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For obsessive compulsive clients, the pattern is slightly different in that to focus is on the client's fight against obsessions and compulsions.
The more the client fights these symptoms, the stronger they become.
Frankl (1975) refers to this pattern as pressure inducing counterpressure, and counterpressure in turn increases pressure, again creating a circle of pathology.
This creates a self-sustaining vicious cycle:
The symptom evokes the phobia; the phobia provokes the symptom; and the recurrence of the symptom reinforces the phobia.
Going back to the starting point: Anticipatory Anxiety.
Anticipatory anxiety begins with a client who experiences a response based on fear that a symptom may recur.
Fear in particular "tends to turn that which the client is afraid of, a reality (Frankl, 1975)."
Paradoxical: seemingly absurd or self-contradictory
Intention: a determination to act in a certain way
Pradoxical intention: psychotherapeutic technique in which the counselor instructs the client to continue, intensify, or extend the symptom as opposed to working with the client to combat it (Riebel, 1984).
Paradoxical intention has been shown to be effective in working with clients who experience a wide variety of psychosomatic dysfunctions.
These include psychological processes in which the autonomic nervous system plays a large role in inhibiting anxiety.
This can also include treating phobias, obsessions, schizophrenia, help- rejection, family fights, binge-eating, panic attacks, blushing, and insomnia, to name a few.
Unlike traditional forms of psychotherapy and some forms of behavioral therapy, paradoxical inention helps to RAPIDLY reduce and frequently ELIMINATE symptoms for clients!
In some cases, especially when symptoms are acute and have been occuring for a short duration, clients can see results anywhere from 4-12 sessions!
In cases where symptoms are more chronic and occur for longer durations, 12-24 sessions have shown to be effective.
In some instances, ONE SESSION can be sufficient!
Frankl suggested focusing on the "anxiety about anxiety," which can lead to anxiety attacks, when working with phobic clients.
The client may begin to avoid whatever situation is likely to cause his or her anxiety to increase.
This may result in the starting point of anxiety neurosis, or phobia.
The client's phobia will then be maintained by avoidance.
The avoidance seeks to reduce the anxiety that the client experiences.
Frankl (1975) believed that phobia can be eliminated by confrontation of the situation that he or she fears.
The key with these clients is to disrupt the
feedback mechanisms.
Here is where PARADOXICAL INTENTION comes in!!
As stated earlier, this involves encouraging the client to do, or wish to happen, the very thing he or she fears!
A key factor in the successful
application of paradoxical intention, is the use of humor.
Using humor allows clients to self-detach.
The ability to self-detach
allows clients to "step away"
from the situation in order
to make improvements.
This involves the counselor exaggerating the extent of the client's symptoms through humor and absurd statements in order to cause a change in attitude.
If the client is able to joke about the symptom, then paradoxical intention can most likely be used.
Educate the client on the nature of anxiety, helping clients to understand that anxiety itself will not hurt them.
Teach the clients on the mechanics of paradoxical intention. This will help the client understand the difference between actual exposure to the feared stimuli and the use of paradoxical intent to reduce symptoms.
Screen for additional concerns or external factors that may contribute to panic attacks or impact treatment.
Ask client to expose themselves to the feared stimuli, and instead of trying to prevent the anxiety from occuring, attempt to make symptoms worse.
Sleep onset insomnia is often thought to be based on performance anxiety based on the client's fears of not being able to fall asleep.
- In some instances, treatment programs may increase this anxiety.
In one study, clients in a sleep treatment program were asked to stay up as long as possible, instead of focusing on trying to make themselves fall asleep.
Paradoxical intention allows clients to break the cycle of focusing on sleep and the negative consequences of loss of sleep.
This resulted in clients experiencing a reduction of sleep related stress and thus reported being able to fall asleep much faster.
Prescribing the symptom: Case Study
Client was asked to keep a diary of when, where and circumstances of each incident of blushing.
In addition, he was asked to practice blushing in the mirror at home. (Which he could not do).
He was also provided with reading material on paradoxical intention.
After 7 sessions, client reported no more incidents of excessive blushing.
Paradoxical intention is not guaranteed to work in every instance.
But here are some ways to improve your chances of sucess!
1. Make sure that the relationship has been thoroughly established.
2. Clearly define the problem.
3. The goals must be clearly established.
4. A plan must be offered to the client.
5. The counselor must gracefully disqualify the current authority on the problem.
6. The therapist must give a paradoxical directive to the client.
7. Observe the response to the directive, and give adequate and continuous encouragment.
8. Avoid taking any credit related to the improvement of symptoms.