- What a Paradox!: Using Paradoxical Interventions for Fun and Change
Paradoxical interventions could best be described as when a therapist directs his or her client to perform the very problem the client is seeking to eradicate. The underlying principle is that clients’ implement certain emotions and actions for specific reasons. Usually the behavior is unconsciously created in order to meet a certain perceived need by the client. Examples of this could be the need to be noticed, the need to feel some degree of control in one’s life, the need to feel safe, the need to appear strong, etc.
By directing the client to enact the problem behavior, the therapist is assisting the client in meeting this need but at the same realizing (consciously or unconsciously) how much control he or she truly has over the behavior. The act of consciously creating the behavior can lead the client to realize that if he or she can create it, then he or she also has the ability to change it. It is important for the therapist to maintain a nonjudgmental attitude toward the client’s behavior as this acceptance of the behavior by the therapist allows for the opportunity of the problem behavior becoming a beneficial resource in the therapeutic process.
To be blunt paradoxical interventions can often be funny. Having someone consciously do the very thing that he or she does not want to do can often bring about comical consequences (it can also bring about profound healing).
Recently I had a young lady in my office that had an issue with shoplifting. She felt she could not go to the store without stealing something. It had got to the point in which she had to have someone go with her when she went shopping to protect her from stealing. She earnestly wanted to stop her problem behavior but felt a compulsion to do it. She would steal something and as soon as she walked out of the store she would intense guilt, shame and anxiety. She felt stuck and hopeless.
After listening to her story and empathizing with how difficult it had been for her to deal with this “compulsion”, I asked her if she could feel that compulsion now in my office. She said she could. I congratulated her on being so in touch with her feelings. I then told her that I wanted her to go out to our busy office area and steal something. She was a little surprised by this request. I told her that I wanted her to go out and steal whatever she wanted as long as she let everyone know she was going to steal something. She had to ask permission to steal.
I went out to the office area with her and told the staff that my client was going to steal some things. They all looked at me and understood that I was doing yet another of my wacky interventions so they agreed without hesitation (I love the people I work with!). I then told my client to take all the time she needed to steal something. It took her a good minute or two to take something (a stapler) and we returned to my office. She handed me the stapler and told me she did not enjoy that exercise at all. I asked her to continue stealing for the rest of the therapy hour. She complied and brought me back many things from the office. By the end of the hour she was not feeling much compulsion any more. She even reported that her feelings about stealing had changed a little. I recommended she go to the store she steals from the most and tell the staff that she is going to steal something as part of her “therapy” but as soon as she walks out the door she will return it. She agreed to this idea but thought I was “crazy” (which is true).
Over the next week she found that her compulsion to steal was nowhere as intense as it used to be, in fact the one time she did take something she immediately returned it. Even though she still has some feelings that encourage her to steal, she has found a new resource due to being put in a paradox of being encouraged to steal.
I would recommend that a therapist utilize a paradoxical intervention when there is a specific problem which the client believes is involuntary. Clients often perceive certain actions they do as out of their control even though they have an unconscious strategy of how to create these actions. A therapist may direct their clients to increase the frequency of the behavior or to schedule it for a specific time each day. It goes without saying that paradoxical interventions are to be used only when it is safe and in the frame work of a positive therapeutic relationship.
Have some serious fun with these interventions (serious fun? What a paradox….).
- Enlightening Discussion: My Interview with Mind Science TV
I was very honored to be asked by my good friend Richard Hill to do an interview for Mind Science TV. Richard is currently the Vice-President of the Global Association of Interpersonal Neurobiology Studies, the Director of the Mind Science Institute in Sydney, Australia and a great psychotherapist whose “curiosity-approach” to therapy is something many therapists will want to check out. Richard was kind enough to do an wonderful interview with me here.
Our “interview” was more like a great discussion among friends which could have gone on for hours. We discussed the ground breaking work of Milton Erickson, how excessive focusing on the problem a client brings to us in therapy may actually inhibit healing, book writing and helping clients deal with the challenges of life in creative ways.
I hope you enjoy our discussion.
- Frame Game: How to Create Change with the Power of Reframing
One of the most important skills a therapist can have is the ability to reframe the problem which their client brings to therapy. Reframing can be defined as a method in which the therapist restates or reinterprets the client’s problem in a way in which the client can experience the problem in a new way. By directing the client to be able to experience the problem from other points of view, the therapist can change the meaning and the definition of the problem into a problem that will be a little easier to solve.
