Paradoxical Interventions in Marriage and Family Therapy

Marriage and family therapy

Wednesday, January 17, 2024. Revised Sunday, January 21, 2024, because it required a poem…

Paradoxical Interventions in Marriage and Family Therapy

Because of my interest in spiritual thinking, I’ve been considering an intriguing therapeutic tool. That tool is the use of paradoxes and paradoxical interventions.

Paradoxical ideas and ways of thinking are as old as humanity, especially in Eastern philosophy.

The Tao Te Ching (Way of Virtue), written by the founder of Taoism, Lao Tzu, contains much paradoxical advice, such as the notion that one can attain a desire by being open to receiving its apparent opposite.

Buddhism similarly contains many paradoxical ideas. For example, a seeker of enlightenment will be unable to attain it because they will have a problematic attachment to the notion of enlightenment itself!

Even Christianity contains many paradoxical statements such as, “So the last will be first, and the first will be last” (Matthew 20:16).

In other words, paradox is similar, but not identical to reverse psychology, and many examples can be found in cross-cultural religion and myth.

Reverse psychology is a term that describes a situation in which encouraging one course of action persuades someone to do the opposite.

My favorite example is how Tom Sawyer persuading his friends to white wash his fence by reframing it as a delightful and rare opportunity, rather than a mundane task.

The history of paradoxes in Marriage and Family Therapy, traces its roots back to the pioneering work of Alfred Adler.

The foundation of Paradoxical Intervention laid by Adler…eventually leading to the rise of Strategic and Systemic Family Therapies, and the eventual paradoxical shifts found in Cognitive-Behavioral Therapy (CBT).

I’ll also briefly mention how Paradoxical Intervention is alive and well, (although in a milder version), in some post-modern applications and clinical innovations.

Along the way, we’ll also discuss the lingering critiques of ethical considerations, ultimately recognizing the utility of paradoxes as an integral part of therapeutic efficacy.

Adler’s thinking…

Alfred Adler, a key figure in the early history of psychology, introduced a holistic approach that emphasized social context and family dynamics. His theories laid the foundation for understanding individual behavior within the context of familial relationships.

Birth Order and Family Dynamics:

Adler's groundbreaking exploration of birth order theory shed light on the intricate influence of family dynamics on individual personalities. This conceptual framework became pivotal in understanding how familial roles shape interpersonal relationships.

Initial Explorations of Paradoxes:

Adler's recognition of paradoxical elements within family systems marked the initial forays into the application of paradoxical interventions in therapy. This nascent stage set the stage for future developments in the field.

The Rise of Strategic and Systemic Family Therapies:

Strategic Family Therapy:

The transition from Adlerian therapy to Strategic Family Therapy marked a paradigm shift. Figures like Jay Haley and Gregory Bateson played instrumental roles in introducing strategic approaches, which utilized paradoxical interventions to disrupt dysfunctional family patterns.

“In paradoxical therapies the task is to have the person “spontaneously” behave differently, not behave differently because he is told to.

The therapist wants the person to take the initiative for new behavior.

One way to achieve that goal is to provide an internal conflict of such a nature that the person “spontaneously” changes rather than continue the past behavior.

Then the new behavior does not occur because the therapist told the person how to act, but because the therapist inspired the person to take the initiative for new behaviors. “

Jay Haley, Ordeal Therapy (1984)

Paradoxical Intentions in Systemic Approaches:

Systemic therapy emerged with a focus on circular causality within family systems.

Paradoxical interventions became a strategic tool to introduce disruptions, offering therapists new ways to navigate and reframe established family dynamics.

The Paradoxical Shift in Cognitive-Behavioral Therapy:

Emergence of Cognitive-Behavioral Therapy (CBT):

The historical rise of CBT brought forth a shift in therapeutic paradigms. Initially met with skepticism, CBT gradually embraced paradoxical interventions as therapists recognized their potential to challenge and reframe maladaptive cognitions.

Integration of Paradoxes in CBT:

Pioneers like Albert Ellis began incorporating paradoxical techniques within the CBT framework. This integration represented a departure from traditional cognitive restructuring, providing therapists with additional tools to address complex issues.

Contemporary Applications and Innovations of Paradoxical Interventions…

Gottman Couples Therapy:

In martial arts such as judo and jujitsu, if you are pulled, you push… and if you are pushed, you pull.

The ‘problem’ (of your opponent’s force) isn’t resisted, but rather encouraged and then directed. You now control the force of the problem. Gottman calls this “yield to win.”

