Strategic psychotherapy and the “decagonal model” in clinical practice

Starting from the strategic model, this research focuses on its critical aspects, to suggest a dynamic and structured model, called “decagonal model” to be applied in clinical practice and organised by actions (what), purpose (why), time/place (when/where) and modality (how).

of the systemic relationships between all the components, according to a scheme of fi rst (objective reality) and second (subjective) order, and no longer linear but circular (the search for a fi rst 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 kinesthetic or emotional, which also includes all the other senses; b) use by the subject of his personal "functioning", 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 fi lter 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 criteria (emotional, motivational, logical, values and according to the states of the mind). 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.
What differentiates one psychotherapy approach from the other, however, is the implementation, in clinical practice, of the specifi c rules of case management and related protocols that may have been devised, concerning evidence-based and best practice.
The strategic approach, as can be deduced from its constitutive history, suffers from an excessive fragmentation of thought, which sees within the same matrix more schools and more visions (often of the same problem); if in common for all there is therefore the clinical logic of starting from the problem to identify the attempted solutions and vicious circles, in order to identify the exact functioning of the person, on the other hand there is the need to use psychodiagnostic 'labels' to frame the subject: In fact, some schools are radically opposed to the use of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) [5], Psychodynamic Diagnostic Manual (PDM-II) [6] or International Classifi cation of Diseases (ICD-11) [7], in favour of a completely innovative approach linked exclusively to the study of the problem in order to identify the solutions, regardless of the co-presence of one or more deeprooted psychic disorders (which would possibly represent only the "rigid" manifestation of a series of vicious circles never interrupted and fed dysfunctionally over time); other schools, on the contrary, prefer to start from the nosographic label, on the basis of the symptomatology described and identifi ed during the fi rst clinical interview, and then to continue as indicated above according to a functional, elastic and dynamic logic of the analysis of the problem and of the solutions. The same interpretative problem is denoted by the absence of a uniform protocol of behaviour to be followed with the client (the term "patient" is avoided precisely in order not to categorise him and make him feel already rigidly embedded in a psychopathological nosography), notwithstanding the organisational settings already stated.
In the writer's opinion, the most favourable thesis, also concerning the scientifi c evidence shared by the community, is to adhere to a "median" position that takes into account both the strictly nosographic instance and the functional instance.
Compared to the psychiatric thesis (which rigidly clusters the patient's symptomatology) and the constructivist / systemicstrategic one (which sees the psychopathological disorder out of the medical context and out of the nosographic "labels", to favour a more functional and reactive approach, starting not from the symptomatology -and therefore from the "why" but from the "how" -but from the attempted solutions, from the vicious circles and the relational context), the writer adheres to the "median position", arguing specifi cally that Framing the patient's symptomatology in a specifi c nosographic framework is useful to photograph him and recognise the habitual toxic patterns and tendencies of his personality; however, this does not mean to contain his personality rigidly or to crystallise it forever, as the personality is plastic (just like our brain) and shapes itself according to newly reached awarenesses and corrective emotional experiences. The more rigid a personality is, the more its capacity to model itself is free. In certain conditions, where psychopathology seriously compromises the functions of reality, such as judgement and awareness, this condition is evident and one cannot ignore the objectivity of the symptoms manifested. In this, the strategic approach is too extreme. Therefore, if on the one hand, it is always useful to frame his personality structure (structural component) Here, therefore, adhering to the median thesis, also about the structure of the Perrotta Integrative Clinical Interview (PICI) [8][9][10][11][12], the writer suggests a model of strategic approach Below is the detail of the "decagonal strategic model"

Drawing up a complete personal and family anamnesis:
This is the action that has the purpose of establishing in a more  general picture as complete and detailed as possible, trying to defi ne in a strategic key the different functional dynamics of the client, including the discomforting profi les (intended as behaviour able to cause an effect perceived negatively by the client), deviant (understood as behaviour capable of provoking an external event perceived negatively by the client because it is socially improper or inappropriate or in violation of rules of conduct and morals) or disturbing (understood as behaviour capable of provoking an effect perceived negatively by the client because it is socially reprehensible or wrong or maladaptive concerning the environment).

