The Power of Paradox
THERAPISTS OF ALL PERSUASIONS have observed that a surprising number of people come to therapy saying they want to change, but in the course of treatment they are not able to move off the dime. These are the contrarians—the “yes, but” people who always find a way to reject the therapist’s suggestions. They’re also the “OK I get it” people, who in fact don’t get it. People like this often languish for months or even years in individual talk therapy, unable or unwilling to make the changes they claim to want so desperately—whether it’s a new job, a new romantic partner, or simply peace of mind. Children, too, can be contrarians. We all know the boy who insists on going to school in February in a T-shirt and shorts, or the girl whose hair hangs over her eyes, to the constant consternation of her mother. But it’s the contrarian or resistant parents we are most concerned with in family therapy because it is they who hold the fate of their children in their hands.
Resistant clients—whether they are adults or children—demand a high level of creativity and even cunning on the part of the therapist because direct interventions will not do the job. Even when it comes to their children, some parents simply cannot bring themselves to follow a therapist’s directions. A mother may say to me, “I will do anything to help my son.” But soon it becomes clear that she is not following my recommendations, sending me the unspoken and contradictory message that “I want you to get rid of my child’s worrisome symptoms, but I’m not going to do what you tell me to do.” With these parents, I have to arrange the situation so that whether they do what I recommend or rebel against me, their child’s problem will be resolved. This is the type of indirect approach that I took with the parents of eight-year-old Samantha.
Samantha’s father, Ray, came to therapy first.
“I’m sorry my wife couldn’t come today,” Ray said when I greeted him in the waiting room. “She’s having one of her bad days and didn’t feel up to it. I hope it’s all right for me to come by myself.”
On the phone, Ray had told me that he and his wife wanted to meet me before they brought in their daughter. It’s not unusual for parents to want to “interview” a therapist to whom they are entrusting their child’s well-being. On my part, I welcome an initial interview session because I need parents to be comfortable so we can work cooperatively to help their child. One of Ray’s colleagues had recommended me; I had treated his daughter, who had symptoms similar to Samantha’s, without having to refer her to a psychiatrist for medication. Ray and his wife did not want to medicate Samantha if they could avoid it.
“What can I do for you?” I asked after Ray had taken a seat on the couch.
“We’re worried about our daughter, Samantha. She just turned eight. She’s our only child.” There was a pause.
“Yes,” I said encouragingly.
“Her teacher says that Samantha has trouble paying attention and focusing. Her grades are falling. She recently got a D on a math test. And the teacher says Samantha is disruptive in class. She taps her ruler on the desk, and the noise is distracting. She also had two or three explosive outbursts when the kids were supposed to line up to go to the playground and also when they were told to put away their workbooks. The teacher thinks Samantha might have ADHD or maybe something worse, like bipolar illness.” Ray looked worried as he told me this.
“Does Samantha have problems at home or just at school?” I asked. Just then Ray’s cell phone rang. He looked at the screen. “Sorry,” he said apologetically, “I forgot to turn it off. It will just take a second.” He fiddled with the phone and finally turned off the ringer. He put the phone back in his briefcase.
“Uh, where were we? Oh, yes, Samantha has problems at home too. She gets very irritable when my wife tries to help her with her homework. She’ll throw the homework on the floor and scream at her, ‘You don’t know anything.’ Then she’ll start crying and run to her room. We worry about her abrupt mood swings. She’ll suddenly get angry for no reason that we can see.” Ray sighed and continued.
“This has been very hard on my wife. She has chronic fatigue syndrome and chronic back pain. It’s very difficult for her to deal with Samantha.”
“Does Samantha do better with you helping her with homework?”
“Maybe a little. The problem is that I don’t get home from work until after seven o’clock. I don’t have that much time to help her because I usually have to cook dinner.”
“Perhaps a tutor would help. Sometimes that takes away the power struggle with parents over homework.” Ray thought a tutor was a good idea. He said he would talk this over with his wife.
