Paradox History

The following offers a brief background and history regarding paradoxical interventions. Included are different theorists and various therapies that have incorporated the method. While it has always been clear that paradoxical methods have been effective, a comprehensive theory has been elusive. The following are theorists that have offered insights into this counter intuitive and fascinating approach: 

Maurizo Andolfi

 Brehm and Brehm

S.D. Schneersohn

Alfred Adler

Victor Frankl - Logotherapy

Paul Watzlawick

John Rosen

Provocative therapy - Farrelly & Brandsma

Gestalt Therapy - Fritz Perls 

Brief Therapy

Arnold Beisser


**Maurizo Andolfi (1974) He notes that in order for paradoxical interventions to be effective the injunctions must be disobeyed in order to be obeyed. He offers a classic example in which the clinician gives a directive to a client who habitually expresses anger to “spontaneously express anger”. The instruction creates a bind that as soon as one attempts to act on the instruction, he cannot. In addition, he also notes that change occurs most when the person is least encouraged to change.

**Sharon and Jack Brehm - Brehm and Brehm (1981) explored the issue of client resistance. In their work together they developed a theory of reactance in which resistance was viewed as an interactive process between client and clinician. One of the main points of their theory is that all people value freedom and the ability to make free will choices.

When a person feels threatened by a ‘loss of freedom’, he will react in a manner to protect that freedom. This often motivates the person to perform a specified behavior to prove his free will has not been compromised. As will be discussed, Reactance Theory is useful in gaining a linear (cause and effect) understanding of paradoxical interventions.

**S. D. Schneersohn - discusses the contrast between free-will and instinctual behavior. Regarding ‘free will’, Schneersohn (1969) notes that man is the only animal that can make ‘free will choices’. Other animals are bound by their instinctual reactions and behavior. It is therefore specifically through man’s ability to make ‘free will choices’ that he is able to assert his ‘superiority’ as a human being and thereby directly raise his intrinsic sense of self-esteem.

**Alfred Adler (1956) - He was the first theorist to document his work using paradoxical interventions dating back to 1923. His interventions were noted for avoiding power struggles.

In this way, his interactions had the one-sided effect of strengthening the therapeutic alliance. Adler’s strategy was to shift the patient’s uncooperative behavior into one of cooperation. He advocated that the clinician should never struggle with the client, but rather ‘join with the resistance’.

**Morzdzierz et al. (1976) described six Adlerian techniques:

1) giving the client permission to have the symptom;

2) Predicting the client’s symptoms or relapse;

3) encouraging the client to exaggerate his symptoms;

4) positive reframing of symptoms;

5) Prescribing the symptomatic behavior;

6) Asking the client to improve or practice his symptomatic behavior.

**Victor Frankl - Logotherapy: Frankl (1965, 1978) is credited as an early pioneer in the use of paradoxical interventions. He is known for the developing logotherapy whose goal is to help the client ‘find meaning’ in their life.  As part of the process, logotherapy encourages the client to accept responsibility for one’s actions. In helping his patients accept personal responsibility, he paradoxically would encouraged patients to intentionally will the symptom to occur and exaggerate it. He also noted that humor was an essential factor, and that the patient’s healing included an ability to self-reflect and laugh at the absurdity of one’s own behavior.

Frankl asserted that paradox lead to deep changes within the client that brought about an ‘existential reorientation’ on both internal and inter-personal levels. He advocated that the depth of the paradoxical process had the potential to impact a broad range of disorders and conditions.

**Paul Watzlawick - Watzlawick et al. (1974) observed that paradoxical interventions placed the client in the dilemma of a ‘win-win double bind.’ Whatever direction the client goes, he comes out a ‘winner’. This creates a pleasant and unanticipated dilemma for the client who has grown to accept his life to be an unending series of ‘lose-lose predicaments.’

As such, these double-binds influence the person as a whole entity and challenge the client’s status quo view of himself and the world. As a result, interventions impact the client simultaneously on many levels of awareness and perception. This is in contrast to linear styles of treatment that may target specific behaviors, feelings, or thoughts. 

Watzlawick suggested that the resolution of paradoxical dilemmas resulted in the ‘internal restructuring’ of one’s self and perception of reality. This type of restructuring matches Frankl’s idea of ‘existential reorientation’. He notes that this restructuring occurs despite the fact that the client has not been instructed to change in any way, but nevertheless results in influencing the client to recognize and experience a new reality.

**John Rosen MD (1946, 1953) - He was the first psychiatrist to document the use of paradoxical methods in treating psychotic symptoms in schizophrenic patients. He developed a therapy system that emphasized a procedure called “re-enacting an aspect of the psychosis.” This idea matches Adler’s concept of ‘symptom prescription’. When a patient began acting in a bizarre manner, instead of suggesting that the patient restrain himself, Rosen would encourage the patient to act out the psychotic episode. He found that these techniques had the effect of reducing the patient’s anxiety, and therefore resulted in symptom reduction. The significance of Rosen’s work was that it showed that paradoxical interventions could have a positive effect even with those who displayed the most severe form of psychiatric illness.

