in a different way. I was already aware of this fact when I wrote the second version of Semantic Polarities and Psychopatholies in the family. Permitted and Forbidden Stories (New York: Routledge, 2013), the only translated in English. DAVID:I have studied this topic in depth as I have been trying to develop specific interventions for each of the psychopathologies I have dealt with most. The type of therapeutic intervention varies for each semantic, and for the related diseases, precisely because people with different dominant semantics build the relationship with the therapist in a different way. I was already aware of this fact when I wrote the second version of Semantic Polarities and Psychopatholies in the Family. Permitted and Forbidden Stories (New York: Routledge, 2013), the only translated work into English.
Some possible therapeutic stories within a semantic, that are in a sense productive, easy to implement, and capable of stimulating change, are prohibited for others, in that they are difficult to develop, unable to promote resources, and destined to solicit dropouts or dysfunctional circuits (Ugazio, 2012, pp. 314-315).
A study that I recently conducted with colleagues (Ugazio, Guarnieri, Anselmi, Castelli, Pandolfi, 2020 and 2021) on 60 patients with different psychopathologies (12 phobic disorders, 12 obsessive-compulsive, 12 food, and 12 mood disorders as well as a control group of 12 clients with existential problems) confirmed this clinical intuition. The story lived between patient and therapist in the here and now of the session is constructed differently according to the patient’s psychopathology.
When, for example, the semantics of freedom characteristic of phobic patients prevail.
the therapeutic relationship can become a safe basis for exploration but also a dangerous springboard. People with a phobic disorder, when they request therapy, are usually frightened by their symptoms, and felt as terrifying and disorienting physical manifestations. This is why they generally rely on the therapist to try to make sense of what is happening to them. Consequently, the therapeutic relationship can become a secure basis for exploring these disruptive emotions, and the therapist is seen as a reassuring guide. The latter can, however, turn into a dangerous guide, particularly if they support the desires for the independence of patients frustrated by their disorder. Some patients were free and independent before the onset of symptoms; it is precisely the symptoms that have delivered them to an uncomfortable position of addiction. Before the onset of symptoms others, such as patients with agoraphobia, were already in a position of dependence; the development of the disorder, however, puts them in a much more humiliating position of dependence than that from which they would have liked to free themselves. Ugazio et al. 2021, pp. 22-23)
While, working with obsessive-compulsive patients, coming from contexts where the semantics of goodness prevails,
the therapist may find himself in the position of being the shepherd of a troubled soul or, on the contrary, an accomplice to behaviors or desires that clients consider morally wrong (Ugazio et al. 2021, p.23).
Due to some of their dynamic characteristics, these patients perceive
the therapeutic relationship as a confessional space, where they can assume their responsibilities and declare their intentions and actions that they deem blameworthy; or they can manipulate and camouflage the facts to their advantage, in such a way as to attribute blame and responsibility to others (Ugazio, et al. 2021, p.24).
To learn more about how patients with phobic spectrum problems, obsessive-compulsive, eating, and depressive disorders build the therapeutic relationship, read these articles:
Ugazio, V., Guarnieri, S., Anselmi, P., Castelli,D. e Pandolfi.M. (2021).
Ugazio, V., Guarnieri, S., Anselmi, P., Castelli,D. e Pandolfi.M. (2021). La relazione terapeutica con i pazienti con disturbi fobici, ossessivo-compulsivi, alimentari e depressivi: Quali significati prevalgono? Rivista italiana di Costruttivismo, 9,1, 19-46, 2021.
Ugazio, V., Guarnieri S., Anselmi P., Castelli, D., Pandolfi, M. (2020)
Ugazio, V., Guarnieri S., Anselmi P., Castelli, D., Pandolfi, M. (2020) The therapeutic relationship with clients with phobic, obsessive-compulsive, eating and depressive disorders: Which meanings prevail? Journal of Constructivist Psychology. To link to this article: https://doi.org/10.1080/10720537.2020.1828203
The research, whose results are presented in these articles, was carried out on 120 videotaped sessions for the analysis of which The Semantics Grid of the Dyadic Therapeutic Relationship -SG-DTR (one of the 4 versions of the Family Semantic Grid) was applied. The SG-DRT allows us to identify and classify the most significant Interactive Semantic Polarity (PSI) of the patient and therapist relationship. Compared to the other 3 versions of the Family Semantic Grid, it is less time-consuming because it focuses exclusively on those PSI in which at least the patient, the therapist, or both – implicitly or explicitly – refer to the therapeutic relationship, moving away from their role, or interpreting it in a personal way.
Here is the article dedicated to the SG-DTR
Ugazio, V., Castelli D. (2015).
Ugazio, V., Castelli D. (2015). The Semantics Grid of the Dyadic Therapeutic Relationship (SG-DTR. TPM. Testing, Psychometrics and Methodology in Applied Psychology,22(1),135-159. DOI: 10.4473/TPM22.1.8
A nice example of the therapeutic relationship of a phobic patient can be found in these sequences of a beautiful French play Les Émotifs anonymes (2010) – directed by Jean-Pierre Améris, with Isabelle Carré and Benoit Poelvoorde
An eloquent example of therapeutic interaction when the semantics of power prevails is provided by one of the patients in Nanni Moretti’s The Son’s Room (2001). The patient is not affected by an eating disorder but the way he interacts with the therapist is in the same semantics. On the other hand, we find these semantics also in different disorders. What characterizes eating disorders is the particular position that the patient assumes within these semantics and the related conflicts.