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Community As Therapist: The San Patrignano Treatment Community


By Wayne P. De Connick M.A., R.C.C.


Nestled between the beautiful green rolling hills and manicured vineyards of the Italian countryside, the vibrant community of San Patrignano welcomes individuals who face challenges related to drug addiction and marginalization (“SanPatrignano,” n.d.). Home to some 1,300 men and women (“SanPatrignano,” n.d.), San Patrignano is Italy’s largest treatment community (Kummer, 2006), and has helped over 20,000 people on their road to recovery since its inception in 1978 (“SanPatrignano,” n.d.). The community does not exclude anyone on the basis of gender or socioeconomic status, and participation in the treatment regime is free for residents and their families (“SanPatrignano,” n.d.). San Patrignano places an emphasis upon being self-sustainable and receives no government funding. This financial strategy, it is argued, leaves residents completely unfettered and allows them to “be the architects and protagonists of their own rehabilitation” (“SanPatrignano,” n.d.).   

According to the community’s website, their treatment regime is based upon education and rehabilitation (“SanPatrignano,” n.d.). The community does not endorse the notion that addiction is a disease and, therefore, neither pharmacological interventions nor “rigid therapeutic steps” are used (“SanPatrignano,” n.d.). Physiotherapeutic and psychiatric treatments are, however, provided if deemed appropriate (“SanPatrignano,” n.d.). Furthermore, individualized treatment programs are developed in order to accommodate the unique needs, qualities, and propensities of each individual (“SanPatrignano,” n.d.).

Upon entering San Patrignano, individuals are integrated into various groups, as well as a specific training sector, which is managed by one or more professional educators (“SanPatrignano,” n.d.). These groups and training sectors provide residents with opportunities to establish meaningful connections, and the diversity between the groups adds complexity to the San Patrignano community (“SanPatrignano,” n.d.). According to Guidicini and Pieretti (1994), the complexity and pluralism of the San Patrignano community produces a “city effect” (p. 5). Due to the city effect, “the community is immediately perceived by the subjects as a viable reality with an organisational structure including its own system of laws, habits, traditions and fixed steps which lead to recovery” (Guidicini & Pieretti, 1994, p. 5). 

The structure and complexity of the San Patrignano community produces a societal microcosm wherein residents face innumerable challenges that expose their vulnerabilities to the light of scrutiny (“SanPatrignano,” n.d.). Consequently, individuals learn to navigate the vicissitudes of life as they face their challenges together with their colleagues and professional educators (“SanPatrignano,” n.d.). As individuals progress through their bespoke programs and participate in the various sub-systems of the San Patrignano community, they are charged with greater responsibilities, and eventually become “tutors” for new residents (“SanPatrignano,” n.d.). The increased responsibility, and concomitant sense of accomplishment, inculcates feelings of gratification that are “the very opposite of the illusory [feelings of] gratification offered by drug use” (“SanPatrignano,” n.d.).As discussed above, residents are integrated into a specific training sector. San Patrignano has more than 50 life and training sectors where residents may acquire the skills and competencies necessary for entering into a specific trade (“SanPatrignano,” n.d.). Furthermore, residents have the option of commencing, or resuming, academic studies (“SanPatrignano,” n.d.). The training sectors, therefore, play a critical role in reintegrating residents into mainstream society. Moreover, residents’ self-esteem is substantially improved as they gain technical mastery and increase their web of meaningful interpersonal relationships (Guidicini & Pieretti, 1994; “SanPatrignano,” n.d.). 


References


​Guidicini, P. & Pieretti, G. (1994). San Patrignano between community and society: A

            research on the biographic routes of 711 San Patrignano former guests. Article             obtained from: http://www.sanpatrignano.org/en/sociological-research  

Kummer, C. (2006). Wine therapy: What makes the wines of San Patrignano so

            distinctive? It’s not just the grapes. The Atlantic Monthly, (September        

            edition), 133-136. 


SanPatrignano. (n.d.). SanPatrignano. Website. http://www.sanpatrignano.org/en 

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An Approach for Couples: Understanding Emotionally Focused Therapy (EFT)


By Wayne P. De Connick M.A., R.C.C.


