Under the direction of Grégoire Vitry, The Great Book of Systemic Diagnosis and Strategic Intervention has established itself as a reference work in the field of brief systemic and strategic therapy. Intended for practitioners and students, this comprehensive manual combines theory and practice by proposing a rigorous framework for diagnosis and clinical intervention.
A real manual of the strategic systemic approach for practitioners and students
under the direction of Grégoire Vitry, ed. Dunod
Under the direction of Grégoire Vitry, The Great Book of Systemic Diagnosis and Strategic Intervention presents itself as a reference work in the field of brief systemic and strategic therapy. This innovative manual, intended for mental health practitioners, therapists and psychology students, offers for the first time a comprehensive theoretical and practical framework for the implementation of an accurate operative diagnosis. Based on the systemic approach developed by the Palo Alto school and enriched by contemporary contributions from the SYPRENE research network, this work offers a rigorous method for analyzing, diagnosing and intervening effectively on psychological and relational disorders. .
A theoretical approach anchored in the system
The starting point of the Big Book of Systemic Diagnosis and Strategic Intervention is the strategic systemic approach, which is based on an interactional reading of disorders. Unlike traditional diagnostic methods focused on individual symptoms, this approach analyzes behaviors according to their relational context and the interaction systems in which they are part. Indeed, the systemic approach is based on the idea that problematic behaviors are not isolated responses, but reactions to complex perception-reaction systems.
One of the major innovations of the book is the way in which it integrates these principles into clinical practice through operative diagnosis. This methodology allows the practitioner to precisely identify redundant solution attempts, that is to say, behaviors that the patient repeats in vain to try to resolve their problems, but which contribute to making them worse. This concept, central to the strategic approach, is developed throughout the work and constitutes the basis of the proposed therapeutic interventions.
A structured manual for practical application
The work is structured in such a way as to make its use accessible and immediately applicable for practitioners. Each pathology is analyzed through several dimensions which make it possible to integrate both the theoretical aspects and the practical tools necessary for the intervention. Twenty-three psychological disorders are studied in detail, including phobic disorders, obsessive-compulsive disorders, depression, eating disorders and addictions. For each of these disorders, the work offers a methodology in several stages.
First of all, it presents a classic nosography which allows the disorder to be placed in a descriptive and diagnostic framework according to the traditional criteria of psychology and psychiatry. Then, a systemic reading of the disorder is proposed, making it possible to analyze redundant solution attempts and to understand their role in maintaining the difficulties. Finally, the book describes strategic interventions specific to each disorder, highlighting therapeutic prescriptions designed to break vicious relational and behavioral circles.
Concrete tools for practitioners: summary sheets and case studies
One of the educational strengths of this manual lies in the use of summary sheets for each disorder. These sheets offer a clear and concise summary of the main aspects of the diagnosis and strategic intervention. They summarize the redundant solution attempts observed for each disorder, the most effective strategic prescriptions, as well as empirical statistics from the SYPRENE network's research.
For example, for phobic disorders, the summary sheet identifies attempted solutions such as avoiding anxiety-provoking situations or overcontrolling emotional reactions (p. 143). Suggested prescriptions include interventions such as the ladder technique or graded exposure, aimed at reducing anxiety and changing dysfunctional behaviors. These sheets are also enriched by case studies which show how theoretical concepts can be applied in practice. The case studies illustrate in detail how a practitioner can identify solution attempts, formulate strategic questions, and implement tailored prescriptions to resolve the patient's problems.
Strategic questions: a guide to discriminating disorders
One of the most innovative aspects of this work is the use of strategic questions to help practitioners refine their diagnosis and discriminate between different disorders. These questions are designed to shed light on the mechanisms underlying solution attempts and guide interventions based on the patient's responses. For example, in the case of panic disorders, a key question to ask is: "Are you afraid of dying or losing control?" » (p. 196). This simple question makes it possible to distinguish whether the patient presents phobic or obsessive symptoms, thus guiding the therapist towards a more precise intervention.
For procrastination, strategic questions help discriminate the underlying causes of the patient's behavior, whether perfectionism or fear of failure. For example: “Are you putting off tasks out of fear of doing poorly or seeking a feeling of excitement? » (p. 170). These questions make it possible to identify the patient's underlying motivations and adjust prescriptions accordingly.
Scientific validation by the SYPRENE network
The book benefits from scientific validation thanks to research from the SYPRENE network (Systemic Practice Research Network), an international network of practitioners and researchers in systemic therapy. The data collected by SYPRENE makes it possible to evaluate the effectiveness of the interventions proposed in the work. Each summary sheet includes statistics that illustrate the results of interventions, such as the average number of sessions needed, the duration of therapy, and case resolution rates.