“Uh,” he hesitated. “I don’t know if it’s relevant, but maybe you should also know that we’re in marriage counseling. We haven’t been happy for a long time. Heidi has such a gloomy outlook on life. She constantly complains about her health. A few years ago, she went to a therapist and he wanted her to take antidepressants. But she’s very antimedication, and she wouldn’t go that route. Nothing I do or say seems to make her happy. Sometimes I feel totally controlled by her health problems and her negativity. Honestly, if it weren’t for Samantha, I think we would have separated.” Ray seemed sad as he told me this. Then he added, “I suppose I should also tell you that we’ve taken Samantha to two other child therapists. She improved for a short time, but now her behavior is worse than ever.”
This statement raised a red flag for me. Did the other therapists fail because they focused only on Samantha and didn’t address the problem in the family? Or were Samantha’s parents resistant to taking good advice? I thought I’d better address this fairly soon.
“Well, I’ll try to help. Of course, I’m not sure I’ll succeed in helping your daughter if two other therapists have failed.” In predicting I might not be able to help, I was putting myself one-down with Ray. As we’ll see, this stance of humility sometimes helps in countering resistance.
Then I asked Ray if his wife complained about her health in front of Samantha.
“All the time,” Ray said. Here’s another red flag, I thought. We’ve seen with Alex and with Elizabeth how a parent’s health problems can affect a child. Alex was the little boy who was worried that his father didn’t have an “occupation” after he broke his arm; Elizabeth was the girl who was overly concerned about her mother’s health.
Ray continued. “Samantha is very sympathetic to her mother. She’s always asking if she can bring her a cool cloth for her forehead or a glass of water.” His voice trailed off. Did Ray approve of Samantha’s hearing her mother complain so much? I wondered. I suggested we schedule a meeting with the whole family.
The following week I greeted Ray, Heidi, and Samantha in the waiting room. Heidi was stunning, with perfectly bobbed blond hair and hazel eyes. Samantha was a younger, livelier version of her mother. For all her attractive appearance, though, Heidi had an air of unhappiness about her. Her face was pale and she seemed nervous about meeting me.
“So what’s the trouble?” I asked when they had settled into my office.
“My teacher is mad at me,” Samantha offered.
“Why is that?” I asked.
“I make noise in class.” She looked at her mother. Heidi nodded.
“Do you like school?” I asked Samantha.
“Not lately.”
“It’s hard even getting her in the car to go to school,” Heidi interjected.
“Heidi, just let Samantha answer,” Ray said, a trace of impatience in his voice.
“I like seeing my friends at school,” Samantha said finally.
I decided that it was time for me to talk with Samantha privately. I asked her parents’ permission, and they agreed.
When Samantha and I were settled in the office and playing a game of Uno, I asked her my usual question to children: was she more worried about her mother or about her father.
“I’m mad, not worried.” Samantha said, slapping down a card. Well, this was an interesting response, I said to myself. Not many children answer like this. Some kids hesitate and ask, “What do you mean?” Others say, “My parents are worried about me.” Only a very few respond like Samantha—that they are mad, not worried.
Then Samantha added, more predictably, “Well, I’m more worried about my mommy because her back always hurts. She just lies in bed most of the day. I feel sad for her. And she argues with my daddy a lot. He has to cook dinner most nights because she can’t stand up that long.”
“I understand why you’re worried,” I said. After a pause, I asked, “And what makes you mad?”
“I hate when Mommy helps me with my homework. She goes too fast. And she doesn’t even understand my homework.” Samantha was discarding her cards quickly. She’s an expert at this game, I thought.
“Would you like Daddy to help you with your homework instead of Mommy?”
“No. I don’t want anyone to help me. Well,” she was thinking this over, “maybe Daddy could help me a little. He knows more than Mommy.”
We finished our game. I asked Ray and Heidi to join us for a few minutes. I wanted Samantha to see that I was a kind person who was going to help her parents so that she didn’t have to. Samantha played quietly on the floor with a dollhouse while I spoke with Ray and Heidi. I first suggested that Ray help Samantha with her homework until they found a tutor, if they both agreed that a tutor was the way to proceed. Heidi said that Ray had brought up the idea of a tutor and she agreed that it would be a good thing. Ray said he would try to come home a little earlier so he’d have time to work with Samantha. I asked the parents to come back alone for the next session. Then, before the session was over, I gave Ray and Heidi a few written recommendations that I thought would be helpful. I said that we could go over them at the next session, which would be with them alone.