When we use paradoxical intervention we recruit the ancient awareness of the counterintuitive.

Narrative Therapy:

Narrative therapy, with its emphasis on storytelling and deconstruction of narratives, naturally incorporated paradoxical elements into therapeutic conversations. The narrative approach allowed for the exploration of paradoxes within the stories clients tell about themselves and their families.

Solution-Focused Brief Therapy:

The brief history of solution-focused therapy introduced a pragmatic approach to therapy. Paradoxical techniques within this framework aimed to shift the focus from problems to solutions, aligning with the brief and goal-oriented nature of the therapy.

Postmodern Influences:

Postmodern perspectives on paradox and contradiction added another layer to contemporary family therapy. Therapists began to explore how acknowledging and navigating paradoxes aligns with postmodern notions of embracing complexity and multiple perspectives.

The Paradox of ongoing challenges and ethical considerations…

As paradoxical interventions gained popularity, therapists grappled with ethical considerations. The potential benefits of these interventions needed to be balanced with concerns related to client autonomy, consent, and especially the potential for unintended consequences.

Cultural Sensitivity:

Recognizing cultural nuances in the application of paradoxical interventions became imperative. Therapists needed to navigate diverse cultural perspectives to ensure that interventions were sensitive and respectful of each client's unique background.

Geez… that seems needlessly risky, we thought…

At some point, in the community of practice, old school, Haley-esque Paradoxical Interventions fell out of favor, and sometimes were dismissed as a vestige of the dark ages of of a more manipulative approach to family therapy.

Final Thoughts

“If you try to fail, and succeed, which have you done? – George Carlin

I like Victor Frankl's comments about using paradox. Frankl attributed the success of paradox, in part, to a sense of humor.

Frankl also believed that paradox allows humans to place distance between themselves and their situation.

Novel, and light-hearted perspectives allow clients to sometimes surrender their symptoms.

Frankl thought paradoxically assisted attitude adjustments could be deep and abiding, and not merely a superficial, temporary change.

“Paradoxical interventions should not be seen as miracle interventions”, said Frankl. Paradox must be used skillfully, with the right human, at the right time, and often in conjunction with other clinical approaches.

Paradoxical intention is successful because it utilizes the human capacity for self-detachment. By laughing at yourself, you put a distance between your own sense of being, and the symptom.

Thought leaders have various reasons to explain why paradoxical intention works. However, what Frankl says about humor offers the most compelling explanation.

Putting something in a humorous way restores a “basic trust in being.” It is in this sense, says Frankl, that paradoxical intention is a therapeutic process in the truest sense.

From Adler's foundational work to the contemporary integration of paradoxical interventions, therapists continue to navigate a dynamic and changing landscape against a backdrop of occasional ethical peril.

The persistence of paradox serves as a testament to the resilience and adaptability of these ideas in Marriage and Family Therapy.

Paradoxical interventions offer compelling, but challenging avenues toward healing and growth within the complexities of intimate bonds.


I’ll offer the last words on paradox to the great Cummington poet, Richard Wilbur…

A Milkweed

Anonymous as cherubs

Over the crib of God,

White seeds are floating

Out of my burst pod.

What power had I

Before I learned to yield?

Shatter me, great wind:

I shall possess the field.

Be Well, Stay Kind, and Godspeed.

REFERENCES:

Adler, A. (1923). The practice and theory of individual psychology. London: Routledge & Kegan Paul.

Google Scholar

Ansbacher, H. L., & Ansbacher, R. R. (1956). The individual psychology of Alfred Adler. New York: Basic Books.

Google Scholar

Ascher, L. M. (1979). Paradoxical intention in the treatment of urinary retention. Behaviour Research and Therapy, 17, 267-270.

Google Scholar

Ascher, L. M. (1981). Employing paradoxical intention in the treatment of agoraphobia. Behaviour Research and Therapy, 19, 1-10.

Google Scholar

Ascher, L. M., & Efran, J. S. (1978). Use of paradoxical intention in a behavioral program for sleep onset insomnia. Journal of Consulting and Clinical Psychology, 46(3), 547-550.

Google Scholar

Ascher, L. M., & Turner, R. M. (1979). Paradoxical intention and insomnia: An experimental investigation. Behaviour Research and Therapy, 17, 408-411.

Google Scholar

Ascher, L. M., & Turner, R. M. (1980). A comparison of two methods for the administration of paradoxical intention. Behaviour Research and Therapy, 18, 121-126.

