Wednesday, January 24, 2007

The Paradox

For this, you should pay.

But okay.

What's a paradox? A mental paradox is a situation in which a person can't help but do the right thing because having exaggerated the wrong thing makes the right thing seem, well, right.

There's an irresistible, hypnotic quality to a paradox, so of course, therapydocs watered in this treatment venue, who see the paradoxical quality to life anyway, will "paradox" you whenever they can. And consciously or not, you'll like it.

My mom and dad hate it when I do this to them, but it always makes them laugh.

It is also what makes good treatment painless.

When I learned about the paradox it wasn't presented this way. A paradox was a carefully thought out strategy with the power, not necessarily the magnitude (it's a brief family therapy technique), to create change. When I was in school I had the feeling that Jay Haley, the father of this kind of treatment, and his strategic team left the family, walked out, smoked, talked, and conspired. The family waiting for help was for sure, putty, powerless against such intellect.

But for me these kinds of things of situations arise serendipitously. I'm rarely on the look-out or even consciously working it. Here's an example.

A couple has an issue with trust. But it's an irrational issue. Both partners are true blue, loyal, fidel, love and respect one another, would never, ever cheat. But one of them trusts no one, really, except the family, and now that he's married (we'll make the distrustful partner, the jealous partner a he, but this is always gender/sexual orientation irrelevant. A he can easily be a she.

So call him Harry. Harry's always putting it out there that he's a married guy, a happily married guy. When he married Felice he was the happiest guy alive, found her the sexiest, most intelligent woman on the planet with a great sense of humor, his very best friend, too.

But Felice didn't make him the center of her universe. Not as much. She worked and had difficulty juggling the idiocy around her. Sometimes she felt that just getting through every day was a challenge, and when she got home she vegged out. She related to him like her mom related to her father. They had dinner, watched television. Crashed around 11:00 p.m.

Sexy though he thought she was, she wasn't all that into it by the time they'd turn off the teev.

So their libidos didn't match precisely (rarely do they ever, peops, except in the movies) and he worried about her love for him. Did she even really love him? He worried especially when he noticed that she missed chances to tell people, upon introduction, Oh, and by the way. I'm MARRIED. You should know that.

Isn't that how you're supposed to introduce yourself? I'm supposed to say, How do you do, nice to meet you. Yes, in case you were wondering, I AM married and happily, too, to a guy I call F.D. Got it, dude? Lose those dirty thoughts.

Clearly a Freudian doc or a psychodynamic doc or a Jungian doc or a Gestalt doc or any other kind of doc could have a field day and spend hours upon hours working with Harry and his issues, and maybe working with Felice on hers, too. If the couple would keep on paying.

A family doc might discuss family traumas, past affairs, even incest.

A STRATEGIC family doc does something like so:

We write new scripts, preferrably with with the couple's participation. LAUGHTER IS KEY, HERE. If they're not laughing, if they're not into it, it's harder. But it can still work very well. Here was the set-up to the new script for Harry and Felice.

TherapyDoc: So what will happen when Felice returns to work tomorrow?
Felice: He's going to call me and ask, Any cute new guys there this semester?
TherapyDoc: And you'll say. . .
Felice: I'll say, Just shut up. I'm sick of this.

(Harry laughs, seems embarrassed)

TherapyDoc: Could you be a little nicer, Felice, on the phone?
Felice (with attitude) : You mean, like I should say, Harry, I only have eyes for you, you're my guy? I do that all the time. It means nothing to him.

TherapyDoc (to Harry): Really?
Harry: Talk is cheap, man.
TherapyDoc: Indeed. So this is what you're going to do. We're going to change tomorrow's phone conversation. Good idea?

They're captive. We spend some time scripting it, mainly me scribbling, them telling me if it'll work or not. All of us are nearly on the floor, in tears it's so funny.

The Final Product

Harry: Any cute guys at work?
Felice (serious) : I just got here, give me time to look around.
Harry: I dare you.
Felice (a lot less serious) : I need the whole day, Harry, to case the place out, look around, really look at them. There are a lot of guys here, hundreds and thousands of men in pants. I won't know if there's anyone to have an affair with until I'm ready to leave, so be patient, and when I get home I'll tell you if I'm going to have an affair. Don't bug me til I get home.

Harry: Ha! Well don't even talk to me, then, because I'll be so angry by then that I'm going to need a lot of space from you. You better stay the (expletive "f") away.

