Post-rationalist cognitive therapy

Domain II · Behavioural & cognitive · Vittorio Guidano · 1983 · Rome

What it is

Post-rationalist cognitive therapy is a constructivist, process-oriented cognitive psychotherapy developed in Rome by Vittorio Guidano. It grew from his structural cognitive work with Giovanni Liotti (1983) and was consolidated in his 1987 and 1991 books. It reverses the "rationalist" premise of…

Format

• Format. Individual, face to face, for adults; couple formats also exist. Usually weekly and longer-term, from several months to around two years, but no source opened gives a session count or frequency. León Uribe & Tamayo describe three phases that overlap rather than run as strict blocks: (1)…
• Content: assessment and diagnosis; setting the frame; symptom history; the life context at onset (relationships, losses, separations, life-cycle transitions); a first sketch of current affective relationships; the agreement that the work will rest on the client's own experience rather than advice.…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• symptom flare-ups as ending approaches. These are usually material, not failure.
• the client recognising their self-image as something constructed rather than a fact. That marks movement toward deeper change.
• your own pull to rescue, reassure, argue or withdraw. It is working when the client can talk about their reactions to you without disengaging.
• sessions that drift into general discussion with no episode. Return to step 2. It is working when the client starts arriving with an episode ready.
• an over-neat story borrowed from the therapist's language. Prefer the client's own idiom. It's working when the story explains new events without strain.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.