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Objective: Bucci’s multiple code theory maintains that for a significant change the patient-therapist relationship should foster a referential process shaping in three alternating phases: arousal of emotion schemas, symbolizing/narrating emotional experiences, and reflecting/reorganizing the emotional meanings. Until now to monitor these phases clinicians and researchers have used several referential process computerized linguistic measures, which however need the sessions verbatim transcription. In order to have a less time-consuming method we developed and tested a therapist self-report questionnaire measuring the referential process phases. Method: We asked eight psychotherapists in a first study and nine psychotherapists in a second study to complete the Referential Process Post-session Scale – Therapist version (RPPS-T) just after the end of their sessions. In a third study we transcribed 29 sessions conducted by three psychotherapists to calculate the correlations between the RPPS-T scores and the computerized linguistic measures of the referential process calculated on the session transcripts. Results: In the first study we collected 105 evaluations regarding 29 patients and an exploratory factor analysis revealed a four-factor pattern consistent with the hypothesized constructs. The analysis reduced the initial pool of 42 items to 12. In the second study 130 sessions with 25 different patients have been evaluated on the shortened version of the RPPS-T and a confirmatory factor analysis found that the four-factor model satisfactorily fitted the new data as well. In the third study we found that the factors of RPPS-T regarding the symbolizing phase correlated with the corresponding computerized linguistic measures calculated on the session transcripts. Conclusions: The RPPS-T received a first validation as a concurrent measure of the referential process, especially for the symbolizing phase, and could be considered a useful instrument for research and supervision.

Introduction: According to Bucci’s multiple code theory (Bucci, 1997; Bucci, Maskit, Murphy, 2015) a significant change in the patient-therapist relationship should reflect a referential process that is shaped by alternating phases: (a) arousal: experiencing emotion schemas, (b) symbolization: translating into words the emotional experiences, and (c) reorganization/reflection: recognizing, understanding and expanding the emotional significance. So far, in order to monitor the development of these three phases therapists and researchers have relied on their own clinical sensitivity and automated measures of the referential process (Mariani, Maskit, Bucci, & De Coro, 2013), which require the use of transcribed session material. In order to develop a parallel and less time-consuming method, developed a self-report questionnaire measuring the phases of the referential process, the Referential Process Post-session Scale – Therapist version (RPPS-T). Six constructs we intended to measure through the questionnaire: the emotional arousal of the therapist at the end of the session, the clarity, specificity, concreteness and imagery of therapeutic conversation according to the therapist – the four linguistic dimensions of the symbolization phase – and the extent of reorganization/reflection work performed during the session according to the therapist. Methods: To test the RPPS-T factorial structure psychotherapists were asked to complete an extended version (36 items) of the questionnaire at the end of their sessions. We collected 105 evaluations form eight psychotherapists regarding 29 patients. From the extended version of the questionnaire, through an exploratory factorial analysis we developed a shortened questionnaire (12 items) completed by other nine psychotherapists on 24 patients for a total of 130 compilations. On this second administration we conducted a confirmatory factor analysis. We also tested the concurrent validity checking the correlation between the RPPS-T scores and the computerized linguistic measures of the referential process obtained onto some session transcripts (n=18) and of therapist’s notes (n=18). Results: The exploratory factorial analysis has detected a well-defined solution, consistent with the hypothesized constructs, consisting of four factors (with three items each), one regarding the therapist emotional arousal, two referring the linguistic characteristics of the in-session conversation and one concerning the in-session symbolization work. We called these four factor a) emotion memory clarity, b) concreteness/imagery, c) specificity, and d) symbolization. The four-factor solution has demonstrated a good fit ( 2(48)=105.395, p.82). Two among the four RPPS-T scales yielded significant correlations with the computerized linguistic measures of the sessions and therapist notes: the RPPS-T symbolization scale positively correlates with High Weighted Referential Activity Dictionary (HWRAD) index measured onto the in-session patients interventions – a measure of the intensity of Referential Activity – and the RPPR-T emotion memory clarity correlates with the Weighted Referential Activity Dictionary (WRAD) and HWRAD indexes measured on the therapist notes. The RPPRS concreteness/imagery and specificity scales instead did not correlate with the linguistic measures of sessions and notes. Conclusions: RPPS-T had shown a valid factor structure and internal consistency and could be considered as a valid instrument from a statistical point of view. The factorial structure found confirms that the questionnaire detects the hypothesized constructs of the referential process. Also the criterion validity is partially confirmed by the correlation with the computerized linguistic measures of the session transcriptions and therapist’s notes. The more the patient has a clear, specific, concrete and vivid language during the session the more the therapist at the end of the session will have the impression of a good work of symbolization and connection jointly carried forward. Moreover, the more the therapist have a clear memory of the emotions experienced during the session, the more her/his notes on the session itself will have a high referential activity indicating a good elaboration and emotional connection with the patient. We can conclude that RPPS-T can be used as a quick and reliable measure of the referential process along the psychotherapeutic treatment. It does not replace the computerized linguistic measures of the session transcriptions, the richer and more direct indicators of the progress of the referential process in the session and in the treatment; however it is a parallel and less timeconsuming measure available to therapists and researchers: the firsts can easily use it as a tool for clinical monitoring and supervision, the seconds can apply it to study the referential process in correlation with the outcome measure and with the other important clinical constructs.

