# Post-rationalist cognitive therapy

Post-rationalist cognitive therapy is a type of constructivist cognitive therapy that was created by the Italian neuropsychiatrist Vittorio Guidano in the 1980s and 1990s.
In the early 1980s, Guidano published the book Cognitive Processes and Emotional Disorders (1983) with his colleague Giovanni Liotti. In this book the authors still adhered to and used the cognitive restructuring techniques created by Albert Ellis and Aaron Beck, although they added to them their own theoretical model about evolutionary development from childhood, influenced by the Jean Piaget's genetic epistemology and John Bowlby's attachment theory.
This model, which the authors call the "evolutionary-structural" approach to cognitive therapy, stated that human beings form certain knowledge schemes from childhood that are affective in nature and more central than propositional knowledge schemes in linguistic format. Central affective knowledge schemes are formed from attachment ties with parents or caregivers, and establish certain biased ways of perceiving the world, perceiving oneself, and relating to others.
Guidano later incorporated the influence of Donald T. Campbell and Karl Popper's evolutionary epistemology (the study of knowledge from a biological perspective), complex systems theory, Humberto Maturana's radical constructivism. and Jerome Bruner's narrative psychology.

## Two levels of human experience

Guidano and Liotti distinguish two levels of human knowledge: the tacit level of sensorimotor, imaginative, and emotional knowledge, and the explicit level of linguistic and propositional knowledge.
The tacit level is hierarchically supra-ordered, that is, it orders and determines the possibilities that the more superficial explicit schemes take. Tacit knowledge structures are “core ordering processes”, unconscious rules that organize current experience and anticipate subsequent experience. Furthermore, tacit processes do not appear in consciousness, that is, they determine explicit cognition without being included in it.
Another postulate of the structural evolutionary approach is that the evolution of knowledge during childhood and later life operates in a dialectical manner, that is, the subject encounters situations in the world that confirm his previous schemes and others that are discrepant. The latter make it necessary to modify the knowledge schemes and/or modify the environment, giving rise to more flexible and abstract cognitive structures.

## Constructivist epistemology

Guidano's constructivist epistemology means that, unlike the cognitive therapies of authors such as Aaron Beck and Albert Ellis, the post-rationalist cognitive-processual systemic approach, like other constructivist therapies, does not assume that the therapist has a superior access to reality than the patient and can identify irrational thought processes in the patient so that the patient can correct them.
Instead, both the patient and the therapist are constructors of meanings that must be reconstructed throughout the therapy. These meanings refer to the patient's life situation and, in later stages of the therapy, to his or her life history. Post-rationalist therapy is therefore historical in nature.
Guidano states that the therapist should not propose to the patient a correct way of thinking or interpreting his life situations, nor should he give the impression that the therapist knows a way of living that, if the patient adopted, would allow him to stop suffering forever. The therapist should not judge or directly criticize the patient's statements or the thoughts he expresses. In fact, the therapist is a "strategically oriented disturber" who seeks to increase the patient's awareness of the tacit rules by which he organizes his experience. The way in which the patient interprets therapeutic interventions does not depend only on the therapist but, above all, on the self-organizing properties of the patient's self system itself. Therefore, the interventions cannot be "instructive," but are disturbances that trigger the spontaneous reorganization of the patient's meaning systems.
Another aspect is that the patient is sought to increase his awareness of those aspects of his experience that, through self-deception, he leaves outside his consciousness. The therapist should therefore not encourage the defensive exclusion of certain areas of the patient's experience or point out to the patient that his interpretations of it are wrong.
All human experience and emotion, however strange or bizarre it may seem to an outside observer, is true as experience. The reorganization of meaning arises from the patient's experiencing of new emotions in therapy, and from the patient's progressive awareness of his tacit operating rules.
Cognitive change at an explicit level does not in itself lead to profound change. Profound change requires the emergence of emotions in the therapeutic relationship, and it is the emotional tone that the patient experiences during the reconstruction of his experiences that will produce the most profound modifications in the tacit emotional structure of his meanings.

