Interview with Anna Maria Sorrentino - The Seven Doors of Systemic Therapy

Editor’s note: The original conversation has been edited for grammatical clarity.

Interview with Anna Maria Sorrentino, coauthor together with Stefano Cirillo and Matteo Selvini of Entrare in terapia: Le sette porte della terapia sistemica [Going into therapy: The Seven Doors of Systemic Therapy], Published by Raffaello Cortina.

Interviewers: Annina Renk, Claudia Tapparelli, Sabrina Scardua and Piera Serra

Piera Serra: We are at the school Mara Selvini Palazzoli. Right this year, which is the centenary of the birth of Mara Selvini Palazzoli, an important book is being launched. It is the result of fourteen years of clinical practice and theoretical considerations from the team formed by Stefano Cirillo, Matteo Selvini e Anna Maria Sorrentino. The book is entitled “Entrare in terapia: Le sette porte della terapia sistemica [Going into therapy: The Seven Doors of Systemic Therapy]”. I am sure it will be a valuable manual for those operating in the field of systemic therapy but also a guide for the theoretical conceptualization for those who research, and a contribution to future research. We are talking about it with Anna Maria Sorrentino and three of her apprentices who are part of a research team that deals with child family psychotherapy. They are therapists and researchers from Switzerland: this is Annina Renk from Berna, Claudia Tapparelli from Basel, Sabrina Scardua from Canton de Vaud.

Annina RenkI like a lot this concept of The seven doors which is very inclusive, each one is like a piece of the puzzle that togheter they show an entire picture of the situation

Anna Maria Sorrentino: Yes it’s true: it’s the result of the studies of many colleagues both systemic and non. Studies about attachment conducted in a cognitive framework have been very valuable. The recent seminar we did with Liotti about reorganizations gave me a great contribution about this topic: you can’t speak of “personality” in a child, rather of posttraumatic reorganization You can often see children who suddenly become tyrants: in this regard the contributions from other approaches may be enlightening. It is important to put them in the clinical work in the right place, like pieces of a puzzle. As a result the puzzle becomes clearer. We are certainly in debt to colleagues with other approaches because they gave us contribution to stimulate our reflection. Omnis, who recently died, was a great family therapist, but he also worked from an analogical point of view, for example when he used sculptures, and we are enriched by these things.

Claudia TapparelliWhat is the meaning of the title “Le sette porte” [“The Seven Doors”]. What are they the symbol of?

Anna Maria SorrentinoI’ll tell you how this title came about. We were on a beautiful lawn all together in Cassinetta di Lugagnano where we meet every year with all the teachers from the school, 30 of them, among beautiful lemon trees. While we were trying to come up with a title for the book the idea of the doors came to us. We were looking at the school’s logo which is the map of a Peruvian city with 5 doors all leading to the center. We first tried to organize our thoughts into 5 issues, but afterwards we decided that 7 were more functional. We choose the doors theme because it symbolizes the entering into the privacy, the individuality, the systemic form of the family that comes to ask for help. Which are the issues? Attachment, the symptom, the pathology of the personality, the three-generational history, the request type, the feelings felt by the therapist are all entrances into a world that is always unique and mysterious: the world of the other and their relationships. With just a little light we can be guided in understanding how the person has been formed , their fundamental relationships, and the crystallization we face now – which could be different in another moment. These doors bring us to understand that some orientations may be a guide for the therapist in order to come into the therapeutic relationship prepared. We structured such topics of study in order to integrate them to help us in our job.

Claudia TapparelliWhat makes this book unique?

Anna Maria SorrentinoIt’s a collection of procedures, so the risk may be that it becomes boring. We tried to avoid it being boring by putting case studies: cases are never boring. Cases are always stories of our lives that touch us, and this puts us in the same narration as the people we work on. So the uniqueness is a twofold polarity: formal procedures, of which we explain the meaning. For example, we may call an 80 year old lady, mother of an adult son who is competent and highly educated but affected by a chronic depression he doesn’t know the cause of, because the old woman knows elements of his past that he doesn’t know. She may know about her own depressive moments the son had to pass through as a young child when she lost her own father. Such information may be not taken into consideration by our patient but reported by the mother in tears. We do this because in some circumstances such information from the testimony of a family member may be very valuable: indispensable in the case of a child or productive in the case of a competent adult. These testaments may shorten the time required to understand the causes of the problem and to find the solution.