At the beginning of the next session, I asked Ray and Heidi if they were in agreement about the rules for Samantha. How did they deal with Samantha’s outbursts at home? What did they do when she wouldn’t get in the car to go to school? Did they give her consequences or punishments for misbehavior? Heidi and Ray said that they threatened to take away television time and video game time, and sometimes those worked to get her into the car in the morning. But enforcing the rules was such a battle that they didn’t always follow through. For example, Heidi was tired and needed a break in the late afternoons, so she often allowed Samantha to watch television even if she had threatened to take it away.
I suggested that they make a firm rule about this and follow through. Samantha had to be in the car by 8:15 or else she would lose TV time and video game time that day. No exceptions. The same would hold true for temper tantrums. If Heidi needed a break, she could hire a teenager to babysit for Samantha in the late afternoons. They thought this might work, and Ray offered to ask at their church for a teenager who wanted to babysit.
So far, so good, I thought. But a tough item was coming up next on my list.
“I’d like to suggest that neither one of you say anything negative about your health in Samantha’s presence.” At this, Heidi bristled visibly.
“I don’t think children should be sheltered from reality,” she said coldly.
Parents rarely objected so forcefully to my directives. Fortunately, I had dealt with this particular objection before.
“I respect your opinion,” I told Heidi as soothingly as I could. “But I think that when a child is having problems, it’s best for parents to shelter them. I know from experience with many children that worries about a parent’s health can affect a child’s behavior in unpredictable ways. Of course when a child is not having problems, parents should do what they think best for their child about this issue.”
Heidi didn’t say anything. I hoped I had gotten through to her.
I wasn’t sharing all my thoughts on this subject with Heidi because I didn’t want her to feel blamed for complaining about her aches and pains to her daughter. But the fact is, I think that the less a child hears about her parents’ problems, the better. A parent’s worries can become exaggerated in a child’s mind. A mother’s casual comment that she’s nervous about the dental implant she’s going to have the next day may linger in the child’s memory long after the Novocain has worn off. The mother may not even think to reassure the child that everything went well. And the child might be afraid to ask, thereby letting the worry fester in her mind. I believe children must be protected. But I did not want to say this to Heidi. I thought it was best for her to feel that I was, at least in part, agreeing with her point of view.
I continued. “I’d like to ask both of you to say positive things about your lives in Samantha’s presence, such as, ‘I feel really happy today’ or ‘I had a good workout at the gym today.’ In fact it would be best to say to Samantha, at least once a day, ‘I had a good day today because…’ You fill in the blanks. Also, Samantha shouldn’t hear anything negative about the other parent.” I paused so they could think this over.
“On the positive side, I’d like you to make a list of Samantha’s best qualities and tell her two or three good things about herself every day. Let’s talk about them right here. What are the best things about your daughter?”
“She’s very kind and very empathic,” Ray offered.
“She’s very bright,” Heidi said. Together we made a list of Samantha’s good qualities. In addition to being kind and empathic, Samantha was artistic, helpful, intelligent, and pretty. I thought focusing on the positive would be especially important for Samantha because there was so much negativity in her family.
With children and especially with teenagers who are having serious problems, the family often gets caught in a downward spiral of negativity and misery. Family life becomes what narrative therapists call “problem saturated.” Having parents make positive comments to the child and creating simple “certificates of praise,” lauding the child’s good qualities, become especially important. Posting a certificate of praise on the refrigerator can work wonders in creating a new, more positive family story. A family doesn’t have to be in therapy to use certificates to good advantage. They are an excellent tool for parents to use themselves with their young children and even teenagers.
Praise for a child should be targeted and realistic or the child won’t believe she deserves the compliments. I recommend that parents give their child a certificate of praise for being helpful around the house in small ways—like feeding the cat or putting away toys without being asked. This does not mean that parents should say “good job” to a child who remembers to wash her hands before dinner. It means catching a child being especially good instead of giving the child attention only when she does something wrong.
