‘Hijacking’ The Alliance

The Alliance –

Research shows that the therapeutic alliance is the most important factor in treatment success. Many clinicians assume that developing the therapeutic alliance with someone who resists treatment will likely to be ‘hard work’ and take much effort. One of the counter-intuitive aspects of paradoxical interventions is to ‘avoid power struggles.’ With the emphasis on avoiding power struggles while building a trusting bond, all paradoxical interventions have the unexpected ability to ‘effortlessly’ develop a strong and positive alliance.

Traditional and other effective therapies understand that the alliance is important for treatment success. Behavioral, cognitive, psychodynamic, motivational interviewing, Emdr, etc. methods see the alliance as a ‘first step’ toward effective treatment. The assumption of these approaches is that the clinician needs to gently coax the client to let go of his defensiveness in order to meet the clinician ‘half way’. The mistaken assumption here is that once the client ‘makes a connection’, the real work of therapy can now begin. From this view, the alliance is considered secondary to the primary importance of the treatment that is about to begin.  

Paradoxical interventions assert the opposite view. In paradoxical interventions, the therapeutic alliance is understood as the primary force behind any successful treatment. From this outlook, the follow up methods of behavioral, cognitive, etc., are of secondary importance to the dominant nature of the alliance.

 

Bold and Exciting approach

In recognizing the primary importance of the alliance, paradoxical interventions take a surprising approach in establishing the therapeutic bond. Rather than allowing the client to control the ‘leisurely pace’ at which the bond develops, the paradoxical method makes the bold move to ‘hijack’ the alliance.

Paradoxical interventions are famous for the unassuming and humorous manner in which the clinician ‘jumps into the driver’s seat’ and takes control of the alliance. By confiscating the alliance, the intervention renders the client’s usual defenses obsolete. While this may initially sound ‘abrupt and harsh’, the client’s experience of the ‘hijacked alliance’ is often one of ‘a pleasant surprise.’ The nature of this sudden bonding experience is most often felt as amusing, non-threatening, and unexpected. At the same time the client is left wondering how the clinician so easily bypassed their usual ‘warning and defense system.’   

 

Clients Who Benefit

As stated, paradoxical interventions are geared toward the client who has no desire, intent, or motivation to change. In general these clients are comfortable within their own behavior, and have no recognition as to their negative impact on others. Often the client is surprised by the degree others complain and confront him. Often, he experiences himself as the ‘victim.’

Since the client has no interest in changing, he has no motivation to participate. In general, the only reason he attends is because ‘someone else’ has told him to do so. This may be a parent who brings their child for family counseling, a school request, an employer, or the legal system. 

Paradox interventions are effective with those who resist treatment, and are helpful in addressing serious and severe issues. The most severe issues include addictive behaviors, borderline personality, eating disorders, problem sexual behavior, and other volatile issues. The method is effective with issues related to anger, control, defiance, poor social skills, and rigid thinking. The approach has particularly rapid results with young children and teens who are not yet hardened by their repetitive patterns.

Intelligence and IQ - As it turns out, paradoxical interventions are not subject to the client’s IQ level. Interventions are just as effective with the ‘low IQ client’, as well as with the ‘intelligent’ (high IQ) client. Some believe that the intelligent client will be unaffected by paradoxical interventions since he will ‘see right through’ the method. Often this client prides himself in his ability to ‘stay one step ahead’ of the treatment. However the depth of the paradoxical method is in its simplicity. Its focus on repetitive and predictable behavior is an aspect that the low IQ client can grasp, and the high IQ client can not side-step or escape. As such, the intelligent client’s attempt to use ‘logic’ in trying to avoid the alliance is ineffective due to the predictability of his behavior where ‘action speak louder than his words.’

 

Clients Who May Not Benefit –

One of the main healing factors of paradoxical interventions is the use of humor to draw attention to the client’s unconscious insistence on remaining trapped in their historic abandonment trauma as noted through the perpetuation of rigid patterns. For this reason caution should be used when employing this method with clients who use their intensity to block humor. These clients include those who are severely depressed, suicidal, or express paranoid ideation. Such clients often guard their perception of historic abandonment experiences as absolute and unshakeable. When paradoxical humor is introduced, such clients are often so self-involved with their perceived isolation that they are unable to recognize on any level the clinician is ‘extending a helping hand.’  