The point of using reframing in a therapy session is to change clients’ view of the problem from something as being unsolvable, into a new experience in which the problem is now something that can be changed and maybe even be appreciated.
Think of reframing as a way to suggest to your client a more resourceful and meaningful experience in which he or she can have access to different behaviors and emotions. Reframing should give your client new possibilities that he or she had not previously considered or experienced.
Here is a simple method one can use to reframe client problems:
1. Notice your client’s present interpretation of the problem
Ask yourself what other possible interpretation of the problem could exist?
Is this problem something that would be appropriate in another setting? If the context of the problem changed would it still be a problem for the client?
2. Find the most interesting new interpretation of the problem and immediately point it out to the client.
The reframe could be something that is humorous, profound, touching or just plain odd.
3. Notice how the reframe affects the client. If it works build on it, if not then discard it.
Here is an example of using this process:
A family came to see me for therapy due to their teenage daughter having occasional anger outbursts. The parents were very concerned with these outbursts as the family was a loving family but was very cerebral in how they interacted and as a result they were rather emotionally distant.
After hearing all the details about the “problem” of the daughter’s outbursts, I asked the parents if they truly appreciated what the daughter was doing for the family. Both parents seemed puzzled by my comment that this behavior was to be appreciated. I went on to tell them that their daughter was trying to help the family have access to more emotions than the handful they had been using. I told them that I believed the daughter was unconsciously trying to get them to “feel more deeply” rather than just “think their way through life”. I added that it took a lot of courage for a young girl to be so open with her emotions and I wondered how the parents could show her that they also had the courage to feel more often.
From that point on the parents began viewing their daughter’s anger as a cry for emotional connection with her family. Her parents began to interact with her more often and even, over time, began to show a little more emotion themselves. The level of love, openness and happiness increased in the family as a result. The problem had become the solution.
I believe reframing is an amazing tool that should be in every therapist’s toolbox.
What frames have you played with recently?
- The Problem with Problem Focused Therapy
Too often we as therapists spend the majority of our time focusing on the problem our clients bring to therapy. By doing so we often inhibit the client in finding the resources needed to transcend the problem they brought.
Here is a short talk about the problem with focusing on the problem.
- Therapist as Client, Client as Therapist
I was talking with a wonderful fellow therapist the other day who told me that she does not follow many of the directions she gives her clients in her own life. We laughed and said that this is often true for many of us as we are all human and have our own personal issues we need to work through. At the same time I have felt that by working with my own clients I am really the one who is the client. What I mean by this is that often the directives and insight I may pass on to my clients is really what I need to be doing or feeling. If I pay attention to the dynamic of interaction between me and my clients I can clearly see that I am not an outsider looking in but rather a part of the therapeutic process and the designation between who is the client and who is the therapist can become blurred. I do not mean that I am spilling out my persona issues through disclosures to the client but rather knowing the things that are said to the client are really meant to be heard by me as well.
I see no difference between self and other in the therapy room. If a client tells me that he or she is frightened to take a certain action, I will gladly assist them in coming up with creative ways to deal with his or her fears. At the same time these same directives are also for me! I have areas of my life where I am fearful so these directives are also meant to be taken by me to move past my limitations. If someone feels stuck in an area of his or her life, the process I help them become unstuck is the very process I need to personally take to become unstuck in some area of my life. If I become frustrated with a client’s lack of motivation in therapy, then this is a great reason to examine where I am not showing much motivation in my own life. If a client is having issues with emotional regulation it is a reminder to me to continue working on my own processing of emotions.
All of this transformational information comes up from the wonderful area of my unconscious mind. I never truly know how a session will turn out so I am often amazed at the incredible information I am giving the client that is really for me. The clients are a reflection of me and I am a reflection of them. Seeing my work as a therapist in this way has allowed me to have more compassion for the people I work with as it is really me that I am working with!
If you have been a therapist long enough you start to notice that people seem to show up in your office with issues which may mirror what you are going through in your life at that moment in time. It is wonderful that they do show up as you get to explore parts of yourself that you might have avoided exploring otherwise. What a wonderful spiritual practice of seeing your clients as your teachers! There is no need to run off to ashrams in India, shamans in Peru or monasteries in Tibet when you have the greatest teachers sitting in your own office.
Which amazing teachers have you encountered in your therapy office?