4.
Drawing up the therapeutic contract: This is the action that aims to strengthen the therapeutic relationship and instruct the patient on the path he will take. It is advisable to draw it up at the fi rst session, after an initial analysis of the problems reported by the client, also clarifying the legal and relational profi les deriving from the drawing up of this agreement. Usually, at the same time, if this has not already been done, it is necessary to obtain the client's signatures for informed consent to treatment and authorisation for the law on privacy, following national and international regulations.

5.
Outline the client's main psychological 'functioning': This action aims at strengthening the therapeutic relationship already started and at understanding in a more and more detailed way the specifi c internal and relational dynamics of the client that feed dysfunctional psychological functioning [13], favouring "attempted dysfunctional solutions" (understood as strategies used to solve a problem but which, on the contrary, maintain it or even accentuate it) and "vicious circles" (understood as reiterations of dysfunctional behaviour that reinforce the problem and consolidate it), paying attention to all the patient's communication (verbal, paraverbal and nonverbal) [14]. This action is sketched out in the fi rst session, but it is developed and perfected during the second, and then fi nally ascertained in the third session, in a detailed and specifi c manner.

6.
Identify the client's psychological functioning in detail: This is the action that aims to strengthen the therapeutic relationship already started and to understand more and more completely the specifi c internal and relational dynamics of the client that dysfunctionally feed the psychological functioning, now fully recognised in all its components (functional and dysfunctional, understood as "personality traits or state personalities", according to Allport's theorisation and subsequent revisions) [15]. This action is concluded between the second and third session, depending on the case under examination and the client's collaboration [16]. During this action, the therapist uses communication and strategic language in a constantly refi ned way [17], through: a.
The "paraphrases", i.e. the exposition of a text in one's own words enriched by clarifi cations, re-elaborations, examples and comparisons. b.
The "paradoxes", i.e. prepositions formulated in apparent contradiction with common experience or the elementary principles of logic, but which on critical examination prove to be valid. c.
The "restructuring" (or in strategic language "reframing"), i.e. psychotherapeutic interventions (in the form of a technique or process or instrument) aimed at changing dysfunctional conduct and solving a problem, using a cognitive, analogical or metaphorical logic. d.
The "recollection" and the "mirroring", i.e. the process by which we send back to our interlocutor by feedback, with our behaviour, the behaviours and strategies that we have observed in him, and trigger the reaction by conformation (mirroring).
e. The "re-enactments", i.e. recalling a given event, circumstance or person belonging to our past. Finally, also in this phase, but in general throughout the therapeutic pathway, it is necessary to avoid as much as possible interpreting the signs and symptoms suffered using "psychopathological labels", to avoid that the patient rigidly approaches his condition and excessively focused on his pathological categorisation; this does not mean, however, that one should ignore the symptoms. According to the strategic school, labelling (i.e. classifying symptoms according to a precise psychopathological nosographic framework) is an operation that risks trapping the patient in that pathological representation and therefore useless and substantially harmful for the positive conclusion of the therapeutic pathway; in the writer's opinion, this approach is incorrect for the following reasons which justify both labelling and functional analysis of the client's perceptual system: a) The international clinical language is based on labelling, which in turn depends on precise organisational and interpretative rules, shared by the whole scientifi c community, precisely to favour a better overview of the patient's psychopathological condition; failing to do so means making a partial intervention since the recognition of certain traits or (rigid) state conditions would not only make understanding between therapists of different clinical orientation more complicated but would not help the client who -aware of his status -would not work consciously on his condition.