**Provocative Therapy - Farrelly and Brandsma (1974) developed an approach called ‘provocative therapy’. The goal of treatment was to provoke a strong emotional reaction in a manner that the client recognizes the humor of his situation. 

Humor was generated from symptom exaggeration, prescription, etc.  ‘Provocative therapy’ would identify a symptom and then prescribe it in an outrageous and humorous way. For example, Farrelly might tell a client who was seeking attention by threatening to hurt himself to “place his arm in a vise in order to cut it off with a hacksaw”. By reframing behavior in a humorous manner, the clinician was able to use absurd logic to bypass client defenses and thereby facilitate an ‘existential reorientation’.

**Gestalt Therapy – Fritz Perls, MD: Fritz Perls, (1969) who developed Gestalt Therapy, would often ask clients to exaggerate and amplify movements and gestures. By exaggerating a gesture the client often was able to spontaneously release a long held symptom. As such, Gestalt Therapy became known for its ability to influence exponential and rapid change.

**Brief Therapy - developed by Weakland, Fisch, Watzlawick, and Bodin (1974) is a short-term treatment model that capitalizes on the seemingly instantaneous changes that occur through the paradoxical method. The goal of Brief therapy is to identify patterns of repetitive behavior and then design interventions that double-bind that behavior. A Brief Therapy intervention might therefore instruct a couple that constantly bickered to “have at least 3 spontaneous arguments this coming week”. Such an instruction places the couple in ‘win-win double-bind’ in which ‘they win if they do, and win if they don’t’.  Either way the intervention was designed to quickly raise the clients’ awareness of habitual behavior.

**Arnold Beisser - (1970) discusses the intent of the clinician who promotes a paradoxical approach. Contrary to most types of therapy that direct the client toward a specific change ‘goal’, here the role of the clinician is to help the client feel connected and accepted in the ‘here and now’. As such, the role of the clinician was not to change the client, but rather to attach, bond, and join.

In short, the process of ‘joining’ occurs by simply identifying facets of the client’s habitual responses and behaviors. This was most easily accomplished by predicting specific details of the client’s repetitive behavior. In a subtle way, this challenges the client as such prediction suggests that the client has ‘lost his free will’. The paradox, of course, is that the more the clinician identifies the client’s predictable pattern, the more quickly the client disengages from these exact patterns. 


 9 Main Points:

A) Paradox is based on the principle that change occurs through accepting a symptom, rather than struggling against it.

B) Interventions place client in ‘win-win double binds’ that enhance joining.

C) When people feel threatened by a loss of freedom, they react in a manner to protect that freedom.

D) Interventions have the one-sided effect of strengthening attachment in the form of the therapeutic alliance.

E) Interventions were shown to have a positive influence on reducing the severity of  psychotic symptoms.

F) Humor is an essential factor. Through humor the clinician is able to disrupt the client’s defenses based on linear and logical thinking. Humor is also useful in helping the client become self-reflective about the absurdity of his destructive patterns.

G) Interventions lead to a broad shift in one’s perception of self and the world. This shift has been termed as either an ‘existential reorientation’ or an ‘internal reorientation’.

H) Interventions influence change in an exponential and rapid manner.

I) The role of the clinician is not to change the client, but rather to join, support, and bond.


References - 

Adler, A. (1956).The individual psychology of Alfred Adler. (H. L. Ansbacher and R. R. Ansbacher, Ed. And Trans.) New York: Harper Row

Andolfi, M. (1974) Paradox in psychotherapy. American Journal of Psychoanalysis, 34, 221-228

Beisser, A (1970) The paradoxical theory of change. In J. Fagan and I. Shepherd (Eds.) Gestalt therapy now. New York: Harper and Row

Brehm, S. S., & Brehm, J. W. (1981). Psychological reactance: A theory of freedom and control. New York: Wiley

Farrelly, F., & Brandsma, J. (1974) Provocative therapy. Fort Collins, Colorado: Shields Publishing

Frankl, V. (1965) The doctor and the soul: From psychotherapy to logotherapy. New York: Knopf

Frankl, V.E. (1978). The unheard cry for meaning: Psychotherapy and humanism.

Haley, J. (1963) Strategies of psychotherapy. New York: Grune and Stratton

Morzdzierz, G., Macchitelli, F., & Lisiecki, J. (1976) The paradox in psychotherapy: An Adlerian            perspective. Journal of Individual Psychology, 32, 169-184 New York: Simon & Schuster.

Rosen, J. (1946) A method of resolving acute catatonic excitement. The Psychiatric Quarterly, 20, 183-198

Rosen, J. (1953) Direct Psychoanalysis. New York: Grune and Stratton

Schneersohn, S. D. (1969) Kuntres Uma’ayon ; Translated by Z. Posner, pp 3 -12; Brooklyn, NY;        Kehot Publication Society

Watzlawick, P., Weakland, J., & Fisch, R. (1974) Change: Principles of problem formation and problem resolution. New York: W. W. Norton

Weakland, J., Fisch, R., Watzlawick, P., and Bodin, A. (1974) Brief therapy: Focused problem resolution. Family Process, 13, 141-16*       EPK Revised: 1-20-12