An Example of a Paradoxical Intervention

While the method is known to influence exponential and rapid change in the ‘treatment-resistant client’ many clinicians have been reluctant to utilize the approach. This is mainly due to the fact that until now, the mechanism has been a theoretical mystery. Clinicians have also been uncomfortable with the approach being counter-intuitive and lacking face validity.  

While traditional methods often find themselves in a “power struggle” to convince, instruct, or reward the client to change, the paradoxical approach purposefully ‘avoids power struggles’ and on the surface appears to support the client to continue a targeted behavior!

For this reason, it is important to gain a theoretical understanding of the method and how the surface presentation differs with the underlying intent. 

*Please Note! The following is a simple example.  Regarding more severe treatment issues, such as addictions, borderline personality disorder, problem sexual behavior (PSB), and other volatile behaviors, it is best that the clinician gain a ‘strategic’ understanding of the approach and its focus. Therefore it is emphasized that the intent here is to offer a simple example as an introduction to clinicians who are unfamiliar with the method. It is hoped that the example will provide a feel and direction for the paradoxical approach.

 

Example: Bickering

Let’s take the issue of a couple who constantly bickers. While ‘history’ is important and gives the clinician a sense of the ‘origins of the problem’, paradoxical interventions do not dwell on unraveling client history.  

Rather, the focus of treatment is on the ‘here and now’ as it pertains to re-occurring patterns that can be objectively identified. Such repetitive patterns may occur daily / weekly / monthly, etc.  

The repetitive pattern we are addressing here is : bickering.  In terms of being ‘treatment-resistant’ -the couple may recognize that a ‘problem exists’, however in the mind of each partner, the bickering that occurs is the fault of the other.  As a result they are hopeful the “other one will change”, but do not see their role in that “it takes two to tango.”

Coming into treatment, the couple each has their “list of reasons” why they argue; “He doesn’t take the garbage out.”; “Her parents are always butting in.”; “He comes home and just watches TV.”; She clutters up the basement.”, etc.

From this couples view, they believe that their bickering episodes ‘occur spontaneously.’ From their perspective, they arrive with the underlying assumption that they are making a ‘free will choice’ to argue. In both of their minds, they may believe that they ‘could stop’, but due to their partner’s insensitivity, they each feel provoked and ‘triggered’ into reacting. 

Behavioral, Cognitive, Psycho-dynamic - In handling the above scenario, the traditional approaches of behavioral, cognitive, and psycho-dynamic, each have their own ‘spin’ on how to best address this situation. On the surface, each approach seems logical, straightforward, - and we would expect any given intervention to work. —But the difficulty we run into is that each partner blames the other for the ongoing bickering. 

1. A ‘behavioral intervention’ may try to get the clients to focus on the ‘rewards’ of refraining from bickering, and the ‘punishments’ (frustration) they each feel when they ‘send barbs’ at each other;

2. A ‘cognitive intervention’ will encourage the clients to think ‘logically’. Often this means identifying ‘thinking errors’ or ‘cognitive distortions’. In addition partners might be encouraged to ‘focus on the positive.’ In this way, the method tries to “logically persuade” each person to communicate differently with each other. 

3. A ‘psychodynamic intervention’ may try to identify the emotions and history behind their bickering behavior. By recognizing historical issues (with parents or previous relationships), the couple may be able to reduce their misdirected emotional volatility that plays out against each other.

Admittedly, while all these approaches sound good and rational on the surface, the difficulty is that each of these approaches requires that one or both clients be vigilant in exerting effort to change. Each method requires the couple to maintain steady focus on his/her behavior, thoughts, and/or emotions in order for the intervention to be effective. In short, the client is ‘working hard’ to change his/her behavior. Unfortunately, while one or both may ‘maintain control’ in the short run, over a period of time this vigilant stance eventually relaxes and the couple often falls back into their familiar pattern. The point here is that when people are ‘working hard’ to change, -they tend to regress back into old patterns.

In general, these forms of treatment, buy into the assumption that if the client ‘tries hard enough’, the new behavior will become ‘second nature’ thereby changing old patterns. —Again, while this sounds good, the unfortunate reality is that for most people this does not work.

Uphill battle - What we have described here is analogous to pushing a car up a long hill. While it is possible to push the car a short distance, eventually the person tires. At some point the person is likely to ‘take-a-break and let go’. As soon as the person ‘takes a break’, in that brief instant that the car will reverse direction and ‘slide back’ down the hill - undoing all that hard work! 

