rodolfo de bernart *, *m.d.psychiatrist, family ... ifti 2012.pdf · istituto di terapia familiare...

Rodolfo de Bernart *, *M.D.Psychiatrist, Family Psychotherapist ,

Family Therapy Institute of FlorenceIstituto di Terapia Familiare di Firenze

Istanbul IFTI 26th and 27th May 2012

1. What does this theory think is the basis of psychopathology or

The basis can be a block of or a distorted communication in the family.

Due to unresolved elaboration of the cultural inputs from the Family of Origin.

The Identified Patient (Scapegoat) has a useful function which can soften the pain of a trigenerational wound and “fix” a problem in the actual family, but stops his/her own developement as a person.

2. How does this theory conceptualize the role of the context

The Context (not only the familiar one) define any communication.

It Must be carefully observed doing the evaluation or the Hypothesis.

Sometimes it has to be changed in order to have a change in the situation

Example of Flomenhalf

4. How does this theory address developmental processes? The developmental process of one or more

members of the family and of the family itself is blocked in the passage from the actual stage to the next one of the Family Life Cycle (FLC).

This is due to the importance of the function which is in competition with the personal growth

May I come in bed with you,Mummy ?

If you like. But do not expect special things

6. What does this theory attempt to do to bring about change? Change occurs through: Important Therapeutic Relation with the Family

and its Members The family makes an important experience in

the session, then reproduced at home. Through a new understanding of the situation

(hypothesis)the Family moves to the next stage of FLC,using its own resources.

7. What time period does this theory suggest is needed for change to

Different approaches within FST Depends on the nature of the problem Generally brief: 8 – 12 sessions. (Watzlawick) ‘Avuncular’ therapy. (J. Byng-Hall) therapist as

an interested uncle – meet with decreasing frequency, sometimes over years.

7. What time period does this theory suggest is needed for change to

The change occurs in seconds In order to stabilize it usually we need one or

two years. But the number of session is low, so that SFT

can be considered a brief therapy. Often a Individual Therapy can be added at the

end (not always for the IP).

8. What aspect of treatment is expected to bring about change? Varies from family to family. What ‘fits’. A number of dimensions:

Family structure The meaning of symptoms or problematic behaviour Change in the meaning of relationships (reframing) Change in the pattern of interactions

Focus of change is what happens between people.

Aim to increase interactional reflexivity. Paradox is that the therapist does not

attempt to create change but a space for reflection and exploration. The family creates change.

8. What aspect of treatment is expected to bring about change? Using the Non Verbal Channel in order to get

into the “Implicit Relational Knowledge” (Stern) Building New Strong Experiences Creating new readings if the Hypothesis trough

“Conversation” (Maturana) Always trough an important Therapeutic

Relation (Bowlby, Byng Hall)

3. How is this theory informed by the cognitive neurosciences?

Can be interesting that Non Verbal communication and Implicit Relational Knowing (Stern) are the most important tools in our work

The “Mirror Neurons” (Rizzolati ,Gallese) explain very much of how NVL and IMPLICIT work.

When I grow You? Forget it : Family I’ll raise a family. must be protected.

9. How does one identify positive or negative outcomes of treatment? We need to achieve a 2° Order Change

(Bateson , Watzlawick) Possibly a Metacognition in the Family Normally the level of MC is different in the

various members of the family, going from : Mentalization and emotional change to Cognitive or just Behavioural change

10. What sort of evidence is used & what is its quality for this treatment?

Follow up to 6 months , 1 year and more With family and individuals Sometimes using tools like AAIF (Adult

Attachment Interview for Families)(de Bernart and others, still in trial)

11.Is the treatment unsuitable for some problems? Which and why? Familes with adopted children , specially if tha

AC is also the IP Paranoic patients (because of the setting with

one way mirror and cameras)

The verbal channel is to much saturated,

We should use a non verbal channel,

Which is less controlled by patients and can allow us to enter into the

internal image of the family

Istituto di Terapia Familiare di Firenze

Implicit Relational KnowingNonverbal , nonsymbolized ,Unnarrated , nonconscious

(Unconscious but not repressed)The vast Majority ( 80% ? ) of all we

know about how to be with others (including the Transference)