## Autopoiesis

Guidano borrows the notion of autopoiesis, originally developed by Chilean biologists Humberto Maturana and Francisco Varela.
Autopoiesis is the self-organizing nature of living beings, which means they have autonomy. Maturana and Varela defined autopoiesis as the characteristic of a system that maintains and reproduces itself through its own processes. A system is autopoietic if it is capable of producing and maintaining the components that constitute it.
These systems have distinct boundaries that separate them from their environment, but they are open to interactions with the environment, such as the exchange of energy or matter. These interactions are regulated by the system itself.
The key idea is that the system's internal processes are organized in a way that they produce the system's own components in a self-sustaining cycle. This makes the system autonomous, as it doesn't rely on external forces for its reproduction.
In their view, living organisms are examples of autopoietic systems because they continually produce and regenerate the components necessary for their existence, such as proteins, cells, and organs. Vittorio Guidano extended the concept of autopoiesis to the realm of psychology and cognitive science. He applied the theory to human psychological development, suggesting that the mind itself is an autopoietic system. According to Guidano, our subjective experiences and the meaning we derive from them are generated by the mind through an ongoing self-organization of cognitive processes.
Guidano also argued that self-identity is formed through this self-referential process. The way we perceive ourselves is constructed by an internal, dynamic system that adapts and responds to both internal and external stimuli.

## Order through fluctuations

The concept of order through fluctuations comes from non-equilibrium thermodynamics and Ilya Prigogine’s chaos theory, developed in his work on non-linear systems. Prigogine, who was a Belgian physicist and chemist, proposed that complex systems, far from equilibrium, can achieve emergent order through fluctuations. These fluctuations include chaotic dynamics that give rise to news structures of systemic order. That is, in dynamic systems, small variations or perturbations can, under certain conditions, give rise to a new state of organization or coherence at the global level. This type of order is not static or predictable in a simple way, but rather emerges emergently through internal interactions of the system.
In Prigogine's theory, this concept is relevant in complex systems, such as nature, the brain or human societies, where internal fluctuations (small changes or perturbations) can generate a new form of organization.
In Guidano's approach, the concept of order through fluctuations is used to understand the dynamic and non-linear processes of the human mind. According to Guidano, people are not static beings or simply reactive to their environment, but continually construct their reality through a constant balancing process that involves fluctuations or changes in their perception or understanding of themselves and the world. Through therapy, one seeks to allow these fluctuations to lead to a new order, a new understanding of experience and identity, thereby facilitating a process of psychological self-organization.
That is, the cognitive and emotional fluctuations that a person may experience are seen as opportunities to reorganize their internal experience in a more coherent and adaptive manner. Through therapy, these fluctuations can be managed in ways that allow the person to achieve greater balance and a new form of inner order.

## Narrative identity

Guidano adopted the concept of narrative identity in the context of his psychotherapy. According to Guidano, human identity is not constructed in a static manner or simply from a series of fixed traits, but is constructed through a personal narrative, that is, from the stories that each individual tells himself about his life, his experiences and his relationship with others.
For Guidano, narrative identity implies that people organize their experiences and give them a coherent meaning through an internal narrative. This narrative is not something fixed or immutable, but is constantly changing, since the person can reconfigure it as he progresses in life, faces new challenges or undertakes new experiences. In fact, identity is seen as a dynamic process, influenced both by social interactions and by the internal reflection that the individual carries out on his own existence.
Although identity is flexible, certain basic themes and characteristics tend to be self-perpetuating. Each person constructs their life narrative, seeking to give it internal coherence. That is, the tendency toward change coexists with the tendency toward maintenance. Each person has a certain "life theme" or "script." For example, a person who decides to become a tennis player will place great importance on tennis in their life, will practice tennis from a young age, will be a tennis player or not (and this will be important to them), and may later become a tennis coach.
Furthermore, the family in which a person grew up will usually have a decisive influence on the script and life plan that a person builds for himself.
Thus, Guidano proposes that identity is not a set of fixed attributes, but a narrative construction that adapts over time, depending on the experiences and the interpretation that each person makes of them. Narrative, therefore, becomes a means of giving meaning and continuity to a person's life, helping to integrate the various episodes and experiences into a coherent and meaningful story.
This idea is especially relevant in psychotherapy, where working with a person's narrative can help them find new ways of interpreting their life and, therefore, transform their identity in healthier and more adaptive ways.