Parents often need to use a powerful magnifying glass to discover their child’s best qualities. They also need to focus on qualities apart from intelligence or academic excellence. Sometimes we forget that a child’s good grades or sports awards are not the only achievements that make us proud. We can too easily overlook other praiseworthy qualities such as creativity or generosity or even promptness. A single mother whose fourteen-year-old daughter was getting D’s and F’s at school gave her daughter certificates of praise for preparing simple dinners that they both ate when she came home from work. This simple strategy went a long way in turning around the atmosphere of negativity that had sprung up between them. The girl had felt that her mother noticed her only when she was doing something wrong.
After Heidi, Ray, and I talked about certificates of praise, which they agreed was a terrific idea, I suggested using a star chart to reward Samantha’s good behavior, as I had done with Alex and Joey.
“Should she be watching so much television?” Ray asked after we had discussed the star charts.
“She doesn’t watch that much,” Heidi objected. I knew she was thinking of the long afternoons when she needed a break from Samantha.
“Does she watch only children’s shows on public television?” I asked. This is what I usually recommend to parents.
“Yes, mostly children’s shows. But I like to watch the news after dinner,” Ray said. “Sometimes Samantha sits next to me while she does her homework.”
“The television could be distracting to her. Could you possibly download the evening news on your iPod and listen to it later?” I asked.
“I could do that,” he said. I explained that with children who have attention and focusing problems, it’s often best to limit distractions. By cutting down on electronic noise, parents can create the kind of home environment that is calming to an inattentive child.
“It’ll help Samantha stay focused if you turn off the television while she’s doing her homework,” I said. “And maybe turn off cell phones during dinner and homework time.” Hearing this, Heidi rolled her eyes.
“Ray lives on his cell phone,” she said. I had seen that myself. Most parents turn off their phones when they come into my office, but Ray had left his on. I wondered how easy he’d find it to keep his phone off at homework time. Ray looked annoyed but said nothing. Our time was up. We made another appointment for them in three weeks.
“By then, you should see some improvement,” I assured them. As it turned out, I was being naïve.
Three weeks later, Ray and Heidi came to the appointment. Ray reported matter-of-factly that although they were following all my recommendations, there had been no improvement whatsoever in Samantha’s behavior. I expressed surprise, but Ray assured me that they were following my directions.
I was fairly certain that one or both of the parents were not implementing the strategies; if they were, there would be at least some change—if not huge improvement—after three weeks. I suspected that there was sabotage going on, either consciously or unconsciously.
A direct approach was not going to work with this family. So I decided that I would try a traditional paradoxical technique called the “incompetent therapist.” I told Ray and Heidi that I didn’t think I could help Samantha after all, and I apologized for failing. I confessed that Samantha’s problems were so difficult that they had defeated me, as they had defeated her previous therapists. I recommended that they consult another therapist or possibly think about taking Samantha to a child psychiatrist to see if medication might help her. In fact, I told them, since they had already seen other therapists, medication might be the only solution.
At this, Heidi cringed. My suggestion of medication was making her uncomfortable, as I thought it would. Ray had let me know in the first session that they were opposed to medicating Samantha.
I was intentionally putting the parents in an awkward situation, sometimes called a “therapeutic double bind.” They could find yet another therapist and move along the road to medication for Samantha, or they could follow my recommendations and prove me wrong in my declaration that I could not help their daughter. Either way, as Jay Haley used to say, they would prove me wrong and put me down. Jay compared the therapist taking a one-down position to a dog lying on its back and showing vulnerability to end a fight that it couldn’t win.
Ray and Heidi thought about my comments and then said that they wanted one more session with me. I repeated that I didn’t think I could help them; their daughter’s difficulties had defeated me even though I had tried my best. But they insisted. And so, appearing very reluctant, I scheduled an appointment for them in two weeks, after I returned from vacation. But I reminded them that I was pessimistic, saying that if my recommendations hadn’t worked by now, they probably wouldn’t work at all. Of course, I was hoping they would rebel against this.