Daniel Stern

Istituto di Terapia Familiare di Firenze

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZEVia Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280e-mail : itff @itff.org

web page: www.itff.orgDirector: Prof. Rodolfo de Bernart

IntelligenceHolisticGeneric

Not definedGlobal

SimultaneousFirst and third

Phase

SequentialAnalytic

StructuredReferentialSequential

Second Phase

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZEVia Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280e-mail : itff @itff.org

web page: www.itff.orgDirector: Prof. Rodolfo de Bernart

H o m oSapiens

Learns by readingDecodificates signs

Auto-drivenMediate Emotions

Sequential intelligence

Videns

Learns by seeingLooks at images

Ethero-drivenImmediate Emotion

Simultaneous intelligence(Holistic)

Rhythm

The Power of Metaphor stays clearly in her capacity to get to

the affective component of Personality which normally

is too much defended to be got

Littmann

Istituto di Terapia Familiare di Firenze

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZEVia Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280e-mail : itff @itff.org

web page: www.itff.orgDirector: Prof. Rodolfo de Bernart

Life, intended as images, doesn’t know what to do with family dynamics and genetic predispositions. Before becoming a story, each life offers itself as a continuum of images: and it asks to be seen, first of all. Even if each image is for sure full of meanings and could be analyzed, when we jump to the meanings without considering the image, we loose a pleasure which cannot be recovered by any interpretation no matters how perfect

(James Hillmann)

Tools in Family Therapy

Istituto di Terapia Familiare di Firenze

1 - Genogram2 - Photographic Genogram3 - Sculpture4 - Conjoint Family Drawing5 - Collage6 - Use of Films7 - Images of art

How is this theory informed by the cognitive neurosciences ??

Can be interesting that Non Verbal communication and Implicit Relational Knowing (Stern) are the most important tools in our work

The “Mirror Neurons” (Rizzolati ,Gallese) explain very much of how NVL and IMPLICIT work.

Implicit Relational KnowingNonverbal , nonsymbolized ,Unnarrated , nonconscious

(Unconscious but not repressed)The vast Majority ( 80% ? ) of all we

know about how to be with others (including the Transference)

Daniel Stern

Istituto di Terapia Familiare di Firenze

Affect Syntonization

Affect Syntonization

Emboded SimulationYou exist in my mind

Sintonizzazione Affettiva e Dialogo Narrativo

Sintonizzazione Affettiva e Dialogo Narrativo

Emboded NarrativeYour Story exists in my Mind

Sintonizzazione Affettiva e Dialogo Narrativo

Sintonizzazione Affettiva e Dialogo Narrativo

Emboded Simulation“You exist in my Mind”

Emboded Narrative“Your Story Exists in my Mind”

Two Therapist’s Agenda

Two Therapist’s Agenda Explicit or Narrative Agenda

Two Therapist’s Agenda Explicit or Narrative Agenda Implicit or Non Verbal Agenda

From Relational Diagnosis

ToImplicit Relational

Diagnosis

Sintonizzazione Affettiva e Dialogo Narrativo

Sintonizzazione Affettiva e Dialogo Narrativo

Core of Therapeutic Change

Tuning In

Neural Integration

From the …To the Mind…

…to the world

InterpersonalNeurobiology

Mind

The adjusting Oscillators

They are a sort of body clocks which explain the mechanisms of coordination and synchronization between two or more persons among themselves.

The adjusting Oscillators

They are a sort of body clocks which explain the mechanisms of coordination and synchronization between two or more persons among themselves.

(G.Ruggiero)

The Adjusting Oscillators

When two violinists play the same musical score, the rhythm of the impulses in their right brain emispheres is very similar

The Adjusting Oscillators

When two violinists play the same musical score, the rhythm of the impulses in their right brain emispheres is very similar

(G.Ruggiero)

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZEVia Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280e-mail : itff @itff.org

web page: www.itff.orgDirector: Prof. Rodolfo de Bernart

An image is better than

a thousand words.

 Le Doux J. “The Emotional Brain”

The verbal channel is to much saturated,

We should use a non verbal channel,

Which is less controlled by patients and can allow us to enter into the

internal image of the family

Istituto di Terapia Familiare di Firenze

Thank youFor your attention!!

