“Anyone can work with a client who is motivated for treatment. The real test for a clinician is being able to influence someone who has no conscious desire, intent, or interest to change. . . ” Eliot P Kaplan, PhD
What does the research show?
A) Which is the best psychotherapy?
B) How do paradoxical methods compare with behavioral, cognitive, and psychodynamic approaches?
C) How important is the client – clinician therapeutic alliance to treatment?
D) How does resistance impact treatment outcome?
E) Does treating secondary non-criminogenic behaviors impact primary targeted volatile behaviors (such as: problem sexualized behaviors, etc.)?
A) Which is the best psychotherapy?
Findings: Unbiased research indicates that behavioral, cognitive, and psychodynamic therapies have success rates that are statistically equal.
Seligman (1995) The Effectiveness of Psychotherapy: The Consumer Reports Study, American Psychologist, Vol. 50, Num: 12, 965 – 974
Smith, Glass, & Miller (1980) The benefits of psychotherapy. Baltimore MD: John Hopkins University Press
B) How do paradoxical (PdxI) methods compare with behavioral, cognitive, and psychodynamic approaches?
Findings: Behavioral, cognitive, and psychodynamic methods work well with motivated and voluntary clients.
Paradoxical Interventions have a higher rate of success with treatment resistant and oppositional clients.
Sheras, P. L. & Jackson, S. R. (1978) Paradox as an Intervention Strategy with
Emotionally Disturbed Adolescents. Paper presented at the Annual Convention of the
American Psychological Association, Toronto, Canada, August 1978
Shoham-Salomon, Avner, & Neeman, (1989) You’re changed if you do and changed if you don’t; Mechanisms underlying paradoxical interventions, Journal of Consulting and Clinical Psychology, 57, 590-598
Horvath & Goheen, (1990) Factors mediating the success of defiance and compliance based interventions. Journal of Counseling Psychology, 37, 363-370
Beuter, Moleiro, & Talebi (2002) Resistance in Psychotherapy: What conclusions are supported by research, Jrnl of Clinical Psychology, 58 (2), 207-217
C) How important is the client – clinician therapeutic alliance to treatment?
Findings: The strength of the alliance is the most important predictor for treatment success.
Horvath & Symods (1991) Relation between working alliance and outcome in
psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38, 139- 149
Keijsers, Schapp, & Hoogdoin (2000) The impact of interpersonal patient and therapist behavior on outcome in cognitive-behavior therapy. Behavior Modification, 24,264–297
Safran & Muran (Eds.) The therapeutic alliance (Special Issue). Session Psychotherapy in practice, 1, (1)(Reissued as millennial issue, February 2000)
D) How does resistance impact treatment outcome?
Findings: Research indicates there is a negative relationship between resistance and prognosis.
Beuter, Moleiro, & Talebi (2002) Resistance in Psychotherapy: What conclusions are supported by research, Jrnl of Clinical Psychology, 58 (2), 207-217
E) Does treating secondary non-criminogenic behaviors impact primary targeted volatile behaviors (such as: problem sexualized behaviors, etc.)?
Findings: Yes. When treatment influences issues related to anger, depression, self-esteem, etc. there is a measurable reduction in deviant and criminogenic sexual fantasies.
Marshall W. (1997) The relationship with self-esteem and deviant sexual arousal in non-familial child molesters. Behavior Modification, 21, 1, 86-96
Marshall, Cripps, Anderson, & Cortoni (1999) Self-esteem and coping strategies in child molesters. Journal of Interpersonal Violence, 14.
Ward & Stewart (2003) The treatment of sex offenders: Risk Management and Good Lives. Professional Psychology: Research & Practice 34. 4,
Treatment of Choice . . .
Given the above research, it stands to reason that PdxI would be the treatment of choice for clinicians who work with treatment resistant populations. However, this is the furthest thing from the truth. In fact, in treatment circles today, PdxI is rarely used. Although there are some books on the topic, most clinicians today are uncomfortable employing and promoting the method. Even the internet offers relatively little information on the topic. As a result, many of today’s upcoming clinicians have had no exposure to this powerful method.
The purpose of this website is to reintroduce the vast and real potential that paradoxical interventions hold in regards to the treatment concerns of such behavioral issues that include, but are not limited to, addiction, borderline personality, compulsive disorders, eating disorders, fire setters, oppositional / defiant behaviors, and sexual aggression.