Claudia Tapparelli: Therefore all the protocols, all of the doors, the entrances are underlined with your examples in the clinical cases

Anna Maria SorrentinoWe used the clinical cases to justify the theory and the theory as a guide for the clinical work. Just as Mara taught us: she was not happy if the clinical work didn’t give the answer that the theory required or vice versa generating new theories that could explain the clinical evidence. The books about anorexia, or psychotic … are the result of her struggle to create an integration between a theory – which should be clear and easy to communicate. She use to say: speak the way you eat, don’t look into the words for an explanation that isn’t there, look for it in reality. This was a great lesson.

Claudia Tapparelli: Therefore the book could be interesting for who is studying familiar therapy and also for those who already have had experience

Anna Maria SorrentinoWe also hope it will be an opportunity to create a debate. One of Mara Selvini’s statements was : “Don’t write a new book before 10 years have passed, because otherwise you can’t write anything new”. She was right: it took 14 years for us to write this book as a team, even if in the meanwhile each one of us wrote a book individually: I wrote “Figli disabili”, Matteo “Reinventare la psicoterapia”, Stefano wrote about abuse. During these 14 years we tried to organize some ideas and our effort, aimed at setting up therapeutic procedures based on clear premises, took some time because comprehension and learning came from clinical work.

Claudia Tapparelli: What are the big differencies, the novelties if we make a confrontation with the other books?

Anna Maria SorrentinoWe deal with topics already treated in “Ragazze anoressiche e bulimiche”: themes like personality, the specification of the symptom, upbringing, attachment, girls who are their mother’s daughters, girls seduced by their Oedipal father, which were simply mentioned in our previous work, in this book they are dealt with in detail. The systemic vision of the family, the individual vision of the subject and their development and attachment, the intergenerational stories are more precisely analyzed, and we clarify how they inform the procedures. The procedure we use now in welcoming the family, in relating to them and in bringing the therapy to a conclusion are different from the time we used to practice the paradoxical techniques: now the final step of a therapy is the re-conciliation with the family system rather than opposition. This has been the result of our experience. The mediating solutions of reciprocicate comprehensions are more efficient and more durable than the solutions of breaking up in the therapeutic process.

Sabrina ScarduaWhat always impressed me and I think was in the core of Mara’s work is how the research was continuously conducted beside the clinical work, which enriched the work itself. It’s the same in this book, isn’t it?

Anna Maria SorrentinoYes, we tried to keep on working in a research perspective. That means not accepting to maintain the usual practice: we always criticize and re-discuss our own methodologies, You can grasp the complexity of clinical themes from many perspectives, which are symbolized by the seven doors, but what increases the knowledge is our capability to correlate what happens in the therapeutic session and our pre-existing ideas: we need “selves” in our head where we can organize the situations we meet, not in order to capture them, but in order to increase our knowledge while noticing differences and similarities. That’s precisely what Mara taught us: never feel satisfied. If you adopt a method, maybe if you think about it again, you’ll find a better one. This teaching guided us and you can find it in our book. I believe that Mara would have liked this book.

Sabrina ScarduaAnd which other feature of this book would have been appreciated by Mara?

Anna Maria SorrentinoThe huge number of clinical cases. She was fascinated by each one of our cases

Sabrina Scardua: My last question is: how is the book linked with psychotherapeutic practice? How can it be useful for psychotherapists?

Anna Maria SorrentinoWe wrote it moved by a sense of responsibility towards our “poor” trainees whose brains we mix up during our 5 years training. Out of pity for them, we tried to give them some references for their work. What we hope is to offer more than a set of tools for young therapists. We hope that somebody enters into a peer to peer debate with us, giving us suggestions, hints, criticisms that might make us work out interesting things. This book contains the soul of everybody: it contains the contribution of Canevaro and the psychoanalytical contribution of Berrini, who are both our teachers. The contribution of Paola Morosini who works at a neuropsychiatric hospital and so deals with organically diagnosed cases. So many people who gave contribution: Paola Covini and Dante Ghezzi with the topic related to the couple. Like when we were together in that garden where we worked out the title of the book, the book is also the synthesis of the work of all the teachers of the school and this is greater than us three. They brought in their target subjects, specialized topics which offer opportunities to discuss the procedures. So we hope that also other colleagues from different approaches might give us food for thought. You suggested that they could use the book. Maybe not actually use it, but perhaps find shared considerations in it.

Published online: 11 February 2015.

Copyright: © 2014 Albert Pesso and Piera Serra. This is an open-access article distributed under the terms of the Creative Commons Attribution License. The use, distribution and reproduction of this article is permitted, provided the original authors and licensor are credited and that the original publication in E-Journal of Psychotherapy Research is cited in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.