Istituto di Terapia Familiare di Firenze

Collage “Idea of the couple”• Card board cm 50 x 70;• Choose and cut from journals,magazines, news

papers : words, images, photos , which evoke in you the idea of the couple;

• Do this homework separatly and keep the secret;• In session we start with a a reciprocal interpretation of

the two collages trying to express the idea each of them has of the image of the couple of the partner;

• At the end each should choose the preferred , the less loved and the “disturbing” picture and explain why;

• Then each reads his/her own collage;• Each should choose the preferred , the less loved and

the “disturbing” picture and explain why;• Each should express how much the two collages are

similar in %:• Each should express how much he/she felt h/she was

well interpreted by the other in %:

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZE

How to look at a Collage•Synthetic general vision•Organization of images:! A - straight line (lines and columns)! B - cyrcular or spyral (clockwise or! counter-clockwise)•Central picture•Other significant pictures•The “Strange” picture•Reading the meanings•The preferred picture, motivation•The refused picture, motivation

•Final general vision

(Each person looks first at the collage of the other person

and then explains his/her collage)

Istituto di Terapia Familiare di Firenze

Collage “Idea of the couple” 2

• Ask each :what images he/she would like to “steal” from the collage of the partner

• Ask each :what images he/she would like to “give as a present” from his/her collage to the partner

• What imaged could be erased to make room in his/her collage?.

Istituto di Terapia Familiare di Firenze

Some Thoughts on Things we look at:

• Similarities and differences• Repetitions• Empty and Full• Real and Ideal• Distance and Proximity• Dipendence and autonomy• Coherence with the phase of the Fam.

Life Cycle• Presence of Projectuality,Sexuality,Love

etc.

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZE

Conjoint family drawing1. Static observation

A. Choosing the spacesB. Dividing and putting the borders

C. Presents and absentsD. Distance and closeness

E. Meanings and interpretations2. Dynamic observation

A. Level of collaboration during the projectB. Levels of participation during the making of

C. Levels of sharingD. Erasing and redrawing)

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZEVia Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280e-mail : itff @dada.it

web page: www.itff.orgDirector: Prof. Rodolfo de BernartObserving the Conjoint Family Drawing

SYMBOLIC INTERPRETATION:Of the drawing of each person

Of the complete drawing Of the relation between drawing and final comments

Observation of the Conjoint Family

Emotional contex tLevel of partecipation- abstention- intermittent participation- active

participation Proximity and exclusion among the

individuals- position into the drawing- position during

the drawing- movements of the family members

The Process Who starts,Who follows, and howtreats or

develops the same theme, take part in some other’s drawing, complete some other’s drawing. Who detaches, Propose a different theme...in opposition...searching a difference ,propose an original theme, Taking the initiative, works alone, ask/offer cooperation, organize his and other’s work, refuses to : isolation of a member , common or couple theme, common theme , different themes

Osservazione delDisegno Congiunto

Il Disegno

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZE

Via Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280

e-mail : itff @dada.it

web page: www.itff.org

Director: Prof. Rodolfo de Bernart

Memory, hystorical and cultural identity are preserved through images.

Representation is the time-space, through which absent becomes present, not only through a magic evocation, but

also through a real substitution of the object

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZEVia Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280e-mail : itff @itff.org

web page: www.itff.orgDirector: Prof. Rodolfo de Bernart

Picture makes us aware for theFirst time of the

OPTIC UNCONSCIOUSJust as psychoanalysis opens theINSTICTIVE UNCONSCIOUS

(W. Benjamin)

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZEVia Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280e-mail : itff @itff.org

web page: www.itff.orgDirector: Prof. Rodolfo de Bernart

Photography is a reverse prophecy:Like Cassandra

BUTWhit eyes turned to the

PAST(R. Barthes)

NONNA MATERNA

Teresa

NONNA MATERNA

Pictures in Training

Istituto di Terapia Familiare di Firenze

1. Prescription2. Journey back home (choice)3. Group Presentation4. Questions5. Restitutions6. Special Procedures7. Ritual closing8. Rielaboration (at home)9. Special Prescriptions

LESORELLE

DAPPORTO

Teresa(Teresina)

Carola(Carolina)

Angela(Angelina)

Paola(Paolina)

Orsola(Orsolina)

Lina e Mauro

Barlucchi

Pictures in Clinic1. Prescription2. Journey back home (the

choice)3. Presentation in phases:

FofO and childhood (10+10)Adolescence (10+10)Adults - meeting of the couple

(10+5+5)Marriage and Children (10+5+5)

4. Direct interpretationReciproc and Common

5. Rielaboration (at home)6. Special Prescription

Istituto di Terapia Familiare di Firenze

How to read picturesParametersInteractiveRelational

Symbolic metaphoricalPoint of viewLongitudinalTransversal

Group PicturesClose / FarAbsence

Redundant PicturesIndividual Pictures

Resemblance , Repetitions , DifferencesPosition in Genogram

B/W - ColourProportions in ages

Proportions between FofO and AF

Istituto di Terapia Familiare di Firenze

Istituto di Terapia Familiare di Firenze

Andolfi (1977) defines sculpture as: "a non verbal creative and dinamic

modality in which sculptor analogically represents his/her

relations with members of his/her family group and relations among others, in a given moment and in a

given context. 

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZE

Group and Family Sculptures 1. Traditional sculptureA. Sculpture of the pastB. Sculpture of the presentC. Sculpture of the futureD. Fenomenological and mythical sculpture2. The new sculpturesA. Instant sculptureB. Dynamic transitional sculpture

What are the MOVIES we use Becoming a couple: Il padre di Famiglia, I Vitelloni, John and

Mary, La Famiglia, Carnal Knowledge 1st Child an childhood : Baby boom, Three men and a baby,Problem

child, L’argent de poche, Totò l’heros, Mit liv som bund, Otak na sluzbenom putu, Fanny och Alexander, Hook.

Adolescence: Dead pet society, Mignon è partita, Pauline a

la plage, Clockwork orange,Peter Pan, Stand

ISTITUTO DI TERAPIA FAMILIARE DI FIRENZEVia Masaccio 175, 50132 FIRENZE, Italia

Tel e Fax --39 55 577280e-mail : itff @itff.org

web page: www.itff.orgDirector: Prof. Rodolfo de Bernart

To look at something, is not receiving it in a passive way, but

putting in order what you see and organizing the experience

(Elio Franzini)

MOVIES IN TRAINING AND IN THERAPY

How to show MOVIES Different ethnic cultures Phases of the life cicle ONLY fragments NEVER show the end Rebuilding the story And the family script Reading the non verbal language Reading relation, not verbal content Looking for hypothesis

Movies we use, 2 Empty Nest : E non se ne vogliono andare, E se poi se ne

vanno, Tanguy. Family with old parents On golden pond, Smult robstallet, Umberto

D., Coccoon, Driving Miss Daisy, Tante Danielle, Fried green tomatoes and the Whistle stop Cafè,

Sexual Language: Carnal Knowledge, Le Declin de l’Empire

Americaine,Rich and famous, Tootsie,

MOVIES we use 3 Separation, Divorce and Step Family: Shoot the Moon, Kramervs.Kramer,Come 2

coccodrilli, When Mummy works, This boy’s life,Radio flyer.

Omosexual couples: Strawberries and Chocolate, In and Out, Other cultures: East is East, Monsoon wedding, Water, Yalla

Yalla, The Weddind Banquet, Dona Flor, AND MANY OTHERS

THE IMAGE OF THE THERAPIST The importance of the non verbal channel The importance of the optical uncoscious The young age of the therapy students,

without personal and professional experience Conny Leporatti

Psychologist Therapist

Family Therapy Institute of Florence

INSTRUCTIONS The group establishes a film list on the topic of

the therapist Every student watches a film and selects 2-4

important tracks about the therapist and the therapeutic relation

Conny Leporatti

Every student introduces to the group the selected tracks

Every student of the group comments the selected tracks

The group reflects on the image of the therapist which is being constructed

Conny Leporatti

Psychologist Therapist

La Vita di noi due / Our life

Test “Images of Art” for Individuals,Families, Couples and Groups

Leon Battista AlbertiHumanist Architect

Florentine 1500

The Chinese Emperor and his painters

And to close… So thank you for

your attention and ……

Do not forget to keep watching images !!

I hope you will invent some new way of doing it!!

THANK YOU FOR LISTENING TO MEAND EVEN MORE FOR

LOOKING AT MY IMAGES

I apologize. From the Direction they tell me

that all I have said is NONSENSE

Another husband kills his wife

Provided they do it between themselves