Those with paranoid ideation, while seeming to make some connection, only do so on their own terms. As such they tend to invest themselves in only ‘serious’ conversations in which they control the flow and direction of conversation. Any attempt to steer them in another direction is often viewed as threatening or an attack. These clients may find the clinician’s use of humor as “insensitive” and resent that their situation is being taken too lightly. Often, this client interprets humor as mocking to his concerns.

While paradoxical humor may not benefit such clients at the clinical level, it can be used as a diagnostic tool to gauge the degree of client’s self-involvement that may not have been evident earlier. The use of humor in treatment thereby helps the clinician gauge the client’s flexibility to interact with others.      

 

Rapid and Exponential

The impact of interventions is both rapid and exponential. ‘Rapid’ refers to the fact that noticeable changes in behavior may occur during and immediately after the initial session. While follow up interventions are needed to secure a long-term successful outcome, the rate of change is surprisingly quick. Brief and ‘short term therapy’ models are known for their inclusion of paradoxical interventions and methodology.

‘Exponential’ refers to the fact that change does not occur in a linear or ‘step-by-step’ progression that most people tend to expect. Often it is assumed that if a person had a problem for the last 10 years, then it can be ‘expected’ that the time needed for recovery may take as long as 3-5 years.

Victor Frankl and others addressed the exponential nature of treatment. He describes how the paradoxical interventions influence the client to experience an ‘existential reorientation’. This existential or internal reorientation affects the client on multiple levels simultaneously – behaviorally, cognitively, and emotionally. Numerous authors and clinicians have described the exponential and rapid changes they observed as “amazing’ and ‘miraculous”.  

 

Deceptively Simple

The success of paradoxical interventions is that they are deceptively simple and unassuming. Interventions hold the advantage that they are disarming, non-confrontational, and non-threatening.

While simple to implement, the power of such interventions must not be taken lightly. Just as a ‘sharp knife’ can be used to harm or heal, clinicians need to refrain from offering an intervention in a manner that is sarcastic, demeaning, or cutting. Since the intent of interventions is to reinforce the alliance, it is self understood that the alliance will not gain strengthen in the context of a cynical or sarcastic exchange. It is suggested that if the clinician is in a ‘sarcastic mood’, he should wait until he is in a more neutral state of mind before engaging his client with a paradoxical intervention.  

 

Self-Reflection and Self-Esteem –

The nature of all paradoxical interventions is to create win-win double binds that ‘leave no other choice’ than for the client to self-reflect on his actions and behaviors. So for example, by ‘predicting’ a future pattern or event, the client is placed in an inescapable position in which he must evaluate and reflect as to whether there is any validity to such a forecast.

The ability to self-reflect is strictly a human attribute. Since animals do not have the ability to evaluate their own behavior, the nature of the intervention serves as an unspoken reminder to the client of his superior human nature. This unique ability to promote self-reflection allows all paradoxical interventions to have the special quality of subtly and delicately direct clients toward increased self-esteem.

Self-reflection occurs through paradoxical dilemmas that highlight ‘win-win double-binds’ aimed at strengthening the therapeutic alliance. In these scenarios, no matter which way the client goes, it is a ‘win’ toward reinforcing the alliance. While on the surface one might think that such double-binds need to be resolved in order to have a positive effect, this is in fact not the case.

In an interesting manner the presentation of the double-bind is not dependent on resolution. Rather the important aspect is to create a quandary in which the client recognizes that he is ‘stuck.’ This in turn ‘forces’ him reflect on himself and his behavior. By engaging the client’s natural ability to self-reflect, the intervention itself generates movement toward raising self-esteem. In this way, the ability to recognize the presence of a win-win double bind –even without the solution- therefore has the impact of highlighting the unique superiority of his human spirit.

 

Resisting a Paradoxical Intervention

When done correctly, the client can not defend against the clinician’s intention to ‘connect and join’. While the ‘motivated client’ is open to developing a treatment bond, the resistant client seeks to avoid the alliance. The advantage of paradoxical interventions is in its ability to ‘hijack the alliance’. This means that paradoxical interventions work despite the client’s conscious intent reject the alliance. A key factor of the intervention is that it is able to bypass client resistance and strengthen the alliance even without the client’s overt agreement, cooperation, or participation. As a result, the interventions unassuming nature and the client’s inability to defend against them make these interventions quite powerful and formidable in the treatment setting.

 www.ParadoxPsychology.com            EPK Revised: 12-20-11