Focus on ISSTD History

Obituary for Giovanni Liotti (27.3.45 – 9.4.18)

Benedetto Farina, MD, PhD, and Adriano Schimmenti, PhD, DClinPsy

Giovanni Liotti, who sadly passed away in April 2018, was one of the fathers of cognitive psychotherapy in Italy, founder and past president of the Italian Society of Cognitive and Behavioural Therapy and prominent scholar of traumatic dissociation. Gianni (to friends and colleagues) used to describe himself as a “pied noire” because he was born in Tripoli (Libya) in 1945 and lived there until he was sixteen. In Tripoli he grew up inside a cultural melting pot where Italian, Arabic and Jewish elements were integrated in a peaceful framework. This integrated multiplicity has been one of the main features of Gianni’s personality and his intellectual background. He was indeed a tireless, inquiring researcher and intellectual, who explored and integrated very different fields of knowledge. This capacity brought him to personally meet John Bowlby and to become one of the most original scholars in the field of attachment theory, by both adopting the theory in the background of cognitive behavioural psychotherapy (Guidano & Liotti, 1983) and advancing the understanding of attachment disorganization as a potential precursor of dissociation (Liotti, 1992).

In a milestone bestseller book that he wrote with Vittorio Guidano entitled Cognitive Processes and Emotional Disorder (1983), Liotti proposed attachment theory as a developmental theory for CBT. He hypothesized that the focus of CBT should be extended from irrational explicit beliefs to the implicit relational knowledge shaped by early attachment relationships. The therapy, in his view, consisted in the transformation of pathological beliefs about the self and the external world, using both cognitive strategies and the therapeutic relationship as a corrective emotional experience. This relational turn of Liotti’s cognitive therapy brought Bowlby himself to state: “…the cognitive therapy that Liotti represents and the psychoanalytic therapy which I represent converge” (Tondo, 2011).

The friendship between Bowlby and Liotti, together with Gianni’s interest in developmental psychopathology, brought him to examine attachment behaviors from an empirical perspective. After viewing videotapes of children with disorganized attachment in the Strange Situation, Liotti noted a suggestive parallel between dissociative phenomena in adult patients and disoriented behaviours in children classified as disorganized. According to the original thinking of Pierre Janet, Liotti hypothesized that both phenomena could be associated to loss of integration in high level mental functions.

In the article Disorganized attachment in the etiology of the dissociative disorders that appeared in Dissociation in 1992, Liotti theorized that early disorganization of attachment may result in vulnerability to adult dissociation, also advancing a diathesis-stress model in which he postulated that infants who were classified as disorganized were vulnerable to subsequent trauma experience (such as severe and prolonged forms of neglect) and then to dissociation in response to these later trauma.

A few years later, John Ogawa, Alan Sroufe and colleagues from the Institute of Child Development at the University of Minnesota, found partial empirical support to Liotti’s model of dissociation. Subsequently, Pasquini et al. (2002) confirmed the preliminary empirical support, and recently Farina and colleagues (2014) added neuroscientific plausibility to the model. Liotti’s theorization on traumatic dissociation influenced many scholars in the last twenty-five years (see, for example: van der Hart et al., 2006, Lyons-Ruth et al., 2006, Schore, 2009, Carlson et al., 2009, Meares, 2012). In 2005 he was honoured with the Pierre Janet Writing Award by the International Society for the Study of Trauma and Dissociation.

Liotti was an attentive therapist and dedicated a large part of his professional life to developing strategies to overcome dissociative and relational problems in patients with a history of early relational trauma. With other scholars, he was convinced that a great part of dissociative symptoms, sudden dysregulation of emotion and behaviours, severe somatization and crisis in the therapeutic relationship could be explained as activations of implicit memories related to disorganized attachment that are re-enacted in the relationship between patient and therapist (Liotti & Farina, 2016). Consistent with this theorization, Liotti proposed the usefulness of shifting the motivational base of the therapeutic relationship, from the patient’s attachment toward the clinician to a cooperative attitude between peers.

Moreover, Liotti with other colleagues promoted the use of multiple integrated treatments for borderline and other patients with traumatic attachment history, hypothesizing that the presence of two therapists could reduce the impact of traumatic relational implicit memories activated by the attachment need of the patient (Liotti, Cortina, & Farina 2008).

However, Gianni was not only a learned and skillful clinician. He was always careful and generous with his patients, and attentive and loving with his pupils. For his pupils he represented not just an intellectual and professional guide, but also a great friend. He was also a model of openness, fairness and correctness toward those who did not agree with his theoretical and clinical considerations. His professional and personal figure stands upon us and upon the entire Italian culture of trauma, attachment and psychotherapy, representing both an ideal Ego and a concrete example to follow. We really miss him. It was so great a fortune to know him, and so painful to have lost him.
References

Carlson EA, Yates TM, Sroufe LA: Dissociation and the development of the self (2009) in Dell P, O’Neil JA (eds): Dissociation and dissociative disorders: DSM-V and beyond. New York, Routledge

Guidano V, Liotti G (1983). Cognitive Processes and Emotional Disorders. Guilford press

Liotti G (1992), Disorganized Attachment in the Etiology of the Dissociative Disorders. Dissociation, 5, pp. 196-204.

Liotti G, Cortina M, Farina B (2008). Attachment Theory and the Multiple Integrated Treatments of Borderline Patients. Journal of the American Academy of Psychoanalysis, 36 (2): 295-315

Lyons-Ruth K, Dutra L, Schuder M.R, Bianchi I (2006). From Infant Attachment Disorganization to Adult Dissociation: Relational Adaptations or Traumatic Experiences? Psychiatr Clin North Am. 2006 March ; 29(1): 63-68

Meares, R. (2012). A dissociation model of borderline personality disorder. Norton, New York, London

Ogawa JR, Sroufe LA, Weinfield NS, Carlson EA, Egeland B: Development and the fragmented self: Longitudinal study of dissociative symptomatology in a non-clinical samples. . Development and Psychopathology 1997;9:855-879

Schore AN (2009) Attachment trauma and the developing of right brain: Origin of pathological dissociation; in Dell P, O’Neil JA (eds): Dissociation and dissociative disorders: Dsm-v and beyond. New York, Routledge

Tondo L., John Bowlby, MD: interview by Leonardo Tondo, Clinical Neuropsychiatry, 8(2): 159-171.

Van der Hart O., Steel K., Nijenhuis E. (2006), The Haunted Self: structural dissociation and treatment of chronic traumatization. Norton W W & Company. New York, London.

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