Google Scholar

Bateson, G., Jackson, D. D., Haley, J., & Weakland, J. (1956). Toward a theory of schizophrenia. Behavioral Science, 1, 251-264.

Google Scholar

Beck, A. T., & Emery, G. (1985). Cognitive therapy of anxiety and phobias. New York: Basic Books.

Google Scholar

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.

Google Scholar

Beck, J. T., & Strong, S. R. (1982). Stimulating therapeutic change with interpretations: A comparison of positive and negative connotation. Journal of Counseling Psychology, 29, 551-559.

Google Scholar

Bodin, A. M. (1981). The interactional view: Family therapy approaches of the Mental Research Institute. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of family therapy. New York: Brunner/Mazel.

Google Scholar

Boettcher, L. L., & Dowd, E. T. (1984, August). Comparison of rationales in symptom prescription. Paper presented at the meeting of the American Psychological Association, Los Angeles.

Google Scholar

Brehm, J. W. (1966). A theory of psychological reactance. New York: Academic Press.

Google Scholar

Conoley, C. W., & Garbar, R. A. (1985). Effects on reframing and self-control directives on loneliness, depression, and controllability. Journal of Counseling Psychology, 32, 139-142.

Google Scholar

Dell, P. F. (1981). Some irrelevant thoughts on paradox. Family Process, 20, 37-42.

Google Scholar

Dowd, E. T., & Brockbank, L. (1985, August). Compliance and defiance-based strategies in the treatment of free and unfree behavior. Paper presented at the meeting of the American Psychological Association, Los Angeles.

Google Scholar

Dowd, E. T., Milne, C. R., & Wise, S. L. (1984, August). The Therapeutic Reactance Scale: Development and reliability. Paper presented at the meeting of the American Psychological Association.

Google Scholar

Dowd, E. T., & Swoboda, J. S. (1984). Paradoxical interventions in behavior therapy. Journal of Behavior Therapy and Experimental Psychiatry, 15, 299-234.

Google Scholar

Dunlap, K. (1928). Revision of the fundamental law of habit formation. Science, 67, 360-362.

Google Scholar

Dunlap, K. (1932). Habits: Their making and unmaking. New York: Liveright.

Google Scholar

Dunlap, K. (1939). Research in methods of adjustment. Faculty Research Lectures, 1-23.

Google Scholar

Dunlap, K. (1942). The technique of negative practice. American Journal of Psychology, 55, 270-273.

Google Scholar

Efran, J. S., & Caputo, G. C. (1984). Paradox in psychotherapy. A cybernetic perspective. Journal of Behavior Therapy and Experimental Psychiatry, 15, 235-240.

Google Scholar

Erickson, M. H. (1959). Further clinical techniques of hypnosis: Utilization techniques. American Journal of Clinical Hypnosis, 2, 3-21.

Google Scholar

Erickson, M. H. (1964). An hypnotic technique for resistant patients: The patient, the technique and its rationale and field experiments. American Journal of Clinical Hypnosis, 7, 8-32.

Google Scholar

Erickson, M. H. (1965). The use of symptoms as an integral part of psychotherapy. American Journal of Clinical Hypnosis, 8, 57-65.

Google Scholar

Erickson, M. H. (1973). Psychotherapy is achieved by a reversal of the neurotic processes in a case of ejaculation praecox. American Journal of Clinical Hypnosis, 15, 217-222.

Google Scholar

Erickson, M. H. (1977). Hypnotic approaches to therapy. American Journal of Clinical Hypnosis, 20, 20-23.

Google Scholar

Erickson, M. H., & Rossi, E. L. (1975). Varieties of double bind. American Journal of Clinical Hypnosis, 17, 143-157.

Google Scholar

Feldman, D. A., Strong, S. R., & Danser, D. B. (1982). A comparison of paradoxical and nonparadoxical interpretations and directives. Journal of Counseling Psychology, 29, 572-579.

Google Scholar

Frankl, V. E. (1939). Zur medikamentosen unterstutzung der psychotherapie bei neurosen. Schweizer Archiv fur Neurologie und Psychiatrie, 43, 23-61.

Google Scholar

Frankl, V. E. (1960). Paradoxical intention: A logotherapeutic technique. American Journal of Psychotherapy, 14, 520-535.

Google Scholar

Frankl, V. E. (1975). Paradoxical intention and deflection. Psychotherapy: Theory, Research and Practice, 12, 226-237.

Google Scholar

Freud, S. (1919). Turning in the ways of psychoanalytic therapy. In Collected papers (Vol. 2). New York: Basic Books.