For obsessive disorders without ritual, data show, for example, that strategic intervention allows resolution in 89% of cases, with an average of six sessions (p. 199). These scientific results, supported by empirical and qualitative data, reinforce the credibility of the systemic and strategic approach and give practitioners concrete benchmarks to evaluate the effectiveness of their interventions.
A rich and accessible educational approach
The Big Book of Systemic Diagnosis and Strategic Intervention is designed to be both a theoretical and practical manual. It offers a clear and structured educational approach, allowing practitioners to learn to use diagnostic tools and intervention strategies in a fluid manner. The presence of detailed case studies, summary sheets and analysis grids makes this work particularly suitable for students and professionals who wish to deepen their understanding of the strategic systems approach.
Each chapter offers a logical progression, going from the theoretical understanding of systemic dynamics to their application in practical cases. Complex concepts are explained clearly and are always followed by concrete examples to facilitate assimilation. Analysis grids, such as the CESAME questioning guide, help practitioners make precise operational diagnoses by identifying solution attempts in different dimensions (cognitive, emotional, somatic, etc.).
The strategic systems approach: a new way of seeing psychological disorders
One of the essential points of systems theory is to understand behaviors not as isolated individual manifestations, but as responses to systems of relationships and interactions. This approach differs from classic models which focus on an individual's internal symptoms, emphasizing the way in which individuals interact with those around them, whether at the family, social or professional level.
The book introduces the notion of redundant solution attempts, behaviors that patients repeat when trying to solve their problems, but which end up making the situation worse. The theory developed in the book postulates that these attempts, often unconscious, are at the origin of the maintenance of disorders. These recurring behaviors, whether avoidance, excessive control, or confrontation, are analyzed through a systemic grid in order to understand their role in the persistence of difficulties.
Perception-reaction systems
Another pillar of systems theory presented in the book is the notion of a perception-reaction system. According to this framework, an individual's behaviors are not direct responses to an objective situation, but to their perception of this situation. The systemic approach is therefore particularly interested in the way in which individuals perceive their environment and how this perception shapes their reactions.
In this framework, solution attempts are direct responses to the perceptions that individuals have of their contexts. For example, a patient who perceives a situation as threatening may develop an avoidance strategy to minimize discomfort, but this strategy becomes dysfunctional when systematic avoidance reinforces anxiety and social isolation. The work thus offers a theoretical reading according to which it is necessary to understand these perception systems to better guide therapeutic interventions.
Systemic modeling of disorders
For each pathology studied, the book offers a systemic modeling of the disorder. Unlike classic classifications in clinical psychology, the strategic systems approach models disorders based on interaction dynamics and redundant solution attempts. For example, phobias are modeled taking into account the avoidance cycles and reinforcements that underlie them, while obsessive disorders are analyzed through the lens of overcontrol.
The theoretical framework thus makes it possible to develop a more detailed understanding of the mechanisms at work in each pathology, taking into account relational systems and the way in which problematic behaviors interact with these systems. The operational diagnosis, introduced in the work, is based on this systemic modeling and allows intervention in a more targeted manner.
A theory centered on strategic intervention
The strategic aspect of the approach is based on the fact that therapeutic intervention is guided not only by the analysis of redundant solution attempts, but also by the objective of modifying these behaviors to obtain lasting change. The theory of strategic intervention, as developed in the book, is built around the idea that changes in the relational and interactional system allow problems to be resolved at the root.
From this perspective, interventions are designed to destabilize dysfunctional cycles and introduce behavioral alternatives that will allow the patient to escape from their ineffective solution attempts. Strategic prescriptions, which are based on this theoretical modeling, aim to “block” or interrupt the repetitive behaviors that maintain the disorder.
The contribution of theory to clinical practice
Strategic systemic theory is not limited to a theoretical understanding of unrest, but is action-oriented. Each theoretical chapter is accompanied by practical examples and specific prescriptions that allow the concepts to be applied directly in clinical practice. The work thus proposes a model where theory and practice are closely linked, allowing practitioners to easily move from theoretical conceptualization to concrete intervention.
One of the great contributions of this theory is to offer a non-pathologizing reading of disorders. Rather than considering patients as “carriers” of intrinsic dysfunctions, systemic theory sees disorders as maladaptive responses to specific contexts, which opens the way to more respectful and less stigmatizing interventions.
Author: Grégoire Vitry
Title: The Big Book of Systemic Diagnosis and Strategic Intervention
Publisher: Dunod
Publication date: October 2, 2024
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