## Personal Meaning Organizations

Guidano developed the concept of Personal Meaning Organizations (PMOs) as part of his theory on the construction of personal meaning. According to Guidano, PMOs are fundamental emotional-cognitive structures or systems that help individuals make sense of their experiences and navigate the world. These organizations form the core of an individual's sense of identity and are critical in the development of their personal narrative.
PMOs are essentially self-organizing structures that give meaning to experiences and help an individual interpret events, relationships, and their own sense of self in a coherent and meaningful way.
Guidano identified four specific organizations of personal meaning (PMOs) that are related to different patterns of psychopathology. These organizations are related to the way individuals process and structure their experiences, particularly in relation to their emotional responses and cognitive styles.
Depressive Organization: The Depressive Organization is characterized by a cognitive style in which individuals interpret their experiences in a negative light, often focusing on feelings of helplessness, worthlessness, and hopelessness. People with this organization tend to have a rigid, self-critical framework and a pervasive sense of failure. Depressive individuals have suffered a loss (which may be the death of a parent in childhood) or an early emotional detachment, which may take the form of emotional abandonment by parents who are only physically present. Themes of loss and defeat are embedded in the non-declarative implicit core of the depressive cognitive organization. From an early age, these individuals become independent and avoidantly attached because they have not received emotional warmth. However, the internal working model and the emotional self-schema related to loss and defeat can lead, in certain patients with a depressive PMO, to the activation of another behavioral-motivational system: the competitive system, which drives them to seek great achievements and thus compensate for their feeling of worthlessness.
Phobic Organization: The Phobic Organization is characterized by an intense need for control and a tendency to avoid situations that might provoke anxiety. People with a phobic organization have often had parents who prevented their child from autonomous discovery and independence. The world outside the family was connoted to the child as dangerous, a place from which he had to be protected. Because of this, according to Guidano and Liotti, people with a phobic PMO perceive themselves as less capable than others of coping with the world and challenges of life outside the family environment. People with this organization structure their meaning around fear and anxiety, often developing rigid patterns of behavior designed to protect themselves from perceived threats. They tend to overestimate the danger in situations and develop avoidance behaviors to cope with perceived risks, leading to restricted life experiences.
Psychogenic Eating Disorder (PED) Organization: This organization is associated with individuals who develop eating disorders, such as anorexia or bulimia. The Psychogenic Eating Disorder organization is marked by issues of control, self-worth, and identity, where individuals use food and eating behaviors as a way to manage emotional distress and regulate their sense of self. There is often a distorted relationship with the body and an obsessive focus on controlling food intake as a means of maintaining a sense of power and self-coherence.
Obsessive Organization: The Obsessive Organization is characterized by a preoccupation with control, order, and perfectionism. Individuals with this organization often experience anxiety when things are not orderly or predictable, and they may engage in compulsive behaviors or thought patterns to alleviate this anxiety. Their meaning-making is often centered around an excessive need for certainty, a fear of making mistakes, and an inability to tolerate ambiguity or imperfection.
These four types of PMOs reflect different ways in which individuals organize meaning in their lives. These organizations are not pathological in themselves, but they can produce psychopathology when they become excessively rigid and limiting, leading to emotional distress and mental health problems.
Treatment, according to Guidano’s approach, often involves helping individuals reframe and reorganize these meanings to promote healthier, more adaptive ways of thinking and living.