Attraverso la ripresa di alcuni passaggi salienti di quattro casi clinici l’Autrice fornisce una descrizione iconica e microanalitica del procedere delle tre fasi del processo referenziale - attivazione, simbolizzazione, riflessione - durante la seduta analitica. La fase finale dell’analisi di Katy, cosi come descritta da Bromberg, esemplifica la natura congiunta ed emotiva del processo di creazione di nuovi significati che avviene nelle tre fasi; le due psicoterapie senso-motorie, descritte da Ogden, mettono in risalto la natura eminentemente corporea, sensoriale e motoria degli schemi dell’emozione dissociati che e necessario ed utile attivare durante la terapia; infine il caso di Ann, descritto da Cornell, fornisce un esempio dell’imprescindibilita dell’attivazione nella relazione analitica dei vissuti corporei, sensoriali e motori che creano sofferenza nel paziente per poterli poi farli accedere al livello simbolico e con cio favorire un cambiamento reale. A conclusione vengono evidenziati i molteplici ruoli che il linguaggio assume all’interno di ciascuna fase del processo referenziale.

A partire dal racconto dell’esperienza personale che l’ha portata a sviluppare il suo modello l’Autrice presenta i capisaldi della sua teoria del codice multiplo, integrata ed aggiornata con le piu recenti acquisizioni provenienti dalle scienze cognitive e dal campo dei modelli psicoterapeutici. Vengono descritte le qualita che caratterizzano i tre principali livelli dell’elaborazione dell’informazione emotiva umana - sub-simbolico, simbolico non verbale, simbolico verbale - e la molteplicita dei codici modalita-specifici attraverso i quali viene esperita l’interazione con il mondo. All’interno di questa nuova teoria della mente vengono definiti concetti e processi clinici cruciali quali quello di schema dell’emozione, le sequenze interattive tipiche che portano alla loro formazione e alla loro riattivazione nella comunicazione terapeutica, i processi interattivi e soggettivi che portano alla persistenza degli schemi dell’emozione dolorosi o alla continua modificazione di quelli che creano benessere. Infine l’Autrice descrive il processo referenziale che connette i vari livelli dell’elaborazione dell’informazione emotiva sia nel contesto quotidiano sia durante la psicoterapia, dove si alternano circolarmente la fase dell’attivazione, della simbolizzazione e della riorganizzazione/ riflessione. L’Autrice conclude mettendo in luce la natura eminentemente incarnata e relazionale di tale processo, come anche i suoi rischi e paradossi.