Google Scholar

Garfield, S. L. (1978). Research on client variables in psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change. New York: John Wiley.

Google Scholar

Gerz, H. O. (1966). Experience with the logotherapeutic technique of paradoxical intention in the treatment of phobic and obsessive-compulsive patients. American Journal of Psychiatry, 123(5), 548-553.

Google Scholar

Greenberg, R. P. (1973). Antiexpectation techniques in psychotherapy: The power of negative thinking. Psychotherapy: Theory, Research and Practice, 10, 144-148.

Google Scholar

Greenberg, R. P., & Pies, R. (1983). Is paradoxical intervention risk-free? A review and case report. Journal of Clinical Psychiatry, 44, 66-69.

Google Scholar

Guidano, V. F., & Liotti, G. (1983). Cognitive processes and emotional disorders. New York: The Guilford Press.

Google Scholar

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

Google Scholar

Haley, J. (1982). The contribution to therapy of Milton H. Erickson, M. D. In J. K. Zeig (Ed.), Eriksonian approaches to hypnosis and psychotherapy. New York: Brunner/Mazel.

Google Scholar

Hughes, S. L., & Dowd, E. T. (1985, August). The effects of restraining and nonrestraining counselor interventions in the treatment of procrastination. Paper presented at the meeting of the American Psychological Association, Los Angeles.

Google Scholar

Jackson, D. D. (1957). The question of family homeostasis. Psychiatric Quarterly Supplement, 31, 79-90.

Google Scholar

Jessee, E., & L'Abate, L. (1980). The use of paradox with children in an inpatient treatment setting. Family Process, 19, 59-64.

Google Scholar

Kelly, G. S. (1955). The psychology of personal constructs. New York: W. W. Norton.

Google Scholar

Kopel, S., & Arkowitz, H. (1975). The role of attribution and self-perception in behavior change: Implications for behavior therapy. Genetic Psychology Monographs, 92, 175-212.

Google Scholar

Kraft, R. G., Claiborn, C. D., & Dowd, E. T. (1985). Effects of positive framing and paradoxical directives in counseling for negative emotions. Journal of Counseling Psychology, 32, 617-621.

Google Scholar

L'Abate, L., & Weeks, G. (1978). A bibliography of paradoxical methods in psychotherapy of family systems. Family Process, 17, 95-98.

Google Scholar

Lopez, F. G. (1982, August). Some considerations regarding the use of paradoxical interventions. Paper presented to the annual meeting of the American Psychological Association, Washington, DC.

Google Scholar

Lopez, F. G., & Wambach, C. A. (1982). Effects of paradoxical and self-control directives in counseling. Journal of Counseling Psychology, 29, 115-124.

Google Scholar

Mahoney, M. J. (1980). Psychotherapy and the structure of personal revolutions. In M. J. Mahoney (Ed.), Psychotherapy process. New York: Plenum Press.

Google Scholar

Mahoney, M. J. (1982). Psychotherapy and the human change process. In J. H. Harvey & M. M. Parks (Eds.), Psychotherapy research and behavior change. Washington, DC: American Psychological Association.

Google Scholar

Marks, I. M. (1970). The origin of phobic states. American Journal of Psychotherapy, 24, 652-676.

Google Scholar

Marlatt, C. A. (1978). Craving for alcohol, loss of control and relapse: A cognitive behavioral analysis. In P. E. Nathan, G. A. Marlatt, & T. Lobers (Eds.), Alcoholism: New directions in behavioral research and treatment. New York: Plenum Press.

Google Scholar

Mavissakalian, M., Michaelson, L., Greenwald, D., Kornblith, S., & Greenwald, M. (1983). Cognitive behavioral treatment of agoraphobia: Paradoxical intention vs. self-statement training. Behaviour Research and Therapy, 21, 75-86.

Google Scholar

Mowrer, O. H. (1947). On the dual nature of learning. A reinterpretation of "conditioning" and "problem solving." Harvard Educational Review, 17, 102-148.

Google Scholar

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

Google Scholar

O'Connell, D. S. (1983). Symptom prescription in psychotherapy. Psychotherapy: Theory, Research and Practice, 20(1), 12-20.

Google Scholar

Olson, D. H., & Dowd, E. T. (1984). Generalization and maintenance of therapeutic change. The Cognitive Behaviorist, 6(1), 13-19.

Google Scholar

Omer, H. (1981). Paradoxical treatments: A unified concept. Psychotherapy: Theory, Research and Practice, 3, 320-324.