Two weeks later, Ray came to the session alone. He reported that there was “huge improvement with Samantha.” Her mood swings were gone and she was behaving well at school and doing better on tests. They had found a math tutor, and she had gotten B’s on the last two tests. The star chart was working too. Ray had taken Samantha to the frozen yogurt shop for a treat two weekends in a row. Surprisingly, Heidi was making great efforts not to complain about her back pain or fatigue in front of her daughter. Samantha seemed to be less concerned with her mother’s health. She expressed interest in having more playdates.
Ray thought that my recommendations were helping after all, but Heidi didn’t want to come to therapy anymore since Samantha was doing so well. They were going to continue marriage counseling. The counselor had encouraged Ray to pursue activities that would make him happier. He was now playing basketball on Sunday mornings, something he really enjoyed, and he had started going to the YMCA to swim two nights a week after dinner. He was creating a space between himself and Heidi that made him less vulnerable to her complaining and negativity. But he was still reaching out to her in positive ways by suggesting that they get a babysitter and go out to dinner and by thinking of interesting family excursions.
I reacted to Ray’s report of Samantha’s improvement with open-mouthed surprise. I was puzzled, I said, because I really hadn’t expected to be able to help. But I was pleased to hear that I had helped Samantha even a little. I added that Ray and Heidi must be doing an especially good job of parenting, and that was probably what was helping Samantha most of all. Here I was deliberately empowering the parents so they would feel confident about dealing with Samantha’s behavior in the future. And once again I was taking a one-down position.
At this point, I predicted that the change in Samantha’s behavior might be only temporary. “Relapses are very typical when a child shows this much improvement so quickly,” I warned, “even when parents are as conscientious as you and Heidi are.” Ray listened closely.
By predicting a relapse, I was hoping the parents would again rebel against me and prove me wrong. Predicting or even encouraging a relapse is a typical family therapy maneuver. It tends to block a relapse from occurring because it poses a challenge to the parents and again mobilizes their resistance.
Milton Erickson had an ingenious way of encouraging a relapse. He would tell the parents to think back to the time when the child’s problem was making them miserable, and see if there was anything from that experience that they wished to salvage. He was, of course, giving the child’s symptom a positive meaning in the life of the family. He was also playing on a common theme in family therapy: focusing on their child’s problem makes parents feel closer because they have to put aside their marital problems and work together to help the child they both love.
Ray said they would call me if Samantha had a relapse, but since there was so much improvement he didn’t think they would have to. After two months, I checked in with Ray. Samantha was getting A’s and B’s and she was not acting out in class anymore. He also told me that marriage counseling was helping them a little. He and Heidi were talking more, and he had been able to get her to go on a weekend family trip to SeaWorld, which they all had enjoyed.
Another name for the incompetent therapist strategy is “the positive connotation of the symptom.” This means that the therapist is joining the family at the level of the family system by acknowledging the power of the child’s symptom in keeping the family stable. The symptom is viewed as positive because it is the glue that holds the family system together. Without a “problem child” to take care of, the marriage might fail.
Some people criticize strategic family therapists for using paradoxical techniques like the one I used with Samantha’s parents. Critics say that these interventions are manipulative since the therapist is not being absolutely up front with the family. My response is that when parents consult me to help a child who is suffering, I feel responsible to try everything in my capacity to help—without doing harm. Every therapist knows that many people resist the therapist’s recommendations and sabotage the therapy. When that happens in family therapy, a therapist must focus on the well-being of the child and, if necessary, use indirect interventions with the parents to bring about therapeutic change.
I believe that parents who come to therapy truly have their children’s best interests at heart, and some part of them wants therapy to work. Otherwise they wouldn’t spend their time and money on therapy. When I use the incompetent therapist strategy, I feel that I am joining the healthy part of the parent, the part that really wants to bring about change, so that together we can overcome the part of their personality that is rebellious and resistant to authority. In fact, of course, the strategy of the incompetent therapist always contains a kernel of truth. I genuinely do feel I’ve failed if several sessions of family therapy have not produced positive results for a child.
