THE USE AND ETHICAL CONCERNS OF THERAPEUTIC PARADOX (STRATEGIC, PSYCHOTHERAPY, DIRECTIVENESS, SURVEY)

MARK JOHN HIRSCHMANN, Purdue University

Abstract

This study surveyed users and non-users of therapeutic paradox randomly chosen from the members of the Association for Marriage and Family Therapy (AAMFT). A response rate of 61 percent yielded 377 respondents for testing the major hypothesis that the users and non-users of paradox are characteristically different. Of the respondents, 76% claimed to be users of paradox and the hypothesis was partially confirmed. The users of paradox are younger, trained more recently, have more supervision in paradox, are more directive in therapy, and have fewer ethical concerns about using paradox. Users of paradox include a higher proportion of women therapists and therapists who define their professional identities as marriage and family therapists. Contrary to the hypothesis, users and non-users of paradox are not differentiated by educational level, context of practice, religious affiliation, functioning level of their clients, religiosity, or liberal/conservative position on social issues. Four types of paradox were compared. Symptom prescription was rated the most widely used but aroused the most ethical concern from users. Ordeal, the least popular, was rated most effective. Among users 46% and among non-users 25% indicated "no ethical concern whatsoever." Losing the trust of the clients concerned 18% of the users. One-third (32%) of the non-users were troubled about the therapist's manipulation of the client. Opinion was evenly divided on the presence of deception in paradox. Ninety percent of the users and 61% of the non-users stated the therapist's choice of intervention for change and significant client resistance were sufficient reasons to use paradox. Two assertions of Jay Haley were affirmed by the respondents. From personal experience, 82% of the users agreed that paradox works even when clients are aware of contradictory directives and 78% of the sample agreed that manipulation is an integral part of psychotherapy. The data from the study validated the five item directiveness in therapy scale by showing its ability to differentiate respondents from various theoretical orientations. Structural, behavioral and strategic therapists were the most directive, while client-centered and psychoanalytic therapists were the least directive. Generally, more directive therapists used paradox more often.

Degree

Ph.D.

Subject Area

Psychotherapy

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