Paradoxical Theory
In order to understand the paradoxical method, it is first important to provide a viable theoretical context that supports the approach. As such, paradoxical treatment can be seen as an outgrowth or extension of 'attachment theory' as described by Bowlby and Ainsworth.
Attachment theory suggests that the progression of a healthy parent-child bond in early development correlates with later stages of responsible behavior and positive social functioning, while wounded or traumatized attachment leads to problems in forming trusting relationships and social isolation. Ongoing studies have confirmed that severe forms of traumatized attachment have a high correlation with many types of serious destructive behaviors, social dysfunction, and emotional conditions.
If we were to define a treatment approach in relation to attachment theory, it would seem that the central factor would be the method's ability to shift the client's (unconsious) familiar bonding pattern based on early trauma to a fresh new perspective of 'unconditional acceptance'. As such the approach would NOT necessarily focus on separate behavioral, cognitive, or emotional aspects, but rather address the person as a single whole in which all aspects would be simultaneously addressed.
Using attachment theory as the anchor, the hypothesis behind paradoxical treatment is to provide the traumatized client with an unambiguous positive experience of 'unconditional acceptance'. By providing a positive bonding experience, the nature of treatment places the client in a win-win (non-logical) double bind. This allows the client to experience (beyond words) a 'new reality' in comparison to the constricted nature of his early childhood experience.
When the treatment resistant client is exposed to even a glimpse of this 'new reality', it disarms his habitual defensive reactions, and often has the immediate effect of reorganizing his perception of himself and the world. In the process of disarming habitual reactions, the client suddenly gains perspective as to the folly and humor of being caught in repetitive and rigid reactions. It is the disarming power of humor that allows the clinician to bypass the client's habitual defensives. In a manner that was unexpected by the client, the process of humor breaches his defensive structure that allows him to 'relax and let his guard down'. It is through ‘relaxing and letting his guard down’ that the constriction and tension associated with traumatized attachment begins to dissipate.
In a dual fashion, interventions have the effect of healing both the attachment bond, while having a simultaneous effect on secondary destructive behaviors associated with it. Therefore, while ultimately paradoxical interventions influence behavior, the focus and thrust of treatment is exclusively on the corrective potential of the attachment / bonding experience as a way to realign trauma and mistrust.
The healing of traumatized bonding is specifically accomplished by strengthening the therapeutic alliance. The more effective a paradoxical intervention is in strengthening the alliance, the more quickly the client will be able to undo guarded and distancing type behavior. While traditional (behavioral, cognitive, and psychodynamic) methods acknowledge the benefit of having an alliance with the client, this is often viewed as secondary to the primary goal of getting the client to behave / think / or feel a certain way. In an effort to accomplish their primary goals, they often mistakenly place the treatment resistant client in the untenable position to ‘meet them half way’. As one can quickly recognize, the expectation of getting the resistant client's ‘helpful cooperation' often leads to a stalemate in treatment, leaving the clinician frustrated by the client's lack of participation. It should be understood that the frustration these clinicians experience is due to the underestimated significance of the therapeutic alliance.
Clinicians utilizing the paradoxical method are often struck by the lack of frustration around the approach, and that its application can be surprisingly effortless. Since the method recognizes that the therapeutic alliance as the ‘active ingredient’ behind all successful treatment, the primary focus of the method is to promote 'unconditional joining'. In this regard, one of the advantages of the paradoxical method is that it purposely seeks to identify and avoid ‘power struggles’. By developing interventions that avoid power struggles the intent of treatment is to further maximize the therapeutic bond. As a result, an advantage of the paradoxical method is that it does not need or rely on the client’s ‘helpfulness’ or ‘goodwill’ for treatment to be successful.
Utilizing attachment theory as our guide, the clinician’s primary and single function is to simply advance and strengthen the alliance. Success is based totally on the clinician’s ability to cultivate, nurture, and reinforce the client’s bonding experience, while simultaneously bypassing his habitual defenses that try to avoid this alliance. Within the context of attachment theory, we come to interesting hypothesis: That by strengthening the client’s experience of 'attachment', it is possible to impact targeted problematic behaviors without directly focusing on those behaviors.
This represents a significant theoretical paradigm shift regarding treatment conceptualization. Currently behavioral, cognitive, and psychodynamic methods function within the assumption that change can only occur by the straightforward targeting of specific behaviors, thoughts, and / or emotional states. Attachment theory and the paradoxical method suggest that the strengthening of the therapeutic alliance ‘in and of itself’ is the central factor in facilitating change. The function of the paradoxical process is therefore to ‘impose’ the strengthening of the therapeutic alliance through ‘unconditional joining’.
EPK Revised: 3-21-2009