The grand master of paradoxical techniques like the one I used with Samantha’s family was Milton Erickson. Erickson had a personal understanding of a patient’s need to rebel. When he was stricken with polio as a child, his doctors predicted he would never walk again. Erickson stubbornly defied their prognosis. After his first year at college, Erickson spent his summer vacation taking a thousand-mile river trip. When he started the trip, he did not have enough strength in his legs to pull his canoe out of the water, and he could swim only a few feet. On the river, he had to fish and forage for his own food since he had few supplies and only $2.32 in cash. With his considerable interpersonal skills, Erickson had no trouble getting fishermen and other travelers to give him the food he could not get on his own. By the end of the summer, he could swim a mile and carry his own canoe. Later in his life, Erickson needed a wheelchair to get around. But that was only after many years of proving his doctors wrong.
Erickson designed many strategies that make good use of patients’ rebelliousness against their doctors. He often told his patients to have more of the very symptom they were trying to overcome. He was counting on their rebelling against his instructions and in fact having less of the symptom. Erickson worked with adults and children, and he devised creative, paradoxical strategies for both groups.
A good example of Erickson’s prescribing the problem behavior was his intervention with a sixteen-year-old girl who sucked her thumb, much to the embarrassment of her parents and the irritation of her teachers. The school counselor had told Erickson that she thought the girl’s thumb sucking was an aggressive act, intended to annoy her parents and other adults. So Erickson suggested that the girl become even more aggressive and really get in her parents’ face. He instructed that every night the girl suck her thumb noisily for an hour in front of her mother and for another hour in front of her father. He also suggested that she suck her thumb in the class in which she most disliked the teacher. Erickson knew that being told to suck her thumb even more aggressively would take away its appeal.
At the same time, Erickson made the girl’s parents promise not to react or try to limit her thumb sucking in any way while she was in treatment. The absence of a negative reaction on her parents’ part also removed the girl’s interest in the problem behavior since she was deliberately trying to annoy her parents and embarrass them by sucking her thumb at church and in other public places. After four weeks, the girl stopped sucking her thumb entirely and became interested in activities more typical for a teenager.
With the thumb-sucking girl, Erickson prescribed the problem behavior to the patient herself to sidestep her resistance. Another common technique for therapists who work with children is to have parents prescribe the problem behavior to their child or teenager, hoping the child will rebel against the parent. I used this technique with Joey when I asked his mother to supervise him in “not going to bed,” and with Elizabeth when I asked her mother to ask Elizabeth to wash her hands even more. In both cases, as with Erickson’s thumb-sucking teenager, holding on to the problem behavior became much more of an ordeal for the child than giving it up.
Utilizing the rebelliousness of his patients by prescribing the symptom is a very different approach to human problems than the one Erickson learned in medical school. In the 1930s, psychiatry in the United States was dominated by Freudian psychodynamic theory, and Erickson would have been well trained in this method. But being the rebellious person he was, Erickson adopted a different stance toward his patients. He made no attempt to uncover the “hidden meaning” behind the girl’s odd behavior; nor did he explore with the girl why she was sucking her thumb at the unseemly age of sixteen. He did not attempt to help her understand why she maintained a behavior that she knew was terribly embarrassing to her parents. Early family therapists like Erickson realized that helping patients achieve insight about their problem did not produce change, especially in a rebellious or resistant teenager.
As for the “reason” for the thumb sucking, a traditional psychodynamic therapist might have posited that the girl was seeking to soothe herself because she was not receiving the nurturing she needed from her parents. Or he might have interpreted the behavior as an angry attempt to get back at her parents for their lack of nurturing. Therapy would focus on increasing the girl’s awareness of how her thumb sucking was related to her childhood experiences and fantasies.
But Erickson was less interested in the psychological underpinnings of a symptom than he was in finding ways to get rid of it. He writes compellingly about another patient of his, a seventh-grade boy who couldn’t read. His parents had tried everything to help him. They bought books for him and offered encouragement. They deprived him of all the things he enjoyed to try to force him to read. They had him tutored privately all through the summer, but when school started in fall the boy still couldn’t read.
