The Referential Process as a Common Factor Across Treatment Modalities

The paper emphasizes the need for a process component in psychotherapy re-search, and the need for a theoretical framework within which process measures may be designed and validated. The referential process, defined in the context of multiple code theory, provides a general psychological framework for understand-ing the mechanisms of therapeutic change in different treatment modalities. The referential process includes three major phases: arousal/activation; narra-tive/symbolizing and reorganizing/reflection. The paper reviews the theoretical roots of psychodynamic treatments, and several forms of cognitive behavioral treatments, including schema therapy for borderline personality disorder and expo-sure treatments for post-traumatic stress disorder, and shows how the phases of the referential process provide common mechanisms of change in each of these ap-proaches. Computerized measures of the referential process, in English and Italian versions, which have been applied and validated in clinical and experimental studies, are discussed.