19. Paradoxical Directives - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Out of the Monkey Trap, Breaking Negative Cycles for Relationships and Therapy
Chapter 19: PARADOXICAL DIRECTIVES
by Ronald Mah





Paradoxical directives are sometimes useful when people are very stuck in the behavior and not responsive to straight directives.  A common paradoxical directive is to prescribe the symptom.  Prescribing the symptom involves giving permission and instruction to engage in the negative behavior- for example, telling a couple to have one fight each day between sessions.  If the couple defies the directive, they achieve their desired behavior of not fighting, while also admitting having control over whether they fight.  On the other hand, if they follow the directive, then they admit they have control over it (again!).  With an encopretic child, prescribing the symptom would be instructing him or her to poop in his or her pants before he or she can go to bed.  This also reveals that he or she has control of pooping.  Another paradoxical intervention is to tell someone to advertise his or her issue.  Advertising would have a shy person tell his or her audience before his or her speech how afraid he or she is that will he or she will screw up.  Another paradoxical intervention would be supporting the symptom.  The therapist would tell an individual, couple, or family to prepare for a lifetime of dealing with tantrums and the chaos of their dysfunctional behavior.  By supporting their helplessness, the therapist is hoping to ignite the partners- perhaps, through their anger to assert themselves more effectively as parents.

"It could be said that the difficult, unusual, and/or paradoxical interventions utilized by strategic therapists are designed to perturb a family's—and its members'—typical or preferred patterns of interaction, coping, and problem solving in the hopes that they will move to another pattern or attractor that does not maintain the identified problem.  This is consistent with Haley's (1984) use of 'ordeals' in his clinical work.  According to Haley (1984), ordeals can be used to promote significant change within a brief amount of time.  In using this technique, therapists impose an ordeal appropriate to the problem of the person who wants to change, an ordeal more severe than the problem.  The main requirement of an ordeal is that it cause distress equal to or greater than that caused by the symptom, just as a punishment should fit the crime.  Usually, if an ordeal isn't severe enough to extinguish the symptom, it can be increased in magnitude until it is… Haley's conceptual motivation for such an approach is that people are participants in a homeostatic system and the governors of that system must be reset to bring about change.  When reset, either by amplifying a small change or by disorganizing the system and forcing a new system, the problem behaviors of the participants will change (p. 20)" (Gardner, et al., 2006, 346).

The therapist disrupts the homeostasis of the individual, couple, or family with simple to complex or straight to paradoxical interventions.  The therapist told Sal and Gemma that their conflict seemed intractable and that they should begin preparing how to divide the household resources and their joint assets in preparation for separation.  Functionally, instead of focusing on their conflicts and making accusations, Sal and Gemma began looking at these other considerations.  When the couple began working through this process, they found that it was not just very complex but also very painful.  The ordeal as Haley would describe it was more painful than the arguments.  Sal and Gemma returned to therapy to tell the therapist that they had a major change of heart.  It was too horrible to think of having to divide the household and actually breaking up.  Instead of being absorbed with all that was wrong with each other, they found themselves remembering and focusing on the positives in the relationship and each other that they had forgotten.  This is obviously a radical paradoxical intervention that cannot nor should not be utilized with all or even many relationships, couples, or families.  It would take very high skills and exceptional judgment for the therapist to venture this intervention.  The therapist needs to take into account many factors, including emotional stability, cognitive functioning, and cultural values before proceeding with any paradoxical intervention.  For example, oppositional and defiant individuals or psychological immature individuals may not be receptive to paradoxical interventions.  Persons who tend to automatically acquiesce to authoritarian direction would also not be good candidates for paradoxical interventions.  Some individuals may take the paradoxical directive as a straight directive and fail to benefit, as well as potentially suffer significant harm to selves and their relationships

continue to Chapter 20
ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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