In the first therapy session, Erickson told the boy that he wasn’t going to teach him how to read, as his parents had requested. Instead, he engaged the boy in a discussion of what he enjoyed doing most. This turned out to be fishing with his father. Where did the father fish? asked Erickson. Colorado, Washington, and California, answered the boy. Erickson then got out maps and together they located the towns in which the boy’s father had fished. We are not reading the map, Erickson assured the boy; we are just looking for the names of towns. Erickson thus ingeniously reframed “reading” as “looking.” When Erickson started to “make mistakes”—searching for a Colorado town in California or a Washington town in Colorado—the boy quickly jumped in to point out the right location of the town. But he was still not reading; he was correcting his therapist.
At this point Erickson engaged the boy in a conversation about fishing, and they pored over the map to find all the good fishing spots. Erickson even got out an encyclopedia so they could look up different kinds of fish.
Erickson worked with this boy all the following summer. When the boy announced that a reading test to determine his grade level was looming at the end of August, Erickson suggested they play a joke on his parents and teachers. The boy was to carefully make mistakes in reading the first-grade book, but to do better on the second-grade reader and even better on the third. Then Erickson instructed him to do an exceptional job on the eighth-grade reader. The boy thought this was a wonderful joke and did as Erickson directed. Later, he played truant and went to visit Erickson to tell him how amazed his parents and his teacher had been. He thought their trick was great fun.
Two paradoxical techniques play a part in this story, both of them directed at the child, not the parents. First, Erickson got the boy to read the map by not reading it. Then, by directing the boy to make intentional mistakes on his test, he was prescribing the symptom. Together these indirect strategies bypassed the boy’s resistance and helped him feel like a winner because he was able to put one over on his parents and his teacher.
When I was in graduate school, I lived in a dangerous neighborhood on the south side of Chicago. Since I was not very strong physically, I decided to learn a martial art so that I would have some means of protection in case I found myself in a threatening situation. I joined the university judo club and practiced judo for three years. The idea behind judo is to use your opponent’s own strength and momentum to defeat him. I have often been struck by the idea that using the strength of a client’s resistance to defeat his problem relies on this same principle.
Helping young people with “resistant” parents who sabotage the therapy was something that Freud found daunting a hundred years ago. He describes a fascinating case of a young agoraphobic girl who was afraid to leave her house and was also afraid to stay at home alone. The girl’s parents brought her to Freud for psychoanalysis. In the process of treatment, the girl confided to Freud that her mother was having an improper relationship with a well-to-do gentleman who was a friend of their family. When the girl made the mistake of mentioning to her mother that she knew about the affair and had discussed it with Freud, her mother pulled her out of treatment and sent her to an institution, where the unfortunate girl remained for many years. Freud declared this girl a notable failure of psychoanalysis.
Although Freud did not realize it, his patient’s agoraphobia had a protective function in her family. The girl was protecting her father by having the symptom. As long as her mother had to stay at home with her daughter, she would have fewer opportunities to go out to meet her lover. Her mother, of course, did not want her affair to become known, so she sabotaged the therapy.
The meaning that Freud took from this case was that the intervention of parents was a danger to psychoanalytic treatment, and one he did not know how to address. Freud knew how to deal with inner resistance—by helping the patient gain insight—but he lamented that he did not know how to deal with what he called “resistance from outside.” This was a cornerstone of a strong tradition in psychoanalytic therapy: excluding the patient’s family members from therapy in order to prevent their sabotaging the treatment. It was not until the 1950s that therapists started to view problems like agoraphobia from an interpersonal perspective, and were led to invent paradoxical strategies to deal with resistant parents. Freud was of course working from an individual perspective. A family therapist would have involved the parents of Freud’s agoraphobic young woman from the very beginning.
Erickson used paradoxical techniques with children, but he was also keenly aware of how their family relationships played a part in their symptoms. With the thumb-sucking girl and the boy who couldn’t read, it was only by mobilizing their rebellion against their parents that Erickson was able to bring about change.
Erickson doesn’t tell us how these young people fared once their symptoms were gone, or how these changes affected other family members. But we do know that Erickson and the other early family therapists made a prophetic observation: If the underlying family issues are not addressed, another family member may develop symptoms, sometimes months or even years later.
In the next chapter, we see what happens when parents end a child’s therapy before resolving the deeper family issues.