In buying real estate, it is said that there are 3 main factors:
1) location
2) location and
3) location
Similarly, in doing paradoxical interventions, there are 3 main factors:
1) joining
2) joining, and
3) joining
All paradoxical interventions have the common theme of:
- ‘unconditional joining’.
All interventions highlight:
- attaching
- agreeing / being supportive
- bonding / connecting
- unconditional positive regard
- strengthening therapeutic alliance
- An attitude of: ‘We are buddies’ working together
Paradoxical interventions ‘join’ by:
1) Prescribing the client to engage in symptomatic behavior;
2) Predicting previous cycles / pattern(s) of behavior;
3) Permission to continue symptomatic behavior;
4) Positive reframing – Explaining the benefits of a given symptom;
5) Overstated agreement with the client’s reasoning and thinking:
6) Encouraging the exaggeration of symptoms;
7) Encourage client to improve or practice behavior;
8) Scheduling and Planning symptoms - (where, when, how, and with whom);
9) Clinician mirrors back or ‘takes on’ behavior client;
10) Interactive role-playing to perpetuate status-quo behavior.
All interventions are designed to have the effect of 'implanting, embedding, or engraving' the clinician's presence, so that the client 'takes the clinician home' when he walks out the door. By attaching in this manner, the intent of successful treatment is for the clinician to ‘pop up’ just as the client is about to do his (usual) habitual destructive behavior.
When the clinician ‘pops up’ the client recognizes that he is not alone and isolated in the world. In that fraction of a second, the client’s habitual behavior is disrupted. The clinician’s ‘prediction’ and presence allows him to recognize that his behavior is not as spontaneous as he had thought. In that moment he has the ability to make a choice; to do the old behavior, or refrain from the behavior. Is he ruled by his habitual behaviors, or can he express his 'free will' by demonstrating impulse control?! Which will he pick?
Which ever way he goes, the intervention has created a 'win-win' dilemma. No matter what happens, the presence of the clinician has surfaced in a manner that will relieve his underlying sense of attachment trauma and isolation. The ‘win-win’ dilemma is that either way, the therapeutic alliance will be strengthened. Even if the client chooses ‘old behavior’, the added awareness of the clinician’s presence will give him resolve for behavior change in the not-so-far-off future.
PdxI has the potential for rapid change. However, like any therapeutic intervention, there is a process that needs to occur. This process is dependent on both the depth of the client's attachment trauma, as well as the clinician's comfort and experience with the PdxI method. As such, some treatment interventions may take longer than others.
If the client does repeat his habitual behavior, this is an opportunity for the clinician to emphasize the existence of the ‘therapeutic alliance’ by complimenting the client on his ability to follow instructions. In this instance the clinician can highlight the ‘objective reality’ (fact) that 'we' are working together.
The clinician needs to remember that the focus of PdxI is not on 'changing behavior', but rather 'strengthening the alliance'.
Within the context of the ‘orbits-gravity’ model, the nature of paradoxical interventions can be used in a ‘diagnostic’ manner. Depending on the depth of a given trauma (and the client’s simultaneous need to find comfort in a certain repetitive behavior), the client’s behavior may not change as quickly as the clinician might assume or expect. The clinician should recognize that if the client's behavior does not change immediately, it does not mean that 'the intervention didn't work'. Rather the clinician needs to continue the process of 'unconditional joining' as a way to softening the client's underlying sense of abandonment / trauma. Through persistence in strengthening the alliance over the course of days and weeks, there will be an eventual ‘thawing’ of the client’s mistrust and investment in keeping his guard up.
EPK Revised: 4-7-09