Attachment Theory 


Emotionally focused therapy (EFT) is predicated upon attachment theory, which was first put forward in a paper by John Bowlby in 1958. In that paper Bowlby proposed that instinctual drives within the infant produce certain behaviours that, in turn, elicit care-giving behaviour from the mother. Bowlby termed such behaviours “‘attachment behaviour’” (p. 351). Although attachment behaviour was initially conceptualized within the context of the mother-child dyad, Bowlby later defined attachment behaviour “as any form of behaviour that results in a person attaining or retaining proximity to some other differentiated and preferred individual, who is usually conceived as stronger and/or wiser” (1977, p. 203). Furthermore, Bowlby asserted that “attachment behaviour is held to characterize human beings from the cradle to the grave” (p. 203).

Overview of EFT 


A central construct of attachment theory is the notion of an attachment bond (Ainsworth, 1989). Circumstances that produce, or have the potential to produce, a rupture within one’s web of attachment bonds can result in significant distress (Hazan, Gur-Yaish, & Campa, 2004). Given that attachment theory serves as the foundation for EFT, it may be asserted that the focus of EFT is to repair, or prevent, ruptures in the attachment bonds between couples and family members. According to Johnson et al. (2005), practitioners of EFT use “the power of emotion to ‘move’ partners and evoke new responses in recurring key interactions that make up a couple’s relationship ‘dance’” (p. 3). Thus, EFT therapists delineate behavioural[1] patterns that contribute to hostility within a relationship and identify the emotions that fuel such behavioural transactions. Once the behavioural patterns that produce hostility have been elucidated, EFT therapists attempt to create new behavioural patterns that foster harmony and strengthen the attachment bonds (Johnson et al., 2005).      

Interventions Used in EFT 


In order to create new behavioural patterns, EFT therapists attempt to accomplish three “tasks,” namely: creating and maintaining a therapeutic alliance, accessing and reformulating emotion, and restructuring key interactions (Johnson et al., 2005). Establishing a warm therapeutic alliance provides couples[2] with a “secure base” where they may explore their behavioural patterns and identify their underlying emotions. Accessing and reformulating emotion entails bringing couples’ unacknowledged emotions to the foreground, and facilitating them in finding new opportunities to relate to each other based upon their expanded emotional repertoire. Finally, restructuring key interactions allows couples to understand their problematic behaviour in terms of unexpressed attachment needs, rather than character flaws within each other. Furthermore, restructuring key interactions exposes couples to “bonding events” that promote security within their relationships (Johnson et al., 2005).            


The Treatment Process 


Practitioners of EFT accomplish the three tasks discussed above by proceeding through nine steps. These steps are organized into three stages, namely: cycle de-escalation, changing interactional positions, and consolidation and integration (Johnson et al., 2005). While working through these stages, EFT therapists employ a number of techniques to facilitate emotional engagement. These techniques include: (a) validation, which conveys understanding and acceptance; (b) using evocative responses, which elicits emotions; (c) heightening, which intensifies an emotional experience; and (d) the use of empathic conjecture and interpretation (Johnson et al., 2005). Yet another technique, peculiar to the practice of EFT, is R-I-S-S-S-C (i.e., repeating words and phrases, using images, keeping responses simple, slowing down the process, employing a soft and soothing tone of voice, and using the client’s own words and phrases). Effective use of these techniques allows clients to access and perceive their emotions more completely. Consequently, couples uncover a rich and varied emotional palette from which they may begin to foster a new and loving relationship dance. 

Foot Notes


[1] I use the term “behavioural” in a very general sense and may be interpreted as patterns of interaction that transpire between couples or family members. 

[2] According to Johnson et al. (2005), these interventions may also be used for treating other family members.


References


Ainsworth, M. D. S. (1989). Attachments beyond infancy. American Psychologist, 44,

            709-716.

Bowlby, J. (1977). The making and breaking of affectional bonds. I. Aetiology and

            psychopathology in the light of attachment theory. British Journal of        

            Psychiatry, 130, 201-210.  


Hazan, C., Gur-Yaish, N., & Campa, M. (2004). What does it mean to be attached? In


            W. S. Rholes & J. A. Simpson (Eds.). Adult attachment: Theory, research, and

            clinical implications, (pp. 53-85). New York: Guilford.    

Johnson, S.M. (2005). Becoming an emotionally focused couple therapist: The

            workbook. NY: Routledge.