4) Prescribing the Symptom One of the best known paradoxical interventions is ‘prescribing the symptom.’ This intervention builds on ‘no-frills predicting’ in that the clinician ‘prescribes’ a repetitive pattern or symptom the client is already doing. ‘Prescribing’ the behavior is therefore a form of ‘joining.’ In a non-threatening manner the intervention forces the client into a therapeutic alliance while undoing underlying abandonment trauma. When done correctly, the client can not avoid the joining process.

The intent of this intervention is to convey that disruptive behaviors (i.e.: arguing, complaining, lying, and other various non-criminogenic behaviors) that the client may consider his unique and special brand of distruptive behavior is actually habitual enough for the clinician to ‘prescribe’ in detail. 

’Prescribing’ is an effortless intervention for the clinician since it negates the usual ‘power struggle.’ The process introduces the clinician’s ‘shadow’ by his active instruction regarding ‘when, where, and with whom’ the behavior should occur.  In paradoxical fashion, the intervention gives the client a new perspective on himself and his behavior.   

By ‘prescribing’ a behavior the clinician places the client in a quandary - Who actually ‘owns’ the behavior?! Is it the clinician who ‘writes the prescription’, or is it the client who has done it more times than he can count?! In addition, if he does the prescribed behavior, what does that mean about the client’s free-will status?!  These are questions that can never be answered.

But of course this is what paradoxical interventions are all about; that they can never be definitively answered. So what is the function of ‘prescribing’ a behavior if the predicament can never be resolved? The answer is that interventions ‘freeze’ the client between two perceptions that are “both valid and correct.”

However, as the client’s mind attempts to make sense of the contradictory messages, he is unable to follow his thoughtless habitual behaviors. In this way interventions suspend habitual activity, while the mind self-reflects on the unresolvable dilemma of 2 right answers.  

Using linear logic one might expect that the behavior would increase since the client now has the ‘excuse’ that it was ‘prescribed by the doctor.’ However by prescribing the ‘forbidden behavior’ the intervention removes the usual ‘tension and excitement’ associated with it.  As a result, the client simply loses interest in engaging in what is now an expected pattern of behavior.

In a subtle way, ‘prescribing’ challenges the client to reflect on his intrinsic expression of his ‘free will.’ The intervention forces the client to self-reflect and be mindful of his habitual actions. Without planning or forethought the targeted behavior fades away as the client simply loses interest to continue the ‘prescribed’ behavior.

As with other paradoxical techniques, if the client is questioned “Why he did not do his usual pattern?” the answer is often, “I just didn’t feel like it.” In interesting fashion, while the client is no longer invested in the rigid pattern, he ‘can not put his finger on’ exactly what happened!  The intervention demonstrates a common aspect of paradoxical interventions in which ‘change occurs’ at such a deep level within the psyche that he is not fully conscious of what has happend to cause his change of attitude. This is the underestimated power of the simple act of negating abandonment trauma.  

In clinical terms we see how paradoxical interventions can be a catalyst for change without relying on the client’s conscious desire for change. The nuances of this phenomenon can only be understood through gaining familiarity with the ‘orbits-gravity paradigm.’ 


5) Permission and Positive Reframing – The intervention of ‘permission’ bypasses the client’s expectation of a power struggle. Offering ‘permission’ for a disruptive behavior does not mean that the clinician gives his ‘unequivocal approval.’  Rather it means ‘joining’ in a way that shows an understanding for the client’s perspective. In the past, the client may have been criticized and judged for a given behavior, leading him to respond in a defensive manner. In demonstrating an understanding, the clinician may offer a positive reframe or ‘spin’ on the symptom. A positive reframe notes the specific benefits of doing a disruptive repetitive behavior. 

Example: Let us take the example of a teenager, Carl, who constantly argues with his mother. In a’permission and reframing’ intervention  the clinician does not say, “Yes, you should argue with your mother!.” Rather he might acknowledge the benefits of arguing: 1) that arguing brings them ‘together’; 2) keeps them ‘both involved and busy’; 3) prevents her from feeling “bored or neglected’; 4) indicates his ‘devotion and sacrifice’; etc. In counter-intuitive fashion, this type of ‘joining’ gives the client a broader view to see that he is stuck in a ‘perpetual loop’. In so doing, the client is now in a position to decide for himself, whether he actually wants to continue the behavior.

This type of intervention focuses on the unexpected results that occur when ‘joining’ and strengthening the ‘therapeutic alliance’. Joining undermines the client’s ‘expected isolation’ that maintains his underlying experience of feeling alone. In addition, the process diminishes the client’s customary guarded and defensive posture. As the client is better able to relax, he is able to gain perspective on his situation, which in turn allows him to take self-responsibility in making more healthy and flexible choices. 

 www.ParadoxPsychology.com    EPK Revised 1-21-12