Google Scholar

Oppenheim, H. (1911). Textbook of nervous diseases for physicians and students (5th ed.). New York: Stechert.

Google Scholar

Papp, P. (1980). The Greek chorus and other techniques of paradoxical therapy. Family Process, 19, 45-57.

Google Scholar

Papp, P. (1981). Paradoxical strategies and countertransference. In A. S. Gurman (Ed.), Questions and answers in the practice of family therapy. New York: Brunner/Mazel.

Google Scholar

Perrin, D. K., & Dowd, E. T. (in press). Effect of counselor self-disclosure and paradoxical directives on counselor social influence. Journal of Counseling Psychology.

Google Scholar

Raskin, D. E., & Klein, Z. E. (I976). Losing a symptom through keeping it: A review of paradoxical treatment techniques and rationale. Archives of General Psychiatry, 33, 548-555.

Google Scholar

Rimm, D. C., & Masters, J. C. (1979). Behavior therapy: Techniques and empirical findings (2nd ed.). New York: Academic Press.

Google Scholar

Rohrbaugh, M., Tennen, H., Press, S., & White, L. (1981). Compliance, defiance, and therapeutic paradox. American Journal of Orthopsychiatry, 51, 454-467.

Google Scholar

Selvini Palazzoli, M. (1981). Comments on Paul Dell. Family Process, 20, 44-45.

Google Scholar

Selvini Palazzoli, M., Boscolo, L., Cecchin, G., & Prata, G. (1974). The treatment of children through brief therapy of their parents. Family Process, 13, 419-442.

Google Scholar

Selvini Palazzoli, M., Cecchin, G., Prata, G., & Boscolo, L. (1978). Paradox and counterparadox. New York: Jason Aronson.

Google Scholar

Shoham-Salamon, V., & Jancourt, A. (1985). Differential effectiveness of paradoxical interventions for more versus less stress prone individuals. Journal of Counseling Psychology, 32, 449-453.

Google Scholar

Stampfl, T. G. (1967). Implosive therapy, Part I: The theory. In S. G. Armitage (Ed.), Behavioral modification techniques in the treatment of emotional disorders. Battle Creek, MI: B. A. Publication.

Google Scholar

Stampfl, T. G., & Levis, D. J. (1967). Essentials of implosive therapy: A learning-theory-based psychodynamic behavioral therapy. Journal of Abnormal Psychology, 72, 496-503.

Google Scholar

Stanton, M. D. (1981). Strategic approaches to family therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of family therapy. New York: Brunner/Mazel.

Google Scholar

Strong, S. R. (1970). Causal attribution in counseling and psychotherapy. Journal of Counseling Psychology, 17, 388-399.

Google Scholar

Tennen, H., Rohrbaugh, M., Press, S., & White, L. (1981). Reactance theory and therapeutic paradox: A compliance-defiance model. Psychotherapy, 18, 14-22.

Google Scholar

Turner, R. M., & Ascher, L. M. (1979). Controlled comparison of progressive relaxation, stimulus control, and paradoxical intention therapies for insomnia. Journal of Consulting and Clinical Psychology, 47, 500-508.

Google Scholar

Turner, R. M., & Ascher, L. M. (1982). Therapist factor in the treatment of insomnia. Behaviour Research and Therapy, 20, 33-40.

Google Scholar

Watzlawick, P., Beavin, J. H., & Jackson, D. D. (1967). Pragmatics of human communication. New York: W. W. Norton.

Google Scholar

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

Google Scholar

Weeks, G. R., & L'Abate, L. (1982). Paradoxical psychotherapy: Theory and practice with individuals, couples, and families. New York: Brunner/Mazel.

Google Scholar

Whitehead, A. N., & Russell, B. (1910). Principia mathematica. Cambridge: Cambridge University Press.

Google Scholar

Wilder, C. (1979). The Palo Alto group's difficulties and directions of the interactional view for human communication research. Human Communication Research, 5(2), 171-186.

Google Scholar

Wright, R. M., & Strong, S. R. (1982). Stimulating therapeutic change with directives: An exploratory study. Journal of Counseling Psychology, 29, 199-202.

Google Scholar

Zeig, J. K. (1980). Symptom prescription and Ericksonian principles of hypnosis and psychotherapy. American Journal of Clinical Hypnosis, 23(1), 16-22.

Google Scholar

Previous
Previous

Is talking to yourself healthy and normal?

Next
Next

2 Books I recommend if your mother is an asshole…