Utilization of Resistance and Paradox Communication in Short-Term Psychotherapy

Abstract

Short-term psychotherapy can be applied most successfully in the treatment of cases which are characterized by great tension, distress and emotional upheaval, accompanied by heightened problem awareness. These cases are mostly acute ones, or represent the flaring up of chronic personality disturbances which have hitherto been compensated. These arise as a consequence of interpersonal conflicts, crisis situations, incapacitating or particularly unpleasant symptoms, object-loss, etc. Increased problem awareness and feeling of helplessness may motivate such patients to seek help more actively; it can make them more prone to develop a close and intense relationship with the therapist. The motivation to psychotherapy can also be elicited and activated by the therapist’s appropriate behavior (i.e., by his congruence, empathy, unconditioned positive regard for the patient, etc.). The patient’s state of mind and his need for attachment to a person in an asymetric, help-seeking way make the therapeutic interaction more dynamic and more intense. The signs of transference (both positive and negative) appear earler and stronger, and projections, regressive behavior patterns, infantile wishes and expectations come forward and can be recognized. These aspects of the patient’s behavior evolve usually in the form of what is called resistance in psychoanalytic therapy, hence, in short-term psychotherapy, special attention must be paid to the various manifestations of resistance. Resistance operates chiefly against the verbalization and working-through of past experiences; it hinders the development of insight, but does not prevent the therapeutic transactions which try to utilize motivational trends, manifested in the patterns of resistance, to help the patient to show and to communicate his problems in an indirect, disguised way to the therapist. This utilization increases the possibility of corrective emotional experience for the patient, and thereby facilitates behavior change. The most appropriate and effective procedure for controlling and utilizing resistance is the paradox communication, in the sense of communicational theory, as developed by Bateson, Jackson and Haley (or the Palo Alto group). Paradox communication – or simply paradox-involves verbal messages as well as nonverbal communication, and im- Bud a plies manipulative tactics on the part of the therapist with the therapeutic relationship; its principle rests on taking into account the adaptive functions of symptomatic behavior, although the adaptation is mostly inadequately accomplished, both within the personality and in the interpersonal field. Paradox communication consists of promoting in the patient some of the motivational tendencies or interactional strategies, which, in the particular case, have consequences that interfere with symptomatic behavior. This leads almost inevitably to change at some level, either in the patients’ relationship with the therapist or in his behavior outside the therapist’s office. Short-term psychotherapy can be regarded as a process of regulation in a two-person system – in the sense of the systems theory – through a sequence of paradox communications; it is thereby a process bringing about a change (mostly a limited one) in the patient’s behavior. The whole process may evolve without the awareness of the patient, and along the lines of resistance. The author elaborates his observations and views about the theory and practical uses of paradox communications, and briefly states his assumptions concerning the limitations in therapeutic goals, and the criteria of the outcome in short-term psychotherapy.