Felice: No, no, no. When I get home I want you naked in a bathrobe, babe. I'm going to so want to (expletive "f") you, I'll have missed you so much all day. All DAY, Harry, without a kiss from you. How do you think that makes me feel? Don't you dare not be naked by the time I get home. Oh, maybe answer the door for me. . . in a towel.

When I made the last suggestion Felice said, Well, he'd want to do that every day!
Of course, this is a terrible price, right, to get a guy to trust you. Making love.

But I reassure her, Most couples don't make huge changes, every day changes. But if you two can make a once-in-awhile change? Some kind of wonderful.

I would imagine, in fact, that a feminist look at this treatment would be disapproving, but you should know that indeed, the woman in this case IS always in charge. She's always on top, if you will.

The paradox, of course, is that he's forced to think of her on the hunt the whole day, or at least to think of her saying that she'll be on the hunt all day, and he really can't see her in this light. It's laughable. He says, I dare you, but inside he's thinking, she's putting me on, she's not looking at guys. She has a difficult job. Her job is demanding, it's stressful. She's not out there looking to replace me. She's not even INTO sex all that much.

He's forced to see the reality, not his catastrophic fears.

Well, I liked it.

Copyright 2007, TherapyDoc


Not-faint-hearted said...

You wrote:

"but you should know that indeed, the woman in this case IS always in charge."

wonder if you could clarify a bit. Where am I always in charge?

trust me, this question could devolve into something I'd definately need to pay for...but just give me a hint, ok? ;)

TherapyDoc said...

Sorry for the confusion. In this INTERVENTION she's in charge. The whole in charge/out of charge issue is a whole other post, but I did want to make it clear that he (or I)was not coercing her into sex she wasn't ready for.

bjurstrom said...

Dear Doc,
Three cheers! I'm still laughing amd musing...If you were a math teacher I'd say that you teach by in how does this relate to my life...what can I do with this information...
I think irrational fears are mixed up preparedness OK if this happens I'm ready. Paradox therapy seems to work with this rationalization in a comical way. Also just another thought....sometimes irrational fears and mind reading games lead to a general loss of respect for the can't keep defending yourself against something that didn't happen. I like the way paradox therapy helps reestablish a respect for the relationship....and perhaps the person. Keep teaching.

TherapyDoc said...

On the reread? It's not that funny. Maybe you hadda' be there?

Not-faint-hearted said...

Oh. Thanks. Well, put me down for requesting that "in charge/out of charge" post...along with the ambiguous grief one from the beginning of the month.

Shoot. I keep requesting, you're gonna need to charge, huh? ;)

TherapyDoc said...

NFH- shoot me an email.

Mark said...

Excellent example of paradox in psychotherapy. Masterful.
Paradox also works well in a number of medical care issues, particularly compliance with long-term treatment for chronic illness (e.g. -- taking high blood pressure medication). Ideally, we let the patient work out in front of us the consequences of not taking the course of treatment, but often it is we who have to provide the catastrophic expectation ("Well, I'll prescribe this for you, but you probably won't take it, so we can just wait til you show up at the ER with your stroke. Or dead.")

TherapyDoc said...
This comment has been removed by the author.
Mark said...

Very interesting. I will be looking for an opportunity to apply this.
Any other examples that you could share with us?

TherapyDoc said...

Two different Marks, I find out. Mark I is FAMDOC. Mark II is my friend the blogger. Mark II, Mark I's example is another good one.

Let's talk about it a second. It's fabulous.

In general I'll only have a problem with this intervention when the therapist/doc is actually deceptive and prescribes something that theoretically CAN be dangerous.

So if a doc said, "I'm going to prescribe this, but don't take it," that is also considered a standard paradoxical intervention-- but it's a bad one, right, if the patient takes the doc literally and the paradox doesn't work and the patient doesn't take it BECAUSE the doc said, Don't take it.

But FAMDOC's verbalization--"You probably won't take it, and you'll probably get sick" is the right way to do the paradox.

People love docs who are honest and clearly caring in this way (like you, F.D.). They feel empowered. It's their choice.

They're not being TOLD what to do, which is something we could talk about for hours, how people don't like being told What To Do. That's something they didn't get over from childhood and it's surely immature.

But we have to deal with it, right, and medical doctors surely have the worst time with these control issues.

Mark said...

Thanks for the example. I love this stuff!

Better Things-- Seeing Ghosts