4. The Paradoxical Approach - In a paradoxical intervention, the clinician capitalizes on the absurdity of the human condition. As such the intervention seems illogical and counter to the goals of treatment.

Rather than fighting or struggling against a given symptom, the clinician accepts that the symptom will occur. The clinician thereby takes advantage of the (analogy) car’s natural momentum to roll down the hill. In this manner, the ‘letting go’ process becomes the experience that leads to change. This, of course, is counter-intuitive to the belief that the bickering must be somehow be forcefully ‘stopped, controlled, or prevented’.

With this in mind, the clinician takes the absurd stance that the “tail wags the dog”. By this we mean that the clinician takes the position that the ‘behavior controls the couple’, rather than the expected assumption that the couple can control their repetitive behavior (bickering).  Instead of focusing on plans to halt or prevent the behavior, the paradoxical approach actually plans and predicts with the couple the details around their upcoming next episode.

It is the absurdity of ‘planning’ the next ‘bickering episode’ that highlights to each partner that his/her behavior is not as spontaneous at all. In so doing each partner gains a new perspective on the predictability of their own repetitive pattern.

In stepwise fashion, the intervention therefore identifies each partner’s specific ‘triggers and reactions’. Once these triggers and reactions have been identified, the clinician ‘plans for’ their occurrence.  - In ridiculious fashion, the clinician will help the couple identify when the husband “won’t take the garbage out”; when her parents will “butt in” next; when the husband will “plop down in front of the TV“; and the best time for the wife to clutter the basement.

The clinician’s role is not to help ‘resolve’ these problems (as one might logically expect), but rather to accept and create a schedule around these events. In this way each partner knows when it will be their turn to initiate the next ‘bickering event’! The clinician might even ‘practice and rehearse’ when each partner will do their assigned ‘homework’! When done correctly, one or both partners will perceive the ridiculous nature of such ‘plans’.

The result of such an intervention is that when these triggers present themselves, the couple has a new perspective. Each partner’s conscious awareness that he/she is ‘expected to bicker’ actually has a paradoxical impact. Rather than the triggers having the usual result of ‘raising tension’, it actually has the effect of disrupting and soothing the tension. In that moment the will and desire to ‘bicker’ literally evaporates in a manner that is effortless and without forethought.

Such interventions are rapid and have a long term effect. What is interesting is that if the couple is asked ‘why they did not do their habitual bickering?’, they will ‘not have a good reason.’ They only know that they ‘just didn’t feel like it.’   

End of example.

As you may sense, although successful there is seemingly a high degree of ambiguity as to what just occurred. It is in fact this sense of ambiguity and the fear of ‘what if it backfires?’ that clinicians have avoided employing this fascinating and approach. Obviously, the mechanism behind this type of exchange needs to be understood.

Science Based Approach  

The above example will no doubt seem to be contradictory and confusing.  After all: How is it possible to explain the reduction of a given behavior by promoting that behavior?! 

As discussed elsewhere, this understanding is accomplished through the science of an ‘orbits-gravity paradigm.’ Within this example, ‘bickering’ represents a recurring and rigid ‘orbit’, while ‘gravity’ is the couples ‘comfort level of attachment’ within their relationship. While most therapies focus on shifting the orbit, in this model the goal is to shift the gravity-attachment.  

When the clinician ‘plans and encourages’ the couple to continue their behavior, he is actually ‘joining’ them in a way that shifts their status-quo ‘comfort-level’ gravity-attachment. Interestingly enough there is no mention during the intervention of anything remotely related to “gravity” or “attachment”. However, by the clinician’s act of  planning ‘when, where, and  how’  the couple will bicker again, he becomes aligned to their world. Essentially the couple is no longer by themselves in the kitchen; the presence or ‘shadow’ of the clinician is now keeping them company.

By planning the next ‘event’, the clinician is conveying without words, “I am on your side!” “I am together with you!” This action not only disrupts, but soothes the ‘status quo tension’ experienced between the partners. Even if only one partner experiences the clinician’s ‘shadow’, this is likely to be enough to shift their bickering dynamic. The better the clinician is able to convey his shadow beyond the therapy room, the more likely the individual or couple will spontaneously shift out of their rigid pattern of behavior. As stated, the fascinating aspect of this type of change is that it does not require the couple to be vigilant, but rather occurs in a manner that is effortless and without forethought.   

Dr. Kaplan can be reached at: email: ParadoxDoc@gmail.com

 

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