G.M. Ruggiero, G. Caselli and S. Sassaroli “Studi Cognitivi” Cognitive Psychotherapy School, Milano Sigmund Freud University, Milano and Wien

1. Practicing REBT in Italy:
cultural aspects
Constructive, Emotive and DevelopmentalComponents in REBT in Italy
G.M. Ruggiero, G. Caselli and S. Sassaroli
“Studi Cognitivi”Cognitive Psychotherapy School, Milano
Sigmund Freud University, Milano andWien

2. REBT in Italy: merging constructivism and
rationalism
• Cesare De Silvestri, Carola
Schimmelpfennig, Franco Baldini, and Mario
Di Pietro were the Italian therapists who
brought REBT to Italy in the 1980s and
1990s
• They had to find a compromise between
REBT and the constructivist viewpoint
dominant in Italy (Ruggiero et al. 2014).

3. REBT in Italy: merging constructivism and
rationalism
• In the ‘70s and ‘80s the major Italian
cognitively based clinicians and
researchers, such asVittorio Guidano,
Gianni Liotti, Sandra Sassaroli, Antonio
Semerari and Francesco Mancini merged
the REBT paradigm with constructivist
and developmental models

4. Italian radical Constructivism
• Guidano and Liotti (1983)
– devalued the concept of a shared, objective and external truth
– expressed doubts about the efficacy of rational disputing as a
therapeutic intervention
• Guidano and Liotti did not think that rational thinking could affect
emotional states and behaviors (Guidano & Liotti, 1983).

5. The interest in clients’ personal development in
ItalianConstructivism
• In addition, Guidano and Liotti (1983), and later Liotti
alone (2001), focused on the developmental roots of
biased beliefs.
• In clinical terms, this meant paying more attention to
the exploration of clients’ personal histories, how they
developed and in what situations and with what
relational patterns they learnt their biased beliefs.
• Difficult relationships were thought to be predisposing
factors paving the way for a cognitive vulnerability to
emotional disorders.

6. Italian cognitive therapy
• Sandra Sassaroli and Roberto Lorenzini merged Kelly’s
constructivism, Bowlby attachment theory and REBT
• However, they never rejected the cognitive principle that
rational thinking can affect emotional states and behaviors

7. Is there a cultural aspect in Italian
constructivism?
• Are there any significant features in Italian culture
to justify the preference of Italian cognitive
therapists for:
– the less rationalistic -and more constructivist-
aspects of cognitive therapy
– their tendency to combine REBT with an analysis of
clients’ personal development and of the history of
their significant relationships with affective figures
during childhood and adolescence
– the higher importance given to the emotive and
behavioral aspects of REBT

8. Method
We chose two different strategies for exploring the
features of Italian culture that could account for the
obstacles to the acceptance of rationalistic and
directive aspects of cognitive therapy
• The first strategy is an analysis of certain
aspects of Italian philosophical thought
• The second strategy is a review of social
research on Italian people

9. Method: how we explored Italian
philosophical thought
• We refer to the three most recent and
comprehensive collective anthologies of
Italian philosophers published in English
(Borradori, 1988; Hardt &Virno, 1996; Chiesa
&Toscano, 2009) and the brilliant review by
Roberto Esposito in Italian (2010, 2012)

10. Italian philosophical tradition as a tool to
understand Italian therapists’ mentality
• There are remarkable similarities
between some specific features
of Italian philosophy and the way
Italian cognitive therapists
adopted cognitive therapy and
particularly REBT

11. Italian philosophical and cultural distrust in the
rational handling of emotions
• In the founding fathers of Italian thought, namely Niccolò
Machiavelli (1469-1527), Giordano Bruno (1548-1600), and
GiambattistaVico (1688-1744), there is the same lack of confidence
in the possibility of tackling emotions using rationality that
distinguishes the Italian approach to cognitive therapy.

12. Italian philosophical and cultural distrust in the
rational handling of emotions
• These three philosophers did not believe in the possibility
of a rational order ruling or at least managing politics
(Machiavelli, 1532), human history (Vico, 1725, 1730, 1744)
or even the structure of universe (Bruno, 1584)

13. Italian culture as defined by its social life
• Using Hofstede’s multi-factorial model of cultural studies
(Hofstede, 2002), we can find in Italian society:
– distrust toward impersonal procedures;
– confidence in emotional and relational bounds;
– tendency to conceive conflicts as an unavoidable aspect of
social life;

14. The contribution of the Italian
cognitive movement
• However, Italian culture not only
created obstacles but have
encouraged a particular
attention to REBT’s
constructivist and meta-
emotional aspects.

15. The contribution of the Italian cognitive
movement
• Albert Ellis stressed that the REBT model was
far from being a purely rationalistic model
and also had a constructivist and emotional
facet (Ellis, 1990) aimed at promoting
increased acceptance and tolerance of
emotional suffering.

16. The contribution of the Italian cognitive
movement
• Italian therapists keenly appreciated REBT’s meta-emotional
aspects.
• In REBT this meta-level is generally called ‘secondary problem’.
• This secondary problem is a vicious circle in which the client has a
biased negative belief towards his or her own mental states.
• Many Italian cognitive clinicians and theorists think that all
emotional disorders are, in fact, always generated by a secondary
process (Lorenzini & Sassaroli, 1987; De Silvestri, 1989; Mancini,
1990).

17. The contribution of the Italian
cognitive movement
• We can see a parallel with the historical distrust of Italian thought
and culture in the capacity of the mind to handle emotional life
using the tool of rational thinking.
• Consequently, the only available instrument is a meta-cognitive
level in which emotions are recognized and regulated but never
really directly controlled (Caselli, 2013).
• It is not coincidental thatWindy Dryden called the ‘secondary
problem’ ‘meta-emotional problem’ (2011, p. 70).

18. Italian americans and Italian
culture
• I would suggest that also in
some American colleagues of
Italian ascendancy we can find
the same interest towards
emotional life and
interpersonal conflicts.

19. Italian americans
• Raymond DiGiuseppe’s studies about anger
• Bernardo Carducci’s researches about shyness
• Philip Zimbardo work about the social roots of
“evil”
• Anthony Scioli’s studies on hope
• Ralph Piedmont studies about spirituality
• Elisabeth Messina’s reflections on social
stigma

20. Future directions
• Overcoming the crude dichotomy of emotion against rationalism;
• Qualifying the cognitive therapeutic process not as "rationalistic"
but as specific work on voluntary executive functions:
– Sharing case formulation in terms of functioning
– Commitment to and confidence in conscious change
• IN constructive cognitive psychotherapy case formulation is a slow
paced discovery not shared from the beginning
• In Psychodynamic therapy case formulation is the exit a conflictual
process not shared from the beginning

21. Future directions
• in cognitive behavioral therapies (CBT) the case
formulation
– is not just the opening move focused on the assessment
– but it is the main operative tool by which the therapist
handles the whole psychotherapeutic process, either
• Either specific CBT interventions
• Or the therapeutic alliance and relationship

22. Future directions
• The case formulation in CBT is a procedure which is unceasingly
shared between patient and therapist from the beginning to the
end of the treatment.
• The case formulation is increasingly becoming the distinguishing
feature of CBT approaches and very specific to its basic tenets,
given that implies full confidence in patients’ conscious
agreement, transparent cooperation and explicit commitment
with CBT’s model of clinical change.