Paradoxical Intention

Description of the Strategy

Of the techniques that fall into the classification of therapeutic paradox, paradoxical intention has been the most common to appear in the literature of behavior therapy and cognitive behavior therapy. This popularity is perhaps due to two factors: It is effective with a wide variety of anxiety disorders, and it is easily incorporated as a primary or ancillary procedure into behavioral treatment programs.

The procedure requires individuals, paradoxically, to intend to do the very thing that they are trying not to do. A common example of its use occurs with some clients complaining of sleep onset insomnia. The paradoxical intention instruction requires, when they go to bed, that they remain awake as long as possible. The instruction is simple, but the preparation is considerably more complex.

All paradoxical therapeutic procedures have two things in common. The first is that they contradict received opinion or common sense. That is, therapists' suggestions oppose clients' expectations. This is similar to the “punch line” of a joke. A good joke leads listeners to imagine possible endings of the story that would not be particularly funny—and instead, surprises them with something that they did not expect, thus producing laughter. The second common element is the goal of the surprising request. In essence, clients are asked to stop “trying” to change and instead to remain as they are with respect to their target behaviors. Of course, in trying to change, clients, in fact, actually are remaining the same. The paradoxical suggestion allows them to cease struggling and thereby forms a platform on which improvement can potentially be based.

Most problems that clients bring to therapists are accompanied by what may be called serious concern. That is, the individuals view their complaints with apprehension and alarm; they believe that unless resolved, their problems can potentially lead to significant negative life changes; in the extreme, some consider their difficulties to be life threatening. Therefore, people who invest sleep, for example, with a disproportionate amount of importance will not willingly agree to give up even 1 hour of sleep, much less one or more nights of sleep. It is for this reason that the preparation and the manner of presentation of the paradoxical instruction are critical to the success of the procedure.

There is a considerable literature on the administration of psychotherapeutic paradox; one area focuses on the use of humor. A number of therapists have discussed the importance of humor and absurdity in reducing the serious concern with which clients invest their problems. When individuals develop a more realistic perspective of their problems, it becomes possible to involve them in experiences that can serve to move them in the direction of their goals. For this reason, paradoxical techniques rely on the element of surprise, which, when successfully administered, introduces humor into the therapeutic situation.

Research Basis

Paradoxical procedures have been described in psychotherapeutic literature since the 1920s. Until relatively recently, reports of success have largely appeared in the context of uncontrolled case studies. Since the late 1970s, data from research incorporating more sophisticated designs have generally supported suggestions of the efficacy of paradoxical intention with a variety of anxiety disorders or anxiety-based difficulties, when used as part of a behavioral treatment program. In addition, several studies have failed to find differences between paradoxical intention and other conventional behavioral procedures with specific complaints.

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