b)
The more the dysfunctional traits are rigid, the more the client's personality takes on the connotations of a welldefi ned psychopathological status and therefore the manifested symptomatology cannot be ignored or underestimated just because the centrality of the work is on the identifi cation of the client's psychic functioning; all the more so in serious personality disorders and in psychotic patients, where the symptomatology is so pervasive and evident as to leave no room for any other interpretation.

c)
Labelling has an educational function. Labelling the patient does not only mean making him aware of it, but it means offering him the opportunity to know his disorder indepth, even in a technical sense, and therefore to anticipate it from time to time when he risks falling into self-deception and mental pitfalls (determined by his condition). Someone could object and say that such restructuring is possible regardless of the labelling, working on his psychic functioning, deconstructing and reconstructing it; to such an objection it is possible to answer by underlining the importance for the client to defi ne himself in a label, also in the key of strengthening the therapeutic relationship, provided that after the labelling the strategic phases identifi ed in the model here explained are followed.
However, another point appears very interesting and that would seem to be more in line with the classic strategic approach that would like to avoid the use of labelling: it appears frequently, in clinical practice, that the psychopathological label used does not correspond to the client's totality and that it almost acts as a diversion concerning his real personological complexity. This objection, in the writer's opinion, appears wellfounded, since the client's personality is a universe in itself, studded with a series of variables determined by the multitude of functional and dysfunctional traits that are not always fi xed but changeable and mouldable according to the emotional experiences of life. For this reason, the writer has proposed a new interpretation of personality and psychopathological disorders, through the PICI-1 [8][9][10][11][12], which reclassifi es the disorders present in the DSM and PDM into 24 categories (for adolescents and adults) or 18 categories (for children and preadolescents) in personality disorders, identifying individual dysfunctional traits to consider them as "creative adaptations of the mind which, by structure and functioning, are shaped based on the main traumatic event, according to the internal response to external stimuli, reinforcing themselves positively or negatively according to them" .

7.
Deconstructing to stressful sources for the client?); d) "necessity" (is the prescription aimed at obtaining an identifi able and functional benefi t necessarily and appropriately?). Therefore, the conscious and safe use of strategic language is fundamental, using clear, direct, precise prescriptions, functional to the client's objective and scope, favouring new "corrective emotional experiences" (understood as concrete emotional experiences that allow the client to "repair" the traumatic infl uence of previous negative experiences, according to Alexander's defi nition).
In this therapeutic moment also the client's "why" plays an important role, aimed at obtaining easy and direct answers to unresolved or tormented questions and dilemmas: in strategic psychotherapy, the psychoanalytical "why" is abolished and replaced with the "how", in the sense of functioning, as the why is too subjective, not easily investigable and often unresolved precisely because of its internal components. Then why does not help to solve the problem and often does not offer solutions, while the how helps to identify one or more solutions starting from the attempted solution and therefore from the problem.
In the writer's opinion, such radicalism is counterproductive, as the "why" can become educational moments able to make the client refl ect on certain aspects, searching inwardly for the hidden answers; correctly, strategic psychotherapy does not reinforce the operations on the search for the answers to the proposed "why", however, I think they can be useful to help the client to disentangle himself emotionally, working in the meantime on his emotional literacy. After all, almost always, when we look for the answer to the "why" we want nothing more than a sensible and logical answer, even if it is not the right one.

9.
Closing of the clinical process: This is the action that aims at strengthening the client's new skills and awareness, to keep the change active. It represents the last session of the pathway and the therapist, always using the strategic language, consolidates the learned skills making the client as independent and autonomous as possible.

Follow-up:
This is the action that aims at verifying the results obtained, reinforcing them from time to time during the medium and long term, according to a schedule decided with the client that varies from a bi-weekly up to an annual frequency, according to a specifi c need.

Conclusion
The research concern the practical and applicative profi les of the model, which is necessarily affected by its implicit theoretical construction; however, the model appears theoretically functional and structurally adequate concerning the dictates of the discipline. There are no confl icts of interest to highlight.