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.

Certain therapeutic stories that are possible in one tipe of semantic – in the sense  of being productive ,  easy to implement, boding well for   change – are  forbiden for another, in the sense that they are difficult to develop, unable to develop, incapable of making best use of personal resource,  resources,  destined to encourage dropping out   or dysfunctional circuits (Ugazio, 2013, p.275).

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 secure basis for exploring these disruptive emotions and the therapist can be seen as a reassuring guide. The latter, however, can turn into a dangerous guide espe- cially when she/he supports the clients’ desires for independence, disheartened by their disorder. Some clients were free and independent before the onset of symptoms; it has been the symptomatology which put them in the uncomfortable position of dependence.
Others, such as agoraphobic clients, may have been in a dependent position even before the symptomatic onset. However, the development of their disorder surrendered them to a far more humiliating position of dependence than the one from which they would have freed themselves.
Ugazio et al. 2020)

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 take on their own responsibilities and declare intentions and actions that they deem reprehensible; or they can manipulate and conceal the facts to their advantage, so as to attribute fault and responsibility to others
(Ugazio, et al. 2020).

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:

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.