So What’s The Problem?
If the research is supportive of the method, then the obvious question is: So what happened?!. As recently as the early 1990’s, PdxI were used by 'master therapists' including Salvador Minuchin and Jay Haley, with great success. However, since then, there has been little mention of the method in the literature.
In short, the problem has been four fold:
1) Most clinicians have dismissed PdxI as simply a form of ‘reverse psychology’ that has no serious underlying psychological context or meaning.
2) The method is often considered too provocative, and the clinician is sometimes viewed as ‘purposely manipulating’ client behavior through ‘trickery’ (and thereby endangering future therapeutic trust).
3) The method seems to defy linear thinking. It simply doesn’t make ‘logical sense’ that the clinician should “encourage, plan, or prescribe” that the client continue the exact behavior that treatment seeks to reduce.
4) And the most perplexing and undermining aspect: The method has historically offered no concise theoretical base; lacks face validity; and is counter-intuitive to the goals of treatment. (This is in contrast to the apparent theoretical support for behavioral, cognitive, and psychodynamic methods; the ‘face validity’ of these respective approaches; and their understandable logic toward achieving treatment goals.) Particularly in these times with the push toward 'evidence based treatment', PdxI seems to offer no foundation to 'justify' its use.
Changing Psychology
This website seeks to guide and educate clinicians in realizing the potential of paradoxical interventions. As such, we address each of the problems listed. The hope is that not only will this site give you a better understanding of the 'evidence' supporting paradoxical interventions, but it will also offer a unified understanding regarding the overall dynamics of psychological change, therapy, and treatment.
Comments:
Regarding (A) ‘the best psychotherapy’:
Some clinicians argue that it is a 'positive and good' that the three prime therapeutic approaches have been shown to be equivalent in treatment effectiveness. They claim that this ‘equality’ allows for treatment creativity, diversity, and a ‘do your own (thing) eclectic approach’.
However, in reality, the fact that such diverse approaches are ‘statistically equal’ has and continues to be a real problem regarding the credibility of psychological treatment, particularly in the view of the medical / scientific world. What the research is pointing out is that our understanding of psychology and treatment is not clearly understood, since we have not identified the 'active ingredient' that is common to each approach. It indicates that within the profession as a whole, we remain fragmented.
The analogy here would be similar to trying to steer a ship with 3 separate rudders. As long as these rudders are working together the ship will move quickly toward its destination, but if each rudder has its own agenda, the ship's ability to move forward would clearly be compromised.
On some level, behavioral, cognitive, and psychodynamic methods share a common ‘active ingredient’ (rudder) that allows each approach to be successful in moving the client forward, however until that ‘common ingredient’ has been fully identified, it is easy to see how separate agendas or orientations may ultimately conflict with each other and impede the progress of treatment.
In the last 75 years, the hallmark of the natural sciences is that fields which were once considered separate and distinct have theoretically been seen to overlap and merge. The converging of the natural sciences has been due to the ability to conceptualize these sciences within a ‘unified field theory’. As a result, astronomy, biology, chemistry, and physics are no longer considered diverse and dissimilar from each other. This unified-field theory was a progressive conclusion as it became apparent that an 'orbits-gravity model' was the exclusive theoretical model that was descriptive of the underlying mechanism within each field. As a result, the 'orbits-gravity model' allowed these diverse sciences to recognize themselves as being theoretical extensions of each other.
In order for the field of psychology to progress, we need to generate an internal ‘unified theory’ to gain clarity regarding the core 'active ingredient' that propels treatment. However, for the field of psychology to become an integrated and accepted member of the ‘scientific / medical community’, this ‘unified theory’ needs to demonstrate that it is relevant to the progression and direction that has already conceptually unified other areas of the natural sciences.
As far fetched as the above goal may seem, this work will attempt to put the pieces together. As will be discussed, a concise understanding of paradoxical interventions will become the bridge that demonstrates the viable unification of behavioral, cognitive, and psychodynamic approaches. In addition we will show the direct relevance of the 'orbits-gravity model' to paradox psychology. The recognition of the paradoxical process in the context of 'orbits-gravity' theory will present a gateway that clearly shows a real and meaningful connection between the field of psychology and the natural sciences.
EPK Revised 3-26-09
