Psychologists do not give advice or write prescriptions. But some of them, in particular, family and cognitive therapists, use prescriptions in their work, sometimes completely unexpected for the client. Paradoxical intervention is one such effective technique.
A man turned to a psychotherapist. He claimed that he could not leave the city. As soon as he drove up to the outskirts, he felt sick, then vomited, and then he lost consciousness. The psychotherapist listened and gave the task: to put on the best clothes and drive to a certain place on the outskirts of the city at three in the morning. Deep ditches stretched along the road. The young man was supposed to get out of the car, jump into the ditch and lie there for 15 minutes. Then it was required to return to the car, drive a distance equal to two of its buildings, and repeat all over again.
Doing the same thing over and over, he had to increase the distance until he could drive from one telephone pole to another. Moreover, at the slightest appearance of symptoms, it was necessary to stop and run into the ditch. The client followed the instructions and then said: “I cursed you for what you made me do, and the further I went, the more angry I got. In the end, I just drove forward, enjoying the road.”
Since then, he has had no problems driving a car. The name of this psychotherapist is Milton Erickson, and the story described in The Extraordinary Therapy of Milton Erickson by Jay Haley (IOI, 2012) shows how paradoxical intervention works.
Get out of the shadows
“Paradoxical interventions are widely used in individual, family and group therapy,” says family psychologist Natalya Olifirovich. – At first, these techniques cause surprise, bewilderment, misunderstanding, because their task is to encourage the client to the opposite behavior. The fact is that our habitual ways of coping with the problem often, on the contrary, strengthen it. The more a person tries not to do, not to think, not to feel, the deeper he gets stuck.
When we fight desperately with some kind of fear or reluctance to do something, we bring to mind all aspects of this fear or internal resistance and thereby only reinforce the unwanted behavior.
“Using the technique of paradoxical intervention, the psychotherapist does not fight the symptom, but brings it out of the shadows,” explains Natalia Olifirovich. — He considers what the client considers bad and wrong and wants to get rid of as important and even valuable. For example, in marital therapy, the psychologist defines problematic behavior as good, correct, contributing to the stabilization of the family, and then gives a prescription.
Example: a wife complains about rare sex. Usually she initiates intimacy, puts pressure on her husband, and if he refuses, she scandalizes and blames him. The therapist reports that the husband, by his behavior, supports the wife’s interest in himself and in the sexual sphere, and forbids the wife to initiate sex, making the husband responsible for this sphere. After the husband ceases to feel pressure and begins to control desire and possibilities himself, the sexual life is getting better.
Or another example. “In family therapy, parents often complain about the problematic behavior of the child,” says Natalya Olifirovich. “For example, in the evenings, a teenager does not want to sleep, but sits on a tablet. The psychologist finds out what is going on and informs the parents that this is a way to help dad and mom unite at least in some way, and the teenager suggests that they continue in the same spirit, otherwise the parents will have nothing in common. Parents are initially confused and angry, then for the first time they think about spending time together. After a while, a new ritual is formed in the family.”
From Resistance to Liberation
Paradoxical interventions are often used in their work by cognitive-behavioral psychologists.
“Such techniques are associated with the psychologist’s calculation of the client’s resistance and, as a result, of his release from problematic behavior,” comments Yulia Zakharova, clinical psychologist, member of the Association of Cognitive Behavioral Therapists. – For example, the client is afraid of thoughts about the partner’s illness, worries that he can “think bad”, “attract the disease”. Attempts to drive away thoughts lead to increased anxiety.
The client asks the psychologist to relieve him of anxiety and panic attacks. The psychologist explains what “magical thinking” and “tolerance to uncertainty” are, then offers a paradoxical intervention as a homework task: think about the partner’s illness for an hour a day, maintain concentration, try not to be distracted by anything.
The client sees that nothing bad happens from thoughts, begins to get annoyed because of the psychologist’s prescription. Resistance arises: “I don’t want to think about this for an hour, I have other things to do.” Thoughts about the illness of a partner cease to frighten, anxiety decreases.
Another technique: the cognitive psychologist suggests that the client, who is tired of disturbing thoughts, begin to say them out loud in different voices, for example, in the voice of a “disaster news radio” radio host.
“However, it should be noted that such methods are not well suited for clients who suffer from severe depression or severe anxiety disorders,” notes Yulia Zakharova. “They may see such an intervention as a devaluation of their suffering and, most likely, instead of following the instructions, they will stop coming to consultations.”
The rule of paradox
In many psychotherapeutic directions there are paradoxical techniques: working with polarities in Gestalt therapy, negative practice with Alfred Adler, positive connotation (reformulation) with Mara S. Palazzolli. It is quite common in emotionally focused therapy to simply use positive redefinition without prescribing.
For example, the spouse’s screams and scandals can be interpreted as a way to “get through” to their spouse, as involvement and indifference, and withdrawal as caring for relationships by refusing the conflict and its escalation. And finally, paradoxical intention is a method developed by Viktor Frankl. This method is used in existential analysis to deal with fear.
“The therapist in this case does not instruct the patient to do something paradoxical,” explains existential psychotherapist Sofya Shokotko. – We work with the patient’s attitude towards fear, relying on his spiritual forces, “stubbornness of the spirit”, so that the patient can wish for himself that what he is afraid of happens right now. Humor and good contact, trust in the therapist work well here. Thus, the client overcomes the automatism of the symptom by an effort of will.